Personnel Needs and Training for Biomedical and Behavioral Research 1981 Report (1981) / Chapter Skim
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2. Clinical Sciences
2. Clinical Sciences
Pages 23-51
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From page 23... ...
As part of the clinical investigation team, they have a multifaceted role that may range f ram studying isolated tissue components derived from patients to close collaboration with a physician-investigator in research requiring experimental manipulation of human subjects and their environment. Moreover, they often help to ensure the application of state-of-the-art technology to clinical investigation.
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From page 24... ...
. clinical training programs early in that period, the decrease in more recent years probably reflects a diminished interest in research careers On the part of the young physician ~ see p.
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From page 25... ...
A selected subset of 24 medical schools have 6 year dual degree programs funded through the NRSA Medical Scientist Training Program of the National Institute of General Medical Sciences. Another source of potential clinical investigators is comprised of students who enter medical school with the Ph.D.
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From page 26... ...
Recent debate over the need for additional subspecialists has prompted questions by federal and other funding agencies as to whether it is appropriate for public funds to be used for research training provided in connection with subspecialty training. This has resulted in diminished funding of subspecialty fellowships which, in turn, has reduced the number of opportunities for training in clinical investigation.
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From page 27... ...
Career Plans of Medical Students The f irst study, which was carried out by the Association of American Medical Colleges, was based on a December, 1979, survey of all medical school seniors who expected to graduate in 1980 (AAMC, 1981b)
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From page 28... ...
Debt The data do not indicate that anticipated accumulated debt at graduation from medical school operates as a disincentive to choice of research career. Factors Inf luencing Research Career Choice Respondents were asked to indicate the relative inf luence each of nine factors played in their consideration of research involvement in their ensuing medical careers.
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From page 29... ...
{3sing different discount rates, the same comparisons yield the following results in terms of lifetime economic loss: Physic fans at NIH at Medical School Dent i sts at NIH Lifetime Economic Loss D i scount Rate 12% 8% o% ~ _ _ $170, 000 $242, 000 $645, 000 $ 70, 000 $127, 000 $239, 000 $111, 000 $164, 000 $550, coo Compared to physicians and dentists, veterinarians have small economic losses, whether employed by the f ederal government or a veterinary school. The economic losses varied considerably by spec tatty for physic fans undertaking 2 years of postdoctoral training and selecting ~ career either at NIH or on a medical school faculty ~ see Appendix Table A9)
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From page 30... ...
Research Careers in Internal Med. ic ine Under Committee sponsorship, researchers at Michigan State University have studied the factors inf luencing choice between careers in academic medic ine and private practice.
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From page 31... ...
D1 scusslon The study of economic rate of retur n, c ited above, has documented that the early and lifelong earnings of physicians in academic medicine are less than comparable average earning s of physic fans in private practice. This fact, plus a high level of debt accumulated before graduation f ram medical school, have been commonly perceived to serve as disincentives for following a research career.
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From page 32... ...
In both the Michigan State University study and the AAMC survey of graduating seniors, payback was seen not to have been a serious deterrent to research career planning. In addition, the survey of successful clinical investigators by Davis and Kelley showed that the payback obligation was perceived to be a relatively minor factor in the decision-making process.
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From page 33... ...
MSTP graduates, Clinical Associates, and Trainees/Fellows had higher approval rates and better average priority scores than those for all applicants. Judged by only a small number of applications, the pert onnance of former Research Assoc fates was mixed -- relatively low approval rate but excellent average priority scores for approved applications.
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From page 34... ...
MSTP graduates and Research Associates appeared to conduct much basic, as well as clinical, research. Research by former Clinical Associates and Trainees/Fellows included a relatively higher proportion of clinical observations and clinical investigations.
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From page 35... ...
TABLE 2.2 Length of Career as NIH Pnncipal Invest~gator With and Without NIH Postdoctoral Training With NIH Postdoctoral No NIH-Supported Fiscal Yesr of T an~ung Postdoctoral Training First Research M.D.
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From page 36... ...
The survey f rom which these data were derived def ined research activity broadly to include all research-related teaching, patient care, and administration ~ including service on human subjects review committees)
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From page 37... ...
The concern should be over how to maximize the Ph.D.'s participation in clinical investigation, rather than on the departmental setting in which he/she has a primary faculty appointment. Consequently, it seems worthwhile to identify models where Ph.D.
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From page 38... ...
Projections Through FY 1985 It is well known that medical school faculty8 members generally distribute their activities in varying proportions among teaching, research, patient care, and administration. The CoTnmittee's model of demand for clinical faculty is therefore based on the hypothesis that the 38
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From page 39... ...
E ^~ ~ t it ~ -- ~ , ° ° ° =~ ° of = ~ If; 3 §6 ~ ~ , ~ 7 ~ o -~= Ad.
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From page 40... ...
. With regard to medical school enrollments, the third component of the demand model, the Committee this year has broadened its definition to include not only medical students but also residents and clinical fellows since all three contribute varying amounts to the demand for clinical faculty.
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From page 41... ...
1 I L I I ~ . _ I 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 FISCAL YEAR FIGURE 2.2 Service income reported by medical schools (1972 A
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From page 42... ...
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 FISCAL YEAR FIGURE 2.4 Clinical faculty in medical schools. Faculty is defined here as a full-time appointment in a clinical department regardless of tenure status.
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From page 43... ...
From 1975 to 1978 only about 21 percent of all new appointments in clinical departments had postdoctoral research training. The AAMC data also show that a signif icant amount of attrition f rom medical school faculties (about 4 percent per year)
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From page 44... ...
m students by 198S 1985 45,950 43,610 41,600 Annual grown rate in CF from 1980 to 1985 5.2% 4.3% 3.5% Average annual mcremcnt due to faculty expansion Annual replacement needs due to:b death and retirement other attrition Expected number of positions to become available annuity on clinical faculties 2,000 1,620 1,280 400 390 380 1,760 1,700 1,660 4,160 3,710 3,320 . Be Will grow at 2.S%/yr., reaching 131,000 students by 1985 Expected Size of clinical faculty m medical schools (CF)
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From page 45... ...
CIn 1978 there were 2,011 budgeted vacancies in clinical departments of medical schools. The demand for clinical faculty generated by the need to reduce this level to 1,000 by 1985 is about 150 per year.
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From page 46... ...
It is appropriate, therefore, to attempt to reduce budgeted vacancies in clinical departments to 1, 000 in 1985 from their 1979 level of about 2, 000. Line 3 is the estimated demand for clinical faculty at dental and veterinary schools.
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From page 47... ...
RECOMMENDATIONS In view of the outlook for continued shortages of clinical scientists to staff the faculty of medical schools and conduct clinical investigations, arm the need to encourage physicians and other health professionals to undertake research training in preparation for research careers, in the sections below the Committee makes two recommendations for training in the clinical so fences area. Tra ineeships and Fe llowsh ips Recommendation.
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From page 48... ...
The relatively small number of physician applicants for NIH postdoctoral research fellowships and traineeships in recent years is one aspect of the problem. Another is NIH' s lack of leverage for inf luencing the change directly, since trainee appointments are the responsibility of the individual training program director.
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From page 49... ...
Recommendation. The Committee recommends that an annual · enrollment of 725 trainees In the Medical Scientist Training Program (MSTP)
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From page 50... ...
8. The clinical faculty data used in this analysis are taken f rom the annual surrey of medical schools conducted by the Liaison Committee on Medical Education and published annually in the Journal of the American Medical Association (AMA, 1960-80)
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From page 51... ...
6 - 103440/Mt) + 0.13, F = full-time clinical faculty in medical schools; S = medical student enrollment including residents and clinical f ellows; and M = weighted average of clinical R&D expenditures plus fee income in medical schools (R)
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