shoes are made on a standard last and feet are completely individual. Much work is being done today to produce devices for the individual which will make the foot fit exactly to the shoe and in this way distributing the stresses properly.

These are constructed in a similar manner that many dentures are made, made to exact impressions of the feet, and then made to fit the shoe exactly.

So that you get even distribution of stress.

Mr. NEAL. There is a certain amount of overlapping between the treatment administered by you as a chiropodist and the treatment administered for various foot deformities and so on by the orthopedist; is that true?

Mr. RUBIN. That is quite true. Many of our people are associated with orthopedic surgeons. They work together.

Mr. NEAL. Yours is more an application of the orthopedic theory. Mr. RUBIN. In general, that would be true. We have more to do with strictly the architecture of the foot. We have problems relative to the aspects of the foot such as determology and medical relationships in general that are not completely orthopedic. So we have other-in fact most of work in hospitals today is in orthopedic and periphical vascular departments where our efforts can reduce the mortality and morbidity of patients and also reduce the number of inpatient visits of these people who have these chronic diseases.

Mr. NEAL. To quote my wife, I would say your group of people are quite successful in relieving human suffering.

Mr. RUBIN. I believe we are. I myself studied mine before I came to this field. I honestly believe we have a much wider opportunity here to do service than is present in many fields.

Mr. NEAL. That is all. Thank you very much.

Mr. WILLIAMS. Dr. Rubin, you mentioned in your statement that there are six schools of podiatry in the country?

Mr. RUBIN. That is correct.

Mr. WILLIAMS. You mentioned that only one was supported to that extent. That would be Temple University.

Mr. RUBIN. I might amplify that.

Mr. WILLIAMS. Before you amplify on the Temple University situation, would you list the other schools for us and let us know whether they are profit or nonprofit institutions?

Mr. RUBIN. They are all nonprofit, sir. All are nonprofit, sir. The New York College of Podiatry is one. And until recently it was part of the Long Island University. But Long Island University was having financial difficulties, and they were going to close our school. So our men decided they had better keep it open.

They are doing that on their own now.

The Temple School which has been mentioned. The Hoy School of Chiropody. The Illinois College of Chiropody and the Chicago College of Chiropody, the latter two being in Chicago. And the California College of Chiropody in San Francisco.

Mr. WILLIAMS. Now, is the chiropodist licensed or permitted to go into the foot and operate on bone structure?

Mr. RUBIN. Yes, sir, in most instances he is, sir.

In fact, most of us have narcotic licenses also.

Mr. WILLIAMS. But your practice is limited entirely to the foot itself; is that right?

Mr. RUBIN. That is correct. We are primarily and only concerned with the care and health of the foot.

In fact that is one of the reasons that we have changed from chiropody-podiatry since the word "podiatry" refers specifically to the foot and chiropody refers also to some service to the hand, which we as an association do not consider part of our field.

Although in some States our members may perform services on the hand.

Mr. WILLIAMS. Any further questions?

(No response.)

Mr. WILLIAMS. Thank you very much, Doctor.

Mr. RUBIN. Thank you, gentlemen.

Mr. WILLIAMS. The next witness is Miss Julia C. Thompson, Washington representative of the American Nurses' Association.

STATEMENT OF MISS JULIA C. THOMPSON, WASHINGTON REPRESENTATIVE OF THE AMERICAN NURSES' ASSOCIATION

Miss THOMPSON. Mr. Chairman, and members of the committee, I am Julia C. Thompson, Washington representative of the American Nurses' Association, and I am here to present a statement on H. R. 7841.

The American Nurses' Association is the national organization of registered professional nurses with over 181,000 members in 54 constituent State and Territorial associations. The major purposes of the organization are to improve the practice of nursing and to promote the welfare of nurses to the end that all people may have better nursing care.

The American Nurses' Association urges early and favorable consideration of H. R. 7841 with the addition of provisions for support of graduate programs in nursing.

This amendment has been discussed with Congressman Fogarty and he has no objection to its inclusion in the legislation.

For reasons well known to this committee, the demand for health personnel has greatly increased throughout the Nation. There is every reason to believe that the demand for physicians, dentists, nurses, and public-health personnel will continue to increase in the years ahead. Unless Congress acts to provide financial assistance to the schools which prepare professional health personnel, the present shortages will become more acute. The schools need assistance now in order that they may expand to admit and educate the growing number of students seeking higher education in the health professions.

In view of the needs for health personnel, provision should be made for training all those with the interest and the ability to enter this field. The American Nurses' Association believes the Congress should act at this time to provide Federal grants for construction of facilities for graduate education in nursing, as well as to provide grants for construction of education and research facilities for medicine, dentistry, and public health.

Nursing is an essential part of the health services of this country. Modern preventive and curative services would not be possible without nursing personnel.

The demand for nurses has increased along with the growth of hospitals and other health agencies. Shortages are especially acute in those complex areas of nursing practice for which higher education is required; namely, teaching, administration, supervision, research, specialized clinical practice, and consultation.

At least 10 percent of the positions in nursing invodve responsibilities which require education on the master's and doctoral level.

Enrollments in these programs have materially increased since the enactment of the Health Amendments Act of 1956. This legislation has already made a substantial contribution toward increasing the number of prepared teachers, administrators, and supervisors of nursing.

The number of full-time students enrolled in master's degree programs rose from 559 in 1955 to 910 in the fall of 1956. This increase was due, in large part, to the traineeship provisions in Public Law 911. It should be remembered, however, that the law provides for grants to qualified students, but makes no provision for financial aid to the schools for either administrative or instructional costs.

If we are to meet the reasonable estimate of need for 300 registered professional nurses per 100,000 population by 1965, and if 13 percent of nurses are to be adequately prepared for positions in teaching, administration, supervision, research, consultation, and specialized practice, there must be at least 5,200 nurses graduating from advanced programs by that time. With the present enrollments we can expect no more than 800 students to graduate from master's programs each year.

In November 1956, the National League for Nursing requested information from the graduate programs in nursing as to their capacities to expand to meet future needs for this type of nursing education. The study revealed that the graduate programs could now accommodate approximately 900 more full-time students, thus increasing annual graduations by 600. With an increase in eligible candidates coming out of baccalaureate programs, and with additional scholarship aid for students, no more than 1,400 annual graduations from master's programs can be expected with the present facilities.

This is far short of the need for 5,200 annual graduations by 1965. Educational facilities for advanced study in nursing must be greatly expanded. Unless Congress acts to further support graduate education in this field, the deficit in professional nurses prepared for teaching, administration, supervision, research, consultation, and specialized clinical practice, which deficit is now critical, will increase at a time when the demands for these services are growing at a rapid rate. The problem is so serious as to require action by the Federal Government at this time.

The American Nurses' Association urges your favorable consideration of H. R. 7841 with the addition of appropriate provisions for support of graduate programs in nursing.

This association recommends that section 801 (c) be revised to read:

It is, therefore, the policy of the Congress to provide funds for construction of health educational and research facilities for our public and nonprofit medical, dental, and public-health schools, and for graduate programs in nursing, thus insuring the continued production of an adequate number of properly qualified and trained physicians, dentists, nurses, teachers, and research scientists.

We recommend that section 802 define the term "graduate program in nursing" to mean: A program in a university or college which provides training in nursing leading to a master's or higher degree approved or accredited by a recognized body or bodies approved by the Surgeon General after he has obtained the advice and recommendation of the Federal Council on Health Educational Facilities. We recommend that section 803 provide for the appointment of a nursing leader to the proposed Federal Council on Health Educational Facilities.

The American Nurses' Association further recommends that section 804 provide for grants-in-aid to graduate programs in nursing in the sum of at least $14 million; no grant to be made to any one school in excess of $1 million. The appropriate inclusion of graduate programs in nursing is indicated in the remaining sections of the bill, as well as the inclusion of nursing in the stated purpose of the bill.

On behalf of the members of the American Nurses' Association, I request that this statement be included in the record of this hearing along with the attached article Educational Resources for the Preparation of Nurses-Part 2: Preparation for Advanced Positions in Professional Nursing, Nursing Outlook, February 1958.

Thank you very much.

Mr. WILLIAMS. You want to insert in the record, in addition to your statement, certain material. Is that the material that is attached to the statement?

Miss THOMPSON. Yes.

Mr. WILLIAMS. Or is that the material that is included in the brochure?

Miss THOMPSON. No. It is only the statement attached to the testimony.

The material in the booklet is only for your use in studying the needs.

Mr. WILLIAMS. Fine.

I will suggest that this be accepted by the committee, of course, for its files. And your statement and the attachment to the statement will be included in the hearings.

(The material referred to above follows:)

[Distributed by American Nurses' Association, New York, N. Y.],

EDUCATIONAL RESOURCES FOR THE PREPARATION OF NURSES

PART 2. PREPARATION FOR ADVANCED POSITIONS IN PROFESSIONAL NURSING1 Between the fall of 1955 and the fall of 1956 the number of full-time students in master's degree programs which prepare for leadership positions in nursing rose from 559 to 910, an increase of 63 percent. This is a giant step toward solving one of the most serious problems in nursing-the shortage of adequately prepared administrators, supervisors, teachers, consultants, and nurse specialists.

Many factors have contributed to this increase, including the eagerness of nurses to prepare themselves for the advanced positions which they are holding or toward which they are aiming; the growth, both qualitative and quantitative, in the facilities for graduate education in nursing; the enlargement of the reservoir of potential master's degree students-graduates from baccalaureate degree programs, and the increasing recognition, on the part

1 Part 1 of this report, Preparation for Beginning Positions in Professional Nursing, appeared in the January issue. The entire report was prepared by NLN's Division of Nursing Education.

of employers of nurses, of the value of advanced training for those in leadership positions. Despite these favorable influences, however, until 1956 enrollments in master's degree programs failed to reach the 2,000 mark (fig. 1). Because two-thirds of these enrollments represented students engaged in parttime study, annual graduations were even lower than the enrollment data might lead one to expect, never topping 550 (table 1). This high percentage of parttime enrollments pointed toward one of the biggest obstacles to the growth of graduate education in nursing-the financial inability of many nurses to undertake even a year's study on a full-time basis.

FINANCIAL AID FOR STUDENTS

If there were any doubts that the real bottleneck has been an economic one, the passage of Public Law 911 in August 1956 quickly dispelled them. Under title II of this law, Federal funds amounting to $2 million were made available during the year 1956-57 for traineeship grants to nurses preparing for administrative, supervisory, or teaching positions. Not one dollar went begging; all $2 million were put to immediate use for full-time study by 471 nurses-307 in master's degree programs, 11 in post-master's programs, and 153 in baccalaureate degree programs.

Figure 1. Full-Time and Part-Time Enrollments in Masters and Baccalaureate Degree
Programs Which Prepare for Advanced Positions in Nursing, Fall 1954, 1955, 1956

*120 students in baccalaureate degree programs which prepare for school nursing, formerly counted as students preparing for advanced positions now included among students preparing for beginning positions.