9
Career Progression

The continued strength of this nation’s health research enterprise will depend on the quality of doctoral programs in U.S. educational institutions, the continuing education and training of researchers after the doctorate, the utilization of an international pool of scientists, and the establishment of a diverse workforce. How careers progress is important in establishing this research enterprise. It depends on the efficient progression of individuals from student to independent researcher, the ability to attract and retain talented foreign-educated scientists, and the engagement of minorities in science at all education levels. The discussion in this chapter concerns research careers in all three major fields: biomedical, clinical, and behavioral/social sciences.

Professional education begins with graduate education, continues and matures with specialized training, and ends when full status as an independent researcher is obtained. It is long and arduous, with graduate school being the place where individuals are initially exposed to research tools and specialized knowledge and are required to carry out an original research project. This is typically followed by a period of postdoctoral training to learn additional skills and develop in-depth knowledge in a particular area. However, this part of the career path is not as well defined as it is for a medical degree with an internship and residency appointments of fixed duration. The career path varies widely across fields. The biomedical sciences often include multiple or extended postdoctoral appointments. The clinical fields, at present, are not usually followed by additional postdoctoral training. The behavioral and social sciences traditionally did not have much postdoctoral training but recently are becoming more like the biomedical sciences. In particular, the increasing interdisciplinary nature of research will require more training. The advancement of science continues to require more knowledge and skills on the part of new entries into the research workforce, and this can be obtained through postdoctoral training. It is, additionally, a time when individuals can refine research interests and begin to establish research careers.

For decades the United States served as the training ground for scientists from all parts of the world. The structure of the research enterprise in educational institutions, government, and industry, on the one hand, has provided foreign-born scientists with an environment that promotes research careers and, on the other hand, has helped meet the increasing demand for highly skilled researchers. In the biomedical and clinical sciences a significant proportion of the doctorates are temporary residents at the time of their degree and many stay in this country for postdoctoral study or permanent employment. There are also a large number of foreign-educated doctorates who come to this country for postdoctoral study and many gain permanent resident status. Of the foreign students who come to the United States for an education, some stay and become part of the workforce, and some return to foreign countries. In either case they are an essential part of the research community in all research fields in the biomedical and behavioral sciences. Changes in immigration policy in this country that make it more difficult for foreign researchers to enter the country, or stay once they have arrived, will increase the attraction of research opportunities in other countries, will reduce the number and quality of researchers in this country, and will almost certainly affect the nation’s ability to carry out its research agenda.

In regard to domestic research training, the underrepresentation of minorities continues to be an issue. In fields that require the most technical and quantitative training, the proportion of underrepresented minorities is vanishingly small.1 It is well documented that this problem will not be rectified by programs aimed solely at doctoral and postdoctoral training levels. One reason for the low level of participation of minorities is the failure of the education system to provide an adequate background.2,3 Predicted demo-

1  

May, G. S., and D. E. Chubin. 2003.

2  

Babco, E. L. 2003.

3  

May and Chubin. 2003. op. cit.



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Advancing the Nation’s Health Needs 9 Career Progression The continued strength of this nation’s health research enterprise will depend on the quality of doctoral programs in U.S. educational institutions, the continuing education and training of researchers after the doctorate, the utilization of an international pool of scientists, and the establishment of a diverse workforce. How careers progress is important in establishing this research enterprise. It depends on the efficient progression of individuals from student to independent researcher, the ability to attract and retain talented foreign-educated scientists, and the engagement of minorities in science at all education levels. The discussion in this chapter concerns research careers in all three major fields: biomedical, clinical, and behavioral/social sciences. Professional education begins with graduate education, continues and matures with specialized training, and ends when full status as an independent researcher is obtained. It is long and arduous, with graduate school being the place where individuals are initially exposed to research tools and specialized knowledge and are required to carry out an original research project. This is typically followed by a period of postdoctoral training to learn additional skills and develop in-depth knowledge in a particular area. However, this part of the career path is not as well defined as it is for a medical degree with an internship and residency appointments of fixed duration. The career path varies widely across fields. The biomedical sciences often include multiple or extended postdoctoral appointments. The clinical fields, at present, are not usually followed by additional postdoctoral training. The behavioral and social sciences traditionally did not have much postdoctoral training but recently are becoming more like the biomedical sciences. In particular, the increasing interdisciplinary nature of research will require more training. The advancement of science continues to require more knowledge and skills on the part of new entries into the research workforce, and this can be obtained through postdoctoral training. It is, additionally, a time when individuals can refine research interests and begin to establish research careers. For decades the United States served as the training ground for scientists from all parts of the world. The structure of the research enterprise in educational institutions, government, and industry, on the one hand, has provided foreign-born scientists with an environment that promotes research careers and, on the other hand, has helped meet the increasing demand for highly skilled researchers. In the biomedical and clinical sciences a significant proportion of the doctorates are temporary residents at the time of their degree and many stay in this country for postdoctoral study or permanent employment. There are also a large number of foreign-educated doctorates who come to this country for postdoctoral study and many gain permanent resident status. Of the foreign students who come to the United States for an education, some stay and become part of the workforce, and some return to foreign countries. In either case they are an essential part of the research community in all research fields in the biomedical and behavioral sciences. Changes in immigration policy in this country that make it more difficult for foreign researchers to enter the country, or stay once they have arrived, will increase the attraction of research opportunities in other countries, will reduce the number and quality of researchers in this country, and will almost certainly affect the nation’s ability to carry out its research agenda. In regard to domestic research training, the underrepresentation of minorities continues to be an issue. In fields that require the most technical and quantitative training, the proportion of underrepresented minorities is vanishingly small.1 It is well documented that this problem will not be rectified by programs aimed solely at doctoral and postdoctoral training levels. One reason for the low level of participation of minorities is the failure of the education system to provide an adequate background.2,3 Predicted demo- 1   May, G. S., and D. E. Chubin. 2003. 2   Babco, E. L. 2003. 3   May and Chubin. 2003. op. cit.

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Advancing the Nation’s Health Needs FIGURE 9-1 Postdoctoral appointments in the three broad fields, 1973–2001. SOURCE: National Science Foundation Survey of Doctorate Recipients. graphics for the next 20 years warrant a more aggressive approach to providing opportunities for minority students to develop their interests in science research, and it is essential that such programs are aimed at all levels of education. Mentorship and faculty involvement during the graduate years play a significant role in nurturing students to continue their progression.4 Doctoral and postdoctoral training programs that target minorities are being examined by another National Research Council (NRC) committee to determine their effectiveness on increasing the participation of minorities in research careers. POSTDOCTORAL TRAINING Postdoctoral training is not a new phenomenon in the biomedical sciences, but it has become increasingly important over the past decades. It has grown in importance to the point where about 70 percent of the doctorates in recent years have elected additional training compared to about 50 percent in 1970. Although not as prevalent, the proportion of behavioral and social sciences doctorates in postdoctoral training increased from about 10 percent in 1970 to 30 percent in 2001. In the clinical sciences, postdoctoral training has been between 15 and 20 percent over the recent 30-year period. The lower level of training in the clinical sciences applies only to Ph.D.s since there are other mechanisms by which M.D.s receive research training. While some M.D.s enter the traditional postdoctoral appointment, many are trained instead on career development awards, which will be discussed in the next section. Figure 9-1 compares the number of postdoctoral trainees in the three broad fields and shows the differences in the level of postdoctoral training. While postdoctoral training is traditionally defined as a period during which researchers increase knowledge and sharpen research skills, it is also the case that it is a period of employment. For those supported by principal investigators’ (PIs) research grants, employment generally is in a laboratory in which the director sets the work agenda, and the postdoctorate trainee’s work is dedicated to that grant. In such cases, scientific and professional mentoring of the postdoctoral trainees is thoroughly mixed with the grant goals and, as a result, may be an implicit but marginal component of the director’s responsibilities.5 Institutions do not keep track of the positions for postdoctorates paid out of research grants and hired into laboratories and typically do not even know how many people are on postdoctoral appointments. As a result, postdoctorate trainees may not be included in the support structure that includes health and other insurance benefits available to students and university personnel. These conditions have prompted the formation of 4   Tsapogas, J. 2001. 5   National Research Council. 2000b.

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Advancing the Nation’s Health Needs organizations within institutions to serve as postdoctoral trainee representatives. These local-level organizations spawned the National Postdoctoral Association (NPA) in order to draw attention to their concerns.6 Consequently, some institutions have started to become responsive by establishing offices to oversee postdoctoral appointments and by setting policies to address working condition issues. In a 2000 report the National Academies recommended increasing stipend levels for predoctoral and postdoctoral trainees on the National Service Research Award (NRSA) program.7 The National Institutes of Health (NIH) responded to this recommendation by setting $45,000 as a target stipend level for first-year postdoctoral appointments, with plans to reach that level through annual increments of 10 to 12 percent over the next few years and to maintain the salary level with cost-of-living increases thereafter. Table 9-1 shows the stipend levels in 2003, which reflect a 10 percent increase over 2002 and a 12 percent increase from 2001 to 2002. While these salary levels apply only to the NRSA, they form a guideline for individuals supported by other mechanisms, including research grants. However, PIs of large research programs have often found it difficult to follow these guidelines because their research grants (which are typically multiyear with budgets that are set years earlier) do not have sufficient funds for both this purpose and the goal of carrying out the research mission of the project. Aside from the increased compensation in the form of salaries for NRSA recipients, they are disadvantaged by the fact that they are not considered employees at many institutions and therefore are not eligible for standard benefits. This is an issue of growing concern as tenure in these positions has lengthened, and NIH is urged to correct the situation, as previously suggested in other reports.8 Compensation is not the only issue of concern to postdoctoral trainees. Even with the formation of local postdoctoral organizations, postdoctoral offices in institutions, and the NPA, the environment in the laboratory poses challenges. Postdoctoral trainees supported on research grants are often seen less as trainees and more as employees of the PI. The nation’s grant structure, therefore, tends to pose obstacles to generalized postdoctoral training, as opposed to training specifically related to the goals of a given grant project. In large laboratories with many postdoctoral trainees, there is seldom an opportunity for generalized training, and real mentoring by the PI is too often missing. Too many trainees end up with long tenures in these types of laboratory positions with little opportunity to establish their own research agendas. These concerns about the nature of postdoctoral training should not be taken as an argument against the need for large TABLE 9-1 Postdoctoral Stipends for the NRSA Program Years of Experience 1999 2000 2001 2002 2003 0 $26,256 $26,916 $28,260 $31,092 $34,200 1 $27,720 $28,416 $29,832 $32,820 $36,108 2 $32,700 $33,516 $35,196 $38,712 $40,920 3 $34,368 $35,232 $36,996 $40,692 $42,648 4 $36,036 $36,936 $38,772 $42,648 $44,364 5 $37,680 $38,628 $40,560 $44,616 $46,404 6 $39,348 $40,332 $42,348 $46,584 $48,444 7 or more $41,268 $42,300 $44,412 $48,852 $50,808   SOURCE: NIH program announcements. numbers of postdoctoral positions to facilitate the research needs of the country. In addition, we should not view postdoctoral positions as “waiting stations” for Ph.D.s unable to obtain faculty positions or other forms of employment.9 Not only are years of postdoctoral training often required to obtain the knowledge and skills need for modern-day science, such positions are increasingly valued for the opportunity they afford new researchers to establish a record of publications and scientific output. Thus, at present, postdoctoral positions are populated by a mixture of doctoral recipients waiting for a suitable faculty or other position to come available and doctoral recipients choosing to extend their prejob period for the purposes of training and producing a record of scientific accomplishment. The fact that the expected boom in the biotech industry in the 1990s did not fully materialize is a key factor underlying the increase in the number of biomedical postdoctorates in the 1980s and 1990s (see Figure 2-4 in Chapter 2). However, Ph.D. production began leveling off in the late 1990s, when there was a decline in the number of doctorates planning postdoctoral study, and growth in postdoctoral positions slowed from 1997 to 1999. In 2001 there was a decline in all employment sectors, which may have been due, in part, to increasing employment opportunities at higher pay outside academia and to a better understanding of postdoctoral working conditions. Figure 9-2 shows trends over time in the length of postdoctoral training by giving the percentage of doctorates in the biomedical sciences from a two-year post-Ph.D. cohort still in postdoctoral positions.10 For example, 54 percent of 6   National Postdoctoral Association Web site. Available at http://www.nationalpostdoc.org/about/. Accessed on 10/22/2004. 7   National Research Council. 2000a. 8   FASEB News June 3, 2004. 9   Regets, M. C. 1998. 10   This analysis uses the Survey of Doctorate Recipients and groups doctorates into two-year Ph.D. cohorts, since the survey is conducted every two years. The proportion of doctorates in a postdoctoral position for the one- to two-year cohort is about 50 percent and is less than the 70 percent seen in Appendix Table E-1 for two reasons: (1) a doctorate with a definite commitment for a postdoctoral position might not take the position, and (2) a doctorate in a cohort that takes a position for only one year and is more than one year from the time of their doctorate at the time of the survey will not be captured in such a position.

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Advancing the Nation’s Health Needs the doctorates who received their degrees in the 1995–1996 academic years were in postdoctoral positions in 1997, and in 1999 about 35 percent of that cohort was still in postdoctoral positions. Figure 9-3 shows a steady increase in the 1980s and 1990s in the percentage of doctorates still in postdoctoral positions several years after receipt of their degrees and a decline in recent years. The decline in 2001 for the 3- to 4-year cohort is partially due to the decline in the 1- FIGURE 9-2 Proportion of biomedical doctorates in academic postdoctoral positions by Ph.D. cohort year, 1973–2001. SOURCE: National Science Foundation Survey of Doctorate Recipients. FIGURE 9-3 Proportion of biomedical doctorates with postdoctoral positions in all employment sectors by cohort year, 1973–2001. SOURCE: National Science Foundation Survey of Doctorate Recipients.

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Advancing the Nation’s Health Needs TABLE 9-2 Sector or Type of Employment for Doctorates in Postdoctoral Positions 2 Years Earlier Status in Year Tenure or Tenure Track Faculty (%) Non-Tenure Track Faculty (%) Non-Faculty Academic Appointment (%) All Postdoctoral Appointments (%) All Non-Academic Employment (%) 1995 11.9 6.1 16.4 49.5 16.2 1997 14.0 6.3 10.1 53.6 16.0 1999 10.9 3.5 10.9 54.7 19.9 2001 10.6 7.0 12.4 47.6 22.4   SOURCE: National Science Foundation Survey of Doctorate Recipients. to 2-year cohort in 1999, and there was a definite decline in 2001 for the 5- to 6-year cohort. It is interesting to note that the data do not show the commonly believed situation that there are large numbers of doctorates in postdoctoral positions 7 and 8 years after receiving a degree. If all postdoctoral positions are taken into consideration, the decline in recent years is even more apparent, as shown in Figure 9-3. The economy in 2001 and tighter budgets in the nonacademic sector may have had an effect here as well. An examination of data for 1995 to 2001 for U.S. doctorates in the biomedical sciences, from the perspective of their career progression, also shows a decline in 2001 in the proportion of postdoctorates continuing their postdoctoral training and an increase in the portion moving into nonacademic employment (see Table 9-2). In 1997, individuals who had been in postdoctoral positions in 1995 went on to nonacademic employment at a rate of 16.0 percent and continued their postdoctoral training at a rate of 53.6 percent. However, the 2001 data for the 1999 postdoctoral appointees show a decline of 6 percent for those continuing postdoctoral training to a rate of 47.6 percent and an increase in nonacademic employment to 22.4 percent. By contrast, the data show a decline in faculty appointments and an increase in nonfaculty academic appointments. The general growth in nonfaculty positions is also seen in the earlier cohort analysis where the five- to six-year post-Ph.D. cohort in these positions increased from 12.4 in 1999 to 17.7 in 2001. The increase in the number of doctorates in nonfaculty positions and the decline in the number of tenure-track faculty positions (see Appendix E) raises the question as to whether bright young talent in the biomedical sciences can find positions where they can develop their own ideas and become independent researchers. While nonacademic employment is a viable career path, individuals trained in the academic environment may see the freedom and security that a tenure-track professorship can bring as a more attractive option, and will hope and wait for a position to come available. Higher salaries may be an influencing factor in shortening postdoctoral appointments (see Table 9-3). The median salaries for academic postdoctorates are similar to the stipends given by NRSA (Table 9-1). The increased salary levels for NRSA recipients may have carried over to postdoctoral appointments on research grants and reduced the number of individuals who could be supported. The situation in the behavioral and clinical sciences is less clear, since fewer doctorates are in postdoctoral positions and the proportion of doctorates in later cohorts has fluctuated over time. A downward trend in the proportion of doctorates in the later cohorts from 1999 to 2001 may be similar to the stronger pattern found in the biomedical sciences. TRANSITION AND CAREER DEVELOPMENT An important step in career progression is the transition from postdoctorate status to independent researcher. The dilemma in the biomedical sciences, described in the preceding section, is a problem that developed along with the advances made in biomedical research. The increase in funding created a need for personnel to carry out the research and led to increases in graduate enrollments and Ph.D. production. At the same time, there was essentially zero faculty growth in educational institutions combined with many senior faculty members continuing in their roles beyond the traditional retirement age. Both factors contributed to an increase in the postdoctoral pool. Although a larger pool is not by itself a cause for concern, it is a problem that too many postdoctoral appointees receive little help or guidance in making the dif- TABLE 9-3 Median Salaries for Academic Postdoctorates in the Biomedical Sciences by Cohort Years from Doctorate Survey Year 1- to 2-Year Cohort 3- to 4-Year Cohort 5- to 6-Year Cohort 7- to 8-Year Cohort 1993 $22,500 $25,600 $27,000 $30,000 1995 $25,000 $28,000 $30,000 $30,800 1997 $25,600 $29,000 $30,000 $31,650 1999 $27,000 $30,000 $31,000 $35,000 2001 $30,000 $35,000 $37,000 $40,000   SOURCE: National Science Foundation Survey of Doctorate Recipients.

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Advancing the Nation’s Health Needs ficult transition out of this pool.11 This leads to the concern that institutions (and in some cases federal granting agencies) do not typically allow postdoctoral trainees to apply for grant support as individual researchers. Consequently, key productive research years are spent working on someone else’s project. Under these conditions, the experience that would allow postdoctoral trainees to develop their own research agenda is not provided, nor do they receive the type of generalized training needed to realize an independent research career. These factors highlight the tension between (1) the need for postdoctoral researchers to carry out the research missions of PIs and laboratories and (2) the inadequate work conditions faced by, and the inadequate training received by, postdoctoral researchers. The importance of the first factor should not supersede attention to the problems posed by the second. Future generations should not be discouraged or impeded from becoming productive, independent researchers, and the best-possible training should not be withheld from them. Another important part of the career progression involves the issue of productivity, for time to degree and the lengthening of postdoctoral appointments affect the productive years of research scientists. NIH has generated data on its Web site (http://grants1.nih.gov/grants/award/trends/prininv.htm) to show the changing age distribution for the principal investigators it supports with R01, R29, and R37 grants. The striking features of these data are the decline in the proportion of awards to individuals under the age of 36 and the increase in awards to the over 55 age group. This shift is in part due to the aging of the biomedical workforce. For example, the percentage of awards to the over 55 age group doubled in the period from 1980 to 2001, but that population also doubled (see Table 9-4). In addition, the distribution of awards has changed over the years. In 1980 the proportion of awards to the youngest age cohort (under 36) was consistent with the academic biomedical population at about 26 percent. However, by 2001 about 16 percent of this population was under 36 but received only 5 percent of the research awards; the 36- to 40-year age group received a proportion of the awards that matched their population; the next older cohort (41 to 55), received awards in greater proportion than their population. One reason for this shift is the increase in postdoctoral positions. If the postdoctorates are not included in the under 36 age group, the proportion of the population drops to 7 percent and is more consistent with the 5 percent award level. By comparison, less complete data are available for the behavioral and clinical sciences. In 1981, 12 percent of the behavioral and 13 percent of the clinical science Ph.D. researchers were over the age of 55, percentages that grew to 29 and 23 percent, respectively, in 2001. In 1981 about 25 percent of the doctorates in these fields were in the under 36 TABLE 9-4 Comparison of the Population Distribution of Researchers in the Biomedical Sciences and NIH Principal Investigators (Percentage Across Cohorts) Age Cohorts of Ph.D.s in the Biomedical Sciences in Academic Institutions (Including Postdoctorates)   Under 36 (%) 36–40 (%) 41–45 (%) 46–50 (%) 51–55 (%) Over 55 (%) 1981 27 25 16 11 11 11 1985 21 22 20 12 10 15 1991 18 22 19 18 10 13 1995 17 19 18 16 14 16 2001 16 17 16 15 13 22 Age Cohorts of Principal Investigators for R01, R29, and R37 Research Grants   Under 36 (%) 36–40 (%) 41–45 (%) 46–50 (%) 51–55 (%) Over 55 (%) 1980 26 29 17 10 8 9 1985 20 28 24 13 7 9 1990 11 25 23 21 9 10 1995 7 18 25 22 16 12 2001 5 14 21 22 18 20   SOURCE: National Science Foundation Survey of Doctorate Recipients. age group, a percentage that fell to 11 percent in the behavioral sciences and 9 percent in the clinical sciences in 2001. Thus, a marked shift in age demographics has occurred in the behavioral and clinical sciences as well.12 The declining research support in the early age groups is related to three factors. One is the increased age at which individuals receive their doctorates. Since the early 1980s, age at degree increased by about 1.5 years. This is due to three incremental increases: a small increase of about a quarter of a year for the age at which they enter graduate school, an increase of about 1 year of actual graduate study, and an increase of about one-quarter of a year out of study during a graduate program (see Appendix E). The second factor is the increasing time researchers spend in postdoctoral positions (e.g., as illustrated in Figure 9-2 by the proportion of a Ph.D. cohort in a postdoctoral position for three or more years). There may be signs of a decrease in the length of postdoctoral positions in recent years, but they are still much longer than in the early 1980s. The third reason for this trend is the changing requirements NIH study sections have established for initial research grants. NIH has recognized the problem associated with the lack of preliminary data and has instituted a check box on the proposal sheet to alert reviewers to proposals that come from individuals who have never had NIH support. Generally, preliminary data are now required 11   National Research Council. 1998c. 12   Unpublished tables from the Survey of Doctorate Recipients.

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Advancing the Nation’s Health Needs for proposals.13 Consequently, new independent investigators may be several years into independent positions before receiving an NIH grant. While there is a need for postdoctoral training, especially for individuals seeking academic research careers, the prospects for such positions are not good. Given that there were approximately 20,000 postdoctoral positions in 2001, with new Ph.D.s entering postdoctoral positions each year, and faculty positions have remained constant at about 38,000, it is unlikely that a majority of postdoctoral trainees will find faculty positions. The use of postdoctorate training as an employment option while awaiting an academic position varies greatly by field, but ideally the postdoctorate training system would allow the best and the brightest to move into faculty positions.14 Nevertheless, the postdoctorate is a necessary and important stage in the research career path and should be maintained in a relatively stable form over the long term. Therefore, cuts are not advisable. That said, something must be done to ameliorate the negative aspects of these positions, including what sometimes is poor training outside the grant topic, research experience that may disappoint potential future scientists, lack of full employment benefits, and obstacles to establishment of an independent research career. There have been a variety of efforts to move people from postdoctoral training to research status. Enhancing the Postdoctoral Experience for Scientists and Engineers, a report published by the National Academies Committee on Science, Engineering, and Public Policy, recommends several action points to improve the conditions of postdoctoral trainees, including steps to improve this transition to career.15 Among the guiding principles presented is the need to ensure that appointments are beneficial to all concerned. There are other notable models that are part of the efforts to move people from postdoctoral training to research status. The Markey Charitable Trust, no longer in operation, developed a program to assist young scholars in making this transition, and the Burroughs Welcome Fund currently has a program modeled after the Markey program. The American Heart Association has a similar program directed at holders of an M.D. or M.D./Ph.D. who are interested in cardiovascular or stroke research. Indeed, NIH’s postdoctoral training programs are noteworthy in providing such opportunities for minority postdoctorates as well. Each of these programs provides a few years of supervised training at the postdoctoral level and additional years of support in a faculty position. While they address the issue of career transition and development, they also have a goal of identifying the best researchers at an early age and of providing sufficient funds so an individual can comfortably pursue research, but only a few doctorates are supported each year since the support levels are reasonably high. The NIH has developed an award series, called the K awards, to assist researchers in making career transitions. The awards in this series fall into three categories: Career development for M.D.s in clinical research Mentored Clinical Scientist Development Award (K08) Mentored Clinical Scientist Development Program Award (K12) Mentored Patient-Oriented Research Career Development Award (K23) Mid-career Investigator Award in Patient-Oriented Research (K24) Skills development Academic Career Award (K07) Career Enhancement Award for Stem Cell Research (K18) Mentored Quantitative Research Career Development Award (K25) Mid-career Investigator Award in Mouse Pathobiology Research (K26) Clinical Research Curriculum Award (K30) Career transition Mentored Research Scientist Development Award (K01) Independent Scientist Award (K02) Senior Scientist Award (K05) Career Transition Award (K22) The career development awards are directed at individuals with an M.D. and were discussed in Chapter 4. Some of the skills development awards are also directed at clinical research but are generally designed to support training in a specific area or curriculum development. The career transition awards are available to Ph.D.s and provide support while learning a new field or transitioning from training to research status. However, in this last group only the K22 is designed to facilitate the transition from a postdoctoral to a faculty position. The K01, at most of the NIH institutes and centers, is designed to support reentry or retraining experiences for fully trained scientists to significantly expand their expertise in their current field. The K02 and K05 are for established investigators who might benefit from a sustained period of support and release time. Table 9-5 shows the number of awards each year from 1994 to 2002, and it is clear that most of the support in the K series is directed at clinical research or career development for established investigators. The K22 award is relatively new, with the first awards in 1999 and the number roughly doubling each year to 92 in 2002. Many but not all institutes and centers offer this award, and they vary in type and support level. Application for the 13   National Academies Workshop: Bridges to Independence. June 16, 2004. 14   Regets. 1998. op. cit. 15   National Research Council. 2000. op. cit.

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Advancing the Nation’s Health Needs TABLE 9-5 Number of Awards for Current K Grant Programs, 1994–2002 Award 1994 1995 1996 1997 1998 1999 2000 2001 2002 Clinical Research Training K08 736 791 929 1045 1174 1155 1208 1140 1161 K12 42 41 39 34 41 49 75 80 107 K23 0 0 0 0 1 142 327 496 664 K24 0 0 0 0 0 81 158 215 261 Total 778 832 968 1079 1216 1427 1768 1931 2193 Skills and Curriculum Development K07 150 158 144 142 149 137 138 122 131 K25 0 0 0 0 0 0 8 31 53 K26 0 0 0 0 0 0 3 8 10 K30 0 0 0 0 0 35 57 57 59 Total 150 158 144 142 149 172 206 218 253 Ph.D. Career Development K01 51 58 90 155 233 319 419 530 603 K02 147 152 193 225 257 277 298 294 278 K05 132 132 131 132 127 110 100 90 80 K22 0 0 0 0 0 5 27 54 92 Total 330 342 414 512 617 711 844 968 1053   SOURCE: NIH IMPACII Database. K22 usually occurs when an individual in a postdoctoral position seeks support for an additional period of training in either that position or a new appointment. It typically provides 2 or 3 years of additional support, followed by support in a faculty position for a total of 5 years. Sometimes this period is required to be intramural at the NIH, and there may be restrictions on the number of years of postdoctoral training prior to receiving it. Basic research could be conducted on the K22. It is usually related to the research area of the awarding institute or center, and support for basic research is limited. While the basic mission of NIGMS is to support students at the predoctoral level and the institute has some postdoctoral traineeships, it does not offer K22 awards. The application process is complicated by the different requirements, as reported in “Science: Next Wave,” which discusses the problems incurred by several people who tried to get advice.16 The K22 award is a step forward in the effort to assist in the transition from trainee to investigator, but it may have more potential that could be explored by NIH. The 93 awards given in 2002 had little impact on the overall postdoctoral picture.17 Fewer restrictions on the field of research and a mechanism that allows for a significant expansion of the K22 program would be helpful in addressing the problem of getting young investigators through postdoctoral positions and into independent research careers. There is at least one category of researchers that does not seem well served by this potpourri of K grants—namely, researchers who have already received extensive scientific training, sometimes through a postdoctoral period, and then choose for personally important reasons to leave the scientific workforce. The typical example is a women scientist who decides to have children and raise a family but does not find it possible to do so while simultaneously fulfilling all of the demands of a normal scientific/academic career that includes teaching, research, and service. Many highly trained, excellent scientists fall into this category but are forced to forego active research for a large enough number of years that they find it difficult, if not impossible, to resume the path to a research career. Retraining programs, such as the NIH supplement to existing research grants, do not always address their needs and would help too few scientists to deal with the problem. The nation invests a large amount of training in these scientists, who are ready to make significant contributions, and cannot afford to see them leave the scientific workforce. NIH should consider a new form of K awards that would allow such individuals to reduce their overall workload for a time but continue their scientific research until they are ready to resume a full-time career. FOREIGN RESEARCHERS The U.S. scientific research enterprise has benefited from the immigration of foreign-born scientists and engineers. They come for doctoral education, postdoctoral training, or employment in educational institutions, government laboratories, and industrial research facilities. Their numbers are significant in most fields and notably high in certain fields. For example, in recent years more than half of the doctorates in engineering have been temporary residents. These numbers increased particularly rapidly in the 1990s, when many researchers entered the country on H1-B visas (part of other highly skilled academic entry visas) during the high-tech Internet boom. Some thought there might be a decline in the number of foreign students and foreign workforce entrants as technological advances were made in other countries, on the theory that U.S.-trained doctorates might return to their home country universities and workforce. Until recently, there has been little support for this prediction. However, new immigration policies following 9/11 have made entry from countries with the largest number of foreign immigrants more difficult. The new immigration policies pose a serious potential threat to the research mission of this country, a point that will be addressed again shortly. Participation of foreign researchers across the three broad fields in this study is quite different. Since 1996, about 24 percent of the doctorates in the biomedical sciences went to temporary visa holders, and the averages are about 7 percent and 20 percent in the behavioral and clinical sciences, respectively. Table 9-6 shows the percentage of non-U.S. citizens with doctorates across the three broad fields. In addi- 16   Science: Next Wave. 2002. 17   Federal Corner. 2002.

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Advancing the Nation’s Health Needs TABLE 9-6 Percentage of Doctorates by Citizenship Status, 1993–2003   1993 (%) 1994 (%) 1995 (%) 1996 (%) 1997 (%) 1998 (%) 1999 (%) 2000 (%) 2001 (%) 2002 (%) 2003 (%) Biomedical Sciences Citizens 69.1 66.4 65.2 62.5 65.8 66.7 66.9 68.0 70.2 69.9 68.7 Permanent residents 6.3 13.3 16.5 15.2 10.7 10.2 9.3 6.8 6.5 6.2 5.2 Temporary residents 24.7 20.3 18.3 22.3 23.5 23.2 23.8 25.1 23.3 23.9 26.1 Behavioral and Social Sciences Citizens 88.6 88.6 88.2 88.4 89.1 89.2 90.8 89.6 90.1 90.1 89.1 Permanent residents 3.5 3.8 4.4 4.1 3.7 3.4 2.8 3.2 2.9 3.0 2.5 Temporary residents 7.9 7.6 7.5 7.4 7.2 7.5 6.3 7.3 7.0 7.0 8.4 Clinical Sciences Citizens 75.2 74.6 71.7 71.8 73.2 74.1 73.6 75.4 73.5 74.3 75.6 Permanent residents 5.9 7.6 8.5 7.2 6.2 6.3 6.4 5.2 5.5 4.4 4.1 Temporary residents 18.9 17.8 19.7 21.0 20.6 19.6 19.9 19.4 21.0 21.2 20.3   SOURCE: Survey of Earned Doctorates. tion, about 1 percent of the M.D. graduates each year are temporary residents, but it is difficult to estimate how many might pursue research careers.18 The training of temporary residents is important on two separate grounds. First, trainees who return to their home countries play an important role in advancing health care knowledge in those countries. Since disease does not respect political boundaries, it is vital to our own interests that the best health research, knowledge, and treatment occur worldwide. Second, we have not found it possible to carry out our domestic health care research at the required highest levels of quality without the contributions of the best foreign researchers. This fact is undoubtedly related to the high percentage of foreigners who arrive in the United States with excellent backgrounds in technical and mathematical areas. There is no database that tracks these individuals, but studies by Finn19 have identified individuals from the Doctorate Records File who at specific times after their doctorate have paid Social Security taxes. Findings for the life sciences, which include both the biomedical and clinical sciences, show that temporary resident doctorates in the late 1990s were staying in the United States in a greater proportion than graduates in the earlier part of the decade (see Table 9-7). The increase is not (yet) seen in the behavioral sciences, where the rates are about the same for doctorates in the 10-year period. There may be some problems in interpreting these data due to the Chinese Student Protection Act, which gave permanent residency to students from China in the mid-1990s who would have normally graduated with temporary resident status. Since students from China have the highest stay rate for temporary residents (about 95 percent), the stay rates for temporary residents might even be higher. These U.S.-trained foreign scientists stay in the United States 5 to 10 years after receipt of their doctorates and are very likely to remain and join the workforce as permanent residents and citizens. One would expect stay rates for doctorates 1 or 2 years after their degrees to be even higher, as is the case in the biomedical/clinical sciences where 77 percent of the 1999 doctorates were in the United States in 2000 and 74 percent stayed in 2001. In the behavioral sciences, about 47 percent of the 1999 doctorates stayed in 2000 and 2001. Some of these short-term stays were probably for additional training in a postdoctoral position, but based on the 5- and 10-year data, many graduates remain in this country after a postdoctoral appointment. TABLE 9-7 Stay Rates for Doctorates with Temporary Resident Visas at Time of Receipt of Doctorate (%)   Year of Doctorate 5 Years Later (%) 10 Years Later (%) Biomedical/clinical sciences 1987 36 39 Biomedical/clinical sciences 1992 39 67 Biomedical/clinical sciences 1996 62 NA Behavioral sciences 1987 30 29 Behavioral sciences 1992 31   Behavioral sciences 1996 33 NA NA = not applicable. SOURCE: Tabulation by Michael Finn from the Doctorate Records File. 18   American Association of Medical Colleges. 2004. 19   Finn, M. 2003.

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Advancing the Nation’s Health Needs Based on the number of temporary resident doctorates and the above stay rates, about 700 of the 1996 and 900 of the 1999 biomedical doctorates remained in the United States in 2002. When compared to the data in Chapter 2 (see Table 2-5) on the citizenship of academic postdoctoral appointees, this means that most of the 10,000 temporary residents have foreign doctorates. How many of these temporary resident postdoctorates eventually stay in this country is difficult to estimate, but data from the National Center for Educational Statistics show that 4 percent of the biomedical faculty had temporary residency in 1999. However, the data do not identify individuals who have converted their status from temporary residency to naturalized citizen. Considering these numbers, it is clear that foreign citizens have made a real contribution to biomedical research. The contribution of foreign scientists to the behavioral and social sciences workforce is comparatively smaller, with only 6 percent of the doctorates going to temporary residents and only about 30 percent of those doctorates staying. However, putting aside changes in immigration policy, the general trend of increased foreign participation in the research workforce seems to apply to all the health-related sciences. The large number of foreign researchers who stay in this country is in no way meant to imply a problem. It is in this country’s interest to gain the best foreign scientists as citizens. What problem there is lies in the opposite domain, when foreign countries lose an important human intellectual resource. Given the worldwide nature of most health problems, at least some thought needs to be given to the potential problem that foreign countries could experience an insufficient number of high-quality health researchers. If the U.S. immigration policies put in place after 9/11 are not altered, the obstacles placed in the path of foreign researchers at every level may drive them to seek training and employment elsewhere, posing a serious threat to the research effort in this country. There are already indications of a slowdown in the supply of foreign scientists. In the fall of 2003 the Council of Graduate Schools (CGS) conducted a survey of graduate schools and found a 47 percent decline in international enrollments for the fall of 2003 compared to the fall of 2002.20 One reason for this decline may be the time required to complete security checks associated with visa applications. A 2003 U.S. Government Accountability Office (GAO) report found that between April and May of 2003 it took an average of 67 days to complete such checks.21 Another CGS survey in February 2004 found that graduate school applications declined by 32 percent and that 90 percent of the surveyed institutions saw a decline. The latest survey in June 2004 on applications and acceptances for the fall 2004 term found that in the agricultural and life sciences applications had declined by 24 percent and admissions by 19 percent over 2003, and in the social and behavioral sciences applications were down 20 percent and admissions were down by 13 percent. The fear of double-digit declines in actual enrollment were allayed by a final CSG survey in the fall of 2004 which overall saw a 6 percent decline in first year enrollments by foreign students and a 10 percent decline in the life sciences.22 Even though this is the third straight year for a decline in foreign enrollments, it might be a temporary occurrence caused by the visa problems highlighted in the GAO report or the beginning of a long-term trend brought on by global competition and international perceptions of America. In either case, the loss of foreign graduate students to U.S. programs could affect research capacity in this country. The career implications for U.S.-trained citizens and permanent residents due to the influx of foreign scientists are difficult to determine. Foreign students makeup 22 percent of the graduate students and 26 percent of the doctorates in the biomedical sciences, and over 50 percent of the postdoctorates in academic institutions. Changes in these percentages could affect career opportunities and the availability of qualified students for doctoral programs. The Committee at the National Academies is Studying the Policy Implications of International Graduate Students and Postdoctoral Scholars, and its report will be issued in the spring of 2005. UNDERREPRESENTED MINORITY SCIENTISTS Minority participation in the biomedical, clinical, and behavioral and social sciences continues at a rate lower than their respective population proportions. The overall percentage of minority doctorates is very low. Recently, minorities have comprised about 9 percent of the biomedical and clinical sciences doctorates and about 17 percent in the social and behavioral sciences (see Table 9-8). In addition to participation levels, the attrition rate of minority scientists from graduate school is a concern. In each of the three fields, the percentage of full- and part-time minority students is greater than the graduation rate. The disparity between graduate student and doctorate rates is likely caused by some combination of two factors: (1) higher than normal dropout rate among minority students or attrition (2) a decision to conclude the training process at a lower level (such as the master’s degree). These factors may be due in part to debt incurred up to this point in the education process, as fewer minorities than whites graduate debt free at the baccalaureate level.23 In either case the result is low participation by minorities in the research workforce. The problem of retaining minority students in the pipeline from high school to the doctorate has been addressed by many organizations, including the NIH. NIH has a number 22   Council of Graduate Schools. 2004. 23   Rapoport, A. 1999. 20   Council of Graduate Schools. 2004. 21   Government Accountability Office. 2003.

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Advancing the Nation’s Health Needs TABLE 9-8 Comparison of Doctorates Awarded to the Graduate Student Population, 1997–2002   1997 (%) 1998 (%) 1999 (%) 2000 (%) 2001 (%) 2002 (%) Percentage of Minority Doctoratesa Biomedical sciences 6.5 6.9 7.9 7.9 9.2 9.4 Clinical sciences 8.6 8.9 10.4 10.1 10.0 9.4 Behavioral sciences 11.4 12.7 13.6 13.8 14.7 15.5 Percentage of minority students in doctoral-ranking institutionsb Biomedical sciences 10.1 10.3 9.9 10.3 10.5 10.8 Clinical sciences 11.5 12.3 13.0 12.8 14.4 14.4 Behavioral sciences 13.9 14.2 14.9 16.5 16.9 17.4 aNational Science Foundation Survey of Earned Doctorates. bSurvey of Graduate Students and Postdoctorates in Science and Engineering. of programs that are monitored by the National Center on Minority Health and Health Disparities. There are 61 different programs at NIH, every institute having at least one. They range from the Minority Access to Research Careers (MARC) program to supplement awards on research grants. The MARC program has been in existence from 1975 and is administered by the NIGMS. It offers awards from the four-year college level to senior faculty fellowships, and each is designed to assist students with their education or to provide existing faculty members with support for retaining or development of a research project. The MARC program was evaluated in 1997 with no conclusive results as to its effectiveness, but it has supported a large number of individuals and is the core of NIH’s activities in this area. Most other programs at NIH are small and are directed by individual institutes and centers. These are usually designed to promote the research interests of the institute or center by providing support at the predoctoral or postdoctoral levels as an individual or institutional award. Each institute- or center-based program supports only a few individuals. Although they do assist students with their education, it is unclear whether they support significant numbers of students beyond those that would have been supported by other mechanisms. These programs are currently being evaluated by another NRC study with the hope of identifying effective models that truly increase minority participation. Although many minority programs are institute and center based, there is a supplemental research grant program that cuts across the NIH institutes and centers and provides additional funds on a research grant to support a student or a faculty member. The intent of this program is to interest students in a particular research area or to develop the research skills of a faculty member. This program could be highly effective in creating opportunities for minority participation. Looking at the various programs in place at NIH, one is struck by their focus on relatively late stages of the training/ academic career. It will be difficult to increase minority participation later in the path if there are too few students at the precollege level with the requisite academic background and interest to pursue a scientific research career. The MARC awards and some of the other institutional programs that support students at the undergraduate level and aim programs at college-level students are one step toward helping minority students pursue advanced degrees and research careers. However, to make a real difference, intervention needs to take place at the precollege level with programs that properly prepare students and capture their interest in the biomedical, behavioral, and clinical sciences. CONCLUSION The road map for career development in scientific research is appropriately multifaceted. Opportunities exist at all levels, as does the need for improvement. The development of a research scientist begins at a very early age. Outreach programs and encouragement are needed well before undergraduate and graduate programs enter the picture. This is particularly true for minorities but includes the entire population. An effective pipeline of students is needed to enter the professional education that begins with graduate training. This situation notwithstanding, it is also true that strong efforts are needed for training and recruitment at the graduate level. Postdoctoral training is becoming a requirement for all fields, and this trend is likely to continue as the complexity of the research enterprise increases. The existence of this large training pool is in fact desirable in terms of both training opportunities and research accomplishments. However, the status and working conditions of postdoctoral candidates need to be improved. Moreover, training and opportunities for advancement to independent research positions must be enhanced. The flow of foreign scientists into the system at this level should be encouraged as an opportunity to improve both training and research in this country. In the case of physicians, programs are needed that permit research training without major disruption of clinical duties. The recommendations presented here should be regarded as only a small part of the integrated effort over all agencies, at all levels, that is needed for the enhanced development of research personnel in this country. RECOMMENDATIONS Recommendation 9-1: The committee recommends that career development grants (currently K awards) be maintained but be restructured such that fewer mechanisms are established and consistently implemented across NIH.

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Advancing the Nation’s Health Needs The concept of K awards is meritorious, but the large variety of K awards and inconsistent usage across NIH institutes and centers makes it difficult for applicants to use the opportunities that exist optimally. Furthermore, the program would be enhanced if K awards were given by a greater number of institutes and centers than is currently the case. Recommendation 9-2: The committee recommends that the restructured K awards include the following: (1) a transition award to span senior postdoctoral status and an independent research position; (2) beginning faculty awards to free certain classes of investigators from nonresearch duties; (3) senior scientist awards for the purpose of faculty moving into new research areas; (4) awards to allow faculty and other researchers to maintain research careers during periods when personal demands (e.g., child rearing) prevent full employment status; and (5) clinical science awards to provide research training for clinical faculty/personnel. The committee recognizes that the above categories, except for the fourth one, are included among existing K awards. However, uniform presentations and criteria across NIH would make these awards more accessible. This list is not meant to be inclusive, but in any event, it is important to delineate clearly what mechanisms are available, who is eligible, and how applications can be made. Recommendation 9-3: The committee recommends that NIH develop a mechanism for support such that NRSA postdoctoral fellows receive the employee benefits of the institutions at which they are located. Although NRSA postdoctoral fellows are selected through a highly competitive process, they are often at a financial disadvantage with regard to postdoctoral employees paid directly through research grants. In particular, health insurance benefits are not always readily provided. This need not be a major budget issue if a portion of the current supplemental allocation is used for this purpose. This usage of the supplemental allowance could even be required if health insurance is not provided by other means. In terms of the normal fringe benefits package provided by institutions, a lower rate should be possible for postdoctoral fellows since they are very seldom able to utilize the retirement portion of the package due to vesting requirements, typically 5 years. Recommendation 9-4: The committee recommends that supplements to existing training grants be made available for the purpose of developing outreach programs for undergraduates and high school students from underrepresented minorities and for the secondary school teachers serving them. Training resources for minorities at the doctoral and postdoctoral levels is clearly insufficient. The pool of suitable candidates is far too small by the time the doctoral level is reached. It is critical that NIH find new ways to encourage members of underrepresented groups to pursue research careers well before the doctoral level. Furthermore, updating and training for secondary school teachers are critical for this effort. By utilizing existing training programs, already evaluated for their excellence, a quality environment is assured and resources can be rapidly dispersed. Among the programs envisioned are summer research experiences, weekend training sessions, and direct interaction of training grant personnel with students. Recommendation 9-5: The committee recommends that NIH work with other federal agencies to find ways to encourage students at precollege levels to pursue training in technical, computational, mathematical, and scientific areas that are necessary precursors for careers in science. In recent years the need for researchers trained in such areas has been filled by an influx of foreign scientists. This influx may change due to immigration laws or changes in the support structure in foreign countries. It is a slow and long process to change the education structure in a way that will produce larger numbers of students capable and willing to pursue careers in science.