The reference in this quotation to skilled technicians is of particular significance. It takes many more skilled hands to apply modern medical knowledge. The physician increasingly must analyze, plan, and administer services which are provided by others others to whom he delegates in large measure routines carried out under his direction. Originally "others" referred to the nurse who was responsible for all paramedical services to the patient. The total environment, after the departure of the physician, was her province. What has happened to her original responsibilities in the intervening years? Perhaps a short list of original nursing functions, indicating how these activities are currently shared or completely transferred to other workers, might serve to remind us of shifting health service responsibilities and the consequent changes in educational requirements for both professional and technical workers. Original RN functions and activities Diet therapy Allied health worker now providing the service Dietician. Social Service: Related to disability, hard- Medical social worker. Medical records: Maintenance of charts, Registered medical record librarian and medical records technician. Recreation therapist. Physical therapist, occupational therapist, and occupational therapy technician. Scrub nurse. Circulating nurse, etc. Inhalation therapy technician, bio- Personnel director. Ward manager. If other existing allied health professions, both professional and technical, are added to this list as well as those still emerging or anticipated, a vast and complex educational job is indicated. Some of the most enlightened planners are undertaking a careful analysis of the skills and knowledge currently being demanded of a worker to function safely and effectively in each allied health profession. Constant review will be necessary because functions are wed to the art and science of medicine and these are continually changing. Not only must individual curriculums change as medical practice changes, but planners must be alert to demands for new categories of personnel. To help relate specific levels of preparation and service to the broad spectrum of health service personnel-professionals, technicians, and practical aids-the following chart has been prepared. *Generally require two years of post-secondary education Mr. KINSINGER. I would like to show you this chart to indicate the level of which I am speaking. Some of you can see it. If you can't, this chart appears in my formal statement. The bill as it presently is constituted is concerned with the area here, paramedical and paradental. We run from one end of the continuum in the health field, from down here where we have ordinarily aids and so forth who are primarily involved in motor skills and very little with background. In other words, it is the how to do something, not so much of the why of doing it. As you move up the scale you get less of the motor skills, the how, and more of the background, the physical and biological science base. At this level, the technical assistance level, the junior colleges are primarily concerned. Here theory and skill are broken down about half and half. The level with which this bill is concerned is the paramedical level. There are some problems with a chart of this sort. One of them that I run across most frequently is someone looking at this chart and seeing how little skill is indicated up here at the physi cian and dentist level and they are concerned that their surgeon has only this much skill with his hands. So you can see the problems inherent in this kind of a chart. A trend toward recognition of the responsibility of professional practitioners to utilize more effectively the skills and knowledge of technical personnel has been spearheaded by the dental profession. With financial help from the Federal Government, dental schools have instituted programs specifically designed to teach graduates how they can serve public health needs better through a careful sharing of appropriate functions with dental auxiliary personnel. The Surgeon General recently highlighted this important aspect of health service. At the 1965 White House Conference on Health he stated, "Year by year, our top professional personnel are being trained to perform still more complex tasks. How long can each profession afford to hang onto its simpler functions-the routine filling of a tooth, for example, or the several easily automated steps in a medical examination? How can we train the physician or dentist to make full use of the skills available in other people, freeing himself to perform only those duties for which he is uniquely qualified?" There is an increasing movement toward interagency and multidiscipline planning for education and training in the health field. The recent Joint Conference on Job Development and Training for Workers in Health Services sponsored by the Department of Labor and the Department of Health, Education, and Welfare is a case in point. A division of the U.S. Office of Education has had a standing Advisory Committee on Health Occupations Training for many years. The work of the National Commission on Community Health Services generated 70 recommendations regarding health manpower. Also extremely promising are two newly formed interorganization committees on health technology education: one between the American Association of Junior Colleges (AAJC) and the National Health Council on Medical Technology Education. The AAJC and the National League for Nursing have had a similar interorganization commlttee for many years. Writing on "The Increasing Role of Paramedical Personnel" in the September 1965 issue of the Journal of Medical Education, Dr. Robin Buerki states "It would seem that junior colleges across the country offer the most appropriate and the most immediate solution to the problem of training in specialty areas where shortages exist. Technical education in many paramedical specialties could easily be accomplished in a 2-year curriculum which would also provide an opportunity for * * * llberal arts subjects." In the light of this statement it is important to note that the first task the AAJC-NHC committee has set or itself is that of writing guidelines for the development of sound educational programs for health technicians at the junior college level. The knowledge explosion has overwhelmed the professional and escalated his responsibilities. A large bulk of the services carried on under professional direction must be rendered by technicians and assistants. The list of supporting technicians is long and some of the names such as medical laboratory assistants, X-ray technicians, opticians, inhalation therapy technicians, and dental assistants are well known. Others, many others, are doing work, but their role as medical and dental assistants is less well developed. They not only assist the physician and the dentist, but, in this expanding field of knowledge and service, there is need for technical assistance for the professional nurse, the physical and occupational therapist, the medical record librarian, the dietitian, and many others. The American Association of Junior Colleges has recently established a special office with a full time professional staff to assist the more than 600 colleges that constitute the AAJC membership to plan sound programs for health service technicians. To be most effective this national effort on the part of the junior colleges should be supported by Federal legislation for allied health personnel in the light of the vast numbers of workers required in the health fieldworkers who require approximately 2 years of postsecondary education for beginning positions. Our society is faced with a growing and shifting need for technicians and assistants in the health field. Community junior colleges have already demonstrated their ability to successfully prepare health technicians and have indicated a willingness to expand their activities. The extent of that expansion will be partially dependent on financial support such as that envisoned in the Allied Health Professions Personnel Training Act of 1966. Because a well-prepared corps of teachers is the heart of any educational program, it would be possible to materially strengthen educational programs for health service technicians by adding only four words to the present wording of the bill. If line 13 on page 14 were changed by adding, "health service technicians or", between the words "teach" and "in", authorization could be provided for traineeships for allied health professions personnel who would be prepared to function as teachers in community junior colleges. Each new teacher, thus prepared, would be enabled to vastly expand his contribution to the public welfare through the minds and hands of the many health service technicians he could teach within the framework of a community junior college program for health technicians. Mr. Chairman, in response to a question that was raised the other day by Representative Rogers, we have submitted-that is, the Junior College Association has submitted a statement. A letter was sent to Representative Rogers, and members of this committee now have copies of this letter and I wanted to call your attention to the letter. I do not believe you would want to take the time to read this letter. If I may read one paragraph which gives the essence of this. The picture, in brief, is that only a few people are being trained at the junior college or equivalent level with vocational education funds that most of these being trained are in practical nursing, that many are part-time people who are taking upgrading courses, and that very limited Federal funds are available in any case. What is more, I am told by State officials who administer junior college programs that in many States junior colleges receive little or no vocational education funds for health-related programs or any other programs. The bulk of the money goes to the secondary level, and many of the State boards appear to be secondary school oriented. The Federal law is permissive, not mandatory, and leaves it up to the State board whether to include junior colleges or other postsecondary institutions. The complete letter follows. (The document referred to follows:). PAUL G. ROGERS, Rayburn House Office Building, House of Representatives, Washington, D.C. MARCH 29, 1966. DEAR CONGRESSMAN ROGERS: In today's hearings before the Interstate and Foreign Commerce Committee on H.R. 13196, the Allied Health Professions Personnel Training Act of 1966, there was considerable discussion as to whether the proposed legislation should be broadened to include Federal support for programs below the baccalaureate level, and specifically at the level of the junior college, since so many thousands of health-related technicians are being trained in these institutions and new programs are being rapidly developed in most parts of the United States. In the testimony of the Secretary of Health, Education, and Welfare, John W. Gardner, on page 5, Mr. Gardner stated that "substantial" Federal aid is being made available at the subprofessional level to train health occupations personnel, through the Vocational Education Act. He stated that some 56,000 persons are being trained annually in such areas as practical nursing, nurses aids, dental assistants, medical assistants, and laboratory assistants. During questioning by yourself and other Members of Congress, Mr. Gardner continued to support the statement that vocational education is providing for this level of training at the junior college, and that, therefore, this new program should "fill the gap" which exists at the baccalaureate level. In response to questions after the meeting by yourself and by Mr. Robert Smith of your staff, I am submitting the following information on this subject, which was furnished to me today by personnel of the Bureau of Adult and Vocational Education of the Office of Education. The picture, in brief, is that only a few people are being trained at the junior college or equivalent level with vocational education funds, that most of these being trained are in practical nursing, that many are part-time people who are taking upgrading courses, and that very limited Federal funds are available in any case. What is more, I am told by State officials who administer junior college programs that in many States junior colleges receive little-or no vocational education funds for health-related programs or any other programs. The bulk of the money goes to the secondary level, and many of the State boards appear to be secondary school oriented. The Federal law is permissive, not mandatory, and leaves it up to the State board whether to include junior colleges or other postsecondary institutions. To cite a few statistics: For the fiscal year 1964, the most recent year on which there is reasonably good information, about 67,000 students in health-related curriculums were partially supported by VEA (Vocational Education Act) funds. About 42,000 of these students were enrolled on the postsecondary level and about 15,000 on the secondary level. About 32,000 of the 42,000 postsecondary students-about three-fourths—were enrolled in practical nursing courses. This means that only about 10,000 students in the whole United States were partially supported by Federal funds in any other health-related field at this level. What is more, many of the 42,000 students were part-time students, adults who are employed and taking a few courses. While the Office of Education did not have exact information, it appears that most of the 16,000 or 17,000 part-time students were postsecondary, which means that still fewer people are being trained in any curriculum at this level. Funds are limited. In that fiscal year, $4,760,000 in Federal funds were made available for training these 67,000 students. If they were all full-time students, this would provide about $70 per student per year. Assuming a reasonable course load for part-time students, the figure might rise to $88 per student per year. This figure of $70 to $88 per year must be compared with costs per student which may run to many hundred dollars per year, and to the suggested formula of $500 per student which would be provided by the proposed legislation, in addition to funds per curriculum of $5,000, and other funds available under other titles of the bill. In other words, baccalaureate students are to be supported at $500 plus per student per year, while junior college students may possibly be supported at a figure of $70 to $88. 62-707-66- -8 |