I feel that we will have a very, very good record, as close to 100 percent as any human program could get, of people who are trained in here going into rehabilitation. We have a number of other community agencies that need personnel and like the personnel that is trained in the Public Health Service programs of mental health, particularly, we feel that the rehabilitation centers that are built with Hill-Burton money and the local hospitals that are likewise built with public funds and institutions of that type, need personnel also. A part of our general support of this whole training program is to increase the total supply of this scarce and treasured talent and we think if that is done, they will go into these places which need them most desperately. Mr. HASKELL. Could I make one comment? I think the general public should be very much aware that the vocational rehabilitation work is a self-financing proposition, because it puts a person back to work. He not only pays taxes, but he may well come off the public assistance payroll and from a financial point of view it is a program where one can afford to make the argument that the Government makes money by helping in the vocational rehabilitation area. Mr. ELLIOTT. I would like to say to the gentleman from Dela ware Mr. HASKELL. You know that better than I do. Mr. ELLIOTT. Recently I have seen in my hometown an example of exactly what you are talking about. We have had 2 or 3 enterprising gentlemen establish a golf bag manufacturing plant where they work handicapped people. The little factory has about 40 people working and about 35 of those are handicapped people. Some of them are rather severely handicapped, and in many instances I was told when I visited the place last fall, they took boys right off the assistance rolls that you are talking about and put them on this job where they are earning at least the minimum wage, and where they are now self-supporting and are taxpayers. I do not know of any program which the Government supports that does any more to, in effect, pay its way than does this program, as you have made the point in your statement. I was glad to hear you make that point. Mrs. GREEN. You would subsidize this specialized medical doctor who is a specialist in the field of vocational rehabilitation and who works with these people. Is not that really a form of socialized medicine? Mr. HASKELL. I do not think so, but you can put your own interpretation on it. Mrs. GREEN. What would it be? The Government pays for the training of the doctor and the doctor gives the services to these people. Mr. HASKELL. The words "socialized medicine" have never been defined to me. Everyone has their own definition. Mrs. GREEN. The definition that many medical doctors give, would it not come Mr. HASKELL. What is their definition? Mrs. GREEN. Well, I have heard several talk a great deal about "galloping socialism." Mr. HASKELL. Yes. Mrs. GREEN. As Congressman McGovern says, the nose of the camel is really getting under the tent; is it not? Mr. HASKELL. I really think they are thinking in terms of a Government health insurance program. That is a practical example of what I think they would term "socialized medicine." Mr. McGOVERN. Is it not a case of what helps me is a fine program, and what helps my neighbor is creeping socialism? Mr. HASKELL. Well, I would not go that far. Mr. ELLIOTT. Could you tell us the number of people that we have trained in this physical medicine rehabilitation category? Do you have those figures? Miss SWITZER. Yes. May I ask for the record, Mr. Chairman, I have a statement, but some of it duplicates what Mr. Haskell said. However, I would like to ask permission to have the entire statement inserted in the record if I may. Mr. ELLIOTT. The statement will follow the questioning of Miss Switzer, and will become a part of the record in full. Miss SWITZER. I would like to express my personal appreciation for Mr. Haskell's earnest pursuit of this small but highly important part of our program, and express also my very real gratitude to the committee for coming together this morning to hear it because of the time pressure I know you are under. It is not too long that we were here for another little problem, and I think the committee is really giving us wonderful support. Mr. ELLIOTT. We are always happy to have you, Miss Switzer. You are very helpful to the committee not only in this instance, but in all instances that you appear, and we appreciate your taking your time to meet with us early this morning on Monday morning when we do not customarily meet. Miss SWITZER. We appreciate it, too. We do not take your support for granted, Mr. Chairman. We want to continue to merit your confidence. On page 3 of my statement [p. 18], we have given the most upto-date figures. You will see this is not a really big problem in terms of numbers, but it is very crucial in terms of importance. As of June 30, 1957, we had a total of 81 physicians receiving officer vocational rehabilitation traineeships in this residency training program. Of this number 20 were in their first year, and will require 2 additional years; 48 were in their second or third year, and 15 were advanced. Four of the 48 in their second year or third year, we did not pay to support them after the second year, and the most important consideration, perhaps, in addition to the fact that you lose the individual, perhaps, after the second year when young doctors are shopping around for the speciality they want to go into, which they do, and there are a variety of sources of support, they will look at the one that will carry them through to the end. One of the reasons it is most important to have this limitation removed is because we want to be able to draw on the very best possible talent and we want to be sure than we have an equal, competitive situation in relation to the other specialities. The kind of physicians that will come into physical medicine and rehabilitation are the ones that would go into psychiatry, which would be preventive medicine, internal medicine, and then the more specialized field of orthopedics and neurology. But, more often, when we get competent orthopedic surgeons and neurosurgeons, they have already had that kind of specialized training, and normally would not come into our program except for a year as expertees in rehabilitation. However, with reference to the young ones that we want to get for the whole time that we want to have them give their professional lives to rehabilitation and physical medicine, we are competing with wellestablished specialties. We are about in the same relationship now to the medical needs and demands for doctors that psychiatry was just after World War II. You had to go around and beg and beg and beg, and try to dramatize the importance and urgency of increasing the supply of specially trained psychiatrists, and this is what the mental health program did for the training program in psychiatry, and now, of course, it has become one of the most popular specialities. So, we need the restriction removed to get those people already in training and to have an equal competitive status for the road ahead for the young physicians that will be coming out next year and the year after and the year after that. Mrs. GREEN. Is there a Federal subsidy in these other fields of medical training? Miss SWITZER. A great deal. Mrs. GREEN. Do you have the total amount of money involved? Miss SWITZER. No; I do not have it here, but we can get it for you. Mrs. GREEN. I would very much like to have it. Miss SWITZER. The mental health program and psychiatry is a tremendous program, and it has been growing, of course, since the passage of the Mental Health Act. They have training grants at every medical school. Mrs. GREEN. There is a subsidy paid by the Federal Government for those programs at all these schools? Miss SWITZER. Yes. Mrs. GREEN. Do we also subsidize the individual doctors? Miss SWITZER. Yes; and we subsidize psychiatry, social work, and the psychologists. The program that is nearest to this program in its concept and in its spread is the mental health training program of the Public Health Service, and we will get you those figures, because I think that would be very interesting. Mrs. GREEN. That would be most interesting in view of the many letters from medical doctors in opposition to Federal aid to schools. Miss SWITZER. We will also send you the other training figures. (The information requested follows:) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. CARL ELLIOTT, House of Representatives, Washington, D. C. This DEAR MR. ELLIOTT: We are transmitting herewith a summary of funds appropriated to this Department for training grants in the health field. information was requested by your committee for use in reviewing H. R. 7155, and is in addition to that which we have forwarded to you under separate cover earlier today. Please call upon us if we may be of further assistance to you. Sincerely yours, E. E. FEREBEE, Acting Director. Funds appropriated for training grants in the health field Office of Education: Practical nurse training, promotion of vocational education.-- Mrs. GREEN. Miss Switzer, on this chart I do not understand why the difference in the amount of subsidy for the individual under the social worker status. For instance, in their fourth year of graduate study the individual payment is $2,800 a year, and yet your first year of work for the doctor is a payment of $3,400. Miss SWITZER. Yes; it is. Mrs. GREEN. Why is there that difference? Miss SWITZER. There is a difference in all programs. It goes to the competitiveness, I guess, in the economic labor market. It is related to what the conventional level of support is in the schools. One of the most important considerations in setting stipends in a publicly managed program like ours is to be in tune with what the schools themselves receive from other sources and we set our stipends, because we were the last in the field, pretty much to conform to all the already established levels. Mrs. GREEN. But is there not as great a dearth of trained social workers as there would be for the rehabilitation people in the medical field? Miss SWITZER. Yes. Mrs. GREEN. Well, partly, the difference in subsidy would be a matter of Miss SWITZER. It is a matter of what it takes to get the individuals together to come in, and a physician, of course, can go out usually after he has served his internship and many of them are men and are married and many of them are women who are married, too, for that matter, but the difference in levels is reflected in the difference in income, really, in the working period of the individual as much as anything else, and is also reflected in the level of support which these programs receive in the setting in which they are carried on. Mrs. GREEN. How long has this program been going on? Miss SWITZER. Our program has been in existence since the summer of 1954, and our vocational-rehabilitation amendments were passed. and signed in August 1954, and we had a supplemental appropriation for the fiscal year 1955. We made our first set of grants in the academic year beginning in the fall of 1954. Is that not correct, Mr. Garrett? Mr. GARRETT. Yes. Mrs. GREEN. Did the doctors ever oppose this program on the theory that it was socialized medicine? Miss SWITZER. No. As a matter of fact, the doctors have always supported the rehabilitation program quite affirmatively. Mrs. GREEN. In the literature which they put out have they ever indicated any inconsistency in their position? Miss SWITZER. No. Mrs. GREEN. Would you care to comment on it? I asked Congressman Haskell about it a few minutes ago while he was here; does it not seem to you to be a strange position? Miss SWITZER. Well, the Mrs. GREEN. I will withdraw the question, considering your position. It probably is not a fair question to ask. Miss SWITZER. I do not mind responding to a question when I have some competency to answer it. I have been associated with the relationship of the Federal Government to organized medicine for a long, long time, and have had responsibilities over the years for carrying on negotiations and relationships with them from 1935, 1936, or 1937, to the present day, and I feel that their attitude on many of our public programs has been the attitude of conservative groups who for the most part do not understand the problem. Now, one reason we have had little trouble as far as relationships with our program is concerned, I think, is for two reasons: First of all, most of the people who come to need physical medicine and rehabilitation in the public program have long since lost touch with a doctor and the hospital in the conventional sense, and nobody is doing anything about them. They represent the forgotten group and I think organized medicine has always maintained that they would try to meet the need of the so-called medically indigent or the people on public assistance, and so forth, and the medical care that we have arranged for through the public program has been done in the conventional manner. Ours is usually arranged through agreements with some medical society and the prevailing rates are paid-not the maximum, but a reasonable fee schedule is worked out in advance. Each community works it out more or less within the mores of that community and we have never been faced with a difficult problem in vocational rehabilitation of the insurance problem, and the public support of a thing across the board with publicly given care through Federal subsidy and that type thing. I would I think we have had to cast about for leaders in medicine to help promote the idea of physical medicine and rehabilitation. Mrs. GREEN. Well, I do not want to be misunderstood. not question for one minute the value of such a program. Miss SWITZER. I understand your point of view. Mrs. GREEN. I do not question its contribution, but it is very interesting to me that the American Medical Association has consistently led the fight against Federal support of any kind for public schools and yet does not hesitate to be back of a program for Federal support not only for the training of doctors, but also the subsidy to the |