1244 



The clash of Congressional and Executive Branch views is also evi- 

 dent in the Senate. On June 5, 1974, Senator Jacob Javits 

 (R-N.Y,) sharply criticized the administration's position on the use 

 of FMGs to alleviate the doctor shortage, giving particular emphasis 

 to the insufficient number of medical schools and inadequate Federal 

 government support for "desperately needed medical, dental, nursing, 

 iind other health profession schools." 



I am convinced, 



he said, 



that where there is an actual shortage of, for example, 30,000 physicians, based 

 on the empirical data, exclusive of the Department of Health, Education, and 

 Welfare's unconscionable reliance upon noncitizen foreign medical graduates — 

 FMG's — to provide medical manpower, Congress should make every approp.ri- 

 -ate effort to increase our Nation's medical schools capacity to increase enroll- 

 ment and train qualified Americans to become physicians.*-^ 



Senator Kennedy followed with a comprehensive critique of the 

 administration's health manpower policies by way of explaining, as 

 he said, two "far-reaching health manpower proposals" he was intro- 

 ducing for Senate action in July.®^^ The Senator pointed out the dis- 

 parity in views on the doctor shortage, citing the familiar 50,000 figure, 

 the Hansen study of 6 major projections during the years 1959-67 



«2^ Sen. Jacob K. Javits, Remarks in the Senate. Congreseional Record, June 5, 

 1974, pp. S9670-S9672. Senator Javits inserted in the record an exchange of corre- 

 spondence with Secretary Weinberger. In his letter of Jan. 17, 1974, the Senator asked 

 for statistical data and analyses upon which HEW relied for their published statements 

 to the effect that the physician shortage will soon be eliminated. "I understand," he 

 wrotp, "that this statement is based upon the assumption that our country will continue 

 to rely upon the utilization of FMG's . . . rather than educating and training the requisite 

 . number of qualified Americans to achieve the goal of eliminating the physician shortage 

 without the 'brain drain' on countries which ought not to be submitted to it. I believe it 

 would be contrary to our nation's ethics to follow such a procedure. I can find no reasonable 

 Intellectual or philosophical rationale for this nation to support the 'brain drain' — take 

 desperately needed medical manpower from underdeveloped, impoverished nations less 

 fortunate than ours to meet our own needs for physicians." 



Not receiving a response, Senator Javits wrote a follow-up letter on Apr. 10, 1974, 

 pointing out the urgency of this request for legislation then under consideration, and re- 

 stating the essence of his inquiry. "As you know," he wrote, "I find it almost degrading 

 for onr nation to take desperately needed medical manpower from developing nations with 

 desperate health and economic problems to meet our nation's physician shortage. More- 

 over, I believe that so long as foreign medical graduates are used to alleviate our medical 

 manpower shortage, our nation will continue to be dependent on this source and that this 

 is improper and deplorable." 



On Apr. 15, 1974, Secretary Weinberger finally responded after a delay of 2 months. 

 He noted that the current output capacity (enrollment) of health professional schools has 

 increased significantly over the past decade (e.g. first-year places in U.S. medical schools 

 increased by 65 percent). The rate of those entering the field, he said, Is much greater than 

 those leaving and as a result "we can expect by 1985, 50 percent more M.D.s, 40 percent 

 more dentists, and 60 percent more registered nurses than in 1970." He defended the 

 administration's position on the use of FMGs, arguing that it was unrealistic to assume 

 that their influx can be entirely eliminated and indicating that physician supply projec- 

 tions were based on a "rather conservative assumption" regarding their Inflow. "The 

 projections for 1984 indicated that the total supply of physicians will range between 

 495.000 and 520,000. These estimates "are based on "the assumption that the net annual 

 increase to total supply attributed to FMGs will range between 3,500 and 5.500 per year. 

 This range represents between 50 percent and 80 percent of the number that were probably 

 added during 1972." The Secretary exi)lalned his position on the use of FMGs, already- 

 described above; indicated administration efforts to urge the return of needed FMGs; elab- 

 orated on the "push" factors causing FMG migration ; acknowledged the concern of the 

 medical profession for possible "inferior" services provided by FMGs ; and indicated an 

 awareness of policy implications surrounding the FMG issue notably the matter of 

 qualifying examinations. 



«22 Edward M. Kennedy, Remarks in the Senate, Congressional Record, June 5, 1974, 

 pp. S9677-S9704. Mr. Kennedy introduced the Health Professions Educational Assistanre 

 Act of 1974 and the Nurse Training Act of 1974. He also submitted amendments S. 3.iS5 

 and S. 3586 to the Public Health Service Act relating to health professions trninir.nr 

 programs. Cosponsors of the leirislation v,-ere Senators Javits, Warren G. Masnuson 

 \D\Vash.), Jennings Randolph (D-W. Va.), Claiborne Pell (D-R.I.), William D. Hathaway 

 ^D-Me.), and Dick Clark (D-Ia.). 



