cent. The one thing this model does not account for is the possible growth in the physician-scientist workforce as the result of expansions in the M.D./Ph.D. programs—that is, the movement of more medically trained doctors into research careers.
The importance of clinical research cannot be underestimated in today’s health care system. Recent efforts to offset the growing shortage of clinical researchers, especially those initiatives aimed at attracting physician-scientists into patient-oriented research, have not been fully evaluated. One program that has been in existence for many years is the MSTP, but it has not brought researchers into patient-oriented research. The MSTP has produced a highly qualified workforce in the basic health sciences, but the potential remains for these scientists to become more involved in translational or patient-oriented research. The forces that constrain the clinical sciences workforce are beyond the control of training programs, as they involve national policies on health care and its delivery systems. Additionally, because many areas of clinical research require medical training, predoctoral support is not possible under a program like NRSA. Intervention must occur at a point beyond the doctorate, with postdoctoral and career development programs.
Recommendation 4-1: This committee recommends that the total number of NRSA positions awarded in the clinical sciences should remain at least at the 2003 level. Furthermore, the committee recommends that training levels after 2003 be commensurate with the rise in the total extramural research funding in the biomedical, clinical, and behavioral and social sciences.
Data on the number of predoctoral and postdoctoral traineeships in 2001 appear to be consistent with earlier years. In 2001 there were over 1,577 predoctoral NRSA training slots in the clinical sciences and 1,830 at the postdoctoral level. Projecting these numbers into 2003, on the basis of a 4.4 percent increase in total predoctoral training and a 5.6 percent increase in postdoctoral training, yields estimates of 1,665 and 1,910, respectively. The 2002 data on fellowships are probably more current at 151 predoctoral and 96 postdoctoral positions, and since there was little change in the level of fellowship support from 2002 to 2003, these levels could be applied to 2003. For both the traineeships and fellowships at the predoctoral and postdoctoral levels, NRSA support is only a small fraction of the total training support (see Figures 4-2 and 4-10). Much more comes from research grants and the retraining of physicians through the K23 and K24 programs or self-support at the predoctoral level.
The relatively low unemployment among Ph.D.s in the clinical sciences and the fact that the pool of postdoctorates appears to be stabilizing suggest that the NRSA training level should be maintained at least at the 2003 level and increase with extramural research funding.
The discussion following Recommendation 2-1 with regard to the quality of NRSA programs and relative balance of biomedical training to the workforce also applies to the behavioral and social sciences.
Recommendation 4-2: This committee recommends that training grants be established for physicians to acquire the skills necessary for clinical investigation.
Clinical research, such as clinical trials and outcome assessment, can be carried out by individuals in a variety of fields, but a shortage of well-trained people appears to exist. Attracting physicians into these areas is highly desirable. Training should include clinical trial design, statistics, and epidemiology. Training programs should be structured so that physicians can maintain other professional activities while pursuing this training and receiving degrees at the master’s level.