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Senator YARBOROUGH. The role of the Veterans' Administration hospitals on the national medical scene is ever increasing. With the advent of the new medical programs such as medicare, the need for medical personnel is rising very sharply in this country. While keeping the treatment and care of veterans as our primary goal, we cannot afford to overlook any possibility which will work to alleviate the problem of the shortage of medical manpower in America.

In the area of sharing of facilities, it is important to see whether these plans do render reciprocal benefits and whether they effectively increase the amount of available medical treatment in this country. The purpose of these hearings is to find out whether these bills, if enacted, would accomplish these objectives. In the area of education

, and training, we should establish in these hearings whether the Veterans' Administration can improve their own services as well as the well-being of the surrounding medical community by providing primary or continuing medical education in those areas. * Corollary to these questions is the problem of how such programs should be implemented if it is found in these hearings that they are feasible, practical, and beneficial.

At this point I will insert in the record statements by Senator Jordan of Idaho and Senator Church.

(The statements referred to follow:)

STATEMENT OF HON. LEN B. JORDAN, A U.S. SENATOR FROM

THE STATE OF IDAHO

Senator JORDAN. Mr. Chairman, the revolutionary advances continuously being made in medical knowledge and technology coupled with an increasing social awareness of the need to extend adequate medical care to all people have brought us to an era of unprecedented challenge and opportunity in the health care field. However, this challenge cannot be met nor this opportunity fulfilled unless sufficient human resources can be mobilized to bring our new concern and our new expertise to bear effectively on the growing numbers of people seeking and requiring medical attention. Education is certainly the key to both the quantity and the quality of the health services this Nation can offer its people.

I feel that H.R. 11631, providing statutory authority for the Veterans' Administration to pursue medical education programs and to enter into agreements with educational institutions and hospitals to this end, can provide a significant advance toward fulfilling our health care responsibilities. The Veterans' Administration is already involved in a vast educational effort aimed at maintaining a broad and rounded hospital program emphasizing treatment, research, and education. H.R. 11631 points the way toward the improvement and extension of this program through specifically recognizing education's vital importance to the overall health service scheme. The cooperative nature of the programs carried on under this measure will profoundly and positively affect the total medical-care situation for whole communities and regions. Studies indicate that in my home State of Idaho the growth in medical needs is rapidly, outstripping the growth in the number of trained personnel to deal with these needs. We have an excellent Veterans' Administration hospital in the city of Boise which has over the years made a valuable contribution to health services for

a wide area.

Increased recognition of medical education through the Veterans' Administration will be a factor in helping us in Idaho to close the gap between our needs and the availability of enough trained personnel to fill these needs. It may provide an avenue toward obtaining such educational facilities as will ultimately be required by the State which, at present, lacks a medical school and has only limited technical training facilities.

Organizations and individuals in Idaho have expressed considerable affirmative interest in this legislation. I ask permission to include two letters indicating such interest and urging passage of this measure in the record of this hearing:

RICHARDS, Haga & EBERLE,

Boise, Idaho, March 18, 1966. Hon. Len B. JORDAN, U.S. Senator, Senate Office Building, Washington, D.C.

DEAR SIR: As you have been aware, I have been quite interested in the educational affairs in Idaho. In the effort to provide education at all levels in the Boise Valley, I would urge you to support H.R. 11631, upon which hearings are presently being held. As I understand this matter the subcommittee in charge of veterans' affairs of the Senate Finance Committee is handling this matter and I would like such recommendations as I can make submitted to it.

There appears to be a continuing increasing demand for medical education with the resultant inability of our students from the Boise Valley to be admitted. The competition for medical school positions results in the increasing level of qualifications for admission because of the lack of facilities. This is not in the best public interest. Many promising young Idaho college graduates who could be come most adequate physicians are unable to obtain medical educations. Likewise, as medical students usually do not return to their homes, but stay in the area of their training, Idaho is hard pressed to acquire sufficient physicians.

The present bill which would authorize the Veterans' Administration to enter into education and agreements for education with institutions and hospitals could easily lead to the development of both technical and professional medical training in Idaho. Certainly the diversity allowed by training of more laboratory technicians, X-ray technicians, and other medical technicians would greatly enhance health care and upgrade the earning ability of the people in the Boise Valley. You are authorized to file this with the interested committee. Best regards,

T. H. EBERLE.

St. Luke's HosPITAL AND SCHOOL OF NURSING,

Boise, Idaho, March 16, 1966. Senator Len B. JORDAN, New Senate Office Building, Washington, D.C.

DEAR SENATOR LEN JORDAN: On March 23, hearings will be held by the Senate Committee on Veterans' Affairs, on H.R. 11631. This is the legislation which has passed the House, and deals with medical education in the Veterans' Administration. It is my understanding that this bill provides for authority for the Veterans' Administration to enter into agreements and relations with educational institutions and hospitals for the purpose of establishing medical schools. We here in Idaho are extremely interested in this particular legislation, since it would provide an additional avenue toward obtaining such educational facilities for Idaho students. As you know, we are exploring and utilizing all of the available facilities for providing medical education for our Idaho youngsters, and therefore, will greatly appreciate any efforts which you may be able to make toward the passage of this legislation by this Senate. If you feel that it will serve a useful purpose, you may feel free to submit this letter to the committee to be included as a part of the record. With kindest of personal regards, I am, Sincerely yours,

ALFRED M. POPMA, M.D., Commissioner, Western Interstate Commission for Higher Education.

STATEMENT OF HON. FRANK CHURCH, A U.S. SENATOR FROM

THE STATE OF IDAHO Senator Church. Mr. Chairman, the provisions of H.R. 11631 will more adequately allow the Veterans' Administration to fulfill its future obligations to the American people and to progress in a logical manner into a new phase of service commensurate with its organizational purposes. The Veterans' Administration has a long and exemplary record of medical service, dating back to 1867 when the Congress authorized the establshment of the National Asylum for Disabled Volunteer Soldiers at Togus, Maine. A century of progress in medical education and medical service now stands behind the VA, and with the passage of time, a new and equally needed task is emerging for the agency.

Barring the tragic possibility of another major war, the next two decades will see a gradual change in the medical program of the VA, to meet the needs of the American veteran population. By 1985, veterans of World War II, who now constitute the majority of those receiving, or eligible to receive, veterans' benefits, will be in their sixties. Their medical and hospital needs will be much on the same order as those of any group of people approaching their senior citizen years. Their numbers also will be dwindling, .

The Veterans Administration today operates 165 hospitals that last year cared for 109,183 patients. Coincidentally with the medical care program, the VA has, for a number of years, been engaged in medical education.

There are 681 separate training programs covering 21 medical specialties, now being conducted by the Veterans' Administration. In 1964, 3,199 residents-in-training were on duty in VA hospitals. This represents 11 percent of all the residents-in-training in the United States.

At the same time, 8,880 undergraduate medical students were utilizing VA hospitals in their educational training, while 4,270 student nurses accomplished a part of their training affiliations at VA institutions.

Thus, Mr. Chairman, the credentials of the Veterans' Administration in the field of medical education are most substantial and impressive. Despite this broad program of education, the need for additional medical personnel in this Nation, from doctors to health technicians, is dangerously behind national goals. It will continue to lag ever further as our population grows, our senior citizens begin taking advantage of the Medicare Act, and increasing efforts are made to improve national health standards.

A critical shortage of medical school vacancies already exists in the West, where today the average medically oriented high school graduate has 50 percent less opportunity of becoming a doctor than a youngster in the East, where the preponderance of medical schools is located. The same situation is applicable to all sparsely populated States. No medical school exists in Idaho, Wyoming, Montana, or Nevada. All face. increasingly serious shortages of doctors.

Medical education surveys show that doctors tend to practice in the vicinity of the medical school or hospital where they received training. Our young people in the West leave for out-of-State schools--when they can find a vacancy-and many do not return on graduation. We are exporting some of our finest young

minds.

But while the shortages in trained medical personnel become more acute, some of the hardest hit States have large and well-established Veterans' Administration hospitals. Such is the situation in my own

' home city of Boise, Idaho, and in Amarillo, Tex., where VA hopsitals are located in communities that have college facilities, along with other well-established public or nonprofit hospitals; in short, all of the bricks for building a medical education but without the mortar to hold the program together.

H.R. 11631, Mr. Chairman, is the mortar that will allow States facing medical personnel shortages to fashion, in the most democratic form of cooperative endeavor, a solution to their own problems. H.R. 11631 allows the Veterans Administration to utilize its facilities and capabilities in cooperation with area hospitals, institutions of higher education, or other qualified organizations or nonprofit foundations, to carry out an expanded program of training and education of health service personnel.

It is through such an alliance of Federal, State, county, local, and private facilities that we can provide a substantial source of medical personnel to meet our ever-growing needs. It will also be evidence of a most wise congressional decision to utilize and apply existing national capabilities to meet new challenges, by the simple expedient of broadening the functional authority of a qualified agency.

I urge the subcommittee, Mr. Chairman, to give favorable consideration to H.R. 11631 and I ask that' letters from concerned Idahoans, supporting my statement, be included in the printed record of the hearing:

ST. LUKE'S HOSPITAL AND SCHOOL OF NURSING,

Boise, Idaho, March 16, 1966. Senator FRANK CHURCH, Old Senate Office Building, Washington, D.C.

DEAR SENATOR CHURCH: I have been informed that on March 23 there will be a hearing before the Senate Committee on Veterans' Affairs on H.R. 11631, which is concerned with medical education. It is my understanding that this legislation will enable the Veterans' Administration to enter into agreement with educational institutions and hospitals for the purpose of establishing medical schools. We in this area are vitally interested in this type of legislation inasmuch as it would open up an additional avenue toward obtaining medical education facilities for Idaho students.

I would sincerely appreciate any effort on your behalf toward expediting the passage of this bill in the Senate, and the entering of this letter into the record, if you deem it desirable. With kindest of personal regards, I am, Sincerely yours,

ALFRED M. POPMA, M.D., Commissioner, Western Interstate Commission for Higher Education.

STATE HEADQUARTERS FOR SELECTIVE SERVICE,

Boise, Idaho, March 16, 1966. Hon. FRANK CHURCH, U.S. Senator, U.S. Senate, Washington, D.C.

DEAR SEnator CHURCH. You probably are well aware of the decision of the Armed Forces to call to active duty a number of doctors of medicine and dentistry when the build up of our military forces began, last fall.

When State Headquarters of the Selective Service System received their quota it was necessary to ask Idaho Selective Service Boards to reclassify or in other words provide us with the names of the individuals who were eligible, under the law, for an order to active duty. Many selective service boards who hitherto had participated in this type of operation during the Korean war made it very clear that they believed that there was a definite shortage of physicians and surgeons in their communities. Many civic minded citizens throughout the entire State objected strenuously to the loss of these young practitioners whose training and practice in certain specialties, they believed, were essential to the medical welfare of their communities. These objections were not made because of antagonism towards the Vietnam conflict but because they felt their communities had a definite shortage of medical personnel.

In spite of the fact that some authorities maintain that there are sufficient medical practitioners in the United States, I believe that the reaction of the public, generally, indicates without a question of a doubt that the majority of our citizenry are convinced that doctors are in short supply. I received many letters from communities in other States where Idaho registrants were practicing their profession that reflected this same attitude.

It has been called to my attention that H.R. 11631 will authorize the U.S. Veterans' Administration to utilize certain of their appropriated funds to assist with the improvement of medical education. In view of the medical situation in the United States, as indicated by our experience last fall in attempting to provide the Armed Forces with adequate medical personnel, it would appear that it is most urgent that Congress give consideration to this measure. Sincerely,

John E. WALSH, Major General, USAR, Retired, State Director.

RICHARDS, HAGA & EBERLE,

Boise, Idaho, March 18, 1966. Hon. FRANK CHURCH, U.S. Senator, Senate Office Building, Washington, D.C.

DEAR SIR: As you have been aware from previous correspondence, I am most interested in better education in Idaho. In a belief that better education at all levels will be aided thereby, I would urge you to support H.R. 11631, upon which hearings are presently being held. As I understand this matter the subcommittee in charge of veterans' affairs of the Senate Finance Committee is handling this matter, and I would like such recommendations as I can make submitted to it.

There appears to be a continuing increasing demand for medical education with the resultant inability of our students from the Boise Valley to be admitted. The competition for medical school positions results in the increasing level of qualifications for admission because of the lack of facilities. This is not in the best public interest. Many promising young Idaho college graduates who could become most adequate physicians are unable to obtain medical educations. Likewise, as medical students usually do not return to their homes, but stay in the areas of their training, Idaho is hard pressed to acquire sufficient physici'ıns.

The present bill which would authorize the Veterans' Administration to enter into education and agreements for education with institutions, and hospitals could easily lead to the development of both technical and professional medical training in Idaho. Certainly, the diversity allowed by training of more laboratory technicians, X-ray technicians, and other medical technicians would greatly enhance health care and upgrade the earning ability of the people in the Boise Valley.

You are authorized to file this with the interested committee.
Best regards.

T. H. EBERLE.
KBOI TELEVISION,
Boise VALLEY BROADCASTERS, INC.,

Boise, Idaho, March 21, 1966.
Senator Frank CHURCH,
Senate Office Building,
Washington, D.C.

DEAR FRANK: May we invite your favorable support for House bill 11631 which we understand will come up for hearing on March 23. We are very much in hopes that this bill will be well received and favorably considered by the Senate.

61-767-66

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