I want to add that as far as the discrepancy in costs of room and board is concerned, I have used the most up-to-date figure from the optometry school at Ohio State; presumably the figure for dental students' room and board, which comes from a booklet published by the American Association of Dental Schools, Chicago, is now comparable.

In addition, most optometry students find it necessary to also attend a summer semester, thus adding $162 and $327, respectively, to their total tuition costs. And I have not even added the additional costs which they incur: For example, they must buy their own meals during part of the weekend, and there is the matter of incidental fees amounting to another $30.

Tuition fees in the various schools range from $840 to $1,280 per year, the average being $1,050. This excludes State universities that offer lower fees for in-State residents. Thus, students pay approximately half the cost of their education. The remaining cost must be met from the income of the public optometry clinic which each school maintains as part of its training program and investments from alumnae fund-raising drives. The State university schools, of course, receive tax support and also receive a portion of the license fees which each registered optometrist in his State must pay annually.

In addition to his tuition fees, each student must purchase certain instruments and tools, at a total average cost of about $300, as well as books and academic supplies. The remaining costs of room, board, clothing, laundering, transportation, and incidentals vary widely according to individual taste and resources. With the extremely heavy course loads now required in the optometric schools, students frequently find it impossible to hold a part-time job to help defray their expenses while attending school. Those who do work, often find that their grades suffer accordingly, a fact which usually precludes any posisbility of winning a scholarship.

Scholarships are available at all schools of optometry. But they are very limited in number, and modest in amount, usually between $50 and $400 per year each. They are variously provided by these schools themselves, by State optometric associations, and their woman's auxiliaries, and by alumnae organizations. A very few come from other sources.

Many students rely on summer employment and family funds to see them through. If these income sources prove inadequate, they must obtain student loans. Some of the schools have small student loan funds which have been supplied by alumnae or by srevice organizations. These will accommodate only a small fraction of the need, and they are generally reserved for emergency purposes only.

Although the National Defense Education Act student loan program has been helpful to some optometry students, it has been inadequate at most schools. Dr. Chester H. Pheiffer, dean of our school of optometry at the University of Houston, testifying last year before this committee, pointed out that the National Defense Education Act gives first choice to students in education, languages, and the like. National Defense Education Act loans at State universities are usually gone before optometry students receive consideration.

Then, too, the National Defense Education Act loan program was designed primarily for undergraduate college students, particularly those planning to go into the teaching profession. As in the study of medicine, dentistry, and osteopathy, the high cost of an optometric education requires a higher loan ceiling than is available to students under the National Defense Education Act. The National Defense Education Act program forgives up to 50 percent of loans for teaching in elementary and secondary schools. There is no similar forgiveness for health professions whereas there is such forgiveness under the Health Profession's Educational Assistance Act for doctors who set up practice in areas critically short of health personnel.

The Health Profession's Educational Assistance Act is also operated by the individual schools of the health professions. Exclusion of optometry from the Health Profession's Educational Assistance Act therefore constitutes an undesirable disadvantage in optometry's recruitment program.

The need for training additional optometry students is acute. For the Nation now faces a serious shortage of professional optometrists. There are about 21,000 licenses issued to optometrists in the United States. On the basis of the average practice span of 30 years, 700 new licenses per year would be required just to maintain that total number. However not all of those licensed are actually practicing full time, and the figure also includes optomists licensed in more than one State. The actual number of working optometrists is about 17,000.

It has long been held that an average ratio of 1 optometrist per 7,000 population is needed to provide even minimum adequate vision care. The current national average is 1 per 11,250 population.

Even with careful redistribution, geographically, of optometrists to provide uniform coverage, there still exists a great need for additional optometrists. A total of about 30,000 optometrists is needed to provide the minimum adequate vision care for a nation of nearly 200 million people.

As longevity increases, raising the average age of the population, the need for optometric services also increases markedly. So the estimate of the need for 30,000 optometrists is assuredly a conservative one. To meet this need the optometry schools must graduate at least 1,000 new optometrists each year. To do this their facilities must be expanded. Enrollments in optometry schools increased sharply for several years following World War II, but even these large increases did not meet all needs created by low enrollments during the war. Enrollments declined again during the mid-1950's as veterans completed their studies, reaching a low point in 1958 when only 368 new students were admitted in the 10 schools. Since then, new enrollments have increased as follows:

Applications for admission at all of the schools have increased each year since 1958. And it is expected that the current year will see several of the schools forced to reject otherwise qualified applicants because of space or facility limitations. Career inquiries directed to the American Optometric Association in the first 4 months of 1964 show an increase of 23 percent over the number of inquiries for the same period in 1963. Similar experiences are reported at all of the schools. The stated total capacity of the 10 schools of optometry is less than 2,000 students. With the adoption of the 4-year professional curriculum, the capacity of the schools will be only about one-half the capacity needed to provide the minimum requirement of 1,000 graduates per year.

I have mentioned so far only the needs of more American trained optometrists to take care of the vision care of our population and the education of future optometrists. But today we have obligations, as Americans, that go far beyond our own needs, that transcend national borders, and reach from one end of the world to the other.

For many years, American optometric schools have acted as a magnet on foreign students, men and women from every continent. Right now, for example, Indiana University's School of Optometry has students from the Philippines, India, Britain, Canada, France, and Australia. In the recent past that school included students from Ghana, Kenya, and Thailand. At the School of Optometry of the University of California, there are currently a number of students from Iran, Holland, Japan, and India.

Some students from abroad who come to study here take undergraduate training in optometry; others take training leading to a doctorate. But there are few optometry schools in existence outside the United States. For example, throughout most of the Far East and the Near East, optometry does not exist as a profession. There are probably less than 100 fully qualified optometrists in those areas. Only in a few countries, including the United Kingdom, Colombia, the Philippines, Japan, Canada, and Australia, can it be said that the profession of optometry, in our sense of that term, exists.

The need for vision care both in quantity and quality around the world is urgent. Potential optometrists from many countries will increasingly turn to the United States for their education. For practical as well as humanitarian reasons we must do our best to provide education in optometry for those students. This is an additional reason why our profession needs to expand in trained manpower, so that we can provide education for our own people and those who come to us from other lands.

Incidentally, some of those students, once they have graduated from an American school, elect to stay and practice optometry in this country. Naturally, in view of our shortage of trained manpower we are delighted to have them stay, although we feel a little guilty about keeping them from their own people who also desperately need their services.

However, we would feel no guilt about Cuban refugee optometrists who elect to study and then practice here. Currently, with the help of the Department of

Health, Education, and Welfare, there are about a dozen Cubans studying optometry at our schools in this country, and I might add that their scholastic standing, despite language difficulties, is high. These refugees from Castroland are needed, and excellent additions, therefore, to our trained manpower pool. In conclusion it is estimated that with

1. The existing severe shortage of licensed optometrists;

2. The normal attrition rate of about 3 percent per year among practicing optometrists;

3. The expanding U.S. population and the increase in longevity; and

4. The increasing demand for optometrists in industry, research, and Government service—

the minimum of 1,000 graduates annually is a most conservative one. The need is there, the supply of qualified students is readily available. To meet our country's requirements for optometrists, support for expansion of facilities is needed, and support by way of financial aid to students is a necessity with the long and arduous training program that optometric students must complete. Thank you.

APPENDIX

Accredited schools and colleges of optometry in the United States, their deans, and year organized

1 All of the above schools and colleges of optometry are accredited by the Council on Optometric Education, the official accrediting agency of the AOA recognized by the National Commission on Accrediting.

Dr. HEATH. I am serving as president of the Association of Schools and Colleges of Optometry. At the same time, I am a professor of optometry at Indiana University. Indiana University's Division of Optometry is 1 of only 10 schools of optometry in the United States. These 10 schools are charged with the responsibility of providing the optometric education for the practitioners who will provide about 70 percent or more of the vision care of the American public. This is a big responsibility.

With the advances in optometric science of recent years, the curriculum has become so full that it has necessitated increasing the length and the depth of the courses to the point where four of the schools presently have had to extend their curriculum to an additional year, making a total of 6 years of college training to accomplish their optometric education.

Now, this includes 2 years of preoptometry. These are general college subjects in mathematics and science courses. And then 4 years of professional courses following that.

Up to this point a 5-year curriculum-2 years preoptometry, 3 years of professional courses-has been the standard.

This increased length of training, and mostly training, of course, poses an additional burden for the student who is contemplating a career in optometry. With these long 5-year programs, very full 5-year programs that we have had, most students have found it completely impossible to do enough part-time work to support themselves while in college.

Our students in a recent study, a study actually being conducted at the present time by the Association of Schools and Colleges and not quite complete, on instructional hours, shows that in many of our schools the students are carrying the equivalent of 21 semester hours of work while the normal college load for a full-time student is 15 semester hours. So it is this sort of thing that has provided the pressure resulting in the increased length of the program.

I should also point out that with 2 years of preoptometry, it is possible to complete an optometric education in 5 or, in the case of some of the schools, 6 years, but over half of the students entering optometry schools have already completed more than 2 years of preoptometric studies, and nearly a third of these entering students already have bachelor's degrees. So they have had 4 years at least of college training before embarking on the additional heavy 3 or 4 years of professional studies in the optometry program.

Now, the student and the school have a load to carry in addition to this heavy curriculum, and that is the financial burden of putting the student through the school. The cost of training an optometry student to the school averages about $2,200 a year judging from estimates received from all of the schools. This is not very far from what it takes to educate any student in a discipline requiring laboratory instruction. If it is lower than that in some other fields, this is undoubtedly due to forced economies and restricted funds, which is not always a good basis on which to attempt to give the highest caliber training. It is often an indication that salary scales for faculty and staff are undesirably low and that available equipment is in short supply, and so on. So these are not good economies if we strike very much below this average cost.

So far as the student is concerned, the tuition charges at these schools range from about $850 to $1,250 per year. So from this we can say that the student pays about half the cost of his instruction, and the rest must be supplied by the schools.

These funds come in part from the income of the optometry training clinics which are maintained at each of the schools as part of their instructional program. Other funds are available from alumni organizations, and in the case of the State universities, of course, there are tax funds, and, also, those schools receive part of the license fees of all the optometrists registered in those States each year.

The heavy course load, as I have pointed out, makes it impossible in general for the optometry students to earn enough or to provide from their own resources for their lengthy optometric training, and consequently, a great number of them have to turn to loans in order to see their way through their total program.

Most of the schools have small loan fund programs. Oftentimes these funds have been supplied by alumni organizations or by local

service groups such as the Lions Club in some cases, but these are small. They are used primarily for acute emergencies. Scholarships are limited in number and limited in amount. They amount to something like $50 to $400 a year as a general rule. The National Defense Education Act, the student loan program in that act, has been inadequate at virtually all of the optometry schools. It has given first choice to student education in languages, et cetera, and, of course, the National Defense Education Act was designed to help primarily the undergraduates who intended to become teachers.

For our purposes, since the cost of optometric education to the student is high, the National Defense Education Act's loan ceiling is not high enough and the repayment provisions are not adequate for our purposes. They have no forgiveness features such as are contained in the Health Profession's Educational Assistance Act for doctors who set up in practice areas which are deficient or critically short of health personnel.

Another feature is that this latter act, the Health Profession's Education Assistance Act, is also operated by the health profession's schools, and optometry's exclusion from it, therefore, is a most undesirable disadvantage in our recruitment program. The need, as has been emphasized and will be repeatedly emphasized, for optometrists is critical. There are about 21,000 licensed optometrists but really only about 17,000 of these can be considered to be available for the health care, for the visual care of the American public. This is a ratio of about 1 optometrist to 11,250, while for a minimum of good visual care, a ratio of 1 in 7,000 is considered to be barely adequate.

To put it another way, a nation of 200 million people needs a minimum of 30,000 optometrists to care for its vision needs. This is a conservative figure. Yet to reach it, we will have to graduate a thousand new optometrists a year. At the present time we are not graduating half that number. This last year we had enrollment in the optometry schools of slightly over 550 new students. This is up nearly 200 students since 1958 when we hit the acute postwar lull. But at this present time, lack of funds and lack of space and facilities at the schools are going to increase the number of rejectees that will be necessary in order simply to handle the increased student load.

Next year the problem will be even more acute unless the schools can expand their facilities.

Meanwhile, American optometry, limited in number and funds as it is, is increasingly becoming the instructor to the world. Students from all the continents in the world are coming to the United States for optometric education. Some stay here and practice. We are glad to have them. They increase our number, and they are needed. We are particularly glad that among these foreign students there are about a dozen Cuban refugee optometrists who are presently studying in the schools with the assistance of the Department of Health, Education, and Welfare. These foreign students are doing very well academically in spite of their language difficulties. They are needed. They are excellent additions to our training manpower pool.

Now, in summing up, just let me say that the need for additional manpower is really acute. The supply of qualified students now as a result of recruitment programs is readily available to meet our requirements for optometrists, our Nation's supply of trained practitioners.