Medical School Aid Measure Waits House Approval; AMA Opposes Bill

As 1950 opens, the nation's medical schools are awaiting a ruling by the House Rules, Committee on a bill to provide them with financial aid from the federal government. The bill, H.R. 59-10, has already been reported on favorably by the House Committee on Interstate and Foreign Committee; and inasmuch as the Senate has passed a companion Act, S. 1453, the bill will become law if and when the House votes for its passage.

Since the end of the War, almost every medical school has been operating far in the red. The Association of American Medical Colleges claims that the average student pays $513 in yearly tuition while he costs his medical school nearly $2200. At Harvard Medical School, according to Dr. Reginald Fitz '05, assistant dean, the school requires three to four times the $800 tuition to educate a student at the high standard the school wishes to maintains.

Endowments Insufficient

Before the era of high taxes, the medical schools could bank on endowment incomes and yearly gifts to make up the greater part of this deficit. But with current levies on high incomes plus the present popularity of donating money for specialized uses such as cancer or heart disease, the schools must make up their debits by unhealthy deficit financing. The only schools which are able to keep their ledger anywhere near balanced are the State schools which can count on a certain amount of tax money each year.

What makes medical education so expensive is the fact that the course of instruction takes place for the most part in the hospital or the laboratory--not in the lecture hall. To provide adequate training, the laboratory must have the ultra -centrifuges, the autoclaves, and numerous thermostatic devices that are necessary in biological chemistry. But more than that, the school must pay many more instructors per student than any other kind of education. In most medical schools, the faculty is equal to or exceeds the student body.

Deficit Dangerous

According to the Association of Medical Schools, the deficit problems is rapidly getting to the point where it threatens the standard of medical education that the Association has hitherto imposed on its member schools. Many of the schools will just have to stop buying new equipment or cut some of their instruction staff. Yet, the Association feels that, if anything, more money should be expended on the faculties in order to induce better doctors to give their full time to teaching.

New Bills Promise Aid

H.R. 5940 is an emergency bill covering Title I of H.R. 4312, the administration's omnibus health bill that was brought up before Congress last Spring. If it passes, a five-year program of aid for education in medicine, dentistry, nursing and related fields will be set up under the Surgeon General and will be administered by the National Council on Education for Health Professions. 'The bill provides for outright financial grants for instruction and expansion plus a federal medical scholarship program. The latter will be taken up in the second article in this series.

Under the bill, a medical school will receive $500 for each student enrolled plus an additional $500 for each student in excess of the school's average past enrollment. Thus a premium is put on the enlargement of the student body. The total payment to any one school is not to exceed 40 percent of the total instruction costs for any year and is not to pay for instruction in research projects or the cost of any hospital's operations. For the construction of new schools and improvement of existing ones, the Surgeon General's office will have an appropriation of five million dollars per year to spend as it sees fit so long as it gives no school more than 50 percent of the yearly cost of expanding or enlarging.

The legislation specifically provides that no department or officer of the federal government "shall prescribe any requirements with respect to the curriculum or administration of any school." In addition the House Committee report emphasizes that the federal aid should be to supplement and not to replace other normal resources. "Each institution," the report states, "should remain free to develop its own educational pattern in accordance with its own concept of its historical destiny, its own philosophy of education and the educational needs of the region within which it operates."

AMA in Opposition

Though favored by the American Association of Medical Colleges, the bill is being strongly opposed by the American Medical Association. The AMA considers the emergency aid as the first step toward the nationalization of the medical profession; they believe that it is the realization of the threat made by the Truman administration, to pass the omnibus health plan in sections if it can't pass the whole thing all at once.

The measure that the AMA opposes most vigorously is the stipend paid to each medical school for the increase of enrollment. Not only do they think that the present fear of a doctor shortage is unwarranted but they are afraid that some schools might lower their standards in order to get more federal aid. "If the quality of medical attention is to be preserved," states an AMA spokesman in the original hearings on the omnibus health bill before the House sub-committee," the schools must be provided with sufficient funds to correct deficiencies in their present programs before they undertake to train an increased number of students."

Pressure exerted by the AMA has changed the bill as it stood in the administration's health plan to its form in H.R. 5940. Originally, the medical schools were to receive $300 per student plus $1700 for students in addition to the average pas enrollment; and the total payment that the federal government can make to any school has been cut ten per cent from the original figure.

Fear Construction Funds

The AMA, however, is still against the bill not only because it offers a premium to new medical students but also because new medical schools under the present bill will get a full $1000 for every student. The medical group, furthermore, has come out against federal aid for construction. In a statement drafted by its house of delegates at the December meeting in Washington, the AMA states, "--no grants or construction should be made until the needs of all the medical schools have been surveyed and balanced, until a long range program has been developed.--Vesting in the Surgeon General such full authority to award grants will open the door for political pressure and interference."

The AMA suggests that the necessary funds could be provided by a nationwide fund-raising campaign--something not yet tried by medical education--or by state and local governments from current taxes. In any case the doctors' organization is diametrically opposed to having the federal government expert any control over the medical profession. In one statement at the meeting in Washington, the group even suggested that "the proponents of socialized medicine plan the training of this excessive number of prac

This is the first of a series of two articles studying the bill in the House of Representatives to provide financial aid to medical schools and a system of federal scholarships to medical students. Tomorrow's section deals with the scholarship program. titioners in order to force the nationalization of medicine through economic pressure."

Conant for Bill

Standing with the Association of Medical Colleges in their move to obtain federal aid are numerous educators and all the public health authorities. President Conant and President H. M. Wriston of Brown University voiced their approval in telegrams sent to the House subcommittee when hearings began on H. R. 4312 in July. Brig. General James S. Simons, retired, dean of the Harvard School of Public Health, testified before the same group that the future of public health services was in serious danger if some aid was not voted soon.

Presently, the bill awaits a ruling in the House Rules Committee before coming up for a vote in the House