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1. Introduction and Summary
Abstract
Research training programs sponsored by the
federal government serve several functions: they
attract able students to research careers by providing
stipends, tuition, and allowances; they encourage
better training environments at colleges and
universities through institutional allowances that
support faculty, equipment, and interdisciplinary
programs; and they contribute to the nation's research
enterprise by promoting the flow of well-trained young
scientists into research careers. These are worthy
goals, and the training programs, filtered through the
peer review process, appear to have been successful in
achieving them. Assessing the appropriate level of
training to be provided under the National Research
Service Award (NRSA} programs--the task of this
study--involves consideration of these objectives
together with the career and employment prospects of
the trainees.
Currently we are facing a period in which faculty
expansion will likely be curtailed by falling
enrollments and slower revenue growth, but increased
replacement demand is expected to be generated by
higher rates of attrition due to death and retirement.
Industrial demand for Geoscientists is increasing and
biotechnology firms expect academia to train the
personnel they need to sustain this growth. The main
issue is how to achieve the proper balance between
maintaining the strength of the nation's biomedical
and behavioral research effort, and adjusting the flow
of young scientists entering the field to the number
of research and teaching positions that are expected
to become available in the next few years.
During the 1970s, training funds declined sharply
relative to research funds and currently amount to
less than 6 percent of research expenditures of the
administering agencies--NIH, ADAMBA, and Division of
Nursing, HRSA--down from 17 percent in 1971. It is
the committee's view that training funds should not be
further reduced. The nation must begin to plan for
the 1990 decade when many current faculty members will
reach retirement age and college enrollments will once
again start to increase.
1
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2
The issues addressed in this report are those presented to the
National Academy of Sciences (NAS) by Congress in the 1974 Act that
reauthorized the research training programs of the National Institutes
of Health (NIH), the Alcohol, Drug Abuse, and Mental Health
Administration (ADAMHA), and by subsequent amendment, the Division of
Nursing of the Health Resources and Services Administration (HRSA).
Congress asked the NAS to monitor the biomedical and behavioral
fields, to assess the national need for research personnel in these
fields, and to determine the kinds and extent of training that the
government should provide.
This report examines the system under which biomedical and
behavioral scientists are trained for research careers in this country
and the government's programs that support such training. Those
programs consist of training grants and fellowships that are designed
to supplement the government's research programs in the biomedical and
behavioral fields by providing support to predoctoral and postdoctoral
students and their institutions. The goal of the training programs is
generally to strengthen the research effort, and they-do so by
encouraging young scientists to pursue research careers, by selecting
the best qualified candidates for support, and by fostering the
development of a strong training environment through competition and
the peer review process.
From the very inception of these programs in 1937, the interdepen-
dence of research and training was recognized. The National Cancer
Act of 1937 established the National Cancer Institute within the
National Institutes of Health and gave it authority for supporting
both research and training in matters relating to the causes and
treatment of cancer. The wisdom of that linkage within our universi-
ties was acknowledged recently by Donald Kennedy, President of Stanford
University, who noted that the government could have followed the
German model and established quasi-independent laboratories with
support from the industrial sector, or it could have created a network
of government laboratories.
That it did neither guaranteed that new discovery and
the training of the next generation of discoverers
would take place in the same locations, thus
establishing one of the great strengths of American
science. That strength is well recognized in Europe;
at the 1977 Nobel awards, when Americans swept the
prizes for the first time, our thoughtful Swedish
colleague Sune Bergstrom pondered the phenomenon and
finally attributed it to the 'democracy of American
science.' He meant the fellowship of the bench--the
system of apprenticeship that is built upon the
coexistence of research with research training.
(Kennedy, 1985)
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3
COMMITTEE'S APPROACH TO ASSESSMENT OF NATIONAL NEED
In response to its congressional charge, this committee and its
predecessors have compiled a substantial data base on national trends
in enrollments, degrees, employment characteristics and funding in the
biomedical and behavioral fields, developed analytic models of the
training system, and made projections of demand for these scientists
over the short term. By means of follow-up studies, we have also
examined the subsequent career achievements of former trainees and
fellows. Comments and suggestions from the scientific community have
been solicited at public meetings following the publication of each
report. A summary of the last public meeting in May 1984 is presented
in Appendix F.
In this report, we present the latest available data on the
components of the system and update the projections to 1990. The
complete data base is published in Appendixes A through C. A chapter
is devoted to each major area of this study, which we have defined as
clinical sciences, basic biomedical sciences, behavioral sciences,
health services research, and nursing research. Our definition of
each area is presented in Appendix D. The taxonomy is based on the
fields that contribute to each area, not on the types of degrees held
by the contributors. Chapter 3 includes the results of the second
survey of personnel needs in the biotechnology industry.
The committee's basic approach has been to examine the systems
that have evolved in this country for preparing the students for
careers in biomedical and behavioral research and by which they
received support for their research as independent investigators and
teachers. These systems function somewhat differently in each of the
major areas of concern. In the basic biomedical sciences, the typical
route to a research career consists of about 7 years of graduate study
leading to the Ph.D. degree, followed by 3 years of postdoctoral
training. The behavioral fields, nursing research, and health
services research are somewhat similar to the biomedical fields,
except that postdoctoral training is less typical. In the clinical
sciences, research-oriented physicians usually complete 4 years of
medical school, 3 years of residency training, and 2 or more years of
research training before they begin to compete for research support.
Postdoctoral research training is often sought by dentists and
veterinarians who intend to pursue research careers.
The committee believes that a solid understanding of how the
systems have functioned in the past and how they can be expected to
function in the next few years is essential to an assessment of
training needs. There are some components of the training system that
are vital to our assessment. Among these are the length of the
postdoctoral training period, the percentage of newly hired faculty
members who have some postdoctoral research training, the percentage
of postdoctoral trainees who subsequently choose academic careers, and
the proportions of predoctoral students and postdoctoral trainees that
should be supported under NRSA programs. Each of these components is
considered along with our projections of faculty demand within the
relevant chapter--clinical sciences, basic biomedical sciences, or
behavioral sciences. Identifying and quantifying these critical
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components of the system provides a rational basis for determining the
appropriate numbers of federally-supported traineeships and fellow-
ships in these fields.
One aspect of this study is quite clear--the universities and
health professional schools are the locus of most biomedical and
behavioral research and training sponsored by the government. The
effectiveness of those programs therefore depends heavily on the
availability of trained and qualified researchers among the faculty
members of these institutions. Faculty members are supported by funds
generated by tuition, research grants and contracts, state and local
government contributions, and increasingly in medical schools by
revenue from faculty practice plans. The latter has taken on an
especially important role over the past 10 years as the medical
schools strive to maintain revenues in the face of rising indirect
costs and slower growth in enrollments, research funds, and other
sources of revenue. Income from medical service plans displaced
federal research grants and contracts as the largest source of funds
for medical schools in the late 1970s and now accounts for over 30
percent of total revenue (AMA, 1960-84~.
From the point of view of clinical research, the growth of income
from medical service activities is a disturbing trend because it means
that the emphasis in clinical departments of medical schools has
shifted away from research toward service activities. As faculty
vacancies occur, they tend to be filled by physicians whose interests
are primarily in providing patient care in an academic setting rather
than in research. Some basic scientists with Ph.D. degrees have moved
into clinical departments to support the research and teaching
activities as physicians in those departments turn more to service
programs. But the pressure on medical school faculties to generate
income means that young physicians may be required to perform service
at the expense of research.
Partially to counterbalance this growing tendency for medical
schools to concentrate on service rather than research activities,
this committee has recommended in the past and continues to recommend
that more research training opportunities be made available to aspiring
clinical investigators. The training system should be adjusted so
that a higher percentage of recruits to clinical faculties will have
some research training experience. A postdoctoral appointment as a
trainee or fellow is the typical mode of acquiring such experience for
physicians, veterinarians, and dentists. Furthermore, the knowledge
base in the biomedical sciences has expanded rapidly in recent years
and this has imposed additional requirements on training. A postdoc-
toral appointment of about 3 years duration is now generally required
because the complexity of biomedical science has increased and the
array of instrumentation that must be mastered has developed rapidly.
Also the boundaries between fields are disappearing (new fields such
as immunogenetics and neurovirology are emerging) and it is mainly
during the postdoctoral period that many bioscientists begin the
process of integrating related fields with their own.
The training programs are designed to complement research programs
by developing the training environment and maintaining an adequate
supply of well-trained scientists. The level and distribution of
training funds provided by NRSA programs should be determined so as to
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achieve a stable and efficient system. Sharp year-to-year variations
in training levels are unnecessarily disruptive. Demand expected to
be generated in the academic and other sectors must be compared with
the anticipated supply. Demography, funding trends, and alternative
sources of support for training are all considered in our projections
and analyses.
A diversified array of disciplines contributes to the biomedical
and behavioral sciences, ranging from mathematics and engineering to
the clinical sciences. This diversity should be encouraged--excellent
research often is produced in non-traditional areas--and the peer
review system should be relied upon to select the best applications.
Underlying all of these considerations is the perception that the
effectiveness of the government's biomedical and behavioral research
programs depends on the continual infusion of young scientists trained
in the latest techniques of a science making startlingly rapid
advances.
RECENT RESEARCH DEVELOPMENTS
Biological science has undergone a remarkable transformation in
the past 3 or 4 decades. It has changed from a descriptive to an
analytical and mechanistic field with a capacity to probe ever finer
levels of organization. The growth in understanding of living things
has been sufficiently dramatic and pervasive to justify use of the
term "revolution" to describe the evolving state of modern biological
science.
Molecular biology began as a discipline that combined the theories
and methods of biochemistry, microbiology, and microbial genetics.
The more recent advent of the recombinant DNA technology permitted
direct study of the genes of higher organisms, including man. It
became possible to observe their structure, to determine how they
function as blueprints for fashioning the cellular machinery, and to
decipher the controls on their operation. As described by Baltimore
(1984), this startling technology could be used ". . . as a molecular
microscope with which to peer into the details of genes and as a
factory able to synthesize the product encoded by the genes."
The past decade witnessed other revolutionary advances in science
and technology. One of the most interesting developments, for example,
has been the detection and isolation of oncogenes, dominant genetic
elements that apparently exist in the chromosomes of every human cell
and in the cells of numerous other organisms. Oncogenes appear to
play a central role in the malignant transformation of normal cells.
Approximately 15-20 percent of all human tumors have been shown to
contain oncogenes in their DNA. Increased understanding of oncogenes
and how oncogene-encoded proteins work may make it possible to anta-
gonize their functioning and to reverse the process of carcinogenesis.
Enriched by new tools and understanding of biochemistry, molecular
genetics, and cell biology, immunobiology has become a fertile source
of insights. Because of the chemical specificity of immunologic
reactants and their products, researchers and clinicians have been
provided with powerful and versatile techniques, such as radioimmuno-
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assays. In addition, hybridoma-derived monoclonal antibodies promise
to revolutionize many aspects of biology and medicine through their
ability to identify almost any molecular structure that can be
purified sufficiently to be used as an antigen.
Fundamental knowledge in the neurosciences has expanded along a
broad front from cellular and molecular aspects to mechanisms of
perception, learning, and emotion. The ingenious application of new
technologies has hastened analysis of structural organization of the
nervous system, and a detailed topography of the functional anatomy of
the brain is close at hand. The chemical mechanisms by which some
cells communicate, as well as the modes of action of many neuro-
transmitter substances, are now understood in considerable detail.
From that knowledge will emerge therapies for disorders associated
with abnormalities in specific neuro-transmitter systems.
Research on the relationship between stress and other physical
problems has produced some significant results. Studies of
hypertension have shown that psychosocial factors are highly
correlated with hypertensive episodes; psychosocial factors may also
be important in the earlier stages of the disease and may play a role
in the etiology of high blood pressure (Kaplan, 1980~. Along with
genetic factors, behavioral factors such as dietary salt intake,
obesity, and psychological stress have been linked to the initiation
of high blood pressure. Experimental studies involving animals have
found that the brain participates at some stage in the increase of
blood pressure levels. A series of experiments with rats demonstrated
that conflict in learning situations was related to the development of
the hypertensive state (Friedman and Dahl, 1975; Friedman and Iwai,
1976).
Studies in a new interdisciplinary research area, psychoneuro-
immunology, have found that stress-responsive hormones can alter the
components of the immune response (Ader, 19811. The psychosocial
influences on immune function have important implications for the
body's defenses against malignancy. Other studies, involving
laboratory animals (Amkraut and Solomon, 1977), and human subjects
(Kasl et al., 1979), have found that psychosocial factors are related
to susceptibility to infectious diseases.
The biological revolution has been fueled in part by the merging
of innovative instrumentation, such as lasers, large-scale integrated
circuits, and computers, with fundamental insights into the nature of
the living cell. Biomedical applications of lasers include laser
cytofluorometry, a technique for separating cells according to size,
shape, and reflective properties, and their further sorting according
to, for example, their shape and DNA content--all within minutes.
A further illustration of evolving instrumentation technology is
positron emission tomography (PET). This provides a non-invasive means
for visualizing the metabolism of the human brain during normal activi-
ties, such as hearing, speaking, or thinking, and in diseased states
in which there are deficits in sensory, motor, or cognitive processes.
Still another technology which opens up new approaches to basic
biomedical problems is electron spin spectroscopy. This is a
particularly sensitive tool which can be used to measure phenomena
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such as oxygen uptake in tissue and electron transport activities
involved in intracellular energy processes. Recent refinements permit
spectroscopic measurements on single muscle fibers or small numbers of
cells without sacrificing resolution or sensitivity.
This rich harvest of knowledge and new technologies has made it
possible to ask more sophisticated and penetrating questions.
Investigators can now move with assurance in experiments that only 10
years ago would have been considered to lie almost in the realm of
science fiction. In this context, the President's Biomedical Research
Panel observed in its 1976 report: "There do not appear to be any
impenetrable, incomprehensible diseases . . . the questions are at
last here, and explorations in search of the answers are under way. n
The following examples attest to the soundness of that observation.
Researchers have developed increasingly detailed
"maps" of human chromosomes, which identify the
individual sites of the genes responsible for
particular genetic defects. Gene mapping has now
identified the chromosomal sites for more than 35 such
genes responsible for specific genetic disorders, such
as sickle cell disease. Several years ago, for
example, the site of the defective gene responsible
for a common form of muscular dystrophy was
pinpointed, thereby setting the stage for efforts to
isolate it and to determine the nature of the
molecular defect that causes this degenerative
disease. Also, a genetic marker closely linked with
the gene that causes Huntington's disease has been
located on the short arm of human chromosome 4. This
landmark discovery is a critical first step toward
developing a test for presymptomatic detection of
carriers of this fatal, late-onset disorder, and
ultimately reducing its incidence.
.
Progress has been made toward treatment of some of the
genetic diseases. Investigations currently underway
with respect to the Lesch-Nyhan syndrome presage
developments in other areas. Specifically, scientists
have recently cloned the gene for HGPRT--the enzyme
missing in Lesch-Nyhan--and have injected it into
cultures of cells derived from Lesch-Nyhan patients,
where the cloned gene corrected the deficient
function. Lesch-Nyhan syndrome, which causes severe
psychomotor retardation and early death in one of
every 50,000 male births, may therefore be the first
candidate for gene therapy in humans, with other
similar genetic metabolic diseases to follow.
As in the case of molecular genetics, the last decade
has witnessed a remarkable leap in understanding what
receptors do and how they work. Receptor research has
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.
resulted in rapid and sensitive methods of following
drug responses of healthy and diseased cells. Tests
based on estrogen receptor determinations provide
guides in the selection of alternative treatments for
human breast cancers. Receptor studies have already
contributed to the development of drugs with
psychopharmacologic importance, and of propranolol for
the treatment of hypertension. Moreover, the
potential exists for a new generation of drugs of
natural or synthetic origin that are much more
specific in their actions and whose pharmacology will
be understood at a molecular level.
Concentrated effort on vaccine development is yielding
positive results. Scientists have been able to
combine vaccinia virus, previously used to immunize
against smallpox, with genetic material from hepatitis
B virus. This hybrid vaccinia virus has been shown to
stimulate in rabbits the production of significant
amounts of antibody to hepatitis B antigen. The
technique has subsequently been used to combine
vaccinia virus with genetic material from influenza
virus, from rabies virus, and from genital herpes
virus. The prospect of a single recombinant vaccine
to protect individuals against many diseases
represents an entirely new approach to mass
immunization that may have enormous worldwide
implications.
These examples are only a sample from a broad array of advances in
biological sciences. But they indicate that the nation's past
investment in biomedical and behavioral research and training has
produced a powerful system for the development of these sciences. To
maintain the momentum, talented students in universities and
professional schools must be attracted to research careers by the
provision of continual opportunities for training with established
scientists, and adequate research funds must be made available to
young investigators at the early stages of their career development.
TRAINING AND RESEARCH FUNDING TRENDS
Expenditures for the NRSA training programs totaled about $190
million in 1983, or less than 6 percent of the research expenditures
of these administering agencies--NIH, ADAMHA, and Division of Nursing,
HRSA (Table 1.1~. With the exception of 1973 when funds were
impounded, training budgets have fluctuated in a fairly narrow range
since 1971 compared with other health expenditures. Consequently,
after adjustment for inflation, training funds have declined by almost
6 percent per year since 1971. By contrast, national research
expenditures have increased over this period by 3 percent per year,
and national health care expenditures by more than 5 percent per year
in real terms.
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NIH/ADAMHA/HRSA
Expenditures
9
TABLE 1.1 NRSA Training in Relation to Some National Health Expenditures, FY 1971-83
(1972 $, billions
Research Training Relative to:
National R&D
Health Care National R&D Grants Research Nat'l. Health Nat'l. Grants &
Fiscal Expenditures Health R&D and Contracts Training Care Expend. Health R&D Contracts
Year (1972 $) (1972 $) (1972 $) (1972 $) (%) (%) (%)
1971 87 3.3 1.0 0.18 0.20 5.3 17.0
1972 94 3.5 1.2 0.18 0.19 5.1 15.0
1973 97 3.5 1.1 0.12 0.13 3.5 10.8
1974 100 3.8 1.4 0.18 0.18 4.8 13.1
1975 104 3.7 1.3 0.14 0.14 3.8 10.6
1976 112 3.8 1.4 0.11 0.09 2.7 7.4
1977 119 4.0 1.4 0.10 0.09 2.7 7.5
1978 124 4.1 1.4 0.11 0.08 2.5 7.3
1979 130 4.3 1.6 0.10 0.08 2.4 6.5
1980 140 4.4 1.6 0.11 0.08 2.5 7.1
1981 147 4.4 1.5 0.10 0.07 2.4 6.9
1982 156 4.5 1.5 0.08 0.05 1.8 5.7
1983 165 4.7 1.5 0.09 0.05 1.9 5.8
Annual
Growth
Rates
1971-83
5.5% 3.0% 3.3% - 5.7% - 10.9% - 8.2% - 8.6%
a1972 dollars were obtained by using the U.S. Bureau of the Census Implicit GNP Price Deflator. See Appendix Table B7
for deflator.
SOURCE: NIH (1966-84). See also Appendix Table D3.
NATIONAL RESEARCH SERVICE AWARDS FOR 1983 AND 1984
In 1983, the three agencies that administer NRSA programs--the
NIH, ADAMHA, and Division of Nursing, HRSA--awarded 11,579 full-time
training positions under these programs (Table 1.2~. This was
slightly lower than the 1982 level of 11,632, and also less than the
12,825 that had been recommended previously by this committee (NRC,
1975-81, 1981 report, p. 20~.
The 1983 awards were about equally divided between predoctoral and
postdoctoral awards. ~ ~ ~ ~
A small number of undergraduate awards were
maue--almost all of them for the Minority Access to Research Careers
(MARC) Honors uroaram.
~ ,__,_ An additional 1,518 awards were made in the
Short-Term Training Program, primarily to health professional
students. Training grant positions far outnumbered fellowships,
accounting for over 83 percent of all awards.
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10
TABLE 1.2 Aggregated Numbers of NIH/ADAMHA/HRSA Traineeship and Fellowship Awards
for FY 1983 and FY 1984a
TOTAL
ALL Biomedical Behavioral Clinical Nursing
FIELDS Sciences Sciences Sciences Research
FY 1983 TOTAL 11,579 6,929 861 3,665 124
Predoctoral 5,207 3,425 408 1,267 107
Postdoctoral 5,915 3,139 373 2,398 5
MARC Undergraduateb 457 365 80 0 12
Trainees 9,711 5,455 758 3,486 12
Predoctoral 5,010 3,363 381 1,266 0
Postdoctoral 4,244 1,727 297 2,220 0
MARC Undergraduateb 457 365 80 0 12
Fellows 1,868 1,474 103 179 112
Predoctoral 197 62 27 1 107
Postdoctoral 1,671 1,412 76 178 5
MARC Undergraduateb 0 0 0 0 0
FY 1984 TOTAL 11,469 6,992 859 3,498 120
Predoctoral 5,096 3,423 391 1,167 115
Postdoctoral 5,912 3,194 382 2,331 5
MARC Undergraduateb 461 375 86 0 0
Trainees 9,578 5,508 753 3,314 3
Predoctoral 4,863 3,339 364 1,158 2
Postdoctoral 4,254 1,794 - 303 2,156 1
MARC Undergraduateb 461 375 86 0 0
Fellows 1,891 1,484 106 184 117
Predoctoral 233 84 27 9 113
Postdoctoral 1,658 1,400 79 175 4
MARC Undergraduateb 0 0 0 0 0
a These are total numbers of awards for traineeships and fellowships. Data on the number of new starts for FY 1983 and FY
1984 are not available. Totals represent full-time positions only and do not include short-term traineeship and fellowship
awards. In FY 1983 there were 1,518 short-term traineeships, of which 12 were prebaccalaureate, 1,394 were predoctoral,
and 112 were postdoctoral. There were also 6 short-term fellowships, of which 3 were Predoctoral and 3 were postdoctoral.
In FY 1984 there were 1,586 short-term traineeships, of which 12 were prebaccalaureate, 1,489 were predoctoral, and 85
were postdoctoral. There were also 4 short-term fellowships, of which 3 were Predoctoral and 1 was postdoctoral. See Tables
1.3 and 1.4 for further detail.
b These are prebaccalaureate awards in the Minority Access to Research Careers (MARC) Honors Undergraduate Training
Program. See Tables 1.3 and 1.4.
SOURCES: Office of the Administrator, ADAMHA (6/15/84 and 6/10/85); Division of Nursing, HRSA (12/14/84); Division of
Research Grants, NIH (4123185 and 7129185).
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11
In FY 1984, the number of full-time NRSA training positions
totaled 11,469. This was down slightly from FY 1983, almost all of
the drop coming in predoctoral awards. MARC Undergraduate awards were
practically unchanged from FY 1983, and awards in the short-term
training program rose somewhat to 1,586.
For both FY 1983 and FY 1984, most of the training positions were
allocated to the basic biomedical and clinical sciences, followed by
behavioral sciences and nursing research. No awards were made by
these agencies in the area of health services research. The actual
and recommended distribution of awards by field is shown in the
following table:
FY 1983
FY 1984
Actual Recommended Actual Recommended
. . .
Biomedical Sciences 59.8% 58.1% 60.9% 57.9%
Behavioral Sciences 7.4% 9.5% 7.5% 9.8%
Clinical Sciences 31.7% 27.5% 30.S% 27.4%
Nursing Research 1.1% 2.3% 1.1% 2.3%
Health Services Research 0.0% 2.6% 0.0% 2.6%
. .
100.0% 100.0% 100.0% 100.0%
The 1983 and 1984 training awards by field, academic level, and
mechanism are shown in Table 1.3 for NIH and in Table 1.4 for ADAMS.
Note that these tables show only full-time training positions and
therefore are not directly comparable to data in previous committee
reports which include trainees in the short-term program.
FINDINGS AND RECOMMENDATIONS
Previous reports have made recommendations for training levels
through 1987. Our recommendations in this report are directed to
fiscal years 1988-90. The analyses leading to these recommendations
in each major area can be found in subsequent chapters of this report.
In general, we find that the NRSA training grants and fellowships
are integral parts of the overall biomedical and behavioral research
programs in this country and play key roles in maintaining the
vitality of those programs.
Among this committee's chief concerns expressed in its past
reports have been the number of biomedical scientists serving in
postdoctoral appointments for prolonged periods and the reduced
number of academic positions that would likely result from declining
enrollments in the 1980s. Those concerns were reflected in
recommendations for a reduction in the number of predoctoral
traineeships that should be provided under NRSA programs, and a
stabilization of postdoctoral training levels through 1987. But the
most recent data available to us indicate that the postdoctoral pool
of biomedical scientists is beginning to decline, as is bioscience
Ph.D. production. During the next ~ years, a large number of faculty
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TABLE 1.4 ADAMHA Traineeship and Fellowship Awards for FY 1983 and FY 1984a
Biomedical Sciences
TOTAL Total Epidenuolo~
ALL Biomedical Biological and Behavioral Clinical
I1ELDS Sciences Sciences Biestatistics Sciences Sciencesb
FY 1983 TOTAL 1,106 388 276 112 576 142
P=docto~ 474 181 114 67 253 40
Postdoctoral 547 202 157 45 243 102
MARC Underclad.' 85 5 5 0 80 0
Trainees 957 317 212 105 ' 516 124
Predoctoral 417 152 89 63 226 39
Postdoctoral 455 160 118 42 210 85
MARC Undergrad.` 85 5 5 0 80 0
Fellows 149 71 64 7 60 18
Predoctoral 57 29 25 4 27 1
Postdoctoral 92 42 39 3 33 17
MARC Undergrad.C O O O 0 0 0
FY 1984 TOTAL 1,105 3% 296 100 541 168
Predoctoral 470 194 133 61 217 59
Postdoctoral 540 193 154 39 238 109
MARC Undergrad.C 95 9 9 0 86 0
Trainees 938 315 221 94 ~2 141
Predoctoral 402 162 105 57 190 50
Postdoctoral 441 144 107 37 206 91
MARC Undergrad.C 95 9 9 0 86 0
Fellows 167 81 75 6 59 27
Predoctoral 68 32 28 4 27 9
Postdoctoral 99 49 47 2 32 18
MARC Undergrad.C O 0 0 0 n ~
a These are total numbers of awards for tralneeships and feUowsh~ps. Data on the number of new starts for FY 1983 and FY
1984 are not available. Totals represent full-time positions only and do not include short-tenn tralneeship and fellowship
awards. In FY 1983 there were 46 short-tenn tra~neeshipa, of which 12 were prebaccalaureate in behavioral sciences, 5 were
Predoctoral in biological sciences, and 29 were postdoetonl (5 in biolo~pcal sciences, 24 in behavioral sciences). There were
also 6 short-tenn fellowships, of which 3 were predoc~ (2 in biological sciences and 1 in behavioral sciences), and 3 were
postdoctoral (1 each in biological sciences, epidemiology/bhstatistics, and behavioral sciences). IQ FY 1984 there were 22
short-term trameeships, of which 12 were prebaccalaureate in behavioral sciences, S were Predoctoral in biological sciences,
and 5 were postdoctoral in biological sciences. There were also 4 short-term feUowships, of which 3 were Predoctoral (2 in
by cat sciences and 1 In behavioral sciences), and 1 was postdoctoral in behavioral scienc.
b Effete [Y 1981, ADAMHA has been using a different system for classifying their trainees and fellows. In prior years,
ADAM reported training in health sernces research but none us clinical sciences.
c These are prebaccalaureate awards in the Minority Access to Research Careers (MARC) Honors Undergraduate Research
Trading Program.
SOURCE: Office of the Ad~nistrstor, ADAMHA (6/15/84 and 6110/85).
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14
members will reach retirement age and consequently the need for young
faculty to replace them will begin to increase. In addition, NRSA
research training funds have declined since 1974, both in real terms
and as a percentage of research expenditures, to a level below that
previously recommended by this committee. As a consequence, the
number of predoctoral trainees in the basic biomedical sciences
supported in 1984 was 11 percent below the committee's recommended
level and is on a steep downward slope. We therefore believe that
the research training programs should be restored to the recommended
number of positions by 1987, and then adjusted to meet the increase
in demand expected to begin in the late 1980s.
As shown in chapters 2-4, we have made projections of faculty
demand under high, best-guess, and low assumptions. The range
between the high and low projections in most cases is fairly wide,
mainly because of the difficulties inherent in predicting future
levels of academic revenues from R and D and other sources. Although
we have based our recommendations on our best-guess estimates of
expected demand, it must be recognized that these estimates could be
thrown off by a number of factors including sudden changes in the
hiring practices of universities and professional schools, shifts in
federal funding patterns for biomedical research, and more radical
revisions to Medicare/Medicaid and other health insurance programs.
Our recommendations, based on our best estimates of the market
situation expected to prevail in the next five years and considera-
tions of how the training system should operate in each area, are
presented below.
Clinical Sciences
The number of full-time NRSA postdoctoral traineeships and
fellowships in the clinical sciences (excluding dental clinical
research--see below) should gradually be increased from the
current level of less than 2,400 to 3,000 by 1990. In order to
encourage more talented physicians to undertake research
training, 85 percent of these postdoctoral awards should De
allocated to M.D.s.
Dental research has not kept pace in recent years with remarkable
developments in other clinical science sectors. One way to
remedy that is to bolster the research training opportunities for
entering faculty of dental schools where most dental investigation
is conducted. Dental research training levels have fallen
precipitously since 1980 and should be strengthened. The number
of postdoctoral traineeships and fellowships in dental clinical
research should be increased gradually from the 1984 level of
about 100 to 320 by 1990.
The Medical Scientist Training Program (MSTP), administered by
the National Institute of General Medical Sciences (NIGMS),
is considered to be one of the most productive mechanisms for
training physician-scientists. However, the costs of MSTP as a
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share of total NIGMS funds for predoctoral training have been
rising steadily. Since continuation of that trend would
inevitably weaken the support of regular predoctoral programs,
there is an urgent need to curb this growth in costs. To ensure
an appropriate balance, we restate our earlier recommendation
that MSTP's share over the near future not exceed 25 percent of
NIGMS predoctoral training funds, with a target goal of 725
trainees by 1988. We believe that level should be maintained
through 1990.
4. We endorse the short-term training program for health professions
students and recommend its continuation. This program is
designed to introduce students in medical, dental, and other
health professions schools to research methods during summer and
off-quarters. It provides predoctoral stipends for up to 3
months of support for research training without payback
obligation.
Minority Access to Research Careers (MARC) Honors
Undergraduate Training Program
This institutional grant program provides support to third and
fourth year honors undergraduates at minority institutions. The
program has grown from about 250 traineeships in 1980 to about
470 in 1983. About 75 percent of these positions were in the
basic biomedical sciences, 20 percent in behavioral fields, and
about 5 percent in nursing research. We recommend that the
program be maintained at its current level for the next few
years.
Basic BiomedicalSciences
Since 1980, the number of NRSA predoctoral awards in basic
biomedical science fields has dropped by over 12 percent. With
about 3,400 positions provided in 1984, the program has fallen
well below the committee's recommended level. This program
(excluding MARC undergraduate traineeships) should be restored to
3,750 positions in 1988 and then gradually increased to 4,150
awards by 1990.~
2. Postdoctoral training awards in the basic biomedical sciences
should be gradually increased from the 1984 level of about 3,200
to a level of 3,800 by 1990.
Win previous reports, awards made in the Minority Access to
Research Careers (MARC) Honors Undergraduate Training Program have
been counted as predoctoral awards. Starting with this report.
awards in that program will be shown separately.
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1
Behavioral Sciences
Predoctoral training in the behavioral sciences should be restored
to the 1981 level of about 550 traineeships (excluding the MARC
undergraduate awards) by 1987 and maintained at that level through
1990.
Postdoctoral training in the behavioral sciences should gradually
increase to 540 awards in 1987 and then be maintained at that
level through 1990.
Health Services Research
The committee has previously recommended that a modest training
program be provided in health services research by the federal
agencies under the NRSA authority, and that such authority be
extended to the National Center for Health Services Research. In
the early 1970s, the federal government provided support to over
800 health services research trainees and fellows per year (NRC'
1975-81~. At present there is no training being provided under
NRSA programs that is identified by the federal agencies as health
services research. We affirm our previous recommendations that
330 awards be made annually in this area through 1990.
Nursing Research
Research on problems arising in nursing is supported primarily by
the Division of Nursing, HRSA, and to a lesser extent by the NIH,
the Veterans Administration, and private organizations such as the
American Nurses Foundation and the Robert Wood Johnson Foundation.
But practically all training for nursing research is provided by a
small NRSA program administered by the Division of Nursing.
Funding for training under NRSA programs in the Division of
Nursing increased in FY 1985 to almost 82 million, but the number
of trainees and fellows supported is still below the level called
for by this committee in past reports. Applications for
fellowships in nursing research rose 50 percent in FY 1985 and are
expected to increase another 30 percent in FY 1986. We recommend
that nursing research training under NRSA authority be increased
from the 1985 level of about 170 awards to 320 awards by 1990.
Table 1.5 summarizes the committee's recommended number of awards
by field, academic level, and mechanism for FY 1988-90. The estimated
costs for the recommended programs are shown in Table 1.6.
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TABLE 1.5 Committee Recommendations for NIH/ADAMHA/HRSA Full-Time Predoctoral
and Postdoctoral Traineeship and Fellowship Awards for FY 1988-9Oa
Clinical Sciences
Fiscal
Year
Type of
Program
1988 TOTAL Total
Predoctoral
Postdoctoral
MARC Undergrad.g
TOTAL Basic Medical
ALL Biomedical Behavioral Scientist
FIELDS Sciencesb Sciencesc Program.
13,035 7,S10
5,470 3,750
7,095 3,400
470 360
1,190 725
550 725
540 0
100 0
200
To
200
o
Other
Dental Clinical Health
Clinical Sciences Services Nursing
Research Programs Researche Researchf
2,800 330 280
0 200 245
2,800 130 25
0 0 10
Trainees Total 8,715 4,110 1,030 725 170 2,400 260 20
Predoctoral 5,145 3,750 500 725 0 0 160 10
Postdoctoral 3,100 0 430 0 170 2,400 100 0
MARC Undergrad.g 470 360 100 0 0 0 0 10
Fellows Total 4,320 3,400 160 0 30 400 70 260
Predoctoral 325 0 50 0 0 0 40 235
Postdoctoral 3,995 3,400 110 0 30 400 30 25
1989 TOTAL Total 13,465 7,760 1,190 725 250 2,900 330 310
Predoctoral 5,540 3,800 550 725 0 0 200 265
Postdoctoral 7,455 3,600 540 0 250 2,900 130 35
MARC Undergrad.g 470 360 100 0 0 0 0 10
Trainees Total 8,910 4,160 1,030 725 210 2,500 260 25
Predoctoral 5,195 3,800 500 725 0 0 160 10
Postdoctoral 3,245 0 430 0 210 2,500 100 ~
MARC Undergrad.g 470 360 100 0 0 0 0 10
Fellows Total 4,555 3,600 160 0 40 400 70 285
Predoctoral 345 0 50 0 0 0 40 255
Postdoctoral 4,210 3,600 110 0 40 400 30 30
1990 TOTAL Total 14,195 8,310 1,190 725 320 3,000 330 320
Predoctoral 5,900 4,150 550 725 0 0 200 275
Postdoctoral 7,825 3,800 540 0 320 3,000 130 35
MARC Undergrad.g 470 360 100 0 0 0 0 10
Trainees Total 9,370 4,510 1,030 725 270 2,550 260 25
Predoctoral 5,545 4,150 500 725 0 0 160 10
Postdoctoral 3,355 0 430 0 270 2,-550 100 5
MARC Undergrad.g 470 360 100 0 0 0 0 10
Fellows Total 4,825 3,800 160 0 50 450 70 295
Predoctoral 355 0 50 0 0 0 40 265
Postdoctoral 4,470 3,800 110 0 50 450 30 30
a These are total numbers of full-time awards recommended.
1984.
b Recommendations for biostatistics, community and environmental health, and other training fields not specifically shown
in this table are included here.
c It is assumed that 90% of behavioral science Predoctoral awards will be traineeships and that 80% of postdoctoral awards
will be traineeships.
These are full-time training positions only, 85% of which should be allocated to physicians. In addition, a program of part-
time research training (up to 3 months per year) for health professions students during summer and off-quarters was authorized
in 1978, with expenditures not to exceed JO of appropriated training funds. In FY 1983, 1,417 traineeships were made
available under this short-term program.
e It is assumed that 60% of these health services research awards will be Predoctoral and 40% will be postdoctoral. Of the
Predoctoral awards, it is assumed that 80~o will be traineeships. Of the postdoctoral awards, it is assumed that 75% will be
traineeships.
f It is assumed that 90~o of these nursing research awards will be Predoctoral and 10% will be postdoctoral.
g The Minority Access to Research Careers (MARC) Honors Undergraduate Training Program is for prebaccalaureate students.
See Table 1.2 for actual numbers of awards made in 1983 and
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TABLE 1.6 Estimated Cost of Recommended NIH/ADAMHA/HRSA Training Programs, FY
1988-90 (millions of dollars
Clinical Sciences
TOTAL Basic Med. Short- Other Health
Fiscal Type of ALL Biomedical Behavioral Sci. Term Clin. Services Nursing
Year Program FIELDS Sciences Sciences Total Prog. Trainingb Postdoc. Research Research
1988 TOTAL 272.6 137.3 23.2 101.4 13.1 3.2 85.1 6.4 4.3
Trainees 173.1 58.0 19.9 89.8 13.1 3.2 73.5 5.1 0.3
Fellows 99.5 79.3 3.3 11.6 11.6 1.3 4.0
Predoctoral 84.6 54.4 7.4 16.3 13.1 3.2 2.9 3.6
Postdoctoral 183.3 79.3 14.8 85.1 85.1 3.5 0.6
MARC Undergrad.C 4.7 3.6 1.0 0.1
1989 TOTAL 284.9 143.8 23.4 106.4 13.4 3.5 89.5 6.5 4.8
Trainees 180.2 59.9 20.1 94.6 13.4 3.5 77.7 5.2 0.4
Fellows 104.7 83.9 3.3 11.8 11.8 1.3 4.4
Predoctoral 87.6 56.2 7.6 16.9 13.4 3.5 3.0 3.9
Postdoctoral 192.5 83.9 14.8 89.5 - 89.5 3.5 0.8
MARC Undergrad.C 4.8 3.7 1.0 0.1
1990 TOTAL 302.3 155.0 23.7 112.0 13.8 3.7 94.5 6.5 5.1
Trainees 190.9 66.4 20.3 98.6 13.8 3.7 81.1 5.2 0.4
Fellows 111.4 88.6 3.4 13.4 13.4 1.3 4.7
Predoctoral 95.2 62.7 7.8 17.5 13.8 3.7 3.0 4.2
Postdoctoral 202.3 88.6 14.9 94.5 94.5 3.5 0.8
MARC Undergrad.C 4.8 3.7 1.0 - - - 0.1
a Calculations were based on 1984 average cost figures derived from NIH data and assumed the following: 1) a 23.8% increase
in Predoctoral stipends and a 36.3% increase in postdoctoral stipends for FY 1985, held constant for later years; 2) a 5%
per year increase in tuition; and 3) maximum annual institutional costs of $1,500 for Predoctoral trainees and fellows, $2,500
for postdoctoral trainees, and $3,000 for postdoctoral fellows. The stipend increases became effective in FY 198S.
b Estimate assumes 1,500 trainees for 1988, 1,600 trainees for 1989, and 1,700 trainees for 1990.
c The Minority Access to Research Centers (MARC) Honors Undergraduate Training Program is for prebaccalaureate students.
ESTIMATED TRAINING COSTS PER AWARD IN FY 1984 (dollars)
Predoctoral Postdoctoral Prebaccalaureate
Clinical Sciences
Basic Behav- Med. Short- Health Behav- Health
Biomed. ioral Sci. Term Services Nursing Biomed. ioral Clinical Services Nursing
FY 1984 Sci. Sci. Prog. Training Research Research Sci. Sci. Sci. Research Research
MARC
Honors
Undergrad.
Trainees 12,385 11,579 15,276 1,833 12,385 12,385 22,236 22,425 22,858 22,236 22,236
Fellows 12,385 11,579 12,385 12,385 17,790 18,510 20,473 17,790 17,790
13,948a
a This estimate applies to all fields.
Representative terms from entire chapter:
marc undergrad
