- Email: [email protected]
Report from the Washington Office
HIGHLIGHTS EMPHASIS ON PREVENTION... The emphasis is on prevention in this issue. Five special contributions deal with this topic, beginning with a program for high school students (p 86) and concluding with a report of programs that have won the ADA Preventive Dentistry Award (p 105) . There also are several scientific articles related to oral health. An editorial on page 12 stresses the importance of prevention rather than promotion.
Life membership applications T h e ADA B u re a u of Data P ro ce ssin g S ervices and M e m b e rs h ip R e co rd s is a c c e p tin g life m e m b e r s h ip a p p lic a tio n s and re tired m em b e rs h ip a ffid a v its . A c c o rd in g to th e A s s o c ia tio n B ylaw s “ an a c tiv e m e m b e r in g o o d s ta n d in g w h o has been an a ctive m e m b e rin g o o d s ta n d in g fo rth irty f iv e (35) c o n s e c u tiv e y e a rs o r a to ta l o f fo r ty (40) years o f active m e m b e r s h ip , h a vin g a tta in e d th e age o f s ix ty -fiv e (65) years may be classi fie d as a life m e m b e r up on a p p li c a tio n to th e E xecutive D ire c to ra n d u p o n p ro o f o f q u a lific a tio n ." A p p lic a tio n s can b e o b ta in e d fro m
th e AD A B ureau o f Data P roce ssin g S e rv ic e s and M e m b e rs h ip R ecords, 211 E C h ic a g o A v e , C h ica g o , 60611. As to re tire d m e m b e rsh ip , the B ylaw s s ta te th a t “ an a ctive m e m ber in g o o d stand ing w h o has been an a c tiv e m e m b e r fo r tw e n ty -fiv e (25) years o r m o re, and is n o w a retired m e m b e r o f his c o n s titu e n t society, if su c h e xists, h a vin g a tta in e d the age o f seventy (70) and n o lo n g e r e a rn in g in c o m e fro m th e p e rfo rm a n ce o f service as a m e m b e r o f the fa c u lty o f a d e n ta l s c h o o l, as a de ntal a d m in is tra to r o r c o n s u lta n t, o r as a p ra c titio n e r o f any a c tiv ity fo r w hich a lic e n s e to p ra c tic e d e n tis try o r d e n ta l h yg ie ne is re q u ire d by the
Report from the Washington Office
state, th e D is tric t o f C o lu m b ia , the C o m m o n w e a lth o f P u e rto R ico o r a d e p e n d e n cy o f th e U n ite d S tates, m ay be cla ssifie d as a re tire d m e m b e r u p o n a p p lic a tio n to th e E xe cu tive D ire c to r and u p o n p ro o f o f q u a lifi c a tio n .” A ffid a v its can be o b ta in e d fro m th e in d iv id u a ls ’ lo cal society. If you m eet a ll re q u ire m e n ts fo r life m e m b e rsh ip o r re tire d m e m b e r sh ip in th e c a le n d a r year 1974 p lease s u b m it th e necessary life m e m b e r sh ip a p p lic a tio n o r re tire d m e m b e r s h ip a ffid a v itto th e B ure au o f Data P roce ssin g S ervices and M e m b e r sh ip R ecords at th e e a rlie st p o ssib le tim e .
troduced. Four views on future fed eral support, as expressed in legis lation, are presented here. HR 14930 (Administration)
HEALTH MANPOWER LEGISLATION The expiration of the Compre hensive Health Manpower Training Act on June 30 has increased the pressure on Congress to pass new health manpower legislation. Agree ment on a final measure, however, could be delayed for several months because of the major differences among the bills that have been in
A stated objective of this bill is "to translate into legislation the health manpower themes of the presi dent's budget for fiscal year 1975." In view of the significant reductions proposed in that budget, HR 14930 has apparently met its intended ob jective. Further amplification of the administration's approach to health professions education was pro vided by Dr. Charles Edwards, HEW assistant secretary for health, in testimony before the House subcom mittee on health. "We should not expect more from our training insti tutions than they can deliver. Ac cordingly, we should not support them for things they cannot accom plish." Dr.Edwards also contended that health manpower education pro grams have not been successful in
addressing issues beyond that of in creasing aggregate numbers of gradu ates . The existing program of capita tion grant support would be phased out within three years. Medical, dental, and osteopathic schools would receive $1,500 per student for fiscal 1975, $1,250 for fiscal 1976, and $1,000 per student in fiscal 1977. This compares with the current authorization of $2,500 for each full-time student plus $4,000 for each graduate. The $50,000 bonus for "small schools" would lapse as would incentives for three-year graduates. It would not, however, be necessary for dental and other health professions schools to accept addition al students in order to qualify for this reduced capitation grant support. Capitation grants are viewed by the administration as an "unnecessary sub sidy of health professions students." Citing the annual income of physicians as an example, the administration's House testimony stated that "health professions students can and should be called upon to assume an increasing share of their educational costs." Construction grants would not be continued under HR 14930. Future fed eral assistance for construction would be limited to a program of guaranteed loans for the remodeling or replace ment of existing teaching facilities. Scholarship support would be linked to a revised and expanded Na tional Health Service Corps in an effort to address the problem of geographic distribution. The administration's fiscal 1975 budget requests $22.5 mil lion for this authority to support an estimated 2,000 health professions students. Federal capital contribu tions to the student loan program would be limited to the amount necessary to continue existing commitments. New student loans would be made from amounts that are repaid and revolve back into a school's loan fund. Special Project Grants and the program of Health Manpower Education Initiative Awards would be consolidated into a single authority and expanded to include nursing, allied health, and public health. The bill would also extend financial distress grants; how-
ever, future awards to a school would be limited to 75% of the award for the previous year. HR 14721 (Rogers, D-Fla) This bill would continue many of the basic features of the existing Comprehensive Health Manpower Training Act. Title II would revise and extend the existing authority for the con struction of teaching facilities. The maximum level for student loans would be revised to equal the cost of tuition plus $2,500 per year. However, the amount of tuition reim bursement would be limited to the cost of tuition at a school in the first year the loan fund is established. HR 14721 would repeal the author ity for health professions scholarships. Although provision is made to continue payment to students currently receiving this support, all new scholarships are to be restricted to the National Health Service Corps program. The capitation grant program would be continued and significantly revised under this bill. Grant amounts would be set at a third of the average net educational expenditures for each dis cipline as determined in the Institute of Medicine cost study. (The Institute of Medicine is a quasi-governmental agency similar to the National Science Foundation and the National Research Council. The IOM's first major assign ment was a study of the actual cost borne by medical or dental schools for education of their students.) For dentistry this equals $2,475 per full time student. In order to qualify for a capitation grant, a school of den tistry would provide assurances that it will do one or more of the following: (1) increase first-year enrollment of dental students; (2) increase enroll ment of expanded duty dental auxilia ries by 25%; (3) apply for and have recommended for approval a Special Project to (a) train students from rural or disadvantaged backgrounds (b) develop or expand programs to train dental students and expanded duty auxiliary students in underserved areas, or (c) establish new programs to train expanded duty dental auxilia ries. There is no provision in the
bill allowing the secretary (HEW) to "waive" these capitation grant require ments . The authorities for Start-Up Assistance, Financial Distress, Area Health Education Centers, Computer Technology, and Family Medicine are retained in HR 14721. Special Project Grant support also would be continued. However, the number of authorized pur poses for these projects would be re duced from those in the current pro gram . HR 14357 (Roy, D-Kan) This bill is unique among the four major health manpower proposals in that it would eliminate all direct federal support to the health professions schools. Future federal assistance would be provided through higher levels of student aid to offset anticipated tuition increases. Geographic and specialty maldistribution are identified as the primary obstacle to improved health care delivery. It is contended by the bill's sponsor that health man power education and voluntary health planning have had only a minimal im pact on this problem. The solution, as proposed in HR 14357, is to channel institutional support through an ex panded program of student assistance that requires recipients to serve in a designated shortage area. Health pro fessions students would be eligible for a federal scholarship of up to $7,500 to meet increased tuition costs plus an additional sum of up to $5,000 for living and other educational ex penses. In return for this support, students would be required to serve in the National Health Service Corps for a period of six months for each one year of assistance. S 3585 (Kennedy, D-Mass) As the fourth major bill to be introduced, this proposal contains many of the features included in the measures discussed earlier. It is similar to HR 14357 in linking support for education to redistribution of health manpower. Unlike that bill, however, basic institutional support to the health professions schools would be continued. Capitation grant
support under S 3585 would be author ized at a third of the Institute of Medicine's net educational cost levels. A new provision would be added, how ever, that requires each eligible school to provide assurances to the secretary (HEW) that each student ac cepted for enrollment has agreed to serve in the National Health Service Corps or in an underserved area as a private practitioner for a period of two years. In order to avoid the problem of an oversupply of graduates obligated to serve, the Department of HEW would be authorized to establish a random selection process similar to the former military draft lottery. Eligibility for a capitation grant award also would require a dental school to either (1) increase the num ber of first-year dental students as provided in the current law, or (2) increase the enrollment of expanded duty dental auxiliary students by 25%. The secretary is authorized to waive these requirements on notification by the appropriate accrediting body that they would lower a school's accredita tion status. The authorities for construction grants. Special Project Grants, StartUp Assistance, and Area Health Educa tion Centers would be continued and revised under S 3585. Student loans would be authorized at levels similar to that proposed in HR 14721. All students who receive a loan, however, would be obligated to serve in an underserved area for two years. The financial distress grant program would be terminated, as would be the health professions scholarship authority. All new scholarship assistance would be provided through the National Health Service Corps scholarship program. The most controversial provision in this bill is the requirement that the secretary (HEW) develop a national licensure program for dentists and physicians that provides for minimum national standards, initial examina tions, reexaminations within six years, reciprocity, and new requirements for graduates of foreign medical and dental schools. States would be prohibited from establishing licensure require ments "not consistent with national standards."
Life membership applications T h e ADA B u re a u of Data P ro ce ssin g S ervices and M e m b e rs h ip R e co rd s is a c c e p tin g life m e m b e r s h ip a p p lic a tio n s and re tired m em b e rs h ip a ffid a v its . A c c o rd in g to th e A s s o c ia tio n B ylaw s “ an a c tiv e m e m b e r in g o o d s ta n d in g w h o has been an a ctive m e m b e rin g o o d s ta n d in g fo rth irty f iv e (35) c o n s e c u tiv e y e a rs o r a to ta l o f fo r ty (40) years o f active m e m b e r s h ip , h a vin g a tta in e d th e age o f s ix ty -fiv e (65) years may be classi fie d as a life m e m b e r up on a p p li c a tio n to th e E xecutive D ire c to ra n d u p o n p ro o f o f q u a lific a tio n ." A p p lic a tio n s can b e o b ta in e d fro m
th e AD A B ureau o f Data P roce ssin g S e rv ic e s and M e m b e rs h ip R ecords, 211 E C h ic a g o A v e , C h ica g o , 60611. As to re tire d m e m b e rsh ip , the B ylaw s s ta te th a t “ an a ctive m e m ber in g o o d stand ing w h o has been an a c tiv e m e m b e r fo r tw e n ty -fiv e (25) years o r m o re, and is n o w a retired m e m b e r o f his c o n s titu e n t society, if su c h e xists, h a vin g a tta in e d the age o f seventy (70) and n o lo n g e r e a rn in g in c o m e fro m th e p e rfo rm a n ce o f service as a m e m b e r o f the fa c u lty o f a d e n ta l s c h o o l, as a de ntal a d m in is tra to r o r c o n s u lta n t, o r as a p ra c titio n e r o f any a c tiv ity fo r w hich a lic e n s e to p ra c tic e d e n tis try o r d e n ta l h yg ie ne is re q u ire d by the
Report from the Washington Office
state, th e D is tric t o f C o lu m b ia , the C o m m o n w e a lth o f P u e rto R ico o r a d e p e n d e n cy o f th e U n ite d S tates, m ay be cla ssifie d as a re tire d m e m b e r u p o n a p p lic a tio n to th e E xe cu tive D ire c to r and u p o n p ro o f o f q u a lifi c a tio n .” A ffid a v its can be o b ta in e d fro m th e in d iv id u a ls ’ lo cal society. If you m eet a ll re q u ire m e n ts fo r life m e m b e rsh ip o r re tire d m e m b e r sh ip in th e c a le n d a r year 1974 p lease s u b m it th e necessary life m e m b e r sh ip a p p lic a tio n o r re tire d m e m b e r s h ip a ffid a v itto th e B ure au o f Data P roce ssin g S ervices and M e m b e r sh ip R ecords at th e e a rlie st p o ssib le tim e .
troduced. Four views on future fed eral support, as expressed in legis lation, are presented here. HR 14930 (Administration)
HEALTH MANPOWER LEGISLATION The expiration of the Compre hensive Health Manpower Training Act on June 30 has increased the pressure on Congress to pass new health manpower legislation. Agree ment on a final measure, however, could be delayed for several months because of the major differences among the bills that have been in
A stated objective of this bill is "to translate into legislation the health manpower themes of the presi dent's budget for fiscal year 1975." In view of the significant reductions proposed in that budget, HR 14930 has apparently met its intended ob jective. Further amplification of the administration's approach to health professions education was pro vided by Dr. Charles Edwards, HEW assistant secretary for health, in testimony before the House subcom mittee on health. "We should not expect more from our training insti tutions than they can deliver. Ac cordingly, we should not support them for things they cannot accom plish." Dr.Edwards also contended that health manpower education pro grams have not been successful in
addressing issues beyond that of in creasing aggregate numbers of gradu ates . The existing program of capita tion grant support would be phased out within three years. Medical, dental, and osteopathic schools would receive $1,500 per student for fiscal 1975, $1,250 for fiscal 1976, and $1,000 per student in fiscal 1977. This compares with the current authorization of $2,500 for each full-time student plus $4,000 for each graduate. The $50,000 bonus for "small schools" would lapse as would incentives for three-year graduates. It would not, however, be necessary for dental and other health professions schools to accept addition al students in order to qualify for this reduced capitation grant support. Capitation grants are viewed by the administration as an "unnecessary sub sidy of health professions students." Citing the annual income of physicians as an example, the administration's House testimony stated that "health professions students can and should be called upon to assume an increasing share of their educational costs." Construction grants would not be continued under HR 14930. Future fed eral assistance for construction would be limited to a program of guaranteed loans for the remodeling or replace ment of existing teaching facilities. Scholarship support would be linked to a revised and expanded Na tional Health Service Corps in an effort to address the problem of geographic distribution. The administration's fiscal 1975 budget requests $22.5 mil lion for this authority to support an estimated 2,000 health professions students. Federal capital contribu tions to the student loan program would be limited to the amount necessary to continue existing commitments. New student loans would be made from amounts that are repaid and revolve back into a school's loan fund. Special Project Grants and the program of Health Manpower Education Initiative Awards would be consolidated into a single authority and expanded to include nursing, allied health, and public health. The bill would also extend financial distress grants; how-
ever, future awards to a school would be limited to 75% of the award for the previous year. HR 14721 (Rogers, D-Fla) This bill would continue many of the basic features of the existing Comprehensive Health Manpower Training Act. Title II would revise and extend the existing authority for the con struction of teaching facilities. The maximum level for student loans would be revised to equal the cost of tuition plus $2,500 per year. However, the amount of tuition reim bursement would be limited to the cost of tuition at a school in the first year the loan fund is established. HR 14721 would repeal the author ity for health professions scholarships. Although provision is made to continue payment to students currently receiving this support, all new scholarships are to be restricted to the National Health Service Corps program. The capitation grant program would be continued and significantly revised under this bill. Grant amounts would be set at a third of the average net educational expenditures for each dis cipline as determined in the Institute of Medicine cost study. (The Institute of Medicine is a quasi-governmental agency similar to the National Science Foundation and the National Research Council. The IOM's first major assign ment was a study of the actual cost borne by medical or dental schools for education of their students.) For dentistry this equals $2,475 per full time student. In order to qualify for a capitation grant, a school of den tistry would provide assurances that it will do one or more of the following: (1) increase first-year enrollment of dental students; (2) increase enroll ment of expanded duty dental auxilia ries by 25%; (3) apply for and have recommended for approval a Special Project to (a) train students from rural or disadvantaged backgrounds (b) develop or expand programs to train dental students and expanded duty auxiliary students in underserved areas, or (c) establish new programs to train expanded duty dental auxilia ries. There is no provision in the
bill allowing the secretary (HEW) to "waive" these capitation grant require ments . The authorities for Start-Up Assistance, Financial Distress, Area Health Education Centers, Computer Technology, and Family Medicine are retained in HR 14721. Special Project Grant support also would be continued. However, the number of authorized pur poses for these projects would be re duced from those in the current pro gram . HR 14357 (Roy, D-Kan) This bill is unique among the four major health manpower proposals in that it would eliminate all direct federal support to the health professions schools. Future federal assistance would be provided through higher levels of student aid to offset anticipated tuition increases. Geographic and specialty maldistribution are identified as the primary obstacle to improved health care delivery. It is contended by the bill's sponsor that health man power education and voluntary health planning have had only a minimal im pact on this problem. The solution, as proposed in HR 14357, is to channel institutional support through an ex panded program of student assistance that requires recipients to serve in a designated shortage area. Health pro fessions students would be eligible for a federal scholarship of up to $7,500 to meet increased tuition costs plus an additional sum of up to $5,000 for living and other educational ex penses. In return for this support, students would be required to serve in the National Health Service Corps for a period of six months for each one year of assistance. S 3585 (Kennedy, D-Mass) As the fourth major bill to be introduced, this proposal contains many of the features included in the measures discussed earlier. It is similar to HR 14357 in linking support for education to redistribution of health manpower. Unlike that bill, however, basic institutional support to the health professions schools would be continued. Capitation grant
support under S 3585 would be author ized at a third of the Institute of Medicine's net educational cost levels. A new provision would be added, how ever, that requires each eligible school to provide assurances to the secretary (HEW) that each student ac cepted for enrollment has agreed to serve in the National Health Service Corps or in an underserved area as a private practitioner for a period of two years. In order to avoid the problem of an oversupply of graduates obligated to serve, the Department of HEW would be authorized to establish a random selection process similar to the former military draft lottery. Eligibility for a capitation grant award also would require a dental school to either (1) increase the num ber of first-year dental students as provided in the current law, or (2) increase the enrollment of expanded duty dental auxiliary students by 25%. The secretary is authorized to waive these requirements on notification by the appropriate accrediting body that they would lower a school's accredita tion status. The authorities for construction grants. Special Project Grants, StartUp Assistance, and Area Health Educa tion Centers would be continued and revised under S 3585. Student loans would be authorized at levels similar to that proposed in HR 14721. All students who receive a loan, however, would be obligated to serve in an underserved area for two years. The financial distress grant program would be terminated, as would be the health professions scholarship authority. All new scholarship assistance would be provided through the National Health Service Corps scholarship program. The most controversial provision in this bill is the requirement that the secretary (HEW) develop a national licensure program for dentists and physicians that provides for minimum national standards, initial examina tions, reexaminations within six years, reciprocity, and new requirements for graduates of foreign medical and dental schools. States would be prohibited from establishing licensure require ments "not consistent with national standards."