Biomedical and Behavioral Research Scientists: Their Training and Supply Volume III: Commissioned Papers (1989) / Chapter Skim
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3. Health Services Research Personnel: Demand, Supply, and Adequacy of Training Programs
3. Health Services Research Personnel: Demand, Supply, and Adequacy of Training Programs
Pages 75-106
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From page 75... ...
Given the complexities of the health care delivery system, the field relies upon researchers trained in numerous disciplines, as well as those capable of bringing disciplines together to work cooperatively. Figure 1 illustrates broadly the domains of health services research.
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From page 76... ...
In an effort to explain through example, the remainder of this paper describes the training of individuals engaged in health services research, the various pathways used to produce these researchers, the current levels of support for training, and future events that might affect the demand for health services research personnel. At the conclusion of the paper, the question of the adequacy of these mechanisms for producing enough well-trained health services researchers for the near term is discussed.
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From page 77... ...
The articles shown in Table 4 provide one indicator of the variety and type of topics addressed by leading health services researchers and some sense of the disciplines involved. The extent to which the field is interdisciplinary is understated because only the first author is shown.
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From page 78... ...
DISCIPLINARY DEGREE PROMS Currently, most individuals engaged in health services research have received their training primarily from disciplinary degree programs, including economics, quantitative methods (e.g., statistics, operations research, epidemiology) , sociology, psychology, management (e.g., business, accounting, planning)
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From page 79... ...
The impact of migration on the supply of personnel is an issue that is particularly relevant to interdisciplinary research. Because little is known about the effects of such labor-market patterns, an investigation of the role of migration on the demand and supply of health services researchers should include attention to the following questions: o What is the minimum amount of time that must be spent in health services research in order to produce highqua~ity research?
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From page 80... ...
This will appeal to those who are interested in applied rather than more theoretical fields of · ~ 1nqulry. INTERDISCIPLIN=Y TWINING PROMS Interdisciplinary training is a relatively new -- and increasingly important -- avenue for producing health services researchers.
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From page 81... ...
Because many research results may suggest needed changes in policy, there are benefits to having trained individuals who are responsible for policy formulation and implementation. POST~CTO"L TWINING PROGRESS Individuals trained in either disciplinary or interdisciplinary programs may require additional career development such as that offered in postdoctoral training programs.
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From page 82... ...
Estimating the demand for entry to postdoctoral programs should be approached in a manner similar to that suggested for interdisciplinary training programs. A comprehensive list of the postdoctoral programs and a survey of program directors that included information from admissions records would provide information on, for example, the number of qualified applicants turned down each year.
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From page 83... ...
. Reliance on this method of producing health services researchers is risky at best because the success of the approach depends upon the quality and commitment of those serving in a supervisory capacity.
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From page 84... ...
These sources include both public and private support. Those more easily identified are the sources dedicated to health services research training fellowships; clearly, this does not capture all of the funding sources for training those who become health services researchers.
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From page 85... ...
NCHSR-HCTA also provides support for predoctoral and postdoctoral training. The agency has authority to award 10 to 20 dissertation grants annually to support individuals pursuing degrees in fields related to health services research while they write dissertations.
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From page 86... ...
HCFA-ORD has indicated that it currently supports the following seven areas of primary interest for funding research activities: o access to quality care under Medicare and Medicaid and improved methods for measuring quality and effectiveness of care; o refinement of the current Medicare physician payment methodology through the study of the causes for the growth in Medicare outlays for physician services and the development of cost-effective approaches to controlling such growth; o increased competition and consumer choice and continued growth of Medicare capitated systems; o continued improvement in the current Medicare hospital prospective payment system and the study of the outpatient delivery system; analysis of other Medicare and Medicaid program services and issues leading to increased efficiency in health care delivery and financing, particularly in program areas that have a significant impact on program and beneficiary expenditures (high-cost, high-volume services) , including such areas as clinical laboratories, home health and long-term care, and treatment of acquired immunodeficiency syndrome; 86
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From page 87... ...
HCFA also maintains four policy research centers that are designed to assist HCFA in conducting short-term policy analyses and other analyses that support HCFA's mission. Although HCFA-ORD does not support the training of health services researchers directly, the projects funded through the agency provide research opportunities for individuals pursuing both predoctoral and postdoctoral training.
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From page 88... ...
The two most established direct training programs are The Robert Wood Johnson Clinical Scholars program, which provides postdoctoral training for physicians, and The Pew Charitable Trusts Health Policy Program, which funds predoctoral and postdoctoral training in health policy. In 1987 The Robert Wood Johnson Foundation provided $1.89 million to support 53 physicians training in 6 programs around the country.
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From page 89... ...
to more than 1,000 individual and 70 institutional members in mid-1988. In 1983 the directory listed 37 university-based health services and policy research organizations and 8 VA Health Services Research and Development Field Programs.
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From page 90... ...
While there does not seem to be a crisis in the availability of research personnel currently, the pipeline required to produce such individuals is sufficiently long to warrant conducting more sophisticated work force estimates now rather than when a problem is upon us. CONCLUSION Any serious effort to address the goal of using scarce health care resources effectively will require a significant increase in the number of trained research personnel.
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From page 91... ...
In the future, preference should be given to supporting these interdisciplinary or multidisciplinary training programs. The number of fellowships available for both predoctoral and postdoctoral training is relatively small: 216 predoctora~ and 133 postdoctoral fellowships (including the Robert Wood Johnson clinical scholars program)
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From page 94... ...
TABLE 1: Membership in the AHSR, by Discipline, as of May 1988 Primary Discipline Percent of Members (n = 1042) Medicine Economics Public health Sociology Business/management Health services research Quantitative methods Other health professions Public administration/ policy Psychology Other professional Education Other 18.1 13.2 12.7 7.4 6.8 5.3 4.8 4.8 4.7 3.6 1.7 1.5 15.4 SOURCE: AHSR, personal communication.
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From page 95... ...
TABLE 2: Educational Background of AHSR Members, May 1988 Type of Degree Ph.D. M.D./other health professional Masters Bachelors Students in training Other/not specified Proportion of Members (n = 1042)
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From page 96... ...
TABLE 3: Institutional Affiliation of AHSR Members, May 1988 Institutional Affiliation Proportion of Members (n = 1042) University Health care delivery Health industry Private organization Government Private Other foundation 46.5 15.6 11.3 10.8 8.2 1.2 6.4 SOURCE: AHSR, personal communication.
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From page 97... ...
Use of Claims Data Systems to Evaluate Health Care Outcomes: Mortality and Reoperation Following Prostatectomy A Randomized Controlled Trial of Academic Group Practice: Improving the Operation of the Medicine C] inic Bringing Excluded Psychiatric Facilities Under the Medicare Prospective Payment System M.D.
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From page 98... ...
Evaluating a New Technology: The Effectiveness Electronic Fetal Heart Rate Monitoring Meta-Analyses of Randomized Controlled Trials L
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From page 99... ...
Technology assessment Health professions training and supply Quality of care Health care financing Organization and service delivery Outcomes assessment 99
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From page 100... ...
TABLE 6: Institutions Participating in Health Services Research Training Category of Number of Number of Number of Training Fellowships Institutions States Predoctoral 216~ 26 15 Postdoctoral 80~ 23 16 Other2 __ 24 15 lithe number shown is a minimum; some programs indicate that the actual number varies from year to year. 2 Includes internships, midcareer training, master's level programs, ad hoc fellowships, research assistantships, independent study, and visiting scholars.
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From page 101... ...
TABLE 7: Funding for NCHSR-HCTA (in thousands of dollars) Category 1986 1987 1988 1989 1990*
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From page 102... ...
TABLE 8: Funding for the HCFA-ORD (in thousands of dollars) Category 1986 1987 1988 1989 1990i Federal funds2 $15,310 $10,000 $9,574 $9,880 $14,000 Trust funds3 14,370 18,000 18,000 17,233 19,760 Total $29,680 $28,000 $27,574 $27,113 $33,760 President's budget.
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From page 103... ...
TABLE 9: VA Health Services Research and Development Field Programs, 1987 Region Projected Spending, 1987 Research Staff (FTEs) Affiliated VA Medical Universities Centers (no.)
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From page 104... ...
Includes two VA fellows. SOURCE: Robert Wood Johnson Foundation, 104 personal communication
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From page 105... ...
TABLE 11: The Pew Charitable Trusts Health Policy Program, 1987-1991 Current Program Grant Current Number of Program (millions of $) Fellows Alumni Type*
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