Survey of dollar need for educational facilities (research and clinical facilities excluded from the estimates)-Continued

Mr. WILLIAMS. Permit me, on behalf of the committee, to express our appreciation to you gentlemen. I know that some parts of this hearing have been rather hectic, but we are very grateful to you for making a clear presentation of your case.

No doubt there is a very serious problem existing in this field.

As I stated in my opening statement, I am personally very much concerned over the extent to which there is a Federal responsibility to solve this problem.

The other members of the committee, I am sure, will disagree with my attitude toward this type of legislation.

That is neither here nor there. That is expected in any legislative committee, but I do think your presentation has been fair and I think it has been invaluable insofar as this committee is concerned. I think you have rendered a great public service in coming here.

Dr. Burney, will you and your associates be able to be here this afternoon?

Dr. BURNEY. Yes.

Mr. WILLIAMS. Will the veterinarians be represented this afternoon?

Dr. ARMISTEAD. Yes.

Mr. DINGELL. I also notice a representative from the AFL-CIO in the room. I think they desire to give us testimony.

Mr. BOOKBINDER. Mr. Chairman, I have a statement from the AFLCIO which I will be very happy just to submit for the record on account of the pressure for time.

Mr. WILLIAMS. If you think that will serve your purpose, we will be glad to receive it. Or if you prefer to appear personally, we will be glad to hear from you.

Mr. BOOKBINDER. Might I submit it for the record; and then, if in your judgment you would like to question us, we will be glad to come back.

Mr. WILLIAMS. We will be glad to receive it.

(The statement of the AFL-CIO follows:)

STATEMENT OF ANDREW J. BIEMILLER, DIRECTOR OF LEGISLATION, AMERICAN FEDERATION OF LABOR AND CONGRESS OF INDUSTRIAL ORGANIZATIONS ON LEGISLATION TO AID MEDICAL EDUCATION

We appreciate very much the opportunity to appear before the Subcommittee on Health and Science in support of legislation to provide Federal aid to medical education.

At the Second Constitutional Convention of the AFL-CIO in December 1957, a resolution was adopted which states, in part, as follows:

"Resolved, That the AFL-CIO reaffirms the principles and objectives set forth in the 1955 convention resolution on health programs and urges, as the steps most needed in the immediate future:

"The enactment of a program of Federal assistance to professional institutions engaged in the training of doctors, dentists, nurses, medical technicians, and related personnel in the form of grants for the construction, expansion, equipment, and maintenance of physical facilities. The program should also provide scholarships to aid qualified students to meet the high cost of medical education."

The pressing need for an adequately financed program of Federal aid to stimulate and help support the expansion of the Nation's medical training facilities is clear and apparent. One of the most serious problems confronting the country today is the persistent shortage of doctors, dentists, medical technicians, and health professionals of all kinds. In the absence of congressional action to meet the problem, this shortage can only grow steadily more acute,.

adding further to the mounting cost of medical care and impairing its quality and availability to the public at large.

Recent years have seen a striking expansion in the demand for medical services. The rapid spread of health-insurance programs and prepayment plans of various kinds has meant that millions of people who previously lacked the means to avail themselves of the kind of medical attention that they needed and should have are now in a position to do so. The shift in population from rural to urban areas has added further to the demand for services. Greater life expectancy has increased the proportion of the population in the upper age groups, where the highest incidence of chronic health conditions and the greatest need for medical services exists. These trends can be expected to continue, at an accelerated pace, in the future.

In the face of this, the supply of physicians is increasing at a relatively static rate that falls far short even of the rate that would be required to maintain the existing doctor-patient ratio against the normal increase in population. More people demanding more services per person, pressing upon a worsening shortage of physicians, can only increase the price of medical services, impair the value of health-insurance plans, and raise a higher cost barrier between the public and the best that modern medical science has to offer.

The simple arithmetic of our present and prospective situation clearly demonstrates the need for prompt and forthright action. There are at present about 130 physicians per 100,000 of population in the United States. Even leaving aside the question of how far below our real needs that is, it is obvious that, with a rate of population growth of 3 million persons a year, a net current addition of about 4,000 physicians a year is the absolute minimum that is needed, just to maintain the present physicians-to-population ratio. Yet today, the net annual gain is the number of physiicans is no more than 3,000, after the number of deaths and retirements from practice are deducted from the 7,000 medical-school graduates newly entering practice.

The prospect for the early future further underscores the need for action. By way of example, no less of an authority than Dr. Vernon W. Lippard, dean of the Yale University School of Medicine, has estimated that if the population reaches 220 million in 1975, as predicted, the Nation's medical schools will have to produce at least 2,000 more physiicans a year in order to maintain a ratio of 1 physician to every 750 persons.

These are very conservative estimates of the measure of need, and of the degree to which we are now falling short of meeting the most minimal requirements of the public. We actually need not only to maintain the supply of doctors relative to the population; we need to improve it so as to overcome our current deficiencies. It may be recalled that in 1952, the President's Commission on Health Needs of the Nation declared that 22,000 additional physicians, over and above the predicted supply, would be needed by 1960 in order to bring the regions of the Nation with the lowest ratios of physicians to population up to the current average for the Nation; 30,000 more than the predicted supply in order to provide reasonably comprehensive medical care to the whole civilian population and to meet other needs such as public health and Armed Forces requirements; and 45,000 more than the predicted supply in order to bring all regions of the United States up to the average physician-populations of New England and the Central Atlantic States.

The chief barrier to any substantial increase in the supply of physicians is the limited capacity of the Nation's medical schools, and the chief barrier to any substantial expansion of medical-school capacity is financial. It costs from $12,000 to $15,000 to train 1 new doctor (more than 4 times as much as a general university education) and more than $25 million to establish 1 new medical school. The medical schools are already hard-pressed just to meet their bare operating budgets at present levels of activity. Existing sources of financial support are completely unable to bear unaided the burden of cost involved in any effort to undertake a construction and expansion program commensurate to the Nation's needs. Federal financial aid is the only realistic and practical

answer.

The AFL-CIO believes, furthermore, that a program of Federal aid should be designed not only to expand the capacity of medical schools to accommodate students without injury to the quality of training they receive, but should also serve to expand the opportunities afforded the Nation's youth to secure a medical education, and increase the number of those who can afford to apply for admission to medical school. A Federal-aid program should, therefore, include aid to the student, in the form of scholarships, as well as aid to the school.

Turning to the bills that are now before the subcommittee, the Fogarty bill (H. R. 7841) approaches most nearly the objectives of the AFL-CIO. The amounts authorized, totaling $60 million per year for medical, dental, and publichealth schools, are much more realistic in terms of the magnitude of the need and the task than the $195,000 5-year aggregate set forth in H. R. 6874 and H. R. 6875. And, perhaps most importantly, the Fogarty bill contains a positive incentive, in the form of an increase in the Federal share of the cost of construction (66% instead of 50 percent) in the case of new schools and schools which give satisfactory assurances that freshman enrollment will be increased by 5 percent. The purpose of the program, after all, should be not merely to support schools at their present levels but to promote the expansion of their capacity to train additional professional personnel so as to overcome the shortages of the present and to meet the demands of the future. The prospect of such expansion represents the primary public interest in this legislation.

While H. R. 7841 does not contain all the provisions that we regard as desirable, its enactment would be a long step toward the solution of an urgent national problem. The AFL-CIO, therefore, strongly urges that the subcommittee give its approval to H. R. 7841.

Mr. WILLIAMS. This afternoon we will hear from the American Veterinary Association and the Public Health Service, Dr. Burney. The committee will stand adjourned until 2 o'clock.

(Thereupon, at 12:25 p. m., the committee recessed, to resume at 2 p. m.)

AFTERNOON SESSION

Mr. WILLIAMS. May I say for the benefit of the people present here and especially the witnesses that we will be operating somewhat of a handicap this afternoon due to the fact that we are expected to be called to the floor any minute.

I have already asked Dr. Burney if it would be possible for him to defer his question and answer period at least until a later date to be mutually agreed upon.

And he has graciously agreed to do that.

I think at this time we will call the gentlemen representing the veterinary schools.

Dr. Armistead.

Doctor, you have a prepared statement, I believe?

The committee will be lucky if we can conclude with your testi

mony.

You may proceed, Doctor.

Dr. ARMISTEAD. Thank you very much, Mr. Chairman and members of the committee.

STATEMENT OF DR. W. W. ARMISTEAD, AMERICAN VETERINARY MEDICAL ASSOCIATION

Dr. ARMISTEAD. I am W. W. Armistead, a doctor of veterinary medicine, appearing in behalf of the American Veterinary Medical Association. I am presently serving as president of this association, and am also dean of the College of Veterinary Medicine, Michigan State University, East Lansing, Mich.

Veterinarians, as a professional group, have definite and individual responsibilities in safeguarding the health of the people of this country.

The immediate contact most of the public have with members of our profession is in safeguarding the health of animals. There is general