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tremendously helpful. Such soft and hardware are often not included in emerging medical school budgets and could be shared with the Veterans' Administration hospital to enhance its professional continuing education program.

The provisions of subchapter III, which provide for improvement and expansion of allied health programs, are especially attractive, if not imperative, in view of the elimination of all other forms of Federal support. An example of the potential significance of this provision is the fact that the College of Health Related Professions at Wichita State University stands to lose as much as $250,000 in the next fiscal year due to probable nonrenewal of four new programs for which developmental support was originally provided by either the Kansas regional medical program or the Bureau of Health Manpower Education of the National Institutes of Health. Each of these programs could be adapted quite well to the Veterans’ Administration format.

Furthermore, with the proposed financial assistance, it would be possible to accept additional numbers of students in certain allied health programs, thus reducing the recognized deficit existing in these disciplínes. As an example, I would cite our dental hygiene program. At present, our clinical facilities will only accommodate 26 students; yet there are consistently over 120 qualified applicants each year for the program. We utilize the dental clinic at the Wichita Veterans' Administration Hospital, which will accommodate only three students. If the latter facility could be expanded, it would be possible to accept additional students in the program; thus helping to reduce the nationwide shortage of dental hygienists. Examples of other programs of equal merit could be cited.

The allied health continuing education program provision, cited in subchapter III, is most significant because it constitutes the only remaining potential Federal source of funds with which I am familiar for an activity all of us in allied health education consider to be of the highest priority. Important as it is, few States provide funds for such activities. If only one subchapter of Public Law 92-541 could receive appropriations, I would select this one above all others that deal with allied health.

Subchapter IV, providing physical improvements to facilitate teaching in health manpower education programs, is also most appealing. A not uncommon example of the importance of this provision can be cited. The Wichita State medical technology program would like to utilize the veterans' hospital clinical laboratory as a major teaching resource. This is not possible, however, because the physical plant is not adequate to accommodate a sufficient number of students or to merit approval by the AMA Board of Schools. A similar example is the fact that the university's physician's assistant program, presently housed in a Veterans' Administration hospital at Wichita, cannot expand unless education remodeling funds are made available.

I have attempted to cite specific examples of how the Veterans' Medical School Assistance and Health Manpower Training Act of 1972 would assist programs with which I am associated. However, these should be considered only as examples and represent only a fraction of a much larger problem; a problem that confronts the entire membership of the Association of Schools of Allied Health Professions.

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Gentlemen, in behalf of my peers currently engaged in allied health and medical education, I seek your support in pressing for the appropriation of funds for this needed legislation.

My sincere thanks for permitting me to appear before you today. Senator CRANSTON. I thank you very, very much.

Mrs. Lundgren, are you going to proceed first, and then I can question both of you or do you wish to proceed in another manner?

Mrs. LUNDGREN. That is at your pleasure, Mr. Chairman.
Senator CRANSTON. Why don't you proceed.

Mrs. LUNDGREN. All right. In the interest of time and so we do have a longer time to chat with you on any questions you may have, I request that my written statement be entered into the record.

Senator CRANSTON. It will at the conclusion of your testimony, and I appreciate that approach.

STATEMENT OF ELIZABETH LUNDGREN, DIRECTOR, DIVISION

OF ALLIED HEALTH STUDIES, MIAMI-DADE JUNIOR COLLEGE, MIAMI, FLA.

Mrs. LUNDGREN. I would like to emphasize two or three things very briefly. You were involved, so I am sure you will remember in May of 1971, when the original legislation was proposed, there were probably three main issues.

I think, judging from the statements of the other individuals here today, and from the news that we all have, that we don't have to worry about duplication of HEW manpower programs anymore, from the standpoint of funds from Veterans Administration. I recall in the transcript there was a long dialog on that.

I would also like to emphasize the 2-year college as a receiver of the returning veteran in education, and that one of our largest components in allied health education is the returning veteran. And, this is not in just one kind of field, but across the board in terms of a specialty group.

Third, I would like to tell you and the other individuals here about a program we are doing with our local VA hospital, which

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not be well-known as yet, which is a pilot-in-agency program for the employees of the Veterans Administration to upgrade the nursing care personnel who are presently at the GS-4, GS-5, and GS-6 level.

With the help of the Veterans Administration and with some funds to the college, we have been able to have the first step in the State law in nursing licensure change in Florida. Our next step will be to let the GS-4's, 5's, and 6's, with some additional education, be licensed as practical and/or registered nurses.

And, with that, I will let you ask your questions.
Senator CRANSTON. Thank you very, very much.

Dr. Reed, turning first to you, how many schools of allied health professions does your association represent?

Dr. REED. At the present time, I would have to defer that to Mr. Samuels, in the office. The exact number—I'm sorry, my colleague tells me it's 116 today. This changes by the week.

Senator CRANSTON. How many of those schools have an affiliation with a VA facility?

Dr. REED. Strictly from the allied health point of view, I am not able to respond to that, but I could get the information for you.

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Senator CRANSTON. Would you do that for the record ?
Dr. REED. Yes, sir.

Senator CRANSTON. What are the innovative programs you mentioned in your statement, which will be phased out by HEW, which can be implemented at VA facilities?

Dr. REED. One is the nurse-clinician program, which was originally funded by the Kansas regional medical program. Another has to do with a modification of the concept of the area health education center, which is best identified in the parlance of the regional medical programs as a health education activity.

Another that is subject to nonrenewal is the health facility administration program, which is to train at the baccalaureate level health care administrators, not hospital administrators. And, the fourth is one that is an expansion of the dental hygienists program from the 2-year to the 4-year program, permitting these individuals to obtain a baccalaureate degree, and at the same time increase their competency as an administrator or a more highly qualified technical person, to operate the manner Dr. Robinson indicated, in the expanded duties of the dental hygienist.

Senator CRANSTON. Could you expand in writing on each of those ? Dr. REED. I will attempt to do so, yes.

Senator CRANSTON. You mentioned that the AMA is unable to approve the medical technology program at Wichita because of inadequacies of the physical plant there.

Do you believe this is an exceptional case, or that other similar programs fail to receive approval only because of the lack of equipment, although the teaching ability is actually available ?

Dr. REED. I think, Senator Cranston, that perhaps it is something of a combination of the factors that you identified in your statement. I think, to a large degree, there are many Veterans' Administration hospitals, not unlike ours in Wichita, that have not been originally geared to accommodate allied health education programs.

Our hospital is on the order of 40 years old at this point, and when it was built it simply wasn't built with having educational activities in mind.

Also, at the same time, many of these hospitals have not been geared in terms of staffing, and they have only had the bare number of qualified, professional people, in this instance, a pathologist, to run the program.

These are not sufficient to meet the qualifications of the accrediting agency, in this instance, medical technology, to permit approval, because they specify that you must have certain types of qualified individuals in the faculty available. So, I think it's a combination of both factors that you mentioned, sir.

Senator CRANSTON. In your statement you refer to the proposed financial assistance, you say, "it would be possible to accept additional numbers of students in certain allied health programs, thus reducing the recognized deficit existing in these disciplines.”

What is that deficit?

Dr. REED. The extent of the deficit, if I had to combine all of the various programs, I am not qualified to give that answer, but I could provide it for you. There are all kinds of numbers. If you read the

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latest statistics, they speak in terms of something on the order of 260,000 allied health workers. But, I think it would probably be something more immediate that would be effective, if I could provide that for you. Senator CRANSTON. Would you do so, please? Dr. REED. Yes, sir.

Senator Cranston. At the end of that paragraph, you refer to the nationwide shortage of hygienists. What is the extent of that short

Dr. REED. You are pointing out some very interesting things, Senator, that our manpower studies are always somewhat retrospective and hardly ever up to date. That has been one of the dilemmas we face in allied health education. So, I am not able to respond affirmatively to that at this time, though I would seek additional information for the record, and will provide that for you.

Senator CRANSTON. I would appreciate it if you would.
[Dr. Reed subsequently supplied the following information:]
THE UNIVERSITY OF KANSAS SCHOOL OF MEDICINE,

WICHITA STATE UNIVERSITY,

Wichita, Kans., May 15, 1973. Hon. ALAN CRANSTON, Chairman, Subcommittee on Health and Hospitals, U.S. Senate, Committee on Veterans' Affairs, Washington, D.C.

DEAR SENATOR CRANSTON: I have just realized that I neglected to include with the corrected copy of my recent testimony before your Commitee on Veterans' Affairs, my responses to questions you proposed in the course of the hearing. I hope it is not too late to do so at this time.

Considerable research was done regarding the question of how many schools of Allied Health have VA affiliations. Unfortunately, there appears to be no accurate tabulation available. However, by virtue of the recent necessity to have signed agreements, it is known there is a minimum of forty. A more accurate tabulation will be available later this calendar year. What is also known is that out of 2,250 Allied Health Programs, 697 had some type of VA affiliations in 1972.

Regarding the shortage of dental hygienists in Kansas I can report the most recent (1972) data available. An ideal ratio of dental hygienists to dentists (according to the ADA) is 1:11. Last year Kansas reported 962 registered dentists and only 174 hygienists which represents not only a significant state shortage but concerns a ratio definitely below the national average.

The last Health Manpower Intelligence Update was conducted in early 1972. While the full relevance of this study is possibly subject to some validation criticism, it is believed that the shortages cited are essentially accurate. The figures have been taken from the heading “budgeted and vacant". Nurses (registered).

183 Physical therapists (registered)

12 Occupational therapists--

2 Respiratory therapists (registered and nonregistered)

10 Medical technologists (registered and nonregistered)

15 X-ray technologists----

6 I regret that my knowledge of VA budgetary practices and program formulation (other than for Allied Health Education) is not adequate to permit expression of an opinion regarding any of the three budgetary questions posed in your April 24 letter.

Thank you for permitting me to respond to your inquiries and my abject apology for the delay in placing this in your hands. Sincerely,

D. CRAMER REED, M.D.,

Dean. Senator CRANSTON. In your prepared statement, you also refer to the allied health continuing education program provision. I agree with you that continuing education is most important.

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In Public Law 92–541, as well as in the new chapter 82, a new chapter II is to be added to chapter 73 of title 38, to create regional medical education centers at VA hospitals, specializing in continuing education for all VA health personnel.

If you would comment on that new subchapter, and if you would do so, too, Mrs. Lundgren, I would appreciate it.

Dr. REED. I would be pleased to do that, and I have been informed of this designation of the regional medical education centers. I would commend the author of this addition to the law because I concur with you, sir, that this is a very much needed component of allied health education.

Certainly, with the system of Veterans' Administration hospitals, that should make them a highly relevant modality of implementing continuing education in a meaningful way.

Senator CRANSTON. We know of nothing the VA has done to implement that provision in the law up to this point.

Mrs. Lundgren, could you provide for the record more details on the program of the Dallas County Junior College in Texas for additional training of returning medics?

Mrs. LUNDGREN. I am not familiar with the entire program, but it was funded by the Public Health Service, and was for the returning military people with a background in medicine.

Senator CRANSTON. Would you be able to get some additional information for the record ? Mrs. LUNDGREN. Yes,

we can. Senator CRANSTON. I would be particularly interested in the career for which these individuals receive additional training, the type of training, academic or clinical, and the duration of the courses, generally.

[Mrs. Lundgren subsequently supplied the following information :] PROJECT MED-VET—EL CENTRO COLLEGE, DALLAS COUNTY COMMUNITY COLLEGE

DISTRICT, DALLAS, TEX. On February 1, 1970, the Associate Degree Nursing Division at El Centro College of the Dallas County Community College District, initiated the “MedVet Project." Officially the title is "A Study to Develop, Implement and Evaluate a Planned Program of Associate Degree Nursing for Veterans with Military Corpsman School Training.” This study was funded by grant No. DIO NU 0046 401, Division of Nursing, U.S. Public Health Service.

The project has two objectives: (1) to identify and use the training corpsmen received while in military service and (2) to provide in a community college program knowledge the veteran is lacking to enable him to progress to the level of a beginning practitioner of registered nursing.

The program is designed to encourage a number of the some 3,500 medically trained veterans returning to civilian life yearly to continue in the health services field as they reenter the civilian setting. Being able to work in a basic Registered Nurse position after graduation will guarantee them a degree of economic security, afford them a position of responsibility and hopefully relieve the present turnover, which is 40 percent annually. The Med-Vet study was divided into four phases extending over some 4 years :

Phase 1: Data (collection) such as expected terminal skills from the three service programs.

Phase 2. Designing evaluation tools to ascertain where the student is and developing curriculum to fill in what the veteran needs to progress to the basic R.N. level.

Phase 3: Admitting of students into the program.

Phase 4: A follow-up study of 18 months duration to gather information about the successes and problems of the graduates of this program.

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