EDITORIALS
D o n ’t
g o
to
s le e p
o n
th e
H D o y o u k n o w w h a t th e H e a lth M a n p o w e r A c t o f 1975 ( H R 5546) is? S om e o f y o u are fa m il ia r w ith th e b ill, and a fe w m o re k n o w o f its “ s tu d e n t p a y b a c k ” p ro v is io n . W h y are w e n o t c o n s p ic u o u s ly o u tra g e d b y th is b ill? W h y are w e a ll n o t ra n tin g and ra v in g o v e r it? V e r y s im p le — n o t one in d iv id u a l n o w in d e n tis tr y (a t le a s t in h is c u rre n t sta tu s ) w ill be a ffe c te d b y th e b ill. I n th e fa c e o f h e a v y o p p o s itio n , th e v e ry c o n tr o v e rs ia l s tu d e n t p a y b a c k p ro v is io n w as s lic k e d th ro u g h th e H o u s e o f R e p re s e n ta tiv e s b y p o s t p o n in g its e ffe c tiv e d a te to in c lu d e o n ly th o se s tu d e n ts e n te rin g d e n ta l (o r o th e r h e a lth p ro fe s s io n s ) s c h o o l a fte r Ju n e 30, 1976. T h is p o s tp o n e m e n t, o f c o u rs e , is sup p o se d to lu ll us a ll to sleep a n d to re m o v e th e e m o tio n a l o p p o s itio n th a t goes w ith b e in g p e rs o n a lly a ffe c te d . B u t th e in ju s tic e is s till th e re , and w e c a n ’ t ig n o re i t ju s t f o r th e sa ke o f to d a y ’ s tr a n q u ility . D d a y w ill e v e n tu a lly com e. O n e o f th e le a d in g o p p o n e n ts to th e p a y b a c k p r o v is io n , R e p . D a n ie l S a tte rfie ld ( D - V a ) , c a lle d th e a c c e p te d p la n a “ fin e ly b a ite d s n a re ,” s ta t in g a ls o th a t i t “ w ill c e rta in ly v io la te th e s p ir it, i f n o t th e le tte r , o f o u r C o n s titu tio n .” I f th e b ill passes th e S enate and be co m e s la w , a le g a l c h a l le nge to its c o n s titu tio n a lity is p re d ic te d since th is w o u ld be th e f ir s t tim e th a t fe d e ra l o p e ra tin g fu n d s to a s c h o o l w o u ld be p a id b a c k b y its s tu d e n ts — a n d in a s e le c tiv e m a n n e r w h ic h d is c rim in a te s a g a in st s tu d e n ts in th e h e a lth p ro fe s s io n s . T h e s tu d e n t p a y b a c k p ro v is io n w o u ld re q u ire a n e w d e n ta l g ra d u a te w h o had s tu d ie d u n d e r th e p ro g ra m to re p a y to th e fe d e ra l g o v e rn m e n t h is a llo tm e n t o f fe d e ra l c a p ita tio n (p e r s tu d e n t basis) fu n d s p a id to h is s c h o o l. T h is w o u ld to ta l a b o u t $8,000 p e r s tu d e n t a n d w o u ld be p a id b a c k a t th e ra te o f $2,000 a y e a r s ta rtin g tw o ye a rs a fte r c o m p le tio n o f tra in in g . G ra d u a te s g o in g
s tu d e n t
p a y b a c k
is s u e
in to m ilita r y s e rv ic e w o u ld be e x e m p t fr o m th e p a y b a c k p ro v is io n , as w o u ld th o s e a g re e in g to w o r k in a H E W -d e s ig n a te d s h o rta g e a re a o n a y e a r-fo r-a -y e a r basis in th e N a tio n a l H e a lth S er v ic e C o rp s . T h is p la n w as o b v io u s ly d e sig ne d to e c o n o m ic a lly “ sq ueeze” th e n e w g ra d u a te o u t o f p riv a te p ra c tic e in to m ilita r y s e rv ic e o r th e N H S C , b o th s p o n s o re d , o f c o u rs e , b y th e fe d e ra l g o v e rn m e n t. B u t th e re is a b ig “ i f . ” A g ra d u a te c o u ld w o r k o f f his p a y b a c k o b lig a tio n i f p o s itio n s w e re a v a ila b le in th e N H S C o r th e m ilita r y . C u rre n t ly th e re are o n ly 475 d e s ig n a te d s h o rta g e a re a s, w h ic h w o u ld a c c o m m o d a te o n ly a b o u t 10% o f th e e s tim a te d 5,000 d e n ta l g ra d u a te s each y e a r, and i t is c o m m o n k n o w le d g e th a t th e n u m b e r o f g ra d u a te s se e kin g to e n te r th e m ilita r y ser v ic e s is g re a te r th a n th e n u m b e r o f o p e n in g s . So th o s e le ft o v e r c o u ld ju s t add o n to an a lre a d y s ta g g e rin g ly h e a v y fin a n c ia l b u rd e n th a t c a n be a d e q u a te ly a p p re c ia te d o n ly b y th o s e w h o h a v e been th ro u g h it. O f c o u rs e , th o s e fin a n c ia lly a b le to d o so c o u ld p a y o f f th e $8,000 in a lu m p su m , o r th e y s u re ly w o u ld n o t change p ra c tic e p la n s i f th e y s e le cte d th e $2,000 p e r y e a r p a y b a c k . B u t as R e p . S a tte r fie ld p o in te d o u t, “ T h e sa d d e st a s p e c t o f a ll is th a t th e ones w h o w il l h a ve n o c h o ic e b u t to e n te r in to a p e rio d o f s e rv ic e w ill be th o s e g ra d u a te s w h o c o m e fr o m th e p o o re s t fa m ilie s .” H o w ’ s th a t f o r e c o n o m ic d is c rim in a tio n ? T h e H e a lth M a n p o w e r A c t o f 1975 ( H R 5546) w ill be c o n s id e re d b y th e U S S enate s o m e tim e w ith in th e n e x t fe w w e e k s . I f y o u a re n o t fa m ilia r w it h th e b ill, d o y o u r h o m e w o rk a n d th e n e x p re ss y o u r o p in io n s to y o u r s e n a to rs . D o n ’ t go to sleep o n th is issu e . W e h a v e a m o ra l o b lig a tio n to o u r p ro fe s s io n a l d e s c e n d a n ts — and in m a n y cases to o u r o w n c h ild re n . H .C .B . JADA, Vol. 91, September 1975 ■ 489
D o n ’t
g o
to
s le e p
o n
th e
H D o y o u k n o w w h a t th e H e a lth M a n p o w e r A c t o f 1975 ( H R 5546) is? S om e o f y o u are fa m il ia r w ith th e b ill, and a fe w m o re k n o w o f its “ s tu d e n t p a y b a c k ” p ro v is io n . W h y are w e n o t c o n s p ic u o u s ly o u tra g e d b y th is b ill? W h y are w e a ll n o t ra n tin g and ra v in g o v e r it? V e r y s im p le — n o t one in d iv id u a l n o w in d e n tis tr y (a t le a s t in h is c u rre n t sta tu s ) w ill be a ffe c te d b y th e b ill. I n th e fa c e o f h e a v y o p p o s itio n , th e v e ry c o n tr o v e rs ia l s tu d e n t p a y b a c k p ro v is io n w as s lic k e d th ro u g h th e H o u s e o f R e p re s e n ta tiv e s b y p o s t p o n in g its e ffe c tiv e d a te to in c lu d e o n ly th o se s tu d e n ts e n te rin g d e n ta l (o r o th e r h e a lth p ro fe s s io n s ) s c h o o l a fte r Ju n e 30, 1976. T h is p o s tp o n e m e n t, o f c o u rs e , is sup p o se d to lu ll us a ll to sleep a n d to re m o v e th e e m o tio n a l o p p o s itio n th a t goes w ith b e in g p e rs o n a lly a ffe c te d . B u t th e in ju s tic e is s till th e re , and w e c a n ’ t ig n o re i t ju s t f o r th e sa ke o f to d a y ’ s tr a n q u ility . D d a y w ill e v e n tu a lly com e. O n e o f th e le a d in g o p p o n e n ts to th e p a y b a c k p r o v is io n , R e p . D a n ie l S a tte rfie ld ( D - V a ) , c a lle d th e a c c e p te d p la n a “ fin e ly b a ite d s n a re ,” s ta t in g a ls o th a t i t “ w ill c e rta in ly v io la te th e s p ir it, i f n o t th e le tte r , o f o u r C o n s titu tio n .” I f th e b ill passes th e S enate and be co m e s la w , a le g a l c h a l le nge to its c o n s titu tio n a lity is p re d ic te d since th is w o u ld be th e f ir s t tim e th a t fe d e ra l o p e ra tin g fu n d s to a s c h o o l w o u ld be p a id b a c k b y its s tu d e n ts — a n d in a s e le c tiv e m a n n e r w h ic h d is c rim in a te s a g a in st s tu d e n ts in th e h e a lth p ro fe s s io n s . T h e s tu d e n t p a y b a c k p ro v is io n w o u ld re q u ire a n e w d e n ta l g ra d u a te w h o had s tu d ie d u n d e r th e p ro g ra m to re p a y to th e fe d e ra l g o v e rn m e n t h is a llo tm e n t o f fe d e ra l c a p ita tio n (p e r s tu d e n t basis) fu n d s p a id to h is s c h o o l. T h is w o u ld to ta l a b o u t $8,000 p e r s tu d e n t a n d w o u ld be p a id b a c k a t th e ra te o f $2,000 a y e a r s ta rtin g tw o ye a rs a fte r c o m p le tio n o f tra in in g . G ra d u a te s g o in g
s tu d e n t
p a y b a c k
is s u e
in to m ilita r y s e rv ic e w o u ld be e x e m p t fr o m th e p a y b a c k p ro v is io n , as w o u ld th o s e a g re e in g to w o r k in a H E W -d e s ig n a te d s h o rta g e a re a o n a y e a r-fo r-a -y e a r basis in th e N a tio n a l H e a lth S er v ic e C o rp s . T h is p la n w as o b v io u s ly d e sig ne d to e c o n o m ic a lly “ sq ueeze” th e n e w g ra d u a te o u t o f p riv a te p ra c tic e in to m ilita r y s e rv ic e o r th e N H S C , b o th s p o n s o re d , o f c o u rs e , b y th e fe d e ra l g o v e rn m e n t. B u t th e re is a b ig “ i f . ” A g ra d u a te c o u ld w o r k o f f his p a y b a c k o b lig a tio n i f p o s itio n s w e re a v a ila b le in th e N H S C o r th e m ilita r y . C u rre n t ly th e re are o n ly 475 d e s ig n a te d s h o rta g e a re a s, w h ic h w o u ld a c c o m m o d a te o n ly a b o u t 10% o f th e e s tim a te d 5,000 d e n ta l g ra d u a te s each y e a r, and i t is c o m m o n k n o w le d g e th a t th e n u m b e r o f g ra d u a te s se e kin g to e n te r th e m ilita r y ser v ic e s is g re a te r th a n th e n u m b e r o f o p e n in g s . So th o s e le ft o v e r c o u ld ju s t add o n to an a lre a d y s ta g g e rin g ly h e a v y fin a n c ia l b u rd e n th a t c a n be a d e q u a te ly a p p re c ia te d o n ly b y th o s e w h o h a v e been th ro u g h it. O f c o u rs e , th o s e fin a n c ia lly a b le to d o so c o u ld p a y o f f th e $8,000 in a lu m p su m , o r th e y s u re ly w o u ld n o t change p ra c tic e p la n s i f th e y s e le cte d th e $2,000 p e r y e a r p a y b a c k . B u t as R e p . S a tte r fie ld p o in te d o u t, “ T h e sa d d e st a s p e c t o f a ll is th a t th e ones w h o w il l h a ve n o c h o ic e b u t to e n te r in to a p e rio d o f s e rv ic e w ill be th o s e g ra d u a te s w h o c o m e fr o m th e p o o re s t fa m ilie s .” H o w ’ s th a t f o r e c o n o m ic d is c rim in a tio n ? T h e H e a lth M a n p o w e r A c t o f 1975 ( H R 5546) w ill be c o n s id e re d b y th e U S S enate s o m e tim e w ith in th e n e x t fe w w e e k s . I f y o u a re n o t fa m ilia r w it h th e b ill, d o y o u r h o m e w o rk a n d th e n e x p re ss y o u r o p in io n s to y o u r s e n a to rs . D o n ’ t go to sleep o n th is issu e . W e h a v e a m o ra l o b lig a tio n to o u r p ro fe s s io n a l d e s c e n d a n ts — and in m a n y cases to o u r o w n c h ild re n . H .C .B . JADA, Vol. 91, September 1975 ■ 489
