J. MILLARD TAWES, Governor                     1371

The Senate of Maryland is much concerned over the shortage of
general practitioners and other types of physicians in the State of
Maryland and particularly in rural areas. For this reason, the Sen-
ate gives its enthusiastic support to current efforts of the University
of Maryland School of Medicine to expand its capacities and facilities.

The present shortage of medical manpower probably will increase
during future years unless strenuous efforts are made to combat the
trend. There is a wide variety of interacting factors responsible for
the current shortage. These factors have been described as follows:

(a)    Increase in population without proportionate increase of
physicians.

(b)     Maldistribution of physicians due to forces producing urbani-
zation of the whole population. These forces include industrializa-
tion, low economic base in some rural areas, lack of educational and
cultural advantages for physician's family, and the whole social
complex producing the "megalopolis." Physicians are like other
people; they are affected by this too.

(c)    Marked specialization to adapt to enormous increase in bio-
medical scientific knowledge. Physicians after graduation from
medical school are currently dispersed into no less than twenty-four
specialties approved by the AMA. Obviously this leaves fewer in
general practice, internal medicine and pediatrics which are the
major three which approach "the whole patient."

(d)     Enormous national emphasis and glamor on research espe-
cially basic research. This is well documented in the budgets of the
space agency, the National Institutes of Health, the Defense De-
partment and also private industry. All of this is of course re-
flected back to the medical school where the young impressionable
student during his first two years is well grounded in the basic
bio-medical sciences. This is correct, good and necessary, but some-
how in the process he also absorbs the notion that herein (rather
than in routine patient care) lies the importance, glamor, status and
future of his career in medicine. The summer training program in
public health for young medical students which our department has
operated for the past fifteen years is, among other things, intended
to partially counterbalance this.

(e)    Enormous increases in expectations by a better informed
public for health services. Average number of visits to a physician
per year have more than doubled recently.

(f)    Great increases in public buying power for medical services,
e.g. Blue Shield, Maryland Medical Care Programs, Medicare, other
insurance and generally increased prosperity.

(g)    Dramatic change in the nature of disease. Illnesses are less
frequently "episodic." For example pneumonia was once a very
common illness and killer. One had a few visits from a physician
and either died or recovered. Then the individual did not call the
physician until the next episode. Now chronic illness and disability
have taken over. This means years or a lifetime of illness—requiring
"maintenance medicine." Examples are heart disease, cancer, stroke,
paraplegias, mental retardation, rheumatism and arthritis, mental
illness and so on. In my view this is by far the most important
factor. It absolutely necessitates organization of the various needed