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Health Services Research:
Work Force and Educational Issues
Committee on Health Services Research: Training
and Work Force Issues
Marilyn I. Field, Robert E. Tranquada,
and fill C. FeasTey, Editors
Division of Health Care Services
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
Washington, D.C. 1995
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National Academy Press · 2101 Constitution Avenue, N.W. · Washington, D.C. 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy of
Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the
committee responsible for the report were chosen for their special competences and with regard for
appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved
by a Report Review Committee consisting of members of the National Academy of Sciences, the National
Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist
distinguished members of the appropriate professions in the examination of policy matters pertaining to
the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter
responsibility to be an adviser to the federal government and its own initiative in identifying issues of
medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
Support for this project was provided by the Agency for Health Care Policy and Research, U.S.
Department of Health and Human Services, under Contract No. 282-94-2008; the Robert Wood Johnson
Foundation, under Grant No. 24791; the Department of Veterans Affairs; and the Baxter Foundation.
The views presented are those of the Institute of Medicine Committee on Health Services
Training and Work Force Issues and are not necessarily those of the funding organizations.
Library of Congress Catalog Card No. 95-71398
International Standard Book No. 0-309-05348-X
Additional copies of this report are available from:
National Academy Press
2101 Constitution Avenue, N.W.
Box 285
Washington, D.C. 20055
Call 800-624-6242 (or 202-334-3313 in the Washington metropolitan area)
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and
religions since the beginning of recorded history. The image adopted as a logotype by the Institute of
Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.
Copyright 1995 by the National Academy of Sciences. All rights reserved.
No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in
the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted' or
otherwise copied for public or private use, without written permission from the publisher, except for the
purpose of official use by the U.S. Government.
Printed in the United States of America
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COMMITTEE ON HEALTH SERVICES RESEARCH: TRAINING
AND WORK FORCE ISSUES
ROBERT E. TRANQUADA,* Chair, Norman Topping/National Medical
Enterprises Professor of Medicine and Public Policy, University of
Southern California, Los Angeles, California
PAULA K. DIEHR, Professor, Department of Biostatistics, University of
Washington, Seattle, Washington
DEBORAH A. FREUND, Vice Chancellor, Academic Affairs, and Dean of
Faculties, Indiana University, Bloomington, Indiana
WILLIAM T. FRIEDEWALD, Senior Vice President and Chief Medical
Director, Metropolitan Life Insurance Company, New York, New York
(resigned January 17, 1995)
JOHN C. GREENE,* Professor and Dean Emeritus, School of Dentistry,
University of California, San Francisco, California
MERWYN R. GREENLICK,* Professor and Chair, Department of Public
Health and Preventive Medicine, Oregon Health Sciences University, and
Director, Kaiser Permanente Center for Health Research, Portland, Oregon
ADA SUE HINSHAW,* Dean, School of Nursing, University of Michigan,
Ann Arbor, Michigan
DAVID A. KINDIG, Professor of Preventive Medicine, and Director,
Wisconsin Network for Health Policy Research, University of
Wisconsin-Madison School of Medicine, Madison, Wisconsin
KENNETH W. KIZER, Professor and Chair, Departments of Community
and International Health, School of Medicine, University of California,
Davis, California (position at time of committee service, resigned
October 24, 1994)
KEVIN J. LYONS, Associate Dean and Director, Center for Collaborative
Research, College of Allied Health Sciences, Thomas Jefferson
University, Philadelphia, Pennsylvania
ALBERT G. MULLEY, Chief, General Internal Medicine Unit,
Massachusetts General Hospital, Boston, Massachusetts
WILLIAM L. ROPER,* Senior Vice President and Chief Medical Officer.
The Prudential Health Care System, Atlanta, Georgia
DONALD M. STEINWACHS,* Chair and Professor, Department of Health
Policy and Management, Johns Hopkins University School of Hygiene
and Public Health, Baltimore, Maryland
BAILUS WALKER, Jr.,* Professor of Environmental and Occupational
Medicine, and Associate Director, University Cancer Center, Howard
University College of Medicine, Washington, D.C.
* Member, Institute of Medicine
. . .
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B1~RILYN J. FIELD, Study Di~c10r (Ann January 15,1995)
JILL C. FEASLEV, Rese~cb Associate bang October 1, 1994)
DONNA D. THOMPSON, A-ink~ive Assistant (1brougb Clay 5, 1995)
hL`ll[LEEN N. LO~nt, Direc10r, Division of Health Care Services
SUSAN TILt[L, Study tremor Obrougb January 15,1995)
BLtHLA R. SECEDERS, A-ink~ive AssL1an1 (aher June 12,1995)
NINA H. SP~uUILL, Financial Of Bcer
1V
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Acknowledgments
The Committee on Health Services Research: Training and Work Force
Issues wants to acknowledge those who assisted it in preparing this report. At
the Agency for Health Care Policy and Research, James Cooper, the project
officer, helped us in many ways. Donnarae Castillo, who is responsible for the
National Research Service Award activities within the agency, patiently answered
questions and compiled information on institutional and individual awards.
Ralph Sloat helped us locate diff~cult-to-find historical information about earlier
training activities. Julius Rosenthal at the Agency for Health Care Policy
Research supplied information on dissertation research awards. At the
Department of Veterans Affairs (VA), Shirley Meehan and Joseph Couch
provided information on the Health Services Research educational programs at
the VA.
Within the National Research Council, Porter Coggeshall, Pamela Ebert-
Flattau, Anthony DeSantis, and others provided information about the series of
studies of biomedical and behavioral science research personnel that the Office
of Scientific and Engineering Personnel has conducted since 1975.
With support from the Pew Health Policy Program, Marion Lewin and
Valerie Tate Jopeck, colleagues within the Institute of Medicine (IOM),
contributed substantially to committee efforts to gain perspectives from private
industry and state government. They helped organize a panel of industry
representatives for the committee's March 1995 meeting in which the committee
heard from Howard Bailit, Henry Bachofer, Carmela Dyer, Lawrence Lewin, and
Bruce Steinwald. Marion Lewin also participated in telephone interviews with
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ACKNOWLEDGMENTS / vi
current and former state officials including Mark Chassin, Dennis Beatrice,
Robert Crittenden, Robert Frank, Alan Well, Pamela Paul-Sheehan, Beth
Kilbreth, and Richard Merritt. The committee also expresses its appreciation to
the two dozen executives of health plans, consulting firms, and similar
organizations who agreed to be interviewed by committee members about health
services researchers in private industry.
At the University of Wisconsin-Madison, Nancy Cross Dunham and Karen
Tyler of the Wisconsin Network for Health Policy Research created the health
services researcher database for the committee and drafted a report describing the
method and results. That database is more comprehensive than any developed
before. Alice Hersh, Suzan Meredith, and Jennifer Rotchford of the Association
for Health Services Research provided considerable information including their
membership files.
As usual, staff at the IOM provided critical support for the work of the
committee and project staff. They include Elizabeth Mouzon, Donna Thompson,
Don Tiller, Nina Spruill, Susan Thaul, Dorothy Majewski, Sarah Reich, Claudia
Carl, Mike Edington, and Richard Julian. An especially heartfelt thank-you goes
to Mary Lee Schneiders who spent many long hours working through the
complexities of database conversion and manipulation.
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Contents
SUMMARY
1 INTRODUCTION AND BACKGROUND
Origins of the Study, 14
Study Approach, 15
Definitions and Concepts, 17
Conclusion, 23
2 OVERVIEW OF HEALTH SERVICES RESEARCH
A Brief Look Back, 26
Health Services Research Today and Tomorrow, 34
Conclusion, 41
3 THE HEALTH SERVICES RESEARCH WORK FORCE
The Current Work Force, 44
The Future Work Force, 49
Conclusion, 54
4 EDUCATIONAL PROGRAMS, RESOURCES, AND ISSUES
Educational Programs, 56
Funding for Education in Health Services Research, 63
Conclusion, 74
. . .
V11
. 13
. 25
. 43
. . .
. 55
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viii I CONTENTS
5 FINDINGS AND RECOMMENDATIONS
Data Availability and Improvement, 77
Work Force Size and Characteristics, 78
Supply in Relation to Demand, 79
Training Programs, 80
Conclusion, 83
6 REFERENCES
APPENDIXES
77
85
A A New Database on the U.S. Health Services Research Work Force . . 91
B Survey of Health Services Research Educational Programs 101
C Multistate Life Table Methodology and Projections 113
D Committee Biographies 121
Multistate Life Table Methodology and Projections
TABLES AND FIGURES
TABLES
1.2
4.1
4.5
A.1
1.1 Federal Expenditures for Health Services Research, FY 1994 and 1995
Appropriations, 22
Federal Expenditures for Health Services Research in Relation to Total
U.S. Health Spending, FY 1970 and FY 1994, 23
Institutions Receiving National Research Service Awards from the
Agency for Health Care Policy and Research, FY 1994, 58
4.2 Awards for Health Services Research Training, 1967-1994, 67
4.3 Recommendations for National Research Service Awards for Health
Services Research by Committees of the National Research Council
(NRC) or the Institute of Medicine (IOM), 1976-1994, 68
4.4 Funding of National Research Service Awards (NRSA) for Health
Services Research, FY 1986-1994, 69
Key Features of National Research Service Awards Traineeships and
Fellowships, 71
Number of Identified Health Services Researchers, by Region/State, 95
Recorted EmnloYment of Health Services Researchers (HSRs) by
A.2
A.3
~ . ~
Organizational Type, 96
Organizations Reporting Difficulties in Recruiting Ph.D.-Level Health
Services Researchers in the Past Few Years, by Type, 97
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CONTENTS I ix
Rank Order of Research Areas in Which Recruiting Difficulties Were
Reported, 98
Number of Organizations Indicating Plans to Recruit Health Services
Researchers in the Next Five Years, 98
A.6 Research Areas in Which Responding Organizations (n = 154) Expect
to Recruit Health Services Researchers in the Next Five Years, 99
Doctoral and Postdoctoral Fellowship Programs in Health Service
Research by Discipline and Degree Level, as categorized in the
1991-92 FHSR Directory, 103
Number and Percentage of Survey Respondents Indicating Typical
Academic Backgrounds of Their Health Services Research Students,
109
B.1
B.2
B.3
B.4
FIGURES
Number and Percentage of Survey Respondents Indicating Typical Work
Backgrounds of Their Health Services Research Students, 110
Number and Percentage of Survey Respondents Indicating Core Courses
for a Standard Health Service Research Curriculum, 111
B.5 Number and Percentage of Survey Respondents Indicating Source of
Funding for Health Service Research Students' Stipends, 112
B.6 Number and Percentage of Survey Respondents Indicating Post-Training
Employment Settings of Graduates in Health Services Research,
112
1.1 Health Services Research Work Force, by Function, 20
4.1 Funding for National Research Service Awards in health service research,
fiscal years 1986-1994, 70
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Health Services Research:
Work Force and Educational Issues
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