MINORITY REPRESENTATION IN HEALTH PROFESSIONS Dr. ENDICOTT. There is an additional element, too, which is important in this area. It is a general concensus that we should make positive efforts to incease the representation of the minorities in the health professions. As a general rule, their ability to finance higher education is not good. So a deliberate policy to involve the minorities carries with it an obligation to find some way, whether it is guaranteed loans or whatever, to give them assistance. Senator MAGNUSON. You testified in the House, and you have said about the same thing here, Doctor, that we are about halfway, when you talk about the shortage. You testified, "We are a little less than halfway there," and you suggested we double it in the next 5 years and double again by 1980. That is your testimony. So we are about halfway there. PROBLEM OF GEOGRAPHIC DISTRIBUTION Dr. MARSTON. I think it is important to note, Mr. Chairman, as this committee knows very well, that just producing more physicians, dentists, nurses and allied health workers will not solve the health problem. There is a problem of distribution that is over and above the problem of numbers. While we feel very strongly that the numbers are important, I think each time there is a discussion of this type it is important that the record show that there is no assurance that all of the problems in the health field will be solved just by having increased numbers, even when we get to the doubling of the number. Senator MAGNUSON. But it bothers me that we are not catching up. You also testified in the House that the health manpower shortage and this is over all-was 481,000, and that the predicted shortage in 1980 will be 724,000. That is not quite double, but it is pretty close to it. A better distribution might be helpful, as you say, but it seems to me we have to have a national goal to keep even with this thing, or we will just stand still. We have to move. OPPORTUNITIES FOR DISADVANTAGED Senator COTTON. I only want to get one point. If Congress and the American people were willing to be perfectly cold-blooded and ruthless and deny opportunity to the minority groups and less advantaged youth, do you have enough applicants right now to fill the capacity of your present school capacity that are probably able to attend without loans or scholarships? Dr. ENDICOTT. I would like to give a qualified answer to that. Senator COTTON. Before you give the answer, let me finish so that I don't get on the record as suggesting any such policy. There is another factor that occurs to me, that a disadvantaged youth is likely to have a less adequate pretraining than one from an affluent family. In other words, if the medical schools are going to just make the policy of accepting the best qualified, no matter what the young person who has been disadvantaged financially and in many other respects has, no matter what his or her native ability may be, they might not show as being as well prepared as those who have great advantage, so we have to have a twofold policy. We have to use the full capacity of the medical schools, and try to increase it, and we also have to keep up with adequate loans and/or scholarships and see to it that the slots in the medical schools are not filled by people from one group in society. So those dual objectives have to be in mind at all times. I assume they are in mind in the policy of the medical schools and academic institutions, and in your own organization. Is that correct? Dr. ENDICOTT. Yes, sir; I would certainly agree. Senator COTTON. I didn't want to interrupt you, but I had said something which could have been readily misinterpreted if I didn't complete what I had to say. INDEBTEDNESS OF MEDICAL GRADUATES Dr. ENDICOTT. About 40 percent of all medical students have either loans or scholarships, or both, and, on the average, they graduate with an indebtedness-I think the figure is $12,000. It is pretty rough financing a college and medical education even if the family has an income of $15,000 or $20,000, especially if there are other children in school at the same time. If the capacity were to be filled without taking students from a family income below $10,000, it would still require availability of loans, perhaps from the private sector or somewhere, to accomplish this. Student assistance is very important for physicians, dentists, veterinarians, those who have already financed 4 years of college and have 4 more years to go. What you said about the educational inadequacies of the disadvantaged and the minority students has a great deal of truth in it and presents special problems. They are more costly to educate in the medical school because either through tutorials or something of the sort, these inadequacies have to be made up. But I think that the social gains are worth all of the effort. Senator COTTON. I think we all agree to that. As you just said, it makes it necessary to have a dual objective in mind to strike a happy medium in dealing with the problem; isn't that correct? Dr. ENDICOTT. Yes, sir. Senator COTTON. Thank you. Incidentally, this ABC program, if it is allowed to grow and develop, is doing a lot on this; isn't it? Dr. ENDICOTT. I would hope so. ENVIRONMENTAL HAZARDS Senator MAGNUSON. You mention on page 8 of your statement that the vast and diverse array of actual and potential hazards and elements are involved when you talk about biological environments, ranging from uncontrolled radiation to enzymes in detergents. Are you making a study of this, or did you contract it out? INSTITUTE EMPLOYEES Senator MAGNUSON. At this point I wish you would put into the record, first of all, how many people you have employed at NIH. Dr. MARSTON. It is about 11,000. This includes both the scientists working there and those who are responsible for administering the grants. It is our total group. Senator MAGNUSON. Is that the total that we pay for? Dr. MARSTON. That is the total that you pay for who are Federal employees; yes, sir. COMPENSATION FOR EMPLOYEES OTHER THAN FEDERAL Senator MAGNUSON. Put also into the record what we pay for other than Federal employees. How many people are we employing in this whole program, that we pay for? Dr. MARSTON. Do you mean through the grant programs? Senator MAGNUSON. Yes, that we pay for. We want to know what we pay for. Dr. MARSTON. The type of problem that one runs into is, for example, an institutional support grant to a medical school. In a sense, I guess, a large number of people working in that medical school might get a small proportion of their salaries through that institutional support grant. Senator MAGNUSON. How many do we pay for? Say we pay a half salary. Two of them would equal one, right? Dr. MARSTON. Yes, sir. Senator MAGNUSON. How many people are the Federal taxpayers paying for? Dr. MARSTON. We don't have that. Senator MAGNUSON. It comes out of the Treasury. You must know what comes out of the Treasury. You have 11,000 Federal employees and then you have employees where you pay part of the salaries. Do you pay part of the salaries? Dr. MARSTON. What happens is that we make a grant to a medical school on a formula basis of so much per medical student, $500 per medical student. We do not know what actually happens to that formula grant in terms of tracing which dollars go to a given person but we will try to get that. Senator MAGNUSON. Don't you think the Appropriations Committee and the Federal taxpayers are entitled to know how many people they are paying for out of the Treasury? Dr. MARSTON. Yes, sir. Senator MAGNUSON. I know that there is a mixing of salaries and funds in these medical schools, where there are some salaries that you pay part of. Is that right? Dr. MARSTON. Yes, sir. Senator MAGNUSON. If you pay one-fourth, then four of those would be one full time equivalent. Dr. MARSTON. Yes, sir. We will do this in man-years, then. Senator MAGNUSON. That is what we want, to know how many people we are employing. 49-433 0-70-pt. 5 Senator COTTON. If you can give a categorical answer to his question, you would be a wizard, and I think you should resign and become chairman. Dr. MARSTON. I think the chairman has given me enough flexibility to come up with an estimate of the man-years we are supporting. Senator MAGNUSON. I want you to tell the Congress how many people we are paying for or are employed, whether they are full or part time Federal employees. We want to see whether Parkinson's Law is taking effect. Surely, when they ask for a grant they estimate how many people they are going to employ, don't they? Dr. MARSTON. Yes, sir. Senator MAGNUSON. And who is going to pay for them? Senator MAGNUSON. All right. (The information follows:) The following tabulation provides an estimate of the employment supported by grants and con- The estimates were confined to employment supported by grantees or prime contractors. Employment The basic units used in the estimates are man-years of employment. This is necessary because In the aggregate NIH supports over 64,000 man-years of non-Federal employment. Over 49,000 man-years, three-fourths of the total, are supported at universities. |