By GARY ADKINS Gary Adkins has written a number of articles for Illinois Issues on subjects as diverse as Chicago sludge disposal and the medical malpractice crisis. He is a former student in Sangamon State University's Public Affairs Reporting Program, where he interned as a legislative reporter.

Health education programs

Recognizing the baroque complexity of health education, the IBHE did not directly address the subject in its Master Plan I of 1964. Instead, it recommended that a study be made of the facilities and programs for health education required for the state to meet the health requirements of its citizens. The IBHE appointed Doctors James Campbell and Randolf Tucker to direct this statewide study. The resultant report, Education in the Health Fields for the State of Illinois, or the "Campbell Report," was issued in 1968 after 20 months of investigation. It included 66 recommendations directed at increasing the number of health practitioners educated and practicing in the state. It also advised improvement in the distribution of health manpower, and increased access to health education programs for Illinois residents,

The programs begun between 1968 and 1976 as a response to the Campbell Report include new components of medical schools in Rockford, Peoria, Urbana-Champaign, Springfield and Carbondale, a new dental school in Alton and many new nursing homes throughout the state. By 1980, when expansion is to be completed, state schools will graduate twice as many physicians and nurses as in 1968, and will substantially increase the number of graduate dentists, pharmacists and veterinarians. The exact figures are as follows:

	1968	1980
Physicians	606	1,298
Dentists	246	428
Nurses	4,000 (approx.)	8,000
Pharmacists	100	170
Public health
professionals	-0-	125
Veterinarians	51	86

These figures will rank Illinois high among all states in its number of health professional graduates. There is also evidence that many of the state's health manpower needs will be met if the longstanding problems of inadequate retention and distribution of Illinois graduates can be overcome.

Last year the Health Education Commission (HEC), formed at the suggestion of the Campbell Report, produced a set of 10 documents outlining plans for the next five years in Illinois health education, as well as providing a review of some of the accomplishments to date. The first of these reports is an overview of the state's health education programs, it is followed by separate reports on each of the nine major areas of health education in the state. What follows is a summary of these large and complex public documents.

Medical education
According to the commission, as of 1972 Illinois ranked 23rd among the 50 states and the District of Columbia in the number of physicians per capita, with 148 doctors per 100,000 population. In 1966 we had only 134 doctors per 100,000. Nevertheless, Illinois had fallen in the national rank from 18th to 23rd between 1966 and 1972.

These figures do not reflect completely the growing number of Illinois medical students and graduates in the first half of the 1970's. There were 55 per cent more enrolled medical students in Illinois in 1975 than in 1968, and nearly twice as many Illinois residents were enrolled. But, the number of graduates had increased by only 35 per cent in the same period of time. The full benefits of Illinois' commitment to expanded medical education are yet to be felt. If all goes well, however, the number of enrolled students and graduates of state medical schools in 1980 will be double the 1968 figure. Also by 1980, the enrollment and graduation of Illinois residents will have nearly tripled, and we will be educating 50 per cent more physicians per capita than the national average.

More entering positions
The state is doing well in terms of providing opportunities for its residents to enter Illinois medical schools. More entering positions for Illinois residents are offered per capita than in most other states for their residents. The number of Illinois residents entering Illinois medical schools stood at 6.9 per 100,000 in 1974. This figure is projected to exceed? per 100,000 by 1980.

The percentage of enrollments for minority groups, however, is still disproportionately low, despite an increase from 3 per cent to 10 percent in the last five years. For example, in 1975 only 5.6 per cent of students enrolled in Illinois medical schools were blacky although blacks constitute 13 percent of the state's population. In response to this problem the commission recommended an affirmative action program in state medical schools to "enroll and retain a student mix that ethnically and geographically reflects the population base from which it draws its Illinios students."

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Another problem addressed by the commission last year was how best to retain physicians for practice in Illinois. Historically, Illinois has retained as many physicians graduated from schools in the state as it has attracted from outside. But Illinois graduates more doctors than most states, and a majority of them leave Illinois after medical school. In 1974 only 35 per cent of the state's medical school graduates remained in the state.

The reason for this exodus is the lack of available positions in the year-long Graduate Medical Education (GME), a post-medical school residency program, required before a physician can be licensed for independent practice. This is a crucial point in the problem of retention of doctors, since a high number of those who complete their internship or residency in a state will remain there to practice. Ail but one of the other 10 most populous states have better retention rates than Illinois.

According to the Health Education Commission report: "While the number of GME positions must be expanded to accommodate the enlarging number of Illinois medical school graduates, it is squally if not more important to make the residency programs attractive for Illinois and other American graduates." To specifically accomplish this task, the commission recommended that each medical school be responsible for at least as many first-year GME residency positions as it will have graduating physicians. It also recommended that emphasis be placed on recruiting Illinois graduates first, and other American graduates second for residency programs.

More importantly, the commission recommended state-funded grants to medical schools of from $15,000 to $ 17,500 for each new approved primary- care residency position. But preference must be given to graduates of Illinois schools.

Another aspect of Illinois medical education affected by the Campbell Report has been the rationalization of medical schools. This was recommended to help alleviate discrepancies in accessibility of physician services. The extremes of poor accessibility had been seen in sparsely populated areas of rural southern Illinois, and in the densely populated Chicago inner city. In these areas the highest percentage of families were found without regular medical care.

In 1968 the worst county ratio— 16.4 physicians per 100,000 population — was in Johnson County at the southern tip of Illinois. This was in sharp contrast to the highest ratio of 170.1 physicians per KM) .000 people in Cook County. In 1974, despite a statewide increase of 3.700 doctors, the distributional discrepancies had widened. Johnson County now had only 13 physicians per 100,000 people, compared to 281 in Cook County. Statewide, however, there was great improvement, with an increase of 28 physicians per 100,000.

We now have 12 whole or parts of medical schools in Illinois. Of the five health planning regions in the state only one does not have a medical school or a component of one. The exception is the area encompassing East St. Louis. Each of the downstate schools is centered in the midst of a population cluster exceeding one-half million people. A major expansion has occurred since 1968, when there were only six medical schools in the state, all located in the Chicago metropolitan region.

The successful rationalization of medical schools may eventually over- come the problem of inadequate distribution of doctors. It is hoped that the presence of medical schools in under- staffed areas will result in more doctors remaining in these areas after graduation and completion of the GME. Of the 102 counties in Illinois, 58 experienced an increase in the number of physicians per capita from 1966 to 1975. Still, only four counties are above the state average, and most of the growth has occurred in urban counties, where the supply of doctors was already high. Most rural counties haven't increased their supply of physicians.

A somewhat related shortage is in the distribution of physicians by specialty type. Studies suggest that well over 50 per cent of all physicians in a balanced health-care delivery system should be engaged in an "initial contact" or primary care specialty. In Illinois only about 45 per cent of active physicians are in primary care specialties, such as family practice, general practice, pediatrics, general intern, and obstettrics/gynecoiogy. What is worse is the fact that only 40 per cent of the state's medical students intend to practice in primary care areas. The Health Education Commission recommended that this trend be reversed as a condition for

August 1976/ Illinois Issues/15

We'll have the doctors, dentists and other medical experts to treat the health problems of people, but there won't be enough veterinarians for the animals

state grants to public and private medical schools.

Nursing education
There are about 49,000 employed nurses or 440 per 100,000 population in Illinois. This is four per cent above the national average. It is also a major increase from the 33,700 employed nurses we had in 1966. The increase comes as a result of the Campbell Report's recommendation for expansion of nursing education at the associate, baccalaureate and masters degree levels. It also called for establishment of a doctorate program. All four points are now a reality. Since 1968, 15 new associate degree programs, seven new baccalaureate programs and three new masters programs have been initiated. A new doctoral program was begun in the fall of last year.

Dental education
Illinois has about six per cent more active dentists than the national average, but has experienced a decrease in dentists since the mid-1960's. In 1966 we had 56 dentists per 100,000 people. This number decreased in 1972 to only 50 per 100,000. One reason for the decline was the comparatively large number of older dentists in 1966, many of whom have retired.

As with medicine, there is a geographic distribution problem in Illinois dentistry. Our number of dentists ranges from 60 per 100,000 in the Chicago area to 36 in the East St. Louis region. It is expected, however, that a new private dental school in Alton will increase the supply of dentists downstate.

There are four dental schools in the state, three in Chicago and one in Alton. are these schools are public and two private. Enrollments in them have increased nearly 50 per cent since 1968, while their number of graduates has gone up by 22 per cent.

Illinois' commitment to expanded dental education, as in medicine, has yet to reach fruition in terms of enrollment and graduation figures. The new school at Alton graduated its first class last year, and the University of Illinois expansion is not yet complete. Projections indicate that by 1979 total enrollments will have gone up by 68 per cent and graduates will have increased by 74 per cent. We may have an increase of about 360 dentists each year until, by the end of the century, there could be 90 to 100 dentists per 100,000 population, a larger number than any other state in the country at present.

Pharmacy education
Illinois has about two per cent more pharmacists per capita than the nation as a whole. We do not have a uniform distribution, but the imbalance is not as bad as with medicine and dentistry. There is only one pharmacy education program in the state, that being the Illinois College of Pharmacy at the University of Illinois medical center in Chicago. Following suggestions in the Campbell Report, the college has expanded its program from 100 graduates in 1968 to 140 last year, with a projection of 170 by 1980.

Veterinary medicine
Illinois does not have enough veterinarians. According to a study by the research council of the National Academy of Sciences, about 17.5 vets are needed per 100,000 population. An additional 600 are needed to reach that ratio, There is only one school of veterinary medicine in Illinois (at the University of Illinois in Urbana-Champaign), but thus far it has done little to combat the shortage. It graduated only 62 veterinarians in 1973, compared to 51 in 1968. But a plan has been formulated there which would, if funded, increase the number of graduates to 100 annually by the early 1980's. The Health Education Commission has claimed that this would be sufficient "over time to achieve the ratio of 17.5 veterinarians per 100,000 population."

Optometric education
Illinois has more active optometrists than any other state, and there will continue to be no dearth of such practitioners for the next decade here. We have one private college of optometry in the state, with 522 students. Since it receives only minimal state aid, the Health Education Commission recommended that it receive an annual operating grant from the state of $ 1,400 per Illinois resident enrolled.

Podiatric education
Illinois ranks seventh among the states and the District of Columbia in active podiatrists (foot doctors) per capita, but nearly half the counties here have no podiatrist.

The Illinois College of Podiatric Medicine is one of six in the nation. It has 452 students, and an entering class of about 150. The HEC recommended a grant to the school of $ l ,900 per Illinois resident enrolled in the college.

Public health and health administration education This field has many sub categories of professional specialties performing functions such as disease prevention, environmental protection, health care delivery systems, occupational and industrial health protection, as well as management of health agencies and institutions.

The only school of public health in Illinois is at the University of Illinois Medical Center in Chicago. It was begun in response to the Campbell Report. At other universities in the state there are five masters programs, one baccalaureate program and one doctoral program in health administration. Only one of these has been in operation for more than five years.

Allied health professions education
This field includes over 200 separate professions, ranging from clinical laboratory scientists to dental assistants, all of whom carry responsibility for care of patients. As members of a health care team, they are guided by physicians or dentists. There are many educational programs preparing such professionals in Illinois. Unfortunately, there are not enough clinical education placements for those finishing formal schooling. This is especially regrettable since training for most of these professions demands considerable clinical experience. A greater cooperation between educational and clinical institutions has been called for by the Health Education Commission. ž

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