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 VÁ 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 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 shortage? 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:] Hon. ALAN CRANSTON, THE UNIVERSITY OF KANSAS SCHOOL OF MEDICINE, Chairman, Subcommittee on Health and Hospitals, U.S. Senate, 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). Physical therapists (registered) Occupational therapists. Respiratory therapists (registered and nonregistered) – Medical technologists (registered and nonregistered). X-ray technologists____. 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. 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 00461-01, 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. The data collected served as a base for the nursing curriculum and, with the help of consultants, a comprehensive identification and testing process was developed. After the initial testing phase, students' strengths and deficiencies were noted and 29 students were enrolled in the courses in the fall of 1970. Since the initiation of the Med-Vet project, 39 students have graduated. Of the 29 students who enrolled in the fall of 1970, 14 graduated in December 1971, three graduated in May 1972, and one graduated in December 1972. Seventeen of these students have taken the Texas State Board Examination and one is enrolled in a B.S. program in New Mexico. Ten completed the examination on first attempt, two on second attempt, and four have not yet completed the examination. Ten students who enrolled in the fall of 1970 have dropped out of the program, and one student who dropped out is now reenrolled. Fifty-one students enrolled in the program in the fall of 1971. Twenty of these students graduated in May 1972 and have taken the Texas State Board Examination, the results of which are not known at this time. Twenty, or 39 percent of the students who enrolled in the fall of 1971 have dropped from the program. The whereabouts of one student, who has not officially dropped, is unknown. Fifty-one students enrolled in the Med-Vet program in the fall of 1972. Of the 38 graduates of the Med-Vet program, 30 are employed full-time. Twenty-five are employed as staff nurses in general civilian hospitals; one is employed in a convalescent center and will soon become an assistant administrator; one is employed at an osteopathic hospital; one is employed at a veterans hospital; and two are at the School of Anesthesiology in Wichita Falls, Tex. Two graduates are employed part-time at an osteopathic hospital. The Med-Vet staff is currently involved in phase IV of the project, gathering information about the successes and problems of the graduates of this program for a final report. Senator CRANSTON. Do you have an estimate of the amount of funding which would be effectively used in expanding training programs at junior colleges affiliated with VA hospital facilities? Mrs. LUNDGREN. There are about 84 junior colleges affiliated with Veterans' Administration hospitals, I believe. Senator CRANSTON. How much funding would be required to use them effectively in training? Mrs. LUNDGREN. We are a rather large community, and for next year, if we had two salaries, instructional salaries, to use within the VA hospital itself for their new employees, as well as the upgrading of their GS-4's, 5's and 6's, somewhere between $25,000 and $30,000 would certainly help in a rather large community. In a smaller one, it would depend upon what kind of services that particular agency would be providing, as to what extent they would want to carry on this activity. Senator CRANSTON. What type of program do you feel the junior colleges can best develop for returning servicemen with health experience, who would like to pursue a health-oriented career? Mrs. LUNDGREN. In the programs we have in the college in Miami, the servicemen, or anyone else, for that matter, with previous experience or formalized training, recorded formalized training, will be allowed to challenge any one of the 10 programs presented at the college. We had one young man interview with us about 2 weeks ago, who was a medic. To us, he appeared so well prepared that we would feel he could almost challenge the entire program in nursing. That varies, of course, from individual to individual, but there are people in physical therapy, assistant-level people, medical lab technologists, who have completed in as little as one semester by challenging the program. [Mrs. Lundgren subsequently supplied the following information:] ALLIED HEALTH STUDIES DIVISION POLICY ON CREDIT BY EXAMINATION, EQUIVALENT CREDIT, GERMANE CREDIT AND/OR DIRECTED INDIVIDUAL STUDIES Programs within the Allied Health Studies Division (AHS) at Miami-Dade Junior College frequently have the opportunity to give students college credits and/or advanced standing in a particular curriculum via the mechanism of: credit by examination, equivalent credit, germane credit and/or directed individual studies (DIS). Each of these procedures is a legitimate process for obtaining college credits at Miami-Dade Junior College consistent with official college policy. However, because of the unique accreditation requirements and restricted enrollments in many of the Allied Health Programs, these procedures are sometimes used in special ways. The following is a statement of clarification on these policies as they relate to each program in the Allied Health Studies Division. Department of Nursing 1. Licensed Practical Nurses (LPN's) with Florida licensure who have completed six (6) credit hours at Miami-Dade Junior College are eligible to take credit by examination for Nursing 177 (Nursing I). Upon passing this exam with a "C" or better and completing the co-requisite sciences, the student may enter the nursing program in Nursing 178 (Nursing II) or be eligible for the "transitional" program. 2. Students transferring from other college nursing programs may be given equivalent Miami-Dade credit for courses which are determined by the department chairman to have similar course objectives. 3. Students entering Miami-Dade Junior College from diploma nursing programs may challenge nursing courses by the credit by examination procedure if it is determined by the department chairman that the curriculum and course objectives are similar. 4. Transitional Pilot Program-Florida L.P.N.'s who are high school graduates with one year experience in Medical Surgical Nursing and have successfully completed the Nursing 177 (Nursing I) exemption exam are eligible for the "Pilot Program" which is 12 calendar months long. Upon successful completion of this program, students receive an A.S. Degree in nursing and are eligible to write the State Board Professional Licensure Exam. At this time there is limited space in this program. Department of Allied Health Technologies (AHT) 1. Students entering any of the AHT programs who have met similar course objectives via previous classroom and/or laboratory experiences may request to challenge individual courses by the credit by examination procedure. Eligibility to use this option is determined on an individual basis by the appropriate program coordinator. Because of the difficulty in evaluating clinical skills by written examination, students are not usually allowed to fulfill clinical course objectives by this procedure. 2. Students who transfer into a particular AHT program from another accredited program with similar objectives may be given equivalent Miami-Dade credit for course work successfully completed. This is determined on an individual basis by the appropriate program coordinator. 3. A student may receive germane credit and advanced standing in a particular program if he has successfully completed the requirements for registry and/or certification in his health specialty. Presently this is an option in X-ray Technology and Respiratory Therapy Technology. Eligibility for this option is determined by the appropriate program coordinator. Those students determined to be qualified must complete the basic education requirements of the program and a clinical course in his particular specialty area. This later process is usually handled by the DIS procedure. (See No. 4 below.) 4. With permission of the appropriate AHT program coordinator, students may fulfill the course objectives and receive credit for any course by directed individual study (DIS). This procedure may be used for regularly scheduled courses or for a new specifically designed course. The advantage of the DIS in a regularly scheduled course is that it can be taken any semester even if out of sequence. The specifically designed DIS course may be accepted as equivalent credits or as the advanced standing course required in the special degree programs described in No. 3. 95-996 0-73- -4 |