necessities of the long and difficult and expensive medical education training.

Senator CLARK. This has all been interesting. Do you see a need for any further organizational structure in the Federal Government to deal overall with this manpower problem or is it your thought that the matter could be handled by appropriating a little more money as far as the medical field is concerned?

Dr. COGGESHALL. I do not believe it can be handled just by more money. I think more money is needed, and I don't think that this is the financial comfort of the medical schools or those responsible for training our health personnel but it is really a requirement for the health of our country.

More specifically, we have in the planning stage the use of health funds, primarily those from Government, which will help alleviate the health manpower situation. Most of the funds allocated through the Congress are spent at the decision and planning of the university investigator or administrator.

As a matter of fact, the Surgeon General of the United States of his own accord cannot initiate or approve one dollar, it is written into the law there must be nongovernmental advisory committees and counsels.

There is adequate factfinding and planning and utilization in the National Institutes of Health and I think the staff has produced a very fine record, so perhaps speaking from the standpoint of my particular discipline, medicine, I am relatively well satisfied with current planning for the future. I think that the same is true of the National Science Foundation. However, I believe something more than a science advisor or a health advisor to the President is essential to meet our manpower need.

I am uncertain whether the Council that is in your bill is the best mechanism or not.

Senator CLARK. I am not, either.

Dr. GOGGESHALL. I am not casting reflections on the suggestion and can see it needs congressional recognition, as well as the recognition of the President himself.

Senator CLARK. I think the latter.

MANPOWER PROBLEMS A PART OF ECONOMICS

This morning we had some very interesting testimony along these lines. Mr. Stanley Ruttenberg, the research director of the AFLCIO, said that this manpower problem may well be just a part of economics and if we had a member of the Council of Economic Advisers who had some competence in the manpower field then he could bring together all of the various manpower efforts which were going on, not only within the Federal Government but in the private economy also and he could tie the whole thing in to the utilization of human resources, the way we attempt to utilize our economic resources.

I don't think I quite agree with him because I think that the two things are essentially different. I am a little skeptical about having economists deal with manpower problems. You come from an entirely different side. We had Dr. Trytten, the Director of the Office of Scientific Personnel of the National Academy of Sciences and his approach was not dissimilar to yours.

I wonder whether you think this whole business of the utilization of human resources, of which the medical field is an important one, does not have to be dealt with at the executive level and coordinated with the economic plan although not a part of it.

You spoke of the way they did these things in Russia. It has been my general understanding, having talked a bit with a number of people, including Gaylord Harnwell, the president of the University of Pennsylvania who went over there and made some study of the Russian educational system, that they start with their economic planning and prepare a 7-year plan and then they turn to experts in the personnel field; they say "Staff this plan," and then they go out into the schools and colleges and the universities and the technical and vocational training places and they try to arrange to get enough little Ivans going into each funnel to come out with trained personnel to implement the economic plan.

Now, I know that you are not too much interested in that side of it. You are interested in the medical profession. But don't we have to look at this thing as a whole and doesn't it have to be looked at from the very highest executive level?

INCENTIVES FOR CAREER CHOICE

Dr. COGGESHALL. It certainly does need to be looked at from the very highest executive level. I have a belief that with our system of government we operate largely by persuasion, if you will. There are many forces not necessarily competitive but more in a sense of complementing each other, each striving for sufficient manpower in his particular field.

It is not because of any parochial or private interest, but he understands the inadequacies of his particular field best. Maybe this is the way that we will have to accept as our method of going ahead and depend upon both private and public initiative to see that these programs are carried through.

One of the difficulties I see in a top-level group with great responsibility and little authority is that they can go only so far in having their recommendations enacted.

For the foreign medical and science field, we can get many individuals to survey a situation, even in any of the most backward countries, but they are not anxious to stay home.

In the Rockefeller Foundation—and similar organizations—one of the great problems has been to keep people overseas for a period of time that they can be effective, and this has only been possible by screening hundreds of individuals to find the few with interest to carry out a long-term assignment.

Senator CLARK. This is all pretty discouraging.

Dr. COGGESHALL. It is discouraging, and I think it is a fact that if we could sit down here this afternoon we could supply reasons to justify a conclusion we would never have a successful program overseas. Of course, this is not the case but it is not a simple problem. We are making forward strides, and we must keep it before the public's attention all of the time.

Senator CLARK. I certainly agree with you that we cannot use compulsion, and that it has to be done by persuasion. I still have the view

that we could utilize an awfully lot more persuasion than we are presently utilizing, in a number of different areas. I am not sure that we know yet exactly where those areas are and to what extent they compete with each other.

A MANPOWER REPORT

How would you react to a requirement that the President should report annually to the Congress and therefore to the American people, the status as he sees it of various manpower needs in the light of what I think we could all relatively easily agree on, of our national goals. We have had this National Goals Commission and it has produced a useful report. I think that we have a pretty good consensus in this country as to where we want our civilization to go, not in detail but in general terms. It cannot go there unless the people are trained and available at the different spots which will move it there. Would it be a useful thing to charge the President with this duty and instead of tying him down with a Council of Manpower Advisers, letting him organize in any way he saw fit to get this report which could contain recommendations to the Congress for legislation.

Dr. COGGESHALL. I think we should, but before I would make a statement I believe a first step that might be very useful would be to assemble a group of outstanding minds in this country, competent to understand the problem, that of background knowledge about the deficiencies in their particular field and offer a joint recommendation.

A WHITE HOUSE MANPOWER CONFERENCE

Senator CLARK. How do you react to the thought of a White House Conference?

Dr. COGGESHALL. I think a White House Conference has been a very good device for some problems. Unfortunately, I believe its influence has been weakened because we have had so many White House Conferences, and they begin to lose their impact.

Senator CLARK. Your thought would be an ad hoc committee to make a report ?

Dr. COGGESHALL. Yes, and there are many ad hoc committees, but address themselves just to the manpower problem.

Senator CLARK, I have coined a somewhat melodramatic phrase "stafling freedom." Our problem is to staff freedom, not in the way the Russians do, but at least as well as they do. You would agree, I guess, that this is a problem which has not received adequate atten

tion.

Dr. COGGESHALL. That is right, sir: relative inattention.

Senator CLARK. I started this thing about 3 or 4 years ago by giving $10,000 to the American Academy of Political Social Sciences for a roundtable conference to be followed by a volume of the annals on this manpower problem. We had a lot of people participate, some skeptical and some enthusiastic. In anticipation of these hearings we got a dozen people who were competent in the field together for an evening meeting and discussed the problem.

You are familiar, I imagine, with the manpower work being done by Dr. David and Dr. Ginsburg at Columbia. They have done an awful lot of work in it.

I think that I am impatient, and I am just beginning to wonder when we are going to stop talking about it and do something.

Dr. COGGESHALL. I realize the appointment of another committee is a good way to procrastinate and not do anything. Perhaps my partial satisfaction in the medical field toward a solution is somewhat tempered by the fact that under Senator Hill's leadership in medicine, we have a very good program in prospect. I hope there is no apathy on the part of Congress or indecision, and perhaps I am not anxious to blunt the edge of progress in the field of medicine which now has some constructive plans for assisting the medical students, and supplying various facilities and funds which will help the manpower

situation.

Senator CLARK. Well, I think that you are in better shape than many others. I would suggest somewhat in jest that you are a lot better off than the political field, that we are not recruiting in politics or even in administration of government anything like our fair share of the brains of the country. The principal reason is that the rewards are inadequate and the punishments are great unless you have an independent income. The teaching profession is in a critical condition.

INTERRELATIONSHIP OF MANPOWER PROBLEMS

I wonder if you could comment in conclusion on this statement of Dr. Henry David, the Executive Director of the Manpower Council, and I am quoting: "What is done with one part of the supply, capable of a high degree of education and training, will affect other parts of this supply. There is a kind of competition among manpower reserves in such supply which is self-defeating. We may be compounding our manpower problems under the impression that we are solving them."

How does that strike you?

Dr. COGGESHALL. There are a lot of arguments in favor of that statement. I believe that the dollar doesn't satisfy everything, but I believe if there are unnatural inducements, unbalanced, more favorable inducements in one area, it will do exactly what Professor David suggests.

I believe students from our manpower reservoir, potential scientists, have been attracted to certain fields because of the lucrative fellowships and job opportunities and ease in financing their education, not always into a field of their choice or ability.

Senator CLARK. Are there not perhaps certain identifiable factors which affect a young man or woman in the selection of a career: what is the pay, what is the prospect of some security, what is the prospect of advancement, and what is the fascination of the work, the opportunity to be of service? We can provide incentives within those various categories, but I am not entirely sure how far it is wise to go within the limits of a free society. Yet, I see ourselves being licked by our opponents who are only too anxious to destroy us. Dr. COGGESHALL. In our free society, I would like to see funds made available from public and private sources to insure the young man or the young woman who has the character, and who has the motivation and the mental equipment to go into the field of his choosing and not be held back because he thought the road was too difficult and costly.

Thereby we are losing or misdirecting the efforts of that very precious resource in this country we cannot afford to lose.

Senator CLARK. And it doesn't shock you to have Government make up part of that?

Dr. COGGESHALL. There must be a participation on the part of the student and the university. I don't think that the student gets the most out of it if he is paid all of his expenses. I think that would act as a detriment in the long run. We are finding that there is some backfire to the Russian program and I wouldn't want to close without saying that some of my colleagues in the health field of other countries, where this talent has been imported, there has been such a political overtone, that they find little use for the Russian visitor after a few months. Some of these programs have folded because they were not backed up by well-qualified people in their particular field.

Senator CLARK. I think Mr. Merrick has a question.

Mr. MERRICK. Just one bit further on Dr. David's rather profound remark that the Senator quoted: the competition that Dr. David is talking about is not only in terms you answered it, but also in whether or not the talent going into the medical profession isn't being lost to other kinds of sciences and other kinds of careers unrelated completely to the medical profession.

If this is true, then the case for a higher level of manpower policy formulation, if you will, is greater than ad hoc committees to cover the particular shortage which someone may be aware of.

Dr. COGGESHALL. I don't believe that applies to medicine because the period of medical training now is so long, difficult, and expensive. I don't think that there are many going into medicine that should be in the humanities or the social or political sciences for example. I believe the trend would be more in the other direction. Nevertheless, an overall manpower board if effective would be in order.

Mr. MERRICK. Perhaps that is so, and perhaps therefore an overall examination as to what is going on in the direction of the development of manpower resources is necessary.

Senator CLARK. Take as an example 100 very bright boys graduating from 100 high schools across the country. How will they select their careers? We don't really know, do we?

Dr. COGGESHALL. We know that 50 percent of the top 25 graduating from high school don't go to the universities. I believe if that 50 percent were presented with an opportunity of partial support which they do not have today, to enable them to select their careers and make their plans for their future, we would recover a lot of that talent and it would not be a question of the Federal Government subsidizing higher education.

Senator CLARK. I tend to agree with you, and I guess that is as good a place to stop as any.

Dr. COGGESHALL. I appreciate the opportunity, sir.

Senator CLARK. Thank you.

The committee will be in recess until 10 a.m. on Friday.

(Whereupon, at 3 p.m. the committee was recessed, to reconvene at 10 a.m. Friday, December 16, 1960.)