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American Dental Association witnesses support federal grants-in-aid on dental education before Congressional Committee
reports of councils and bureaus
Am erican Dental A ssociation w itnesses support federal gran ts-in -a id on dental education before C ongressional Comm ittee
COUNCIL ON LEGISLATION
On January 24 Gerald D. Timmons, president-elect of the American Dental Associ ation, and Raymond J. Nagle, chairman of the Council on Dental Education, presented the viewpoint of the Association on H.R. 4999, a bill to provide federal grants-in-aid for construction of dental and medical facilities, scholarships to dental and medical students and for cost of education grants related to the scholarship program, to be distributed to the dental and medical schools. Dr. Timmons and Dr. Nagle emphasized the Association’s interest in the construc tion program, particularly in light of the predicted need for several new schools within the next 10 to 15 years. The hearings on H.R. 4999 were conducted by the Interstate and Foreign Com merce Committee of the House of Representatives. Representative Oren Harris (D. Ark.) introduced the bill in behalf of the Kennedy Administration. The American Association of Dental Schools also presented testimony on H.R. 4999. Lester W . Burket, dean, University of Pennsylvania School of Dentistry and president of the American Association of Dental Schools, was the witness for the dental schools. I am Gerald D. Timmons. I am president elect of the American Dental Association, and I am dean of the College of Dentistry at Temple University in Philadelphia. With me is Raymond J. Nagle who is chairman of the Association’s Council on Dental Education
and dean of the College of Dentistry at New York University. I am also accompanied by Mr. Bernard J. Conway of Chicago, who is in charge of the Association’s legal and legis lative affairs and by Mr. Hal M. Christensen, the Association’s Washington Counsel.
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We are here today to present the American Dental Association’s views on H.R. 4999, the Health Professions Educational Assistance Act. Within the dental profession there is an increasing concern over the problem of pro viding the quantity and quality o f dental health care that a rapidly expanding and in creasingly health conscious American public demands and expects. Through recently ex panded programs in dental research and through other important developments, sig nificant progress has been made in controlling dental diseases and in extending the availabil ity of dental care. Yet much more needs to be done. At the present time, the shortage o f dental manpower stands out as the most formidable barrier to continued progress in dental health. The capacity to produce dental personnel con tinues to be outrun by the growth in popula tion and the increased demand for dental care. Responsible government and private groups have conducted study after study and have consistently documented the acute needs in this area. There is no room for reasonable dispute that the situation is becoming increas ingly critical. In his health message to Congress last year, the President of the United States pointed out that if during the next ten years we could increase the capacity of our dental schools by 100 per cent, we would still be able only to maintain the present ratio of dentists to popu lation. T o accomplish even this much, we must have increased enrollment in existing schools plus 20 new dental schools. Again this year, in his State of the Union message, the President emphasized the serious nature of the situation. The American Dental Association believes the President’ s appraisal of the situation is a fair one, and unless immediate corrective ac tion is taken, the problem may reach insur mountable proportions. There is an immediate need for funds to provide additional and improved dental edu cational facilities, and to provide increased support for dental students and dental schools to help meet the already high and steadily rising costs of dental education. Enactment of H.R. 4999 would be of sub stantial assistance in meeting these needs. In the case of dentistry, the bill would pro vide 15 million dollars a year for ten years for matching construction grants for new schools or for major expansion of existing schools. The bill would also provide 15 million dollars a year for renovation and replacement of obsolete dental, medical, osteopathic or public health school teaching facilities. In the case of new schools or major expansion of
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existing schools, the federal share could be up to 662/s per cent of costs. Grants for renova tion or replacement o f existing facilities could not exceed 50 per cent of construction costs. The bill also would authorize $500,000 per year for ten years for projects for planning of dental, medical or public health education pro grams by schools and other public or nonprofit private agencies. In addition, the bill would provide scholarship support for each school in an amount equal to $1,500 times 25 per cent of its first year class enrollment and increasing to $1,500 times 25 per cent of the total en rollment by the end o f the fourth year. Maxi mum scholarship for any one student would be $2,000. T a meet the instructional costs of these students, the bill would authorize grants to schools in an amount equal to $1,000 for each scholarship holder but not in excess of $1,000 for 25 per cent of the first year class' in the first year, with this maximum increasing by the fourth year to $1,000 for 25 per cent of the four-year enrollment. The bill also extends the research facilities construction grant program for three years and raises the authorization from 30 million dollars to 50 million dollars annually. As already indicated, the American Dental Association believes that enactment of H.R. 4999 would go far to alleviate the severe prob lems facing dental education today and in the future. It should be pointed out that these problems are national in scope and require for their full solution a remedy of equal dimension. At the present time, there are 47 dental schools lo cated in 26 states, the District of Columbia and Puerto Rico. These 28 jurisdictions sup ply the dentists for their own populations in addition to dentists for the remaining 24 states. Thus, slightly more than half the states furnish dentists for the entire country. There is also another national aspect to the dental manpower problems. The federal government itself is a large consumer of den tal services. The Armed Forces and other gov ernment agencies exert considerable and continuous pressures on available dental man power. Among the professions, only dentistry and medicine are subjected to special draft call. Both public and private schools are finding it difficult to meet costs. Funds from local and state governments and private sources are not available in sufficient amounts to provide the needed educational facilities. In this situation, it is believed, the federal government has a ' vital interest and responsibility. It is our opinion that unless some assistance is forthcoming at the national level, no new private dental schools will be established and
REPORTS O F C O U N C IL S A N D BU REAUS
some of those now in existence will find it increasingly difficult to continue. The Associa tion believes this should not occur. An effort should be made to maintain privately en dowed and operated schools in the dental education system. I would like to emphasize to the Committee that this Association recognizes and appreci ates the great demands on the federal Treasury at this time. I would like to be able to tell this Committee that the dental manpower problem can be solved with private, state and local resources. It is an undeniable fact, however, that the size of the problem is of such proportions that its solution requires national attention. We are firmly convinced that unless federal funds are made available to help arrest the impend ing decline in dental manpower, there will not be enough dentists to provide the dental care the public needs and deserves. As the repre sentative of a responsible health profession, it is the Association’s obligation to do everything possible to prevent this occurrence. Representatives o f the American Dental As sociation have testified before Congress in sup port o f federal grant-in-aid legislation for as sisting dental schools six times since 1949. In that year the Association’s House of Delegates adopted the following resolution: “ Resolved, that the American Dental Associa tion approve the policy that Federal funds, with justification, might be appropriated in support of dental education programs, pro vided that such funds when appropriated should be accepted with the understanding that the Government shall not exercise any control over, or prescribe any requirements with respect to, the curriculum, teaching per sonnel or administration of any school or the admission of applicants thereto.” The bill, H.R. 4999, is in keeping with the policy of the American Dental Association. It is believed, however, that one clarifying amendment might be in order. It is suggested that Section 726, “ Noninterference With A d ministration of Institutions” be extended to apply to Part C o f the bill relating to the scholarship program. While it is recognized that little or no discretion is conferred upon the Surgeon General in administering this part of the program, adoption of the suggested amendment would make crystal clear the in tent that there shall be no interference with school administration. Recommendation: The American Dental Association with a membership of 95,000 and representing more than 80 per cent of the
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nation’s dentists, urges Congress to enact H.R. 4999 as a significant step toward im proving the dental health o f the people of this country. At this time, I should like to introduce Raymond J. Nagle who is eminently qualified to speak on the specific needs in dental edu cation. DR. N a g l e ’ s TE STIM O N Y
I am Raymond J. Nagle, dean of the College of Dentistry at New York University. In 1955 and 1957, the American Dental Association presented to this Committee data and statistics related to the dental manpower problems and the legislative remedies which appeared to be indicated. Since that time, ad ditional factual information has been assembled as the result of several additional studies con ducted by groups from within and without government. (See Appendix.) All of these studies considered the predictable growth in population as related to the existing and fu ture capacity to train dental personnel. Each study arrived at the conclusion that to meet the existing and impending shortage of dental manpower, training capacity must be expanded and federal financial assistance is necessary to stimulate such expansion. The American Dental Association believes that the areas of need have been defined and documented, and that a careful review o f the available factual data provides a convincing demonstration of the need for action by the Congress. NEED FOR CONSTRUCTION FUNDS
Present Capacity of Dental Schools • There are now 47 dental schools in operation, includ ing four that have started operations since 1956. Tw o new dental schools are in develop ment and will be able to accept students within the next two or three years. The 1961 undergraduate dental schools enrollment is 13,513 students. In addition, there are 1,398 students engaged in graduate, postgraduate and special study programs, and 1,169 students enrolled in dental hygiene schools which are not affiliated with dental schools, but which offer programs that have been approved by the American Dental Association. From October, 1955 to October, 1961, un dergraduate dental school enrollment has in creased from 12,730 to 13,513. The number of students engaged in special studies and seeking advanced degrees has increased from 539 to 1,398. The number of dental hygiene undergraduates has increased from 1,160 to
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1,571. The number of continuing or refresher students has increased from 4,673 to 9,471.
students. In 1962 it is anticipated that the schools will graduate about 3,294 dentists.
Growing Need for Dentists and Dental Auxil iaries • The continuing expansion of training programs offered by the schools reflects the constant effort of the schools to meet the grow ing demand for dentists and dental auxiliaries made necessary by the prevailing population growth and the replacement of dentists and auxiliaries lost through death and retirement from active practice. But these increases in enrollments, utilizing present facilities to their greatest capacities, do not enable dental schools to graduate the needed personnel. In our testimony before this Committee in April of 1958, figures were given projecting the need for dentists in 1975. Based on the population projection for the year 1975 of 228/2 million, 133,250 dentists will be needed in that year to maintain the 1958 dentist-population ratio of 1 to 1,767. On the basis of the present number of dental school graduates, it is estimated that by 1975 there will be only about 118,000 dentists in active practice or approximately 15,000 less than are needed to retain the 1958 ratio. Instead of a ratio of 1 to 1,767, there will be a ratio of 1 to 2,000. T o regain the 1958 ratio, a pro gressively increasing number of graduates will be needed each year, so that by 1975, an additional 2,700 dentists will graduate yearly. If these additional graduates can be provided by the dental schools, there would be by 1975, 133,250 practicing dentists. As stated in the Association’s testimony of 1958, leaders in the profession and dental edu cators view these statistics with serious con cern. The profession feels that the most obvious solution to these problems would be the expan sion of existing dental teaching facilities and the construction of new schools. Although ob vious, this is an expensive course of action requiring not only the resources of the profes sion, but also the resources of public and pri vate agencies, including those of the federal government. According to the report of the Surgeon Gen eral’s Consultant Group on Medical Educa tion, confirmed by a study of a consultant committee on medical research which advised Senator Lister Hill’s Subcommittee on Appro priations, the country will need an equivalent of 22 new dental schools. The consultant group further stated that “ . . . to arrest the decline in the national ratio of dentists to population at its 1959 level will require that dental school training capacity be increased sufficiently to produce 6,180 annual graduates by 1975, or about 2,700 more than can be expected.” As of June, 1961, dental schools graduated 3,290
Present Plans for Expansion (without Federal Aid) • According to a 1961 survey conducted by the American Dental Association and the American Association of Dental Schools, 28 dental schools are now planning expansion of teaching facilities, involving some 68 million dollars during the next ten years. Approxi mately 18 of these schools are contemplating construction to be commenced within the next three years. Without federal aid, the construction now planned will provide new student places for 354 dental students, 447 dental hygiene stu dents, 380 dental assistants and 155 dental laboratory technicians. Expansion with Federal Support • In the opinion of most schools, federal aid would provide a major stimulus to needed construc tion. O f these 28 schools now planning con struction, 23 would modify these plans in some respect, either by enlarging them to undertake a more ambitious building program or by advancing or making definite the scheduled starting date. All of the 19 schools not now planning construction would, under some con ditions, undertake construction. Instead of a planned expenditure of 68 million dollars for dental school construction there would be 148 million dollars spent for that purpose. Instead of only 18 schools scheduling con struction within the next three years, there would be 39. With federal aid the construction planned will increase the number of new student places from 354 to 725 for dental students, from 447 to 915 for dental hygiene students, from 380 to 714 for dental assistants and 303 new places for dental laboratory technicians rather than 155. About half of the schools plan larger gradu ate, postgraduate and research programs, whether or not federal aid is available. With aid, nearly every school will expand these pro grams. If federal matching grants are made avail able as envisioned in the “ Health Professions Education Assistance Act,” H.R. 4999, exist ing dental schools have indicated a willing ness to undertake new construction and re modeling costing over 148 million dollars. In terms of the available and anticipated match ing funds, the schools estimate over 58 million dollars as available within five years and about 73 million dollars within the next ten years. The Association believes that the matching grant formulas as set forth in H.R. 4999 are realistic and would be fully utilized when these funds become available.
REPORTS O F C O U N C IL S A N D B U R EA U S .
SC H O LA R SH IPS FOR DENTAL STUDENTS
Cost of Financing a Dental Education • An other, but no less important, factor in provid ing adequate dental care of the public, is the cost of dental education to the individual stu dents. Dental education is, without question, the most expensive of the professional disci plines from the standpoint of student finances. Undoubtedly this fact contributes to the fail ure of many promising students from lower and middle income families to enter dentistry. Both the profession and public vitally need these students and the public interest is not well served if the profession is unable to secure them. At the present time, the average cost to students of a four year dental education is $15,043. This can be broken down into school expenses of $5,824 and average living expenses of $9,219. The figures are slightly higher for students in private dental schools. For the mar ried dental student, and an ever increasing number o f dental students are married, the average cost of a dental education is over $ 18,000; if he attends a private dental school, this figure rises to over $19,000. Present Scholarship and other Financial As sistance to Dental Students • The 1961 Survey of Financial Aid for Dental Education reveals some startling figures with respect to students receiving aid from their schools. It is estimated that 91 per cent of all dental students do not receive any scholarship aid. This is an insignifi cant improvement over the years 1953-54 when 92 per cent did not receive scholarships. More than three fourths of the dental students do not receive school loans (76 per cent). The average amount received in scholarships (among those who receive scholarships), is $480, and the average amount received in loans is $627. Significantly, only 5 per cent of the freshmen in dental schools receive scholar ships and only 8 per cent receive loans. Need for a Federal Scholarship Program for Dental Students • As nearly as can be deter mined, only about 40 per cent of the dental students are able to pay for their own educa tion through a combination of personal sav ings, parental assistance and help from rela tives and friends. For the remaining 60 per cent, some financial aid is needed. In 1960-61, dental schools received scholar ship requests from 12 per cent of their stu dents. The students requested $809,547 and approximately $580,000 was awarded in schol arships. Twenty-seven per cent of the students requested 2.6 million dollars in loans and only
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slightly over 2 million dollars was awarded. Although a large percentage of the students who requested scholarships were awarded them (75 per cent), the amounts awarded were obviously inadequate. Further, there is no way of recording the number of competent and needy students who did not apply for scholar ships or loans because they knew that none were available. Relatively few schools have uncommitted loan funds in any volume. At the time of the 1961 Survey on Financial Aid for Dental Edu cation, 14 schools said they had no uncom mitted loan funds and another 22 reported that the funds on hand amounted to less than $10,000. Actually, there were 11 schools which held almost 80 per cent of all uncommitted funds. The profession is vitally concerned with the public need for an adequate supply of dentists. One of the major deterrents encountered in the recruitment o f dental students is the high cost of dental education for some and the prohibitive cost for others. There is plainly an ever increasing need for funds to provide scholarships so that able and qualified students are not prevented, for financial reasons, from selecting dentistry as a profession. Through both private and public programs, a part of the need for financial assistance to dental students is now met with student loans. Monies available under the National Defense Education Act probably represent the major new source of loan aid, providing help to 12 per cent of the total student body in 1961. The Association agrees that loan funds are essen tial and needed in dental education, but it observes also, that indebtedness of dental stu dents at the outset of a professional career is formidable. For example, dental students must invest from $7,000 to $10,000 to equip an operatory. This cost of equipment, unequaled by the other professions, is usually financed as a commercial loan by the new graduate and more often than not, such a loan is in curred in addition to existing indebtedness for professional education. Therefore, in the Association’s view, it is preferable that greatly increased scholarship funds be made available so that dental stu dents are not overburdened with debt at the outset of their professional careers. Although the profession now has available both loans and scholarship funds for needy and qualified dental students, it is evident that the present volume of these funds is insuffi cient to bring into the profession the number of qualified students required to meet the fu ture dental manpower needs of the nation. Therefore, the Association views as urgent, a federal scholarship assistance program for dental students as outlined in H.R. 4999.
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COST OF EDUCATION PAYM EN TS TO T H E SCHOOLS
Cost of Educating a Dental Student • Educat ing dental students costs much more than the schools receive from tuition charges paid by students. On the average, the dental student contributes in tuition only 29 per cent of the cost of educating him. In private schools, the average is 41 per cent and in the public schools, it is only 16 per cent. Although tuition costs have increased in the past ten years, a dental student ten years ago contributed ap proximately one third of the cost of his educa tion, a generation ago, he contributed almost half. The cost of the regular education programs of the schools is now almost ri/ i times what it was ten years ago. Approximately 38.5 million dollars is now being spent in support of the regular programs, as compared with 15.7 million dollars in 1949-1950. Now, how ever, only 73 per cent of these costs are met by the dental schools out of their own budgeted funds, whereas ten years ago, the schools met 88 per cent of their own expenses. Today, the annual cost of educating more than 13,000 dental students is 44.5 million dollars. As recently as 1955, the annual cost for 45 dental schools was 32 million dollars. If we translate these figures to average cost per student, today’s cost for dental schools is about $3,000 per student, whereas the 1955 cost was about $2,500 per student. We must expect this cost per student to continue to increase. Assistance Needed by the Dental Schools • The answer cannot, in fairness or in terms of our democratic goals, be an excessive increase in tuition charges aimed to meet full educa tional costs. This would, in our opinion, have two obviously unfortunate results. With tui tion charges increased from about $3,000 to $5,000 a year, the number of dental students would be diminished to perhaps a quarter of today’s enrollment. Additionally, the source of students would necessarily be that very small segment o f society with extremely high income. These consequences must not occur. We want to keep tuition cost for dental edu cation at a reasonable level so that all those with a dedication for dentistry who have the ability to fulfill the rigid education require ments will not be deterred from seeking a dental education for financial reasons. The position of the American Dental Associ ation is, as it has been in the past, in favor of dental grants-in-aid for dental education. Association witnesses have supported proposals similar to H.R. 4999 at Congressional hearings
at least five times since 1950. It should be noted that the Commission on the Survey of Dentistry comments favorably on this realistic attitude o f the dental profession through its national Association. The Commission on the Survey of Dentistry also compiled information on the attitude of those university presidents having dental schools within their purview and the deans of the dental schools on accepting federal funds to support their dental schools and programs. The Commission reports that the majority of university presidents favor such support. Likewise, the dental school deans endorse fed eral aid. CONCLUSION
The legislation to which we are addressing our comments, namely H.R. 4999, would provide annually for ten years 15 million dollars in grants on a matching basis for construction of new dental teaching facilities and 15 million dollars in matching grants for replacement or rehabilitation of existing teaching facilities in schools of dentistry, medicine and public health. The American Dental Association strongly supports this much needed federal aid. H.R. 4999 also includes provisions for scholarship grants to dental schools to be allo cated to dental students in a manner which seems eminently reasonable to the American Dental Association. In addition to the schol arship grants, there would be cost o f education payments to the schools to make up the deficit between the scholarship grants and the actual cost to the schools for educating students re ceiving those scholarships. The Association favors the utilization o f federal funds for this purpose, provided such aid does not affect admission policies of the schools or the content of the curriculum. The Association also supports the provision of H.R. 4999 which would strengthen and expand the program for grants to assist in the construction of health research facilities. The American Dental Association reaffirms its recommendation that this committee report favorably on H.R. 4999. APPENDIX
I. Medical School Inquiry, Staff Report to the Committee on Interstate and Foreign Commerce, House of Representatives, Eightyfifth Congress, First Session (Committee Print). 2. U.S. Department of Health, Education, and Welfare, Office of the Secretary. “ The Advancement of Medical Research and Edu cation Through the Department of Healthj
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Education, and Welfare: Final Report of the Secretary’s Consultants on Medical Research and Education, 1958” (The Bayne-Jones Re port). 3. U.S. Department of Health, Education, and Welfare, Public Health Service. “ Physi cians for a Growing America: Report of the Surgeon General’s Consultant Group on Medi cal Education, 1959” (The Bane Report). 4. Subcommittee on Departments of Labor,
Health, Education, and Welfare, of the Com mittee on Appropriations, United States Sen ate (86th Congress: Second Session). “ Federal Support of Medical Research: Report o f the Committee of Consultants on Medical Re search,” 1960. 5. American Council on Education, Com mission on the Survey of Dentistry in the United States, “ The Survey of Dentistry,” 1961.
A dditions to the Library
BUREAU OF LIBRARY AND INDEXING SERVICE
The books listed here have been added recently to the Bureau collection. Re quests for this material, available on loan to all members of the Association, should be addressed to the Bureau of Library and Indexing Service. There is no charge for borrowing books, but there is a mini mal charge of one dollar ($1.00) for each package library. Illinois residents add 4 per cent Retailers Use Tax. (This applies also to the purchase of books.) Practically all the dental journals pub lished in the world at present are avail able to members on loan. Lists of books, package libraries and journals are avail able on request. BOOKS A l d o u s , J. A . A radiographic method to study
the absorption of a radiopaque solution from an injection site. (M . S. thesis— Northwest ern University.) Chicago, 1961. Typewrit ten. On microfilm only. A m e r i c a n D e n t a l A s s o c i a t i o n . A manual for component dental societies. [Chicago, 1962] 47 p.
A m e r ic a n
D e n t a l A s s o c ia t io n .
B u rea u
o f
American dental directory, 1962. Chicago, 1962. 1,276 p. $15. M e m b e r s h ip
A m e r ic a n
R ecords.
D en ta l
A s s o c ia t io n .
C o u n c il
Accepted d e n tal r e m e d i e s ; drugs used in dental p r a c t i c e including a lis t of b r a n d s accepted b y t h e C o u n c i l on Dental T h e r a p e u t i c s of t h e American Dental Association. 27th ed. C h i cago, 1962. 235 p. $3. D ’ A m i c o , A n g e l o . The canine teeth; normal functional relation of the natural teeth of man. Stockton, Cal., The Author, [1958, cl955 and 1957] 74 p. Reprinted from the Journal of the Southern California State Dental Association, Vol. 26, 1958. D i e t z , D . R. A histologic study of the effects of formocresol on normal primary pulpal tissue. (M . S. thesis— University of Wash ington.) [Seattle] 1961. 55 p. Typewritten. On microfilm only. T h e D o c t o r ’ s T a x L e t t e r . Tax handbook for medical men, 1962. Chicago, 1962. 38 p. $2.50. D o u b , R. G. The relationship of the mandibu lar central incisor to its supporting tissues in Class I and Class II, division 1 maloc clusions. (M . S. thesis— University of Ten nessee.) [Memphis] 1961. 69 p. Typewritten. on
D e n t a l T h e r a p e u t ic s .
Am erican Dental A ssociation w itnesses support federal gran ts-in -a id on dental education before C ongressional Comm ittee
COUNCIL ON LEGISLATION
On January 24 Gerald D. Timmons, president-elect of the American Dental Associ ation, and Raymond J. Nagle, chairman of the Council on Dental Education, presented the viewpoint of the Association on H.R. 4999, a bill to provide federal grants-in-aid for construction of dental and medical facilities, scholarships to dental and medical students and for cost of education grants related to the scholarship program, to be distributed to the dental and medical schools. Dr. Timmons and Dr. Nagle emphasized the Association’s interest in the construc tion program, particularly in light of the predicted need for several new schools within the next 10 to 15 years. The hearings on H.R. 4999 were conducted by the Interstate and Foreign Com merce Committee of the House of Representatives. Representative Oren Harris (D. Ark.) introduced the bill in behalf of the Kennedy Administration. The American Association of Dental Schools also presented testimony on H.R. 4999. Lester W . Burket, dean, University of Pennsylvania School of Dentistry and president of the American Association of Dental Schools, was the witness for the dental schools. I am Gerald D. Timmons. I am president elect of the American Dental Association, and I am dean of the College of Dentistry at Temple University in Philadelphia. With me is Raymond J. Nagle who is chairman of the Association’s Council on Dental Education
and dean of the College of Dentistry at New York University. I am also accompanied by Mr. Bernard J. Conway of Chicago, who is in charge of the Association’s legal and legis lative affairs and by Mr. Hal M. Christensen, the Association’s Washington Counsel.
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We are here today to present the American Dental Association’s views on H.R. 4999, the Health Professions Educational Assistance Act. Within the dental profession there is an increasing concern over the problem of pro viding the quantity and quality o f dental health care that a rapidly expanding and in creasingly health conscious American public demands and expects. Through recently ex panded programs in dental research and through other important developments, sig nificant progress has been made in controlling dental diseases and in extending the availabil ity of dental care. Yet much more needs to be done. At the present time, the shortage o f dental manpower stands out as the most formidable barrier to continued progress in dental health. The capacity to produce dental personnel con tinues to be outrun by the growth in popula tion and the increased demand for dental care. Responsible government and private groups have conducted study after study and have consistently documented the acute needs in this area. There is no room for reasonable dispute that the situation is becoming increas ingly critical. In his health message to Congress last year, the President of the United States pointed out that if during the next ten years we could increase the capacity of our dental schools by 100 per cent, we would still be able only to maintain the present ratio of dentists to popu lation. T o accomplish even this much, we must have increased enrollment in existing schools plus 20 new dental schools. Again this year, in his State of the Union message, the President emphasized the serious nature of the situation. The American Dental Association believes the President’ s appraisal of the situation is a fair one, and unless immediate corrective ac tion is taken, the problem may reach insur mountable proportions. There is an immediate need for funds to provide additional and improved dental edu cational facilities, and to provide increased support for dental students and dental schools to help meet the already high and steadily rising costs of dental education. Enactment of H.R. 4999 would be of sub stantial assistance in meeting these needs. In the case of dentistry, the bill would pro vide 15 million dollars a year for ten years for matching construction grants for new schools or for major expansion of existing schools. The bill would also provide 15 million dollars a year for renovation and replacement of obsolete dental, medical, osteopathic or public health school teaching facilities. In the case of new schools or major expansion of
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existing schools, the federal share could be up to 662/s per cent of costs. Grants for renova tion or replacement o f existing facilities could not exceed 50 per cent of construction costs. The bill also would authorize $500,000 per year for ten years for projects for planning of dental, medical or public health education pro grams by schools and other public or nonprofit private agencies. In addition, the bill would provide scholarship support for each school in an amount equal to $1,500 times 25 per cent of its first year class enrollment and increasing to $1,500 times 25 per cent of the total en rollment by the end o f the fourth year. Maxi mum scholarship for any one student would be $2,000. T a meet the instructional costs of these students, the bill would authorize grants to schools in an amount equal to $1,000 for each scholarship holder but not in excess of $1,000 for 25 per cent of the first year class' in the first year, with this maximum increasing by the fourth year to $1,000 for 25 per cent of the four-year enrollment. The bill also extends the research facilities construction grant program for three years and raises the authorization from 30 million dollars to 50 million dollars annually. As already indicated, the American Dental Association believes that enactment of H.R. 4999 would go far to alleviate the severe prob lems facing dental education today and in the future. It should be pointed out that these problems are national in scope and require for their full solution a remedy of equal dimension. At the present time, there are 47 dental schools lo cated in 26 states, the District of Columbia and Puerto Rico. These 28 jurisdictions sup ply the dentists for their own populations in addition to dentists for the remaining 24 states. Thus, slightly more than half the states furnish dentists for the entire country. There is also another national aspect to the dental manpower problems. The federal government itself is a large consumer of den tal services. The Armed Forces and other gov ernment agencies exert considerable and continuous pressures on available dental man power. Among the professions, only dentistry and medicine are subjected to special draft call. Both public and private schools are finding it difficult to meet costs. Funds from local and state governments and private sources are not available in sufficient amounts to provide the needed educational facilities. In this situation, it is believed, the federal government has a ' vital interest and responsibility. It is our opinion that unless some assistance is forthcoming at the national level, no new private dental schools will be established and
REPORTS O F C O U N C IL S A N D BU REAUS
some of those now in existence will find it increasingly difficult to continue. The Associa tion believes this should not occur. An effort should be made to maintain privately en dowed and operated schools in the dental education system. I would like to emphasize to the Committee that this Association recognizes and appreci ates the great demands on the federal Treasury at this time. I would like to be able to tell this Committee that the dental manpower problem can be solved with private, state and local resources. It is an undeniable fact, however, that the size of the problem is of such proportions that its solution requires national attention. We are firmly convinced that unless federal funds are made available to help arrest the impend ing decline in dental manpower, there will not be enough dentists to provide the dental care the public needs and deserves. As the repre sentative of a responsible health profession, it is the Association’s obligation to do everything possible to prevent this occurrence. Representatives o f the American Dental As sociation have testified before Congress in sup port o f federal grant-in-aid legislation for as sisting dental schools six times since 1949. In that year the Association’s House of Delegates adopted the following resolution: “ Resolved, that the American Dental Associa tion approve the policy that Federal funds, with justification, might be appropriated in support of dental education programs, pro vided that such funds when appropriated should be accepted with the understanding that the Government shall not exercise any control over, or prescribe any requirements with respect to, the curriculum, teaching per sonnel or administration of any school or the admission of applicants thereto.” The bill, H.R. 4999, is in keeping with the policy of the American Dental Association. It is believed, however, that one clarifying amendment might be in order. It is suggested that Section 726, “ Noninterference With A d ministration of Institutions” be extended to apply to Part C o f the bill relating to the scholarship program. While it is recognized that little or no discretion is conferred upon the Surgeon General in administering this part of the program, adoption of the suggested amendment would make crystal clear the in tent that there shall be no interference with school administration. Recommendation: The American Dental Association with a membership of 95,000 and representing more than 80 per cent of the
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nation’s dentists, urges Congress to enact H.R. 4999 as a significant step toward im proving the dental health o f the people of this country. At this time, I should like to introduce Raymond J. Nagle who is eminently qualified to speak on the specific needs in dental edu cation. DR. N a g l e ’ s TE STIM O N Y
I am Raymond J. Nagle, dean of the College of Dentistry at New York University. In 1955 and 1957, the American Dental Association presented to this Committee data and statistics related to the dental manpower problems and the legislative remedies which appeared to be indicated. Since that time, ad ditional factual information has been assembled as the result of several additional studies con ducted by groups from within and without government. (See Appendix.) All of these studies considered the predictable growth in population as related to the existing and fu ture capacity to train dental personnel. Each study arrived at the conclusion that to meet the existing and impending shortage of dental manpower, training capacity must be expanded and federal financial assistance is necessary to stimulate such expansion. The American Dental Association believes that the areas of need have been defined and documented, and that a careful review o f the available factual data provides a convincing demonstration of the need for action by the Congress. NEED FOR CONSTRUCTION FUNDS
Present Capacity of Dental Schools • There are now 47 dental schools in operation, includ ing four that have started operations since 1956. Tw o new dental schools are in develop ment and will be able to accept students within the next two or three years. The 1961 undergraduate dental schools enrollment is 13,513 students. In addition, there are 1,398 students engaged in graduate, postgraduate and special study programs, and 1,169 students enrolled in dental hygiene schools which are not affiliated with dental schools, but which offer programs that have been approved by the American Dental Association. From October, 1955 to October, 1961, un dergraduate dental school enrollment has in creased from 12,730 to 13,513. The number of students engaged in special studies and seeking advanced degrees has increased from 539 to 1,398. The number of dental hygiene undergraduates has increased from 1,160 to
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1,571. The number of continuing or refresher students has increased from 4,673 to 9,471.
students. In 1962 it is anticipated that the schools will graduate about 3,294 dentists.
Growing Need for Dentists and Dental Auxil iaries • The continuing expansion of training programs offered by the schools reflects the constant effort of the schools to meet the grow ing demand for dentists and dental auxiliaries made necessary by the prevailing population growth and the replacement of dentists and auxiliaries lost through death and retirement from active practice. But these increases in enrollments, utilizing present facilities to their greatest capacities, do not enable dental schools to graduate the needed personnel. In our testimony before this Committee in April of 1958, figures were given projecting the need for dentists in 1975. Based on the population projection for the year 1975 of 228/2 million, 133,250 dentists will be needed in that year to maintain the 1958 dentist-population ratio of 1 to 1,767. On the basis of the present number of dental school graduates, it is estimated that by 1975 there will be only about 118,000 dentists in active practice or approximately 15,000 less than are needed to retain the 1958 ratio. Instead of a ratio of 1 to 1,767, there will be a ratio of 1 to 2,000. T o regain the 1958 ratio, a pro gressively increasing number of graduates will be needed each year, so that by 1975, an additional 2,700 dentists will graduate yearly. If these additional graduates can be provided by the dental schools, there would be by 1975, 133,250 practicing dentists. As stated in the Association’s testimony of 1958, leaders in the profession and dental edu cators view these statistics with serious con cern. The profession feels that the most obvious solution to these problems would be the expan sion of existing dental teaching facilities and the construction of new schools. Although ob vious, this is an expensive course of action requiring not only the resources of the profes sion, but also the resources of public and pri vate agencies, including those of the federal government. According to the report of the Surgeon Gen eral’s Consultant Group on Medical Educa tion, confirmed by a study of a consultant committee on medical research which advised Senator Lister Hill’s Subcommittee on Appro priations, the country will need an equivalent of 22 new dental schools. The consultant group further stated that “ . . . to arrest the decline in the national ratio of dentists to population at its 1959 level will require that dental school training capacity be increased sufficiently to produce 6,180 annual graduates by 1975, or about 2,700 more than can be expected.” As of June, 1961, dental schools graduated 3,290
Present Plans for Expansion (without Federal Aid) • According to a 1961 survey conducted by the American Dental Association and the American Association of Dental Schools, 28 dental schools are now planning expansion of teaching facilities, involving some 68 million dollars during the next ten years. Approxi mately 18 of these schools are contemplating construction to be commenced within the next three years. Without federal aid, the construction now planned will provide new student places for 354 dental students, 447 dental hygiene stu dents, 380 dental assistants and 155 dental laboratory technicians. Expansion with Federal Support • In the opinion of most schools, federal aid would provide a major stimulus to needed construc tion. O f these 28 schools now planning con struction, 23 would modify these plans in some respect, either by enlarging them to undertake a more ambitious building program or by advancing or making definite the scheduled starting date. All of the 19 schools not now planning construction would, under some con ditions, undertake construction. Instead of a planned expenditure of 68 million dollars for dental school construction there would be 148 million dollars spent for that purpose. Instead of only 18 schools scheduling con struction within the next three years, there would be 39. With federal aid the construction planned will increase the number of new student places from 354 to 725 for dental students, from 447 to 915 for dental hygiene students, from 380 to 714 for dental assistants and 303 new places for dental laboratory technicians rather than 155. About half of the schools plan larger gradu ate, postgraduate and research programs, whether or not federal aid is available. With aid, nearly every school will expand these pro grams. If federal matching grants are made avail able as envisioned in the “ Health Professions Education Assistance Act,” H.R. 4999, exist ing dental schools have indicated a willing ness to undertake new construction and re modeling costing over 148 million dollars. In terms of the available and anticipated match ing funds, the schools estimate over 58 million dollars as available within five years and about 73 million dollars within the next ten years. The Association believes that the matching grant formulas as set forth in H.R. 4999 are realistic and would be fully utilized when these funds become available.
REPORTS O F C O U N C IL S A N D B U R EA U S .
SC H O LA R SH IPS FOR DENTAL STUDENTS
Cost of Financing a Dental Education • An other, but no less important, factor in provid ing adequate dental care of the public, is the cost of dental education to the individual stu dents. Dental education is, without question, the most expensive of the professional disci plines from the standpoint of student finances. Undoubtedly this fact contributes to the fail ure of many promising students from lower and middle income families to enter dentistry. Both the profession and public vitally need these students and the public interest is not well served if the profession is unable to secure them. At the present time, the average cost to students of a four year dental education is $15,043. This can be broken down into school expenses of $5,824 and average living expenses of $9,219. The figures are slightly higher for students in private dental schools. For the mar ried dental student, and an ever increasing number o f dental students are married, the average cost of a dental education is over $ 18,000; if he attends a private dental school, this figure rises to over $19,000. Present Scholarship and other Financial As sistance to Dental Students • The 1961 Survey of Financial Aid for Dental Education reveals some startling figures with respect to students receiving aid from their schools. It is estimated that 91 per cent of all dental students do not receive any scholarship aid. This is an insignifi cant improvement over the years 1953-54 when 92 per cent did not receive scholarships. More than three fourths of the dental students do not receive school loans (76 per cent). The average amount received in scholarships (among those who receive scholarships), is $480, and the average amount received in loans is $627. Significantly, only 5 per cent of the freshmen in dental schools receive scholar ships and only 8 per cent receive loans. Need for a Federal Scholarship Program for Dental Students • As nearly as can be deter mined, only about 40 per cent of the dental students are able to pay for their own educa tion through a combination of personal sav ings, parental assistance and help from rela tives and friends. For the remaining 60 per cent, some financial aid is needed. In 1960-61, dental schools received scholar ship requests from 12 per cent of their stu dents. The students requested $809,547 and approximately $580,000 was awarded in schol arships. Twenty-seven per cent of the students requested 2.6 million dollars in loans and only
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slightly over 2 million dollars was awarded. Although a large percentage of the students who requested scholarships were awarded them (75 per cent), the amounts awarded were obviously inadequate. Further, there is no way of recording the number of competent and needy students who did not apply for scholar ships or loans because they knew that none were available. Relatively few schools have uncommitted loan funds in any volume. At the time of the 1961 Survey on Financial Aid for Dental Edu cation, 14 schools said they had no uncom mitted loan funds and another 22 reported that the funds on hand amounted to less than $10,000. Actually, there were 11 schools which held almost 80 per cent of all uncommitted funds. The profession is vitally concerned with the public need for an adequate supply of dentists. One of the major deterrents encountered in the recruitment o f dental students is the high cost of dental education for some and the prohibitive cost for others. There is plainly an ever increasing need for funds to provide scholarships so that able and qualified students are not prevented, for financial reasons, from selecting dentistry as a profession. Through both private and public programs, a part of the need for financial assistance to dental students is now met with student loans. Monies available under the National Defense Education Act probably represent the major new source of loan aid, providing help to 12 per cent of the total student body in 1961. The Association agrees that loan funds are essen tial and needed in dental education, but it observes also, that indebtedness of dental stu dents at the outset of a professional career is formidable. For example, dental students must invest from $7,000 to $10,000 to equip an operatory. This cost of equipment, unequaled by the other professions, is usually financed as a commercial loan by the new graduate and more often than not, such a loan is in curred in addition to existing indebtedness for professional education. Therefore, in the Association’s view, it is preferable that greatly increased scholarship funds be made available so that dental stu dents are not overburdened with debt at the outset of their professional careers. Although the profession now has available both loans and scholarship funds for needy and qualified dental students, it is evident that the present volume of these funds is insuffi cient to bring into the profession the number of qualified students required to meet the fu ture dental manpower needs of the nation. Therefore, the Association views as urgent, a federal scholarship assistance program for dental students as outlined in H.R. 4999.
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COST OF EDUCATION PAYM EN TS TO T H E SCHOOLS
Cost of Educating a Dental Student • Educat ing dental students costs much more than the schools receive from tuition charges paid by students. On the average, the dental student contributes in tuition only 29 per cent of the cost of educating him. In private schools, the average is 41 per cent and in the public schools, it is only 16 per cent. Although tuition costs have increased in the past ten years, a dental student ten years ago contributed ap proximately one third of the cost of his educa tion, a generation ago, he contributed almost half. The cost of the regular education programs of the schools is now almost ri/ i times what it was ten years ago. Approximately 38.5 million dollars is now being spent in support of the regular programs, as compared with 15.7 million dollars in 1949-1950. Now, how ever, only 73 per cent of these costs are met by the dental schools out of their own budgeted funds, whereas ten years ago, the schools met 88 per cent of their own expenses. Today, the annual cost of educating more than 13,000 dental students is 44.5 million dollars. As recently as 1955, the annual cost for 45 dental schools was 32 million dollars. If we translate these figures to average cost per student, today’s cost for dental schools is about $3,000 per student, whereas the 1955 cost was about $2,500 per student. We must expect this cost per student to continue to increase. Assistance Needed by the Dental Schools • The answer cannot, in fairness or in terms of our democratic goals, be an excessive increase in tuition charges aimed to meet full educa tional costs. This would, in our opinion, have two obviously unfortunate results. With tui tion charges increased from about $3,000 to $5,000 a year, the number of dental students would be diminished to perhaps a quarter of today’s enrollment. Additionally, the source of students would necessarily be that very small segment o f society with extremely high income. These consequences must not occur. We want to keep tuition cost for dental edu cation at a reasonable level so that all those with a dedication for dentistry who have the ability to fulfill the rigid education require ments will not be deterred from seeking a dental education for financial reasons. The position of the American Dental Associ ation is, as it has been in the past, in favor of dental grants-in-aid for dental education. Association witnesses have supported proposals similar to H.R. 4999 at Congressional hearings
at least five times since 1950. It should be noted that the Commission on the Survey of Dentistry comments favorably on this realistic attitude o f the dental profession through its national Association. The Commission on the Survey of Dentistry also compiled information on the attitude of those university presidents having dental schools within their purview and the deans of the dental schools on accepting federal funds to support their dental schools and programs. The Commission reports that the majority of university presidents favor such support. Likewise, the dental school deans endorse fed eral aid. CONCLUSION
The legislation to which we are addressing our comments, namely H.R. 4999, would provide annually for ten years 15 million dollars in grants on a matching basis for construction of new dental teaching facilities and 15 million dollars in matching grants for replacement or rehabilitation of existing teaching facilities in schools of dentistry, medicine and public health. The American Dental Association strongly supports this much needed federal aid. H.R. 4999 also includes provisions for scholarship grants to dental schools to be allo cated to dental students in a manner which seems eminently reasonable to the American Dental Association. In addition to the schol arship grants, there would be cost o f education payments to the schools to make up the deficit between the scholarship grants and the actual cost to the schools for educating students re ceiving those scholarships. The Association favors the utilization o f federal funds for this purpose, provided such aid does not affect admission policies of the schools or the content of the curriculum. The Association also supports the provision of H.R. 4999 which would strengthen and expand the program for grants to assist in the construction of health research facilities. The American Dental Association reaffirms its recommendation that this committee report favorably on H.R. 4999. APPENDIX
I. Medical School Inquiry, Staff Report to the Committee on Interstate and Foreign Commerce, House of Representatives, Eightyfifth Congress, First Session (Committee Print). 2. U.S. Department of Health, Education, and Welfare, Office of the Secretary. “ The Advancement of Medical Research and Edu cation Through the Department of Healthj
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Education, and Welfare: Final Report of the Secretary’s Consultants on Medical Research and Education, 1958” (The Bayne-Jones Re port). 3. U.S. Department of Health, Education, and Welfare, Public Health Service. “ Physi cians for a Growing America: Report of the Surgeon General’s Consultant Group on Medi cal Education, 1959” (The Bane Report). 4. Subcommittee on Departments of Labor,
Health, Education, and Welfare, of the Com mittee on Appropriations, United States Sen ate (86th Congress: Second Session). “ Federal Support of Medical Research: Report o f the Committee of Consultants on Medical Re search,” 1960. 5. American Council on Education, Com mission on the Survey of Dentistry in the United States, “ The Survey of Dentistry,” 1961.
A dditions to the Library
BUREAU OF LIBRARY AND INDEXING SERVICE
The books listed here have been added recently to the Bureau collection. Re quests for this material, available on loan to all members of the Association, should be addressed to the Bureau of Library and Indexing Service. There is no charge for borrowing books, but there is a mini mal charge of one dollar ($1.00) for each package library. Illinois residents add 4 per cent Retailers Use Tax. (This applies also to the purchase of books.) Practically all the dental journals pub lished in the world at present are avail able to members on loan. Lists of books, package libraries and journals are avail able on request. BOOKS A l d o u s , J. A . A radiographic method to study
the absorption of a radiopaque solution from an injection site. (M . S. thesis— Northwest ern University.) Chicago, 1961. Typewrit ten. On microfilm only. A m e r i c a n D e n t a l A s s o c i a t i o n . A manual for component dental societies. [Chicago, 1962] 47 p.
A m e r ic a n
D e n t a l A s s o c ia t io n .
B u rea u
o f
American dental directory, 1962. Chicago, 1962. 1,276 p. $15. M e m b e r s h ip
A m e r ic a n
R ecords.
D en ta l
A s s o c ia t io n .
C o u n c il
Accepted d e n tal r e m e d i e s ; drugs used in dental p r a c t i c e including a lis t of b r a n d s accepted b y t h e C o u n c i l on Dental T h e r a p e u t i c s of t h e American Dental Association. 27th ed. C h i cago, 1962. 235 p. $3. D ’ A m i c o , A n g e l o . The canine teeth; normal functional relation of the natural teeth of man. Stockton, Cal., The Author, [1958, cl955 and 1957] 74 p. Reprinted from the Journal of the Southern California State Dental Association, Vol. 26, 1958. D i e t z , D . R. A histologic study of the effects of formocresol on normal primary pulpal tissue. (M . S. thesis— University of Wash ington.) [Seattle] 1961. 55 p. Typewritten. On microfilm only. T h e D o c t o r ’ s T a x L e t t e r . Tax handbook for medical men, 1962. Chicago, 1962. 38 p. $2.50. D o u b , R. G. The relationship of the mandibu lar central incisor to its supporting tissues in Class I and Class II, division 1 maloc clusions. (M . S. thesis— University of Ten nessee.) [Memphis] 1961. 69 p. Typewritten. on
D e n t a l T h e r a p e u t ic s .