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EXECUTIVE SU+ARY Introduction and Summary of Numerical Recommendations, Fiscal Years 1982-1985 In this year's report, we seek to advance our understanding of the labor market for health research personnel, with special emphasis on the clinical sciences; update our recommendations based upon an analysis of the current market situation and projections for the next few years; and discuss other relevant policy issues, including the stabilization of federal support and the recruitment of minorities. We emphasize the need to stabilize fundamental training in the basic disciplinary areas at the predoctoral level and to use specialized training at the postdoctoral level to meet short-tenm national research priorities. We endorse the use of the training grant mechanism because of the stability that it provides to departments and institutions. In carrying out our charge to specify the nation's needs for biomedical and behavioral research personnel, we have undertaken an analysis of the current supply/demand situation and have made projections to 1985. Since most of these scientists are employed in colleges and universities, the projections are focused primarily on the academic sector, but considerable attention has been given this year to the fast-moving developments in the private sector. The models used to make projections of academic demand have been updated and extended with the most recent data. In the last part of Chapter 1, we provide summary tables with overall recommendations for FY 1982-1985 as regards numbers, levels, and types of awards for each major area of research training, and estimates of the costs attendant to their implementation. Clinical Sciences In light of the decline in recent years in the number of physicians electing to pursue research training under NRSA programs, factors pre- sumed to be influencing career decisions are examined in depth. Data from two Committee-sponsored studies suggest that intellectual stimula- tion and challenge of the search for knowledge are major incentives for selecting a research career. A1SO significant is exposure to and participation in research activities. Financial disadvantages of a research career were not regarded as disincentives by young physicians who recently chose an academic career. By contrast, income expectations were of moderate importance to those who selected a career in private practice. While the NRSA payback obligation appeared in several studies not to deter research career plans, the evidence for such a view remains inconclusive. Graduates of four principal NIH-supported programs for the research training of physicians are compared in terms of several performance measures. All programs were highly successful in producing physician investigators, although there were differences in persistence in research, publication activity' and rate of advancement. Labor market data show that personnel shortages continue in clinical science fields, primarily because of the strong demand medical schools for faculty members to conduct research as well 1 the an as teach

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and provide patient care, and the difficulty in recruiting young physicians for research careers. This situation has existed for some tome now and has prompted us to recommend special emphasis on NRSA training pro-trams in clinical fields. . -- ,, ~ _ _ _ There are signs of improvement in market balance, but conflicting trends make interpretation difficult. Funds available to support clinical faculty in medical schools are not growing as fast now as in the early 1970's, while teaching responsibilities have grown in recent years at about 5 percent per year. Perhaps most Importantly, the nether of M.D.'s and other health professionals participating in NIH research training programs has not changed appreciably since 1976 and is currently well below the level we consider appropriate. In the next few years, we foresee somewhat slower growth in medical student enrollments and very little real growth in clinical R and D expenditures after adjusting for inflation. However, medical school income from patient care should continue to show real growth of about 6 percent per year. As a result, clinical faculties are expected to expand by almost 3 percent per year through 1985. The way the system operates to produce the supply of clinical scientists governs to a large extent the role to be played by NRSA programs. Most of the individuals taking faculty appointments in clinical departments of medical schools have not had a period of formal research training--only about 21 percent of newly hired clinical faculty members in recent years have had some postdoctoral research training. This percentage formerly was much higher, and we view the reduction as symptomatic of the problems facing medical schools in their recruitment efforts. In developing our recommendations, we have attempted to encourage a higher level of research capability for clinical investigation. The intended result is that by 1985, at least one-third of the individuals joining clinical faculties will have had some postdoctoral research training. Basic Biomedical Sciences A review of recent data indicates that the demand for research scientists in the basic biomedical sciences in the academic sector remains generally favorable. We are therefore cautiously optimistic about academic employment opportunities in these fields. Projections of demand for academic research personnel are based on the dynamics of faculty change and on assumptions of modest growth in enrollments and research and development funds. Continued steady demand or modest growth is projected through 1985. In addition, developments in some biomedical science fields are creating expanded opportunities in the business sector' but it is too early to make quantitative projections of this demand. Because of the generally favorable outlook through 1985, we reaffirm our recommendations for NRSA predoctoral and postdoctoral support in the basic biomedical science fields through 1985. In past years we have attempted to document the role of training grants in improving the quality of both the training environment and training programs. This year, we have undertaken in-depth reviews of limited number of programs to ascertain the impact of losses of this support on predoctoral programs. The findings indicate substantial negative effects on such areas as recruitment, curriculum, and intellectual vitality. 2

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Predoctoral and postdoctoral research training are primarily conducted in the nation's leading research universities. To provide high-quality, up-to-date training, it is essential that they have modern instrumentation and facilities. Recent reports indicate that the quality of research instrumentation and facilities, even at leading institutions, has seriously declined. We discuss these reports and endorse the need to improve research facilities and instrumentation. Behavioral Sciences The analysis of market conditions highlights differences between clinical and nonclinical segments of the behavioral sciences, which possess different training and employment characteristics. Market indicators are examined, including changes in labor force size, enrollments, and Ph.D. production; ability to find jobs; field-switching; research activity; and utilization of postdoctoral training. Evidence indicates that the market for the research-intensive nonclinical fields remains soft overall, while the market for the practice-ariented clinical fields remains strong. We have made projections of faculty demand through 1985 and also report new projections of the number of NRSA postdoctoral trainees needed to meet this academic demand. Based upon these analyses and projections, we reaffirm our previous recommendations to decrease predoctoral support and increase postdoctoral support. Implementation of our past recommendations by AD~HA has been hindered by budgetary constraints and slow acceptance by the professional community. We continue to encourage the efforts by ADAMHA to effect the recommendations. We are concerned also over reductions in research and research training support in the behavioral sciences. While noting that some reductions may be warranted as part of broader national policy, we believe that cutbacks that are so deep that they disrupt high-quality programs will risk long-tenm damage to these programs and to future research. Another matter of concern has been recent attempts to eliminate "social" research and research training. We discuss the mistaken nature of this argument and instead recommend that the proper basis for making awards, apart from quality, should be their health-relatedness. Health Services Research and Nursing Research Health services research and nursing research were not studied in depth this year. We do, however, review briefly the status of agency training programs. Federal funding for both programs remains meagre, at levels we believe do not permit the development of adequate numbers or quality of training. The present report contains the highlights of the 1977 survey of health services research trainees and principal investigators. The findings indicate that trainees and researchers remain active in health services research, thus confirming the success of prior federal support programs. In nursing research, we are concerned about the growth in the number of doctoral programs in schools of nursing without a strengthening of the training quality in existing doctoral programs. 3

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Minorities in the Biomedical and Behavioral Sciences We believe that the pool of students from which scientists come should reflect the broad ethnic and cultural heritage of the nation. This is not only a matter of equity; it is a matter of quality and talent as well. In order to maintain the high quality and vitality of scientific research in the future, it is important for the nation to take full advantage of the talent of all its citizens. Thus, we support the full participation of minorities in science as a necessary step toward the fullest use of this country's human resources. From our review of the literature from 1974 to 1980 on the participation of minorities in the sciences, it is clear that a wide range of education-related problems exists, beginning in the primary grades and continuing through post- secondary levels. These problems, which discourage minorities from pursuing science education, include cultural differences, lack of science career information and vigorous recruitment, weak academic preparation, inflexible college admissions criteria, and inadequate financial resources. We also have examined national data on enrollments and degrees that demonstrate that the flow of minority students through the highest levels of the education system remains limited. Those who have continued on from the baccalaureate to earn the doctorate are concentrated in conscience fields. Although minorities were gradually increasing as a proportion of new doctorates in all fields from 1974 to 1980, Blacks and Hispanics remain severely underrepresented in the biomedical sciences. Despite significant growth, minorities are still underrepresented in the behavioral sciences as well. Current federal programs intended to increase the number of minorities earning Ph.D.'s are examined. At this time their efficacy has not been determined. In addition, it must be acknowledged that such programs are ultimately faced with an impossible task unless accompanied by efforts at earlier educational levels to increase the number of minority students who are academically prepared and motivated to pursue science careers. Recommendations General The Committee recommends that federal support for research training should be stabilized and provided at levels commensurate with the scope of national needs. At the center of federal policy there should be an irreducible number of trainees who are supported in the basic disciplines regardless of fluctuations in demand for short-term research needs. Additions and reallocations in support may be undertaken as special needs come and go. In this way the benefits of stability can be achieved while providing a flexibility to respond to changing priorities in the nation's research needs. The level of stabilization should be determined after reviewing available data, findings, and recommendations, including those of this Committee. 4

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Clinical Sciences 1. The Committee recommends that 2,400 traineeships and 400 fellow- ships be awarded annually for postdoctoral research training in the clinical TIC' ences from FY 1982 through FY 1985. The Committee also urges a greater emphasis on filling these training positions with physicians. Most of the funding should be in the form of training grants, which are particularly suited to meet the needs of the physicians whose doctoral training usually involves only^limited research participation and, as previously recommended, approximately 15 percent for individual fellowships. 2. The Committee recommends that an annual enrollment of 725 trainees in the Medical Scientist Training Program (MSTP) should be maintained through FY 1985 and high priority given to preserving this level should it become necessary to reduce the overall number of NRSA trainees. Bat: Bic~medinal !::~i "n~.c 1. The number of predoctoral trainees and fellows supported annually in the basic biomedical sciences should be maintained at 4,250 in each year from the present through FY 1985. 2. The number of federally funded postdoctoral awards in the basic biomedical sciences should be maintained at 3,200 annually for FY 1982-1985. 3. While training grants should continue to be awarded on the basis of national competition, it should also be recognized that a minimum nether of grant-supported trainees, the number of which will vary with the specific training program, is essential to ensure the critical mass necessary for a vital and effective training program. Behavioral Sciences 1. While reductions in training support may be necessitated by overall budget constraints, it is important that some training support be preserved in the health-related behavioral and social sciences and that this support be directed to the highest-quality programs. 2. All fields of the behavioral and social sciences continue to make valuable contributions to the solution of health problems. Beyond quality, the proper criterion for awarding behavioral and social science training grants should remain the relevance of the applications to the solution of health problems that are the responsibility of NIH and ADAMHA. 3. The Committee reaffirms its position that training in the behavioral sciences shift its emphasis from predoctoral to postdoctoral. A gradual phasing in is recommended so that a level of 390 predoctorals and 910 postdoctorals will be supported annually by 1985. 5

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The training grant should be the predominant mechanism of support in the behavioral sciences with an 80 percent/20 percent traineeship to fellowship ratio. In addition, because of the importance of the institutional support component of the award in planning and administering health-related training programs in behavioral science departments, the Committee strongly endorses the continuation of the training grant mechanism. Health Services Research and Nursing Research \ 1. It is recommended that 330 health services research trainees and fellows be supported annually through FY 1985. NRSA support for nursing research training should rise to 300 trainees and fellows annually from FY 1982 through FY 1985. No more than 15 percent of these trainees should be at the post- doctoral level. Minorities Current federal programs that recruit and train minority students in the biomedic al and behaviors 1 sc ienc es should be evaluated in order to identify the most successful approaches to increasing minority participation in the sciences. Existing programs should be continued pending the outcome of this evaluation. 6