Personnel Needs and Training for Biomedical and Behavioral Research 1983 Report (1983) / Chapter Skim
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2. Clinical Sciences
2. Clinical Sciences
Pages 18-49
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From page 18... ...
INTRODUCTION AND OVERVIEW Clinical investigation, as defined by the Committee, includes research on patients, on samples derived from patients as part of a study on the causes, mechanisms, diagnosis, treatment, prevention, and control of disease, or on animal studies by scientists identifiable as clinical investigators on the basis of their other work. Clinical investigation is generally performed in academic health centers.
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From page 19... ...
Highlights of the new data presented in Table 2.1 are as follows: . demand for faculty in clinical departments continued to be strong · clinical R and D expenditures rebounded sharply in 1980 after a decline in 1979, but have fallen back since then .
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From page 21... ...
The total of medical students, residents, and clinical fellows has grown at an average annual rate of only 3.2 percent since 1979. Hit simultaneously by steep borrowing rates and substantial tuition increases, student indebtedness continues to grow.
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From page 22... ...
This may result from incentives for expansion of graduate medical training contained in the Medicare prospective payment plan recently passed by Congress.3 Also, with the growing complexity of medical services, prolongation of training programs and increase in number of residency years are a possibility. MAINTAINING THE FLOW OF NEW CLINICAL INVESTIGATORS ' The future vitality of clinical investigation depends upon the medical schools' ability to maintain a flow of qualified physician investigators.
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From page 23... ...
The data files on NIH/ADAMHA trainees and fellows and principal investigators maintained by the Committee could be combined with the AAMC'S Medical School Faculty Roster, the Dental School Faculty Roster, and files maintained by various professional societies to form a composite data base that would include almost all clinical investigators. Samples could be drawn from the population for use in periodic surveys of research activity, sources of support, training background, and other information vital to the task of monitoring this important pool of scientists.
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From page 24... ...
In this connection, it is to be noted that NIB training grants provided support for periods of 1-3 months to 12,6'45 ' individuals during the years 1960-1974. Subsequent postdoctoral training, NIH/ADAMHA grant activity, academic appointments, and publications will be scrutinized.
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From page 25... ...
Based on an outcome study of the first 53 graduates of MSTP with respect to research retention, rate of advance in academic positions, research grant success, and publication performance, the program has been successful (NRC, 1975-81, 1~ 1 Report)
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From page 26... ...
s An Annual NIH Survey, Manpower Report, collected data from principal investigators regarding persons receiving salary from each grant during those years. The NIH Central Scientific Classification System was used in this analysis to identify clinical grants -- i.e., those involving human subjects as individuals or as groups.
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From page 27... ...
scientists has moved into clinical departments of medical schools (Appendix Table Ark. Under these circumstances, one of the questions examined by the Committee concerned the extent to which the steady increase in the postdoctoral training pool might be used to mitigate a possible shortage of physician investigators.
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From page 28... ...
Ph.D.s with primary appointments in basic science departments 3. M.D.s with primary appointments in clinical departments.
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From page 29... ...
For these reasons, data for faculty in psychiatry departments are shown separately from other clinical departments in Tables 2.3 and 2.4. Clinical department Ph.D.s are younger in career age than both basic science department Ph.D.s and M.D.
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From page 30... ...
aExcludes departments of psychiatry. Ph.D.s in psychiatry departments appear to have different characteristics from those in over clinical departments.
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From page 31... ...
bExcludes departments of psychiatry. Faculty members in psychiatry departments appear to have different characteristics from those in other clinical departments.
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From page 32... ...
The remaining four categories of clinical investigation involve materials derived from humans; animal studies or models for human experimentation; epidemiologic studies; and miscellaneous projects (communications, data systems, etc.~. For research in those categories, a Ph.D.
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From page 33... ...
used the table of contents of one issue of the Journal of Clinical Research to demonstrate that research in clinical departments frequently "falls within the traditional purview of basic science departments." In keeping with the trend toward integration of the clinical and basic sciences, the NIH has announced a new program -- the Physician Scientist Award -- designed to promote opportunities for young clinicians to develop research skills and experience in a fundamental science. The Committee has repeatedly stressed the importance of the physician-scientist in clinical investigation.
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From page 34... ...
According to that model, the F/S ratio is dependent on funds generated by R and D expenditures and fee income (hereafter denoted as "clinical funds. Therefore a high F/S ratio should be associated with a high level of funds, and since private schools have higher F/S ratios, we would expect to find higher levels of these funds in private schools than in public schools.
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From page 35... ...
, , , I · I , · , , I , ~ , , 1 1 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 FISCAL YEAR FIGURE 2.3 Medical students, residents, and clinical fellows at U.S. medical schools, by control of institution, 1961-82.
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From page 36... ...
10 ~ ~~==~ Public Schools' . I I I I I 1 1 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 FISCAL YEAR FIGURE 2.4 Full-time clinical faculty in U.S.
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From page 37... ...
The rationale for this modification is the belief that faculty size does not change in response to changes in current year 7 Faculty is defined in this model as full-time faculty in clinical departments, while students are defined as the total of medical students, residents, and clinical fellows.
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From page 38... ...
for all medical schools. The ratio is defined as follows: CF = full-time faculty in clinical departments of U.S.
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From page 39... ...
weighted average of clinical R and D expenditures plus professional service income per school (1972 $, millions) c = scaling constant: CF/WS = c when M = 0 a,b = parameters to be determined empirically With this type of growth function, the percentage change in CF/WS is assumed to increase proportionately to 1/{M2~.
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From page 40... ...
Private School' Publ ic School s * = Private Schools 61 = Publ i c School s 7 8 9 FIGURE 2.8 Clinical faculty/student ratio (CF/WS)
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From page 41... ...
1. Enrollments: medical school enrollments, defined as medical students, residents, and clinical fellows, are expected to show no growth between 1982 and 1988.
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From page 42... ...
3. Professional service income: the best-guess assumption is for real growth (after adjusting for inflation)
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This produces an estimated upper limit for clinical faculty size of 49,640 members by 1988, for a faculty growth rate of 3.9 percent per year.
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From page 44... ...
, clinical funds would expand by about 2 percent per year through 1~8-yielding ~ CF/WS ratio of 0.344 -- and enrollments would remain at 1981 levels. The best estimate of clinical faculty size under these assumptions is 40,700, an increase of 500 positions per year or 1.3 percent per year over the 1980 level.
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From page 45... ...
Will grow at 2.5%O/yr., Expected size of clinical faculty in reaching 141,000 medicalschools (CF) in 1988 49,640 46,600 43,800 students by 1988 Annual growth rate in CF from 1980 to 1988 3.9 3.0~o 2.2~o Average annual increment due to faculty expansion 1,620 1,240 890 Annual replacement needs due to:C death end retirement 430 420 400 other attrition 1,900 1,830 1,770 Expected number of positions to become available annually on clinical faculties 3,950 3,490 3,060 B
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From page 46... ...
the need to reduce budgeted vacancies in clinical departments b} demand for clinical faculty in dental and veterinary schools the number of accessions to clinical faculty positions who have (or should have} research training 3. the appropriate length of the research training period 4.
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From page 47... ...
training period and portion of trainees seeking clinical faculty positions is: a.
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From page 48... ...
The best-guess assumptions yield a range of 1,8S0-2,660 postdoctoral trainees in the clinical sciences. Long-Term Considerations The foregoing analysis is an attempt to translate the Committee's assessment of enrollments and funding in the next few years into projections of academic demand for clinical faculty and ultimately into training levels needed to satisfy that demand.
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From page 49... ...
Our recommendations for training in the clinical sciences acknowledge the continuing need to attract and train physicians for research careers. Yet the overall recommended level of training in the clinical sciences has been formulated under our best judgment about the research opportunities that are expected to become available within the next few years under the most likely set of circumstances in medico education.
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