AMA Blocks Truman Plan to Give Scholarships to Medical Students; Plan Would Distribute Physicians

One section of H.R. 5940, the new bill calling for federal aid to medical education, provides that scholarships be given by the government to qualified medical students. As in the case of outright financial aid to the medical schools, this proposal has raised a serious controversy between the government and the medical profession.

The American Medical Association, fearing federal control and eventual nationalization of the profession, has voiced a strong protest while the Federal Security Administration, alarmed at the already exorbitant tuition's in many medical schools and the prospect of a doctor shortage, has fostered the government plan.

The immediate question is whether or not there is a doctor shortage. The AMA terms the emergency in medical education "fictitious;" they point to the fact that the number of physicians has increased 14 percent over the years 1940 to 1948 while the general population has grown only 12 percent. With normal efficiency, the AMA feels, one doctor should be able to care for a population of 1200 (this presumes adequate health workers to help the doctor). The present ratio of doctors to total number of people is about 1 to 730 and, if the new bill is passed as such, that ratio would be better than 1 to 700 in 1960 (see graph).

Actually, the AMA's deductions are consistent with the report made in 1932 by the Commission on Medical Education headed by President Lowell. That study predicted that if the maximum number of medical students graduated per year the physician population ratio would be 1 to 740. Furthermore, the report expressed the opinion that even with an average number of students graduating yearly, the medical profession was becoming overpopulated.

Changes In the Bill

The AMA's opposition has changed sections of the bill, too. The present form that "scholarships shall be awarded only in fields in which there are not enough qualified applicants to fill enrollments," nearly eliminates pre-medical students because there is at this time such an over-population of qualified premedical applicants.

As the FSA presented the administration's recommendations last Spring to the hearings on the omnibus health plan, the scholarships were to be apportioned to the States, according to their population, not less than two to any State. The object of the scholarship program, as the FSA saw it, was to "keep pace with the progress made in financing the costs of instruction and facilities."

Here again the doctors' organization is primarily afraid of H.R. 5940 as an overture to socialized medicine. They claim the bill would provide "a subsidy for the unqualified political appointees, nullifying efforts of admissions committees to maintain standards" and thereby causing the public to lose faith in the profession.

Within the profession itself, the AMA feels that a spirit of competition might develop between doctors that would hurt their practices. Worst of all, the group believes that the federal scholarships would extend one step further the encroachment of the government into the affairs of medical schools and lead eventually to their nationalization.

Qualification of Need

The Association of Medical Schools has taken a more liberal view of the problem. Some form of aid, it thought, was a good thing but it recommended that there be a qualification of need in each scholarship case and that there be no "indenture clause." (As the FSA originally presented the bill there was a suggestion that the holders of federal scholarships be obligated to serve for a period of time after their graduation in a government agency or in a shortage area designated by the government.)

The AAMC objected to such a plan because they thought some medical students signed up might be seriously maladjusted to work in rural areas. With the AMA, the medical schools did not press to increase enrollments but thought that government aid should be extended to students already in medical schools.

The discussion of the indenture clause brings up the further question of the distribution of physicians. Though the AMA's figures probably reflect the consideration that there is an adequate supply of doctors, they do not consider how well those doctors are spread. While the supply of physicians in a city like New York is generally 3 to 4 times as great than the national average, some rural areas have only one doctor for every 1500 or 2000 people.

When the administration offered the plan of limited indenture, it was thinking of supplying doctors to staff the hospitals provided for in the recently passed Hill-Burton Act--legislation setting-up rural health facilities.

Distribution Problems

The same 1932 report that considered the doctor shortage idea unfounded, emphasized the importance of poor distribution. Only 48 percent of the physicians settled in towns with less than 100,000 people were over 70 percent of the population resided. Yet speaking even in 1932, the report suggested that communications had been so improved in rural areas to permit country doctors to cover much greater territories.

Inducement of physicians to rural areas, the medical groups think, cannot be forced. The AMA spokesman at the July hearings stated that "one of our large philanthropic foundations has experimented with such a program (indenture) and found it to be unsatisfactory."

The doctors organizations both feel that indenture represents too much regimentation plus the fact that an important career in medical research or teaching might be interrupted.

In the hearings, numerous alternatives to federal scholarships were proposed. Some of the medical educators felt that a loan system would work--either 1) a government loan which would be retired at an annual rate for rural area service, teaching and research, or service in government agencies or 2) a loan from the medical school.

Dr. Herman G. Weiskotten, dean of the Syracuse University College of Medicine, testified that his medical school had "loaned thousands of dollars over the past 27 years and never lost a cent of principal or interest."

Scholarship Program

Another form was the scholarship from the medical school; at Harvard Medical School, Dr. Reginald Fitz '05, assistant dean, stated that "we are able to help many students every year who otherwise would be unable to go through medical school. Our principle consideration is need. We do not want Harvard Medical School to become a school for rich men's sons." The final alternative suggested was state and local scholarships; the AMA thought that if any governmental aid was needed it ought to come from and be controlled by the region concerned.

The Fear of Federal Control

Although more implicit than explicit, the AMA still nurtures a fear of too much federal control. Especially in the case of the scholarship grants the organization feels that political appointees will replace qualified medical students.

The AMA thinks that political interference would be the result of any government participation in the profession. But the bill explicitly states that "no officer, agency or department of the government shall influence the curriculum or choice of students in any way."

In the final analysis, there must be some resolution between the medical groups' fear that the profession will be over populated and the government's fear that not enough of the right caliber student can afford modern medical education. Both are justifiable fears; the medical profession was dangerously overcrowded in 1906 before the accrediting of medical schools, while the administration knows that fewer and fewer students will be able to pay 600-800 dollars yearly to become doctors. H.R. 5940 is the first legislative attempt to resolve this problem