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TRAINING OF PHYSI CIA NS, DEN TIST S, AND^

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H E A R I N G S

BEFORE THE

COMM ITTEE ON

INT ER STAT E AN D EO RE IGN COMM ERCE 

HOU SE OF RE PR ES EN TA TI VE S

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EIG HT Y-S EV EN TH CONGRESS 

SECOND SESSION

ON

H.R . 4999, H.R . 8774, an d H.R. 8833

BILLS TO INCREASE THE OPPORTUNITIES FOR TRA ININ G 

OF PHYSICIANS, DENTISTS, AND PROFESSIONAL PUB LIC 

HEALTH PERSONNEL, AND FOR OTHER PUR POS ES

JANUARY 23, 24, 25, 26, AND 30, 1962

Printed for the use of the 

Committee on Interstate and Foreign Commerce

TRAINING OF PHY SICI ANS , DENTIS TS, AND

PROF ESSIO NAL PUBLIC HEALTH PERSONNE L

H E A R I N G S

BE FORE TH E

COMMITTEE ON 

INT ERS TATE AND FOREIGN COMMERCE 

HOR SE OF REPRESENTATIV ES

EIGIITY -SE VE NT H CONGRESS

SECOND SESSION

ON

H.R . 4999, H.R. 8774, and H.R. 8833

BILL S TO INCREASE TIIE OPPORT UNITIES FOR TRAINING 

OF PHYSICIANS, DENTISTS, AND PROFESSIONA L PUBLIC 

HEALTH PERSONNEL, AND FOR OTHER PURPOSE S

JANUARY 23, 24, 25, 26, AND 30, 1962

Printed for th e use of the 

Committee on In terstate and Fore ign Commerce

80014

O.S. GOVERNMENT PR IN TING OF FIC E 

WAS HINGTON : 1962
COMMITTEE ON INTE RSTATE AND FOREIGN COMMERCE

OREN HA RR IS, Arkansas, Cha irman

JO HN BE LL WILL IAMS , Mississippi

PET ER F. MA CK , Jr., Illinois

KENNET H A. RO BE RT S, Alabam a

MO RG AN M. MO UL DE R, Missouri

HAR LE Y O. STAGGERS, West Virginia

WAL TE R RO GE RS, Texas

SAMU EL N. FR IE DEL , Maryland

TORBERT II. MA CDON AL D, Massachusetts

GE OR GE M. RHOD ES, Pennsylvania

JOHN JARM AN , Oklahoma

LEO W. O’BR IEN, New York

JO HN E. MOSS, California

JOHN D. DI NG EL L, Michigan

JOE M. KILG OR E, Texas

PA UL G. ROGERS, Florida

RO BE RT W. HE M PH IL L, South Carolina

DAN RO ST EN KO WS KI, Illinois

JAME S C. HE AL EY , New York

HO RA CE R. KO RN EGAY , North Carolina

JOHN B. BEN N ETT, Michigan 

WILLIAM L. SP RIN GER , Illinois 

PAUL F. SC HE NC K, Ohio 

J. AR TH UR YO UN GE R, California 

HA RO LD R. CO LL IE R, Illinois 

MILT ON W. GL EN N, New Jersey 

SAMUEL L. DEVIN E, Ohio 

ANCH OR NEL SE N, Min nesota 

HA STING S KEIT H, Massachusetts 

WILLAR D S. CURTI N, Pennsylvania 

AB NE R W. SIB AL, Conn ecticut 

VE RN ON W. TH OM SO N, Wisconsin 

PE TER H. DOM IN IC K, Colorado

W. E. Williamson, Clerk

Kenn eth J. P ainter, Aes ie ta nl Cle rk

Pro fe ttio na l S ta ff

Andrew Stevenson Sam G. Spal

K urt Borchardt Martin W. Cunningham

II
C O N T E N T S

Hearings held on— Page Jan uary 23, 1962____________________________________________ 1

Jan uary 24, 1962____________________________________________ 51

Jan uary 25, 1962____________________________________________ 211

Jan uary 26, 1962____________________________________________ 339 Jan uary 30, 1962____________________________________________ 433

Text of H.R . 4999_____________________________ _________________ 3

Report of—

Secretary of Health, Education, and Welfare_____________________ 9

Comptroller General____________________________________ 10

Executive Office of the Pre sident_________________________________ 11

Department of Labor:

Secretary_________________________________________________ 11

Solicitor__________________________________________________ 11

Sta tem ent of—

American Dental Association, sum ma ry_________________________ 177

American Dental Association, sup pleme ntary____________________ 180

American Osteopathic Association, sub mitted by Lawrence L.

Gourley__________________________________________________ 270 American Pharmaceutic al Association___________________________ 477

American Public Hea lth Association____________________________ 495

Anderson, Donald G., President, Association of American Medical 

Colleges, dean, University of Rochester School of Medicine and

De nti stry_______________________________________________ 101, 107

Association of American Medical Colleges_______________________ 505

Bennett, Hon. Charles E., a Representative in Congress from the

Sta te of F lor ida ____________________________________________ 428

Bennett, Dr. H. Stanley, dean, the Division of the Biological Sciences,

University of C hicago______________________________________ 389 Berson, Dr. Robert C., dean of the Medical College, the University of 

Alabama, and representative of the Association of American Medical Colleges_____________________________________________ 110, 111

Biemiller, Andrew J., director of legislation for the American Fed eration of Labor and Congress of Industrial Organizations, accompanie d by Lisbeth Bamberger_______________________________ 433 Bliven, Dr. Charles W., American Association of Colleges of

Pharm acy______________________________________________ 418, 419 Bonnet, Dr. Philip D., adm inistrator, Massachusetts Memorial Hospital; member of the Board of trus tees of the American Hospita l Association; accompanied by Kenneth Williamson, associate

director of the American Hospital Association________________ 255, 256

Brademas, Hon. John, a Representative in Congress from the S tate of

Indian a___________________________________________________ 463

Burk et, Dr. Lester W., dean, School of Den tistry, University of 

Pennsylvania, and president, American Association of Dental

Schools___________________________________________________ 193 De Bakey, Dr. Michael E., professor and chairm an of the Department of Surgery of Baylor University College of Medicine, in 

Houston, Tex., accompanied by Dr. Sidney Farber, scientific 

direc tor of the Children’s Cancer Research Foundation, Boston,

Mass-------------------------------------------------- -------- --------------------- 361 De Bakey, Dr. Michael K . add itional__________________________ 509 Dempsey, Gov. John, of Connecticut___________________________ 336 Diehl, Dr. Harold S., senior vice president for research and medical 

affairs and deputy executive vice president of the American Cancer

Society, Inc _______________________________________________ 439

in
IV CONTENTS

Statement of—Continued

Dorman, Dr. Gerald D., accompanied by Dr. Walter S. Wiggins an d

Dr. Leland S. McKittrick, on behalf of the American Medical Page 

Association_______________________________________________ 339

Elvehjem, Conrad A., president, University of Wisconsin__________ 322

Eve rett, Dr. Mark R., director and dean, University of Oklahoma

Medical Cen ter____________________________________________ 487

Fogarty, Hon. J ohn E., a Representative in Congress from the State of

Rhode Island_____________________________________________ 212

Folsom, Marion B., director and managemen t adviser, Eastman 

Kodak Co.; chairman, executive comm ittee, board of trustees, 

University of Rochester; and former Secretary of Health , Education,

and Welfare______________________________________________ 222

Foote, Dr. Fran klin M., commissioner, Sta te dep artment of health,

Hartford, Con n____________________________________________ 335

Godwin, Winfred L., director, Southern Regional Education Board. _ 468

Gonzalez, Hon. Henry B., a Representative in Congress from the 20th

Distric t of the Sta te of Texas________________________________ 450

Independent Committee for Medical Deve lopm ent submitted by

Prof. H. M. Somers and Dr. B. J. Duffy, Jr___________________ 397

Jehle, Philip F., Washington represe ntative and associate general

counsel of the National Association of Retail Druggists________ 422, 424

Kilgour, Frederick G., librarian, Yale Medical Library, New Haven,

Conn., for the American Library Association___________________ 485

Kroepsch, Robert H., executive director, Western Interst ate Commission for Higher Education, Fleming Law Building, Boulder, C olo. 401, 404 

Laird, Hon. Melvin R., a Representative in Congress from the Sta te

of Wisconsin______________________________________________ 429

Leavell, Dr. Hugh R., president of the Association of Schools of Public

He alth_________________________________________________ 277,279

Lichterman, Dr. Martin, executive secretary , New England Board of

Higher Education, Winchester, Mass_________________________ 451

Lieberman, Rabbi Morris, chairman, subc omm ittee on medical education and research, committee on medical care, Maryland Sta te

Planning Commission____________________________________ 203, 206

MacCracken, William P., Jr., Washington counsel for the American

Optometric Association_____________________________________ 312

Macdonald, Hon. Torbe rt H., a Represe ntative in Congress from the

State of Massach usetts_____________________________________ 310

Mazique, Dr. Edw ard C., represe ntative for the National Medical

Association on medical legislation____________________________ 457

Means, Dr. James Howard, Boston, Mass_______________________ 415

Millis, John S., president, Western Reserve University, Cleveland,

Ohio, on behalf of the American Council on Education________ 305, 306

Moore, Dr. Robert A., president, Dow nstate Medical Center of the 

State University of New York and dean of the center’s college of

medicine in Brooklyn, N.Y ________________________________ 250, 252

Nagle, Dr. Raymond J., dean, College of Den tistry, New York 

University, and chairman, American Den tal Association Council on

Dental Education__________________________________________ 172

National Farm ers Union, by Richard C. Shipman, assistan t dir ector . 427 

Poor, Dr. Russell S., provost, J. Hillis Miller Health Center, University

of Florida _______________________________________________ 326, 327

Rhodes, Hon. George M., a Represe ntative in Congress from the

State of Pennsylvania ______________________________________ 460

Ribicoff, Hon. Abraham, Secretary of Health, Educatio n, and Welfare; 

accompanied by Wilbur J. Cohen, Assistant Secretary; Boisfeuillet 

Jones, Special Assistant to the Secretary, Hea lth and Medical 

Affairs; and Dr. Luther L. Terry, Surgeon General, Public Hea lth

Service, Department of Health, Educatio n, and Welfare-------------- 12, 52

Rosenbloom, Dr. Alfred A., Jr., dean, Illinois College of Optometry, 

and member, American Optometric Association, Council on Optometric Education; accompanied by William P. MacCracken, Jr.,

Washington Council for the American Optometric Association------ 312

Rubin, Dr. Abe, secretary and editor of the American Podiatry Association; accompanied by Lloyd E. Blauch, Ph. D., consultant to the 

APA Council on Edu cation __________________________________ 409
CONTENTS V

St atem en t of—Con tinu ed

Rusch, Dr. Harold P., director, McArdle Memorial Laboratory for Page 

Cancer Research, University of Wisconsin_____________________ 322

Shelley, Hon. John F., a Representative in Congress from the S tate of

Californ ia_________________________________________________ 462

Shipman, Richard C., for the National Farm ers Union____________ 427

Somers, Prof. Herman M., chairman, Depar tment of Political Science, 

Have rford College, Haverford, Pa.; and Dr. Benedict J. Duffy, Jr., 

professor of preve ntive medicine, Seton Hall College of Medicine,

Jersey City, N .J___________________________________________ 397

Stebbins, Dr. Ernest L., dean, School of Hygiene and Public Health

of th e Johns Hopkins University_______________________ 277, 285, 294

Tilley, Dr. R. McFarlane, dean and director of hospitals and clinics, 

Kirksville College of Osteopathy & Surgery, Kirksville, Mo.; 

accompanied by Lawrence L. Gourley, legal counsel, American

Osteopathic Association_____________________________________ 262

Timmons, Dr. Gerald D., president-elect, the American Dental Association, and dean, College of Dentistry, Temple University______ 168

Turner, Dr. Thomas B., dean, John s Hopkins University School of

Medicine_______________________________________________ 120, 121

Warren, Dr. Stafford L., dean, School of Medicine, University of

Wegman, Dr. Myron E., dean of the School of Public Hea lth, UniverWiggers, Dr. Harold C________________________________________ 485

Wolf, Dr. George A., Jr., executive director and vice president for

medical and dental affairs, Tufts University, Boston, Mass____ 232, 237

Yale, Dr. Irvin , chairm an, Council on Education, American Pod iatr y

Association________________________________________________ 476

Communications submitted to the comm ittee—

American College of Surgeons, Dr. J. B. Mason, assista nt director,

letter dated Jan uar y 25, 1962________________________________ 503

American Library Association, Germaine Krette k, director, letter

dated Jan uar y 22, 1962_____________________________________ 484

American Nurses Association, Inc., letter dated Jan uar y 22, 1962__ 488

American Pharmaceutical Association, Dr. W. S. Apple, secretary ,

letter dated Jan uary 29, 1962________________________________ 477

American Public Health Association, Inc., Dr. B. F. Mattiso n,

executive director, letter dated Jan uar y 22, 1962_______________ 495

Baylor University College of Medicine, Dr. S. W. Olson, dean,

letter dated Jan uar y 17, 1962________________________________ 479

Baylor University College of Medicine, letter dated February 5, 1962_ 509

Brandeis University, Louis Levin, dean of science, letter dated

Jan uary 18, 1962__________________________________________ 489

Brown, Gov. Edm und G., of California, letter dated Jan uar y 30, 1962. 467

Brown University , letters by Mr. B. C. Keeney dated Jan uary 19,

1962_____________________________________________________ 480

California College of Medicine, W. B. Henley, president, letter to

Dr. Warren of Ja nuary 16, 1962_____________________________ 377

California Departme nt of Public Hea lth, Office of the Director, letter

dated Jan uar y 24, 1962_____________________________________ 503

California University, San Francisco Medical Center, letter to Dr.

Warren dated Jan uar y 15, 1962_____________________________ 377

California University School of Dentistry , W. C. Fleming, dean,

letter dated February 14, 1962_______________________________ 518

California University, School of Public Hea lth (Berkeley, Calif.), Dr.

C. E. Smith, dean, letter d ated Jan uary 17, 1962_______________ 493

California University , School of Public Health (Los Angeles, Calif.),

Dr. L. S. Goerke, dean, lett er dated Jan uary 19, 1962___________ 501

Chicago College of Osteopathy, Dr. R. A. Kistner, dean, lette r to

Mr. Lawrence Gourley of F ebruary 5, 1962____________________ 276

College of Osteopathic Medicine and Surgery, Merlyn McLaughlin,

president, letter to Mr. L. L. Gourley of February 4, 1962_______ 274

Comen, Dr. Richard L., letter dated Jan uary 16, 1962____________ 499

Daddario, Hon. Emilio Q., a Represe ntative in Congress from the

Sta te of Connecticut, letter dated Jan uary 26, 1962_____________ 431

Eli Lilly & Co., letter dated February 6, 1962____________________ 505
VI CONTENTS

Communica tions submitted to the committee—Continued

Fascell, Hon. Dante B., a Represe ntative in Congress from the State Page

of Florida________________________________________________ 465

Fenton, Hon. Ivor D., a Representative in Congress from the State

of Pennsylvania, letter dated Jan uar y 17, 1962_________________ 466

Fund for the Advancement of Podiatry-C hiropody Education, letters

dated February 1, 1962_____________________________________ 514

Georgia Departm ent of Public Health, Dr. J. H. Venable, director,

letter dated January 31, 1962________________________________ 504

Granaha n, Hon. Ka thryn E., a Representative in Congress from the

Sta te of Pennsylvania, letter dated Jan uar y 31, 1962____________ 465

Harvard Medical School, letters dated Jan uar y 22, 25, 1962_______ 481

Harva rd School of Public Health, Dr. J. C. Snyder, dean, letter of

Jan uary 31, 1962__________________________________________ 504

Idaho Department of Health, Dr. T. O. Carver, adm inistra tor of

health, letter dated Jan uary 23, 1962_________________________ 501

Kansas City College of Osteopathy and Surgery, J. M. Peach, president, letter to Mr. L. L. Gourley of Febru ary 5, 1962___________ 272

Kansas City University School of Dentistry, H. B. G. Robinson, dean,

letter d ated February 3, 1962________________________________ 516

Kansas State Board of H ealth, Dr. R. H. Riedel, executive secretary,

letter dated Jan uary 22, 1962________________________________ 501

Loma Linda University, Dr. W. E. Macpherson, dean, lette r to Dr.

Warren of January 16, 1962_________________________________ 376

Louisville University School of Dentistry , Raymond E. Myers, dean,

letter d ated February 1, 1962________________________________ 512

Ma rquette U niversity School of Dentistry, Dr. L. C. Alexander, dean,

letter dated February 5, 1962________________________________ 515

Maryland Departme nt of Planning and Planning Commission, letter

dated January 26, 1962_____________________________________ 502

Maryland University School of Medicine, Dr. W. S. Stone, dean,

letter dated Jan uar y 25, 1962________________________________ 483

Miami University School of Medicine, letter referred to Hon. Dan te B.

Fascell, Member of Congress________________________________ 465

Montana State Board of H ealth, letter dated Jan uary 22, 1962_____ 500

Nebraska University College of Dentistry, R. L. Ireland, dean, letters

of February 5, 1962, a nd Jun e 27, 1961------------------------------------ 516

No rth Carolina University School of Public Hea lth, Dr. E. G. McGavran, dean, lett er dated Jan uar y 18, 1962----------------------------- 492

Northern Association for Medical Educatio n, John W. Hedback,

executive director, letter dated January 29, 1962----------------------- 470

Northe rn Association for Medical Education, newspaper article by

Hal Quarfoth, reprint from Minneapolis Star, July 29, 1960--------- 475

Northwestern University Den tal School, G. W. Teuscher, dean, letter

dated January 31, 1962_____________________________________ 504

Pharmaceutical Manufacturers Association, letter dated February 2,

1962_______________________________ - _______________ ____ 512

Philadelphia College of Osteopathy, Frederic H. Barth, president,

letter to Mr. L. L. Gourley of February 5, 1962------------------------- 275

Pue rto Rico University School of Medicine, letter dated Jan uar y 19,

1962__________ _______ ___________________________________ 494

Rann, Dr. Emery L., lett er dated Jan uary 20, 1962----------------------- 498

Rutgers State University, letter date d Jan uary 22, 1962----------------- 432

St. Germain, Hon. Fernand J., a Representative in Congress from the

State of Rhode Island, letter dated February 16, 1962---------------- 464

Schuylkill County Optometric Association, letter to Hon. Ivor Fenton,

Member of Congress, dated Jan uary 13, 1962---------------------------- 466

Southern California University School of Medicine, Dr. C. G. Loosli,

dean, letter dated Jan uar y 15, 1962___________________________ 375

Stanford University Schooi of Medicine, Dr. R. H. Alway, dean,

letter to Dr. Warren dated Jan uary 15, 1962___________________ 374

Stevens, Dr. H. W., letter dated Jan uary 24, 1962------------------------ 500

Tennessee University, Ru th N. Murray, R.N ., dean, letter dated

Feb ruary 15, 1962_________________________________________ 519

Texas University, Ha rrv Ransom, chancellor, lette r d ated Jan uar y 18,

1962.......................... ....... ................. ............. ......... ......... ............. ....... 494
CONTENTS VH

Communications subm itted to the committee—Continued

Texas University, Medical Branch, Dr. J. B. Truslow,,dean and ex- Page

ecutive director, letter d ated Jan uary 16, 1962_________________ 478

Tufts University School of Dental Medicine, Dr. J. W. Hein, dean,

letters dated February 5, 1962, and Jun e 30, 1961______________ 607

Veterans’ Administration, Office of Chief Medical Director, Depar tment of Medicine and Surgery, letter d ated Jan uary 18, 1962____ 492

Volpe, Gov. John A., of Massachusetts, lett er d ated Ja nuary 31, 1962, _ 467

Weis, Hon. Jessica McCullough, a Representative in Congress from

the Sta te of New York, letter d ated Jan uar y 31, 1962___________ 464

West Virginia University School of Dentistry, letter dated Feb ruary

3, 1962_______________ ________ ____ _____________________ 507

Western Reserve University School of Dentistry, Dr. P. E. Boyle,

dean, letter dated February 13, 1962__________________________ 482

Yale University School of Medicine, Departme nt of Epidemiology 

and Public Health, letter d ate d Jan uary 19, 1962_______________ 499

Additional da ta subm itted to the comm ittee—

Annual number of deaths of physicians repo rted to the AM A______ 167

Applicants and their college record a nd first-year enrollment, 1950-61,

table furnished by Dr. Wiggins______________________________ 355

Association of American Medical Colleges:

Five-year summary of admission and enrollment da ta for all

schools of medicine, 1956-57, 1960-61_____________________ 133

Summary of application, admission, and enrollment da ta for each

U.S. school of medicine, table I ________________________ 134—145

Summary of attrition rates for all U.S. schools of medicine, table

II ___________________________________________________ 146

Summary of a ttrition rates for each U.S. school of medicine, table

II I ________ _____ _____________ _________ _______ 148-165

Categorical exhibit of expenditures for co nstructio n and major renovations for teaching and research in biology and medicine at the 

University of Chicago, 1949-62_______________________________ 393

Den tal education, material submitted by Public Health Service____ 191

Estimated costs for construction of teaching and research facilities, 

table submitted by the University of California Medical Center,

Los Angeles_______________________________________________ 380

Expenditure s and commitm ents for new construction and major renovations for teaching and research in biology and medicine at the

University of Chicago, 1949-62, table_________________________ 393

Five- to ten-year projected construction needs of California schools of

medicine, table submitted b y Dr. Warren______________________ 374

Group Health Association of America, Inc., resolution sub mitted by

Dr. Means________________________________________________ 415

Health, Educatio n, and Welfare, Depar tment of:

Appendix A_____________________________________________ 20

Appendix B_____________________________________________ 24

Cost of education payments, table__________________________ 21

Distribution of new obligational authority, table______________ 39

Economies of 1962_______________________________________ 39

Federal fellowships and loa ns______________________________ 52

Geographical source of entering studen ts in public and private 

medical schools and basic medical service schools in the United

States, 1960-61 _____________________________________ 98

Hea lth research facilities constru ctio n_______________________ 68

N1H fellowship awards, by types, tabl e_____________________ 53

NIH undergraduate training grants for fiscal vears 1957-61,

tab le____________________________________ 58-67

Natio nal Cancer Institute appropriation histories____________ 40

National defense fellowships distribution, tab le______________ 53

National defense student loans approved, tab le______________ 57

National Science Foundation fellowships awarded for fiscal 1961,

tab le_________________________________________________ 55

Osteopathic physicians, types of practice in 1961, table________ 78

Percent of graduates of each medical college in private practice in 

the same State as the medical colleges att ended—selected 

classes, 1930-50________________________________________ 100
VIII CONTENTS

Additional da ta submitted to the committee by—Continued

Health, Education, and Welfare, Departm ent of—Continued Page

Physicians and dentists in geographic regions, tab le___________ 93

Physicians, types of practice in 1959, tab le__________________ 78

Place of training of foreign-trained physicians, tab le___________ 69

Scholarship funds________________________________________ 20

Scholarship grant, table___________________________________ 21

Scholarships and money to be awarded to studen ts in dental

schools, tab le__________________________________________ 24

Structure of grad uating classes in the U.S.S.R. and the United

States, tab le__________________________________________ 42

Stud ent loan borrowers entering medical sciences field, table__ 87

Scholarships and money to be awarded to studen ts in schools

of medicine and osteopathy, table________________________ 22

Teaching hospital construction under the Hill-Burton program. _ 69

Loss of students enrolled in medical schools, table________________ 167

Loss of studen t enrolled in osteopathic colleges, supp leme ntal information furnished by Public Health Service, table_______________ 277

Manpower data, 1961-62, table subm itted by Mr. Jeh le___________ 423

Northern Association for Medical Educatio n, location of schools of

medicine, 1959, ma p________________________________________ 473

Number of physicians and physician-population ratios, United States, 

1931-58, with projections to 1975, table submitted by Mr.

Gourley_________ _____ _________________ ____ ________ ____ 269

Optometric amendments to H.R. 4999__________________________ 316

Optometric school and college graduates by years, graph__________ 317

Optometrist ratio to population, graph__________________________ 318

Pamphlet entitled “Em ployment Outlook for Optom etrists” furnished by HE W___________________________________________ 320

Percent distribution of medical college graduates in private practice 

whose prior residence was in various size communities by size of 

community of practice, 1950 class, table sub mitted by R. C.

Shipman_________________________________________________ 428

Private expenditures for medical care, table supplied by Dr.

Timm ons_________________________________________________ 189

Supplementary information furnished by HEW re enrollment in osteopathic schools_____________________________________________ 277

Supplemental inform ation on optometrists furnished by HE W____ 319
TRAINING OF PHYSICIANS, DENTISTS, AND PROFESSIONAL PUBLIC HEALTH PERSONNEL

TUESD AY , JA N U A R Y 23 , 19 62

H ouse of Repr esenta tives,

Com mittee on I nterstate and F oreign Comm erce,

Washington, D.G.

The committee met at 10 a.m., pursuant to call, in room 1334, New 

House Office Building, Hon. Oren Harris (chairman of the committee) presiding.

The Chairman. The committee will come to order.

This morning the committee begins hearings on a most im portant 

piece of legislation, on a bill, H.R. 4999, which I introduced at the 

request of the President transmitted through the Secretary of Health, 

Education, and Welfare. Identical bills have been introduced by our 

colleague from West Virginia, a member of this committee, Mr. 

Staggers, H.R. 8774, and the gentleman from Florida, Mr. Bennett, 

H.R. 8833.

I might interpolate tha t our colleague from Alabama, Mr. Andrews, has a bill which he has just called to my attention tha t is related to this subject, and I think during the course of the hearings 

we should include it and give an opportunity for him to appear and 

the party tha t he desires to be heard, who, I believe, is Dr. Anderson, 

vice president of Auburn University.

The committee wishes to explore every aspect connected with this 

general subject at this time, although I would like to emphasize tha t 

the administration’s proposal provides Federal assistance for the construction of medical and dental schools, as well as osteopathic schools, 

together with scholarships for students at these schools.

The bills are designed to increase opportunities for training physicians, dentists, and other professional health personnel and to provide 

for (1) gran ts for the construction of medical, dental, osteopathic, 

and public health teaching facilities; (2) medical, osteopathic, and 

dental scholarship grants; (3) extension and strengthening of the 

research facilities construction gra nt program.

A related health bill recommended by President Kennedy which I 

introduced at his request, H.R. 4998, and which is designed to expand community facilities and services for the health care of the aged 

and other persons, has already been enacted by the Congress. It is 

now Public Law 87-395, approved September 20, 1961. That law 

extended the health research facilities program until June 30, 1963, 

in order to give this Congress an opportunity in the meantime to 

take a fresh look at the adequacy of tha t program. Since the cutoff 

date for the filing of applications under tha t program is June 30, 

1962, it is of vital importance that Congress take action at this session

1
2 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

on legislation designed to extend, and, if necessary, to modify this 

program. It will be the purpose of these hearings, therefore, to explore both the need for a new program aimed at teaching facilities 

and scholarships, and the need for the extension and modification of 

an existing program dealing with health research facilities.

This is not the first time tha t this committee is holding hearings 

on these two important subjects. As a matter of fact, it would be 

possible for me to spend the better part of this morning’s hearings 

with a recital of the legislative histories of bills intended to provide 

Federal support in one way or another for the construction of medical 

and dental school teaching facilities, for the support of medical and 

dental school operations, and for assistance to students who study 

medicine or dentistry.

During the 81st Congress, the Senate passed legislation providing 

for a 5-year emergency program of Federal aid to training in the 

principal health professions which included operational subsidies, 

scholarship aid, and aid for the construction of teaching facilities. 

Our committee held hearings and reported favorably a bill similar 

to the one passed by the Senate. However, the Rules Committee 

failed to grant a rule clearing it for consideration by the House.

During the 84th Congress, hearings were held by this committee 

on bills much more limited in scope than those considered during the 

81st Congress. However, while legislation resulted in providing 

Federal aid for the construction of health research facilities, no action 

was taken on proposals to extend such aid for the construction of 

teaching facilities.

At that time, the committee directed its professional staff—

to gathe r all possible information bearing on the subject of Federal aid to 

medical schools and rep ort to the committee ear ly in the next Congress.

This was done, and the committee print entitled “Medical School 

Inquiry ” resulted from this study. I suggest that each member of 

the committee get a copy of it and have i t available in case you do not 

already have it. I understand that there is a constant demand for 

this staff rep ort and that it has become one of the standard reference 

works in this field.

Do we have other copies of it, Mr. Clerk ?

The Clerk. Yes, sir.

The Chairman. I think it would be a good idea to have copies 

available for members in case they care to refer to it.

I do know tha t there is constant demand for this staff report, and 

the staff is to be complimented for it.

During the 85th Congress, hearings which were held by this committee on the two subjects of Federal aid f or the construction of teaching facilities and research facilities resulted only in the extension of 

the research facilities program.

This brief recital of the legislative history of earlier bills dealing 

with Federal aid to medical and dental schools indicates the highly 

controversial nature of legislative proposals aimed at extending Federal aid for teaching as distinguished from Federal aid for research.

I would like to state right at the beginning of these hearings that 

I am entering into the consideration of these bills with an open mind. 

The long history of failures of previous efforts to enact legislation 

to aid in the construction of medical and dental school teaching facil-
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSO NNEL 3

ities prompts me to state for the record tha t the burden is on the witnesses who are appearing in support of these proposals to make it 

abundantly clear that such a program is needed in the best interests 

of the American people.

It goes without saying that such a program stands to benefit medical 

and dental schools and that they can probably make good use of any 

funds which may be offered to them. That is not enough, however, 

and the burden is on the proponents that such a program of Federal 

aid is absolutely indispensable if the health needs of the American 

people are to be met.

This is not only directed at the Secretary, who will be the first witness this morning, but to those groups and organizations who have 

advised me and the committee of their interest in and support of the 

legislation. Particularly this interest comes, of course, from persons 

connected with medical colleges and imiversities through the country.

At this point I will place in the record a copy of H.R. 4999, along 

with reports received from executive departments and agencies.

(The bill, H.R. 4999, and reports mentioned above, follow herewith:)

[H.R. 4999, 87th Cong., 1s t sess.]

A BILL To increase th e oppo rtu nit ies fo r trai ni ng of physicians, de ntists, and pro fessional 

pub lic he alth personnel, an d fo r ot he r pur poses

Be it enacted by the Senate and House of Representatives of the United

States of America in Congress assembled, Th at this Act may be cited as the 

“He alth Professions Educational Assistance Act of 1961”.

GRANTS FOR CONSTRUCTION OF MEDICAL, DENTAL, OSTEOPATHIC, AND PUBLIC HEALTH

TEACHING FACILITIES

Sec. 2. (a) Title VII of the Public Hea lth Service Act (42 U.S.G. chap. 6A) 

is amended by inserting “AND TEACHING” after “RESEARC H” in the head ­

ing thereof, by inse rting “AND TRAINING OF PROFESSIONAL HEALTH 

PERSONNEL” after “FA CIL ITIES” in such heading, and by inserting immediately below such heading “Part A—Grants for Construction of Health

Research Facilities”, and by changing the words “this title” wherever they 

appea r in such t itle to rea d “this p ar t”.

(b) Such title is fu rth er amended by adding a t the end thereof the following:

“Part B—Grants for Construction of Medical, Dental, Osteopathic, and

Public Health Teaching Facilities

“authorization of appropriations

“Sec. 720. There are hereby authorized to be app ropriated for each fiscal 

year in the period beginning Jul y 1, 1961, and ending June 30, 1971, (1) not to 

exceed $45,000,000 for gra nts to assist in the construction of new teach ing facilities for the training of physicians or professional public hea lth personnel, (2) 

not to exceed $15,000,000 for gra nts to assist in the construction of new teaching facilities for the training of dentists, and (3) not to exceed $15,000,000 for 

replacement or rehabilitation of existing teach ing facilities for the training of 

physicians, professional public he alth personnel, or dentists.

“approval of applications

“Sec. 721. (a) No application for a gra nt und er this pa rt may be approved 

unless it is subm itted to the Surgeon General prior to July 1, 1970.

“ (b) To be eligible to apply for a grant to assis t in the construction of any 

fac ility under this part, the applicant must be (1) a public or other nonprofit 

school of medicine, dentistry, osteopathy, or public health and (2) accredited 

by a recognized body or bodies approved for such purpose by the Commissioner 

of Education, except th at a new school which (by reason of no, or an insufficient, 

period of operation) is not, at the time of application for a gra nt to construct
4 TR AIN IN G OF PR OFE SS IO NAL PU BL IC H E A L T H PE RSO N N EL

a fa cil it y un de r th is part , eli gible fo r ac cr ed itat io n by such a recogn ize d bod y 

or bodie s, sh al l be dee me d ac cr ed ited fo r pu rpos es of th is p a rt if th e Co mm ission er of Edu ca tio n find s, a ft e r co ns ul ta tion w ith th e appro pri ate ac cr ed itat io n 

bod y or bodies, th a t th ere is re as on ab le as su ra nce th a t th e sch oo l will, up on 

co mpleti on of such fa ci lity , mee t th e ac cr ed itat io n st an d ard s of such body or 

bodies.

“ (c ) A g ra n t un de r th is p a rt may be mad e on ly if th e ap plica tion th er ef or is 

ap pr ov ed by th e Su rgeo n Gen eral up on his det er m in at io n th a t—

“ (1 ) th e ap pl ic an t mee ts th e el ig ibili ty co nd itio ns se t fo rt h in su bse ction (b ) ;

“ (2 ) th e ap pl ic at io n co nt ai ns or is su pp or te d by re as on ab le as su ra nc es 

th a t (A ) fo r no t les s th an te n yea rs aft e r co mpletion of co ns truc tion , th e 

fa cil it y wi ll be used fo r th e pu rp os es of th e te ac hin g fo r which it is to be 

co ns truc te d, (B ) sufficie nt fu nd s wi ll be avai la ble to m ee t th e no n- Fe de ra l 

sh are of th e co st of co ns truc ting th e fa ci lity , and (C ) suffi cien t fu nd s wi ll 

be av ailable, whe n co ns truc tion is comp leted, fo r effecti ve us e of th e fa ci lity 

fo r th e tr ain in g fo r w hich it is be ing c on st ru ct ed ;

“ (3) (A ) in t he c ase of an ap pl ic at io n fo r a g ra n t fr om fu nds ap pr op ri at ed 

p urs uant to clau se (1 ) of se ct io n 720, such appl ic at io n is fo r ai d in the 

co ns truc tion of a new sch ool of me dic ine , ost eo pa th y, or pu blic hea lth, or 

co ns truc tion which will ex pa nd th e tr ain in g ca pac ity of an ex is ting such 

school, (B ) in th e ca se o f an a pp lica tion fo r a g ra n t from fu nds app ro pri at ed 

p urs uant to cl au se (2 ) of su ch section, su ch ap plica tion is fo r ai d in the 

co ns truc tion of a new sch ool of den ti st ry or co nst ru ct io n whi ch will ex pa nd 

th e ca pa ci ty of an ex is ting sch ool of den tist ry , or (C ) in th e ca se of an 

ap pl ic at io n fo r a g ra n t from fu nds ap pro pri ate d p u rs u an t to cl au se (3) 

of such secti on , su ch ap pl ic at io n is fo r ai d in const ru ct io n which will 

repl ac e or re habil it ate fa ci li ti es of an ex is ting sch oo l of me dic ine , denti st ry , 

os teop athy , or pu blic hea lth which are so ob solete as to re quir e th e sch ool 

to curt ail su bst anti all y eit her it s en ro llm en t or th e quali ty of th e tr ain in g 

pro vid ed;

“ (4 ) th e pl an s an d sp ec ifi ca tio ns a re in ac co rd an ce w ith re gul at io ns re la ting to mi nimum st andard s of co ns truc tion and equip m en t;

“ (5 ) th e ap pl ic atio n co nta in s or is su pp or te d by adeq uat e as su ra nce th a t 

an y la bo re r or mec ha nic em ploy ed by an y contr acto r or su bco nt ra ct ors in 

th e pe rfor m an ce of w or k on th e co ns truc tion of th e fa cil it y (A ) will be 

pai d wa ges a t ra te s not less th an thos e pr ev ai ling on si m il ar co ns truc tion in 

th e loca lit y as de te rm in ed by th e Sec re ta ry of Lab or in ac co rd an ce w ith 

th e Da vis -B acon Act, as am en de d (40 U.S.C. 27 6a -2 76 a5 ), an d (B ) wi ll 

rec eive co mpe ns ation a t a ra te no t les s th an one an d on e-ha lf tim es his 

ba sic ra te of pa y fo r all hour s worke d in an y workw ee k in excess of eigh t 

ho ur s in an y w or kd ay or fo rt y ho ur s in th e workw ee k. The Sec re ta ry of 

Lab or sh al l ha ve , w ith re sp ec t to th e la bor st an d ard s spe cified in th is 

par ag ra ph , th e au th o ri ty an d fu nc tion s se t fo rt h in Reo rg an iz at io n Pla n 

Num bered 14 of 1950 (15 F. R. 3176; 64 S ta t. 1267), an d section 2 of the 

Ac t o f J un e 13,193 4, as a m en de d (40 U.S.C. 276 c) ; an d

“ (6 ) if th e ap plica tion re ques ts ai d in co nst ru ct io n of a fa ci lity which 

is a ho sp ital or di ag no stic or tr eatm en t ce nt er , as defin ed in section 631, an 

ap pl ic atio n w ith re sp ec t th ere to ha s been file d unde r ti tl e VI an d ha s been 

de nied th er eu nder be ca us e (A ) th e pro je ct has no or ins uff icient pr io rity , 

or (B ) fu nd s are not av ai la ble fo r th e pro je ct from th e S ta te ’s al lo tm en ts 

unde r t itle VI.

Befor e ap pr ov in g or dis ap pr ov in g an ap pl ic at io n under th is par t, th e Surge on 

Gen er al sh al l se cu re th e ad vi ce of th e N at io na l Adv iso ry Co uncil on Edu ca tio n 

fo r H ea lth Pro fe ss io ns es ta blish ed by se ction 725 (h ere in aft er in th is p art re ­

fe rr ed to as th e ‘Co un cil ’).

“ (d ) In co ns id er ing appl ic at io ns fo r gra nts , th e Co un cil an d th e Su rgeon 

Gen eral sh al l ta ke in to a cc ou nt—

“ (1 ) (A ) in th e ca se of a pr oje ct fo r a ne w sch ool or fo r ex pa ns io n of 

th e fa ci lities of an ex is ting sch ool, th e re la ti ve effecti ve ne ss of th e prop osed 

fa ci lities in ex pa nd in g th e ca pa ci ty fo r th e tr ain in g o f firs t-ye ar st uden ts of 

me dic ine , den tist ry , or os te op at hy (o r, in th e ca se of a tw o-ye ar school 

wh ich is ex pa nd in g to a fo ur -y ea r school, ex pa nd in g th e ca pa ci ty fo r four - 

yea r tr ain in g of st udents in th e field) , or fo r th e tr ain in g of pr of es sion al 

pu blic he al th p erso nn el, an d in prom oting an eq ui ta bl e ge og ra ph ical dis tr ib utio n of op po rtun itie s fo r su ch tr ain in g (g iv ing du e co ns id er at io n to po pu la-
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 5

tion, available physicians, dentists, or professional public health personnel, 

and available resources in various areas of the Nation for training such 

persons) ; or

“ (B) in the case of a project for replacement or rehabilitation of existing 

facilities of a school, the relative need for such replacement or rehabilitation 

to prevent curtailment of the school’s enrollment or deterioration of the 

quality of the training provided by the school, and the relative size of any 

such curtailment and its effect on the geographical distribution of opportunities for training (giving consideration to the factors mentioned above in 

paragraph (1)) ; and

“ (2) in the case of an applicant in a State which has in existence a State 

planning agency, or which participates in a regional or other interstate 

planning agency, described in section 728, the relationship of the application to the construction or training program which is being developed by 

such agency with respect to such State and, if such agency has reviewed 

such application, any comment thereon submitted by such agency.

“amount of gra nt; payments

“Sec. 722. (a) The amount of any grant under this part shall be that recommended by the Council or such lesser amount as the Surgeon General determines 

to be appropriate; except that (1) in the case of a g rant for a project fo r a new 

school, and in the case of a grant for new facilities for an existing school in cases 

where such facilities are of particula r importance in providing a major expansion of training capacity, as determined in accordance with regulations, such 

amount may not exceed 66% per centum of the necessary cost of construction, 

as determined by the Surgeon General, of such project; and (2) in the case of 

any other grant, such amount may not exceed 50 per centum of the necessary 

cost of construction, as so determined, of the project with respect to which the 

grant is made.

“ (b) Upon approval of any application for a grant under this part, the 

Surgeon General shall reserve, from any appropriation available therefor, the 

amount of such grant as determined under subsection (a) ; the amount so reserved may be paid in advance or by way of reimbursement, and in such installments consistent with construction progress, as the Surgeon General may 

determine. The Surgeon General’s reservation of any amount under this section 

may be amended by him, either ui>on approval of an amendment of the application or upon revision of the estimated cost of construction of the facility.

“ (c) In determining the amount of any grant under this part, there shall be 

excluded from the cost of construction an amount equal to the sum of (1) the 

amount of any other Federal grant which the applicant has obtained, or is 

assured of obtaining, with respect to the construction which is to be financed 

in part by grants authorized under this part, and (2) the amount of any nonFederal funds required to be expended as a condition of such other Federal 

grant.

“recapture of payments

“Sec. 723. If, within ten years afte r completion of any construction for which 

funds have been paid under this par t—

“(a) the applicant or other owner of the facility shall cease to be a 

public or nonprofit school, or

“ (b) the facility shall cease to be used for the teaching purposes for 

which it was constructed (unless the Surgeon General determines, in accordance with regulations, tha t there is good cause for releasing the applicant or other owner from the obligation to do so),

the United States shall be entitled to recover from the applicant or other owner 

of the facility the amount bearing the same ratio to the then value (as determined by agreement of the parties or by action brought in the United States 

district court for the district in which such facility is situated) of the facility, 

as the amount of the Federal participation bore to the cost of construction of 

such facility.

“definit ions

“Sec. 724. As used in this part—

“(1) The terms ‘construction’ and ‘cost of construction’ include (A) the construction of new buildings, the expansion of existing buildings, and remodeling, 

replacement, renovation, major repair (to the extent permitted by regulations),
6 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

or altern ation of existing buildings, including arc hitects’ fees, but not including 

the cost of acquisition of land or off-site improvements, and (B) initial equipment of new buildings and of the expanded, remodeled, repaired, renovated, or 

alte red p art of existing building s;

“ (2) The term ‘nonprofit school’ means a school owned and operated by one 

or more corporations or associations no part of the net earn ings of which inures, 

or many lawfully inure, to the benefit of any private shareholder or ind ivi dual; 

and

“ (3) The terms ‘school of medicine’, ‘school of denti str y’, ‘school of osteopa thy’, and ‘school of public hea lth’ mean a school which provides training 

leading, respectively, to a degree of doctor of medicine, a degree of doctor of 

dentistry or an equivalent degree, a degree of doctor of osteopathy, and a 

graduate degree in public health.

“nat ion al advisory cou ncil on education for he al th pro fessions

‘‘Sec. 725. (a) There is hereby established in the Public Hea lth Service a 

National Advisory Council on E ducation for Health Professions, consisting of the 

Surgeon General of the Public Health Service, who shall be Chairman, and the 

Commissioner of Education, both of whom shall be ex officio members, and twelve 

members apixfinted by the Secretary without regard to the civil service laws. 

Fou r of the appointed members shall be selected from the general public and 

eight shall be selected from among leading autho rities in the fields of higher 

education, at least four of whom are particularly concerned with training in 

medicine, dentistry, osteopathy, or the public health professions. In selecting 

persons for appointment to the Council, consideration sha ll be given to such 

facto rs, among others, as (1) experience in the planning, constructing, financing, 

or adm inistration of schools of medicine, dentistry, or osteopathy, or schools of 

public health, and (2) fam ilia rity with the need for teaching facilitie s in all 

are as of the Nation.

“ (b) The Council shall advise and assist the Surgeon General in the pre paration of general regulations and with respect to policy ma tters arising in the 

adm inistration of this pa rt and pa rt C, and in the review of applications thereunder.

“ (c) The Surgeon General is authorized to use the services of any member or 

members of the Council in connection with ma tte rs rela ted to the administration 

of this part, for such periods, in addition to conference periods, as he may 

determine. The Surgeon General shall, in addition, make appropriate provision 

for consultation between and coordination of the work of the Council and the 

National Advisory Council on Hea lth Research Facilities with respect to matter s 

bearing on the purposes and adm inistration of thi s pa rt and part C.

“ (d) Appointed members of the Council, while atte nding conferences or meetings of the Council or while otherwise serving at the request of the Surgeon 

General, shall be entitled to receive compensation at a rate to be fixed by the 

Secretary but not exceeding $50 per diem, including trave l time, and while away 

from their homes or reg ular places of business they may be allowed trav el 

expenses, including per diem in lieu of subsistence, a s authorized by law (5 U.S.C. 

73b-2) for persons in the Government service employed intermittently.

“nonin terfe rence w it h ad minis tration of in st it uti on s

“Sec. 726. Nothing contained in this part shall be construed as authorizing any 

departm ent, agency, officer, or employee of the United States to exercise any 

direction, supervision, or control over, or impose any requ irem ent or condition 

with respect to, the personnel, curriculum, methods of instruction, or administration of any institution.

“regula tions

“Sec. 727. (a) The Surgeon General, after consultation with the Council and 

with the approval of the Secretary, shall presc ribe general regulations for this 

pa rt covering the eligibility of institutions, the order of prio rity in approving 

application, the term s and conditions for approving applications, determination s 

of the amounts of grants, and minimum standard s of construction and equipment 

for various types of institutions.

“ (b) The Surgeon General is authorized to make, with the approval of the 

Secretary, such other regulations as he finds necessary to carry out th e provisions 

of th is part.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 7

“T EC HN IC AL a ss is ta n ce

“S ec. 728. In carry ing out the purposes of this part, and to fu rth er the development of State, or joint or coordinated regional or other intersta te, plan ning or 

programs for relieving shortages of training capacity in the fields of medicine, 

den tistry, osteopathy, and public health, through constructing teaching facilities, 

providing adequate financial supp ort for schools, or otherwise, the Surgeon 

General is auth orized to provide techn ical assistance and consultative services 

to Sta te or interst ate planning agencies estab lished for any of such purposes.

“pl an ni ng grants for medical, osteopathic, dental, or pro fes sio na l public

HE AL TH EDUCATION PROGRAMS

“Sec. 729. There is hereby authorized to be appropriated for each fiscal year 

in the period beginning July 1, 1901, and ending Jun e 30, 1971, the sum of 

$500,000 to enable the Surgeon General to make gra nts to regional, interstate , 

State, or local public or priv ate nonprofit agencies and organizations and to any 

public or private nonprofit inst itution for planning and determ ining th e need for 

teaching facilities for, or otherwise planning a new, expanded, or improved 

program of, tra ini ng physicians, professional public hea lth personnel, or dentists.

“P art C— Sch ol ar sh ip Grants to Schools of Med icine, Osteo pa th y, or

Den tis tr y

“sc ho la rs hi p grants

“Sec. 740. (a) The Surgeon General shall make grants to each public or other 

nonprofit school of medicine, osteopathy, or dentistry (as defined in section 724), 

which is accre dited as provided in section 72 1(b)(2), for scholarships to be 

awarded ann ually by such school to studen ts thereof.

“ (b) The amount of the grant under subsection (a) to each such school shall 

be equal to $1,500 multiplied by (1) for the fiscal year ending June 30, 1962, 

one-fourth of the number of first-year studen ts of such school; (2) for the fiscal 

yea r ending Jun e 30, 1963, one-fourth of the number of first-yea r studen ts and 

second-year stud ents of such school; (3) for the fiscal ye ar ending Jun e 30, 1964, 

one-fourth of the number of first-year students, second-year stud ents, and thirdyear studen ts of such school; and (4) for each fiscal year the rea fter, one-fourth 

of the number of students of such school.

“ (c) (1) Scholarships may be awarded by schools from grants under subsection 

(a) only to individuals who have been accepted by them for enrollment as fulltime first-year stud ents in the case of awards from gra nts und er subsection (a) 

for the fiscal year ending Jun e 30, 1962; only to indiv iduals who have been so 

accepted and individuals enrolled and in good stand ing as full-time second-year 

studen ts in the case of such awards from such gra nts for the fiscal yea r ending 

Jun e 30, 1963; and only to individuals so accepted or enrolled and individuals 

enrolled and in good standing as full-time third-year studen ts in the case of 

such awards from such gra nts for the fiscal yea r ending June 30, 1964; and 

the reafter only to individuals who have been so accepted and individuals who 

are enrolled as full-time students in the school.

“ (2) Scholarships awarded from grants under subsection (a) for any school 

yea r shall be awarded to tale nted stud ents on the basis of need for financial 

assistance in pursuing a course of study at the school for such year. Any such 

scho larsh ip awarded for a school year shall cover such portion of the stu dent’s 

tuition, fees, books, equipment, and living expenses at the school making the 

award, but not to exceed $2,000 for any year, as such school may determin e the 

studen t needs for such year on the basis of his requirem ents and financial 

resources.

“ (d) The Surgeon General shall also make cost of education paym ents to 

schools which receive gran ts under subsection (a). Such payments to any school 

for a year shall be equal to $1,000 for each of its studen ts who is awa rded a 

scho larsh ip from a gra nt under subsection (a) for such year, but not in excess 

of the number of students determ ined for such school for such year und er clause 

(1) , (2), (3) , or (4), as the case may be, of subsection (b).

“ (e) Gra nts under subsection (a) and payments under subsection (d) shall 

be made in accordance with regu lations prescribed after consultation with the 

National Advisory Council on Educatio n for the Hea lth Professions (established by section 725). Such regulations shall include provisions relatin g to
8 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

determina tion, for purposes of grants or paym ents for a fiscal year, of the 

number of students enrolled in a partic ula r year-class on the basis of estimates, 

or on the basis of the number in such year-class in an ear lier year, or on such 

other basis as he deems appropriate for making such determination, and including methods of making such dete rmin ation when a year-class was not in 

existence in an earlie r yea r at a school.

“ (f) Grants under subsection (a) and paym ents u nde r subsection (d) may be 

paid in advance or by way of reimbursement, and at such inte rvals as the 

Surgeon General may find nec essary ; and with appro priate adju stments on 

account of overpayments or underpaym ents previously made.”

EX TE NS IO N AN D EX PA N SI ON OF RE SE ARC H F A C IL IT IE S GR AN TS

Sec. 3. (a) Effective with respect to appropriations for fiscal years beginning 

after Jun e 30, 1962, section 704 of the Public Health Service Act is amended by 

striking out “$30,000,000” and inserting in lieu thereof “$50,000,000”. Such 

section is furth er amended by striking out “five succeeding fiscal yea rs” and 

inserting in lieu thereof “eight succeeding fiscal yea rs” .

(b) Section 705(a) of such Acts is amended by striking out “Jun e 30, 1961” 

and inserting in lieu thereof “June 30, 1964”.

(c) Section 706(a) of such Act is amended by striking out or in the case 

of a multipurpose facility ,” and inserting in lieu thereof “in the case of a 

facility which the Surgeon General determines is to be used for research, or 

resea rch and purposes rela ted thereto (including researc h tra ini ng), in the 

sciences rela ted to health or, in the case of any other multipurpose facility ,”.

(d) Sections 704 and 705(c) (2) of such Act are each amended by inserting 

“, or research and rela ted purposes,” after “resear ch” , wherever it appe ars 

therein. Section 705(e) of such Act is amended by insertin g “, or resea rch and 

rela ted purposes,” after “research” the first time it appears therein and ins erting “or related purposes” after “research ” the second time it appe ars therein. 

Section 707(b) of such Act is amended by inserting “, or resea rch and related 

purposes,” after “research purposes”. Section 706(a) of such Act is amended 

by striking out “facility for research” and inserting in lieu thereof “facility for 

research, or resea rch and rela ted purposes,”. Section 708 of such Act is 

amended by inse rting “or rela ted purposes” after “res earch”.

(e) Section 705(c) of such Act is furth er amended by striking out “and” at 

the end of para graph (2), by striking out the period at th e end of p aragraph (3) 

and inserting in lieu thereof and”, and by adding aft er paragraph (3) the 

following new p ar ag ra ph :

“ (4) the application contains or is supported by adequate assurance that 

any laborer or mechanic employed by any con trac tor or subcontractor in the 

performance of work on the construction of the facility (A) will be paid 

wages at rates not less than those prevailing on sim ilar construction in the 

locality as determined by the Secretary of Labor in accordance with the 

Davis-Bacon Act, as amended (40 U.S.C. 276a-276a5), and (B) will receive 

compensation at a rate no t less than one and one-half times his basic rate of 

pay for all hours worked in any workweek in excess of eight hours in any 

workday or for ty hours in the workweek. The Secretary of Labor shall 

have, with respect to the labor standard s specified in this paragraph, the 

authority and functions set forth in Reorganization Plan Numbered 14 

of 1950 (15 F.R. 3176; 64 S tat. 1267), and section 2 of the Act of Jun e 13, 

1934, as amended (40 U.S.C. 276c).”

(f) Pa rt A of tit le VII of such Act is furth er amended by inserting after section 

710 the following new sections :

“ TECHNIC AL A SSIS TA N C E

“Sec. 711. The Surgeon General is auth orized to provide assistance to applicants under this part, and other public or nonprofit institu tions engaging or competent to engage in research, or research and rela ted purposes, in the sciences 

rela ted to health, in designing and planning the construction of facilities for 

the conduct of such research or research tra ining.

“construction of regional fac ilit ies

“Sec. 712. When the Surgeon General finds, in accordance with regulations, 

that the purposes of this part can best be achieved through the construction
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 9

of research, or research and related purposes, facilities of particular value or 

significance for the Nation or a region thereof, and tha t because of the cost of 

such facilities or their use as a national or regional resource for research 

or related purposes a grant pursuant to the preceding provisions of this part 

does not provide an effective or appropriate means of financing the construction 

of such facilities, he may construct or make arrangements for constructing, 

through contracts for paying (including advance or installment payments) 

part or all of the cost of construction or otherwise, facilities for the conduct of 

research, or for research and related purposes, in the sciences related to health. 

The Surgeon General may, where he deems such action appropriate, make 

arrangements, by contract or otherwise, for the operation of such facilities (for 

the conduct of such research, or research and related purposes) or may make contributions toward the cost of such operation of facilities of this nature whether 

or not constructed pursuant to, or with aid provided under, this section. Title to 

any facility constructed under this section may be transferred by the Surgeon 

General on behalf of the United States to any public or nonprofit private institution competent to engage in the tyi>e of research, or research and related purposes, for which the facility was constructed. Such transfer shall be made 

subject to the condition that the facility will be operated for the research, or 

research and related purposes, for which it was constructed and to such other 

conditions as the Surgeon General deems necessary to carry out the objectives 

of this part and to protect the interests of the United States.”

(g) The parenthetical phrase in the first sentence of section 433 (a) of such Act 

which reads “(including grants-in-aid for drawing plans, erection of buildings, 

and acquisition of land therefor)” is repealed.

Department of H ealth, E ducation, and Welfare,

Washington, January 23, 1962.

Hon. Oren H arris,

Chairman, Committee on Inter state and Foreign Commerce, House of Representatives, Washington, D.C.

Dear Mr. Chair man : This is in reply to your request of March 16, 1961, for a 

report on II.R. 4999, a bill to increase the opportunities for training of physicians, dentists, and professional public health personnel, and for other purposes.

The bill was prepared by this Department and carries out the President’s 

recommendations for aid to education for the health professions and for extension of research facilities, set forth in his health message of February 9, 1961.

The bill provides for: (1) grants for construction, renovation, and planning 

of medical, dental, osteopathic, and public health teaching facilities; (2) grants 

to medical, osteopathic, and dental scholos for student scholarships, together 

with grants to schools participating in the scholarship program to assist in 

meeting the costs of instruction of these students; and (3) extension and 

strengthening of the research facilities construction grant program.

Enclosed for your reference is a copy of our letter transmitting the proposed 

bill to the President, which summarizes the principal provisions of the bill.

Because of the lapse of time since its introduction, the bill will require technical amendments of the various provisions in which specific dates are mentioned.

In addition, you will note that section 3 of the bill contains several provisions 

which were enacted in whole, or part, last October as part of the Community 

Health Services and Facilities Act of 1961 (Public Law 87-395). Appropriate 

adjustments will, therefore, need to be made in the provisions of tha t section. 

In response to your specific request of J anuary 9, 1962, we are submitting with 

our testimony on II.R. 4999 a revision of section 3 which incorporates the technical changes necessary to bring our proposal up to date.

We, of course, strongly endorse the bill and urge its immediate passage. 

Sincerely yours,

Abraham Ribico ff,

Secretary.

S00 14— 62
10 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Comptroller Genera l of th e United States,

Washington, January 26, 1962.

Hou. Oren Harr is,

Chairman, Committee on Inter sta te and Foreign Commerce, House of Representatives.

Dear Mr. Cha irm an : Your lette r of January 9, 1962, acknowledged Jan uary 

11, requests our comments on H.R. 4999.

This bill, which is ide ntical w ith H.R. 8774, H.R. 8833, and S. 1072 of the same 

Congress, would provide grants-in-aid for construction of medical, dental, osteopathic and public health teach ing facilities, as well as scho larsh ip grants to 

schools of medicine, den tistry and osteopathy to be awarded by such schools 

to the stud ents thereof. We have no special information as to the need for or 

desirability of the proposed legislation and, consequently, we have no recommendations to make on its merits. We do, however, have some comments which 

we offer for consideration of your committee.

The bill would provide additional gra nt programs to be administered by the 

Public Health Service. No provision is made in the bill nor in legislation applicable to other gra nt programs now authorized by the Public Health Service 

Act, as amended, to requ ire a grantee to keep adequa te cost records of the 

projects or undertakings to which the Federal Government makes financial contributions, or to auth orize the Surgeon General or the Comptroller General 

to have access to the grantee’s records for purposes of audit and examination. 

In view of the increase in gra nt programs over the l as t several years, we believe 

that in order to determ ine whether gra nt fund s have been expended for the pur ­

pose f or which the gra nt was made, the grantee should be required by law to 

keep records which would fully disclose the disposition of such funds. We also 

believe that the agency as well as the General Accounting Office should be permitted to have access to the grantee’s records for the purpose of audit and 

examination. We the refo re suggest th at consideratio n be given to amending the 

bill to include such requirements w ith respect to the proposed new programs, or 

preferab ly by an amendment of the Public Health Service Act to cover all grant 

programs therein authorized. The latte r could be accomplished by the following language:

“records and audit

“ (a) Each recipient of assistance under this Act shall keep such records as 

the Surgeon General shall prescribe, including records which fully disclose the 

amount and disposition by recipient of the proceeds of such grants, the tota l cost 

of the project or underta king in connection with which such funds are given or 

used, and the amount of th at portion of the cost of the project or undertaking 

supplied by other sources, and such other records as will fac ilitate an effective 

audit.

“ (b) The Secretary of Health, Education, and Welfare and the Comptroller 

General of the United States or any of the ir duly authorized represe ntatives shall 

have access for the purpose of audit and examination to any books, documents, 

papers, and records of the recipien ts that are pertin ent to the grants received 

under this Act.”

Language similar to that suggested above is contained in H.R. 132, 87th Congress, reported by your committee August 21, 1961, and in section 25 of the Area 

Redevelopment Act, Public Law 87-27, approved May 1,1961.

Attention is invited to the provisions of section 3( a) (b) (c) (d) and (g) of the 

bill. We note that these provisions have already been enacted by sections 7 and 

8 of the Community H ealth Services and Facilities Act of 1961, Public Law 87-395, 

approved October 5,1961, in identical or almost identical form. It would appear 

that some correction o r deletion of these provisions of the bill should be made.

We have no other comments or recommendations with respect to th e bill. 

Sincerely yours,

J os ep h Campbe ll,

Comptroller General of the United States.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 1 1

Executive Office of the President,

Bureau of the Budget, 

Washington, D.C., April 7, 1961.

Hon. Oren Harris,

Chairman, Committee on Inter sta te and Foreign Commerce,

House of Representatives, Washington, D.C.

My Dear Mr. Chairman: This is in reply to your letter of March 16, 1961, 

requesting the views of the Bureau of the Budget on H-.R. 4999, a hill to increase 

the opportunities for training of physicians, dentists, and professional public 

health personnel, and for other purposes.

This bill provides a 10-year program of g ran ts for the construction of medical, 

dental, osteopathic, and public hea lth teach ing facilit ies; a program of medical, 

osteopathic, and dental scholarship gra nts to enable a larger number of qualitied 

studen ts to meet the high cost of education in these fields: and the extension and 

expansion of the health research facilities constructio n gr ant program.

The bill would carry out the recommendations contained in the Preside nt's 

health message “* * * to stimulate and assist in the establishment and expansion 

of medical and dental schools, and to help more tale nted but needy studen ts to 

enter the health professions while bolstering the qua lity of their training.” I 

am authorized to advise you th at the enactment of H.R. 4999 would be in accord 

with the program of the President.

Sincerely yours,

P hi ll ip S. Hughes,

Assistan t Director for Legislative Reference.

U.S. Department of Labor,

Office of the Secretary,

Hay 2}. 1961.

Hon. Oren Harris,

Chairman, Committee on Inte rstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Congressman Harris: This is in reply to your recent requests for the 

views of the Department of Labor concerning H.R. 4999, II.lt. 4226, and II.R. 

2414, three bills which would increase the number of doctors and dentists by 

providing Fed era l financial assistance for the construction of medical and dental 

teach ing facilities and also for scholarships for medical and dental students.

Of the three measures under consideration, we believe th at H.R. 4999 is the 

most responsive to our Nation’s increased need for well traine d medical personnel as outlined by the President in his recent special health message to the Congress. Moreover, from the stan dpo int of the par ticula r responsibilities of the 

Departm ent of Labor, we find th at only H.R. 4999 contains ad equate labo r stand ­

ards requirem ents for the construction projects contemplated under its provisions. These requirements are in accord with estab lished policy that constru ctio n work assisted by Fed eral grants of this nature should be made subject 

to proviions ensuring protection of the labor standard s of lab orers and mechanics 

employed thereon.

In view of these considerations we would refer the enactment of H.R. 4999 

rather than H.R. 4226 or H.R. 2414.

The Bureau of the Budget advises th at there is no objection to the presentation of this report from the standp oint of the administration’s prog ram and that 

enac tment of H.R. 4999 would be in accord w ith the P resident’s program.

Yours sincerely,

Arthur J. Goldberg,

Secretary of Labor.

U.S. Department of Labor,

Office ofthe Solicitor, 

Washington, Ja nua ry 10,1962.

Hon. Oren H arris,

Chairman, Committee on Intersta te ami Foreign Commerce,

House o f Representatives, Washington, D.C.

Dear Congressman Harris : Thank you for th e notice of public hearings to be 

held by the Committee on Interstate and Foreign Commerce on Janu ary 23, 24, 

25, and 26, 1962, concerning H.R. 4999, H.R. 8774, and H.R. 8833, bills cited as 

the “Hea lth Professions Educational Assistance Act.”
12 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

As you know, under date of May 24, 19(51, the Department subm itted to your 

committee a report on H.R. 4999 and other bills which would provide Federal 

financial assistance for the construction of medical and dental teaching facilities 

and scholarships for medical and dental students. We would appreciate your 

considering this report as an expression of our views on legislatio n in this area. 

Yours sincerely,

Charles D ona hue,

Solicitor o f La bor.

The Chairman. It is our privilege this morning to have as the first 

witness the Honorable Abraham Ribicoff, the Secretary of Health, 

Education, and Welfare, a former colleague of ours, I might say, in 

the House of Representatives. Many of us served with him and recall 

the pleasant association we had during his brief stay in the House of 

Representatives, which I believe was two terms, though I am not 

sure, and a former Governor of the great State of Connecticut, now 

Secretary, assuming the responsibility of this very large and highly 

important agency of our Government, of Health, Education, and 

Welfare.

Mr. Ribicoff, we are glad to welcome you back to this committee 

and we will be glad to hear your testimony on this important matter.

STATEMENT OF HON. ABRAHAM RIBICOFF, SECRETARY; ACCOMPANIED BY WILBU R J. COHEN, ASSISTANT SECRETARY; BOISFEUILLET JONES, SPECIAL ASSISTANT TO THE SECRETARY,

HEALTH AND MEDICAL AFFAIRS; AND DR. LUTH ER L. TERRY,

SURGEON GENERAL, PUBLIC HEALTH SERVICE, DEPARTMENT

OF HEALTH, EDUCATION, AND WELFARE

Secretary Ribicoff. Thank you, Mr. Chairman and members of 

the committee. I have with me at the witness table Mr. Wilbur 

Cohen, Assistant Secretary; Mr. Boisfeuillet Jones, Special Assistant 

to the Secretary on Health and Medical Affairs, and Dr. Luther Terry, 

our Surgeon General.

Mr. Chairman, the impact of the bill on which I testify today would 

be felt—in an immediate, practical way—by every man, woman, and 

child in the United States.

The bill introduced by the chairman of this committee is an urgent 

bill because it deals with an urgent health problem.

THE URGENT NEED

Let me state the problem as simply and concisely as possible. The 

Nation is facing a critical shortage of physicians, dentists, and public 

health specialists. The impact of this shortage is already being felt 

in many ways, but its full force is yet to come. Because of the 

lengthy training period for these professions, corrective measures 

must be taken immediately or we will be faced with very grave consequences within the next decade.

Numerically, the supply of physicians and dentists has been increasing steadily in recent years. In relation to the population, however, it has been declining.

The potentials of the shortage can best be summarized by a glance 

at the ratios of professional health personnel to population. Today 

the United States has about 141 physicians (doctors of medicine and
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 13

osteopathy) for every 100,000 people. A decade ago, however, the 

ratio of physicians to population was 143. This means that our 

population has increased at a faster rate than our supply of physicians. The population is expected to continue to soar, reaching 235 

million by 1975.

Unless action is taken now, the ratio of physicians to population 

will drop to 138 in 1970 and to 135 in 1975. The decline in dentist 

supply is of even longer duration and greater severity.

At the same time that the population has been expanding, the 

demand for medical services has been increasing tremendously. This 

is due in part to important changes in the composition of the population -changes tha t will become still more important in future years. 

The number of children under 15 is expected to increase by nearly 

35 percent and the number of people 65 and over by almost 40 percent. 

These are the groups which are the heaviest users of medical services.

Other facts add to the demand : the increasing complexity of modern 

medicine, the high level of public awareness of health, the mobility of 

the population.

Although we define these shortages in terms of ratios and abstractions, the problem is f ar from abstract to people who need care. 

The real meaning is that some communities, some families, have had 

to go without care or adopt heroic measures to attract doctors and 

dentists to their areas. When there is a pinch, something has to 

give. Who is to determine which of the programs vital to the Nation’s 

health will have to be curtailed? There is no way of stretching an 

inadequate total number to meet all the demands tha t are made on 

professional health manpower today, and the even heavier demands 

of tomorrow.

The essential factors contributing to this problem are: (1) The 

limited enrollment capacity of the schools; (2) The mounting costs 

of professional education, both for construction and operations; and 

(3) The dwindling supply of qualified applicants.

Even to maintain the present levels of physicians and dentists in 

relation to population—simply to keep up with population growth— 

we must in the next decade increase the admissions to medical schools 

by almost 50 percent and nearly double the admissions to dental 

schools. Admissions to medical schools must be increased from about 

8,200 today to about 12,000 in 1970, or by about 3,800. Admissions 

to dental schools must be increased from 3,600 to 6,900, or about 3,300.

A part of the need could be met by expanding the capacity of the 

92 existing schools of medicine and osteopathy and the 47 schools 

of dentistry. But it would simply be beyond their reach to provide 

the 3,800 additional training places for physicians and the 3,300 

additional training places for dentists that will be needed by 1970.

To meet this goal we will need the estimated 20 new medical schools 

and 20 new dental schools.

Let me emphasize, Mr. Chairman, tha t the conclusions regarding 

manpower shortages and training requirements are not jus t ours. 

They represent the consensus of a number of expert studies. The 

most recent was a study made in 1959 by the Surgeon General’s Consultant Group on Medical Education, headed by Mr. Fra nk Bane.

In addition to expanding school enrollments, we must assure an 

adequate number of qualified applicants for the schools. We cannot 

afford quantity at the expense of quality.
14 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

For many years there were far more qualified applicants than 

the schools could admit. There are disturbing indications today 

tha t the trend is in the other direction. Although the number of 

college graduates is going up sharply every year, the number of 

applicants for medical and dental schools is actually falling. The 

total number of medical school applicants, for example, dropped 

from 22,279 in 1950 to 15,170 in 1958. And within this group there 

has been a downward trend in the quality of applicants. Some 

schools have found it necessary to resort to active recruitment campaigns to attract promising youngsters. The recruitment problem 

will obviously become even more serious when enrollments are expanded to meet our rapidly growing needs.

The reasons for the decline in qualified applicants are not hard to 

find. Professional training is long and arduous. It is costly. And 

sources of student aid are very limited.

After finishing 4 years of college, the student must spend another 4 

years in medical or dental school, plus an additional 1 to 6 years as 

intern, resident, or fellow in a specialty. This means a total of 5 to 

10 years of graduate education before he can s tart his practice.

Although costs are high, scholarship funds for medical and dental 

students are grossly inadequate. About 1 medical student in 8, and 

about 1 dental student in 12, receives a scholarship averaging $500 a 

year. Scholarship funds for first-year students are especially limited.

It is not surprising, therefore, that 40 percent of all medical students now come from families with incomes of $10,000 or more a year. 

The same is true of students applying for admission to dental schools. 

The fact is that many students run up heavy debts before they finish 

their professional training, debts which must wait several more years 

before they can be paid.

Yet medical or dental students share very little in the fellowships 

and other graduate awards given by the Federal Government. For 

example, such agencies as the National Science Foundation, the National Institutes of Health of the Public Health Service, and the 

Office of Education are currently awarding some 10,000 science fellowships annually. These usually cover both tuition and living expenses for graduate science students. It is small wonder, then, tha t 

the Nation’s brightest college students are drawn to other scientific 

fields. They are turned away from the health professions by the exhausting requirements in time and money.

We need to draw our future supply of doctors and dentists from 

the largest possible reservoir of able young men and women, regardless of financial condition. This will require financial aid for students in all parts of the country. We are convinced that this aid 

should fake the form of scholarships rather than loans. A student 

from a low-income family would be discouraged by the prospect of 

adding a new indebtedness of $5,000 or more to the debts he has already incurred in financing his basic college education.

THE NEED FOR FEDERAL AID

Confronted with this clear evidence tha t our supply of medical 

and dental manpower is falling behind our rapidly increasing demands, we must come to grips with two tough but unavoidable questions—what has to be done, and who is going to do it ?
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 15

The answer to the first question has alr eady been p oin ted out. The 

total enrollment of ou r schools must be sh arply increased du ring the 

1960’s. A t the same tim e we must low er the financia l obstacles to 

professional edu cation which are th ro ttling our supply of qualified 

medical a nd den tal studen ts.

Th e ans wer to the second questio n is two fold. Fi rs t, all of the 

pre sen t sources of school fina ncing mu st increase th eir contr ibu tions. 

Th is means St ate leg isla ture s, alu mn i, busin ess and indu str y, foun da ­

tions and pr ivate donors, and vo luntary societies and org aniza tions. 

Second, some majo r new sources of fund s must be fou nd du ring t his 

period of ex tra ordina ry expansion. Th e plain fact is th at the present sources of fund s cannot meet all of the a dd ition al needs—or m eet 

them in tim e to fores tall a crip pl ing ma npow er shortag e in the very 

ne ar futur e.

Th e proo f of this conclusion is writ ten cle arly in the record of the 

las t 10 ye ars. In 1951 there were 86 schools of medic ine and oste opa ­

thy in the Un ite d Sta tes . Th ere com bine d annual ou tp ut was 6,600 

grad ua tes annuall y. Th roug h ex trao rd in ar y pl an ni ng an d fu nd ­

raising efforts, six new medical schools were establ ished between 

1951-61, an d a numb er of existing schools expanded th ei r enrollment substan tia lly . As a res ult, the annu al numb er of grad ua tes 

fro m the schools comb ined was increased by abo ut 1,000 above the 

1951 level.

In a dd ition , St ate agencies sh arply increased the num ber of licenses 

issued to physicia ns tra ined in other countries. In 1951, some 600 

grad ua tes of for eig n schools were newly licensed to pra ctice med icine 

in the Un ite d Sta tes. By 1959 the nu mber had risen to nearly 1,800 

per year.

But despite a 15-percent increase in Am erican grad ua tes and a 

200-percent increase in the licensing of phy sician s t rained abroa d, ou r 

ratio of physicia ns to population is low er tod ay than it was 10 years 

ago. Assum ing th at this pre sen t tre nd of enrollment exp ans ion can 

be ma int ain ed for this next 10 years, the tot al numb er of new gra duates in 1971 will lx? 8.600—more than 1,000 sho rt of the numb er 

req uir ed to keep pace with po pulat ion grow th alone.

No, Mr. Ch air ma n, we cannot get the job don e jus t by ur ging othe rs 

to redo uble th eir efforts. A majo r new source of financial str en gth 

must be add ed to existing efforts. The only source that can supp ly 

the required str en gth in time to meet the need is th e Federal Government.

I t sho uld also lie pointe d out th at the F ed eral Gov ernment its elf h as 

a direct int ere st in expand ing the s upply o f healt h manpo wer. It has 

become inc rea sin gly difficult to re cr uit and ret ain profe ssional he alt h 

specialists fo r the Arm ed Forces and th eir dep end ents, for veter ans’ 

medical care, and fo r the p rogra ms of the Public He alth Service , and 

the competition for a vailable person nel is becoming keener every year.

The question, the ref ore , is not wh eth er the Fe de ral Governm ent 

should help to meet the natio nal need. Th e key que stio ns are the se: 

Wh ere shou ld we dire ct our aid so as to ge t the most imme dia te res ult s ? 

W ha t for ms o f aid will be m ost effective in supplem entin g th e sti m ulatin g non-Federal fun ds without di srup tin g existing res ponsibilities 

in pro fessional edu cation ?
16 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

The provisions of H.R. 4999 reflect our considered judgment as to 

how these questions should be answered. They include: (1) Planning 

grants to accelerate the establishment of new and improved teaching 

facilities and programs and to focus State and community attention 

on local needs and responsibilities for the training of health personnel; (2) matching grants for the construction of new and expanded 

teaching facilities; and (3) grants to schools for scholarship aid to 

talented but needy students, with payments to schools to help meet 

the instructional costs related to these federally aided students.

We believe that this aid will provide the additional support required 

to arrest the downward trend in our manpower supply. But this aid 

alone will not do the job. Increased support from non-Federal sources 

will also be needed. These sources must supply the funds required 

to match Federal construction grants. They must meet most of the 

mounting costs of modernizing and maintaining existing teaching 

facilities. And finally, they must assume most of the additional costs 

of providing high-quality professional instruction for a greatly 

expanded enrollment.

Neither of these additional financial burdens—the Federal or the 

non-Federal—will be easy to meet. But both must, be met as the 

unavoidable cost of providing for the health needs of the Nation.

With this background summary of the problem we face and the 

action required for its solution, let me now proceed to a description 

of the key features of H.R. 4999.

GRANTS FOR T EA CH ING FA CILITIES

To provide for an immediate expansion in training capacity, H.R. 

4999 would authorize both planning grants and construction grants, 

over a 10-year period, for schools of medicine, dentistry, osteopathy, 

and public health.

Planning grants would be available to “regional, interstate, State, or 

local public or private nonprofit agencies” to help in planning and 

determining the need for teaching facilities or for improved programs 

of training professional personnel. They would thus not be limited to 

existing schools or to universities considering the establishment of a 

new professional school. The bill authorizes $500,000 annually for 

these planning grants.

The construction grants provisions, however, constitute the core 

of the training expansion proposal. To help build new schools and 

expand the enrollment capacity of existing schools, the bill would 

authorize Federal construction grants totaling $60 million annually for 

10 years. Of this total, $15 million annually would be earmarked for 

dental school facilities, and $45 million would be available for medical 

schools (including schools of osteopathy) and schools of public health. 

Any teaching facilities essential to the establishment of a new school 

or to the expansion of an existing school would be eligible for Federal 

grant assistance—including classrooms, laboratories, libraries, and 

(under special circumstances) teaching hospitals or other clinical 

teaching facilities.

The national goal is expanded enrollments. Therefore, the highest 

priority would be given to those projects that provide for the greatest 

number of students. The maximum Federal gra nt—two-thirds of the
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 17

total construction costs—could be awarded for the construction of a 

new school or for construction that will permit a m ajor expansion in 

the enrollment capacity of an existing school. The maximum for 

other projects would be 50 percent.

This differential in matching is based on the fact tha t a school 

embarking on a major expansion of enrollment is assuming a new 

budget responsibility of unusual proportions. It takes considerable 

time to obtain a large construction budget, and construction may have 

to be postponed pending the availability of matching funds. This is 

a delay the Nation can ill afford, however. In view of the 6- to 8-year 

time lag between the beginning of construction and the graduation of 

the first new or expanded class, we cannot await further postponement.

The bill also provides limited aid for schools having urgent problems of obsolescence and renovation. Without aid, something must 

suffer—either enrollment or the quality of training. The bill therefore authorizes construction gran ts for the replacement or rehabilitation of existing teaching facilities—

which are so obsolete as to require the school to curtail substantially its enrollment or the quality of training provided.

Schools of medicine, osteopathy, dentistry, and public health would 

be eligible for such grants. Over a 10-year period, annual appropria ­

tions of $15 million would be authorized for this purpose. Priority 

would be based primarily on the relative urgency of the need for corrective action, and the maximum amount of any Federal grant could 

not exceed 50 percent of the costs of construction.

MEDICAL AND DENTA L SCHO LARSHIP S

To help overcome the financial barrier to medical and dental education, H.R. 4999 authorizes a program of scholarship gran ts to schools 

of medicine, osteopathy, and dentistry. Because graduate traineeships are already authorized for students in schools of public health, 

these schools are not included in the scholarship provisions of the bill.

Federal scholarship aid would be provided throu gh grants to the 

schools for specific awards to students on the basis of their individual 

financial needs, subject only to certain statutory guidelines, such as 

the provision that no scholarship could exceed $2,000 a year.

During the first year of the program, only freshman students would 

be eligible for scholarships, with progressive eligibility for one more 

class each year. By the fou rth ye ar all classes would be covered. The 

amount of scholarship funds granted to each school would permit an 

average award of $1,500 for one-fourth of the students in each eligible 

class.

Appendix A, which is attached to this statement, amplifies this brief 

description of the scholarship provisions of the bill. It contains a 

more complete description of the scholarship grant program and tables 

indicating how the funds will be distributed among the schools.

Scholarship grants to the schools could be used only for helping students to pay for tuition, fees, books, equipment, and living costs. To 

help the schools meet their ow n costs of trainin g recipients of federally 

financed scholarships, the bill w ould also authorize the Surgeon General to make cost-of-education payments to schools receiving the 

scholarship grants. For each student aw arded such a scholarship, up
18 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

to a maximum of one-fourth of each eligible class, the school would 

receive a payment of $1,000 annually. More complete explanatory 

material on this point is also contained in appendix A.

We recognize that such payments will not completely bridge the 

gap between what the student pays and what it costs the school to train 

the student. In most instances, the net cost to the school far exceeds 

$1,000 a year. These payments will help, however, in meeting the 

rising costs of instruction.

Before completing this review of the provisions of II.R. 4999 relating to training for the health professions, let ine explain why the 

bill concentrates on the training of physicians, dentists, and public 

health specialists. These are by no means the only shortage groups. 

The national shortage of nurses, for example, is probably the greatest 

in quantitative terms.

The concentration on these three groups is based on three primary 

considerations. First, these are all key professional groups whose 

services are so basic to a broad range of health programs tha t any 

serious shortage has particular national significance. Second, the 

cost of professional training—both to the school and to the student— 

is so high that Federal assistance is clearly needed to augment other 

sources of funds. Third, careful studies have been made of the manpower and training problems in each of these categories. These 

studies not onlv document the nature and scope of the problems but 

also provide a basis for developing app ropriate remedial measures.

Physicians, dentists, and public health specialists are the only groups 

to which all three of these factors currently apply. I should add, 

however, that we are fully aware of the problems in several other 

categories and are taking steps to assess the needs. For example, the 

Surgeon General last May appointed an expert consultant group to 

review and evaluate the field of nurse training and education. We 

expect to receive the findings and recommendations of this group 

soon, and we are hopeful that they will point the way to the expansion 

and strengthening of training programs for nurses.

CONSTRUCTION GRANTS FOR RESEARCH FACILITIES

The bill as introduced also includes a series of amendments to extend and strengthen existing provisions in the Public Health Service 

Act authorizing grants to aid in the construction of health research 

facilities. The principal amendments would:

1. Extend the present construction grant provisions in title 

VII of the act for another 3 years at the current appropriation 

authorization of $50 million annually;

2. Provide new authority for direct Federal construction or 

financing of special national or regional research facilities; and

3. Repeal the authority in section 433(a) of the act for unmatched construction grants for research facilities in certain 

fields.

Before explaining the purpose of these amendments, let me acknowledge tha t certain actions taken durin g the last congressional 

session require some modifications of the original provisions of H.R. 

4999. As enacted by the Congress, Public Law 87-395 (the Community Health Services and Facilities Act) included some of the amendments originally proposed in IT.R. 4999.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 19

In recognition of this action, Mr. Chairman, you recently requested 

tha t in the course of our testimony on II.R. 4999 we point out the 

necessary revisions in the research facilities provisions of this bill. 

You also asked for our comments on certain questions arising from 

your previous consideration of these proposals. In response to this 

request, we have prepared a point-by-point reply, which you will find 

in appendix B at the end of this statement. I will not undertake at 

this time to summarize the information covered in appendix B, but I 

should like to comment on some of the key points.

The research facilities construction gra nt program has been a 

highly successful one. It is now in its sixth year. To date a total of 

872 grants have been awarded to 336 research institutions. The total 

amount of Federal funds awarded has been approximately $180 million which has stimulated construction of at least $360 million of research facilities. The result has been a substantial expansion of the 

Nation’s plant capacity for research in the sciences related to health. 

Despite the accomplishments thus far, there is a continuing need for 

new and improved research facilities to advance our fight against 

disease and disability.

The proposal before you calls for an extension of this program over 

an additional 3-year period. This does not mean that the needs for 

research facilities will be substantially met within 3 years. Rather, 

it represents our belief that, in a field characterized by ra pidly changing needs and developments, periodic appraisals of program objectives, requirements, and priorities are in the public interest. There 

is obviously a close relationship between the construction of research 

facilities—an ongoing program—and the construction of teaching 

facilities—a new responsibility. It is important tha t our next appraisal of these programs give special attention to this relationship 

on the basis of actual operating experience.

The authorization of $50 million annually will strengthen the program substantially. It will not be adequate, of course, to finance all 

the research facilities which are needed. We believe, however, that 

this is a reasonable amount in the context of the many meritorious proposals brought before the Federal Government in the health field and 

the other demands on the Federal Treasury. In our opinion, Federal assistance for the construction of medical and dental teaching 

facilities has the highest urgency in the health field now and for some 

years to come. Any competing demands must be appraised in the 

light of this No. 1 priority.

In addition to strengthening the existing research facilities construction grant program, II.R. 4999 would supplement this program 

with a new provision authorizing the Surgeon General to construct, or 

finance the construction of, certain national or regional research facilities and to enter into arrangements with public and nonprofit agencies 

for the operation of such facilities.

Under special cooperative arrangements with a “host” institution, 

Federal funds will be used for construction costs, and perhaps for 

certain operating costs, while the host institution will assume primary 

responsibility for directing and staffing the research program. Although arrangem ents of this kind will be employed only in a limited 

number of cases, it is important that such authority lie available as 

an adjunct to the construction grant program.
20 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Finally, I should like to comment on the repeal of the categorical 

construction grant provisions in section 433(a) of the Public Health 

Service Act—and on the relation question of increased Federal Matching raised in your chairman’s letter of Janu ary 9.

1. Although only limited use has been made of this categorical 

grant authorization in recent years, and the facilities aided have 

warranted substantial Federal assistance, we believe tha t the continuation of this overlapping authorization is unnecessary and unwise. Whatever provisions are made for research construction grants 

should be contained in a single authorization and administered with 

the aid of a single advisory council.

2. We believe that an unmatched construction gra nt for a facility 

to be used primarly for the conduct of the research facility of a single 

institution is unwise; the institution should assume some share of the 

construction cost.

3. While authorization to make research facility construction grants 

in excess of 50 percent might be a useful tool under certain special circumstances, the increased matching thus provided needs to be weighted against the increased Federal cost, the reduction in institutional 

involvement, and the difficulty of distinguishing among institutions 

objectively and fairly.

There matters are discussed in greater detail in appendix B.

In conclusion, Mr. Chairman, I have undertaken in this general 

statement to cover only the major objectives and provisions of H.R. 

4999. Some additional information and explanatory materials are 

included in appendix A and B. We shall be pleased at this time to 

amplify any points tha t may be of particular interest or concern to 

your committee. This is a major legislative proposal to which we 

assign the highest priority. We urge its enactment at the earliest 

possible date.

Thank you, Mr. Chairman, for your courtesy and attention.

(The information referred to follows:)

Appendix A 1

SC H O LA R SH IP FU NDS

The proposed scholarship program would provide scho larsh ips as follow s:

In the first year each school would receive for thi s purpose an amount equal 

to $1,500 times one-fourth of the number of first-year students, with only firstyear students eligible for thi s scholarship aid. In the second year the school 

allotm ent would be increased to provide for one-fourth of the first- and secondyear classes, with aid available to the stud ents in these two classes. A similar 

increase would be made in the third yea r; and in the fou rth year the four 

classes would be included.

Within the school’s a llotmen t limitations, more or less than one-fourth of the 

stud ents of a class might be aided, with scholarships in varying amounts up to 

a maximum of $2,000 a yea r for any one student.

1

 Supplement to Secretary Riblcoff’s statement before Senate Committee on Labor and 

Public Welfare on H.R. 4999, Ja n. 23, 1962.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 21

The computation formulas for an individual school would be:

Year

1962

1963

1964

1965

Formula

Number of 1st y ear students X $1,500

Number of 1st and 2d y ear s tudents X $1,500

Number of 1st, 2d, and 3d year students

Number of stud ents in all 4 classes

X $1,500

X $1,500

The following table shows the number of scholarships, and the amount of 

scho larship funds, which would be available to medical, dental, and osteopathic 

schools of different sizes, in the first, second, third, and fou rth year of the 

prog ram:

Scholarship grants

T o ta l en ro llm ent

N u m b er of 

st u d en ts 

pe r cla ss

N u m b er of sc ho la rs hi ps T o ta l am o u n t

1963 1964 1965 1966 1963 1904 1965 1966

200________________ 50 13 25 38 50 $19,500 $37,500 $57,000 $75,000

300__________________ 75 19 38 56 75 28,5 00 57,0 00 84,000 112,500

400__________________ 100 25 50 75 100 37, 500 75,000 112,500 150,000

500__________________ 125 31 63 94 125 46,5 00 94,5 00 141,000 187,500

600__________________ 150 38 75 113 150 57,0 00 112,500 169,500 225,000

COST OF EDUCATION PA YM EN TS TO SCHOOLS

In addition to amounts for student scholarships the bill authorizes cost of 

education paym ents to schools which receive scholarship grants. These payments to the schools would ass ist in providing stability in operating budgets 

essential to expansion of enrollment and main tenance of high qua lity instruction. For this purpose each school would receive an amount equal to $1,060 for 

one-fourth of the first-year class (or $1,000 for each scholarship holder, whichever was smaller) in the first year, increasing by the fourth yea r to $1,000 for 

one-fourth of the 4-year enrollment (or $1,000 for each scho larship holder, whichever was smaller).

The following table shows the amounts of cost of education paym ents for 

which medical, dental, and osteopathic schools would be eligible, in the first, 

second, third, and fourth years of the p rogram :

Cost of education payments

E n ro ll m en t

N u m b er of 

stu d en ts p er 

cla ss

T o ta l am o u n t

1963 1964 1965 1966

200....................... ........... 50 $13,000 $25,0 00 $38,000 $50,000

300 ........... ........... ......... .. 75 19,00 0 38,000 56,0 00 75,0 00

400______ __________ 100 25,0 00 50,000 75,000 100,000

500........... 125 31,0 00 63,000 94, 000 125,000

600____ ____________ 150 38^000 75; 000 113,000 150,000

Proposed Health Professions Educational Assistance Act, H.R. 4999

Estimated number of scholarships and amount of money to be award ed to stu ­

dents in schools of medicine and osteopathy

Note.—The number of scholarships for the first yea r of the program was 

estimated as one-fourth of the first-year enro llment in each school in 1959-60, 

plus 5 i>ereent. The fifth year e stim ates are based on one-fourth of the expected 

4-year enrollment in each school. Experienced enrollment expansion is shown a 

sep arate item at the end of the table. Cost estimates were based on an average 

$1,500 scholarship.
22 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

S ta te an d sc hool

1st ye ar 5t h ye ar

Sc ho larsh ip

A m ount Sc ho larship

A m ount

T o ta l............................................................... - ................... 2,3 42 $3,513 ,000 9,900 $14,850,000

Alaba ma- M ed ic al College of A la b am a.. .......................... 20 30,0 00 80 120,000

A rk an sa s: U niv er si ty of A rk an sa s Sc hool of M ed ic in e.. 23 34,500 92 138,000

Califo rn ia:

College o f M ed ic al E vangel is ts __________ _________ 27 40,500 108 162,000

U niv er si ty of Cal ifor ni a a t Los An ge les....................... 15 22,500 60 90,000

U niv er si ty of South er n C al if orn ia ................................. 18 27,000 72 108,000

St an fo rd U niv er si ty School of M ed ic in e........ ............. 18 27,0 00 72 108,000

U niv er si ty of C al ifor ni a School of M ed ic in e............. 26 39,000 104 156,000

Co lleg e of O st eo pa th ic P hysi ci ans an d S u rg eo n s.. .. 27 40,500 108 162,000

Color ad o: U n iv ers it y o f Col or ad o Sc ho ol of M ed ic in e.. 

C onnec ticu t: Yale U niv er si ty School of M ed ic in e_____

22 33,0 00 88 132,000

20 30,0 00 80 120,000

D is tr ic t of C ol um bi a:

Geo rg etow n U niv er si ty Sc ho ol o f M edic in e........ .. 29 43,5 00 116 174,000

Ge org e W as hi ngt on U niv er si ty Sc ho ol of M ed ic in e. 26 39,000 104 156,000

H ow ar d U niv er si ty Co lle ge of M edic in e........... ......... 27 40,500 108 162,000

Flo rida:

U niv er si ty o f M ia m i Sc ho ol of M edic in e.................... 21 31,5 00 84 126,000

U niv er si ty of Flo ri da College o f M ed ic in e-------------- 13 19,500 52 78,000

Geo rgia:

E m ory U niv ers it y Sc ho ol o f M ed ic in e------------------- 20 30,000 80 120,000

M ed ical College o f G eo rg ia ____________________ _ 26 39,0 00 104 156,000

Illin ois:

Chic ago M ed ic al Sch ool.____ ______ ________ _____ 19 28,500 76 114,000

N ort hw es te rn U niv er si ty M ed ic al S ch o o l. . ............ 33 49, .500 132 198,000

S tr it ch Sc ho ol of M ed ic in e________ ____ __________ 22 33,000 88 132,000

U niv er si ty of C hica go Sc ho ol of M e d ic in e .. .............. 19 28,500 76 114,000

U niv er si ty o f Illin oi s Co lle ge o f M edic in e_________

Chic ago Co lle ge o f O st eo p ath y ____________ _______

.50 75,000 200 300,000

19 28,500 76 114,000

In dia na: In d ia n a U n iv ers it y Sc ho ol o f M ed ic in e............ 46 69,000 184 276,000

Io wa:

S ta te U n iv ers it y of I ow a Co l1"ce of M ed ic in e_____ 30 45,000 120 180,000

College o f O st eo pa th ic M ed ic in e an d S urg ery ........... 21 31, 500 84 126,000

K an sa s: U niv er si ty of K an sa s Scho ol of M ed ic in e......... . 26 39,000 104 156, 000

K en tu ck y:

U niv er si ty o f Lo ui sv ille Sc hool of M ed ic in e........... 25 37,500 100 150,000

U niv er si ty of K en tu ck y Schoo l of M ed ic in e----------- 18 27,000 72 108,000

Lou isiana :

Lou is ia na S ta te U n iv ers it y Sc hool of M ed ic in e____ 32 48,000 128 192,000

Tula ne U niv er si ty Sc hool of M ed ic in e____________ 33 49,500 132 198,000

M ar yla nd:

Jo hn s H opkin s U n iv ers it y Sc hool of M ed ic in e------- 20 30,0 00 80 120,000

U niv er si ty o f M ary la n d Sc hool of M ed ic in e----------- 25 37,500 100 150,000

M as sa ch us et ts :

Bos ton U niv er si ty S choo l of M ed ic in e. __________ 18 27,000 72 108,000

H arv ard M ed ic al Sc ho ol ________ _______ ____ ___ 25) 43,500 116 174,000

T uft s U niv er si ty Sc hool of M edic in e______________ 29 43,500 116 174,000

M ichi ga n:

U niv er si ty of M ic hi gan M ed ic al Sc ho ol ___________ 49 73,500 196 294,000

W ay ne S ta te U n iv ers it y Co lle ge o f M ed ic in e--------- 32 48,000 128 192,000

M in nes ota : U niv er si ty of M in nes ota M ed ic al S ch o o l. .. 36 54,000 144 216,000

M ississip pi: U niv er si ty of M is si ss ip pi School of M ed ici ne ............ .................... ..................... ....... ................................ 20 30,000 80 120,000

M isso ur i:

U niv er si ty of M is so uri S ch oo l of M e d ic in e ............. .. 19 28,500 76 114,000

St. Lou is U niv er si ty Sc ho ol of M ed ic in e..... ............... 29 43,500 116 174,000

W as hi ng to n U n iv ers it y S ch oo l of M ed ic in e .. . . . . 22 33,000 88 132,000

K an sa s C it y College of O st eopath y a n d S u rg e ry .. .. 

K irks vi lle Co lle ge o f O st eopath y a n d S urg er y...........

27 40,500 108 162,000

26 39,000 104 156,000

N eb ra sk a:

C re ig ht on U niv ers it y Sc ho ol of M ed ic in e___ ______ 20 30,000 80 120,000

U niv er si ty of N ebra sk a Co lle ge o f M ed ic in e_______ 22 33,0 00 88 132,000

N ew H am ps hire: D a rt m o u th M ed ic al Sc ho ol _________ 6 9,000 ’ 12 18,000

N ew J er se y: Seton H al l Co lle ge of M ed ic in e__________ 21 31,5 00 84 126,000

N ew Y ork :

A lb an y M ed ic al Col le ge ___ _____ _____ _____ ____ 16 24,000 64 96,000

U niv er si ty of Bu ffalo Sc ho ol of M ed ic in e...... ......... .. 21 31,500 84 126,000

A lb er t E in st ei n College of M ed ic in e................. ........... 24 36,000 96 144,000

C olu m bia U niv er si ty College of Physi ci an s an d

8u rg eo ns ___________ _______ _________ ____ ______ 30 45,000 120 180,000

Cor ne ll U niv er si ty M ed ic al C ol le ge ............................ 21 31,500 84 126,000

New Y or k M ed ic al C ol le ge ........... ................... ............... 32 48.000 128 192,000

New Y or k U niv er si ty College of M ed ic in e________ 34 51,000 136 204,000

Sta te U niv ers it y of N ew Y ork , D o w n st atc M ed ic al

Co lle ge....................... . ..................... . ................................ 39 58,500 156 234,000

U niv er si ty of R oc hes te r Sc ho ol of M ed ic in e_______ 18 27,000 72 108,000

S ta te U niv er si tv of N ew Y ork U p st ate M ed ic al

Co lle ge............................................ ................. . ................. 21 31,500 84 126,000

1 2- ye ar schoo l.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 23

S ta te a n d sc hool

N o r th C a ro li n a :

U n iv e rs ity of N o r th C a ro li n a Sch ool of M e d i c i n e -

D u k e U n iv e rs ity S chool of M e d ic in e ..............................

B o w m a n G r a y S chool o f M e d ic in e ....................................

N o r th D a k o ta : U n iv e rs ity o f N o rth D a k o ta S ch o o l of

M e d ic in e ...............................................................................................

O hio :

U n iv e rs ity o f C in c in n a ti C olleg e o f M e d ic in e .............

W e ste rn R e se rv e U n iv e rs ity S chool of M e d ic in e .__

O hio S ta te U n iv e rs ity C oll ege of M e d ic in e ................ .

O k la h o m a : U n iv e rs ity of O k la h o m a S chool of M e d ic i n e . . . ...................................................................................................

O re g o n : U n iv e rs ity of O re g o n M e d ic a l S ch o o l__________

P e n n s y lv a n ia :

H a h n e m a n n M e d ic a l C o ll eg e_____ __________________

Je ff e rs o n M e d ic a l C o ll e g e ........................................................

T e m p le U n iv e rs ity S chool of M e d ic in e ......... .................

U n iv e rs ity o f P e n n s y lv a n ia S chool o f M e d ic in e ____

W o m a n ’s M e d ic a l C olleg e of P e n n s y lv a n ia _________

U n iv e rs ity o f P itts b u rg h 8ch o o l o f M e d ic in e _______

P h ila d e lp h ia C oll ege o f O s te o p a th y _________________

P u e r to R ic o : U n iv e rs ity of P u e r to R ic o S ch o o l o f M e d ic in e _______________ _____. . . __________ __________________

S o u th C a ro li n a : M e d ic a l C oll ege of S o u th C a r o li n a ... 

S o u th D a k o ta : S ta te U n iv e rs ity o f S o u th D a k o ta

S ch o o l o f M e d ic in e ____________________________________

T e n n e sse e :

U n iv e rs ity o f T e n n e sse e C oll ege o f M e d ic in e ______

M e h a r r y M e d ic a l C o lle g e .._________________________

V a n d e r b il t U n iv e rs ity S ch o o l of M e d ic in e ________

T ex as:

S o u th w e s te rn M e d ic a l S chool_______________________

U n iv e rs ity o f T e x a s M e d ic a l B ra n c h _______________

B a y lo r U n iv e rs ity S chool of M e d ic in e ______________

U ta h : U n iv e rs ity of U ta h C oll ege o f M e d ic in e ..................

V e rm o n t: U n iv e rs ity o f V e rm o n t C oll ege o f M e d ic in e .. 

V ir g in ia :

U n iv e rs ity o f V ir g in ia S chool o f M e d ic in e ................ ..

M e d ic a l C oll ege o f V ir g in ia ...................................................

W a sh in g to n : U n iv e rs ity o f W a sh in g to n S ch o o l of

M e d ic in e _______________________________________________

W e st V ir g in ia : W e s t V ir g in ia U n iv e rs ity S ch o o l of 

M e d ic in e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

W is co n sin :

U n iv e rs ity o f W is c o n sin M e d ic a l S c h o o l___________

M a rq u e tte U n iv e rs ity S chool of M e d ic in e ...................

U n a ll o c a te d e x p a n s i o n . .. . ................................................... ...........

1st y e a r 5 th y e a r

S c h o la rs h ip

A m o u n t S c h o la rs h ip

A m o u n t

18 $2 7,00 0 72 $1 08 ,000

19 28 ,500 76 114,00 0

14 21 ,000 56 84 ,000

11 16 ,500 '2 2 33 ,0 00

24 36 ,000 96 11 4,00 0

22 33 ,000 88 13 2,00 0

38 57 ,000 152 228, COO

26 39 ,0 00 104 156,00 0

20 20 ,000 80 12 0,00 0

28 42 ,000 112 16 8,00 0

45 67 ,500 180 27 0,00 0

35 52 ,600 140 21 0,00 0

33 49 ,500 132 198,00 0

13 19,50 0 52 78 ,000

27 40 ,500 108 16 2,0 00

21 31 ,500 84 126,0 00

13 19 ,500 52 78 ,000

20 30 ,000 80 120,00 0

11 16 ,500 '2 2 33 ,000

51 76 ,500 204 30 6,00 0

20 30 ,000 80 12 0,0 00

13 19 ,50 0 52 78 ,000

26 39 ,000 104 15 6,00 0

37 55 ,500 148 22 2,00 0

21 31 ,500 84 12 6,00 0

14 21 ,000 56 84 ,0 00

13 19 ,500 52 78 ,0 00

19 28 ,500 76 11 4,00 0

21 31 ,500 84 12 6,00 0

20 30 ,000 80 12 0,00 0

12 18 ,000 48 72 ,000

22 33 ,000 88 132,0 00

26 39 ,000 104 156,00 0

112 16 8,0 00 1,03 6 1, 55 4, 00 0

1 2 -y ear sch o o l.

Proposed Health Professions Educational Assistance Act, H.R. 4999

Estimated number of scholarships and amount of money to be awarded to 

studen ts in dental schools

Note.—The number of scholarships for the first yea r of the program was 

estim ated as one-fourth of the first-year enrollment in each school in 1959-GO, 

plus 5 percent. The fifth year e stim ates a re based on one-fourth of the expected 

4 yea r enrollment in each school. Expected enrollment expansion is shown as 

a sep arate item at the end of the table. Cost estimates were based on an average 

$1,500 scholarship.
24 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

State an d school

1st y ear 5th y ea r

Scholarships

Am ou nt Scholarshi ps

Amou nt

To ta l---------------- ------------------------ ------------- ----- 1,000 $1,500,000 4,100 $6,150,000

Ala bam a: Unive rsity of Alaba ma.......... ............................. 14 21,000 56 84,000

California:

College of Ph ysicians an d Surge ons......................... .. 15 22,500 60 90,000

Unive rsity of C ali for nia ____________________ ____ 18 27,000 72 108,000

Unive rsity of S ou thern C al ifo rn ia ., . . ---------------- 27 40,500 108 162,000

College of Medic al Ev an ge lis ts........ ........................ 15 22,500 60 90,000

Distric t of Colum bia :

George town Uni ve rsity ............... .......... ....................... 22 33,000 88 132,000

Ho wa rd U ni ve rsity ------- ------------- ------------------- 20 30,000 80 120,000

Geo rgia: Em ory Unive rsity ----------- ------------------------- 21 31,500 84 126,000

Illin ois:

Loy ola U nive rsity , Ch ica go____________________ 25 37,500 100 150,000

Northwestern Uni ve rsity .............................................. 18 27,000 72 108,000

Unive rsity of Illino is------- ------ -------------------------- 23 34,500 92 138,000

Indian a: Indian a U ni ve rsity ............................................... 23 34,500 92 138,000

Iowa: State Un iversit y of Io w a .___________ _____ ___ 14 21,000 56 St . 000

Ken tuck y: Unive rsity of Lo uisville-------------------------- 16 24,000 61 96,000

Lou isiana: Loyola Unive rsity , New Or lean s................... 14 21,000 56 84,000

M arylan d: Unive rsity of M ar yl an d-------------------------- 25 37,500 100 150,000

Mass achuset ts:

Ha rva rd Uni ve rsity -------------------- --------------------- 3 4, .500 12 18,000

Tu fts Unive rsity ................ ............... ............................ 25 37, 500 100 150,000

Michi gan :

Unive rsity of D et ro it------------ ------- ------------------ 20 30,000 80 120,000

Unive rsity of M ichi ga n------- ------ ---------------------- 19 28, 500 76 1D,000

Minn eso ta: Unive rsity of M in ne so ta ........... ................... 26 39,000 104 156,000

Missouri:

St. Lou is Uni ve rsity ......................................... ............ 8 12,000 32 48,000

Unive rsity of Kansa s C it y --------------------------------- 29 43, .500 116 174, 000

Wash ing ton Uni ve rsity ------------------------------------- 12 18, 000 48 72,000

Neb ras ka:

Creig hto n Uni ve rsity ---------------------------------- ----- 12 18, 000 48 72,000

Un iversit y of N eb ra sk a.......... . ..................................... 9 13,500 36 54,000

New Jersey:

Fairleigh Dickins on U niv ers ity.................. ................ 12 18,000 48 72,000

Seton Hall Uni ve rsity --------- ----------------------------- 9 13,500 36 54,000

New York:

Co lum bia U ni ve rsity ..................... ................................ 10 15,000 40 60,000

New York U niv ers ity...------ ------------ ----------------- 42 63,000 168 252,000

Un iversit y of B uff alo _____________ _____________ 17 25,500 68 102,000

Nor th Carolina: Unive rsity of N or th Ca ro lin a........ ....... 13 19, 500 52 78,000

Ohio:

Ohio State U ni ve rs ity ................................................... 38 57,000 152 228,000

Western Res erve U ni ve rs ity ........................................ 16 24,000 64 96,000

Oregon: Un ive rsity of O reg on_______ _____ _____ _ 20 30,000 80 120,000

Pe nnsylva nia:

Temple Unive rsity ----- ------ ---------- -------------------- 32 48,000 128 192,000

Un iversit y of Pe nn sy lv an ia ---------- ------ -------------- 33 49,500 132 198,000

Unive rsity of Pit ts bur gh _______________________ 24 36,000 96 144,000

Pu erto Rico: Unive rsity of Pu erto R ic o .. ..................... . 7 10,500 28 42,000

Tennessee:

M eh arry Medic al Col lege .------- ------------------------- 10 15,000 40 60,000

Un iversit y of Tenness ee......... . ...................................... 27 40, 500 108 162,000

Texa s:

Bay lor Uni ve rsity ...................................... .......... .......... 22 33,000 88 132,000

Un iversit y of Te xa s____________ _______ ________ 25 37,500 100 150,000

Virgini a: Medical College of Vi rgi nia................................ 20 30,000 80 120,000

Wash ington: Unive rsity of W ashing ton-------- ------ ----- 17 25,500 68 102,000

West Virg inia: We st Virgin ia U ni ve rs ity ------ ------------ 7 10,500 28 42,000

Wisconsin: M arqu ette U niv ers ity.................................... 29 43,500 116 174,000

Unallocated ex pa ns io n. ------------ ----------------------------- 97 145,530 488 732,000

App end ix B 1

On Jan uary 9, 1962, the chairman of the House Interstate and Foreign Commerce Committee directed to the Secretary of Hea lth, Education, and Welfare a 

letter containing a series of five questions relating to th at portion of II.R. 4999 

which amends title VII of the Public Hea lth Service Act covering the health 

research facilities construction program. The following statement provides 

inform ation in reply to these questions supplementary to the comment thereon 

contained in the Secretary’s formal testimony.

1

 S upple m ent to S e c re ta ry R ib ic nff 's s ta te m e n t befo re th e H ouse C om m itte e on In te r s ta te 

an d F o re ig n C om m er ce on H .R . 49 99 , J a n . 23 , 19 62 .
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSON NEL 25

For purposes of clarity, the questions raised by the committee are set forth 

in full, followed by the departmental comment thereon :

Question 1. What revisions in the language of that portion of H.R. 4999 

dealing with the construction of health research facilities are necessary as 

a consequence of the enactment of Public Law 87-395?

To reflect passage of Public Law 87-395 the following changes in the current 

language of H.R. 4999 would be required :

1. 3(a ) : Strike out the first sentence increasing the appropriation authorization to $50,000,000. In the second sentence change the words ‘five 

succeeding fiscal years” to “six succeeding fiscal years” and the words 

“eight succeeding fiscal years” to read “nine succeeding fiscal years”.

2. Section 3(b) : Change the date “June 30, 1961” to read “June 30, 1962” 

and the date “June 30,1964” to read “Jun e 30,1965”.

3. Section 3 (c), (d), and (g) : Strike out these sections in their entirety.

4. Section 3 (e) and (f) : These sections remain unchanged.

Marked copies of the bill reflecting these changes are available for the use 

of the committee staff. Final dates for acceptances of grant applications and 

termination of the program have been revised to reflect the lapse of time since 

the bill was drafted.

Question 2. In the light of the continuing growth of medical research does 

the level of annual appropriations of $50 million contained in Public Law 

87-395 provide adequately for the construction of health research and 

research training facilities in this country?

The $50 million annual appropriation authorization for Federal construction 

grants as now in effect for this program through the enactment of Public Law 

87-395 will permit the initiation of a minimum of $100 million worth of health 

research facility construction each year. Over the 4-year period in which this 

authorization would be effective under the proposed terms of H.R. 4999, the 

minimum volume of research facility construction would total $400 million. 

This Department believes tha t these levels of construction would provide for a 

reasonable balance among Federal programs for the support of research and 

research training in the health sciences and the proposed program of construction for medical and dental teaching facilities.

This $50 million level of authorization would not, on the other hand, build all 

the health research facilities which this country may need or could use to advantage. While there are no definite measures of these needs, a recent survey 

among currently eligible institutions which were asked to project their needs 

for fiscal years 1963, 1964, and 1965 indicated tha t they would expect to request 

almost $425 million in Federal funds for their research construction at 50 percent matching. At this level of need, upward of $100 million in Federal funds 

per annum would be required. However, few if any Federal construction aid 

programs contemplate that all desirable construction will or should be assisted 

by Federal funds. Furthermore, Federal action in this area must be viewed in 

the context of related Federal programs as well as overall national needs and 

budgetary considerations. Over the past several years, substantial Federal 

support has been provided for health research programs, including $180 million 

in matching grants for research construction. Pending the enactment of H.R. 

4999, there is at present no means by which the Federal Government can act to 

meet this Nation’s desperate need for enlarging the output of physicians and 

dentists. It is this latter need which must at this time be given the highest 

priority.

For these reasons, this Department believes the current $50 million authorization for the health research facility construction program is an appropriate 

level of Federal support in this area.

Question 3. Does the present requirement of 50 percent matching in the 

construction of health research facilities permit the achievement of the 

objectives of this program or would some form of flexible matching ratios 

be preferable in order to recognize regional and institutional differences in 

research construction needs and financial ability to match Federal funds? 

The matching requirement of the present health research facilities construction program permits flexibility within the 50-percent maximum imp'sed by 

the law. The major problem which is presented by such flexibility is the difficulty of devising adequate and objective guidelines and conditions governing its 

application in specific eases. The heart of this difficulty lies in determining 

the relative ability of institutions to provide a matching share of the cost of the 

•construction involved.

80 01 4— 62 ----- 3
26 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

The diverse chara cter and sponsorship of the ins titu tions partici pating in 

thi s program is a large part of this problem. Many institu tions are public and 

tax sup ported; others are private and dependent upon the ir own resources 

and private giving. Public institu tions sometimes obtain matching funds from 

alumni and other private sources, and private ins titu tions sometimes receive 

supp ort from public funds. Few institution s have the full amount of matching 

money in hand, or in reserves, at the time of application. The amount which 

they can make available is rela ted to the ir general financial condition, the 

skill and effort directed toward raising money from private sources, and the 

rela tive urgencies of the several needs confronting tlie institution. Under 

these circumstances, it becomes extremely difficult to assess with objectivity 

an institu tion’s “ability” to match Federal funds. As a consequence, the 50- 

percent maximum has been allowed in the majority of awards for construction 

under the current program.

Although considerable effort has been expended by the staff of this Dep artment in exploring the feas ibility for a formula, based on objective measures, for 

determ ining an appropriate Fed eral share in any particular project, it has not 

yet been possible to develop a formula which can encompass the diverse considerations which should be taken into account in the research facilitie s program. In the face of our inab ility thus fa r to develop such an objective formula, 

this Department does not recommend modification in the present matching requirements of the statute.

We would, of course, be glad to share with the committee the results of our 

explorations. In general, we have reached the following conclusions with 

respect to any new approach to matching on these projec ts:

(a) Percentage of Federal participation.— Some limit on Fed eral participation is essenti al; the concept that there must be a sub stantial institution al 

involvement in any institu tional construction project financed with the aid of 

a Federal grant should he m aintained.

(&) Criteria for special matching.— In order to be eligible for special matching, projects should be requ ired to meet rigorous criteria, such as—

(1) Facilities required to initiate, accelerate, or expand research in 

partic ula r research fields deemed in the n atio nal intere st to require unusual 

or extraordin ary s up po rt;

(2) Facilities which place an unusual financial burden or risk on the 

sponsoring institution s because of the high cost of their specialized design 

or equipment or changing concepts or approaches in the field which make 

them p articularly susceptible to obsolescence; and

(3) Facilities which will provide for the development of research potentia l of a given institu tion which could not be expected to develop withou t 

such support.

Departm enta l staff is prep ared to discuss the fu rth er resolution of such 

crite ria with committee staff.

Question 4. If provision is made for flexible matching, are there any 

needs in the area of resea rch facility construction which would require the 

continued retention of a nonmatching program—as provided in section 

433(a) of the Public Health Service Act?

If the authority for Federal financing up to the full cost of the construction 

of regional and national facilities contained in section 3( f) of H.R. 4990 is 

enacted, this Departm ent believes that there is no need for the nonmatching 

construction authority provided in section 433(a) of the Public Hea lth Service 

Act.

As a ma tter of policy, thi s Department believes th at Federal assistance in 

the construction of research facilities to meet the needs of institution s and 

organizations engaged in hea lth research should ordinarily be provided in the 

form of matching grants. This is believed to be sound as a general rule because 

matching provides a basis upon which both the Feder al and institution al 

in such construction can be joined to mutual adv antage without modification 

of normal institu tional responsibilities. This require ment of matching funds 

serve s to stim ulate fund -raising efforts on the pa rt of others—with the result 

th at the total sums available for construction capital are increased. It also 

encourages prud ent economy in the development of construction plans and 

specifications.

The construction of resea rch facilitie s for the most part arises from needs 

and priorities as perceived by ins titu tions; as such they reflect the cha racter 

and extent of the ir research inte rests and when completed become an integral 

pa rt of the institutional plant. Federal partici pation in the cost of such con-
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 27

struction derives from the national interest in expanding the Nation’s resources 

for health research.

There are some kinds of research facilities, however, for which it is believed 

special Federal financing policies and arrangements are warranted because 

the need for, and use of, the facilities extend well beyond the interests of any 

single institution. An example is those facilities which, because of their 

specialized character and high costs, can best be utilized on a national or 

regional basis, subserving the interests of many institutions and investigators. 

Insuch cases, the requirement of institutional matching funds may well be 

prohibitive from the standpoint of the institution best qualified to operate a 

particular facility. Yet from the Federal standpoint these are the very kinds 

of facilities tha t can contribute most to expansion of the Nation’s research 

potential. In view of this, the Department believes it is important to provide 

flexible authority for the Federal Government to enter into arrangements 

whereby Federal funds may be used to pay all or most of the construction 

and equipment costs of such facilities, and in some cases for a major share 

of their operating costs. The proposed addition of section 712 to the Public 

Health Service Act as provided for in section 3(b) of H.R. 4999 is specifically 

intended to provide the requisite flexible authority to meet these needs.

Question 5. What is the need for the construction of medical libraries, 

and can this need be met adequately under the provisions contained in 

87-395 which authorizes the construction of facilities for “research and 

related purposes” ?

Three out of four medical libraries in the country today have outgrown their 

physical facilities. In 1957 88 percent of the medical school libraries stated 

tha t their space needs were cru cial; 31 percent of them required new buildings.

These needs have cumulated over the past 30 years for several reasons. First, 

it is the nature of libraries to increase in size. Historically, medical libraries, 

similar to all research libraries, have tended to double in size every 15 years, 

The enormous increases in scientific publication have accelerated this growth 

rate.

Second, medical libraries generally serve three medical needs, each of which 

has sharply increased in the past 15 years. Libraries are necessary to the 

advancement of research knowledge; they are an indispensable adjunct of 

medical teaching; and they meet the working needs of health practitioners. 

The same facilities, the same personnel, and the same books and journals are 

used to advance all three objectives.

Third, perhaps as a consequence of serving not one, but three purposes, medical 

libraries have not been able to focus attention on their needs for support. 

During a period of general expansion, they have had low priority. The share 

of the university dollar devoted to libraries has actually declined from 4.8 

cents to 3.1 cents over the last ten years.

Under the provisions of Public Law 87-395 plus those proposed in H.R. 4999, 

construction assistance would be available from two sources depending upon 

the purpose to be served by the library. Medical libraries whose services 

would be directed toward “research and related purj)oses” would qualify for 

construction assistance under the health research facilities construction program 

as amended by Public Law 87-395. Where new or expanded medical libraries 

are needed to permit expansion of medical and dental school enrollments (or 

where replacement or rehabilitation of library facilities so obsolete as to require the school to curtail substantially either its enrollment or the quality of 

training provided are needed), aid for construction could be obtained through the 

provisions of II.R. 4999 authorizing grants for medical and dental teaching 

facilities.

Although these two authorizations will not meet all needs for medical libraries 

this Department believes they will be of material assistance.

The Chairman. I observed the various appendixes attached to your 

statement, Mr. Secretary, and other information, which will be included in the record to go along with your statement.

You mentioned something about the number of medical and dental 

schools in the Nation. Did you include with this information the 

names of all medical, and dental, and osteopathic schools in the 

country ?
28 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Secretary Ribicoff. Yes, I have, sir. They are included in appendix A. You will find them beginning on the fourth page. We 

have listed by State all the medical schools in the Nation, and the 

impact of the scholarship program on them, and also the dental schools 

follow that, and the schools of osteopathy.

The Chairman. Those not only include the State institutions, but 

pri vate nonprofit medical schools as well ?

Secretary Ribicoff. Tha t is right. All medical schools that come 

within the definition of private and State and community. They are 

all listed here.

The Chairman. They will be entitled to consideration under this 

proposal ?

Secretary Ribicoff. That is correct, Mr. Chairman.

The Chairman. Mr. Williams, any questions?

Mr. Williams. Mr. Secretary, one thing that concerns me greatly 

about this kind of legislation is the constitutional authority of Congress to spend public funds for these purposes. In the light of article 

X of the Constitution, I would like to get an expression from you 

as to where in the Constitution the Federal Government is granted 

authority to spend money for this purpose ?

Secretary Ribicoff. I would say, Mr. Williams, tha t the general 

welfare clause of the Constitution provides the basic authority for 

Congress to expend funds for this particular purpose. The general 

welfare clause has always been a clause hedged about with different 

interpretations. Going back to it historically, you find tha t when it 

was first advanced, Alexander Hamilton was the advocate of the 

broad interpretation of this clause and Thomas Jefferson was the man 

who was for a narrow interpretation of the general welfare clause. 

When Jefferson became President and wanted to acquire the Louisiana Territory, and the question was raised, sir, that you raise now, 

tha t there was no authority in the Constitution for the United States 

to acquire this te rritory, Thomas Jefferson then, I think, changed his 

mind about the general welfare clause and, I believe, asked Congress 

not to be petty or picayune because the general welfare clause gave 

him the authority to acquire this territory. I think all of us feel 

tha t it w’as a pretty good deal.

Ever since t hat time I think that the great wisdom of the d rafters 

of our Constitution in leaving the general welfare clause as broad as 

it is has given us the flexibility as a Nation over these many decades 

to appraise the changing times and the different national needs. As 

long as a need is general, as against local or specific, to take care of a 

basic need to advance the general welfare of our people, I believe w’e 

have the authority, sir. There is no question in my mind tha t the 

general welfare clause of the Constitution has given us the authority 

for this measure and has given us the authority tha t has allowed our 

Nation to advance in the decades that it has.

Mr. Williams. I don’t want to argue the point. I did want to 

get an expression from you as to where you felt the Federal authority 

was delegated in the Constitution for this purpose. Can you reconcile 

that position in the light of article X ? The 10th amendment, I 

presume, it is still in the Constitution. I don’t know. I sometimes 

wonder.

Secretary Ribicoff. The 10th amendment reserving the rights of 

the States ?
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 29

Mr. Williams. Yes.

Secretary Ribicoff. I see no conflict here at all with the 10th 

amendment reserving the rights of the States, because year in and 

year out Congress has recognized that there are general national needs 

and there is no interference at all with what the States will do. There 

is nothing to prevent the States from entering into these fields and the 

States continue in these fields by building these medical schools. I 

think we are not interfering with the States. No State needs to 

apply for these funds and no State needs to have scholarship programs. The bill specifically provides tha t in no way will there 

be an interference by the Federal Government in the administration, 

or the curriculum, or the running of these medical or dental schools. 

What we are actually doing here is coming in and helping the States 

supply the basic national need for health personnel which is so essential for the future of our Nation.

Mr. Williams. Does that also apply to the administrative requirements of the several States ?

Secretary Ribicoff. As far as we are concerned, there is nothing 

in this bill which tells a State who they should admit, and when they 

should admit, and how they should admit. You will note tha t this 

bill specifically gives the grants to each medical school. The medical 

school then distributes the scholarship itself.

The Federal Government does not set up the standards. Each 

medical school will be allocated scholarships equivalent to one-quarter 

of the entering class multiplied by $1,500. The school then determines who will get the scholarship, and the amount of the scholarship. No scholarship may exceed $2,000. So here we have complete 

autonomy in each medical school, whether it be a State medical or 

dental school or private medical or dental school.

Mr. Williams. You missed the point of my question entirely.

Secretary Ribicoff. I am sorry.

Mr. Williams. If a school is set up by a State to educate redheaded 

people, how would this be administered? For instance, would the 

State’s right to educate only redheaded people be recognized in this 

instance ?

Secretary Ribicoff. All I would say is t hat I am sure tha t somebody in th at State would take the case to the Supreme Court and have 

it declared unconstitutional.

Air. Williams. I am speaking from an administrative standpoint. 

I am not talking about what the courts might do.

Secretary Ribicoff. It is very difficult to characterize an answer 

to this question because I respect you so.

Mr. Williams. I mean, how would you plan to administer the bill ?

Secretary Ribicoff. I know what I would like to say to that question, but I respect you too much.

Mr. Williams. I will pass, Mr. Chairman.

The Chairman. Mr. Spring er ?

Mr. Springer. At the present time I presume, Air. Secretary, tha t 

you have had correspondence with various medical schools over the 

country expressing an interest in this bill ?

Secretary Ribicoff. Aly understanding is th at the medical schools 

almost unanimously are in favor of this. Beginning last year, I met 

with a committee of deans representing the medical schools of this
30 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

co un try who believe th at this is absolut ely essential if they are going 

to be able to continu e th eir efforts to bu ild up th ei r res erv oir of 

doc tors and also to at tr ac t the br ight er yo ung men. Th ey pointed 

ou t a sta tistic th at I have here , th at may be very inter estin g along 

th is line, on wh at has been h ap pe ning to the qua lity o f men an d women 

who en ter medical schools.

In 1950-51, 40 p erc ent o f the stu de nts en terin g medical school ha d 

A averages . In 1960 to 1961, th at drop pe d to 13 pe rcen t; in oth er 

words, from 40 to 13 percen t. In 1950 you ha d 43 percen t with B 

averages. Today , 1960 to 1961, i t is 71 perce nt. In other words, 10 

years ago we were at tr ac ting our br ight es t peo ple to the field of 

medicine. That h as ha d a f an tasti c n osed ive, as these sta tistics show.

Th e deans of the medical schools, an d I believe th at the y will be 

here to te stify, and the rep res entative s of t he de ans o f m edic al schools, 

feel t hat they hav e pr ac tic ally exh austed th ei r su pp ly of pr ivate and 

insti tutio na l fund s to expand th eir fac ilities . Th e costs of med ical 

edu cation keep ris ing so astron omically th at they are all deeply concerned fo r the fu tu re of med icine and de ntistry in th is cou ntry.

I t is my fee ling th at as thes e heari ngs develop you will find pr ac ­

tic al un anim ity a mong med ical a nd denta l school ad minist rativ e pe rsonn el throug ho ut th is Na tion, north , south , east, and west, of the 

basic need fo r th is bill if they a re to continue t o do thei r job.

Mr. Springer. May I ju st develop th is a mi nute ?

Secre tary R ibicoff. Yes.

Mr. Springer. I s it yo ur t ho ug ht and those in the med ical schools 

th at by this additio na l ap prop ria tio n you will inc rease or imp rove 

the qu ali ty of the people who are a pp lying to get into the schools ?

Se cre tar y Ribicoff. Yes, definitely.

Mr. Springer. Do you ha ve any proof of that ?

Secre tar y Ribtcoff. Th e proof is in th is respect. We tak e the 

figu res of 1950 and we tak e the figures of 1960 an d 1961. W ha t has 

ha ppened in th e las t 10 ye ars is something like th is. Th e br ig ht yo ung 

men who liked science and were attra cted to med icine and dentist ry 

find over the l ast 10 years that more and more schola rsh ips and f ello wships have been availab le, as the testim ony has ind icated , in the o the r 

scientific fields, in phy sics, and mathe matics , an d biochemistry, and 

th e oth er sciences.

Th ey find th at th e len gth of stu dy is nowhere a s lo ng or as ard uous 

as th at of medicine a nd den tistry .

Mr. Springer. M igh t I in te rrup t you, Mr. Secre tar y, if I may , at 

th at po int ?

Se cre tar y R ibicoff. Yes, sir.

Mr. Springer. I s the re an ything in he re prov iding for scholarships ?

Secre tar y R ibicoff. Th is b il l; yes, sir.

Mr. Springer. Th ere is ?

Se cre tar y Ribicoff. Yes.

Mr. Springer. H ow much money ?

Secre tary Ribicoff. Ea ch medical school will st ar t off th e first year 

aft er the bill is enacted receivin g an amount which is figured by multiplying 25 percent of its en ter ing class by $1,500. Th is fun d will be 

distr ibuted by each medical school to those stu dents it selects, and 

in the amoun t that they determ ine but in no event to exceed $2,000. 

Th e program will exp and in the second ye ar to cover the first- and
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 31

second-year students; in the third year, the first, second, and third; 

and in the four th year, all four classes. Thus, after the fourth year 

25 percent of the attendance in medical and dental schools will be 

scholarship students.

Mr. Springer. How many ?

Secretary Ribicoff. Twenty-five percent.

Mr. Springer. Afte r how many years?

Secretary Ribicoff. Afte r 4 years, but the first year of the bill, it 

would go to the first-year students only.

Mr. Springer. Are we short of doctors in this country ?

Secretary Ribicoff. I would say we are short of doctors in this 

country.

Mr. Springer. Do we have any facts on tha t ?

Secretary Ribicoff. I would say all the studies tha t have been made 

have indicated a shortage of doctors, the fact that our population 

grows and our ratio of number of doctors per hundred thousand 

population keeps declining, the fact tha t the Surgeon General’s Consultant Group on Medical Education, as of 1959, has laid this out. 

If I may, I will file this report which is a complete study, with the 

committee.

Air. Springer. That is perfectly all right. Now, may I ask a question direct to the point here ? There have been no new medical schools 

in this country created since the end of World War I I ?

Secretary Ribicoff. There have been eight new medical schools 

since 1945.

Air. Springer. And you have an increase in population of how 

much ?

Secretary Ribicoff. It runs about 2i/> million a year.

Air. Springer. In other words, somewhere between 35 and 40 million people?

Secretary Ribicoff. Tha t is correct.

Air. Springer. Are you intending to increase the number of doctors 

per thousand population ?

Secretary Ribicoff. No. This bill would just keep it at what it 

is now.

Air. Springer. Isn’t that the essential point ?

Secretary Ribicoff. I would say this. If this committee wanted to 

enlarge this it would be fine. But we are struggling to keep even, sir.

Air. Springer. Air. Secretary, you were here in the Congress when 

we had this bill up before when Percy Priest was the chairman of this 

committee and the chairman of the Subcommittee on Health and 

Science, of which I was a member at that time. AATe did not have this 

bill on the floor and I won’t dwell on wdiy it didn’t get there. It was 

a problem which we could do nothing about, but there was a very important clause in there and the medical schools came forward with this 

incentive for the reason that we were short of doctors.

In the armed services, fo r example, about 2,500 to 3,000 doctors a 

year were taken. AVe even had it laid out here in graphs showing 

the need for increasing the number of doctors, not improving the 

quality. The fact is there was very little discussion o t

time, 6 years ago, the last time this bill received any se -

tion.
32 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Th e w hole emphasis by the med ical schools was th e wan t o f increasing t he nu mb er of do ctors pe r tho usand po pulat ion , and there is no thin g in this bill to th at end.

Se cretary Ribicoff. I w ould say th is: No, t he re isn’t, bu t wh at concer ns us is th at if we don’t do som ething we will have a fantas tic 

dec line to even keep even.

Mr. Springer. Fa nt as tic decline?

Se cretary R ibicoff. T hat’s righ t.

Mr. Springer. Aren’t they taki ng all of the med ical students th at 

they can at the prese nt time?

Se creta ry Ribicoff. Ar e the y taking all of the medical studen ts 

th at the y can ?

Mr. Springer. Yes, sir.

Se cre tar y Ribicoff. That is co rrect, but our po pu lat ion f or th e n ext 

decade will have a co ntin ued growth.

Mr. Springer. Do you have any gu aran tee th at they are goi ng to 

inc rease th e num ber of students a dm itted to any school th at will receive 

benefits und er this bill ?

Se cre tar y Ribicoff. Yes. I would say this. Th e con dition of this 

gra nt of two-thi rds is on the basis th at the y will have fac ilities to 

br in g in new studen ts. In o ther wo rds, the 66% will be given only to 

a new me dica l school o r f or an ex pansion of exis tin g fac ilitie s to b rin g 

in ex tra stu den ts.

Mr. Springer. Does it say so ?

Se cre tar y R ibicoff. Yes, it does.

Mr. Springer. Does the bill sa y so?

Se cre tar y Ribicoff. I t certa inly does.

Mr. Springer. Does it say how man y the y shall bring in ?

Se cre tar y Ribicoff. No, it doesn’t. That depe nds on each pa rti cu ­

la r school, bu t t he a mo unt t hat is a llocated w ill have a r ela tio nship as 

to the amount of new stu dents they can handle , sir.

Mr. Springer. Ju st let me say this. I th in k I know som ething 

about th is because Nlr. Ha yw orth, who is no lon ger in the Con gress 

on th at side of the aisle, and I travel ed over the country vis iting 

me dic al schools. We visited only a few med ical schools th at wan ted 

to increase th eir num bers . They just wa nte d more building s and 

mo re space. I t is true the y migh t improve the qu ali ty, bu t I could 

find school af te r school th at ha d no desire wh ate ver t o increase th eir 

num bers.

In the 1955 bill th e g ra nt in g o f money was pr op ortio na l, a nd my recolle ctio n is—I will sta nd cor rected—th at they go t 50 perce nt if they 

increa sed their enrollment by 5 percen t in th e first year af te r the 

gra nt was mad e and they received, it is my recollection, 75 p erc ent i f 

they agreed t o increase t he ir enro llm ent by 10 pe rce nt in the next en ­

te ri ng class o f medical school.

W ou ld the re be any reas on why you wou ld be opposed to such an 

am end me nt or sim ila r amend ment th at cou ld be worked ou t th at is 

fa ir an d reasonable upon th e question of inc rea sin g the numb er or 

mak ing your g rant s upon t he basis th at t he school increase its beginni ng enrollment in the ye ar imm ediately aft er this gr an t?

Se cretary Ribicoff. I th in k wh at you say, Nlr. Sp rin ge r, can be 

worke d out. Basically , the whole philosophy an d the ory of this 

bill is based upo n the exp ans ion o f tea ching f acilitie s to bring in new
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 33

stu dents, the am oun ts to dep end upon the incentive as to how man y 

mo re new stu dents will be brou gh t in. I would say the re th at we 

ce rta inly wou ld be willing to sit down and work ou t a for mu la with 

you on t ha t.

Mr. Springer. I th ink here is, if not the m ost im po rta nt one o f the 

two or t hree most im po rta nt th ing s, Mr. Secre tar y, th at should be inclu ded in this bill. I f we are ju st going to pas s ou t a lot of money 

based on the the ory th at we are going to increase qu ali ty alone, th at 

is n ot a sufficient in cen tive fo r me to sup po rt thi s bill.

Thi s I am read ing fro m the bill at th at time. Thi s is section 806, 

subsection (2 ):

Where a medical, dental, or public health school gives satisfa ctory assuranc e 

th at the freshman enro llment will be increased by live per centum of the 1957-58 

freshmen enrollment, the gran t may be made in an amount not to exceed sixtysix and two-thirds per centum of the cost of construction.

T hat finally was pu t in the bill ju st based upo n th at one assu mption, an d it seems to me th at th at kind of a th in g ou gh t to be pu t in 

here.

Se cretary Ribicoff. Con gressm an Sp rin ge r, the Ass ocia tion of 

Am erican Medical Colleges ha s i nforme d us th at it is th ei r consid ered 

opinion and judg men t th at should this bill pass they would be able 

to ad mit an ad ditio na l 1,700 studen ts each ye ar whi ch is abso lutely 

esse ntial if we are to do the job in Am erica, ju st to keep even.

Mr. Springer. W ha t percen tage wou ld th at roughly be, Mr. 

Se cretary ?

Se cretary R ibicoff. Ab out 20 percent.

Mr. Springer. That would be a 20 perce nt increas e? 1,700 would 

be a 20 percent increa se ?

Se cretary Ribicoff. T hat’s right. Th is would be w ha t the present 

schools would be able to inc rease it.

Mr. Springer. In other words, only about 8,500 peo ple are in the 

med ical schools at the p res ent time?

Se cre tar y Ribicoff. Ab out 7,500 g radu ates each year. More come 

in. Ab out 8,200 freshm en enter. Th ere is a ce rta in amount of at ­

tritio n fro m the en ter ing class. Stud en ts dr op ou t, bu t there are 

ab ou t 7,500 graduates .

Mr. Springer. Mr. S ecret ary , ju st one more po int a nd I am thr ough. 

You ma y no t have y et adopted any policy with reference to the distrib ut io n of fund s and I d on’t know th at I am pa rticul ar ly inte rested 

now as to how the y are dis tribu ted , bu t there is to be some kin d of a 

policy.

W he n we went ove r the country we found, fo r inst ance, th at St an ­

fo rd —I am ju st t ak in g my recollection now—ha d about 1,600 square 

fee t pe r stu dent. Thi s was ju st medical schools, no t hospita ls. A t 

Geo rgetown the y ha d 80 sq uar e feet p er p up il. T hat is a trem end ous 

discrepan cy in the am ount of space availabl e pe r stu de nt in medical 

schools. I don’t mean to say th at Geo rgetown was doing any worse 

job th an St an ford . I t pro bably was doing eve ry bit as good a job. 

Th e po int I am mak ing is, pu ttin g these sta tis tic s before you, in the 

gr an t of money do you intend to give subs tan tia lly more to those 

schools which are , say, in the condition o f G eorgetown t ha n you wo uld 

in one such as St an fo rd ? As I u nd ers tan d it, it is a question of space. 

I t is equ ipm ent too, b ut i t is s ub sta ntially a p roblem o f space in orde r 

to educ ate student s.
34 TRAINING OF PROFESSIONAL PUBLIC HE ALTH PERSONNEL

Wha t is going to be your policy with reference to grants?

Secretary Ribicoff. The Surgeon General will issue these grants 

and there will be an advisory council set up who the Surgeon General 

will consult and advise with. That is set out in the bill. Each medical 

school or dental school will come with its plans and indicate what it 

intends to build.

It is estimated that a new medical school averages about $10 million, 

and they will take a list of priorities on where the need is greatest, 

how many new students will be taken into the school, and what the 

results will be. I mean, these are all factors that the Surgeon General 

and the advisory council will consider.

It is hard to lay down a complete set of stan dards until you examine 

each application as it comes in.

Mr. Springer. I understand. I was trying to get your policy as to 

where the money was going substantially. If you have an institution 

which looks like it has substantial space to do the job, I take it tha t 

just because i t was demanding money, it would not necessarily get it. 

That is the problem which I am talking about.

Secretary Ribicoff. Of course I am not the Surgeon General or the 

advisory group, but if I were to hand it out or give the grants myself, 

I certainly would take into account th at one might have an extravagant use of space tha t they could economize on against the other 

school that probably was doing a good job under very difficult circumstances.

Mr. Springer. Just one thing furth er, and this is a difference I 

thin k between this bill—I have only read it roughly—and the 1955 

bill. Are you proposing in this bill if you make a grant, tha t you 

are going to pay 100 percent on that building ?

Secretary Ribicoff. No, no; the maximum is two-thirds for new 

students. The maximum in this bill provides a two-thirds grant for 

additional teaching facilities to bring in new students. When it comes 

to renovation or obsolescence, it is up to 50 percent.

Mr. Springer. Tha t is all, Mr. Chairman.

The Chairman. Mr. Roberts ?

Mr. Roberts. Governor, first of all, I would like to compliment you 

on your statement. I think it is full, and clear, and to the point. I 

congratulate you on your appearance here before the committee. You 

mentioned one place tha t the Surgeon General’s consultant group 

on nursing is due to make a report at a very early date. Soon, I believe you said. Could you give us any indication of when that report 

would be made ?

Secretary Ribicoff. The last indication is that they expect to be 

ready with their report in about 2 months’ time.

Mr. Roberts. As you know, we are being pressed with a lot of legislation and if there is any way th at th at report could be made available 

at an earlier date I think it would give us a much better chance to try 

to get out some legislation at this session.

Secretary Ribicoff. They have a tremendous amount of work to 

do. I w ill bring your comment to the attention of the chairman, Mr. 

Eurich, to see if it is possible to have th at report sooner, but the last 

information tha t w’e have is tha t they would expect to be ready in 

about 2 months with their report.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 35

Mr. R oberts. I certainly agree with your statement tha t there is a 

great need for additional nurses and 1 think tha t need is probably 

as great or greater than the one we are dealing with here. With referenece to Mr. Springer’s question as to the requirement—I think I 

know what he has in mind—that schools would guarantee to enlarge 

freshman classes by a certain number, I have examined that very carefully at hearings through the years and I am wondering if we might 

run into the danger of lessening the quality of the doctors we get and 

if we might not be better to take it on a matter of good faith as far 

as the schools are concerned and leave it up to them as to what they 

can do because they know better what facilities they have and the kind 

of doctors they can turn out, I think, better than if we laid down a 

hard and fast percentage requirement.

Secretary Ribicoff. I th ink you make a very strong point because I 

think it would be tragic in a Held such as medicine and dentistry to 

just give an incentive to quantity. I think quality is most important. 

We certainly don’t want to be in the position of graduating people 

who don’t have the qualifications in such an important field as health 

to take care of patients and we are definitely interested in quality and, 

as the figures indicate, there is a decline in the higher level students.

We do want both, and I have the utmost confidence in the good 

faith of every medical school in this country, and I am sure tha t if 

they accept these grants to expand their facilities they will in their 

application indicate how many more students they will be able to 

teach and handle and that they will live up to what they are to do, 

once they build these facilities. I would not question the good fa ith 

and the bona fides of the medical schools in this country, Congressman Roberts.

Mr. Roberts. I am glad to have tha t comment. One thing I have 

been concerned about is the trend or tendency in the direction of 

specialization and the concentration of doctors in large centers of 

population. I am wondering if you might not consider the fact th at 

we should, instead of an outright grant, follow the precedent laid 

down in the National Defense Education Act, the Hill-Elliott bill, 

and make part of this money available on a loan basis.

It may be all right to make grants to those who have given assurance that they were going into the armed services, or in some other 

governmental activity, but i t would seem to me that a young man who 

prizes his chance to enter the profession of the healing arts should be 

willing to pay that money back.

I think we could very well make it an interest-free loan until he 

reaches a point where he can get his equipment and get started, but 

it seems to me tha t we might get people who would sustain themselves 

if we allowed them to pay this money back. I would like to see some 

consideration of th at point.

Secretary Ribicoff. I think, Congressman Roberts, that the point 

you make is one of the best arguments for the scholarship gra nt instead of the loan, for this reason: There may be many men who go 

into these fields who would like to go into a poor community, a rural 

community, in the Armed Forces, or in the Public Health Service, 

but if they have to borrow and are deeply in debt and the ir compensation is much lower in the rural, poorer sections of our country, o r in 

the Public Health Service, or in the armed services, the inclination
36 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

under those circumstances would be for them to go where they could 

make much more money. Thus, one of the reasons we have advocated 

the scholarship grant program, instead of the loan program, is to 

make sure tha t these people who go into the poorer paying parts of 

the medical profession would be encouraged to do so and not have 

hanging over their heads a heavy burden.

Mr. Roberts. I say tha t in those instances where they want to go 

into medical teaching, or they want to go into the Public Health Service, or give some assurance th at they will spend so many years in the 

armed services, or in the Veterans’ Administration, or in other places 

that we know are not well paid when you consider what a private 

practitioner makes, I could see making a grant. But it would seem 

to me if he is going into the private practice of medicine that he is 

a mighty good risk.

I am not as a fraid of debt as a lot of people because most of everythin g I have, and tha t is not much, I owe for it or am paying on it, 

so I don’t share the great fear of debt that is expressed in your statement, and I would like to see a proposition, say, along this line: 

loans which would be forgiven in proportion to the number of years 

spent in general practice in ru ral areas or in small communities or in 

teaching.

Let me say this, I have had this experience in my district: For 

several years we have tried to get a doctor in one of my county seat 

towns, now about, I suppose, 2,500 people. We had one doctor there 

and the people built him a clinic. They even gave him a cattle farm 

to start out with. We have had a p retty hard time keeping doctors 

in the small community and this particular community tha t I am 

thinking about is about 25 or 30 miles from a hospital, and it would 

seem to me that if the Government is willing to assure a man a chance 

to practice his profession, they ought to require from him some assurance that he is willing to make restitution of these funds by going into 

a small rural community or small town. I don’t think my problem 

is just a problem in Alabama. I think it is all over. I would just 

like to have your opinion of that situation.

Secretary Rtbicoff. It would be very difficult tp write a definition of 

where this would take place. I know some towns of 2,500 population 

that are very prosperous towns where a doctor has very, very high 

compensation for his services.

I would say this: Our preference is definitely for the scholarship 

gran t. Should it be the desire of this committee to work out some 

loan provision, we would like the opportunity to sit down with the 

committee and its staff to work out a provision in such a way to make 

sure tha t we are not defeating our objective and try to accomplish 

what you seek to accomplish. One of the basic reasons for the scholarship is to make sure th at if there is an inclination for a young man 

to come back to his own hometown to practice, that he feels he will 

come back debt free and not have to pay off $11, $12, or $13,000, or 

go to the big city or prosperous area where his compensation would 

be much higher.

These are problems, b ut if there is this inclination on the committee’s part, we would hope to have the opportunity of sitting down with 

you to work this out most carefully so we could accomplish the result 

you seek to accomplish, Mr. Roberts.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 37

Mr. R oberts. I want to ask you one question, and that is : Are you 

familiar with the loan program instituted in the State of Mississippi 

where loans granted by the State for medical education were forgiven 

in return for practice in rural areas ?

Secretary Ribicoff. I am not familiar with that.

Mr. Roberts. You mentioned the fact, and I think this is one of 

your strongest arguments, tha t there is definitely a shortage in the 

medical and dental profession and that we have coming into this country several hundred doctors, usually at the interne stage. Would you 

repeat th at number ? 1 believe you said 1,800.

Secretary Ribicoff. It is very interesting, Mr. Roberts. In 1950 the 

number of graduates of medical schools outside the United States licensed for the first time was 458. In 1959 this number had gone up 

to 1,776. In other words, you had coming in from other countries 

1,776 doctors, over 3 times as many as in 1950. This is also a great 

problem. Let me say tha t many of these countries as their prosperity increases will retain their own doctors in their own countries.

This would even make our problem worse. I mean these foreign 

doctors have helped keep the average up. Wha t if there was a cutoff of these foreign doctors? This would make our problem so much 

worse in this country.

Mr. Roberts. Isn ’t it true also that we are going into many of the 

countries of the world and attem pting to build up their economies 

and doing various things for them, and yet at the same time we are 

taking from them through this medium one of the most precious 

possessions they have, and tha t is medical personnel ? We ought to 

be educating our own.

Secretary Ribicoff. Not only educating our own, it would be my 

hope that a nation like this, instead of being an importer of doctors, 

would be an exporter of doctors. Now, along this line, while the 

United States has about 7,500 medical graduates a year, Russia has 

27,000 a year. Keep in mind tha t their doctors aren’t trained as well 

as our doctors.

They don’t have the same length of training. I don’t think their 

quality can compare with ours. But in many countries, in Asia or 

Africa, for example, where there are no doctors or very few, and where 

the medicine is n ot on the same stand ard as the United States, a Russian-trained doctor is very adequate in many of these countries. What 

we are finding internationally is tha t the Russian doctors are available to go in and be very influential, because when you bring healing 

and prevent death, you are making a great impact upon people of the 

world.

When you consider that the Soviet Union turns out 27,000 doctors 

a year to our 7,500, this becomes a great problem. It is my hope that 

some day we could be an exporter of doctors instead of an importer 

of doctors.

Mr. Roberts. I would not, of course, like to reflect on any of the 

doctors coming from other countries. I know some of them are very 

well qualified. I will put the question this way: Isn ’t is true tha t 

most of the schools in other countries do not meet the high standards 

of our American medical schools?

Secretary Ribicoff. Let me put it this wa y: I don’t think there 

is any question today that our medical schools are the best in the world.
38 TRAINING OF PROFESSIONAL PUBLIC HE ALTH PERSONNEL

Th e d octors, however, it m ust be k ep t i n m ind, t hat come fro m foreign 

cou ntries must pass the St ate lice nsing r equ ireme nts, an d this would 

ind ica te th at they have been abl e to satisfy by exam ina tio n the requirem ents of the variou s State s, which are hig h. But I don’t think 

there is any question th at med icine in the United States is sup erior 

medicine.

Mr. Springer. Would you yield fo r one questio n ?

Mr. Roberts. Yes.

Mr. Springer. Along those lines, Mr. Secre tar y, would you tell the 

committee how many stu dents we have s tudy ing in forei gn coun tries?

Secre tary Ribicoff. I can ’t give you how m any are stu dying , except 

in 1959, 36G Ame rican grad ua tes o f medical s chools outside the U nit ed 

State s and C anada received t he ir licenses in th e Uni ted Sta tes, so th at 

mi gh t give you an ind ication. In oth er wor ds, 366 Am erican s who 

ha d s tudied abroad , in 1959, came back to the United State s, got their 

licenses, an d are pr actic ing medicine.

Mr. R oberts. That is all, Mr. Ch air ma n. Tha nk you, Mr. 

Secre tary.

Th e Chairman. Mr. Yo unger ?

Mr. Younger. Mr. Se cre tar y, I would like to ask a few questions 

which I think are re lat ed to t his bill. I have had some m ail critic izi ng 

the Congress on the grou nd s th at we did no t ap pr op riat e as much 

money this year for canc er r ese arc h as we d id in pr io r yea rs an d, upo n 

an inqu iry and looking at the ap prop ria tio ns , I find th at th at is not 

tru e. I find t hat the se ap prop ria tio ns ha ve no t been spe nt. Ca n you 

inform t he committee as to why the re has been a cu rta ilm en t in this 

field?

Se cretary Ribicoff. Th ere ha sn ’t been a cu rta ilm en t in this field. 

Th e amount th at was fin ally m ade available was mo re money than the 

App ro pr iatio ns Com mittee a nd you peop le in the Hou se voted upon. 

Th e sum th at is availa ble fo r cancer rese arch th is year is approx imately 

$25 million more th an last year.

I t h as been the desire of t he P resid en t to bal ance the budget. The 

Pr es id en t in an o rder to the vari ous de partm ents, includ ing the d ep ar tme nt over which I preside, asked for a very close scrutin y of all our 

ex penditu res and we trie d very car efu lly to scrut inize these and we 

effected a s avi ng in ou r d ep artm en t overall, of some $102 million. Bu t 

the se sav ings were very, v ery care fully gone over to make su re th at no 

basic p rogram was cur taile d o r interfered w ith. I f my memory serves 

me correctly, in the field o f cancer th ere is available still, even w ith the 

overa ll curtailm ent, $25 millio n more fo r cancer research th an the re 

was av ailabl e last year , so the re is no cur tai lm ent.

Mr. Younger. Did you cu rta il the e xp endit ures fo r the balance of 

the ye ar in cancer research ?

Se cre tar y Ribicoff. We di dn ’t increase it as much as it could have 

been increase d, bu t we di dn ’t c urtail it, sir. We have more. If you 

so desire a t this point in the r eco rd I will be pleased to give you a comple te analysis of w ha t was done with the $102 millio n cutbac k in the 

H E W new obliga tional au thor ity , Con gressm an Younger .

Mr. Younger. I wou ld appreciat e very much if th at could go into 

the record, the savings in ou r ap prop ria tio ns so fa r as H EW is concer ned of $102 million an d where th ose cutbac ks were made ou t from 

ou r a pp ropriat ion s.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PER SON NEL 39

The Chairman. If you can supply tha t information, it may be included in the record at this point.

(The information referred to above follows:)

1962 Economies

In October of last year, after Congress had finished its action on the 1962 

budget, President Kennedy i>ointed out tha t it had become necessary to review 

the budget and effect economies. The President, therefore, requested each Department and agency to examine its programs, giving particular attention to 

expanding activities, with the objective of achieving the maximum possible 

economy within the appropriations provided. In response to this request and 

afte r a careful review of the department’s programs, it was determined tha t 

approximately $102 million of the funds available in 1962 should not be used.

The application of this reduction to the 1962 appropriation was made on the 

basis of the following three considerations:

1. Due to changes in program circumstances and requirements, funds 

amounting to approximately one-third of the reduction would not be used 

irrespective of the need to effect economies.

2. No reductions were applied to any program involving the direct care 

of hospital patients, to any program of formula grants to States or communities, or to programs pertaining to defense preparedness; and

3. Reductions of $66 million were applied only to those remaining activities for which the 1962 appropriations provided an expansion over the 1961 

program level, and these reductions were made uniformly by applying the 

same iiercentage factor to every affected program.

The distribution of the reduction by appropriation is shown in the following 

table.

Department ok Health, E ducation, and Welfare

Distribution of $102,000,000 in new obliyational auth ority , fiscal year 1962

[In th ousand s of dollars]

NO A reduction

Positions Amount

Expenditure

reduction

Food and Drug Administration: Salaries and expenses. 

Office of Education:

Defense educational activities___ ______________

Savings in 1961 balance brought forward_________

Expansion of teaching in education of the deaf___

Salaries and expenses_________________________

Cooperative research_________________________

Total, Office of Edu cation ___________________

Office of Vocational Rehabilitation:

Research and tra in in g..___ __________________

Salaries an d ex pe ns es ... ______ _______________

Total, Office of Vocational Rehab ilita tion ..........

Public Health Service:

Building s and facilities_______________________

Accident preventio n................ .......................... ........

Chronic diseases and health of the ag ed_________

Communicable disease activ ities..---------------------

Comm unity health practice and research-------------

Dental services an d resources________________ _

Nursing services and resources....... . .........................

Hospital construction activ ities......... ........................

Air pollution control...................................................

Milk , food, inte rstate a nd community sa nitatio n...

Occupa tional he alth____ ______________ ______

Water s upply and w ater pollution contro l------------

BSS management fun d_______________________

Foreign q uarantine activities__________________

Nationa l Inst itu tes of Health................... . ........ .

Nationa l health statisti cs_____________________

Operations, National Library of Medicine_______

Salaries and expenses, O SO___________________

Total, P ublic H ealth Service..............................................

58

17

17

1,146

19,004 1 

798 I

337

123

352

20,614

1,052

5 40

5 1.092

10,000 

6 156

15 1,193

22 233

6

5

6

22

151

33

17

8

307

10

2

4

479

202

100

82

1,883

425

262

114

1,337

18

60,400 

147 

170 

46

76,768

1,120

309

12

120

326

767

918

39

957

500

150

1,000

220

175

95

75

1,150

400

240

90

1,170

16

33,500

140

160

44

39,125
40 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

Dist ribu tio n of $102,000,000 in neic obligational au thority , fisc al year 1962—Con. 

[In thous ands of dollars]

NO A reduction

Positions Amount

Expenditure

reduction

Social Security Administration:

Salaries and expenses, Bureau of P ublic Assistance_____

Salaries and expenses, Children’s Bureau_____________

Gra nts to States for m aternal and child welfare (research

and d emonstration projects in child welfare)_________

Cooperative research in social security______ _________

Salaries and expenses, Office of the Commissioner, (general

funds)_______ ________ . . _______________________

Total, Social Security Adm inistration_____________

Office of the Secretary:

Salaries an d expenses__________ _____________ ______

Salaries and expenses, Office of Field Adm inistration____

Surp lus property utilization____ _________ _______ _

Salaries and expenses, Office of the General Counsel........

J uvenile de linquency and youth offenses______________

Total, Office of the Secretary______________________

Other minor adjustments______________________________

96 95

36 36

75 40

75 40

34 32

18 316 243

8 69 63

5 47 43

1 11 10

1 11 10

9 1,75 4 912

24 1,892 1,0 38

4

601 101,832 43,25 0

6,5 95

16,1 55

Total, Departm ent of Health, Education, and Welfare - 

Revision in expenditure estimates:

Granls for cancer research facilities___________________

Hospital and medical research facilities_______________

ND EA stu dent loan supple mental (technical adjustment

to defer expenditures unti l stu dents enroll in sc ho ol ).. .. 

Total expenditures_____________________________ 601 101,8 32 66,0 00

Ap propriation his tor ies fro m 1961 operating level to 1962 operating plan,

Na tio nal Cancer In st itute

1961 opera tin g level_________________________________________ $105,906, 000

1962 Pr es iden t’s bud get______________________________________ 109, 292, 000

1962 Hou se allo wance_______________________________________ 125, 672, 000

1962 Senate allow anc e______________________________________ 160, (XX), 000

19(52 ap pr op ria tio n_________________________________________ 142, 836, 000

19(52 opera ting plan _________________________________________ 127, 585, 000

In crea se in 1962 operati ng p la n :

Over 1961 operati ng level_______________________________ 21,6 79,000

Ove r 1962 Hou se allow ance______________________________ 1, 913,000

Secretary Ribicoff. I will, but I do want to make a point that the 

final figure made available was still a substantial amount more than 

the House originally voted in its appropriations for this Department.

Mr. Younger. Do I understand tha t what Congress finally appropriated is not going to be spent ? Eith er you asked for too much, or a 

curtailment that you have made now from the appropriated funds 

is not warranted.

Secretary Ribicoff. We didn't ask for too much. I mean the House 

voted much more than we asked for. The Senate voted much more 

than the House voted, and then there was a conference committee report and there was a certain amount curtailed in the final result. But 

what was made available was still much more than the House voted, 

which was more than we originally felt could be effectively spent.

In other words, the question here is one of effectiveness. Money is 

important, but to me only money that is spent effectively is important, 

Congressman Younger.

Mr. Younger. What I want to do is tr y to get this out in the open 

because evidently the information given to the press and the stories
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSON NEL 41

tha t have gone out to the public are a reflection back on Congress, not 

on the administration. It is the administration that has curtailed anything pertaining to these Health Institutes, it wasn’t Congress, and 

we are gettin g the blame for it. We are getting letters all the time.

Secretary Ribicoff. I didn’t know that you were getting the blame. 

I thought I was getting it all, Congressman Younger.

Mr. Younger. We are gettin g it.

Secretary Ribicoff. But let me say this. We haven’t curtailed, but 

you are entitled to that information and I will get it over to the committee and any particular question th at you might like answered for 

your constituents we will be glad to supply to you, sir.

Mr. Younger. Thank you very much. How many doctors are we 

sending to foreign countries through the foreign-aid program ? Are 

we sending any ?

Secretary Ribicoff. Through the various programs about 120 to 

125.

Mr. Younger. Doctors th at we are supplying through the foreign 

aid to the various countries ?

Secretary Ribicoff. Tha t is right.

Mr. Younger. Supposedly undeveloped countries?

Secretary Ribicoff. That’s right.

Mr. Younger. Where do you get your figure of 27,000 doctors 

grad uating each year in Russia?

Secretary Ribicoff. This was a report made by the DeWitt committee and we would be pleased to put figures from the DeWitt report 

at this place in the record, th eir analysis of their study of what was 

happening in medicine in the Soviet Union.

(The report referred to above follows:)

(The following material is taken from DeWitt, Nicholas, “Education and 

Professional Employment in the U.S.S.R.,” National Science Foundation, U.S. 

Government Pri nting Office, Washington, D.C., 1961. 856 pages.)

“Medical-health gradua tes in the Soviet Union, consisting primarily of physicians, accounted for about 9 perc ent of tota l graduatio ns, as aga inst 6 percent 

in the United State s. It must be noted moreover, that the Soviet medical category 

excludes medical techn icians and nurses (train ed in semiprofessional schools), 

who are included in, and represe nt a sizable proportion of, U.S. medical field 

gr ad ua tes; and also that Soviet gra duates in this field include a much smaller 

proportion of pharma cists and oth er such specialists tha n is the case in the 

United State s. If medical doctors alone are considered, the U.S.S.R. had a 4 

to 1 a dv an tage : physicians accounted for 8 p ercent of all Soviet gradua tes compared to 2 perce nt in the United States.”

8 0 0 1 4 - 6 2 -
T a ble IV -51.—Structure of graduating classes in the U.S.S.R . and the United States

U.S .S.R . 1959 > “ di pl om a” gr ad ua tio ns b y field of st udy Uni te d State s, 1958 

1 b ac he lor’s a nd 1st pro fessional degree by field of s tu dy

Fi eld

Grand to ta l--------------------------------------------------------

I. En gine ering, all fields ______________________________

II . Agricultural, in clud ing agrono my an d an im al hu s­ ba nd ry , fores try , and vet er in ar y me dicine.

II I. Socioec onomic (econom ics, man ag em en t, an d juris ­ pru de nc e). IV . Ed uc ationa l-c ultural, to ta l................. ..................................

1. Unive rsity prog ram s, to ta l................... ...................

M athe matical, phy sic al, and bio log icalscien ces 2. Te acher tra ining esta bl ishm en ts_______________ M athe m at ic s an d science teache rs__________ 3. Other c ul tu ra l service fields___________________

4. Fine a rt s____________________________________ V. Hea lth fields, to ta l_________________________________

Ph ys icians onl y________________________________

En gine ering, science an d ap plied science professions (excluding sc ience tea che rs) (su m of I, II , IV -1, V).

Th ou sa nd s Pe rc en t

338.0 100.0

108.6 32.2

34.5 10.225.0 7.4

140.4 41.5

37.6 11.1

(21.0) (6.2) 91.4 27.0(40.0) (11.8)

9.0 2.7

2.4 .7

29.5 8.7

(27.0) (8.0)

191.0 56.6

Fie ld

Grand t ota l......................................................................

I. En gineeri ng, all fields (35.3) an d R O TC programs (2.0).

II . Agriculture (5.5), includ ing agron om y an d an im al 

hu sb an dr y, fores try (1.3), a nd ve te rin ar y m edicine (0.8).

II I. Bu siness an d com me rce (51.3), econom ics (7.5), an d law (9.4).

IV. Ed uc ationa l-c ultural, all fiel ds .......................................

1. Science majors: mathe matical (6.9), physica l (14.4), a nd bio logical (14.4).

2. Edu ca tio n (teacher tra in in g establish men ts an d education ma jors o nly ).

3. Hum an ities, languages, an d social sciences— En glish an d jou rnalism (19.2), foreign lan­ guage an d lit er at ur e (4.5), ge ograp hy (0.8), social sciences (except e conomics) (40.7), ps y­ chology (6.9), ph ilo sophy (3.0), re ligion (8.8), home economics (4.3), lib rary science (1.7), othe r mis cellaneous (7.3). 4. Fi ne a rts (12.3) an d arch ite ctu re (1.6)________ V. Hea lth fields, to ta l_______________________________

M .D .’s on ly ............. . ....................................................

En gineeri ng, science, an d ap plied science professions (exclu din g teachers-science m ajors) (su m of I, II , IV-1, V .).

Th ou sa nd s Pe rcen t

366.0 100.0

37.3 10.2

7.6 2.1

68.2 18.6

229.6 62.7

35.7 9.782.9 22.797.2 26.5

13.9 3.8

23.2 6.4

(6.9) 0.9 )

87.7 23.9

1 U.S. D ep ar tm en t of H ea lth , Ed uc ation, an d Welfare, Office of Ed uc ation, “ Ear ne d Sour ces: App . tabl e IV -A -l -G . Fo r di stribu tio n of un iv er si ty gr ad ua tes in sciDeg rees Co nferred by Hi gh er Edu ca tio na l In st itut io ns , 1957-58,” Circ ular No . 570, ence s, see discus sio n in text a bove.

W ashing ton, D .C ., U.S . Gov ernm en t Pr in ting Office, 1959, especia lly p p. 5-9.

42 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 43

Mr. Younger. Why I asked this is, this magic figure of 27,000 seems 

to be coming up all the time. I have heard it bandied around that 

Russia graduates 27,000 engineers, or 27,000 physicists, and th at figure 

of 27,000 creeps into the Russian propaganda all the time, whatever 

type of scientist.

Secretary Ribicoff. This isn’t taken from the Russian figures. It 

is the analysis by Americans who have studied the system over there. 

This is the only 27,000 th at I know of, in the field of medicine. As 

to the engineers, I wish it were only 27,000 in engineers and scientists, 

which is much greater than 27,000, but I think it should be kept in 

mind that many more women go into the field of medicine there than 

we have. Their training is much shorter. They don’t have as exhaustive and as full a training as we do.

I think the American system is the longest and the most disciplined 

of all medical training in the world. Yet, to trea t simple diseases 

and epidemics, and where you don’t have the same standards, the Russian system is adequate, even though it wouldn’t live up to what Americans would expect from their doctors.

Mr. Younger. Just to make the record clear, you are not advocating 

tha t the Federal Government ought to tell these youngsters what 

they should do and what they should study in college as Russia does 

their youngsters ?

Secretary Ribicoff. I have always been against that. My contention is tha t every American boy or gir l should make up his own mind 

what he wants to do, where he will live, and what profession he will 

go into. I am for supplying opportunities to American boys and girls, 

young boys and girls of ability, to make sure that we don’t lose the 

talent tha t we have. From there on, they can do what they want.

Mr. Younger. Tha t is all, Mr. Chairman.

The Chairman. With the indulgence of my Democratic colleagues, 

may I take this moment to extend a cordial welcome to our colleague, 

Mr. Komegay, of North Carolina, who has just become a member of 

this committee and who is with us this morning for the first time. Mr. 

Kornegay, we are glad to have you now to become a pa rt of this family 

and the membership of this committee. We welcome you to this tremendous responsibility tha t it has and the difficulties and many complexities tha t go with it, as well as the enjoyment and pleasure you 

will receive certainly on this committee from associating with these 

Members of Congress.

Mr. Springer. Air. Chairman, may I reciprocate for this side of the 

aisle and say we too welcome him to the committee and if he can 

stand us, we can stand him.

The Chairman. In view of tha t I know my colleagues would not 

mind if I go out of turn and give him an opportunity to ask the Secretary a question at this time. Do you have any questions you would 

like to ask of the Secretary at this time ?

Air. Kornegay. Air. Chairman, I have no questions at this time, 

but I would like to say that I am delighted to be on this committee. 

It is a fulfillment of my committee ambition since coming to Congress 

to be associated with this wonderful group.

The Chairman. Thank you. AVe are glad to have you. AVe think 

tha t you have excellent judgment in your desire to become a member 

of this committee. That is the first expression th at you will meet the 

requirements of a member of the committee. Air. Friedel?
44 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

Mr. F riedel. I want to also welcome Mr. Kornegay as a member 

of this committee. You will find out there will be many a meeting 

■when you will never be heard because by the time they get to you the 

meeting will have adjourned.

Secretary Ribicoff. I want to compliment you on your very, very 

fine statement and I want to tell you tha t there is a great deal of 

sentiment for this House bill H.R. 4999 in Baltimore and in Maryland.

I have a re port here of the State of M aryland Plan ning Commission, devoted to this bill. They are in favor of it and I would just 

like to quote one little thing they say. The fourth major recommendation on pages 1 to 9 cites the fact that “increased scholarship 

and loan funds are desperately needed.” They are in favor of this 

100 percent. We have some most outstanding doctors and laymen in 

the city of Baltimore and State of Maryland who worked on this bill 

for months. They intend to testify and they will be here tomorrow 

and Thursday, and the rest of the week if necessary.

I am in accord with this bill and I think tha t it is a very, very 

good bill. Maybe there might be a few minor amendments to take 

care of, but I think it is a step in the right direction.

Secretary Ribicoff. Thank you very much, Congressman Friedel.

Mr. F riedel. Tha t is all Mr. Chairman.

The Chairman. Mr. Collier.

Mr. Collier. Mr. Secretary, this legislation deals with medicine, 

dentistry, and osteopathy. Is there some particu lar reason why 

optometry is omitted ?

Secretary Ribicoff. Yes. We have tried to handle the three fields 

where there is the greatest shortage, the greatest national need, and 

where the surveys have been made and the factors are there, knowing 

where we stand. There are many other fields where there are problems, but we have to sta rt somewhere, sir, and I think at this time 

we are tryin g to start where the greatest problem exists.

Mr. Collier. I would conclude that there apparen tly is no shortage 

of professional help in the field of optometry.

Secretary Ribicoff. This I don’t know. Dr Terry.

Dr. Terry. We don’t know, sir.

Secretary Ribicoff. Most of our data are based on exhaustive 

surveys and studies. To my knowledge there hasn’t been one in the 

field of optometry, and I don’t have the knowledge or the facts to 

properly answer you, sir. That is why we come in the fields that had 

been surveyed and studied, and where we know that a need definitely 

exists.

Mr. Collier. What increase in enrollments could existing facilities 

in the various medical schools accommodate ?

Secretary Ribicoff. At the present time without the expansion of 

medical facilities they couldn't accommodate any more. In other 

words, my understanding is that every medical school has students to 

the upper limits of its capacity to handle.

Mr. Collier. There are none then that could handle more students 

if in fact they had the enrollees ?

Secretary Ribicoff. That is correct.

Mr. Collier. Mr. Secretary, on page 2 there is a statement I wanted 

clarified with reference to the fact tha t a greater amount, you might 

say, of medical care is given to children 1 to 15 and those people over
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 45

65. Do the statistics actually show that less medical care was rendered 

to that portion of our population from 16 years to 64 years than from 

1 to 15 and over 65 ?

Secretary Ribicoff. They don’t need it, sir. I think generally the 

need for treatment and medical care is more prevalent among children 

and the aged than those of us in the middle years, and this is the reason 

for the statistics. Dr. Terry is here, the Suregon General, and he 

could amplify tha t as a doctor.

Mr. Collier. In view of the segment of the population in those age 

categories I would be inclined to question whether or not this is a 

factual statement. From 1946 to 1950, and I have some personal 

recollection is, it became extremely difficult for young men to get into 

the medical schools, principally, as I recall, because the academic 

grades which they were required to submit from their high schools had 

to be exceedingly high. Whether or not the medical schools at the

?

resent time maintain the same yardstick for determining enrollment 

don’t know, but is it possible in your opinion tha t because of the 

almost restrictive qualifications for enrollment this may have contributed to the dropoff in the number of students who in the years 

that followed chose to enroll in the medical school ?

Secretary Ribicoff. The years you were talking about, Congressman Collier, were the years when you had applicants in the 20,000’s. 

Now your applications are in the 14,000’s. Naturally the schools with 

more applicants would pick what they considered the best students and 

the figures th at I cited you were that in the year 1950. Tha t year 40 

percent of the entering class were A students, whereas, in 1960 only 13 

percent were A students, so you do see tha t the A students are dropping 

off in the percentages that enter medical schools.

Naturally a medical school wants to get—and I thin g they are 

righ t—the best qualified students that they can to be our future doctors 

and dentists, and the number they will take and admit will depend 

upon the number of applicants and their qualifications.

Mr. Collier. To your knowledge, Air. Secretary, has there been a 

relaxation in more recent years of the basic qualifications and academic standards from high schools than there were during those years 

previously ?

Secretary Ribicoff. No; I think the same thing applies even to the 

high school and college. As you have more and more high school 

students seeking admission to college I think the colleges are doing 

the same thing. They are taking the more able students. I think it 

is the reverse that holds true because I think tha t you have to have 

better grades today in high school to get into college than you had to 

have 15 or 20 years ago, but today you can get into medical school 

with lower grades than you could 10 or 15 years ago. I mean the 

opposite is taking place.

Mr. Collier. Do you think, and I pose this strictly as a question 

for my own edification, that we might be going a b it far afield in all 

phases of higher education by placing the premium upon the A 

student and possibly sacrificing some good students who m ight have 

been B and C students in high school, but who, in fact, are talented 

and who have ability?

Secretary Ribicoff. I would say it is most interesting tha t th ere is 

a realization in the field of education today tha t college boards and
46 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

grades are not the only ind ica tor. Th ere are ma ny colleges in the 

Uni ted Sta tes who are deeply concerned wi th just wha t you are saying, the so-called lat e star ter, the young man who m ight hav e come 

fro m a hig h school where his trai ni ng wasn’t as good as in other commu nities, but who has g ood na tiv e ability and good inte lligence.

I have had a numb er of college adm issions dea ns telling me th at 

they a re m uch more selective in looking a t these stu de nts to see wh ere 

here an d there the y could g et a C stu dent w ho f or some reason or o the r 

could do be tte r work, bu t ha sn ’t, and the y have ha d very good luck 

with th eir selectivity. Th is is bein g done at some of the lea din g 

schools in the country, inc ludin g W est P oint, H ar va rd , and other un iversities where th e entra nce requirem ents ar e very s trict.

Mr. Collier. Mr. Secre tar y, addin g to yo ur own sta tem ent on pag e 

4 s tatin g the nu mb er of years th at a stud ent a nd a postme dical s tud ent 

must spend before he actua lly s tarts h is pra ctice, might I su bm it th at 

you om itte d 2 ad dit ion al years in almost every case th at these young 

men have to p ut in, in the m ilitary, which a dds to t he nu mb er of y ear s 

th at the y must wa it un til the y have any r etur n fro m th ei r p rofe ssion.

Ju st one other qu es tio n: Has any thou gh t been given in the 

ap proa ch to this problem of the cost of high er edu cation, and I say 

th is as one who has two y oungsters of my own in college, t hough cer ­

ta in ly n ot in my own behalf, to pro vide some tax incentive that would 

be to some degre e, certa inl y, an answer to parents, shall we say, who 

have incomes of less th an $10,000 a year, b ut wh o a re faced w ith sending one, two, o r t hree s tud ents to college. Maybe if we looked at th is 

pro ble m of the cost of high er edu cation th ro ug h prov idi ng a tax incentive in excess of the totally unrea listic $600 figure which ap pa rently is allowed tod ay fo r a dep end ent, we might relieve the burde n 

in th at manner.

Secre tar y Ribicoff. Th ere hav e been many bil ls to this effect in troduc ed before Congress. Of course the y are before the Ways and 

Means Com mittee and have arg um ents fo r and again st. Perso nally, 

1 am symp ath etic towa rds something, worke d ou t alo ng this field, 

som eth ing being done by way of tax ince ntiv e to encourage people 

sending th ei r youngsters to college, but the m at ter to my know ledge 

has nev er come ou t of the Way s and Means Com mittee.

Mr. Collier. Since I introd uce d such a bill I hop e th at the Secreta ry , if it e ver gets to a hearing, will offer his wh ole heaited support. 

T hat is all I have. Th an k you, Mr. Secre tary.

The C hairma n. Mr. Rhodes.

Mr. Rhodes. Th an k yo u, M r. Chairm an.

Mr. Sec retary , I too wan t to commend you fo r yo ur statem ent and 

also f or your efforts in th is field which I belie ve h ave wides pread public support . You said, Mr. Secre tary, th at Fe de ral gr an ts would not 

exceed 50 perce nt fo r t he cost o f con stru ctio n. W ou ld th is a pp ly also 

to construc tion o f res earc h f acilities?

Se cre tar y Ribicoff. W ha t I said was tw o- third s fo r new facilities. 

Th is bill provides t wo -th ird s on new f aci lities an d 50 perce nt fo r renova tio n of obsolescent existing facilities. W he re there won’t be any 

new stu dents add ed is 50 percen t, no t tw o-thi rds. Th e am ount we 

have in the bill is $15 m illion ava ilab le fo r ren ovation and $60 million 

fo r new facilities.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 47

Th e tw o- third s money is $60 millio n and th e 50 p erc ent is $15 million. Th e research fac ilitie s is 50 perce nt in the measures th at Congres s has alre ady adopted .

Air. R hodes. W ha t about the schools of public he alth which trai n 

doctors an d other skilled people fo r public he alt h service?

Se cretary Ribicoff. Th ey are not covered fo r sch ola rsh ips in this 

bill, b ut th ey a re covered in th is bill fo r c onstruct ion on th e same basis 

as med ical and den tal schools. In othe r words, a school of pub lic 

he alt h if it applies to ad mit new stu de nts would be en titled to twoth irds match ing; if fo r ren ovati on an d taki ng care of obsolescence, 

up to 50 perc ent.

Th e sch ola rsh ip pro vision isn ’t there because at th e prese nt time 

stu dents who go to public he alth schools hav e other sch ola rsh ip provisions ma de a vai lab le to them .

Mr. R hodes. Tha nk you, M r. Secre tary.

Se cretary Ribicoff. I t is th e Rhode s A ct ?

Mr. Moulder. Will the gentlema n yield ?

Mr. R hodes. Yes.

Mr. Moulder. Mr. Se creta ry, I re gr et I wa sn’t here fo r yo ur testim ony, bu t ju st one question. Ha ve you made a sta temen t of wh at 

th e med ical sch ola rsh ip cost will be un de r the pr og ram fo r th e 10- 

ye ar pe rio d ?

Se cretary Ribicoff. Yes. You will find it in appe nd ix A (see insert 

on p. 20 ), Con gressm an Mo ulder. Th e dolla rs on th e sch ola rsh ip 

would be 5,100,000 the fir st yea r.

Th e C hairman. W ha t p age is th at?

Se cretary Ribicoff. I am read ing the sta tis tic s to you th at I have 

here .

Th e C hairm an. T hat is a ll r ight .

Se cre tar y Ribicoff. Th e bre akdown is in appendix A, b ut ru nn ing 

th ro ug h the sum mary, it wou ld be $5,100,000 the first year, $10,200,000 

the second year, $15,375,000 the th ird year, $20,625,000 th e fo ur th 

year, an d the fifth year it would be $21 million. I t is a 10 ye ar au thor ization. We hav e broken it down fo r the first 5 years, an d then it 

wou ld stabilize from the re on.

Th e Chairm an. Sta bilize a t $21 m illion a ye ar fo r th e next 5 years?

Se cretary R ibicoff. Yes, sir.

Th e Chair man. Tha t would be th e max imu m cost?

Secretary7

 Ribicoff. Yes, sir. I t w ould go up a lit tle bit as you g ot 

mo re schools coming in and the y ha d more stu de nts and if they got 

25 perce nt of th eir stu dent bod y it would increase it, bu t basically 

ou r estimate is it will be $21 millio n in the fifth year, and it wou ld 

go up a lit tle b it a fter t hat d ependin g on how lar ge the schools were.

Th e Chairman. Air. Devine.

Air. Devin e. Air. Secre tary, th is 5-y ear prog ram , bas ed on th e figure s you have given, totals $72,300,000, I believe, yo ur est imate in 

the first 5 years.

Se cretary Ribicoff. No; we are no t talk in g about the scholarshi p 

pro vision. We are only ta lk in g abou t th at . If you wan t to know 

the t ot al of the entire pr og ram------

Air. Devin e. Yes.

Se cretary Ribicoff (con tin uing ). Th e firs t ye ar th e en tir e pr ogram , inclu din g grants, pl an ni ng gr an ts, an d sch ola rsh ips , would be 

$34,352,000.
48 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Mr. D evine. For what purpose?

Secretary Ribicoff. Tha t is for the entire program, construction 

grants, planning grants, and the scholarship program. It would be 

$34,352,000 the first year, $92,900,000 the second year, $101,525,000 

the third year, $110,275,000 the fourth year, and $110,900,000 the 

fifth year.

Mr. Devine. Have you totaled the entire thin g on a five-year program?

Secretary Ribicoff. The total amount for the 5 years would be 

$600,800,000.

Mr. Devine. Mr. Secretary, what new taxes or additional taxes do 

you propose be enacted on the American people to finance the 

program ?

Secretary Ribicoff. Let me say this: The President’s budget takes 

into account the cost of this for this coming year. I would assume 

as each budget is developed the figures tha t you have here will be 

folded into the budget and arrangements will be made for tax revenues and expenditures. It would be my hope tha t we would have 

a sufficient acceleration in th e growth of th is country to take care of 

our basic needs without new taxes.

Mr. Devine. You anticipate no new taxes, but you are depending 

on the same theory tha t the President does tha t our increased gross 

national product, and so forth , will provide for this without new 

taxes ?

Secretary Ribicoff. I do.

Mr. Devine. Directing your attention to the top of page 4 of your 

statement you say:

Although the number of college graduates is going up sharply every year, the 

number of applica nts for medical and dental schools is actua lly falling.

You give several reasons for that but I notice that you say nothing 

in connection with this partic ular fact, th at perhaps some of the proposed applicants to medical and dental schools are being discouraged 

from going based on the type of legislation th at is being introduced in 

the Congress and has for the last 4 or 5 years, very frankly, the fear 

tha t we are getting into perhaps socialization in the medical field and 

for tha t reason they are not interested in getting into medicine. Do 

you think there is anything to that at all ?

Secretary7

 Ribicoff. I don’t think there is anything to that at all, 

because I don’t think we are getting into socialized medicine, sir.

Mr. Devine. I am sure you don’t think we are but a lot of people 

that have been in medicine or perhaps thought they would go into 

medicine have that very real fear as expressed in many letters.

Secretary Ribicoff. I would say tha t the doctors are doing pretty 

well, and I think doctors will continue to do pretty well. I think that 

what you have is competition from the other professions where the 

cost of an education isn’t as high and the year span isn’t as high.

Mr. Devine. On this influx of so-called foreign-trained medical 

people, has there been a grea t influx from Great Britain in the last 

few years?

Secretary Ribicoff. I don’t have the breakdown of countries, but 

I would be pleased to insert it. I have the overall from all the nations, 

but I don’t have the breakdown country by country as to where they 

come from.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 49

Mr. Devine. The reason I asked is we in Congress received mail in 

the last 30 days indicating what they say is a wholesale exodus from 

England and Great Britain and coming to this country.

Secretary Ribicoff. This is new to me.

Mr. Devine. You have no figures either.

Secretary Ribicoff. We will get the breakdown of where these doctors come from for you and we will put them in the record.

Mr. Devine. I would appreciate it.

Secretary Ribicoff. We will get that to you.

(The information referred to appears on pp. 69, 70.)

Mr. Devine. Thank you. That is all, Mr. Chairman.

The Chairman. It is now almost 12 o’clock. The House will be 

in session and I am sure there will be a quorum call in a few minutes 

afte r the House is in session. We have an im portant bill scheduled for 

consideration by the House and therefore we will be unable to meet 

this afternoon. There are a number of members of the committee who 

have not had an opportunity yet to ask questions of the Secretary.

Would it be convenient for you to come back at 10 o’clock tomorrow 

morning, Mr. Secretary ?

Secretary Ribicoff. I will make it convenient, Mr. Chairman.

The Chairman. Very well. The committee will adjou rn until 10 

o’clock tomorrow morning at which time we will start with you, Mr. 

Jarm an, and Mr. Nelsen, you will follow.

(Whereupon, at 12 m., Tuesday, Jan uary 23, 1962, the committee 

adjourned, to reconvene at 10 a.m., Wednesday, Ja nua ry 24, 1962.)

TRAINING OF PHYSICIANS, DENTISTS, AND PROFESSIONAL PUBLIC HEALTH PERSONNEL

W EDN ESDA Y, JA N U A R Y 24 , 19 62

H ouse of Repr esentative s, 

Com mittee on I nterstate and F oreign C ommerce,

Washington, D.C.

The committee met at 10 a.m., pursu ant to recess, in room 1334, 

New House Office Building, Hon. Oren Harris (chairman of the 

committee) presiding.

The Chairman. The committee will come to order.

This morning we continue hearings on II.R. 4999 and related bills, 

providing for a program of training additional physicians, dentists, 

and professional public health personnel.

We appreciate having the Secretary of Health, Education, and 

Welfare back with us this morning. We realize the grea t interest 

in this proposal and, as the Secretary said yesterday, insofar as the 

President and the Department are concerned this legislation is of 

high priority.

Mr. Secretary, I think it is highly important for the committee 

to be correctly informed as to how the new medical school program 

dovetails with other Federal programs in this field. We want to be 

certain tha t there is no unnecessary overlapping or duplication. You 

mentioned yesterday tha t scholarships and fellowships are available 

under other Federal programs for science students. We would like 

you to supply for the record what the programs are and under what 

terms and conditions the scholarships are available.

I believe you have supplied this information to another great committee of the Congress. We would also like to know which of the 

agencies grant such scholarships. Are they given to the schools or 

to students, and just how are they administered ?

We would like to know whether or not there are loans available 

to students, what the forgiveness features are, if any, in connection 

with such loans, and to what extent such loans have lieen made available to medical students.

51
52 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

STATEMENT OF HON. ABRAHAM RIBICOFF, SECRETARY OF HEALTH, 

EDUCATION, AND WEL FARE; ACCOMPANIED BY WILBUR J. 

COHEN, ASSISTANT SECRETARY; BOISFEUILLET JONES, SPECIAL 

ASSISTANT TO THE SECRETARY, HEAL TH AND MEDICAL AFFAIRS ; AND DR. LUTHER L. TERRY, SURGEON GENERAL, PUBLIC 

HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND 

WELFARE—Resumed

Secretary Ribicoff. Mr. Chairman, we certainly will be able to 

supply the information you ask. We will make a compilation along 

this line and, if we may, present it in a very short time to you.

The Chairman. Yes. I knew you would not have the information 

this morning, but I wanted to get it in the record so tha t you could 

supply it for the information of the committee. I think the record 

should contain complete information in this regard, and I am sure 

other members of the committee share this feeling with me, since 

undoubtedly questions will be asked of us by the Members of Congress 

when the bill goes to the floor, or even when we go to the Rules Committee for a rule.

(The information referred to follows:)

F ederal Fellowships and Loans

GRADUATE FE LL OW SH IPS AND TR AIN EE SH IP S 1

Gra dua te fellowships and traineeship s are made available by a number of 

Fed eral agencies. Most are from fou r agencies—Office of Education, the Public 

Health Service, the Atomic Energy Commission, and the National Science Foundatio n. In general they provide stipends of between $1,800 and $2,500 a year, 

plus depen dents’ allowances, for a wide variety of fields of study, including 

medical research, but excluding study leading to the M.D. or D.D.S. degree. 

The student’s tuition usually is paid. None of the fellowship programs requ ire 

repayment.

National defense fellowships (National Defense Education Act )

The pa rt of the National Defense Act providing for federally financed graduate fellowships had two objectives: The first was to increase the supply of 

tra ine d college and univ ersity tea chers ; the second was promotion of a wider 

geographical distribution of facilities for gradua te study.

Congress specified that the Commissioner of Education should awa rd fellowships to students who had been accepted for study in pa rticular gradua te 

prog rams approved by the Office of Education at particular institutions. The 

prog rams approved were to be “new or expanded” and were to “sub stantially 

fu rthe r the objective of increasin g the facilities available in the Nation for the 

gra duate training of college and university teachers and of promoting a wider 

geographical distribu tion of such facilities thro ughout the Nation.” Moreover, 

applica nts were to be given preference if they expressed an intere st in going 

into college or university teaching.

The act provided for 1,000 fellowships the first year and 1,500 in each of the 

3 succeeding fiscal years. Since the fellowships run for 3 years, 4,500 students 

will be supported simultaneously at the height of the program. During the 

first 4 years of its operation, the gradua te fellowship program has enabled 5,500 

studen ts to pursue gra duate work in preparation for college teaching careers.

The fellows receive stipends of $2,000 for the first year; $2,200 for the second ; 

$2,400 fo r the third ye ar: plus $400 a year for each dependent. These amounts 

are supposed to be sufficient to cover living expenses; indeed, fellows are not 

permitted to hold paying jobs during the academic yea r except for limited parttime research and teac hing commitments at their institutions.

1

 Gratef ul acknowledgment Is made to the book by Alice M. Rlvlln, the “Role of the 

Federal Government In Financing Higher Education,” published by the Brookings Insti tution in 1961.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 53

In addition to the stipends paid the fellows, the act authorized the Government to compensate the institutions for the added cost of the fellows’ education, 

up to .$2,500. The cost-of-education payments to the schools have averaged 

jus t under $2,500, usually including tuition, with the average actual cost to 

the institutions running around $3,400.

Technically, the national defense fellowships are awarded to individuals 

by the Commissioner of Education, but, in practice, the Commissioner has relied on the institutions to select the fellows.

Table 1.—Distribution of national defense fellowships, by field of study, 1962

Field of stu dy N um be r Pe rcen t

T T n m an it ie s 316 21

Ed uc at io n____________________________________________________________ 144 10

Social scien ces........ ............ ............................ .............. .............. .................................. 373 25

Biologic al sci ences_____________________________________________________ 240 16

P h y s ic a l sc ie n c e s . . . . . 255 17

En gi ne ering__________________________________________________________ 172 11

T o ta l__________________________________________________________ 1,500 100

Source: U.S. Office of Ed uc ation, “ Ap prov ed Pr og rams an d Fello wsh ips.” [N ationa l Defense Ed uc ati on Act. 1959-62] J an . 15, 1962.

Public Health Service—National Institutes of Health fellowships

At present, NIH offers half a dozen different types of fellowships. Research 

fellowships are awarded to predoctoral, postdoctoral, and special students in the 

basic and clinical health sciences. These a re designed to allow the recipient to 

spend full time on research, or training for research, for the duration of the 

fellowship. Most of these fellowships are for a year, but some are for longer 

periods. The predoctoral fellowships are renewable as long as the fellow is 

making satisfactory progress toward his degree. The predoctoral fellowships 

carry stipends of $1,800, $2,000, and $2,200, plus dependency allowances and tuition, for the lirst year, the intermediate years, and the terminal year, respectively. 

The postdoctoral and special fellowships are more generous. Some “senior research fellowships” and "foreign research fellowships” are also awarded. Moreover, qualified students in medical and dental schools are encouraged to drop out 

of regular course work for a period of 1, 2, or 3 years to do scientific research on 

a “postsophomore research fellowship” from NIH. In all, over 3,000 full-time 

fellowships were awarded by NIH in fiscal year 1061.

In addition to the full-time fellowships, about 1,200 part-time fellowships were 

awarded in 1960 for student research in schools of medicine, osteopathy, dentistry, public health, and nursing. These fellowships ($600 each, plus an allowance to the institution for indirect costs) are not awarded directly to the students 

by NIH. Rather, a certain number are allocated to each qualifying institution 

which requests them, and the institution is allowed to use the funds to compensate students for time spent on research—either part time during the regular 

term or full time for 2 or 3 months. The main aim is to orient the students toward 

research while they are still in school in the hope of attracting them to research 

careers.

Table 2.—National Institu tes of Health fellowship awards, by type of fellowship,

fiscal year 1961

Awards

Full time------------------------------------------------------------------------------- 3, 051

Predoctoral___________________________________________________1,128

Postdoctoral and special________________________________________ 1, 331

Postsophomore________________________________________________ H6

Senior_______________________________________________________ 334

Foreign--------------------------------------------------------------------------------- 98

Other full time_______________________________________________ 44

Part time------------------------------------------------------------------------------- i , 154

Total-----------------------------------------------------------------------------4,205

Note.—Includes renewals.

Sou rce: National Institute s of Health, Division of Research Grants.
54 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Another type of supp ort provided by N IH is sub stantial training grants made 

to schools of medicine, dentistry, public health, and osteopathy, and to other 

univ ersity depa rtments with gra duate programs in the health and biological 

sciences. In general, these grants are used for two purposes. They pay 

operating expenses (including faculty salarie s) of special programs designed 

to tra in students for research, teaching, or clinical work rela ted to cancer, 

heart disease, mental health, and other specific hea lth are as; and they pay 

stipends (trainee ship s) to stud ents in these programs. The institutions are 

allowed to select the trainees and determine the level of stipends. These 

stipends of full-tim e trainees are generally sufficient to allow the trainee to 

devote himself to his training with out support from other sources. The amount 

varies widely from program to program. Over 11,000 trainees now receive 

full-time or part-tim e support unde r th is program.

Public Health Service—Bu reau of Sta te Services

The Public Health traineeship s program (title I) , establish ed in 1956, authorizes the Surgeon General to awa rd traineeships for gra duate or specialized 

public health training either (1) directly to individuals whose applications 

have been accepted by the public or nonprofit institu tion providing the training, 

or (2) through gra nts to such training institutions. The primary aim of the 

program is to bring new people into the field of public hea lth by providing 

pos tgradu ate training opportunities for men and women who have completed 

the ir basic professional education.

Six hundred and seven doctors, nurses, san itary engineers, and other professional workers were awarded such train eeships during the fiscal year 1961, 

most of them for 12-months’ training. The program pays studen t stipends of 

$4,800 for postdoctoral traine es ; $3,600 for post-m asters; $3,(XX) for i>ost-bache- lor; and $2,400 for pre-bachelor. An additional $360 is allowed for each legal 

dependent as well as some allowance for travel. The actual cost of tuition 

and fees is also paid in addition to th e stu den t’s stipends.

The professional nurse trainee ship program (ti tle II ), also established in 

1956, is designed to improve the quality of patient care by increasing the 

number of gradua te nurses with preparation for positions as administrators, 

sui>ervisors, and teachers in hosp itals and rela ted institution s, public health 

agencies, and schools of nursing. The program provides: (1) long-term trai nee ­

ships for full-tim e academic study in univ ersities and colleges; and (2) 

traineeship s for short-term study in intensive training courses sponsored by 

cer tain public and nonprofit institutions. All trainee ships are awarded by 

the in stitutions.

The long-term traineeships, for a maximum of 12 months, provide—

(a) Tuition and fees a s established by the school;

(b) Stipends ranging from $200 to $300 a month during the period of 

study, plus dependency and travel allowance.

Trainee ships for short-term intensive study (often for only 3 or 4 days) 

are awa rded for the study in short-term courses approved by the Division of 

Nursing of the Public Hea lth Service. Such a traineeship provides tuition 

and fees and in some cases a daily stipend. iFor the fiscal year 1960 there 

were 1,614 long-term academic trainees and 2,366 short-term intensive course 

trainees.

Atom ic Energy Commission

The Atomic Energy Commission has several specialized programs designed 

to tra in scientists in par ticula r fields closely related to atomic energy. These 

fields include reac tor technology, health physics, radiation control, and the 

special ind ustrial medicine and hygiene problems of the atomic energy industry. 

The AEC has arranged for particular universities to offer instruction to graduate studen ts in these fields, often in conjunction with on-the-job training at 

an AEC installatio n. Stipends of various sizes and allowances for dependents 

ar e provided, and AEC pays tuition or its equivalent to the universities. The 

largest program involves 150 special fellowships in nuclear science and engineering—mainly reac tor technology—offered at 48 participating institutions. 

Seventy-five fellowships are offered at six institu tions for a yea r of gradua te 

study in health physics, combined with 10 weeks of special training at an AEC 

installatio n.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 5 5

National Science Foundation fellowships

The act of Congress establishing the National Science Foundation in 1950 

specifically directed the NSF to support scientific education by awarding graduate 

fellowships in the mathematical, physical, medical, biological, engineering, and 

other sciences.

There are now nine student-support programs administered by the Foundation. 

The numbers of students aided under these programs totaled over 4,000 in 1961, 

as shown in table 3.

Table 3.—National Science Foundation fellowships awarded for fiscal 1961

Pro gram: Awards Postdoctoral______________________________________________ ISO

S enio r p o std o c to ra l------------------------------------------------------------------------------- 75

Secondary school teachers (summer)_________________________ 500

Science faculty____________________________________________ 285

North Atlantic Treaty Organization_________________________ 41

Organization for European Economic Cooperation_______________ 27

“Regular” graduate_________________________________________ 1,200

Cooperative graduate________________________________________ 1,190

Teaching assistants (summer)_______________________________ 580

Total__________________________________________________ 4.078

Source : U.S. National Science Fou ndation press releases.

Each of the nine programs has a somewhat different objective. The postdoctoral fellowships for advanced study or research are for scientists who have 

recently completed graduate work, and the “senior” postdoctoral fellowships are 

for those who have had doctorates for 5 years or more. The NSF fellowships 

for science teachers give such teachers a respite from instructional duties 

in which to improve their capacity for stimulating teaching by engaging in 

furth er study and research. There are fellowships for college faculty as well 

as summer fellowships for secondary schoolteachers of science. The NSF 

also administers two programs, paid out of the State Department budget, which 

enable American scientists to do advanced work in European institutions. 

These are the North Atlantic Treaty Organization postdoctoral fellowships 

and the Organization for European Economic Cooperation senior visiting fellowships in science. Both the “regular” graduate fellowships and the cooperative 

graduate fellowships support predoctoral students in the sciences, and the 

summer fellowships for teaching assistants are designed to make the holding 

of teaching assistantships more attrac tive to graduate students.

All NSF fellowships carry stipends designed to cover essential living expenses 

in an academic community and allow the holder to devote full time to his studies 

for the duration of the fellowship. The regular graduate fellowships, for example, pay $1,800 to first-year students, $2,000 in subsequent years, and $2,200 

in the terminal year—plus modest allowances for dependents and necessary 

travel. The cooperative graduate fellowships pay $2,200 (without allowances) 

to which the institution may, if it so desires, add as much as $800. Under the 

graduate program, NSF pays tuition and all necessary fees incurred by the 

fellows. Under the cooperative graduate program the institutions receive 

standard cost-of-education payments ($1,800 per fellow) in lieu of tuition 

and fees. Teaching assistants on summer fellowships get $50 to $75 a week 

for the summer session, plus tuition and fees.

The National Science Foundation Act specifies tha t fellowships shall be 

awarded “solely on the basis of ability,” except that, where several candidates 

are considered by NSF to be of “substantially equal ability” and they cannot 

all be awarded fellowships, the available fellowships shall be “awarded to the 

applicants in such a manner as will tend to result in a wide distribution of * * * 

fellowships among the States, territories, possessions, and the District of 

Columbia.”
56 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

LOA N PROGRAMS

The only Federal loan program for stud ents is the nation al defense student 

loan program.

Over 1,300 institutio ns of higher education particip ate in this program. The 

Government contributes up to 90 percent of the cap ital of these studen t loan 

funds, while the institution s put in the rema inder. The Federal funds are 

dis trib uted among the States on the basis of full-time enrollment in higher education. But, w ithin each State, funds are distributed to participating institution s 

in proportion to their requests for them. The Commissioner of Education has 

worked out an informal system whereby ins titu tions may be asked to scale 

down requests which seem unreaso nably large in proportion to their enrollment. 

The law has placed a ceiling of $250,000 on the Feder al contributions to the loan 

fund at any single institution.

Both undergraduate s and gradua te students are eligible to borrow so long as 

the y are full-time stud ents in good stand ing and need the money to complete 

their studies. An individual studen t may borrow up to $1,000 a year for 5 

years, or $5,000 in total. The institution s make their own selections among 

applicants for the loans, but the act provides th at “special consideration shall 

he given to (a) students with a superior academic background who express a 

desire to teach in elementary o r secondary schools, and (&) stud ents whose a cademic background indicates a superior capacity or pre paration in science, mathematics, engineering, or a modern foreign language .” However, nothing is 

said about the courses these students shall pursue after they get the loans.

The loans be ar intere st a t 3 percent, beginning 1 ye ar after th e borrower ceases 

to be a full-time studen t at the institution. They are to be repaid in periodic 

installm ents over a 10-year period. Payments of both int ere st and principal may 

be suspended while the borrower continues full-time studies at another ins titution or serves in the Armed Forces. A student who borrowed to complete his 

und ergraduate education, then spent 3 years in the Army a nd 4 years as a grad uate student, would have been out of college 7 years before he was obligated to 

make paym ents on his loan. As an inducement to students to go into teaching the 

act provides th at pa rt of the repay ment obligation may be forgiven if the 

studen t becomes an elementary or secondary school teacher. In the language of 

the act, an amount “not to exceed 50 per centum of any such loan (plus intere st) 

shall be canceled for service as a full-tim e teache r in a public elementary or 

secondary school in a State, at the rat e of 10 per centum of the amount of such 

loan plus inte rest thereon, which was unpaid on the first day of such service, 

for each complete academic year of such service.”

Gradua te and professional studen ts represente d about 12 percent of the borrowers. The average size of loans to all studen ts climbed from a little over 

$330 in 1959 to about $450 in 1961. Graduate studen ts have tended to borrow' 

somew'hat more, on the average, tha n undergraduates (table 4). Approximately 

ha lf of the loans approved in fiscal years 1959 and 1960 went to students who 

had been given special consideration because they expressed a desire to teach.

In the fiscal year 1961, about 3,000 loans were approved for students enrolled 

in medical schools. These stud ents include a few who are not cand idate s for 

M.D. degrees. In all, about one-tenth of all medical studen ts were receiving such 

loans. The average amount of these loans w'as $644.

Sub stan tial numbers of undergraduate college studen ts now receiving loans 

have indicated that they inten d to go on to medical or dental school. Because 

of the 5-year limit on receiving loans, an increasing proportion of medical and 

den tal stud ents will, in coming years, no longer be eligible for loan benefits by 

the time they reach the second and third yea r of medical or dental school.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 57

Table 4.—National defense student loans approved, by level and average

amounts, fiscal year 1960

Level Number Average

amoun ts

Entering freshmen........ . ........................ ..................... 30,180 

76,193 

12,627

$469

485

615

Other und ergrad ua tes...................... . ..............

Graduate an d professional_____ ______ _______ __________

Total.............................................................................................. 119,000 495

Source: U.S. Office of Education, “ The National Defense Studen t Loan Program: A 2-Year Report.” 

pp. 18-19.

SUMMARY

Graduate fellowships and traineeships, which do not require repayment, are 

available from the following Federal agencies: The Office of Education and the 

Public Health Service of the Department of Health, Education, and Welfare; 

the Atomic Energy Commission; and the National Science Foundation. Few of 

the fellowships, however, are available to students who are candidates for the 

M.D. or D.D.S. degrees.

The National Defense Education Act (Office of Education) provides the 

only Federal loan program. Medical and dental students are eligible to apply 

for these low-interest, long-term loans, within the limits of time and amount 

established.

The Chairman. Then we should like to know about payments made 

to medical schools under existing programs for teaching in particular fields, such as heart, cancer, or mental illness. I should like you 

to give us complete information on grants for, say, about 5 years. I 

think that would indicate the trend pretty well.

(The information referred to follows;)

80014— 6! ■5
Undergraduate trainin g grants supported by the Nat ional Ins titu tes of Health for fiscal years 1957—61

I n s titu tio n T o ta l

N a tio n a l C a n c e r I n s titu te N a tio n a l H e a r t I n s titu te N a tio n a l I n s titu te o f M e n ta l H e a lth

T o ta l 1961 1960 1959 1958 1957 T o ta l 1961 1960 1959 1958 1957 T o ta l 1961 1960 1959 1958 1957

ALA BAM A

U n iv e rs ity of A la b a m a .............. $4 05 ,118

M e d ic a l C o lle g e .........................S chool of D e n tis tr y ....................

380, 97 8 

24 ,1 40

$125, 000 

24, 140

$2 5,00 0

5, 00 0

$2 5.00 0 

5,0 00

$2 5,00 0

5, 00 0

$25, 000 

5, 00 0

$2 5,00 0 

4,14 0

$124, 988 $2 4,99 7 $2 4,99 7 $2 4,99 7 $24, 997 $2 5,00 0 $130, 990 $25, 576 $25, 288 $25,38 4 $2 5,28 8 $29, 454

ARKA NS AS

U n iv e rs ity of A rk a n s a s M e d ical C e n te r ........................................

CALIFORNIA

38 1,05 7

86 2,30 3

12 4,9 55 24 ,99 1 24 ,991 24 ,991 24 ,991 24,99 1 12 5,0 00 25 ,0 00 25 ,0 00 25 ,000 25 ,0 00 25 ,000 13 1,1 02 25 ,4 80 25 ,4 80 25 ,4 96 25 ,2 88 29,3.58

M e d i c a l C e n t e r ( L o s 

A n g e le s)......................................

S chool of D e n tis tr y __________

M e d ic a l C e n te r (S a n F r a n ­

c is co )______________________

S chool of P u b lic H e a lth --------

38 1,01 5 

24 ,8 18

38 1,47 0 

75 ,000

124, 99 9 

24 ,8 18

125,00 0

25 ,0 00 

4, 99 7

25 ,0 00

25. 000 

4, 95 7

25 ,0 00

25 ,0 00

4,95 7

25 ,0 00

25 ,0 00

4,93 9

25 ,0 00

24 ,999

4,96 8

25 ,0 00

125.00 0 25 .0 00 25 ,0 00 25 ,0 00 25 ,0 00 25 ,0 00 131,01 6 25, 576 25 ,5 58 25 ,5 60 25 ,062 29 ,2 60

125,00 0

75 .000

25 ,0 00

15 .000

25 ,0 00

15 ,000

25 ,0 00 

15 ,00 0

25 ,0 00

15 ,000

25 ,0 00

15 ,000

131, 470 25, 576 25 ,5 76 25, 576 25 ,288 29 ,4 54

C o ll eg e of O s te o p a th ic P h y s ic ia n s a n d S u rg e o n s .....................L o m a L in d a U n iv e r s ity ..............

32 8,65 2 34 2,67 6

125,00 0 25 ,000 25 ,0 00 25 ,000 25 ,000 25 ,000 125,00 0 25 ,0 00 25 ,000 25 ,000 25 ,0 00 25 ,0 00 78 ,652 15 .288 15 ,288 15 ,288 15 ,28 8 17 ,500

S ch o o l o f M e d ic in e .....................

S ch o o l o f D e n t is t r y ....................

31 7,67 6 

25 ,0 00

12 5,0 00

25 ,0 00

25 ,0 00

5, 00 0

25 ,000

5.00 0

25 ,000

5,00 0

25 ,0 00

5,00 0

25 ,000

5,00 0

12 5,0 00 25 ,000 25 ,0 00 25 ,000 25 ,000 25 ,000 67 ,676 13 ,61 4 13 ,506 12 ,993 12 ,788 14 ,775

U n iv e rs ity of S o u th e rn C a li -

40 6,08 9

S ch o o l o f M e d ic in e ....................S ch o o l o f D e n t is t r y ....................

38 1,08 9 

25 ,0 00

12 5,00 0

25 ,0 00

25 ,000

5,00 0

25 ,0 00

5,00 0

25 .0 00

5,00 0

25 ,000

5,00 0

25 ,0 00

5,00 0

12 5,00 0 25 ,000 25 ,0 00 25 ,000 25 ,000 25 ,0 00 13 1,0 89 25 ,5 76 25, 576 25, 576 25 ,2 88 29 ,0 73

S ta n fo rd U n iv e rs ity M e d ic a l 

C e n te r ................................................ 38 0,28 5 123,81 5 24 ,8 52 24 ,9 98 24 ,993 24 ,832 24 ,1 40 12 5,00 0 25 ,000 25 ,0 00 25 ,000 25 ,0 00 25 ,0 00 13 1,47 0 25, £76 25 ,576 25 ,5 76 25 ,2 88 29 ,454
COLORADO

U n iv ers it y o f C ol ora do , M od i125,000 25,00 0 25,000 25,000 25,000 25,000 125,000 25,000 25,000 25,000 25.000 25,000 130,990 25,4 80 25,480 25,480 25,288 29,262 ca l C en te r_______ ____ ____ 380,9 90

CONNECTICUT

Y al e U n iv e rsit y ............................ 456,917

Sc ho ol of M ed ic in e .. 379,4 17

77,5 00

125,000 25,0 00 25,0 00 25,0 00 25,0 00 25,000 125,000

77,5 00

25,0 00

15,000

25,0 00

15,000

25,000

15,000

25,0 00

15,000

25,000

17,500

129,417 25,4 80 25,480 24,118 25,240 29,099 D e p a r tm e n t of P u b li c H e a lth .. ..........................

DISTRICT OF COLUMBIA

G eo rg et ow n U n iv ers it y .............. 406,278

M ed ic al Sch ool ........ .................. 3M.27S

25,0 00

125,000

25,000

25,0 00

5,000

25,000

5,00 0

25,0 00

5,00 0

25,0 00

5,000

25,0 00

5,000

125,000 25,0 00 25,000 25,000 25,000 25,000 131,278 25,5 76 25,5 76 25,5 76 25,288 29,2 62 D en ta l S ch ool............................

G eo rg e W ash in g to n U n iv ers it y M edic al Sc ho ol _ _.......... 380, 942 

401,7 19

124, 904 24,904 25,00 0 25,0 00 25,0 00 25,000 125,000 25,000 25,000 25,000 25,000 25,000 131,038 25,5 76 25,5 76 25,4 32 25,2 88 29,166 H o w ard U n iv ers it y . . ...............

College o f M ed ic in e ............... 376,7 19 

25,0 00

125.0 00

25,00 0

25,000

5,000

25,0 00

5,000

25,0 00

5,000

25,000

5,000

25,0 00

5,000

125,000 25,000 25,000 25,0 00 25,000 25,0 00 126.719 25,384 25,384 25,384 25,481 25,0 86 Colle ge o f D e n ti str y .................

FLORIDA

U n iv ers it y of F lo ri da, College 

of M ed ic in e . . . 321,7 05

380,318

104,995

125,000

25,00 0

25,000

25,0 00

25,0 00

25,0 00

25,000

25,0 00

25,0 00

4,995

25,0 00

125,000

125,000

25,000

25,000

25,000

25,000

25,0 0025,000

25,000

25,000

25,000

25,000

91, 710

130,318

25,567

25,288

25,567

25,2 88

25,5 7625,288

15,000

29,16 6

U n iv ers it y of M ia m i, Sc ho ol 

of M ed ic in e________ . 25,2 88

GEORGIA

E m o ry U n iv ers it y .............. ....... 365, 767

Sc ho ol of M ed ic in e_____ 340, 767 125 000 

25,0 00

25 000 

5,000

25,000 

5,000

25,0 00

5,000

25,0 00

5,000

25 ,0C0 

5.000

125. 000 25. 000 25,0 00 25,0 00 25,0 00 25,0 00 90, 767 25, 383 25, 192 192 15,000 25,000 D en ta l Sch oo l............................. 25,0 00

M ed ic al College of G eo rg ia ___ 380, 768 124, 731 24, 731 25,0 00 25.0 00 25, 000 25,0 00 125,000 25,000 25,0 00 25.0 00 25,000 25,0 00 131,037 25,4 32 25, 432 25,4 32 25,2 88 29,453

ILLINOIS

C hi ca go Co lle ge of O ste o p ath y . 

C hi ca go M ed ic al Sch ool.............

329, 466 

380,894

255, 593

125,000 125,000

25.0 00 25,0 00

25, 000 25,0 00

25,000 

25,000

25,000 25,0 00

25,0 00 25,000

124,950 125.000

125,000

25,0 00 25, 00025.0 00

25,0 0025.0 0025,0 00

25,000 

25,0 00

25,000

25,000 25,00025.000

24. 950 25,0 0025,0 00

79, 516 

130,894130, 593

15, 576 

25,2 8825.383

15, 576 

25,2 8825,288

15,576 

25, 57625,372

15.288

25.2 8825,2 88

17,5 00

29,45429, 262

U n iv ers it y of C hi ca go Sc ho ol 

of M ed ic in e.................................

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 59
Undergraduate trainin g grants supported by the Nat ional Instit ute s of Health for fiscal years 1957—61— Co ntinued

I n s titu tio n

Il l in o is —c o n ti n u e d

U n iv e rs ity of Ill in o is .....................

C oll ege of M e d ic in e _________C o ll eg e of D e n tis tr y ...................

L o y o la U n iv e r s ity _____________

S tritc li S chool of M e d ic in e .. 

S chool of D e n t is t r y ....................

N o r th w e s te r n U n iv e r s ity _____

M e d ic a l S c h o o l______________

D e n ta l S c h o o l_______________

INDIANA

I n d ia n a U n iv e rs ity F o u n d a ­

tio n R e se a rc h D i v i s i o n .. ..

M e d ic a l S c h o o l.. ....................... ..S chool o f D e n t is t r y ....................

IOWA

C o ll eg e o f O s te o p a th ic M e d ic in e a n d S u rg e ry .........................S ta le U n iv e rs ity of I o w a ............

C oll ege o f M e d ic in e ...................C oll ege o f D e n tis tr y ...................

KANSAS

U n iv e rs ity o f K a n s a s , M e d ic a l 

C e n te r ....................... ................... ..

T o ta l

N a tio n a l C a n c e r I n s titu te N a tio n a l H e a r t I n s titu te N a tio n a l I n s t i tu t e o f M e n ta l H e a lth

T o ta l 1961 1960 1959 1958 1957 T o ta l 1961 1960 1959 1958 1957 T o ta l 1961 1960 1959 1958 1957

398, 529

37 3,52 9 

25 ,0 00

12 5,0 00

25 ,000

25 ,000

5,0 00

25 ,0 00

5,0 00

25 ,0 00

5, 00 0

25 ,0 00

5,00 0

25 ,000

5,00 0

12 5,0 00 25 ,0 00 25 ,000 25 ,000 25 ,000 25 ,0 00 12 3,5 29 25. 576 25, 576 25, 57fl 25, 252 21 ,549

40 5,38 238 0,38 2

25 ,0 00

124,87 5 

25 ,0 00

24 ,975 

5,00 0

24 ,975 

6,00 0

24 ,975 

5,00 0

24 ,975 

5, 00 0

24 ,975 

5, 00 0

12 5,0 00 25 ,0 00 25 ,0 00 25 ,000 25 ,000 25 ,0 00 13 0,5 07 25 ,2 87 25 ,2 87 25 ,383 25 ,2 88 29 ,262

40 6,28 338 1,28 3

25 ,0 00

12 5,00 0

25 ,0 00

25 ,0 00

5, 00 0

25 ,0 00

5,0 00

25 ,0 00

5,00 0

25 ,000

5,00 0

25 ,000

5,00 0

125,00 0 25 ,000 25 ,0 00 25 ,0 00 25 ,0 00 25 ,0 00 131,28 3 25 ,576 25 ,5 76 25, 576 25 ,1 28 29 ,427

380,98 1

35 6,00 6

24 ,975

12 5,00 0 

24 ,9 75

25 ,0 00

4, 99 5

25 ,0 00

4,9 95

25 ,0 00

4, 99 5

25 ,000

4,99 5

25 ,000 

4,99 5

100, ooo 25 ,0 00 25 ,0 00 25 ,000 25 ,000 131,00 6 25, 576 25 ,5 76 25 ,5 76 25 ,288 28 ,990

32 7,22 2 

40 6,37 4

12 3,71 2 25 ,000 25 ,0 00 25 ,0 00 24 ,647 24 ,0 65 12 4,13 8 25 ,000 25 ,0 00 25 ,000 25 ,000 24 ,1 38 79 ,372 15 ,432 15 ,432 15, 432 15 ,288 17 ,788

38 1,37 4

25 ,0 00

125,00 0

25 ,0 00

25 ,0 00

5,0 00

25 ,0 00

5, 00 0

25 ,0 00

5, 00 0

25 ,000

5,00 0

12 5,00

5,0 00

12 5,00 0 25 ,0 00 25 ,0 00 25 ,0 00 25 ,0 00 25 ,0 00 131,3 74 25 ,5 76 25 ,5 76 25, 576 25 ,2 88 29 ,3 58

38 0,46 5 12 4,88 9 24 ,9 89 24 ,9 00 25 ,0 00 25 ,000 25 ,0 00 12 4,6 53 24 ,997 24, 948 24 ,894 24 ,9 74 24 ,8 40 130,92 3 25 ,5 76 25 ,5 76 25 ,375 25 ,1 28 29 ,2 68

60 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
U n iv ers it y of K en tu c k y Colleg e of M ed ic in e___________

U n iv ers it y o f L ouis vil le ...........

Sc ho ol of M ed ic in e. Sc ho ol of D en ti str y .

LOUISIANA

L ouis ia na S ta te U n iv ers it y , 

Scho ol of M ed ic in e_________

L oy ol a U n iv ers it y , Sc ho ol of 

D e n ti s t r y ..................................

T u la n e U n iv ers it y .......................

Sc ho ol of M ed ic in e...............

D e p artm en t of T ro pic al 

M e d ic in e a n d P u b lic 

H e a lt h .....................................

MARYLAND

Jo h n s H o p k in s U n iv e r s ity .. ..

Sc ho ol of M ed ic in e_____

Sc ho ol of P u b li c H e a lt h .

U n iv ers it y of M a ry la n d .

Sc ho ol of M ed ic in e. 8c ho ol of D en ti str y .

MASSACHUSETTS

B os to n U n iv ers it y , Sc ho ol of 

M ed ic in e___________________

H arv ard U n iv ers it y __________

Sc ho ol of M ed ic in e...................

Sc ho ol of D en ta l M ed ic in e.. . Sc ho ol of P u b li c H e a lt h .........

T u ft s U n iv e rsit y .

Sc ho ol of M ed ic in e_________ Sc ho ol of D en ta l M e d ic in e .. . !

100,184 

403,123

378,1 55 

24,9 68

381,0 86

25,0 00 

456,1 82

381,182

75,000

495,865

380,3 65 

115,500

384,8 52 

25,000

360,840 461,054

358,5 54

25,0 00 77,500 

392,9 32

367,9 32 

25,000

25,0 00 25,0 00 49,948 24,948 25,0 00 25,2 36 25,236

125,000

24,9 68

125,000

25,0 00

125,000

125,000

125,000

25,00 0

125,000

125,000

25,000

25,0 00

5,000

25,0 00

5,00 0

25,0 00

25,0 00

25,000

5,00 0

25,00 0

25,0 00

5,000

125,0 00 25,000 

25,0 00 5,000

25, 000 25,000 

5,0 00 4,96 8

25,0 00

5,000

25,0 00

5,000

25,0 00

25,0 00

25,000

5,00 0

25,0 0025,000

5,00 0

25,000

5,00 0

25,0 00

25,000

25,0 00

5,00 0

25,000

25,0 00

5,000

25,0 00

5,00 0

25,0 00

25,000

25,000

5,000

25,000

25,0 00 25,000 

5,0 00 5,000

25,000

5,000

25,000

5,000

25,000

5,000

25,0 00

5,000

25,000

25,0 00

25,000

5,000

25,0 00

25,0 00

5,000

25,000

5,000

125,000125,000

125,000

75,000

125,000115,500

129,167

125,000

125,000

77,500

125,000

25,0 00 25,0 00 25,000 25,000 25,0 00 128,155 25, 480 25,4 80 25, 480 24,937 26,7 78

25,0 00

25,0 00

15,000

25,000

15,000

25,000

25,000

25,00015,666

25,000

25,0 00 25,0 00 25,000 25,0 00 131,086 25,5 76 25,384 25,384 25,288 29,454

25,0 00

15,000

25.000

15.000

25.000

25,000

25,00015,000

25,0 00

25,0 00

15,000

25,0 00

15,000

25,0 00

15,000

131,182 25,480 25,4 80 25,4 80 25,288 29,4 54

25,00027,000

25,000

27,000

25,000

31,500

130,365 25,288 25,288 25,2 87 25,2 88 29,2 14

25,000 25,0 00 29,167 130,685 25,137 25,5 76 25,5 76 25,1 28 29,2 68

25,000 25,000 25,000 110,840 25,576 25,000 19,410 19,410 21, 444

25,000 25,000

15,000 15,000

25,00017,500

108,554 25, 576 25,5 76 25, 576 288 31,5 38

25,000 25,000 25,000 117,932 25,144 25,0 96 25,0 96 25,0 96 17,500

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 61
Undergraduate training grants supported by the Nat ional Instit ute s of Health for fiscal years 1957—61 Co ntinued

In sti tu ti o n

MICHIGAN

U n iv ers it y of D etr o it , Sc ho ol 

of D e n ti str y ................................. U n iv ers it y o f M ic hig an -----------

Sc ho ol o f M edic in e............ . . .Sc ho ol of D e n ti str y ........ .........Sc ho ol o f P u b li c H e a lt h ____

W ayne S ta te College of M ed icin e________ ____ __________

MINNESOTA

U ni v ers lt v of M in n e so ta ............

Medical School......................

Sc ho ol of D e n ti str y ...................Sc ho ol of P u b li c H e a lt h ...........

MISSISSIPPI

U n iv ers it y of M is si ss ip pi 

Sc ho ol of M edic in e....................

MISSOURI

K an sas C it y C olle ge of Os te op ­

a th y a n d S u rg ery ......................

K er ksv il le College of O st eo pa th y a n d S u rg ery ......................

U n iv ers it y of K an sa s C it y , 

Sc ho ol of D e n ti s try -.............. ..

U n iv ers it y of M is so uri , Sc ho ol 

of M ed ic in e..................................

S t. Loui s U n iv ers it y ....................

Sc ho ol of M edic in e__________

Sc ho ol of D e n ti s t r y .- ............

T o ta l

N ati o n al C an cer I n s ti tu te N ati o n al H eart In s ti tu te N ati o n al In s ti tu te of M en ta l H ealt h

T o ta l 1961 1960 1959 1958 1957 T o ta l 1961 1960 1959 1958 1957 T o ta l 1961 1960 1959 1958 1957

25,00 0 

379, 959

25,000 5,00 0 5,00 0 5,000 5,000 5,000

279, 97,9

25,00 075,00 0

380,2 35481.192381.192

25,000 

75,00 0

123,2 99

25,000

24,991

5,00 0

24,944

5,00 0

24,721 

5,000

24,505

5,000

24,138 

5,000

73,5 70 25,0 00 15,000 10,800 10,800 11,970 83,0 90 16,964 16,964 16,374 15,288 17,500

75,000

125,000

15,000

25,000

15,000 15,000 15,000 15,000

124,053 24,9 95 24,915 24, 755 24,3 88 25,000 25,000 25,000 25,000 25,000 131,182 25,5 76 25,5 76 25,576 25,000 29,454

125,000

25,000

25,0 00

5,00 0

25,0 00

5,00 0

25,0 00

4,600

25,000

5,400

25,000

5,000

125,000 25,0 00 25,0 00 25,0 00 25,0 00 25,000 131,192 25, 576 25, 576 25, 576 25,288 29,176

75,000 15,666 15,000 15,000 15,000 15,000

381,470 125,000 25,0 00 25,0 00 25,000 25,000 25,000 125,000 25,0 00 25,0 00 25,0 00 25,000 25,0 00 131,470 25, 576 25,5 76 25,5 76 25,2 88 29,454

328, 364 125,000 25,000 25,0 00 25,0 00 25,000 25,0 00 125,000 25,0 00 25,0 00 25,0 00 25,000 25,000 78,364 15,288 15,288 15,288 15,000 17,500

327, 740

25,0 00

125,000

25,0 00

25,0 00

5,00 0

25,0 00

5,000

25,000

5,000

25,000

5,000

25,0 00

5,000

125,000 25k 000 25,0 00 25,000 25,000 25,0 00 77, 740 15,000 15,000 15,240 15,000 17,500

129,167 25,000 25,0 00 25,0 00 25,0 00 29,1 67 69, 310 25,144 15,000 29,166 323,477 

405,1 07

125,000 25,000 25,0 00 25,000 25,000 25,0 00

3*0, 112 

24,9 65

124,840 

24,9 65

25,000

5,000

25,0 00

4,99 9

25,0 00

4,999

24,8 40 

4,999

25,0 00 

4,968

125,000 25,000 25,0 00 25,0 00 25,0 00 25,000 130,302 25, 576 25,5 76 25,318 24,9 74 28,8 58 ----------- --------—. —--------
W as hin gto n U n iv ers it y ..............

Sc ho ol of M ed ic in e____ ______

Sc ho ol of D e n ti str y ..................

NEBRASKA

C re ig hto n U n iv ers it y ..................

Sc ho ol of M ed ic in e....................

Schoolof D en tistry ...............

U n iv ers it y of N e b ra sk a_______

C ol le geo f M ed ic in e............ ..

College of D e n ti str y ________

NEW HAMPSHIRE

D a rtm o u th M ed ic al S c h o o l. .. .

NEW JER SEY

F ai rl ei gh D ic kin so n U n iv e rs it y , Sc ho ol of D e n ti str y ____

Set on H all .......... ..................... ..

C olleg eo f M edic in e........ .........College of D e n ti str y ........... ......

NEW YORK

C o lu m b ia U n iv ers it y ..................

College of P h y si cia n s an d 

Surg eo ns...................................

D en ta l an d O ra l S u r g e r y .. .. 

Sc ho ol o f P u b li c H e a lt h ____

C orn el l U n iv ers it y M ed ic al 

Col le ge ...........................................

N ew Y ork M ed ic al C o ll e g e .. .. N ew Y ork U n iv e rsit y .................

Sc ho ol o f M ed ic in e...............College of D e n ti str y ................

S ta te U n iv ers it y of N ew Y ork . 

D o w n sta te M ed ic al C e n te r.. 

U p sta te M ed ic al C en te r.........

406,288

381,288 

25,00 0

124,9 86

25, 000

25, 000

5,000

25, 000

5,000

24,986

5,0 00

25,0 00

5,000

25,0 00

5,0 00

125,000 25,000 25,000 25,0 00 25,0 00 25,0 00 131,302 25, 576 25, 576 26, 576 25,1 45 29,4 29

405, 030380,030 

25, 000

125,0 00

25, 000

25,0 00

5,000

25,0 00

5,0 00

25,00 0

5,0 00

25,0 00

5,000

25,000

5,0 00

125, COO 25,000 25,0 00 25,000 25,000 25,000 130,030 25,288 25,000 25,000 25,2 88 29,454

409,436384,436 

25. 000

124,794 

25, 000

25,0 00

5,0 00

25,0 00

5,0 00

24, 954 

5,0 00

25,000

5,0 00

24,840 

5,000

129,167 25,000 25,000 25,000 25,0 00 29,167 130,475 25,288 25,2 88 25,288 25,158 29,4 53

165,7 16

20, 000 

235,213

25,0 00

20, 000

5,000

5,0 00

5,0005,000

5,000

5,0 00

5,000

5,0 00

5,000 60,5.58 14,796 11,8 00 11,800 11,081 11,081 80,1 58 15,822 15,822 15,822 14,166 18,526

210, 720 

24,4 93

85, 000 24,4 93

25, 000 

5,000

25, 000

5,0 00

25,0 00 

4,973

5,000

4,552

5,0004,968

75,0 00 25,000 25,000 25,000 50,720 25,576 25,144

472,8 00

371,1 94

24,991 

76,615

124, 980 

24,991

25,0 00

5,0 00

24,995 

4,9 99

24,9 95

4,9 99

24,9 95 

4,999

24,9 95 

4,99 4

114, 766 24,9 48 29,969 19,980 19,980 19,899 131,448 25,5 76 25,554 25,5 76 25,288 29,454

76, 615 14,990 14,990 14,887 14,887 16,861 29,454 ______ 356,9 97 124,979 24,9 92 24,994 24,998 24,9 98 24,997 125 ,0C0 25,0 00 25,0 00 25,0 00 25,0 00 25,000 107,018 25,264 25,1 92 25,128 288 29,454

379,147 406, 235

125,0 00 25,0 00 25,0 00 25,000 25,0 00 25,0 00 123,120 24,624 24,624 24,624 24,624 24,624 131,027 25,576 25, 576 25, 521 25, 236 31,1 46

381,235

25,0 00

124, 765 

25, 000

25,0 00

5,000

25,0 00

5,0 00

25,000

5,0 00

24, 795 

5,0 00

24,9 70 

5,0 00

125.000 25,0 00 25,0 00 25,0 00 25,0 00 25,000 131,470 25, 576 25,576 25, 576 25,288 29,1 15

757, 532 

379,1 38 124,939 24,991 25,0 00 24,9 59 24,997 24,9 92 122, 729 24,9 99 24.999 25,0 00 24,943 22, 788 131, 470 25, 576 25, 576 25, 576 25,2 88 29, 454

378,394 125,000 25,0 00 25,0 00 25,000 25,0 00 25,000 123,568 25,0 00 25,0 00 24,0 00 24,769 24, 799 129,826 24,802 24,802 25,480

TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 63
Undergraduate trai ning grants supp orted by the Na tional Instit ute s of Health for fiscal years 1957 -61— Co ntinu ed

I n s t i t u t i o n

n e w y o b k — c o n t i n u e d

U n i o n C o ll e g e a n d U n i v e r s it y , 

A l b a n y M e d i c a l S c h o o l..........-

U n i v e r s i t y o f B u f f a lo ___________

S c h o o l o f M e d i c i n e .......................

S c h o o l o f D e n t i s t r y ......................

U n i v e r s i t y o f R o c h e s t e r S c h o o l 

o f M e d i c i n e a n d D e n t i s t r y .

Y e s h iv a U n i v e r s i t y , A l b e r t 

E i n s t e i n C o lle g e o f M e d i c i n e .

NORTH CAROLINA

D u k e U n i v e r s i t y M e d i c a l 

C e n t e r .................................................

U n i v e r s i t y o f N o r t h C a r o l i n a .

S c h o o l o f M e d i c i n e .......................

S c h o o l o f D e n t i s t r y . . . ...............

S c h o o l o f P u b l i c H e a l t h --------

W a k e F o r e s t C o ll e g e , B o w - 

1 m a n G r a y S c h o o l o f M e d i - 

r c i n e ...........................................................

NORTH DAKOTA

U n i v e r s i t y o f N o r t h D a k o ta , 

S c h o o l o f M e d i c i n e .......................

OHIO

U n i v e r s i t y o f C i n c i n n a t i , C o lle g e o f M e d i c i n e .......... ...................

O h io S t a t e U n i v e r s i t y ....................

C o ll e g e o f M e d i c i n e . . .............

C o lle g e o f D e n t i s t r y ....................

T o t a l

N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l H e a r t I n s t i t u t e N a t i o n a l I n s t i t u t e o f M e n t a l H e a l t h

T o t a l 1961 19 60 19 59 19 58 19 57 T o t a l 1961 19 60 1959 19 58 19 57 T o t a l 1961 19 60 19 59 19 58 1957

33 0, 26 2 124,9 44 2 4 ,9 9 6 2 4 ,9 9 6 2 4 ,9 6 0 2 4 ,9 9 6 2 4 ,9 9 6 1 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 13 0, 31 8 2 5 ,3 8 4 2 5 ,3 8 4 2 5 ,3 8 4 2 5 ,0 0 0 2 9 ,1 6 6

33 7, 31 5 1 2 5 ,0 00 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 1 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 8 7 ,3 1 5 25 , 24 0 15 ,4 9 5 15, 01 0 1 5 ,0 1 0 1 6 ,5 6 0 ?5 non 5 nn n 5 ,0 0 0 5 ,0 0 0 _______ ______ ________ ________ ________ ________ ________ 33 1, 46 2 1 2 5 ,0 00 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 124 ,9 9 2 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 4 ,9 9 2 13 1, 47 0 25 , 57 6 25 , 57 6 25 , 57 6 2 5 ,2 8 8 29 , 45 4

38 1, 39 9 125,0 00 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 1 2 4 ,9 2 9 2 4 ,9 9 8 2 5 ,0 0 0 2 4 ,9 7 7 2 5 ,0 0 0 24 , 95 4 131, 47 0 25 . 57 6 25, 57 6 25 , 57 6 2 5 ,2 8 8 2 9 ,4 5 4

3 8 0 ,8 0 9 12 4, 531 2 4 ,9 3 9 24 , 93 9 24 , 82 4 2 4 ,9 7 0 24 , 85 9 125 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 131, 27 8 25 , 57 6 2 5 ,4 8 0 2 5 ,4 8 0 2 5 ,2 8 8 29 , 45 4

4 7 5 ,0 8 3

36 7, 58 3 125 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 124 ,9 6 9 2 5 ,0 0 0 2 5 ,0 0 0 24 , 98 9 2 4 ,9 9 6 24 , 98 4 117,6 14 2 5 ,5 7 6 25 , 57 6 2 3 ,4 1 2 20 ,7 9 4 2 2 ,2 5 6

5 ,0 0 0

8 2 ,5 0 0 8 2 ,5 0 0 1 6 ,5 0 0 1 6 ,5 0 0 16 ,5 0 0 16 ,5 0 0 1 6,5 00

32 1, 49 2 125,0 00 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 125 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 7 1 ,4 9 2 11 ,9 7 2 1 1 ,4 3 2 1 5 ,0 1 2 1 5 ,2 8 8 17, 78 8

9 9,8 71 2 5 ,0 0 0 5, (XX) 5 ,0 0 0 5 ,0 0 0 5 ,0 0 0 5 ,0 0 0 74,8 71 1 4 ,9 8 5 1 4 ,9 8 5 1 4 ,9 5 8 1 4,9 85 1 4 ,9 5 8

3 8 0 ,6 4 6 125,0 00 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 125,0 00 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 130 ,6 4 6 25 , 57 6 2 5 ,4 3 2 2 5,3 84 2 5 ,1 9 2 2 9 ,0 6 2

3 97,3 91

37 2, 391 125 ,0 0 0 2 5 .0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 125,0 00 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 122,3 91 2 4 ,9 5 5 2 4 ,8 0 0 2 5 ,4 8 0 2 4,3 41 2 2 ,8 1 5

5 no n 5 ,0 0 0 2 5 ,0 0 0 _________ ________ ________ ________ ________ — — , - — — ■ — — ■ ■■
W e st er n R es er ve U n iv e r s it y -

Sc ho ol of M ed ic in e_________

Sc ho ol o f D e n ti str y ..................

OKLAHOMA

U n iv e r s ity of O k la h o m a ,

Sc ho ol o f M ed ic in e...................

OREGON

U n iv ers it y o f O re gon..................

M ed ic al S c h o o l......__ ____

D en ta l Sch ool ______________

PE NN SYLV AN IA

H ah n em an n M ed ic al C oll eg e. .

Je ff er so n M ed ic al Col le ge ..........

P h il a d elp h ia College of O st eo p a t h y . . . . ...................................

T em p le U n iv ers it y ___________

Sc ho ol o f M ed ic in e_________

8c hoo l of D e n ti str y --------------

U n iv ers it y o f P e n n s y lv a n ia .. ..

Sc ho ol o f M e d ic in e .------------

Sc ho ol of D e n ti str y ..................

U n iv ers it y o f P itts b u r g h ...........

Sc ho ol o f M ed ic in e---------------

Sc ho ol o f D e n ti s t r y ...............

Sc ho ol o f P u b li c H e a lth .........

W o m an ’s M ed ic al C ol le ge ____

SOUTH CAROLINA

M ed ic al College of S o u th 

C a r o lin a ........... — ......... .........

SOUTH DAKOTA

S ta te U n iv ers it y of 8 o u th 

D ak o ta , Sc ho ol of M ed ic in e.

404,1 27

379,191 

24,9 36

125,000 

24,9 36

25,0 00 

5,000

25,0 00 

5,000

25,0 00 

5,0 00

25,0 00 

4,968

25,0 90 

4,968

123,681 24,975 24,8 10 24, 948 24,0 00 24,948 130,510 25,2 88 25,2 88 25,4 80 25,2 88 29,1 66 ______ ______ ______

— 379,7 50

387,9 73

125,000 25,000 25,0 00 25,0 00 25,0 00 25,0 00 123,568 25,0 00 25,0 00 24,000 24,769 24,799 131,182 25,288 25,576 25,576 25,2 88 29,454

362,973 

25,0 00

125,000 

25,0 00

25,0 00

6,000

25,0 00

5,000

25.0 00

5,000

25,000

5,0 00

25,000

5,000

122,758 25 .0)0 25,000 24, 758 24,0 00 24,000 115,215 25.5 75 25,5 76 25,576 15,288 23,2 00

379,8 38 

381, 467

276,9 60 

405,972

125,000 

125,000

121,960

25,0 00

25,0 00

25,0 00

25,0 00

25,00 0

25,0 00

25,000

25,0 00

25,0 00

25,0 00 

25,0 00

23,2 80

25,0 00

25,000

23,680

125,000

125,000

125,000

725,000 

>25,000

25,0 00

25,0 00 

J2 5, 000

25,0 00

25,0 00 

125,000

25, 000

25,0 00

25,000

25,0 00

25,0 00

25,0 00

25,0 00

129,838 

131, 467

30,0 00

25,1 92 

25,576

25,1 92 

25,576

15,000

25,192 

25,5 76

25,096 

25,2 85

29. 166 

29, 454

15,000

380,9 72

25,0 00

125,000 

25,0 00

25,0 00

5,00 0

25,0 00

5,00 0

25,000

5,000

25,0 00

5,00 0

25,0 00

5,000

124, 740 24,9 48 24,9 48 24,9 48 24,948 24,948 131,232 25,5 76 25,5 76 25,5 76 25,2 36 29,2 68

403,765

378, 765 

25,0 00

124,945 

25,0 00

25,0 00 

5,000

25,0 00

5,00 0

25.000

5,000

24,962 

5,000

24,9 83 

5,000

125,000 25,0 00 25,0 00 25,0 00 25,0 00 25,0 00 128,820 25,5 76 25,5 76 25,5 76 25,2 88 26,8 04 ______ . ------ r~~

477,082

374,5 82

25, 000

77,5 00

125,000 

25,0 00

25,0 00

5,000

25,0 00

5,00 0

25,000

5,000

25,0 00

5,000

25,0 00

5,000

125,000 25,0 00 25,000 25,0 00 25,0 00 25,000 124,582 25,288 25,288 25,192 25,0 00 23,8 14

77,500 15,000 15,000 15,000 15,000 17,500

381,4 70 125,000 25,0 00 25,000 25,0 00 25,0 00 25,000 125,000 25,0 00 25,0 00 25,0 00 25,000 25,000 131,470 25,5 76 25,576 25,5 76 25,2 88 29,4 54

310,203 125,000 25,0 00 25, 000 25,0 00 25,0 00 25,000 125,000 25,0 00 25,0 00 25,0 00 25,0 00 25,0 00 60,203 12,438 12,133 12,134 11,804 11,694

124, 494 25, 000 5,00 0 5,00 0 6,00 0 5,00 0 5,000 75,000 15,000 15,000 15,000 15,000 15,000 24, 494 5,53 3 5,576 4,50 2 4,37 4 4,509

TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 65
Undergraduate training grants supp orted by the National Instit ute s of Health for fiscal years 1957 -61— Co ntinued

In sti tu ti o n T o ta l

N ati o n al C ancer In s ti tu te N ati o n al H eart In sti tu te N ati o n al In s ti tu te of M en ta l H ealt h

T o ta l 1961 1960 1959 1958 1957 T o ta l 1961 1960 1959 1958 1957 T o ta l 1961 1960 1959 1958 1957

TENNESS EE

M eh arr y M ed ic al C ol le ge ......... 395,0 54

M ed ic al C o ll eg e....................... 370,0 54 

25,0 00

125,000

25, 000

25, 000

5,000

25,0 00

5,00 0

25,000 25,000

5,000

25,0 00

5,000

129,167 25,0 00 25,0 00 25,0 00 25,000 29,167 115,887 25,0 00 25,0 00 25,0 00 25,000 15,887 Sc ho ol o f D e n ti str y ........ ......... 5,000

U n iv ers it y o f T ennes se e______ 344, 781 — — College of M ed ic in e________ 319, 781 

25,0 00

125,000

25,0 00

25,0 00

5,00 0

25,0 00

5,00 0

25,0 00

5,00 0

25,000

5,000

25,000

5,000

124,984 25,000 25,000 25,000 24,985 24,9 99 69, 797 13,807 13,711 13,556 13,412 15,311 College of D e n ti str y ................

V an d erb il t U n iv ers it y , Sc ho ol 

of M ed ic in e________ _____ . . 379, 502 125,000 25,0 00 25,0 00 25,000 25,0 00 25,0 00 125,000 25,0 00 25,0 00 25,000 25,000 25,0 00 129,502 25,192 25,1 44 25.000 25,0 00 29,166

TEXA S

B ay lo r U n iv ers it y ........................ 377,9 70

Co lle ge of M ed ic in e________Co lle ge o f D e n tis tr y .. .............

352,9 70 

25, 000

125,000

25,0 00

25,0 00

5,00 0

25,0 00

5,00 0

25,0 00

5,000

25,0 00

5,000

25,000

5,000

124,200 24,840 24,840 24,8 40 24,8 40 24,8 40 103, 770 25,221 25,2 23 25,480 25,2 88 2, 558

U n iv ers it y of T ex as..................... 731,3 45

S o u th w e s te r n M e d ic a l 

Sch oo l........................................ 380,678 

325,6 67 

25, 000

125,000 

125,000 

25,0 00

25,0 00

25,0 00

5,00 0

25,0 0025,0 00

5,000

25,0 0025,0 00

5,000

25,0 0025,0 00

5,000

25,0 00

25,0 00

5,00 0

125,000 124,956

25,0 00

25,0 00

25,0 0025,0 00

25,0 00

25,0 00

25,0 0025,0 00

25,000 24,956

130,678 

75, 711

25,576 25,5 60

25,432 

25,576

25,432 24,1 43

25,2 40 

288

28,998 

144 Sc ho ol of M ed ic in e_________ Sc ho ol o f D e n ti str y ..................

UTAH

U n iv ers it y of U ta h , Co lle ge 

of M ed ic in e....................... . 379,649 125,0 00 25,000 25,0 00 25,0 00 25,000 25,0 00 125,000 25,0 00 25,000 25,0 00 25,000 25,0 00 129,649 25,5 76 25,555 25,555 25,288 27,6 75

VERMONT

U n iv ers it y of V erm ont, Col ­

leg e of M ed ic in e.....................- 383,8 13 125,000 25,000 25,000 25,000 25,000 25,0 00 129,167 25,0 00 25,000 25,0 00 25 ,00o| 29,167 129,646 25,096 25,096 25,096 25,096 29,262
VIRGINIA

M ed ic al College of V ir g in ia ----- 369,322

Sc ho ol o f M ed ic in e ________ 344,322 

26,0 00

124,948

25,0 00

25,0 00

5,000

25,000

5,00 0

25,0 00

5,000

24,9 98

5,000

24,9 50 

5,000

125,000 25,000 25,000 25,0 00 25,000 25,0 00 94,374 25,1 92 25,1 92 25,192 48 18,750

Sc ho ol o f D e n ti str y --—. . —. —- .

U n iv ers it y of V irgi nia , College 

of M e d ic in e _____ _________ ______ — 380,379

394,8 04

125,0 00 25,0 00 25,000 25,0 00 25,0 00 25,0 00 124,629 24,9 48 24,9 48 24,948 24,837 24,9 48 130, 750 25,384 25,384 25,336 25,2 88 29,3 58

WASHINGTON

U n iv ers it y o f W a sh in g to n -------

College of M ed ic in e ______ 369,8 04

25, 000

125,000

25,0 00

25,0 00

5,000

25,0 00

5,000

25,0 00

5,00 0

25,000

5,00 0

25,0 00

5,000

125,000 25,0 00 25,0 00 25,0 00 25,0 00 25,0 00 119,804 25,576 25,5 76 25,5 76 25,2 88 17,788

College of D e n ti s try ,...............

WEST VIRGINIA

W est V irgi nia U n iv e rsit y ..........

College of M e d ic in e ........... —

234,9 52

219,9 52 

15,000

125,000

15,000

25,000

5,00 0

25,0 00

5,000

25,0 00

5,00 0

25,0 00 25,000 84,984 25,0 00 14,996 14,996 14,996 14,996 9,968 4,979 4,98 9

WISCONSIN

M a rq u e tt e U n iv ersit y ------------ 362,126

Co lle ge o f M ed ic in e _______

Co lle ge o f D e n ti str y .................

337,126 

25,0 00

124,786 

25,0 00

25,0 00

5,000

24,7 86 

5,000

25,0 00

5,000

25,0 00

5,000

25,0 00

5,000

125,000 25,000 25,0 00 25,0 00 25, COO 25,0 00 87,340 24,8 40 15,000 15,000 15,000 17,500

U n iv ers it y of W isco ns in , Col ­

leg e of M ed ic in e____________ 376,909

480,384

125,000 25,0 00 25,000 25,0 00 25,0 00 25,0 00 122,000 25,000 25,0 00 25,0 00 25,0 00 22,0 00 129,909 24,840 24,8 88 25,4 80 25,2 88 29.4 13

PUERTO RICO

U n iv ers it y of P u erto R ic o .........

Sc ho ol of M ed ic in e ............... 385.384

20,0 00

75,0 00

I2 5.00 0

20,0 00

25,0 00

5,00 0

25,000

5,000

25,000

5,000

25,000

5,000

25,0 00 129,167 25,0 00 25,0 00 25,000 25,0 00 29,167 131,217 25,576 25,5 76 25,5 76 25,2 88 29,201

Sc ho ol o f P u b li c H e a lth ------- 75,000 15,000 15,000 15,000 15,000 15,000
68 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

The Cl iairman. Medical schools obviously need teaching hospitals. 

You are quite familiar with the Hill-Burton program since it is 

administered under your direction. We would like to have inform ation as to what extent tha t program has been helpful in the construction and expansion of teaching hospitals.

I do not like to bring into this hearing, even by reference, any 

experience of my own State of Arkansas. I do know, however, th at 

in the case of the Arkansas Medical School this new construction and 

expansion has been rathe r extensive. In my judgment the results 

have been among the best in the last very few years tha t we have had 

in the United States. That has been accomplished, I believe, in part 

by the Hill-Burton program, but largely through certain special taxes 

which have been levied within our own State.

What we would like to know is if there is any overlap between this 

proposed new program and the Hill-Burton program insofar as 

teaching hospitals are concerned and, as I indicated to you in a letter, 

and as was mentioned yesterday, we have the health research facilities 

program. We amended that program last year, as you stated yesterday in your statement, and modified somewhat the definition of a 

“multipurpose facility.” Can you tell us what the effect of that 

change will be, and to what extent medical school teaching facilities 

may be constructed under that program? We would also like to know 

to what extent that has been done in the last 5 years.

Secretary Ribicoff. Mr. Chairman, we will be very pleased to 

supply all the information and the answers to the questions in very 

short order. We will have it for the committee.

The Chairman. In doing so, I know you will make it as brief as 

you can. Would you then give us copies of it so each member of the 

committee could have a copy? We can’t wait until the record is 

printed for this purpose and the committee should have that information.

Secretary Ribicoff. All right.

(The information referred to above follows:)

H ea lt h R es ea rc h F a cil it ie s Const ru ct io n

The effect of the change in the definition of the kind of facilities eligible for 

matching gra nts under the health research facilities program is to remove the 

previous rigid distinction between that portion of a facility which was for health 

researc h purposes, and, therefore, supportable under this program, and the other 

portions of the facility which may have been used for other purposes which were 

not supportable under the prior concept, whether the other purposes were research rela ted or not. Thus, those laboratories and space to be utilized for 

graduate level research training in a resea rch building are now eligible for Inclusion in a health research facility gran t along with the reg ula r health resea rch 

laboratory space of the building, whereas under th e prior limited definition space 

used exclusively for research training purposes w’ould not have been supportable. 

Medical school teaching facilitie s—that is classrooms and labo ratory space for 

und erg rad uate medical students—are not eligible for support under the health 

research facilities program even under the broadened definition referred to above. 

Since such und ergraduate medical school teaching facilitie s have never been sup ­

portable under this pro gra m; no funds have been utilized for th at purpose in the 

last 5 years.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 69

Teaching H ospit al Constru ction U nder th e H ill-B urton P rogram

During the l ast 5 fiscal years, GO teaching hospita l projects owned and opera ted 

by universities or medical schools have been approved under the Hill-Burton program. These projects cost a total of over $71 million and were allo tted Fed eral 

Hill-Burton fund s of nearly $16 million. Generally, those Sta tes with only 

one medical school allo t some Hill-Burton funds for construction of teach ing 

hospitals. It is not alway s possible to use Hill-Burton fund s for this purpose, 

however, in those States which have seve ral medical schools since the demands 

on relatively small a llotm ent of Hill-Burton funds would be excessive.

There is no possible overlap between the Hill-Burton program and the program which would be authorized by the bill under consideratio n. Section 

721(c) (6) specifically provides that under the proposed legislation the Surgeon 

General may approve aid for constructing a hospital or diagnostic or treatm ent 

center as defined in the Hill-Burton legislation only if an application has been 

filed for assistance under the Hill-Burton program and aid has been denied because the project has no sufficient priority or fund s are not available for the 

project from th e Sta te allotm ent of Hill-Burton funds.

Secretary Ribicoff. Mr. Chairman, a few questions were asked yesterday and we were able to get information overnight tha t might be 

of interest to you and the committee. You may recall we mentioned 

the DeWitt report. This is the DeWitt report which was prepared for 

the National Science Foundation by the Office of Scientific Personnel 

of the National Academy of Sciences and the National Research 

Council.

There is a very interesting figure that might interest the committee 

on page 453 of that report which indicates that between 1928 and 1959 

the Soviet Union graduated and trained 420,000 doctors. During the 

period of 1926-58, the United States graduated and trained 181,700 

doctors.

The Chairman. This is what year ?

Secretary Ribicoff. This is 1926 to 1958 against the Soviet’s 1928 

to 1959; in other words, 32 years for the United States and 31 years 

for the Soviet Union. They just overlap a little bit: 420,000 for the 

Soviet Union and 181,000 for the United States. In other words, the 

Soviet Union trained 2.3 times as many as the United States.

Another question was asked about these foreign doctors, their place 

of origin, and from what countries they came. The specific question 

asked was about England. Our figures show that in 1960, out of some 

2,000 foreign-trained physicians licensed by State board examinations, 

including some Americans—it is not just foreign doctors, but Americans trained abroad—the figure from England is 95. Some of the 

other countries with large figures, much larger than England, include 

Germany, with 199; Italy, 264: Spain, 101; Switzerland, 196; and 

Mexico, 94.

We will be pleased to give you a complete breakdown of the place 

of tra ining of the foreign-trained physicians licensed in 1960, country 

by country, to be inserted at this place in the record.

(The complete breakdown referred to above follows:)

P lace of T ra ining of F oreign-T rained P hysi ci ans

No (lata are available to show the country of origin of the 1,000 gra duates 

of foreign medical schools who are newly licensed in the United States each 

year. In 1060, some 2,000 foreign-trained physicians (including some Americans) were licensed by State boards on the basis of passing exam inations.
70 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

This figure includes some duplications. The 2,000 physicians were graduated 

from medical schools in the following countries :

Eu rop e:

Au stria___________________ 44

Belgium___________________ 33

Bulgaria__________________ 3

Czechoslovakia_____________ 13

Denmark__________________ 5

Eng land___________________ 95

Ire lan d____________________ 06

Scotland__________________ 30

Wales_____________________ 2

Eston ia_____________________ 3

Fra nce _________ 27

Germ any___________________ 199

Greece____________________ 05

Hungary__________________ 95

Ita ly_______________________204

Latvia____________________ 10

Lithuania_________________ 0

Netherlands_______________ 07

Norway___________________ 3

Poland____________________ 22

Portugal__________________ 2

Ruman ia__________________ 12

Spain______________________ 101

Sweden___________________ 2

Switzerland_________________ 196

U.S.S.R___________________ 9

Yugoslavia_________________ 17

Australia______________________ 8

New Zealand__________________ 5

Philippines____________________ 73

Central and South America :

Arg entina__________________ 28

Bolivia____________________ 4

Bra zil_____________________ 7

Chile______________________ 5

Colombia__________________ 8

Ecu ado r___________________ 5

Guatemala_________________ 2

Hondu ras__________________ 2

Mexico____________________ 94

Nicaragua _________________ 1

Parag uay__________________ 4

Pe ru______________________ 16

Asia:

Ch ina _______________________ 32

Formosa___________________ 2

Hong Kong________________ 1

Ind ia______________________ 18

Iran ______________________ 32

Iraq ______________________ 6

Isr ae l_____________________ 6

Japa n_____________________ 14

Korea_____________________ 28

Lebanon___________________ 30

Pakis tan __________________ 1

Turkey____________________ 28

Africa:

Egypt-------------------------------- 29

South Africa_______________ 8

West In di es :

Cuba_______________________ 77

Dominician Republic__________ 31

Haiti_______________________ 10

So ur ce : Council on Medical Ed ucation and Ho spitals of the Am erican Medical Association . Medical Lice nsure St at is tics fo r 1960. Jo urna l of the American Medical Asso ciation, 

176. pp. 693-738, May 27, 1961.

Th e Chair man. Tha nk you, Mr. Secre tary. Mr. Ja rm an ?

Mr. J arman. Air. Ch airm an , I have no questions at this time. I 

would like to join in welcom ing th e Secre tar y and com plime nting him 

on his very able pres entation . I would also like to add, Mr. Chairma n, 

th at Dr. M ark R. Ev erett, d ire ctor and dean o f th e U nive rsi ty of O klahoma Medical Center, in Oklahoma City, is here wi th us and will 

tes tify to the comm ittee lat er, specifically on the needs of our own S tate 

and on how H.R. 4999 will aid mate ria lly in me eting those needs. 

Th an k you.

The C hair man. Mr. Nelsen ?

Air. Nelsen. Th an k you, Air. Ch airma n. Air. Secre tar y, I would 

like to reem phasize the point th at was brou gh t up by Air. Rob erts 

rega rd ing doctors in ru ra l areas. I have in mi nd UaKe Cr ystal, Minn., 

and Ka sot a, M inn., where the local citizens bu ilt a clinic and a you ng 

doctor came in only to leave in a short tim e and the bu ild ing stands 

empty. A beautiful facil ity , b ut no one seems t o wan t to come o ut to a 

sma ll ru ral com munity, and it seems to me th at there might be some 

me rit to the provision th at is in the N ati onal Defense Ed ucation Act 

whe re loan s a re mad e and a c ertain forgiveness is app lied to the loan 

if a studen t teaches school, so I made i t my business to check a b it on 

the performance o f the Na tional Defense Ed uc ati on Ac t and it is my
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONN EL 71

un de rstand ing th at the perfo rm ance has been very good, and I quite 

agree th at in this pa rti cu la r bill th at we are discussing a loan featu re 

has me rit.

I t seems to me tha t any good citizen would like t o have a chance to 

pa y it back i f he can, b ut I do t hink th ere shou ld be some libe ral p ro ­

visions in the bill where forgiveness can be appli ed in case of har dship, bu t certa inly we like to see a stu dent who has a loan wi lling to 

pay it b ack if he can, and ha ving in mind thhe long-r ange picture .

Now, in the Defense Ed uc ati on Ac t repaym ent has been $1,951,260 

alread y and this act was passed in 1958. It did no t go into effect 

really un til 1959 a nd in that sh ort time there has been a r epayme nt of 

$1,951,260 a nd th e record shows 12,785 b orro wers, so these n otes say— 

I presum e th at is schools—with 238,928, or a qu ar te r of a million 

yo ungster s invo lved.

I f thi s prog ram were to go into effect wi th a loan feature in it a nd 

if the repayment rec ord cou ld be as good as un de r the National Defense 

Ed uc ation Act, look ing ou t ahead we wou ld hav e money com ing into 

the fund to repe at on wh at we are t ry in g to do un de r this bill, and I 

believe we s hould give serious t ho ug ht to a loan feature in th is bill if 

it becomes law. Tha t is my com men t, Mr. C hairm an.

Th e Chairm an. Mr. O'Br ien .

Mr. O 'Brien. Mr. Se cre tar y, I listen ed very ca refully to yo ur te stimony yesterda y. I wan t to comm end you for it. I am very strongly 

in fav or of the purposes of th is bill and I assure you th at yo ur t estimony did no t weaken my fee ling in th at respect. I would like to 

ask one question just so we can have it emphasize d at th e p ro pe r point 

in the record. You gave those figu res this morning th at were requested ye ste rda y on th e numb er o f do ctors gr ad ua ted fro m the S oviet 

Un ion compar ed to the United Sta tes. As I r ecall, y ou said y ester day 

th at we shouldn ’t be too deceived by num ber s because the trai ni ng 

was not as good as our doctors receive. Is tha t correct ?

Se cretary Ribicoff. That is correct.

Mr. O’Brie n. They in effect tu rn out people who wou ld be doctors 

by courtesy o nly in th is co untry , I assume.

Se cre tar y Ribicoff. I wou ld say there is no que stio n th at v ery few 

of them could qualify un de r Am erican sta nd ards, wh ich are very 

str ict, an d wi th the num ber of y ears o f professional t ra in in g required. 

I would say th e Am erican sy stem o f trai ni ng do ctors is w ith ou t question of the hig hest sta nd ard, with the most s tri ng en t req uir em ents of 

any n ati on in th e world.

I cite thes e figures to ind ica te th at the y have a dif fer ent system. 

They are trai ni ng a numb er of doc tors which gives the m a surpl us, 

and many of these physicia ns certa inly do good wor k in ma ny places 

in the world th at do n't have the same sta nd ards t hat we have in the 

Un ite d States.

Mr. O'Brien. Yes. In othe r words, we are not doing such a bad 

job. It is ju st th at we have such high requirements. Has t he re been 

any thou gh t at all, Mr. Se cre tar y, or have you he ard any one in the 

medical pro fession discuss the pos sibility of estab lis hing in thi s 

country wh at might be so rt o f a second-grade ty pe of doc tor?

Se cre tar y Ribicoff. We ll, there has been some talk , bu t I would 

be ag ain st it and I guess most Am erican s would be ag ain st it. We 

don’t figure there should ever be a second -grade docto r ta ki ng care
72 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSO NNEL

of an American person. I think we are entitled to the highest qualities 

and I am sure all of us are very proud of the type of training th at we 

have for the physicians of th is country. Wha t we are seeking in this 

act is to make sure it continues this way. Tha t is why I gave you some 

figures indicating the drop in the A students in recent years. We 

would like to make sure tha t the quality of the men who go 

into the medical profession continues on the highest possible level in 

our Nation.

Mr. O’Brien. I agree with you, Mr. Secretary, but I wanted to 

say we not only want more doctors; we want more good doctors.

Secretary Ribicoff. Yes, sir.

Mr. Friedel. Would the gentleman yield ?

Mr. O’Brien. Yes.

Mr. F riedel. I am sorry that I have to leave. I have to go to another committee, but in our audience we have Rabbi Morris Lieberman, chairman of the Subcommittee on Medical Education and Research, Committee on Medical Care, Maryland State Planning Commission. He worked on this program and he will testify later. I just 

wanted to pay my respects to Rabbi Lieberman. Than k you.

Mr. O’Brien. I am glad to yield to the gentleman and I might say 

tha t I also have a distinguished witness in the audience from my hometown, but I am going to wait until he testifies. That is all, Mr. 

Chairman.

The Chairman. Mr. Curtis.

Mr. Curtin. Thank you, Mr. Chairman. Mr. Secretary, I too listened with much interest to your statement yesterday. I believe you 

touched lightly on the question of optometry.

Secretary Ribicoff. Yes, sir.

Mr. C urtin. What is your opinion as to the adequacy of the facilities and the persons trained in this field ?

Secretary Ribicoff. I would say that the optometrists are being 

well trained and they are competent, but it is our understanding that 

the need isn’t as great in the field of optometry as it is in the field of 

physicians and dentists, and, of course, you have to star t somewhere. 

A number of careful studies and surveys have been made in the fields 

covered by this bill. Such studies have not been made in the fields of 

optometry and veterinary medicine, and many other very worthwhile 

branches of the health professions. An advisory committee to the 

Surgeon General is now making a study of nursing. I would hope 

tha t while studies were being made in these important fields we would 

not delay placing on our statute books legislation that is so needed in 

the field that we are discussing today, Congressman Curtin.

Mr. Curtin. Then you did consider the possibility of the need of 

optometry when you were making your studies on this program?

Secretary Ribicoff. The studies in medicine and dentistry have 

been going on for sometime. To mv knowledge there hasn’t been a 

national study of the same scope in the field of optometry.

Dr. Terry. That is correct.

Secretary Ribicoff. But these studies were started d uring the Eisenhower administration with the appointment of the Bane Committee, 

which was composed of many distinguished members. It is a problem tha t has been brought to the attention of many of us for many, 

many years.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSON NEL / 3

Now, of course, as I indicated yesterday, within a few months we 

will have completed a study in nursing, and I guess there is a limit of 

how many studies can be going on at the same time, Congressman 

Curtin.

Mr. Curtin. Bo I understand then that you don't feel there is any 

need to include optometry in this particular legislation?

Secretary Ribicoff. I don’t think so.

Mr. Curtin. That is all. Thank you, Mr. Chairman.

The Chairman. Mr. Moss.

Mr. Moss. No questions, Mr. Chairman.

The Chairman. Mr. Sibal.

Air. Sibal. Thank you, Mr. Chairman.

Mr. Secretary, it is always a p artic ular pleasure for me to have you 

appear before our committee so we can renew our old association and 

acquaintance. I am interested in the identical approach the proposed 

legislation takes to the basic medical school, the osteopath study, and 

the dental study. Is it your opinion that the need in all these areas is 

identical ?

Secretary Ribicoff. I would say that the need is equally great in all 

of them. They are all considered to be p art and parcel of the basic 

health professions. We would be proceeding in proportion, basically, 

to the number of schools of each and where the problems are. The 

shortage of dentists is even greater relatively than the shortage of physicians—twice as great, as a matter of fact. This is a great problem in 

the dental field, and of course today the osteopath, who is licensed to 

practice medicine has a role to play too, but the number of osteopathic 

physicians is proportionately much smaller than tha t of doctors of 

medicine and dentistry.

Mr. Sibal. The statistics which you gave are most helpful in terms 

of the apparent reduction in quality of applicants for medical school. 

Would these statistics apply to osteopathy and dental schools too?

Secretary Ribicoff. We don’t have data on the grades in dentistry 

and we don’t have the grades in osteopathy comparable to what we 

gave yesterday, relating to the number of A students applying to medical schools, so all it would be would be an educated guess. However, 

there are representatives that will be testifying from dental schools 

and the dental profession and I think it would be pertinent, Congressman Sibal, to ask tha t question of them from their own personal 

experience.

Mr. Sibal. Mr. Williams touched on a problem which from one point 

of view or another most Americans are concerned with these days and 

tha t is the question of the administration of these programs in areas 

where possible promulgations of policies of admission which some 

might consider discriminatory might exist.

Do you have any feeling as to whether or not this legislation is a 

proper vehicle for considering this problem in terms of Federal 

participation?

Secretary Ribicoff. Well, I would hope that this legislation would 

not be the vehicle for such consideration. We have a basic problem 

here. It is my feeling that in this legislation we should not attempt 

to set the standards or admission policies in all of the medical schools, 

private and public, throughout our Nation. What you have here is 

a proposal that each school should determine who gets the scholar80014—62-
74 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

ship s. I am sure th at throug ho ut the Un ite d States the re are sufficient medical and denta l schools so th at a qualified person would find 

sch olarship aid or a fac ility, no matt er what his race, color, or creed 

may be, and it is our hope th at this leg islation would pass.

We believe it is vital and necessary and we have trie d not to involve 

th is legislation with man y of th e problems th at I believe the C ongress 

should address them selves to dire ctly .

Mr. Sibal. But wo uld n’t this be one way of addre ssing ourselves 

dir ectly to this problem ?

Secre tary Ribicoff. You could addre ss yo urself to this prob lem, 

Mr. Sibal, but I think you would fai l in pas sag e of this legislation . 

Th is problem we will have to face up to as a Na tio n and face up to 

directly. It is my hope th at we could eliminate th is problem of 

discriminat ion as rap idly as possible throug ho ut ou r cou ntry. I believe th at gre at stride s are bein g made throug ho ut our Nat ion. I 

believe great stride s will continue to be mad e, but the surest way to 

doom thi s legislation , which would he a grea t tra ge dy , would be to t ry 

to force upon such an important measure an othe r im po rta nt issue. 

I do n’t downgrade the issue at all, sir, but I think it would be most 

un fortu na te f or every person in this co untry, no m atter what his race, 

color, or creed may be, to have this N ation wi tho ut the sufficient sup ply 

of medical and den tal personnel to care for all people.

Mr. Sibal. Well, I am in complete agreem ent with that, bu t it is 

difficult for me to un derst and why thi s legislation would be doomed. 

As 1 recall, both ma jor political parti es cle arly have endorsed the 

principle of non discriminat ion in terms of th ei r natio nal platfo rm 

and in the uttera nces of the national leaders, and it would seem to me 

th at if we did not req uire a medical school before it pa rticipated in 

the very obvious benefits which would accrue to it from Federal 

moneys fo in fact admit ou tst an ding students, which is the purpo se of 

this, to increase the numb er and q uality of ou r phy sicians, and which 

school did not s imply because of their race or creed or color, somehow 

or o the r we are in effect com pou nding the felony, to use a legal term .

I t seems to me th at we can provide legal and moral leadership on 

the Feder al level if we sim ply say we don't necessarily require th at 

you pa rti cipa te, but say that if you want to pa rti cipa te in this pr ogr am you cannot turn boys o r g irls down except fo r good and sufficient 

academic reasons.

Secre tary Ribicoff. Well, let me say this . I would hope th at every 

college a nd u niv ers ity and eve ry school in this Na tion would eliminate 

discrimination, th at we would have no seg reg ated schools anywhe re 

in this Nation . Th is is a problem that wi thou t question bedevils our 

society. Yet until these policies are adopted loca lly, statewide, and 

natio nally , I am still inte rested in the he alt h of people in com mun ities and State s that may or may not agree with whate ver p hilo sop hy 

I may have in these fields.

These States and these communities should have hea lthy people. 

I think tha t a healt hy co mm unity and a health y peop le is a great asset 

to our Nation , and I think the re certa inl y will come a day when segregation and dis crimination will end in all pa rt of the Un ited Sta tes, 

but I would hope th at we would look at this bill on its own merits, 

and I would hope that the Congress of the Un ite d State s would be 

willin g to face up to the civil rig hts issue on its merits and not try
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 75

to use other good legislation as a vehicle to force this issue. These 

are important issues and this is an important bill.

Mr. Younger. Mr. Chairman, would the gentleman yield?

Mr. Sibal. Yes, be happy to yield.

Mr. Younger. Mr. Secretary, I don’t think you have answered the 

question. You made a statement that an injection of this principle 

into the bill would defeat it. Now, why ?

Secretary Ribicoff. Well, because I think I am aware of the political facts of life, Congressman Younger. I read the newspapers 

and know what the temper and tenor of Congress is on this issue, I 

would hope.

Mr. Younger. Just a minute. Are you accusing Congress of being 

opposed to the principle of desegregation, et cetera?

Secretary Ribicoff. I follow the newspapers and the Congressional 

Record, sir.

Mr. Younger. Well, again you don’t answer the question.

Mr. Williams. You mean privately or publicly ?

Mr. Younger. That is what I am trying to get at. I would like 

to find out. You made a statement about Congress, as to our attitude.

I want to know why you think Congress would defeat this bill if the 

race, creed or nationality was injected in it. I don’t believe it. I am 

a Member of Congress. You have made the statement about Congress. Now, why ?

Secretary Ribicoff. Congressman Younger, may I ask you what 

measure that Congress has had before it has passed that contained this 

type of a provision ? Will you give me an example of a measure that 

has had success on the floor of this Congress ?

Mr. Younger. Yes; on educational bills we have put it in every 

t ime the educat ion bill has been up.

Secretary Ribicoff. Does it pass with that condition ?

Mr. Younger. It passed the House, yes.

Secretary Ribicoff. lia s it passed both liodies? It takes action by 

both tiodies before it becomes a law.

Mr. Younger. I don’t think it was on account of that. There were 

other principles which were involved. I think that we have as good a 

record probably as the administration on this point.

The Chairman. Let the Chair say that he hopes the hearings will 

not get bogged down in the expression of opinions between this witness and the members. After all, Members of Congress decide what 

they are going to do on any question and I think the Secretary has 

a righ t to express his opinion on this or any other question just as each 

member.

Mr. Younger. I yield the floor.

Mr. Sibal. Thank you. I am concerned about some action in this 

whole area, not just expressions of philosophy which you have expressed and which I am in complete accord with, and I recognize the 

problem, but I wonder, and I would like your expression on this, if 

somewhere along the line we cannot expect some leadership from the 

administration in this area and if this wouldn’t be the kind of place 

where this leadership can be exercised.

Secretary Ribicoff. I would say, Congressman Sibal, tha t this 

administration doesn’t have to apologize for its leadership in this 

field of action. I think the conduct of the President in his Executive
7 6 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

orders on the employment practices, the appointment of Negroes to 

high public office and responsibility, and the bringing in at lower 

echelons of qualified Negroes, is a record tha t has never been equaled 

before in the history of this country, or by the prior administration. 

I am proud to be a member of an administration tha t has done so 

much.

Mr. Sibal. ITow about the Negro medical student ?

Secretary Ribicoff. 1 would say that a qualified Negro medical 

student will find a place among the medical schools of this country. 

While he m ight not be admitted in some of the Southern States, I believe that there are many States in this country tha t are only too glad, 

and many medical schools tha t are only too glad, to take a qualified 

Negro medical student. I believe that no qualified Negro medical 

student fails of admission to a medical school somewhere in the United 

States. These scholarships, of course, would be available throughout 

the country. I mean, if he were qualified and in need, whether he 

went to Harvard, or Michigan, or Ohio State, the scholarship would 

be just as available to him as if he went to Mississippi or Arkansas.

Mr. Sibal. And conversely, it would be just as available in Mississippi and Arkansas to somebody who, you might say, earned admission over this boy strictly on the basis of his race ?

Secretary Ribicoff. I would say that under this bill each school is 

going to have to administer its own affairs. Each school will have 

its own admission policy. Do I understand tha t you would like the 

Federal Government to write into its legislation the control of the 

local admission of students? This is one of the problems that complicates all educational programs, the so-called Federal control issue.

We have tired to preserve in all educational measures that have 

come before this committee or any committee of this House in any 

field, complete local autonomy. We have drawn our legislation in 

such a way that the Federal Government could not interfere in the 

practices and administration of programs that go through Congress. 

To sta rt writing in the qualification that you would ask us to do would 

mean we would be in the position of controlling the entire administrative practices of every medical school and dental school in the 

country. I don’t think that Congress wants us to do that.

Mr. Sibal. I would disagree with that, but tha t is another question. 

What T am trying to do really is not to in any way dictate the internal 

policy, as I indicated earlier,* but if Federal participation is involved 

and we have the law of the land insofar as the Federal Government is 

concerned clearly defined by the Supreme Court, then I think that is 

quite a different question.

If the Federal Government participates with its money, it seems 

to me we should have every right to expect that the Federal law would 

be followed. I have no further questions, Mr. Chairman.

The Chairman. Mr. Rogers?

Mr. Rogers of Florida. No questions, Air. Chairman.

The Chairman. Governor Thomson ?

Mr. Thomson. Governor, did you say. yesterday tha t you would 

have no objection to writing into this bill a requirement that these 

scholarships be repaid on some terms or in some proportion?

Secretary Ribicoff. I said this: If there was an inclination on the 

pa rt of the committee to substitute this provision for our grant
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 77

scholarship proposal I would hope that our staff would have the opportu nity to consult with your staff in the drafting of these proposals 

to make sure that the ends that we sought to accomplish were actually 

being accomplished. I think there are many formulas that could 

be adopted and it has to be very carefully drafted.

I personally am for outrig ht scholarships, and not a loan program. 

1 was just offering our staff services in the event this committee during 

its deliberations thought that it preferred the loans, because I think 

they have to be carefully d rafte d not to be self-defeating.

Mr. Thomson. Congressman Roberts talked about the inadequacy 

of medical and dental people in rura l areas, and I think there are large 

areas where it is easily identified as an area in need of tha t type of 

service. Would you have any objections to requiring tha t at least 

part of these grants be in the nature of scholarships which would be 

repaid if the recipient did not serve a certain length of time in the 

public health field, or in the military field, or in the field of evident 

need for th at p artic ular type of service?

Secretary Ribicoff. You mean the forgiveness feature?

Mr. Thomson. The forgiveness feature if they served in those fields.

Secretary Rtbicoff. I would say if this committee decided to go to 

Ihe loans I would strongly advocate t hat such a provision be written 

in to encourage men and women in these fields to go into the lowerpaid areas where the need is great.

Mr. Thomson. Is the purpose of the outright grant merely to attrac t these qualified people to this field that is so badly needed?

Secretary Ribicoff. This is one of the purposes, to attrac t these 

people, qualified people, to the field of medicine and dentistry. I 

think, too, it would encourage people to go into the lower paid parts 

of the medical and dental professions if they did not have a debt, 

hanging over their head. I recognize that if there was a forgiveness 

over a period of years this might also help to induce people to go into 

those fields. I do recognize the validity of that particular point. 

Governor Thomson.

Mr. Williams. Will the gentleman yield at that point?

Mr. T homson. Yes.

Mr. Williams. We have such a program in Mississippi, a State p rogram of scholarship loans to medical students. As I understand it, 

those loans are made and the student promises to practice medicine 

after graduation in a community of some 5,000 people or less for a 

period of 5 years. If he fails to carry out that promise, then he is 

obligated to repay that scholarship loan with interest. If he carries 

out that promise, a t the end of the 5 years it is forgiven, and we have 

found that that program has been very successful in providing an incentive for doctors to go to rural areas.

We don’t suffer the same acute shortage of doctors in the rural 

areas that so many other sections of the country do.

Mr. Collier. Will the gentleman yield for one question at that 

point?

Mr. T homson. Yes.

Mr. Collier. Mr. Secretary, has there been a categorical breakdown 

or is one available, that would show how many doctors presently are 

general practitioners, and how many in fact are specialists in some 

field? If that could be submitted for the record th at would be satisfactory.
78 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Secre tar y Ribicoff. We could. We would be gla d to submit those 

figures to you.

Th e C hairman. You m ay sub mit it f or the record.

(T he in for ma tion r eferred to above follows:)

Type of practice of physicians, 1959 (48 States and Dis trict of Columbia)

Type of practice Nu mb er of Percent of 

physic ians physicians

All physicians............................................—

Active non-Federal physicians..........................

Private practice................................ . .............

General practice and p art-time specialty.

Full-time specialty....................................

Hospital se rv ic e___ __________________

Training programs__________ _____

Other full-time staff_________________

Teaching, administratio n (full-time)______

Medical school staff_________________

Medical adm inistration______________

Research....................................... . ...........

Public health, industry, insurance_____

Federal Government ervice________________

Not in medical practice.........................................

Retire d_____ ____ ________________ .....

Other th an medical p ractice.. ........................

236,089 

208,253 

160,592

81,957 

78,635

39,730

24,818 

14,912

7,931

2,780 

682 

601

3,868

17,519

10,317

7,177 

3,140

100

88

68

35

33

17

11

6

3

1

2

7

4

3

1

i Less than 0.5 percent.

Source: Health Manpower Source Book 10. Public n ea lth Service Pub lication 263, sec. 10.

Type of practice of osteopathic physicians, 1961 (50 Sta tes and District of

Columbia)

Ty pe of practice Num ber of Percent of 

physicians physicians

All physicia ns...........................

Private practice ................................

General practice_____________

Part-tim e specialty............ ..........

Full-time sp ecialty___________

Full-time m anip ulative therap y. 

Hospital service..................................

Internship__________________

Residency....... . .............. . ...........

Assistants hip or fellowship____

Other full-time staff__________

Other practice....... . ............................

Full-time college fa cu lt y...........

Federal G overnment_________

Other medical practice................

Not in practice__________________

Retired____ ________________

Not in practice.............................

Unknown practice___ ___________

14,350

11,034

6,557 

2,080 

1,150 

1,247

1,012

431

298

55

228 (')

100

77

46

14

8

9

7

3

2

2

1

1

130

98

1,188 8

1,061 7

127 1

986 7

1

 Less than 0.5 percent.

Source: Pennell, Maryland Y. Osteopathic College Alumni. Submitted for publication in Jour nal 

of American Osteopathic Association.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 79

Dr. Terry. If I may, Mr. Chairman, I would like to call your attention to this publication—the Health Manpower Source Book, section 10, which has been prepared by the Public Health Service. It 

goes into great detail with regard to physicians' age, type of practice, 

and location, and also with regard to cities, counties, and States. 

I believe it would be of interest to the committee.

The Chairman. You may submit that for the files and information 

of the committee, I)r. Terry. We will be glad to have it.

Dr. T erry. Thank you, sir.

The Chairman. Do you have extra copies of it ?

Dr. Terry. Yes, sir; we can provide them, sir.

The Chairman. Thank you.

Mr. Springer. Mr. Chairman. Governor Thomson, would you yield 

for just one question?

Mr. T homson. Certainly.

Mr. Springer. Can you tell me in general terms whether or not 

statistics indicate at the present time th at there is an overall shortage 

of physicians, doctors, and nurses, in this country and if there is a 

shortage, could you tell this committee approximately what it is?

Dr. Terry. This question of whether there is a shortage or not involves a judgmental factor.

Mr. Springer. That is a debatable question at this time ?

Dr. Terry. There is obviously a shortage in certain localities, particularly in our small towns and more rural areas, but whether one 

can say tha t there is an overall national shortage of any specific size 

or number is open to question, sir.

Mr. Springer. Thank you.

The Chairman. Mr. Hemphill?

Mr. Hemphill. Thank you, Mr. Chairman. Mr. Secretary, I received a call yesterday afternoon and was asked to inquire if optometrists were included in the scope of this legislation. Are they, 

sir?

Secretary Ribicoff. No, they are not. I think 1 have answered tha t 

question three times. 1 will be glad to do it again. In the first place, 

we don't find tha t the basic need is as great among optometrists. 

There has never been a national survey or study on this problem as 

there has been regarding dentists and the doctors.

Furthermore, we have to make a start on the basic needs. We believe the basic needs are here and it would be most unfortunate if 

we would hold up or fail to take into account the supplying of the 

basic need waiting for the surveys in every health field.

Mr. Hemphill. I am sorry if I asked you to repeat the answer. 

I didn't hear you yesterday and I was here most of the time. I had 

to go out for 10 minutes; but the legislation is confined absolutely to 

doctors, dentists, and osteopaths ?

Secretary Ribicoff. That is correct, Congressman Hemphill.

Mr. H emphill. Thank you.

The Chairman. Mr. Dominick?

Mr. Dominick. Thank you, Mr. Chairman. Mr. Secretary, if I 

may, I would like to dig in a little bit on this question of need. You 

have lumped in this bill three or four categories of people. Do your 

records show which is the most needed from the point of view of 

health service—dentists, or osteopaths, or doctors ?
80 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Se cre tar y Ribicoff. In the pro jected req uirements fo r den tists, the 

pre sen t num ber of denta l grad ua tes is 3,200. Th e numb er who will 

be grad ua ted in 1975, at presen t and planne d levels of gra duate s, 

wou ld be 3,500. Th e n um ber o f g radu ate s needed in 1975 to m ain tai n 

the 1959 ratio o f den tists to population is 6,200. Th e prese nt numb er 

of first-year den tal school places is 3,600. Th e numb er of first-y ear 

places needed in 1971 to pro vid e 6,200 gradu ates in 1975, alll owing f or 

about 10 pe rcent attriti on , dr op ping out, is 6,900. So you find a v ery 

gr ea t need in the field of de ntistry as we t ake the ratio of d entists to 

populat ion , us ing the 1959 figures.

Mr. Dominic k. Would you say th at de ntist ry the n is the most im ­

po rtan t item t hat we should get to ?

Secre tary Ribicoff. I would say it isn’t the most im po rta nt item, 

bu t if you take the percen tage of need the prop or tio n of pro jected 

short age is greater in the denta l profession th at it is in the medical. 

How ever, I th ink we need more doctors, too.

Mr. Dominic k. I know th at is you r opinion. I ga th er th at this is 

a question of opinion as to wh eth er we have a shortag e o f do ctors now 

or no t. Is i t also a question o f opin ion as to whether we have a sh ortage of dentists now o r not ?

Secre tary Ribicoff. Well, we believe ev erything is a question of 

opinion . I would suppose, li ste nin g to the gen tlema n fro m Min nesota 

and the gen tlem an from Ala bam a, th at if you wou ld talk to them 

about, their respective State s, the y would tell you definitely the re is a 

sho rtage. Th is becomes a grav e problem. Th ere m ay not be a s ho rtage in a prosperous com munity , or many pro spe rou s com mun ities in 

the U nited States. Th e sup ply may be ample, bu t unless we p roduce 

more d octors I don ’t know how we a re going to ta ke c are of the problem in Mr. Rober ts’ district or the p roble m in, I believe, Air. Nelsen’s 

distr ict.

Mr. Dominick. I jet me go on a little fu rthe r. I wa nt to get this 

dow n fo r the record. Wou ld you say, the ref ore, th at from the p oin t 

of view o f d entists and doctors, pa rt of the problem is in distribu tio n, 

where th ey are located ?

Secre tar y Ribicoff. I would say th at t hat would rep res ent par t of 

the problem, b ut I am also thinking ahead and not wo rry ing so much, 

sir , about today. I am wo rry ing about the pro blems 10 yea rs from 

now. I do think we have an obligation to wo rry about our Na tio n’s 

fu tu re in the problem s of vital health needs with a gro wing p opula tion 

and a continuin g req uirement o f a dditio nal med ical c are as o ur h ealth 

discoveries con tinu e and our p opula tion g row s older.

Mr. Dominick. Would you say th at part of the problem th at we 

are faced with at th e prese nt mom ent is sim ply distr ibu tio n?

Se cre tar y Ribicoff. I would say th at th at is part of the problem, 

yes.

Mr. Dominic k. Would you say th at this bill if passed is going to 

cha nge the situ ation with resp ect to distr ibution?

Se cre tar y Ribicoff. I would say it would cha nge it in this respect. 

If a young man or woman graduates from a denta l or medical school 

heavily in debt, I th in k he or she will gr av ita te tow ard the community where the fina ncia l return would be the high est to enable such 

an ind ividual to pay of! the debt so much fas ter .
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL SI

It is my feeling th at if such pers ons were no t in debt, they migh t 

follo w their na tura l proclivitie s to go to the com munity th at might 

mean the most to them , to go back to th ei r hometow n or go back to 

where the ir fam ily may be.

Mr. Dom inick. Th ere is nothi ng in this bill which would orien t 

any of the new’ grad ua tes who would be obtained presum ably if we 

build these schools to go into the areas where the re is a sho rtage of 

doc tors or dentists , is th ere ?

Secre tary Ribicoff. I would hope the day would neve r come in the 

Un ite d State s when by any legi slation we would tell anybody where 

to live or where to e arn a living. I would certa inly be again st wr iting 

into any legislation a req uir em ent as to where a person s hould live or 

practic e his pro fession or business.

Mr. Dom inick . Have you received any assurance th at any new 

schools w ill be bu ilt i f th is bill is passed?

Secre tary Ribicoff. In talking to the deans of the medical schools 

we have had an ind ica tio n from them th at they would expan d their 

schools. Fr om con versations with peop le from aro und the country 

the re is an ind ica tio n th at the re would be an int ere st in build ing 

schools if they ha d Fe de ral con trib utio ns.

Mr. Dom inick. W here would this be ? Do you know ?

Secre tary Ribicoff. From Medical Ed uc ation in the U nited Sta tes, 

Jo ur na l of the Am erican Medical A ssociat ion, vol. 178, No. G, November 11,1961. I w ill read th is par ag ra ph:

Five universities are now developing plans for estab lishm ent of new medical 

schools. Brown and Rutgers Universities during the present year announced 

decisions to ini tia te 2-year programs in the basic medical sciences. Earlier 

commitments by the Universities of Connecticut and New Mexico for the development of 2-year schools have been furthered by the acquisition of construction 

and planning funds from the ir State governments and the Kellogg Foundation. 

In Texas, a site has been selected in the San Antonio area and funds have been 

committed for the establishm ent of the South Texas Medical Center. This will 

be developed as the third medical schol of the University of Texas and construction of new facilities will be initiated in the immediate future.

In addition to these five assured new medical schools, favorable decisions 

can be expected to res ult from some of the many feasibility studies which are 

now underwa y in almost every region of the country. Under the auspices of 

universities, State or local governments, or State or county medical societies, 

serious study of the possibility of establish ing one o r more new medical schools 

is being undertaken in Arizona, California. Idaho, Illinois, Maine, Massachusetts, Michigan, Minnesota, New York, and Ohio.

Mr. Dom inick . These are medical schools, not den tal schools.

Secre tar y Ribicoff. We are talk ing about medical schools here. 

This comes from the Jo urna l of the Am eric an Medical Association.

Mr. Dom inick. Let me ask just a few more questions. Do I un de rstand this bill to say th at each den tal or medical school will get the 

same amount of money regard less of qu ality or length of time of 

study ?

Secre tary Ribicoff. No. The disc reti on is in the Sur geo n Gen eral. 

Wh ere you have a new' school or a major expansion of the facilities 

of an existing school, the Sur geo n Gen eral wi th the advice of the 

Advisory Council can gran t up to 66% percen t of the con struction 

costs. Th e e xact amoun t d etermi ned would be based on all the fac tor s 

of need fo r the facility, the numb er of addit ion al stu dents to be ad ­

mitted , the ty pe o f b uil din g, the basic community needs, and so forth .
82 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

If you are to renovate obsolescent buildings in which you are not 

having admission of additional dental or medical students, the Sur ­

geon General has the discretion up to 50 percent. It is not an absolute 

figure, but is a discretionary figure up to 66% percent in the first case 

and up to 50 percent in the second case.

Mr. Dominick. Section 726 of this act specifically provides tha t no 

one in the Government shall have any supervision or control over 

personnel, or curriculum, or methods of instruction, or administration of any institution. Would this also mean that any school regardless of the type of curriculum would be entitled to a grant?

Secretary Ribicoff. No. It would have to be an approved school— 

one that is accredited. If it weren’t accredited it would not be eligible. 

It would have to be a school that would be accredited.

Mr. Dominick. Is there a provision in the bill for tha t ?

Secretary Ribicoff. On page 3 section 721 (b) rea ds:

To be eligible to apply for a gra nt to assist in the construction of any 

facility under this part, the applicant must be (1) a public or other nonprofit 

school of medicine, dentistry, osteopathy, or public hea lth and (2) accredited 

by a recognized body or bodies approved for such purpose by the Commissioner 

of Education, except th at a new school which (by reason of no, or an insufficient, 

period of operation) is not, at the time of application for a gra nt to construct 

a facility under this part, eligible for accreditation by such a recognized body 

or bodies, shall be deemed accre dited for purposes of this pa rt if the Commissioner of Education finds, after consultation with the app ropriate accreditation 

body or bodies, that there is reasonable assu rance that the school will, upon 

completion of such facility, meet the accreditation sta ndard s of such body or 

bodies.

Mr. Dominick. What body or bodies would this include who would 

have the right to say whether these schools are eligible or not?

Secretary Ribicoff. Medical schools are approved jointly by the 

Council on Medical Education and Hospitals of the American Medical 

Association and by the Association of American Medical Colleges. 

For dentistry the organization that does the accrediting is the Council 

on Dental Education of the American Dental Association.

Mr. Dominick. Thank you, Mr. Chairman.

The Chairman. Mr. Kornegay.

Mr. Kornegay. Mr. Secretary, I gather from your statement tha t 

you feel that under the scholarship program if i t were changed from 

gran ts to loans it would lose some of its attractiveness, is that correct, 

sir?

Secretary Ribicoff. I do.

Mr. Kornegay. You may have been over this before, but would you 

mind very quickly amplifying your reason for it ?

Secretary Ribicoff. The reason for it is tha t today a bright young 

man in the sciences has open to him fellowships and scholarships in 

many of the fields that might interest him. Such an individual would 

find tha t afte r a much briefer period of study, not in any way comparable to what it would be to be a full-fledged practicing doctor, he 

could then expect substantial financial returns, equivalent to or even 

greater than that of a doctor. Certainly these young men who might 

come from lower income brackets might be unwilling to undertake 

the long, arduous course of study and then, after they get out in the 

practice of whatever profession they may choose, to have a substantial 

debt hanging over their heads.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 83

Many o f these you ng men and women find themselves in th e position 

where the y hav e alread y gone into debt to acquire their basic college 

edu cation. Now, to suddenly find themse lves go ing fu rthe r into debt 

for med ical edu cat ion which will cost the m appro xim ate ly $12,000— 

$11,000 is the 1959 figure —fo r 4 yea rs, to go into inter nship where the 

pay is nominal, to say the least, or residency at a very, very sma ll 

sal ary , is a d iscourag ing fac tor.

F urthe rm ore, de ans of medic al schools ar e conc erned about the sh arp 

decline in the num ber of bett er qualified stu dents who app ly fo r m edi ­

cal schools as com pared to 10 years ago. I t is our belief th at , to encou rage hi gh qu ali ty of ap pli cants and to at tr ac t back to med icine 

men who are i n the to p levels of th ei r classes, we must open up o pp ortunitie s fo r th ese people to find s chola rsh ips at lea st equiva len t to w hat 

they can ac quire in t he oth er science fields.

Mr. K ornegay. In oth er words, it boils down to a m at te r of competition.

Secre tar y Ribicoff. Comp etition is a very decided facto r.

Mr. K ornegay. Th is is a que stion whic h probably should be directed 

to Dr . T erry.

Doctor, is there any feeling in th e med ical profession th at there is 

a p oint in en rol lm ent above which a m edical school cannot go and s till 

maintain the excellence that it desires?

Dr. Terry. Yes ; I think this is very definitely tru e. It will va ry 

fro m in sti tutio n to institut ion , bu t I t hi nk t hat we are q uite confident 

tod ay th at ou r med ical schools are enrolled up to the hilt in ter ms o f 

wh at the y can do in main taining the q ua lity and taki ng the m ost students possible. We have to have more fac ilitie s and more physica l 

fac ilities in orde r to take more med ical stu dents and still maintain 

quality.

Mr. Kornegay. An d if most of the medical schools of the country 

have rea che d th ei r optimum or m aximum capacity, then it is going to 

be necessa ry to look to con struction of new schools, is th at righ t?

Dr. Terry. It is going to be necessary to expand ex isting schools 

and to con stru ct new schools. Ov er seve ral years the medical ed ucators have been aware of the difficulties t hat we p roject fo r th e fu tu re 

unless we do expand our enrollment. As a consequence I th in k I can 

say without exception each ind ividual school has looked very c rit ically 

at what is the largest number of stu de nts it can tak e and still do a 

quality job, and I believe we are about as close to th at toda y as we 

could ever get.

Mr. Kornegay. Do you have a figure? I realize i t wou ld va ry and 

you probably have to state i t in ran ges , wh at, in yo ur o pin ion, is th at 

figure or what would the range be in the en rollment in m edical schools 

and still m aintain q uality in medical edu cation.

Dr . Terry. Today with the ph ysical fac ilities and t he fac ult ies that 

we have ava ilab le about 8,200 new stu dents are being accepted each 

ye ar by schools of medicine and osteo pat hy. Th is is ove rall. Now, 

you will find a trem end ous va ria tio n in terms of the individu al 

schools because of some of th eir physical fac ilities are obsolete, they 

are s trug gl ing alo ng with build ings th at a re practic all y fa llin g dow n 

aro und th eir neck, and un de r those circum stance s the y are ta ki ng a ll 

of the stu dents th at the y can.
<84 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Some of our schools have been able to expand in the last few years, 

and in the past 10 years we have had six new medical schools established, but even so, today we are still at tha t level where we are talk ­

ing about the need for 12,000 entering medical students by 1971, to 

provide 11,000 graduates in 1975. Our facilities available today can 

only accept 8,200.

Secretary Riiucoff. I would like to give you a figure that might be 

of interest to you as to why scholarship grants are needed instead of 

loans. Forty-three percent of the 1959 medical school graduating 

class came from the 12 percent of the American families having incomes of over $10,000.

Now, in the United States, in 1959, 45 percent of the families were 

in the income group of under $5,000. Yet 1959 medical school graduating classes who came from families with incomes under $5,000 

represent only 14 percent, so you had 45 percent of families and yet 

only 14 percent of the graduates came from these families. This indicates that this is certainly a discouraging factor for the brighter 

young men from lower income families who are reluctant to assume 

a debt for medical school over their normal debt.

Mr. Dominick, on the question about dental schools, our records 

show that there is specific interest to build dental schools in the following locations: Connecticut, Georgia, Oklahoma, Cincinnati, Colorado, Florida, South Carolina, and Massachusetts.

Mr. Dominick. Thank you.

Mr. J ones. Mr. Komegay, in relation to your question of optimum 

enrollment, I think it should be clear that the optimum enrollment as 

represented now by capacity is limited bv the availability of facilities. 

The medical schools bave indicated to the Association of American 

Medical Colleges, in a recent survey, that with the availability of 

assistance of the kind proposed in this legislation, the existing schools 

of medicine could increase capacity by some 1,700 new students with 

new facilities and the kind of support that is envisioned in this legislation, and still maintain the quality of the educational program at 

this expanded level.

This would be in addition to new schools that would provide for 

additional capacity.

Mr. Korneoay. I had heard the statement made by some of the 

medical people that there is a point beyond which you could not go 

in medical training, in education, regardless of the facilities because 

of the close relationship between the professor and the student.

Mr. J ones. This is a judgment by each school in terms of its own 

environment and its own capacity, and as adjudged by the accrediting 

agency as they make their periodic studies of the quality of education 

at each institution. But the point is that the schools themselves, keeping in mind quality, do say that they can undertake a major expansion 

if they have the kind of support this legislation would make available 

with which to help do the job.

Mr. Curtin. Would the .gentleman yield at that point ?

Mr. Korneoay. Yes, indeed.

Mr. Curtin. Thank you. sir. Mr. Secretary, you have just indicated the financial background of some of the students in the medical 

schools. That brings up a question in my mind as to what is going 

to be the criteria upon which scholarships are going to be awarded?
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 85

How are you going to pick between those that get scholarships and 

those who do not ?

Secretary Ribicoff. Each school would make its own determination, 

and I have the highest faith in the integrity of the deans of admission and the scholarship committees of every medical school in the 

country tha t they will take into account the factors of ability and 

need, and they will themselves make the determination of any sum 

tha t they believe a student needs to finish his education up to a 

maximum of $2,000. John Jones, they might feel, would need only 

$800, taking his family circumstances into account. They might 

have another young man who would need $2,000 in order to finish 

his education. So basically, it would lie the deans of admission 

and the scholarship committees tha t would sift these applicants and 

come to the determination.

Mr. Curtin. Do I understand then that need is going to be the 

primary factor?

Secretary Ribicoff. I would say definitely t hat need would be the 

primary factor. It certainly is provided tha t way in the bill. Page 

16, line 12, read s:

Scholarships awarded from grants under subsection (a) for any school year 

shall be awarded to talented studen ts on the basis of need for financial assistance in pursuing a course of study at the school for such year.

Mr. Curtin. Mr. Secretary, as you know the Kerr-Mills bill uses 

need as the main criterion for getting medical care relief and, as you 

also know, tha t has come in for some very serious criticism. Don’t 

you think similar criticism is going to apply here ?

Secretary Ribicoff. I don’t think there is any comparison at all 

between them. We have always recognized in education the concept 

of a scholarship program based upon giving the scholarships to those 

who not only are qualified, but who may be in need, to pursue an 

education. We are opening up opportunities. What is bad with the 

Kerr-Mills bill is that there the criterion of need is based on a sum 

so low, and the cost of hospitalization care is so high, that it hits 

thousands upon thousands upon thousands of Americans who do not 

have the income and the means to pay hospital bills of such a magnitude.

Mr. Curtin. What financial background is going to be so low that 

a medical student would be entitled to a scholarship:

Secretary Ribicoff. Well, if a boy has no resources from his family 

or outside help, he is going to have to have $2,000. If it will cost 

$2,500 a year and a boy could find resources through work or through 

a family of $1,500, the need there would be a thousand dollars in 

order to complete his education, a thousand dollars a year. These 

are all factors tha t are weighed by scholarship committees with questionnaires, and a survey, and investigation of the resources of each 

individual boy and his family. So I don’t think you can set a hard 

and fast rule.

It is a question of making sure that you have a meeting of qualifications, plus resources, plus need, to finish your education. That is why 

the discretion is placed within each university to determine how much 

and the size of the scholarship th at each boy will get.
86 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Mr. Curt in. As I un derst and it, ap prox im ate ly a fourth of the 

stu dents of each class will eve ntually be ge tti ng these sch olarships if 

th is bill is enacted i nto law ?

Secre tary Ribicoff. There will be an am ount gr an ted to the school 

equ ivalent to a fo ur th of the studen t bod y eve ntu ally. I t star ts in 

the fres hman class, mult ipl ied by $1,500. Th en t he amoun ts th at will 

be given out as sch olarships to indiv idu al stu de nts will be anywhe re 

fro m a low sum u p to $2,000. Depending up on the nu mb er of sch olarships the school gave out from its gr an t, you mi gh t have more than 

a q ua rte r or less tha n a qua rte r of the stu de nts ev entua lly gettin g th ese 

scholarship s. Tha t would depend on the way the school distr ibu ted 

th e one -qu arter times $1,500 t ha t each school will have.

Ea ch school will make its own deter mi natio n as to the size of the 

sch ola rship to each ind ividual.

Mr. Collier. Will the gentlem an yield there fo r one question ?

Mr. Curt in. I do n’t hav e the floor.

Th e Chairman. We will go otf the rec ord.

(Discussion off the record.)

Air. C urtin. T h ave no f ur th er questions.

Air. Collier. T res pectfully withd raw my question.

Mr. Kornegat. I have no fu rth er q uestions, Mr. Chairma n.

The Chair man. Mr. Rob erts ?

Mr. Roberts. Mr. Chairma n, T am very relucta nt to say an ything 

at this point, bu t T would like to com plim ent the Secre tary on his 

affirmation and reaffirm ation of his be lief in local control in the schools. 

T would also like to complim ent him on his wo nderful appeara nce 

before this committee, a nd wi thout attempting to blemish h is radi anc e, 

I would like to say T think p ar t o f his success h ere has been due to the 

fact th at he is fla nked by a fellow Ala bam ian , Dr . Te rry, the Sur geo n 

General, and D r. Jon es, of m y neigh borin g St ate of Georgia. li e h as 

been subjected to two wonderful influences a nd T am h ap py to hav e all 

of them.

Th ank you, M r. Ch air ma n.

The Chairman. Mr. Collier?

Mr. Collier. T have ju st one question, and T think it is entirely 

worthwhile to ask. We k now when a tea cher pa rti cipa tes in the National D efense A ct, th at is, a studen t, and he gets a loan, a fter 5 year s 

of teach ing a p erc ent age o f th e loan is waived.

Us ing the same ru le of thu mb and using the figures from your 

statem ent th at it req uir es 1 to 6 ad ditio na l years as an intern , 

resident, or fello w, in a spe cialty, why then wou ld it not be jus t as 

justifiable where you hav e been a stu dent who ha s pa rti cipa ted in his 

prem edic al un de r a N ati onal Defense E du catio n Act loan to waive 50 

percen t of such indebtedn ess th at he would hav e af te r he completes 

his inter nship ?

Sec retary Ribicoff. I t is a very interesti ng suggestion. Th is is 

the first tim e I he ard th at one made. It is very intere sting. I 

wou ldn’t wa nt to dism iss th at with an offh and answ er. I think th at 

is worthy of tho ug ht as to how i t w ould work out.

In oth er words, do I un de rst an d you correctly th at i f a young man 

has a National Defense Ed ucati on Act loan of a tho usa nd dolla rs a 

ye ar for 4 years, let us say, and he goes on to medical school, the 

same you ng man, because he is going in to a s hortage profe ssion, could
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 87

get a credit or forgiveness on his loan for each year tha t he takes to 

complete his medical education and goes into internship ?

Mr. Collier. That is right. Since we provide the incentive of the 

waiver of 50 percent of the loan to the teacher, it would seem to me 

tha t this would properly and justifiably apply in this field.

Secretary Ribicoff. Offhand, I would like that a lot better than 

the suggestion th at it all be loans in the first instance, but I don’t have 

the figures, and awaiting that, I would have to give some thought 

as to about what percentage of men would go on to medical school 

with this partic ular type of loan.

What do we do about a young man who might have a loan not from 

the Government? There are some loan funds that are being established in various States, as you know, to loan to students, or their 

fathers might go to a bank and borrow money for a college education. What worries me is would we be discriminating in favor of 

tha t young man who got his money from the national defense education fund. If there is to be some sort of forgiveness program this 

seems attractive to me, but 1 don’t know the full implications. Congressman Collier, I think you made a very interesting point.

Mr. Collier. I mention that, Mr. Secretary, because admittedly 

there are thousands of students who, as you know, reach their second 

year of college without having determined by this time just what profession they will pursue, and this might well provide an incentive, as 

it does to students who go into the teaching profession.

Secretary Ribicoff. What I would like to determine, which I will 

try to find out because your point is so interesting, is whether there 

are any figures which would indicate how many students with loans, 

undergraduates, under NDEA, then going into medical school. I 

am going to see if we have such a record available. I think you have 

raised a very interesting point, Congressman Collier.

(The information mentioned above follows herewith:)

Based on a sample of about 150.000 NDEA studen t loan borrowers in 1961, 

7.4 percent said they intended to enter occupations in the medical sciences field. 

The component occupations were as follow s:

Fi el d P erc en t 

of al l

bo rr ow er s

E sti m ate d 

n u m b e r of 

bo rr ow er s

T o ta l m ed ic al scien ce s.......................... ............................. . ................................... 7. 4 11,043

M ed ic in e...... .................. ........................................ . ..................... 4 0 fi 122 D e n ti str y __________________ ________ _____________ 1.4 2 135 M ed ic al te ch nol og y.................................................. ........... ............... 5 69S N u rs in e.......... .................................................................... 9 1 301 P hysi ca l or o ccupat io nal th e r a p y ................................ ....................... 2 ’ 253

V ete ri nary m edic in e........................... ................. ............................................... 4 837

So urce : U np u b li sh ed d a ta f rom th e U .S . Office of E d u cati o n .

These figures include both candidates for the bachelor's degree and for pro ­

fessional degrees.

Mr. Collier. That is all, Mr. Chairman. Thank you.

The Chairman. Mr. Staggers.

Mr. Staggers. Mr. Secretary, I, too, wish to congratulate you on 

your support and interest in this legislation which I think is basic to 

the strength of America. I believe tha t is the reason the bill is before Congress at the time tha t those who have tho ught of the future
88 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

of (bis pro gra m deem it wise, and th at means the ad mi nis tra tio n and 

others, th at some sort of legislation be enacted fo r the fu ture of the 

Nation . As Dr. Te rry , I believe, exp lain ed, in 1975 th e estima te was 

we needed 11,000 physician s. Is th at r ight, D r. Te rry ?

Dr. T erry. Gr aduated p er ye ar; yes, sir.

Mr. Staggers. An d at the prese nt ra te unless it is enlarged the re 

will be only between 8,000 and 9,000, is th at correc t ?

Dr. T erry. Yes, sir.

Mr. Staggers. I t shows th at som ething mu st be done. I believe 

most of th e S tat es are doing w hat they can do. If they could do more 

they pro bab ly would do it. I know ou r St ate is doing wh at it can 

with our medical school. Th ey built a new modern medical school 

which is costing some $30 million, which the S ta te p aid for, b ut unless 

they do get some help they are not goi ng to lie able to exp and and 

perhap s do the job th ey need to do.

Looking at the basic princ ipl es of the bill, “to increase the op po rtun ities for trai ni ng of physicians, dentists, an d pro fessional pub lic 

healt h pers onnel, and fo r othe r purposes,” wou ld not this be the 

basic prem ise of th e bill then : To give to those y oung men and women 

an op po rtu nity to att en d medical school who now do not hav e the 

op po rtu nity?

Secre tary Ribicoff. T hat is correct.

Mr. Staggers. Not only moneywise. To day the medical profession is composed of those who have money and could afford to go to 

school. Is th at basically righ t ?

Secre tar y Ribicoff. I would say th at t his is h ap pe ning in too larg e 

a prop ortio n of cases. I don’t think it is wr ong fo r a young man 

of mea ns to atten d medical school, bu t I th in k th at what we must 

mak e sure is th at we afford opportu nit ies fo r young men witho ut 

mea ns who migh t desire to go to medical school to do so.

Mr. Staggers. Is n’t th at the basic premise of ou r Na tion, and I 

mean the Co nst itution, th at everybody hav e equal rig hts? I am like 

you; I believe the ric h, if th ey hav e th e qualific atio ns, an d abi lity , and 

the inc lination, should go to medical schools, bu t I believe, too, th at 

those young men and women who have the ability an d the desire but 

no t the mean s should hav e the op po rtu nity in this land and th at we 

ju st do n’t pric e them ou t of the market,

Secre tar y Rtbtcoff. Tha t is correct.

Mr. S taggers. An d i t has gotten to th at po int today .

Se cre tar y Ribicoff. That is correct.

Mr. Staggers. I th in k th at is one of t he basic things pe rhap s in the 

bill. The next the n is to giv e an op po rtu ni ty to all, wh eth er they 

have the money or not, of fac ilities to att en d school. I know in mv 

com munity a nd in my d istri ct I see hundred s of yo ung men an d women 

who would like to go to medical school and they ca n’t g et int o medical 

school, some of them because of money and others because maybe the y 

ju st don’t rate in the top 10 and they have to go ou t of the State or 

som ething like that. They ha d to in the p ast. Le t us p ut i t th at way. 

Th ey have tro uble ge tting to medical school also because of the lack 

of facilities. Th is then opens up the avenue b oth way s in giv ing to 

all Am ericans, if they hav e the abi lity the inc lin ati on or desire to go. 

the op po rtu nity to serve in this field, an d we have been tryi ng to 

pro vid e it. 1 thi nk , in most other fields.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 89

Again I want to congratulate the Secretary and his assistants.

The Chairman. Mr. Glenn ?

Mr. Glenn. No questions, Mr. Chairman.

The Chairman. Mr. Williams?

Mr. Williams. Mr. Secretary, I would like to take just a moment 

to congratulate you on making a splendid presentation to this committee. As I mentioned to you yesterday, there is one phase of this 

that I think perhaps has not been covered completely and I would 

like to go into tha t for a moment. Having been in hearings of this 

nature on legislation of this type for the past 8 or 10 years, I would 

think tha t the mere addition of numbers of doctors would not necessarily solve the problem th at you are seeking to solve. 1 have reached 

the conclusion tha t our chief problem in this field lies in lack of 

availability of doctors to the public, and distribution. To some extent you have already covered the distribution of doctors and the 

difficulties that we have in connection with bringing about a proper 

distribution of doctors.

However, you touched very lightly on the subject of the availability, 

and, of course, one of the elements being distribution. The other element in my opinion is in specialization or overspecialization. Do you 

have statistical data which would give us the numbers of specialists 

as opposed to the numbers of general practitioners ?

Secretary Ribicoff. The latest figures we have are for 1959. Firs t, 

we had a total of 236,089 doctors. In private practice there were 

160,592; in general practice and part-time specialty, 81,957; full-time 

specialists, 78,635; and not in private practice, 65,180.

Mr. Williams. When you say not in private practice, what category 

is that?

Secretary Ribicoff. I will now give them to you. Hospital service, except Federal, 39,730; teaching, research, public health, 7,931; 

in Federal service, including military service, 17,519.

The Chairman. How many ?

Secretary Ribicoff. 17,519; retired doctors not in practice, 10,317. 

Taking the percentages, 35.6 percent are in general practice and 33.5 

percent are in full-time specialty practice.

Mr. Williams. "When you consider the numbers of doctors tha t we 

have in proportion to the population you have to subtract, of course, 

that 10.000 that you mentioned who were retired.

Secretary Ribicoff. Tha t is correct.

Mr. Williams. So that removes 10,000 doctors from service to the 

public. In addition to that you would have to remove—what is it?— 

16,000 in Government service and institutional work.

Secretary Ribicoff. That is about right.

Mr. Williams. And you would also have to remove to some extent 

some of the specialists as being immediately available to the public, 

which reduces considerably the number of doctors who are available 

to the public for treatment of ailments that might arise in the home. 

I have found that one of the most difficult problems tha t we have to 

encounter is that of getting a doctor to our home when we need him, 

and I think everybody else has had that same problem, especially at 

night. Do you think that the passage of this act will help alleviate 

that situation?

80 014— 62
90 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Secretary Ribicoff. I would say by increasing the supply of doctor’s 

you would lie in a position of having more doctor’s available to treat 

the people. Many of these doctors are overworked. I would like 

to read from the Bane Committee report on specialization because it 

might be most pertinent to see the growth of specialization in the 

United States.

The Bane Committee repo rt points o ut :

A fundamental change in medical practice, and the one which has had the 

greatest impact on medical care, is the greath grow th of specialization. In 

1931 only one private pra ctitioner in six considered himself a specialist; by 

1940 one in four. Today almost half of all physicians in private practice limit 

themselves to specialty practice. For many people the function of the family 

physician is now served by the spec ialist in intern al medicine and the pediatrician. These two groups with the general practitio ner make up the family 

physician potential today. Even so, the number of potential family physicians 

has actually decreased from 117,000 in 1931 to 102,000 in 1957.

Mr. Williams. Decreased?

Secretary Ribicoff. Decreased.

In recognition of the need for good family physicians a special committee of 

the American Medical Association has developed a recom mendation for 2-year 

training programs which students can ente r immediately upon gradua tion from 

medical school. It will emphasize internal medicine, jiediatries, obstetrics, and 

minor surgery.

So I must admit from the records and the statistics that your comment that there has been a decline in people in general practice is borne 

out by the facts.

Mr. Williams. The general practitioner is obviously the one that 

is closest to the family or closest to the people. 1 realize tha t there 

is nothing tha t the Government can do to encourage general practice 

unless we do adopt some kind of a loan program which is similar to 

the one th at we have in Mississippi which would encourage or give 

an incentive to the young medical graduate to go into general practice for a certain period of years.

I live in a rural area, as you know. I have found, and my experience 

has been, that whenever there is one doctor in a given community and 

another doctor moves into that community, even though the first doctor 

may be overworked, one of them goes off and takes a residency and 

gets some specialty, moves to the city, and that still leaves us with a 

shortage of medical care.

Is there anything tha t we can do to alleviate tha t situation other 

than by providing some kind of a loan incentive?

Secretary Ribicoff. I don’t know whether that would do it. To be 

frank, I would have to give this a lot of thought.

Mr. Williams. That is the reason I am inclined to lean more toward 

the scholarship loan than I am the outright grant.

Secretary Ribicoff. The problem tha t worries me, Mr. Williams, 

is trying today to anticipate what the basic needs and the pattern of 

our Nation will be 10 years from now. Wha t I am worrying about, 

frankly, is not today, because what we do today will not affect the 

supply of doctors today. In other words, all of us are aware of the 

tremendous shift in this country from a rural economy to an urban 

economy. This is taking place very, very rapidly. I am sure that 

everybody in this room, including yourself, lias seen the fantastic 

change of the pattern, whether it is in Mississippi, or Maryland, or 

Connecticut, Pennsylvania, or New York. There has been this shift,
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 91

which I am sure is taking place in the growth of your large cities and 

the decline of your rural populat ion.

I would be deeply concerned at trying to write in a pattern of action 

now, anticipating what might take place 10 years from now, and find 

10 years from now what we have provided for is no longer the problem. 

Wha t we are trying to do is to cope with a problem that will be acute 

10 years from now. This is the basic duty that you have and I have, 

looking forward to the future needs of our country. By the time you 

pass this bill and get your planning grants, and get your medical 

schools built, and get your young men into medical schools, with 4 

years of medical school, and the years of internship and training, 10 

years have gone by.

I would hope tha t we would be farsighted enough not to try to 

write in a formula concerning a condition which may not prevail 10 

years from now. Who knows what the pattern will be then ? I find, 

not so much in the East but in the Middle West—I haven’t had the 

experience in the South—a great growth of group practice where a 

group of doctors in specialties gather together, practice together. 

They might be set up in the small town tha t serves a large rural area 

where they can take care of all the basic needs in one place of whatever 

health need may be in that entire area.

Whether this is taking place in the South I don’t know.

Mr. Jones. It is.

Secretary Ribicoff. It is. So you might find, whether it is in 

Mississippi, Arkansas, or Connecticut, or Colorado, or California, t hat 

group practice may be an answer. There will be great changes, and 

what I am deeply concerned with, Congressman Williams, is th at we 

be farsighted enough in this country to make sure that as our population grows we suddenly don’t find ourselves bereft and without 

enough doctors to take care of the health needs. I would be more concerned about tha t than just what the pattern will be between rural 

and urban areas, because I have the feeling that in 10 years from 

now the shift of population and the methods and medicine, itself, that 

develop will take care of the basic needs of most of our population.

Mr. Williams. I am sure all of us agree with the objective that 

you have in mind, but I would repeat that in my opinion the mere 

condition of numbers of doctors does not necessarily meet the problem tha t we are faced with. I think that the primary problem is 

the availability of medicine to the family, or the availability of medical 

care and treatm ent for the families of the country. I have found even 

here in Washington, as a matter of fact even more so in Washington, 

in the home it is extremely difficult to get hold of a doctor at night. 

You have to call some kind of a medical exchange or something. You 

don’t know what doctor you are going to get in touch with. The 

doctors all see to it that their numbers are unlisted where you can’t 

reach them at home, and I think that that is the tiling that we should 

be directing our attention to; that is, bringing medicine back closer 

to the people.

In my opinion, overspecialization of the profession certainly removes medicine from the people. Not only that, but it increases the 

cost of medicine and medical care. All of us would like to see the 

numbers of doctors increase. I think tha t we should make certain that 

we get a good distribution and that the increase results in bringing 

medicine closer to the people.
92 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Secre tar y Ribicoff. I would s ay this, Congressman Willia ms, while 

yo ur concern is very well tak en, the problem would be even greater 

if th ere were fewer doctors inst ead of more.

Air. W illiams. I gra nt that.

Secre tary Ribicoff. I think it is a problem th at deserves the concern of the AM A and the concern of every St ate and county medical 

assoc iatio n in the Un ite d Sta tes. I know th at docto rs are concerned 

with this. The y oft en set up a pane l, wi th some rot ati on, to make 

sure that there are alw ays on call, 24 hours a day , eno ugh doc tors to 

tak e care of emergency needs. I do hav e en oug h confidence—although 

I have had my qu arrels with the AMA and pro bably will in the days 

ahead—in the bon a tides of the medical pro fession to believe that 

this is a problem th at they are addre ssing them selves to and will 

add ress themselves to more and more in the future. The good will 

and the sta nding of the medical profession bas ically depend s on the 

feeling of the pub lic th at the y are bein g served and served pro perly 

and tha t doctors are ava ilab le to take care of the basic he alt h needs 

of the Am erican people.

Mr. Williams. I yie ld to the gentleman fro m W est V irg ini a.

Mr. Staggers. I ju st want to know if you hav e the figures, Mr. 

Sec retary , of the ratio of practic ing doctors and peo ple the y serve 

tod ay in the Uni ted States.

Secre tary Ribicoff. I di dn ’t g et tha t question.

Mr. Staggers. I mea n each practic ing docto r in common medicine 

who answ ers the or dina ry call : How ma ny peo ple would lie have 

to serve of our population according to t he docto rs’ a vailabil ity ?

Secre tary Ribicoff. If you use the poten tia l fam ily p hysician tota l, 

and not the specialists, he wou ld have about 1,700 people to ta ke care of.

Mr. Staggers. 1,700?

Secre tary Ribicoff. When we use the fam ily physicia n poten tial, 

which includes general pract ice pedia trics, and inter na l medicine, 

that would rep resent aro und 1 doc tor fo r every 1,700 people.

Mr. Staggers. Tha nk you very much . Tha nk you, Mr. Williams.

Secre tary Ribicoff. An d in dentist ry it is 1 de ntist fo r every 2,178 

people. Th at doesn’t prevail equally aro un d the country because 

you have varia tio ns in ratio s aro und the coun try th at make a great 

deal of difference. In o ther word s, if you wou ld t ake the non-F edera l 

doc tors of medicine pe r hu nd red tho usand civ ilia n po pu lat ion in 1961, 

you run this w ay : New Eng la nd has 159 d octors pe r hundred th ou ­

sand ; the Mid dle Atla nt ic Sta tes , 158 pe r hu nd red thou sand ; the 

Ea st No rth Central, 114 doctor pe r hun dred th ou sa nd ; the We st No rth 

Ce ntral , 110 doctors pe r hu nd red thou sand ; So uth Atla ntic area, 111 

doc tors per h un dred th ou sa nd ; the E as t S outh Ce ntral area, 88 doctors 

pe r hundred th ou sa nd ; the W est South Ce ntral, 101 d octors p er hu ndre d tho usand; the Mounta in Sta tes, 111 pe r hu nd red thou sand ; and 

the Pacific States, 150 docto rs per hu nd red tho usa nd. As you can 

see. we have quite a va ria tio n in different se ctio ns of o ur Nation.

Mr. Williams. Do those figures include the r etire d doctors, the ones 

who are not in p rac tice, the ones who are in some type of Gov ernmen t 

work or instituti onal work?
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 93

Secretary Ribicoff. All doctors except Federal physicians. If you 

would like, we will insert in the record at this point the breakdown 

throughout the Nation in the different regions, both for doctors and 

dentists.

The Chairman. I think it would be appropriate for the record to 

have it, to be included at this point.

(The information referred to follows:)

Physicians (M.D. and D.O.) and dentists, numbers and rates per 100,000

persons in each geographic region, division, and State

R eg io n, di vis io n, an d Sta te

N u m b er of physi ci an s, 

1961 N u m ­

ber of 

d en ­

tist s, 

1960

R ate per 100,000 civ ilia ns >

T ota l M .D , D .O .

P hysi cia ns

D en ­

tist s

T ota l M .D . D .O .

U n it ed S ta te s 2

........... ............ 261,622 247,2 72 14,350 102,340 141 133 8 56

N o rt h east______ ____ _____ 74,655 71,511 3,14 4 31,110 165 158 7 70

N ew E n g la n d ___________ 17,573 16,827 746 6,64 6 166 159 7 64

C o n n ecti cu t________________ 4,32 7 

1,192 

9,405 

838 

1,178 

633

4,261 

971

9,095 

809

1,096

595

1,733

440

3,52 0 

287 

482 

184

166

123

181

137

139

160

164

100

175

132

130

151

2

23

6

5

10

10

68

45

68

47

56

47

M ai ne. ___________

M assa ch u sett s_____________

N ew H am p sh ir e_____ _.

R ho de Is la n d ____ _

V erm o n t______ ___ .

M id dle A tl a n ti c................... 57,082 54.68 4 2,3 98 24, 464 165 158 7 72

N ew J ers ey ________ ______ 8,095

32, 785 

16,202

7,61 2

32,2 52 

14, 820

483

533

1,382

3,81 9

13,811

6,834

131

193

142

123

190

130

8

3

12

63

82

60

New Yor k

P en n sy lv an ia ....................... ..

S o u th .................................... 58,996 56.8 40 2,156 19,465 107 103 4 36

South A tl a n ti c........... ............. .. 29,885

567 

2,542 

6,75 8 

3,6 88 

4,321 

4,26 5 

1,830 

4,14 0 

1,774

29.0 08 877 9,491 114 111 3 37

D el aw ar e______ . . 529 

2,5 22 

6.2 42 

3,6 09 

4.29 9 

4,226 

1,821

4,10 4 

1,656

5*5 -« r* cm w *

170

721

2,29 6

1,092

1,259

1,345

503

1,402

703

126

343

131

94

138

94

78

106

96

118

340

121

92 

137

93 

77

105

90

8

3

10

2

1

1

(')

1

6

38

94

46

28

41

30

21

35

38

D is tric t of C o lu m b ia _______

F lo ri d a_____ ________ _

G eo rg ia ....................... ..

M ary la n d . ..................

N ort h C aro li n a________

S outh C aro li n a___ .

V ir g in ia ............

W es t V ir gin ia ____

E ast so uth ce n tr al______ 10,785 10,658 127 4,08 2 89 88 1 34

A la b am a_________ . 2,486 

2,752 

1,686 

3,861

2.4 83

2,711

1,68 3

3.78 1

3

41

3

80

955

1,100

599

1,428

76 

90

77 

107

76

89

105

(’)

1

(’)

2

29

36

28

40

K e n tu c k y .. _____ _

M is si ss ip pi. ___________

T ennes se e. . . .

West so ut h ce n tr al_____ 18,326 17.174 1,152 5,892 108 101 7 35

A rk ansa s____________ . . 1,597 

3.66 4 

2,65 3 

10,412

1,57 0

3,649 

2.262 

9,6 93

27

15

391

719

548

1,164

904

3,276

90

111

114

108

88

110

97

101

2

1

17

31

36

39

34

L o u is ia n a________ _

O kla hom a___________ . .

T exas______ ______

See footno tes at end of list.
94 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Physicians (M.D. and D.O.) and dentists, numbers and rates per 100,000 persons

in each geographic region, division, and Sta te— Continued

R eg io n, di vi si on, a n d S ta te

N u m b er of phy si ci an s, 

1961 N u m ­

b er of 

d e n ­

ti st s, 

1960

R ate per 100,000 ci vilia ns 1

T o ta l M .D . D .O

Physi ci ans

D en ­

ti st s

T o ta l M .D . D .O .

N o rt h ce n tr al. . ___________________ 64,412 59,098 5,314 28,3 07 123 113 10 55

E a st n o rt h c entr a] ______________ 45,2 76 41.999 3,27 7 19, 495 123 114 9 54

Hlin oi s____ ________________ 13,264

4,81 5

10,349 

12,461 

4,38 7

12,888

4,621

8,705

11,562

4,223

376

194

1,644

899

164

6,249

2,1 43

3,9 60

4,660

2,483

130 

102

131 

126 

109

126

98

110

117

105

4

4

21

9

4

62

46

51

48

63

In d ia n a________ ____ ______

M ic hig an __________________

O hio .7 .................. ........... ...........

W isco ns in __________________

W est n o rt h c e n tr a l.. _____ ______ 19,136 17,099 2,037 8,812 123 110 13 57

Io w a_______________________ 3,2 44 

2,445

4,742 

6,07 0 

1,58 0 

524 

531

2,792

2,236 

4,663 

4,894 

1,518 

510 

486

452

209

79

1,176

62

14

45

1,610 

1,01 5 

2,3 46 

2,3 69 

894 

273 

305

117

114

137

139

111

83

78

101

104

135

112

107

81

71

16

10

2

27

4

2

7

58

47

69

55

63

43

45

K ansa s_____________________

M in neso ta _________ _______

M is so uri _______ ______ ____

N ebra sk a__________________

N o rt h D ak o ta . _

S outh D ak o ta ______________

W est .......................... .................................. 43,7 32 39,996 3,736 16,480 153 140 13 60

M o u n ta in __________ ___________ 8, 427 7,735 692 3,236 121 111 10 48

A rizo na ____________________ 1,524

2,9 56

626

704

321

842

1,147

307

1,347

2,717

586

652

290

728

1,126 

289

177

239

40

52

31

114

21

18

470

1,018

311

354

129

258

535

161

111

169

92

105

111

88

126

91

98

155

86

97

100

76

124

86

13

14

6

8

11

12

2

5

36

58

47

52

45

27

60

49

C ol or ad o___________________

Id ah o ______________________

M o n ta n a.............. ............... .......

N ev ad a____________________

N ew M ex ico_______________

U t a h . . . . .......... ...........................

W yom in g__________________

P ac if ic _________________________ 35,3 05 32,261 3,044 13,244 164 150 14 63

C al ifor ni a__________________ 28,040

2,485 

3,948 

124 

708

25,379

2,323 

3,743 

123 

693

2,661 

162 

205

1

15

9,55 0 

1,323 

1,939 

56 

385

174

139

139

62

119

158

130

132

61

116

16

9

7

1

3

61

75

68

25

61

Orego n_____________________

W ash in gto n________________

A la s k a .. ______ ____________

H aw aii __________ __________

O th er area s:

P u ert o R ic o____________________ 1,334

142

(‘)

1,334

142

18,351

0

0

(‘)

362

31

6,585

56

64

56

64

15

O utl yin g are as 14

F ed er al

1

 U .S . ra te s b as ed on t o ta l popula ti on i nclu din g Arm ed For ce s ov er se as .

2

 In clu d es 50 Sta te s, th e D is tr ic t of C ol um bia , P uer to Rico, o u tl y in g ar ea s, an d F ed er al .

• Le ss t h a n 0.5.

« T h e 9 ost eo path s in F ed er al se rv ice ar e in clu ded i n S ta te fig ures.

The Chairman. Do any other members of the committee have any 

questions?

Air. O’Brien. Mr. Chairman, may I ask one question ?

Secretary Ribicoff. May I say this? The medical school inquiry 

provided by your staff, as Mr. Williams points out, indicates that the 

Mississippi State scholarship program is probably the most extensive 

of all State programs designed to aid medical students.

Air. Williams. Thank you. We are quite proud of our program 

down there and, if you will notice, this was back in 1957 when this 

repo rt was made. Tha t program was relatively young then, but it 

was already beginning to get results. It is indicated that 191 doctors 

were in general practice in rural areas in accordance with the terms
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 95

of th eir con tra ct fo r th eir loan sch ola rship. We only have 82 countie s 

and that pro gram is re ally pr od ucing res ults.

T hat was, as I say, 4 yea rs ago when the prog ram was rel ati ve ly 

young. I d on’t kno w wh at it m ight be now, bu t it resu lted in ma kin g 

medical car e av ailable to the pe ople of M ississippi.

The Chairm an. Mr. O’Brien.

Mr. O’Brien. Mr. Secre tar y, I would like to pin dow n this questio n of need. We ha ve thi s figure of 141 phy sician s fo r every 100,000 

people tod ay, as ag ains t 143 a decade ago. You could say it was 

about the same. Is n’t it a fact th at if the re ha d been no po pu lat ion 

increase whatsoev er in those 10 ye ars, the d emand s on the doc tors for 

service wou ld have almost doubled because of people going to doc tors 

more often th an th ey used to because it is a be tte r thi ng to do, perha ps 

because peop le a re more en lighte ned, pe rhap s because they are economically be tte r off, with more insu ran ce money ?

I rem ember as a youngster we ha d a bo ttle of castor oil and some 

su lfu r and molasses fo r seven kid s and we got a dose of one or the 

other and seldom saw a do ctor. My son has a large and young fam ily, 

with the old est being seven, a nd there are six kid s, and t hey have seen 

the docto rs twic e as much alread y in th ei r sh ort lives as we did up 

to th e time we lef t home. So don ’t we have a situ ati on h ere th at makes 

the need much more acute th an the sta tistic s rec ited wou ld ind icate?

Secre tar y Ribicoff. I would say there is no question th at wi th each 

passing ye ar, o ur popula tio n uses med ical services more often th an in 

the pas t. W he ther doc tors’ serv ices are used mo re th an is actua lly 

needed is a que stio n th at many people ac tua lly rais e, bu t wi th the increase in the economic stat us of m ost Am erican s and wi th the a dvance 

of medical science, it is true t hat people see doc tors mo re often th an 

the y did 10 years, o r 20, or 30 years ago.

Mr. O’Brien. Wh ich I th in k is a good thing . We are healt hie r.

Secre tar y R ibicoff. Yes, we are a he althier nation .

Mr. O 'Brien . Th an k you.

The Chairm an. Does any other mem ber of th e com mittee have any 

questions?

Mr. Secre tar y, I have only two o r three questio ns th at T would like 

to ask, one or two fo r clarification, and one o r two to obtain ad ditio na l 

inf orma tio n. First , I wa nt to say th at I, too, am int ere ste d in the 

subject tha t Mr. W illiam s bro ug ht up about th e dist rib ution of d octors, 

and I th in k the prim ary purpo se of th is pro posal sho uld be, an d I 

am sure it is, to have more doc tors ava ilable to serve the need s of the 

Am eric an people and , a t th e same time, im pro ve the qua lity of me dical 

care.

Obviously, wi th more doctors being ava ilab le, the pro ble m Mr. 

William s m entioned would more nearly take care of itse lf. However, 

is it not also tru e th at the lack of clinical fac ilities in certa in areas, 

especially in smaller towns, contr ibu tes to the fact th at the doctors 

who come o ut o f schools a re r eluc tant to go i nto those are as ?

Se cre tar y Ribicoff. I th in k th at you have placed yo ur finger on a 

very, very im po rta nt fac tor. I t is certa in th at doc tors are at trac te d 

where the fac ilities are loca ted an d there is a reluct anc e fo r a docto r 

to pra ctice where there is no h ospital or clinic or com mu nity fac ilities .

The Ilill-B ur to n Act, and also the Comm unity Fa cilities Ac t th at 

your com mittee passed las t year, are b oth acts th at will have a gr ea t
96 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

impact in bringing into the rural areas and the small communities 

excellent facilities which will give good surroundings and good opportunities for doctors to be able to practice their profession, and practice 

it well.

The Chairman. Of course the Community Facilities Act is a very 

limited program and it is not going to reach many of these smaller 

rural communities. As important as it is, there is an inclination as 

it is administered through the States, which we intended, to allocate 

the funds to those areas which are more readily capable of meeting 

the local requirements, and the rural areas seem not to get in on the 

ground floor.

I am speaking from my knowledge of the way it is administered 

in my own area. Second, in the Hill-Burton program, as fine as it 

is, and it has made a tremendous contribution throughout the country, it is obvious that you don't get Hill-B urton funds allocated to 

these small rural communities.

I suppose tha t is because—I am talking generally—the funds are 

generally used in the more populous areas. I know it is not a part 

of this legislation, but it does relate to it. It seems to me tha t we 

should have some kind of a program to go along with the Hill-Burton 

program where these smaller clinics might be encouraged and developed and in this way I think attract the doctors, and particularly 

young doctors, to those areas.

Secretary Kibicoff. Mr. Chairman, if it would be your request that 

our Department look into this question that you have raised, I don’t 

think we could do an adequate job for this bill, but T think we wbuld 

lie able to come back to you next year with a report.

The Chairman. In time I hope to go into that, but as I say, it 

is not a problem involved directly in this legislation. I hope the 

time will come when we will take a good look at tha t situation in 

review ing the Hill-Burton program. Yes, I would like your Department to give attention to it at such time as you can.

Doctor Terry, in answer to Mr. S pringer’s question as to whether 

there is a present shortage of doctors, you stated the answer to the 

question involved a judgment factor. I should like to ask, Do you 

expect that there will be in the future on account of population 

growth an increased demand for health services and, therefore, a 

shortage of doctors ?

Dr. Terry. Yes, sir; I think there most certainly will be.

The Chairman. How long does it take to establ ish a medical school ?

Dr. Terry. In general, from the planning stage, afte r the decision 

to move ahead, in other words, the beginning of the active planning 

stage, construction, and placing in operation, will require somewhere 

between 3 and 5 years. Say, if one takes 4 years, as tlie average, tha t 

would still mean under those particular circumstances that a school 

would not graduate a person for 8 years from the time the active planning stage began. This is one of the reasons why we feel it is so urgent 

that we move now. because we are talking about, as the Secretary has 

emphasized, the greatly increased needs that will exist a few years 

fro m now and we have to move tod ay in orde r to meet those needs 

the n.

Th e Chairman. In terms of yea rs would general ly the same time 

be req uired on majo r expan sion ?
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSO NNEL 97

Dr. Terry. No, sir; I don’t think tha t is necessarily true. Major 

expansions of existing medical schools in general would not require 

that length of time. I should think from the active planning stage 

tha t on an average in a year and a half or 2 years the construction 

could be very well completed toward that major expansion.

The Chairman. But it would require then an additional 4 years at 

a minimum, so it would lie 6 ?

l)r. Terry. That is right, sir.

The Chairman. In other words, do 1 understand then that if this 

legislation is enacted it would he 6 to 8 years before we could start 

realizing the actual results from it ?

Dr. Terry. I think we could not possibly see any significant increase 

within 5 years; th at is, for physicians.

The Chairman. I have had a good many of the educational institutions inquire with reference to the availability of funds for the first 

2 years of basic medical training. Is there any intention of extending 

this program to such basic medical train ing? Brandeis University 

is an example, and I have several more, suggesting the consideration 

of 2-year medical schools or basic medical science train ing programs 

to provide the preclinical training.

I)r. Terry. Tha t is included m this proposed program. Many of 

our schools today could take more students in the clinical years of 

teaching, in the third and fourth years, if they had more students 

who had had the first 2 years of training.

Establishing the 2-year schools may help us to move ahead faster. 

Tn other words, our existing medical schools today can take students 

at the third- and fourth-year level if we can produce more out of our 

first 2 years of basic medical training.

The Chairman. And that is authorized in this proposal ?

Dr. Terry. Yes, sir; 2-year schools are specifically included.

The Chairman. I suppose, then ; they could be called medical junior 

colleges, as has been suggested.

Dr. Terry. I am afraid that they would resent being called junior, 

even though they had only 2 years, Mr. Harris. It is sort of like 

someone might say the patient has minor surgery, but to the paten t 

any surgery he has is major.

The Chairman. With reference to the renovation, does that mean 

to tear down an old building and build a new one ?

Dr. Terry. If the old building is in such condition that there is 

serious jeopardy to the continuation of this school because of this 

physical facility; yes, sir. In many instances it will also include 

renovation of an existing facility which would make a more effective 

educational process possible.

The Chairman. Then some of the buildings could he improved and 

that would be included in this proposal ?

Dr. Terry. Oh, yes; many of them could be, sir.

The Chairman. Suppose there are certain facilities that would be 

desired in connection with present institutions that would not require 

a major renovation or expansion. Would that be permitted?

Dr. T erry. That would be permitted if it improved the educational 

process or the number of students tha t that school could take. Now, 

obviously, Mr. Harris, we are going to have more applications for 

money fo r construction grants than we are going to have money, even
98 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

if the committee gives us all we have asked for. Only $15 million 

annually would be authorized for renovation construction th at would 

not expand enrollments.

The Chairman. I don’t think there is any doubt about that.

Dr. Terry. So that I think tha t obviously priority will be given 

by our review bodies to those instances where, for instance, in renovation or replacement the physical facilities are such tha t the school 

is really in danger.

The Chairman. As an example, suppose you have a school that in 

order to be more proficient, for example, needs air conditioning. We 

have many of these facilities tha t are several years old, and suppose 

it could be more efficient, for example, if it were air conditioned. 

Would that be permitted under the legislation here ?

Dr. Terry. Possibly so, if it improved the educational process or 

if it allowed tha t school to take more students, but the authorization 

for modernization construction is a very limited one.

The Chairman. I believe you are going to include in the information tha t you are to submit, as I requested at the outset of the session 

this morning, information as to how this scholarship program works?

Dr. Terry. Yes, sir.

The Chairman. Mr. Secretary, and your associates with you here 

today, let me thank you on behalf of the committee for your appearance here and the excellent presentation tha t you have made in advocating this program, and not only in your presentation, but in your 

responses to questions from members of the committee who havesearched for information with reference to this program. I would 

like to join the other members of the committee in commending you 

for it.

Secretary Ribicoff. Thank you very much, Mr. Chairman.

The Chairman. We appreciate the 2 days that you have given us. 

We know you have a very busy schedule, bu t should something else 

develop that would require your presence, we would notify you.

Secretary Ribicoff. 1 will be available on your call, Mr. Chairman.

The Chairman. Than k you very much.

(Additional information requested follows:)

Geographical source of entering studen ts in public and private medical schools

and basic medical service schools in the United S tate s, 1960-61

Medical school Total

freshmen

Home State Out of State

To tal....................................................

Pub lic schools________________________

Medical College of Alabam a_________

University of Arkansas_____ _______

University of California, Los Angeles .. 

University of California, San Francisco.

University of Colorado_____________

University of Flo rida______________

Medical College of Georgia............. .

University of Illinois_______________

Ind ian a University ________________

State University of Iowa_____ ______

University of Kansas______________

University of Ke ntu cky ____________

Louisiana State University_________

University of Ma ryland ____________

University of Michigan..........................

Wayne State University____________

University of Minnesota___ ________

University of Mississippi___________

8,2 98

4,10 4

80

92

71

103

85

53

104 

2(H) 

194

124

105

40

142

98

2(H)

125 

141

81

5,53 0

3,59 1

75

92

65

96

55

46

103

198

179

108

95

34

141

79

MB

117

127

77

2,76 8

513

5 0

6 

7

30

7 

1

2

15

16 

10

6

1

19M8

li

4
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 99

Geographical source of entering stud ents in public and private medical schools

and basic medical service schools in the United States, 1960-61—Continued

Medical school Tota l

freshmen

Home State Out of Sta te

Pu blic schools—Continued

University of Missouri______ ______________

University of Neb raska........................................

State University of New Y ork, New York City.

State U nive rsity of New York, Syracuse....... .

University of North Ca rolin a_______________

University of Cin cinnati.......... ......... . ......... .

Ohio Sta te Un iversity............. ........... . ................

University of Oklahom a......... .............. .........

University of Oregon ............. ......... ...................

University of Pu erto Rico_________________

Medical College of South Carolina_______ ___

University of Tenn essee___________________

University of Texas, Sou thw estern----------------

University of Texas, Medical Bra nch-------------

University of U tah------ ------- -------- -------------

University of Vermo nt--------- -------- -------------

University of Virginia____ _________________

Medical College of Virginia________________

University of W ashington__________________

University of Wisconsin................... ...................

University of North Da kota______ _________

State University of South Dakot a.......................

West Virginia University__________________

Priva te schools______________________________

Loma Linda University____ _______________

University of Southern California___________

Stanford University________________ _____ _

Yale University........... . ......... ........- ...................

Georgetown University____________________

George Washington U niversity_____________

Howard University_______________________

University of Mia mi______________________

Emo ry University________________________

Chicago Medical School......... .............................

Northwestern University__________________

Stritch School of Medicine...................................

University of Chicago_____________________

University of Louisville____________________

Tulane University___ ____________________

Johns H opkins University_________________

Boston University................. . .............................

Harva rd Medical School_________________ .. .

Tu fts Un iversity—.................. .............................

St. Louis University____________ __________

Washington University, St. Louis___________

Creighton Uni ve rsity. ..___ . ____ _________

Seton Hall College of Medicine & D en tistry ....

Albany Medical College......... ............................

University of Buffalo.............. .............................

Albert Einstein College of Medicine........... .......

Colum bia University______________________

Cornell University_____ __________________

New York Medical College________________

New York University_____________________

University of Rochester____________________

Duk e University........... ........- ................... .........

Bowman Gray School of Medicine__________

Western Reserve University________________

Hah nem ann Medical College_______________

Jefferson M edical College_________ ____ ___

Temple University_______________________

University of Pennsylvania................................ .

Wom an’s Medical College_________________

University of Pit tsb urgh ___ _______________

Me harry Medical College__________________

Vanderbilt U niversity_____________________

Baylor University________________________

Ma rqu ette University_____________________

Dartm outh Medical School................................ .

81 80 1

90 86 4

156 145 11

84 77 7

69 60 9

98 62 36

151 149 2

104 100 4

80 57 23

55 52 3

80 80 0

204 144 60

100 93 7

144 140 4

55 41 14

51 6 45

77 51 26

85 62 23

77 66 11

92 82 10

42 30 12

45 30 15

46 45 1

4,194 1,939 2,255

103 37 66

69 63 6

60 30 30

80 10 70

117 12 105

102 14 88

106 18 88

82 76 6

75 42 33

76 13 63

131 53 78

88 41 47

73 24 49

95 83 12

133 28 105

78 8 70

74 37 37

117 19 98

115 62 53

122 19 103

88 22 66

77 12 65

80 51 29

64 40 24

88 77 11

98 73 25

120 52 68

85 28 57

128 82 46

130 105 25

72 32 40

75 23 52

55 20 35

87 63 24

111 83 28

176 117 59

137 107 30

127 69 58

63 18 45

101 78 23

71 6 65

.54 14 40

85 35 50

102 43 59

24 0 24

Source: Wiggins, Walter S. et al., “ Medical Education in the United S tates.” Jou rnal of th e American 

Medical Association 178: 579-652, Nov. 11, 1961.
100 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Percent of graduates of each medieal college in private pra ctice1

 in the same

Sta te as the medical college attended —Selected classes, 1980-50

Medica l college

To tal.

Pu blic schools.

Medic al College of A lab am a....................................

Unive rsity of A rka nsas______________________

Unive rsity of California, San Francisco.............. .

Unive rsity of Colorado..............................................

Medic al College of Georgia.......................................

Unive rsity of Ill ino is_________ _____ _______ _

In di an a Uni ve rsity ............. ................................ ......

State Unive rsity of Iow a.........................................

Unive rsity of K ansas ...................... ..........................

Lo uis ian a Sta te U n iv e rs it y .. .. _______________

Unive rsity of M ar yla nd-........ . ................... ............

Uni ve rsity of M ich igan .................... . ......................

W ayne State Unive rsity ___ _____ ____________

Unive rsity of Minn esota ...........................................

Unive rsity of N eb ra sk a. .............. ............................

State Unive rsity of New Yo rk, New Yo rk C ity.

State U niv er .ity of N ew Yo rk, Sy racu se_______

Unive rsity of C incinn ati......... . ...............................

Ohio State Unive rsity __________ ____________ _

Uni ve rsity of Ok lah om a........ ............ .....................

I' n i ver si ty of O regon.......... ...................................

Medic al College of So uth Ca rolin a.........................

Uni ve rsity of Tenness ee..................... . ..................

Uni ve rsity of Texas, So uthw es tern ........................

Unive rsity of Te xas, Medica l B ra nc h. ..................

Uni ve rsity of U ta h............. ......................................

Uni ve rsity of Vermon t______ ________________

Medica l College of Virginia___________________

Unive rsity of Virginia_______________________

Unive rsity of W ashin gto n____________________

Unive rsity of Wisconsin __________ ___________

Pr iv at e schools .

L im a Lin da U ni ver si ty ....................

Unive rsity of Southe rn Califo rn ia ..

Sta nfo rd Unive rsity ............................

Yale U ni ve rs ity ............... ....................

Georgetown Unive rsity ......................

Oeorge W ashin gto n Unive rsity ____

How ard Unive rsity .......................

Em or y Uni ve rsity _______________

Chicag o Me dic al School....................

Nor thwes tern Uni ve rsity _________

St ritch Scliool of M edici ne_______

U ni ve rs ity of C hicago ........... ............

Uni ve rsity of Louisv ille ...................

Tu lane U niv er si ty ...........................

Jo hn s Hop ki ns Unive rsity ..............

Bo ston Uni ve rsity ......... .....................

Har va rd Med icafSc ho ol................ .

Tuf ts U ni ve rs ity ________________

St. Lou is Unive rsity ________ ____ _

W ashin gto n Unive rsity , St. Louis ..

Cr eig hto n Unive rsity ......... .............. .

Alban y Medic al College....................

U ni ve rs ity of B uffalo____________

Colum bia Uni ve rsity .........................

Co rne ll Unive rsity ______ ____ ____

Ne w Yo rk Medic al College_______

Ne w Yo rk Uni ve rsity ____________

Uni ve rsity of R ocheste r.....................

Bo wm an Gray School of M edici ne.

Duk e U ni ve rs ity .................................

W estern Res erve Unive rsity ........... .

Hah ne m an n Medic al College..........

Jeff erso n Medical Colleg e..............

Unive rsity of P en ns ylva ni a..............

Unive rsity of P itts bur gh ...................

Te mp le Uni ve rsity ...........................

W om an ’s Medical College________

M eh ar ry Medical College________

Van de rb ilt Unive rsity ___________

Ba ylo r Unive rsity ..............................

M ar qu ette U nive rsity .................. .

Year of gr ad ua tio n

1930 1935 1940 1945 1950

56 51 46 46 46

56 55 53 52 55

63

.50 33 47 67 49

94 86 97 86 80

.50 44 .50 61 51

.56 63 69 60 66

71 46 .51 42 44

SO 83 68 57 52

57 .53 63 52 46

29 53 44 44 46

35 46 49 54

26 37 37 32 39

54 43 .50 54 62

94 77 79 61 79

65 .55 45 44 71

51 18 41 33 35

90 67 45 51 66

SI 76 69 65 67

67 .54 51 45 62

92 84 73 68 70

.55 53 68 55 62

46 79 39 44 40

81 67 61 72 69

43 .53 43 46 48

68 59

85 95 91 88 89

70 19

37 29 33 36 10

12 38 31 40 48

17 .50 46 32 54

61

80 52 42 57 45

55 49 42 42 38

50 64 51 62 46

94 100 91 86

91 97 97 89 91

35 25 32 17 18

10 10 20 16 3

12 30 32 23 11

5 24 5 4

38 47 47 44 45

85 78 65 36

30 29 26 21 27

58 61 37 47 48

9 29 13 8

41 44 31 38 53

33 22 2.5 20 26

12 15 14 6 22

47 46 38 36 .56

.50 28 27 2.5 33

.58 58 .50 59 42

33 28 14 25 32

38 43 33 38 31

18 25 8 12 13

79 90 63 72 .50

94 86 79 74 64

73 49 43 33 39

67 46 49 24 37

94 70 39 62 44

80 71 51 69 39

50 .56 43 46 32

75 44

20 32 16 28

73 6.5 68 60 .52

5.5 55 44 45 37

.56 54 42 33 35

44 57 46 46 30

94 S3 84 78 75

74 64 46 .50 34

57 31 44 22 27

9 0 0 0 3

22 27 32 20 .50

84 SO 78 79 78

88 47 36 46 32

19.50 in 1959. i C lass of 1930 surveyed in 1936,1935 and 1940 in 1950, 1945 in 1954, a nd 1950 in 1959.

Source: W eis kottcn, H. G. an d Alten derfer, M . E., “Tr en ds in Me dic al Pr ac tic e.” Jo ur na l of M edica l 

Ed uc ation 31: 1-92, J ul y (pt. II ), 1956. W eis ko tte n, H. G. et al, “Trend s in Medica l Pr actic e.” Jo ur na l 

of M edical E du ca tio n. 35:1071-1121, De cemb er 1960.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 101

Mr. Rhodes. Mr. Chairman, before we adjourn 1 wonder if it would 

be possible to have Dr. Gerald D. Timmons, who is here from Philadelphia, file a statement since he cannot appear tomorrow. He is associated with Temple University, and is head of the American Dental 

Association.

The Chairman. Yes. The doctor may file a statement, but we are 

going to come back at 2 o’clock this afternoon.

The committee will adjourn until 2 o’clock this afternoon.

(Whereupon, at 12:05 p.m., Wednesday, Janu ary 24,1962, the hearing in the above-entitled matter adjourned, to reconvene at 2 p.m., 

the same day.)

A FTER N OON SESSK >N

(The committee resumed at 2 p.m., pursuant to the recess.)

The Chairman. The committee will come to order.

This afternoon our first witness will be Dr. Donald G. Anderson, 

president of the Association of American Medical Colleges and dean 

of the University of Rochester School of Medicine and Dentistry.

Dr. Anderson, 1 am glad to extend to you in behalf of the committee a welcome to this committee.

We shall be glad to have your testimony.

In the meantime, I believe you have with you here and supporting 

you a number of deans of various schools.

I think it would be helpful to the committee, and certainly we will 

be glad to have it for the record if you will present them and identify 

them for the record.

STATEMENT OF DR. DONALD G. ANDERSON, PRESIDENT. ASSOCIATION OF AMERICAN MEDICAL COLLEGES. DEAN. UNIVERSITY OF

ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY

Dr. Anderson. Thank you very much, Mr. Chairman. I appreciate greatly this opportunity to appear in support of II.R. 4999.

I would like at this time to introduce the representatives of the medical schools of this country who are here today.

I am accompanied by Dr. Robert Berson, the dean of the Medical 

College of the University of Alabama and vice president of the U niversity for Health Affairs, and by Dr. Thomas Turner, the dean of the 

Johns Hopkins University School of Medicine. Each of these uentlemen will also present testimony for our association in support of 

H.R.4999.

Mr. Chairman, may they join me at the table ?

The Chairman. We shall be very glad to have both Dr. Berson 

and Dr. T urner join you for this presentation.

Dr. Anderson. I would like to ask the following deans to stand as 

I name them :

Dr. Edward Dempsey, dean of the Washington University School 

of Medicine in St. Louis.

Dr. John Ilirschboeck, dean of the Marquette University School of 

Medicine in Milwaukee.

Dr. Stafford L. Warren, dean of the University of California School 

of Medicine at Los Angeles.

Dr. G. O. Broun, dean of the St. Louis University School of Medicine.
102 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Dr. Samuel Trufant, associate dean of the University of Cincinnati, 

College of Medicine.

Dr. James McCormack, dean of the Seton Hall College of Medicine, 

Jersey City, N.J.

Dr. John E. Deitrick, dean of the Cornell University Medical 

College.

Dr. George Wolf, vice president for medical and dental affairs at 

Tufts University, Boston.

Dr. Robert A. Moore, president of the medical center and dean of 

the College of Medicine of the Downstate Medical Center, Brooklyn, N.Y.

Dr. John Sheinin, president of the Chicago Medical School.

Dr. Arthur P. Richardson, dean of the Emory University School 

of Medicine in Atlanta.

Mr. Harold Wiggers, dean of the Albany Medical College of Union 

University in Albany, N.Y.

Dr. Joseph Hinsey, director of the New York Ilospital-Cornell 

Medical Center.

Dr. John Parks, dean of the George Washington University School 

of Medicine.

Dr. Vernon Wilson, dean of the University of Missouri College of 

Medicine.

Dr. Kenneth Penrod, vice president for medical affairs of the U niversity of West Virginia.

Dr. Gordon Scott, dean of the Wayne State University College of 

Medicine.

Dr. John Sheehan, dean, Stritch School of Medicine, Loyola University, Chicago.

Dr. Houston Merritt, dean of the College of Physicians & Surgeons of Columbia University of New York.

Dr. Stanley Bennett, dean of the University of Chicago School of 

Medicine.

Dr. Richard Young, dean, Northwestern University Medical School, 

Chicago.

Dr. William Stone, dean of the University of Maryland School of 

Medicine.

Dr. Mark Everett, dean of the University of Oklahoma School of 

Medicine.

Also we have representatives of four universities who are giving 

serious consideration to the establishment of new schools, Dr. Louis 

Levin, dean of the School of Science, Brandeis University in Waltham, 

Mass.

Dr. L. D. Haskew, vice chancellor of the University of Texas, which 

already has two schools and is planning a third.

Dr. Gliddon Brooks, director of the In stitute of Health Sciences of 

Brown University.

Dr. David Denyer, assistant to the president of Rutgers University.

We appreciate the opportunity to introduce these gentlemen, Mr. 

Chairman. I am sure that they will be happy to answer questions 

that the committee may wish to direct to them after our testimony.

The Chairman. I assume they are merely here to be present for 

this presentation and do not expect to testify, do they?
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 103

Dr . A nderson. I believe, Mr . Chairm an, a few of them are sche duled 

to testify on othe r days on behalf of o ther organiza tio ns o r the y have 

mad e arr an ge me nts thro ug h other auspices to ap pe ar before your 

committee.

Th e Chairm an. Gentlem en, we are gla d to have all of you here. 

You are welcome. We are glad to know of yo ur int ere st in the 

legisla tion .

Dr . Anderson. Mr. Ch air ma n, as I have ind icated , we are very 

gr at ef ul fo r the op po rtu nity to ap pe ar befo re this com mittee and its 

dis tin guish ed chair ma n who to ge ther have done so muc h over the year s 

to f urther the cause o f healt h and m edical science.

Our a ssoc iation is ke enly aw are a nd believes tha t all citizens shou ld 

be gr at ef ul fo r the close and intellig ent attentio n you have given to 

the healt h need s of the N ation. Yo ur lea dersh ip in the ena ctm ent of 

the leg islation prov idi ng fo r insti tutio na l rese arch gr an ts and the 

Comm unity Fa cil ities and Service s Ac t of 1961 will foste r great and 

tang ible benefits com par abl e to the benefits th at have res ulted from 

other measures stem ming fro m this co mmittee.

Mr. Ch air man, I should like to acknowledg e the fo rthr ig ht sta tement wi th whi ch you opened these heari ngs yeste rday in which you 

sta ted the bu rden is on the pro po nents th at such a p ro gram of Fe de ral 

aid is abs olutely ind ispensable if the he alth needs of the Am erican 

people a re to be met.

My colleagu es and I acc ept the res ponsibility whi ch you have 

plac ed on us.

May I com men t th at we come here not ju st as dea ns of med ical 

schools but. in effect as the tru ste es of one of our Na tio n’s majo r resources, a resource on which the success of our coun try ’s efforts in m edical c are and medical rese arch is wholly de pen den t.

We urge ena ctm ent of this leg islation not in the self-i nte res t of the 

medical schools bu t to mak e it possible for the medical schools to do 

the job th at is requir ed of them by the people of th is country.

I hope th at my colleagu es a nd I shall be successful in de mo nstra tin g 

to you and the com mittee th at ena ctm ent at this tim e of II.R. 4999 is 

essential.

Th e argu men t in favo r of this legislation is very stra ig ht fo rw ar d. 

A numb er of au thor ita tiv e stud ies, none of whi ch has been seriously 

questioned, h ave es tablish ed th at to avoid a serious shortage of ph ysician s in the WTO’s, the numb er of medical stu dents in the Un ite d 

State s mu st be increased in the next 8 to 9 years by approx im ate ly 

,50 perc ent.

The first medical school in the Un ite d State s was establ ished by the 

1 ’nive rsify o f Pennsylva nia in 1765 an d admi tte d a class of f ewer than 

20 studen ts. In the inter vening 197 years, ou r fac ilitie s fo r medical 

edu cation have grad ua lly been ex panded throu gh the efforts of pr ivate 

ph ila nthr op y and local tax fund s to the point where today ap pr ox imately 8,200 new medical stu dents can be accepted fo r trai ni ng each 

year in our 86 medical schools.

Now, because of the conti nu ing grow th of our po pu lat ion an d the 

inc rea sing dem and bv all segments of society fo r more servi< » from 

phy sicians, we mu st, j ust to maintain t he present physician p op ulation 

ratio, ju st to m ain tain this ratio we must in the sh ort span o f the next 

8 to 9 years cre ate facilities fo r a n ad dit ion al 4.000 stu dents, or, to p ut
104 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

it an othe r way, we must in a decade or less increase by 50 percen t 

fac ilitie s that required nearly 200 yea rs of private and local effort to 

esta blis h.

It is the considered jud gm ent of our association, a judg me nt t ha t is 

unanim ous ly sup ported an d agr eed to by all of th e existing 86 medical 

schools of the Un ite d State s, th at expansion of this ma gnitu de can 

be accomplished in the tim e req uir ed only if Fe de ral fun ds on a 

ma tch ing basis are ava ilab le fo r the con struct ion of new schools and 

fo r the exp ansion and ren ovation of the e ducatio nal and researc h fa ­

cilities of exi sting schools.

I t is our sober judg me nt th at while pr ivate an d local tax moneys 

shou ld pa rti cip ate s ignific antly in the ex pansion th at is needed, fun ds 

from these sources will not be sufficient to accomplis h the task th at 

confr onts us.

It is our fu rthe r opinion th at, to at trac t sufficient stu dents to pr ovide an entering class of 12,000 qualified medical stu de nts by 1970 

or 1971, more ade qua tely sch ola rsh ip fun ds will be need ed than can 

be raised from local or priva te sources.

Finally , it is clear t ha t the hig h cost o f c onducting a med ical school 

tod ay will make existing schools reluctant to expand and will deter 

those unive rsities that might lie ca pable aca dem ically of establishin g 

new medical schools, fro m assu min g this ad ditio na l res ponsibility 

unless they can have some assurance of assistan ce in meeting th e substa ntial increase in operat ing expenses that they will incu r.

I should point out that the conclu sions that p riv ate and local fun ds 

will have to be supplemented by Fed eral funds to permit the necessary 

developm ent of medical edu cation in this coun try was not reac hed 

lig htl y. But even those of us who most regret t he need to seek Fe dera l assistance could come to no other conclusion but th at such assistance is necessary as we exam ine soberly and rea listic all y the costs of 

bu ild ing and op era tin g modern medical schools.

Mr. Cl lairm an and m embers of the committee, I shou ld like to stress 

th at while we are disc ussing the Na tio n’s need fo r phy sician s in the 

period of 1970 to 1975, the matter before us tod ay is an urge nt one 

as of t hi s moment.

As you have hea rd, the output of physicians cannot be incre ased 

ov ernigh t or even in a year or two or three of fou r. Exper ience 

pro ves th at under the most fav ora ble circums tanc es, it takes from 2 

to 4 years to pla n and constru ct new facilities, to raise the necessary 

fun ds, to recruit the fac ulty and ad mi nis tra tiv e personnel needed, 

and to plan a cu rricul um ; all tas ks t hat mu st be done befo re the first 

class of s tud ents can be adm itte d.

Und er more normal circumstances, these steps may require 6 to 8 

years.

An othe r 4 years mu st pass before thi s first class gra duate s. These 

yo ung phy sician s will spend stil l anoth er 2 to 5 ye ars in hos pital 

trai nin g as intern s and residents b efore they are available to serve th e 

peop le o f o ur country.

In o ther words, M r. C hairm an, the adequacy of ou r co un try ’s sup ply 

of physicia ns from 1970 on depend s on the act ion s we tak e now. If 

we coiild push the clock ahe ad 10 y ears, I believe ou r tas k to demonstra te the need f or this l egi slation would be much easier.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 105

The shortage of doctors would be clearly apparent and the protests 

of those affected would be far more eloquent than any words we can 

offer today.

However, if we wait until the crisis is upon us, our action will be 

too late to be effective.

Thus we plead most earnestly that Congress l>e farsighted and take 

action now.

Mr. Chairman, with your permission. 1 should like to confine the 

balance of my testimony to the need for Federal grants on a matching 

basis to assist in the construction of educational facilities.

Dr. Berson will present testimony on the need for funds for 

scholarships and genera! operating expenses, and Dr. Turner on the 

need for continuing the Health Research Facilities Act.

The medical schools are fully agreed that first priority in our national effort to provide an adequate number of physicians should be 

the provision of Federal funds on a matching basis for the construction of medical school teaching facilities. We urgently need classrooms, student laboratories, libraries, teaching hospitals, and clinics, 

and the essential supporting service facilities.

Lack of physical space in which to accommodate more students is 

without question the most serious single bottleneck to increasing the 

output of physicians.

Funds to assist with the construction of educational facilities are 

needed for four principal purposes:

(1) To enable existing medical schools to expand their classes.

(2) To enable universities to establish new medical schools.

(3) To enable existing medical schools to modernize and at times 

even replace antiquated and inadequate classrooms, laboratory, and 

library facilities.

(4) To enable existing medical schools to establish, modernize, or 

expand their teaching hospitals and clinics.

I should like to comment briefly on each of these needs.

A study by the Association of American Medical Colleges and the 

American Medical Association has shown that existing medical 

schools can expand their first year classes by approximately 1,700 

places if funds can be secured for the construction of teaching facilities and there is no question at. all, Mr. Chairman, that if funds are 

available and this construction can be provided these schools will 

create these additional places. Because these existing schools are 

already in operation and can get new construction underway with 

a minimum of delay, their expansion represents the most effective 

way to increase our medical manpower within the next few years.

However, if we are to meet our goal, and it is a minimum goal in 

terms of the needs of the country, if we are to meet our goal of 4,000 

new places in the medical school entering classes by the early 1970’s, 

in addition to expanding existing schools, a significant number of new 

medical schools must lie established. In fact, we must build sufficient 

schools to admit approximately 2,300 students annually, 2,300 additional students.

We should, therefore, think in terms of the establishment of 23 new 

medical schools. Various figures have been suggested ranging between 20 and 24, but I have taken the figure 23, each a dmitting a class 

of 100 students.
106 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

As we have alread y brou gh t out, even if the fund s were in hand 

tod ay, it would he 1968 to 1970 or even later before th ese schools would 

be gr ad ua tin g physicians.

A n um ber of o ur ex isting schools a re in da ng er of h av ing to reduce 

the size of t he ir classes because th ei r fac ilities a re an tiq ua ted and not 

capable of being m odernized. Other schools are op erating , we know, 

less effectively than the y sho uld because th ei r lab orato rie s are improp erly constru cted to accommodate mo dem teachin g equipment. 

Assisting these schools to replace or m odernize th ei r fac ilities should, 

we believe, clea rly be an im po rta nt pa rt o f o ur n ati onal pro gram.

Fina lly , con stru ctio n fund s fo r clinical tea ch ing facilities are 

urgently needed by many o f our schools.

In a mod ern medical school, the hospital, an d the ou tpatient clinic 

are the classrooms and the lab ora tories for the th ird and fourth year 

studen ts. Today , m any o f o ur schools have i nadequate clinical facilities in wh ich to teach even th eir present stud ent bodies.

These schools, we feel, need assistance to modernize, exp and , or in 

certa in cases even to create prop er te ach ing hospit al facilities.

Now wh at are the estimated costs of expa nd ing ou r enrollme nt of 

medical studen ts to meet the need th at has been establ ished?

A survey las t sum mer of the cost to expand and mod ernize our 

existing schools of medicine reveale d the need fo r $518 million, $78 

million of which would be for modernizatio n an d $440 million for 

expansion.

W ith respect to the cost of new schools, the cost of con struction 

varies d epe nding on the pree xis tin g related fac ilitie s at the unive rsity, 

the breadth of the new program fo r edu cation in the health profe ssions, an d the av ail ability in th e same com munity of a suitable hospit al and clinic t eac hin g fa cili ties .

Recogn izin g thes e varia tio ns, a reasonable est imate of the cost of 

constru cti ng a medical school with its tea ching h ospital may be said 

to ran ge f rom $25 to $35 million and thu s 23 new schools would rep resent a to tal cost o f between $475 to $805 million.

We th ink it is unrea listic to h ope or to exp ect that o ur un iversities, 

wi th th eir lim ited resources and with all of the othe r dem ands th at 

the y mu st meet— it is unrea listic to hope or to exp ect that they can 

pro vid e or raise from local and priva te sources du ring the next 8 to 

9 years the appro xim ate ly $1 billion to $1.3 billion of cap ital fun ds 

need ed fo r the expansio n of o ur facilitie s f or medical edu cation.

We firm ly believe, however, th at with the stimu lus and with the 

dir ect assistan ce th at F edera l fund s on a l iberal matc hin g ba sis would 

pro vid e, we can achieve or come close to ach iev ing the ex pansion th at 

is needed.

Th ere fore, the Ass ocia tion of Am eric an Medical Colleges has 

fo rm ally recom mended by unanimous vote, and the association, I 

should say, includes in its mem bers hip all th e medical schools in the 

Uni ted Sta tes, th is assoc iatio n has form all y recommended bv un animous vote th at Federal ma tch ing fun ds fo r tea ching facilities be 

pro vid ed under con ditions t hat w ill—

1. be sufficient in amount to enc ourage acti on that is lx>th 

pr om pt and ade quate ;

2. encourage the modernizatio n and expansion of existin g 

schools;
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONN EL 107

3. encourage academic institutions not presently involved in 

medical schools to plan and develop new schools;

4. encourage an institution’s continuing effectiveness in maintaining diversity in its sources of financial support;

5. recognize the essential unity of medical education and research by identifying the support of one with the other; and

6. recognize the indispensabilitv of the library, the university 

hospital, and clinic to medical research and education.

We believe tha t H.R. 4999, although it provides somewhat less 

than the amount of Federal assistance th at we estimate is required, 

does incorporate these basic conditions and we believe that it is soundly 

conceived to provide a basic program of Federal assistance tha t wiil 

encourage and ultimately make possible the expansion of our facilities 

for medical education that is needed if the Nation is to avert a serious 

shortage of physicans.

We, therefore, express the earnest hope tha t this bill will be 

enacted into law at an early date.

Mr. Chairman, I thank you and the members of the committee again 

for this opportunity to speak in support of this legislation which is 

so essential to the Nation’s welfare.

(The prepared statement, of Dr. Anderson follows:)

Sta te m ent of D r. D on al d G. And erson

Mr. Chairman and members of the committee, I am Dr. Donald G. Anderson, 

dean of the University of Rochester School of Medicine and Dentistry. I am 

appearing as a representative of the Association of American Medical Colleges of 

which I have the honor to be president.

I am grateful for the opportunity to appear before this committee and its distinguished chairman, who together have done so much over the years to further 

the cause of health and medical sciences. The Association of American Medical 

Colleges is keenly aware of and all citizens should be grateful to you for the 

close and intelligent attention you have given to the health needs of the Nation. 

Your leadership in the enactment of the legislation providing for institutional 

research g rants (Public Law 87-798) and the Community Facilities and Services 

Act of 1961 (Public Law 87-395) will foster great and tangible benefits such as 

have already resulted from the Health Research Facilities Act and many others.

I am accompanied by Dr. Robert C. Berson, dean of the Medical College of 

Alabama and vice president of the University for Health Affairs, and Dr. Thomas 

B. Turner, dean of the Johns Hopkins University School of Medicine. Each of 

these gentlemen will also present testimony for the Association of American 

Medical Colleges in support of H.R. 4999.

On behalf of the association, I should like to express our appreciation for this 

opportunity to appear before you today to endorse the provisions of H.R. 4999 

and to urge tha t this bill receive the favorable consideration of this committee 

and th at it be enacted into law at this time.

The argument in favor of this legislation is very straightforward. A number 

of authoritative studies, none of which has been seriously challenged, have 

established th at to avoid a serious shortage of physicians in the 1970’s, the number 

of medical students in the United States must be increased in the next 8 to 9 

years by approximatley 50 percent.

The first medical school in the United States was established by the University of Pennsylvania in 1765 and admitted a class of fewer than 20 students. 

In the intervening 197 years our facilities for medical education have gradually 

been expanded through the efforts of private philanthropy and local tax funds 

to the point where today approximately 8,000 new medical students can be accepted for training each year in our 86 medical schools. Now, because of the 

continuing growth of our population and the increasing demand by all segments 

of society for more service from physicians, we must in the short span of the 

next 8 to 9 years create facilities for an additional 4,000 students, or put another 

way, we must in a decade or less increase by 50 percent facilities tha t required 

nearly 200 years of private and local effort to establish.
108 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

It is th e co nsidered ju dgm en t of the Assoc iatio n of A merican Me dic al Colleges, 

a ju dg m en t th at is un an im ou sly su pp or ted an d ag re ed to by al l th e ex is ting 8G 

med ical schools in th e U ni ted Sta te s, th a t an ex pa ns io n of th is m ag ni tu de can be 

acco mplish ed in th e tim e re qui re d on ly of F ed er al fu nds on a m at ch in g ba sis a re 

av ai la ble fo r th e co ns truc tion of new sch ools an d fo r th e ex pa ns io n an d re no va ­

tio n of the ed uc at io na l an d re se ar ch fa ci lities of ex is ting sch ools. I t i s our sobe r 

ju dg m en t th at while pri vate a nd loc al ta x mon eys sh ou ld part ic ip ate s ignific an tly 

in th e ex pa nsion th a t is needed, fu nds fro m th es e so ur ce s will no t be av ai la bl e 

in suf ficien t am ou nt s to ac co mplish th e ta sk th a t co nfr onts us.

It is ou r fu rt h er opinion th a t to a tt ra c t suffi cie nt st udents to prov id e an en te ring clas s of 12,000 qu ali fie d med ical st uden ts by 1970 o r 1971, mo re ad eq ua te 

sc ho la rs hi p fu nd s will b e ne ed ed t han can be r ai se d fr om loc al o r pri vate s ou rces.

Fin al ly , it is cl ea r th a t th e high co st of co nd uc ting a med ical sch ool to da y 

will mak e ex isting sch oo ls re lu cta nt to ex pa nd an d will d ete r thos e un iv er si ties 

th a t mig ht be ca pa ble of es ta bl is hi ng ne w m ed ic al sch oo ls from as su m in g th is 

ad ditio nal resp on sibi lit y un le ss th ey ca n ha ve some as su ra nce of as si st an ce in 

m ee ting th e su bst anti al in cr ea se in op er at in g ex pe ns es th ey will incu r.

I shou ld po in t ou t th a t th e co nclus ion th a t pri vate a nd loca l fu nds will ha ve to 

be supp lemen ted by Fed er al fu nds to per m it th e ne ce ss ar y de ve lopm en t of 

med ical ed uc ation in th is co un try was no t re ac he d ligh tly. B u t even th os e of us 

wh o m us t re gre t th e need to see k Fed er al ass is ta nce co uld com e to no oth er 

co nc lusio n as we ex am in ed so be rly and re ali st ic all y th e co sts of bu ild ing an d 

op er at in g mod ern med ical schools.

Mr. C ha irm an an d mem be rs of th e comm ittee, I sh ou ld lik e to st re ss th a t while 

we are disc us sing fo re ca st s of th e N at io n’s ne ed fo r ph ys ic ia ns in th e pe rio d 

1979 to 1975, th e m att er be fore u s to da y is an urg ent one as of th is mo me nt. The 

outp ut of ph ys ic ians ca nn ot be incr ea se d ov er ni gh t or ev en in a yea r or two, 

or th re e or four . Exp er ienc e prov es th a t in th e mos t fa vor ab le ci rc um stan ce s, 

it ta kes from 2 to 4 years to pl an an d co ns truc t new fa ci lities , to ra is e th e 

ne ce ss ar y fu nd s, to re cru it ad m in is tr ati ve an d fa cu lt y pe rson ne l, an d to pl an a 

cu rr ic ul um —all ta sk s th a t m us t be done be fore th e firs t cl as s of st uden ts can 

be ad m itte d. Und er more no rm al circ um stan ce s, th es e step s may re qu ire 6 

to 8 ye ars.

A no ther 4 ye ar s m us t pa ss be fore th is first cl as s gra duate s. And th es e yo un g 

ph ys ic ia ns will spend st ill an oth er 2 to 5 year s in ho sp ital tr ain in g as in te rn s 

an d re si de nt s be fo re th ey are av ai la bl e to se rv e th e i>eople of ou r co un try.

In ot he r words, Mr. C ha irm an , th e ad eq ua cy of our countr y's supp ly of ph ys icia ns fro m 1979 on de pe nd s on th e ac tio ns we ta ke now . As you can deduce, 

fr om th e in fo rm at io n I ha ve pr es en ted, we are al re ad y be hind sche du le if we 

are to m eet th e de m on st ra bl e ne ed s of th e Nation in th e ear ly 1979’s.

Thus we plea d mo st ea rn es tly th at th e Co ng ress lx* fa rs ig hte d an d ta ke ac tio n 

now to av oid a cri si s th a t will mo st su re ly oc cu r if ac tion is no t take n.

Par en th et ic al ly . I m us t ob serv e th at shou ld th e in te rn ati onal si tu at io n re qu ire 

th e mob ili za tio n of an y su bst an tial nu mbe r of phys ic ia ns in th e ne xt se ve ra l 

ye ar s, a se riou s sh or ta ge of ph ys ic ians fo r ou r civi lian po pu latio n will mos t cer ­

ta in ly occ ur. W hile it is too la te to pr ev en t su ch a cr is is fro m oc cu rrin g in th e 

n ex t few ye ars, th e ex istenc e of a sou nd, lon g-rang e, pr og ra m fo r th e ex pa ns ion 

of our fa ci lities fo r med ical ed uc at io n wo uld re du ce th e hyst er ia th at wo uld 

ac co mpa ny suc h a cr is is an d wo uld les sen th e need fo r th e ad op tio n of un so un d 

and e xp en siv e c ra sh pr og rams.

Mr. Cha irm an , w ith yo ur pe nn ission . I shou ld lik e to con fine th e ba lanc e of 

my testim on y to t he need fo r Fed er al gra nts on a m at ch in g ba si s to ass is t in th e 

co ns truc tion o f e du ca tion al fa ci lit ie s.

Dr. Per so n wi ll pr es en t testim on y on th e need fo r fu nds fo r sc ho la rs hi ps an d 

ge ner al op er at in g ex pe nses, an d Dr. T urn er on th e nee d fo r co nt in uing th e progra m of Fe de ra l m at ch in g gra nts fo r th e co ns truc tion of re se ar ch fa ci lit ie s.

The med ica l sch ools are fu lly ag reed th a t first pri ori ty in ou r nat io na l effort 

to pr ov id e an ad eq ua te nu mbe r of ph ys icians sh ou ld lx* th e prov isi on of Fe de ra l 

fu nds on a m at ch in g ba sis fo r co ns truc tion of med ical sch ool teac hi ng fa ci lities . 

W e ur ge nt ly nee d cla ssroom s, st ud en t la bo ra to ri es , libra ri es , teac hing ho sp ital s 

and cli nic s, an d es se nt ia l su pp or tin g se rv ice fa ci lities . La ck of th e ph ys ical 

sp ac e in wh ich to ac co mmod ate mo re st uden ts is th e m os t se riou s sing le bo ttl ene ck to i nc re as in g t he ou tp ut o f phy sician s.

Fun ds to ass is t w ith th e co ns truc tion of ed uc at io na l fa ci lities are needed fo r 

fo ur pr in ci pl e p urp ose s:

1. To en ab le ex is ting m ed ical sch ools to expa nd th e ir classes.

2. To en ab le u niv er si ties to esta bl ish ne w m ed ical sch ools.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 109

3. To en ab le ex is ting medica l sch oo ls to m od ernize an d repl ac e anti quate d 

an d in adeq uate cla ssroom s, la bo ra to ry , and li bra ry fa ci lities .

4. To en ab le ex is ting med ical sch ools to es ta bl ish, mod ernize , or ex pa nd 

th eir te ac hin g ho sp ital s a nd c lin ics .

I wish to c om m en t brie fly on e ac h of th es e needs.

A st ud y by th e Assoc iatio n of American Med ica l Colleg es an d th e American 

Med ica l A ss oc ia tio n has show n th a t ex is ting med ical scho ols ca n ex pa nd th eir 

lirs t- ye ar cl as se s by ap pr ox im at el y 1,700 plac es if fu nd s ca n be se cu re d fo r co nst ru ct io n of te ac hin g fa ci lities . Bec au se th es e schools are alr ea dy in op er at io n 

an d ca n ge t ne w co ns truc tion und er w ay w ith a m in im um of de lay, th eir ex pan ­

sio n re pre se nts th e m os t effective w ay to in cr ea se ou r med ical m an po wer w ithin 

th e nex t few y ea rs .

How ev er, if we are to mee t our go al of 4,000 new plac es in med ical sch ool 

en te ri ng clas se s, in ad di tion to th e ex pa ns io n of ex is ting sch ools, a sign ifi ca nt 

nu m be r of ne w m ed ical schools m us t be es ta bl ishe d. In fa ct , we m ust bu ild 

suffi cie nt ne w sch oo ls to ad m it 2,300 (t he differen ce be tw ee n 4,000 an d 1,700) 

ad dit io nal fi rs t-ye ar med ical st uden ts an nu al ly . We shou ld, th er ef ore , th in k in 

te rm s of th e es ta blish m en t of 23 new med ical sch ools, ea ch adm it ti ng a clas s 

of 100 st uden ts . As al re ad y br ou gh t ou t, ev en if th e fu nds were in ha nd toda y, 

it wo uld be 1968 to 1070 or la te r be fo re th es e sch oo ls wo uld be gra duati ng 

ph ys icians .

A nu m be r of ou r ex is ting schools are in dan ger of ha vi ng to re du ce th e siz e 

of th eir clas ses, be ca us e th eir fa ci li ti es a re anti quate d and not ca pa bl e of being 

mod ernize d. O th er scho ols are oper at in g less eff ec tiv ely th an th ey sh ou ld, beca us e th eir la bora to ri es are im pr op er ly co nst ru ct ed to ac co m mod ate mod ern 

te ac hi ng e qu ipm en t. A ss isting th es e scho ols to r ep la ce or mod ernize th eir fa cil iti es shou ld, th er ef or e, cl ea rly be an im port ant p a rt of our nat io nal pr og ra m .

Fin al ly , co ns truc tion fu nds fo r cl in ic al te ac hin g fa ci lities are urg en tly ne ed ed 

by man y of our sch ools. In a mod er n m ed ical sch ool th e ho sp ital and clinic are 

th e clas sroo m s an d la bora to ri es fo r th e th ir d- an d fo urt h-y ea r st uden t. Tod ay 

man y schools ha ve in ad eq ua te clin ical fa cil it ie s in whic h to teac h th eir pre se nt 

st ud en ts . The se scho ols need as si st ance to mod ernize , ex pa nd , or even cre ate 

pr op er t ea ch in g ho sp ital fac ilitie s.

W hat are th e es tim at ed ca pit al co sts of ex pa nd in g our en ro llm en t of med ical 

st uden ts to m ee t th e in di ca te d ne ed fo r ph ys ic ia ns ? A su rv ey la st su m m er of 

th e co st to ex pa nd an d mod ernize ou r ex is ting schools of m ed icine re ve al ed a 

ne ed fo r $518 m ill ion—$78 mill ion fo r mod er ni za tio n an d $440 mill ion fo r 

ex pa ns ion.

The co st of co ns truc ting new m ed ical schools var ie s de pe nd ing on pre ex is ting 

re la te d fa cil it ie s a t th e uni ve rs ity, th e bre ad th of th e ne w pro gr am fo r ed uca ­

tio n in th e healt h pr of es sion s, an d th e avai la bility of hos pi ta l an d clinic te achin g fa ci lities . Rec og nizing th es e var ia tions, a re as on ab le es ti m ate of th e co st of 

co ns tr uc ting a med ical sch ool w ith its teac hi ng hos pi ta l may be sa id to ra nge 

from $25 to $35 millio n. Twen ty -thr ee ne w sch ools wo uld th us re pre se nt a to ta l 

co st of $575 to $805 mi llion .

I t is unre ali st ic to ho pe or to ex pe ct th a t ou r univ er si ties w ith th eir lim ited 

re so ur ce s an d w ith al l th e ot he r de m an ds th ey m ust m ee t ca n pr ov id e or ra is e 

from loc al an d pri vat e so ur ce s duri ng th e nex t 8 to 9 yea rs th e ap pro xim at el y 

$1 billion to $1.3 billion of ca pital fu nds ne ed ed fo r th e ex pa ns io n of ou r fa ci lities fo r med ical ed uc at io n. We firmly believe, ho wev er, th a t w ith th e stim ul us 

an d th e di re ct ass is ta nce th a t Fed er al fu nd s on a liber al m at ch in g ba sis wo uld 

prov ide, we ca n ac hiev e or com e clo se to ac hi ev in g th e ex pa ns io n th a t is needed.

Th er ef or e, th e Assoc iatio n of American M ed ical Colleg es has fo rm al ly reco mmen ded by un an im ou s vo te th a t F ed era l m at ch in g fu nd s fo r teac hi ng fa ci lities 

be pr ov ided under con ditio ns t h a t w ill—

1. Be suf fic ien t in am ou nt to en co ur ag e ac tion th a t is bo th pr om pt an d 

ade quate .

2. Enco ur ag e th e m od er ni za tion and ex pa ns io n of ex is ting sch ools.

3. E nc ou ra ge ac ad em ic in st it uti ons not pr es en tly inv olv ed in med ical 

ed uc at io n to p la n an d dev elo p new sc ho ols.

4. Enc ou ra ge an in sti tu ti on’s continuin g eff ec tiv en ess in m ai nta in in g 

div er si ty in i ts so ur ce s of fin an cial s up po rt.

5. Re cogn ize th e es se ntial unity of med ical ed uc at io n an d re se ar ch by 

id en tify in g th e support of one w ith th e ot he r.

6. Re co gn ize th e in dis pe nsa bility of th e libr ar y, th e univ er si ty ho sp ital , 

an d clin ic to m ed ica l re se ar ch a nd e du ca tio n.
1 1 0 TRAINING OF PROFESSIONAL PUBLIC HE ALTH PERSONNEL

We believe that H.R. 4999, although it jjrovides somewhat less than the amount 

of Federal assistance tha t we estimate is required, does incorporate these basic 

conditions, and we believe that it is soundly conceived to provide a basic program of Federal assistance tha t will encourage and ultimately make possible 

the expansion of our facilities for medical education that is needed if the Nation 

is to avert a serious shortage of physicians.

We, therefore, express the earnest hope tha t this bill will be enacted into 

law at an early date.

Mr. Chairman, I thank you and the members of the committee again for this 

opportunity to speak in support of this legislation which is so essential to the 

Nation’s welfare.

Dr . Anderson. I would appre ciate it if D r. Berso n and Dr. Tur ne r 

cou ld now be hea rd.

Th e C hairma n. Mr. Roberts ?

Mr. Roberts. Mr. Ch airma n, I do not know who will be the next 

witness but you m entioned D r. Berson.

I would lik e to say at this poin t th at I am very hap py that Dr. Berson 

cou ld be here to ap pe ar before our comm ittee.

Recently a su bcommittee of this com mittee vis ited Birm ing ham, th e 

Sub com mittee on He alth and Safety, an d Dr . Berson was our host. 

He made the arr angeme nts fo r the com mittee to meet ou t at the 

Un iversit y of A lab am a Ho spita l where we ha d a very fine h ear ing .

Of course, in Ala bam a, as th e c hai rman knows, co ming fro m A rk an ­

sas, we are not only fam ous for our foo tball bu t we also are famous f or 

ou r unive rsity medical center .

Dr. Berson has ha d an ou tstan din g part in est ablishin g our cen ter 

and in d oing the wo nderful work especially i n t he card iov asc ula r field 

in ou r unive rsity m edical center.

It is e spec ially p lea sin g t o me t o h ave this o pp or tunity to say a few 

wo rds for D r. Berson.

Dr. Berson. Th an k you, sir.

Th e Chairman. Dr . Berson, we a re very glad to hav e you present 

here testimo ny on one phase of this subject. I do no t know, however, 

to wh at extent Ar kansas mi gh t have any clai m at all with refe rence 

to the medical prog ram in Alabam a. We do hav e at prese nt at the 

Un iversity of Ar kansas some ind ivi duals who go t a grea t deal of experience over yo ur way. How ever, since some of the best football 

players fro m Ar kansas wen t to Alabam a and since our coach is at 

Alabam a now, I can u nd ers tan d you r success in th at field.

Dr . Berson. Th an k you, Mr. Ch airma n.

Th e Chair man. We are v ery glad to have you and shall be gla d to 

he ar you r statem ent.

STATEMENT OF DR. ROBERT C. BERSON, DEAN OF THE MEDICAL

COLLEGE, THE UNIVERSITY OF ALABAMA, AND REPR ESENTATIVE OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES

Dr. Berson. Th an k you, Mr. Chairma n. I a pprec iat e Mr. Ro berts’ 

kind words. I have presented to yo ur se cre tary a pre pared statem ent. 

A ft er l istening to the testimo ny of the las t 2 day s, with yo ur per mission I would like to sim ply follow this sta temen t in a gen eral way 

ra th er tha n rea ding it in its entire ty.

Th e Chairman. You may have yo ur en tire statem ent included in 

the record an d su mm ariz e i t as you desire, Doctor.

Dr . Berson. I would apprec iate t ha t op po rtu nity, sir.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 111

(The statem ent refer red to f ollows:)

Statement of Dr. Robert C. Beeson

Mr. Chairman and members of the committee, I am Dr. Robert C. Berson, dean 

of the medical college and vice president for hea lth affa irs of the University of 

Alabama. I am appe aring as a representativ e of the Association of American 

Medical Colleges on whose executive council I have the honor of serving.

I want to endorse the provisions of H.R. 4999 and to urge th at it receive the 

favorable consideratio n of th e committee and be promptly enacted into law.

First, I would like to underscore Dr. Anderson’s line statement concerning the 

impending serious shortage of physicians. In doing so I would emphasize the 

fac t that the 50 percent expansion of enrollmen t to which he—and other autho rities—have referred will only provide enough physicians to maintain th e p resent 

physician to population ratio. In my opinion this is truly a minimum objective. 

If the increase in the supply of medical manpower is no grea ter than 50 percent 

by 1975, not only would a su bstantial increase in the m ilita ry needs for physicians 

crea te a marked shortage in the civilian supply, as Dr. Anderson has indicated, 

but also the lag in applying newly acquired medical knowledge from our expanding resea rch effort to the needs of patients would surely increase. This 

committee has already taken an important step toward improving techniques and 

facilities for applying this new medical knowledge to the needs of patients 

through its support of the Community Facilities and Services Act of 1961. Additional medical manpower, proi>erly oriented and educated, as well as facilitie s 

and techniques will be needed to accomplish this imp orta nt end. And there is 

growing evidence that the medical knowledge and skill available in this country 

already could be enormously helpful to less well developed countries if adeq uate 

medical manpower and appropriate cooperative arra ngemen ts were available.

I agree completely with Dr. Anderson’s statement that the first consideration 

be given to a program of Federal match ing grants for the construction of new 

and the modernization of old f acilitie s to accommodate the necessary incre ase in 

the number of medical students and graduates.

The institu tional members of the Association of American Medical Colleges 

are also in unanimous agreem ent th at nex t must come steps to insu re that there 

will be a sufficient number of well qualified studen ts to fill these expanded classes 

and become the additional graduates needed. This need is almost as urgent as 

the need for facilities.

It is no secret t ha t while th e number of gra duates from our liberal a rts colleges 

has been increasing in the past several years, there has been a steady decrease 

in the number of studen ts applying for admission to medical schools. Thus, in 

1956-57, there were 15,900 applican ts to medical schools while in 1966-61, the 

number had dropped by 1,500 to 14,397.

Although 14,400 applican ts for the 8,298 places in the entering medical school 

classes might appear to provide a comfortable margin, this is not the case. 

As the admissions committee of any medical school can report, a substan tial 

number of those who apply to medical school each year are not qualified on 

any count for the study of medicine and would fail within a few months if 

they were to be admitted. In recent years, a number of admissions committees 

have reported privately—no school likes to adm it such a fac t publicly—th at they 

have had to scrape the bottom of the barrel of applicants to fill their classes.

All schools have agreed for several yea rs that strenuous efforts must be made 

to maintain and incre ase both the number and quality of applica nts to medical 

school. The medical schools individually, collectively through the Association 

of American Medical Colleges, and cooperatively with the American Medical 

Association have been exerting themselves to at trac t more able studen ts to the 

study of medicine. These efforts have included the development by individual 

schools of closer relationships with high school and college stud ents and their 

counsellors, the preparatio n and dissemination of pamphlets and brochures on 

medical education, the production of motion pictures on careers in medicine 

to be shown to high school and college studen ts and many oth er efforts. In 

addition, the schools, their alumni associations, and the American Medical 

Association have made some progress in increasing the scho larship and loan 

funds available for medical students, and the National Defense Education Act 

has begun to make loan funds available to medical studen ts in sub stantial 

amounts.
112 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

D es pi te al l th es e effo rts a t re cr uitm en t, we ha ve no t l>een ho ldin g ou r own 

in th e nu m be r of ap pl ic an ts as th e fig ures I pre se nt ed a few m in utes ago 

re ve al.

Tho se of us wh o ha ve stud ie d th e pro ble m clo sely belie ve th a t th er e are a 

nu m be r of th in gs resp on sibl e fo r th e de cr ea se in th e nu mbe r of ap pl ic an ts fo r 

med ical school. Alth ou gh it is no t th e only fa ct or , we be lie ve th a t th e co st o 

ob ta in in g a med ical ed uc ation, bo th in it se lf an d in co mpa riso n w ith th e cost 

of g ra duate ed uc ation in oth er fields is one of th e mo st im port ant de te rr en ts . 

We be lie ve th a t if we are to ha ve a sufficient nu m be r of qu ali fie d stude nts to 

fill th e ne w sch ools an d th e ex pa nd ed school s th a t are needed in the nat io na l 

in te re st , ab le yo un g men an d wo me n w ith lim ited mea ns m us t ha ve mo re 

ass ura nce th a t it will be fin an cially possi ble fo r th em to st ud y me dicin e th an 

th ey ca n now be given. F urt her, th is as su ra nc e m us t be cl ea rly vis ibl e to thes e 

yo un g pe op le while they are in high school an d college— th a t is du ring th e 

cri ti cal year s when th ey m ak e th e decis ion of w het her or no t to tr y to stud y 

med icine.

We be lie ve th a t th e fina nc ial as si st an ce needed shou ld com e par tl y thro ug h 

lo an s but no nr ef un da bl e gra nts —w het her calle d sc ho la rs hi ps or fello wsh ips— 

are also needed to do th e jo b which th e nat io nal in te re st re qu ires . And we 

be lie ve th a t ef fo rts to in cr ea se sc ho la rs hi p an d lo an fu nds from pri vate an d 

loc al so ur ce s will an d shou ld co nt in ue bu t th a t th ey will no t suffice an d th a t 

th e Fed er al Gov ernm en t sho uld su pp lemen t the se efforts .

I be lie ve ju st a few ba sic fa ct s wi ll mak e clea r th e im po rtan ce of the po sitio n 

I ha ve ju st stnted .

A t th e pr es en t tim e only 15 pe rc en t of me dical st udents com e from th e mo re 

th an 40 pe rc en t of th e Am erican fa m ilie s who ha ve inc om es of les s th an $5,000 

per ye ar , while al m os t on e-ha lf of th e stud en ts com e fro m th e less th an 10 

pe rc en t of fa m ilies w ith an nual inc om es of more th an $10,000. 'Phis is no t 

su rp ri si ng when you re la te it to th e fa ct s th at th e 4 yea rs of me dical scho ol 

re quir e a ca sh o ut la y of m or e th an $11,000 by the st uden t an d th a t th is is follo we d 

by years of ho sp ita l tr ain in g ch ar ac te ri ze d by ve ry low inco me.

The fa ct th a t loan s are luring used fo r th e stud y of med icine is illu st ra te d 

by a st ud y of in di vi du al s gra duati ng fro m med ica l sch oo ls in 1050. Thi s stud y 

reve aled th at 20 pe rc en t of th es e men an d women a t gra duati on ha ve de bts of 

ov er $2,500 w ith an av er ag e de bt fo r th is grou p of $0,000. Thi s am ou nt of de bt 

is a fo rm id ab le dete rr ent to a yo un g pe rson wh o has ne ve r ea rn ed an incom e 

an d who se fa m ily’s inc om e is les s th an $5,000.

Subst an tial in cr ea se s in th e fu nds av ai la bl e fo r lo an s ha ve oc cu rred in re ce nt 

ye ar s. Se veral Sta te s ha ve se t up ex tens ive loa n fu nd s an d th e American Medica l Assoc iatio n is pre par in g to beg in a prog ram of under w ri ting lo an s to me dic al 

st udents in su bst an ti al am ou nt s. The Nationa l Defen se E du ca tion Act of 1958 

pr ov id es lo an s to medica l st ud en ts . W hile we believe th es e fu nds shou ld co ntinue to increa se, it is w orthy of no te th at sin ce th e N at io na l D ef en se Edu ca tio n 

Act be ca me effective, th e tr en d of de clining nu mbe r of ap pl ic an ts fo r a slowly 

in cr ea si ng nu m be r of plac es in th e en te ri ng clas s has co ntin ue d. Fr om 1958-59 

to 1960-61, the nu mbe r of ap plica nts dec lined from 15.170 to 14.397. an d th e 

nu m be r of en te ri ng st uden ts in cr ea se d fro m 8,128 to 8,298, al th ou gh 2,585 stu ­

de nt s in 78 med ical schools rece ived $1.64 mi llion in nat io nal de fens e loan s in 

1859-60 .

A m att er of e qu al or gre ate r sig nific an ce i s th e fa ct th a t th e su bst anti al fel low ­

ships. sc ho la rshi ps , an d oth er su bs idies fo r gra duate st uden ts in th e ph ysical, 

biolog ica l, an d social scienc es th at ha ve be en prov ided in re ce nt year s ha ve ma de 

it mu ch less co stly fo r ab le yo un g men an d wo me n to pu rs ue gra duate stud ies 

in th es e fields ra th e r th an in me dicin e. A s tu dy by th e nat io nal op ini on rese ar ch 

ce nt er o f th e U ni ve rs ity of C hica go in 1959-60 r ev ea led th a t th e av er ag e gra duat e 

st udent in th e a rt s an d scienc es pa ys les s th an h alf as mu ch as th e av erag e 

m ed ic al st udent fo r his e duc at io n an d yet h e rece ived fo ur tim es as man y do lla rs 

to mee t th is cost.

In re ce nt ye ars, p art ic u la rl y sin ce the ac ce le ra tion of th e ro ck et an d miss ile 

pr og ra m , th ere ha s been a gr ow in g aw ar en es s of th e im po rtan ce of scienc e an d 

w el l- trai ned sc ho la rs in m an y fie lds an d th e us ual g ra duate st ud en t, onc e he 

rece ives his Ph. D. de gree , ca n st ep in to a job pa yi ng a t le as t $6,000 or $7,000 a 

ye ar . Th e med ical st ude nt , ho wev er, st ill ha s anoth er 2 to 5 ye ar s of ho sp ital 

tr ain in g to go th ro ug h as an in te rn an d a re si den t be fo re he be gins to pra ct ic e 

his pr of es sion or ta kes his plac e in one of th e m an y po sition s of pu blic service 

in which th e nat io na l in te re st re quir es a w el l-trai ne d ph ys ician.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 113

It is im port an t to recogn ize th a t th e Fed er al Gov er nm en t now pr ov id es 

sc ho la rs hi ps or fello wsh ips fo r hi gh er ed uc at io n in ev ery field of scienc e ex ce pt 

th e he al th pr of es sion s. At pr es en t, ea ch yea r ap pr ox im at el y 10,(XX) pr ed oc to ra l 

fe llo wsh ips in th e ph ys ical lif e an d social scien ces, psycholog y, en gine er ing, 

th e hu m an itie s, an d ed uc at io n are aw ar ded by var io us ag en cies of th e F edera l 

Gov ernm en t. The se fello wsh ips pr ov id e st ip en ds of $1,800 to $2,500 w ith a 

$500 al lo wan ce fo r ea ch de pe nd en t pl us tr av el allo wan ce an d fu ll pa ym en t of 

tu it io n fees an d us ua lly prov ide a “eos t-o f-ed ue atio n pa ym en t” to th e in st itution. 

In addit io n to th es e Fed er al pro gr am s th ere a re su bst anti al pri vat el y fin an ce d 

pr og ra m s fo r th e s upport of gra duate st ud en ts .

The co nc ep t ha s long bee n ac ce pted th a t th e in di vi du al w ith a Ph . I), de gr ee 

us ua lly sp en d hi s ca re er in publi c se rv ice an d th a t it is, th er ef or e, in th e pu blic 

in te re st fo r him to rece ive fina nc ial as si st ance du ri ng hi s g ra duate stud y. It 

see ms im p o rt an t to em ph as ize he re th at an ad eq uat e supp ly of w el l-trai ne d 

ph ys ic ia ns in m an y po sitio ns of pu blic se rv ic e is also es se nt ia l. A su bst anti al 

an d in cr ea si ng nu m be r of ph ys ic ia ns is ne ed ed fo r th e Arm ed Fo rces, th e U.S. 

Pu bl ic H ealt h Servi ce, V et er an s’ A dm in is tr at io n ho sp ital s, loc al an d S ta te he al th 

de pa rt m en ts , m en ta l an d tu be rc ul os is ho sp ital s, an d fu ll- tim e po sition s in rese ar ch an d teac hi ng .

I t seem s cert ain th a t as appro pri at e co op er at iv e ag re em en ts are re ac he d an d 

su itab le te ch ni qu es are av ai la bl e fo r m ak in g th e medica l kn ow led ge an d sk ill of 

th is co untr y us ef ul to les s we ll de ve lope d na tio ns , a gr ow ing nu mbe r of 

ph ys ic ia ns will in g to de di ca te al l or p a rt of th eir ca re er s to se rv in g hum an ity, 

w ith re la tivel y low pe rs on al co mpe ns atio n will be ne ed ed an d high ly us ef ul in 

th es e pr og ra m s, as hav e been th e m ed ical m is si on ar ie s up to now .

The med ical sch oo ls are no t un ha pp y th at g ra duate st udents a re be ing giv en 

su ch ge ne ro us su pp or t. On th e cont ra ry , we be lie ve th es e pro gra m s are cl ea rly 

in th e nati onal in te re st . How ev er, th e m ed ic al sch oo ls are gr av el y co nc erne d— 

an d th e fa cts su pp or t th is co nc ern—th a t un less more su bst anti al fina nc ial as ­

si st an ce is cl ea rly an d visib ly av ai la ble fo r st udents of med icine th e nu m be r of 

st udents wh o choose to st ud y med icine will be insu ffi cie nt to m ee t th e N at io n’s 

well-d oc um en ted ne ed s fo r ph ys ic ia ns i n th e y ears ahe ad .

Se rio us ef fo rts to o bt ai n sc ho la rs hi p fu nds fr om loc al an d pri vate so ur ce s hav e 

bee n an d will co nt in ue to be ma de. T he de an s of se ve ra l in st it uti onal mem be rs 

of th e Assoc iatio n of American Med ica l Co lleges ha ve se rv ed ac tivel y on a 

spec ial co mm itt ee of th e Amer ican Med ical Assoc iatio n st udyin g th e ne ed in 

ord er to reco mmen d ac tio n by th e AMA. T hi s co mmitt ee has reco mmen de d 

th a t th e AMA sp ea rh ea d an d in itia lly fin an ce a nat io nw id e pro gr am to pr ov id e 

ab ou t 50 sc ho la rs hi ps a yea r to st udents en te ri ng med ical sch oo ls. On e of th e 

fo unda tion s re ce ntly m ad e on e-t im e g ra n ts of $15,000 to ea ch m ed ical sch oo l (a 

to ta l of ov er $1 m illion ) fo r no nr ef un dab le s ch ol ar sh ip s. An d nea rl y e ve ry med ica l sch ool do es w hat it ca n to obta in sc ho la rs hi p fu nds by co nt ri butions or th e 

ap pro pri ati on o f S ta te f un ds . B u t th e n ati onal ne ed i s fo r sc hola rs hip s upport o f 

ap pro xi m at el y 25 pe rc en t of th e ex pa nd ed en ro llm en t reco mmen de d by ev ery 

re ce nt st ud y. We believe th a t F ed er al par ticip ati on in th e ef fo rt to pr ov id e th is 

fin an cia l as si st ance is ne eded an d we ll ju st ifie d in th e nati onal in te re st . H.R . 

4999 pr ov id es a long s te p to w ar d m ee tin g th is need.

In ad ditio n to fa cil it ie s an d an ad eq uat e su pp ly of ab le st uden ts , th e th ir d 

es se nt ia l el em en t in th e pr og ra m to ob tain more ph ys ic ia ns is fu nds fo r th e 

ba sic co st of oper at in g th e ed uca tional pr og ra m of ex is ting an d ne w m ed ic al 

sch ool s.

Fig ur es fro m m an y sch oo ls could be cite d to sho w th e need fo r in cr ea se d 

oper at in g fu nds w ith wh ich to m ai nta in th eir pr es en t pr og ra m s an d fa ci lities . 

Ev en more co nv incing to me is th e ev iden ce on ev ery han d of under pai d fa cu ltie s. un de rs ta ff ed pr og ra ms, an d fa il ure to in sti tu te new ed uca tiona l pro gr am s 

to ke ep pa ce w ith th e m ar ch of th e sci ence and a rt of med ici ne . An d th ere is 

re al da ng er th a t some med ica l schools, la rg ely fo r th e lack of oper at in g fu nd s, 

will be un ab le to mee t re as on ab le st an d ard s of q ual ity an d will ce as e to oj je ra te . 

L ittle won de r th a t som e un iv er si ties w ith th e ac ad em ic pote ntial fo r de ve loping 

fine new m ed ical sch oo ls are re lu cta n t to co mmit them se lv es to do so un less 

th er e is mor e ass ura nce of as si st an ce in mee tin g th e co st of th e ir op er at io n.

The re as on med ical sch ools need in cr ea se d fina nc ial su pport fo r th eir oper ation s can be st ate d sim ply . Not on ly h as th e de clining purc has in g po wer of th e 

do llar affected them as it has al l oth er in st it uti ons bu t also th e de m an d fo r 

ph ys icians , sc ie nt is ts , an d all th e oth er high ly tr ain ed peop le ne ed ed in a mod er n 

med ical sch oo l is ru nn in g ah ea d of th e supp ly. Thi s m ea ns th a t th e m ed ic al
114 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

schools have had, somehow, to provide high er salarie s and wages tha n was 

the case in the past, although they still lag fa r behind the “going rat e” in their 

communities, and the cost of supplies and equipment has increased dramatically. 

Also, the continued expansion of the national effort in research poses a serious 

thre at to the proper balance between resea rch and education within an institution. With the financial supp ort of research incre asing at the rate of about 

30 i>ercent a year and the supp ort of the basic educ ational program increasing 

bare ly enough to keep up with the declining purc hasing power of the dollar 

the re is a builtin tendency for individual faculty members and institu tions to 

shift their emphasis farth er toward research tha n is desirable for the educational program. In larg e part, research with in a medical school is, and should 

be literally inseparable from edu cation ; the same studen ts and faculty being 

engaged to some extent in both activities simultaneously in the laboratory, conference room, or hospital ward. What is needed is more substan tial supp ort 

for th e basic educational program.

Afte r prolonged and careful consideration, the Association of American Medical Colleges has reached the opinion that it is necessary and wise, in the 

national interest, for the Federal Government to begin to partici pate in meeting 

the basic cost of oj>erating the educational programs of medical schools. The 

reasons f or this opinion can be summarized unde r six categories.

(1) Prom pt action on a national scale is necessary if sufficient funds from 

all sources are to be made available in time. The long experience of each 

medical school in trying to obtain sufficient funds from private, local, and State 

sources, plus a decade of experience of trying to increase coriairate giving for 

this purpose through the National Fund for Medical Education and professional supp ort through the American Medical Education Foundation have 

convinced us that these sources alone cannot supply sufficient funds to expand 

with in a decade a national enrollment that has been achieved through almost 

200 years of effort. The re is some reason to believe th at in this field, as in the 

construction of health research facilities, Fed eral supp ort will provide a marked 

stimulus to the other sources of potential supp ort and thus, through combined 

effort, the need can be met.

(2) The expansion of population, the larg est single factor in creating the 

need for more physicians, is a national phenomenon, very unevenly distributed 

among the several State s. The grad uate s of medical schools, wherever located, 

spread to the four corners of the country as interns, residents, and to pursue 

their careers. But many of our existing medical schools are located in States 

in which the population is not increasing rapidly. It is difficult to see how such 

a State as Alabama, whose population is increasin g very slowly, could mobilize 

enough additional Sta te supp ort to expand enrollments to meet needs in dis tan t 

and rapidly growing sections. Nor is it likely th at privately supported medical 

schools can obtain the additional funds from private sources to meet such needs 

without the stim ulus of some Federal participation .

(3) Pa rt of the need for the present as well as the futur e increasing supply 

of physicians is generate d by Federal programs of vital importance. The Armed 

Forces, the U.S. Public Health Service, the Vete rans’ Administration and, to a 

lesser extent, other Fed eral agencies, could hardly accomplish their mission 

without steadily replenishing their supply of physicians from the gradua tes of 

our medical schools, and it is imperative that such future expansion of their 

needs, as events may require, be well met.

(4) Pa rt of th e need has been generated by programs the Federal Government 

has stimulated, encouraged, and supported financially. Our great national program of medical research now requires the full-time efforts of a substan tial 

number of physicans and will, in the future, require even more. Our efforts to 

make the results of that resea rch more quickly and effectively available to 

patients, such as the Community Facilities and Services Act, require an adequate 

number of physicians. And such programs as the Hospital Construction Act 

(Ilill-Burton) assume that there will be an adeq uate number of physicians to 

staff the needed facilities.

(5) Our rela tions with less well developed countries make it logical and necessary that we find ways to make available to them the medical knowledge and 

skill we have. This will requ ire not only app ropriate techniques and agreements but also an adeq uate supply of physicians.

(6) Finally, the Federal participation in the support of the basic cost of the 

education al program would not seem to involve any new decision concerning 

policy since several programs of Federal supp ort for gradua te education in 

nea rly every field except the health professions alre ady provide “cost of educa-
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 115

tion” payments to the institution s and several Federal gra nts for re search tra ining include such basic elements as the sala ries of the faculty involved.

We believe H.R. 4999 is an excellent bill as written and would recommend 

changes in only two details. We do believe that the limitation on the amount 

of scho larsh ip th at could be awarded to an individual should be raised from 

$2,000 to $2,500 per year (pt. C., sec. 740, p ar. (c) (2), p. 16). The la tte r amount 

is more rea listic in relation to the cost of attending medical school for the s tudent who needs full scholarship supp ort and is in line with many other Federal 

fellowships for graduate study.

We would also recommend that the amount of Federal cost of education 

payments be increased eith er by the addition of a lump sum gra nt of $200,000 

a yea r for each 4-year medical school ($100,000 for each 2-year school), or by 

increasing the payment i>er studen t to accomplish the same end (pt. C., sec. 740, 

par. (d) (a ), p. 17). In this connection it should be emphasized tha t, as H.R. 

4999 is now written, the cost of education payments would increase in four 

ann ual steps and reach a maximum of less than 6 percent of the basic operating 

costs of the Nation’s medical schools. The total appropriations authorized by 

this section would be a little more than $11 million and last year the basic 

operating expenses of the Nation’s medical schools were about $198 million. 

Close stud y of the effects of this program in operation for a few years will 

provide a sound basis for deciding the amount of futur e auth orizations, but 

the problem is so urge nt and the leadtime in developing new schools so long 

that I am convinced it should s ta rt at the higher level recommended.

Mr. Chairman, in closing I would like to make it clear why the Association 

of American Medical Colleges does not fear th at this legislation will lead to 

Fed eral interference with the sound prerogatives of the institution, the ir faculties, their students, or the ir graduates who con stitute the hea lth professions. 

For more tha n two decades our member institu tions have had extensive experience with large, diverse, and growing Federal programs for the supp ort of 

resea rch and resea rch training and have found them sing ularly free of such 

interference. The legislation itse lf provides for a Natio nal Advisory Council 

an arrang ement most successful to this end in other Fed eral programs and its 

noninterference clause is clear and strong.

I am personally convinced th at Edmund Burk e was right, more tha n a century 

ago, when he said: “Government is a contrivance of human wisdom to provide 

for human wants. Men have a right th at these wan ts should be provided for 

by this wisdom.’’ Thank you.

I)r. Berson. First I would like to underscore Dr. Anderson's statement about the need for more physicians and in doing so would like 

to emphasize that the projection of a 50-percent increase in enrollments and graduation will only be sufficient to maintain by 1975 the 

present physician population ratio. It is my own opinion tha t this 

is truly a minimal objective.

In the testimony this morning, figures were brought out of the 

gross decrease in the number of physicians in general practice or 

internal medicine or pediatrics who serve in the family physician 

capacity. A little more increase in the military needs for medical 

manpower would produce a severe problem. All of us are concerned 

about ways to make the results of medical knowledge more quickly 

available to patients who need it. This will take not only techniques 

and facilities, but manpower; and to me the opportunity of this country to help less well developed countries improve their health is a very 

great and exciting challenge, but this too will take more people. So 

I think that when we speak of simply maintaining the present physician-to-population ratio we are talkin g of minimal objectives, rather 

than of anything overly optimistic or necessarily optimal.

The institutional membership of the association is also in unanimous agreement tha t after considerations of means to get the facilities 

needed, the next consideration should lie given to means to get a 

sufficient number of well qualified students who choose to study
116 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

medicine . It is no secret that we have been losing gro und in th is 

respect for some years. Tn 1956-57 there were 15.900 app l icants. But 

in 1960-61 there were only 14,397, an actu al drop of about 1.500.

A t fi rs t glance it might seem that a little more than 14,000 ap pl ican ts fo r 8,200 places leaves a com fortable ma rgin but this is not the 

case. Any admissio ns committee in the country could tes tify that a 

great man y people ap ply for admissio n to medical schools who really 

are not pre pared and who would fail out within a very few weeks if 

the y hap pen ed to be admitted. So that the gross num ber of 14.400 

includes a very lar ge numb er of people who are not well pre pared 

fo r th is field.

I want to e mphasize that all of the schools have mad e v ery s tren uou s 

efforts of th eir own s ort to improve this sit uatio n throug h rec ruitme nt 

cam paigns, throug h bette r con tac t with the adv isers of studen ts in 

colleges, throug h havin g stu dents visit the cam pus, motion picture s, 

coopera ting with local and county and St ate medical societies, and 

the Am eric an Medical Association, to rec ruit tal ented you ng people 

to choose the study of medicine. But in spite of these efforts we are 

not even holding our own. Those of us who have stu die d this pro blem closely are convinced that there are many fac tors in thi s decline 

in the num ber of appli can ts, hut that a very large fac tor, and one 

abo ut which som ething can be done is the need of stu dents for fina ncial assistance. We are convinced that the high cost of stu dy ing 

medicine, coming as it does af te r college, plu s the f act that goi ng into 

gr ad ua te study in many oth er fields can he very inex pensive for the 

stu dent and his fam ily, pu ts medicine at a disadvantag e in recruitin g 

the num ber of youn g peop le we need to exp and the medical manpo wer 

base of the cou ntry. Also, we believe tha t this finan cial assistance 

should come pa rtly throug h loans but that ad dit ion al mechanisms., 

nonrefu ndable gran ts, are also needed.

One of the main reasons fo r this feeling is th at, as the Se cretary 

men tioned, we are now ge tting only 15 percent of our students from 

the 40 percent of fam ilies whose income is less than $5,000 a year. In 

this country native ability is not distr ibu ted acc ord ing to fam ily income. Fo r a studen t from such a low-income fam ily to elect a c are er 

in medicine which will require a cash outlay of $11 ,000 or $12 ,000 on 

his own or his fam ily 's pa rt, in con trast to anoth er useful and fine 

caree r in a scientific field that will require no outlay, is a very difficul t decision. Some such students still stu dy medicine. There are 

some very fine people who are ge tting throug h medical school on so 

lit tle money and so much effort tha t it is amazin g. But when you 

con sider the need to exp and the enrollment by 50 percent in the 

future, we do not believe th at the re will be enough of those unusual 

peop le who will make that much effort to meet the need. Th ere are 

loan fun ds ava ilab le and being used. These loan funds have l>een 

increased su bstan tia lly in recent years. Loans under the National 

Defe nse Ed ucation Act are availab le to medical stu dents in most 

schools. My inf orma tio n is tha t by now some 2,50 0 stu dents in 78 

medical schools bor row money from the national defense loan pro ­

visions. Th is is a new prog ram but it has not reversed the tre nd in 

ap pli cants because last ye ar t her e was a fu rthe r decline in applican ts 

from the year previous although the schools had con tinu ed with th eir 

efforts to expand enrollments so that the en terin g class in the last 2 

years had increased in size by 170 from our 8,828 t o 8,998.
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSONN EL 117

Th e co ntrast with the op po rtu nitie s to enter many othe r Helds of 

gr ad ua te stud y is v ery gre at. In recent yea rs, pa rticul ar ly since such 

gr ea t attention has been paid to space pro gra ms , grad ua te stu dents 

in n early every scientific field have a vai lab le a wide va rie ty of fellow ­

ship s, sch ola rships, and tea ching ass istantsh ips , to such an ex ten t 

that many peop le whose own resources are lim ited can go into one of 

those prog rams af te r ge tting the ir b ach elo r’s degree and be no lon ger 

depen den t upo n th ei r fam ily. Wh en they get their Ph. I), the y can 

go to w ork at a salar y of $6,000 or $7,000 a year.

In o ur countr y the concept that the ind ividual who ear ned a Ph . D. 

degre e u suall y spen t his ca ree r in public service an d there fore deserved 

financ ial assistance by society du ring his period of stu dy, th at has 

long been a p art of our thi nk ing.

1 would like to emp hasize the f act t ha t in medicine there are a lre ady 

a gr ea t ma ny people who spend th eir careers in pub lic service at 

rel atively low per son al income and th at th ere is need fo r a g reat many 

more physicians in th at sort o f capacity. Th is is local, State , and 

Fe de ral public he alt h service, the Ve ter an s’ A dm inist ratio n program , 

men tal and TB hospitals, fac ilities of medical schools, rese arch institutes, the grow ing op po rtu nitie s in inter na tio na l fields, the medical 

mis sion aries. We need a great ma ny people in these fields.

Ac tua lly the medical schools are not un ha pp y th at the su pp ort of 

grad ua te stu dents in many other discip lines has gotten as solid as 

it has. We think these fields are esse ntia l to the natio nal int ere st, 

but we are concerned that, if there con tinues to be this imb alance in 

op po rtun ity t o choose the field of stud y, we m ay not be able to at tr ac t 

and to edu cate enough phy sician s to meet the co un try 's needs.

There are real efforts being made to obtain sch ola rsh ip fund s from 

local and pr ivate sources. Not man y of these effo rts have b orn e v ery 

rich fr uit bu t the effo rts are real and very sincere.

One fou ndation has rece ntly given each medical school $15,000 in 

nonrefu ndable grants. Th is was a one-time gift. We cannot expect 

it to be rep eated.

In my own ins titution we miss no op po rtu nity to seek funds for 

sch ola rships from donors, from the St ate leg islatu re, bu t ou r success 

is very small to date.

One reason th at we feel so str on gly th at rem oving this economic 

obstacle to stu dy ing medicine, is the experie nce o f the years imm ediatel y af te r World W ar II when a gr ea t many people had the bene ­

fits of the GI bill, and this res ulted in no t only a bump er cro p of 

fine a pp lic an ts for th e study o f m edicine but a g reat m any peop le who 

had never thought they could stu dy medicine previously, when the y 

fou nd th at the y had the benefits of th at su pp ort chose to stu dy medicine. They turned out, in general, to be an extrem ely satis factory 

grou p of stu dents and they are tu rn in g ou t to be v ery fine p hysicians. 

You have pro bab ly seen th e figu res on how m any a pp lic ants t he re were 

while those l>enefits were available. Th is is one reason we th in k th at 

if we can find ways to remove the economic ba rrier the re will be an 

adequ ate num ber of fine people who choose this p rofession.

In addition to fac ilities and an ade quate supply of stu dents , the 

th ird essential is some means of su pp or tin g the basic op er at in g cost 

of the medical schools. You could quote figures from many schools 

sho win g what schools now need, and ac tua lly on ev en ’ hand there is
1 1 8 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

evidence of underpaid fac ulty, understaff ed program s, failu re to insti tute new pro gra ms th at are cle arly sensible and needed. There is 

rea l dang er that some medical schools that are ha vin g a pa rti cu larly 

ha rd tim e find ing enough op erating fun ds, will be unable to meet 

reas onable stan dards and will go ou t of existence.

So it is not very su rpris ing th at some unive rsitie s whi ch have the 

academic poten tial to deve lop a fine medical school are reluctan t to go 

into th at field un til there is some better assura nce th at they can get 

the money to ope rate it. Th e reasons medical sc hools need more money 

now th an they used to are v ery simple. Not only has the decreas ing 

pu rch asing power of the dollar affected them , as all othe r institu tions, 

bu t hig hly tra ined physicians and scientists and the other tra ined 

people the y need are in ve iy sh ort sup ply com par ed wi th th e dem and, 

so they have had to pay high er wages a nd salar ies th an they used to, 

altho ug h they still lag way behin d the going rate, and the cost of 

all the goods and sup plie s th at they use and all the equ ipm ent has 

increased trem endously.

W ha t is needed is not ju st money to mee t the go ing costs bu t 

a sufficiently soun d pa tte rn fo r mee ting o pe ratin g fund s so t hat un iversities can look forw ard to crea tin g new schools and ex pa nd ing the 

ones th at they have.

A fter a lot of con sideration the Asso ciation of Am erican Medical 

Colleges has reached the opinion th at it is necessary and wise in the 

natio nal inte rest fo r the Fe de ral Gov ernm ent to begin to pa rticipate 

in meetin g the basic op erating cost of the educational prog ram s of 

medical schools. Maybe I can summarize my reason s fo r this best 

under six categories.

Th e first is th at prom pt acti on on a natio nal scale is necessary if 

sufficient fun ds from all sourc es are to be made availabl e in time. 

Th e lon g experien ce of each medical school in tryin g to obtain sufficient funds from priva te, local, a nd S tate sources plu s a decade of experi ence in tryi ng to increase corporate giving fo r th is pur pose 

thro ug h the National Fu nd fo r Medical Ed ucati on and professional 

su pp or t throug h the Am eric an Medical Ed ucati on Foundatio n, have 

convinced us th at these sources alone can not supp ly sufficient fun ds to 

expand within a decade the national enrollment which has been 

achieve d throug h almost 200 years of effort. Th ere is some reason 

to believe th at in this field as in the construc tion of hea lth-research 

fac ilities, Federal su pp ort will pro vide a ma rke d stimu lus to the 

othe r sources of poten tia l su pp ort and thus thro ug h combined ef ­

fo rt the need can be met.

Th e second reason is th at the expansion of population , which is 

the largest sing le factor in crea tin g a need fo r more phy sicians, is 

a natio nal phenomenon! th at is very unevenly distr ibuted amo ng the 

various States. Th e grad ua tes of medical schools scatter to the fou r 

cornel’s of the ea rth as soon as they grad ua te, for th ei r intern ship 

resid ence and to follo w th ei r career. But many of the schools that 

exist now are located in St ates w here th e population is n ot exp andin g 

much and about ha lf of them are pa rt of privately su pp ort unive rsities. It is ha rd to see, fo r instance, how Ala bam a, whose population is expanding only a lit tle bit, can find the resou rces to meet a 

gro wing need for physicians in oth er pa rts of the cou ntry that are 

grow ing rap idl y.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 119

Another reason is that part of the need for more physicians is the 

result of programs of the Federal Government that are tremendously 

important. The Armed Forces, the Public Health Service, the Veterans’ Administration, other Federal agencies could hardly carry out 

their mission if they could not replenish their supply of doctors as 

they need them. And part of this need has been generated by programs the Federal Government has stimulated, encouraged, and supported financially. The great national program of research requires 

righ t now the full-time services of a good many physicians and it is 

going to require more in the future. The effort to apply the results 

of this research to patients is going to take more doctors to carry it 

out. Such programs as the Hill-Burton program assume that there 

will be enough doctors to staff those facilities.

A fifth reason is that our relationship with the less well developed 

countries could benefit greatly if we were able to export the medical 

knowledge and skill that we have effectively. But this will take 

people.

Finally, the Federal participation in the support of the basic cost 

of the educational program would not seem to involve any new decisions concerning policy since several programs of Federal support 

for graduate education in nearly every field except the health profession, already provide cost of education payments to the institutions 

and several Federal grants for research training include such basic 

elements asthesalaries of the faculty involved.

We believe this is a good bill as it is written and we would recommend changes in only two details. We do believe th at the limitation 

on the amount of scholarships that could be awarded to an individual 

should be raised from $2,000 to $2,500 a year because this would be 

more in line with the actual cost of studying medicine and with many 

other fellowship programs already in existence.

We also think tha t it might be wise to consider increasing the cost 

of education payments either by adding a lump-sum grant to each 

school or by increasing the per student ratio to accomplish the same 

thing.

I want to emphasize here that as this bill is now written when the 

cost of educational payments become fully effective they will amount 

to about 6 percent of the basic operating cost medical schools of this 

countiy had last year, not some future projection.

Air. Chairman, in closing I would like to make clear why the 

Association of American Medical Colleges does not fear that, this 

legislation will lead to Federal interference with the sound prerogatives of the institutions, their faculties, their students, or their graduates who constitute the health professions. For more than two decades our member institutions have had extensive experience with 

large, diverse, and growing Federal programs for the support of research and research training and they have found them singularly 

free of such interference, The legislat ion itself provides for a national 

advisory council, an arrangement most successful to this end in many 

Federal programs and its noninterference clauses are clear and strong.

Thank you very much.

The Chairman. Thank you very much, I)r. Berson, Now I lielieve 

Dr. Turner has a statement on the other phase of the legislation.
120 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

STATEMENT OF DR. THOMAS B. TURNER, DEAN, JOHNS HOPKINS 

UNIVERSITY SCHOOL OF MEDICINE. BALTIMORE, MD.

Dr. Turner. Mr. Chairman, members of the committee, I appreciate 

the courtestv of the privilege of presenting a statement to you.

With your permission, I would like to enter my written statement 

in the record and summarize briefly what is contained therein.

I would first like to indicate my wholehearted support of the principal provisions of If.IL 4999. The previous speakers have outlined 

clearly the urgent need for more physicians to care for the health of 

the American people, keeping in mind that there is a leadtime of 8 

to 10 years before we can expect any increased production.

The bill before us deals with two different problems.

First, with how to persuade more qualified students to enter the 

field of medicine,

Secondly, it deals with how to induce medical schools, which are 

already overburdened financially, to expand their facilities in order 

to accept these students, or to persuade overburdened universities to 

develop new schools.

My own comments will be directed primarily to the health research 

facilities aspects of the bill but, in doing so, I would like to approach 

it from two standpoints.

First, for its own merits but. secondly, as an excellent example of 

how the Government can take the lead in a health program and at 

the same time increase participation at local levels in the program 

which it is leading.

This program has been in effect some 7 or 8 years. It has been administered by the Public Health Service and the NIII with its advisory councils with wisdom, in my opinion, and great fairness. The 

impact on the medical schools has been enormous. To indicate some 

of its impact, it has led to an enormous expansion of research which 

in the longrun will greatly benefit the American people.

At the same time, it has greatly enhanced the quality of medical 

education.

Finally, the research building program has gone a long way toward 

creating a true medical center of our medical schools so that we are 

are now geared up to do the job of training almost all types of health 

personnel that the country will need.

I think that the provisions in this bill are conservative in asking 

for $50 million for a 3-vear period.

Through the health research facilities bill approximately $15 million annually has been going to medical schools for the creation of 

new or expanding research facilities. This has been matched dollar 

for dollar at the local level.

There is clear indication that this same amount, $15 million, will be 

needed annually, for in existing schools, I understand that requests 

before the N III Council already exceed this amount.

In addition, additional funds will be needed for the creation of 

new research facilities in new schools that may be started.

As good as this program has been, however, it has had very little 

impact on increasing the number of physicians. This is why we 

would like to support strongly the statements of Dr. Anderson that 

building funds for educational purposes are needed if we are to 

produce more doctors and develop medical schools.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 121

Finally, Mr. Chairman, I would like to point out tha t the construction of new buildings at a medical school immediately adds to 

the operating cost of that school.

For example, in my own school, Jo hns Ilopkins, we have built new 

facilities in an amount of approximately $8% million. This has 

increased our annual operating budget by $350,000 the type of funds 

which are very difficult to come by. Merely building the buildings 

therefore is not going to solve the problems of the school th at wishes 

to expand, or the university tha t wishes to establish a new medical 

school.

Mr. Chairman, I thank you very much for the privilege of making 

this statement.

The Chairman. Thank you, Dr. Turner.

(The formal statement of Dr. Turner follows:)

Sta te m en t of D b. T hom as B. T ur ne r

Mr. C hai rm an and mem be rs of th e co mm itt ee , I am Dr. Tho m as B. T urn er, 

de an of th e Jo hns Hop kins Me dic al School an d a mem be r of th e ex ec ut iv e 

coun cil of th e Assoc iatio n of American Medica l Col le ge s; it is pri m ari ly in th is 

la tt e r ca pa ci ty th a t I ha ve th e pr iv ile ge of ap pea ri ng be fore yo u toda y.

I wo uld lik e first to in di ca te my su pport of H.R . 4999 and si m il ar hills . Th e 

is su e un der co ns id er at io n c an be simply st ate d. T hi s co un try is fa ci ng a se riou s 

sh ort ag e of ph ys ic ia ns an d oth er m ed ical man po wer. In de ed , th e sh ort ag e is 

alr ea dy upon us, as ca n lie att est ed by ev eryd ay ex pe rien ce in al l p a rt s of th e 

co un try. At th e same tim e our med ical sch oo ls are un de rfinan ce d. F or th is 

reason , ex is ting med ical scho ols a re re lu cta n t to in cr ea se en ro llm en t an d few 

uni ve rs itie s are ab le to as su m e th e he av y fina nc ial bu rd en of sta rt in g a new 

med ical sch ool . T her e is good re as on to be lie ve th a t th e he lp pro vi de d in H.R. 

4999 will lead to an in cr ea se in th e num be r of med ical gra duat es , reco gn izing 

that, a le ad tim e of 5 to 10 yea rs wi ll be re quir ed be fo re t he nu m be r of ph ysi ci an s 

ca n be sign ifi ca ntly au gm en ted.

My ow n co mmen ts will be direc te d pri m ari ly to th e co ns truc tion fe atu re s of 

H.R . 4999. Sinc e 1958, in th e ord er of $75 million of Fed er al fu nds ha ve been 

gr an te d fo r th e co ns truc tion of re se ar ch fa ci li ti es in American m ed ical sch ools. 

Sin ce 1: 1 m at ch in g of Fed er al mon eys is re qu ired , th e to ta l out la y in m ed ical 

sch ools fo r re se ar ch co ns truc tion has been a t le as t $150 mi llion . Fed era l su pport of re se ar ch fa ci li ti es shou ld be co nt in ue d as prov id ed by II. R. 4999. The 

im pa ct of th is bu ild ing pr og ra m an d th e att en d an t su pport of re se ar ch on th e 

qua lity of m ed ic al ed uc at io n has been im m ea su ra bl y gre at . Mo reov er, it has 

en ab led th e med ical sch ool to d evelo p in to a tr u e med ica l ce nter , w he re a ll ty pe s 

of ba dly ne ed ed m ed ical man po wer may be tr ai ned .

Tin s fo rw ar d- lo ok in g pr og ram shou ld be co ntin ue d, fo r th e re se ar ch re so ur ce s 

of th e co un try st ill re quir e au gm en tin g. Of th e $30 mill ion avai la ble annual ly 

fo r Fed er al su pport of re se ar ch co ns truc tion , abou t half has gone to med ical 

schools, an d th e re m ai nder to ind ej> end ent ho sp ital s, den ta l sch ools, an d no nmed ical in st itutions. We belie ve th a t ap pro xim at el y th is sa m e am ou nt will be 

ne eded an nual ly fo r fu rt h er re se ar ch co nst ru ct io n in ex is ting m ed ical sch ools. 

S ubst an tial ad ditio nal am ou nt s wi ll be re quir ed fo r re se ar ch const ru ct io n in 

new medica l sch oo ls now in th e pla nn in g stag es .

As va lu ab le as th e fe de ra lly su pp or te d re se ar ch pr og ra m has been, it h a s no t 

led to an ap pr ec ia bl e in cr ea se in th e nu m ber of ph ys ic ians gra duat ed . In de ed , 

an im ba lanc e has cr ep t into ou r med ica l sc ho ol s; fo r ex pa ns io n of th e te ac hi ng 

pr og ra m has no t ke pt pa ce w ith th es e gre at an d la uda ble re se ar ch ac co m pl ishmen ts.

If th e nu m be r of ph ys ic ians is to be in cr ea se d to me et th e c om bine d ne ed s of 

th e ar m ed se rv ices an d th e civi lia n po pu la tion , an d to man ex pa nd ed med ical 

re se ar ch fa ci lities , it is im por ta nt th a t Fed er al as we ll as non -F ed er al fu nds 

begin to go to th e su pport of co ns truc tion th a t will au gm en t our ed uca tional 

fa ci lities . Fed er al fu nds are ne eded fo r tw o purp ose s; (1 ) T he ex pa ns io n an d 

mod er ni za tion of ex is ting me dic al sc ho ol s; an d (2 ) th e co ns tr uct io n of ne w 

med ical sch ools. Sin ce I)r. An derso n has give n th e co m m itt ee det ai le d ju st i80 014— 6: 9
122 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

fication for both the expansion of the existing schools and the construction of 

new ones, I will not go into furth er details.

One final point is pertine nt to this problem. The constru ction of a new building whether for research or educational purposes, or both, immediately throws 

a financial burden on the medical school for its maintenance. For example, at 

my own medical school, Johns Hopkins, recent construction of research and educational facilities in the amount of $8.5 million, with the help of Federal funds, 

has increased our operatin g budget for building maintenance alone by $350,000 

annually. It is the conviction of the Association of American Medical Colleges 

th at along with construction funds the Federal Government should share, 

through a cost-of-education allowance, in the deficit which each medical student 

creates—the difference between what he pays in tuition and the actual costs of 

his education.

Mr. Chairman, please let me thank you for the privilege of appearing before 

this distinguished committee.

The Chairman. Mr. Williams, do you have questions of either of 

these gentlemen ?

Mr. Williams. I have one or two questions I would like to ask 

Dr. Anderson.

Doctor, throughout your statement you make continual references 

to your inability to obtain the necessary funds to carry out this program from local sources, including local tax sources.

Has your association appeared before the State legislatures requesting these funds from the States?

Dr. Anderson. The association has not, sir, but in those States that 

have State medical schools, I am sure that the representatives of the 

universities and schools concerned have made vigorous presentations 

to the legislature.

Sometimes this is done through the president of the university, 

sometimes the dean is permitted to speak directly.

Also, wherever there has been a State commission appointed to survey the needs of the State, the medical schools in that State have 

presented their case as vigorously as they can.

Mr. Williams. In cases where medical schools have presented their 

cases before the State legislatures and have actually demonstrated 

a real need for additional funds, have they been denied those funds?

Dr. Anderson. I cannot answer categorically State by State, Congressman Williams, but I think what we are presenting is our judgment based on the experience we have had with State legislatures as 

to the amount they can provide.

Mr. Williams. Is it the amount they can provide or the amount 

they will provide?

Dr. Anderson. Well, sir, it is probably some of both. I cannot 

speak for the legislatures but I would imagine it is some of both.

Again I am no authority on this but I imagine the State legislatures, 

like universities, are faced with tremendous demands on many fronts 

and their financial capacity, I imagine, is-----

Mr. Williams. Not nearly so much as the Congress is faced with 

demands for funds.

The President has indicated he will request Congress to increase 

the debt ceiling to something above $300 billion. On a per capita 

basis, our Federal debt exceeds by far that of the States.

It is rather difficult for me to understand how the Federal Government will be in a better financial position to furnish this money than 

will the States. Yet your statement makes continued reference to it.

Are you forgetting the $300 billion that we owe?
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSON NEL 123

Dr. Anderson. No, sir; I think we are quite mindful of that.

Mr. Williams. 1 am just wondering, why not make a concerted 

effort through the States to get these funds because, after all, it is 

the States’ primary responsibility to furnish these funds for this 

purpose.

1 notice the colleges do not seem to have too much trouble to get 

funds to build a stadium with.

I)r. Anderson. I think my best answer to that is, as Dr. Berson explained, this is a national problem and not a State problem, that the 

need for physicians extends unevenly but widely throughout the Nation and it, would seem very difficult to get all 50 States to take concerted action promptly enough and in sufficient scope to meet what is 

a national problem.

1 think that would have to be my answer.

Mr. Williams. Then do you not think that since education is a 

national problem perhaps the States could just yield their prerogative of educating their children to the Federal Government? Wha t 

would be the difference in the programs?

Dr. Anderson. I think we look on this, sir, as a partn ership between private and local taxing agencies and the Federal Government 

and I think many of us feel at least that some of the problems today 

are so large that they can only be solved by a partnership effort.

As 1 have tried to bring out in my testimony, many of us make this 

request for Federal assistance with real regret tha t it is necessary, 

but we have had a decade of experience of trying to find from other 

sources the amount of funds we need and when, as I pointed out, we 

must in the course of a decade increase by 50 percent the facilities that 

it required 200 years to develop, frankly, our advice, if you will, as 

trustees of this great national resource, is that the Nation’s needs 

cannot be met without the Federal Government joining in partnership with local and private sources.

Mr. W illiams. Even so you are unable to give us the answer why 

State legislatures have denied a reasonable request for funds because 

the State did not have the funds available?

Dr. Berson. May I speak to that ?

Mr. Williams. Certainly.

Dr. Berson. I think, Air. Williams, it would lie difficult for any 

individual to speak for all States. I have now made entirely reasonable and I think well justified presentations to four sessions of the 

legislature in Alabama under the administration of two different 

Governors.

In our situation, the State legislature has met in very small pa rt our 

needs.

One example was the matching funds for a research building. The 

availability of the matching funds was apparently one of the most 

persuasive arguments because the availability of the State funds was 

the other part of this.

Mr. Williams. What has the Federal Government given to the 

State of Alabama ?

Dr. Berson. I do not know.

Mr. Williams. Is it as large on a per capita basis as the public debt 

of the Federal Government ?
124 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Dr. Berson. I doubt th at very seriously, but I am not really expert 

on the State’s indebtedness.

My point is tha t in two sessions of the legislature the Governor and 

the committees expressed to me and to the university’s president serious 

regre t tha t they were unable to provide the funds to meet our well 

justified requests.

Now, I cannot look beyond their statement of inability in any informed manner but this is what they told me and I am convinced they 

felt tha t way.

Mr. Williams. I, of course, would not want to question the purpose 

for which these funds would be used. No one would question that.

But I have my serious doubts as to whether this is properly the 

Federal responsibility, particularly in the ligh t of the tremendous 

national debt tha t we are staggering under.

Now, in regard to one more item and I am throug h, you make reference throughout your statement to the ever-increasing cost of construction. For example, on page 2, you make this statement. You 

say:

But even those of us who must regret the need to seek Federal assistance 

could come to no other conclusion as we examined soberly and realistic ally the 

costs of building and op erating modern medical schools.

Do you endorse the provision which is included in H.R. 4999 known 

as the Davis-Bacon Act, which would undoubtedly require even a 

greater increase in the cost of construction, or which would prevent 

the cost of construction from being lowered considerably? I)o you 

endorse that ?

Dr. Anderson. I think we are going here into political and economic 

areas on which we are not expert to pass an opinion, Mr. Williams.

Mr. Williams. Doctor, you have endorsed a bill and this is part of 

the bill and is a very vital part of the bill. You have endorsed it on 

the basis that you need money to keep up with the costs of construction, and so forth, it has gone so high that the States cannot take care 

of it.

I wonder if you also endorse the idea of giving the Department of 

Labor the right to put a floor under the labor costs ?

Dr. Anderson. I think all I can say, sir, is th at we are testifying 

to the medical aspects of the bill. We will have to leave to those who 

are more competent-----

Mr. Williams. Would you like to express a personal opinion on 

th at ?

Dr. Anderson. I regret anything that unnecessarily increases construction costs.

Mr. Williams. Thank you.

The Chairman. Mr. Younger?

Mr. Younger. Dr. Berson, do we understand from your testimony 

tha t you have educational facilities for medical students tha t are 

unused ?
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 125

I)r. Berson. No, sir; I did not mean to leave that impression. The 

number of students applying is declining while the number of entering places is increasing. But there are still enough students to fill 

every place in every school.

Mr. Younger. You are talking about your own ?

Dr. Berson. In our own there are enough students to fill every 

place at the moment.

Mr. Younger. I gathered from your testimony tha t you were endeavoring to recruit students and tha t you were not very successful.

Dr. Berson. Yes, sir, we would like to have more applicants from 

which to choose the 80 students who enter.

We would like at some time to plan expansion. This would not be 

wise unless the supply of good students was also expanding. But we 

are very anxious to stop the decline in the number of applicants which 

has been going on for us locally as well as nationally.

Mr. Younger. It is not a question of students, then. It is a question of applicants. And you do not have as great a choice among 

applicants as you would like to have ?

Dr. Berson. Yes, sir. We end up accepting about 15 out of the 

80 who look to their college advisers and our admission committee as 

very poor risks. Some of them work out all right. Some of them 

turn out the way their professors have predicted they would. This 

is a tragedy for them.

We would like to be able to select 80 instead of 65 who look like 

fine risks because, even so, your predictions are not entirely accurate.

Mr. Younger. So that you are advocating the scholarships to encourage more applicants who might apply due to the fact tha t they 

have scholarships offered rather than their having to pay their own 

way?

Dr. Berson. Yes, sir. We are convinced in our own school and in 

the association nationally that among this large segment of the population whose family income is $5,000 or less, there is quite a lot of native 

ability, and if you could say to a talented high school student that 

“If you are good enough and interested enough, the financial problems 

of studying medicine can lx* solved,” that this would lead a lot of 

people to choose medicine.

Mr. Younger. There is a standard in this bill of need tha t would 

be determinative.

Dr. Berson. Yes.

Mr. Younger. I know in regard to the present scholarships which 

are only granted on need.

Dr. Berson. Yes, sir.

Mr. Younger. We had a boy back here who was a page, who was 

an A-student, and eligible certainly for a scholarship. Unfortu ­

nately, his folks were in no financial position to send him to Stanfo rd 

and he was passed up, he could not get the scholarships. This need
126 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

requirement is in tlie bill. As to bow it is going to lie applied, we 

are not sure yet, as to where the limit is going to be as to income for 

the family.

I have one other question. One of the reasons given as to why 

the doctors’ bills are so high is th at it takes such a long time to become 

a doctor and it is such an expensive education. Now, if we grant 

scholarships to assist in the paying for that education, do you think 

this will tend to drive down the cost of medicine ?

Dr. Berson. Mr. Younger, I think predicting tha t sort of thing is 

difficult.

It is my own opinion, personally, that unless we forestall the shortage of doctors that I foresee in the future, the likelihood of doctors’ 

fees going up will be very real.

One of the basic forces counteracting high fees in all of our society is if you do not like the high fee of this individual lawyer, doctor or whatever, you choose someone else.

If there is a great shortage of doctors, the individual’s choice of 

some other doctor will be very much limited.

I would think tha t an adequate supply of physicians is a basic 

approach to doctors’ fees getting to a point tha t people consider inappropriate.

Mr. Younger. That is all, Mr. Chairman.

The Chairman. Mr. Collier?

Mr. Collier. Yes, Mr. Chairman.

As we progress through these hearings some of the statements that 

have just been made rath er trouble me. They are these: I directed 

a question to the Secretary yesterday asking whether or not existing 

facilities could handle any more medical students than they presently 

do. Substantially, the answer was “No.”

In further testimony, it was stated that if this program got off the 

ground, let us say it was enacted in this session of Congress, it would 

be 2 years before existing facilities could be renovated and expanded 

to the point where they would be available to accept students.

It was further stated that it would be as much as 3 to 5 years before any new facilities could be established.

Now, this legislation, as you know, is generally broken into rather 

distinct provisions, the scholarship-fellowship angle, and, of course, 

the brick and mortar.

Now, if it is going to take roughly 2 years to provide additional 

and renovated facilities in the case of the existing facilities and if it 

is going to take 3 to 5 years to establish new facilities, then why is it 

necessary to embark upon the balance of the program until the other 

phases are established?
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 127

In other words, why provide seed before we prepare the lawn for 

planting?

Does that not seem sensible to get the program off the ground t hat 

the original appropriation and the bill itself should embrace pri ­

marily a physical facility that would be necessary then to accommodate the students ?

Dr. Anderson. That is a very good question, Mr. Collier.

I think the answer is this. We are gravely concerned about a 

trend which has been downward. We believe it is im portant to reverse th at trend just as promptly as we can and we believe tha t the 

assurance of financial assistance, to those students who require it will 

be importan t in reversing the trend.

Now, just as it takes 2 or 3 years to build these facilities or even 

longer and put them in operation, it takes 4 years for a man to prepare himself to enter medical school. So that, from those students 

entering college next fall as freshmen, if we expect to draw more 

premedical students from t hat class when they graduate 4 years later 

we would like to encourage them as they enter school to believe that 

medical education is financially not beyond their resources.

So there is a long lead time necessary to build up our pool of applicants.

Mr. Collier. Might I suggest, legislatively speaking, then if that 

is the case it would seem to me th at the most feasible program would 

be to embrace for these first 2 or 3 years in the necessary degree this 

program within the present framework of the National Defense Edu ­

cation Act which presently, as you know, gets into such things as 

modern languages and so on, with which I have no quarrel, but certainly has departed from the principle of defense as such, as certainly 

is medicine.

It would seem to me that if this is the case and until such time as 

we secure the necessary physical facilities to handle the enrollments, 

we should probably give some thought to the feasibility of putting 

this under the National Defense Education Act which would insure, 

as you say is necessary, to the prospective student this assistance.

A program announced on that basis would provide further assurance that it is in fact the intent of Congress to do this.

Dr. Anderson. There is one limitation in the National Defense 

Education Act loan program tha t works very disadvantageously to 

the medical students; namely, he must begin repaying tha t loan 1 

year after he completes his formal education, namely, 1 year afte r he 

gets his M.D. degree and he must complete repayment w ithin 10 years.

As we have brought out, the average medical graduate today spends 

2 to 5 years as an intern and resident at a very low stipend, many of 

them struggling to raise a family. So, this requirement of these loans 

tha t repayment start at such an early date limits very greatly their 

usefulness to medical students.
128 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Mr. Collier. I am happy you said that, Doctor, because that meets 

with the points th at 1 made in the hearings th is mom ing and that 

is to provide, as an incen tive, a waive r as in the case of teach ers, which 

is presen tly written into the National Defense Ed uca tion Act, of pa rt 

of this sum.

I think this would be more att racti ve . I would much ra th er have 

everybody I owe money to tell me I only h ave to pay ha lf of it r at he r 

tha n the whole t hing over a period o f tim e.

I feel this would pro vid e more of an ince ntiv e and I think this 

ang le should be explor ed.

Dr. Anderson. I believe the re is one other problem, Mr. Collier. I 

think the maximum th at may be borrowed un de r the National Defense Education Act by any ind ividual is $5,000. If the boy has used 

up his cre dit going throu gh college, he has lit tle or no cre dit against 

this pa rti cu lar loan pro gra m on which to draw as he goes t hrou gh the 

4 years of medical school.

W ha t I am bringing out is th at as it pre sen tly opera tes this loan 

prog ram , while it is of some help to ou r med ical stu dent, is very 

limited in its value.

Mr. Collier. I have just, one fu rth er observatio n re fe rrin g to the 

rem ark s th at Dr. Berson made in reg ard to the recr uitin g and generally the pub lic relations problem of inducing young people to go into 

medicine. As we all know, af te r the Soviet Union sent a lit tle meta l 

ball whizzin g aro und the ea rth in space, we began to com pletely reeva luate the whole set of sta nd ards for high er edu cation , the res ult 

of which was a treme ndous emphasis upon ma the ma tics and certain 

fields of science, in the fields of eng ineerin g, the fu rther result of 

which, if the rep orts we get from time to time fro m engin ering 

societies are accurate, we now have a surplus of eng ineers in this 

cou ntry. I am not suggesting th at we d e-em phasize the need for good 

engin eers; but, I am sug ges ting that perha ps som eth ing in the a rea of 

a diffe ren t public relations appro ach to gen era te this same deep inter ­

est in a ttr ac ting more medical stude nts.

Dr. Anderson. Th is is, of cours e, a very real pa rt of our problem, 

the numb er of fields now that compete in int ere st with medicine. It 

is o nly a sho rt time ago when the re were only three m ajor area s into 

which a m an could go for gradu ate study : law, mi nis try , an d medicine.

A hu ndred yea rs ago, this was the limit practic all y of gradua te 

study. Yet in the last 50 ye ars, as you have pointed out, even in the 

last, 10 ye ars, many other exc itin g Helds of intellectua l activity have 

appeare d and are c ompet ing vigorously with us.

At one time in medicine we got on e-third of all the college 

gra duate s.

To day we are gettin g less than 5 percen t.

Ev ery year over rece nt decades, the perce nt of college gra duate s 

going into medicine ha s declined, for very good reasons.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 129

Physics, chemistry, astronomy, space science, engineering, social 

sciences, all now oiler exciting opportunities in graduate and professional study.

At the moment, as we have pointed out, because of the very substantial Federal fellowship and scholarship programs in the other sciences, 

we are at an increasing disadvantage in attracting students.

Mr. Collier. Perhaps TV's Dr. Ben Casey will add a little glamour 

to the profession.

Mr. O’Brien. May I ask if the distinguished deans and gentlemen 

who were introduced will be permitted to tile statements in the record 

if they do not testify personally ?

The Chairman. Yes, you may have that privilege, any one of the 

deans who are here who have been introduced, or any other who are 

unable to be here desire to include a statement in the record, may have 

the privilege.

Mr. O’Brien. Mr. Chairman, that leads up to a rare opportunity.

I seldom have any witnesses here from my hometown. I was a 

little abashed when I realized the extent of the football might at tha t 

end of the table. The University of Arkansas, the University of Alabama, and the University of Mississippi. Little Union University does 

not belong in that league but scholastically, 1 think perhaps we do.

I would like to welcome here the very distinguished dean of the 

Albany Medical College, Dr. Harold C. Wiggers, a small college compared to some but the heart and center of the Albany Medical Center 

which services about 2 million people in 18 counties. So it is big 

league in that respect.

I am happy tha t he is here today. I have known him for many 

years. I talked to him about this problem before this bill came in.

I would like to ask one question. All three of the gentlemen who 

testified mentioned the fact that this Federal aid, Federal assistance 

would serve as a stimulus, the word they use was “stimulus.’’

Do you believe. Dr. Anderson, that if we get these Federal grants 

for construction and scholarships or one or the other that it will dry 

up or increase local contributions by private sources or State legislatures?

Dr. Anderson. Mr. O’Brien, based on the experience of both the 

Hill-Burton Act and Health Research Facilities Act, I am convinced 

it will increase local contributions rather than dry them up.

Mr. O’Brien. All of you gentlemen are deans and I assume tha t the 

young men you talk with would be students, but, Doctor, have you 

had the personal experience as a dean of being forced to turn away 

from your institution young men or women that you recognized as 

good potential doctors because of their economic status?

Dr. Anderson. We try, Mr. O'Brien, if we see a man of merit, to 

somehow or other help him finance his way through medical school. 

Our concern is that we do not see the promising young bovs who at 

the high school level or early in college feel medical education is too 

expensive. We never get a chance to see them and offer them help.
130 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

But we also know th at even with the effo rts we make tod ay to help 

the wo rth y and des erving s tude nt tha t we a re not able to pro vide the 

am ount of help th at they deserve. The result is many of them are 

ca rrying work outside of th ei r medical school course and we think 

the stu dy of medicine is a full-t ime occupation. We th ink this interferes n ot only with th eir studies but also jeopard izes th ei r health. Ou r 

boys are earn ing a very larg e pa rt of wh at it costs them to go th roug h 

med ical school today. They are no t lazy.

Mr. O'Brie n. Then your p osition is t hat m any of these you ng people at the hig h school level, or when the y begin to th in k of medical 

edu cation, eithe r th ey or their f amilies reco gnize th e economic impossibility and they go in other fields a nd you lose some g ood people?

I)r . Anderson. Yes, sir.

Mr. O'Brie n. Now, some questions here hav e rel ate d to the sta nd ­

ards th at might be used for need. Do you no t th in k it would be rath er 

difficult for Congress to pu t a dollar figure on th at ? Would there 

no t be instances, fo r exam ple, where a fam ily m ight have an income 

of $10,000 a year but the re might be a situatio n there , known to the 

local gro up th at would pass on these thi ngs, such as an inv alid wife, 

where a perso n of th at income would actua lly have less spa re cash 

for the education of a child than some one wi th a lesser income?

Dr. Anderson. Yes, sir. Wh en we consider a sch ola rsh ip ap pli cation, we ask for full inf orma tio n about not only the family ^ finances 

but abo ut th eir financial responsibilities. We ask each stu dent to give 

us the income of his f athe r an d his mother, to lis t all the persons w ho 

are dependent on his father, and his mo the r if she is a wage ear ner, 

and we ask him to list all the resources th at he perso nally has in the 

way of either income or prop erty, down to a sav ing s ban k account, 

stocks, automobiles, or wh ate ver it may be, a nd then we ask him to give 

us a statem ent as to how much his fa mily will pro vid e him, how much 

he has earned both in course and du rin g vac ations, and the n we ask 

him fo r a detailed state ment of his expenses.

Th e scholarship committee the n sits down and carefully weig hs all 

of these things. If necessary, the boy is called in for a fu rthe r discussion of his financial situ ation.

So we make—as you suggest, we t ake all factors into con sideration 

th at prop erly should be in deter mi nin g need.

Mr. O’Brie n. Then the re is no need fo r ala rm on the par t of this 

com mittee over the po ssibility tha t one of these c omm ittees m igh t give 

an economic need sch olarship to the son of a p res ide nt of a lar ge bank 

in th e com munity?

D r. A nd erson. N o, sir.

Mr. O 'Brie n. Ju st one final tho ught. I agree to a great exten t with 

Air. Collier and w ith th e suggestion th at he made, b ut I am no t so sure 

about the pub lic relations app roach. I rea lize th at we did swing into 

action and a pp ropr iate a lot of money when t hat littl e metal ball went 

aro un d and the wrong people sent it first. But I do n ot th ink we can
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 131

do qu ite th e same th in g here. I do th in k it is ju st as im po rtan t to t he 

healt h of o ur p eople, although not pe rhaps as dram ati c, to move into 

this field.

Th an k you.

Th e Chair man. I will say to my colle ague fro m New Yo rk we are 

well aw are in th at pa rt of the country of the h igh intellectual at ta in ­

ment and the caliber of the insti tutio ns up your way, bu t we have 

also he ard o f Syracuse.

Mr. Tho mso n?

Mr. T homson. No questions.

The C hairman. Mr. Ko rnegay?

Mr. Kornegay. Doc tor, ta lk in g of edu cation gen era lly, there has 

been some suggestion by some peo ple t ha t the fac ilities, school bu ild ­

ings, are not being used enough, o r th at b y using th em m ore we could 

handle the problem of ove rcro wde d schools. 1 am talk ing now pri ­

mari ly of t he public school systems where th e build ings are used only 

9 m onths o f t he y ea r; they stan d idle so m any hours a day or so man y 

many mo nth s ou t of the year. Is any thou gh t being giv en to fulle r 

uti liz ati on of the presen t med ical fac ilities if such is possible? I do 

no t know th at it is. I ju st wa nt to find out, first, if you th in k it is 

possible and , second, wh eth er any thou gh t is being giv en either by 

yo ur org anizati on or by the ind ividua l medical schools of fu lle r ut iliza ­

tion of ex isting facilities?

Dr. Anderson. Mr. Ko rnegay, I think the best answer I can give 

you is t hat the average medical school opera tes at least G days a week 

fro m rou ghly 8 to 8:30 in the morning un til well af te r 6 o’clock at 

nigh t, and, of course, those p ar ts of the medical school th at have to do 

with the care o f p atients, they a re usu ally in operat ion 24 hours a day, 

7 day s a week, as we all know.

Now, under the pressu res of t he work we are doing now, I believe 

most of us have exercised ou r ingenu ity to the maxim um to get the 

maxim um uti liz ati on ou t of ou r present space.

I think it is w orthy o f n ote th at even d ur ing th e t ra di tion al su mm er 

vac atio n periods, the med ical schools are now rea lly making use of 

th ei r plant. Sev eral schools hav e e xtended th ei r school ye ar to a full 

12-month school year. Ot hers, such as our own, in w hich we s till m ain ­

ta in a sum mer v acation , en cou rage th ei r students to stay on as summer 

student fellow s, rese arch ass istants, an d the like. In any one summer 

over a th ird, now ap proa ch ing close to one-half, of ou r stu de nts are 

still the re in the medical school even tho ugh nominally the y are on 

vacation.

Fu rthe r, th roug h the use of wh at we call multid isc iplin ary lab oratories, we are tryi ng to make more efficient use of th e space so th at 

the studen t is using the same l ab orato ry in courses in anato my , biology,
132 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

chemistry, which means he is in them all the time instead of having 

separate laboratories which would mean they were being put to use 

only one-third of the time. I would say there is not much f at to be 

squeezed out of our present space.

Mr. Kornegay. In other words, in your opinion, existing facilities 

are being utilized to their maximum extent ?

I)r. Anderson. Yes, sir.

Mr. Kornegay. 1 have one more question, Doctor. If this piece of 

legislation is passed and becomes law, do you think there will be any 

real problem in recruiting the needed faculties, or additional teaching 

personnel, in order to handle the increase in enrollment which you 

anticipate?

Dr. Anderson. I do not believe so, sir. We have been able to double 

our faculties in the past 10 years. We have been able to staff six new 

medical schools and, as a result of the research training programs of 

the N il I, we have a growing pool of young, very able, well-trained 

men, who, as added opportunities to take faculty positions come along, 

will be ready to step into these.

Now, there are a few areas, certain subjects, which have not attracted very many men, such as anatomy, anesthesiology, pathology, 

to mention a few, where it may be very difficult. On the other hand, 

I think the knowledge that opportunity exists will attrac t people.

So I believe, Mr. Kornegay, while we may all feel a squeeze for a 

period, we can provide the faculty for the expanded facilities needed.

Mr. Kornegay. Thank you.

The Chairman. Mr. Friedel, do you have any questions?

Mr. Friedel. No questions, Mr. (diairman.

The Chairman. Dr. Anderson, I would like to pursue for just one 

moment the question which I think Mr. Collier appropriately raised 

this morning.

Can you and your organization provide for the committee information from each and every medical school in the country, which I believe, are 86 in number, for each of the last 5 years on the number of 

students that were admitted and the number that the school could 

accommodate?

I )r. Anderson. Yes, sir, we can do that. We will be happy to do so.

The Chairman. Do you know of any medical school during this 

period of time that could have accommodated more students than they 

did accept or had applications for ?

Dr. Anderson. I would like to poll each school to be sure of our 

answer.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 133

We will poll them and supply that information, Mr. Chairman, to 

be sure that our information is accurate.

The Chairman. Would it take much time to supply this information?

Dr. Anderson. No, sir: I believe we could get it within a matter of 

2 weeks at the most, I would think.

Mr. Younger. Would it not be well at the same time we have those 

figures to get the number of applicants as well as the number that were 

admitted just for comparison's sake?

The Chairman. Yes, we would like to have that information.

Dr. Anderson. Mr. Chairman, we can very quickly provide you 

with the total number of applicants from the United States.

The number per school is not very meaningful because, as you all 

know, many of these men make multiple applications.

So, the one firm figure that you have on which to measure the pool 

of students is the national number of individual students applying to 

one or more medical schools.

The Chairman. Do you have that information ?

Dr. Anderson. Yes, sir. We can provide that.

The Chairman. I think that Mould give us more accurate information.

Mr. Younger. That is right.

The Chairman. If you would supply that for us.

Dr. Anderson. Yes, sir : we will be very happy to.

(The information referred to follows:)

5-year s ummary of admission and enrollment data for all schools of medicine,

1956-57—.1960-61

A ca dem ic y ear

1956-57 1957-58 1958-59 1959-60 1960-61

T o ta l ap p li cati o n s................................................................... 59,7 98 60,951 59,1 02 57,888 54,6 62

T o ta l a p p li can ts ____________ _____ ____ ____ _______ 15,917 15,791 15,1 70 14,952 14,397

N u m b er e n ro ll ed _________________ ____________ 8,014 8,0 30 8,128 8,173 8,29 8

P erc en t e n ro ll ed ........ .................................... ................. 50.3 50.8 53.5 54.6 57 .6

T o ta l stu d e n t en ro ll m en t (1st th ro u g h 4t h ye ar 

cl as se s)...................... . ............. ............................................... 29,1 30 29,4 73 29,614 30,084 30 ,28 8

T o ta l g ra d u ate s........................................................... ............ 6,7 96 6,861 6,8 60 7,081 6.99 4
T able I.—Summ ary of application, admission, and enrollment data for each U.S. school of medicine for the 5-year period 1956 57 to 1960 61

S ta te a n d m ed ic al sch oo l

O w ner sh ip

A la bam a: M ed ic al College o f A la b a m a ..................................... A rk an sa s: U n iv ers it y o f A rk an sa s Sc ho ol o f M edic in e-------

C al ifor ni a:

Lom a L in d a U n iv ers it y Sc ho ol o f M edic in e----------------- U n iv ers it y o f C al ifor ni a a t Lo s A n g ele s, ............................. U n iv ers it y o f S outh ern C al ifor ni a a t Lo s A nge le s........... S ta nfo rd U n iv ers it y Sc ho ol o f M e d ic in e .. .. ................ . . . U n iv ers it y o f C al ifor ni a a t San F ra n cis co .......................... Col or ad o: U niv er si ty o f Colo ra do Sc ho ol o f M ed ic in e........... C onnecti cut: Y ale U n iv ers it y Sc ho ol o f M edic in e..................

D is tr ic t of C olu m bia :

G eo rg et ow n U n iv ers it y Sc ho ol o f M ed ic in e----------------- Geo rg e W as hin gto n U n iv ers it y Sc ho ol o f M e d ic in e .—

H ow ard U n iv ers it y Co lle ge o f M ed ic in e............................

F lo ri da: , U n iv ers it y o f Flo ri da Co lle ge o f M ed ic in e.............. ........... U n iv ers it y o f M ia m i Sc ho ol o f M ed ic in e-------- -------. . . .

G eo rg ia: . E m o ry U n iv ers it y Sc ho ol o f M ed ic in e.........- ............... —- M ed ic al Co lle ge o f G eo rg ia ............................. ........... .............

Illin ois:

Chi ca go M ed ic al S ch o o l......... .............................................--- N o rt h w este rn U n iv ers it y Sc ho ol of M e d ic in e .......... - — S tr it ch Sc ho ol o f M ed ic in e of L oy ol a U n iv e rs it y ............

U n iv ers it y of C hi ca go Sc ho ol o f M ed ic in e-------------------- U n iv ers it y of I llin oi s Sc ho ol o f M ed ic in e......................— In d ia n a: In d ia n a U n iv ers it y Sc ho ol of M e d ic ir e --------------- Io w a: S ta te U n iv ers it y of Io w a College o f M ed ic in e.............. K a rs rs: U n iv ers it y of K ar .s as Sc ho ol of M e d ic ir e ------------- K en tu c k y : ,, , U n iv ers it y of K en tu c k y Sc ho ol of M edic in e..................... U n iv ers it y of Lou is vi lle Sc ho ol o f M ed ic in e...................... L ouis ia na: , , L ouis ia na S ta te U n iv ers it y S ch oo l o f M edic in e................ T u la n e U n iv ers it y Sc ho ol of M edic in e-------------------------

P u b li c . 

____d o. .

P ri v ate -

P u b li c ..

P riv a te .

....... d o .. .

P u b li c ..

___ d o .. .

P riv a te .

d o .

_d o.

-d o .

P u b li c .. 

P riv a te .

___ d o .

P u b li c .

P riv a te .

........d o ...

____d o ...

....... d o .. .

P u b li c ..

____d o .. .

____d o .. .

........d o .. .

____d o .. .

P riv a te .

P u b li c ..

P riv a te .

1956-57

G ra duP erc en t T o ta l at es ,

A ppli- 1st yea r ap pl ic an ts en ro lled J u ly 1,

can ts class en ro lled (4 y ea rs) 1956, t o

Ju n e 30,

1957

280 81 28.5 299 71

164 100 60.9 341 77

202 98 48.5 376 98

557 50 8. 9 180 36

676 68 10.0 266 68

511 62 12.1 232 57

533 78 14.6 312 74

232 84 36 .2 322 70

995 80 8. 0 322 80

952 114 11.9 424 114

1,355 102 7.5 372 88

451 78 17.2 297 72

11 7 47

189 71 37.5 236 34

646 74 11.4 286 74

266 102 38.3 376 78

1,058 74 7.0 277 66

1,482 133 8.9 520 126

827 88 10.6 330 82

1,023 72 7.0 287 69

667 191 28.6 644 146

452 159 35.1 583 139

189 122 64 .5 433 97

355 104 29 .2 415 107

285 104 36 .5 379 90

277 125 45.1 428 96

936 134 14.3 506 124

1957-58

A p p li ­

cants

297

180

185

585

647

513

411

211

994

1,03 6

1,370

534

319

227

672

273

1,090 

1,439 

829 

1, 111 

549 

505 

203 

360

298

1,049

1st yea r 

class

P erc en t

ap plica nts

en ro lled

T o ta l 

en ro lled 

(4 y ea rs)

G ra d u ­

at es , 

Ju ly 1, 

1957, to 

Ju n e 30, 

1958

81

93

112

49

67

62

79

85

79

108

101

103

51

79

74

103

73

130

88

72

190

158

120

102

103

125

134

27.3

51 .6

60.5

8.3

10.3 

12.0

19.2

40.2 

7.9

10.4

7.3

19.2

15.9

34.8

11.0

37.7

6.7

9. 0

10.6

6.4 

34.6

31 .2 

59.1

28 .3

39.3

41 .9

12.7

289

345

384

195

264 

234 

324 

318 

309

407

383

320

92

265

278

386

275

519

337

268

677

583

434

412

382

434

503

£ 2 8 5 8 £ 8

79

72

100

90

67

60

66

93

65

131

73

70

150

138

104

107

95

128
M ar yl an d: Jo hn s Hop kins Unive rsity School of M ed icine................ Un ive rsit y of M ar yl an d School of M edicine _______ ........d o........ 950 328 7893 8.2 28.3 293 363 6794 901 338 7493 8.2 27.5 293 355 7578 Publi c_____ M as sa ch us etts:

Bostt n Unive rsity School of M edicine . ____________ P ri vat e......... 1,158 76 6.5 286 69 1,211 74 6.1 291 71 H ar va rd Medica l School 2 , ___________ ........do............ 1,370 115 8.3 515 145 1,277 114 8.9 512 135 Tuf ts Unive rsity S choo l of M ed icine________________ ........do ............ 747 112 15.0 441 113 840 114 13.5 430 109 M ichiga n: Ur iv ei si ty of M ich igan School of M ed ic ir e__________ Publi c.......... 676 202 29.8 762 186 652 206 31.5 750 169 W ay ne St at e Uni ve rsity School of M ed ic in e____ _____ ____d o_____ 398 77 19.3 285 65 408 75 18.3 282 72 M in re sc ta : Unl ve isity of M in ne sc ta Medica l School.......... ........d o............ 300 130 43.3 474 109 351 131 37.3 489 113 Miss iss ippi: Uni ve rsity of Miss iss ipp i School of M ed icine.. ........d o............ 182 76 41.7 214 24 189 80 42.3 253 44 Miss< Uli:

Unive rsity of Missouri School of M ed icine....................... ........do............ 178 75 42.1 170 21 190 75 39.4 206 32 St. Lo uis Uni ve rsity School of M ed icine_____ ________ P ri vat e......... 1,080 123 11.3 481 112 1,269 121 9.5 467 117

Washing ton Uni ve rsity Scht ol of Medicine, St. Lou is.. ........do .......... 1,316 86 6.5 347 93 1,686 86 5.5 344 87

Creighton Unive rsity Schcol of M ed ic ir e................. ....... ___ do ............ 675 76 11.2 287 69 787 77 9.7 283 64 U r ivei si ty of Neb raska College of M ed ic ir e_________ Pub lic_____ 213 87 40.8 318 77 239 87 36.4 327 83 New J ersey: Seton Hall College of M ed icine_____________ P ri vat e____ 882 80 9.C 80 1,042 80 7.6 157

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONN EL 135
T able I.— Su mmary of application, admission, and enrollment data fo r each U.S . school of medicine fo r the 5-year period 1956-57 to 1960 -61— Co ntinued

(N ote.—Da ta for Uni ve rsity of Flor ida College of Medicine, Se ton H all College of Medicine, an d Unive rsity of Ken tu ck y School of Me dic ine inc om ple te because th ey w ere or are newly develop ing sch ools . D at a for West Virginia U nive rsity School of M edicine in comp let e b ecause it is i n tran sitio n from a 2- to a 4-year program]

1958-59 1959-60

Sta te a nd m edica l school

Ow nersh ip App licants 1st ye ar class

Pe rcen t

applican ts enrolled

To tal 

enrolled 

(4 years)

Gradu ­

ate s, 

Ju ly 1, 1958, to 

Ju ne 30, 

1959

App lican ts 1st year class

Pe rcen t

applican ts enr olled

To tal 

enr olled 

(4 years)

Gradu ­

ate s, 

Ju ly 1, 1959, to 

Ju ne 30, 

1950

Alabam a: Medi cal College of Alabam a . _________ ____ Public_____ 326 81 24.8 297 64 386 80 20.7 300 71

Arkansas: Unive rsity of A rka nsas School of M ed icine____ ... d o ............... 179 95 53.0 339 69 167 92 55.0 343 86 Califo rnia :

Lom a Li nd a Uni ve rsity School of Med icine__________ Pri vat e......... 191 114 59.6 371 81 235 105 44.6 381 85 Unive rsity of C alifor nia a t Los Angeles ___ Pu bl ic ........ . 594 56 9. 4 208 46 523 57 10.9 218 49 Unive rsity of Sou thern Californ ia at Los Angeles_____ Pri vat e____ 687 68 9.8 260 66 643 69 10.7 272 64 Sta nfo rd Unive rsity School o f M ed icine..... ...................... ... d o .......... 660 61 9.2 237 57 708 71 10.0 242 57 Unive rsity of Califor nia a t San Fra ncisco ..................... Public_____ 617 101 16.3 338 80 642 101 15. 7 35b 79 Co lora do: Unive rsity of C olorado School of M edici ne_____ Con ne cticut: Yale Unive rsity School of M edici ne................. ...d o ..............

Pri vat e.........

217

1,057

86

81

39.6

7.6

317

316

81

79

243

904

85

80

34.9

8.8

312

303

71

72

D is tri ct of Co lum bia :

Ge orgeto wn Unive rsity School of Me dicine .. .d o 1,165 112 9.6 404 93 1,058 113 10.6 404 102 Qeorge W ash ing ton Unive rsity School o f M ed ic in e. __ Ho wa rd Unive rsity College of Med icine............ .............. ... d o ..... ......... . .. d o . . . . . . . . . 1,271 662 101 105 7.9 15.8 389 337 9175 1,315 609 102 105 7.7 17.2 392 355 9769 Florida :

Unive rsity of Flo rid a College of Medi cin e _ ________ Pub lic_____ 318 50 15.7 137 402 49 12.1 177 40 Unive rsity of M iam i School of Med icine_____________ Pri vat e......... 237 75 31.6 262 59 220 81 36.8 273 .56 Oeorgia: Em or y Unive rsity School of M e d ic in e .. ...... .................. ... d o .............. 693 74 10.6 284 65 612 77 12.5 293 71 Medical College of O eorgia_________________________ Pub lic.......... 262 102 38.9 370 88 292 102 34.9 365 88 Illinois:

Chicago Medic al S c h o o l_____________ _____________ Pri va te ......... 999 72 7.2 274 68 1,057 73 6.9 267 65 N o r th w e s te r n U n iv e rs ity S chool o f M e d ic in e . .d o_______ 1,383 132 9.5 521 133 1.314 130 9.8 520 132

St ritc h School of Medi cin e of Loy ola U ni ve rs ity ............ Unive rsity of Chicago School o f M ed ic in e. ................ .....

...d o ..............

...d o ..............

734

990

88

73

11.9

7.3

340

290

86

69

695

958

88

73

12.6

7.6

326

299

79

75

Unive rsity of Illin ois School of Medicine ........... -...........- Pub lic_____ 661 201 30.4 707 153 665 200 30.0 731 170 In di an a: In di an a Unive rsity School o f M edic in e................. Iow a: S ta te I’n iv crs it v of Io wa Co lle ge of M e d ic in e ............ ........do ........... ........do ........... 512 199 160 120 31.2 60.3 585 437 140 100 523 170 182 120 34.7 70.5 601 436 132 103 Ka nsas: Unive rsity of K an sas School of Me dicine ........do........... 306 98 32.0 402 101 284 101 35.5 393 98 K en tu ck y:

Uni ve rsity of Louisville School o f M ed icine......... ........... P ri vat e........ 330 166 30.3 370 86 303 99 32.6 375 89

136 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
80014— 62-

Loui si an a:

L ouis ia na S ta te U n iv ers it y Sc ho ol o f M edic in e................

T u la n e U n iv ers it y Scho ol of M e d ic in e .- ...........- ............... M ary la n d :

Jo h n s H opkin s U n iv ers it y Sc ho ol of M ed ic in e................. U n iv ers it y o f M ary la n d Sc ho ol o f M ed ic in e......................

M as sa ch use tts:

B os to n U n iv ers it y Sc ho ol o f M ed ic in e................................

H arv ard M ed ic al S c h o o l..........................................................

T u ft s U n iv ers it y Sc ho ol o f M edic in e....................................

M ic hi gan : U n iv ers it y o f M ic hig an Sc ho ol o f M ed ic in e ...................... W ayne S ta te U niv er si ty Sc ho ol o f M ed ic in e..................... M in nes ota : U n iv ers it y of M in nes ota M ed ic al Sc ho ol ------ M is si ss ip pi : U n iv ers it y of M is si ss ip pi Sc ho ol of M ed ic in e. 

M isso ur i:

U n iv ers it y o f M is so ur i Sc ho ol of M ed ic in e......................... St. Lou is U n iv ers it y Sc ho ol of M edic in e............................ W ash in gto n U n iv ers it y Sc ho ol of M ed ic in e, S t. Lou is .

C re ig hto n U n iv ers it y Sc ho ol o f M ed ic in e........................... U n iv ers it y o f N ebra sk a College o f M ed ic in e......... ............

N ew Je rs ey : Set on H all College o f M ed ic in e.............................

P u b li c ........... 275

P riv a te ......... 1,085

. . . d o ........... 1,000

P u b li c _____ 337

P riv a te __ __ 1.183

. . . . d o ........... 1,274

__ d o .............. 1,001

P u b li c ........... 603

. . . d o ....... .. 314

___ d o ............ 307

. . . . d o ............ 252

___ d o ............ 207

P riv a te ____ 1,148

. . . . d o ............ 1,414

___d o ............ 1,069

P u b li c _____ 204

P riv a te ......... 1,259

46.9 443 110 268 128 47.7 437 95

12.3 494 118 1,149 132 11.4 499 118

7.4 282 68 823 78 9.4 286 63

29.6 363 83 299 100 33 .4 369 84

6. 2 285 66 1,140 72 6. 3 284 71

8.9 516 147 1, 119 116 10.3 505 143

11.3 432 104 1,066 114 10.6 438 103

32.6 744 186 798 196 24.5 720 177

39.8 328 66 364 126 34 .6 375 63

45 .2 504 113 320 141 44.0 514 122

30.9 272 62 220 80 36 .3 274 63

36.7 234 31 174 75 43.1 272 59

10.9 451 116 1.101 113 10.2 420 97

6. 0 342 88 1,303 86 6.6 343 85

7.2 277 70 996 77 7.7 271 65

39.7 312 72 208 85 40.8 314 80

6. 2 224 1,156 81 7.0 299 71

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONN EL 137
Table I.—Sum mary of application, admission, and enrollment data for each U.S. school of medicine for the 5-year period 1956-57 to 1960-61—Continued 0000

St at e an d me dic al schoo l Ow nersh ip

Alab am a: Medica l College of A la bam a........................... Arkansas : Uni ve rsity of A rkan sas School of M ed icine. Califo rnia :

Lo ma Li nd a Unive rsity School o f M ed icine............. Unive rsity of Califor nia a t Los An geles..................... Unive rsity of Sou thern Californ ia at Los A ngele s.. Sta nford Unive rsity School o f M ed icine................... .

Unive rsity of C alifor nia a t San Francisco..................

Colorado: Unive rsity of C olorado School of M ed ic in e. . Con ne cticut: Yale Unive rsity School o f M ed icine.......... Distri ct of C olu mb ia:

Ge orgeto wn Unive rsity School o f M ed icine..............

Geo rge W ashing ton Unive rsity School o f M edicin e. How ard Unive rsity College of M ed icine.................... Flo rid a:Unive rsity of Florida College of Medicine................. U ni ve rs ity of M iam i School of M e d ic in e .. .. ............ Geo rgia:

Em or y Unive rsity School of M ed icine........................ Medica l College of Georg ia....................................... Illinois:

Chicago M ed ie tl Schoo l..... ....................................... Nor thwes tern Unive rsity School of M ed icine........... St ritch School of Medicine of Loy ola U niv ers ity.... Unive rsity of Chicag o School of Medicine................. Unive rsity of Illinois School of Med icine...................

Indi an a: In dia na Unive rsity School of M ed ic in e. .......... Iow a: State Un iversit y of Iow a College of M ed icine.__ Kan sas: Uni ve rsity of Ka nsa s School of Med icine_____ K en tu ck y:

Unive rsity of Ken tu ck y School of M edici ne.............. Unive rsity of Louisville School of M ed icine.............. Lo uis ian a.

Lo uisia na S ta te Unive rsity School of M ed icine........ Tu la ne Unive rsity School of M ed icine___________ M ar yl an d:

Jo hn s Hop ki ns U ni ve rs ity School of M ed icine......... U ni ve rs ity of M ar yl an d School of M ed icine..............

Pu bl ic . 

........d o.

Pr iv at e P ubli c. Pr iv at e

____d o. Pu bl ic .

........d o..

Pr iv at e -

........d o ..____d o .. ........d o ..

P u b li c.. 

Pri vate .

........d o ..

Publi c. .

Pri vate .

____d o .. ........d o ..___ d o ..

P u b li c..

___ d o .. ....... d o ......... d o ......... d o ..

Pr iv at eP ub li c.. 

P ri vate .

....... d o ..

P u b li c..

1960-61

App lic an ts 1st y ea r class Pe rc en t ap ­ plican ts en ­ rolled Tota l en ­ rolled (4 years) Gra du at es , Ju ly 1,1960, to Ju ne 30, 1961

310 80 25.8 300 76 146 92 63.0 336 82

291 103 35.3 380 87

524 71 13.5 238 53 534 69 12.9 278 66 712 60 8.4 234 62

614 103 17.0 377 73 441 85 19.2 327 73

918 80 8.7 311 67

1,148 117 10.1 397 88 1,231 102 8.2 389 95

591 106 18.1 369 83

364 53 14.5 179 41

300 82 27.3 286 69588 76 12.7 287 69

249 104 41.7 366 84

965 76 7.8 263 65

1.075 131 12.1 520 126

565 88 15.5 321 81

917 73 7.9 293 75641 200 31.2 741 169

546 194 35.5 630 141

172 124 72.0 448 96

330 105 31.8 389 92417 40 9.5 40

329 95 28.9 359 85

245 142 59.2 460 101

928 133 14.3 499 115816 78 9.5 299 69

428 98 22.8 377 87
M ass achuse tt s:

jlost on U n iv ers it y Sc ho ol of ^lo dic in o _______ P riv a te ....... ................................. 1,044 74 7.0 285 62 llu r v o r d \ I o d i p o l f ip h rv il —————————————— ____ d o ................ . ......................... 936 117 12.5 482 131

........ d o ............................................ 792 115 14.5 443 109

M ic hig an : ITr»i i n rc if xr \finV»{<ron fiplinnl f\f Vf odipinp _ _ P u b li c .......................................... 626 200 31.9 723 177

W i i v n a Q t n t n TTni vnr el I v .Qplmnl f\f \lod ip1HP _ ____ d o ............................................ 436 125 28.6 417 71

____ d o ............................................ 313 141 45.0 507 113

___ d o ............................................ 228 81 35.5 274 54

M is so ur i:

U n iv ers it y o f M is so ur i Sc ho ol of M ed ic in e ........ d o ________________ ____ 195 81 41.5 280 62

St Ix )u is U n iv ers it y Scho ol of M ed ic in e ________________ P r iv a t e ....................................... 954 122 12.7 425 88 W’• » ii iit t/tn I*11 i v p r^ it v S chool of M ed ic in e S t Tamils ........ d o ...... ................................... 1,044 88 8.4 336 85

N eb ra sk a: 77 9.1 274 52 C re ig hto n U n iv ers it y Sc ho ol nf M ed ic in e _____ ........ d o ............................................ 845

U n iv ers it y 

n f N e i 'r e ^ k f t (C o lle g e o f M e d i c i n e P u b li c .......................................... 200 90 45.0 319 74

N ew Jerse y* Set on it ell College n f M ed ic in e ____ P riv a te ....................... ............. . . 1,137 80 7.0 296 69

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONN EL 139
Table I.—Sum mary of application, admission, and enrollm ent data for each U.S. school of medicine for the 5-year period 1956-57 to 1960-61—Contin ued

N o t e .—D ata for U n iv ers it y of F lo ri da College of M ed ic in e, S et on H all Co lle ge of M ed ic in e, an d U n iv ers it y of K en tu c k y Sc ho ol of M ed ic in e in com ple te be ca us e th e y w er e or a re new ly de ve lo pi ng sc ho ols. D a ta for W es t V ir gin ia U n iv ers it y S ch oo l o f M ed ic in e in com ple te be ca us e it is in t ra n si ti o n f ro m a 2- t o a 4- ye ar p ro gr am ]

S ta te an d m ed ic al sch oo l

O w ner sh ip

1956-57 1957-58

A p p li ­

ca nts

1st yea r 

class

P erc en t

ap pl ic an ts

en ro lled

T o ta l 

en ro lled 

(4 ye ar s)

G ra d u ­

at es , 

J u ly 1, 

1956, to 

Ju n e 30, 

1957

A pplicants 1st yea r cla ss

P erc en t

ap pl ic an ts

en ro lled

T o ta l 

en ro lled 

(4 ye ar s)

G ra d u ­

at es , 

J u ly 1, 

1957, to 

Ju n e 30, 

1958

N ew Y or k:

A lb an y M ed ic al College of U nio n U n iv e rsit y _________ P riv a te ____ 1,215 68 5.6 230 49 1,106 63 5.7 229 60 U n iv ers it y of Ku tLi lo Sc ho ol of M ed ic in e_____________ ........ d o . . . . . . 827 84 10.1 300 65 801 84 10.4 304 78 A lb er t E in st ein Co lle ge of M ed ic in e _ __________ ____ d o ____ __ 1,093 96 8.7 151 1,139 98 8. 6 245 C o lu m b ia U n iv ers it y Co lle ge of P h y si cia n s an d Sur ge on s. C orn el l U n iv ers it y Xf edicn l C ol le ge. . ______________ ____ d o .......... . 1,61 2 120 7.4 472 114 1,680 120 7. 1 470 115 ____ d o ............ 1,302 84 6.4 335 86 1,325 84 6.3 334 81 N ew Y or k M ed ic al Co lle ge _ ________________ ........ d o ............ 1,969 128 6.5 486 109 1,794 128 7. 1 497 115 N ew Y ork U n iv ers it y College of M ed ic in e . . . . d o ............ 1,490 136 9. 1 522 127 1,335 134 10.0 519 125 S t a t e U n i v e r s it y o f N e w Y o r k a t N ew Y o rk __________ P u b li c ____ 1,503 155 10.3 587 145 1,321 153 11.5 589 145

U n iv ers it y o f R oc he st er Sc ho ol o f M ed ic in e...................... P riv a te ......... 1,174 71 6. 0 279 65 1.120 71 6. 3 283 73 S ta te U n iv ers it y of N ew Y or k a t Syr ac us e P u b li c ........... 1,087 79 7. 2 288 63 1,094 86 7.8 300 71 N o rth C ar olina:

D u k e U n iv ers it y Sc ho ol of M ed ic in e_____ ____________ P riv a te ____ 819 78 9. 5 319 80 865 79 9. 1 315 81 B ow m an G ra y Sc ho ol o f M ed ic in e _____________ ____ d o ______ 630 54 8. 5 209 55 812 54 6. 6 204 49 U n iv ers it y of N o rt h C ar oli na Sc ho ol of M edci ne______ P u b li c ........... 293 67 22.8 252 58 284 69 24.2 257 58 Ohio;

U n iv ers it y of C in cin n ati Co lle ge o f M ed ic in e ________ ___ d o ______ 1,085 94 8. 6 336 79 1,051 93 8.8 343 76 W es te rn R es er ve U n iv ers it y Sc ho ol o f M edic in e______ P riv a te ____ 1,272 91 7. 1 324 73 1,372 82 5.9 325 77 O hi o S ta te U n iv ers it y College of M edic iu e....................... P u b li c _____ 508 150 29.5 567 133 567 150 26.4 572 139 O kla hom a: U n iv ers it y of O kla hom a Sc ho ol of M edic in e— Orego n* U niv er si ty of Or egon Sc ho ol of M ed ic in e.. _____ ____ do............ ___ d o .......... . 275 382 10176 36.7 19.8 373 293 8865 262 480 10079 38. 1 16. 4 372 292 8370 P en n sy lv an ia : H ah n em an n M ed ic al College ............ _..................... -- P riv a te ......... 1,058 108 10.2 398 97 1,152 108 9.3 394 96 Je ffer so n M ed ic al College o f P hil ad elp h ia . . . d o ............ 1.827 180 9. 8 682 165 1, 749 178 10. 1 682 158 T em p le U n iv ers it y Sc ho ol of M ed ic in e ___ d o ............ 1,552 137 8. 8 491 114 1,535 136 8. 8 495 118 U n iv ers it y of P en n sy lv an ia Sc ho ol o f M ed ic in e.............. W om an’s M ed ic al Co lle ge of P en n sy lv an ia __ .........d o ............ ........ d o ............ 1,500 222 126.50 8.4 22.5 503 182 12640 1,624 199 12851 7. 8 25.6 509 185 12645 U n iv ers it y of P it ts b u rg h Sc ho ol of M ed ic in e. . . . d o . . . . . . . 592 100 16.8 362 91 557 102 18.3 365 80 P u erto Rico : U n iv ers it y o f P u ert o Rico Sc ho ol of M ed ic in e- S o u th C ar oli na: M ed ic al College o f S outh C aro li n a.............. P u b lic .......... 125 52 41.6 184 41 123 53 43.0 188 45 ........ d o ............ 162 80 49.3 305 74 203 80 39.4 305 75

140 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
Ten ne ss ee :

U niv ers it y of Ten ne ss ee Co lle ge o f M ed ic in e ____ d o ........... 545 225 41.2 787 185 555 220 39 .6 768 182 M eh arr y M ed ic al Co lle ge . .. ............. ............. P riv a te ____ 510 74 14.5 258 53 447 73 16.3 267 57 V an d erb il t U n iv ers it y Sc ho ol o f M ed ic in e-. .........d o ............ 793 54 6. 8 202 53 764 53 6. 9 197 46 Tex as :

U n iv ers it y of T ex as S o u th w este rn M ed ic al Sch ool......... U n iv ers it y of Tex as , O al vest on . . . ____ ___ P u b li c ........... 451 106 23 .5 390 91 504 104 20.6 388 90 ____ d o ........ . . 497 164 32 .9 601 129 557 132 23.7 573 151 B av lo r U n iv ers it y College of M ed ic in e........................ ....... P riv a te ......... 877 82 9. 3 336 90 943 86 9. 1 321 78 U ta h ' U n iv ers it y o f U ta h Sc ho ol of M ed ic in e P u b li c ........... 272 54 19.8 212 57 306 58 18.9 207 48

V er m ont: U niv er si ty of V erm o n t Co lle ge o f M ed ic in e__ .. . . . d o . ........ 396 50 12. 6 179 40 373 51 13.6 179 38 V irgi ni a:

U n iv ers it y of V irgi ni a Sc ho ol o f M ed ic in e............ . ........... ____ d o ............ 712 76 10.6 297 75 693 77 11. 1 290 66 M ed ic al College o f V ir g in ia ___ . ___ _____ __ ____ do............ 335 84 25.0 364 95 363 85 23.4 357 97 W as hin gto n: U n iv ers it y of W as hin gto n S ch oo l of M ed ic in e. W isco ns in :

U n iv ers it y o f W is co ns in Sc ho ol of M ed ic in e........ . . .

.........do ............

____ d o ..........

461

193

76

83

16.4

43.0

290

318

72

77

471

194

75

90

15.9

46 .3

288

320

72

76 M arq u ett e U n iv ers it y Sc ho ol o f M e d ic in e .. ___ P riv a te ____ 1,013 103 10. 1 397 100 1,034

135

105 10.0 393 96

W es t V irgi ni a: W es t V irgi ni a U n iv ers it y Sc ho ol of M ed i­ cine .

PA SIC ME DICAL SCH OOLS

P ubli c 122 31 25.4 58 40 29.6 70

N o rth D ak ota : U n iv ers it y of N o rt h D ak o ta Sc ho ol of M ed ic in e.

N p w H am psh ir e: D art m o u th M ed ic al Sc ho ol

____ do 99 41 41. 4 80 100 40 40.0 78

P r i v a t e __ 312 24 7.6 48 320 24 7.5 48 S o u th D akota : U n iv ers it y of S outh D ak o ta Sc ho ol of M ed ic in e. P u b li c . 224 41 18.3 77 263 46 17.4 80

H

53

►
Table I.

—Sum mary of application, admission, and enrollment data for each U.S. school of medicine for the 5-year period 1956 57

to 1960-61—Continued

N ote.—D at a for Unive rsity of Fl or ida College of Medicine, Seton Hall College of Medicine, an d Unive rsity of K en tu ck y School of Me dic ine inc om ple te bec aus e t he y wer e or are ne wl y develop ing schools. D at a for West V irg ini a Unive rsity School of M edicine in comp lete bec aus e it is in tr an sitio n from a 2- to a 4-ycar pro gra mj

1958-59 1959-60

St ate an d me dic al s chool

Ow nersh ip App li­ ca nts 1st ye ar class

Pe rcen t

applican ts enrolled

Tot al 

enrolled 

(4 years)

Gradu ­

ate s, 

Ju ly 1, 

1958, t o 

Ju ne 30, 

1959

App licants 1st ye ar class

Pe rcen t

applican ts

enrolled

To tal 

enrolled 

(4 years)

G ra du ­

ate s, 

Ju ly 1, 

1959, to 

Ju ne 30,

1960

Ne w York:

Alban y Me dic al College of U nio n U ni ve rs ity................

Uni ve rsity of Buffalo S choo l of M ed ic in e----------------- Albert Ei ns te in College of M ed ic in e. ----------------------- Col um bi a Unive rsity College of Ph ys icians an d SurP ri v ate ____ ___ do ........... ___ do _____ 1,111 694 936 1,341 65 5.8 88 12.6 96 10.2 120 8.9 229 300 332 477 517050 117 1,074 547 1,072 1,249 638396 120 5.8 15.1 8.9 9.6 238 299 369 472

M63

90

116

geuu s. Co rne ll Unive rsity Medi cal Colleg e-------------------------- Ne w York Medical Co lleg e...........................- ............ ......... Ne w Yo rk Unive rsity College of M ed icine....................... Sta te Uni ve rsity of New York at Ne w Y ork ...................

U ni ve rsity of Ro chester Sc hool of M ed icine--------------- St ate Unive rsity of Ne w Yo rk at Sy racuse.......................

___ d o .. ___ d o .. ........d o ..

Publi c.. Priva te . Publi c..

1,1691,679

1,372

1,2181,084

914

s.;

127

132

171

6987

7.37.5

9.6 

12.6

6.3 9.5

337

496526570262

302

82

123132

138

6365

1,1981,7281,349

1,2561,033

894

83

128

133155

72

83

6.9

7.4

9.8 

12.3

6.9 9.2

335

49

517568276

302

86

112

128

134

5973

N orth Ca rolina:

Duk e Unive rsity Schoo l of M ed icine...................... ........... Bo wm an Oray School of M edici ne...................................... Uni ve rsity of N or th Ca rolin a School of Med icine--------

Ohio:

Unive rsity of C in ci nn ati College of M ed ic in e. ------------

W estern Reser ve U nive rsity School of M ed icine--------- Ohio St at e Uni ve rsity College of M ed icine...................... Ok laho ma: Unive rsity of O klahom a School of M ed icine— Ore gon : Uni ve rsity of Oreg on School of Medicine .................

P ri vate ____ ___ do _____

Pub lic_____

___ do _____ Pri vate ____

Publ ic ..........

___ do _____ ___ do _____

920

860

327997

1,353

525250

459

795570

9278

151100

80

8.6

6.4

21.4

9.2

5.7

28.740.0

17.4

311207264

342321

569

371

295

78 

47 5979 72

140

93

66

979480239996

1,223

506204

387

76

.5.5

699488

150

mi

79

7.7

11.4 

28.8

9.4

7.2

29.749.5 20.4

312214266

352332

568

364304

745369

87

85

137

8572

Pe nn sy lv an ia: Hah ne m an n Medica l Co lleg e----------------------------------- Jefferson Medi cal College of P hi la de lp hi a------- ----------- Te mple Unive rsity School of Me dic ine ................- ......... U ni ve rs ity of P en ns yl va ni a School of M ed icine........ . W om an ’s Me dic al College of P en ns yl va ni a..................... U ni ve rs ity of P itts burg h School of Med icine........ ........... Pu er to Rico: Uni ve rsity of P ue rto R ico School of M edi cin e- So uth Ca rolin a: Medica l College of S ou th Carolina.............. P ri v ate ____ ___ do _____ ___ do _____ ___ do _____ ___ do _____ ___ do _____ Pub lic_____ ___ do ............ 690 1,599 1,244 1,669 207 670 123 205 109 15.7 175 10.9 136 11.0 126 7.5 51 24.6 101 15.0 55 44.7 80 39.0 393 677 507 .506 180 378 193 299 93 166 115 12541804374 1,039 1,476 1,398 1,488 220 600 118 182 111 177 137 13051 10852 80 10.6 11.9 9.7 8.6 23.1 18.0 44.0 43.9 386 659 .521 521 185 379 195 299 90 163 125 13140974270

142 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL
Tenness ee:

203 26.4 760 187 Uni ve rsity of T ennesse e College of M ed icine_____ ____d o............ 759 202 26.6 658 173 769 M eh ar ry M edical Colleg e.................................... ......... P ri vat e......... 362 74 20.4 269 67 355 79 22.2 264 64 Van de rb ilt Unive rsity School of M edicine _ ___ do ............. 703 52 7.3 199 48 641 52 8. 1 205 48 Texas:

104 21.4 400 101 Unive rsity of T exa s So uth we ste rn Medi cal School. Pub lic........ . .505 101 20.0 397 91 485 U ni ve rsity of Texas, Galv est on .. _____________ ____do............ 534 143 26.8 529 132 .502 148 29. 4 .507 140 Ba ylo r Uni ve rsity College of M ed icine...................... Uta h: U ni ve rsity of Utah School of M ed icine................. P ri vat e____ 961 84 8 7 310 73 855 84 9.8 330 67 Pub lic_____ 312 57 18.4 206 48 313 56 17.8 203 44 Vermon t: U ni ve rs ity of Ve rm ont College of M ed icin e. ........d o........ .. 320 51 15.9 185 40 375 52 13.8 184 42 Virginia: Unive rsity of V irg ini a School of M ed icine________ ___ do ______ 565 76 13.5 281 68 538 76 14 1 287 65 M o d fr il l C o lic o f V i r g i n i a . _ . . ____do.......... . 405 85 20.9 354 94 399 84 21.0 351 95 W ashing ton: Uni ve rsity of Wa sh ington School of Medicine . ........do............ 423 75 17.7 291 68 415 78 18.8 288 72 Wisconsin:

88 32.8 342 U ni ve rs ity of Wisconsin School of M ed icine______ ___do ............. 209 101 48.8 340 71 268 73 M ar quet te Uni ve rsity School of M ed ic in e.. .......... Pri vat e____ 779 105 13.6 380 95 821 104 12.6 393 89 West Vi rgi nia : West Virginia Uni ve rsity School Medici ne.

BASIC ME DIC AL SCH OOL S

of 114 41 35.9 74 109 45 41.2 82

N or th Dak ot a: Uni ve rsity of N or th Dak ota School Medici ne. of 82 41 50.0 75 89 44 49.4 81

279

309

24

44

8.6

14.2

48

80

Ne w Ham ps hire: D ar tm ou th Medica l School..... ........... So ut h Dak ota: Uni ve rsity of So uth D ak ota School M ed icine. of Pri vate ____ Pub lic.......... 324 297 2444 7.4 14.8 4879

A

50

>

§

2

o

hi

d

4^

CO
Table I.—Summary of application, admission, and enrollment data for each U.S. school of medicine for the 5- year period 1956-57 to 1960-61—Continued

1960-61

Sta te a nd m edica l school Ow nersh ip

App lic an ts 1st ye ar class Pe rcen t ap ­ pl ican ts en ­ rolled Tot al e n­ rolled (4 years) Gr ad ua tes , Ju ly 1,1960, to Ju ne 30, 1961

New York:

Alban y Medica l College of Unio n U niv er si ty ___________ Uni ve rsity of Buffalo School of Med icine........................ . Albert Ei ns te in College of M ed icine............. . .............. ......... Colum bia Unive rsity College of Ph ys icians a nd Surg eons. Co rne ll Uni ve rsity Medica l C olleg e. .__________________ New Yo rk Medica l C ollege. ,________ ________________ New York Uni ve rsity College of M ed icine_____________ State Unive rsity of Ne w York at New Y o rk ............. ......... Uni ve rsity of Ro ch ester School of M ed icine......................... State Uni ve rsity of Ne w Yo rk a t Sy racu se........................... Nor th Carolina:

Duk e Unive rsity School of M ed ic in e.................................... Bo wm an Ora y School o f M ed icine.......................... ............ Unive rsity of N or th Ca rolin a School of M ed icine_______

Ohio:

Unive rsity of C in ci nn ati College of Medicine ....................... W estern Reserve Unive rsity School of Medicine _______ Ohio State Unive rsity College o f Med icine........................... Ok lah om a: Unive rsity of Ok lah om a School of Medicine ......... Oregon: Unive rsity of Oregon School of M ed icine.....................

Pe nn sy lvan ia: H ah ne m an n Me dic al College ................................................. Jefferson Medic al College of Ph ilad el ph ia ................... .......... Te mple Unive rsity School of M ed ic in e...____ __________

Unive rsity of Pe nn sy lvan ia School of M ed ic in e................ W om an ’s Me dic al College of Pe nn sy lv an ia .......................... Unive rsity of Pi ttsb ur gh School of Med icine..................... Pu er to Rico: Unive rsity of Pu erto Rico School of M ed ic in e... So ut h Ca rolin a: Medica l College of So uth C ar ol in a------ ------ - Senness ee:

Unive rsity of Tenn ess ee College of M ed ic in e............ ............ M eh ar ry Medic al College .................................................... . Van de rb ilt Unive rsity School of M ed icine........... . ............ Texas:

Uni ve rsity of Texas So uthw ester n Medica l School_______ Uni ve rsity of Texa s, Galve ston ____ ___________________ Ba ylor Unive rsity College of M ed icine........... ....................... Uta h: Unive rsity of U ta h School of M ed icine______________

Pr iv at e

........d o.........do.____do. ____do. ____d o.. ____do. Pu bl ic .

Pr iv at e

Pub lic.

Pr iv at e.

........d o ..

Pu bl ic .

........do ..

Pr iv at e

Pu bl ic .

........do..........do ..

P ri vat e.

___ do . ___ do . ___ d o .. ___ d o .. ___ d o ..

P u b li c.. 

___ d o ..___ d o .. Pri va te . ___ d o ..

Publi c.

___ d o .. Pri vat e.

Pu blic.

1,048

462

979

1,209 

1,027 1,681 

1,273 1. 160 

913 922984

611

240

863

1,080

506

233

386891

1,3261,343

1,341

226

630

119

17C

734376

585447461

MS

322

6488

98

120

85

128

130

156

72

84

75

556998

87

151MM

80

111

176

137

127

63

161

55

80

6.1

19.0 10.0 

o 9 

8.2 

7.6 

10.2 

13.4 

7.8 

9.17.69.0

28.7

11.3

8.1

29.844.6

20.7

12.413.210.2 

9.4

27.8

16.0

46.2

47.0

204 27.7

71 19. 1

54 9.2

166

144

8555

22.331.2

12.9

17.0

243

308366

476

326506507 575 

285 

306313215258

360

327561

374

300384645519518

201373

198

303

759

263200395

475

348203

5772

87

117

76

120128

131

71

6881

S3

60

83

78 iaa

8361

03

167

125

130

4091

45

72

177

64

51

161161

86

48

144 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
Vermon t: University of V ermont College of Medicine __ ....... do . . ........ . ....................... 351 Virginia: University of Virginia School of Medicine ___ d o .. ................................. 506 Medical College of Virginia _ __ __________ ....... do . . ................................ 327 Washington: University of Washington School of Medicine........................ . ___ do ........... ......................... 433 Wisconsin:

University of Wisconsin School of Med icine.................................. ............. ___ do ..................................... 274 Ma rquette University School of Medicine . .......................... Pr ivate. -............................ . 787 West Virginia: West V’irginia University School of M ed icine____________ Publi c.................................... 91

BA SIC MED IC AL SC HO OL S

North Dako ta: University of N orth Dak ota School of Medicine ___ do ..................................... 87 New Hampshire: Dartm outh Medical School. Pr ivate____ _____________ 231 South Dakota: University of South Dakota School of Medicine Pu blic________ _______ __ 293

51 14.577 15.285 25.977 17.7

92 33.5

102 12.9

46 50.542

24

45

48.2

10.315.3

189

292331289340392

109

43

74

89

o

80 ......................47 ......................

75 ......................

do

4^

C3
T a ble II .— Sum m ary of a ttrition rates fo r all U.S. schools of me dicine fo r the 5-y ear per iod 19 55 -56 to 19 59 -60

Ac ade mic year

N um be r of 

1st y ea r stud en ts

N um ber of 

drop ou ts

Pe rc en t of 

dr op ou t

To tal

en rollm en t 

(4 classes)

Per ce nt of 

dr op ou t Ac ademic ye ar

N um be r of 

1st ye ar 

stud en ts

N um be r of 

dr op ou ts

Pe rc en t of 

dr op ou t

To tal

en rollm en t 

(4 classes)

Pe rc en t of 

drop ou t

1955-56.............. 7,742

8,014

483 6. 23 28,748 

29,130 29,473

2.73 1958-59____ 8,128 

8,173

565

541

6.95 6.61

29,614 30,084

2.84 3.36 1956-57......... . 510 6. 36 3.03 1959-60___ 1957-58.............. 8,030 598 7.44 3.84

T a b le I I I.— Sum m ar y of attri tio n rates fo r each U.S . school of m edicine fo r the 5-y ear per iod 19 55 -56 to 1959—60

[N ot e.—D at a for the U ni ve rs ity of Florid a College o f M edi cin e, Seton H al l College o f M edi cin e, an d Unive rsity of K en tu ck y School of M edi cin e inc om ple te bec aus e th ey w ere or are n ew ly develo pin g schools. D at a for West V irginia School o f M edicine incom ple te because it is in tra ns iti on from a 2- to a 4-year program ]

1955-56

St at e an d me dic al school Ow ner shi p

1st year, 1955 2d year, 1956 Num be r dr op ou t Pe rcen t dr op ou t Tot al en­ rollm en t,

1955

To tal,

1956

Tot al

percent dr op ou t

Alab am a: Medica l College o f A la ba m a_________________________ Ar kansas: Unive rsity of A rk an sa s_____________________________Ca liforn ia:

Loma Lin da U ni ve rs ity___________________________________ Uni ve rsity of Californ ia, Los Angel es_______________________

Uni ve rsity of So uthe rn Ca liforn ia........ . ............ . ............................. St an ford U ni ve rs ity_____ _________________________________ Unive rsity of Californ ia, San Fr an cisco_____________________ Co lorado: Uni ve rsity of Co lor ado_____ ________________________ Co nn ec tic ut: Yale U ni ve rs ity____ . __________ _________________ D is tric t of Co lumbia:

P ubli c- ...........................

___ do ______________

Pri vat e___ _________ Pub lic---------------------

Pri vat e...........................

___ do ______________

P u b li c............................

___ do ______________ Pri vat e--------------------

81

93

99

60

6958

77

Mi

79

77

77

8450686876

8680

4

16

4.

17.

15 15.

0 0

1 1.

0 0

1 1.

0 0

+ 1 -1 .

296 291317 303

385 362

168 166

271 266236 232314 313

315 310

316 313

441

372289

1.6

4.4

5.9

1.2

1.8

1.6

.3

1.5 

.9

Ge orgetown Uni ve rsity .. George W ashin gto n Uni How ard U ni ve rs ity___ Flor ida:

U ni ve rsity of F lo ri d a .. . U ni ve rs ity of M iam i___

ve rsity .

.do______________ .do ....... .......................do______________

115

102

79

OB92

78

19

10

1

16.5

9.8

1.2

420

358287

Publi c. . 

Priva te . 73 69

4.7

3.7 

.7

3.5

146 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL
Geo rgia:

Em or y U ni ve rs ity________________________________________ ........ do .............................. 73 71 2 2.7 284 283 .3 Medic al College of G eorg ia ___ _____ __________________ Publi c____ __________ 101 98 3 2.9 352 341 3.1

Illi nois:

Ch icago Medi cal __ ______- ____________________________ P ri v ate _____________ 73 68 5 6.8 283 276 2.4 Nor th wes tern U niv er si ty - ___ __________________ ____do ............. ................ 133 128 5 3.7 523 521 .3 50 St ritch (Loyola U ni ver si ty )________________________________ ........d o.............................. 88 88 0 0 325 321 1.2 > U ni ve rs ity of C h ic ag o __ ____________________________- - __ ........d o_______________ 72 73 +1 -1 .3 286 286 0 K U ni ve rs ity of Illino is Publi c.............. .............. 167 154 13 7.7 636 618 2.8

In dia na

- In dia na U ni ver si ty ___________________________________ ____d o.............................. 165 141 14 9.0 586 565 3.5 §

o Io w a’ Sta te Uni ve rsity of I ow a________________________________ ........d o.............................. 120 102 18 15.0 441 421 4.5 Kansas* U ni ve rsity of Kan sa s_____ ........d o................. - ........... 101 96 5 4.9 428 431 - . 7

K en tu ck y: d o __

ohej

Uni ve rsity of L ouisv ille____ Pr iv at e ___________ 97 89 8 8.2 379 368 2.9

Lo uisia na :

Lo uisia na St ate U ni ver si ty ____________ ___________ ________ Pub lic_____ _________ 126 108 18 14.2 426 399 6.3 50 Tu la ne U ni ve rs ity _________ P ri v ate _____ ________ 131 120 11 8.4 511 496 2.9

O

M ar yl an d: Jo hn s Hop kins U ni ve rsity _________________________________ ___do................................ 74 73 1 1.3 286 284 .6 tson

Si—i

o

U ni ve rsity of M ar yl an d ____________ Publi c............................. 96 93 3 3.1 375 369 1.6 M assa ch us etts:

Bo ston U ni ve rs ity _________________________ P ri v ate _____________ 73 66 7 9.5 284 280 1.4 H ar va rd Me dic al Colleg e______ ........do .............................. 118 118 0 0 530 551 -3 .9 5! Tuf ts U ni ve rs ity___________ ____d o............. . .............. 111 105 6 5.4 443 440 .6 ►

M ichiga n: U ni ve rs ity of M ich igan ____________________________________ Publi c.......... . ................ 206 193 13 6.3 762 749 1.7

c

W ay ne St ate U ni ve rs ity ______ ____ ____ __________ ........do........ ...................... 76 71 5 6.5 281 271 3.6 M in ne so ta : Unive rsity of M inne so ta __________________________ ____do .............................. 128 119 9 7.0 481 459 4.5 dto M iss iss ippi: Uni ve rsity of M iss issip pi__________________________ ........do .............................. 80 69 11 13.7 162 138 14.8

Miss ou ri:

U ni ve rsity of Miss ou ri____ ........do .............................. 45 39 6 13.3 113 95 15.9

A

Q

St Louis "Un ive rsity______________________________________ P ri v ate .. ..................... 127 125 2 1.5 479 472 1.4 W as hi ng to n Unive rsity , St. L o u is _________________________ ____do............. . .......... 87 81 6 6.8 359 360 - . 2 a

W> N eb ra sk a: Creighton U ni ve rs ity______________________________________ ____d o.............................. 76 76 0 0 297 288 3.0 Un i vers! tv of Neb rask a_____ _ . _______ ___ ______________ P u b li c .. ................. ....... 87 72 15 17.2 331 314 5.1 Pr iv at e 3

hd

w

50

qp

o

w

t1—*

•M
T able I I I.— Sum m ar y of a ttr ition rates fo r each U.S. school of m edicine fo r the 5-y ear period 19 55 -56 to 19 59 -60— Con tinu ed

[Note.—Data for the University of Florida College of Medicine, Seton Hall College of Medicine, and University of Kentucky School of Medicine incomplete because they were or are newly developing schools. Da ta for West Virginia School of Medicine incomplete because i t is in tran sitio n from a 2- to a 4-year program]

State and medical school Ownership

Alabama: Medical College of Ala bam a----- Arkansas: University of Arkansas_______ California:

Loma Lind a U niv er sity ................ ....... University of California, Los A nge les.. University of Southern California......... Stanford Un ive rsity................................ University of California, San Francisco Colorado: University of Colorado___ ____ Connecticut: Yale U ni ver si ty ..................... District of Columbia:

Georgetown U ni ve rsity. ........................ George Washington U niv ers ity_______ How ard U ni ver si ty ....___ _________ Florida:

University of Florida _______________ University of Miami___ ____________ Georgia: Emory U niversity......... ....................... Medical College of Georgia..................... Illinois:

Chicago Medical.................... ........... . Northwestern Un iversity......... .............. Stri tch (Loyola U niv ersity).................... University of Chicago.............................. University of Illinois................................ Indiana: Ind iana University............... ......... Iowa: State University of Iowa ..... .............. Kansas: University of K an sa s... .................. Kentucky: University of Ke ntucky .......................... University of Louisville.................... ...... Louisiana:

Louisiana State University.................... Tula ne Un iversity.................................... Maryland: Joh ns Hopkin s University_______ ____ University of M ary lan d...........................

Publ ic .. 

....... d o ..

Private. 

Pub lic.. 

Pr ivate.

....... do ..

Pub lic. .

___ do .. Private ........ d o ..___ do .. ....... do ..

Pub lic..

Pr ivate.Pri vate .. 

Pu blic...

Pr iv ate..

.......do. ..___ do. .. .......do. ..

Pu blic...

___ do ... ___ do ... ___ do ...___ do.... Priva te ..

Pub lic... 

Priva te ..

___ do ... . Pu bl ic ...

1956-57

1st year, 1956 2d year, 1957 Number dropou t Percent dropout Total en­ rollm ent, 1956 Tota l, 1957 Total percent dropout

81 71 10 12.3 299 279 6.6 100 93 7 7.0 341 329 3.5

98 94 4 4.0 376 370 1.5 50 50 0 0 180 182 -1 . 1 68 67 1 1.4 266 265 . 4 62 61 1 1.6 232 229 1.3 78 81 +3 -3 .8 312 319 -2 .2 84 70 14 16.6 322 303 5.9 80 80 0 0 322 310 3. 7

114 106 8 7.0 424 413 2.5 102 101 1 .9 372 370 .5 78 73 5 6.4 297 289 2.6

47 41 6 12.7 47 41 12.7 71 64 7 9.8 236 220 6.7

74 71 3 4.0 286 278 2.8 102 95 7 6.8 376 361 3.9

74 71 3 4.0 277 268 3.2 133 123 10 7.5 520 515 .9 88 86 2 2.2 330 331 - .3 72 73 +1 -1 .3 287 285 .7 191 179 12 6.2 641 633 1.7 159 146 13 8.1 583 564 3.2 122 110 12 9.8 433 411 5.0 104 96 8 7.6 415 417 - .4

104 97 7 6.7 379 369 2.6

125 103 22 17.6 428 405 5.3 134 121 13 9. 7 506 493 2.5

78 71 7 8.9 293 286 2.3 93 99 +6 -6 .4 363 356 1.9

148 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
M assach usetts:

Boston U niv er si ty ............................ H ar va rd Medi cal C o ll e g e.. .. ........ Tuf ts U ni ve rs ity ____ __________ Mich igan: Unive rsity of M ich igan ................... W ay ne State U n iv e rs it y .. ............. M inne so ta: Uni ve rsity of M inne so ta. Miss iss ipp i: Uni ve rsity of Missis sippi Missouri:

Unive rsity of M iss ou ri......... ...........

St. Lo uis U ni ve rs ity......................... W ashing ton Unive rsity , St. Lou is Neb raska:Creighton U niv er si ty ....................... U ni ve rs ity of N eb ra sk a_________ Ne w Jersey : Seton H a ll ................. ........

Pri vate ...........................

___ do ...................... . ___ do ..............................

Publi c.............................

___ do .............................. ___ do .............................. ___ do ..............................___ do _______________ P riv a te ..........................----- do ..............................----- do..............................

Publi c.............................

P ri vat e_____________

76 78 +2 -2 .6 286 286 0

115 115 0 0 515 543 -6 .4

112 102 10 8.9 441 429 2.7

202 183 19 9.4 762 730 4.1

77 68 9 11.6 285 272 4.5

130 124 6 4.6 474 467 1 4

76 66 10 13.1 214 197 7.9

75 65 10 13.3 170 152 10.5

123 110 13 10.5 481 458 4.7

86 82 4 4.6 347 351 -1 .1

76 67 9 11.8 287 275 4.1

87 82 5 5.7 318 317 .3

80 77 3 3.7 80 77 3.7

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 149
T a ble III.— Su m m ar y of attr iti on rates fo r each U .S . school of me dic ine fo r the 5-y ear period, 1955—56 to 1959—60— C on tinu ed

(Note

—D at a for the Uni ve rsity of Flor ida College o f Medi cin e, Seton Il all College o f Me dic ine , an d Uni ve rsity of K en tu ck y School of Me dic ine in comp lete bec aus e th ey w ere or are n ew ly develo pin g schools. D at a for West V irg ini a School of M edicine in comp lete bec aus e it is in t ra ns iti on from a 2- to a 4-year pro gram]

I—i

CnO

A

M

> 1957-58

St at e an d me dic al school Ow ner shi p

1st year, 

1957 2d year, 1958 N um be r dr op ou t Pe rcen t dr op ou t Tot al en­ rollm en t, 1957 To tal, 1958 Tot al pe rcen t dr op ou t

ao

o

Alabam a: Medi cal College of A la ba m a__________ Pub lic______________ 81 80 1 1.2 289 284 1.7

”3

Ark ansas : Unive rsity of Arkansa s ........do .............................. 93 85 8 8.6 345 329 4.6

Califo rnia:

Jxima Li nd a Uni ve rsity _ _ ___________________________ P ri vat e....................... 112 91 21 18.7 384 353 8.0

50

O

MCO

Unive rsity of Ca liforn ia, Los An geles. _ Pu bl ic ............................. 49 54 + 5 -1 0 .2 195 199 -2 .0

Unive rsity of So ut he rn Ca liforn ia___________ P ri vat e_____________ 67 62 5 7.4 264 252 4.5

S ta n fo rd U n iv e rs ity ........do ............................ - 62 62 0 0 234 230 1.7 on

Uni ve rsity of Ca liforn ia, San Fr an cisco_______ _____________ Pu bl ic ........ .................... 79 74 5 6.3 324 320 1.2 Q

>

Colorado- U n iv e rs ity of C o lo ra d o __ do .............................. 85 76 9 10.5 318 310 2.5

Con ne ct ic ut ' Yale Uni ve rsity _________________________________ Pri vate ........................... 79 81 + 2 -2 .5 309 307 .6

D is tri ct of Co lumbia:

G e o rg e to w n U n iv e rs ity ___d o.............................. 108 96 12 11.1 407 392 3.6

G eo rg e W a sh in g to n U n iv e rs ity _ ___ do ............................ - 101 97 4 3.9 383 378 1.3

H o w a rd U n iv e rs ity _ ___________________________ ___ do ............................ 103 86 17 16.5 320 299 6.5

Florida :

Unive rsity o f F lo rid a __________________________ Pub lic__________ --- 51 47 4 7.8 92 87 5.4

wf

Uni ve rsity of Miam i __ _ _______________________ P riv a te .. .....................- 79 73 6 7.6 265 247 6.7

Georgia: E m o rv U n iv e rs ity ___ do .................... ......... 74 70 4 5.4 278 276 .7

o

W \1 edit-al College of Georgia - ___ __________- __ Pu bl ic ............................. 103 91 12 11.6 386 361 6.4

Illinois:

Chicago Medical ____ _____________________________ P ri vat e........................... 73 68 5 6.8 275 267 2.9

w>

Nor thwes tern U n iv e rs ity ........do.............................. 130 122 8 6. 1 519 520 —.2 t"

1

St ritc h (Loyola Un iversit y) _ _ ___________________ ____do.............................. 88 80 8 9.0 337 325 3.5 3

U n iv e rs ity of C h ic ag o ___ do .............................. 72 74 + 2 -2 .7 288 287 .3

Unive rsity of Illino is _ ___ ___________ Pub lic____ __________ 190 180 10 5.2 677 656 3.1

In d ia n a * I n d ia n a U n iv e rs ity ........do......... . ................- 158 148 10 6.3 583 563 3.4 *0

M to w n - S ta te U n iv e rs ity of Io w a ____d o......... .................... 120 11) 10 8.3 434 421 2.9

K a n sa s- U n iv e rs ity of K a n sa s ____d o.............................. 102 100 2 1.9 412 411 .2 50CD

O K en tu ck y:

U n iv e rs ity Of K e n tu c k y do ____ _______ -

U n iv e rs ity of T^ ou isvi lle ____________________ P riv a te .................... . 103 92 11 10.6 382 365 4.4

Lo uisia na :

I/ O ii is ia na S ta te U n iv e rs ity _ _______________ Pub lic........ . .................. 125 1C5 20 16.0 434 409 5.7

Mf Tula ne Unive rsity - -- ______________ P ri vat e_____________ 134 121 13 9.7 503 488 2.9 M aryl an d: Jo hn s Ho pk ins Unive rsity _ __________ ___________ ___ do_____ _________ 74 72 2 2.7 293 283 3.4 U ni ve rs ity of M arylan d __________________ Pub lic............................. 93 95 + 2 -2 .1 355 341 3.9
Mass achu setts :

Boston University_____ ________ Harvard Medical College_______ Tu fts U niv er si ty ........... . ........... Michigan: University of M ic hi ga n. ................ Wayne State Un ive rsity________ Minnesota : University of M inne sota. . Mississippi: University of Mississippi. Missouri:

University of Missou ri............ ........ St. Louis U ni ver si ty ..................... Washington University, St. Louis. Nebraska:

Creighton Un ive rsity............ . ........ University of N ebraska................... New Jersey: Seton Ha ll........ ............. .

Pr ivate.

___ do.. ___ do..

Publi c.

___ do . ___ do . ___ do .___ do .. Priv ate. ___ do ..___ do.. Pu blic..

Pr ivate .

74 71 3 4.0 291 282 3.0 114 no 4 3.5 512 537 -4 .8

114 no 4 3.5 430 427 .7

206 180 26 12.6 750 716 4.5 76 73 2 2.6 282 275 2.4 131 123 8 6. 1 489 478 2.2 80 68 12 15.0 253 238 5.9

76 69 6 8.0 206 190 7.7 121 109 12 9.9 467 442 5.3 86 83 3 3.4 344 343 .3

77 64 13 16.8 283 264 6.7 87 75 12 13.7 327 314 3.9 80 73 7 8.7 157 144 8.2

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONN EL 151
T ab le I I I.— Sum m ar y of a ttrition rales fo r each U.S. school of medicine fo r the 5-y ear period, 19 55 -56 to 19 59 -60— C on tinue d

S ta te an d m ed ic al school O w ner sh ip

1958-59

1st yea r, 

1958

2d yea r, 

1959

N u m b er

d ro p o u t

P erc en t

dro p o u t

T o ta l en ­

ro llm en t, 

1958

T o ta l,

1959

T o ta l

per ce nt

d ro p o u t

A l a b a m a

- M e d ic a l C o ll e g e of A la bam a___________________________ P u b li c .................- ......... - 81 71 10 12.8 297 284 4.3

Ar kansas* U n iv ers it y n f Ark an sa s .........d o .................... ........... 95 80 15 15.7 339 320 5.6

C al ifor ni a:

l^ n m a T d p d a U n i v e r s it y P riv a te ______________ 114 99 15 13.1 371 357 3. 7

Un ive rsity* n f C a lif o r n ia , U os A n g e le s P u b li c ............. ................. 56 57 + 1 - 1 .7 208 207 . 4U n iv ers it y o f S o u th e r n C a lif o r n ia P riv a te ______________ 68 70 + 2 - 2 . 9 260 269 - 3 .4

S ta nfo rd U n i v e r s it y _ _ _ ____________ __ ____ d o . ........................... 61 59 2 3.2 237 228 3.8

U niv ers it y of C a l i f o r n i a , S a n F r a n c is c o P u b li c .............................- 101 101 0 0 338 337 .3

C o lo r a d o

- U n i v e r s it y o f C o lo r a d o ____ d o ................................ 86 80 6 6.9 317 308 2.8

C o n n ecti cu t • V ale U n iv ers it y P riv a te -------- ------------- 81 81 0 0 316 302 4. 4

D is tr ic t of C olu m bia :

G eo rg et ow n U n iv ers it y ____ do - - - - - - - - - - - - - - - 112 97 15 13.3 404 384 4.9

Geo rg e V^ftSbingtoD U niv er si ty d o . ............................. 101 96 5 4.9 389 381 2. 0

H ow ard U n iv ers it y __ _ - __ - __ - ___ ____ d o ..............................- 105 96 9 8.5 337 325 3. 5

F lo ri d a:

U n iv ers it y of F lo ri da - - _____________ _____________ P u b li c ........... ................... 50 45 6 10.0 137 127 7. 2

U n i v e r s i t y o f M ia r p i _ _ _ __________________________ P riv a te ....................... . 75 68 7 9.3 262 251 4.1

Georgia:

E m o ry Un ive rsi ty* - - ___________ - ........ d o . ---------------------- 74 72 2 2. 7 284 281 1.0

M ed ic al College of G eo rg ia - - _____________ - __ - P u b li c -------- --------------- 102 91 11 10.7 370 351 5.1

Illinoi s:

C hi ca go M ed ic al -- - ___ - ____________ - __ - - __ P riv a te ......... ................... 72 64 8 11. 1 274 262 4.3

N o rt h w este rn U n iv ers it y - - __________________ ........ d o ................................ 132 126 6 4.5 521 523 - . 3 S tr it ch (Ix >yola U niv er si ty ) _________ - _________ ____ do_ - ---------- - 88 75 13 14.7 340 324 4.7

U n i v e r s it y o f C h ic a g o ........ d o ________________ 73 74 + 1 - 1 .3 290 295 - 1 .7

U n iv ers it y of Illinois - _____________ P u b li c ........... ................... 201 184 17 8.4 707 684 3. 2

In di an a* In d ia n a U n iv ers it y _________________ ____do................................. 160 142 18 11.2 585 559 4.4Io w a' S ta te U n iv ers it y o f Io w a -- - ______ ____ d o _______ _- - - - - - . 120 109 11 9. 1 437 416 4.8

Kan sa s* U n iv ers it y Of K an sa s ________________ ........ do.............. ................. 98 95 3 3.0 402 393 2. 2

K en tu ck y : d o __ ____________

U n iv ers it y of U ou isville _ ___________ - P riv a te ........... ............. . 100 98 2 2. 0 370 362 2.1

L ouis ia na:

L o u i s i a n a S ta t e U n i v e r s i t y _ _ _ ______________________ P u b li c ............. ....... ......... 129 111 18 13.9 443 419 5. 4

T u la n e U n iv ers it y ............................................................................. ......... P riv a te . . ..................... -- 134 129 5 3.7 494 485 1.2

Cn

to

OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
800 14— 6:

M ar yl an d:

Jo hn s Hop kins U ni ve rsity ............... Unive rsity of M a ry la n d .................. Massach usetts:

Bo ston U ni ve rs ity_______ ____ _ H ar va rd Medica l Colleg e________

Tuf ts U ni ve rs ity ................................. Mich iga n: Uni ve rsity of M ic hig an ................. Wayne St ate U ni ver si ty .................. M inne so ta: Unive rsity of M in nes ota .. Mi ssissippi: Unive rsity of M iss iss ippi. Mi sso uri:

Uni ve rsity of M iss ou ri____ ____ _ St. Lou is U ni ve rs ity .......................... W ashin gto n Unive rsity . St. Lo uis. Ne braska :

Cr eig hto n U ni ve rs ity____________ Unive rsity of N eb ra sk a.................... New Jerse y: Seton H al l...........................

----- do ..

P u b li c..

Pri vate .

----- do..

----- do ...

Pu bl ic .

— .d o.

----- do.

----- do .

----- do ...

P ri vat e. 

----- do ...

----- do..

Publi c..

P ri vat e.

74 76 + 2 -2 .7 282 276 2.1

100 98 2 2.0 363 352 3.0

74 74 0 0 285 278 2.4

114 111 3 2.6 516 536 -3 .8

114 111 3 2.6 432 428 .9

197 168 29 14.7 744 710 4.5

125 114 11 8.8 328 315 3.9

139 130 9 6.4 504 486 3.5

78 69 9 11.5 272 256 5.8

76 76 0 0 234 228 2.5

12.1 113 13 10.3 451 423 6.2

86 85 1 1.1 342 345 .8

77 73 4 5.1 277 264 4.6

bt 73 8 9.8 312 301 3.5

80 74 6 7.5 224 218 2.6

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 153
T a ble I l l — Sum m ar y of a ttr ition rates fo r each U.S. school of m edicine fo r the 5-y ear period, 19 55 -56 to 19 59 -60— C on tinu ed

S ta te an d m ed ic al scho ol O w ner sh ip

1969-60

1st yea r, 

1959

2d yea r, 

1960

N u m b er

d ro p o u t

P erc en t

d ro p o u t

T o ta l en ­

ro ll m en t, 

1959

T o ta l,

1960

T o ta l

p er ce nt

d ro p o u t

P u b li c -------- --------------- 80 77 3 3.7 300 291 3. 0

____d o . .. - - - - - - - - - - - 92 83 9 9.7 343 330 3. 8

C al iforn ia : P riv a te ............................. 105 100 5 4.7 381 362 4. 9

I * iii vcr**itv of C al ifor ni a Lo s Ang eles P u b li c .............................. 57 57 0 0 218 216 .9 P riv a te ______________ 69 66 3 4.3 272 273 - . 3

___ do 71 63 8 11.2 242 231 4.5

T ' n l v n r d f v n f C* tl ifa mlA Sim KnWPiSPO P u b li c .............................. 101 98 3 2.9 358 353 1.3

P u b li c ............................... 85 85 0 0 312 313 .3

C onn ec tic ut* Y al e U n iv ers it y P riv a te ............................. 80 82 + 2 - 2 .5 303 303 0

D is tr ic t of C olu m bia :

O eo r^ et 0

w n U niv ers it y__ ____d o ........................ —— 113 95 18 15.9 404 382 5.4

Geo rg e ^^ Bsb ip gt n n U niv ers it y ........d o ...................... ......... 102 97 5 4.9 392 384 2.0

H ow ard U n iv ers it y -- ........d o ........ .................. 105 107 + 2 - 1 . 9 355 332 6.4

F lo ri da:

T T v tl w A V eit v r tf P ' ln r i f li l ______ P u b li c .............................- 49 41 8 16.3 177 166 6. 2

TTnl v n f \ l v i n i i __ ___________ P riv a te ................. - ......... 81 73 8 9.8 273 260 4.7

G eo rg ia: ____ d o ................................ 77 76 1 1.2 293 283 3.4

A f z i r l l o i l f^ o ll o o r o o f ( J o o r tr ii l _ _ _ _ P u b li c ............................... 102 96 6 5. 8 365 350 4.1

Illino is :

C hi ca go M ed ic al - __ ___ ______________ - ___----- P r iv a te ............................ 73 66 7 9.5 267 252 5.6 ____d o ................................ 130 130 0 0 520 521 —.2

Q tr it e h n v n li U n iv e rs it v ^ - - - - - - _ _ ____ do - - - - - - - - - - - - - - - 88 83 5 5.6 326 312 4. 2 ____d o .................. - ........... 73 68 5 6.8 299 295 1.3

P u b li c .............................. 200 191 9 4.5 731 711 2.7

In dia na * In d ia n a U n iv ers it y -- —-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ————____ d o .............. - ............... 182 155 27 14.8 601 568 5. 4

T n u * a * S ta te TTni v e r c it v n f In w A .........d o ......................— 120 115 5 4.1 436 427 2.0

Kansas* Univ *ersi ty o f K an sa s ———————————————————————————————————.........d o ................................ 101 95 6 5.9 393 382 2. 8

K en tu c k y :

U n iv ers it y o f Loui sv ille _ - _____ P riv a te ---------------------- 99 8S 11 11.1 375 353 5. 8

L ouis ia na:

S ta te U n iv ers it y ________ P u b li c ................. - ......... - 128 114 14 10.9 437 413 5.4

T u la n e U n iv ers it y _________ P riv a te ................... ......... 132 117 15 11.3 499 484 3. 0

M ary la n d : Tnhns Hn pfcin c U n iv ers it y ____ d o ____ - - - - - - - - - - - - 78 76 2 2.5 286 284 .6

U n iv ers it y of M a ry la n d ----------------------------------------------------------- P u b li c _______________ 100 93 7 7.0 369 363 1.6

154 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
Massachusetts:

Boston University_____________ Harvard Medical College ............. Tufts University............................ Michigan: University of Michigan.................. Wayne State University________ Minnesota: University of Minnesota.. Mississippi: University of Mississippi. Missouri:

University of Missouri................... St. Louis University....................... Washington University, St. Louis. Nebraska:

Creighton University__________ University of Nebraska_________ New Jersey: Seton Hall........................

Private.

-----do...-----do...

Public.

...... do.___ do.. -----do.-----do..

Priv ate. 

-----do..___do.. Public.. 

Private.

72 75 + 3 - 4 . 1 284 282 .7 116 115 1 .8 505 508 - . 5

114 110 4 3 .5 438 431 1 .5196 175 21 10 .7 720 700 2 .7

126 112 14 11 .1 375 355 5.3

141 126 15 10 .6 514 488 5 .0

80 69 11 13 .7 274 256 6 .5

75 71 4 5 .3 272 258 5. 1 113 105 8 7.0 420 400 4 .7 86 78 8 9 .3 343 333 2 .9

77 77 0 0 271 262 3 .3 85 80 5 5 .8 314 309 1.8 81 74 7 8 .6 299 287 4 .0

TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 155
T ab le 111.— Su mm ary of attrition rates for each U.S. school of medicine for the 5-year period, 1955-56 to 1 959-6 0— Co ntinued

1955-56

Sta te a nd me dic al school Ow ner shi p 1st year, 1955 2d yea r, 1956 Num be r dr op ou t Pe rcen t dr op ou t Tot al en­ rollm en t, 1955 To tal, 1956 To tal IMircent dr op ou t

Ne w Yo rk:

Alban y of Un ion Uni ve rsity .................................... Uni ve rsity of Bu ffalo....................- ........................... Ei ns te in of Yesh iva Uni ve rsity ...........................—

Colum bia U ni ve rs ity................................................ Co rne ll U ni ve rs ity ............................................ ........ New York M ed ical....................................................

Ne w Yo rk U niv ers it y............................................ Sta te Unive rsity of New Yo rk, New Yor k-------U ni ve rsity of Ro chester ....... - ....................... .......... St ate Uni ve rsity of New Yo rk, Sy racu se............ N or th Ca rolina:

Du ke U niv er si ty ....................................................... Bo wm an Gray of Wake Fo rest....... ...................... Uni ve rsity of N or th Carolina............................ . Ohio:

U ni ve rsity of C in ci nn at i............. - ................... —- W estern Reserve Uni ve rsity _________________ Ohio St ate U ni ve rs ity.................................-........... Ok laho ma : Unive rsity of O klah om a........................... Ore gon: Unive rsity o f O regon...................... - .............. Pe nn sy lv an ia: H ah nem an n.........................- ....................... - ..........Jefferson M ed ic al. .. .................................................

Te mple U ni ve rs ity ................................................... U ni ve rs ity of Pe nn sy lv an ia ----------- --------------- W om an 's M ed ical.......................- --------------------

Unive rsity of Pitts burg h.................... .................... Pue rto Rico: U ni ve rs ity of Pu er to Ric o........... ......... So ut h Ca rolin a: Medical College of S ou th Carolina 

Tenness ee:

U ni ve rsity of Te nn essee............ ................. ........... M eh ar ry .............. ............................................. ......... Van de rb ilt U ni ve rs ity .............................................

Texas:

So ut hw es tern ..............................................................

Uni ve rsity of Te xa s____ ____________________ Ba yl or U niv er si ty ...................................................-

Pri vat e...........................

___ do .............................. ___ do _______________ ___ do ----------------------___ do ............. - .............. ___ do ----------------------___ do ........................ — Pu bl ic ______________ Pri vat e_______ ______ Pub lic______________

Pri vat e--------------------

___ do _______________ Pu bl ic --------- ------------___ do .............................. Pri vat e_____________ Pu bl ic ______________ ....... do _________ _____....... do .............................

Pri vat e.............. ............

........do ------- ---------------___ do ----------------------___ do ............. . .............. ___ do ------- --------------- ........do............- .......... —-

P ubli c- — .....................

........d o . . .................................do .......................

Pri vat e--------------------

____d o----------------------

Publi c- ...........................

........d o..............................

Pri vat e_____________

6485

56

119

84

128131151

7180

775468

93

83

151101

77

109176128125

51 

100

52 

79

217

75

51

102

166

87

63

7455

122

83

128

129

141

69

7478

51

66

86

80

144

977397

175120122

46

874675

194

64

48

91

148

82

11

11

1

+3

1

0

2

10

26

+ 1 

3 2

7

3 

74 4

17.1 

12.9

1.7 

-2 .5

1.2

0

1.5

6.62.8 

7.5

-1 .3

5.5

2.9

7.53.64.6 3.9 

5.1

12 11.0

1 .6

8 6.2

3 2.4

5 9.8

13 13.0

6 11.5

4 5.0

13

11

3

8

18

5

6.0

14.6

5.8

7.8

10.8

5.7

221296

56

462

338

476527

587

273286314

204249338322

573

379

295

399

677488

500

182

363

184

296

781

259

204

394614342

210 4.9278 6.0

55 1.7

470 -1 .7

335 .8

466 2.1528 - . 2578 1.5

272 .3

280 2.1321

202244

327311

561

368

288385

673

479501

172

349

175

292

761

MB

199

382588331

-2 .2

.9

2.0

3.2 3.4 2.0 2.92.3

3.5 

.6

1.8

- . 2

5.5

3.8

4.9 

1.3

2.5

5.0

2.4

3.0

4.2

3.2
■

U ta h: U ni ve rsity of U ta h________________ Ve rm ont: Unive rsity of V er m ont.................. Virginia:

Unive rsity of Virg inia................................ Medical College of Virg inia ___________ W ash ing ton : Unive rsity of W ashing ton___ We st Virginia : Unive rsity of West Virginia Wisconsin:

Uni ve rsity of W isco nsin ......................... . M ar quet te ___________________ . _____ _

BASIC ME DIC AL SCH OOL S

Ne w Ham ps hire: Dar tm ou th .........................

N or th Dak ota: Unive rsity of N or th Dak ota. So uth Dak ot a: Unive rsity of S ou th D ak ot a.

Publi c.............................

___ d o . . ..........................___ do ............................. ___ d o ...........................___ do.............................. ___ d o .. ..........................___ do............................. Pri vat e..... ............ .........

___ d o ......... ............ . P u b li c .. ............... .........___ d o ----------------------

5450

77

81

77

3187

102

25

5448

7483

69

278196

24

023

1

84

66

1

0

4.0

3.8 

1.2

10.4

12.9

6.8 

5.9

4.0

209

180

289

366

288

60

325

394

198173

282

378282

27

314381

5.2 3.92.4 

—3.2

2.1

55.0

3.4

3.3

40 39 1 2.5

42 36 6 14.2

TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSON NEL 157
T abl e III .— Su mmar y of attrition rates fo r each U.S . school of medicine for the 5-year period, 1955-56 to 1959 -60 Co nti nued

Sta te an d me dical school Ow nersh ip

1956-57

1st year, 1956 2d year, 1957 N um be r dr op ou t Pe rcen t dr op ou t Tot al en ­ rollm en t, 1956 To tal, 1957 To ta l percent dr op ou t

New Yo rk:

Alban y of Union Uni ve rs ity- _ ____________ Pr iv at o ......................... 68 55 13 19.1

F^230

PR

215 6.5

Uni ve rsity of Buffalo * - _____________ ........do .............................. 84 72 12 14.2 300 285 5.0

Ei ns te in of Y eshfva Uni ve rsity ______________ ........do.............................. 96 96 0 0 151 153 -1 .3

Colum bia Unive rsity " ________ ______ ____d o.............................. 120 117 3 2.5 472 464 1.7 Co rne ll Uni ve rsity ____ ____ __________ ........do.........................—- 84 86 + 2 -2 .3 335 336 - . 3 New Yo rk Medica l . _ ____________ ........do.............................. 128 130 + 2 -1 .5 486 478 1.6

New Yo rk Uni ve rsity _ _ __________ ........ do .............................. 136 131 5 3.6 622 512 1.9 Sta te Uni ve rsity of New Yo rk, Ne w Yo rk ________ P ubli c............................. 155 148 7 4.5 587 581 1.0

Uni ve rsity of Ro chester . ____________________________ Pri vate _____________ 71 69

2 2.8 279 277 .7

Sta te Unive rsity of N ew Yo rk, Syrac use Publi c............................. 79 75 4 5.0 288 277 3.8 N ort h Ca rolina: 319 316 .9 Duk e Unive rsity ____________________________ Pr iv at e ......................... 78 76 2 2.5 Bo wm an Qrav of Wake Fores t ____________ ____d o_____ _-- - - - - 54 51 3 5.5 209 205 1.9

U ni ve rs ity of N or th Ca ro lin a__________ _______ ____________ P ubli c_________ ____ 67 69 + 2 -2 .9 252 246 2.4 Ohio:

Unive rsity of C in ci nn ati _____________ _________ _______ __ ____do .............................. 94 91 3 3.2 336 329 2.0 Western Reserve U n iv e rs ity _ ____________________________ P ri v ate . ....................... 91 86 5 5.4 324 316 2.4

Ohio Sta te Unive rsity Publi c........ - ............ — 150 142 8 5.3 567 555 2.1 Ok laho ma : Unive rsity of Ok lah om a ____d o ............................ 101 95 6 5.9 373 360 3.5 Ore gon: Uni ve rsity of O regon ........do .............................. 76 65 11 14.4 293 278 5.1

Pen ns yl va ni a: 96 12 11.1 398 383 3.7 H ah nem an n. . _ _ ___________________ P ri v ate . _------ ----------- 108

Jefferson Medica l ______________________________ ____do............... .............. 180 167 13 7.2 682 669 1.9 Te m pl e Unive rsity ________________ ____do.............................. 137 121 16 11.6 491 473 3.6

U ni ve rsity of Pe nn sy lvan ia ........do ........................... 126 125 1 .7 503 507 - . 7 W om an ’s Medical _ ____ _________________ ........d o.............................. 50 47 3 6.0 182 174 4.4

Unive rsity of Pitts burg h __ _ ________ ___ do ............................ . 100 97 3 3.0 362 354 2.2 Puer to Rico: U ni ve rsity of Pu er to Rico Pub lic______________ 52 44 8 15.3 184 176 4.3 So uth Ca rolin a: M ed ical Colleg e of Sou th Ca ro lin a______________ ____d o.............................. 80 75 5 6.2 305 299 1.9

Te nn essee: 12.8 787 733 6.8 U ni ve rs ity of Tenness ee _ ________________ ........d o.............................. 225 196 29

M eh ar ry . . . . __________________________ P ri vat e_____________ 74 66 8 10.8 258 247 4.2 V an de rb ilt U ni ve rs ity ________________ ........do .............................. 54 50 4 7.4 202 197 2.4

Te xa s: 390 375 3.8 So uthw es tern __________ _ _ __ _ _ __________ Pu bl ic ______________ 106 96 10 9.4

U ni ve rs ity o f Tex as____ ____ ________ ____________ ........d o.............................. 164 154 10 6.1 601 570 5.1 Ba ylor U ni ve rs ity...................................................... ........................... Pri vate _____________ 82 82 0 0 336 325 3.2

158 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
Utah: University of Utah ______________________________ Public 54 52 2 3.7 212 206 2.8 Verm ont: University of Vermo nt____________________________ ___ do 50 49 1 2.0 179 168 6.1 Virginia: University of Virginia . _____________________________ ___ do 76 72 4 5.2 297 288 3.0 Medical College of Virginia _____________________________ ___ do 84 79 5 5.9 364 367 - .8 Was hing ton: University of Washing ton______________________ ___ do 76 69 7 9.2 290 285 1.7 West Virginia: University of West Virginia___________________ ___ do.. 31 30 1 3.2 58 30 48.2 Wisconsin:

University of Wisconsin________________________________ ___ do....... 83 82 1 1.2 318 307 3.4

Marqu ett e______ ___________________________________ Private 103 93 10 9.7 397 388 2.2

BASIC ME DICA L SCH OOL S

New Ham pshire: Dartm outh ____________________ Private 24 24 0 0 No rth Dakota: University of North Dakota . . . . . . Public 41 38 3 7.3 South Dakota: Universit y of South Dakota ___ do 41 34 7 17.0

TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 1 5 9
T a ble I I I .—Sum m ar y of att rit ion rates fo r each U.S. school of me dic ine fo r the 5-y ear period, 19 55 -56 to 19 59 -60— C on tinu ed

St at e an d me dic al school Ow ner shi p

1957-58

1st year, 1957 2d year, 1958 Num be r dr op ou t Pe rcen t dr op ou t Tot al en­ rollm en t, 1957 To tal, 1958 Tot al pe rcen t dr op ou t

New York:

Alban y of Un ion Unive rsity _ Pri vat e........................... 63 59 4 6.3 229 224 2.1

Unive rsity of Buffalo - - __ _ _____ ________________ ........d o.............................. 84 76 8 9.5 304 290 4.6 Ei ns te in of Y esh iva Uni ve rsity ____________ ______________ ........d o.............................. 98 95 3 3.0 251 236 5.9 Colum bia Unive rsity __ do........................... 120 120 0 0 470 471 - . 1 Co rne ll Unive rsity .. .d o __ _________ 84 81 3 3.5 334 332 .6 New York Medical ............................... . ........................................ ___do ---- -- _______ 128 128 0 0 497 484 2.6

New York Uni ve rsity -________ _______ _____________ ...d o ______________ 134 130 4 2.9 519 519 0 Sta te Unive rsity of New York, New Y ork .... ......................... Pub lic_____ ______ __ 1.53 135 18 11.7 489 561 4.7

Unive rsity of Ro che ste r ________ ____________________ Pri vat e_____________ 71 70 1 1.4 283 266 6.0

S ta te Unive rsity of N e w Y o rk , S y ra cu se Pu bli c 86 73 13 15. 1 300 286 4.6 Nor th Ca rolina:

Du ke U ni ve rs ity ................................ ..............- ____ ________ P ri v a te .......................... 79 75 4 5.0 315 313 .6 Bo wm an Orav of Wa ke Fo res t .................... ........................... _ .. .d o - - - - - - - - - - ........ .54 53 1 1.8 204 201 1.4 Uni ve rsity of Nor th Ca rolin a Pub lic...... .................... 69 64 5 7.2 257 252 1.9

Ohio:

Unive rsity of Cin ci nn ati _ .......................... ......................... .. .d o .......- .........-......... 93 82 11 11.8 343 326 4.9

W est ern Reserve U niv er si ty ........................... .........-.............. ......... Pri vat e........ . ................ 82 80 2 2.4 325 320 1. 5

Ohio Sta te Unive rsity ........- __________ ___________ _____ Pub lic....................... . 150 141 9 6.0 572 557 2.6 Ok lah om a: Unive rsity of O klahom a __ ... d o ...........................- 100 92 8 8.0 372 354 4.8

Oregon: Unive rsity of O rego n - ..................................... ____d o............................. 79 73 6 7.5 292 285 2.4 Pe nn sy lv an ia: Hah ne man n ...................................................... Pri vate ........................... 108 97 11 10.2 394 380 3.5

Jefferson Medical ___do............................. 178 164 14 7.8 682 660 3.2

Tem ple Unive rsity . . __ ___________________________ ___d o....... -.................... 136 129 7 5. 1 495 489 1.2 Uni ve rsity of Pe nn sy lv an ia . __________________________ ____d o-------- ------------- 128 122 6 4.6 509 506 .5W om an ’s Medi cal _ ________ _____ ___ ___ _____ ____d o......... - .................. 51 46 5 9.8 185 174 5.9 U ni ve rsity of P ittsbu rg h . .......................... ___d o........... . ................ 102 98 4 3.9 365 357 2.2 Pue rto Rico: Unive rsity of Pue rto Rico __________ _____ Pu bl ic _______ - ____ 53 48 5 9.4 188 183 2.6 So uth Ca rolina: Medic al College of So uth Carolina . ...... .................. ____do ............................. 80 73 7 8.7 305 294 3.6 Tenness ee:

U ni ve rsity of Ten nesse e________ . . ................................ ____d o_____ ______ _ 220 189 31 14. 1 768 638 16.9 M eh ar rv ______________________ Pri vat e_____ _______ 73 59 14 19. 1 267 252 5.6 V an de rb ilt U niv er si ty ......................................... ................................. ____d o.............................. 53 51 2 3.7 197 193 2.0

160 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
Texas:

South we ste rn,............ . ....................... ...... .................................... Pub lic..... ...................

University of Tex as........................................................... ............. ___ do _____________ Baylor U ni ve rsity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... ............. Pr ivate____________ Uta h: University of Utah,, . _____ ________________________ Publi c........ .................. Vermont: University of V er m on t______________________ _____ ___ do........................... Virginia: University of Virginia .............................................. ............... ___ do___________ __ Medical College of Virginia _____ ___________ - ________ ___ do........................... Washington: University of Washington ........... ___ do_____________ West Virginia: University of West Virginia...................................... ___ do........................... Wisconsin:

University of Wiscon sin.,- ................... ........... . d o ______ Marqu ette.............. ....................... . ................ „ .. Priva te____ _______

BASIC MEDIC AL SCH OOLS

New Hampshire: D artm ou th___ ___________________ __ do........ ............. .... North Dakota: University of North Dak ota_______ ___________ Pu blic.......................... South Dako ta: University of South Dakota______ _____ _ __ do____________

104 98 6 5.7 388 386 .5132 112 20 15. 1 573 537 6.3

86 84 2 2.3 321 304 5.358 55 3 5.1 207 197 4.851 50 1 1.9 179 172 3.977 71 6 7.8 290 271 6.5

85 78 7 8.2 357 366 -2 .5

75 74 1 1.3 288 288 0

40 33 13 32.5 70 33 52.8

90 93 +3 -3 .3 320 315 1.5

105 87 18 17.1 393 371 5.6

24 24 o o40 34 6 15.046 35 11 23.9

TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 161
Table III .— Su mm ary of attrition rates for each U.S . school of medicine fo r the 5-year period, 1955 -56 to 1 959-60—Co nti nued

(N o t e.—D a ta f or th e U n iv ers it y o f F lo ri d a Co lle ge of M ed ic in e, Set on H all Co llege of M ed ic in e, an d U n iv ers it y o f K e n tu c k y Sc ho ol of M ed ic in e in com ple te be ca us e th e y were or 

ar e n ew ly d ev el opin g sc ho ols. D a ta f or W est V irgin ia Sc ho ol of M ed ic in e in com ple te be ca us e it is in tr an si ti o n f ro m a 2- to a 4- ye ar p ro gr am

1958-59

S ta te an d m edic al scho ol O w ner sh ip

1s t yea r, 

1958 2d yea r, 1959 N u m b er d ro p o u t P erc en t d ro p o u t T o ta l en ­ ro ll m en t, 

1958

T o ta l,

1959

T o ta l

per ce nt

dro p o u t

N ew Y or k:

A lb an y o f U nio n U n iv e r s ity _________________________________ P riv a te ______________ 65 63 2 3.0 229 226 1.3

U n iv ers it y of Bu lTa lo ___________ _ ________ _______________ ........ do................................ 88 79 9 10.2 300 286 4. 6

E in st ein of Y es hiv a U n iv ers it y _ ___________________________ ____ do................................ 96 94 2 2. 0 332 323 2. 7

C olu m bia U n iv ers it y ____ "________________________________ .........d o ................................ 120 118 2 1.6 477 469 1.6

C orn el l U n iv ers it y ____ d o ________________ 86 83 3 3. 4 337 334 .9

N ew Y ork M ed ic al __________________________________________ .........do................................ 127 128 + 1

2

- . 7 496 485 2 2

N ew Y ork U n iv ers it y _____________________________________ _ .........d o ................................ 132 130 1.5 526 516 1. 9

S ta te U n iv ers it y o f N ew Y ork , N ew Y ork ___________ . ___ P u b li c_______________ 154 143 11 7.1 570 551 3. 3 

— 1. 9 U n iv ers it y of R och est er __ . ___________________________ ___ P riv a te ______________ 69 68 1 1.4 262 267

S ta te U n iv ers it y of N ew Y ork , S yra cu se ................ P u b li c _______________ 87 74 13 14.9 302 284 5. 9

N o rth C ar olina:

D u k e U n iv ers it y ______________________________ _ P riv a te ______________ 79 78 1 1.2 311 314 - . 9 

. 4 B ow m an G ra y of W ake F o re st____________________________ . . ........ do................................ 65 51 4 7. 2 207 206

U n iv ers it y of N o rt h C aro li n a______________________________ __ P u b li c .............................- 70 64 6 8. 5 264 256 3.0

O hio:

U n iv ers it y of C in c in n a ti__ _ ____________ - _______ ........ do________________ 92 86 6 6.5 342 337 1. 4

W est er n R es er ve U n iv ers it y __________________________________ P riv a te ......... - - ......... .. 78 79 + 1

0

- 1 .3 321 316 1. 5

O hi o S ta te U n iv ers it y P u b li c............................... 151 151 0 569 557 2.1

O kla hom a: U n iv ers it y of O k la h o m a __________________________ ___ d o _____ __________ 100 91 9 9.0 371 356 4. 0

1.3 Orego n- U n iv ers it y of O rego n ____ do................................ 80 75 5 6. 2 295 291

P en n sy lv an ia :

H ah n em an n ____________________________________________ P riv a te ................... ......... 109 89 20 18.3 393 368 6.3

Je ff er so n M ed ic al____________________________________________ ____ d o ................................ 175 150 25 14.3 677 648 4. 2

T em p le U n iv ers it y - _____________________________________ ........ do...................... ......... 136 130 6 4. 4 507 499 1. 5

U n iv ers it y of P e n n s y lv a n ia _______________________________ __ ____ do.................... ........... 126 127 + 1

+ 1

21

—. 8 506 517 —2.1

W o m an ’s'M ed ic al " ____ __________________________ . . ____ do............ . ......... ....... 51 52 — 1. 9 180 175 2 7

U n iv ers it y of P it ts b u rg h ____ do.............................. . 101 80 20.8 378 351 7.1

P u erto Rico: U n iv ers it y o f P u ert o R ic o. . P u b li c _______________ 55 51 4 7. 2 193 186 3. 6

S outh C ar oli na: M ed ic al College of S outh C aro li n a_______________ .........d o ...... ......................... 80 73 7 8. 7 299 291 2. 6

Ten nes se e:

U n iv ers it y of T ennes se e____________________ _____ ___________ .........d o ...... ......................... 202 193 9 4. 4 658 730 - 1 0 .9

M e h a rry __________________________ P riv a te ______________ 74 61 13 17.5 269 252 6. 3

V an d erb il t U n iv ers it y ________________________________________ .........d o ................................ 52 53 + 1 - 1 .9 199 201 - 1 . 0

162 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
Texas :

S o u th w este rn . . . . . . . . . . . . . . . . . . . . . . . . . . .

U n iv ers it y o f T ex as______ ______ ______ B ay lo r U n iv e rsit y _____________________

U ta h : U n iv ers it y of U ta h __________________

V erm o n t: U n iv ers it y of V erm o n t................. ..

V ir gin ia : U n iv ers it y of V ir g in ia .. _____ _________

M ed ic al College of V ir g in ia ........................

W ash in g to n : U n iv ers it y of W ash in g to n ........

W est V ir gin ia : U n iv ers it y of W es t V ir gin ia . 

W is co nsi n:

U n iv ers it y o f W is consi n..................... .........

M a rq u e tt e .............................. ...........................

P u b li c ..

____d o ..

P riv a te . 

P u b li c .. 

____d o . .

.d o .

.d o .

.d o .

.d o .

____d o ..

P riv a te .

BASIC MEDICAL SCHOOLS

N ew H am p sh ir e: D a rtm o u th ..................... .........

N o rth D ak o ta : U n iv ers it y of N o rt h D a k o ta . 

8 o u th D ak o ta : U n iv ers it y of S o u th S ak o ta .. .

____d o .

P u b li c . 

____d o .

101 92

143 111

84 92

57 53

51 45

76 68

85 75

75 66

41 37

101 93

105 104

24 24

41 37

44 36

9

32

+ 8

4

6

8

10

9

4

8

1

0

4

8

9.0 397 387 2.5

22.3 529 491 7.2

- 9 .5 310 319 - 2 9

7.0 206 195 5. 3

11.7 185 172 7.0 W

>

10.5 281 279 .7 a

11.7 354 361 - 1 . 9

12.0 291 278 4.4

9. 7 74 37 50.0 o

7.9 340 325 4 4 ©

.9 380 384 - 1 . 0 a

a

x

0 o

9.7 a

18.1 afZJ

CZI

0 5
T able III.— Su mm ary of attrition rales for each U.S. school of medicine fo r the 5-year period, 1955-56 to 1 959 -60 —Co nti nued

(N ot e.—Data for th e U ni ve rs ity of Flor ida College of Medi cin e, Seton Il all College of Medicine, an d Uni ve rsity of K en tu ck y School o f Medicine incom ple te because th ey were or are ne wly develo pin g schools. D at a for We st Virginia School o f M edicine in comp let e because it is in tra ns ition from a 2- to a 4-ye ar p rogram ]

St ate an d medica l school Ow ner shi p

1959-60

1st year, 

1959 2d year, 1960 N um be r dr op ou t Pe rcen t dr op ou t Tot al en­ rollm en t, 1959 To tal, 1960 To ta l pe rcen t drop ou t

New Y ork:

Alban y of U nion U n iv e rs it y ._ P r iv a te .. ....................... 63 60 3 4.7 238 233 2.1 Uni ve rsity of Buffalo . . . . . d o ............................. 83 76 7 8.4 299 283 5.3 Ei ns te in of Y esh iva Unive rsity .. ____d o_____________ - 96 90 6 6.2 369 358 2.9 Colum bia U ni ve rsity _______................ ............. ____d o ... ....................... 120 119 1 .8 472 472 0 Co rne ll Univ ers ity .."........... . . . do______________ 83 79 4 4.8 335 327 2.3 Ne w York M ed ical______ _ _ do ............................. 128 126 2 1.5 490 490 0

New Yo rk U n iv e rs it y .. ................................. ........d o______ ________ 133 128 5 3.7 517 505 2.3 St ate Unive rsity of New Yo rk, Ne w Yor k. . Pub lic______________ 155 139 16 10.3 568 553 2.6 Unive rsity of R o c h e s te r. .. __ ______ _______ Pri vat e_____________ 72 72 0 0 276 272 1.4 State Unive rsity of New York, Syrac use . . . . Publi c........ . .............. - 83 79 4 4.8 302 295 2.3 N orth Carol ina :

Du ke U ni ve rs ity__ ____ ____ _____ _____________ . Pri vate _____________ 76 77 +1 -1 .3 312 312 0 Bo wm an Gr ay of W ake Fo rest. .. _ __do______________ 55 56 + 1 -1 .8 214 213 .4 Uni ve rsity of N or th Ca ro lin a________________ P ubli c.. __________ 69 64 5 7.2 266 258 3.0 Ohio:

Uni ve rsity of Cincinn ati- _____ ___ do ____ _________ 94 92 2 2.1 352 349 .8 W est ern Reserve U ni ve rsity _______________ . . .. P ri vat e_____________ 88 83 5 5.7 332 325 2.1 Ohio St ate Uni ve rsity .. ____________ Pub lic______________ 150 140 10 6.6 567 547 3.5 Ok lah om a: Unive rsity of Ok laho ma . ___ do ............................. 101 93 8 7.9 364 355 2.4

Oregon: Unive rsity of Oregon .. ___ do ______ ________ 79 72 7 8.8 304 292 3.9 Pe nn sy lvan ia: Hah ne m an n ______ ______________ ___ ___ _______ _ ______ Pri vat e____ _ ____ — 111 98 13 11.7 386 363 5.9

Jefferson .Medical ____do .............................. 177 154 23 12.9 659 632 4.0

Te mple Uni ve rsity . ........d o______________ 137 127 10 7.3 521 507 2.7 Uni ve rsity of Pe nn sy lv an ia ______________________ ____d o...................... ....... 129 125 4 3. 1 521 522 — .2 W om an ’s M ed ical. ____d o____________ — 51 50 1 1.9 185 178 3.8Uni ve rsity of Pi tts bu rg h . ___ do ............................ - 108 101 7 6.4 379 369 2.6 Pu er to Rico: Unive rsity of Pu erto Rico Pub lic____________ - 52 46 6 11.5 195 185 5. 1 So ut h Ca rolina: Me dic al College of S ou th Ca rolin a______________ ____d o .. ....................... 80 76 4 5.0 299 293 2.0 Tenness ee:

Unive rsity of Ten ne ssee . . __________ ___________ ______ ___ ........d o....... ...................... 203 200 3 1.4 760 742 2.3 M eh ar ry . ............................ ...... . . .. Pri vat e_____________ 79 76 3 3.8 264 256 3.0 Van de rb ilt Unive rsity ____________________________________ ____d o______________ 52 44 8 15.4 205 194 5.3 Texas:

So ut hw es tern __________________ ___ . . __ _ _ ______ Pub lic______________ 104 93 11 10.5 400 396 1.0 Uni ve rsity of Texas_________ . ___ do _______________ 148 121 27 18.2 507 471 7.1 Ba yl or U ni ve rs ity______ ____ _______ ___________ _________ . Pri vat e....................—— 84 89 +5 -5 .9 330 330 0

164 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL
Utah: U ni ve rs ity of U ta h .. ___ ______ Pu blic 56

52

5453

2

+1

3.5

-1 .9

203

184

192180

5.7 

2.1 Ve rm ont: Uni ve rsity of Vermon t________ do Virginia:

Unive rsity of V ir gin ia .............................. do 76

84

78

45

75

6473

47

1

20

5

+2

1.3 

23.8

6.4 

-4 .4

287 

351

288 

82

2X0

341284

63

2.4 

2.8

1.4 

23.1

Medica l College of Virg inia..................... do _ W ash ing ton : Unive rsity of W as hi ng to n. .. do West Virginia : Uni ve rsity of We st Virginia ........ _ _ do_. Wisconsin :

Unive rsity of Wisc onsin ............................... do 88

104

77

99

11

5

12.5

4.8

342393

321379

6.1 M ar quet te ....... ............................... . ................ P r i v a t e 3. 5

BASIC MEDIC AL SCHO OLS

New Ham pshire: D ar tm outh ........................ ___ do . ____________ _ 24 23

38

1

6

14

4. 1

13.6

31.8

Nor th Da kota: Unive rsity of N or th Da kota . Pu bl ic . ........................... 44 So uth Dak ota: Unive rsity of S ou th Da kota ___ do. . ......................... 44 30

TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 165
166 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

The Chairman. On behalf of the committee, let me thank each of 

you gentlemen for your presentation here on this important legislation 

in behalf of your association.

Dr. Anderson. Thank you, Mr. Harris, we have appreciated this 

opportunity.

The Chairman. While we are asking for additional information, 

Mr. Jones, I notice you are in the room, I would like to have a further 

comment from the Department on this same question as to the need for 

scholarships for the first 2 or 3 years in view of the fact that you are 

not going to have any expansion of facilities for tha t period of time.

Mr. J ones. I can give you the comment now if you would like, 

sir.

Would you like it in writing or orally ?

The Chairman. If it is going to be extended comment, we have to 

get on with some other witnesses.

Mr. J ones. I will give you a statement for the record.

(The statement referred to above follows:)

T he Need foe an I mm ediate Sch ol ar sh ip P rogram

Questions have been raised as to whether a scholarship program Is needed at 

once, or whether it might be delayed a few years until a construction program 

has made a significant number of new places available.

We ar e convinced that the program is needed now. Im portant reasons are 

th es e:

(1) The number and quality of applicants to medical schools has dropped in 

recent years. This program would immediately reverse this alar ming trend.

(2) The establishment and operation of such a program now would give the 

needed leadtime to establish career plans in medicine and dentistry for present 

college students.

(3) It would avoid some of the cancellations of acceptances of next yea r’s 

studen ts because of financial straits and prevent some of the droixmts at the 

end of the first year of study.

(4) It would give immediately a better selection of students to those schools 

now having difficulty in filling the ir classes with well-qualified applicants.

(5) It would give new and expanding schools some assu rance th at they would 

have an adequate supply of well-qualified students.

(6) The funds would be rela ted to size of enrollment, so th at scholarship 

support would grow as enrollment increased.

The Chairman. I would also like to have you supply for the record 

the total number of doctors in the United States, the total number of 

general practitioners in the United States. You gave it in percentages this morning, the total number of specialists, those who specialize 

in a given field. You gave that in percentages this morning, the total 

number of those in private practice.

I suppose tha t would be included in the above, too, but you mentioned this morning there are so many in nonprivate practice, that is, 

who are engaged in hospital service and things of that kind.

Af r. J ones. Yes. We will break that down.

The Chairman. And the number of those who were in Federal service. I think you gave that this morning. I am not sure.

Mr. J ones. That is correct.

The Chairman. The number of those who are retired.

If you have it, I would like you to give us the number enrolled in 

the medical schools, each of the last 5 years.

We would like to have the number who graduated from medical 

schools for each of the last 5 years.
TRAIN IN G OF PR OFE SS IO NAL PU BLI C H E A L T H PE R SO N N E L 167

We would like to have the number of doctors who have gone out of 

practice or quit practice either by retirement or death in each of the 

last 5 years, if that information is available. This will all be in the 

record. You can take it from the record, Mr. Jones.

(The information on deaths of physicians follows:)

Annual number o f deaths reported to the AMA

Y e a r:

1960.

1959.

1958.

1957.

1956.

Es tim ated

numb er of

death s

__ 3, 700

__ 3, 500

__ 3, 700

3, 500 

__ 3 ,7 00

Source : Journal of American Medical Association, May 27, 1961, p. 707 and prior annual 

issues of the State board number of the journal.

Mr. Younger. If the Chairman will yield, I wonder if it will be 

possible also to get the number who have fallen by the wayside or who 

entered medical school and did not graduate. 1 think this is important.

I have heard that the figure is very high as compared with other 

courses, but I have no knowledge on that. I think this ought to be a 

part of our information.

(The information requested appeal’s on p. 146.)

The Chairman. I might say to the gentlemen, we are going to get 

the number who have entered each year for the last 5 years and the 

number who have graduated each year for the last 5 years, so we can 

deduct it.

Air. J ones. I think there are some interesting figures on reasons in 

broad categories on dropouts. We can get tha t fo r you.

The Chairman. If you will do tha t for us, we will appreciate it.

(The information referred to follows:)

Loss of studen ts enrolled in medical schools

E n te ri n g clas s G ra d u ati n g c las s

P erc en t n o t 

gra d u ati n g

D ate N u m b er D ate N u m b er

S epte m ber 1953_____ ________ . . . . - 7,449

7,57 6 

7,68 6 

8,014 

8,03 0

Ju n e 1957............... .. 6,796 

6,861 

6,860 

7,081 

6,994

8.8

9.4

10.7

11.6

12.9

S epte m ber 1954__________ ________ ___ J u n e 1958.....................

S epte m ber 1955____________________ . . Ju n e 1959_________

S epte m ber 1956____ ____ _________ . . Ju n e I96 0................. ..

S ep te m ber 1957____________ __________ Ju n e 1961. ..................

T o t a l ...................... - ........... - ......... . 38,755 34.5 92 10.7

Dr. Anderson. If I might make this point. The failure rate in 

medical school is lower than in any other professional graduate training program. We are proud of this. We believe it reflects in part at 

least the care with which we select our students. The failure rate over 

the years has dropped markedly.

Before World War II , it was in the neighborhood of 25 percent. 

Today it is 10 percent or less. However, it has gone up slightly in 

recent years from a low of, I believe, about 4 or 5 percent in the mid1950’s, to approximately 9 or 10 percent now. We feel this does reflect 

some decline in the quality of the applicants that we have been receiving and whom we have accepted in recent years.
168 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

There, is an old story which T might tell, it takes only a moment. 

When a freshman class in medical school used to be called together 

for its first session, it was customary for the dean, as I am sure many 

of you have heard, to tell each student to hxik to the men to the right 

and left of him because one of them would not be there 4 years later.

Today we say, look to the man on your left, look to the man on your 

right, and be confident tha t all three of you will be here when you 

graduate.

The Chairman. That is very good. Doctor, hut T am still of the old 

school—T suppose it is the old school of philosophy—that every person who has an ambition and desire and can meet the requirements 

ought to have his opportunity.

Dr. Anderson. Yes, sir.

The Chairman. I do not know that T subscribe to this business of 

takin g only those who do have the desire and can meet the highest 

possible standards there are. I do not like to see them screened that 

close.

We are glad to now have as our next witness, representatives of the 

American Dental Association, Dr. Gerald Timmons, president-elect 

of the American Dental Association, dean of the dental school at 

Temple University, also Dr. Raymond J . Nagle, chairman of the association’s council on dental education, dean of the College of Dentistry 

at New York University.

STATEMENT OF DR. GEEALD D. TIMMONS, PRESIDENT-ELECT, THE

AMERICAN DENTAL ASSOCIATION, AND DEAN, COLLEGE OF

DENTISTRY, TEMPLE UNIVERSITY

Dr. Timmons. Thank you very much. T should also like at this 

time to introduce Mr. Bernard J. Conway, who is the legal and legislative representative of the American Dental Association and who is 

seated at my right.

The Chairman. Very well, Mr. Conway, we are glad to have you 

with us.

Dr. Timmons. Mr. Chairman and members of the committee, T 

have prepared a short statement which will be distributed to the 

committee. T should like to read a part of it but in reading it I 

shall refrain from reading some of it because it is but a repetition of 

other material which vou have in your hand.

The Chairman. Your entire statement will be included in the 

record.

Dr. Timmons. Thank you, sir.

(The statement referred to follows:)

Sta te m ent of I) r. T im m o n s on R e ii a i.f of t h e Am er ic an D en ta l Assoc ia tion

T am Dr. Gerald D. Timmons. I am president-elect of the American Dental 

Association, and I am dean of the college of dentistry at Temple University in 

Philadelphia. With me is Dr. Raymond J. Nagle who is chairman of the association’s council on dental education and dean of the college of den tistry at New 

York University. I am also accompanied by Mr. Bernard J. Conway, of Chicago, 

Ill., who is in charge of the association’s legal and legislative affairs and by 

Mr. Hal M. Christensen, the association’s Washington counsel.

We are here today to present the American Dental Association’s views on 

II.R. 4999, the Health Professions Educational Assistance Act.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 169

W ithi n th e de nt al pr of es sion th ere is an in cr ea si ng co nc ern ov er th e prob lem 

of pr ov id ing th e quanti ty an d qual it y of den ta l he al th car e th a t a ra pid ly 

ex pa nd in g an d incr ea sing ly he al th co nsciou s American pu blic de m an ds an d 

ex pe cts. Thr ou gh re ce nt ly ex pa nd ed pro gr am s in den ta l re se ar ch an d th ro ug h 

oth er im port an t deve lopm en ts, sign ifi ca nt pr og re ss ha s been mad e in co nt ro llin g 

de nta l di se as es an d in ex tend in g th e a vai la bil it y of den ta l ca re. Ye t mu ch mor e 

ne ed s to be do ne.

At th e pr es en t tim e, th e sh or ta ge of den ta l man po wer st ands ou t as th e 

mo st fo rm id ab le b arr ie r to co nt in ue d pr og re ss in den ta l he al th . The ca pac ity 

to pr od uc e den ta l pe rson ne l co nt in ue s to be outr un by th e gr ow th in po pu latio n 

an d th e in cr ea se d de man d fo r den ta l c ar e.

Res po ns ible Gov ernm en t an d p ri vate gr ou ps ha ve co nd uc ted st udy a ft e r st ud y 

an d ha ve co ns is te nt ly do cu men ted th e acu te ne ed s in th is ar ea . The re is no 

room fo r re as on ab le di sp ut e th a t th e si tu ati on is becomi ng in cr ea sing ly cr itic al .

In hi s healt h mes sa ge to Co ng ress last, yea r, th e Pre si dent of th e United 

S ta te s i>ointed out th a t if du ri ng the n ex t 10 y ears w e c ou ld in cr ea se the c ap ac ity 

of ou r d enta l scho ols by 100 pe rc en t, we wo uld st ill be ab le on ly to m ai nta in 

th e pr es en t ra ti o of den tist s to po pu latio n. To accompli sh even th is mu ch, we 

m us t ha ve in cr ea se d en ro llm en t in ex is ting scho ols plus 20 new den ta l sch ools. 

Ag ain th is ye ar , in his st ate of th e Union me ssag e, th e P re si d en t em ph as ized 

th e ser io us n atu re of th e situ at io n.

The American D en ta l Assoc iatio n be lie ve s th e Pre si dent’s appra is al of th e 

si tu ati on is a fa ir one , an d un le ss im m ed ia te co rr ec tive ac tion is ta ke n, th e 

pr ob lem m ay re ac h in su rm ou nt ab le pro po rtio ns .

Ther e is an im m ed ia te nee d fo r fu nds to pr ov id e add itio nal an d im prov ed 

den ta l ed uc at io nal fa ci lities , an d to pr ov id e in cr ea se d su pport fo r den ta l stu ­

de nts an d den ta l sch ools to he lp m ee t th e al re ady hig h an d st eadil y risi ng co sts 

of den ta l ed uc ation.

Enac tm en t of H.R. 4999 wo uld be of su bst anti al ass is ta nce in m ee ting th es e 

needs.

In th e ca se of den tist ry , th e hill wo uld pr ov id e .$15 m ill ion a y ear fo r 10 year s 

fo r m at ch in g co ns truc tion gra nts fo r ne w sch oo ls or fo r m ajo r ex pa ns io n of 

ex is ting sch ools. The bill wo uld also pr ov id e $15 mi llion a year fo r re no va tion 

an d re pl ac em en t of ob solete den ta l, med ical, os te op athi c, or pu blic hea lth sch oo l 

teac hi ng fa ci lities . In th e case of new sch oo ls o r m aj or ex pa ns io n of ex is ting 

sch ool s, th e Fed er al sh ar e could be up to 66 % per ce nt of co sts . G ra nts fo r 

re no va tion or re pl ac em en t of ex is ting fa ci lities could no t exce ed 50 per ce nt 

of co ns truc tion costs. Th e bil l also wou ld au th ori ze $500,000 i>er yea r fo r 10 

ye ar s fo r pro je ct s fo r pl an ni ng of den ta l, med ical, or pu blic healt h ed uc at io n 

pr og ra m s by schools an d oth er pu blic or no np ro fit pri vate ag en cie s. In additio n. th e bill wo uld pr ov id e sc hol ar sh ip su pport fo r ea ch sch ool in an am ount 

eq ua l to $1,500 tim es 25 pe rc en t of it s firs t-ye ar clas s en ro llm en t an d in cr ea si ng 

to $1,500 tim es 25 i>ercent of th e to ta l en ro llm en t by th e en d of th e fo urt h ye ar . 

M ax im um sc ho la rs hi p fo r an y on e st udent wou ld be $2,000. To m ee t th e in ­

st ru cti onal co sts of th es e st uden ts , th e bil l wou ld au th ori ze g ra nts to scho ols 

in an am ou nt eq ua l to $1,000 fo r ea ch sc hol ar sh ip ho ld er but no t in ex ce ss of 

$1,00 0 fo r 25 per ce nt of th e first-ye ar cla ss in th e first ye ar , w ith th is max im um 

in cr ea sing by th e fo urt h yea r to $1,000 fo r 25 per ce nt of th e 4- ye ar en ro llm en t. 

The bil l also ex te nd s th e re se ar ch fa cil it ie s co ns truc tion gra nt pr og ra m fo r 3 

yea rs an d ra is es th e au th ori za tion fr om $30 mill ion to $50 million an nu al ly .

As in di ca te d above, th e Amer ican D en ta l Assoc iatio n belie ves th a t en ac tm en t 

of H.R. 4999 wou ld go fa r to all ev ia te th e se ve re prob lems fa ci ng den ta l ed uca ­

tio n to da y an d in th e fu tu re .

It shou ld he i>ointed ou t th a t th es e pr ob lems a re national in sco pe an d re quir e 

fo r th eir fu ll so lu tion a remed y of eq ua l dimen sion . At th e pre se nt tim e, th ere 

a re 47 denta l schools loca ted in 26 Sta te s, th e D is tr ic t of Co lum bia , an d P uert o 

Rico. The se 28 ju ri sd ic tions su pp ly th e denti st s fo r th eir ow n popula tions in 

ad di tion to den ti st s fo r th e re m ai ni ng 24 Sta te s. Th us , sl ig ht ly mor e th an h alf 

th e S ta te s f urn is h d enti st s fo r t he e n ti re co un try.

Ther e is also anoth er nat io na l as pec t to th e den ta l man po wer prob lems. T he 

Fed er al Gov er nm en t it se lf is a la rg e co ns um er of de nta l se rv ices . The Arm ed 

For ce s an d oth er Gov ernm en t ag en cies exert co ns id er ab le an d co nt in uo us 

pre ss ur es on av ai la bl e den ta l man po wer. Am on g th e pr of es sion s, on ly d en ti st ry 

an d me dicin e are su bj ec ted to spec ial d ra ft ca ll.

Bo th pu blic an d pri vate sch oo ls a re fin din g it difficult to mee t co sts. F unds 

fro m loc al and S ta te go ve rn m en ts an d pri vate so ur ce s a re not avai la ble in su f80014— 62 12
170 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

ficient amounts to provide the needed educational facilities. In this situation, 

it is believed, the Federal Government has a vital inte rest and responsibility.

It is our opinion that unless some assistance is forthcoming at the national 

level, no new priv ate dental schools will be established and some of those now 

in existence will find it increasingly difficult to continue. The association 

believes this should not occur. An effort should be made to maintain privately 

endowed and operated schools in the dental education system.

I would like to emphasize to the committee th at this association recognizes 

and apprecia tes the gre at demands on the Federal Tre asu ry at this time. I 

would like to be able to tell this committee that the dental manpower problem 

can be solved with private, State, and local resources.

It is an undeniable fact, however, that the size of the problem is of such 

proportions that its solution requires national atte ntion. We are firmly convinced th at unless Federal funds are made available to help arrest the impending decline in dental manpower, there will not be enough den tists to provide 

the dental care the public needs and deserves. As the representative of a responsible health profession, it is the association’s obligation to do every thing possible 

to prevent this occurrence.

Representatives of the American Dental Association have testified before 

Congress in support of Federal grant-in-aid legislation fo r assisting dental schools 

six times since 1949. In th at year the association’s house of delegates adopted 

the following resolution:

“Resolved, That the American Dental Association approve the policy that 

Federal funds, with justificatio n, might be appropriated in supp ort of dental 

educ ation programs, provided that such funds, when appropriated, should be 

accepted with the understanding that the Government shall not exercise any 

control over, or prescribe any requirements with respect to, the curriculum, 

teaching personnel, or administra tion of any school or the admission of applicants 

thereto.”

The bill, II.R. 4999, is in keeping with the policy of the American Dental 

Association.

It is believed, however, th at one clarifying amendment migh t be in order. 

It is suggested that “ Section 726: Noninterference With Administration of Institution s” be extended to apply to pa rt C of the bill relatin g to the scholarship 

program. While it is recognized th at little or no discretion is conferred upon 

the Surgeon General in administering this part of the program, adoption of the 

suggested amendment would make crystal clear the intent th at there shall be 

no interference with school administration.

Recomm endatio n.—The American Dental Association with a membership of 

95,000 and representing more than SO percent of the Nation’s dentists, urges 

Congress to enact II.R. 4999 as a significant step toward improving the dental 

health of the people of this country.

A th is time, I should like to introduce Dr. Raymond J. Nagle, who is eminently 

qualified to speak on the specific needs in dental education.

Dr. T immons. I am Dr. Gerald D. Timmons. I am president-elect 

of the American Dental Association, and 1 am dean of the College of 

Dentistry at Temple University in Philadelphia. With me is Dr. 

Raymond J. Nagle who is chairman of the association’s council on 

dental education and dean of the College of Dentistry at New York 

University. I am also accompanied hy Mr. Bernard J. Conway of Chicago, Ill., who is in charge of the association’s legal and legislative 

affairs and by Mr. Hal M. Christensen, the association’s Washington 

counsel.

We are here today to present the American Dental Association’s 

views on II.R. 4999, the Health Professions Educational Assistance 

Act.

Y ithin the dental profession there is an increasing concern over 

the problem of providing the quantity and quality of dental health 

care tha t a rapidly expanding and increasingly health-conscious 

American public demands and expects. Through recently expanded 

programs in dental research and through other important develop-
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 171

merits, sig nif ica nt pro gre ss has been made in contr oll ing denta l dis ­

eases and in exte nding the av ailability of de nta l care. Ye t much mo re 

needs to be done.

A t the prese nt time, the s hortage of denta l manpower sta nd s o ut as 

the most formidable ba rri er to con tinued pro gre ss in denta l health. 

Th e capacit y to produc e denta l person nel continu es to lie ou tru n by 

the g rowt h in population and the increased dem and for denta l care.

Responsib le Government a nd pr ivate grou ps h ave con ducted stu dy 

af te r stu dy an d hav e consistently doc umented the acu te needs in thi s 

area. Th ere is no room for reasonable dispute th at the sit ua tio n is 

beco ming inc rea sin gly c ritical.

In his he alth message to Congress last year, the Pr es iden t of the 

Un ite d States po inted out th at if du ring the next 10 years we could 

increase the capacit y of our denta l schools by 100 percent, we wou ld 

stil l be able only to ma intai n the prese nt ra tio of dentists to po pu lation. To accomplish even this much, we mu st hav e increased enrol lment in existing schools plu s 20 new denta l schools. Ag ain this year, 

in his sta te of the Un ion message, the Pr esiden t empha sized the ser ious n atur e o f the situ ation.

Th e Am erican D ental A ssociation belie ves t he P reside nt’s a pp raisa l 

of the sit ua tio n is a fa ir one, and unless immedia te correc tive action 

is tak en, the problem may reach ins urmo untab le pro portions.

Th ere is an immediate need fo r fund s to pro vid e ad ditio na l and 

imp roved den tal edu cational fac ilities, and to pro vide increased suppo rt fo r denta l stu dents and denta l schools to help meet the alr eady 

hig h a nd ste adily ri sin g costs of de nta l e ducation.

En ac tm en t of H.R. 4999 would be of su bstan tia l assistance in 

meetin g th ese needs.

As ind ica ted above, the Am erican De nta l Associa tion believes th at 

ena ctm ent of H.R. 4999 would go fa r to allevi ate the severe prob ­

lems facing denta l education to day a nd in the future.

I t should be pointed out th at these problems are natio nal in scope 

and req uir e fo r th ei r full solu tion a rem edy of equal dimension. At 

the prese nt tim e, there are 47 denta l schools located in 26 State s, the 

District of Columbia, and Pu erto Rico. These 28 juris dic tio ns su pply the denti sts fo r th ei r own popu lat ion s in ad dit ion to denti sts fo r 

the remain ing 24 Sta tes. Thus, sli gh tly more th an ha lf the States 

fu rnish denti sts f or t he entire c ountry.

Th ere is also an othe r n ational asp ect to th e denta l ma npow er pr ob ­

lems. Th e Fe de ral Government its elf is a lar ge consum er of denta l 

services. Th e Arme d Forces and othe r Government agencies ex ert 

con side rable and continuous pre ssures on ava ilable denta l manpower. 

Am ong the professions, only de ntist ry an d med icine are sub jected to 

special dra ft call.

Bo th public and p riv ate schools are findin g it difficult to meet costs. 

Fu nd s fro m local and St ate gov ernments and pr ivate sources are not 

ava ilab le in sufficient amoun ts to provide the needed edu cat ion al fa ­

cilities. In this situatio n, it is belie ved, the Fe de ral Go vernm ent h as 

a vital intere st and respo nsibility.

It is our opinion th at unless some assistance is forth comi ng at the 

national level, no new private denta l schools will be established and 

some of those now in existence will find it inc rea sin gly difficult to continu e. The association believes this sho uld no t occur. An effo rt
172 TRAININ G OF PRO FES SIO NAL PUB LIC HEA LT H PERSON NEL

sho uld be made to m ain tain privately endowed and op era ted schools in 

the d ental education system.

I would like to emp hasize to the com mittee th at this assoc iation 

recognizes and appre ciates the great dem and s on th e Fe de ral Tr ea sur y at thi s time. I would like to l>e able to tell th is committee that 

the dental man pow er problem can be solved with pr ivate, State , and 

local resources.

I t is an undeniable fact, however, th at the size of the problem is of 

such pro portio ns th at its solution requires natio nal attentio n. We 

are firmly convinced that unless Fed eral fund s are mad e ava ilab le to 

help arrest the impen din g decline in denta l manpower, the re will not 

be enough dentists to pro vid e the dental care the public needs and 

deserves. As the rep res entative of a responsible he alth profession, it 

is the association’s ob ligation to do e veryt hin g possible to prevent th is 

occurrence.

Repre sen tati ves of the Am eric an Denta l Ass ociatio n have testified 

before Congress in su pp ort of Federal gr an t-in-aid legislation for 

assisting denta l schools six times since 1949. In th at year the association ’s house of delegates adopted the fol low ing reso lu tio n:

Re solve d, T hat th e American D en ta l Assoc iatio n ap pr ov e th e policy th at Fed ­

er al fu nd s, w ith ju st ific at io n, mig ht l>e a pp ro pr ia te d in su pport of den ta l ed uc atio n pr og rams, pro vide d th a t such fu nd s wh en appro pri at ed shou ld be accepted 

w ith th e un de rs ta nd in g th a t th e Gov ernm en t sh al l no t ex er ci se an y co ntro l over, 

or pr es cr ib e an y re qu irem en ts w ith res pe ct to. th e c urr ic ul um , te ac hi ng pe rson ne l, 

or ad m in is tr ati on of an y sch ool, or the ad mission of a pplica nts th er eto.

Th e bill, II.R. 4999, is in keeping with the policy of the Am eric an 

De nta l Associatio n.

I t is believed, however, th at one c larif ying a mendme nt might be in 

ord er. It is suggested th at section 726, “ No nin terference W ith Adminis tratio n of In stitu tio ns ,” be exte nded to ap ply to par t C of the 

bill relatin g to the sch ola rsh ip pro gram. While it is recognized th at 

lit tle or no discretion is con ferred upon the Surg eon General in a dm inist ering this part of the pro gra m, ado ptio n of the sugg ested am endment would make cry stal cle ar the intent that there shall be no interfere nce w ith school admi nis tra tio n.

Recom menda tion : Th e Am erican Den tal Association with a mem ­

bersh ip of 95,000 and r epres entin g more t ha n 80 perce nt of the N ation ’s 

denti sts, ur ges Co ngress to en act II .R. 4999 as a significa nt step toward 

im proving the den tal healt h of the people of this cou ntry.

At this time, I should like to introd uce Dr. Ray mon d J. Nagle, 

who is eminently qualified to speak on the specific needs in dental 

education.

STATEM ENT OF DR. RAYMOND J. NAGLE, DEAN, COLLEGE OF

DENTISTRY. NEW YORK UN IVE RSITY . AND CHA IRM AN. AM ER ICAN DENTAL ASSOCIATION COUNCIL ON DEN TAL EDUCATION

Dr. Nagle. I am Dr. Ray mond J. N agle. I am dean of the College 

of D en tis try of New York Un ive rsity an d chairma n of the Ame rican 

De nta l Association Council on Denta l E du catio n.

I would like to than k the committee fo r aff ordin g the American 

Denta l Association this op po rtu nity to inform the comm ittee on the 

needs in den tal education.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 1 7 3

Several expert groups have scrutinized dentistry and its professional manpower to determine what this Nation needs to do to assure 

tha t our people will continue to have adequate dental services and 

care. All have concluded that the job that needs to l>e done cannot 

be done without Federal financing of dental education. These groups 

I speak about, a few of which are listed in the appendix of the statement which has been dist ributed to the committee are—

1. “Medical School Inqu iry,'’ staff report to the Committee 

on Interstate and Foreign Commerce, House of Representatives, 

85th Congress, 1st session( committee print).

2. U.S. Department of Health, Education, and Welfare, Office 

of the Secretary, “The Advancement of Medical Research and 

Education Through the Department of Health, Education, and 

Welfare : Final Report of the Secretary’s Consultants on Medical 

Research and Education, 1958” (the Bayne-Jones report).

3. U.S. Department of Health, Education, and Welfare, Public Health Service, “Physicians for a Growing America: Report 

of the Surgeon General’s Consultant Group on Medical Education, 1959 (the Bane report).

4. Subcommittee on Departments of Labor, Health, Education, and Welfare of the Committee on Appropriation s; U.S. 

Senate (86th Cong. 2d sess.), “Federal Support of Medical Research: Report of the Committee of Consultants on Medical Research, I960.”

5. American Council on Education, Commission on the Survey 

of Dentistry in the United States, “The Survey of Dentistry, 

1961.”

Mr. Chairman, this is a summary of the longer report which has 

been filed with the committee.

All of these expert groups agreed tha t the Federal Government 

should delay no longer in bearing a substantial share of the cost of 

training dental students. All concluded that each year the Federal 

Government delays in assuming this obligation means a predictable 

loss of dental sendees to our people.

Upon what did these expert groups rely to justify th eir strong urging tha t Federal funds be used to assist dental education? In brief, 

they looked first at the dental services available to our 185 million 

people today. Next, they determined the number of dentists the 

schools would have to graduate to maintain today’s level of dental 

services for 230 million people in 1975—only 13 years away.

These groups saw that we would need about 35,000 more practicing 

dentists in 1975 than we have today. They consulted with dental 

educators and other interested persons and concluded that we have 

to add substantially to enrollment in the 47 existing schools and 

build 22 new dental schools to graduate these additional dentists. 

These same consultants estimated that to build one new dental school 

costs between $6 and $8 million.

These expert groups also looked at the costs involved in training 

dental students today. They found, for example, that the tuition 

charges for a course in dentistry are, on the average, $800 per year. 

But they also found that the schools, on the average, spent about 

$2,200 additional per year to educate each student.
174 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

The se experts did no t of course lim it th ei r findings and recom ­

mendatio ns to build ing new schools in new locations. Th ey also reviewed the cri tical need fo r rem ode ling and expa nd ing the existing 

denta l schools. They recognized th at in a few instances an entire 

new edu cation al fac ility would be req uired to su pp lant antiq uated 

an d outmoded classrooms, lab ora tories, and clinics. In many more 

instances the experts foun d th at schools were ina deq uat ely housed 

and equ ipped because the funds needed to mak e up the difference betwee n tuition and the am ount of money needed to main tai n an effectiv e fac ulty and a modern facility were now here to be found.

Th is is a bro ad out line of the problem th at , in ou r opinion, can not 

be solved witho ut Federal financ ing of denta l edu cation. W ha t follows is a des crip tion in gr ea ter detail of the fac ts about denta l manpow er an d care tod ay and wh at will be ne eded in 1975.

In the Un ite d State s tod ay the re is a denti st- to- po pu lat ion rat io of 

1 to 1,900. Th is reflects th e 95,000 dentists who are actively practic ing 

th ei r profession. The p opula tion today is about 185 million . In 1975 

the populat ion will reach 230 million and this is a conserv ativ e estimate. To m ain tai n the presen t rat io of denti sts to p opula tio n in 1975 

will req uir e a forc e of 130,000 dentists.

ITow can this be achie ved ?

To day the 47 U.S . dental schools are g ra du ating about 3,200 den tists 

each yea r. To ma intai n the exi sting ratio of dentist s to populat ion 

will req uire tha t the to tal of de nta l school grad ua tes increase by abo ut 

250 each year, star ting with the 1963 gradua tio n. Th e Comm ission 

on t he Sur vey of Den tis try su pp orts this projected increase an d recom ­

mends t ha t pla ns be star ted now to assure th at 6,200 den tists will gr ad ­

uate in the 1975 class—t his means 3,000 more th an th e 1962 class will 

produce. It means d ou bli ng th e output of denta l grad ua tes in a lit tle 

more th an 10 years.

In o rder to keep pace—that is, to add 250 denta l g radu ates a y ear— 

the Commission on the Survey of De ntistry recommends th at pla ns 

be s tarte d to build the necessary facilities—the classrooms, the lab oratories, and th e clinics. Specifically, th is m eans that the se schools which 

have outm oded and wo rno ut building s and equip me nt mu st be reha bilitated so th at there will be no reduction in th eir enr ollments and 

no fu rthe r th re at to the h igh s tand ard of education th at must prevai l 

to gradu ate com pete nt dentists . These p lan s for imme dia te actio n dema nd next th at the large majo rity of our 47 den tal schools add the 

edu cational and clinical fac ilitie s needed to g radu ate 750 more den tists 

in the next 10 years. Fi na lly this means th at there b e con stru cted at 

leas t 22 new d ental schools, each of which would be expected to grad uate about 100 dentists a year.

Th e cost of the program I have sugg ested wou ld be in the n eighborhood of $350 million. IIow would thi s estimated expenditure for the 

need ed expansion of our d ental schools be raised ? I t will require contin ue d contribu tions fro m priva te and local gov ernme ntal sources. 

But none of the exp ert groups th at hav e stu die d the problem of expa nd in g denta l edu cational facilities believes tha t th e job can be done 

unless the Federa l Gover nment pro vide s a sub sta nti al sha re of the cost. 

IT.B. 4999, in the opinion of the American Dental Association, offers 

a sou nd plan of Fe deral financial su pp ort of denta l educatio n and 

sho uld be enacted w ith out an y fu rthe r delay.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 175

II.R. 4999 would provide $150 million in Federal matching funds 

for 10 years on a 66%-33V^ percent basis for new dental schools and 

expansion of existing schools. The schools would be required to raise 

the remaining $75 million from private and local governmental 

sources. Additionally, II.R. 4999 offers $150 million in matching 

funds over the next 10 years on a 50-50 percent basis for rehabilitation 

of obsolescent facilities in dental, medical, osteopathic, and public 

health schools. There is evidence to indicate that the dental schools 

will be able to match and use nearly half of these funds.

If the Congress should follow through immediately on the recommendation we are making today and provide the construction funds 

authorized in II.R. 4999, it would be at least 3 year's before the first 

dental student would be admitted to a new school and 4 years beyond 

tha t before he would be graduated. It would be at least 2 year’s 

before any of the existing schools cordd substantially increase capacity 

and begin to enroll the additional students to fill tha t capacity. 

Meanwhile the population will continue to grow and the health 

education level of our people will continue to rise.

With the certainty of this tremendous demand for dental services 

within the next 10 years, it is obvious tha t the most immediate and 

critical need in dental education is for expansion of enrollment. We 

must graduate more dentists. The conclusion is just as obvious th at 

funds for constructing the needed buildings to increase our output of 

dentists must have priority over other needs of the schools.

There are other needs in the critical area for dental education and 

they are covered in II.R. 4999. I shall briefly indicate why the 

American Dental Association supports the scholarship plan and the 

cost of education grants offered within II.R. 4999.

There is a competition for highly qualified students today that 

places dentistry and medicine in an unfavorable situation. The 

fellowships in the physical sciences leading toward a Ph. D. degree, 

in our opinion, have attracted many students who would otherwise 

enter dental or medical schools. This was described eloquently in 

Secretary Ribicoff’s testimony and the additional material submitted 

bv the Department of Health, Education, and Welfare. Again, all 

of the expert study groups which have explored the dental and medical 

manpower problems have substantiated the facts expressed by Mr. 

Ribicoff.

It should be kept in mind that our highly qualified students have 

a choice between a tuition-free graduate training program, a fellowship leading to a Ph. I), in one of the basic sciences, and a $1,000 

to $1,500 annual charge for dental or medical education. In addition, the typical science fellowship provides another $1,500 to $2,000 

annually to the recipient student toward his cost of living.

What does the typical dental student face in the way of education 

and living expenses ?

The average annual tuition fee for dental education is about $800. 

The average expense, for school equipment, books, and other needed 

items is $650 per year. The average living expenses for each student 

per year is $2,300. This means th at the total cost of a 4-year dental 

education averages $15,000.

Now where does a typical dental student obtain his needed finances 

today? Prim arily from his family. And in this instance we must
176 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

include his wife because many dental students are married. We find 

approximately one-third of the students are married as freshmen, 

about 45 percent of the sophomores, 55 percent of the juniors, and 

65 percent of the seniors. And this may seem as though most of the 

students do have a wife working to help them get through school. 

But there are many unexpected things about family life, and many 

find themselves with small children and find illnesses occurring.

Many students also have jobs, and often these students are working 

much longer hours than they should be. We all know that such 

employment is detracting from their education. Yet the deans of 

the various schools dare not deny them the opportunity of obtaining 

added income because it might otherwise mean tha t they will have 

to leave school.

There are some scholarships in dental schools, but not very many. 

A few less than 10 percent of the students get scholarship support, 

which averages about $500 per recipient.

Insofar as loans are concerned, no more than 23 percent get loan 

support, and again this averages about $500. The average graduate 

of a dental school has a sizable debt when he leaves school. Twothirds of them have a debt of approximately $4,500 and one-third of 

them owe $6,500.

We estimate that the cost of a man's education and his setting 

up of a dental office is rather staggering. The minimum cost of his 

liberal arts or predental education will be about $4,000. The cost 

of his dental school education, a little over $15,000. And it will cost 

in between $7,000 and $8,000 to set up his office. So he will then 

have invested in his education a minimum of $27,000 by the time 

he is ready to see his first patient.

So, in summary of this section, recruitment is extremely necessary. 

There has been a great decrease in both the quality and quantity of 

applicants that must be rectified in the days ahead as far as dental 

education is concerned, and we feel that the dental schools must 

obtain their fair share of the better students of the country in order 

to provide the teachers, researchers, specialists, and leaders that are 

so badly needed in dentistry.

Now insofar as cost of education payments to the schools, the cost 

of educating dental students is extremely high. I would like to read 

a few paragraphs from the report of the Commission on Survey of 

Dentistry in the United States. This however has been made available to the members of this committee and also Dr. Lester Burkett, 

president of the American Association of Dental Schools is to make a 

presentation to the committee and he will touch on this subject. So 

in the interests of time I will not review what I know he will also 

speak about.

Much of the data upon which the Commission on the Survey of 

Dentistry based its findings and recommendations stemmed from a 

series of surveys conducted by the Council on Dental Education of 

the American Dental Association. These association fact sheets and 

studies are revised regularly as new information is collected from the 

dental schools.

There should be no doubt of the position of the American Dental 

Association on Federal grants-in-aid for dental education. Association witnesses have supported such proposals at congressional hearings
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 177

at least six times since 1949. Again, the Commission on the Survey 

of Dentistry7

 comments favorably on this realistic attitude of the 

dental profession through its national association.

The Commission on the Survey of Dentistry also compiled info rmation on the attitudes of those university presidents having dental 

schools within their purview and the deans of the dental schools on 

accepting Federal funds to support their dental schools and programs. 

The commission reports tha t the majority of university presidents 

favor such support. Likewise, the dental school deans endorse Federal aid. The witnesses for the American Association of Dental 

Schools will, I am sure, confirm this statement.

Again, 1 am just trying to show how close the position of the commission and the American Dental Association is. And, in closing, 

Mr. Chairman, I would like to ask for permission to submit additional explanatory data for the record.

Thank you for the opportunity to appear before the committee. I 

shall be happy to answer any questions you may have.

The Chairman. Very well. I assume that the statement tha t was 

submitted, tha t you started off on and which you expanded on, I 

observed, that you want it included in the record?

Dr. Nagle. Yes, sir.

The Chairman. Is that the information you have reference to?

Dr. Nagle. Yes, sir.

The Chairman. Very well. It will be included in the record at 

this point.

(The statement referred to follow s:)

Sum m a ry Sta te m en t of t h e A m er ic an D en ta l Ass oci ati on

Mr. C ha irm an and mem be rs of th e co mm itt ee , I am Dr. Ray mon d J. Na gle . 

I am de an of th e College of D entist ry a t New York Uni ve rs ity an d chai rm an 

of th e American D en ta l Assoc iatio n Co un cil on D en ta l Edu ca tion .

I wo uld like to th an k th e co mm itt ee fo r af fo rd in g th e American D en ta l Associat io n th is opport unity to info rm th e co mm itt ee on th e ne ed s in den ta l ed uca tio n.

Se ve ra l expert gr ou ps ha ve sc ru tiniz ed denti st ry an d it s pr of es sion al m an ­

po w er to de te rm in e w hat th is N ation ne ed s to do to as su re th a t our peop le will 

co nt in ue t o ha ve ad eq uat e den ta l se rv ices an d ca re . All ha ve conc lude d th a t th e 

job th a t ne ed s to be do ne ca nn ot be do ne w ithout Fed er al fin an cin g of denta l 

ed uc at io n.

All of th es e exper t gr ou ps ag reed th a t th e Fed er al Gov ernm en t shou ld de la y 

no long er in be ar in g a su bst anti al sh are of th e cost of tr ain in g den ta l st uden ts . 

All conc lude d th a t ea ch yea r th e Federa l Gov ernm en t de la ys in as su m in g th is 

ob lig atio n m ea ns a pr ed ic ta bl e los s of den ta l se rv ices to ou r peo ple.

Up on w hat did th es e ex pe rt gr ou ps re ly to ju sti fy th eir st ro ng ur gi ng th a t 

Fed er al fu nd s be used to ass is t den ta l ed uc at io n? In brief, th ey loo ked firs t 

a t th e de nta l serv ices av ai la bl e to our 180 mill ion peop le toda y. Nex t, th ey 

de term in ed th e nu m be r of den tist s th e scho ols wou ld ha ve to g ra duate to m ain ­

ta in to da y’s lev el of d enta l se rv ices f or 230 million peop le in 1975—on ly 13 years 

aw ay .

The se gr ou ps saw th a t we wo uld ne ed ab ou t 35,000 mo re pra ct ic in g denti st s 

in 1975 th an we ha ve toda y. Th ey co ns ul ted w ith den ta l educa to rs an d oth er 

in te re st ed pe rs on s an d conclud ed th a t we ha ve to ad d su bst anti all y to en ro llm en t in th e 47 exis ting sch ools an d bu ild 22 new den ta l sch oo ls to g ra duate 

th es e ad ditio nal den tist s. The se sa m e co nsu lt ants es tim at ed th a t to bu ild one 

ne w de nt al sch ool co sts between $6 an d $8 million.

The se ex per t gr ou ps also loo ked at th e co sts inv olved in tr ain in g den ta l stu ­

den ts to da y. The y foun d, fo r ex am pl e, th at th e tu itio n ch ar ges fo r a co ur se 

in denti st ry ar e, on th e av erag e, $800 per ye ar . But they also fo un d th a t th e 

sch ools, on th e a ve ra ge , sp en t abou t $2,500 jier yea r to ed uca te ea ch st uden t.
178 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

These experts did not, of course, limit the ir findings and recommendations to 

building new schools in new locations. They also reviewed the c ritic al need for 

remodeling and expanding the existing dental schools. They recognize that in 

a few instances an entire new educational facility would be required to supp lant 

antiquated and outmoded classrooms, laboratories, and clinics. In many more 

instances the experts found that schools were inad equa tely housed and equipped 

because the funds needed to make up the difference between tuition and the 

amount of money needed to maintain an effective faculty and a modern facility 

were nowhere to be found.

This is a broad outline of the problem tha t, in our opinion, cannot be solved 

withou t Federal financing of dental education. Wh at follows is a description 

in gre ate r detail of the facts about dental manpower and care today and what 

will be needed in 1975.

In the United States today there is a dentist to population rati o o f 1 to 1,900. 

This reflects the 95,000 dentists who are actively prac ticing the ir profession. 

The population today is about 185 million. In 1975 the population will reach 

230 million, and this is a conservative estimate. To maintain the present ratio 

of dentists to population in 1975 will require a force of 130,000 dentists.

How can this be achieved?

Today the 47 U.S. dental schools are gradua ting about 3,200 dentists each 

year. To maintain the existing rati o of dentists to popu lation will require that 

the total of dental school gradua tes increase by about 250 each year, starting 

with the 1903 graduatio n. The Commission on the Survey of Den tistry supports 

this projected increase and recommends that plans be sta rted now to assu re 

th at 6,200 de ntists will gradua te in the 1975 class—th is means 3,000 more than 

the 1902 class will produce. It means doubling the output of dental gradua tes 

in a little more than 10 years.

In order to keep pace, th at is to add 250 dental gra dua tes a year, the Commission on the Survey of Dentistry recommends that plans be started now 

to build the necessary facilitie s—the classrooms, the laboratories, and the 

clinics. Specifically, this means tha t these schools which have outmoded and 

wornout buildings and equipment must be rehabilita ted so that there will be 

no reduction in the ir enrollments and no furth er threat to the high standard 

of education that must prevail to gradua te competent dentists. These plans 

for immediate action demand next th at the larg e majority of our 47 dental 

schools add the educational and clinical facilitie s needed to gradua te 750 more 

den tists in the next 10 years. Finally this means that there be constructed 

at least 22 new dental schools, each of which would be expected to gradua te 

about 100 dentists a year.

The cost of the program I have suggested would be in the neighborhood of 

$350 million. How would this estim ated expenditure for the needed expansion 

of our dental schools be raised? It will require continued contributions from 

private and local governmental sources. But none of the expert groups that 

has studied the problem of expanding dental educational facilities lielieves that 

the job can be done unless the Federal Government provides a substan tial share 

of the cost. II.It. 4999, in the opinion of the American Dental Association, offers 

a sound plan of Federal financial support of dental education and should be 

enacted without any furthe r delay.

H.R. 4999 would provide $150 million in Federal matching funds for 10 

yea rs on a 66%-33% percent basis for new dental schools and expansion of 

existing schools. The schools would be required to raise the remaining $75 

million from priv ate and local governmental sources. Additionally, II.It. 4999 

offers $150 million in matching funds over the next 10 years on a 50-50 percent 

basis for rehabilitation of obsolescent facilities in dental, medical, osteopathic, 

and public health schools. There is evidence to indic ate th at the dental schools 

will be able to match and use nea rly half of these funds.

If the Congress should follow through immediately on the recommendation we 

ar e ntaking today and provide the construction fund s authorized in H.It. 4999, 

it would be at leas t 3 years before the first dental studen t would be admitted 

to a new school and 4 years beyond that before he would be graduated. It 

would be at least 2 years before any of the existing schools could substantially 

increase cap acity and begin to enroll the additional studen ts to fill tha t capacity. 

Meanwhile the population will continue to grow and the health education level 

of ou r people will continue to rise.

With the certainty of this tremendous demand for dental services within 

the next 10 years, it is obvious that the most immediate and critical need in 

denta l education is for expansion of enrollment—we must gradua te more den tists.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 179

The conclusion is just as obvious th at funds for constructing the needed buildings 

to increase our output of dentists must have priority over other needs of the 

schools.

There are other needs in the critical area for dental education and they are 

covered in H.R. 4999. I shall briefly indicate why the American Dental Association supports the scholarship plan and the cost of education grants offered 

within H.R. 4999.

There is a competition for highly qualified students today th at places dentistry 

and medicine in an unfavorable situation. The fellowships in the physical 

sciences leading toward a I’h. D. degree, in our opinion, have attracted many 

students who would otherwise enter dental or medical schools. This was described eloquently in Secretary Ribicoff’s testimony and the additional material 

submitted by the Department of Health, Education, and Welfare. Again, all of 

the expert study groups which have explored the dental and medical manpower 

problem have substantiated the facts expressed by Mr. Ribicoff.

It should be kept in mind that our highly qualified students have a choice 

between a tuition-free graduate training program, a fellowship, leading to a 

Ph. D. in one of the basic sciences and a $1,000 to $1,500 annual charge for 

dental or medical education. In addition, the typical science fellowship provides 

another $1,500 to $2,000 annually to the recipient student toward his cost of 

living.

What does the typical dental student face in the way of educational and living 

expenses?

The average annual tuition fee for dental education is about $800. The 

average expense for school equipment, books and other needed items is $050 

per year. The average living expenses for each student per year is $2,300. 

This means that the total cost of a 4-year dental education averages $15,000.

Now where does a typical dental student obtain his needed finances today? 

Primarily from his family. And in this instance we must include his wife because many dental students are married. We find approximately one-third of 

the students are married as freshmen. About 45 percent of the sophomores, 55 

percent of the juniors, and 05 percent of the seniors. And this may seem as 

though most of the students do have a wife working to help them get through 

school. Put there are many unexpected things about family life, and many find 

themselves with small children and find illnesses occurring.

Many students also have jobs, and often these students are working much 

longer hours than they should be. We all know that such employment is detracting from their education. Yet the deans of the var’nus schools dare not 

deny them the opportunity of obtaining added income becau e it might otherwise 

mean th at they will have to leave school.

There are some scholarships in dental schools, but not very many. A few less 

than 10 percent of the students get scholarship support, which averages about 

$500 per recipient.

Insofar as loans are concerned, no more than 23 percent get loan support, and 

again this averages about $500. The average graduate of a dental school has a 

sizable debt, when he leaves school. Two-thirds of them have a debt of approximately $4,500, and one-third of them owe $6,500.

We estimate that the cost of a man’s education and his setting up of a dental 

office is rath er staggering. The minimum cost of his liberal arts or predental 

education will be about $4,000. The cost of his dental school education, a little 

over $15,000. And it will cost in between $7,000 and $8,000 to set up his office. 

So he will then have invested in his education a minimum of $27,000 by the time 

he is ready to see his first patient

So, in summary of this section, recruitment is extremely necessary. There has 

been a great decrease in both the quality and quantity of applicants that must 

be rectified in the days ahead as far as dental education is concerned, and we 

feel that the dental schools must obtain their fair share of the better students of 

the country in order to provide the teachers, researchers, specialists, and leaders 

tha t are so badly needed in dentistry.

Now insofar as cost of education payments to the schools, the cost of educating 

dental students is extremely high. I would like to read a few paragraphs from 

the report of the Commisison on Survey of Dentistry in the United States:

“When projecting estimates of future costs for higher education one must determine whether any economies might be made to lessen estimated additional 

costs. Because of inadequate supi>ort in the past, dental education has already 

been forced to make every possible economy. In the decade following World
180 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

W ar II, th e de nt al scho ols in th e United Sta te s in cr ea se d th eir comb ine d en ro llm en ts sh ar ply, an d they did so w ith as li tt le ad de d ex pe ns e as they could . The 

scho ols now find them se lv es in an in flat io na ry eco nom y. En do wmen t incom e is 

mu ch de pressed in it s purc has in g powe r an d man y S ta te s are ex jie rie nc ing 

difficulty in su pp or tin g hig he r ed uc ation. The denta l scho ols ca n mak e no signi fica nt sav in gs w ith ou t de cr ea si ng th e qua lity of t h eir tea chin g or redu cing t heir 

en ro llm en ts, an d nei th er ac tio n wo uld serve th e be st in te re st s of the N ation an d 

it s peop le * * *.

“If d en ta l ed uc at io n is to im prov e in th e m an y w ay s th a t ha ve bee n sugg ested , 

it mus t rec eiv e an an nu al incom e of ap pr ox im at el y $75 million by 1970, ex cl ud ­

ing an y ad di tion al re se ar ch fu nds th at may be fo rthc om in g f ro m ou tsid e ag en cies 

by th a t tim e. Since inc om e is now $43.3 mi llion . $31.7 mi llio n mus t be ob ta in ed 

duri ng th e coining de ca de . Und ou bted ly, in flat io n will per m it an in cr ea se of 

ab out $1.5 m illion in c lin ic inco me, an d tu itio n in cr ea se s m ay a cc ou nt f or ap pr ox im at el y an oth er $7 million by incr ea sing the av er ag e tu it io n to $1,300 pe r ye ar . 

The dif ference, ab ou t $24 mi llion , mu st be ob tain ed from oth er so ur ce s to per m it 

den ta l ed uc ation to pr og re ss a s an in te gr al p art o f h ig he r ed uc ation.

“Ba sed upon pr oj ec ted an nu al ex pe nd itur es of a ppro xim at el y $3,000 in 1958-59 

to ap pr ox im at el y $5,000 in 1970. Th is av er ag e an nual co st to the un iv er si ties 

of $5,000 jie r de nt al st uden t ap pea rs to be a re ali st ic est im at e fo r tin* coming 

de ca de wh en it is no ted th a t th e av erag e cost i>er stinlent in 1958-59 in th e 10 

be st-s up po rted de nt al sch oo ls w as ap pr ox im at el y $ 0,4 00 (Cou ncil on D en tal 

Edu ca tion , American D en ta l As socia tio n, ‘Survey of Den ta l School Fin an ce s’). 

The 10 schools w ith th e lowest co st pe r stu dent, av er ag ed ap pro xi m at el y $1,800 

in 1958-59, an d obvio usly, th es e sch ools are in se riou s need of fina nc ial help.

“Actu all y, a pr oj ec te d ba sic annual op er at in g ex pe ns e of $5,000 pe r den ta l 

st udent by 1970 may be a ra th e r co ns er va tive es tim at e. In th e ac ad em ic year 

of 1949-50 th e med ian ba sic op er at in g ex pe ns e per st udent fo r all 40 sch oo ls 

th en in ex istenc e was $1,316. (F in an ci al S ta tu s an d Ne ed s of D en ta l Schoo ls, 

U.S . Pu blic H ea lth Se rvice Pub lica tion No. 200, p. 50.) In 1958-59 th e averag e wa s $2,967, or an in cr ea se of 125 pe rc en t in 9 ye ar s. (C ou ncil on D en ta l 

Edu ca tion . Am erican D en ta l As sociati on , “Su rv ey of D en ta l School Fin an ce s. ’’) 

I f a co mpa rable in cr ea se w er e to ta ke plac e be tw ee n 1959 an d 1970, th e av er ag e 

an nual t ot al co st pe r st udent w ou ld he o ver $6,(XM).”

Mu ch of th e data up on which th e Co mm iss ion on th e Su rv ey of D en tist ry 

ba se d its fin din gs an d re co mmen da tio ns stem med from a se ries of su rv ey s condu cted by th e Counc il on D en ta l Edu ca tio n of th e American Den tal Assoc iatio n. 

Th ese as so ciatio n fa ct sh ee ts an d st ud ie s are revi se d re gula rl y as new in fo rm ation is coll ected fr om th e d en ta l schools.

The re shou ld be no do ub t of th e po sit ion of th e American Den tal Asso cia tio n 

on Fe de ra l gr an ts -in- ai d fo r den ta l ed uc ation. Assoc iatio n w itn es se s ha ve su ppo rted such pr op os als a t co ng ressiona l he ar in gs a t le ast six tim es sin ce 1949. 

Ag ain , th e Co mm iss ion on th e Su rv ey of D entist ry co mmen ts fa vo ra bl y on th is 

re ali st ic att it u d e of th e de nt al pr of es sion th ro ug h it s nat io nal as so ciation.

Th e Co mm ission on th e Su rv ey of D en tist ry also comp ile d in fo rm at io n on th e 

att it u d es of thos e un iv er si ty pr es id en ts ha vi ng den ta l sch oo ls w ith in th eir p u rview an d th e de an s of th e den ta l sch ools on ac ce pt ing Fed er al fu nds to su ppor t 

th e ir de nt al sch ools an d pr og ra ms. The Co mm iss ion re port s th a t th e m aj ori ty 

of un iv er si ty pr es id en ts fa vo r such su pp or t. Like wise , th e den ta l school de an s 

en do rs e Fed er al aid . Th e w itn es se s fo r th e American Assoc iatio n of Den ta l 

Sc hools w ill, la m s ur e, c onfirm th is st at em en t.

Ag ain I am ju st tr yin g to show how close th e po sitio n of th e Co mm ission an d 

th e American D en ta l Assoc iatio n is. And, in clo sin g. Mr. Cha irm an , I wo uld 

like to as k fo r pe rm ission to su bm it ad di tion al ex pla nato ry d ata fo r th e reco rd.

Tha nk you fo r th e opp or tu ni ty to ap pea r be fo re th e co mmittee . I sh al l be 

ha pp y to an sw er any q ue stio ns you ma y h ave.

SUPPLEME NTAR Y STAT EM EN T OF TITF. AM ER ICAN DEN TA L ASS OCIATION

I am Dr. Ra ym on d J. Na gle , de an of th e Co llege of D en tist ry at New York 

Uni ve rs ity .

In 1955 a nd 1957. th e American Den tal Assoc iatio n pr es en te d to th is c om mittee 

d a ta an d st ati st ic s re la te d to th e de ntal m an po w er pr ob lem s an d th e legi slativ e 

re m ed ies wh ich ap pe ar ed to be indica ted . Sinc e th a t tim e, ad di tion al fa ct ua l
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 181

in fo rm at io n h as be en assembled as th e re su lt of se ve ra l ad ditio nal st ud ie s condu ct ed by gr ou ps from w ithin an d w ithout go ve rn m en t.1

 All of th es e st udie s 

co ns id er ed th e pr ed ic ta bl e gr ow th in po pu lation as re la te d to th e ex is ting an d 

fu tu re ca pac ity to tr a in den ta l pe rson ne l. Eac h st ud y arr iv ed a t th e c on clu sio n 

th a t to m ee t th e ex is ting an d im pe nd ing sh ort ag e of den ta l m an po wer , tr ain in g 

ca pa ci ty m us t be ex pa nd ed an d F ed er al fina nc ial as si st an ce is ne ce ss ar y to 

st im ula te s uc h ex pa ns ion.

The Amer ican D en ta l Assoc iatio n be lie ve s th a t th e are as of ne ed ha ve been 

defin ed an d do cu men ted, an d th at a ca re fu l review of th e av ail able fa ctu al data 

pr ov id es a co nv incing de m on stra tion of th e ne ed fo r ac tion by th e Co ng res s.

NEED FOR CO NS TR UC TION FU NDS

Pre se nt cap ac ity of de nt al scho ols :

The re a re now 47 den ta l sch oo ls in op er at io n, in cl ud in g 4 th a t ha ve st art ed 

op er at io ns si nc e 1956. Two new d en ta l sch oo ls a re in d ev elop men t a nd w ill be a ble 

to ac ce pt st udents w ithin th e nex t 2 or 3 ye ar s. The 1961 underg ra duate den ta l 

sch oo l en ro llm en t is 13,513 st ud en ts. In ad di tion, th ere a re 1,398 st udents en ­

ga ge d in gra duate , post gra duat e an d sp ec ia l st udy pr og ra m s, an d 1,169 st uden ts 

en ro lled in den ta l hy gien e sch oo ls which a re not affil iated w ith denta l sch ool but 

which off er pr og ra m s th a t ha ve been ap pr ov ed by th e American D en ta l 

Assoc iatio n.

Fro m Octo be r 1955 to Oc tob er 1961, underg ra duate den ta l sch oo l en ro llm en t 

has in cr ea se d from 12,730 to 13,513. The nu m be r of st uden ts en ga ge d in sp ec ial 

st ud ie s an d se ek in g ad va nc ed d eg re es h as in cr ea se d from 539 to 1,398. The n um ­

be r of denta l hy gien e under gra duate s has in cr ea se d from 1,160 to 1,571. Th e 

nu m be r of co nt in ui ng or re fr esh er st udents has in cr ea se d from 4,673 to 9,471.

T he g ro win g need fo r den ti st s a nd d en ta l a ux ilia ri es

The co nt in ui ng ex pa ns io n of tr ain in g pr ogra m s off ere d by th e sch oo ls refle cts 

th e const an t ef fo rt of th e schools to m ee t th e gr ow ing de man d fo r denti st s an d 

den ta l auxil ia ri es m ad e ne ce ss ar y by th e pre vai ling po pu la tion gro w th an d th e 

re pl ac em en t o f denti st s an d auxil ia ri es lo st th ro ugh dea th an d re ti re m ent from 

ac tive p ra ct ic e.

But th es e in cr ea se s in en ro llm en ts, utilizi ng pre se nt fa cil it ie s to th eir gre ate st 

ca pa ci tie s, do no t e na bl e den ta l s ch oo ls to g ra d u ate the n eeded pe rson ne l. In our 

te stim on y be fo re th is co mmitt ee in A pr il of 1958, fig ures were give n pr oje ct in g 

th e ne ed fo r den tist s in 1975. Ba sed on th e po pu lation pr oj ec tion fo r th e y ear 

1975 of 22 8% mi llion , 133,250 d en tist s will be ne ed ed in th a t yea r to m ain ta in th e 

1958 de nt ist-po pul at io n ra ti o of 1 to 1,767. On th e ba sis of th e pre se nt nu m be r of 

den ta l sch ool gra duat es , it is e st im at ed th a t by 1975 th ere w ill be on ly ab ou t 118, 

000 denti st s in ac tive pr ac tic e, or ap pro xim at el y 15,000 les s th an a re ne ed ed to 

re ta in th e 1958 ra tio. In st ea d of a ra ti o of 1 to 1,767, th ere w ill be a ra ti o o f 1 to 

2,000. To re ga in th e 1958 ra tio, a pr og re ss iv ely in cr ea si ng nu m be r of gra duate s 

will b e n ee de d ea ch y ea r, so th at by 1975, a n ad ditio nal 2,7000 d enti st s wi ll gra dua te y ea rly. If th es e add itio na l g ra d u ate s ca n be prov id ed by th e den ta l scho ols, 

by 1975 th ere wo uld be 133,250 pra ct ic in g de ntist s.

As st ate d in th e as so ci at io n’s testim on y of 1958, le ad ers in th e pr of es sion an d 

den ta l ed uc at or s vie w th es e st ati st ic s w ith se riou s co ncern . The p ro fe ssio n feels 

th a t th e m os t ob vio us so lu tio n to t hes e prob lems wo uld be th e ex pa ns io n of exis ting de nta l te ac hi ng fa ci lities an d th e co nst ru ct io n of new sch ools. Alth ou gh obvio us, t h is i s an e xp en sive co ur se o f a ct io n re quir in g n ot o nly th e re so ur ce s of th e 

pr of es sion b ut a lso th e reso urce s of p ub lic an d pri vate a ge nc ies , in cl ud in g th os e of 

th e F ed er al G ov ernm en t.

Ac co rding to th e re port o f th e Su rgeo n G en er al ’s C onsu ltan t Group on M ed ical 

Edu ca tion , confi rm ed by a st ud y of a consu lt ant co m m itt ee on m ed ic al re se ar ch 

which ad vi se d Sen at or L is te r H ill 's Su bc om m itt ee on A pp ro pr ia tio ns , th e co un ­

tr y wi ll need an eq uiv al en t of 22 ne w den ta l sch ools. The consu lt ant gr ou p fu rth er st ate d th a t “* * • to a rr e st th e de clin e in th e nat io nal ra ti o of denti st s to 

po pu lation a t its 1959 level wi ll re quir e th a t den ta l sch ool tr ain in g c ap ac ity be in ­

cr ea se d suf fic ien tly to pr od uc e 6.180 annual gra duate s by 1975, or ab out 2.700 

mo re th an ca n be ex pe cted .” As of Ju n e 1961, den ta l scho ols gra duate d 3.290 

st ud en ts. In 1962 it is antici pat ed th a t th e scho ols will g ra duate 3.294 de nt is ts .

1

 See ap pe nd ix.
182 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Present plans fo r expansion (without Federal aid)

According to a 1961 survey conducted by the American Dental Association and 

the American Association of D ental Schools, 28 de ntal schools are now planning 

expansion of teaching facilities , involving some $68 million during the next 10 

years. Approximately 18 of these schools are contemplating construction to be 

commenced within the next 3 years. Without Fed eral aid, the construction now 

planned will provide new studen t places for 354 den tal students, 447 dental hygiene students, 380 dental ass ista nt, and 155 dental laboratory technicians. 

Expansion with Federal support

In the opinion of most schools, Federal aid would provide a majo r stimulus 

to needed construction. Of these 28 schools now planning construction, 23 would 

modify these plans in some respect, eithe r by enlarging them to undertake a more 

ambitious building program or by advancing or making definite the scheduled 

sta rting date. All of the 19 schools not now planning construction would, under 

some conditions, und ertake construction. Instead of a planned expenditure of 

$68 million for dental school construction there would be $148 million spent for 

that purpose. Instead of only 18 schools scheduling construction within the 

next 3 years, there would be 39.

With Federal aid the construction planned will increase the number of new 

studen t places from 354 to 725 for dental students, from 447 to 915 for dental 

hygiene students, from 380 to 714 for dental ass ista nts, and 303 new places for 

den tal laboratory technicians r athe r than 155.

About half of the schools plan larger graduate, postgrad uate , and resea rch 

program s, whether or not Federal aid is available. With aid, nearly every 

school will expand these programs.

If Federal matching gra nts are made available as envisioned in the Health 

Professions Education Assistance Act (H.It. 4999), existing dental schools have 

indicated a willingness to underta ke new construction and remodeling costing 

over $148 million. In terms of the available and anticip ated matching funds,, 

the schools estimate over $58 million as available within 5 years and about 

$73 million within the next 10 years.

The association believes that the matching grant fo rmulas as set forth in ILK. 

4999 are realistic and would be fully utilized when these funds become available.

B. SCHO LARSHIPS FOR DENTAL STUDENTS

Cost of financing a dental education

Another, but no less important, factor in providing adeq uate dental care of 

the public is the cost of dental education to the individual students. Dental 

education is, without question, the most expensive of the professional disciplines 

from the standpoint of studen t finances. Undoubtedly this fact contributes to 

the fail ure of many promising students from lower and middle income families 

to enter dentistry. Both the profession and public vitally need these students 

and the public inte rest is not well served if the profession is unable to secure 

them.

At the present time, the average cost to stud ents of a 4-year dental education 

is $15,043. This can be broken down into school expenses of $5,824 and average 

living expenses of $9,219. The figures are slightly higher for stu dents in p rivate 

den tal schools. For the married dental studen t—and an ever-increasing number 

of dental stud ents are married—the average cost of a dental education is over 

$18,000; if he attend s a private denta l school, this figure rises to over $19,000. 

Present scholarship and other financial assistance to dental studen ts

The 1961 survey of financial aid for denta l education reveals some startling 

figures w ith respect to stud ents receiving aid from the ir schools. It is estimated 

th at 91 percent of all dental students do not receive any scholarship aid. This 

is an insignificant improvement over the years 1953-54 when 92 percent did not 

receive scholarships. More tha n three-fourths of the dental students do not 

receive school loans (76 percen t). The average amount received in scholarships 

(among those who receive scholarships) is $480, and the average amount received in loans in $627. Significantly, only 5 p ercent of the freshmen in denta l 

schools receive scholarships and only 8 percent receive loans.

Need for a Federal scholarship program for dental students

As nearly as can be determ ined, only about 40 percent of the dental studen ts 

are able to pay for the ir own education through a combination of personal savings, parental assistance, and help from relatives and friends. For the remaining 60 percent, some financial aid is needed.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 183

In 1960-61, dental schools received scholarship requests from 12 percent of 

their students. The students requested $809,547 and approximately $580,000 

was awarded in scholarships. Twenty-seven percent of the students requested 

$2.6 million in loans and only slightly over $2 million was awarded. Although 

a large percentage of the students who requested scholarships were awarded 

them (75 percent), the amounts awarded were obviously inadequate. Further, 

there is no way of recording the number of competent and needy students who 

did not apply for scholarships or loans because they knew tha t none were 

available.

Relatively few schools have uncommitted loan funds in any volume. At the 

time of the 1961 survey on financial aid for dental education, 14 schools said 

they had no uncommitted loan funds and another 22 reported tha t the funds 

on hand amounted to less than $10,000. Actually, there were 11 schools which 

held almost 80 percent of all uncommitted funds.

The profession is vitally concerned with the public need for an adequate 

supply of dentists. One of the major deterrents encountered in the recruitm ent 

of dental students, is the high cost of dental education for some and the 

prohibitive cost for others. There is plainly an ever-increasing need for funds 

to provide scholarships so that able and qualified students are not prevented, 

for financial reasons, from selecting dentistry as a profession.

Through both private and public programs, a part of the need for financial 

assistance to dental students is now met with student loans. Moneys available 

under the National Defense Education Act probably represent the major new 

source of loan aid, providing help to 12 percent of the total student body in 

1961. The association agrees t hat loan funds are essential and needed in dental 

education, but it observes also, that indebtedness of dental students at the 

outset of a professional career is formidable. For example, dental students 

must invest from $7,000 to $10,000 to equip an operatory. This cost of equipment, unequaled by the other professions, is usually financed as a commercial 

loan by the new graduate and more often than not, such a loan is incurred 

in addition to existing indebtedness for professional education.

Therefore, in the association’s view, it is preferable that greatly increased 

scholarship funds be made available so th at dental students are not overburdened 

with debt at the outset of their professional careers.

While the profession now has available both loans and scholarship funds 

for needy and qualified dental students, it is evident tha t the present volume 

of these funds is insufficient to bring into the profession the number of qualified 

students required to meet the future dental manpower needs of the Nation. 

Therefore, the association views as urgent, a Federal scholarship assistance 

program for dental students as outlined in II.R. 4999.

C. COST OF EDUCATION PA YM EN TS TO TIIE SCHOOLS

Cost of educating a dental student

Educating dental students costs much more than the schools receive from 

tuition charges paid by students. On the average, the dental student contributes in tuition only 29 jiercent of the cost of educating him. In private 

schools, the average is 41 percent and in the public schools, it is only 16 

percent. Although tuition costs have increased in the past 10 years, a dental 

student 10 years ago contributed approximately one-third of the cost of his 

education, a generation ago, he contributed almost half.

The cost of the regular education programs of the schools is now almost 

2V, times what it was 10 years ago. Approximately $38.5 million is now being 

spent in support of the regular programs, as compared with $15.7 million in 

1949-50. Now, however, only 73 percent of these costs are met by the dental 

schools out of their own budgeted funds, while 10 years ago, the schools met 

88 percent of their own expenses.

Today, the annual cost of educating more than 13,000 dental students is 

$44.5 million. As recently as 1955, the annual cost for 45 dental schools was 

$32 million. If we translate these figures to average cost per student, today’s 

cost for dental schools is about $3,000 per student, while the 1955 cost was about 

$2,500 per student. We must expect this cost per student to continue to 

increase.

Assistance needed by the dental schools

The answer cannot, in fairness or in terms of our democratic goals, be an 

excessive increase in tuition charges aimed to meet full educational costs. This
184 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

would, in our opinion, have two obviously unfortun ate results. With tuition 

<-harges increased from about $3,000 to $5,000 a year, the number of denta l 

students would be diminished to perhaps a quarter of today's enrollment. Additionally, the source of students would necessarily he that very small segment of 

society with extremely high income. These consequences must not occur. We 

want to keep tuition cost for dental education at a reasonable level so that all 

those with a dedication for dentistry, who have th e ability to fulfill the rigid education requirements, will not be deferre d from seeking a dental education for 

financial reasons.

The position of the American Dental Association is. as it has been in the past, 

in favor of dental grants-in-aid for dental education. Association witnesses 

have supported proposals similar to II.It. 4990 at congressional hearings at least 

five times since 1950. It should be noted that the Commission on the Survey of 

Den tistry comments favorably on this realistic att itu de of the dental profession 

through its national association.

The Commission on the Survey of Dentistry also compiled information on the 

attitu de of those univ ersity presidents having dental schools within their purview and the deans of the dental schools on accepting Federal fund s to suppo rt 

the ir dental schools and program s. The Commission repo rts th at the majority 

of university presidents favo r such support. Likewise, the dental school deans 

endorse Federal aid.

CONCLUSION

The legislation to which we are addressing our comments, namely II.It. 4999, 

would provide annually for 10 years $15 million in gra nts on a matching basis 

for construction of new dental teach ing facilities and $15 million matching 

gra nts for replacement or rehabilitation of existing teach ing facilities in schools 

of dentistry, medicine, and public health. The American Dental Association 

strongly supports this much needed Federal aid.

II.R. 4999 also includes provisions for scholarship gra nts to dental schools to be 

allocated to dental students in a manner which seems eminently reasonable to the 

American Dental Association. In addition to the scholarship g rants, there would 

he cost of education payments to the schools to make up the deficit between the 

scho larsh ip grants and the actu al cost to the schools for educating stud ents receiving those scholarships. The association favo rs the utilization of Federal 

fund s for this purpose, provided such aid does not affect admission policies of 

the schools or the content of the curriculum.

The association also support the provision of II.R. 4999 which would strengthen 

and expan d the program fo r gran ts to assist in the constru ction of h ealth research 

facilitie s.

The American Dental Association reaffirms its recommendation that this committee report favorably on II.R. 4999.

App en di x

1. Medical school inquiry, staff repo rt to the Committee on Inter sta te and 

Foreign Commerce, House of Representatives, 85th Congress, 1st session (committee print).

2. U.S. Department of Health, Education, and Welfare, Office of the Secretary. 

“The Advancement of Medical Research and Education Through the Department 

of Health, Education, and We lfare: Final R eport of the Secretary’s Consultants 

on Medical Research and Education, 1958" (th e Bayne-Jones reix>rt).

3. U.S. Department of Health, Education, and Welfare, Public Health Service. 

“Physicians for a Growing America : Report of the Surgeon General’s Consultant 

Group on Medical Education, 1959” (the Bayne r eport ).

4. Subcommittee on Departm ents of Labor. Health, Education, and Welfare, of 

the Committee on Appropriations, U.S. Senate (86th Cong., 2d sess.). “Federal 

Support of Medical Re sea rch : Report of the Committee of Consultants on Medical Research,” 1960.

5. American Council on Education, Commission on the Survey of Dent.istrv 

in the United States, “The Survey of Dentistry,” 1961.

The Chairman. At this point, do you have any further statement, 

Dr. Timmons?

Dr. Timmons. Xo, Mr. Chairman, we shall be happy to attempt to 

answer any questions that the members of the committee might have.

The Chairman. Thank you very much.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 185

Mr. F ried el ?

Mr. F riedel. I have no questions. I t was a fine statem ent.

Th e C hairman. Mr. Younger.

Mr. Younger. Dr. Timmon s, in rega rd to the medical schools, one 

of the reasons advocated why we sho uld do som ething is because of 

the numb er of doctors bein g gr ad ua ted in Rus sia. IIo w about dentistry in R ussia ? Do yo u know a ny thing about t hat ?

Dr. Timm ons. Mr. You nger, it happens th at I was accorde d the 

privilege of s pending a month in the Sov iet Union this pa st summer. 

I was assi gne d on a commission th at went over to look at the denta l 

sit uatio n in the Sov iet Union. Th e mission of which I was a member 

visited the rep res entative s of Russia, the Uk rai ne, and Georgia, and 

several d iff eren t cities, Moscow, L en ingrad , K iev, B ileski, Soche. We 

were given the op po rtu nity of looking at their edu cational prog ram 

and looking at the opera tion of the res ults of th eir denta l edu cation 

pro gra m.

Th e whole sit ua tio n to me was one of the most incong ruous, par adoxical, enig ma tic thin gs tha t I eve r saw in my life. You ke pt saying 

to yours elf a ll the time as you saw thes e things that, this is t he nation 

th at put a man in orb it. Th e de nta l sit ua tio n is th at the y ad mit to 

havin g 216 million peop le in the Sovie t Un ion . In 1917 the y h ad ab out 

5,000 practic ing dentists—pr ac titione rs of de ntist ry in the Soviet 

Union. Cur rently they have 45,000 “dentist s” to tak e care of 216 m illion people. Th e edu cation al prog ram of Russia in de ntistry is at 

two levels. They educate a person th at t hey call a de ntist in a period 

of 3 years. Th en they educate a person th at they call a stoma tologist, 

who also has responsibility in a he alt h area in a perio d of 5 years. 

Ne ith er of these edu cation al prog rams is carried on as a univers ity 

disc ipline, as it is in our cou ntry. Most of them or all of them are 

carried on in wh at is know n as the med ical insti tut es of the Sov iet 

Union.

Of the 45,000 “d en tis ts” they have the re are 29,000 of them who hav e 

had bu t 3 ye ars of education. Th e r em ain ing 16,000 of the 45,000 have 

had the 5 y ears of edu cation. Qu ite fran kly, it was difficult fo r me 

in exam ining the mo uths of the pa tie nts whom I saw to in any way 

differentiate from those who ha d ha d 5 y ears of edu cation an d those 

who had ha d 3 years of edu cation. It has been my privileg e to see 

de nti str y in several foreig n countri es. Of the de ntist ry th at I have 

observed in the foreig n cou ntri es there is no thing th at will com pare 

with Russia. It is witho ut a doubt the poo rest th at I have ever seen.

The concept of a denta l healt h service does not begin to ap pro ach 

the co ncep t of a denta l health service of the Un ite d Sta tes. Th e tr ain ­

ing of the pers ons cha rged with the res ponsibility of ren de rin g th at 

service does no t begin to com pare wi th the edu cation of the per son s 

in the Un ite d State s who are charg ed with th at responsi bility. A 

tre atmen t th at a pa tie nt receives a t the ha nd s of an op erator is something th at I certa inly would no t wa nt to und ergo, myself. I could 

elaborate at conside rable len gth on it. I can only sum ma rize by say ­

ing t hat com pared to wh at we have in the Un ite d St ates the y have a 

very , very long p ath to trave l.

Does that answer your question ?

Mr. Younger. Yes, than k you very much. I am glad to hav e th at 

in th e record.

80014— o: 13
186 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

The Chairman. Mr. Rhodes.

Mr. Rhodes. Mr. Chairman, the need for legislation posed in your 

bill is made quite clear by the evidence of these medical and dental 

school deans who have come here to testify. I wish to commend them 

for their interest in seeking effective means for meeting the shortage 

of physicians and dentists and in giving the best possible service to 

our people. I am pleased to see among those here today Dr. Gerald 

Timmons who is associated with Temple University, which is in my 

State. I feel that it is one of the finest medical and dental schools 

in the country. I say that not only because it is in Pennsylvania but 

because of personal experience with the college since my son is a 

graduate of the medical school at Temple. Dr. Timmons has been 

honored recently in being selected to head the Medical-Dental Association. I have a few questions for you, Dr. Timmons.

In your opinion, doctor, what does the dental education program 

need most? Funds for construction? Funds for scholarships? For 

dental students? Or funds for operation of the course of the school?

Dr. Timmons. Mr. Rhodes, the policy of the American Dental Association has been established that in our opinion the greatest priority 

is brick and mortar. We need the money for the construction of 

facilities in which to teach dental students.

Mr. Rhodes. Thank you. Doctor, what had led the American 

Dental Association to conclude that the Federal Government has an 

obligation to assist in financing dental education?

Dr. T immons. Well, the magnitude of the problem in the first place 

is very, very great. We have had little success in attempting to 

interest the legislators or the legislatures of the several States in 

carrying out the program that has been advocated. I was interested 

in listening to some of the testimony t hat went on here this morning, 

the questions that were asked by Mr. Dominick of Colorado in that 

for some time they have been attempting to get a dental school in 

Colorado and it has been, up to date, impossible for them to get the 

funds from the Legislature of the State of Colorado. Yet there is 

not a dental school, after you leave Kansas City, until you get to the 

city of San Francisco.

Mr. R hodes. We are aware, Dr. Timmons, tha t a considerable number of foreign trained physicians come into the United States to 

practice medicine each year. Is there a substantial number of foreign 

trained dentists entering the United States?

Dr. T immons. Very, very few and those that do come have not been 

permitted to practice dentistry in the United States until such time 

as they have taken additional education in the dental schools of the 

United States. The level of dental education, particularly in the 

sections of Europe that have been most greatly affected as a result of 

the war, that is Central Europe, is of such a nature that the persons 

in dentistry do not feel that these people are qualified to render a high 

quality dental health service to the public without having further 

training.

Mr. Rhodes. Are many American boys attending foreign dental 

schools and returning to the United States to practice dentistry?

Dr. Timmons. Very very few, and those who do are not eligible 

for the State board examinations until such time as they have graduated from a dental school tha t is accredited. The quality of educa-
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 1S7

tion tha t they have received in foreign schools is of such a nature 

tha t they cannot take the examination for license until such time as 

they have had further education.

Mr. Rhodes. I s it not practically impossible for dentistry and 

dental education to do all that is needed in the next 10 years to keep 

pace with our expected population expansion, for example, adding 

250 graduates each year for 10 years and building 22 new dental 

schools in the next 10 years ? What else can be done and what alternatives are there?

Dr. T immons. I think the dental profession as a whole in the past 

few years, in the past several years, has been turning its attention 

to problems in the area of research tha t would reduce the incidence 

of dental disease.

As an example I would call to your attention the great progress 

which has been made by the fluoridation of communal water supplies. 

It has been shown on the basis of research that was done in Kingston, 

N.Y., with the control in Newburgh, and what has been done in Grand 

Rapids, in Branford, Ontario, and in other areas, that we have brought 

about a diminution of the incidence in dental caries in mouths of our 

children tha t in some instances have gone to as high as 65 percent. 

We think tha t the dental profession throug h its research has made a 

great contribution. As you gentlemen probably know, we are meeting with grea t resistance in areas and in many instances have lost— 

in the city of Allentown I would call to your attention we lost a 

referendum in Allentown because the citizenry of Allentown voted 

not to avail themselves of this health measure through the fluoridation 

of the communal water supply.

Mr. Rhodes. I am aware of that.

Mr. F riedel. Doctor, we had the same problem in Baltimore City. 

It was a long, long fight before we succeeded. I was a member of 

the city council when we finally approved fluoridation for Baltimore.

Dr. Timmons. In the city of Philadelphia while Senator Clark was 

the mayor of Philadelphia we introduced fluorin salts into the communal water supply in the city of Philadelphia and the figures have 

shown that we have had a 40-percent diminution in the incidence of 

dental caries in the mouths of our schoolchildren that have periodic 

examinations. Also there has been a diminution of about 47 percent 

in the necessity fo r extracting 6-year molars which in the opinion of 

the dental profession are as important teeth as a child can have in his 

mouth.

Mr. Rhodes. Thank you very much, Dr. Timmons. That is all, 

Mr. Chairman.

Mr. Thomson. I was wondering whether that void between Kansas 

City and San Francisco is explained by the fact that there are natu ral 

fluorides in the water in tha t area ?

Dr. Timmons. Well, Mr. Thomson, I do not think that is the whole 

answer. I think t hat I said the diminution is only 40 percent which 

leaves 60 percent and that 60 percent can be a pretty painful percent. 

Also, the needs of the adult persons, and there I think again dentistry 

deserves a great deal of credit because we are now, through the 

research tha t has been done in peridontal disease, maintaining the 

teeth in the mouths of our elder citizens to an extent we never did 

before.
188 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Back when I was a youth growing up when anybody got as old as I 

am he was expected to have full upper and lower dentures. T have 

almost reached it. I have a full upper and partial lower, hut the research that the dental profession has done has kept these teeth for 

me as they have kept them for a great many other people. Thai adds 

to the load of the dental profession. I realize that you asked th at 

question in a facetious manner but I think the distribution of population in the United States had considerable to do with the geographical 

location of the dental educational institutions.

Mr. Thomson. Are you familiar with the Marquette University 

Dental School in Milwaukee?

Dr. Timmons. Yes, sir.

Mr. T homson. We are proud of that in Wisconsin. They have been 

rendering a very fine service for many years. It is, by the way, a private institution. It is not receiving tax support..

Dr. Nagle. I might, say recently they were able to expand through 

receiving a health research facility grant.

Mr. Thomson. T know that Dr. Tlirschbeck was here from Marquette. Of course, Marquette is the largest Jesuit university in America. Many people don’t realize that that, is a fact but I think it is. I 

am aware of the problems they are having in raising funds.

Dr. T immons. They have not only contributed to the needs of Wisconsin but, I think an analysis of the persons enrolled in Marquette 

will show th at they have also contributed greatly to the States which 

do not have dental schools. It is much the same as my own school in 

that in our student body we have 21 States represented in our total 

student body although the majority of our contributions are being 

made to the Commonwealth of Pennsylvania, yet we are contributing 

to a great many States tha t do not have dental schools of their own, 

as is true in Dr. Nagle’s school, as is also true in Dr. Burket’s school. 

I would like to call to your attention, Mr. Rhodes, since you mentioned Pennsylvania, tha t I, as the dean of Temple, am very sorry 

tha t the dean from the University of Pennsylvania, my own city, is 

not here sitting with me. He happens to represent another organization but, there is a more amiable condition existing between the two 

schools than would be indicated by us being separated now.

Mr. Rhodes. Also a very good school.

Dr. T immons. Yes.

The Chairman. Doctor, if the construction phase of this would not 

produce any facilities available for students for at least 3 years, why 

should you have a scholarship provision provided by this proposal 

durinsr the interim 2 years?

Dr. Timmons. I think the same reasons would prevail as I heard 

presented here by representatives of the American Association of 

Medical Colleges. I think the student that is in the stage of making 

up his mind as to what he wants to do would be greatly reassured if 

he had some assurance that there would be a possibility of his entering 

into a dental career. I noticed one question was asked of Dr. Anderson. I repeatedly am called upon as the dean of a school to interview 

students who are in the liberal arts college who are attempting to 

make up their minds. I have had repeated instances in which when 

it is called to their attention as to the cost of dental education, they 

sa y: “There is no use for me to consider it—I can’t go on with it.”
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 189

So 1 think tha t if this incentive was held out at this particular time 

it would give him the opportunity during his liberal arts education 

to so direct his education as to permit him to be entered into a medical 

or dental school.

The Chairman. Then the answer to the question, I assume, is tha t 

you would very likely get a lot of better qualified applicants than you 

are receiving now?

Dr. Timmons. Yes, I think that is perfectly true.

The ( 'iiairman. Even though now you are getting all the applicants 

that you can take care of?

I)r. Timmons. Well, in numbers we are getting sufficient applicants 

but the quality of the applicant that is applying has consistently 

dropped. In other words, the boy that is applying is not as good a 

student as we would like to have apply.

The Chairman. Then the major argument for the scholarship 

provision at this time is an effort to improve the quality of the applicants?

Dr. Timmons. Yes.

Dr. Nagle. I think on that point I might bring out also the early 

activation of such a program is something that we can anticipate a 

renewal of the quality and quantity that we did see and had the advantage of immediately following World War II when the students 

had the advantage of this GI bill of rights. Also, the cut in quality 

has dropped in such a way that it is giving us great concern. This 

would be one way of attracting students to study dentistry who would 

be of a better quality. It may also change the ratio between the large 

urban applicants and those from rural areas. The rural student is 

very frequently at an economic level that does not permit an education in an area that is so expensive. These are things that would point 

in the direction of the advantages of early activation of this program.

T'he Chairman. Is there any information or figures as to what th e 

total cost of medical and dental care is to our people on an annual 

basis ?

Dr. Timmons. Mr. Conway says we can supply tha t to you.

The Chairman. I wish you would supply that information.

(The information referred to follows:)

Private expenditures for medical care: Amount and percent distribu tion by type

of service, 1960

Type of expenditure Amount 

(in millions)

Percent

Total.................................................................................................................... $19,566 100.0

Hospital care..........__________ . ............................................................. 5,324

5,090

1,992

3.930

27.2 Physicia ns’ services______ ____ 26.0 Den tists’ services.. - ______ _________ 10.2 Drugs and drug sundries _________ _______________ ____________________ 20.1 Eyeglasses and appliances....... ................ ..................... . ..................... ................... 1,219

886

6.2 Other professional services........................... ........................... .......................... 4.5 Home nursing care . ___________ ... . 280 1.4 Hea lth insurance, net cost............ ...................................... ....................................... 845 4.3

Source: "P riv ate Medical Care Expenditures and Volunteer Health Insurance 1948-60,” Louis S. Reed, 

Social Security Bulletin 1961, Departm ent of Health, Education, and Welfare.
190 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Th e Chairman. Now, would you care to comment on wh at might 

be saved, if anythi ng, in the total cost of our medical and denta l bills 

in the coun try i f t here were adequate assistance given to the A merican 

people while they are childre n ?

Dr. Timmons. I do n't th ink I can an swer th at question as to whether 

it would lower the cost or not.

Th e Chairman. You would not care to commen t the n on whe ther 

or not as an example, a youngster who has had op po rtu nity to give 

ade qua te attention to his denta l needs would be saved in his lat er 

yea rs o f life the cost of some denta l care that he would have otherwise ?

Dr. Timmons. Yes, on the mainte nance base it has been definitely 

pro ven th at if mainte nance care is render ed to a pa tie nt the total 

cost is much less th an a catastro phe cost.

Dr. Nagle. I think the re is anoth er facto r in the re too, Mr. Harris , 

th at throug h some of the results of the gr ea tly exp and ed research 

prog ram in the past 10 yea rs that denta l disease is bei ng better contro lle d. We antic ipa te too th at as a result of the fluoridation of 

the comm unal wa ter sup ply th at these youngsters who have had the 

ad vanta ge of this will not need the expensive de nta l care later in 

life. Th is could c arr y throug h into the ag ing p ati ent.

Th e Chairma n. I hope we don ’t get too fa r into this subject of 

fluoridation.

Dr. T immons. I think anoth er answer to th at is th e sta tistic s which 

have been compiled on the basis of experience th at we now have had 

in the denta l insurance pro gra ms , the re are some pro gra ms in opera ­

tio n in the United S tat es in which persons are able to purch ase d ental 

insu rance. Th e experienc e which has been had has show n th at comprehen sive childhood care has resu lted in a lesser expense— a lesser 

expenditu re of fun ds over a period of years than to wait fo r catas ­

tro ph ic trea tment.

Th e Chairman. Th ere are 47 dental schools now ?

Dr . T immons. Yes, s ir.

Th e C hairma n. And two new ones coming in op era tion ?

Dr . T immons. Yes, sir .

Th e Un ivers ity of Ke ntu cky will admi t new stu dents this coming 

fal l and the U nive rsi ty of Ca lifornia is opening a new denta l school 

at th e Los Angeles division.

Th e Chair man. Fo rty -nine schools in how m any Stat es?

Dr . Timmons. Th ere are 28 of the cu rre nt 47 schools in priva te 

institut ion s, bu t 19 of them are in State ins tituti ons.

Th e Chair man. Th e 47 schools now op erating are loca ted in 28 

State s?

Dr. T immons. In 28 States , yes.

Th e Chair man. W ith the oth er 2 there will be 30 State s then?

Dr. T immons. No, because the two State s that are star tin g new 

schools now have den tal schools. In oth er word s, the Un ive rsity of 

Louisville has been in opera tion in Kentu cky for a long period of 

tim e and the new den tal school at the Un ivers ity of Ca lifornia , Los 

Ang eles Division, will be the fifth den tal school in the S tate of Ca lifor nia .

Th e Chairman. I s it con tem plated under thi s pro gra m th at there 

will be some new d ental schools?

Dr. Timmons. The sta tistic s are compiled on the basis th at there 

will be that, many schools needed in order to supp ly the needs.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 191

The Chairman. Do you know, in what States tha t need exists?

Dr. Timmons. Preliminary studies have been made. As I heard 

Secretary Ribicoff mention this morning, under consideration right 

now is a dental school in the State of Connecticut. A dental school 

is under consideration in the State of Florida. One is under consideration in the State of Colorado and with possibly another under consideration in the State of Massachusetts which already has two, and 

South Carolina which at the time does not have any.

The Chairman. I would like to see my State of Arkansas get included in that list.

Dr. Timmons. Well, you have some good dentists in Arkansas who 

have been active in this program.

The Chairman. I am well aware of that. Thank you very much, 

gentlemen, for your presentation here. We appreciate the information you have given us, and the booklet “Dentistry in the United 

States” will be received for the files and information of the committee.

Dr. Timmons. Thank you very much. Thank you for the privilege of appearing.

(Additional information submitted for the record:)

Material on Dental Education Submitted by P ublic H ealth Service

DENTAL SCHOOL APPLICANTS, ADMISSIONS, AND VACANCIES

The number of studen ts applying for admission to dental schools has falle n 

sharply in the past few years. In 1960, there were only 5,200 applicants, or 1.4 

for every applicant accepted. Fou r yea rs earlier , there were 7,400, or 2.1 for 

every applica nt accepted f or admission.

The average dental student of the past 5 y ears has applied for admission to 

at leas t 4 schools. Some schools however, receive as many as 15 applications 

for each freshma n position available, while others receive as few as two. Even 

so, nearly all schools have been filled to c apacity or have had only the occasional 

vacancy which results when a studen t delays too long in notifying a school of 

his inten tion to enroll elsewhere. In 1960, there were 175 unfilled freshman 

places, of which 105 were in 5 schools. The majority of all vacancies occur 

in high-tuition schools located in States which have more tha n one school.

Sc ho ol ye ar

N u m b er apply in g for ad m is si on N u m b er of ap plica tions

U nf ille d

fr es hm an

plac es

T o ta l

N u m b er

ac ce pte d

P er

ac ce pt ed

ap p li can t

T o ta l

P er

appli cant

P er

ac ce pte d

ap p li can t

1960-61__________ 5,200 3,64 8 1.4 (') (■) (*) 164

1959-60__________ 6,498 3,573 1.8 14.950 2.3 4. 2 175

1958-59.................... 6,469 3,607 1.8 15, .566 2.4 4. 3 (i)

1957-58 .................. 7,286 3,60 0 2. 0 16,172 2. 2 4. 5 0)

19.56-57.................... 7,376 3,561 2.1 16,475 2. 2 4. 6 (*)

1955-56.................... 7205 3,445 2.1 15,222 2.1 4. 4 «

1

 N o t av ai la bl e.

So urces: D a ta for 1960-61 fro m “ T re nds in d en ta l sc ho ol a n d d en ta l hy gi en e sc ho ol en ro ll m en t” , J A D A 

62:211-3, F e b ru a ry 1961. In fo rm at io n for all o th er yea rs from A m er ic an D en ta l A ss oc ia tion . U n p u b ­

li sh ed d ata .

DENTAL SCHOOL ENROLLMENT, GRADUATES, AND DROPOUTS

The number of students dropping out of d ental school prior to gra dua tion has 

risen stea dily over the past 5 years. From a low 6.4 for the class of 1956, the 

percent dropping out has risen to 8.6 for the class of 1960. Inform atio n is as 

yet incomplete for the class of 1961, but curre nt indications are th at dropouts
192 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

have risen still further. Reports from the denta l schools indicate that financial 

difficulties account for by f ar the ma jority of all dropouts.

School year

Num ber

enrolled

Number

grad uated

Num ber 

dropping 

out prior 

to graduation

Percent of 

those 

entering

1969-61 - . - ___ ________ - 13,580 (') (') (')

1959-60 __________________ _____ 13,581 3,253 308 8.6

1958-59 _____ _____________________ 13,509 3.156 289 8.4

1957-58 ... ____________________________ 13,279 3,083 246 7.4

1956-57 _______ _______ _____ ___________ 13,004 3,050 224 6.8

1955-56____ _____________________________ 12,730 3,038 206 6.4

1

 Not available.

Source: American Dental Association; d ental s tud ent registers.

STATUS OF DENTISTS IN 19 60

At the prese nt time, about one dentist in every eight is retired . Of an estimated 12,670 dentists who were no longer in practice in 1060 approximately 

6,000 h ad retired within the previous 5 years. Total losses from activ e practice over the 5-year period included, in addition to the 6,000 retirements, an 

estim ated 2,400 deaths, or 9,300 in all.

Number of

Ac tivity dentists

All den tists_____________________________________________1 101, 000

Retired _____________________________________________________ 12, 670

A ct iv e______________________________________________________ 80, 230

Active de ntist s:

Non-F ede ral____________________________________________ 82, 630

Spe ci al ists______________________________________________ 3, 030

O th er___________________________________________________ 78, 700

F ed er al _______________________________________________ 6, 600

Specialists ______________________________________________ 240

O th er___________________________________________________ 6, 360

All specialists_____________________________________________ 4,170

1

 E x c lu d e s 3, 25 0 d e n ti s ts g ra d u a te d In 19 60 .

THE DENTAL HE AL TH BIL L AND TH E EFFECT OF ADEQUATE CHILD HOOD CARE

Priva te expenditures for dental care were estim ated by the Department of 

Commerce at approximately $2 billion for 1060. Since thi s level of expenditures represents a standard under which almost 60 percent of the population 

get no dental care at all in the course of a year, it is unlikely that expenditur es could be reduced even if all people were to have adequate care in childhood. Instead, the tota l dental bill would probably rise even more rapidly 

tha n is presently anticipated. If per capita demands for car e continue to rise 

at th e rate of the past decade, the amount spent for dental car e can be expected 

to reac h the .$5 billion level within about 15 years, provided that sufficient 

services are available.

Wh at could be accomplished if adequate care were received in childhood 

would be a better standard of dental health throughout life. If fewer teeth 

were lost or damaged during childhood, more people would reach maturity with 

teeth which wa rra nt preventiv e care. Later on, when rehabilitation became 

necessary, full mouth reconstructio n would be more frequently indicated. 

Perio dontal trea tme nt, bridges, and partial den tures would continue to be 

indicated for many people long af ter they reach an age which finds their counterparts today completely without natur al teeth.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 193

Si nc e a t pre se nt 3 in 10 peo ple p ast th e ag e of 35 an d mor e th an h alf of 

th os e p ast 55 are comp let ely ed en tulo us , ad eq uat e ch ild ho od care wo uld pr ob ­

ab ly ad d to th e p ati ent ro st er va st ly in cr ea se d nu m be rs of pe op le in th eir 

mid dle an d la te r ye ar s. F or th e av er ag e pe rson , th en , re ce iv ing ad eq uat e 

den ta l care in ch ild ho od mig ht we ll mea n g re ate r ex pen di tu re s ov er a lif et im e, 

and fo r th e po pu la tion as a whole, it wo uld un qu es tion ab ly mea n man y more 

co ns um er s of den ta l serv ices in ev ery ye ar .

OPERATING REVENUE FOR EXPANDED DENTAL SCHOOL FACILITIES

Sin ce m os t den ta l sch oo ls are h ard p re ss ed to m ee t even th eir cu rr en t op er at in g 

expenses, th e fina nc ing of ex pa nd ed fa cil it ie s will be ex trem el y difficult. How ­

ev er, pr ob ab ly a t le ast a t hir d of th e co st of e du ca ting a dd itio nal st udents will be 

rec ov ered in th e fo rm of tu itio n an d fees an d in ad de d clinic incom e. And, ju dging from pr ev io us ex pe rie nc e, Sta te le gis la tu re s or oth er sp on so rin g bo die s will 

mak e su b sta n ti al co nt ribu tion s, a s wi ll p are nt un iv er sities . The g ra nts av ai la ble 

un der th is b ill will no t only act to s ti m ula te th is ad ditio nal in ve st m en t in den ta l 

ed uc at io n but w ill als o prov ide th e a dd ed m ea su re of su pp or t need ed to g uar an te e 

th a t ex pa ns io n is n ot ac hiev ed a t th e e xp en se of t he qual ity o f ins truc tion .

Dr. Nagle. Thank you, Mr. Chairman.

The Chairman. Now at this time we are going to take Rabbi Lieberman. Dr. Burket, will you be here tomorrow ?

Dr. Burket. I had not planned on it, Mr. Harris. I could be.

The Chairman. II ow much time would you require to present your 

statement, Doctor ?

Dr. Burket. I could summarize it perhaps in 10 minutes at the 

most.

The Chairman. Well, I think you had better come around then. 

Come ahead. Rabbi Lieberman, we will take you next.

STATEMENT OF DR. LESTER W. BURKET, DEAN, SCHOOL OF DENTISTRY, UNIVERSITY OF PENNSYLVANIA, AND PRESIDENT,

AMERICAN ASSOCIATION OF DENTAL SCHOOLS

Dr. Burket. Mr. Chairman, members of the committee, with your 

permission, I would like the privilege of having the statement tiled. 

I will summarize it briefly since I know the hour is late and the most 

effective testimony tha t I can give at this time perhaps would be the 

briefest.

(The formal statement referred to follows:)

Stateme nt of Dr. Lester W. B urk et on Beh al f of th e American Asso ciation

of Den tal Schools

I am Dr . L es te r W. Bur ke t, de an of th e Sch ool of D en tist ry , U ni ve rs ity of 

Pe nn sy lv an ia , an d pre si den t of th e Am er ic an A ssoc iatio n of D en ta l Schoo ls. The 

as so ciatio n which I re pre se nt ha s a lon g and co nsi st en t reco rd of su pp or t of th e 

pr in cipl es co nt ai ne d in th e va riou s le gi sl at iv e pr op os al s fo r ai di ng hea lth ed uca ­

tion which ha ve be en in trod uc ed in th is Co ng res s. I am . th er ef or e, plea se d to 

ha ve th is op por tu ni ty once a ga in to o utlin e th e po si tion o f th e American Assoc iation o f D en ta l Schools o n va riou s pr op os al s fo r F ed er al as si st an ce to den ta l ed uca tion and , s pe cific all y, on II. R. 4999, in trod uce d by M r. Or en H ar ri s.

INTRODUCTION

Ov er th e p ast de ca de an d a half th ere has be en a mar ke d aw ak en in g w ithin 

de nta l ed uc at io n an d w ith in th e den ta l pr of es sion a t la rg e to th e prob lem of pr oviding th e quanti ty a nd q ua lity o f d en ta l healt h c ar e th a t a ra pi dl y ex pa ndin g a nd 

incr ea sing ly he alth-con sc ious American po pu la tion de m an ds an d ex pe cts. In a 

fo rt h ri g h t att em p t to m ee t th e ch alle ng es of mod ern-da y social pr og re ss , den ta l 

ed uc at or s and denta l pra ct itio ner s, th ro ugh th eir or ga ni za tion s, hav e sp ea r-
194 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

head ed on a broad front the efforts to control dental diseases and extend the 

ava ilab ility of dental care.

Over a very brief period, extrem ely significant achievement has been made. 

Dental research, concentrated in dental educatio nal centers, has advanced at a 

hea rten ing rate, bringing with it new perspectives in the fields of prevention and 

tre atm ent of dental diseases and new and improved standa rds of dental teaching 

and dental education generally. Since as recently as 1956 when the National 

Congress first made a beginning toward providing financial support on a realistic 

basis, the dental research programs in the schools have multiplied many times 

over. Funds available for this purpose are at last beginning to approach an equation with the need and the seriousness of the den tal disease problem. Although 

these programs are still in the ir infancy, the public already has received a rich 

return on the expenditures tha t have been made.

Yet, much more rema ins to be done both in dental research and in other 

crit ical a reas th at have been neglected. The mani>ower shortage, both in teaching 

and in denta l practice, looms as the foremost obstacle to continued progress in 

den tal health. The capacity to produce dental teach ers, rese archers and practitioners continues to be outpaced by the explosive production of new generations of 

health-awa re Americans. The acute need for additional i»ersonnel has been established. Study upon study by responsible Government (1,2,3) and private groups 

(4) has pointed up and documented the critical natur e of the situation.

The President of the United States in his health message to Congress last year 

recognized the seriousness and magnitude of the problem when he stated :

“We have now 92 medical and 47 dental schools. These gradua te only 7,500 

physicians and 3,200 dentists each year. If during the next 10 years the capacity 

of our medical schools is increased by 50 percent and that of our dental schools 

by 100 percent, the output will still be sufficient only to m aintain the present rati o 

of physicians and dentists to population.

“To do this we must have within the next 10 years sub stantial increases in 

enrollment in existing schools, plus 20 new medical schools and 20 new dental 

schools.”

In thus focusing national atte ntion on the need for increasin g dental personnel, the P resident was echoing the forewarnings that have emanated in increasing volume from dental education and the dental profession over the last several 

years.

In his message to Congress on Jan uary 11, 1962, Presiden t Kennedy again 

referre d to this serious problem in the following wo rds:

“To relieve the critical shor tage of doctors and dentists, and expand research, 

I urge action to aid medical and dental colleges and scholarships and establish 

new national institutes of health.”

The American Association of Dental Schools believes firmly th at unless specific 

action is taken immediately and with vigorous purpose, the size and the rat e 

of growth of the problem will reach insurmountable proportions.

The re must be prompt action to provide funds for additional and improved 

dental educational facilities. In addition, there must be provided increased 

financial support for dental schools and dental stud ents to help meet the already 

high and steadily risin g costs of educating dental personnel. Dental educators 

will continue to seek expanded suppo rt from all sources but, in the belief t ha t the 

health of the American people is as surely a national asset as any segment of 

tod ay’s society, the association wishes to urge prompt approval of the programs 

presented in H.R. 4999.

GRANTS FOR CONSTRUCTION OF DENTAL TEACHING FACILITIES

On the basis of all majo r studies of denta l manpower projections, it is 

apparen t that the number of dental grad uate s must be nearly doubled within 

the n ext 15 years if we expect to keep pace with the expanding population and 

the increase in demand for dental services. The accomplishment of this 

formidable objective will demand an immediate increase in the capacity of 

existing institutions and the construction of many new dental schools. It is 

certain that the degree of expansion needed cann ot be achieved with the resources of local and Sta te funds alone ; there must be liberal assistance and 

encouragem ent from the Federal Government if we are to meet this impending 

nation al health emergency.

The American Association of Dental Schools is on record as favoring Federal 

legislation which would provide funds for use in the construction of dental 

teaching facilities. It is felt th at the Federal supp ort should be based on a
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 1 9 5

matching form ula which is realistically designed so that the Federal Government shall supply the major portion of such funds. As a furth er indication of 

the att itu de of dental educators on this im portant potentia l Federal legislation, 

the association emphasizes th at any legislation in this area should include provision for the rehabilita tion of existing ins titu tions as well as the construction 

and equipping of new or expanded dental education facilities.

We are pleased to see that H.R. 4999 makes provision in section 721(c> 

(3 )(B) for the construction of expanded training facilitie s as well as the 

building of new dental schools. The association believes that the investment 

of Federal construction funds in those institu tions which have, over the pa st 

14 years, spent nearly $80 million for the construction and equipping of their 

educational facilities is a sound investment. These schools, th e 47 dental schools 

now in operation have reported plans for nearly $150 million in construction 

expenditures during the next 10 years, if Federal matching fund s are made 

available. The expansion of existing facilities in this amount would provide 

for an add itional 725 dental graduates a yea r by 1970 and would contribute 

considerably to meeting the projected manpower needs by that time.

In addition, the construction plans for existing dental schools during the 

next 8 years would provide training facilities for greatly increased enrollments 

of auxiliary personnel. A recent survey of the dental schools indicates that 

the planned $150 million construction expenditure would permit the training 

of 915 additio nal dental hygienists each year, would increase the production of 

chairside ass ista nts by 714 a year, and would add over 300 more dental laboratory technicians annually. By perfo rming duties for which they have been 

specially trained, these aux ilia ry personnel relieve the dentists of many tasks 

to which he would otherwise have to devote his time, thereby increasing the 

productivity of the dentist. Definitive studies on the impact of d ental aux iliaries 

on the productiv ity of the dentist are still in process, but it is known th at the 

efficient use of a single chairside assistan t can increase the tre atm ent capacity 

of the den tist by about 50 percent. Thus, the training of an additio nal 750 

den tal ass istants a yea r can be expected to reduce materially the number of 

new dental gra dua tes needed by 1975.

The additional manpower which can be expected from the expansion of existing institutions, the increased productiv ity which will inevitably come from 

more effective and broader utilization of auxiliary personnel, and the reduction 

of the incidence of dental disease which can be anticipa ted from the constantly 

expanding research programs will still not, in the minds of responsible autho rities, be sufficient to meet the dental care needs of the population in the years 

ahead. We must find the resources to construct additional dental schools and 

to expand the capac ities of existing institu tions.

The association urges that there be no furth er delay on this section of II.It. 

4999. It is estimated that 3 to 4 years of planning time is requ ired for the 

inau guratio n and construction of a new den tal school. Add to this the 4 years 

required to educate the dental student, and it is obvious tha t those plans which 

are started next yea r will not produce dental practit ioners until 1968 or 1969. 

It is increasingly urgent, therefore, that favo rable consideration be given to 

construction grant legislation which has api»eared in Congress during nearly 

every year of the pa st decade.

Recent studies made by the American Association of Dental Schools and the 

American Dental Association, in cooperation with the Division of Dental Public Health and Resources of the Public Hea lth Service, suggest $6 million as a 

reasonable cost for constructing and equipping a school of dentistry today. 

The association has been acquainted with fairly definite plans for the constru ctio n of three new dental schools, and it is highly probable that the ava ilability of Federal construction grants would encourage action by at lea st four 

other universities which have given some thought to dental education during 

the past 4 or 5 years. On the basis of information prese ntly available , it is 

estim ated that 10 to 12 new dental schools might be established or sta rted 

with in the next 10 years, if legislation such as proposed in H.R. 4999 is adopted.

In final comment on p ar t B of H.R. 4999. “Grants for construction of medical, 

dental, osteopathic, and public health teach ing facilities.” the association would 

like to give wholehearted endorsement to the plan to establish a National Advisory Council on Education for Health Professions. The experience which 

dental education has had with the excellent administrative mechanism in existence at the National Ins titute s of Hea lth suggests that the carefu l selection 

and effective utilization of a National Advisory Council is one of the be st means 

of assuring the proper relationship between the Federal Government and higher
196 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

education. I would also like to record the association’s support of section 728 

(tech nical assistance) and section 729 (planning gra nts for medical, osteopathic, 

dental, or professional public health education programs) as essential parts of 

an effective construction g ran t program.

SC H O LA R SH IP GR AN TS

Close to the top of the lis t of problems facing den tal education today is the 

difficulty of obtaining sufficient numbers of well-qualified studen ts to enter the 

study of dentistry. The following figures show the trend in the number of 

applicants to dental schools during the past 5 ye ar s:

Y ea r

N u m b e r o f 

ap p li can ts

N u m b er

ac ce pte d

A pplican ts

per

ac ce pt an ce

I960 ........................................................... ......... ......... ......... 6,119 3,616 1.7

1959 .............. .. . . . . . . . . . _____________________________ 6.4 98 3,573 1.8

1958 ...................... ......... ................. - ____________ 6,4 69 3,607 1.8

1957 ............ . . . . __________________ 7,2 86 3,600 2. 0

1956 ___ ____________ 7,3 76 3,561 2.1

It will be observed that the ratio of applicants to accepted stud ents has decreased steadily during this period to the point where it reached a 15-year low 

in 1960.

In the fall of 1960 there were 28 dental schools which did not fill their firstyear classes. On a national basis, there were about 164 vacancies in the dental 

schools in the country last fall and there is reason to believe th at this situation 

will be at le ast as serious this fall.

This condition is the res ult of many influences. An expanding economy with 

more scientific and technical fields of employment, a decrease in the number of 

college students until 4 or 5 years ago, and—perhaps most important of all—the 

steadily increasing cost of denta l education, have all contributed to the shortage 

of well-qualified dental applicants. The American Association of Dental Schools, 

along with other agencies of the den tal profession, is engaged in several programs 

of recruitm ent for dental education. The combined investme nt of the dental 

profession on recruitm ent activities this year will amount to thousands of dollars. We are convinced, however, that all of these efforts toward recruitm ent 

will be only p artiall y successful so long as the economic b arr ier to the study of 

dentistry exists for such a large portion of our well-qualified young people.

Den tal education requires a minimum of 6 years of education beyond high 

school: 2 years of preprofessional study and 4 years of d enta l school. At graduatio n, the new dentist must invest at leas t $7,000 for the establishm ent of his 

private office. On the basis of recent information, the college studen t contemplating the study of den tistry must plan to invest a minimum of $22,000 before 

he accepts his first patient—and the national average exceeds $26,000.

There is no way to sta te precisely the number of stud ents who might have 

considered dental education had this formidable economic investm ent not existed. 

We do know, however, that even those students who are enrolled accrue a substa nti al debt by the time of graduation . Sixty-seven perc ent of the dental school 

seniors have an average debt of $4,500, with one-third of these owing more than 

$6,500 by the time they are graduated .

In considering the financial problems of dental stud ents, educators have supported the need for both scholarship and loan funds. Although still inadequate, 

there has been an increase in the amount of loan funds available for students 

of den tistry through such programs as the National Defense Education Act of 

1958 and the Fund for Dental Education, Inc., a nonprofit private agency supported by the dental profession, the dental industry, and other groups interested 

in the denta l health of our people. We do not believe, however, that loan funds 

alone will solve the increasing financial problems of dental students. We do not 

believe that the hea lth professions can expect to recruit the quality of students 

which they must have in the face of increasing scholarship and fellowship support for nearly all segements of higher education in the physical and social 

sciences. We do not believe that the children of families with an annual income 

of six or seven thousand dollars can and will embark on an educational program 

which will cost them 6 to 8 yea rs a nd $22,000 to $26,000 unless they can be assured
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 197

of bo th sc ho la rs hi ps an d loa n as si st an ce w hi le th ey are pre par in g th em se lv es to 

se rv e th e pu bli c.

A t th e pre se nt tim e, sc ho la rshi p fu nds fo r den ta l st uden ts are ex trem el y lim ­

ite d, w ith less th an $600,000 aw ar de d la st yea r by al l den ta l scho ols fo r th eir 

enti re st udent bodie s. This am ou nt w as gra nte d to sl ig ht ly mor e th an 1,200 

den ta l st udents (9 pe rc en t of t he e nr ol lm en t) m ak in g an av er ag e aw ard o f sl ig htly less th an $500. W he n it is re al ized th a t th e av er ag e co st of 4 yea rs of den ta l 

ed uc at io n to da y is ov er $15,000 it is re ad ily appare nt th a t ex is ting sc ho la rs hi p 

fu nds are to ta ll y in ad eq ua te . As an ad ditio nal fa ce t of th is prob lem , I wou ld 

lik e to re tu rn to th e ob se rv atio n th a t th e su rv ey in fo rm at io n whi ch we are 

ab le to ob ta in is ne ce ss ar ily ba sed on th os e st udents who are en ro lled in th e 

den ta l sch ools. It is ob vio us th a t man y of th es e st uden ts are in se riou s ne ed 

of mu ch g re ate r fina nc ial as si st an ce bu t th es e st ati st ic s do no t id en tify th e ex ­

ce llen t st udents an d sc ie nt is ts wh o ha ve been lo st to den ta l ed uc at io n be ca us e 

of th eir in abil it y to carr y th e he av y fina nc ial bu rd en of pr ep ro fe ss io na l an d 

pr of es sion al ed uc at io n.

A la te r se ction of th is st at em en t will show th a t ab ou t $11 % mill ion of th e 

1959 oper at in g ex pe nses of the den ta l scho ols ca me from tu itio n an d fees pa id 

by st udents an d th eir fa m ili es . A si m il ar am ount was prov id ed by S ta te app ro ­

pr ia tion s, ab ou t $6 mill ion came from univ er si ty fu nd s an d th e pati ents wh o re ­

ceive d tr eatm en t in th e clinics of th e den ta l sch oo ls co nt ri bute d nea rly $7 m illion to th e co nd uc t of den ta l ed uc ation. The se p ri vate an d S ta te fu nds in an 

am ou nt ap pro xim at in g $36 mi llion in 1959— a fig ure which is in cr ea si ng ea ch 

yea r—pr ov id ed th e m ajo r p a rt (84 per ce nt) of th e c os t of ed uc at in g denti st s fo r 

th e en ti re po pu la tion of th e United S ta te s, in cl ud ing th e mem be rs of ou r Ar med 

Fo rces th ro ug hou t th e wo rld . An in ve st m en t of ab ou t $3% mill ion a year in 

den ta l ed uc at io n by th e Fe de ra l Gov ernm en t, as prop osed in II.It . 4999, to he lp 

ass ure th e po ss ibili ty of den ta l ed uc at io n to mor e of ou r young, in te llig en t stu ­

de nt s su re ly ca nn ot be co ns idered oth er th an a pr op er part ic ip ati on of our N ation al Gov ernm en t in a cri tica l as pe ct of nati onal w elfa re .

The co mm itt ee is well aw ar e of th e g re at benefit which has been re al iz ed from 

th e s upport w hich suc h ag en cies a s th e N at io na l Scien ce Fou nd at io n, t he N at io na l 

In st it u te s of H ea lth , an d th e Office of Edu ca tion ha ve give n to g ra d u ate s tu dents 

in m an y of th e sc ientifi c disc iplin es. The pr ogra m s of th es e ag en cies are 

de se rv ed ly re ce iv ing in cr ea se d su pp or t fr om Co ng res s. I t is our be lief th a t 

g ra duate ed uc at io n in pre para ti on fo r on e of th e hea lth pr of es sion s, which 

den ta l ed uc at io n su re ly is, ne ed s and de se rv es F edera l as si st ance in th e fo rm of 

sc ho la rs hi ps if we a re to ass ure th e lev el of den ta l ed uc ation, re se ar ch , an d 

se rv ice which we all w an t fo r th e peop le of th is co un try .

The Amer ican Assoc iatio n of D en ta l Sc ho ols give s it s st ro ng su pport to th e 

sc ho la rs hi p gra nts , se ction of II.R . 4999.

COST OF EDUCATION PA YM EN TS

The “Su rv ey of D entist ry ,” to which I ha ve al re ady mad e refe renc e, st ate s 

th a t “lac k of pr op er fin an cin g is th e m os t se ri ous pro ble m of den ta l scho ols 

to da y. ” I feel confiden t th at den ta l ed uc at or s wo uld su pport th is st ate m ent 

w ith h eart fe lt en th us ia sm . If th is st ate m ent is va lid , as I am cert ain it is, it 

wo uld th en see m re as on ab le to su gg es t th a t th e av ai la bil it y of ad eq uat e fin an cing wi ll becom e an even g re ate r prob lem in th e year s ah ea d as th e ex is ting 

den ta l sch oo ls ex pa nd th eir en ro llm en t and as ne w sch oo ls are es ta bl ishe d. I 

wo uld lik e to ci te a few fig ures to id en tify some of th e fina nc ial pr ob lems w ith 

wh ich th e denta l schools are now face d, ke ep ing in mind th a t al l of th es e fina ncial sh or ta ge s a re cert ain to gro w wor se as en ro llm en ts are in cr ea se d—un le ss 

add itio nal op er at in g fu nds can be fo un d pr om pt ly an d in su bst anti al am ou nt s.

In 1958-59 th e mea n sa la ry of all fu ll-tim e den ta l te ac her s w as $8,568, compa re d to th e mea n net incom e of $14,311 fo r all non sa la ried , pra ct ic in g denti st s 

in 1958 (4 ), Keezer, in “F in an ci ng H ig her E duca tion, ” (5 ) est im ate s th a t 

colleg e an d univ er si ty sa la ri es will need to be in cr ea se d by a t le ast 100 pe rc en t 

in th e ne xt de cade, which mea ns th a t th e $15,600,000 sp en t fo r fa cult y sa la ri es 

in 1959 will ha ve to be incr ea se d to a t le ast $31 mill ion by 1970. O th er oj ierating ex pe nses of th e den ta l schools in 1959 w er e re po rted as $27,700,000 an d it 

ha s been es tim at ed th a t th es e ex pe ns es will in cr ea se by a t le ast 50 per cent in 

th e ne xt 10 ye ar s. Thi s wo uld mean an addit io nal need fo r a t le ast $14 mi llion .

Th e follo wing qu ot at io n fro m th e “Sur ve y of D enti st ry ” pre se nts si m il ar 

pr oj ec tion s of th e fina nc ial dilem ma of den ta l ed uc at io n in te rm s of th e co st of 

ed uc at io n fo r a sin gle st u d en t:
198 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

“Based upon projected annual expe nditures of approximate ly $75 million, the 

average total cost per studen t per year to the schools would increase from 

approximately $3,000 in 1958-59 to approximately $5,000 in 1970. This average 

annual cost to the universities of $5,000 per dental studen t appears to be a 

realistic estim ate for the coming decade when it is noted that the average cost 

per student in 1958-59 in the 10 best supported dental schools was approximately 

$6,400. The 10 schools with the lowest cost per studen t avera ged approximately 

$1,860 in 1958-59, and, obviously, these schools are in serious need of financial 

help.

“Actually, a projected basic ann ual operating expense of $5,000 per dental 

student by 1970 may be a rather conservative estim ate. In the academic year 

of 1949-50, the median basic operating expense per stud ent for all 40 schools 

then in existence was $1,316. In 1958-59 the average was $2,967, or an increase 

of 125 percent in 9 years. If a comparable increase were to take place between 

1959 and 1970, the average annual cost per student would be over $6,000” (4).

In 1959, the tota l operating expenses of the 47 dental schools were slightly 

•over $43 million, obtained from the following sources in the indicated amounts 

(4 ):

So ur ce o f I ncom e A m o u n t P er ce nt

S ta te g en er al ap pro pri at io ns ___ ___________________________________________ $12,000,000 27.7

T u it io n an d fees ______________________________ _________________ ____ 11,4K4,OOO 26.5

Clini c in co m e -- _______________________________________________ 6,904,00 0 16.1

TT niv ers ity tran sf er (p ri vate fu n d s)_____________________ - _______ - ___________ 6,3 17, 000 12.3

Res ea rc h gra nts ________ __________________________- ___________ 5,062,00 0 11.7

P ri v ate gif ts _ _______________________________________________________ 1,353,000 3.1

E n d o w m en t inco me ___________________________________________________ 716,000 1.7

D onate d te ac hi ng s er vi ce s___________________________________________________ 374,000 .9

Of the $3,000 a y ear average cost for the education of one stu dent, the stud ent 

paid about $800 in 1959 and the balance came from the sources cited in the 

table above. It is reasonable to expect tha t there will be moderate increases 

in the suppo rt which dental education will receive from Sta te appropriations 

and private sources, although it is generally accepted that the increased financial 

demands which are being placed on all of higher education will make suppo rt 

for all divisions of the university more difficult to secure in the years ahead. 

Dental educators agree unanimously that appreciable expansion of operating 

income should not be expected from clinical operations, and there are few who 

would recommend that the dental studen t be called upon to pay a much greater 

pa rt of the cost of his education. Where are the fund s to be secured to pay 

the increasing costs of dental education and to perm it the expansion of enrollment to which I have referred earlie r in th is statem ent?

The American Association of Dental Schools ha s expressed its belief that the 

Feder al Government has a proper concern to aid in meeting the very difficult 

problems of providing the dental manpower needed by the citizens of the United 

States.

The proposals contained in H.R. 4999 would help but it should be observed 

th at the cost of education payments would represen t only 7 percent of the 

investme nt made in denta l education in 1959 by private and State sources. 

There are, we believe, many excellent examples of the contributions which the 

Fed eral Government h as made and is making in this imp orta nt area of natio nal 

hea lth and welfare. Under acceptable provisions which would assure the continu ed management and control of all aspects of dental education programs by 

the adm inistration of the individual dental schools, the American Association 

of Dental Schools would in principle, look with favor on a program of direct 

Fed eral aid for the operatin g support of the schools of dentistry. In reaching 

thi s policy position, the association has been influenced strongly by the sound 

relations which exis t between the Federal Government and the dental schools 

in the fede rally supported research activities.

The proposal for a cost of education payment to the dental schools contained 

in H.R. 4999 will not solve the financial problems of dental education by any 

means. These fund s will, however, he of material assistance in helping the 

den tal schools to contin ue the level of education which our people deserve and 

expect and to look forward more realistically to the expansion of enrollment 

which must inevitably come. We strongly urge favorable action on the cost 

of education payment program contained in II.R. 4999.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 199

HEALTH RESEARCH FA CILIT Y CONSTRUCTION

The association has expressed its supp ort of the Health Rese arch Fac ility 

Construction program on previous occasions and is fully in accord with the proposals in II.R. 4999 to continue and expand thi s very imp orta nt activ ity. It is 

particu larly gratify ing to note the recommendation for increasing the scope of 

usefulness of the resea rch facilitie s which could be constructed under the proposals in H.R. 4999.

CON CLUSION

In summary, the American Association of Dental Schools is fully in support 

of the several programs proposed in II.R. 4999. The critical needs toward which 

this bill is directed have had extensive study by professional, educational, and 

governmental agencies, with app are nt agreement that prompt, affirmative action 

must be taken if the country is to avoid a crippling shortage of professional 

health personnel. We urge this committee to give H.R. 4999 full support with 

the view of securing its approval d urin g th is session of Congress.

I appreciate the opportunity to testify on this imp ortant legislation in behalf 

of th e American Association of Den tal Schools. I will be pleased to comment on 

any questions which the committee may have.

REFE RENCES

1. l’.S. Departm ent of Health, Education, and Welfare, Office of the Secretary.

“The Advancement of Medical Research and Education Through the Department of Health, Education, and Walfare : Final Report of the Secretary ’s Consultants on Medical Research and Education, 1958” (The BayneJone s rep ort).

2. U.S. Department of Health, Education, and Welfare, Public Hea lth Service.

“Physicians for a Growing America: Report of the Surgeon General’s Consulta nt Group on Medical Education, 1959” (The Bayne report).

3. Subcommittee on Departments of Labor, Health, Education, and Welfare, of

the Committee on A ppropriations, U.S. Senate (86th Cong., 2d se ss.), “Federal Support of Medical Research” : 1960.

4. American Council on Education, Commission on the Survey of Dentistry in

the United States, “The Survey of Den tistry.” 1961.

5. Dexter M. Keezer (ed.), Fina ncin g Higher Education, 1960-70 (New York:

McGraw-Hill Book Co., 1959), p. 71.

I)r. Burket. I am Dr. Lester W. Burket, dean of the School of 

Dentistry, University of Pennsylvania, and president of the American Association of Dental Schools. The association which I represent 

has a long and consistent record of support of the principles contained in the various legislative proposals for aiding health education which have been introduced in this Congress. Specifically, we 

wish to support H.R. 4999.

Dental educators for several decades have been aware of the need 

for improvement of dental educational facilities and have attempted 

to obtain the funds for these from private and public sources with 

limited success.

The magnitude of the problem is of such a nature and the urgency 

is so great that since the problem of health involves such an important 

national asset, it is our belief that this is a responsibility which should 

be shared by the Federal Government.

Our association is on record in favoring the construction phase of 

H.R. 4999. We are also of the opinion that legislation in this area 

should include provisions for expansion and rehabilitation of existing 

facilities.

You have previously heard testimony that within the next decade or 

15 years, at the most, we must double the number of dental graduates.

It is urgent tha t action be taken now since 2 to 3 years is required 

for the department of a dental school and, as you have heard, 4 years 

more before the first class can be graduated.
200 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

On the basis of information which the association I represent has, 

it is likely th at 10 to 12 new dental schools might be established or 

started within the next 10 years if matching funds were made available.

We also have figures to indicate that, if funds were available for 

expansion of present facilities, we could accommodate 725 more graduates by 1970.

One of the other major problems in dental education which you 

have previously heard is the difficulty in recruiting a sufficient number of qualified students.

During the last 5 years, we have had a continuous group in applicants, from 7,376 in 1956 to 6,191 in 1960. This represents a 15 year 

low in the number of applicants which we have had.

From the number of 6,191, 3,616 were accepted.

You have already heard of the high cost of dental education and 

the establishment of an office so T will not speak to th at point.

T again want to indicate that the social structure from which we 

recruit many of our students is of sucsh a nature that it is impossible 

for them to bear the total cost of the professional education. Loan 

funds are extremely limited from which our students can seek assistance.

Last year there was a total of $600,000 in loan funds available to the 

47 dental schools with an entire student body of approximately 14,- 

000 students. Of this group, 1,668 students received loans from the 

National Defense Educational Act. This is of some assistance. However, T would like to point out that the maximum per year which can 

be obtained under the provisions of NADA is a thousand dollars 

which does little to assist a student who has no other financial resources.

Furthermore, as has been previously brought out by the group for 

the Association of American Medical Colleges, many of our students 

have already used up the maximum sum of NADA money by the 

time they enter professional school.

It is of prime concern to the deans of dental schools tha t excellent 

students have been lost to dentistry because of their inability to carry 

the financial burden of both the preprofessional and professional educational program.

We are particularly concerned about the young man who decide 

against dentistry as a profession because the financial cost of this 

profession, totaling approximately $26,000 by the time they can see 

their first patient, is far beyond their means.

The American Association of Dental Schools gives strong support 

to the scholarship grants section of TT.R. 4999.

T would just like to speak briefly about the cost of educational 

facilities. The recently completed survey of dentistry, of which you 

have a summary, has indicated that the total cost per student in the 

dental schools in 1958-59 was $3,000 and the projected cost to the 

schools in 1970 will rise to $5,000. Of this cost to the institution, the 

student now contributes an average of $800, or less than one-third. 

The remainder is made up from State tax funds, clinic incomes, university transfers, private gifts, and small endowment funds which 

dental educational institutions might have.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 201

The American Association of Dental Schools would, in principle, 

look with favor on the proposal for cost-of-education payment as contained in ILK. 4999 under the provisions which would assure continued management and control of all aspects of administration of the 

individual dental schools.

You have already heard testimony on the health research facilities 

construction and I can only concur with previous witnesses that this 

has been a most useful source of funds for the dental school. It has 

stimulated the faculty and has also permitted us to carry on an educational program which is truly professional in character.

In summary, the American Association of Dental Schools is fully 

in support of the several programs proposed in II.K. 4999. The criti ­

cal needs toward which this bill is directed have had extensive study 

by professional, educational, and governmental agencies with app arent agreement that prompt affirmative action must be taken if the 

country is to avoid a crippling shortage of professional health personnel.

We urge this committee to give II.K. 4999 full support with the view 

to securing its approval during this session of Congress.

I appreciate the opportunity to present testimony on this important 

legislation and particularly in view of the lateness of the hour. Thank 

you very much.

The Chairman. Dr. Burket, thank you very much for your statement. Your complete statement will be included in the record. I 

want to compliment you for the very concise yet very lucid statement of this entire problem. Certainly it is a very fine statement and 

the information will be very helpful to us.

I should like to ask this one question tha t I thought about here 

before but did not ask other witnesses. I think I will ask the Secretary of Health, Education, and Welfare to comment on it, and perhaps if Dr. Anderson is still here he can comment on it, too, or provide 

a statement. I think we should have it for the record. That is about 

the ability of these institutions, whether they are State or private 

medical schools, to provide sufficient operating revenues for these expanded facilities.

You mentioned the fact that, in 1959, the total operating expenses of 

the 47 dental schools was slightly over $43 million. Then you seek 

to indicate the sources from which that sum was obtained.

Now with the expanded facilities tha t are contemplated by this 

legislation, what about the operating costs ?

Dr. Burket. It is our hope that we could meet those from other 

sources.

The Chairman. This bill does not provide for that, as you know. 

Would there be any question in your mind as to whether or not maintenance and operating costs could be provided ?

Dr. Burket. My answer would be an indirect one, Mr. H arris, that 

in the case of the Health Research Facilities Act we have had a sizable 

building paid from those sources in the school of dentistry’ and we 

have found it possible to carry on the cost of the operation of that 

facility.

I think that has been true of other dental institutions. It poses a 

problem in administration, but it is one of those problems that we find 

a solution to in some way.

80014— 62 ------ 14
20 2 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Th e Chairma n. We ll, most everyone says, inc ludin g the Secre tary 

him self, they do not w ant to encroach up on the r ig ht s and prerogatives 

of the institut ion s themselves, they should determine t he ir own policies 

wi th refe rence to the opera tion of the school, the admissio ns, and so

fo rth.

Now we do not wa nt to set up som ething here and in a few yea rs 

you come back and say: “You gave us all th is and now we can not 

op erate it.” I do no t think th at anyo ne has com men ted on th at yet. 

I certa inly think it is a question th at sho uld no t be overlooked.

Dr. Burket. I ag ree with you.

The Chair man. Dr. Anderson, I notice you are holdi ng up yo ur 

hand. Wo uld you like to make a comment on it a t t his time?

Dr. A nderson. I would be happy to, sir, if I may.

Th e association feels th at assistance with op erating expense is and 

will be esse ntial. Th e statem ent we p rep are d a year ago analy zin g the 

pro blems of medical edu cation and ma kin g some recommen dations 

does say th at some Fe de ral assistance with op erating costs will be 

both necessary an d real ly essential.

W e do supp ort th e cost-of-ed ucation prov isio n of H.R . 4999 and feel 

as D r. Tu rner, I think , p ut it very well, t hat this is m ost im po rta nt so 

th at we are n ot faced with the pre dic am ent t hat you spoke of.

I would say, tho ugh, at t he same time we intend and are working 

ha rd to develop fu rthe r op erati ng fun ds fro m all sources. I think , 

in gen era l, it has been eas ier fo r us to get ad ditio na l op erating f imds 

than i t ha s been to g et the large sums that are n eeded at one time to go 

ahe ad with a con stru ctio n pro gra m. But you are q uite rig ht, sir, in 

po intin g out this is sti ll a major problem to find ade quate funds to 

ca rry on our pro gra ms.

Th e C hairman. Did I u nd ers tan d you to say th at th e position th at 

yo ur association ha s ta ken i s that you wo uld expect or ask fo r Fe de ral 

fund s in the o peration of these ins titu tions?

Dr . A nderson. Si r, we feel t hat we made no specific request as to the 

form ula or the amount bu t in our statem ent w’e said th at we felt th at 

some assistance ultim ate ly with the e ducational prog ram th at is to be 

ca rri ed on in the scope and quali ty necessary or desired wou ld be 

needed.

We look on the co st-ofe ducation provision of th is bill as a provision 

fo r some assistance with these op era tin g expenses.

A t th e bo ttom of page 16, lin e 22:

The Surgeon General shall also make cost-of-education payments to schools 

which receive grants under subsection (a ). Such paym ents to any school for 

a year shall be equal tc $1,000 for each of its students who is award ed a scholarship from a gra nt under subsection (a) for such year, but not in excess of the 

number of students determined for such school for such yea r under clause (1), 

(2), (3), or (4) , as the case may be, of subsection (b).

We ar e very much in fav or of t ha t prov isio n o f this bill, Mr. Ha rri s.

Th e C hairma n. Very well.

Dr. Burket. Mr. Har ris , I think for the record th at t he te stim ony 

I g ave i ndicated t hat o ur association, in pri ncipl e, looks with fav or on 

th is proposal fo r cost-of-education pay me nts as contain ed in this bill.

I interpreted yo ur question to ind icate wh eth er for expanded 

fac ilities th at m igh t be available, wh eth er we c ould find an op era tin g 

budget for the exp anded facilities.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 203

The Chairman. I have been under the impression tha t this bill 

has for its purpose primarily to provide construction funds for the 

expansion of present medical, dental, and osteopathic facilities and 

such new facilities as would be desired in order tha t we could meet 

the continuing demands that are made and to provide adequately for 

the people in the years to come.

Am I incorrect about that ?

Dr. Burket. No, sir. That is the main purpose of the bill, as I 

see it.

The Chairman. All right. Now, in order to accomplish that, funds 

provided for construction purposes on a matching basis, No. 1; No. 2, 

for scholarships in order to obtain additional applicants, and increase 

the quality of the applicants by doing so. That is the second purpose, the second primary purpose of the program. It tha t true?

Now, in doing to, the $1,000 for cost of education that goes to the 

medical schools would be a very small pa rt of the total operating cost 

of the school.

Thank you very much. We appreciateyour testimony.

Dr. Burket. Thank vou, Mr. Chairman.

The Chairman. Rabbi Lieberman, our very good friend, a member of this committee, Mr. Friedel, of Baltimore, a city from which 

you come, Rabbi, has been very anxious to get you scheduled here. 

We assured him we would get to you before we concluded, as I 

understand you cannot be here tomorrow.

Rabbi Lieberman. Tha t is true.

The Chairman. So we are glad to have your testimony.

Mr. Friedel. Mr. Chairman, I want to thank you for keeping 

the committee going so late t hat we can hear our real beloved citizen, 

Rabbi Lieberman, who has put in so many months of work on this 

problem. He is not a doctor, he is not a dentist, but he is a public 

spirited citizen and I think you will find his statement very wortny.

STATEMENT OF RABBI MORRIS LIEBERMAN, CHAIRMAN, SUBCOMMIT TEE ON MEDICAL EDUCATION AND RESEARCH, COMMITTEE

ON MEDICAL CARE, MARYLAND STATE PLANNING COMMISSION

Rabbi Liberman. Thank you fo r the opportunity of testifying, Mr. 

Chairman. I come not only as an interested individual citizen but 

also as the chairman of a citizens’ committee which recently completed 

a study of medical education needs in Maryland.

The staff director of th at study is with me and I would respectfully 

request your permission, Mr. Chairman, to have join me at this witness stand, Mr. Marshall Raffel.

The Chairman. You may come around, then.

Did you identify the director?

Rabbi Lieberman. Mr. Marshall Raffel, the staff director of the 

Maryland Committee on Medical Care.

The Chairman. Very well.

Rabbi Lieberman. Mr. Chairman, our committee, consisting of private practicing physicians, medical school faculty members, leading 

industrial executives and businessmen, attorneys, educators, and 

clergymen, was asked by the Committee on Medical Care of the 

Maryland State Planning Commission to examine the State’s needs
204 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

and resp onsibilities for the trai ni ng o f phy sicians. Two of onr conclusions are pa rti cu larly pe rtinent to the bill un der con sideration by 

this committee o f the House of Repre sentatives.

The question was raised this mo rni ng as to why th is expenditure 

should be a responsibility of the Federal Government. Part of the 

del iberations of our com mittee bore heavily upo n th is point.

It was ou r conclusion th at m edical schools, inclu din g those operated 

by State gov ernm ents , a re esse ntia lly natio nal resources. The prop er 

focus for all State s is to p artic ipate in me eting n ati on al medical manpow er requirements. Our grou p felt compelled to adh ere to this 

national persp ective because of six f ac ts :

1. About one -ha lf of the medical schools in the Na tion are priva te 

schools, with no com mitmen ts to meet local or St ate needs for ph ysicia ns; their pro gra ms are gener ally not hamp ere d by State lines and 

residency requirements . The ir graduates mee t natio nal, as well as 

State needs. Bu t es sentially these priv ate schools, as n ational schools, 

forc e us to consider the national problem of supp ly, fo r no State can 

really c alculate its needs witho ut tak ing into account what the p riv ate 

schools can an d will turn out.

2. Schools with a high per cen tage of th eir own reside nts do not 

achieve the objective of kee ping them in the State . One stu dy of 

the Un ive rsity of M arylan d Medical School gradua tes, for example, 

reve als th at only 36 per cen t ended u p in the St ate despite the f act t ha t 

75 or 80 percen t of those grad ua tin g, were originall y Mary lan d 

residents.

3. Some State s can not supp ort a med ical school clinically or economically. The form er is especially sign ific ant. To educate a ph ys ician o f quality req uires e xten sive clinic al reso urces; it requires a wide 

va rie ty of pa tie nts of all ages and with all typ es of diseases. Some 

are as sim ply can not pro vid e this; th ei r po pulat ion s are too hom ogeneous, or too sma ll, to pro vid e the wide ran ge of cases necessary 

fo r a good medical school. Who w ill trai n the physicians they need? 

Th is is a nati onal obligation of the schools in ot her S tates.

4. Th e Arme d Force s require a cer tain numb er of phy sicians, as 

do the Ve terans’ Ad minist ratio n and the De pa rtm en t of He alth, 

Ed uc ati on , and Welfare . Federal needs mu st be met by the e xis tin g 

schools.

5. Few State s can calcula te the full effect of population shifts . 

M arylan d’s population , we expect, will increase to 1975 at a gr ea ter 

ra te than the Nation as a whole. We shall experience a sub stantial 

inmigratio n of people from oth er States. Is Mary lan d responsible 

now for planning to meet the needs of those people? Or is it also 

the responsibility of the State s from which the peop le come? We 

do not believe th at Marylan d shou ld assum e the full burde n of inmi gra tion. Th is fu rthe r confirms the position th at the problem of 

physician supply can be viewed only from a na tio na l view point.

6. Medical schools cannot expand and co ntract with population 

movements. The costly inv estment in ph ysic al plan ts requires a s table 

appro ach to the use of medical school facilities.

These were the fa cto rs which lead us to conclude t ha t medical schools 

are essentially national resources.

Our second conclusion, which is pertinent to th is com mittee’s inquiry , is that finan cial aid is central to the problem of pro cur ement
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 205

and training in medical education. It is central with regard to construction and with regard to student assistance.

These points have been covered extensively in testimony tha t the 

committee has already heard and I should like simply to refer the 

rest of this statement to the record with your permission. But I 

should like to go on to one furthe r point which, to my knowledge, has 

not yet been raised or at least not in the way that our committee has 

analyzed it. This has to do with the need for scholarship funds as 

an incentive to attract more students of better quality to our medical 

schools because of the problem that is now presented by the proportion 

of foreign graduates that is now counted upon to make up and maintain our national standard of 133 physicians per 100,000 of the 

population.

This was a matter of concern to our committee because in the 10 

years from 1950 to 1960 the percentage of foreign medical graduates 

rose very sharply. In 1950, out of 6,002 physicians licensed in the 

United States for the first time, 308 were foreign medical graduates, 

a ratio of 1:19.5. In 1960 out of 8,030 physicians licensed to practice 

lor the first time, 1,419 were foreign medical graduates, a ratio of 1 :5.7.

It was a matter of grave question to our committee whether our 

country should rely upon this great proportion of foreign physicians 

in meeting our own medical needs because of the great variability of 

factors involved in the total picture.

It is questionable whether the nations abroad will continue to 

finance their medical schools to train doctors for foreign use.

It is questionable whether the political, economic, and cultural 

leadership of the United States or of the other nations will fail to 

make those homelands sufficiently attractive to their medical graduates to discourage immigration.

It is not our suggestion that this immigration in any way be stopped. 

On the other hand, we do not believe th at it is in the best interest of 

our Nation to be so dependent upon foreign medical graduates.

We should aspire to maintain the present physician-population ratio 

from domestic sources. Any other course places us in a highly vulnerable position should the foreign situation change, as well it might.

Any other position could create havoc in the event of national emergency, and any other position does not enable us to make our greatest 

possible national effort in world leadership.

Therefore, as a nation we should be graduating more doctors from 

domestic sources in order to be self-reliant and to maintain our 

standards.

We should consider the foreign physicians intake over and above 

our domestic turnout as a plus factor which can be used advantageously, for despite anticipated medical advances and more efficient 

modes of practices, the demand for medical services and use of medical services will rise generally as our population ages, as health 

insurance becomes more comprehensive and more available, and as 

our economy advances the higher standard of living leading our people 

to spend and to need a higher standard of medical care.

For these reasons, therefore, Mr. Chairman, it is the view of our 

committee tha t this bill which is before you here is one of the utmost 

urgency and that its passage in the nearest possible futu re would be 

greatly advantageous to the welfare of our country.
206 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

The Chairman. Thank you, Rabbi Lieberman, for your statement. 

Your complete statement will be included in the record.

(The complete statement referred to follows:)

Statem ent of R abbi Morris Lieberm an, Cha ir man , Subcomm ittee on Medical

E ducation and R esea rch

Mr. Chairman, I am most grateful for the opportunity to appear in suppo rt 

of H.R. 4999. I do so, not as an individual, but rather as chairman of a citizens’ 

committee which recently completed a study of medical education needs in 

Maryland.

Our committee, consisting of private practicing physicians, medical school 

faculty members, leading industrial executives and businessmen, attorneys, educators, and clergymen, was asked by the Committee on Medical Care of the 

Maryland State Planning Commission to examine the State ’s needs and responsibilities for the training of physicians. Two of our conclusions are particularly pertinent to the bill under consideration by this comm ittee of the House 

of Representatives.

First, we concluded that medical schools, including those operated by State 

governments, are essentially national resources. The proper focus for all States 

is to participate in meeting national medical manpower requirements. Our 

group felt compelled to adhere to this national perspective because of six fa ct s:

1. About one-half of the medical schools in the Nation are p rivate schools, 

with no commitments to meet local or State needs for physicians; their 

programs are generally not hami>ered by State lines and residency requirements. Their gradua tes meet National as well as Sta te needs. But essentially these private schools, as national schools, force us to consider the nation al problem of supply, for no State can really calculate its needs without taking into account what the private schools can and will tur n out.

2. Schools with a high percentage of the ir own residents do not achieve 

the objective of keeping them in the State. One study of the University 

of Maryland Medical School graduates, for example, reve als that, only 

36 i>ercent ended up in the State despite the fact th at 75 or 80 percent of 

those grad uating were originally Maryland residents.

3. Some States cannot support a medical school clinically or economically. 

The form er is especially significant. To educate a physician of q uality requires extensive clinical resource s: it requires a wide variety of patients 

of all ages and with all types of diseases. Some a rea s simply cannot provide th is ; their populations are too homogeneous, or too small, to provide 

the wide range of cases necessary for a good medical school. Who will trai n 

the physicans they need? This is a national obligation of the schools in 

other States.

4. The Armed Forces require a certain number of physicians, as do the 

Vete rans’ Administration and the Depa rtment of Health, Education, and 

Welfare. Federal needs must be met by the existing schools.

5. Few States can calculate the full effect of population shifts. Marylan d’s population, we expect, will increase to 1975 at a gre ate r rate than 

the Nation as a whole. We shall experience a sub stantial in-migration of 

people from other States. Is Maryland responsible now for planning to 

meet the needs of those people? Or is it also the responsibility of the 

Sta tes from which the people come? We do not believe that Maryland 

should assume the full burden of in-migration. This furth er confirms the 

position that the problem of physician supply can be viewed only from a 

national viewpoint.

6. Medical schools cannot expand and con trac t with population movements. The costly investment in physical pla nts requires a stable approach to the use of medical school facilities.

These were the factors which lead us to conclude th at medical schools are 

essentially natio nal resources.

Our second conclusion, which is pertine nt to this committee’s inquiry, is 

th at financial aid is central to the problem in medical education. It is central 

with reg ard to construction and with regard to studen t assistance.

Consider the ma tter of construction. We recommend tha t there should be 

established a school of basic medical sciences on some college campus in Maryland. Such a school would provide the first 2 years of medical school training, 

after which the stu dent would tra ns fer to the third-year class of a 4-year medical
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 207

school. Because of dropouts and ease of expansion in the las t 2 years, the 4- 

year schools can often absorb an appreciable number of tra nsfer s at this level. 

Our task now in Maryland is to prevail upon some college to und erta ke the 

responsibility of developing a school of basic medical sciences. Our major 

problem is th at the stron gest colleges to hand le such a gra dua te program are 

all private, nongovernmental institutions. Pri vate colleges, as you well know, 

are in severe financial straights. Our ability to achieve the objective will have 

a dire ct bearing on the level of support which can be secured from various 

sources for construction and equipping of the required facilities. In our view, 

II.R. 4999 will greatly facilitate the development of app ropriate facilities to 

help Maryland do its pa rt in meeting the national need for physicians.

Consider the ma tter of scholarships. All available data indicates that not 

enough college stud ents are interested in, and not enough are suitably prepared 

for, the study of medicine and graduate study in the medical sciences. The 

high cost of medical education prevents many from considering medical studies. 

The findings of a study conducted by the Association of American Medical Colleges makes this patently clear. Th at study found that medical studen ts pay 

more than twice as much as Ph. D. studen ts for their education and receive only 

one-fourth the financial assistance from scholarships, fellowships, and assistantships. Illu strative ly, that study found th at the average direct cost of medical 

school (living costs excluded) to the medical studen t is about $1,000 a year for 

4 y ears compared to $450 yearly for 4 yea rs for the Ph. D. student. Those cost 

figures ar e now—I believe—more than 2 years old.

When one considers that in other scientific are as the length of training is 

frequently shorter, scholarships fa r more plentiful, the prestige high, and the 

income potential of the gradua te comm ensurate with th at of physicians, we 

can app reciate the need for grea tly augmented scholarship programs to attrac t 

qualified stud ents and to meet thereby the national need for physicians. Maryland’s s tudy committee recommended th at the proposal in H.R. 4999 should be 

the minimal sum appropriated. Medical schools should seek to augment these 

funds from other sources.

Our recommendations were unanimously approved by the committee, by the 

parent Committee on Medical Care and by the Maryland Sta te Plan ning Commission.

I should point out th at no single economic philosophy existed with in our committee. Some were extremely conservative with regard to fiscal policy; others 

were more liberal in the ir outlook. Yet we could all supp ort this bill (H.R. 

4999) for Federal aid to medical schools.' It was not th at we anticip ated th at i t 

would answ er all the needs of the schools. Indeed, we considered it the minimal 

sum necessary, and we strongly encouraged augm entation of the Fed eral effort 

from othe r sources.

But why Federal funds? Federal funds because medical education problems 

are fund ame ntally national in scope and not a ma tter which any one Sta te can 

contr ol; medical schools, even those which are State owned, are essentially na ­

tional res ource s; Maryland’s need—any Sta te’s need—can only be met as the 

Nation’s needs are met. The stimulus for coping with this national problem 

should come from the Federal Government. The various States will then be in 

a more favorable position to provide the solutions.

Again, may I express my appreciation for the opportunity to appear before 

this committee in su pport of H.R. 4999.

Maryland State P la nn ing Com m is si on , Com mi ttee on M edical Care

SUB COMM ITT EE ON ME DIC AL EDUCATION AND RESEAR CH

Rabbi Morris Lieberman, Ph. D., Chairman.

Wa lter A. Anderson, M.D.

E. Clinton Bamberger, J r., attorney.

Rev. Vincent F. Beatty, S.J., president, Loyola College.

Ivan L. Bennett, M.D., professor of pathology, Jo hns Hopkins University .

Henry A. Briele, M.D.

C. Lockhard Conley, M.D., professor of medicine, John s Hopkins University. 

Leon L. Gallin, M.D.

Daniel Z. Gibson, Ph. D., president, Wash ington College.

Ha rry II. Gordon, M.D., head of pediatrics, Sinai Hospital.

John H. H ornbaker, M.D.

Shelby H. Jarm an, businessman.
208 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Page C. Je tt, M.D.

Joh n Wesley King, Ph. D., professor of biology, Morgan College.

Louis A. M. Krause, M.D.

Albert I. Mendeloff, M.D., physician in chief, Sinai H ospital.

Mrs. Lewis Rumford, II, civic leader.

Irvine II. Rutledge, attorney.

Ernes t L. Stebbins, M.D., director, School of Hygiene and Public Health, Johns 

Hopkins University.

Saul I. Stern, businessman.

William S. Stone, M.D., dean, School of Medicine, University of Maryland.

C. T. Scott, general manager, Bethlehem Steel Co.

Fur man L. Templeton, executive director, Baltimore Urban League.

Mrs. John Tucker, civic leader.

Thom as B. Turner, M.D., dean, School of Medicine, Joh ns Hopkins University. 

J. Theodore Wolfe, President, B altimore Gas and Electric Co.

Theodore E. Woodward, M.D., professor and head of Departm ent of Medicine, 

University of Maryland.

Staff Directo r: Marshall W. Raffel, chief, Committee on Medical Care, Maryland State Planning Department.

Maryland State P la nn ing Com mission , Com mi tt ee on Medical Care

George II. Yeager, M.D., Chairman, professor of clinical surgery, University of 

Maryland; School of Medicine, Medical Arts Building, Baltimore, Md. (1962)

E. I. Baum gartner, M.D., 25 Alder Street, Oakland, Md. (1963)

Ha rry II. Gordon, M.D., pediatrician-in-chief, Sinai Hospital of Baltimore, Greenspring and Belvedere Avenues, Baltimore, Md. (1963)

Jam es II. Grove, M. J. Grove Lime Co., Lime Kiln, Md.

Paul A. IIari>er, M.D., p rofessor of public hea lth administration, the Johns Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, 

Baltimore, Md. (1962)

Louis A. M. Krause, M.D., 11 E ast Chase Stree t, Baltimo re, Md. (1963)

Waldo B. Moyers, M.D., 3503 Perry Street, Mt. Ranier, Md. (1963)

Ha rry M. Murdock, M.D., medical director, Sheppard a nd Enoch Pra tt H ospital, 

Towson, Md. (11)64)

Mrs. Lewis Rumford II. 4401 Greenway, B altim ore Md. (1964)

Edward S. Stafford, M.D., vice chairm an, associate professor of surgery, the 

Johns Hopkins Un ive rsity: office: 11 East Chase Street, Baltimore, Md. (1962) 

Sidney II. Tinley, Jr., President, Weaver Bros., Inc., 100 St. Paul Street, Baltimore, Md.

Harvey H. Weiss, executive director, Sinai Hospital of Baltimore, Greenspring 

and Belvedere Avenues, Baltimore, Md. (1963)

John C. Whitehorn, M.D., professor emeritus of psyc hiatry, the John s Hopkins 

University, 210 Northfield place, Baltimore, Md. (1964)

C. E. Wise, Jr., sec reta ry-treasurer, Maryland Farm Bureau, Inc., P.O. Box 520, 

Randallstown, Md. (1962)

Theodore E. Woodward, M.D., professor and head of Departm ent of Medicine, 

University of Maryland, Baltimore, Md. (1962)

Marshall W. Raffel, chief. Committee on Medical Care, Maryland Sta te Planning 

Department, 301 West Preston Street, Baltimore, Md.

The Chairman. Are there any questions ?

Mr. F riedel. No. T just want to thank you for being so kind in 

waiting to hear Rabbi Lieberman.

I would like to have Mr. Raffel leave one of these reports for the 

committee files.

They have done a wonderful job, I think and I believe this report 

will be very helpful to the committee as we go along.

That is all, Mr. Chairman.

The Chairman. Mr. Thomson ?

Mr. Thomson. T have no questions.

The Chairman. Mr. Rhodes ?
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 209 

Mr. Rhodes. No questions.

The Chairman. Thank you very much for your testimony.

Rabbi Lieberman. Thank you, Mr. Chairman.

The Chairman. This will conclude the hearing for today.

The committee will adjourn until 10 o’clock tomorrow morning. 

(Whereupon, at 5:20 p.m., the committee adjourned, to reconvene 

at 10 a.m., Thursday, January 25,1962.)

TRAINING OF PHYSICIANS, DENTISTS, ANI) PROFESSIONAL PUBLIC HEALTH PERSONNEL

THU RSDA Y, JA N U A R Y 25 , 19 62

H ouse of Repr esentative s,

Com mittee on I nterstate and F oreign Commerce,

Washington, D.C.

The committee met at 10 a.m., pu rsua nt to recess, in room 1334, 

New Hou se Office B uil din g, Hon. Oren H ar ris (ch air man o f the committee) pre sid ing .

Th e Chairman. The committee will come to ord er.

We have a gr ea t man y witnesses th at we hope to accommodate to ­

day. The fact t ha t we do have a lot of witnesses, who are representatives of gr ea t organiz ations and asso ciations, as well as ind ivi duals , 

ind icates the trem end ous inter est in th is legi slation.

As I sta ted at th e outset o f these heari ngs, this is a cha llen ge to all 

of us, and the committee has cha llenged those of you who recognize 

the needs in this field and who know the purpo ses and obje ctives of 

thi s prog ram to make a record th at cannot be in any way overcome 

or con troverted .

I am exceedingly well pleased with the record th at has been made 

thu s far. As I say, I hope th at we can accommodate the many witnesses who are here today and those who are to come tomorrow' and 

later. We exp ect to have a com plete and tho roug h reco rd.

I would like to suggest to all witnesses to be as brief as possible in 

the pre senta tio n of their testimony . I would like to encourage my 

colleagues to be as brief as you can w'ith your questions. Ye t we 

wa nt ful l an d complete answ ers to those questions w’hich are up pe rmost in yo ur mind.

I have received a good many com municatio ns from various in stitutions and ind ivi duals which will be included in the record at the ap ­

pr op ria te place.

We are very gla d at t his time to welcome to the com mittee ou r colleague from Rhode Isl and, Mr. Fo ga rty . Mr. Fo ga rty and I came 

to the Con gress at the same time. I have enjoyed thes e 22 years of 

asso ciation in this grea t body. Mr. Fo ga rty is chair ma n of the subcommittee of the gr ea t App ropriatio ns Com mittee ha nd lin g, am ong 

oth ers, the funds fo r pub lic healt h pro gra ms . He h as over the years 

made a gr ea t record for him self in a field th at is so im po rtan t an d 

vital to the p eople of th e U nited State s o f America.

He has given a lot of stu dy and attention to these pro blems, and 

I suppose he is as knowledgeable in this field as any Member of Congress. For th at reason, an d man y othe r reasons, in behalf of the 

committee, Jo hn , let me say we welcome you and we a re glad to hav e 

you here to testify on this problem.

211
212 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

STATEMENT OF HON. JOH N E. FOGARTY. A RE PRES EN TA TIVE IN 

CONGRESS FROM THE STATE OF RHODE ISLAND

Mr. Fogarty. Thank you very much, Mr. Chairman. You may look 

a lot younger than 1 do, but 1 feel a lot older than you this morning. 

My committee is meeting at 10:30, so that means that 1 am not going 

to take much time today. I would like permission to file my statement, and make a brief statement, and then answer any questions that 

1 can.

The Chairman. You may file your statement at this point in the 

record.

(The statement of lion . John E. Fogarty follows herewith:)

Sta te m ent of IIon. J o hn E. F oga rty, a Rep re se nta ti ve in Con gr es s F rom th e

Sta te of R hode I sl an d

I am gratefu l for this opportunity to appear before your distin guished committee in hearings concerning a ma tter of such vita l intere st to the American 

people—medical education and research. It is a pleasure to cite at the outset 

the impressive record of this committee with respect to legislation in these areas, 

and to say a word in praise of your own leadership, Mr. Chairman, in this important and complex field.

The hill before you today proposes desperately needed and long overdue measures to f urther the trainin g of physicians, dentists, and other professional healthwork ers through construction of teaching facilitie s and scholarships, and to extend and expand construction for medical research. While I believe this hill 

to be a thoughtful measure, I am convinced that its provisions are not adequate 

to meet, in a completely effective way, the issues which we face in this area.

I can make this statement with confidence, for the committee which I have 

served since 1948 has studied these problems deeply in connection with appropriatio ns to the Public Health Service. We have witnessed the mounting shortage of physicians, now grown to alarming proportions, ns well ns the problem 

of providing adequ ate physical resources for medical resea rch. I see in this 

bill one possible approach to several issues that my committee has faced.

As you know, I have proposed legislation during the las t two sessions of 

Congress which concerns specifically the manpower need and offers similar solutions to those we are weighing here. I should like to point out that the judgments of the groups I have conferred with in these ma tters correspond very 

closely with those represented in this bill and the Senate’s counterpart, S. 

1072, which in tur n reflect the President’s wishes. My only concern is that it 

may not go f ar enough in meeting the urgent needs of medical education today.

In May 1959 and again in J anuary 1961, I introduced bills before the Congress 

which were designed to authorize a 10-year program of grants for the construction of medical (including osteopathic), dental, and public health teaching facilities. I did so because the Nation’s need for essential healthworkers had already become so acute th at important national groups and expert witnesses 

before m.v committee had urged congressional action. In October 1959 the 

needs were summarized in a masterful document entitled “Physicians for a 

Growing America,” a report by consulta nts to the Surgeon General under the 

chairmanship of Mr. F ran k Bane.

Th at distinguished consultant group—composed of 22 non-Federal leaders in 

medicine, medical education, and related fields—affirmed th at the prevailing 

ratio of physicians to population must be maintain ed in order to protect the 

hea lth of the people of the United States. “To achieve this,” and T quote Mr. 

Ban e’s tr ansm itta l letter to Surgeon General Burney, “the number of physicians 

gradua ted annually by schools of medicine and osteopathy must be increased 

from the present 7.490 a year to some 11,900 by 1976—an increase of 3,600 

gra duate s.” More than 2 years have passed since that statement was written. 

And the statemen t voiced a problem that was alre ady one of national concern.

It was clear to the consultant group that the country ’s need for physicians 

would requ ire an immediate and strenuous program of action by the Nation as 

a whole. Medical care, teaching, research—activities of such magnitude and 

far-reac hing importance—demanded no less. The group expressly stated tha t 

the Public Health Service must assist in every way possible in planning and
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 213

implementing such a program. With respe ct to education al facilities, the report makes th ese recom mendations:

“Probably the greatest immediate obstacle to expanding the Nation’s medical 

educational capacity in existing schools and in the development of new schools 

is the problem of financing the needed physical facilities. In addition, many 

schools are beset by problems of atte mpting to carry out teaching activities in 

overcrowded and obsolescent buildings * * *.

“The consultant group is convinced that the Nation’s physician supply will 

continue to lag behind the needs created by increasin g population unless the 

Federal Government makes an emergency financial contribution on a matching 

basis toward the construction of medical school facilities. Only with such a 

Federal stimulus will adequate funds become available for needed construction.”

Acting in the light of these recommendations, I proposed at the beginning of 

this Congress the Health Educatio nal Facilities Construction Act of 1961 

(II.R . 27). The bill before us embodies the essential principles of that proposal. I should like, however, to see it provide for use of a portion of the 

funds to mainta in the new facility when deemed necessary by the institution.

The Federal Government, while aidin g the construction of medical research 

and hospital facilities, has neglected medical education, which is basic to both 

efforts. If the supply of physicians is to be increased, and if the full value of 

the Federal investment is to be realized, Fed eral supp ort must be given to the 

construction of facilities for medical teaching.

I should like to ask the committee to give furth er consideration to means for 

stre ngthening the financial underpinning of existing and new schools. In 

January 1961 I introduced the Professional Health Tra ining Act, which would 

provide 10-year supp ort to medical and dental schools in the form of block 

gra nts plus an additional amount based on the number of studen ts enrolled. 

Specifically, that legislation, II.It. 3276, would auth orize basic grants of .$100,000 

a yea r to each 4-year school, or $25,000 a yea r times the number of yea rs of 

training provided. An additional $500 would be paid to each school per student 

enrolled, plus $500 for each studen t in excess of past enrollment.

While I do no t believe that this is the only reasonable basis for cost-of-education payments, it does indic ate the order of magnitude th at we should aim at. 

The bill before you would provide limited payments based on the number of 

stud ents receiving scholarships at each institution. But the amounts involved 

are much too small. Accordingly, I would urge th at this committee provide 

more adeq uate operating-cost supp ort tha n is now proposed for these schools 

in II.R. 4999.

In Janu ary 1961 I also introduced, for the second consecutive year, a bill 

proposing that the Federal Government ass ist top quality young people to obtain the medical education necessary to serve the Nation’s hea lth needs (II.R. 

3438). Again, I had aimed at this tremendous national problem—the swiftly 

developing shortage of physicians, dentists, and other health workers. The 

objectives of that legislation, to be entitled “The Medical and Dental Student 

Scholarship Act,” are also incorporated in the present bill. The method for 

distrib uting the scholarship funds, however, differs in these two proposals. I 

favo r the more equitable distribu tion through Sta te governments, as presented 

in H.R. 3438.

The shortage of physicians are recently called to our atte ntion in a very 

dramatic way. More than 7,000 foreign-trained doctors are serving as inte rns 

and residents in the hospitals of this country. Certainly, we welcome qualified 

physicians from abroad who wish to study and practice here. But the fact 

that many are not qualified was revealed by exam inations of the Educatio nal 

Council for Foreign Medical Graduates. Now I hold this to be a symptom of 

the serious crisis in hospital medical care. We are simply not traini ng enough 

doctors in the United States to meet our growing demands for medical services. 

Young doctors from foreign coun tries are needed to fill the gai>—though it is 

a time to be offering the benefits of our advanced medical knowledge and technology to peoples of other lands.

Let me review once more a few pertinent facts. The number of college graduates throughout the United States is increasing sharply each year. But the 

number of applican ts to medical and dental schools is actually falling, and the 

average qua lity of those accepted, as judged by their previous grade s, shows a 

marked decline. The reasons for this situatio n are plain enough if you look 

at the prac tical problem confronting an outstand ing studen t at the point of 

selecting his carrer. Unless he is in a very exceptional financial position, the 

road to a medical career will be discouraging if not impossible.
214 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

After completing 4 years of college, he must und erta ke ano ther 4 years in 

medical or dental school at an average cost of over $11,000. Add to this his 3 

yea rs of hospital training at a pay th at falls short of bare living expenses, and 

he is nea rly 30 years old when he starts to earn a living. Moreover, a third of 

all graduates are over $2,000 in debt when they finish medical scho ol; 17 percent have debts of $5,000 or more at that point, with yea rs as inte rns and resi 

dents still ahead.

By contrast, the prospects of this promising studen t as he surveys the requireme nts for such fields as physics or electronics are fa r more attr active. In 

4 years he can e arn a l'h. D. degree in a science, aided thro ughout by substan tial 

fellowships. While the sciences I have mentioned are also essential to our 

Nation at this time, and should, of course, be stim ulated in every way possible, 

the fac t remains that comparable assistance has not been made available to 

medical and dental students. The young man or woman considering a care er in 

science or medicine does not have an equal choice among fields. And unless 

thi s situ atio n is corrected, the health of the American people will surely suffer

Legislation is required that would help overcome the financial barrier to 

medical and dental education through a program of scho larship grants for the 

supp ort of talented students on the basis of ability and need. Obviously, such 

payments would not make the atta inm ent of a medical or den tal degree in itself 

a less strenuous task, for nothing can be done to lighten the burden of study 

required to equip a young man or woman for these professions, which demand 

the highest order of ability and dedication. But such paym ents could be of real 

value to students in financial difficulty, to the schools themselves, and to the 

Nation as a whole.

At this point, gentlemen, I should like to call to your attention a letter I 

wrote to Presiden t Eisenhower in April of 1960—my fou rth letter to him on 

the subject of the national shortage of health manpower. 1 stated in that letter—and I repe at to you—tha t we must act promptly to check the growing 

shortage of physicians and other health personnel. Such present programs 

as the Hea lth Research Facilities Construction Act, the Hospital Construction 

Act, and the National Defense Education Act clearly dem onstrate that construction of facilities and provision of scholarships for higher education are appropri ate Federal undertakings in are as of recognized need. Why are such program s lacking in the vital are a of medical education?

I w as compelled to s tate a t tha t tim e:

“Our real problem is not lack of economic capacity. It is lack of leadership 

and of a political philosophy that will capitalize boldly and affirmatively on the 

oppo rtunities that are before us. It is not irresponsible to recommend stre ngt hening good Federal programs.

“Irresponsibility consists of failur e to look at problems squarely, to look at 

our national capacity to solve them, and to take a considered line of constructive 

action.”

It is my impression t ha t the climate has changed since I made those comments 

It is still necessary, however, to rei»eat this sta tem ent: “I do urgently believe 

that w’e must enact legislation and provide appropriations to meet the crisis 

posed by the threa t of a shortage of 15,000 physicians and an equal number of 

dentists by 1975, and the resulting impairmen t of th e level, quality, and distribu ­

tion of hea lth and medical care services.”

In addition to expanding the capacity of the schools and aiding students, the 

legislation we are considering here is designed to extend, expand, and improve 

the existing program of resea rch facilities construction grants. This is a program t ha t I have consistently supported since its inception in 1956. The present 

bill, however, would introduce certain much needed amendments to the original 

legislation.

Since 1956 Federal supp ort for medical resea rch and research training has 

undergone majo r changes. Fund s c urrently available to the National Institutes 

of Health for these purposes tota l $526 million, or 10 times the 1956 level. 

Private sup port for medical research has doubled over the same period. In s harp 

contr ast to these increases, funds for research construction gra nts were frozen 

by s tatute to $30 million a year until 1961. Another way to view this change is 

to consider the funds for research facilities construction, in 1957, the year of the 

first appropriation, in relation to other program components. Extramural funds 

in 1957 w ere distribu ted 60 percent for research grants, 20 percent for research 

trai nin g, and 20 percent for construction grants. In fiscal year 1962 this distribution is 70 percent for research projects, 25 percent for research training, and 

only 5 percent for construction. In other words, investment in physical resources
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 215

for resea rch has dropped from one-fifth to one-twentieth of NIH extramu ral 

fund s over this period.

Thus the supp ort of research is badly out of balan ce with the support of 

research resources. The research facilities program does not provide a solid 

physical base for research project support and the training of research manpower as now budgeted. At a time when a growing number of highly traine d 

medical scientists are embarking on the ir caree rs, a major national deficit is 

developing in the availability of modern facilities in which to work. This is 

the gre atest single obstacle to the advancem ent of medical researc h in this 

country.

As I view the situatio n, several modifications are necessary in the research 

construction a uth ority a s it now stands :

Fir st, an extension of the program. I think it should be extended for at lea st 

5 years.

Second, an increase in the appropriation auth orization. The present ceiling 

of $50 million which was voted last y ear for a 1-year period, although a welcome 

increase over the previous auth oriz atio n of $30 million, is still inadequate.

Third, a change in the matching requirements. The present 50-50 matc hing 

requirem ent limits th e effectiveness of this program.

The bill now before the committee approaches these needs in wh at I believe 

is a conservative way. It calls for a 3-year extension of the program at an 

ann ual authorization of $50 million. This, however, is hardly comm ensurate 

with the grant applications, approved and pending, which total over $100 million, plus additional evidence of intent now on file in the Public Health Service. 

I urge that the committee consider both extending the period of authoriz atio n of 

this program and increasing the ann ual appropriation to at least $75 million.

The bill in its present form takes no recognition of the problem presented by 

the current 50-percent matching restriction. Many insitutions with strong 

resea rch capabilities but lacking rich endowments are now unable to build the 

facilities commensurate with their research potential. It is my firm belief that 

some provision should be made to permit Federal match ing in excess of 50 

percent in cases where institution al research needs and capa bilities are strong 

but financial resources inadequate.

I am fully in accord with the provision of this bill which would permit the 

Surgeon General, in cases of special national or regional need, to support or carry 

out research construction without matching requirements. I believe this prov ision to be a sound one. However, it does not meet, nor was i t intended to meet, 

the needs of poor institutions in respe ct to the construction of resea rch facilities 

for the ir own use.

One other clause in the legislation th at I should like to say a word about is 

section 725, which spells out the fram ework for a National Advisory Council on 

Educatio n for Hea lth Professions. This, again, closely parallels a provision that 

my own committee has proposed. The bill is quite specific as to requirements 

for appointment, the role of the council in policy development, and its relationship to the National Advisory Council on H ealth Research Facilities. The cre ation of this Council—composed of eight autho rities in education and four civic 

leaders, with the Surgeon General and the Commissioner of Education as ex officio 

members—would insu re the kind of expert, imp arti al adm inistration of the act 

th at has alw ays characterized the su pportive programs of the Nation al Institut es 

of Health.

I wish to dwell for a moment on the thoughtful structur e of these advisory 

groups and the rela ted technical study sections, which I believe embody the 

highest principles of government in a democracy. The combination of a utho rit ative non-Federal leadership with responsible Federal adm inistra tion has made 

possible th e full participation of the scientific and academic world in the Fede ral 

support of medical research and research training. Scientists have been the 

first to assure me th at scientific freedom has been maintained. Heads of unive rsities and medical schools att est that academic freedom has been maintained. 

And earlie r fea rs that this would not be so, even among some who serve the people through government, have proved groundless. I believe we owe this in larg e 

measure to the sincere efforts of academic leaders and the Public Health Service 

to develop a prod uctiv e p artnersh ip—one th at now stands a t the threshold of an 

era in which medical research can prev ail unfettered by bur eaucratic and economic bar riers. I have no doubt whatev er th at th e same efforts would rule with 

respect to the Fed eral stimulus and aid to medical resources to he provided by 

this bill.
216 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

In summary, then, we have before us an opportunity to tak e prompt and 

affirmative action that would help ave rt a serious decline in medical manpower 

within the next few years. The legislation, with the modifications I have outlined, would atta ck this problem in several ways, none of which would be 

fully effective without the others. First , it would give support to the construction and improvement of medical and dental teach ing facilities. Second, it 

would provide basic supp ort for institution al operations. Third, it would 

make scholarships available to the most deserving students, with a view to 

raising the level and quality of grad uate s. Fou rth, it would extend, expand, 

and improve the present support of medical researc h construction, with pa rticular attention to special regional needs. Finally, it would do all this within 

a proven structure that should allay any doubts as to the preservation of those 

freedoms so real and essential to the advancement of science and education.

I urge you, gentlemen, to lend your wholehearted supp ort to legislation for 

these purposes. With the modifications I have suggested, II.It. 4999 would provide much-needed support for the essential process of medical education. The 

problems it would help to resolve are among the most pressing that confront our 

Nation today.

Mr. Fogarty. I appreciate the opportunity to be heard first this 

morning so that I can get back to our Appro priations Committee, but, 

first, I would like to say and reiterate what the chairman has said. 

We both came to Congress 22 years ago and we have been working 

close together on matters tha t affect the health of the people of our 

country.

I can think of many areas, like the Hill-Burton hospital law, and 

the health facilities law, and others that you and your predecessors, 

Percy Priest, and Mr. Wolverton from Xew Jersey, have helped pass. 

You certainly have had some wonderful chairmen of this committee 

and I think you are one of the best because you see eye to eye with 

most of us who want to improve the health of all the people of our 

Nation.

I just want to say categorically that I am here this morning to support the administration bill. 1 have introduced legislation myself 

on these three issues, but I am here this morning to support the administration bill in its entirety.

I am pleased to know th at the present Secretary of H ealth, Education, and Welfare, Mr. Ribicoff, appeared before your committee and 

gave this bill his unqualified support. I was also very pleasantly 

pleased to see another former Secretary of Health, Education, and 

Welfare, Mr. Marion Folsom, come into the room this morning. I 

have said this on more than one occasion: I think he was one of our 

great Secretaries of Health, Education, and Welfare, even though he 

served under a Republican administration. When I first met him 

years ago right after the war he was serving as a consultant to the 

Colmer committee at that time, a postwar economic policy and planning committee. He has been one of the foremost men in this field 

and I am pleased to see that he is here today to testify in favor of 

these bills.

I don't think I have to go back all over the statistics. T think those 

who favor the bills have given you all this. You know th at we have 

a real shortage of doctors in our country and in the next 10 years it 

could be a real health problem for our Nation unless we take action on 

this type of legislation.

We know the number of additional doctors tha t are needed just 

to keep up with the growing population in the next 15 years. We 

know tha t it takes 10 years from the time of enactment of legislation 

to graduate the first graduating class from a dental school, or a
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 217

medical school, or a school of public health, and this bill takes in all 

three, dental schools, medical schools, and schools of public health. 

It will take a 10-year period in order to get our first graduating class.

It is distressing to me, Mr. Chairman, to find that we have 7,000 

foreign doctors practicing in this country today, and every member of 

this committee who has a mental institution in his district knows that 

unless we had these foreign doctors, our mental institutions would 

not be manned today. In my own State many of those who come from 

foreign countries and who are doing a good job in their own way in 

these mental institutions are taking up the so-called slack that exists 

at this present time.

Then a year ago it was found tha t many of these foreign-bom 

doctors were not qualified or did not meet the qualifications of the 

American Medical Association and as a result have not been allowed 

to practice in tha t particular State.

I am also happy to note th at the American Medical Association is 

supporting particularly the construction part, of the bill, although 

they may have some reservations on other parts.

I understand the American Dental Association is supporting the 

bill in full, tha t the schools of public health are supporting all three 

phases of this bill, and that the American Hospital Association, I 

was just told by one of their men this morning, is supporting all three 

phases of the bill.

I think we have more public support today for this kind of legislation than we have had in the past 8 or 10 years, and I think tha t 

speaks well for this kind of legislation. The only thing I can say to 

you is that I hope that, you will take action on the three phases of the 

bill and give Congress a chance to vote on it. When the bill is enacted 

into law I will guarantee to you tha t I will do everything I can to get 

Congress to appropriate the necessary funds to put this legislation 

into action.

There is one point tha t I would like to make. I have served on the 

Appropriations Committee now for 16 years and have listened to our 

governmental witnesses and hundreds of outside doctors from almost 

every State in the Union, who are specialists in their field, talking 

about the necessity of doing something in this area. Almost without 

exception every doctor who has appeared before our committee in 16 

years has talked about the shortage of facilities, the shortage of 

trained personnel, and the shortage of medical personnel. They are 

practically unanimous in it.

There have been four or five studies made by nongovernmental 

experts in this field, the last the Bane report that spells out very specifically the shortage tha t exists today, and what must be done in the 

next 10 or 15 years in order to avert a health breakdown in our country.

However, many Members of Congress criticize medicine and dentistry because they are not happy with the availability of medical 

and dental care. There are complaints, and I am sure you have heard 

the same, about the waiting periods for an appointment and about 

what some people think are too high fees. It is an ordinary thing to 

wait, 2 or 3 weeks to get an appointment with the dentist today, and I 

might say in the field of dentistry I saw figures the other day where 

we used to have about 58 dentists per 100,000 in our country. We 

are down to 46 dentists now per 100,000 people in our country. Unless

80014— 62----- 15
218 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

we take some action we are going to get fewer and fewer dentists and 

not more. These people are appearing before Congress telling us 

what must be done to ease the situation by increasing the supply of 

health manpower and 1 think we ought to listen to them because they 

are experts in their field.

In my opinion if Congress does not pass this bill this year it will 

be the same as announcing that we don’t believe there is a shortage 

of these essential health services today and we don’t believe there will 

be a more serious problem 10 years from now.

I say this because 1 sincerely believe, as do other experts in this 

field, that only Federal financing can help solve this problem, and, 

Mr. Chairman, I am not concerned about Federal control of any kind 

We have had Federal aid to education for over a hundred years in 

all the land-grant colleges in our country. We have been supporting 

almost unanimously the hospital construction law for these so many 

years th at you have been so active in having the act extended without 

any complaints of any kind of any type of control.

We are giving direct Federal aid to medical education now. In 

our committee we are giving grants to every one of the 4-year medical 

schools to teach in the area of cancer, and heart, and in about half of 

these schools giving teaching grants for mental health, and never 

have we had one complaint from the American Medical Association 

or any group of medical or professional people in this regard.

In the field of vocational education, th at is history. It is one of 

the finest examples 1 think of Federal aid to education tha t we have 

and I have never heard any one in my 22 years in Congress ever complain about this system of helping to educate the youth of our country.

I have much more in my prepared statement, but I think T better 

stop now with that. I just want you and your committee to know 

tha t I am wholeheartedly behind this. I think it is a necessity. I 

think that if we don’t take action we are going to do the people of this 

country a great deal of harm. We are not going to provide for them 

the doctors to give them decent medical care in the next 10 or 15 

years because of the increase in the population.

I will be very glad to answer any questions if there are any members of the committee who would like to ask me any questions.

The Chairman. Thank you, Mr. Fogarty, for your statement with 

reference to this legislation. I am sure there could be many questions 

from members of the committee. However, we do appreciate and 

understand your situation and certainly your time problem now in 

having to go to your own committee. There may be a question or 

two that some member might have.

Mr. Friedel ?

Mr. Frieiiel. To save time I am not going to ask any questions 

but I do want to compliment our colleague, Mr. Fogarty. He has 

always been in the forefront for public health and medical research 

and I knew it would be interesting to listen to him.

The Chairman. Mr. Younger?

Mr. Younger. Just one question, Mr. F ogarty. I know how hard 

you have worked for the appropriations for HEW each year and 

very effectively. The other day when the Secretary was here he 

was asked alxmt the reduction of the expenditures of HEW and he
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 219

said, if I recall his testimony, that they had withheld at the President's request some $102 million out of the appropriation.

I asked him about tha t reduction and he said that Congress gave 

them more than they asked and more than they could intelligently 

spend. Do you want to comment on that, because 1 think one of the 

reductions was made in the cancer research ?

Mr. Fogarty. I have publicly stated my position. I think he is 

entirely wrong. I think i t is one of the biggest mistakes he has made 

since he has been Secretary of Health, Education, and Welfare. Congress (lid not appropriate more than we could spend. We have 

scientifically approved projects now that could be paid that are not 

going to be paid, especially in the field of health, where they have 

reduced the budget by $60 million, and it is going to hurt al l- ri ght 

down the line. It was an across-the-board cut. I don’t agree with an 

across-the-board cut or meat-ax approach, and tha t is how this cut 

was made.

In other areas, in the Food and Drug Administration, for example, 

they went even below the Eisenhower budget. In the field of vocational rehabilitation, they cut back, and, Mr. Chairman, in this coming 

appropriations for the coming year, they are cutting back substantially 

the hospital construction funds for 1963, and we hope to remedy that.

We hope, Mr. Younger, to correct the impression that Mr. Ribicoff 

has left and I do not believe that he is right. I believe he is wrong and 

I have stated that categorically just as clearly as I can. I think he has 

made a real mistake in this area by cutting back these funds. There 

are going to be approved projects that cannot be met in this fiscal year 

of 1962 unless he or the President releases some of the funds that they 

have put in reserve. Do I make myself clear ?

Mr. Y OUNG ER. Yes, indeed. I am glad to get that of record.

The Chairman. Mr. Schenck ?

Mr. Sciienck. Mr. Chairman, I don’t want to take the time of our 

colleague and friend, Congressman Fogarty, except to just agree and 

share his views and opinion in his statement about the sendees.

Phe Chairman. Would there lie any further questions?

Mr. Rhodes. Mr. Chairman, first I want to join with you and our 

other committee members in paying a tribu te to our colleague, Congressman Fogarty, for the record that he has made in this field. The 

people of our country are deeply indebted to him for his contributions 

to the cause of public health and seeking the cause and cure for crippling and killing diseases.

T feel that because of his untiring efforts and dedicated public service there are many citizens in our country who are well and alive today 

who otherwise would have suffered crippling diseases or death. His 

support for this legislation I feel is strong evidence of the merit and 

need for the legislation proposed in IT.R. 4999. Because of Mr. 

Fogarty's experience and knowledge about this legislation I would like 

to have for the record his views on a few questions which I would like 

to ask at this time.

Mr. Fogarty, I wonder if you would mind telling us why you believe 

the Federal Grovernment has an obligation to participate in educating 

health personnel ?

Mr. Fogarty. In my opinion, Mr. Rhodes, this is a national problem and not a State problem. Every time a disease breaks out, whether 

it be in Mississippi, or Pennsylvania, or New York, the Public Health
220 TRAINING OF PROFESSIONAL PUBLIC HE ALTH PERSONNEL

Service moves in, the y don’t, wait, a nd in this way it is a na tional prob ­

lem and unless the Fe deral Government tak es the lea d in prov idi ng 

finan cial assistance t o thes e schools, these schools are no t going to be 

bu ilt and these doc tors are not going to be gradua ted .

Th ere is o nly one way ar ou nd it. The pr ivate fu nd s are dr ying up. 

Ev ery medical school dean in the country will agree wi th th at sta tement. I don ’t know of one th at disagrees.

Mr. R hodes. Do you believe, Mr. Fo ga rty , th at if th is bill were 

passed and it pro duced the expected expansion, the schools would be 

able to opera te on th ei r own fro m th at po int, or do you th ink th at 

Congres s would have to p rov ide a continuin g ope ratin g sub sidy ?

Mr. F ogarty. No, I do not. I th ink the ho sp ita l c onstruction la w is 

a good exam ple. Tha t has been in effect now f or 12 or 13 ye ars and the 

same question was raised whe n the hospital construction law was 

passed by Congress. W ha t a bout 10 or 15 years f rom now ? Will the 

Fe de ral G ove rnm ent be called upon to su pp ort these hospitals?

Th e chai rman of o ur approp ria tio ns com mittee has r ais ed that questio n conti nually with me, but we have no evide nce of any kin d at this 

tim e in the h istory of the Hi ll- Bu rto n law th at th e Fe de ral Governme nt h as been c alled upon to su bsidize any of these h ospit als bu ilt with 

Hi ll- Bu rto n funds.

Mr. R hodes. W ha t is y ou r fe eling about loa ns to medical and denta l 

stu dents with a forg iveness fea ture ava ilab le to the graduates who 

pra cti ce in c ritica lly needed are as or in public he alth assignm ents fo r 

sta ted periods of time ?

Mr. F ogarty. T testified in b eh alf of t he bi ll and th e bill calls fo r a 

sch olarship pro gra m, bu t there are peop le in the country who think 

th at maybe a loan prog ram wou ld be be tte r th an a sch ola rsh ip pr ogram. If th at was t he des ire of the comm ittee, I w ould n ot arg ue with 

the committee.

I f the y decided th at a loan program was be tte r th an a sch olarship 

prog ram I wou ld go alo ng w ith the loan prog ram an d I think if we 

ha d some pro vision s in a loan program where some of these doctors 

could tak e advanta ge of a forg iveness feature if the y went into areas 

where there are no doc tors ava ilable at th is tim e, th at it would be a 

treme ndous help to areas whi ch are not give n this medical pro tection 

because of the lack of pr op er medical personnel.

Mr. R hodes. Do you agree with some of the witnesses who have 

appeare d before the committee th at the enactme nt of this legisla ­

tio n would produce a larg er pool of well-qualified ap pli cants for 

medical and dental schools ?

Mr. F ogarty. Oh, I don’t thi nk th ere is an y question about it, espe ­

cially if we ena ct the th ree phases of this bill. The medical profession 

tells'm e t hat they hav e m any y oung people th at just can ’t afford to go 

to medical school tod ay because a medical edu cation is the highest 

price d education we have. You go 4 years to college and 4 years to 

medical school, and a couple o f y ears, 3, as an intern e and in residency.

I t is 11 yea rs af te r you leave hig h school before you can even get 

star ted, and then abo ut 30 or 40 perc ent of people going to medical 

schools to day end up w ith a debt of $2,000 or $3,000 an d a cer tain pe rcen tage have a debt of $5,000 to pay off. Man y are not g oin g to medical schools bu t are going on to get their Ph. D. because they can get 

into th e lab or market at a quicke r rat e and get paid for it.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 221

Mr. R hodes. Mr. Fogarty, I am in accord with Secretary Ribicoff, 

the American Dental Association, the school associations, and the 

American Medical Association, tha t the construction funds are the 

ones of greatest need. What do you think is the highest prior ity in 

the medical and dental schools ?

Mr. F ogarty. I would think from what talks I have had with all 

of these professional groups tha t if the committee decided on a p riority system in these three phases of the bill, the one part tha t I think 

everyone agrees on is the construction part, and I think tha t should 

receive the No. 1 priority if a priority system has to be developed by 

the committee. I would hope t hat all three phases of the program 

could be enacted into law, but if we have to take these piece by piece 

or p art by pa rt, the one tha t would receive the overwhelming support 

of all the medical groups and the Congress, I am sure, is the construction part of the bill, and I would not argue with the committee if tha t 

was their decision.

Mr. Rhodes. Mr. Fogarty, you have had considerable experience 

with programs for Federal grants in support of health resources. In 

your experience have there been any complaints about Government 

interference in the teaching process or research programs?

Mr. Fogarty. No, we have had no complaints Decause all of these 

grants are made on the basis of approval by a committee of experts 

in this field who have no connection with the Federal Government 

at all. They go through two steps. First, the grant has to be worked 

up by the individual. It has to have the approval of the dean of 

the medical school. It then goes on to a study section of experts in 

tha t pa rticu lar field. If they pass on it, it then goes before a national 

advisory board. If they pass on it the Surgeon General OK’s the 

application of the gran t of these funds if we have appropriated sufficient funds, so we have had no complaints at all.

Mr. Rhodes. Thank you, Air. Fogarty, for your information and 

your views on this important legislation.

The Chairman. John, thank you very much. I know there would 

be a lot more questions but I know you want to get to your committee 

and we have a lot of other witnesses here to be heard.

Mr. F ogarty. Mr. Chairman, I have one letter from the president 

of Brown University in the city of Providence supporting this bill. 

Brown is one of the oldest universities in the country and I was 

wondering if I could have permission to insert this in the record at 

this point?

The Chairman. Yes, it shall be inserted in the record and, incidentally, I had a wire from Brown University which was inserted in the 

record a moment ago and they can go in together at the same place.

Mr. Fogarty. Thank you very much, Mr. Chairman.

The Chairman. Thank you very much. We appreciate your interest and your testimony.

Air. Fogarty. Thank you.

The Chairman. At this time we will hear from the Honorable 

Alarion B. Folsom. Air. Folsom is a former Secretary of the D epa rtment of Health, Education, and Welfare and is now a member of 

the board of trustees and chairman of the Executive Committee of 

the University of Rochester and director and management adviser 

of the Eastman Kodak Co.

Air. Folsom, let me welcome you back to this committee in a different capacity from which you have been here before.
222 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

STATEM ENT OF M ARION B. FOLSOM, DIRECTOR AND MANAGEMENT

ADVISER, EASTMAN KODAK CO.; CHA IRMAN. EXECUTIVE COMMI TT EE , BOARD OF TR USTEES, UN IVER SIT Y OF ROCHESTER ; AND

FOR MER SECRETARY OF HEA LTH , EDUCATION. AND WE LFAR E

Mr. Folsom. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, it is a pleasure to 

appear before your committee in support of the proposals incorporated 

in H.R. 4999, to increase the opportunities for the training of physicians, dentists, and public health personnel. This is a problem to 

which I devoted considerable study while I served as Secretary of 

Health, Education, and Welfare in the Eisenhower administration in 

1955-58, and since then in my capacity as chairman of the Executive 

Committee of the Board of Trustees of the University of Rochester.

We have made great progress in the fields of medical science and 

health care in recent years, but we have many problems facing us and 

there is still much to be done in both fields.

In pointing out the serious problems we are still facing in the field 

of health care, the group of consultants appointed by the Senate A ppropriations Committee in 1959, under the chairmanship of Boisfeuillet Jones, estimated the annual toll of disease and disability at 

$35 billion.

First, I would like to take up the need for more physicians and 

dentists.

The need for more physicians and dentists presents one of the more 

serious problems. The number of physicians per 100,000 population 

increased from 125 in 1930 to 134 in 1950. There has been practically 

no change in the last 10 years, and we are barely holding our own 

with the increased population. While there was an increase in the 

number of graduates from medical schools from 1940 to 1954, there 

has been practically no change in the last 6 years.

There has been a similar trend in the number of dentists and graduates of dental schools. The number of dentists per 100,000 population 

was 59 in 1930, 62 in 1940, and has been at 57 since 1949. The number of graduates has shown little increase since 1954.

People naturally raise the question as to why, with the great strides 

which have been made in medical science, we cannot get along with 

a smaller number of physicians in relation to population. There are 

several reasons. We now have a greater percentage of the population 

in the very young and very old age groups, each of which requires 

much more medical care than the remainder of the population.

The increase in standard of living has enabled more families to 

obtain health services. The widespread use of hospital and medical 

insurance has resulted in greater health consciousness of the people— 

and a greater purchasing power for health services. There has also 

been an increase in demands for physicians for research work, employment in public health agencies, and in industry.

It is interesting to note that 17 percent of the physicians entering 

practice in the United States in 1959 were educated abroad. It seems 

strange that a country with our position in the world should have to 

depend upon foreign medical schools for so many of our physicians. 

Should not our goal be to train the numlier of physicians we need 

and also our share of the physicians needed by the less well-developed 

countries of the world ?
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 223

THE NEED FOR EXPANSION OF MEDICAL AND DENTAL SCHOOLS

As Secretary, in 1957, I appointed an able group of consultants, 

under the chairmanship of Dr. Stanhope Bayne-Jones, to explore the 

field of medical research and education. They reported in 1958 that 

some 14 to 20 new medical schools will lie needed in the United States 

by 1970 if the existing number of physicians per 100,000 population 

is to be maintained and if sufficient personnel is to be available for 

research work.

Another committee appointed later by the Surgeon General, and 

under the chairmanship of Fran k Bane, estimated that to maintain 

the present physician-population ratio and to provide the necessary 

physicians for teaching, research, public health, and industrial medicine, 11,000 graduates per year would be needed by 1975, or a 3,600 

increase over 1959. It was estimated that, with adequate financial 

aid, existing and planned schools could add about 1,000 graduates per 

year.

I understand tha t the medical schools now estimate tha t existing 

and planned schools might add about 1,700 graduates—still far short 

of the need. The Bane committee indicated tha t the balance will 

have to come from 20 to 24 new 2-year and 4-year schools.

While in the past the construction of medical schools was financed 

largely from non-Federal sources—mainly State and private 

sources—it is now generaly agreed tha t in the future the Federal 

share in the construction of new schools and the expansion of existing 

schools will have to be considerably greater than in the past.

The Eisenhower administration recognized this need in 1956 when 

the President recommended to Congress that $50 million a year be appropriated for a period of 5 years, to be given in the form of grants on 

a matching basis to medical schools for research and teaching facilities. With the matching funds, this program would have involved an 

expenditure of about $500 million over a 5-year period, which would 

have gone a long way toward meeting the need at tha t time for expansion in the medical schools.

In amending the Public Health Service Act tha t year, Congress 

authorized matching grants of $30 million a year for research facilities but nothing for teaching facilities. The research provision covered <3 years and was later extended for another 3 years so that, for the 

6-vear period beginning in 1956, $180 million have been made available by the Federal Government. Last year the act was extended for 

the 7th year and the ceiling raised to $50 million per year.

While these grants for research facilities have been of great help 

to the medical schools, there is still a serious need of funds for classrooms and laboratories for teaching.

It would be necessary for schools to obtain matching funds from 

individuals, corporations, foundations, and State governments. But, 

since 1956, schools have been very successful in obtaining matching 

funds for research facilities, with the supplementary funds being well 

above the matching amount required.

It naturally would be expected that the bulk of the matching fund s 

for the medical schools of the State universities would have to come 

from the State governments. It may also become necessary for the 

States to provide some of the money for the matching funds for the 

private schools.
224 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

From the financial po int o f view, it would, of course, be hig hly desirable if existin g schools could exp and . Th e cost wou ld be much 

less than to s ta rt new schools. In view of th is sav ing and of the g reat 

need fo r large r enrollments, every effo rt sho uld be made by the medical 

schools to increase th eir stu de nt bodies witho ut low erin g the quality 

of th eir teac hing . To obtai n an increase in enr ollments, fund s must 

be mad e availab le to modernize and expan d present facilities.

In look ing to t he future, th e consensus is t ha t, w ith th e already h igh 

cost to the ind ividual of med ical e ducation, we c annot look fo r much, 

if a ny, increase in tuiti on and fees. In t he pa st few years, there h as 

been a grad ua l increase in contrib utions f rom corpo ration s tow ard the 

op erating costs of medical schools. Such contr ibu tio ns should contin ue to increase, as sho uld contribu tions fro m ind ividuals, pa rticularly fro m phy sician s to the medical schools fro m which they were 

gradua ted .

Th e dem ands for hig her edu cation in all de pa rtm en ts are t o be so 

gr ea t in the next few yea rs th at we should no t expect the unive rsi ­

ties to subsidize th eir medical schools out o f th ei r g ene ral fun ds. We 

sha ll have t o look to all sourc es of revenue, exc ept possibly increa sing 

tuition , if medical schools are to meet th e N ation’s needs.

UN IVE RSI TY OF ROCHESTER MED ICAL SCHOOL

Le t me cite as an example the situatio n at the Un iversit y of Ro ­

chester, of which I am chair ma n of the executive com mittee of the 

board of trustees. Th e princ ipal build ing s of its ou tst an ding school 

of medicine and its university -ow ned St rong Memorial Ho spita l are 

nearly 40 y ears old. All are crow ded and cramp ed. A numb er are 

obsolete. Sev eral areas, includ ing th e op erating room s an d n urserie s, 

do no t m eet cu rre nt stan da rds.

Th e fac ult y and tru ste es clearly recognize th at to con tinu e and in ­

crease its im po rta nt contr ibu tions to med ical edu cation, the un iversity ’s medical cen ter mu st be mod ernized and exp and ed. Th e cost 

of the ren ovation and con struction th at mu st be don e at the med ical 

cente r in the next 5 years will exceed $15 million. A t the same time, 

the unive rsity has iden tified urge nt needs of its othe r colleges th at 

will require the raising of over $30 million a dd ition al du rin g the same 

5-y ear perio d.

We are ma kin g a strenuous effort to obtain these fund s from local 

and nat ion al private sources, but we know th at ou r needs fa r exceed 

th e resources of those to whom we can look f or sup po rt.

As a consequence, we face the prospect of ha ving to make a number of serious comprom ises in our dev elopment—com promises th at 

will res ult in the un iversity’s ma kin g a much lesser con trib ution to 

society in medicine and in othe r a reas th an th at o f which it is capable.

I am confident, however , th at with the stimu lus and the assistance 

of a pro gra m of Federal ma tch ing gr an ts for the constru ctio n of 

edu cation al facilities, such as th at proposed in II.R . 4999, we will be 

able to achieve at ou r medical cen ter the dev elopment and the expan sion of our prog ram of medical edu cation th at we desire and 

whi ch the Na tion needs.

I know th at many other unive rsities and medical schools face 

very sim ila r p roblems. Th e reco gnition by the C ongress at this tim e
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 225

of the magnitude of the need of our medical schools and adoption 

by the Congress of a program of Federal assistance to these schools 

is, in my opinion, the only way in which the Nation's well-documented need for expanding its facilities for medical education can 

be achieved promptly and on the scale required.

As to the need for more applicants to medical and dental schools, 

during recent years, the number of college graduates has been increasing, but the number of college students applying for medical 

school has declined.

In 1948, medical school applicants reached 6.6 percent of college 

graduates but this percentage had declined to 3.9 percent in 1958. 

As a result, for all schools combined there are now only about two 

applicants for each one accepted, and many schools are having serious difficulty in filling their first-year places with well-qualified students—that is, qualified both intellectually and emotionally and with 

a real interest.

Among the reasons why medicine as a career is declining in popularity are the length of time and the high cost of medical training; 

competition from many other stimulating careers, especially in science; 

the comparatively small number of scholarships and training gran ts 

available for medical students; the lack of part-time jobs, which are 

generally available for other graduate students; and the failure to 

interest high school and college students in the attractiveness of a 

medical career.

Medical school faculties and others feel that, with the increasing 

complexity in medical science, it would not be wise to cut down the 

number of years now devoted to medical training, including internship and residence.

A considerable number of fellowships are available for graduate 

work in the sciences through the National Academy of Science, National Institutes of Health, the Defense Department, other Government agencies, and private industry. Fellowships are available in 

other fields under the provisions of the National Defense Education 

Act. Yet very few fellowships or scholarships have been made available for medical students, except for those being trained in research 

work.

There are a number of constructive measures which can be taken 

to overcome these obstacles. There should be an expansion of scholarships from Federal, State, and private agencies for students in 

medical schools, especially fo r those from lower income families who 

cannot afford the high cost. Likewise, there should be an expansion 

in loan funds, such as provided under the National Defense Education Act, with interest fixed at 3 percent, to star t 1 year out of college, and with payments spread over a 10-year period.

I understand tha t about 3,000 medical students obtained small loans 

under NDEA last year. More States should follow the example set 

by New York this year in subsidizing the difference in interest between 

the going rate charged by the banks and the 3 percent to be paid by 

the student.

The proposed program of Federal scholarships for talented medical 

and dental students in need of financial assistance would go a long way 

to meeting this problem of shortage in applicants, and would be p articularly helpful for those coming from families with low or moderate
226 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

incomes. The matching cost-of-education grants of $1,000 for each 

scholarship would also be of assistance in meeting the operating 

deficits of the medical and dental schools.

In conclusion, it is my considered opinion tha t to continue and 

expand the progress we have made in medical science and health care, 

a program of grants for the modernization and expansion of medical 

and dental schools and the program for scholarships with the accompanying cost-of-education grants, as provided in H.Il. 4999, are 

urgently needed. Three exhaustive studies during the last 4 years 

have well documented this need. I therefore strongly urge action on 

these proposals by the present Congress.

Thank you very much.

Mr. Friedel (presiding ). Thank you, Mr. Folsom.

Mr. Macdonald ?

Mr. Macdonald. I just have one question. It is good to see you up 

here again, sir.

Mr. Folsom. Thank you.

Air. Macdonald. You say that roughly now 50 percent of the students that apply for medical schools are turned down; is that correct ?

Mr. Folsom. Yes, sir.

Mr. Macdonald. And you think that is not enough. What percentage do you think should be turned down in order to h it a norm that 

medical schools would like?

Mr. F olsom. This varies quite a bit. The topflight medical schools 

now have applicants of about 8 or 10 to 1 from which they can make 

a choice, and those that are not so well known and not so wrell established a much smaller choice. I wouldn’t know what the average 

should be, but I think it is alarming due to the fact th at the rate has 

been going down too steadily. There are many other things that have 

to be considered besides a person’s standing in his class.

Mr. Macdonald. But in reverse, is it not alarming, but it is not good 

tha t more people can be accepted, because one of the complaints we 

hear and one of the problems th at faces the medical profession, and 

which can be treated by this bill, is that there are not enough doctors 

presently to go around. Do you think one of the ways of meeting this 

problem would be to expand and let in more people ?

Mr. Folsom. You have to be sure they are qualified. Unless they 

are well qualified emotionally, intellectually, and have a real interest 

they will go to medical school and flunk out.

Mr. Macdonald. Just one last question. If you can capsule it, what 

is an emotionally adjusted applicant ?

Mr. F olsom. That is up to the medical profession to decide. Some 

people can make good doctors and others can’t, and they would like to 

try to find out ahead of time who is going to turn out to be a good doctor. You will have to ask the professional people that question.

Mr. Macdonald. In other words, all this stuff I hear about the 

quota system being applied is just talk ?

Mr. F olsom. It has changed considerably in the last 8 or 10 years. 

There are not nearly as many applicants to choose from now as there 

used to be and it is an alarming situation.

Mr. Macdonald. Thank you.

Mr. Friedel. Mr. O’Brien ?
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 227

Mr. O’Brie n. I hav e no questions. I want to com plim ent y ou on a 

very fine prese nta tion. I wou ld also add th at the witnesses I have 

heard, inclu din g yours elf, are obviously no t pie -in-the-sky witnesses, 

but they are looking forw ard a numb er of years to mee t the Na tio n’s 

needs.

Mr. F riedel. Mr. Collier?

Mr. Collier. Mr. Fo lsom , I reg ret that th ro ug h no fa ul t of m y own 

I was not able to hear yo ur verbal statem ent. I sh all rea d it, however. 

I would like to pose one question because I th in k it is im po rta nt 

enough to explo re fro m the stan dp oint of opinions. I t is one which 

I asked yeste rday, also. We were told in testim ony by the Secre tary 

th at it would tak e rou ghly 2 y ears before ad dit ion al fac ilities in the 

existing colleges c ould be completed and be ready to accep t an increa sing enrollment in medical schools. We were also told th at where 

there were no fac ilitie s at all it would take somewhere between 3i/£ 

to 5 years to com plete those fac ilities. Re pe ating again th at this 

prog ram is bas ically div ide d into three phases, t he brick and mo rta r, 

and the schola rsh ip, fello wsh ip pro gra ms , an d so on, does it n ot seem 

fea sible to you th at in the firs t 2 years at lea st of this prog ram the 

emphasis sho uld be placed upo n prov iding the physical fac ilities so 

th at the y wou ld be ava ilab le to acco mmodate increased enrollments 

at such tim e as t hey we re completed ?

Mr. F olsom. Yes, I do think th at the empha sis ou gh t to be placed 

on the con struction gr an ts first, but I would ha te to see y ou pos tpone 

the s cho larship pro visions because I t hi nk we have to get more peop le 

intere sted in going int o medical schools, and th at is a lon gru n affa ir.

Air. Collier. I i the program were passed in a form th at w ould pr ovide the bulk of the fund s for the first 2 y ears fo r the so-called brick 

and m ortar phase of it and fac ilities, a nd were to in clud e as p ar t of the 

prog ram an effective date 2 yea rs hence fo r ge tting into the incentive 

recruitin g of stu dents would you no t serve the same purpo se bu t be 

ap proa ch ing the pr oblem in a b it of a more practic al w ay ?

Mr. F olsom. Bu t I th ink the p rior ity of th is is so hi gh that I would 

still strongly u rge you to do both of them . I think we can well afford 

to do them because I don’t think there is an ything more im po rta nt 

than to pro vid e for the h ealth care for the country.

Air. Collier. AVe are told t hat at the pres ent time ex isting facilities 

are accommodating all of the stu dents which can possibly be accommodated. Assum ing th at we tak e yo ur po int of view on th is what 

do we do wi th the fun ds pro vid ed fo r th is pur pose if in fac t the 

existing fac ilities cann ot accept m ore students?

Air. F olsom. I don’t think the prese nt situatio n is quite fa ir because it is such a handica p now to the yo un gster from a low-income 

fam ily or mid dle-income fam ily who just does no t wa nt to tak e on 

a heavy load of expense fo r man y, ma ny years of trai ni ng fo r the 

medical profession. We are confining ou r ap pli cants too much to the 

peop le in mid dle and high er income and it is rea lly not fa ir fo r the 

you ngsters in othe r ty pe families. I th ink it wo uld ease th at s itu ati on 

if we had more scho larship or loan fun ds availab le.

In other words, we are no t gettin g a good cross section, as we shou ld, 

from the total po pulation .

Air. Collier. If you have those, as you say, from the mi ddle and 

high er income class fam ilies who are alr eady in medical school and
228 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

assu min g the same t rend will pro bab ly be the case in the n ext 2 years, 

wh at do you do about those in the lower income gro ups if the presen t 

fac ilities can’t ha ndle the m ?

Mr. F olsom. You ge t a b etter selection. You h ave m ore appli cants 

to pick from . I think this would be a gr ad ua l expansion as fa r as 

the exi sting schools are concerned. I don’t th in k you wou ld have to 

wa it 2 years to g et them to increase to some ex ten t t he p res ent stu dent 

body. Some of them could pro bab ly come wi thin a ye ar or so.

Mr. Collier. I am generally in fav or o f the legisla tion. I am just 

tryin g to u nders tan d wh at ste ps should come first, where th e emphasis 

should be placed on the program at its incep tion.

Mr. F olsom. I agree th at the first pr io rity is the moder niz ation of 

existing schools and co nstruc tion of new schools. Th en if you have to 

postpon e any of it you could phase into the sch ola rsh ips more gr ad ­

ually. It would be a pr actic al pro gra m.

Mr. Collier. Th an k yo u very much. That is all.

Mr. F riedel. I would like to say to the mem bers of the com mittee 

we have a lot of witnesses. Is the re any othe r member who wou ld 

like to ask a question ?

Mr. Moss. Yes, M r. C hairm an.

Mr. F riedel. Mr. Moss.

Mr. Moss. First, Mr. Folsom, I would like to exp ress my ple asu re 

at seeing you back on the Hi ll. I think you ha d a m ost dis tinguish ed 

record as Secretary.

Mr. F olsom. Th an k you ve ry much.

Mr. Moss. And I think you have made an excellent sta tem ent here 

tod ay. On this matt er of pr iorit y, if a pr io rity is to be assi gned by 

this comm ittee, isn’t it true th at the pr iorit ies would be so closely 

spaced it would be difficult to differentiate as to w here the emphasis 

sho uld go first?

Air. F olsom. Yes, I wo uld a gree on th at.

Mr. Moss. On pag e 8 of yo ur statem ent you express concern over 

the decline in the number of applican ts fo r med ical schools. Th is 

give s the schools a fa r less rep res entative g roup from which to select 

the studen ts, and if we pro vide now for sch ola rships we will pr ob ­

ably be up gr ad ing the c aliber of those ente rin g the stu dy o f m edicine 

imm ediately. We will encourage more th an the present 3.9 per cent 

whi ch you cite for the y ear 1958 ?

Mr. F olsom. Yes.

Mr. Moss. Yo ur concern there has not been th at th ey are expecting 

more, b ut r at he r that few er a re a pp lyi ng ?

Mr. F olsom. Yes, sir.

Mr. Moss. And it is equally im po rta nt here th at we increase the 

nu mber of appli cants as to provide fac ilities for ye t addit ion al students ?

Mr. F olsom. Yes, sir.

Mr. Moss. I have also been inte rested in the fa ct that we have tend ed 

in discussio ns he re to lump tog eth er all m edical schools, an d yet w ith in 

the medical schools them selves we have diffe rin g problems. Ha ve the 

schools of public he alt h access as rea dily to matc hin g funds fro m 

pr ivate sources as th e medical schools themselves?

Mr. F olsom. No; I doub t it. The y have a more difficult prob lem.

Mr. Moss. Do you think t hat the need here is as urg en t ?
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 229

Mr. F olsom. Yes; and of course we did get some gran ts for public 

health schools recently through congressional action.

Mr. Moss. Do you think the need is sufficiently urgent to justify 

a slight enrichment of the Federal contribution for the expansion and 

construction of facilities in schools of public health ?

Mr. Folsom. I would like to study tha t a little more carefully. Offhand, I would say “yes,” but I wouldn't want to give a categorical answer until I really looked into the situation.

Mr. Moss. I would be interested in your more carefully considered 

opinion.

Mr. Folsom. I will talk to other people and get a little better informed on it.

Air. Moss. Thank you, sir. Those are all the questions, Mr. Chairman.

The Chairman. Air. Devine?

Air. Devine. Air. Folsom other than the reasons you have given 

here about the length of time it is to take a medical course and dental 

course, 10 or 11 years, what other reasons did you feel exist for the 

situation today rather than what it was 20 years ago?

Air. Folsom. Well, in the first place, we have a big increase in population projected ahead and if we don’t increase we won’t keep up in 

the ratio of number of physicians to population. There is no indication we ought to cut down on the number of physicians per thousand 

population.

Air. Devine. Twenty years ago, Air. Folsom, of course we had a 

lot of persons who were making applications to get into medical and 

dental schools and on that basis the requirements were quite strict 

and many of them were rejected. Now you say it is necessary to try 

to induce the younger people to come into this profession, and vet 

we don’t have the facilities to accommodate them if they do ; is that 

correct ?

Air. Folsom. Yes, the two go together. We need the facilities and 

we need more applicants too.

Air. Devine. 1 think if we had the facilities probably there would 

be more applicants tha t wouldn’t need the Federal aid or scholarships.

Air. Folsom. That does not necessarily follow because now we are 

not getting a wide enough choice. The applicants, as I indicated, 

have gone down considerably, from 5 or 6 to 1 and now it is down 

to 2 to 1, and we know the medical schools are saying that they are 

not getting the quality which they desire.

Air. Devine. Is there a possibility that the medical profession is not 

as attractive today as it was years ago ?

Air. F olsom. I indicated several reasons why. I think to a youngster science offers a much more attractive career right now than medicine, because in the first place it seems to have a lot more glamor and 

a man working for a Ph. D. in physics or chemistry, for instance, will 

find fellowships readily available.

Practically all the graduate students in physics, and chemistry, and 

other science studies have fellowships. They are available, not only 

from Government but from private industry. If a youngster gets his 

Ph. I)., he starts in immediately at a very high salary; whereas the 

medical fellow has 4 years more to go before he will lx* making a liv-
230 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

3\fr. Devine. That was true many years ago, too, was it not?

Mr. F olsom. Not to the extent it is now. There wasn’t the competition with science that there is right now.

Mr. Devine. I am not talking about the competition. I am talking 

about the length of time it takes to receive the medical education.

Air. F olsom. Oh, yes; but you didn’t have the competition in other 

fields at tha t time which pulled them away from medicine. I think 

there is much the medical profession can do to attract many more 

people. I think they ought to do a better job of telling high school 

students or college students about the profession and why it is desirable to get more people in, and try to get them interested. I think 

they can do a better job than they have been doing.

Mr. Devine. Thank you very much.

The Chairman. Mr. Dingell ?

Air. Dingell. Thank you, Air. Chairman. Understanding the 

shortness of time, Air. Chairman, I shall be very brief. Mr. Folsom, 

it is a privilege to have you before this committee.

Air. Folsom. Thank you.

Air. Dingell. I recall very well the very fine job you did when you 

served in the Government as Secretary of Health, Education, and 

Welfare, and I am happy to note that you are continuing your good 

work. I commend you for what you did as Secretary and also for 

what you have done today in presenting this committee with this 

very fine and helpful statement.

I would just like to add one little bit to the record, and that is to 

discuss with you briefly the proposal which you alluded to in your 

statement which came before this committee in 1956. That was the 

proposal which you, as Secretary of Health, Education, and Welfare, 

and the Eisenhower administration endorsed. Tha t proposal was 

substantially identical to the bill which is before us today, was it not?

Air. Folsom. As far as the construction feature.

Air. Dingell. Yes.

Air. F olsom. We covered research and teaching facilities, and Congress at that time made grants for research but not the teaching 

facilities, so this bill now goes into the teaching facilities.

Air. Dingell. I intend to treat of that. We did not have a scholarship proposal in the bill at that time?

Mr. F olsom. No.

Air. Dingell. However, as I recall the testimony at that time, the 

administration did allude to the problem of the student in meeting 

the cost, the very substantial cost, which he faced.

Air. Folsom. Yes.

Air. Dingell. And the administration at that time was aware of 

this difficulty. As I remember, the substantial difference in the field 

of construction grants which existed between the proposal then and 

the present proposal was simply that the administration proposal at 

tha t time did not provide for incentive features in the grants. Am I 

correct ?

Air. F olsom. No; they were straight 50-50 matching grants.

Air. Dingell. Would I be fai r in inferring that you do support the 

66%-percent increment which will go to facilities under certain circumstances in the present bill now ?

Air. Folsom. Yes; I read this bill. I think they are pretty sound.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 231

Mr. Dingell. Mr. Folsom, you do su pp ort the pro vision wi th rega rd to sch ola rships tod ay?

Mr. F olsom. Lat er on the Eisen howe r ad mi nis tra tio n, when I was 

Se cre tar y, advocated a sch ola rship prog ram when Con gress was consid ering the Na tional Defense Ed uc ati on Act. At th at time, the ad ­

minist ratio n proposed a limited schola rsh ip prog ram f or u nd er gr ad uate students, a nd t hat was d eleted by Congress, bu t t he loan fund was 

included.

I s till feel, myself, th at i t wou ld be well to have a sch ola rsh ip pr ogram un de r the National Defense Ed ucati on Act, as well as a loan 

pro gra m. I think there is a need for both . Tha t is why I am p ar ticu ­

larly glad to see the sch olarship pro vision in this bill.

Mr. Dinge ll. There is one othe r section I haven’t notice d received 

a gr ea t dea l of attenti on fro m the com mittee and from the witnesses 

in que stio ns back and fo rth , an d th at is the pro vision wi th rega rd to 

ad ditio na l gr an ts to schools whose stu dents happ en to be rec ipients 

of thes e sch olarships, to cove r the defic its which happen to exist between the tuition or th e sch ola rsh ip and the actua l cost to the school. 

Th is is a substan tia l fac tor , is i t not ?

Mr. F olsom. Yes. Of course it wou ld not be very a lar ge item as 

fo r th e school, b ut very help ful. Th e prec edent w as es tablish ed un de r 

the N ational Defense E du catio n Act. In the Na tional Defense E ducati on Act pro vision is made fo r fellow ships up to $2,500 f or gradu ate 

students , and the school selects the in dividu al; and fo r each fellow ­

ship gran ted to a school the re is a ma tch ing gra nt of $2,500.

Th is follows exa ctly th at same pri ncipl e. I th in k it is very 

desirable.

Mr. Dingell. I did not mean th at the cost of this to the Govern me nt 

was going to be su bs tant ial; I me ant th at the cost to the schools is a 

conside rable problem to them.

Mr. F olsom. Yes; it is.

Mr. Dinge ll. We mi gh t also approa ch it fro m the sta nd po int, Mr. 

Folsom , th at these schools are pe rfo rm ing a public service an d in 

op erating at a deficit are co ntrib uting to the gen eral we lfare of the 

po pu lat ion an d almost in effect s erving a gove rnm ental fun ctio n.

Mr. F olsom. Yes; I think in that re ga rd medical schools a re in quite 

a different cate gory fr om many othe r grad ua te schools.

Mr. Dingell. Yes; because they are prov iding the people who look 

af te r th e he alt h o f the popula tio n, which is a very intim ate and a v ery 

im po rtan t thing in the society.

Mr. Folsom , I do w ant to commend you and t ha nk you v ery much for 

your kindne ss th is mornin g.

Mr. F olsom. Th an k you, Mr. Congre ssman.

The C hairman. Are the re any f urther questions? Mr. C urt in ?

Mr. C urtin . Mr. Chairma n, I wo uld like to ask a question.

Mr. Folsom, you say the re are pre sentl y very few sch ola rsh ips or 

fellow ships ava ilable for medical stu dents . Do you kno w wh eth er 

there are any statistics availab le as to j us t how m any such scholarshi ps 

and fello wships there are ?

Mr. F olsom. No. I ima gine may be Dean Ander son , pr esiden t of 

the Am erican Medical Schools Ass ocia tion , could pro bably give you 

the a nsw er to th at, but I h ave not had figures availabl e to me. How ­

ever, I know when I was S ecret ary we fo und very few.
232 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Mr. Curt in. Do you know whether or no t all of those th at are 

ava ilab le are tak en up ?

Mr. F olsom. No; I would no t know that.

Mr. Curtin. Tha t is all, Mr. C hai rman.

Th e Chairman. Mr. Dom inick ?

Mr. D ominic k. Mr. Folsom, the re are a gr ea t numb er of turn down s 

at the bette r qualified schools of ap pli cants fo r med ical edu cation. 

Is that not t ine?

Mr. Folsom. Yes; because th ere is a doublin g up of a pp lic ants ju st 

like the re is of ap pli cants to colleges generally, so the be tte r know n 

schools probab ly get 8 o r 10 for every 1 the y can take and the re are 

na tura lly going to be hig her turndo wns.

Mr. D ominic k. Do you kno w w hether any o f these ap pli cants crossfile fo r oth er schools?

Air. F olsom. Oh, surely.

Mr. I )ominick. Do man y of the m go to oth er schools ?

Mr. F olsom. I imagine the y do.

Mr. Dominic k. Do you h ave any statistics on th at ?

Mr. F olsom. No, I have not, but I th in k prob ab ly the medical 

school association would hav e them.

Mr. Dominick. Secondly, we have ha d tes tim ony indic ati ng th at 

par t of the problem is not necessarily in the numb er per hu nd red 

tho usa nd, but in the distr ibution of doctors. Do you have any suggestions on how this sit uatio n o r this problem mi gh t be cured ?

Mr. F olsom. I know the re have been suggestion s, as Congressman 

Fog ar ty ’s suggestion in answer to a question th at there might be some 

incentive in the loan fea tur es, to have a loan provision in which you 

could forgiv e the loan if the y go to certa in loca lities. Bu t it would 

be very difficult to w ork out a plan like tha t in practice.

We do have in the National Defense Ed uc ati on Act, as you know, 

the loan provisions there , t hat if a pe rson goes into tea ching he is fo rgiven 50 pe rcent of the loan, or 10 percent fo r each of five years. Of 

course i t would be possible to work out some prov isio n like tha t if you 

had the loan fund h ere, bu t it would be h ar d to draw the line a nd say 

in wh at are as these doctors should pra ctice, because the situation 

changes so from time to time. So I don’t know of any feasible way 

of do ing that.

Mr. Dominic k. Th an k you, sir. Tha t is a ll, Mr. C hairm an.

Th e Chairma n. Any one else? Mr. Folsom, th an k you vers7

 much. 

We are glad to have your pre sen tation here of th is problem and we 

appre cia te your being back with us again.

Mr. F olsom. Th an k you. I am pleased to have been here.

Th e Chair man. Dr. George A. Wolf , Jr. Dr . Wolf, will you 

id en tif y yo urself fo r the record, please, s ir ?

STATEM ENT OF DR. GEORGE A. WOLF. JR ., EXECUTIVE DIRECTOR

AND VICE PRESIDENT FOR MEDICAL AND DENTAL AFFAIRS ,

TUFTS UN IVER SIT Y, BOSTON, MASS.

Dr . Wolf. Yes. T am Dr. George A. W olf , Jr ., executive dir ector 

of the Tu fts-New En glan d Medical Ce nte r and vice pre sid ent for 

medical and dental affairs at Tu fts Univ ers ity . Fr om 1952 to 1961 I 

was dean of the Un iversity of Ver mont, College of Medicine.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 233

The Chairman. Very well. We are glad to have your statement.

Dr. Wolf. Thank you. With your permission, Mr. Chairman, I 

would like to take a somewhat different approach here and use some 

examples rather than statistics to indicate what has been accomplished 

by this type of legislation and what I think this legislation under 

consideration today might accomplish.

I have been around just a little bit, I have been in Iran, I have 

been in Europe, and I have visited many institutions here in the 

United States, but 1 would like to confine my remarks to the New 

England area because I am more familiar with tha t than any other.

1 am also a member of the Advisory Council to the Health Research 

Facilities Construction Division of the U.S. Public Health Service.

New England has always provided somewhat more educational 

opportunities for non-New England people than have many of the 

other regions of the country. For example, about 60 percent of the 

medical students at the University of Vermont, College of Medicine, 

are not residents of the State of Vermont.

The well-known private schools in New England also have predominantly out-of-State enrollment. When people think of New England, 

they think in terms of Yale and H arvard and their very large endowments, but 1 think there are two things you must realize about this 

region. One is that the income from the large endowments which 

Harvard and Yale have, for the most part, is restricted by the donor 

to specific use, and 1 think if you inspect these endowments you will 

find in most instances building is not included in the use to which 

these endowment incomes can be put.

The second point is that New England is often thought of in terms 

of being a thr ifty part of the country and it has beautiful scenery. 

This beautiful scenery contributes to their thriftiness, because the 

nature of the land up there is such that, it does not produce much 

income.

Therefore, you will find in the States of Maine, New Hampshire, 

and Vermont a rathe r low per capita income. Massachusetts and Connecticut are somewhat more prosperous. However, it has been the 

tradition of these areas for years, as you know, to develop private 

schools and private hospitals and not to have State schools. As a 

matter of fact, there is only one State-supported medical school in 

all of New England and that is the University of Vermont, supported 

by one of the smallest and poorest States in the area, Yet the people 

of Vermont are supporting medical education at the rate of two dollars 

a head.

On the other hand, should the State of Massachusetts build a medical school when they have three medical schools in Boston—Tufts, 

Boston University, and Harvard—and one dental school at Tufts?

In addition there is a rather high rate of acceptance of Massachusetts residents in medical schools, even though they do not have 

a State medical school, whereas in Maine the picture is entirely different because the rate of acceptance of medical students is quite 

low and they do not have a medical school. Should Massachusetts, 

Maine, and New Hampshire, with their limited assets build a new 

medical school at the present time when they are using their State 

funds to subsidize medical students at the University of Vermont?

Connecticut is already planning State medical and dental schools, 

80014— 62------16
234 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Brow n Un ive rsity in Rhode Island is also con sidering a medical 

school.

Thus, New En glan d is a very diverse area and must he considered 

from the sta ndpoint of the indiv idu al insti tutio ns and their specific 

problems. Th is is not int ended to imply th at other are as are not 

diverse. Remembe r, I am using New Eng la nd as an exam ple, but 

its div ers ity tends to su pp ort very much the varia ble ma tch ing fo rmula fo r con stru ctio n gr an ts th at is in th is pro posed legislation.

In aw ardin g ma tch ing con stru ctio n gr an ts up to 66% percen t of 

the t otal cost, th e amo unt of ma tch ing funds sho uld be base p rim arily 

upo n the jud gm ent of the professionals who sit on the adv isory 

councils.

Inspectin g various ind ivi dual ins titution s and ap plyi ng the fun ds 

where they will do the most good, will accomplis h the most for the 

cou ntry. It has been dem onstrated by the activ ities of the hea lth 

rese arch facilities con stru ctio n division th at research constru ctio n 

dollars have served to uncover and bring out local money. I would 

like t o ref er to two simple examples which occ urred in New En gla nd.

Incid en tal ly, I have some pic tur es here which I think you may 

have difficulty seeing and 1 apologize, but l>eing a th ri ft y New Eng ­

lan der. 1 fe lt the expense of ge tting these blown up in size to where 

they could be more easily seen to be pro hib itiv e. Thi s is the University of Vermont College of Medicine, which is a 50-year-old bu ild ­

ing. The college had n ot bu ilt a t all since th at tim e u p to a few yea rs 

ago. As a matter of fac t, it conv erted some coalbin s in the basement of th at old bu ild ing to researc h lab ora tories, and it also remodeled this framehouse which is a very lovely old house, bu t un ­

fortu na tely it was bu ilt in 1793. I t is stil l in use fo r medical research.

One of the lab ora tor ies in the coilbin looks as you c an see, crowded 

and pro bab ly not the best place in the world fo r peo ple to work, 

pa rticul ar ly the you ng lady shown there .

Th e alumini of the Un iversity of Vermont College of Medicine 

ha d never contribu ted more than $5,000 a year to the school and it 

ha d never had a pr ivate gif t or a fou ndation gr an t fo r bu ild ing in 

50 years. When a gr an t became available from the Hea lth Rese arch 

Fa cilities Construction Div ision, $700,000 in 3 y ears was raised from 

the alumn i body a nd fro m pr ivate sources over a ha lf million dollars 

were raised in 3 months. As a res ult a new research par t of the 

Unive rsity of Ve rmont College of Medicine was bu ilt and , as you 

can see, islbeing expand ed.

However, the rat e of exp ansion of the prog ram is so g reat th at the 

1793 bu ild ing is stil l being used for medical research as is the old 

med ical school bui lding. Un fortu na tel y, and I th in k th is point has 

been made by th e oth er gentlem en, the medical st udents who are lea rning t o be our futur e doctors are still in the 50-year-old bu ilding , so that 

some thi ng has to be done abo ut this. We ju st can’t go on bui lding 

only research facilities.

Ev en tho ugh the research bu ild ing is excellent, we still need space 

fo r the medical studen ts. The Tuf ts Un ive rsi ty School of Medicine 

an d De nta l Medicine are in a converted factory bu ild ing bu ilt 30 

years a go righ t in t he middle o f Bosto n.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 235

Now, this complex includes several hospitals as well as the medical 

and dental schools, but in this 30-year-old factory building there are 

400 dental students, 400 medical students, and 30 graduate students, 

appropriate staff and their research activities, all in a converted factory building.

They make the windows smaller, clean it up, and p ut in partition s, 

and it really works out very well. However, this is only p art of the 

picture because some of the best research at Tufts University, in the 

hematologic field, is going on in this old thing which was built about 

100 years ago, still going on very actively, in spite of the fact that 

additional research space has been built.

Here is another instance of some men who are doing medical research, obviously working in a basement. You can see the pipes and 

the big electrical switches in the background.

Again when health research facilities construction money became 

available they took over another old factory, obtained some money 

from the Commonwealth fund to match, and added 64,000 square feet 

of converted factory space for the expanding research program in the 

college of medicine. The dental college was not able to get this matching money and therefore they now have just converted an old firetrap built in 1850 into a research laboratory and have moved into 

a wooden furn iture loft to conduct their research.

My point here is that we are not overbuilding in these general areas 

and that we are making compromises. We are using what we have. 

We are buying factory buildings cheaply and converting them to fairly

effective buildings. We are not tearing everything down and building 

beautiful new glass structures. Tn other words, the money we think 

has been spent well and we think more money is still needed.

In spite of the progress that has been made at T ufts we still have 

the medical and dental students, 400 each, crowded into the old 30- 

year-old converted factory building, so something again must be done 

about that. This is only, as I say, an example, and I know of other 

instances all over the country where this sort of thing is going on.

Funds available from the Federal Government on the matching 

basis have permitted expansion of our research programs and have 

uncovered previously unobtainable private funds, and I give you 

Vermont as a good example. There are a lot of unmet needs, however. 

Obviously the coalbin basement is not the a pprop riate place to do research. It isn’t a good place to keep coal any more, as a matter of 

fact.

There are other areas in New England where the same kind of situation exists.

For example, at the University of Maine there is a old building, and 

Heaven knows how long ago this was built—I have seen this myself—where very effective work on health-related genetics in the department of biology is being conducted. They too have laboratories 

which are in basements, as you can see.

At the University of New Hampshire in the College of Agriculture 

they are doing some good work with viruses, and they are working in 

this concrete block building, which is perfectly all right for chickens, 

but, I don’t think it is very good for medical research on viruses these 

days.
236 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

We need a little bit more elaborate qu art ers t ha n th at . Th is is the 

inside of the lab orato ry which shows people wo rki ng un de r crow ded 

conditio ns.

Da rtm ou th Medical School is a 2-year m edical school in New H am pshire. I t has a wonderful repu tatio n and i t gai ned th is rep utation, it 

is t rue, in this building , whi ch I th ink you would say is qu aint and 

unique, but pro bably no t a good medical school bui lding.

How ever, Da rtm ou th with th ei r abi lity to raise fund s fro m private 

sources—as you know, they are a fine school—an d wi th Hea lth Research Facil ities Const ruc tion Division money came up with this 

building . I consider that pro gress, not only in ter ms o f the bu ild ing; 

the im po rta nt thing th at is when th at bu ild ing went up the staff impro ved dram atical ly. Th ey add ed man y good people to the staff 

who are not only doing rese arch bu t are also tea ching stud ents. 

Ag ain , I refer t o the fact t hat th e needs in dif fer ent places are differen t an d th at a var iab le ma tch ing formu la is most im po rta nt.

I would like to add one factor about, libraries. In the de velo pment 

of resear ch lab ora tories most of us th ink o f test tubes, and machinery, 

an d th at sort of business, bu t libr aries are j us t as im po rtan t a par t of 

the research program as are research lab ora tories a nd I urg e strongly 

th at fu nd s be made a vailable fo r libraries.

Fi na lly , I would like to say a word about the manpower situation. 

Th ere is one thing th at hasn’t been men tioned here and I am no t sure 

why —I have had th e privileg e of being h ere the last 2 days —an d th at 

is t hat th e birth rate in 1946 went from ab out 19 p er th ousan d to about 

24 pe r thousand at the n ational level and in some State s, as you know, 

the ris e was a good deal more th an that.

In 1946 th is happened ra th er sud den ly fo r I th in k ra th er obvious 

reasons. These boys and gi rls will be of th e age to a tte nd medical and 

denta l schools in abo ut 1966 or 1967 and I wou ld ventu re to predict 

fo r the reco rd th at we will see q uite a dram ati c increase in the number o f appli cants at th at tim e and the n 20 years fro m the n, in 1986, 

th eir boys and girls will be ap plying to medical and denta l schools.

I th in k we should pay att en tio n to this significant sta tistic. I t is 

pe rfe ctly c lear fro m my own experience, as the other men have mentioned here today, th at the hig hly qualified stu de nt often would 

ra th er pursu e the science of phy sics or mathe matics tuition -fr ee on 

a sala rie d fellowship and get a s alaried job 4 yea is af te r his bac helor’s 

degree th an he would to p ay $1,200 to $1,400 a ye ar tu ition at a school 

of medicine or denta l medicine f or 4 ye ars and then spen d 1 to 5 ye ars 

wo rking up to a sal ary of $3,000 per yea r as a resi dent in some hos pital.

It is no t difficult to calc ulate with a pencil th at fro m the time thi s 

young doc tor leaves his residency to the time he stops wor k at age 65 

he will have to earn $4 for every $1 th at a high school grad ua te would 

have to ear n to make the same life income. As has been said here, 

it h as been shown th at o ur medical and denta l stu de nts are deep ly in 

debt, a nd I can attest to this fr om my own expe rien ce at V ermont and 

Tu fts .

It is difficult to see why we allow these fina ncia l ba rriers to stand 

in fro nt of our medical stu dents when we wan t more doctors and 

dentists. I t is just as simple as that. It seems t hat sch ola rsh ip fun ds 

would go a long way tow ard removin g these ba rriers and a much 

lon ger way than loan fun ds.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 237

Again, I feel this very strongly. These scholarship funds, in my 

opinion—I wrote this before I heard yesterday’s testimony—would 

complement nicely the teaching construction grants as proposed in 

this bill. The reasons for this are there is a leadtime, so to speak, in 

recruitment. In other words, young people make up their minds 

before they apply for medical school tha t they are going to apply, 

so there is a certain amount of time lost here, but in addition this 

bill has taken into account some of the things tha t you gentlemen 

brought up and that is it is phased.

If you will read it carefully, and I am sorry I don’t have it at hand, 

you will note tha t the grants for scholarships are made first to the 

first-year class, then the next year to the first- and second-year classes, 

the next year to the first-, second-, and third-year classes, and so on, 

so that I think this is in pa rt an answer to some of the questions that 

you have raised.

In summary, the needs for additional research construction funds 

have been demonstrated in my opinion and the value of the matching 

formula has been described by example. The hope is expressed that 

expanded legislation will permit a variable matching formula, healthrelated teaching construction funds, health-related research construction funds, in greater volume, of course, library construction, and 

scholarship funds for medical and dental students.

Mr. Chairman, I appreciate your courtesy in permitting me to appear before you.

(The statement of Dr. Wolf follows:)

Gentlemen, I am Dr. George A. Wolf, Jr., executive dire ctor of the TuftsNew England Medical Center and vice president for medical and dental affa irs 

of Tufts University. From 1952 to 1901 I was dean of the University of 

Vermont College of Medicine. I am a member of the Advisory Council to the 

Hea lth Research Fac ilities Construction Division of the U.S. Public Health 

Service. Before coming to T ufts University this summer, 1 received a Commonwealth Fund fellowship which perm itted me to visit medical cente rs, including 

medical and dental schools, hospitals, and research institu tes in Scandinavia, 

the British Isles, and Switzerland. I have also been privileged to act as consulta nt to the University of Massachu setts, the University of Maine, the University of Connecticut in their explorations concerning the sta rting of a new 

medical school. In addition, I have made project site visits to Dartmouth, 

University of New Hampshire, Brandeis University , Harvard, MIT, Boston University, New England Deaconess Hospital. Yale, Ha rtf ord Hospital, University 

of Rhode Isla nd and Rhode Island Hospital. Furthermore, I have visited, in a 

variety of capacities, medical institu tions outside of the New England area over 

the past 10 years. I believe my experience in New E ngland qualifies me to appear 

before you to speak of the benefits alread y derived from the Health Research 

Facilities Construction Division program, but, in addition, to emphasize the 

futur e needs.

NEW ENGLAND

New England has always provider! somewhat more educational oppo rtunities 

for non-New E ngland people than have other regions of the country. For example, about 60 percent of the medical studen ts at the University of Vermont 

College of Medicine are not residents of the Sta te of Vermont. The well-known 

private schools in New England also, of course, have predominantly out-ofSta te enrollment.

Although the number of dollars for research construction in New England 

and the Northeast have been high, the percentage of approved applications has 

been low and in itse lf testifies to the needs of the area . Many, in considering 

New England, thin k of Harva rd and Yale with their large endowments but 

neglect to recognize two important facts. Most of the income from the endowments of these two schools and, of course, all other univ ersities and hosp itals 

are restric ted to some specific purpose following the wish of the donor. It is
238 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

ra re th at donors provide in the ir gift that income can be used for building. 

It is true , of course, tlia t gifts for building purposes are given to universities 

and hospitals, but, I repeat, it’s rar e that income for endowment can be used 

for program of construction. Thus, the size of endowment is not a measure of 

the schools’ or hospitals’ ability to build new buildings.

New England is thought of in terms of beautiful scenery and thr ift, but the 

bea utiful rugged hills lend themselves poorly to the use of modern farm machinery. For example, hard ly a year passes withou t a far mer being killed by 

a tra ctor built for tilling the western plains, which flips over on a rocky hillside. Thus, although the scenery is beautiful, the t hr ift gene rates from low percap ita income in Maine, New Hampshire, and Vermont. On the other hand, 

Massachu setts and Connecticut are somewhat more prosperous. Nevertheless, 

the tradition in New England is the main tenance of priva te schools and hospita ls. There is only one State-supported medical school in all of New England—the University of Vermont College of Medicine. Thus, we find, next to 

the well-endowed priv ate schools, other priv ate schools with woefully small endowments which are not only inadequate for operational purposes, which results 

in high tuition charges to students, but also, as has been said, endowments 

restric ted by donors so that funds cannot be used for building.

Wh at about the role of the New England States in supporting medical education and research? The only State medical school in New England, the University of Vermont College of Medicine, is being supported at a rat e of $2 per 

cap ita by the residents of Vermont, probably the highest per capita rate of support of medical education in the country.

But, should Massachusetts build a State medical school when they are already 

subsidizing the medical students at other schools, when the re is a high rate of 

acceptance of Massachusetts resid ents in medical schools and when they are 

alre ady three private medical schools in Boston? Should Maine and New Ham pshire build new medical schools when they are subsidizing medical stud ents at 

the University of Vermont? Connecticut is planning Sta te medical and dental 

schools. Brown University in Rhode Island is also thin king of sta rting a 

medical school. Thus, New England is a very diverse area , and thus must be 

considered from the standpoint of the individual institutions and the ir specific 

problems.

VALUE OF VARIABLE MATCHING FORMULA

It is not intended to imply th at other are as are not equally diverse, but 

simply to support, the idea that a variable match ing form ula for the awarding 

of construction grants based primarily upon the judg men t of professionals who 

sit on the advisory councils would permit aid to those individual institu tions 

where such aid would gua ran tee maximum results. It has been well demonstrate d that Federal research construction dollars have served to uncover and 

bring out local money and private funds.

Two simple examples, however, emphasize specifically how this can happen 

in the case of research construction. The University of Vermont College of 

Medicine had not built for 50 y ears. Its physical expansion had been accomplished by the conversion of coal bins and the remodeling of a fram e house 

built in 1793. Its alumni had never contributed more tha n $5,000 a year to the 

school, and it had never had a priva te gift or a foundation g rant for building in 

50 years.

When a gran t became available from the Health Research Facilities C onstruction Division, $700,000 was raised from the alumni over a 3-year period and onehalf of a million dollars was rais ed from private donors and foundations in 3 

months. Therefore, a new building opened 2 yea rs ago, which is now full of 

resea rch activity in the hea lth-related area , and an extension of this building is 

nearing completion at the present time. Regardless of this, the coal bin and the 

1703 house are still being used to their full capacity for health-related research. 

The medical students, however, are still being tau ght in the 50-year-old building.

The Tufts Schools of Medicine and Dental Medicine are in a converted factory 

built 30 years ago with extensive crowding by 400 dental. 400 medical and 30 

gradua te students, staff and research activities. Another factory next door was 

purchased for a fraction of its replacement cost, and, because of the Health 

Research Facilities Construction Division which permitted matching by an 

unre stricted grant from the Commonwealth Fund, an additional 64,237 square 

feet, of converted factory space is now available for the expanding research program of the college of medicine. Unfortunately, the needs of the denta l school
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 239

in te rms of research, because the Commonwealth g rant was to the medical school, 

have not been met, and the dental school has been forced to convert a fire trap 

built in 1850 and the basement and one lloor of a wooden furnitu re loft into 

researc h laboratories.

Moreover and also unfortu nate ly, the medical and dental stud ents are still 

crowded, although some of the research needs are being taken care of by the 

conversion of the factory building. It is obvious th at fund s for teaching construction are sorely needed, both at Tufts and the University of Vermont and 

elsew here in New England and the United States of America, but the availa bility 

of research construction funds has permitted some partial satisfac tion of research space needs, has perm itted expansion of resea rch programs and has 

uncovered previously apparently unobtainable private funds.

UN ME T NEEDS

It is clear, however, th at the needs are far from being met. Coal bins a re outmoded, not only for coal but for carrying on modern research with its delicate 

instrume ntation, complex microchemical techniques and qua lity investigation 

of elusive micro-organisms, to say nothing of the physical comfort of the scarce 

investigato r and his hard -to-recruit technicians. Although gre at thoughts are 

still had on mossy banks and before the hea rth at home, modern scientific methods demand space, instruments, and technical help to prove or disprove the ideas 

so obtained. The re is good work going on, it is true, but too often a compromise 

is involved, and space limitations from the stan dpoint of size and adequacy are 

limiting factors, possibly as to quality and certainly as to volume.

The pictures in hand are those of buildings which I have visited personally 

which are being used for health-related research, which I and the investigators 

consider inadequate. Important work in genetics is going on at the University 

of Maine in an old converted house. Superior work in virology is being conducted 

in this concrete blockhouse better suited for chickens at the University of New 

Hampshire.

Dartmouth Medical School trie d to hold onto Its fine reputation in a quaint 

structure, and Health Research Facilities Construction Division funds helped 

build a modern building worthy of the school’s tradition.

There are many such examples which I have seen in State, private, wealthy, 

and impecunious schools and hospitals testifyin g to the needs of more matching 

funds tha n are currently available, preferably by a variable matching formula. 

Acceptable stru ctures now will become obsolete soon, and thu s we must think 

of replacement of the inadequate, expansion, and future obsolescence.

LIBRARIES

With the expansion of resea rch activity, the need for libr ary space has increased enormously. The materi als in libraries are just as imp ortant to the 

activities of an inve stigator as are the instrum ents and technicia ns refe rred to 

above. But we find it extrem ely difficult to raise fund s for libra ries, especially 

withou t matching funds.

MANPOWER

Most importa nt of all is our future supply of stud ents to head our laboratories 

and to apply the information obtained through research to our people. It is 

clear, from my experience, that the highly qualified studen t often would rather 

pursue the science of physics or math ematics or sociology, tuition-free on a salaried fellowship, and get a sala ried job 4 years afte r his bachelor of a rts or science 

degree than he would pay $1,200-41,400 a yea r tuition at a school of medicine 

or dental medicine for 4 years, and then spend 1 to 5 yea rs working up to the 

munificent salary of $3,000 a year as a re sident in some hospital.

It is not difficult to calculate with a pencil that from the time he leaves his 

residency to the time he stops work nt 65. he’ll have to earn $4 for every $1 

that a high school gra duate would have to earn to make the same life income. 

It has been shown th at our medical and dental studen ts are deeply in debt at 

the time of graduation, although they are married and have families, as most 

normal people do these days. The rat e of marria ge is, of course, lower than 

that of their conte mporaries who are on fellowships or who are working in industry. In our pu rsu it of more research and better health of our people, both 

here and abroad, it is difficult to see why we allow these barriers to occur in 

fro nt of medical and dental students. Scholarship fund s would go a long way 

toward removing these b arriers. Such funds would complement nicely teaching 

construction grants.
240 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

In summary, the needs for additional research construction fund s have been 

demonstrated. The value of the matching formula has been described by 

example. The hope is expressed that expanded legislation will permit a variable 

matching formula, health rela ted teaching construction funds, library construction, and scholarship funds for medical and dental students.

I apprecia te your courtesy in permitting me to appear before you, and I hope 

that I have provided you with information and thoughts which will assist you 

in making the important decisions of our current legislation in the are a under 

consideration.

Mr. Williams (presiding). Thank you very much. Any questions? Mr. Friedel ?

Mr. Friedel. No questions.

Mr. Williams. Mr. Springer ?

Mr. Springer. Dr. Wolf, would you hold tha t picture up there of 

Dartmouth again ?

Dr. Wolf. Yes.

Mr. Springer. Would you hold up the one there of the white frame 

building up on the hill ?

Dr. Wolf. The old frame building?

Mr. Springer. Yes.

Dr. Wolf. Yes.

Mr. Springer. What university is that ?

Dr. Wolf. That is Dartmouth, the medical school.

Mr. Springer. What is it now ?

Dr. Wolf. Now I honestly don’t know.

Mr. Springer. But 1 hat is where the old medical school used to be ?

Dr. Wolf. That is right. My point is this is what construction 

funds helped to accomplish.

Mr. Springer. Is it your thought that primarily replacement of 

brick and mortar is what is going to make more doctors or improve 

the quality of them ?

Dr. Wolf. I can say I think to date, and again speaking from my 

experience at the University of Vermont, tha t the construction of a 

research area improved the quality of our staff up there.

Mr. Springer. Did it improve the number of doctors? Did it 

increase the number?

Dr. Wolf. No, because we have not been able to build additional 

teaching space to have additional students.

Mr. Springer. Have you ever visited the University of Heidelberg?

Dr. Wolf. No, sir.

Mr. Springer. Have you ever seen the medical school there.

Dr. Wolf. No, sir.

Mr. Springer. You would admit it has a rather worldwide rep utation, would you not ?

Dr. Wolf. Did you say “has” or “had” ?

Mr. Springer. Has now; is that correct ?

Dr. Wolf. Yes, sir.

Mr. Springer. Has had for a hundred years, has it not ?

Dr. Wolf. Yes, sir.

Mr. Springer. At one time it was probably one of the three or four 

outstanding medical schools in the world. T doubt if there would 

lie many students in this country that would even want to go there 

if they went by the looks of the buildings, which are dark and I 

don't know how many hundred years old, but they seem to turn out 

pretty good doctors.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONN EL 241

About the time we were studying this thing in 1955 I visited there 

and 1 asked them why not a new’ building, and they were horrified at 

the thought tha t they should have a new’ building. This is the one 

tha t has tradition and all the things tha t go with it and they expect 

to be using this a hundred years from now’.

Did you ever visit the University of Vienna?

Dr. Wolf. No, sir.

Mr. Springer. You will admit it has some reputation throughout 

the world ?

Dr. Wolf. Had.

Mr. Springer. It doesn’t have any more ?

Dr. Wolf. Not as much as it used to have.

Mr. Springer. But at one time it was the preeminent medical 

school in the world, wasn’t it? The buildings were dilapidated, I 

would say, with spots on the walls and scratches on the walls. As I 

recall, there were marks on the outside, but it was still operating and 

still turn ing out a lot of doctors. Maybe they weren’t, but the one I 

happened to talk with there was an elderly man who was the preeminent man in the world at tha t time—I can’t think of his name 

now—in his particular field.

The thing I am coming back to is I think the quality in all of our 

medical schools is pretty high. Are you in agreement on that?

Dr. Wolf. Yes, sir.

Mr. Springer. You have visited most of those in New England and 

are pretty w’ell acquainted w ith them, aren’t you ?

Dr. Wolf. I have visited about half the medical schools in the 

country.

Mr. S pringer. About half the medical schools in New England?

Dr. Wolf. No, I have personally visited about half in the country.

Mr. Springer. Northwestern?

Dr. Wolf. Yes, sir.

Mr. Springer. Stanford ?

Dr. Wolf. Yes, sir.

Mr. Springer. Cornell ?

Dr. Wolf. Yes, sir.

M r.Springer. Tulane?

Dr. Wolf. No, sir.

Mr. Springer. University of Michigan? University of Illinois?

Dr. Wolf. No, sir.

Mr. Springer. It is true today tha t the United States has a great 

many more of the quality medical schools in the world; isn’t tha t 

true?

Dr. "Wolf. I would think so.

Mr. Springer. "Which was not true years ago when the century 

opened. Tha t is why you had people going to the University of 

Heidelberg or Vienna, because they did not have the quality or numbers of schools in this country. Is tha t not a fair statement?

Dr. Wolf. Yes, sir.

Mr. Springer. I am not disturbed about the quality. I think the 

quality at least is fine, at least from what I saw, but the p art tha t has 

been greatly disturbing to me is the numbers tha t are able to serve 

per 100,000 population.
242 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

I f I back this bill, which I am inclined to do now, it is g oin g to be 

on the basis th at you and your people are going to tu rn out more 

doc tors than you are now. I am satisfied with the qu ali ty of the 

docto r which this country is turning ou t in the med ical schools th at 

I kno w of, bu t it is the nu mb er of doctors th at I am think ing of, especially in view of the dem and of the arm ed services since abo ut 1951. 

I t is sim ply trem end ous the num bers of doctors the y want.

I will give you a fu rthe r reason and the n I will win d up. A grea t 

difficulty in a very pro spe rou s agric ultural area, such as I repres ent , 

one of the hig hest in the wor ld, is you find alm ost no rural doctors. 

We t alk about the ones that go out in the c ommunities of 400 to 2,000. 

We hav e had th ree in the last 5 years th at I kno w of. One was a Cuban, 

one was an Au str ian , a nd one was a German, all refu gees. Th at is all 

we were able to get out in the r ural area in Illino is, a very pro sperous 

one where the village rs themselves raised the money, pu t the man’s 

bu ild ing up, and his office.

There is the problem fo r America. As lon g as I live in W ashing ­

ton , I can always get good medical care, bu t if I go to Weldon , Il l. 

I hav e to dri ve 27 miles in each direction in orde r to find a hospital 

or a do ctor. Tha t is why I am. intere sted in the passage of this bill.

Dr. W olf. May I a tte mp t to answ er this la st one aga in by example?

Mr. Springer. Yes, sir; go righ t ahea d.

Dr. Wolf. I would like you to comp are Maine a nd Verm ont. Maine 

has a physici an-pa tie nt ratio of about 90 to 95 doc tors pe r 100,000 

population . These are ap pro xim ate. Ve rmont has a ph ysici an-pate nt 

ra tio of 140 doctors pe r 100,000 people. Ve rm ont has a medical 

school—G6 p erc ent of the doctors in the St ate of Vermont are gr ad uates of the Un ivers ity of Vermont.

Maine had a medical school which closed in 1930, somewhere aro un d 

the re, 1928 or 1930, and a s you reach the perio d when those gradua tes 

are dying off t he rate has been falling since th at time.

You can in terp ret these figures the way you wa nt, bu t my only 

po int is, a nd I su pp or t som ething tha t some of th e men said t he other 

day, th at I feel by giv ing an op po rtu nity to young peop le to ge t a 

medical edu cation and by increasing the ou tp ut of the numb er of 

doctors , we can solve ma ny of these problems of distr ibution of 

doctors.

I have anoth er piece of evidence in Vermont. They have a law 

on the books w hich says the studen t, if he accepts the redu ced tuition 

provide d by the State of V ermont, mu st pract ice in the S tate of Vermont a year fo r each year th at he accepted this reduced tui tio n, and 

then there is some penalty a bou t p ay ing th e money back to the Sta te.

Mr. Springer. Th is is a sim ilar pro vision to w ha t the S tate o f M ississ ippi has, w hich p rov ides rou ghly $5,000 f or a sc holarship and you 

must pra ctice the re for a period of 5 y ears in an are a of less than a 

certain population , o r pa y al l the mon ey bac k.

Th ere are State s th at have these pro vision s in an attempt to get 

these people to the rural communities. Is not th at tru e ?

Dr. Wolf. That is true. We studie d the rate o f settlem ent o f the 

grad ua te phy sicians in Ve rmont before a certain thing, and it will 

tak e me too long to tell you wha t th at th in g is, and af te r a certa in 

thing . W hat is meant was th at before th at th in g we certainl y enforced the rule. After th at thing we could n’t enfo rce th e rule. Yet
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 243

the rat e of settlem ent was the same before as after. I t is my considered opinion fro m the stu dy we did in Ve rm ont th at such a th in g 

wr itten in to the law does not have an effect on m aking the you ng doctor 

sta y there.

Mr. Springer. Do you think if we w rote som eth ing in the law here 

with refe rence to these sch ola rsh ips we wou ld be more successful in 

ge tti ng some people in some of the ru ra l areas?

Dr. Wolf. No, sir.

Mr. Springer. I t is y ou r conside red opinion we wou ld not.

Dr . Wolf. No, sir. It is n ot only my opinion. I t is ba sed on t hat 

experience I ha d and the evidence I was able to g et in Ve rm ont th at 

this does n ot work, a t l east in Vermont.

Mr. Springer. Th an k you, Mr. Ch air ma n.

Mr. Williams. Mr. Ma cdo nald?

Mr. Macdonald. Dr. Wo lf, I am delighte d to see you h ere thi s morning re presentin g New E ng land . As a m atter o f fact, I have th e ho nor 

of rep res entin g Me dfo rd in whi ch as you know , Tuf ts is loca ted, b ut 

there were a coup le of things I di dn ’t quite understand. On page 3 

you sa id :

* * * should Massac huset ts bui ld a St ate med ical school when the y are sub ­

sidizing the medical stu de nts a t o th er schools * * *

W ha t does th at mean ? Is there some such prog ram in Massachu ­

setts of sub sidizing medical students .

Dr. Wolf. I pro bab ly should have exp and ed th at a lit tle more. 

Wh en I said shou ld Massac husetts, New Ha mpshir e, and Maine buil d 

new medical schools when the y are sub sidizing med ical stu dents at 

the Un ive rsity of Vermo nt, it is all pa rt of the same th ing. Th e New 

En glan d Bo ard of Hi gh er Ed ucati on , was established 7 or 8 years 

ago and it repres ent s all of the New En gl an d Sta tes. It has est ablished a contract with the Unive rsi ty of Vermont whereby Maine, New 

Ha mps hire, and Massac husetts pa y a sum which is about $2,000 or 

$2,500 per student to the U nive rsi ty o f V erm ont f or the m to give p re ference to reside nts o f those Sta tes. Do you follow me?

Mr. Macdonald. Not rea lly, no.

Dr. Wolf. Jo hn nie J ones from Massachu setts wa nts to go to medical school. The Un iversit y of Vermont has given Massachu setts a 

quo ta of 70 stu dents who can att end the Unive rsi ty of Ver mont. 

Jo hn nie J ones ap plies to the U nive rsity of Vermont. Th e Un ivers ity 

of Vermont looks him over and decides wh eth er or no t he is qualified 

fo r the stu dy of medicine. If he is they the n accept him over and 

above, say, a New Yo rk reside nt or someone like th at. He is then 

charg ed the in -S tate r ate of tu it io n ; $550, instea d of the out-o f-S tat e 

rat e o f tu iti on of $1,500.

In othe r words, he has the same privi leg es as the Ve rmont res ide nt 

has. b ut th e State of Massac husetts creates this bv pa ying to the U nive rsi ty of V erm ont the sum of $2,000 or $2,500. Th is is not a unique 

pa tte rn . Th ere is a South ern In te rs ta te Educati onal organiz ati on 

and the W estern In tersta te Compac t fo r high er ed ucation in the W est 

which does the same kin d of thing. Does th at answer y ou r questio n?

Mr. Macdonald. Yes. Th e second t hi ng is you said there is a h igh 

rat e of acce ptan ce of Ma ssachu setts res ide nts in medical schools. Is 

th at a fact? My mail would ind ica te th at th at isn’t alw ays the fac t.
244 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Dr. Wolf. It is not the highest, but it is high for States without 

State supported medical schools.

Mr. Macdonald. Can you state categorically that the universities 

around Boston or Vermont tha t you are familiar with do not practice 

a quota system of admittance by virtue of race, or geographical 

location ?

I)r. Wolf. Oh, no. In Vermont we have a quota on the basis of the 

geographical location of the applicant because we have a responsibility 

first to Vermont residents because it is being supported by the State; 

secondly to Massachusetts, Maine, and New Hampshire because they 

have contracts with the University of Vermont; and, thirdly, anywhere else in the country. The quota is only for those who are contributing financially to the medical school at the University of Vermont. The Boston schools have no quota in those terms.

Mr. Macdonald. Are there any ratios in effect? Has any medical 

school that you know’ of kept figures about the racial origin of applicants and the number of those racial applicants who are turned down ?

Dr. Wolf. Again, I was very close to admissions at the University 

of Vermont, and we had nothing on the application sheet of what the 

man’s race, origin, or anything else was. We did have a picture, but 

tha t was not to determine his shade. It was to recognize him when 

he came in.

Mr. Macdonald. I was not talking about color. I was talking 

about race.

Dr. Wolf. No, we did not ask that question on the application blank 

at all.

Mr. Macdonald. Is that also true at Tufts ?

Dr. Wolf. I don’t honestly know. I am not tha t close to admissions. I would assume that most of the medical schools in the country 

do not have it on their application blanks and I know there are some 

areas that forbid it by law.

Mr. Macdonald. Do you think it would be a good thing for all 

medical schools not to have that inquiry on their application?

Dr. Wolf. As a personal opinion, yes. I am the one who took it off 

the University of Vermont application blank.

Mr. Macdonald. It was on there before ?

Dr. Wolf. It was on there before, years ago. I took it off 7 or 8 

years ago because that was my personal feeling about it.

Mr. Macdonald. Thank you.

Dr. Wolf. There is no law concerning this in Vermont.

Mr. Williams. Wha t percentage of colored students do you have 

at Tufts?

Dr. Wolf. I do not know. There are some, but I have not any idea 

what the percentage is.

The Chairman. One question. If the principle and intent of this 

legislation is carried out, a major decision of this kind would be left to 

the decision of the institution, would it not ?

Dr. Wolf. What would be left to the decision ?

The Chairman. As to whether or not this information would be 

requested in the admission application.

Dr. Wolf. Yes, sir.

The Chairman. Do you think it would be best for the institution to 

make that decision?
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 245

D r.W olf. Id o.

Th e Chairm an. Mr. You nge r?

Mr. Younger. Ju st one question. If I understood you correctly, 

yo ur r ecomm endatio n was th at in the b uilding gr an ts we ou gh t to use 

some discre tion as to building gr an ts where the re are alread y large 

med ical schools, such as Boston, and pay more atte ntion to othe r areas 

whe re there are fewe r medical schools in a sta te such as Ve rmont. Is 

that, w ha t you h ad in m ind ?

I)r . IVolf. No. My inte nt was t ha t ea ch i nstitution ha d t o be j udged 

in terms of its own merits. In othe r words, you cannot say “W e 

sho uld no t give money to Yale because they have a big endowm ent .” 

Ea ch in stitu tio n has its own ind ividual problem which 1 t hi nk requires 

stu dy by p rofess ion als; in o the r words, the advisory councils.

Mr. Younger. Th at is all.

Th e Chairman. Does anybod y else hav e a question? Mr. Collie r?

Mr. Collier. Dr. Wolf, I hav e been tryi ng to establ ish some inform ation h ere, unsuccessfully, because I have not h ad a n ans wer t hat 

was an ythi ng bu t vague. I don’t mean to be overly persiste nt, bu t 

I think it is absolutely essential to the pr op er appro ach to leg islati ng 

this type of a prog ram , so I am going to be specific. Ta king T uf ts, at 

the present time what is yo ur en rol lm ent in yo ur medical school?

Dr. Wolf. Ap proximate ly 110 in a class.

Mr. Collier. Next y ear you c ould n ot handle 120 with yo ur ex isting 

fac ilities?

Dr. Wolf. No, we have 800 or 900 applications.

Mr. Collier. I t is t he size of the classroom s and lab ora tor ies ?

Dr. W olf. Yes, sir.

Mr. Collier. I f this prog ram went into effect, and le t’s say if it 

were enacted in this session of Congress and went into effect fo r the 

school year b egi nning Sept ember 1963, will you be able to handle any 

more appli cants or accept any more applican ts in 1963, be aring in 

mind th at you obviously n eed new fac ilitie s and you have to staff ad di ­

tional m embers of the staff ?

Dr. Wolf. No, at tha t p oint we could not.

Mr. Collier. In 1964 would y ou be able to ac cept more ?

Dr. Wolf. If you ask me th is que stio n about Ve rmont, I would 

say yes.

Mr. Collier. I am s peaki ng just of T uft s now because you are very 

famili ar with T ufts?

Dr. Wolf. There are dif ferent situa tio ns there. Tuf ts has just 

used “H ea lth research fac ilitie s” money to con vert th is one fac tory 

bu ild ing in to research space. Th ey ha d to g et m atc hin g fun ds for that 

so th at th ey have used u p some available fund s in recent cons truc tion . 

Ve rmont is different. Tha t is w hy I am stress ing that.

Mr. Collier. Gr anted th at it is different from Vermont wou ld you 

say th at you are not unique in thi s respect, tha t ther e are other medical 

schools th at have the same basic problem th at y ou do at Tu fts .

Dr. Wolf. I am sure there are some, yes. On the o ther hand, there 

are oth ers like Ver mont with wo rking draw ing s ri ght on the board s 

rea dy to go if this bill were to be passed, and one othe r point about 

Ve rmont is th at they alr eady in th is new bu ild ing used their own 

funds to b uild one classroom to tak e care of 50 perc ent more stu dents , 

sho win g th eir intent.
246 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Mr. Collier. The point th at I am driving at, and I hojie I can make 

this point, is that if Tuf ts is not unique in the problem that exists 

there, which is obviously not like Vermont, there are many that are 

in the same situation that Tufts is. Therefore, these many schools 

that we are speaking of that are in the same situation as Tufts would 

not in fact be able to accommodate additional students for 2, 3, or 4 

years, depending on the type of physical facility and the securing of 

an adequate medical staff to staff these schools. Is this right?

I)r. Wolf. Yes; there are some, no doubt, in which this is the case.

Mr. Collier. One other question. What is your present medical 

staff at T ufts for this 100-odd students?

Dr. Wolf. I am sorry, 1 just can’t answer it. I have only been at 

Tufts 3 months.

Mr. Collier. I think that for the first time establishes the point 

tha t I have been trying to make on the matter of priority of the use 

of money in the program, realizing that there is to some degree a 

phasing out. I think tha t this points up that it would not increase the 

enrolment. What it might do is provide financial assistance to students already in the college, but it would do nothing for a few years 

in certain areas of increasing the number of the students that could 

be accepted.

Is this a fair statement ?

Dr. Wolf. Yes, but, again, I think you must think in terms of when 

the man is making up his mind to go to medical school and figuring 

about his finances. You must think of the time it takes for a student 

to get into medical school.

Mr. Collier. I have already indicated two answers to that. One 

is the preliminary program and the availability of funds in the National Defense Education Act, plus a proposal tha t at a given period 

of time when the facilities are available, then the scholarship funds 

would be expanded or grants would be made. It just seems to me to 

be the proper sequence of providing funds to meet the problem that 

we are trying to meet.

Dr. Wolf. But don’t forget about this lag period of time. In 

other words, 3 years is too late. As a matter of fact, may I say one 

thing? I have had some experience in a rural community in Vermont and I have neighbors who are farmers and tha t have children, 

and I have watched these children grow up. I have watched the 

farm er look at his milk check coming in once a month and worry.

As a matter of fact, you can demonstrate tha t the rate of enrollment of farm children in the University of Vermont School of Agriculture follows the annual fluctuation in the farm income in the State 

of Vermont. This farmer is having to make plans for his children, 

li e makes plans back in high school, really, because he has to decide 

tha t this boy is going to college or he is not. This means, even if he 

is a potential applicant for medical school, this decision is made 'wav 

back in high school.

Then the boy gets to college and they have to decide whether or not 

he can go on to medical school. In making those plans 'way back in 

high school, this farmer has to look at how much it is going to cost 

him. In Vermont he knows, because the State is subsidizing the 

school, tha t it is going to cost his boy in tuition $550 a year and that 

if he went to Harvard, or Cornell, or some of those places it would 

cost him $1,500.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 247

Right away he begins to narrow down on where this boy is going 

away back in high school. My point is, and I think some of the 

other men would agree with me, tha t if the Federal Government 

subsidizes medical student in this sense, with scludarships, and this 

gets generally known, then the kids who are now in high school are 

going to begin to think right away, “Ah, I can make mine medicine.

1 am not too poor to be a doctor. 1 am not going to have to stay 

here and work on the farm.”

Mr. Collier. 1 think you are establishing my very point, that if 

such a program is set ahead and announced at a given date, the boy 

who is a sophomore in high school making plans is no different from 

the boy who is a senior making plans in reality if he intends to go 

to college, and so the program is set forth for him to consider the 

point regardless of whether it is when he is a freshman, or a sophomore, or senior in high school.

Dr. Wolf. Except I am making a plea for the boys who are now 

juniors in college and tryin g to make up their minds, and to get into 

medical school in the fall of 1963 they have to make up their minds 

thisy ear.

Mr. Collier. Of course this is not unique to medical students. 

Let's face it. This is true of every parent with an income of less than 

$6,000 or $7,000 who is going to send his son or daughter to school, 

whether engineering school, or anything else. I realize there are 

facets to this that are slightly different, but really this problem of 

projecting the education for children, and preparing to meet the 

costs thereof, is not certainly confined to those going to medical 

school.

Dr. Wolf. No, but why should a boy or girl be penalized because 

lie wants to go into dentistry or medicine, and tha t is the way it is 

now.

Mr. Collier. Well, I would have to go furth er then. Thank you, 

sir.

The Chairman. Mr. Keith ?

Mr. Keith. As a graduate of the University of Vermont who 

lived at one of its dormitories and cooked meals down in the basement with many medical students, I appreciate the problem tha t you 

have presented here and have some rather firm convictions concerning the best way to help the medical profession in the long run.

Would you say, for example, Dr. Donaghy was a good doctor?

Dr. Wolf. Yes, sir.

Mr. Keith. He worked his way through medical school. He had 

very little in the wav of financial assistance from his family, but there 

were scholarships available and there were means by which he could 

earn an income, and he did an outstanding job as a student and is 

doing an outstanding job as a doctor now.

Dr. Wolf. There is one point; but he was being subsidized by the 

State of Vermont when he went through medical school.

Mr. Keith. He was ? And th at subsidization still exists ?

Dr. Wolf. Yes, sir.

Mr. Keith. It is commendable. It has kept him in the State of 

Vermont, has it not?
248 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Dr. Wolf. No, I don’t mean that. His tuition was much lower 

because he was a resident of the State of Vermont and because Vermont had a medical school which he could attend.

Air. Keith. It seems to me that the best way to keep the costs down 

and to continue to get medical students of high caliber is to subsidize 

a building program rather than to subsidize by scholarship at the 

Federal level and tha t the same end could be obtained if we assume 

tha t your standards now are high and that the students now are making good doctors. It is the incentive to go to school that we want to 

maintain and we want to continue to have high caliber people entering into the medical educational system.

Dr. Wolf. May I interject at this point with a question? Let’s 

leave Dr. Donaghy out of it because I was delighted to have him at 

Vermont. He is professor of neurosurgery and a fine person. But 

just take any other fellow. Do you feel he should be required because 

of financial exigencies to go to Vermont? Maybe he wants to go to 

Cornell or Harvard. The way it is now with the U niversity of Vermont subsidizing the Vermont boy, if he has a financial problem, has 

to go there. If he were subsidized at the Federal level he could go to 

Harvard or Cornell, or whatever he could feel he could best get his 

education.

Mr. Keith. I would like to see the subsidy taking the form of decreasing the cost of medical education by helping to underwrite the 

construction program rather than providing a scholarship. Then the 

cost of obtaining a medical education would be lower at both Cornell 

and the University of Vermont, because of the significant role tha t 

could be played by the Federal Government in contributing toward a 

building program rath er than toward a scholarship program.

I am concerned about the pressures that we get on behalf of families 

who want their boys to go to medical school. They expect their Congressman to be able to help the individual get in. I would like to see 

less of that and more of the lowering of the tuition so that the rank 

and file can go and not merely people of influence.

Dr. Wolf. My one reaction is that I think my colleagues would agree 

tha t the getting of funds for a building is different from getting funds 

for operation, so that even if we had help on construction it would 

not be reflected in lower tuition. In other words, one is capital funds 

and the other is operating funds. The two are different. You get 

them different ways.

Mr. Keith. I appreciate th at, but you nevertheless have to charge 

a great portion o f your expense in many instances to the maintenance 

and construction of buildings, and in this area the Federal Government can do a good job and is doing something, I believe, under the 

National Defense Education Act in the way of equipping laboratories.

Dr. Wolf. I certainly don’t know any school in this country that 

is putting tuition funds that they get from students into buildings. 

I mean heat, light, power, yes; but not into construction.

Mr. Keith. They don’t pay any of the capital costs?

Dr. Wolf. I am practically positive. I can’t prove it now.

Mr. Keith. Perha ps the alumni contributions could go toward 

scholarships if they were not used for capital contributions.

Dr. Wolf. Of course in Vermont we use the alumni contributions 

to match the Federal funds for the research construction. This is one
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSONNEL 249

of our sourc es of capital fun ds. The alumni is a stron ger source of 

capit al fund s th an it is of o pe ratin g funds in most instances.

Mr. Kei th . Pe rh ap s the alumni fund s could l>e div erted from 

capital funds to op erating costs by a more sub stantial particip ation 

on the pa rt of the Fed eral Governme nt tow ard the subsidization of 

buildin g.

I)r. Wolf. You recall from my testim ony I said that the annual 

contr ibu tion by the alum ni for op erating funds to the Un ive rsity of 

Vermont College of Medicine never exceeded $5,000 a year, but when 

we went to the alumni with a pr etty pictu re of a bu ild ing and said 

how about it, then they came up with $700,000 in 3 years.

In other words, a build ing is more sala ble to the alumni than are 

op erating costs. If you go and ask the alumn i at a meeting, as I 

have, ‘“Wo uld you con tribute to our op era t ing c os ts?" th ey say, ‘“What ? 

I)o you want to take anoth er tr ip o r some thi ng?” They think I want 

to use it for my own pers onal benefit or s omething.

Mr. Kei th . Th an k you, Mr. Ch airma n.

The C hair man. Any fu rthe r questio ns? Do you have a question, 

Mr. K om egay?

Mr. Korneoay. I ju st want to ask one question, Mr. ( ’hairm an. 

Am I correct in assuming, Dr. Wo lf, th at you do not adv ocate the 

abando nment or dem olition of build ing s sim plv because of the age 

of them ?

Dr. Wolf. Oh, no.

Mr. Korneoay. You ref err ed to the fac t so man y time s th at this 

bu ild ing was 100 y ear s old.

Dr. AV olf. No; those building s are being used now.

Mr. Korneoay. If th is pro gra m were to go into effect do you thi nk 

there would be a ny tend ency on the pa rt of the opera tor s, the trustees 

of these ins tituti ons, to want to do awa y with some of the building s 

simply because of the age o f the b uildin gs.

I)r. V olf. Not because of the age, but because of th e na ture of their 

con stru ctio n. Fo r ex ample, at the I 'Diversity of Ve rmont the y have a 

lecture room th at was built 50 years ago and when you lecture you 

stand like this looking up. The stu dents are way up this way. It is 

this kind of thi ng . In your research lab orato rie s the re is much waste 

space in an old build ing because of the natur e of con stru ctio n, the 

we igh t-supporting pilla rs and that sort of thing , in such a way th at 

lim its your ab ility to get in big pieces of mac hinery and things like 

that.

Mr. Korneoay. I un derst and th at. I wan t to complime nt you on a 

very fine statem ent and for the use of yo ur dem ons trat ive evidence.

The Chairman. Th ank you, Dr. Wolf , for your testimony. The 

committee will ad jou rn until ‘2 o'clock, at which time D r. Robert Moore 

will be the w itness.

I)r. Wolf. Th an k you, Mr. C hairm an.

(W hereu pon, at 12:10 p.m., Th ursd ay , Ja nu ar y 25, 1962, the committee adjou rned, to reconvene at 2 p.m., the same day .)

AFTERNOON SESSION

I he ( hairma n. Th e committee will come to order.

1 )r. Robert A. Moore.

4 on m igh t id en tif y yourself for t he re cord. Dr. M oore, and proceed. 

80014— 62----- 17
250 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

We want to extend to yon a welcome. I recall I believe that we 

have bad some correspo nden ce with yon in the pas t rega rding this 

matter , and we are glad to hav e you r testimo ny.

STATEMENT OF DR. ROBERT A. MOORE. PRESIDEN T, DOWNSTATE

MEDICAL CENTER OF TH E STATE UN IVER SIT Y OF NEW YORK

AND DEAN OF THE CEN TER 'S COLLEGE OF MEDICINE IN

BROOKLYN, N.Y.

Dr. Moore. Th ank you, Mr. Chairm an. My nam e is I)r. Rober t A. 

Moore. My present position is president of the Downstate Medical 

Cente r and dean of the College of Medicine o f the St ate Un ive rsity of 

New York in Brooklyn. I asked, Mr. Ch air ma n, fo r the op po rtu nity 

to appear before you in relation to ILK. 4999 v ery largely because of 

the o pp ortun ity 1 had to serve for a per iod of 4 y ears on the origin al 

He alth Research Fa cilitie s Council. Du rin g th at 4 yea rs 1 made 129 

site visits to variou s universities, medical colleges, hos pitals, and research institu tes, and amo ng these the re were 44 of the pre sen t 86 

medical schools. As a result of th at experience I have developed a 

deep interest in and great confidence in the prog ram of the He alth 

Research Facilitie s Act, and what 1 wish to say tod ay ref ers only to 

th at part of II.R . 4999. I would like to discuss chiefly the thi rd m ajo r 

section of the hill, Mr. Ch airma n, and members of the comm ittee, in 

relation to six topics.

Fi rs t, the amount to he authorized.

Second, the slidi ng scale of matching.

Thi rd , the ge ograph ic dis trib ution.

Fo ur th , kee ping all constru ctio n gr an ts in this are a un der one act.

Fif th , th e inclusion of li bra ries.

Sixth , the m akeup of the N atio nal Adv isory Council.

Under t he first item I would like to suggest that the re is a rela tion 

between the op erati ng expen diture s in a research ins titu tion and its 

need for cap ital funds. Fo r exam ple, in fiscal year 1957 the Con gress 

ap prop ria ted $160 m illion fo r the research gr an ts to non -Fe der al institut ion s. Of this, $30 million was for facilities. In oth er words, 

the fac ilities at that time were 19 percent of the approp ria tio n.

In fiscal year 1961 the approp ria tio n for research gran ts had increased to $480 million, hut the facilities were stil l $30 million.

Now, unless the ins tituti ons had space th at the y were not using in 

1957, I believe it is fa ir to say that they would need increased space 

with the incre ased amo unt of research which was l)eing sup ported. 

In 1961 only 6 percen t of the total ap prop ria tio n was for facilities. 

If one follow ed alo ng thi s line of reason ing, the ap prop ria tio n for 

research gran ts is now $320 million high er th an it was in 1957, and in 

general one needs for capit al expenditures of space about the same 

sum as is needed fo r 1 ye ar of op erating expenditu res within that 

space.

So that with $150 million paid out du ring the 5-year period we 

have developed a deficit acc ord ing to this typ e of reason ing of $170 

million in capital exp end itures. Th is type o f reas oning plus the actua l 

visits to the various ins titution s du ring th at 4-y ear period lead me 

to believe that the need is closer to $100 million a year for health 

research facilities th an it is to the $50 m illion which is pr ovid ed for in
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 251

this bill. I think that is a need which is legitimate and reasonable 

in terms of what 1 have seen around the country.

On the second item, the sliding scale of matching grants, the bill 

as now written provides that in educational grants there may be 

matching of 66% percent of Federal money if it is a new medical or 

dental school. As 1 understand it, the matching principle of 50-50 

in the health research facilities is unchanged.

May I suggest, sir, that you give consideration to the principle of 

a sliding scale of matching in both parts of the bill. Now, this could 

be done perhaps in many ways. One would be to write into the bill 

certain provisions concerning 60 percent, 70 percent, and so on. Another would be, as you have done on many other occasions in a similar 

situation, to instruct the Surgeon General and the National Advisory 

Council to give consideration to certain factors in awarding grants 

and in setting the percentage of Federal participation.

I believe that this second method is satisfactory and will work. I 

would suggest to you, sir, that there are certain factors, as I have 

toured the country and seen the institutions, that are worthy of your 

consideration. The first would be a factor similar to that in the 

Hill-Burton Act which makes provision for the population and the 

wealth of the State.

The second factor, which I believe is important, is consideration of 

how much that State, the people of that State, either publicly or 

privately, have invested already in educational facilities and in health 

educational and research facilities.

The third factor, which is already provided for, will be how will 

this appropriation increase the number of medical students and thereby the number of graduates, either in terms of expanding the classes 

of an existing school or of the establishment of entirely new schools.

In relation to my th ird point of geographic distribution, I would 

hope th at the Congress would include in this bill, as they did in the 

original Health Research Facilities Act, directions to the Council and 

the Surgeon General to give a fair and equitable distribution throughout all parts of the country rather than to write in any required geographic distribution of the grants.

My fourth point is that I would hope that all construction grants 

would be, as they are now, under a single act rathe r than to have two 

or more acts which make it possible for one to secure construction 

assistance in different ways.

The matter of libraries, Mr. Chairman and gentlemen, is a most 

serious one. In the original applications in the first year of the health 

research facilities program we had applications from medical schools 

and dental schools to include libraries in the grants. The Council did 

a great deal of soul searching in this matter trying to interpret the 

intent of the Congress that there was urgent need to get on with more 

research facilities and to improve research facilities. The council 

decided for the moment that they would not include libraries. Since 

then there has been some question as to whether or not the Health 

Research Facilities Act as originally written does include libraries.

I would urge you, sir, in the development of this new act, tha t 

libraries be specifically included, either in the act or in the report to 

the Congress bv the committee so that there will be a clear definition 

that research and teaching libraries are a part of the two parts of 

the act.
252 TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSONNEL

My final po int concerns the C ouncil.

As I understood the bill, II.R . 4999, as wr itten, would continue the 

presen t Nationa l Adv isory Council on He alth Rese arch Fa cilitie s and 

wou ld e stab lish a new council, a Na tional Ad vis ory Council on Teach ­

ing F acilities.

I think thi s would lie confusin g. I think it would be difficult. 1 

can imagine th at a single medical school or den tal school or public 

healt h school would make two app lica tions, one to the Research Facilities Council, the oth er to the T eac hing Fa cil ities C ouncil, and that 

there mig ht be some difference of opinion between these two councils 

as to whether a room here is teaching or a room here is research. I 

believe that it would be hig hly desirable if this could be bro ugh t before one National Advisory Council.

1 app rec iate the op po rtu nity, Mr. Ch airma n, to ap pe ar before you. 

I shall be glad to discuss these p oints, or answer any questions which 

the members of the committee wish to pose that I can answer.

(T he sta temen t ref err ed to fo llow s:)

Sta tem ent Subm itted by Dij. R obert A. Moore

M.v na me is Rob ert A. Moore. I am the pre si de nt of th e D ow ns ta te Me dical 

Cen te r of the Sta te U ni ve rs ity of New York an d de an of th e cente r’s Colleg e of 

Medicine in Broo kly n, N.Y\ I appear before th is co mm itt ee to da y in no official 

ca pa ci ty , lint only as a citiz en in te re st ed in the hea lth pr of es sion s an d part ic ula rl y in te re sted in the presen t H ea lth Resea rch Fac ilitie s Act. Thi s la tt er in ­

te re st stem s in la rg e part fro m my service fo r 4 yea rs on th e or ig in al N ationa l 

Adv iso ry Counc il on H ea lth Res ea rc h Fa cilities fro m 1956 to 1960. More re ­

ce ntly tii e Nationa l Can ce r In st it ute , on the N at io na l Adv isor y Co uncil of wh ich 

I se rv ed fro m 1954 to 1958, as ke d me to serve in a te m pora ry ad vi so ry ca pa ci ty 

on th e ev al ua tio n of th e re que st s fo r un match ed gra nts fo r co ns truc tion of 

ca nc er rese ar ch fa ci lities . W hile on th e H ea lth Res ea rch Fac il it ie s Co un cil I 

mad e 129 site vi sits, includ ing vis its to 44 med ical sch oo ls in all p art s of the 

Nati on . For th e Natio na l Can ce r Co uncil in th e sp ring of 1961 1 visited 10 

in st itutions wh ich ma de a pp lica tion s f or un match ed g ra nt s.

I sh al l con iine my re m ar ks larg el y to the th ir d m aj or section of II. R. 4999, 

th at is to he al th re se ar ch fa ci lities un de r six topics th e re la tion of op er at io na l 

an d ca pital costs, a slid in g scale of Fe de ra l pa rt ic ip at io n, ge og raph ic dis tr ib utio n. no nc ateg oric gr an ts , re se ar ch libr ar ie s, an d th e m ak eu p of th e Council.

On th e ba sis of th e vis its I ha ve ma de to uni ve rs itie s, ho sp ital s, an d re se ar ch 

in st it u te s in th e pa st 6 yea rs in part ic ula r, an d of my ob se rv atio ns an d di sc us ­

sion s w ith man y peop le in med icine in ge ne ra l, I am co nv inc ed th e pr es en t 

auth ori za tion of $50 mi llion in Pu blic Law 87-395 an d th e sa m e am ou nt fo r the 

fu tu re ca lle d fo r in H.R . 4999 is no t ad eq ua te to me et th e ne ed s of th e co un try . 

It is difficult fo r one wh o is no t de vo tin g fu ll tim e to st udy of a pro ble m to a rrive a t an d su bst anti ate a de fin ite figu re, bu t I be lie ve th e need is clos er to $100 

mill ion a yea r th an to $50 mi llio n. My re as on s fo r comi ng to th is conclus ion 

are va ried .

F ir st, an d per ha ps fo re mos t, is my be lie f co nc er ni ng th e in te rr ela ti ons nt op ­

er ati onal fu nd s an d ca pit al fu nd s in an in st it uti on de vo ted to hea lth- re la te d 

re se ar ch . It is ge ne ra lly ac ce pted th at fo r ev er y pe rson on th e pa yr ol l in med ­

ica l re se ar ch it ta kes ab ou t $7,000 a yea r to pa y sa la ries, buy eq uipm en t an d 

su pp lie s, tr av el to mee tin gs , etc . Fur th er , it is ge ne ra lly ac ce pted th at on an 

av er ag e 200 sq uar e fe et of net sp ac e sho uld be pr ov id ed fo r ea ch perso n on th e 

pa yr ol l in clud ing all gen er al spac e such as an im al q u art ers , sto rer oo ms, etc. 

If we as su me a minim al fig ure of $35 a sq ua re fo ot of net re se ar ch spac e as const ru ct io n cost, th is m ea ns th e ca pital co st pe r pe rson w or ki ng is $7,000, o r th e 

same as th e a nnual o pera ti ng cost.

In fiscal yea r 1957, th e fi rs t y ear of th e H ea lth R es ea rc h Fac ilitie s Act, th e 

to ta l ex pe nd itur es f or extr am ura l rese ar ch , tr ai nin g, and con stru ct io n were $160,- 

700,000. of wh ich $30 mi llion , or 19 jierce nt, w er e fo r co ns truc tion . In fiscal ye ar 

1961, th e co mpa rable fig ures were $480,100,000, $30 mi llion , an d 6 pe rcen t.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 253

In oth er words, in this 5-year period ann ual o pera ting expenditures increased 

from roughly $130 to $450 million, or $320 million. During this same time 

$150 million was expended for space, or less than half ns much as would be required under my assumptions th at for each additional dollar of ann ual ojierating 

fund s there should be a new dollar of capital funds. Thus, by thi s crite rion 

we have an accumulated deficit of $170 million in construction just to keep up 

with the increase in operational funds of the la st 5 years.

One might say this has been absorbed into excess space available in 1957. 

From my many visits I can assure you this is not tru e; rather projects and 

people have been crowded beyond the point at which optimal work can he done. 

Further, I have l>een told that some institution s have not applied for research 

funds because of lack of space and 1 can assure you tha t in my own school this 

is the case.

Let us approach this problem of inte rrelation of operating and capital funds 

in ano ther way. In fiscal year 1957, Congress authorized $-30 million for construction at a time when the operatin g costs were $130,700,000. Construction 

was 19 p ercent of the total. I believe there are few. if any, who would say this 

amount was excessive. Certainly the approved applications were every year in 

excess of it. Now in fiscal yea r 1901 there is the same $30 million for construction at a time when the operating costs are $450,100,000, or over a 3.4-fold increase. Yet the construction is the same at $30 million. If 19 percent were 

correct in fiscal yea r 1957 with an increasing budget, it is even more correct 

today. By th is measure the construction expenditures in fiscal year 1961 should 

have been $91,200,000. (Note.—the figures on expenditures in the preceding 

par agraph s are from the Resource Analysis Section, Office of Program Planning, 

NIH, Aug. 9, 1961, as published on p. 57 of “Hearings on Community Health 

Facilities and Services” before the Subcommittee on Health of the Committee 

on Labor and Public Welfare, U.S. Senate, 87th Cong., on S. 1071, II.Ii. 4998, 

and S. 719, Aug. 3 and 4, 1961.)

May I be so bold, Mr. Chairman, as to suggest tha t the Congress, after a careful study and assessment of the backlog of need for research facilities, then 

establish a rati o between increases in operatin g budget and capital funds for 

facilities so this problem may be dealt with rationally and on a continuing 

basis. If my reason ing is correct, this should for some years be dollar for 

dollar for each increase plus some significant part of the accumulated needs.

Other witnesses have or will, I am sure, present the facts derived from sur ­

veys of estim ated needs by the institutions, and I shall not atte mpt to repeat 

them. However, it is my understanding tha t these add up to about $100 

million a y ear for 5 years.

There is, however, Mr. Chairman, one special faetof of which I would like 

to speak. It might best be put as an answer to the question, Why do you think 

there is a continuing large demand when in the last 5 years many of the research institu tions have been awarded a gra nt and have built new facilities?

It is tru e that most of the more active institution s have received a grant, 

but in many instances the gra nt was less than was applied for. Decreases 

were made in most cases, not because the Council did not believe the institution 

could use the requested space in the future, but because it was clear to the 

Council the first yea r tha t some fair and equitable limitation on construction 

for the fut ure would be necessary or grants could be made to only a few institutions. Accordingly approved gra nts were based on estim ated needs up to 

only 2 year after completion.

If medical resea rch continues to grow in volume, and there is every indication it will, then many of the institu tions will be back in a year or two to say— 

we are grateful for the grant in 1957 and as you predicted the space is now 

all used and we need more.

My point is that just because university A or hospital B got a grant for its 

current and 2-year projected needs between 1957 and 1961, this does not rule 

out a new application which is entirely reasonable and legitim ate from the 

same institution in 1962-67. In fact. I would be surprised if many of the 

institu tions did not apply again soon.

As an example of this situation let me cite the case of my own institution— 

the Downstate Medical Center of the State University of New York. In 195S 

the State of New York authorized new construction at the Dow nstate Center 

of a 350-bed hospital, an outp atient depa rtment, and a clinical resea rch build ­

ing. For the latter, we applied for and were awarded a gra nt und er the Health 

Research Facilities Act. We will star t construction in the nex t few months.
254 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

W hen it ope ns in 1965 ev ery sq uar e foo t will be occupie d by pr es en t an d pr oje ct ed pe rson ne l w ith no in cr ea se in ad ditio nal re se ar ch pe rson ne l. I am ce rta in th er e will see n be pre ss ur es fo r ad ditio nal co ns truc tion .

As a second po int, Mr .C ha irm an , I wi sh to pre se nt som e th ou gh ts co nc erning 

a slidin g sca le fo r m at ch in g of th e Fed er al g ra n t w ith loc al fu nd s. Th e presen t 

H ea lth Re search F ac ilitie s Act pr ov ides fo r on ly on e lev el of match ing— 50-5 6. 

On th e ba sis of my man y si te vis its I am no t co nv ince d th is is fa ir an d in keeping w ith the basic ph ilo soph y of th e Co ng res s on m at ch in g gra nts in ge ne ral.

F ir st, let me mak e it cry st al cl ea r th a t I do no t belie ve th e Fed er al Gov ernm en t shou ld pay al l th e costs . We ha ve de ve lope d a tine co op er ative pr og ra m 

of med ical re se ar ch in th e co un try based on a part n ers h ip of Fe de ra l an d local 

fu nd s, ei th er pri vat e or go ve rn m en tal. Th us , 1 be lie ve th ere shou ld be a m in imu m an d a max im um of Fed er al pa rtic ip at io n an d I su gg es t 50 an d 75 pe rc en t 

resp ec tiv ely .

T her e are two way s in which th e Co ngres s could pr ov id e fo r th e slidin g sc a le : 

fir st, w rite in to th e law a fo rm ul a; or sec ond, in str u ct th e Natio na l Adv iso ry 

Co un cil on H ea lth Res ea rc h Fac ilitie s to giv e co ns id er at io n in ap pl ic atio n of th e 

sl id in g sca le to ce rt ai n specified fa ct or s name d in th e law . I believ e th e la tt er is 

th e pr ef er re d metho d an d I belie ve it is w or ka bl e on th e ba sis of ex pe rie nc e. 

The H ea lth Res ea rch Fac ilitie s Act in st ru ct ed t he C ouncil to :

"In ac tin g upon ap pl ic at io ns fo r gr an ts , th e Co un cil an d th e Su rgeo n Gen eral 

sh all t ak e into c on side ra tion th e r el at iv e effecti ve ne ss of th e p ropo sed fa ci lities — 

in prom oting an eq ui ta bl e ge og raph ical dis trib ution of su ch re se ar ch * *

I be lie ve ev ery on e wi ll ag re e th e Counc il ha s do ne th is ad m irab ly .

Am ong the fa ct ors wh ich I believe might be used in ap pl yi ng th e slid in g sc ale 

a re re la tive w ea lth of th e S ta te in wh ich th e in st it uti on is located , re la tive 

am ou nt t he i ns titu tion ha s al re ad y inv ested in hea lth-r el at ed fa ci lities fro m ot her 

th an Fed er al fund s, ra te of re ce nt pa st an d pr oj ec ted fu tu re gr ow th in re se ar ch 

an d rese ar ch tr ain in g an d tr ain in g pr of es sion al he al th pe rson ne l, an d w he th er 

or no t it is a comp letely new in st itut io n in contr ast w ith ex pa ns io n of an old.

Thi rd , alo ng th e same lin e I wo uld urge th e Co ng ress to lea ve actu al geogr ap hic di st ribu tion to th e Co uncil and Su rgeo n G en er al as in th e pr es en t ac t, 

ra th e r th an to w rite in de fin iti ve figures fo r th e minim um an d max im um to ea ch 

reg ion.

Fou rt h, I wo uld st ro ng ly ur ge th at the pr es en t policy of th e Co ngres s, eff ectiv e 

a ft e r Ju ly 1, 1962, of plac ing all he al th -r es ea rc h fa ci lities gra nts on a nonca tego ric ba sis un de r one ac t an d on e Council be co ntin ue d. I ha ve no pr ac tica l 

di sa gr ee m en t w ith ap pro pri at io n an d allo ca tio n of r es ea rc h gra nts on a ca tego ric 

ba si s fo r 1 to 5 ye ar s as th ey are re la te d to a spe cif ic prob lem . But, in th e ca se 

of bu ild ings , wh ich la st fo r 20 to 50 ye ar s, one simply ca nn ot ca tego riz e th ei r 

us e fo r mo re th an a sh ort tim e. Thi s ye ar be ca us e of pe rson ne l on dut y th er e 

m ay be a la rg e pr og ra m in univ er si ty A on ca nc er . Som e of th is pe rson ne l ma y 

mo ve ne xt yea r to anoth er univ er si ty —u ni ve rs ity B—which ha s a bu ild ing fo r 

re se ar ch in heart dise as e. If th er e was st ri ct in te rp re ta ti on of th e law , we 

wo uld in a few ye ar s ha ve gre at em ba rr as sm en t in uni ve rs itie s, som e wo uld be 

cr ow de d an d som e ha ve empty spa ce.

It is tr u e th er e are a few in tr auniv ers it y an d in de pe nd en t re se ar ch in st itute s 

de vo ted to on e ca tego ry of re se ar ch wh ich are as pe rm an en t as un iv er sities . 

How ev er, they can an d ha ve q ua lif ied un de r th e curr ent ac t ju st as we ll as un de r 

a se para te act f or th a t c ateg ory.

Fif th . I ur ge t he Co ng ress to includ e in th e am en de d H ea lth Res ea rch Fac ilitie s 

Ac t. spec ific auth ori za tion to mak e gra nts fo r biom ed ica l re se ar ch li bra ri es or 

fo r th e rese ar ch p a rt of a ge ne ral bio me dic al li bra ry . D ur in g th e first yea r of 

th e pr es en t ac t, se ve ra l med ical sch ools ap plied fo r g ra n ts wh ich includ ed a p a rt 

of th e co st of a new me dical li bra ry . Ea ch ca lc ula te d th e re se ar ch p art of th e 

li b ra ry in a di ff er en t way , but in each in st an ce th e re ques t was fa ir ly la rg e in 

dol la rs . A fter leng th y stud y of th e pro ble m an d of th e a pp lica tion s, th e Council 

decid ed no t to recom me nd an y gra nts f or l ib ra ry sp ac e be cause, fir st, th e r el at iv e 

doll ar s inve sted th ere wo uld lim it th e do llar s avai la ble fo r ac tu al re se arch an d 

th u s de fe at th e in te nt of th e Co ng res s “to ex pa nd th e he al th -r el at ed rese ar ch of 

th e Nation,” an d sec ond, th e Council was no t cer ta in ho w to de term in e th e 

re se ar ch p a rt of a li b ra ry w ith in the in te nt of th e Con gr es s in th e H ea lth Rese ar ch Fac il it ie s Act. A few yea rs la te r th e Co un cil decid ed it con’d dev elo p a 

sa ti sf acto ry fo rm ula fo r a rese ar ch libr ar y, b ut by th en th ere w as q ue stion in th e 

min ds of man y th a t Co ng ress intend ed to incl ud e re se ar ch li bra ri es un de r th is 

act , so no g ra n ts hav e bee n ma de.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 255

I need not tell a Member of Congress with the reference and research resources 

of the Library of Congress that modern research is not possible unless its practitione rs have an adequate libra ry available. The recent growth in research has 

correspondingly Increased research publications. Most medical school librarie s 

were built many years ago, and additional space is now or soon will be needed.

Sixth and finally, I wish to comment on the proposal in H.R. 4999 to establish 

a National Advisory Council on Education for Health Professions. I agree completely with the principle of the Natio nal Advisory Council, but I believe, Mr. 

Chairman, it would be a serious mistake to have one Council for Educational 

Facilities and another Council for Research Facilities.

With two councils each school of the health professions would have to make 

two applications if it wished to construct a combined educational and research 

building. I can well imagine some day tha t the Educatio nal Council would rule 

a room research and the Research Council rule the same room educational, in 

spite of the fact that both councils agree such a room is necessary to the inst itution as a whole. The Health Research Facilities Council has had a difficult time 

deciding what is research and what is education. Let us not magnify and duplicate and confuse the problem by asking another council to decide what is education and what is research. Certainly a single council with proper membership 

could solve these difficulties with fair ness to all.

The Chairman. Thank you very much, Dr. Moore.

I want to compliment you on your statement, as you have devoted 

it to this particular subject and developed some ideas and thoughts 

and made suggestions here that have not heretofore been given the 

attention which you have given to it. Are there any questions bv 

any members?

Mr. Younger. Yes, Mr. Chairman.

Dr. Moore, how would you apply the Hill-Burton formula, which is 

designed for hospitals, and there are hospitals in every State, as 

against medical schools where medical schools exist only in 24 States.

Dr. Moore. 1 was thinking, sir, only in terms of applying the HillBurton formula as I understand it, the principle of it, that a State 

receives increasing matching funds, Federal participation, in relation to the wealth of that State and the population of that State.

Mr. Younger. In other words, you would apply the Hill-Burton 

formula to any State which did not get a grant?

Dr. Moore. Yes, sir.

Mr. Younger. That is all.

The Chairman. Is there anything further?

Thank you very much, Doctor. We appreciate your presentation to 

the committee.

Dr. Moore. Thank you, sir.

The Chairman. I)i

-

. Philip Bonnet?

Dr. Bonnet, we are glad to have your presentation here todav. I believe you are the administrator of the Massachusetts Memorial Hospital, a member of the Board of Trustees of the American Hospital 

Association.

STATEM ENT OF DR. PH IL IP D. BONNET. ADMINISTRAT OR, MASSACHUSETTS MEMORIA L HO SPITA L: MEMBER OF TH E BOARD OF

TRU STEES OF TH E AMERICAN HOSPITA L ASSO CIATION: ACCOMPA NIED BY KENN ETH WIL LIAMSO N. ASSOCIATE DIRECTOR OF

TH E AMERIC AN HOSPITAL ASSOCIATION

Dr. Bonnet. Yes, sir. I am appearing on behalf of the American 

Hospital Association. I have with me Mr. Kenneth Williamson, 

associate director of the association.
256 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

The ( 'iiairman. We are g lad to have you, Mr. W illiamson .

Mr. W illiamson. Th ank von.

I)r. Bonnet. I have here a full pre pared statem ent which 1 would 

like to request be entered into the record. In orde r to save the committee ’s time I would like to make a few brief rem ark s rather tha n 

rea ding the full statement.

The ( 'iiair man. Very well, Doctor, your full statem ent will be included in th e record.

Dr. Bonnet. Th an k you , sir.

(T he sta tem en t ref err ed to follow s:)

Stateme nt of Dr. P h il ip I). Bonnet in Beh al f of th e A merican

Hosp ital Association

Mr. C ha irm an , I am Dr . Philip I). Bo nnet, o f Bo sto n, Ma ss. I am th e ad m in istr a to r of the M as sa ch us et ts Mem orial Hos pital an d a mem be r of th e bo ard of 

tr ust ee s of th e Am erican Hos pital As socia tion. I appear to da y on be ha lf of 

th e as so ciatio n. Ac comp anying me is Mr. Ken ne th W ill iamso n, as so ci at e di re cto r of th e Ame ric an Hos pital As socia tio n.

Th e American Hos pital Assoc iatio n is a vol un ta ry , no np ro fit mem be rsh ip 

or ga ni za tion with ov er 7,000 me mb ers , includ ing th e gre at m ajo ri ty of all type s 

of ho sp ital s. Th e pr im ar y in te re st of the as so ciatio n— an d th e reason fo r its 

or ga ni za tion — is to prom ote th e pu blic w elfa re thro ug h th e de ve lopm en t of be tte r hos pi ta l ca re fo r all th e peo ple. Ou r me mber hosp ital s prov id e ov er 1)0 

pe rcen t of th e Natio n's ge ne ra l ho sp ita l beds. La st yea r, more th an 23 millio n 

people w er e ad m itte d as pati ents in to ou r ho sp ital s— ab ou t one in eigh t of the 

co untr y’s po pu latio n— an d ea ch ye ar , mo re an d mor e people seek ca re in a 

ho sp ita l.

In or de r to impro ve know led ge of dise as e an d to me et th e gr ow ing need fo r 

more an d be tter do cto rs in ou r ho sp ital s, the Am erican Hos pital As sociati on ha s 

fo r a nu m be r of ye ar s su pp or ted prop os als fo r Fed er al gra nts to as si st in the 

co ns truc tion not only of he al th ca re an d rese arch fa ci lities bu t also of teac hi ng 

fa ci lities fo r the N at io n’s med ica l schools. Thi s su pp or t ha s been set fo rt h in 

st at em en ts pres en ted to th e Con gress ur ging gra nts fo r medica l school fa ci lities 

to as si st in prov iding ad eq uat e nu m be rs of w ell-trai ne d ph ys ic ia ns to serve the 

American people.

Th e ho sp ital s of the co un try are dee ply concern ed w ith bo th th e quan tity 

an d qua lity of me dic al ed uc ation. Ma ny of the m are a p a rt of, or ar e aff ilia ted 

w ith , med ical scho ols. Ov er 800 ho sp ital s offer in te rn sh ip s an d nea rly 1.300 hospit als off er me dical an d su rg ical reside nc y tr ain in g pr og ra m s. A good ma ny 

of them are also engaged in pro gr am s of co ntin uing ed uc at io n fo r me dical pra ctition er s.

G re at pu blic atten tion is being co nc en trat ed upon med ical re se ar ch . Thi s re ­

se ar ch is co nd uc ted in larg e p a rt w ithin ho sp ita ls, an d hosp ital s are pri m ar ily 

re sp on sibl e fo r tr ansl ati ng th e benefits of suc h re se ar ch in to metho ds an d proc edure s fo r pa tien t ca re. Bo th ho sp ital s and th e me dical sch oo ls m us t ha ve the 

ne ce ss ar y fa ci lities an d eq uipm en t if re se ar ch is to be mea ni ng fu l to th e peo ple 

an d adap te d to me et th eir needs.

I t is ob vio us th a t th e prov ision of ad eq ua te nu m be rs of good do ctor s is de ­

pe nd en t up on th e qu al ity an d av ai la bility of med ical ed uc at io n in th is co un try . 

At th e pr es en t tim e, man y medica l sch ools an d th eir te ac hin g ho sp ital s ar e 

ho used in po or an d in ad eq ua te bu ild ings. Th e olde r scho ols hav e a m aj or need 

fo r re no va tion an d m od er niza tio n. Som e ma y eve n ne ed repl ac em en t. A stud y 

by th e Assoc iatio n of Am erican Me dic al Colleges in di ca te d th a t if th e ex isting 

med ical sch oo ls were ab le to carr y ou t ne ce ssary new co ns truc tion , as well as to 

re nova te an d mod ernize th eir pr es en t fa cilit ies, th ey wou ld lie ab le to increa se 

th eir e nr ol lm en t by more th an a th ou sa nd stud en ts

Ther e ha ve be en a nu m be r o f stud ies do cu men tin g th e av ail abil it y o f p hy sician s 

an d pro je ct in g th e ex te nt to wh ich th eir fu tu re nu m be r may me et th e needs 

of th e co un try. In 1957. th e re por t “M edical Sch ool In quir y,” pr ep ar ed by th e 

staf f of th is co mmittee , mad e an im po rtan t co nt ribu tion to th e in fo rm at io n on 

th is su bj ec t. Th e re po rt of th e Su rgeon G en er al’s C on su ltan t Group on Medical 

Edu ca tion , en titled “P hy si ci an s fo r a Gr ow ing America.” pu blishe d in Oc tob er 

1959, is an ex ce lle nt st at em en t of th e fa ct s re la ting to th e ava ilab ility of phy-
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONN EL 257

si ci an s, th e nee d fo r ph ys icians , an d th e prob lems faci ng th e med ical sch ools. 

I sh al l no t att em pt to rei»eat th e ev iden ce se t fo rt h in th es e re po rts. W e ag re e 

w ith th e conc lusio n of th e 1959 re po rt, an d w ith th e mo re re ce nt rejior t on 

“ Fed er al Sup po rt of Me dical Res ea rc h, ” deve lope d fo r the Sen at e A pp ro pr ia tio ns 

Su bc om mitt ee , th a t in view of th e ex pa nd in g po pu latio n am i th e co mplex ity of 

med ici ne , th e United Sta te s ha s an in cr ea sing need fo r med ical ser vice s an d face s 

a gr ow in g sh ort ag e of ph ys icians .

Th e p att ern of med ical ed uc at io n an d pra ct ic e in re ce nt years has ch an ge d 

w ith th e gr ow th in ho sp ita l reside nc y an d in te rn sh ip pr og ra m s. Al mo st ev ery 

ph ys ic ia n now gra duati ng from a med ical sch ool se rv es an in te rn sh ip . Many 

also ac ce pt re side nc ies or fello wsh ips. P ri o r to W orld W ar II , ho sp ital s offered 

a to ta l of 13.000 ap prov ed in te rn sh ip s an d reside nc ies. A t th e pre se nt tim e, 

th er e a re more th an 30,000 in te rn sh ip s an d re side nc ies av ai la bl e in ho sp ita ls. 

The se fig ures show a ch an ge in th e pre para ti on of ph ys ic ia ns an d a gr ow th of 

sp ec ia liza tion . The ph ys ician pre par in g fo r a sp ec ia lity is re qu ired to ta ke a 

reside nc y pr og ra m of fro m 3 to 5 ye ar s, or more, be fo re he is eli gible to ta ke 

hi s sp ec ia lty bo ar d ex am in atio ns .

TRENDS TOWARD DOCTOR NEED

We wh o ad m in is te r th e N at io n’s hos pital s are ab le to ob se rv e ce rt ain in ­

fluences an d tr ends which in dic at e th e in cr ea si ng need fo r ph ys ic ians . For 

exam p le :

At pr es en t ou r ho sp ital s are una ble to fill a su bst anti al pe rc en ta ge of th e 

av ai la ble in te rn sh ip s an d reside nc ies. I t is es tim at ed th a t ab out on e- fo ur th 

of th es e po sition s are va ca nt . T hi s sh ort age of in te rn s an d re si den ts m ea ns t h a t 

att endin g ph ys ic ia ns m us t pe rf or m m an y of th e pr of es sion al duties fo r th eir 

pat ie nts which a re ord in ari ly ha nd le d by in te rn s an d re side nt s. Thu s, th e 

pr ac tici ng ph ys ic ia n can tr e a t fe w er p ati ents an d th e need fo r do ctor s grow s 

as a re su lt. Also, th e nu mbe r of in te rn s an d re si den ts in ou r hosp ital s wh o are 

gra duate s of foreign med ical scho ols ha s bee n red uced. H ig he r st andard s of 

ad mission ap plicab le to fo re ign med ical gra duate s— which are de si ra ble an d are 

su pp or ted by th is as so ciatio n— ha ve mad e fo r more va ca nc ies on ho sp ital house 

staf fs an d addi tion al in -h os pi ta l acti vit ie s fo r th e att en din g ph ys ic ians .

Pre pa id he al th ca re is co ve rin g an in cr ea si ng pe rc en ta ge of our po pu latio n. Gov ernm en t also is in cr ea sing its fin an cin g of he al th se rv ices fo r var io us 

segm en ts of th e po pu latio n. The re fo re , mor e people are de m an di ng hea lth ca re 

an d th is c an no t bu t re qui re a ddi tion al p hy sician s.

More att enti on an d fu nd s are be ing direc te d to w ar d tr ea tm en t of th e m en tally 

ill. The ne ed s of th e men ta lly ill ca nn ot be met w ithou t mo re do cto rs.

The nu m be r of aged pe rson s in our co un try is grow ing. Exp er ie nc e show s 

th a t ol de r pe rs on s ha ve a gre ate r ne ed fo r hea lth ca re th an th e yo un ge r gro up: 

co nseq ue ntly, th e nu m be r of do ctor s m us t grow alo ng w ith th e ag ed se gm en t of 

ou r po pu latio n.

We are co nf ro nt ed w ith th e prob lem of bu ild ing more in st it uti ons to ca re 

fo r th e ag ed an d ch ro ni ca lly ill an d to ra is e th e st andard s of th e ex is ting one s. 

Me dic al car e an d med ica l su pe rv isio n are es se ntial to im prov e th e quali ty o f 

ca re in nurs in g ho me s an d ch ro ni c ill ne ss in st itutions. Thi s will re quir e the 

avai la bility of mo re p hy sician s.

FEDERAL IMP ACT

F or a nu m be r of reas on s th e prob lems of me dical ed uc at io n a re F edera l issues. The do ctor s wh o serv e in all th e un ifor m ed serv ices an d who st af f Fed ­

er al ho sp ital s rece ive th eir enti re med ical ed uc at io n an d tr ai nin g, pri or to inte rn sh ip , in no n- Fe de ra l sch ools. Co ns eq ue ntly, th e med ical scho ols an d the 

teac hi ng ho sp ital s of th e co un try are inve stin g he av ily of th eir mu ch ne eded 

fu nd s in t ra in in g phy sician s fo r Fed er al service .

The re a re do ctor s in ev ery Sta te , bu t no S ta te is se rv ed ex clus iv el y by 

ph ys ic ia ns ed uc at ed in th at Sta te . T ra in in g th es e do ct or s th us become s a re ­

gion al an d nat io na l en te rp rise . Tea ch in g hos pital s an d med ical scho ols pre par e 

ph ys ic ians fo r dis ta nt ge og raph ical ar ea s. Und er th es e ci rc um st an ce s it shou ld 

be rec og nize d th a t th ei rs is no mer e loca l or S ta te fu nc tion . It is ev en in te rna tion al sinc e th ey as si st ma ny fo re ig n la nd s by tr ain in g phy si ci an s under th e 

ex ch an ge v is itors p rogr am .

Th e se cu ri ty an d de fe ns e of our N atio n re quir es ad eq uat e med ical pe rson ne l. 

T heir tr ain in g is im pe ra tive if we are to be st ro ng an d hea lthy in th e fa ce of
258 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

th re ats to ou r se cu rity . Th e hea lt h of ou r de fe ns e pe rson ne l an d of th e 

ci vi lian po pu latio n mus t he pr es er ve d as a na tion al as se t. Thi s re quires an ad equat e nu m be r of d octor s.

I ha ve ou tli ne d th es e po in ts to em ph as ize th e in cr ea se d ro le of th e ho sp ita l 

in th e ed uc at io n of ph ys icians , its Fed er al im plicatio ns , an d to dem on st ra te 

th at co nt in ua tion of h igh q uali ty ph ys ic ian tr ain in g will re quir e ex pa nd ed te ac hing fa ci lities in h os pi ta ls as we ll as in m ed ical schools.

In ou r view, H.R. 4999 will pr ov id e fina nc ial ass is ta nce fo r th e needed im ­

prov em en t an d ex pa ns ion of our med ical school fa ci lities , a m att er of ut m os t 

im po rtan ce to th e he al th an d w el fa re of th e Nati on . We ur ge Con gress to pr ovide t hi s as sistan ce .

SUGGESTED AME NDM ENT

The re is a secti on of part B, de al in g w ith gra nts fo r th e co ns truc tion of te ac hing fa ci lities , wh ich we believe shou ld be modified in tw o re sp ec ts.

F ir st , un der sec tion 7 2 1 (c )(3 )(A ), th e Su rge on G en er al ’s ap pr ov al of a 

co ns truc tion gra nt is co nd iti on ed up on a show ing th a t th e co ns truc tion will 

ex pa nd th e “tra in in g ca pac ity” of an ex is ting school of me dic ine . Sin ce ho spit al s pr ov ide a la rg e m ea su re of th e tr ai nin g of med ical st uden ts , one would 

ex pe ct th a t th e section is desig ne d to en co urag e new or ex pa nd ed co ns truc tio n 

of th os e ho sp ital s wh ich pr ov ide tr ain in g fa ci lities fo r med ica l schools. W he re 

a med ical scho ol ha s it s own ho sp ita l, ex pa nsion of th e “t ra in in g ca pac ity” of 

th a t sch ool would ce rtai nly co ve r co ns truc tio n fo r its ho sp ita l me mb er. Bu t 

it is no t cl ea r w he th er th e hill wo uld apply to th e si tu ati on w he re th e medic al 

sch ool do es no t ha ve its own ho sp ita l. It is ob vio us th a t w he re a ho sp ita l is 

us ed fo r th e teac hi ng pu rp os es of a me dic al school, it pr ov ides es se nt ia l “t ra in ­

ing ca pac ity” fo r th a t school w he th er it is a p art of th a t school or inde pe nd en t 

of it. We urg e, th er ef or e, th a t th e hill he am ende d to mak e cl ea r an intent io n 

to includ e all ho sp ital s a ffi lia ted with a medic al school.

Sec ond , un de r th e pr es en t te rm s of th e hill, an y ap pl ic at io n m us t be in it iat ed direc tly by a me dical school, even tho ug h it may be fo r co ns truc tio n of 

ho sp ita l teac hi ng fa ci lities . We be lie ve th at th e bil l shou ld be am ende d to 

pr ov ide th a t an ap pl ic atio n ma y be in itia te d by a ho sp ita l no t owned an d oper at ed by a me dic al school, bu t aff iliate d with it. an d th a t such an ap plicatio n 

ma y be accepted if it ha s th e ap pr ov al of th e de an of th e medica l school.

SC HO LA RS HIP GRANTS

P art C of the bill se ts up a new pr og ra m of sc hol ar sh ip g ra nts to sch ools of 

me dicin e, th e gra nts to be used to pr ov id e sc ho la rs hi ps fo r st udents an d to meet 

p a rt of th e in stru ct io na l co sts of th es e st ud en ts. Me dic al under gra duat es , 

gr ad uat es , an d in te rn s as well as re side nt s, all rece ive co ns id erab le tr ain in g 

an d in st ru ct io n in ou r ho sp ital s. We know th is is ve ry ex pe ns ive ed uc ation. 

The co st to th e ho sp ita l fo r such med ical ed uc at io n is ne ve r fu lly rec ov ered 

from th e st ud en t or th e affil iated me dical college. W ith th is in mind, th e 

bo ard of tr us te es o f the A merican H os pi ta l Asso cia tio n has resolve d :

“* * * th a t me dic al an d den ta l scho ols m us t re ce iv e adeq uat e fin an cin g an d 

th a t a mea ns shou ld be foun d fo r in su ring th a t de si ra bl e st uden ts in thes e pr ofess ions who ar e in need of fina nc ial as si st an ce fo r th eir ed uc ation ar e so as ­

sis ted.

“T he re fo re , th e Am erican H os pi ta l Asso cia tio n su pp or ts pr og ra m s pr ov id ­

in g Fed er al sc ho larshi ps to st udents in me dicin e an d den tist ry , an d Fe de ra l 

gra nts to me dical an d den ta l schools an d to hos pi ta ls en ga ge d in ed uc at iona l 

pro gra m s * *

We su pp or t p art C of H.R. 4999 as a sig nific an t mo ve to w ar d reso lving th e 

prob lems stem ming fro m th e high co st of me dic al an d de nt al ed uc ation.

RESEA RCH FACIL ITIES

The bil l pro poses , in ad di tion , to ex te nd an d st re ngth en fa ci lities fo r rese ar ch 

in th e he al th field. We ha ve al w ay s su pp or ted pr og ra m s fo r Fed er al as si st an ce 

in th e co ns truc tion of res ea rc h fa ci lities . We know th at fu nds av ai la ble fo r th is 

pu rp os e in th e pa st yea r ha ve not been suf ficien t to m eet de man ds . For th is re ason. th e pr op os al to in cr ea se th e auth ori za tion fo r ap pr opri at io n of g ra n t fu nd s 

fro m $30 mi llio n to $50 mi llio n has our c om plete su pp or t.
TRAINING OF PRO FES SIONAL PUBLIC HE AL TH PE RSON NE L 259

SCHOOLS OF PU BL IC HE AL TH

We reco gn ize th a t II.It . 4999 re fe rs to pu bl ic hea lt h ed uc at io na l fa ci lities as 

well as to med ical ed uc at io na l fa ci lities . Si nc e th is as so ci at io n ha s ad op ted no 

pol icy re co m m en da tio ns r el at in g to th e ne ed s of sch oo ls of p ub lic hea lth—sch ools 

whic h ha ve a mu ch less d ir ec t re la tion sh ip t o hos pital s th an do med ical schools —

I ha ve no t incl ud ed an y commen ts on ai d to th is ki nd of school . We ha ve no 

reas on , thou gh , to qu es tio n th eir inclus ion in th e legi slatio n.

In conclus ion , I wish t o th an k th e co m m ittee fo r af fo rd in g us an op po rtun ity to 

pre se nt ou r view s on th is legislation.

I)r. Bonnet. Hospitals are deeply involved with medical education 

both directly and indirectly. Two out of the 4 years of medical schools 

education are conducted largely within the walls of hospitals. These 

are the clinical years. After graduation from medical schools the 

young physicians spend varying number of years in graduate training 

programs in the hospitals in order to become specialists. In addition, 

hospitals are dependent on the supply of doctors in order to maintain 

an adequate staff so that the hospitals may fulfill their objectives in 

serving the public.

We believe there is a doctor shortage, and we lielieve the doctor 

shortage will grow steadily worse unless the facilities and the opportunities for medical education are expanded to keep up with the 

population growth, new knowledge in medicine, and the new needs 

which are continuously uncovered, to say nothing of meeting some of 

our international obligations to help underprivileged countries with 

their medical needs.

For many years the American Hospital Association has supported 

legislation of this type, and we are still in favor of this legislation and 

this particular hill in all of its parts. We believe construction of 

medical facilities, both replacement, renovation, and expansion is 

necessary for medical schools, dental schools, and schools of public 

health.

Tn addition, we believe that scholarship or loan aid is necessary in 

order to maintain sufficient qualified applicants for entering medicine, 

and although this is of probably the greatest importance in increasing the number of doctors in the future, we believe that it is also important to alleviate much of the economic hardship that now falls to 

the lot of medical students today.

We have one amendment to suggest. Because of the fact that in referring to teaching hospital facilities in the bill as drawn, it requires 

that these teaching hospital facilities be part of, as we understand it, 

the corporate structure of the medical school and university. Many 

of the principal teaching hospitals are not pa rt of the corporate structure of the medical school and university. They are private hospitals, 

separately incorporated, but closely affiliated with the medical school. 

Therefore, we request that the legislation recognize this fact and make 

such construction that is to be made available for teaching hospital 

facilities equally available to those hospitals which are affiliated with 

medical schools, but not part of the corporate structure of them.

We suggest that the bill lie amended to provide that an application 

may be initiated by a hospital not owned and operated by a medical 

school, but affiliated with it, and such application may be accepted if 

it has the approval of the dean of the medical school.

T am deeply grateful for the opportunity to appear before the committee. I would be happy to try to answer any questions.
260 TRAININ G OF PROFESSIONAL PUBLIC HEA LT H PERSON NEL

The Chairman. Thank you, Doctor. I have looked over your statement very hurriedly. Personally 1 am glad to have the information 

which you have given the committee on behalf of vour association. I 

particularly want to refer to one statement which is made here on 

page 4, “Trends Toward Doctor Need’’:

At pr es en t ou r ho sp ital s are un ab le to fill a su bst anti al pe rc en ta ge of the 

av ai la ble intern shij>s an d resid encie s. It is est im at ed th a t ab ou t on e- fo ur th of 

th es e p ositi on s are va ca nt .

That means that the hospital are not able to obtain the desired 

interns or residents that they are needing.

Dr. Bonnet. That is correct.

The Chairman. Is it not a requirement for all doctors to spend 

some time now in internship and residencies prior to their practice?

Dr. Bonnet. I believe there is a requirement in about 24 States that 

there be an internship year prior to a licensure by the State.

In the other States where there is not such a legal requirement it is 

nevertheless customary and I think almost universal that the American graduate spend an additional year in hospitals.

The Chairman. You would not suggest that that be made a requirement in the other States?

Dr. Bonnet. No.sir; I would not suggest it.

The Chairman. You would like to encourage the States to adopt 

that principle?

Dr. Bonnet. T think it is probably a wise provision.

The Chairman. Are there any questions by members of the committee?

Air. Dinoell. Mr. Chairman, I know how pressed the committee 

is for time, but I wonder if the witness would elucidate on this thing. 

I have tried to read your statement in connection with the bill, particularly the language in your prepared statement at the bottom of the 

fourth-to-the-last page, the top of your third-to-the-last page going 

from the back where you refer to 721(c) (3) (A ). As I understand it, 

you are tryin g to include into the purposes of the grant section institutions which are essentially hospitals, teaching hospitals; is that 

correct?

Dr. Bonnet. Yes, sir.

Mr. Dinoell. Are these teaching hospitals covered by Hill-Burton 

grants?

Dr. Bonnet. They are technically eligible for Hill-Burton grants, 

but because of the great emphasis in the Hill-Burton program of 

establishing hospitals in areas which did not previously have hospitals, 

the amount of Hill-Burton funds generally that has gone to the teaching hospitals, and the university hospitals, has been severely limited. 

The Hill-Burton program does not provide for the extra features 

teaching hospitals require, such as classrooms, conference rooms, lecture halls, student lalxiratories. and the like. These are educationaltype facilities and are not clearly provided for under the Hill-Burton 

program.

Mr. Dinoell. Doctor, I assume you would lie able to draft an 

amendment to carry out the purposes of this? I know I would like 

to look a t it.
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSO NNEL 261

I)r. Bonnet. 1 am not sure that I would lx1 competent to draft 

legislation, sir, hut I could provide the information to whoever was 

competent. 1 believe.

Mr. Dingell. I would like to see it, Doctor.

Dr. Bonnet. Thank you.

Mr. Dingell. Thank you, Mr. Chairman.

The Chairman. Are there any further questions ?

Mr. Collier. Yes, I have one question.

Doctor, as I understand it, there is some very limited compensation 

which interns and resident doctors receive when assigned to training 

in the hospital. Is there a wide variation in the compensation across 

the country?

Dr. Bonnet. There is probably the variation of a magnitude of 

100 percent between the bottom and the top across the country. It is 

a matter of opinion as to whether this is a wide variation.

Mr. Collier. Does that account for the fact that notwithstanding 

the hospitals that are actually short of interns there are others that 

have waiting lists for interns to get into ?

Dr. Bonnet. No, sir; there are not hospitals with waiting lists. 

There are hospitals, just as there are medical schools, that have more 

applicants than others, but the entire graduatin g class of students 

are distributed among the hospitals which offer internships on the 

basis of the student preferences by a national program known as the 

intern matching plan. This is a way of eliminating a great deal of 

competition among institutions for the limited supply that is available. 

There are no waiting lists. Everyone who wants an internship today 

gets one, and in a good hospital.

The Chairman. Mr. Thomson.

Mr. Thomson. Were some of the vacancies in internships caused 

by callup of reservists in recent months?

Dr. Bonnet. In recent months there have been a few vacancies so 

caused. We were not referring to these temporary and, we hope, 

emergency vacancies. We were talking about the general and chronic 

problem of an inadequate number of interns and residents to fill all 

of the available opportunities.

Mr. T homson. That is all.

The Chairman. Doctor, thank you very much.

Mr. Williamson, we are glad to have had you, too.

Dr. Bonnet. Thank you, sir.

The Chairman. Will this conclude the presentation of the association ?

Dr. Bonnet. Yes, sir; it will.

The Chairman. And you speak for the entire group?

Dr. Bonnet. Yes, sir; except for providing Mr. Dingell the information which he requested.

The Chairman. Thank you very much. We are glad to have your 

presentation.

Dr. R. McFarlane Tilley, dean and director of hospitals and clinics, 

College of Osteopathy and Surgery, Kirtsville, Mo.

I believe you are representing the American Association of Osteopathic Colleges.
262 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

STATEMENT OF DR. R. McFARLANE TILLEY. DEAN AND DIRECTOR 

OF HOSPITALS AND CLINICS. KIRKSVILLE COLLEGE OF OSTEOPATHY & SURGERY. KIRKS VILLE. MO.; ACCOMPANIED BY LAWRENCE L. GOURLEY, LEGAL COUNSEL. AMERICAN OSTEOPATHIC 

ASSOCIATION

I)r. Tilley. Mr. Chairman, members of the committee, my name is

Dr. R. McFarlane Tilley. I am clean, and director of hospitals and 

clinics, of the Kirksville College of Osteopathy & Surgery at Kirksville, Mo.

The American Osteopathic Association and the American Association of Osteopathic Colleges are dedicated to maintain and improve 

high standards of medical education in osteopathic colleges. Manifestly, they are interested in the pending bill, II.R. 4999, which proposes to increase the opportunities for training of physicians. On 

their behalf, may I express our appreciation for the opportunity of 

bringing to you our views on this most important bill.

The bill amends the Public Health Service Act to include a 10- 

year program of matching construction grants for new schools or for 

major expansion of existing schools of medicine, dent istry, osteopathy, 

and public health, and for renovation and replacement of existing 

teaching facilities of those schools. The program also authorizes Federal grants to accredited schools of medicine, osteopathy or dentistry 

to be used by the schools to make scholarship awards to talented students on the basis of need for financial assistance in pursuing a course 

of study at the school, and in order to aid the schools to meet p art of 

the instructional costs of these students, each school would receive additional grants.

In 1956-57 we were privileged to cooperate with your professional 

staff in connection with the medical school inquiry staff report to your 

committee containing background information relating to schools of 

medicine, dentistry, osteopathy, and public health on the subject of 

Federal aid for construction of teaching facilities. We shall try to 

update some of the material contained in that most invaluable report.

During the ensuing 5 years, the six colleges of osteopathy and surgery, all being accredited private nonprofit tax-exempt institutions, 

graduated 2,280 physicians of the osteopathic school of medicine. 

These derived from freshman classes totaling 2,551, an average of 20 

below overall freshman capacity annually (see Guidance Leaflet 23, 

U.S. Office of Education), and represent an attrition of 10.6 percent.

If Federal funds are made available on a matching basis for construction of educational facilities as proposed in this bill, it has been 

estimated that present plans of the colleges for expansion of facilities 

could increase the freshman capacity to 630, or nearly 20 perecnt.

All the colleges require a minimum of 3 years of preprofessional 

study in an approved college or university. Seventy percent of the 

entering freshmen hold baccalaureate or advanced degrees. Some 

o'hers obtain B.A. or B.S. degrees after completing the first year at 

osteopathic college under combined degree agreements with various 

undergraduate colleges and universities.

F ir st -y ea r stud en ts in 1961 received th eir requ ired prep rofessiona l 

tr ai nin g in 241 und er gra du at e colleges in 40 Stat es . Geo grap hic di str ib ution of th e en tire os teop athic pr ed oc to ra te en ro llm en t 1961 -62
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 263

shows stu dents derived from 47 St ates and the District of Colu mbia. 

Fre shm en at my own college at Kirks ville were tra ined at 71 colleges 

in 25 States.

The sta nd ard curr iculum of an osteopathic college requires at least 

5.000 hou rs of professional ins tru ction d ist rib uted over 4 college years. 

Upon grad ua tio n, the degree of docto r of osteop athy (D.O.) is conferred . The gradua te then begins an inter nship of 12 to 24 months in 

a hospital appro ved for intern trai ni ng by th e Am eric an Osteopathic 

Association. After in ternsh ip, an inc rea sing num ber of g rad uates en ­

ter on 3-y ear te rm s of residency trai ni ng in appro ved residency tr ain ­

ing hospitals, follow ed by 2 ye ars o f spec ialty pra ctice prep arator y to 

exa mination for certification by spe cialty b oar ds in such specialties as 

intern al medicine, surgery, rad iol ogy, obstetrics, gynecology, pe dia ­

trics. a nd path olo gy.

Doc tors o f osteopathy are eng aged in the legalized pract ice of the ir 

profession in each of the 50 S tates and the District o f Columb ia. In 

38 Spates and the District of Col umbia, most osteopathic phy sicians 

practic e u nder unlimited licenses. Th e licensure law s in th e re ma ining 

State s have not kept pace with the advancement in the trai ni ng and 

practic e o f osteo pathic ph ysicia ns and surgeons.

I might add that 75 percent of D .O.’s are in general or fam ily pra ctice and 20 perc ent practic e in com munities of less than 5,000 po pu ­

lation.

In the fall of 1958 the Sur geo n Gen eral of the Publi c Hea lth Se rvice invited a gro up o f 22 n ational leaders in medicine, e ducation , and 

pub lic affairs to serve as a consultant gro up to the Pu blic He alth 

Serv ice on medical education, and specifically to c onsider the question : 

“How shall the Nation be supplied with adequate num ber s of wellqualified physicians?”

Dr Morr is Tho mpson, pre sid ent of the Kirksville College of Osteo pathy and Su rgery , had the honor of ser vin g as a mem ber of the 

gro up. In September 1959, the Sur geo n Ge neral’s Co nsult ant Group 

on M edical Education mad e its repo rt, un de r the c aptio n “P hysic ian s 

for a Gr ow ing America." The rep ort points out th at in the Un ite d 

Sta tes in 1959 the re were—

some 235.000 doctors of medicine and 14,000 doctors of osteopathy for a population of 177 million people, or 141 physicians p er 100,000.

The r eport the n s ta te s:

The consultant group considers the main tenance of the present ratio of 

physicians to population a minimum essential to protect the health of the people 

of the United States. To achieve this, the number of physicians gradua ted annually by schools of medicine and osteopathy must be increased from the present 7,400 a year to some 11,000 by 1975—an increase of 3,600 graduates.

Accor din g to the con sultan t grou p, the Na tion's physicia n supply 

will continu e to lag be hind the needs cre ated by inc rea sing population 

unless the Federal Governmen t mak es an emergency finan cial co ntribution on a ma tch ing basis towa rd the con stru ctio n of med ical school 

facilities.

A survey in 1958 ind icated th at the oste opa thic colleges spe nt $6.8 

million fo r basic ope rations , only $1.4 million, o r 21 perce nt, o f whi ch 

came from tuition and fees. Gifts and gr an ts and deficit financ ing 

supplied the rest.
264 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

One of (he colleges, the Philadelphia College of Osteopathy, since 

1955 has received over $100,000 annually from the State appropriations for instructional grants to medical institutions in the State. 

Pennsylvania is also providing $1 million for provision of a new 

teaching hospital for the college.

The profession recognizes a continuing responsibility to the osteopathic colleges. During the past 16 years doctors of osteopathy have 

contributed some $9 million to osteopathic education and research. 

Twenty-three State societies covering 80 percent of the profession 

annually contribute directly through a support-through-dues program. In 1961 the profession contributed over $1 million.

Last year the alumni of the Kirksville College contributed 

$297,660. It is noteworthy that this college has alumni practicing in 

each of the 50 States and the District of Columbia.

Every ell'ort is being made on the part of each of the colleges and 

the American Osteopathic Association to obtain funds from private 

sources for proper maintenance of these institutions for the trainin g 

of physicians (D.O.).

In recommending a 10-year program of Federal grants on a matching basis for the construction of medical teaching facilities, the Surgeon General’s Consultant Group on Medical Education pointed out, 

that only with such Federal stimulus will adequate funds become 

available for needed construction.

There is abundant evidence of a catalytic effect of the availability 

of Federal matching funds. The Kirksville College of Osteopathy 

and Surgery was enabled to match Dill-Burton funds to build a new 

teaching hospital. The availability of Dill-Burton funds aided the 

Kansas ( ’ity College of Osteopathy and Surgery in obtaining matching funds for construction of a diagnostic and treatment facility, and 

assisted the College of Osteopathic Physicians and Surgeons at Los 

Angeles in obtaining matching funds for construction of a rehabilitation facility. More recently, the college at Los Angeles received an 

award under the Health Research Facilities Act for construction of 

a research facility, and the Chicago College of Osteopathy has received an award under that act for procurement of research equipment.

The osteopathic colleges cannot adequately meet their needs for 

construction of teaching facilities without additional assistance. 

Much of our teaching activities are in overcrowded and obsolescent 

buildings.

We endorse the report of the Surgeon General’s Consultant Group 

on Medical Education calling for Federal assistance for construction 

of teaching facilities, and we favor enactment of H.R. 4999 for the 

purpose.

According to the Surgeon General’s Consultant Group, “there must 

be some 12,000 admissions to schools of medicine and osteopathy in 

1971” if the “minimum goal of 11,000 physician-graduates a year by 

1975” is to be met. Two major programs were recommended:

1. Adequate expansion of teaching facil ities.

2. Increase in funds available to make it possible to finance a 

medical education.

The. average cost of tuition and fees, room and board, and other 

school and living expenses to the student for 4 years of osteopathic
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSO NNEL 265

college is about $10,000. Th e studen t has alr eady spent from $5,500 

to $7,000 on pre professiona l college tra ining.

Th e A merican Osteopathic A ssociat ion stu den t loan prog ram m akes 

low -interes t loans o f $750 or less to junior a nd senior stu de nts for repaymen t af te r graduatio n. More than $350,000 in such loans are 

curre ntl y outstandin g. The Au xilia ry to the Am erican Osteo pat hic 

Association offers freshmen stu dents 15 $1,500 sc holarshi ps each yea r. 

Some gr an ts and loans are furni shed by State and local societies. 

Pha rmace utical houses and othe r don ors are offerin g increa sing 

amoun ts for student assistance. The National Defense Educa tion 

Act prog ram is also helpf ul. Bu t the dem and for assistan ce fa r exceeds the supply.

Federal sch ola rship aid is needed to increase the pool of ava ilab le 

superio r studen ts. Con side r the fact that at the Kirksville College 

alon e we have lost 22 members from our second year class. They 

sta rte d with 100 students. Th ey are down to 78 at the presen t time. 

Most of the loss was due to financial reasons p er se. Th is could have 

been avoided with adeq uate scholarshi p aid. More im po rta nt and 

more complex, however, is the fac t that a num ber of these people 

were “b ord erline acceptancies.” Th e pool from which we are selecting has few er and fewer str on g young studen ts. Be tte r stu dents 

who mig ht othe rwise lie intere sted but who have lim ited fun ds are 

going into those fields where National Defense Ed ucation Act fellowships are ava ilab le and their financial problem s are tak en care of 

rig ht throug h to the Ph. 1). (see “Physi cians for a Grow ing 

Am erica" ).

If F ede ral fund s are made av aila ble f or student s chola rsh ips as p ro ­

posed in I I.R . 4999, more stud ents of sup erior quality will be attra cted 

to the schools, and the rate of at triti on and last-m inu te can cellations , 

and dro pouts , most of which are due to financial reasons, should be 

sharply reduced.

Th e cost of e ducation paym ent s to schools which receive the sch ola rship g rants, as p rop osed un de r II. R. 4999, will greatly assist effo rts in 

our colleges to stabilize op erating budgets which is esse ntial to improvem ent and mainte nan ce of high qu ali ty ins tru ction. At the 

Kirksville College last year facu lty salar ies moved from $468,272 in 

the pre vio us year to $520,832 in the ye ar completed Ju ne 30, 1961. 

Furt her imp roveme nt in com pensation is overdue. A fac ulty retir ement prog ram is l ong overdue. Comp etition fo r superio r talent must 

be met.

We also support section 3 of H.R. 4999 which proposes extension 

and exp ansion of the health researc h fac ilities pro gra m. More of 

ou r colleges would have been able t o pa rti cipa te in the pr ogram to date 

if ma tch ing fu nd s o f the G overnm ent could have been made ava ilab le 

for faci lities used both f or teaching and for research.

We wish to commend this committee fo r its lea der ship in the enactment of the institut ion al research g rant s progra m, P ub lic L aw 86-798. 

All ou r colleges are pa rtic ip at in g in the pro gra m. The researc h poten tial of ou r colleges has been advance d ma terially by the rese arch 

gr an ts received from the Na tional In stitu tes of He alt h. In that connection, I sho uld like to quote from the 1961 rep ort of the pre sident

80014— 62-------18
266 TRAININ G OF PRO FES SIONAL PUBLIC HE AL TH PERSON NEL

of the Kirksville College of Osteo pat hy and Su rgery, Dr. Morris 

Thompson, as fo llows:

I shou ld like to ac kn ow led ge th e wi se an d he lp fu l co un sel of officials an d 

ad vi se rs to the Natio na l In st it u te s of H ea lth . W hile p art ic u la r referenc e is 

projierly ma de he re to th e de ve lopm en t of th e Vas cu lar-Neu ro logic Cl inica l Re ­

se ar ch Ce nte r, st ill ev ery year th e colleg e be ne fits from th e he lp of th es e ca pa ble 

an d de dica ted perso ns.

Mr. C hairman and members of the com mittee, we are indeed g rateful 

for this op po rtu nity to make our position known on thi s legislation.

Th e Chairman. Th an k you very much, Docto r, for your statement.

Are there a ny questions?

Mr. Younger. I have just one question. You mentioned the intern ­

ship in the hospitals of the gra duate s. Do you find any objection on 

the pa rt of the medical association to th ei r wo rki ng in the hos pitals 

where vo ur grad uates are wor king?

Dr. Tilley. Mr. Young er, all our grad ua tes tak e th ei r intern ships 

in osteop athic h ospitals.

Mr. Younger. Not in the ge nera l h osp itals?

Dr. Tilley. In gen eral hospitals, staffed by osteop ath ic phy sicians 

and surgeons.

Mr. Younger. Th an k you, t ha t is all.

Dr. Tilley. There are more intern shi ps ava ilab le than the re are 

oste opathic gr aduates to fill them.

Th e C hairman. Mr. Din gell?

Mr. Dingell. No questions, Mr. Chai rman.

The C hairman. Mr. Collier?

Mr.C 'ollier. T have just one comment, Doc tor.

I think it is n oteworthy th at your alum ni contr ibu ted $297 million, 

over $297 million to the college-----

Dr . T illey. No, $297,000.

Mr. Colije r. Th e rat e establishes, co ntrary to the belief in some 

quart ers , that even doc tors know it is as blessed to give as it is to 

receive.

Dr. T illey. Th ank you, sir. We work very ha rd at this ma tter.

Mr. Keith . With refe renc e to Mr. Collie r's comm ent, it is not quite 

as blessed as you thought it was. It is $297,000 instead of $297 million.

Mr.C Yillier. Well, th e sp iri t is there.

Th e Chairman. Mr. Thom son, can you contr ibu te to this subject 

ma tte r?

Mr. T homson. No, th an k you, Mr. C hairm an.

Th e ( 'hairman. Doctor, I observed vour statem ent on the first page 

in reference to gradu ating 2,280 physicians from osteop ath ic schools of 

medicine, referri ng to the en suing 5 years. These derive d from fre shman classes to tal 2,551.

At the outset, to me it is a rem ark able I'ecord th at you had fres hman 

classes du rin g those 5 ye ars totaling 2,551 o ut of w hich you graduated 

2,280 os teopathic phy sicians. I won der if you can elaborate on that. 

Ts not that figure of those who enter and those who graduate much 

hig her than the results we get from the medical schools?

Dr. T illey. I do not think it is very’ differe nt, M r. Chairma n. Ou r 

attri tio n rate run s arou nd 10 percen t ave rag e thr ou gh th e y ears . Ou r 

total fres hman cap aci ty in o ur colleges is about 530.

Th e C hairman. Now, the next statem ent says th at fres hman classes 

are on an averag e of 20 below f reshman capacity. You mean you have
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONN EL 267

capacity to accommodate an average of 20 more students than you 

have applicants?

I)r. Tilley. Actually, sir, nowadays all our classes are filled, hut we 

lose students every year. We believe we would not lose so many students if the quality of the entering student was improved. There 

would be less attrition. Once we drop a student we can’t p ut a man in. 

The place in the class is lost forever. This is a very serious matter 

with us.

The Chairman. Yes, I can very well understand it being a very 

serious matter, hut you have facilities to accommodate about all who 

applyDr. Tilley. That is true, hut we lose them.

The Chairman. Is it the future tha t you are afraid of?

Dr. T illey. We are not afraid of the future if we can build some 

more facilities. If we can take in a class of 120 students and we had 

sufficient laboratory space, a few more faculty, more space in the 

anatomical areas and so on, we could train these students and the 

dropouts would not he so serious.

The Chairman. Evidently you don’t understand me, or I don’t 

understand you. We are talking about the capacity that you have for 

freshman applicants. Do I understand you to say that you have had 

applicants to the extent that you accommodate those who apply and 

who meet the requirements, but still on an average could take some 20 

more in each class? The point is, if you could accommodate more 

than you accept in the freshman classes and you lose some as you go 

along, then it would leave unused capacity for even more students.

Dr. Tilley. At the present time I do not think we have that capacity, 

Mr. Chairman.

Mr. Gourley. As many as 2,486 have applied and only about 530 

could he accepted.

The Chairman. You mean durin g the different years?

Mr. Gourley. No, during a single year. For the year, 1960-61, 

there were, just a moment, please.

Mr. Macdonald. Could 1 ask one question while we are waiting?

The Chairman. Yes.

Mr. MacDonald. What is the definition of an osteopath?

Dr. Tilley. I will be glad to see if I can help you. Osteopathy is a 

school of medicine that involves general practice and the specialty 

fields of practice, but places a particular emphasis upon the study of 

the structure of the body and the relationship of disturbances in the 

structure of the body and biomechanics to the general health. We 

have developed methods of therapy and of diagnosis that lead toward 

normalization of these parts that are abnormal. That is the major 

difference, as I see it. between the practice of medicine and the practice 

of osteopathy, a special emphasis on the structure of the body.

Mr. Gourley. In 1960-61, 496 first-year students were enrolled. 

These were culled from 2,240 applications by 1,768 applicants.

The Chairman. You enrolled 496?

Mr. Gourley. That is right.

The Chairman. From how many applications?

Mr. Gourley. From 2240 applications by 1,768 applicants. Some 

were multiple applications.

Mr. Younger. Duplicate applications.
268 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

The Chair man. Tha t mean s that you had 1,768 who app lied for 

entrance and you enrolle d only 496?

Mr. Gourley. Th at is rig ht.

Th e Chairman. Wh y di dn 't you get your capacity then ?

Mr. ( tOURley. The y were accepted for capac ity but there is a ttr iti on 

between acceptanc e and enrollment , such as last min ute cancellations 

fo r fina ncia l reasons.

The Chairma n. Were the 1,200-plus who applied, that is, the 1,200- 

plu s appli cants ------

Mr. Gourley. 1,768.

The C hairman. I know, but the 1,200-plus ap pli cants tha t were 

not enrolled—l et us tal k about them for a minute—they could not 

meet the ent rance require ments.

Dr. T illey. They do not meet the requiremen ts. Many more apply 

th an we enroll. In our case it is one o ut of thre e.

The Chair man. Let us sa y, t hen , th at you had, out of all those who 

appli ed, app rox imately 500 who could meet the requirements, and 

you had appro xim ate ly 500 places tha t you could accommodate them.

Dr. T illey. Yes, sir.

The C hairman. Wo uld that be correct ?

Dr. T illey. Yes, our full en ter ing class now is 530.

The Chairman. In othe r word s, in th e 6 colleges you have fac ilities 

to tak e care of 530 each year on an average.

Dr. T illey. Th at is rig ht.

The Chair man. Then you just about get y our ca pacity ?

Dr. T illey. Th at is rig ht.

The* Chairman. Now, if you had more fac ilities ava ilab le would 

that cause you to have to reduce yo ur requirem ents?

Dr. Tilley. No, cert ain ly not.

The Chairman. What makes you think you would have a greater 

num ber of a pplications the n ?

Dr. Tilley. I think th at un de r the terms of the leg isla tion this 

would undoubtedly stimu late more ap plications. I am sure we would 

get more a pplicants. Mr. Ch airma n, if th ese financial pro blems did not 

arise. Most of our stu dents come from the large citie s, very few of 

them as a matt er of fac t come fro m the ru ra l areas.

Th e Chairman. You think th at ther e are many people who have 

the necessary qualifications who would become ap pli cants if the in ­

centives t ha t you have in thi s proposed legis lation were giv en ?

Dr. T illey. I am quite sure that is true. I live in a ru ral are a 

and I meet a lot of people in the office. They come and talk to us 

abou t these problems.

The Chairman. I recall one time when we h ad the proposed salary 

increase for Members of Congress before us, a lad y asked one of our 

colle agues if he tho ught the increase in salaries to the Members of 

Congress would mean the country would get be tte r Mem bers to serve 

in Cong ress. Of course, he h ad to rep ly to th at th at he did not think 

so at all, but it would give an incentive fo r those of us who are h ere 

tod ay.

So we w ant to find out, i f the re is an actual need f or this legislation. 

Tha t is w hat I said at the outset, a case h ad to be made by you people 

who are ask ing for this assistan ce th at t his leg islation is req uired to 

supp ly the needs of the country for medical care. Now, it would seem
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 269

to me tha t your greatest argument here would be that the legislation 

is needed to meet future needs. Is this situation of yours static? It 

has been about the same for the last 5 years. It has not increased or 

decreased.

I)r. T illey. That is true. We feel the number of qualified students 

has diminished. We believe that the contemplated legislation will be 

a very strong stimulus to improving the number of applicants and 

their qualifications.

The Chairman. But the ratio per 100,000 population has gone up 

steadily year to year.

Dr. T illey. That is right.

Mr. Gourley. Ratio of what, Mr. Chairman ?

The Chairman. The ratio of the available osteopaths to serve the 

public, the ratio to population.

Mr. Gourley. I think that is about 8 per 100,000. It has been that. 

I don’t think it has gone up.

The Chairman. You mean you have had a steady increase in the 

availability of osteopathic doctors?

Mr. Gourley. No, I mean that we graduate around 450 a year, but 

there is a considerable attrition. My understanding is that while 

there has been some increase each year, nevertheless the population 

ratio remains about the same.

The Chairman. You know the population has increased.

Mr. Gourley. That is right. Public Health Service figures for 

1961 show the osteopathic census at 14,350 and the ratio of physicians, 

D.O., per 100,000 population, at 7.7.

The Public Health Service Health Manpower Source Book (1059) 

lists the ratio at 8.5 in 1949 and 8.0 in 1957 and 1958. I will furnish 

this information for the record.

(The information mentioned above is as follows:)

Number of physician# and physician-population ratios: United States, 1931-58,

with projections to 1975

Midyear

Total 

population >

Num ber of physicians ’ Physicians per 100,000 

population

Total M.D . D.O. Total M.D . D.O.

1931.................. -........ .

Thousand*

124,149 166,900 156, 490 19.500 134.4 126.0 8.4

1940................................. ........ 132.122 187,6 X) 175.290 12, 4<X) 142 0 132.6 9.4

1919............. ....................... 149,188 214.000 201,300 12.700 143.4 134.9 8.5

1957........................................ 171.196 249,390 226. 690 13,790 149.4 132. 4 8.0

1958____ __________ ____ - 174.064 244. 590 230. 690 13.900 149.5 132. 5 8.0

1975 ................................... 235.246 312,800 296. 100 16,700 133.0 125.9 7.1

1

 Includes Armed Forces overseas.

1

 Excludes graduates of the years concerned.

Sources: Physicians (M.D.) 1931-57—American Medical Association. “ American Medical Directory, 

1958: a Register of Physicians of the United St ites.” Tw entieth e lition. Chicago, the association, 1958. 

Table 2.

Physicians (D.O.) 1957—American Osteonathic Association. “ A Statistical Stu dy of th» Os'eopathic 

Profession, Dec. 31, 1957.” Chicago, the association, 1958. Estim ates for other years by Public Health 

Service based on numbers survi dng from all D.O.’s graduated from U.S. schools of osteopath y.

M.D.’s a nd D.O .’s 1958 and 1975—Estim ates by Public Health Service, based on num ber of grad uate s 

of U.S. schools at levels currently predicted (7,410 graduating M.D .’s and 525 graduating D.O.’s each year 

1965-74).

Note.—To maintain the 1957 ratio of 140.4 physicians per 100.000 population in 1975 requ ires about 330,000 

physicians (M .D. and D.O.). The num ber of physician s required in 1975 to raise below-average States 

the 1957 national r atio is about 360,000.
270 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Mr. Y oungbr. I have just one question.

Are there any osteopathic physicians in the Government hospitals 

or military hospitals that you know of ?

I)r. Tilley. There are none in the military.

Mr. Gourley. There are some in the Veterans' Administration and 

the Public Health Service. I do not believe, however, tha t those who 

are serving now in the Public Health Service and the Veterans’ Administration are in the hospitals.

Mr. Younger. That is all.

Mr. Collier. I have just one question, if I may. Every college 

and university, as we know, has an annual academic and economic 

student fatality rate each year. In your own case have you ever 

broken down the loss of students, call them “washouts” or whatever you desire, on the basis of those which were economic and those 

which were academic ?

I)r. Tilley. I haven't got the figures. As a matter of fact, we do 

this. We know pretty well. It is about even, as a matter of fact, in 

our school.

Mr. Collier. Thank you, sir.

The Chairman. Thank you very much, gentlemen, for your testimony.

I)r. Tilley. We thank you, Mr. Chairman.

I'lie Chairman. Mr. Gourley's supplementary statement, with attachments, may he placed in the record at this point.

(The supplementary statement submitted by Mr. Gourley, with 

attachments, follows:)

American Osteopathic Association,

Washington, D.C., February 7 ,1962.

Re II.R. 4999, supplementary osteopathic statement.

lion. Oren Harris,

Chairman, Committee on In terstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Mr. Harris: The Surgeon General’s Medical Education Consultant 

Group in 1959 charged the medical and osteopathic colleges to expand the ir 

training facilities, and recommended Federal assistance, so that increased numbers of physicians could be made available for the rapidly rising population.

At that time, 1959, the physician-population ratio was 133.4 M.D.’s and 8 

D.O.’s per 100,000 ( 48 States and the District of C olumbia). The 1961 physicianpopulation ratio was 132.8 M.D.’s and 7.7 D.O.’s i>er 100.000 population (50 

States. District of Columbia, Puerto Rico, and outlying U.S. are as) . Source: 

Public H ealth Service.

A new osteopathic college is in the planning stage. Major expansion is planned 

by four of the existing colleges.

In the attached letter of February 5 from J. M. Peach, president of the 

Kansas City College of Osteopathy and Surgery at Kansas City, Mo., he says in 

p a rt :

“The present educational plant was constructed to accommodate classes of 

from 60 to 70 in each of the 4 years of the instructional program. Recognizing 

a number of years ago the basic necessity of providing education and training 

for an increasing number of physicians, we have increased the utilization of 

our classrooms and laboratories from the usual 3 or 4 clock hours per 

day for classroom an d/or laboratory, to from 6 to 8 or 10 clock hours per 

day in classroom and laboratory utilization. We have reached the “bursting” point as it relates to our present physical facilities and are desperately in 

need of additional classrooms, laboratories, equipment, and personnel to maintain standard s of education and training and also to provide educational opportunitie s for a larger number of students * * •

“We are at a very important stage at this time with the Redevelopment 

Authority of Kansas City in connection with the acquisition of land for our 

expansion of our educational plant purposes in a renewal project area tha t is
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 271

im med ia tely ad ja cent to th e ex is ting ca m pu s of th e coll ege. We ha ve unde rta ke n th is ac qu isitio n of ap pr ox im at el y 15 ac re s of land in an tici pat io n of aid 

from F edera l or oth er so ur ce s th at will en ab le us to br in g in to actu al being 

th e clas sroo ms, the labo ra to ries , cli nics, an d ho sp ital s th at are urg en tly neede d 

by our in sti tu ti on to me et th e ch alleng e of prov id ing mo re do ct or s fo r th e incr ea si ng pop ul at io n of o ur l an d * * *.

“G ra nts an d av ai la bl e loan s fro m th e F edera l Gov ernm en t fo r th e pu rp os es 

of pr ov id in g ed uca tion al fa ci lities fo r an in cr ea sing nu mbe r o f do ctor s in tr a in ­

ing wo uld en ab le us to sa ti sf y th e im port ant qu es tio n of tim in g as it re la te s to 

th is de ve lopm en t pr og ra m .”

In th e att ached le tt er of Feb ru ary 4 from Merlyn M cL au gh lin , pre si de nt of 

th e College of O steo pa th ic Me dic ine an d Su rg er y at Des Moines, Iowa , he st ate s 

in p a r t:

"O ur fa cil it ie s are ad eq uat e fo r ac ce pt in g 70 st uden ts per cla ss. The at ta ch ed 

ch art po in ts ou t th a t th e colleg e has been ac ce pt ing mo re th an th e nu m be r of 

70 fres hm en . A t th e same tim e yo u will not e th a t th e college has been tu rn in g 

aw ay 10 to 20 qu alifi ed st uden t per ye ar . I t is es tim at ed on ba si s of pre se nt 

ap pl ic at io ns we will tu rn aw ay at le ast 40 qu ali fie d st uden ts th is ye ar . It mus t 

also be po inted ou t th a t we ce ase ac ce pt ing ap pl ic at io ns as soo n as th e clas s is 

filled. F o r ex am pl e, la st yea r we tu rn ed ba ck all ap pl ic at io ns aft e r th e 1st of 

Ju ly .”

In th es e da ys of keen co mpe tit ion by oth er ca re ers of ferin g les s ex pe nsive 

tr ain in g an d earl ie r re w ar ds , wh o kn ow s how man y qu alifi ed st udents ar e 

di ve rt ed to ot her fields be ca us e th e colleg e of th eir choic e is not av ai la bl e.

Pre si dent M cL au gh lin fu rt h er s ta te s :

"P re se nt fa ci lities a re no t adeq uat e fo r al l ne eded as pec ts of ou r te ac hi ng progr am , no r do th ey prov ide sp ac e fo r th e po stdo ct or al co ur se s th a t are re qu ired 

by th e pr of es sion * * *. The bo ar d of tr ust ees is ac tiv ely en ga ge d in se cu ring 

land fo r a new ca mpu s wh ich wi ll pr ov id e fo r needed ex pa ns io n. The urb an 

re ne wal bo ard ha s se t as id e 27 ac re s fo r a ca m pu s * * *. T he pr es en t pla ns call 

fo r a college an d re se ar ch bu ild ing to ac co mmod ate a clas s of 100 en te ri ng fr esh ­

men pe r ye ar . The college m us t ha ve Fed er al ai d to su cc es sful ly acco mplish 

th es e pl an s. ”

An att ac hed le tt er dat ed Feb ru ary 5 from Fre der ic H. B art h, pre si de nt of the 

Phi la del ph ia Co llege of Osteo pa th y st ate s in p a r t :

“O ur pl an s fo r fa cu lty, fa ci lities , an d fin an cing are all pr ed ic at ed on a pre- 

(lo cto ral en ro llm en t of 000 (150 p er c la ss ) an d 150 f ul l-t im e po stdo ct or al st uden ts 

(i nte rn s an d re si de nt s) pl us an in det er m in at e nu mbe r of par t- tim e st uden ts .

"W e a re un de r co ns id er ab le pre ss ure from th e prof ession , th e Co mmon we alth, 

an d nu mer ou s co mmun iti es now w ithout a ph ys ic ia n’s se rv ices to in cr ea se ou r 

en ro llm en t. We are also under pre ss ure fro m th e ap pl ic an ts them selves.

" It is es se nt ia l to em ph as ize th a t th e college teac hi ng fa ci lities (c on st ru ct ed 

in 1020) were bu ilt to ac co mmod ate a cl as s of 75 st ud en ts . We hav e al w ay s 

ov erload ed t his li m it d uring th e pas t 15 yea rs .”

An att ac hed le tt er da te d Feb ru ary 5 fro m It. A. K istn er , D.O., M.D., de an of 

th e C hica go College o f O steo pa th y re ad s in p art as f oll ow s:

"O ur pr og ra m is ca re fu lly do ve taile d in to th e ov erall Hyd e Pa rk-K en woo d 

urb an re ne wal pr og ram. We are pre se nt ly in th e proc ess of de ve loping rou gh 

pl an s fo r th e ba sic scien ce re se ar ch bu ildi ng wh ich wi ll occ upy a po sitio n ac ro ss 

th e st re et from th e p re se nt ho sp ital an d clin ic on land wh ich we ha ve an op tio n 

to bu y from th e city aft er th e ex is ting slu m bu ild ings are de molish ed an d the 

la nd is clea re d. I t is an tici pat ed th a t th is st ru ctu re will co nt ai n th e le ct ur e 

room, la bo ra to ry , an d se m in ar sp ac e fo r clas se s of 100 mem be rs.

"I wo uld lik e to tou ch on one addi tional im portan t are a in th e ap pare ntl y 

hig h a tt ri ti o n ra te betwe en ac ce pt an ce an d m atr ic ula tion of our st uden ts . This 

ha s to do w ith finances. The gre ate st ac ti vit y in st uden t re cr uitm en t, of 

co urse, comes from th e are as of g re ate st osteo pa th ic po pu latio n. The Ch ica go 

Colleg e of Osteo pa th y a tt ra cts th e m ajo ri ty of it s st uden ts from in dust ri al ar ea s 

such as D et ro it, So uth Be nd, Yo un gstown , an d othe rs. When an y fo rm of 

bu sine ss rece ssion en te rs in to our nat io nal eco nom y, it ap pea rs th a t th es e are as 

are ge ne ra lly inv olv ed to a siza ble de gree . A gre at nu m be r of our pot en tial 

m atr ic ula nts w er e forced to w ithdra w a t th e la st m in ut e be ca us e of un em ploy ­

men t of th e su pp or tin g par en t or lack of avai la bility of a su m m er jo b fo r th e 

st ud en t.

"I wou ld like to co rrec t on e e rr o r re gar din g th e ca pac ity of ou r fres hm en 

cla ss. It is (g en er al ly ) listed as 76. Actua lly , we can ta ke bu t 72 st uden ts 

in th e fr es hm en clas s. We ha ve ex ac tly 72 spac es in th e bi oc he m is try lab. 72 

plac es in th e a na to m y la bo ra to ry , et c. ”
272 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Figures furnished in the oesteopathie testimony indicated an overall average 

of about 97 percent utilization of freshmen capacity, for a specific period. More 

meaningful are Public Health Service figures showing the student body and 

graduates of the six osteopathic colleges each yea r during the past decade as 

follow s:

A c a d e m ic 

y e a r e n d in g

N u m b e r S tu d e n ts G ra d u a te s A ca d e m ic 

y e a r e n d in g

N u m b e r S tu d e n ts G ra d u a te s

1951 6 1,876 427 1957.................... 6 1,8 66 442

195 2_____ 6 1,928 427 1958 _________ 6 1,921 439

1953 . 6 1,917 462 1959 _________ 6 1,9 42 469

1954 . 6 1,897 449 I9 60 _____ . . . 6 1,9 15 427

1955 . 6 1,867 459 1961 _________ 6 1,9 44 506

1956............. 6 b 8 8 3 467

It is respectfully requested tha t this supplementary statem ent and attachments 

be made a part of the record immediately following the testimony of Dr, R. 

McFarlane Tilley, witness for the American Association of Osteopathic Colleges.

The privilege of submitting this additional materi al is very much appreciated. 

Very truly yours,

Lawrence L. Gourley,

Legal Counsel.

Kansas City College of Osteopathy ano Surgery,

Kansas City, Mo., February 5, 1962.

Mr. Lawrence L. Gourley,

Counsel, Couneilon Federal He alth Programs,

American Osteopathic Association, Washington, D.C.

Dear Mr. Gourley: Referring to our telephone conversation of Saturday, 

February 3, and your need for prompt and accu rate information concerning our 

college in a variety of its activities, I am sending to you in this letter items of 

information tha t I believe will be of help in presenting the circum stances of 

the Kansas City College of Osteopathy and Surgery in rela tionship to its need 

for aid and suppo rt in connection with its educational program.

In our convention you evidenced an interest to know exactly the number 

of applications that we have received for enrollment in our college for the several entering classes beginning in 1957 and contin uing through the most recent 

freshm en class tha t was enrolled in September 1901. I would explain to you 

that this information is very accurate and obtained from our records tha t are 

compiled on a fiscal year basis beginning J une 1 of each calendar year and ending 

May 31 of the following calendar year.

In tabular form. I am showing the number of qualified cand idate s whose applications were received by us in the fiscal period ending May 31. 1957. and each 

fiscal period thereafter. The first figure represents the tota l number of applications received for the period ending in May of the indicated year, the second 

figure indicates the number of freshmen stude nts actually enrolled fo r t ha t year, 

and the third figure represents the total number of studen ts enrolled in the 4- 

yea r course of studies in the fall of the indicated year.

T o ta l

a p p li c a ti o n s

F re sh m a n

s tu d e n ts

T o ta l 

en ro ll ed 

in fal l

19 57 .............................. ?5 5 105 1958............. .. 263 100 400 1959 _____ 264 101

1'FO ____ 317 76 1961 _____ 281 103 □ -4 o /4

Commenting on the 76 freshmen enrolled in the fall of 1960 and the significant 

drop in enrollment of tha t year, I believe tha t it can be accounted for in an 

unde rstandable fashion. The undersigned unfortu nate ly sustained a coronary 

attack in the early summer of t ha t year th at had been preceded by a very serious 

inj ury to the dean that incapacitated him for a period of at least 6 to 8 weeks a t
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 273

a cri tica l pe rio d in th e en ro llm en t season , all of wh ich re su lted in co nf us ion in 

th e selecti on a nd e nr ol lm en t pro ce du re of o ur fr es hm an c las s.

A fin al an d un ex pe cted difficulty ar ose th ro ugh the fa ct th at 27 of thos e 

st uden ts who ha d been foun d ac ce pt ab le an d ha d bee n ap pr ov ed fo r en ro llm en t 

fa iled to re por t fo r en ro llm en t a t th e tim e of th e op en ing of th e sch ool year in 

Se ptem be r of I960 . Th e ex pl an at io n giv en in m an y in stan ce s was th a t of fin an ­

cial ha rd sh ip an d in ab ility to en ro ll as ori gi na lly intend ed . It is cu st om ar y in 

ou r pl an ni ng to pr ov ide a "c us hi on ” of ap pro xim at el y 10 to 15 per ce nt in an ti cipa tion of such o cc ur re nc es in th e fu tu re .

Fr om th is re por t, I believe th at we ha ve es ta bl is he d re as on ab ly th e ab ility of 

ou r in st itution to en ro ll st uden ts th a t m ee t our es ta bl ishe d pr em ed ical re quir emen ts in a sa ti sf acto ry fa sh ion. Our pr es en t effo rts to w ar d co mpleti ng th e en ­

ro llm en t of th e fr es hm an clas s th a t will co mplete its work in Se ptem be r of 

1902 are proc ee ding ap ac e. Ab out 75 per ce nt of th e li t) ap po in tm en ts ha ve 

al re ad y been mad e an d we ha ve m ore th an an ad eq uat e ba cklog of we ll m ot ivated 

an d de si ra bl e ap plica nts to mo re th an fill th e re m ai ni ng plac es in th is p art ic u la r 

cla ss.

You wi ll no te from th e ta bul at io n th a t we rece ived ab ou t 2.75 qu alifi ed ap pl ic ation s fo r ea ch place th a t is av ai la bl e in ou r en te ri ng fr es hm an cla ss. It has bee n 

ou r ob se rv at io n th a t th e ge ne ra l sc ho la stic quali ty of our ca nd id ate s has tend ed 

to im prov e slig ht ly du ring each succ ee ding ye ar . Our reco rd s show th at th e 

av er ag e sc ho la stic prem ed ical rec ord of thos e st uden ts en te ri ng our fr es hm an 

cl as s in Se ptem be r 1961 was ap pr ox im at el y 1.65 on a 3-po int sc ale wh ich can 

reas on ab ly be de sc ribe d as a fa ir B— av er ag e fo r th e enti re clas s. We wi ll no t 

ac ce pt ca ndid ate s wh ose gr ad e po int av er ag e is les s th an 1.2. You ca n see fro m 

th e reco rd giv en ab ov e th a t th e ge ne ra l sc ho la stic att ain m ents of th e ap plica nts 

to th is college are of a reas on ab ly com men da ble qu al ity.

We ha ve a de fin ite pr og ram of de ve lopm en t fo r ou r colleg e th at wi ll en ab le 

us to in cr ea se ou r to ta l en ro llm en t by at le as t 25 pe rc en t su bjec t, of course, to 

its im pl em en tatio n fro m th e st an dpoin t of co ns truc tion , eq uipm en t, an d pe rs on ­

nel. On th e ba si s of th is mod est in cr ea se in en ro llm en t, we do no t anti cip ate 

th e slig ht es t dif ficult y in en ro lli ng cl as se s of sufficie nt siz e to bring ab ou t th is 

in cr ea se in to ta l en rollm en t.

1 might say in pa ss ing th at th e pr es en t ed uc at io na l pla nt w as co ns truc te d to 

ac co mmod ate clas se s of fro m 60 to 70 in ea ch of th e 4 yea rs of th e in st ru ct io nal 

prog ram. Re cogn izi ng a nu mbe r of years ago th e ba sic ne ce ssity of pr ov id in g 

ed uc ation an d tr ain in g fo r an incr ea sing n um be r of ph ys icians , we ha ve inc re as ed 

th e ut iliz at io n of ou r clas sroo ms an d la bora to ri es fro m th e us ua l 3 or 4 clo ck 

ho ur s j>er da y fo r cla ssroom an d /o r la bo ra to ry , to fro m 6 to 8 or 19 clock ho ur s 

pe r da y in clas sroo m an d la bo ra to ry utiliza tion . We ha ve reac he d th e ‘‘b u rs ting " po int as it re la te s to ou r pr es en t ph ys ic al fa ci lities an d are de sj)e ra tely in 

nee d of addi tion al cla ssroom s, la bo ra to ri es , eq uipm en t, an d pe rson ne l to m ai nta in st andard s of ed uc at io n an d tr ain in g an d al so to pr ov ide ed uca tion al op po rtu nitie s fo r a la rg er nu mbe r of st ud en ts.

I ha ve men tio ne d rejie ated ly th e nu m be r of quali fie d ap pl ic at io ns th a t we 

ha ve been ac cu stom ed to rece ive ea ch yea r as ru nnin g in a ra ti o of 2.75 to ea ch 

av ai la bl e plac e in th e clas s. You can see th at by in cr ea sing ou r ph ys ical pla nt, 

ou r eq uipm en t, an d ou r fa cu lty pe rson ne l, we wo uld be ab le to no t find it neces sa ry to tu rn aw ay qu ali fie d ap plica nts wh o are pr op er ly m ot iv at ed , pr op er ly 

pr ep ar ed , an d ab le to under ta ke pr of es sion al tr ain in g lead in g to gra duat io n as a 

ph ys ician to se rv e his fel low ma n.

R et ur ni ng brief ly to our pr og ram of de ve lopm en t, we are a t a ve ry im port ant 

stag e at th is tim e w ith th e Re de ve lopm en t A ut hori ty of K an sa s City in co nne cti on w ith th e ac qu isitio n of la nd fo r our ex pa ns io n of ou r ed uc at io na l pla nt 

pu rp os es in a re ne wal pr oj ec t are a th at is im m ed ia tely ad ja cen t to th e ex is ting 

ca mpu s of th e college. We ha ve under ta ken th is ac qu is itio n of ap pro xim at el y 

15 ac re s of la nd in antici pat io n of aid from F ed er al or oth er so ur ce s th a t wi il 

en ab le us to br in g into ac tu al being th e clas sroo ms, th e la bo ra to ri es , cli nics, an d 

ho sp ital s th at are ur ge nt ly needed by our in st it uti on to mee t th e ch alle ng e of 

pr ov id ing more do ctor s fo r th e in cr ea si ng po pu lation of ou r land .

We ha ve av ai la bl e th e fu nd s ne ce ss ar y to mee t ou r sh are of th e co st of th is 

la nd ac qu isiti on , bu t we are ha vi ng som e dif ficult y a t th is p art ic u la r mom en t in 

sa tisf yi ng th e red eve lop ment, a uth ori ty on ou r tim et ab le of co nst ru ct io n th a t will 

en ab le us to ut iliz e th is land fo r th e pu rp os es ou tli ne d. G ra nts an d av ai la ble 

lo an s fro m th e Fed er al Gov ernm en t fo r th e pu rp os es of pr ov id in g ed uca tion al 

fa ci lities fo r an incr ea sing nu m be r of do ct or s in tr ain in g wou ld en ab le us to 

sa tisf y th e im po rt an t qu estio n of tim in g ns it r ela te s to t h is dev elop men t pr og ra m .
274 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

A community study carried on in Kansas City duing the past 3 or 4 years by 

the Planning Committee of the Kansas City Area Hospital Association has established, through a coordinated hospital planning study, the needs in this area of 

our citizenry for the next 10 years. Our college and its teaching hosp itals have 

been included in this coordinated program and on the basis of study, our facilities 

have been described as being both structurally and functionally obsolete and as 

being unsuitable for an educational program and for adeq uate patient care. 

I hasten to say tha t the great majority of the hospitals and related health facilities in Kansas City were similarly described and a program of raising fund s to 

improve this position from the business, indu stry, and philanthropic agencies of 

our city has been und ertaken in the total amount of over $18 million. At this 

moment, the program has reached a standstill, hut we have great confidence in 

its ultimate success and our participa tion in the program in substantial amounts.

It is my hope that this brief summary of our position from the standpoint of 

our ability to obtain substan tial numbers of well-qualified students for our educational program and the needs tha t we have to supplement our existing physical 

plant, equipment, and faculty personnel through outside help is understa ndab le 

to you in presenting our case to the Congress.

Please do not hesitate to call upon me for additional or supplemental information that you may require.

Sincerely yours,

J. M. Peach, President.

College of Osteo pa thic Med icine and S urgery,

Pes Moines, Iowa, February 4.1962.

Mr. Lawr ence L. Gourley,

Legal Counsel, Amcriean Osteopathic Assoeiation,

Washington, D.C.

Dear Mr. Gourley: Our facilities are adeq uate for accepting 70 stu den ts per 

class. The atta ched cha rt points out tha t the college has been accepting more 

than the number of freshmen. At the same time you will note that, the college has been turning away 10 to 20 qualified stud ents p er year. It is estim ated 

on basis of present applications we will tur n away at least 40 qualified students 

this year. It must also he pointed out that we cease accepting applications as 

soon as the class is filled. For example, last year we turned back all applications after the 1st of July.

SELECTION OF ST UD EN TS

In addition to the selection requirements listed in the catalog, pages 8 and 

0. all applicants are required to come to the college for entrance exams and a 

personal interview.

The exams given are Minnesota multiphasic personality inventory and the 

Ohio State University psychological test. The interview committee is composed 

of the dean, a representativ e of the basic science faculty, and a represen tative 

of the clinical staff who is a D.O. The applicant is also given a tou r of the 

college facilities at this time.

FACILITIES

Present facilitie s are not adequate for all needed aspects of our teaching program, nor do they provide space for the postdoctoral courses tha t are required 

by the profession.

The college is located in a newly established urban renewal dis trict; however, 

no land is available adjacent to the present campus for expansion.

The board of trus tees is actively engaged in securing land for a new campus 

which will provide fo r needed expansion.

The urban renewal board has set aside 27 acres for a campus. There is a 00- 

acre plot of surplus land at Fort Des Moines which will be available and a real 

estate company has offered 25 acres of land if the college will locate in his area. 

We will have to make a choice here.

The present plans call for—

t l ) A college and research building to accommodate a class of 100 ente ring freshmen per year.

(2) A 150-bed teaching hospital which will be expanded to 400 beds over 

a period of 10 years.

(3) Housing for students, faculty, and staff.

The college must have Federal aid to successfully accomplish these plans. 

Sincerely,

Merly n McLau gh lin, P re si den t.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 275

5-year enrollment data

1957 1958 1959 1960 1961 1962 •

Num be r of ap pli cati ons............................... 177 187 190 161 199 250

Num be r qua lified _____ ____ ______ _ 90 90 95 90 105 125

Num be r e nrolled ..................._................ 80 74 75 70 82 82

Qualified tu rn ed a w ay ......... ......................... 10 16 20 20 23 43

Num be r gr ad ua ted 74 3

 64 >67 • 65 5 80

Attriti on to da te 6 10 8 5 2

> Es tim ated .

» Expecte d to grad ua te in J un e 1962.

3

 C ur re nt ly rn rolle d in 3d-yea r class.

4

 C ur re nt ly en rolled in 2d-yea r class. 

3

 C ur re nt ly en rol led in lst-y ea r class.

Philadelphia College of Osteopathy,

Philadelphia, Pa., February 5, JU62.

Lawrence L. Gourley, Esq.,

American Osteopathic Association,

Washington, D.O.

Dear Mr. Gourley : I present herewith certain additional facts for your use 

in considering the enrollment of Philadelphia College of Osteopathy:

1. Philadelphia College of Osteopathy in making its plans for the future 

and in response to an increasing demand for admission expects within the 

next college generation to double its size. Our plans for faculty, facilities, 

and financing are all predicated on a predoctoral enrollment of GOO (150 per 

class) and 150 full-time postdoctoral students (interns and residents) plus 

an indeterminate number of part-time students. (The enrollment for this 

group has averaged each year for the past several years around 300.)

2. We are under considerable pressure from the profession, the Commonwealth, and numerous communities now without a physician’s services 

to increase our enrollment. We are also under pressure from the applicants 

themselves.

I submit below a report on our application experience for 5 years. I wish to 

emphasize that the figures given in the “Applications considered” column are 

actually figures resulting from a prescreening of applications. If these were 

included, we would have to add from 50 to 75 applications each year.

It is essential to emphasize that the college teaching facilities (constructed 

in 1020) were built to accommodate a class of 75 students. We have always 

overloaded this limit during the past 15 years.

I wish also to call to your attention, in the cases of the classes admitted in 

1050, 10G0. and 1061, the attrition came very early in the program and overwhelmingly because of financial distress on the part of those who dropped out. 

Some of these will be picked up again in the next few years afte r they have sta ­

bilized their finances.

Ap plicat ion s

conside red

Acc epted

Adm itted 

(according 

to re gistrar’s 

rep ort)

G ra du at ed 

or cu rren tly 

enrolle d

1957.................. ........................... 259 94 91 84

1958........... .......... .................................. 239 90 84 79

1959____ ____ _____ ________ 232 84 79 67

I960_________ ___________ 220 87 66 64

1961............ ................. . 251 108 91 86

Comparing the application rate of February 1061 with February 1062 we find 

that we are over 50 applications ahead of 1061.

We hope this information will asisst you in any presentations you make. 

Yours very sincerely,

Frederic II. Barth, President.
276 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Chicago College ok Oste opathy,

Chicago, III., Fe br ua ry 5, 1962.

Mr. Lawrence Gourley,

Was hing ton, D.C.

Dear Mr. Gou rl ey : It is my pl ea su re to give you a re po rt on the long -ran ge 

grow tii pl an s of th e Ch ica go Osteo pa th ic Cen ter. Our pr og ra m is ca re fu lly 

do ve taile d in to th e ov erall Hyd e Pa rk-K en woo d urb an re ne wal pr og ram. As 

yo u wi ll re ca ll from nat io nal news re leas es ov er th e pas t se ve ra l ye ar s, th e Hyd e 

Pa rk-K en woo d are a ha s been tran sf or m ed from a high clas s re si den tial are a in to 

an ex trem e slu m si tu at io n. W ith th e co op eration of th e Fed er al Gov ernm en t, 

city of Chica go ag en cies, Uni ve rs ity of Chica go an d man y civ ic grou ps, th is ar ea 

is slo wly un de rgoing a tr ansi ti on back into a ne ighb or ho od whe re peo ple mi ght 

liv e and w ork w itho ut f ear of th eir pe rson al s af et y.

As p a rt of a 5-ye ar plan fro m 19(50 to 19(55, th e follo wing are th e m aj or de ve lopme nt are as: ( 1 ) A sm all ad di tion to th e clinic which wo uld mak e th e pr es en t 

fa ci lities ad eq ua te un til a new cli nic bu ildi ng co uld be dev elo ped, (2 ) th e const ru ct io n of two ho sp ital wings wh ich wo uld in cr ea se th e comp lem ent of te ac hing be ds in ou r affil iated hos pi ta l to 175, (3 ) th e co ns truc tion of a new m ultipu rpos e bu ild ing wh ich wo uld ho use cla ssroom s, la bo ra to ries , ad m in is trat iv e 

offices, fa cu lty offices, an d rese ar ch fa ci lities fo r ou r fa cu lty, (4 ) th e co ns truc tion 

of a new cli nic bu ild in g which would ha ve th e ov er al l an nu al ca pa ci ty in ex cess 

of 150,000 p ati ent visit s.

Th e ad di tion to th e pre se nt cli nic was comp let ed la st ye ar an d is in op er at io n 

pres en tly . We ha ve complete d the arc hit ectu ra l dra w in gs o f ou r ho sp ita l win g, 

an d cu rr en tly are stud yi ng the co nt ra ct s. It is an tici pat ed th at th is ph as e of 

our develop ment will beg in th is ye ar.

We are p re se nt ly in th e proc ess of deve loping roug h plan s fo r the ba sic sci ence 

rese ar ch bu ild ing wh ich wi ll occ upy a po sitio n ac ro ss th e st re et fro m th e pr es en t 

ho sp ita l an d clinic on land wh ich we ha ve op tio n to bu y fro m the cit y aft e r th e 

ex is ting s lum bu ild ings are demo lished an d the land is cle ared . It is an tici pa te d 

th at th is st ru ctu re will co nt ai n th e le ct ure roo m, la bo ra to ry , an d se m in ar spac e 

fo r c las ses of 100 me mb ers .

I rec og niz e th at we might ha ve som e dif ficult y in es ta bl ishi ng th e nee d of 

fa ci lities fo r clas se s of 100 when we ha ve fa ile d to m at ri cula te a full clas s in 

eac h of th e pa st 5 ye ar s. Ho wever, we do ha ve sufficie nt nu mbe r of ap pl ic atio ns an d we do ac ce pt in th e vicinity of 1(M) ap pl ic an ts ea ch ye ar. Ho we ver, 

we in si st on a pe rson al interview w ith ea ch ap plica nt prior to ac ce ptan ce . 

This is a good til in g in th a t we are as su re d of top ca lib er m at ri cu la nts . It 

als o works ag ai nst us as ma ny of ou r ac ce pted st uden ts selec t an oth er school 

wh en they ha ve th e op po rtun ity to view th e slu m en viro nm en t in wh ich ou r 

school is located . As our campu s de ve lopm en t pl an pro ce ed s an d th e Hyd e 

Pa rk-K en woo d ur ba n rene wal pr og ram develop s more im pe tus, th is det er re nt 

wi ll be rem oved. Alre ad y, a no tic ea ble ch an ge in our neigh bo rhoo d is vis ible.

Befor e I leav e th e su bj ec t, I would lik e to touc h on one ad di tion al im po rtan t 

ar ea in th e appa re nt ly hig h att ri ti on ra te betw een ac ce ptan ce an d m atr ic ula ­

tio n of ou r st ud en ts. Thi s ha s to do w ith fin ances. Th e gre at es t ac tivi ty in 

st uden t re cr ui tm en t, of course, conies from th e are as of gre at es t os te op athi c 

po pu latio n. Th e Ch ica go College of Osteo pa th y a tt ra c ts th e m aj ori ty of its 

st uden ts fro m in dust ri al are as suc h as D et ro it. So uth Bend. Yo ungst ow n, an d 

othe rs . When an y form of bu sine ss rece ssion ente rs in to ou r nat io nal econ ­

omy, it ap pe ar s th a t th es e ar ea s are gen er al ly inv olved to a siz ab le degre e. A 

gr ea t nu m be r of ou r po te nt ia l m at ri cula nts w er e forced to w ithdra w at th e la st 

m in ut e be cause of un em ploy men t of th e su pp ort in g par en t or lac k of av ailab ility of a su mmer job f or t he stud en t.

Befor e closing, I wo uld lik e to co rr ec t one err o r re ga rd in g th e ca pa ci ty of 

our fres hm an cla ss. Mr. La wre nc e Mi lls of th e office of ed uc ation of th e AOA 

list s th is figure as 76. Actua lly , we can ta ke bu t 72 st ud en ts in th e fr es hma n cla ss. We ha ve ex ac tly 72 spaces in th e bioc he m istry la bo ra to ry , 72 pla ces 

in th e an atom y la bo ra to ry , e tc.

I hop e th at th is in fo rm at io n will l>e he lpfu l to you . I would be pleased to 

am pl ify th is m at er ia l if n ec essa ry.

Ve ry tr uly y ou rs,

R. A. K istn eb, D.O., M.D.. Dean.
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSONNEL 277

Supplement Material Prepared by Public Health Service

Lo o 0/ stud ents enrolled in osteopathic colleges

E n te rin g cla ss G ra d u a ti n g c la ss

P e rc e n t n o t 

g ra d u a tin g

S e p te m b e r N u m b e r J u n e N u m b e r

1954.......................................... 487

520

495

553

516

1958 ......................................... .......... 439

469

427

506

457

9 .9

9 .8

13 .7

8 .5

11 .4

1955 1959....... .............................................

19.56 1960................ ....................................

1 9 5 7 .. . 1 9 6 1 .. ................................................

1958 ......................................................... 1962.................. ..................................

T o t a l . . 2, 571 2,29 8 10 .6

(S up pl em en ta ry in fo rm at io n fu rn is hed by D ep ar tm en t of H ea lth , Edu ca tion , 

an d W el fa re )

Dear Mr. Harris : Thi s wi ll reply to you r le tt er of Jan u ary 2G, co nc erni ng 

os teop aths .

W ith re sp ec t to en ro llm en t in sch ools of os te op at hy th e Ja n u ary 19(51 ed uc ation al su pp lemen t to th e Jo urn al of th e American O steo pa th ic Assoc iatio n has 

th e follo wing in fo rm ati o n :

“A pp lic ations fo r ad mission to os te op at hi c colleges fo r th e ac ad em ic ye ar 

sta rt in g in th e fa ll of 19(59 did no t show a de cr ea se fro m th e nu m be r of ap plica tio ns from th e en te ri ng cl as se s of th e fa ll of 1959. U nfo rtunat el y, fo r th e 

pa st se ve ra l ye ars, one o r tw o os te op athi c colleges ha ve e xp erienc ed a la rg e nu mbe r of la st-m in ut e ca nc ellatio ns . La ck of money , fa il ure to co mplete th e re ­

qu ired cr ed its fo r ad mission , or a la st -m in ut e decis ion to att end an oth er os teopa th ic college neare r home us ua lly ac co un ts fo r th es e la st-m in ut e ca nc ellatio ns . 

Las t ye ar , th e Phi la de lp hi a Colleg e of O steo pa th y espe cially was har d hi t whe n 

23 a pp lica nt s who ha d been gr an te d fid l ac ce pt an ce o r pla ced on th e alt ern ate lis t 

fnile d to m at ricu la te . Con sequ en tly th er e were 14 em pty places in th at college 

in 1959. In 19(50, on ly 75 first-ye ar st uden ts m at ri cu la te d at the K an sa s Ci ty 

College of Osteo pa th y an d Su rgery, which fo r yea rs has been ad m it ti ng a fr esh ­

man clas s of 100. Mo st of th e dr op ou ts w er e ac co un ted fo r by fa il u re to complete ce rt ain pre re quis ite su bj ec ts fo r ad mission or to m ai nta in th e re qu ired 

gr ad e leve l. On th e oth er ha nd , th e Phi la de lp hi a college, which ha d exi>erienced 

a se ries of la te ca nc el la tion s in 1959, gra nte d ac ce pt an ce s to a la rg er nu m be r of 

ap pl ic an ts in 19(50 an d st art ed th e ac ad em ic yea r w ith 11 more st udents th an 

its ex pe cte d cl as s o f 80. Th e co m pa ra tive ly sm al l en te ri ng clas s at K an sa s C ity 

College of Osteo pa th y and Sur ge ry ac co un ts al m os t en tire ly fo r the ov er al l de ­

cr ea se in th e six e nt er in g clas se s.”

We h av e in se rted in th e reco rd of th e hea ring s on H.It . 4999 in fo rm at io n on the 

nu m be r of os te op athi c ph ys ic ians in ea ch Sta te , an d th e ra te i>er 100,000 po pu ­

latio n.

The Chairman. Dr. Hu gh R. Leav ell ?

STATEMENT OF DR. HUGH R. LEAVELL, PRESIDENT OF THE ASSOCIATION OF SCHOOLS OF PUBLIC HEALTH: ACCOMPANIED BY

DR. ERNEST L. STEBBINS. DEAN OF THE SCHOOL OF HYGIENE

AND PUBLIC HEALTH OF THE JOHNS HOPKINS UNIVERSITY. AND

DR. MYRON E. WEGMAN. DEAN OF THE SCHOOL OF PUBLIC

HEALTH, UNIVERSITY OF MICHIGAN

Dr. Leavell. I wonder if Dr. Stebbins a nd Dr. AA’egman could join 

me at this poin t?

The Chairman. Dr. AA’egman an d D r. S tebbins .

Dr. Lea vell, I believe you are the pre sid ent of the Association of 

Schools of Pu bli c H ealth .

Dr. Leavell. Tha t is righ t, sir.
278 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

The Chairman. I)i\ Wegman is the dean of the School of Public 

He alt h of the U niv ers ity of Michig an. Dr. S teb bin s is the dean of the 

School of Hygiene and Public Health of Jo hn s Ho pkins Un ive rsity.

Mr. F riedel. It is a gre at plea sure for me as a Repre sen tative from 

Ma ryland to greet Dr. Ernest L. Stebbins, the dis tinguish ed dean of 

the School of Hygiene and Public He alth at Jo hn s Ho pkins Unive rsity in my home city of Baltimore.

Jo hn s H opkin s fou nde d the first school of public hea lth in th e country, and Dr. Stebbins has been its dean since 1946. Pr io r to that he 

was comm issioner of he alt h fo r New York Cit y, and had served in 

the State hea lth de pa rtm en ts of New York and Vi rgini a.

Dr. Stebbin s is a leader in public health fo r this cou ntry and also 

in int ern ational health. He is preside nt of the Citizens Com mittee 

for the Wo rld He alt h Or ganiz ation, an d president of the committee 

for specialty board s of the Ame rican Medical Asso ciation. I look 

forw ard with keen inte rest to his testimo ny before this committee.

Th e Chair man. Th an k you Mr. Friede l.

Mr. Ke ith , ou r colle ague from Massachusetts, would like to say a 

few words.

Mr. Keith . It is gr at ifyi ng to me that thi s comm ittee w ill have 

the benefit of testimony by Dr. Hug h Leavell, one of our country 's 

most emin ent public h ealth leaders, as evidenced by his present pos ition as pre sident of the Association of Scho ols of Pub lic Health and 

his past presiden cies o f the American Pub lic Health Association and 

of the Nation al Health Council. I know him best as pro fessor of 

pub lic health pra ctice at the Har va rd Un ive rsity School of Public 

He alth in Boston.

Dr. Leavell is a Ke ntu ckian , educated at the U niv ers ity o f V irg ini a, 

H ar va rd Medical School, and the Yale Un iversity School of Public 

He alt h. He prac tice d medicine for several yea rs in Louisville and 

won recognition there fo r his skillfu l work as hea lth comm issioner 

du ring and af te r the disast rou s Louisville flood in the 1030’s. He h as 

since served with the Rockefeller Fo undatio n, with UN RA in E urope, 

and with the F or d Fo undatio n in India . He is about to devote a s abbatical leave from Harva rd to a glob e-circling study of wavs in which 

the schools of public health can improve the ir alre ady extensive tr ai ning of foreign public hea lth students and other contribu tions to the 

health aspects of the foreign aid pro gram.

We can learn much from Dr. Leavell and I am delighted that he 

is here today.

Mr. Dinoell. Very briefly I would like to welcome Dr. Myron 

We gman, who is the dean of our Un iversity of Mic higan School of 

Publi c He alth. He is one of our o utsta nd ing citizens. He is dean of 

a school which has compiled a trem end ous reco rd in the research and 

trai ni ng in the field of public health. He is a tra ined pedia tric ian 

but fore wen t his m edical ca reer to enter the field o f co mmunity service. 

He h as a pa rti cu larly distinguished reco rd in th is field. He was S ecretary General of the Pa n American Sa ni tary Bu rea u, which is the 

Wo rld He alth Organiz ation agency in Latin Am eric a. He h as been 

a d isti nguished member of and c onsultan t to na tio nal and int ern ational 

bodies in the field o f public hea lth. I th in k th at h is testimo ny will be 

of partic ul ar and unique value to the com mittee tod ay.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 279

The Chair man. Gentlem en, let me say on behalf of the com mittee 

we a re glad to have each and all of you here to pre sen t testim ony on 

this leg islation in beh alf of the Association of Scho ols of Publi c 

He alt h. 1 am sure o ur colleague from Pennsylva nia , a member o f th is 

committee, Mr. Rho des, would like to be here, too, because he h as been 

especially active in this field.

Now, i observe you h ave thre e statem ents here, and each one o f the m 

is severa l pages.

Dr. Leavell. Could we have those ins erted in the record, sir, and 

ju st s peak ext emporane ous ly ? If we could do th at we w ould ap pr eciate th at opp ortunity.

The Chairm an. \ ou would like to have all three of the statem ent s 

included in the reco rd s im ult aneously; t ha t is, one following the other ?

Dr. Leavell. Yes.

The Chairm an. At this point in the record?

Dr. Leavell. Th at would be very helpf ul. If we could just speak 

briefly extem porane ous ly.

The Chairm an. Very well. You may have th at privilege . Your 

statem ent s will be incl uded in the rec ord.

(T he sta tem ents of Drs. Lea vell, Ste bbins, an d We gman follow :)

Stateme nt Submitted by Dk. H ugh It . Leavell

Gentle meu, I am Hug h It. Le avell, pre si den t of th e Assoc iatio n of Scho ols of 

Pu blic H ea lth. Our 12 mem be r sch oo ls in th e U ni ted S ta te s are th e only pu blic 

hea lth schoo ls our co un try has; 2 schoo ls i n C an ad a al so belo ng to ou r as so ciatio n.

Before go ing i nt o pu blic hea lth nea rly 30 years ago , my work w as as a pri vate 

medica l pra cti ti oner in Ken tuck y. Thi s pri vate pra ct ic e ex pe rien ce he lp s me to 

see th e im port ant differen ce s betw ee n pra ct ic e w ith in di vi du al p ati en ts an d the 

co mmun ity work done in pu blic he al th . My pu blic hea lth wor k has been as a 

local he al th officer, in foreign serv ice duri ng th e la st w ar , w ith th e Roc ke fe lle r 

an d th e For d Fou nd at io ns , an d fo r th e p ast 15 year s as p ro fe ss or of p ub lic hea lth 

pr ac tice a t th e H arv ard School of Pu blic H ea lth .

Th e sch oo ls of p ub lic h ea lth a ppr ec ia te th e opp or tu ni ty of en do rs in g th e leg isla ­

tio n wh ich is be fo re y ou in H.R. 4999 an d th e s im il ar bills . We a re g la d th a t th e 

adm in is trat io n has sug ge ste d a vigo rous app ro ac h to w ar d s olving th e h ealt h m an ­

po wer prob lem . We are ple ased , too, th is co mm itt ee is giving it high pri ority .

Mr. Cha irm an , you an d yo ur co lle ag ue s ha ve an im pr es sive re co rd of de alin g 

eff ectiv ely w ith th e N at io n's h ea lth needs. Bec au se of th e le ad ers hip wh ich you 

ha ve ex er te d, ou r sch oo ls of pu blic hea lth fee l th a t we ha ve in th e Con gress a 

gre at man y fr ie nds wh o un de rs ta nd our sp ec ial prob lems. Am ong se ve ra l de se rv ­

ing of sp ec ial men tio n is yo ur colleague, Mr. Rho de s of Pen ns yl va ni a, wh o has 

ta ke n th e tim e to stud y our ne eds an d th e co ntr ib utions we ca n make. For his 

ef fo rts in be hal f of gra duate pu blic hea lth educati on th e wh ole field of publi c 

hea lth ow es a re al de bt of gra titu de.

M.v as so ciates . I)r. Stebbins, of M ar ylan d, an d Dr . W eg ma n, of Mich iga n, an d 

I w an t to leav e se ve ra l idea s with you .

We in th e sch oo ls of pu blic he al th find th a t m an y peop le ha ve ve ry ha zy id ea s 

ab ou t th e wor k we do. May I bri efl y cla ri fy th is poi nt ? We kn ow from ex pe rienc e th a t when people un de rs ta nd ou r work th ey appre ci at e it s im po rtan ce to 

th e Nation.

It h as been sa id tr uly th a t “p ub lic healt h is pe op le.” To under st an d mo re of 

w hat th a t mea ns , le t us look bri efly a t w hat a m an m us t do to pre par e hi m se lf 

as a pu blic healt h ph ys ic ian to serv e th e pe op le of a co mmun ity such as we all 

kn ow well. He m us t go th ro ug h colle ge and th ro ug h med ical school . A fter 

th is he ta kes an in te rn sh ip an d perh aps a reside nc y. D ur in g th e pe riod of 

ho sp ital tr ain in g he ge ts his bo ar d an d ke ep an d a tin y sa la ry wh ich is som ew hat bigg er now th an was th e ca se in my tim e. Rec en tly I fig ured ou t my 

ea rn in gs duri ng 4 year s of ho sp ital tr ain in g, an d they ca me to ra th er less th an 

a to ta lly un sk ill ed la bor er in In di a mak es—a ru pe e a day, or ab ou t 20 ce nts. 

Mo st of th e ph ys ic ia ns now in pu blic healt h jo bs also ha ve ha d some tim e in 

pr ac tic e, eit h er in pri vat e pr ac tice as w as my case, o r in th e Ar med For ce s or
2S0 TR AINI NG OF PR OFE SS IO NA L PU BL IC H E A L T H PE RSO NNEL

som e in dust ri al kind of em ploy me nt. Somehow th ey come to fee l th at publi c 

he al th would be mo re ch alleng ing, be ca use it ge ts at th e roo t of the dise as e 

pro ble m by tryi ng to ke ep it from hapi>ening at al l in st ea d of w ai ting to tr eat 

it aft er it ha s al re ad y hapi»ened.

To he pr ep ar ed fo r le ad er sh ip in public hea lth a ph ys ic ia n als o mus t become 

a sp ec ialis t, an d to do th is he m us t go to a pu blic healt h school fo r 1 or mo re 

year s fo r hi s m ast er’s degre e. He also ne ed s a re side nc y in a pu blic hea lth 

agency fo r 2 ye ars, an d then aft e r a coup le of yea rs mor e wor king unde r a 

pu blic he al th sp ec ia list he is re ad y to ta ke hi s ex am in at io n fo r ce rti fica tio n by 

th e bo ard of prev en tiv e me dic ine . Thi s ho ar d is un der th e su pe rv isi on of the 

American Medica l As sociati on ju st as a re t he oth er ho ar ds in su rg ery, pe di at rics ,

ob stetrics , an d so on.

Let ’s ad d up th e ye ar s aft er high sc ho ol : Ye ar s

Co llege__________________________________________________________________ 4

Medical sch oo l__________________________________________________________ 4

In te rn sh ip ___________________________________________________________________ 2

School of pu blic healt h__________________________________________________ 1

Res iden cy _______________________________________________________________ 2

Pra ct ic e un der su pe rv isio n---------------------------------------------------------------------- 2

T ota l_____________________________________________________________ 15

Thi s 15- year to ta l is ju st ab out the mi nim um , as th e gre at m aj ori ty of ph ys ici an s ha ve som e ye ar s of medica l pr ac tice ad de d to th e list ju st giv en. All th is 

tr ain in g mea ns a trem en do us inve stm en t of bo th tim e an d mon ey. By th e tim e

it i s finished the ma n or w om an will he well ov er 30, an d un le ss he is ve ry un us ua l 

he will w an t to he m ar ried an d ha ve a family by then . Now ad ay s the wife ve ry 

of ten wo rks to heli) ou t, be fore th e ch ild ren come.

W hat so rt of a care er can th e fully qu ali fie d pu blic hea lth man look fo rw ar d 

to? He will ge ne ra lly he a go ve rnmen t se rv an t, wor ki ng in som e local commun ity , in a St ate, in th e Fed er al Go vernme nt, or per hap s in som e in te rn at io nal 

po sit ion. His sa la ry will he ve ry much les s th an th e ea rn in gs of th e av er ag e 

pr iv at e pr ac tition er , so th at th e possible fin an cia l re w ar ds of pu blic hea lth ar e 

ce rt ai nly not gr ea t.

Why doe s he w an t to mak e th is sacrifice? Pr ob ab ly th e mo st im po rtan t re ason is th at publi c he al th work is ex trem ely sa tisf yin g fo r th e kind of pe rson 

wh o finds sa tisf ac tion in pu blic ser vice. It t akes a pe rson wh o can th in k a b str actly an d in te rm s of th e grou p ra th e r th an only of th e indi vi du al pa tien t. It ta kes 

a pe rso n wh o find s hi s re w ar d, not in th e g ra ti tu d e of in di vidu al pati ents or 

pe rson al fin ancia l ga in, bu t in se rv ing th e ge ne ra l good. Cer ta in ly , not ev er yon e is su ite d fo r th e wo rk. But it is scarcely ne ce ss ar y to tel l Co ngres sm en ab ou t 

th e joys an d th e tr ia ls of pu blic service.

To us, pu blic he al th mea ns th e so rt of hea lth work th a t is done in an or ga nized way fo r a grou p of peop le or a wh ole co mmun ity an d no t ju st fo r a sin gle 

in di vi du al pa tien t. Pu blic hea lth wo rk is gen er al ly do ne by a tea m of j>eop]e, 

fo r exam ple , a ph ys ician, nu rse, engin eer, de ntist , vet eri nari an, hea lth ed uc at or , 

social worke r, st ati st ic ia n, an d so on. Much of th is orga nize d ac tivity is carried on by go ve rn m en tal he al th de pa rtm en ts. Th ou gh differen t fro m the wo rk 

do ne by th e indi vidu al pra ct itio ner , it c er ta in ly is no les s es se ntial.

The co mmun ity mus t look to th e publi c hea lth tr ain ed lead er fo r gu idan ce 

ab ou t its ov erall he al th serv ices. He is tr ain ed in th e sch ool of pu blic he al th to 

loo k at th e to ta l pi ct ure of he al th . He mus t know ab ou t th e re se ar ch coming 

ou t of th e labo ra to ries . He m us t be ab le to m ak e a co mmun ity diag no sis , in ­

cl ud in g w ha t th e he al th needs may be. w hat reso ur ce s th er e nr e to de al w ith 

th em , an d w ha t th e people of t he co mmun ity know an d “f ee l” ab ou t th eir hea lth. 

W hen it is d e a r th at som e he al th ac tio n is re qu ired , it is up to th e publi c he alth 

m an to see th a t th e needed ac tio n is take n. He ma y do th is thro ug h his own 

he al th de pa rtm en t, or get som e vol un ta ry ag en cy to do it. or convince the loca l 

pri v ate pra ct it io ners th a t th e job is up to them . As th e work goes on, th e public 

he al th man mus t ev al uate it. to see w he th er some ch an ge s in the metho d of 

ap pr oa ch wo uld lik ely br in g bett er re su lts . Or it ma y be th at th e pro ble m has 

to be ta ke n ba ck to th e la bor at ory fo r more re se ar ch be fo re a sa tisf ac to ry pr ocr am can be mou nted in th e comm un ity .

If I ha ve a pa in or fe el sic k. I w an t n do ctor tr ai ned to look aft er me as an 

indi vi du al . Tf on th e oth er ha nd , ma ny p eop le become sic k at th e same tim e fro m 

th e s*)me ca us e we pr es um e th a t th er e is an ep idem ic to be de al t with , an d it 

becom es th e pu blic hea lth m an ’s Job to ge t nt th e root of th e trou bl e an d no t
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 281

ouly correct it, but see th at it doesn’t happen again. (The public hea lth man 

trie s to forestall the epidemic even before it occurs, if he has the tools, such 

as immunization, necessary to do so.) Aly individual doctor may send me to 

the hosp ital as a patient, and prescribe for me there. But the construction and 

operation of the hospital itse lf is an organized community activ ity.

The Congress has been generous in supporting health research, and there is 

no doubt that the Nation approves this support. We must never lose sight of 

the fact, however, tha t the res ults of this research must be applied in our 

communities if the people are to benefit. The private practitioner makes the 

application with his individual patient, and the public hea lth man sees to the 

application on a communitywide basis. Both applications are again essential.

The glaucoma control program is a good example of how public hea lth workers 

can cope w ith problems any of us may have as we grow older. Glaucoma is a 

disease in which pressure builds up with in the eye and it is second ouly to 

catar acts in causing blindness. This disease is found in 2 percent of the people 

over 40—ju st suppose there were 500 Members of Congress in this age group, 

and all had the pressure within the ir eyes tested, we should expect to find 10 with 

glaucoma. With eye drops progress of the disease can be halted If it is discovered early.

The health departm ent of Brookline, Mass., sta rte d a regular detection center 

a few years ago to detect glaucoma early, with approval and cooperation of 

local eye doctors. All available appointments are filled, yet at the same time a 

gre at many more people are having the ir eyes tested privately tha n ever did so 

before, as education has spread through the town. This is how public health 

works, through health education, through clinics for those who need them, and 

through stimulating private doctors to examine their p atie nts thoroughly to find 

early disease. This kind of work keeps people off relief rolls, saves money and, 

in the long run, more than pays fo r itself.

Unfortunately, I must point out that Brookline, Mass., is an exception in being 

able to control glaucoma. It is one of the wealthiest towns in the country, able 

and willing to finance a comprehensive public health program. It has the funds 

with which to compete successfully for trained public health personnel who are 

in such sho rt supply. The prev ailing situ atio n in State s, cities, and towns 

throughout the Nation is that, for lack of trained hea lth workers, detectable 

and treata ble diseases such as glaucoma go largely undetected and untreated. 

The same is tru e of cancer of the cervix, which kills 16,000 women a year although, if detected early, this condition can almost Invariably be corrected. This 

also applies to many other forms of cancer in men and women and in a host 

of childhood afflictions as well. If detected in time, they can be controlled. It 

is often said tha t the individual is a t f au lt in not seeking periodic physical checkups and in not heeding the advice of health officials and private physicians. True 

enough, and yet here again the shortage of trained public health personnel is a 

critical factor for the health education of the public is one of the prim ary jobs 

of health departments. Without adequate staff members, trained in the tech ­

niques of health education and in the necessary followup of individuals and of 

groups, the job simply cannot be done. Health educators are trained in schools 

of public health, but there are not enough of them to go around.

The Congress has also provided support for internatio nal health work, on a bilate ral basis—the United States working direc tly with some other country— 

as well as on a multila tera l basis, as in the case of the World Health Organization or the Pan American Hea lth Organization. To ca rry on th is internatio nal 

health work there must be traine d people going out from this country. There 

must also be provision for training hea lth workers from the other countries. 

Both types of training are the job of the public hea lth schools.

Public health cannot stand still. It is constantly on the a lert to deal w ith new 

hazards as they arise in the environment, such as radiation, air pollution, and 

stream pollution, new food additives, new ind ustrial haz ard s and new sources 

of accidents. Public health must find ways to combat new infectious diseases 

as they appear. And people must be persuaded to eat as they shou ld as we 

learn more about the relationship between various foods and diseases such as 

arte risclero sis and heart disease. As new measures to deal with cancer are 

found, they must be applied. Public health work ers in economically fortu nate 

countries like ours must find ways of ada ptin g the ir knowledge to fit th e health 

problems of the less fortunate countries.

80014 — e: 18
282 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

W ith his st ro ng co nc ern fo r th e hea lth of th e enti re co mmun ity , th e pu blic 

hea lth w or ke r is bo un d to ha ve g re at in te re st in th e su pp ly of p ro jie rly tr ai ned 

ph ys ic ians an d de nt is ts . We, th er ef or e, shou ld lik e to ex pre ss our gra tifica tion 

in yo ur co ns id er at io n of H.R. 4999 sin ce we be lie ve en ac tm en t of th is m ea su re 

will be ve ry he lp fu l inde ed in mee tin g th e N at io n’s ne ed s fo r hea lth man po wer.

W e sh al l no t att em pt to do cu men t th e ne ed fo r in cr ea se d nu m be rs of ph ys ician s. w he th er med ical or os teop athic, an d de nt is ts , as th is has been done in 

deta il by oth er witn es ses. Our po int as pu blic healt h peop le is simply th a t an 

ad eq ua te su pp ly of w el l-trai ne d ph ys icians an d denti st s is es se ntial to pu blic 

he al th . Fr om th is supp ly m us t be dr aw n no t only p ri vate p ra ct itio ner s, b u t also 

men an d wo me n wh o will sp ec ializ e in pu blic hea lth, who will ca re fo r our 

Arm ed Fo rces an d th eir de pe nd en ts, who will loo k aft e r o u r in d u st ri al po pu la ­

tio n, an d wh o wi ll re pre se nt th is co un try in te rn at io nal ly . The on ly qu alificatio n we ha ve in ou r en do rs em en t of efforts to au gm en t tr ain in g fa ci lities an d to 

re cru it mo re st ud en ts, is th a t th is should ha ve been done som e yea rs ago. The 

ne ed is no t newl y discov ere d.

Su pp ose we a s a na tion ha d ha d enoug h tr ai ned phys ic ia ns t o l>e ab le to match 

th e Rus sian off er to send do ctor s in co ns iderab le nu m be rs to th e Congo a t th e 

tim e the United N ations w en t in. No one ha s th e illu si on th a t it mig ht ha ve 

be en po ssible fo r us to do this, an d so we mad e no su ch off er, whic h is fo rt unate 

as we could no t ha ve mad e good. But the in ab ility to even co ns id er th e po ssibility of such an offer gr ea tly wea ke ns ou r ha nd in te rn at io nal ly . In st ea d of being 

ab le to “e xport ” do ctor s to mee t em erg ency si tu ati ons in var io us p art s of th e 

world, we are in fa ct im po rtin g larg e nu mbe rs of ph ys ic ia ns fr om oth er co un ­

tr ie s each yea r to man ou r hos pi ta ls w ith in te rn s an d re si de nts . Som e of you 

may ha ve see n the ne tw ork do cu men tary televisio n pr ogr am on th e Ca mbridge , 

Mass., Ci ty H os pital in Ap ril of la st ye ar. C am br id ge is my ho me co mmun ity , 

an d st ud en ts fro m ou r school of public hea lth su rv ey ed th is ho sp ital a few 

years ago. The pr es en t si tu at io n is wo rse th an it w as a t th e tim e of ou r survey . 

Yet it is ty pi ca l of th a t in many, ma ny oth er hosp ital s of th is co un try. If you 

sa w th is tel ev isi on prog ram you will re ca ll th a t on e fo re ig n ph ys ician st at ed 

th a t he w as working 120 ho ur s a week in ord er th a t th e workloa d m ig ht ,h> 

covered , even if only s up erfic ially . It is ob vio us th a t we nee d more do cto rs, w it hout fu rt h er delay .

Let us look a t th e publi c hea lth schools, fo r th a t is w her e the pu blic hea lth 

le aders ar e tr ai ne d. The fa cu lty as we ll as th e st udents com e fro m man y 

di ffer en t prof ession s—th e pr of es sion s which m ak e up th e pu blic he al th team . 

Before ta ki ng th e co urse in th e pu blic hea lth sch ool pr ac tica lly all of them ha ve 

qu ali fie d them selves as pr of es sion al pra cti ti oners in med icine, den tist ry , en gi ­

ne er in g, nu rs in g an d so on. T he pu blic healt h curr ic ulu m is re al ly po st-p os tgra duat e.

The school of p ublic he al th m ust bring th es e di ffer en t pe op le to ge th er to focu s 

on th e he alth nee ds of gr ou ps an d co mmun iti es , ra th e r th an sim ply indi vi du al 

pa tien ts . It is no t ea sy to bri ng ab ou t such a ch an ge in po in t of view, yet th is 

is w hat m us t ha pp en to pr od uc e le ad er s ab le to gra sp co mmun ity he al th pr ob ­

lems an d to cope with t he m eff ectiv ely .

The ed uc ation of pu blic healt h le ad er s in sch oo ls of pu blic he al th is co mplica te d and expensi ve, av er ag in g more th an $5,000 per st uden t pe r ye ar. It is 

no t su rp risi ng th at ou r pu blic hea lth sch oo ls ha ve re al fin an cia l pro ble ms .

Th ese p roblem s are du e to se ve ra l fa c to rs:

1. Th e ed uc at io n it se lf is co stl y be ca us e we m ust ha ve peop le from a 

co nsiderab le nu m be r of dif fe re nt type s of pro fe ss io ns as teac he rs to giv e 

th e n ec es sa ry b ro ad b ac kg ro un d.

2. Much of th e te ac hin g m us t be done in sm all se m in ar an d la bo ra to ry 

gro up s, be ca use th e st udents also ha ve ve ry di ff er en t ty pe s of ba sic pr of es ­

sio na l trai ni ng . Only a lim ited am ou nt of our te ac hi ng ma y be done by th e 

les s e xp en siv e le ct ur e metho d.

3. The pri vate fo undat io ns which pr ov id ed fu nds to he lp mo st of th e 

publi c he al th schools in th e past no lo ng er a re pr ov id in g an y su bst an ti al 

sums fo r teac hing . The se fo un da tion s ta ke th e vie w th a t they ha ve do ne 

th ei r part in dem onst ra ting th e im po rtan ce of th e schools, an d th ey feel 

th at th e su pp or t m us t no w com e from th e univ er si ties an d fro m Gov ernmen t whic h em ploy s th e gra duate s of th e pu blic hea lth school s.

4. The un iv er si ties which ha ve pu blic hea lth sch oo ls ar e in te re st ed in 

the m, an d w an t to do a ll th ey c an to k ee p them ru nn in g. Ho we ver, th e cos t 

pe r pu blic h ea lth gra d u ate is re la tive ly larg e. Dem an ds on th e uni ve rs itie s 

fro m all q u art ers ha ve m ul tipl ie d to su ch an ex te nt, th a t they are less an d
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL ‘2 S 3

less ab le to carr y th e he av y fina nc ia l lo ad of th e pu blic healt h sch ools, 

which en ro ll th re e ou t-of -S ta te st udents fo r ev ery one st udent from w ith in 

th e Sta te .

5. The po ss ib ility of in cr ea si ng tu it io n to nar ro w th e de fic it pe r st uden t 

ha s been ex plor ed . It is ev id en t th a t w hi le mo de st tu itio n incr ea se s may 

be po ssibl e, part ic ula rl y in some of th e pri vate sch ools, th ere is no po ssibility of in cr ea sing th e tu itio n to th e po in t w he re th e de fic it wo uld be n arrow ed s ig nifica ntly .

W hat is th e N at io n’s need fo r pu blic hea lth tr ain in g? The H ea lth Am en dm en t 

Act (P ub lic La w 84 -91 1) pr ov id es pu blic healt h tr ai nee sh ip s. Und er th is act, 

th e Su rgeo n Gen er al of th e Pu blic H ealth Se rv ice w as re qu ired to call a confe re nc e to appra is e th e need fo r co nt in ui ng an d th e effectiven ess of th e traine esh ip plan . Thi s co nf er en ce was held Ju ly 28-30, 1958. It w as re po rted th at 

“t he d ata in di ca te a se riou s deficien cy in th e tr ain in g of m an y cu rr en tly emplo yed pe rson ne l an d do cu men t th e are as of need fo r ad ditio nal ad eq ua te ly qu al ified pe rson ne l to de velop the specific hea lth pro gra m s aut hor iz ed by Co ng ress and 

oth er pu blic b od ies .”

The c on fere nc e re po rted th at a t th e be ginn in g of 1958, “in official hea lth ag en ­

cie s alo ne , th er e w er e we ll ov er 2,500 va ca nc ie s in pro fe ss io na l ca te go ries due 

to lack of tr ain ed pe rson ne l.” In ad di tion, be ca us e tr ain ed i>eople w er e no t 

av ai la ble f or em ploy men t “o ve r 20.00 0 pr of es sion al w or ke rs now em ploy ed * * * 

do no t ha ve th e fo rm al spec ializ ed tr ain in g th ey ne ed to pr ov id e fo r th e peopl e 

th e he al th pr ot ec tion m ad e po ssibl e by to day ’s techn olog y.”

In ad ditio n to th e 22,500 men tio ne d above, th e co nf er en ce es tim at ed th a t th er e 

mus t be ad de d 0,100 more pro fe ss io na lly tr ain ed w or ke rs to mee t th e in ev itab le 

ex pa ns io n ne eded in th e nex t 5 years du e to po pu la tion gr ow th an d new he al th 

ha za rd s, su ch as ra dia tion, an d oth er hazard s in ci de nt to ra pid ly develop ing 

tec hn olog y. T hat mak es a to ta l o f 28,000 to be tr ai ned . Not all th es e peo ple 

can or sh ou ld be tr ain ed in sch oo ls of pu bl ic he al th , bu t if we ca n ge t co ns truc ­

tio n fu nd s ou r ca pac ity can be ex pa nd ed by 30 to 50 pe rc en t fro m th e pre se nt 

nu m be r o f ab ou t 1,200 st ud en ts . The Pub lic H ealth Se rvice est im at es co ns truc ­

tio n ne ed s fo r te ac hin g fa ci lities in exis ting sch ools of pu blic healt h as am ou nt ­

ing to .$34 million, w’ith an oth er $18 million fo r new sch ools, a to ta l of $52 

mi llio n.

Th e B ure au of th e Bud ge t a few m on th s ago as ke d th e Pu blic H ealth Se rvice 

to rep ort o n th e us e of Fed er al fu nds to ass is t tr ain in g p ro gr am s in pu blic h ea lth 

sch ools. O ur as so ciatio n we lco me d th e opp or tu ni ty to co op er ate in ge ttin g the 

needed in fo rm at io n to ge th er . We also as ke d our mem be r sch oo ls to ex am in e 

ve ry ca re fu ll y th e ne ed s fo r as si st ance in fu nd s fo r te ac hi ng , re se ar ch , and 

co ns truc tion . Bas ed on th is ex am in at io n, we pre par ed a re port fo r th e Bur ea u 

of th e Bud ge t, co m pl em en tary to th e re port of th e Pu bl ic H ea lth Servi ce.

TI.R. 4999 mak es prov ision fo r Fed er al ai d in co ns truc tion of bo th teac hi ng 

an d re se ar ch fa ci lities . Ther e is no qu es tio n ab ou t th e need fo r mor e sp ac e in 

wh ich to carr y on our work now an d of th e ne ce ss ity fo r addit io nal co ns truc tion 

to do th e pu blic he al th job of th e fu tu re . The gre at prob lem we ha ve is in 

fin din g t he m at ch in g fu nd s.

We as ke d ea ch of our sch ools, “W hat is th e pe rc en ta ge of m at ch in g fu nd s 

wh ich yo ur school wo uld be ab le to ra is e to w ar d th e co ns truc tion of teac hi ng 

fa ci lities ?” In an sw er in g th is q ue stion, mos t sch oo ls said th ey could ra is e about. 

15 pe rc en t, th ou gh som e w er e les s op tim istic. It is “v ery dif fic ult to in te re st 

fo un da tion s in th e su pp or t of co ns truc tion of teac hi ng fa ci lities .” And thou gh 

some S ta te u ni ve rs itie s “find it m o j| p o ssib le to se cu re le gis la tive appro pri at io ns 

fo r teac hi ng th an fo r re se ar ch b u iO h g s,” th e le gis la tu re s ba lk a t m ak in g ap pr opri at io ns which wi ll larg ely se rv < stu d en ts who wi ll wor k in oth er Sta te s.

O ur sch oo ls ha ve foun d th a t if is mor e po ss ible to ra is e fu nds fo r re se ar ch 

co ns truc tion th an it is to fin an ce te ac hi ng fa ci lities . “It is sa id th a t ‘rese ar ch ’ is fa sh io na bl e an d glam or ou s an d te ac hi ng is no t. At th e pre se nt tim e, 

re se ar ch co ns truc tion nee ds come muc h clos er to being met th an do teac hi ng 

fa ci lities which are sorely needed by m an y of th e sch oo ls.” We m us t ad d th at 

we co ns id er th e pas t rig id se par at io n of te ac hin g an d of re se ar ch co ns truc tion 

to be “e xt re m el y det rim en ta l an d w as te fu l. A mor e fle xib le an d les s rigid 

in te rp re ta ti on of th is sh ar p se par at io n could pr ov id e an appro pri ate solutio n. 

The se tw o fu nc tion s are too clo sely re la te d in th e ac ad em ic se tt in g to be separa te d ” in di ff er en t bu ild ings .

The ne ed fo r co ns truc tion of te ac hin g fa ci li ti es fo r tr ain in g pu bl ic hea lth 

w or ke rs will he pr es en te d fu lly by Dr. Myro n Wegma n, de an of th e U niv er si ty 

of Mich iga n School of Pu blic H ea lth. M ichiga n is a S ta te univ er si ty , sup-
284 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

por te d by th e S ta te le gis la tu re w ith S ta te ta x fu nd s. I) r. Wegina n will de ­

sc ribe th e dif fic ultie s th e six S ta te public hea lth schools antici pat e in tryi ng 

to se cu re co ns truc tion fu nds from th eir S ta te le gi sl at ur es .

I t is fa ir to say, on th e p a rt of the pu blic healt h sch oo ls, th a t if we are to 

m ak e pr og re ss in bu ild ing neede d teac hing fa ci lities , th e pr og ra m needs to l»e 

ba se d on ou r ra is in g fo r m at ch in g pu rpos es ab out 15 per ce nt of th e to ta l cost. 

It wo uld be un re al is tic to ex pe ct th a t we ca n ra is e a la rg er pr op or tio n. W ith 

th is 85-15 m at ch in g fo rm ul a, th e to tal am ou nt of Fed er al fu nd s requ ired fo r 

teac hi ng in th e publi c hea lth sch ool s would be $44.2 mi llion , o r less th an <5 

per ce nt of th e to ta l au th ori ze d fo r teac hing fa ci lities under ILK . 4999.

In re la tions hi p to th e m at ch in g form ula. Su rgeo n G en er al T er ry ha s lik en ed 

th e si tu at io n of th e schools of pu blic he al th to th a t of th e region al pr im at e 

cen te rs to be es ta bl ishe d to ca re fo r mo nkeys used fo r re se ar ch . As he pu t it, 

th e Fed er al Gov ernm en t ne eds bo th th e pri m at e ce nt er s an d th e pu blic hea lth 

scho ols to se rv e re gi on ally an d na tion al ly an d no t loca lly . Und er thes e cir ­

cu mstan ce s, ex pe ct at io n of la rg e local su pp or t is no t rea listic.*

The Pre si den t’s Scien ce Ad vis ory Co mmittee ’s Pan el on Bas ic Re search an d 

G ra duate E du ca tio n ha s sa id alon g the s am e lin es :

“O bviou sly , wh en th e Gov ernm en t ha s a p art ic u la r in te re st in a par ti cula rl y 

ex pe ns iv e in st al la tion of more th an loca l im po rtan ce , it m us t ex pe ct to me et 

all or ne ar ly all of th e co st of th e un de rtak in g. Ther e may also be oth er cir ­

cu m stan ce s in wh ich a p art ic u la rl y good op po rtunity fo r prog ress wo uld be 

lo st if ‘ma tc hi ng ’ w er e in sisted on, an d we be lie ve th a t un match ed gra nts 

sh ou ld be used in such c as es .” 1

In fram ing, II.K . 4999, decis ion wa s mad e to tr eat den ti st ry in a ca tego ry 

se para te fro m th a t of me dicin e. For som e reas on pu blic hea lth was no t so 

se pa ra te d. We shou ld lik e to su gg es t th at it wo uld be mo re ap pro pri at e to als o 

bu t prov isions re la ting to th e pu blic he alth sch oo ls in a se para te sec tio n of th e 

bill. We propo se th is s ep ar at io n f or sev eral re aso n s:

(1 ) Th e pu blic hea lth sch oo ls ha ve re ce nt ly de term in ed th eir nee ds, so 

th a t it wo uld be simpl e to earm ar k th e needed fu nds in a se par at e sec tio n.

(2) Th e Co ng ress th ro ug h th e Hill-R ho de s Ac ts (P ub lic Law 85-544 

an d Pu blic Law’ 86-720) has de m on stra te d it s reco gn iti on of th e special 

te ac hing fu nc tion s an d ne ed s of th e pu blic hea lth sch ools. It is a log ical 

fu rt h er step to pr ov id e co ns truc tion aid to th es e sch oo ls in th eir special 

ca pa city.

(3 ) In th e p ast th ere has been som e co nt ro ve rsy co nc erning th e des ir ­

ab ility of Fe de ra l ai d to med ica l ed uc ation. Such co ntro ve rsy ha s not 

ex isted in re la tion to th e pu blic he al th sch ools, an d it see ms ap pro pri at e 

fo r th is reas on also to tr e a t them in a se para te fash io n.

The Su i»erintend en ts of W es t Poi nt , An napolis, an d th e A ir F or ce Ac ade my are 

fo rt h ri g h t in as ki ng th e Co ng ress fo r bu ild ing fu nd s. Th e me n tr ai ned in th es e 

bu ildi ng s will pl an fo r an d adm in is te r th e de fe ns e of our co un try. Th os e re ­

sp on sible fo r th eir ed uc ation are als o resp on sible fo r pr es en ting th e ne ed s of 

th eir in st itutions to th e only national ap pro pri at in g au th ori ty , th e Congres s. 

The Arm ed Fo rces Ac ade my Sup er in te nd en ts are fo rt h ri g h t in pr es en tin g th es e 

needs. It is th eir d uty to as k fo r spec ial tr ea tm en t.

Li ke wise we wh o are re sp on sibl e fo r ou r sch oo ls of pu bl ic hea lth re al iz e fu ll 

w’el l th a t we are as ki ng fo r spec ial tr eatm ent in th e m at ch in g fo rm ula fo r 

co ns truc tion of teac hi ng fa ci lities . We ar e prou d to be do ing a jo b so im port an t 

to th e Nati on as to ju sti fy be ing p u t in a sp ec ial ca tego ry . W e are n ot as ha m ed 

th a t ou r gra du at es wor ki ng fo r th e pu blic are w illing to se rv e fo r pa y whic h 

leav es the m sc an t lee way to co nt ri but e to th e sch oo ls which tr ai ned them .

We realize th a t th e fo undat io ns an d in dust ri al fir ms ha ve a r ig ht to co nt ribu te 

to ca us es th at ha ve th e gre at es t aiip ea l fo r them , an d to focu s th eir at te ntion 

on pri vate ne eds , ra th er th an p ub lic .

We can un der st an d why th e le gis la tu re of a S ta te which has a pu blic he al th 

sch ool tr ai nin g fo r th e N atio n or fo r a wh ole region , rebe ls a t i nc re as in g gre at ly 

th e sum it will pa y to ex te nd th is tr ain in g fro m which it rec eive s lim ite d benefit.

We believ e th a t as mem be rs of th is co mm ittee, yo u will reco gn ize th e n at io nal 

im po rtan ce of ou r wor k in tr ain in g pu blic healt h lead er s. And we ha ve fa it h 

th a t you will so fr am e th e legi slat io n pr ov id in g Fed er al fu nds fo r bu ild ing up 

our pu blic he al th sch ools, th a t we may proceed w ithout de la y to too l up fo r 

th e job ah ea d.

«J_Th e P a n p l o n Basic Research and Graduate Education of the President’s Science Advisory Committee, “Scientific Progress—the Universities and the Federal Government," Nov. 15, 1960 (preface by Dwight D. Eisenhower).
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 285

Dr. Stebbins will present the special problems of our six priva te schools, and 

Dr. Wegman will speak on beha lf of o ur six schools which are in Sta te universities.

Statement Submitted by Dr. Ernest L. Stebbins

I am Ernest L. Stebbins, dean of the School of Public Health of the John s 

Hopkins University. 1 am here represen ting the schools of public health in privately endowed universities. As has alre ady been pointed out there are 12 

schools of public health in the United States accredited f or pos tgradu ate training 

for public health personnel. Six of these schools are in privately endowed universities and six are in State universities. The six privately endowed schools 

are at th e following un ive rsities: Columbia, Harvard, John s H opkins, Pittsburgh, 

Tulane, and Yale. The support of the private schools is derived prim arily from 

income from endowment supplemented in recent years by research and teaching 

gra nts from various sources an d in recent years materially supported by research 

gra nts and to a lesser extent by teach ing gra nts from the Fed eral Government.

As previously pointed out, the schools of public health receive stud ents from 

all parts of the United States and from all parts of the world. A very large 

proportion of the gradua tes of the schools of public health go into public service. 

A recent tabulation showed t ha t more tha n 95 i>ercent of the gradua tes of these 

schools go into local, State, or Fed eral service. A high proportion of th e students 

are federally sponsored by such agencies as the U.S. Public Health Service, the 

Army, the Navy, and the Air Force. A considerable proportion of the students 

are sponsored by our foreign aid agencies. In my own institu tion more than 

half of the stud ents are federally sponsored.

As previously pointed out the training of public health personnel is a very 

exj>ensive form of education, because of the necessary small group teaching and 

because of the expensive labo ratory equipment required. In all of the schools 

the cost to the university per studen t is many times the tuition paid by the student or by the sponsoring agency. It has been said, and with considerable basis 

in fact, that the universities are subsidizing the Federal Government in the 

training of federally sponsored students. We have been grea tly encouraged in 

recent years by the interest shown by Congress in the problems of the schools 

of public health. We are indeed grateful for assistance th at has been given 

through appropriations by the Congress to support—in part, nt leas t—research 

and teach ing activities in the schools.

We are greatly encouraged by the introduction of H.R. 4999 which is another 

indication of the unde rstanding on th e p ar t of the Congress of the problems and 

the needs for trained public hea lth personnel. We strongly approve the prin ­

ciples established in this legislation. We recognize the general need to expand 

training programs for professional health personnel of all tyi>es. We draw our 

students from the medical schools, the den tal schools, and other professional 

schools after they have completed the ir basic professional training. In order 

to fulfill our puri>ose we must have an adequate supply of these professionally 

trained people.

We are particularly concerned with the problems of teach ing facilities. All 

of the priv ate schools are desperately in need of improved and expanded teaching facilitie s if they are to mainta in high standa rds of education and provide 

the trained personnel th at are now needed and will be needed in the future.

A questionnaire sent to the various deans of these schools resulted in the following inform ation:

Columbia

“Our present physical facilitie s are severely limited. We are housed in the 

top 3% floors of the District Health Center in space which was originally planned 

for a studen t body of 20 and the necessary faculty. The last full professor appointed to the faculty was placed in an office 7% feet wide constructed by closing off the last corridor possible under the fire la ws • * ♦. The a cquisition of additio nal facilitie s is absolutely necessary if we are to increase our enrollment. 

Our classrooms are so crowded now tha t at times the regular facu lty member 

in charge of the class has to s it in the doorway if we have a visiting lecturer.” 

Harva rd

“Examples of overcrowding:

“ (a) Number of students enrolled for 1960-61,113; number of seats in largest 

lectu re hall, 96.

“Note.—The number of mas ter’s degree candidates admitted each yea r is limited to 80 in order to accommodate them in the lecture hall and teaching labora-
2S G TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

tories. We are able to squeeze only 60 students in the biostatistics laboratory, 

a required course for all mas ter of public health degree candidates.

“ (b) It is obvious from the above that we have no meeting place large enough 

for student body and faculty members, nor for professional public health personnel who might otherwise atte nd training conferences and institu tes here.

“ (c) We lack sufficient rooms for seminars, which provide for the most effective teaching of public health gra duate students.

“ (d) Full-time faculty members, who devote most of the ir time to teaching 

and counseling students, are crowded into small offices which are entirely inadequate for interviews and conferences.

“ (e) We are entirely with out—

“Desk space for part-time faculty members and visiting lecturers.

“Desk space for doctoral candidates.

“Dining facilitie s for facu lty or students.

“Parkin g space for students, many of whom must commute by automobile. 

“Auditorium for lectures and institu tes involving not only our faculty and 

stud ents but also Federal, Sta te and local public health personnel.

Note.—The school has many requests from public and private health agencies 

to provide refresher and continuation training in the form of special lectures, 

conferences and institu tes for professional public health personnel from the field. 

This is an imp ortant teaching function which the school cann ot develop satisfactorily without adequate facilities.

“ (/ ) The school is operating under cramped conditions in two form er hospital 

buildings, neither of which were designer! to serve a s schools; one of these build ­

ings should be abandoned as obsolescent.”

Johns Hopkins

“We are continuing to add inadequate but absolutely necessary space, through 

the renting of houses and buildings in the vicinity of the school. Our division 

of mental hygiene is housed in the eastern health district, some six blocks away 

from the school. Our matern al and child health division is housed in an old 

hospital buiding, three blocks from the school. A large pa rt of our chronic 

disease division is housed in rented housing in the neighborhood, some as much 

as two or three blocks aw ay from the school.

“All of this dispersed space is required for teach ing and research, with the 

major emphasis on teaching. We have some temporary relief through the construction of the new basic science building, which will house some of the basic 

science departments of this school. However, we have alre ady more than outgrown the space tha t was so made available.”

Tulane

“The School of Public Health at Tulane (designated the division of gradua te 

public health) is small, adm ittin g annually some 30 to 50 stud ents selected 

ordinarily from some 50 to 74 applicants. The lower figure of 30 students admitted was reached 4 years ago for the first time despite the fact th at we had 

been granting M.P.H. and M.P.H. and T.M. degrees since 1948. Secondly, our 

programs have been limited—indeed the programs have been of a general natur e 

with partic ula r emphasis upon the basic science aspects, biostatistics, microbiology. and epidemiology. Tropical medicine and parasitology have remained 

the only areas of specialization. It can be stated quite unequivocally that the 

principal factor limiting development both in term s of the number of students 

admitted and th e content of the programs offered in floor space,

“Our present and prospective situation is one of expediency and compromise. 

In addition to the present departmental space (10.359 squ are feet) some 2.000 

squa re feet is rented in a commercial building nearby to provide office space and 

soace for gradua te students. 1.600 square feet of lab ora tory space is occupied 

at the U.8. Public Health School Hospital four miles away, and lastly we are 

dej>endent for classroom space for the M.P.H. studen ts on the Sta te health department located behind us.

“We hone to ren t another floor in the commercial building referred to above 

for the 1961-62 academic year, mainly to accommodate gra duate students. We 

are trying to develop courses and research in maternal and child health, in 

public health nursing and in mental hygiene, since these are as represent our 

most outstand ing nrogram deficiencies. We also intend to develon a Ph D. degree nrogram in biostatistics hv 1963. Clearly, this would he enormously facilitated by expanded construction.”
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 2S7

I ale

‘•We ue ed e xt en si on a nd r en ov ation of p re se nt bu ild ing q u art ers o r a new bui ld ­

ing to incl ud e som e fu nc tion al act iv itie s ho us ed else whe re (e.g ., p a rt of our 

epidem iology , oc cu pa tion al he al th la bo ra to ri es , co ns id er ab le ex pa ns io n of bi osta ti st ic s offices an d labo ra to ries , au ditori um . * * *) O ur cr ow di ng is illu str ate d by fo rc ed us e of ou r main sta ti st ic al la bora to ry fo r fo ur diffe re nt kin ds 

of clas se s an d se m in ar s du ring th e w eek ; an d we carr y an ass is ta n t pro fe ss or 

and th re e ass is ta n ts in st ati st ic al re se ar ch in an ad jo in in g room. Our sm all 

clas sroo m s a re ov ercrow de d. We ha ve as m an y as th re e st af f peop le in mor e 

th an o ne o ne -u ni t r oo ms.”

In th e past th e pri vate sch ools ha ve rece ived ve ry co ns id er ab le he lp from th e 

fo un dat io ns in te re st ed in publi c he al th , no ta bl y th e Roc ke fe lle r Fou nd at io n, th e 

Com mon wea lth Fu nd , an d th e W. K. Ke llogg Fou nd at io n. In re ce nt years th is 

fo un da tion su pp or t has de crea sed m ar ke dl y. W hen th e fo undat io ns a re a p ­

proa ch ed fo r fu nd s th ey remind us th a t our gra duate s go la rg el y in to Gov er nmen t se rv ic e an d sugg es t th at we sh ou ld look to Gov ernm en t fo r fu nds to mee t 

ou r ba sic n eeds.

Ab out a year ago th e pr es id ie nt s of th re e of th e p ri vate uni ver si ties an d th e 

de an s of th eir sch ools of pu blic he al th as ke d fo r th e op por tu ni ty to pr es en t th is 

pro ble m to th e he ad s of a la rg e fo un da tion . The he ad of th e fo un dat io n su gge ste d th a t th ey com e a t lunc ht im e so th a t th ey wo uld ge t so m ethi ng ou t of th e 

tr ip an d th a t w as w hat they g ot. lunc h an d not hi ng m ore .

Rec en tly a la rg e in dust ry th a t pr of es se s g re at in te re st in pu blic hea lt h w as 

ap pr oa ch ed w ith a ra th er el ab ora te pre se nta tion of th e ne ed s of a sch ool of 

pu blic he al th fo r new fa ci lities es tim at ed to co st in th e ra ng e of $<! million. 

The in dust ry ex pr es se d gre at in te re st in th e pr op os al an d sa id th ey wishe d to 

su pp or t th is ac tivi ty . A check fo r $5,000 w as received . A no th er po ssible 

so ur ce of fu nd s fo r th e pri vat e univ er si ty is co ntr ib utions from th e alum ni . 

If ou r sch oo ls of pu blic he al th tr ai ned peop le fo r p ri vate pra ct ic e or in dust ry , 

wh ich is of te n qu ite lu cr at iv e we m ig ht hope to rece ive sign ifi ca nt gif ts from 

ou r alum ni, bu t be ing Gov ernm en t se rv ants fo r th e mos t p a rt ou r al um ni giv e 

re gula rl y but in sm all amou nts.

On th e p art of th e pri vate schools of pu blic healt h it is fa ir to sa y th a t if 

we are to mak e pr og re ss in bu ild ing ne eded te ac hi ng fa ci lities th e pr og ra m 

ne ed s to be ba sed on our ab ility to ra is e m at ch in g fu nds es tim at ed a t ab out 15 

pe rc en t of th e cos t. I t wo uld be unre ali st ic to ex pe ct th a t we ca n ra is e a 

much la rg er pr op or tio n. We wo uld lik e to st ro ng ly rec om me nd , th er ef ore , th a t 

th e sch ools of pu blic hea lth be giv en sp ec ia l co ns id er at io n in th e es ta blish m en t 

of th e m at ch in g fo rm ul a. We be lie ve th a t th is can be ju st ifie d on th e gr ou nd 

th a t th e sch ools of pu blic he al th are re gi on al or nat io nal in ch ar acte r. We 

se rv e th e Nati on , ju st as th e m ilitar y ac ad em ies se rv e th e N atio n in th e tr a in ­

ing of pe rson ne l fo r th e de fens e of th e N atio n ag ai nst ag re ss ion from ou tsid e 

po we rs. We in th e schools of pu blic healt h tr ain pe rson ne l fo r th e de fens e 

of o ur N ation ag ai nst d isea se an d di sa bi lity .

Sta teme nt Submitted by Dr. Myron E. Wegma n

Ge ntl em en, I am Myro n E. Wegma n, de an of th e Sch ool of Pub lic H ealth of 

th e U ni ve rs ity of Michig an, one of th e six sch oo ls of pu blic hea lth loca ted in 

S ta te un iv er sities . Th ese are th e U ni ver si ty of C al if orn ia a t Berke ley, th e Unive rs ity of Cal ifor ni a a t Los Angeles, th e U ni ver si ty of Minne so ta, th e U ni ve rsi ty of N or th Car olin a, th e U ni ve rs ity of Puert o Rico, an d th e U niv er si ty of 

Mich iga n. My testim on y wi ll be de vo ted la rg el y to some spec ial co nc er ns of 

th es e schools bu t be fore en te ri ng on th es e I sh ou ld lik e to sa y a few wor ds on 

th os e po rtio ns of II. R. 4999 co ve rin g scho ols of me dic ine , den tist ry , an d ost eop athy . You ha ve hea rd of th e bo ar d an d m ultid is ci plinar y ch ara cte r of pu blic 

he al th and of how it includ es ph ys ic ians , den tist s, nu rs es , en gi ne er s, sta ti stici an s, nutr it io nis ts , an d ma ny oth er pr of es sion al grou ps. N ev er th el es s I m us t 

em ph as ize th e key roles play ed in pu bl ic hea lth ac ti vit y by phy si ci an s an d 

de nt is ts . Im pr ov em en t in th eir ed uc at io n is of vital im po rt to pu bl ic healt h 

both be ca us e of th e da ily wo rk of all phy si ci an s an d denti st s an d be ca us e of 

th e urg en t need to ha ve an ad eq ua te pool of qu ali fie d me n wh o may be att ra cte d 

to pu blic hea lth as th eir sp ec ialty . I, th us , st ro ng ly su pport bo th th e co ns tr uctio n an d sc hol ar sh ip prov isions of th e bill re ga rd in g phy si ci an s an d de ntist s. 

Our ow n high ly sa ti sf acto ry ex pe rie nc e w ith th e lim ited nu m be r of tr ai neesh ip s
288 TRAINING OF PRO FES SIO NAL PUBLIC HEA LT H PERSON NEL

sch oo ls of pu blic he al th ha ve had convinc e me of th e desi ra bility of ex tend in g 

th is p rin cip le.

The pro ble ms of th e S ta te schools of pu blic healt h vary in som e de gr ee beca us e of th e special prob lems of th e Sta te s in which th ey are located , bu t sim ila ri ti es ou tw eig h th e differen ce s sin ce al l th e scho ols se rv e a mu ch w id er are a 

th an th eir own Sta te s. Thi s is tr ue also of th e pri v ate sc ho ol s: an d. in th is 

connection. I po in t w ith pri de to th e close co op er ation am on g th e pri vat e am i 

pu blicly su pp or ted sch ools of pu blic he al th . W or ki ng to ge th er ha s been a 

lo ng stan di ng fe atu re th a t has led to hi gh er st andard s, ne w mea ns of in st ru ctio n. a br oa de r ba se of se rv ice to th e pu blic an d to th e prof ession , ex ch an ge o f 

sta ff, an d a co ns ta nt se ar ch fo r cu rricul um revi sion s to ke ep abre as t o f the 

dy na mic ch an ge s ta kin g plac e in co mm un ity hea lth needs.

SPECIAL CHA RAC TERISTICS OF TH E STATE SCHOOLS

In il lu st ra ti ng th es e I sh al l, pe rforce , re fe r spec ifica lly to my own un iv er sity , 

th e situ at io n I know best. T he re m ar ks , ho we ve r, will ap ply eq ua lly well to 

th e ot her schools. S ta te scho ols fa ce prob lems of p art ic u la r m ag ni tu de in re ­

sp ec t to th eir need fo r sp ac e an d fa cilit ies. S ta te un iv er si ties ar e by th eir 

ve ry natu re larg e in sti tu ti ons an d in re ce nt ye ar s pre ss ure of ap pl ic an ts has 

se nt to ta l un iv er sity en ro llm en t co ns ta nt ly hi gh er . Thu s, th es e uni ve rs itie s 

offer a fe rt il e ar ea fo r re cru it m ent of urg en tly needed new person ne l in pu blic 

hea lth, a need th e Co ng res s has recogniz ed in th e es ta bl is hm en t of pu blic hea lth 

trai ne es hi ps . More ad eq uat e fa ci lities wo uld allow th e sch ools of pu blic he al th 

to play a la rg er role in uni ve rs ity af fa irs an d th us to l>e a mo re im po rtan t in ­

fluence in att ra cti n g br ig ht yo un g mi nd s to th e ta sk of co mmun ity he alth se rv ­

ice fo r wh ich pr of es sion al ed uc at io n in pu blic he al th is es se nt ia l. Dr. Leavell 

ha s em ph asize d th e ve ry br oa d base of th e pu blic he al th professio n.

It ha s been tr uly po inted out th at pu blic hea lth is un iq ue in ha vi ng a sol id 

fo un da tion both in th e socia l sci ences an d th e natu ra l sciences. As a nat ura l 

an d de sira bl e consequence th e Scho ol of Pu bl ic H ea lth a t the U ni ve rs ity o f 

Michiga n off ers a wide var ie ty of pr og ra m s to college gra duate s wh o ha ve ha d 

ad eq ua te pre pa ra tion in biology, ch em istry , ph ysics, an d the soc ial sci enc es. 

Th e stud y pr og ra m s may co nc en trat e on pu blic hea lth ad m in is trat io n, pu blic 

hea lth de ntist ry , med ical car e ad m in is trat io n, hea lth ed uc at io n of th e publi c, 

pu blic he al th nu rsing, nutr it io n, m at er na l an d ch ild hea lth, bio st at istics , ep idem iology , pu blic healt h la bora to ry pr ac tic e, en vi ro nm en ta l he alth , radiolog ical 

he alth , in dust ri al hea lth, an d ot he r specific fields. A pp ro pr ia te em ph as is is 

giv en to th e prob lems of ch ro ni c dis ea se, men tal hea lth, at m os ph er ic an d w ate r 

po llu tio n, an d co mm un ity de ve lopm en t as well as to th e c ha lle ng es of th e ne wer 

viru se s, to xi ca nt s in foo ds, and to th e devas ta ting prob lem of ac cide nts. Th e 

var ie ty of tr ain in g pr og ra m s th a t nee d to be giv en co mplica tes th e pro ble m o f 

sp ac e an d fa ci lities . Alth ou gh mo st st uden ts ta ke ce rt ai n ba sic co urse s to ­

ge ther, th ey m us t be sp lit up fo r some of th e mor e sp ec ializ ed wo rk.

S ta te le gi sl at ur es ha ve in ge ne ral been sy m pa th et ic to th e need fo r ba sic 

bu dg ets fo r th e scho ols of pu blic he alth , but th ey ha ve been ve ry h e sit a n t no t 

to sa y re si st ant, to th e idea of th e ex pa nd ed ca pi ta l ou tlay necessar.v fo r in ­

cr ea si ng fa ci lities . Schools w ith so high a pr op or tio n of st uden ts fro m ou t of 

S ta te ha ve a low er p ri ori ty fo r scar ce fund s.

Furt he rm or e, th e trem en do us in cr ea se in pre ss ure on th e un iv er si ties fo r 

under gra duat ed tr ain in g is ta xin g reso ur ce s to th e ut m os t. In th e case of the 

Uni ve rs ity of Michig an, fo r exam ple , sh or ta ge of fu nds has put th e to ta l c o n ­

st ru ct io n pr og ra m of th e uni ve rs ity alm os t 5 yea rs be hind schedu le. We have 

been told, fr an kl y, th a t th e rec ogniz ed ne ed s fo r ex pa nd ed fa ci lities in the 

School of Pu blic H ea lth ca nn ot be satis fie d fro m S ta te fu nds in th e im med iate 

fu tu re . On th e ot he r ha nd . I can re port w ith gre at sa tisf ac tion th a t in a rece nt 

long ra ng e plan on fu tu re d ev elo pm en t of th e med ica l ce nt er th e special im po rtan ce of pu blic he al th was cl ea rly rec ogniz ed. A ve ry de sira bl e loca tio n ha s 

been de sign ated f or o ur ur gen tly needed e xp an sion .

OUT-OF-STATE STUDENTS

Th e School of Pu bl ic H ea lth nt th e U ni ver si ty of Mich igan has th e high es t 

no'-centag e of no n-M ich iga n re si de nts of an y school or college in th e un iv er sity . 

Thi s yea r th e no n-M ich iga n re si de nts to ta l 75 pe rc en t of th e st uden t body. De- 

«”ife th e ve ry much hi gh er fe es pa id by on t-of -S tn te st ud en ts, th es e fee s do no t 

com e an yw he re nea r pa yi ng th e co st of in st ru ct io n. It is un de rs ta nd ab le , there-
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 289

fore, that the Sta te legislature is reluctan t to expan d furth er the State ’s contribution to what is, in effect, a national school.

GENERAL FIN AN CIAL PROBLEM OF BTATE UN IVE RSITIES

The Sta te of Michigan has a distinguished record and intere st in higher education. There are a t present nine State-supported universities in Michigan. The 

Sta te fund s which go to higher education are sub stan tial.

Nevertheless, the needs have outstripped the fund s and the present situ atio n 

of the universities is desperate. Las t spring, for example, the Sta te legislature 

gran ted only a token budgetary increase to the University of Michigan and suggested th at studen t fees be raised again. These had been raised seve ral times 

in the preceding years and the board of regents declined to raise them furthe r. 

The regents contended that fu rth er increases in tuition would serve only to keep 

deserving and capable young men and women o ut of university education. This 

meant a budget which “stood still” despite risin g costs, with resulta nt loss of a 

disturbing number of highly valued faculty members to other institutions. Considering the tru ly national cha rac ter of the schools of public hea lth the only 

logical recourse is to extend the use of Fed eral funds to supp ort more nearly 

the ac tual costs of education.

The committee has had presented to it a table showing the conservative and 

realistically calc ulated space needs of all the schools, including th e Sta te schools. 

I shall not rehearse for you the many instances of serious overcrowding, doubling up, insufficient classroom space and serious teaching handicaps which have 

plagued us and which have been repo rted from all the schools. I would, however, pay trib ute to the measure of improvement which has been made possible 

because of the ava ilab ility of Federal funds for research construction. These 

have allowed considerable improvement in facilities for investigation and in some 

instances, furth erm ore, have allowed space now inadequate for research purposes 

to be converted to teach ing use. I should like at this time, therefore, to endorse 

strongly the section of H.R. 4999 dealing with construction of resea rch facilities. 

Research is a vita l component of th e work of any school, but adequate classroom, 

seminar, and office space is essential if the schools a re to c arry out satisfa ctorily 

their basic function of teaching.

CO NTINU ING AND POSTGRADUATE EDUCATION

An important aspect of the work of Sta te schools relates to pos tgradu ate institutes and courses for practicing public health workers and for ancillary 

groups allied to public health. This type of development recognizes that, on the 

one hand, with the gre at backlog of persons who have never had form al education in public hea lth and, on the other, with those whose education dates back 

sufficiently far tha t they are not alway s completely abrea st of new developments, 

refresher and review courses are essential.

Earlie r in my career I was professor and head of the Depa rtment of P ediatri cs 

of Louisiana Sta te University Medical School and p<‘diatric ian in chief on the 

L.S.U. Service at Cha rity Hospital in New Orleans. There I learned the need 

of the rural medical practitioner for constan t refresher work. In clinical fields 

it is possible to car ry out a substatial amount of postgraduate teaching in local 

hospitals and clinics. In the field of public health, however, the material to he 

covered is of such a natur e that the specialized equipment and specialized resources of the univ ersity environment are uniquely necessary for success. With 

increased facilities it would be possible to expand these courses considerably 

and reach large numbers of health officers and other health workers now employed by the cities and States. During the academic yea r 1960-31 more tha n 

1.000 public health workers attended sho rt courses at the University of Michigan, 

for periods from 2 days to 2 weeks. Each course, however, has nece ssitated considerable sh ifting around of classes w ith loss of time and efficiency for all. With 

additional classroom and teaching space we could expand and improve our efforts 

to meet more nearly the insistent demands for continuing education from people 

who are on the job.
290 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

K EEPIN G PA CE W IT H NEE DS — U NIV ERSIT Y OF CALI FO RN IA AN D U NIV ER SI TY OF NO RT H 

CA ROLIN A

A spe cific in st an ce f ro m th e Uni ve rs ity of C al if or ni a a t Ber ke ley ma y se rv e to 

il lu str ate an oth er dif ficulty in ca llin g upo n th e S ta te s to su ppor t fu rt h er in ­

cr ea se s. In 1955 th e Schoo l of Pub lic H ea lth a t th e U ni ver si ty of Cal ifor ni a in 

Ber ke ley occupie d it s ne w pu blic healt h bu ild ing w ith an are a of 43,000 sq uar e 

feet. W hile t hi s bu ild ing m et t he n ee ds n ice ly in 1955, in th e sh ort in te rv al sin ce 

th en th e gra duat e st udent body has dou bled. Thu s, des pi te a re ce nt new bu ild ­

ing th e Sch ool of Pu blic H ealth fin ds it se lf fo rced to do ub le up fa cu lty mem bers 

an d to re n t sp ac e ou tsid e th e bu ildi ng fo r both in st ru cti on and re se ar ch . Inde ed 

th er e are se ve ra l needed te ac hi ng pr og ra m s which ca nn ot be st art ed sim ply beca use th er e is not spa ce fo r them .

The Uni ve rs ity of N or th C ar olina is now bu ildi ng a new scho ol but th ey kn ow 

al re ad y th a t it is only on e- ha lf as larg e as th ey need. The y are ha pp y w ith 

th e pr os pe ct of new q u art ers an d recogn ize th at in re la tion to th e en dles s difficu ltie s of th e past few ye ar s, th e new bu ild ing wi ll see m al m os t luxu riou s. On 

th e oth er ha nd , th ey know th a t th ey wi ll be ov ercrow de d be fo re th ey move in. 

F u rt h e r su pp or t from S ta te fu nds is co nsidered co mplete ly ou t of th e qu estio n.

IN TE RN A TI O NA L ASP EC TS

Pro fe ss io na l ed uc at io n in pu blic hea lth ha s serv ed a un ique fu nc tio n in de ve lop ing close ties w ith si m il ar sch oo ls in ot he r co un trie s. Thi s ha s se rv ed to 

st re ngth en pr of es sion al co nt ac ts an d to fa cil it ate in te rc han ge of idea s in a nu mber of fields of scien ce as well as in th e field of pu blic he al th . As ha s been em ­

ph as iz ed to th is co mm itt ee man y tim es, di se as e kn ow s no bo un da rie s. Pu blic 

healt h ad va nc es ha ve co ns ta nt ly br ou gh t w ith them th e ne ce ss ity fo r th in ki ng 

in bro ad term s. The sch oo ls of pu blic he al th are of p art ic u la r im po rtan ce beca us e th eir ve ry rec ency of de ve lopm en t ha s fa cil it ate d a m utu al un de rs ta ndin g 

an d in te rr ela tionsh ip of h igh de gree .

I ha ve ha d ex tens ive jie rson al ex pe rien ce w ith th e in te rn ati onal scene. Be fore 

as su m in g my pr es en t jxi st a t th e Unive rsity of M ichiga n, I w as se cr et ar y ge ne ral 

of t he Pan A merican S anit ary B ur ea u, wh ich is th e se cre ta ri at of the Pa n America n H ea lth Org an izat io n an d also th e Re gio nal Office fo r th e Americas of th e 

W or ld H ea lth O rg an izat ion. D uring t he 8% yea rs th a t I worke d fo r th e O rg an iza tion I ha d close co nt ac ts w ith al l th e sch ools of pu bl ic he al th in Lat in Am eri ca 

an d to a mo re lim ite d exte nt th os e in W es tern Eur op e. I shou ld po in t ou t th at 

in th es e ot her co un tries, man y of wh ich mo deled th e scientific co nt en t of th eir 

pr of es sion al pu blic he al th scho ols on thos e in th e United Sta te s, it ha s been ac ­

ce pted w ithou t discus sio n th a t th e fin ancin g of pr of es sion al ed uc ation in pu blic 

h ealt h is ba sica lly a nat io nal g ov er nm en t fu nc tio n. Gov ernm en tal resp on sibi lity 

is per hap s mo re obvio us in are as w he re high lev els o f co mmun ica ble an d oth er 

di se as es e xi st and w he re org an ized p reve nt iv e m ea su re s are more ur ge nt . Sch ools 

of pu blic he al th in th e United S ta te s are co ns ta nt ly be ing as ke d to play a mo re 

ac tive role in co llab or at in g w ith sch oo ls of pu blic h ea lth in oth er co un tries. T his 

co llab or at io n, wh ich br in gs a g re a t de al of m ut ua l ben efit, inv olv es mu ch in te rch an ge of pe rson ne l. In al l of th e schools of pu blic hea lth in th e U nited S ta te s 

th ere a re p erso ns fro m ab ro ad , var yin g fro m fel low s to vis itin g sc ho la rs of hig h 

em inen ce fo r who m ad eq ua te w or ki ng sp ac e m us t be prov ided . I be lie ve I ma y 

say ve ry prou dly th a t th ere has been more fr u it fu l co llab or at io n in th e hea lth 

field an d mo re i mprov em en t in in te rn ati onal under st an din g in th is field th an an y 

ot he r. In th is w ay th e sch oo ls of p ub lic he al th , th ro ug h de vo tin g a p a rt of th eir 

sp ac e an d fa ci lities to rece ive st udents an d sc ie nt is ts fro m oth er co un tries, ha ve 

co nt ri bu te d in hig h de gree to im pr ov em en t of th e pre st ig e an d inf lue nce of th e 

U ni ted St at es .

Dr. Le av ell ha s em ph asize d th e im po rtan ce of st uden ts fro m ab ro ad in th e 

p ri v ate schools. Th e U niv er si ty of Mi chiga n, as a S ta te scho ol, ha s a br oa d conce pt of its re sp on sibi lit y to th e N at io n an d to th e w o rl d : some 15 pe rc en t of th e 

to ta l en ro llm en t a t th e sc hoo l of pu bl ic h ea lth ar e fro m ab ro ad . Sin ce t he fo undin g of th e school in 1941. 371 st uden ts fro m 56 oth er co un trie s ha ve rec eive d 

g ra duate pr ep ar at io n an d de gr ee s in pu blic he al th . Sim ilar fig ures could be 

cited fro m th e ot he r schools.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 291

A special case should be noted for the University of P uerto Rico. This school 

performs a unique function inte rnation ally since it carries on instruction in 

Spanish. In this way it is able to serve the Spanish-speaking coun tries of the 

Americas and has att racted an increasin g number of qualitied students. With 

renewed and expanded inte rest in joi nt efforts of the countries of the Western 

Hemisphere to improve health the number of studen ts is likely to improve. As 

these retur n to the ir own homes i t is im por tant t ha t they, as well as the students 

in the schools on th e mainland, carry away a picture of a quality of education of 

which the United States may be proud.

PROBLEM OF MA TC HING

Sta te schools are in a dilticult position with rega rd to matching Federal aid. 

Their basic support is from the Sta te and the usual donors of endowments, therefore, consider the needs of Sta te schools to be less urgent than those of the private 

institution. The alum ni of the university, usually an imp ortant source of funds, 

cannot co ntribute su bstantially. Gra duates of schools of public health are, in the 

very n atu re of their work, employees of government, community, or eleemosynary 

organizatio ns. Their incomes are too low to perm it the level of giving which, in 

the ir loyalty to the university, they would like to reach.

Sta te legislatures, for the reasons cited above, are loath to app rop riate State 

funds for construction, particu larly durin g the p rese nt period of ever higher costs.

A 50-percent matching requirement would be exceedingly difficult for the S tate 

schools to meet. A figure of 15 percent would be far more rea listic and consistent with the contribution schools of public health make to the natio nal health.

SCHOOL S ARE NA TION AL AN D INTE RN AT IO NA L

May I close by repeating the observation th at our schools of public health, 

State supported and private, are in the broadest sense of the words truly nation al 

and inte rnational. Their service to the country and to the world, the need for 

maintaining sta ndard s of education of which the Nation can be proud, make it 

essential that legislation be enacted to provide these urgently needed educational 

facilities.

The Chairman. Dr. Leavell, you may proceed.

Dr. Leavell. Thank you. sir. This committee, as all of us are very 

well aware, has been extremely helpful and understanding of the 

special problems of the schools of public health, and we appreciate 

vour calling particular attention to Mr. Rhodes’ interest, because he 

has made a special point of studying our problems. We want to say 

at the outset that as public health people we are very interested in all 

of the provisions of this bill. We are concerned that the Nation have 

a sufficient number of doctors, both of medicine and osteopathy and 

dentists, and this is a matter with which every public health man takes 

great concern.

For example, when the Congo incident came up a year and a half 

or so ago you may be aware that Russia offered to send several 

thousand doctors to the Congo. It is fortunate that we did not, we 

would not have been able to send them. We are in the doctor importation business. Some of you may have seen a television program 

on a national hookup which showed the Cambridge, Mass., city hospital. The doctor who was sort of center of the scene was a foreign 

doctor. We were not able to get sufficient numbers of American doctors and he reported on this national television that he was working 

120 hours a week to care for the patients in this hospital. So you can 

see that we have an interest in this as public health people.
292 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

We s hould like to po int out several major po ints . One, th at pu blic 

healt h is different f rom the g ene ral pra ctice of medicine or d entistry . 

Second, that th e schools of pub lic healt h have certain pa rticul ar pr ob ­

lems th at are ra th er peculiar to them. Th is com mittee is familiar to 

a conside rable degree with th is; th at there is a need fo r addition al 

trai ni ng o f pub lic hea lth people. I shall commen t abo ut some i nf or ­

ma tion that ou r schools gathe red for the Bu rea u of the Budget this 

pa st December, and the n Dr. Stebbins cou ld speak about the pri vate 

schools, of which we have six in the cou ntry, and Dr. We gman abo ut 

the State schools, of which we also have six.

We find, in tal king with people about pub lic h ealth , th at the subject 

is not well und erstood and it is more fo r the rec ord th at we now 

speak tha n for this committee, because we do believe th at the members 

of this comm ittee un de rst an d ou r problems.

You have had some discussion about how lon g it tak es to prepare 

an o rd inary doctor. Well, add 2 or 3 yea rs to th at fo r a public health 

doctor and you have a to tal of about 15 ye ars fo r a public he alt h man 

to pr ep are himself to work as a specialist in m edicine.

Our work is p ost-postgraduate. We sho uld also p oint out t ha t our 

schools tra in not only phy sicians bu t also nurses, he alth edu cators, 

and th e whole p ublic he alth team th at works in t he com munity env iro nment.

An oth er difference is th at essentially all of ou r grad ua tes are Government serv ants. We are in a way very much like the Arm ed Forces 

academy.

Our people are concerned with working at the org anized community level, w orking with gro ups of people r at he r tha n wi th individuals, 

being fam ilv d octor to the comm unity.

We are concerned essent ially to the gre ate st degree th at we can be 

with preven tion . As an example, one of ou r com munities in Massachu setts has set up a glaucoma detection prog ram . About 2 percen t 

of the people over 40 have glauc oma, which is an increased pressure 

within the eyeball. We have estimat ed th at if the Mem bers o f Congres s were in thi s respect like the rest of the p opula tion th at pr obabl y 

the re would be 10 Congressmen with glaucoma at th is time. We are 

sure th at the re are none with myopia, which is n earsightedne ss.

We also have the inter natio nal problem where about 25 percent of 

our total stu dents come to us from fore ign cou ntries to be tra ined , 

and we also are trai ni ng peo ple from t his country t o go out and work 

in int ern ational hea lth. One of Dr. Ste bbins’ associates who is h ere 

tod ay has jus t ret urned from fi years of doing a very sple ndid job 

of l>eing responsible for ou r tech nica l assistance program in India , 

Dr. Jo hn Hum e. We have to meet the new problem s th at arise, 

the accidents, the rad iat ion hazards, the ai r pollution th at is getting 

worse instead of be tte r, the inc rea sing pollution of wa ter, and all of 

these new things .

Now, why is it th at our schools of p ublic he alth h ave special financial prob lems?
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 293

Most of our work must be given in a single year, and we have all of these different disciplines—medicine, nursing, social work, engineering, education, and so forth, to bring in. We also have the students 

with these different backgrounds and people coming from different 

countries, which means that we must do our teaching in a very concentrated way, unfortunately an expensive wav, but we lielieve that it 

is valuable.

Our State universities, and Dr. Wegman will go into this, are 

having heavy calls upon them with our 12 schools of public health. 

We find that only about 25 percent or so of the graduates will work 

in the State where they are trained. Private foundations which 

used to be very helpful have said that most of your people are Government workers, you must go to Government, we helped you to get a 

start 40 years ago, now we cannot do this any more.

Our graduates are not in high-earning positions and we are not 

able actually to count on much in the way of alumni contributions.

In 1958, a conference was held, called by the Surgeon General, to 

examine the need for training in public health. They found at that 

time th at there were 22,500 people now working in public health who 

needed training at the graduate level and if we took and looked into 

the immediate future there would be probably 6,000 more, making 

more than 28,000. Not all of these would need to go to schools of 

public health, but the leaders do need to go to those schools.

We have estimated that if the construction portions which do apply 

to the schools of public health in this bill were carried out we could 

increase our present enrollment from 1,200 to 30 to 50 percent more 

than that. The Public Health Service lias estimated tha t to provide 

funds for construction for the existing schools some $34 million would 

be needed. If there should lx1

 three new schools, which perhaps would 

be the appropriate number, $18 million more would be required for 

them.

Last December, as we pointed out, the Bureau of the Budget inquired into the whole matter of Federal assistance of various kinds 

to the schools of public health. We asked each of our members to 

look at their situation and see what they thought would be possible 

for them in the way of matching funds for educational training facilities construction. We think we can perhaps continue to meet the 

50-percent matching on research facilities, because industry and others 

are interested in that. We are quite convinced tha t we cannot meet 

this percentage for teaching facilities, and most of the schools feel 

tha t probably 15 percent would be about as much as they could meet. 

So that the idea of some special treatment for schools of public health 

is one which we feel we need to present here. We are not ashamed 

of this any more than the people responsible for the Armed Forces 

academies would say that we are training Government servants, we 

must ask for special treatment. We feel we would be derelict in not 

asking for special treatment. We think the country needs more public 

health people, they are there waiting to be trained and we would like 

to do the joo of training them.
294 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

I should like to just call to yo ur attention one commen t which the 

Sur geo n General made when we likened our sit uatio n, when we 

bro ugh t our special needs to him , Surg eon Gen eral Ter ry said, and I 

hes itate to get thi s in the record, hut he like ned the sit ua tio n of the 

schools of public health to the regional prim ate cen ters to be estab ­

lished to care for monkeys used for research. As he pu ts i t :

Federal Government needs both the primate cente rs and public health schools 

to serve regionally and nationally, ami not locally. Under these circum stances 

the expectation of large local support is not realistic.

I would like also to quo te from the Pr esiden t's Science Adv isory 

Com mittee Pan el on Basic Research in Gradu ate Educati on which 

said:

Obviously when the Government has a particu lar interest in a particu larly expensive installation of more than local importance, it must expect to meet all 

or nearly all of the cost of undertak ing. There may also be oth er circum stances 

in which a particularly good opportunity for progress would be lost if matching were insisted on, and we believe tha t unmatched gra nts should be used in 

such cases.

We are not asking, sir , fo r unm atched gran ts. We certainl y wan t 

to do our pa rt to the extent th at we can, hut we do believe that we 

need special trea tm ent here.

I think perha ps now if Dr. Stebbins could speak, pa rti cu larly for 

the private schools, and Dr. W egman for th e State schools.

STATEMENT OF DR. ERNEST L. STEBBINS, DEAN, SCHOOL OF

HYGIE NE AND PUB LIC HEA LTH OF TH E JOH NS HOPKINS

UN IVE RSITY

Dr. Stebbins. I appre cia te the op po rtu nity to present the problems 

of the priva te health schools of the cou ntry. As you pointed out, I 

am dean of one of these schools, the Jo hn s Ho pk ins Un ivers ity School 

of Pub lic He alth. Prior to that time I was first a cou nty hea lth 

officer, then an assis tan t St ate health officer, an d finally I was health 

officer o f the city of New York. T mention th is merely because I 

know from thi s experience the great difficulty th at our hea lth officers 

have in pro vid ing the services that are n ecessary with the inadeq uate 

number of tra ined public health personnel ava ilab le.

We in the schools of public health are atte m pt in g as 'best we can 

to J irovide these tra ine d pub lic health wor kers. I will speak partic ularly of the six pri vate schools which are located in Columb ia, 

H ar vard, Jo hn s Ho pkins , Pitts bu rgh, Tu lan e, and Yale Universities.

These pri vate universities derive th eir income and support pri ­

mari ly from endowment and thi s has been supplemented in rece nt 

yea rs by research and teaching gr an ts from foundations and in recent yea rs by teaching gr an ts from the Fe deral Governme nt which 

this committee recom mended, and is b ein g pro vid ed to all the schools 

of public health.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 295

As has l>een pointed out, our students come from every State in 

the Union. They come in our own institutions over the years from 

as many as 88 foreign countries. A large proportion of our students 

come from the U.S. Public Health Service, the Army, Navy, and Air 

Force. At the present time, in my own institution between fiO and 

70 percent of our students are from these Federal institutions, or 

federally sponsored.

fhe Public Health Service, as you know, has lieen administering a 

program of traineeships in public health, authorized by the Congress. 

I am informed by the administrators of this program that they have 

more than twice as many qualified applicants as our present funds 

will provide for, indicating tha t there is need for greater teaching 

facilities if we are to train all of the applicants that would like to go 

to a school of public health—qualified applicants.

We are greatly encouraged by the introduction of H.R. 4999, which 

is another indication on the part of Congress of the recognition of the 

problems and the needs for trained public health personnel. We 

strongly approve of this bill, and we want to urge its very serious consideration. We are particularly concerned with the problems of the 

provision of funds for construction for teaching facilities because all 

of the private schools, as I believe all of the schools of public health, 

are extremely limited in their physical facilities. This means that we 

cannot maintain as high a standard of training as is desirable. It also 

means that we are limited in the number of students that can be admitted. A questionnaire sent out to all of the private schools came 

back with almost uniform answers, that there is extreme crowding of 

their present students and the faculty of every one of the schools. 

There is pointed out in every instance that increasing enrollment was 

an impossibility without increased teaching facilities. Many of the 

schools have 50 percent or more students than can be accommodated in 

their major teaching laboratories or in their main lecture halls. Many 

of the schools are very definitely limited in the number of students 

that they can admit and this is largely because of inadequate teaching 

space.

In the past, private schools have received very considerable help 

from foundations interested in public health, notably the Rockefeller 

Foundation, the Commonwealth Fund, and Kellogg Foundation.

In recent years this foundation support has been markedly decreased. About a year ago the presidents of three of the private universities, and the deans of their schools of public health, asked for the 

opportunity to present this problem to the head of a very large foundation. The head of the foundation informed the presidents that they 

were not primarily concerned with training in public health, they 

would be glad to have them come, but would they come for lunch, so 

that they would at least get something from the meeting, and that is 

exactly what they got out of the tr ip : a good lunch and nothing more.
296 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Recently a very large industry that professes great interest in public 

health was approached by one of the private schools of public health 

with a rather elaborate presentation of needs for future expansion of 

teaching facilities, an expenditure in the range of $C> million. The 

industry expressed great interest and said th at they would like to support this activity and a check for $5,000 was received.

Another possible source of funds for the p rivate universities is the 

contributions from alumni. As Dr. Leavell has pointed out, our 

alumni are almost exclusively public servants receiving relatively small 

salaries, and they are not in a position to contribute largely to thp 

schools of public health.

I would just like to give you a little personal incident. Just 2 weeks 

aco there was a meeting of the Johns Hopkins School of Public 

Health alumni in Tokvo, and each one of the members of that alumni 

association contributed what to him was a rath er significant sum; 

3,500 yen. There were 10 alumni, 35,000 yen. When that arrived in 

TT.S. dollars it was $94.50.

T would like to also point out, as has been mentioned bv Dr. 

Leavell, that the schools of public health are in many respects like the 

military academies. The military academies train the personnel to 

defend this Nation against aggression from outside. We in the 

schools of public health trian personnel for the defense of this Nation 

against disease and disability. Although we do not in any realistic 

way have assurance we can match dollar for dollar Federal money 

for teaching facilities, we do believe that we can raise private funds, 

perhaps 15 to 20 percent of the cost of our needed facilities. We hope 

tha t you will give serious consideration to a formula that will take 

these needs and the role of the schools of public health into consideration.

Thank you, sir.

The Chairman. Thank you, Doctor Stebbins.

STATEMENT OF DR. MYRON E. WEGMAN. DEAN OF THE SCHOOL 

OF PUBLIC HEALTH. UNIVERSITY OF MICHIGAN

Dr. Weoman. Mr. Chairman, I am Myron E. Wegman. T wish 

first to thank Nfr. Dingell sincerely for the very kind words he said 

about me. T might add only tha t after direct experience in county, 

city, and State health departments, my international experience gave 

me a chance to see problems of professional education in public health 

in many parts of the world, notably in L atin America. In those parts 

of the world the general tendency is for all of the schools to be 

State schools. Here in the United States ha lf of the schools are State 

schools. These are, as listed in my statement, the two in California— 

Los Angeles and at Berkeley, the University of Minnesota, the University of North Carolina, the University of Puerto Rico, and the University of Michigan. These schools have certain problems which are 

given in more detail in my statement and which I think can be typified by those at the University of Michigan. The State of Michigan 

on the whole, I think, has been very generous in terms of higher education. Our university is not satisfied with our allocation from the
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 297

State legislature, but we recognize that the legislature now supports 

nine State universities. All these schools and colleges in the State 

universities naturally tend to serve first citizens of the State of Michigan, and this is true in the other State schools as well. On the other 

hand, the school of public health is unique among the colleges and 

universities in tha t 75 percent of our student body are from out of 

State. The State legislature finds it a little difficult to contemplate 

large increases in appropriations for a school which is serving much 

more on a national basis than the other schools and colleges of the 

university.

A similar observation might be made in regard to our foreign enrollment. We are one of the smallest schools on the campus of the University of Michigan, yet we have the highest proportion of foreign students of any of the schools on the campus. Again, there is question 

about the responsibility of the State for the education of people from 

abroad and the underlying support for them. An interesting fact to 

me in the time I have been at the U niversity of Michigan is evidence 

of the support from the university administration despite the fact 

that we are serving so many out-of-State students. Despite the fact 

that the school is one of the smaller schools, the interest of the president, vice president, and the administrative officers in helping the 

school of public health has been very heartening. I might say that 

our university administration is strongly interested in and support 

all pa rts of this bill, which is before you now.

One of the phases of public health education which interests our 

school particularly is that having to do with continuing education. 

Dr. Leavell has pointed out the number of persons who are lacking in basic formal preparation for the profession of public health. 

We have tried over the years to develop an extensive program of continuing education with courses for such persons as public health administrators, water plant operators, public health nurses, statisticians, 

nutritionists, all of the various disciplines of public health. We have 

recently had one for dental public health administrators. We are 

having one within 2 weeks on hospital safety, in collaboration with 

our hospital and medical school.

These are short courses designed to keep the persons who are in 

the practice of public health up to date. We find considerable difficulty in carrying this program out a t present within our facilities because every classroom is used practically all the time. It means moving people out, using space not designed for classes in order to accommodate this part of the work th at I believe has great importance and 

holds great promise.

I should like to cite illustrations from two or three of the other 

schools to support the argument with regard to space. First, the 

University of California opened a new building for public health, 

some 3 years ago. They already are so crowded tha t they are in 

rented space outside of the school of public health for a large part 

of their training program. The University of North Carolina is finishing a new building for the school of puolic health right now, and

8 0 0 1 4 -6 2 - 20
29S TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

they know that they are going to be crowded before they get into it, 

that they have to maintain some of their older and unsuitable space.

Finally, an illustration of importance is the University of Puerto 

Rico. This university is unique among the schools of public health 

in that it carries on its instruction in Spanish. This is because it 

recognizes that one of its major functions is not only to train the public 

health workers of Puerto Rico, but to reach out to Latin America as 

an im portant bridge in the international program of the educational 

institutions of this country.

More than half of the students at the University of Puerto Rico 

come from Latin America, yet they are in very seriously crowded and 

inadequate quarters. I submit tha t it gives anything but. a good impression to students from abroad who are coming to the United States 

for training to go back, having had more crowded study conditions 

than had they gone perhaps to the University of Chile or University 

of Sao Paulo.

T would underwrite, sir. what Dr. Leavell said about matching with 

regard to our own State university. There are problems in regard to 

a 50-percent formula. A far more reasonable figure for us, and one 

that I think we can meet, is a matching figure of 15 percent on the 

instructional program. T think most of the other points that I had 

in my statement have already been covered, Mr. Chairman, and I shall 

not take more of your time at this time other than to repeat 1 think in this case the State schools are national and international schools.

Thank you, Mr. Chairman.

The Chairman. Thank you very much. Doctor. We are very glad 

to have these statements on liehalf of each of you.

Mr. Macdonald, do you have any questions ?

Mr. Macdonald. I do not have any questions. I have one short 

observation. The Massachusetts delegation in Congress, Speaker 

McCormack, and members of the Rules Committee and myself, had 

the great privilege of visiting the School of Public Health at Harvard, 

and although we have all been familiar with it. I think that none of 

us had personally seen it in action. T would suggest tha t we adopt 

the same forwardlooking program tha t the Harvard school did. I 

think it was a great eve opener. I can only say that you have understated your case rather than overstated it, especially in the field of international relations in Latin America. I want to compliment all 

of von on your statements today.

The Chairman. Mr. Younger.

Mr. Y ounger. T want to add mv compliment to the three papers on 

the subject. We in California believe in these schools, as evidenced bv 

the fact that we have 2 of the 12 schools in our State. I think they 

have been rather well supported by the State. T have no question but 

what they could raise the matching funds.

That is all, Mr. Chairman.

The Chairman. Mr. Dingell ?

Mr. Dingell. Yes, Mr. Chairman. Thank you very much.

I am interested in the testimony you gentlemen have given today. 

There are several points T would like to go over with you, if I might.

First of all, as regards cost, would you say that* the schools of
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 299

public health are high- or low-cost institutions of learning as related, 

let us say, to other institutions; that is, other institutions for teaching 

of medical, and so forth, subjects?

Dr. Leavell. I would say they are high cost, probably more expensive than most of the other schools of the university.

Mr. Dingell. Would you be able to give us an idea of the cost per 

student in a school of public health as opposed to an ordinary school 

of medicine ?

Dr. Leavell. There is some variation among the schools. The average would be close to $5,000 per student per year.

Mr. Dingell. Would it run above or below th at in some other institutions?

Dr. Leavell. It would be above the medical schools generally; yes.

Mr. Dingell. Now, that would be true in regard to medical school. 

Now, how about with regard to the schools o f public health? How 

much per student does it cost to operate them ?

Dr. Leavell. This was the $5,000 figure.

Mr. Dingell. How about medical schools ? Would they run above 

or below that ?

Dr. Leavell. They would run below that.

Mr. Dingell. Wha t is your tuition per student, roughly, in schools 

of public health?

Dr. Leavell. It varies from school to school. I think the maximum 

is about $1,500. In some of the State schools—what is your tuition ?

Dr. Wegman. Our in-State tuition is $550 and out of State is 

$1,050. I think the University of California has about the lowest 

tuition of the group. I think they are down in the neighborhood of 

$400, or $450, but that is the minimum.

Mr. Dingell. You run a very substantial deficit per student.

Dr. Wegman. Yes, sir.

Mr. Dingell. Could you give us an idea, roughly, of what that is?

Dr. Leavell. The question of whether you take the deficit, the d ifference between the amount of tuition and the actual cost of training 

the student, we have computed this from time to time and the tuition 

comes to something like 11 to 13 percent of the total cost.

Mr. Dingell. The balance of this, you indicated, comes from endowment appropriations from the States, Federal assistance, and so 

forth.

Dr. Leavell. Grants from industries, and so on.

Mr. Dingell. You gentlemen alluded to the "Rhodes bill. T am sure 

it was very helpful. But, obviously, you have found some shortcomings and deficiencies in it with regard to the schools you speak for 

today.

Would you want to elucidate on that ?

Dr. Leavell. I am sure that every one of our deans would say that 

this was an absolute lifesaving measure. You will recall tha t this 

committee changed the authorization at the last session of this Congress from the original $1 million per year to be divided among the 

schools to an authorization of $ 2^ million per year.

Mr. Dingell. This is limited to research, though, is it not ?

Dr. Leavell. No : this is teaching.
300 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Mr. Dingell. It does not go to resea rch ?

Dr. L eavell. It does not go to research.

Mr. Dingell. How does this do with reg ard to the needs of the 

school? Obv iously, if the re is no need with rega rd to schools, then 

there is no need to have schools of pub lic health included in TI.R. 4999. 

I would lik e to have your comment on tha t.

Dr. Leavell. The schools of public hea lth, we should say, are inclu ded in H.R. 4999 only on the co nstruction p art. No fund s fo r fel ­

low ships are inclu ded in H .R. 4999.

Mr. D ingell. Th ere are no fellowship funds in H .R. 4999?

Dr . Leavell. Not fo r schools of public hea lth. Tha t is handle d by 

a different act. So th at o ur pers onal intere st in H.R. 4999 as schools 

is in th e co nstruction phase.

Mr. Dingell. You get your opera tin g and tea ching money under 

the Rhodes Act, and, of course, you come in un de r the Researc h and 

Fa cility Act.

Dr. L eavell. Yes.

Dr. W egman. I might in terrup t to supplement th is by Saying th at 

it is th is very experien ce we hav e had with the tra ineeships un der the 

Pu blic He alth Service Act tha t has made us feel th at the idea of suppo rt for s tud ents in thi s kind of work is an e xceedingly helpf ul one in 

ge tti ng better stu den ts and ge tting them along.

Mr. Dingell. You also ind icated to us th at a substan tia l num ber 

of yo ur stu dents are foreig n studen ts. Could you give us an idea of 

the numb er of foreign stu dents who come from this country ?

Dr. Leavell. About 25 pe rce nt of the total are foreig n studen ts.

Mr. Dinge ll. W ha t per cent of vo ur studen ts are gov enm ental stu ­

den ts in the sense t hat the y would be, let us say, sent to yo ur schools as 

a part of the Governm ent trai ni ng pro gra m, eit he r by the Fed eral 

Government or by State or local governm ent ?

Dr. Leavell. Th is va ries some from school to school.

Dr. Stebbins?

Dr. Stebb ins. We have between GO and 70 percent th at a re federally 

spo nsored stud ents.

Mr. Dinge ll. Ar e ac tua lly federally sponsored studen ts?

Dr. Stebbins. From the Publi c He alth Service, Army , Nav y, Ai r 

Force , and A ID fellows hip tr ai ni ng prog ram .

Mr. Dinge ll. Wo uld this be more or less unifo rm throug ho ut the 

coun try ?

Dr. L eavell. Th at would be tru e. Pe rhaps a little more in some of 

the schools.

Dr. Wegman. I might cite a figure : In terms of tuition income, 

rou ghly a l ittle less tha n one-sixth of the tuition th at we received last 

year for students in the school of pub lic health was paid by the stu ­

dents themselves. The rest was pa id by variou s gov ernmental agencies and o ther sponsors.

Mr. Dingell. Now, when the Fe deral Government sends a studen t 

to the school of pu blic health, and th is is spe aki ng only to the general 

thing, do they furnish the full cost of trai ni ng of the stu de nt or do they 

pa y only the r eg ular tui tio n ?

Dr . L eavell. Th e re gu lar tuit ion .
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 301

Mr. Dingell. Which leaves the school of public health with a substantial deficit to recover from its own resources, either from the p rivate endowment in the case of private school or from the legislature 

and other sources in the case of public institutions.

Dr. Leavell. It was to meet this need that the Rhodes Act was 

established.

Dr. Stebbins. It is established that the distribution of the funds 

appropriated under the Rhodes Act shall be distributed to the schools 

in proportion to the federally sponsored students they have enrolled.

Mr. Dingell. I wanted to bring out the Federal and the public interest. Just briefly for the record, would you give the committee a 

little bit of an insight into the nature of the problems tha t public 

health schools train people to face; for example, outbreaks of hepatitis, 

water pollution, and things of that sort? Could you do that for us?

Dr. Stebbins. We will lie glad to do that.

Mr. Collier. To get this business of public health firmly in the mind 

of the layman, as I understand it, actually you deal with community 

health rather than with the health of the individual, as such: is that 

right ?

Dr. Leavell. Yes.

Mr. Collier. In speaking of students that come to the various public 

health schools, is it not true that in addition to the funds that are paid 

under various programs in the I ’.S. Public Health Service, there are 

many local jurisdictions that pay fees to their health officers for advanced training? In fact, do not many of these continue to receive 

their salaries while they are getting this advanced training?

Dr. Leavell. Not many. There are certainly some, and this number has been reasonably constant over the years. It is a relatively 

small proportion of the total.

Mr. Collier. In speaking of the 3 additional years to which you 

refer, Doctor, is it not true th at a very high percentage of those getting 

the additional training, afte r they once have become a public health 

officer in some phase of public health, that they are in fact employed 

while they get this additional training?

Dr. Leavell. They, of course, are not employed while they are in 

the school, although there are a few local departments and State 

departments that continue their salaries. Mostly they go on to a 

training stipend which is at a lower level.

It certainly is true that if they take a public health residency, training on the job a fter the school of public health is over, they will get 

a salary which will usually be at, again, something like five or six or 

seven thousand dollars a year, perhaps as a resident. This is about a 

2-year program afte r the school of public health is completed while 

they are preparing themselves for certification as a specialist in public 

health. This applies only to the physicians.

Mr. Collier. So, actually, they do not have any acute financial 

problem if they are getting six to seven thousand dollars a year.

Dr. Leavell. Tha t is true, but you must bear in mind our average 

student is 34 years old and he has a family, so this is not a munificent 

sort of thing for a man who has had 15 years of training , or 13 

years, up to this point.
302 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Dr. Wegman. Is it not (rue that that figure would apply to physicians? It would not apply to the other students.

In our own school, for example, we have a relatively smaller proportion of our students who are physicians, hut among the engineers, 

nurses, statisticians, and others the training stipend is $200 or $250 

a month.

Mr. Collier. Now you are geting in the very area I was leading 

into. We are getting into the training of sanitarians who are in fact 

not doctors, as such, nor medical students.

I)r. Wegman. They are not medical students: no, sir.

Mr. Collier. Yet, we are embracing these in this program. We are 

talking about nurses gettin g advanced public health, a woman who 

may be a registered nurse but who now is moving into the field of 

public health and therefore needs public health training. We are 

getting into an area where we are talking now about people who deal 

with water sanitation on a broad scale.

We were talking earlier about this business of this Nation being 

an exporter and importer of doctors.

I put this not in the light of what need may exist because of conditions around the world today as they are in all of the many, many 

backward nations, but have we not actually become an exporter of 

public health doctors by comparison to what our status was 20 years 

ago with the number of public health doctors who were trained here 

and abroad?

Dr. Leavell. Dr. Wegman has been with the World Health Organization. I think he ought to speak about this.

Dr. Wegman. I am not quite sure I understand the question clearly, 

Mr. Collier. I would say this: that there are relatively few U.S. 

citizens who are trained in public health who are working abroad 

other than in the programs of the AID or very few in the World 

Health Organization. But there are relatively larger numbers of 

students from other countries who have received their training here, 

citizens from other countries.

If you mean exporters in the sense that we have brought people 

in and exported the training, I would agree. But as far as exporting 

our own citizens to work abroad, this is true only to the extent that 

they have been used as advisers on a temporary basis.

Mr. Collier. Well, to clarify it in my own mind, I would like to 

see some figures on the number of public health personnel and 

doctors tha t we exported, so to speak, 20 years ago as compared to 

what it is today.

Dr. Leavell. Exclusive of missionaries, it is estimated that there 

were probably fewer than 25 people, officers of the U.S. Government, 

who were engaged in international public health in 1940.

When the Institute of Inter-American A flail’s got underway in 

about 1942-43, Campbell estimates that there were about 150 employed, being assigned to the Latin American countries, the largest 

group of about 70 being assigned to Brazil.

Dr. Campbell estimates that there are now some 600 health personnel (by no means all physicians) overseas with the AID agency plus 

the Public Health Service.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 303

Mr. Collier. I have just one other question. It may be a difficult 

one to answer specifically but it would seem to me tha t we are going 

to have some limitation in establishing the program as embraced in 

the legislation before us. Therefore, I question seriously whether 

we could project the best possible program in the field to cover public 

health based upon the need of public health personnel abroad. In 

other words, I think you gentlemen would be the first to agree that 

the problems of public health abroad are so completely vast that we 

could never hope as a nation to meet these. Therefore, it would 

just seem feasible that there will be some limitation as to what percentage of the public health people that we train here should be 

trained with the thought of sending them abroad.

Dr. Leavell. If I gave the impression that we were advocating 

sending large numbers of people abroad, I was in error there. I did 

use the illustration of the Congo and compared this to the situation 

that we now currently are importing some 7,000 or more foreign 

doctors to run our own medical care services in this country and compared this to the Russian situation where they actually were in a 

position to make available a couple of thousand doctors to the Congo 

if they had asked for this.

I do not think we should send a couple of thousand to the Congo 

hut we are in a quite different situation than that.

Mr. Collier. I may be pleading some ignorance with this next 

question. To what extent is internship in the broad trainee program 

of this type of physician required in equipping a public health doctor 

for an assignment?

I)r. Leavell. I would say from my own experience tha t there are 

very few public health men that. I have had contact with that did not 

have an internship or residency. They felt very much at a loss. I had 

one as my assistant when I was a local health officer who had gone in 

without this. After 10 years he said, “I just am not able to talk on an 

equality with the other doctors in the community. I am going to stop 

and take an internship,” which he did.

We would say it would be very foolish for a man to go into public 

health work without that.

Dr. Wegman. I can underwrite this in terms of specifics since 1 

review all the applications for admission to our school. 1 have yet to 

see a medical applicant for the school who has not had an internship.

Mr. Collier. IIow many public health people who go through 

public health training and who in some instances have a public health 

assignment later go into private practice ?

Dr. Leavell. We do not have any figures, I am pretty sure, on that. 

I would say a smaller number recently than in the past. I would 

not say a large number.

We could try to get some figures on this. Would you think there was 

a large number ?

Dr. Stebbins. No. We follow all of our graduates. This is a guess, 

hut it would not lie more than 3 or 4 percent of the graduates that go 

into private practice after having had their training in public health.

Dr. Leavell. We did make a check on this, on all of the schools a 

few years ago with the cooperation of the Public Health Service.
304 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

We found at that time, I believe, that there were only 7 percent of 

the graduates who had gone into some kind of industry or private 

practice of one kind or another.

Mr. Collier. One final question. In view of the direction of this 

legislation, where would we stop in attempting to provide within this 

program assistance for every phase and type of public health personnel, or should this be restricted in line with the basic subject matter 

of the legislation, public health personnel that are directly in the field 

of medicine, as such, or as public health doctors ?

Dr. Leavell. The legislation, as it is now written, relates to graduate public health training which we interpret to mean essentially the 

kind of training t hat is given in the schools of public health where a 

person would get a master’s degree. This is certainly only a fraction 

of the people in public health. It is a significant fraction because 

it contains, we believe, most of the leaders in public health, the nurses 

who come to our schools are the ones who are going to be head of a 

State service or head of a school of nursing or something of that kind.

The engineers are going to have very responsible posit ions.

There are a small number of sanitarians, but they are going to be 

supervising other people. They are not run-of-the-mine people who 

are trained in public health.

You could put it, in brief, it is mostly chiefs and not very many 

Indians that we train , but we think that these are the people that 

communities must look to for guidance and that we must have these 

people.

Obviously, we do not try to train the whole 28,000 people tha t this 

conference we cited pointed up.

Mr. Collier. Then we must assume that within this legislation we 

will also be embracing the cost in case of scholarships or loans for 

those attending public health schools?

Dr. Wegmax. That is not within this legislation.

Mr. Collier. Would this be part of the overall proposal or would 

this be restricted as you say ?

Dr. Leavell. These people mostly have got to be financed some way 

if they are to take the training and the Federal Government is doing 

this to a very considerable degree at present. Either through the 

Armed Forces or the Public Health Service or grants to foreign 

people to come here for training or grants to some promising young 

fellow who just wants to go into public health and State and local 

people.

Mr. Coijjer. The States now in many instances do, however, finance 

the training for the sanitarians, the sanitary engineer, the public 

health nurse?

Dr. Wegmax. And public health physicians. All of these, sir. 

you understand, are all graduate students. We admit no one to a 

school of public health who does not already have some degree.

Mr. Collier. I understand. I have looked at the bulletins of help 

wanted for public health doctors in various counties and so on, and I 

generally know what the basic requirements are.

I was curious about this, because it is such a broad field that extends 

beyond the doctor or the medical field, that I just pursued this line of 

questioning.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 305

Tha nk you v ery much, Mr. C hai rman.

Th e Chairman. Mr. Ke ith ?

Mr. K eith . It would seem to me tha t the pub lic healt h personnel 

would have tremendo us resp ons ibilities in the event of a catas tro phic 

war. Have a ny of your schools t ha t you know of con ducted any stu dy 

with refe rence to the civil defense req uirements as they pe rta in to 

public h ealth ?

Dr. L eaveijl. Yes, sir, I am sure th at all of the schools are concerned 

wi th this in differen t ways, inc lud ing th is in th eir ins tru ctions, working on committees with the State health people or the local health 

people whe rever they are opera ting. Th is certa inly is a realm th at 

pub lic health people would feel was their respo nsibility.

Mr. Keith . Do you have many Arm y officers who pa rti cipa te by 

quo ta in pub lic healt h schools th at you know of?

I)r. L eavell. Com ing to schools as stud en ts?

Mr. Keith . Yes.

Dr. Leavell. Yes, and both Hopkins and H ar va rd have had fo r 

man y y ears now a dozen or so A ir Force peop le each year.

Th is is a reg ular p art of their tra ining fo r medical people, one of a 

3-y ear program , to send them to schools of public h ealth.

Ca lifornia is ha vin g them now.

Dr. W egman. We have A ir Force people, too.

Mr. K eith . W ha t about the oth er branches ?

Dr . Leavell. Army and Na vy as well.

Mr. K eith . Th an k you very much.

Th e Chairman. Th an k you very much, gentlem en. We appre cia te 

yo ur testimo ny and prese nta tion on behalf of the schools of public 

health.

Dr. Leavell. Th an k you, sir.

Th e Chairma n. We sha ll now have Mr. Jo hn S. Millis, president 

of Western Reserve Un iversit y and a member of the Commission on 

Federal Relations o f the Am erican Council on Ed ucati on , Clevela nd, 

Ohio.

We welcome you to this he aring and we shall be gla d to have y our 

statem ent.

STATEMENT OF JOHN S. MILLIS. PRESIDENT, WESTERN RESERVE

UNIVERSITY, CLEVELAND. OHIO. ON BEHALF OF THE AMERICAN

COUNCIL ON EDUCATION

Mr. Millis. I am here on beh alf of the Commission on Federal 

Relatio ns of the Am eric an Council on Ed uc ation. Th is council includ es in its membersh ip 145 educational org aniza tio ns and 1,079 

educational ins titu tions, a mong which are all of the universities which 

are operat ing schools of medicine and d entistry .

I have, sir, presented a writte n piece of testim ony which I ask to 

lie included in the record.

In ord er to save your tim e I should like sim ply to comment on the 

major points.
306 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Th e Chairman. It may be inclu ded in the record a t this point.

(T he pr ep ared sta tem ent r efe rre d to foll ow s:)

Statement of J ohn S. Millis, President, Western Reserve University, 

Cleveland, Ohio

Mr. Chairm an and members of the committee, I am John S. Millis, president of 

Western Reserve University. I am appearing as a represe ntative of the Commission on Fe deral Relations of the American Council on Education. The council 

includes in its membership 145 educational organizations and 1,079 educational 

institutions. Among the institutions belonging to the council are all those 

accredited universities which have schools of medicine and dentistry.

The American Council on Education wishes to sta te its strong support of the 

proposed Health Professions Assistance Act, II.R. 4999, hut fur the r wishes to 

sta te the opinion that should it lie enacted by the Congress, it will constitute hut 

the first step in solving the complex and highly important problem of fu rnishing 

the members of the health professions th at are and will be required for health 

service to the American people.

We are concerned with the public welfare. Th at welfare is dependent upon our 

resources, both physical and human—resources of soil and its fertility, raw 

materials for our industrial complex, the ind ust rial plan ts and their efficiency, 

our citizens and their health. Of these resources, the health of our people is 

the greatest, and there fore the means by which th at health can be maintained 

and improved is of the utmost concern to our citizens and to their Government.

The Federal Government has alre ady made larg e contributions to the maintenance of health and the prevention of disease by substan tial financial support 

of health-related research. This support has taken the form of dire ct financial 

support of research workers through the large and varied programs of the National Institu tes of Health, and by matching gra nts to universities and other 

nonprofit organizatio ns for the construction and equipment of health -related 

research facilities. This sub stantial support of resea rch has led to many discoveries which have made vast improvements in both the trea tment and prevention of disease. Other and even more dra matic results will follow as the 

result of a large and vigorous research effort, on a national scale.

New knowledge is available and will continue to come in ever-increasing 

amounts in the future. But all the new knowledge in the world is of no value 

unless there are highly trained men to use it. We can know all about the cure 

and prevention of every known disease hut if there a re no physicians and dentists 

to use that knowledge in the care of patients, the health of our Nation will decline and people will suffer and die jus t as if the knowledge had never been 

discovered. Thus should H.R. 4999 he enacted, the Congress would take the 

logical and necessary step to make its program for the health of the Nation 

functional and more nearly complete.

The schools of medicine and dentistry of the United States are hard pressed 

to main tain both the qua ntity and quality of educational opportunities in the 

health professions. Many schools suffer from the handicaps of obsolete and 

inadequa te physical facilities. All suffer from inadequate financial support to 

meet the rising costs of the ir educational programs. It will take grea t efforts 

on the part of both public and independent institutions to maintain adequate 

educational opportunities for the present number of students. Yet, the United 

States must have much larg er numbers of physicians and dentists in the very 

near fut ure or the health care of our citizens will decline in quality and in 

availability. Any realistic estimate of the needs of our schools, if the.v are to 

educate more students, shows that a very substan tial source of financial suppo rt 

must be found in addition to the presen t priv ate and public sources. Most educators believe tha t such new support must involve th e participation of the Federal 

Government.

In order to educate more physicians and dentists, our schools require four 

things—larger and more a dequate physical facilities, increased operating funds, 

larger faculties, and more and better students. H.R. 4999 is concerned with all 

fou r of these needs.

We believe tha t the proposed program of matching Federal grants for the 

erection and equipment of new facilities for teach ing purposes and the renova-
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 307

tio n of e xi st in g fa ci lities will be of en or m ou s he lp in mak in g po ssible th e ac ce pt ­

an ce o f l ar ge en te ri ng clas se s of st udent phy si ca ns and de ntist s. We believe th a t 

th e en co ur ag em en t fo r en larg em en t of th e size of th e st udent bod y by th e mo re 

ad va nt ag eo us pr og ra m of m at ch ing g ra n ts on a 2 fo r 1 ba sis fo r thos e pr es en t 

sch oo ls pr op os ing to ac ce pt la rg er cl as se s is em in en tly sou nd.

Thi s po in t ne ed s p art ic u la r em ph as is. T he pr os pe ct of obta in in g an y su bsta n ti al in cr ea se in th e nu mbe r of ph ys ic ians an d denti st s by cre ati ng new 

sch oo ls is sli g h t F ir st , th e co st of be ginn in g a new school is ex trem el y hig h. 

Secondly, th e prob lem of re cr ui ting a fa cu lt y in a m ar ket alr ea dy high ly compe titive a nd w ith a no ne xi st en t supp ly o f ca ndid ate s is nea rl y inso luble. Thi rd ly , 

th er e a re ve ry few’ un iv er si ties now w ithout healt h scien ce sch oo ls which ha ve 

th e re so ur ce s— fina nc ial, hu man , an d phy si ca l— to under ta ke th e re sp on sibi lity 

of pr es en ting hi gh qu al ity ed uc at io n a t th e high level re qu ired . The re fo re , in 

my o pin ion , o ur b es t c ha nc e to m ak e a su bst anti al g ai n in th e nu m be r o f p hy sician s 

an d denti st s is to m ak e it po ssible fo r th e ex is ting sch oo ls to ac co mplish su bsta n ti a l ex pa ns io n. I t is fo r th is re as on th a t ev ery indu ce m en t sh ou ld be giv en 

th a t en co ur ag es an d mak es po ss ible p la n of ex pa ns ion.

We will hav e li tt le success in our ef fo rts to ed uc at e more phy si ci an s an d 

denti st s un le ss we ca n re cru it can did ate s from a la rg er se gm en t of our to ta l 

ixipulation. The co sts , bo th in mo ney and tim e, of ob ta in in g a pr of es sion al ed uca tion ha ve t>ecome so hig h th a t only th e sons an d dau ghte rs o f th e econ om ica lly 

mo st fo rt u n ate fa m ilie s ma y asp ir e to ca re er s in th e he al th scien ces. It is 

im pe ra tive th a t bold an d co ns truc tive st ep s be ta ken to pr ov id e fina nc ial ass is tan ce to les s fo rt u n ate yo un g peop le who se ta le nts an d de di ca tio n our society 

so rely needs. We feel th a t th e pr ov isio ns of II.R. 4999 to pr ov id e Fed er al fu nd s 

fo r scholarshi i>s a re ge ne ra lly soun d. The as si gn m en t of th e resp on sibi lity 

fo r decis ion as to whi ch st uden ts sh al l rece iv e th e sc hola rs hi ps up on a ba sis 

of need an d m er it, to th e school in whi ch th ey are en rolle d, is soun d policy. Th e 

fa cu ltie s an d officers of th e schools are in th e bes t po sitio n to m ak e such de cision s fo r th ey know th e st ude nts in tim at el y an d can be st ju dge th e m er its of 

ea ch in di vi du al cas e.

At th is po in t we wo uld pr es en t one cr itic ism . The max im um sc ho la rs hi p 

allo wed in th e II.R. 4999 is $2,090 j>er an nu m. The annual co sts of st ud yi ng 

in mo st sch oo ls is su bst anti all y in ex ce ss of th is figure . I wo uld su gg es t th a t 

a max im um o f $2,500 per an nu m w ould be mor e re ali st ic a nd w ou ld m ak e po ssible 

en tr ance in to scho ols of me dicin e an d denti st ry of an even la rg er gr ou p of 

prom isin g st ud en ts.

The th ir d re quir em en t of ev ery sch ool wh ich under ta kes to ac ce pt a la rg er 

st udent body is au gm en te d fu nd s fo r op er at io n. The scho ols are alr ea dy har d 

pressed to m ee t th eir curr ent bu dg ets. To undert ake th e co sts in ci den t to 

teac hi ng mor e st uden ts is vir tu all y inq>ossible in mo st cases. H.R. 4999 pro ­

vides a cost of ed uc at io n gra nt of $1,000 per an nu m fo r on e- fo ur th of th e nu m ­

be r of st udents en rolle d. Thi s fig ure is w’oef ully in ad eq ua te . The co st of ed uca ting a st udent fo r th e he al th pr of es sion s is of th e ord er of a t le ast $5,000 per 

ye ar . To pr ov id e ass is ta nce of on ly on e-f ifth of th is fig ure fo r on ly on e-fo ur th 

of th e st udents is unre al is ti c an d will in no w ay en co ur ag e our pre se nt schools 

to ex pa nd th e nu m be r of st ude nt s ad m itte d. I wo uld re sp ec tfully su gg es t th at 

a su bst anti al in cr ea se in th is fig ure is ne ed ed . I wo uld fu rt h e r su gg es t th a t 

th e co st of ed uc at io n gr an ts , bo th as to nu m be r an d am ou nt , sh ou ld be tie d to 

th e in te nt an d th e ac co mplish men t of th e sch oo ls in in cr ea si ng th e nu m be r of 

st uden ts in tr ain in g so th at a po sitiv e an d co nst ru ct iv e en co ur ag em en t can be 

giv en to th os e w’ho ac ce pt such en la rg ed re sp on sibi lities .

The fo urt h ne ce ss ar y ele ment in th e pr od uc tion of more phy si ci an s an d 

den tist s is th e prov ision of m ore hea lth sc ie ntist s fo r th e fa cu ltie s of o ur sch oo ls. 

The pr es en t nu m be r of suc h hea lth sc ie nti st s is in ad eq ua te . T her e are now 

va ca nc ie s on ev er y fa cult y j u st be ca us e th ere a re no ca ndid ate s to fill them . As 

pr es en t scho ols ex pa nd th eir st uden t bo die s, as new sch oo ls are be gu n, man y 

ad ditio na l te ac her s m us t be r ec ru ited . As th in gs now st an d, th ey m us t be ta ken 

fro m th eir pre se nt po sitio ns , leav ing m or e va ca nc ie s an d fu rt h er wea ke ni ng ou r 

cai>acity to do our pre se nt job . We m ust ac hi ev e a la rg e in cr ea se in th e n um be r 

of he al th sc ie nti st s an d mus t do so im m ed ia tely . T hi s is th e ke y log in th e ja m . 

We can ha ve pl en ty of fa ci lities , lo ts of st uden ts , an d enou gh money , b u t w ithou t 

mo re te ac he rs we will not pr od uc e any in cr ea se in th e nu m be r of gra duate 

ph ys ic ia ns an d de nt is ts .
308 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Health scientists are educated through and in research. Therefore we must 

enla rge and enhance our resources for research training. H.R. 4999 provides 

a positive and constructive step in this regard. The enlargement and extension 

of the program for facilities gra nts for health rela ted research, and the amendment to include research rela ted activities and specifically resea rch train ing, is 

an absolute must. We therefo re support most heartily this i>ortion of the act.

In conclusion, may I express my gratitu de to the chairman and to the members of the committee for the privilege of presentin g the views of the American 

Council on Education concerning H.R. 4999, the proposed Health Professions 

Educatio nal Assistance Act. May I furth er offer my cong ratulations to the 

cha irm an who has dra fted and presented this bill to the Congress which, if 

passed, will have imp orta nt and beneficial results in insuring adequ ate health 

care to the citizens of th e United States.

Mr. Millis. First, the American Council supports enthusiastically 

H.R. 4999 and believes it is extremely constructive. I think it can be 

viewed from one point of view which has not yet been stated; namely, 

tha t it is a logical extension of the interest which the Federal Government has already expressed and demonstrated in the health of the 

citizens of this country for, by the several pieces of legislation which 

have supported research in the health sciences, great progress has been 

made in our knowledge and in our skill in coping with disease and 

with its prevention

However, I would point out to you tha t with all the knowledge 

in the world, with all the skill in the world, unless there are men 

capable of using tha t in the practice of medicine and the care of 

patients, we have produced little, if anything.

Therefore, our No. 1 problem at this point is to provide a sufficient 

number of health personnel, to utilize the knowledge which has come 

from the past and which will be coming in the future so that our 

people’s health will be maintained at an appropriate level.

Therfore, there is an obligation laid upon the institutions of this 

country which have taken the responsibility of operating schools of 

medicine and of dentistry to find the ways and means whereby the size 

of these schools may be expanded and the number of students admitted 

and therefore the number of graduates produced may be expanded.

There are four matters to he concerned with as expressed in this 

bill and in stating them I shall indicate my personal judgment as to 

their order of importance.

First, facilities; second, faculty; third, students; and fourth, operating funds.

AVe are at about the point where we cannot accommodate anv increase in the size of our entering classes in medicine or in dentistry in 

this country and. therefore, if we are to produce 25 or 30 or 40 or 50 

percent increase in the number of students admitted, we must have 

new facilities. Certainly, therefore, the legislation is most sound in 

proposing a matching program which encourages new institutions, 

No. 1, but more particularly the expansion of existing institutions. I 

say more particularly the la tter for the simple reason that the task is 

easier to expand an existing medical school than to gain a new one.

The cost in dollars is less. The problem of recruiting an expanding faculty is less and the time element is also less.

Secondly, I would speak of faculty, which is perhaps our most acute 

bottleneck because we are all competing in a market in which there is 

no supply and there is a question of robbing Peter to pay Paul. Therefore, we need to expand the number of competent faculty members
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 309

an d in this th e research f acility pro vision o f th e act is most sta tesm an ­

like for it propo ses the extension in time, the extension in the a mount 

of the ap prop ria tio n hut pa rti cu larly the expressed inclu sion of research tra ining.

I po int th is out because of the fac t that the fac ulty member fo r a 

medical school or den tal school is a rese arch tra ined person. He is 

tra ined in bu t specifically throug h research.

The th ird po int is the numb er of studen ts. The great est num ber, 

the gre atest am ount of increase in the numb er of stu dents ap plying 

fo r medicine and de ntist ry will come by widen ing the economic level 

from which stu dents may asp ire to careers in the healt h sciences, 

the ref ore th is prop osal of schola rsh ip on the basis of need and merit is 

an extrem ely wise one.

I think if you review class af te r class o f m edical schools aro und thi s 

country , you would see valid ate d the fac t th at for the most pa rt 

stu dents of m edicine and the othe r h ealth sciences come from the more 

economically fav ore d gro ups but the re is talent and the re is devo tion 

among all segm ents of our society.

I'liere is one cav eat I would raise here and poin t out to th e committee 

(hat the maximum sch olarship pro vid ed here is $2,000, which is not 

larg ely but still substan tia lly below the cost of a year in a medical 

school. Probably $2,500 would lie more realistic because by going 

from $2,000 to $2,500, y ou would fu rther widen the spectru m of the 

young people from which you migh t rec ruit more stu de nts for the 

health sciences.

Last is the sup port of the schools in their att em pt to expand the 

size of th eir classes by giv ing some assistance in op erating expenses 

throug h a subven tion matched to the sch olarship gr an t.

I would point out to you as othe r speakers have, or the witnesses 

have, th at the cost of hea lth edu cation is on the orde r of $4,000 to 

$5,000 pe r stu dent per year, in some cases maybe $6,000, an d a subvention of a tho usa nd dollars per stu dent as the cost of an edu cation 

gr an t is rat he r unrea listic all y rel ate d to t hat figure.

I would fu rther poin t out th at this m ay be a nothe r p oi nt wher e y ou 

can enco urage the exis ting schools to ex pan d to a g reater degree. Tha t 

if the cost of edu cation gr an t was also pre dic ate d upon th e rate and 

the accomplis hment of the expansion of the school, th is might make 

some of the schools exp and more ra pi dl y an d more effe ctively with the 

resu lt of the pro duction o f more p erso nnel.

There , sir, I sh all rest my b rief statem ent.

If th ere are questions, I shall be ha pp y to atte mpt to answ er them.

The Chairman. Th an k you very much, Doc tor.

Are there any questions?

We are ve ry glad to have your sta tem ent.

Mr. Millis. Th an k you, Air. Ch air ma n.

Th e Chairman. Dr . Al fre d Rosenbloom.

May T inquire, Doctor, before I recogn ize Mr. Macdonald, may I 

inq uire if th ere a re a ny of the othe r w itnesses who are here who intend 

to file a statem ent a nd de sire to do so ?

May I have vou name?

Dr. Rusch. ’Mv na me is Rusch.

The Chairman. Dr. Rusch?

Dr. Rusch. Yes.
310 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

'fhe Chairman. Do you intend to file a s tatem ent or w ould you like 

Io tes tify t

Dr. R usch. I w ould like to testify.

Th e Chairman. I had reference to those who m erely might want to 

file a statement.

Very well.

Mr. Macdon ald ?

We are glad to have our colleague, a member of this committee, 

Mr. Macdonald.

STATEMENT OF HON. TORBERT H. MACDONALD, A REPRESEN TA ­

TIVE IN CONGRESS FROM THE STATE OF MASSACHUSETTS

Mr. Macdonald. Th an k you, Mr. Ch air ma n. I wil make my statement as brie f as possible.

Th e reason I take this opp ortun ity to te sti fy is t hat I would like th e 

opin ion of people who follow concern ing the s ubjec t matter on which 

I am about to speak.

I am offe ring ame ndm ents to H.R . 4909 which will make the 

authorized fun ds ava ilable to optom etry schools and studen ts. 1 

want to call your attention to the fact th at the bill, as introd uced, if 

enacted into law would autho rize annual ap prop ria tio ns to talin g $75 

million fo r con stru ctio n of new facilities and th e reha bilitation of 

existing ones.

Tn order to make certain that some fund s would lie. aut horized for 

schools and colleges of optom etry , one of my ame ndm ents would in ­

crease this amount by only 1 percent. In th is day and age, vision is 

so im po rta nt to ou r school children, our college studen ts, ou r men 

and women in indu str y and the Armed Forces, opera tor s of mo tor 

vehicles and to ou r rapidly inc reasing numb er of ret ire d citizens. 

Ce rta inl y, 1 percent is a very modest sum fo r our schools and colleges 

of optometry. The se schools are engaged in trai ni ng men and women 

to exam ine the eyes of the public, to imp rove th ei r vision by means 

of lenses or visual trai ni ng and, where nece ssary, to refer them to 

phy sicians fo r medical or surg ical tre atm ent. Congres s would be 

open to the severest criticism if we mad e no provision fo r this segment of the health profession.

The vast m ajority of o ur citizens who rely upon optom etric care for 

th eir visual needs are located in the smaller communities. Oph th al ­

mologists, optom etr y’s c ounte rpa rt in the med ical profession, are located in the l arge r centers o f p opula tion. Th ere are ab out on e-fourth 

as man y board certified ophth alm olo gists as there are optometri sts. 

The vast majority of these are to be fou nd in the me tro polita n areas 

such as Boston, Ph ila de lph ia, Chicago, St. Lou is, San Francisco, Los 

Ange les, and so forth . Few citie s of any size hav e enough opto metrists in ratio to population . Today in the Un ite d State s there is one 

opt om etrist fo r each 10.000 persons, whereas the need is one optometrist for each 7,000 persons.

As our civiliza tion becomes more h ighly mecha nized, vision req uir emen ts become more exa ctin g. Ev ery age of o ur p opula tion continue s 

rising, with more a nd more Americans liv ing beyond the age at which 

unaided vision serves th ei r needs. As ou r school population swells 

with incr easingly larg er generation s of youth , the field of prev ention
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 31 1

and correction fo r chi ldren grows proport ion ate ly. Dur in g the 1950’s 

the ratio o f the population we aring spectacles increased more than 10 

percen t. Th e tre nd obviously con tinu ed up wa rd as a more visionconscious public dema nds professional attention.

The arm ed services at the pres ent time have some 350 commissioned 

optom etr ists on active duty. Th ey hold ran ks rang ing from second 

lieute nant to colonel in the Ar my and A ir Force, with correspo nding 

ran ks in the Nav y. Th is numb er is no t adequa te to meet the needs 

of the military, and yet th e schools o f optom etry in t he en tir e Un ite d 

State s are at the pre sen t tim e gr ad ua ting only abo ut 350 students a 

yea r. Of course, I realize th at the Arm ed Forces do not hav e to replenish th eir optom etric manpower annuall y, but it does illustra te 

the serious problem which would confr ont this Nation should the re 

be a natio nal emergency which req uir ed a sub sta ntial increase in our 

Arm ed Forces.

Massachu setts is fo rtu na te in tha t it ha s 1 o f the 10 accr edited schools 

of optom etry within its borders. Th e Massachu setts College of Optom etry has to pro vid e not only th e optom etr ists for Massachusetts, 

but for all of New En glan d and the St ate of New York. Th e nearest 

school to Massachu setts is in Ph ila de lphia. Th e sou the aster n po rtion of the Un ite d State s does not have a sing le school of optom etry 

and the same is tru e of the Rocky Mo untain area. Th ere are no 

schools of optom etry west of the Mis sissippi Riv er, no rth of Tex as, 

and east of the Sierr a Mounta ins. Th is are a has to be served by 

optom etrists who have traveled tho usands of miles to secu re their 

edu cation. You may be intere sted to know th at ou r schools and 

colleges of optom etry are being call ed upon to trai n op tom etr ists for 

Latin America, Asia, and Africa. As a matter of fact, We stern 

Europe is dependent upon London and the Un ite d State s to tra in its 

optom etri sts.

Th ere was a tim e when anyo ne could offer to examin e eyes and 

prescribe glasses. Today , in orde r to secure an origin al license to 

practic e, an op tom etr ist must be a gr ad ua te of an accredited school 

of optom etry. All schools of optom etry require a min imu m of 5 

years o f stu dy at the college level and some require a 6th ye ar f or the 

O.D. degree. In addition to comp leting these educational req uir ements, a St ate board exa mination is required. Ev ery 1 of the 50 

State s and the Dist ric t of Columbia, eit he r by legisla tive acti on or 

reg ula tions ha ving the force of law, make thi s a req uir em ent to 

practice.

The. IL S. Supre me Court, in upho lding the co nstitution ality of an 

Oklahoma sta tu te reg ulati ng the pra ctice of optom etry and the sale 

of co rrectiv e eyeglasses, s aid :

It seems to us that this regulation is on the same constitutional footing ns 

the denial to corporations of the righ t to prac tice denistry (William non v. Lee Optieal of Oklahoma, 348 U.S. 483).

I t seems to me th at Congress should provide the same edu cation al 

foo ting for optom etry as it prop oses to provide fo r denistr y and 

osteopathy. A f ailu re to include op tom etric insti tut ion s w ill adv ersely 

affect the visu al car e of millions of Am ericans. Tha t is the purpo se 

of the ame ndm ents which I intend to offer to II.R. 4999 at the ap ­

pr op ria te time.
312 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Th e Chairman. Th an k you. We ap preciat e yo ur advising us of 

yo ur intention.

Mr. M acdonald. Th an k you, sir.

The Chairman. Dr. Rosenbloom, rep res entin g the American Optom etric Association, dean of the Illino is College of De ntistry.

1 notice you hav e an old frie nd with you.

STAT EMENT OF WILLIA M P. MacCRACKEN, JR ., WASHIN GTON 

COUNCIL FOR TH E AMERICAN OPTOMETRIC ASSOCIATION

Mr. MacCracken. Mr. Chairma n, it is always a pleasure to ap pe ar 

before this com mittee.

Du rin g the noon luncheon I rem inded the chair ma n th at my first 

appeara nce was when Congres sma n Win slow of Massachusetts was 

chairma n 40 yea rs ago next month. I think I can call the roll of 

the chairmen without looking back. I can not call the roll of all the 

com mittee mem bers, t hough.

It is a pleasure to nave had tha t experience.

I am glad to be here this afte rnoon.

Th e Chair man. I believe you should fully identify yours elf for 

the record.

Mr. MacCracken. William P. Mac Cracken, Jr. I am an att orney 

practic ing in W ash ing ton , D.C.

I rep res ent the Am eric an Optom etric Ass ocia tion as their W as hing ton counsel.

The Chairma n. Th an k you very much.

We are glad to have y ou back with us to be with the doctor du rin g 

the presen tation of the sta tem ent on be ha lf of th at association.

STATEMENT OF DR. ALF RED A. ROSENBLOOM, JR ., DEAN, ILL INOIS

COLLEGE OF OPTOMETRY. AND MEMBER, A MERICAN OPTOMETRIC

ASSOCIATION. COUNCIL ON OPTOMETRIC EDUCATION: ACCOMPA NIED BY WILLIA M P. MacCRACKEN, JR ., WASHINGTO N

COUNCIL FOR TH E AMERICAN OPTOMETRIC ASSOCIATION

Dr. Rosenbloom. Th an k you very much, Congres sma n Macdonald.

Mr. Chairma n and mem bers o f the com mittee, my name is Al fre d 

A. Rosenbloom. My residence is 6829 S outh Cransto n Avenue, Ch icago, Ill. I grad ua ted f rom No rth ern Ill inois College of Optom etry, 

cum laude, in 1948 with the degree o f do cto r of op tom etry, af te r receiving an A.B. degree from P ennsy lva nia S tate Universi ty in 1942. Since 

1948,1 have been a mem ber of the fac ulty at Ill inois and in 1956 was 

appoint ed dean of the college. Cu rre ntly. I am com pleting the 

requirem ents fo r a Ph. D. at the Un iversity of Chic ago, Depar tment 

of Ed ucation, havin g alr eady received a ma ste r's degree from that 

institut ion . For the past 6 yea rs I have served as optometri c consu lta nt fo r the Chicago Lig hth ouse fo r the Blind. My app earance 

here is as a mem ber of the Council on Op tom etric Ed uca tion of the 

Am erican Op tom etric Asso ciation and as a spokesman for the Am erican Op tom etr ic Asso ciation in behalf of an ame ndm ent which we 

believe merits you r att entio n and support .

In this day and age peop le have a tendency to tak e too much for 

gran ted and this is p artic ularly tru e with what is sometimes refer red
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 313

to as “God’s greatest g ift to mankind.” namely, eyesight. The visual 

tasks which are required of children, college students, men and women 

in our offices, factories and research laboratories, on the highways, in 

the air, for national defense, and in outer space, as well as the enjoyment of added years of life were unknown at the beginning of the 

century and are not fully appreciated by most people today.

The vision care of your fellow citizens rests primarily on the shoulders of the members of the optometric profession. There are some 

18,000 practicing optometrists in the United States and approximately 

two-thirds of them are members of the American Optometric Association. AVe have always advocated that there should be 1 practicing 

optometrist for every 7,000 of our population; today the ratio is less 

than 1 to 10,000. The number of practicing physicians and dentists 

is declining in relation to the population, but so is the number of practicing optometrists. Our ratio of decline is more rapid than that of 

physicians and dentists, the demand for whose services is being reduced through sanitation, vaccination, fluorination, and other preventive measures.

While our population increase affects all age groups, the greatest 

increase is in the group over 50, the vast majority of whom are in 

need of optometric services to enable them to continue to contribute 

to our economy, to enjoy the well earned rewards which should be 

theirs in their later years and to enable them to be self-reliant, useful 

citizens.

All 50 States and the District of Columbia have laws regulating 

the practicing of optometry and the licensing of optometrists. One 

entering our profession today must have successfully completed 5 

years of study in an accredited school or college of optometry, at least 

3 years of which are devoted to subjects dealing with our specialty, 

following which they must pass a State board examination.

There are only 10 accredited schools and colleges of optometry 

in the United States. These ar e:

The Massachusetts School of Optometry, Boston.

The Ohio State University School of Optometry, Columbus. 

The Pacific University College of Optometry, Forest Grove, 

Oreg.

The Pennsylvania College of Optometry, Philadelphia.

The Southern College of Optometry, Memphis, Tenn.

University of California School of Optometry, Berkeley, Calif. 

University of Houston College of Optometry, Houston, Tex. 

The Illinois College of Optometry, Chicago.

Indiana University Division of Optometry, Bloomington.

The Los Angeles College of Optometry, Los Angeles.

For the past 3 years as a member of the Council on Optometric 

Education, I visited most of our schools and colleges of optometry. 

T can sav from firsthand experience that most of these schools are 

all faced with serious financial problems in order to continue their 

operation. In Texas, for example, the optometrists themselves supported a bill which passed the State legislature raising the annual 

fee charged practicing optometrists, the additional money to go to 

support the Optometry School of Houston University. A similar 

program was adopted in California, the additional money to go to 

support the School of Optometry of University of California.

80014— 62 ------ 21
314 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

None of our schools and colleges can boa st of substan tia l endow ment 

fun ds, although all of them do receive supp ort fro m th eir alumni 

and other optom etric groups, such as the Women’s A ux iliary of the 

Am eric an Op tom etric Ass ocia tion and the Am erican Optom etric 

Fo un datio n, a nonprofit corpo rat ion whose fund s are derived almost 

exclusively from mem bers of ou r profession an d th ei r families.

Our profession was fir st recognized by Congress in 1924 when it 

enacted the D ist ric t of Columbia optom etry law.

In 1945 Congress passed the Op tom etry Co rps bill over the stre nu ­

ous objection of the W ar De partm ent . Pr esiden t Tr um an vetoed 

the bill bu t only af te r he had been assured by the W ar De partm ent 

th at follow ing the cessation of hos tilities in W orld W ar 11, th e Depa rtm en t would sponsor legisla tion to commission optom etrists in 

the arm ed services. In 1947 the Medical Service s Corps law was 

enacted which pro vided fo r commissioning of optom etrists in the 

arm ed services.

To day the re are on active d uty in the A rm y, Navy, an d Air F orce 

som eth ing over 350 comm issioned optom etry officers and more are 

needed. Th eir ran ks r ange from second lie ute nant to colonel, or th eir 

equ iva len t ranks in th e Navy.

The 1950 amendments to the social sec urity law pro vid ed th at optom etric services should be mad e available to the beneficiaries of the 

aid to the blind pro gra m who desired to utilize them, and in 1959 th e 

same privilege s were accorded to vete rans e nti tle d to ou tpatient vision 

care. Th e enactment of thes e las t two laws p romp ts me to call your 

attenti on to the fact th at opt hal mo log ists and occulists who pro vide 

pr im arily eye surge ry and med ication, as well as pe rfo rm ing oth er 

services sim ilar to those pro vided by optom etrists, are located for 

the most p ar t in the l arge r c ent ers of population . Th e b oar d certified 

ophth alm olo gists who a re practic ing number less one-third the number 

of practic ing optom etrists . Th e vision care of those citizen s res iding 

in the smaller cities and ru ra l are as is pro vid ed alm ost exclusively 

by optom etrists .

Th e d ra ft doctors law incl ude d op tom etrists and P res ide nt Ken nedy 

has ju st appointed Dr. P. N. DeVere, of Morg ant on, N.C., a past 

pre sid ent of the Americ an Optom etric Association, as a mem ber of 

the Na tional Advisory Com mittee to the S elective Serv ice System on 

the Selection of Phy sician s, Dentists, and Allied Specialists. The 

com mittee was esta blished by an act of Congress.

Op tom etr y performs a n uniq ue and dis tin ct vision car e service. It s 

uniq uene ss stems from its extensive education not only in the sciences 

of physiology, anatomy, and patholog y given in the trai ni ng afforded 

all the hea lth care professions, bu t in addit ion the exclusive formal 

edu cation in physiological optics. The only courses of gradua te 

studies leadin g to the Ph . D. degree in phy siological optics a re found 

on campuse s where schools of optom etry exist. Th e hard core of 

th ei r fac ult y teaching th is subject is composed almost exclusively of 

opt om etrists.

Highwa y safety is a subject th at has been of vital interest to this 

committee. It is my un de rstand ing th at on e-t hir d of the automobile 

mileage in this cou ntry is driven between sundown and sunrise, but 

that tw o-thi rds of the automobile acciden ts occu r du ring t ha t period. 

The Indian a Un ive rsity Division of Op tom etry, with the financial
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 3l5

backing of the American Optometric Foundation, is engaged in a research program dealing with night vision for automobile drivers. 

Prior to the time this program was undertaken, there had never been 

any attempt to determine the visual requirements for nigh t driving. 

This is only one instance among many others in which our profession 

has pioneered in the interest of safety and welfare of the American 

public.

It may have occurred to some of you tha t the adoption of the 

amendment which I am about to suggest will add greatly to the cost 

of the program. These bills authorize annual appropriation of $75 

million for new or enlarged schools of medicine, dentistry, osteopathy, and public health. I am suggesting tha t this amount be 

increased by only $750,000 a year. This is 1 percent of the annual 

total authorization, a mere pittance as far as the overall cost of the 

building program is concerned, yet it will be of great benefit to the 

public in that it will enable our schools and colleges to graduate more 

and better trained optometrists to provide for the visual welfare of 

our American citizens.

Six or seven veal's ago we lost one of our largest and oldest, schools 

of optometry which was located at (’olumbia University in New York 

City. Since then our profession has been trying to establish a new 

school of optometry in that area. The inclusion of optometry in this 

bill will greatly facilitate the accomplishment of tha t important 

objective.

Another area which is greatly in need of a school of optometry is 

the. southeastern section of the United States. Virginia, West Virginia, the Carolinas, Georgia, Alabama, Missisippi, and Florida are 

greatly in need of such a school. The Florida Legislature makes an 

annual appropriation for the expenses of a few students from that 

State to attend one of our accredited optometric institutions. West of 

the Mississippi River to the Sierras and north of the Texas border 

there is not a single school or college of optometry. Young men and 

women living in this vast area must go either to the Pacific coast, 

Houston, Tex., or east of the Mississippi River in order to obtain an 

optometric education.

To give you some idea of the work being done by our profession 

through the committees and departments of the American Optometric 

Association, I should like to name the m:

Council on education, department of education, committees on contact lenses, ethics, international affairs—this committee among other 

things is struggling for a solution of the Cuban refugee problem as 

it affects optometrists—motorists’ vision and highway safety, occupational vision, orthoptics and visual training, research, social and 

health care trends, standards, vision aid to the partially blind, vocational guidance, vision care of the aging, visual problems of children 

and youth.

The last two committees made significant contribution to the White 

House Conferences dealing with these areas.

The most recent committee to be appointed is th at on visual problems of aeronautics and space.
316 TRAIN ING OF PROFE SSIONAL PUBLIC HEA LT H PERSON NE L

This month they met in Washington and conferred with representatives of the Federal Aviation Agency, Office of Naval Research, and 

the Armed Forces Committee on Vision. Time will not permit my 

describing the work of these committees but their names will give 

you some idea of the important contributions they are making to the 

modern demands of vision in their respective fields. They are cooperating with agencies of our Federal Government interested in 

these subjects and have received many commendations for the work 

they are doing.

May I pause here to state tha t the problem of student recruitment 

for schools and colleges of optometry, which is very serious, will 

become more so if this legislation is enacted without including 

optometry students.

In the interest of conserving your time, much tha t I would like 

to say, and which I hope would be of interest to you, has been omitted 

from this statement, but I am attaching to it some material which I 

tru st when you come to study this legislation you will find interesting 

and helpful in leading you to include optometry colleges and students 

in this legislation.

The amendments which we propose are also at tached.

(The attachments referred to follow:)

Optometric Amendments to II.R . 4999

Pag e 1, lin e 6, be fore th e wo rd “a nd” in se rt th e word “o pto m et ric” .

Pag e 2, lin e 9, aft e r th e wo rd “o steo pa th ic ” in se rt th e word “o pt om et ric” .

Pag e 2, lin e 15, s tr ik e o ut “$45,000,000” an d in se rt “$45,750,000”.

Pag e 2, lin e 16, aft er th e wo rd “p hy sician s” in sert th e w or d “o pt om et ri st s” .

Pag e 2, lin e 22, aft er th e wo rd “p hy sician s” in sert th e wor d “o pto m et ri st s” .

Pag e 3, lin e 8, aft er th e word “o steo pa th y” in se rt th e w ord “o pt om et ry ”.

Pag e 4, line 18, a ft e r th e word “o steo pa th y” in sert th e w or d “o pt om et ry ”.

Pag e 5, lin e 4, aft e r th e word “o steo pa th y” in se rt th e wo rd “o pt om et ry ”.

Pag e 6, lin e 23, aft e r th e word “d enti st ry ” in sert th e word “o pt om et ry ”.

Pag e 7, line 5, aft e r th e word “d en ti st s” in se rt th e word “o pt om et ri st s” .

Pag e 10, lin e 23. aft er the wor ds “sc hool of ost eo pa th y” in se rt th e words 

“s choo l of op to m et ry ”.

Pag e 11, lin e 2, aft e r th e word “o steo pa thy” in sert the wor ds “o f do ctor of 

op to m et ry or an eq ui va le nt de gr ee ”.

P ag e 11, lin e 14, st ri ke ou t th e wo rd “four” an d in se rt in lieu th er eo f th e 

word “five” .

P ag e 11, lin e 16, aft e r th e wor d “o steo pa th y” in se rt th e wo rd “o pt om et ry ”.

P ag e 11, lin e 20, aft e r th e word “d en ti st ry ” in sert th e word “op to m et ry ”.

P age 14, lin e 6, aft e r th e word “o steo pa th y” in sert th e word “opt om et ry ”.

P ag e 14, lin e 12, aft e r th e wor d “d en ta l” in sert th e wor d “o pt om etric” .

Pag e 14. lin e 23, aft e r th e wor d “p hy sician s” in sert th e wor d “o pt om et ri st s” .

Pag e 15, lin e 2, aft e r th e word “o steo pa th y” in sert th e word “o pt om et ry ”.

Pag e 15, li ne 6. aft er th e word “o r” in se rt th e word “o pt om et ry ”.

Pag e 18, lin e 3, st ri ke ou t th e lin e and in se rt in lie u th ere of th e fo llo wing: 

“ Sec. 3 (a ). Section 792 ( 4) of th e Pu blic H ea lth Se rvice Act is am en de d by 

in se rt in g ‘Optometry ’ a ft e r ‘d en ti st ry ’.”

“ (b ) Effec tiv e w ith re sp ec t to ap pr op riat io ns fo r” .

Pag e 18, line 10, str ik e o ut “ (b )” an d in se rt in lie u th er eo f “ ( c )”.

Pag e 18, lin e 13, s tr ik e o ut “ ( c ) ” an d in se rt in lie u th er eo f “ ( d ) ”.

Pag e 18, lin e 20. st ri ke ou t " ( d ) ” an d in se rt in lie u th ere of “ ( e ) ”.

P ag e 19, lin e 8, st ri ke ou t “ ( e ) ” an d in se rt in lie u th er eo f “ (f)" .

P age 20, lin e 6, s tr ik e o ut “ ( f ) ” an d in se rt in lie u th er eo f “ (g )”.
GRADUATES OF OPTOMETRIC SCHOOLS AND COLLEGES BY YEARS

*7 10 new opto m et ri st s ne ed ed eac h ye ar to re pla ce lo ss from dea th an d re tire m en ts and mee t po pu la tio n gro wth

TRAINING OF PROFESSIONAL PUBLIC HEA LTH PER SONNEL 317
RATIO OF ONE OPTOMETRIST TO POPULATION

12 ,0 00

11 ,0 00

10 ,0 00

9,0 00

8,0 00

*7 ,5 0 0

7,0 00

1959

6,0 00

Optimum Ra tio : One opto m et rist to ea ch 7,5 00 pe rs on s
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 319

Dr. R osenbloom. Mr. Chairma n, may I than k you an d th e comm ittee 

for the pri vil ege of pre senti ng the op tometris t’s position to th is 

comm ittee.

Mr. Macdonald (presid ing). Th an k you very much.

Are the re any questions?

Mr. C ollier. Yes, if I may.

Wh en Se cre tar y Ribicoff testified b efore thi s comm ittee on the legis ­

lation , I do not recall whe ther you were here, but I sim ply asked him 

why optom etry was not embraced in the bill. I ask him at the same 

time wh eth er he fel t the re was a short age of optom etrists. Hi s 

answer wae-iti the negative.

Going back to the Se creta ry’s sta tem ent, could you supp ly any 

figure as to the numb er of optom etr ists pe r capita in this country , 

what it was, say, 10 yea rs ago, which they have in the S ecret ary 's s tate ­

ment, a s compared to what it is p er cap ita today?

I)r. Rosenbloom. Congres sma n, if you would care to examine ou r 

ch art which is a ttached to the statem ent, sir, in 1952 there w as a ratio 

of 1 op tometr ist to 8,300 citizens. Tn 1961, thi s has climb ed to a ra tio 

of 1 o pto me trist to 10,300 citizens.

Mr. Collier. I only went as fa r in your statem ent as you went. I 

did not see the ch art on the back.

Now, wh at in years is the per iod of training for a gr ad ua te 

optom etrist ?

Dr. Rosenbloom. There is a min imu m trai ning p erio d of 5 years, 2 

years pr eprof ess ion al, and 3 or 4 yea rs profes sion al. Some of ou r pr ogra ms have been exp and ed to include 4 y ear s, which makes a total o f 6 

yea rs of collegiate training.

I mi gh t add th at appro xim ate ly 20 percen t of our stu dents come to 

the opto me try school or college wi th a bachelor 's d egree in which case 

the prog ram of tra in in g in these instanc es would be seve ral years 

longer.

Mr. Collier. All I am try in g to do in bringing the Se cretary’s 

sta tem ent in is to esta blis h th at the arg um ents fo r the othe r phases 

of the field of medicine, and so on, ap ply here.

The statem ent says essen tial fac tor s co ntrib uting to the problem of 

sho rtage of doctors is, No. 1, limited en rollment capacity of th e schools.

Does th is a pp ly to the schools o f optom etr y ?

Dr. Rosenbloom. Yes.

Mr. Collier. No. 2, the mo unting cost of pro fessional edu cation 

both f or con struction and opera tions.

Dr. Rosenbloom. Yes, this is very m uch o ur problem.

Mr. Collier. Th e dwi nd lin g supp ly of qualified appli can ts.

Dr . R osenbloom. Yes, th is is also a prob lem.

Mr. Collier. Th e same qualifica tion s the n ap ply to optom etrists?

Dr. R osenbloom. Yes.

Mr. Collier. Th an k you very much.

Mr. Macdonald. Th an k you, D r. Rosenbloom .

Dr. Rusch ?

Dr. Rusch is directo r of the Mc Ard le Memorial La bo rat ory for 

Cancer Research at the U nive rsi ty of Wisconsin.

(Sup ple men tar y inf orma tio n fu rnishe d by De partm ent of He alth, 

Ed ucation, an d W el fa re :)

In response to your requ est concerning optom etrists, the American Optometric 

Association reports th at 19,000 opto metrists were in activ e prac tice in 1958, in-
320 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

eluding 336 employed by the Federal Government. There are 10 accredited 

schools in the United State s, as follows :

Ca lifornia : Los Angeles College of Optometry, University of Califo rnia 

School of Optometry.

Illin ois: Illinois College of Optometry.

Indiana : Indiana University Division of Optometry.

Ma ssachu setts: Massachusetts College of Optometry.

Ohio: Ohio State University School of Optometry.

Oregon : Pacific University College of Optometry.

Pennsylvania : Pennsylvania State College of Optometry.

Texas : University of Houston College of Optometry.

Tennessee: Southern College of Optometry.

The numbers of students and graduates in schools of optometry have decreased 

sharply in the p ast 10 ye ar s:

Scho ol ye ar S tu d en ts G ra duat es Sc hool ye ar S tu den ts G ra duat es

1951-52 . 2,015 636 1956-57............ ................. . 1,175 355

19 52 -53-.................. ............... 1.959 684 1957-58___________________ 1,155 349

1953-54 1.631 674 1958-59__________ ________ 1,235 323

1954-55 1, 396 473 1959-60_____ __________ . 1,168 317

19 55 -5 6. ... 1,233 333 1960-61.......... . ....................... . 319

Fu rth er information which may be of help to your committee is contained in 

the attac hed “Employment Outlook for Optometrists,” which follows :

E mployment Outlook for Opto me trist s

NA TU RE OF WORK

Optometrists examine eyes and do other work concerned with safeguarding 

and improving vision. They use special instrum ents and tes ts to find and measure defects in vision and. when needed, prescribe eyeglasses, eye exercises, or 

other trea tment that does not requ ire drugs or surgery. Most optom etrists 

supply their patients with the eyeglasses prescribed. However, they usually 

have the lenses ground at an optical laboratory and then cut them to fit the 

fram es selected by patie nts. Some optom etrists do only minor repair work, 

such as straightenin g frames or replacing nose pieces on glasses.

A growing number of optometrists include visual training, the use of corrective eye exercises, in their practice. Some do other specialized work such as 

fitting persons who are nearly blind with telescopic spectacles, fitting contact 

lenses, studying the relationship of vision to highway safety, and analyzing 

lighting and other conditions tha t affect th e efficiency of w orkers in industry. A 

few optometrists are engaged primarily in teaching or research.

Opto metrists should not be confused with ophthalmologists, oculists, or opticians. Ophthalmologists and oculists are licensed physicians who specialize 

in the medical and surgical care of the eyes and may prescribe drug s or other 

treatm ent, as well as lenses. Opticians grind lenses according to prescriptions 

for eyeglasses written by physicians who are medical eye specialists or by optometr ist s ; they do not exam ine eyes or prescribe treatment.

WH ER E EMPLOYED

Most of the 17,000 opto metrists professionally activ e in early 1058 were in 

private practice in their own offices. However, some were salaried employees 

working as ass ista nts to established prac titioners or for hea lth clinics, hospitals, 

optical instrum ent manufac turers, and Government agencies. A few taught in 

colleges of optometry or served as optometrists in the Armed Forces.

Optometrists are located chiefly in large cities and ind ustrial areas where 

many people are engaged in office work or other occupations which place a stra in 

on the eyes. Nearly 40 i>ercent a re in the four States with the greatest population—Illinois. Califo rnia. New York, and Pennsylvania. Many small towns and 

rural areas, especially in the South, have no optom etrists.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 321

TRAINING ANO OTHER QUALIFICATIONS

A license Is required in all States and the Distric t of Columbia for the prac tice 

of optometry. To obtain a license, one must be a graduate of an accredited 

school of optometry and pass a State board examination. In some State s, only 

gradua tes of certain accredited schools of optometry are adm itted to these examinations. A studen t planning to become an optometrist should, therefore, 

choose a school approved by the board of optometry in the State where he expects to practice. Altogether, there were 10 schools of optometry in the country 

in 1958.

Five years of study beyond high school is the minimum education needed to 

become an optom etrist. Usually this consists of 2 years of preoptometry education in an approved college, followed by 3 years of training in an optometry 

school. Some schools require a total of 6 years—2 of preoptometry study and 4 

in a school of optometry. Preoptometry courses include math ematics and the 

basic sciences of physics, biology, and chemistry, as well as general education 

courses. The curriculum in schools of optometry provides not only for classroom 

and laboratory work but also experience in treating patients in the school’s 

clinic. Most schools give the ir graduates the degree of doctor of optometry 

(O.D.) but some confer the degree of bachelor of science in optometry or master 

of optometry. Optometrists who wish to specialize often take additional tra ining. The master's or Ph. I), degree in physiological optics or a rela ted field is 

usually required for teaching and research work.

Qualifications considered imp ortant for a prospective optometrist are a liking 

for mathematical and scientific work, the ability to use delicate precision instruments, mechanical aptitude, and good vision. In addition, successful practice requires the ability to deal with people tactfully. In 1958, applicants with 

the necessary qualifications had an excellent chance of adm ittance to a school 

of optometry.

The majority of optometrists star t either by setting up a new prac tice or by 

purchasing an established one. Some begin as ass istants to established pra ctitioners, and young gradua tes are frequently advised to do this in orde r to acquire experience and the funds necessary to equip an office. Office location is 

of major importance for a successful practice. The opto metrist should consider 

the number of optometrists and medical eye specialists in the vicinity compared 

with the number, occupation, age, and income level of the population requiring 

eye care.

EMPLOYMENT OUTLOOK

Employment opportunities for new gradua tes of schools of optometry in 

the early 1960’s are expected to aris e mainly from the need to replace optometrists retiring or otherwise leaving the field. During this period, the number 

of new gradua tes is likely to be considerably less than the number of experienced optometrists dropping out of practice. As in the past, opportunities 

for beginning prac tice will generally be best in small towns and in resid ential 

are as of citie s where the new optometrist can easily become known and where 

comjietition with established optometrists and medical eye specialists is not 

as keen as in large business centers. Communities, especially in the South, 

that have no optometric services available will also offer some opportunities for 

new grad uate s.

The demand for eye-care services will continue to grow over the long run. 

The importance of good vision to efficiency at work and in school is becoming 

more widely recognized, eye str ain has been increased by many aspects of 

modern living; and the use of eyeglasses has come to be generally accepted. 

The volume of eye-care services needed will also be increased by the anticipated growth in population, especially by the expected sharp rise in the number 

of older people—the group most likely to need glasses. Although the expanded demand will be met in pa rt by medical doctors who are eye specialists, 

optometrists will continue to supply a sub stantial proportion of all eye-care 

services.

Women optom etrists, who constitute about 5 percent of the profession, have 

many opportunities to work as salaried assista nts, especially in the field of 

visual training. Those in priv ate practice have been particularly successful 

in work with children.
322 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

EARNINGS AND WORKING CONDITIONS

In optometry, as in some of the other health fields, a low income must be 

expected for the first 2 or 3 yea rs of practice. However, as a practice becomes established, earn ings usually rise significantly. In 1957, the average 

income above expenses for self-employed opto metrists was $9,750, according 

to the American Optometric Association.

Optom etrists practicing in towns and small cities have high er net earnings, 

on the average, than opto metrists in large cities. However, there are some 

successful prac titio ners in big cities who have very high incomes. Although 

optometrists in salaried positions may at first earn more tha n the self-employed, 

earnings of those in prac tice for themselves usually outstrip incomes of salaried 

optom etrists a fte r a few yea rs of experience.

Working hours in this profession are usually regular. Many offices a re ojien 

6 days and at least 1 night each week. However, some practitioners keep 

only scheduled appointments. Since the work is not strenuous, optometrists 

can often continue to practice a fte r the normal retire ment age.

WHERE TO GO FOR MORE INFORMATION

Additional information on optometry as a career is available from : American Optometric Association, Inc., 4030 Chouteau Avenue, St. Louis 10, Mo.

Information on requ ired preoptometry courses may be obtained by writing 

to the optometry school in which the prospective student wishes to enroll. The 

board of optometry in the capital of the State in which the student plans to 

prac tice will provide a list of optometry schools approved by that State.

STATEM ENT OF DR. HAROLD P. RUSCH, DIRECTOR, McARDLE MEMORIA L LABORATORY FOR CANCER RESEARCH, UN IVER SIT Y OF

WISCONSIN

Dr. Rusch. Mr. Chairman, gentlemen of the committee, I am 

Harold Rusch, director of the McArdle Memorial Laboratory for 

Cancer Research at the University of Wisconsin. Dr. Conrad Elvehjem, president of the University of Wisconsin, had intended to be 

here to give testimony but was unable to do so. lie has prepared a 

statement, however, and I am asking permission to submit this for 

the record.

In addition, I have a short statement, and if I have your permission 

I wish to present it at this time.

Mr. Macdonald. We will be happy to have your statement as well 

as Dr. Elvehjem’s statement.

(The statement referred to follows:)

Statement of Conrad A. Elveiijem, President, University of Wisconsin

My name is Conrad A. Elvehjem. I am now preside nt of the University of 

Wisconsin. However, from 194(5 to 1958, I was dean of the Graduate School of 

the University of Wisconsin; and from 1923 to 1958, a period of 35 years, I was 

very active in teaching and research in the biological area, specifically biochemistry.

During my period in the laboratory, I worked with many gradua te students 

and as a resu lt of our efforts several fundame ntal findings in the field of biochemistry, for example, the discovery th at nicotinic acid is the antii>ellagra 

factor, were published. About 80 I’h. I).’s received degrees with me and many 

more took the ir minor with me. During the period that I was grad uate dean, I 

saw the number of graduate stud ents at the University of Wisconsin increase 

from about 2,000 to almost 4,000 students. Since 1958 the number has increased 

to close to 5,000 students, and similar increases have taken place in all the large 

institutions. Thus, I have seen the increased need for support for research in 

the biological sciences in a very intimate way and I have seen the growing need 

for additio nal facilities.
TRAIN ING OF PRO FES SIONAL PUBLIC HEA LT H PE RS ON NE L 323

When I sta rt ed work in 1923 a few hun dr ed dollar s an d sm all la bora to ry 

q u art ers w er e suf fic ien t fo r us to do mo st of our work. How ev er, th e ne ed s 

ha ve grow n tre m en do us ly an d one of th e gre ate st curr ent bo ttlene ck s to fu rt h e r 

re se ar ch pr og re ss in th is co un try is th e lack of la bor at or y fa ci lities . T her e a re 

se ve ra l re as on s fo r this. F ir st , we ha ve seen a trem en do us in cr ea se in th e 

su pport o f re se ar ch ; th is w as po inted out c le ar ly by Dr. Sh an no n in th e he arings : 

la st yea r on bill 4998— in which he in di ca te d th a t th e ap pro pri at io n fo r th e 

N at io na l In sti tu te s of H ea lth in 1956 w as $97 mi llion an d in 1960 it w as $56 0 

mi llio n.

Sim ilar in cr ea se s ha ve ta ke n plac e from oth er source s. N at ura lly, th is involves a ve ry la rg e in cr ea se in th e nu m be r of la bor at ory w or ke rs. Second , the 

eq ui pm en t ha s incr ea se d. Th e m ag ni tu de an d co mplex ity of th e eq uipm en t 

re qui re s la rg er an d bet te r q u art ers and in m an y ca se s th e q u art ers m ust ha ve 

te m per at ure an d hu m id ity co ntro ls. Th e co mpe tit ion be tw ee n bu ildi ng fa ci litie s fo r gra d u ate an d under gra duat e wor k is ob vio us in all in st it uti ons ca rr yin g 

on bo th tyi»es of trai ni ng . As re se ar ch pr ogra m s bec ome more comp lex , the 

ne ed fo r po st do ct or at e tr ain in g be co mes"in ore ur ge nt . This ty pe of wor k requ ires eve n mo re office a nd la bo ra to ry s pace.

I kno w th a t ev ery in st itution ex pe rien ci ng th es e pr ob lems has m ad e ev ery 

ef fo rt to tin d sp ac e fo r it s re se ar ch w or ke rs . F or ex am ple, a t W isco ns in we 

ha ve ta pp ed ev ery po ssible av en ue , al w ay s co ns id er in g fi rs t an d fo re m os t ap pro ­

pri ati ons fro m th e Sta te le gi sl at ur e. We ha ve bee n fa ir ly su cc es sful in 

em ph as izin g to th e S ta te l eg is la tu re th e im po rtan ce o f re se ar ch fa ci lities as we ll 

as su pp or t fo r teac hi ng fa ci lities . Actua lly , fo r th e p ast 10 years we ha ve bu ilt 

mo re ra pi dl y fo r re se ar ch th an we ha ve fo r teac hing . How ev er, we are now 

a t a po int w he re we m us t plac e cla ssroom fa ci lities an d office fa cil it ie s hi gh er 

on th e pri ori ty list th an bu ild ings fo r la bora to ri es an d re se ar ch ac tivity. Th us 

I ca nn ot em ph as ize too stro ng ly my su pport f o r th e c on si de ra tion of $100 mi llion 

pe r yea r fo r bu ildi ng fa ci lities in th e med ical and biolog ica l t ield s.

Th e urge nc y of th es e ne ed s ha s be en se t fo rt h d e a rl y in th e st at em en t by th e 

P re si den t's Scien ce Adv iso ry Co mm ittee, entitled “Sc ien tif ic Pro gr es s, th e Un ive rsiti es , an d th e Fed er al Gov ernm en t.” N ov em be r 15, 1960:

“T he dra m ati c ex pa ns io n of scienc e in th is co un try has outr un our abi lity 

to pr ov ide up -to- da te sp ac e an d eq ui pm en t fo r eit h er re se ar ch or teac hi ng —s ti ll 

les s fo r th e tw o to ge th er. W hile in th e en d men a re more im p o rt an t th an 

fa ci lities , th e im m ed ia te bo ttl en ec k toda y, in man y fields an d in man y univ er si ­

tie s, is in bu ild ings an d eq uipm en t. * * * Th es e pr op os iti on s carr y a m ora l fo r 

bo th univ er si ties an d th e go ve rnmen t. N ei th er side shou ld exj>ect to develop 

firs t-ra te pr og ra m s w ith ou t appro pri ate sp ac e an d eq uipm en t, an d on bo th side s 

an in cr ea se d em ph as is on in ve stm en t in fa ci li ti es is de si ra bl e. ”

Thi s st ate m ent is very ge ne ra l, an d I re al iz e th a t I ha ve em ph as ized fa cil ities fo r ba sic re se ar ch in the bio logical field, b u t I ag re e w ith Dr. Rad vin, who 

st at ed la st y e a r:

“T he re ca n be no do ub t but th a t th e mos t pr od uc tive lin e of med ical ef fo rt 

ha s com e from a cl ea re r under st an din g of th e bio log ica l pr oc es se s which control no rm al fu nc tion an d th e de vi at io n from th e no rm al which conie s ab out as 

a re su lt of dis ea se.

I wo uld lik e also to em ph as ize th a t li b ra ry sp ac e is a ve ry im port ant p a rt of 

all ou r re se ar ch pr og rams. Thi s im port an ce of th e li bra ry is of te n fo rg ot te n, 

al th ou gh I w an t to say th at a t W isc on sin we ha ve bee n fo rt u n ate in hav in g 

rec og nize d th a t ea ch college ne ed s im port an t li bra ry spa ce. F or man y years the 

colleg e of ag ri cult ure ha s m ai nta in ed a ve ry outs ta ndin g li bra ry fo r th e biolog ica l ar ea. We are now in th e m id st of in it ia ti ng a new li bra ry fo r th e 

med ical sch ool . We built a ne\v gen er al li bra ry a li tt le ov er 10 years ago, but 

th e sp ac e is ra pid ly bec om ing in ad eq ua te —a nd if a sm all po rtio n of th e to ta l 

g ra n t could be allo ca ted to li bra ry spa ce, I am su re it wo uld gre at ly fa cil it ate 

re se ar ch a cti vit y in man y un iv er sities .

May I ad d th a t I was a mem be r of th e firs t N at io na l Adv iso ry H eart Co un cil, 

an d some of you remem be r th a t th is co un cil was give n a sm all am ount fo r 

bu ild ing fa ci lities . I visite d in st it uti ons a t th a t tim e an d re al iz ed how de sj ie ra te 

th e need was. The few mi llio n dol la rs th a t w er e allo ca te d th ro ugh th is coun cil 

was a g re at he lp an d we see th e be ne fits to da y. B ut th e ra te of de ve lopm en t 

sin ce th a t tim e has been so ra pi d th a t a hu nd re d mi llion dollar s to da y co uld be 

sp en t in a very, ve ry eff ectiv e wa y. In fa ct , it w’ould not on ly be eff ec tiv e, it 

wo uld de te rm in e w het her we wo uld be all ow ed to co nt in ue re se arc h acti vit y in 

th is co un try, es pe cially in th e biolog ica l field, a t a ra te ne ce ss ar y to m ee t th e 

de m an ds fro m a ll an gles.
324 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

The question of matching funds is also an imp ortant one. Certainly, it would 

be helpful to have grants that would require a 50-pereent matching fund from 

the institution. However, it would be much better to consider, during this 

emergency and urgency of building, a variable matching relationship. In some 

cases a tota l grant might he most significant in getting certain buildings under 

const ruc tion; in other cases there might be a varia ble matching fund between 

25 percent and 50 percent from the institution. I have no strong feelings on 

this matter, except that the rati o should be considered in line with the urgency 

of the buildings t ha t are needed.

Dr. R rs ci i. From 1954 to 1958 I served on (he Na tio nal Adv isory 

Can cer Council, du rin g which time I became famili ar with the needs 

of research laborato ries in v arious parts o f th e coun try.

Researc h may be ham pered by various factors. Th e lack may be 

in tra ined personnel, in good ideas, or in sufficient space to test new 

ideas. A lab ora tory in which the pressing need was fo r space is the 

Mc Ard le Mem orial La bo rat ory , and I shall cite ou r experience to 

ill us tra te the predicament.

Im aginative people with pro mising ideas were in good sup ply, but 

we lacked space to tes t new leads. A g rant from the He alt h Research 

Fa cil ities Bra nch of the N II I could not solve ou r problem , since the 

unive rsity was unable to pro vid e the required equal ma tch ing funds. 

The constant ly ex panding stu dent population has made it necessary 

fo r t he u niversity to give first priorit y to the con struct ion of building s 

needed for teaching and fo r research directly associated with the 

trai ni ng of students.

Th e followi ng figures ill us tra te the exten t of the unive rsity bu ild ­

ing prog ram: Fo r the period 1951-61, the Un ivers ity of Wisconsin 

spe nt $36 million for building s, of which $14.2 million was fo r research and $21.8 m illion for teaching. Fo r 1961-63, $40.8 million has 

been com mitted ($22.1 million for researc h and $18.7 million for 

tea ch ing ). The proposed figures for 1963-69 are $99.5 million ($44 

million f or research and $55.5 million fo r te ac hi ng ).

I t is obvious from thes e figures that the Un iversity of Wisconsin 

not o nly has been very active in its bu ild ing prog ram , bu t th at it has 

been and is co ntr ibuti ng lar ge amo unts fo r rese arch fac ilities used 

directl y by stud ents. These req uirements are at present so g reat that 

the unive rsity could not ju stify the expenditure of equal ma tch ing 

fund s for the con stru ctio n of a building to lie used exclusively for research on a specific disease, especially when one considers that the 

disease is not lim ited to Wisconsin but is of worldwid e importance. 

I f each State require d a given research cen ter of t his t ype, then each 

St ate should be expected to assum e its fa ir share of the financial bu rden, bu t in this case it seemed unreaso nable to expect the State to 

ma tch the Federal funds for a new can cer research bui lding.

Ef forts were, t herefore , m ade to ob tain m atc hin g f un ds from p rivate 

sources, bu t it was soon evid ent th at it would tak e years to raise su fficient fun ds to match a healt h research fac ilities gr an t on a 50-50 

basis— fa r longer th an such g ra nt could be held open. Moreover, such 

delay in th e expansion of the cancer research effort did not ap pe ar jus tified. Fo rtu na tely, fund s rece ntly made ava ilab le by the Nationa l In ­

stitu tes of He alt h, from the fiscal 1961 ap prop ria tio n for special can ­

cer rese arch facilities, will cove r most of the cost of a new build ing 

fo r can cer research at the Un ive rsity of Wisconsin.

Al thou gh the principle o f a 50-50 split o f t he co nstruc tion costs between Fe de ral and local sources has in most cases been sat isfactory,
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 325

our situatio n illustra tes the need for some flex ibility in th is rule fo r 

exceptional cases. In our new bu ild ing appro xim ate ly 25 perce nt of 

the tot al costs will be supplied from local funds. Other cases with 

problems co mparable to Olli’s undoubted ly exist, and I adv ocate ma kin g 

provisions in bill H.R. 4999 fo r exceptions. How ever, to pr event any 

abuses and to answer possible criticisms, I urge th at the con ditions 

under w hich such ex ceptions migh t be gran ted be cle arly defined.

The fol low ing guidelines are proposed in assessing any requ est 

fo r an ex ce ption:

1. Th e evidence of ou tst an ding researc h poten tia l, as determ ine d 

by a com mittee of scientific experts, should be sufficient so as to rat e 

the high est priorit y.

2. Adequ ate evidence must lie s ubmi tted th at ma tch ing fund s on a 

50-50 basis h ad been sought dilig en tly b ut could not be obtained.

3. Ad equ ate proo f mu st be given th at the ap plican t insti tutio n is 

doing its par t in prov idi ng fund s fo r the construc tion of needed 

bui ldings.

4. Th e facility in question mu st be devo ted to an aspect of hea lth 

research of benefit to all ma nkind bu t of a type f or which t here is no 

need to have one in every Sta te ; there would, there for e, be no just 

reason to require the local source to pro vid e full matc hin g funds.

The numb er of str uctur es th at would meet all the above req uir emen ts is n ot larg e. For exceptional cases, 1 believe t hat F edera l suppo rt might go as hig h as 75 perce nt when adequa te proo f of me rit 

and need has been e stab lished according to th e above points.

In addit ion , I wish to stre ss the need for an increase in the total 

funds pro vided for research facilities. W ith in the las t few yea rs 

the re has been a significant increase in the av ail ability of rese arch 

fun ds an d of trained , expe rt scie ntists. It is evid ent t hat a c omparable 

increase in researc h fac ilities is now needed to house the new pro jec ts 

and personnel. If we are to proceed most effectively in the str ug gle 

to conquer disease, it is nece ssary to doub le or trip le the fund s now 

ava ilable for construction .

Ina sm uch as adequate lib ra ry fac ilitie s are an integ ral par t of research. I also urg e that bill H.R. 4999 be amended to pe rm it construction o f lib ra ry faci lities associated with healt h researc h facilities, such 

allo cation s to be made on a 50-50 ma tch ing basis only.

I t is m y un de rst an din g t ha t an othe r p ar t of bill H.R. 4999 will provide fund s fo r the con stru ctio n of tea ching fac ilities at med ical 

schools. Because more stu dents will be needed to fu rn ish sufficient 

num bers of phy sician s to care fo r the ex panding population and to 

cond uct clin ical researc h prog ram s in the variou s fields of medicine, 

I endorse this proposal enthu sia stic ally.

Th an k you, Mr. Ch airma n, for the privilege of presen tin g this 

ma terial.

Mr. Macdonald. Th an k you very much , Doctor.

Ar e th ere any questions ?

Mr. Younger. I have one question. You are pa rticul ar ly interested in the cancer research ?

Dr. R us cii. Yes, sir.

Mr. Younger. You ask for more money. Did you he ar the Secre ­

ta ry o f IIFAV say the oth er day th at Congres s had ap pr op riated more 

money fo r HEW in health and rese arch than they could spend?
326 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Dr. Rusch. I did not hear his testimony. However, in answer to 

your question, there were insufficient funds for facilities construction.

Mr. Younger. That is all, Mr. Macdonald.

Mr. Macdonald. Mr. Collier?

Mr. Collier. I have just one question, Doctor. In the final para ­

graph you point to the need for increase in total funds providing for 

research facilities.

It is always difficult to measure the merit of this type of legislation 

in dollars. Unfortunately, we who are legislators are obliged to do 

that, distasteful as it might sometimes seem.

Where would we expand the projected cost of this bill without cutting in some other area ? In what area of any Federal program would 

we remove from the established budget enough to take care of this 

expanded need for these funds ?

Dr. Rusch. Sir, if I could answer that, question, I would probably 

be in a field other than I am now engaged in.

Mr. Collier. I might suggest that in looking at our national debt 

and the demands before Congress this year th at perhaps I should, too. 

That is all I have.

Mr. Macdonald. I just have one short question, Doctor. In your 

statement, on page 2, you say that, when special circumstances are 

present, certain guidelines would be followed; No. 1, you say, as determined by a committee of scientific experts. From what field would 

these scientific experts come? Would they be governmental scientific 

experts?

Dr. Rusch. I had in mind that this would be done by the Council 

on Health Research Facilities that now exists or a comparable committee.

Mr. M acdonald. What is their present function ?

Dr. Ruscii. Their present function is to determine the needs of various institutions and to assign priorities to the various approved 

applications. I think everyone who has had occasion to deal with 

this committee has felt that they have acted very wisely in every case.

Mr. Macdonald. You would indicate tha t tha t would be the committee that you referred to in your guidelines ?

Dr. Ruscii. Yes; the only reason I did refer to them specifically is 

because I was not certain whether the committee would be reconstituted.

Mr. Macdonald. Thank you very much, Doctor.

Dr. Rusch. Thank you.

Mr. Macdonald. Is Dr. Poor here of the University of Florida?

Will you come forward, sir?

STATEMENT OF RUSSELL S. POOR, PH. D., PROVOST, J. HILLIS

MILLER HEAL TH CENTER, UNIVERSITY OF FLORIDA, GAINESVILLE, FLA.

Dr. Poor. Mr. Chairman, members of the committee, my name is 

Russell S. Poor. I am provost of the J. Hillis Miller Health Center 

of the University of Florida. We have in this center four colleges,
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 327

the college of medicine, nursing, and health related services, and pharmacy, and a 400-bed teaching hospital.

I would like to make it clear th at I am a Ph. D. and serve the function in this university as coordinator of these colleges, somewhat in 

the same fashion they do in other institutions by vice presidents.

I have a statement to submit. I will skip over it in the interest of 

time and catch some of the highlights.

Mr. Macdonald. It will be received for the record.

(This statement submitted by Dr. Russell S. Poor, follows:)

State m ent S ub mit te d by Dr. R u ss ell S. P oor

Mr. C hai rm an and mem be rs of th e co mmitt ee , my na me is Rus se ll S. Po or. 

I am pr ov os t of th e J. H ill is M ill er H ea lth Ce nter, U ni ve rs ity of F lo ri da, 

Gaine sv ill e, F la . O ur he al th cente r co ns ists , a t pr es en t, of fo ur colleges 

(m ed ici ne , nu rs in g, ph ar m ac y, an d healt h re la te d se rv ices ) an d a 400-bed 

te ac hi ng hosp ital an d cli nic s. A ne w colle ge of den tist ry is anti ci pat ed w ithin 

a few ye ar s. I am a Ph . D. an d my adm in is tr ati ve du ties are th os e of a vice 

pre si de nt co or di na ting fo r th e pre si den t are as of th e un iv er si ty ha vi ng to do 

w ith he al th . I am ho no red to ha ve an oppor tu ni ty to spea k briefly co nc erning 

H.R. 8833, in tr odu ce d by a good fr ie nd of th e U ni ve rs ity of Flo ri da, th e H on or ­

ab le C har le s B. B en net t fro m Ja ck so nv ill e, Fl a., an d th e co mpa nion bills H.R. 

4999 (H arr is ) an d H.R. 8774 (S ta ggers ).

Ne ed fo r m ed ical an d ot he r he al th re la te d teac hing fa ci lities

C on stru ct io n ne ed s fo r th e 85 med ical scho ols in th is co untr y hav e be en a 

m att er of studi ous co nc ern by th e American A ssoc iatio n of Medica l Co lleges 

fo r se ve ra l ye ar s. The se stud ie s are re por te d an nual ly in th e ed uca tiona l 

nu m be r of th e Jo u rn al of th e American M ed ical Assoc iatio n. No oth er st udie s 

are as de ta iled as th os e of th is or ga ni za tion .

The la te st d ata on co ns truc tion ne ed s fo r ed uc at io nal fa ci lities as of 1960 

were pr es en te d an d ad dr es se d to all dea ns of U.S . med ical sch oo ls as m em or an ­

du m No. M62 -1 by th e AAMC da te d Ja n u a ry 5, 1962. I ha ve th es e d ata br ok en 

down fo r th e so ut he as t reg ion .

The do llar va lu e of ne eded new co nst ru ct io n an d m od er ni za tion of exis ting 

st ru ctu re s is $518 million, over $100 mill ion a year fo r 5 ye ar s. I t is es tim at ed 

th a t th is sum cou ld m ak e possi ble an in cr ea se of sp ac e av ai la ble to ente ri ng 

first-ye ar med ical st udents so as to in cr ea se th eir nu m be r from 8,188 to 9,894, 

or slig ht ly m or e th an 20 pe rcen t. Si xt ee n S ta te s in th e so uth east regi on 

need $129.6 mill ion, or ab ou t 25 pe rc en t of th e to ta l es tim at ed . T his sum wou ld 

en ab le th e 27 med ical sch ools in th es e S ta te s to in cr ea se th e nu m be r of th eir 

first-ye ar m ed ical st udents by 338.

Pla nn in g an d co ns truc ting a new med ical sch oo l is a time-co ns um ing oper atio n. At th e U ni ve rs ity of Flo ri da we de vo ted a fu ll yea r (19 52 -53) to th e 

st ud y of ou r S ta te 's need fo r he al th re la te d pe rs on ne l an d th e ro le of th e 

un iv er sity in med ical an d re la te d ed uc at io n. D uring th is pe rio d a ph ilo soph y 

of medica l an d re la te d ed uc ation w as de sig ne d to me et th e S ta te ’s ne eds. Li ke ­

wise, sc he m atic pl an s w er e develope d fo r th e st ru ctu re s re qu ired by th e type 

of ed uc at io n ad op ted. Th e S ta te le gis la tu re pr ov id ed fu nds fo r co ns truc tion 

an d ne ce ss ar y te ac hi ng eq uipm en t th e nex t yea r. Cl as se s were ad m itte d to 

th e new colle ges of med icine an d nurs in g in Se ptem be r of th e fif th yea r (1956) 

follo wing th e in it ia ti on of plan ning . O ur 400-b ed te ac hi ng ho sp ital an d cli nics 

rec eive d its firs t p ati ents 26 mon th s la te r, or 6 years an d 7 mon th s (O cto be r 28, 

1958) a ft e r th e in it ia ti on of plan ning .

If we sa y 5 yea rs a re requ ired fro m th e be gi nn in g of pl an ni ng to the ac ce pt ­

an ce of a fi rs t-ye ar clas s of med ica l st udents , th en it will be 9 yea rs from 

th e same po in t in tim e be fore th e first cl as s ca n be gra duat ed . Ad d an in te rn 

yea r an d 2 years of m ilitar y duty an d it will be ne ar ly 12 yea rs be fore th es e 

fir st st uden ts are re ad y fo r ge ne ra l pr ac tice . To becom e a sp ec ialis t fro m 2 

to 5 ad ditio na l ye ar s, or a po ssibl e to ta l of nea rl y 17 ye ar s, are re qu ired be fo re 

a su rg eo n is co m pe te nt to pr ac tic e.

It is fo r th es e re as on s th at tim e is so ve ry im port ant in pla nn in g sp ac e fo r 

th e pr od uc tio n of pra ct ic in g ph ys icians . T hi s is es pe cially t ru e w hen new sch oo ls 

are co nc erne d. As a rule, th e m od er ni za tion of old st ru ctu re s ca n be acc om -
328 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

plished in somewhat less time and while classes continue, but there are enough 

exceptions to make this a had risk. It is not within the purview of our discussion 

to analyze such pertinen t questions as the time required to obtain a quality 

faculty or the recruitmen t of well qualified applicants.

AAMC Memorandum No. M02-1, referred to above, has other interesting data 

relative to non-Federal matching funds. Only 2 of the 85 schools (Puerto 

Rico not included) in the United States believed they could raise as much as 

66 percent of the needed funds. Eight schools did not re ply; 8 said they could 

rais e no non-Federal money from any source; 50 thought they could raise up 

to one -tliird; and 17 believed they could obtain up to 50 percent of the construction funds needed.

It is significant to examine the estimates made by medical schools of the 

Southeast (region II as used by N1H, plus 3 States making the 10 so-called 

compact States of the Southern Regional Education Board ). There are 27 

medical schools in this region (17 public, 10 priva te) . With regard to obtain ing non-Federal matching funds, 1 of the 27 said it could obtain no matching funds while 7 did not answer the question, probably indicatin g the same 

thing. Nineteen out of 27 schools (70 jiercent) in this region believed they 

could obtain about one-third of the ir total needs. In other words, 70 percent 

of the 27 southeastern medical schools feel they need a 2 for 1 rati o of Governm ent funds to local money.

All States in the southeast region are generous j>ercentagewise in the ir support of education from tax sources. The real difficulty is a relatively lower 

tax revenue rat her tha n an unfavorable attitu de toward or an unwillingness 

to suport medical education. The need is great but the ability of these States to 

provide matching funds is relatively low.

Scholarship grants (pt. C, p. 15)

It is a fam iliar fact that the cost of medical and dental education is a cause 

for many students refusing to enter these fields and likewise a cause for many 

dropouts. The American Association of Medical Schools endorses a strong 

program of financial assistance combining nonrefundable gra nts and loans.

The ninth annual legislative work conference sponsored by the Southern 

Regional Education Board in August of 1900 (1959 data provided by AAMC) 

summarized the problem of financial assistance to medical students as follow s:

“Today the South’s need for doctors is one of its most pressing problems. 

But the number of applican ts to its medical schools has dropped steadily since 

1957.

“As the need for doctors increases and the number of medical students decreases, the cost of medical education to the student is risin g and discouraging 

still more potential students from entering the long traini ng program.

“The cost of medical training in the South is on a par with the cost of such 

tra ini ng in other p arts of the country.

“Four years of medical education in the South now costs an unmarried stu ­

dent $9,689. The cost for a married student increases to $12,397 and the figure 

goes up proportionally as the stud ent's family gets large r.

“There are several standard sources of funds for the medical student. Eighty 

perc ent of his costs are defrayed by g ifts or loans from family. Other sources 

include his own earnings, his wife’s earnings, and in-law contributions; loans 

from the medical school or local financial agencies: scholarships from medical 

school or other organizations, and other miscellaneous sources, such as the GI 

bill and savings p rior to the time of entering school.

“Though scholarship aid is not readily available in all cases, roughly onefourth of the students in all U.S. medical schools receive some am ount of scholarship aid.

“The students themselves, in a recent poll, suggested more loan funds to be 

paid back after the student began practicing.

“Any such program should—

“ (1) Leave the stud ents free to select the school of the ir choice.

“ (2) Impose no obligation upon studen ts’ pos tgra dua te training or practice prerogatives.

“ (3) Be sufficient so tha t the student is not forced to turn to ex tra ­

curricular work to the (detrim ent) of his study effort.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 329

“ (4) Be sufficient so that upon grad uation the studen t's accumulated debt 

does not unreasonably hamper his fu rth er education.

“ (5) Leave the medical school free to determine the balance between 

loan and scholarship assistance which is app ropriate for the individual 

stud ent.” In addition to the cost to the student, there is, of course, a considerable cost 

to the professional school and the university over and above income from tuition. 

“A fairly well estab lished current figure shows that it costs the medical school 

between $2,000 and $3,000 per und ergraduate medical studen t j>er year,” according to Dr. I^ee Powers of the AAMC.1 *3

Therefore, the provision in the bill under discussion (II.It. 8833, pt. C. sec. 

740(D), p. 17) which recognizes this cost to the institution by proposing an 

allowance to each school of ”$1,000 for each of its stud ents who is awarded a 

scholarship” is both realistic and commendable.

Ext ension and strengthening of health research facilities ip. J8)

From my knowledge of universities and hospitals in general, and those in 

the 10 southeast regions in particu lar. I am convinced the annual rate of i>ermissihle Federal spending under the Health Research Facilities Act (Pub lic 

Law 87-395) should be increased to at leas t $100 million per year if we are 

even to approximate estim ated needs in this vital area . There are a number 

of ways of reaching this conclusion.

First, evidence has been, or will he, presented to show that for each dollar 

of operating expense for research by medical schools there should he $1 ava ilable for research facilitie s construction. During the 5-year period 1957-61, 

operating expe nditures increased about. $320 million. In this period the g ranting program under this act produced $150 million, which was less than 50 pe rcent of the capital construction needed, if we assum e the ratio cited above to 

be valid. I believe the rati o of $1 for capital structur e for $1 of operatin g expense in research areas is realistic. We are indebted to Dr. Robert A. Moore, 

president of the Downstate Medical Center of the Sta te University of New York, 

for this convenient figure. Second, data collected in early 1901 shows an anticipated need for health 

research facilitie s construction matching funds on a 50-50 basis for 11X53, 11X54 

and 1905 to tota l over $424 million, or approxim ately $141 million per yea r? 

Of course, the sums institu tions expect to apply for and the overall dollar value 

of finally approved gra nts are two different things, as was pointed out in the 

testimony cited. Recognizing some shrinkage from total applied for to the 

tota l approved. $109 million annually would app ear not to be excessive.

It should be emphasized that this $141 million is the total for those institutions which believe they can obtain fund s necessary to match this amount of 

Federal money dollar for dollar. Eight institution s did not respond to the 

questionnaire. None of the 27 medical schools in the 10 Southeastern States 

considered it likely that they could obtain matching fund s up to 50 i»ercent * 

for new construction or remodeling of old medical school buildings. Of the 

southeastern medical schools 70 percent (17) believe they can secure matching 

fund s up to 33% percent.

Third, there is the strain placed upon Sta te resources to meet the demands of 

the ir tota l needs for higher education. This situ atio n is especially acute in 

a number of Southeastern States. I have visted within the last few yea rs some 

30 to 32 institutions of higher education in this region. They have crowded 

every square foot of space available for research. Some situatio ns I have seen 

are incredible. It is considered reasonable policy to allow a minimum of 200 

squa re feet per research worker, yet I have seen many situ atio ns where considerably less than one-half that amount per man is all there is available. When 

the Hea lth Research Facilities Act was enacted into law the accumulated 

backlog of need up to that date, 1957, was doubtless in excess of $700 million 

because the $150 million supplied by Fed eral matching during those 5 years

1

 S outhe rn Regional Educa tion Board, Ni nth Ann ual Legislati ve Con ference Rep ort,

Augus t 1960, p. 4.

3

 S7th Cong., 1st sess.. hen rlngs before the subcom mittee of the Com mittee on Ap propria ­

tion s, U S. Sen ate (for 1962). pp. 1075-1079.

•AAMC Mem orandum No. M 62-1, Issued Ja n. 5. 1962.

80014— 6! 22
330 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

produced projects valued at $671,418,438; i.e., the 323 ins titu tions receiving 

Federal funds raised $521,431,056.*

When we started construction of our medical sciences building at the University of Florida in Jan uary 1955 we planned about 25 to 30 percent of our space 

for resea rch and most of that was for the preclinical sciences. We reasoned 

we should be able to obtain Sta te funds more readily for clinical research space. 

This has not happened because of the urgent need elsewhere on our campus. 

Now our original space is badly overcrowded. Some relief has come from the 

occupancy (September 1961) of a new basic research wing of 22,736 square feet. 

One-half the cost of this building was provided by Health Research Facilities 

Act funds. This new building, however, is hardly one-half the size we originally 

planned, once again because we had insufficient matching funds. We are not 

ung rate ful for what we have but we ce rtain ly are not meeting the needs of our 

staff nor are they contributing what they might to the resea rch needs of the 

country.

Fourth, in the hearings before the 87th Congress previously cited4 * it was shown that the estimated needs for Federal funds on the current 50-50 matching basis for 1963, 1964, and 1965 construction, exclusive of hospital needs, 

amounts to $364,683,363 for health-relate d educational and research purposes, 

which is somewhat in excess of $100 million per year.

As a university adm inistrator responsible for health affairs, I am deeply 

concerned about the poorly understood term “balance” in medical schools. By 

“balance” is meant the ratios of expenditures resu lting from the teaching, 

research, and service functions. As has been pointed out, unfortu nate ly, there 

is no concrete evidence to show whether the emphasis on sponsored program s 

and the financial growth of medical schools during the las t 4 years has been 

healthy or unhealthy. Some schools are spending more than five times as much 

for research as they are for undergraduate medical education, and in some 

departm ents the full-time research work ers outnumber full-time facu lty members 

by more th an 10 to 1.” ’

While I firmly believe the National Advisory Council for Health Research 

Facilities should have available at least $100 million per yea r to meet research 

construction needs, the facts seem to prove tha t medical education needs a like 

amount as was stated earlier. The bill we are referring to today calls for $45 

million annually for new teaching facilities and $15 million for replacement or 

rehabilitation of existing teach ing facilitie s for medical, public health, and 

dental schools. The third stipulation is $15 million for new teach ing facilitie s 

for the train ing of dentists.

Here is another instance where the “balance” factor enters. The backlog of 

needs in both educational facilities and research facilitie s is so g reat as to make 

one wonder whether grants to one in excess of the other is furth er exaggerating 

the imbalance between the two which probably exists in several universities today. Approximately thre e times as much money is allocated by the medical 

schools for research facilitie s as for tea ching7

 at the present time.

Inh ere nt in all the foregoing designed to ju stify matching g ran ts for new teaching facilities , scholarships for needy students, and research facilitie s is the need 

for li brary facilities which will be demanded by any program which increases the 

number of academic and resea rch personnel and students.

Few quantita tive data are available to sub stan tiate the need for more library 

facilities for health-relate d (ields. As one visits these librarie s, only the most 

recently built seem to be ad equa te in size. In our own case at the University of 

Florida, we provided space for 80,000 volumes when our health center opened in 

1956. We now have over 90,000 volumes. For medical studen ts our library is 

used largely for reference work only since each student has a private study 

cubicle. Conditions vary from school to school but it is safe to say most of them 

are in serious need of space.

The latest study was made by questionnaire in 1957 as reported by Fry and 

Adams.*

4

 8 7th Conj?., 1 st seas., op. ctt. tab le on p. 1074.

B Op. clt. table on p. 1078.

’ Journa l of the American Medical Associatio n, vol. 178 (Nov. 11), 1961, p. 590. 7

 Idem., p. 586.

"P ry , Alderson and Adams, Scott, “Medical Lib rar y Ar chitectu re In the Pas t 50 Te ars,” 

Bullet in of the Medical Library Association 45 : 471—479 (October 195 7).
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 331

Some of th eir m ajo r c on clu sio ns wer e as fo ll ow s:

“O f th e li bra ri es replying on sch ools, 45 of them , they ra nge in ag e from 

1834 to 195 7: 11 pe rc en t were built be fo re 1900, 9 pe rc en t be tw ee n 1910 an d 

1920, 30 pe rc en t in th e tw en ties , 13 pe rc en t in th e th ir ti es, and 35 per ce nt 

sin ce W or ld W ar II. “T he se li bra ri es ha ve te nd ed in t he p ast t o do ub le in siz e ev ery 12 yea rs — 

a t le as t from 1927 to date. “T he re port show s th a t 88 pe rc en t of th e l ib ra ri es are pla nn in g sign ifi ca nt 

a lt e ra ti o n s; 27 pe rc en t are ad di ng stac ks , an d 31 pe rc en t w ant new li bra ri es 

ve ry soo n. And if prev ious p att ern s are fol low ed, 20 per ce nt of th es e new 

li b ra ri es will be o ut o f s pace w ithin 9 y ea rs.

“In th e la st 50 yea rs th e exte rn al fo rm of th e libra ry h as follo we d th e 

dic ta te s of s ur ro un di ng arc hit ectu re o r cu rr en t st yl es of th e tim e. Ther e ha s 

been a gra dual gr ow th in th e siz e of li bra ri es in te rm s of sq uar e feet. Mate ri al has grow n a t th e ge om et rica l ra th e r th an an ar ithm eti cal ra te . Li ­

bra ri es are coming dow nst ai rs an d n eare r th e en tran ce , an d while th ere is 

of co ur se in te llig en t an d unin te ll ig ent pl an ni ng , th e ov erwhe lm ing ne ed is 

simply fo r mor e an d more sq ua re f ee t.”

Fin al ly , if I may, I wo uld like t o ex pre ss a pe rs on al op inion ab out th e prop os al 

in II.R . 8833 an d its compa nion b ill s to es ta blish a new N at io nal Adv iso ry Council 

on Edu ca tion fo r H ea lth Pr of es sion s (se c. 725, p. 11 ). As you know , th e N at io na l 

In sti tu te s of H ea lth has a Natio na l Adv iso ry Co un cil fo r H ea lth R es ea rc h Fac ilitie s. Thi s Co uncil h as fu nc tio ne d mos t eff ici ently a t m in im al co st to th e Go ve rnm en t sinc e 1957 in th e a dm in is tr ati on of g ra n ts fo r re se ar ch fa cil it ie s in med ical 

sch oo ls an d re la te d fields." Es pe cially in med ical, d en ta l, an d pu blic hea lth schools 

an d prob ab ly also in os te op athi c sch ools, re se ar ch an d in st ru ct io n are so in ti ­

m at ely as so ci at ed as to mak e th e differen ce on ly one of th e det ai l whe n pl an nin g 

fa ci lities fo r ho us ing ed uc at io na l ac tivitie s. The m em be rshi p of th e prop os ed 

new N at io na l Adv iso ry Council on Edu ca tion fo r H ea lth Pro fe ss io ns could no t 

differ in an y sign ifi ca nt way from th a t of th e N at io na l Adv isor y Co uncil fo r 

H ea lth Res ea rc h Fac ilitie s. The se tw o Co un cil s wo uld ha ve ve ry clos ely re la te d fu nc tion s an d wo uld be un ne ce ss ar y du pl ic at io n. Th e la tt e r Co uncil has a tr e ­

men do us am ou nt of d ata an d ex pe rien ce which is alm os t id en tica l w ith th a t 

which wo uld be re qu ired by th e prop os ed ne w Co uncil. Why m ul tipl y ad m in is ­

tr ati v e co sts th ro ug h a du pl ic at in g org an iz at io n? Also , sin ce th e mem be rshi p of 

N III co un cil s is dra w n larg ely from univ er si ties an d th e nu mbe r of suc h pe rs on s 

now se rv in g on stud y sections an d co un cils is ve ry co ns id erab le an d univ er si ty 

pe rson ne l qu ali fie d to fill su ch as si gn m en ts a re in sh ort supp ly, dup lica tion of 

ef fo rt sh ou ld b e c ar ef ully av oid ed.

Dr. Poor. Thank you, sir. In a recent survey that was issued on Janu ary 5 by the American 

Association of Medical Colleges, the total value of needed new construction and modernization of existing structures was estimated by the schools to be $518 million. This was considered on a 5-year basis in excess of $100 million per year. It was estimated that this would 

increase the number of students entering the first year classes in medical schools by 1,706. I would like to emphasize the southeastern section of the country, 

which I have the honor to represent, as broken out of these figures 

which did not appear in the original memorandum as it was issued 

but I have asked the association to do that for me and these figures, 

I think, will be helpful. The estimate for the 27 schools that are in the Southeastern 16 

States making up the area that is covered by the Southern Regional Education Board was for $129.6 million, or about a quarter of the 

rotal estimated for the country. Of these schools, 17 are State schools 

and 10 are private.

® 87th Cong., 1st sess., hearings before the subcommittee of the Committee on Appropri­ ations, U.S. Senate (for 1961). See table on p. 1080.
332 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

It lias been stated here a numb er of time s the len gth of time re ­

quired to produce g radu ate s o f these schools, from the tim e a pp ro pr iations are made, and I thi nk it is important to emp hasize that this was 

our experience in Florida. We opened our school in 195C, in Sep tem ­

ber, and our period of time from the begin nin g of plan ning was 5 

yea rs before we accepted the first studen t.

If one pro jects thi s student on throug h grad ua tio n to the M.D. and 

inter nship , a c ouple of yea rs in the militar y service and perha ps even 

going on to an advance d specialized surgeon, as much as 17 years would 

be consumed in this process.

Am ong the Sou the astern Sta tes, 70 percen t of them fel t th at the 

best they could do was to raise no more than on e-t hird of the amount 

as a ma tch ing fun d. The 50-50 ma tch ing pla n the n perhap s, if one 

tak es a national survey and in pa rti cu lar the sou theastern survey, 

ap pa rently would impose upon them a ta sk w hich the y feel they could 

not assume.

In our own case, the State of Florida financed the entire medical 

school with two exceptions.

We received some G overnm ent fun ds in he lpi ng us to construc t the 

reh abilitation center appro xim ate ly a little less than a qu arter of a 

million dollars and we have recentl y h ad a g ra nt tha t provide d us oneha lf of the funds necessary to produce a basic medical science win g 

under the He alt h Researc h Fa cility Act. Th is bu ild ing was only 

one-h alf the size we ha d plan ned because we could not raise any m ore 

matc hin g funds.

When we built ou r school, which is new now, ha ving grad uated jus t 

two classes, we p rov ide d more research space fo r the basic sciences in 

medicine than we d id for the clinical sciences because we felt th at it 

would be e asier f or us to get these supplemented throug h State fun ds 

and priva te gra nts .

Up to this time we have been unable to do this. So it is an honest 

estimate to say that every availab le square inch in our bran d new 

build ing is jam med full of research at thi s moment and we still do not 

have the prop er amount of clinic al rese arch going on.

We are very g rateful for w hat we have.

Th is ap prop ria tio n from the State of Fl or id a will appro xim ate 

$30 m illion up to this point, and the needs of th e rest of the unive rsity 

and the oth er univer sities in the State are jus t so grea t th at they 

will not place us on the prio rit y list.

Th ere is a po int or two that might be made in reg ard to the 

sch ola rsh ip aspect of thi s bill which 1 have not heard in toda y’s testimony, although it may have been given earlie r. Th is was the rep ort 

of the Ninth Annua l Legislative Wo rk Conference supported by the 

So uthe rn Regional Ed ucati on Board and the da ta was published in 

Au gu st of I960. A numb er of th e familiar sta tem ents about the need 

for doc tors are con tain ed the rein but I have some exa ct figures th at 

are give n on the estimate of cost for medical stu dents at th at time. 

Fou r years of medical edu cation in the So uth now costs an un married student $9,689. The cost for a marrie d stu dent increases to 

$12,397 a nd increases fu rth er , of course, as his fam ily enlarges.

Th is legisla tive work conference also reporte d a survey of all the 

stu de nts in the up pe r years of medical schools in the Sou the ast and 

I thou gh t some of the conclusions mad e by the stu dents survey 

might be helpfu l. I will mention jus t a few.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 333

They should leave the student free to select the school, impose no 

obligation upon the student postgraduate's training or practice prerogatives. It should be sufficient so that he should not have to do 

outside work.

There was a time when work outside of medical school was possible 

but we find that this is highly impractical now. The speed and the 

content of medical education is so great that this is very impractical. 

We find students breaking their health if they are permitted to do so, 

so we have practically eliminated such outside work. It should be 

sufficient so that he would not be saddled with a great debt when he 

leaves. This is the student speaking now. It should leave the medical school free to determine the balance between loan and scholarship 

assistance which is appropriate for the individual student.

Of course, in addition to the cost to the student himself, there is 

the cost to the institution and this has been taken into account by the 

bill, ILK. 4999.

I recognize also the companion bill of our friend of the University 

of Florida Charles Bennett, ILK. 8833, from Jacksonville, Fla. This 

estimate has shown that in the South the institutions shoulder a cost 

of somewhere between $2,000 and $3,000 per student. These are just 

for the first 4 years of medical education, not having anything to- do 

with the advanced residency years. Therefore, the bill provides to 

give the institution $1,000. While, from the standpoint of the total 

situation over the country, this may not be realistic, we do think tha t 

State institutions should, wherever possible, shoulder as much of this 

cost as they can. We think $1,000 is, in the light of tha t consideration, a fair sum.

I will not repeat some of the evidence which has been given here 

today, that of Dr. Moore, with which I am familiar.

I would call your attention to some facts that were presented before 

the 87th Congress, 1st session, that showed that the data collected in 

early 19(51 showed an anticipated need for health research facilities 

construct ion and matching funds on a 50-50 basis for the 3 years, 1963, 

1964, and 1965, a total of about $424 million. Averaged over the 3 

years, this is $141 million per year. Now, this is what we thought they 

would apply for. It does not mean that many would be improved but 

we think with the shrinkage that comes from this kind of activity on 

the part of a very fine Council, the Health Research Facilities Council, 

that the $100 million is a little more realistic and represents even considerable shrinkage from what the schools estimate.

The inability of States like our own to be able to raise the 50 percent 

matching funds is based upon many considerations with which you 

gentlemen are familiar. There has been a tremendous expansion of 

university and junior colleges in our State and the costs, the rising 

costs of other things, has made such a demand on the tax dollar in the 

Southeast that this becomes an extremely difficult problem for them in 

order to move as they think they should move. I am sure, in the direction of the supp ort of medical education.

The percentage contribution to higher education in the Southeastern 

States is very good but the total tax revenue is such that they fall 

short of what they would like to do.

It was also shown in the estimates that the need for Federal funds 

on the current 50-50 matching basis for the 3 years I mentioned, 1963, 

1964, 1965, exclusive of hospitals, is something over $364 million for
334 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

both education and research purposes. Th is, too, is in excess o f $100 

million a year.

Fina lly , 1 would like to say a word abo ut the lib rarie s which are 

not specifically named in the bill. But the healt h related fac ilities 

that are provided fo r in the bill migh t conceivab ly include libraries. 

It is cer tain that, when you increase the researc h poten tial we-feel you 

shou ld seriously con sider the e ducational tea ching fa cilities because of 

this thing which we, as u niv ers ity adm inist rators, ha rdly know how to 

evaluate. It is tied up with this thing we call “ba lance,” and we do 

know th at the men to do the research mu st be produced in the schools. 

These thing s require library resources.

In our own case, just a few years ago now, we opened our school 

with a l ibr ary capa city o f 82,0(M) volumes and we now have 92,000, and 

it is going to stifle the gro wth of our colleges if we cannot exp and 

that.

I have rep orted in my wr itten statem ent the last study which has 

been made in the Nation on medical librar ies , dated 1957. I will not 

tak e the time to detail it here, but it will be available when you study 

this legislation.

One final word. I think the He alt h Res earc h Fa cilities Council, 

when they deal with educational facilities, is de ali ng with the same 

kin ds of data and requires the same kin d of peop le to make these 

studies.

Th e bill provide s f or a new council to deal with edu cational services. 

It is my opinion that, this is not necessary. Th e Hea lth Research F acili ties Council has done a fine economical job and they can handle this 

addition al item when the time comes.

Th an k you very much fo r the op po rtu nity to mak e this statem ent, 

Mr. Ch airma n.

Th e C hair man. Th an k you, Docto r, fo r yo ur statement.

Are there any qu estions ?

Mr. Collier. I have one question.

Doctor, you said that, you thou gh t it would be in the best inte rest 

of the p rog ram to pe rm it the medical school to mak e its de terminat ion 

as to wheth er a sch ola rship shou ld be an ou tri gh t gr an t or given to 

the studen t on a loan basis.

Dr . P oor. I quoted the stu de nt survey in the Sou the ast as say ing 

that.

Mr. Collier. This, of course, then , would entail in the case of ou tri ght grants, I pres ume , the usual very len gth y and prop er financial 

statem ent of the p are nts?

Dr . P oor. Th at is rig ht. It would be a m eans test.

Mr. Collier. I have seen some of these college sch ola rsh ip forms. 

Th e opp one nts of medical care pro gra ms based upo n need have attac ked it on the gr ound that requ esting a finan cial statem ent to establish need was indeed embar rassing, to use the arg um ent lig htl y, for 

an eld erly citizen to fill out such a financial s tatem ent .

I wonder if you can help me reconcile why it wou ld be any different 

to ask a pot ent ial doctor to file a financial statem ent to dete rmine need.

Dr. P oor. I do not share the view th at t his wou ld be emb arrassing. 

I th in k the need s hould be justified.

Mr. Collier. Th an k you, sir.

Th e Chairman. Doc tor, than k you very much. We are glad to 

hav e you r statement.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 335

Dr. Fran klin M. Foote, commissioner of the State department of 

health, H artford, Conn.

STA TEM ENT OF FRAN KL IN M. FOOTE, M.D., COMMISSIONER, STATE 

DEP ARTMENT OF HEALTH, HARTFORD, CONN.

I)r. F oote. Mr. Chairman, I appreciate your courtesy in permitting 

me to place on record a statement which was actually prepared by 

the Honorable John Dempsey, Governor of the State of Connecticut, 

who would have been here today himself, hut he had commitments 

tha t prevented his coming either today or tomorrow. He therefore 

asked that I extend his greetings to the members of the committee and 

place his statement on record.

I am commissioner of health of the State of Connecticut, and come 

from Wethersfield, Conn. It is a very fast-growing State in recent 

years, highly industrialized.

You might wonder why a State w ith 1 physician for every 640 people feels the need for more doctors and more dentists. But actually 

we do not have too many doctors even in our biggest cities where they 

are more concentrated. If you try to get an appointment with a physician in one of our largest cities, you may find you have to wait some 

period of time.

In five of our eight large counties, the five more rural counties, we 

have a definite lack of doctors, and this lack has become worse during 

the past 10 years. In Tolland and Windham Counties, respectively, it 

is down to 1 physician to 1,100 persons, and 1 to 2,200 persons.

During this decade when the population increased 26 percent we 

were able to maintain even this proportion of physicians only because 

of importing a large number who had their training from outside 

the United States which represented a 48 percent increase in physicians licensed from outside this country.

Many of our general hospitals in Connecticut, which have internships approved, are unable to fill their quota of interns. The shortage 

was shown in an article which appeared in the September Reader’s 

Digest in 1961 and we are rather embarrassed that the writer of the 

article documented the fact tha t in one of our hospitals they had to 

wait 3 hours before an emergency physician who was on call came 

to take care of a person who had been injured.

Our dentist per population ratio has dropped 12 percent between 

1950 and 1960, and again it is much more severe in the rural areas.

Because of these situations, the Connecticut State Citizens Committee for a Medical-Dental School was organized. The committee had 

before it recommendations which had been made by the New England 

Council on Higher Education recommending medical schools in both 

Massachusetts and Connecticut.

In the same year, the Connecticut Legislative Council, factfinding 

agency of the general assembly, stated that there is no question of 

need for a medical-dental school. It is merely a m atter of financing.

For these reasons, a year ago Governor Dempsey recommended to 

the general assembly an appropriation of $2 million toward starting 

a medical-dental school in H artford County as p art of the University 

of Connecticut.

This recommendation was endorsed by many professional and civic 

groups in the State, was given strong support by both major political 

parties and was approved by the general assembly.
336 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

A commission is at work right now looking fo r a site to place this 

medical-d ental school. Al thou gh the ap prop riation of $2 million 

pro vides an excellent st ar t on this im po rta nt pro jec t, we have no 

hes itan cy in say ing th at Connecticut will be able to do more, have a 

larg er school and have it soon er if Federal fund s are made available 

un der th e provis ions of II.R. 4999.

Governor D empsey wante d me to stre ss his very str on g su pp ort of 

the scholarship p rov isio ns of this bill.

We know t ha t from our g uidance people in the schools of Conne cticu t th at the re are many talented , able young men and women who 

do not even conside r g oin g to medical school or d ental school because 

they know the y cann ot afford this.

We are sure t hat members of y our honorable com mittee will agree 

th at it is not a healthy situa tio n to have 43 perce nt of medical studen ts 

come from the top l i percent of our social economic stra ta, as is now 

the case. It is un fortu na te, too, th at GO percen t of the studen ts in 

medical school where th e w ork is most d em andin g and time co nsuming 

must obta in part-tim e outside work in o rder to pay fo r their expenses.

Like wise, wi th reg ard to the graduate pub lic he alt h edu cation which 

wou ld be supported here, we have a gr ea t many vacancies both in 

the St ate services and in our mu nic ipa liti es fo r tra ined public he alt h 

workers.

So we, therefore, a re stron gly in sunport of provisions which would 

heln schools of public health in this bill.

Th an k you very much, Mr. Chai rman.

The Chairman. Th an k you, Doctor. We appre cia te havin g your 

testimon y.

A re th ere any questions ?

Dr. F oote. I appre cia te vour cou rtesy, sir.

(The sta tem ent of Gov. Jo hn De mpsey follo ws:)

Statement by Gov. J ohn Dempsey of Connecticut

Connecticut, the fas test growing State in the highly industria lized Northeast, 

is concerned about the availability of facilities for medical, dental, and public 

hea lth education. We feel that it is of the utmost importance that such facilitie s be increased to meet an ever growing need.

Since the end of World War II, leaders of the medical and dental professions 

hav e called atte ntion to the fac t tha t it is becoming increasingly difficult for 

Connecticut young people to obtain medical and dental education.

Yale University’s outstand ing medical school, in New Haven, Conn., is able 

to accept, at the most, only 17 Connecticut stud ents each yea r because of heavy 

admission pressure from o ther pa rts of the Nation.

It is significant that the State of Vermont, which has a medical school as part 

of its State university, puts 35 percent more of its students, per 100,000 population. into medical school than does Connecticut.

Connecticut’s rati o of 1 physician to 640 persons probably exceeds tha t of a 

number of States, hut such data gives no comfort to the 5 of Connecticut’s R 

counties where the ratio dropped during the decade between 1950 and 1900. 

Connecticut’s 2 lea st populous counties, Windham and Tolland, have, respectively. a ratio of 1 physician to each 1.124 persons and 1 to each 2,200.

During thi s decade, in which the State’s population increased by 26 percent, 

even this ratio of physicians to population was maintained only because there 

was a 48-percent increase in the licensing of physicians who had received the ir 

training outside of North America.

We have no way of knowing, of course, how many young people have abandoned consideration of a career in medicine or den tistry because of the scarcity 

of educational facilities, even though they have an intere st in such a care er and 

are intellectually suited to pursne it.

We do know that many of our general hospitals, approved for internsh ips 

by the Joi nt Commission on Accreditation, have been unable to obtain their
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 337

quota of inte rns during the past 2 years. A shortage of physicians for emergency service in one Connecticut hospital was noted in an article in the September 1961 issue of Reader’s Digest. Connecticut’s den tist i»er ix>pulation rati o dropped 12 i>ercent between 1950 

and 1960 and, as in the case of the physician per population ratio , the drop w as 

greatest in the more ru ral areas. Because of this situation, a Connecticut Sta te Citizens Committee for a 

Medical-Dental School was organized more tha n 2 years ago und er the chair ­

manship of Mrs. Alexander J. Keller, of Bloomfield, Conn. This committee had before it a specific recommendation made in 1959 by the 

New England Board of Higher Education that “Massachusetts and Connecticut 

extend their programs of publicly suppo rted higher education by estab lishing 

medical and dental schools.” In the same year, 1959, the Connecticut Legislative Council, fa ctfinding agency 

of the Connecticut General Assembly, came to this conclusion : “There is no question of the need (for a medical-dental school). It is purely a ma tter of finances.”

For these reasons, I recommended to the Connecticut General Assembly early in 1961 an appropriation of $2 million toward starting a medical-dental school 

in Ha rtfo rd County as part of the University of Connecticut. The recommendation, endorsed by many professional and civic groups and given stron g supp ort 

by both major political parties, was approved. A commission has been named 

to choose a site and is now working at this task. An appropriation of $2 million provides an excellent st ar t on this imp orta nt 

project. Connecticut can do much more, however, if Federal fund s are made 

available under the provisions of II.R. 4999. Obviously, a larg er school can he built and put into oj>eration in a sho rter 

amount of time if the State of Connecticut does not have to depend on its own 

funds alone. It is also obvious that such a school as is contemplated in Connecticut will grea tly benefit all of New England and, indeed, the entire nor theastern region, even though in all probability prio rity in admissions would be 

granted to Connecticut students. The scholarship provisions of II.R. 4999 are of great importance because of 

the many highly qualified stud ents who are now prevented from obta ining 

gradua te education due to the cost. I am sure the members of your honorable committee will agree that it is not 

a healthy situatio n to have 43 percent of medical studen ts come from the top 

11 i»ercent of our socioeconomic s tra ta, as is now the case. It is unf ortuna te, 

too, that 60 percent of the students in medical school, where the work is most 

demanding and time consuming, must obtain part-tim e outside jobs in order to 

pay their expenses. Gra duate public health education prepares persons who are needed in Federal, 

State, and municipal health programs. The re is a great shortage of all kinds 

of skilled workers who could help close the costly timelag between scientific 

discoveries in the laboratory and the application of this hard-earned preventive 

knowledge in our homes and communities.

These work ers are not sufficiently well paid to be able to endow’ the ir professional public health schools to the extent th at schools of business and engineering. for example, have been endowed.

Because Connecticut now has many vacancies for trainer! public h ealth workers, 

I strongly urge your support of provisions of II.R. 4999 which would aid schools 

of public health.

The Chairman. Let the record show that Dr. Newman C. Taylor, 

chairman of the Legislative (’ommittee, National Dental Association, 

is present observing the hearings, showing the interest of the association in this legislation.

This concludes the witnesses for today.

Tomorrow morning at 10 o’clock, the committee will meet, at which 

time we will hear the representatives of the American Medical Association.

The committee will adjourn.

(Whereupon, at 5:20 p.m., the committee adjourned, to reconvene 

at 10 a.m., Friday, January 26,1962.)

TRAINING OF PHYSICIANS, DENTISTS, AND PROFESSIONAL PUBLIC HEALTH PERSONNEL

FR ID A Y , JA N U A R Y 26 , 19 62

House of Representatives,

Committee on I nterstate and F oreign Commerce,

IFasAm/jtfon, D.C.

Th e com mittee met at 10:10 a.m., pu rsua nt to recess, in room 1334, 

New House Office Bu ilding , Hon. Ore n H ar ris (ch air ma n of the committee ) pre siding .

The C hairman. The committee will come to order.

Th is mo rning, as we constinue hearings on II. R. 4999 and relate d 

bills, we are glad to welcome to t he c omm ittee I)r . Ge rald D. Dorman, 

rep res entin g the Am erican Medical Association.

Dr. Dorman, we a re glad to have you and yo ur associates. I believe 

you ha ve with you Dr. Lel and S. McK ittric k and pe rhaps some other 

whom yo u may id en tif y if you will.

Dr. Dorman. I also have Dr. W iggins he re, who is sec retary of the 

Council on Medical Ed ucation and Hospitals .

The Chairma n. You may have a seat and , if you wish, Dr. McKittrick and Dr. W igg ins may join you.

Dr. Dorman. Th ey will not mak e a s tatem ent, Mr. Har ris, but they 

will be here for the pur pose of answering questions.

The Chairman. Very well. You may proceed.

STATEMENT OF DR. GERALD D. DORMAN, ACCOMPANIED BY DR.

WA LTER S. WIGGINS AND DR. LELA ND S. McK ITT RIC K, ON BEHA LF OF TH E AME RICAN MEDICAL ASSOCIATION

Dr. Dorman. Mr. Chairma n and mem bers of the committee, I am 

Dr. Ge rald D. Dor man of New Yo rk Cit y. I am ap pe aring here 

tod ay as a mem ber of the boa rd of tru ste es of the Am eric an Medical 

Association. I am also second vice pre sid ent of, and medical consu lta nt to, the New York Life Insuran ce Co.

W ith me are Dr. Lelan d S. M cK ittric k of Bro okline, Mass., and 

Dr. W alter S. Wigg ins of Riv erside , Ill ., chairma n and sec retary , 

respective ly, of the Council on Medical Ed uc ati on and Ho spita ls of 

the Am eric an Medical Associatio n.

Th e Am eric an Medical Association is a natio nal asso ciation of 

approx im ate ly 180,000 phy sicians. Th e association, since its inc eption, has continuo usly worked towa rd increa sing the n um ber o f qu alified physic ians . In th e p ast 10 ye ars, the association, in collaboration 

with the Associatio n of Am eric an Med ical Colleges, ha s aided in te rested org aniza tions in the establishment of six new med ical schools. 

Cu rre ntly, com mitmen ts have been obtained fo r an othe r 5 schools 

339
340 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

and we a re in con sultation with 16 insti tutio ns or org aniza tions pre sently conte mp lating the establishment of newr

 medical schools.

The Americ an Medical Associatio n has a s erious and long s tan ding 

interest in main taining the high qu ality of medical edu cation in the 

Un ited State s witho ut which the re can not be high quali ty medical 

care. Fo r over a c ent ury , th e Am erican Medical Association has been 

actively and effectively engaged in the imp rovement of medical education in the Un ited States. It can now be said, with assuranc e, th at 

medical edu cation in this country is supe rio r to that found anywhe re 

else in the world. It is not a coincidence th at the improved sta nd ards 

of medical care in the last ha lf centu ry saw the elim ination of sub ­

sta nd ard medical schools and diplom a mills which had been tu rn in g 

our gradu ates in large num bers. Th is imp rovement in medical edu cation is the result of the vigorous effo rts of this assoc iatio n and oth er 

inte rested org an ization s.

Recogn izin g the problems in the field of medical edu cation, the 

American Medical Association for the p ast s everal yea rs has endorsed 

a l imited pro gra m of Federa l aid to medical schools.

In Ju ne of 1955, the American Medical Associa tion support ed the 

medical school con stru ctio n provisi ons con tain ed in II.R. 4743, 84th 

Congress, introd uce d by the late chairma n of this committee, Mr. 

Priest, o f Tennessee.

In Ap ril of 1958, the association favored th e constru ctio n pro vision s 

of II.R . 6874, 85th Congress, introd uce d by the chairma n, Mr. Har ris.

Again in Ju ne 1960, the as so ciation support ed the constru ctio n 

provisi ons of II.R . 6906, 86th Congress, introd uce d by Mr. Fo ga rty, 

of Rhode Island.

I should like to tak e thi s op po rtu nity on behalf of the Am eric an 

Medical Association to respec tfully subm it fo r y our c onsideration our 

views on II. R. 4999, 87th Congress, wh ich is now pen din g before vour 

comm ittee.

It is our u nd ersta nd ing that this bill would amend the Pu blic Hea lth 

Serv ice Ac t to prov ide :

(1) Matc hin g gr an ts for the con struction , repl acement, or re ­

ha bil ita tio n of medical schools;

(2) Gr an ts fo r scholars hips and rel ate d g rant s to p ar tia lly meet 

the cost of instru ction at medical schools;

(3) For an extension and exp ansion of the research fac ilities 

con stru ctio n pro gra m.

I shall discuss in pa rti cu lar those pro visions of the bill prov idi ng 

for ma tch ing gr an ts fo r the con struct ion , replace ment, or reha bilitation of medical schools.

If the hig h sta nd ards of medical edu cation are to be ma int ain ed, 

increased attentio n must be given to the adeq uacy of physical facilities. the av ail ability of qualified instr uctors and the availability of 

tea ching m aterial and patients f or the clinical phases of medical education. Any a tte mp t to increase th e n um ber of medical students w ith ­

out reg ard to these conditio ns will result in a lowering of th e sta nd ard 

of medical edu cation. At this tim e, pr io rit y should be given to an 

increase in the physical facilities available fo r m edical e ducation.

We believe th at there is need fo r assistan ce in the expansion, constructio n, and rem odeling of the physical fac ilities o f medical schools 

and, the ref ore, a one-time expenditure of Federal fun ds on a match-
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 341

ing basis is justified, where ma xim um freedom of the school from 

Fe de ral con trol is assured.

Th e su pp ort of these pro vision s in H.R. 4999, 87th Congres s, is 

based on the a ctio n of the house of delegates o f the A me rican Medical 

Associatio n tak en initiall y on Ju ne 13, 1951, and reaffirmed on occasions since th at time.

We w ould also urg e th at th e Na tio nal Ad vis ory Cou ncil on Edu ca ­

tion for Hea lth Professions, suggested in the bill, be composed of 

person s sk ille d in the broad aspects of eng ineering, edu cation, finance, 

arc hitectur e, as well as those concern ed with trai ni ng in medicine, 

de ntist ry, or pub lic healt h professions .

A t th is time, I can not supply you with a reco mm end atio n on the 

other sections of H.R . 4999. I wou ld like to acquain t t he comm ittee, 

however, wi th certa in related prog rams which the A me rican Medical 

Ass ocia tion ha s in itiated in th ese areas.

For some tim e, the Am erican Medica l Ass ocia tion ha s been awa re 

of the decline in the numb er of elig ible college stu dents seeking 

adm ission to med ical schools. Th is ap pa re nt sh ift awa y fro m medicine is due, in pa rt, we believe, to the high cost in tim e and money of 

securing a med ical education. Th is tre nd has been acc ent uat ed by 

a dram ati c empha sis on c are ers in science and eng ineering.

A stu dy of th is problem reveals th at the cost to the stu de nt of a 

post baccalaure ate edu cation in othe r sciences is usu ally considerably 

lower th an the cost o f a medical edu cation We have also fou nd th at 

there are many more sch olarships, fell owships, and other finan cial 

aids ava ilable fo r grad ua te stu de nts in fields other th an medicine.

On the basis of these findings, the house of dele gates of the Am erican Medica l Associa tion in Novemb er 1960 establ ished two programs, the objectives of which are com plementary an d inter rel ate d.

Fi rs t, the house authorized a stu de nt hon ors and sch ola rsh ip pr ogra m designe d to focus attention on careers in medicine , to attrac t 

a substan tia l gro up of able stu de nts to prepare fo r adm ission to 

medical schools and to assist financ ially a lim ited numb er of ou tsta nd ing stu de nts who, for fina ncia l reasons, are una ble to pu rsu e a 

caree r in medicine .

Second, the AM A house of delega tes has adopted a stu dent loan 

prog ram designed to alleviate the financia l difficulties of medical 

stu dents and to encourage ca ree r d ecisions in fav or o f medicine. Th is 

prog ram will utilize the princ iple of a sec urity fund, functio ning as 

a suret y agency, to make availabl e unsecured person al loan s at a low 

rat e o f inte res t to med ical studen ts.

Adm inist rativ e costs will 1)© paid by the Am eric an Medical Ass ocia ­

tio n-Ed uc ati on and Research Fo un da tio n. These loan s will be av ailable by m idsp rin g to m edical stu dents , intern s, and res ide nts a nd w ill 

provide each borrower as much as $10,000 over a 7-y ear borro wing 

period.

These prog rams have been adopted with the firm con viction th at if 

they are im plemented with wisdom and vig or the q ua ntity a nd qu ali ty 

of the medical schools’ ap pli cants will be increased. Th e pe rfor m ­

ances of m any medical stu dents will be improve d by the alleviation of 

th eir financial problem s and the profession will the reb y demo nstrate 

a significan t ackn owledgm ent of medicine’s obligation in t his a rea . It
342 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

is logical to assume th at fu rthe r impro vem ent in medical care will 

ultimately res ult fro m i mm edia te po sitive action .

In sum mary, the Am erican Medical Ass ociatio n by its own action 

has given clear recognition to the fina ncia l problems of medical students. How ever, we would like to emp hasize ou r convictio n th at the 

med ical school construc tion provisions should be g iven first legi slative 

priorit y.

The Americ an Medical Associa tion appre cia tes this op po rtu nity to 

make our position known to yo ur com mittee with resp ect to certa in 

provisions of H.R. 4999, 87th Congress, and requ ests that this statement be made p ar t of the record of yo ur hearings.

Dr. McK ittr ick , Dr. Wigg ins , and I will be ha pp y to answer any 

questions th at the com mittee may have.

The Chairman. Th an k you very muc h, Do cto r, fo r yo ur splen did 

statement. I t was br ief an d to the p oin t. 1 am perso nally—and I am 

sure I can speak for th e m embers o f the comm ittee—very gla d to have 

the position of the Am erican Medical Assoc iation on the provisions 

of this bill.

1 am also gla d to hav e an explanation o f the lo ng continuing i nte res t 

of the Am eric an Medical Asso ciation in m aintaining th e hig h quali ty 

of a pplicants to medical schools. I t is certa inly commendable of the 

association tha t you have been as active as you h ave state d in im proving 

medical education in th e U nited States.

I think it was said by the S ecr etary of H ea lth , Ed ucati on, a nd W elfare th at we did h ave superio r medical care available for t he people of 

this cou ntry. Yo ur s tatem ent substan tiates t hat this country has the 

finest the re is in th e wo rld.

A sta tem ent was made befo re this com mittee by two witnesses here 

which also te nds in m y judgme nt to confirm th is fact . Bu t we cannot 

rest on sta tus quo, we can not rest on the fac t t hat we have done a good 

job in this coun try in the past.

Ce rta inl y you recognize this since you are advis ing the committee 

what actions l ooking to the f utur e hav e been tak en by your own association . The re would be litt le need o f my ask ing a ny questions about 

the position which yo ur association tak es in refe rence to constru ctio n 

fund s for m edical schools. Th at position seems to be firm and precise 

and I have no questions about it.

I think it wou ld be h elpful to reca ll the fact t hat this has been the 

position of the as sociation since 1951.

I would like to ask you two or three questio ns tho ugh, about your 

pro gra m of assisting stu dents seek ing adm ission to medical school. 

First, I think it is a laudab le and co mmendable t hi ng fo r the doctors 

of th e c ountr y to recog nize this need and to do som ething about it. I 

think pe rhaps th e only c ritic ism would be du e to the fact th at you have 

not let it be known to the Nation what you ar e doing.

Ap pa rently no t enough people know wh at has been done in th is 

field. Th ere fore, I would like to ask a lit tle more inf orm ation. How 

long has this pro gra m of supplyi ng assista nce to college stu dents 

seeking admission been in effect?

I)r. Dorman. Could I have Dr. W igg ins give yo u th e d eta ils because 

he is closely asso ciated with it.

The Chairman. Yes, we will be gla d to hav e Dr. Wigg ins reply.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 343

I)r. Wiggins. Mr. Harris, the loan provisions of the association 

program will become effective in the spring of this year. The announcement of the program is to be made in the middle of February. 

It is expected that applications from students, interns or residents will 

be received and processed by the first of March. It was only a year 

ago that the house of delegates of the American Medical Association 

approved the general principle of the loan program and honor and 

scholarship program. The details of it have been worked out since 

tha t time.

The honors program has not been settled in all of its details as yet 

and we cannot at this moment say when it will go into effect.

The Chairman. Now you have covered three things here tha t I 

want to break down a little bit. Let us take No. 1, loans. This is 

your first year that you will have an actual program of loans to 

eligible college students?

Dr. Dorman. Yes, sir, that is correct. We have been in the process 

of making the arrangements for over a year.

The Chairman. Yes, I appreciate that. But the program is just 

now being initiated.

Dr. Dorman. Yes, sir. We are speaking now of the American 

Medical Association because on the State level our S tate organizations 

have had programs in effect prior to this.

The Chairman. Yes. Well, I want to talk about the American 

Medical Association now.

Dr. Dorman. Yes, sir.

The Chairman. Now, if it is appropriate, and there is no reason 

why you should not answer it, how much money will the American 

Medical Association have the first year for the purpose of making 

loans to college students?

Dr. Wiggins. Because of the design of the loan programs, Mr. 

Harris, I could not say the funds available will lie limitless, but they 

will be very substantial, in the millions of dollars. The American 

Medical Association will serve as the surety agency for the loans which 

will be made by a bank to the student, intern or resident. This will 

allow the loan to be made at, I believe, one-half of 1 percent more than 

the prime bank interest rate.

The American Medical Association will stand behind every loan so 

that the student need sign no notes, he will need no cosigners, no 

collateral of any kind. The American Medical Association, by standing behind each loan, simply guarantees to the bank that if the student 

does not repay his loan, the American Medical Association will.

The Chairman. Who is going to sign the papers on it ?

Dr. Wiggins. The American Medical Association.

The Chairman. In other words, this is a contract between the 

American Medical Association and the bank and not the student?

Dr. Wiggins. Yes, sir.

The Chairman. But the student’s obligation is worked out and 

made a record of in connection with his application?

Dr. Wiggins. I should add, Mr. Harris, the student will sign his 

own note but he will not need a cosigner. The g uarantor of the note 

will lie the American Medical Association.

The Chairman. Yes. I am glad to get that clarified. I thought 

you said the student would not sign any note or would not do any-
344 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

th in g at all. If you can estima te for the com mittee, how man y students do you expect, to assist und er t his loan pro gra m, ent ering medical 

schools th is fall of 1962 (

I)r. W iggins. We ho nestly don’t know, Mr. Harris , and won't know 

un til the pro gra m goes into effect.

Th e Chairman. Now, applicat ion f or admis sion s a re being accepted 

now for next year, are they not ?

Dr. Wiggins. Th at is rig ht.

The C hair man. By early summer I suppose the decisions on admission will have been made. You would not know un til that time ?

Dr. Wiggins. Yes, sir; th at is r igh t.

Th e Chair man. Who in you r own orga nizatio n take s care of thi s 

prob lem, does t he detaile d admi nis tra tiv e work fo r it?

Dr. Wiggins. Th e Business Division of the American Medical As ­

sociatio n will han dle the business work of it, the kee ping of accounts 

and records.

Th e Chair man. In yo ur Chicago office?

Dr. Wiggins. Yes, sir.

The Chairman. Do you have any ind ication wh eth er there will be 

a few studen ts that will be assisted in th is manner thi s year or a 

num ber, or can you give any indication at all how it mig ht work?

Dr . D orman. I t is very difficult, Mr. Har ris , t o say exac tly. In the 

las t yea rs the re has been close to $U/£ million on loans throug h the 

medical schools to th eir needy stud ents. Those scholarships have 

helped a bou t 2,000 and loan s have h elpe d a bout 3,000. These a re very 

rou gh figures.

The Chairman. Wh o has done that?

Dr . Dorman. Th e medical schools. I t is ex pected t ha t thi s may be 

doubled with this loan pro gra m.

The Chairman. Now, t ha t gives us some idea.

Dr. D orman. I am sorry to be so in definite, b ut t his sho uld give you 

some idea of it.

The Chairman. Tn o ther words, the medical schools adm it ap prox imately 2,000 stu dents who receive scholarship s?

Dr. Dorman. Between 2,000 and 3,000.

Th e C hair man. And under th e loan program s of the medical school 

abou t 3,000?

Dr. Dorman. That is rig ht. Sometimes the same person may get 

a sch olarship and a loan, so there are not necessa rily a total of 5,000.

The Chairman. We ll, th at does give us some idea.

You say that it is entirely possible th at this may be doubled und er 

the AMA program ?

Dr. Dorman. I say it might be, sir. I can not say it will be. We 

have to wait until we have our first y ea r’s experience in.

The Chairman. Out of your experien ce and the inform atio n that 

you have, what perce nta ge of medical stu dents requ ire financial help.

Dr. W iggins. I f my mem ory serves me ri gh t, Mr. Harris , something 

in the ran ge of 30 percen t of medical stu dents have indicated a need 

fo r fu rthe r financial assistan ce beyond all the resources curren tly av ail ­

able to them. These curre nt resou rces incl ude some commercial-type 

loans. Th is program would be fa r more favora ble to the stud ent 

than a com mercia l-ty pe loan. We believe and hope it will replace 

com mercial-type loans so tha t it will be less of a dra in on the student.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 345

Fu rthe r, the prog ram will provide loans to int ern s and residents. 

No one has any experience in this are a, so we c ann ot an tic ipate how 

man y dolla rs or how man y inter ns or reside nts will be involved.

The Chairman. You have fac ilitie s to acce pt some 7,000 to 7,500 

stu dents in th e medic al schools o f th e c ountr y each year. Is that about 

rig ht?

Dr. Wiggins. A lit tle more th an 8,000.

The Chairm an. Un de r the p rop osa l in th is bill we hope to accom ­

plish an increase to aro und 11,000 o r 12,000. So it is going to tak e 

some prog ram over and above wh at you are doing which would encourage and assist students seek ing adm ission to medical school, and 

the bill here proposes a prog ram towa rd th at objective.

Dr. Dorman. Yes, sir.

The Chairm an. I t is going to be absolutely necessary for fac ilities 

to be m ade ava ilable even i f yo ur loan program would become effective, 

would it not?

Dr. Dorman. Yes, sir.

The Chairman. Mr. Sp rin ge r.

Mr. Springer. May 1 say first, Docto r, I want to co ngrat ula te you 

on the objectives in the s tatem ent—m ay I say the bre vity, too. Th is 

com mittee is man y time s bored by 45-page statem ents. Th is one was 

to the point and I think you said all you could possibly say.

I wa nt to pursu e befo re 1 forget it what the chair ma n has ment ioned here. 1 low much m oney do you a nti cip ate , when y ou r progra m 

gets und erw ay, will be ava ilab le for sch ola rsh ip loans each year?

Dr. Dorman. Th ere will be the pr im ary money which we gu ar an ­

tee, which will be in the are a of anyw here from $3 million up.

Mr. Springer. Up to what?

Dr. Dorman. Tha t depends on the amo unt of su pp ort we get 

throug h ou r edu cation and rese arch fou ndation. We have been receiv ing promis es of very large contr ibu tio ns, some from foundatio ns 

in other are as th at are intere sted in edu cation.

Aside from th at there is alw ays a drive for the edu cation among 

the doc tors of th is cou ntry. Some State s require th at every docto r 

who is a mem ber of the St ate society pay $10 or $20 into this f un d as 

pa rt of his membership o bligation.

Tho se fund s we know. Beyond th at —when we get into th e foun da ­

tio ns’ contr ibu tions—I can not give you a specific figure bu t there 

has been ta lk of $10 to $20 million.

Mr. Springer. In addit ion to the $3 million th at you have mentioned ?

Dr. Dorman. That is rig ht. Tha t is why I cannot giv e you the 

up pe r lim it.

Mr. Springer. You are th inking in ter ms toda y of a roun d $15 m illion ha rd cash ?

Dr. Dorman. Possibl v, yes.

Mr. Springer. Th is bill, if I figu re it righ t and you mentioned 

8,000—I think the figure o f 7,200 was mentio ned by the S ecret ary t he 

other day, as th e gr ad ua tin g figure—in my estima te h ere will generate 

30,000 stu de nts in the medical colleges each year.

Now multip lying th at by $1,500, th at would be $25 millio n, and a 

fo ur th of th at would be rou ghly six an d a qu arter million do lla rs is

80014— 6! 23
346 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

all that would be needed if one-fourth o f the e ntire enrollment is ult imately un der thi s bill to be financed by them .

Now, do my figures correspond roug hly with yo ur estimates of 

wha t thi s bill has ?

Dr. Dorman. We estim ate t ha t it may be up to 30 percen t th at will 

need some help.

Mr. Springer. Up to 30 percen t instead of 25 perce nt ?

Dr. Dorman. Yes, sir ; bu t your estimates are correct in the lon g 

run .

Mr. Springer. H ow lon g do you th in k before this will be in 

ope ration ?

Dr. Dorman. It will be in ope ration in the sum mer on a star ting 

basis, bu t I would guess it will not reach its full exten t for abo ut 

5 years.

Mr. Springer. How much do you think you are going to have av ailable for th is incoming class in Septem ber 1962? Availa ble f or loans?

Dr. Wiggins. We would anticipa te, Mr. Sp rin ge r, th at we would 

be able to provide loans for all students who wish to use thi s source. 

Beyond th at I could not say.

Past experienc e with medical stu de nt loan s has been very good. 

The ir rate of defau lt is very, very low.

Mr. Springer. Th e effect of this is for you to gu ara nte e a loan ?

Dr. Dorman. Yes.

Mr. Springer. Now, do you believe th at in Septe mb er of this year 

you will be able to take care of those who want to get a loan from 

a priva te b ank or any len din g institut ion s ?

Do you feel you are going to be able to back all of those loans 

in 1962?

Dr. W iggins. Yes, sir.

Mr. Springer. Fo r every body who a pplies for them ?

Dr. Wiggins. Ye s,sir.

Mr. Springer. Th is 30 percent. I want to ge t thi s in the record.

Dr. Wiggins. I understand the question, but the 30 perce nt that 

I used perha ps canno t be tra ns ferre d total ly to o ur pro gra m. Th ere 

are 30 perc ent of the students who have need fo r fu rthe r financial 

assistance.

Th eir need may or may not be of the ch aracter th at would cause 

them to wan t to pa rticipate in this pa rti cu la r loan pro gra m.

Mr. Springer. Th at is what I am tryi ng to find out so th at the 

record is made on which there can be no doubt when we d iscuss thi s 

bill, as to what exte nt this pro gram is going to be positive assistance 

to the September 1962 en terin g class.

If you cannot supply th at today, can you supp ly tha t fo r t his record 

so that thi s record will lie complete as to wh at your pro gra m will do 

for thi s 30 percen t who need financial aid in one form or another.

If one-th ird is appro xim ate ly 10,000 stu de nts that need it in one 

form or ano ther, $100, $500, $1,000, or $1,500, how many of those 

is your pro gra m going to be able to help, of these 10,000 applican ts 

which you have s tate d possibly will be ne eding help ?

Dr. Wiggins. As fa r as 1 know. Mr. Sp rin ge r, for those who wish 

to p artic ip ate in this loan pro gra m there will lie a mechanism available 

fo r the ent ering class of 1962.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 347

Mr. Springer. Do you mean by ‘‘mechanism ” a pract ica l loan pr ogram under which they can apply and get cash ? Do you mean th at 

by the w ord “mechanis m” ?

Dr. Wiggins. Yes, sir.

Th e Chairman. Will the gen tlem an y ield ?

Mr. Springer. Yes.

The Chairman. I got the imp ression, Doctor, th at an ap plican t 

had to meet certain sta nd ards in or de r to be eligible fo r y ou r program , 

had to be an honor studen t or had to have made a certain record.

Am I m istaken in tha t?

Dr. Dorman. He has to be accepta ble fo r the medical school. He 

has to be accep ted on his record but he does not nece ssarily have to be 

the top of his class. It is not a scholarship.

Th e Chairma n. Them do I un derst and th at any stud ent th at would 

be accepted on app lication to a medical school would be elig ible fo r 

this pro gra m ?

Dr. Dorman. Yes, sir.

Mr. Springer. In sho rt, Doctor, 100 percen t of those who ap ply 

and are accepted, everybody who applies and is accepted is eligible 

fo r a loan und er your prog ram ?

Dr. Dorman. Yes, sir.

Mr. Springer. Now, if you will tu rn to page 1 of yo ur statem ent, 

down at th e botto m you make th is sta te m en t:

In the past 10 years, the association, in collaboration with the Association of 

American Medical Colleges, has aided interested organizatio ns in the establishment of six new medical schools. Currently commitments have been obtained for another five schools.

Can you nam e those schools?

Dr. Dorman. Dr. Wigg ins has the nam es of the schools.

Mr. Springer. Will vou put those in the record at th is point. Doctor? 1

 ’

Dr. W iggins. Yes, sir.

In Texas, t he I niv ers ity of Texas has e mba rked on the creatio n of 

a new m edical school in San Ant onio as part of the Un ive rsity of Tex as 

system.

Mr. Springer. Tha t will be a new medical school?

Dr. W iggins. Yes, sir.

The 1 niv ers itv of Xew Mexico has embarked on the establ ishme nt 

of a new medical school in Albuqu erque as pa rt of the Un iversit y of 

New Mexico.

The I niv ers ity of Connecticut has mad e a commitm ent for the 

esta blis hment o f an ew medical school.

Brow n I niv ersity in Rhode Island has made a sim ila r co mm itment.

Ru tgers U nive rsi ty in the State of New Jerse y has mad e a sim ila r 

com mitm ent.

Mr. Springer. Now can vou give us an estimate of wha t the enrollment s will be of these schools when they get underway? A fa ir 

estimate?

Dr. Dorman. Dr. Wigg ins can give th at as soon as he has jotte d 

down his figures. He has the estima tes in mind.

Dr. Wiggins. The total firs t-year enrollment of the 5 schools is 

like ly to be in the neighborhood of 300 students.
348 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Mr. Springer. Now, what will they lx? when they are underway 5 

years later ? I)o you have that ?

Dr. Wiggins. No, sir; except tha t I think it will be influenced a 

great deal by what happens to this legislation.

Mr. Springer. In other words, if this legislation goes through a 

great deal will be done in building the schools. Is that the situation now ?

Dr. Wiggins. Yes.

Mr. Springer. And you say:

We are in consultation with 16 institu tions or organizations presently contemplating the es tablishm ent of new medical schools.

Will you supply the record with the names of those 16 schools or 

organizations ?

Dr. Dorman. We have those here available.

Mr. Springer. Will you read into the record the names of those 

16 schools?

Dr. Wiggins. In the State of Arizona, one of the two major State 

universities. The decision has not finally been made by the State 

legislature as to which of the two.

The University of California is currently undertaking a study as 

to the development of a new medical school as part of its statewide 

university system. The location of this has not as yet been decided.

The University of Delaware and other groups in the State of Delaware have been considering the establishment of a new medical school. 

They are not nearly as far advanced in their thinking and studies 

as the first two.

The State Medical Society in Idaho—and now with the support 

of other groups—is very much interested in the development of a 

medical school somewhere in Idaho. There are problems related 

to this—in terms of population concentration, character of higher 

institutions and so forth.

Mr. Springer. Doctor, th at is four. Will you rapidly read the 16 

so that we will have them in the record ?

Dr. Wiggins. All right, sir.

A large hospital in the State of Illinois; the University of Maine; 

in Massachusetts, there is legislative interest at the State University 

and also a private university in Massachusetts; in Minnesota, a 

group of physicians. Michigan State University. In New York 

there is interest, both at the State level and at the city level in the 

city of New York.

There is also interest in the city of New York in a large private 

hospital.

In the State of Ohio there are three cities where educational institutions, physician groups, and other interested groups are concerned 

and studying the possibilities.

In Norfolk, Va., largely through the activities of the local medical society, there has been created interest in this area.

Mr. Springer. I s that the 16 ?

Dr. Wiggins. I believe it is. I will check them.

Mr. Springer. Doctor, can you give us any estimate provided 

these were established as to what the increase would be if these went 

through, the increase in enrollment, in the hundreds or thousands?
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 349

Dr. Wiggins. If they all developed into what is now the average size 

medical school, it would be something less than 1,600 new enrollments 

per year.

Mr. Springer. I want to be sure that your association is on record 

here. You are on record here for bricks and mortar. Is that correct?

Dr. Dorman. Tha t is right.

Mr. Springer. You are on record “not for scholarships.”

Dr. Dorman. We have taken no position on the scholarships. Dr. 

McKittrick’s council is making a study on scholarships. The question 

becomes more intricate when Federal funds are involved. Recommendations will be made to our board of trustees.

Mr. Springer. Then you are for bricks and m orta r; you have taken 

no position on scholarships?

Dr. Dorman. Tha t is correct.

Mr. Springer. Do you have any position on loans?

Dr. Dorman. The position on loans is the same as on scholarships. 

In other words, no present position. It is under study.

Dr. Dorman. Yes, sir.

Mr. Springer. Thank you.

The Chairman. Mr. Younger.

Mr. Younger. Doctor, I do appreciate very much this help tha t you 

have given the committee.

On page 4 you apparently accept the establishment of a separate 

advisory council as advocated in the bill. Many of the witnesses have 

asked tha t the present council be given this additional authority and 

not to establish a new council.

Have you any thought on that?

Dr. Dorman. We have a feeling tha t if you have the same council, 

you should have it expanded as indicated with further specialists in 

some of these other fields of architecture, engineering, finance. We 

have no objection as it is set up in the bill.

Mr. Younger. In regard to whether you advocate loans or scholarships, which phase of that do you advocate ?

Dr. Dorman. We have, as 1 have said, taken no position on it. 

Perhaps Dr. McKittrick could give us a little background from the 

study tha t his group is making on these to show some of the problems 

tha t we are facing in not as yet having made our position clear in this 

matter.

Could I have Dr. McKittrick speak to that ?

Mr. Younger. Yes.

Dr. McKittrick. Mr. Chairman and Mr. Younger and members of 

the committee, I don't know how much you want to go into it, so I 

will make it brief. If I seem a little muddled in what I have to say, it is 

probably because I am muddled.

A year ago I thought tha t I knew the answer to the scholarship 

question, which is essentially what you have in this bill. On more mature thinking—and when our Council took it up more thoroughly, it 

seemed to us th at it was not a simple matter of talking in terms of 

paying the student through his educational program. You had to start 

when he became a freshman in the medical school.

As a matter of fact, he should have assurance before he is a freshman in medical school—while he is in college. Then the student has 

2 to 5 years of graduate training afte r he receives his M.D. degree.
350 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Th e entire period of 4 years in medical school and 2 to 5 y ears af te r 

medical school is deficit financing. He has to have help financially.

It seemed to us th at befo re going out on a limb on scholarship s, 

thou gh t should he given to the entire cost to the prospective doctor. 

Some thi ng has to be done about the othe r end o f the line.

If you could crea te a mechanism which mad e him self-supportin g 

when he got his M.I). degree, you then could look at the whole situ atio n in rela tion to sch olarships and see where you come out. Th at is 

where we are at the pres ent time.

Th is brings u p thi s question th at you have all he ard so many times, 

Fe de ral aid. Tha t b rin gs up th e problems of the support o f th e medical school and of the financin g of medical edu cation at the medical 

school level.

We recognize the schools and studen ts need help. Governme nt is 

in this very deeply. Nobody is sure th at the presen t mechanism is 

going to end up in the best intere st of medical edu cation because of 

the way the moneys are given. And , the ref ore , an integr al pa rt of 

this whole problem is to review all of the fun ds that go into medical 

edu cation, from sources oth er tha n the medical school itself.

Th e more that we got goin g, fhe more com plicated it became. We 

are at the present time in the midst of an effo rt to try to untan gle 

th is whole situ ation, to clarify our own think ing , and to make specific 

recommendations to the house of delegates of the Americ an Medical 

Association.

Mr. Y ounger. In y ou r th inking about prov idi ng a means by which 

the doc tor could become self-supportin g af te r he got his M.I)?d egree, 

do you con tem plate a method by which his internship mig ht be more 

luc rat ive t ban at t he pr ese nt time ?

I)r . M cK rr prick. Well, we hope very much—ce rta inly within a 

year, and possibly withi n 6 month s—to have some specific recommendatio ns relative to t ha t.

The house of dele gates of the American Medical Association has 

appro ved in princ iple the concept th at the intern and resident should 

be more adequa tely paid. Th e problem is, and thi s becomes com plicated, too, to develop a mechanism which is fair, is pro per, and is in 

kee ping with the best interest of the peop le who are being served.

W e are hopeful th at there may he some specific reco mmendations 

relat ive to those details , possibly by June . I would hope certainly by 

nex t December.

Mr. Younger. Ha s yo ur gro up given any thou gh t to the question 

of forgiving a par t of the loan if the fun ds are advanced in the form 

of a loan rath er than an ou t and out gr an t of sch olarship, because of 

certa in work or assignments th at the doc tor migh t tak e af te r he has 

his medical degree and his af ter-de gre e training ?

Dr. McKittrick. I cannot answer t ha t in detail. All I can say is 

th at our committee, in develop ing and recommen ding the develop ­

me nt of a loan pro gra m, t ho ug ht t hat the loans should he made with 

no string attach ed. There for e, we have not made thi s as a pa rt of 

the reco mmendation.

Mr. Y ounger. In othe r words, it would be just a clea r loan th at 

wou ld be paid back on a reasonable basis af te r he has sta rte d pr ac ­

tice?
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 351

I)r. McKittrick. Th at is r ight . I think the im po rta nt th in g abou t 

the loan is that at the pres ent time one of the problems with loans 

is that they are relativ ely sho rt term , at least1

 in most instance s, and 

must lie paid back at a time when the young phy sician is least able 

to p ay th em back.

Ou r loan program will give him ade quate time , and also mak es it 

possible for him to secure loans af te r he has left the medical school.

Mr. Younger. Th ank you very much.

The Chairman. Mr. C ollier.

Mr. Collier. Yes, Mr. C hairm an.

Before I ask any questions here , I think sometimes it is well to get 

this whole complex situ atio n back in pers pective. First of all, as a 

matter of statem ent, 1 would like to say tha t the re are bu t two purposes fo r this legislat ion, that is pr edica ted on two thin gs:

No. 1, th e need to provide an ade qua te num ber o f phy sician s to tak e 

care of the medical prob lems o f the Am eric an pub lic in the fu ture as 

well as the presen t, of course.

No. 2, to cre ate an improved medical care o r attentio n to our people.

Now, speaki ng to No. 1, we have been told in testim ony g iven to t his 

com mittee du ring the past 4 days by the Secre tary of the De partm ent 

of He alt h, Ed ucation, and W elf are and, of course, by var iou s medical 

school deans that have been here that, at pres ent there is no means of 

accommodating an add itio nal num ber o f medical stu dents because of 

the inad equ acy of facilit ies.

Xo. 2, we were told that it would tak e a minimum of 2 years to 

pro vid e new fac ilities for those existing facilities before any ad dition al enrollment c ould be accom plish ed.

Now, Xo. 3, we were told it would take 3 to 5 years, where an 

entirely new fac ility was to be esta blis hed ;

Th ere fore, any sch ola rship aid or loans tha t were given in the next 

2 ye ars ad mitted ly would not increase the acco jnmodations fo r en rollment any whe re. Th is has been esta blished.

Now, the question is this. I f this is tru e and if we embark upon 

a sch ola rsh ip pro gra m at this time, rea lizing , of course, th at there 

are loans and sch olarships ava ilab le to pres ent medical education, 

what effect would this have on the enro llm ent s for the next 2 years?

Dr. Dorman. It probably would not increase the enrollments until 

the fac ilities are enlarged. Tha t is why we have been a little bit 

insisten t on bricks and mortar facilities.

It would, however, help those young men who are in college, in 

either th eir first or second yea rs of the 4-y ear academic course, havin g 

to plan fo r their futur e, to know that funds will l)e ava ilable to him 

in 2 years when he graduates. Many of th e ones who decide now that 

they will have to go into e ngine ering o r other sciences may then say, 

“I guess I can take my first love, which was medicine.”

Mr. ( 'ollier. Let us take a hypothe tical case of J oh n Doe who is a 

straight ‘‘A" stu dent, who financia lly is una ble to attend medical 

school because of the cost. An d we have the case of Sm ith who is a 

“B ” student. All other fac tor s would be equal except th at fina ncially 

he would be able to go to school.

Now, if the colleges, medical colleges, pre sen tly c ould not accommodate for 2 ye ars any addition al stu dent, thi s would only result in 

more selectivity so to speak . Th is pro gra m for 2 years, un til you
352 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

could accomm odate more stud ents, would conceivably foreclose Sm ith , 

who is a “B ” studen t bu t who, in fac t, could affo rd to pay his way 

throug h medical school, in order to pro vid e a place for Jo hn Doe 

who is an “A ” stu dent bu t could not afford to go to medical school. 

Is tha t correct?

Dr. Dorman. At the pre sen t time, the deans th at I have talked to 

tell me th at if the y hav e a top man, the y have sufficient funds to see 

to it th at h e gets in and goes through.

Mr. Collier. They do?

Dr . Dorman. That is w hat they tell me. I believe Dr. McK ittric k 

can give you a l ittle more infor ma tion on tha t.

Dr . McKittr ick. May I jus t say a word, M r. Collier?

Our council, in co nsidering th is whole q uestion, because a purp ose of 

ou r sch olarship prog ram is really a stimu lus t o rec ruitm ent, al te r we 

go t into this quite deeply, suddenly realized if the rec ruitm ent aspect 

of this was pushed too ha rd an we r ecr uited a lot of top flight peop le 

with no place to put them, we would be in a jam . Tha t is why we 

believe so strongly th at wh at we need now are facilities. The n the 

mechanism of financ ing students , which is not do ing too bad ly now, 

can be pick ed up and can be added.

Bu t we c ann ot get these fac ilities overn igh t, as you point out, and 

th at is why we fel t so very, very urgent abo ut the need fo r brick and 

mo rta r.

Mr. C ollier. Would you say then in yo ur o pinion, Dr. McK ittric k, 

th at the emphasis fo r assistance should be mad e upo n those yea rs of 

actual medical trai ni ng r at he r than th at per iod of prem edical educa ­

tio n th at a person, a po ten tial doctor mu st get?

Dr. McKittr ick. I am not sure th at I totally und ersta nd your question. My an swer may not be w hat you have in mind.

Mr. C ollier. I have no an swe r in m ind, sir.

Dr . McKittrick. I think one of the u rg en t needs—I say I, I mean 

we—is to recog nize the prop erly motivated and the talented young 

ma n at th e college level. Ev en go back to the h igh school level, if you 

will.

Most sch ola rships now do not come un til af te r the stu dent h as been 

admi tte d. It was o ur hope th at we could designat e the b rig hter yo ung 

people— prop erly mo tivated at the college level—so that at least a 

few of them would know' th at the y ha d a sch ola rsh ip when the y 

we nt in.

As Dr. Do rm an has said, and I don’t know wh eth er thi s holds in 

every medical school or not, but I know th at it holds in a gr ea t many 

med ical schools, once a medical student has been admi tte d and if his 

academic wo rk is good, h e does no t have to leave fo r economic reasons. 

Now, I cannot answer as to every medical school, bu t I know' th at that 

holds in a num ber of the medical schools whose d ean s I have talk ed to.

Mr. Collier. Go ing back to my o rigina l sta tem ent on the rec ognized 

pur pose o f the p rogram . W ha t I w as attempt ing to poin t o ut was th is. 

Wo uld it not be possible un de r the broad prog ram th at we are consid eri ng here, as it might ap ply to a stu de nt en terin g college w ith all 

the good intentions of pu rsuing a med ical pro fession, for a stu dent 

to receive assistan ce an d the n at the end of 2 yea rs, which fr eque ntly happens an d it is hig hly probab le, he might c hange his min d 

an d decide to be an engine er at this p oin t. T hat is why I say, should
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 353

there not be emphasis on those years where lie is actually in medical 

work, bearing in mind of course that the National Defense Education 

Act permits many a loan in his first 2 years of college, which might be 

liberal arts or premed or preanything else, bearing in mind that there 

are many other scholarships in the field of liberal arts that are available to him for his premedical or pregraduate or postgraduate work. 

That is the point I was trying to make. That must be considered.

While I do not have the statistics I am aware of numerous cases 

where a young man entering college, pursuing in good faith study for 

a given profession, and at the end of his second year, for whatever 

reason, good, bad, or indifferent, he might have, he goes into another 

field.

I just thought it might be worth considering where the emphasis 

would be to achieve the admitted purpose of the legislation before us.

I)r. Wiggins. We believe that part of our problem, Mr. Collier, is 

tha t during the college years those students who enter college with a 

commitment to the study of medicine, become aware of other careers 

tha t until th at time he had not seriously considered. lie also becomes 

aware of the costs involved in these other careers as opposed to the 

costs involved in a medical career. So tha t the other side of our 

concern, and the reason that we have no position in regard to the 

scholarship provision of this bill, is that we do know t hat we must 

do something to maintain the interest of the young man all the way 

through college and not let him drift into another career. Although 

we cannot document it, we believe tha t sometimes, at least, individuals 

truly interested in medicine, motivated highly to medicine, eminently 

well-qualified for it, drift from medicine into other sciences because 

of the financial implications. They are aware that there are stipends 

of one sort or another available that ease the burden of graduate study 

in the other sciences that are not available at least to the same degree 

in medicine.

Mr. Collier. Getting back to the loan program and to the concept 

of the loan feature that is to be in the legislation before us, do you 

see anything that could be construed as hum iliating or embarrassing 

in asking a student in need of financial assistance to secure an education to fill out a detailed and comprehensive financial report or asking 

his parents to do that?

Dr. Dorman. My own personal opinion on a thing of this sort is 

tha t we are asked for financial support every time April 15 comes 

around. There are financial reports that have to be filled out every 

time someone goes to a bank to secure a mortgage on a new home or 

a loan. It is one of the basic thin gs in free enterprise I think that 

we have to estimate a person’s responsibility, his financial ability, and 

I personally see nothing demeaning in fulfilling the obligation of 

putting on a private limited area your financial problems.

When we have a person admitted to a medical school we go p retty 

thoroughly into other phases of his life, his scholarships, his emotional stability, his ability, his fitness.

When you go on and extend tha t a little further into his ability to 

meet obligations, it is not for the purpose of prying tha t these questions are asked; it is to be helpful.
354 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL.

I think th at th at is sufficiently well indo ctr ina ted in o ur way of life 

so tha t 1 see no thing dem eaning in that, pa rtic ul ar phase of the 

problem.

Mr. Collier. In other words, you do not feel tha t there is a ny thing 

wrong w ith ask ing fo r a financial statem ent, any time anyone desire s 

Governm ent assistance, to establish need reg ard les s o f wh at th at need 

might be, be i t medical care or be it assistan ce from the Feder al Governm ent to secure edu cation o r a ny thing of th at natur e?

I)r . Dorman. I think if tha t type o f t hi ng is r eque sted, th ere should 

be safe guard s so th at this is not kicked aro und fo r publicity purposes.

Mr. Collier. Th an k you, sir. Th at is all 1 have, Mr. Chairma n.

The Chairman. Air. McDonald .

Mr. McDonald. Mr. Chairma n, I don’t hav e any questions. I 

might indulge in a personal reference. I would like the committee 

to know th at Dr. M cK ittric k is, in my opinion, the most outstandin g 

surgeon in Massachu setts and some 20 years ago saved my mo the r’s 

life and as recen tly as last year a ttended my f athe r.

I feel 1 should*be sitti ng down below liim ra th er than up here.

Dr. McKittrick. You are very generous. Th an k you very much , 

Mr. McDonald .

The C hairman. Mr. Devine.

Mr. Devine. I noticed in the statem ent on page 4 in the mid dle it 

says for some tim e the AMA has been aware of the decline in the 

num ber of elig ible college students seek ing admission to medical 

school. You say this ap paren t sh ift away fro m medicine is due in 

pa rt, you believe, to the hig h cost and tim e in securing medical education with which, I think, everyone wo uld a gree.

Of course, fo r quite some num ber of years the time period to get a 

medical edu cation has been about the same bu t the costs ha ve gone up 

like every thing else. It used to be, howe ver, that you had to tu rn 

appli cants away. Is tha t not correct ?

Dr. Dorman. Th at is correct.

Mr. Devine. You say thi s is due in pa rt. Now what other aspe cts 

do you contribu te to the lack of a pp lic ants fo r medical school?

Dr. Dorman. Part, of it is the com petition from oth er gro ups, engineering, science, and so on. There have been cases where some of 

the youn ger p eople that are going into college o r m edicine have asked 

me, “W ha t are t he chances of Gov ernment medicine coming in ? We 

are not sure th at we Want t o risk p racti cing und er a system o f Gover nment medicine.” There are many of th at type o f fac tors com ing in.

If you are inte rested in the specific falling off of the app lications, 

Dr. W igg ins has the figures for the last 4 years.

Mr. Devine. I have an interest because I felt th at was one very 

basic, reason, that the practic e of medicine in the future is much less 

attra ctive in view of the type of legislation that, is often bein g conside red by the Congress.

Dr. Dorman. I had one doc tor who is a recruiter tell me that lie 

hes itated to get out now and recruit among t he high school and e arly 

college years as he had in th e past..

Mr. Devine. Is Mr. Wigg ins going to subm it those figures fo r the 

record ?

I )r. Wiggins. Yes, sir. I have them here.

Mr. Devine. You do not have to read them at thi s time. You 

mig ht furni sh the m for the record.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 355

Dr. Wiggins. Yes, sir.

(Following are the figures requested and furnished by Dr. 

Wiggins:)

T able 9.—Applicants and their college record, and lst-ye ar enrollm ent, 1950-61

Y ear

N u m b er 

of ap p li ­

ca nts

A pplica ­

tions pe r 

in d iv id u al

N um ber 

of ls t- year 

st u d en ts

Co llege 

reco rd o f 

ls t- year 

st u d en ts 

(p er ce nt )

ls t- year

st u d en ts

ba ch elor

degree

(perce nt)-

A B C

1950-51.................... .............................................. 22, 279 3.7 7.177 40 43 17 75

1951-52_________________ ______________ 19,920 3.5 7, 436 30 55 15 78

1952-53........................ ........................................... 16,763 3.4 7,425 18 68 14 86

1953-54.......... ............... ........................... . ........... 14.678 3. 3 7, 449 21 69 10 70

1954-55...................... ................... ......................... 14.538 3.3 7, 576 17 69 14 71

1955-56................................................................... 14.937 3. 6 7.686 16 71 13 70

1956-57_________ ____________ ___________ 15,917 3.8 8,01 4 16 70 14 73

1957-58_____________ ____ ______ ______ 15, 791 3. 9 8.030 18 66 16 72

1958-59.................... ............... ....... ....................... 15,170 3. 9 8, 128 16 70 14 74

1959-60___________ ______ ______ ________ 14,951 3. 9 8.173 15 70 15 75

1960-61___________________________ _____ 14,397 3 8 8.29 8 13 71 16 74

Dr. Dorman. There is one other point, Mr. Devine. Could 1 have 

Dr. "Wiggins speak ?

Mr. Devine. Yes.

Dr. Wiggins. We are not certain of the impact of this but during 

recent years there has been developed, I believe to the advantage of 

everyone, a far closer relationship net ween the admission committees 

of our medical schools and the premedical advisers or their counterparts in colleges. The premedical adviser has a far better knowledge 

now of what characteristics and competencies the medical school will 

look for in the students who apply.

We have estimated that because of this far better understanding, 

premedical advisers advise better and, therefore, try as gently as they 

can, early in the college years when they can see these characteristics 

and intellectual competencies are not present, to deter the student 

early so that he makes specific plans for another field.

The degree to which this is a factor we certainly could not ouantitate but we have measured, over the past 5 years, the number in 

over a hundred colleges and universities that normally provide a 

large segment of our medical students. "We measured the numbers 

of students enrolled who can lie identified by their own college faculty 

members as premedical students. The percentage of the total enrollment of the colleges that are identified as premedical students has 

remained remarkably constant. This, we think, perhaps supports 

the notion that some of the decline in the number of applicants may 

be due to something that is good for everyone concerned and, that is, 

that college students are now advised better. This is certainly not 

all of it by any manner of.means.

Mr. Devine. Thank you very much.

That, is all, Mr. Chairman.

The Chairman. Mr. Hemphill.

Mr. Hemphill. Noquestions.

The Chairman. Mr. Curtin.

Mr. Curtin. Thank you, Mr. Chairman.
356 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Dr. Dorman, y ou hav e spok en abo ut the two pr og rams being in iti ­

ated by you r association, one would be a loan prog ram and the oth er 

would be a scholarship p rogra m.

You also said about $15 million would be available when the pr ogra m got rolling. Would th at all come un de r the loan program ?

Dr. Dorman. That would be prim arily in the loan program ; yes.

Mr. Curt in. H ow much do you think will eventua lly be ava ilab le 

in th e scholars hip or fellow ship pr og ram ?

Dr. Dorman. Th e board of tlie Am eric an Medical Associa tion has 

been talking in the neighborho od of $250,000 a y ear on t he sc holarship 

pro gra m. That wo uld be Am erican Medical Associatio n money.

Mr. Curtin. Tha t would be over and above th e $15 million t hat we 

discussed ?

Dr . Dorman. Yes, sir.

Mr. Curtin. Where would th at money come from ?

Dr. Dorman. Tha t would come from America n M edical A ssoc iatio n 

funds.

Mr. C urtin. Pr iv at e contr ibu tio ns of doctors to the association ?

Dr . Dorman. Yes, sir; or ap prop ria tio ns fro m dues and oth er 

income.

Mr. Curtin . Th an k you.

Th e Chairman. Mr. Dom inick.

Mr. D om inick. Tha nk you, Mr. Chairma n.

Dr. Dorman, t here are a couple of thi ng s on t his loan prog ram that 

I thou gh t maybe we could clea r up.

Th is $15 millio n will lie availab le, as I un de rst an d it, each year?

Dr. Dorman. Ev en tually, yes, sir.

Mr. Dom inick. Secondly, at what point do the people who get the 

loans have to rep ay them? How long a tim e is the loan?

Dr . Dorman. Cou ld I have Dr. Wigg ins ans wer th at ?

Dr. Wiggins. I t is set u p so th at he bor row s the loan, which is at 

th is low int ere st rat e, fo r 7 yea rs. At the end of the seventh year, 

the n he renego tiates with th e hank th at mad e the loan or with an ­

oth er b ank of his own choosin g.

At this time it becomes more of a pe rsonal lo an of the usual v ariety . 

But it would allow the stu dent, the b orrow er, to in iti at e a loan. As 

a first-year medical stu de nt he would not be invo lved in rep ayme nt 

un til he had finished all 4 ye ars of medical school and had 3 yea rs 

beyond medical school fo r f urther tra ining.

Mr. Dominic k. Tha nk you. You also said in the process of an ­

swe ring questions, I th in k by Mr. Sp rin ge r, th at you would have 

money available to tak e care of ap pli cants in the en ter ing class of 

1962, in September. Would it n ot also be true t h at those people who 

need financial assistance who are alr ead y in medical school or intern ­

ship would also be availabl e this Septe mb er fo r aid ? Is th at tru e?

Dr. Wiggins. Yes, sir.

Mr. Dominic k. Now, Dr . Dorman, do you know whether th e five 

schools which are comm itte d at this mom ent, as indicated on pag e 1 

of yo ur statem ent, will go ahead with the con struction if this bill is 

no t passed?

Dr. Dorman. I believe th at these five defi nite ly will. As fa r as 

th e 16 under con sideration , those are no t firm com mitm ents. Those
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 357

may not all materialize. Some of those may depend on the building 

commitments of this bill.

Mr. Dominick. In connection with the number of applicants, referred to above, you still have more applicants than you have space 

available, do you not, in your medical schools ?

Dr. Dorman. We, at the present time—Dr. Wiggins has the exact 

figure—I am under the impression it is around 14,000 applicants for 

a little over 8,000 positions at this time. The exact figures will be 

in the record.

Mr. Dominick. I received a call yesterday from the president of 

the University of Colorado, which has an extremely fine medical school, 

indicating to me that the publicly supported schools such as the Un iversity of Colorado Medical School and others, are not in a position 

to receive a loan for construction purposes because they have no repayment method.

Do you happen to know whether this is equally true on other 

publicly supported colleges?

Dr. Dorman. Could I have Dr. Wiggins speak on that?

Dr. Wiggins. I can't. I don't know.

This is loan for construction ?

Mr. Dominick. A loan for construction purposes.

Dr. Wiggins. I don’t know.

Dr. Dorman. I'm sorry, but I do not have the answer to that.

Mr. Dominick. There was testimony from the Secretary and also 

from others that the per capita amount of doctors 20 years ago per 

100,000 of population is about the same as it is now, there is not very 

much difference. However, they said that with the expanding population there was no assurance tha t there would still be tha t many 

doctors per 100,000 of population in 1970.

Obviously, since we have had an expanded population over the last 

20 years, we must have had an expanded number of doctors in the 

United States. Is there any reason to feel that we won’t have an increase in doctors anyhow, even if we should not pass this bill, in order 

to keep that ratio constant?

Dr. Dorman. Many of the medical schools a t the present time are 

hard pressed to take in their maximum. There are some of the medical 

schools, even in this city, whose facilities are getting so far behind, 

that unless they are able to rehabilitate them, bring them up to modem 

standards, there may be a danger of their dropping off the number 

they are now graduating.

It will take a continued effort to keep up the number of schools that 

are now available and to keep this increasing.

Mr. Dominick. Would you say then tha t not only the location of 

the graduate doctors but also the applications for medical schools is 

a matter of distribution in large part ?

Dr. Dorman. There is more than the problem of just distribution 

in this.

Mr. Dominick. That is what I wanted to find out. You think this 

is more than the problem of distribution ?

Dr. Dorman. Yes, Mr. Dominick; it is more than just that.

Mr. Dominick. Is my understanding correct that your student honor 

and scholarship program is designed to take care of students in college 

or is it designed to take care of students who are in medical school?
358 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Dr . Dorman. Stud ents going into medical school.

Mr. Dominick. It does not a pp ly then while they are in college?

Dr . McKittrick. No, M r. Domin ick; it does not ap ply except that 

while they a re in college they know th at th ey are g oin g to get it. By 

the time they are rea dy fo r medical school, once they have been 

admitted they will know, th at the sch ola rsh ip is the irs.

Mr. Dominic k. In the his tor y of medicine as fa r as you know it. 

over the past 30 years as an example, have there lieen periods of 

decline in appli catio ns an d the n a pic kup again ? Is it a cyclical 

thing a t all?

Dr. Dorman. Dr. W igg ins ha s th at informa tion.

Dr. W iggins. If I may take a m omen t 1 can show you a p arag raph 

th at indicates this. Th ere have been in recent years, prim ari ly since 

the l ast World W ar, two peaks of ap plican t ac tiv ity . The first following the last Wo rld W ar when we got as hig h as 3.8 appli cants per 

position in a medical school available. Th is was relate d largely to 

the accumulation of stu de nts whose edu cation had been inter rupted 

by service in the A rmed Forces, plus the a va ila bility of GI hill fun ds 

to assist in t he ir education.

The same phenomenon occurre d bu t to a fa r lesser degree af te r 

the K orean war.

When looked at ove r a longer period of time there have been fa r 

smaller peaks and vall eys h ut, as with any oth er activ ity of thi s kind, 

it is not con stant each year.

Mr. Dom inick. I hav e one more question, D octor. There have been 

a num ber of people, inc lud ing myself, who have been interested in 

whether or not op tome trists should be included in a bill of this kind 

if it passes a t all.

W ha t is yo ur opinion on th at ?

I)r. Dorman. We have not take n any sta nd on the question of ex ­

clusion of optom etrists from thi s bill. The whole matter of wh at we 

call the ancillary service— if you want to call them paramedical 

service—those people who sup port us in ou r care of the patie nt, is a 

field that we are doin g a lot of researc h in. It is not just the question 

of the optometri sts, alt hough they are very im po rta nt to the vision 

of t his countr y. There a re the pod iatri sts an d the various people who 

work along in oth er fields th at sup port the med ical profession. We 

have not taken any position on en lar ging this hill io where it would 

support all of the medical supports, shall I say, which we use in ca ring for o ur patients.

Air. Domtnick. Th an k you. Th at is all, Mr. Ch airma n.

Th e C hairman. Doctor, I am not sure if I und erstoo d y our reply to 

Mr. Dominick with reference to the repa ym ent o f the loan. I believe 

his question was at what time would th e repa ym ent liegin ?

Dr. Dorman. lie can star t repa ying it almost at will. It can run 

fo r 7 y ears at a level inte rest rate to him. At the end of 7 y ears he 

can renegotiate that loan eit her with the original hank or his own 

hank, at which time he would he doing it as a pers onal loan, not necessar ily guaran tee d by the association.

The C hairman. At that time, should he renego tiat e and make 

acceptable arrang em ent , the association would he relieved of any 

fu ither o bligation ?

Dr. Dorman. That is corr ect.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 359

The Chairman. Bu t if he were no t able to ren egotiate the loan, 

the n the association would continu e as one of the spo nso rs an d be 

obligate d to m ake pay ment ?

Dr. Dorman. At th is time we have not mad e any such com mitments. But we would certa inl y tak e any case un der con sidera tion, 

ind ividually.

The C hairma n. Well, say the accumulate d loan becomes due at the 

end of 7 years and the studen t was not able to pay it, and dem and 

was made. Would the association then ha ve to pay for it?

Dr. Dorman. Th ere is a pro vision th at covers that. Could I have 

1 )r. W igg ins an swe r th at po rtion of it?

Dr. Wiggins. Mr. Har ris , the con ditions of the loan are such th at 

he could benefit by lesser intere st as a res ult o f the assoc iations se curing his loan only for 7 years.

The C hairman. W ha t is that now ?

Dr. W iggins. He would h ave the benefit of the asso ciations se curing 

his loan only fo r 7 years . Beyond th at time the asso ciation will not 

secure his loan. If the y did , pr etty soon an unknown qu an tity of 

poten tia l loan s would be tie d up in physicians who are m prac tice . 

Th at is no t the intent of this pro gra m.

The C hairman. Yes, I ap preciat e that. Biit I am tryi ng to figure 

out what is going to happen at the end of th at 7 years.

Dr . Wiggins. He must neg otiate with the bank.

Th e Chair man. Suppose he does not ?

Dr. Wiggins. The ban k would be first charg ed to attempt to re ­

captu re the loan. I would presum e th at if the asso ciation learned 

that he was in a position to rep ay his loan they would tak e whatever 

recourse was necessary to have the loan rep aid .

Th e Chairman. But if he was una ble to rep ay the loan, the n the 

asso ciation is stuc k with it?

Dr. D orman. Yes, sir.

The Chairm an. Tha t is what I was tryi ng to get at.

Dr. Wiggins. We hop e there will not be man y instanc es of that.

The Chairman. Well, I certa inly hope so, too. Bu t, in ad dit ion 

to the fact th at you gentlem en are professiona l peop le and yo ur association is a professional association in the medical field, there have to 

be observed some realistic business princi ple s in yo ur prog ram th at 

you are in iti ating here.

Dr. Dorman. As un de rw rit ers we are responsible, yes, sir.

Th e Chairman. But could ther e be accumulated intere st on the loan 

for a period of 7 years?

Dr. D< Irman. Yes, sir.

The Chairma n. You men tioned a moment ago th at the late st date 

when a scholarship com mitm ent should lx* m ade was when the student 

had finished his sophomore year. Now if you wan t to accomplish 

that sch olarships will be ava ilab le at that time, would it not be necessar y to hav e the sch olarship pro gra m pro vided now for the stu dents 

who would en ter medical school in 1964? Unless you have a scholar ­

ship prog ram now there is no way in which a com mitment could be 

mad e to a stu dent enter ing in 1964.

Dr. McKittrick. I think that I must have made myself misu nd erstood, Mr. Chairma n. The sch ola rsh ips are not to lie desig nated at 

the e nd of the sophomore yea r. Th is is called an honor and scholar-
360 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

ship program. The program was established with full realization 

tha t the American Medical Association could never give enough 

scholarships to really made a dent in the problem. The intent was to 

begin to select a group of students in the sophomore year that you 

might call honor students, who become eligible by virtue of their 

motivation and their scholastic standing to be designated for a scholarship. But the designee of the scholarship, if the intent of the committee is finally fulfilled, will not be named until toward the end of 

his college career.

In other words, toward the end, and I don’t know whether it will 

be the th ird or the fourth year because the last I knew—and I am not 

too close to the details—these were not worked out. The student 

would definitely know tha t once he was accepted by a school, the 

scholarship was his.

But it is really trying to accomplish two things, recruitment of the 

higher quality of student and the designation of the group in the 

various colleges tha t make really potentially good medical students.

The Chairman. I)r. McKittrick, your scholarship program is going 

to be very limited, is it not ?

Dr. McKittrick. Yes, sir.

The Chairman. Now, under the proposed bill here, construction 

grants are to be made on a matching basis requiring 50 percent or 

33^ percent of the funds to be furnished by the recipient.

Have you ever given any thought to applying the same principle 

to the loan funds which would be made available?

Dr. I )orman. As far as I know, no.

I )r. Wiggins. In terms of our own loan program, Mr. 1 larris ?

The Chairman. I am talking about the bill, and I am talking about 

the Federal Government providing loan funds on condit ion that such 

funds are matched 50 percent or 33% percent by industry and by the 

medical profession and by others who want to contribute to the funds.

Dr. Dorman. Under our own program we have not gone into the 

matching funds problem because under our program the loan would 

be tailored to what the particular individual needed.

The Chairman. Dr. Dorman, thank you very much for your testimony here and you, Dr. McKittrick, and Dr. Wiggins. We appreciate the contribution you have made to this proposed legislation. 

We appreciate the benefit of your testimony.

Dr. I)orman. Thank you, Mr. Chairman.

The Chairman. Dr. Wiggins, you may supply the information that 

Mr. Devine, I believe, asked.

Dr. Michael E. De Bakey.

Dr. De Bakey, I believe you have with you Dr. Sidney Farber.

Dr. De Bakey. Yes, sir.

The Chairman. You are professor of surgery at Houston, Tex., and 

Dr. Farb er is scientific director of the Children’s Cancer Research 

Foundation, Boston, Mass.

Dr. De Bakey. Yes, sir.

The Chairman. We will be glad to receive your presentation.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 361

STATEMENT OF DR. MICHAEL E. DE BAKEY, PROFESSOR AND 

CHAIRMAN OF THE DEPARTMENT OF SURGERY OF BAYLOR UN IVERSITY COLLEGE OF MEDICINE. IN HOUSTON. TEX., ACCOMPANIED BY DR. SIDNEY FARBER, SCIENTIFIC DIRECTOR OF THE 

CHILDREN’S CANCER RESEARCH FOUNDATION. BOSTON. MASS.

I) r. De Bak ey. I am Dr . Mich ael E. De Ba ke y, ch ai rm an of th e

D ep ar tm en t of Sur ge ry o f B ay lo r U ni ve rs ity College of Me dicine. I 

wan t to say fir st, Mr. C hai rm an , th a t 1 am very gra te fu l fo r th e 

opp ortun ity to ap pea r be fore th is comm ittee an d to te st ify on be ha lf 

of the prop os ed l eg islatio n, H .R . 4999, wh ich will, I believe, stim ul ate 

th e es tabl ishm en t of some new sch ools of me dic ine an d en co urag e th e 

ex pe nd itu re of enr ollm en ts o f ou r ex is ting me dic al schools an d en ab le 

la rg er nu mbe rs of ca pa ble yo un g men an d wom en to stud y me dic ine 

irresp ec tiv e of w he th er the y come from hom es of hi gh or low income 

levels.

Mr. Cha irm an , I ha ve pr ep ar ed a stat em en t wh ich I shou ld like to 

su bm it fo r th e r ec ord, if I may.

The C hair man . L et it be inc lude d in t he record.

(P re pare d st at em en t of D r. Mich ael E . De B ak ey fo llow s:)

Prepared Statement of Dr. Mich ael E. De Bakey

Mr. C ha irm an an d mem be rs of th e co m m itt ee , I am Dr. Mich ael E. De Ba key, 

pro fe ss or and chai rm an of th e D epar tm en t of Su rg er y of Bay lo r U ni ve rs ity 

College of Med ici ne in Hou sto n, Te x. I am gra te fu l fo r th e oppo rt un ity to 

appea r be fo re th is co mmitt ee of th e U.S. Co ng res s to te st if y in be ha lf of th e 

prop osed le gi slatio n, H.R. 4999, which will st im ula te th e es ta bl is hm en t of new 

sch oo ls of med icine, en co ur ag e th e ex pa ns io n of en ro llm en ts in our ex is ting 

med ical sch oo ls, an d en ab le la rg er nu m be rs of ca pa ble yo un g me n an d wo me n 

to stud y med icine irre sp ec tive of w het her th ey com e from home s of high or 

low incom e levels .

Th e ev iden ce th a t our co un try ne ed s to pr ov ide fo r th e ed uc at io n of more 

ph ys ic ia ns has been th or ou gh ly do cu men ted an d is now we ll es ta bl ishe d. C ar efu lly prep ared , st ud ie s mad e by no fe w er th an li v e 1

 grou ps of ex pert s re port in g 

to th e Pre si den t, th e Congres s, an d th e Su rgeo n Gen eral of th e U.S. Pu blic 

H ealth Se rvice, show th a t by 1970 we sh al l ha ve to gra duate 3,500 more ph ysi ­

ci an s th an w er e gra duate d in I96 0 in ord er ju s t to m ai nta in th e sa m e ra ti o of 

po pu lation to ph ys ic ia ns (720 to 1) th a t we ha d in 1900. Any on e wh o has 

vi si te d hi s ph ys ic ian re ce nt ly an d ha s ha d to w ait w ith man y oth er p ati en ts 

be fore he co uld ob ta in me dical at te nti on is aw are of th e sh ort ag e th a t exis ts 

now. An d th os e wh o are as so ciated in tim at el y w ith ph ys ic ians as I am ev ery 

da y kn ow how lon g an d how har d th es e ph ysi ci an s wo rk in ord er to see al l th e 

p ati ents w ho come fo r tr ea tm en t.

The sh or ta ge o f phy si ci an s is no t a pro ble m th a t an y giv en S ta te o r co mmun ity 

ca n solve by its el f. Many Sta te- supi> ort ed sch oo ls of med icine ha ve lim ite d th eir 

en ro llm en t to re si den ts o f th eir Sta te , ho ping th a t th es e st udents wo uld be lik ely 

to e st ab lish a medica l pra ct ic e in th eir ho me Sta te . Some S ta te s ha ve even pr ovide d fu ll co st scholarshi i>s to se lecte d st udents in re tu rn fo r a guar ante ed pe riod 

of pra ct ic e in a co mmun ity in th e S ta te w her e a do ctor is ba dly ne ed ed . The 

ex pe rien ce of m an y o f thes e Sta te s an d Sta te -s upp orted sc ho ols i s th a t they c an not 

und er th es e circ um stan ce s a tt ra c t th e bes t quali ty of st uden ts an d th at, in an y

1

 See the following:

1952—Report of the President's Commission on the Health Needs of the Nation.

1958— Final Report of the Secretary’s Consultants on Medical Research and Education.

1959— Report of the Surgeon General’s Consultant Group on Medical Education..

1960— Report of the Committee of Consulta nts on Medical Research to the Subcommittee on Departments of Labor. Health. Education, and Welfare, of the 

Committee on Appropriations. U.S. Senate, 86th Cong., 2d sess.

1960—The Report of the Pres ident’s Commission on National Goals.

80014—62-----24
362 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

event, they cannot compel the physician graduate to practice there unless he 

wishes to do so voluntarily.

The physician sh ortage is a nd will continue to be a national problem. I, along 

with all those who have given thoughtful consideration to this problem, am convinced that it can best be solved by the judicious use of fede rally appropriated 

funds to assist local institution s in meeting the exceptionally heavy costs of 

medical education.

Studies on the cost to the s tudent of a medical education, based upon the experience of the 1959 gra dua ting classes, show that the average cost per student 

was $11,642, or $2,911 per year. It was found that 82 percent of the financial 

assistance the student received came from his own or his wife's immediate family. 

Only 18 percent of such assistance came in the form of loans or scholarships from 

banks, the medical school, or other agencies. It is not surpris ing to find, therefore, th at 43 percent of all medical students came from families with incomes in 

excess of $10,000 per year, another 48 percent came from families with incomes 

ranging from $10,000 to $5,000, and only 14 percent from families whose incomes 

were less than $5,000 per year. Yet this latter category includes 41 percent of 

the white urban families in the United States.

Many medical students work during the school term and in the summer vacation period to help pay for the cost of their education. Only 25 percent were 

able to earn more than one-fourth but less than one-half of the total cost 

($11,642). Sixty-seven percent earned up to one-fourth of this cost by their own 

efforts.

It is a common experience to encounter in colleges and univ ersities wellqualified students who are overwhelmed by the prospect of paying for a medical 

education and are diverted to other fields where adeq uate support for grad uate 

education is read ily available.

We must all concern ourselves with the urgency of getting on with a comprehensive constructive approach to the physician shortage. The time required to 

plan and construct new schools of medicine is 4 to 6 years. Another 4 years is 

required before a stud ent can complete his basic medical education. And 2 to 5 

more years are required before he can assume the heavy responsibilities of caring 

for patients independently. There is no time to be lost if we are to remedy the 

shortage which now exists and if we are to prevent the even greater shortage 

which will surely develop unless proi>er steps are Liken now.

It has been my privilege to work closely with advisory committees and councils 

of the U.S. Public Health Service and with members of the U.S. Congress in 

helping to improve the health of our people through medical research. A great 

deal of effort has been expended in seeking to select and define those research 

activities which could get the job done most effectively. We have been fortunate 

in securing the support of the Congress in developing a comprehensive program 

of supp ort for research and resea rch training. This latte r category has been 

highly effective in making possible the training of resea rch personnel and of 

teac hers whose services are now so critically needed. We must expand these 

traini ng program s rapidly or the shortage of qualified teac hers will nullify our 

efforts to expand the education of physicians.

Wh at is needed now. I believe, is the same kind of concerted effort to expand 

education al facilities th at has brought us such fruitfu l resu lts from the suppo rt 

of medical research.

The treatm ent of human illness is constantly being improved. What we must 

now do is to insure that such trea tment is made readily available to our people 

by ed ucating enough physicians to get the job done. We cannot expand medical 

knowledge continually and fail to make these benefits available.

Good health is one of the foundation stones on which the strength of our 

country rests. It is absolutely essential to the inte grity and security of our 

Nation and the maintenance of its leadership in world affairs.

In light of these considerations, I should like to urge the passage of this legislatio n, II.R. 4999. which I strongly believe is urgently needed to maintain and 

promote our Nation’s welfare, strength, and security. Thank you.

Dr. De Bakey. Then, if I may have the opportunity to do so, I 

should like to amplify this statement with some additional comments.

These are concerned primarily with the opportunity that this hill 

provides for not only increasing our total medical school enrollment
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 363

but for also im pro vin g the quality of the stu dents who may be able 

to seek medical careers.

There has been ade quate documentatio n of the need for this, so I 

shall not go into it, but there are some figures that T think will help 

to indicate why the re is need for help in the sch ola rship area.

Now, the quali ty of medical care is dep end ent upon at least two 

factors , first, qu ali ty of the medical trai ni ng provided the stu dent 

and , secondly, u pon the cap acity and capabilit ies o f the studen t.

The num bers of medical stud ents, the numb er of college students 

apply ing for medicine, as you have alread y heard, has decrea sed sub ­

sta nti ally. Ind eed , in about a decade the re has been a decrease from 

about. 6.6 percen t, that is the percent of total college graduates ap plying for medicine to in the neig hborhoo d of 3.9 perc ent. Th is is obviously a very significant decrease.

Secondly, and I think of equal, if not of gr ea ter importance, is the 

fact that, th e prop ortio n of A student s has also decreased sign ific antly 

In a bout 10 years.

The percen tage of A students in the first ye ar of medical school 

ap proxim ate ly 10 years ago was 40 percent. But the perc enta ge 

within the past ye ar or so has decreased to 15 percent. So th at we 

are not only losin g in terms of the num bers of stu dents that a re ap pl ying for medicine but also losing in terms of the pro portio n of A stude nts a pp lying for medicine.

You have heard , I am sure, testimony abou t the many factors tha t 

are involved that have influenced this and the one which I would like 

to speak about most is the fac tor of the finan cial burden of the cost 

of medical education o f the student.

The sch olarships and the loans the re are ava ilable t oday for med ­

ical studen ts does help some but it does not help enough, as is evident 

from the figures 1 have j us t given you.

The re is one other figure tha t I think may also reflect the importance o f this financial facto r and tha t is t ha t the re is also a significant 

difference in the rat io of the num ber of s tud en ts from fam ilies of income in relation to the total populatio n. Th us there are ap prox imately 45 percent of the fam ilies of ou r populat ion who hav e estimated income of $5,000 or less. But only 14 percen t of the 1959 g ra dua tin g class came from these fam ilies.

Xow, the prov ision of loans for these stu dents T do not believe will 

be adequa te to meet these needs the reason being th at the a ddition of 

a financial burden of a loan obligation is a de terri ng factor for many 

of these stu dents who not only are concerned with the length of time 

necessary to obtain their medical education but with the fac t that at 

the end of their educational period a loan burden will remain to be 

paid off, when the y have the op po rtu nity to obtain a caree r in oth er 

sciences which will resu lt at the end of that period of education wi thout such a financial bur den upon them.

'Phe availability of add itio nal loan fun ds, however large, is not 

likely to provide ade qua te inducement for s tud ents to choose medicine 

in prefere nce to a career in anoth er life science. I thi nk this fac tor 

will deter man y students , pa rticular ly the students in the A gro up, 

from seeking a medical education.

The second facto r that T would like to emphasize in support of this 

bill is the factor relatin g to the research and academic aspects of
364 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

medicine. Now, we ha ve increased our rese arch supp ort in this country . Congress has been generous in prov iding ade quate su pp ort for 

con stru ctio n of researc h fac ilities con stru ctio n and fo r medical research activities. Over the past decade 1 believe t here is good evidence 

of th e great valu e of thi s prog ram which has provide d great benefits 

in not only advan cin g ou r know ledg e bu t in making ava ilable to the 

people of this country new know ledg e th at is h elp ful in the diagnosis 

and treatm en t of medical ills.

In the continu ed su pp ort of this pro gra m I th in k it is absolutely 

essential th at we support our medical educational fac ilitie s and suppo rt the expansion of th ese insti tut ion s in pr ov iding inc reasing numbers of doctors who in t urn will be able no t only to con tinue in th ei r 

academic and researc h careers bu t also in me etin g the obligation s of 

prov iding this new know ledg e fo r our people.

In the lig ht of these fac tor s. Mr. Ch airma n, I would like to urge 

the passage of this entire bill because I believe th at lx)th provisions 

of th is bill, con struction as well as the sch ola rsh ip prov isions, are 

essential in m eeting the tota l needs of our c ountr y fo r t his purpo se.

Th e Chair man. Doc tor, th an k you very much . T hat does comple te yo ur sta tem ent ?

Dr . F arbe r, do you have any fu rthe r statement?

Dr . F arber. Yes, Mr. Ch airma n and gentlem en of the committee, 

I am grate ful for this op po rtu nity to join Dr. De Bakey in speaking 

in str on g sup port of all of the provisions of th is bill, II.R. 4999.

May I for the rec ord submit my present affilia tion ?

I am pro fessor of pat holog y, H ar va rd M edical School, at the C hildr en ’s Ho spital, scientific director, the Ch ild ren’s Cance r Research 

Foundatio n, Boston. Mem ber of the Na tional Ad visory He alth 

Council, Nationa l Insti tut es of H ealth , c hairm an o f the C ancer Che moth era py N atio nal Com mittee.

I speak tod ay as a private citiz en intere ste d in medical education 

and in research but intere sted much more in the achieve men t of ou r 

natio nal goals f or the health of our people.

May I restate these very briefly ?

These nation al goals are, first, to give to ou r peop le when sick the 

finest medical care in the lig ht of our present know ledg e.

Second, to pre ven t or e rad ica te the dre ad diseases by means of research and to add good years of hap pin ess and prod uctiv ity to the 

lives of our people. In short , to pro lon g the prime of live.

Fina lly , to bring to the pa tie nt, wi thou t loss of time, the results 

of research today, and as research prog resses, throug h superbly tra ine d 

doc tors who tak e care of ou r people, and these doc tors must be ade ­

quate in num ber as well as in trai ni ng fo r th is very im po rta nt task. 

These are ou r goals and this bill adds one more extrem ely im po rta nt 

method of ach ieving these g oal s as ra pi dl y as possible.

I am in complete agreem ent with the vari ous item s which have been 

listed in th is bill. May I select two f or specific m ention ?

In addition to the obviously needed con struction resources for medical schools existing today, and those medical schools which are to be 

built in the next few y ear s, which are so badly needed, there has been 

specific mention of s cho larships and specific mentio n also of research 

con struction facilities. May I say a word abo ut the research construction facilities. Th ere is a men tion of renewal of this support
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 365

for the construction of research facilities which has been going on for 

a number of years now to the great advantage of medicine in the sum 

of $50 million a year for each of 3 years.

I would like to urge tha t this sum be increased to $100 million a 

year for the next 3 years in order to help the country, medical schools, 

research institutions, and hospitals of the country, achieve as rapidly 

as possible the conditions which are badly needed for the conduct of 

research by people who are being trained in our research programs 

and who are able to carry out research through the appropriations 

made by the Congress of the United States with great wisdom and 

vision for the achievement of our national goals in health.

In addition, in this construction of research facilities there should 

be an item of great importance, the provision of $50 million for over 

a period of the next 5 years for the construction of badly needed library 

facilities in our medical schools.

The last item, Mr. Chairman and gentlemen, that I would like to 

mention concerns the necessity for scholarships which are provided in 

this bill. Scholarships 1 believe are badly needed. 1 would like to 

stress first tha t every private resource of the country in the medical 

schools and available to those who are interested in medical education 

should be used for the support of our boys and girls who want to 

become doctors, but I believe that these private resources will not be 

sufficient and have not been sufficient in the past and certainly are not 

adequate to meet our present needs.

The suggestion of loans instead of scholarships has been made 

repeatedly. I would hope that that would not be the solution because 

I think it is a very inadequate one.

Let me picture to you for a moment the young man or young 

woman at the end of medical school with 3 to 5 years of postgraduate 

training looming ahead, with the normal natural desires to build a 

family of their own, to begin practice with the great expense there, 

and then with the additional privilege, which is given young men and 

women, of helping to support th eir parents and perhaps their younger 

brothers and sisters who are also wanting an education; all of this 

tremendous financial load comes in the first 5 to 10 years afte r a man 

or woman has graduated from medical school.

From my own long experience of almost 35 years as a teacher in 

medical schools and in close contact with medical students from all 

over the country, I am convinced that a loan would be nothing but 

an added burden which would deter people from going into medicine 

or make those who do go into medicine because they are so dedicated 

go through a period of unnecessary hardship which can hold back 

the happiness of a whole new family of a young doctor. This I have 

seen repeatedly through the years and all of of us who are in medicine 

are quite familiar with this picture.

I do hope that the scholarship provisions of this bill will be m aintained and tha t this bill will turn out to be the will of the Congress.

Thank you very much.

The Chairman. Thank you, Doctor.

Mr. Macdonald.

Mr. Macdonald. I have no questions. I once again would like to 

point out that it makes me very proud to sit here from Massachusetts
366 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

an d being an alum nus o f the school at which you are a distinguished 

professo r.

I was wondering at one point du rin g thi s hearing, with adminis ­

tra tio n app oin tments dow ntown and this he ari ng goi ng on, who is 

kee ping the store up th ere?

Dr. F arber. Fo rtu na tely, the re are airpla nes , Mr. Macdon ald.

Mr. Macdonald. It is a gre at pleasure to see you and, although you 

are testi fying as a pri vate citizen, your rep uta tio n gives your words 

much weight.

rPhe great work you have done in the Held of canc er research for 

everyone in the cou ntry, hut especially Massachusetts, is cer tainly 

noted by everybo dy here.

I)r. F arber. Th ank you very much.

Th e Chair man. Mr. You nger.

Mr. Younger. No questions.

Th e C hairman. Mr. ('oilie r.

Mr. Collier. 1 have one question.

You refer red to a dropoff of “A" grade stu dents admi tte d to medical l schools from 40 to 14 perc ent, it is a well-known fact in many 

high schools the better stu dents of toda y in the past several yea rs 

have been placed in accellerated courses where it is fa r more difficult 

toda y to give “A’s” than it w asa few years hack.

Wo uld you say that a doctor who eventually got out of medical 

school who was an “A” studen t would necessarily 1m* any bette r doctor 

or phy sician than one who po ssibly was a “B" stude nt ?

Dr. De Bakey. Well, I thi nk this is best answered by sim ply st at ­

ing th at if it were possible to do so every medical school would like to 

have every stud ent be an “ A" s tud ent.

Mr. ( ’olije r. Are n't you a little frightene d at the trend in edu cation tod ay tha t might be fore closing some good norm al “ B” or 

stu dents who might have som eth ing worthwhile to contribu te to ou r 

society ?

Dr. De Bakey. I don't think that this would prevent them from 

ma kin g whatever con trib ution their capacities will allow them tomake.

Mr. ( 'ollier. But it would prev ent them if the re was priorit y given 

to the “A” studen t in every case and assu min g that you had an enrollment of only “A" studen ts, this would lie the case, would it not ?

Dr . De Bakey. It would pre vent them from going into medicine if 

you took only “ A" studen ts, to be sure, but we are fa r away from that 

position.

Mr. Collier. Th ank you, sir.

The Chairman. Doctor, I would not want the record to show that 

we are o verlooking the “( '“ an d “ I)" stu den t, either.

Dr. De Bakey. That is r ight.

Phe C hair man. Mr. Devine?

Mr. Devine. Doctor, 1 have a let ter here from the McG raw-Hill 

Pu blish ing Co., d ated Ja nuar y 24, the first pa ragr ap h of which I think 

is interestin g.

It say s:

President Kennedy in opening bis press conference last week expressed concern over the diminishing inte rest of young students in those fields of engineer­ ing and science which are vital to the welfare of our country.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 367

We know you, too, are concerned. We have heard testimony here 

for the last 3 days saying th at it is necessary to attract people in the 

medical profession now because science and engineering is drawing 

them away, it is a more lucrative field and more desirable field. I 

bring this up fortw o reasons:

First, it does dispute some of the testimony given heretofore.

Xo. 2, if this bill is passed by the House and Senate and it becomes 

law we can expect that each school, whether it is animal husbandry, 

dairy technology, chemistry, etc., will come to the Congress saying 

if you build us more buildings, provide us scholarships, we will have 

better students.

Won’t we set up a dangerous trend if we get into this field?

Dr. De B akey. In the first place, Mr. Devine, adequate support for 

the education of other sciences than medicine exists now. Medicine 

is the only science that does not have adequate support for its students.

Mr. Devine. Medicine is the only one?

Dr. De Bakey. Yes, I am quite sure.

Mr. Devine. I was not aware of the President’s remarks at his conference last week but tha t is what is contained in this letter. I 

thought it was very appropriate at this time.

Dr. De Bakey. I am sure all fields would like to have more people 

coming into them and applying for them and a better selection from 

them.

Mr. Devine. That is all. Mr. Chairman.

The Chairman. As I understand the program next week, we are 

going to take up a bill in the House of Representatives that will provide assistance to colleges and universities primarily in other fields.

On behalf of the committee we want to express our appreciation 

for the contribution you have made to this program.

Dr. De Bakey. Thank you, Mr. Harris.

The Chairman. The committee will adjourn until 2 o’clock this 

afternoon.

(Whereupon, the committee recessed at 12:07 p.m., to reconvene at 

2 p.m. the same day.)

AFTERNOON SESSION

The Chairman. The committee will come to order.

1 think for the information of those who certainly are interested 

and will be affected, I might advise that we have a great many witnesses on the list this afternoon and it is going to be imperative that 

we try to cover every phase of the hearing and presentations and 

questions, but we are also going to have to do what we can to conserve 

time.

The first witness will be Dr. Stafford L. Warren, dean, School of

Medicine. University of California Medical Center.

STATEMENT OF DR. STAFFORD L. WARREN. DEAN, SCHOOL OF 

MEDICINE. UNIVERSITY OF CALIFORNIA MEDICAL CENTER, 

LOS ANGELES, CALIF.

Dr. Warren. Mr. Chairman and members of the committee, I am

Dr. Stafford L. Warren, professor of biophysics and dean of the School 

of Medicine at the University of California at Los Angeles. I come
368 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSO NNEL

in a ra th er unusual cap aci ty in th at I am representin g the deans of 

the five o ther medical schools in Ca lifornia , and I think perha ps I)r . 

Wolf is the only other one who has spoken for a g roup o f schools, and 

it is int ere sting th at we are on oppos ite sides of the con tinent.

I am very much impressed by the patie nce th at yo ur co mm ittee h as 

and with the gr ea t insigh t that it has developed over the day s of this 

hea ring. I realize th at some of you are veterans in havin g gone over 

these subjects several y ears in succession.

I would like to do two things. I have presented a statem ent for 

the record.

Th e C hairman. It may be included in the recor d, Docto r.

(T he statement of Dr. W arr en foll ow s:)

Statement ok Dk. Stafford L. Warren

My name is Stafford L. Warren, M.D. I am professor of biophysics and dean 

of the School of Medicine of the University of California, Los Angeles. It gives 

me gre at pleasure to have the opportunity and privilege to speak before your 

committee. I would like to present testimony on behalf of the deans of the 

existing priv ate and public medical schools of the Sta te of California, and to 

provide certain relevant inform ation regarding our individual or collective experiences as our parent institutions have attem pted to modernize, expand or 

build new medical, dental, and public health schools and the ir rela ted facilities. 

The curre nt and future demands upon the existing education al institution s are 

exceedingly burdensome financially in capital improvement plants, operating 

budget estim ates, and even in the direct costs to the studen ts themselves.

There will be others testifyin g here regarding these particular matters, for 

they per tain to all institution s in the United States. However, Califo rnia in 

particular has been and is still witnessing an immigration which started at a 

high level at the end of World War II and has been maintained at such a consta nt high level that all form er estimates of population increases a re now incorrect by a large factor. There is no evidence which indicates in any way that 

this migration will eith er markedly diminish or cease. During the decade 1950- 

00, two-thirds of the population incre ase was due to immigration. The census 

shows a growth from 10.5 million in 1950 to 15.7 million in 1900. At this rat e 

of growth, it is predicted tha t California will have a jxipulation of 21.0 million 

in 1970 and 24.8 million in 1975. Thus, rather suddenly it has become obvious 

that the physical plant of the State was rapidly becoming inadequate in almost 

every respect, and tha t all public and many private ente rprises and sendees 

would have to be provided in an accelerated fashion in a man ner never contemplate d before.

Certainly growth in accordance with birth rat e is no longer the baseline. It 

must be calculated from the total of births plus migration. During normal 

growth periods (birth rate), calculations and adjustments are fam ilia r and can 

be made, for the expansion is relatively slow and even. However, the immigration phenomenon requires that the facilities and services lx* available instantly 

and upon arrival. Yet the tax contribution of tin* new population lags a year 

or more behind the demand made upon our facilities upon arriv al of th e migrant. 

This includes roads, utilities, housing, and many other things, as well as the 

educational facilities. Today my own par ticu lar intere st is in that part of the 

educational facilitie s re lating to the medical and health related institutions. The 

result of this almo st incredible population increase has been called in the press 

a population explosion. The effect upon the education al institutions in California, both priv ate and public, has been explosive also. At every level of education from kindergarten and prim ary and secondary schools through the 

higher levels of educ ation and professional train ing, the demands for expansion 

are tremendous, even almost incomprehensible.

A private school normally can grow in strength and size only over several 

decades as a result of financial contributions coining main ly from its alumni. 

However, new residents of wealth have not yet developed stro ng ties locally and 

have many commitments in their former hometowns. Thus, a long timelag exists 

before new priv ate support can be expected from the large migra nt group who 

now need the facilitie s in their new location. Strong efforts have been made 

by the existing priv ate education al institutions in California, and it is likely
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 369

th a t th eir cu rr en t fu ndra is in g effo rts ev en tu al ly wi ll be su cc es sful. How ev er, 

a la rg e p a rt of th is mo ney will go to expan din g o r re no va ting th e ir ge ner al ed uca tion al pr og ra m s, an d a le ss er an d ra th e r in adeq uate am ou nt to th eir pro fe ssion al m ed ical and oth er hea lth re la te d pr og ra m s. Thu s, th e pri v ate m ed ic al 

sch oo ls are h ard pr es se d to re nov at e or im prov e an d en la rg e th eir ex is ting 

pr og ra m s.

A t pre se nt th ere are fo ur pri vat e med ical sch oo ls in C al ifor ni a, i.e., Sta nfo rd , 

Lo ma Lin da , U ni ve rs ity of Sou th er n C al iforn ia , an d th e C al if orn ia M ed ical Colleg e (f or m er ly th e C ollege of O st eo pat hy) . All of th em a re c urr entl y rem od elin g 

an d pl an ni ng to e nl ar ge th eir fac ilitie s. T her e are th re e p ri vate d enta l scho ols— 

a t U ni ve rs ity o f Sou th er n Cal ifor ni a, Lo ma Lin da Uni ve rs ity , and th e College of 

Phy si ci an s and Su rgeo ns in Sa n Fr an ci sc o. T he Uni ve rs ity of C al if orn ia has 

scho ols of med icine, den tist ry , ph ar m ac y, and. nurs in g in Sa n F ra ncis co; a t 

Berke ley, a sch ool of pu blic h e a lt h ; a t Los An geles, new scho ols of me dicin e, 

pu blic hea lth, an d nu rs in g, an d pl an s fo r a ne w sch ool of d e n ti str y ; an d a t San 

Diego pla ns fo r a ne w med ical sch ool. T he co sts of th e pl an ne d ex pa ns io ns in 

th e U ni ve rs ity of C al if orn ia alon e to ta l ap pro xi m at el y $67 million. T his su m 

will re su lt in a gai n of only 175 ne w M.D .’s an d 96 new denti st s per y ear an d 

pr ov id es on ly m in im al fa ci li ti es fo r th e ed uca tiona l pr og ra m . In pre se nting 

C al if orn ia ’s pro blem , it is we ll reco gn ized th a t w hi le it is not un ique th e fiscal 

prob lems a re no do ub t mo re ac ute an d urg ent th an else w he re in th e co un try.

A Gov er no r’s co mm itt ee on med ical ai d an d hea lth has m ad e a co mpr eh en sive 

st ud y of med ical ed uc at io n an d re la te d prob lems. T heir Dec em be r 1960 re port , 

“H ealth C ar e fo r C al if orn ia ,” m ak es some in te re st in g pre di ct io ns (p. 51) fo r 

th e S ta te ’s pr oj ec te d ne ed s in 1975 ba se d up on th e nu m be r of firs t-ye ar plac es 

av ai la bl e in 1971 in th e me dical sch ools. The pro je ct io n is bas ed u po n a co ntinuation of th e pre se nt ra te of m ig ra tion , th e pre se nt ra ti o of 175 phy si ci an s pe r 

100,000 po pu lation , and a ph ys ic ia n ro ste r of 44,300 w ith a to ta l po pu la tion in 

ex ce ss o f 24 m ill ion in 1975.

I t pre dic ts th a t th ere will be 1,300 M.D.’s m ig ra ting to C al if orn ia annuall y 

from ou t of th e Sta te . Thi s is eq ui va le nt to th e out pu t of 13 ou t- of-Sta te med ica l sch ool s. Al lowi ng fo r ou t-m ig ra tion (a bout 340) an d att ri ti o n in tr ain in g, 

ab ou t 1,400 firs t-ye ar plac es are n ee de d in an d by 1971. C urr en tl y prop os ed ne w 

med ical sch oo ls an d ex pa ns ion of ex is ting schools wi ll pr ov id e from 635 to 675 

first-ye ar plac es by 1971. Th e de fic it is th us ov er 700 first-ye ar pla ce s, or th e 

eq ui va le nt of 7 new an d curr en tly un pl an ne d med ical sch oo ls to be fu nd ed and 

co mplete d by 1971. Sin ce th ere is a co ns id er ab le le ad tim e in plan ni ng , fu ndin g, 

and c on st ru ct io n (4 or 5 ye ar s) be fore st udents ca n be ad m itte d to a ne w sch oo l, 

th is mea ns th a t th er e is an acu te em erge nc y in re sp ec t to fu nd in g of th e seve n 

new sch oo ls as we ll as urge nc y in co mpl etin g th e remod eling a n d /o r ex pa ns io n 

of th e ex is ting o nes by 1971.

Th e ra ti o of M.D.’s is high er in C al iforn ia , 175 pe r 100,000, th an th e N at io n 

as a wh ole, 143 pe r 100,000. The re do not exis t an y pec ul ia ri ties in th e u ti li zation of ph ys ic ia ns fo r 73 per ce nt a re in pri vate pra ct ic e in C al if orn ia in co mpa riso n to 74 pe rc en t in th e United S ta te s as a wh ole. W hile th ere is no ev ide nce th a t th e S ta te att ra c ts pe rs on s of po or he al th , st ati st ic al st udie s show 

th a t th e po pu lation in Cal ifor ni a re quir es m or e m ed ical se rv ice th an el se w he re 

in th e U ni ted Sta te s, an d th a t th ere are m an y ga ps in bo th th e fa cil it ie s and 

pe rson ne l to man th em in th e are a of ch ro ni c dise as e, re habil it ati on, or ga ni ze d 

home ca re , nurs in g homes, etc. Exp an sion of ph ys ical pla nt an d fa ci li ti es fo r 

th es e ne ed s an d fo r ho sp ital s will co mpe te w ith th e f undin g of n eeded ex pa ns io ns 

of th e p are nt an d oth er ed uc at io na l in st it uti ons.

Befor e loo king a t th e co sts of th e ex pa ns io n of med ical schools by 1971 (i.e., 

th e ne xt 10 y ears ), le t us ex am in e briefly th e outlay fa ci ng th e S ta te in th e educa tion al field alo ne . In ord er to m ee t th e pop ul at io n tide comi ng fr om th e childr en now (19 61 -63) in th e prim ar y an d se co nd ar y school s, it wi ll be ne ce ss ar y 

fo r th e ju n io r an d S ta te college sy stem to co nst ru ct ab ou t $450 million w ort h 

of fa ci li ti es be fo re 1971, an d fo r th e U ni ver si ty of C al ifor ni a to en la rg e it s pre sent ca m pu se s an d to bu ild a t le as t tw o more re qu irin g $1.25 billi on fo r cap it al 

pla nt by 1971. T hi s includ es th e a ppro xim at el y $60 mi llio n fo r co mpletion of it s 

tw o ex is ting med ical ce nt er s (a t U CSF and UC LA ) an d a ne w S ta te m ed ic al 

school a t Sa n Diego.

Thi s hu ge su m of $1.7 bil lio n fo r th e phy si ca l pla nt of t he S ta te ’s h ig her ed uca ­

tiona l sy stem do es not includ e th e nu m er ou s gra m m ar an d hi gh scho ols w hi ch 

local school d is tr ic ts thr ough ou t th e S ta te w ill ha ve t o fu nd . No r do es it i ncl ude 

th e nu m er ou s no ne du ca tion al se rv ices an d fa ci li ti es which th e S ta te m ust expa nd a t th e sa m e tim e.
370 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

In no rm al t im es i t is us ua l to bu ild a med ical ce nte r or school in stag es be cause 

of th e gre at expense. If th e pr ed ic tion s of man y ot he rs , as we ll as th os e ma de 

by th e Gov erno r's co mmittee , are co rrec t, th er e is no t tim e to sp re ad ei th er the 

in cr ea se s of en ro llm en t no r, th er ef or e, th e fu nd in g of th es e new med ical in st itu ti ons over man y ye ars. It m us t be accom plish ed in C al iforn ia with in th e nex t 

de cade. It is sugg ested th a t th is fin an cia l load is too g re at fo r ei th er pri vat e 

ph ilan th ro py o r th e S ta te tax b ase to b ea r d uring th is de cade.

I ha ve prev ious ly co mm ented ab out th e redu ce d ability of th e pri vat e med ical 

in st it uti ons to ra is e fu nd s. W hi le Califor ni a has a larg e nu m be r of ex ce lle nt 

p ri vate ed uc at io na l in st itut io ns , th es e are ge ne ra lly sm all w ith lim ite d st uden t 

en ro llm en t ob jectives in ord er to keep th ei r underg ra duate quali ty hig h. Few 

are stro ng ly endo we d an d alm os t none look w ith fa vor up on ac ce pting th e 

ob lig atio n an d co sts of under ta kin g th e es ta bl is hm en t of a new me dical school.

Thu s, th er e ca n be li tt le ex pe ct at io n th at mor e th an one . or a t be st two, 

pri vate ed uc at io na l in st itutions wo uld come fo rw ar d to m ee t p a rt of th e need, 

an d on ly if larg e m at ch in g fu nds fro m Fe de ra l so ur ce s w er e av ai la bl e fo r co nst ru ct io n, an d if a co ns id er ab le p a rt of the oper at in g co st could be subsidized 

als o. Th us, if th e es tim at es of th e po pu latio n an d th e ne ed s fo r ph ys icians by 

3975 are co rrec t, it wo uld ap pea r th at most of th e cost of co ns truc tio n an d 

op er at io n will fa ll u pon S ta te an d Fe de ra l s up po rt.

I wou ld lik e now to co ns id er th e pr es en t st ate of th e ex is ting fa ci lities of th e 

pu blic an d pri vat e med ical sch oo ls in Califor ni a. As sta te d ear lier , th e Unive rsi ty o f C alifor ni a prop os es t o en la rg e its two med ica l sch oo ls by 1966 to g ra duate 

128 new do ctor s each per ye ar an d to ad d an oth er in Sa n Diego fo r 100 M.D.’s 

mak in g a to ta l of 356 new M.D .’s p er yea r at a co st in ex ce ss of $60 mi llion .

Sta nf or d has j u st co ns olidated its me dical sch ool in new bu ild ings on th e main 

ca m pu s at a ca pa ci ty of 64 new M.D.’s per ye ar. Ther e are man y ga ps in th eir 

pr og ra m , par ti cu la rl y a t th e g ra duate level in th e ba sic scienc es an d in th e post ­

do ctor al level o f th e c lin ical s cie nces (se e at ta ch m en t I I ,.

Th e Uni ve rs ity of Sou ther n Cal ifor ni a is pl an ni ng to mo ve it s ba sic scien ce 

dep ar tm en ts fro m th e mai n ca mpu s to a new s ite close to th e Lo s An geles Co un ty 

G en er al Hos pital whe re it w ill co ns ol idate its und er gra duat e, gra duat e, an d po stdo ctor al pr og ra ms fo r th e fir st tim e. Lik e Sta nfo rd its new pl an t will ha ve 

man y ga,>s (see at ta chm ent I I I). In the remod eli ng it will ra is e its new M.D. 

ou tp ut fro m 72 to 80 p er ye ar .

Loma Lind a Unive rsity (f or m er ly the College of Medica l E va ng el is ts ) is re ­

mo de lin g an d ex pa nd in g its reso ur ce s a t tw o si te s— on e on th e ma in ca mpu s in 

Lo ma Lin da an d the ot he r at th e si te of th e W hite Mem orial Hos pital wh ich is 

also clo se to th e Los An geles Co un ty Gen eral Hos pital. Th e un iv er sity ne ed s to 

re pl ac e outm od ed bu ildi ng s as we ll as to in cr ea se its in st ru ct io nal an d re se ar ch 

fa cil it ie s (see att ac hm en t IV ), It will co ntin ue to g ra duate 72 M.D.’s pe r yea r 

h u t wi ll incr ea se its gra duate st ud en t load.

The Califor ni a College of Me dic ine (for m er ly th e Colleg e of Osteo pa thic Physi ci an s an d Su rgeo ns a t Los An geles ) needs co ns id er ab le rem od eli ng an d re ­

pl ac em en t of old st ru ctu re s an d ex tens ive ad ditio ns of te ac hi ng eq uipm en t fo r 

th e up gr ad ed underg ra duate pr og ra m in th e ba sic sciences. It comp let ely lac ks 

an y re se ar ch fa ci lity . If th e quali ty of its ed uc at io na l effo rt is to be ra is ed an d 

mod ernize d, it wil need a high m at ch in g ra ti o fo r it has only ju st now st art ed its 

ca m pa ig n to ra is e fu nd s fo r co ns truc tio n. It has a 700-bed re la tive ly new wing 

of th e Los An geles Co un ty Gen eral Hos pital fo r its clin ical pr og ra m and ot he r 

us ef ul fa ci lities (see attachm ent V ). It cu rr en tly gra duate s 72 new D.O.’s, bu t 

may co ns id er lowering th e med ica l stud en t ca pa ci ty fo r a while an d gra duat e 

on ly 64 M.D.’s. It will no t ha ve mu ch gra duat e st ud en t outp ut fo r a lon g tim e 

an d on ly wh en it ob ta in s ad ditio nal spa ce. It wi ll ha ve a mod est po stdo ctor al 

outp ut.

The to ta l ou tp ut is th us es tim at ed at a mi nim um of 636 new M.D.’s j»er yea r 

w ith th e po ss ibili ty of a max im um of ab ou t 675 in 1970. Ex ce pt fo r the two 

ex is ting U ni ve rs ity o f C al ifor ni a sch oo ls each of wh ich are p a rt of an in te gra te d 

med ical ce nt er com plex, ac co un ting fo r th eir la rg er size, th e pri vat e sch ools ten d 

to re str ic t th eir pr og ra m s to th e tr ain in g o f M.D.’s. po stdo ct or al fel low s (i nte rn s 

an d re si den ts ), an d a few gra duate stud en ts in th e ba si c scienc es. Eac h has 

some sp ec ia lti es an d a few pa ra m ed ic al pr og ra ms, b u t th ey do not at te m pt to 

co ve r the he al th an d med ica l scienc es in a co mpr eh en sive fash ion. Th us, they 

a re no t a larg e so ur ce o f te ac her s in th e basic a nd c lin ical sci enc es.

All of t he i nst itut io ns, bo th pu blic and p riva te , are in need o f libra ry exp an sion . 

T h is is par ti cula rl y tr u e of th e C al ifor ni a Colleg e of Me dic ine. Th e cr ea tion of 

libra ri es fo r th e new sch oo ls wi ll be a ve ry ex pe ns ive an d difficult pro ble m.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 371

Costs of co ns truc tion in C al if orn ia ha ve rise n alm os t 5 pe rc en t pe r ye ar . 

C on stru ct io n to be st art ed in m id su m m er o f 1962 is es tim at ed a t ab ou t $45 tier 

sq uar e fo ot gr os s (E N R 850) fo r cl as s A co nc re te an d stee l fr am e bu ild ing. 

T his is ov er tw ice th e cost pa id in 1950 fo r th e same tyi»e of co ns truc tion . It is 

an al l-in clus iv e cost, ex clus ive of land .

In th e ve ry thor ou gh an d pe rc ep tive st udy of “M edica l Sch ool Fac il it ie s, ” 

U SP HS pu bl ic atio n No. 875 iss ue d in 1961. th e av er ag e co st of $30 i>er sq ua re 

fo ot is used i p. 137) wh ich does no t incl ud e si te im prov em en ts, mov able eq uipm en t o r fee s. Th es e elem en ts are in th e C al if or ni a fig ure of $45 an d are re qu ired 

by th e fu nd in g pr oc ed ur e of th e univ er si ty an d Sta te le gi sl at ur e. T his mak es 

qu ite a differen ce in th e co st es tim at es . On pa ge 137 of th e re po rt, school It is 

es tim at ed as c os ting $7,980,000 fo r th e co nv en tion al ba sic sci ence fa ci lities f o r an 

en te ri ng cl as s of 96 st uden ts a t $30 pe r sq uar e foot, gros s w ithout th es e ex tr as , 

while a t $45 wh ich includ es them , as we ll as our hi gh er ov erall co sts , ou r to ta l 

wo uld be $11,970,000. It is ea sy to unders ta nd wh y th e co mm itt ee w ri ti ng th e 

re port wou ld wish to avoid in clud ing th es e elem en ts be ca use th e loca l co sts may 

va ry gre at ly from plac e to pla ce. If th es e item s are le ft ou t of th e ap pl ic at io n 

fo r m at ch in g fu nd s, however, th e in st it uti on may he le ft in a ba d po sitio n to 

meet, th es e co sts aft erw ard . Also ap plica tion s fo r m at ch in g fu nds includ ing 

them might be th oug ht to b e un us ua lly e xp en siv e.

A fter re vi ew in g th e si tu at io n in th e C alifo rn ia sch oo ls an d re al iz in g th e 

difficul ty of ob ta in in g th e ne ed ed co ns truc tion fu nd s from loc al p ri vate an d ta x 

source s, it is appare nt th at H.R . 4999 wo uld mee t a ve ry gre at an d urg en t need 

if it wer e to be ap prov ed an d en ou gh mo ney w er e to be m ad e av ai la ble to th e 

in st it u ti o n s unde r a m at ch ing pr og ra m . Su ch su pport wo uld go a lon g way 

to w ar d stab iliz in g our med ica l sch ool pro gr am s an d in cr ea sing th e num ber of 

tr ain ed pe rson ne l, as well as M.D .’s.

I w ould like to di sc us s each of th e th re e p art s of th e bill se par at el y :

PA RT A. GR AN TS FOR CO NS TR I CT IO N OF H EA LTH RE SE AR CH FA C IL IT IE S

In th e pa st few year s a g re at de al of te stim on y has been bro ug ht to bea r on 

th e se riou s defic ien cie s in rese ar ch fa ci lities in th e N at io n’s med ical sch ools. 

Co ng ress h as d em on st ra te d its co nc ern w ith th is deficie ncy by appro pri ati ng som e 

$180 mi llion up to 1962 tow ar d m ee ting th is need th ro ug h th eir pa ss ag e of the 

H ea lth Res ea rc h Fac ilitie s Act. T he Natio na l Adv iso ry Co uncil of th e H ealth 

Res ea rc h F ac ilitie s Branc h of th e USP HS . which is resp on sib le fo r dis tr ib uti ng 

th e fu nd s ap pro pri ate d un de r th e ac t. has us ed gre at wi sdo m in it s dis trib ution. 

How ev er, th e need is so trem en do us th a t th ere re m ain gre at ga ps in ev ery sch ool 

if th e goal is to a tt a in a ba lanc e of re se ar ch of hig h qu al ity an d to pr om ote 

gra duate ed uc at io n in th e man y di sc iplin es ex isting in th e med ical an d hea lth 

re la te d fields.

A fter sp en di ng som e 20 y ea rs in re se ar ch in med ica l schools mys elf an d ha vi ng 

some 18 y ears of ad m in is tr ati ve co nc ern ov er th e de ve lopm en t of med ical ed uc ation an d re se ar ch , I am convi nce d th a t we ha ve ne ve r tr uly ex ploited th e full 

po te nt ia l of ou r fa cu ltie s. The re is ev iden ce in ev ery in st it uti on th at giv en th e 

spa ce, too ls, an d bu dg et, our fa cu ltie s ev er yw he re ha ve th e intellige nc e, im ag in atio n, an d dr iv e to be as cr ea tive as th e be st in th e ph ys ical scienc es an d oth er 

disc iplin es . Ea ch pr of es so r can su jier vi se th e tr ain in g of fro m 1 to 4 ad va nc ed 

or gra duate st ud en ts . In mo st in st it uti ons th e nu m be r of gra duate st udents is 

muc h les s th an th is be ca us e th ere is no sp ac e fo r mor e th an on e or tw o per 

pr of es so r. H er e is whe re ex pa ns io n ca n be m os t effective. T her e has been co nside ra bl e ex pe rien ce in the la st few year s to sa y th a t th ere are en ou gh yo un g 

I>eople in th e un iv er sities who can su pp ly th e ta le nt fo r th e med ical an d healt h 

scienc es pr og ra m s if th er e are fa ci lities in which to tr a in them . In th e W es t 

ce rt ain ly t here h as be en no lac k of w ell qu ali fie d st uden ts to fill all of t he tr ain in g 

op po rtun ties wh ich are av ailable. In ad ditio n th er e are man y who go E a st to 

find such op po rtuni ty . With th e p op ul at io n in cr ea se an d th e pre se nt nat io nw id e 

re su rg en ce of in te re st in sci ence ge ne ra lly, we ca n ex pe ct an eve n hi gher 

pe rc en ta ge of yo un g i»eople in th es e fields. F or th e ne xt de ca de we sh al l ne ed to 

in cr ea se t he nu m be r o f t he se g ra duate s an d sc hola rs to fill th e new te ac hin g p os ts, 

a s well as t o in cr ea se th e nu mbe r of p ra ct ic in g M.D.’s.

W hile th e gre at va lu e of re se ar ch fin ding s to th e N at io n' s well-b ein g is th o roughly rec og niz ed, it is mo re im port an t a t th is st ag e of our de ve lopm en t th a t 

we recogn ize th e ne ce ss ity of pr ov id ing th e re se ar ch ex pe rien ce to th e gra duate 

an d po stdo ct or al st uden ts in th e ba sic an d clin ical scienc es as a p a rt of th eir 

trai ni ng . The re se ar ch pr od uc t is a val ua bl e pr od uc t, but a se co nd ar y one .
372 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

I wou ld lik e to em ph asize , th er ef or e, th e vi ta l ne ce ss ity of pr ov id ing fa ci lities 

an d eq uipm en t as a mea ns of in cr ea sing ou r man po wer in th e ad va nc ed fields 

of ou r disc iplin es. If th e me dica l, den ta l, an d pu blic hea lth schools are to be 

st re ng th en ed , th e be st in ve stm en t of th e in sti tu ti on’s doll ar s an d thos e of the 

Fed er al Gov ernm en t is in th e m at ch in g of an y re se ar ch co ns truc tion fu nd s 

which can be ra ised by th e in st itut io ns. Thr ou gh th e co op er at io n of the oth er 

de an s of th e Cal ifor ni a med ical sch oo ls, I am pr es en ting fo re cast s of th eir ne ed s 

fo r th e nex t 5 to 7 ye ar s an d ha ve se pa ra te d in att achm ent I th eir rese ar ch - 

gra duate in st ru ct io n pr oj ec tion s fr om th eir ed uc at io na l pr oj ec tio ns . The re is 

an in here nt wea kn es s in th is proc ess, be ca us e th e pro je ct io ns fo r rese ar ch - 

gra duate in st ru ct io n fa ci lities ha ve rec eiv ed li tt le su pport fr om th e adm in is tr ation s of th e in stitut io ns , bo th pri vate an d public. R es ea rc h prev io us ly ha s bee n 

co ns id ered an en rich m en t am i no t a source of ad va nc ed st uden ts . Thu s, su ch 

pr oj ec tion s ha ve been giv en a less er p ri ori ty by adm in is tr ati ons to th e pr oj ec tio ns 

fo r under gra duate me dical, den ta l, an d public hea lth st udent ed uc ation. My 

re as on fo r plac ing re se ar ch -g ra duat e st ud en t fa ci lities in a hig he r pri ori ty is 

th a t mos t of th e schools will ha ve a t le as t som e pr ov ision fo r th e unde rg ra duat e 

pr og ra m s an d lac k ad eq uat e su pport of th e fa cult y-g ra duat e st uden t pr og ram. 

If a hi gh er m at ch in g ra ti o th an 1 to 1 were es ta bl ishe d, th e in sti tu ti on's do llar 

wo uld go mu ch fu rt h e r an d th e re al nee d wo uld be mor e ne ar ly sa tis fie d by the 

fu nds av ai la bl e to th e in st itution.

The critic ism has bee n mad e th a t no de an is ev er satis fie d an d th a t as a clas s 

we a re al l loo king fo r mor e money . The reas on is cl ea r to me a t le as t— few 

if an y in st it uti ons in th e co un try ha ve re al ly pla nn ed an d been ab le to fund 

th e co mplete ly ba lan ce d pr og ra m fo r th e m ed ical-h ea lth sciences. If th is were 

done, I belie ve it cou ld be show n th a t while th e sums re qu ired to bu ild an d 

opera te such a pr og ra m w er e ve ry larg e, th e co st i>er st udent wo uld be com ­

pa ra ble to th a t in th e oth er scien ces. Thi s comes ab ou t by utilizi ng th e fa cu lty 

fo r bo th under gra duat e an d gra dua te -res ea rc h in st ru ct io n an d ba lanc in g the 

tim e an d en ergy ap pr opri at el y betw ee n the m. The big ga in is in th e nu mbe r 

of ad va nc ed st ud en ts. I t m ay be th a t only th e ol de r an d ri ch er pri vate in sti tu ­

tion s an d th e pu blic on es ca n ac hi ev e th e larg e st udent body re qu ired to prod uc e 

th es e low co sts pe r stud en t.

I t follo ws also th a t th e m ajo ri ty of th e p ri vate in sti tu ti o n s may need to co ncen tr ate upo n th e underg ra duate m ed ical st uden t pro gr am s w ith som e sp ec ia ltie s 

in th e gra duat e an d pos td oc to ra l are as , be ca us e of th eir mor e lim ite d fu nd s. 

Th ey prob ab ly m us t ac ce pt a hig her co st pe r st ude nt, too , in ord er to ke ep th eir 

qual ity up.

On e ot he r elem en t in th e re se ar ch -g ra duat e pi ct ure , an d part ic ula rl y in th e 

ca se of th e publi c sch ool s, is th a t S ta te le gi sl at ure s te nd to believe, righ tly or 

wrong ly, th at sin ce re se ar ch be ne fit s th e N ation as a wh ole , th e su pp or t of 

re se ar ch shou ld com e from a bro ad er ta x ba se th an ju st th e S ta te alo ne. Th us , 

a ge ne ro us Fed er al m at ch in g pla n in th e re se ar ch co nst ru ct io n pr og ra m is apt 

to ob ta in mo re resp on se fr om th e le gis la tu re s ac ro ss th e co un try. A si m il ar 

resp on se fro m pri vat e do no rs is of co urse obvio us, i.e., one of th eir dol la rs ca lls 

fo rt h $2 f ro m oth er so ur ce s (F ed era l) .

W hi le I sugg est w ith som e hesi ta tion th a t a br oa d or sl id in g scale of m at ch in g 

mig ht be ve ry us eful to th e C ou ncil in m ee tin g some ve ry m er itorious re qu es t, I 

re al iz e th a t such a prov ision wou ld plac e a he av y adm in is tr ati ve resp on sibi lit y 

up on them . Per ha ps it wo uld be fa ir e r to se t th e m at ch in g ra ti o a t 2 to 1 as 

prop os ed in II.K . 4999, but I re sp ec tful ly sugg est th a t th is op tio n to mak e adju st m ents be discus sed by th e ho no ra bl e mem be rs of you r co mmittee .

PART B GRANTS FOR CONSTRUCTION OF MEDICAL, DENTAL, OSTEOPATH IC, AND PUB LIC 

HE AL TH TE ACHIN G FA CILITIES

Ther e is no do ub t th at man y scho ols ac ro ss th e N atio n need ad di tion al fu nds 

fo r re mod eling an d en larg in g th e ed uc at io na l fa ci li ti es of th eir ex is ting pla nts 

in med icine, de nt is tr y, an d pu blic hea lth. Ma ny ch an ge s ha ve oc cu rred in th e 

med ical an d he al th field s as a re su lt of th e la rg e vo lume of rese ar ch which has 

bee n su pp or te d by th e Co ng res s th ro ug h the Nationa l In st it ute s of H ea lth an d 

oth er Fed er al an d pri vat e gra nti ng agencie s. The se ad va nc es mu st be refle cte d 

in th e u nder gra duat e (a nd post gra duat e) cu rr ic ul um s an d re quir e man y ch an ge s 

in lal »o rat ory fa ci lities a nd pr oc ed ur es , as well as e qu ipmen t. B et te r metho ds of 

te ac hi ng ha ve a lso o cc ur red an d re or ga niz at io n of th e b asic s cien ce u nder gra dute 

st u d en t la bo ra to ri es is being pr oj ec te d. Thi s is ce rt ai nly tr u e in C al if orn ia 

scho ols as insp ec tio n of th e at ta ched tabl es an d le tt ers wi ll in di ca te .
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 373

Ther e is no way of se par ati ng re se ar ch from teac hi ng in th es e pr of es sion al 

sch oo ls no r c an a n u nder gra duate p ro gra m e xis t fo r long a t a high lev el of q ual ity 

un less th e f ac ul ty ha ve some w ay o f ke ep ing up to d ate. Th e co nd uc t of re se ar ch , 

th e su pe rv isio n of th e re se ar ch of th e gra d u ate st uden t an d po stdo ctor al fel low , 

an d th e in te rp re ta ti on of th e re su lts of re se ar ch to th e under gra duat e duri ng his 

in st ru ct io n a re in ex tric ab ly e nt w in ed if th e g re ate st be nefits are to be de riv ed by 

all co nc erne d. Th us , in pl an ni ng fo r underg ra duate in st ru ct io n pr ov isio ns fo r 

fa cu lty ca nn ot be ju st an office, bu t m us t in cl ud e la bor at or y fa ci li ti es fo r th e 

fa cu lty an d a t le as t one “fe llo w” (r ese arc h st u d en t) . In te re st in gl y enough, rec ­

og nitio n of th is f acto r oc cu rs in t he re ce ntly i ss ue d USP HS R ep ort No. 875 “Me dica l F aci lities .” Mos t of us wo uld co ns id er th is an ex ce lle nt mo del but on th e 

m in im al sid e, fo r it prov ides fo r ex pa ns io n by ad ditio n of re se ar ch wings which 

are co ns idered en rich m en ts an d of seco nd pri or ity. I wo uld co ns ider th is to be 

tr ue only in a new sch ool f or ob vio us p ra ct ic al reas on s.

If th e N at io n ne ed s mo re th an 10 new m ed ical sch oo ls by 1975, an d som e ha ve 

es tim at ed th e ne ed a t ab ou t 20 (B ay ne -J on es re po rt, 1958 ) an d if m at ch ing is 

mad e on a 2-to-l ba sis, fo r 10 scho ols a to ta l of some $350 million will be needed 

be tw ee n 1962 an d 1972 to ge t th e ne w sch oo ls un de rw ay . Of th is $300 millio n, 

som e $110.0 mill ion will nee d to be ra is ed by th e in st it uti ons an d $233.4 million 

pr ov id ed by F ed er al su pp or t. If 20 ne w sch oo ls are n eeded, th e am ou nt of co urse 

wo uld be tw ic e this. New teac hi ng fa cil it ie s fo r ex pa ns io n of ex is ting sch ools 

wo uld ra is e th is to ta l even mo re. It is un like ly th at th es e su ms ca n be ra is ed 

qu ickly by eit h er pri vat e or pu blic sch ools, part ic ula rl y sin ce eit h er en la rg em en t by bu ild in g new te ac hin g fa ci lities or sta rt in g a new sch ool re quires su stai ne d 

oper at in g bu dg ets of con side ra bl e m ag ni tu de . W hile co ns truc tion ma y be co nsider ed t o be a nonre cu rr in g exp ense, few , p art ic u la rl y in th e p ri vate field, ca n es ta blish t he re so ur ce s f or op er at io n qu ick ly.

Th us, a co ns id er ab le tim e may elap se be fo re ap pl ic at io ns ca n be mad e for 

match ing, an d a ve ry la rg e sum may be re qui re d 3 or 4 year s a ft e r pa ss ag e 

of II. R. 4999. My po in t is th a t it m ig ht be well to m ak e a pr ov ision in II.It . 

4999 whe reby fu nds could be car ri ed ov er to me et th is co ntinge nc y fo r ex pa nd ed 

an d new te ac hin g fa ci lities . It is my op ini on , w ithout go ing in to de ta il, th a t 

it wi ll re quir e an av er ag e of nea rl y $100 million per yea r of m at ch in g fu nd s 

fo r 10 year s to br in g th e ed uca tiona l system in th e med ical an d hea lth sci ences 

up to th e ne ed fo r m an po wer in th is field. We are th a t fa r be hind in mee tin g 

th e cu rr en t an d pr oj ec te d de man ds . P ara ll el shou ld be an eq ua l am ount fo r 

re se ar ch fa cil it ie s to b uild up th e gra duate a nd po stdo ctor al man po wer re so ur ce s 

to st af f th es e in cr ea se d fa ci lities an d to do re se ar ch fo r th e F ed er al and pri vate 

or ga ni za tion s. T hi s to ta l ex pen diture of $2 billi on of Fed er al m at ch in g fu nds in phy si ca l 

pla nt is c ert ain ly in th e N at io n' s in te re st in eve ry way.

PART C. SC HO LA RS HIP GRANTS TO SCHOOLS OF MEDIC INE, OSTEOPATH Y, OR DEN TIST RY

Exp er ie nc e in our Sta te -s up po rted school in di ca te s th a t be fo re g ra duati on ov er 

on e- ha lf of ou r med ical st uden ts ha ve bo rrow ed money , an d m an y ne ed to 

co nt in ue bo rrow in g du ri ng th eir in te rn sh ip an d reside nc y i»eriod. The pr opo rtio n is pr ob ab ly no t as hig h in th e pri vate schools, but it is a pro ble m th er e 

too. Thi s de bt pre ve nt s man y st udents fro m co nt in ui ng in th eir pos td oc to ra l 

ed uc ation, an d is a p art ic u la r ha nd ic ap to thos e co ns id er in g te ac hi ng as a 

ca re er . Th us , th ey go into pra ct ic e a ft e r th eir in te rn sh ip . The p ri vate pra cti ti oner to da y wo uld benefit gre at ly by an addi tional yea r of tr ai nin g. Bec au se 

he ca nn ot do th is, man y of us feel th a t we ha ve slip pe d bac kw ar d in tu rn in g 

ou t ph ys ic ia ns bett er pr ep ar ed to mee t to day ’s de m an ds up on him . In ad di tion , 

we be lie ve th a t we are miss ing man y high ly qu alifi ed st udents in al l of th es e 

fields be ca us e th eir fin an cia l re so ur ce s are in ad eq ua te . T hei r pr og ra m is long er 

an d mor e ex jie nsive th an th a t of th e ad va nc ed st udent in th e ph ys ic al an d 

en gi ne er in g scien ces whe re sch ol ar sh ip s are ava ilab le .

May I re sp ec tful ly re qu es t th a t th is p a rt of II.R . 4999 be give n you r fu ll 

su pp or t.

On beh al f of th e de an s of th e C al if or ni a sch oo ls of med icine, I wou ld lik e 

to ex pr es s our ap pr ec ia tion fo r th e op po rtuni ty affo rd ed me to su bm it th es e 

op inio ns fo r your co ns id eration. So th a t th ere will be no m is under st an din g, 

I wo uld lik e to st ate th at w hat I ha ve sa id ab ou t th es e pr ob lems in re se ar ch , 

ed uc at io n, an d sc ho la rshi ps ap pl ie s eq ua lly fo r med ici ne , denti st ry , an d pu blic 

hea lth.

Stafford L. Warren, M.D.,

(F o r th e ad hoc co mmittee o f th e M ed ical School Dea ns of C al iforn ia ,

Pa cific Pal is ad es , C ali f. ).
374 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Attac hm en t I

5 to 10 year projected construction needs of California schools of medicine—

Authorized, but unfunded 1961, funding needed before 1966, completion

needed bp 1911

[In mill io ns ]

Te ac liin g under gra du at e

Res ea rch

gra duate

C al iforn ia College of M edic in e.............................................. . . . $10,000 

0.500 

24.800 

3.100

10.452

’ (7. 461) 

3

 30. 900

3

 (6. 500)

3

 « (7. 300) 

25. 00C

3

 (100.000) 

» (231.000)

$5. 000

7. 000

4.40 0

6. 500

14.840 

’(10. 079 / 

’ (12.700)'

Lom a L in da U n iv ers it y ...... .................... ........................

Sta nfo rd U n iv e rs it y .. .

U n iv ers it y of S ou th er n C a li fo rn ia ............. . .

U n iv ers it y of C al ifor ni a:

San Fra nc is co >........ .........................

Los Ang eles 5

..................................................................

San D ie g o .. . .................................

(?)

(?)

(?)

3 new m ed ic al scho ols o n lv .. ___

7 new m ed ic al scho ols o n lv .................

T o ta l, au th o ri zed .............................. 110. 752 

’(25 2.261)

37.740 

’(22. 779> T o ta l, pr ojec ted u n au th o ri zed _________ ______

T o ta l......................................... 363.013 60. 519

G ra nd to ta l, 5 to 10 ye ar p ro je ct ed (a uth orize d an d unau th ori ze d) co nstr u cti o n ne ed s of C al ifor ni a scho ols of m edic in e........................ 423.532

' In cl udes m ed icin e an d d en ti str y .

1

 It em s en cl os ed in pa re nt hes es a re p ro je ct ed , b u t un au th ori ze d. 

3

 In cl udes m ed icin e, d en ti str y , an d pu bl ic h ealt h .

‘ Public health.

» E sti m ate d .

Attac hm en t II

Stanford Univ ers ity School of Med icine,

Stanford Medical Cent er,

Pa lo Alto , Ca lif., January 15, 1962. Dea n Stafford Warren,

Scho ol of Me dicine,

University of California Medical Center,

Los Angeles, Calif.

Dear Dean War re n: In as m uc h as I ca nn ot be pre se nt in W as hi ng ton, D.C., 

th e we ek of Ja n u ary 22 to t es tify fo r th e Sta nf or d Me dic al Sch ool in conn ectio n 

with he ar in gs re la tive to H.R. 4009, I am fo rw ar din g un de r se par at e cover (JO 

copie s of ou r pr oj ec ted needs.

You will no te (1 ) a new bu ildi ng fo r fiscal yea r 1903, clin ical sci ences an d conco m itan t rem od eli ng o f exis ting fa ci lities ; (2) med ica l school II an d La ne II fo r 

fiscal year 1900: (3 ) Edw ar ds II in fiscal yea r 1908 or fiscal year 1970.

Pro gr am in g fo r th e clinical scien ces bu ild ing is prw ee di ng . Thi s bu ild ing 

re pr es en ts comp letion of ph as e I o f th e new Sta nf or d Medica l Cen te r an d is to 

pr ov id e clinica l re se ar ch sp ac e pl an ne d, bu t no t bu ilt, pri or to th e mov e fro m 

Sa n Fra nc isco in 1959. as ne ce ss ar y fo r ou r ed uc at io na l pr og ra m a t it s pr es en t 

level.

Me dic al school II an d Lan e II . “d up lica ting ” pre se nt so-nam ed bu ild ings, 

wo uld prov ide sp ac e fo r (a ) an atom y, mi cro bio log y, an d ph ysiolog y pr es en tly 

else whe re on th e camp us, (ft) ad ditio nal sp ac e fo r I>ane Me dic al Li br ar y, an d 

(c ) ad di tion al b asic m ed ical scien ce te ac hi ng l ab ora to ri es f or pre -M.D., p re-P h. D. 

an d pa ra m ed ical st ud en ts.

E dw ar ds II is in no way te nta ti vel y pr og ra m ed but it is ap pr ec ia te d th a t new 

or diffe re nt in te re st s wi ll un do ub tedl y ju sti fy su ch siwice by 1970.

No spac e fo r a school of denti st ry or pha rm ac y is co ntem plated . Pre se nt 

pl an s in nu rsing, ph ysical th er ap y, an d speech pa tholog y-au diolog y do not en ­

vis ion ex pa nsion.
TRAIN ING OF PROFESSIONAL PUBLIC HEALTH PER SON NEL 3/5

I trust you will l>e prepared to advocate a matching basis more realistic and 

favorable than the present 1 :1, for I am sure we shall find moneys from nontax 

sources progressively harder to get.

We at Stanford, like our sister California medical schools, appreciate your 

time and effort in behalf of the citizens of our State and country. To this, I 

add my own personal thanks.

Yours sincerely,

Robert H. Ai.wa y, M.D., Dean.

Stanf or d U niv er si ty Sch oo l of Med ic in e, Stanford Med ical Cen te r, 

P alo Alto , C ai.i f .

Projected needs f or construction of facilities for research and research training

in the sciences related to health

B u il d in g

G ro ss are a 

s q u a re fe et

E s tim a te d 

co st p er 

s q u a re fo ot

T o ta l co st

Y e a r fu n d s 

n eed ed 

(f is ca l y ear)

P e rc e n t 

d e v o te d to 

rese a rc h

C li n ic a l sc ie n ces ....... ............ .................. 115.0 00 $4 5.00 $5,17 5, 000 1963 90

R e m o d e li n g 1 .................................- .............. 16.500 20 .0 0 330, 000 1963 90

M e d ic a l school 11 ____ _____ __ ___ - - 102, (KM) 52. 00 5, 304. 000 1966 75

U m e II 2- ......... .............................. 100. 000 52.(X) 5, 2tM). 000 1966 75

R d w a rd s II __ ______ _______ ____ 100. (XX) 57. 50 5, 750, 000 1968 90

E d w a rd s U ................................................................... 100,00 0 63 .3 0 6, 330, 000 1970 90

T o ta l t n 19f»X 433. 500 21, 759, 000

T o ta l to 1970 43 3.50 0 22. 339, (XX)

1 E x is ti n g (1962) 377 ,49 5 e x clu siv e of h o s p it a l a n d co re .

2 In c lu d e s L a n e L ib ra ry e x p a n sio n a n d a d d it io n a l b a sic m ed ic al scie nce te a c h in g la b o ra to rie s for p re - 

M .l ) . p re -P h . D ., a n d o th e r s tu d e n ts .

Attachment III

T h e U ni ve rs ity of So uthern Cali fo rn ia Sch oo l of Med ic in e,

Lo s Angeles, Calif., Junuary 15, 1962.

I m m ed ia te B uil din g Needs

In 1949, the board of trustees of the University of Southern California purchased a 12-acre site across the street from the Los Angeles County General 

Hospital for a medical campus, which would afford the opportunity to consolidate 

its teaching and research programs.

For many years the first 2 years of instruction were given on the University 

campus while the clinical instruction was given at the Los Angeles County 

General Hospital 9 miles away. Although the University of Southern California 

has had a school of medicine since 1885, the decision to consolidate the medical 

campus requires the raising of funds for the construction of all new buildings 

for its medical school teaching and research programs. In 1952, the B. O. 

Raulston Research Building was completed. During 1960, two additional buildings were completed. One, McKibben Hall, is the multidiscipline teaching laboratory building for first- and second-year students. The other is the Seeley 

Wintersmith Mudd Memorial Laboratory of the Medical Sciences. It contains 

the research laboratories of the faculty in the basic sciences, including anatomy, 

biochemistry, microbiology, pharmacology, physiology, and the research laboratories for visiting scientists.

In 1959, four additional buildings to be constructed on the medical campus 

were authorized by the board of trustees of the University of Southern California. 

Again, construction of these buildings is dependent on a successful fund raising 

program.
376 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

These buildings include:

(a) Student-faculty building, containing a cafeteria, a private conference and dining rooms, locker rooms, faculty women’s 

lounge, men’s and studen ts’ lounge, etc. The present estimated cost of this building is___________________________ $800, 000

(ft) Library building, housing 100,000 to 125,000 volumes. The

present estimated cost of the library is____________________ 1, 270, 000

(c) Pos tgraduate school, lecture ball (500 seating capacity) and Administra tive Office Building. The present estim ated cost is__ 900, 000

(<Z) Medical research building : This building is to bouse the research 

laboratories of the departm ents of pathology, medicine, pediatrics, surgery, obstetrics and gynecology, preventive medicine, 

public health, physical medicine and rehabilitation, and additional space for expansion of research training and research 

in the basic sciences. The present estimated cost of this

building is___________________________________________ 0, 500, 000

The tota l present estim ated cost of th above four buildings is_ 9, 500, 000

With the completion of the above medical school facilities , the University of 

Southern California School of Medicine will have the environment to increase 

both its gradua te (basic and clinical sciences) training program s, and increase 

its present medical school class from 72 to 80 students.

Under the National Institutes of Health research facilities program, the University of Southern California has received $854,500 and $45,345 in matching 

fund s respectively for construction and equipment of the Seeley Wintersmith 

Mudd Memorial Laboratory of the Medical Sciences. And a nonmatching gra nt 

of $085,000 toward construction of the Raulston Research Building.

Clayton G. Loosli, M.D., Dean.

Attachment IV

Loma Linda University,

School of Medicine,

Los Angeles, Calif., January 16,1962.

Dr. Stafford L. Warren,

Dean, University of California Medical Center, School of Medicine, Los Angeles,

Calif.

Dear Dr. Warren : In accord with your request, I am su bmitting a brief repo rt 

on the plans for this school of medicine over the next few years. You are 

acquainte d with the fac t that during the 52 years of its existence this school 

of medicine has operated on two campuses in a manner whereby the first 2 

years, which includes the bulk of basic science teaching, is on the Loma Linda 

campus and the last 2 years, which includes the hulk of the clinical teaching, 

is on the Los Angeles campus. The desirability and actual necessity of having 

basic science teaching located geographically in a manner which would perm it 

close integration with clinical teaching has been known for many years. Recently, 

the board of trustees has committed itself to the co nstru ction of a basic science 

building on the Los Angeles campus for the purpose of teaching 4 years of 

medicine there.

Perhaps the major problem which projects itse lf into this planning is a 

financial one, namely, the lack of funds adequate to do the job. Also, on the Los 

Angeles campus there is great need for new and expanded facilities for the 

facu lty in the clinical departments. As of the moment, the architect is working 

on plans for buildings to accommodate these functions, and it is our hope that 

these will have been completed within the next few years.

Briefly these facilities which are planned are as follows:

(1) A basic science building which will accommodate all basic science departments with classroom space, laboratory space for studen t use, and necessary 

facilities for the faculty. The estim ated cost is around $4 million.

(2) A library building. Currently, the school has two libraries, one at Loma 

Linda and one in Los Angeles. The one at Loma Linda is quite adeq uate hut 

is being expanded soon in order to accommodate additional books and 

periodicals for the graduate school. The lib rary in Los Angeles is very inadequa te 

and has been for many years. When the basic science departm ents and teaching
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 377

are established in Los Angeles within the next few years, it is essential that a 

new library building be constructed in orde r to accommodate this additional 

service. The estim ated cost of library facilities, for this purpose, is approximately $1 million.

(3) Clinical departm ents are very inadequately accommodated, and it will be 

necessary to construct entirely new facilities for this purpose. The cost of this 

building will be approximately $7 million.

(4) In the construction of the new’ buildings some of the old ones must be 

destroyed. Currently, th e ad min istrativ e officers are within such a building. Constru ctio n of a new building for adm inistrative purposes will cost approximately 

$1% million.

The estimated cost for this tota l construction, plans for which are already 

on the drawing boards, w ill be approximately $1 3^ million.

I believe tha t you are a lread y acquainted with the fac t th at it is our inten tion 

to continue basic science teach ing on the Loma Linda campus for medical 

students. Thereby, there will be a possibility of increasin g the tota l enrollment 

with in the school of medicine so f ar as available accommodations are concerned 

w’hen this total project will have been completed. Although eventually there 

will need to be an expansion of hospital facilities, I am not mentioning this here 

in a specific way because it is somewhat different tha n construction for medical 

education purposes.

I hope th at this brief report will be of help to you in the presentation of your 

testimony to the Committee on Inter sta te and Foreign Commerce of the House 

of Representatives when it meets on Jan uary 24.

Very sincerely yours,

W. E. Macpherson, M.D., Dean.

Attachment V

California College of Medicine,

Los Angelea, Calif., Ja nuary 16, 1962.

Stafford L. Warren, M.D.,

Dean, UCLA School of Medicine,

West Los Angelea, Calif.

Dear Dean Warren: This is to confirm the telephone conversation I have 

ju st completed with you.

In the plans for the developing of this institution, our program includes the 

following recommendations to be found in the Public H ealth R eport No. 875 which 

is a study of medical school facilities.

It is our estimate th at we will need, in the next few years, about $10 million 

to modernize our present laboratories and equip them for a modern medical 

educational program.

It is also our plan to develop the gradua te program and postdoctoral training. 

This, of course, involves the expansion of the research program. It is our estimate that this will require ano ther $5 million.

Our library is cramped, not only for table space, but also for shelving and 

back-journal files, and for storag e and workrooms.

We greatly need assistance for the libr ary necessary to meet the demands of 

the school of tomorrow.

Yours sincerely,

W. Ballentine Henley, President.

Attachment VI

J anuary 15, 1962.

Dr. Stafford L. Warren,

Dean, School of Medicine,

Univ ersity of California Medical Center,

Los Angeles Campus.

Dear Dean Warren : The enclosed stateme nt is transm itte d in response to 

your request for information on the needs of the University of California, San 

Francisco Medical Center, for construction of teaching and research facilities.

As you will see, the information is presented and explained in three categories: alre ady funded pro jects: projects accepted by the university adminis80014—62----- 25
378 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

tr ati on fo r inc lusio n in th e bu ildi ng pr og ra m bu t not ye t fu n d e d ; an d pr oj ec ts 

bey ond th e bu ild ing pr og ra m . I shou ld po in t ou t th a t se ve ra l of th e nee ded 

fa ci lities lis ted in th e th ir d ca tego ry are co ns idered of su ch im i*o rta nce th a t it 

shou ld be possibl e to br in g the m in to th e univ er si ty ’s bu ildi ng pr og ra m in th e 

very near fu tu re , part ic ula rl y if Fed er al or oth er non -S ta te fu nds bec ome availab le to a ss is t w ith t heir fin ancin g.

J. B . deC. M. Saunders, M.D., Pr ov ost.

Univ ersi ty of Calif orn ia ,

San F ra nc isco Med ical Cen te r,

Jan uary 15, 1962.

Spa ce an d F a c il it ie s R eq u ir em en ts

In resp on se to recogn ize d needs, in Cal ifor ni a an d th ro ughout th e Nati on , 

fo r in cr ea se d nu mbe rs of med ical an d he al th pe rson ne l, th e long -ran ge pla ns fo r 

de ve lopm en t of th e U ni ve rs ity of Cal ifor ni a, Sa n Fra nc is co Medica l Ce nter, ca ll 

fo r tr ain in g of more st uden ts in ev er y ca tego ry of th e hea lth sci ences. Sig nif ica nt in cr ea se s are pr oje ct ed no t on ly fo r en ro llm en t of re gula r med ica l an d 

den ta l stud en ts, but also fo r tr ain in g of ac ad em ic gra d u ate st uden ts in th e 

he al th scie nce s, po stdo ct or al pr of es sion al st uden ts (i n te rn s an d re si den ts ), 

tr ai nee s in re se ar ch , post gra duate fel low s, an d te ch ni ca l sp ec ia list s of va riou s 

kin ds.

In th e ye ar s 196 1-6 2 th e fo urt h-y ear clas s of th e sch ool of med icine ha s ris en 

to 100 st ud en ts, th u s co mpleting th e in cr ea se in med ical st udent en ro llm en ts 

fro m 75 to 100 st udents i»er clas s which w as in it ia te d in 1958-59. Pla ns are 

now be ing develop ed to in it ia te a fu rth e r step in cr ea se , to 128 st uden ts p er clas s 

or a to ta l of 512 in th e re gula r underg ra duate cu rr ic ul um w ithin th e nex t few 

ye ar s if th e ne ed ed ad ditio nal fa ci li ti es are prov ided . Th e nu m be r of de ni al 

st ud en ts will also be in cr ea se d from 75 to 100 st udents per cla ss, an d th e en ­

ro llm en t of ac ad em ic gra d u ate st uden ts in th e ba sic hea lth scien ces in th e 

sch ools o f med icine and p ha rm ac y will ap pr ox im at el y double.

In ad ditio n to th e pl an ne d gro w th of th e re gula r st uden t te ac hi ng pr og rams, 

th e as so ci at ed re se ar ch pro gra m s co nd uc ted by su ch uni ts as th e Can ce r Re ­

se ar ch In st it ute , C ard io vas cu la r R es ea rc h In st it ute , an d Hoo pe r Fou nd atio n 

fo r Medica l Res ea rc h m ust be e x p an d ed ; a su bst an tial ex pa ns io n of th e L angle yP ort er N eu ro ps yc hia tric In sti tu te —op er ated jo in tly by th e un iv er si ty an d th e 

Sta te depar tm en t of m en ta l hy gien e— is needed an d is be ing p la n n ed ; an d the 

school of med icine te ac hin g se rv ices a t th e Sa n Fra nc is co Ci ty an d Co un ty 

Hos pital, w he re th e th ir d-y ear m ed ical st uden t cl as s re ce iv es it s in st ru ct io n, 

m us t be fu rt h e r deve lope d and ad eq uat e fa cu lty re se ar ch fa ci lities m us t soon be 

prov id ed th er e.

A pr og ra m fo r a ne w Neu rologica l Res ea rch In sti tu te is a ls o be ing dev eloped, 

an d proj iosa ls ha ve been m ad e or a re be ing dr aw n up fo r new fa ci lities to house 

pr og ra m s in re hab il it at io n, biom ec ha nics r es ea rc h, an d en vi ro nm en ta l he al th a nd 

oc cu pa tio na l med ici ne .

Th e d ata pr es en te d in th e follo wing para gra phs includ es on ly fa ci lities fo r 

di re ct teac hi ng a n d /o r re se ar ch , an d the ho sp ital an d clin ic fa ci lities es se nt ial 

to th e te ac hi ng an d cl in ic al re se ar ch pr og rams. Sp ac e fo r ad m in is trat iv e, 

m ai nt en an ce , or oth er ancil la ry su pp or tin g service s ha s bee n exclu de d.

Funded projects

Gross s quare 

feet

Cost

Hea lth sciences instru ction an d res ear ch bu ild in g................................ ............ . 280,000 $11,700,000 Ad dit ion al cam pus research fa ci lities ................ . .................................................... 66,000 3,140,000

Alth ou gh it will he lp m ee t ne ed s re la te d to th e fu rt h er in cr ea se of me dic al 

st udent clas ses to th e 12 8-stud en t leve l, an d to th e in cr ea se of de nt al st uden t 

clas se s to 100, th e H ea lth Sc ien ces In st ru ct io n an d R es ea rc h Bui ld in g was 

ne ed ed an d pl an ne d in co nn ec tio n w ith th e pr ev io us in cr ea se in med ical st ud en t 

cl as se s fro m 75 to 100, an d th e pr oj ec t was fu nd ed by th e S ta te pri or to the 

decis ion to pl an fo r fu rth e r in cr ea se s beyon d th e 10 0- stud en t level. Almo st 

on e-ha lf of th e sp ac e prov id ed by th is bu ild ing will be fo r re pl ac em en t, th e ne t
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 379

ad di tion to ca m pu s spac e be ing 164,000 gro ss sq uar e feet , as co mpa red to th e 

280,000 gr os s sq ua re fe et show n fo r th e to ta l pr oj ec t. Th e ad ditio nal ca mpu s 

re se ar ch fa ci li ti es pr oje ct was fu nd ed by a U.S. Pub lic H ea lth Se rvice co nst ru ctio n g ra n t un der th e hea lth re se ar ch fa cil it ie s pr og ra m .

P ro je ct s in clud ed in u niv ers it y bu ild ing prog ra m bu t not ye t fu nd ed

G ro ss s quar e 

fee t

Cos t

1. Clini cs e xp an si on pro je ct ___________________________ __________________ 139,000 $5,4 16,0 00 2. E xpan si on of te ac hin g fa ci litie s_______ _________ _______ ____________ ___ 37,400 2,058,000 3. U .C . H o sp it al co nv er si on , st ep s 2 a n d 3_____________________________ ___ ('4,000 2,678,000 4. Sc ho ol of d en ti str y ad d it io n , clinics b u il din g___________ ________ ________ 5,800 300, (K)0

Cl inics ex pa ns io n pr oj ec t.— The ex is ting c lini cs b ui ld in g w as c on st ru ct ed a bo ut 

30 year s ag o whe n med ical st udent en ro llm en ts w er e a t th e lev el of ap pro xim at el y 60 med ical st uden ts pe r cla ss, an d less th an 40 den ta l st udents i>er cla ss. 

The clin ics ex pa ns io n pro je ct w as origi na lly pl an ne d as a p art of th e fa ci lities 

re qu ir em en t as so ci at ed w ith th e in cr ea se in med ical sch ool cl as se s to th e 100 

st udent lev el, but pl an s fo r th is pro je ct hav e re ce nt ly been en la rg ed in view of 

th e pr oj ec te d fu rth e r in cr ea se s in bo th m ed ic al st udent and denta l st udent en ­

rollm en ts. Bec au se of kn ow n an d pr os pe ct iv e lim it at io ns on S ta te fi na nc ia l su ppo rt, ho we ver, it ha s not bee n po ss ible t o pr ov id e fo r all id en tif iabl e ne ed s w ithin 

th e ex is ting univ er si ty bu ild ing pr og ra m . The re fo re , in reco gn iti on of th e need 

fo r fu tu re ex pa ns io n, th e ph ys ical str u ctu re is to be buil t w ith th e re in fo rc ed 

fo und at io ns needed fo r su bs eq ue nt co ns truc tion of a ddit io nal floors.

E xp an sion of teac hing fa ci lities .— The al re ady fu nd ed hea lth scienc es in st ru ctio n an d re se ar ch bu ild ing an d addit io nal ca m pu s re se ar ch fa ci lities pr oj ec t will 

m ee t pr es en t teac hi ng an d re se ar ch fa cil it ie s ne eds a t th e lev el of 160 medica l 

st uden ts p er cla ss, an d will help si gn ific an tly to m ee t e xp an de d ne ed s fo r re se ar ch 

fa ci lities a t th e 128 st uden t level. How ev er, th es e pro je ct s will no t pr ov id e th e 

ne ed ed ex pa ns io n of teac hi ng la bora to ri es to ac co mmod ate 128 st udent cla sse s; 

no r will they mee t al l th e ne ed s fo r office an d re se ar ch sp ac e fo r th e new’ fa cu lt y 

which mu st be ad de d as en ro llm en ts in al l st udent ca te go ries co nt in ue to rise. 

Add iti on al re qu irem en ts fo r th es e pu rp os es ha ve bee n es tim at ed at ab out 75,000 

gr os s sq uare f ee t, a t a co ns truc tion co st o f ab out $3,800,000. On ly ab ou t on e- ha lf 

of th is a m ou nt i s inc lude d in the univ er si ty ’s bu ild ing p ro gr am .

U ni ve rs ity of C al ifor ni a hos pi ta l co nv ersion st ep s 2 an d 3, will ad d ab out 120 

ho sp ital be ds an d wi ll co mp let e th e re no va tion of th e old teac hi ng ho sp ital wh ich 

w as init ia te d sev er al ye ar s a go.

Add itio na l f aci lities re qu irem en ts

In cl ud ed he re a re ne eded addi tional pr oj ec ts, bey ond th e ex is ting U ni ve rs ity 

of C al ifor ni a bu ild in g pr og ra m, an d fo r which th er e is no as su ra nce th a t const ru ct io n fu nd s will bec ome av ai la ble in th e nex t 10 ye ar s. The pr og ra m s fo r a 

few of th es e pr oj ec ts are st ill be ing develop ed , but mos t ha ve alr ea dy been proposed in th e Sa n Fra nc is co Medica l C en te r’s pre se nt at io n of i ts bu ildi ng n ee ds to 

th e univ er si ty a dm in is trat io n.

G ro ss squar e 

feet

C ost

1.

2.

3.

4.

5.

6.

S.

9.

10.

11.

12.

F u rth e r exp an sion of teac hin g fac ilitie s_________________________________

A ddit io nal floors , cl in ic s e xp an sion pro je ct_________________________ ____

B io ph ys ic s u n it ________________________________________________________

Expa nsi on o f p h arm acy g ra duat e le ac hin g p ro gra m _____________________

Expa nsi on of m ed ic al l ib ra ry ..................... ....................... . .......................................

M ed ic al res ea rc h ad d it io n N o. 3 ________________ _________________ _____

N eu ro lo gi ca l In s ti tu te . ____ ___________________________________________

In s ti tu te f or h u m an d is ab ilitie s an d re h ab il it ati o n ________ ______ ______

Res ea rc h an d t eac hin g f ac ilities, San Fra nc is co C it y -C o u n ty H o sp it al___

E xpan si on , C an ce r R es ea rc h In s ti tu te _______ ______________ _____ _____

Expa nsi on , C ar dio vas cu la r Res ea rch In s ti tu te __________________________

In sti tu te for en v ir o n m en ta l healt h a nd o cc upat io nal m ed ic in e.....................

37.500

60.5 00 

13,300 

13.200 

18,0 00 

20,600 

46,600 

98,000 

16,700

21.500 

9,3 00

12.5 00

$1,75 0,0 00

2,38 0,00 0 

760,000 

750,000 

750,000

1,1 80,00 0 

2,45 0,00 0 

4,40 0,00 0 

760,000 

1,3 80,00 0 

600,000 

446,000
380 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Tlie first two items above ar e designed to fill ou t the needs f or clinics expansion 

and expansion of teaching facilities as explained in the previous section. Item 

No. 4 will provide space for the planned expansion of gra dua te student enrollments in pharmaceutical chemistry. Medical researc h addition No. 3 will meet 

long-recognized and already pressing needs for expansion of surgical laboratories, 

larg e animal housing, and the Radioactivity Research Center. The proposed 

Neurological Ins titute will inte grate existing research on the nervous system 

and provide facilities for a multidisciplinary approach to studies of the brain 

and its diseases.

The Institute for Human Disabilities and Rehabilitation would bring together 

in one project separate proposals which had previously been made to establish 

a rehabilitation center and house the activities of the Biomechanics Laboratory, 

now widely scattered in loaned si>ace, and it would provide needed facilities for 

specialized clinical service and training programs. The need for adequate research and teaching facilities at San Francisco City-County Hospital will become 

critical with the increase in medical student classes to 128. It is expected that 

the city of San Francisco may assist in funding these facilities.

The institu te for Environmental Health and Occupational Medicine will be 

developed by the school of medicine in cooperation with the school of public 

health.

Attachment VII

TTniv ers ity ok Califo rn ia Medical Cen ter, L os Angeles

Estima ted costs for construction of teaching and research facilities (all estimates on EN R 850)

[In millions]

A

U

Education Research

Authorized:

To enlarge the entering class of medical stud ents from 56 to 128 and to 

provide basic science curriculum for 2 years of dentist ry with an 

entering class of 96 dental stud ents (1962 and 1964)............................

To construct the o ther facilities for support of entering class of 96 dental stud ents (1963)........ . ......... ........................... ........... . . . . . . . . . . . . .

Authorized:

Projected research and graduate training facilities for the dental school. 

Projected enlargement and relocation of the school of p ublic health

(1965)............................. . .............. . .................... ...............................

Projected research and graduate program for school of public hea lth ..

Projected completion of graduate program for school of medicine........

Projected completion of undergra duate and postdoctoral clinical program of the school of medicine (1971).............................. ...................

$25.0

5.9

7.3

6.5

$1.7

2.0

9.0

Totals_________ _________________________________ ________

Grand to ta l.............. ............................ ................................................ 12.7

Estimated projected to tal medical center studen t body, 1975

Medical studen ts________________________________________________ 512

Den tal students 384

Pred octoral and postdoctoral fellows________________________________ 200

Interns and reside nts_____________________________________________ 400

Masters and Ph. I), candidates____________________________________ 240

Paramedical stud en ts------------------------------------------------------------------- 514

Public Health studen ts___________________________________________ 250

Estim ated total ____________________________________________2, 500

Dr. Warren. And I have given your staff an official publication, 

a “Report of the Governor’s Committee on Medical Aid and Health, 

Health Care for California,” which I will refer to rather frequently, 

but I felt that it was so large that I should not request its incorporal i n n in t l i e r o e n r /1
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 381

1 would like to as briefly as possible point out two things: one, a 

rather peculiar situation that California is in because of the huge 

migration of people into the State over the last 15 years, and then 

paint a picture of the problems which medical schools and their administrations have in creating and organizing, building, and operating a medical school.

In my statement for the record, I have pointed out that the population in 1950 of the State of California was lO1

/^ million. In 1960 

it was 15.7 million. It is predicted tha t in 1965 it will be 21.6 million. In 1970 it will be somewhere between 20 and 25 million, and 

in 1975 it might even double what it is now; but it will be somewhere 

between 25 and 30 million.

The impact of this growth, which represents an increase in the 

population of 5 percent a year, is quite extraordinary. In fact, 1 

think you could say its effect was something that staggered your imagination. Right after the war, as in the case of most States, the State 

and all of the enterprises in the State went about improving, repairing, and expanding the resources in the way of schools, highways, 

factories, and things of this sort, which had to be held in abeyance. 

Some States, like California, accumulated what they call a rainy 

day fund; namely, they didn’t expend all the tax income during the 

war period and banked this against this time when they had to repair 

their resources and facilities. It was in that period that the University of California achieved a priority to start a second medical 

school in Los Angeles and I was appointed as the dean.

I have had the opportunity of working for 25 years in the University 

of Rochester, in Rochester, N.Y. I came there during the building of 

the school. It is a private institution and Dean Anderson was here 

and testified for the American Association of Medical Colleges.

I think from this experience I have considerable knowledge about 

the problems of a private institution, and I have been 15 years in a 

State institution up to now. The problem in the State is quite dif ­

ferent and something like this. The planning can be done on the 

basis of the birth rate in a rath er steady and easy way. It has been 

familiar and predictions could be made that forecast needs in almost 

every area: but in California the opinion was widespread among the 

administrators that this immigration could not last and should be 

discounted. It was very marked during the return of the veterans. 

The universities and all the schools expanded. There was the refresher program put in for the doctors that had been trained on the 

accelerated program during the war.

Under the GI bill, these men went back to school and got their residencies and postdoctoral program. Then there was a slight lull and 

then the veterans began to return from the Korean war. Very’ few 

institutions durin g this time refurbished their plants. In fact they 

were rather apathetic about this. This was true all over the country, 

but to a great extent in California.

About 6 years ago it became apparent that this flood of immigration 

was not stopping. In fact it was almost at a steady rate with some 

ups and downs. Then committees began to arise of laymen and professionals in health and medical care. These made investigations. 

The legislature had very many committees in the same way, and 

enough momentum was developed so that they l>egan to accept the
382 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

fact that we were in trouble, that our populat ion was sky rocket ing, 

and that som ething h ad to he done abou t it, so ma ny pla ns were laid.

There is still a g reat uncerta int y as to the slope of the curv e of the 

rise of thi s tid e of people. 1 think it is im po rta nt to recognize the 

fac t that when a fam ily migra tes into the St ate they expect to pu t 

their chi ldren in the schools the next day . Th ey expect to use the 

highwa ys. The y expect to he able to buy a house or ren t a house 

with sewers and all of the utilities ava ilable.

We now have lost so many cit rus orchard s th at we are dr inki ng 

ora nge juice from Fl orida and we get our gr ap ef ru it from Texas. 

I think Mr. Younger probab ly knows som eth ing about this, too.

The gre atest pa rt of this new population , almo st 2.5 million, has 

settled in the Los Angeles area, about a million in the San Fra ncisco 

area, and oth ers elsewhere.

My point is they do not sup port the tax income base un til af te r 

they have been the re essentially a year, on the ave rage (5 mon ths, of 

course, but they dem and fac ilities now. If you will look at o ur prob ­

lem, you will see that we have put man y bond issues out at all levels 

of governm ent and there is serious question, or discussion at least, 

abou t the exten t to which we can stretch o ur credit.

Th e analysis has been made from the numb er of scho olchildren in 

the high schools and gram mar schools at thi s point, and the design 

then for the hig her education levels has been predicted from this, and 

thi s is pr etty good ev iden ce of the need tha t is to be expected and 

projecte d to 1971 o r 1975.

I can tell you tha t un der the new plan of hig her education there 

will he about 400,000 stu dents in the St ate colleges and the junior 

colleges, and somewhere in the neighborhood of 120,000 in the U niversity of Ca lifornia . I know there are figures in excess of th at, 

but on this basis the unive rsity has finally bought two new campuses, 

has decided to exp and Berke ley to 25,000, UC LA to 25,000, and the 

oth er campuses are prepare d to rise in their fac ilities to meet this 

dem and. Calcu lation s as to the cost of this high er edu cation for 

the junior and State colleges indicate $450 million. Fo r the un iversity it is $1,200 m illion, wihch means a total inve stment in phy sica l 

plants for the unive rsity, the Sta te, and the junior colleges of $1,700 

million by the period 1965 to 1971.

In my case, as a dean of a State insti tutio n, a medical school, it 

was necessary for me to stu dy very carefully the needs in my area 

and und er my ins tru ctions from the pre sid ent, I was to deve lop a 

medical center in which the re was a medical school, a school o f n urs ing , 

a school of public health, and pro bab ly a school of pha rmacy.

Du rin g these 14 yea rs it is quite eviden t th at we are in need of 

trai ni ng of all of the paramedicals, those who assist the doctor in 

his practice. The Go ver nor app ointed a committee which issued this 

publica tion that I referre d to previously, the “H ealth Care for Ca lifornia, " in Decem ber 1960. I would like to just read you the recommen dations of th is comm ittee, and, rememb er, this is a committee of 

citizens from all walks of life and they were assisted by a knowledgeable staff from the de partm ent of public health :

The committee recomm ends: (1) Th at Califorina proceed at once to expand 

medical educational capacity in priv ate and public institution s with the goal of 

1.400 first-year places by 1971, (2) that Californ ia proceed at once to expand
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 383

dental education capacity in private and public institu tions with a goal of 785 

first-year places by 1971, (3) that California proceed at once to expand professional nursing and educational capacity in public and priv ate institutions, (4) 

th at Californ ia proceed at once to expand education capacity for social workers, 

clinical psychologists, public health workers, et cetera.

There are other recommendations too, but I read these, which 

gives you a sense of emergency which is felt by the State government 

and by the university.

Now, in reviewing the need, it is estimated on a conservative basis 

that California will need 44,300 physicians by 1971. Interestingly, 

we have had a migration of physicians into the State. It is not quite 

up to the migration of others, but it is almost a cross section, and we 

take each year into our State, and this is expected to continue, the 

complete output of 13 medical schools of the Nation each year.

In other words, we have 1,300 physicians migrating in. This is a 

contribution which we feel, of course, is justified since we are taking 

the citizens from other States and have to provide the resources for 

them, and it is a good thing for us that these physicians come along 

with them.

It is estimated, to take care of the death rate, and the dropouts, 

and other attrition, that we should graduate 1,400 new doctors a year. 

If we refurbish all the plans, the 6 medical schools, and bring them 

up to capacity, and we add a seventh, we will put out in 1966 675 

new doctors a year, leaving a deficit of 725. This is approximately 

t he out put of seven more new schools.

I would like to discuss a bit the problem of private medical schools 

and the difficulties in raising more funds. I have gotten from the 

administration of these schools some information which might be of 

interest to you. I am trying now to give you information in answer 

to some questions which I have heard in the last few days that are not 

in my testimony.

Since the war the medical schools and the universities of private 

institutions, have tried to raise money with great effort. Stanford 

has raised $13.2 million in the 7 years up to 1961, and tha t went into 

their rejuvenation and reunion of their school in Palo Alto which 

has just been completed, to the point that they are now, and I will 

remark something about that late r; USC, $2,400,000 in 5 years; Loma 

Linda, which is the former College of Medical Evangelists, $5,964,- 

000, between 1953 and 1960, 7 years; formerly the College of Osteopathy, which is now the California College of Medicine, $150,000 in 

3 years. That is a total of $21,500,000.

The dental schools in the private institutions, USC, raised $1,368,- 

000 from 1955 to 1960, or 5 years, and last year raised $250,000, or a 

total of $1,600,000.

The State schools have not been inactive. I find that I cannot 

depend upon the State to provide resources in many areas, particularly special ones, so that we have gone out to raise money, and we 

were able to get a gift from Marion Davies for a children’s clinic, 

but it took 8 years to convince the donor that this was a good thing 

to do.

The Los Angeles Arthritis and Rheumatism Foundation have given 

us $100,000 for the rehabilitation of a laboratory. The University 

of California at San Francisco has several endowments which were 

available prewar, but they have received nothing since. In other
384 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

wor ds, from priva te sources in the State since the war, $24,200,000 

has been raise d.

I hav e shown you in the testimony th at the vario us schools are 

un de rta king cam pai gns now, St an ford to raise $24 million , US C to 

raise $5 million, the College of Medical Ev an ge lists has n’t set its 

goal yet, and Un ive rsi ty of Ca lifornia has a conside rable sum to 

invest on a pr iorit y th at extends over a series of y ears.

It is m y e stim atio n, and I show this on the firs t pag e of the atta ch ­

ment, th at Ca lifornia will need to pu t out fro m priva te and State 

fund s or oth er sources by 1971 in order to be rea dy for 1975 $423 

millio n to bring these schools up to the s teady sta te th at I mentioned 

ea rli er of 675 new doctors a yea r, leav ing stil l a deficit of some 700 

new ones a y ear.

A private ins tituti on may look at their costs, a nd th is is intim idating to a new ins tituti on, pa rti cu larly to a lette rs and science college, 

or a small college. We have many fine small colleges in the Sta te, 

but very few lar ge enough to und ertake this so rt of thing. If you 

look at a small op erating bud get, the most economical school is a 

a school of 64 stu dents per class, and most of the pri vate schools 

are at this level. Th is pro bably costs fro m $7,000 to $9,000 a year 

per studen t. The cos t-per-studen t is not revelan t here , perhap s. It 

is the total amount of money th at the p riv ate insti tutio ns can raise fo r 

op erating each year.

The 96-student level is pe rhaps the next one. In the repo rt from 

the Pu blic He alt h Serv ice on medical school facil ities con stru ctio n, 

No. 875, there is a minimal op erating facility pro posed the re for 96 

stu dents and they recom mend th at this is lower in cos t-per-studen t 

than the one at 64 and the fac ilities don ’t cost very muc h more, bu t 

the op erating costs go up, even tho ugh the cost-per-stud ent migh t 

l>e redu ced by a thousa nd d ollars or more.

In my own case I have sta rte d with a school of 26 stu dents in 

tem po rary bui ldings, tri ed out a cur riculu m while ou r own bu ild ­

ing was bein g built, and wen t to 32 as soon as we could . Th is was 

the lim it of the n um ber of kneeholes in the benches in th e bioc hem istry 

lab ora tories, and anatom y, and so on. In ou r new bu ild ing the 

leg islatu re wanted us to st ar t at 100. Wh en they fou nd out how 

much it was going to cost, the y said build it half-size, but build it 

to l)e expanded and to expand the oth er schools on it, so we are 

in a build ing which cost $22 million in 1950 to 1957 while it was 

bei ng built, and we are teaching 56 stu dents pe r class. By the expe nd itu re o f $30 millio n more, I can cut the cost fro m $7,000 a y ear 

per stu dent to betw een $3,000 and $3,500 a stu dent, and tra in, in 

in additio n to the 128 medical studen ts per class, 96 den tal studen ts 

in each of the first 2 years by pooling the fac ultie s; because the 

enlargeme nt of the stu dent body does not req uire any more pro fes ­

sors, bu t the slack is take n up by tea ching assistan ts and ins tru cto rs 

who are less costly and, therefore , as the stu dent numbers increase 

the cost-per-stud ent fall s.

Th e goal eve ntu ally is 2,500 student s in th is cen ter a nd these will be 

dis tribu ted , among the medical school 512, th e denta l school 384, predocto ral and pos t doctoral fellows 200, intern s and residents 400, 

masters and Ph. P. can did ate s 240, param edi cal students —that includes n urses—514, and pub lic health stu de nts 250.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 385

Tha t is 10 percent of our campus’ goal of 25,000 students, and we 

have found as the population in our campus has gone up that the number of qualified students coming in for entrance to the medical school 

has improved greatly. In starting this school we realized we would 

have to proselytize our leadership among the various disciplines from 

other institutions, but we would have to get a large bulk of our younger 

people from our own resources.

Fortunately, the National Institutes of Health and the private 

granting agencies were in a position to supply research grants and 

later training grants. Now we are probably among the top 10 in the 

dollar volume of our research and training grants and this serves us 

2 purposes: One, if we have good scholars in our leadership doing 

good research we can get others to come on the faculty to join a powerful teaching and research team. The word gets around to the students 

that our pedagogy’ is apt to be of high quality so we get good students.

Thirdly, and not least of all, we get good graduate students in the 

basic science and these become our teaching assistants and our instructors, and we have staffed about a third of our organization from 

this source. There was no other place much to get these from.

I would, therefore, like to pay great tribute to the wisdom of Congress in setting up the NI II system and the grants and training programs, for today I think almost the entire graduate and research postdoctoral training program of the medical schools in this country derives its strength from this source. This was not mentioned here 

l)efore because the research was only talked about in reference to the 

product of the research. The gain by the Nation as a whole from 

the knowledge of this research is important, but from my pragmatic 

standpoint the gain from the manpower was as important and it will 

continue to be important as we staff th e vacancies that will be available when the school and its accessories are enlarged.

The source of students has been a question raised here. As I said, 

we have derived our teaching strength in the junior levels from the 

new trainees and we find that as we build our institution and expand 

in all directions time passes and we can tap the resources of these new 

students who come in. In other words, the market is not static and 

we can improve it and take advantage of it.

We have organized, together with the private schools, teams to go 

into the smaller universities and into the big State colleges to talk about 

medical educat ion and the prospects of good students coming into our 

field. We have in our own building had about 2,000 high school 

students on Saturdays who have come to look at our equipment and 

listen to our proposals.

We have had to, as a State school, accept perhaps a larger number of students from the lower economic levels than the private 

schools, although they accept some too, and we have had to get 

money to support these students on loans and scholarships. We 

have 12 scholarships now from Samuel Goldwvn. Anna Bing, Carolyn 

Lyle Davis, and so forth, and the Hollywood Canteen loan program. 

This is 6 to 8 a year. We have put out in loan funds from private 

sources something like $150,000 since we have opened. We are graduating our eighth class.

The university has $600 loan funds, $600 being the maximum. This 

is only suitable fo r emergencies and must be paid back in a relatively 

short time.
386 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

A couple of things were not discussed when you were discussing 

the difference between loans and scholarships. I would like to point 

out that these students, while they may think they are, are not 

really mature. Very few of them have had any business experience. 

Over half of the class probably are from the families of lower economic levels. Many of them are from very conservative families. 

Some of them have revolted and it is very frequent for the application to say “I have saved $2,000 and I am getting married this June 

and my wife will work while I am going through the medical school.”

Well, of course, this is ridiculous. First, $2,000 will hardly pay 

much more than his board and room and his tuition. In our place 

where the student has to travel almost 30 miles to classes for part of 

his clinical work in the county hospital in Torrance, he has to have 

a car and he usually buys a jalopy. He has a high insurance and he 

runs out of tires and he has mechanical troubles, so his car costs him 

something like $2 a day, so (hat before the year is over, even though 

our fee is very small, he is required to have nearly $2,700 to $3,000 

to stay in school.

We have organized a large voluntary group among the women 

who try to raise emergency funds for these students. Fortunately, 

our problem has not been too great yet because the numbers of our 

students are low. We have almost no alumni. In fact the first 

graduating class of 2G represents really our only alumni, so we cannot look to them for support.

In this revolt from the family, the student is very wary about 

becoming entangled with financial debt. lie doesn’t know much 

about the future. lie has heard a lot about the fact that doctors 

make a lot of money, but when he talks to the younger graduates, he 

finds that they are not rolling in wealth yet. A great many of them 

are having a hard time repaying their loans. They are just able 

to get along. They either live in a rented house or they have a heavy 

mortgage. They have children ready to go to school, and they 

don’t have any leeway.

Therefore, I would like to see this scholarship element in the bill 

passed. I don't think our experience is part icularly unusual.

One mention was made, rather delicately, earlier that plans to not 

have a family often go awry and this precipitates a financial crisis, and 

we have had students whose grades go down and who threaten to leave 

school because they cannot make the grade financially.

There are many other things I could talk about, sir, but I think 

I have covered those that were not covered by previous speakers, and 

I think I will stop here and be glad to answer any questions.

The Chairman. Thank you, doctor. We are glad to have your 

statement. Any questions?

Mr. ounger. Yes. Dr. Warren, as a Californian, I am very 

happy to welcome you here to the committee and congratulate you 

on your help in this problem.

If I understand your remarks, it has been almost impossible from 

private sources to raise the amount of money necessary for construction, brick and mortar funds?

I)r. W arren. Yes, sir. The difficulty in just keeping the operating 

funds going is enough, and before the war the analysis of a cominu-
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 387

nity for fund raising indicated th at you could come back about once 

every 20 years.

Now, in California the schools are not doing that. As you know, 

Stanford has just raised a large sum of money. In 7 or 8 years it is 

going back for almost an equal amount : $24 million. The people 

who come into our State are not devoid of wealth, but most of them 

have strings in the East. In fact, if I could do so I would put up a 

barrier to the deans and presidents of other universities who come 

to California to look up their alumni and their old friends and get 

contributions from them which they bring back here. I can’t, of 

course, blame them, but we would like to know who those people are 

and tap them for our support in California.

Mr. Younger. There is one thing that hasn’t been covered yet 

which is the grants to a college to enlarge. If you build more buildings you have more students and you increase the cost. I am par ­

ticularly referring to private schools, not those supported by taxation.

In making a grant of that kind do you think there ought to be some 

proof of the ability of the school to operate and maintain itself on 

an expanded basis before the new building grants are made?

Dr. Warren. I think, sir, that th at will be taken under very serious 

consideration by the trustees of the institutions. Certainly in the 

University of California we have to discuss this very completely with 

the administration and the regents before we can get anything 

through, and I know from my contacts with the other schools that this 

is one of their very serious problems—how are they going to get the 

budget to sustain this operation.

As I pointed out earlier, these research grants help the expansion 

in the graduate area and the ability of the professors to keep their 

hand in and grow, but it is not unlikely that if this is to be done on as 

big a scale as we have talked about, many of the private institutions 

will only come in if there is some guarantee that they will get some 

sustaining support, possibly through the device that you have in 

your scholarship proposal of $1,000 to a quarter of the class, or up to 

tha t amount. That is not an awful lot towards the real cost of that 

student’s education, but it is a big help. I think that if you were to 

examine the total impact of medicine and medical care on the Nation 

you would find—I saw this several years ago, and I could not find the 

reference again—that the hospital and medical care organization, 

dollarwise, was the fourth largest industry, just below the automobile 

industry, in dollar volume.

Well, the thing tha t makes all this go is the doctor, and if we 

can't get the doctors produced, then a lot of this falls down. Along 

with the doctor, in order to save his energy and time and to spread 

the work we need to train these others. I forgot to mention the 

School of Pharmacy in the San Francisco campus of the University 

of California. We have not any evidence yet that we need another 

school in the south, the School of Pharmacy, but all my remarks pertain to all parts of this educational system—medicine, dentistry, p harmacy, public health, nursing, and all of the support people. If you 

want to get the proper balance, and perhaps this can only be done at the 

State school level, you then need to train all of these people in the 

same environment together with a pooled faculty ami you get the 

greatest economies and benefits.
388 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Mr. Younger. That is all, Mr. Chairman.

The Chairman. Mr. Collier?

Mr. Collier. Doctor Warren, in discussing the problems of some 

of these medical students you hit on something that disturbs me and 

it. disturbs me very deeply as one who attended college during the 

rough years of the depression, and that is this. Where does the student have any degree, and what degree of obligation does he have, 

to securing an education through at least in part his own efforts to 

raise part of the cost?

Dr. Warren. I think that most of these students have a very deep 

sense of obligation in that respect and most of them expect to work 

during this period and say so. This has been mentionea before, but 

T would like to bring another point to view in here. Due to the rise 

of all of this research we have had to add tremendously to our curriculum, and we have not had time to digest this and simplify it. The 

result is we have just added to what we already had before the war. 

In our own case we .started out with 4,500 clock hours of instruction 

in the 4 years. Now, it is 5,500 hours, plus about 8 hours’ night study, 

and the student cannot work during the school term.

Mr. Collier. To clarify my question, and I know your point, and 

I think it is a good point, and I understand that it becomes increasingly difficult for a student to work while he is in the school because of 

this, I am talking about preparation. I am talking about the summer months when an average student, if he is willing to roll up his 

sleeves and work at a lumberyard, and any place else, can work, and 

1 am not advising that everyone do, but I am saying it is there, and 

it was a way of life for years. It did not particularly kill anybody 

tha t I know. During the summer months he can make between 

$650, usually, and up to $900. Maybe I got your statement in the 

wrong light, but you talked about the student who says, “I am going 

to get married. I have $2,000 and, therefore, it follows that someone 

has to take care of me.” You talked about the student who spends 

$2 a day to travel 30 miles. I hope these are unusual. You can practically take a cab 30 miles to get to and from a clinic. I presume then* 

are other means of transportation. I don’t know.

Dr. Warren. There are not.

Mr. Collier. I am using these in the generalities. At what point 

do we expect to have a little personal effort p ut forth to get an education so that we do not destroy by the very image of any program this 

concept th at many of us lived with, and you probably did yourself, 

and I am sure you must have in years gone by. In other words, I am 

frightened t hat we get to a point where many people will say, “Well, 

this problem I had of providing an education is entirely that of the 

Federal Government. If I am broke, and my financial statement will 

so show when I enter college, and if I am a good student, this then 

becomes a public responsibility. It is no longer mine particularly, 

unless I desire that it should be.” This is the thing th at I think we 

have to think about. I wonder what your views are.

Dr. Warren. This is a very good question because it challenges 

basically the integrity of the individual, doesn’t it ?

Mr. Collier. Yes, sir.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 389

Dr. Warren. We had a lot of that in the CCC camp situation during the depression. People who got out of tha t were not inclined to 

be self-supporting i f they did not have to. However, I think I can 

assure you that this is not the case in the young man or woman today. 

In my own experience a t least, and I think this is not uncommon, 

these students are independent. They do not want to get in debt. 

They do not want anybody’s largesse. They want to earn their own 

way. Every one of these students are investigated by our office as to 

their summer work and we find work for them if they do not get it. 

We would rather have them work in the laboratory and get paid for 

it than to have them work in a gasoline station. On the other hand, 

some will need it physically and we suggest they go into hard labor 

and work in the forest, or in a ditch, or in a trucking industry, or 

something like that, where their lack of precise skills does not matter, 

and they do not have a union problem because the unions are not apt 

to accept some of these. Some of these have had good jobs all during 

college and have worked 40 hours a week while they have taken their 

full college schedule. This is quite an accomplishment and these 

men have been able to organize their energies and lives so that they 

can work and work effectively, and they expect to, and a lot of them 

do not want gifts and would rather have a loan.

Mr. Collier. I did not personally mean to give the impression that 

I do not know that there are many, many students in all areas of college that are willing to work. It is just tha t I think we have to be 

cognizant of this area. That is all I have, Mr. Chairman.

The Chairman. Doctor, thank you very much. We are glad to 

have your testimony.

Dr. Warren. Thank you.

The Chairman. Dr. II. Stanley Bennett ?

Off the record.

(Discussion off the record.)

The Chairman. Dr. Bennett, you may proceed.

STATEMENT OF DR. H. STANLEY BENNETT. DEAN. THE DIVISION 

OF THE BIOLOGICAL SCIENCES, UNIV ERSITY OF CHICAGO

Dr. Bennett. Yes, Mr. Harris. I have placed the statement before 

you. I hope you will enter it in the record. I shall be happy to summarize it and be brie f in accordance with the well considered words 

which you just uttered.

The Chairman. Your statement will be included in the record.

(The statement of Dr. Bennett follows:)

Statement Submitted by Db. H. Stanley Bennett

Mr. Chairman and members of the committee, I am pleased to have this 

opportunity to lay before you my views as to the significance of H.R. 4999 in 

relation to the hea lth of our Nation and to its general strength and benefit. I 

urge its passage, though I believe it might be improved by a few modifications. 

I speak as the responsible administrator of one of our Nation’s gre at private 

medical schools—one which has been since its inception amongst the leaders in 

training physicians of quality and ability; which has, in addition, shouldered 

much of the expensive burden of training faculty members for the 80-odd medical 

schools of our Nation and for ins titu tions abroad, and which stands as the 

Nation’s leading medical school with respe ct to the emphasis it places upon 

biomedical research and research trainin g. I speak also as a devoted citizen,
390 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

deeply concerned for the future of our Nation, and cognizant of the sobering 

task s facing our universities and our medical schools as they contemplate their 

responsibilities to our beloved country.

Before speaking specifically of the bill before us, I wish to portray in broad 

outline the basic situation facin g our universities, including our schools of medicine. Before World War II, most Americans thou ght of our universities only 

as places to which young men and women went for a |»eriod of a few years in order 

to get an education and thus to enhance the ir earning power. A college education was primarily to benefit the student, so people thought. A university does 

indeed benefit its students, but more important—we realize now that our universities are necessary fo r ou r national survival, for our Nation needs the tra ined 

minds which only our universities can produce. We support the training of 

physicians, scientists, engineers, lawyers, teachers, and other learned persons— 

not to equip a few agreeable young men and women with the means to earn a 

satisfying livelihood, but to provide our country with the knowledgeable and 

trained manpower which it needs in order to maintain its health, its economy, 

its diplomacy, its government, its armed strength, and its free institutions. But 

our universities provide our Nation with much more. Pow erful weapons upon 

which our Nation’s survival now depends were developed not by soldiers or manufacture rs, but by university scientists. Now tha t our Nation has decided to 

develop the capacity to send manned vehicles to the moon and to embark on 

manned interp lanetary voyages, our country turns once more to our universities 

as our principal resources for training the men and providing the competence 

we need for this magnificent enterprise.

Less dram atically, but relentlessly, our country has piled demand iqion demand on our universities. Our universities must tra in more scientists and 

phy sicians; must provide more expe rts in southeast Asian languages and culture ; must discover new knowledge of the power of the at om ; must teach a 

host of new studen ts conceived during and since the w ar; must develop new 

methods of business an alys is; must advise our Nation’s strate gis ts as to the 

best ways of preserving our precious liberties and our personal safeties. And 

so on and on, these demands, coming from business, from government, and from 

the patriotic and discerning insight of some of our own university people—for 

it was university people who first suggested to President Roosevelt th at we 

develop atomic arms and power—these demands have inundated our universities and have overwhelmed their resources. The tradition al financing of 

university activ ities as they functioned l>efore World War II is entirely inadequate for their role today as our prime reliance for national competence. 

Today the main commodity which our universities provide for our country is 

knowledge. Our universities comprise our Nation’s storehouses of knowledge, 

our factories for knowledge, our reprocessing centers for knowledge, and our 

distribution centers for knowledge. This knowledge is the chief basis of our 

national competence. It is essential for our survival th at our universities 

fulfill the responsibilities our Nation is placing upon them. Since our universities are essential organs of our Nation, it is necessary th at we, as a Nation, 

insure their continued strength.

The trends which affect our universities broadly also affect our medical 

schools. Our Nation is growing rapidly in population. More physicians will 

be needed to care for our people. In addition, much new medical knowledge 

is needed in order to make each physician more effective. Thus our Nation is 

demanding of our medical schools more research, more physicians, and more 

effective physicians. Moreover, our country is asked to assum e health and 

medical responsibilities abroad. We are asked to help initia te or improve medical 

school is less well-developed land s, to train medical scientists and faculty 

members for foreign medical schools, and to provide for selected foreign 

physicians examples of the best of modern American medical and scientific 

training. Yet our people have supported our medical schools so inadequately 

th at we are unable right now to tra in all the physicians we need, let alone 

tra in an excess for work abroad. We have even been forced to imjmrt physicians from other countries in ord er to provide our own people with enough 

doctors.

In one respect—with respect to direct support of research in biology and medicine—our Nation has embarked on a realistic program. Through congressional 

appropriations to the NIH, the NSF. the AEC, and the Armed Forces, through 

gra nts from private foundations, through a multitude of private gifts, large and 

small, given individually or through voluntary agencies such as the American 

Cancer Society and the American Heart Association, we have been able to
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 391

m ou nt a po w er fu l an d ex pa nd in g bioc he mica l re se ar ch ef fo rt which has been 

effecti ve an d w hich lias br ou gh t n ot icea ble b en efit to o ur people.

B ut th e ful l pote nti al of th is s pl en di d re se ar ch effo rt has no t be en mad e avail ­

ab le to ou r peop le fo r tw o re aso n s: F ir st , be ca us e our N at io n has no t suffi cie ntly 

su pp or te d th e teac hi ng of me dicin e an d th e tr ain in g of ph ys ic ia ns an d med ical 

sc ie n ti sts ; an d sec ond, be cause our N at io n has no t prov ided ad eq uat e fu nds 

fo r co nst ru ct io n of new fa ci lities fo r m ed ic al te ac hing , re se ar ch , an d tr ai nin g, 

or fo r m od er nizing an d re no va ting old st ru ctu re s fo r th e sa m e pu rpos es. As 

a re su lt o f fina nc ial string en ci es re la te d to te ac hing , m an y m ed ical schools ha ve 

been fo rc ed to ra is e tu itio n ch ar ge s to th e po in t whe re th ey are a su bst anti al 

fin an cial im pe tli m en t t o ab le st uden ts o f m od es t me ans.

ILK . 4999 prop os es to de al w ith th es e cr uci al lim itat io ns .

Th e pr ov isio n fo r sc ho la rshi ps auth ori ze d in th is bil l will, if en ac te d in to law 

an d im plem en ted by ap pr op riat io ns , be ve ry he lpfu l. Th e pro fe ss io na l schools 

co nc erne d will th en be ab le to ta k e in su per io r st uden ts of lim ited mea ns who 

could no t oth er w is e aff ord to att end th e sch ool. Thi s will hel p el ev at e th e 

quali ty of pe rs on s en te ri ng th e healt h pr of ession s. I urg e en ac tm en t of th is 

po rtio n of th e bill. It prom ise s a good s ta rt to w ar d th e so lu tion of a seriou s 

nati onal p roblem .

The re m ai nder of th e bill de al s pri m ari ly w ith m at ch in g fu nds to ass is t in 

th e co ns tr uct io n of he al th te ac hi ng or re se arc h fa ci lities . In reco mmen ding 

mod ifi ca tio n an d ap pr ov al of th es e po rtio ns , I ho pe you will be ab le to per su ad e 

you r di st in gui sh ed co lle ag ue s in th e Con gress to ac co mplish th e follo wing 

im pro vem en ts :

F ir st , to in cr ea se th e au th ori zati on of fu nds fo r re se ar ch fa ci lities const ru ct io n to a t le as t $100 m ill ion a y e a r ;

Second, to au th ori ze a vari able m at ch in g pl an whe reby ea ch dollar ra is ed 

fo r co ns truc tion o f a h ea lth te ac hi ng or re se ar ch f ac il it y b y a lo ca l i nst it uti on 

co uld be m at ch ed by mor e th an on e F ed er al dollar —p erh aps up to th re e 

Fed er al do llar s fo r each no n- Fed er al doll ar— th e m at ch in g fo rm ula to be 

one of adm in is tr ati ve re gu la tion an d no t of le g is la ti o n ;

T hird, to in cr ea se th e au th ori zati on of Fed er al fu nds fo r co ns tr uct io n of 

he al th te ac hin g fa ci lities to not less th an $100 million a y ear;

Fou rth, to au th ori ze specifically in le gi sl at io n th a t re se ar ch an d tr ain in g 

co ns truc tion fu nd s ca n be us ed fo r th e b ui ld in g an d rem od elin g of b iomed ica l 

libra ri es on a su itab le m at ch in g ba sis, w ith an auth ori za tion to appro pri ate 

$10 mill ion a year fo r bio med ica l li b ra ry c on st ru ct io n pu rpos es.

Let me il lu str ate th e urg en t ne ce ss ity fo r th is ki nd of legi slat io n an d au th o riz at io n by ci ting re ce nt an d re pre se nta ti ve e xp er ie nc es o f my ow n in st it uti on, the 

U ni ve rs ity o f C hic ago School of M edicine. T his sc hoo l h as a ve ry s tr ong res ea rc h 

em ph as is an d has qu ali fie d fo r co ns id er ab le re se ar ch su pport from F ed ­

er al , Sta te , an d p ri vate sou rces. Yet fo r years it has been lim ite d pri m ari ly 

by sp ac e co ns id er at io ns . It s la bora to ri es and oth er fa ci li ti es ha ve lon g 

been so crow de d w ith sc ie nt is ts an d tr ain ees th a t ex pa ns io n of it s re se ar ch 

an d te ac hi ng effo rt could not be ac hiev ed w ithout add itio nal co ns truc tion . 

Re co gn izi ng th is lim itat io n, my pr ed ec es so r as de an , Dr. Lo we ll T. Coggesh al l, in it ia te d a n ex tens iv e bu ildi ng a nd mod er ni za tion pr og ram in 1949. T here ­

aft er, up until now . un de r Dr. Cog ge sh all’s le ad er sh ip , th e U ni ve rs ity of Ch ica go 

has ra is ed an d ha s sp en t or co mm itt ed ov er $21.5 million of pri vate mo ney to 

fin ance new co ns truc tion an d m aj or re no va tion fo r teac hing , re se ar ch , an d tr a in ­

ing in bio log y an d me dic ine . The ex hib it ac co m pa ny ing th is st ate m ent su m ­

m ar izes th is he roic eff ort. On e ca n see th a t th is sum of pri vate mo ney of ov er 

$21 million has been s up plem en ted by abou t $4,800,000 of Fed er al fu nd s, m os tly in 

th e healt h re se ar ch fa ci lities an d H ill- B ur to n ca tego rie s, an d by an appro pri atio n of $4,500 ,000 fro m th e Fed er al G ov er nm en t to th e AEC fo r th e co ns truc tion 

of th e Argon ne Can ce r Res ea rch H os pi ta l, which now st ands adja cent to an d 

co nn ec ted w ith th e ot her U ni ve rs ity of Ch ica go ho sp ital s. The se sums, to ta li ng 

nea rly .<31 mi llion , ha ve been ex pe nd ed ov er a 13-ye ar pe rio d on ly fo r const ru ctio n an d re no va tion of re se ar ch , teac hi ng , an d tr ain in g fa ci li ti es in bio log y an d 

me dic ine . The ho sp ital an d outp ati ent fa ci lities wer e built fo r an d exis t solel y 

fo r clin ical re se ar ch an d fo r te ac hin g in med icine th ro ug h th e dem onst ra tion of 

ex em pl ar y med ical an d de nt al di ag no si s an d ca re.

Thi s pr od ig io us fin an cia l effo rt may see m like mu ch, but is it not en ou gh to 

pr ov id e th e b ui ld in gs th e Uni ve rs ity of C hica go ne eds in ord er to fu lfill it s ob liga ­

tion s to the N ation in th e fields of bio log y an d me dic ine . We a re c u rr en tl y tr yin g 

to ra is e an ad ditio nal $8 mi llio n of co ns truc tion fu nds; an d be yo nd th at, duri ng
392 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

the immediate future, we must program and construct to an additional sum of 

$54 million for biology and medicine lone. At the ra te we have been able to raise 

money over the past 13 years, it will take us 26 years more—until 1988—before 

we can raise the funds we need for construction which we are programing now, 

and for which we have immediate requirements.

Honorable Members of Congress, this illu strate s why II.R. 4999 must pass. 

It will not be enough, but it will help. Our Nation cannot afford to wait until 

1988 for the trained persons and new lifesaving knowledge which it expects and 

deserves from our medical schools. It needs these benefits now.

In order to assist Members of Congress in evaluating these figures and sta tements, I make the following clarification :

First, the construction program above is just what is necessary to build the 

laboratories, library, teaching facilities, offices, shops, animal quarters, teaching 

and research hospital facilities and utility facilitie s needed at the University 

of Chicago in order to enable it to keep abre ast of the curre nt pact of advances 

in biology and medicine and to maintain its accustom ed position among the 

leading institution s of the country. It will enable the University of Chicago 

to do its research, to train about 75 new physicians a year, and to provide 

resea rch training for about 300 graduate stud ents and for about an equal 

number of postdoctoral fellows and train ees at any one time. It will enable the 

University of Chicago to replace obsolete and inad equ ate teaching and research 

facilities and librarie s and to build new facilities for biophysics, molecular 

biology, genetics, biomathematics (including cente rs for computers and statistics), quantum biology, theoretical biology, bioinstrumentation, clinical research, 

and the like. The figure is realistic, functional, and urgently practical. It is 

not padded. It is not luxurious or lush or lavish or excessive. It is wh at is 

needed.

Second, the order of magnitude of need at the University of Chicago is not 

unique among our medical schools. I know of a number of other medical 

schools which face similar requirements. In this respect, the University of 

Chicago is more typical than exceptional.

Third, the prodigious and partial ly successful financial effort for construction 

of the University of Chicago in biology and medicine does not stand alone.

Other medical schools have likewise been exerting themselves with similar 

results, ns is evidenced by much new construction and renovation at State and 

private schools alike. But I know’ of no medical school which has been able 

to raise all the funds it needs.

Fourth, and most impo rtant, the University of Chicago and other priv ate 

and public medical schools cannot afford to put larg e sums of non-Federal 

money into construction without at the same time building up endowment or 

other resources for facu lty sala ries and concurrent expenses. Even if Chicago, 

for example, could, during the next few years, raise from private sources a sum 

equal to the $00-odd million it needs for construction, it could not wisely use 

this all for building withou t an appropriate increase in endowment. Chicago 

already has run into a deficit here, as in order to fulfill its buildng needs in 

biology and medicine during the last 13 years it has borrowed against endowment income and has even committed a few millions of precious endowment 

capital. A priv ate univ ersity cannot afford to put all its new funds into buildings. Yet our construction needs are so great that these alone can more than 

preem pt all the new’ priv ate money we can reasonably expect to get, even with 

prodigious effort.

Honorable gentlemen. I have presented you with some features of the situation facing the University of Chicago as a represe ntative priv ate American 

medical school. Our country is demanding much of our medical schools and 

w’ill require much more. We are doing our strenuous utmost—and it is a very 

effective utmost—to create the facilities needed so we can deliver wh at our 

country expects of us. Our country benefits from our achievements in research 

and from the skill and knowledge of the men we train. But we are not raising 

and cannot raise priv ate funds f ast enough to enable us to build at the required 

rate. Our country calls on us to provide the knowledge and men needed for our 

Nation’s health. We call on our country to make it possible for us to fulfill our 

country 's expectations and needs. The passage of II.R. 4999 can contribute 

significantly to this end.

Thank you, honorable Members of Congress, for your courteous attention.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 393

E x h ib it

Expenditures and comm itments for new construction and major renovations for

teaching and research in biology and medicine at the University of Chicago.

19 >,9-62

So urce o f funds

Fed er al

G over nm en t

P ri v ate

T o ta l

Y ea r compl et ed

N ew co ns truc tio n:

G old bla tt H os pi ta l an d L abora to ri es........ .......

G ilm an -S m ith H os pi ta l an d L abora to ri es. . . .

O u tp ati en t b u il d in g ................................................

C hr on ic Disea se H os pi ta l an d L ab o ra to ri es. ..

R es id en t-in te rn b u il d in g ....................................

C h il d re n ’s H osp it al..................................................

A rm our Clini ca l Res ea rc h B ld g..........................

Ani m al be ha vi or la b o ra to ry ............ .....................

B ot an y co ntr olled -e nvironm en t la b o ra to ry .. .

Res ea rch In sti tu te (b iology w in g )......................

S u b to ta l....................................................................

N ew c onst ru ction (u n iv ers it y af fi liat ed ):

Arg on ne C an ce r R es ea rc h H osp ital an d L ab ­

ora to ri es (b u il t by A EC , oper at ed by U niv ers it y o f C al iforn ia ).................................. .........

L aR ab id a In s ti tu te R es ea rc h B uil din g............

S u b to ta l...................................................................

T o ta l, ne w co n str u c ti o n .....................................

M aj or r en ovat io ns:

Support in g s ci en ce s..................................................

H osp it al s an d cl in ic s................................................

T o ta l, ren o v ati o n s................................................

T o ta l, new co nst ru cti on an d re n o v a ti o n s.. .

F u n d s cu rr en tl y be in g ra is ed for ne ce ss ar y ne w 

co nst ru ction:

M ole cu la r biolog y b u il d in g ...................................

C en tr al an im al q u art ers (R C -3 14) .....................

P ed ia tr ic s r es ea rc h fa ci litie s______ _____ ____

T o ta l..........................................................................

A ddit io nal fu nds re q u ir ed for ne w co ns truc tion 

an d for m odern iz at io n of ex is ting educat io nal 

facilitie s (fro m all s ourc es ).......... ......... .....................

$690,000

1,175,000 

188,700 

357,647

1,128,409

115,000

189,000

3,843,756

4, 500,000 

192,000

4, 692,000

8, 535,756

781,175

781,175

9, 316,931

(750,000) 

2, 500,000

2,500,000

$1,5 73,607

3,1 14,91 5 

1,813,028 

2,5 92, 353 

1,120,156 

2, 500, (MX) 

1,835,605 

50,9 05 

55,000 

1,733,000

$2,263 ,607

4.2 89, 915 

2,001,72 8 

2. 950,000 

1,12 0,15 6 

2. 500,0<M) 

2,964,014 

165,905 

244,000 

1,73 3,00 0

1950

1953

1961

1961

1959

1963

1963

1961

1962 

1950

16,3 88,569 20,2 32,3 25

558,000

558,000

16,946,569

1,70 3,72 7 

2,952, 304

4,656,031

21,6 02,60 0

2,5 00,00 0 

750,000

2,500,00 0

5,750,000

4, 500,000 

750,000

5,25 0,00 0

25,482,325

2,484,902 

2,952,304

5,43 7,20 6

30,919, 531

2,500,000

750,000

5,000,000

8,250,0 00

.54,000,000

1951

1959

Categorical exhibit of expenditures for construction and major renovations for

teaching and research in biology and medicine at the University of Chicago,

19^9-62

Teaching fac ilities__________________________________________ $587,137

Research facilities__________________________________________ 13,112, 201

Teaching and research hospitals (does not include studen t classrooms, laboratories, and equ ipm ent)_________________________ 15,611,023

Other (res iden t-intern hou sing)______________________________ 1,600,170

Total_______________________ ____ ___________________ 30,919, 531

CO MM EN T ON E X H IB IT

Particular ly noteworthy is the low percentage of Government funds used— 

30 j>ercent of tota l expe nditures were from Government agencies, or, excluding 

Argonne Cancer Research Hospital, less than 16 j»ercent. All of the hospitals 

constructed in this i>eriod—Goldblatt, Gilman-Smith, Chronic Disease, and Children’s Hospital (in process and included in this rejio rt)—include research laboratories and classrooms. Moreover, all the patient-care are as in these hospitals 

exist for the purpose of teaching and research.

80 01 4— 6! ■26
394 TRAININ G OF PRO FESSIONAL PUBLIC HEA LT H PERSON NE L

Th e am ou nt of en do wm ent used fo r th e bu ild in g pr og ra m has no t been dete rmin ed. hu t I es tim at e th a t close to $7 mill ion ha s been ex te nded , plus se ve ra l 

mi llion mo re in en do wmen t inco me which w as “bor ro w ed ” until ple dg es we re 

pa id. Tiie G ol db latt Hos pital, fo r in stan ce , st il l has no t ha d al l pledges pa id 

an d W or ch es ter en do wmen t money was ne eded to co mplete th e fin ancin g.

Mod erniza tio n an d ex pa ns io n o f teac hi ng fa ci lities (i nc lu di ng libr ar ie s, which 

th e divisio n ha s no t at te m pte d to fin ance pre vi ou sl y) , has not kep t pa ce w ith 

rhe ex pa nsion of re se ar ch fa ci lit ie s. Su ch fu nds are am on g th e mos t dif ficult 

to get in th e larg e am ou nt n ec essa ry.

I)r. Bennett. Am ong the problem s wi th which this bill deals, and 

on which I wish to speak, are thre e. First , why is the topic of Fe deral support, of c onstruc tion and of Fe deral support fo r sch ola rships 

one which is worthy of the att en tio n of Congress? Second, why 

should these be sch olarships and no t loan s? And, th ird, have the 

univers ities done th eir pa rt in the problems which face o ur Na tion?

Th is bill imp lies th at adequate fund s fo r construc tion of fac ilities 

for medical and den tal teaching and rese arch constitu te a Federal 

problem. I believe th is position is soun d. We are well aw are of 

the fact t hat th e healt h of our N ation is the problem of all o f us. We 

realize th at medical and biological research, pro ducin g new kno wledge, make our physicia ns more effective and greatly improve their 

power to aid th ei r patie nts . We have been wi lling to ap po rtion s ubsta ntial funds to str ength en the biom edical researc h efforts of our 

Xat ion. Ou r medical schools a nd schools of de ntist ry and osteopat hy 

find themselves faced wi th the necessity of g earin g their activities to 

the stepp ed-up pace of ou r popula tion expa nsion and to the stepped- up 

pace o f th e acq uisition o f new medical know ledge. Th e resu lts of new 

research have to be taug ht to phy sicians if they are to be used fo r the 

benefit of the peaple. Th us the prov ision in this bill to pro vid e for 

teaching fac ilitie s is ap prop ria te. I t will benefit the Na tio n’s health 

by im pro vin g ou r Na tio n’s ab ility to make the new know ledg e resu lting from rese arch ava ilab le to the people thr ou gh the doctors who will 

be ta ug ht th is new knowledge.

We have been used to t hink ing of our univer sities a nd our m edical 

schools as insti tutio ns prim arily designe d to benefit the stu dent who 

attends them. Dur ing the war and subs equently, we have learned 

th at we mu st tu rn to ou r universities fo r much essential knowledge. 

We now find our universities pressed by our Nation to tu rn out many 

more d octors, more scie ntists, more enginee rs, more ling uists, to p ro duct muc h more research , to develop com puters, to develop new me thods fo r developing our cou ntry , to deve lop new weapons, to develop 

new knowledge of cancer and heart diseases. We find th at the demands which our country is pla cin g upon ou r univer sities are ou tstripp in g their custom ary financial resources. Ju st as our cou ntry 

tu rn s to our un iversities, including our medical schools, and asks them 

to help our country meet the cha llenges which face our N atio n, so o ur 

universities find themselves turning to ou r country and s aying, please 

help us pro vid e wha t our cou ntry needs in or de r to meet these ch allenges. Th is in broad outline is the basic reason why universities, 

includ ing medical schools, find themselves coming to the F edera l G overn ment for help. Ou r Nation depend s on the continued healt h of 

our u niv ersitie s and our medical schools. There for e, it is ap prop ria te 

th at ou r Nat ion insure the continuing he alt h o f these vital ins titu tions.

As fa r as sch olarships are concerned, so m uch has been said in thi s 

connection th at T shall add only one po int which I hav e not heard
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 395

utter ed in this chambe r, tho ugh possibly it has been men tioned at 

hearings which I was not att endin g. I have been in medical education for a good man y yea rs and have o ften observed t hat if a student 

appro ach es the end o f his medical school or his hos pital trai ni ng un der 

a load of debt, he feels forced fre qu ently to cut short his tra ining. 

Th en he cuts him self loose from op po rtu nitie s to enrich his backgro un d in order to enter pra ctice at an earlier stage th an he would 

othe rwise. He then practices as a doctor less well equ ipp ed with 

know ledg e th an would be th e case had he con tinu ed his edu cation, his 

hospital t ra in in g, o r his special fellow ship trai ni ng somew hat longer. 

I believe th at as a nation we pa y a pric e in the q ua lity an d the dura ­

tion of trai ni ng fo r some of our docto rs because of the deb t fac tor. 

I believe th at sch olarships would redu ce this pa rticul ar cost to the 

quali ty of medical care which our population receives.

I migh t illus tra te by cit ing my own case, since Mr. Collie r has 

raised the point of ind ividuals assum ing responsibility fo r the fina ncial bur den of th ei r own tra ining. I came from a missio nary fam ily 

with fo ur child ren , all of whom went throug h college. 1 went on 

throug h medical school. I did work fo r my expenses in college and 

in medical school, as you have in dic ated, Mr. Collier. Bu t had I faced 

a load of debt in addit ion , it would have been a very serious handica p 

to me. I wished to go into tea ching and research in med ical schools. 

Th is is a low -pa yin g branch of medicine. After gr ad ua tio n I had 

man y years on a low salary . Before these were com pleted I ent ere d 

the arm ed services as a young officer in the N avy, 1 went to the South 

Pacific and served with the M arines. Th is dela yed very c ons iderably 

my op po rtu nity to earn a satisfac tor y liv ing on which to supp ort my 

fam ily and edu cate my children. Ha ving continu ed in the tea ching 

area, my income has not been as lar ge as that of man y of my classmate s who went into prac tice. It would have been very disadv an ­

tageou s fo r me and for others in my position to have been faced with 

a load of debt in addition . I am grateful th at ther e were sch ola rsh ip 

fun ds a vailable at my m edical school to help me go th roug h t his period. 

I believe t ha t there are oth ers who could have b enefited likewise from 

sch olarships. Moreover, even if one does work du ring the sum mer 

and pu t in a strenu ous time earning $650 or $1,000 or more, a sum 

which able stu dents are able to earn in a summer, this is n ot sufficient 

to meet the cost of a ye ar’s medical edu cation. There rem ain ad di ­

tion al sums which are necessary if the student is to meet the $1,500 

tuition , fo r exam ple, which some schools cha rge and the $l,000-o dd 

living expenses which may be imposed upon their studen ts. Ev en if 

stu dents do work to earn some expense an d even i f they get t he scho lar ­

ships provide d in this bill, this will not suffice to meet all th ei r expenses.

Fu rth ermor e, because of the press of the increased pace o f medical 

studies we must do all we can to give ou r stu dents the tim e to ma ster 

the knowledge with which they are con fronte d. I bus the y can become well qualified as physicia ns. It is w orthwhile for many of them 

to use th eir spa re time in the sum mer for work, either in the laborato ry, in research , or in the lum ber ya rd, as you sug gest, but the 

hulk of th eir time du rin g their academic year shou ld be ava ilable for 

their studies. Scholarships can be very he lpf ul here.
396 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

The last, point I want to make, Mr. Chairman, relates to the question which I have sometimes heard. Have our universities done their 

part ? Whv should they turn to the Federal Government ? Why don't 

they do it themselves? I would like to present to you the effort which 

the University of Chicago has expended in its desire to equip itself 

to meet its responsibilities in relation to the demands which our country is placing upon medical schools broadly.

The University of Chicago School of Medicine is a private school. 

It has no public tax-derived support, other than the funds which it 

gets from grants and contracts of the usual type, and other than a 

small annual appropriation through the Atomic Enegry Commission 

to support the very special kind of research which goes on in the 

Argonne Cancer Research Hospital. The great part of the medical 

school then, is privately financed. Recognizing the need for additional buildings for research and for improvement in teaching a fter 

the war, my predecessor as dean, I)r. Coggeshall, as can be noted 

from the exhibit at the end of my statement, led the University of 

Chicago School of Medicine to raise more than $214/2 million in private money since 1949 for new construction. This has been supplemented by public money to the extent of a little over $9 million, 

making a total of $31 million in construction for new research and 

teaching, hospital, and laboratory facilities. This does not suffice to 

meet, our needs. Just as Dr. Warren has been able to present you 

with the continuing needs of the University of California at Los 

Angeles, so I too can, in a similar manner, project our needs for the 

next few years. We have immediate need for construction funds 

alone totaling somewhere in the neighborhood of $54 million, in addition to construction programed at present somewhat in excess of $8 

million.

These funds are entirely apart from funds for endowment and for 

ongoing maintenance and operation. The figures represent the magnitude of the financial job facing our private and public medical institutions as they address themselves to the tasks which the Nation 

places on them. This task is to provide our Nation with knowledge 

in medicine and biology and with people trained in this knowledge.

If you look at the last page of this exhibit you will notice that of 

this sum of $31 million only a little less than $600,000 has been available for construction for teaching purposes. This emphasizes the 

virtues of the provision in the bill II.R. 4999 which allows Federal 

matching funds for teaching facilities. With matching funds for 

teaching facilities, we shall be in a better position to build up our 

capacity to teach students at the University of Chicago and at other 

medical schools throughout the country.

I shan’t burden you further, Mr. Chairman, and honorable members 

of the committee, with the details of this report. You can follow it 

at your leisure. I make myself available for your questions.

The Chairman. Mr. Younger?

Mr. Younger. No questions.

The Chairman. Mr. Collier?

Mr. Collier. One statement, Doctor. I tru st you did not conclude 

that I had the remotest idea tha t one could send himself through school 

by working in the summer. As one who has a son and daughter in a
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 397

college and a university, I know of course tha t this is completely 

impossible.

Dr. Bennett. Yes.

The Chairman. Doctor, thank you very much.

Your statement will be included in the record. I have had occasion 

to look over it and it is a very good explanation of the needs of your 

own institution.

Dr. Bennett. I think this is a representative need, sir. I have 

chosen this as an example, which is not atypical.

The Chairman. Thank you very much.

I )r. Bennett. Thank you.

The Chairman. Prof. Ilerm an Somers ?

I understand Dr. Benedict J . Duffy, Jr., is appearing with Professor Somers.

STATEMENTS OF PROF. HERMAN M. SOMERS. CHA IRM AN, DE PARTMENT OF POL ITIC AL SCIENCE, HAV ERFORD COLLEGE, HAVER -

FORD. PA .; AND DR. BEN EDICT J. DUF FY, JR ., PROFESSOR OF

PR EV EN TIVE MEDICINE. SETON HALL COLLEGE OF MEDICINE,

JERSEY CITY, N.J.

Mr. Somers. Mr. Chairman, honorable members, 1 am Herman 

Somers, professor at Haverford College, Pa. My colleague with me 

is Dr. Benedict Duffy, Jr., who is a practicing physician and professor 

of preventive medicine at Seton Ilall College, Jersey City. We are 

here representing the Independent Committee for Medical Development. We have submitted a very brief statement which we hope will 

appear in the record.

The Chairman. It will lie included in the record, Doctor, at this 

point.

(Thestatement referred to follows:)

Sta teme nt of th e I ndependen t Com mi tt ee for Medical Development

INTRODUCTION

The Independent Committee for Medical Development is an outgrowth of the 

national symposium on "The Health Care Issu es of th e ltXIO’s” held in New York 

City October 2. 3, and 4, 19G1, under the sponsorship of Group Hea lth Insu rance, 

Inc., a nonprofit organizatio n. A group of participants in th at meeting agreed 

on the value of creating a continuing committee of inte rested private indiv iduals 

concerned with the improvement of our health care system. Besides the spokesmen of ICMD noted above, members includes Dr. Martin M. Cherkasky, director, 

Montefiore H osp ital; Mr. Arthur H. Harlow, Jr., president, Group Health Insurance. In c.; Mr. Jerome Pollack, program consulta nt, Social Security Depa rtment, 

UAW; Dr. Caldwell B. Esselstyn, director, Rip Van Winkle Clinic; Mr. Alphonse M. Wilson, ass istant vice president, Libe rty Mutual Insurance Co.; 

Dr. George A. Silver, chief, Division of Social Medicine, Montefiore Hospital; 

Mr. Ila rry Becker, vice president. Blue Cross Association; Dr. Aims C. McGuinness. executive secretary , Committee on Medical Education, the New York 

Academy of Medicine; Mr. Fra nk Van Dyke, associate professor of admi nis tra ­

tive medicine, School of Public Health and Adm inistrative Medicine, Columbia 

University; Mr. Winslow Carlton, chairman of the board, Group Hea lth In su rance, In c.; and Mr. Edw ard T. Chase, con sultant and writer.
398 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

STATEMENT

One of the vital issues th at will engage Congress in the weeks ahead is the 

ma tter of allev iating our increasingly critical shortage of doctors. Under consideration will he II.R. 4999 authorizing $75 million annually over a 10-year 

period for new medical schools, scholarships for medical students and aid to 

certain research facilities . The intent of this modest legislation is to help 

correct a deteriorating situ atio n tha t reflects more adversely on our society than 

almost any other national shortcoming. The United Sta tes is already seriously 

short of doctors; the situ atio n is rapidly worsening: there is no present prospect 

whatsoever of improvement without immediate sub stantial aid. In the crucial 

matter of providing medical care for its people, the world's richest nation has 

tolerated an all but incredible condition to develop. In words of Walter Wiggins, M.D., the secretary of the Council on Medical Education and Licensure, 

American Medical Association, “This is perhaps the first prosperous, gre at and 

strong nation since the Roman Empire tha t has ever needed physicians educated 

outside its own boundaries to provide necessary medical care for its own populace.” While II.R. 4999 cann ot by itself do more tha n modify the problem, we 

do believe it is imperative that this hill be enacted as the lirst in a number 

of steps to resolve the doctor shortage.

The consequences of contin uing inaction are serious in the extreme. There 

is now a consensus that the United States is failing to maintain an adequate 

ratio of doctors to population. The two most widely known and respected official 

inquiries, the Bayne-Jones report and the rep ort of the Surgeon General’s Consul tan t Group on Medical Education, show th at some 11,000 medical school 

graduates are required annually to m aintain the present ratio of 133 doctors per 

100,000 of population. We are turning out only about 7,300 gra duates annually. 

These reports and other official studies agree th at to increase the admissions to 

our medical schools by the roughly 50 percent requ ired to maintain present 

ratios, the United States must have at lea st 20 new medical schools by 1970 

as well as considerable stren gthening and expansion of our present 92 schools. 

When it is realized that a new school costs from approximately $10 to $25 

million and that the funds II.R. 4999 is to provide annually for construction of 

medical schools and schools of public health come to $45 million, it is clear 

we are talking about a minimal program.

What does the worsening doctor shortage mean for the individual? It means 

an exacerbation of many of the shortcomings in medical service th at the public 

suffers from and rese nts in o ur medical care system as it is presently organized. 

There will be needless deaths and needless suffering; there will be fewer doctors 

for emergency house and night calls; immediate access to emergency service 

generally will be incre asingly spotty; patients will wa it longer to see doctors, 

will be subjected to more hurried examinations, and receive less than optimum 

ca re ; hurried diagnoses will resu lt in more e rrors ; the discrepancy between available hospital house staffs and increased numbers of hospital beds will incre ase ; 

patient supervision in the hospital will deteriora te; the difference between the 

quality of care given the well to do and th at given most of the population will be 

accentuated. All these items have a bearing not on peripheral matter s but on 

matters of life and death. And this is a kinetic, not a stat ic situation, a situation 

bound to get worse.

What are the prospects for reform? Candor must acknowledge they are slim 

indeed, despite the seriousness of the matter, and, oddly, despite the unanimity 

of opinion on the facts. If this seems passing stran ge, which indeed it is. one 

must recognize that it is not an easy ma tte r to rally the American public to 

concern themselves with what seems to be an abstract problem because it seems 

to lie somewhere in the future. While the need for Government assistance for 

physical construction of fac ilities is generally accepted, there has been resistance 

to acknowledging the equally essential need for outrigh t scholarship grants for 

stud ents and dire ct aid to medical teachers. The argument repeatedly has 

been invoked that new schools aren’t any good withou t teachers and th at you 

can ’t get the teachers.

However, the fac ts suggest otherwise. Recent stud ies show tha t in the past 

decade the number of preclinical teachers has been doubled and the number of 

full-tim e teachers in the clinical field almost quadrupled. If money is available 

it will not be hard to keep new grad uate s in teaching. Every teacher in a medical 

school today and every atte nding physician in an affiliated hospital knows dozens 

of young men finishing their training who would prefer work in the hospital or
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 399

med ical sch ool to go ing in to im med iate pra ct ic e. Ag ain , th er e is co mpe lli ng ev idence th a t th e av ai la bil it y o f larg e sc hol ar sh ip s (m ed ic al e du ca tion is no to riou sly 

co stly) will qu ickly st ep u p th e quan tity a nd q ual ity o f m ed ica l st uden ts . In additio n, th e pu blic and th e Co ng res s m us t appre cia te th a t dir ec t su bs idy of op er ation s is es se nt ia l fo r man y of ou r med ical sch ools. The pr ec ed en ts fo r su ch Gover nm en t s up po rt o f ed uc at io n in o th er fields a re m an y.

I t is true, of co urse, th a t mu ch ca n be do ne to mo dif y th e do ctor sh or ta ge 

th ro ug h re or ga ni za tion of pr es en t pr ac tice s. Th e re gi on al plan ni ng of hos pi ta ls 

on a m et ro po lita n ar ea w id e basis, mor e pre pa ym en t co ve rage of am bu la to ry an d 

ho me service s, and th e d ev elo pm en t of gr ou p pra ct ic e a re step s th a t co uld prov e 

he lpful.

But th e ess en tial st ep is to c re at e th e p ro gr am s and th e ne ce ss ar y fin an cin g fo r 

pr od uc in g mor e do ctor s. T hi s is a m att er th a t ca nnot w ai t. It is a ca us e th a t 

de se rv es fe rv en t, wid es pr ea d, pu blic su pp or t. An im port an t in it ia l st ep is the 

pa ss ag e of II.K. 4999.

Mr. S omers. Th an k yon, sir. 1 w ill be e qua lly brief in makin g a few 

rem ark s about it, I think 1 should po int ou t th at the indepe ndent 

committee is mad e up of ind ividuals in th eir pr ivate cap acities who 

sha re a concent and a considerable degree of professional experienc e 

in vario us phases of the medical care field.

We have join ed together to see what we c an do to help the medical 

problem. Th e com mittee meets regu larly fo r intensive discussio n of 

medical care. Th e comm ittee includes men in hosp ital admi nistr ation, 

phy sicians, men in various sectors of the health insu rance business, 

medical teache rs, and ad mi nis tra tors, wr ite rs, and oth ers who are involved in medical care problems. These people do not agree on every ­

th in g in medical care. We are t ry in g to find wha t it is tha t peop le of 

good will and knowledge concerned with the N ation's health problems 

can agree upon which w ould be of service. Th is very problem t ha t you 

are dealing with was the first one on which we could get absolutely 

unanimous support without qua lification from all of these p eople from 

different professiona l bac kgrou nds and long experien ce with medical 

care problems.

We all have person ally endo rsed the statem ent th at has been sub ­

mi tted to you in supp ort of II.K. 499!). 1 do not believe I need to

rep eat th e content of the f orm al statem ent . Some of the t hing s in o ur 

statem ent have alr eady been said by people who have preceded me. 

I do wish to add th at it is the view of our grou p that the pro visions 

of the bill are, in rel ationship to th e ma gnitude of the problem, modest. 

I t is a valuab le and useful beg inn ing , but we feel that actua lly the 

problem and the need are very much larg er th an the bill provides for. 

I t is a con serv ative begi nning by an y m easure.

I would also like to make one or two commen ts which arise from 

my ha ving listen ed to earlier tes tim ony tod ay, pe rhaps to help clarify 

one or two p oints. It has been me ntio ned by one of the Congressm en— 

I believe it was Mr. Nelsen—that othe r sciences and eng ineering, are 

also ap pe aling for more money fo r sch olarships. li e referre d to the 

Presiden t's recent statem ent.

I think this is actua lly a str ong support for thi s bill. We have a 

prob lem in th is country of en lar ging the entire reservoir of scientific 

and tech nical person nel, o r we will l>e in gra ve difficulty. We are not 

ge tting eit he r the qu an tity or the qu ali ty of ma npo wer we need because we have been confining, pa rti cu larly in the medical field, access 

to the profession largely to mid dle and up pe r class people. Some 40 

perc ent o f peo ple who g o to medical school come from the to p 8 percent 

of our income gro ups. The finan cial bar ri er is too great. I am not
400 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

here disc ussing the question of the fai rness to th e om itted individ uals. 

I am concerned th at unless the Nation opens up access to all the 

sciences and tech nica l ar ts within the next few years, to as large a 

portion of th e p opula tion as possible w ith po ten tia l t ale nt, bv removing 

the financial ba rri ers and increas ing educational fac ilities, we will not 

only be in difficulty in medicine: we will be in difficulty in the sciences 

on which medicine also depends, che mistry , biochemistry, et cetera. 

It is correct, the re is a com petition among these fields for students 

but we must enlarge the a rena of com petition. We have to remember 

at the mom ent th at medical studen ts are worse olf in the com petition 

for scholarships an d o the r form s of sup port.

A second point th at was made ea rlier by one of the honorable mem ­

bers, relate d to the constan cy in the ratio of doctors to population 

ove r the past couple o f decades. Th is is true , b ut it is easily p redictable that it will not rem ain tru e for the next 20 ye ars, since gro wth of 

population is a relatively predic table phenomenon, and we also know 

abou t the pla ns a nd cap acities of our medical schools. The da ta has 

alread y been introd uce d in your record.

I wish t o add th at the ratio of d octors to p op ulation alone is a r athe r 

misleading figure, because it includes all living phy sicians. Th e 

figure includes ret ire d physicians, physicians in research, phy sicians 

who are in teac hin g, physicians who w ork for Governm ent, and o the rs 

who are not trea tin g patients. Our dat a show th at the proport ion 

of doc tors not in private practice has incr eased from 10 perce nt of 

the profession in 1931 to about 27 percen t by 1957. Th is is not s aying 

the work they do is less valuable. It is dif fer ent research , teaching, 

et cetra. To add to th at picture , 30 y ears ago 72 p erc ent of the phy sician s in priva te pract ice were general practition ers. 4 ou could go 

to them directly. Th is gro up by 1957 had been reduced one -ha lf, to 

only 36 percent.

In sho rt, the tot al numb er of liv ing physicians does not give you a 

picture of the doctors who are really ava ilable to the population . If 

you add to that, the fact that p eople are using a nd need more m edical 

services than ever before, th at the meani ng of our population data 

is also chang ing , I th in k the constan cy of the docto r-p atient ratio is 

mislead ing. It is true th at the ind ividual docto r’s productiv ity has 

also gone u p ve ry rapidly, th at is to say, each docto r sees more p atients 

tha n in the past, bu t this has been more th an cou nteracted by the 

fac tors I ha ve men tioned.

As you know, medical care is a field with enormo us controversies 

and disa greement, b ut I know of n othing in t he field th at has as much 

agreem ent, alm ost unanimity , than the fact t hat we need more ph ysicia ns, and I believe it is also clear there is ju st no way of ge tting 

them in sufficient numb ers without Fe de ral aid.

Th an k you, sir.

The C hairman. Dr . Du ffy, do you ha ve a ny thin g further?

I)r . Duff y. A very brief comment, Mr. Har ris. I t is my un de rsta nd ing from sitti ng here this mo rni ng th at the American Medical 

Association has not tak en a position upo n th is question of scholarships and loans. I th in k th at the gr ea t majority of practic ing and 

tea ching physicians would take a position, were th ey given the o pp or ­

tunity, and I think they would be in favo r o f Federal sch olarships on 

a p ar ity with t he other gr aduate sciences.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 401

Th e C hairman. Th an k you very much.

We are g lad to hav e you r statem ent.

Dr . D uf fy. Th an k you, sir.

Mr. Somers. Tha nk you.

Th e Chairm an. Dr . Ro ber t Kroep sch ?

Dr . K roe psc h, you may identify yo urself and proceed.

STATEMENT OF ROBERT H. KROEPSCH. EXECUTIVE DIRECTOR,

WESTERN INTERSTATE COMMISSION FOR HIGH ER EDUCATION,

FLEMING LAW BUILDING, BOULDER, COLO.

Dr . Kroepsch. Mr. Chairma n, an d mem bers of the comm ittee, I am 

Ro bert H. Kroep sch, executive directo r of the We stern In te rs ta te 

Commission fo r Hi gh er Education. I am here tod ay un de r specific 

au tho riz ation of the 12-man ex ecutive com mittee of the commission.

W IC H E , which is the short title fo r the comm ission, is a public 

interstate com pact agency of the 13 W ester n States. Th e 39 commissioners are appoint ed by the 13 Western Gov ernors and re po rt di ­

rec tly to them. Th eir names are atta ched to th e statement fro m which 

I am rea din g. It is the tas k of ou r sma ll staff in Boulder, Colo, to 

can y out the basic respon sibility of the commission which is to improve and increase hig her edu cation al op po rtu nitie s fo r the young 

peop le of th e W est throu gh in terstate cooperation.

Since its f ou nd ing in 1953, the commission h as been deep ly involved 

in findin g solu tion s to the West ’s inc rea sin gly critical pro fessional 

manpower problems. Ou r staff has been specifically concerned with 

ascerta ining the health manpo wer needs of the Western State s and 

with plan ning pro gra ms fo r meeting these needs. Two stu die s conducted by the Commission are pa rti cu la rly germa ne to th e matter 

before this comm ittee. One is en titled “rfh e West ’s Medical Manpow er Needs,” a copy of which I hold in my hand, and the other is 

“D en tal Manpower Req uirement in the West.” Copies of t hes e two 

stud ies are ava ilable for the com mittee’s files. The find ings of the 

medical stu dy in pa rti cu lar hav e pro vid ed essential data fo r "Western 

State s seeking ways of mee ting th eir medical education needs.

In view of th e findings of these studie s and on the basis of my partic ipa tio n in efforts to find educ atio nal answers to medical and denta l 

manpo wer shortage s both in New Eng land and in the W est, I believe 

that we are fac ing a sho rtage of healt h edu cation fac ilities whi ch 

will tak e on the c harac ter o f a national healt h hazard unless immediate step s are tak en to provide the needed facilities.

He re are some high lig hts from ou r studies of the West ’s medical 

and denta l manpower needs. I think th at very implication is here.

1. The West has 14 percent of the N ation 's p opula tion, b ut its m edi ­

cal schools ed uca te only 9 p ercent of the N ation’s doctors. Th is mea ns 

that Western State s depend heavily on the migrati on of physicians 

from othe r par ts of the cou ntry . Hence, westerne rs hav e a du al concern over the outcom e of this hearing. Not only must we str ive to 

produc e ou r fa ir sha re of the Na tio n’s physicians, but un til we are 

able to do so, we sha ll be heav ily dep end ent on medical educa tion in 

the res t of the States. We know, perhap s as well as any region, th at 

edu cation fo r the healt h professions is a natio nal and no t a strictly 

regional o r S tate problem .
402 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

2. Eleven of the thi rteen West ern State s are below the national 

average of phy sicians per 100,000 population . An d these 11 State s 

are fa r below the nat ion al average. Eig ht of the eleven do not, at 

present, have any medical school within th eir borders . You can see 

that the western region indeed had its work c ut out fo r it in the yea rs 

ahead if it is to pro vide enough medical edu cation oppo rtu nitie s for 

its young people.

3. The West does not have a sufficient numb er of places in its nine 

medical schools to educate all qualified applican ts from the West. 

Perha ps the sta tem ent sh ould be revised to refe r to 10 medical schools 

since the shift over of the Ca lifornia College of Medicine.

At present more than ha lf of the stu dents fro m We stern State s 

witho ut schools leave the region fo r th eir edu cation. As enrollment 

pressures increase, western students will find it more difficult to gain 

admission to non western medical schools. Unless addit ion al medical school places are created in the West, many stu dents will sim ply 

have no place to go.

4. Rep orted plans fo r medical and den tal school exp ansion will not 

be sufficient to meet the needs of the West. I f the West continues to 

educate 9 percent of the total num ber of do ctors, it will need about 170 

add itional enter ing places by 1975 when the West will have 20 pe rcent of the to tal U.S. populatio n.

To sup ply 20 percent of the yearly total of the 8,700 new doctors 

needed for the Nation as recommended by the Surg eon General, would 

mean, in the West, immediate pla ns for over a tho usa nd more firstyear places—the equivalent of 10 o r 11 average -sized medical schools. 

So grea t an expa nsion can pro bab ly not be expected. Up to 500 more 

places within the next few yea rs would be more obtain able tho ugh 

minimum goal. If Federal stimula tor y fund s are available, the W est 

will have a ch ance o f a chie ving its m inim um goal and may even asp ire 

to tra in its prop ortio na te sha re of the national sup ply of physicians 

and dentis ts.

To sum marize, an imm edia te and substan tial expansion of medical edu cation and rese arch fac ilities is essential if the We st is to (a)

ma intain c urrent levels o f medical manpower while keeping pace with 

its rapid populat ion gro wth, (6) pro vide its qualified stu dents with 

the op po rtu nity for medical education, (c) provide fac ulty necessary 

to edu cate increased num bers of medical stu dents , and (</) safeg uard 

high sta nd ar ds of medical edu cation and research.

The problem of prov idi ng sufficient denta l man pow er for the West 

is no less serious than the medical situation. The W IC II E stu dy of 

denta l manpower req uirem ent s in the West rep orted that in orde r to 

ma intain 1955 levels of dental care, the Western States mu st fill an 

ann ual deficit of 1,260 d ental school grad ua tes each ye ar between 1960 

and 1975. Dur in g these yea rs of rapi d populat ion gro wth the present ou tput of d en tis ts will be nowhere near adequate. At presen t, the 

West, depend s hea vily upon oth er pa rts of the country to meet its 

den tal ma npo wer needs. But as the short age grows more acute, the 

West will be able to depend less an d less upon other State s to pro vide 

dentists, and W estern s tud ents will find it inc rea sin gly difficult to ga in 

admission to schools outside the West. Th e only way the West can 

hope to obtain an addition al 1,200 denti sts each year is to expand 

existin g schools and establis h several new ones. Most of the new d ent al
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 403

school places will be needed in California, hut the Northwest will need 

110 more graduates annually. The Rocky Mountain region 111 more 

and the Southwest 99 more.

Financing these new dental education facilities will present the 

same kind of problems as does the financing of new medical education 

facilities. The financial burden on the States will l>e great—a burden 

which they can probably not carry adequately without supplementary 

funds from the Federal Government.

Several of the provisions of II.R. 4999 strike a responsive chord in 

the West.

1. This is particularly true of the section which would provide 

stimulatory grants for tiie construction of medical and dental teaching facilities. Many of the Western States have small populations 

which are nevertheless growing rapidly. Several of these States also 

have tax problems growing out of the fact that within their borders 

are large Federal land holdings. Most such States will be hard put 

to it to meet the demands which will lie placed upon them to provide 

undergraduate and graduate education to say nothing of medical and 

dental education. Yet we know that the pressure to build medical and 

dental schools is mounting.

Only 2 weeks ago four of the eight Western States without medical 

schools (Idaho, Montana, Nevada, Wyoming) sent representatives 

to a WIG I IE-sponsored meeting to discuss ways of meeting their 

medical education needs. Participants included the official representatives of higher education, the State medical societies, and personal 

representatives of the four Governors. They agreed to consider all 

possible ways of meeting their needs including the establishment of 

a regional school to serve all four States. Copies of a report of this 

meeting and a roster of participants have been placed on file with 

the committee. But whether these States decide to go it alone or 

to unite in building a medical school, they will, in my opinion, need 

resources beyond those available within their own borders if they are 

to plan and construct the kind of high quality medical and dental 

education facilities necessary to maintain high standards of medical 

care.

2. Because of WICH E's regional interest in higher education, we 

strongly endorse those sections of H.R. 4999 which recognize the 

planning functions of regional agencies and which provide for grants 

to such agencies for planning and determining the need for medical, 

dental, and public health teaching facilities.

That part of the bill providing for planning grants can be of vital 

importance in the West. I mentioned that S of our 13 States do not 

at present have a medical school within their borders. Six of the eight 

are only beginning to plan for such facilities. While I do not personally believe that all six of these States will want to establish 

medical and dental schools of their own, I am sure that they will need 

to he involved in planning for schools which will provide places for 

their qualified young people.

In those States which already have medical schools, the need for 

planning funds is equally urgent, For example, the State of California is growing so rapidly in population that its existing schools, 

cannot possibly provide the needed number of medical and dental 

student places. Additional schools will have to be planned and built.
404 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

And on the other side of the coin, since California is a heavy importer 

of practicing physicians, it is of interest to the people of California 

tha t funds are available for other States in the West and in the Nation 

as a whole so that necessary planning can take place and needed 

teaching facilities can be constructed.

3. On the matter of scholarships I shall be brief. The need for 

additional scholarship funds for medical and dental students is nationwide and not confined to any one region. I assume that you have 

heard or will hear testimony by the Association of American Medical 

Colleges concerning the small amounts of financial aid available to 

medical students as compared to graduate students in the sciences. 

Medicine and dentistry are seriously handicapped by this lack of 

scholarship funds in the competition for top talent. No nation concerned with the health of its people can ignore this fact. The medical 

student has to pay twice as much for his education as does a graduate 

student and at the same time on the average he can look forward to 

about one-fourth as much financial aid.

Some have argued tha t physicians should be willing to go into 

debt, even heavily in debt, for their educations because they will 

eventually be more than able to pay back their loan obligations. But 

the promise of a future high income is not very comforting to a new 

M.D. who must look forward to 4 more years of apprenticeship wages 

and the heavy expense of setting up practice afte r that.

But perhaps the most disconcerting result of our failure to provide 

enough financial aid for medical and dental students is th at people 

from the lower income groups are selected out of these professions; 

thus the schools are denied access to a valuable reservoir of talent. 

Federal scholarship funds distributed by and through the medical 

and dental schools without strings attached can do much to rectify 

this potentially dangerous situation. Let me just briefly summarize.

Our Nation, and the West in particular, is now facing a shortage 

of facilities for medical and dental education. This shortage can constitute a national health hazard. In the face of this shortage there 

is a need for Federal stimulatory grants for the planning and construction of teaching facilities and for scholarships. This bill it seems 

to me is in concert with the responsibility of the Federal Government 

to promote the general welfare of the people—in this case by assisting those institutions which are engaged or wish to engage in tra ining 

medical and dental manpower. This bill should make it possible 

for the Federal Government to meet its responsibility in this area 

without exercising undue control over medical and dental schools 

and without impairing the rights of such schools or the States in which 

they are located. The WICHE commissioners strongly urge favorable 

consideration of II.R. 4999.

Mr. Chairman, on liehalf of the Western Interstate Commission 

for Higher Education, I thank you for th is opportunity to speak.

(The statement referred to follows:)

Statement hy Robert II. Kroepsch, Executive Director, Western I nterstate

Commission for Higher Education

Mr. Chairman and members of the committee. I am Robert II. Kroepsch, 

executive dire ctor of the Western Inter sta te Commission for Higher Education. 

1 am here today under specific authorization of the 12-man executive committee 

of the commission.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 405

WICHE, which is the short title for the commission, is a public inter sta te 

compact agency of the 13 Western State s. The 39 commissioners are appointed 

by the 13 Western Governors and report directly to them. It is the task of our 

small staff in Boulder, Colo., to car ry out the basic responsibility of the commission which is to improve and increase higher educational opportu nities for 

the young people of the West through intersta te cooperation.

Since its founding in 1953, the commission has been deeply involved in finding 

solutions to the West’s increasingly critical professional manpower problems. 

Our staff has been specifically concerned with asce rtaining the hea lth mani>ower 

needs of the Western States and with planning programs for meeting these 

needs. Two studies conducted by the commission are particu larly germane to 

the ma tte r before thi s committee. One is entitle d “The West’s Medical Manpower Needs,” and the other is “Dental Manpower Requirements in the West.” 

Copies of these two studies are available for the committee’s files. The findings 

of the medical study in partic ula r have provided essential data for Western 

Sta tes seeking ways of meeting the ir medical education needs.

In view of the findings of these stud ies and on the basis of my participation 

in efforts to find educational answers to medical and dental manpower shortages 

both in New England and in the West, I believe tha t we are facin g a shortage 

of hea lth education facilitie s which will tak e on the chara cter of a national 

health hazar d unless immediate steps are taken to provide the needed facilities.

Here are some highlights from our studies of the West’s medical and dental 

manpower need s:

1. The W est has 14 percent of the Nation’s population, but its medical schools 

edu cate only 9 i>ercent of the Nation’s doctors. This means that Western States 

depend heavily on the migration of physicians from other i>arts of the country. 

Hence, westerners have a dual concern over the outcome of this hearing. Not 

only must we strive to produce our fa ir share of the Nation’s physicians, but 

until we are able to do so, we shall be heavily dependent on medical education in 

the res t of the States. We know, perhaps as well as any region, th at education 

for the hea lth professions is a national and not a strictly regional or State 

problem.

2. Eleven of the thirteen Western States are below the national average of 

physicians per 100,000 population. And these 11 States are fa r below the 

national average. Eight of the eleven do not, at present, have any medical school 

with in their borders. You can see th at th e Western region, indeed, has its work 

cut out for it in the years ahead if it is to provide enough medical education 

opportu nities for its young people.

3. The West does not have a sufficient number of places in its nine medical 

schools to educate all qualified applicants from the West. At present more than 

half of the stud ents from Western States withou t schools leave the region for 

the ir education. As enrollment pressures increase, Western studen ts will find 

it more difficult to gain admission to non-Western medical schools. Unless add itional medical school places are created in the West, many studen ts will simply 

have no place to go.

4. Reported plans for medical and dental school expansion will not be sufficient 

to meet the needs of th e West. If the Wes t continues to educate 9 percent of the 

total number of doctors, it will need about 170 additional entering places by 1975 

when the West will have 20 percent of the tota l U.S. population.

To supply 20 perce nt of the yearly tota l of the 8,700 new doctors needed for the 

Nation as recommended by the Surgeon General, would mean, in the West, immediate plans for over a thousand more first-year places—the equivalent of 

10 or 11 average-sized medical schools. So grea t an expansion can probably not 

be expected. Up to 500 more places within the next few years would be a more 

obtainable, though minimum, goal. If Federal stim ulatory funds are available, 

Ihe West will have a chance of achieving its minimum goal and may even 

aspire to tra in its proportionate sha re of the national supply of physicians and 

dentists.

To summarize, an immediate and sub stantial expansion of medical education 

and research facilities is essential if the West is to (a) maintain curre nt levels 

of medical manpower while keeping pace with its rapid population growth, (b) 

provide its qualified students with the opportunity for medical education, (c) 

provide faculty necessary to educate increased numbers of medical stud ents, 

and (d) safeguard high standa rds of medical education and research.

The problem of providing sufficient dental manpower for the West is no less 

serious than the medical situation. The WICHE study of dental manpower 

requirements in the West reported th at in order to maintain 1955 levels of
406 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

dental care the Western States must fill an annual deficit of 1,260 denta l school 

grad uate s each year between 1960 and 1975. During these years of rapid population growth the present output of dentists will be nowhere nea r adequate. 

At present, the West depends heavily upon other pa rts of the country to meet 

its dental manpower needs. But as the shortage grows more acute, the West 

will he able to depend less and less upon other Sta tes to provide dentists, and 

western students will find it increasingly difficult to gain admission to schools 

outside the West. The only way the West can hope to obtain an additional 

1,200 dentists each year is to expand existing schools and establish several new 

ones. Most of the new dental school places will be needed in Califo rnia, but 

the Northwest will need 110 more graduates annually , the Rocky Mountain 

region 111 more and the Southwest 99 more.

Financing these new dental education facilities will present the same kinds of 

problems as does the financing of new medical education fa cilities. The financial 

burden on the States will be g reat—a burden which they can probably not carry 

adequately without supplementary funds from the Federal Government.

Several of the provisions of II.R. 4999 strik e a responsive cord in the W es t:

1. This is particu larly true of the section which would provide stimulatory 

grants for the construction of medical and dental teaching facilities. Many of 

the Western States have small populations which are, nevertheless, growing 

rapidly. Several of these States also have tax problems growing out of the 

fact tliat within their borders are large Federal landholdings. Most such States 

will be hard put to it to meet the demands which will be placed upon them to 

provide undergraduate and gradua te education to say nothing of medical and 

dental education. Yet we know th at the pressure to build medical and dental 

schools is mounting.

Only 2 weeks ago four of the eight Western States without medical schools 

(Idaho, Montana, Nevada, Wyoming) sent representativ es to a WICHE-sponsored meeting to discuss ways of meeting the ir medical education needs. Pa rticipants included the official representatives of higher education, the State 

medical societies, and personal represen tatives of the fou r Governors. They 

agreed to consider all possible ways of meeting their needs including the esta blishment of a regional school to serve all four States. Copies of a report of 

thi s meeting and a roster of participan ts have been placed on file with the 

committee. But whether these States decide to go it alone or to unite in building a medical school, they will, in my opinion, need resources beyond those 

available within their own borders if they are to plan and construct the kind of 

high quality medical and dental education facilitie s necessary to maintain high 

standa rds of medical care.

2. Because of WICHE’s regional interest in higher education, we strongly 

endorse those sections of II.R. 4999 which recognize the planning functions of 

regional agencies and which provide for gra nts to such agencies for planning 

and determining the need for medical, dental and public health teaching 

facilities.

That pa rt of the bill providing for planning gra nts can be of vital importance 

in the West. I mentioned tha t 8 of our 13 States do not at present have a 

medical school within their borders. Six of the eight are only beginning to 

plan for such facilities. While I do not personally believe th at all six of these 

States will want to establish medical and denta l schools of their own, I am 

sure that they will need to be involved in planning for schools which will provide 

places for th eir qualified young people.

In those States which alread y have medical schools, the need for planning 

funds is equally urgent. For example, the Sta te of California is growing so 

rapidly in population th at its existing schools cannot possibly provide the needed 

number of medical and dental student places. Additional schools will have to 

be planned and built. And on the other side of the coin, since Califo rnia is a 

heavy impo rter of practicing physicians, it is of intere st to the people of Californ ia that fund s are available for other States in the West and in the Nation 

as a whole so th at necessary planning can take place and needed teach ing 

facilities can be constructed.

3. On the ma tter of scholarships I shall be brief. The need for additional 

scholarship funds for medical and dental studen ts is nationwide and not confined to any one region. I assume that you have heard or will hea r testimony 

by the Association of American Medical Colleges concerning the small amounts 

of financial aid available to medical stud ents as compared to gradua te students 

in the sciences. Medicine and den tistry are seriously handicapped by this lack
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 407

of sc ho la rs hi p fu nds in th e co m pe tit io n fo r top ta le nt. No nat io n co ncern ed 

w ith th e hea lt h of its peop le can igno re th is fa ct . The med ical st uden t has to 

pa y tw ice as mu ch fo r hi s ed uc at io n as do es a gra duate st udent an d a t th e same 

tim e on th e av er ag e he can look fo rw ard to ab out one -f ou rth as mu ch fina nc ial 

aid.

Som e ha ve ar gued th a t ph ys ic ia ns sh ou ld be w ill ing to go in to de bt—even 

he av ily in de bt—f or th eir ed uc at io ns be ca us e th ey will ev en tu al ly be mor e th an 

ab le to pa y ba ck t h eir loan o bligations . B ut th e pr om ise of a fu tu re high income 

is no t ve ry co m fo rtin g to a new M.D . who m ust look fo rw ard to 4 mor e yea rs 

of ap pr en tice sh ip wag es an d th e he av y ex pe ns e of se tt in g up pra ct ic e aft er 

th at .

B ut pe rh ap s th e mo st di sc on ce rtin g re su lt of ou r fa il u re to pr ov id e eno ugh 

fina nc ial a id f or med ica l an d den ta l st udents i s th a t peo ple from th e l ow er incom e 

grou ps are selecte d out of th es e pro fe ss io ns ; th us th e sch oo ls a re de nied access 

to a va lu ab le re se rv oi r of ta le nt . Fed er al sc hol ar sh ip fu nds d is tr ib ute d by and 

th ro ug h th e med ical an d den ta l scho ols w itho ut st ri ngs att ached ca n do mu ch to 

re ct ify th is j> otentially da ng er ou s si tu at io n.

SU M M ARY

Our Nation, an d th e W es t in part ic ula r, is now facing a sh ort ag e of fa ci li ti es 

fo r m ed ical a nd de nta l ed uc ation. T hi s sh or ta ge ca n co nst itute a nati onal he al th 

ha za rd . In th e fa ce of th is sh or ta ge th er e is a need fo r Fed er al st im ula to ry 

gra nts fo r th e pl an ni ng an d co ns truc tion of te ac hi ng fa ci lities an d fo r sc hola rships. T hi s bill, it seem s to me, is in con ce rt w ith th e re sp on sibi lity o f t he Fed er al 

Gov er nm en t to pr om ote th e ge ne ra l w el fa re o f th e peo ple— in th is ca se by assis ting thos e in sti tu ti ons wh ich a re en ga ge d or wi sh to en gage in tr ain in g medica l 

an d de nt al man jio wer. Thi s bill sh ou ld mak e it po ssible fo r th e Fed er al Gov ernmen t to m ee t it s re sp on sibi lity in th is are a w ithou t ex er cising un du e co ntro l 

ov er m ed ical an d de nt al sch oo ls an d w ithout imiMiiring th e ri ghts of su ch sch oo ls 

or th e S ta te s in wh ich they are loca ted. T he W IC H E co mmission ers st ro ng ly 

ur ge fav or ab le co ns id er at io n of II .It. 4999.

Mr. C ha irm an , on be ha lf of th e co mmiss ion, I th an k you fo r th is op po rtunity 

to speak.

W IC H E Com mi ssione rs ( as of Decem ber 19(51)

A la sk a;

I)r. Th eo J. N orb y, Al aska c om m ission er o f ed uc ation.

Dr . W illiam It. Woo d, pr es id en t, U ni ver si ty o f A las ka .

A ri zona:

D er m on t W. Me lick,1

 M.D., Ph oe nix.

A le xa nd er A. Raisin, Ph oe nix.

Dr . R ic ha rd A. Il arv il l, p re si de nt , U niv er si ty of Ariz on a.

C a li fo rn ia :

Dr . F ost er H al l Sh erwoo d, 1

 vice ch an ce llo r. U ni ve rs ity of C al if orn ia a t Los 

An geles.

Dr. Roy Sim pso n. S ta te su peri nte ndent of p ub lic in st ru ct io n.

Dr . W. B al le ntine H enley , pr es id en t, C al if orn ia Colle ge o f Me dic ine .

C olo ra do:

Dr . W ill iam E . M orga n, 1

 pre si de nt , Co lorado S ta te U ni ve rs ity .

Qn igg New ton , p re side nt , U niv er si ty of Co lor ado.

W alt er W. Jo hn so n, Pueblo .

H a w a ii :

Dr . W illa rd W ils on ,1

 p rovo st. U ni ve rs ity o f H aw ai i.

Tho m as Itich er t. M.D.. Ho nolulu.

Jo hn J . U eliara , Hon olu lu.

Id a h o :

Alfr ed M. Po pm a. 1

 M.D., B oise .

Dr. D. It. Th eo ph ilu s, pr es id en t, U ni ver si ty of Id ah o.

Dr. Don ald E . W alke r, pr es id en t, Id ah o S ta te College.

M onta na:

Dr . Go rdo n B. Cas tle .1

 M on tana S ta te U ni ve rs ity .

F ra nk L. McP ha il, M.D., G re at Fal ls.

Pau l W orking , Living sto n.

1

 Member, executive committee.
408 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Nevada:

Fred M. Anderson,1 M.D., Reno.

Dr. Charles J. Armstrong, president, University of Nevada.

Dr. John Morrison, University of Nevada.

New Mexico:

Dr. Tom L. Popejoy, 1 president, University of New Mexico.

Dr. Roger B. Corbett, president, New Mexico Sta te University.

Dr. Donald C. Moyer, preside nt, Eastern New Mexico University.

Ore gon :

Frank J. Van Dyke,1 Medford.

Mrs. Thomas Scales, Sandy.

Utah:

Dr. Milton R. Merrill,1 vice president, U tah Sta te University.

Dr. Lorin F. Wheelwright, Salt Lake City.

Dr. Arthur D. Browne, director, Coordinating Council of Higher Education. 

Wa shington:

Dr. C. Clement French,1 president, Washington Sta te University.

Dr. Charles E. Odegaard, president, University of W ashington.

Hon. Gordon Sandison, Sta te senator, P ort Angeles.

Wyoming:

Dr. George D. Humphrey, 1 president, University of Wyoming.

Lloyd R. Evans, M.D., Laramie.

Charles II. Welsh. D.D.S., Cheyenne.

1

 Member, executive committee.

The Chairman. Doctor, your complete statement will be included in 

the record. The information referred to will be received for the files 

as it was with the “Health Care for California,” which is a report of 

the Governors committee on medical aid and health presented by Dr. 

Warren.

Any questions?

Mr. Younger. Just one. Doctor, in “The West Medical Manpowers 

Needs” on page 85 you see this ratio of physicians in private practice 

which has been steadily declining since 1931. If we are going to 

graduate more doctors and more of them are going into other services 

other than private practice, how are we going to get more doctors to 

satisfy the needs of our people out in the country ?

Dr. Kroepsch. Tha t is a very good question which I have not heard 

satisfactorily answered by anyone to date. My own feeling is that the 

reduction in the number of general practitioners does not necessarily 

mean less medical care for people who lives in nonurban areas. It may 

mean that their town or country may not lie immediately covered by 

a general practitioner, but in terms of transportation, communication, 

and other facilities at the present time, I think we are increasingly giving better medical service to people, even those who live in remote 

rural areas.

Mr. Younger. We are talking all the time, Doctor, about 1975; if 

we are to keep the same ratio of practicing physicians that we now 

have per 100,000 population, we need more doctors. If the number of 

doctors tha t we graduate is going to be less in proportion each year 

as to the practicing physicians or full-time specialists, you are not 

going to reach that goal.

Dr. Kroepsch. This is p art of the problem. We may have some 

problem in semantics here. I suspect tha t when we are talking about 

the need for more doctors we are talking about both general practitioners and specialists and not using the word “doctor” simply as 

being synonymous with general practitioner. At least that is my understanding.

Mr. Younger. That is all, Mr. Chairman.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 409

The Chairma n. Th an k you very much , Dr. Kroep sch.

Dr. Kroepsch. Th an k you.

The Chairm an. Dr. Abe Ru bin ?

STATEMENT OF DR. ABE RUBIN, SECRET ARY AND EDITOR OF TH E 

AMERICAN PODIATRY ASSOCIATIO N; ACCOMPANIED BY LLOYD 

E. BLAUCH. PH . D., CONSULTANT TO TH E APA COUNCIL ON 

EDUCATION

Dr. Rub in. I am Abe Rubin , doctor of p od iatry and secre tar y and 

edito r of t he Am eric an Po diatry Association.

W ith me is Llo yd E. Bla uch , Ph . D., form er U.S. As sis tan t Com ­

missioner fo r Highe r Educa tion , who serves as consu ltant to ou r cou ncil on edu cation.

May I ask perm ission th at my whole docu ment be inserted in the 

record and I will tr y to give some hi gh lig hts and am plify some of it 

so tha t there m ay be some tim e fo r q uestioning if yo u so desire.

The Chairman. Yo ur sta tem ent may be inclu ded in the record, 

Doctor, togethe r w ith the referenc es ther eto .

(P re pa re d statem ent of Dr. A be R ubin follo ws :)

Sta te m en t by I) r. Abe Rubi n, Secretary and Editor, American Podiatry

Association

Mr. ( hairman and members of the committee, I am Abe Rubin, a doctor of 

Itoditary and secretary and edito r of the American Podiatry Association. With 

me is Lloyd E. Blauch, Ph. D., formerly U.S. A ssistant Commissioner for Higher 

Education, who serves as consultant to our council on education.

The American Pod iatry Association is a voluntary, nonprofit federation of 52 

component societies, one in each State, the District of Columbia, and the Commonwealth of Puerto Rico. Our membership comprises 68 percent of the 7,(500 

practicing podiatrists. This August wre will celebrate our 50th yea r of service to the profession and the public.

We support the general inte nt and purposes of II.R. 4999 (and similar legislati on). However, we believe it should be modified to provide comparable a ssistance for all the professions serving our people’s health needs, and esiieciall.v 

foot health needs. We hope our presenta tion will persuade you tha t, in the 

best public inte rest, grants for construction of podiatric teaching facilitie s and 

scholarship gra nts to podia try schools should be part of the present legislation.

Since we devote our services exclusively to the foot, we recognize that we 

have a major obligation to society to insure th at ther e shall be an adequate supply 

of well-trained professional people caring for the Nation’s foot health problems. Accordingly, in August 1960, our house of delegates authorized the e stablishment of the special commission on the sta tus of podiatry educatio n “to 

examine, from a broad point of view, the profession's education al program 

and advise on steps necessary to improve this program.'’

William K. Selden, LL.D.. executive secretary of the National Commission on 

Accrediting, agreed to cha ir the commission and select the oth er members. 

Their repo rt "Po diatry Education in the 1960’s, Status and Opportunities” has 

been received recently. Copies of this repo rt have been provided the members 

of your committee. Our leadership has. with a very large gulp, accepted the 

challenges laid down in the commission’s 26 recommendations, 11 of which contain 48 related parts. A perusal of the report will establish that p odiatry schools 

face problems para llel to those reported for medical and denial schools by 

Secretary Ribicoff ear lier this week.

At this point I should like to quote one of the commission's recommendations:

“10. It is recommended that attention be focused on the stra ined financial 

conditions of the colleges of podiatry and that the following measures be adopted 

imm edia tely:

“ (o) That the American Pod iatry Association represent to the app rop riate 

legislative and executive officials of the [Feder al] Government the need and 

social advisability of making financial provisions for podiatry education 

in ways similar to those made for the other health services.

800 14— 62------ 27
410 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Wliat a re we podiatrists doing to help meet our schools’ needs? For one thing, 

we are here today. Some measures a re :

(a) We have organized a fund for the advancement of podiatry education. 

This has stimulated the giving of $106,000 by our members in its first 2 years 

of operation.

(ft) We have increased our dues structure to provide $10,000 annually to 

each of our schools, in the form of equal matching grants for full-time teaching 

and resea rch salaries.

(c) One alumni association raised $35,000 in 1 year and has pledged to raise 

at leas t $20,000 annually for the teaching and research salaries.

(d) Another alumni group obtain ed $250,000 from its members to construct 

a small teaching hospital in conjunction with its school. It is now in operation 

and they are forging ahead on their second quarter million for a new teaching 

and research laboratory facility.

(e) The American Pod iatr y Association, by providing m aterials and guidance 

to our component societies, has stimulate d a grea tly increased awareness, 

interest, and effort in student recruitm ent and selection programs. However, 

the high cost to the student for the 4 years of professional schooling following 

2 years of bacc alau reate work is the same depressing factor it is in medicine, 

dentistry, and osteopathy.

We have touched on our schools’ needs, hut it is there a public need for foot 

health service? A 1951 Public Health Service repo rt,1

 “Physical Status of Men 

Examined Through Selective Services in World War II,” disclosed that twice 

as many registr ants were rejected for foot problems (1.4 percent) as were for 

denta l problems (0.7 percent). In all examined reg istran ts 90.1 per 1,000 had 

foot defects and 11(5.1 per 1,000 had dental defects.

These numbers pale when compared with the incidence of fo o t problems in 

the rapidly expanding older population. Appendixed to this state ment are five 

abstracts from publications and reports of the 1901 White House Conference 

on Aging. One short quote seems to he in orde r her e: "The institutionalized 

or home-care patie nt, once moving about with pain-free feet, is more easily 

motivated for total rehabilitation. Eighty-five perc ent of these older people 

have foot problems.” (Dr. E. L. T arara, 2 * pod iatrist at Mayo Clinic, in a study 

made in preparation for the White House Conference, repo rted that in a survey 

of 182,491 patients trea ted in the offices of 228 podiatrists, 27.67 itercent were 

65 or over (9 percent of the U.S. population is 65 or over). A few podiatrists 

had as high as 65 percent of the ir patients in this age bracket.

In a hearing before this committee this past May 3, 1961, on H.R. 4998, Dr. 

Huntington Williams, city of Baltimore health commissioner and president, 

U.S. Conference of City Health Officers, sa id : “I would like to point out in a 

different, direction the need for more adequate facilitie s to provide health and 

medical care to elderly persons in vital items that are often overlooked in 

current programs. I will mention thr ee: eyesight, hearing, and care of the 

feet in the elderly.”

The question might be raised, isn’t foot health care and service provided 

by the medical profession? The American Medical Association says no. In 

a repo rt of its judicial council,* published in April 1939, it says that this field 

“too often is neglected. General opinion seems to be that podiatry fairly well 

satisfies a gap in medical care that the [medical] profession has failed to fill.” 

Samuel L. Andelman, M.D., M.P.H.4

, commissioner of health. Chicago Board 

of Hea lth, says podiatry is “not just filling a gap: actually it is a vacuum.”

Pod iatry extends, complements, and supplements the phys ician ’s service. Because we are licensed to tre at independently, we free him for other service. 

Also it h as been our experience that early evidence of many systemic and chronic 

diseases first manifest themselves in the foot. One of our schools is presently 

cooperatin g with the Chronic Disease Section of the Public Health Service to

1

 Goldstein. Marcus 8., “Physical St at us of Men Examined Throu gh Selective Service in 

World W ar II’’; re pr in t No. 3080, Pub lic Health News, vol. 66, No. 19, Mav 11. 1951, 

pp. 587-609 .

2

 T arar a, E. L.. “P od ia try ’s Role in the Care of the Aged.” Jo ur na l of the American 

Po di atry Association, vol. 50. No. 12, December 1960, pp. 972-974 .

* R epo rt of the Judicia l Council, Journa l of the American Medical Association, Apr. 8, 

1939, p. 1,384 (abs tra cted and an no tated in Journa l of the American Medical Association, 

special edition , June 7, 1958).

4

 Andelman. S. L.. “Public He alth and the Aged,” Jo ur na l of the American Po diatr y 

Association, vol. 50, No. 12. Decem ber 1960, pp. 967-969.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 4 1 1

determine the incidence of c ertain previously undiagnosed systemic and chronic 

diseases present in patients complaining only of foot problems.

Another significant factor was pointed out by Walter C. Alvarez, M.D.,* in an 

editorial in the May 1961 issue of “Geriatrics.” He was commenting on the importance of i»odiatry service to the older patient and related how the podiatry 

service in a home for the aged kept jiatients ambulatory who might otherwise 

be bedridden. “And this is important,’’ he writes, “because in 1950 the cost of 

a bedridden patient was $4.03 a day while th at of an ambulatory patient was 

only $1.78 a day.”

Ear ly in 1960 we desired to obtain some quantita tive data,’ about our services. 

A survey question naire w as designed and the replies were collected and tabulated 

by an IBM subsidiary. Three thousand two hundred and ninety-six (40.19 percent) replies were received. Among others we le arned the following facts about 

podia tr is ts :

Percent

Perform some institu tional service_________________________________ 64. 6

Serve in nursing homes___________________________________________ 31. 2

Serve homes for the aged_________ ______________________________ 28. 8

Serve on a hospital surgical service_________________________________ 19. 8

Serve on other hospital service____________________________________ 19. 0

Serve some governmental ins titu tion_______________________________ 9. 3

Obviously, many of our respondents serve more than one institution. From 

the same survey we learned tha t, although the average number of office visits 

per week was 63.27 and that in 1959 th e respondents trea ted an average of 739.63 

different patients one or more times, the entire profession could only serve 6 

million of our p atien ts.

At present there is 1 pod iatrist for every 23,900 i>ersons, a completely inadeq uate number. Until 10 years ago, the growth of the podiatry population 

was running ahead of the general population growth. The past 10 years it has 

been sta tic, and without the imjietus that could be given by the legislation under 

consideration, the ratio will worsen.

In recent yea rs in our five schools (all accredited, private, nonprofit ins titutions) fimds that had been se t aside to provide for development, expansion, and 

rehabilitation of existing facilities have been called on to simply maintain 

stan dards. Financial assistance is needed to p revent dete riora tion. Our schools 

report that by 1965 they will require $4,787,349 for improvement and reh abilita ­

tion of physical facilities. A sixth school is in the planning stage. It is in 

association with a large metropolitan hospital and presently offers internship, 

residencies, some gradua te training, and refresher courses. It anticip ates expanding to include the 4-year professional curriculum of 4,400 hours as soon as 

financial arra nge ments can be assu red. An amount equivalent to 1 jiercent of 

that being considered for scholarship grants would provide each pod iatry school 

the same arra nge ments promised for medical, dental, and osteopathic schools. 

In fact, an amount equivalent to the 1 percent of the construction gra nts is also 

suggested for podiatry schools.

The U.S. Civil Service Commission brochures on the Federal Government-wide 

health insuranc e plans include the podia tris t with the medical doctor, doctor 

of osteopathy, and dentist in the definition of physician because all four, and 

only these four, health professions are licensed to tre at our people by medical 

and surgical and other means. We subm it th at H R. 4999 should also recognize this distinction. H.R. 4999 provides supp ort to educational institutions 

providing training facilities for practit ioners for all parts of the human body 

except the foot. The foot is deserving of the same good health care accorded 

the other pa rts of our anatomy.

I should like to present one other item for your consideration. The problem 

of the continuously and rapidly increasin g body of knowledge in the health 

sciences cannot be solved by adding additional yea rs of training to the alre ady 

lengthy training required for medical specialization. Some medical schools 

are now experimen ting on shortened programs f or exceptional students. Dentis-

• Alvarez, Walter C., “The Value of Foot Care to the Aged” (an editorial) , “Geriatrics,” vol. 16. May 1961.

• Reprint, “Some Quantitativ e Information About Podlatrv-Chlropodv.” a repo rt of the 

statistical survey. Council on Professional Information. Stat istical Survey Committee, 

Egerter, B.C., Jou rnal of the American P odiatry Association, vol. 50, No. 10, October 1960, pp. 824-829.
412 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

try has and podiatry is demonstrating that com petent qualified practitio ners can 

be trained for service in limited fields hy complete specialized separate programs. This should be encouraged as it may be possible to do likewise in other 

areas.

We respectfully suggest that your committee will now wish to modify II.It. 

4999 to provide for podiatry institu tions, sim ilar and proportionate support 

being considered for medical, dental, and osteopathic schools. In this way, 

much more of the public need for more and better foot hea lth can he met.

This stateme nt could have been filed for the record, but we have learned tha t 

we have failed to expose ourselves sufficiently and, as a consequence, too few 

people are fam iliar with podiatry and its service. It is especially important 

that we provide you gentlemen who must make decisions with adequate info rmation. We are, therefore, appearing before you to provide you this occasion to 

question us.

Thank you for the opportunity to come before you and present this information.

White House Conference on Aging, J anuary 9-12, 1961

ABSTRACTS FROM CONFERENC E PU BL ICAT IO NS AN D REPO STS

“Foot care.—Older people must he able to move about * * *. There is no 

question tha t the feet are a dang er point for the aged. To neglect or mistreat 

them can result in serious setbacks * * *. Hospitals, nursing homes, etc., 

have found that prophylactic foot care for their aged patients helps to contribute to the well-being of the whole person. Podiatry has known and shown 

that many patients, with precisely made and fitted footgear and appliances 

and devices to redistribute weight stresses, will seem to have feet that are 

almost new. Our geriatr ic patient, once moving about with pain-free feet, 

is more easily motivated for total rehabilitation ” (from ‘’Background Paper 

on Health and Medical Care,” prepared under direc tion of Planning Committee, Health and Medical Care, April 1960, pp. 48-49).

An example of many State r ep or ts:

‘‘No. 34. It is recommended that nursing homes and geriatric clinics be made 

aware of the availability of qualified podiatry services in all major cities in 

Georgia; that podiatry representatives l»e included with dentistry, medicine, 

hospital and nursing home administration, and public health representatives in 

planning for the total health of the older citizens” (from “Report of Recommendations for Georgia,” prep ared by the Governor’s Commission on Aging; 

August 1960, Atlanta, G a.).

“The institutionalized or home care patient, once moving about with painfree feet is more easily motivated for total rehabilitation. * * * 85 percent 

of older people have foot problems * * *. Since the doctor of podiatry (chiropody) is the only person devoting his professional services solely to the foot 

and although he does devote considerable professional time to older jteople, 

it is necessary for him to devote more time and rec ruit fellow pod iatrists to 

such service * * *. He should engage in research * * *. Develop improved 

and more economical footwear and more specific pharmaceuticals for the 

foot • * *. He should develop educational foot, care programs for the older 

person” (from “Role and Tra ining of Professional Personnel,” group VI, sec. 

19; B. Health Services, Podia try).

“* * * 4. Scope and methods of partic ipation: At the national level our committee on aging is stimulating, guiding, and assisting State and local committees. 

The American Pod iatry Association is providing consultation in the development of the White House Conference on Aging program through the consultant 

in podiatry. At the Sta te and local levels committees and individuals are pa rticipating in State and city conferences on aging and public education programs 

lor senior citizen groups” (from “Handbook of National Organizations.” Department of Health, Education, and Welfare).

“* * * While no blueprin t can be offered at this stag e of deliberation, the 

need for diagnostic facilities , day care centers, mental hygiene outpatient and 

home services, halfw ay houses, regional rehabilitation cente rs as well as new 

self-care and other services in hosp itals has been stressed. Within these s tru ctures as well as in independent practice the resources of the dental, optometric. 

and iMxliatric professions should be afforded the elderly” (from “Recommendations—Governor’s Conference on Aging,” Sta te of California ).
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 413

Dr. Rub in. In an effort to learn som eth ing abou t ou r own educa ­

tional prog ram , its pa rti cu lar defects and wha t we should do abo ut 

it we insti tuted, in the last year, a stu dy and obtained some outsid e 

people to determ ine for us what we should do. Out of this came a 

docume nt called “P od iatry Ed ucati on in the 1060's, St atus and 

Op po rtu nitie s.”

Dr. Blauch was asked to be a member of th at comm ission. Sufficient copies o f this have been pro vided fo r members of the comm ittee. 

If you do not con sider it too voluminous you may wish to include it in 

the record as well.

I th ink the point we would like to make first of all is before we can 

come to you to ask for support we should determ ine fo r ourselves 

what we have done. On page 2 we have listed some of the things we 

have done in the p as t few y ears.

One th in g I would like to mentio n is th at our mem bers throug h 

th ei r dues, $10 each yea r, are now co ntrib uting towa rd the support 

of our school.

I men tion also—No. 4—one alumn i gr ou p has rais ed $250,000, and 

is now wo rki ng on a second qu arter million dollars. Th is gro up is 

in Ca lifornia .

We have considered so f ar our school needs and what we h ave done 

up to this mom ent, but I think an im po rta nt question is, is the re a real 

need fo r the foot health service th at we perfo rm ? Does the pub lic 

require th at service?

I would like to men tion that a Publi c He alth Service rep ort pu blished in 1951 disclosed that of all the registr an ts who were rejected 

in the W orld W ar II , twice as man y were rejec ted for foot problem s, 

1.4 percen t, as were rejected for denta l prob lems, 0.7 percen t.

Th ere is some othe r inform ation alo ng t he same line demo nstra tin g 

th at need.

The second question is: Is our service a dupli cate of some that is 

being performed by o the r people and isn't foot hea lth care a nd service 

pro vided by the medical profession?

Th e Am eric an Medical Asso ciation says “No.” In a rep ort of its 

Ju dicial Council publis hed in Ap ril 1939, it says tha t this field, ou r 

field—

Too often is neglected. General opinion seems to be that podiatry fairly well 

satisfies a gap in medical care tha t the (medical) profession has faile d to fill.

We also would like to point out that on page 4 are some figures about 

how our mem bers pa rti cipa te in ins titution al service. Fu lly oneth ir d o f ou r prac tic ing po diatr ists, one ou t o f every three po diatr ists, 

serve some nu rsing home or home fo r the a ged.

Alm ost 10 percent serve in some governmental institut ion at the 

St ate or F edera l level. Almost every men tal ins titu tion has a po diatr is t on its staff.

Now, to do all the t hin gs that shou ld be done, we certainl y do n't have 

enough po diatris ts and we are going to have to do som eth ing about 

ge tti ng more of them.

Ou r schools now need alm ost $5 million just for reh ab ilitat ion to 

keep up th eir phy sical pla nts . Th ey have fallen way down in the 

las t few years. In fact, they have had to lim it their—I sho uld not 

say they have l imited but ra th er the nu mb er of spaces th ey can ac tua lly
414 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

fill is less tha n 10 yea rs ago, alth ough these are not completely filled 

at this time anyway.

There is one oth er point we should like to make. We believe th at 

the p od iat ry school should be inclu ded in this pro vision f or one m ajo r 

reason. The po diatr ist, the M.D., D.O., and dentist are the o nly four 

gro ups licensed to tre at ou r people by medical, surgic al, and oth er 

means.

We think this, th at by being licensed in every one of the State s of 

the Un ite d State s to trea t by medical and surg ical means, di stin ­

guishes us from othe r groups. You will note th at I)r . Do rm an of 

the AMA Board of Tru stees, when the question was asked about 

optom etry, included podia try .

We respec tfully suggest that your com mittee will wish to mod ify 

II.R . 4999 to pro vide for our po dia try schools and studen ts in the 

same manne r that you may provide f or other institu tions.

At this time, I would like to answ er any questions you might have 

in reg ard to this , sir.

The Chairm an. Th an k you, Doctor. You say you have five schools 

of pod iatry.

Dr. Rubin. Th at is corr ect. There are five schools and one is in 

the process of building. It presently presents only gradua te stu dy in 

Philadelph ia.

The Chairman. Will you name those five?

Dr. R ubin. Lew is School in New York, Ohio School in Clev elan d, 

Illino is College in Chicago , and the Chicag o College in Chicago , the 

Califo rnia College in San Francis co, and the new college in Phi la ­

delp hia.

The Chairman. I believe you said the re were 7,600 practic ing 

podia tris ts.

Dr. Rubin. Tha t is correct. Of 8,100 po diatris ts aro und 7,600 are 

in actual practice.

The Chairma n. Ilow many stu dents do these five schools accommod ate ?

Dr. Rubin. Th ey can accommodate aro und 1,250. The y are ap ­

pro xim ately 60 percent of capacity.

The Chairma n. Th ey can accom modate 1,250?

Dr. Rub in. Th at is c orre ct.

The Chair man. They are about 60 perc ent of cap acity?

Dr. Ri bin . Th at is co rrect, sir.

The Chairman. Th en you are ge tti ng only about 750 studen ts in 

each class each year?

Dr. Ri bin . You mean all told ?

The C hair man. Well, if your state me nt is correct.

Dr. Rubin. Twelve hu nd red and fifty . Th is is all classes, this is 

not the entrance class.

The C hairman. How m any do you hav e enterin g each year?

Dr. Rubin. I have the figures fo r the last few yea rs here, sir. In 

all schools combined this fall there were 147. Th e y ear previous, 127.

The Chairman. How many could you accom modate if you had 

appli cants ?

Dr . R ubi n. About 220, sir.

The C hair man. T wo hu ndred and tw ent y?

Dr. Rubin. Yes, sir.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 4 1 5

The Chairman. Then, Doctor, there is no shortage in facilities for 

the applicants that are available ?

Dr. Rubin. We anticipate there will be in 3 years. We have learned 

that we have not done sufficient student recruiting and people generally have not really l>een aware of the existence of our schools and 

of our service.

One of our schools did fill its incoming class this year. We had 

a rise of about 15 percent in enrollment this past year.

The C hairman. Mr. Younger?

Mr. Younger. I have one question. Are these schools which you 

refer to, the five, operated for private gain or are they nonprofit?

Dr. Rubin. They are all nonprofit private schools. They are listed 

by the Office of Education of the Federal Government in their Directory of Institutions of Higher Education.

Mr. Younger. Those are the only schools that confer a degree of 

podiatry ?

Dr. Rubin. Yes, sir: that iscorrect.

The Chairman. Doctor, thank you very much. We are glad to 

have your test imony in behalf of your profession.

I)r. Blanch, we are glad to have had you here with him.

Dr. James Howard Means.

STATEMENT OF DR. JAM ES HOWARD MEANS. BOSTON, MASS.

Dr. Means. Mr. Chairman, members of the committee, I am a 

physician, now retired, and have spent 40 years of my professional 

life in full-time teaching and research in clinical medicine.

It seems to be the increasing number of the likes of me that is 

part of our problem.

I am a member of Group Health Association of America, which 

organization has asked me to represent it before this committee in 

supjiort of the bill H.R. 4999. A resolution in support of TI.R. 4999 

was unanimously adopted at our annual meeting last May and was 

transmited to the committee in June. I would like to supply this 

resolution for the record.

The Chairman. Without objection, the resolution will appear in 

the record at this point.

(The resolution submitted by Dr. Means follows:)

Group H eal th Asso ciatio n of America, I nc.

RESOL UTION NO. 3

Whereas to make the benefits of modern medicine available to all Americans 

requires, in addition to better arrang ements in the financing of health care, a 

substantial incre ase in the number of professional health personnel, and a significant expansion of community health facilities and services: and

Whereas Fed era l action is urge ntly requ ired to bring about these critically 

needed improvements, since:

1. Existing sources of financial support cannot meet the costs of a construction, 

expansion, and scholarship program adequate to the Nation's need for more physicians and other health perso nnel; and

2. Local communities need Federal financial aid to develop b etter services for 

the aged and chronically ill, such as organized home care, anti other services not 

now widely ava ilab le; and

3. The improvement of the abysmal sta te of currently available nursing home 

care requires an Increase in the fu nds available through the Hill-Burton program 

for the construction of high quality nonprofit nursing homes; and
4 1 G TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

4. The combination of comprehensive prepayment with the group practice of 

medicine holds grea t promise for making high quality care more readily available. but the difficulty of financing needed facilities has been a major obstacle 

in the furth er development and expansion of such plans; and

.Whereas legislation has been introduced in the Congress of the United States 

to provide for effective F ederal action toward these e nd s: Th erefore be it

Resolved, Th at the Group Health Association of America convey to the members of the Senate Committee on I-Jibor and Public Welfare, and the House Committee on Inter sta te and Foreign Commerce, and other members of Congress the 

unanimous belief of its members and affiliates t ha t favorable action is urgently 

requ ired this year on the following thre e legislative proposals:

1. S. 1072 and H.It. 4909, Health Professions Educatio nal Assistance Act. to 

provide grants to medical and dental schools for construction, expansion, cost of 

education and for scholarships to gifted students in health professions who are 

in need of Federal assis tan ce; ami

2. S. 1071 and ll.It. 4998, the Community Health Services and Facilities Act, 

to provide funds for the co nstru ction of nursing hom es; g ran ts to State and local 

governments, and voluntary agencies and institution s to stim ulate the development, improvement, and expansion of health services, particularly for the aged 

and chronically il l; and to provide funds for research and demonstration in the 

utilization ami provision of hospital services; and

5. 1158 and ILK. 5887, the Health Services F acilitie s Act, to provide long-term, 

low-interest loans to comprehensive medical care plans for financing of necessary 

facilities.

Unanimously adopted at the annual meeting of Group Health Association of 

America in Portland, Oreg., on May 10, 1901.

Gr ou p Health Asso ciation of America is a vo lunta ry, nonprofit organiz ation rep res enting the h ealth in terests of approxim ate ly 5 million 

ind ivi duals throug ho ut the Un ite d State s who are members and ad ­

minist rators of labor-manag ement, labor, coop erative , and c omm unity 

sponsored medical care pro gra ms.

Gr oup Health Association of America believes in the development 

of nonprofit com preh ensive prepaid dire ct services medical care program s with pa rti cu lar emp hasis on provision of the services bv a 

balanc ed team of fam ily phy sicians, specialists, and tech nical per son ­

nel op erating in group practic e medical centers. I t is motivated by 

the un de rst an ding th at only b y inc orpo rat ing th e above mechanism in 

a he alth program will people obtain modern, scientific, preventive , 

dia gno stic , the rap eutic medical services o f s ustain ed h igh quali ty and 

integ rat ed in a most efficient manner.

e stre ss pa rti cu larly the role o f the c onsume r and advocate co ntrol 

of policy and admi nis tra tiv e functio ns of medical care pro gra ms by 

or m the inte rest of consumers of health services, ju st as professional 

pra ctice and sta nd ards should be con trol led by qualified professiona l 

personnel.

It is in behalf of consum ers of health services—our subscribers and 

the gen eral pub lic—that Gr oup He alth Ass ocia tion of America 

stron gly support s 11.K. 4999. The financial pl ight o f t he medical and 

denta l schools and the gro wing com petition of othe r scientific and 

tech nica l fields for stud ents is well known to this committee. It is the 

imp act of these tre nd s on the consumers’ ab ility to secure hea lth care 

th at I wish to emphasize.

Gr ou p He alt h Associatio n of Am erica in its own work of r ecruiting 

phy sician s for medical prac tice gro ups has become keenly awa re of 

the g row ing sh ortage o f doctors. It believes th at th is situ ation can be 

effectively corrected only by an increased rat e of pro ductio n of doctors o f medicine in the N ation.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONN EL 417

This, in turn, requires greatly expanded educational facilities and 

support of education itself through scholarship aid of the sort which 

II.R. 4999 would make possible.

The need for more doctors has been spelled out and documented 

thoroughly by the Secretary of Health, Education, ami Welfare in 

his statement to this committee on Tuesday last. Group Health Association of America is in close agreement with the Secretary’s statement, as needless to say am I, as an individual. Otherwise I would 

not be here.

I am grateful both for Group Health Association of America and 

myself for the opportunity to be heard by this committee on this bill.

Mr. Chairman, if I could take one minute 1 would like to comment 

on a remark that the Honorable Mr. Younger made a little while ago. 

I was speaking of the fact that the number of physicians, the number 

of doctors not in private practice, was increasing and you also asked 

the question how are we going to get doctors for rural areas. Is that 

correct, that you asked that question i

M r. Younger. That was part of my question.

I)r. Means. I would like, in that connection, to say that I think 

what we need to practice in this country, and I have thought this for 

a long time, is better organization to provide medical care.

We hear a great deal about organized medicine but organized medicine is organized to protect the interests of the doctor. I would like to 

see more organization to provide good medical care for the l>enefit of 

patients. I think the best way to do that is by association of doctors 

in groups with the proper sprinkling of general practitioners and 

specialists.

I think that if we had more of that we could make the medical manpower go fu rther because they would all be operating in a more efficient way so that one way of helping the medical manpower is to 

increase the efficiency of how medical care is provided. I think this is 

very important and is not stressed very much actually.

Mr. Younger. Doctor, let me intervene. The statistics I am quoting 

from, gave those doctors not in private practice in the following category: Retired—which is your category—Federal Government, teaching, research, hospital service.

Now all the other doctors are considered to be in either full-time 

specialty or general practice. It does not give a category there for 

those tha t are in Group Health.

Dr. Means. No, but they are in practice. They are in practice in 

partnership.

Mr. Younger. Yet the total number of doctors in full-time specialty 

and general practice has been decreasing every year.

Dr. Means. I know, sir. The point I am trying to make is that 

these doctors would lx* more efficient and take care of more patients if 

they practiced in groups and had a little teamwork rath er than solo 

practice.

Mr. Younger. That is your opinion in advocacy of the Group 

Health program and that is all right but that does not have anything 

to do with this program here other than to say that if all the doctors 

would go into the Group Health program we would not need as many 

doctors.

I)r. Means. That is right.
418 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Mr. Younger. That is all.

The C hairman. Th an k you, Dr. Means.

Dr. Means. Th ank you v ery m uch.

The Chairman. Dr. C harles W. B liven.

STATEMEN T OF DR. CHARLES W. BLIVEN . AMERICAN ASSOCIATION 

OF COLLEGES OF PH ARM ACY

Dr. Bliven. Th ank you, Mr. Chairma n fo r the privilege of ap ­

pearing befo re you.

My name is Char les B liven. I am execu tive secr etary o f the Am erican Asso ciation of Colleges of Pharm acy . Our assoc iatio n rep resents 77 schools and colleges of pha rma cy and 75 of these are located 

in 44 State s and the District of Colu mbia and all are nat ion ally 

accredited.

1 appear before you in behalf of thi s legislation and I ask that as 

the committee gives con sideration to this or sim ila r legisla tion , that 

it is our sincere desire to have the schools and colleges of pharm acy 

included because throug h such added assistance the pha rmace utical 

segment of the hea lth profession will be ab le to maintain and improve 

our professional service in th e yea is ahead.

1 invite your attenti on to S. 1072, a bill which is identical to the 

hill und er con sideration , to which Senator Hu mp hrey has introd uce d 

amen dments. These ame ndm ents would make ou r schools and colleges of pha rmacy elig ible fo r financial aid as is prop osed for the 

schools of medicine, den tis try , an d schools of public he alth.

The American Asso ciation of Colleges of P ha rm ac y s upported these 

amendm ents in th e last session.

To aid in deter mi nin g the existent and of fu ture needs of the profession, the pub lic Hea lth Service with the coo peratio n of some 16 

pharma ceutica l organiz ati ons is working tow ard a professiona l manpower stud y. It is asked th at the needs of schools and colleges of 

pharm acy be inc orp ora ted in to this legisla tion .

I am going to pick out par ts of th is in the inte rest o f time.

Wh ile many of ou r schools have good physical fac ilities and equip ­

ment, others must seek fund s from outside sources to provide these 

essentials. We realize tha t qu an tity as exe mplified bv sq uare feet an d 

the num ber of stu dents is not in itse lf sufficient to meet our pub lic 

health resp onsibilities . Qu ality of stu dents and staff are equally essential to the edu cation of tom orrow's pharm aci sts. All of these 

needs have high pr iorit y in the t hink ing and pl an ning of our college 

adminis trators.

There is an inc rea sin g need for financial aid to students in order 

th at pha rmacy can con tinue to sup ply the esse ntia l num ber of wellqualified g rad uat es.

W ith respect to this legislation which wou ld exp and and extend 

research fac ility gran ts, it is ou r specific request th at this legislation 

lie amended for the inclusion of pharm acy by nam e as we wish to be 

inclu ded by name in the definitio n of science rel ate d to hea lth which 

is given in Title Y I I : Hea lth Rese arch Fa cil ities, section 702 (4).

To thi s end I have att ached amend ments which would achieve thi s 

objective. I might add that our schools are now elig ible for research
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONN EL 419

facility giants and are eligible and receiving research gran ts under 

the Nil 1 program.

1 think onr needs in the decade ahead lie in the area of modernization and rehabilitation of existing facilities, not necessarily in the 

origin of new schools. I feel, too, that one of onr great needs is in 

the area of scholarships, to increase the number of well-qualified applicants to onr schools of pharmacy.

These, together with continued aid and under the Research Facilities Act and the research grants program, will help ns improve the 

quality of onr students and onr staff. An increased number of applicants through scholarships would help us materially in producing the 

qualified candidates essential for the years ahead.

1 shall be happy to attempt to answer any questions that you may 

have.

The Ciiairmax. Doctor, your complete statement will lie included 

in the record.

I)r. Bliven. I appreciate that, Mr. Chairman.

( Prepared statement of Dr. ('harlesW . Bliven follows.)

Statement of I)k. ('iiaki.es W. Bliven in Beiiai.e of the American Association

of Colleges or Pharmacy

M.v name is Charles W. Bliven. I am executive secretary of the American 

Association of Colleges of Pharmacy and present the statement in this capacity. 

Before assuming this office I served for 14 years as dean of the School of Ph armacy of the George Washington University, Washington, D.C.

I appear before you in behalf of the membership of the American Association 

of Colleges of Pharmacy, which consists of 77 schools and colleges of pharmacy. 

Seventy-five of our member schools are located in forty-four States and the 

Dis trict of Columbia and are nationally accredited. Approximately 1,100 teachers are engaged in the instruction of some 10,800 underg raduate and 950 gradu ate 

stud ents enrolled in our schools.

The curriculum leading to the undergradua te professional degree has required 

4 years since 1932 and a minimum of 5 years since September 1960. Two of 

our member schools offer only a 6-year curriculum and two others offer this 

longer program on an optional basis. In the 5-year program a minimum of 3 

years of work in the professional subjects are required in addition to a 2-year 

basic science program. In the 6-year curriculum at least 4 years are mandatory 

beyond the 2 years of science.

The objective of the American Association of Colleges of Pharmacy is the 

promotion of education and resea rch within the member institutions. Our 

association is a nonprofit organization.

I app ear before you in support of H.R. 8774 which would increase opportunities for training certain health science jiersonnel and would amend title VII 

of the Public Health Service Act.

As the committee gives consideration to this or similar legislation, it is our 

sincere desire to have the schools and colleges of pharm acy included. Through 

such added assistance the pharmaceutical segment of the health professions will 

be able to maintain and improve our professional service in the years ahead.

Your atte ntion is invited to S. 1072. a bill identical with H.R. 8774, to which 

Senator Humphrey has introduced amendments. These amendments would make 

our schools and colleges of pharmacy eligible for financial aid as is proposed for 

schools of medicine, den tistry, and public health .

To aid in determining the existent and futur e needs of the profession, the 

Public Hea lth Service, with the cooperation of some 16 pharmaceutical orga nizations, is working toward a professional manpower study. It is asked that the 

needs of the schools and colleges of pharmacy l»e incorjiorated into H.R. 8774 

which is designed to increase the opportunities for training hea lth science 

personnel.

Our member colleges have the responsibility of gradua ting an ade qua te number of pharmacists at both the undergraduate and graduate levels to meet not 

only the replacement needs of the profession but also the demands of our rapidly
420 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

expa nding area of the health sciences. A rather constant pharmacist-to-population ratio of 67 to 100,000 has existed from at least 1920 u ntil recently. If this 

ratio is used in the projection of manpower needs, schools of pharmacy will 

need to produce annually, during the period 1965-70, twice as many graduates 

as are currently being grad ua ted; during 1970-75, the average annu al number 

of graduates must he increased by 15 percent over 1965-70 if the ratio is to he 

maintained.

The 07 to 100,000 rati o based on a population of ISO million would require 

120,000 p harmacists; however, the current number is closer to 117,000 providing 

a pliarinacist-to-population rati o of 05 to 100,000.

Approximately 90 percent of our professional personnel are practicing in the 

community pharmacies throughout the country. The remaining 10 percent are 

engaged in the many other areas of the profession: in the pharm acies of our 

hospita ls: in the control, research, or product development laboratories of the 

manufacturing pl an ts; as medical service represen tatives to the physicians: in 

our educational prog rams; in Government; and in the Armed F'orces. The 

schools of pharmacy are making every effort to respond to the demands for 

personnel from all of these public health areas.

The educational program in pharmacy provides our gra duates with an excellent background in the basic sciences as well as in the professional courses. 

For this reason, allied health tields are utilizing an incre asing number of our 

grad uates.

To provide an adeq uate number of pharmacists for the tota l profession, our 

schools and colleges need financial assistance beyond that currently available. 

While many of our schools have good physical facilitie s and equipment, others 

must seek funds from outside sources to provide these essentials.

We realize, however, that quantity as exemplified by square feet and numbers of students is not in itself sufficient to meet our public health responsibilitie s; quality of students and staff are equally essential to the education of tomorrow’s pharm acist. All of these needs have high priority in the thinking 

and planning of our college administrators.

Too, there is an increasin g need for financial aid to studen ts in order tha t 

pharmacy can continue to supply the essential number of well-qualified graduates.

In addition to an improved and lengthened undergradua te program, many of 

our schools have developed excellent gradua te programs for the prep aration of 

teac hers and resea rch personnel. This is a vital part of the educational program and must be expanded rapidly in the years ahead. An adequate supply 

of teachers is an imp ortant need currently. A recent survey revealed tha t we 

need over 100 new teac hers for the year sta rting September 1962. Less than 

two-thirds of this number will receive the desired training in time to qualify 

for the positions; and some of these will take work in the research laboratories 

throughout the country.

H.R. 8774 would expand and extend research facilitie s grants. It is our 

specific request that this legislation be amended to provide for the inclusion 

of pharm acy by name in section 702(4) of the Public Health Service Act; we 

wish pharmacy to be included by name in the definition of the term “sciences 

rela ted to hea lth” as given in title V II : Health Research Facilities. To this 

end I have attached to this statem ent amendments which would achieve this 

objective.

Pharmacy is currently eligible for research facility grants. Our member 

schools and colleges of pharm acy have received grants through 1960 estimated 

at $2 million. A recen t survey of schools of pharm acy indicates that for the 

period 1963-65, 47 schools will require for new research facilities, remodeling, 

and for equipment funds in excess of $20 million, based on total cost of construction.

In addition, our member colleges are eligible for research grants from the 

National Ins titu tes of Health. Approximately 700 resea rch projects were in 

progress in schools of pharmacy in 1960. During the academic year 1960-61. 

45, more than 50 percent, of our schools received research grants from NIH and 

oth er Federal sources in the amount of $1,600,000. Research grants totaling 

an additional $724,000 were obtained from the parent institutions, foundations, 

and from industry. Total research funds available to our schools in 1960-61 

amounted to $2,460,000.

The figures on research facility gran ts and on research projects indicate the 

increased inte rest and activity of pharmacy schools in fundamental and applied
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 421

re se ar ch in our br an ch of th e he al th sci ences. In th e 9- ye ar pe rio d, 195 1-00 , the 

nu m be r of pr oj ec ts in ph ar m ac y sch oo ls re ce iv ing N IH su ppor t has in cr ea se d 

mo re th an 20 tim es ; th e do llar va lue of th e pr oj ec ts ha s in cr ea se d mor e th an 

30 tim es .1

The ad m in is tr ato rs of ou r me mb er colleg es are gra te fu l fo r Fed er al su pp or t 

in th e co ns truc tion of re se ar ch fa ci lities an d in re se ar ch pr oj ec ts. It is ou r 

ear nes t re qu es t th a t ph ar m ac y co nt in ue to be includ ed in pr og ra m s re la ti ng to 

th e he al th prof es sion s. Thr ou gh th e es ta bl is hm en t of a nat io nal ad vi so ry 

co un cil on ed uc at io n fo r th e hea lth pr of es sion s as prov ided in II.R . 8774 th er e is 

am pl e pr ot ec tion t h a t fu nd s wi ll no t be al lo ca te d un wise ly.

P roposed A me nd me nt s to II.R. 8774 by th e A merican Association of Colleges

of P harmacy, J anuary 26, 1962

On pa ge 18, st ri k e ou t lin es 3 th ro ug h 9, an d in se rt in lie u th er eo f th e 

fo llow in g:

“Sec. 3. (a ) Se cti on 70 2(4) of th e Pub lic H ea lth Se rvice Ac t is am en de d by 

in se rtin g ‘phar m ac y, ’ a ft e r ‘denti st ry ,’.

“ (b ) Ef fective w ith re sp ec t to appro pri at io ns fo r fiscal yea rs be ginn in g aft er 

Ju ne 30, 1962, section 704 of such Act is am en de d by st rikin g ou t ‘$30,000,000’ 

an d in se rt in g in lie u th er eo f ‘$50,000,000’. Such section is fu rth e r am en de d by 

st ri kin g ou t ‘five succ ee ding fiscal years ’ an d in se rtin g in lie u th er eo f ‘eigh t 

su cc ee ding fisca l years ’.”

On pa ge 18, lin e 10, st ri ke ou t “ ( b ) ” an d in se rt in lie u th er eo f “ (c )”.

On pa ge 18, lin e 13, str ik e out “ ( c )” a nd in se rt in lie u th er eo f “ ( d ) ”.

On pa ge 18, lin e 20, st ri ke o ut “ ( d ) ” a nd in se rt in lie u th er eo f “ ( e ) ”.

On p ag e 19, l in e 9, s trik e o u t“ ( e )” an d in se rt in lie u th er eo f “ ( f ) ”.

On p ag e 20, lin e 7, s tr ik e o ut “ ( f ) ” a nd in se rt in lie u th er eo f “ ( g ) ”.

Am end th e ti tl e so as to re a d : “A bill to in cr ea se th e o pp ortunity fo r tr ain in g 

of ph ys ic ians , de nt is ts , ph ar m ac ists, an d pr of es sion al pu blic hea lth pe rson ne l, 

an d for o th er p ur po se s.”

The Chairman. I am glad to have the information which is contained in your statement regarding the colleges of pharmacy, the 

status of these schools.

Mr. Younger, do you have any questions?

Mr. Younger. I have one question.

Is there any shortage of pharmacists now ?

Dr. Bliven. I think I would answer that, Mr. Younger, by saying 

tha t perhaps it is a matter of distribution at the present time, as we 

heard earlier this week. We are concerned, however, with the number 

of replacements. The total number of replacements coming out of our 

schools, the total number of graduates for replacement, is just a little 

bit less than those who are leaving the profession but in some areas 

there is a shortage and in other areas there are more graduates.

Mr. Younger. There is no great group of unemployed pharmacists 

then?

Dr. Bliven. Not to my knowledge, sir.

Mr. Younger. Tha t is all.

The Chairman. What about attract ing new applicants for students 

to pharmacy?

Dr. Bliven. This is one of our problems. We had a large number 

of applicants right after World War II with the aid of the GI bill. 

Our number of applicants then dwindled and probably reached a low

Allen, Ern est M.. American Journal of Pharmacy, ed. 25, 211 (1961).
422 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

point in about 1954 or 1955. I am happy to say th at star ting in 1959 

our stu de nt bodies have increased across the country, very slowly, 

1.6 percent in 1959 and 8 percen t in 1960.

We hope thi s will con tinu e hu t we do have a large at triti on rate 

which we do not like—we are not pro ud of it. Th is mean s we need 

bette r qualified or more qualified applican ts.

The Chairman. Th an k you very much. We are gla d to have this 

inform ation and your contr ibuti on for the reco rd.

I)r . Bliven. Th an k you, sir.

The Chairman. Mr. Ph ili p F. J ehle.

STATEMENT OF PH IL IP F. JEHLE. WASHINGTON REPRESENTATIVE

AND ASSOCIATE GENERAL COUNSEL OF THE NATIONAL ASSOCIATION OF RETAIL DRUGGISTS

Mi-. J ehle. Mr. Ch airma n, wi th yo ur perm ission I would like to 

have my pre pared sta tem ent inserted in the record at thi s point as 

tho ugh read.

The Chairman. It may be included.

Mr. J ehle. I wish at t his time only to emphasize wh at seems to he 

an obvious sho rtco min g or pe rhaps overs igh t evid ence d in the scope 

of the bill. I refer to the f ailure of the mea sure to pro vid e any means 

of boosting the outpu t of the Na tio n’s pharm acy schools in con trast 

to the specific provisions fo r substan tia lly rai sin g the num ber of 

medical, den tal, and pub lic school gra duate s.

Th ou gh a gre ein g th at the ran ge of the medical, denta l, and public 

health professions must be aug mented , the Na tional Association of 

Re tail Druggists res pectfully urges th at H.R. 4999 be amended to 

offer its benefits to all of the h ealth professions, inc lud ing pharm acy , 

in w hich an appreciabl e pers onnel sho rtage is found . Pract ica l justice 

for American pharm acy would seem to require th at the needs of the 

healt h professions be met in a comprehensiv e and nondisc rim ina tory 

manner.

T would like to call to yo ur att ention, Mr. Ch air ma n, the fact th at 

Mr. Mack of thi s comm ittee only this aft ern oon intr odu ced in the 

Hou se an ame nded H .R. 4999. I don 't know the num ber of if yet, sir, 

but the bill has been introd uced in the House and I am sure will be 

ref erred to this committee fo r earnest and symp ath etic conside ration.

In addit ion , I should like t o have inserted at the conclusion of my 

testim ony anoth er tabl e, anoth er sta tistic al tab le C which gives the 

ma npo wer da ta fo r the y ear 1961 a nd fo r the year 1962 f or the ph ar ­

maceutical profession. It is a State -by-State brea kdown showing, 

fo r examp le, how man y pharm aci sts a re in the St ate of Ark ansas, and 

how man y are req uired every year to replace those who die or leave 

the State or fo r one reason or anoth er no lon ger actively practic e 

pharm acy .

T h e Chair man. W e w il l re ceiv e t a b le C a n d g o o v e r it a n d see w h a t 

p a r t is a p p ro p ria te to go in to th e re cord .

M r. J e h l e. T h a n k y o u v e ry m uch .
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 423

(Following is the table C referred to and prepared by Mr. Jehle:)

T able C.—Manpower data, 1961-62

N um ber o f 

reg istered 

ph ar m ac is ts 

en ga ge d in 

pr ac tice 

Ja n. 1, 1961*

(1)

N u m b er of 

re pl ac em ents 

ne ed ed 

an n u all y

(3.5 per ce nt )

(2)

P o te n ti al re pla ce m en ts enro lled in c ollege s 

of ph arm acy *

For 1961, 

se ni or 

st u d en ts 

(fall of I960)*

(3)

F or 1962, 

se ni or 

st u d en ts 

(fall of 1961)’

(4)

F o r 1963, 

ju n io r 

stu d en ts 

(fall of 1962)’

(5)

F or 1964, 

so ph om or e 

st u d en ts 

(fall of 1963)’

(6)

A la bam a..... ............. ........... ......... 1,402 49. 1 96 152 155 49

A ri zo n a.. . . .................. ............. 873 30.5 24 21 43 41

A rk a n s a s _____________ ____ 892 31. 2 22 28 27 36

C al if orn ia ......................... ............. 9,667 338 .3 225 193 192 216

C olo ra do ______ _____________ 1.796 62 .9 23 9 17 48

C onnec ticut ................................ 2,086 73.0 74 98 91 0

D el aw ar e____________________ 209 7.3 0 0 0 0

D is tr ic t of C o lu m b ia ________ 900 31.5 69 49 68 4

F lo ri d a.................................. ......... 3, 494 122.3 63 51 108 76

G e o rg ia .......... ... ........................... 2.568 89.9 110 119 116 69

Id ah o .... ............................ 467 16.3 32 26 18 52

Il li n o is ___________ __________ 5,948 208 .2 90 106 156 62

In d ia n a........................................... 2,986 104.5 137 151 182 35

I o w a ................... ............... . .......... 1.557 54.5 90 96 108 40

K an sa s ................................... 1,347 47.1 29 18 30 39

K e n tu c k y .__ 1,215 42.5 50 21 34 38

Louis ia na_______ ____________ 2,198 76 .9 82 88 101 96

M a in e .. . . ___________ _____ 440 15. 4 0 0 0 0

M ary la n d . ...... ........................ 1.701 59.5 38 43 61 2

M as sa ch use tt s_______________ 4.500 157.5 160 138 159 9

M ic hig an ............ . ............. . ......... 5,83 9 204. 4 172 161 219 85

M in neso ta __________________ 1.957 68.5 33 32 34 59

M is sis sip p i. .................................. 941 32 .9 47 52 63 72

M is so uri ....................................... .. 3,081 107.8 96 100 170 50

M o n ta n a. .......... ............. ......... 394 13. 8 15 18 15 19

N e b r a s k a .................................... 980 34 .3 14 33 47 50

N ev ad a............................... ......... .. 265 9. 2 0 0 0 0

N ew H am psh ir e___ _________ 356 12.4 0 0 0 0

N ew J ers ey.................................... 3,567 124.8 60 61 90 0

N ew M ex ico.................................. 557 19.5 16 23 26 27

N ew Y o rk ...................................... 14.364 502 .7 493 491 600 35

N orth C a r o lin a .......................... 1.659 58.1 48 72 85 33

N o rt h D ak o ta .................. ........... 354 12.4 55 59 85 16

Ohio ............................................. 5, 656 198.0 207 226 280 59

O kla hom a___________________ 1,591 55 .6 87 82 129 85

O re go n................................ ........... 1,435 50.2 49 46 84 64

P en n sy lv an ia _______ ________ 9,400 329.0 310 348 386 48

Rho de Is la n d .................... ........... 673 23 .6 15 21 24 8

S outh C aro li n a__ 1,042 36.5 51 53 79 38

S outh D ak o ta ....... ..................... .. 4.50 15.8 53 47 49 0

Te nn es se e ...................... ............. 2,197 76.9 63 79 100 90

T exas ........................... ....... ......... .. 5,42 6 189. 9 164 200 208 206

U ta h .............................. ........... ...... 599 21.0 31 38 35 21

V erm o n t........................... ............. 182 6. 4 0 0 0 0

V ir gin ia ...................... ....... ......... .. 1,636 57.3 59 56 74 25

W as hi ng to n .......................... 2,671 93.5 37 44 59 91

W es t V ir gin ia _________ ____ _ 612 21.4 20 26 28 8

W is consi n.............. 2,29 9 80.5 67 79 99 28

W yom in g..... ......... ......... ............. 280 9. 8 15 28 24 5

T ota l .................................. 116,709 4,08 4.8 3,691 3,882 4,758 2,137

1

 Cen su s an d lic ense d ata co m pi la tio n. N at io nal Assoc ia tion of B oar ds of P h arm acy , 1961.

2

 A A C P re port on e nro llm en ts , fall te rm , 1960.

’ A A C P re port on e nro llm ents , fall te rm . 1961.

'fbe Chairman. Thank you very much, we are glad to have this information in behalf of the National Association of Retailing Druggists.

Mr. J ehle. Thank you, Mr. Chairman.
424 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

(Prep ared statement of Philip F. Jehle follows:)

Statement of P hi lip F. J ehle, Washington Representative ani> Associate

General Counsel of the National Association of Retail D ruggists

Mr. Chairman. I appea r here this morning in behalf of the National Association 

of Retail Druggists, a small business association having a nationwide membership of 36,000 family pharmacists. As you know, the NARD speaks for its 

retail pharm acist members on all national legislative matter s affecting their competitive and professional interests.

The NARD is deeply apprecia tive of this opportunity to testify in support of 

II.R. 4999 and the perfecting amendments thereto introduced in the House yesterday by Congressman l’ete r Mack. Accordingly, you may be assured tha t my 

testimony on this subject will be brief and to the point. I understand the practical problems involved in scheduling the many witnesses who desire to be heard 

on this very impo rtant measure.

In both principle and purpose, the NARD endorses II.R. 4999, the bill for 

increasing the opportunities for training of medical, dental, and public health 

personnel. The Nation’s retail pharm acists have no hesitancy in supporting 

efforts to relieve the serious manpower shortages existing in the related health 

professions. In fact, such an undertaking deserves and. I am sure, enjoys the 

supp ort of all American citizens interested in the main tenance of our high health 

ca re sta nd ards.

While generally supporting II.R. 4999, the NARD wishes to call atte ntion to an 

obvious shortcoming or, perhaps, oversight evidenced in the scope of the bill. 1 

refer to the failure of the measure to provide any means of boosting the output 

of the Nation’s pharm acy schools, in contrast to its siteciflc provisions for substantially raising the number of medical, dental, and public health graduates. 

Though agreeing that the ranks of the medical, dental, and public health professions must be augmented, the NARD respectfully urges that II.It. 4999 be 

amended to offer its benefits to all of the health professions, including pharm acy, 

in which an appreciable personnel shortage is found. Practic al justice for 

American pharmacy would seem to require that the needs of the health professions be met in a comprehensive and nondiscriminatory manner.

Available statistics reveal that the supply of registered pharmacists lias not 

kept pace with a growing America. In 1930, when there were only 88,(MK) registered pharmacists, the United States enjoyed a rati o of 69 pharmacists for 

every 100,000 persons in the population. Today, by comparison, there are only 

67 pharmacists per 100,000 persons, although we have about 120,000 registered 

pharmacists in the country. But an even more serious manpower shortage is 

disclosed, if only the 116,000 pharmacists currently registered and actively engaged in the practice of pharmacy are considered. The ratio then drops to 64 

to 100,000. (See table A.)

These statistics become even more meaningful when it is considered that, some 

30 years ago, almost all registered pharmacists were working in retail drugstores, 

while currently about 10 jiercent are employed in such rela ted health areas as 

pharmaceutical research and development, pharmacy education, ethical drug 

promotion and distribution, hospital pharmacies, and Federal and State public 

health agencies, including military dispensaries. In other words, the failure to 

keep the supply of registered pharmac ists in line with population growth since 

1930 has been aggrava ted by the fact th at at least 10 percent of today’s 

pharma cists are not available for reta il pharmacy work. Small wonder, then, 

that a vexing shortage of pharmacists for prescription counter duty is found to 

exist in retail drugstores across the country.

At the same time, it should be understood that the registered pharmacists 

activ e in the rela ted health fields mentioned do not satisfy the numerical requirements for pharm acists in those areas, either. The demand for pharmacists in 

such are as fa r exceeds the available supply. Over the past 30 years, very little 

preparatio n of any kind was made to meet what have become the subs tantial 

needs for trained pharmacists in such associated fields of interes t.

As one informed observed of the pharm aceutical scene h as reported “* * * the 

cur ren t shortage of phannacists seems certain to become even more pronounced 

in the years ahead . • * * More than 160,000 registered pharmacists will be 

required 15 years from now to satisfy the needs stemming from continued popu-
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSONNEL 425

la tion gr ow th only, as su m in g th a t curr ent ra ti o o f av ai la bility of phar m ac is ts 

ca n be term ed ad eq ua te . Of th is nu mbe r, an es tim at ed 10,000 wi ll be need ed in 

ho sp ital ph ar m ac ie s an d an oth er 2,000 to mee t w ha t ar e prob ab ly th e minim um 

re qu irem en ts fo r teac hi ng an d re se ar ch . For th e mo st i>art, th e oth ers wi ll be 

enga ge d in re ta il ph ar m ac y an d allie d hea lth fields, us is th e ca se to da y. (See 

ta bl e B.)

In plan ni ng to me et th e needs fo r phar m ac is ts in th e fu tu re , att enti on m us t be 

giv en also to th e ra pi dl y develop ing tr end in re ta il ph ar m ac y to w ar d th e 8-h our 

da y an d th e 5-da y week. Ev en now , th e sm al l re ta il ph ar m ac is t is so rely pres sed 

to prov ide hi s cu stom er s w ith pr of es sion al ph ar m ac eu tica l se rv ice s th ro ug ho ut 

the 14- 10 ho ur s of hi s da ily op er at io ns . B ea r in mind th a t 40 pe rc en t of all 

dru gs to re s oj te ra te w ith only one pharm acis t an d an oth er 45 per ce nt are service d 

by only two . Once re ta il ph ar m ac y gen er al ly ad opt s the 40 -hou r week en joye d 

by th e oth er he al th pr of es sion s, a su bst anti al in cr ea se in th e supp ly of pharm ac ists wi ll be re qu ired . The a lt ern ati ve wo uld be a det er io ra tion in th e q ua lity 

an d conv en ienc e of p har m ac eu tica l service .

The se o bs er va tio ns co nc erning curr ent an d fu tu re sh or ta ge s in ph ar m ac y m an ­

po we r find co nfirm ation, I believe, in th e 1050 re port of th e Su rgeon G en er al ’s 

C on su ltan t Gro up on Me dic al Edu ca tion , entitled “P hy si ci an s fo r a Gr ow ing 

America.” Acc ording to th e cons ultan t grou p, “s ho rtag es of tr ain ed people ex ist 

in pr ac tica lly ev ery on e of th e man y pr of es sion al an d tech ni ca l care er s in th e 

he al th field. In te ns iv e re cr ui tm en t of yo un g peop le fo r th es e man y es se nt ia l 

hea lth service s, in cl ud ing me dic ine , is im pe ra tive .”

Th e des ir abil it y of co up lin g th e prob lem of med icine w ith th os e in th e re la te d 

he al th pr of es sion s w as rec ogniz ed by th e co nsu lt ant grou p. “* * * Phy sici an s 

ca nn ot carr y th eir load of re sp on sibi lit y w itho ut co mpe tent an d w el l-trai ne d 

te am m at es a nd as so ciates .

“T he re is in cr ea si ng rec og nitio n of in te r- re la te d re sp on sibi lity of hea lth 

w or ke rs w ith a var ie ty of sk ill s an d ed uc at io na l pre pa ra tions . One ev iden ce of 

th is is th e de ve lopm en t of un iv er sity -b as ed hea lth ce nte rs w ith clo sely re la te d 

sch oo ls of med ici ne , den tist ry , nu rsing, an d oth er he al th pr of ession s.

"♦ • * In 1900, fo r ev ery ph ys ician in pr ac tice th ere w as one o th er pr of es sion al 

he al th p ra cti ti o n er; to da y, th er e are fo ur such a r s o n s fo r ev ery ph ys ic ia n. ”

A fter ou tlin in g ou r ph ar m ac y m an po w er re qu irem en ts, ou r ta sk is to mee t 

the m. To ac hiev e even our mi nim um go als in th e supp ly of re gis te re d p h armac ists will re qu ir e mu ch la rg er pha rm ac y sch ool en ro llm en ts an d gra du at io ns. 

T hat being th e cas e, ph ar m ac y sch ool fa cil it ie s will ha ve to be su bst anti all y 

en la rg ed an d teac hi ng st af fs co rres po nd ingl y in cr ea se d to ta ke car e of th e 

ad ditio na l st uden ts to be en rolle d, al l w itho ut re du ci ng th e pre se nt high qual ity 

of phar m ac eu tica l ed uc at io n. For su ccess in th is im port an t under ta kin g, som e 

Fed er al ass is ta nce wi ll be re qu ired by th e pha rm ac y sch oo ls ju s t as w ith th e 

medica l an d den ta l sch ools.

In view of th es e co ns id er at io ns , th e NA RD feels ju st ifie d in as ki ng th a t 

H.R. 4999 be am en de d to mak e ou r N at io n’s ph ar m ac y sch oo ls eli gible fo r th e 

m atch ing g ra nts pr og ra m th a t th e bill ex te nd s to med ical an d den ta l sch ools. 

Th e NARD al so as ks th at II.R. 4999 be am en de d to mak e ph ar m ac y st uden ts 

eligible fo r th e sc hol ar sh ip fu nd s th a t th e bill wo uld off er med ica l, de nta l, an d 

publi c he al th st ud en ts.

Und er le gi sl at io n of th e pa st, ph ar m ac y scho ols ha ve part ic ip ate d in ot her 

fina nc ial gra nt pr og ra m s pri m ar ily es ta bl ishe d fo r med ical an d den ta l sch ools. 

A good ex am pl e of such legislation is th e H ea lth Res ea rc h Fac ilitie s Act of 1956. 

Pha rm ac y scho ols also rec eiv e money gra nts from th e N at io na l In sti tu te of 

H ea lth fo r he al th re se ar ch projec ts.

The N at io n' s re ta il pha rm ac is ts as k you r sy m pa th et ic co ns id er at io n of Co ngr es sm an P ete r Mack’s proposed am en dm en ts to H.R . 4999. Ado ption of th e 

am en dm en ts will be an im port an t st ep to w ar d relie vi ng th e cr it ic al m an po wer 

sh or ta ge s ex is ting in American ph ar m ac y.

80014—62----- 28
426 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

T able A

S ta te s

A la bam a.......................

A la sk a...........................

A rizo na ..........................

A rk an sa s.......................

C ali fo rn ia .....................

C olo ra do .......................

C o n n ec ti c u t................

D el aw ar e.................. ..

F lo ri d a.................... ..

Q eo rg ia ..........................

H aw aii ..........................

Id ah o ..............................

Il li nois ...........................

In d ia n a.........................

Io w a...............................

K an sa s ........................

K niiucky...................

L ouis ia na.....................

M ain e............................

M ary la n d ....................

Ma ssa chusetts ...

M ic hig an ......................

M in nes ota ....................

M is si ss ip pi------ -------

M is so uri.......................

M o n ta n a......................

N eb ra sk a. _..................

N ev ad a................. ..

N ew H am psh ir e.........

N ew J ers ey.............. .

N ew M exico........ ..

New Y ork ....................

N o rt h C ar olina...........

N ort h D akota ______

O hi o....................... ..

O kla hom a....................

O re go n...........................

P e n n sy lv a n ia .............

R hode Is la n d ..............

South C ar olina...........

South D akota .............

Ten nes se e............. ..

T exas .............................

U ta h ..............................

V er m ont............... ..

V irgin ia .........................

W ashing ton............ .

W es t V ir gin ia .............

W is co ns in .....................

W yom in g ...................

D is tr ic t of C olu m bia

P o p u la ti o n

(thousa nds)

P h arm acis ts

R at io o f 

phar m ac is ts 

to 100,000 

popula tion

3.267 1,402 42 .9

226 74 32.7

1,302 873 67.0

1,786 892 49.9

15,717 9. 667 61.5

1,754 1.796 102. 3

2,535 2.086 82 .2

446 209 46.8

4.952 3. 494 70. 5

3,943 2. .568 65. 1

633 191 30. 1

667 467 69. 9

10.081 5. 948 59.0

4, 662 2,986 64.0

2. 758 1.557 .56. 4

2. 179 1,347 61.8

3.03 8 1.215 39.9

3.257 2.198 67.4

969 440 45. 3

3. 101 1.701 ,54.8

5. 149 4. 500 87.4

7. 823 5.839 74.6

3.414 1.957 57. 3

2, 178 941 43 .2

4,320 3.081 71.3

675 354 58.3

1,411 9.80 69.4

285 265 92.8

607 356 58.6

6,067 3.56 7 58.7

951 557 58.5

16. 782 14.364 85.5

4.556 1.659 36.4

632 354 55. 9

9.706 5,656 58.2

2.32 8 1,591 68.3

1,769 1,435 81. 1

11,319 9, 400 83.0

859 673 78.3

2.383 1,042 43. 7

681 450 66. 1

3.567 2.197 61.5

9. 580 5, 426 .56. 6

891 599 67. 2

390 182 46.6

3.967 1.636 41.2

2.85 3 2.671 93.6

1.860 612 32.8

3. 952 2,299 58. 1

330 280 84.8

764 900 117.8

N o t e.—N at io nal ra ti o o f p har m ac is ts to 100,000 of p opula tion, 64.

So urce : B ul le tin of th e N at io nal Assoc iatio n of Boa rd s of P h arm acy , vo l. 12, No. 12. O ct ob er , N ovem ber , an d D ec em be r, 1961.

T able B.—Pha rmacixts fo r a gro win g Americ a 1 *

Y ea r

T ota l

U. S.

popula tion 1

N ee d of 

ph ar m ac is ts 

at pr es en t

ra ti o of 

67/100,000

A nnu al 

re pl ac em en t 

ne ed at

3.5 p erc e n t3

Actua l 

re pl ac em en t 

to ta l 4

I960 .............. ............ . 180,000,000 120,000 4,200 3,200 1965 ........ ........... ...................................... 196,000,000 131,000 4 600 1970 . . . _________. 214.0 00.000 143,000 5,000 1975.......................................................................... . . . 240,0 00,000 161.000

1

 S u bm it te d by Sen at or H u b ert II . H um p h re y to th e Sen at e Lab or an d P ublic Welf are C om m it te e 

d u ri n g pu blic he ar in gs la st ye ar on S. 1072, a co m pa ni on m ea su re to II . R. 4999.

* Bas ed o n serie s 2 figu res fro m B ur ea u of C en su s.

* F ac to r of 3.5 pe rc en t su ppl ie d by th e N at io nal A ss oc iatio n of B oa rd s of P har m acy .

4

 R ep re se nt s p har m ac y s chool gr ad ua te s.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 427

The Chairman. The final witness will be Mr. Richard C. Shipman. 

Mr. Shipman, I believe you are a representative of the National 

Farmers Union ?

STATEMENT OP NATIONAL FARMERS UNION BY RICHARD C. 

SHIPMAN. ASSISTANT DIRECTOR

Mr. Shipman. Yes, sir. My name is Richard C. Shipman. I am 

assistant director of the legislative services division of National 

Farmers Union.

We appreciate very much this opportunity to appear before the 

committee to express the point of view of the more than 250,000 farm 

families who are members of our organization.

National Farmers Union wishes to express this afternoon our full 

support of H.R. 4999. We do so because we recognize the critical 

need of the Nation as a whole for more doctors, dentists and health 

specialists, but more especially we wish to emphasize the serious 

problem of keeping professional people of this kind in the small 

towns of rural America where they are available to farm people. 

The country doctor who once served farm people is now long gone 

from the countryside. The typical situation today is that farm people 

depend to a great extent upon the occasional services of the public 

health doctor and nurse except in those instances where they happen 

to be adjacent to some metropolitan area.

Many rural sociologists believe th at a large investment in regional 

medical schools serving several sparsely populated States would be a 

much wiser investment than a medical school attached to each State 

University. 1 refer you to the regional studies of Dr. Carl Kraenzel, 

formerly of Montana State College.

According to statistics from the Health Manpower Source Book of 

the U.S. Department of Health, Education, and Welfare, there are 

37 States which fall below the national average of 125.3 doctors per 

100,000 of the civilian population. The problem is most acute in 

Southern, Midwestern, and Great Plains States. South Dakota, for 

example, has only 70.7 doctors per 100,000 people. In the more 

isolated areas of these States, the ratio falls below 50 physicians per 

100,000 population.

We believe that there are two main reasons why it is difficult to 

secure doctors for rural areas. One is cultural background—the other 

is money.

Let us consider the first reason. There is an old saying that you 

can take the boy out of the country but you can't take the country 

out of the boy. This old saying has a kernel of tru th which we believe the committee should consider.

Statistics from the Journal of Medical Education indicate that the 

place where the boy is brought up is the most significant factor in 

determining where he will practice a fter leaving medical school. We 

refer you to the table attached. Therefore, the problem, it seems to 

us, resolves itself down to the question of how we get more farm boys 

to study medicine.

Here we find the second hard fact that the vast majority of young 

men who study medicine come from families with incomes of over 

$10,000 per year. According to 1959 statistics, farm income is $965
428 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

per ca pita, or about 45 per cent of no nfarm income which is $2,21(5. 

I t is not ha rd to see from thes e figures th at few farm fam ilies can 

aff ord the long and expensive tra in ing necessary to mak e doctors out 

of th ei r sons.

I t is for these reasons th at we urge upon the committee the passage of II.R. 4999 pro vid ing gran ts to schools fo r sch ola rsh ip aid to 

tal ented bu t needy students.

May I close by say ing it is a well-known fac t that the ag ric ult ura l 

technological rev olution is forcin g many of ou r young people out of 

farm ing. It seems to us both wise and fa ir, as well as in the national 

inter est, to make it possible fo r these young peop le to get the kind of 

pro fessional education th at will allow them to go back to their boyhood sur roundin gs to serve the people of those are as as doctors and 

dent ists which are so badly needed.

(Table I referre d to by Mr. Richard C. Sh ipm an f ollows:)

T ab le I. —Percent distribution of medical college graduates in private practice

whose prior residence was in various size communities by size of community

of practice, 1950 class

S iz e of c o m m u n ity o f p ra c ti c e

Si ze of c o m m u n ity of p rio r re sid en ce

A ll size s 500,000 

a n d o v er

100,1X10 t o 

499 ,999

25,(XX) t o 

99,999

5,000 to 

24,9 99

U n d e r

5,000

N u m b e r of g ra d u a te s ............................................ i 3 ,311 850 729 577 488 590

A ll siz e s............................................................ 10 0.0

17 .6

19.7

19 .8

22 .9 

19.6

.4

100.0 10 0.0 10 0.0 10 0.0 10 0.0

500 ,000 a n d o v e r...................................... ................. 45 .6 

10 .8

13 .8

17 .6

11 .8 

.4

7.3

41 .3 

14.7 

19 .9

16.4 

.4

9 .5

13 .2

40.4 

22 5

14 4

7.4

14 9 

20 .9 

36 .7 

20 .0

7.3 

15.9

14 .6

22 .7 

39 .5

lOO’OOO to 499 ,909.......................................................

25,0 00 to 99,99 9......... .................................................

5,000 to 24 ,9 99. ..........................................................

U n d e r 5,000________ _______ _____ _____ _____

F o re ig n o r n o t re p o r te d .......................................

1

 In c lu d e s 77 g ra d u a te s w h o se c o m m u n ity of p ri o r resid en ce w as o u ts id e th e U n ite d S ta te s o r w as n o t 

re p o rte d .

Th e Chairma n. Mr. Sh ipm an, tha nk you very much .

Mr. Younger, do you have any questions?

Mr. Younger. I have no questions, Mr. Ch airma n.

Th e Chair man. We are glad to have the sta tem ent fro m the Na ­

tio na l F armers Union.

Mr. S hipm an . Th an k you very much.

Th e Chair man. We will now hea r from o ur colleagu e H on. Charles 

E. Benn ett.

STATEMENT OF HON. CHARLES E. BENNETT. A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF FLORIDA

Mr. Benn ett. Th an k you, Mr. Ch airma n, fo r this op po rtu nity to 

testify on the ad minist ratio n’s “H ealth Pro fes sio ns Ed ucational Assistan ce Ac t of 1901,” which I was happy to join in introd ucing . We 

all have been long intere sted in some mea ns of of reli evi ng the contin ui ng c ritica l short age of doctors an d healt h person nel in this coun ­

try , a nd I have no ted fo r a nu mber of years, in my wor k on the Armed 

Services Comm ittee , the serious problem t his poses also fo r ou r fighting 

forces in th ei r atte mpts to m ain tain adequate m edical services. It was
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 429

to help alleviate this problem that I intr oduce d H.R. 67 in the 84th 

Congress to pro vid e for Arm ed Force s medical sch olarships. Ho wever, if the cap acity of medical schools is not increased, the overall 

benefit from these ap proach es is limited.

I will not add, a t thi s time, to the many sta tistic s this com mittee has 

received in the past showing the need for doctors. Suffice it to say t hat 

thi s need only increases. A rec ent lette r to me from the dean of the 

Un iversity of Mia mi School of Medicine confirms the urg enc y of the 

present situatio n, and points o ut in a dd ition th e good job sma ll schools 

are doing in pr ep ar in g gradua tes fo r pract ice in ru ra l and sem irural 

are as w here the need is most critica l. Th is p artic ul ar school, altho ugh 

only 10 years old, was the first medical school in Florida. It has now 

grad ua ted 307 stu dents from 45 cou nties in Florida. The dean continues, “These men are now f inishing th ei r hosp ital t ra in in g and a rmed 

service requ irem ents, and are now re tu rn in g to Fl or id a to practic e.”

These sma ll schools, however, mu st be allowed to exp and and new 

schools are needed. The Associa tion of Am erican Medical Colleges 

rep ort s th at 3,500 a dditio nal physicians must be g radu at in g each year 

from medical schools by 1975. Ano ther inter estin g fac t bro ught out 

by them points to the need for action by Congress at the earlie st momen t because it takes 6 to 10 y ears to develop a medical school and 5 

to 9 ye ars af te r college to complete a med ical edu cation. In the c ur ­

ren t session of C ong ress I introd uced II.R . 4226, but am now seeking 

to sup port the ad minist ratio n's policies by introd uction of II.R. 8833. 

companion to the c hairm an's bill, II.R. 4999.

I hope Congres s will no longer delay in fac ing thi s prob lem which 

not only affects the health of our whole Na tion, but its very sec urity 

in seeing th at its fighting men have sufficient medical services.

The C hair man. Th an k you, Mr. Be nnett, for your statem ent .

I would now like to include in the record at th is time, a prepared 

statem ent from ou r colleague, M r. Melvin R. La ird .

(P re pa re d statem ent by Hon. Melv in R. La ird , a Re pre sen tative in 

Congres s from the S tate of W isc on sin :)

Sta teme nt of Hon. Melvin R. Laird, a Represe ntative in Congr ess F rom th e

State of Wisco ns in

Mr. Chairman, the introduction of the Health Professions Educational Assistance Act in the 87th Congress and the hearing s which this committee is holding 

on the hill are a recognition of serious problems that fact us now and will continue to face us in the next decade in the medical care of the people of this 

country.

For several years scientfic groups, meeting as advisory units and as orga niza ­

tions devoted to medical care and medical welfare, have recognized a growing 

shortage of physicians and of candidates for medical and dental degrees—a 

shor tage which throws a long, dark shadow on the future of our medical 

well-being.

The Rayne-Jones rei>ort of 1938. the Bane report of 1939, the Boisfeulllet 

Jones report of 1960, the Association of American Medical Colleges rejM^rt, 

“Proposals for the Support of Medical Education by the Federal Government.” 

of 1961. and the reports of several oth er groups addressing themselves to the 

same problem have all recommended a program of Federal support for the construction of medical and dental teach ing facilities, a program of medical and 

dental scholarships for needy students, and the expansion of the present program for the construction of medical and dental research facilities. They have 

uniformly and consistently built up a record of need in each of these are as which 

is a compelling one and which has convinced me we need the kind of legislation 

before this committee today.
430 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Th e Ban e re port po in ts ou t th a t sin ce 1950 th e ra ti o of ph ys ic ia ns to po pu latio n ha s remaine d at ap pr ox im at el y 132 per lOO.OtXl. Thi s ra ti o wo uld be much 

low er if du ring th is tim e we ha d not licensed nea rly 10,000 fo re ig n- trai ne d 

ph ys icians—1,680 in 1960, mo re th an the out put of 16 av erag e- size d U.S. sch ools 

of me dic ine . If the pr es en t ra ti o of ph ys icians to po pu la tion is to be m ai nt ai ne d 

in th e face of ou r in cr ea sing po pu latio n, part ic ula rl y if we are to cease dei>ending up on the pr es en t ra te of lic en sing fo re ig n- trai ne d ph ys ic ians , we will ha ve 

to in cr ea se th e nu m be r of ad m ission s to med ical sch oo ls from th e curr ent figure 

of ab ou t 8,200 to ab ou t 12,000 by 1970. In den ta l sch ools, we will ha ve to in ­

cr ea se ad mission s fro m ab out 3,600 to ab ou t 6,900. Thi s m ea ns an in cr ea se in 

med ica l school ad mission s of ab ou t 50 pe rc en t an d in den ta l scho ols of a bo ut 1CH) 

pe rcen t. I believe th er e is no pr of es sion al gr ou p co nc erne d w ith th e fu tu re of 

the he al th ne ed s of th e ci tize ns of th is N atio n th a t ta kes iss ue with th es e 

statem en ts.

To en ab le th es e in cr ea se s in en ro llm en t to be ph ys ic ally acco mmo da ted , we 

will need su bst an ti al ex pa ns io n of ex isting med ical sch ool an d de ntal scho ol 

fa ci lities an d th e es ta blish m en t of som e 20 new me dical sch oo ls an d 20 new 

de nta l schools. Th e co st of such a to ta l pr og ra m is so ss ta gger in g th a t it ca nno t be met en tire ly by loc al co mmun iti es or by pri vate m ea ns an d, th er ef or e, 

the pro visio n of th e bill be fo re yo u—se ttin g up a Fed er al pr og ra m of match ing 

gra nts f or t he purpo se—is a ve ry s ou nd one.

Th e co ns truc tion in ci den t to th e ex pa ns io n of ex is ting sch oo ls an d th e constru ct io n of new scho ols ta kes tim e. It also ta kes tim e fo r th e st uden ts who 

will beg in th eir ed uc at io n in th es e fa ci lities to gra duate an d. be fore the y ar e 

av ai la bl e fo r in de pe nd en t pr of es sion al re sp on sibi lit y, mor e tim e to serv e th eir 

in te rn sh ip s and re side nc ie s an d sa tisf y th eir m ilitar y re qu irem en ts. Th er ef or e, 

tim e is of th e ess ence.

Th e ex pa ns io n of ph ys ic al fa ci lities in which to tr ain yo un g do ctor s an d 

den tist s doe s no t solve th e who le pro ble m ho wev er. Th e co st of medica l an d 

de nt al ed uc ation grow s hig her ea ch ye ar. The av er ag e med ical school st uden t 

wh en he fin ish es hi s ac ad em ic trai nin g, in te rn sh ip , an d resid en cy sp ec ialty 

tr ai nin g is clo se to 30 years or mor e of age. He is usu al ly m ar ried an d has a 

yo un g family . He ha s sp en t ab out $11,000 on th e med ica l school ph as e of his 

medica l ed uc at io n an d mu ch mor e if he is m ar ried an d has ch ild ren. He is 

ve ry lik ely in se riou s deb t—he may be in th e 20 pe rc en t of gra duat es w ith an 

av er ag e in de bt ed ne ss of $6,000 or more. D uring his su bs eq ue nt in te rn sh ip an d 

reside nc y tr ai nin g, he rece iv es a scale of pa y th at fa ll s fa r sh or t of ac tu al 

liv ing expense s. It is th ere fo re ea sy to see wh y 40 per ce nt of all medica l stu ­

de nt s come from fa m ilie s w ith inc om es of $10,000 a y ear or more, an d wh y 

only 15 pe rc en t ar e from fa m ilie s w ith an nual inc om es of $5,000 or less. Th e 

high co st of med ical ed uc at io n ne ce ss ar ily cu ts off th e How of po tent ially good 

ph ys ic ians in th e pi jte lin e of med ical ed uc at io n wh o a re no t we ll end ow ed 

fin an cially as th ey loo k fo rw ard to a lon g pe rio d of ex pe ns ive tr ain in g in ord er 

to ge t th eir de gree s. It is my hope th a t th e sc ho la rs hip fe atu re of th is bil l 

will be ch an ge d to an ad eq uat e loa n pr og ram. A loan pr og ra m can he lp mo re 

in di vi du al s an d w ith libe ra l fe atu re s will a tt ra c t to med icine high ly co mpe tent 

yo un g men an d wo me n wh o ot he rw ise wo uld be forced in to oth er fields of 

en de av or.

Th e part of t he H ealth Pr of es sion s Edu ca tion al A ss istanc e Act wh ich in te re st s 

me part ic ula rl y is th e p a rt wh ich prov ides fo r th e ex te ns io n an d ex pa ns ion 

of th e pr og ra m fo r th e co ns truc tion of re se ar ch fa ci lities . I ha ve ha d a deep 

in te re st in th is a nd ha ve ta ken an ac tiv e p art in it as a mem be r of the Com mittee 

on A pp ro pr ia tio ns duri ng th e pas t 6 ye ars. Th e pr og ra m ha s been one of the 

mo st eff ectiv e th e Con gress has ev er au th or iz ed in th e field of pu blic he alth . It 

has ha d 6 fu ll years of life an d. while mo st of th e re se ar ch co ns truc tio n was 

done on a 59-50 m at ch in g ba sis, ac tu al ly th e am ou nt co nt ribu te d by ou tsid e 

sour ce s ha s fa r more th an mat ch ed th e 50 per ce nt co nt ribu te d by th e Fed er al 

Go ve rnme nt.

I believe th e m at ch in g pr in ci pl e is a sou nd one an d th a t ba sica lly th e pr og ram 

shou ld re st on suc h a fo rm ul a. Ho we ver, I ha ve know n al so fo r th e la st se ve ra l 

yea rs th a t th er e a re in st it u ti o n s in th e co un tr y—mo st of them co nn ec ted with 

un iv er sities—whic h a re do ing fine rese ar ch an d wo uld lik e to do mo re, but wh o 

ca nn ot ra is e th e mo ney to ta k e ca re of th eir sh are of th e 50-50 re qu irem en t. 

I am tol d th er e are on file in th e Pu blic H ea lth Se rvice mo re th an $70 mi llio n 

of un met ne ed s in th e re se ar ch co ns truc tio n pr og ram. Th ese re qu es ts—all of 

wh ich are re ga rd ed as m er itor io us—are from in sti tu ti ons wh ich can me et th e
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 431

matching requirements. The backlog would be much larger if we had a statement of need from those institution s equally qualified who cannot raise their 

half of the funds.

I believe th at the language in the bill before you, which enables some unmatched 

resea rch construction funds to be provided, is based on the theory tha t there 

is a need for some research facilitie s—special in cha rac ter and high in cost— 

serving a national or a regional need of many institutions and a grea t many 

investigators. I thin k this regional concept is sound and such a provision should 

be made. I also believe, though, th at there are institutions which do not meet 

these cri ter ia but rather are in undeveloped areas of research where research 

is needed and possible, but facilitie s in which the scientific work can go on are 

lacking. I believe these institutions, too, should be enabled to apply for funds 

on a nonmatching basis. I think that th e decision on the interpreta tion of merit 

and need should be le ft to the Public Hea lth Service and the Council empowered 

to carry out the purposes of the act. I would hope that the bill in its tinal form 

would give to the Council and the Service authority to make this judgment 

themselves and to vary the balance of matching and nonmatching funds from 

yea r to y ear as circumstances require. Since there is a ceiling on the authorization, there could be no excessive expenditure of Federal funds in any given year, 

but the amount of matching and nonmatching fund s could vary as annual requirements dictated.

In closing, I would point out th at in the field of health and medicine, if our 

people are to have adeq uate professional care, we must provide for increasing 

the number of medical scientists and teac hers as well as practitioners. Therefore, as we look to the continued development of the research facilities in which 

the finished medical scientists can work, we must also provide for the basic education of the two groups from which they must come—the young people studying 

for M.D. and Ph. D. degrees. The medical school is essential to the early professional education of both of these groups and it is to this end, as well a s the provision of research facilities, that this bill is designed.

I tru st th at the Congress will pass the bill this year and, in so doing, make a 

gre at contribution to medical resea rch and medical care and to the well-being 

of our Nation.

The Chairman. I have a letter from our colleague, Mr. Daddario, 

which will be included in the record.

(Letter referred to from lion. Emilio Q. Daddario, a Representative 

in Congress from the State of Connecticut, follows:)

H ou se of R epr es en ta ti ves , 

Washington, D.C., January 26, 1962.

Hon. Oren Harris,

Chairman, Inters tate and Foreign Commerce Committee,

House o f Representatives, Washington, D.C.

Dear Mr. Chairma n: Your committee has under consideration H.R. 4999 and 

related bills, to increase the opportunities for training of physicians, dentists, 

and professional public health personnel. I should like to urge favorable consideration of this legislation and ask th at my state ment be placed in the record.

I am partic ularly concerned because this legislation would be of assistance 

to Connecticut. There are only four medical schools now in New England, all 

of them fine institutions, but in need of help to meet an increasin g public demand for medical and dental care.

Gov. John N. Dempsey, who is fully in supp ort of this legislation, has given 

you information regarding the present situ atio n in our State and I)r. Franklin 

Foote of our State health department has discussed it with you. I would note 

that our ratio of physicians to population was main taine d only through a majo r 

increase in the licensing of physicians who had received the ir training outside 

North America.

I have been acutely aware of the critical shortage of training facilitie s for 

professional personnel facing us in the coming years. President Kennedy has 

referre d to this shortage in his public stateme nts. This same pressure on the 

limited number of physicians and den tists available to our country can be eased 

best through legislation of the type before you. through making greater opportunitie s available for the training of additional personnel to high standa rds.

The legislation which is before you is essential in the national interest. 

The basic problem of meeting this need for additional qualified medical and 

dental personnel is financial, and it is imp ortant to determine a fair sha re of 

our fiscal resources to be allocated in its suppo rt. I believe th at H.R. 4999
432 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

and the related bills offer a good sta rt on which the committee can base its 

judgment and I commend the principles of this program.

Sincerely,

E milio Q. Daddario, 

i f em be r of Congress.

The Chairman. A letter from Rutgers State University, which 

will be included together with accompanying letter.

(The two letters referred to from Rutgers State University follow:)

Rutgers State University,

Netc Brunswick, N.J., January 22, 1962.

Hon. Oren Harris,

House of Representatives, Washington, D.C.

Dear Mr. Harris : Last May I wrote a statem ent to explain our a ttitude toward 

the recommendations of the Association of American Medical Colleges in support 

of medical education by the Federal Government (see att ached). To this sta tement I would add these marginal comments to indicate the importance of H.R. 

4999 to Rutgers: The No. 1 prio rity for medical schools in this country is Federal 

matching funds for the expansion of existing medical schools and the construction 

of new medical schools. I am confident that such fund s will hasten the development, among other things, of 2-year programs in the medical sciences. Schools 

of the basic medical sciences encompass the first 2 yea rs of the medical curriculum. with a view tow ard tra nsfer of the stu den ts to 4-year medical schools for 

the ir junior and senior classes. Contrasted to the crowded freshman and 

sophomore classes, it is estimated tha t there are nearly 1,000 openings annually 

in both the third and fourth year classes of our Nation’s medical schools, with 

this situation pointing to an opportunity to add significantly to the number of 

young people undertaking the study of medicine.

I want to close by saying that medical program s, carefully organized and 

skillfully administered, can help meet the cou ntry ’s hea lth care needs in the 

next two decades. The Federal Government’s encou ragem ent of these programs 

would increase the total contribution to the expanding body of knowledge. 

Sincerely yours,

Mason W. Gross. 

May 4,1961.

Dr. Ward P arley,

Executive Director, Association of American Medical Colleges,

Evanston, 111.

Dear Dr. P arley: Your recent letter concerning the recommendations of the 

Association of American Medical Colleges in support of medical education by the 

Federal Government has been reviewed by several members of my staff. Rutgers 

supports your proposals in principle because the need for medical education in the 

United States is so gre at tha t it must be met quickly if we are to avoid the 

serious consequences resulting from a lowering of the current ratio of physicians 

to population.

* * * * * ♦ ♦

We at Rutgers feel tha t one way in which the available supply of physicians 

and related medical scientists can be increased is through the establishment of 

2-year program s in the medical sciences. Qualified gra duate s of these programs 

may elect to go on to medical schools for the ir thi rd and fou rth years, or may 

continue at the university for their Ph. D. Since most medical schools can 

enroll additional third- and fourth-y ear studen ts without significant additions to 

plant or faculty, it would seem th at such a program should be incorporated into 

any plan to increase the supply of medical personnel.

The number of 4-year schools is totally inadequate to supply the required 

physicians and we must increase them : but we should also atte mpt to increase 

this supply through all means available to the universities of the United States. 

Sincerely yours,

Mason W. Gross.

The Chairman. This concludes the witnesses for today.

The committee will adjourn until Tuesday next, at 10 o’clock.

(Whereupon, the committee adjourned at 4 p.m., to reconvene at 10 

a.m..Tuesday, Janu ary 30.1962.)
TRAINING OF PHYSICIANS, DENTISTS, AND PROFESSIONAL PFBLIC HEALTH PERSONNEL

TUES DAY, JA N U A R Y 30 . 19 62

H ouse of R epre sent ativ es,

Com mittee ox I nterstate and F oreign Commer ce.

Wa shi ngton , D.C.

The com mittee met at 10 a.m., p ursuan t to recess, in room 1334. New 

Hou se Office B uil din g, Hon. Oren H ar ris (ch airma n of the full committee) pre siding .

Th e Chairman. Let the com mittee come to order .

In resum ing the hearings this mo rni ng on II.R. 4999 and related 

bills, our first witness will be Mr. An drew J. Bie miller, directo r of 

the De pa rtm en t of Leg isla tion , Am erican Fe de ratio n of Labor and 

Congress of Ind ustri al Organiz ations.

Mr. Bie miller, I am gla d on beha lf of the committee to extend to 

you a welcome back to this committee. I am pa rticul arly gla d to 

welcome you because of the association th at we have had over the 

years da tin g back to your service in the Con gress and as a mem ber 

of this comm ittee.

We a re glad to hav e your state me nt this m orning.

STATEMENT OF ANDREW J. BIEM ILLER, DIRECTOR OF LEGISLATION FOR THE AMERICAN FEDERATION OF LABOR AND

CONGRESS OF INDUSTRIAL ORGANIZATIONS. ACCOMPANIED BY

LISBETH BAMBERGER

Mr. Biemiller. Th an k you, Mr. Ch airma n. Fo r the record, my 

nam e is An dre w J. Biemiller. I am director of legisla tion fo r the 

Am erican Fe de ratio n of Labor and Congres s o f In du strial Org an izations. I am accompa nied by Miss Lisbeth Bamb erger, assis tan t direc tor of the De partm ent of Social Security of the A FL-C IO .

I ap pe ar before you to pres ent the views of t ha t org aniza tio n on II.R. 

4999, t he proposed “H ealth Pro fessions Educational Assistance Ac t.’’

I know that you and many mem bers of this com mittee are awa re 

th at I have had a personal intere st of long sta nd ing in Fe de ral aid 

for medical edu cation. Du rin g my ten ure in the House, I spo nso red 

legisla tion to meet th at objective , and I am very pleased to hav e an 

op po rtu nity to ap pe ar here tod ay to express the str on g supp ort of the 

A FL -C IO fo r I I.R . 4999.

The need for th is legislation was am ply dem onstrate d at th at tim e; 

ir is even more critica l now. Our failu re to provide Fe deral su pp ort 

fo r medical edu cation has created severe hardsh ips for med ical students, for medical schools, and fo r the practic ing physicia ns whose 

433
434 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

time and str en gth are ove rtax ed because there are too few tra ined 

min ds and han ds to share t he ir burdens.

The greatest ha rdship, however, fai ls on the Am eric an people, 

whose medical care is too costly and too hard to get.

Let me illustr ate w ith an item that ap pe ared in the magazine . Newsweek, on Octob er 19, 1961:

At 7 p.m., wea ke ne d by a hy sterec to my, th e la w ye r's wife was giv en a blood 

tr an sf usi on by tw o re si de nt do cto rs, a German an d a Viet na mese. Silently, 

they rig ge d the tr ansf usi on bot tle an d in se rted th e ne ed le into he r ri ght arm. 

Th en , ju st as silent ly , they disa pp ea re d, leav ing th e pati ent alon e in a wellknow n W ashing ton, I).C., ho sp ita l.

An ho ur l at er , th e p ati ent no tic ed th at th e seru m in th e bo ttle was se pa ra ting, 

an d th e tu be seem ed clogged. Fr ig ht en ed , sh e ra ng th e call bu tton w ith he r 

fr ee left ha nd . No on e an sw er ed . Th e ph on e was ju st ou t of reac h on her ri gh t 

sid e. B it by bi t, re st in g be tw ee n moveme nts , sh e inch ed to w ar d it. Fin al ly at 

10 p.m., mo re th an 2 ho ur s a ft e r th e tr an sf usi on sh ou ld ha ve bee n comp leted, 

sh e was ab le to kn oc k th e ph on e to th e floor, an d th e tel ep ho ne oper at or se nt a 

nurs e to see w hat w as wr on g. She ca lle d th e tw o fo re ig n do cto rs, bu t nei th er 

spok e En glish , an d th e nu rs e tol d the p ati ent th at th ere w as n’t a sing le En glish - 

sp ea ki ng d oc tor av ai la bl e in th e ho spita l.

Now, pa ni c- strick en a nd w ith no one to re as su re he r, th e law ye r’s wife w atch ed 

the two fo re ign do ctor s ti nker with th e tr an sf usi on rig . Fi na lly, they go t it 

go ing an d th e tran sf us io n was co mp let ed at midnigh t.

As Newsweek comm ented on thi s s tory :

Th is is a ha rr ow in g ex am pl e of th e so rt of exi>erionee th at will becom e mo re 

com mon as th e na tion al doc to r sh or ta ge becom es more ac ute. The do ctor sh ort ­

ag e is no t only se riou s in ho sp ita ls. It pl ag ue s pare nts who are tryin g to find 

a do ctor fo r a sick ch ild at nig ht, re si den ts of ru ra l are as th at ac tu ally ha ve 

no do cto rs, an d. po te nt ia lly, an yb od y in a tim e of em erg ency.

But grim as the tale s may be of physicians una vailable at a time 

of crisis and emergency, thi s is only pa rt of the price the Nation is 

pay ing for ha vin g too few doctors to meet its needs.

Recently the D ep artm ent of He alth, Educat ion, and W elfare issued 

a r epo rt giv ing some of the sta tistics of the losses we suffer as a result 

of not fully using th e medical know ledg e we have.

At. leas t 40,000 cu rren t canc er death s are needless. If all curre nt 

knowledge about control, detection, and trea tm ent of cancer were fully 

app lied, 120,000 p atients with cancer could be saved ann ually instead 

of o nly 80,000. Cance r costs some $350 million in hospital bills, and 

more than $90 million in lost income of workers every yea r. Loss in 

goods and services res ultin g from can cer death s of people in the 

productive ages has been estima ted to total $15 billion a year.

Rheumatic fever and rheumatic heart disease take 20,000 Am erican 

lives each yea r. But doc tors can preven t rheum atic fev er by tre ating 

strep throats prom ptly with antibiotics. A study of 1,000 persons 

hospitalized because of recurrent att acks of rheumatic fever found 

that if these pa tie nts had been put on a schedule of antibiotic tr eatment at their first att ack. 90 percent could have avoided the second.

About a millio n pers ons who have glaucom a and almost a million 

and a ha lf persons who have diabetes are receiving no treatm ent lo ­

calise they don’t even know they’re sick—tho ugh these con ditions can 

now be easily detected . Un tre ate d diabetes and glaucoma tog eth er 

account for abou t 20 perc ent of all cases of blindness. More tha n 

100,000 blind people are receiving pub lic assistance at a cost of about 

90 million tax dollars a ye ar.
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSONNEL 435

The figures I have just cited e mphasize the do lla r value of needless 

loss throug h illness. The y provide no estima tes of the loss or delay 

in ideas, in scientific discoveries, or in political skills. Nor do they, 

or can they, estimate the h ours of suffering and agony bro ught by ill ­

ness, disab ility, a nd prem atu re death .

H.R. 4999 is not, of course, a full answer to this challenge. The 

Federal Government must also un derta ke othe r pro gra ms to provide 

services which citizen s have been unabl e to provide for themselves 

ind ividually o r th roug h local or St ate governments.

Economic ba rri ers that now sta nd betw een man y citiz ens and the 

medical care they need must be removed. We in the lab or movement 

have at least lowered that ba rri er fo r our own mem bers by establishing, throug h collective b arga ining , a wide ran ge of he alt h plans. We 

will continue our efforts in that direction . But we have found, throug h 

experience, th at these efforts need to be sup pleme nted by legisla tion . 

One ou tst an din g exam ple is an old-age medical care, where it has become obvious that the social sec urity appro ach, as pro vid ed by the 

King-A nders on bill, is both sound and necessary.

We believe there is a pres sing need for the expansion and reorga niz ation of health services, especially at the com munity level. Th e Com ­

mu nity Hea lth Serv ice and Fa cilitie s Act of 1961, passed un de r the 

lea der ship of this comm ittee, holds great prom ise for imp rovements 

in th is realm.

But the soundest reo rga niz ation of health care, and the most lite ra l 

prov isions f or financing it, to be fu lly effective must have the personnel 

to carry it out. In that sense, the bill te fo re you now is th e keystone 

of a sound healt h str uc ture for America.

A rec ita tio n of the sta tistical support fo r H.R. 4999 would, I am 

sure, be re du nd ant at thi s time. Th e witnesses who have preceded me 

du rin g these h earings have ably contrast ed the numb er of doc tors ou r 

Nation has with th e n umber of doctors ou r N ation needs, and will need 

in the futur e. The y have comp ared the pres ent cap aci ty of ou r medical schools with the medical school cap aci ty we must have and will 

requ ire in the fut ure. They have c ited the enormous costs o f a me dical edu cation, both to the studen t and to the insti tut ion which he attends, and the probability of future increases in these costs.

The evidence at han d shows une quiv ocally that in the absence of 

congressional action, the existing shor tag e of health personn el can only 

grow ste adily more acute, ad ding fu rt her to the mou nti ng cost of 

medical care and im pa iring its qu ali ty and avail ab ility to the public 

at large.

Recent years have seen a striking exp ansion in the dem and for 

medical services. The rap id spre ad of h ealth insurance pro gra ms and 

pre paym ent pla ns of various kin ds has meant th at million s of people who prev iou sly lacked the means to avail them selves of the k ind of 

medical attentio n that they needed a re now in a position to do so. The 

sh ift in population from rural to urban are as has added fu rthe r to 

the demand for services. Gr eater lif e exp ectancy has increased the 

pro portion o f the popula tion in the u pp er age g rou ps, where the h ig hest incidence of c hronic illness and the great est need for medical ser vices exists. These tre nds can be expected to continue , at an accelerated pace, in the futu re.
436 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

In the face of this, the sup ply of physicians is increasing at a 

relativel y static rat e that fal ls fa r short even of the rate that would 

be require d to ma int ain the existin g do cto r-p atien t ratio again st the 

normal increase in population . More people, dema nding more services per person, pre ssing upon a worsening shortage of phy sicians, 

can only increase the price of medical services, erode the valu e of 

health insuranc e pla ns and raise a hi gh er cost ba rri er between the 

public and the best th at modern medical science has to offer.

The c hief b ar rier to any sub stantial increase in our sup ply of ph ysicia ns is, of course, the lim ited cap aci ty of the Na tion’s medical 

schools. Ex istin g schools must be expand ed and new schools must be 

built. Both can be done witho ut in jury to the quality of education. 

It is clear that existing sources of finan cial supp ort are completely 

unable to meet the costs o f a construction and expa nsion pro gra m ade ­

qua te to the Nation’s needs. Federal financial aid, as provide d in 

II.R. 4999 is the only rea listic and pract ica l answ er.

The re has been con side rable discussion abo ut the decline in ap plications to medical schools du rin g the last several years. We believe 

th at the reasons fo r this are ma nifold . But cer tainly it is clea r 

th at with an ave rag e cost of $11,600 fo r 4 years of medical tra ining, 

the re is a vast res erv oir of talent ed young people who can not conside r the possi bil ity of e nte rin g the medical profession for purely economic reasons.

Tf the Na tion is no t going to lose the servic es of those who are 

gif ted bu t poo r, and if the equ ality of op po rtu nity we cherish in 

America is not, because of the enormo us cost of medical tra ining, 

going to exclude prom ising yo ung people from the o pp ortunity to become physicia ns and den tists, then a prog ram enacted by this Con ­

gress to pro vid e sch olarships to stu dents of medicine and denti str y 

is an absolute necessity.

In conc lusio n, let me suggest th at the Am eric an pub lic is acutely 

conscious o f o ur p resent sh ortage o f physicians. Recently, the m agazine, Good House kee ping, surveyed a sample of 1.744 women in all 

pa rts of the U nited State s, prim arily from the midd le-income groups, 

as to wh at these women think of their doc tors and of the medical profession. It is interesting th at the most fre quent com plaint th at ap ­

peared among the comments th at were volunteered at the end of the 

que stio nnaire rel ate d to doctors being too busy, not there when they 

were needed, a nd overworked. Here are some typical comm ents:

From a young woman in Florida : “We like onr doctor, but he is never available when we need him.” A housewife in a large Alabama city says. “I think 

most of the doctors today are overworked, overtired to do as well by their 

patients as they would like to. A tired body makes a tired mind." The young 

wife of a semiskilled worker in an Oklahoma city sta tes pointedly, “Doctors are 

overpaid and overworked. The solution is simple. More doctors are needed. 

Competition will at once make a man a more intelligent doctor and a more 

rested one. We can only profit with this * • •” iVom a city in Texas, an older 

woman writes, “We feel our doctors are trying to care for too many 

patients * * * the Fed eral Government ♦ • • can make more scholarships 

available, open more medical schools.” From a large city in Mis souri: “Being 

a registered professional nurse, I thin k * * * the general shortage of doctors 

taxes them individually to meet the public demand for care.” A widow in a 

small New York com munity; “I think we have a severe shortage of doctors, 

especially in rural communities. One doctor in our town has office hours until 

10:30 or 11 n.m.” A mother in a large Illinois cit y: “The present supply is 

entirely overburdened and overworked. Th at is why they are in a hurry, make
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 4 3 7

you wait hours in the waiting room.” A Colorado divorcee who lives with 

here two children in a medium-sized city: “Some persons feel they aren ’t 

given enough time by their doctor, but they don't realiz e the critical shortage 

of doctors and the tremendous demand * * *”

Although the concept of a physician shortage was never mentioned 

in the questionnaire sent out by Good Housekeeping, the magazine 

concluded that the existence of a doctor shortage was demonstrated 

by its national survey panel, and that—

the eloquent comments volunteered by the panelists lend human substance to a 

problem tha t can never be appreciated in terms of s tatistics alone.

Gentlemen, the members of the A FL-CIO throughout the country 

are also well aware of our national physician shortage. The AFL - 

CIO stated in convention action that the training of more doctors 

was—

among the most pressing of America’s health needs.

The AFL-C IO convention, meeting less than 2 months ago, called 

upon Congress to enact legislation—

to provide grants to medical and dental schools to assist these schools in financing 

of planning, construction, expansion, restoration, and cost of education, and for 

scholarships to qualified medical and dental students in need of financial 

assistance.

The need for legislation to provide Federal assistance to medical, 

dental and public health education is too compelling, so well documented and so immense that it is impossible to justify a single further 

day of hesitation or delay. We hope tha t this committee will act 

with a sense of urgency, to insure that when this session of Congress is 

over, programs will be underway to deal with a problem which is 

steadily increasing in severity.

The Chairman. Mr. Friedel, any questions?

Mr. F riedel. I want to thank Mr. Biemiller for a very fine statement. He has made some very good points.

Mr. Biemiller, you brought up the question of scholarships and the 

problem of the person who has the qualifications and could become 

a medical doctor or dentist but doesn’t have the funds to go forward.

And you also brought out that this is a national problem and not a 

State problem.

For instance, in Maryland we have the University of Maryland, 

and about 75 or 80 percent of the students are Marylanders. But after 

they graduate only about 38 percent practice in the State of Maryland, 

and the others go to other States. And it is not fair to make Maryland 

pay for the education of the doctors that go out to other States.

I do think it is a national problem. And I want to compliment 

you for a very fine statement.

The C hairman. Mr. O’Brien?

Mr. O’Brien. No questions, Mr. Chairman.

The Chairman. Mr. Hemphill?

Mr. Hemphill. Thank you, Mr. Chairman.

There is quoted from Newsweek here a statement which says:

Residents of rural areas tha t actually have no doctors.

One of the concerns that I have about this legislation is that we 

might not accomplish what we all want to accomplish by it. and that 

is. getting the doctors in the small towns at the rural areas where you
438 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

do not make $50,000 a year and where von have to see folks at ni gh t 

an d give them service. Fo rtu na tely I hav e a docto r th at serves well 

in my hometown. An d I suppose there is no way to write it into 

legislation, i t’s a m atter of m orals and service.

Mr. Biemiller. The suggestion has been made. Mr. Congressm an, 

in some insta nces—an d I am throwi ng it out as a suggestion wi tho ut 

try in g to pass jud gment on its value—that you might give a gr ea ter 

sch olarship in monetary terms to those who would agre e to serve X 

num ber or years in a rural area. I know that on a very small scale 

th is has been done in some institu tions.

Now, w hether th is has va lid ity or not, as I said , I do not at this tim e 

presume to pass jud gm ent, you would have to tal k to some of the 

people who deal with thi s problem day by day.

Mr. H em phill. Then we would have to go back to one of the elemental questions here, the question of a g ra nt o r the question of a loan, 

which appears to be one o f the questions befor e you. And you c ouldn ’t 

have a forg iveness featu re unless von had a lo an, the way I see it. Do 

you see any way of having a forgiven ess featu re in a g rant?

Mr. Biemiller. On loans , I would agre e. Bu t on the question of 

sch olarships, I would suggest the p ossibility of giv ing a more substa ntia l sch olarship to a person who would agre e to serve X number of 

ye ars in a rural area.

On the question of loans, if you are going to get into th at —we p re ­

fe r scholarship s, but if you are going into loans—you have got a patter n alread y set in ND EA , a va ria nt of this proposal under ND EA 

whe rein a person who agre es to teach for 5 y ear s is given 10 percen t

In some medical circles 1 know this matter has been discussed and 

put f orwa rd on a quite serious basis.

Mr. Hem phill. One of the thing s th at is bo the rin g me is the fact 

th at the re seems to have been a good bi t of testim ony here th at the 

peop le just cou ldn’t afford to go to medical school. As I understand 

the problem, the y haven’t got room fo r them if they go there.

Mr. Biemiller. Th at is a question. As I sta ted here earlie r, and 

as the cha irm an well knows, in 1949-50 1 was coautho r of the Taf tBie miller bill in which we attemp ted to set up a simi lar program . At 

th at time, I was, fran kly, a little more cu rre nt in my knowledge in 

ter ms of details than I am now. At th at tim e, the re was indeed a 

treme ndous sh ortage of places fo r ap pli can ts. But my u nd ersta nd ing 

is th at this is no longer the case tod ay, th at some medical schools are 

recruitin g—n ot recruitin g in any cru de sense—b ut are very anxious 

to have appli cants come in, and th at a well-qualified person doesn’t 

have too much difficulty finding a spot. However, if your statem ent 

is correct—a nd I am not dou bting th at there is valid ity in the term s 

of some schools—th is means th at the exp ans ion of existing schools 

as well as the bu ild ing of new schools is necessary, because you can 

only tak e so many p eople into t he fa cil ities, you can’t expand medical 

school fac ilitie s as you can, say, fo r a histo ry class, doub le it—while 

it is a bad th in g to do, you can do it with a his tory class—but you 

can ’t do th at with a medical lab orato ry, obviously.

And th at is anoth er reason why we feel very strongly th at we do 

want to get expansion of tea ching fac ilitie s as well as sch olarships 

for deserving students .

Mr. H em ph ill . Th an k you.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 439

The C hairm an. Any f urther questions ?

Th an k you v ery much, Mr. Biem ille r, for your appear anc e.

Dr. H ar ol dS .'D ie hl ?

Dr. Diehl, will you identify yours elf fo r th e record a nd proceed ?

STATEMENT OF DR. HAROLD S. DIEHL. SENIOR VICE PRESIDENT

FOR RESEARCH AND MEDICAL AFFA IRS AND DEPUTY EXECUTIVE VICE PRESIDENT OF THE AMERICAN CANCER SOCIETY. INC.

Dr. Die hl. Yes, Mr. Ch airma n.

Mr. Ch air man, and members of the comm ittee, I am Dr. Ha rold 

Diehl, sen ior vice presi dent fo r research and med ical affairs and 

deputy executive vice pre sid ent of the Americ an Cance r Society, 

Inc. Pri or to the assu mption of my presen t position, I serv ed for 23 

years as d ean of the medical sciences of the Un iversity of Minneso ta.

The privilege of my appeara nce before you this mo rning was requested by the Am erican Cance r Soc iety fo r two reason s: first, th at 

I mi gh t convey to you the so ciety’s ea rne st and str on g su pp ort of bill 

H.R . 4999, kn own as the “ Hea lth Pro fes sio ns Educati onal Assistance 

Ac t of 1961” : and second, that I might exp ress to yo u my own opinion 

based on ma ny years of experience in medical edu cation relative to 

cer tain aspe cts of t hi s bill.

Th e Am eric an Cance r Society is convinced th at the pur poses of 

this bill, nam ely, the e xpansion and imp rovement of medical researc h 

and the edu cation and tr ai ni ng of more ph ysicians are essential fo r the 

control of can cer and for the p rev ention of s uffering and death s from 

this dre ad disease.

Part A , section 3, of this bill pro vid es fo r the extension and expa nsion of rese arch fac ilities grants. Th e need fo r more an d be tte r fa ­

cili ties fo r medical researc h is so well recognized and has been so ably 

discussed b y othe rs who ha ve appeare d before you that 1 will not speak 

of this except to say that physicia ns are help less and will con tinu e to 

lie helpless to preven t fully ha lf of the 275,000 dea ths from cancer 

which occur each year in this country until scientific research gives 

us more com plete un de rst an ding o f the causes and the na ture o f cancer and pro vid es us with new tools and pro ced ure s fo r its early di ag ­

nosis, for its bet ter tre atm ent a nd ultim ate ly we hop e fo r its prevent ion.

The Con gress has given great im petus and assistan ce in recent y ears 

to the expansion and improveme nt of fac ilities fo r medical research. 

How ever, the re is still a great need fo r many unive rsities and me dical researc h centers fo r addit ion al rese arch facilities. Th e American 

Cance r Society hope s that you will assist in meetin g this need by the 

passage o f th is section of II.R. 4999.

Part, B of thi s bill pro vides gr an ts, on a ma tch ing basis, fo r construction of medical, den tal, osteopathic and pub lic health tea ching 

facilities. The need of more physicians to pro vid e ade quate medical 

care for the inc rea sin g population of o ur countr y is too well accepted 

to req uire arg um ent or do cum entatio n. Yet, the urgency of thi s need 

is pa rti cu larly impressive to those of us who are devotin g ourselves 

and ou r efforts to the contro l o f cancer. Th e reason is tha t we alrea dy 

have th e sc ientific knowledge necessary to save fu lly ha lf of the 450,000 

person s in th is co untry who each ye ar develop cancer. We are, however, sav ing only appro xim ate ly one-t hir d of these. In othe r words,
440 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

we have the medical and scientific know -how to save an addition al 

75,000 persons who each ye ar die from cancer.

Inc ide nta lly, let me interj ect, Mr. Ch air man, that yon and the 

members of the committee may note th at Mr. Biem ille r's figures are 

more conservative than mine. I think he mentio ned the figure of 

40,000 th at might be saved each yea r, as to the number of cancer 

death s that it should be possible to pre ven t. I am cer tain, however, 

that the figures th at I present are con servative ra th er than libe ral 

est imates in th is area.

To accomplish this we need not only the underst andin g and coopera tion of th e p ublic, but also more physicians to conduct the regu ­

lar tho rou gh phy sical exa mination s upon which the ear ly diagnosis 

of cancer so largel y depe nds. The Am eric an Cance r Society, therefore, has a very special intere st in havin g availabl e an adequate nu mber of well-train ed and cancer-conscious p hys icia ns.

In order to educate the physicians which ou r country needs, the 

tea ching facilities of existing medical schools must be exp and ed and 

improved and new medical schools must be developed. Th is need 

has been so well docu mented and convinc ingly pres ented to you by 

the presi dent of the Association of Americ an Medical Colleges, Dr. 

Don ald Anderson, that I will merely say th at I thoroughly subscribe 

to and endorse every thi ng that Dr. And erso n has pres ented and th at

I hope th at you will pass favora bly upon this section of the He alt h 

Pro fessions Ed ucational Assistan ce Act of 1961.

Pa rt C of this bill pro vides for sch olarship gr an ts fo r stu dents of 

medicine, osteop athy, and denti stry. It is to th is section of the bill 

th at I pa rti cu larly wish to address my rem arks.

It is obvious tha t if we are to have more phy sicians and m ore medical inv estigators we must have more high-qu ali ty medical stud ents. 

It is the pu rpose of the sch ola rsh ip section or this bill to help p rovide 

more such stud ent s for the hea lth profession.

To justify enactment of this section of the bill, you doubtless need 

to be satisfied upon several points; such as, is th ere a need for scholarship aid for medical stu de nts: will sch ola rships result in more high - 

quali ty appli cants for medical schools; and are sch olarships pr efer ­

able to o the r types of financial assistance such as loan funds?

Had I been talking with you about these questions prior to Wo rld 

W ar I I. my comments would h ave been q uite d ifferent from w hat they 

are today. To a very lar ge ex tent I worked my way throu gh medical 

school. I envied my classmates who did not need to spen d the time 

an d effort th at I did on all soils of jobs and acti vities. Yet I and 

many oth ers got our medical educations by so doin g. In my early 

years as a medical school dean , I felt th at most medical stud ents, if 

they had sufficient abilit y, energy, and desire, could do likewise. On 

this point, however, my thinking was vas tly cha nge d by my expe rience with the s tud ents who were in medical school du rin g Wo rld W ar

I I under the Army A STP and the Navy Y-12 pro gra ms and af te r 

World W ar II under the GI bill. As you doubtless remember, the 

stu dents under these military and vetera ns pro gra ms were pro vided 

with tui tion, books, and essential liv ing expenses. The resu lt was 

th at a large pro portio n of our medical stu dents were able and dedicat ed voun g men who without financial assistance would not have felt 

th at they could even dre am of un de rta king the long, expensive yea rs
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 441

of edu cation required for the practic e of medicine or fo r service in 

t he oth er he alt h professions.

And th at was 15 or 20 years ago. Tod ay the expenses of a tte nd ing 

medical school are vas tly gr ea ter and the possibi lities of earni ng 

money while so do ing are dis tin ctly less. Fu rth ermore, tod ay a larg e 

perce nta ge of poten tial medical studen ts are marrie d before they are 

rea dy to enter medical school. In fact, of las t ye ar ’s m edical gr ad uates 24 percent had been marr ied before en ter ing medical school and 

36 percen t were ma rried while in school. Many wives of ma rried 

stu de nts work to help su pp ort their h usbands in school bu t the arriv al 

of child ren usu ally puts an end to this at the same tim e th at it increases financial obligation s. We may not look w ith favo r upon these 

early marr iag es; nevertheless, they are amo ng the fac ts of life which 

we must face realist ically.

An oth er distu rbing fac t is th at more than ha lf of our medical 

stu dents come from the 10 percen t of fam ilies with incomes of $10,000 

or more per year. In other word s, about h alf o f ou r m edical studen ts 

come from 10 percent of ou r up pe r income fam ilies . Incid ental ly, as 

I am sure many of you realize from personal experience, it is not easy 

today, even with a fam ily income considerably in excess of $10,000 a 

yea r, to finance the college education of one’s children even tho ugh 

they do not asp ire to the long expensive edu cation required for medicine or m edical research.

Since Worl d W ar II , and the ter mination of benefits under the G I 

bill, the Un ive rsity of Minneso ta Medical School, with which I was 

asso ciated, has made a great effort to raise funds fo r sch olarships from 

alumni and from intere sted citizen s, p riv ate foundatio ns, a nd co rporat ions w ith in the Sta te.

Th e amount of these fund s has g rad ua lly increased but the num ber 

of sch olarships and the stipends which they ca rry are still, a nd from 

these sources always will be, woefully inad equate. For example, during the cu rre nt school year, the Unive rsity of Minnesota Medical 

School had $30,250 available fo r scho larsh ips. Th is am ount was used 

for the sup port of 70 sch ola rships with stipends rang in g from $100 

to $750 b ut avera gin g only $432. Yet 213 stu dents a pp lie d for these 

70 very m odest sch olarship a wards.

Loan fun ds, such as pro vid ed by the Na tio nal Defense Ed uca tion 

Act, are very valuable in helpi ng students meet emergency and un ­

antic ipated expenses but few studen ts are willing or able to borrow 

the basic fun ds req uired to finance the y ears of edu cation and tr ai ning req uired of physicians.

Business, ind ustry , and intelle ctual activities of all type s are competing for the best young candidates . Yet, rec rui tment for medicine 

and the oth er healt h professions is handica pped by the length and 

the costs of trai ni ng and the inadequacy of financ ial aid. To ma intain quality in our iu tu re physicia ns, we must be able to rec ruit a fa ir 

share of Am eric a’s finest minds fo r the medical profession. An d the 

rec ruits for a profession which serves all of ou r citiz ens should come 

fro m all walks of Am eric an life witho ut financia l roadbloc ks dive rting them to oth er vo cations o r occupations.

Su pe rio r ability and the desire to be of service to others are not 

limited to the children of pa rents in the up pe r income brackets. If 

sch olarship aid as pro vid ed in this bill becomes available, I am con80014— 62------ 20
442 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

vinc ed th at many more able and ded icated young men and young 

women will prepare themselves fo r careers in the healt h professions.

Pa ra gr ap h 2( d) un de r section C pro vides fo r educational grants 

to med ical schools. On the basis 01 long exp erie nce as a medical 

school dean, I can assure you th at the med ical schools need more 

funds th at their pa rent universities can pro vid e if they are to assemble and ret ain the fac ulties require d fo r the ins tru ction of the 

large num ber of stu dents whom we need fo r the h ealth profe ssion s.

I, therefore , urg e supp ort also for the op erating budgets of our 

medical schools.

In conclusion, 1 wish to express my appre cia tio n fo r the priv ilege 

of spe aking with you concerning this bill which the Am erican Ca ncer Society and I person ally feel is of basic im porta nce to the medical 

services which our people need a nd deserve.

I th an k you.

Th e C hairman. Mr. Rogers, an y questions?

Mr. Rogers of Texas. Dr. Diehl, I have been rec eiv ing quite a bit 

of mail from optom etrists com plainin g about not being inclu ded in 

this. Do you have any obse rvat ion on th at ?

Mr. Diehl. I have not had any pa rt in the for mula tio n of the bill. 

How ever, as much as we need to have our eyes refra cted and our 

glasses corrected, I would question whether optom etry is as basic a 

need of our society tod ay as t he other h ealth p rofessions pro vided for 

in the bill.

Mr. Rogers of Texa s. Do you think, then, th at it would lie sep arated even from the ge nera l catego ry of public h ealth personnel, Pu blic H ea lth Service personn el ?

Mr. Diehl . No; I do not feel th at optom etry should lie sepa rated 

from the catego ry of public healt h personnel, but the re are man y 

oth er health professions that are not incl uded in the bill, and if the 

bill covers too much it will become too impra ctical to enact.

Mr. Rogers of Texas. Doc tor, what pa rt, o r what percen tage of the 

needs can be met by the Cance r Society contr ibu tions, by volun tary 

contr ibu tions?

Dr. Diehl . Well, it is difficult to say. Some medical schools have 

more sch olarships from priva te sources than oth ers. At the Uni ­

versity of Minneso ta we have had—I say we, although I have lieen 

away from the re for almost 5 years—we have had unusual inte rest 

and support from the peop le of th e State in the medical school. And 

last year they succeeded in raising some $30,000, which pro vided 70 

sch ola rships averag ing $440 each. But for those 70 scholarships they 

had, I thin k, 213 app lications.

A $400 scho larship is rea lly inad equ ate to meet presen t day needs. 

Th is concerns me deeply , n ot only because o f wh at it mean s to medical 

stu de nts who are compelled to live in sit ua tio ns tha t handicap them in 

th ei r work and their fam ily life , but also, because I am convinced, 

af te r being acquainted with the students who received more adequate 

supp ort under the V-1 2, AST P, and GT prog ram s, that there are 

lar ge num bers of students who never ap ply fo r adm ission to medical 

schools, because they do not see any possibility of fina ncing the long, 

expensive medical course.

Mr. Rogers of Texas. I think that is righ t, Doctor. And 1 thi nk 

this, th at perha ps ther e are quite a few of these sch olarships that are
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 443

wasted to a certain extent, because you talk about giving a man $100 

or $150 it is like giving a starving man one drop of water to help 

him. A hundred dollars doesn’t go very far, or $150. 1 just wonder if 

any thought has been given to reevaluating the scholarship programs 

generally and trying to coordinate the efforts.

Dr. Diehl. 1 think studies of that sort have been made by the Association of American Medical Colleges. If I remember correctly, 

this bill provides scholarships to qualified students according to need 

but not to exceed $2,000 per year for up to 25 percent of the students 

in the school.

At the University of Minnesota last year approximately 40 percent 

of the students applied for 70 very modest scholarships available. So 

there is definite need for private funds to provide scholarships beyond t hose provided by this bill.

Mr. Rogers of Texas. Doctor, you do feel, though, that the provisions of this bill are properly the office of the Federal Government ?

Dr. Diehl. I feel that is a very proper area for the Federal Government to support, or one might say, to invest in, because no medical 

school provides physicians exclusively for any particular or limited 

area.

At the University of Minnesota, which is a State university, a large 

portion of the medical students are residents of the State. And yet 

less than 40 percent of these students practice medicine in the State.

So even a State university is not training students exclusively for 

that State. Its graduates are not only scattered throughout the 

United States for the practice of medicine but they also serve in the 

Armed Forces, the 1 .S. Public Health Service, the Veterans' Administration and other Government services.

Mr. Rogers of Texas. You think the proper procedure is for the 

States to move in this plan rather than create Federal universities to 

meet these needs?

Dr. Diehl. I do, definitely.

Mr. Rogers of Texas. Now, do you differentiate, Doctor, between 

grants-in-aid for construction purposes with relation to scholarship 

grants ?

Dr. Diehl. Well, they are both needed. In some medical schools 

facilities are adequate and do not meet modern requirements for instruction. These need modernizing and expansion. But buildings 

are of no value without students and we need more well qualified 

medical students.

Somebody stated earlier, I think it was Mr. Hemphill, that he understands that many students cannot get into medical school. In response to this I would say th at I do not know of a medical school in 

this country that is not desirous of more good applicants. The total 

number of applicants for admission to medical school is less than there 

were some years ago.

Every medical school is filling its classes, but some of the students 

are not very promising. In fact, the last ones admitted by practically 

every medical school are students of relatively lower levels of ability. 

I know that this was true at Minnesota where, we had a good group 

of applicants to draw from and the dean of Harvard told me that 

the same situation pertains there.
444 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Furth erm ore , stud ies have shown that medical schools are not g ettin g as larg e a percentage of hig h ability stu dents as measured by 

ap titud e tests and college grades as we were some years ago; and that 

a lar ge r proport ion of such stu dents are going into eng ineering, p hysics, and sim ilar profe ssion s.

Mr. Rogers of Texas. Doctor, 1 have been told several times by 

doc tors that the re are vacancies in all the medical schools thro ughout 

the Un ited States, in oth er words, that they could use more student s, 

th at they are not full, and tha t the re isn’t any need fo r building ad ­

dition al medical schools. Now, do I assume from th at statem ent t hat 

what you need is a reh abilitat ion of present fac ilitie s and an expa nsion of pres ent facilities?

Dr. Diehl. Both, man y medical schools need rehabil ita tio n and 

exp ans ion of pre sen t fac ilities, and we also need some new schools.

Mr. Rogers of Texas. Do you think. Doctor, th at the num ber of 

doc tors with relation to the population ou gh t to be increased?

Dr. Diehl. I do. Th ere are man y areas in which more phy sicians 

are needed. An d of course the population is inc rea sing.

A question was raised earlier about ge tti ng doc tors out to small 

commun ities, w hether a provision to encourage t his sho uld be attach ed 

to thi s bill. Per son ally , I question whether it would be desirable to 

req uir e th is as a p rovision of the bill. In M inne sota th e State m edical 

society has p rov ided a few scholars hips with provision th at recipients 

of these scholarships agre e to practic e for several year’s in com munities of 3,000 or less population . Som ething sim ila r migh t be considere d by your committee. On the othe r hand, some of the students 

who need financial assistance may make th ei r greatest con trib utions 

in research , teaching, or one of the specialties of med ical practic e.

How ever, if we trai n more doctors they will find th ei r ways into 

the s ma ller communities.

An othe r thing th at Congres s is doing whi ch will assist in this is 

the bu ild ing of hospitals and imp rov ing medical fac ilitie s in small 

commun ities. The young docto r who goes into a small com munity 

usu ally can make a be tte r income tha n the doctor who takes more 

ye ars of specialty trai ni ng and then locates in a city. A ma jor 

difficulty is th at in man y small communities physicia ns do not have 

the fac ilitie s required fo r modern medical practic e. A young doctor 

ju st does not feel he is doing rig ht by his pa tie nts unless he has the 

facil ities to pra ctice good medicine. Fu rth ermore, doc tors in small 

com munities are o ften overworked.

Mr. Rogers of Texa s. I was inte rested in y ou r statem ent that you 

worked yo ur way throug h medical school. Of course, everyone who 

did th at is very pro ud of it, includ ing me, who worked my way 

th roug h law school—there were time s when I di dn ’t think I was 

going to mak e it. But don ’t y ou think at the prese nt time th at the 

new* numb ers you have ap plying for medical school is due pa rtl y to 

the fact th at many of these ooys hes itate to get into prem ed because 

they do n’t have any assurance th at they are going to be allow ed to 

get, int o medical school when they finish th ei r prem ed?

I know several boys who were in school at th e time I was th ere, and 

some of them wen t thro ug h a prem ed course and were blocked from 

ge tting into medical schools and went back and ha d to tak e a B.A.

Dr. Diehl. That may well be true.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 445

Many medical educators, ho wever, do not like this so-called premed 

course. We think th at a doc tor should have a good libera l edu cation 

with the inclusion of certain science subject s which are necessary as 

a bac kgrou nd fo r medicine.

When I go t my B.A. degree I had not pla nned to stu dy medicine. 

So I taug ht high school a coup le of years to pay back the money I 

borrow ed fo r college and saved a little , and the n I decided to go into 

medicine. Th e lon g time involved in such a prog ram may de ter some. 

Bu t the stu de nt can pla n his course to pro vid e a good libera l edu cation an d still incl ude the science courses th at he needs. I deplore 

the pra ctice of the stu dent who goes into academic college as a pr emedical stu de nt and tak es a lim ited, narro w prog ram to tak e the 

short est rou te th at h e think s is going to get him into med ical school.

Mr. R ogers of Texas. Now, Doc tor, in your State , do you have 

sch ola rsh ips where the recipient of such a sch ola rship is req uir ed to 

agre e to serve in a small com munity for a certain len gth of time ?

Dr. Diehl. The State medical society has pro vided one of those 

sch olarships each year.

Mr. Rogers of Texas. W ha t was yo ur experienc e with them ?

Dr. Dieh l. We have alw ays had ap pli cants for them . But as 1 

say. we have only had one such sch ola rsh ip a year.

Mr. IhxiERs o f Texas. Do you think, i f you exp and ed the n um ber of 

sch olarships in that reg ard , with the numbei of a pplic ati ons it would 

help out on this smalltow n s itu ati on ?

Dr. Dieh l. It might help. But as I said Indore, I feel tha t if we 

tra in more doctors, many of them will find their way into the sma ller 

communities. It certainl y would not be a happy s itu ati on f or a youn g 

doc tor to go to a small com munity merely because of an obligation 

to do so; or to remain there if he were dissatisfied or unhappy.

Actua lly, the finest satisfaction that a doctor can get in the practic e 

of medicine is fr equ ent ly found in a small com munity where he knows 

the people, they know him, he is t he ir counselor and th ei r friend, and 

still he has the facilities to pra ctice the q uality o f medicine tha t fiv es 

him a personal and p rofessional satisfac tion.

Mr. R(xjers of Texa s. Doctor, what would you thi nk of a provision 

in thi s bill requ iri ng a sort of po sti nternship in a small town of, say. 

the same length of t ime as an inte rnship ?

Dr. Dieh l. No, I do not think that would lx* d esirable. Some medical schools are req uirin g stu dents as pa rt of their clin ical trai ning to 

spend 6 weeks or a month with docto rs in small com mun ities . The 

Un iversity of 'Wisconsin and the Un ive rsity of Kansa s Medical 

Schools do that. Th is is fine, but I think that it would lie undesira ble 

to r equire it of all medical schools.

Mr. R ogers of Te xas. Th an k you, Mr. Ch airma n.

The Chair man. Any fu rth er questions?

Mr. Younger ?

Mr. Younger. Dr. Diehl, when the Se creta ry appeare d before the 

committee lie told us that he had plac ed a holding on $102 million of 

their ap prop riated funds. And pa rt of those fun ds were withhe ld 

from the Can cer Research In stitu te. He answ ered the que stio ns, as 

I recall, that the Congress had ap prop ria ted more money than could 

be int ellige ntly used—I would like yo ur opinion on that as to can cer 

research.
44f) TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

I)r. Dieh l. The American Can cer Society has given thi s question 

very careful con sideration because we have hea rd sim ila r reports . 

Ou r conclusions are, as repres ent atives of the society will tes tify before Congress, that not only the amo unt ap prop riated last year 'out a 

very substan tially larg er amo unt can be effectively used and is really 

needed to su pport w ort hw hile cancer researc h to day .

The American Cance r Society has scientific adv isory comm ittees 

composed of scientists all over the country th at pass upon the requests 

fo r rese arch su pp ort th at we receive. An d at the last mee ting o f the 

board of di rec tors we ha d appro xim ate ly $4 million in app lications for 

gr an ts app rov ed by ou r adv isory committees beyond that we were 

unable to sup port because o f ina deq uate fun ds. In addition , we have 

stu died the situation o f the National Cance r I ns titu te , and we are convinc ed that the statem ent th at there is more money for cancer research tha n can lie use effectively is inaccura te.

Mr. Younger. I am glad to get that testimony.

T hat is all, Mr. C hai rman.

Th e Chairma n. Mr. O'B rie n?

Mr. O'Brien. You s tated, I believe, t hat 60 pe rcen t of the graduates 

of medical schools last ye ar were ma rried, is that cor rect?

Dr. Dieiil . Yes, th at is correct.

Mr. O'Brien. W asn’t there a time when most colleges and unive rsiti es frow ned upon ma rried studen ts? I know the GT bill changed 

a g rea t deal of th e t hink ing in t ha t respect. But isn't it a fac t that in 

many schools th at if you were marrie d du ring yo ur un dergrad uate 

period von were dism issed from school ?

Dr. Diehl . Th is has never been tru e of medical schools and certainly in recent years it has not been tru e of other colleges. When I 

was in medical school, the re were not more than 3 or 4 stu dents in my 

class who were marrie d when they finished. Now 60 perc ent or more 

are m arried . I person ally wish that these y oung fo lks would postpone 

ge tting ma rried. I think it would be bette r fo r th eir edu cation, and 

be tte r f or th eir l ater family development. But this is one of the situ atio ns that we are faced with. In some instances, as you said, the GI 

bill enabled them to get ma rried, and, of course, many of them had 

postponed t he ir m arr iag e d ue to wa r service. It was the general opinion th at af te r the end o f th e wa r an d th e te rm ina tio n of the GT bill, the 

pro portion of student ma rriages would drop , but it has not done so.

Mr. O’Brten. Doctor, I was inte rested in your statistics. T have 

been a little concerned d ur ing the h earin g w ith the suggestion that pe rha ps because of the lack of fac ilities we should proceed now with the 

con stru ctio n in t his bill and perha ps p ostpon e the scholarships. Isn’t 

it a fact that when it comes t o decision or desire to go in to t he medical 

profession, th at is v ery often bom at the hig h school level, a studen t 

mi gh t have a pa rtic ul ar talent in that dir ection, he consults with his 

parents, or he looks aro und in his house and finds out th at ther e are 5 

othe r kids th at have to go to colleges, so he aba ndons the idea of tha t 

an d pursues a course o f stu dy in anoth er dir ection, is th at tr ue ?

Dr. Dieh l. I am s ure th at is true .

Mr. O’Brien. Wouldn 't the sch olarship prov ision in this bill help 

not only those who are very near going to medical school but those 

some distanc e away in planning their medical career?
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 447

Dr. Diehl. That is right. If this bill is passed they can look forward to an opportunity for financial assistance if they need it and 

can qualify for it by the t ime they get to medical school.

Mr. O’Brien. Wouldn’t you say a very heavy percentage of those 

who might otherwise go into medical school or try to get into medical 

school are diverted at the high school level because of the financial 

situation of their family ?

Dr. Diehl. Yes, in both high school and college.

Mr. O'Brien. Statistics always overwhelm me a little bit. You 

say that, over half of our medical students come from 10 percent of 

the families with incomes of $10,000 or more a year. Isn’t it a fact 

that nearly half of your students come from about 7 percent of the 

families, and tha t $10,000 a year nowadays, if there is more than one 

child in the famly, would make it very difficult to educate a boy all 

the way through medical school ?

Dr. D iehl. Tha t is quite true.

Mr. O’Brien. And if it is done it would often be done at the expense of other children in the family ?

Dr. Diehl. That is right.

Mr. O’Brien. Thank you very much, Mr. Chairman.

Mr. Nelsen. Mr. Chairman, I wish to welcome Dr. Diehl to the 

committee. I remember his appearances before our legislative committees in Minnesota for many years, and we are grate ful for his 

leadership in the University of Minnesota Medical School, which is 

one of the best in the country.

1 was interested in your statement as to working your way through 

medical school. And this same question has been brought up several 

times by other members of the committee, t hat a part of the makeup 

of any good citizen is a desire to want to pay back any assistance that 

has been given him in any field. And, of course, the testimony tha t 

you cite presents some factors tha t have come with the times, which 

makes it more difficult.

But there would be merit, in my judgment, to a liberal loan program that would have some liberal forgiveness features in it, at the 

same time also presenting a situation where a revolving fund could 

build up where there would be money coming back to educate those 

who follow and those who might have enjoyed some assistance and 

help from that program.

Wouldn’t you feel that there would lie some merit in the liberal loan 

feature also ?

Dr. Diehl. You speak of a loan program with forgiveness features 

in it. Such loans would be somewhat like scholarships.

As I said before the situation is vastly different today from when 

I was a student. Expenses are higher, the medical curriculum is 

heavier, and the students do not have the opportunities to work on 

the side t ha t we had. In fact, I feel quite certain tha t at the one 

time tha t I had to make a decision as to whether to take a position 

that was available to me or go into medicine, I would not have felt 

that I could have gone into medicine had I been faced with the financial situation th at confronts medical students today.

And. as to loans, they are very helpful, but not all students are 

willing to accept loans. At the University of Minnesota some loan 

funds were unused because students, particularly if they are married.
448 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

just, do not wa nt to mo rtg age their future. I do not thi nk that 

sch ola rsh ips should be so large that they jus t tak e care of all expenses so that stud ents can ju st ride alon g. If sch olarships a re mod ­

est, a s pro vid ed by this bill, an ind ividual would hav e to make a real 

contr ibuti on h imse lf. There is m uch to be said for a person showing 

incen tive.

Mr. Nelsen. At Good Th un der, Minn ., the com munity there built 

a clinic for the denti sts and a docto r, a beau tiful fac ility. And a 

docto r came in at their inv itation, bu t left withi n a mon th, and they 

still have no doctor. Th is was several mo nth s ago.

You mentioned som ething a bou t facilities in which to work. And 

as I mentioned before, the incentive featu re in this bill mig ht not do 

the job. But would it not be tru e that if we had an abundance of 

doc tors th is would be corre cted, b ut not u ntil ?

Dr . Diehl . Th at is rig ht. In fact, I saw’ in the pa pe r recen tly 

th at Graceville, where Se na tor Oliver used to live, is now with out a 

doctor. Sh ortly before I left Minnesota as dean, a you ng doctor 

came to me anti said , “Can you help me find someone who will join 

me in pract ice ?” He was located way up no rth ne ar the Canad ian 

borde r. He said , “So fa r as income is concerned, I am makin g more 

th an I am inte rested in or concerned with. ” Bu t, he said, “I just 

can’t stay , I am going to hav e to leave unless I get some help. I 

am no t living, I am going 7 day s a week, and ha lf the nig ht. And I 

cannot take it much longer. Unless I can ge t help I will go to the 

city and take oth er work at ha lf the income I am ge tting now."

So it isn't prim arily income, it is havin g fac ilitie s and sufficient 

oppo rtu nity as to pati ent load and so as to do a satisfac tor y type of 

work.

Mr. Nelsen. W ha t percen tage of your grad ua tes at Minn esota go 

outside th e S tate to pr ac tic e; have you any figu re th ere ?

Dr . Diehl. A few’ yea rs ago when we surv eyed th at , it was abo ut 

GO perc ent.

Mr. N elsen. Almost < wo-thirds go out of the State ?

Dr. Dieh l. Yes. But Minnesota gets abo ut an equal num ber who 

come into the State from other medical schools.

Mr. Nelsen. H ow does the Un ive rsity of Minnesota Medical 

School, as fa r as size is concerned, c ompare with th e country ?

Dr. Diehl. Wh en T left I think we had about 125 students to a 

class, tod ay they are taki ng 140. And as fac ilitie s are e xpa nded this 

number will be increased somew hat.

As you know, the Min nesota Legislature has been very help ful in 

ex panding and im proving our medical school fac ilities .

Sir. Nelsen. Th an k you very much, Doctor.

The Chair man. Mr. Korne gay?

Mr. Kornegay. No questions.

The Chair man. Mr. Cu rti n?

Mr. Curtin. Th an k you, Mr. Chairma n.

Doctor, from w’hat you say there would ap pe ar to lie no question 

bu t what the g rea tes t sca rcity of do ctors is in the ru ral com mun ities ; 

is tha t correct ?

Dr. Dieh l. Yes.

Mr. Ci rtin. Is th ere a nyw ay we could work these gra nts , or loans, 

whic hever they might eve nutally be, so th at a fa ir pro portio nate
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 449

numb er of these new doctors would become gen era l pr ac titione rs in 

a rur al are a ra th er tha n spe cialists in an urb an com mu nity?

Dr. Diehl . Mr. Nelsen men tion ed the possibility of a forg iveness 

feature. One possibility th at has been suggested is a loan fund 

with certa in forgiven ess fea tures fo r the yea rs th at the y spe nd in a 

small com munity or in tea ching or researc h in which there is a need. 

Th at has appe ali ng feature s. On the othe r hand, I feel, as I said 

before, th at basically the best solu tion is to provide more doctors so 

that, the re will tie more of them to go ou t into these communities.

Mr. Curt in. Ap pa rently one of the main objections to being a 

general pr ac titione r is the very lon g hou rs, and I presum e th at the 

income fea ture is also a factor.

Dr. Diehl . By and larg e, the gen era l pr ac titione r does well as fa r 

as income is concerned.

Mr. Curtin. But isn't it a fa ct th at we are ge tti ng a dispropo rtionate numb er of doctors cong rega tin g in the urban com munity 

where they become specialists a nd do no t work long hou rs, while this 

sca rcit y of doc tors in the ru ral are as gro ws more noticeab le?

Dr. Die h i. Th ere is a limit to the numb er of spe cialists th at are 

needed in the var iou s areas. In general, our country has opera ted 

on the princ iple of sup ply and dem and . An d I think it would a pp ly 

here.

Mr. Curtin. What would be yo ur final word , then, on some form 

of a con ditiona l gr an t if it was a gra nt or forg iveness of par t of a 

loan, if it was a loan, con dition al on practic ing in a ru ra l are a?

Dr. Die hl. Perso nally, I think the bill is excellent as it is. If 

the committee wishes to consid er the pos sibility of loans w ith f orgive ­

ness for service to certa in com mun ities , in tea chi ng, in rese arch, and 

in oth er typ es of public sendee, I agree th at the suggestion is well 

worthy of explo ration .

I might add th at at the time the V-1 2 and A STP prog rams were 

disc ontinued, I was associated wi th the National He alth Resources 

Com mittee, and there was the question, how we could get enou gh doctors fo r the arm ed services. W ith th is in mind, I asked ou r medical 

stu dents how many of them w ould be willing to agre e to serve a year 

in the arm ed servic es—Army, Nav y, or A ir F orce—for each ye ar th at 

you receive a continuation of financia l assistance such as you have 

had under A STP or V-12. As I rem emb er it, about 40 perce nt of 

the hands went up.

Mr. Cur tin. That would ra th er ind ica te th at such a complete, or 

pa rti al forgiveness o f a loan, or a condition al gr an t, would be successful, don’t you th ink ?

Dr. Diehl . Yes: I do. In fac t, I tri ed to ca rry on a one-man effort 

to get th at sort of prog ram appro ved, bu t I did not get any where 

with it.

Mr. C ur tin. Tha nk you, Mr. Ch airma n.

The Chairma n. Mr. Heale y, any que stio ns ?

Mr. H ealey. No questions.

The C hairman. Th an k you very much, Doctor.

We a re very g lad to have you r presence here tod ay.

At this time, I am gla d to welcome ou r colleagu e, the Ho norab le 

Henry B. Gonzalez.

Mr. G onzalez, we want to extend to you a welcome to this comm ittee . 

I believe th is is your first visit.
450 TRAININ G OF PRO FES SIO NAL PUBLIC HE AL TH PERSON NE L

STAT EMENT OF HON. HENR Y B. GONZALEZ. A REPRESEN TA TIV E

IN CONGRESS FROM THE 20TH DIS TRICT OF TH E STATE OF

TEXA S

Mr. Gonzalez. Yes; it is, sir.

The Chairman. And 1 think it is quite interesting that you would 

come here on such an important proposal as this bill is under consideration now.

Mr. Gonzalez. Thank you.

The Chairman. And we are very glad to have your statement.

Mr. Gonzalez. Thank you very much, Mr. Chairman.

Mr. Rogers of Texas. Mr. Chairman, as a fellow Texan may I also 

welcome Mr. Gonzalez and say that he is probably moving faster than 

any man 1 know in Congress. A week ago I introduced him as the 

newest member of the Texas delegation. lie has gained two places 

in less than a week. So if he continues to move that fast, he is going 

to go far.

11 is good to have you, Mr. Gonzalez.

Mr. Gonzalez. Well, I have a mighty big place to fill. You know 

my predecessor, Mr. Kilday, was highly thought of, and served very 

ably in my district, and it is a pretty tough job to come in at midstream 

and try to carry on.

But I deeply appreciate your willingness to listen to me. I don’t 

intend to take much of your time, because 1 think that most of what 

I have to say may already have been on record here through other 

sources.

I know Dr. Ransom, the chancellor of the University of Texas, 

and Dr. James P. Hollevs, who is president of the medical foundation 

in Bexar County, and also other people are interested in this bill. But 

essentially I just want to reemphasize some of the points that Dr. 

Ransom lias made in his letter to the committee in behalf of this 

11.R. 4999.

It is a very important bill to us.

I have a little bit more than just a passing knowledge of the need, 

because 1 served in the State senate, and had the bill in the senate 

that designated Bexar County as the site fo r the third branch of the 

University of Texas Medical School. And last year the State legislature appropriated moneys. But p art of the moneys were ap prop riated on the basis that there would oe matching funds available from 

the Federal Government.

Now, Dr. Ransom points out that in Texas the demands placed 

upon the institutions providing supplies of doctors and dentists are 

such that unless this type of legislation is enacted, Texas will fall short 

of meeting its obligations in that very important respect.

I want to especially emphasize one statement that he made. He 

sa id :

The se re al it ie s dic ta te our conclus ion th at es se nt ia l ph ys ical fa ci lities fo r me dica l an d de nt al ed uc at io n in th e Sta te can he pr ov id ed on ly thro ug h the sh ar ed 

fin an cing a rr an gem en ts p ropo sed in II.R. 41MM1—

and with particular reference to section B or part B of the grants-inaid on a shared-cost basis for the physical plants that are necessary.

I know that my community has thoroughly showed its wholehearted 

and solid support, because we had a $9 million bond issue that carried overwhelmingly 10 to 1 in behalf of providing the local funds,
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONN EL 451

I ho countywide funds, in its attempt to share the cost of construction 

of the third branch of the school.

I would like to conclude by saying tha t everything you have here 

on the record from Dr. Ransom and the other doctors and leaders 

from this area is not only true, but in fact we could add a lot more to 

them, and that this is very, very important legislation, it means a 

great deal to us in Texas generally ami in Bexar County particularly. 

And I, for one, would be most grateful to you for your favorable 

consideration of this measure.

I want to express my personal admiration of this committee. I 

know what you have done. And I know some of the very intricate 

bits of legislation you have had here. But 1 want to thank you for 

what you have done already. And I know that many, many of our 

activities in Texas certainly would not have been possible had it not 

been for the realistic confrontation on the part of committees like this 

one, particularly in the past, to help us through grants-in-aid and a 

shared-cost basis for construction of hospitals and medical schools 

and the facilities that are needed. We have had a shortage. We were 

able to sell the legislature, which was pretty hard to sell at a time when 

we were having a financial crisis. So I think you gentlemen can understand that that legislature was a very hard body to sell, and when 

it reached the point that it was willing to authorize the construction 

of a third branch of the medical school of the University of Texas, it 

must have been because we really had the facts, and the shortages 

t here were obvious.

So 1 want to thank you very much for your time and your patience. 

And if there are any questions you feel 1 can answer, I will try to 

answer them, though I must say in all fairness that some of the written material that has been sent here has been prepared by experts 

like the chancellor of the university and the men who head this medical foundation in my hometown.

But 1 am very grateful, Mr. Chairman.

The Chairman. Let me say to our colleague that we appreciate 

your interest in the legislation and the problems involved here. We 

have had a great amount of testimony, a lot of testimony from highly 

qualified experts in the field and from doctors and deans and a lot of 

other people throughout the United States. I am sure there could 

be a lot of questions asked by the members.

Is there anyone who has any questions ?

Thank you very much. We appreciate your taking the time from 

your busy schedule and expressing your feelings with respect to this 

legislation.

Air. Gonzalez. Thank you, Mr. Chairman, and members of the 

committee.

The Chairman. I)r. Martin Lichterman ?

Dr. Lichterman, we would be glad to have your presentation.

STATEMENT OF DR. MARTIN LICHTERMAN. EXECUTIVE SECRETARY. NEW ENGLAND BOARD OF HIGHER EDUCATION. W IN ­

CHESTER, MASS.

Dr. Lichterman. Mr. Chairman, and gentlemen of the committee, 

I am Dr. Martin Lichterman, executive secretary of the New England 

Board of Higher Education, an interstate agency with headquarters 

in Winchester, Mass.
452 TRAIN ING o r PRO FES SIONAL PUBLIC HE AL TH PERSON NEL

1 deeply appreciate the privilege and opportunity of coming before 

your honorable committee to testify in favor of H.R. 4999. 1 should

like to state at the outset that I am not a physician.

But my interest in the legislation now being considered by this 

committee arises from the work that has been done by the agency 

with which I am connected. The New England Board of Higher 

Education is an interstate agency established under a compact approved by Congress in 1954 and by legislation enacted by the six New 

England States. We are thus an official agency of the States and we 

are supported by appropriations on a per capita basis by each of the 

New England states. Our board consists of 18 members, both laymen and educators—3 from each State who are either appointed by 

the Governor or who serve ex officio, and I might add that they are 

distinguished members of their respective communities, and include 

5 of the 6 university presidents in the region, a former dean of one 

of our medical schools, and many other outstanding citizens.

From its inception, one of the major objectives of the New England 

Board of Higher Education has been identical to those of the proposed bill—

to in cr ea se th e op po rtun itie s fo r th e tr ai nin g of ph ys ic ians , den tist s, an d pr of es ­

si on al pu blic hea lth pe rson ne l an d for ot he r pu rpos es.

While we have been concerned with improving and extending the 

opportunities for the youth of New England for higher education 

generally, we have been especially concerned with stimulating and increasing the opportunities for education in medicine and dentistry. 

As we have surveyed the region’s manpower needs in specialized 

fields, we have viewed with increasing concern the declining number 

of New England students entering the fields of medicine and dentistry.

While New England at present enjoys a favorable position as 

compared to the United States at large in terms of the ratio of 

physicians per 100,000 population, 155 per 100,000 in contrast to 

the national average of 118, in actuality three of our States are 

below the national average and one, Maine, has a ratio of physicians 

to population that is among the lowest in the Nation. Far more 

significant is the fact that of the six New England States only one, 

Vermont, ranks above the national median in the number of firstyear medical students per 100,000 population. Of the 50 States and 

the District of Columbia, Vermont ties with Wyoming for 18th 

place: Massachusetts ranks 26th; Connecticut 33d; Rhode Island 

44th; New Hampshire, 46th: and Maine is in last place at 51st. Our 

futu re sunply of physicians, therefore, is very much in doubt.

In seeking ways and means of providing our region with adequate 

numbers of physicians and dentists, the New England Board of 

Higher Education, after considerable study, recommend the establishment of additional publicly supported medical and dental schools 

and the establishment of programs which will encourage interest in 

medical and dental education and provide financial assistance to prospective students. For this reason we are particularly interested in 

parts B and C of the proposed act dealing with grants for construction of medical, dental, osteopathic, and public health training facilities, and scholarship grants to schools of medicine, osteopathy, and 

dentistry. The needs of our region and the Nation at large will be 

met only by the expansion and rehabilitation of our existing medical
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 453

schools and develop men t of new ones and by a sch ola rsh ip prog ram 

which will ease the cost of edu cation of t he stu dent and , at the same 

time, help to meet the necessary incr eased cost of edu cat ion to the 

ins tituti ons enrolling t he addit ion al studen ts.

Th is com mittee has alread y he ard testimony fro m dis tin guish ed 

New En glanders, as well as a gr ea t many of other peop le fro m all 

pa rts of the country , including Gov. Jo hn Dempsey, of Conne ctic ut, 

and Dr. Geo rge A. Wo lf, Jr ., executive directo r of the Tu fts-N ew 

En gland Medical Ce nte r and vice president for medical and denta l 

affairs o f T uft s Un ive rsity, as to the importance o f H.R. 4999 to New 

En glan d. I t has also, I believe, received a lette r fro m the deans of 

Boston’s three schools of med icine stat in g th ei r str on g su pp or t of 

the pending legisla tion. I do not wish to impose on the com mittee’s 

time by repe ating wh at has alr eady been sta ted by these gentlem en. 

I would, however, like to sum marize wh at the im pact of gr an ts fo r 

con struction of fa cil ities would be on New Eng la nd ’s ex isting medical 

schools.

Th e Un ivers ity of Ve rmont’s College of Medicine would be able 

to increase its class size from 50 to 75, bu t only with substan tia l 

Federal assistance. Th e thr ee Bos ton are a medical schools wou ld 

be able to expan d sufficiently as a result of the leg islation to equal 

one entire ly new medical school. The Tuf ts Un iversity School of 

Den tal Medicine which has lieen the lar gest single source of denti sts 

for the whole region, not only would be able to increase its en rollment of d ent al stu dents but would be able to develop an en tirely new 

prog ram fo r trai ni ng ancillary pers onnel th at might well be able 

to supply all of New En glan d's den tal needs for the foreseeable 

fut ure . Har va rd Denta l School would be able to increase its enrollment by 50 percent.

As to new schools, the situation is even more dra ma tic. Th e St ate 

of Connect icut has alr ead y autho rized the esta blis hment of a medicalden tal school as pa rt of the State unive rsity and an ap prop ria tio n of 

$2 million was auth ori zed at the last session of the Con necticut G ene ral 

Assem bly to commence plan ning and con struction of the school. 

Gr an ts for construc tion pro vided un de r H.R. 4999 would mean th at 

Ibis new fac ility would l>e built and pu t into opera tion at an ea rli er 

date than is at prese nt con tem plated, and pe rhaps an even la rg er 

school could be established. The Com monwe alth of Massachu setts 

is also consider ing the esta blis hment of a medical school as pa rt of 

its St ate unive rsity and a recess comm ission of the gen eral court ha s 

una nim ous ly recommended the establ ishment of such a school, and 

legislation is now befo re the general cou rt. There is no doubt th at 

Federal aid would be a trem end ous ince ntive to the con struction of a 

new medical school.

Brown Un iversit y's pla ns fo r est ablishin g a 2-vear college of basic 

medical science will pro bab ly be unable to get off th e ground withou* 

susta nti al Fe de ral assistance.

Fina lly , I would like to m ention the needs of New En gl an d's school: 

of pub lic health. These ins tituti ons at H ar va rd and Yal e Unive r 

sitie s tra in men and women for national service. They are in desperate 

need o f additional facilities. Har va rd , if aided in t he co nstru ction of 

these f acilities, could increase its enrollments by as much as 35 per ce nt 

and Yale, w hich h as a t p resent a v ery small pro gra m in publi c h ea lth 

could double its enrollment, were ad dit ion al fac ilities provide d.
454 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

In sho rt, then, the New En gla nd Boa rd of Hi gh er Education is 

persuaded that one way, and an effective one, of incr easing the op po rtun itie s for education and training of physicia ns and dentists and 

pub lic hea lth pers onnel, and thu s ass uring ade qua te hea lth care for 

our citizens, is new gr an ts for the con struction of teaching fac ilities 

as provide d for in the proposed bill H.R. 4999.

GRANTS FOR SCH OLARS HIPS

Qu ite as important, I believe, as the provision of addition al ph ysical facilities for the edu cation of medical stu dents is the need for 

add itio nal fun ds to finance medical stu dents edu cation. Ex am ina - 

t ion of t he mil ional, as well as t he local pict lire in New En gla nd, reveals 

a str iking paradox. On the one hand, we say th at we need more 

medical schools, and on the o the r hand we look at the figures provided 

by such ins titu tions as the Association of American Medical Colleges— 

and I have hea rd thi s from the deans of medical schools themselves— 

and we find that over th e past decade our medical schools have experienced a very real decline both in the overall qu ali ty and the qu an tity 

of appli cants for admissio n. We have seen a dram atic rise in the 

tota l number of stu dents in o ur colleges and universities, yet. ther e has 

been a fall in the numb er o f a pplic ants for medical and d ental schools. 

W ha t exp lain s thi s paradox'^ The answer is a rigoro us com petition 

among many professional disciplin es for a supp ly of ou tstan din g 

talent.

A comparison of medical school enrollments wi th grad ua te enrol lments in scientific lields reve als a str ik ing contr ast. Between 1953- 

54 and 1959-60 medical school enrollments increased by 7 percent 

whereas enrollments in certain selected science lields increased by 36 

percen t.

Ad mi ttedly , the increase in enrollments in med ical schools were 

very sharp ly lim ited by ina deq uate fac ilities in pa rt, bu t this alone 

does not account for th e tremen dous c on tra st in g rowth of o the r lields. 

In the biosciences alon e the increase in gr ad ua te stud ents was 23 p er ­

cent; in mathe matics and sta tistics by 110 p ercent; and the phy sical 

sciences by 34 perc ent. Th e demands, of course, of our society, our 

tech nology, our nat ional security certa inly hav e exp lain ed a good 

par t of the gro wth in these othe r lields.

But wh at this mea ns is th at man y stu de nts who mi gh t well have 

gon e into medicine as a car eer are choo sing othe r fields. To all of 

us who are concerned with at trac tin g an ade quate sup ply of talented 

young men and women into medicine, th is m ust be of gr ea t concern. 

Th e reasons f or th is sh ift , I thin k, are relati vely simple. I have sta ted 

some already. But I think the firs t and most im po rta nt is the ha rd 

fact of the economics of pro fessional edu cation. The average medical stu dent h as to pa y more than twice as much as the average g ra duat e stu dent fo r his edu cation. Only one-tenth—and I imagine you 

have heard thi s figu re befo re, but 1 rep eat it, one-te nth of all medical 

stu dents receive any sch olarship aid, com par ed to one-q uarter of 

grad ua te students in th e a rts and sciences.

The average stipend of the medical stu de nt who does receive aid 

is $500 a year com pared with an ave rage of $2,000 per year for the 

ar ts and sciences gr ad ua te studen t. Th us, as the Asso ciation of 

Ame rican Medical Colleges points out, if one combines the fact that
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 455

the medical student, as contrasted with other graduate students, has 

to pay twice as much for his education at the same time lie received 

one-quarter as much stipend income, it becomes clear tha t there is 

an 8 to 1 fiscal ratio of income and expense working to persuade the 

the college student to enter graduate school rather than medical 

school.

I think it is clear that financial assistance must be given to students 

in the health sciences comparable to those in other graduate fields. 

We need physicians, and dentists, and the other health science personnel. I reject the proposal, 1 must say respectfully, that the financial problem can be solved by a loan plan. The Association of American Medical Colleges has pointed out that 33 percent of the 1959 

gradu ating class of medicine had a loan liability directly related to 

their medical education averaging $4,258 per student. An expanded 

program of loans rath er than scholarships will merely mean that 

more medical students will stagger under the burden of loans and 

more will be asked to tackle the long, arduous grind of 4 years of 

medical school, 2 or 3 years of internship and residency, all before 

they have any assurance of beginning to earn income and during 

which they will pile up an ever-growing burden of debt.

It has been argued that indebtedness of this magnitude should not 

be of concern to a person whose future earning power is as high as 

that of a physician. A more realistic view, however, would seem to 

be that the prospect of (1) substantial indebtedness at the time of 

graduation, (2) the prospect of 2 to 4 additional years of study at low 

income or no income at all, and (3) the high cost of setting up practice at the end of a period of study—all of these factors have combined 

to place medicine in an extremely poor competitive position as compared to related graduate disciplines.

Not the least of the problems of the medical schools in attracting 

highly qualified students in competition with the graduate schools of 

arts and sciences is the fact that many students in all fields as you 

know, today marry early and have children. The prospect not only 

of financial support for their doctoral studies, but of immediate and 

lucrative employment upon the completion of their professional tra ining, attracts students to doctoral programs in the physical and natural 

sciences, engineering and mathematics, in preference to medicine and 

dentistry.

Present patterns of financing the education of medical students 

tend to “select out" people from the lower income groups, as one of 

the gentlemen of the committee mentioned earlier this morning. 

Hence, the medical schools are denied access to a valuable reservoir 

of talent, the children of lower income groups of our Nation.

Increased investment of Federal and State funds in student aid 

programs will help to tap this reservoir and at the same time contribute to a more heterogeneous student mix in the medical schools.

The need for scholarship assistance is a very real and pressing one 

today. It is not one of 6, 8, or 10 years from now when the new 

medical schools are constructed or when the existing schools are 

expanded.

Again, I was happy to hear this point made earlier here this 

morning.
456 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Students in o ur high schools and colleges are plan ning th eir careers, 

and knowledge th at a Federal sch ola rsh ip prog ram for medical and 

den tal education exists will enco urage talented stu dents to enter these 

fields. Students alr ead y enro lled in medical and den tal schools would 

receive much-needed assistance and encouragement. In sum, then , 

the New En glan d Bo ard of Highe r Ed ucati on is persuaded th at the 

provisions of bill H.R. 4999 if enacted into law, would be a majo r 

step forw ard tow ard mee ting the needs of doc tors, den tists, and professional public h ealth workers.

We respec tfully urge that the pro visions of II.R. 4999 be enacted , 

because, as we have stated , there is a need for more health service 

personnel. And thi s need can be met by gr an ts for expanding e xis ting schools, estab lishin g new ones, and prov idi ng scholarships to assist 

both the student and the institut ion in de fra ying the costs of 

educatio n.

Th ank you.

The Chairman. Th an k you very much, Doctor, for your s tate ment 

and the inf orm ation that you have given to the committee on this 

hig hly im porta nt problem.

Mr. Rogers of Te xas. May I ask one sh ort question ?

I assume you a re speak ing for th e g roup on hig her education which 

is an inter sta te co mpact grou p.

Mr. Liciiterman. Right.

Mr. Rogers of Texas. An d I also un derst and th at you have concluded tha t th is is a p rope r Federa l office ?

Mr. Liciiterman. Oh, yes.

Mr. Rogers of Texas. In other words, the responsibility th at is a ssumed in this field?

Mr. Lichterman. Well, we have also urged the ind ividual State s 

to assume p art o f t he b urd en of fina ncing scholarships.

Mr. Rogers of Texas. Tha t is the nex t question. Have you reached 

the conclusion th at it is a prop er Fe deral office because the State s 

have not been ab le to meet the needs, is it an economic situation ?

Mr. Lichterman. Yes, sir. We feel th at the State s have done a 

grea t deal. We do feel th at some of the State s are capable, in our 

region certainl y, of doing more, and we have urg ed them to do more, 

and the y are taki ng such steps. But this alone we do not feel will 

meet the problem.

Mr. Rogers o f Texas. And do you t hink th at ra th er tha n to create 

Federal schools, if thi s is a Fe de ral office, th at the problem can be 

answ ered by ma kin g gran ts to St ate schools and nonprofit organiz ations in the field?

Mr. Lichterman. Ce rtainl y I wou ld not expect Federal schools to 

be esta blis hed , sir.

Mr. Rogers o f Texas. Wh y not, if i t is a Fe deral office?

Mr. Lichterman. Well, I th ink th at this ce rta inl y has not been pa rt 

of t he tr ad iti on and pa tte rn o f o ur education al system in this cou ntry. 

An d I think it certainl y is not des ired by anyone. I can only speak 

fo r our own region, but I don’t thi nk t hat is any ind ication th at an yone would w an t tha t.

Mr. Rogers of Tex as. W ha t you mean is th at money ought to be 

furni shed by the Fe deral Gov ernment, bu t th at the Fe deral Go vernment should n ot operate the schools.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 457

Mr. Lichterman. Yes, in the pa tter n of many othe r acts of this 

Congress.

Mr. Rogers of Texas . You do think, th ough, t hat this money oug ht 

to be made ava ilable to all pub lic schools and to all pr ivate or re ligious 

schools so long as they a re nonpro fit o rganiza tio ns ?

Mr. Lichter man. Sir, I would say “Yes.” We need healt h service 

personnel, all th e medical schools are tr ai ni ng them.

Mr. Rogers of Texas. You wa nt doc tors and pub lic healt h perso nnel, you don’t care where th ey came fro m ?

Mr. L ichterman. Yes, th an k you, sir.

The C hairm an. Any fur th er question s ?

Th an k you very m uch, Doctor.

Th e H onora ble Edw ard C. M azique.

Mr. Mazique , we are g lad to hav e yo ur p res entat ion as the medical 

rep res entat ive of th e National Medical Association.

STATEMENT OF DR. EDWARD C. MAZIQUE, REPRESEN TATIVE FOR

THE NATIONAL MEDICAL ASSOCIATION ON MEDICAL LEGISLATION

Dr. Mazique. Mr. Ch air ma n, and honorable mem bers of the committee, tha nk you for the o pp or tunity of ap pe aring before y ou today.

I am Ed ward C. Mazique, a prac tic ing phy sician in the Di str ict of 

Columbia for the pas t 20 years. At the presen t time I have been 

delegated as medical rep res entat ive on legisla tion by the National 

Medical Association.

For those o f you who m ay not be fam ili ar with the N ational Medical 

Association, it is a national medical org aniza tio n whose membership 

com prises essentially all of the Negro phy sician s in Am eric a, which 

numb er about 5,000.

The Na tio nal Medical Ass ocia tion whole hea rtedly endorse s a bill 

H.R. 4999 designed to increase the op po rtu nitie s fo r the trai ni ng of 

phy sician s, denti sts, and professional pers onnel, and fo r othe r purposes, and strongly urges its approv al by this comimttee and favo rable recommen dation to the Congress.

Th ere is an imm ediate need fo r the erection of medical healt h fa ­

cilities such as hospitals and medical schools as well as an exp ansion 

of those th at are pre sen tly in existence.

Simila rly more doctors an d allied medical pers onnel ap pe ar imminen t in Americ a tod ay where we a re con fronte d with the problems 

of an explo din g po pulat ion th at is destin ed to reach 225 millio n people 

by the year 1975. Th is is fu rther inten sified because of the many 

new challen ges th at we face in the medical care prog ram such as 

urb aniza tio n, housing , indu str ializ ation, and com plex ities and fr ustrations th at necessitate the cre ation of such new healt h agencie s as 

the Bu rea u of En vir onme nta l He alth that must cope with the pr ob ­

lems of w ate r and air pol lution b ro ug ht abo ut by increased i nd us tria liza tio n: problems in radiation and space bro ught abou t as a res ult of 

advanced knowledge in science and technolog}'.

The sho rtage of medical ma npow er is so crucial in Am erica th at it 

is reporte d in some ru ral are as, th ere is only 1 docto r p er 6.000 p op ul ation. Th e average num ber of grad ua tes from all of the medical schools

soon—62----30
458 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

in the United State s total appro xim ate ly 7,000 ann ually . There is an 

imm edia te need fo r 12,000 medical grad ua tes annually.

While medical education is the basis fo r good health services, it 

receives only I percent of the total expenditures o f the Nation despite 

the fact that, it perfo rm s a most vital function in any society—tha t of 

the pre ser vat ion of h ealth and the extension of life.

There has been no drastic change in the ph ysici an -pati en t rat io in 

the last qu arter of a centu ry despite a rapi dl y expand ing and more 

complex society. Fo r example, in 1950 there were 143.4 phy sicians 

for each 100,000 pers ons in the United Sta tes. Today the rat io is 

140.7 and by 1975 at the pres ent rat e of tra in ing, it will be only 133. 

The ratio fo r d entists for each 100,000 perso ns was 59 in 1930. Today 

it is 56 and will be appro xim ate ly 50 by 1975 unless den tal schools 

and studen ts substan tially increase. A recent stu dy has shown the 

need for 20 new medical schools.

One of the basic reasons fo r physician shorta ge is economic. Some 

late statistical data indicate that 40 perc ent of all medical studen ts 

now come from th at 10 percent of the fam ilie s with the highes t income. It is, t heref ore , obvious th at sch ola rship gr an ts are indicated 

to schools of medicine, denti str y, and osteop athy in orde r to supplement. the mea ger wealth of meritor ious stu dents with po ten tials of 

becoming good scientists.

Th e low-income group in ou r society may serve as an un tap ped reserv oir to till the vacuum in the medical man pow er sho rtag e.

In an effort to assure rapid rec ruitme nt and equal rig hts for all 

ap pli cants who may become recipients of such funds a nd of such d esignated medical and hea lth fac ilities as set out in bill H.R. 4999, the 

National Medical Asso ciatio n urge s th at th is com mittee seek the 

proper term inology whereby it will be assured th at ind ividuals may 

fully utilize all such designated facilities withou t rega rd to race, re ­

ligion , or previous con dition o f servitu de.

It is difficult, Mr. Ch air ma n, for me to tell you exa ctly the langua ge 

that we seek and we are ask ing t ha t you might p ut in here. Bu t the 

essence of such language might be as follows: that thi s bill, H .R. 4999, 

is herein sub mitted to improve the health and medical services of our 

Nation . The recipient s and pa rti cipa nts shall sha re and sha re alike 

in its pro gra m, both in its activation as well as in its benefits to enhance the health sta nd ards of America and to assure the availability 

of good hea lth and trai ni ng opportu nit ies to all of its citizens.

Finally , our association reque sts that con sideration be given in this 

bill for the expansion of medical libraries. Good lib rary facilities 

are as essential to a pro gra m of medical edu cation as its clinics, classrooms, and la borato ries .

Th ank you very much , Mr. Ch airma n, fo r the op po rtu nity of ap ­

peari ng before you tod ay.

The Chair man. Doctor, than k you very much fo r you r statem ent 

and your suggestions with reference to th is legisla tion .

Mr. Rogers, any questions?

Mr. Rogers of Texas. I only wan t to com plim ent the doctor on his 

fine presentation.

Th e Chairman. Mr. Younger?

Mr. Younger. Doctor, do you rep resent the National Medical Association ?
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSO NNEL 459

Dr. Mazique. Yes.

Mr. Younger. Wh at is the reason for havin g two associations, the 

AMA and the National Medical Associa tion {

Dr. Mazique. Th ere is a little histo ry behind that, Yo ur Honor. 

Th at was brou ght about because of the dis cri mi nator y practices at one 

time by the State component mem bers of the American Medical As ­

sociation whereby the y fai led to perm it Negro physicians to become 

members.

Mr. Younger. How long ago was thi s?

I)r. Mazique. Th is was before 1895, the time when our Asso ciation 

was organized.

Mr. Younger. But since then they have taken in Negro members?

Dr. Mazique. In recent yea rs essent ially all of the State s societies 

of the Americ an Medical Ass ocia tion will tak e in Negro members. 

However, the matter of doing it is le ft en tirely w ith the S tates. Ph ys icians in each State m ust first become a member of this State co nstituent 

society ; let’s say in the State of Mississip pi, and then if they become 

a mem ber of th at constitu ent org aniza tio n the y are pe rm itted to become a mem ber of the Am erican Medical Association. So you see 

many Negroes are not mem bers of the Am erican Medical Association, 

for this reason. Predom inantly most of them may now become members. Th is tra ns ition , I would say, has tak en place withi n the last 

10 y ears.

Mr. Younger. W ha t medical school are you from?

Dr. Mazique. I am from Ho wa rd Unive rsi ty in W ashing ton, D.C.

Mr. Younger. Did you have any difficulty in ge tti ng yo ur first 

choice of medical schools, or di d you have to go to Ho wa rd?

Dr. Mazique. I had no difficulty at t he tim e. Th e time th at I came 

to medical school was in 1937. Th e basic factor fac ing the Negro at 

that time was s tri ctly economic. He ha d only a choice of tw o med ical 

schools to att end, and that was Ho wa rd Un ivers ity and Meharr y in 

Nashville. Tenn. Hi s choice was practic all y lim ited to only two 

institu tions. But the com petition was not so keen because the economic 

factor played such a g reat p art. Com ing fr om lower income brack ets 

prim arily and basically, th e matter of jus t havin g been able to attend 

medical school with tra in in g was enough. So in th ose days it was no t 

too difficult to gain entranc e o r to qua lif y so lo ng as you were prep ared 

academ ically and financially.

Mr. Younger. W ha t is the s itu ati on tod ay in the medical schools?

Dr. Mazique. To day it is a different pictu re altoge ther.

For exam ple, at Ho wa rd Un iversity and Meharry, tw o-thi rds of all 

the Negro physicians come from these two schools. How ever, the 

medical op po rtu nitie s have open ed up in most of the Sta tes , so th at 

you get a sp rin kling of student s in ma ny o ther schools throu gh ou t the 

variou s Sta tes . Th is is espe cially true up No rth , and in a smaller 

degree down South . Fo r exam ple, the U nive rsi ty of Ar kansas as fa r 

back as 1948 grad ua ted a Negro physicia n. Th is anted ated the Litt le 

Rock incident. So t ha t actual ly it had Wen going alo ng as f ar back as 

that. Bu t op po rtu nitie s have increased trem end ous ly, and yet the re 

is very much yet to lie done.

T h is is in co n n ecti o n not o nly w it h sc hools b u t h o sp it a ls as w el l.

Mr. Younger. Thank vou, Mr. Chairman.

The Chairman. Any further questions?
460 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Doctor, let me thank you on behalf of the committee for your statements here upon this important question.

Dr. Mazique. Thank you very much, Mr. Harris.

The Chairman. This will conclude the hearings on the legislation. 

The record will remain open for 1 week for the inclusion of further 

information tha t is to be supplied or any further statement that will 

be appropriate tha t anyone wants to include in the record on this 

subject.

The committee will adjourn.

(The following material was submitted for the record:)

Stat ement S ubm itted by IIon. George M. R hod es, a Repr esenta tive in

Congr ess from th e State of P en nsyl va nia

Congressional hearings have just been held on a bill, H.R. 4999, entitled, 

'‘Health Professions Educatio nal Asistance Act of 1961.” This is the most 

imp ortant piece of medical legislation to be considered by Congress since the 

act s which established the National Ins titu tes of Health. Indeed, in certain 

respects, this bill could have more far-reaching significance both for medicine 

and for the Nation than the latter, since it is designed to meet a more urgent 

fundame ntal need.

The purpose of H.R. 4999 is to stimulate the establish ment of new schools 

of medicine, to encourage the expansion of enrollments in existing medical 

schools, and to enable larg er numbers of capable young men and women to study 

medicine irrespective of the ir financial status. To achieve these purixises the 

bill makes two importa nt provisions, namely, g ran ts on a matching basis for constru ction of educational facilitie s and scholarship grants equal to $1,500 multiplied by one-fourth the number of students in each class. Each scholarship 

provides, in addition, $1,000 to the medical school to help defray the cost of the 

studen t’s education.

The critical need for more physicians is now unquestioned. Over the past 

decade there have been no fewer than five thoroughly documented studies, prepared by recognized experts, which show clearly that o ur Nation faces a serious 

shortage of physicians and den tists unless we take energetic corrective measures immediately.

It has been demonstrated, for example, tha t by 1970 we shall have to g raduate 

3.500 more physicians than were graduated in 1960 in orde r just to main tain 

our present rati o of physicians to a population (1 to 720). And were it not for 

the immigration to our country of a large number of foreign-trained physicians, 

representing in 1958, 17 percent of the new physicians entering practice, that 

rat io would already have dropped significantly. This fac t in itself not only 

highlights this problem, but provides a wry commentary upon our judgm ent in 

meeting the health needs of our people. One might well ask why a country 

such as ours, with all its wealth and industrial might, should choose to provide 

billions of dollars for foreign aid program s of various kinds and yet be dependent upon other natio ns with far less economic resources for the education 

of those additional physicians we urgently require to meet the minimum needs of 

our own people.

The genuine need for this legislation has been documented furth er by certain 

fac ts related to the recruitment of medical students. Over the past decade 

there has been a serious decrease both in the number and quality of college 

gra duates applying for admission to medical schools, despite the fact that the 

total number of college graduates has increased. In 1948, for example, the 

number of medical school applicants represented 6.6 percent of the college gra duates. In 1959, this figure had dropped to 3.9 percent. The overall failure rate 

in medical schools has been increasing in recent yea rs as certain schools have 

had to fill th eir classes with candidates who are not well qualified.

There are undoubtedly many diverse factors responsible for these sobering 

statistics rega rding the recru itment of medical students, but unquestionably the 

most important among these is the great cost of a medictal education. The 

average cost to each student of 4 years of medical education, based upon data 

from the 1959 medical school grad uating class, was more than $11,600. It is, 

therefore, not surprising to find tha t more tha n half the 1959 medical grad uate s 

had to borrow substantial sums to complete the ir education and that one-third
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 461

of the tota l group hud an average debt of $4,258. Upon completion of his basic 

medical education the young physician must take at least 1 yea r of internship, 

and, if he desires a care er in a specialized field of medicine, 3 to 5 additional 

years of residency training during which time his earnings will not provide even 

a bare subsistence. It should come as no surprice, therefore, to lear n that our 

physicians are coming mainly from the families with sub stan tial economic resources. In 1959, 45 percent of families in the United States had an ann ual 

income under $5,000, but they contributed only 14 percent of the 1959 medical 

school gradua ting class. However, 43 percent of this same class came from 

the 12 percent of U.S. families with an annual income of $10,000 or more.

In addition to these important financial considerations which have deterre d 

many outstand ing college graduates from entering upon the study of medicine, 

the situation has been furth er worsened by the development in recent yea rs of 

many intellectually stimulating career opportunities in science for which generous scholarship provisions are available.

The Federal Government now provides fellowships for every field of higher 

education in the sciences except medicine. Through its various agencies—the 

Department of State, the National Science Foundation, the Office of Education, 

and the National Institut es of Health—appro ximately 10,000 predoctoral fellowships are provided each year. These fellowships afford the studen t not only 

free choice of the institution in which to pursue his study, but also provide full 

tuition, a stipend plus a dependency allowance, a trav el allowance, and in some 

instances, an additional subsidy to the institution. It should be obvious that 

the college student with limited economic resources who is interested in science 

may not only select a career which will offer prestige and financial security, 

but may do so under circum stances which will provide adequate supp ort for his 

entire education as well. It would indeed be small wonder if a studen t desirin g 

such a career in the sciences were to choose medicine in con trast to a science 

in which such fellowships are available.

We have with good reason taken pride in the high standard s of medical 

care which we have been able to provide, and we have developed over the 

past decade, especially with the aid of the Natio nal Ins titu tes of Health and 

the funds that Congress has generously appropriated for this purpose, the finest 

overall general medical research program in the world, one that is att rac tin g 

increasing numbers of foreign individuals here for research training. The 

quality and high standard s of these activities are largely dependent upon the 

maintenance of high quality personnel and the attrac tion of the best qualified 

college stud ents into medicine. It should be obvious that if these college students are dete rred from entering medicine, it will be only a ma tter of time 

before the sta ndard and quality of both medical care and medical research, 

as well as medical education, will grad ually deteriorate.

All of the many persons who testified before the committee in the hearings 

on II.R. 4999 were enth usiastica lly and overwhelmingly in support of the full 

provisions of the bill except for the spokesmen of the American Medical Association. They, to be sure, supported th at portion providing construction gra nts 

for educational facilities , but refused to tak e a positive position on the matter 

of scholarships, and instead, spoke about the interest of the American Medical 

Association in developing a program of loan assistance.

It should be obvious even to the American Medical Association that augmentation of loan fund s will not meet the need of many well-qualified students. 

Many schools and State medical societies alre ady have sub stantial loan funds, 

but the experience of past years has dem onstrated the ir inadequacy to increase 

the attr activenes s of a medical career because of the high cost to the stud ent. 

Sub stan tial increases in priv ate scholarship and loan resources have been provided in the past decade, but it is appar ent that these efforts to make adeq uate 

support available through private means have not met the problem, and it is 

for this reason that the importance of the scholarship provisions in the bill 

becomes even more significant.

There has been concern in some quarters that Federal aid to medical education may bring about undesirable governmental controls. The experience of 

medical schools with respect to Federal participation in supp ort of medical 

research over the past decade gives no substance to these fears. Not only has 

there been no interference with research, but it is now generally agreed that 

this type of aid has been of tremendous benefit to the schools. There is therefore good evidence and experience to demonstrate t ha t support from the Federal 

Government can be administered with out interference in academic affa irs
462 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

an d w ith ou t th e in tr od uc tion of re st ri ct iv e co ntro ls. Furt her m ore , th er e is no 

prov ision in th is hil l which wou ld in an y way cre ate su ch und es irab le fa ct or s.

H as no t ou r sens e of va lues become dis to rt ed whe n we as a nat io n ca n provide billi on s of do llar s fo r fo re ig n ai d pr og ra m s of all kin ds an d fo r pr oj ec ts 

conc erne d w ith reac hi ng th e moon an d ye t be re lu cta nt to pr ov id e even a sm all 

fr ac tion of th is sum fo r cri tica lly urg en t m ea su re s to m ain ta in th e hea lth of 

ou r people? The s ec uri ty an d in te gri ty of our N at io n are mor e de pe nd en t upon 

th eir he al th th an on an y oth er sing le fa ct or . We ha ve long ha d a re al co nc ern 

fo r th e w el fa re of th e in di vid ual citiz en an d ha ve de rive d deep sa tisf ac tion 

from mee tin g his need in a hum anit ari an wa y. W hy sh ou ld we th en kn ow ingly 

deny ou rselve s th es e m ea su re s to st re ng th en ou r ca pab ilitie s an d to mee t ou r 

tr adit io nal ob lig ations , an d why shou ld we affo rd our yo ut h op po rtun ity to 

ac hiev e an d m ai nta in his pro pe r ro le in ou r society in ev ery field but me dicin e?

T hi s m att er is of de ep es t co nc ern to ou r peo ple. W hi le pa ssag e of th is bill 

will no t en tire ly reso lve th e problem , it wi ll be a gre at st ep to w ar d its ultim at e 

solutio n.

Mic h a e l E. D e B a key, M .D.,

Houston, Tex.

State m ent of I I on . J o hn F . Sh e i.le y, a R ep re se nta tive in Con gr es s F rom t h e

Stat e of Califo rnia

Mr. C ha irm an , it is w ith mu ch pl ea su re th a t I pre se nt to yo ur committee my 

su pport fo r H.R. 4999, which if e na cted , will in cr ea se the op po rtun itie s fo r tr a in ­

ing of ph ys icians , de ntist s, an d prof ession al pu blic hea lth person ne l in th e 

U ni te d St at es .

A nu m be r of Gov ernm en t an d pri vat e st ud ie s in th is c ountr y ha ve been unde rta ken which dem on st ra te co nc lus ive ly th a t th e quanti ty an d (pialit y of me dic al 

an d de nt al ca re pr og ra ms, m ust be ex pa nd ed in th e im m ed ia te fu tu re if the 

de m an ds of ou r gr ow ing po pu latio n an d th eir med ical an d den ta l needs are to 

be me t. Sta ti st ic s in th es e st udie s abou nd po in ting to th e sh or ta ge of me dic al 

an d de nt al man po wer a t pr es en t. Th ese fig ures in di ca te clea rly th e si tu at io n in 

th e fu tu re wi ll be mu ch mo re cr itic al . Pr es id en t Ken ne dy ’s hea lth message to 

th e Co ng res s la st yea r su cc in ctly ou tlin es th is cr itic al man po wer sh or ta ge in th e 

med ical, d en ta l, an d allie d prof ession s.

Mr. Cha irm an , th e en ac tm en t of H .R. 4999 in prov id ing fo r gra nts fo r co nst ru ction of me dic al, de nt al , os teop athi c, an d publi c he al th te ac hi ng fa ci lities , an d 

sc hol ar sh ip gra nts to ac cr ed ited schools of med icine, os te op athy , an d den tist ry , 

will be a su bst an tial st ep on th e p a rt of th e U.S. Con gress in di sc ha rg in g ou r 

ob lig atio n to m ee t th e he al th an d den ta l ne ed s of our Nation.

Mr. Cha irm an , th e nee d fo r Fe de ra l as si st an ce to th e N atio n's me dic al and 

den ta l sch ool s was re ce nt ly dra m ati call y br ou gh t to my at te nti on by th e plig ht 

of th e lon g-res pecte d den ta l college in Sa n Fra nc isco , th e College of Ph ys ic ians 

an d Su rge ons.

The Colleg e of Phy sici an s an d Su rgeo ns ha s m ai nta in ed a re puta tion ov er th e 

years of b ein g one of th e fin est den ta l schools in the co un try. Ho we ver, be ca us e 

of t he obsol esc enc e of it s ex is ting p hy sica l fa ci lity , th e sc ho ol's ac ad em ic ac cr ed ita ti o n cu rr en tly is in je opar dy an d, in fa ct , th er e are in di ca tion s th at loca l 

auth ori ti es ma y cond em n th e pre se nt bu ild ing as uns af e fo r st ud en t occupancy.

As I un der st an d it , school auth ori ti es ha ve sou gh t a ss is ta nce from go ve rnmen tal 

so ur ce s w ith ou t succes s. Th ey ha ve succeeded, ho wev er, in ra is in g fro m pr iv at e 

so ur ce s ov er th e la st se ve ra l year s ab ou t $1.5 mi llion fo r the bu ild ing , and the 

alum ni ha s pledged an ad ditio nal mi llion doll ar s wh ich will be co nt ribu te d ov er 

an ex te nd ed pe rio d of tim e. In ad di tion , th e den ta l st udents now at th e school 

ha ve ple dged them se lves to c ont ri but e $222,000 ov er a pe rio d of 10 ye ars. A new 

sch ool, ho we ve r, wi ll co st in th e ne ighb orho od of $5 mill ion to $0 millio n, an d 

it is un lik ely th a t th e re m ai ni ng fund s ca n be ra is ed fro m vo lu nt ar y co nt ribu to rs .

The c ollege ha s comp leted ne go tiat io ns to become a sch ool of the Unive rsity of 

th e Pacific, wh ich will as su re th e sch oo l’s accr ed it at io n st atu s if a new bu ild ing 

ca n be co ns truc te d. Gr ou nd sp ac e fo r th e bu ild ing has been ar ra nged at th e 

Pre sb yte ri an Me dic al Ce nter, an d mo ney now ap pe ar s to be th e on ly su bst an tial 

block to th e scho ol’s con tinu in g suc ces s.

At th e pr es en t tim e, th e 4 ex is ting de nt al sch oo ls in Cal ifor ni a ar e gra duati ng 

fro m 275 to 300 de ntist s a ye ar , but t he S ta te is lic en sing fro m 500 to 000 den tist s 

a ye ar . It is ob vio us, t her ef or e, th a t Cal ifor ni a is dra w in g h ea vily o n th e sch oo ls 

of oth er S ta te s to pr ov ide th e den tist s it needs. I am su re I need no t re ci te to 

you the fig ures re la ting to th e ra pi d in cr ea se in po pu la tion in C alifor ni a.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 463

As in di ca te d abo ve, th e Co llege of Phy si ci an s an d Sur ge on s ha s ra ised th e 

am ou nt wh ich wo uld be ne ce ss ar y to m at ch th e Fed er al fu nd s wh ich would be 

pr ov id ed if I I.R . 4999 is en ac ted, an d co ns truc tion of a new an d ex pa nd ed fa ci lity 

could b e b egun immed iatel y.

To un de rs co re th e im po rtan ce w ith which the co mmun ity vie ws th is pr es sing 

need in Sa n Fr an ci sc o, I su bm it to you th e follo wing reso lu tio n ap pr ov ed by the 

Boa rd of Su pe rv isor s of th e city an d co un ty of Sa n Fra nc is co :

"R es ol ve d, T h at th e Boa rd of Su pe rv isor s of th e city an d co un ty of Sa n F ra n ­

cisco do he reby un qu alifi ed ly en do rs e H.R. 4999 an d S. 1072, to pr ov ide match ing 

Fed er al fu nd s fo r co ns truc tion an d alt era ti on of med ica l an d den ta l sch ools, an d 

do he re by ur ge th e Co ng res s to en ac t sa id m ea su re s into law a t th e ea rl ie st 

po ssible date in ord er th a t th e peop le of th e Un ite d S ta te s may ha ve th e ad van ­

ta ge of th e be ne fits in her en t th er ei n ; * *

In co nc lusio n, Mr. Cha irm an , it is my ho pe th at th is bill wi ll be en ac te d into 

law duri ng th is session of Co ng res s, as a needed step fo rw ar d in m ai nt ai ni ng 

an d pr om ot in g th e hea lth an d den ta l ne ed s of t he peo ple of our co un try.

Statement Submitted by Hon. J ohn Bradf.mas, a Representative in Congress

From th e State of I ndiana

Mr. C ha irm an , I ap pre ci at e th e opp or tu ni ty to te st if y in su pport o f legi slatio n 

which wou ld he lp th e United S ta te s mee t th e urg en t need fo r ed uc at in g more 

ph ys ic ians , den tist s, an d pr of es sion al pu blic hea lth pe rson ne l.

As yo u kno w, I ha ve in trod uc ed a bill, wh ich is one of se ve ra l bills now 

und er co ns id er at io n by you r co mmittee , de sig ne d to pr ov id e more as si st an ce 

fo r th e co ns truc tion of med ical an d den ta l sch oo ls in o ur co un try.

Th e ev iden ce is cl ea r th a t if we are go ing to m ai nta in th e ex is ting ra ti o of 

phy si ci an s an d den tist s to our po pu latio n, we sh all ha ve to tr ain man y mo re of 

bo th. The fig ures show th a t we m us t in th e ne xt 10 yea rs ra is e th e ad m ission s to med ical sch oo ls by nea rl y 50 pe rc en t an d alm os t do ub le the nu mbe r 

of s tu dents ente ri ng den ta l sch ools.

And exis ting sch oo ls of med icine an d os te op athy an d denti st ry ju st do not 

ha ve th e ca pa ci ty to tr ain th e 3,800 more ph ys ic ians an d 3.300 mo re den tist s 

we will ne ed in th e n ex t d ecade.

Simply to ke ep pa ce w ith th e gr ow th in po pu latio n we m ust bu ild an est im at ed 20 new m ed ical sch oo ls an d 20 n ew d en ta l schools by 1970.

Rec en t testim on y be fore th e Edu ca tion an d Lab or Co mm ittee, on wh ich I 

ser ve, ha s m ad e cle ar th e in ad eq ua cy of th e ph ysical fa ci lities of in st it uti ons of 

hi gh er le ar nin g ge ne ra lly in th e United St at es . It was my pr iv ile ge du ring 

the m on th s of th e rece ss to se rv e as ch ai rm an of a bip ar tisa n Ad visory Group 

on H ig her Edu ca tion .

Our ex te ns iv e disc us sion s w ith lead in g college an d un iv er si ty adm in is tr ato rs 

co nv ince d th e five mem be rs of th e Adv iso ry Gr ou p th at th e American univ er sity 

co mm un ity is unit ed in ag re em en t th a t a Fe de ra l pr og ra m to he lp our colleges 

an d univ ers it ie s fin ance th e bu ildi ng of cla ssroom s, libr ar ie s, an d la bora to ri es 

is es se nt ia l. I am conv ince d th a t th er e wi ll be ov erwhe lm ing bip art is an su pi xirt 

in Con gres s th is y ear fo r th e college aca de m ic fa ci lities b ill.

But , Mr. C ha irm an , we c an no t ne glec t th e nee d fo r med ica l an d den ta l sch ools. 

T hat is wh y I st ro ng ly su pp or t th e prov isi on of Fed er al fu nd s, on a m at ch in g 

ba sis , to he lp th e ex pa ns ion, co ns truc tio n, an d remod eli ng of th e ph ys ic al fa ci litie s of med ical, de nt al , os teop athic, an d pu blic hea lth te ac hi ng fa ci lities .

I may say, Mr. Cha irm an , th a t I ha ve disc us sed th is bill w ith a re pre se nta tive 

of th e A m er ic an Me dic al Assoc iatio n he re in W allin gt on an d th e AMA fa vors 

th e prop os al. More over, I ha ve discus sed th e bill w ith do ctor s an d denti st s in 

my own co ng re ss io na l dis tr ic t an d ha ve le ar ne d th ey su ppor t it as well.

It al so seem s cl ea r th at, as Dr. Gerald D. Dor man , a mem be r of th e bo ar d 

of tr ust ees of th e AMA. told you r co mm itt ee som e da ys ago . “m edica l school 

co ns truct io n pr ov isio ns shou ld be giv en firs t le gi sl at iv e p ri o ri ty ” in an y pr ogr am of Fed er al as si st an ce to me dic ine .

In co nclus ion . Mr. Cha irm an , le t me sa y th a t we m us t co nt in ue to m ain ta in 

high st an d ard s of me dical ed uc ation if Amer ican s a re to en joy th e be st med ical 

att enti on in th e wo rld .

I am cert ain th e pa ss ag e of th is med ical an d den ta l sch ool bil l will he lp 

in su re th a t goal.
464 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

House of Representatives, 

Washington, D.C., February 16, 1962.

Hon. Oken Harris,

Chairman, House Committee on I nte rstate and Foreign Commerce,

Washington, D.C.

My Dear Mr. Chairman : This is to urge favorable action by the Committee 

on Inter sta te and Foreign Commerce with respect to H.R. 4999, the Health 

Professions Educational Assistance Act.

Among the many excellent fea tures of this bill is the 10-year program of 

gra nts for the construction of medical, dental, and public health teaching facilities. This partic ular phase of II.R. 4999 is of the gre ate st importance to Rhode 

Island, as I know it is to the many other areas of the country where such 

schools exist or are in the planning stage.

As you are aware, Brown University of Providence, R.I.. approved the establishment of a 2-year program in the basic medical sciences in Jun e of 1961. 

The program will take the form of a 2-year medical school, similar to that 

described in H.R. 4999.

We in Rhode Island are proud of the outstanding contributions which Brown 

University has made to the cultural and professional life of our State. Brown, 

along with our other schools of higher learning: Providence College, the University of Rhode Island, Rhode Island College, Bry ant College, Salve Regina 

College, and others, has enriched and benefited the community beyond measure. 

For these reasons, I am more than pleased that Brown has seen fit to fur the r 

expand its energies and efforts to include the field of basic medicine.

However, it will be impossible for Brown University to achieve this worthy 

goal through private funds alone. Federal help is needed, and that help is adequately provided for in H.R. 4999. With such assistance, plus the dedication 

and hard work of its faculty and students, I feel certain that Brown University 

will soon have one of the finest schools of basic medicine in this Nation.

Therefore, Mr. Chairman, it is my sincere hope that this bill will be favorably considered by your committee, passed by the Congress, and signed into 

law by the President.

With best wishes, I am,

Yours sincerely,

Fernand J. St. Germain,

Member of Congress.

House of Representatives, 

Washington, D.C., January 31,1962.

Hon. Oren Harris,

Chairman, Committee on Interstate and Foreign Commerce, U.8. House of

Representatives, Washington, D.C.

Dear Chairman Harris: This brief letter is w ritten to express again my personal interest in H.R. 4999. upon which you are now conducting hearings.

Dr. Donald G. Anderson, president of the American Medical Colleges, and a 

distinguished constituent of mine, has already appeared before your committee. 

I could not improve upon his presentation, which I find very persuasive.

I know that this ma tter has your careful atte ntio n, and I am hopeful that 

this much-needed legislation will be forthcoming from you r committee at an 

early date.

Very sincerely yours.

J essica McCullough Weis.

House of Representatives. 

Washington. D.C., January 31, 196.1.

Hon. < >ren Harris,

Chairman, Inters tate and Foreign Commerce Committee,

House of Representatives. Washington, D.C.

Dear Mr. Chairman : The Woman’s Medical College of Pennsylvania has written to me in strong endorsement of H.R. 4999. a bill which I also support.

The president and dean of the college. Dr. Marion Fay, pointed out tha t “the 

medical schools of the country are greatly in need of financial assistance. We 

have had generous gra nts for research, evidence of which are the new research 

facilitie s which you visited. But teaching facilities are urgently needed if the 

medical schools of the country are to keep up their teach ing stan dards and also 

be able to add to the numbers of graduates.”
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 465

I wo uld ap pre ci at e it If til ls in fo rm at io n wo uld be mad e p art of th e reco rd 

in yo ur he ar in gs on H.R. 4999.

Sinc er ely yo urs,

K ath ryn E. Gra na ha n,

Member of Congress.

House oe Represent at ives,

Washington, D.C., Januar y 26,1962.

Ho n. Oren H ar ris,

C/Hltrwian, Committee on Inte rstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Mr. Cha irma n : In co nn ec tio n w ith the he ar in gs yo ur co mm itt ee is 

pre se ntly co nd uc tin g on H.R . 4999 an d re la te d hil ls. 1 am su bm itting to you 

her ew ith a st at em en t fu rn is hed me by th e U ni ve rs ity of Miam i Sch ool of Medicine, C or al G ables , Fla.

I will ap pr ec ia te yo ur ha vi ng th is st at em en t in co rp or at ed in to th e reco rd of 

yo ur h ea ring s.

In any legi slatio n which you r co mm itt ee ma y rec om men d to th e Ho use . 1 

re sp ec tfully re qu es t th a t th e Uni ve rs ity of Miam i Sch ool of Medici ne will he 

in clud ed in its prov isi on s. You will no te fro m th e att ached st at em en t, th e un ive rs ity is w ithout a pe rm an en t med ical ed uc at io na l fa ci lity . In sp ite of th is 

ha nd icap , th e med ical sch ool has becom e ac cr ed ited by al l ac cr ed itin g ag encie s 

an d has mad e an ex ce lle nt reco rd, in its sh ort hi stor y, as a pr og re ss iv e an d pr odu ct iv e school f or m ed ica l tr ai ni ng .

If th e co mm itt ee feels th ere is an y ad di tiona l data it m ig ht need in or de r to 

co ns id er th e un iq ue ci rc um stan ce s un de r which th e school of med icine is oper at ­

ing, I wou ld welc om e a n opp or tu ni ty to o bt ai n th is for you.

Sinc erely ,

Dante B. F asc ell, 

Member of Congress.

Stateme nt of Univ ers ity of Mia m i School of Medicine Regarding th e Fact

T ha t It Has Never H ad a P erma nent Medical Educational F acilit y

Th e U ni ve rs ity of Miami, an inde pe nd en t no np rofit in st it uti on of hi gh er le ar ning, es ta bl is he d a 4- ye ar m ed ical school which opened in th e fa ll of 1952 un de r 

th e mos t difficu lt fin an cial circu m stan ce s.

In 1952 Flo ri da was th e only S ta te in th e So uth, an d one of th e few Sta te s 

in th is co un try, w itho ut a med ical school an d, th er ef or e, was in dir e an d cr itic al 

need fo r a med ical ed uc at io na l fa cil it y w ith in th e Sta te . The Flo rida Le gislatu re rec og nized th e fa ct th a t Flo ri da men an d wo me n w er e un ab le to ob tai n 

med ical ed uc ation, as med ica l sch oo ls of oth er S ta te s foun d it al m os t impo ssi ble 

to ac ce pt Flo ri da re si de nt s se ek ing med ica l ed uc ation. In 1951. in or de r to 

en co ur ag e th e es ta blish m en t of a med ical school in th e S ta te of Florida , th e 

le gis la tu re en ac ted into law a bill ap pro pri ati ng a $3,009 i>er year su bs idy fo r 

each Flo ri da re side nt en rolle d in th e first m ed ic al sch ool es ta bl is he d in Flo rida .

In ord er to becom e the fir st es ta bl is he d med ical school in Flo rida , th e U nive rsity of Miam i un de rtoo k to qua lify fo r th e su bs id y set fo rt h abo ve, an d du e to 

a lack of fu nd s fo r co ns truc tio n of a med ical ed uc at io na l bu ildi ng th e Unive rsity 

of Miam i leased a bu ild ing loca ted on th e re se rv at io n of th e V et er an s’ Hos pital 

in Coral Ga ble s, Fl a., fo r th e pu rp os e of ho us in g its pr ec lini ca l dep ar tm en ts on 

a te m po ra ry ba sis. The U ni ve rs ity of Miam i Sch ool of Med ici ne has co ntin ue d 

to op er at e it s pr ec lin ic al dep ar tm en ts in th is outm od ed bu ildi ng fo r th e p as t 8% 

ye ar s sinc e it s ince ption. In sp ite of th e inad eq ua cy of th es e fa ci lities , th e Unive rs ity of Miam i School of Me dic ine ha s bec ome ac cr ed ited by al l ac cr ed itin g 

ag en cies an d ha s m ad e an ex ce lle nt reco rd in it s sh or t his to ry as a pr og re ssiv e 

an d pr od uc tive sch ool fo r med ical tr ai nin g. Thi s te m pora ry bu ildi ng fo r pr eclin ical med ical ed uc ation ha s co nt in ue d to be us ed be ca us e of th e lac k of fu nd s 

re qu ired to bu ild a pe rm an en t f ac ility.

The U ni ve rs ity of Mi am i ha vi ng no ac ce ss to ta x mon ey s of an y kind or 

de sc ript io n, ot her th an th e S ta te su bs idy men tio ne d he re in , is unab le to supp ly 

fu nd s fo r th is ne ed ed fa ci lity ex ce pt th ro ugh gif ts an d do na tion s.

In 1956 th e U ni ve rs ity o f Miami qu ali fie d fo r a re se ar ch fa cil it ie s co ns truc tion 

gra nt w ith th e m at ch in g po rtio n be ing pr ov ided by th e ta x p ay ers of Dad e 

Co un ty, Fla . T hi s bu ild ing, wh ich is now co mplete an d oc cu pie d, co st ap pro xim at ely $2,250,000 fo r co ns truc tion , les s th an half of th is mo ne y hav in g com e 

fro m th e Fed er al Gov ernm en t an d th e re m ai nder fro m th e ta x p ay ers of Dade
466 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

County, Fla. This building is located at the site of the county-provided clinical 

facilities 7 miles distance from the temporary preclinical building.

Dade County is making available sufficient land adjo ining the research building aforementioned for a perm anen t educational building for the University 

of Miami School of Medicine, which building is a critical need for the adequ ate 

development and continuation of the University of Miami School of Medicine 

and will give it a permanent facility for the first time since the establishm ent 

of the medical school.

This sta tement is made for the specific purpose of showing that the University 

of Miami School of Medicine is in a unquie position among the 85 accredited 

medical schools in the United States, in that it is the only school of medicine 

in the United States, to o ur knowledge, t ha t has never had a permanen t medical 

educational facility. The only exception to the above statement could possibly 

he the University of Utah, a State-supported institution , which we understan d has available at this time funds to construct a perm anent medical educational facility.

House of Repr ese ntative s. 

Washington, D.C ..January 77, 1962.

Hon . Oren Harr is,

Chairman, Inte rstate and Foreign Commerce Committee,

New House Office Building, Washington, D.C.

Dear Oren: The attached communication received from Dr. C. E. Moverman, 

a resident of my home community is self-explanatory.

You will note that Dr. Moverman wants optometrists included in the provision 

of your hill, II.R. 4999.

Your consideration will he appreciated, and I will be pleased for any advice 

you can give me to impart to Dr. Moverman.

Sincerely yours,

I vor I). F en ton.

Sch uylk ii.i, County Optometric Asso cia tio n,

Mahan'ay City, Pa., January 13,1962.

Hon. Ivor Fenton,

House of Representatives Office Building,

Washington, D.C.

Dear Congressman Fenton : The House hill 4999 was introduced by Congressman Harris, of Arkansas, auth orizing the expenditure, on a matching basis, of 

fund s for the construction of classroom and research facilitie s for schools of 

medicine, dentistry, osteopathy, and public health and also for scholarships for 

students in these schools. Optometry is not Included in eith er of the bills and 

unless they are amended so as to authorize the expenditure of funds for optometry schools and students, our profession will he discriminated again st.

We urge you that it is in the public inte rest that optometric schools and 

students should be eligible to participate in this program.

There is no question but that the best possible vision is a must for students, 

adults, and the ever-increasing number of older citizens. It is a comparatively 

small percentage of these who require medication or surgery. The visual needs 

of the vast majority can be supplied by the members of the optometric profession. The opthalmologists are located in the larg er centers of jiopulation: 

the opto metrists are found in most of the smaller communities. The rati o of 

optometrists to population is steadily decreasing. The public will find it increasingly difficult to secure adequate vision care unless more optometrists are 

grad uate d by ou r schools and colleges.

The American Optometric Association and the schools give special consideration t<> such problems as motorist’s vision and highway safety, visual problems 

of children and youth, vision aid to the partially blind, vision care of the aging, 

occupational vision, and problems of ae ronautics and space.

There are only 10 schools and colleges of optometry in the e ntire United States. 

This is a small group. Therefore, if they are included it would be only a small 

portion of the fund s which would be utilized for this purpose.

Your coofieration will be appreciated and will be a service to our profession 

and to your country.

Yours truly,

C. E. Moverman, O.D.,

Public Relations Chairman.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 4G7

State of Cal ifo rn ia,

Governor’s Off ic e, 

Sa cr am en to , January 30, 1002.

Hon. Oren H ar ris,

Hou se of Rep re se nt at iv es , Ho use Office Build ing,

Was hing ton, D.C.

Dear A1r. H arris : I w an t to ex pr es s st ro ng en do rs em en t of your bil l H.R. 

4990, th e H ealth Pro fe ss io ns Edu ca tion al Ass istanc e Act of 1961.

C alifor ni a, as we ll as ot he r S ta te s of ou r co un try, gre at ly ne ed s to ex pa nd 

fa ci lities fo r tr ain in g of the hea lth prof es sion s. The tr en d to w ar d utiliza tion 

of ph ys ic ia ns ed uc at ed in oth er co un trie s (o ften a t st andard s in fe ri or to our 

ow n) to pr ov ide healt h serv ices fo r our peop le is inde ed al ar m in g. I believe 

th a t th e tim e has come fo r the Sta te s, w ith th e as si st an ce of th e Fed er al Gover nm en t, to mo ve ra pid ly in th e de ve lopm en t of ad eq uat e fa cil it ie s fo r th e 

ed uc at io n of ph ys ic ia ns an d oth er hea lt h pe rson ne l. Thi s is a na tion wid e 

problem .

In C al if orn ia a co mmitt ee which I ap po in te d in 1960 to st ud y med ical ai d 

an d he al th ga ve sp ec ial atten tion to ou r ne ed s fo r hea lth man po wer. Th e comm itte e reco mmen de d th a t "C al ifor ni a proceed a t once to ex pa nd med ical ed uc ation al ca pa ci ty in p ri vate an d pu blic in st it uti ons, w ith th e goal of 1,400 first-ye ar 

plac es by 1971.”

Thi s go al w as de term in ed on th e ba sis of th e sa m e ph ys ician- po pu latio n ra tio 

fo r 1975 as ex isted in 1960, an d on th e as su m pt io n th a t C al ifor ni a will co ntin ue 

to a tt ra c t in to th e S ta te th e sa m e nu m be r of phy si ci an s tr ain ed ou tsid e th e 

S ta te as in re ce nt ye ar s. Th e pre se nt an d curr en tly pl an ne d ex pa ns io n of med ica l school fa ci lities pr ov id es f or les s th an 700 f ir st -y ea r pla ce s; th a t is, les s th an 

half th e 1,400 plac es nee ded in C al if or ni a by 1971. I t is th er ef ore es se ntial 

th at th e S ta te pr om ptly ex pa nd its co ns truc tion of med ical sch ool fa ci lities .

I believ e th a t th e pr ov isions of yo ur bill a re wise ly dr aw n. In part ic ula r, th e 

prov ision fo r pl an ni ng g ra nt s, th e es ta bl is hm en t of a N at io na l Adv iso ry Co uncil, 

an d th e re qu irem en t of m at ch in g fu nds all tend to ass ure th e de ve lopm en t of a 

high q ua lity a nd u se fu l prog ram.

I am in de ed plea se d th a t you ar e ta kin g th e lead in th is m att er an d w an t to 

as su re yo u th a t we in C al if or ni a th or ou gh ly su ppo rt th e bill. I am se nd in g 

copie s o f t his le tt er to a ll C al ifor ni a Co ng res sm en.

Sinc erely ,

E dmu nd G. Brown, Go vernor.

T he Com mo nw ealth of Mas sa ch us et ts ,

E xecutiv e Depar tm en t, 

Bo sto n, January 31, 1962.

Ho n. Oren H ar ris,

Hou se o f R ep re se nt at iv es ,

Washington, D.C.

Dear Congressma n H arris : I re sp ec tful ly su bm it th is l ett er to y ou r co mmitt ee 

as an en do rs em en t of H.R. 4999 which w as in tr od uc ed by yo u in th e Hou se of 

R ep re se nt at iv es .

From all of th e ev iden ce an d d ata th a t we ha ve gat her ed in M as sa ch us et ts, 

we are pe rs ua de d th a t ou r ex is ting sch oo ls of med icine, denti st ry , an d pu blic 

hea lth re quir e g re ate r su pp or t if th ey are to in cr ea se th e op por tu ni ties fo r 

more st udents an d tr ain mo re do ctor s, den tist s, and pro fe ss io na l pu blic he al th 

I*ersonnel.

The re i s a ne ed t o ex pa nd or re h ab il it ate exis ting s ch oo ls an d th ere is an addition al need to en co ur ag e mo re st udents to en te r our pr of es sion al school s. To 

me et th e first need will re qu ire gra nts fo r co nst ru ct io n or re hab ilitat io n of ex is ting fa ci lities an d th e sec ond will re quir e sc hola rs hip g ra nts th a t will he lp no t 

on ly th e st udents but will ass is t th e sch oo ls in co ve ring th e co st of ed uc ation. 

Sup po rtin g d ata to su bst anti ate th es e st ate m ents are includ ed in th is le tter . 

( See at achm ents .) 1

Bill H.R. 4999 is d esigne d to he lp m ee t th es e tw o ne eds. Th ey are na tional as 

we ll as re gion al.

In M as sa ch us et ts, we ha ve th re e med ical sch oo ls, tw o den ta l sch ools, an d a 

school of pu blic h ea lt h, all pri vat e and al l adm it ti ng qualified st uden ts from an y

1

 Material referred to is on file In the records of the committee.
468 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Sta te in the United States of America or abroad. We a re one of the constituent 

members of the New England Hoard of Higher Education. The board comprises 

representativ es of Rhode Island. Massachusetts, Connecticut, Maine, New Hampshire, and Vermont, and is vitally concerned with increasing the opportunities 

for New England students in the health services. The States have entered into 

agre ements with medical schools and dental schools of the region to i»ay “cost of 

education grants” to those schools th at were able and willing to increase their 

enrollment of students from the areas over that which existed in 1955. and by 

entering into contract with such schools as the University of Vermont, to accept 

up to 70 students from Massachusetts over a 4-year period.

These plans took into account the promotion of an equitable geographical distrib ution of opportunities for training based upon such considerations as population, available physicians and their age, number of stude nts en tering medical and 

dental schools in the region and in the Nation, as well as the available resources 

in the New England region.

Massachusetts has a limited scholarship program for medical and dental stu ­

dents. The existing programs for increasing opportunities for the students of 

the area have assisted in solving some of the problems but they have also 

uncovered the great need for the future.

It is my opinion tha t bill H.R. 4999, if enacted, would be a great step forward 

in helping to solve some of the problems in the training of more professional personnel in the health services and we favor its enactment.

Sincerely yours,

J ohn A. Volpe. Governor.

Stateme nt by Winfred L. God win, Director, Sou thern Regional E ducation

Board

I am Winfred L. Godwin. I serve as the director of the Southern Regional 

Education Board. I present this stateme nt at the request of Gov. Terry Sanford, of North Carolina, chairman of the board, to comment on H.R. 4999 

in light of the interests and studies of the Southern Regional Education Board 

in the health fields. Since my board has not had the opjtortunity to discuss this 

bill in any detail, it should be understood that I submit the stateme nt as head 

of the board’s staff and at the request of my chairman. Both Governor Sanford 

and I had hoped that we could appear in person before the committee, but this 

was impossible because of calendar conflicts.

The Southern Regional Education Board is the operating agency of an intersta te compact in the field of higher education. The 16 member States of this 

compact include: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, 

Louisiana, Maryland, Mississippi, North Carolina. Oklahoma, South Carolina, 

Tennessee, Texas, Virginia, and West Virginia.

Since its beginning in 1949, SREB has been concerned with the supply of 

trained health manpower. Through regional con trac t programs which have 

pooled many of the region’s resources in medicine and dental education, to 

mention two fields, SREB has arranged for the training of over 3,000 medical 

and over 3,000 dental students. Many of these students, especially in medicine, 

were trained under int ers tat e agreem ents pending the opening of new medical 

schools.

A major responsibility of SREB is to call to the atte ntio n of the States of the 

region changing needs and resources in various fields and to recommend needed 

action. Two recent studies—with recommendations—are of special interest here, 

one in den tistry and one in medicine. These studies reveal findings consistent 

with trends repo rted in many other studies in various parts of the country : a 

growing, more urbanized, better educated, and more prosperous population need, 

and is demanding more and better health services. The demand for professional 

health services in the South will increase substan tially by 1975 because; (1) the 

jtopulation will have increased by 13 million; (2) an eighth more of the populatio n will live in cities; (3) the proportion of elderly people will increase by 

12 percen t; (4) the educational level will continue to ris e; (5) incomes will increase : and (6) insurance coverage will continue to grow rapidly.

This means, for example, that my region will need some 86,000 physicians by 

1975. compared with 54,000 currently, just to reach a level that the Nation has 

already attained . Or. in the case of dentists, the South will need 36,000 by 

1975 against a current total of some 14,000, if it is to attain 15 years hence the
TRAINING OF PROFESSIONAL PUBLIC HEAL TH PERSO NNEL 469

cure nt national relationship between the number of dentists and the popu lation’s 

income.

These needs dictate an expansion of training facilities, as indicated in our 

reports on medical and denta l education which I am filing with your committee. 

The thing I would like to stress most emphatically Is th at the States and institutions of my region have been making strenuous efforts in recent yea rs to expand 

their programs for training health manpower, more than any other region of the 

country.

New public medical schools have been erected in Florida and Kentucky : 

and Mississippi, North Carolina, and West Virginia have expanded their 2-year 

schools of basic medical sciences to 4-year schools. Texas has assumed public 

control and financing of a formerly private medical school in that State.

In dentistry, Alabama, Kentucky, North Carolina, and West Virginia have 

established new schools in recent years.

Despite these striking advances by States and institutions of the region, 

however, southern medical schools alone need some $15 million for rehabilita ­

tion and remodeling of present teaching facilities, and an additional $55,500,000 

by 1965 for new teaching facilities. These sums do not include estim ates for 

teaching hospital construction (an estima ted $60,000,000) or for studen t facilities 

or administrat ion facilities (another $40 million).

In dentistry, at least five schools in the region need new physical plants, 

and two more need additions to present plants if research and gra dua te training 

are to develop.

The South already makes a relatively greater degree of effort in providing 

opportunity for medical education, for example, than does th e rest of the Nation. 

In the Nation at large in 1958, there was an average of 25 first-year places in 

medical schools for every billion dollars of personal income, but the corresponding figure for the South was 29. Yet the average expenditure per southern 

medical school is almost $1 million less than the average expenditure of medical 

schools in the United States. All of this adds up to the fact that my region, 

despite tremendous outlays for new facilities, faces the need for still more 

facilities, at a time when it continues to lag in operating supp ort for such 

facilities.

It is my judgment that little additional expansion of health education facilities will occur in the South in the foreseeable future without some stimulation 

from Federal funds. Leaving aside the whole matter of the national inte rest 

in having an adequate numbers of trained health manpower, it can be noted 

here tha t the principle of local effort has been demonstrated well by State 

legislatures and private institutions in the South in the ma tter of education 

for the health professions.

In this connection, may I call your atte ntion to the Commission on Goals 

for Higher Education in the South, chaired by former Virginia Governor 

Colgate W. Darden, Jr., which expressed “seriou s doubt” that higher education needs could be met from State and local governments and priv ate groups 

alone. The Darden commission, composed of seven of the region’s most distinguished natives, said “it is clear that supp ort through fede rally collected 

revenue also must be increased.” A copy of the commission’s complete repo rt 

is also being submitted for your information. If Federal fund s become available for construction, expansion, or renovation of teaching facilities, I am confident tha t several States and private institu tions will move to match such 

funds. The provision of H.R. 4999 for such gra nts will definitely stim ulate 

added training capacity in the southern region.

But school capacity alone is not enough if we are to secure needed health 

personnel. The scholarship portion of H.R. 4999 would help deal with one 

of the most serious deterre nts to the pursuit of education in the health professions—the high cost to students. Four-year expenses at a medical school, for 

example, average about $10,000 for an unm arried student. In the South, about 

70 percent of medical students are married, and for these costs average from 

$12,000 to $16,000 depending on the number of children.

Even these figures f ail to define the real financial load which a medical ed ucation means, when it is remembered th at the doctor’s training is not completed 

until 8 to 12 or 14 years after enterin g college. This extreme postponement 

of earning capacity is a serious hind ranc e to the attrac tion of potential medical 

students, especially from families of average or lower income levels. Several 

years ago it was shown that only 15 percent of medical studen ts came from 

the income bracket of “less than $5,000 per annum " although 41 percent of
470 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

white urban families earned no more than this. A slightly gre ate r jjercentage 

of so uthern students came from the lower bracket but, as elsewhere, almost half 

came from the “plus $10,000” bracket, which accounted for only 11 percent of 

families.

Paren tal income can hardly be justified as the imp ortant selective criterion 

for study ing medicine which, in effect, it has become. If capab le students are 

to enter medical schools from moderate and lower income groups of the population, ways must be found to assis t these students in meeting the costs of medical 

education. Ironically enough, it is in the most expensive fields of professional 

education that the availability of stipends appears to be lea st ample. Almost 

40 perc ent of graduate students in the art s and sciences receive income from 

scholarships, fellowships, research or teaching ass ista ntship s which average 

$1,800 or more annually, as compared with only 2 perc ent of medical students 

who receive that much in stipends. While medicine still has great prestige 

in our society, the attrac tions of new and exciting avenues for vocational expression, especially in the sciences, present tough competition to the medical 

schools apart from the short-term advantages of fellow ship support.

The scholarship awards proposed under H.R. 4999, while modest in comparison with the high costs of medical education, should be adequate in the 

context of the medical studen t’s other sources of funds. While almost half 

of these funds, in some form, come from the paren ts of the students, it should 

be noted that 99 percent of medical students pay pa rt of the ir expenses by 

working. In fact, student earnings cover 20 percent of costs an d wive’s earnings 

accou nt for another 17 percent. Loans and scholarships have provided only 

9 percent of costs in the past.

The principle of cost of education payments as proposed in H.R. 4999 is a 

sound one, which has worked well in the operation of the national defense 

graduate fellowship programs. Certainly, if the effect of scholarship grants is 

to stimulate enrollments, ways of meeting corresponding increases in opera tio nal 

costs must be assured since tuition covers only a frac tion of these costs. The 

amount of the proposed cost of education payments is modest, being less than 

half the maximum allowed under the national defense gradua te fellowship 

programs. While scholarships stim ulate qua ntity of medical education, cost of 

education payments may be expected to help assure main tenance of quality in 

medical education.

The wise provision of H.R. 4999 to extend and expan d the research facilities 

gra nt program has eloquent enough testimony from the results already achieved 

through that program. But our recent medical education study still showed a 

need by 1965 of some $20 million for new re search facilities.

I would like to make one final comment about H.R. 4999. I heartily endorse 

its emphasis on the need for adeq uate planning of new facilities. I am pleased 

especially that the bill notes the role of State and regional planning in leading 

to wisest use of construction funds, and that it also perm its grants for the 

construction of regional facilities for research.

As early as 1957 we recommended intersta te planning in the Southwest and 

the upper South subregions for expansion of existing denta l schools or establishment of new dental schools. And in the more recent medical education report, 

we stated that one idea which has not been studied carefully is the possibility 

of intersta te agreements to expand or construct medical school facilities. This 

would be a new departure , but. then the extent of our growing need is new and 

we will be taxed to find all promising solutions. I am confident th at interstate 

planning can play a helpful role in expanding facilities in the future.

In conclusion and summary, I believe that the passage of II.R. 4999 would 

provide important and needed assistance in meeting the health needs of the 

South and the Nation.

Northe rn Association for Medical E ducation,

St. Pan/, Minn., .January 29. 1962.

Re H.R. 4999 medical schools construction bill.

Hon. Oren Harris,

Houae of Repreaentatirea, Waahington, D.C.

Dear Chairman Harris: The Northern Association for Medical Education.

NAME, is an organization comj>osed of 505 doctors, who have been working to 

establish a new medical school in St. Paul, Minn.

The association wishes to express its hope that your committee will report 

H.R. 4999 favorably to the House of Representatives, and requests this lett er 

be included in the records of the hearing.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 471

NAME has been organized since 1958 to develop a school of medicine in St. 

Paul, Minn. The members of the association became aware at that time of the 

impending shortage of medical manpower tha t faced the Nation. They surveyed 

the clinical facilities in St. Paul and found them well suited for the establishment 

of a new medical school in this city.

During the i>ast 3 years the organization has conducted an information program 

to impress the community with the need for medical schools in the United States 

and for the establishment of a new school in St. Paul. Members of th e association 

have been enlisted, not only from the Twin Cities, but also from Minnesota 

statew ide, Wisconsin, North and South Dakota, Montana, and Wyoming.

The association has had its plans for a new medical school endorsed by the 

Ramsey County Medical Society, the Minnesota Sta te Medical Association, the 

city government of St. Paul, the chamber of commerce, representativ es of the 

labor movement, and a number of other civic and community organizations in the 

area.

The importance of H.R. 4999 to our proposed medical school cannot be overemphasized. To our knowledge everyone agrees tha t a new medical school in 

St. I’aul is imp ortant to the community and to the Nation, but the problem of 

finding adequate funds to construct the school has been the one imp orta nt 

obstacle th at must be overcome before the plans for the school reach fulfillment.

Our medical school will have the advanta ges of new clinical teaching facilities 

in the city-county hospital that is being built to replace an old structur e in St. 

Paul. There is also new and progressive programs for the cooperation of p rivate 

hosp itals and clinics in the teaching of medicine, here, as well as the care of the 

medically indigent.

As you know, there is only one other 4-year school in the five-State area from 

which members of NAME are drawn. The enclosed map graphically illu strates 

this point.

All these factors, and others combined, contribute to the natural development 

of a medical school here. With match ing funds from the Federal Government 

local resources can establish 1 of the 20 or more needed schools in St. Paul. 

Sincerely,

J oh n W. IIedback,

Exe cutive Director.

Northern Association for Medical E ducation Charts Pla ns for a New

Medical Schoo l in St. Paul

On April 1, a yea r after organized activities were launched, the Northern 

Association for Medical Education has grown to 488 physician members. A 

program for its future efforts has been adopted ns projected in the accompanying charts.

The critical need for additional medical schools in the United States is 

shown in the first two graphs. Next is a map th at demonstrates better than 

words the importance of a medical school in the Northwest area.

Plans for the development of St. Paul’s medical school follow.

In studying the cost of a school, as shown in the las t illustration, it must be 

stressed th at all of th is funding is not expected to be developed locally.

Legislation now in Congress proposes to pay 06% percent of the costs of new 

medical school construc tion; up to .$500,000 a yea r in planning and development 

costs; sub stan tial sums to the operating deficits once th e school is running.

National foundations are expected to help. The Kellogg Foundation las t year 

gave two gra nts of more than $1 million each to the universities of New Mexico 

and Connecticut to develop new medical schools.

NAME is now working to be organized and ready for the acceptance of such 

grants. The cost of a new medical school in St. Paul is upward from $40 million, 

but the need for local financing is a frac tion of that to bring this worthwhile 

institution to our city.
472 TRAINING OF PROFESSIONAL PUBLIC HE AL TH PERSONNEL

NORTHERN ASSOCIATION FOR MEDICAL EDUCATION FACT SHEET

Obje ctive.— The establishm ent o f a new medical school in St. Paul, Minn. 

Pacts on medical education

There are :

Eighty-two 4-year schools (40 are State owned) ; three 2-year basic medical 

science schools.

Avera ge graduating clas s is 00. Total 85 schools graduated 7,081 M.D.’s in 

1060.

The re are 132 doctors per 100.000 population in United St at es ; 235,000 doctors, 

156.000 in p rivate practice.

Need

To merely maintain this ratio, by 1075, we must gra duate 4.000 more doctors 

each y ear.

Full expansion of our prese nt schools (maximum resou rces in money and 

fac ilit ies ) would produce only 2,000 more grad uates.

At an average of 100 per gra duating class, 20 more schools must there fore be 

established.

Thes e fac ts are agreed upon by the U.S. Public Health Service, the American 

Medical Association, and the Asso ciation of American Medical Colleges.

Nature and costs of medical school

Course is 4 yea rs af te r premedical training (usually a deg ree ).

First 2 yea rs of basic medical science requ ires hea vily equipped laboratories, 

cadavers fo r anatom y, etc.

Second 2 yea rs require s hos pita ls and outpatient clinics, approximate flow of 

10 patients per senior stud ent.

Average cost of new schoo ls in las t 10 years. $22.5 million includ ing hospital.

Medical Science Buildin g cost, ave rag e $7 million.

Average school expend itur es per yea r $2 to $3 million. (Spread $088,000 to 

$12 million including rese arch ex pend iture s.)

Why a new school in S t. Paul?

The $16 million new city-cou nty hospital is two-t hird of the cost of a new 

school.

Only one 4-year school in northwest are a : Universit y of Minnesota. No 

private school in northw est area.

St. Paul is only comm unity with enough clin ical mat erial (patien ts) for new 

school in area.

Six private libe ral arts colle ges in St. Paul.

Will boost St. Pa ul’s economy by $4 to $5 million a yea r, boost its health 

standards and facilitie s appr eciab ly.

One of few places in Unit ed Sta tes to place a new school (chosen by U.S. 

Public Health Service a s plausible locatio n).

About NAME

Organized in 1958 by St. Paul doctors to develop a pri vate school.

Four hundred and eighty doctors in five Sta tes are members, 273 St. Paul 

doctors (m ajo rity).

Program endorsed by mayor, cit y council, chamber of commerce. Downtown 

St. Paul. Inc., Ram sey County Medical Society, Minnesota Sta te Medical Association. president o f AMA , newspapers, and labo r or ganizatio ns.

Two hundred doctors have contributed $25,000_to laun ch program.

NAME plans are to aim at opening school in 1967.

474 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

T h e Nor th er n Ass oc ia tion for Med ical E ducatio n

NAME

Dedicated to the establishme nt of a new medical school in St. Paul, Minn.

BACKGROUND

NAME was organized by 71 physicians in the fall of 1958. This group saw 

the impending shortage of physicians that faced the Nation in the next 20 

years and felt the imperative to take action.

The announcement of the ir intentions brought in other members until the 

organization grew, within a few months, to more than 248 doctors.

During the first year NAME developed its program through committees: 

to incorjiorate as a nonprofit org anization; to establish relations with education al ins titutions; to formulate the definition of its objectives in term s of a 

medical school; to create intere st from civic and governmental bodies, and to 

document the reasons why St. Paul was a logical place to build a new school 

of medicine.

At the end of a year of hard work, the group had made sufficient progress 

so th at it was in a position to invite a team composed of I)r. Ward Darley, 

executive direc tor of the Association of American Medical Colleges, and I)r. 

Walter Wiggins, secretary of the Council on Medical Education and Hospitals 

of the American Medical Association, to visit St. Paul. The invitation was 

co-extended by the Minnesota State Medical Association, the Ramsey County 

Medical Society and the city government of St. Paul.

The team surveyed the clinical facilities in the city and pronounced them 

adeq uate to support a medical school. Dr. Wiggins and Dr. Darley pointed 

out what must be done to develop a modern medical school and advised NAME 

of the importance of adeq uate financing and proper educational sponsorship.

With the help of this guidance NAME moved ahead. In 1960 it set up offices 

and retained an experienced adm inistrator in the field of medical education. 

To indicate the sincerity of the physician members, the funds for this first 

yea r of operation were contributed by doctors alone. No others were asked 

to help.

Future program

NAME is now in the development period. It is striving to work out a detailed 

program and schedule culm inating in the admittance of the first freshman class. 

At present it plans to—

Enlist community lead ers in its membership for their wisdom and activ e 

participation.

Complete the programing necessary to describe the school minutely. 

Work out relationship with hospitals, governments, academic institutions, 

and interested organizations.

Secure adequate financing for th e development period.

Interest substan tial benefactors in the importance of the school to secure 

sufficient capital fund s for its medical science building.

Retain a dean with the sta tur e necessary to organize the faculty and 

school.

WA j/ Ft. Pault

NAME has chosen St. P aul as the seat of a new medical school because—

St. Paul has an impressive numlier of p atients for students to study.

St. Paul has fine hospital facilities available to give students firsthand 

experience.

St. Paul is building a new city-county hospital costing more than $16 

million that can serve as the heart of the school’s teaching program.

St. Paul has a medical profession trained in teaching through affiliation 

with Mayo Clinic and the U niversity of Minnesota.

The Twin Cities would be the geographic choice for the many stud ents 

from the Northwest area.

Only one 4-year medical school, the University of Minnesota, exists in 

the Northwest area until the Pacific coast is reached.

St. Pau l has a tradition of higher education with six private colleges 

located in the city.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 475

Wha t will the nature o f the medical school bet

NAME hopes the school will develop along th e following li ne s:

It will be a priva te medical school. As such it will not have the r estriction 

on its source of students as do Sta te universities. (See Time arti cle.)

Present plans a re to admit a fresh man class of 70. a tota l medical studen t 

enrollment of 270, plus nurses, stud ents of medical technology, bacteriologists, etc.

It will have a budget of approximately $2 million a year, treat thousands of 

indigent patients, and conduct responsible research projects.

Because it is new, it can incorporate many advanced concepts in medical 

education, apply accelerated teach ing programs if they are found practicable 

elsewhere.

Its philosophy will emphasize the practit ioner of medicine, the dedication 

of his science and healing ar t to mankind through ste adfas t study of the 

human pa tient and his ecology as well as h is parts.

BOA RD OF TR U ST EE S

Dav itt A. Felder, M.D., president 

Edw ard P. Burn, M.D., vice president 

Ian A. Brown, M.D., secretary 

Ben Sommers, M.D., trea sur er 

John B. Coleman, M.D.

(Tiarles C. Cooper, M.D.

Delmar R. Gillespie, M.D.

Jane E. Hodgson, M.D.

Robert W. Holmen, M.D.

Milton M. Hurwitz, M.D.

Wallace P. Ritchie, M.D.

Albert E. R itt, M.D.

Gilbert P. Wentzel, M.D.

John W. Hedback, executive directo r

The Northern Association for Medical Education

[R ep ri nt fro m M in ne ap olis Sta r, Ju ly 29, 1960]

This a rtic le summarizes the background and plans NAME now has for a new 

medical school:

Would E nroll 270—New Medical School Will Open in 1967

(By Hal Quarfoth, Minneapolis Star staff writer)

By 1967 the Northern Association for Medical Education hopes to open the 

doors of a new medical school in St. Paul.

Plan s call for a 4-year school with an enrollment of 270 to 280, gra dua ting 

70 doctors a year.

Estimated costs include about $8 million for construction of a medical science 

building and supplem entary research and adm inistrativ e facilities, possibly $500,- 

000 for development of plans, faculty, and curriculum and an endowment, possibly as high as $30 million.

The school would be the only 4-year school in the area besides the University o f 

Minnesota Medical School and would be the only private doctor-training institution between the Tw in Cities and the w est coast.

“We believe the new school should be private, rather than State or municipal, 

to m aintain a balance between public and private e ducation,” said John Hedback. 

executive director of the association.

The idea of a new medical school in St. Paul is backed by city officials, civiq 

organizatio ns, and the House of Delegates of the Minnesota State Medical 

Association.

The association believes the school could be erected near the new Ancker 

Hospital planned in the eastern redevelopment area, east of the capitol, and dovetaile d with th e hospital’s program.

Thursday Dr. Da vitt A. Felder, association president, urged that the Ancker 

Hospital Building Commission emphasize the importance of the teaching function in the new city-county hospital.

“If the new medical school is an imp ortant program for Ancker, the hospital 

will be a better hospital,” he said.

He pointed out th at the present gra duate medical education program could 

easily be expanded for und ergraduate clinical instruction as well.

A lot of hard work lies ahead before the school can open, said Hedback.

His group was formed in 1958 to set up a medical school in St. Paul.
476 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

The association lias raised more than $15,000 from its 248 doctor members 

to finance preliminary operations.

It i»ians to invite physicians from the entire Sta te and from North Dakota, 

South Dakota, Wyoming, Montana, and western Wisconsin to join.

Lay members also will he added. A committee on lay member policy has 

drawn up a list of about 80 influential Twin Citizens who will be urged to 

become the nucleus for a widely expanded general membership.

Planning for the school fall s into thre e phases, Hedhack said.

The first, now going on, is the development of a detailed program and schedule, including an analysis of the cap ital funds required.

The second, expected to be launched by Jan uar y 1, will be requests for large 

grants from philanthropists, foundations, and others for building funds. In 

this phase, it also is hoped th at a dean can he selected.

The third, largely the responsibility of the dean working with the association, 

will consist of construction plus organizatio n of faculty and curriculum. The 

time schedule is between 1963 and 1967.

Meanwhile, efforts to raise an endowment fund will continue. The $30 million figure, Hedback pointed out, is subject to modification because of the possibility of income from the Federal Government and other sources. All other 

phases of the program, too, will be studied by a programing and scheduling 

committee and could he changed.

The endowment would provide operating income. Annual budget is expected to be about $2 million, with perhaps $500,000 of that retu rned as income 

from p atient care and research grants.

The $8 million construction estimate is also tentative , based on the experience 

of the eight entirely new medical schools built in the country since 1943.

Costs for these schools averaged between $22 and $25 million, Hedback said, 

but about two-thirds went into construction of teaching hospitals.

“In St. Paul, we have a prime area of clinical teaching facilities at Ancker 

Hospital and excellent teaching facilitie s at (he other major hosp itals,” he said, 

“so we can eliminate the cost of teach ing hospitals.”

The association hopes to have from $2 to $4 million in building funds by the 

time a dean is selected, and $6 or $8 million in the endowment fund when doors 

open. No public subscription campaign is planned at present.

“We would like to be under the academic sponsorship of a St. Paul Liberal 

Arts College,” Hedback said, “and one is studying the feasibility.”

lie is confident the school will have no difficulty in acquiring a staff. “Many 

of the physicians in the association have clinical professorships, and most 

are teaching in hospitals,” he said.

Sta teme nt by Dr. I rvino Yale, Cha ir man , Cou nc il on Education, American

P odiatry Association

Mr. Chairman and members of the committee, I am Irving Yale, D.S.C., 

Ed. D., chairman of the Council on Education of the American Podiatry Association. I would like the following statement incorporated into the official 

record of this hearing.

The Council on Education is the accrediting body recognized by the Dep artment of Health. Education, and Welfare, and the Department of Labor. As in 

the oth er health fields podiatry is confronted with the problem of increasing 

the opportunities for training of podiatrists.

Pod iatry is a recognized member of the health team and has no counterpart 

in other health professions. Our professional people are serving the public 

as commissioned officers in the Armed Forces, in hospitals and clinics maintainin g services for the elderly and chronically ill, in industry and as private 

doctors of podiatry on the local community level.

Our institutions of learning are nonprofit and are sorely in need of modern 

facilities for training our scientists and future prac titio ners. Progress in research on foot disorders has been hampered by lack of adequate physical 

facilities and personnel. It is unwise to expect the foot health of the American 

public to be maintained at the high level which now exists without some governm enta l assistance as proposed fo r other health fields. Several of our colleges 

have plans for expansion on the drawing boards and are thw arte d by the high 

costs of construction.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 477

The p odiatrists commissioned, in th e Army, Navy, and Air Force, together with 

those prac ticing witli the Veterans’ Administration, need furth er advanced 

training to maintain their status alongside the other health professions. This 

opportunity has not been made available to them due to certain restrictions 

and inadequate facilities. These men should receive the ir pos tgra dua te tra ining at a college of jmdiatry where present personnel devote the ir time to 

teaching th e foot doctors of tomorrow’s America.

Our scholars are in dire need of funds, by way of scholarships, to improve 

themselves, educate others, and to tak e the ir place in the profession as teachers 

of foot h ealth in the best inte rest of the public need.

The Council on Education recognizes th at the high cost of operation of our 

professional schools cannot possibly be justifie d by tuition alone. Improvement 

of physical plants, construction of modern laboratory facilities , and matching grants for futur e development can make it imssible to tra in more foot 

doctors.

The statem ent by Dr. Rubin, secretary of the American Pod iatr y Association, 

describes vividly the needs as pointed out by the Special Commission on the 

Status of Pod iatry Education. It is also evident tha t the profession has contributed to its institution s of learning beyond its call of duty. The record will 

show th at while other professions have received aid from governmental and 

philanthropic funds the profession of podiatry has stood on its own two feet 

in the pioneering manner that has made our country so great. However, with 

the tremendous advancements in educational qualifications, and the need of more 

foot doctors to satisfy the public need, it is essential that we respectfully 

request inclusion in your present legislative effort to provide assistance to the 

health professions. Increased opportu nities for training of more pod iatrists 

has now become the re sponsibility of all of us working together.

I want to thank you for this opportu nity to advise you that the Council on 

Education of the American Pod iatr y Association is in accord with the broad 

concept of II.R. 4999 and that we respectfu lly request inclusion in the public 

interest.

Res pe ctfu lly s ub m itt ed .

Irvino Yale, D.S.C., Ed. D., Cha irman.

HEAD QUARTER S OF AM ER ICA N PH AR MA CE UT ICAL ASSOCIA TIO N,

Washington, D.C., January 29,1962.

Re II.It. 4999, II.It. 8774, and II.R. 8833.

Hon. Oren Harris,

Chairman, Comm ittee on Interstate and Foreign Commerce,

U.8. House of R epresentatives, Washington, D.C.

My Dear Mr. Harris: The American Pharmaceutical Association is pleased 

to submit the enclosed stateme nt to you, and respectfully requ ests th at it be 

made a p art of the official record.

We sincerely apprecia te this opportunity to express ourselves in the ma tte r 

of H.R. 4999, II.R. 8774, and II.R. 8833.

Sincerely yours,

William S. Apple, Ph. D., Secretary.

Statement of the American P harmaceutical Association

The American Pharmac eutical Association, organized in 1852, is the oldest 

national association in American pharmacy. The objectives of the association 

since its inception have concerned themselves exclusively with the development 

of standard s to improve and promote public health. For 110 years, we have 

devoted our energy to main tain and achieve higher standa rds of professional 

practice and improvement of the qua lity of drugs available to the American 

people.

The American Pharmac eutical Association has no financial, business, or commercial inte rest in any pharmaceutical product, manufacturer, wholesaler, or 

pharm acy ; its sole inte rest is promoting the highest sta ndard s of public hea lth 

through improved professional pharmaceutical service.

One basic objective of the association, as stated in its constitution, is : “To 

provide a system of education and training in the art of pharmacy, calculated 

to produce competent personnel through all phases of the p ractice of pharmacy
478 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

and the training of pharmacists as the means of providing the greatest protection fo r the public a t la rge.”

On behalf of the high standard s of professional competence we have fostered, 

and which we seek not only to maintain but improve, the American Pharm aceutical Association favors congressional consideration of means of making 

fund s available in order to foster adequate facilities for public health education 

and the training of professional health personnel. Moreover, pharmacy, like 

medicine and dentistry, is an integral phase of total public health care and we 

therefo re feel that it is necessary and desirable to make specific reference to 

the profession of pharmacy in the proposals you a re now considering.

We must emphasize th at the public health function of pharmacists is not 

merely a phase of the practice of the profession of pharm acy, but rather , the 

prac tice of the profession of pharm acy is an inte gral phase of the practice of 

public health.

Pharmacy is one of the public health professions and has been considered 

as such since time immemorial. Pharmacists jo in with physicians, dentists, and 

oth er members of the public health team to assure our citizens the highest 

obtainable type of health care. The pharmacist’s role in the public health of 

the Nation is an ever expanding one as newer, more effective, chemotherapeutic 

agen ts are made available and new approaches to the mitigation and cure of 

disease are developed.

Community and hospital pharmacies, research and control laboratories, product development and manu factu ring, and numerous governmental agencies are 

among the numerous public health areas utilizing pharm aceutically trained personnel. The special education, background and knowledge of pharmacists is 

creatin g additional public health service responsibilities for members of our 

profession. Schools of pharmacy are making every effort to respond to the demands for the ir graduates.

To determ ine whether or not there is a need for additional facilities and to 

intelligently project the futur e demands for pharmacists in all professional 

specialities, the American Pharmaceutical Association and the American Association of Colleges of Pharmacy, in cooperation with the I'.S. Public Health Service, 

is undertaking a professional manpower study in pharmacy. Thus, by first, accurately determ ining the areas and amounts of manpower needs within the profession. both priv ate and Government, funds invested in pharm aceutical education would be used most effectively.

With appropriate amendm ents, the assistance proposed by the bills before 

you would enable pharm aceutical education to move forw ard without delay. 

In this connection, your atte ntio n is invited to a para llel Senate bill (S. 1072) to 

which such amendments have already been introduced. These amendm ents 

make schools of pharm acy eligible for financial aid as is proposed for schools of 

medicine, dentistry, and public health. With such assistance to education, the 

public would be assured of the availability of competent personnel to provide 

complete professional services and thus preserve our high stan dard of health 

care.

T he University of Texas—Medic ai. Bra nc h,

Galveston, January 16, 1962.

Hon. Joe M. Kiloore,

House of Representatives.

Washington, D.C.

I >ear Mr. Kiloore: My atte ntion has been called to the fact tha t the House 

Committee on Inte rstate and Foreign Commerce is holding hearings on H.R. 4999, 

Janu ary 23-26, 1962, and that, representatives of our Association of American 

Medical Colleges will apjiear on the morning of Janu ary 24.

I profoundly believe it to be in the best inte rest of the Sta te of Texas and of 

the United States tha t you favor reporting th is bill out. with committee endorsement : and that you actively supi>ort its passage by the House.

The Nation needs well-trained doctors in larger numbers. Texas needs welltrained doctors In larger numbers than our facilities through out the State p ermit: 

thoroughly trained family physicians, specialists, medical school teachers in both 

clinical and basic science fields, investigators and medical scientists of the first 

rank.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 479

Facing this challenge, what a re our major problems today in Galveston; tom orrow in San Antonio? They are ones toward the solution of which H.R. 4999 

goes a long and careful way :

1. Construction funds for teaching facilitie s (specifically outside the hospital 

purposes of the Hill-Burton Act, and outside the research purposes of the Health 

Research Facilities Construction Act).

2. Additional construction funds for health research facilities. Gra nts alread y 

approved by this agency today, cannot be awarded because fiscal 1962 funds are 

exhausted. X.B. The University of Texas Medical Branch will submit our first major request from this agency on April 1 in the amount of over $2,500,000, for which 

University of Texas available fund bond issue money will be earm arked for 

matching purposes.

These two are essentially one-shot items, with no troublesome strings at ­

tached. The Texas Legislature, facing the new medical school in San Antonio 

(not to mention the University of Houston) next session cannot be expected to 

provide funds of this sort.

The third problem relates to the need for medical studen t scholarships in 

the face of a nationwide decrease in the numbers of well-qualified applicants to 

schools of medicine. The long and expensive training for medicine and medical 

science (in an age group that will get marrie d) is widely regarded by medical 

education a s a major factor in this re cruitment problem.

H.R. 4999 hits these thre e problems squarely. It is a bill which has had the 

benefit of the most c areful study possible; and it has the merit of rega rding the 

national problem in term s of medical education, students, and the need for 

doctors—rathe r th an in terms of a special-interest group.

I am taking the liberty of forwarding a copy of this letter to my Congressman 

and friend, Clark W. Thompson, with the confidence th at he will assure you 

that I am no spe ndthrift liberal, and with the hope th at he will add his voice 

of conviction to mine—to the end that you will consider H.R. 4999 in the highest 

priority for your endorsement.

Sincerely yours,

J ohn B. Truslow, M.D., 

Executive Dean and Director.

Baylor University,

Collegeof Medicine,

Texas Medical Center, 

Houston, Tex., Jan uary 17,1962.

Hon. Joe M. Kilgore,

House of Representatives,

Washington, D.C.

Dear Mr. Kilgore: The House of Representatives Inter sta te and Foreign 

Commerce Committee of which you are a member, has scheduled hearing s on 

H.R. 4999. “a bill to increase the opportu nities for training of physicians, 

dentists, and professional public hea lth i>ersonnel, and for other purposes” for 

Jan uary 23-25, 1962. I am writing to urge that you give favorable consideration to this proposed legislation.

My interest in this bill stems from the fac t th at I have been dean of a medical 

school for the past 12 years, 9 of which have been at Baylor University College 

of Medicine. I have served on the Executive Council of the Association of 

American Medical Colleges for the past 5 years d urin g which time I have become 

convinced that our country does indeed need additional facilitie s for the education of physicians and dentists to meet the rapidly rising level of population. 

A gradual reduction in the ratio of physicians per population has occurred in 

recent years, and it seems highly likely tha t this ratio will continue to drop 

unless the ra te of production of physicians is increased sharply. Baylor University College of Medicine does not at this time contemplate the use of such 

funds as may be made available for construction. The Sta te of Texas, however. has initiated steps to construct a new school of medicine to be located in 

San Antonio and opera ted as a branch of the University of Texas. This facility 

would be eligible for a matching gra nt in the event H.R. 4999 was enacted into 

law and funds were appropriated to implement its provisions.

Careful studies by the Association of American Medical Colleges in dicate tha t 

the largest number of students und ertaking the study of medicine come from
480 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

families whose income is substan tially above th at of the national average. The 

high cost of medical education almost surely accounts for this phenomenon. The 

distribution of intelligence and ability, however, is not rela ted to the economic 

level of the family into which children are born, and it seems certain tha t there 

are large numbers of qualified stud ents among the lower income levels who could 

and should prepare themselves for careers in the health professions and who 

would do so if it were economically possible. The provisions of II.It. 4999 with 

respect to scholarships would bring a medical or dental education within the 

means of a large number of indiv iduals who now seek other occupations for 

economic reasons. The scholarship provisions would benefit the students of 

each of th e professional schools in the State of T exas equally.

An additional factor which may be of interest to you as a Representative from 

the State of Texas is th at for many years we have trained less than 50 percent 

of the total number of physicians licensed annually in this State. It is only 

in the past 4 or 5 years that the percentage 1ms increased to as high as 55 percent of the total. This means that the State-supported and private schools in 

other States have educated approximately 50 percent of the physicians who serve 

the people of the State of Texas. The enactment of legislation which would provide for the expansion of education al facilities for physicians, dentists, and other 

health personnel would benefit Texas substan tially in the fut ure even as it has 

been benefited by the contributions of medical schools in other States for many 

years in the past.

Your favorable action in recommending this bill will be deeply appreciated. 

Yours sincerely,

Stanley W. Olson, M.D., Dean.

Bbown University, 

Providence, R.I., Januar y 19,1962.

Hon. J ohn E. Fogarty,

House of Representatives Office Building,

Washington, D.C.

Dear Congressman Fogarty: I enclose a copy of a letter that I have just 

writte n Representative Harris . As I am sure you know, this bill is of great importance to Brown’s effort to establish a program of medical education in Rhode 

Island. I hope you will give it whatever supp ort you feel is appropriate. 

Sincerely yours,

Barnaby C. Keeney.

Brown University, 

Providence, R.I., January 19,1962.

Hon. Oren Harris,

Chairman, Committee on Inte rst ate and Foreign Commerce,

House of Representatives,

Washington, D.C.

Dear Congressman Harris: In Jun e 1961 the corporation of Brown University approved the establish ment of a program in the basic medical sciences at 

the university. This is the equivalent of a 2-year school of medicine as described 

in the bill, II.R. 4999, which, I understand, was intro duce d by you and is to 

be the subject of a hearing before the House Committee on Inters tate and For ­

eign Commerce. I strongly recommend favorable action ui>on this bill by the 

committee and the Congress.

At the present time Brown University is the only priv ately supported independent university which is committed to the establishment of a new program 

in medical education. This step was taken only after serious consideration of 

the opportunities and obligations for this university which arise from the present and predicted future need for increased efforts in the field of medical education. In assuming this obligation the university recognized that its successful 

implementation could not be accomplished with funds from priv ate sources 

alone. In view of the philosophy and record of action of the Federal Government in supp ort of medical research, its concern for the fut ure supply of physician s as documented by recent studies and the knowledge that legislation such 

as that proposed in II.It. 4999 was pending, the university anticipates the necessity and likelihood of Federal participation in the support of medical education.

The pattern already established in governmental supp ort of research and 

research training which is reflected in II.It. 4995) is an appropriate pattern for 

Government supp ort of medical education in private institutions. It is doubtful
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 481

that any independent school, including Brown University, can successfully 

und ertake the estab lishm ent of a 2- or 4-year medical school withou t such 

governmental aid.

Sincerely yours,

Barnaby C. Keeney.

Harvard Medical School, 

Boston, Mass., January 25,1962.

Hon. Oren H arris,

Chairman, House Committee on Interstate and Foreign Commerce,

House Office Building, Washington, D.C.

My Dear Representative Harris: I enclose a copy of a letter concerning 

II.R. 4999 the deans of the three medical schools in Massachusetts have sent 

to Representatives Hastings Keith and Torbert Macdonald of your committee, 

and to the other members of the Massachusetts delegation to the Congress. 

Sincerely yours,

Henry C. Meadow, Associate Dean.

Harvard Medical School, 

Boston, Mass., Janu ary 22,1962.

Hon. Hastings Keith ,

House Office Building, Washington, D.C.

My Dear Representative Keith : The House Committee on Interst ate and 

Foreign Commerce has scheduled hearings on II.R. 4999, a bill to provide matching grants to medical schools for the construction of teaching facilities and 

scholarship su pport for medical students. The objective is to in crea se the opportunities available in our Nation for the education of physicians and teachers.

On behalf of the three medical schools in Massachusetts—those of Boston 

University, Harvard, and Tufts—we are privileged to write the present lett er 

to urge your strong supp ort of this bill. The passage of the proposed legislation 

holds gre at promise for the welfare of our country.

The problem of educating doctors in sufficient numbers to care for the N ation ’s 

expanding population has been recognized by Congress since 1948. Subsequent 

to that time, many studies undertaken under private and public auspices have 

documented and analyzed the problem. Between 1948 and the present time, 

many suggestions have been put forward concerning how the problem might 

be solved.

During the past year, a consensus has been achieved among me dic al educators, 

legislators, physicians, and the executive branch of the Government, as to the 

form and direction that an assistance program should take. On Janu ary 10, 

1901, Preside nt Kennedy’s Task Force on Health and Social Security published 

the resu lts of the ir study. They recommended, among other things :

“Federal aid for the construction of new educational facilitie s and renovation 

and expansion of existing facilities for the purpose of increasing the numbers of 

persons being trained in these fields.”

On Jan uary 11, 1961, at the stated meeting of the institution al members, the 

Association of American Medical Colleges adopted several proposals of the support of medical education by the Federal Government. While I am sure you 

have seen copies of these proposals, they are enclosed for your convenience. 

Briefly, the AAMC recommends that Congress enact legislation “* * • that will 

provide funds for the full modernization and expansion of existing programs in 

medical education and the development of new programs,” provide operatin g 

suppo rt for medical schools, and provide scholarship assistance for medical stu ­

dents. Finally, it is proposed that the present program of resea rch supp ort be 

continued and expanded.

It would seem to us, the deans of medical schools in Massachusetts, to be a 

ma tter of utmost importance tha t action be ta ken promptly. Apart from considerations of better education for physicians and the better utilization of their 

services, the problem of the supply of doctor^, teachers, and medical scie ntists 

must he dealt with realistically if the Nation is to maintain the exis ting ratio of 

doctors to population. As you know, it is agreed by most of those who have 

studied the problem that by 1970 this Nation “must provide an increase of ap ­

proximately 4.000 first-year places in its schools of medicine.” In our opinion, 

the passage of H.R. 4999 will go a long way toward making this expansion 

possible.
482 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

Because of our mutual concern for the Commonwealth, let us turn to the situation in M assachusetts. Our State, with its three schools of medicine, has one 

of the most significant concentrations of medical educational resources in the 

country. Although each of our schools is unique in function and character, each 

shares common objectives and problems. Each school is devoted to providing 

the highest level of teaching, research, and patient care consonant with its resources. Each experiences the problem of soaring costs of education and the 

lack of adequate capital to exjaind educational facilities . Apart from the improved instruction tha t better facilities will make possible, the most immediate 

and visible impact of the passage of H.R. 4999 will be increase in the number of 

students each school can accept. The increase will come about in two w ay s:

First, the schools will be able to increase the ir first-year enrollment.

Second, the schools will be able to increase the number of transf er studen ts 

they can accept into the third year from the growing number of 2-year medical 

schools already in operation or planned. (The passage of H.R. 4999 will help 

in this direction.)

The resu lt of these increases will be the equivalent of a new medical school.

The majo rity of the physicians serving the i»opulation of Massachusetts are 

grad uate s of our three schools. More gradu ates will inevitably mean improved 

service to the community—not only through direct iiatient care, but through 

exjuinded program s of patient care achieved by schools and their affiliated 

hospitals.

There is a nother point to which we should like to invite your attention. New 

medical schools and larger medical schools must have more faculty members. 

These additional teachers can now be educated only in existing schools. It 

will interest you to know tha t Harvard, for example, prepares more medical 

teach ers than any other two schools in the Nation.

In the past. Federal programs for the support of research in medicine and in 

medical science and for construction of research facilitie s have been successful 

from the point of view of improving the Nation’s health and from the point of 

view of the institutions involved. Federal participation in the support of these 

activ ities has not mean t Federal control. We believe that this will continue 

to be true for a program of matching grants for teaching facilities and grants 

for scholarship support. The importance to our country of research in the medical and biological sciences has been recognized for many years. It is now time 

for the Congress to recognize tha t education in medicine underlies both resea rch 

and patient care.

Finally, a word about the scholarship provision of the proposed bill. Medical 

education is a long and costly process for the student as well as for the school. 

Scholarship funds such as those visualized in this bill will place medical education within the reach of many who cannot now contemplate such a care er because of economic circumstances. If these scholarship grants are made, the 

Congress will in our opinion have done much to assure the supply of talented 

physicians and scholars for the future.

Please let any of Us know if you have questions. We will do our best to answer 

them.

Sincerely yours,

Georoe Pacher Berry, M.D..

Dean, Harvard Medical School.

Joseph M. Hayman, M.D..

Dean, Tu fts University Medical School.

Lewis H. Rohrbaugh,

Acting Dean, Roston Univ ersity School of Medicine.

Westebx Resejive University.

School of Dentistry. 

Cleveland. Ohio, February 19, WC)2.

Representative Oren Harris.

Chairman, Committee on Interstate and Foreign Commerce,

U.S. House of Representatives, Washington. D.C.

Dear Representative Harris: May I respectfully request tha t this letter be 

included within the hearing record on II.R. 4999.

The School of Dentistry of Western Reserve University is housed in a building which is 45 years old. Two hundred and forty-five students are crowded
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 483

into a building with less than 30,000 square feet of floor space. Research in 

the etiology of dental disease designed ultim ately to be applied in the prevention 

of dental caries, the most prev alen t of all diseases, and oth er dental diseases is 

housed in a separate building on the university campus.

Preliminary archite cts’ dra wings for a new building have been prepared. The 

proposed building will allow us to increase by one-third the size of the entering 

class of future dentists. The gra duate training program will be greatly expanded as will the training of aux iliary personnel in cooperation with other 

educational institutions in this area. The estim ated cost of the new building 

for teaching, research, and patient service is $4 million. A fund drive to raise a 

portion of this sum from our alumni and others is being inaugurated this month. 

Matching funds from the Federal Government will be essential if this goal is to 

be accomplished.

It has been estimated by the Manpower Division of the Dental Corps, U.S. 

Public Health Service, th at the critical need for educ ating dentists is greater 

in Ohio than in most other States. Wliile about two-thirds of our students are 

residents of Ohio, we have students from many other parts of the country. Also, 

Ohio residents aft er graduation often decide to practice in other States.

Passage of H.R. 4999 would greatly increase our capacity to serve the Nation 

in the education of fut ure d entists and denta l specialists. It would also enable 

us to strengthen and broaden our program of research.

Sincerely yours,

P au l E. Boyle, D.M.D., Dean.

Univ ers ity of Maryland,

School of Medicines

Baltimore, Md., January 2a, 1962.

Hon. Oren Harris,

Chairman, Interstate and Foreign Commerce Committer,

House Office Building, Washington, D.C.

Dear Congressman Harris : Reference is made to your stateme nt that deans 

of medical schools in attendance at the hearing on H.R. 4999 on the aftern oon 

of Jan uary 24, 1962, were invited to submit a statement for the record if they 

so desired.

I would like to supp ort the statements of Dr. Donald G. Anderson, Dr. Robert 

C. Berson, and Dr. Thomas B. Turner. In addition, I would like to submit a 

stateme nt in reference to the question raised by Congressman John Bell Williams, 

of Mississippi: Namely, “Why is support of medical education a national responsibility?”

It is both a State and Natio nal responsibility. Natio nal responsibility exists 

for a number of reasons. They a re :

A. Eleven States have no medical schools and three States only provide the 

first 2 years of medical education. While increased tuition is charged nonresiden t medical students it does not cover but a fraction of the costs. If tuition 

was increased for nonresident students to cover costs, it would be so high practically none could attend. States without medical schools or only 2-year schools 

have inade quate or no ixdicies that have been effective in providing costs to 

schools where the ir residents atte nd medical schools. Some Federal action appears to be necessary to provide this supixirt in a reasonable period of time.

B. The Federal Government uses a large number of physicians, and other 

tha n in the field of research provides no funds for their education in medicine.

C. National defense loan funds are allocated to univ ersities on the basis of

enrollment. The medical school has such small enrollments tha t w’heu funds 

are allocated on this basis within the univ ersity the loan funds are totally 

inadequate to meet needs in the medical school. In a recent survey of the 

medical school classes of this medical school the aggregate of loans being 

carried by all s tudents as of June 1961 was $229,818. ( See enclosure.) Much of

thi s money had to be borrowed at inte rest rates of G jiercent or higher. The 

studen ts still have 2 to 5 y ears of medical education to finance, and the income 

they can earn as interns and residents in hosp itals will on the average be 

considerably below living costs.

D. Considering weapons of mass destruction that will probably be used in any 

future major war, the ability to stand up to such an attack and recover from 

it will depend much more than ever before on the number and quality of 

physicians available to control disease and tre at casualties. A 10- to 20-j>ereent
484 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

second-degree burn is usually not fatal. Fif ty to one hundred roentgens of 

general laxly radiation is not fatal. The combination of minor injury and 

suhlethal radiation can he fatal up to 60 percent if the infection that usually 

follows cannot be adequately treated. An adequate number of well-educated and 

trained physicians is vital to our natio nal defense.

In reply to your questions and tha t of Congressman Harold R. Collier, of 

Illinois: “Are the medical schools through H.R. 4999 trying to increase the 

number of medical school applications and could not thi s he done by better 

public relations?”

Better public relations are always helpful but this is not believed to he a key 

factor. Two significant studies of in dividuals a t the age when they were choosing 

caree rs have been done:

1. O’Dowd. Donald D., and David C. Beardslee, “College Stud ent Images of a 

Selected Group of Professions and Occupations” (cooperativ e research project 

No. 562 (8142), TT.S. Office of Education, Department of H ealth, Education, and 

Welfare, April 1960. pages 26, 32. and 33.

2. Department of Defense study on career preferences of young people of 

milita ry age, 19(51.

Both of these studies show that the career of the physician is considered most 

desirable of all careers available.

It is not believed th at better public relations could materially change this 

picture. Financing of medical education appears to he the real deterrent to 

selecting medical education and a medical career.

In reference to your statement “We should allow all individuals with a 

desire and the ability required to enter a profession,” I would concur. Aside 

from the financial aspects, I believe we are now affording individuals such an 

opportunity. It m ust be appreciated tha t desire and ability are being measured 

from the time an individual ente rs premedical studies. The grades earne d and 

the opinions of the faculty teaching the individual are used as measures of ability. As would be expected, many students change their minds for various reasons and some do not measure up. If sufficient laboratories in medical schools 

were available at this time to admit all the applicants this ye ar that were refused 

admission, it is not believed it would be a rewarding experience. All really 

qualified stud ents are being admitted to medical school. At this time some of 

those admitted are such border-line students that a high percentage of them 

fail. Fur ther, they requ ire so much faculty time in an atte mpt to get them to a 

passing level that in some instances inade quate faculty time is devoted to the 

better students. If we increased the number of poorly qualified students in 

medical school, i t would be detrime ntal to the whole program in medical education. The time to e liminate poor students is at the end of the premedical period, 

not after they enter medical school. This allows individuals with poor to 

mediocre records to choose another field of endeavor where they can make a 

better contribution.

What, the medical schools need are more well-qualified students, not numerical 

increase in applicants. Increase in population numbers will bring this about 

to a certain extent, but the financial requirements deter many good students 

that would choose a medical career if they could finance it. There is substantial 

shopping around through the medical schools fo r scholarships by medical school 

applicants. Because of the small number of scholarships and great overall costs, 

many students, after exploring the cost of medical education, enter other fields. 

Sincerely,

William S. Stone, M.D., Dean.

American Library Association. 

Washington, D.C., January 22,1962.

Hon. Oren H arris.

Chairman, House Inte rstate and Foreign Commerce Committee,

House of Representatives, Washington. D.C.

Dear Mr. Harris: Attached is a copy of a stateme nt which was prepared by 

Frederick Kilgour, librarian. Yale Medical Library, for the American Library 

Association. We would appreciate it if this stateme nt could be made a pa rt 

of the printed record of hearings before your committee on H.R. 4999, the 

Health Professions E duca tional Assistance Act of 1961.

Sincerely yours,

Germaine Krettek, Director.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 485

Stateme nt by F rederick G. Kilgoub, Libr arian , Yai.e Medical Library, New

H aven, Con n., for th e A merican Library Association

Mr. Chairman, gentlemen of the committee, my name is Fred erick G. Kilgour, and I am librarian of the Yale Medical Library. As a represen tative of 

the American Library Association having 25,000 members, I would like to inform you of the association’s recommendations for action on II.R. 4999, the 

Hea lth Professions Educational Assistance Act of 1961. In brief, I can say 

that the association requests that your committee make a favorable report on 

II.R. 1999.

The association continues to be concerned with assurin g increasing library 

contributions to the national welfare and secu rity including, of course, our 

most imp orta nt resource, namely, health. The association supports II.R. 4999 

because it believes that th is bill will effectively stim ulate much needed construction, renovation, and equipping of medical libraries as a necessary area in health* 

resea rch and teaching facilities.

Medical educ ation and medical research without medical libr aries is unimaginable. Yet Federal funds have not been available to medical librarie s 

during the period of tremendous expansion of research. In fact, Federal moneys 

have been so successful in stim ulating research that there has been a powerful impact on librarie s forcing them into desp erate circumstances.

Research programs have trebled and quadrupled the numbers of libr ary 

users, and at the same time, have immensely increased the amount of medical 

publications which librarie s must have on the ir shelves. Multifold expansion in numbers of volumes and users has generated serious inadequacies for 

libra ries, and inadequa te space for readers, books, and staffs has become a critical 

deficiency requ iring expensive correction. H.R. 4999 will enable libraries to 

expand physically so that they can furnish effective services thereby increasing 

the advances of health programs.

The association, therefore, supp orts the objectives of II.R. 4999 and requests your committee to render a favorable repo rt on the Hea lth Professions 

Educational A ssistance Act of 1961.

Statement of Dr. Harold C. Wiggers

Mr. Chairman, I am I)r. Harold C. Wiggers, dean of the privately supported 

Albany Medical College of Union University, situ ated in Albany, N.Y. Founded 

in 1839, the medical college is the core of the Albany Medical Center which 

services approxim ately 2 million residents of the surrounding 18 counties.

In 1961, 62 percent of its 243 s tudents were residents of New York State, the 

remaining 38 percent claiming 20 other States and foreign coun tries as home. 

These studen ts graduated from 77 different colleges and universities. The size 

of the ente ring class is 60; tran sfers are admitted into the second- and third-year 

classes.

The extensive growth of the institution is reflected in the significant increase 

in the faculty, studen t body, and nonprofessional employees during the last 

decade and. particu larly, in the annual expenditures, which have increased from 

less than $400,000 in 1931 to approximately $3,410,000 in 1961. Of the lat ter , 

general budgetary expe nditures were $1,650,000 and resea rch expe nditures $1,- 

760.000. This gre at augmentation of activity has occurred despite the fac t th at 

the m ajority of operations are being conducted in a building constru cted in 1928, 

plus a very small a ddition which was completed in 1951.

To sta te that our grea tly expanded efforts in research, education, and patient 

care responsibilities are carried out in cramped, overcrowded, inconvenient, outmoded, and even unsafe space and facilities is the greatest of understatem ents. 

In particular, our teaching outpatient clinics, though renovated, are grossly 

inadequa te and most inconvenient for the scheduling of teaching programs. We 

are enthusiastic about tha t portion of II.R. 4999 which might enable us to constr uct modern teaching clinic facilities of adequate size to accommodate the 

increasing number of teaching patients. Currently , we could not handle a larg er 

class in our clinics.

Needless to say, the overcrowding of our existing physical pla nt has han dicapped the college in its atte mpts to acquire outstan ding facu lty members and 

medical students. I am happy to rela te that a $5 million medical science building is in the process of construction. Even when available in July 1963, the col-
486 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

lege will still be lacking a satisfac tory medical library facility (the core of 

research and educational programs), an auditorium to enable us to convene 

eith er the entire faculty or student body and appropriately designed teaching 

clinics. Nor will the college be able to enroll any additional medical students. 

The 27 percent of the building oriented for adm inistra tion and teaching will 

only provide adeq uate space and facilities for our curre nt studen t body. The 

remaining 73 percent of the building is designed for research in orde r to take 

full effect of matching funds providing only for that purpose by the Health Research Facilities Construction Agency. Should the medical college decide to 

augment its student enrollment it would be required to construct additional 

teaching facilities. To do so, in view of our current indebtedness, the college 

would require the 66% percent matching funds which the Health Professions 

Educational Assistance Act provides. This explains one reason why Chancellor 

Davidson and the bo ard of trustees and the faculty a nd myself enthusiastically 

endorse passage of H.R. 4999 during this session of Congress.

The Albany Medical College is even more interested in that portion of H.R. 

4999 which provides for scholarship grants to schools of medicine as well as the 

associated “cost of education” payments to schools receiving grants. We are 

of the opinion that the formula for the awarding of these gra nts and payments 

has been soundly conceived.

Inasmuch as we process and interview for admission more applican ts per 

available place in the class tha n any other medical school in the country, we 

have gained a rather broad perspective as to what has been hapi>ening to the 

number and quality of medical school applicants during the last 5 years. We 

are not only disturbed, but. actually alarm ed about the steady decline in quantity and quality of applicants. Though concerned with both, it is our studied 

opinion that the dropoff in quality is more dangerous, since the quality of the 

product of any medical school is directly determ ined by the quality of those 

who are admitted. Within a comparatively few years our annual applications 

have dropped from 1,800 to less than 1.000. Even considering the fac t th at our 

applicants usually apply to many schools. It. is a sad commentary that we are 

unable to obtain 60 tr uly qualified and satlfac tory candidates from nearly 1,000 

applicants. If we had sufficient, space for more students in our classes today, 

we wouldn’t fill them because of the poor q uality of the applicants. The situation is not only pathetic, it is dangerous, for it portends a drastic reduction in 

future stan dar ds of medical practice, education, and research unless dra stic 

measures are immediately adopted to inte rest better stud ents in the pursuit of a 

medical career.

Time precludes elaboration of the many fac tor s concerned with the decline in 

the interest of outstand ing students in the study of medicine. On the basis of 

experience, it is evident th at the heavy cost of obtaining a medical education, 

especially when superimposed upon the cost of 4 years of college education, is a 

majo r dete rren t. The outlook to a potential applicant who comes from a family 

of mediocre or ,»oor income is bleak and selfish. It seems faire r and certainly 

easier for them to embark upon a well-subsidized training program in one of 

the other sciences or on a business career which promises immediate income and 

the possibility of early marriage. Many applican ts have withdrawn from the 

medical college when it became necessary for us to reject their pleas for minimal 

scholarship aid because of o ur greatly inadequa te scholarship funds.

I will not be naive enough to proclaim that mere enactment of the scholarship 

grant, program as provided in H.R. 4999 will resolve all the problems in relation 

to recru itment of an increased number of qualified applicants for the study of 

medicine. There is no doubt that it will have a significant positive effect. I 

will, on the other hand, predict that unless this major bottleneck—the financial 

suppo rt problem—is removed by a scholarship gra nts program, no other measures 

will pay dividends in increasing the supply of outstanding and satisfactory 

applicants for medicine. The result will be that, the demands for an increasing 

number of physicians simply will not be met. Since Federal scholarships are 

the crux of the problem, it would be most imprudent to delay for another year 

tin* inqietus which can do the most, to increase the flow of good medical 

applicants.

Increased and adeq uate scholarships help will become more significant as my 

college takes necessary step s to augment rates in orde r to help meet increasing 

operation al costs. Currently , tuitio n fees at Albany Medical College provide 

only 18 percent of the income n<*eded to meet annu al budgetary expenses. It is 

no longer possible to operate on tlie basis of obtaining 82 percent «»f the income
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 487

from other sources, especially when invested fund s can only provide 12 perc ent 

of the requ ired annuul income. Soon this will be furth er reduced as we utilize 

invested fund s to meet the cost of our new medical science building. For this 

reason, the Albany Medical College not only favors, but actually dei>ends for 

maintenance of curre nt stan dards upon the provisions of H.R. 4999 which 

guarantees scholarsh ip grants and cost of education payments. Without this 

legislation, risin g tuition in private medical schools will discourage even more 

studen ts from applying for admission.

Although I have concentrated on a few provisions of H.R. 4999 which are vital 

to the fut ure of the Albany Medical College and its products, the school endorses 

heartily all aspects of H.R. 4999. We know that all of its provisions will be 

helpful to all the Nation’s medical schools and to those who may become interested in applying for admission.

This bill, if enacted, would help the Albany Medical College avoid certain 

financial pitf alls ahead which could lead to lowered stan dar ds of research, education, and patient care. Hence, the Albany Medical College wishes to go on 

record as enthusiastically endorsing enactmen t of the Hea lth Professions Educational Assistance Act as outlined in H.R. 4999.

Statement by Dr. Mark R. Everett, Director and Dean, University of

Oklahoma Medical Center, Oklahoma City, Okla.

The privilege of presenting a statem ent to this committee is greatly appreciated. H.R. 4999 is a truly progressive, vitally important, and timely atte mpt 

by Members of Congress to provide tangible aid and encouragement to our 

schools of medicine, dentistry, osteopathy, and public health. The task of such 

schools to maintain and increase the output of capable health personnel, in everincreasing numbers, is indeed a difficult assignment.

There have been sufficient studies and national discussion of the present 

inadequate financing of medical schools. The resulting national pictu re is a 

summons for commencing action. The details incorporated in H.R. 4999 appe ar 

to me to lie wise and helpful steps. Pa rts A, B, and C of the act are all 

designed to provide assistance to medical schools for several very serious problems. Pa rt C, especially, recognizes th at all of these schools need assistance 

according to the number of students they are educating. An effective solution 

of the problem of training increased numbers of physicians in the fut ure must 

be based on such principles, rather than on extraneo us matters or contentions. 

In my opinion, based on a graphic knowledge of the majo r financial struggle 

being experienced by the majority of schools of medicine in the United States, 

a situatio n exis ts which is very grave, and which cannot be overlooked if the 

supply of capable physicians is to be maintain ed and increased materially.

I wish, therefore, to respectfully urge that H.R. 4999 be supported with conviction by all who have the opportunity to take a position on it. The aid which 

this act proposes to schools that develop hea lth personnel demonstrates your 

judicious intere st in the future health sta tus of the American community. It 

will furth er indicate to the Nation that its represen tatives sha re the people’s 

desire to support medicine as one of the world’s two greatest concepts of mercy.

Than k you.

general statement

As was so forcefully and logically brought out in Secretary Ribicoff's sta tement to the committee, our Nation is falling behind in the required rate of training of physicians. Medical education in America is at a critica l point, which 

invites deliberate and thoughtful action by Members of Congress if the needs 

and requirements of the American people are to be met. Because of many 

scientific advances, medical education has increased in extent and complexity, 

causing the gap to widen lietween the cost of offering it and the ability of local 

agencies to support it completely.

The States are faced with heavy demands for funds to improve general edu ­

cation and they view medical education as something of considerable national 

importance which transcen ds State borders.

H.R. 4999 proposes (1) assistance in constructing and modernizing teaching 

facilities by means of grants. The medical schools have the burden of constru ctin g teach ing hosp itals and clinics and medical libraries, as well as the 

usual school facilities , and they need gra nts to ass ist them in these various
488 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

re sp ec ts. Th is ac t wi ll also (2 ) prov ide sc ho la rs hi p g ra n ts to ass is t med ical 

st uden ts in th eir tr ain in g whic h is long er th an th a t of mos t sc ie ntist s an d th er efo re more ex pe nsive to st ud en ts . If these st uden ts had ch osen to ta ke gra duat e 

st ud y in sci ences ot he r th an me dicin e, they wo uld ha ve sc ho la rs hi ps of $2,000 

pe r an nu m from bo th Fed er al and pri vat e source s. Th e pa ss ag e of II.It. 4091) 

wo uld he a co nc rete in di ca tion th a t Co ng res s is in te re st ed in th e as pe ct s of 

med ical ed uc ation wh ich bea r dir ec tly on the tr ain in g of mor e ph ys icians .

HOW II. It . 4 99 9 PE RTA IN S TO OKL AHOM A

As you kno w, th e U ni ve rs ity of Ok lah om a Sch ool of Med ici ne ha s been g ra n ting th e M.l). de gree fo r 51 ye ars. As rece ntly as 10 yea rs ago ou r school of 

med icine fa cu lty re al ized th e u rg en cy to do ub le th e s ize of its clas ses in th e fa ce 

of th e S ta te ’s need fo r ph ys ic ians . We began adm itting 100 me dical st uden ts 

pe r ye ar . Sin ce it ha s re qu ired al l of th e in te rv en in g tim e to secu re an yt hi ng 

lik e a co mpa ra ble in cr ea se in th e op er at in g bu dg et of th e school, we ha ve ha il 

to cu rt ail ev ery as pe ct of new co ns truc tion an d mod er ni za tion an d ha ve been 

un ab le to se t up s ch ol ar sh ip fun ds .

O ur Sta te le gi sl at ur e w as no t inse ns iti ve to th e need fo r new co ns truc tio n an d 

th ey did, fo r ex am ple, pr ov ide fu nd s fo r an ad ditio nal wing fo r th e teac hing 

ch ildr en 's ho sp ita l, which prov ided 40 ad di tion al beds, an d an oth er wi ng of th e 

m ai n ho sp ital to co nt ai n GO ps yc hia try beds. In th e fina nc ia l stru gg le to bo th 

co ns truc t an d oi ie ra te th es e fa ci lities , it rtMjuired al m os t 4 yea rs to act iv at e th e 

be ds in th es e tw o es se ntial ad di tion s. We face si m il ar pr ob lems to da y an d need 

co ns truc tion gra nts th at we c an bo th build an d oper at e the sch ools fa cilit ies.

O ur me dical school mus t now accommo date all of its past en te rp ri se s plus 

ex pa nd in g are as fo r me dical re se ar ch ne ce ssary fo r th e w el fa re of th e American 

people.

T he alum ni of ou r sch ool of me dicin e ha s fo rm ula te d a 10-ye ar de ve lopm en t 

pr og ra m fo r th e U ni ve rs ity of Oklahom a Me dical Cen te r wh ich will re qu ire th e 

ex pm id itu re of ap pro xi m at el y $15 millio n. The re ge nt s of th e un iv er sity ha ve 

ap pr ov ed th e pr og ra m wh ich includ es the bu ild in g of a new GGO-bed teac hing 

ho sp ital . A rc hi te ct ua l st ud ie s ha ve been mad e an d th e S ta te ha s prov ided an 

in it ia l $1 mi llion fo r th e pr oj ec t to ge th er with $200,000 fo r th e pu rc ha se of lan d. 

You ca n re alize how muc h it wi ll me an to O klah om a in th is pr og ra m if m at ch in g 

co ns truc tion fu nd s fo r teac hi ng f ac ilitie s are m ad e av ai la ble by Co ng res s ac co rd ­

in g to II.It . 4999.

Th e sc ho la rshi p fu nd s prop osed in II.It . 4999 will al so me an mu ch to our 

Sta te . At ou r school of me dicin e tw o- th ird s of th e st udent bod y is m ar ried , 

th ere is no un iv er si ty ho us ing fa ci lities fo r med ical st uden ts , an d th is fa ll we 

w er e ab le to off er on ly tw o sc ho la rshi ps to our st udent body of 385 med ical 

st uden ts . Again, I wou ld re sp ec tful ly ur ge th a t se riou s co ns id er ation be giv en 

to th is bill an d th a t al l co nt en tion s no t di re ct ly re la te d to th e pro ble m be su bmerge d in a de sire to he lp th e med ica l schools of America su rm ou nt th ei r dif ficult 

circum stan ce s.

American Nur ses’ Asso cia tio n, I nc.,

New York, N.Y., January 22, 1962.

Hon . Oren H arris,

Chairman, Committee on Interstate amt Foreign Commerce, V.S. House of Representatives, House Office Building, Washington, D.C.

Dear Mr. Harri s: The American N ur se s’ A ssoc iatio n wish es to rec ord its su pp o rt of both sc ho la rshi p an d co ns truc tion pr ov isio ns of II.It . 4999 (H arr is , of 

A rk ansa s) , II. R. 8774 (S ta gge rs , of W es t V irgin ia ), an d II. R. 8833 (B en ne tt, of 

F lo ri d a)— trai nin g of ph ys ic ians , den tists, an d pr of es sion al publi c he alth jiersonn el. We rec ogniz e th e urg ent need fo r in cr ea si ng th e nu mbe rs of med ical, 

den ta l, ami pub lic he al th jie rso nn el, an d we be lie ve Unit tin* Fe de ral Go ve rnme nt 

has a di st in ct r es po ns ibili ty in th e e nti re a re a of h ig he r edu ca tio n.

Th e Am erican Nur se s' Assoc iatio n ha s testifi ed in fa vo r of all le gi slatio n 

pr op os ing Fe de ra l fin ancia l ai d fo r hi gh er e du ca tion an d in Ap ril 1958, an d Ju ne 

I960, su pp or ted bil ls si m ilar to thos e be ing co ns idered a t th is tim e. In pr ev ious 

testim on y we requ es ted th at th e legislation lie am en de d to inc lude gra duate e duca tion in nu rs in g in thos e 4 3 1

 sch oo ls of ferin g m ast er’s de gree s in nu rs in g

1

 “F acts Ab out Nur sing ,” p. 116, ta bl e 8 (1961 ed .).
TRAIN ING OF PRO FES SIONAL PUBLIC HE AL TH PERS ON NE L 489

ed uc ation oth er th an pu blic he al th nu rs in g. We in te rp re t th e hills now being 

co ns idered as includ ing nu rs es en ro lle d in gra duate pr og ra m s in scho ols of 

public he al th .

Th e es se nt ia l role of th e nur se in th e he al th team mak es th e co ns id er at io n of 

th is am en dm en t by yo ur co mmittee imi>erutiv e. Ac tion by th e Con gress in su ppor t of ed uc at io n fo r he al th pe rson ne l is lon g ov erdu e. Ev en if th e legi slat io n 

is pa ssed by th is Co ng res s, a de ca de will pa ss be fore an y re al be ne fit s will be 

de rive d fro m th is as si st an ce prog ram. Ac co rding to th e Ban e reix»rt, “ Phy ­

sician s fo r a Growing America’’ (195 9) , th e co un try is fa llin g fa rth e r be hind 

every yea r in m ai nta in in g an ad eq uat e su pp ly of med ica l, den ta l, an d pu bl ic 

hea lth pe rson ne l.

We have, fo r ma ny ye ar s, brou gh t to th e att enti on of th is co mm itt ee th e g re at 

need fo r Fed er al fina nc ial as si st an ce to nu rs in g ed uca tion : th e in ad eq ua te fa cil ­

itie s fo r pr ep ar in g th e nu mbe rs of nu rs es re qui re d to me et th e pre se nt ex pa nd in g 

ne ed s; an d th e sh ort ag e of quali fie d ed uca to rs a nd ad m in is tr ati ve pe rson ne l. At 

pr es en t it is es tim at ed th at les s th an 2 p e rc e n t2

 of emplo yed pr of es sion al nurs es 

in th is co un try ha ve m ast er’s de gree s— a minim um re qu irem en t fo r te ac hi ng in 

an y ot he r field of hig her ed uc ation. The gra duate nur se tr ai nee sh ip pr og ram, 

au th or iz ed by th e H ealth Am en dm en ts Act of 1956, ha s ha d a m ar ke d im pa ct on 

th is prob lem but even w ith th is pr og ra m only 1,197 s

 nu rs es rece ived m ast er’s 

de gree s in 1960.

Be cause of th e m an y scientific ad va nc es th ere m us t be mor e high ly sk ill ed 

nu rs es in th e clin ical sp ec ialti es . N ur se s wh o ass is t in th e tr eatm ent an d car e 

of pe rson s wh o ha ve ha d hea rt su rg er y, wh o work with th e pr og ra m s in sp ac e 

me dic ine , wh o wo rk w ith pati ents re ce iv ing tr eatm ents w ith th e ra di oi so ­

top es, an d wh o wor k in psy ch ia tric nu rs in g, m us t be exper t pra ct itio ne rs . 

Th e nursies wh o dir ect or wo rk in th es e co mpl icated se rv ic es shou ld be pr ep ar ed 

in gra duate ed uc at io n pr og rams.

Ho we ver, th e ur gen t ne ed in nur si ng a t th is ti me, if w e are to m ee t th e d em an ds 

of th e pr es en t an d im med iate fu tu re , is ai d to ba sic co lle giate ed uc at io n. Re pre se nta tive St ag ge rs , a me mb er of th is co mmitt ee , has in trod uc ed bi lls in bo th 

th e 86th an d 87 th Co ng res s fo r th is pu rpos e. II.It . 5682 wo uld pr ov id e ai d fo r 

co ns truc tion , in st ru ct io n an d sc ho la rs hi ps fo r bacca la ure at e pr og ra m s in nu rsing. 

At pr es en t about 80 per ce nt of nur se s gra duate from ho sp ital nurs in g school d iplo ma pr og ra ms. Be fore they are elig ible fo r stud y on a m ast er’s level, they 

m us t spend 2 to 3 years in a colleg e or univ er si ty in ad ditio n to th e 3 years sp en t 

in a ho sp ital sch oo l of nur si ng to ac qu ir e a bac ca la ure ate deg re e; w he re as th e 

co lle giate st udent ca n rec eiv e a B.S. in 4 ye ar s. W ith th e supp ly of all hea lt h 

j>ersonuel in gre at de man d, th e co un try ca n ill affo rd w as te of pro duc tive ye ar s.

Th e ge ne ra l po pu la tion ex pe cts an d de m an ds th e serv ices wh ich th eir ho sp ita liza tion an d he al th in su ra nc e will buy fo r them : an d they exjtec t th es e se rv ices 

to be of a high qu al ity. If ou r ci tize ns are to be prov ided w ith th e am ou nt an d 

qua lity of he al th ca re wh ich they hav e le ar ne d to ex pect, it is vi ta l th a t th is 

le gi slatio n be en ac te d du ring th is Co ngres s.

Very sinc er ely yo urs,

(M rs .) J ud ith G. W hit ake r, R.N.,

Executive Secretary.

Brandeis Unive rsity ,

Off ice of D ean of F acult y, 

W al th am , Mann., January t8, 1963.

Ho n. Oren H arr is,

Chairman, Committee on Inter state and Foreign Commerce, V.S. House of

Itcprcsentatives, House Office Building, Washington, D.C.

Dear Congressman Harris : It has come to our attention that your committee

will soo n be ho lding he ar in gs on II.R . 4999. th e H ea lth Pr of es sion s Edu ca tion al 

A ss ista nc e Act of 1961. I am w ri ti ng now to co nv ey to you th e g re at in te re st of 

B ra ndei s U ni ve rs ity in th is bil l an d to ur ge yo u an d yo ur co lle ag ue s to su pp or t 

it s en ac tm en t mo st vig orou sly .

We be lie ve th at en ac tm en t of th is le gi sl at io n is in th e bes t in te re st s of th e

United S ta te s an d is ur ge ntly re qu ired . T her e is no do ub t ab out th e fa ct th a t 

th is co un try is ra pi dl y fallin g be hind in its pr od uc tio n of ph ys ic ia ns an d med ical sc ie nt ists . Ther e is lik ew ise no do ub t th a t mo re pe rs on s tr ain ed in th es e

’ “Facts About Nursing'’ (1061 ed.), p. 109. • “Fac ts About Nursing” (1961 ed.), p. 114, table 6. 

80014—62----- 32
490 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

fields nre needed if we are to continue to provide the jieople of this country witli 

adequa te medical care, including preventative care, and to continue our research 

efforts toward understanding and conquering the diseases which still plague our 

I»eople. In addition, of course, there is little doubt but tha t this country will be 

called upon to take leadership in assisting the many emerging natio ns with resj>ect to medical techniques, medical care and medical research. All of these, 

taken together, point to an unquestionable need for more doctors and medical 

scie ntists and for added facilitie s and institutions for the ir training. And it is 

equally certain that the universities cannot do these things unless financial aid is 

forthcoming. Thus, we believe that enactment of II.K. 4t>99 is urgently required.

1 am certain that you know that approximately 800 additional physicians and 

medical scientists could be produced each year by our existing 4-year medical 

schools if there were available a pool of students who had received the first 2 

yea rs of medical instruction elsewhere. This is so because one of the bottlenecks 

in medical training is the limited amount of space available for the first 2. or 

precllnical, years of medical instruction. As has been reported, this situation 

could be alleviated by creating new 2-year medical schools or basic medical 

science training programs to provide the precllnical training for such a pool of 

stud ents. Although this would not entirely solve the problem of our growing 

shortage of physicians and medical scientists, it would certain ly be of considerable help, because each year’s graduating class would lx* increased by at least 

10 percent. An additional benefit would be, of course, tha t simultaneously there 

would be created that many additional centers of basic medical research, a very 

desirable development.

With the view toward atte mpting to contribute to the alleviation of tills 

problem, Brandeis University is currently making an intensive study of the 

feasibility of initiatin g a program of training in the basic medical sciences. The 

aim of this program is to provide thorough training in the fundamental sciences 

and in the basic medical sciences equivalent or, if possible, superior to tha t 

afforded by our best conventional medical schools.

With the aid of an advisory group of experienced educators drawn from leading U.S. medical schools and a gra nt from the Commonwealth fund, we are 

preparing plans for a program which will, we believe, provide the very finest 

training to students who, when they leave here, will be acceptable for admission 

to the third year classes of the best medical schools of the country. Our target 

date for admission of the first group of students is September 1963, and our 

present expectation is tha t, when the program reaches maturity, 40 students 

will complete their training here each year.

One of the real questions in our minds is whether or not we can afford to 

initiate such a program. In order to conduct the program properly, it will be 

necessary for us to construct facilitie s which we estimate will cost at least $5 

million and to acquire equipment to the extent of at leas t $1 million. In addition, we estimate operating costs will be about $2 million per year. A significant 

proportion of this would be for student aid. which we con sider most important, 

particu larly since our plans call for students being in atte ndance for 11 months 

per year. They will thus be precluded from earn ing money during the summer and, accordingly, will require even more scholarship aid than usual. Thus, 

in order to carry out our plan, we will require an initial investment of $6 million 

or more and the rea fter an annual expenditure of almost $2 million. Whether 

we can do this without assistance is most problematical. It is obvious, of 

course, that passage of H.R. 4999 will be of great inte rest to us. for it will afford 

us the possibility of obtaining significant aid in constructing the needed facilities 

as well as some assistance toward the student aid we will require.

It may be helpful to you to have a brief stateme nt about our university, particu larly in view of th e statemen ts above about the financial problem of initi atin g 

the new program we are planning. Although a young institution, now only in its 

14th year. Bran deis University has grown and developed rapidly and now has a 

significant program of education at the undergraduate, graduate, and postdoctoral levels. Undergraduate enrollment at present is limited to 1.400, including SO stud ents from 33 foreign countries. Applications for admission outnumber available space by about 7 to 1. Admissions stan dar ds are high, and 

we believe the scholastic abilities and achievements of our students compare 

favorably with those of any other institution in the country.

Our gra duate school, begun about 6 years ago, is growing rapidly. We now 

have doctoral programs in 14 depa rtments and we are adding about 1 new 

gradua te program per year. We have an enrollment of over 430 gradua te stu-
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL 491

dents who come to us from 117 colleges and universities in 31 States and 24 

foreign countries.

We have one professional school, the Florence Heller Gradu ate School for 

Advanced Studies in Social Welfare, which, though initiated only 3 years ago, 

is already functioning in an extrem ely successful manner. It adm its only advanced studen ts who alread y have the ma ster’s degree and continues their training to the Ph. D. level. Although its tirst Ph. D. degrees were awarded only 

last June, its methods are already being adopted at other institutions.

Our facu lty numbers approximately 250 full-time persons, thus providing a 

very high faculty-to-student ratio . A very large proj>ortion of the faculty have 

been widely recognized for the ir scholarship, intellectual achievement, and 

community service. In addition to our regular faculty, many of our advanced 

graduate studen ts serve as teaching assistan ts during part of the ir stay here. 

Over and above these, we have about 100 i>ostdoctoral fellows, research associates, visiting scholars, etc., in residence who are receiving additional training 

and research opportunity here.

Starting 13 years ago with a trac t of land and 3 old buildings, we now 

have a fine campus with more than 50 modem instructional and resea rch buildings erected at a cost of more than $25 million. As we continue to grow, we 

must contin ue to add to our physical plant. For example, we now have on the 

draw ing boards 13 building projects, which Involve an expenditure of about $12 

million. Thus, we are undertaking a gre at deal, and our finances are stretched 

to an extrem e limit.

Altogether, we are quite proud of our accomplishments thus far. Although 

very young, we l»elieve this university has achieved a considerable reputation as 

a very high quality educational and research institution. For example, we have 

recently been granted a Phi Beta Kappa chapter, one of the youngest institu ­

tions ever to have been so honored. We have a very active and productive research program, which, exclusive of faculty salaries, involves an expenditure 

of about $2 million i»er year. Much of the ongoing research is in the healthrela ted sciences.

All of this has been accomplished in 13 year s and without the aid of significant 

initial endowment or of appropriations from any State or municipal body and 

with an alumni group as yet too young to contribute significant support. In 

this time, we have not only built the physical pla nt and campus but, more importantly, we have assembled a faculty of fine teachers and scholars, and we 

are able to attrac t a select student body of gre at potential. We believe we are 

rendering a very imp ortant service to the Nation through providing high 

quality education and productive research.

In toto, we believe we have demonstrated our willingness to lift ourselves by 

our bootstraps toward the goal of superior educational accomplishment, intellectual achievement and community service. We believe most strongly tha t we can 

do an equally fine job in training stu den ts in the basic medical sciences; stu dents 

who can go on to the final 2 years of medical training at other institution s and 

who, upon graduation, can contribute significantly to the welfare of the Nation 

as physicians, medical researchers, and teachers. But to do this, particu larly 

for a young institu tion like ours which does not have any stable financial resources of its own, requires some help. This kind of help can come through 

the provisions of H.R. 4999 which, if enacted, will provide an opportunity for 

us. as well as for other institutions, to make even greater contributions to the 

welfare of this country.

I should like to add this final statement. Regardless of whether or not 

Bran deis University does decide to initiate a basic medical sciences program, 

we urge your supp ort of H.R. 4999. As stated above, we believe most sincerely 

that this legislation will be of gre at benefit to the inte rests of the Nation and 

to the welfare of its people. There is no question in our minds but tha t this is 

urgently required legislation. We ask you and your colleagues to give it your 

most vigorous support.

Sincerely yours,

Lo uis Levin, Dean of Science.
492 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

Veterans’ Administration,

Office of Chief Medical Director, 

Department of Medicine and Surgery,

Washington, D.C., J anu ary 18, 1962. Hon. Oren Harris,

House of Representatives, Washington, D.C.

Dear Mr. Harris : As chairman of the Interst ate and Foreign Commerce

Committee, you will preside over hearings on II.R. 4999, cer tain elements of 

which inte rest me greatly as a private citizen.

Before coming to Washington as the Chief Medical Dire ctor of the Vete rans’ 

Administration, I served on the medical faculty of the University of Wisconsin 

for some years and was dean of th e medical school for 20 years. The University 

of Wisconsin has profited greatly through the supp ort of resea rch and research 

construction in several respects. The dividends on these investments will 

undoubtedly he collected by the American people and hum anity at large for 

years to come.

In a somewhat more specific vein, I am interested in the supp ort of medical 

libraries. Not only is this a general weakness in our system and in governmental 

support but thefuu lt may seriously impair both medical education and research. 

Th at I may not be flying under false colors, I should like to indic ate the crying 

need at the University of Wisconsin Medical School. By dent of gre at effort on 

the pa rt of frien ds and gradua tes of the medical school, some $"><>0,000 have 

been collected. This sum will not meet the construction req uirem ents; but, in 

my judgment, it is the type of commendable effort th at could, in fairness, could 

be speeded to its proper end by matching funds.

Should you be interested , I would make myself available to you for a personal 

conference at your convenience.

Itesi>ectfully yours,

William S. Middleton, M.D.

Tiie University of North Carolina,

School of P ublic Health, 

Chapel Hill, January 18,1962. Hon. Oren Harris,

Chairman, Interstate and Foreign Commerce Committee,

House o f Representatives, Washington, D.C.

Dear Representative Harris : I am writing to express my deep inte rest and 

concern in the passage of II.R. 4999, the teaching facilities construction bill, 

which I understand is coming before your committee for hearing shortly. My 

endorsement of this bill is based upon my intim ate knowledge of the tremendous 

and increasing shortages of graduate trained public hea lth personnel in all of 

our 50 States.

The 12 schools of public health which prese ntly exist ar e regional schools 

serving not just their States and regions but all of the United States. A large 

proportion of our training is done for people employed in the Federal Government—Army, Navy, Air Force, Public Health Service, Children’s Bureau, ICA, 

AID, etc. It would, therefore, be obviously unfair to ask the taxp ayers of the 

Sta te to provide the teaching facility for the training of three-fo urth s of the 

studen ts atten ding our school who come from out of State and return to work 

out of S ta te ; they are largely federally sponsored students.

Our facility cannot be expanded to increase education and training for public 

health personnel without substan tial Federal supp ort for both teaching and 

resea rch. There is little point in Congress providing increased funds for health 

services, facilities, and research unless adequ ately trained personnel can also 

be provided, to provide the services and facilities and to do the research.

I hoj>e you and your committee will act favorably upon this bill and request 

that this letter be included in the record of the hearing.

Sincerely,

E. G. McGavran, M.D., M.P.H., Dean.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 493

Univ ersit y of Cal ifo rn ia,

School of P ublic H ea lt h, 

Ber ke le y, Ca lif. , Ja nuury 17, 1962.

Hon. Oren Harris,

Chairman, Interstate and Foreign Commerce Committee,

House of Representatives, Washington, D.C.

Dear Congressman Harris : I am deeply regretful that I shall not be privileged to appea r in direct testimony at the hearings on II.R. 4999, so important 

for the health of our Nation. Fortunately, at the hearings our schools of public health will he most ably represente d and specifically Dean Myron Wegman 

will testify rega rdin g the special problems of our five State-supported natio nal 

schools of public hea lth to complement the testimony of Drs. Stebbins and 

Leavell in behalf of the privately supported schools and of our association. I 

shall be g ratefu l if you will include thi s letter in the record of the hearings on 

H.R. 4999.

Having served on the Surgeon Gene ral’s C onsultant Group on Medical Education which also included brief consideration of needs for dental education, I 

am acutely aware of the pressing need for passage of H.R. 4999 to aid in building of more medical and dental schools, to provide scholarships for students, 

and to aid in the costs of the oi>erations of the schools. Construction of facilities for research must be complemented by construction of teaching facilities 

to prepare research work ers and both are needed to provide medical and dental 

services (including future public health lead ers) for our burgeoning population. 

However, the construction needs in our schools of public health are even more 

acute. While each of the five State -supported accredited gradua te schools of 

public health has its individual problems with respect to its unmet space 

requirements, they share common difficulties in solving them. All of our schools 

of public health, priv ate and tax-supported, are national and, because of fellowships of ICA and WHO, internation al schools. Especially since the passage of 

the U.S. Public Health Service Traineeship Act of 1956 and the res ultant stim ulus to national public health recru itment, the Sta te taxpayers who supp ort the 

Sta te schools have been carrying a disproportionate share of a national responsibility. The enac tment of the Hill-Rhodes Public Law 86-720 providing Federal aid to these national and inte rna tional schools of public health for assistance in teaching these expanded classes has brought a degree of alleviation to 

the schools and some equalization for the taxpay ers of State-supported schools. 

No comparable supp ort exists for medical and dental schools. However, even 

in our schools of public health the concomitant augmentation of facu lty and 

auxiliary teaching personnel has accentuated alre ady existing deficiency in 

space.

Our State taxpay ers already have provided basic building requirements. Thus 

in 1955 the School of Public Health at the University of California in Berkeley 

occupied its new Public Health Building, Ear l Wa rren Hall, with 43,000 sq uare 

feet. While this met our needs in 1955, now our gradua te studen t body has 

doubled. Some of our facu lty members are forced to double up in occupancy 

of rooms and we have had to resort to rented space both for instruc tion and for 

research. Indeed, there are needed teaching programs which we ca nnot provide 

because we cannot house them.

Scholarships to encourage and support students for care ers in medicine and 

dentistry withou t overwhelming burdens are necessary if we are to provide the 

doctors and den tists ne<*ded in our country. Each of our State universities is 

faced with the overwhelming problem of providing educational oppo rtunities for 

our exploding population. To provide higher education, California taxp aye rs 

must grea tly expand the ir junior colleges. Sta te colleges and state-wide university. In the univ ersity system the existing five general campuses must he 

expanded and three more major campuses of the size of Berkeley and of Los 

Angeles be built. These demands stre tch the resources of our Sta te to their 

limits. Comparable demands face the taxpay ers in our other States as well.

Moreover, in ou r own Sta te of California we m ust expand our two tax-su pported 

medical schools and estab lish from one to three, and, some would say, five or six 

more medical schools in order to mainta in the medical services of our Sta te’s 

population at their present level. An equal need is present for expanding the 

dental schools. The proposed legislation by assisting in the operating costs is 

equally essential.

In summary, H.R. 4999 will provide assistance in construction for the necessary expansion of schools of medicine, dentistry, and public health. Moreover,
494 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

it will go a significant way in meeting needs for scholarships in medicine and 

den tistry and for support of operating costs in medicine and den tistry which, to 

a degree, have been provided with such great value for schools of public health.

Thus, the favorable consideration of H.R. 4999 is a ma tte r of major importance 

to all of us in the field of the health sciences.

Sincerely yours,

Cha rles E. S m it h, M.D.

Dean, School of Public Health,

President, California Sta te Board of Public Health.

T he Univ ers ity of Texa s, 

Austin, Tex., Januar y 18,1962.

Hon . Oren Harris,

Chairman, Committee on In terstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Conoression man Harris : H.R. 4999 contains provisions which if implemented, should meet pressing needs in the prejMiration of practioners in the 

health sciences.

The Legislature of the Sta te of Texas, moving to fore stall a threaten ed grave 

shortage of physicians, lias authorized the University of Texas to establish a newmedical school, the South Texas Medical School, in Bexar County (San Antonio). 

It will graduate an additional 109 physicians each year. Physical facilitie s for 

this school will require an initial investment approxim ately $25 million at the very 

least.

In addition, each of our two other medical schools—the University of Texas 

Medical Branch at Galveston and the University of Texas Southwestern Medical 

School a t Dallas—are in sore straits for physical facilitie s to accommodate the ir 

present loads of teaching and essential research. To cope with the demands 

placed upon them we estimate a minimum physical plant additional investment 

of $15 million will be required by 1970, in addition to approximately $7 million in 

new construction c urrently in process.

The capital investments already outlined take only modest cognizance of 

increasingly imperative necessities for the education of additional den tists and 

the professional specialists demanded in modern health practice. Nor do they 

reflect adequately the research endeavors which must now undergird and 

accompany the education of practitioners.

Operating costs for medical and dental education are high. To provide these 

alone, the State of Texas must antic ipate an annual additional load ui>on its 

budget of $6 to $10 million in the period between now and 1970. In the same 

l>eriod, it must shoulder vastly increased sums for the operation of other units 

of higher education and additional very large sums for housing its colleges and 

universities. These realitie s dictate our conclusion th at essential physical 

facilities for medical and dental education in this Sta te can be provided only 

through the share d financing arrangem ents proposed in H.R. 4999.

Si>ecifically, we do not see how the South Texas Medical School can be activate d by its target date of 1904 unless construction gra nts of the cha rac ter 

proposed in jiart B of H.R. 4999 become available almost immediately.

Sincerely yours,

Harry R ansom, Chancellor.

Unive rsity of Puerto Rico,

Schoo l of Medicine,

School of T ropical Medicin e,

Sun Juan, P.R., Ja nuary 19, 1962.

Hon. Oren Harris,

Chairman, Interstate and Foreign Commerce Committee,

House of Representatives, Washington, D.C.

Dear Mr. C ha irma n : The School of P ublic Health of the University of Puerto 

Rico strongly endorses H.R. 4999 (the teaching facilities construction hill). This 

school has an average annual enrollm ent of 90 fulltime students, of whom some 

45 percent are from Latin America.

Although the school is bilingual, because of the Latin Americans, the language 

of postgradua te instruction is in Spanish.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 4 9 5

There is no other North American school so badly in need of new physical 

facilities, inasmuch as we are still housed in the temp orary quarters of the 

form er school of tropical medicine. Classroom space must be arra nge d each 

yea r on an expediency basis through arra nge ment with the school of medicine, 

whose basic sciences occupy the same building. Some instructors have to double 

up in small offices. In fact, lack of space is a deterren t to recruiting additional 

staff.

Consequently, in view of the foregoing, we hope your bill can be favorably 

reported, and we trus t this letter can be recorded in the record of the hearings. 

Sincerely yours,

Nelson Biagoi, Ph. D.,

Acting Head of the Department.

T he A merican Public Health Association, I nc.,

Washington, D.C., January 22,1962.

Hon. Oren Harris,

Chairman, Committee on In ter sta te and Foreign Commerce,

New House Office Building, Washington, D.C.

Dear Mr. Harris : I wish to submit to you the accompanying state ment made 

in behalf of the American Public Health Association for consideratio n by your 

committee rela tive to your hearings on II.It. 491>9. It would be furth er appreciated if this stateme nt could be made a pa rt of the official record of these 

hearings scheduled for Janu ary 23-26, 1962.

Thank you.

Yours truly,

Berwyn F. Mattison, M.D..

Executive Director.

Statement of th e American P ublic H ealth Association

As this Nation’s larg est represen tative of those presons engaged in the prevention of illness and disability, the American Public Health Association is 

pleased and grateful for this opportunity to present testimony on legislation proposed to increase this Nation’s skills and ability to better her people’s health. 

The APIIA is composed of 13,000 members with an additional 20,000 members 

o f State affiliated societies. These members are almost exclusively jiersons 

whose full-tim e activities with official and volu ntary agencies at local, State, and 

Federal levels are dedicated to the betterment of the individual's and the community’s health. Our interest in and concern with the problem posed by insufficient numbers of qualified, well-trained physicians and dentists is self-evident.

It is the experience of our members, and partic ularly those charged with administrative responsibilities, th at there is presently a serious lack of qualified 

personnel to press forw ard needed public health programs. Two categories 

where these shortcomings a re most painfully evident are those of physicians and 

dentists. Similar shortages exist in other professional public health proficiencies, most notably nurses, and the necessity for increasing the abilitie s of 

this Nation’s schools of public health, we believe, is of para mount importance.

In addition to the convictions which arise from our personal experience, we 

are furth er impressed by the commendably thorough and forthrigh t documenting of our Nation’s needs in these areas by care ful and objective assessments 

made by well respected and recognized panels o f persons expert in this field. 

This is certainly tru e in the case of physician needs for our Nation. The report 

of the Consultant Group on Medical Education, appointed by former Surgeon 

General Leroy E. Burney and chaired by Mr. Fra nk Bane, former executive director, Council of Sta te Governments, contains a wealth of factual information 

which, we are sure, this committee will consider carefully. While the same 

figures and statistics may mean different things when given different int erpretations, we believe the inform ation both startling and somewhat frightening. 

According to this report, the rati o of physicians to population has increased 

from 134 per 100,000 in 1930 to 141 per 100,000 in 1959, but the latte r is a slight 

decrease from the 143 per 100,000 in 1949. And when considering the needs of 

our people to se cure the services of a private, practicing physician, this ratio has 

shrunk from 108 per 100,000 in 1931 to 91 per 100,000 in 1959.

We recognize and wholeheartedly approve of changes and vast improvements 

in medical practice which account in part at lea st for the lesser ratio of physi-
496 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

cians in priv ate practice. Better service to patients with acu te illness in hospitals rather than at home has resulted in a rati o of 1 to 6 physicians in fulltime hospital service in 195!) in comparison with 1 to 16 in 1930. A survey in 

1957 indicated 23,800 physicians were active full time in teaching, research, 

public health, indu strial medicine, or the m ilita ry—this compared with 6,400 so 

involved in 1931. An additional factor of importance to the patient is that in 

1931 one out of every six physicians was a specialist. In 1940, this ratio has 

gone up to one in four, and in 1959 every other physician was a specialist. Despite an increase in the overall number of physicians, the general practitioner, 

inte rnist, and pediatrician (those specialists generally considered available for 

general practice), numbered 117,000 in 1931, but in 1957 were but 102,000 strong.

What is the picture at present following marked changes in the methods of 

the prac tice of medicine, and what furth er efficiencies can be realized? In 1930, 

physicians saw an average of 50 patie nts per week. In 1959, ibis number had 

been doubled although 17 percent of all physicians see more than 40 patients 

Iter day. In 1930, 4 out of each 10 patients was visited in his home. In 1959, 

this had shrunk to 1 in 10. There is but slight room for furth er change in this 

direction. In 1959, the civilian population per physician rati o was approximately 

100,000 per 100. It was estim ated by the Bane group that the number of graduates from medical schools would have to be increased from the present 7,400 

each year to 11,000 annually by 1975 if the 100 per 100,000 ratio is to be maintained. We are convinced th at this must be done—in the light of increasing 

spe cialization; of the need for increasing numbers of physicians in wholly 

meritorious and vitally needed research, teaching, public health, and other activ ities; of the changing complexion of our population where, in particu lar, our 

older, aged population requiring more than normal medical care has and will 

continue to increase.

What are the problems confronting both the intending medical student and 

our Nation’s medical schools? Why don’t we have more physicians? Why c an’t 

medical schools increase enrollments and graduate s? The reasons are many 

and varied and no panaceas are evident. For the inten ding student, tuitio n 

costs are high and the period of training long. Eight yea rs of college must be 

followed by from 1 to G or more years of internship and residency or fellowship 

training. And unlike the day not too many years ago when the talented youngste r had as a choice of professions the church, the law, or th e healings arts, there 

is now a plethora of well-respected, remunerative occupations.

That adequate financial backing is deemed necessary seems evident in the 

fact th at 40 percent of all medical studen ts come from families with an annual 

income of $10,000 or more althou gh this group comprises but 8 percent of our 

population. Financial support for the first-year student is prac tically nil, and 

the reality of competition from new vocations with the loss of monopoly on the 

budding scientific mind would have appeared to have resulted in something less 

tha n the best going into medical schools of late. In the 4 years prior to 1959, 

an increasing proportion of students were failing or withdrawing due to poor 

academic standing.

In the case of the institutions, training costs are high and going higher. In 

1948, the cost for basic operation of our medical schools was $53 million. By 

1958, ju st 10 years late r, the cost had soared to $176 million. In 1941, tuitio n 

and fees made up 32 perc ent of the basic operation budget. By 1948, this 

had reduced to 23 percent, and in 1958 it accounted for but 13 percent. Public 

medical schools receive about 70 percent of their funds from State and local 

appropriation s. But the apparent willingness of Sta te and local governments 

to support medical education within their means to do so is varied. Furnishing 

40 cents or more per $1,000 personal income is Vermont in the Ea st; Arkansas, 

Mississippi, and Alabama in the South: Minnesota and North Dakota in the 

North Central are a; and Utah and Oregon in the West. Some States and localities fu rnish no support.

The re has been both direct and indirect support from the Federal Government. Contributions in the area of construction include a portion of the costs 

for hosp itals through the Hill-Burton program, and research facilities and stu ­

dent dormitorie s from the college housing program. Federal teaching and 

traini ng grants have shown a marked increase too. In 1948, these amounted 

to $2 million. In 1958, they totaled $14.4 million and were furnished by the 

U.S. Public Health Service, the Department of Defense, the Veterans’ Administra tio n, and the Atomic Energy Commission.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 497

Ref er ri ng now specifically to th e ne ed s of pu blic hea lth pr og ra m s th ro ugh out 

th e N ation, 28,600 pr of es sion al pu blic hea lth w or ke rs were ju dg ed in 1958 to 

re qu ir e som e de gree of ad di tiona l tr ai nin g, incl ud in g up to an ac ad em ic y ear of 

at te ndan ce a t a sch ool of pu blic he al th . It sh ou ld be em ph as ized th a t th is fig ure 

re pre se nts lev els as they p ert ain to pr es en t-da y ci rc um stan ce s of po pu la tion , 

healt h pr og ra m s, an d he al th prob lems. Und ou bted ly ov er th e nex t de ca de , al l 

th re e—]>opulution, prob lem s, an d pr og ra m s—will in cr ea se ap pr ec ia bl y. T her efore, w itho ut ev en pr oj ec ting in to th e fu tu re , an d allo win g 16 years fo r el im in atio n of th e cu rr ent bac klo g, fa ci lities fo r tr ain in g a t le as t 2,566 st uden ts per year 

sh ou ld be mad e av aila ble. D uring th e p ast ac ad em ic ye ar , 1,346 st udents we re 

en ro lle d in th e 12 sch ools of pu blic hea lth in th e United St at es . Thi s co mpa res 

w ith a fig ure of 1,331 fo r the pr ev io us yea r, an d 1,461 fo r the year be fo re th at. 

Sin ce ap pr ox im at el y on e-fo urth of th es e st udents are from oth er co un trie s, th en 

a t be st we are pr ep ar in g only ab out 1,666 pu blic he al th w or ke rs j>er ye ar . It is 

clea r, th er ef or e, th a t a do ub lin g of fa ci li ti es fo r teac hi ng an d tr ain in g in scho ols 

of pu blic he al th is in di ca ted as a fi rs t an d im m ed ia te ste p.

Th e scho ols of pu blic he al th var y co ns id er ab ly in size of ph ys ical pla nt, fro m 

16,606 sq uar e fe et to 155,666 sq ua re feet, w ith an av er ag e of ap pro xi m at el y 

63,700 sq ua re feet. Th e nu mbe r of sq ua re fe et pe r st uden t ex te nds am on g th e 

12 scho ols f rom 164 to 1,782, w ith an a ve ra ge fig ure o f 479. Som e o f th e var ia bility 

may be e xp la in ed by th e fa ct th a t ea ch in st it uti on c on ce nt ra te s on a di ff er en t su bje ct or su bj ec ts, which im poses g re ate r or le ss er sp ac e re qu irem en ts.

In oth er ed uc at io na l in st itutions whe re li tt le if an y la bora to ry fa ci lity is re ­

qu ire d, eit her fo r teac hi ng or re se ar ch , on e mig ht say th a t 479 sq ua re fe et of 

spac e pe r st udent mig ht he ad eq uat e fo r in st ru ct io nal pu rpos es. How ev er, 

schools of pu blic he al th do no t fa ll in to such a clas sifica tio n. Pub lic healt h st u ­

den ts m us t ha ve a t th eir d ispo sa l se ve ra l ki nd s of l ab or at or ie s, su ch as c he m istry, 

st ati st ic s an d epide mi olog y, ba cteriolo gy , pa ra sito lo gy , gr ap hi c a rt s, in dust ri al 

hy gie ne, an d ot her s ub je cts whe rein pra ct ic al work un de r su pe rv isio n is es se nt ia l.

It is sa fe to s ay th a t the nu m be r of p ub lic hea lth st uden ts curr entl y en ro lle d in 

sch ools of pu blic he al th is fa r too sm all to mak e ap pr ec ia bl e in ro ad s in to th e 

backlog of tr ain in g re qu irem en ts in th is co un try. F urt her, th e fa cil it ie s fo r the 

curr ent e nr ol lm en t are stre tc hed b eyon d re as on ab le lim its in mos t of the se schools. 

In or de r to pr ep ar e now fo r th e fu tu re , it is our be lie f th a t addit io nal fa ci lities 

are u rg en tly requ ired .

Relia bl e ev al ua tion of th is N at io n’s ne ed s re la ti ve to den ta l se rv ices in di ca te s 

a si m il ar pict ur e. The re port of th e Su rvey Co mm iss ion of D en is tr y in the 

United S ta te s to th e American Co un cil on Educ at io n appea rs to us to be the 

re su lt o f a ca re fu l an d ob jec tiv e stud y by a dis ting ui sh ed assembly of exix*rienced 

an d kn ow ledg ea ble pe rson s who mad e up th e comm iss ion . H er e ag ai n, it seem s 

to us th e fin din gs of th is grou p m er it ca re fu l sc ru tin y.

Th e e xp er ie nc e of h av ing to w ait 4 to 8 weeks fo r a den ta l ap po in tm en t fo r an yth in g but em erge nc y ca re sp ea ks mor e eloq ue ntly of th e sh ort ag e of th es e pr ac ­

ti ti oners th an pa ge s of st at is ti cs , but th e follo wing wi ll pr ov ide som e co nc rete 

inde x of ou r need.

Th e comm iss ion re port pu bl ishe d in 1960 po inted ou t th a t th e cu rr en t 90.000 

den ti st s pr ov id in g a ra ti o of 1 denti st pe r 1,900 po pu la tion is sufficie nt to pr ovide co mpr eh en sive den ta l ca re fo r but on e- th ird of our po pu latio n. To eve n 

m ai nta in th e pre se nt in ad eq uat e de ntist-to -p op ul at io n ra tio, it will be ne ce ss ar y 

to in cr ea se th e nu m be r of pr ac tici ng denti st s to 134,000 by 1975. To acco mplish 

th is end, th e ra te of an nual den ta l sch ool gra duate s mus t be do ub led by th at 

dat e. To pr ov id e th e fa ci lities ne ce ss ar y fo r th is ob jec tiv e, a to ta l of $250 

mill ion is re qu ir ed fo r re no va tio n an d ex pa ns io n of ex is ting sch oo ls an d const ru cti on of new sch ools. On ly a ft e r such st ep s are ta ken ca n th e pre se nt ra te 

of 3.200 gra duate s an nual ly be in cr ea se d to th e ne ed ed 6.000 g ra duate s.

Num er ou s ad ditio nal step s were urge d to im prov e den ta l pr ac tice . As of the 

d ate of th e stud y, 4.360 te ac he rs in de nt al sch oo ls re pr es en te d on ly 1.878 fu ll ­

tim e te ac he rs . P ra ct ic in g den tist s co mpr ise 58 pe rc en t of den ta l te ac her s on a 

pa rt-tim e, pa id in st ru cto r ba sis . An ad di tiona l 16 pe rc en t of th e den ta l sch ool 

fa cu ltie s a re cons titu te d of pr ac tici ng den tist s who teac h on a pa rt-tim e, nonre m unera ti ve ba sis. P ar t- tim e te ac her s from bo th of th e ab ov e ca te go ries 

co mpr ise up to 85 pe rc en t of th e in st ru cto rs a t som e sch ools. The co mmiss ion 

mad e st ro ng reco m m en da tio ns th a t den ta l school su pport be ob ta in ed from 

alum ni, be ne fa ct or s, bu sin ess, fo un da tion s, an d fro m S ta te an d loc al go ve rn ­

men ts. an d th at, in ad di tion , th e as si st an ce of th e F ed er al Gov ernm en t sh ou ld be 

ob tain ed fo r bo th co ns truc tion of fa ci lities an d fo r oper at io nal co sts .
498 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

In the light of the foregoing data , we believe steps should be taken to increase 

the number of physicians, dentists, and public health personnel. We believe th at 

such an increase should be made without sacrifice to the present high quality of 

training provided. In 1960, the governing council of the APHA approved endorsement for appropriate Federal suppo rt to qualified institu tions which trai n 

medical personnel for construction of needed facilities, for operation al costs, and 

for scholarship aid for students. We believe II.R. 4999, if enacted, would provide a balanced, practical, and reasonable program to help meet these critical 

needs. We, therefore, supp ort passage of this legislation. It is most important 

to begin the construction gra nt program immediately as an incentive both to 

replace or renovate facilities which are outmoded or beyond rehabilitation and 

to build new schools. We subscribe to the matching provisions—this should be 

ano ther of the time-honored Federal-State partnership undertakings.

Likewise, we suppo rt scholarship aid for deserving students. It appe ars to 

us that this step must be taken to increase the attractivenes s of a care er in 

medicine or dentistry. Other Federal scholarship programs have in effect done 

much to price a choice of medicine out of the reach of all except those most 

favored financially. This is not a condemnation of the other scholarship programs. As the sciences progress, however, the competition can only increase. 

Incentives, therefore, should be equalized insofar as is possible.

The APHA also supports modest Federal supp ort of operational costs. The 

marked increase in basic operational costs results, in the main, from the remarkable advances in medicine. Continued advance should be encouraged, not 

curtailed. Grad uates are th e better for improved teaching, facilities, and equipment. The patient is the ultimate recipient of the improvement, or the loser in 

the event progress is not continued.

We are of the firm opinion that this is a sphere of activity rightfully falling 

to the Federal Government. Ins ofa r as this legislative proposal is concerned, 

we believe section 726 provides ample safeguards against any possible Federal 

interference or control over medical education. We applaud the lack of any 

dire ctio ns tha t greater emphasis be placed on the training for par ticula r areas 

in the health field. We are well acquainted with numerous join t programs in 

public health training and activities wherein the Federal Government is a 

pa rtn er with Sta te and local health departments, institution s, and voluntary 

agencies in what we consider altogether wholesome and beneficial arrangem ents. 

We believe f urt her tha t the Federal Establishment, and specifically the Congress, 

has contributed to the current and forthcoming dilemma. By appropriating 

funds for medical research and for the construction of research facilities, the 

Congress has made signal contributions to the discovery of new and dram atic 

medical knowledge. But by the same token, as the corps of resea rchers is 

increased, the number of potential priv ate prac titio ners is decreased. By sui>- 

porting advanced training in several other scientific areas, the Congress made 

more difficult the recru itment of high-caliber stud ents for medical careers. 

Precisely how this imbalance is to be corrected is properly the concern of the 

Congress, but that the Congress has contributed to the problem, in our opinion, 

must be conceded.

The American Public Health Association appreciates this opportunity to 

present the views and beliefs of its members on this imp ortant legislation. We 

respe ctfully urge prompt action by the Congress in the passage of H.R. 4999.

Char lotte, N.C., -Ja nuary 20, 1962.

Com mi tt ee ox I nter state am i F oreign Comm erce,

JTowtr of Rep res entative s,

Washin gto n, D.C.

Gentlemen : It is my understanding tha t beginning January 23, 1962, your 

committee is to hold hearin gs on H.R. 4999, and rela ted bills, which are designed 

to increase opportunities for the training of physicians, dentists, and public 

hea lth jiersonnel.

On behalf of the Imhotep Conference, an organizatio n dedicated to the eliminatio n of segregation and inequities in health matters, sponsored by the National 

Medical Society, the NAACP and the National Urban League, we wish to urge 

you to consider the insertion of nondiscriminatory provisions in this bill.

Nationally opportunities for the training of Negroes and othe rs of minority 

groups is at a minimum. We should think that in a crisis such as we are
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 499

faced with at present, there is no place for segreg atory or discrim inatory practices. Hence we appeal to you to include a provision proh ibiting fu rth er limiting these mino rity groups in opportunities for training to b ette r serve ou r country. 

Very truly yours,

Emery L. Rann, M.D. 

Chairman, The Imh otep Conference.

Santa Monica, Cau f., January 16,1962.

Chairman Harris,

House In ter sta te and Foreign Commerce.

Dear Chairman Harris: I notice th at hearings will begin on Janu ary 23 

regarding increased o pportunities for training health i>ersonnel. May I suggest 

that your committee need look no furth er tha n to encourage passage of the 

Keogh bill. This would eradica te a grave injustice in our country’s taxatio n 

setup for the professional man and increase ou r incentive.

As the tax laws now discriminate against the self-employed, I can assure 

your committee th at my two sons will be discouraged from the health professions. 

Sincerely,

Richard L. Combn, D.D.S.

Yale University School of Medicine, 

Department of Epidemiology and Public Health,

New Haven, Conn., January 19,1962.

lion. Oren Harris,

House o f Representatives, Washington, D.C.

Dear Representative Harris : I wish to express the full support of the Yale

University School of Public Health for the teaching facilitie s construction bill 

H.R. 4999. The proposals contained in this bill will go fa r to meeting a longfelt need for improved facilities and supp ort for education in the hea lth professions. As is well known the medical profession in general and the public 

health profession in particular are facing lean years in the coming decades 

aris ing in pa rt from competition with the new developments in the physical 

sciences in att racting stud ents of the quality needed to face the increasin g 

complexity of the health problems of the futu re.

At Yale the present facilities for teaching Epidemiology and Public Hea lth, 

and for und ertaking resea rch in these fields, are woefully inadequate. There 

have in fact been no significant changes in them for over 20 years. The time 

has come when some degree of expansion of these facilitie s is absolutely essential if the school is to fulfill its present obligations, and the construction of 

completely new and enlarged facilitie s are necessary if the school is to play 

its potential role in meeting the problems of the future. These facilitie s are 

needed both for teach ing and research, a division which is of course largely 

artificial as fnr as graduate train ing is concerned since the best advanced tra ining is conducted in a framework of ongoing research. Matching Federal support 

can, it is true, be obtained for construction of research facilities, though schools 

of public hea lth generally have considerable difficulty in att rac tin g the basic 

funds needed from other sources because public health research does not have 

the glamour atta che d to medical research. But even more serious tha n this is 

the fact that resea rch cannot be carrie d through successfully withou t an 

adequate number of highly traine d scientists of real ability.

It is my opinion that we are rapidly approaching the point at which the fine 

and hither to most rewarding policy of the supp ort of research on a large scale 

may founder owing to the lack of such trained men. If the research workers 

of the futu re are to be there when they are needed they must be trained now and 

if we are to attrac t men of the quality we need, we must be able to offer them 

training facilities and ancillary support comm ensurate with the ir professional 

and personal needs. If the House of Representatives inten ds to continue its 

support of research in the health fields, it would seem both logical and essential 

that it should supp ort the training which is absolutely necessary for the development of the coming generation of research workers. This is of course in addition to the many other cogent reasons for the support of training to meet the 

pressing needs of the communities of the State of Connecticut in the immediate 

futu re.
500 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

Being aware of your fine efforts in the past as chairman of the House Inter ­

state and Foreign Commerce Committee in the supi>ort of legislation to improve 

the hea lth of this country, I believe there is no need to urge you to suppo rt this 

bill. May I therefore simply assure you of the full supp ort of this school of 

public hea lth and that if there is any way in which we can help please do not 

he sitate to call on us.

I respectfu lly request t ha t this letter be included in the record of the hearings. 

Sincerely yours,

A. M.-M. Payne, M.D., M.R.C.P., Chairman.

State Board of Health,

Helena, Mont., Janua ry 22,1962. Re H.R. 4990.

Hon. Oren Harris,

Chairman, Interstate and Foreign Commerce Committee,

House o f Representatives, Washington, D.C.

My Dear Mr. Harris: In view of the fact that, at present, Montana must depend entirely on other States for education of persons in the medical, dental, 

public health, and other related fields, it is my hope that the House Inters tate 

and Foreign Commerce Committee will endorse II.R. 4999 and will rei»ort it 

favo rably to the House.

This bill would certainly be imp ortant to our State, as well as the Nation, 

when we recognize the unmet needs in the health fields, both in training facilities 

and personnel.

Will you please include this let ter in the record of the hearing.

Resiiectfully submitted.

Mary E. Soules, M.D.,

Dcptly Health Officer and Director,

Division of Disease Control.

Asheville, N.C., January 2^, 1962. Hon. Orf.n Harris,

Chairman, Intersta te and Foreign Commerce Committee,

House of Representatives,

House Office Building, Washington, D.C.

Dear Congressman Harris: I am very interested in II.R. 4999, known informally as the medical schools construction bill. Speaking from iiersonal ex­ perience as a health director for the past 22 years, I regret to repo rt that there 

is a gre at shortage of traine d medical personnel in the preventive field. The outlook is not optimistic unless our medical schools, and partic ularly our high er 

professional training schools, are given some type of financial aid. The days of 

foundations and large ph ilanthropic gifts are gone.

In my State of North Carolina and also your Sta te of Arkansas and many 

oth er States in the West, there is indeed a great demand for trained public 

health personnel in the field of preventive medicine. As we make gre ater progress in our medical sciences, preventive medicine will play an increasingly more 

important roll. I feel sur e that my colleague, Dr. Mason Lawson, health director of Little Rock, will sub stantiate these statements. I am taking the liberty of sending a copy of this lette r to my friend, Congressman Roy A. Taylor, 

in hopes that you and Roy will sprea d the news that H.R. 4999 is quite necessary 

to the field of medical progress and the protection of our citizens throughout the 

entire United States.

Respectively yours,

II. W. Stevens, M.D.

President Elect, Southern Branch,

American Public Health Assoeation. Cc.—Congressman Roy A. Taylor.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 501

T he K an sa s State B oard of H ea lt h,

To pe ku , Run s., January 22 ,19 62.

H o n . Oren H arris,

Ch airm an , In te rs ta te an d Fo reign Co mm erce Com mitt ee ,

The H ou se o f Rep re se nt at iv es , W as hing ton, D.C.

Dear Cha ir man Harr is : I wo uld lik e to ta ke th is op po rtunity to ex pre ss my 

pe rs onal en do rs em en t of H.R . 4999, w ith th e hope th a t your co mm itt ee will re ­

port i t fa vo ra bl y to th e House.

Per hap s th e m aj or co nt ribu ting fa cto r to th e pr es en t sta te of pu blic d is sa ti sfa ct io n w ith healt h ca re in th is c ou nt ry lie s no t so mu ch in th e are a o f e conomics, 

but in th e fa c t th a t pr of es sion al pe rs on ne l sh or ta ge s co nf ro nt th e in di vi du al 

citiz en w he ne ve r hi s ne ed fo r th eir se rv ices ar is es . Th e re ce nt W es t V irgi ni a 

ex pe rien ce in ad m in is te ri ng Kerr-M ill s prov isions , refle cts in p art , th e pu bl ic ’s 

co nd iti on ed re ac tion to pr of es sion al st arv ati on. The pr of es sion al pre ss ure s pro ­

du ced, allo wed a ce rt ain am ou nt of in di vi dua l ra tional iz at io n fo r co mm itt in g 

et hic al tr an sg re ss io ns. A suf ficien t nu m ber of tr ai ned pr of es sion al an d no npr of es sion al healt h pe rson ne l wh o could un de rs ta nd, define an d mee t th e re al 

loc al pu blic he al th ne ed s wo uld ha ve pr ev en te d mo st of th es e tran sg re ss io ns .

Also, co nt em pl at io n of ou r pre se nt hea lth pe rson ne l sh or ta ge s become s st ag ­

ge ring whe n pr oj ec te d into even th e im m ed ia te fu tu re . Fa ce d w ith th is, we 

m us t in sti tu te som e mea ns of mee tin g th e need, an d it see ms to me th a t H.R. 

4999 is t he an sw er .

If ti m e pe rm its, p leas e includ e th is l ett er in th e reco rd o f th e he ar in g. 

Res pe ctfu lly yo urs,

R obert H. Riedel, M.D.

E xecuti ve Se cr et ar y.

State of I daho, 

Depa rtm ent of Hea lt h,

Ja nuary 2S, 1962.

Hon. Oren Har ris,

■Chairman. In te rs ta te a nd F oreig n Co mm erce C om mitt ee ,

Ho use o f R ep re se nt at iv es , Was hing ton, D.C.

Dear R epresen tat ive Harri s: Bec au se we know from lon g co nt in ue d ex ­

pe rie nc e th e dif ficulty in re cr uitin g pr of es sion al w or ke rs to th e field of pu blic 

he al th , we wish to en do rs e si>ecifically th a t p a rt of H.R. 4999 pr ov id in g g ra nts 

to pu blic he al th te ac hi ng fa ci lit ie s. We hojie th a t yo ur co mm itt ee wi ll re port 

th is hill w ith f av or t o th e H ouse of R ep re se nt at iv es .

Ex pe ns ive tr av el wi ll ob vio usly m ak e it im po ssible fo r us to att end an y of 

th e he ar in gs . We shou ld like, th er ef or , to as k th a t th is le tt er be m ad e a p a rt 

■of the he ar in g, if th is is possible.

Sinc erely ,

Terrell O. Carver, M.D.

A dm in is tr ato r o f H ea lth .

Univ ersit y of Cal ifo rn ia School of P ublic H ea lt h,

Office of th e Dea n,

Lo s An ge les , Ca lif. , Ja nuary 19, 1962.

Hon. Oren Harris,

Cha irman , In te rs ta te an d Foreign Co mm erce C om mitt ee ,

Ho use of R ep re se nt at iv es , Was hing ton, D.C.

Dear Congressma n H arri s: The hea lth an d med ical prof es sion s ap pre ci at e 

your supi»ort of Fed er al le gi slatio n which en ha nc es th e tr ain in g of pr of es sion al 

l»ersonnel to mee t th e ne ed s fo r pr ev en tion an d tr eatm ent of di se as e an d fo r 

re habil it ati on o f th e disa bled . N at io na l an d world socia l tren ds fo rc es us region ­

ally to see k su pp or t from na tion al an d in te rn ati onal reso urce s in th e tr ain in g of 

pot en tial le ad er s in th e hea lth an d med ical sci ences. W hile we a re mak in g 

pr og re ss in ex pa nd in g in te rn at io nal , N atio na l, Sta te , an d local su pport fo r re ­

se ar ch an d ed uc at io n, th is m us t he eq ua liz ed w ith th e fa ci lities av ai la ble fo r 

th es e en de av ors. II. R. 4999 is a mo st re ali st ic w ay of as si st in g th e hea lth an d 

me dical scienc es to mee t th e ch alleng e of incr ea sing th e nu m be r of gra duat es , 

im prov ing th e qual it y of tr ain in g an d ed uc ation, an d of m ee tin g th e se rv ice re ­

qu ir em en ts of ou r co un try. Also F edera l su ppo rt fo r th e co ns truc tion of addition al fa ci lities is th e on ly way we can ev er ho pe to me et th e in te rn ati onal 

co m pe tition of th e tr ain in g of fo reign pr of es sion al s an d American s fo r fo re ign
502 TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL

health assignments. While local and State citizens are willing to support the 

expensive graduate training in these health fields to meet the ir own demands, 

in our own State with our explosive population, we cann ot meet our local 

demands.

We have come to the crossroads of decision in the hea lth and medical sciences just as we have in other are as of national intere st wherein we wish to 

maintain or acquire internatio nal leadership. In exam ining the record you will 

find that public health assistance, which we have provided foreign countries 

through education and training, has been most popular and a realistic approach 

to improving mu tual inte rnation al relations.

Schools of medicine and den tistry prim arily tra in American citizens and 

State-supported schools prim arily State citizens for service to individuals within 

our geopolitical boundaries. A majority of gradua tes engage in such rewa rding 

activities which enables them to channel more material support to the ir jatrent 

school than the public health school graduates who engage in community service, 

governmental and inte rnational service. The preparatio n of physicians and 

dentists for community and inte rnational health service begins with the training 

of a sufficient number to meet our own local needs and a small percentage each 

year for public health gradua te training. However, schools of public health 

draw from all disciplines and professions for the preparatio n of teams of physicians (hea lth adm inistrators and epidemiologists), dentists, veterinarians , engineers, nurses, social scientists, educators, sanitarians, nutritio nists, microbiologists, etc.

There are only two schools of public health west of the Mississippi, both 

Sta te schools attempting to meet the personnel needs of States with the grea test 

Imputation increase within our own State as well as adjace nt States. There 

is a serious lag between the tax contribution of this increased population and 

the prep aration of health professionals to meet service needs.

Now is the time, therefore, for Federal supp ort for the construction of 

facilities which will fac ilitate the grad uate professional training of personnel 

to expand community services for the prevention of disease and disability and 

to take leadership in community organization for medical care and rehabilitation .

We are pleased to have Drs. Stebbins (Johns Hop kins), Leavell (H arva rd), 

and Wegman (Michigan), represent the schools of public health in testimony 

before your committee. I personally am happy th at Dr. Stafford L. Warren, 

our UCLA vice chancellor of health and medical science, can represen t our 

schools of medicine, dentistry, and public health.

We know tha t Representatives J. A rthus Younger and John E. Moss appreciate 

our problem for meeting the health needs of California and the West and the 

stre ss placed on our California schools in the education of professional personnel for foreign service.

Sincerely,

L. S. Goerke, M.D.,

Dean. President, Los Angeles City Board of Health, Vice President,

California Sta te Board of Health.

State of Maryland,

Department of Planning and Planning Commission,

Baltim ore, Md., January 26, 1962.

Hon. Oren Harris,

Ch airman, Committee on Intersta te and Foreign Commerce,

House Office Building. Washington, J).C.

Dear Congressman Harris : I want to than k you again for the opportunity to 

appea r before the Committee on Inters tate and Foreign Commerce in sup port 

of HR. 4999.

As you may recall, when I appeared before the committee, I made reference 

to a problem with rega rd to foreign medical graduates, a reference which did 

not appear in my prepared statement.

Our committee, in studying the problem of physician supply, concluded that 

it was quite likely that the influx of foreign medical gradua tes would begin 

to taper off in the next few years. (Reference to th is will be found in the mimeographed copy of our report, ch. II, pp. 22-27, which is on file with your committee.) Since 1 out of 5.7 medical gradua tes licensed for the first time 

in the United States each yea r is currently a foreign medical graduate, and 

since these graduates are currently essential to maintain our physician-popula-
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSO NNEL 503

tion ratio , you can apprecia te what a severe impact a decrease in foreign 

immigration can have.

To my knowledge all other reports calling for expansions to meet 1975 goals 

did not consider a possible decline in the number of foreign medical graduates 

being licensed. If we are correct in our analysis, the speed with which we need 

to expand our facilities, and induce more stud ents to und ertake the study of 

medicine, must be gre atly accelerated . H.R. 4999 will do much in this regard, and 

its early passage is critically necessary.

Sincerely yours,

Rabbi Morris Lieberman,

Chairman, Subcomm ittee on Medical Education and Research.

State of California Department of Public Health,

Office of the Director. 

Berkeley, Calif., Jan uary 24, 1962.

Hon. Oren Harris,

House of Representatives,

Hou se Office Buildi ng,

Wash ington, D.C.

Dear Mil Harris: On behalf of the Association of State and Territorial Health 

Officers, I want to express a strong endorsement of your bill, H.R. 4999, the 

Health Professions Education Assistance Act of 1961. As public health officials 

we are most cognizant of the need for expanding facilitie s for training of the 

health professions. With the rapid population increase, the relatively slower 

increase in the training of individuals for the health professions is resulting in 

a decrease in the physician, dentist, and public health specialist population 

ratio . This deficit is magnified by the increasing demands placed upon the 

professions of our country for assistance in the internatio nal health programs.

It seems to us as State directors of public health tha t this is an appropriate 

area for the Federal Government to rend er assistance and that the provisions 

of H.R. 4999 in general will lie expected to accomplish the desired objectives.

While we do not desire to take th e time of the committee for specific presenta 

tion, we would apprecia te having this letter included as pa rt of the record 

of the hearings.

Very sincerely yours,

Malcolm H. Merrill, M.D.,

President, Association of State <t Territorial Health Officers.

American College of Surgeons,

Chicago, III., Ja nua ry 25, 1962.

Mr. William E. Williamson,

Clerk, Comm ittee on Interstate and Foreign Commerce,

U.S. House of Representatives,

'Washington, D.C.

Dear Mr. Williamson : It will not lie possible for me to accept the invitation 

to be present at the meeting of the Subcommittee on Hea lth and Safety on 

February 6, 1962, as a represen tative of the American College of Surgeons, when 

H.R. 133 is to be considered at a public hearing.

The American College of Surgeons and its committee on traum a have an 

intere st in the end products of this bill should it be enacted into law. This 

intere st has been heightened by reason of projects and programs form ulate d 

within the joint action program (established 1958) of this college with the 

National Safety Council and the American Association for the Surgery o f 

Trauma.

We have conferred with officials of the National Safety Council and carefu lly 

reviewed the objectives implementing language and effects of the proposed 

legislation, and are in entire agreement with the position which the National 

Safety Council will take. I have informed Mr. William Johnson, general manager 

of the National Safety Council, th at our views on this bill coincide with the 

views of his organization and th at he may so advise the subcommittee. 

Sincerely yours,

J ames B. Mason, M.D., FACS,

Assista nt Director.
504 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

State of Georgia, 

Department of Public Health,

Atlanta, Ga., January SI, 1962. lion . Oren Harris,

Chairman, I nte rstate and Foreign Commerce Committee,

House of liepre scntatives, Washington, D.C.

Dear Congressman Harris : We in public health in Georgia are very much 

inte rested in the provisions of II.R. 4999 which, I understand, is now before your 

committee.

This bill provides for gra nts for construction of health teach ing facilities including teaching ho spitals for such professions as medicine, dentistry, and public 

health and furth er provides for gra nts for scholarships and supporting costs.

The shortage of such trained personnel is nationwide and certainly Georgia 

is no better than the average and in some respects well below the average. It 

is our considered opinion that thi s bill, adequately supported by appropriation, 

will do much to alleviate the problem.

I would appreciate it very much if your committee could see fit to report this 

bill favorably to the House and will hope this letter may be included in the 

report of the hearing.

Sincerely,

John H. Venable, M.D., Director.

Harvard School of P ublic Health,

Boston, Mass., January 31,1962. Re H.R. 4999.

Hon. Oren Harris,

Chairman, Committee on In terstate and Foreign Commerce,

U.8. House of Representatives, Washington, D.C.

Dear Mr. Chairman : As a physician engaged in gra dua te public health education and research, I wish to be recorded as strongly endorsing II.R. 4999 which 

your committee is now considering. The bill is soundly conceived. I thank you 

for introducing it and for giving all who are interested an opportunity to offer 

comment.

Speaking for a school of public health which has been forced to limit 

its stud ent enrollment because of lack of adequ ate teach ing space, I earn estly 

request that II.R. 4999 be amended to provide sitecial treatm ent of the schools 

of public health in the form of a separate auth oriz atio n for teaching facilitie s 

gra nts and an 85 percent Federal share of construction costs. This request 

is based on the fact that this school and the others have found that they cannot 

match Federal funds for teaching facilities because of (1) unavailability of 

endowment funds for construction: (2) disinclination of priv ate foundations, 

industries and individuals to provide facilities for the training of stud ents for 

public service; (3) reluctance of State legislatures to provide facilities for t raining out-of-State students.

The 12 schools of public health in the United States serve the other States and 

the Federal Government by prep aring physicians, dentists, engineers, nurses, 

and othe rs for leadership in public health agencies and institutions. The severe 

shortage of graduate-trained personnel cannot be met without Federal assistance in the expansion of teaching facilities. This school would like to build 

new teaching facilities t ha t would permit a 35 jtercent increase in student enrollment, but we know from experience that we would be unable to obtain more th an 

15 percent of construction costs from non-Federal sources.

With best wishes,

Sincerely yours,

J ohn C. Snyder, M.D., Dean

Northwestern University,

Dental School, 

Chicago, III., Jan uary 31, 1962. Hon. Oren Harris,

Chairman. Committee on Inte rstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Dear Mr. Harris: I would like to acquaint you and the members of the Committee on Intersta te and Foreign Commerce of my inte rest in H.R. 4999.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 505

Dental schools are particu larly needful of construction funds. I am hoping 

that some tyi>e of legislation in this imp ortant area may be produced at this 

session of Congress. Your interest will be appreciated.

Very truly yours,

George W. Teu sc he b, D ea n.

Stateme nt in Support of H ealth P rofessions E ducatio nal Ass ista nc e Act

hy tii e Association of American Medical Colleges

Mr. Chairman and members of the committee. I am Dr. G. O. Broun, dean 

of St. Louis University School of Medicine. I am appe aring as a represen tative 

of the Association of American Medical Colleges.

I am gra teful for the opportunity of api>earing before this committee. I 

wish to endorse the provisions of H.lt. 41199, and to urge that it receive favorable consideration from the committee and be promptly enac ted into law.

I am in full agreement with the very fine state ments of Dr. Anderson, Dr. 

Berson, and Dr. Turner.

An acute shortage of physicians is alre ady evident in certain areas and will 

become increasingly severe within a few years. New medical schools will be 

needed a nd existing schools must be improved and expanded.

In our school of medicine, it has been difficult to secure adeq uate funds for 

construction of teaching facilities both for the basic medical sciences and for 

building programs of our teaching hosp itals and clinic. Hence, th e need of those 

provisions of II.R. 4999 which refer to construction of medical educational facilities. There is urgent need of increasing the number of qualified studen t 

applicants through provision of scho larsh ips for students who otherw ise could 

not afford the high costs of medical education.

We have noted a decrease in the number of properly qualified applican ts seeking admission to our school of medicine. I strongly urge th at favo rable consideration be given to bill II.R. 4999.

E li Lilly & Co., 

Indianapolis, February 6,1962.

Hon. Oren H arris,

Chairman, Interstate and Foreiyn Commerce Committee,

House of Representatives, Washington, D.C.

Dear Mr. H arris : I am Thomas P. Carney, Ph. D., vice presiden t of research, 

development, and control for Eli Lilly & Co. I would appreciate it if this 

statem ent could be made pa rt of the record of your hearings on II.R. 4999, 

the Hea lth Professions Educational Assistance Act of 1961.

My deep intere st in II.R. 4999 stems from my close association with the 

creation of prescription medicines and from my past service as a special consultan t to the Secretary of Health, Education, and Welfare on problems of 

medical research and medical education. In the latte r capacity I was 1 of 10 

physicians and scientists under the chairmanship of Stanhope Bayne-Jones, 

M.D., whose final repo rt was issued June 27, 1958, under the title ‘‘The Advancement of Medical Research and Education Through the Department of 

Health, Education, and Welfare.” My work has brought me into close association with the prac tice of medicine and into many dire ct relationships with 

medical schools.

It should be unnecessary to review the importance of medical schools to 

the health of the American people. There is disturbing evidence, however, tha t 

the crucial role of medical education has not been so widely appreciated as 

it should be. Public attention and political support in recen t yea rs have centered on other medical and scientific fields.

Somehow our society has faile d to recognize the clear tru th that medical 

schools are the key to all health progress. They provide (1) the scientific 

research ers who oi>en new frontiers of knowledge. (2) the physicians who apply 

this knowledge for the benefit of th e people, and (3) the teache rs who tra in both 

research scientists and medical practit ioners of the futu re. Medicine cannot 

advance without an adequate supply of all three —medical schools ar e the 

funnel from which al l th ree must come.

My conviction as to the par amoun t importance of medical education is derived not only from general observation but from personal experience. Eli 

Lilly & Co. now invests more than $20 million annually in the search for new 

80014—62-----33
506 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSO NNEL

and better medicines. We rely on physicians and other medically trained personnel to study basic disease conditions, to identify opportu nities for therapeutic advances, to help explore the possible advanta ges and disadvan tages of 

new drug s in the treatm ent of diseases, to develop effective dosage forms and 

modes of adm inistration, and, finally, to determine in clinical practice the 

physiological effects and limitations of our products. We rely on physicians 

and other medically trained personnel to assure that our information to the 

medical profession about the proper use of our medicines is accurate and 

useful.

In recent years remarkable scientific developments have produced incredible 

health progress and medical advances. Here a re some startling fa ct s:

More than 4.4 million Americans living today would be dead If the Nation’s 

mortality r ate had remained a t the 1937 level.

Since 1944 the death rat e from influenza has dropped 90 percent; the 

rate from tuberculosis, 83 percent; acute rheu matic fever, 83 percent; 

syphilis, 79 percent. Since 1940 the death rat e among mothers in childbirth 

has declined by over 90 percent.

During the 5 years ending in 1900, the number of patients released from 

mental hospitals has increased over 51 percent. Over 200,000 more persons 

were released than would have been at the 1955 rate.

Equally startling is the realization that, although mankind has been battling 

disease and disability for thousands of years, all of this progress has occurred 

within the last qu arter of a century.

Economic benefits cannot be compared with considerations of life and death, 

but they are Impo rtant:

The National Health Education Committee has estim ated that the decline 

in mortality rates since 1937 adds almost .$9 billion to the national income 

every year.

Millions of people have been freed from hand icaps of disease to perform 

productive and useful work : People buy antibiotics and are freed from long 

hospitaliz ation with pneumonia; they buy polio vaccine and escape iron 

lungs and braces.

The decline in the number of mental hospital patients below the number 

predicted 5 years ago for 1960 has saved approximately $1.8 billion in institutional construction costs.

The availability and skill of our Nation’s physicians are essential to continuing the kinds of progress which I have enumerated. Looking to the futu re, it is 

unmistakably clear that this country must undertake a major and rapid expansion of medical teaching facilities if we a re to maintain our standard s of medical care.

First, we know that there will be a tremendous increase in the demand and 

need for medical care. The burgeoning of our population, if nothing else, would 

assure this. The need for medical care also will be heightened because the 

population is increasing fas tes t in the younger and older age groups, which require more medical atte ntio n than other groups, and because the expansion of 

medical knowledge and rising levels of income tend to increase demands and 

oppo rtunities for medical care.

Second, the presently planned facilitie s of our medical schools will fall far 

short of providing the physicians and other personnel required. There is str iking agreement on this point among all students of the problem. The BayneJones report of 1958 unanimously concluded that the ann ual o utput of our medical schools would have to increase from 6,800 physicians in 1956 to 8,700 by 

1970 if we are to maintain the present rati o of physicians to population. The 

report estim ated that 700 of the needed additional physicians could be provided 

by improving and expanding existing schools, but 1,200 additional physicians 

would have to be provided through the construction of new schools.

In 1959 a more detailed study by another group of expert consulta nts to the 

Surgeon General of the Public Health Service, under the chairmanship of Mr. 

Frank Bane, arrived nt similar conclusions. This report, also unanimous, 

showed that even if medical education facilities continue to expand at the 

recent increasing rat e there would be a serious shortage of physicians in the 

1970’s. The consultan ts found that admissions to medical schools must be increased by 50 percent by 1971 if we are to main tain the present ratio of physicians to population—certainly a necessary and reasonable minimum objective. 

To provide the required facilitie s would necessitate construction of the equivalent 

of 20 to 24 new medical schools.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 507

Statements by the American Medical Association, the Association of American Medical Colleges, the Public Health Service, and othe rs all tend to support 

the fact that we must expand medical teaching facilitie s well beyond the present 

plans and capacity of our medical schools if we are to avoid a serious shortage 

of physicians in this country.

Third, I would like to emphasize the need for early action to meet this problem. It is extremely important to recognize th at many years are required to 

plan, build, equip, and staff an adeq uate modern medical school. In most 

cases a st ar t on this process today would not produce gradua tes unt il 1970 

or after. In view of the long leadtime required, therefore, the question is not 

whether actio n is needed now but whether we are alre ady too late.

With the need for expansion in medical education so thoroughly established, 

we come to wh at is perhaps th e ce ntral issue in the minds of Congress: Is Fed eral 

aid justified and required?

Let me m ake it clea r that my own philosophy is th at I would much prefer to 

see the needs met by State and local and private action if this could be rea listically expected. However, in view of th e magnitude of the need and the urgency 

of early action to meet it, present sources of supp ort for medical schools will 

not be adequate to inaugurate soon enough the large expansion program which 

is so vitally necessary. This means, I am convinced, th at a temporary program 

of Federal stimulus and suppo rt for construction of medical schools is essential.

In saying this, I realize that there are always dangers of possible Federal 

intervention when Federal funds are used. I sincerely hope tha t, if this bill is 

enacted into law, it will always be administered in such a manner as to obviate 

any possibility of such interference with any education al institution.

I do not believe that this country can afford to let acute shortages develop in 

medical education and, thus, in our supply of physicians and medical resea rchers. 

This is why, in the inte rest of continued hea lth progress, I hope y our committee 

and Congress will authorize Federal grants to assist medical schools in meeting 

their urgent construction needs. The program is indeed imp ortant to the 

future health of the American people.

Sincerely,

Thomas P. Carney.

West Virginia University,

The School of Dentistry, 

Morgantown, February 3,1962.

Representative Oren H arris,

Chairman, Committee on Interstate and Foreign Commerce,

U.8. House of Representatives, Washington, D.C.

Dear Mr. Harris : The purpose of this communication is to urge your sup ­

port to the pending bill, H.R. 4999, which would provide Federal funds for sup ­

porting dental education. The provision of adeq uate manpower to supply the 

oral health needs of a rapidly increasing population is a majo r concern of the 

dental profession. New schools must be constructed and old schools expanded 

to provide the necessary educational facilities . More of the highly competent 

stud ents must be recru ited for the hea lth professions. An increased financial 

support is necessary to accomplish these needs.

Your favorable consideration of this request will be appreciated.

Sincerely yours,

Kenneth V. Randolph, Dean.

Tufts University,

Schoolof Dental Medicine, 

Boston, Mass., February 5,1962.

Hon. Oren Harris,

House Office Building,

Washington, D.C.

Dear Representative Harris : Last summer and again at this time I sent 

the attached letter and supporting material to the Representatives of the New 

England States, urging them to support H.R. 4999.

This measure is absolutely essential if private dental education is to survive 

in this country. The extremely high costs of professional educ ation make it 

necessary for priv ate enterprise and Government to combine forces in order to 

achieve the facilities required for a tru ly modern dental school. In addition, we
508 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

must be able to compete on an equal basis with other scientific areas for outstan ding college grad uates. Pa rt of this conqietition lies in the scholarship 

area , and it is a ma tter of record th at dental schools have for all practical purposes negligible scholarship resources.

In many respects the problem of producing dental manpower for the sake of 

the oral health of the people is similar to the production of missiles for the 

defense of the people. In the latte r case, the Government and private enterprise become a team. The Government programs in supp ort of Ph.D. training 

produce the expe rts who join various companies which in turn through various 

arra ngemen ts with the Government produce missiles. The Government obtains 

its objectives while at the same time preserving our cherished trad itions of 

private e nterprise. In the same way II.R. 41)99 will permit private denta l education to join forces with the Government to meet the need for dental manpower 

while at the same time preserving the trad ition and freedom of private educational institutions.

I urge you to bend every effort to achieve the passing of H.R. 4999 and would 

be pleased to have you include this letter or the one atta ched in the hearing 

record.

Respectfully yours,

J ohn W. Hein, D.M.D., Pli.D., Dean.

J une 30, 1961.

Hon. J ohn W. McCormack,

Bou se Office Building,

Washington, D.C.

Dear Congressman McCormack : Proposals for aid to dental schools are coming before the Congress in the ne ar future. Since the School of Dental Medicine 

of Tu fts University is the majo r single source of dentists for New England, I 

though you would be interested to learn more specifically of the effect of these 

proposals on the problems of denta l education at our dental school.

Our school is one of the oldest and largest in the country. The student body 

numbers 394 undergraduate s plus 43 grad uate students. In addition, during 

the past year we gave sho rt refresher courses to 183 gradua te dentists. The 

imp ortant role that Tufts plays in the New England region is best illu strated 

by the percentage of stud ents a t our school from the various St at es :

Tot al in 

de nt al 

schools

N um be r a t 

Tu fts

Tu fts 

perce nt of 

to ta l

Con ne ct ic ut ______ _____________ _____________ __________ 169 46 27

M ai ne ................................ .. -............................... .......... .. 26 14 53

M as sa ch us et ts..................................................... .............................. 429 199 47

New Ham ps hire................................. ............................................... 38 20 53

Rh od e Is la nd ......................... ............................................................. 44 17 38

Ver m on t___________________ ____ ____________________ 23 14 61

T o ta l. .......................................................................................... 729 310 42

In spite of the vital importance of our school in the denta l manpower picture 

we are experiencing a very difficult time meeting this obligation. During the 

last few yea rs the deficit of the school of dental medicine has exceeded or 

closely approached $100,000 a yea r and it has been necessary for Tufts University to use a majo r pa rt of its income from general university endowment 

to meet our expenses. The seriousness of this situ atio n is highlighted by the 

observation that our own dental school endowment totals less than $18,000.

Our equipment and physical plant must be completely replaced in the near 

future if we are to continue to give our stud ents the best possible training. 

We have been making plans in this direction as shown by the attached proposal 

for a Tufts University Rental Center. Without Government support however, 

this project will be impossible. The measures currently pending before the 

Congress will bring our plans much closer to realization and thus we ultimately 

would be able to increase our enrollment by 20 percent. In addition, the 

instruction al costs appropriation would enable us to relieve the serious burden 

which the denta l school cu rren tly places on the university.

The School of Dental Medicine of Tufts University is very proud of the example it has set of the manner in which a priv ate educational institution can
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 509

successfully meet the health needs of a whole region of the country. We feel 

that our dental center plan would be an excellent illustration of the way private 

enterprise and Government can combine forces to meet the future dental needs 

of the people of New England. We a re happy to find tha t the young men, who 

are our students, supjxirt this concept as illustrated by the unsolicited pledge 

of $100,000 toward the dental center project by the 100 members of the senior 

class who have ju st been graduated. (See attache d copies of press clippings.)

The average New England student attend ing our school comes from an economic background wdiich is considerably lower tha n that of dental studen ts in 

other are as of the country. This is clearly indicated in the following ta bl e:

[In pe rce nt]

Na tio na l Tu fts

Will n ot h av e t o w o rk ______ __________ ________ ______ ______________ 45 18

Will h ave to w ork su mmers ________ _____ _________ _____ _____________ 66 90

Wo rk pa rt tim e du rin g ye ar ______ ________ __________ ____ _____ 8 36

No family aid . . . _____ ______ __________________________ _______ 6 18

Obviously the scholarship provisions of the pending legislation will be of 

immense help to New England dental students. These Federal scholarships will 

also enable many qualified stud ents to thin k of atte nding dental school, where 

this is probably now impossible, as shown by the following data :

[In p ercent]

Na tio nal TYifts

Pa re nt s of stu de nt s, yearly income:

Under $4,000 ......................_ ......................................... ............................. 7 15

$4,000 to $6,000 ............................................. ............... .......... 18 29

$6,000 to $8,000 .......................................- .................................. -....................- 20 16

$8,000 to $10,000 _______ ____ ______________________________ ___ 16 11

$10,000 to $12,000 . ________ ____ ____ _______- _____ _______________ 13 8

Over $12,000 . ___ ____ ____ ____________________ ________ 26 20

Any supp ort you can give the Federal programs for dental education as covered by H.R. 4999 will certainly benefit the people of your State. If you d esire 

any add itional information, I shall be most happy to fu rnis h it to you.

Sincerely,

J ohn W. II ein, D.M.D., Ph. D., Dean.

Baylor University,

College of Medicine,

Texas Medical Center, 

Houston, Tex., February 5,1962.

Hon. Oren Harris,

U.8. House of Representatives,

Washington, D.C.

My Dear Mr. Har ris: I should like to thank you again for the opportunity 

and privilege of appearing before your committee on behalf of II.R. 4999.

I have since prepared an additional statem ent which may be of intere st to 

you.

Sincerely,

Micha el E. DeBakey, M .D.

Meeting th e Need for More P hy sic ian s I s a National Responsibility'

Congressional hearings have just been held on a bill, H.R. 4999, entitled, 

“Health Professions Educational Assistance Act of 1961.” This is the most 

important piece of medical legislation to be considered by Congress since the 

acts which established the National Institut es of Health. Indeed, in cer tain 

respects, this bill could have more far-reachin g significance both for medicine 

and for the Nation than the latter, since it is designed to meet a more urgent 

fundame ntal need.
510 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

The puri>ose of II.R. 4999 is to stim ulate the establish ment of new schools 

of medicine, to encourage the expansion of enrollments in existing medical 

schools, and to enable larger numbers of capable young men and women to study 

medicine irrespective of the ir financial status. To achieve these purposes the 

hill makes two important provisions; namely, gra nts on a matching basis for 

construction of educational facilities and scholarship grants equal to $1,500 

multiplied by one-fourth the number of studen ts in each class. Each scholarship provides, in addition, $1,000 to the medical school to help defray the cost 

of the studen t’s education.

The critical need for more physicians is now unquestioned. Over the past 

decade there have been no fewer than five thoroughly documented studies, prepared by recognized exi»erts, which show clearly that our Nation faces a serious 

shortage of physicians and dentists unless we taken energetic corrective measures immediately.

It has l>een demonstrated, for example, that by 1970 we shall have to graduate 3,500 more physicians tha n were graduated in 1900 in order j us t to main tain 

our present ratio of physicians to population (1 to 720). And were it not 

for the immigration to our country of a large number of foreign-trained physicians, representing in 1958 17 percent of the new physicians entering practice, 

that rati o would already have dropped significantly. This fact in itself not 

only highlights this problem, but provides a wry commentary upon our judgment in meeting the health needs of our people. One might well ask why a 

country such as ours, with all its wealth and industrial might, should choose 

to provide billions of dollars for foreign aid programs of various kinds and yet 

be dependent upon other nations with fa r less economic resources for the education of those additional physicians we urgently requ ire to meet the minimum 

needs of our own people.

The genuine need for this legislation has been documented furth er by certain 

fac ts related to the recruitm ent of medical students. Over the past decade 

there has been a serious decrease both in the number and quality of college 

gradua tes applying for admission to medical schools, despite the fact that 

the total number of college graduates has increased. In 1948, for example, 

the number of medical school applicants represented G.O percent of the college 

graduates. In 1959, this figure had dropped to 3.9 percent. The overall failure 

rate in medical schools has been increasing in recen t years as certain schools 

have had to fill the ir classes with candidate s who are not well qualified.

There are undoubtedly many diverse factors responsible for these sobering 

statistics regarding the recruitm ent of medical students, but unquestionably 

the most important among these is the great cost of a medical education. The 

average cost to each student, of 4 years of medical education, based upon data 

from the 1959 medical school graduating class, was more than $11,600, It is, 

therefore, not surprisin g to find that more than half the 1959 medical graduate s had to borrow sub stan tial sums to complete the ir education and tha t onethird of the total group had an average debt of $4,258. Upon completion of 

his basic medical education the young physician must take at leas t 1 year of 

internship, and. if he desires a career in a specialized field of medicine, 3 to 5 

additional years of residency train ing during which time his earn ings will not 

provide even a bare subsistence. It should come as no surprise, therefore, to 

lear n that our physicians are coming mainly from the families with substan tial 

economic resources. In 1959 45 percent of families in the United States bad 

an annual income under $5,000, but they contributed only 14 i>ereent of the 

1959 medical school gradua ting class. However, 43 percent of this same class 

came from the 12 percent of U.S. families with an annual income of $10,000 

or more.

In addition to these important financial considerations which have deterred 

many outstanding college grad uate s from enterin g upon the study of medicine, 

the situation has been furth er worsened by the development in recen t years of 

many intellectually stimulating caree r opportunities in Science for which fully 

generous scholarship provisions are available. The Federal Government now 

provides fellowships for every field of higher education in the sciences except 

medicine. Through its various agencies—the Department of State, the National 

Science Foundation, the Office of Education, and the National Ins titu tes of 

Hea lth—approximately 10,000 predoetoral fellowships are provided each year. 

These fellowships afford the student not only free choice of the institution in 

which to pursue his study, but also provide full tuition, a stipend plus a dependency allowance, a travel allowance, and in some instances, an additional
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 5 1 1

subsidy to the institution. It should be obvious that the college studen t with 

limited economic resources who is interested in science may not only select a 

care er which will offer prestige and financial security, but may do so und er 

circum stances which will provide adequate support for his entire education 

us well. It would indeed be small wonder if a student desiring such a ca reer 

in the sciences were to choose medicine in con trast to a science in which such 

fellowships are available.

We have with good reason taken pride in the high stan dar ds of medical care 

which we have been able to provide, and we have developed over the past decade, 

especially with the aid of the National Ins titute s of Health and the funds that 

Congress has generously appropriated for this purpose, the finest overall general medical research program in the world, one that is attrac ting increasing 

numbers of foreign individuals here for research training. The quality and 

high standard s of these activ ities are largely dejieudent ui>on the main tenance 

of high quality personnel and the attrac tion of the best qualified college stu ­

dents into medicine. It should lx* obvious that if these college studen ts are 

dete rred from entering medicine, it will be only a ma tter of time before the 

standard and quality of both medical care and medical research, as well as 

medical education, will gradually dete rioriate.

All of the many persons who testified before the committee in the hearings on 

H.R. 4999 were enth usiastically and overwhelmingly in supp ort of the full provisions of the bill except for the sjatkesmen of the American Medical Association. They, to be sure, supiajrted that portion providing construction gra nts 

for educational facilities, but refused to take a positive position on the ma tter 

of scholarships, and instead, spoke about the intere st of the American Medical 

Association in developing a program of loan assistance.

It should be obvious even to the American Medical Association t ha t augmen tation of loan funds will not meet the need of many well qualified students. Many 

schools and State medical societies alre ady have sub stan tial loan funds, but 

the experience of past years has demonstrated their inadequacy to increase the 

attractiveness of a medical career because of the high cost to the student. Substantial increases in private scholarship and loan resources have been provided 

in the past decade, but it is ap parent that these efforts to make adequate support 

available through priv ate means have not met the problem, and it is for this 

reason that the importance of the scholarship provisions in the bill becomes even 

more significant.

There has been concern in some quarters tha t Federal aid to medical education may bring about undesirable governmental controls. The experience of 

medical schools with respect to Federal participation in support of medical research over the past decade gives no substance to these fears. Not only has 

there been no interference with research, but it is now generally agreed t ha t this 

type of aid has lx*en of tremendous lx*nefit to the schools. There is therefo re 

good evidence and experience to dem onstrate th at support from the Federal 

Government can be administered without interfere nce in academic affairs and 

without the introduction of restrictive controls. Furthermore, there is no provision in this bill which would in any way create such undesirable fa ctors.

Has not our sense of values become distorted when we as a Nation can provide billions of dollars for foreign aid programs of all kinds and for projects concerned with reaching the moon and yet be reluctan t to provide even a small 

fraction of this sum for critically urgent measures to maintain the health of our 

people? The secu rity and inte grity of ou r Nation are more dependent upon the ir 

health than on any other single factor. We have long had a real concern for 

the welfare of the individual citizen and have derived deep satisfactio n from 

meeting his need in a hum anitarian way. Why should we then knowingly deny 

ourselves these measures to strengthen our capabilities and to meet our trad itional obligations, and why should we afford our youth opportunity to achieve 

and maintain his proper role in our society in every field but medicine?

This ma tter is of deepest concern to our people. While passage of this bill 

will not entirely resolve the problem, it will be a great step toward its ultimate solution.

Michael E. De Bakey, M.D.
512 TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL

University or Lou isv ill e,

School of Den tis tr y,

Louisville, Ky., February 1, 1962.

Ho n. Oren Harris,

U.S. House of Representative#,

Washington, D.C.

Dear Mr. Harris: The bill II.R. 4989 now pending in Congress to provide 

Federal funds (1) for construction of teaching facilitie s at den tal schools, (2) 

for scholarships to dental students and (3) for cost of educational payments to 

dental schools is of vital inte rest to the University of Louisville School of 

Dentistry as well as to other dental educational institu tions and to the citizens 

of the country at large.

The expanding population and increasing demand for dental services clearly 

indicate the need for additional dental manpower. Dentistry is an indispensable 

health service and it is to the public interest tha t the mechanisms which produce 

those who make these services possible a re proiierly main tained.

The final report of the Commission on the Survey of Dentistry in the United 

States recommends th at :

“The Federal Government assist denta l education by providing funds for operatio nal expenses, as well a s fo r new construction and remodeling and for scholarship and loan funds for dental students ; present schools be expanded and new 

schools constructed to jiermit the grad uation of at leas t (5,180 dentists annually 

by 1975” and “additional facilitie s should be provided by the training of auxiliary personnel both in dental schools and other institu tions.”

All dental schools a re in a very definite sense public institu tions in that they 

contribute to the promotion and safeguarding of the health of the Nation. 

Society owes professioal education mate rial supp ort and the Federal Government should in my opinion, be willing to shoulder some of the burden of educating dentists and auxiliary personnel.

The building presently occupied by the University of Louisville School of 

Dentistry was built in 1900. Although extensive renovations have continually 

been made over the years, the building is outmoded and illy adapted to the 

conduct of the progressive educational program we are atte mpting to carr y out. 

The ground where the building is situated is too restricted in area to accommodate the type of enlarged physical plant tha t is required. The present location is a noisy and congested intersection, and these unfavorable conditions have 

now become more intole rable by the construction of an elevated expressway within 30 feet of the building. A new .$2.(500.000 medical-dental reesarch building 

which is being made possible by matching funds from the Federal Government, 

will poon lie built in the medical center a few blocks away. A ne\v denta l 

school building in the center is necessary if we are to continue to provide 

dental health services, through the education of den tists and auxiliary personnel.

It is equally imp ortant th at scholarships gra nts to dental students, and financial assistance to the schools to meet part of the instruction al costs of these 

stud ents, now borne by the universities, be made available.

I hope you will see fit to support legislation to provide Federal aid for dental 

education and for dental research.

May I request that you. as chairman of the committee, include my lette r within th e hearing record on II.R. 4999.

Yours sincerely,

R aymond E. Myers, Dean.

Pharmaceutical Manufacturers Association,

Washington, D.C., February 2,1962.

Re II.R. 4999.

Hon. Oren Harris,

Chairman, Inte rstate and Foreign Commeree Committee,

House of Representatives, Washington, D.C.

Dear Mr. Chairman : This letter is submitted on beha lf of the Pharmaceutical

Manufactu rers Association on II.R. 4999, a bill amending title VII of th e Public 

Health Service Act and entitled the “Health Professions Educational Assistance 

Act of 1961.”

This association is a nonprofit membership association, incorporated under 

the laws of Delaware, with its principal office in the city of Washington, D.C.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONN EL 513

At the present time, there are included in its membership about 140 member 

companies which are engaged essentially in the manufactu re of prescription 

drug products, and these companies produce in excess of 95 percent of the 

Nation’s total production of such products.

The Pharma ceu tical Man ufacturers Association would like to supp ort the 

provisions of the bill providing Federal matc hing gra nts for the construction 

of medical schools. We recognize that the quality of medical education bears 

directly on the tota l quality of medical care which is provided to the public. 

We, therefore, believe tha t the high quality of medical education in this country, 

which is exceeded by no other, should be main taine d at the highest possible 

level. This N ation indeed owes a gre at debt of g ratitude to our medical leaders 

and educ ators who through the ir drive, direction, and wisdom brought American 

medical education to its present foremost position.

Unquestionably, the adequacy of physical facilitie s has an imp ortant rel ationship to the quality of medical education. In recent decades, the advances 

and brea kthroughs in medical science have been startling and dram atic. With 

them have come g rea t changes in all aspects of medical education and medical 

care, extending to the facilities in which such education is tau ght and such 

care is provided.

I would like to explain briefly the contributions the pharmaceutical industry 

makes in the fields of medical education and research, and also to give this 

committee some facts concerning the amazing progress in this country due in 

greatest measure to revolutionary changes which have taken place in this industry. Both of these give evidence of our intere st in the bill now under 

consideration :

More tha n $206 million in I960, and more than $227 million in 1961 

(estimated) in cost were incurred for all human ethical drug or medical 

research and development. Of this amount during these 2 years, by contracts or grants, $9.5 million went to medical schools, $8.5 million to other 

academic institutions, $9 million to hospitals and clinics, and $4.8 million 

to nonprofit research laboratories.

In 1955 a tota l of 480 medical school fellowships or scholarships were 

supported by the pharmaceutical manufacturin g industry. (See also “Medical School Inquiry ,” staff report of this committee, 85th Cong., 1st sess., 

pp. 356 and 357.)

The Natio nal Health Education Committee has estimated th at the decline 

in mortality rates since 1937 adds almost $9 billion to the national income 

every year.

Millions of people have been freed from handicaps of disea se to perform 

productive and useful work: People buy antibiotics and are freed from 

long hospitaliz ation with pne umonia; they buy polio vaccine and escape 

iron lungs and braces.

The decline in the number of mental hospital patients below the number 

predicted 5 years ago for 1960 has saved approximately $1.8 billion in 

institu tional construction costs.

Witnesses before this committee have alre ady discussed the need for additional medical schools and for the renovation or replacement of existing ones. 

They have also discussed facility obsolescence which results from gre at advances 

in medical science. They have presented to this committee extensive data on 

the dimensions of these needs. Because we can add little , if anything, to what 

they have said on these needs, we only offer our stron g belief that the adequacy 

of the physical facilities of our medical schools should be given increasin g 

attention.

We feel tha t this program should not contain any factor calling fo r the dilution 

of American medical education. On the contrary, the availab ility of Federal 

matching gra nts for the construction, rehabilitation, or replacement of medical 

schools should, in any legislation enacted by this Congress, give due considera ­

tion to all factors implicit in maintaining the presen t high standard s of medical 

education. We would also urge that thi s program be so designed as to give 

prim ary consideration to the construction of new medical schools in those States 

which now have none.

We have confined our comments to the matching gra nt construction portion 

of the bill as we believe that this proposed program should be given the opportunity to dem onstrate what it can do and thu s perm it a determination to be 

made as to what else might be needed, if anything, before other programs in 

this area are initiated.
514 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

It would be deeply appreciated if you would make this letter a i>art of the 

record of your committee’s hearin gs on H.R. 41)99.

Sincerely yours,

Austin Smith, M.D.

Fund fob the Advancement of P odiatry-Chiropody E ducation,

Washington, D.C., February 1, 1962.

Hon. Oren Harris,

Chairman, Committee on In terstate and Foreign Commerce,

Jlouse of Representatives, Washington, D.C.

Honorable Sir : Enclosed you will find a statem ent from the Fund for the 

Advancement of Podiatry-Chiropody Education on bill II.R. 4999.

We respectfully request th at it be included in the official record of the hearing held on said bill on J anuary 26,1962.

Very truly yours,

Dr. Harry Horowitz, President.

Fundfor the Advancement of Podiatry-Chiropody Education,

February 1, 1962.

Hon. Oren Harris,

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives, Washington, D.C.

Honorable Sir : We note, supixirt, and applaud the intent of II.R. 4999 which 

would increase the opjxirtunities for training physicians, dentists, osteopaths, 

and professional public health personnel. These increased opportunities not only 

lie in the are as of providing moneys for the building of new schools and for the 

enlarging of present facilitie s for each of the disciplines mentioned, but also for 

creating scholarships in the respective professions listed.

However, we note an omission in bill H.R. 4999. Assistance for new schools of 

podiatry or enlargement of present schools of podiatry and the providing of scholarships for the und ergraduate students in podiatry schools are not included in 

said bill.

The podiatrist—the foot specialist—together with h is medical, osteopathic and 

dental colleagues are the only individuals licensed by each of our States to 

diagnose, tre at, surgically and medically, for the human body.

The numerous reports emanating from various sources including those of 

agencies of the Federal Government, the associations representing the professions 

in the healing arts as medicine, dentistry, osteopathy, and podiatry all agree 

th at increased practitioners in the ir respective profession will be needixl in the 

immediate future. The continued increase of our population, the proportional 

increase of our “aged” population with its specific medical needs to main tain 

healthy individuals and collectively to insure a healthy nation must, of necessity 

depend on healing professions to provide the trained personnel m inistering to the 

needs of our peoples.

To meet the increased need for health services, the facilities of established 

schools of all the health disciplines must be enlarged, brought and kept up to 

date. Add to this, the need of establishing new halls of learning to accommodate 

the increased numbers needed in each profession. The facilities referred to, not 

only includes the physical a sse ts of a teach ing institution, such as a building 

or buildings, not only the equipping of these areas, too, but also to provide the 

necessary teaching personnel who will impar t the instruction and direct the 

und ergraduate stu de nt

Four years ago, after studying the problems confronting the profession of 

podiatry we concluded th at large sums of moneys must be raised if the podiatry 

profession was to continue to fulfill and expand its responsibilities to the public’s 

health. To a ttemp t to do this a Fund for the Advancement of Podiatry-Chiropody 

Education was founded. Being active these past years, moneys have been 

contributed to our fund by members of the pod iatry profession, the public and 

commercial firms. During this time, the fund has made grants to three of our 

colleges. The use of these grants varied from providing necessary moneys to 

purchase sterilizin g equipment for a new foot hospital, to the providing necessary moneys in meeting the salaries of some facu lty members. Grants were 

made to California Pod iatry College, Illinois College of Chiropody & Foot 

Surgery, and Chicago College of Chiropody.
TRAINING OF PROFESSIONAL PUBLIC HEA LTH PERSONNEL 515

In 19(50-61 a g rant was made to secu re the employment of a group of respected 

educators to survey i»odiatry schools and the accrediting agency of these schools— 

the Council of Education of the American Pod iatry Association—to rej>ort their 

findings as to the needs of these schools and this council and to guide them to 

furth er fulfill the ir responsibilities in the public interest. The report of this 

commission is enclosed.

We of the Fund for the Advancement of Podiatry-Chiropody Education have 

stimulate d the giving of over $106,000 toward podiatry education in the sho rt 

time of its existence. Our organizatio n has also provided the clim ate whereby 

the professional society representing the isx liatris ts of the country have voluntarily assessed themselves to provide at least $46,000 annually to the podiatry 

colleges as gra nts on a matching basis for teaching and research needs.

While the fund has been successful, to a degree, in raising moneys, these 

moneys fall fa r sho rt of the necessary fund s that will be needed if the schools 

training podiatris ts are to provide the exposures and courses that these foot 

specialists must have to practice the ir profession. The general public, the 

armed services, the aged, the veteran, and his family, etc., are all dependent 

on this group of foot specialists to m inister to the ir foot needs.

The moneys necessary to educate men and women in the healing professions 

far exceed those moneys collected through tu ition alone.

Reference is made to a sample listing of various Federal and State depar tments and agencies that recognize and/o r provide for the services of the 

pod iatr ist i.e.:

(a) Higher education, Departmen t of H ealth , Education, and W elfare.

(ft) Departm ent of Labor, occupation titles, “Occupation Handbook.”

(o) Armed Forces.

(</) Veteran s’ Administration.

(e) Federal Employees Health Insurance Act.

(/ ) U.S. Public H ealth Service.

(g ) Departm ent of W elfare—on Sta te levels.

(h ) Workmens compensation departments on State levels.

(t) Department of hospitals—on local and Sta te levels.

(;') Departm ents on education—State, city, and local.

(k) Office of C ivili an d efe nse.

(l) Health insurance program s sponsored by nonprofit Blue Cross-Blue Shield

types of companies, regular insuranc e companies, labor, an d/or management insurance programs.

If II.R. 4999 is not enacted immediately the futur e health needs of our expanding and of our aging populations will not be met.

We therefore, respectfully request, th at in your consideration of bill II.R. 4999 

th at the wording be amended to include podiatry schools and und ergraduate 

podiatry stud ents together with medical, dental, osteopath, and public health 

schools and undergraduate students as potentia l partici pan ts in the program 

provided in said bill.

Very truly yours.

Dr. H arry H orowitz, P re si dent.

Marquette U nive rs ity,

School of D en tist ry, 

Milwaukee, Wis., February 5,1962. Hon. Oren H arris,

U.S. House of Representatives, Washington, D.C.

Dear Represen tat ive Harris : I wish to urge your suppo rt of H.R. 4999 now

pending in Congress. We in dental education are well aware of the immediate 

need for funds to provide additional and improved teach ing and research fac ilities and to help meet the alread y high and steadily rising costs of dental educ ation.

In 1957-58, Marquette University built an addition to Its school of den tistry. 

This addition gave us much-needed clinical and classroom spac e: however, extensive remodeling is urgently required in the old building, and we must expand our 

research facilities. The equipment in our main clinic has been in steady use 

since the school of den tistry was built in 1922. The 155 den tal units and cha irs 

must be replaced, and this will also entail new plumbing, new wiring and new 

gas and air outlets. This 40-year-old de ntal equipment curta ils our teaching of 

high speed techniques so imp ortant in modern dentistry. We estimate th at the
5 If) TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

complete remodeling project—units, chairs, plumbing, electricity, etc.—would 

cost approximately $500,000. We are also badly in need of space for expanding 

research activities. We have struggled along with the space we have, but 

additional facilities are necessary if we are to carry on with research projects 

so importan t to the health and welfare of the American people.

Marquette University School of Dentistry, as the only dental school in the 

Sta te of Wisconsin, is prim arily interested in providing the best possible dental 

education and thereby den tal care for the citizens of this Sta te and the other 

States in which our gra duates locate. As a priv ate school with limited income, 

we need help. Your supp ort of II.It. 491)9 will be of gre at assistance to us.

With kind regards, I am,

Sincerely yours,

L. O. Alexand er, D.D.S., Dean.

T he Univ ers ity of Kan sa s City,

School of D en tis try, 

Kansas City, .Mo., February 3,1962.

Hon. Oren H arr is,

House of Representatives,

Washington, D.C.

Dear Mr. Harris : I am tnking the liberty of writing to you again concerning 

the need for Federal supp ort of dental education in our area of the country 

through construction, grants, and other means. As you probably are aware, the 

University of Kansas City assumes some responsibility for teaching dentistry and 

to residents from the State of Arkansas. This year, we have 18 residents of 

Arkansas in the School of De ntistry at the University of Kansas City.

Our School of Dentistry here at the University of Kansas City is part of an 

independent university not supported by State or municipal funds. We do receive over $200,000 per year in Federal grants for research ami training programs 

which contribute to our overall dental educational program. As a result of our 

geographic position (there are no other schools from here u ntil one reaches California, Oregon, or Washington to the west or Texas to the south and Nebraska 

to the north) we have had thrust upon us responsibility for educating dental 

studen ts from the Midwest, the intermountain area, and the Southwest. Our 

present total enrollm ent of 54G stu dents come from 27 States and 3 foreign allies. 

There are many dental schools in the United States which are in a similar s ituation as independent schools with broad responsibilities. If we, and other schools 

in our position, are to continue our present roles, it will be necessary for us to 

have new facilities in the futu re as well as for some additional schools to be built 

in certain areas of the country.

We have been conducting a campaign among our alumni and to date have contributio ns and pledges of approximately $425,000 tow ard a new building. Since 

we cannot expect support for capital improvement from the States from which 

studen ts are drawn, we have no o ther resources except the Federal Government 

when we seek funds for our building expansion. An adequate dental building will 

cost from $3 to $5 million even with the equipment we have available in our present facilities.

While other features of II.R. 4999 a re important, I do feel th at the paramount 

one is tha t of construction, ami I believe tha t matching gra nts on a 50-50 basis 

will be inadequate in many areas.

I am making this plea to you because I know of your inte res t in this bill and in 

the suppo rt of dental education. If there is any information which you would like 

me to supply to you in th e Held of dental education in this are a, or in general, I 

should be most happy to do so.

Sincerely,

H amilton B. G. R obinson, Dean.

T he U nive rsity of N ebrask a,

College of D en tis try, 

Lincoln, Ncbr., February 5,1962.

Representative Oren H ar ris,

Chairman, Committee on Interstate and Foreign Commerce,

U.S. House of Representatives,

Washington, D.C.

Dear Mr. H arris : I am enclosing copies of letters I have w ritte n to Representative I’hil Weaver of Nebraska urging him to support and vote for II.R. 4909.
TRAINING OF PROFESSIONAL PUBLIC HEALT H PERSONNEL 5 1 7

I respe ctfully request that you, as chairma n of the committee, include my letters 

within th e hearing record of II.R. 4999.

Sincerely yours,

Ralph L. Ireland, Dean.

The University of Nebraska, 

Lincoln, Nebr., F ebruary 5,1962.

Hon. P hil Weaver,

House of Representatives,

Washington, D.O.

Dear Mr. Weaver: It is my understanding that H.R. 4999 is now pending 

in Congress. You will recall that I wrote you on Jun e 27, 1961, and outlined 

the reasons why the enactment of this bill was so important to den tistry in 

general and to the welfare of the University of Nebraska College of Dentistry. 

Because my l ett er of June 27 stated the specific needs of ou r college of den tistry 

and outlined the programs which the college could institute if this bill is 

enacted, and because you may have misplaced this letter I am enclosing another 

copy.

I sincerely hoi>e that you and the other Representatives from Nebraska will 

support and vote for H.R. 4999.

Sincerely yours,

Ralph L. Ireland, Dean.

J une 27, 1961. Hon. P hil Weaver,

House of Representatives,

Washington, D.C.

Dear Mr. Weaver: I am writing this lette r to request your assistance and 

supiMirt of H.R. 4999. This bill is identical to S. 1972.

I should like to tell you as I told Senators Ilruska and Curtis some of the 

problems which dental education is facing in Nebraska and the reaso ns why 

the passage of this bill is so important in the futur e welfare of the University 

of Nebraska College of Dentistry.

The college of den tistry has been housed in Andrews Hall since 1928. At 

present, the college occupies the third floor, approxim ately two-fifths of the 

second floor and a small portion of the basement. The departm ents of English 

and classics occupy the rema inder of the building. To the best of my knowledge, 

we are the only dental school in the United States th at does not have an entire 

building of its own.

For the 133 stud ents in our four classes, we have only two classrooms and 

two laboratories. The equipment in our one main clinic is 33 yea rs old. It is 

practically impossible for our staff to teach modern operative procedures with 

such outd ated equipment.

Because of our limited space and facu lty, we are able to accept only 34 

students each year in our freshm an class. In this connection, the impact vvhich 

the expected population increase will have on the prac tice of den tistry in 

the United States and particularly in Nebraska is of vital importance. The 

reports which come from the Division of Dental Resources of the U.S. Public 

Health Service indicate that the dental schools in the United States presently 

are not gradua ting enough dentists to meet future requirements. In order to 

regain even the present dentist-population ratio by 15)75, dental schools must, 

by 1970, be gra dua ting 2,700 more den tists annually than are now in 

prospect. The U.S. Public Health Service also estimates that by 1975 there 

will he a deficit of more than 300 dentists in Nebraska. In order to foresta ll 

this deficit and maintain the ratio of den tists to population th at currently 

exists, the University of Nebraska College of Den tistry should now have a 

minimum class size of 64 and beyond 1975 the class size should be increased 

to 75.

In addition to the 4-year course of study for the D.D.S. degree, the college 

of den tistry offers 2-year gradua te programs in orthodontics, pedodontics, and 

periodontics. Our facilities permit us to accept a limited number of gradua te 

students each yea r (three in each ar ea ). This past yea r we had over 75 

applications alone for the gradua te orthodontic program.

The programs which the college of den tistry plans to institute jus t as soon es 

our physical plant is expanded and our staff increased are (1) increase the 

undergraduate enrollment, (2) increase the number and effectiveness of sho rt
518 TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL

postgraduate courses for practicing dentists, (3) add several gradua te courses 

to those we now offer, (4) offer a course of study for dental hygienists (there 

is great demand by many young women in our State and by the practicing dentis ts to institu te such a course), and (5) increase our research activity.

Tremendous changes have taken place in dental education in the past 25 

years. The University of Nebraska College of Dentistry has attem pted to keep 

pace with these changing concepts. However, lack of space and facu lty have 

prevented us from moving ahead and initiating some essential programs and 

today the college of den tistry tinds itself in the position where improvement is 

needed for our program to attain a quality level consistent with the college’s 

potential as contrasted with meeting more minimum standards.

I am convinced that the only way we will be able to accomplish our objectives 

is to receive outside financial assistance. Therefore, I urge you to support and 

vote for H.R. 4999 so tha t the college of den tistry may realize its potentia l and 

the people of Nebraska may continue to have the best of dental care.

Sincerely yours,

R al ph L. I reland, Dea n.

Univ ers ity of Califo rn ia,

San F rancisc o Medical Cent er,

Schoo l of Den tis try,

February H, 1962.

Hon. Oren H arr is,

Chairman, Committee on In terstate and Foreign Commerce,

House of Representatives, Washington, D.C.

My Dear Mr. H arris : This lett er is written in rela tion to II.R. 4999 now in 

Congress. This hill will provide Federal funds for construction of teaching 

facilities in the health sciences and stren gthen the health sciences generally. 

My concern is more specifically directed toward dental education and the need 

for dental manpower to meet the increasing population growth and the increasing i>ercentage of th at population that is requesting dental service.

My qualifications and background to write on this subject are as follow s: I 

am dean of the School of Dentistry, University of California, vice provost of 

the San Francisco Medical Center, a commissioner in the Western Inter sta te 

Commission on Higher Education, a former member of the Council on Dental 

Education of the American Dental Association, a commissioner on the recently 

completed “Survey of Dentistry.”

Most dental manpower surveys stress the growing population and by simple 

arithmetic determ ine the number of d entis ts, based on dentist-i>opulation ratios 

today, that will be needed to service the increased number of people. An important point that is overlooked is the incre asing demand of that increasing 

population for dentistry. For example: In 1940 about 25 percent of the population requested dental service in any 1 year. This percentage of request 

has now risen to well over 40 i>ercent of the population. The reasons are severa l—such as improved economic level of the population, higher level of education, and improved health education, and programs of the dental profession, 

and the various public health groups. All of this combines to develop a greater 

need for more d entists.

Dental education and facilities are costly. Minimum figures will show that 

a dental student required 200 net square feet of space. In other words, a school 

with 400 dental stud ents will need about 80,000 net square feet. Construction 

and equipment will vary in different par ts of the country, but takin g $40 to $50 

per squa re foot (ne t) one can readily come up wdth a cost of from $3,500,000 to 

over $4 million for a school of dentistry.

This sort of money is simply not raised by private donations and foundations 

partic ularly in this day and age. Even the populous States faced with rising 

costs of general education are in trouble in providing health science facilities.

Of particu lar inte rest to the citizens of the Sta te of California are the following figures th at we compiled at the school of dentistry in 1960.

Out of 25 Califo rnia applicants to study de nt istry: 2 ^ will study at the University of Ca lifornia : 6 will ente r one of the other three Califo rnia dental 

schools: 2% will be admitted to schools out of State; 13% will not be admitted 

to any school.
TRAINING OF PROFESSIONAL PUBLIC HEALTH PERSONNEL 519

As regards the ma tte r of student suppo rt, I do not believe I have to go into 

any great detail to point out what is generally accepted that the courses in the 

health sciences are the most expensive among the university discipline and have 

the poorest supp ort in the way of loans, grants-in-aid, and scholarships. It has 

reached a point where the most imp ortant qualification to study medicine or 

den tistry is the a bility of the stu dent to pay the bill. This is wrong as the qualities of motivation, intelligence, in tegrity, kindliness, and others are the im portant 

ones.

These are some of the important reasons why I believe H.R. 4999 should be 

given favorable consideration.

Sincerely yours,

Willard C. Fleming, Dean.

The University of Tennessee, 

Memphis, Tenn., February 15,1962.

Hon. Kenneth A. Roberts,

Interstate and Foreign Commerce Committee,

House of Representatives, Washington, D.C.

Hear Mr. Roberts : We commend you for your strong supp ort of H.R. 4999. 

We also appreciate your interest in previous legislation designed to improve 

health care.

The number of hea lth workers per population in o ur region is a cause for great 

concern by each of us. In Tennessee, as in Alabama, medical education will 

profit greatly by th e provisions of H.R. 4999.

Sincerely yours,

Ruth Neil Murry, R.N., Dean.

(W her eup on, at 12 noon, the com mittee recessed, subject to th e call 

of the Chair.)

o