On this international health bill that was mentioned, actually we could probably stand some help from some other country. Our infant mortality rate is still quite high, is it not, for a country which has supposed to have reached the medical competence we have here? I understand some of the Scandinavian countries have reduced their infant mortality far beyond ours.

Dr. TAUSSIG. I am sure when we go and work with our foreign doctors we learn, too. We bring back good ideas to our country. This is not a one-way street we are sending those people out on. Mr. ROGERS of Florida. Thank you very much.

Mr. ROGERS of Texas. Mr. Broyhill.

Mr. BROYHILL. No questions.

Mr. ROGERS of Texas. Mr. Kornegay.

Mr. KORNEGAY. Thank you, Mr. Chairman. Dr. Taussig, it is certainly a pleasure to have you before the committee.

Dr. TAUSSIG. Thank you.

Mr. KORNEGAY. It is always a great gratifying experience for us to have one who has distinguished herself, as you have, in your chosen field of medicine.

I congratulate you on the wonderful work you have done over the years.

I, like some of my colleagues on the committee, have some misgivings about this bill. You point up the question of money. I think some of us are concerned over whether or not this particular legislation actually gets to the heart of the problem, and that is training people to look after the sick. We see it quite often in the doctor training program, the productivity is very limited. I want to congratulate you and thank you for coming over and giving us the benefit of your knowledge.

Dr. TAUSSIG. It seems to me with the increasing demand for medical care, although it may be possible, it is very difficult to speed up greatly the training of the doctors. We tried it during the war. We can speed up the training of the paramedical and we can increase use of the paramedical people. I feel this is a very important area of legislation in order to really be able to come give the people the care they want and to give it to them promptly. That is why I think the money is well invested.

Mr. KORNEGAY. There is a great need for paramedical personnel, practical nurses, people who are whose training is not so extensive and whose educational background need not be as intensive as that of the doctors or dentists.

Mention was made of the Manpower Redevelopment Training Act. It is doing wonderful things in training people.

Mr. ROGERS of Texas. Thank you.

Mr. Satterfield.

Mr. SATTERFIELD. No questions.

Mr. ROGERS of Texas. Thank you very much, Dr. Taussig.
Dr. TAUSSIG. Thank you, Mr. Chairman.

It was a pleasure to be here.

Mr. ROGERS of Texas. The next witness who will testify is Dr. Rovelstad along with Dr. Mann.

STATEMENT OF DR. HOMER D. ROVELSTAD, DR. WILLIAM R. MANN, BEN F. MILLER, AND BERNARD J. CONWAY, ON BEHALF OF THE AMERICAN DENTAL ASSOCIATION AND AMERICAN ASSOCIATION OF DENTAL SCHOOLS

Dr. ROVELSTAD. My name is Dr. Homer D. Rovelstad of Grand Forks, N. Dak. In addition to maintaining a private practice, I am a member of the American Dental Association's Council on Legislation.

With me here today are Dr. William R. Mann, dean of the University of Michigan School of Dentistry; Mr. Ben F. Miller III, assistant secretary of the American Dental Association's Council on Dental Education; and Mr. Bernard J. Conway, chief legal officer of the American Dental Association.

We are testifying on behalf of the American Dental Association and the American Association of Dental Schools.

The associations we represent, Mr. Chairman, believe that passage of H.R. 13196 can be of some benefit in improving the quality of training of dental auxiliary personnel. There can be no question but that assuring an adequate supply of highly trained health personnel in the years to come is one of the most pressing responsibilities facing the Nation.

The proposal presently before you is a step in the total effort to meet this responsibility. With your permission, I will ask Dr. Mann to comment in detail on the provisions of H.R. 13196.

Dr. MANN. Mr. Chairman, H.R. 13196, as we understand it, would authorize a new 3-year program providing grants for construction of training centers for the allied health professions, grants to improve the quality of such centers, traineeships for advanced training to prepare personnel for teaching, supervision, and other specialized functions and project grants to training centers to develop, demonstrate, or evaluate curriculums for training of new types of health technologists. The bill is limited in applicability to training centers that provide programs "leading to a baccalaureate or equivalent degree or to a higher degree" with priority going to those that provide three or more of the curriculums to be specified in regulation of the Surgeon General.

Given this latter limitation, the bill is not applicable to all three dental auxiliary categories. The dental laboratory technician, the dental assistant, and the dental hygienist. Neither the dental laboratory technician nor the dental assistant is trained at the baccalaureate level.

In addition, there exists both 2- and 4-year training programs for the dental hygienist and thus not even all of these training programs would qualify under the terms of the bill.

It would be a mistake, then, to view H.R. 13196 as mounting a program for the allied professions parallel in scope to that provided dentistry and medicine by the Health Professions Educational Assistance Act. The thrust of the bill we are considering today is toward supplying more teachers and administrators to staff existing and projected educational programs and will not substantially reduce the present and growing shortage of dental auxiliaries.

There are at present 16 universities that have well-defined health science centers that probably would qualify immediately under H.R.

13196 as training centers for dental hygienists. In addition, we would judge that some of the other existing programs would be able to qualify within a short period of time.

With regard to new programs, it should be noted that the American Dental Association and the American Association of Dental Schools both have policy urging that all dental schools do establish dental hygiene programs. About 20 of the schools do not now have such programs but some of these might be expected to react to the stimulus provided by this bill.

While precise statistics are not available, it is believed that the 4-year dental hygiene programs contribute substantially to providing the personnel needed for teaching and dental public health. At the present time, there are three graduate programs in dental hygiene that are primarily designed to prepare supervisors and administrators for both 4- and 2-year curriculums.

Of the six exclusively 4-year curriculums, only one is structured and so designed as a total of 4 years of dental hygiene education. The others represent the completion of 2 years of dental hygiene education and 2 years of additional general education in the arts and sciences.

Experimentation in the design of the 4-year curriculum is, then, desirable and the provisions of H.R. 13196 for curriculum design and experimentation seems appropriate to this purpose. Such experimental programs could include

1. Teacher training programs for the development of instructors and teachers in a 2-year dental hygiene, dental assisting, and dental technology programs.

2. Four-year curriculum development for the training of public health dental hygienists.

3. Experimental investigations into the expansion of the duties of presently recognized auxiliaries, based upon the educational experience of graduates from 2-year dental hygiene programs.

With regard to the improvement grants section, we believe that the availability of such funds will prove useful in enabling the schools to enhance the quality of their offerings. Similarly the traineeship provision should have the effect of broadening the opportunities of selected dental hygienists and make it possible for these superior students to prepare themselves for specialized service in the educational and administrative fields.

H.R. 13196, then, is well designed to make some contribution to the health manpower needs of the Nation and we support these aspects of the bill.

We would also like to comment on section 4 of the bill which increases the loan forgiveness for physicians who practice in low income rural areas. There also is a serious and well-documented shortage of dentists in many rural areas throughout the country and we believe the bill should be amended to provide equal inducements as between physicians and dentists.

Finally we, would like to comment on that section relating to student loans. While our association does not feel competent to comment on the relative fiscal merits involved in these alternate forms of financing, we are concerned that nothing be done to jeopardize the continuing provision of loans to dental students.

There are many students who are now in dental schools who could not continue their education without loans under this program.

We believe, consequently, that funds should be appropriated under present arrangements until such time as this new proposal be implemented without interruption of the program.

Mr. Chairman, the American Dental Association and the American Association of Dental Schools are grateful for this opportunity to appear before your committee on these vital matters. We would be glad now to try and answer any questions you or committee members may have.

(The complete statement of the American Dental Association and the American Association of Dental Schools follows:)

STATEMENT OF THE AMERICAN DENTAL ASSOCIATION AND THE AMERICAN ASSOCIATION OF DENTAL SCHOOLS

Mr. Chairman and members of the committee, my name is Dr. Homer D. Rovelstad of Grand Forks, N. Dak. In addition to maintaining a private practice, I am a member of the American Dental Association's Council on Legislation. With me here today are Dr. William R. Mann, dean of the University of Michigan School of Dentistry; Mr. Ben F. Miller III, assistant secretary of the American Dental Association's Council on Dental Education, and Mr. Bernard J. Conway, chief legal officer of the American Dental Association. We are testifying on behalf of the American Dental Association and the American Association of Dental Schools.

The associations we represent, Mr. Chairman, believe that passage of H.R. 13196 can be of some benefit in improving the quality of training of dental auxiliary personnel. There can be no question but that assuring an adequate supply of highly trained health personnel in the years to come is one of the most pressing responsibilities facing the Nation. The proposal presently before you is a step in the total effort to meet this responsibility. With your permission, I will ask Dr. Mann to comment in detail on the provisions of H.R. 13196.

Dr. MANN (commenting). For some 5 years now, this committee has been deeply immersed in the plans being made cooperatively by private and public agencies to increase the Nation's overall capability, both qualitatively and quantitatively, for training health professionals. Throughout this time, the committee has exercised its leadership in a prudent yet vigorous way, making real progress possible. The passage of the Health Professions Educational Assistance Act in 1963, and the amendments to it passed in 1965, are landmarks in the history of health legislation. Together with the Nurses Training Act, it constitutes the heart of our effort to assure that the American Nation has an adequate supply of highly qualified professional health manpower.

The legislation passed thus far, however, has related primarily to what might be called the major professions, those who bear the ultimate responsibility for the well-being of the patient himself. I refer here especially to the dentist and the physician. We have, of course, long recognized that the dentist and the physician are not the only professional workers in the health field. They receive vital assistance, assistance they must have, from many allied or auxiliary personnel. In the field of dentistry, three such categories of personnel can be identified. First of all, there is the dental hygienist. The dental hygienist, who is licensed in every State, is trained to carry out certain procedures inside the mouth that are necessary to the maintenance of oral health such as oral prophylaxis, taking X-rays, and applying topical fluorides and these aspects of the hygienist's work is done under the supervision and direction of a dentist. Education of the dental hygienist is conducted at the college level. In 1965, there were 56 2- and 4-year dental hygiene curriculums and enrollment was approximately 3,850. Thirty of these programs are in dental schools; 12 are in 4-year institutions and 14 are in junior colleges.

The second of the three dental auxiliaries is the dental assistant. Her responsibilities are more directly related to the functions of the dentist himself. She works at this side, assisting him in providing dental care to each patient. In addition, the dental assistant typically will have some tasks to discharge in the area of office management. In 1965, there were 64 1- and 2-year post-high-school technical-training programs for dental assistants. Approximately half are located in junior or community colleges. The total enrollment was approximately 2,800.

Given what we know about the new number of programs now being readied, by the end of this year we can estimate that enrollment will be raised to between 3,400 to 3,800 students.

Finally, there is the dental laboratory technician who has as his primary responsibility the fabrication of prosthetic devices, such as fabrication being carried out on the basis of detailed specifications ordered by the dentist. There were, in 1965, five accredited schools of dental technology with a training capacity of 334 students. Seven additional schools have applied for and are in the process of accredition. In the instance of all three auxiliaries, it should be noted, the accreditation is by the Council on Dental Education of the American Dental Association.

The American Dental Association and the American Association of Dental Schools have long recognized the important role that these auxiliary personnel play in enabling dentists to provide better dental service and to care for more people on a more efficient and economical basis. Indeed, if there has been a change in the character of dental practice within the past decade or so, it is because many dentists have been able to accomplish this result by employing formally trained auxiliaries to whom can be delegated necessary services that do not need the dentist's personal attention.

There is a shortage of formally trained auxiliaries in all three categories. While the dental profession and other interested groups have been involved for some time in vigorous efforts to remedy these shortages, it has become increasingly clear that more intensive assistance is needed.

H.R. 13196, as we understand it, would authorize a new 3-year program providing grants for construction of training centers for the allied health professions, grants to improve the quality of such centers, traineeships for advanced training to prepare personnel for teaching, supervision and other specialized functions and project grants to training centers to develop, demonstrate, or evaluate curriculums for training of new types of health technologists. The bill is limited in applicability to training centers that provide programs "leading to a baccalaureate or equivalent degree or to a higher degree" with priority going to those that provide three or more of the curriculums to be specified in regulations of the Surgeon General.

Given this latter limitation, it is obvious that the bill will not be applicable to the dental assistant, the dental laboratory technician or, immediately, to all dental hygienists. It would be a mistake, then, to view H.R. 13196 as a mounting program for the allied professions parallel in scope to that provided dentistry and medicine by the Health Professions Educational Assistance Act. The thrust of the Allied Health Professions Personnel Act of 1966 is toward supplying more teachers and administrators to staff existing and projected educational programs and will not substantially affect the present and growing shortage of dental auxiliaries.

There are at present 16 universities that have well-defined health science centers that probably would qualify immediately under H.R. 13196 as training centers for dental hygienists. In addition, we would judge that some of the other existing programs would be able to qualify within a short period of time.

With regard to new programs, it should be noted that the American Dental Association and the American Association of Dental Schools both have policy urging that all dental schools establish dental hygiene programs. About 20 of the schools do not now have such programs but some of these might be expected to react to the stimulus provided by this bill.

While precise statistics are not available, it is believed that the 4-year dental hygiene programs contribute substantially to providing the personnel needed for teaching and dental public health. At the present time, there are three graduate programs in dental hygiene that are primarily designed to prepare supervisors and administrators for both 4- and 2-year curriculums.

Of the six exclusively 4-year curriculums, only one is structured and designed as a total of 4 years of dental hygiene education. The others represent the completion of 2 years of dental hygiene education and 2 years of additional general education in the arts and sciences. Experimentation in the design of the 4-year curriculum is, then, desirable and the provisions of H.R. 13196 for curriculum design and experimentation seem appropriate to this purpose. Such experimental programs could include:

1. Teacher training programs for the development of instructors and teachers in 2-year dental hygiene, dental assisting, and dental technology programs; 2. Four-year curriculum development for the training of public health dental hygienists;

3. Experimental investigations into the expansion of the duties of presently recognized auxiliaries, based upon the educational experience of graduates from 2-year dental hygiene programs.