allocation to 1 percent of NRSA funding in 1999, which has remained unchanged.
It should be noted that in the early 1990s Congress authorized a 15 percent set-aside for both research and NRSA training in service-related research supported by the National Institute of Mental Health (NIMH), the National Institute of Drug Abuse (NIDA), and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) as part of the reorganization of the former Alcohol, Drug Abuse and Mental Health Administration into the National Institutes of Health. Even with this congressionally mandated set-aside for these NIH institutes, AHRQ remained the lead agency for health services research. NIH funding has been directed at HSR focused on questions related to the delivery of health care for specific diseases/disorders. AHRQ and NIH fund complementary research and in many instances have co-funded major health services research studies.
No national statistical system reports on the size and composition of the health services research workforce (Moore and McGinnis, 2009; Pittman and Holve, 2009). Obtaining information on the workforce in this field is a challenge. Identifying scientists who primarily do health services research is complicated by the interdisciplinary nature of the field. Health services research is an applied field, and so most health services researchers have another unique discipline or profession that they bring to health services research. Workforce data usually classify health services researchers by their primary discipline or profession and often are unable to identify the field of scientific inquiry as health services research. As NIH moves more toward trans-disciplinary research, the problem of not having multiple classifications incorporating both discipline and field of application may be an issue faced by many basic sciences and clinical researchers, as well as health services research.
In addition, anecdotal evidence suggests that some investigators involved in health services research studies do not identify themselves as health services researchers, nor do they necessarily belong to the only national professional association in this area, namely AcademyHealth. This partial or part-time involvement of many scientists in health services research only further complicates efforts to estimate the size and composition of the health services research workforce.
McGinnis and Moore addressed this issue in their study on the current status of the health services research workforce. In a conservative estimate of the field, counting HSRProj investigators (since 2004), speakers from AcademyHealth’s Annual Research Meeting in 2007, and AcademyHealth members whose membership has lapsed or joined in 2000 or later, Moore and McGinnis found that the field has more than doubled in size since the IOM’s estimate in 1995, growing from approximately 5,000 health services researchers to more than 13,000 researchers in 2007. Using a more expansive definition of the field by including researchers in disciplinary associations with subgroups that sometimes do health services research, such as the American Public Health Association, the American Society of Health Economists, the American Statistical Association, and the American Sociological Association, there could be an additional 6,000 intermitted members of the field (Moore and McGinnis, 2009).
The best data available on the composition of health services research workforce5 likely comes from the most recent AcademyHealth membership survey in 2008 (AcademyHealth, 2008). AcademyHealth draws its members from both health services research and health policy, and includes student memberships. Although this database more than likely underestimates the total size of the workforce, it does provide some insights into its composition.
As of 2008, 51 percent of AcademyHealth’s 3,500 individual members report having a Ph.D., Sc.D., or other doctoral-level training in science. There are another 12 percent reporting an M.D. Table 8-1 shows the distribution of health services researchers by employment sector.
AcademyHealth membership has greater female representation (60.7 percent) than male (39.3 percent). This representation has changed slightly from AcademyHealth’s survey of members in 2002, when 55 percent of the respondents were women and 45 percent were men. Of note is that the youngest members were twice as likely to be female as to be male, while the oldest respondents were twice as likely to be male as to be female. The ethnic mix of members is 21 percent from minority ethnic backgrounds, including Asian/Pacific Islanders (10.6 percent), African Americans (5.2 percent), and Hispanics/Latinos (2.6 percent), plus 79 percent Caucasian and 2.5 percent other. Representation of all minorities has increased since 2002—to 21 percent from 12.8 percent.
Table 8-2 shows the primary field of interest by the members of AcademyHealth, and the largest share of the members classify their primary discipline as public health (21.5 percent). Only 13.3 percent of members identify their primary discipline as health services research.
In a study on the demand for health services researchers, Thornton and Brown (2009) found that the demand from both universities and non-academic employers is expected to increase. Based on their work one can anticipate there will be a growing demand for “people who can analyze the effectiveness of health service systems from disease management firms; investment firms with a large stake in the health care sector; state and local government; hospitals and providers that will be implementing quality reporting systems and pay-for-performance systems;” and the health