Training
Health Service

RIES
The Critical CIE

Proceedings of the
Department of Labor-Department of Health, Education, and Welfare
Conference on Job Development and Training

For Workers in Health Services

Washington, D.C. February 14-17, 1966
 

THE WHITE HOUSE

It gives me pleasure to extend my warmest
greetings to those attending this Conference on
Job Development and Training for Workers in
Health Services.

One of the basic goals of the Great Society
is to guarantee that our people receive the best
possible health care.

But today we are faced with critical manpower
shortages in the health services. These hinder
our efforts to ensure a healthy, America.

By focusing on these critical shortages, Con-
ference participants are playing an important
role in meeting this national challenge.

| am confident that these shortages will be
met.

Your deliberations at this Conference are also
vitally important in our national efforts to find
meaningful employment for every citizen during
this period of record prosperity.

May this Conference prove highly productive
for each of you and the Americans and the
government you so faithfully serve.

LYNDON B. JOHNSON

 

 

 

Read by Secretary of Labor Wirtz at opening session
of Conference.
Training
Health Service

Workers:
The Critical Challenge

Proceedings of the Conference on
Job Development and Training
For Workers in Health Services

Sponsored by the
U.S. Department of Labor
U.S. Department of Health, Education, and Welfare

Washington, D.C. February 14-17, 1966

 

U.S. DEPARTMENT OF LABOR
W. Willard Wirtz, Secretary

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
John W. Gardner, Secretary

 
Lucy M. KraMER of the Manpower Resources Program, Division of Com~
munity Health Services in the Public Health Service, had the major responsi- «
bility for editing and preparing the Proceedings for publication. She was
assisted by Marguerite Wazler and Nancy Lindsay.

 

 

 

 

This report is issued from the Office of the Assistant Secretary for Education
in the Department of Health, Education, and Welfare and the Manpower
Administration, Department of Labor.

 

For sale by the Superintendent of Documents, U.S. Government Printing Office
Washington, D.C. 20402 - Price 60 cents

 
5
A: C55

FOREWORD 94 4
PUBLIC
HEALTH
LIBRARY

The decision by the U.S. Department of Labor and the U.S. Department of Health, Education,
and Welfare to sponsor a Conference on Job Development and Training for Workers in Health Services
was based on a number of compelling factors:

® There is a deep and growing concern about the shortage of trained workers in the health service
industry, and employers of health manpower, unions, professional organizations, and educators are
searching for ways to bring health manpower supply and demand into better balance.

® The President's Job Development Program, designed to “expand employment by the filling
of those service and related needs which are not now being met because of lack of trained workers or
other reasons affecting employment or opportunities for employment,” had significant implications
for the development of health manpower and services.

® (Questions were and are being raised about changes in technology, occupational structure, and
employment patterns in the health fields, and the relationship of these changes to the preparation and
upgrading of personnel for technical, skilled, and semiskilled jobs in health and related service
occupations.

These explorations and questions revealed :

1. That the unemployed and underemployed constitute a potential source of manpower for entry
jobs in the health service industry.

2. That training programs for health and related service workers must be expanded.

3. That research and demonstration programs in the health occupations are needed.

4. That Federal resources for training and related manpower programs need to be utilized more
extensively for programs in the health fields.

The Conference addressed itself to these and other trends, programs, and practices which affect
the development and utilization of less-than-baccalaureate-degree trained workers in health and related
service occupations.

Almost 300 representatives of labor, management, education, health organizations, government,
professional associations, and other interested groups attended the 3-day meeting. They participated
actively in the discussions, and offered many constructive suggestions for increasing the quantity and
improving the quality of auxiliary health workers. Reports of the major presentations and the group
sessions appear in these Proceedings.

The U.S. Department of Labor and the U.S. Department of Health, Education, and Welfare
acknowledge, with appreciation, the many and significant contributions which the speakers and the
participants made to the Conference and to the important task, which all of us share, of ensuring a
healthy America. They opened new doors to understanding and action in meeting the health manpower
challenge of our times.

SECRETARY OF LABOR SeEcrRETARY OF HeaLTH, EDUCATION,

AND WELFARE

761
 

 
CONTENTS

FOREWORD_______

IL

II.

IIT.

IV.

VI.
VII.
VIII.
IX

HIGHLIGHTS OF CONFERENCE DELIBERA-

GREETINGS FROM THE DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE_____

PROGRAM... o = se 5.20mi 5105 = 0 0 wins mom Sie omens mem

. MAJOR ADDRESSES________ ll

PANEL DISCUSSION—SUMMARY_ __________ __
TABLE DISCUSSIONS—DIGEST._______________
WORK GROUP DISCUSSIONS—SUMMARY_____
CLOSING SESSION—ADDRESSES_______ ______
APPENDIX ____

B. Roster of Participants______________________

C. Discussion Leaders, Recorders, Resource
Persons. _______________________________

D. President's Message on Job Development
Program ________________________________

E. Paper—‘“The President’s Job Development
Program: Its Implications for Health Man-
power and Services” _______ ____________

F. Selected Reference Material, U.S. Government _

G. Legislative Survey, 1956-1965______

Page
iil

11
45
49
53
61

73

73

75
85
86
88

91

93

 
 
|. Highlights of Conference Deliberations

The Labor-HEW Conference on Job Develop-
ment and Training for Workers in Health Services
was planned and conducted as a medium for the
discussion of issues, for the exchange of views,
and for the sharing of experiences in matching
people and jobs in the health service industry. In
addition, it provided an opportunity to explore
the various ways of meeting the health manpower
needs of today and of the future, in terms of re-
cruitment, training, and deployment of supportive
health personnel.

During the discussion sessions, conferees offered
many suggestions for increasing the quantity and
quality of health service workers. These sug-
gestions represented the individual opinions of
participants, and did not constitute commitments
on the part of their organizations or policy on the
part of the two sponsoring Departments. How-
ever, the suggestions merit the attention of all the
participating groups and agencies, both public
and private.

Conferees suggested :

® Strengthening the health team, in concept
and in practice.

® Delineating the duties and functions of health
service workers.

® Coordinating Federal health manpower pro-
grams and resources.

® Utilizing Federal resources more extensively
for training auxiliary health workers.

® Increasing wages and improving working
conditions for health workers.

® Strengthening curricula, teaching methods,
and instructional materials.

® Improving methods of recruiting trainees
and employees for health and related service
occupations.

® Developing the unused resources in our man-
power pool for service in health and related
occupations.

® Conducting regional and State conferences
on training workers for health services.

® Developing qualified teachers, administra-
tors, and supervisors for health service training
programs.

® Providing refresher and reorientation train-
ing programs for inactive professional health
workers.

® Improving communications between and
among the diverse groups concerned with the sup-
ply and demand of health manpower.

® ILstablishing and effectively utilizing local
advisory committees for health service training
programs.

® (Creating job ladders and providing upgrad-
ing opportunities for qualified workers in health
services.

® Expanding sound training programs of all
kinds for health and related service workers.

 
Il. Greetings from the Department of Labor

W. WILLARD WIRTZ, Secretary

You run the risk which any audience encounters
when they are faced by a group of people who
know one another so well that they have spent the
first part of the evening in friendly colloquy of
one kind or another and find it difficult to make
the shift to the more demanding formalities of
the rostrum and microphone.

For my remarks I am going to be very informal.
They proceed from the exercise of a privilege
which is mine, to bring to this group a message
from President Johnson*, and to extend the greet-
ings of the Department of Labor to you. I mean
not to trespass at all upon the real subject matter
of the evening or upon the subject matter of this
Conference as a whole, but to express again sin-
cere appreciation for the opportunity to work
with those from the Department of Health, Edu-
cation, and Welfare in this particular enterprise.

I note only one point of any real substance as
far as this meeting is concerned. It seems to me
that what you are looking for involves a point of
very difficult identification because it lies between
extremes. It is also difficult to describe either
extreme without risking an offense, and so I do
it very shortly and in terms of points of views of
others.

There have been conversations over the years
between the Department of Labor and the Ameri-
can Nurses’ Association about the matter of trying
to train those who fall into the middle category to

* See inside cover for text of message.

 

which you have referred as auxiliary, ancillary and
paramedical. We have talked about developing
supportive nursing personnel and at the same time
not excluding the profession. Surely that is an
important part of our task here—to see to it that
we develop this particular area of occupational ac-
tivity—but that we not trespass in doing so upon
the responsibilities of those whose training has
gone so much more beyond that which it would be
possible for some of us to obtain. It is quite im-
portant that auxiliary health manpower be devel-
oped both with the realization that there are
differences in level and that people have an oppor-
tunity to move up from one level or area to an-
other—with due regard for the demands of the
higher level or professional area.

The other extreme is one to which I would like
to refer in terms of an article which was handed
me just this evening as I came in. It was found
in the current issue of 7'he New Republic. The
article was by Mr. James Ridgeway, on “The
Girls in White.” 1 hesitate to do anything ex-
cept quote because I am concerned about the laws
of libel and slander. 1i's a story about the Career
Academy, Inc., with which some of you may be
familiar. According to Mr. Ridgeway, the Acad-
emy offers a training course for health service
workers for $697.50. I think I could have stood
the $697, but when I came to the 50 cents, my an-
tennas began to vibrate. The article goes on to
describe the contributions of organizations of this

3

 
kind. As I understand it, there is the prospect
of people taking training offered by the Career
Academy and upon completion of their course
identifying themselves, for a sum of $15, with
the American Registry of Medical Assistants and
Medical Secretaries, a self-constituted registry in
Oklahoma.

The article relates to one experience which the
authors, or someone, had in connection with the
Registry, and I'm going to quote that paragraph
in full.

Recently an application form and $15 were sent off
in behalf of “Molly Bloom Conner” of Vienna, Virginia,
who sought registration as a dental assistant. She “quali-
fied” by way of her high school education in Texas and
recently claimed to have worked for a doctor in Washing-
ton. Last week Molly Bloom got in the mail an impressive
diploma with a large gold seal stuck in the left corner.
It was from the American Registry and it read: “Know
all men by these presents, By authority of the Board of
Trustees, on recommendation of the Board of Examiners,
in recognition of the fulfillment of its requirements, here-
by confers upon Molly Bloom Conner, R.D.A., the title
of Registered Dental Assistant, with all honors, rights,
privileges, and immunities pertaining thereto here and else-
where. In witness whereof, the Great Seal of the Reg-
istry and signatures of the duly authorized officers are
hereunto affixed.”

The editorial explanation is that actually the
high school Molly Bloom said she attended is a
boys’ school, the doctor she worked for is a real
estate agent, and Molly Bloom herself is a 3-year-
old St. Bernard dog.

We embark upon an era in which the welfare—
the happiness—and the meaning of life for a good
many people depend upon those whose training
will come from this Conference this week. To
have gone during the last year through the hor-
rible agony of trying to find nurses around the
clock for a member of your family is to realize
with a special poignancy the shortages which char-
acterize this particular area. It is to realize that
the whole Medicare program and all it stands for
could be stunted by lack of personnel in this area

just as the education program could be crippled

by lack of adequate teachers. It is to feel no
danger of exaggerating the importance of a meet-
ing such as this. It is to realize that great numbers
of health service workers will be needed in this
country to do what we want to do by way of mak-
ing life a little better for a great many people.

It is to realize again that it would be impossible
to over emphasize the importance of why you are
here. And yet I suppose that the danger in these
214 days is that you will probably—or perhaps at
least—be so shocked and saturated by the statistics
and so overwhelmed with the impressiveness of
your obligation—that it will seem hard to get down
to the ways and means of seeing to it that enough
people are trained, that they are given enough
training, that they are moved easily and effectively
into what is a profession in the finer sense of the
word.

I would like to add only one other thing—just
as some of us spent a good deal of our lives in
teaching, a good many of you have spent a great
deal of your lives in medical services of one kind
or another. Both are areas in which the thanks
of the beneficiaries are very rare—the thank-you’s
are hardly ever said—and tlie satisfactions are
pretty much inner-satisfactions that make you
go to bed at night thinking that today has been a
pretty good day because there has been an op-
portunity to do something for somebody else.

The satisfactions of the professions—and I
think particularly of the medical and the teaching
and the clerical professions—Ilie in serving others.
The rewards do not show any place at all except
in your mind and in your own realization that
some other person is happier tonight, and, there-
fore, you are. I don’t understand the chemistry

of life at all, but that makes more sense than any
other of the compensations I know anything about.

I would like to express just a personal word
that I hope is in the minds of all of you—the sig-
nificance of service and of this particular opportu-
nity to make service real in the lives of millions of
troubled people.

 
ll. Greetings from the Department of Health,

Education, and Welfare

WILBUR J. COHEN, Under Secretary

I bring the greetings of the Department of
Health, Education, and Welfare and those of Sec-
retary Gardner to what, as Secretary Wirtz said,
is an auspicious and momentous occasion—this
joint Conference on training workers in health
services.

1965 was a monumental landmark year in the
history of health legislation of our country.
More health legislation was enacted in 1965 than
in any other year in the history of our Republic.
And although this fact is of importance in itself,
of even greater importance, as you meet here in the
next 214 days, is the fact that we have left behind
a great plateau in this last year, and we are now on
a new upward movement to a much higher plateau,
an escalation if you want to call it that, in the
whole field of health for our Nation.

For 30 years or so, there raged in this country
one of the most bitter, ideological controversies in
the whole history of health and social reform leg-
islation. This issue has now been decided and rec-
onciled in a truly democratic manner with the
passage by Congress of recent legislation. We
now go into a period in which there is a dialogue
and a communication and a relationship that has
not existed for many, many years, in which the
American Medical Association and other associa-
tions in the professional field are sitting down to-
gether and discussing matters of health of joint
concern. Six months ago, it would not have been
possible to get these people into the same room, let

 

alone to even talk in a gentlemanly way about
issues that are now being discussed freely. So
when you in the Conference meet here today, you
meet in an atmosphere which could not have been
reproduced earlier. In my opinion our Nation
has really taken a new point of departure in the
health field, a departure which Secretary Wirtz
has already pointed out to you, that is increas-
ingly important not -for just this year but for
several decades to come.

At the University of Wisconsin, when I began
the study of medical economics in the early thirties
under Prof. John R. Commons and Prof. Edwin
Witte, we as a Nation, were spending a little over
314 percent cf the gross national product on medi-
cal care. I think it actually came to 3.6 percent
in 1929. Last year, in 1965, medical care expendi-
tures in the United States reached a total of $40
billion from public and private sources, equivalent
to about 5.9 percent of the gross national product.
The amazing thing that has happened in these 35
years or so since I was a student, is the fact that
the American people have increased their relative
expenditures in the whole medical field by some-
where between 50 and 6624 percent, which is an
indication of the great importance which they
attach to the problem of medical care. I do not
mean to imply that the American people are
happy about this tremendous rate of expenditure
or that they dance a little jig about spending more
money, but what matters in the economic market

5
 

  

place is how willing you are to spend money for
the product you think is important. The Ameri-
can consumer is putting nearly 6 percent of the
gross national product into medical care, and there
is every indication that the percent will go even
higher—to 7 percent, with some estimates circu-
lating that it will reach anywhere from 8 to 10
percent in the next 20 or 25 years. This gives
some indication of what you might call one of the
phenomenal growth industries in our country.
The current estimate is that before the end of this
decade, our Nation will be spending, instead of $40
billion, close to $50 billion in this particular
industry.

The important point I want to make here is that
the increase in health manpower requirements is a
corollary of the growth in the health industry.
There are about 3 million people employed in the
total health industry at the present time. Despite
that large number there is also a tremendous
shortage of skilled and subprofessional and allied
health personnel. And if the demand continues
to go up along the line I have tried to portray,
there will continue to be great manpower short-
ages if we are going to implement what I think is
now a fundamental belief of our entire Nation—
namely, that health services ought to be available
to everyone, regardless of race, creed, color, na-
tional origin, sex, or even income.

With the passage of Medicare and the 15 or so
other pieces of legislation last year, and with the
general recognition of their importance by Con-
gress and all the various groups, a new national
policy appears to be emerging whereby medical
care in the future will truly be available to all.
This will be accomplished by a complex method
of financing, organization and development which
many people, 10 or 15 years ago, thought would
not occur for generations to come. And yet, if
adequate medical care is to be available to all, the
vast shortages of physicians, dentists, nurses and
all the various allied personnel must be met. This
means that financial compensation will have to be
increased in these areas if we are to recruit and
retain the manpower and womanpower needed to
provide the health services.

Hospital costs in this country have been going
up about 6 or 7 percent per year; at present daily
hospital costs over the Nation average about $41

    

per day. Yet we are not going to close our hos-
pitals because the price of service goes up to a
point greater than people can afford or are willing
to pay in the market place. Health services are
too important to be decided simply by economics
alone. We are going into a period, it seems to me,
when we not only must train more people and give
more services, but when we also must develop a
whole series of rationalizations in the health indus-
try to be able to provide the kinds of services that
I think the American people expect.

As a final point, I think we in this country are
on the threshold not only of exciting changes in
the direction of health services, but, as all who are
familiar with this field know, we are also on the
threshold of continued miracles—scientific and
medical miracles. I think it would not be pro-
phetic of me if I were to say that in our lifetime
the artificial heart probably will be available to
millions of people who today die prematurely be-
cause of heart disease and stroke. It would not
be prophetic of me if I were to say that in the next
b or 10 years the artificial kidney will very possi-
bly be available to millions of people who today
do not have that advantage. And diseases such
as leukemia, and all types of communicable and
other diseases that today cause death and disability
will have been eliminated in the time that is still
allotted to us.

These miracles of modern science and the vast
potentialities that exist in the field of health make
this an especially momentous time in which to meet
and confer. All of you, all the organizations you
represent as well as those of us in the Department
of Labor and the Department of Health, Educa-
tion, and Welfare are fortunate to be able to work
together to develop more and better manpower and
womanpower which is basic, as Secretary Wirtz
has pointed out, to the provision of proper health
service to our people. For the first time in our
Nation’s history the principle that medical care,
and the highest quality of medical care (which
heretofore was available only to a few), should be
available to every man, woman, and child, may
well become a reality. And so on behalf of the
Department, I want to greet you and welcome you
to a most challenging job, in which all of us, work-
ing together, can make a great contribution to the
service of our people.
IV. Program

 
 

 

Program

Monday, February 14
6:30 p.m. RECEPUON + unvns sennusasrats insiinrsnssovinsvhnensns East Room
7:30 p.m. Dinner iii eee aaa State Room

Chairman: Mr. Stanley H. Ruttenberg
Manpower Administrator
U. S. Department of Labor

Greetings

The Honorable John W. Gardner
Secretary of Health, Education, and Welfare

The Honorable W. Willard Wirtz
Secretary of Labor

Address

NATIONAL RESPONSIBILITY FOR HEALTH MAN-
POWER

Speaker: The Honorable Francis Keppel
Assistant Secretary for Education
Department of Health, Education, and Welfare

Tuesday, February 15 General Session .ouveveeeeneeeenenenenennennnn.. Colonial Room

9:00 a.m. - 12 noon Session 1
Chairman: Dy, George Silver
Consultant and Special Assistant to the Assistant

Secretary for Health and Scientific Affairs
Department of Health, Education, and Welfare

Address

MANPOWER IN A SERVICE ECONOMY

Dr. Eli Ginzberg

Director of Human Resources

Columbia University; and

Chairman, National Manpower Advisory Committee

Address

HEALTH MANPOWER NEEDS AND REQUIREMENTS

Dr. Philip Bonnet, President
American Hospital Association

Panel Discussion
Moderator: Mr. Jack Konecny, Assistant Director
James Connally Technical Institute
Texas A&M University

 

 

 
 

 

Panelists: Mr. R. M. Laughry, Administrator
Washington Hospital Center

Mr. Peter Ottley, Director

Department of Civil Rights and Economic
Opportunity

Building Service Employees International Union

Dr. A. N. Taylor, Associate Secretary
Council on Medical Education
American Medical Association

Dr. Walter J. Pelton
Professor of Dentistry
University of Alabama

Miss Frances Purdy, Chairman
Nursing Administrators Section
American Nurses’ Association

Mr. Norman Mitby, Director
Madison Vocational, Technical, and Adult Schools
Madison, Wisconsin

Dr. Kathryn Stone, Director
Program on Human Resources
Washington Center for Metropolitan Studies

12:30 - 2:45 LUNCHEON tiveiieriiiiieeeeeieeeeseeaneaesnneneens State Room
Session 2

Chaiman: Dr. Ellen Winston
Commissioner of Welfare
Department of Health, Education, and Welfare

Address
TRENDS IN EDUCATION AND TRAINING OF HEALTH
SERVICE WORKERS
Dr. Robert Kinsinger, Director, Health Careers Project,

The University of the State of New York

Address
THE COMMUNITY'S RESPONSIBILITY FOR HEALTH
MANPOWER DEVELOPMENT

The Honorable Charles Vanik
U. S. Representative from Ohio

2:45 - 4:30 p.m. Table Discussion SeSSIONS .oiiviiiiiiieieerannns State Room
Session 3

Wednesday, February 16 General Session ....coeviiiiiiiiniinnnnens Colonial Room
DO Gite = TOLLS Dalle: vivnsnniss sus sient ss farsa Era SS NSS Sh Cpr Session 4

Chairman: Mr. James Clarke, Assistant to the Assistant
Secretary for Education
Department of Health, Education, and Welfare

Address
FEDERAL RESOURCES FOR TRAINING WORKERS IN
HEALTH SERVICES

Dr. John P. Walsh, Assistant Manpower Administrator
U. S. Department of Labor

 

 

 
 

 

10:30 a.m. - 12 noon

12:00 noon - 2:00 p.m.

2:00 p.m. - 4:30 p.m.

WORK GROUP SESSIONS
Group #1
Group #2
Group #3
Group #4
Group #5
Group #6
Group #7

RECESS

Work Groups (Continued)

Thursday, February 17 General Session ...........

9 a.m. - 12 noon

Chairman: Dr. Louis Levine
Assistant Manpower Administrator
U. S. Department of Labor

Pan American Room
Cabinet Room
Potomac Room
District Room

Capitol A Room
Capitol B Room
Colonial Room

AANA REE Ae Session 5

EE ——— Colonial Room

Session 6

Reports of Work Group Sessions

General Discussion

Address

MOBILIZING OUR VAST
SERVICES

RESOURCES FOR HEALTH

Dr. William H. Stewart, Surgeon General

Public Health Service

Department of Health, Education, and Welfare

The Challenge

MATCHING PEOPLE AN
SERVICES

D JOBS IN THE HEALTH

The Honorable Wilbur Cohen, Under Secretary
Department of Health, Education, and Welfare

Mr. Stanley H. Ruttenberg, Manpower Administrator
U. S. Department of Labor

 

 

10

 

 
V. Major Addresses

NATIONAL RESPONSIBILITY FOR HEALTH MANPOWER

FRANCIS KEPPEL, Assistant Secretary for Education,

Department of Health, Education, and Welfare

I am grateful for the gracious introduction by
Stanley Ruttenberg. If Stanley were speaking
tonight—and I wish he were—I would find it a
privilege to introduce him and return the com-
pliment. Stanley has been the Manpower Ad-
ministrator only a little more than the year that
has passed since President Johnson announced his
Job Development program. That announcement,
just last February, said that the President ex-
pected 10,000 new jobs per month to be developed
by July 1, of last year. There was some con-
sternation around this city—even, I am told, in
the Department of Labor. Yet by the year’s end,
the goal had not only been reached—it has been
exceeded by 25 percent. The goal had not been
an exaggeration. Its announcement showed that
the President shrewdly estimated what we could
do, and had to do.

Nevertheless, this accomplishment took a Man-
power Administrator with drive, ingenuity, and
a dedication to produce. It took a Manpower Ad-
ministrator who did not waste any time on reasons
why the job could not be done, but who looked
instead for ways in which 10,000 new jobs per
month could be developed.

But if Stanley Ruttenberg has a reason tonight
for some pardonable pride, I doubt if that is the
source of his relaxed affability. I suspect him
of looking at those of us who represent education

223-124 0—66

2

 

  

and the health services, as one who anticipates
having his misery relieved by company. He
knows all too well that beginning very soon, there
will have to be produced something like 10,000
new jobs per month in the health services alone!

Now there is an escalation for you—by 100 per-
cent. I doubt, however, if there is anyone here
tonight who did not know that this crunch was
coming. It is for that reason that you were in-
vited to this conference sponsored by the Depart-
ments of Labor, and of Health, Education, and
Welfare. We are here, for the next 3 days, not
to shrink from this challenge, but to tackle it.

Just what is the magnitude of our task in re-
cruiting and training more health manpower?
Let me summarize briefly at least the gross dimen-
sions of our health manpower needs, before going
on to why we have those needs, then to specify
some of the problems that face us in meeting our
demands, and leaving you finally, not frightened,
I hope, but determined.

Among those responsible for making projec-
tions in the realm of our national requirements for
health manpower up through 1975, it is estimated
that we will need an increase of a million in-
dividuals, above present totals, in all the health
occupations. Divide that by the 120 months of
10 years, and you derive that arresting demand
upon us to develop an average of nearly 10,000

11
 

new jobs per month in the health services alone.

Our calculations are not as precise as we would
like them to be. Nevertheless, we have more than
just a ball park estimate. Presently we come to
our gross estimates in this fashion: On one hand
we multiply the number of extra physicians
needed, estimated at 60,000, by the 8 allied med-
ical occupations which the American Medical As-
sociation says are already required to support
each physician. This brings us to nearly half
a million people needed. But the allied medical
fields to which the AMA refers do not include
dentists, and their support personnel, nor do they
include registered or licensed practical nurses. If
we also include needed technicians in radioiso-
topes, medical electronics, and similar fields
recently identified, we get to a million easily.

Our second method breaks down all the cate-
gories we know about, and makes an estimation
for each one, of the needs by 1975. It comes out
about the same.

But we do not even have names yet, for some
of the occupations which are emerging. There is
every reason to believe that our estimations of
need are conservative.

What is the sudden cause of this great demand
for health services manpower? How did it creep
up on us in these near-crisis proportions? In this
turbulent century many things have exploded at
once: A rapid expansion of knowledge, a sharp in-
crease in population, and a volcanic shaking of
world power relations bringing new problems and
responsibilities to us. Over all, the issues of war
and peace are pervasive and abrasive on our con-
sciousness. Many issues nag us at the same time.
Even the wisdom of hindsight, however, is not
very useful, if it only causes us to grumble. The
task is to take a calm measurement of what has
happened and what we must do. We do have a
number of reasons that define our problem of need
for more resources in the health services. Let me
just sketch a few of the major ones:

1. In the first place the American people have
been accustomed to, and expect, the best in health
services. In this country access to medical care is
a right, not a privilege. In spite of our enviable
record in this regard, we must admit that we have
slipped behind the best of which we are capable.
We no longer have the lowest infant mortality
rate in the world. Life expectancy is greater in
most of the other industrial countries of the world,

12

exceeding ours in some places by as much as 5
years. The U.S. death rate from heart disease is
the highest in the world. The mortality rate of
males in the highest productivity bracket, from
ages 40 to 54, is substantially higher in the United
States than in other industrial countries, and is
twice the rate of Sweden. These are telltale indi-
cators. We are not doing our best. We are not
doing what we should. Our knowledge is not
lacking, but our service personnel and facilities
are.

2. Second, there is a disproportion in our health
services. Good figures do not lie, but they can be
cruelly deceiving if not analyzed. Our gross in-
fant mortality rates are not really bad, but they
san conceal, if one is not careful, the fact that the
rate is three times higher among Negroes than
among whites. The medical services in West-
chester County, N.Y., will show a commendable
record, but what about Harlem ?

Most of our cities have medical centers unsur-
passed elsewhere in the world. But running from
Pennsylvania to Alabama, in the vast region of
Appalachia, we have not brought to many of our
people many of even the most elementary health
services.

And there are other equally deprived areas.
Even in the glittering cities, we must remember
that the poor are congregated in increasing num-
bers: Children do not get cared for medically and
unattended illness is another indignity of old age.

3. A partial reason for both the disproportion
in our services and an overall decline in service.
has been the load of a greatly increased popula-
tion. In the third place, then, we must reckon
medically, with this population explosion.
Since World War II we have added more people
than the entire population of Great Britain. By
1975 we shall have nearly 30 millions more, and
will continue to grow. The birth rate in the
United States has been declining slightly, but even
the lower percentage, working on a broader base,
will inexorably increase our numbers.

We are becoming a younger nation on the aver-
age. But we are getting more older people also.
Nearly 1,000 persons reach the age of 65 every
24 hours in our nation. We have long known of
the greater need for medical care in this portion
of our citizenry and that they were not getting
it. Just this last year, the Medicare legislation
was passed which will make it possible to give
more adequate medical attention to our senior
citizens. This was a deliberate—and may I say
too long delayed—effort to bring a national health
responsibility to active attention. The exact
magnitude of that load on our health services can
perhaps not yet be estimated, but it will demand
significant increases of people and facilities.

The amendments to the Social Security Act of
1965, however, extend a commitment to health
services for children of the poor and other needy
groups. This, too, is a delayed obligation.

4. Fourthly, our success in health research has
set higher standards for implementing its results.
Our National Institutes of Health do magnificent
work. Private medical research is brilliant. We
know enough to be able to cut deaths from cancer
in half. We can cut down greatly on our shocking
heart disease fatality rate. Diphtheria, pneu-
monia, syphilis, and other serious diseases will
yield radically if we can get enough human chan-
nels of our knowledge to bring it to bear on those
afflicted. Medical practice without research would
be blind. But research not supported in the field
is impotent.

5. Fifth, we face the high cost of medical care.
Since 1940, the cost of medical care in the private
citizen’s budget has outstripped all other cate-
gories of his spending in percent of increase. No
small part of our disproportion in health services
is due to the fact that medical care has been priced
out of the market for many. We know that this
sharp cost rise is heavily due to the high cost of
personnel and facilities. Can we then cut costs
by greatly increasing the number of personnel?
The answer is yes, if there were the proper num-
bers and distribution of personnel for ambulatory
care, home care, and hospital preadmission test-
ing. There could be a greatly increased efficiency
in the use of hospital beds. Some hospitalization
could be avoided entirely. Other stays could be
shortened, and more patients could be better and
more economically treated. The cost for much of
the personnel to do this is considerably less than
that for acute inpatient service.

Even at the upper end of the skill spectrum,
highly skilled physicians are performing duties
of a routine nature that could be relieved by sub-
professional aides without loss of standards and
with increased efficiency.

Not only have I not been exhaustive of the rea-
sons why we need more health manpower, I have
stayed mainly within the confines of the need for
more care of the kinds we are giving. But there
is a spectrum of services we ought to have, and
to which little attention is given at present. Let
me give but one dramatic example here.

Dr. Kinsinger, who will address you tomorrow
noon, has pointed out that only 162 cities and
towns out of a nationwide sample of 900 require
attendants, either trained or untrained, to accom-
pany ambulance drivers. The American College
of Surgeons has suggested that “casualties on the
streets should get as good care as those on the bat-
tlefield.” Many thousands are not getting this
care, and what a magnitude our casualties here
are!

Since World War II, we have killed many thou-
sands more individuals on American highways,
than those who died from a// causes in World War
II. Our total highway casualty list in just the
last 5 years is higher than the World War II
casualty list.

But let us just compare 3 years of the Korean
war to 1 year, 1964, in respect to highway cas-
ualties. Total deaths suffered by our armed forces
in the Korean war, were 54,246. Highway fatali-
ties in America in 1964 alone were only slightly
lower, at 47,700. But look at the injury rate. In
3 years of the Korean war there were a total of
103,284 nonmortal casualties. In 1964, highway
accidents injured 1,700,000 Americans. But note:
140,000 of these suffered injuries of permanent
impairment !

Our casualties in Korea shook the Nation polit-
ically. In any given year in traffic accidents we
make the casualties in that war pale. Yet, for the
most part, we send out to the scenes of accidents
people who don’t know a tourniquet from a squash

racquet, much less how to move a person with an

injured back, or how to treat for shock—from
which as many people die as from wounds.

It may be time for a teach-in on this subject.
But in any case, along with whatever measures
may be devised to improve traftic safety, much.
much more trained medical service should be pro-
vided for the victims of traffic accidents.

I do not wish to overkill the subject of need. I
do, however, wish to prevent the phrase “we need
a million more persons in the health services in
the next 10 years” from making a soft landing on
our consciousness.

13

 
Ours is not the goal of a lunar landing. Ours
is the goal of branding on our consciousness an
urgent need, and of stimulating action to meet it—
among all our professional associations, in all of
our health and educational institutions, and in all
of the local communities from which we come.

Remember, we are going to need an average of
10,000 new people per month, for 10 years, to meet
minimum requirements in the health area of the
Great Society. It can be done, and I am confident
it will be done, but it will not be easy.

What are some of the problems to solve in meet-
ing these needs in health service manpower, and
what are the Government resources? 1 am sure
it has been made clear to you, but let me emphasize
that this Conference is concerned with those health
workers and auxiliary personnel below the bacca-
laureate level in training need. It is not that we
can be complacent about the numbers in profes-
sional training, but we have done a better job of
joining the battle there. Of more immediate and
crucial need is the development of the supportive
health workers who must fill the chinks between
professionals.

The discussion agenda provided for you lists a
long roster of problems. Where are we going to
recruit the people? Who is going to train them ?
Where are they going to be trained? Who will
develop the appropriate curricula in new areas?
Who will do the certification? How can we make
many of the new positions as occupational and
physical therapists, medical record librarians,
medical electronics technicians and others com-
petitively attractive in a labor market which will
demand this quality of personnel in many other
places in industry ?

Will physicians accept nonprofessional assist-
ants? Will all professional associations take an
enlightened view on opening subcategories for
training? Can we devise career ladders to give
people of talent an upward mobility to the limit of
their capacities and break down some of today’s
artificial barriers in the health manpower pool ?

At the lowest end of the skill spectrum how far
can we go in developing some of the physically
and educationally disadvantaged? And can we
qualify the positions at all levels, at adequate
standards of wages and working conditions?

These and other problems we have tried to an-
ticipate. We expect you will find many more to

add.

14

What are the resources which your Government
is offering? These are in the areas of training
support and in research money that can be di-
rected to new and improved instructional ma-
terials and methods, job analysis in the health
fields, and systems analysis of functions in health
service institutions.

We know shamefully little about what today’s
health workers actually do, how they spend their
time, how their functions mesh, and to what extent
their training is fully used. The new Manpower
Resources Program of the Public Health Service
will be developing major projects of time and
skill utilization studies which will tell us much
about the concrete kinds of manpower. we need
and how to use them better.

The Division of Adult and Vocational Research
has made a priority activity of developing para-
medical training programs of sufficient scale to
test how to improve instructional skill, curricula,
identify job clusters in which a job ladder train-
ing base can be developed, and to improve the per-
formance of facilities. There is a major source
of funds here for creative, practical proposals.

More than 30 pieces of Federal legislation pro-
vide for some kind of occupational training. Not
all of these can be used for training health service
occupations. But some are well suited and ought
to be used more than they have been, e.g., the man-
power training program, the vocational education
program, and the antipoverty program.

These resources will be carefully explained to
you in these 3 days. In addition, resource staff
from both Federal departments will assist every
discussion session to explain from the ground up
how any given resource can be used, or perhaps
how a combination of them may be put together.

We hope this will be a working conference,
getting into the most elementary nuts and bolts
questions of how to get a specific training pro-
gram going, for a specific kind of person, that a
specific community needs.

The Federal resources will be no stronger than
the links of local initiative and professional leader-
ship. If we in Government are here to help to
the best of our ability, we frankly expect to learn
more from you about what the real nature of the
problem is, and what more we must do to help you.

Let no stony problem remain unturned, but I
beg of you—Ilet us not lose sight of the goal of
need and the demand that it be met. We must not

 
stop with asking ourselves what are the problems.
We must go on to require of ourselves a solution.

We are not here to lower health services stand-
ards, but to elevate them sharply. A better cali-
bration of the skills needed and a more precise
relating of skill levels to more classes of workers
is one practical way to do this.

We are not here to liquidate professional organi-
zations. But integrity and independence need not
be parochial. The spirit of that part of the Hip-
pocratic Oath which commands the physician to
“teach the art” can have a new birth of application
throughout the range of associations that provide
medical services and support.

 

We do not want job development in this area in
just any old way that we can get it. We want job
opportunities opened up that are attractive, re-
warding economically, and self-fulfilling per-
sonally. We want careers opened up that embody
the spontaneity of service that motivated the Good
Samaritan. We want them for the many people
who know what the answer is to Cain’s question
whether or not he was his brother’s keeper.

The most practical realism and the highest
idealism are combined in the task before us. If
we are going to be creditors of the future, as we
are debtors to the past, we must delay no longer
in setting about it.
MANPOWER IN A SERVICE ECONOMY

ELI GINZBERG, Ph.D., Director of Human Resources, Columbia University

My job this morning is to lay out some of the
links, some of the connections, between your spe-
cial problems, about which you know much more
than I do, and some of the larger dimensions of
the manpower theme, about which I may know a
little bit more than you.

One of the troubles of a highly specialized world
is that we get to know our own bailiwick quite well
and we lose a sensitivity for the other half. Now
in manpower that is dangerous because the supply
of people, their allocation, their rewards, are all
linked to a market. For example, if you attempt
to formulate policy about health manpower with-
out an adequate perception of the economy and the
problems it presents, you will make poor policy.
Therefore, my job will be to try to call some things
to your attention which you can reflect upon and
put together with the experience and the knowl-
edge which you have.

Let me begin by saying that in my opinion the
word “crisis” has been bandied around a little too
much. The United States is a rich country, al-
though we are not as rich as we would like to be.
That applies from the point of view of: money,
people, skill, whims, whatever. One might say
that we are in a perpetual crisis, in the sense that
we are short or have deficiencies in all of these
things. I would like to be a little bit more mod-
erate when we talk about a crisis.

For example, if you say that by a crisis we mean
that the Federal Government and other agencies
of society and the American consumer are now

16

 

spending more money and are therefore desirous
of purchasing more and better services in the
health field, I will understand that. But then I
would point out to you that the market for health
services has been reasonably responsive; that its
capacity measured in manpower terms grew be-
tween 1950 and 1960 over 50 percent. It was the
fastest growing large industry in the country, or
at least one of the fastest. There is some basis for
concern with the present balance of demand and
supply, but we must be cautious about accepting
certain categories which are easier to respond to
emotionally than to appraise critically. Let me
give you another illustration. I asked one of my
associates to check some figures for me yesterday.
I asked him to find out what proportion medical
personnel represented of total nonagricultural em-
ployment. In 1940, this segment was just over
3 percent, and in 1960 it was just under 5 percent.
These few figures should indicate again that the
health services market does respond to a rapidly
increasing demand. It may not respond as
quickly as you would like it, but it does move.

I want to describe briefly some of the character-
istics of the changing American manpower scene
before I present a few specific parameters and
make the linkages between the general scene and
your own concern. We now have what is called
in shorthand, a service economy : two out of every
three workers in the United States work in serv-
ices sector rather than in the goods producing sec-
tor. Agriculture, manufacturing, mining, and

 

 
construction, account for only one out of three
workers. Two out of three workers are in the
service sector.

These are some of the general dimensions of the
service economy. Kirst, the services tend to use
more highly trained people. Secondly, the ques-
tion of access to education and training therefore
becomes a crucial matter. Education is the deter-
minant, the path along which one acquires skills.
Thirdly, because of rapid technological progress,
there is rapid skill obsolescence, which in turn
means that one can never train just for entry jobs.
The next proposition is that, other things being
equal, the more education a person has initially the
more likely he is to remain attached to the field in
which he enters. However, this proposition must
be handled with caution when it comes to profes-
sionals, such as engineers and lawyers, since con-
siderable numbers of them do not remain in the
practice of their profession, but move horizontally
into general business or politics or administration.

The next point is that the service field has a high
proportion of women, and women continue to have
certain special characteristics. Among the most
important of these characteristics is that they tend
to be educated and trained at times different. from
men ; their attachment to the labor force is differ-
ent in that they prefer increasingly to work part-
time or part-year; and they enter, leave and return
to the labor force, differently from men.

My eighth point is that trade unions, until re-
cently, tended to be underrepresented in the serv-
ice sectors of the economy by and large. We now
begin to see a shift. They still tend to be under-
represented when the employer is a nonprofit and/
or governmental agency. There are some big
changes looming on this particular front. My
own guess is that the unions’ future strength will
lie in the not-for-profit sector; today, more and
more governments find it essential to permit their
employees to join unions if not to strike. In New
York, we have had a few experiences in recent
months with “service employees,” first the teachers
and then the subway workers.

The next point about the service fields is that
some of the workers tend to have low wages, poor
working conditions, and a limited range of fringe
benefits. This is not unconnected with the earlier
statement that the nonprofit sector and the govern-
mental sector have been characterized by a lower
degree of unionization, hence with lower wages
and less desirable working conditions.

One additional point: Economies of scale which
make it possible for people to be paid better, are
more difficult to introduce in the service area.
Management, the effective management of a serv-
ice operation, is frequently much more difficult
than the running of an automobile factory or any
kind of manufacturing plant. As a professor, I
know there are university presidents and there are
university deans, but the professors generally con-
tinue to do what they want to do. There are also,
then, limitations in how much efficient manage-
ment of professional groups can be instituted.

Now that I have listed some of the general back-
ground characteristics of our service economy, I
want to focus more specifically on your problems.
A long time ago I used to know something about
hospitals and medical problems, but recently I
have been far away from them. I keep a con-
tinuing interest in them but I may be oft base now
and again. First, I think it’s a great error to put
all the emphasis, as this Conference would suggest,
on supply and training. Supply and training is
simply one aspect of a general manpower problem.
If you move on the supply and training side only,
you will have a bag with a hole in it—you keep
putting water in the top of it and it keeps coming
out the bottom. Wages and working conditions
in a free society, in which people can decide what
they want to do, become an absolutely essential
part of a general attack on this problem. You
must provide for meaningful jobs and meaningful
careers. Turnover figures are strange and unre-
liable, but the turnover figures in your field are
very high. They're high partly because you have
a lot of women who inevitably tend to go in and
out of the labor market, but they are high also be-
cause you have a lot of people who don’t want to
stay. That is proposition number one.

Proposition number two is that initial training
can be important in helping you to recruit, but
people are concerned about what happens to them
after they get their first job. All first jobs have
somewhat questionable quality and yield question-
able satisfaction. Just think of the first job of a
newly graduated physician who may get the
munificent salary of $50 a week. Nobody is
really interested in his first job. He is interested
in what will happen over time. Unless you de-
velop training systems that are geared to systems
of promotion, that are geared to significant in-
creases in wages and fringe benefits, you don’t
have a true training program. Your efforts will

17
be largely wasted. You will be going through the
same system the Armed Services have followed,
that is, every year they take in hundreds of thou-
sands of people, they spend a tremendous amount
of money training them, they get very little service
out of them, and the people disappear. The
Armed Services have strengthened their system
slowly but surely only after they geared their
training system to a promotion and reward system.

Third proposition: The Federal Government is
now heavily committed to help alleviate the med-
ical manpower shortage through the financial
front. But don’t overestimate what it can or will
do. In the current issue of the Industrial Labor
Relations Review, Mr. Yett does an analysis of
the Nurse Training Act of 1964. His conclusion
is that despite the large sums that the Federal
Government is committed to spend for training
of nurses, the net effect on the recruitment of addi-
tional nurses may be negative. This backs up
my saying that unless the education and training
structure of the health field is correctly rooted in
the general occupation and training structure of
the community at large, it will never do the job.
Hospitals play a large part in the training of
various types of medical personnel all the way
from neurosurgeons to orderlies. 1 submit that

one of the great difficulties in the health manpower
field stems from the fact that hospitals were never

meant to be educational institutions. They are
not financed to be effective educational institu-
tions, and they are not staffed to be educational
institutions. We must work out a much closer
alignment between training of health manpower
and the rest of the educational and training facil-
ities in the United States that we rely on for rais-
ing the skill and competence level of the
population.

My fourth proposition is that although a wom-
anpower revolution has been underway since
World War II, it has been only a partial revolu-
tion. We have not adjusted the institutional
structures, from the college all the way to the em-
ployment situation, to the professional needs of
women. The further fact that, historically,
leaders in the nursing profession were single
women without the responsibility of family, made
them additionally insensitive, additionally aggres-
sive, about making adjustments. Under duress, I
suppose that even leaders learn. However, as re-
cently as 2 days ago, the New York Times said that
the Board of Education in our great city has finally

18

awakened to the fact that they could use teachers
who can work only half a day. I just want to call
your attention to the fact that lots of adjustments
are needed with respect to women who represent
such a large part of the total labor force potential.

My fifth proposition is even more difficult to do
any thing about, but I will call it to your atten-
tion. This has to do with the under-investment
of capital. Tam an economist and I see the ques-
tion of manpower utilization very much as a func-
tion of the total economic situation. In your
language this means, to what extent is the hospital
unable to make efficient use of people? If it does
not use people efficiently, you must have more
people: and in order to have more people, you have
to spread your dollars over a large number and
pay each one less. This creates the serious situa-
tion of having to function with antiquated plants
and equipment. That is another way of saying
that the public is under-investing in hospitals, and
this forces one to operate in a manner which results
in poor manpower utilization. Yesterday’s news-
paper (Monday, February 14, 1966) reported that
the Jacobi Hospital at the Einstein Medical
Center in New York has moved toward sub-
stantial automation, with corresponding econ-
omies looked for in the use of manpower.

The sixth proposition is that any service for
human beings must inevitably be concerned with
quality, but it must not be concerned with quality
in such a way that it blocks itself. Of course, we
are interested in teachers and ministers and nurses
and physicians who are capable. But there is no
reason for a large industry to establish unneces-
sarily high standards. For example, despite the
efforts nursing leaders, at least in some organiza-
tions, have been making to attract more nurses
with baccalaureate and master’s and even doctor’s
degrees into the system, the hospital administra-
tors have been buying a different type of personnel
on the market. They have apparently been in-
terested in two practical nurses rather than one
baccalaureate nurse. From this I conclude that
they have made an assessment about manpower
utilization different from that made by the heads
of the profession.

I just want to call your attention to the fact that
while quality is a consideration of importance, it
can be an umbrella for many different kinds of
machinations. Some years ago I visited the Men-
ningers in Topeka. TI asked them to give me their
estimate of the qualifications of a good ward at-

 
 

tendant. They said that a man with an eighth
grade education, with the right personality, the
right spirit, and the right inclination, would be a
better attendant than a college graduate with the
wrong inclination; that the emotional determi-
nants are much more important than the intellec-
tual determinants. If you stop and think about it
for a moment, it is clear that this should be so. A:
man with some education who can live in an en-
vironment made up of people who are mentally ill
and find that satisfying is better qualified for this
job than the individual with a lot of degrees.

So far, I have put forth easy propositions. The
most serious barrier to effective manpower utiliza-
tion in the health field that I see is the fact that
each group is not strong enough to fight success-
fully against the group which is higher on the
ladder and which spends most of its energy pre-
venting those below from moving up. The
struggle for social prestige and market power be-
tween physicians and nurses, and the nurses and
the technicians, the technicians and the practical
nurses or auxiliary nurses, etc., makes any rational,
long-term policy for manpower utilization so diffi-
cult to realize. People are motivated to work by
the possibility of advancement, of growth, of de-
velopment, of progress. And until very recently,
a nurse who had just received her diploma often
received the same pay as a nurse who had had 40
years of experience. I know of no barrier more
important to the sensible development of the
health service field than this confrontation of pro-
fessional and subprofessional groups, fighting it
out with each other, for the dollar in the first
instance and, secondly, for the prestige that
follows the dollar.

Now, the health service field does not have
enough leverage to remedy this situation alone.
Obviously, the people at the top of the pile do not
want to remedy anything; they want to leave it
strictly alone. The people at the bottom of the
pile are simply too weak to do anything. The
way these kinds of problems get resolved in our
type of free society is that if enough attention is
given to the situation, it will eventually begin to
give at the margin. If a woman finds out that if
she takes a course in practical nursing for twelve
months, she can earn almost as much as a regis-
tered nurse earns after a course of 3 years, that
starts to muddy some water. Supplies begin to
shift in accordance with relative wages.

In psychiatry, for example, they have gone to
ridiculous lengths in controlling the training, so
that a man may not finish his psychiatric training
until he is 40 years of age. At that point there are
all kinds of competition on the margin and people
may decide that to get help it isn’t important
whether the practitioner studied anatomy, physi-
ology, biochemistry. I do not suggest that these
subjects are unimportant ; and the medical schools
may yet agree. I am just reporting how the pub-
lic finally responds to these facts of life. There
are tensions in the situation, and they are not all
bad. Perhaps health manpower must live in a
perpetual crisis; in that case it is important to
think our way through long-term solutions that
make sense rather than short-run solutions that
will not pay off.

I will end with these comments. First, the in-
adequate financing of education and training in
the health service field in general is still a major
challenge to the public. Although the Federal
Government’s action is helpful, I do not think we
have yet taken the basic steps to come to grips with
this facet of the phenomenon.

Second, any good education and training is
costly to the institution and society, and can be
very costly to the individual who has to forego
earning power and may have to pay a considerable
amount of tuition. This implies the desirability
of making sure that you have the kind of training
system you need, dovetailed to insure that people
do not get too much training at the wrong time or
too little at the right time, since training is
a prerequisite of personal advancement and
progression.

Third, I will go out on a limb with regard to the
training of nurses. By now, we should have moved
to a basic 2-year registered nurse training pro-
gram. However, many nurses have continued to
insist on the 3-year program, partly because the
hospitals need the nursing services which students
provide. But this ignores the realities of the mar-
ket place.

My fourth and final point is that this problem
will never be solved, because the level of demand
for medical services will be determined by the sup-
ply. Whatever the supply, the demand will al-
ways rise to a litle bit beyond it. We have lived,
and we will continue to live, with the problems of
medical manpower shortages. We must reconcile

19

 
ourselves to it, just as we reconcile ourselves to
living in a nuclear age. There are better ways to
live with the nuclear bomb, and there are better
ways to cope with the manpower shortages. But
if at all possible, you must use what you call the
“crisis,” and what I call the “chronic condition”

20

to learn (1) more about the people whom you are
trying to recruit and train; (2) more about your
own values both with respect to medical service
and training; (3) more about methods of training;
and (4) more about the relationships of training
tothe whole wage and career structure.

 
HEALTH MANPOWER NEEDS AND REQUIREMENTS

PHILIP D. BONNET, M.D., President, American Hospital Association

A well-known columnist recently wrote two ar-
ticles on the subject of health manpower, in which
it was reported that one million additional work-
ers in the health professions and occupations are
needed now and even more millions will be needed
in the years ahead. Among the reasons given for
the shortages were: (1) Increased spending on
health services—more than doubled in the past
decade; (2) Increased sophistication of demand;
(3) Medical advances; (4) Expansion of health
insurance, welfare programs; (5) Increasing life
span; (6) High costs of medical education and
training. The writer estimated that there are now
more than three million workers in the “health
business,” and health business is one of the most
rapidly growing businesses in the nation—out-
ranking all but education in rate of growth—and
exceeded in numbers only by the traditional
giants—agriculture and construction. “Narrow-
ing the career gap in the health services will be
exceedingly costly. But what will be the cost to
you and me of not ending the critical shortages?
The cost easily could be our lives.” *

These two articles clearly reflect the attitudes
not only of this well-informed columnist but gen-
erally also that of the American public. Some of
the facts are as follows:

*From Sylvia Porter's syndicated column Your Money's
Worth. This quote appeared in the second of two articles
in the Washington Evening Star, January 12, 1966, under
the title “Careers in Health Services.” The first article,
entitled “Health Services in Need,” appeared the day be-
fore, on January 11, 1966. [Ed. note.]

 

In 1950, there were 1.6 million workers in all
health services of which 52 percent were pro-
fessional or technical workers—that is those re-
quiring special education and formal training.
In 1960, this number had increased to 1.95 million
workers, of which 71 percent were professional
and technical. In 1965, the numbers had become
about 3 million workers of which about 76 per-
cent were professional and technical. These
figures indicate two things: the rapid rate of in-
crease in the number of health service workers
and the continuous upgrading of qualifications re-
quired of them.

About two-thirds of all health workers work
in hospitals or other patient care institutions.
This proportion has increased from about one-half
in 1945.

Concerning health manpower there seems to be
quite universal agreement on just about one
thing—that we need more. But how many more
we need; and how many more of what; are just
two of scores of questions for which the answers
have not yet been found and for which the answers
can only be educated guess work.

Isaiah Bowman, the great geographer, once said
that Chesapeake Bay is a body of water sur-
rounded by study commissions. I think that this
is true of many of our health problems and we are
often quick to respond to a question by saying
that another study is needed. I think that more
exact information on our needs at the present
would be desirable, but perhaps we may be looking

21
too much at the present instead of at the future.
Perhaps our next efforts should be toward fore-
casts rather than precasts. Certainly we need to
realize that facility planning without personnel
planning can be wasteful. There is now an en-
couraging trend, however, toward a greater recog-
nition of the need for orderly planning to encom-
pass people as well as pillars.

The manpower problem has been viewed as four
large sections: The physician, the dentist, the
nurse, and all the other paramedical callings.
How many doctors there are and what kind of a
doctor he is and what he does, how many nurses
there are, what kinds of nurses they are and what
they do, and, for example, how many physical
therapists and social workers and pharmacists
there are among 20 or 30 different paramedical oc-
cupations—these are all interacting problems af-
fected by a variety of social, economic and scientific
forces. We cannot fully measure our manpower
needs until we are able to measure the efficiency of
utilization of the manpower we have, the man-
power we say we need, and the manpower we get.
I, for one, do not claim that we are using our
present manpower resources as well as we might.
The nature of health services carries with it the
necessity of providing an individualized service for
each different sick person and this imposes
definite limits on how far we can go in mechaniza-
tion, depersonalization and reduction of personnel
hours. Nevertheless, a way must be found to in-
crease the direct patient service component of hos-
pital staffs and at the same time to reduce the in-
direct service and administrative components of
health care programs.

We are all fully aware of the rapidity of scien-
tific advances and its enormous impact on and its
transformation of the medical care system, es-
pecially that which revolves about the hospital.
In addition, but as yet unmeasured, is the impact
on health services and manpower needs of the steps
just taken through legislation: the Social Security
Amendments of 1965 and the Heart Disease, Can-
cer and Stroke Program of the same year.

Most of what I say today will be centered on
hospitals. This stems from two sources. (1) I
have spent most of my professional life in hospital
administration and (2) the hospital as an institu-
tion has been a source of much measurable infor-
mation as to resources and needs. All that is said
here should be understood within this limitation
and should recognize that the provision of health

22

service outside of hospital programs will make
whatever estimates are made here understatements
rather than overstatements.

We all seem to be agreed that we need many
more doctors just to keep abreast of our physician-
population ratio currently about 133 per 100,000.
We are moving rapidly and vigorously to build
and expand medical schools in order to run as fast
as we can to stay where we are. There is similar
support for schools of dentistry, nursing and pub-
lic health. Building buildings, however, isn’t
enough and more substantial aid to students of all
kinds will be required if we are to attract an in-
creasing number of students to the health
professions in competition with other career
opportunities.

Numbers alone aren’t enough. How will the
physicians and the other health workers be dis-
tributed? I do not mean just geographically.
I am thinking more of the distribution of physi-
cians between a specialty and general practice and
among the various specialties. Have we enough
general surgeons and not enough ophthalmolo-
gists? Similar questions arise with respect to
nurses, technicians, social workers and therapists.
As specialization increases with “know-how,”
people become less and less interchangeable with-
out additional education or training.

The most significant influences on our need for
health manpower will be the nature of the prac-
tice of medicine, the nature of medical technology
and the organization of medical care services in
the years immediately ahead. As specialty ad-
vances, teamwork in some form becomes more
and more necessary. Up to now the hospital has
been the focus of most efforts to develop teamwork
among physicians and their coworkers. It ap-
pears likely that the hospital will continue to offer
and to enlarge the opportunity for teamwork.
Effective teamwork under expert physician leader-
ship may in time offer a major part of the answer
to the more effective use of scarce, skilled, educated
personnel.

Full time personnel in all hospitals increased
on the average 50 percent between 1953-62. In
acute short-term hospitals, the increase was 68 per-
cent. About half of these increases were due to in-
creased numbers of patients. The other half was
due to intensification of treatment, more rapid
turnover, and improved techniques. Though it is
unlikely that this rate of increase will continue,
it is altogether likely that full time personnel in

fa SST S———————————_—_—_—__——
hospitals will need to increase at least 20 percent
every 10 years. This means that hospitals alone
will require at least 20,000 additional workers each
year and that there will be commensurate increases
in all other health service programs.

Let us turn to the problem which occupies more
of the attention of the administrators of our Na-
tion’s hospitals than any other of the many man-
power problems—the availability of nurses. We
hear occasionally of a few bright spots around the
nation where hospitals have all the nurses they
need, but here again one man’s ease is another
man’s shortage. There are now budgeted vacan-
cies for at least 75,000 registered nurses and 25,000
licensed practical nurses. The desirable ratio of
nurses per patient varies sharply from the figure
in the northeastern United States, where I live,
downward in other areas of the country. The
most recent national study of nursing was by the
Surgeon General’s group in 1962 which reported
that there were approximately 550,000 registered
nurses employed in United States hospitals and
allied health institutions, 225,000 practical nurses,
and 400,000 nursing aides. One must remember
that no matter what the facts of the situation are
right now, they would undoubtedly have been
much worse had it not been for the vigorous efforts

of nurses and hospitals to train and utilize a type
of supportive nursing personnel, the nursing aide.
Without the 400,000 of them in our hospitals, the

situation would be worse than it is. The use of
large numbers of practical nurses, 225,000, in addi-
tion to nursing aides, nearing half a million,
underline response to changed requirements of the
nursing profession. We hear pleas for a return to
the good old days when the nurse was a bedside
nurse and did everything for the patient and the
physician. But those days have gone and will not,
return. The modern professional nurse not only
does many complex procedures that were unknown
a generation ago, but now from the moment of
graduation is called upon to employ supervisory
and managerial skills that often have not been
taught nor has an opportunity to learn them been
provided.

The Surgeon General’s group reported that
ideally by 1970 we should have in our hospitals and
health facilities 850,000 registered nurses and
350,000 practical nurses and 300,000 nurses’ aides.
This compares with the actual figure in 1962 of
550,000 R.N.s, 225,000 practical nurses, and
400,000 nurses’ aides. The reduction in the 1970

estimate of the need for nursing aides is a reflec-
tion of the Surgeon General’s group that too much
of the nursing service in some of the hospitals is
given by nonprofessional and inadequately trained
nursing personnel. Realizing that the goals it had
just set were unrealistic, the group scaled them
down from 850,000 registered nurses to 680,000 by
1970 leaving the figures for practical nurses and
nursing aides unchanged. But these are large
goals and T do not think we have a chance of
reaching them without some new and as yet un-
known approaches to improve working conditions
and social recognition of nurses. The greatest
problems occur during the “off-hours”—the even-
ing period, the night period and weekends.

The area of this burgeoning mixture of occupa-
tions about which we know the least and which like
the submerged part of the iceberg is probably the
largest of all, is the paramedical sector, that great
diversity of activities ranging from such well
known professional functions as pharmacy and
dietetics to such newer personnel as cytotechnol-
ogists, nuclear medicine technologists, and inhala-
tion therapists. The Department of Labor’s recent
revision of the excellent study by the National
Health Council on Health Careers lists in its
Health Careers Guidebook 200 health career oc-
cupations. This is an area where our knowledge
is limited and where the impact of Medicare
may be most important. It is to be expected
that the hospital patient profile will be materi-
ally affected by the over-65 admissions, bring-
ing additional need for rehabilitative services
such as physical therapy. The home care
programs will certainly accentuate the need for
social workers so that the patient can be trans-
ferred from the acute hospital of the extended care
facility to the home when proper care can be given
in that home. The American Hospital Associa-
tion and the Public Health Service are cooperating
at the very moment in a survey of such manpower
resources and needs in hospitals. We hope that
the survey will help us do the kind of forecasting
needed. We have modest hopes for it, but we
trust that it will give us some reasonable guide-
lines as to our needs for a few years ahead, and
what is required to meet those needs. In phar-
macy, some 45 percent of our hospitals do not have
a pharmacist on their staff, in spite of the fact that
the number of full- and part-time pharmacists in
hospitals has doubled from 3,000 in 1947 to 6,000
in 1962. A professional estimate is that 10,000

23

 
will be needed by 1975. The emphasis on hospital
care and the provision of financing for out-of-hos-
pital services in Public Law 89-97 may make even
this too small a figure.

The American Association of Nurse Anesthetists
has stated that it is hard to see how we can double,
much less triple, the supply of nurse anesthetists,
as we ought to.

With respect to qualified laboratory workers,
who must cope with steadily increasing numbers
and complexity of laboratory procedures, the head
of the American Society of Clinical Pathologists
believes that to achieve a proper ratio, the number
of medical technologists in hospitals should be
doubled. The American Association of Medical
Record Librarians believes that we need almost
twice as many medical record librarians as we now
have. Thus while I have stated that complete re-
liable data are hard to come by, because of differ-
ent methods of counting noses and different
definitions in use, there is general agreement
among informed and knowledgeable people that
the number of health workers should be substan-
tially increased.

I would like at this point to make a few general
comments on the hospital as an educational institu-
tion and, as I put it, education with a big “E,” not

on-the-job or inservice training programs, but as
offering educational courses leading to some sort

of formal certification. Dr. Crosby, the director
of the American Hospital Association, estimated
2 years ago in his presidential address to the
National Health Council, that approximately
300,000 health personnel are in formal educational
programs in U.S. hospitals at any given moment.
This makes the hospital a large and important
educational institution, a responsibility that hos-
pitals have not always understood properly, with
imbalance between service experiences and educa-
tional quality, whether it be intern, resident, or
nurse. Now we have many understandable but
potentially disconcerting differences of opinion on
the educational role of the hospital. There are
some who argue that the hospital should have no
responsibility for education, even though lending
its facilities for field experience. There are others
who argue that hospitals should acquire educa-
tional charters and specific funds to support edu-
cation. In face of the large and growing demar-';
for more educated manpower, it appears that all
educational programs by whomever sponsored
should be expanded, with upgrading where neces-

24

sary to meet appropriate accreditation standards.
As noted above, there are some 300,000 health per-
sonnel in training at any one time in all hospitals.
In most cases each program is independent of
every other even within a single hospital, in spite
of substantial amounts of common subject matter.
All deal with aspects of disease, human anatomy,
physiology, and of management. A core curric-
ulum and a common portal are perhaps useful
devices for increasing the availability and effec-
tiveness of faculty members. Programed instruc-
tion too may extend the effectiveness and
productivity of teachers.

There is an employment market in hospitals
that might be used to meet several goals, simul-
taneously relieving manpower shortages and also
providing economic assistance for some of the
unskilled and unemployed. The American Hos-
pital Association’s Research and Educational
Trust has entered into a contract with the Depart-
ment of Labor for $1.6 million to provide financial
assistance from Federal funds under the Man-
power Development and Training Act for hos-
pitals to train beginners for such jobs as nursing
aides, orderlies, ward clerks, and housekeeping
and dietary aides. This is a start but it must not
be overlooked that hospital and health services
require a high standard of performance and spe-
cific training for personnel in nearly all positions.
Hospitals cannot safely use the unemployable,
the incompetent, the undependable. There must
be “no margin for error” in employee performance.
It should be obvious by now that we are sorely
pressed to meet our present demands for health
services and must face the prospect of a further
aggravation of this situation because of an increas-
ing demand for health services, a demand that has
been spurred on by recent health legislation.
However, the prospect is not all bleak. The health
services “industry” may become a mainstay of
our employment market even more than it is to-
day. As I told the American Hospital Associa-
tion at its last annual meeting in San Francisco
last year, investment in health and in reduction
of sickness and liability can be among the most
significant contributions to increasing productiv-
ity and continuing prosperity. More scholarly
studies of the role of health services in our economy
are urgently needed. The hospital is essential,
and, though expensive, is economically produc-
tive. Expanded medical and hospital services,
along with educational services can—and in my

 
 

opinion must—provide a large number of new op-
portunities for productive effort by those young
people who will in the future not be needed for in-
dustrial and agricultural production of the mate-
rial necessities of life.

There remain many problems to be faced:

1. How can health service occupations be made
more attractive and satisfying to larger numbers
of students and prospective employees? Among
other obstacles are the emotional resistance of
many people to work involving sick people and the
necessity for staggered schedules to cover the
7-day week in a 5-day society.

2. Are we overtraining and overeducating some
personnel with resulting frustration and dis-
appointment ?

3. Are the rising requirements for certification,
registration and accreditation realistic, adaptable
to changes, and justified or are they becoming
rigid, unrealistic, and restrictive ?

4. Can we enlist the public in a program to
keep well, to prevent illnesses and accidents to the

end that the additional health personnel needed
can be held to a reasonable and feasible proportion
of the work force?

5. Do public attitudes give sufficient support and
recognition to all health service occupations ap-
propriate to their importance?

In summary, the problems of Health Manpower
require major attention to:
Recruitment.
Education and Training.
Working Conditions and Job Satisfaction.
Social and Economic Recognition.

More information through surveys and studies
is desirable. The answers to current needs how-
ever cannot await the results of such studies. The
problems are now and we must begin to solve them
now by increased effort. Furthermore, surveys
will only reveal what the situation is in the recent
past and present. They do not decide or indicate
what ought to be. Such value judgments—of
what ought to be and what is desired—must come
from the wisdom of professional, political, and
public leaders.

25

 
    

  

ROBERT E. KINSINGER, Ed.D., Director, Community College Health
Careers Project, The University of the State of New York

Identification of a trend in any field is a hazard-
ous activity as many a bankrupt businessman can
testify. Efforts to anticipate trends are often
compounded of wishful thinking and highly un-
scientific spot checks. Even if enough substantial
information has been gathered to warrant a some-
what objective analysis, the vagaries of people
may well upset a well-developed case just 1 month
after the facts are in. In the health field, we fre-
quently do not have even quantitative data. This
is particularly true of education and training for
health service workers.

In spite of these difficulties, it is possible to iden-
tify with fair certainty several trends in the train-
ing of health service workers; trends that are de-
veloping as a direct response to changes in social
and educational patterns and health service prac-
tices. Some of the forces at work are:

1. The knowledge explosion.

2. Increasing use of medical services and ex-
panding health services.

3. Changing roles of ancillary personnel in the
health field.

4. Development of a multimedia approach to
instruction.

5. New concepts in the use of auxiliary per-
sonnel by professionals.

These forces have, in turn, resulted in several
educational trends:

26

TRENDS IN EDUCATION AND TRAINING OF HEALTH SERVICE WORKERS

 

1. A process analysis approach to curriculum
planning.

2. Recognition of levels of health workers.

3. Identification of the unique and appropriate
contribution of a variety of institutions to educa-
tion and training for health workers.

4. Innovations in providing clinical experiences
for college students.

5. New efforts at interorganization and regional
planning for education and training.

6. Greater
concept.

use of the “Core Curriculum”

7. Applications of multimedia to education for
health workers.

8. Increased emphasis on counselor training for
the health field.

9. Greater educational mobility for students be-
tween institutions and programs.

10. New programs for teacher preparation.

It is particularly important that these trends
be identified early and guided in a constructive
way to avoid an unfortunate duplication of efforts
and a confused overlapping of official and semi-
official “standards” as well as jurisdictional claims
and counterclaims. Within the time limit avail-
able, T would like to discuss some of these trends
as they are influencing and will continue to in-
fluence education and training for health workers.

 
 

First, we must recognize that the traditional
health team of doctor, dentist, and nurse can no
longer serve, without assistance, the health needs
of patients. There is no need to labor the point;
the evidence is on all sides. However, to bring
the picture dramatically up to date in terms of the
magnitude of change in the composition of the
modern health team, let me quote from the recent
Coggeshall Report, Planning for Medical Progress
Through Education. “Once it took only one doc-
tor to resign himself and the child’s parents to the
inevitable death of a ‘blue baby.” It now takes
a team of medical specialists and auxiliary person-
nel to correct the congenital abnormality of a
baby’s heart to insure the child a normal life span.
At least 15 persons, including four surgeons, are
needed in the operating room for the repair of a
congenital lesion of the heart. More than 100
medical specialists, nurses, and skilled technicians
are involved in preparations for, and performance
of, the operation and in the post-surgical care of
the patient.” !

Simply stated, the knowledge explosion has
overwhelmed the health field, as it has so many
other areas of human endeavor. It takes many
more skilled hands to apply modern medical
knowledge. The physician increasingly must an-
alyze, 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? Per-
haps 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 re-
sponsibilities and the consequent changes in edu-
cational requirements.

ORIGINAL RN
FUNCTIONS AND
ACTIVITIES

ALLIED HEALTH
WORKER NOW
PROVIDING THE
SERVICE

Dier THERAPY DieTICIAN

Mzpicarn SociaL
WoRrkER

SocianL  ServicE—related
to disability, hardship,
etc.

223-124 0—66——3

 

CENTRAL SUPPLY
TECHNICIAN AND
WORKER

CENTRAL SUPPLY SERV-
ICE — cleaning,  wrap-
ping supplies, steriliz-
ing packs, etc.

REecisTERED MEDICAL
Rrecorp LIBRARIAN

Mepicarn.  Recorps—main-
tenance of charts, rec-

ords, discharges, ab-
stracts, etc.

RecreaTION T'HERAPY—0ac- RECREATION THERA-
tivities, games, amuse- pist and volun-
ments, reading materi- teers, candy-strip-
als, ete. ers, etc.

RenmapiLitatioNn Tuerary  Puysican THERAPIST,

(OCCUPATIONAL
THERAPIST

OPERATING Room
TECHNICIAN

OperaTiNG Room, Drriv-
ERY RooM—scrub nurse,
circulating nurse, etc.

Licexsep Pracrican
Nursk, aide, order-
ly, etc., volunteer

Bepsipe Nursing

INmavaTioNn THERA-
rist and Bromep-
ICAL ENGINEERING
TecHNICIAN

NURSING SPECIALTIES : Re-
covery room, postopera-
tive nursing care, mon-
itoring devices, hypo-
thermia techniques, use
of pacemakers, etc.,
oxygen tents, cannulae,
ete.

EMmproymMeENT INTERVIEWS PERSONNEL DIRECTOR

(for nursing service)

ADpMINISTRATION (nursing Warp MANAGER

unit)

If other existing allied health professions are
added to this list as well as those still emerging or
anticipated, a vast and complex educational job
is indicated. What approaches are being taken
to expand the education and training for health
workers? First, 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 contin-
ually changing. Not only must individual cur-
riculums change as medical practice changes, but
planners must be alert to demands for new cate-

27
 

gories of personnel. To help educators relate
specific levels of preparation and service to the
broad spectrum of health service personnel (pro-
fessionals, technicians, and practical aides), the
following chart has been prepared.

 

THEORY—SKILL SPECTRUM IN THE
HEALTH FIELDS*

 

Turory RESEARCH SCIENTIST

 

Puysician AND DENTIST
PRACTITIONERS

 

PARAMEDICAL-PARADENTAL :
R.N. (B.S)
Dietician
Pharmacist
Medical Record Librarian
Occupational Therapist
Physiotherapist

 

TECHNICAL ASSISTANT:
X-ray Technician
R.N. (A.D.N.)
Medical Record Technician
Dispensing Optician
Occupational Therapy Assistant
Inhalation Therapy Technician

SKILL

 

PRACTICAL ASSISTANT:
Licensed Practical Nurse
Psychiatric Aide

 

AmE:
Orderly-Nurse Aide
Dietary Aide
Housekeeping Aide

 

*This chart was accompanied by a projected slide which
indicated that as the theory component increased, there
was a corresponding decrease in emphasis on the skill
component.

Can the hospital continue to carry the major
responsibility for financing, administering, hous-
ing, staffing, and planning for such a broad and
complex training responsibility? At one end of
the occupational scale the answer is probably
“yes.”  On-the-job education for aides, orderlies
and others who are almost exclusively concerned

28

with “how” and very little with “why,” may con-
tinue to be the major responsibility of the hos-

pital. The education of other diverse groups on
the subprofessional level requiring formal educa-
tion calls for large, professionally competent fac-
ulties, increasingly complex laboratory facilities,
and massive financial support. In these instances,
the education will probably move more and more
into educational institutions; into the high schools
on the assistant level, and into 2-year colleges on
the technical level. The hospital will become an
extension of the college campus—the clinical
laboratory.

Training Professionals To Utilize Technicians

A trend toward recognition of the responsibility
of professional practitioners to utilize more effec-
tively the skills and knowledge of technical per-
sonnel has been spearheaded by the dental profes-
sion. With financial help from the Federal
Government, dental schools have instituted pro-
grams 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 2”?

Innovations in Providing Clinical Experiences for
Students

The impetus for the recent trend to transfer
training responsibilities from clinical agencies to
educational institutions stems from economic con-
siderations, the tendency of high school graduates
to prefer the college setting for postsecondary edu-
cation, and problems encountered by hospitals in
recruiting and retaining qualified faculty. How-
ever, the specific innovation that has made the
shift in educational responsibility possible is a

 

 
relatively new technique for utilizing clinical
agencies as extended college campuses or clinical
laboratories.

An earlier relationship between colleges and
hospitals called for paramedical students to begin
with courses in general education and to develop
their background in the physical and biological
sciences on the college campus. The student, sub-
sequently, moved to the clinical agency where he
came under the tutelage of agency personnel.
Here he was exposed to the occupational setting,
gained specific occupational know-how, and prac-
ticed clinical skills on-the-job. The inevitable
conflict between education and service frequently
plagued the instructor-practitioners and ham-
pered the process of student assignments for clin-
ical practice. A more recent approach calls for
occupational instructors (nurses, laboratory tech-
nologists, or whatever their field) to function as
full-time members of the college faculty. These
instructors integrate their teaching with the col-
lege humanities and science courses and accom-
pany their students to the clinical agency to select
appropriate clinical experiences for students.
The college instructor takes full responsibility for
supervising the student’s learning experiences
during the time that the student works with pa-
tients in the clinical agency. This arrangement
requires a carefully developed and continually
evaluated plan based on a written contract be-
tween the clinical agency and the college. The
contracts vary with the institutions and the cir-
cumstances, but they usually are built around one
key responsibility of the clinical agency and an-
other central responsibility of the college, namely :

A. The clinical agency agrees to provide oppor-
tunities for clinical practice and for observation
on the wards and in the various departments of
the agency.

B. The college agrees that its instructors will go
through proper agency channels to make plans for
observations and for clinical experience and that
college instructors will provide all supervision
and instruction required in the program.

Movements Toward Interorganizational and
Regional Planning

Another trend, one of the most promising, is an
increasing movement toward interagency and

multidiscipline planning for education and train-
ing in the health field. There are a number of
encouraging examples. I will not attempt to cite
all of them or even suggest which are the most
important. This Joint Conference on Job Devel-
opment and Training for Workers in Health
Services is a case in point. Plans are being
formulated within the Department of Health,
Education, and Welfare to convene interdis-
ciplinary planning groups. A division of the
U.S. Office of Education already has a standing
Advisory Committee on Health Occupations Ed-
ucation. The work of the National Commission
on Community Health Services generated 70 rec-
ommendations regarding health manpower. Also
extremely promising are two newly formed inter-
organization committees on health technology ed-
ucation: one between the American Association
of Junior Colleges (AAJC) and the National
Health Council and another between the AAJC
and the National Council on Medical Technology
Education. The AAJC and the National League
for Nursing have had a similar interorganization
committee for many years. Writing on “The In-
creasing Role of Paramedical Personnel” in the
September 1965 issues 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 so-
lution to the problem of training in specialty areas
where shortages exist. Technical education in
many paramedical specialties could easily be ac-
complished in a two-year curriculum which would
also provide an opportunity for . . . liberal arts
subjects.” ® In the light of this statement it is
important to note that the first task the AAJC-
NHC committee has set for itself is that of writing
guidelines for the development of sound educa-
tional programs for health technicians at the jun-
ior college level.

In a few areas, regional study and planning
groups comprised of employers, practitioners, and
educators ave providing a framework for mutual
planning regarding education for the allied health
professions. As I suggested at a recent confer-
ence, “without such an Allied Health Professions
Regional Education and Training Council, or
some similar organization, health needs of our
citizens will continue to be poorly served by the
existing laissez-faire attitude which forces each
health agency and educational institution to make
a unilateral assessment of educational priorities

29

 

 
 

and educational practices. Hospitals will con-
tinue to establish training programs in despera-
tion when forced by crises created by personnel
shortages. Colleges will establish or expand pro-
grams only when government or philanthropic
funds are offered for a particular program or
when an unusually persuasive professional associa-
tion gains the ear of a college administrator or col-
lege board member.” *

The ‘“Core Curriculum’ Concept

The development of a “core curricnlum” at com-
munity colleges offering several occupational pro-
grams for health service technicians is a promis-
ing trend. Curriculum study groups have identi-
fied general areas of knowledge, skill, and under-
standing common to all health technologies.
These commonalities constitute the basis for a
beginning curriculum pattern for all students
electing the health field. College instructors and
facilities can be utilized with increased efficiency if
such a health technology foundation program is
offered to all entering students who think they are
interested in the health service field. In addition
to building a common scientific base for the tech-
nology they will study during subsequent semes-
ters, students are introduced to a broad spectrum
of career opportunities and assisted in selecting a
specific career for which they have demonstrated
interest, ability, personality, and character. “Core
curriculum” students:

1. Become oriented to and gain understanding
of health service resources.

2. Gain understanding of and experience with
team relationships.

3. Become acquainted with health field ethics.

4. Gain beginning knowledge and understand-
ing of pathophysiology and pathopsychology.

5. Gain an understanding of how diseases are
treated.

6. Develop beginning skills in maintaining en-
vironments conducive to patient welfare.

7. Gain skills to achieve and maintain asepsis.

30

Recruitment is also simplified if students can be
attracted to programs leading to careers in the
health field generally, rather than requiring them
to make a premature choice of a technical specialty
based on a less than complete knowledge of the
fields from which they may choose.

The Use of Multimedia

Promising ways to stretch instructional talent
have burst upon the educational scene in great pro-
fusion during the past decade. Programed in-
struction has been utilized in a number of ways for
the education of health workers. At one extreme,
programs have been developed for physicians on
the diagnosis of myocardial infarction. At the
other end of the scale, an elementary program for
aides and orderlies teaches medical terminology
by making extensive use of mnemonics.

Television has been employed imaginatively to
provide for transportation, magnification, mem-
ory, transformation, associations, and image multi-
plication. New experiments in connection with
clinical teaching promise dramatic instructional
breakthroughs. Groups of hospitals, anxious to
share master teachers in the process of upgrading
supervisory skills of their personnel, are paving
the way to more efficient use of the best teachers
by using television for inservice education.

The most recent efforts to merge education and
technology have called for applications of com-
puter science to the problems of education for the
health field.

An experience may be simulated and, through
dialogue with the computer, the student can either
be taught how to deal with the situation or be
tested on his ability to cope with it. An example
from an actual dialogue from a medical program
will illustrate the point:

A hypothetical situation has been presented to
the student and he must ask for various kinds of
information in order to make his diagnosis. Note
that he may ask for the information in the order
that he deems correct. The following exchange oc-
curs after a series of preliminary requests and re-
sponses. (The capitalized words are those of the
student, the others are the computer’s.)

COUGH?
Yes, developed yesterday.

BACKACHES?
No.

 
HEART EXAM?
Not enlarged to percussion but low-grade sys-
tolic murmur at apex. Otherwise normal.

ABDOMINAL EXAM?

Diffusely tender, splinting noticed in lower right
quarter and occasionally radiating to right flank
area.

THE GRIPPE!?

There’s insufficient information for any conclu-
sive diagnosis at this time. You're not being care-
ful!

MUSCULO-SKELETAL SYSTEM?
Essentially negative, except for generalized
weakness and aching.

EXTREMETIES?

Normal, except nail beds are questionably cya-
notic but difficult to determine because of patient’s
skin color.

RECTAL EXAM’
You're not being careful! The patient is too
acutely ill for rectal examinations.

LABORATORY REPORTS?

Fine. Which lab tests would you like to have
done?

RBC?

A red count will be done.
to you as soon as possible.®

Results will be sent

Far out? Perhaps, but computers represent an
important instructional trend. Computer termi-
nals can be placed at convenient locations at any
distance from the computer itself and be used at
each location virtually at the convenience of the
user.

Counselor Training for the Health Field

Brief note should be made of the need for con-
tinuing education for high school counselors and
others who are influential in steering potential
students into the most appropriate educational
programs for health careers. The Health Man-
power Source Book divides the spectrum of health
occupations into approximately 40 categories, and
the newly released Health Careers Guide Book
subdivides these into more than 200 separate
health occupations, including specialties and sub-
specialties. Even to keep moderately well in-
formed regarding these fields and the educational

opportunities leading to these careers is a monu-
mental task. There is a trend, only in its infancy,
to provide regular inservice education for counsel-
ors regarding health careers. A specific example
of this trend is the 2-week summer institute being
planned by the Health Careers Committee of the
United Hospital Fund of New York for this sum-
mer. Counselors from the greater New York area
will be offered an opportunity to bring their
knowledge up to date by working with leading
educators and employers of workers in the health

field.

The College Proficiency Examination Program

Several educational groups are hard at work
on plans for a program which will permit stu-
dents, by means of examinations, to acquire college
credit without regular college attendance. This
new approach may help overcome deterents to
ambitious individuals who wish to advance them-
selves on the vocational ladder. In the past, col-
leges have found it difficult to grant advanced
standing to health and related workers who have
received their initial training in other than colle-
giate institutions. A solution to this serious trans-
fer problem may be in the offing.

The essence of collegiate education is the learn-
ing that takes place. It ought not to matter when
or how the competence, knowledge or skill is ob-
tained if it is comparable to achievement ordinar-
ily developed by individuals who complete college
courses in the field. To help colleges determine
credit allocation for off-campus or out-of-course
learning, a College Proficiency Examination pro-
gram has been established by the New York State
Board of Regents.” The College Entrance Exami-
nation Board has recently created a Council on
College-Level Examinations to develop a similar
program on the national level. The examining
groups will not give credit—this is solely a matter
for the colleges—but they will certify that, within
the limitations of the examination, a level of per-
formance above the minimum required for earn-
ing credit in courses has been demonstrated.

The complexities involved in these new college
proficiency programs should not be minimized, but
they offer at least a ray of hope to those now
caught in the web of academic bookkeeping.

An even more important trend for promoting
student mobility and institutional articulation is
the development of programs in pre-technical edu-

31
cation. The comprehensive high school, Coopera-
tive Education Centers, and similar institutions are
developing a unique role in the field of education
and training for health service workers. In ad-
dition to establishing programs leading directly
to employment at the aide and practical assistant
level, they are becoming more and more interested
in pre-technical education leading to college tech-
nical programs. Under this program, students en-
roll during their 11th and 12th year in a course
of study which assures that they will have ade-
quate prerequisite courses in physical and biolog-
ical sciences and general education courses required
for community junior college entrance to a health
service technology program. During the last 2
years of high school, they learn beginning tech-
nical skills in the health field. The students are
exposed to a wide range of health technologies
through field visits to health agencies. In some
instances, they are afforded opportunities to per-
form tasks at an aide level in these agencies. The
pretechnical program coupled with intensive
student counseling should provide a much needed
feeder mechanism for health service technology
programs.

Health Agency Inservice Education

There seems to be a trend away from the unco-
ordinated establishment of on-the-job training
programs. Clinical agencies, forced by critical
personnel shortages to prepare workers for needed
agency health services, are tending to utilize com-
mon guidelines and teachers’ manuals prepared
by their own associations and by governmental
bodies. Many hospitals have long used the stand-
ards provided by the American Medical Associa-
tion’s Council on Medical Education and Hospitals
and by the National League for Nursing. They
are now receiving additional guidance from mate-
rials and consultants concerned with inservice
education.

Federal funds recently made available for these
programs are sometimes tied to curriculum guide-
line stipulations. These directives have also pro-
vided in many instances for consultants who have
in turn influenced the programs. An even greater
influence in this direction may result from the
recently launched American Hospital Association
project to develop a broad national program of
continuing education for personnel in the hospital

32

field. This project is being carried out by the Hos-
pital Research and Educational Trust.”

A Distinction Between Patient-Contact and
Nonpatient-Contact Occupations

The Bureau of the Census identified 2.6 million
individuals employed in the “Health Services in-
dustry” in 1960. This was a 54-percent increase
in the decade between 1950 and 1960. Recent
trends indicate even more dramatic expansion in
the near future. However, it is clear that various
categories of health workers are subject to differ-
ential growth rates. From the standpoint of edu-
cation and training, it seems important to draw a
distinction between two broad classifications of
workers in the health service field: (a) occupa-
tions that require the worker to provide a direct
service to an individual, i.e. patient contact, and
(b) occupations that support the operation of
health agencies and individual practioners, i.e.
institution and staff support. The emotional sta-
bility, maturity, and native sensitivity of candi-
dates for patient contact jobs is of a different vari-
ety than that demanded of those engaged in house-
keeping, business, laboratory, and supply functions
for institution and staff support. Both categories
are vital to the growth of the Nation's health serv-
ice capability. However, the distinction is impor-
tant when planning for job development and
training in the health field. The ill and otherwise
handicapped are least able to defend themselves
from inept service. Adequate education for those
who will be entrusted with the health of their fel-
lowmen, on whatever level, is seldom accomplished
through short-term, cookbook, training activities.

Teacher Preparation

The final trend I would like to discuss, is the
keystone of the entire educational arch and yet,
sadly, it seems to have the least momentum of all.
As Thomas Huxley observed, “It is much better to
want a teacher than to want the desire to learn,”
but, even assuming motivation and intellectual
curiosity on the part of students (a dangerous
assumption), the heart of any educational effort is
its corps of teachers. A wealth of clinical experi-
ences, ready access to a fine library, and even expo-
sure to practitioners worthy of emulation are only
important aids to the central ingredient : the com-
petent teacher.

 
Ambitious plans for a broad expansion of edu-
cational programs for health service workers have
dealt with curriculum organization, financing, stu-
dent recruitment, laboratory facilities, arrange-
ments for clinical practice, and textbooks. Very
little is being planned to build a trained corps of
instructors. A few universities have undertaken
programs, particularly in nursing, to enable an
individual to shift his vocation from paramedical
practitioner to accomplished teacher in the health
service field. Objectives for these teacher training
programs are based on the assumption that the
trainee is a competent experienced paramedical
practitioner. The composite goals of these pro-
grams are to enable the teacher trainee :

1. To become familiar with the underlying phi-
losophy and operating procedures of the educa-
tional institution in which he will teach.

2. To learn to use a variety of instructional
techniques, i.e., lecture-discussion, demonstra-
tion, independent study assignments, audio-visual
media, directed clinical practice, etc.

3. To organize a curriculum in his field using all
tools of instruction such as tests and measure-
ments, library resources, a variety of health agen-
cies for practice and observation, etc.

4. To bring his knowledge up to date in his
technical field and add to his depth of understand-
ing in this field.

5. To supplement, as appropriate, his general
background in the physical and biological sciences
and the humanities.

I end my discussion of trends under the rubric
of teacher training, because it is central to all.
Programs for identifying outstanding health
service workers and preparing them as instructors
must have top priority in any plan for job de-
velopment and training. Without such a corps of
teachers, energy expended on curriculum develop-
ment, facilities planning, student recruitment and
planning for financial support is misdirected.
When the teachers are available, the other facets
of the problem tend to fall much more easily into
place as we work toward the ultimate goal: a
trained manpower pool to serve the health needs of
all our citizens.

FOOTNOTES

1. Lowell T. Coggeshall, M.D., Planning for Medical
Progress Through Fducation (Association of Medical
Colleges : Evanston, I1l., 1965), p. 26.

2. William H. Stewart, M.D., Education for the Health
Professions (paper given at the White House Conference
on Health, Washington, D.C., November 3-4, 1965,
mimeographed).

3. Robin C. Buerki, M.D., “The Increasing Role of
Paramedical Personnel” The Journal of Medical Educa-
tion (September, vol. 40, No. 9, 1965), p. 852.

4. Robert E. Kinsinger, Role of the Allied Professions:
Education and Training (paper given at the White House
Conference on Health, Washington, D.C., November 3—4,
1965, mimeographed).

5. John A. Swets and Wallace Feurzeig, “Computer-
Aided Instruction” Science (October, vol. 150, 1965), p.
574.

6. Adapted from College Credit for Off-Campus Learn-
ing, an unpublished paper by Norman D. Kurland, Di-
rector, Center on Innovation in Education, New York
State Education Department, Albany, N.Y.

7. An American Hospital Association project to de-
velop a broad national program of continuing education
for personnel in the hospital field carried out by the Hos-
pital Research and Educational Trust.
 

THE COMMUNITY'S RESPONSIBILITY FOR HEALTH MANPOWER DEVELOPMENT

Hon. CHARLES VANIK, U.S. Representative, Ohio

I appreciate very much this oportunity to dis-
cuss with you the problems of community respon-
sibility for health manpower development. Dur-
ing the Floor debates on the Social Security
Amendments of 1965, many of my colleagues ex-
pressed concern on the adequate staffing of med-
ical facilities as the medical insurance program
came into reality.

I hope to be able to describe, at this time, the
process by which the Cleveland community has be-
gun to move in this area of providing a great num-
ber of training opportunities for the unemployed
and underemployed people in the city of Cleve-
land in the area of health occupations. While I
do not claim that the manner in which we carried
forward our community action program is the
only way to solve the critical shortage of medical
occupations personnel, it might serve as an indi-
cation of how a community might go about fulfill-
ing this important need.

On the 15th of October, my office sponsored an
all-day seminar on the new medical insurance pro-
gram, attended by representatives of all areas of
community health in Cleveland, from the Presi-
dent-elect of the National American Medical As-
sociation to members of the Senior Citizens Coun-
cil and Golden Age Clubs. For those of you who
are interested in looking at the results, I have
brought four copies of the verbatim transcript of
the day’s proceedings which will be available at the
back of the room for you to leaf through.

All of the groups represented officially at the

34

 

Conference had an opportunity to air publicly
their point of view with respect to the implemen-
tation of this new law. The meetings were ably
key-noted by Robert M. Ball, the capable Admin-
istrator of Social Security, and Wilbur Cohen,
the Under Secretary of Health, Education, and
Welfare who was so instrumental in the develop-
ment of this new law, during the long executive
sessions of our committee.

The panels were devoted to specific topics.
The last panel in the day was devoted to medical
and health occupational training and lasted for
1% hours. The panel members represented the
State Vocational-Education Office, the Cleve-
land Board of Education Vocational-Education
Office, the National Coordinator of Training for
the Economic Development Administration, the
Training Director for the Cleveland Hospital
Council, and the Director of Training for Medical
Occupation for Cuyahoga Community College
and a member of my staff.

It became clear, as this discussion progressed,
that it would be necessary for this panel to include
others involved in training to form a working
committee to carry the discussions about tech-
niques for training in this area beyond the lim-
itations of the 1-day Conference. Such a com-
mittee was formed and announced at the close of
the Conference and met shortly thereafter in my
offices in Cleveland.

My interest in the health occupations program
was twofold. My community included most of the

La

 
24,000 unemployed people of Cleveland. A health
occupations training program would help reduce
unemployment while, at the same time, produce a
critically needed supply of trained workers.

My next task was to find available Federal
funds toni this program. Since Cleveland
was a laborssupply area, I rushed over to Eugene
Foley of the Economic Development Administra-
tion and pointed out the high ratio of jobs created
to Federal dollars invested in this program. He
was enthusiastic in response and immediately as-
signed two staff members, William Batt and Ann
Gould, to work with my local committee to create
a Cleveland program.

Thereafter came weeks of conferences and prep-
aration. I was personally involved in eight long
conference meetings where I struggled to bring the
varied groups into a composite presentation.

One of our first requirements was to conduct a
census of medical employment needs by the ad-
ministrators of each of the hospitals in the Cleve-
land metropolitan area to determine how many
people could be trained or retrained to meet their
existing needs. This duty fell squarely on the
shoulders of the Cleveland Hospital Council, since
it already had the machinery to make such in-
quiries rapidly. The Hospital Council of Cleve-
land represents 42 metropolitan-area hospitals
with almost 12,000 beds.

Since we were breaking new ground in making
such determinations, it became necessary for my
office to make available to each of the administra-
tors copies of the Federal laws dealing with train-
ing to make the administrators aware of the Fed-
eral resources currently available for their use in
the area of training personnel.

I found understandable hesitancy on the part of
some hospital people about getting involved in
utilizing Federal funds for this purpose. Frankly,
the administrators were concerned that they would
lose control over the high standards of training
and ultimate level of competency which had been
established. After much discussion between the
representatives of the Federal offices responsible
for training within the Economic Development
Administration and discussions in which I person-
ally was involved, the hospital administrators sub-
mitted requests for over 1,300 training positions.
It, then, became the duty of the Ohio State Em-
ployment Service, working with Federal funds, to
make applications in conjunction with the local
school board as contractor for funds available

under Section 241 of the Manpower Development
and Training Act, as it relates to the Economic
Development Administration, since our city quali-
fies as a labor-surplus area under that act.

It has taken us from the date of our Conference
in the middle of October, to the present time to
reach the application stage. We have only until
July 1, 1966, until Medicare goes into effect. My
grave concern is that we will underestimate the net
effect of the activation of Medicare upon the med-
ical personnel shortages which might well result
after July 1.

We hope, in Cleveland, to submit our applica-
tions tomorrow to the proper Federal officials and
begin recruiting trainees in a very short time, so
that 6 or 9 months from now, we can begin fitting
adequately trained personnel into hospitals of
greatest need.

From these experiences, it can be observed that
a minimum of 5 months lead time must be con-
templated in preparing a community for health
occupations training program. The time required
may be longer if an area is not qualified to par-
ticipate in the special benefits of the Economic
Development program. As far as I can deter-
mine, every large city has extraordinary unem-
ployment at its core, a great portion of which is
not reported under available systems or census.
These are the people who appear nowhere as a
statistic. They are the unemployed who have
given up and no longer report at the State Em-
ployment Service office. They are supported by
their parents, their brothers and sisters, their chil-
dren and public welfare. Present programs do
not seek them out.

Ironically, these people, once found and trained,
may prove to be your best resource for health occu-
pations. Once trained, they may develop into the
core of permanent employees which is needed to
make your institutions run smoothly and meet the
demands of the Medicare program.

One of the great areas of resistance we had to
meet in the Cleveland program was the availabil-
ity of suitable trainees. The local Ohio State Em-
ployment Service reported that they were at the
bottom of the well.

They confronted me with this statement while
I was suffering the pressure of thousands of un-
employed who seemed to be searching for any kind
of employment hope. They simply did not fit the
skill demands of Ohio State Employment Service
jobs.

35

 
In my office, I use the case study approach to
unemployment problems. I find people anxious
to work. I have service case records of mothers
with children eligible for Aid for Dependent Chil-
dren who work and earn $7 per month more than
they would get by simply staying home. Employ-
able persons on ADC and ADCU would make
good candidates for work in the health occupa-
tions. They must be encouraged to work and
must receive a family settlement which they can
recognize as a worthwhile differential.

Manpower benefits must equal or better the pub-
lic welfare payments for subsistence so that we can
induce capable workers to move from dependency
to self-sufficiency. If we can succeed in making
capable health occupations workers out of the de-
pendent unemployed, the Federal investment in
training will produce benefits a thousand times the
training cost.

It is imperative for every community to antici-
pate the full impact of the Medicare program and
its critical need for added trained personnel. The
success of this vital program demands it.

The role of experts and the leadership of local
community groups in the development programs
is the key to assuring adequate staffing for our hos-
pitals and nursing homes, medical laboratories,
and extended-care facilities. It cannot and
should not be the responsibility of the Federal gov-
ernment to initiate such programs, since only the
local people, like yourselves, know the personnel
who will be required to provide adequate, high
standard medical care.

The use of Federal training resources should

never result in the lowering of your standards of
training or placement of personnel.
- Under the circumstances, it is vitally important
that hospital administrators and health occupa-
tional employees in any local area use these
Federal training resources for this important
work.

In this partnership of efforts, we will help each
other. You will receive trained personnel and
the community will combat unemployment.

The Cleveland program provides for the train-
ing of 1,315 health service workers in the following
categories:

1. HOUSEKEEPING SERVICES

a. Housekeeping Supervisor; 20 trainees, 10
weeks; maintenance of sanitary conditions.

b. Custodial Workers; 125 trainees, 14 weeks.

c. Laboratory Helper, 40 trainees, 10 weeks;
keep materials in order.

2. FOOD AREA SUPPORTIVE SERVICES

a. Food Service Supervisor; 40 trainees, 40
or 50 weeks.

b. Main Course Cook, 40 trainees, 20 weeks.
c. Dietary Aid, Counter Worker, Special Bar
Help Cook; 150 trainees, 12 weeks.
3. BUSINESS ORIENTED SERVICES

a. Medical Transcriber; 100 trainees, 36
weeks; general dictation, clerical and medical
terms.

b. Clerk Typist; 150 trainees, 24 weeks.

c. Nursing Unit Clerk; 100 Trainees; general
clerical and work on medical records-admissions.

4. PATIENT-CARE SUPPORTIVE
SERVICES

a. Orderly; 125 trainees, 10 weeks; work in
wards.

b. Nurse Aid, 200 trainees, 10-week course.

c. Psychiatric Attendant Aid (male) ; care of
male patients, physical work.

5. LAUNDRY ROOM SUPPORTIVE
SERVICES

a. Laundry Workers; T5 trainees, 10 weeks;
sorting, washing, shaking, pressing.

6. HOMEMAKER SERVICES

a. Homemaker; T5 trainees, 16-week course.

 
FEDERAL RESOURCES FOR TRAINING WORKERS IN HEALTH SERVICES

JOHN P. WALSH, Ed.D., Assistant Manpower Administrator,

U.S. Department of Labor

The need to structure pathways for the develop-
ment of the multitude of health service workers
required to man the emerging health programs
in a variety of agencies has been made clear for
all to see in the preliminary presentations and
discussions of the Conference. To deny that the
need exists or to assume that the supply of work-
ers in all categories is now in the wings waiting
for their entry would be futile in the light of the
demand factors displayed before the group.

Therefore, it is our purpose in this session to
review the array of Federal resources available
to assist in the orderly development of programs
designed to meet the determined needs. Such
a delineation of resources can best be achieved
through a systematic review of the several re-
source areas, legislation, agencies, and programs
coupled with an assessment of their inter-
relationships and possible integration in provid-
ing pathways to effective employment and man-
power utilization of our available human
resources.

Federal Resources Areas

The resources of the Federal Government which
contribute to the generation of adequate quantities
of qualified health service workers running the
gamut of employment needs can best be described
in three basic areas— (1) Technical Assistance
Support, (2) Research, Experimental and Dem-

   
 
 

onstration Support, and (3) Training Support.
A definite interrelationship exists between the
three areas, resulting in an interplay that provides
for effective overall assistance in program de-
velopment.

In effect, two basic areas undergird and supply
the base for the education and training action
area.

Technical Assistance Support

The area of technical assistance support is a
multifaceted one. It involves the application of
the professional competence of an array of tech-
nicians representing the several agencies of
government utilizing an abundance of governmen-

 
     
     
  

TRAINING
SUPPORT

  
   
   
   

TECHNICAL
ASSISTANCE
SUPPORT

   
  

R.E.D.
SUPPORT
tal data and know-how in a wide variety of activi-
ties. These activities are cogently related to the
tasks involved in manpower planning, program
development, and in mounting the important pro-
gram actions so necessary to generate a posture of
job readiness on the part of individuals in the
process of matching men and women with evolving
job requirements.

Specific examples of the wide variety of such
technical assistance activities are: *

® Requirements—Resources Analysis

® Needs Evaluation

® Job Development
Systems Analysis
Occupational Engineering
Programing Manpower Utilization
® Program Planning

Education and Training Analysis (Basic
Education, Remediation, Skill Development,
Worker Attitudes)

Developing Training Plans

® Program Development
Structuring the Pathways to Employment
Developing Program Linkages
Developing Instructional Competence
Programing Training Resources

® Developing Program Materials
Curriculum Development
Instructional Area Guidelines
Instructional Materials

Utilizing Instructional Technology

® Human Resources Development
Personal Evaluation
Matching Potential Workers With Jobs

® Program Evaluation and Adjustment

For each of the activities enumerated, there
exists in the Federal Government a group of dedi-
cated technicians, equipped with supporting ma-
terials, available to work with individuals and
groups in the generation of actions required to
move into a positive posture for programing the
development of health service workers.

"In the actual presentation, each of the activities was
delineated.

38

Research, Experimental and Demonstration
Support (R,E&D)

In a period highlighted by change and identified
as one of shifting parameters in the arenas of tech-
nology and socioeconomic conditions, it is impera-
tive that we have a willingness to explore and seek
out more efficient and effective ways of assisting
not only the business-industry-health community
in providing services demanded by the people, but
also in reaching the disadvantaged sector of our
population which has been denied by society the
opportunities to participate in the fruits of our
economic growth. Because traditional methods
seem to have failed in this respect, we are being
constantly challenged to innovate in the genera-
tion of programatic activities in such a manner
that will bring the disadvantaged back into the
fold of the employed, contributing citizenship.

To accomplish this objective, the “Great So-
ciety” legislation makes possible the support of
research and studies of a socioeconomic nature and
also stimulates and financially supports experi-
mental, demonstration and pilot projects designed
to provide insight into new and exciting ways of
meeting the needs of the more disadvantaged
members of our society. It is the purpose of such
R, E, and D efforts to discover, document, and
disseminate workable techniques that expand our
capabilities to do the job that is required if we are
to achieve full employment in the range of occu-
pations needed to support our expanding economy
and to provide the goods and services that our
people need.

A few examples of such R, E and D support
are:

® Research and Studies in the Paramedical
Arena
Linkages and Interrelationships
Identification and Implementation of Ca-
reer Patterns

® Exploring New Techniques and Methodology
in Health Services Manpower Development and
Utilization

® Developing New Mechanisms to Close the
Requirements-Resources Gap

® Facilitating Interdisciplinary and Inter-
agency Participation in Human Resources De-
velopment and Utilization

 
® Launching of Pilot Projects and Demonstra-
tions of New Approaches to the Development of
Qualified Manpower

Training Support

The area of training support as used in this dis-
cussion includes all those activities that come into
play when an effort is mounted to recruit, select,
train, and place an individual in a specific area of
employment. In short—providing assistance to
bridge the gap between unemployment and con-
tributing citizenship through employment.

It can be seen quite clearly that both technical
assistance and R, E and D support contribute to
this area. However, our emphasis here is on the
actual Federal dollar support for action programs
involving the people who require the program
services.

The range of services includes the following :

® Providing Outreach and Recruiting Services

® Supporting Programs of Personal Evalua-
tion to Identify Potential Manpower
Counseling Selection
Testing Referral
® Supporting the Development of Counseling
and Instructional Personnel
® Supporting Job Development and Placement
Activities
® Supporting Traineeships, Internships, and
Apprenticeships
® Supporting Training Efforts in the Public
and Private Sectors
Basic Education
Remediation
Technical Knowledge
Skill Development
Attitude Development

Personality Development

® Supporting Both Institutional and On-the-
Job Training
® Job Entry

® Supporting Individuals in Training

® Skill Improvement

® Providing Direct Employment in the Public
Sector

Federal Resource Legislation

A considerable range of Federal legislation hav-
ing impact in the manpower arena has been gen-
erated over the years. However, it remained for
the decade of the sixties for us to experience a
quantum gain that is now being reflected in pro-
gram expansion in geometric progression. The
Great Society legislation has produced explosive
gains in the arena of manpower education and
training of an order never before envisioned.
These legislative actions set the stage for program
activities required in the health service worker
field. To assist you in reviewing the various
pieces of legislation and their impact in this pro-
gram area, our colleagues in the Public Health
Service have prepared an effective document.
Section III of the Background Data Book pre-
sents Federal Legislation Affecting the Supply
and Demand of Health Manpower. Included is
legislation dealing with professional manpower
as well as manpower below the professional level.

Legislation Having Impact Below the
Professional Level

For the purpose of the discussion of preparing
health service workers, in the context of this Con-
ference, our focus shifts to that legislation having
impact on programing for the development of
workers below the professional level. Specific
legislation identified in this category includes the
following: ?

® Vocational Education Act of 1963 (Smith-
Hughes Act of 1917, George-Barden Act of 1946)

® Health Amendments Act of 1956

® National Defense Education Act of 1958
® Social Security Act

® Vocational Rehabilitation Act

® Adult Indian Vocational Training Act
® [iconomic Opportunity Act

® Iconomic Development Act

? Conference Background Data Book, Sec 111, “Federal
Legislation Affecting the Supply and Demand of Health
Manpower, 1956-65.”

The several pieces of legislation were reviewed for the
Conference participants.

39

 
® Manpower Act of 1965 (Area Redevelopment
Act of 1961, Manpower Development and Train-
ing Act of 1962, as Amended)

Federal Resource Agencies and Programs

Specific programs designed to reach particular
segments of the population have been structured
within agencies responsible for carrying out legis-
lative intent. Interdepartmental delegations and
cooperative agreements pertinent to program de-
velopment under various sections and titles of the
acts utilize the capability and expertise of the sev-
eral agencies. To assist in understanding the
alphabetise of the Federal structure, a glossary
of alphabetical designations is provided.

Agencies Involved

One could, with comparative ease, identify a
contribution to the overall manpower program
stemming from any one of the complex of Federal
agencies. However, in the context of this discus-
sion of resources for the support of health service
manpower development efforts our focus turns to
five major agencies—the Departments of Labor;
Commerce; Interior; Health, Education, and Wel-
fare, and the Office of Economic Opportunity.

Each of the five agencies is charged with respon-
sibility for the development of policy, program
planning, and program funding of one or more
phases of the manpower development effort
through the legislation previously reviewed. Op-
erating Bureaus of the Departments thus become

‘See “Glossary of Alphabetical Designations” below.

40

the action points for program initiation. In order
to identify the agency structures and to relate
legislation and program areas to the departments,
the following chart on “Federal Resource Agencies
and Programs” has been prepared. Reference to
the “Glossary of Alphabetical Designations”
which follows the chart will assist in identifying
the agency components.

Resource Programs

Rather than discuss at length each of the pro-
gram elements that emerges from the several acts,
it would seem to be more appropriate to view the
several elements in relation to the agency having
program responsibility and the legislation from
which it stems. The chart, “Federal Resource
Agencies and Programs,” does just this. Full
descriptive information on specific program areas
can be obtained through the departmental chan-
nels identified.

It is to be noted that considerable interdepart-
ment linkage has been achieved. Thus the range
of competence available has been increased and
the range of resources multiplied. Most notable
linkages exist between the Labor, HEW, and the
Office of Economic Opportunity. Indeed, pro-
gram elements stemming from the Economic Op-
portunity Act are to be found in all three agencies
linked to specific agency and staff expertise.

In building the chart, only those programs hav-
ing identifiable impact in the development and
utilization of health service workers below the pro-
fessional level were considered. Dissecting the
supporting legislation for the several program
elements produced the resultant distribution.

 
 

Iv

 

 

ag TT ge

SR a — ar

FEDERAL RESOURCE AGENCIES AND PROGRAMS

 

 

 

 

 

 

 

 

 

 

 

INTERIOR HEW LABOR OEO COMMERCE
BIA OE VRA OMPER BAT JC EDA
WA PHS BES NYC CAP
AIVTA MDTA EOA PWEDA
® Technical Assistance @ Institutional Training and Training Allowances ® Jobs Corps ® Technical Assistance in
and Training Support for @ Basic Education ® Determining Training Camps Training Program Plan-

the Vocational Training of
Adult Indians

® Supplemental Instruc-

tion

Needs
® On-the-Job Training

® Experimental and Demonstration Projects

® Curriculum Planning
® |nstructional Materials

VEA

® Vocational - Technical
Education

@® Area School Develop-
ment

® Teacher Training

® Work-Study Program
® Guidance and Coun-
seling

® Research, Experimen-
tal Demonstration and
Pilot Project Support

EOA

® Adult Basic Education
® College-Work-Study

® Work Experience (WA)

VRA

® Research and Training
Support for the Handi-
capped

PHS

® Health Manpower
Studies

® Experimental and
Demonstration Grants

® Nursing School Con-
struction

® Recruiting, Testing, Se-
lection and Referral

® Job Development

® Manpower Research

® Program Evaluation

® Research Grants and
Contracts

EOA
® Neighborhood Youth
Corps
Inschool Youth
Out-of-School Youth

® Employment Service
Activities
Youth Opportunity
Centers

Apprentice Informa-
tion Centers
Selection, referral
and placement fol-
lowing personnel
evaluation

Training Centers

® Community Action

Agency Support
Sec. 205 Program
Grants and Con-
tracts
Sec. 207 Demonstra-
tion Grants
® VISTA Volunteers in
Service to America

ning and Development
for Designated Redevel-
opment Areas

Sec. 241. MDTA

DEPARTMENT OF LABOR, FEBRUARY 1966

jeeys Pipi]
 

Lv

FEDERAL RESOURCE AGENCIES AND PROGRAMS

 

 

 

 

 

 

 

 

 

 

 

 

 

INTERIOR HEW LABOR OEO COMMERCE
BIA OE VRA OMPER BAT JC EDA
WA PHS BES NYC CAP
AIVTA MDTA EOA PWEDA
® Technical Assistance © Institutional Training © Determining Training @ Jobs Corps ® Technical Assistance in
and Training Support for and Training Allowances Needs Camps Training Program Plan-

the Vocational Training of
Adult Indians

® Basic Education

® Supplemental Instruc-
tion

® Experimental and Dem-
onstration Projects

® Curriculum Planning

® Instructional Materials

VEA

® Vocational - Technical
Education

® Area School Develop-
ment

® Teacher Training

® Work-Study Program
® Guidance and Coun-
seling

® Research, Experimen-
tal Demonstration and
Pilot Project Support

EOA

® Adult Basic Education
® College-Work-Study

® Work Experience (WA)
VRA

® Research and Training
Support for the Handi-
capped

PHS

® Health Manpower
Studies

® Experimental and Dem-
onstration Grants
® Nursing School
struction

Con-

® On-the-Job Training
® Recruiting, Testing, Se-
lection and Referral

® Job Development

® Manpower Research

® Program Evaluation

® Research Grants and
Contracts

EOA
® Neighborhood Youth
Corps
Inschool Youth
Out-of-School Youth

® Employment Service
Activities
/outh Opportunity
Centers

Apprentice Informa-
tion Centers
Selection, referral
and placement fol-
lowing personnel
evaluation

Training Centers
® Community Action
Agency Support
Sec. 205 Program
Grants and Con-
tracts
Sec. 207 Demonstra-
tion Grants
® VISTA—Volunteers in
Service to America

ning and Development
for Designated Redevel-
opment Areas

Sec. 241. MDTA

DEPARTMENT OF LABOR, FEBRUARY 1966

 

 
GLOSSARY OF ALPHABETICAL
DESIGNATIONS
AIVTA—Adult Indian Vocational Training Act
BAT—Bureau of Apprenticeship and Training

BES—Bureau of Employment Security
BIA—Bureau of Indian Affairs
CAP—Community Action Program
EDA—Economic Development Administration
EOA—FEconomic Opportunity Act

HEW-—Department of Health, Education, and
Welfare

JC—Job Corps
MA—Manpower Administration

MDTA-—Manpower Development and Training
Act

NDEA—National Defense Education Act
NYC—Neighborhood Youth Corps
OE—Oftice of Education

OEO—Oftice of Economic Opportunity
OJT—On-the-Job Training

OMPER—Oftice of Manpower Policy, Evaluation
and Research

PHS—Public Health Service

PWEDA—Public Works and Economic Develop-
ment Act

VEA—Vocational Education Acts
VRA—Vocational Rehabilitation Administration
WA—Welfare Administration

MDTA Programs

Programs stemming from the Manpower De-
velopment and Training Act (MDTA), as
amended, produced one of the great interdepart-
mental and interbureau relationships involving
several bureaus within the Departments of Labor
and Health, Education, and Welfare. Both De-
partments are involved in action elements of the
programs—indeed both Departments utilize a com-
mon National Manpower Advisory Committee as
the sounding board in policy matters and for pro-
gram planning advice.

Each Department carries out specific responsi-

42

bilities as indicated and participates jointly in
others. Major program elements are :

® Iixperimental and Demonstration Projects
(D/L & D/HEW)

® Institutional Training Programs and Train-
ing Allowances (D/HEW & D/L)

® Development of Manpower Centers and
Multioccupation Projects (D/L & D/HEW)

® Determining Training Needs; Recruiting,
Testing, Selection, and Referral to Training; Job
Development (D/L)

® Basic Education, Institutional Training,
Supplementary Instruction, Curriculum Plan-
ning, Instructional Materials Development (D/-
HEW)

® Manpower Research, Program Evaluation,
Research Grants (D/L)

® On-the-Job Training (D/L)

Prior to the enactment of the MDTA, the Area
Redevelopment Act of 1961 was active in support-
ing programs of training in areas of persistent
unemployment. With the passage of the Man-
power Act of 1965 (the Manpower Development
and Training Act, as Amended), the training
phases of the ARA were assimilated. However,
the passage of the Public Works and Economic
Development Act placed a responsibility with the
Economic Development Administration of the De-
partment of Commerce for the promotion of eco-
nomic development activities, including training
in areas identified as economically depressed or
suffering severe and persistent unemployment.
Thus, a linkage has been established between the
Departments of Labor; Health, Education, and
Welfare; and Commerce in the planning, develop-
ment and approval of such projects to be funded
under section 241 of the MDTA.

EOA Programs

Programs stemming from the various titles of
the Economic Opportunity Act (EOA) are im-
plemented through HEW, Labor and the Office
of Economic Opportunity as indicated on the
Specific delegations have been made to
carry out certain activities as follows:

® Title IB—Neighborhood Youth Corps—De-
partment of Labor

chart.
® Title IIB—Adult Basic Education—Depart-
ment of Health, Education, and Welfare, Office of
Education

® Title V—Work Experience Program—De-
partment of Health, Education, and Welfare,
Welfare Administration

The Neighborhood Youth Corps’ Out-of-School
Youth Program provides for the direct employ-
ment of NYC enrollees in the public or not-for-
profit sector, thus making hospitals eligible as em-
ployers, with the Federal support provided for the
payment of salaries and provision of supervision.

The Adult Basic Education Title provides for
a program resource for the development of basic
literacy and three-R competence to assist individ-
uals to enter training programs to develop the job
competence needed for jobs in the health service
field.

The Work Experience Program serviced by the
Welfare Administration of HEW gives direct
employment and training to heads of public assist-
ance families and provides such work experience
activities in public and not-for-profit settings as
health institutions and others.

Of course, the Office of Economic Opportunity
has full operational responsibility for other major
elements of the “War on Poverty.” Most notable,
in the context of this discussion, are the Com-
munity Action Program and the Job Corps Pro-
gram, especially that phase of Job Corps activity
dealing with residential training centers having
training capability for occupational categories
meeting health manpower needs.

The Community Action Program is also of con-
siderable concern to you because of the manpower
components involved. Section 205 grants pro-
vide for the establishment of Community Action
Agencies in the cities and also support a variety
of program activities aimed at improving the pos-
ture of the disadvantaged population and moving
them into the mainstream of program actions lead-
ing to employability and employment. Section
207 grants provide for demonstration activities
to try out innovative ideas of accomplishing move-
ment of people from the grip of poverty into
employment.

Vocational Education Act Programs

One of the major sources of support for train-
ing programs in the health service worker arena

223-124 0—66——4

is the Vocational Education Act of 1963. The
operating programs, falling under the purview of
the Department of Health, Education, and Wel-
fare, include:

® Programs for Practical Nursing and Other
Health Occupations

® Teacher Training

® Work Study
Students

Programs for Vocational

® Research, Experimental, Demonstration and
Pilot Projects

® Area Vocational School Development

Programs generated under the Vocational Edu-
cation Act conform with State Plans generated
by State Vocational Education authorities and
approved by the Office of Education. Thus, the
potential of these programs should be explored
with State and local directors of Vocational
Education.

Vocational Rehabilitation Act Program

Too often we neglect consideration of employ-
ment of the handicapped to meet the burgeoning
job requirements. However, through the Voca-
tional Rehabilitation Administration of HEW
there exists an area of program support for re-
search and training of the handicapped that should
not be overlooked.

Adult Indian Vocational Training Act

The Bureau of Indian Affairs of the Depart-
ment of Interior has responsibility for the pro-
gram of vocational training of Indians. Thus,
another manpower resource can be tapped and
future health service workers developed through
training programs on or near Indian reservations.

Public Health Service Programs

Our chart includes only a few of the PHS pro-
gram areas. While the major portion of program
activities deals for the most part with professional
development, it is important to note the elements
that have impact in the development of health
service workers.

43

 
® Health Manpower Studies and Projections
® Experimental and Demonstration Grants
® Nursing School Construction

® Inservice Training Support

Integration of Resources—Providing Pathways
to Employment

Whenever one talks about programs for the de-
velopment of occupational competence, the ten-
dency exists to equate such training activity to
one’s own experience. Thus, for the most part,
our thoughts turn to the traditional practice of
directing recruits to institutional or school pro-
grams. However, if we are to utilize all of the
Federal resources available for the development of
qualified health service workers, consideration
must be given to the multifaceted network of path-
ways that are now emerging. In addition, our
consideration must be directed to the fact that for
many of the occupations in the health service field
the training can take place either in the school or
on the job or through a combination of the two.

In a period of economic progress and techno-
logical growth characterized by increasing em-
ployment and emerging skill shortages, the
remaining pool of untapped manpower resources
can be found in the concentrations of disadvan-
taged people who, for the most part, lack the edu-
cation and training to match the requirements of
existing or emerging jobs. Our challenge then is
to motivate and recruit the disadvantaged and de-
prived into program activities and pathways to
employment. The program elements exist and can
be woven, in many combinations, into the neces-
sary pattern to develop needed attitudes, knowl-
edge, skills, and readiness that spell employability.

Because we must tap the unemployed and dis-
advantaged population by reaching out to them
where they are concentrated, we are observing the
growth of a new establishment—the neighborhood
center—which is becoming the focal point of com-
munity action activity. Through such centers
located in “ghetto” areas of our metropolitan
areas, the combined efforts of agencies can be di-
rected to carry out such activities as: outreach with

44

indigenous workers; counseling for health, wel-
fare, and employment services; motivation for
basic education, remedial education, skill training,
and retraining for upgrading; and referral to
schools, rehabilitation service, Job Corps, MDTA
training, Neighborhood Youth Corps, and other
developmental activities.

All this is accomplished by bringing the serv-
ices of traditionally “uptown” agencies to the peo-
ple through the outstationing of qualified per-
sonnel to the neighborhood centers. Experience
is proving that the concept works.

The following chart on “Employment and In-
service Development” diagrams the variety of
pathways to employment and also indicates vari-
ous linkages that now exist to fashion programs
geared to the needs of the individual on the one
hand and to the world of work on the other. The
variety of program elements are arrayed in such a
manner as to avoid overlap and to provide spe-
cificity to deal with special characteristics of the
various segments of the population making up the
unemployed and disadvantaged group.

Through such coordination and integration of
Federal program efforts, pathways now exist for
the development of qualified health service work-
ers to meet the expanding needs of a health con-
scious population.

 

EMPLOYMENT AND IN
SERVICE DEVELOPMENT

 

 

 

 

on _ DIRECT coo.
AT, EMPL.
REFRESHER
iy PEP APP. TRNG.

~
~

Nay

 

 

 

 

 

N
~

 

MDTA

I

 

 

 

 

 

 

 

 

 

 

VOC.
REHAB. 1 SCHOOL
SERVICE

— iNn—]
” SCHOOL
NYC

NEIGHBORHOOD CENTERS

EMPL. WORK
SERVICE [—f  |NsT ~~ EXPERIENCE fei
Yoc : NYC

 

 

JOB
CORPS

 

 

 

 

 

 

 

 

 

 

UNEMPLOYED AND
DISADVANTAGED
POPULATION

 

 

 
 

VI. Panel Discussion—Summary

 

Following the address on “Manpower in a Serv-
ice Economy” by Dr. Eli Ginzberg of Columbia
University, and the address on “Health Manpower
Needs and Requirements” by Dr. Philip Bonnet,
president of the American Hospital Association,
a panel composed of experts in their respective
fields and representing a broad spectrum of pro-
fessional and community interests discussed the
two presentations in the light of their own experi-
ences and special competence. The panel moder-
ator was Mr. Jack KonkcNy, Assistant Director,
James Connally Technical Institute, Texas A&M
University.

The panelists’ contributions are summarized
below :

Mg. R. M. LouvcuEry, Administrator
Washington Hospital Center
MDTA funds are not always available in a com-

munity to organize or expand health service
training.

School counselors need more realistic occupational
information about the health service fields in order
to provide effective guidance.

The cost of hospital training programs is borne
largely by the patient. Research is needed on
where and by whom training should be given and
how it should be financed.

Workers are interested in future earnings as well
as in beginning wages. Salary limitations affect
recruitment for training and employment.

Each job must be made worthwhile so that the em-
ployee feels the service he contributes is important,
regardless at what level he is working.

Hospitals could operate more economically if
manpower and facilities were programed on a
7-day week basis.

Upgrading of employed workers in health service
occupations is important.

45

 
e.

Dr. KatHRYN STONE, Director
Program on Human Resources
Washington Center for Metropolitan Studies

Counseling for health service careers should be
available in all high schools.

Better utilization should be made of part-time
workers in health services. Hours should be stag-
gered so that more women could be recruited.

Community colleges and technical institutes
should offer more paramedical training curricu-
lums.

More emphasis should be placed on the “middle
level” health service worker. Mental health
workers in this level are needed, too.

Salaries must be raised. Six months’ training in
stenotyping pays off better than 3 or 4 years of
nurse training.

Health and related councils offer a good commu-
nity approach to developing manpower and serv-
ices.

Recruitment of high school trainees should not be
based solely on 1.Q.

Mg. Norman MrirBy, Director
Madison Vocational, Technical, and Adult Schools
Madison, Wis.

Active advisory committees are essential to health
occupations training.

In order to insure quality training programs, it
is necessary to have qualified teachers. There is
a shortage of health teachers with baccalaureate
degrees.

Health service training programs should have ade-
quate facilities and modern equipment.

The core curriculum seems to break down at a cer-
tain point. More research is needed in this area.

Greater use should be made of multimedia teach-
ing aids (closed circuit television, programed in-
struction, ete.) .

Education and training of health service workers
belongs in educational institutions, with clinical
facilities supplied by hospitals and other health
care facilities. Close coordination by the aca-
demic and clinical facility is very important.

Selection of highly qualified applicants for health
service training is important. This does not mean

46

Phi Beta Kappas but the trainees should be
qualified.

Manpower needs in the community must be identi-
fied before training programs are developed.
More workers should not be trained than needed.

Some graduates of health service training pro-
grams have been underutilized, others have been
overutilized. Research is needed on health man-
power utilization.

Mr. Peter OrTLEY, Director
Department of Civil Rights and Economic Oppor-
tunity

Building Service Employees International Union
The health service industry is greatly dependent
on aides and orderlies but very little has been done
to improve compensation or working conditions
for these workers. Compensation and working
conditions have a great impact on training and em-
ployment.

Red tape must be cut in order to get more health
service training programs started.

Scholarships or some type of financial assistance
should be made available to health workers with
potential to train for higher level positions.

Racial discrimination denies training and employ-
ment opportunities to persons in many areas where
there are severe manpower shortages in the health
field.

Government, hospital administrators, and unions
must work together to improve wages and work-
ing conditions.

Limitations on upgrading training under MDTA
should be relaxed.

Miss Frances Purpy, Chairman

Nursing Administrators Section

American Nurses’ Association

Student selection is poor in many nursing pro-
eorams; this results in a waste to the trainees and
to the program.

A basic need is to make maximum use of the health
services of people already employed, through re-
training and upgrading.

Each community must determine what its health
manpower problems are and what the community
can afford as a solution. Money and other re-

 
sources can be a disservice to the community if
they are channeled into the wrong program.

Working conditions and the social and economic
status of health service workers must be improved.
Employee dissatisfaction will not help recruit-
ment.

Training programs in the nursing field should
take into account changes in organizational struc-
tures, shifts in nursing functions, etc.

Training . programs in economically depressed
areas have many problems stemming from poor
facilities, poor student selection, poor faculty, ete.

The nursing profession is particularly concerned
about training programs in areas where placement
is not available; programs which do not ade-
quately prepare trainees for employment; and the
imbalance of auxiliary workers, licensed practical
nurses, and registered nurses.

Dr. Warrer J. PELTON

Professor of Dentistry

University of Alabama

Accreditation of paramedical training programs
should be the responsibility of the peer groups.
However, these groups should organize and co-
ordinate their accrediting activities so that the
respective programs in an educational institution
can be evaluated for accreditation at the same
time.

Upward mobility might be increased by encour-
aging accrediting agencies and educational insti-
tutions to allow some credit for training on one
level toward requirements of a higher level pro-
gram, e.g., credit for dental assistant training
toward completion requirements of dental hygiene
training or even toward a 4-year course In
dentistry.

Not enough is being done to train professionals
to use subprofessionals. Experience in the dental
field has shown that such use of subprofessionals
actually improves the quality of dental care. In
1956 the Division of Dental Manpower Resources
in the U.S. Public Health Service began a program
to encourage and assist dental schools to train
dental students in the utilization of dental assist-
ants, and all but one dental school is now provid-
ing such training with the help of a Federal grant-
ing program. Unfortunately, however, funds
have not been available to expand this profes-
sional training program as it should be expanded.

The foregoing program to stretch professional
manpower through the greater use of auxiliaries
has created a demand for more training programs
for dental assistants, especially, as well as for den-
tal hygienists and dental laboratory technicians.
Financing construction of training facilities for
such people seems to exist in current post-high
school and junior college planning and construc-
tion programs. The void seems to be in the lead-
ership of the dental profession on the local level
to get the job done.

Hospital employees at all levels ought to have
medical and dental services readily available to
them. More complete health services, including
dentistry, for trainees and employees of medical
centers could be provided as a fringe benefit. In-
deed, few dental schools and probably no medical
schools require a healthy mouth as a condition for
enrollment or departure from those respective
institutions.

The program for the construction of medical and
dental schools is not adequate and is not moving
fast enough.

Dr. A. N. TAYLOR, Associate Secretary
Council on Medical Education
American Medical Association

The problems of health manpower are chronic in
nature. The demand most always outstrips the
supply.

Many military corpsmen return to civilian life
each year but most of them go into other areas of
work and are lost to the health field. Government
and the health service industry should find a way
to tap this valuable source of trained health
manpower.

The primary problem is not to create 10,000 jobs a
month (the jobs are already available) but to train
people to fill these jobs. The time lag in training
is a critical factor in meeting health manpower
needs.

The supply of health service workers must not be
expanded willy-nilly. Workers must be able to
perform competently and safely. The public must
be assured that those involved in direct health
care are qualified.

Before a training program for a particular occu-
pation can be developed, it is necessary to know
what the workers in that occupation will have to
do. Duties and functions must be analyzed in

47
terms of present and projected job requirements.

People should not be locked into jobs without an
opportunity for advancement. Workers in lower
level jobs who are willing to learn should have a
chance to move up.

Health service training should be a joint responsi-

48

bility of educational institutions (community col-
leges and vocational high schools) and health care
facilities.

The logical accreditors of education and training
programs for health fields are the professions most
directly concerned and knowledgeable about the
respective fields.

 
Vil. Table Discussions—Digest

The Conference, which opened with broad pres-
entations on health manpower, moved rapidly to
areas of concern at the local level in developing
jobs and training for workers in health services.

Twenty-two simultaneous discussion groups con-
sidered seven questions pertaining to some of the
practical aspects of expanding the supply of quali-
fied auxiliary health workers. The following is a
digest of the varied responses to the questions, and
indicates the broad range of participant opinion:

QUESTION 1: How can a determination or esti-
mate be made of the number of people who should
be trained for health and related occupations, by
category, within a community? Within a geo-
graphical area?

Use resources of the public employment office.

Make a survey of employers (hospitals, nursing
homes, practitioners, etc.) to determine needs.

Consult professional planners.
Conduct needs survey based on 5-year projections.

Contact supervisors for information about per-
sonnel needs.

Establish an advisory committee whose duties
would include the planning and execution of a
continuing study of training needs.

Request local and/or State hospital associations,
hospital councils, medical society, dental society,
laboratory groups, and other organizations to esti-

mate the number of people who should be trained
for their respective fields.

Design surveys that take into account the utiliza-
tion of health service workers—the changing
functions of workers in each category.

Develop standard nomenclature and job analyses
in order to make realistic determinations of train-
ing needs.

Make and maintain a continuing inventory of
shortages.

Include new and emerging health occupations in
surveys of manpower and training needs.

Use available data from studies conducted by
various health organizations in community or area.

Enlist cooperation of local public health officer in
determining needs.

QUESTION 2: What are the different target
populations from which recruits can be sought to
fill skilled and semiskilled jobs in health and
related service occupations?

Total population.

Unemployed and underemployed workers.
Disadvantaged persons.

The handicapped.

Former armed forces personnel.

 
 

TABLE DISCUSSION GROUPS IN SESSION

Married women who are planning to reenter the
job market.

School dropouts or potential dropouts.
High school graduates.

Currently employed hospital workers to train for
higher level jobs.

Minority group members.

Inactive health workers, for full- or part-time
work.

Men for positions traditionally held by women.

Disemployed workers—those displaced by auto-
mation.

Noncollege bound youth.

Socially oriented people on all levels.

Retired workers.

QUESTION 3: How can the image of personal

and custodial service positions in the health service
field be improved ?

Raise wages.

50

Adopt attractive uniforms for each category of
worker.

Improve fringe benefits, working conditions.

Provide opportunities for advanced training and
promotion.

Develop a respect for the role of each employee.

Stress dignity of each job and importance of each
worker.

Discontinue use of term, “personal and custodial
service position.”

Institute programs of rewards, recognizing all
levels of work.

Develop job titles that carry status.

Use appropriate title (Mr.,, Mrs., Miss) for all
workers, regardless of level of work.

Provide continuing inservice training programs
for auxiliary health and supportive workers.

‘reate job ladders and opportunities for open end
progression.

Provide better job satisfaction and security

 
 

through the development of written job descrip-
tions for all workers.

Develop a greater acceptance, by higher level
workers, of lower level personnel.

Improve supervision.

Promote the “team” concept.

Stimulate the organization of membership soci-
eties for auxiliary workers.

Require formal training.

 

A TABLE DISCUSSION GROUP AT THE CONFERENCE

QUESTION 4: How can training programs be
kept current with the changing functions and re-
sponsibilities of health service workers?

Evaluate training programs continuously, includ-
ing followup of trainees (utilization, perform-
ance, etc.).

Revise training courses to reflect changing func-
tions and responsibilities.

Organize new courses to meet changing needs.
Utilize advisory committees to determine necessary
changes in training programs (employing agen-
cies, educational institutions, practitioners, com-
munity leaders).

Recognize trends in job dilution and effect on job
and training requirements.

Facilitate the initiation of curriculum changes.

Consult workers to determine what they see as
changes in function, in addition to consulting em-
ployers, professional groups, etc.

Develop flexible attitudes toward change on part
of instructional staff.

Consider new or changing functions and responsi-
bilities of auxiliary health workers in all inservice
training programs.

Promote and maintain good communications be-
tween and among employers, educators, profes-
sional organizations, employee groups.

Conduct continuing research on changing func-
tions and responsibilities of health service workers
and use findings to strengthen training.

Encourage instructors of health occupations train-
ing programs to work in the occupation periodi-

51

 
cally (summer or part-time) in order to keep up
with the latest advances.

Develop job descriptions for each level and
classification.

QUESTION 5: How can professional integrity
be maintained along with a flexibility to create
new positions?

Analyze new positions according to the standards
of the profession, regardless of current legislation.

Set up safeguards to prevent lowering of stand-
ards.

Recognize that adaptation to change is a profes-
sional responsibility.

Analyze the job to determine which parts are
essentially “professional” and can not be dele-
gated ; and which are “nonprofessional” and can
be used to formulate new positions.

Strengthen skills of upper level workers by esca-
lating the duties of less technical personnel.

Create new jobs only after careful planning.

Make provision in professional curricula for train-
ing in the development and utilization of new
groups of supportive personnel.

Define the role of the professional and its implica-
tions for development of new positions.

Delineate the various levels involved in the pro-
fession.

Extend professional pride to all levels so that new
positions can be created without the feeling of
being “crowded out” or standards being “watered
down.”

Define and evaluate the job to be done, on a

continuing basis.

Establish and maintain good communications be-
tween all groups concerned.

QUESTION 6: How can training and employ-
ment opportunities for health and related service
workers be expanded for older persons (mature
women, retired workers, etc.) ?

Change employers’ attitudes and hiring practices
in relation to older workers.

Recognize value of previous employment and life
experience.

52

Identify positions which are suitable for older
workers.

Provide part-time job opportunities for older
workers whose earnings are limited under Social
Security.

Arrange flexible hours and schedules to meet, train-
ing and employment needs of older workers.

Orient employers and educators to the benefits of
training and utilizing older workers.

Recruit and screen older workers on the basis of
individual abilities and potential, not as a group.

Reexamine the generally accepted economic deter-
rents to employing older workers (insurance costs,
pension plans, accident and absenteeism rates) to
see if they are completely valid and/or insur-
mountable.

Provide refresher courses for workers who have
been out of the field for some time.

Establish standards for employment of older
workers as a safeguard.

Provide scholarships for training.

QUESTION 7: What is the responsibility of
professional associations and unions in developing
jobs and training opportunities for workers in
health and related service occupations?

Establish standards for training.
Conduct surveys.
Improve wages and working conditions.

Determine functions of workers in health and
related service occupations.

Provide scholarships for upgrading skills of low-
paid, low-skill workers.

Take leadership in developing job and training
opportunities.

Undertake joint research studies.
Develop and conduct upgrading programs.
Develop job descriptions.

Maintain close liaison between professional associ-
ations and unions.

Work closely with employers and educators.
 

VIII. Work Group Discussions—Summary

SUMMARY OF COMMUNITY TRAINING EXPERIENCES

ELEANOR N. McGUIRE, Coordinator, Health Careers Program,

National Health Council

In yesterday morning’s eight work groups, we
discussed our various experiences in developing
programs for training health workers—what ap-
proaches have been used in communities for the
training of health workers at less than the bac-
calaureate level.

One of the techniques most commonly found in
the development of such programs in the com-
munity begins with the appointment of an ad-
visory committee. Advisory committees are of
two types. One type is broadly representative
of all the community agencies involved, including
the consumer, employers, professional supervisors,
and, where possible, representatives of the tech-
nical level itself. This committee does the broad
area planning necessary prior to the determina-
tion of where health workers are needed, how
they are to be taught, and how many. A second
type of advisory committee may include faculty
representatives of the profession responsible for
the supervision of the curriculum content so that
the program will be acceptable in other communi-
ties on a national basis. There may be representa-
tives on this second type of advisory committee
of all the community facilities that will either
utilize the employee or be utilized by the employee
as part of the training program. Representatives
of types of future employers may also be found
on this committee.

The advantages of such advisory committees

 

are not only to prepare the public and the facil-
ity to produce needed health workers, but to edu-
cate the professional in the proper supervision
and utilization of such workers supporting health
workers. Thus the professional worker may be
educated to delegate some of the chores that cut
into his efficiency. It was pointed out that not
only through the local advisory committees is this
educating of professionals carried on, but that a
responsibility rested in the national professional
health organizations to do an “intraprofessional”
education program which would make the prac-
titioners in the field aware of the new supporting
members and of their role and responsibilities in
helping to meet the health needs of the public.
In addition to the establishment of advisory
committees as a method for community develop-
ment of programs to train needed health workers,
there is a second approach which may originate
with the professional himself who is completely
snowed under with work, and who recognizes
and pleads for assistance of supporting, less-
professionally-trained personnel. Because of his
recognition of the need for such health workers
by the professional, the training possibility is
brought to the attention of the employer. The
employer and the professional together may there-
upon identify what level of training is needed,
and then may as a team approach the educational
area. Frequently, it is the employer himself who

53

 
 

recognizes that his program could be more effec-
tively and efficiently conducted if he had some
less-than-baccalaureate-level workers on his staff.

A third approach to the recognition of the need
to train health workers may come from a com-
munity planning group which is charged with
the responsibility for specifically identifying com-
munity needs. And one of these needs may be for
the less-than-baccalaureate-level health worker.
Still another beginning for training programs for
health workers may come from educational in-
stitutions because of the interest of parents or
counselors or students themselves in a specific
health area. The school may then take the initia-
tive, go to the employer or the professional group,
try to ascertain whether there may not be an em-
ployment market for such supporting of health
personnel, and if there is, set up a proper train-
ing program for the students.

The problems and successes were indicated as
generalities throughout the eight group reports.
I will try to give you the highlights, although the
task is difficult, since in the time allotted we were
very humanly and typically delighted to have
somebody share and listen to our problems, even if
not to find solutions.

I think the one problem that was most uni-
versally mentioned in the eight work groups was
the problem of selection of candidates for training.
It was often the problem not only of not having
candidates available, but of not having the right
candidates referred for training. This was par-
ticularly true in those areas which received MDT A
financial support.

There was a strong feeling that there needed
to be a closer working relationship between those
involved in training at the local level, and the
staffs of the State Employment Service. The se-
lection of the student must be the responsibility
of those conducting the program. However, we
at the local level cannot maintain such an adamant
attitude. We have not in many cases been quite
fair to the Employment Service. We often have
not given the USES job descriptions or job out-
lines. We have often neglected to analyze or
transmit to the Service the personality traits we
thought desirable, or other basic requirements in
the worker who is to be admitted to the health
training programs under MDTA.

There has to be, on the other hand, a recognition
by the U.S. Employment Service that although
we at the local level and in health organizations

54

are sympathetic to programs to reduce unemploy-
ment, and to educate the uneducated, it is not
within health services that all of these people will
find their future. It was felt that those of us in
the health field must maintain set standards for
trained personnel and for educational programs.
We must explain this stand and gain the coopera-
tion of persons knowledgeable and of influence in
the community since they can frequently help us
obtain the proper candidates for our programs.

The second problem that seemed quite common
was the absence of specific job standards, job de-
scriptions, and job requirements identified and
published prior to any project description. Fre-
quently, there is duplication of testing of the
candidates who are referred and accepted into a
training program. This goes back to the first
problem—the selection of candidates.

The third problem mentioned frequently was
the lack of qualified instructors at the technological
level in the training programs. Often such in-
structors have neither the educational background,
the certification, or the licensure required of those
who teach in a regular school system.

There is a need for all of us involved in such
training of health personnel at the prebaccalau-
reate level to sit down with those contacts in a
specific field at our own State education level
concerned and involved in these problems, and
discuss their possible solution. It will not be a
question of asking them to lower standards any
more than we would lower ours, but rather how
we can meet the educational requirements of the
projects we are proposing and still meet the re-
quirements for certification and licensure.

One of the major points made here was that we
must begin to think of methods to elevate the
standards for those people going into technical and
vocational education so that they may meet the
high standards set by general school educators.

The recruitment of health workers was another
problem discussed. Recruitment is frequently in-
fluenced by the tremendous turnover problem.
Some of the factors that increase the turnover rate
include: (1) the wage scales offered in competition
with other areas of the community; (2) lack of
job satisfaction (which the work group members
felt stems from lack of good supervision, lack of
good guidance, and lack of reasonable expectation
of job performance) ; (3) lack of a feeling of se-
curity in their job role.

 
There was a great deal of discussion of the need
to do something about educational opportunities
for those technical and vocational personnel who
are going to have even the most minor responsi-
bilities for supervision. Supervision at the tech-
nical level of training is equally as important as
at the professional level.

Another common problem identified was the
frequent lack of coordinated community planning,
with the resultant duplication of programs, un-
necessary competition for students, poor utiliza-
tion of staff, and poor utilization of existing
teachers and supervisors. It was believed that
much needs to be done on a community level to
coordinate programs and to work jointly not only
to meet the needs of specific projects in schools
or organizations but to meet the demands of the
public.

The need for more information about Federally
supported training programs was expressed,
largely the result of the enlightenment of the con-
ferees by Dr. Walsh's presentation on Wednesday,
of the intricacies of Federal financial support and
programs.

Although the complexity of Federal financing
frequently causes frustration and delay, it is gen-
erally the result of lack of understanding or mis-
interpretation of the Federal programs. This was
found not only by us poor non-Federal workers in
the field, but frequently it was found in our con-
tacts at State levels. Often the department in a
State was aware of the specific programs within
its Federal counterpart, but was not aware of the
implication for itself in other departments in the
State or in other Federal agencies. Therefore I
think what we are looking for is somebody we
can call and say “Big Brother, where can we go
to find money we need for a project we've got?”
And have somebody say, “Well, you write to Jo
Blow and this is his address.”

This ignorance is the real problem as far as our
State relationships are concerned. However, it
was found in the work groups that the lack of
“clearing house” information channels was true
also of the regional representatives of the Federal
offices who visit our local communities. They are
pounced on by people who are sure the representa-
tive knows the answer; he generally knows only
that “there is something back in Washington” but
he too is not quite sure to whom one writes for
definitive information.

It is really a serious problem for those of us in

 

the field who are trying to utilize the resources
available to us at the regional and the State and

the Federal levels. There was in addition to lack
of information on sources of support, a great lack
of understanding of the procedures to be followed.
Procedures varied from Federal Department to
Federal Department, and the variations were not
always made clear in advance of application, thus
causing confusion and delay.

The lack of communication among the various
groups at the State and local level when it comes to
regional planning, was identified also as a prob-
lem that has been haunting us in our efforts to
plan local programs. Frequently there may be
a regional setup within a geographic area in which
a local program is planned. Just at the point
where they are applying for Federal or State
funds and where both are recruiting for the pro-
gram, it is discovered that just 20 miles away there
is another community that already has an on-
going program, is in dire need of students and
has the staff. There was no interrelationship be-
tween these two communities.

Another question we were asked to discuss was
what type of agencies were involved in the devel-
opment of training programs. This area of dis-
cussion did not identify any standards for agen-
cies represented in training programs, nor in the
preplanning, operation, or follow-through on any
project, except to emphasize that the broadest pos-
sible representation was necessary, and that organ-
ization must be flexible. In the preplanning of
a project, and in the conduct of the project itself,
only those agencies which had a direct responsi-
bility for the project from its development to its
completion should be included, according to the
work groups.

The next question discussed at great length was
recruitment. It was the consensus that students
should be sought in all areas which offered po-
tential personnel who could meet the criteria
established and the demands of the job perform-
ance. Facilities available in the community
should be utilized which meet the objectives of
an educational program geared to produce workers

capable of performing “the duties outlined in a
given job description. Close cooperation is
necessary between interested agencies and their
staff and the staff and the program in educational
training courses. As most of you know, funds
are available for the rental of facilities if and
where necessary. However, in at least one of the

55

 
groups, the problem of no available facilities for
rent was brought up, a lack which hampered the
training project.

The question of funding was then discussed.
Many programs presented by the discussants had
been funded by various Federal agencies. Prob-
lems encountered in the initial grant were gener-
ally worked out in the succeeding years, or in the
second or third parts of the project. A problem
met in all the projects was the funding for devel-
opment phases of the projects, and the preplanning
stage prior to approval. One aspect of the prob-
lem that should be considered by the Federal Gov-
ernment was the lack of money ; and a second thing
was the hidden cost of developing these programs
in the education of the professional personnel to
provide the necessary services and to assure the
proper utilization of these supporting groups.

I't was made clear in discussion that prior to sub-
mission of a plan to the Federal Government, an
evaluation process should be built into the project,
as well as a clear, realistic and well supported
presentation.

Iwill mention here a few of the unique ongoing
programs reported by discussion leaders. If I
omit some that deserve mentioning, I hope I
will be forgiven.

In various discussion leaders’ reports, mention
was made of a program for the certification of the

56

occupational therapy assistants—a 20-week pro-
gram. There are 11 such programs of training
in operation in the United States, I assume under
Federal funding. I believe it is under the VRA.
There was a report on a homemaker and nursing
home aides program in one city. Unfortunately
in this city there are three separate agencies under
three separate Federal Government grants which
are training the same level of health worker. The
agencies do cooperate, but they do not coordinate
their programs. Another new program reported
was in training medical assistants. It was a dem-
onstration project with four students at present.
Several cooperative programs in several groups
were reported—cooperative programs between
groups and boards of education at a high school
level, usually at the 11th- or 12th-grade level. The
local health community facilities are used. These
projects provide an introduction for health
career opportunities to young high school students
and attempt to educate the students toward any
type of employment after high school. In several
groups there was discussion of programs being
developed in junior colleges in the health field,
on a cooperative basis between the professions
and educators. These projects at junior college
level help to set standards for content, facilities for
affiliation, and educational and other requirements
for the students in order for them to be accepted
into the health training programs.

 

 
SUMMARY OF ANSWERS TO NINE SPECIFIC QUESTIONS

MATTHEW McNULTY, Jr., General Director of the University of Alabama

Hospitals and Clinics

This morning anything either Eleanor McGuire
or I missed and may miss in the work group
reports, results from our own concentration on our
own areas of interest and exposure in education.
As an operating hospital official in the area of
health, I would say the obvious—that central to
the delivery of health services is the urgent and
critical need (and any other adjectives or adverbs
one would have) for manpower. Among the in-
stitutions concerned with the delivery of health
services I would include hospitals, extended health
care institutions, long-term health care institu-
tions, and other special health-care institutions.
“Manpower” covers every type of discipline that
works in the delivery of health services, which
in turn means all sorts of educational activities.
Coming from a hospital background, I may say
“hospital” and “hospital personnel” when actually
I mean all types of institutions and all types of
persons involved in the delivery of health services.

I will present the results of the work group
discussions according to the nine specific questions
asked of the conferees and discussed by them.
This method of presentation is based on the con-
sensus of the eight work groups.

Two ideas which were pertinent to every discus-
sion I shall merely mention here, since they were
presented so forcefully yesterday; namely remu-
neration (by Dr. Ginzberg) and quality (by Dr.
Bonnet). Dr. Ginzberg indicated that recruit-
ment is fine, education is fine, all other elements
are fine, but when you get the workers in the vine-

 

yard they're going to work there only if the pen-
nies they receive, to use the Biblical analogy,
equate to the pennies that are appropriate to that
type of work in various areas of the country. I
shall say nothing about quality first, because we all
take for granted the fact of quality, and second,
Dr. Bonnet highlighted that aspect of health serv-
ices so well that any thing more would be redun-
dant. But these two themes—remuneration and
quality—run through all the discussions. It was
agreed that there was need for an adequate, or if
you will, effective personnel management. program
in every area involving health workers. This
personnel program would go all the way from re-
muneration, to counseling, retirement, and all the
other important elements of life.

QUESTION 1: Where does the initiative lie in
the local community for promoting effective train-
ing programs’

The conclusion seems to be that the initiative
could lie anywhere with anybody, but that it was
more likely to be exercised by vested interest
groups. I use the words “vested interest” here in
the finest sense, meaning those groups such as hos-
pitals and nursing homes that have a responsi-
bility for the delivery of health services; groups
such as the chamber of commerce, that have com-
mercial and economic interests; and those groups
in the community, similar to health councils, that
have a conscience, a specific concern, for the health
care of the community. What is required is good

57

 
 

hard work of local committees, with participation
by the many diverse people who have a “vested”
interest in starting necessary training programs
for health workers, and insuring that they are
sustained.

The likely flow of action is from employers, to
educators, to establishment of new training pro-
grams. In any case, however, planning should
arrive, ultimately, at comprehensive community
participation. In this connection, note was taken
of the fact that local Manpower Advisory Councils
are developing in many communities. Such al-
ready exist at regional levels, and there is a
National Manpower Advisory Committee. In
view of the importance of the need for developing
health service manpower, it was suggested that the
growing number of advisory committees at all
levels include representation from the health
service industry. There was general agreement
that the role of the Federal Government as stimu-
lator was being recognized and welcomed, and the
Federal assistance was useful in planning. Fed-
eral support would be more effective, however, if
it. could work with a representative local group,
planning comprehensively for a given community.

QUESTION 2: What can be done to move aux-
iliary health workers into higher level jobs in
their respective occupations?

One of the words that has become common in
the corridors and in our meetings here is the word
“ladder” —meaning the ladder of progression for
employment and education. There was general
agreement that there should be available to every
health worker specific rungs in the ladder of his
occupation that he or she can climb to better
remuneration and more rewarding work. The
realisms were faced that constant upward mobility
was not possible for everybody. But individuals
should have the opportunity, in the best American
tradition, to move upward if they were so moti-
vated and able. There is a too frequent loss of
health personnel who come to believe that they are
locked in dead-end positions.

A variety of suggestions were given in the
discussion on how upward mobility might be
accomplished.

Some participants suggested the development
of equivalency examinations to permit people to
move up to the next rung, without taking course
work. Another suggestion was to develop “core
curricula” to span several different occupations.

58

Within this there could be provided various
stopping-off places. If a person wished to ad-
vance further at a later time, he would not have to
start over at the beginning.

It was acknowledged that getting credit for as-
sociate arts degrees toward more advanced work
was sometimes hard to do. Certification and
licensing boards were sometimes refractory on this.
Much coordination will have to be done between
such boards and educational institutions.

In order to get more ease and convenience in
training for upgrading those already employed,
courses would have to be geared to the changing
work schedules and work shifts of people, par-
ticularly of hospital personnel.

It was suggested that scholarships or other finan-
cial aid be made available at all levels, to aid
individuals who wished to advance in skill and
position.

Some participants believed that supervisory
groups needed to be stabilized in order to stimu-
late upward mobility and carry it through. There
was alleged to be too much turnover at the super-
visory level. In this connection, it was noted that
the time had come to restructure jobs, and that
for this, it was necessary to have some fundamental
time-and-skill-utilization studies done.

QUESTION 3: What are some effective methods
of selecting trainees for health occupations?

It was acknowledged that there is a necessity
to recruit actively, in order to get sufficient man-
power for the health occupations. Such recruit-
ment should begin in the high school, with a
strengthening of the guidance and counseling pro-
grams for the health services. Employers might
also expand the development of work experience
projects in the health services for youth, and be-
come more acquainted with the resources of the
U.S. Employment Service.

Fundamental to all recruitment and selection,
however, is the establishment of clear job analysis,
a specific job content, and a determination of the
minimum standards for any given job. From that,
one can devise all kinds of psychological testing,
dexterity testing, language testing—both reception
and articulation—and so on through whatever else
is required.

Participants also noted that at present the pro-
fessional positions in the health field tend to be
overstructured, and the supportive or less than
professional positions understructured. Also, in

 
the supportive areas particularly, the generally
low wage-scales are a major hindrance to
recruitment.

QUESTION 4: What can be done to train work-
ers in areas which do not have junior colleges and
community colleges?

A variety of suggestions were offered in answer
to this question. These included: the establish-
ment of technical training institutes attached to
the vocational sections of high schools or of area
technical schools; the transportation of trainees
from outlying areas to the centrally located
schools; and the greater use of either open or
closed circuit television.

It was also suggested that, in areas of need,
multioccupational skill centers for health occupa-
tions only, be developed under MDTA.

To the conferees, all these suggestions seemed to
entail more regional planning in those areas not
well served by existing educational institutions in
the health service fields.

QUESTION 5: How may inactive professional
nurses and other workers be attracted in greater
numbers to re-entry into health service through
MDTA refresher and reorientation courses?

Basic to an answer to this question is the identifi-
cation of the “inactive” people. Just who are they,
how many are there, where are they, and how many
want to come back into the health services? What
needs of the “inactives” have to be met to get them
back? Some women might well come back into
the field if their family needs could be accom-
modated. Tt was suggested that some system of
part-time training and part-time work, particu-
larly, would attract a greater number of returnees,
especially women.

Again the subject of low salary scales and in-
adequate working conditions were cited as hurdles
to overcome in recruitment.

Nevertheless, some successful efforts to reach
such persons were reported in the group discus-
sions. Employers were to be encouraged to do
more to develop techniques for reaching out to such
former workers in health occupations, and to
accommodate to their needs.

QUESTION 6: What are the elements of a good
on-the-job training program for health service
workers?

 

223-124 0—66

5

The usual elements of education were explored—
qualified faculty, quality curricula, good facilities,
and proper supervision. Most emphasis was given
to a qualified faculty. The American Hospital
Association, under Federal grant, has developed
guides for training instructors and for qualifying
supervisors. It may be necessary to establish
special manpower courses and training for such
supervisors and instructors. That is, some indi-
viduals may be good workers or technicians in their
personal work, but lack a teaching expertise in
communicating their knowledge to others.

Also emphasized were good clinical facilities,
adequate compensation during training, and a
well-defined job analysis so that trainees know for
what they are training.

It was pointed out that theory should be inte-
grated with work, whenever the need for theory
arises. Theory should not be given abstractly or
in a situation unrelated to, or before, on-the-job
training.

QUESTION 7: How can more instructors and
supervisors be trained now and in the future?

This question was a real challenge, and generous
discussion surrounded each item of a grocery list
of elements that conferees thought were necessary
to attract an adequate faculty.

The list starts with sympathy and interest. It
includes identification of where one can find pro-
spective teacher material. There must be the re-
cruitment of such persons into a healthy ongoing
educational environment which is rewarding and
productive. There may be a necessity to give.
scholarships, fellowships, or other incentives to in-
dividuals who may have been away from teaching
for some time. Again the subject came up of
instituting manpower training courses for instruc-
tors and supervisors.

A controversy over the certification of instruc-
tors arose. Some conferees believed it would be
possible to contract for educational services and
get around certification requirements in that
fashion. Some questioned whether all technical
instructors needed degrees from institutions of
higher learning. Many present believed that from
a practical point of view, not all instructors needed
a degree, but that from the standpoint of status in
their fields, it might be necessary.

It is safe to conclude that this is a particularly
knotty and challenging problem in the develop-
ment of health service manpower.

59

 
QUESTION 8: What do we need in the way of
research in meeting needs of job development in
health occupations?

One type of research need that was identified
was the pragmatic, empirical, get-on-with-the-job-
of- educating- and training-more-health-workers
type of research. It is largely one of research into
presentation, into educational techniques, mate-
rials, and methods.

A second research need that was identified might
be called more theoretical. For what, for how
many, for what different elements of quality, and
for what knowledges, are we to train and educate
health workers?
tion and training be done? Is this a junior college
function, a community college function, a hospital
function, a vocational or secondary education func-
tion in a school system, or a separate institutional
function? What elements of society are best
equipped to do this, not in terms of jurisdiction,
but in terms of preparation? Can we concentrate
on those training elements, not to the exclusion of
others, but in order to emphasize certain institu-
tions because of their greater potential for
productivity ?

Another important area of investigation cited
was just how this training should be financed. Is
the expense of training health personnel in a hos-
pital situation a fair charge to the patient, or
should it be spread over a broad base of taxation?

More evaluation of on-going programs and of
research should be done. Evaluation should be
more than a narrative of what took place. It
should note what took place and why, in the various
models that can be set up, tested, and expanded.

QUESTION 9: What can be done to implement
this Conference—by the Government, by the par-
ticipants, by others?

The Government can try to disseminate infor-

60

And where should this educa-’

mation more widely, and to elaborate, elucidate,
and clarify even more than it does now, the op-
portunities that are available for job training and
development of health workers as a result of Con-
gressional action and executive implementation.
The Government can also be helpful in initiating
regional and State conferences similiar to this
National Conference.

The participants in this Conference might
both stimulate their own organizations to consider
the suggestions of the Conference for opening more
training and job opportunities, and assume a
leadership role in their local communities in job
development and training activities for health
service workers.

The aid of many other persons and organiza-
tions, in addition to those represented in this Con-
ference, must be enlisted. The average citizen,
if you will, does not understand the manpower
shortage in the health occupations. Various
voluntary fund agencies, civic clubs, ladies’ groups,
churches—all of the elements of our society who
help mount campaigns and arrive at effective ob-
jectives in any community—must be enlisted in
the effort to implement the purposes of this Con-
ference, namely, job development and training for
workers in health services and related occupations.

Let me conclude on this note. If there is a dis-
cipline, or an organization that entered into the
discussion which I omitted to mention, that is my
error only. If I omitted any particular subject
matter which was reported by some work group,
it was not intentional. Let me suggest that if
there is any point that was not touched upon, which
a conferee thinks needs to be brought into the open
and discussed at a later time, or on which he or she
may have some cogent recommendations, a written
statement on the matter to the Conference Coordi-
nator is a very effective mechanism open to all of
us.
 

IX. Closing Session—Addresses

MOBILIZING OUR RESOURCES FOR HEALTH SERVICES

WILLIAM H. STEWART, M.D., Surgeon General, Public Health Service,
U.S. Department of Health, Education, and Welfare

This Conference is the latest in an impressive
series of events recognizing the importance of
health manpower. Other meetings, publications,
legislative actions and administrative decisions
have preceded it. And more will surely follow.
Each one moves us forward as it adds to our under-
standing and consolidates our efforts.

In considering what I might be able to con-
tribute on this fourth day of your intensive ses-
sions, I decided that I could most appropriately
talk to you as a member of the rather small group
which administers the enormous health services
industry—in short, as a physician.

More and more, the physician is functioning as
a manager—a job for which he is not specifically
prepared, either by training or by tradition.
Typically, he used to be a soloist. At most he was
the director of a small, compact team in which
each individual's role was clearly delineated.
Today he must direct the efforts and energies of a
growing number and variety of health workers.

The pivotal role of the physician is easily
demonstrated. If he does not send samples to the
laboratory, there is no need for the technician.
His prescriptions set the pharmacist in motion, his
directives send nurses and aides on their appointed
rounds, his decisions open hospital doors to the
patient. The surgeon performing a complicated
operation may have 100 people representing

 

literally dozens of special skills under his direct
or indirect command.

But it is not my purpose here to glorify the role
of the physician. One point I wish to emphasize
is that as the managerial function of the physician
increases, so does his dependence upon others. If
he is to succeed in his task, for which he has spent
a quarter of a century in educational preparation,
each member of his corps of supporters must per-
form to specifications. Their skills must interlock
in the right way at the right time. And the high-
est possible wager—human life—is riding on the
outcome.

Thus the training of supportive health workers
is of much more than academic interest to the
physician. He stakes his professional life on their
competence every day. As medicine advances in
complexity, his dependence cannot possibly dimin-
ish; it can only increase.

The magnitude of the training challenge is
enormous in quantitative terms. Today in medi-
cine, dentistry, nursing, and the other health pro-
fessions there are perceived needs for over 500,000
additional workers—numbers far greater than the
national training capacity. This means that two
things must be done. First, we must augment and
make the best possible use of programs and fa-
cilities for training professional health workers.
Second, we must give greatly increased effort to

61

 
 

the analysis of health service functions, to the
development of meaningful technician and assist-
ant groups, and to the development and support
of training programs which will prepare people
to work together much more effectively.

The number of workers in the health occupa-
tions increased at a rate of 3 percent a year between
the 1950 and the 1960 census. If this rate is con-
tinuing, the totals will increase from about 2.4
million this year to some 3.3 million 10 years
from now.

The health service industry, as you know, has
many workers other than those in the health oc-
cupations. The number of these has grown even
faster. Thus, while those in the health occupa-
tions have been increasing at an annual rate of
3 percent, the number in the health service indus-
try has been increasing at a rate of about 4 percent.
If growth should continue at between 3 and 4 per-
cent we would add between 1 and 1.5 million health
service workers in the next 10 years.

But there is also a qualitative component to the
training problem. In meeting the overwhelming
challenge of numbers we cannot neglect quality of
preparation. The cost of carelessness or error is
too great. The price of ineptitude is not only the
loss of somebody’s job but perhaps the loss of
somebody else’s life. We must do more than turn
out a million health workers in 10 years. We must
turn out a million good ones.

Moreover, almost none of these people can be
successfully trained in isolation from the health
complex of which they will become a part. Team-
work in medicine is not an assembly-line kind of
teamwork where each man tightens his particular
bolt, more or less irrespective of what happens
before and after. Skills don’t just touch each
other; they are interwoven. A good nurse’s aide
is constantly growing in her understanding of the
nurse's job. A good nurse develops many of the
capabilities of the physician.

In fact, many of the barriers that now exist at
strategic locations along the many roads of health
service are arbitrary. They were placed by the
traditions of another era. They are maintained
by a kind of thinking more appropriate to a guild
of the middle ages than to a modern profession.
I have spoken before about the need for career
ladders in the health professions. I think this
need extends through the subprofessional levels as
well, and crosses that no-man’s-land where the
prefix “sub” is tacked onto the word “profes-

62

sional.” I might add parenthetically that we
ought to find a better word than that patronizing
term “subprofessional”—a word that is used only
by professionals.

Our aim, clearly, is not just to recruit and retain
bodies. We want to challenge the people with
promise, at every entrance level. For many bright
young men and women who might join the health
enterprise after leaving high school, the road to a
medical degree would seem impossibly long. But
there is no reason for us to train them in such a
way that we put a heavy lid on their aspirations.

Today, in order to advance upward in the health
disciplines, it is generally necessary to go back to
the beginning and start over. Academic credits
acquired in pursuit of one occupational goal rarely
count toward a higher goal, and work experience
is generally undervalued. This is extremely dis-
couraging to the individual. It is also extremely
wasteful of talent that will always be in short
supply. The guild system is a luxury we cannot
afford.

Obviously there is no single answer to the prob-
lem of providing health manpower to meet the
demand of the future. You have been discussing
many courses of action already underway, under
many sponsorships, designed to meet many sepa-
rate needs. This is a healthy condition. It would
become unhealthy only if each separate course of
action should become, in turn, a new self-contained
compartment to be buttressed and defended, build-
ing a new set of rigidities into a system that is
desperately in need of the fluid and flexible.

This will not happen if the schools and institu-
tions carrying out the training, and the agencies
to which they turn for support, keep their eyes
firmly fixed on the purpose of the whole en-
deavor—the provision of better health services for
more people. All these separate channels must
converge upon health care. By the same token
someone must keep track of the changing and
growing manpower resource. Someone needs to
be able to say, authoritatively, which channels
are overflowing and what new courses must be
developed.

And here, of course, the primary burden rests
squarely upon the health professions themselves.
We must furnish the answers to the basic ques-
tions: What kinds of training? For how many?
And finally, after training, what? How shall we
make use of the outpouring of human talent and
energy that these training programs will generate ?

 
How can we best mobilize this growing resource
and direct it toward the health needs of the people
we serve?

These are sticky questions. At the outset we
have to admit that we have not been overwhelm-
ingly successful in using the talent we already
have. Medical research has been quick to catch
the accelerating tempo of our times. By compari-
son, medical practice has been slow. We are barely
beginning to exploit the potential of automation.
The organizational patterns of health service are
not yet generally adapted to the widespread de-
livery of the right care to the right patient at the
right time. We have not yet mastered the effective
employment of specialization. We are just start-
ing to pass through the managerial revolution that
has reshaped industry and science.

There are, however, many hopeful signs. Rou-
tine chores are increasingly delegated to assistants.
Computers are being allowed to do the things they
can do faster and better than people. I believe the
day is rapidly approaching when health profes-
sionals and their associates will be using their
highest skills far more efficiently in behalf of their
patients.

And yet, even when that day arrives, some ques-
tions will remain to be answered. The abstract
problem of applying health manpower to health
need is at root a human problem and must be
considered in human terms. I should like to con-
clude by tossing out to you a couple of these human
problems for which I have no handy solution.
The problems are cast in terms of health profes-
sionals—nurses and physicians—but they are simi-
larly applicable to other health disciplines.

Consider, first, the classic dilemma of the nurs-
ing profession. It is axiomatic that for every pro-
fessional nurse actually in practice, several have
fallen by the wayside—either because they did not
finish school or because they entered the profession
and subsequently left it for marriage and a family.
The mystery is not why the nurses leave, but why
the profession has not accommodated itself to the
natural and inevitable.

As TI said, I have no pat solution. But it seems
to me that there must be ways whereby a nurse
can be married and raise a family without being
irrevocably lost to her profession.

I have the impression, for example, that ma-
ternity leave provisions in most health enterprises
are far less liberal than those in industry and
government. I am not aware of any systematic

provision of refresher courses for nurses who
would like to return to the profession after a few
years’ absence. I don’t know of many institutions
in which a nurse can practice a few hours a day,
or a couple of days a week, to contribute her much-
needed skills at times which do not conflict with
her family responsibilities.

I have heard one serious proposal to build a
large and attractive apartment house next to a
hospital, specifically designed for nurses and their
families, with day nursery services for young chil-
dren and other features that would help overcome
the many minor hardships that now discourage the
married woman from practicing her profession.
Whether or not this becomes a reality, it represents
creative thinking in the right direction. We need
more of it.

My second problem in search of a solution con-
cerns a young physician who, after about 25 years
of education, is ready to finish the last year of his
internal medicine residency and set up practice.
What are the chances that he will locate where his
skills are needed most, and how can those chances
be influenced in favor of applying talent to need?

We talk glibly about equal access to health serv-
ices as a major goal for the future. But health
professionals are human beings. They want to
locate where the money is—or where they think it
is. They want to locate where they can continue
the stimulating professional associations to which
they have become accustomed. They want their
children to go to the best schools. And already
the deck is heavily stacked against equal access to
their services for rural Americans, for slum-dwell-
ing Americans, for small-town Americans.

Here again I have no all-inclusive answers to
propose. The idea of locating physicians by fiat
would be totally unacceptable in our society. Cer-
tain strictly economic incentives, such as forgive-
ness features in loan programs, have been tried
with inconclusive results. We know that physi-
cians who choose to practice in small towns and
rural areas are usually those with rural or small-
town origins; but we know also that a very small
proportion of medical students come from such
areas, and that many of them are won over by the
advantages of the metropolitan environment.

Somehow, the conditions of practice in areas
of special need must be made attractive and chal-
lenging. In terms of one important factor—the
stimulating professional association—I believe
we are making a significant start in the regional

63

 
medical programs for heart disease, cancer, and
stroke. Under this concept, the health services
of an entire region will be linked to a central
focal point of medical excellence, with built-in
provisions for continuing professional education,
interchange of personnel and systematic consulta-
tion and referral on individual cases.

But we still have a long way to go to counter-
act the unfortunate tendency for the rich to get
richer and the poor to get poorer in terms of avail-
able health services. As with our other problems,
we shall need all the creative thinking we can find
in the days ahead.

It may appear that I have strayed rather far
from the central concern of this Conference. I
think, however, that the necessity for thinking in
large numbers—hundreds of occupations and mil-

lions of workers—carries with it an implicit dan-
ger. We are dealing with health care. Health
care is perhaps the most compellingly human of
all occupations.

Therefore, in mobilizing our army of health
workers, let us remember that it is not an army.
We have no battalions and regiments to be pressed
into service and ordered wherever the need is
greatest.

Rather, we are dealing with individual human
beings who, we hope, will choose to enlist in the
health enterprise and serve it to the height of
their capacity. Their free choice can be our
greatest asset. If we perform our training func-
tions well, and if we design our health resources
so as to encourage full individual development, we
will achieve the kind of competence and dedica-
tion we need to advance the health of our people.

 
HEALTH MANPOWER: THE CHALLENGE OF THE NEXT DECADE

WILBUR J. COHEN, Under Secretary, Department of Health, Education, and Welfare

I think the Conference now drawing to a close
has been a most important Conference in that it
demonstrates a relationship between the Depart-
ment of Labor and the Department of Health,
Education, and Welfare based on a community of
interest in the whole broad field of manpower and
training. This particular Conference is but one
manifestation of that very pervasive interest.

Last year I established in the Department of
Health, Education, and Welfare a task force on
manpower requirements and training programs
for our entire Department, and a subcommittee of
that task force on health. The reason that I did so
was that during the last 5 years, as I worked on leg-
islation in the fields of health, education, and so-
cial welfare, I became more and more convinced
that the overriding limitation on development and
escalation in these fields was manpower require-
ments and not money or facilities. I think that,
as difficult as it is always to get money out of ap-
propriating bodies and as much time as it takes to
build the mortar of facilities, those are achieve-
ments that can be worked out successfully. But
you can not produce an additional man or woman,
trained to do a job, simply by saying, “Here is a
certain amount of money. Here is a piece of legis-
lation. Now see if you can not put these programs
in operation tomorrow morning.”

We are finding the problem of manpower re-
cruitment a key one every day now, in our effort to
implement the tremendous landmark pieces of leg-
islation that were passed last year—e.g., the edu-

cation legislation, and the Medicare legislation.
We're working hard at it, but you would be sur-
prised at the shortage of qualified experienced
people we find when we want to recruit in these
fields. There are lots of difficulties. I might say
parenthetically that I have become an expert on
some of these problems. Two or three of the peo-
ple we particularly wanted asked whether I would
take their wives to dinner and try to persuade them
to come to Washington. I found myself for the
first time in a difficult position. A wife would
say, “Well, I've just bought new drapes, or I’ve just
put in a new kitchen, or the children have just
been enrolled in a new school.” You would be
surprised at the manifold human personal and
emotional problems that are involved, besides
problems like fringe benefits and retirement plans,
that must be considered in pulling up stakes and
accepting Federal employment in Washington.
Quite frankly, the scale of pay is the last point
that seems to present any difficulty.

What I am trying to say is that as we go for-
ward in the development of the Great Society
programs so essential to the quality of American
life, I think that we are going to find implementa-
tion of these programs more and more a problem.
And so we must begin to build in at an early stage,
and at the earliest possible stage, the thinking
about training and manpower requirements. I
always add “womanpower” requirements because
in the programs about which I am talking, there
is a very high concentration of women workers,

65

 
and even a greater potential for further employ-
ment of women.

This brings us to the whole question of continu-
ing education, of bringing women back into their
fields of early training after they have reared their
families. I think this is one area that our uni-
versities, colleges, junior colleges, and technical
institutes will have to go into even more intensively
in the future. I see a tremendous role here for
refresher, continuing, or retraining higher educa-
tion courses to bring women back into the employ-
ment market. This would hold true not only for
those women who have raised their families but
for those who are still raising them. Their family
experience is particularly helpful and particularly
pertinent to the whole field of health, education,
and social welfare which is our prime concern.

I hope the Task Force which was appointed last
year will help us in our Department, and in other
Government agencies that are attempting to deal
with the manpower problem, to see where we can
go in the next decade to meet our requirements.
I hope also that our Special Task Force on Health
Requirements, under Assistant Secretary Philip
Lee, will have the results of your thinking at this
Conference to build into its future program devel-
opments, because despite the tremendous landmark
legislation of last year there still is a great and
imminent need. I hope, and I go so far as to
predict, that the Congress this year will enact at
least 7 to 10 more pieces of health legislation of
importance. Some will have significant training
elements in them, but all will put additional re-
sponsibilities and additional burdens upon the
whole health field to recruit and train personnel.
This is going to bring, as it has already brought,
a lot of rethinking into the field—of how we utilize
the personnel we have, how we train more person-
nel, how we rationalize our services, and how we
create the economies and efficiencies in the whole
program as it evolves.

As I said on the opening night of this Confer-
ence, 3 million people employed in health services,
$40 billion of expenditures for health, 6 percent of
the gross national product, represent an area of
our national life so important it cannot even be
measured by statistics. It is essential to the well
being not only of the individual and the family,
but of the Nation itself.

I would like to close by pointing out what I see
ahead, in the next 10 to 15 years or so. Significant
changes will be taking place in the whole field of

66

health and welfare which will give a basis for the
utilization of the new types of personnel, and the
employment of additional persons in the field with
a whole new role of creativity and innovation.
I would not want you to leave this Conference
thinking that the health professions field of 1976
is going to be the same as that of 1966. I think
that we all are working in a field of very exciting
change. And out of the ferment that is taking
place, now that there has been a reconciliation in
ideological controversy, as I mentioned the other
night, you are going to find emerging in the entire
health field a host of new concepts and new ar-
rangements and new answers. And as the medical
sciences advance, and as they become more com-
plex, as many cooperative forces are unleashed,
there will be new steps taken in the organization,
financing, and delivery of medical care throughout
the country.

This Conference has brought together a wide
variety of experts who are the extensions of the
arms and legs of the trained professional man-
power. I think that we are going to find a tre-
mendous growth in all of these fields.

The new education assistance programs which
have been enacted in the past few years offer a
wide variety of Federal financial support of train-
ing in the health field. Quite frankly, however,
what has been done in the past is clearly inade-
quate, and I predict that in the Congress this year
we are going to see new legislation that will extend
Federal financial aid to support the allied health
professions personnel.

Effective community planning, active coopera-
tion between the educational systems, the hospital
and health facilities, and the professional organi-
zations are essential ingredients in implementing
the new programs at the local level. And I see, as
I'look ahead, a new era of cooperation among these
institutional bodies such as we have not had before.

There still are many unanswered questions in
the health field which we will have to tackle in the
years ahead.

The salary level in the allied health fields, it has
been pointed out, is still so low that recruitment
and retention of personnel are a recurring head-
ache to administrators of hospitals and nursing
homes and other health facilities. I think the pub-
lic has to be educated, if you will, has to be per-
suaded to the concept that good health care has to
be paid for in terms of relative opportunities in
other fields in our economy, in terms of adequate
payment to all workers in the health field, if we
are going to get the supply of trained manpower
and womanpower that is required for the future
expansion of health programs.

A second question relates to the problem of how
education for health professions, subprofessions,
and health supportive personnel is to be provided
and financed. We should be working toward the
result that nursing education, for example, will be
an educational cost to be funded through the edu-
cational system rather than being absorbed by the
hospital and passed on further to the patient or
third party payee.

A third question that needs consideration is the
cost of hospital care. With hospital costs rising
about 6 or 7 percent a year or about $2.50 per day
per year—the average patient cost now is $41.58
per day—we must begin to think about financing
hospital costs in a different way so that the total
cost is not put entirely on the paying patient at
the time he needs medical care. That is one of the
great advantages of hospital insurance. However,
not all hospital costs are insured at the present
time, and even to the extent they are, there is a
serious question whether items like nursing educa-
tion and emergency rooms and other aspects of
hospital costs should be borne by those who are
insured or by the patient. I think that this is
going to result in a whole reexamination not only
of how hospital costs are financed, but how hos-
pitals are operated and how they are organized.
The efficiency of hospital operation as well as the
method of financing in the future are questions
that await scrutiny and answer.

As I said, IT foresee a new working relationship
in the health professions among schools, colleges,
hospitals, and health facilities in order to explore
fundamentally new and effective ways of organiz-
ing medical and paramedical functions, and to
give a greater emphasis to preventive health care,
home health services, and a whole host of new
types of out-of-hospital, out-of-institution care. I
think you will find that as these functions are
organized and coordinated more effectively, the
result will be better care for more people, higher
levels of health, which are still attainable in this
country, economic gain in terms of productivity,
lower morbidity and mortality, and of course a
justification for paying those employed in the
allied health professions higher incomes.

The organization and delivery of medical serv-
ices in this country, even at the high level they are

today, will also be changed in my opinion as we
go along. We will have to make better use of
health manpower by delegating certain of the re-
sponsibilities to subprofessional aides. This will
create, of course, a certain amount of tension in
the health field between those in the professional
areas and those in the supporting nonprofessional
roles. As Dr. Louis Levine said, “Sometimes the
professional thinks of the nonprofessional as being
of a lower echelon that need not be consulted or
worked with in a cooperative spirit.” As a result
of this evolution of changing roles and division of
responsibility, which may well bring with it
greater tensions, government as well as nongovern-
ment organizations will have to work together
more effectively to meet this problem. And I
think it can be done if we look at the whole pic-
ture, at total health services as a joint public-pri-
vate cooperative effort.

I think that we are going to see, as our metro-
politan areas develop, a greater degree of out-of-
hospital, out-of-institution neighborhood services,
neighborhood health services that will be allied
perhaps with hospitals or State health depart-
ments, home health services, extended care facili-
ties, and skilled nursing homes that will be related
to the hospitals which will bring many services
closer to the individual than ever before.

I was quite impressed, as I worked some months
ago on the problem in the Watts area in Los
Angeles, to learn what a tremendous amount of
time the low income people had to take in order
to get to the available health services—clear across
the vast expanse of Los Angeles. It was not only
a burden to them financially which they could not
bear, but for many of the mothers with young
children it was a tremendous waste of time. Fur-
thermore, they had to get somebody to take care of
the children while they were gone. In general, it
was inefficient and unsatisfactory both from the
standpoint of the patients and the kind of medical
care that they got. I think that the Watts situa-
tion indicates the need, as is the case in many areas,
to bring health services closer to mothers, to chil-
dren, to old people, and to people who can’t travel,
as well as to cut down on the time wasted by the
physician and the health personnel, and by the
patient. I think that we are going to see a whole
new effort to bring the health services right into
the neighborhood, particularly for the lower in-
come group, the less educated, and the poor. Of

67

 
 

   

  

course, this also should be done in the suburban
areas for the very well-to-do.

I think, as we look ahead, that we shall see State
health and welfare departments working much
more closely with voluntary agencies in providing
access to family planning services on a voluntary
basis. I think that this is one of the areas in which
there is a great potential for development on the
America scene. I think there is a need for it, and
a willingness to accept it. I think that many of the
problems in family planning that were present in
past years have now been worked out, perhaps
not completely, but with the cooperation of the
public and private areas I think they can be worked
out satisfactorily. I think we will see close cooper-
ation between a whole host of personnel, not. only
in the medical subprofessional or allied medical
fields, but in many different fields that are impor-
tant in bringing family planning information to all
of our people. That means making information
and services available not only to the well-to-do,
not only to the poor, but to everyone in our society
who chooses to have them.

These same agencies in the community are going
to reduce the differential morbidity and mortality
rate between negroes and whites that exist in this
country, which is truly a blot on our total health
services in this country. T think that we are going
to find cures for leukemia and other forms of can-
cer through the heart disease, cancer, and stroke
program. We are going to retard deaths due to
these three major killers. As Isaid the other night,
through the artificial heart and artificial kidney,
I think that we are going to prolong life. Life ex-
pectancy at birth is now hovering about 70 years.
I think that we are going to increase that about 1
year every 5 years. It may not sound like much—
to increase life expectancy from the level of 70
years now to 71 years by 1970, 72 by 1975, and 73
by 1980—but in my opinion it represents a feasible
goal based on what is happening now in medical
science and in medical organization.

All these developments, all these changes, of
course, will bring with them tremendous new re-
sponsibilities not only to the health field and to
the health professions but to our society as a
whole—in terms of programs for the aged, pro-
grams for the poor, programs in urban and subur-
ban areas, and programs that relate to the leisure
activities for our aged and middle-aged people.

As you look ahead you can see that the 86 medi-
cal schools that we have now in this country are
going to have to be increased in number. Ten years
from now, I think we may have something in the
neighborhood of 125 medical schools. As I said
before, building the bricks and mortar is not so
difficult, but neither is it easy, especially if we are
going to add 40 new medical schools, expand the
number of nursing schools at the same time, and
enlarge our whole higher education program. I
think that we have to expand similarly in all of the
health fields.

In my opinion what we have started to talk about
today is one of the most important goals of the
Great Society: bringing the exciting miracles of
modern medicine, the continuing miracles of mod-
ern medicine, the future miracles of modern medi-
cine and science that are yet undreamed of, to
everyone of the 200 million people in our society
regardless of any factor other than the need for
medical care. I think that goal is going to be a
great challenge, and it is a challenge that we will
meet in our own way. It will be a way that is
strikingly different from that to be found in any
other country in the world. It is not going to be
a system of free enterprise medical care in the
Adam Smith tradition, and it is not going to be a
system of socialized medicine in terms of the Euro-
pean or foreign system. We are going to develop,
as we have been developing for 175 years but partic-
ularly for the last 30 years in this country, a
pluralistic system utilizing many different kinds of
institutions and arrangements, using both the
private sector and the public sector in a relation-
ship that no other country in the world has ex-
perimented with.

And T think, cliches apart, we are going to find
that the American system of organized medical
care will be a vital one, a changing one, one that
will be able to deliver more medical care to more
people, and to improve the quality of medical care
in a way that will surprise all of us 10 or 20 years
from now.

In helping to close this Conference I want to say
that all of you here have contributed immeasur-
ably, step by step, to one of the most interesting,
one of the most challenging, and one of the most
important ventures in improving the quality of
American life.
THE CHALLENGE: MATCHING PEOPLE AND JOBS IN HEALTH SERVICES

STANLEY H. RUTTENBERG, Manpower Administrator, U.S. Department of Labor

When I was Research Director of the CIO, I
had the privilege of serving as a member of a com-
mission appointed by the American Hospital As-
sociation, to study the cost of hospital care. I
learned a little bit about health manpower prob-
lems then, and as I listened to some of the speak-
ers and discussions during this Conference I
discovered that the problems we talked about in
that Commission some 15 or 16 years ago were
really not much different than they are today, ex-
cept that their magnitude is considerably greater.

Wilbur Cohen certainly made this crystal clear
when he outlined the great expansion in health
services that will take place over the coming dec-
ade and the impact of this expansion on health
manpower needs. As he pointed out, we will not
be able to meet.the increasing demands for health
care nor will we be able to utilize all the advances
in scientific and medical knowledge, unless we
really come forward with the manpower.

It will take not one kind or level of health man-
power, but many, to do the job. We are going to
have to come forward with semiprofessional health
manpower as well as professional; workers who
can provide direct services as well as supportive
services; personnel for nursing homes and home
care as well as personnel for hospitals.

This Conference has addressed itself to job de-
velopment and training for paramedical and aux-
iliary health service workers, and the more I have
heard during the past 214 days the more I am con-
vinced that it has been an exceedingly useful Con-

 

ference. It has given us in the Department of
Labor and the Department of Health, Education,
and Welfare the opportunity and the climate to
concentrate and coordinate our thoughts, atten-
tions, and energies upon a central problem—the
manpower shortage in the health services area.
And it has brought together the employers, unions,
educators, professional groups, and others who are
interested in trying to resolve the problem that
confronts us all.

Certainly the Conference has given us direc-
tion—helpful suggestions about the kinds of things
that need to be done in order for us to better meet
the health manpower needs of today and the fu-
ture. The whole notion of coordinating Govern-
ment resources and programs is of vital
importance—you need to know where to go to get
overall information about available programs,
funds, and assistance for training workers in
health service, and we need to see that Federal
manpower services and assistance are coordinated
in a way that will expedite the development of
training programs.

There has been great stress in some of your dis-
cussions, and rightly so, upon professional stand-
ards in the development of auxiliary health man-
power, as well as on the growing need for techni-
cal and supportive personnel. Certainly the
whole area of worker competency and the mainte-
nance of quality in health services is essential. To
try to meet health manpower needs with incompe-
tent workers would be futile. When we talked

69

 
 

about developing 10,000 jobs a month in the health
field, some of you pointed out that the jobs are
going to be there and what we need to do is de-
velop 10,000 workers to fill the jobs. We need
to develop competent people for these jobs—
people who are capable of performing their re-
quired tasks—workers who are adequately trained
to provide health and related services. This
means that we have to develop training; we have
to develop upgrading programs; we have to de-
velop and utilize our manpower properly.

My central theme this morning is that we must
involve in these paramedical and ancillary occu-
pations and training programs those individuals
in our society who are disadvantaged—disadvan-
taged because they are school dropouts or have had
limited opportunity for education and training.
Many of these individuals must be prepared, but
properly and adequately prepared, to fill jobs in
the health service industry. What bothers me is
that we sometimes equate lack of opportunity with
lack of potential —we equate low levels of educa-
tion and training with inadequacy, with incompe-
tence, and with discourtesy—and nothing could
be further from the truth.

I had a very interesting experience the other day
of talking to some people who had returned from
one of our southern States where there is large-
scale nonwhite unemployment. Many of the non-
white people had been unemployed because they
had not had the opportunity for education, or had
dropped out of school, or had attended schools
which did not provide them with the kinds of edu-
cation they had to have or needed. They are at
the low end of the education and training ladder,
but yet these individuals after several weeks or a
month or two of refresher education, after being
reoriented to the problems of today and given help
and assistance, are sometimes just as smart, just as
bright, just as competent, and just as courteous as
others who have had the fortunate opportunity of
going through high school.

I am reminded of an experience I had in World
War II. TI was an officer in a quartermaster sal-
vaging company stationed in one of the Pacific
Islands. We had 225 nonwhite troops and 4 white
officers. These nonwhite troops had received low
scores on what was called the Army General Clas-
sification Test. They had had very little educa-
tion and two of my fellow officers were very much
discouraged and felt that they could not do much
with this kind of an outfit. But fortunately the

70

company commander was a good man who really
didn’t feel this way toward the troops. After the
two officers were replaced and we began to work
with the troops, we found that this unit—individ-
uals who had a score of 80 or less on the Army
Classification Test—individuals who had not gone
very far in school—all nonwhite—turned out to be
one of the best outfits on the whole island. So
much depends on the kind of training that is given,
the kind of sympathy that is provided.

When I was in Newark early this week to an-
nounce the establishment of some training pro-
jects and Neighborhood Youth Corps programs, I
visited the city hospital and saw there a great num-
ber of Youth Corps trainees. This is that part of
the Poverty Program which provides work oppor-
tunity and experience for 16 to 21 year old youth.
These young people were engaged in all kinds of
aide and assistant services, and in addition to their
lectures relating to health services and medical
occupations, they were taking such courses as
grooming, communications, getting along with
people, and the like.

I sat through some of the lectures given by
nurses and doctors to the young people who had
been assigned to the hospital 6 or 7 months before
as nurses aides or laboratory aides or to perform
other types of work. It was interesting to com-
pare this group with the new group of Neighbor-
hood Youth Corps trainees who had come in just
that day. The incoming trainees were not very
well groomed; they were afraid to talk up; they
didn’t have any knowledge or understanding of
what they were doing. IT was told that the train-
ees who impressed me so much when IT went
through the wards and laboratories earlier in the
day were no different when they entered the hos-
pital 7 or 8 months ago. They had been given
an opportunity to develop their potential and had
proved to be useful citizens.

If we use this approach to the problem of un-
employment in this country and give the disad-
vantaged the right opportunities and the right
kind of assistance, even though they have been
school dropouts, whether they are white or non-
white, they can become exceedingly useful citizens
and make a great contribution to the health service
industry.

How do we develop these kinds of people?
How do we help them? We need to develop the
cooperation, the ingenuity, the initiative of edu-
cators, of Employment Service counselors, of
people who are involved in stimulating, motivat-
ing, and activating people in our population; the
people who are involved in curriculum develop-
ment and in devising teaching techniques that will
help these people so that they can become produc-
tive and fill many, not all, but many of the jobs in
the health service industry that must be filled now
and during the next 10 years.

Now let me make one further point that relates
to a professional problem that bothers me. Yes-
terday it was my good fortune to appear before
a House Congressional Committee on Education to
talk about the professional manpower needs of this
country, not only in the health service field but
in the social science field, in the natural science
field, and the field of science and engineering, and
to review for the Committee what the manpower
demand and supply might be over the coming
year. I made a point at that hearing based on a
study by Dr. Earl McGrath, the former Commis-
sioner of the U.S. Office of Education, a point
which was that our Negro institutions, our Negro
colleges in the United States that train more than
60 percent of the Negro graduates in this country,
are not really training these people for the kinds
of occupations in the business and professional
fields that they ought to be training them for. I
made another point that these colleges do not
really have adequate facilities to train their stu-
dents in the fields for which they ought to be
trained on a professional level. It is not the fault
of the Negro institutions of higher learning; it
is our fault, it is society’s fault for refusing to pro-
vide the professional openings and opportunities
for the nonwhite population. We have a tremen-
dous reservoir of highly competent people. If they
were given the opportunity to move through uni-
versities that are well prepared to train them, they
could be prepared to move into the health pro-
fessions and to other professions as well. But fi-
nancial help would be necessary to enable nonwhite
institutions to improve their curriculums, the kinds
and types of offerings, and opportunities for
graduate study.

We must also provide adequate facilities for
training in the less than professional area. There
have been frank and candid discussions about this
throughout this Conference and I am glad to know
that nobody has pulled any punches. Some con-
cern has been expressed about using disadvantaged
people in the health and related service occupa-
tions—that it is essential to preserve the integrity

of patient care. Some fear has been expressed
about upward mobility of people who might not
meet the standards for higher level training or
employment. I think that this is a legitimate fear
on the part of the professions. Employers are
concerned about financing training programs and
increasing wages of health service workers, not
because they want to deprive or depress the wage
levels but because the increased costs would have
to be passed on to the patient.

Labor unions are deeply concerned about turn-
over and opportunities for upgrading. Like hos-
pital administrators, they want to attract into the
industry the best possible workers and workers
with good potential. Labor’s interest, naturally,
is in maintaining a living wage for the people that
are working—and people just don’t work because
of their love for the particular job. I think some
of us who come into Government service do so be-
cause we are willing to make the sacrifices. But
when one is at the low, poverty wage level paid in
hospitals and nursing homes, we no longer can
think in terms of that individual's willingness to
make sacrifices because the job is so important or
satisfying. We have decided, therefore, in the
Department of Labor that approval of any Fed-
erally financed training program for which we
have responsibility, whether it is a regular institu-
tional training program or an on-the-job training
program, will require that the prospective job
entry wage rates for the occupation shall be at
least the equivalent of a $1.25 or the prevailing
wage in the community, whichever is higher.
While this might cause some problems to em-
ployers, it is fundamentally and essentially im-
portant if we are going to develop the kind of
personnel we need.

Many educators, of course, have been concerned
about the kinds of people who are being selected
for health occupations training. They have raised
questions about whether or not the tests used by
the Employment Service are really the tests that
find and select the kinds of personnel that are
needed for health services. They are worried that
the Employment Service isn’t really selecting the
right people. Now that may be true in certain
areas, but there is a lot of work being done by the
Employment Service to improve testing, to im-
prove referral, to get at the problem of dupli-
cation.

Now, having said all of this in terms of some
of your concerns, I would just like to pose for you,

71

 
if IT might, our concern that we not equate low
levels of education and low levels of training with
incompetency and inability ; we should equate op-
portunities for disadvantaged people with the
competencies they could have, if properly devel-
oped. I would say, as one concerned with man-
power development and utilization, that we must
look to our educators, to our vocational institu-
tions, to develop the kinds of training techniques,
the kinds of curriculum, the kind of technical
information that is so essential, in order that these
people will be trained for health service occupa-
tions.

I don’t know much about curriculum for a
health occupations training program, but I have
had some experience around the country with dis-
advantaged folk and have found that it is difficult
in many communities to even locate some of the
disadvantaged—they are so afraid, they are afraid
to come out, they are afraid to come to the Em-
ployment Service to say they need help or are look-
ing for a job. New methods have to be developed
to reach out and find these people, motivate them,
stimulate them, counsel with them, and work with
them while they are being trained so they do not
become dropouts from training just as some of
them were dropouts from school. But just as we
have the tremendous responsibility in the U.S.
Employment Service to develop new techniques of
outreach and motivation, so must the vocational
educator face the fact that if some of the dis-
advantaged are hard to reach, they are also going
to be hard to teach. But because they are hard
to teach is no reason to abandon them and not
teach them, any more than we should abandon
them when we find they were hard to reach. We
are working very closely with the vocational edu-

72

cators and with the research and curriculum people
in the Office of Education to see that there are
techniques developed in terms of teaching the hard
to reach. I am confident that similar kinds of ac-
tivities can be and will be conducted in this area.

Let me say in conclusion that the implementa-
tion that flows from this Conference will involve
a number of things. We need to have a report of
this Conference and it ought to be disseminated
widely. It has been suggested that similar con-
ferences be held on regional and State levels, and
that we sponsor a regional or area conference that
could be used as a model by States and local com-
munities throughout the country. We need, of
course, as has come out from this Conference, a
greater degree of coordination of Federal man-
power program information and services. We
should add to our manpower advisory committees,
and we have one in every State of the Union, some
people who understand and appreciate the prob-
lems of health manpower training and utilization.
And this also applies to the some 900 local man-
power advisory committees throughout the United
States. You folks with your background and ex-
perience ought to be involved in these activities.

Now I have not touched on all the proposals
that have been made. I have only touched on a
limited number but there are many suggestions
that have come from your discussions which need
to be implemented and which will receive our close
attention and consideration. I pledge to you the
continued interest of the Department of Labor and
the best efforts of the Manpower Administration
in meeting one of the great challenges of our
time—matching jobs and workers in health
services.

 

 
APPENDIX A

 

Conference on Job Development and Training for Workers in Health Services

CONFERENCE COORDINATOR

MARY S. RESH, Deputy Assistant Manpower Administrator, U.S. Department of Labor

PLANNING COMMITTEE

ViADIMIR D. CHAVRID, Director

Office of Manpower, Analysis, and Utilization, Bureau of
Employment Security, U.S. Employment Service, U.S.
Department of Labor

JouN B. EiscHEN, National Representative for Trade and
Service Industry

Office of Industry Promotion, Bureau of Apprenticeship
and Training, U.S. Department of Labor

VELMA KINSEY, Manpower Development Specialist
Neighborhood Youth Corps, U.S. Department of Labor

MORTON LEVINE, Labor Economist
Office of Manpower Policy, Evaluation and Research, U.S.
Department of Labor

LILLIAN PETERSEN, Manpower Development Specialist
Office of Manpower Policy, Evaluation and Research, U.S.
Department of Labor

CHARLES W. PHILLIPS, Staff Assistant to the Assistant
Secretary for Education and HEW Coordinator for
Conference

U.S. Department of Health, Education, and Welfare

HELEN Powers, Chief, Health Occupations Unit
Division of Vocational and Technical Education, Office of
Education, U.S. Department of Health, Education, and
Welfare

HARVEY I. SCUDDER, Manpower Resources Consultant and
HEW Coordinator for Conference
Division of Community Health Services, U.S. Department
of Health, Education, and Welfare

MARGARET WEST, Assistant Chief
Division of Public Methods, Public Health Service, U.S.
Department of Health, Education, and Welfare

CONSULTANTS TO COMMITTEE

CARL A. HEINZ, Chief
Division of Technical Development, Bureau of Employ-
ment Security, U.S. Department of Labor

CARYL HOLIBER, Supervisory Labor Economist
Bureau of Employment Security, U.S. Department of
Labor

WiLriam L. Kissick, Deputy Chief
Division of Public Health Methods, Public Health Service,
U.S. Department of Health, Education, and Welfare

CorNELIA KNIGHT, Representative of Commissioner of
Hducation’s National Advisory Committee on Health
Occupations Education

U.S. Department of Health, Education, and Welfare

Tuomas F. RovaLs, Manpower Dcvelopment Specialist
Office of Manpower Policy, Evaluation and Research,

U.S. Department of Labor

73
   
   
   
 
   
   
   

CONFERENCE STAFF
Department of Labor

MARY S. RESH
AGNES M. Douty
FRANCES PucH
PaYLLIS MULLINS

Department of Health, Education, and Welfare

CHARLES W. PHILLIPS

Lucy M. KRAMER
ROBERT A. BURTON
NEweL B. KNIGHT
NANCY E. LINDSAY

LILLIAN PETERSEN
MARJORIE FREEMAN

HARVEY I. SCUDDER

RicaARD P. LOVETT
SHIRLEY J. MARTIN
JoN RASMUSSEN

 
W. FULTON ABERCROMBIE

Acting Chief

Training Branch

Division of Health Mobilization

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

RutrH R. ADAMS
Associate Professor
School of Social Work
Howard University
Washington, D.C.

ALEXANDER ADLER

Division of Community Health
Services

Public Health Service

U.S. Department of Health,
Education, and Welfare

DR. MICHAEL ALDERMAN

Division of Public Health Methods

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

SALLY ANDERSON

Division of Community Health
Services

Public Health Service

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

HENRY A. ARONSON

Director

Division of State Merit Systems

Office of the Secretary

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

JoHN L. BATCHELOR
Occupational Analyst

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

WiLLiaM L. BATT, JR.

Consultant on Training for Workers
in Health Services

6425 31st Street NW.

Washington, D.C.

223-124 0—66——6

APPENDIX B
ROSTER OF PARTICIPANTS

WALTER BEATTIE

National Committee on Community
Health Services

7815 01d Georgetown Road

Bethesda, Md.

OLGA C. BENDEROFF

Chairman

Committee on Nursing Service
American Nurses’ Association
University Hospitals of Cleveland
Cleveland, Ohio

NELLiE: MAY BERING

Education and Research Fund, Inc.
Suite 1000, 915 19th Street NW.
Washington, D.C.

MARK BERKE

Executive Director

Mount Zion Hospital and
Medical Center

San Francisco, Calif.

VirGINIA K. BETZOLD
Committee on Education
American Nurses’ Association
20 Newburg Avenue
Baltimore, Md.

LAURA ANNE BIGLOW

Chief

Education Programs

American Association of Medical
Record Librarians

840 North Lake Shore Drive

Chicago, Ill.

JOAN BIRCHENALL

Supervisor

Health Occupations Education

State of New Jersey

Department of Education

Trenton, N.J.

SARAH BI1zzELL

Education Committee

American Dental Assistants
Association

108 Magnolia Avenue

Fayetteville, N.C.

Lucy BLAIR

Executive Director

American Physical Therapy
Association

1790 Broadway

New York, N.Y.

JoHN BLANCHETTE

Bureau of Apprenticeship
and Training

U.S. Department of Labor

Washington, D.C.

C. B. BLANKENSHIP
Legislative Director
Communications Workers
of America, AFL-CIO
1925 K Street NW.
Washington, D.C.

BerTHA H. BOLDEN

D.C. Public Schools

Wormley Administration Annex
3331 Prospect Street NW.
Washington, D.C.

DoNALD BONE

Division of Public Health
Methods

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

PHILP D. BONNET

President

American Hospital Association
750 Harrison Avenue

Boston, Mass.

JENNIFER BOONDAS

Division of Medical Care
Administration

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

Scott BOWMAN

Bureau of Apprenticeship
and Training

U.S. Department of Labor

Washington, D.C.

MARILYN Boyp

Chairman

Department of Nursing

Northern Virginia Technical College
3443 South Carlyn Spring Road
Bailey's Crossroads, Va.

MoNTAGUE BrOwWN
Hospital Research and
Educational Trust

Princeton, N.J.

75

 
  

Harry W. BRUCE, Jr.

Chief

Manpower and Education Branch

Division of Dental Health

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

RurH W. BRUNYATE
Consultant in Occupational Therapy
Maryland State Department
of Health
301 West Preston Street
Baltimore, Md.

Er1zABETH D. BUCHANAN

Chief

Health Manpower Section

Division of Health Mobilization

Public Health Service

U.S. Department of Health, Education,
and Welfare

Washington, D.C.

JANET BURNHAM

Consultant, Dental Hygiene

Manpower and Education Branch

Division of Dental Health

Public Health Service

U.S. Department of Health, Education,
and Welfare

Washington, D.C.

TroMAs E. CALLAHAN

Executive Director

Hospital Council of Western
Pennsylvania

4029 Biglow Boulevard

Pittsburgh, Pa.

EUGENIA CARPENTER
University of Michigan
School of Public Health
Ann Arbor, Mich.

WirLriam E. CASTLE

Associate Secretary

American Health and Speech
Association

1001 Connecticut Avenue NW.

Washington, D.C.

JosePH CAVANAUGH

National Institute of Mental Health

Public Health Service

U.S. Department of Health, Education,
and Welfare

Bethesda, Md.

CoLIN W. CHURCHILL

Secretary

Hospital Research and Educational
Trust

840 North Lake Shore Drive

Chicago, 111.

76

JAMES CLARKE

Assistant to the Assistant Secretary
for Education

U.S. Department of Health, Education,
and Welfare

Washington, D.C.

ELEANOR COLLARD

Training Consultant,
Inservice Training

National Institute of Mental Health

Public Health Service

U.S. Department of Health, Education,
and Welfare

Bethesda, Md.

ErrEL I. CoLLINs

Office of Manpower Policy,
Evaluation, and Research

U.S. Department of Labor

Washington, D.C.

MostELLE COMER

First Vice President

American Dental Assistants
Association

1727 Cromwell Road

Norfolk, Va.

GEORGE E. CONLEY
Licensed Nursing Home Association
Trenton, N.J.

RoBerT COON

Chemist

Pathology Department

University of Vermont
Medical School

Burlington, Vt.

ARTHUR R. CORNELUSEN

President

Licensed Nursing Homes Association
Trenton, N.J.

THEODORE J. COTE

Director

Professional Services

State Department of Education
State of New Jersey

225 West State Street

Trenton, N.J.

RarpH L. Cowart

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

WiLriam Cox

Physical Therapy Consultant

Home Health and Related
Services Branch

Division of Medical Care
Administration

Public Health Service

U.S. Department of Health, Education,
and Welfare

Washington, D.C.

 

MERRILL W. CREWS

Assistant Executive Director

Florida Hospital Association

Orlando, Fla.

DwiecHT CRUM

Manpower Branch

Office of Education

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

RoBERT CUMMINGS

MDTA Coordinator

California State Employment
Service

800 Capitol Avenue

Sacramento, Calif.

DororHY B. DALY

Project Director

Task Force on Social Work

Education and Manpower

Office of the Under Secretary

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

HELEN M. DANLEY

Division of Hospital and
Medical Facilities

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

W. PALMER DEARING

Executive Director

Group Health Association of America

1321 14th Street NW.

Washington, D.C.

Arva R. DITTRICK

Deputy Superintendent

Cleveland Public Schools

1380 East Sixth Street

Cleveland, Ohio

DENNIS CHARLES Dix

Director of Education
and Research

American Nursing Home
Association

1101 17th Street NW.

Washington, D.C.

GILBERT DONAHUE

Office of Manpower Policy,
Evaluation and Research

U.S. Department of Labor

Washington, D.C.

ANN DONOVAN

Manpower Program

Division of Vocational-Technical
Education

Office of Education

U.S. Department of Health, Education,
and Welfare

Washington, D.C.

     
 

ELSIE DORMAN

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

AeNES M. Douty

Consultant

Office of Manpower Policy,
Evaluation and Research

Manpower Administration

U.S. Department of Labor

Washington, D.C.

BERNARD DOWNEY

Bureau of Apprenticeship
and Training

U.S. Department of Labor

‘Washington, D.C.

DALE C. DRAPER

National Education Association
1201 16th Street NW.
Washington, D.C.

SAMUEL S. DUBIN

Associate Professor of Psychology
Pennsylvania State University
University Park, Pa.

CHESTER DZIEKOWSKI
American Medical Technologists
Chicago, Ill.

Wirtriam C. ECKERMAN

Senior Research Consultant

Michigan Health and Social
Security Research Institute

7891 East Jefferson

Detroit, Mich.

Louise C. EAN

Educational Supervisor

Practical Nurse Education

Department of Community
Colleges

Raleigh, N.C.

JoHN B. EISCHEN

National Representative

Bureau of Apprenticeship
and Training

U.S. Department of Labor

Washington, D.C.

Erick K. ERICKSON

Assistant to the Chancellor

Office of the Chancellor

University of California, San Fran-
cisco Medical Center

San Francisco, Calif.

GEOFFREY W. EsTY

Chairman

New Jersey Health Careers Service
Trenton, N.J.

PAULINE M. FAHEY

Director

Program on Nursing Service
American Nurses’ Association
10 Columbus Circle

New York, N.Y.

GEORGE E. FAIRCHILD

General Secretary-Treasurer

Building Service Employees’ Inter-
national Union

‘Washington, D.C.

Jorn T. Fay, Jr.

Director

Division of Pharmaceutical Services

American Pharmaceutical
Association

2215 Constitution Avenue NW.

Washington, D.C.

SISTER M. FERDINAND
Administrator

Mercy Hospital
Pittsburgh, Pa.

DoroTHY B. FEREBEE
Medical Director
Howard University
‘Washington, D.C.

Isaac FINE

Division of Employment Security
Commonwealth of Massachusetts
881 Commonwealth Avenue
Boston, Mass.

MARJORIE FI1sH

Consultant, Occupational Therapy

Vocational Rehabilitation
Administration

U.S. Department of Health, Education,
and Welfare

Washington, D.C.

MARGARET FOLEY

Consultant in Nursing Education
Catholic Hospital Association
1438 South Grand Boulevard

St. Louis, Mo.

CONSTANCE FoSHAY

Health Division

Community Action Program
Office of Economic Opportunity
1200 19th Street NW.
‘Washington, D.C.

DoroTHY FOWLER

Group Health Association of America
1321 14th Street, NW.

Washington, D.C.

EvererT V. Fox
Administrator

Goldwater Memorial Hospital
Welfare Island, N.Y.

 

RUSSELL FRAZEE
Allegheny General Hospital
Health Research Project
320 East North Avenue
Pittsburgh, Pa.

MARVIN FRIEDMAN
Economist
AFL-CIO

815 16th Street NW.
Washington, D.C.

WARREN GANONG

Health Research Project
Allegheny General Hospital
320 East North Avenue
Pittsburgh, Pa.

HENRIETTE GEBERT

Vocational Specialist in
Commercial Foods

American Dietetic Association

620 North Michigan Avenue

Chicago, Ill.

MARGARET GILSTRAP
U.S. Department of Agriculture
‘Washington, D.C.

Err GINZBERG

Director

Conservation of Human Resources
Columbia University

New York, N.Y.

Wo0oDROW GINSBURG

Industrial Union Department
AFL-CIO

815 16th Street NW.

Washington, D.C.

ErLriortr GODOFF

Vice President, Local 1199

Retail and Wholesale Department
Store Union, AFL-CIO

132 West 43d Street

New York, N.Y.

OPAL GOODEN

Special Assistant

United Mine Workers of America,
Welfare and Retirement Fund

907 15th Street NW.

Washington, D.C.

ROBERT GRANAKIS
Neighborhood Youth Corps
U.S. Department of Labor
Washington, D.C.

CATHERINE GRANT

Assistant Director

Vocational Education
Philadelphia Board of Education
Philadelphia, Pa.

PETER HAASE
INTEC, Inc.

740 North Rush Street
Chicago, Ill.
 

JosepH HALL

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

HELEN B. HAMER

Chief

Program Development Branch

Bureau of Family Services

Welfare Administration

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

EraiNe HANDY

Office of Manpower Policy,
Evaluation and Research

U.S. Department of Labor

Washington, D.C.

MERWIN HANS

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

IvaAN O. HARRAH

Assistant Vice President
Appalachian Regional Hospitals
Lexington, Ky.

JoHN K. HARRIS

Senior Social Scientist
System Development Corp.
5720 Columbia Pike

Falls Church, Va.

STANLEY HARRIS
Bureau of the Budget
Washington, D.C.

RALPH S. HASKINS

President

American Medical Technologists
8400 Stanton Road

Little Rock, Ark.

CARL A. HEINZ

Chief

Division of Technical Development
Bureau of Employment Security
U.S. Department of Labor
‘Washington, D.C.

ROBERT HERMAN

Project Oflicer

Division of Adult and Vocational
Research

Office of Education

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

ToBA S. HERZENBERG

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

78

Herren HILLE

Nutrition Consultant

Children’s Bureau

Welfare Administration

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

AppisonN S. Hoss
Supervising Director
Trade and Industrial Education
District of Columbia
Public Schools
Washington, D.C.

Davip HooVER

Division of Community Health
Services

Public Health Service

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

Howarp W. HOUSER

Director of Manpower Development

University of Alabama Hospitals
and Clinics

Birmingham, Ala.

AvrictaA HowARD

Head

Department of Oral Hygiene
Howard University
Washington, D.C.

EsTELLE L. HOWARD
Assistant Director
Nursing Service
Providence Hospital
1150 Varnum Street NW.
Washington, D.C.

Jay M. HUDSON
Administrative Resident
Mount Zion Hospital
and Medical Center
San Francisco, Calif.

H. C. HUNTLY

Appalachian Regional Commission
1666 Connecticut Avenue NW.
Washington, D.C.

Jack HURT

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

MerYLE V. HUTCHISON
Assistant Director

American Nurses’ Association
1030 15th Street NW.
Washington, D.C.

SISTER ANNE JOACHIM
President

St. Mary’s Junior College
Minneapolis, Minn.

EvuGENE V. JOBE

American Medical Association
1634 I Street NW.
‘Washington, D.C.

DonNarp W. JOHNSON

Chief

Special Studies Section

Division of Dental Health

Public Health Service

U.S. Department of Health,
Education, and Welfare

8120 Woodmont Avenue

Bethesda, Md.

Lyra JoHNSON

Chief of Personnel

Group Health Association of America
Washington, D.C.

MARTHA JOHNSON

Nurse Consultant

American Hospital Association
840 North Lake Shore Drive
Chicago, I11.

RutH L. JOHNSON

Division of Nursing

Public Health Service

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

RurH R. JOHNSON

Division of Public Health Methods

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

ArToN M. JONES
Manpower Development Specialist
Bureau of Apprenticeship

and Training
U.S. Department of Labor
Washington, D.C.

Raymond L. KAHN
Associate Director
Association of

Rehabilitation Centers
828 Davis Street
Evanston, Ill.

WINIFRED KELLOGG
Assistant Director
Visiting Nurse Association
Detroit, Mich.

EvrizaBerH E. KErRr

State Consultant

Health Occupations Education
The University of Iowa

Iowa City, Iowa

 
MARKAY KERR

Division of Public Health Methods

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

S1sTER VIRGINIA KINGSBURY
Provincial Nursing Education
Consultant
Daughters of Charity of
St. Vincent de Paul
Marillac Provincial House
St. Louis, Mo.

Lucite KINLEIN

Assistant Professor of Nursing
Education

The Catholic University

Washington, D.C.

ROBERT KINSINGER

Community College Health
Careers Project

State Education Department

Albany, N.Y.

Ear T. KLEIN

Acting Deputy Assistant Director

Office of Manpower Policy,
Evaluation and Research

U.S. Department of Labor

Washington, D.C.

CORNELIA KNIGHT

Director

Allied Nursing Personnel Program
American Nurses’ Association

10 Columbus Circle

New York, N.Y.

Jack KONECNY

Assistant Director

James Connally Technical Institute
Waco, Tex.

Lucy M. KRAMER

Division of Community Health
Services

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

LAURA MAE KRESS
Specialist for Professional
Information
American Personnel
and Guidance Association
1605 New Hampshire Avenue NW.
Washington, D.C.

Lots KRYGER

Dental Assistant Consultant

Division of Dental Health

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

WALTER LABANOW

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

RuTH LAPE
Assistant Principal
Central High School
Cincinnati, Ohio

CRISTINE LAZATINE
Science Attaché
Philippine Embassy
Washington, D.C.

Or1ro LEGG
Division of Adult
and Vocational Research
Office of Education
U.S. Department of Health,
Education, and Welfare
Washington, D.C.

WirLiaM LENTZ

Health Research Project
Allegheny General Hospital
Pittsburgh, Pa.

EILEEN LESTER

Division of Medical Care
Administration

Public Health Service

U.S. Department of Health,
Education and Welfare

Washington, D.C.

EUGENE LEVINE
Chief
Manpower Analysis
and Resources Branch
Division of Nursing
Public Health Service
U.S. Department of Health,
Education, and Welfare
Washington, D.C.

Louris LEVINE

Assistant Manpower Administrator
U.S. Department of Labor
Washington, D.C.

J. ROBERT LINDSAY

Deputy Chief

Division of Community Health
Services

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

FLORENCE S. LINDUFF

Consultant, Physical Therapy

Vocational Rehabilitation
Administration

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

Roger C. LiriTz

Executive Director

House in the Pines Nursing Homes
Baltimore, Md.

Mary F. LISTON

Nursing Education

National League for Nursing
10 Columbus Circle

New York, N.Y.

Davip R. Lit

Social Security Administration

U.S. Department of Health, Educa-
tion, and Welfare

Baltimore, Md.

R. M. LOUGHERY
Washington Hospital Center
‘Washington, D.C.

ARCH LUGENBEEL

Project Director

South Carolina Hospital
Association

Columbia, S.C.

ATHALIE LUNDBERG

Administrator

D.C. General Hospital School for
Medical Laboratory Assistants

19th and E Streets SE.

Washington, D.C.

WirtiaM P. McCAHILL

Executive Secretary

The President’s Committee on
Employment of the Handicapped

Washington, D.C.

ROBERT MCCONNON

Bureau of Apprenticeship
and Training

U.S. Department of Labor

Washington, D.C.

RopeErRICK D. McCRIMMON

Department of Employment
Security

174 Social Hall Avenue

Salt Lake City, Utah

MarcormM McDONALD
Director of Training Programs
New York City Department

of Labor
New York, N.Y.

James J. McFADDEN
Acting Commissioner of Labor
New York City Department
of Labor
New York, N.Y.

JAMES McGOWAN
State Coordinator of
Manpower Training
Division of Vocational Education
Frankfort, Ky.

79

 
G. E. McGrew
State Department of Education
Columbia, S.C.

ELEANOR N. MCGUIRE
Coordinator

Health Careers Program
National Health Council
1790 Broadway

New York, N.Y.

RicaHARD B. MCKENZIE
Pennsylvania Medical Society
Harrisburg, Pa.

NAN McKINNEY

American Optometric Association
1026 17th Street NW.
Washington, D.C.

PATRICIA MCLEAN
Columbia University
630 West 168th Street
New York, N.Y.

MATTHEW MCNULTY, JR.

General Director

University of Alabama Hospitals and
Clinics

Birmingham, Ala.

EpMUND J. MCTERNAN
Associate Professor
Northeastern University
Boston, Mass.

STANLEY MARKUSON

Bureau of Apprenticeship and
Training

U.S. Department of Labor

Washington, D.C.

ELEANOR D. MARSHALL
Assistant Director

American Nurses’ Association
10 Columbus Circle

New York, N.Y.

JAN C. MARTIN

Personnel Director
Washington Hospital Center
Washington, D.C.

DARREL J. MASE

Dean

College of Health Related Professions
University of Florida

Gainesville, Fla.

HowARD MATTHEWS

Manpower Branch

Division of Vocational Technical
Education

Office of Education

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

80

James C. Mau

Administrative Director
Physician Assistant Program
Duke University Medical Center
Durham, N.C.

Kraus MAYER

Associate Chief

Laboratory Services

Memorial Sloan-Kettering
Cancer Center

444 East 68th Street

New York, N.Y. 10021

Lee H. Mayo

Teaching Supervisor

Certified Laboratory Assistants
School

Wake County Memorial Hospital

Raleigh, N.C.

THOMAS P. MELICAN

Research Director

Catholic Social Services of
Wayne County

9851 Hamilton Avenue

Detroit, Mich.

Louise A. MEYER

American Nurses’ Association
84 Island Bay Lane
Springfield, I11.

BEN F. MILLer, ITI
Assistant Secretary

Council on Dental Education
American Dental Association
211 East Chicago Avenue
Chicago, Ill.

WILLIAM MIRENGOFF

Deputy Director

Office of Manpower Policy,
Evaluation and Research

U.S. Department of Labor

Washington, D.C.

NorRMAN P. MITBY

Director

Madison Vocational Technical
and Adult Schools

Madison, Wis.

HELEN MORAN
Boston Public Schools
Boston, Mass.

PaILIP W. MORGAN

Staff Associate for Health Careers
United Hospital Fund of New York
New York, N.Y.

Epwarp L. MORRIS
Chicago Educational

Television Association
Chicago, I11.

HARRY MURPHY
Personnel Director
St. Mary’s Hospital
407 East Third Street
Duluth, Minn.

RicrarD E. MURPHY
International Representative
Building Service Employees’
International Union
Washington, D.C.

EVELYN MURRAY

Chief

Youth Services Branch

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

Jose A. NALpO
Labor Attaché
Philippine Embassy
Washington, D.C.

GRACE NANGLE

Senior Supervisor

Health Occupations Training
State Department of Education
Boston, Mass.

MARTHA NAYLOR

Chief Nursing Consultant

Home Health and Related Services

Division of Medical Care
Administration

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

Ersa NELSON

Division of Community Health
Services

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

EprisoN E. NEWMAN

Sanitarian Director

Division of Indian Health

Public Health Service

U.S. Department of Health,
Education, and Welfare

Silver Spring, Md.

Paur G. O'CONNOR

Nutrition Consultant and
Physical Therapy Consultant

Division of Medical Care
Administration

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.
 

PETER OTTLEY
Director
Department of Civil Rights and
Economic Opportunity
Building Service
Employees’ International Union
New York, N.Y.

Jack OWENS

Director of Curriculum

Greenville Technical
Education Center

Greenville, S.C.

DAVID A. PEARSON

Division of Medical Care
Administration

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

Davip K. PECHMANN

Assistant Executive Director

Hospital Council of the National
Capital Area, Inc.

Washington, D.C.

WALTER J. PELTON
Professor oflDentistry
University of Alabama
Birmingham, Ala.

BLANCHE PENN

Director

David Hale Fanning Trade School
‘Worcester, Mass.

MARYLAND Y. PENNELL

National Center for
Health Statistics

Public Health Service

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

PAUL PENNINGROTH
Assistant Director
Mental Health Training
and Research
Southern Regional
Education Board
Atlanta, Ga.

FREDERICK C. PFISTERER

President

Westchester Nursing Home
Association

Mount Vernon, N.Y.

ARNULF M. PINs

Associate Director

Council on Social Work Education
New York, N.Y.

CHARLES W. PHILLIPS

Office of Assistant Secretary for
Education

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

MARTHA PHILLIPS

Division of Chronic Diseases

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

KEN E. POHLMANN

United Mine Workers Welfare
and Retirement Fund

Washington, D.C.

HELEN K. POWERS

Chief, Health Occupations

Division of Vocational and
Technical Education

Office of Education

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

HENRY PRZELOMSKI

Bureau of Apprenticeship
and Training

U.S. Department of Labor

Washington, D.C.

FRANCES PUrDY

American Nurses’ Association
330 East 33d Street

New York, N.Y.

Louis RAvVIN

Specialist on Aging

Administration on Aging

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

Jack REES

American Nursing Home
Association

Cheswick, Pa.

WiLLiaM G. REIDY

Editor

Bulletin of Association of
American Medical Colleges

1501 Massachusetts Ave. NW.

Washington, D.C.

Mary S. REsH

Deputy Assistant Manpower
Administrator

U.S. Department of Labor

Washington, D.C.

MiriAM RIDDLE
State Department of Education
Columbia, S.C.

ROSALIE RISINGER

Principal

Essex County Vocational
Technical School

Newark, N.J.

Guy ROBBINS
Memorial Hospital
New York, N.Y.

Mary ELLA ROBERTSON
School of Social Work
University of Pittsburgh
Pittsburgh, Pa.

R. THAYNE RoBSoN
Executive Director
President’s Committee

on Manpower
U.S. Department of Labor
Washington, D.C.

SISTER MARY ROSARIT

Little Company of Mary
Hospital

Evergreen, Ill.

NEAL ROSENTHAL
Bureau of Labor Statistics
U.S. Department of Labor
Washington, D.C.

WiLriaM A. ROTHMAN
Associate Administrator
Metropolitan Hospital
Detroit, Mich.

HAroLD RUSSELL

Chairman

President’s Committee on
Employment of the
Handicapped

Washington, D.C.

ELIZABETH RYAN

Chief

Training Section

D.C. Department
of Public Health

‘Washington, D.C.

Joan B. REID

Director of Public Relations
and Development

Beekman-Downtown Hospital

New York, N.Y.

MORRIS SACKMAN

NIRHS—National Institute on
Rehabilitation and Health
Services

1714 Massachusetts Avenue NW.

Washington, D.C.

Etta B. ScEMIDT

Executive Director

National Federation of Licensed
Practical Nurses, Inc.

New York, N.Y.

81

 
  

MILDRED SCHWAGMAYER

Assistant Director of Education

American Occupational Therapy
Association

250 West 57th Street

New York, N.Y.

Louls SCHWARTZ

Local 144, Building Service
Employees’ International Union

New York, N.Y.

M. K. SCHWARTZ

Memorial Sloan-Kettering
Cancer Center

410 East 68th Street

New York, N.Y.

HArvVEY I. SCUDDER

Manpower Resources Consultant

Division of Community Health
Services

Public Health Service

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

PHIL SEAGREN

Director

Adult Vocational Education
1410 NE. 2d Avenue

Miami, Fla.

DesMoND H. SEALY
Associate Director
National Urban League
‘Washington, D.C.

MARIAN SEIFERT

Assistant Training Director
Lincoln Hospital

Bronx, N.Y.

DAVID SHARMAN

American Optometric Association
1026 17th Street, NW.
Washington, D.C.

Ross S. SHEARER
Manpower Administration
U.S. Department of Labor
Washington, D.C.

MARGARET SHEEHAN

Division of Nursing

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

RICHARD SHOEMAKER

Assistant Director

Department of Social Services,
AFL-CIO

815 16th Street NW.

‘Washington, D.C.

82

 

RALPH SHOWALTER
Hazecutive Director

Social Development Corp.
1126 16th Street NW.
‘Washington, D.C.

KENNETH G. SKAGGS
American Association
of Junior Colleges
1315 16th Street NW.

Washington, D.C.

PAUL SLONE
National Association

of Dental Laboratories, Inc.
‘Washington, D.C.

CHARLOTTE E. SMITH

Nutrition Consultant and Physical
Therapy Consultant

Division of Medical Care
Administration

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

GEORGE J. SMITH

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

LESTER SMITH
Executive Director
American Orthotics

and Prosthetic Association
919 18th Street NW.
Washington, D.C.

ANN R. SoMERS

Research Associate
Industrial Relations Section
Princeton University
Princeton, N.J.

ESTHER SPENCER

Director

Home Health Aide Program
Office of Economic Opportunity
Washington, D.C.

PEARL SPINDLER

Chief

Branch of Special Projects
Women’s Bureau

U.S. Department of Labor
Washington, D.C.

GEORGE STEPHENSON

National Committee for Careers
in Medical Technology

1785 Massachusetts Ave., NW.

Washington, D.C.

 

KATHRYN STONE

Director

Program on Human Resources

Washington Center for
Metropolitan Studies

1726 Pennsylvania Ave., NW.

Washington, D.C.

JOHN STRAUMFJORD

University of Alabama
Medical Center

Birmingham, Ala.

TrOMAS W. STRICKLAND

State Supervisor for
Technical Education

Tallahassee, Fla.

MerLE E. STRONG

Assistant Director

Program Services Branch

Office of Education

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

WALTER S. STUDDIFORD

Bureau of Employment Security
U.S. Department of Labor
Washington, D.C.

HERMAN STURM

Bureau of Labor Statistics
U.S. Department of Labor
Washington, D.C.

PATRICIA SUSSMANN

Director

Health Careers Program
American Hospital Association
Chicago, I11.

JEAN SzALOCZI

Task Force on Social Work
Education and Manpower

Office of the Secretary

U.S. Department of Health,
Education, and Welfare

‘Washington, D.C.

A. N. TAYLOR

Associate Secretary

Council on Medical Education
American Medical Association
535 North Dearborn Street
Chicago, I11.

RicaARD C. THOMPSON

Public Information Officer

D.C. Department of Public Health
‘Washington, D.C.

TERESINA B. THOMPSON
Assistant Principal
Springfield Trade High School
Springfield, Mass.

  

 

   
RoBERT M. TOMLINSON
Assistant Professor
University of Illinois
Urbana, Ill.

PaYLLIS I. TOWNSEND
Consultant

Practical Nurse Education
Michigan Board of Nursing
Lansing, Mich.

BrRAHNA TRAGER

Executive Director

San Francisco Homemaker
Service

San Francisco, Calif.

James L. TROUPIN

Director

Professional Education

American Public Health
Association

1790 Broadway

New York, N.Y.

MERLIN TRUMBULL

National Committee for Careers
in Medical Technology

1785 Massachusetts Ave.,, NW.

‘Washington, D.C.

LeoN TUNKEL

Program Director

Operation Manpower Program

New York State Department
of Labor

Albany, N.Y.

MARY McCarLL TYRIE

Director of Education

Visiting Nurse Service
of New York

New York, N.Y.

CONGRESSMAN CHARLES A. VANIK
House of Representatives
Washington, D.C.

SHADA VON HEIN

Bureau of Apprenticeship
and Training

U.S. Department of Labor

Washington, D.C.

ROBERT VAN HOEK

Special Assistant to Assistant Chief

Division of Hospitals

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

ELLWYNNE M. VREELAND

Nurse Consultant

Division of Nursing

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

LiLLiaAN M. WAGNER

Coordinator

Practical Nursing

Jane Addams Vocational
High School

Cleveland, Ohio

JorN P. WALSH

Assistant Manpower
Administrator

U.S. Department of Labor

Washington, D.C.

BETTINA WEARY

Specialist

Career Development

Guidance and Personnel Services
Branch

Office of Education

U.S. Department of Health,
Education and Welfare

‘Washington, D.C.

W. A. WEBER

Director

Division of Medically Related
Programs

Dade Junior College

Miami, Fla.

Epwarp W. WEIMER

Administrator

Manpower for Health

Hospital Research and
Education Trust

840 North Lake Shore Drive

Chicago, Ill.

G. ANTHONY WEINLEIN
Director
Department of Research
and Education
Building Service
Employees’ International Union
Washington, D.C.

HARRIET E. WELLAND

Supervisor

MDTA Practical Nursing Program
Henry Ford Community College
Dearborn, Mich.

Max WENK

Bureau of Family Services

Welfare Administration

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

HARVEY WERTLEIB

Administrator

Randolph Hills Nursing Home

American Nursing Home
Association

Wheaton, Md.

ELEANOR F. WESOLOWSKI

Division of Community Health
Services

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

SUSANNAH WEST

Assistant Principal

Whitney Vocational High School
Toledo, Ohio

J. A. WHITEHEAD

National Association of Dental
Laboratories, Inc.

1330 Massachusetts Avenue NW.

Washington, D.C.

DANIEL F. WHITESIDE

Chief

Auxiliary Utilization and
Development Section

Division of Dental Health

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

RUTH WIENCEK

Educational Director

International Union of Electrical,
Radio and Machine Workers,
AFL-CIO

Washington, D.C.

Rose K. WIENER

Office of Manpower Policy, Evaluation
and Research

U.S. Department of Labor

Washington, D.C.

MARJORIE WILLIAMS

Chief

Office of Medical and Allied
Health Sciences

Veterans Administration

810 Vermont Avenue NW.

Washington, D.C.

LESLIE WILSON

American Society of Radiologic
Technologists

Roanoke Memorial Hospitals

Roanoke, Va.

THELMA WILSON

Beckley Appalachian
Regional Hospitals

Beckley, W. Va.

CHARLES WINKLER
Medical Center
University of Alabama
Birmingham, Ala.

83

 
Ebpwarp WISE
1200 Tanley Road
Silver Spring, Md.

BETTY JANE WOLFENBARGER
Regional Supervisor
Tennessee Department

of Education
Knoxville, Tenn.

FRANCES WOLFORD

Division of Medical Care
Administration

Public Health Service

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

84

W. J. WooDIN

Memorial Sloan-Kettering
Cancer Center

410 East 68th Street

New York, N.Y.

Nina WoODSIDE

Chief

Bureau of Chronic Disease Control
D.C. Department of Public Health
Municipal Building

Washington, D.C.

RoBERT E. WOODWARD

Director of Program Planning

State Committee for Technical
Education

State Board of Education

Columbia, S.C.

BERNARD YABROFF

Director of Employment Opportunities
Branch

Office of Education

U.S. Department of Health,
Education, and Welfare

Washington, D.C.

ALLEN ZIEGER

Executive Director

Zieger Osteopathic Hospital
Detroit, Mich.

 

 
WirLiaM L. BATT, JR.
MONTAGUE BROWN
HARrY W. BRUCE, JR.
THOMAS E. CALLAHAN
SAMUEL S. DUBIN
DoroTHY B. FEREBEE
Isaac FINE

MARVIN FRIEDMAN
WARREN GANONG
EARL T. KLEIN
EUGENE LEVINE
DARREL J. MASE
HowArp MATTHEWS
James J. McFADDEN
EreaNor N. McGUIRE

SALLY ANpERsoN DHEW
JorN BaTcHELOR DOL
DonarLp Bone DHEW
JosepH HALL DOL
HerLeNn Hamer DHEW

JosepH CAavaANAUGH DHEW
EraeL Corrins DOL
Rape Cowart DOL
DwicaT CRM DHEW
DoroTHY B. DALY DHEW
BerNARD DowNEY DOL
BoB GRANAKIS DOL
EraiNne Hanoy DOL

APPENDIX C
DISCUSSION LEADERS

MATTHEW McNULTY, JR.
PHILLIP W. MORGAN

HENRY PRZELOMSKI

Guy ROBBINS

RALPH SHOWALTER
KENNETH G. SKAGGS

ANN R. SOMERS

GEORGE STEPHENSON

MerrE E. STRONG

PATRICIA SUSSMANN

TERESINA B. THOMPSON

RoBERT M. TOMLINSON

PaYLLIS I. TOWNSEND

LeoN TUNKEL
W. A. WEBER

Recorders

MargAY Kerr DHEW

WALTER LaBaNow DOL
MARGARET SHEEHAN DHEW
Jean Szaroczi DHEW

ELeaNorR F. WeEsoLowskKl DHEW

Resource Persons

RoBertr HERMAN DHEW
Davip Hoover DHEW
DonaLp JoENsON DHEW
RutrH L. JoENsoN DHEW
RurH R. JoENsoN DHEW
Arron JonNEs DOL

Orro Lecce DHEW

EmeeN Lester DHEW

STANLEY MARKUSON DOL
EveELYN Murray DOL

EpisoN NEwMAN DHEW
Harry Novick DOL

MarTHA PHILLIPS DHEW
MARYLAND Y. PENNELL DHEW
GEORGE SMITH DOL

WALTER STUDDIFORD DOL

 
APPENDIX D

THE WHITE HOUSE

Statement by the President on Job Development Program

February 1, 1965

UNEMPLOYMENT in America stands at al-
most five percent. Yet we face the paradox that
with nearly four million people unemployed

—it often takes weeks to have an appliance or
other repair made

—hospitals and many other community services
are understaffed

—housewives cannot get the help they seek for
work in the home or in the yard

—we have been admitting almost 200,000 foreign
workers annually because American workers were
not considered available

—and the papers are full of Help Wanted Ads.

I am convinced that a substantial number of
jobs can be developed from such presently exist-
ing and unmet service needs—in business, at
home, on the farm and in the community.

Therefore, I am launching a nationwide Job
Development Program in service and related fields

—to assure that trained workers are available to
provide needed services at satisfactory wages and
working conditions

—to assure that managerial skills are developed
to provide these services as part of our free enter-
prise system

—to assure that consumer needs are met better and
more fully.

The Secretary of Labor and the Secretary of
Commerce are charged with responsibility for
carrying this program forward. They are to
work with other Federal, State, and local agencies
and to enlist the fullest possible private participa-
tion in the planning and operation of this program.

86

Government can make great contribution

—by assembling information about job opportuni-
ties, unmet needs and available manpower

—by promoting institutional and on-the-job train-
ing and apprenticeship

—Dby providing technical assistance to management

—by stimulating new enterprises through small
business loans and in other ways.

But ultimate success will depend on the resource-
fulness and cooperation of business, labor and
consumer groups. In many cases training and
other parts of this program can best be arranged
by joint labor-management committees.

By July 1, 1965, this Job Development Program
should reach 10,000 jobs a month.

This initial five-month stage can be accomplished
under existing law. It will be supported out of
funds already appropriated or requested in my
Budget Message.

I will also propose to the Congress the adoption
of legislation by amendment of the Manpower
Development and Training Act and in, if neces-
sary, other appropriate ways which will give this
program the broadest and firmest possible basis.

For I mean to press far beyond this initial stage.
Our service needs are increasing and will continue
to do so—reflecting the growing proportion of
consumer spending that goes to services as in-
comes rise. We must meet this demand and real-
ize fully its employment potential.

But this will not be an easy task.

We will need to provide many of the presently
unemployed with the basic training—and educa-
tion—which these service jobs require.

 

 
Our present information about existing and
potential job opportunities must be greatly
increased.

New ways of providing home and community
services must be explored.

Difficult management problems in filling what
are often part-time—or seasonal—jobs must be
solved.

Better means of transportation between unem-
ployed workers and jobs—either within a large
city, or between the agricultural areas in the coun-
try where various peak demands occur—need to

be developed.

Many of these prospective jobs are with small

 

employers, so greater efforts must be made to work
with trade associations and similar groups.

There are two other problems which have pre-
vented a more rapid expansion of service employ-
ment—low wage rates and an attitude that much
service work lacks dignity.

This Job Development Program must be so ad-
ministered that it does not undercut present wage
or other work standards. It should contribute to
raising these standards and to recognition of the
importance and value of all service work.

But these problems can all be met. They must

be met if we are to advance toward our goal of full
employment opportunity in America.
APPENDIX E

The President's Job Development Program: Its Implications for Health Manpower and Services

CHARLES W. PHILLIPS, Staff Assistant to Assistant Secretary for Education, HEW

(The following paper was prepared for the Job
Development Conference on Training Health
Service workers, to explain the President’s Job De-
velopment Program, and relate it particularly to
the health service industry.)

A YEAR AGO, on February 1, 1965, President
Johnson launched a nationwide Job Development,
Program in service and related fields. President
Johnson’s statement declared the purposes to be:

® to assure that trained workers are available to
provide needed services at satisfactory wages and
working conditions

® to assure that managerial skills are developed
to provide these services as part of our free enter-
prise system

® to assure that consumer needs are met better and
more fully.

The President called upon all government agen-
cies, under the leadership of the Secretaries of the
Departments of Labor and of Commerce, to work
with State and local agencies, and to “enlist the
fullest possible private participation in the plan-
ning and operation of this program.” Among
other aids, the Federal Government was to assem-
ble information about job opportunities and avail-
able manpower; promote institutional, on-the-job,
and apprenticeship training; and provide techni-
cal assistance to management. A goal was set for
the program—to develop 10,000 jobs per month by
July 1, 1965.

The Manpower Act of 1965 (P.L. 89-15, April
26,1965, 79 Stat. T5—amending the Manpower De-
velopment and Training Act of 1962) incorporated
the program into section 103, which reads:

The Secretary of Labor shall stimulate and assist
in cooperation with interested agencies both public

and private, job development programs, through
on-the-job training and other suitable methods,
that will serve to expand employment by the filling
of those service and related needs which are not
now being met because of lack of trained workers
or other reasons affecting employment or opportu-
nities for employment.

The Program Thus far

There has been enthusiastic nationwide response.
The initial goal of developing 10,000 jobs per
month has been met and exceeded, according to
Department of Labor Statistics. By the end of
1965 over 112,000 potential jobs were developed in
service and related occupations.

Institutional (in school) training programs ac-
counted for between 60 and 70 percent of the total
number of training opportunities since the begin-
ning of the program. Local public employment
offices pinpointed the need for and the selection of
over 70,000 trainees under institutional training
projects.

The on-the-job training program accounted for
the remaining percentage of the total. There have
been nearly 42,000 on-the-job trainees in the serv-
ice and related fields for whom projects have been
approved and funded since the initiation of the
Job Development Program.

An important innovation began under this pro-
gram, namely, the developing of national contracts
between the Secretaries of Labor and Health, Edu-
cation, and Welfare on the one hand, with private
employers or trade associations on the other.
These contracts set up industrywide training pro-
grams, or programs which include large geo-
graphic areas cutting across State boundaries.
For example, a contract with the Tidewater Oil
Co. provides training for 1,000 new service station
managers. A contract with the National Tool,
Die, & Precision Machine Co. provides for training

 

 
 

1,200 workers. Most significant to this Conference
on Job Development and Training for Workers in
the Health Services, is the contract with the
American Hospital Association for the training of
4,000 workers in the auxiliary health occupations.

Most of these national contracts provide for
joint institutional and on-the-job training. It is
recognized that although parts of some training
must be done on the job in a work situation, it is
equally necessary to have some supplementary
classroom instruction. The classroom instruction
may range from basic education, where needed, to
various elements of vocational and technical edu-
cation which may be required.

Looking Ahead in Job Development Generally

The Job Development Program may be viewed
as three links in a chain: (1) developing jobs; (2)
upgrading the skills of workers and making the
work force adaptable; and (3) matching workers
and jobs. In each case, the metaphor of a link
requires imaginative understanding and a com-
plexity of working relationships between all levels
of government, private enterprise, and the public.

The full meaning of job development has been
partially obscured by its primary focus to date on
getting jobs for the unemployed. That emphasis
has been justifiable, considering the intolerably
high rate of unemployment the Nation has had to
endure. That emphasis must continue, even
though we have made a sharp reduction in the
unemployment rate to the present 4.1 percent and
may look forward to driving it still lower. But
there is another side to the coin.

We must recognize a whole new dimension of
service needs of our people, and a basic shift in
work orientation which this will entail. In the
early days of this Nation and until the latter part
of the 19th century, the largest industry in Amer-
ica, by far, was agriculture. Most workers were
“husbandmen,” or farmers. For many years, how-
ever, agriculture, in spite of its increasing pro-
ductivity, has suffered a declining work force.
Today, a very small percentage of our work force
can supply us with all of the food and fiber we
need.

Until recently, increase in manufacturing em-
ployment more than compensated the decline of
farm workers, absorbed, in addition, millions of
immigrants, and built the strongest industrial
nation in the world. As yet, evidence is indeter-
minate whether the pace and role of technology

will sustain high productivity with a declining
work force. Technology may only change the role
of workers within the manufacturing sector,
rather than cause a decline in their absolute
numbers.

But even a stabilization or dynamic equilibrium
in the manufacturing labor force would not be
enough to meet the job needs of a rising popula-
tion. A new job-wage sector is needed.

We do not have to invent this new sector. It is
not only at hand but is pressing us for attention.
A brilliant achievement in tilling the soil, and an
equally impressive development of a capacity to
produce goods, has brought us to the wealth and
resources wherein most Americans have a good to
high standard of living, and wherein all can be
above poverty. We can turn more attention to
what one works for when he is not working for
bread alone. We are on the threshold of a Great
Society quantitatively and can give the attention
long demanded to making it equally great in
quality for all.

The improvement in the quality—in the hu-
manly productive use of our wealth—will come
through the development of the service occupa-
tions. This is no effort to create work for work’s
sake, or simply to find something to do with people.
These jobs, as President Johnson has insisted, must
pay good wages and have good working condi-
tions. “Service” is not “servitude” (in history,
the primary means by which a few lived well at
the expense of the many). Moreover, the nature
of a service occupation offers new opportunities
for self-fulfillment and satisfaction, making more
of work than a mere economic activity.

The trend toward which we are moving may be
clear, but not all of the dimensions of what it will
entail are. The other links in the chain—devel-
oping skills in a work force and matching men and
jobs—require much effort.

The service occupations now include many hun-
dreds of categories. Many of these positions may
have the security of not succumbing easily to auto-
mation, but they have grown markedly in skill
requirements. New categories of service are com-
ing into being. An oxygen therapist was not
known a very few years ago. Some professions
have grown so complex that they have moved
through professional specialization on to the devel-
opment of subprofessional aides who are develop-
ing new occupational careers as such. This latter
is true in education, in health services, in the whole

89

 
spectrum of scientific and technical fields.

In one sense, job development is choosing us in-
stead of us choosing it. To develop the curricula,
do the training, upgrade the skills, and match
workers and jobs, will be a major hurdle. The
challenge may well take us far beyond soaking up
the presently recorded unemployed. It may well
demand much of us in seeking greater efficiencies in
the use of employed manpower and in overcoming
an underutilization of manpower.

Looking Ahead in Job Development in the
Health Services

The attention of this Conference is focused on
job development in the health services. In the
next 5 years this will present one of the most for-
midable tasks the Nation will face. How many
additional auxiliary and subprofessional health
service workers will be needed in each occupational

90

category in the years ahead is yet to be determined,
but it is estimated conservatively that we will re-
quire at least 1 million more persons in the health
services by 1975. It will not be an easy task to
find this number of available persons, to train them
adequately, and to match them to jobs where
needed.

Legislation in recent years has done much to
augment the supply of professionals in the health
services, by providing for expanded training fa-
cilities and financial aid to students. Hopefully
this will begin to meet the need for the many more
physicians, dentists, osteopaths, nurses, and other
health professionals that are required. But, as
the number of sorely needed health professionals
is increased in arithmetic sequence, so will the need
for supportive personnel, i.e., workers in the health
services, be increased in geometric sequence if the

health requirements of Americans are to be served
fully.

 
 

APPENDIX F

Selected Reference Material, U.S. Government

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

The recent Medicare legislation will bring more
medical care in institutions and in the home to
millions of elderly persons who need it. Our
population—increasing in numbers, more knowl-
edgeable of scientific advances and consequently
more demanding of health services—has been out-
stripping our capacity to provide such services.
The results of medical research are making pos-
sible even better medical care for all Americans
of all ages, if we can provide enough trained
people to implement the results of that research.
The need for expansion of health service man-
power is present and clear.

Under various pieces of legislation, which this
Conference will discuss, the Federal Government
has provided support for a wide variety of train-
ing programs, particularly in the field of health.
The task before us is to expand these programs, to
find where such trained persons are or may be
needed, to recruit them, to train them, and then to
place them so that their skills can be fully utilized.

Federal programs will be no more effective than

local initiative to help define specific needs for
specific communities, to help develop concrete pro-
grams that can be reviewed and funded, and to
give the professional leadership and cooperation
necessary to define contents, maintain standards,
and train people.
Background Data Book, February 1966. This
book was prepared by the Manpower Resources
Program, Division of Community Health Serv-
ices, Public Health Service, (Lucy M. Kramer,
editor), specifically for the Job Development
Conference on Health Service Workers. Contents
include tables and charts on health manpower
statistics, DHEW training aid available, reports
on selected training projects and research, a legis-
lative digest, and a bibliography of reference
materials. (There is a limited supply of these
books available from the Manpower Resources
Program, Division of Community Health Serv-
ices, Public Health Service, U.S. Department of
Health, Education, and Welfare.)

223-124 0—66——7

Hill, Elmer L., M.D., and Kramer, Lucy M.
Training for Service and Leadership in the Health
Professions. (Reprint from HEW Indicators,
August 1964.) U.S. Department of Health, Edu-
cation, and Welfare, Office of the Secretary.

President’s Commission on Heart Disease, Cancer
and Stroke. A National Program to Conquer
Heart Disease, Cancer and Stroke: Report to the
President, vols. 1 and 2. “Report of the Sub-
committee on Manpower,” Reprint from vol. 2,
February 1965, pp. 262-317, by Public Health
Service, U.S. Department of Health, Education,
and Welfare, from U.S. Government Printing Of-
fice publication, Washington: 1965.

Utilization of Auxiliary Staff in the Provision of
Family Services in Public Welfare. Monograp

prepared jointly by Office of Secretary (Division
of State Merit Systems) and Welfare Administra-
tion (Bureau of Family Services), December 1965.

OFricE oF EDUCATION PUBLICATIONS.

Directory of State Officials Responsible for Super-
vision of Health Occupations Training. (Mimeo,
November 1965.)

Guidelines for Developing a Training Program

for:
. Medical Office Assistant.

Nursing Unit Management Assistant.

Operating Room Assistant.

Physical Therapy Assistant.

Occupational Therapy Assistant (Mimeo-

graphed separates, 1964).

Practical Nurse Education: Impact of Federal Aid
on Basic Preparatory Programs, 1957-62.
(Mimeo, December 1963.)

The Vocational Act of 1963.
1965.

SRO

OE Pub. No. 80031,

OFFICE OF PROGRAM A NALYSIS.

To Improve Medical Care: A Directory of Fed-
eral Grants and Other Financial Programs to Aid
the Development of Medical Care, Services Per-
sonnel, Facilities. U.S. Government Printing Of-
fice, Washington: December 1965.

91

 

 
Reference Facts on Health, Education, and Wel-
fare. U.S. Government Printing Office, Wash-
ington: January 1966.

OrFICE OF THE UNDER SECRETARY.

Health Professions Educational ~~ Assistance
Amendments (P.L.89-290). (Article by Eugenia
Sullivan. Reprinted from HEW Indicators.
November 1965.)

Medicare—Social Security Amendments of 1965.
Reprint of article by Wilbur J. Cohen and Pearl
Peerboom from HEW Indicators, August 1965.
(Contains calendar of significant dates and events;
selected references on legislative history of social
security ; etc.)

PusLic Heart SERVICE.

Health Manpower Source Book, Section 18, “Man-
power in the 1960's.” PHS Pub. No. 263 (sec.
18), U.S. Government Printing Office, Washing-
ton: 1964.

Health Manpower Source Book, Section 19, “Lo-

cation of Manpower in Eight Occupations.”
PHS Pub. No. 263 (sec. 19), U.S. Government
Printing Office, Washington : 1965.

West, Margaret D. “Man Power for the Health
Field: What Are the Prospects?” Paper prepared
in Division of Public Health Methods for Plan-
ning Meeting with American Hospital Associa-
tion, Spring 1963. (Reprinted in Hospitals, vol.
37, No. 18, September 16, 1963. Copies available
from Division of Public Methods, Public Health
Service, U.S. Department of Health, Education,
and Welfare.)

SOCIAL SECURITY ADMINISTRATION.

Questions and Answers on Health Service of the
Aged. U.S. Government Printing Office, Wash-
ington : September 1965.

U.S. DEPARTMENT OF LABOR

An Employer's Guide to On-the-Job Training
Under the Manpower Development and Training
Act. Bureau of Apprenticeship and Training,
Manpower Administration, September 1965.

Guidelines for Applications for Grants in Support
of Research Projects Under the Manpower Devel-

92

 

opment and Training Act of 1962, as Amended.
Office of Manpower Policy, Evaluation and Re-
search, Manpower Administration, DL-MT-242,
Budget Bureau No. 44-R1296.

Health Careers Guidebook. U.S. Employment
Service, Manpower Administration, U.S. Govern-
ment Printing Office, Washington: 1965.

Information About Youth Opportunity Centers.
Bureau of Employment Security, Manpower Ad-
ministration, February 1966.

MDT A, A Summary of the Manpower Develop-
ment and Training Act of 1962, as Amended.
Manpower Administration, December 1965.

Manpower and Automation Research Sponsored
by the Office of Manpower, Automation and
Training Through June 30, 1965. Office of Man-
power, Automation and Training, Manpower
Administration, September 1965.

Manpower Report of the President and a Report
on Manpower Requirements, Resources, Utiliza-
tion, and Training by the U.S. Department of
Labor, 1966. U.S. Government Printing Office,
Washington: 1966.

Occupational Outlook Handbook. Bureau of
Labor Statistics, Bulletin No. 1450, Superintend-
ent of Documents, U.S. Government Printing Of-
fice, Washington : 1966.

Report of the Secretary of Labor on Manpower
Research and Training Under the MDT A, 1966.
U.S. Government Printing Office, Washington :
1966.

Training Under the Manpower Development and
Training Act for Health Occupations. Office of
Manpower Policy, Evaluation and Research, Man-
power Administration, 1966.

What Is the Neighborhood Youth Corps? Neigh-
borhood Youth Corps, Manpower Administration,
1965.

 

 
APPENDIX G

FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*

 

Date

Purpose

 

Public Law Title

84-652 | National Health Survey Act
(S. 3076).

84-830 | Alaska Mental Health
Enabling Act (H.R. 6376).

84-835 | Health Research Facilities
Act of 1956 (S. 849).

84-911 | Health Amendments Act of
1956 (Graduate Training
of Professional Public
Health Personnel)
(S. 3958).

84-941 | National Library of Medi-
cine Act (S. 3430).

85-26 | Untitled (H.R. 3035) ________
85-110 | Untitled (FL.R. 7238)________

 

See footnote at end of table.

 

July 3,1956

July 28,1956

July 30, 1956

2, 1956

3, 1956

. 25,1957

July 17,1957

 

To provide for a continuing survey and
special studies of sickness and disabil-
ity in the United States and for periodic
reports of the results thereof, and for
other purposes.

To confer upon Alaska autonomy in the
field of mental health, transfer from the
Federal Government to the Territory
the fiscal and functional responsibility
for the hospitalization of committed
mental patients, and for other purposes.

To amend the Public Health Service Act,
so as to provide for grants-in-aid to
non-Federal public and nonprofit insti-
tutions for the constructing and equip-
ping of facilities for research in the
services related to health.

To improve the health of the people by
assisting in increasing the number of
adequately trained professional and
practical nurses and professional public
health personnel, assisting in the devel-
opment of improved methods of care
and treatment in the field of mental
health, and for other purposes.

To amend title III of the Public Health
Service Act, and for other purposes.

To provide a temporary extension of cer-
tain special provisions relating to State
plans for aid to the blind.

To give the States an option with respect
to the basis for claiming Federal partici-
pation in vendor medical care payments
for recipients of public assistance.

93

 
FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

Public Law Title

Date

Purpose

 

Indian Health Facilities Act
(H.R. 8053).

856-151

Public Health Service Act
Amendment (H.R. 11414).

85-544

85-840 | Social Security Amendments

of 1958 (H.R. 13549).

86-571 | Untitled (S. 2331)___________

86-610 | International Health Re-
search Act of 1960 (S.J.

Res. 41).

86-720 | Public Health Service Act

Amendment (H.R. 6871).

 

See footnote at end of table.

94

 

Aug. 16, 1957

July 22,1958

Aug. 28,1958

July 5, 1960

July 12,1960

Sept. 8, 1960

 

To authorize funds available for construc-
tion of Indian Health facilities to be
used to assist in the construction of
community hospitals which will serve
Indians and non-Indians.

To amend sec. 314(c) of the Public Health
Service Act, so as to authorize the Sur-
geon General to make certain grants-in-
aid for provision in public or nonprofit
accredited schools of public health of
training and services-in the fields of
public health and in the administration
of State and local public health pro-
grams.

To increase benefits under the Federal
Old-Age, Survivors, and Disability In-
surance System to improve the actuarial
status of the Trust Funds of such Sys-
tem; and otherwise improve such Sys-
tem; to amend the public assistance and
maternal and child health and welfare
provisions of the Social Security Act;
and for other purposes.

To provide for the hospitalization at St.
Elizabeths Hospital in the District of
Columbia or elsewhere, of certain na-
tionals of the United States adjudged
insane or otherwise found mentally ill
in foreign countries, and for other
purposes.

To establish a national institute for In-
ternational Health and Medical Re-
search to provide for international
cooperation in health research, research
training, and research planning, and for
other purposes.

To amend title III of the Public Health
Service Act, to authorize project grants
for graduate training in public health
and for other purposes.
 

FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

Public Law

Title

Date

Purpose

 

86-778 | Social Security Amendments | Sept. 13, 1960

of 1960 (H.R. 12580).

87-22 | Practical Nurse Training Ex- | Apr. 24, 1961

tension Act of 1961 (S. 278).

87-27 | Area Redevelopment Act May 1, 1961

(S. 1).

87-64 | Social Security Amendments | June 30, 1961

of 1961 (H.R. 6027).

87-274 | Juvenile Delinquency and Sept. 22, 1961

 

See footnote at end of table.

Youth Offences Control
Act of 1961 (Requires
Health Manpower for
Mental Health and Health
Services in Correctional
Institutions) (S. 279).

 

 

To extend and improve coverage under
the Federal Old-Age, Survivors, and
Disability Insurance System, and to
remove hardships and inequities, im-
prove the financing of the trust funds,
and provide disability benefits to addi-
tional individuals under such system;
to provide grants to States for medical
care and for aged individuals of low-
income; to amend the public assistance
and maternal and child welfare provi-
sions of the Social Security Act; to
improve the unemployment provisions
of such Act; and for other purposes.

To amend title IT of the Vocational Edu-
cation Act of 1946 relating to practical
nurses training and for other purposes.

To establish an effective program to alle-
viate conditions of substantial and
persistent unemployment and under-
employment in certain economically
distressed areas.

To improve benefits under the old-age,
survivors, and disability insurance pro-
gram by increasing the minimum bene-
fits and aged widow’s benefits and by
making additional persons eligible for
benefits under the program, and for
other purposes.

To provide Federal assistance for projects
which will demonstrate or develop tech-
niques and practices leading to a solu-
tion of the Nation’s juvenile delinquency
control problems.

95

 

 
 

FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

 

Public Law Title Date Purpose

87-276 | Training of Teachers for the |. ____ do_______ To make available to children who are

Deaf (S. 336). handicapped by deafness, the specially
trained teachers of the deaf needed to
develop their abilities and to make
available to individuals suffering from
speech and hearing impairments the
specially trained speech pathologists
and audiologists needed to help them
overcome their handicaps.

87-293 | Peace Corps Act (H.R. 7500) _|_____ do______. To provide for a Peace Corps to help the
peoples of interested countries and areas
in meeting their needs for skilled man-
power.

87-395 | Community Health Services | Oct. 5,1961 | To assist in expanding and improving

and Facilities Act of 1961 community facilities and services for the
(H.R. 4998). health care of aged and other persons,
and for other purposes.

87-415 | Manpower Development and | Mar. 15,1962 | Relating to manpower requirements, re-
Training Act of 1962 sources, development, and utilization,
(S. 1991). and for other purposes.

87-510 | Migration and Refugees June 28,1962 | To enable the United States to participate
Assistance Act of 1962 in the assistance rendered to certain
(Requires Health Man- migrants and refugees.
power) (H.R. 8291).

87-543 | Public Welfare Amendments | July 25,1962 | To extend and improve the public assist-
of 1962 (Requires expanded ance and child welfare services pro-
health and rehabilitation grams of the Social Security Act, and
services) (H.R. 10606). for other purposes.

87-692 | Untitled (S. 1130)___________ Sept. 25, 1962 | To amend title III of the Public Health

 

See footnote at end of table.

96

 

 

Service Act to authorize grants for
family clinics for domestic agricultural
migratory workers, and for other pur-
poses.

 

 
FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

Public Law Title

Date

Purpose

 

87-838 | Untitled (H.R. 11099)______

87-868 | Vaccination Assistance Act
of 1962 (H.R. 10541).

88-129 | Health Professions Educa-
tional Assistance Act of
1963 (H.R. 12).

88-156 | Maternal and Child Health
and Mental Retardation
Planning Amendments of
1963 (H.R. 7544).

88-164 | Mental Retardation Facili-
ties and Community Men-
tal Health Centers Con-
struction Act of 1963

(S. 1576).

 

See footnote at end of table.

 

Oct. 17,1962

Oct. 23,1962

Sept. 24, 1963

Oct. 24,1963

Oct. 31,1963

 

To amend the Public Health Service Act to
provide for the establishment of an
Institute of Child Health and Human
Development, to extend for 3 additional
years the authorization for grants for
the construction of facilities for research
in the sciences related to health, and for
other purposes.

To assist States and communities to
carry out intensive vaccination pro-
grams designed to protect their popula-
tions, particularly all preschool children,
against poliomyelitis, diphtheria, whoop-
ing cough, and tetanus.

To increase the opportunities for training
of physicians, dentists, and professional
public health personnel, and for other
purposes.

To amend the Social Security Act to assist
States and communities in preventing
and combating mental retardation
through expansion and improvement of
the maternal and child health and
crippled children’s programs, through
provision of prenatal, maternity, and
infant care for individuals with condi-
tions associated with child bearing
which may lead to mental retardation
and through planning for comprehensive
action to combat mental retardation,
and for other purposes.

To provide assistance in combating mental
retardation through grants for construc-
tion of research centers and grants for
facilities for the mentally retarded and
assistance in improving mental health
through grants for construction of com-
munity mental health centers, and for
other purposes.

97
FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

Public Law

Title

Date

Purpose

 

88-204

88-210

88-214

88-352

88-368

88-443

 

Higher Education Facilities
Act of 1963 (H.R. 6143).

J

Vocational Education Act of
1963 (H.R. 4955).

Manpower Development and
Training Act of 1962,
Amendment (H.R. 8720).

Civil Rights Act of 1964
(H.R. 7152).

Juvenile Delinquency and
Youth Offences Control
Act Extension (H.R.
9876).

Hospital and Medical
Facilities Amendments of
1964 (H.R. 10041).

See footnote at end of table.

98

 

Dec. 6,1963

Dec. 18, 1963

Dec. 19, 1963

July 2, 1964

July 9, 1964

Aug. 18, 1964

 

To authorize assistance to public and other

nonprofit institutions of higher educa-
tion in financing the construction, reha-
bilitation or improvement of needed
academic and related facilities in under-
graduate and graduate institutions.

To strengthen and improve the quality of

vocational education and to expand the
vocational education opportunities in
the Nation, to extend for 3 years, the
National Defense Education Act of 1958
and Public Laws 815 and 874, 81st
Cong. (federally affected areas), and for
other purposes.

To amend the Manpower Development

and Training Act of 1962.

To enforce the constitutional right to vote,

to confer jurisdiction upon the district
courts of the United States to provide
injunctive relief against discrimination
in public accommodations, to authorize
the Attorney General to institute suits
to protect constitutional rights in public
facilities and public education, to extend
the Commission on Civil Rights, to
prevent discrimination in federally as-
sisted programs, to establish a Commis-
sion on Equal Employment Opportunity,
and for other purposes.

To amend the Juvenile Delinquency and

Youth Offenses Control Act of 1961 by
extending its provisions for 2 additional
years and providing for a special project
and study.

To improve the public health through

revising, consolidating, and improving
the hospital and other medical facilities
provisions of the Public Health Service
Act.
FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

 

 

 

 

Public Law Title Date Purpose
88-452 | Economic Opportunity Act Aug. 20,1964 | To mobilize the human and financial re-
of 1964 (S. 2642). sources of the Nation to combat poverty
in the United States.
88-497 | Graduate Public Health Aug. 27,1964 | To amend the Public Health Service Act
Training Amendments of to extend the authorization for assist-
1964 (H.R. 11083). ance in the provision of graduate or
specialized public health training, and
for other purposes.
88-560 | Housing Act of 1964 Sept. 2,1964 | To extend and amend laws relating to
(S. 3049). housing, urban renewal, and community
facilities, and for other purposes.
88-581 | Nurse Training Act of 1964 Sept. 4,1964 | To amend the Public Health Service Act
(H.R. 11241). to increase the opportunities for training
professional nursing personnel, and for
other purposes.
88-597 | District of Columbia Sept. 15,1964 | To protect the constitutional rights of
Hospitalization of the certain individuals who are mentally ill,
Mentally Ill Act (S. 935). to provide for their care, treatment, and
hospitalization, and for other purposes.
88-665 | National Defense Education | Oct. 16,1964 | To amend and extend the National De-
Act Amendments, 1964 fense Education Act of 1958 and to
(S. 3060). extend Public Laws 815 and 874, 81st
Cong. (federally affected areas).
89-4 | Appalachian Regional Mar. 9,1965 | To provide public works and economic
Development Act of 1965 development programs and the planning
(S. 3). and coordination needed to assist in the
development of the Appalachian Region.
89-10 | Elementary and Secondary Apr. 11,1965 | To strengthen and improve educational
Education Act of 1965 quality and educational opportunities in
(H.R. 2362). the Nation’s elementary and secondary
schools.
89-15 | Manpower Act of 1965 (S. Apr. 26,1965 | To amend the Manpower Development
974). and Training Act of 1962, as amended,
and for other purposes.
89-36 | National Technical Institute | June 8, 1965 | To provide for the establishment and op-
for the Deaf Act (H.R. eration of a National Technical Institute
7031). for the Deaf.

See footnote at end of table.
FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

Public Law

Title

Date

Purpose

 

89-73

89-97

89-105

89-109

89-115

 

Older American Act of 1965
(H.R. 3708).

Social Security Amendments
of 1965 (Medicare) (H.R.
6675).

Mental Retardation Facilities
and Community Mental
Health Centers Construc-
tion Act Amendments of
1965 (H.R. 2985).

Community Health Services
Extension Amendments of
1965 (S. 510).

Health Research Facilities
Amendments of 1965 (H.R.
2984).

See footnote at end of table.

100

 

July 14, 1965

July 30, 1965

Aug. 4,1965

Aug. 5,1965

Aug. 9,1965

 

To provide assistance in the development
of new or improved programs to help
older persons through grants to the
States for community planning and
services and for training, through re-
search, development or training project
grants, and to establish within the
Department of Health, Education, and
Welfare an operating agency to be
designated as the “Administration on
Aging.”

To provide a hospital insurance program
for the aged under the Social Security
Act with a supplementary medical bene-
fits program and an expanded program
of medical assistance, to increase bene-
fits under the Old-Age, Survivors, and
Disability Insurance, to improve the
Federal-State public assistance pro-
grams, and for other purposes.

To authorize assistance in meeting the
initial cost of professional and technical
personnel for comprehensive community
mental health centers, and for other
purposes.

To extend and otherwise amend certain
expiring provisions of the Public Health
Service Act relating to community
health services, and for other purposes.

To amend the Public Health Service Act
provisions for construction of health
research facilities by extending the
expiration date thereof, and providing
increased support for the program, to
authorize additional Assistant Secre-
taries in the Department of Health,
Education, and Welfare, and for other
purposes.
FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

 

 

 

 

 

Public Law Title Date Purpose

89-117 | Housing and Urban Develop- | Aug. 10,1965 | To assist in the provision of housing for
ment Act of 1965 (H.R. low- and moderate-income families, to
7984). promote orderly urban development, to

improve living environment in urban
areas, and to amend and extend laws
relating to housing, urban renewal, and
community facilities.

89-136 | Public Works and Economic | Aug. 26,1965 | To provide grants for public works and
Development Act of 1965 development facilities, other financial
(S. 1648). assistance and the planning and coordi-

nation needs to alleviate conditions of
substantial and persistent unemploy-
ment and underemployment in economi-
cally distressed areas and. regions.

89-171 | Foreign Assistance Act of Sept. 6,1965 | To amend further the Foreign Assistance
1965 (H.R. 7750) Act of 1961, as amended, and for other

purposes.

89-174 | Department of Housing and | Sept. 9, 1965 | To establish a Department of Housing and
Urban Development Act Urban Development, and for other
(H.R. 6927). purposes.

89-236 | Immigration and Nationality | Oct. 3,1965 | To amend the Immigration and National
Act, amendments (H.R. ity Act, and for other purposes.

2580).

89-239 | Heart Disease, Cancer and Oct. 6,1965 | To amend the Public Health Service Act
Stroke Amendments of to assist in combating heart disease,
1965 (S. 596). cancer, stroke, and related diseases.

89-253 | Economic Opportunity + | ____ do. ______ To expand the war on poverty and en-
Amendments of 1965 hance the effectiveness of programs
(H.R. 8283). under the Economic Opportunity Act of

1964.

89-258 | Educational Media for the Oct. 19,1965 | Toamend the Act entitled ‘An Act to pro-
Deaf, Loan Service Legis- vide in the Department of Health, Edu-
lation Amendments cation, and Welfare for a loan service of
(S. 2232). captioned films for the deaf,” approved

Dec. 2, 1958, as amended, in order to
further provide for a loan service of edu-
cational media for the deaf, and for
other purposes.

See footnote at end of table.

101

 
FEDERAL LEGISLATION AFFECTING THE SUPPLY AND DEMAND OF HEALTH
MANPOWER, 1956-65*—Continued

 

Public Law

Title

Date

Purpose

 

89-287

89-290

89-291

89-329

89-333

 

National Vocational Student
Loan Insurance Act of
1965 (H.R. 7743).

Health Professions Educa-
tional Assistance Amend-
ments of 1965 (H.R. 3141).

Medical Library Assistance
Act of 1965 (S. 597).

Higher Education Act of
1965 (H.R. 9567).

Vocational and Technical
Rehabilitation Act Amend-
ments of 1965 (H.R. 8310).

 

Oct. 22,1965

8, 1965

 

To establish a system of loan insurance
and a supplementary system of direct
loans, to assist students to attend post-
secondary business, trade, technical, and
other vocational schools.

To amend the Public Health Service Act
to improve the educational quality of
schools of medicine, dentistry, and os-
teopathy, to authorize grants under that
Act to such schools for the awarding of
scholarships to needy students, and to
extend expiring provisions of that Act
for student loans and for aid in con-
struction of teaching facilities for stu-
dents in such schools and schools for
other health professions, and for other
purposes.

To amend the Public Health Service Act
to provide for a program of grants to
assist in meeting the need for adequate
medical library services and facilities.

To strengthen the educatiorial resources of
our colleges and universities and to pro-
vide financial assistance for students in
postsecondary and higher education.

To amend the Vocational Rehabilitation
Act to assist in providing more flexibility
in the financing and administration of
state rehabilitation programs, and to
assist in the expansion and improvement
of services and facilities provided under
such programs, particularly for the
mentally retarded and other groups pre-
senting special vocational rehabilitation
problems, and for other purposes.

 

*This is a list of major legislation enacted during the last decade, implicitly or explicitly affecting the supply and demand of health manpower in relation

to the programs of the Department of Health, Education, and Welfare.

Social Security legislation establishes and implements programs that often involve

health personnel but its major professional and technical manpower requirement is in the field of social work. Therefore, only major amendments to the Social
Security Act that refer specifically to new or expanded health programs (e.g. maternal and child health, medicare etc.) are included in this listing. It was pre-
pared by Lucy M. Kramer, under the direction of Dr. Harvey I. Scudder, Chief, Manpower Resources Program, the Division of Community Health Services,
Public Health Service, specifically for the Department of Labor—Health, Education, and Welfare Conference on “Job Development and Training for Workers
in Health Services” held in Washington, D.C., Feb. 14-17, 1966.

102

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, PUBLIC HEALTH SERVICE,

DIVISION OF COMMUNITY HEALTH SERVICES, JANUARY 1966.

U.S. GOVERNMENT PRINTING OFFICE :1966 O-—223-124
 

 
 
 

C. BERKELEY LIBRARIE

029419849