dental schools, of the bill proposed in the report of the National Security Training Commission.

Section 10 authorizes the training agency, among other things, to furnish dental care to each trainee. It may be impractical to define in the text of the bill the quantity of dental care to be provided but the problem should be discussed in the report of this committee so that the training agencies may have a definite point of reference for the formulation of policies relative to the furnishing of dental care.

EXTENT OF DENTAL CARE FOR TRAINEES

The association believes that the responsibility for good health care rests primarily with the individual and with his family. It recognizes that the failure to exercise this responsibility will result in many inductees presenting themselves to the training agency when in need of dental treatment of varying degrees. However, it does not believe that the Government should undertake to repair any neglect on the part of the inductees unless the dental treatment offered is specifically required to permit the member of the corps to perform their training duties efficiently and comfortably. The American Dental Association, therefore, recommends that at the time of induction and release each trainee be given a complete dental examination with bite-wing roentgenograms. During the period of training dental treatment should, in general, be limited to provide early treatment of extensive or advanced caries and periodontal disease and emergency dental treatment for such conditions as injury, acute oral infections, or painful conditions.

This relatively limited program is suggested principally because the association recognizes that the training period of 6 months must be devoted chiefly to military indoctrination. A major part of the training period cannot, therefore, be expended in the furnishing of rehabilitative health services. If an extensive program of dental rehabilitation were to be undertaken for members of the corps it would soon be found that this program was taking a disproportionate amount of training time.

In recommending a limited program of dental treatment, the association also has in mind the over-all dental manpower problem in this country. During the past year the Armed Forces have cut sharply into the number of dentists available for civilian practice; even more dentists will be lost to the civilian economy when the Armed Forces reach their authorized strength. The quantity of dental treatment to be provided to members of the training corps will actually control the amount of dental service available to civilians.

DENTAL MANPOWER SITUATION

The initiation of this program will have a decided effect upon the dental manpower situation. At the present time the ratio of active dentists to over-all populaton is 1: 1,900. The armed services employ dentists on a basis of 1: 500 active-duty strength. Thus, every time 1 dentist enters the service, 1,400 civilians must seek a new place to obtain dental treatment. When the armed services reach their maximum authorized strength there will be about 10,000 dentists on active duty, exclusive of members of the United States Public Health Service. The Commission recommends that the training cadre be in addition to the authorized strength of the Armed Forces and presents evidence to indicate that about one trainer will be required for every two trainees. Accepting the Commission's estimate of an average corps strength of 400,000, this will demand 200,000 for the cadre. If 600,000 persons were to receive dental care from a number of dentists employed at Armed Forces ratios an additional 1,200 dentists would be permanently lost to the civilian population. Since the permanent dental strength of the regular establishments is only about 1,500, it is readily apparent that when the Armed Forces and the training corps achieve maximum strength there will be an average loss to the civilian population, for the duration of the present indefinite emergency, of 9,700 dentists. Thus, these activities will require about 14 percent of all available dentists in the United States, or 12 percent if the permanent military dental personnel strength is not included. It is to the interest of the total population that the number of dentists required by the training corps be kept as low as is consistent with good quality dental care in the areas in which it is provided. It is believed that the association's recommendations for limited treatment will assist measurably in achieving this goal. It is further believed that the intelligent use of Reserve dental officers on day-to-day duty and of civilian practitioners for the purpose of making the

initial induction and the final release examinations will tend to reduce the need for excessive numbers of dentists to service the corps and will also help to lower the cost to the Government of providing the requisite dental care. With Federal budgets at today's level, it is important to consider fiscal effects when establishing new programs.

POSTPONEMENT OF RESERVE LIABILITY FOR DENTAL STUDENTS

After considerable study of the Commission's recommendations for scheduling inductions, as that schedule would affect future dental school enrollments, the association is willing to recede from its recommendations made to the Commission for a proposed system of student deferment. It is willing to accept the Commission's recommendation that all physically acceptable high-school graduates be processed through the corps during the transitional period between high school and college.

The Commission suggests (pp. 28-29) that a study should be made to determine some system for suspending the liability of certain professional students for post-training service in the Reserve until the completion of their professional courses. It is the opinion of the association that such a policy should be determined without further delay since it believes that there is enough experience with practical mechanics of deferment to be found in the methods of the Selective Service System and its handling of similar cases in the years since 1940. The association has for several years offered an aptitude testing program to the dental schools of the country. It is used by all 42 dental schools at the present time as part of the criteria for determining the admissibility of applicants. The results obtained in these tests will permit the prediction, with the expectation of 95 percent or more accuracy, which students are best equipped to pursue successfully the dental curriculum. This test is now administered as early as the conclusion of the freshman year in college and, with some adjustments, could be offered either to high-school graduates or to entering college freshmen who have completed their training in the corps. Persons who qualified under this test and who could offer otherwise acceptable qualificatons to dental schools could be tentatively accepted and be identified as is now the practice under selective service. If accepted they could at any time prior to graduation file appropriate evidence with the headquarters of the Reserve component to which they were assigned of their status as a professional or preprofessional student in the healing arts and on the strength of such evidence be relieved from call to active duty until graduation from dental school or until such time as their courses were otherwise terminated.

Policies with regard to the obligation of professional students should be determined and enunciated before the first person is ordered to active duty with the corps. Such students, if delayed in call-up, would constitute a valuable reservoir of trained personnel for the future health care of the military forces and the Nation. Temporary suspension of their obligation to serve would not amount to exemption. It would merely be postponement.

DISTRIBUTION OF SERVICE BURDEN

This course will require, however, that equities of the situation be nicely balanced. Under the general theory of the act, 18-year-olds who have completed training will be transferred to the Reserve for a period of 71⁄2 years. Their total obligation would normally be fulfilled at age 26. Under the association's proposal the postponed obligation of Reserve service would not commence for students of dentistry and medicine until about their twenty-fifth year. Since it is expected that the program will continue indefinitely, in both wartime and peacetime, it can readily be seen that there will be an especial need for trained health personnel at all times. Unless safeguarded by law, dentists and physicians might become particularly vulnerable to recall as reservists to care for the health needs of this continuing group. In accepting the Commission's recommendation that all should serve in the corps immediately after graduation from high school, this potential vulnerability of physicians and dentists to recall has been kept in mind by the association which recommends that provision be made so that they will not assume a greater amount of service as a matter of course than nondentist and nonphysician trainees. One method of doing this might be to give them credit for service in the Reserve program until such time as their particular class of UMT trainees began to be called for duty as reservists. At such time the exemption as a student could be claimed with resulting liability for

Reserve service after graduation limited to the period of time during which they were exempted on account of their student status.

To illustrate. A and B reach 18 on the same day and are inducted into the corps together. At 181⁄2 they complete their training and are transferred into the Reserve. At 19 they enter college where each takes 2 years of preprofessional training. A then enters law school and B dental school. When they are age 23 and have completed 2 years of professional school a national emergency occurs which results in their class from the corps being called to active duty as reservists. At this time each has completed 41⁄2 years of service in the Reserve, A enters upon active duty but B claims his exemption as a dental student. A is released after 1 year of service. Two years later he has completed his entire period of obligated service. B graduates from dental school 61⁄2 years after release from the corps. He then resumes his Reserve status and may be called at any time during the succeeding 3 years, which represents the balance of his obligated Reserve service remaining at the time his obligation was suspended by a claim of exemption as a dental student.

POSTSERVICE DENTAL CARE FOR SERVICE-INCURRED DISABILITIES

When it appeared before the National Security Training Commission, the association recommended that the liability of the Government for any posttraining dental care be predicated only upon clear and convincing evidence that the dental condition was not present at the time of entry into training, that it actually occurred during the period of training, and that it was not treated or completely corrected during training. The American Dental Association repeats this recommendation to your committee and adds one additional qualification, namely that dental treatment for training-incurred diseases or injuries be limited to correction of the dental condition as initially discovered.

The association believes that this is the time to recognize and assert that the period of training in the corps which will be undergone by all physically qualified males, is an obligation of citizenship imposed by the Congress; that to no person who serves is there due any special reward or claim upon the Government on account of his fulfillment of this obligation which will not of itself be hazardous and which in any event could not be avoided without incurring severe penalties under the law. Consequently, there ought not to be provided a system of special benefits and bonuses for former members of the corps. However, because of his acceptance of the obligation imposed upon him, the trainee ought to receive health service care for any injuries or diseases which he incurs as a direct result of his period of training. Care should, however, be limited to such restoration as can feasibly be made by medical and dental treatment.

In its bill (secs. 16 and 22) and its report (p. 58) the Commission has substantially taken the stand just expressed by the association. It points out that the Government should develop no extensive program of postservice care for UMT trainees such as is provided to veterans of the Armed Forces under laws administered by the Veterans' Administration. It states: "As a matter of principle, we do not believe the many ancillary benefits awarded to military veterans are warranted for trainees in a 6-month program; we believe the cost would be exorbitant over a period of time, even if, as is expected, the number of trainees who suffered disability as a result of injury or sickness should be very small." The Commission then recommends the adoption of benefits under the Federal Employees' Compensation Act, with modifications, as the basis for providing postservice benefits or for caring for disabilities incurred in service.

The Commission also recommends in section 33 of the bill, the extension of the period of training with the consent of the trainee for the purpose of furnishing hospitalization, medical, dental, or surgical care.

Until practical experience with the program demonstrates the need for other benefits, these two suggestions would appear to be both reasonable and just. If the training agencies adopt the recommendation of the association to require a complete dental examination of the trainee at the time of induction and separation, a comparison of the results of the two examinations will readily indicate what new dental disease or disorder has developed or been incurred during the training period. These dental disabilities could be permanently cured in all but the most exceptional cases if the trainees were to be held in service for a relatively short time for the sole purpose of having his training-connected mouth condition corrected.

If the Federal Employees' Compensation Act is to be adopted as the vehicle for providing postservice health care in cases of training-incurred dental disorders

the association recommends that title III be added to the bill as proposed by the Commission. Title III, which follows hereafter, would amend the Federal Employees' Compensation Act so as to authorize specifically the rendering of dental benefits. At the present time dental benefits are offered under the act but only by administrative regulations. In order to round out the program proposed by the Commission it would appear necessary to take this step. Since the amendments proposed by title III are to the basic compensation act, it would not be necessary to make any changes in the commission-proposed section 16.

PROPOSED AMENDMENT

Amend H. R. 5904 on page 24 by adding thereto an additional title to read as follows:

"TITLE III

"SEC. 301. SHORT TITLE.-This title may be cited as the Federal Employees' Compensation Act Amendments of 1952.

"SEC. 302. The first two sentences of section 9 of the Federal Employees' Compensation Act, as amended, (5 U. S. C. 759) are amended to read as follows:

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"(a) For any injury, sustained by an employee while in the performance of duty, whether or not disability has arisen, the United States shall furnish to the employee all services, appliances, and supplies prescribed or recommended by duly qualified physicians and dentists which, in the opinion of the Secretary, are likely to cure or to give relief or to reduce the degree or the period of disability or to aid in lessening the amount of the monthly compensation. Such services, appliances, and supplies shall be furnished by or upon the order of United States medical and dental officers and hospitals, but where this is not practicable they shall be furnished by or upon the order of private physicians, dentists, and hospitals designated or approved by the Secretary.'

"SEC. 303. The first two sentences of section 21 of the Federal Employees' Compensation Act, as amended, (5 U. S. C. 771) are amended to read as follows: 'SEC. 21. After the injury the employee shall, as frequently and at such times and places as may be reasonably required, submit himself to examination by a medical or dental officer of the United States or by a duly qualified physician or dentist designated or approved by the Secretary. The employee may have a duly qualified physician or dentist designated and paid by him present to participate in such examination.'

SEC. 304. Section 22 of the Federal Employees' Compensation Act, as amended, (5 U. S. C. 772) is amended to read as follows: .

"SEC. 22. In case of any disagreement between the physician or dentist making an examination on the part of the United States and the employee's physician or dentist, the Secretary shall appoint a third physician or dentist, as the case may be, duly qualified, who shall make an examination.'

"SEC. 305. The first sentence of section 23 of the Federal Employees' Compensation Act, as amended (5 U. S. C. 773) is amended to read as follows:

"SEC. 23. Fees for examinations made on the part of the United States under sections 21 and 22 by physicians and dentists who are not officers or employees of the United States and not under contract to the United States to render medical or dental services to its employees shall be fixed by the Secretary.'

The CHAIRMAN. The committee is fortunate in having a real expert on all the matters that you have disscussed, Doctor, so I will forego any questions and ask if Senator Hunt has any questions.

RESERVE OFFICERS AND DENTAL EXAMINATIONS

Seator HUNT. I wonder, Dr. Earnest, if you would elaborate a little on the latter part of the first paragraph on page 2. What do you mean "Reserve officers on day to day duty assignments"?

Dr. EARNEST. Well, in other words, there are several ways that Reserve officers can get points for retirement, and things of that type. And you might be able to set up a program in a community that a Reserve officer could give one day of his time to these examinations,

and in that way he could earn points for his retirement. That is just one suggestion.

And another thing-it might be in small communities where there are just a few inductees, that could be handled at a local level on a civilian standpoint. In other words, he could go to his family dentist and get this necessary examination.

CAN LOCAL DENTISTS HANDLE THESE EXAMINATIONS?

Senator HUNT. Doctor, I do not quite get your thinking therein. Assuming we have 20,000 trainees in a camp and that camp may be adjacent to a small community, where we may have, let us say, 10 dentists, and their time is thoroughly taken, it would be impossible, of course, under those conditions for local dentists to handle the work; would it not? Or did you mean to imply that local dentists should do all of the work?

Dr. EARNEST. I mean that they should be allowed to help.
May Mr. Garvey speak to that?

Senator HUNT. Yes.

Mr. GARVEY. Senator, I think what we had in mind there was the idea of conserving dental manpower without translating them actually physically into the service. We thought that some of these initial physical dental examinations which we recommend as distinguished from the ordinary treatment program, or some of the release examinations which we recommend be made at the time of release from the service could be made either by Reserve officers in the home towns of individuals as distinguished with areas near the cantonments where they might be trained, or even perhaps by a civilian dentist on a semicontract basis.

Our principal idea, of course, is to reduce the number of dentists that would have to be on permanent military duty in order to take care of the needs of the trainees.

Senator HUNT. I think your suggestions, if they can be worked out from a practical angle, are very good because you conserve dental manpower, and you would also cut down expenses.

POLICY TOWARD MEDICAL AND DENTAL STUDENTS

With reference to the next paragraph, Dr. Earnest, about the middle of the paragraph—

The association, however, recognizes that future enrollments in dental schools will suffer unless those engaged in predental and dental study are permitted to continue their courses of study until graduation or withdrawal

I do not think that paragraph will apply at all to trainees in the first instance, because we expect to get these trainees, of course, before they get into dental school; and, secondly, we already have the authority— it may be necessary to rewrite it, however—to keep those predental and premedical students in school until they have completed their course. That is what we all, of course, are in favor of doing.

Dr. EARNEST. I just wanted to be sure. In other words, we did not know the exact status of what the present selective service would be if this was instituted and wanted to be sure the boy could continue his dental education without interruption.

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