March 1, 1984 EXTENSIONS OF REMARKS 4223 EXTENSIONS OF REMARKS NEW PRESIDENT OF MOUNT the manpower problem must now be enunci­ these schools are in the Caribbean Islands SINAI MEDICAL CENTER ated by the concerned parties. I have also and 16 in Mexico. United States authorities SPEAKS ON HEALTH MANPOW­ spoken with the Commissioner of Health, have not seen fit to accredit any of these in­ Dr. Axelrod, who agreed that the issue is of stitutions. Nonetheless, a significant ER paramount importance because it bears number of these students-certainly as upon the publicly sustained cost of medical many as several thousand United States citi­ HON. CHARLES B. RANGEL care. I have had a frank and amicable dis­ zens each year-will find their way back OF NEW YORK cussion of points of agreement and disagree­ into the licensed practice of medicine in the ment with the Chancellor of the Board of United States by one mechanism or an­ IN THE HOUSE OF REPRESENTATIVES Regents of New York State, Mr. Genrich, a other. Whether they are capable or compe­ Thursday, March 1, 1984 fine and dedicated gentleman who is genu­ tent is not in the central issue. The issue is inely devoted to the public interest. It is my that they add to an already inflated pool of • Mr. RANGEL. Mr. Speaker, on De­ sincere hope that what I say here this after­ physicians who bear the ultimate responsi­ cember 8, 1983, Dr. James F. Glenn noon will provoke a tripartite discussion of bility for expenditure of the health-care was inaugurated as the fourth presi­ the medical manpower problem between the dollars in this nation. dent of the Mount Sinai Medical three elements most concerned: our medical The high cost of medical education in the Center, which is in my congressional schools <the educators), the responsible United States reflects the problem of pro­ district. public authority <the Commissioner of viding adequate laboratory and bench space, He served most recently as dean of Health and his colleagues), and the licens­ lecture hall accommodations, and faculty re­ the medical school at Emory Universi­ ing and credentials authority for physicians sources for students. Here at Mount Sinai, a <our Board of Regents). facility of over 1,200 beds with more than ty in Atlanta. Prior to his deanship, First, to summarize, let us acknowledge 100 basic science full-time faculty, more Mr. Glenn was chief of the division of certain facts relative to medical manpower than 200 full-time clinical faculty and a host urologic surgery at Duke University in the 30 years from 1950 to 1980. Our ca­ of outstanding voluntary physicians, we still Medical Center, one of the largest and pacity to educate physicians has almost tri­ strain our resources to provide an appropri­ most prestigious urological residency pled, from approximately 5,500 graduates 30 ate educational experience each year for 100 programs in the country. His book, years ago to some 16,000 graduates this past students who are in the first two years of "Urologic Surgery," is considered the spring. Medical schools have increased from school, 130 students per year who are in the standard reference text in the field, about 80 in number to 127 accredited last two years of medical education. In con­ schools at this time. In 1982, there were trast, the offshore schools accept vast num­ and he is the author of more than 200 nearly 483,000 licensed physicians in the bers of students. At last report, there were scientific papers. United States, an increase of 3 percent over 9,000 students in Monterrey. Recent press Dr. Glenn spoke considerably, in his 1981. If we continue at this pace, we will see reports say that St. George's Medical speech, about the problems facing us a doubling of the number of physicians in School in Grenada admits 384 students an­ with regard to medical manpower. He the nation over the next two decades. nually, compared to our own class of 100. included his concerns about Federal In 1970, there were 168 physicians for Virtually every study of medical manpower policy in this area. every 100,000 people in the United States; has indicated that we are in a posture which As you know, health manpower leg­ today, there are nearly 200 physicians per will produce an overabundance or glut of 100,000 population, and by 1990, the ratio physicians. islation comes up for reauthorization will be 250 doctors for every 100,000, consid­ In 1980, the Graduate Medical Education in 1984. I am sure Dr. Glenn's remarks ering the trainees who are now in the educa­ National Advisory Committee <GMENAC), will be very useful to the members and tional pipeline. sponsored by the Department of Health and staff of those committees dealing with This past year, there was a small decrease Human Services, projected a rather massive the matter. I have excerpted from the in the number of students entering medical surplus of physicians by 1990. This oversup­ speech portions dealing with medical schools, triggered by budget cuts, spiraling ply primarily involves the medical special­ manpower. I urge my colleagues to tuition costs, and cuts in federal aid. This ties, the surgical specialties, radiology, and read and carefully consider his re­ reduction reflects the current state of the even some of the primary care specialties. economy, as opposed to policy planning. It The only projected potential shortages were marks. therefore may not prove to be a long-term in the fields of adult and child psychiatry, PRESIDENT OF MOUNT SINAI MEDICAL CENTER trend and it should not be relied upon to rehabilitation medicine, and emergency DISCUSSES HEALTH MANPOWER solve the medical manpower problem. medicine. I would like to address the medical man­ At the highwater mark in 1974, over Without quibbling, it can be stated that power issue as the principal theme of my 42,000 people applied to medical schools in there will be an excess number of physicians discussion with you today. I am not alone in this country, but in 1983 there were under available in this country very soon. The De­ my concern with regard to this thorny issue. 36,000. Just over 30,000 of last year's 36,000 partment of Health and Human Services Good and thoughtful men, dedicated public were first time applicants. The remainder has even recommended that the entering servants, representatives of many aspectS of were repeat applicants who had been reject­ class size in U.S. medical schools be reduced public and private life have given serious ed on prior occasions. Since there were over by 17 percent and that the inflow of foreign consideration to the medical manpower 17 ,000 students admitted to accredited medi­ trained physicians be severely restricted. problem. It is a problem which centers in cal schools in the United States, the chances Why is this so important? What differ­ medicine and involves all of society. The of admission for a first time applicant were ence does it make if we have too many phy­ deans of our medical schools, the accredita­ better than 50 percent-one student admit­ sicians? Will not the laws of supply and tion authorities for medical education at the ted to medical school for every two who ap­ demand work to lower the cost of medical various levels, the federally and locally plied. care if we have more physicians than we sponsored agencies which regulate medical What happens to the remaining appli­ need? Unfortunately, the answers are not care, the licensing organizations, the health cants? Well, some are carried over to subse­ simple. The societal costs of training a phy­ agencies, private foundations, economists quent years when they reapply. Still, others sician are almost incalculable. It begins with and concerned individuals in many other abandon the thought of a medical career preparatory schooling, it continues through areas have given thoughtful consideration and enter other fields. A gratifying number four expensive years of college education, it to the medical manpower problem, each per­ select paramedical careers, where we gener­ is maintained through four years of medical haps with a different perspective and a dif­ ally have a shortage of personnel. education <now at a level of over $43,000 per ferent agenda. I can tell you that I have Unfortunately, however, a large number student per year here at Mt. Sinai) and it shared my own views with the deans of the of rejected medical school applicants seek extends into a period of post-graduate train­ twelve medical schools in the State of New refuge in non-accredited medical schools of ing that ranges from 3 to 8 years depending York who represent 10 percent of the na­ questionable credibility and capability. It is on the specialty. Society bears the cost of tion's medical educational capability. I have estimated that there may be approximately this long and expensive educational process. discovered that there is at least unanimity 12,000 to 18,000 United States citizens en­ Indeed, the student may pay tuition-which in the opinion that a plan of approach to rolled in 56 foreign medical schools. Ten of is in many instances extremely high-but e This "bullet" symbol identifies statements or insertions which are not spoken by the Member on the floor. 4224 EXTENSIONS OF REMARKS March 1, 1984 society incurs a debt as well, because public Students of the social scene argue that med­ trade restrictions, or by the adminis­ agencies and public dollars underwrite the icine must be organized and regulated, but tration· that we can bargain for trade educational process in many ways.