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Advancing the Nation’s Health Needs
and career development programs, using its estimates of future needs as well as information about the rate of Ph.D. production.
Assess the quality of existing NIH research training and career development programs.
Recommend modifications in the existing programs so that they may better prepare the research workforce to meet anticipated needs.
The committee’s initial attention was focused on the biomedical, behavioral, and clinical fields, but it expanded its analysis to include oral health, nursing, and health services research. These three new fields were not addressed in the last report, nor were they initially identified for consideration in the current study. However, the corresponding NIH institutes and centers and the AHRQ asked the committee to examine training in these fields, given an apparent shortage of research personnel in oral health and nursing and a need for more training in health services research.
For this report a life-table model was developed to simulate the changing characteristics of the research workforce in the biomedical, behavioral, and clinical sciences and to assess the future need for personnel in each of these fields. Data from various sources were used to estimate the input of research personnel into the model and to estimate the outputs with mortality and retirement data. In assessing the results of this analysis, several qualifications are in order. First, the model is necessarily fairly simple. Second, available data for the model are incomplete, since it is difficult to determine what proportion of the workforce is actually engaged in research, the number of foreign training scientists that are researchers, and whether available data represent current trends. Third, the models base projections only on the current situation—or, to be more precise, the situation for which the data were valid (typically 2–3 years earlier). Fourth, extrapolation to the future depends in large part on unknown variables, such as the strength of the economy and the amounts of federal spending for research. This analysis was not conducted for oral health, nursing, or health services research for the same reasons as above, and in addition, the results would be even more questionable, since the size of the workforce is small.
It should be noted that the life-table model and much of the analysis in this report address the supply side for research personnel. Metrics for the demand side of the analysis are either unknown or are difficult to quantify. The demand for research personnel could depend on the state of the U.S. economy, the speed at which discovery takes place, levels of research support from government and foundations, the outsourcing of research to foreign countries or the growth of research in foreign countries, and the importance of a field of research in the general scientific and engineering enterprise. The unprecedented growth in the biomedical research workforce in the 1980s and 1990s was fueled by the important discoveries during and before this period and the financial resources that were available to support the research. Predicting this growth in the 1970s on the basis of the current workforce and degree production would have been difficult.
When developing recommendations for the future, it should be remembered that workforce models are only part of the necessary considerations. As shown in the data presented earlier in this chapter, NRSAs support only a relatively small fraction of the total number of people being trained in the biomedical, social and behavioral, and clinical sciences. This is a significant addition to the pool of trained personnel, but the primary role of the NRSA program is not to just add numbers to the pool. It serves several other more important roles. The NRSA program serves as a beacon to attract quality people into biomedical, behavioral, and clinical research. Perhaps the best example of this is the MSTP, which has a well-established track record for launching physicians into outstanding research careers. The program also serves to facilitate training in specific research areas, such as molecular and cell biology and biophysics. These awards also establish training standards that affect not only NRSA awardees but all trainees. Generally, the requirements imposed on individuals supported by training grants, for example, are also imposed on trainees supported by other means. Finally, they offer the possibility of providing support for training in emerging areas for which other mechanisms may not be available. This has been particularly important in promoting multi- and interdisciplinary training.
Because the NRSA program’s leadership role in research training is so vital to the health of the biomedical, behavioral, and clinical research establishments, a regular assessment is important. Moreover, in formulating this report the committee tried to weigh all of the above factors not only to assess the situation but also to arrive at a set of recommendations for optimizing the NRSA program in the future. In that way the committee anticipates that the NRSA program will continue to be the bellwether for improved health care through research.
Following this introductory and background discussion, Chapters 2, 3, and 4 focus on research workforce considerations in the biomedical sciences, behavioral and social sciences, and clinical sciences, respectively. The next three chapters examine in succession the training issues in oral health, nursing, and health services research. In Chapter 8 the committee addresses aspects of training for emerging fields and interdisciplinary research. Chapter 9 discusses various stages in the career progression of biomedical, behavioral, and clinical researchers, as well as the impact—or lack of it—of foreign-trained scientists and underrepresented minorities. Chapter 10 offers some final overarching comments and recommendations.