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The need for new health professions
The need for new health professions
Thomas C. Points, M D , PhD
There is a dictum in mathematics that, “one can only find a solution to a problem if one has a clear statement of what the problem is.” This should be our approach in the difficult area of medical and health manpower. The following is a “semiquote”“Why is our health care system in trouble? Today there are some 350,000 physicians in the country - one for about 750 people. This is expected to worsen. An estimated 52,000 more must be educated and trained to provide enough qualified physicians to service the continuous soaring of the ~~
Thomas C. Points, M D , PhD, i s deputy assistant secretary for health services, Department of Health, Education and Welfare, Washington,
DC. H e was
educated a t Oklahoma University, Oklahoma City, and has experience as a member of the faculty there in the school of medicine. Dr. Points is a member of various professional associations and societies, including the American Medical
Association’s
Council
on
Health
Man-
power. O n this council, he has served as chairman of the Committee on Emerging Health Manpower and the Physician’s Assistant.
June 1972
demand. The effects of the physician, and other health manpower shortages, may be compounded by a lack of sound management in the healthcare systems and hospitals. We’ve got to arrange things so we don’t have professionals using up their time on similar jobs which can be handled by persons of relatively lower skill levels. The specialist should be used on the tough jobs. The consumer will ultimately pay the bill for this shortage. A uniform quality of service must be made.” Remember I said this was a “semiquote.” It is not a direct quote, because I changed the subject words.
This was from the September 1969 Reader‘s Digest article, “Behind the high cost of auto repairs.” The terms “physicians” and “health workers” were substituted for “mechanics.” So, really, the health field is not the only segment of our iives with problems; but people, and in turn political leaders, tend to become emo-
151
tional when they talk about high cost, poor, or nonexistent health services. To me the word “new” in “the need for new health professions” has two meanings: 1) more people as professionals in the health occupations which now exist; and 2) categories of health-care-provider professionals whose work involves entirely different functions from those now in existence.
The opportunity is excellent for the medical profession, through its professional organization, the American Medical Association, to make more health services available to the American public. The AMA has been actively supporting and encouraging the production of additions to the existing categories of health manpower. They also have been providing some support and professional direction from innovation and experimentation in developing new categories of health manpower. Perhaps the importance of these new health professionals can best be explored by a review of three topics:
1. What casual factor or factors created the need for new health professionals? 2. What are the critical issues in the development of new health professionals?
3. How do the present experimental projects approach the engineering of new professionals? Let’s begin with the first question. The increased demand for health services has resulted from: 1) an expanded population which requires services; 2) increased available dol-
152
lars to buy services; 3) an increased propensity to consume services; 4) a more enlightened consumer to ask for services; 5) an increased effective demand for physician services at a time when the nation’s medical schools have not been able to significantly increase their output of physician graduates; and numbers of other factors. In dealing with the increased propensity of the consumer to purchase health services, I think of those routine services of the “worried well” type opposed to the “early sick.” As incomes have grown through wage agreements, some sectors of the population have not only received dollars available to buy services, but an increasing percentage of these consumers’ total income is being spent for health services. At the other end of the income spectrum, the welfare recipients have been made more aware of health services, whether paid directly by themselves or through an agency. Due to the headlines on the marvels of present day medical care and even the run-of-the-mill every day health problems, there is definitely a more enlightened public, asking for more health services. Where this
quest is coupled with dollars, there is effective demand for health services which turns into increased demands for new health professionals! A need for new health professionals also results from the existence of
factors restricting the supply of health services. These restrictions on the supply side have a direct impact on the required number and types of new health professionals. Three important supply factors are: 1)the in-
AORN Journal
creasing specialties in medicine resulting in the creation of new products of medical education institutions; 2) the unequal distribution of physicians in the United States; and 3) the seemingly unnecessary duplication of medical equipment. Why has the medical profession gotten into this situation? There are several postulations. The career paths for both physicians and health related professions h a v e followed parallel primrose paths, but on opposite sides of the mountain. Neither group has bothered to look at what was happening to the other until they met common chasms.
First let us look at the physician’s path. He graduated from a medical school, hung up his shingle and began to take care of people. It wasn’t long until it was a common belief that an MD degree really didn’t provide enough education and training for a physician to be turned loose on the public. Thus, a general rotating internship was instituted for the physician before he could be allowed to work on his profession. As these physicians practiced, they developed an interest and/or competence in one area of medicine. However, they persisted in the overall practice of medicine. Subsequently, several physicians with this common interest began visiting with one another, then they bonded together into society. Their stated motivation in such a move was to “improve standards;” but the suspected real reason was to gain prestige. Those MDs who followed the initial charter members were forbidden, by the “grandfather clause,” to
154
join this select group until they had served a long enough apprenticeship under a “grandfather” and had achieved enough prestige to be judged competent by their peers. When this belief became widespread and hospital staffs really organized along jurisdictional lines, the various groups or societies said to all other physicians, “stay out of my domain.” Before long, prescribed residency training programs were established and accredited. . In the beginning, these were created for one or two years, then four years, then some for five and the real super-duper ones, six years of eternity. All the while the one physician whom most people related to has been shoved out. A new concept of family physician has developed, but even this requires three years of academic preparation after the MD degree is earned. Why give a degree at the point in time if the knowledge gained in obtaining it is unusable? Possibly our m e d i c a 1 educational institutions should hold off providing a degree until the residency is finished and the candidate judged by his peers. Then a doctoral degree might be conferred in the specialty rather than as a doctor of medicine degree. Of course, we physicians desire to create in our own image, and even attempt to improve on the mold, but are we accomplishing our mission or destroying it? Could it be that our educational institutions are really falling down on their jobs if they have not been able to educate and train a person until after four years of premed, four years of medical school, and three years of residency?
AORN Journal
IS all this education necessary to look after most of the ills of the POPulation? Or should a baccalaureate graduate of a physicians’ assistant program, nursing, or one equal to the independent duty of military corpsman do this essential primary care?
of the nursing profession, the biomedical technician, who, it is pRdicted, will in time replace the nurses in these units. Therefore, nurses, like general practitioners of medicine, have been relegated to less and less stature. In reality there are the ones who have related to the people in time of need. They are trained professionals the public knows.
Two years ago, the personnel director of a large corporation sitting as an advisor to a vocational technical education program stated, “When, oh when, are you educators going to produce the type of workers that are needed, instead of those you want to produce?” Perhaps the same thing can be said to the medical profession and educators.
Now that we have explained some of the causal factors which created the need for new health professionals, the next step is to examine the critical issues which influence the development of these new health professions.
I said earlier that physicians and the health-related professions have followed parallel paths, so let’s see what happened on the other side of the mountain. There were the nurses, the original physicians’ assistants, whether in the office or the hospital.
The critical issues will vary, depending upon the specific health occupation, but there are some common areas of concern which confront the development of any new health profession.
Some of these professionals spent part of their time taking the x-rays, another group spent part-time doing urinalyses, blood counts and chemistries. Another group spent part of their time exercising the patient and trying to assist the physician in rehabilitation. Later these different g r o u p s banded together with their fellow enthusiasts. They decided that the person working in the medical laboratory really didn’t need to go through nurse’s training but they did need four years of college. The x-ray technologists, physical therapists, and others decided the same course of action. In recent years, nurses have been the mainstay for the coronary and intensive care units of hospitals, but now there is developing outside
156
Broadly speaking, there are three steps for the development of a new health profession: 1) the recognition of the potential necessity for an emerging profession versus the expansion of an existing profession; 2) the achievement by an emerging health profession of medical professional support and direction which establishes a viable relationship of the new profession to existing health occupations; and 3) the documentation of an emerging health profession in accordance with the substantive issues raised by the AMA Guidelines for Development of Health Occupations. In doing this it has shown that there is a need to develop an empirically-derived job description, a system of medical supervision, and
AORN Journal
an understanding of the limits of functions for a new health profession. The need for such a profession requires a definition of the employment setting, projected numbers which can reasonably be employed in the profession, and determination of consumer acceptance of the health services provided by a new profession. Realistic education and training requirements need to be established along with a realistic salary potential based upon economic studies. The amount of compensation, opportunities for advancement, location of employment, provisions for career, education and geographic mobility need to be determined. Eksential are employment opportun ities which guarantee that people will be prepared for professions and jobs which really exist. Why train people who won’t be employable just because you want to train another body? Currently there are several physician’s assistant programs which can be examined to give some insight into this category of professionals. There are programs such as the Physician’s Assistant Program a t Duke University, the MEDEX Program at the University of Washington, the Orthopedic Assistant Program of the American Academy of Orthopedic Surgeons, and others. All of these programs are being assessed along the AMA Guidelines for Development of New Health Professions and from them some hard facts so an assessment of further will efforts along these lines won’t falter or become chaotic just because the present glory name is, “physician’s assistant” and because this seems to
158
be an area where money may be available. Yes, there is a need for “new” health professionals; new in the definitions of more of what we have been having, and new in the definitions of entirely different functions based on training and education. The former of these have been talked, retalked, bashed, and based so that everyone says we need X number of physicians, K2number of nurses, and so on down the line, Larger numbers alone, however, are not the solution. One possible alternative can be lifted from the method of teacher certification. In most areas of this country, to be eligible to teach in our primary and secondary schools, one has to have a baccalaureate degree with‘ some basic requirements; that is, 50 semester hours of general education to include some hours in at least six of the following areas: English, social studies, physical education, science, mathematics, foreign language, fine arts, humanities, psychology or practical arts; p l u s required six semester hours in American history and American government. Then they must have 21 semester hours in professional education, which is learning the tools to be used in teaching, 30 hours in a particular major field of teaching, such as mathematics or science.
For certification in another subject as a minor, the graduate has to have a specific number of hours in that field also. The certification of a graduate to teach in certain fields is valid for five years and renewable on completion of three years teaching experience O r eight mnester hours of approved college credit. In addition, the teacher has to enroll and
AORN Journul
pass a specific number of credit hours during varying periods throughout the professional life. For the health workers this would begin at junior college level or baccalaureate college level. A potential health professional would take a two semester general education curriculum, one semester general science curriculum, and specialized health science with practical experience for the fourth semester. This would provide an associate degree in health sciences and a certificate to work in a specialized area of nursing, medical laboratory, x-ray, physical therapy or whatever. Should they later become disenchanted with their chosen field, they could return to the junior college for one semester of another specialized field and would gain certification in the new field of endeavor also. On the other hand, if they wished to go on up the health career ladder toward a baccalaureate degree, the credits would be transferable and then they would be required to take a specified number of additional hours in general education, more advanced health-science courses, and two semesters of specialized health sciences with practical experience. At the completion of this, the degree would be a baccalaureate in health sciences and the graduate would become eligible for certification by a state agency to perform in that special area.
they will have the basics in health sciences to progress upward to master’s and/or doctorate degrees including the MD. At all times, to retain their certification they would have to work three out of five years, plus some college hours every few years. Medical education might also look at itself. Reports have shown the high percentage of entering freshmen medical students who have completed many of the so-called basic sciences as an undergraduate. Why can’t these courses in undergraduate years be “beefed-up,” so that by the time a student receives his BS degree, he has nearly completed his basic medical s c i e n c e requirements? This could cut some time from medical education that can be utilized in serving the public. There may well need to be new health professions or realignment of old ones. This requires serious study to determine the right kinds and numbers of physicians. You can bet that where there is a vacuum of health services someone will come up with a person to provide some level of care, even if it turns out to be third or fourth class.
Later, should they desire to change fields, they would only have to take the one year of specialized health-science courses and practice in the new area.
The answers to the various approaches to physicians’ assistants are available. Much evaluation, discussion and soul-searching needs to be accomplished on such innovations before a mass program is promulgated. Otherwise, a holocaust due to poor medicine, people produced and no jobs, health services not acceptable to the public and even less acceptable to the medical profession will come out.
On the other hand, should they decide they are in a dead-end area,
Lest we forget it, if this happens, it is the physician who is the ulti-
160
AORN Journal
mate responsible person. Unless there is professional support and direction for innovation and experimentation in the emergence of new health professions, an intolerable situation can develop.
number of years of education and training? Are we utilizing the right people in their proper functions to provide care to people who do not receive it, whether it be their fault or ours?
Are our medical colleges producing the best physicians, in the necessary numbers, in the right categories needed by the public, in the optimum
There should always be questions like these, but there should be documented facts to back up any recommended innovations and changes. @
Employment education Five regional seminars on employee-employer relations in the Veterans' Administration under Executive Order 11491 are planned through July by the American Nurses' Association. Designed t o develop basic understanding of the principles of collective bargaining, especially as they pertain t o provisions of Title 38 of the United States code, the two-day seminars began last month in New York City. Subsequent seminars are scheduled June 10-11, Ambassador Hotel, Chicago: June 24-25, Mark Hopkins Hotel, Son Francisco: June 28-29, Houston Oak Hotel, Houston: and July 12-13. H o t e l Americana, Bal Harbor. Ha. The series of regional seminars sponsored by ANA is part of the Association's education program t o foster understanding of the rights of nurses in directing nursing care in a collective bargaining setting. For further information, write: Convention Manager American Nurses' Association 10 Columbus Circle New York, MY 10619
162
AORN Joumurl
Thomas C. Points, M D , PhD
There is a dictum in mathematics that, “one can only find a solution to a problem if one has a clear statement of what the problem is.” This should be our approach in the difficult area of medical and health manpower. The following is a “semiquote”“Why is our health care system in trouble? Today there are some 350,000 physicians in the country - one for about 750 people. This is expected to worsen. An estimated 52,000 more must be educated and trained to provide enough qualified physicians to service the continuous soaring of the ~~
Thomas C. Points, M D , PhD, i s deputy assistant secretary for health services, Department of Health, Education and Welfare, Washington,
DC. H e was
educated a t Oklahoma University, Oklahoma City, and has experience as a member of the faculty there in the school of medicine. Dr. Points is a member of various professional associations and societies, including the American Medical
Association’s
Council
on
Health
Man-
power. O n this council, he has served as chairman of the Committee on Emerging Health Manpower and the Physician’s Assistant.
June 1972
demand. The effects of the physician, and other health manpower shortages, may be compounded by a lack of sound management in the healthcare systems and hospitals. We’ve got to arrange things so we don’t have professionals using up their time on similar jobs which can be handled by persons of relatively lower skill levels. The specialist should be used on the tough jobs. The consumer will ultimately pay the bill for this shortage. A uniform quality of service must be made.” Remember I said this was a “semiquote.” It is not a direct quote, because I changed the subject words.
This was from the September 1969 Reader‘s Digest article, “Behind the high cost of auto repairs.” The terms “physicians” and “health workers” were substituted for “mechanics.” So, really, the health field is not the only segment of our iives with problems; but people, and in turn political leaders, tend to become emo-
151
tional when they talk about high cost, poor, or nonexistent health services. To me the word “new” in “the need for new health professions” has two meanings: 1) more people as professionals in the health occupations which now exist; and 2) categories of health-care-provider professionals whose work involves entirely different functions from those now in existence.
The opportunity is excellent for the medical profession, through its professional organization, the American Medical Association, to make more health services available to the American public. The AMA has been actively supporting and encouraging the production of additions to the existing categories of health manpower. They also have been providing some support and professional direction from innovation and experimentation in developing new categories of health manpower. Perhaps the importance of these new health professionals can best be explored by a review of three topics:
1. What casual factor or factors created the need for new health professionals? 2. What are the critical issues in the development of new health professionals?
3. How do the present experimental projects approach the engineering of new professionals? Let’s begin with the first question. The increased demand for health services has resulted from: 1) an expanded population which requires services; 2) increased available dol-
152
lars to buy services; 3) an increased propensity to consume services; 4) a more enlightened consumer to ask for services; 5) an increased effective demand for physician services at a time when the nation’s medical schools have not been able to significantly increase their output of physician graduates; and numbers of other factors. In dealing with the increased propensity of the consumer to purchase health services, I think of those routine services of the “worried well” type opposed to the “early sick.” As incomes have grown through wage agreements, some sectors of the population have not only received dollars available to buy services, but an increasing percentage of these consumers’ total income is being spent for health services. At the other end of the income spectrum, the welfare recipients have been made more aware of health services, whether paid directly by themselves or through an agency. Due to the headlines on the marvels of present day medical care and even the run-of-the-mill every day health problems, there is definitely a more enlightened public, asking for more health services. Where this
quest is coupled with dollars, there is effective demand for health services which turns into increased demands for new health professionals! A need for new health professionals also results from the existence of
factors restricting the supply of health services. These restrictions on the supply side have a direct impact on the required number and types of new health professionals. Three important supply factors are: 1)the in-
AORN Journal
creasing specialties in medicine resulting in the creation of new products of medical education institutions; 2) the unequal distribution of physicians in the United States; and 3) the seemingly unnecessary duplication of medical equipment. Why has the medical profession gotten into this situation? There are several postulations. The career paths for both physicians and health related professions h a v e followed parallel primrose paths, but on opposite sides of the mountain. Neither group has bothered to look at what was happening to the other until they met common chasms.
First let us look at the physician’s path. He graduated from a medical school, hung up his shingle and began to take care of people. It wasn’t long until it was a common belief that an MD degree really didn’t provide enough education and training for a physician to be turned loose on the public. Thus, a general rotating internship was instituted for the physician before he could be allowed to work on his profession. As these physicians practiced, they developed an interest and/or competence in one area of medicine. However, they persisted in the overall practice of medicine. Subsequently, several physicians with this common interest began visiting with one another, then they bonded together into society. Their stated motivation in such a move was to “improve standards;” but the suspected real reason was to gain prestige. Those MDs who followed the initial charter members were forbidden, by the “grandfather clause,” to
154
join this select group until they had served a long enough apprenticeship under a “grandfather” and had achieved enough prestige to be judged competent by their peers. When this belief became widespread and hospital staffs really organized along jurisdictional lines, the various groups or societies said to all other physicians, “stay out of my domain.” Before long, prescribed residency training programs were established and accredited. . In the beginning, these were created for one or two years, then four years, then some for five and the real super-duper ones, six years of eternity. All the while the one physician whom most people related to has been shoved out. A new concept of family physician has developed, but even this requires three years of academic preparation after the MD degree is earned. Why give a degree at the point in time if the knowledge gained in obtaining it is unusable? Possibly our m e d i c a 1 educational institutions should hold off providing a degree until the residency is finished and the candidate judged by his peers. Then a doctoral degree might be conferred in the specialty rather than as a doctor of medicine degree. Of course, we physicians desire to create in our own image, and even attempt to improve on the mold, but are we accomplishing our mission or destroying it? Could it be that our educational institutions are really falling down on their jobs if they have not been able to educate and train a person until after four years of premed, four years of medical school, and three years of residency?
AORN Journal
IS all this education necessary to look after most of the ills of the POPulation? Or should a baccalaureate graduate of a physicians’ assistant program, nursing, or one equal to the independent duty of military corpsman do this essential primary care?
of the nursing profession, the biomedical technician, who, it is pRdicted, will in time replace the nurses in these units. Therefore, nurses, like general practitioners of medicine, have been relegated to less and less stature. In reality there are the ones who have related to the people in time of need. They are trained professionals the public knows.
Two years ago, the personnel director of a large corporation sitting as an advisor to a vocational technical education program stated, “When, oh when, are you educators going to produce the type of workers that are needed, instead of those you want to produce?” Perhaps the same thing can be said to the medical profession and educators.
Now that we have explained some of the causal factors which created the need for new health professionals, the next step is to examine the critical issues which influence the development of these new health professions.
I said earlier that physicians and the health-related professions have followed parallel paths, so let’s see what happened on the other side of the mountain. There were the nurses, the original physicians’ assistants, whether in the office or the hospital.
The critical issues will vary, depending upon the specific health occupation, but there are some common areas of concern which confront the development of any new health profession.
Some of these professionals spent part of their time taking the x-rays, another group spent part-time doing urinalyses, blood counts and chemistries. Another group spent part of their time exercising the patient and trying to assist the physician in rehabilitation. Later these different g r o u p s banded together with their fellow enthusiasts. They decided that the person working in the medical laboratory really didn’t need to go through nurse’s training but they did need four years of college. The x-ray technologists, physical therapists, and others decided the same course of action. In recent years, nurses have been the mainstay for the coronary and intensive care units of hospitals, but now there is developing outside
156
Broadly speaking, there are three steps for the development of a new health profession: 1) the recognition of the potential necessity for an emerging profession versus the expansion of an existing profession; 2) the achievement by an emerging health profession of medical professional support and direction which establishes a viable relationship of the new profession to existing health occupations; and 3) the documentation of an emerging health profession in accordance with the substantive issues raised by the AMA Guidelines for Development of Health Occupations. In doing this it has shown that there is a need to develop an empirically-derived job description, a system of medical supervision, and
AORN Journal
an understanding of the limits of functions for a new health profession. The need for such a profession requires a definition of the employment setting, projected numbers which can reasonably be employed in the profession, and determination of consumer acceptance of the health services provided by a new profession. Realistic education and training requirements need to be established along with a realistic salary potential based upon economic studies. The amount of compensation, opportunities for advancement, location of employment, provisions for career, education and geographic mobility need to be determined. Eksential are employment opportun ities which guarantee that people will be prepared for professions and jobs which really exist. Why train people who won’t be employable just because you want to train another body? Currently there are several physician’s assistant programs which can be examined to give some insight into this category of professionals. There are programs such as the Physician’s Assistant Program a t Duke University, the MEDEX Program at the University of Washington, the Orthopedic Assistant Program of the American Academy of Orthopedic Surgeons, and others. All of these programs are being assessed along the AMA Guidelines for Development of New Health Professions and from them some hard facts so an assessment of further will efforts along these lines won’t falter or become chaotic just because the present glory name is, “physician’s assistant” and because this seems to
158
be an area where money may be available. Yes, there is a need for “new” health professionals; new in the definitions of more of what we have been having, and new in the definitions of entirely different functions based on training and education. The former of these have been talked, retalked, bashed, and based so that everyone says we need X number of physicians, K2number of nurses, and so on down the line, Larger numbers alone, however, are not the solution. One possible alternative can be lifted from the method of teacher certification. In most areas of this country, to be eligible to teach in our primary and secondary schools, one has to have a baccalaureate degree with‘ some basic requirements; that is, 50 semester hours of general education to include some hours in at least six of the following areas: English, social studies, physical education, science, mathematics, foreign language, fine arts, humanities, psychology or practical arts; p l u s required six semester hours in American history and American government. Then they must have 21 semester hours in professional education, which is learning the tools to be used in teaching, 30 hours in a particular major field of teaching, such as mathematics or science.
For certification in another subject as a minor, the graduate has to have a specific number of hours in that field also. The certification of a graduate to teach in certain fields is valid for five years and renewable on completion of three years teaching experience O r eight mnester hours of approved college credit. In addition, the teacher has to enroll and
AORN Journul
pass a specific number of credit hours during varying periods throughout the professional life. For the health workers this would begin at junior college level or baccalaureate college level. A potential health professional would take a two semester general education curriculum, one semester general science curriculum, and specialized health science with practical experience for the fourth semester. This would provide an associate degree in health sciences and a certificate to work in a specialized area of nursing, medical laboratory, x-ray, physical therapy or whatever. Should they later become disenchanted with their chosen field, they could return to the junior college for one semester of another specialized field and would gain certification in the new field of endeavor also. On the other hand, if they wished to go on up the health career ladder toward a baccalaureate degree, the credits would be transferable and then they would be required to take a specified number of additional hours in general education, more advanced health-science courses, and two semesters of specialized health sciences with practical experience. At the completion of this, the degree would be a baccalaureate in health sciences and the graduate would become eligible for certification by a state agency to perform in that special area.
they will have the basics in health sciences to progress upward to master’s and/or doctorate degrees including the MD. At all times, to retain their certification they would have to work three out of five years, plus some college hours every few years. Medical education might also look at itself. Reports have shown the high percentage of entering freshmen medical students who have completed many of the so-called basic sciences as an undergraduate. Why can’t these courses in undergraduate years be “beefed-up,” so that by the time a student receives his BS degree, he has nearly completed his basic medical s c i e n c e requirements? This could cut some time from medical education that can be utilized in serving the public. There may well need to be new health professions or realignment of old ones. This requires serious study to determine the right kinds and numbers of physicians. You can bet that where there is a vacuum of health services someone will come up with a person to provide some level of care, even if it turns out to be third or fourth class.
Later, should they desire to change fields, they would only have to take the one year of specialized health-science courses and practice in the new area.
The answers to the various approaches to physicians’ assistants are available. Much evaluation, discussion and soul-searching needs to be accomplished on such innovations before a mass program is promulgated. Otherwise, a holocaust due to poor medicine, people produced and no jobs, health services not acceptable to the public and even less acceptable to the medical profession will come out.
On the other hand, should they decide they are in a dead-end area,
Lest we forget it, if this happens, it is the physician who is the ulti-
160
AORN Journal
mate responsible person. Unless there is professional support and direction for innovation and experimentation in the emergence of new health professions, an intolerable situation can develop.
number of years of education and training? Are we utilizing the right people in their proper functions to provide care to people who do not receive it, whether it be their fault or ours?
Are our medical colleges producing the best physicians, in the necessary numbers, in the right categories needed by the public, in the optimum
There should always be questions like these, but there should be documented facts to back up any recommended innovations and changes. @
Employment education Five regional seminars on employee-employer relations in the Veterans' Administration under Executive Order 11491 are planned through July by the American Nurses' Association. Designed t o develop basic understanding of the principles of collective bargaining, especially as they pertain t o provisions of Title 38 of the United States code, the two-day seminars began last month in New York City. Subsequent seminars are scheduled June 10-11, Ambassador Hotel, Chicago: June 24-25, Mark Hopkins Hotel, Son Francisco: June 28-29, Houston Oak Hotel, Houston: and July 12-13. H o t e l Americana, Bal Harbor. Ha. The series of regional seminars sponsored by ANA is part of the Association's education program t o foster understanding of the rights of nurses in directing nursing care in a collective bargaining setting. For further information, write: Convention Manager American Nurses' Association 10 Columbus Circle New York, MY 10619
162
AORN Joumurl