2
Crosscutting Issues

This chapter addresses some training issues that cut across disciplines and that pertain generally to the National Research Service Award (NRSA) and other training mechanisms. The committee considered a number of these issues and identified the following as ones that require attention:

  • financial support of the trainees,

  • cost recovery by educational institutions,

  • participation by underrepresented minorities,

  • responsible conduct of research,

  • National Institutes of Health (NIH) data systems

  • the emerging role of biomedical informatics,

  • workforce data requirements, and

  • international workforce.

FINANCIAL SUPPORT OF THE NRSA PROGRAM

The National Research Council (NRC) in the report, Addressing the Nation’s Changing Needs for Biomedical and Behavioral Scientists (2000), recommended “that stipends and other forms of compensation for those in training should be based on education and should be regularly adjusted to reflect changes in the cost of living.” In 2001 the NIH concurred with this recommendation and set a target of $45,000 per year for new postdoctoral scholars, with the expressed intention to raise the then-current stipends by 10 to 12 percent per year until this target was reached. Additionally, the NIH pledged to budget for annual cost-of-living increases to keep pace with inflation and to prevent the loss of buying power seen as stipends had remained largely flat over the previous decade. However, stipend levels at both the predoctoral and postdoctoral levels have not kept pace with the NIH targets. There were increases in 2000, 2002, and 2003 at all levels that conformed to the goals set by NIH in 2001, but in 2004 the increase was less than half the recommended level, and from 2006 to2008 there were no increases (see Table 2-1). Of course, from fiscal year 1999 to 2003 the NIH budget was doubling, but from fiscal year 2004 to 2008, the budget was essentially unchanged, and, in fact, during this interval it lost nearly 13 percent of its purchasing power. In fiscal year 2009, there was a small increase of about 1 percent in the NIH appropriation, and a similarly modest increase was enacted for fiscal year 2010. These modest increases, well below the levels of biomedical research inflation (as measured by the Biomedical Research and Development Price Index in the respective years), were independent of the nearly $10 billion of American Recovery and Reinvestment Act (ARRA) funding that was awarded in fiscal year 2009 for NIH research. The ARRA initiative was driven by the goal of creating or saving jobs, and the funding for NIH was explicitly a one-time infusion of “stimulus” funds that were to be entirely obligated within 2 years for primarily short-term research projects. None of the ARRA funds were to be used to address structural problems in research training programs. The President’s NIH budget request for 2011 contains a 6 percent increase for NRSA trainee stipends, but at the cost of a 1 percent decrease in the number of training slots.

In addition to supporting the originally targeted stipend increases, the 2005 NRC report also recommended that NIH develop a mechanism for support such that postdoctoral fellows receive the employee benefits of the institution in which they are located. It is clear that all postdoctoral fellows should be supported in terms of receiving appropriate benefits at each institution. However, the fact that there are two categories of postdoctorates—NRSA trainees and postdoctoral employees—is a consequence of a federal decision to pay trainees a stipend (as opposed to a salary). As such, following the requirements of the Internal Revenue Service imposes different tax liabilities on the two groups of post-doctorates. Trainee postdoctorates cannot be categorized as employees, they do not pay Federal Insurance Contribution Act (FICA), and they cannot receive benefits in the same fashion as employees. However, this should not mean that they cannot receive parallel support systems.

To demand then that all postdoctorates be treated identically becomes the training equivalent of trying to put a square



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2 Crosscutting issues This chapter addresses some training issues that cut budget was essentially unchanged, and, in fact, during this across disciplines and that pertain generally to the National interval it lost nearly 13 percent of its purchasing power. In Research Service Award (NRSA) and other training mecha- fiscal year 2009, there was a small increase of about 1 percent nisms. The committee considered a number of these issues in the NIH appropriation, and a similarly modest increase and identified the following as ones that require attention: was enacted for fiscal year 2010. These modest increases, well below the levels of biomedical research inflation (as • financial support of the trainees, measured by the Biomedical Research and Development • cost recovery by educational institutions, Price Index in the respective years), were independent of the • participation by underrepresented minorities, nearly $10 billion of American Recovery and Reinvestment • responsible conduct of research, Act (ARRA) funding that was awarded in fiscal year 2009 • National Institutes of Health (NIH) data systems for NIH research. The ARRA initiative was driven by the • the emerging role of biomedical informatics, goal of creating or saving jobs, and the funding for NIH was • workforce data requirements, and explicitly a one-time infusion of “stimulus” funds that were • international workforce. to be entirely obligated within 2 years for primarily short- term research projects. None of the ARRA funds were to be used to address structural problems in research training pro - fiNaNCial SuPPort of the NrSa Program grams. The President’s NIH budget request for 2011 contains The National Research Council (NRC) in the report, a 6 percent increase for NRSA trainee stipends, but at the cost of a 1 percent decrease in the number of training slots. Addressing the Nation’s Changing Needs for Biomedical and Behaioral Scientists (2000), recommended “that stipends In addition to supporting the originally targeted stipend and other forms of compensation for those in training should increases, the 2005 NRC report also recommended that NIH be based on education and should be regularly adjusted to develop a mechanism for support such that postdoctoral reflect changes in the cost of living.” In 2001 the NIH con- fellows receive the employee benefits of the institution curred with this recommendation and set a target of $45,000 in which they are located. It is clear that all postdoctoral per year for new postdoctoral scholars, with the expressed fellows should be supported in terms of receiving appropriate intention to raise the then-current stipends by 10 to 12 per- benefits at each institution. However, the fact that there are cent per year until this target was reached. Additionally, the two categories of postdoctorates—NRSA trainees and post- NIH pledged to budget for annual cost-of-living increases doctoral employees—is a consequence of a federal decision to keep pace with inflation and to prevent the loss of buying to pay trainees a stipend (as opposed to a salary). As such, power seen as stipends had remained largely flat over the following the requirements of the Internal Revenue Service previous decade. However, stipend levels at both the pre- imposes different tax liabilities on the two groups of post- doctoral and postdoctoral levels have not kept pace with the doctorates. Trainee postdoctorates cannot be categorized as NIH targets. There were increases in 2000, 2002, and 2003 employees, they do not pay Federal Insurance Contribution at all levels that conformed to the goals set by NIH in 2001, Act (FICA), and they cannot receive benefits in the same but in 2004 the increase was less than half the recommended fashion as employees. However, this should not mean that level, and from 2006 to2008 there were no increases (see they cannot receive parallel support systems. Table 2-1). Of course, from fiscal year 1999 to 2003 the NIH To demand then that all postdoctorates be treated identi- budget was doubling, but from fiscal year 2004 to 2008, the cally becomes the training equivalent of trying to put a square 

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES TABLE 2-1 NRSA Stipends Years 2001 Percent 2002 Percent 2003 Percent 2004 Percent Predoctorate $ 16,500 10 $ 18,156 10 $ 19,968 10 $ 20,772 4 Postdoctorate Level 0 $ 28,260 5 $ 31,092 10 $ 34,200 10 $ 35,568 4 Postdoctorate Level 1 $ 29,832 5 $ 32,820 10 $ 36,108 10 $ 37,476 4 Postdoctorate Level 2 $ 35,196 5 $ 38,712 10 $ 40,920 6 $ 41,796 2 Postdoctorate Level 3 $ 36,996 5 $ 40,692 10 $ 42,648 5 $ 43,428 2 Postdoctorate Level 4 $ 38,772 5 $ 42,648 10 $ 44,364 4 $ 45,048 2 Postdoctorate Level 5 $ 40,560 5 $ 44,616 10 $ 46,404 4 $ 46,992 1 Postdoctorate Level 6 $ 42,348 5 $ 46,584 10 $ 48,444 4 $ 48,852 1 Postdoctorate Level 7 $ 44,412 5 $ 48,852 10 $ 50,808 4 $ 51,036 0 Years 2006 Percent 2007 Percent 2008 Percent 2009 Percent Predoctorate $ 20,772 0 $ 20,772 0 $ 20,772 0 $ 20,976 1 Postdoctorate Level 0 $ 36,996 4 $ 36,996 0 $ 36,996 0 $ 37,368 1 Postdoctorate Level 1 $ 38,976 4 $ 38,976 0 $ 38,976 0 $ 39,360 1 Postdoctorate Level 2 $ 41,796 0 $ 41,796 0 $ 41,796 0 $ 42,204 1 Postdoctorate Level 3 $ 43,428 0 $ 43,428 0 $ 43,428 0 $ 43,860 1 Postdoctorate Level 4 $ 45,048 0 $ 45,048 0 $ 45,048 0 $ 45,504 1 Postdoctorate Level 5 $ 46,992 0 $ 46,992 0 $ 46,992 0 $ 47,460 1 Postdoctorate Level 6 $ 48,852 0 $ 48,852 0 $ 48,852 0 $ 49,344 1 Postdoctorate Level 7 $ 51,036 0 $ 51,036 0 $ 51,036 0 $ 51,552 1 SOURCE: NIH Stipend Levels, http://grants.nih.gov/nrsa.htm. peg into a round hole. The simplest solution is to create a The estimated annual cost when fully implemented would square hole, which offers all the advantages of a round one. be about $80 million, or 10 percent of the NRSA budget. If With increasing awareness of this contradictory issue, many phased in over 4 years, the $20 million dollar annual increase institutions have devised creative solutions aimed at main- would be about 2 percent of the NRSA training budget. taining parity between the two groups of postdoctorates. This should not be implemented by reducing the number of Thus, although trainee postdoctorates cannot usually be individuals supported by the NRSA program. The committee included on employee health coverage, highly competitive notes that the Obama administration has recently proposed a insurance can in fact be purchased, usually more cheaply 6 percent increase in stipends for 2011 over the 2010 level. than the employee plan and offering better coverage because This is a positive step on the way to the recommended sti- the postdoctorates tend to be younger than the general pend levels. employee population. It is true that postdoctorate trainees cannot get university retirement benefits, but the cash value iNdireCt CoSt rateS lost is in fact less than the gain in income from not paying FICA. Not being on the human resources list of employees It is debatable whether training grants lead to a superior may cause frustration with issues such as parking and child or better trained individual in the long run. The rather limited care. However, payment of a very nominal sum to the trainee amount of data and related evaluations are certainly consis- as salary solves this problem without jeopardizing his or her tent with this conclusion, although the degree of significance status as primarily a stipend-receiving trainee. is not high. Of course, institutions tend to put their best students on training grants, and the outcomes likely should Recommendation 2–1: NIH should reinstitute its 2001 be better. However, to a degree this is immaterial. The key commitment to increase stipends at the predoctoral and role of NRSA training lies in the fact that the applications are postdoctoral levels for NRSA trainees. This should be done scrupulously peer reviewed. This, in turn, drives institutions by budgeting regular, annual increases in postdoctoral to review their approaches to graduate education on a regular stipends until the $45,000 level is reached for first-year basis and encourages them to establish best practices that can appointments, and stipends should increase at the cost then be honed through the peer-review system. As a result, in of living thereafter. Predoctoral stipends should also be the competition to recruit graduate students, even non-NRSA increased at the same proportional rate as postdoctoral schools will feel the pressure to create an excellent training stipends and should revert to cost-of-living increases once environment. In this sense, over the past decade or so the the comparison postdoctoral level reaches $45,000. training grants have served as major drivers of innovation in

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 CROSSCUTTING ISSUES applied to research grants. The increase in the rate could graduate education, and this may be their greatest contribu - be phased in over time, for example, by increasing the tion to the biomedical research training environment. rate by 8 percent each year until the negotiated rate is Thus, the many requirements and expectations for sup- reached. port activities centered on training grants, such as minority recruiting, education in the responsible conduct of research (RCR), and professional development, have improved the Implementing this recommendation would require a overall tenor of graduate education immensely over the five- or six-fold increase in indirect costs, or $191 million past decade. These expectations have come at a consider- for the NRSA program at its current size and $338 mil- able price, however, and this price has largely been covered lion for K awards. An increase of $529 million is significant, by institutional funds. The current 8 percent indirect cost even in light of the reasoning to have NIH share the full cost allowance (which is not applied to tuition and fees, health of administrating these programs, but the committee wanted insurance, and expenditures for equipment) is insufficient to to record its support for the measure and its hope that it could cover the university’s costs. Similarly, the K awards, which be implemented at some point. have served a tremendously important role is fostering the early career development of both basic and clinical biomedi- reSPoNSiBle CoNduCt of reSearCh cal researchers, use the same facilities as funded researchers and generate their own significant administrative costs, yet NIH’s NRSA grants require awardee institutions to estab- they have the same 8 percent indirect cost allowance, which lish specific curricula in the responsible conduct of research. as best one can determine is arbitrary and is based on no Indeed, in late 2009 NIH issued a detailed policy statement carefully argued rationale. outlining its expectations along with recommendations on The indirect cost rate has varied over time. Prior to 1958, how to approach these expectations (NIH policy statement the rate for training grants was set at 8 percent by the Depart - NOT-OD-10-019). It is worth noting that National Science ment of Health, Education and Welfare, and the rate has Foundation (NSF) has issued similar requirements for all remained at this level to this day. The rate on non-training personnel participating in NSF-funded research, including grants was increased to 15 percent in 1958 and to 20 percent undergraduate students. in 1963. In 1966 the ceiling on indirect costs was removed, The requirement of RCR training within the T32 mecha- but in 1991 OMB Circular A-21 imposed a cap of 26 percent nism has led to the development of curricula and educational on the recovery of administrative costs from research grants, practices for NRSA that would benefit all students and post- and the cap has remained unchanged in spite of compelling doctorates being trained in biomedical and health sciences documentation by the Council on Governmental Relations research and should be required in all graduate and post- that these costs in all the top research universities sampled doctoral education programs supported by the NIH. Since were significantly greater than could be recovered under the with relatively few exceptions the majority of this training 26 percent cap. As a result, many of the improvements in takes place in laboratories supported by NIH research pro- graduate education and early career development, such as gram grant (RPG) mechanisms, this leads to the expectation special skills courses, increased focus on interdisciplinary that all students supported by the NIH (i.e., including those studies, increased diversity, RCR training, and career advis- students supported by R01 grants during their education) ing and outcomes research, have all come through resources should be required to benefit from such training. provided by the institutions applying for NRSA support. Recommendation 2–3: All graduate students and post- The committee finds that the institutional commitment doctoral fellows who are supported by the NIH on RPGs of resources for training grants and K awards is no different should be required to incorporate certain additional from that for research grants. Graduate and postdoctoral “training-grant-like” components into their regular trainees require the same facilities in the laboratory as their academic training program. These should include RCR counterparts in the same laboratory who are supported on a training, exposure to quantitative biology, and career research grant that carries the institution’s negotiated rate. guidance and advising. Likewise, individuals on K awards act in a capacity similar to that of a researcher on an R01 or other research project grant. The committee was not unanimous with regard to the Nih diverSity iNitiativeS WithiN NRSA part of the following recommendation because of the NrSa Program concerns about costs and the reduction in program size that could result from a stagnant NIH budget, but it did endorse Minorities1 n ow account for 50 percent or more of the increase for the K awards. the population in several states, and at some time within Recommendation 2–2: NIH should consider an increase Minorities are defined as Blacks, Hispanics of Puerto Rican , Cuban, 1 in the indirect cost rate on NRSA training grants and K or Mexican extraction, American Indians, and Pacific Islanders. Does not awards from 8 percent to the negotiated rate currently include Asian.

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES the foreseeable future the demographics of the country will R01 recipients. Broadening the K24 program to include basic have changed to the point where current minority groups biomedical studies is both feasible and readily achievable. will be approaching a majority of the citizenry. The NIH Recommendation 2–5: The K24 mentoring award mecha- is committed to increasing the diversity of the biomedical nism should be expanded to include the basic sciences. workforce. There is no doubt that over the past 15 years Use of the K24 award to enhance efforts to recruit diverse NIH-supported training programs have driven major changes faculty should be a component of the award criteria. in trainee diversity. Leadership from the Minority Opportuni- ties in Research (MORE) division of the National Institute of General Medical Sciences should be acknowledged in this Nih data SyStemS regard. As a result, the number of minority students in bio- medical graduate programs has increased from 2 percent in Any discussion of the merits of NRSA training, both at the 1980 to 11 percent today (and, relative to U.S. nationals, the level of T32 and of F31/32 awards, invariably includes the percentage is actually a little higher since the denominator question: Are the individuals educated in this fashion more for this calculation includes international graduate students). successful and productive in their future careers? Although We should bear in mind that the current participation level the competitive initial and renewal applications for these is not far from the 14 percent of underrepresented minori- programs contain an enormous amount of information, no ties students among all students receiving a B.S. degree systemic approach has been developed to capture this infor- in biological sciences. Comparable results are seen in the mation for rigorous scrutiny, and, as a result, no critical, data- U.S. citizen component of postdoctoral programs in the bio- driven analysis can be applied to the wealth of information medical sciences. Sadly, however, the minority representa- that institutions have provided for more than 30 years. This tion of 2 percent on tenure-track medical school faculties has problem will become all the more acute if trainees supported not changed significantly since 1980. Unfortunately, there on R01 grants become a part of the overall database. The are essentially no data on what careers prove to be attractive availability of such data would be enormously helpful to the to minority graduates after they leave postdoctoral training NIH in the development of sound future policy. Accordingly, and why on average they choose careers other than academic a modern data recording and management system is needed research. desperately and should be implemented without delay. The following recommendations pertain to strengthening Newly instituted data collection procedures at the NIH diversity within the educational system supported directly or will provide data on graduate students and postdoctorates indirectly by NIH grants. with NIH support, as long as the data are input into a data- base or a tabular file and not simply recorded as unformatted Recommendation 2–4: Graduate student and post- electronic files. These data will be useful in estimating the doctoral training programs that educate and train numbers and research areas of individuals in training, but students who are funded by RPGs2 should be subject to the lack of data on the career outcomes of NRSA- and R01- expectations for diversity of U.S.-native trainees similar funded trainees makes it difficult to produce an informed to those expected of training grants. Such programs comparative assessment of the research training programs. should be required to provide assurance on R01 grant Moreover, this lack of information hinders the development applications that efforts are being made. of those training mechanisms and strategies that will best ensure a talented and productive research workforce. The K24 mentoring award has been successful in devel- Recommendation 2–6: To assist future assessments of oping the careers of clinical scientists. The committee the research training more effectively, the NIH should views this program as highly valuable and would like to collect reliable data on all of the educational components see this approach applied to the basic sciences; in addition, that it supports in such a manner that this information a mechanism may be developed to this end that also serves can be stored in an easily accessible database format. to support diversity at the faculty level. The impact of this Such data might include important components of the type of mid-career career development award would enable training grant tables as well as retention and subsequent faculty members to incorporate mentoring of other junior outcomes. and early-stage investigators in order to enable their success in leading and managing a research team. The basic sci- Recommendation 2–7: The applications for training ence faculty member, particularly in today’s system where grant support require many detailed data tables. Some faculty members need to generate protected time much like of these are very important and essential for the review; clinicians, would also serve to acknowledge and reward best some are merely compendia of largely irrelevant data mentoring practices that can support the success of a diverse that could equally well be summarized briefly. The com- array of new investigators including K01 , R00, and first-time mittee recommends that the data tables be reviewed and a determination made, in consultation with the awardee Research Project Grant (RPG). 2

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 CROSSCUTTING ISSUES community, as to which are really essential for reviewing clinical and translational science awards—has created a need the proposal and which should be incorporated into the for trained scientists in this field. databases described in Recommendation 2–6. The principal extramural funding source for research and training in biomedical informatics has been the NLM, which In addition, one aspect of the outcomes of training pro- is both a significant research institute at the NIH and the grams that has not been evaluated to date is how the value largest and most innovative medical library in existence. Its of the research training is perceived by the program director role as an NIH institute is often overlooked because its name and by the trainees themselves. In no sense should collecting conjures up images of a library facility, but its intramural and such data be a popularity contest or, worse, a complaint ses- extramural research have played key roles in advancing the sion against individual training-grant principal investigators. infrastructure for modern biological science as well as elec - Rather we believe that broad anonymous surveys, in which tronic health records, decision-support systems, and online the only identifier would be the fact of having been an NIH access to the biomedical literature. supported trainee, can be quite valuable. The NIH institute NLM programs all deal with information and knowl- or office funding the training might be identified, but the edge management used to support biomedical research and institution offering the training would be confidential. clinical care along with the development and promotion of standards that allow the integration of biomedical and clini- Recommendation 2–8: We recommend that a training cal data from diverse resources. Its training programs in bio- evaluation questionnaire be created so that all partici- medical informatics, which have supported graduate degree pants in the full range of NIH-funded training vehicles programs and postdoctoral fellowships since the early 1970s, can provide a confidential, unbiased evaluation of the are responsible for producing a generation of leaders who program in which they were trained. The intent of this now head academic programs in health science institutions, recommendation is not to provide additional information perform today’s cutting-edge informatics research, fill major for the competitive renewal of a particular program, but leadership roles in the government’s commitment to health- rather to allow the NIH to evaluate the merit of all of its care information technology, and staff or lead the companies training approaches broadly. that produce, sell, and implement today’s burgeoning clinical information systems. The NLM training grants (see Table 2-2) are administered iNterdiSCiPliNary fieldS aNd the emergeNCe as T15 programs, but although they are not formally desig- of NeW kiNdS of traiNiNg ProgramS nated as NRSA programs, they do follow NRSA guidelines With the evolution of team science and the increasing for funding and training requirements and are in this sense dependence of research on interdisciplinary activities, new indistinguishable from the other programs emphasized breeds of scientists have emerged in recent decades. Initia- in this report. Because NLM’s programs are not formally tion of new kinds of formal training programs has occurred designated as NRSA programs, they are not monitored or as a natural consequence, but these programs are too often measured in the same way that NRSA programs are, and the neglected when NIH-funded NRSA training is considered existence of its training programs is often overlooked. This and measured. Perhaps the most obvious examples can be has constrained the programs’ growth despite the burgeoning found in the quantitative and computing sciences—areas national demand for trained research scientists in the field of that are now heavily represented in the research portfolios biomedical informatics (which spans bioinformatics, clinical of the categorical institutes but that generally, other than informatics, and public health informatics). a modest effort at National Institute of General Medical It is shortsighted for HHS to fund current implementa- Sciences and at the National Library of Medicine (NLM), tions of health information technology (as the Office of the are not extensively supported by them as areas for focused National Coordinator for Health Information Technology research training. For example, the increasing interest in, has done with ARRA stimulus funds) without a concomi- and importance of, biomedical informatics—as reflected in tant investment in the basic research and graduate training the mandated biomedical informatics core resources for all needed to develop the concepts and innovations that will TABLE 2-2 Number of Full-time Pre- and Postdoctoral Research Training Slots Awarded FY 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009a Postdoctoral 60 84 105 103 130 109 110 99 82 94 Predoctoral 38 56 97 118 169 162 160 179 186 189 The training slots for 2009 include those awarded with ARRA and other supplemental funds. a SOURCE: NIH National Library of Medicine, 2009.

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES Recommendation 2–10: The committee believes that drive progress in the future. Computer science in general has subsequent workforce committees would greatly benefit been a major stimulant to the U.S. economy and has had a from continuity in terms of crafting recommendations remarkable influence on our quality of life, but the biomedi- and following and monitoring the implementation of those cal world cannot rely on the general engineering community recommendations by the NIH. Accordingly, it is recom- to develop the solutions that health care and medical research mended that the appropriate office at the NIH involved in require. The biomedical informatics community can fill that analyzing these recommendations should issue an annual pipeline, as it has in the past, but this requires a program of report to the director’s advisory committee on the status funding and training that will produce both the ideas and the of review and implementation. In addition, the NIH may scientists that are needed to restore the momentum that we wish to invite external experts to provide added insight into need in these important disciplines. The NLM is the only the analysis. There are a number of ways that this could be agency that has consistently supported such education, and done, but the exact mechanism is left up to the NIH. it needs the resources to continue its important programs. There may be other similar interdisciplinary programs at NIH that have been overlooked because they do not use the iNterNatioNal CoNtriButioN to the NRSA or T32 mechanism. All such programs need to be BiomediCal WorkforCe considered explicitly in the guidelines and recommendations offered in this report. Chapter 3 documents the contributions of foreign-educated scientists, particularly at the postdoctoral level, to the U.S. Recommendation 2–9: The unique graduate training biomedical research workforce. Indeed, in the biomedical programs of the NLM, plus its postdoctoral fellowships postdoctorate pool more than 60 percent of the fellows are in biomedical informatics, should receive gradually foreign trained. In addition, typically 60 to 65 percent of increasing support with incremental dollars over 5 years these individuals indicate that they hope to stay in the United to produce a 50 percent increase in the number of funded States after they have completed their fellowship. Without training programs and a doubling of the number of this component of the workforce, U.S.-educated Ph.D.s, at funded training positions. the current level of production, would not be able to provide the amount of human capital needed to meet the demands for research in this area. Over the past two decades the number of CoordiNatioN With Nih foreign-trained individuals in the postdoctoral workforce has When a new workforce committee is constituted, it spends steadily increased. However, we are now faced with a highly a considerable amount of time reviewing the previous rec- uncertain future in this regard. This is a direct consequence ommendations and the response by the NIH. This is often of two powerful forces, the effects of which are impossible quite difficult to do in a satisfying manner since the exact to determine at present. On the one hand, the enormous implementation can be piecemeal, and, indeed, sometimes growth of the Chinese and other Asian economies—and there may be very sound reasons for non-implementation. It their explicit intentions to invest in the biomedical and life is not easy for the new committee to triangulate how things sciences and become “research powerhouses”—has already have evolved in the four years since the previous recommen- begun to attract their nationals to return and conduct research dations were first presented. This committee was helped by at their home institutions, a phenomenon that seems likely a small number of individuals who had sat on the previous only to increase over the next decade. On the other hand, the committee and were able to offer a valuable extended per- pressing economic situation in the United States, especially spective. Clearly, better communication between the NRC the uncertainty of job availability in the future, may lead to a review committees and the NIH could speed up the overall decreasing attractiveness of U.S. biomedical research careers review process. The committee debated this issue for some to Ph.D.s from these foreign countries. time and eventually decided to make a recommendation that Although there is a great deal of uncertainty about how the NIH establish a review group that would analyze and col- these phenomena will affect the contributions of interna- late the NIH responses to the committee recommendations tional scientists to the U.S. biomedical research enterprise, and report its findings to the director’s advisory committee. our leaders at the NIH and in the Congress should be aware In this way the director of the NIH would be apprised of the of this committee’s concerns. It is probably not yet time to relevant issues, and the appropriate components of the min- suggest that U.S. production of biomedical Ph.D.s should utes could be used to inform the next NRC review committee be increased, but clearly this issue needs to be carefully and four years from now. continuously monitored.