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schools are in those throes of verging on collapse without the traditional funds, albeit, they would like to have.

Mr. HARRIS. May I say to the gentleman that on page 19 of the report the gentleman will find a quote from the American Council on Medical Education and they did refer to the fact that there were, as the gentleman from Illinois [Mr. SPRINGER] mentioned, 10 that were in dire circumstances and possibly 12 that were in need, and some question as to whether they could continue unless unless something were done.

Mr. QUIE. Madam Chairman, will the gentleman yield?

Mr. SPRINGER. tleman from Minnesota.

Mr. QUIE. Undoubtedly there are a number of colleges and universities in the country that are going to expand their enrollment.

After we have set this precedent, at least, there should be no more opposition to providing the same type of basic and professional improvement grants to any college or university for increasing enrollment?

Mr. SPRINGER. May I say we do not approach this as general education. The gentleman may assume that. gentleman may assume that. We approach this in the Subcommittee on Health and Safety because we believe this affects a vital interest, which is the I yield to the gen- health of the country. We do approach this simply as an educational matter. We would have no jurisdiction to do anything with reference to anything other than what I am talking about, the health of this country. That is our philosophy. of this country. That is our philosophy. Mr. QUIE. Well, as far as you have been able to establish, the need for doctors, on that principle, at least this committee would not be in opposition to that same type of assistance?

Mr. QUIE. I would like to ask the gentleman if the committee considered the implication that this legislation might represent a precedent with reference to the basic improvement grants and the special improvement grants, because I understand this is the first time any college or university would receive money which would go directly for current operating expenses such as salaries and administrative expenses.

Mr. SPRINGER. Insofar as I know this is the first instance.

Mr. QUIE. So, this is the first time that this has been done?

Mr. SPRINGER. Yes.

Mr. QUIE. If the gentleman will yield further, we went at great length into this when the Higher Education and Academic Facilities Act was up for consideration, and there was some discussion of this when the facilities part of the medical bill came up in the last Congress; that is the question of direct grants to private and church-related institutions, because we do have a constitutional question involved.

Did the constitutional question come before the Committee on Interstate and Foreign Commerce at all, since I note that there are 13 of the 84 schools which are church related and 11 of the 47 dental schools that are church related? Mr. SPRINGER. May I say to the gentleman from Minnesota that I think we approached this on this premise. I doubt that there was a lot of discussion, but we approached it on the premise that in the medical schools they are not going to teach religion.

When we had the facilities bill up in 1963-and I will stand corrected by my chairman if my information is falsewe provided in that legislation that there could not be used any funds of any kind to even build any building in which there was so much as a chapel.

Mr. SPRINGER. I would want to reserve that until I knew the nature of the need, and the extent of the need. I do need, and the extent of the need. I do not take this as basic college education or as graduate education. I take this as something which has been defined to this committee as far as the health of the country is concerned. I would not want country is concerned. I would not want to go beyond that in my dialog with the gentleman.

Mr. QUIE. The gentleman does recognize this is precedent-setting when we will pass this legislation?

Mr. SPRINGER. We believe this is a

precedent based on the health of the

country.

Mr. HARRIS. Madam Chairman, will the gentleman yield?

Mr. SPRINGER. I yield to the gentleman from Arkansas.

Mr. HARRIS. Is it not a simple statement of fact that instead of catching up ment of fact that instead of catching up we are actually losing ground in providing adequate manpower so far as doctors and other medical personnel are concerned, to meet the needs of the future; cerned, to meet the needs of the future, and with the expanding population and with the greater demands that are being thrown on the professional people in ing thrown on the professional people in this field? We have simply got to do something on a long-term basis if we meet it in the future.

Mr. SPRINGER. That was in essence what I am trying to say.

Mr. QUIE. Just one more comment: It is just that. A number of other professions have made the same kind of

Mr. QUIE. That is correct, or the claim to us. You will recall the need for teaching of any sectarian course.

Mr. SPRINGER. We did try to eliminate any possibility that any churchrelated school could use any funds for anything other than the purely bricks and mortar building of a medical facility.

Under this legislation we feel we have it in the position where none of this could be used for any other purpose except teaching and that kind of operation.

I do admit that there will have to be some regulation made by the Secretary in this matter to assure that this will be true.

engineers, technicians, and a number of others. Then the humanities came in. We are caught now in a war with another nation, in labor management difother nation, in labor management difficulties, the poverty matter, and the ficulties, the poverty matter, and the other struggles. I recognize we do have other struggles. I recognize we do have health needs, but I recognize the other health needs, but I recognize the other areas feel just as much a need. I want to point this out today so that we may point this out today so that we may know we are setting a precedent for the know we are setting a precedent for the future.

Mr. SPRINGER. May I say that in the general broad field we have not done anything in the field of education. anything in the field of education. There was Sputnik in 1957, and that re

sulted in a request specifically of the President in two or three fields. National Defense Education Act was formed. Engineers, mathematicians, certain types of scientists were needed. We went into that field because there was an immediate need which the President said affected the security of this country. I felt it was right because this was a need with which the Defense Department was actually confronted. I am putting this in on a similar, not as an excuse, but on a similar basis. I am not surrendering this any further than I have indicated so far. I know how the gentleman feels about this.

Mr. HARRIS. Madam Chairman, will the gentleman yield?

Mr. SPRINGER. I yield to the gentleman.

Mr. HARRIS. With reference to what the gentleman from Minnesota said, I want to call attention to the fact that there were other professions in the field of health making the same claim to us and we did not include them in this program because we did not have the record to prove that the need existed.

Mr. SPRINGER. There was discussion on these problems in the committee and this would have been expanded by at least five or six more professions. But we did not feel the need was there. In fact there is at least one in the bill that I had serious reservations on and I do have today serious reservations on it but by a narrow margin it was put in the bill.

Mr. QUIE. And veterinarians were left out by the committee's action.

Mr. DON
DON H.
H. CLAUSEN. Madam

Chairman, will the gentleman yield?
Mr. SPRINGER. I yield to the gen-
tleman.

Mr. DON H. CLAUSEN. I have before

me a letter from the president of one of my junior colleges in California. He says we are supporting the Rogers amendment in H.R. 3141 which would permit the benefits of the nurses training act to come to junior colleges with registered nurses programs. I note the gentleman chairman on the floor. I have been told from Colorado [Mr. ROGERS] and the that this particular amendment was included in the committee bill.

Mr. SPRINGER. It is in the bill.

Mr. DON H. CLAUSEN. So I can assure the president of this college that his particular request is already covered?

Mr. SPRINGER. That is correct.

Mr. DON H. CLAUSEN. I thank the gentleman.

Mr. HARRIS. Madam Chairman, I yield 10 minutes to the gentleman from California [Mr. CоHELAN].

Mr. COHELAN. Madam Chairman, I would like to make clear initially that I strongly support the basic provisions of this Health Professions Educational Assistance Act. Our Nation's health can be no stronger than the availability and the skills of our health personnel-of our doctors, dentists, and nurses. Yet the greatest breach in our health defenses today is the critical lack in many areas of such personnel. This legislation is designed to deal specifically with this problem and I believe that it should be strongly supported.

But, Mr. Chairman, I am seriously disturbed about one amendment to this otherwise meritorious bill, an amendment which was added by the committee in executive session without the opportunity of public discussion or dissent.

This is an amendment which provides that in the field of nursing alone of all the health professions, accreditation, which is the requirement for receiving Federal assistance, would not be made by the recognized accrediting body within the profession.

This bill provides that in medicine, dentistry, osteopathy, and optometry, accreditation of all educational programs will be made by each group's accrediting body. But not for nursing. This amendment, adopted by the committee without hearings, means that accreditation by the National League for Nursing for baccalaureate and associate degree programs in nursing could no longer be a requirment for receiving Federal funds under the Nurse Training Act of 1964.

It is both obvious and imperative that the quality of nursing and other health care be maintained and improved. To accomplish this, I believe it is essential that the accrediting body within the profession itself should be the judge of the quality of the preparation.

Madam Chairman, several arguments have been advanced in support of this amendment and I have asked for this time today since there was no opportunity at the time the committee considered this amendment to discuss them.

First it is alleged that in the field of nursing education there have been "delays in the processing of applications for accreditation." This just is not so.

Since passage of the Nurse Training Act in August of 1964, a total of 167 programs applied for reasonable assurance of accreditation, the standing which enables a school to apply for Federal funds under the Nurse Training Act. Each of these 167 applications was considered and 113 were granted reasonable assurance.

To accomplish this, the National League of Nursing planned closely with the Public Health Service, with the Commissioner of Education, and the schools themselves. The schools were informed well in advance of the dates for submitting reports, visits, and meetings of the review panels.

A second allegation has to do with expense. This likewise is not justified.

For reasonable assurance, institutions offering new nursing programs are charged an accrediting fee of $100, plus the travel and per diem expenses of two visitors. Institutions offering established nursing programs are charged an accrediting fee of $100.

Schools that are agency members of the National League for Nursing pay an accrediting fee to cover the cost of travel and daily expenses of the two accrediting visitors at the time of the visit. Visits Visits are made approximately every 6 years. For junior colleges-nonagency members of the National League for Nursing a fee of $1,500 is charged at the time of the visit every 6 years to assist in defraying the cost of the visit, convening the board of review, processing of mate

rials, correspondence with the school, to a medical school by experts in the and listings of the program.

Certainly, these fees are not unreasonable when placed in perspective with the importance of this work and the fees charged by other professional accrediting bodies.

A third and very serious allegation is that the accreditation provisions contained in the Nurse Training Act can be modified without impairing the goals of that act. This assumption just does not withstand the test of experience.

There is danger in permitting State or regional accreditation, when experience has shown that the highest percentage of nurses are graduated by nationally accredited programs and the highest percentage of passing scores on licensure examinations are achieved by graduates of nationally accredited schools.

The record of nationally accredited schools of nursing demonstrates that they are able to attract, maintain, and graduate the largest numbers of students. Seventy-five percent of all students are enrolled in the 717 nationally dents are enrolled in the 717 nationally accredited programs. accredited programs. A higher proportion of graduates from accredited programs pass State board examinations and are licensed to practice. The accredited associate programs had a 10percent failure on State boards, while the nonaccredited programs had a 25percent failure on State boards. The Federal support of nonaccredited programs is wasteful of public funds as well as being costly to the individual student who has completed a training program and is then unable to pass a licensing and is then unable to pass a licensing examination as a safe practitioner of examination as a safe practitioner of nursing.

The effect of lowering the quality of nursing education would be tragic when there have been and are continuing to there have been and are continuing to be such striking advances in the development of the medical sciences and the opment of the medical sciences and the nurse is faced with greater and greater responsibilities and decisionmaking in responsibilities and decisionmaking in the care of the sick. It is imperative It is imperative that we at least maintain the current standards of nursing education and it is standards of nursing education and it is unthinkable that we would do anything unthinkable that we would do anything to lower the quality of nursing education. to lower the quality of nursing education.

A fourth point which has been made is that accrediting or approval agencies is that accrediting or approval agencies shall be those which are responsible for accrediting or approving the educational accrediting or approving the educational institution as a whole rather than only the nursing programs conducted in the institution. The inconsistency of this provision should be readily clear.

Accreditation by a regional association gives approval of an institution in its totality. A particular program within the institution may be very weak. State the institution may be very weak. State approval establishes minimum standards only. These vary from State to State as the quality of the educational systems the quality of the educational systems vary. The Federal Government cannot in all reason, equity, and fairness afford in all reason, equity, and fairness afford to give financial support to a nursing to give financial support to a nursing education program in one region of the education program in one region of the country whose standards might be too country whose standards might be too low to make it eligible for that support low to make it eligible for that support if it were located in some other region.

Furthermore, this general accreditation is not the same as specialized accreditation of a specific program. Specialized accreditation, given for example cialized accreditation, given for example

medical field, is doubly important because the performance of the graduates involves the life and health of the people. By the same token, it is equally important that programs in nursing education be accredited by experts in nursing education in order to assure the public of quality preparation of future nurses who will be caring for them. The Commissioner of Education recognized the necessity for this type of professional competence in the accrediting of nursing education programs by designating the National League for Nursing as the national accrediting body for all types of nursing programs specified in the Nurse Training Act of 1964.

Madam Chairman, I have taken the time to make these rather extensive remarks because I believe this particular amendment to H.R. 3141 has been inadequately and insufficiently considered. I intend to vote today for the overall program which the original provisions of this bill so constructively advance. But I believe and I urge that the Rogers amendment, which is both unnecessary and harmful, be deleted from the final measure which is approved by the Congress.

Mr. BENNETT. Madam Chairman, I rise in support of H.R. 3141, legislation to improve the educational quality of schools of medicine, dentistry, and allied sciences by providing scholarships to needy students and aid for school construction.

I have also introduced legislation to accomplish the same purpose as H.R. 3141, including H.R. 2366 and H.R. 8751. I have long had interest in providing assistance to schools teaching students in the health professions. It was my privilege in the last Congress to support and take an active part in the passage of the Health Professions Educational Assistance Act of 1963, of which I was a cointroducer. The long-range planning to produce the needed doctors to serve our Nation's growing population, including the construction of medical schools and scholarships to needy students in the field of medicine, is one of our most challenging problems, and I have been happy to take an active part in this endeavor.

As a member of the House Armed Services Committee I have witnessed how this national problem of inadequate medical schools and not having enough doctors affects our national defense mission. It was with this in mind that I introduced legislation in this field back in the 84th Congress, and I have continued to have a very great interest in it. In this session of Congress I have reintroduced measures to establish an Armed Services Medical School-H.R. 272-and to provide for scholarships to medical and dental students who would serve in the armed services for a period of time after they completed their education-H.R. 2365. These measures would help to eliminate the "doctor's draft" and are now pending in the Armed Services Committee.

The facts and figures about the critical demand for doctors and teaching facilities have been well publicized. In October 1959, the report of the Surgeon

General's Consultant Group on Medical Education pointed out that the expected 1975 population of 235 million will require a total of 330,000 doctors of medicine and osteopathy. This would necessitate the annual graduation of 11,000 students, an increase of approximately 3,600 over the 1959 graduates. In the President's message to Congress on health, earlier this year, he said that we would need 346,000 physicians in 10 years, almost 60,000 more than we now have. The Association of American Medical Colleges reported in 1963 that 3,500 additional medical doctors must be graduated each year from medical schools by 1975. This is supporting evidence to the need for more doctors.

A survey in 1963-64 showed the expenses of single medical students were about $2,700 a year, and of married students who had more than one child, $5,200. Fifty percent of the income of the single student comes from gifts and loans from his family. Earnings account for 30 percent, and only 8 percent comes from nonrepayable grants. Among married students with no children, 57 percent of the income derives from the earnings of the spouse, and only 16 percent from the family.

One-half of last June's medical school graduates came from families with incomes exceeding $10,000 a year.

It is essential that medical schools accept talented young people from every level of income status. This is not the case now. The high cost of a medical education prevents many qualified students from pursuing medical careers.

The Federal Government has an obligation to the Nation's health and wellbeing, to help where it can properly help in filling this medical gap. The Government has done much in this field, and now 51 percent of total medical school expenditures are provided by the Gov

ernment.

I have contacted the medical associations directly involved in my legislation and have favorable replies. Bernard J. Conway, secretary, council on legislation, American Dental Association, wrote me:

The American Dental Association has, in the past, favored Federal financial support for the operational costs of dental schools and scholarships for dental students. To the extent that H.R. 2366 would supply Federal funds under appropriate safeguards, the association could approve your proposal in principle.

Dr. Campbell A. Ward, president, American Osteopathic Association, wrote:

With regard to the bill, H.R. 2366, which amends the Health Professions Educational Assistance Act of 1963, I recall that our osteopathic witness before the House Commerce Committee in testimony * * advo

cated Federal scholarship aid as necessary to increase the pool of available superior students, and the need continues. I am sure the program advocated in your bill would be of great assistance in the improvement and extension of physician training in our institutions.

The American Medical Association favors part, but not all, of these legislative proposals, as shown by the printed hearings on the bill.

The urgent need for this legislation is well documented. I congratulate the

chairman and the Committee on Inter-
state and Foreign Commerce on taking
a leadership role in this problem of pro-
viding adequate medical facilities and
doctors to meet the demands of the
future.

construction, replacement, or rehabilitation of teaching facilities for the training of physicians, dentists, professional public health personnel, optometrists, pharmacists, and podiatrists. An appropriation of $160 million per year

This legislation is needed now, and I would be authorized. hope the House acts favorably.

Mr. FARNSLEY. Madam Chairman, I ask unanimous consent that the gentleman from Rhode Island [Mr. FOGARTY] may extend his remarks at this point in the RECORD and include extraneous matter.

The CHAIRMAN. Is there objection to the request of the gentleman from Kentucky?

There was no objection.

Mr. FOGARTY. Madam Chairman, I
Madam Chairman, I
rise to speak in favor of H.R. 3141, the
Health Professions Educational Assist-
ance Amendments of 1965.

the present Health Educational Profes-
These amendments extend and expand
sions Assistance Act of 1963, an act that
was one of the most significant land-
marks in health legislation that I have
seen in the course of nearly a quarter
of a century in the Congress. Passage
of that historic measure by the 88th
Congress, after earlier Congresses had
considered the problem of the dwindling
supply of medical manpower in the
United States, but had failed to act,
United States, but had failed to act,
makes our course of action here today
so clear that we have to do no more
than follow a blazed trail, and enlarge
3141 is designed to do.
it and smooth it out. This is what H.R.
This is what H.R.

In his health message to Congress last
January President Johnson-whose per-
sonal interest in the health field is known
to all of you-summarized what must be
done. He pointed out that the need for
trained health personnel continues to
outstrip the supply, and that high operat-
ing costs and shortage of operating
funds are endangering our health pro-
fessions educational system. He said
that the high costs of medical school
must not be permitted to deny access
must not be permitted to deny access
to the medical profession for able youths
of low- and middle-income families, and
that the number of physicians and
other health professions must be sharply
increased if we are able to meet future
needs.

The President also recommended legislation to authorize formula grants to help cover basic operating costs of our health profession schools, and project grants to enable these schools to experiment and demonstrate new and improved educational methods. And he urged, scholarships for medical and dental students who could not enter or complete their professional training without such assistance.

After lengthy hearings before my distinguished colleague, the gentleman from Arkansas [Mr. HARRIS]-soon to be a Federal judge-H.R. 3141 which we are considering today proposes to carry out the President's recommendations through a series of amendments to the existing law.

Briefly, these amendments would accomplish the following:

First. Extend for 3 years the current program of matching grants to aid the

Second. The bill extends for 3 additional years, until July 1, 1969, the current program making grants to schools of medicine, dentistry, and optometry for the operation of student loan funds and permits the extension of such loans to students at schools of pharmacy and podiatry. An appropriation of $25 million per year is authorized for this

purpose.

Third. In a new provision, the bill authorizes a 4-year program of basic and special improvement grants to schools of medicine, osteopathy, dentistry, and optometry to enable these schools to inteaching programs as other funds have crease the scope and quality of their served to aid their research programs. Total appropriations authorized for this purpose would amount to $200 million over the next 4 fiscal years.

Fourth. The bill establishes a new 4

year program under which grants are to be made to schools of medicine, dentistry, osteopathy, and optometry from which scholarships may be awarded up to $2,500 per year per student.

Fifth. Finally, the proposed bill also carries an amendment to expedite accreditation of nursing schools which have experienced difficulty receiving Federal aid because of the delays and expense associated with the accreditation procedure. The new provision considers programs of nurse education accredited if they are furnished by a junior college or college approved or accredited by either a regional or State approving agency.

As one who supported the Nurse Training Act of 1964, and as one who has long been aware of the deepening need for more nurses in this country, I am in sympathy with any move that will increase the quantity of nurses. However, I believe that we must be careful that there is no decline in the quality of nursing care in our efforts to augment the numbers of nurses. I am afraid that this is being lost here.

Under the amendments made by the Nurse Training Act of 1964, schools of nursing are prohibited from receiving assistance under the legislation unless they are accredited by a recognized accrediting body approved for this purpose by the Commissioner of Education, with certain exceptions. These exceptions are, I think, generous. In the case of new schools, or schools receiving special improvement grants, or grants for student loan funds, the schools may be considered as accredited and, therefore, eligible for participation in the programs under the act, if reasonable assurances are provided that at the time specified in the law, the school will be accredited by the body or bodies recognized for this purpose.

I recall that the American Nurses Association, testifying in behalf of the inclusion of nurses in the Health Professions Educational Assistance Act of 1963,

pointed out that the number of nurses graduating from collegiate courses would have to double from 4,000 in 1960 to at least 8,000 in 1970. We have narrowed the gap a little, and we have so far made no compromise with the quality of nurses training. I regret that I cannot support this portion of this otherwise excellent bill, H. R. 3141, which we are considering here, today.

At this point, I would like to include several letters I have received from persons in my Second Congressional District of Rhode Island with whom I am in agreement on this proposal:

STATE OF RHODE ISLAND AND PROVI-
DENCE PLANTATIONS, DEPARTMENT
OF HEALTH,

Providence, R.I., August 23, 1965.

Hon. JOHN E. FOGARTY,
House Office Building,
Washington, D.C.

DEAR MR. FOGARTY: I am most grateful to you for the opportunity you provided in meeting with Miss Brandt and myself last week in your office. My tardiness in respond

ing sooner is due to a vacation leave.

Your counsel proved to be most valuable. Commissioner Keppel was also supportive, interested, and concerned. The opportunity to have met Dr. Shannon and to have shared our concerns regarding the technical amendment attached to H.R. 3141 was most satisfying.

On our return to Rhode Island, we informed Miss Margaret Kelleher of the technical amendment which caused her and her board grave concern. I am certain that she has been in communication with you. We sincerely trust, at this writing, that a sincere concern has been affected to halt the proposal from becoming law.

Thank you for your kind, personal attention.

Sincerely,

RITA M. MURPHY, R.N.,
Director,

Division of Public Health Nursing.

STATE OF RHODE ISLAND AND

PROVIDENCE PLANTATIONS
DEPARTMENT OF HEALTH,
Providence, R.I., August 18, 1965.

Hon. JOHN E. FOGARTY,
House Office Building,
Washington, D.C.

DEAR MR. FOGARTY: I have learned with great concern of the provisions of the technical amendment attached to H.R. 3141 since I, as well as my associates in nursing education in Rhode Island, support in full the accreditation program of the National League for Nursing.

The quality of nursing care rendered by graduates of schools of nursing depends, in no small measure, on the type of education received by the student nurse. Quality nursing care for the citizens of our country is the greatest challenge facing schools of nursing today, and toward this end they have received immeasurable assistance from the National League for Nursing.

I am proud to tell you that all of the professional schools of nursing in Rhode Island have achieved the distinction of accreditation by the National League for Nursing, and that this accreditation program has done more to upgrade the standards of nursing education in this State than any other movement. I should also add that I had the privilege of serving on the National League for Nursing's Board of Review for the accreditation of schools of nursing for 7 years. In this capacity, I had the experience of witnessing equally dramatic improvements in the schools of nursing throughout the country. To undo the progress made in the field of nursing edu

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RHODE ISLAND HOSPITAL, Providence, R.I., August 26, 1965. Hon. JOHN E. FOGARTY, House Office Building, Washington, D.C.

DEAR MR. FOGARTY: Because of your vital and continuing interest in the health of our citizens, I urge your consideration of matters outlined in this letter.

It has come to my attention that the Committee on Interstate Commerce of the U.S. House of Representatives, meeting in executive session, adopted a technical amendment to H.R. 3141, the Health Professions Educational Assistance Amendments

of 1965, which reads: "any program of nurse ing, means a program accredited by a receducation, offered by a diploma school nursognized body or bodies approved for such purpose by the Commissioner of Education, and when applied to any collegiate or associate degree program of nurse education, means a program provided by an educational institution approved or accredited by either a regional accrediting agency or a State approval agency."

In essence this means that baccalaureate and associate degree programs in nursing would no longer be required to achieve accreditation by the National League for Nursing in order to qualify for receiving Federal funds under the Nurse Training Act of 1964. It is my opinion that this would seriously jeopardize the quality of nursing care for patients attended by graduates of the programs which have failed to apply for or which failed to qualify for National League for Nursing accreditation. My opinion is based on the following facts:

1. The National League for Nursing program in accreditation is designed to involve schools of nursing in improving their programs in the interest of graduating more competent nurses. Since 1952 the number of accredited programs has increased from about 150 to 707. This number includes diploma programs, baccalaureate programs, and associate degree programs. It represents the majority of nursing programs in the United States.

2. Accredited programs attract and graduate the majority of students. Seventy-five percent of all students are enrolled in National League for Nursing accredited programs.

3. The National League for Nursing accredited programs are able to attract faculty better qualified to guide students toward safe

and sound nursing practice. For instance, a faculty study conducted by the National League for Nursing in 1964 showed the following distribution of educational credentials among faculty of accredited and not accredited baccalaureate degree and diploma programs.

Percentage of full-time nurse-faculty in baccalaureate programs by highest earned credential and accreditation status

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HOSPITAL ASSOCIATION OF RHODE ISLAND,
Providence, R.I., August 27, 1965.
Hon. JOHN E. FOGARTY,
House Office Building,
Washington, D.C.

DEAR CONGRESSMAN FOGARTY: The Labor and Public Welfare Committee has amended H.R. 3141, medical school bill, to remove from the accreditation program of the National League for Nursing both college and 2-year junior college schools of nursing. On behalf of the hospital schools in our State I have telegraphed Senator PELL, who as you know is a member of this committee, urging that he oppose this amendment and strongly support continuation of the National League for Nursing accreditation program as written into the original bill before it is reported out of committee.

Your continued support in behalf of hospital schools is needed in this regard and to help resolve for the future their status and financing. I believe that any action by Government which further beclouds or diminishes the absolutely essential role of the hospital school will do irreparable damage to the end which you and I are striving to serve optimum care of the sick and injured.

Your awareness in regard to health care needs and problems is probably unmatched in the history of our Congress. Your knowledge of the great need to achieve a dramatic breakthrough in nursing supply, even in relatively high resource areas, such as Rhode Island, led to the creation of the Surgeon General's Consultant Group on Nursing. Yet, after the protracted efforts of this group and the implementation of its recommendations, the problems of supply persist and the financing dilemma of hospital sponsors grows steadily worse.

I have yet to find the opportunity to discuss with you the deliberative process of this task force and its report-I visited your office several times for this purpose when I was in Washington attending its meetingsbut I am certain that you know of my ex

treme disappointment in the lack of emphasis and support for diploma schools.

In this current move to separate diploma schools from other nursing education by means of different accreditation authorities I see a continuation of the process which received preponderant support in the Surgeon General's group. There are those articulate members within the profession and those in general education who vehemently criticize and oppose any assistance to diploma schools because "they are not the mainstream of American education," and such assistance would tend "to perpetuate this anachronism in education." I am not negative in regard to legitimate goals of the profession for self-improvement-the achievement of advanced status and better compensation-as I believe that this is needed to make nursing more attractive visa-vis other career opportunities for women. Neither am I opposed to assistance programs for collegiate based nursing education. However, I believe the desire of the nursing

profession to achieve self-determination, and the goal of professional educators to absorb this important segment of education for women, together do great disservice to the unmet need of the American people for more

nurses.

This continuing controversy, which thus far has successfully denied deserved support to the main source of supply for professional nurses, must not be additionally encouraged to the further detriment of diploma schools. I believe that more confusion and uncertainty regarding the future of diploma schools would result inexorably from the passage of the amended version of H.R. 3141. Instead, what is clearly needed is emphasis

on the essentiality of the diploma school for fulfilling national health care goals so that necessary financial support by society-not the hospitalized patient or third party agency-may be achieved. In my opinion, this recognition and support is inevitable. Roadblocks, such as those referred to above, which confuse or delay the establishment of affirmative public policy for diploma schools, should be vigorously opposed as being con

trary to the public interest.

I will appreciate an opportunity to talk with you further about this important problem whenever you desire. Sincerely,

WILLIAM K. TURNER, Chairman, Council on Hospital Financing and Government Relations. Mr. Chairman, it is extremely encouraging, I think, that the Health Professions Educational Assistance Act has the enrollment at medical and dental already caused a significant increase in schools and that-if the trend continues the continuation of this program represented today by H.R. 3141 will mean that we may be able to at least maintain in this country the current ratio of medical, dental, and other health professional manpower to population during

the 1970's.

In 1962, for example, the total first year enrollment in medical schools in the United States was 9,200; it is estimated that next month, the first year enrollment will total 9,925. In 1962, the total first year enrollment in dental schools was 3,680; it is estimated that next month the first year enrollment will total 3,850. Substantial increases have also occurred in public health, nursing, pharmacy, and optometry enrollments. These significant increases are attributable-in part, at least-to the programs of construction assistance and-for students of medicine, osteopathy, and denCXI-1413

tistry-the loan provisions of the 1963 act to aid the health professions. This is the This is the act which we are amending and extending today.

These statistics are indeed encouraging, but to be realistic we must recognize that at best we can only hope to hold the present ratio of physicians and other health personnel to our population at a time when our population is growing and increasing demands are being made upon health manpower, which is already in short supply.

Just to give a glimpse of future needsto maintain the present inadequate ratio of physicians to population, we will need 346,000 physicians by 1975. We have less than 290,000 today, and even with the aid of health professions assistance we will get only about 9,000 graduates per year by 1975.

opathic, and optometric schools under a new program of so-called basic improvement and special improvement grants. To get basic grants, schools must increase their enrollment by 22 percent or a minimum of five students. To get the special grants, they must continue spending non-Federal funds at a specific rate. specific rate. That is the mechanical side of it.

On the philosophical side, these two grants are designed to help schools of medicine, dentistry, osteopathy, and optometry improve their strength and programs. The basic improvement grant would provide a larger proportion of the budget of underfinanced schools than it would of budgets of better endowed schools. Inadequately supported schools could use these funds to improve student-faculty ratio, attract more highly

We will be short about 15,000 dentists qualified faculty, and to strengthen basic by 1980.

Public health workers who guard against air and water pollution, radiation, epidemics-to name only a few national dangers-are being trained in only 13 schools. Indeed, there are actually fewer public health physicians in this country today than there were 15 years ago-a shocking example of the neglect of a vital health profession.

To provide for the national deficit in pharmacists and optometrists, it is estimated that the current number of graduates must be doubled, to maintain current population ratios.

And schools of podiatry must triple their number of graduates, if current ratios are to be maintained by 1980.

inadequate in all of these health profesPrecisely because current ratios are sions, it is particularly gratifying to me to note that H.R. 3141 extends the student loan program for another 3 years, boosts the amount from $2,000 to $2,500, and adds pharmacists and podiatrists to the list of those eligible for such loans. A related provision of H.R. 3141 adds Federal scholarship authorization for the first time for full-time medical, dental, osteopathic, and optometric students.

Some of you may recall that earlier this year I introduced a bill before this House-H.R. 6000-to provide Federal that time I pointed out that it is a sad scholarships not to exceed $2,500. At instance of economic discrimination that half of last June's medical school graduates came from families with incomes of over $10,000 a year. over $10,000 a year. Surely there are many young people from low- and midmany young people from low- and middle-income families well qualified to become physicians and dentists but who come physicians and dentists but who are blocked by lack of finances from realizing their abilities.

In the past three Congresses I introduced bills to provide Federal assistance in awarding scholarships to students of medicine and dentistry. The scholarship provision was stricken from those bills. I ask this Congress to carefully consider this bill and not take similar consider this bill and not take similar action. The need for qualified, wellaction. The need for qualified, welltrained health personnel is so grave that trained health personnel is so grave that this time we must not fail to do what we can to meet this urgent need.

Finally, I want to touch upon the provision in H.R. 3141 authorizing Federal operating funds for medical, dental, oste

curriculum. More adequately supported schools could use these grants for experimenting with new ideas in professional health education. The special improvement grant would provide the incentive for development of specific programs or departments within inadequately supported schools, and more fortunate schools could use them to develop new programs in rapidly expanding fields such as genetics and biophysics.

Because these two kinds of grants would be made on the basis of need, they will tend to narrow the gap in quality between individual schools. They will insure the more adequate preparation of all future physicians and dentists and in this way increase the standards of medical care for all our citizens.

It is of special concern to all of us that at least 10 medical schools are in serious financial straits at a time when this Nation has to look to these schools to provide more and more trainingfor medical graduates, for practicing physicians, for ancillary health workers. It is incomprehensible to me that at this same time the American Medical Association opposed this operating fund provision of H.R. 3141 in committee because

it regarded these funds as a step toward

"Federal domination of medical education." It is not, I think, necessary to matters must face certain facts. As the dignify that old charge with an answer. President said in his health message last

Those of us concerned with health

January:

We must fact the fact that high operating costs and shortage of operating funds are jeopardizing our health professions edumedical and dental schools are threatened cation system. ** Several underfinanced with failure to meet educational standards. New schools are slow to start, even when construction funds are available, due to lack of operating funds.

is no partisan measure. I want to urge
Finally, I want to emphasize that this
every Member of this House-Republi-
can as well as Democrat-to give careful
consideration to this bill. Health mat-
ters should know no politics, because
disease is no respecter of political party
allegiance. In our health-in the health
of our citizenry—is
our
country's
strength.
Mr. MATSUNAGA. Madam Chair-
man, I rise in support of H.R. 3141, the

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