JEF Draft - 1-31-60

Dear Mr. President:

I feel I must communicate with you again about the imminent and
threatening shortage of physicians, dentists, and other personnel who
must be available to meet the health needs of our expanding population.
You will no doubt recall my letters to you on this subject dated July 27
and September 12, 1959, and your reply dated August 11 and an acknowledge-
ment from Mr. Gerald D. Morgan on September 22 last year.

In your August 11 letter, you referred to a study of health man-
power needs being carried out by the Department of Health, Education,
and Welfare. You indicated that if the study demonstrated a need for
Federal action, you would recommend such action to the Congress.

The study to which you referred was completed last October. In

a summary report entitled Physicians for a Growing America, it confirms

 

and extends every fact I presented in my letters to you. It points out:

eosee THAt we will need a 50 percent increase in the number of
graduating physicians if we are to maintain the present ratio
of physicians to population.

eeooe That this increased output of physicians will require expan-
sion of present schools and the establishment of new schools.

esooe That since it takes about 11 years to plan a new school,
construct it, staff it, and carry it forward to its first gradu-
ating class, steps must be taken now if the threatened shortage
is to be averted. ~~

eseee That as one partial answer to this issue, Federal support
should be given to the construction of medical school facilities.

eoces That "medical school facilities" means expanding and improv-
ing existing medical schools, constructing new schools of basic
medical sciences, constructing new 4-year medical schools, and
constructing the necessary teaching hospitals.
seeee That there is the same urgency in terms of increasing

the number of graduating dentists in the years immediately

ahead.

eeoee That increasing the supply of physicians and dentists is

"sa national health problem, a need of the whole people. ‘The

provision of the needed support is without question a national

responsibility."

I do not know, Mr. President, how there could be a more clear-
eut case than that for Federal action that will give leadership and
stimulus to State and local action, both public and private. ;

Yet I have looked in vain, as this 2nd Session of the 86th, has
#econvened, for any legislative or fiscal proposal by the Administration
that makes even one small step toward meeting this challenge.

I have noted the single sentence on Page 63 of your Economic
Report that reads: "The assurance of an adequate supply of doctors
and other health personnel will require an expansion of medical training
facilities." But I also note that your 1961 budget contains cuts in
the funds requested for the two existing programs that assist in the
construction of the hospital and the research aspects of the medical
schools and related institutions.

I do not suggest that construction programs, financed in part by
the Federal government, will meet the total need. I am equally concerned,
for example, with the fact that on the average the applicants for admission
fo medical and related schools are declining in number and deteriorating
in quality. There are many aspects of this problem that the Federal

government cannot become involved in under our present concepts of its

proper relationships to nonfederal institutions and agencies. We can
and should, however, remove a part of the economic barrier which keeps
talented and interested young people from seriously considering medical
and related careers. And I propose within a few days to introduce
legislation which will authorize an annual appropriation of $10 million

to provide scholarships for students in schools of medicine, dentistry,
and osteopathy. Under my proposal, which calis for matching funds from
the States, some 8000 students -- selected by State commissions on the
basis of ability and need -- would’ receive scholarships each year. Only with
such heip and incentive, it seems to me, can many young men and women from
families in the middle and low income groups even consider the lengthy

and expensive training process involved in medical and dental education.
It is my hope that this bill will be supported by the Administration.

Last year, Mr. President, I introduced legislation -- H.R. 6906 --
broadening the present Public Health Service program of matching grants
for construction of research facilities to include teaching facilities.

My bill calls for $50 million a year for five years for the expansion

and improvement of existing schools of medicine, dentistry, and public
health; a total of $100 million over a 10-year period for the construction
of new schools in these fields; and a slightly more favorable matching
provision for new. schools or for projects that will demonstrably -expand
the enrollment of existing schools.

Although this bill of mine is similar in principle to legislation
introduced by the Administration two years ago (but not, curiously enough,

re-introduced in the 86th Congress), I have not been able to get Executive
Branch interest or support for my bill. I simply cannot understand why,
since it is so clearly within the general policy lines laid down by the

Administration and since the need for such legislation has been stressed
repeatedly by competent authorities within and outside of government

for the past several years.

I call upon you, Mr. President, to use the power and prestige of
your office to help put an end to further delays in what should be and
must be affirmative action now to assure an adequate number of well
trained physicians and dentists for the years ahead.

The practice of medicine is becoming more complex and more special-
ized. There is no reason to believe that one doctor in 1975 will be able
to take care of more patients in 1975 than he can today. The number of
people in the U. S. population continues to spiral upward. The largest
proportionate increases are the age groups under 12 and over 65 -- the
eroups that have the greatest need for health services. But nothing is
being done to Pace up to this problem, despite the fact that it is well
within our capacities as a Nation to do so without either placing a
strain on our eéonony or interfering with established patterns of coopera-
tion among public and private groups and agencies.

Everything we do as a Nation and as a member of a community of
nations is important, Mr. President. One of our first and paramount
responsibilities, however, is to assure the health and well-being of our
people. If we do not have good health, we are weak. An adequate number

of well-trained physicians and other health personnel is essential to our
good health. We will not have enough doctors to assure our good health
unless we act now. It is as simple as that.

It is my hope that the Congress and the Executive Branch can act
as one in this matter about which there can be no fundamental disagree-
ment.

Sincerely,

John E. Fogarty, M. C.