TABLE 7-5 Field of Research Doctorate for Agency for Healthcare Research and Quality T32 Postdoctoral Trainees by Cohort

Cohort (Start Year)

N

Social Sciences

Health Sciences

Other Research Doctorates

1986–1989

11

6

3

2

1990–1993

24

13

8

3

1994–1997

27

17

8

2

 

SOURCE: Tabulation for the Agency for Healthcare Research and Quality.

thirds (119, or 66 percent) had earned a doctorate in one of the clinical professions prior to NRSA training, the majority of which were in internal medicine (62, or 52 percent). Other clinical postdoctoral T32 trainees specialized in pediatrics (16 percent) or family practice (8 percent). Among the 62 research doctorates pursuing postdoctoral research training through AHRQ NRSA T32 awards, half earned a doctoral degree in the social sciences. Furthermore, it appears that AHRQ T32 postdoctoral research training has increasingly attracted individuals from the social sciences since 1986 (see Table 7-5).

The AHRQ NRSA F32 fellowships attracted individuals from both the clinical professions and the sciences into careers in health services research. Nearly half (26, or 46 percent) held a doctorate in a research field such as epidemiology, health policy, sociology, or psychology. The remainder (24, or 42 percent) earned a clinical doctorate in such fields as internal medicine or pediatrics and held both an M.D. and a Ph.D. degree prior to pursuing AHRQ fellowship training (7, or 12 percent). The majority (two-thirds) of individuals holding AHRQ F32 fellowships between 1986 and 1997 worked prior to receiving NRSA support. More than half (55 percent) had been employed in academia prior to F32 training, especially those with research doctorates.

CONCLUSION

Health services research relies on the knowledge and understanding of a broad spectrum of research fields, and the field is growing as both public and private research funding increase and as the breadth of research expands to include greater emphasis on intervention and translational research. Data show an increasing demand for researchers in this area and the need for increased training to meet the demand, both for students in doctoral programs and health professionals who bring specialized skills to the field. This training should include the knowledge and skills needed to function effectively as a member of an interdisciplinary team, and the NRSA program is the appropriate vehicle for this training.

RECOMMENDATIONS

Recommendation 7-1: Health services research training should be expanded and strengthened within each NIH institute and center.


Biomedical research has created a growing gap between research advances in biomedical science and the ability to apply them effectively to improve the health of the public. Thus, there is a need for more effective health care delivery practices to ensure effective and evidence-based care and to reduce waste and unnecessary risk to patients. These issues are not particular to just a few NIH institutes and centers where training support for health services research is now focused, and the health services research would be better served if training occurred more broadly across NIH.


Recommendation 7-2: AHRQ training programs should be expanded, commensurate with the growth in total spending on health services research.


Recognition of the rising costs of care, together with concerns about quality and consistency, has driven increases in health services research. Health services research has established an important evidence base to enable patients and health care organizations to evaluate the benefits and risks of diagnostic and therapeutic intervention and to compare relative values of older and newer approaches as choices proliferate. This field can also evaluate different approaches to health care delivery and financing, which will allow the nation to benefit optimally from the dramatic advances in biomedical science. Training programs should grow proportionately with the need for individuals who have a wide range of disciplinary skills to conduct this research effectively.



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