maceutical and health insurance industries.11 Unfortunately, no national statistical system reports on the size and composition of the health services research workforce, since national workforce statistics usually capture information about these scientists in terms of their primary discipline of training or employment and fail to identify the field of scientific inquiry as “health services research.”12 In other words, many scientists who work on health services research problems may do so while conducting research in other areas, such as social, biological, or health research. Furthermore, many health services researchers conduct research as part of their primary employment in nonacademic settings, such as those working in government policy and planning offices or those employed in the pharmaceutical or insurance industries. Therefore, this “part-time” involvement in health services research only further exacerbates efforts to estimate the size and composition of this workforce.

Despite the absence of a national database, a number of studies over the years have yielded important insights into the nature and composition of this group of specialists.13 For example, the field of health services research draws talent several ways. In the early years of the field’s development in the 1960s and 1970s, clinicians and other health scientists simply redirected the focus of their research on the matter of improving health care delivery.14,15 Today, individuals enrolled in more traditional fields of science and engineering have the opportunity to focus their studies at the doctoral level specifically on problems related to health care services and delivery. They may do so as doctoral candidates in public health or health policy; in the social sciences, including health economics; in other health sciences such as epidemiology or biostatistics; or in health services research itself. Indeed, the NRSA program has made it possible for many individuals interested in receiving formal training in health services research at the predoctoral level to do so.16

Postdoctoral research training is another mechanism that has emerged over the past 20 years to foster the growth of a skilled health services research workforce.17,18 The AHRQ T32 NRSA program has proven to be an especially effective mechanism for attracting clinicians into a health services research career. Of the nearly 200 individuals who received postdoctoral NRSA support through AHRQ between 1986 and 1997, two-thirds had earned a doctorate in one of the clinical professions prior to NRSA training, primarily in internal medicine.19 Among those individuals holding a research doctorate and pursuing postdoctoral training, half had earned a doctoral degree in the social sciences.20

The best data available on the actual size of the health services research workforce comes from the membership roles of the professional organization, AcademyHealth. AcademyHealth draws its members from both health services research and health care policy and includes student memberships. While this database more than likely underestimates the total size of the workforce, it does provide some insights into its composition.

The total AcademyHealth membership in 2004 was 3,745, and 1,688 members (45 percent) reported having a Ph.D., Sc.D., or other doctoral-level training in science. There were another 710 (19 percent) reporting an M.D. and only 15 with a D.D.S. The primary locus of employment for doctoral degree holders who are members of AcademyHealth is the academic sector. Table 7-1 shows the distribution of these individuals across all sectors.

AcademyHealth membership includes roughly equal gender representation, females (51 percent) and males (45 percent), while student membership has greater female representation (64 percent) than male (30 percent). The ethnic mix of members is 13 percent from minority ethnic backgrounds, including Asian/Pacific Islanders (7 percent), African Americans (3 percent), and Hispanics/Latinos (1 percent); 24 percent are “unknown.” The remainder (63 percent) are Caucasians. Student membership shows greater diversity—24 percent coming from minority ethnic backgrounds, including 14 percent Asian/Pacific Islanders, 6 percent African Americans, and 2 percent Hispanics/Latinos, plus 54 percent Caucasians and 22 percent unknown.

Table 7-2 shows the primary fields of interest of AcademyHealth members. Most members classify themselves into health services research, and only 15 to 20 percent, depending on their degree, list health policy. The exceptions are those with J.D. degrees, who are strongly oriented toward policy.

11  

Based on data collected by the Agency for Healthcare Research and Quality, 2000.

12  

As NIH moves more toward transdisciplinary research, the problem of lacking multiple classifications for both “discipline” and “field of application” may be faced by basic science and clinical researchers, as well as those working in health services research.

13  

Institute of Medicine. 1995.

14  

National Research Council. 1978.

15  

Ebert-Flattau, P. 1981.

16  

An AHRQ-funded review of the curricula vitae (CV) provided by former AHRQ trainees and fellows revealed that 73 percent of the AHRQ T32 predoctoral trainees had earned a doctoral degree by 1998, and the remaining 27 percent was either in training or ABD. Of those who earned a doctorate by 1998, about three-quarters had earned them in a health science field, including health services research, a related multidisciplinary health field such as health policy, health administration, or public health or in one of the other health sciences. Over three-quarters of the T32 predoctoral trainees had earned their baccalaureate degrees in one of the sciences, with 38 percent in the social sciences, 19 percent in the health sciences, and 22 percent in other scientific fields, including the physical and mathematical sciences.

17  

In addition to federal programs of support, private foundations such as the Pew Charitable Trust have played a significant role in promoting training in health policy and health services research. See Institute of Medicine, 1997.

18  

Institute of Medicine. 1997.

19  

Other clinical postdoctoral T32 trainees had specialized in pediatrics (16 percent) or family practice (8 percent).

20  

Ibid.



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