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5
Nurturing Scientific Talent
Maintaining a cadre of highly talented health scientists is the most
critical element in sustaining the vitality of the U.S. system of health
sciences research. Evidence from across the educational spectrum indicates
that the United States is facing a future shortage of qualified researchers,
which will threaten the nation's ability to prepare for scientific challenges
of the twenty-first century. In the next 15 years many of the individuals who
conceived the ideas that have revolutionized health sciences research will
be retiring. Neglect in educating and training their replacements inevitably
will lead to a decline in the nation's capabilities in health-related research,
an area in which the United States has maintained an unchallenged world
leadership for the past 40 years.
Particularly alarming is the apparent decline in the number of physi-
cians engaged in health-related research. The study of many fundamental
biological questions begins with investigation into human disease processes,
and human data are essential to address these questions effectively. The
defining and understanding of these problems are largely in the hands of
physician-scientists, who also serve as technology-transfer agents, translating
fundamental laboratory discoveries into clinical practice.
Accurately assessing the magnitude and timing of an impending per-
sonnel shortage depends upon a variety of factors. Scientific employment
growth in academia, government, and the private sector is tied closely to
the economic health of the nation. As the post-World War II baby boomers
grow older, the retirement rate among scientists trained in the l950s and
1960s will accelerate, increasing the demand for replacements. Also, a
117
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118
FUND NO HEALTH SCIENCES RESEARCH
higher death rate in this more elderly scientist population will increase
demand in the health scientist labor market. The composition of the future
health scientist work force also will be affected by changing demographics
with regard to age, gender, race, ethnicity, and immigration, as well as the
quality of scientific education and training.
An accurate assessment of all of these factors affecting the scientific
work force must be part of a decision-making process regarding research
training needs. A comprehensive talent renewal plan must encompass
the multitude of research disciplines that range from basic to applied
investigation. This chapter examines the available data on the research
work force and highlights the possible implications for the future health
scientist talent pool.
PROBLEMS IN THE HUMAN RESOURCE BASE
Precollege
The pathway to a scientific career does not begin in undergraduate
or postgraduate years; rather, an interest in science is kindled in the
early years of formal education kindergarten through grade 12. However,
several recent national and international studies have shown a continuous
decline in science and mathematics skills by American students at all
educational levels. Although the committee focused its deliberations on
the resources for graduate and postdoctoral education and training, the
committee recognized that competency in precollege and undergraduate
science and mathematics education is critical for preparing students for
scientific careers. Additionally, an early appreciation of the excitement
of scientific discovery is important for attracting students into scientific
careers.
About three-quarters of all students who eventually major in science
and engineering follow a college preparatory curriculum.) However, the
National Assessment of Educational Progress, which is part of the federally
sponsored Nation's Report Card conducted by the Educational Testing Ser-
vice, concluded that only 7 percent of 17 year olds in 1986 were prepared
adequately for college-level science courses.2 This report also confirmed the
race and ethnicity gaps that previous studies have found in science achieve-
ment. Whereas only about 15 percent of African-American and Hispanic
17 year olds demonstrated the ability to analyze scientific procedures and
data, nearly half of their white peers could do so.
~ .
Despite inherent difficulties in interpreting comparative international
education data, a study of mathematics and science abilities among students
in four foreign countries, four Canadian provinces, and the United States
ranked the American students near the bottom in these skills.3 The National
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NURTURING SCIENTIFIC TALENT
NUMBER (Millions)
3
2.9
2.8
2.7
2.6
2.5
/ \
Rae
/
\
2.4 , , , 1 , , 1 , 1 , 1 1 1 1 1 ,
86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2
YEAR
119
r
... . ...
. .
3 4
FIGURE 5-1 Projected number of U.S. high school graduates from 1986 to 2004.
(Repented with permission from Western Interstate Commission for Higher Education.
High School Graduates: Projections by State, 1986 to 2004. Boulder, CO; 1988.)
Research Council has drawn attention to the poor mathematics proficiency
of American students in a report entitled Everybody Counts: A Report to
the Nation on the Future of Mathematics Education.4 This study called for
a complete overhaul of precollege mathematics education in the United
States and suggested alternative educational strategies to counteract this
growing problem.
Moreover, national demographic evidence indicates that the number
of high school graduates is expected to decline by 12 percent between 1988
and 1992, from nearly 2.77 million to 2.44 million students (Figure 5-1~.5
Unless these trends change, the declining number of high school graduates
is expected to lead to declining undergraduate enrollment in U.S. colleges
and universities in the early to mid 1990s. However, the number of high
school graduates is expected to return to the 1988 level by 1998 and will
coincide directly with a rapidly increasing retirement rate of university
faculty.
Undergraduate
A recent study by the Office of Technology Assessment, tracldng the
progress of American students toward careers in science and engineering,
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FUNDING HEALTH SCIENCES RESEARCH
exemplifies the attrition rates from the available talent pool during all stages
of scientific career development.6 From an original study group of 4,000
ninth-grade students, only 1,000 had sufficient mathematics abilities at that
point to pursue a scientific or engineering career. When these students
had completed their secondary school education, only 500 were adequately
prepared to continue in a science or engineering college curriculum. At
this point, women were represented equally in the study group. However,
upon entering college the number of women electing to pursue a science
or engineering career fell to 44 of 250 individuals compared to 140 of 250
for men. By the completion of their baccalaureate programs, only 66 of
the original study group of 4,000 received B.S. degrees-a precipitous drop
of more than 98 percent in the original. This example illustrates vividly the
problem of recruiting individuals into the sciences, especially as it applies
to women and other underrepresented groups.
Unfortunately, major losses in the science and engineering talent pool
occur during the undergraduate years.7 Students usually make career deci-
sions during this critical undergraduate period. Thus, recruiting individuals
into the health sciences will depend upon the following factors:
· enthusiasm engendered by high-quality teaching,
· scientific opportunity and excitement,
· economic status of the nation,
financial support for education, and
financial rewards from employment opportunities.
Students interested in health sciences research generally follow curric-
ula that prepare them for graduate study leading to professional degrees
either Ph.D.s or M.D.s. Relevant areas include not only biology and chem-
istry but also such fields as physics, mathematics, psychology, or the social
sciences. Data gathered over the past 10 years reveal a decline in earned
bachelor degrees in the life sciences (Figure 5-2~.7~8 Although life scientists
are not the exclusive talent pool for the health sciences, the committee
believes that a significant portion of health scientists with advanced degrees
come from this student population. Also, the committee believes that over
the last 10 to 15 years, the supply of high-quality graduate students in the
health sciences has declined.
Considerable discussion has focused on reasons for the failure of
science educators to stimulate student interest in scientific careers. The
committee believes that this failure may be due partly to the widespread
practice of collegiate science education stressing passive learning through
lectures rather than active learning through participation in research. Hon-
ors programs that include hands-on research in conjunction with faculty
mentors provide an example of active learning that can stimulate students
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NURTURING SCIENTIFIC TALENT
250
200
150
100
50
121
Thousands
if+
O 1 1 1
71 73 75 77
79 81 83 85
YEAR
Life Sciences ~ Soc/Behav Sciences - + - Busine&s/Mgm t
FIGURE S-2 Number of bachelors degrees awarded in the life sciences, social and
behavioral sciences, and business/management from 1965 to 1985.3
to pursue research careers. Also, family values concerning education have
a great deal of influence on childhood learning and performance.
Although science education and training for undergraduates fall within
the purview of the Science and Engineering Education Directorate of the
National Science Foundation (NSE;), the problem of recruiting students into
science and engineering careers has recently been addressed by Congress.
The National Science Scholars Program, part of the President's Educational
Excellence Act, is designed to encourage exceptional students to pursue
careers in scientific and engineering fields.9 Modeled on congressional
appointments to military academies, the proposed program calls for federal
support for undergraduate education in science and engineering for two
appointees (one female and one male) for every member of Congress.
The awards would be 4-year fellowships, based on merit and a competitive
selection process, for study at an institution of the student's choice. The
program would sponsor approximately 1,000 new scholarships per year,
each having an annual stipend of $5,000. Staling $18 million per year
when fully operational, this program should act as a catalyst to attract
additional student financial aid from other sources. The committee believes
that this type of program focuses local attention on science and engineering
education and serves as a highly visible example of congressional support for
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FUNDING HEALTH SCIENCES RESEARCH
renewing scientific talent. The small size of this program, however, clearly
will not be sufficient to meet expected shortages in all of the sciences.
The racial and ethnic composition of the U.S. population is changing,
and these changes also will affect the pool from which scientific talent
is drawn. The U.S. Bureau of the Census estimates that the minority
composition of the 22-year-old population will grow to 20 percent by 200W
up from 14 percent in 1975.~° Ethnic and racial minorities historically have
been underrepresented in science and engineering. Whereas nearly 5
percent of white and Asian 22 year olds have earned baccalaureate degrees
in natural science or engineering, only 1.6 percent of blacks, Hispanics, and
Native Americans have earned the same degrees.
In the 1970s the National Institutes of Health (NIH) created the
Minority Access to Research Careers (MARC) Honors Program to increase
the number of minority students pursuing graduate study leading to a Ph.D.
in biomedical science. The largest portion of the MARC program is the
Honors Undergraduate Research Raining Program. Trainees at selected
institutions receive tuition support and a stipend to participate in a specially
structured curriculum. Working closely with faculty members on laboratory
research projects in the biomedical sciences is a key element in the training
experience. Longitudinal data are not yet substantial enough to determine
if this program is having a significant effect on recruiting minorities into
graduate health research programs, however. Although the Institute of
Medicine (IOM) undertook a survey evaluation of the MARC program in
1985, it was too early to gauge the success of the program, and no remedies
were suggested to address the problems identified.
Scientific Doctorates (Ph.D.s)
The transition from undergraduate to graduate school is another criti-
cal juncture in the retention of candidates for future careers in the health
sciences. Large numbers of undergraduates elect not to pursue graduate
studies; of those who do, an unknown number either may not complete
their graduate program or may leave research upon earning a doctorate.
Data from the NSF Survey of Graduate Science and Engineering Students
and Postdoctorates reveal that graduate student enrollment (not including
postdoctorates) in the life sciences has grown only slightly since 1980, from
102,504 to 108,641, whereas enrollment in the physical sciences has grown
by more than 23 percent annually, from 26,952 to 33,203.~3 Enrollment in
the social sciences has declined slightly over the same period, from 94,778
to 91,884.~3
There is a considerable lag time affecting the scientific labor market
that must be considered when policy is formulated. Presently recognized
opportunities will affect the scientific work force 5 to 8 years hence, upon
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NURTURING SCIENTIFIC TALENT
123
completion of a doctoral program, clinical training program, or a postdoc-
toral fellowship. In short, salaries and economic opportunity in 1989 will
have affected graduate enrollment that year, but the 1989 graduate school
entrants will not affect labor force supply until possibly 1995. This scenario
is compounded by the fact that there also will be a significant decline in
the size of the 18- to 24-year-old population the talent pool available
for recruiting into graduate study in the late l990s, when many tenured
faculty members are expected to retire.8
The number of foreign graduate students enrolled in U.S. institutions
as well as the percent of degrees conferred on foreign nationals has in-
creased steadily over the past decade.~4~5 The United States produces
nearly 14,500 natural scientists and engineers annually, up from 12,000
in 1978. In 1987 about 9,700 science and engineering doctorates were
conferred on U.S. citizens or foreign nationals with permanent visas. The
remaining 3,800 doctorates were conferred on foreign citizens with tempo-
rary U.S. visas. Of those students on temporary visas receiving doctorates
in 1987, about half remained in the United States to pursue employment
(23 percent) or postdoctoral studies (25 percent). Thus, immigration com-
pensates for shortages in trained U.S. personnel and adds to the intellectual
and technological abilities of the country's scientific work force. But while
foreign students earned only 16 percent of the doctorates in life sciences in
1987, the committee believes that the health sciences should not follow the
path of engineering, in which almost half of the doctorates are conferred on
foreign nationals. Such heavy reliance on foreign talent could jeopardize
the future success of American science efforts and the national economy
should fewer and fewer degree recipients elect to remain in the United
States.
Although women make up 42 percent of the U.S. work force (U.S.
Department of Labor Statistics, personal communication, 1~19-89) they
have been underrepresented historically in science and engineering. In
1977 women represented only 10.4 percent of all doctoral scientists and
engineers.~7 Although their numbers have grown from 31,800 in 1977 to
73,423 in 1987, for example-women scientists and engineers still account
for only 16.3 percent of the total doctoral population. However, the annual
proportion of doctorates conferred on women has been growing steadily
over the last three decades.~5 In 1987 women earned 35 percent of the
doctorates awarded in the life sciences. In the social sciences they earned
43 percent, but they earned only 17 percent of all doctorates in the physical
sciences. Since individuals in each of these broad categories pursue careers
in the health sciences, these data indicate that there have been small gains
toward equal representation between men and women in the scientific work
force.
The proportion of non-Asian minorities receiving doctorates is not
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124
FUNDING HEALTH SCIENCES RESEARCH
increasing; rather, recruitment appears to be worsening in these groups.l5
Whereas the number of black women earning doctorates annually between
1977 and 1987 has remained fairly steady at about 500, the number of
degrees conferred annually on black men has been halved to about 300.
Also, whereas doctorates conferred on Hispanic women have more than
doubled to 28~in the same period, the number going to Hispanic men
has remained steady at about 300. These data raise serious questions
about policies and programs for improving minority participation in higher
education as well as research and pose a problem regarding cultural values.
The committee emphasizes that the recruiting difficulties of non-Asian
minority males should be of particular concern to all policymakers and
educators.
The United States employs about 12,500 new Ph.D. scientists and
engineers each year. Industry has been creating about 5,500 new Ph.D.
positions per year for scientists and engineers. If these hiring practices
prevail and retirements in this sector begin to increase as we approach the
year 2000, the demand in industry and business could increase to nearly
9,500 by that time. Retirement rates of academic faculty also are expected
to increase over the next 15 years, rising from about 2,000 in 1988 to
more than 4,500 in 2004. Although demographic evidence indicates that
there may be a dearth in undergraduate enrollment in the early l990s,
the impending retirements, coinciding with a surge of 18 to 24 year olds
toward the end of the next decade could create an annual academic demand
for new Ph.D. scientists and engineers of nearly 8,500 by 2004. At current
production rates, even if we rely heavily on the possibility of filling positions
with foreign students receiving U.S. doctorates, the annual shortfall still may
be as high as 7,500 in the first decade of the twenty-first century. Although
these data predict shortages for all natural sciences and for engineering,
potential shortages in the health sciences can be expected as well.
Data from the Doctorate Records Survey shows that between 1973 and
1987, employment of biomedical scientists by all sectors grew 4.9 percent
annually, rising from 43,000 to 84,500. This includes the 43,000 scientists
and 8,200 postdoctorates employed by academic institutions regardless of
their level of research activity, 16,000 scientists employed by industry, as
well as other Ph.D.s outside academia actively engaged in or managing
research and development.
Seventy-six percent of these scientists hold doctorates in biomedical
sciences (Figure 5-3~; the remaining twenty-four percent have doctorates
in fields other than biomedical science. Over this same period the annual
output of new biomedical Ph.D. recipients grew by 12.8 percent from 3,520
to 3,969. However, not all recipients of biomedical degrees are employed
as biomedical scientists; approximately 24 percent are engaged in other
activities (Figure 5-4~. Over the past decade the growth in employment for
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NURTURING SCIENTIFIC TALENT
/
/::
f
Biomedical Sciences 7696 ::
125
Other 996
Physical Sciences 8%
,7 Engineering 3%
\ I ,~ Behavioral Sciences 4%
Degree Types as a Percent
of the Workforce
FIGURE 5-3 Composition of the biomedical work force. (Source: Office of Science and
Engineenng Personnel, National Research Council)
Biomed ical
76%
a_
Other
24%
~ _
Field of Employment
Physical 3
Engineering 1.2
Humanities 3.5
Behavioral 0.5
Other 14.6
FIGURE Sot Employment of biomedical scientists. (Source: Office of Science and
Engineering Personnel, National Research Council)
biomedical scientists largely has been in industry, growing an average of 12
to 13 percent annually.l9
The employment of behavioral scientists grew 113.6 percent between
1973 and 1987, rising from 31,669 to 67,651.~9 More than 91 percent of
the vacancies in behavioral sciences are filled by individuals with doctorates
in the behavioral sciences. The number of behavioral sciences doctoral
degrees conferred annually has climbed from 3,542 to 3,960, reflecting an
11.8 percent change over the same period. One element that may skew
these data is the surge in clinical psychology degrees that has occurred over
the past few years.
One factor affecting the output of Ph.D. scientists is the increasing
time needed to earn a doctorate.20 Whereas the median registered time to
degree (i.e., the time the student is registered for formal courses or thesis
preparation with the university registrar) for all fields was about 5.4 years
in 1967, by 1987 it had increased to 6.9 years. While the largest increase
was noted for graduate students in the humanities, doctoral candidates in
the physical and life sciences now spend more than 6 years in graduate
study, compared to just over 5 years two decades ago. In the social sciences
the median was 7.2 years in the 1987 survey, compared to 5.2 years in
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FUNDING HEALTH SCIENCES RESEARCH
1967. It is not clear to the committee how this affects the financial support
mechanisms from the federal government or other sources.
Professional Doctorates (M.D.s and M.D./Ph.D.s)
Physician-scientists are charged with carrying fundamental discoveries
in the laboratory to the patient and assessing the efficacy of new treatments
and other interventions for improved health care. The recruitment of
physician-scientists into research careers is hampered severely by the length
of time necessary for clinical training, the often unfocused structure of
clinical research experience, the need for the individual to understand
increasingly complex technologies, and the requirement of the physician to
generate clinical income at the expense of time for performing research. At
a time when biology and medicine offer exciting opportunities for improved
health care, this declining interest in investigative careers is particularly
troublesome. The problem is magnified for the fields of public health and
preventive medicine, where no practice income is raised to support salaries
or subsidize education.
The majority of M.D. and M.D./Ph.D. scientists are employed by med-
ical schools, the government, and private research institutions. According
to the American Medical Association (AMA) Physician Masterfile, there
were 569,160 federal and nonfederal physicians in the United States as of
December 1986.2i Of these, 86,670 (15.2 percent) were female and 123,090
(21.6 percent) were foreign medical graduates (excluding Canadian gradu-
ates). The number of physicians reporting research activity had grown from
11,929 in 1970 to 18,535 in 1983. However, from the time of the 1983 survey
to 1986, there was a drop of nearly 700 to 17,847 physicians engaged in
research.2i This also reflects a drop from 3.6 percent of the total physician
population engaged in research in 1983 to 3.1 percent in 1986. The 1986
population of physician researchers was composed of 16.2 percent women
and 23.5 percent foreign medical graduates, both groups being represented
slightly higher than their proportion in the total physician population. A1-
though these data may be flawed and the small shifts reported by the AMA
may not be significant, the committee believes that in recent years there
has been no growth in the number of physicians participating in research.
The number of applicants to U.S. medical schools has dropped by
more than 30 percent in the past 10 years, from 40,600 in 1977 to 28,100 in
1987 (Figure 5_5~.22,23 This decline has engendered concern in the nation's
medical centers about the future quality of medical care in the United
States as well as the capabilities of physician-scientists.
With the increasing sophistication of health sciences research, educa-
tors have recognized the need to develop pathways to ensure that physicians
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NURTURING SCIENTIFIC TALENT
NUMBER (Thousands)
40
30
20
10
127
77 78 79 80 81
Total Applicants
82 83 84 85 86 87
YEAR
_ Total Enrollees
FIGURE 5-5 Number of U.S. medical school applicants and enrollment Mom 1977 to
1988 22,23
are as rigorously trained in scientific methodology as their Ph.D. counter-
parts. One pathway for achieving this goal is to encourage some physicians
to enter doctoral programs in specific research areas leading to a combined
M.D./Ph.D. degree. While more than 100 of the 127 U.S. medical schools
offer programs for combined M.D./Ph.D. degrees in various areas such as
biomedical sciences, social sciences, humanities, biomedical engineering,
and law, and only 20 to 30 graduate significant numbers of M.D./Ph.D.
candidates.23 Such combined training provides enhanced research experi-
ence that more thoroughly prepares physician researchers for independent
basic or clinical investigation.
Some committee members believe that although M.D./Ph.D. programs
provide a suitable model for training physicians in research methodology,
these are not the pathways followed by most physicians pursuing careers as
independent investigators. There are existing models in the nonbiological
sciences that tailor coursework in areas to meet the special needs of the
physician-scientist, and that link supervision with an established physician
mentor (e.g., the Robert Wood Johnson Clinical Scholars Program). For
physicians who choose investigative careers in disciplines such as epidemi-
ology, health services research, or health policy, these alternative models
may be preferred.
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FUNDING HEAI=H SCIENCES RESEARCH
From Degree to Scientist
The prolonged period of time it takes to earn a doctorate and the
subsequent extensive postdoctorate training time necessary for both Ph.D.
and M.D. scientists often force these individuals to postpone at least some
aspects of their personal lives. Both the financial concerns of young families
and the balancing needs of two~areer families encourage these scientists
to move more quicldy to establish a stable career.
Clinical training is of particular concern because it requires a sub-
stantial time investment, especially if the physician embarks on a career
requiring subspecialization. Subspecialties in internal medicine and surgery
now require between 5 to 7 years of postdoctoral training after medical
school. Since many specialty boards do not allow credit toward certification
for research, a formal research training period most often following the
clinical subspe~cialty training, extends the training time invested to 8 or
more years. This training time often coincides with the payback period of
the considerable financial debt that many physician graduates accumulate
during medical school.
Moreover, because of clinical training demands, research training ex-
periences for physician-scientists often are unstructured and poorly focused.
It is rare for either clinical training or clinical research experiences to in-
clude formal instruction in scientific design, research methodology, and
statistical analysis. Additionally, if they lack critical review or accreditation,
clinical research training programs fail to introduce standards and account-
ability. As a result, physician-scientists often are less prepared for pursuing
research than more rigorously trained Ph.D. scientists who have had 4 to
5 years of formal research laboratory training. A 2-year research experi-
ence, particularly when poorly focused, often leaves physician-scientists less
prepared for competing in the peer-reviewed grant system than are more
formally trained Ph.D. scientists.
Other pressures in the modern medicine environment add to the
discouragement of physicians involved in clinical investigation as well. A
recent IOM report on resources for clinical investigation concluded that
fundamental changes in the organization of health care and the mounting
efforts aimed at cost containment discourage clinical research scientists
from pursuing clinical investigations.24 Along with the pressures that young
physician-scientists face earn in their careers, there are pressures upon all
physicians to earn clinical income for their academic health center. Clinical
income is more predictable than research grants, particularly in terms of
institutional revenues. As medical schools rely more and more on faculty
practice plans for salary support, clinical faculty members are pressured
to maintain their clinical practice incomes. These pressures~irect or
indirect, bold or subtle are felt by virtually all M.D. investigators.
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NURTURING SCIENTIFIC TALENT
129
Compounding these difficulties, the practice of medicine has become
more complex and uses more advanced technology than ever before. Even
the so-called cognitive specialties such as internal medicine are heavily de-
pendent upon advanced technological procedures, which require technical
skills that must be practiced regularly to maintain a high level of compe-
tence, making it more difficult for physician-scientists to devote precious
time to scientific investigation (unless these individuals are in unusually
supportive academic environments).
PROBLEMS WITH THE FINANCIAL SUPPORT BASE
For nearly 40 years the Science and Engineering Education (SEE) Di-
rectorate of NSF has been the primary sponsor of programs for developing
scientific talent at the undergraduate level. At its peak in 1960 and 1961,
this directorate controlled more than 40 percent of the NSF budget.25 In
the ensuing 20 years, appropriations to SEE failed to keep pace with other
parts of the NSF budget, until only 1.5 percent was allocated to science
and engineering education by 1983. In recent years, however, the admin-
istration has recognized the vital importance of science and engineering
to national security and international competitiveness. This reemphasis is
reflected in the recent NSF budgets where funding to SEE has grown from
$55 million in 1987 to a proposed $251 million in 1991 nearly 10 percent
of the 1991 NSF budget.
Federal support for training health scientists began with the passage
of the National Cancer Act of 1937 which authorized the U.S. Surgeon
General to provide fellowships and train personnel for cancer research
and prevention. This authority was expanded in the Public Health Service
Act of 1944, expanding training programs sponsored by the NIH. This act
not only increased the research capacity of the U.S., but also provided
broad financial support to medical students, whether or not they expected
to pursue research careers. In 1973 the Nixon administration impounded
NIH training funds in an effort to phase out all research training. Congress
responded by passing the National Research Service Award (NRSA) Act
(P.L. 93-348) in 1974. This act authorized training at the level of the
Public Health Service to be conducted primarily in the NIH, the Alcohol,
Drug Abuse, and Mental Health Administration (ADAMHA), and the
Health Resources Service Administration (HRSA). By creating a separate
authorization, research training is now loosely connected to research but
the budgets are acted upon separately by congressional appropriations
committees.
The NRSA act eliminated support for medical students except those
pursuing research careers. Additionally, the act included a service obli-
gation requiring those trainees receiving funds to be actively engaged in
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130
250
200
150
100
50
FUNDING HEALTH SCIENCES RESEARCH
DOLLARS (Millions)
350
300 _
~ ,
O 1 1 1 1 1 1 1 1 1 1 1 1 1
77 78 79 80 81 82 83 84 85 86 87 88 89 90 91
YEAR
- Constant 1988 $ -+- Current $
{~.) {~es.)
FIGURE 5~ NIH obligations for National Research Service Award (NRSA) training.
(AppendLx liable A-12)
research equivalent to one month of service for each month of support.
This requirement has been modified to allow for short periods of support
without a payback However, if trainees elect not to pursue research ca-
reers they must pay back the costs of their education to the government.
The NRSA act limited support to an aggregate of 5 years for predoctoral
studies and 3 years for postdoctoral research.
The NIH and ADAMHA are the primary federal sponsors for training
in the health sciences. In 1971 NIH allocations for training as a percent
of R&D funds exceeded 18 percent.26 Research training allocations fell
below 11 percent of the NIH research budget in 1973 and have continued
to decline, accounting for less than 5 percent of R&D allocations in
1988. Additionally, appropriations targeted for training have declined from
nearly $290 million in 1980 to about $250 million in 1990 when measured
in constant 1988 dollars (Figure 5~.27
The number of full-time training positions (t l l Ps) supported by NIH
has remained fairly constant each year-between 11,000 and 12,000 since
the late 1970s (Figure 5-7~. However, in order to increase sagging stipend
levels, NIH trimmed support for 1,000 ~ l lPs in fiscal year 1989.28 Since
NIH supports approximately one-quarter of the graduate students in the
biomedical sciences through the NRSA program, these cuts in training
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NURTURING SCIENTIFIC TALENT
131
positions were quite significant. NIH reestablished these positions by re-
programming other funds in 1989.
Declining training support has devastated the training of the next gen-
eration of behavioral and social scientists.29 In the early 1970s ADAMHA
allocations for research training exceeded 14 percent of R&D funds. As
with NIH, training allocations in ADAMHA have declined to about 5 per-
cent of research funds in 1988. Whereas NIH training obligations have
declined about 17 percent in constant dollars, ADAMHA obligations for
research training have been reduced by more than half since 1977 (Figure
5-8~. There also has been a concomitant decline in the number of training
positions, falling from 1,800 in 1977 to a low of 1,100 in 1986. The number
of positions rebounded slightly, to nearly 1,300, in 1988 (Figure 5-9~.
Raining funds from NIH and ADAMHA are awarded through compet-
itively reviewed institutional training grants or individual fellowship awards.
About 85 percent of NIH-sponsored training appointments are supported
on NRSA training grants awarded to institutions for either predoctoral (50
percent) or postdoctoral (35 percent) training.27 Of the remaining training
funds, 13 to 14 percent are awarded through NRSA individual postdoctoral
fellowship awards, and slightly less than 2 percent are allocated to individ-
ual predoctoral fellowships. About 55 percent of the predoctoral training
positions are awarded through the NIGMS followed distantly by NCI with
14
1 2
10
8
6
4
2
o
NUMBER of FTTP (Thousands)
77 78 79 80 81 82 83 84 85
YEAR
~ Predoctoral ~ Postdoctoral
86 87 88 89 90 91
(...., ,..t.,
FIGURE 5-7 Number of full-time training positions (t l lYs) sponsored by the NIH from
1977 to 1991. (Appendix Able A-19)
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132
35
30
25
20
15
10
FUNDING HEALTH SCIENCES RESEARCH
DOLLARS (Millions)
o
78 79 80
81 82 83 84
YEAR
~ Constant 1988 $ ~+- Current $
85 86 87 88 89
FIGURE 5~ ADAMHA obligations for NRSA training. (Appendix liable A-20)
2000
1 500
1 000
500
o
NUMBER of FTTPs
_-, i,:.:.: ... . ..
78 79 80 81 82 83 84
YEAR
Predoctoral
85 86 87 88 89
Postdoctoral
FIGURE 5-9 Number of full-time training positions (LllPs) sponsored by ADAMHA
from 1978 to 1989. (Appendix Table A-20)
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NURTURING SCIENTIFIC TALENT
133
10 percent of the predoctoral slots. NHLBI has the largest portion of
postdoctoral positions-sponsoring about 20 percent of all NIH-supported
postdoctorates.
Similar to NIH, about 87 percent of ADAMHA training funds are
distributed through predoctoral and postdoctoral training grants, and only
13 percent support fellowship awards.30 Currently, there is about equal dis-
tribution between predoctoral and postdoctoral support of full-time equiv-
alent training positions in both NIH and ADAMHA Whereas this ratio
has been stable over the last decade for NIH, the cuts to research training
in ADAMHA have affected only predoctoral positions, which have fallen
from 1,178 to 694.29 30 It should be noted that ~ l l Ps totals are generally
less than appointments because several short-term appointees can equal
one ~ l lP.
The distribution between M.D. and Ph.D. postdoctoral training ap-
pointments has shifted slightly since 1980. In 1980 support was weighted
more heavily toward Ph.D. postdoctorates, with 3,656 supported in com-
parison to 2,092 M.D. postdoctorates.27 By 1987 the number of M.D.
postdoctorates had increased to 2,532, thereby bringing support more in
line with the 3,139 Ph.D. postdoctorates supported that year (Figure 5-10~.
Increased efforts to support more physician-scientists should increase the
competitiveness of this group and enable them to win a larger share of
investigator-initiated research project support.
The Medical Scientist Gaining Program (MSTP) sponsored by NIH
is the largest national program for individuals pursuing joint M.D./Ph.D.
degrees. This program is sponsored by NIGMS and has supported about
700 MSTP trainees annually throughout the 1980s.27 Although the NIH
funds programs in 28 medical schools, many more combined programs
are supported in U.S. medical schools by private, state, and institutional
funds. However, the committee was not able to determine the size of these
commitments.23
The NSF Survey of Graduate Science and Engineering Students and
Postdoctorates reports that large numbers of students are supported by
teaching assistantships and a smaller but still significant number are sup-
ported on research grants.~3 Unfortunately, graduate students and postdoc-
toral fellows supported on research project grants from NIH and ADAMHA
are not identified in the NIH database and the magnitude of this support,
therefore, is difficult to ascertain. However, data from the Survey of Grad-
uate Science and Engineering Students and Postdoctorates conducted by
the NSF indicates a growing trend toward supporting trainees as research
assistants on NIH research grants. The recent NRC report, Biomedical
and Behavioral Research Scieniists: Their Raining and Supply, estimates that
NIH supported research assistantships have grown from 2,673 in 1979 to
4,426 in 1987.
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134
14
12
10
8
6
4
FUNDING HEALTH SCIENCES RESEARCH
NUMBER OF APPOINTMENTS (Thousands)
o
80 81 82 83
84 85 86 87 88
YEAR
~ M.D. ~3 Ph.D. ~ Predoctoral ~ Total
FIGURE 5-10 Number of trainee appointments in NIH sponsored training programs by
academic level from 1980 to 1988. (Appendix Bible A-21)
The MARC program administered by NIH attempts to address the
problem of underparticipation by minority groups in the health sciences
at both the undergraduate and graduate levels of training. Since 1982,
NIH has supported about 400 MARC undergraduate training positions
annually.27 However, NIH support for MARC NRSA faculty fellowships
has been dismal. In 1980 NIH supported only 36 of these faculty fellowships,
and the number declined steadily to 18 in 1987. The committee believes
that although this program offers the potential for recruiting individuals
in minority groups into the health sciences, limited data do not allow a
thorough program evaluation.
Other Support Mechanisms
By all measures, the private sector is increasing its commitment to
training health scientists as well. According to one estimate, more than
$17 million were invested in training by private foundations and voluntary
health agencies. Contributions made at the undergraduate level generally
provide support for curriculum development and improving the undergrad-
uate teaching environment. For example, the Howard Hughes Medical
Institute (HHMI) has initiated a series of grants programs to strengthen
undergraduate science education and research in private undergraduate
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NURTURING SCIENTIFIC TALENT
135
colleges and research universities with undergraduate colleges.31 The goal
of this program is to increase the number of students, especially minori-
ties and women, pursuing careers in the biomedical sciences. In 1988
HHMI awarded $30.4 million to 44 colleges, including 10 historically black
colleges. In the second year of the program the Institute expanded this
initiative with $61 million awarded to colleges affiliated with research uni-
versities and other doctorate-granting institutions. Voluntary health agen-
cies generally sponsor research fellowships or career development awards
for postdoctoral training in their respective area of interest (e.g., cancer,
heart disease, arthritis). Other programs target specific groups like the
Robert Wood Johnson program to encourage underrepresented minorities
to pursue careers in the health sciences including biomedical research.32
The committee believes that an increasing number of postdoctoral fel-
lows are being supported by industrial sponsors. Favorable tax policy that
has stimulated growing levels of investment in research and development
may be responsible for this growing trend. Postdoctorates may be spon-
sored directly by the pharmaceutical or biotechnology industries to work
in industrial R&D laboratories or, in some instances, in academic settings.
It is unlikely that industry will invest significant amounts of funds at the
undergraduate or predoctoral levels of training without more assurances
that these trainees will be employed by their firms. Like foundations,
corporate contributions for undergraduate and predoctoral education and
training most likely will be used for curriculum development and updating
the teaching environment. However, no centralized data base is available to
determine either the magnitude of industry and private nonprofit support
or the number of individuals supported. Clearly, the private sector can play
a very significant role in training future health scientists, but the committee
believes it simply cannot replace federal funding for research training.
SUMMARY AND CONCLUSIONS
The committee emphasizes that the single most critical long-term
investment in the U.S. health sciences research enterprise is the sustained
development of well-trained, creative scientists. Future progress toward
improving health will continue only if efforts are sustained by talented
individuals on all fronts to ensure a balanced attack on disease processes
and exploration of all means of disease prevention. The emergence of an
unexpected health crisis such as AIDS emphasizes the importance of trained
scientific personnel who can be redirected quickly as needed. Successful
handling of future epidemics will require a strong health sciences research
system, particularly trained researchers.
Demographic data indicate that later this decade there will be in-
creasing attrition of scientists trained in the 1950s and 1960s. Removing
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FUNDING HEALTH SCIENCES RESEARCH
mandatory retirement ages may reduce some attrition due to retirements,
but the effects will not be measurable until many years later. Employment
growth in the private sector over the past decade has exceeded that in
academia twofold. If this trend continues, competition for scientific talent
between academia and industry will intensify.
Thus, evidence is mounting that the supply of health sciences re-
searchers will be grossly inadequate to meet estimated demands by the
end of this decade. These work-force trends will slow advances in the
health sciences if they are not offset with careful planning and allocation
of resources. In order to develop a highly qualified population of health
scientists for the twenty-first century, the committee believes that:
.
at a minimum, steps must be taken now to maintain the pool
of scientific intellect in our society by improving the quality of science
education and training;
· efforts must focus on recruiting, training, and retaining the most
promising and talented individuals; and
· any new strategies should include programs targeted at increasing
the numbers of scientists from underrepresented groups as well as improving
multidisciplinary and interdisciplinary training of scientists.
Coordinated efforts across the educational spectrum are needed to
sustain a pool of qualified health science researchers and to continue the
progress already made in improving both the health care and quality of life
of the American people. The failure to recruit qualified candidates into
the health sciences is due partly to declining levels of support in the NRSA
predoctoral and postdoctoral training programs as well as to neglect across
the entire educational spectrum. The committee also concluded that the
number of trainees supported on research project grants has been growing.
Indeed, this type of support closely links research training with research.
However, the committee acknowledges that there are disadvantages to
supporting training on research project grants as well. Research grants
commonly do not provide tuition support for graduate students since they
may be classified as technical assistants receiving salary. The committee be-
lieves that often times support for these positions are reduced or removed
when study sections provide recommended funding levels. Also, supporting
trainees on research grants obligates trainees to perform established re-
search protocols in order to ensure research productivity for the principal
investigators rather than acquiring a broad philosophical background for
asking pertinent scientific questions. Policies therefore must be developed
to address the needs of ongoing research as well as those ensuring the
long-term vitality of the health sciences enterprise.
The committee is convinced that allocation policies in recent years em-
phasizing research project support have underemphasized the commitment
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NURTURING SCIENTIFIC TALENT
137
for broad training experiences. Resource allocation policies should foster
the development of highly qualified health researchers and should pro-
vide the opportunity for support throughout their careers. These policies
should focus on the long-term goals of the research enterprise rather than
short-term corrections. Academia, government, and industry must play co-
operative roles in developing and pursuing effective strategies for enhancing
and renewing the nation's health sciences talent base. Furthermore, alloca-
tion policies for training must prepare the nation for achieving its long-term
research goals rather than merely making short-range adjusunents to meet
current needs.
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Representative terms from entire chapter:
nurturing scientific
