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Basic Biomedical Sciences

INTRODUCTION

The goal of basic biomedical research is to provide comprehensive and detailed understanding of the mechanisms that underlie the development and normal function of humans and other living organisms and thereby gain insights into the pathological and pathophysiological mechanisms that cause disease. A detailed understanding of these mechanisms and pathways is essential for identifying potential targets for rational therapeutic interventions, and for disease prevention. The scope of basic biomedical research is, therefore, broad, ranging from the study of single atoms and molecules to the complex functions and behaviors of the whole organism.

Although distinct from clinical research, which is covered in Chapter 5, it is basic biomedical research is nonetheless an important component of clinical success. In particular, it provides the detailed understanding of disease processes that undergird the development of new diagnostic procedures, therapeutic interventions, and preventative strategies that can be tested in clinical studies. In turn, the encounters of astute clinicians with patients can stimulate clinical investigations that may suggest novel mechanisms of disease that can be further examined in basic studies that may involve model organisms. Observations that drive new understandings of human diseases and the development of new strategies for their prevention, diagnosis, and treatment, flow bidirectionally from patient to laboratory and back, often passing en route through various stages of experimentation and validation in lower and higher animal species. There can be no doubt that the frequency and intensity of interactions between basic and clinical scientists will continue to increase. However, the basic and clinical workforces are for the most part distinct and linked by a third genus of biomedical scientists dubbed “translational” researchers, who have been trained to be knowledgeable in both the basic and clinical biomedical sciences, as well as proficient in patient care.

With respect to behavioral research, covered in a later chapter, there is a similar continuum within the neurosciences from basic neurochemistry and molecular neurobiology through cognitive neuroscience to biological psychology and behavior. The overlaps among these areas will inevitably increase as genetic and environmental influences that affect the formation and function of the nervous system are better understood.

It is fair to say that the landscape of biomedical research has been revolutionized in the past 20 years by major advances in technology and in our understanding of fundamental aspects of cell and organ function as well as by the impact of this work on human health. Genomic biology is now a fundamental aspect of research strategies and is in the process of leading to the realization of “personalized medicine.” Concomitantly, quantitative biology has become an essential component of biomedical graduate education, and it is essential to know how to handle the prodigious influx of massive amounts of data generated by the new technologies. There have been astounding advances in our discovery and understanding of the roles of different populations of RNA molecules, such as RNAi, in cellular regulation and as research tools, and soon, as biologic interventions in disease. Cancer is being more effectively treated than ever before, the decreased incidence of cardiac mortality has been a major success story, and recently the first AIDS vaccine that may hold significant promise has been tested for the first time.

In order to apply scientific discoveries to the improvement of human health, a sufficiently large and diverse workforce trained in basic biomedical research is essential. That workforce must be able to conduct research in a wide variety of settings, including academic institutions, government laboratories, and a broad range of companies in pharmaceutics, biotechnology, bioengineering, and others.

BIOMEDICAL RESEACH WORKFORCE

For the descriptive material and the data presented in this report, researchers in the basic biomedical sciences are defined as individuals holding a Ph.D. in a field that deals



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3 Basic Biomedical Sciences iNtroduCtioN from basic neurochemistry and molecular neurobiology through cognitive neuroscience to biological psychology The goal of basic biomedical research is to provide com- and behavior. The overlaps among these areas will inevitably prehensive and detailed understanding of the mechanisms increase as genetic and environmental influences that affect that underlie the development and normal function of humans the formation and function of the nervous system are better and other living organisms and thereby gain insights into the understood. pathological and pathophysiological mechanisms that cause It is fair to say that the landscape of biomedical research disease. A detailed understanding of these mechanisms and has been revolutionized in the past 20 years by major pathways is essential for identifying potential targets for advances in technology and in our understanding of funda- rational therapeutic interventions, and for disease prevention. mental aspects of cell and organ function as well as by the The scope of basic biomedical research is, therefore, broad, impact of this work on human health. Genomic biology is ranging from the study of single atoms and molecules to the now a fundamental aspect of research strategies and is in the complex functions and behaviors of the whole organism. process of leading to the realization of “personalized medi - Although distinct from clinical research, which is covered cine.” Concomitantly, quantitative biology has become an in Chapter 5, it is basic biomedical research is nonetheless essential component of biomedical graduate education, and an important component of clinical success. In particular, it it is essential to know how to handle the prodigious influx provides the detailed understanding of disease processes that of massive amounts of data generated by the new technolo- undergird the development of new diagnostic procedures, gies. There have been astounding advances in our discovery therapeutic interventions, and preventative strategies that can and understanding of the roles of different populations of be tested in clinical studies. In turn, the encounters of astute RNA molecules, such as RNAi, in cellular regulation and as clinicians with patients can stimulate clinical investigations research tools, and soon, as biologic interventions in disease. that may suggest novel mechanisms of disease that can be Cancer is being more effectively treated than ever before, the further examined in basic studies that may involve model decreased incidence of cardiac mortality has been a major organisms. Observations that drive new understandings of success story, and recently the first AIDS vaccine that may human diseases and the development of new strategies for hold significant promise has been tested for the first time. their prevention, diagnosis, and treatment, flow bidirection- In order to apply scientific discoveries to the improvement ally from patient to laboratory and back, often passing en of human health, a sufficiently large and diverse workforce route through various stages of experimentation and valida- trained in basic biomedical research is essential. That work- tion in lower and higher animal species. There can be no force must be able to conduct research in a wide variety of doubt that the frequency and intensity of interactions between settings, including academic institutions, government labo- basic and clinical scientists will continue to increase. How- ratories, and a broad range of companies in pharmaceutics, ever, the basic and clinical workforces are for the most part biotechnology, bioengineering, and others. distinct and linked by a third genus of biomedical scientists dubbed “translational” researchers, who have been trained to BiomediCal reSeaCh WorkforCe be knowledgeable in both the basic and clinical biomedical sciences, as well as proficient in patient care. For the descriptive material and the data presented in With respect to behavioral research, covered in a later this report, researchers in the basic biomedical sciences are chapter, there is a similar continuum within the neurosciences defined as individuals holding a Ph.D. in a field that deals 

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8 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES with the biological mechanisms that are ultimately related of the students planning a postsecondary education can be to human health. These fields are listed in Appendix C. In examined by the percentage taking the biology AP examina- this report we have attempted to focus on these specific tion. The number has increased from about 32,000 in 1985 areas, but on occasion, the available data may refer to bio- to 150,000 in 2008 and is second to mathematics at 280,000.3 logical sciences in general because sometimes no grouping The interest in biology continues into college with 6.8 percent of specific biomedical disciplines is available, and in these of the 2006 freshman science and engineering population cases we have emphasized this point in the discussion. declaring a major in biology. This is the second highest field The workforce discussion below includes individuals who preference in science and engineering (S&E), exceeded only may also hold other degrees, such as an M.D. through an by computer science. Overall, from 1980 to 2008 the fraction M.D./Ph.D. program or other dual-degree programs, but of the freshman college population who are biology majors it does not include individuals with an M.D. degree alone. increased from 4.9 to 9.3 percent. The number of bachelor’s This is a shortcoming of the analysis, because a significant degrees awarded in the biological sciences was fairly constant number of M.D.s have conducted and continue to carry out in the 1970s and 1980s at about 40 thousand, and increased basic research in the fields listed in Appendix C, and some to 60,000 in the mid-1990s. Since that time it has steadily have won Nobel Prizes for their contributions. However, increased to nearly 78,000 in 2008. These data are for all areas pertinent demographic information on these degree holders in the biological sciences and are presented to show the trend is limited. The American Medical Association maintains a in the field in pre-graduate education. national database that tracks the careers of all practicing The number of students entering graduate school possibly physicians, but there is no database that specifically tracks in order to prepare for advanced degrees (M.S. and Ph.D.) in the academic careers of graduates from medical schools, the biological sciences was about 9,400 in the early 1990s except for the data collected by the Association of American and increased to a little less than 12,400 in 2008. Obviously, Medical Colleges (AAMC) and published annually in its some of these first-year students are only pursuing a master’s Directory of Medical School Faculty. However, this database degree, but the 32 percent increase in number of students does not identify research areas. The analysis of the clinical does show the substantial overall growth of interest in the research workforce in Chapter 5 will address these biomedi- field. If we focus on students that enter into doctoral-granting cal researchers to the extent that they can be identified. It biomedical sciences department, the entering student popu- should also be acknowledged that the committee’s analysis lation was 8,800 in the early 1990s and has increased to does not include individuals with doctorates in other profes- 11,800 by 2008. The total full-time graduate enrollment in sions, such as nursing, dentistry, and public health, if they the biomedical sciences was fairly steady in the 1990s until do not hold a Ph.D. in addition to their professional degree. the doubling of the NIH budget. The doubling began in 1998, There are important workforce issues in the first two of the and after a two-year lag, the number of biomedical graduate three fields just cited, and they will be addressed in separate students increased steadily by a total of 22 percent over the chapters in this report. period 2001-2006 (see Figure 3-1). Such an increase should yield a proportionate increase in the number of Ph.D.s awarded from 2005 and succeed- eduCatioNal ProgreSSioN ing years, an increase that has now been detected (see Fig- Most researchers working in the United States in the bio- ure 3-2). It should also be noted that about three-quarters of medical sciences obtained their doctorate degrees from U.S. the Ph.D. graduates in biomedical programs also received research universities, but a substantial number come from their bachelor’s degree in the same field.4 In addition, since foreign institutions, either directly into a graduate research 1998 there have been more female than male graduate stu- program, or more frequently via a postdoctoral position in dents enrolled in biomedical programs such that in 2008 the United States.1 females represented 56 percent of the graduate students. As For many in the biomedical sciences, interest in the field a result of the increased participation of women in graduate begins at an early age, in high school or even grade school. school, the gender distribution of Ph.D.s in the biomedical In this regard, over the past 20 years, the percentage of high sciences was almost equal in 2008 at 3,584 males and 3,511 school graduates who took a biology course has remained females. The data on student enrollment do not accurately about the same at around 90 percent. This level is less than reflect the doctoral population and are presented to show 99 percent of high school graduates who have taken math- the growth in the field over time. A more accurate assess- ematics course but greater than the percentage of any other ment of total enrollment in Ph.D. programs comes from the type of science; only 60 percent of high school graduates have research-doctorate study for one year, the fall of 2005, on taken a chemistry course, for example.2 The characteristics Ph.D. enrollment (see Table 3-1). National Center for Educational Statistic, Digest of Educational 1 Statistic, 2008. National Science Foundation, 2010. Science and Engineering Indica­ 3 National Center for Educational Statistic, Digest of Educational tors, Washington, DC: NSF. 2 Statistic, 2008. Unpublished tabulation from the Survey of Earned Doctorates, 2001. 4

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 BASIC BIOMEDICAL SCIENCES 60,000 Total Enrollment First-Year Enrollment 50,0 00 Number of Graduate Students 40,0 00 30,0 00 20,0 00 10,000 0 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year FIGURE 3-1 Full-time graduate enrollment in the biomedical sciences 1983-2008. SOURCE: NSF. 2008. Surey of Graduate Students and Postdoctorates in Science and Engineering, 008. Washington, DC: NSF. 3-1.eps 8,000 7,000 Male Female 6,00 0 Number of Doctorates 5,000 4,0 00 3,00 0 2,000 1,000 0 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Year FIGURE 3-2 Biomedical Ph.D.s by year of degree and gender, 1970-2008. 3-2.eps SOURCE: NSF. 2008. Surey of Earned Doctorates. Available at http://www.nsf.gov/statistics/srvydoctorates/.

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0 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES These data are reported by the institutions and represent Similarily, the percentage of underrepresented minority almost all doctoral programs. In 2005, the reported total of doctoral students in biomedical graduate programs is 11 Ph.D. students in the biomedical sciences was 41,115 or percent from the research-doctorate data, but in the same year about 7,500 fewer students than the NSF data, which most these student make up 8 percent of graduates, again likely likely reflects the inclusion of masters students. These data reflecting an expanding pipeline (see Table 3-4 and Figure again show more female than male students, but only by a 3-3). It is unclear why these percentages are greater, but these few hundred. Data from the research-doctorate study for the students might take longer to get their degree. period from 2002 to 2006 on first-year enrollment mirrors the growth of the NSF data (see Table 3-2) and is generally the NumBer aNd demograPhiCS of about 1,500 less, accounting for master’s students. Project- BiomediCal SCieNCeS Ph.d. reCiPieNtS ing the research-doctorate data, using the change in the NSF data, shows an increase in 2008 to about 10,000 first-year The increase in funding and enrollments led to increases enrollees in Ph.D. programs. in doctoral degrees. The numbers of Ph.D.s in the biomedi- Data on citizenship and race/ethnicity of doctoral stu- cal sciences awarded by U.S. institutions have increased dents in the biomedical sciences are also available from from roughly 3,000 during the 1970s to 6,895 in 2007. The the research-doctorate study. The percentage of doctoral increase presumably reflects increases in the Gross National students on temporary visas is about 30 percent, although the Product (GNP) as well as increases in the NIH budget over percentage of doctorates conferred on such students is some- this time period, although over the past decade the percent- what less (see Table 3-3 and Figure 3-3), likely reflecting a age increases in the NIH budget have substantially exceeded continuing increase in the number of international students those of Ph.D. output (see Figure 3-2). admitted into graduate programs and the attendant delay of Most of the surge occurred in the early to mid-1990s and, five years before graduation. more recently, from 2003 to 2007. The latter increase can TABLE 3-1 Number of Ph.D. Students Enrolled in the Biomedical Sciences, Fall 2005 Field Male Female Biochemistry, Biophysics, and Structural Biology 3515 3021 Biomedical Engineering and Bioengineering 2842 1589 Cell and Developmental Biology 2602 2989 Genetics and Genomics 1230 1495 Immunology and Infectious Disease 1155 1429 Integrated Biomedical Sciences 3285 3664 Microbiology 1200 1592 Neuroscience and Neurobiology 2007 2019 Pharmacology, Toxicology, and Environmental Health 1755 1989 Physiology 784 953 Total 20375 20740 SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs. Washington, DC: The National Academies Press. TABLE 3-2 First-Year Enrollment in Biomedical Ph.D. Programs Field 2001-02 2002-03 2003-04 2004-05 2005-06 Biochemistry, Biophysics, and Structural Biology 1334 1385 1556 1445 1437 Biomedical Engineering and Bioengineering 716 784 921 938 924 Cell and Developmental Biology 1365 1464 1558 1556 1610 Genetics and Genomics 594 582 654 674 619 Immunology and Infectious Disease 712 728 774 803 812 Integrated Biomedical Sciences 1288 1367 1398 1497 1519 Microbiology 669 672 731 728 688 Neuroscience and Neurobiology 761 891 957 886 913 Pharmacology, Toxicology, and Environmental Health 812 825 844 886 822 Physiology 397 417 481 456 445 Total 8648 9115 9874 9869 9789 SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs. Washington, DC: The National Academies Press.

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 BASIC BIOMEDICAL SCIENCES TABLE 3-3 Citizenship of Doctoral Students in the Biomedical Sciences, Fall 2006 Percentage Field Citizens Permanent Residents Temporary Residents Biochemistry, Biophysics, and Structural Biology 61 3 36 Biomedical Engineering and Bioengineering 61 4 35 Cell and Developmental Biology 65 4 30 Genetics and Genomics 68 3 30 Immunology and Infectious Disease 70 4 26 Integrated Biomedical Sciences 69 3 28 Microbiology 73 3 24 Neuroscience and Neurobiology 75 3 22 Pharmacology, Toxicology, and Environmental Health 59 4 37 Physiology 64 3 33 Total 66 3 31 SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs. Washington, DC: The National Academies Press. 35.0 30.0 Temporar y Residents Minorities 25.0 20.0 Percent 15.0 10.0 5.0 0.0 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2008 Year FIGURE 3-3 Biomedical Ph.D.s by citizenship and race/ethnicity, 1973-2008. SOURCE: NSF. 2008. Surey of Earned Doctorates. Available at http://www.nsf.gov/statistics/srvydoctorates/. 3-3.eps TABLE 3-4 Race/Ethnicity by Percent of Doctoral Students in the Biomedical Sciences, Fall 2005 American Field White Black Hispanic Asian Indian Minoritya Biochemistry, Biophysics, and Structural Biology 77 3 5 14 1 9 Biomedical Engineering and Bioengineering 69 5 4 21 0 10 Cell and Developmental Biology 75 4 7 14 1 11 Genetics and Genomics 78 5 5 11 1 11 Immunology and Infectious Disease 76 6 6 12 1 12 Integrated Biomedical Sciences 79 5 5 10 1 11 Microbiology 78 6 7 9 0 14 Neuroscience and Neurobiology 76 4 7 12 1 12 Pharmacology, Toxicology, and Environmental Health 72 7 6 14 1 14 Physiology 77 7 5 11 1 12 Total 76 5 6 13 1 11 Minority refers to Underrepresented Minorities that include Blacks, Hispanics, and American Indians a SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs, Washington, DC: The National Academies Press.

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES be linked to the elevated research expenditures during the substantially at institutions receiving NIH training grant doubling of the NIH budget. Interestingly, a substantially support, almost certainly a reflection of the mandate the larger fraction of the increase in the number of doctorates NIH has placed on these institutions to aggressively recruit has come from increased participation by women. a diverse student group. In a dramatic demographic shift, the fraction of Ph.D.s awarded to temporary residents has increased from about emPloymeNt immediately after 10 percent in 1970 to more than 30 percent in 2007 (Fig- reCeiviNg the Ph.d. degree ure 3-3).This fraction is still lower than that in many fields in the physical sciences and engineering, but this differential is The percentage of newly minted doctoral recipients with closing. In analyzing the participation by foreign-born stu- definite plans to do postdoctorate training relatively soon dents, we note that the dramatic spike in Ph.D.s awarded to after receiving their degree increased sharply during the international students in 1991-1993, presumably a reflection 1970s from about 50 percent to 80 percent in the mid-1980s of increased entry into U.S. schools post-Tiananmen Square. and remained at that level until the mid 1990s with only Since the peak in 1993, the proportion was steady until 2003, periodic decreases since then (see Figure 3-4). Over the same when students admitted in the early years of the NIH doubling time period, the fraction of new Ph.D.s who go directly into began to graduate. In the most recent three years the percent- regular employment decreased steadily until about 1997, but age has been almost constant, and maybe an indication of a subsequently appears to have stabilized. decrease in Ph.D.s to foreign students in the future. As the number of minorities gaining a Ph.D. has increased, The number of minorities earning a Ph.D. degree in it is useful to ask about their plans upon graduation. Fig- biomedical research has doubled since the early 1990s. ure 3-5 shows that minority and majority outcomes were Minority citizen and permanent resident Ph.D. awardees in quite different over the period from 1973 to 1993 when 2008 stood at 8.0 percent of all biomedical research gradu - minority Ph.D.s were much less inclined to take a postdoctor- ates in the United States; if one corrects for the number ate position and more inclined to go directly into industry. of non-U.S. citizens in the graduating class this amounts However, since 1993, although there is a great deal of scat- to 12.6 percent of graduating U.S. citizens and permanent ter in the data points, it is clear that the career progression residents. The fraction of minorities in the biomedical sci - of minority graduates now closely reflects that of majority ences has increased more than is seen in other biological graduates. The number of unemployed Ph.D.s at this stage areas. Recent studies show that this increase has occurred of their careers is very small. 90 Postdoctoral Appointment Employment 80 70 60 50 Percent 40 30 20 10 0 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 Year FIGURE 3-4 Postdoctoral plans at time of doctorate. 3-4.eps SOURCE: NSF. 2008. Surey of Earned Doctorates. Available at http://www.nsf.gov/statistics/srvydoctorates/.

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 BASIC BIOMEDICAL SCIENCES 10 0 Minorities in Employment Minorities in Postdoctoral Training Non-Minorities in Employment Non-Minorities in Postdoctoral Training 90 80 70 60 Percent 50 40 30 20 10 0 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 Year FIGURE 3-5 Postdoctoral plans of minorities and non-minorities in the biomedical sciences. 3-5.eps SOURCE: NSF. 2008. Surey of Earned Doctorates. Available at http://www.nsf.gov/statistics/srvydoctorates/. The time to doctorate and age at time of receiving the ences and on average is 5.5 years, or about 1.5 years shorter degree have been cited as critical issues in terms of career than the data collected by NSF. progression of biomedical researchers and the increased length of training prior to reaching R01 research status.5 PoStdoCtoral felloWS Data from NSF suggest that graduate students are spending longer periods of time in their programs, with the median With the growth of research funding driving a major registered time in a graduate degree program increasing expansion of the biomedical research enterprise, and with the from 6 years in 1970 to 7 years in 2002, although there was remarkable advances that have taken place in the biomedical a modest shortening of the time to 6.58 years in 2008. These times to completion are not significantly different from those in other S&E fields. However, these data run counter to the experience of essentially everyone in the biomedical research TABLE 3-5 Average Time to Degree field. This may be because these data reflect the time from Field Years entering a graduate program to receiving the doctoral degree, Biochemistry, Biophysics, and Structural Biology 5.61 and because some graduate students work for a period while Biomedical Engineering and Bioengineering 4.92 in graduate school (a phenomenon that has increased over the Integrated Biomedical Sciences 5.61 past 15 years) then this way of measuring time to degree is Cell and Developmental Biology 5.65 increasingly imprecise. A new and very valuable resource has Genetics and Genomics 5.74 Immunology and Infectious Disease 5.31 come from the Assessment of Research Doctorate Programs, Microbiology 5.56 which collected data on the median time to degree from indi- Neuroscience and Neurobiology 5.67 vidual programs. Table 3-5 shows that the program reported Pharmacology, Toxicology, and Environmental Health 5.23 time ranges from 4.9 to 5.7 years across the biomedical sci- Physiology 5.17 Average time to degree 5.52 Goldman, E., and E. Marshall. 2002. “NIH grantees: Where have all the SOURCE: NRC. 2010. A Data-Based Assessment of Research-Doctorate 5 young ones gone?” Science 298(5591):40-41. Programs. Washington, DC: The National Academies Press.

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES sciences in recent years, the postdoctoral appointment has It is interesting to note that an increasing fraction of these now become a sine qua non for most subsequent career non-tenure faculty positions are held by females. Twenty positions. From the 1980s to the late 1990s the number of years ago the half-life in these non-tenure-track faculty posi - postdoctoral appointments increased by about 60 percent for tions was 7-8 years, but over the last decade this has dropped Ph.D. scientists at U.S. institutions (see Figure 3-6). to 4-5 years, suggesting a more transient activity. Further, The rapid increase in the total U.S.-trained postdoctoral non-tenure-track positions may afford principal investigator pool from 1993 to 1999 was probably the result of a num- privileges but they often lack oversight, and whether this is a ber of factors. One was the increase in women graduates; viable next step on the employment ladder or whether those another was the growth of international students attending holding such appointments are merely “Postdoctorates by U.S. schools. another name” remains to be seen. Finally, it should be men- Data on the length of the postdoctoral period show a tioned that the AAMC databases do not give any information steady increase in the 1990s, but this generated an outcry on citizenship of these individuals. from postdoctoral organizations and, subsequently, several Data from the research-doctorate study show there are national university organizations. In response, the American almost 24,000 postdoctoral appointments in biomedical pro- Association of Universities issued a white paper in 2000 grams (see Table 3-6). This is larger than the number reported endorsing a limit of no more than 5 years for postdoctoral on the NSF survey for academic postdoctorates by about 20 appointments. With some slight modifications to fit academic percent, and it may be a more accurate figure, since the NSF medicine, the Association of American Medical Colleges data are drawn from a sample of institutions. It should also be (AAMC) endorsed a companion white paper addressed to noted that females represented about 41 percent of the post- medical schools and teaching hospitals. Since then, many doctoral population, but they have represented more than 45 institutions instituted limits to the postdoctorate training percent of the U.S.-trained doctorates since 2000. Also note period. These responses evidently yielded results, judging that the percentage of minorities in postdoctoral positions is from data for the most recent period showing that the average a little over 7 percent, which is consistent with the fact that postdoctoral training period has been significantly reduced. minorities accounted for 6 to 7 percent minority U.S. doctor- Whether term limits aided postdoctorates’ ability to find ate degrees over the period from 2000 to 2006. new permanent positions is debatable. Indeed, a perusal of the AAMC faculty database over this period indicates that the PartiCiPatioN of iNterNatioNal the number of tenure-track faculty positions did not increase PoStdoCtorateS iN BiomediCal reSearCh over the past decade (and in fact they have declined), but a 40 percent increase was seen in the number of non-tenure-track U.S. citizens in postdoctoral positions in the biomedical (research-track) faculty as well as “other faculty,” presum- sciences constitute only part of the postdoctoral training ably senior research staff positions (see also Figure 3-7). sector. There are also large numbers of doctoral recipients Academic postdoctorates Industrial postdoctorates 12,0 00 Government postdoctorates 10,000 8,000 Number 6,00 0 4,000 2,000 0 2005 2003 2001 1983 1985 1999 1995 1989 1993 1987 1977 1997 1991 1973 1979 1981 1975 Year FIGURE 3-6 Postdoctoral appointments in the biomedical sciences. SOURCE: NSF. Surey of Doctorate Recipients, ­00. Washington, DC: NSF. 3-6.eps

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 BASIC BIOMEDICAL SCIENCES Tenured faculty Tenure-track faculty 60,000 Non-tenure -track faculty Other academic appointments 50,0 00 40,0 00 Number 30,0 00 20,0 00 10,000 0 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2006 Year FIGURE 3-7 Academic positions of doctorates in the biomedical sciences, 1975-2006. SOURCE: NSF. Surey of Doctorate Recipients, ­00. Washington,s 3-7.ep DC: NSF. TABLE 3-6 Postdoctoral Appointments in the Biomedical Sciences in Fall 2006 Field Number of Applications Male Female Minorities (%) Biochemistry, Biophysics, and Structural Biology 3,625 2,087 1,242 5.1 Biomedical Engineering and Bioengineering 944 675 280 5.6 Cell and Developmental Biology 3,586 1,991 1,537 9.1 Genetics and Genomics 1,664 956 705 7.5 Immunology and Infectious Disease 1,688 875 746 9.1 Integrated Biomedical Sciences 5,349 2,493 1,790 6.7 Microbiology 1,413 739 624 7.2 Neuroscience and Neurobiology 2,620 1,515 1,049 8.5 Pharmacology, Toxicology, and Environmental Health 2,045 1,169 817 7.5 Physiology 793 464 330 7.5 Total 23,727 12,964 9,120 7.3 SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs. Washington, DC: The National Academies Press. with degrees from foreign institutions who are being trained vey of Graduate Students and Postdoctorates show that the in U.S. educational institutions and other employment number of temporary resident postdoctorates in academic sectors. Data are available on the number of postdoctoral institutions steadily increased through the 1980s and 1990s; appointments in academic institutions,6 but there is no com- by 2008 the number was almost 12,000 in the biomedical parable source for data from the industrial, governmental, sciences. Currently temporary residents hold almost three- and non-profit sectors. However, the NIH supports about fifths of the postdoctoral positions in academic centers (see 4,000 intramural postdoctorates, and just over 60 percent Figure 3-8). of them are temporary residents from countries around the There has been little change in the number of U.S. citizen world, with the largest numbers coming from the People’s and permanent resident postdoctorates in academic institu- Republic of China, India, Korea, Japan, and Europe. Almost tions since the early 1990s, though there was a 20 percent all of them have foreign doctorates. Data from the NSF Sur- increase in temporary resident postdoctorates between 1998 and 2003 coinciding with the NIH doubling. The leveling off in the number of foreign postdoctorates from 2003 to 2006 is NSF. 2004. Surey of Graduate Students and Postdoctorates in Science 6 most likely related to the plateau in NIH funding rather than to and Engineering; 00. Washington, DC: NSF.

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES Number of U.S. Citizen and Permanent Resident Postdoctorates 12,0 00 Number of Foreign Postdoctorates 10,000 8,000 Number 6,00 0 4,0 00 2,000 0 2000 2006 2004 2005 2008 2002 2003 2007 2001 1990 1996 1980 1984 1986 1988 1998 1999 1983 1985 1994 1995 1989 1992 1982 1993 1987 1997 1991 1979 1981 Year FIGURE 3-8 Postdoctorates in academic institutions. SOURCE: NSF. Surey of Graduate Students and Postdoctorates in Science and Engineering, 008. Washington, DC: NSF. 3-8.eps Career ProgreSSioN post-9/11 security issues. Almost certainly, the recent ARRA stimulus funding will generate a demand for additional post- Traditionally, the career progression for biomedical sci- doctorates, and since most of the U.S. graduates already enter entists after graduate school and a postdoctoral appointment this pool, the additional needs will be satisfied by an increase was to next take a position in an academic institution or in an in international postdoctorates. It seems unlikely that the industrial environment. However, individuals with a Ph.D. in U.S.-trained postdoctorate pool would have been sufficient to the biomedical sciences now have a range of career opportu- produce the workforce for a response to the ARRA funding. nities, from academia and industry to science administration, Clearly, some of these international postdoctorates are well policy, writing, and law, to name but a few of the options. trained. However, a significant (and unknown) number have Until 1985, the first position to which Ph.D.s would aspire been trained as M.D.s, and their laboratory skills are hard to was generally in a university on the tenure track. However, gauge; they may well receive much “on-the-job” training. after 1985 the bulk of the growth in academia has been in Nonetheless, the international postdoctorate pool is highly non-tenure-track appointments, with many in this latter elastic and responds quite rapidly to funding exigencies and category on “soft funding.” Figure 3-9 shows that the aver- opportunities driven by the NIH appropriation. Data indicate age annual growth in the academic population was about 5 that 65 percent of these postdoctorates will probably stay in percent from the 1970s to 1991, except for a slowdown in the United States and will thus contribute to the biomedical the late 1980s and early 1990s due to economic conditions. workforce over an extended period. However, exactly where Since 1995, however, growth has slowed significantly, and these individuals will be employed has not been carefully what growth there is has been in the area of non-tenure- measured. Nor has it been clearly defined how these interna- track faculty and other academic positions. From 1999 to tional postdoctorates will handle the post-stimulus funding 2003, the number of positions in these areas grew about 20 employment situation. percent (roughly 4 percent each year). Note that these data The Research-Doctorate Study collected data on pro- are from the NSF Survey of Earned Doctorates, and as such grams with foreign postdoctorates and the country of origin they apply to all biomedical science postdoctorates including for those postdoctorates. For the 983 biomedical programs those in clinical departments, but they do not include foreign in the study, 839 reported foreign postdoctorates in the non-tenure-track faculty, who have contributed additionally program. For 430 of these programs, more foreign post- to the growth of this category of employment. doctorates came from the Peoples Republic of China than This growth is almost certainly due to the efforts of any other country. India and Japan were the most populous institutions to accommodate term limits for postdoctorates, for many fewer programs (see Table 3-7). as discussed above, and it is likely that these are individuals

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 BASIC BIOMEDICAL SCIENCES TABLE 3-7 Number of Programs with Foreign Postdoctorates and the Three Most Popular Countries of Origin in Fall 2006 Countries of Origin Field Programs with Foreign Postdoctorates China India Japan Biochemistry, Biophysics, and Structural Biology 139 73 14 3 Biomedical Engineering and Bioengineering 59 32 8 2 Cell and Developmental Biology 113 56 8 5 Genetics and Genomics 54 31 5 2 Immunology and Infectious Disease 66 37 7 Integrated Biomedical Sciences 106 44 13 5 Microbiology 67 34 6 3 Neuroscience and Neurobiology 72 40 4 3 Pharmacology, Toxicology, and Environmental Health 107 58 15 3 Physiology 56 25 4 3 Total 839 430 84 29 SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs. Washington, DC: The National Academies Press. TABLE 3-8 Tenure Status of Basic Science Medical School Faculty, 2002, 2005, and 2009 Degree M.D. M.D./Ph.D. Other Ph.D. Unknown Total 2002 Tenured 821 642 17 7401 33 8914 Tenure Track 329 261 22 2419 23 3054 Non-Tenure Track 847 375 241 3269 162 4894 Tenure Not Available 151 39 21 423 9 643 Total 2148 1317 301 13512 227 17505 2005 Tenured 764 679 18 7346 46 8853 Tenure Track 330 319 23 2619 31 3322 Non-Tenure Track 879 425 259 3857 108 5528 Tenure Not Available 194 52 22 503 16 787 Total 2167 1475 322 14325 201 18490 2009 Tenured 600 684 16 6895 49 8244 Tenure Track 377 320 28 2844 71 3640 Non-Tenure Track 829 389 238 3561 122 5139 Tenure Not Available 250 66 43 640 48 1047 Total 2056 1459 325 13940 290 18070 SOURCE: AAMC. 2010. Association of American Medical Colleges Faculty Roster, 00. Available at https://www.aamc.org/data/facultyroster/. whose appointment titles changed from postdoctoral trainee and during this period the number of non-tenure-track faculty to research associate, research scientist, instructor, or some has increased by 12 percent. The stasis in overall tenure-track similar title but who continued to do the same kind of faculty numbers, coupled with the dramatic decrease in the work. number of faculty taking retirement, means that new, tenure- The almost flat growth over the three-year period from track assistant professor positions are increasingly scarce. 2003 to 2006 in all position categories is almost certainly The decreased retirement rate and the longer time to a consequence of the flat NIH budget after the doubling independent research status are seen in the changes in the years. While data on the current faculty are not available, age distribution of tenured faculty from 1993 to 2006 (see one expects that the ratio of tenure track to non-tenure-track Figures 3-9 and 3-10). academic positions may well look very different in 2009 These figures provide dramatic evidence that the aca- and beyond due to the severe economic downturn and the demic workforce is aging. By 2006 about 25 percent of the financial problems besetting many institutions. It is worth tenured academic faculty were over the age of 60, and about mentioning that the number of basic sciences tenured and half were 55 or older. At the same time, the proportion of tenure-track faculty at medical schools increased from 2002 younger tenured faculty has necessarily declined over time, to 2005 and has actually declined in number since 2005 (see which is, of course, ultimately reflected in the increased Table 3-8). The faculty size in 2009 stands at the 2002 level, average age at award of first R01 grant. Given the current

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0 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES 10 0 90 80 70 60 Percent 50 40 30 20 10 0 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2006 Year Academic Industrial Government Other sectors FIGURE 3-12 Percentage employment by sector. SOURCE: NSF. Surey of Doctorate Recipients, ­00. Washington, DC: NSF. 3-12.eps 87% 85% 84% 84% 82 % 81% 80 % 79 % 78 % 76 % 75% 73 % 72 % 71% 69 % 67% 65% 35% 33 % 31% 29 % 28 % 27% 25% 24% 22 % 21% 20 % 19 % 18 % 16 % 16 % 15% 13 % 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2006 Year Percent Females Percent Males FIGURE 3-13 U.S. biomedical Ph.D.s employed in S&E fields by gender. SOURCE: NSF. Surey of Doctorate Recipients, ­00. Washington, DC: NSF. 3-13.eps x-axis labels retyped

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 BASIC BIOMEDICAL SCIENCES 50 45 % Female Faculty % Female Ph.D.s 40 35 30 Percent 25 20 15 10 5 0 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year FIGURE 3-14 Percentage of female faculty in 2006 in the biomedical sciences by year of Ph.D. compared with the number of female Ph.D.s 3-14.eps in the same year. SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs. Washington, DC: The National Academies Press. TABLE 3-9 Distribution of Medical School Faculty by Track and Gender, 2002, 2005, and 2009 Percent 2002 2005 2009 Females Males Females Males Females Males Tenured 18 82 20 80 21 79 Tenure Track 30 70 32 68 33 67 Non-Tenure Track 36 64 37 63 40 60 Total 26 74 28 72 30 70 SOURCE: AAMC, 2010. Association of American Medical Colleges Faculty Roster, 00. Available at https://www.aamc.org/data/facultyroster/. 2009, 40 percent of women Ph.D.s were in non-tenure-track percentage points below their numbers in the overall popula- positions. tion, but in the early 1980s when they represented about 20 The data from the AAMC Roster are similar to the NSF percent of the workforce, they held about 40 percent of the data concerning the entire population of U.S. doctorates. In non-tenure and non-faculty positions, and that percentage 2006 females occupied 31 percent of the faculty positions has varied between 40 and 45 percent over the past 25 years. and represented 35 percent of the S&E workforce, and they Women are recruited into tenure-track assistant professor held 45 percent of the non-tenure and non-faculty positions. positions to a reasonable degree, but several studies have The data on faculty appointments are consistent over time, shown that the fraction of females in associate and in full- with the percentage of female faculty appointment about 2 professor positions declines substantially, and these numbers

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES have not changed very much over the past 20 years or so. it is highly likely that the proportion of these research- A detailed study of the reasons for these observations was ers who hold two degrees is increasing. Because the first published recently in a study of female academics in the formal M.D./Ph.D. training programs were introduced in California system.7 1964, opportunities for dual-degree training have steadily increased, and by 2009 some three-fourths of all medical schools offered their students an opportunity to earn both the diversity of the Workforce degrees; 40 of these programs currently receive funding as a The number of underrepresented minorities in the basic Medical Scientist Training Program (MSTP) from the NIH. biomedical workforce has increased significantly, from In 2009 M.D./Ph.D.s in medical schools represented 8.1 per- 2.5 percent of the workforce in 1973 to 6.2 percent in 2006.8 cent of the 18,957 faculty in basic sciences departments and These numbers reflect the increasing numbers of minorities in 7.6 percent of the 118,559 faculty in clinical departments. postdoctoral positions, which have grown from 1.6 to 6.8 per- A recent study9 published by members of the M.D./Ph.D. cent during the same period. Given that the number of minority Section of the AAMC Group on Graduate Research Educa- biomedical Ph.D. recipients is also increasing, we may expect tion and Training discusses the success of the MSTP. It reports the workforce number to increase. Nonetheless, despite the on career choices of trainees who had received both M.D. and growth in recent years, minorities still remain a small frac- Ph.D. degrees from 24 MSTPs enrolling 43 percent of current tion of the overall workforce. At the current rate of increase trainees and representing about 50 percent of the MSTPs. Of of minorities obtaining the Ph.D. degree, it is conceivable that 2,383 alumni from these programs only 16 percent were in the production rate could reach 14 percent, but this may well private practice, while 68 percent were in academic centers, become a “pipeline” ceiling, as this is the fraction of minori- 8 percent in industry, and 5 percent in research institutes. Of ties presently earning the B.S. degree in biological sciences. those with academic appointments, 82 percent were conduct- Clearly, additional representation in the workforce will depend ing research. This level of research activity is reflected in an on the issues of attracting additional minority undergraduate estimated 73 percent with research funding. This is higher students into science and reducing dropout rates. These are than the 58 percent of the faculty with Ph.D. degrees from major challenges, but they are beyond the scope of this report. the Research-Doctorate Study who reported research grant Although the data concerning diversity are encouraging, there support. Because M.D./Ph.D. programs were envisioned as a continues to be a serious problem. means of fostering transitional or clinical research, the study of M.D./Ph.D. recipients found that 56 percent were conduct- ing basic research, 41 percent were conducting transitional PhySiCiaN reSearCherS research and 43 percent were conducting clinical research To this point the discussion has addressed only individuals (percents do not add to 100 percent because combination of with a Ph.D. in one of the fields listed in Appendix C, and has areas could be selected). not taken into consideration physicians who are conducting In addition, Dickler et al.10 found that M.D./Ph.D. appli- basic biomedical research. It is difficult to get a complete cants for both first and second R01 grants had a higher suc - picture of this workforce, because there is no database that cess rate than applicants with either an M.D. or Ph.D. alone, tracks physician-scientists who are actively involved in and that the number of first-time M.D./Ph.D. applicants for research in the same way as are Ph.D. scientists. NIH R01 grants has become almost equal to that of M.D.s However, according to the American Medical Association only by 2006. The findings are consistent with those of an (AMA), the number of physicians active in research rose earlier study by the National Institute of General Medical throughout the late 1970s and early 1980s and reached Sciences (NIGMS) in 1998 of graduates from MSTPs, which 22,945 by 1985. Since then, however, the number of M.D.s found that by almost all measures the MSTP-trained gradu- (and M.D./Ph.D.s) identifying research as their primary ates were better than the other control groups. They entered professional activity has steadily declined, dropping to graduate training more quickly and took less time to com- 14,434 in 1997. This figure remained about the same until plete the two degrees than comparable degrees for the other 2008 at about 14,880 (12 percent) of the faculty engaged groups. In terms of research activity, the NIH data showed in research. However, these numbers have to be interpreted that the MSTP graduates applied for research grant support conservatively as the AMA’s “physicians active in research” from the NIH at a greater rate, and they were more successful may mean many things, including participation as workers, in receiving support. These outcomes provide a remarkable not leaders of clinical trials. testimony to the success of M.D./Ph.D. programs in train- Although these data do not distinguish between physician- ing physician-scientists, who after graduation continue to scientists holding an M.D. and those with M.D./Ph.D.s, Brass, L. 2010. Are the M.D.-Ph.D. programs meeting their goals? 9 See http://www.americanprogress.org/issues/2009/11/women_and_ Academic Medicine 85(4):692-701. 7 sciences.html. Dickler, H.B., D. Fang, S.J. Heinig, E. Johnson, and D. Korn. New 10 NSF. Surey of Doctorate Recipients, ­00. Washington, DC: physician-investigators receiving national institutes health research projects 8 NSF. grants. Journal of the American Medical Association 297(22): 2496-2501.

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 BASIC BIOMEDICAL SCIENCES participate successfully in a broad spectrum of research and school classmates, and they enter the job market on better research-related activities. financial footing and with better job prospects than investiga- Over the past decade the MSTPs have also begun to tors with only one degree. make significant strides in terms of including minority stu- Moreover, unlike their counterparts with a Ph.D., who dents. The racial distribution for the cohort of students who often have difficulty obtaining faculty positions, M.D./Ph.D.s matriculated into an M.D./Ph.D. program in 2009 is shown are reportedly in great demand as medical school faculty in Table 3-10. members, particularly in clinical departments (Brass et al.), The proportion of URM students in M.D./Ph.D. programs and they are very well represented among clinical division is considerably lower than that in the general population of the heads and department chairs. Graduates of M.D./Ph.D. pro- United States. However, it is perhaps more relevant to compare grams are now a critical and very successful component of the the compositions of these programs to the proportion of URMs clinical, translational, and basic research workforces in medi- among those who graduate with B.S. degrees in biology. cal schools and major teaching hospitals. They are in demand Table 3-10 shows that in the group of M.D./Ph.D. programs as medical school faculty members and are well represented the proportion of URMs is only slightly less than that of among clinical division heads and department chairs. URMs in the pool of B.S. degree graduates in the biological However, in spite of their success, the training in MSTPs sciences, a major pool from which the programs recruit their has declined over the past few years from a maximum of 933 students. Nevertheless, these data show that the total number full-time trainee positions in 2002 to 911 positions in 2009. of URMs in M.D./Ph.D. programs represents only about 0.7 The current number of trainees is at the 2006 level. Since percent of the biological sciences B.S. pool and less than 2006 the program has been co-funded by other institutes, 0.1 percent of the total pool of B.S. graduates. Thus, there is and the number of positions has ranged from 48 in 2006 to clearly both an opportunity and the need for increased effort 71 in 2009. The total funding of M.D./Ph.D. programs by to attract URMs into M.D./Ph.D. programs (both MSTP and the NIGMS in NIH has not increased in 1990 dollars from non-MSTP). Women accounted for 37 percent of the current 1990 to 1997 and increased during the doubling of the NIH trainees in the programs participating in this study, and they budget by 38 percent, has declined in recent years (see Fig- had the same attrition rate as men (approximately 10 percent). ure 3-15). From 2008 to 2009 it actually decreased in actual These successful women who hold both degrees serve as dollars and the result was a decrease in training positions outstanding role models for female scientists in training and from 923 to 911. underscore the need for M.D./Ph.D. programs to continue aggressively to pursue the goal of gender equity in this area. u.S. CaPaCity to ideNtify outStaNdiNg Given the increases of the number of woman gaining Ph.D. aPPliCaNtS to m.d./Ph.d. ProgramS degrees in the biomedical sciences, along with the fact that women earn the B.S. degree at a higher rate than men, we Among the 16,127 students who graduated in 2007 from may expect that parity should be reached in these programs all medical schools, 494 (3.1 percent) received M.D./Ph.D.s. over the next decade. NIH estimates that only 350 of these graduated from NIH- On average, M.D./Ph.D. students take about 8 years to supported MSTPs, while 150 future physician-scientists complete their degrees, during which time most receive graduated with both degrees from M.D. and Ph.D. programs tuition waivers and a stipend from a combination of public that do not receive NIH funding. To support programs cur- and private funding sources. As a consequence, on comple- rently training this non-NIH funded pool of future physician- tion of their training, overall indebtedness levels reported by scientists to the same degree as the NIH funded pool, the M.D./Ph.D.s are about half (or less) of those of their medical MSTP would have to increase by 40 percent. This raises the TABLE 3-10 Compositions of M.D./Ph.D. Programs in United States by Racea Program URMb % Asian % White % Totalc MSTPd 52 14.4 93 25.7 217 59.9 362 Non-MSTPd 20 10.7 52 27.8 115 61.5 187 All MD/PhDd 72 13.1 142 25.9 332 60.4 549 B.S. Degrees (All Sciences) 73,835 18.3 37,050 9.2 268,783 66.4 404,494 B.S. Degrees (Biological Sciences) 11,841 15.4 11,572 15.0 49,771 64.6 77,015 USA Population 2008e 86,878,906 28.6 13,549,064 4.5 199,491,458 65.6 304,059,724 Percentage values are based on total values in column one. a URM values are the sum of Black African American + Hispanic + Native American and Alaskan Native + Hawaiian and Pacific Islander. b Total number of students minus foreign students and those who gave no response to race. c Data are from the Association of American Medical Colleges (AAMC) for classes entering 2009. d Data are from the U.S. Census Bureau for 2008. e

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES $ 45,000 $ 40,000 Actual Obligation Obligation in 1990 Dollar s $ 35,000 Obligation (in thousands) $ 30,000 $ 25,000 $ 20,000 $15,000 $10,000 $5,0 00 $— 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year FIGURE 3-15 NIH funding of the Medical Sciences Training Program (dollars in thousands). SOURCE: Data obtained from the National Institute of General Medical Sciences. 3-15.eps question of whether there are a sufficient number of highly were 607 applicants who applied to, but did not join an qualified applicants to expand the MSTP by this amount. M.D./Ph.D. program, who obtained an MCAT score of 30 For the class entering in 2009 there were 1,703 applica- or higher, which is close to the average of all medical school tions to M.D./Ph.D. programs, of which 601 matriculated matriculants. These data, together with the fact that there into an M.D./Ph.D. program (397-MSTP; 204 non-MSTP are presently 204 students in non-MSTP-funded programs, supported M.D./Ph.D. program) leaving 1102 who did not strongly indicate that there is a sufficiently deep applicant join one of these programs. Several qualifications of appli- pool, and that the size of the MSTP could easily increase by cations are examined to identify those that have the highest 30 percent or more by accepting students whose acceptance probability of success in an M.D./Ph.D. program. Among did not demand a lowering of the program’s rigorous aca- these are prior research experience, undergraduate and demic standards. graduate GPA, and evidence of sustained motivation toward Moreover, the committee felt strongly that in today’s a career as a physician-scientist. An additional important climate of changing strategies to provide more extensive parameter is the MCAT score. Although on its own it is of health care coverage while simultaneously controlling the limited predictive value for success, it does give a good esti- costs of medical care, it is vitally important to expand the mate of a student’s performance in the United States Medi- M.D./Ph.D. program to include the behavioral and clinical cal Licensing Examination Step 1. AAMC data for those research workforce. As a result of these considerations the students matriculating in 2009 are shown in Table 3-11. current committee endorses the intent of the recommenda- In 2009, there were 258 applicants to M.D./Ph.D. pro- tion of the previous committee with the modification that grams who did not matriculate into an M.D./Ph.D. program MSTP funding be expanded by more than 20 percent. There even though they obtained an MCAT score of 34 or higher is no intent to add extra support to extant programs, which (which is within the range of students joining an MSTP). might not lead to an increased number of trained individuals. Recognizing that no MCAT score should be considered as Thus, we strongly recommend that there be assurance that a cutoff for acceptance into an M.D./Ph.D. program and this increase in funding will result in an increase in the that other factors are taken into account when students are total number of M.D./Ph.D. students trained, especially in selected, it does appear that there are about the same number excellent programs at institutions not currently supported by of applicants with MCAT scores of 32 or higher to M.D./ the MSTP. A significant portion of this increase in funding Ph.D. programs who did not join an M.D./Ph.D. program as should be targeted at trainees in the social and behavioral joined an MSTP. To take this line of thought further, there sciences, as well as dual-degree programs in dentistry and

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 BASIC BIOMEDICAL SCIENCES TABLE 3-11 MCAT Scores Number Average Median All medical students who matriculated into medical school 18,390 30.8 31 All medical students who matriculated into an M.D./Ph.D. program (MSTP plus non-MSTP) 601 34.3 34 All students who matriculated into an MSTP program 397 35.3 35 All students who matriculated into a non-MSTP-funded M.D./Ph.D. program 204 32.3 32 SOURCE: Association of American Medical Colleges data. 2010. nursing. Certainly, standards must remain high, and if there grant funding at $14.0 billion and funding for training at is an insufficient number of highly qualified applicants for $518 million. The decline in total training support was not this increased level of funding, NIGMS should redirect reflected in the number of training position, which remained unused funds to support other categories of its sponsored almost constant, but in the stipends that remained constant research training programs. Also see the section “The and declined when adjusted for inflation and in the capped Role of the National Research Service Award Program” in tuition support. The President’s budget request for fiscal year Chapter 5. (FY) 2011 is aimed at correcting the stipend problem with a 6 percent increase over FY 2010 in the NRSA funds that are directed at training stipends, and a decrease of about 1 fiNaNCial SuPPort of BiomediCal traiNiNg percent in the number of awards. Corresponding changes aNd the NatioNal reSearCh ServiCe aWard are seen in the data for academic research and development Program (R&D) expenditure in the biological sciences. R&D expen- Exciting advancements in biomedical research, together ditures in constant 1998 dollars increased slightly in the with a generally strong economy in the 1990s and again in early 1990s from a little over $4 billion in 1990 to $5 billion the early part of this decade after 2002, were reflected in in 1998, and then increased during the doubling of the NIH increased research and development support from the NIH. budget to almost $8 billion in 2005. Since 2005 there has The NIH budget and its funding of extramural research and been a decline to about $7.5 billion in 2008. training doubled in nominal dollars from a little over $10 bil- Essentially all graduate students in the biomedical sci- lion in 1998 to $20.2 billion in 2004, during which time total ences receive funding of one sort or another. There is no NIH expenditures grew from $13.0 billion to $27.2 billion. comprehensive data source for the funding of students in Measured in constant 1998 dollars, the extramural increase doctoral programs, but the Research-Doctorate Study col- was 65 percent from $10.0 billion to $16.5 billion. The lected data from the institutions that are heavily invested change in the budget for training during the period increased in biomedical research. Across the fields that correspond to from $428 million to $604 million in 1998 dollars. Increases the biomedical sciences in that study, almost all students are in the NIH extramural budget over the years following the supported in their first year (see Table 3-12). This funding doubling were exceedingly small and actually declined in pattern continues during their doctoral studies with few stu- constant 1998 dollars to $14.5 billion in 2009, with research dents receiving partial or not support (see Table 3-13). TABLE 3-12 First-Year Support for Doctoral Students in the Biomedical Sciences Percent Field Full Support Partial Support No Support Biochemistry, Biophysics, and Structural Biology 96 3 1 Biomedical Engineering and Bioengineering 86 7 7 Cell and Developmental Biology 97 1 2 Genetics and Genomics 93 4 4 Immunology and Infectious Disease 95 4 1 Integrated Biomedical Sciences 97 1 2 Microbiology 96 2 2 Neuroscience and Neurobiology 96 3 1 Nutrition 88 10 2 Pharmacology, Toxicology, and Environmental Health 94 4 2 Physiology 96 2 2 Total 95 3 2 SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs. Washington, DC: The National Academies Press.

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 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES TABLE 3-13 Funding Across Graduate Studies in the Biomedical Sciences, Fall 2005 Percent Fellow or Teaching Research Combination Less than Full Field Trainee Assistant Assistant Funding Funding Unfunded Biochemistry, Biophysics, and Structural Biology 20.9 10.8 39.8 25.7 1.1 1.7 Biomedical Engineering and Bioengineering 17.5 7.6 46.0 19.6 3.2 6.1 Cell and Developmental Biology 21.7 8.3 40.4 27.0 1.0 1.6 Genetics and Genomics 22.7 7.9 42.9 24.4 0.4 1.7 Immunology and Infectious Disease 29.6 4.1 33.2 29.9 2.1 1.2 Integrated Biomedical Sciences 18.3 26.3 30.4 20.7 1.1 3.2 Microbiology 17.5 15.1 41.9 22.3 1.4 1.8 Neuroscience and Neurobiology 28.8 6.6 31.1 30.8 1.3 1.3 Nutrition 15.9 11.0 41.9 20.9 3.2 7.1 Pharmacology, Toxicology, and Environmental Health 23.5 9.7 41.6 22.7 1.1 1.4 Physiology 22.3 6.6 37.6 29.6 2.0 1.9 Total 21.9 10.9 38.4 25.0 1.4 2.3 SOURCE: NRC. 2010. A Data­Based Assessment of Research­Doctorate Programs. Washington, DC: The National Academies Press. When the NRSA was established in the 1970s, the and this reasoning is the basis of a recommendation out- majority of the graduate student funding came from these lined in Chapter 2. It is also worth noting that predoctoral f ellowships and traineeships, with additional support fellowships amounted to only 2.7 percent of the NRSA from research grants (graduate research fellowships) and support in 1974, but currently contributes 20 percent, and from institutional teaching assistantships. This began to that since 2006 there has been a decline in the number of change in the early 1980s when support of training from R01-supported graduate students. research grants became more common and quickly grew in share until in 2006 it represented the means of support fuNdiNg of PoStdoCtoral felloWS for most graduate students in the biomedical sciences (see Table 3-14). Specifically, research grants funded about 40 Information on overall funding patterns for postdoctoral percent of all students in the early 1980s and 70 percent by fellows in the basic biomedical sciences is not as complete as 2006. This increase mirrors increased overall NIH funding that for graduate students, because academic institutions are during this period and the corresponding increase in gradu - the only source of data, and their information almost certainly ate student numbers overall (see Figure 3-16). The greatest is an underestimate because of the varieties of appointment growth in research assistantships, however, occurred from titles for postdoctoral trainees. Figure 3-17 shows the type 2000 to 2004, during and toward the end of the NIH budget of postdoctoral support in doctoral-granting institutions for doubling. Given that the majority of graduate students are both U.S. doctorates and doctorates with degrees from foreign trained while being supported by R01 grants, it does not institutions. As is the case for graduate student support, the seem unreasonable to expect that the same high standards fraction of postdoctoral support from federal funds derived expected of T32 trainees should be applied to these students, from training grants and fellowships has actually diminished TABLE 3-14 NRSA Trainees and Fellows by Broad Field (Basic Biomedical Sciences), 1975-2008 Predoctoral Postdoctoral Trainees Fellowship Trainees Fellowship Total 1975 1,009 27 474 1,106 2,616 1980 4,184 21 2,200 1,982 8,387 1985 4,026 80 2,128 1,583 7,817 1990 4,701 123 2,232 1,483 8,539 1995 5,095 411 2,191 1,679 9,376 2000 4,628 400 2,310 1,598 8,936 2005 4,845 862 2,598 1,365 9,670 2006 4,516 962 2,463 1,374 9,315 2007 4,937 1,074 2,386 1,291 9,688 2008 5,390 1,154 2,475 1,284 10,303 SOURCE: NIH Database.

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 BASIC BIOMEDICAL SCIENCES 12,000 10,000 Fellowships Traineeships Research Assistantships Number of Students Suppor ted 8,00 0 6,00 0 4,0 00 2,00 0 0 2000 2006 2004 2005 2008 2002 2003 2007 2001 1990 1996 1980 1984 1986 1988 1998 1999 1983 1985 1994 1995 1989 1992 1982 1993 1987 1997 1991 1981 Year FIGURE 3-16 NIH support of graduate students. 3-16.eps SOURCE: NSF. 2008. Surey of Graduate Students and Postdoctorates in Science and Engineering. Washington, DC: NSF. 18,000 Fellowships Traineeships Research Grants Non -Federal Sources 16,0 00 14,0 00 Number of Postdoctorates Suppor ted 12,0 00 10,000 8,000 6,00 0 4,000 2,000 0 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 Year FIGURE 3-17 Postdoctoral support in the biomedical sciences. SOURCE: NSF. 2008. Surey of Graduate Students and Postdoctorates in Science and Engineering. Washington, DC: NSF. 3-17.eps

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8 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES because of the dramatic increase of trainee funding from might expect when the trainees are a major component of the research grants. In 1979, 2,217 (or 31 percent) of the total academic workforce), the size of doctoral programs is driven 6,698 federally funded university-based postdoctoral fellows primarily not by the labor market for Ph.D.s.12 but rather by received their training on a fellowship or traineeship. Over individual faculty needs for research and (to a lesser extent) time the trainee and fellowship support has remained fairly teaching assistants, and in the biomedical arena it is largely constant at around 2,000, but in 2007 and 2008 there was a the former that is driving the size of graduate student and decline, and in 2008 only 1,502 postdoctorates were sup- postdoctoral pools. ported on these mechanisms and represented 8 percent of the Despite this massive shift in relative federal support of federal support. The remaining 96 percent came in the form of training over the past 30 years, NRSA training grants to research grants. From 1979 to 2006 the share of non-federal institutions are highly prized and competitively sought. They funding for postdoctoral positions had been almost constant bring prestige to institutions that have them, and they add at about 25 percent but increased to 35 percent in 2008. stability to graduate programs, because they are usually for Over the past 25 years, research grants awarded by the 5 years and allow for future planning. In addition they have NIH and other Health and Human Services agencies have been immensely potent forces stimulating the development more than doubled.11 With the increase in the amount of of creative approaches to graduate education and providing laboratory work required to meet the aims of these grants, focus on the need to apply evaluations of post-graduation principal investigators have come to depend increasingly outcomes in assessing the success of the programs. In addi - on graduate students and postdoctoral fellows: the trainees tion, they have been a strong motivator in the quest to diver- have in essence become the academic research workforce. sify the biomedical workforce, and nowhere has this been As a result, the number of universities awarding Ph.D.s in more successful than in those schools aggressively compet- the basic biomedical sciences, and the number of Ph.D.s ing for training grant support. On the other hand, only U.S. awarded by existing programs, has grown. Thus, federal citizens and permanent residents now qualify for support funding policies provided universities an incentive to appoint under NRSA training grants and fellowships, and because students and postdoctoral fellows to research assistantships a growing number of graduate students and fellows with in addition to training grants or fellowships. Indeed, there is temporary resident status make up the research workforce, a cost-benefit to the university and to the federal sponsor to these temporary residents have necessarily been supported support students on research grants because the indirect cost by research grants. rate for institutional training grants is capped arbitrarily at Another factor in the shifting patterns of federal research 8 percent, far below the significantly higher negotiated rates training support is the type of education that students receive. on research grants, and below the administrative and facili- From their inception, NRSA predoctoral training grants in ties costs incurred by the institutions that could justifiably the basic biomedical sciences have been multidisciplinary— be allocable to “training.” However, this is likely not the emphasizing the importance of having students exposed to driver in this case. a wide range of fields and technologies in the biomedical Rather, as mentioned above, the growth in training sup- sciences, and even to fields in other branches of science. port from research grants reflects the fact that graduate At a time when many of the frontiers of science demand students and postdoctoral fellows are the backbone of the multidisciplinary and interdisciplinary research capabilities biomedical research workforce, and the increase in student to produce significant advances, this requirement becomes trainees/workers simply reflected the additional research that ever more pressing. Although the amount and quality of can be performed with the additional federal support. The multidisciplinary training may vary from program to pro- large increase in the fraction of the postdoctoral workforce gram, students in programs supported by training grants that is supported by RPGs brings to the forefront the need to might arguably have a better and more complete educational ensure that all postdoctorates, no matter how funded, should experience than those on a research assistantship. benefit from the expected enrichments offered to postdoctor- Given the fact that more than half of the graduate student ates by the NRSA training programs. and postdoctoral fellow training is not funded by the NRSA As described in Chapter 1, the number of graduate students mechanism, it is legitimate to ask if the training that these and postdoctoral fellows who have been provided research individuals receive is preparing them optimally for their training through NRSA training grants and fellowships has future roles in the biomedical workforce. The majority of been deliberately limited over most of the past 25 years with graduate students in the biomedical sciences who receive the (utterly unrealistic) goal of controlling the number of their funding support as RAs are situated within depart- independent researchers entering the workforce. However, if ments and as such are subject to the rules and expectations that was really the goal, it has been singularly unsuccessful. of their graduate schools and departmental programs. In As Massy and Goldman concluded in their 1995 analysis of science and engineering Ph.D. production (and as one Massy, W.F., and C.A. Goldman. 1995. The Production and Utilization 12 of Science and Engineering Doctorates in the United States. Stanford Insti- Unpublished tabulation from the NIH IMPAC System. tute for Higher Education Research Discussion Paper. Stanford, CA. 11

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 BASIC BIOMEDICAL SCIENCES this sense, the expectations for their overall performance scientists really should not be in “training” programs as they are not radically different from those of students supported were admitted on the assurance that they are fully trained! by NRSAs. Although the training may be less interdisci- Adding to the confusion in terms of pay and benefits for plinary and may lack the same emphasis on exposure to postdoctorates is the federal mandate that NRSA recipients Responsible Conduct of Research (RCR), career planning, are stipendiary, and because they are not categorized as and quantization in science, we may nonetheless expect that employees, they do not pay the Federal Insurance Contribu- these programs should be comparable academically to the tions Act (FICA) tax and do not receive employee benefits, NIH-funded programs. such as health insurance and contributions to retirement It is not so immediately apparent that these same con- funds. Many institutions have successfully attempted to clusions necessarily apply to the postdoctorate workforce. address this situation by providing separately negotiated Postdoctoral fellows are recruited to individual labs and are medical insurance, but the retirement benefits usually have rarely involved in a highly structured program comparable to to be secured independently by using the savings from not the graduate education model. For well-trained individuals, paying FICA to cover the cost of a personal investment this is an opportunity to broaden their experience and develop mechanism. Postdoctorates who are not supported by NRSA their independence and can be a valuable component of their are treated as employees, but, depending on the institution, professional development. Nonetheless, as was indicated in they may be offered full or sometimes, restricted employee Table 3-14, a significant number of U.S. national postdoctoral benefits. Following prompting by the NRC report Trends fellows are trained as fellows or on training grants, each with in the Early Careers of Life Scientists, many institutions explicit NIH-mandated components (such as diversity and have moved to provide employee postdoctorates with health exposure to multidisciplinary research and RCR). However, benefits comparable to those provided to the rest of their the pool of postdoctoral fellows who are the most responsive employees. However, there remains the paradox of postdoc- to rapid deployment of recently received research funds is the torates who perform similar tasks but who are remunerated in international pool—a group that now makes up the majority different fashions depending upon their NRSA status. Faced of the postdoctorate component of the workforce. There is with the difficulty of turning NRSA trainees into employees, a need to ensure that the programs in which these trainees some institutions have paid such trainees an additional, find themselves are adequately developed, indeed that there nominal salary, which can give them access to employee is a training component, and to ensure that the caliber of health plans, while others have converted all the postdoc- work is high, that the expectations of the NIH are met, and torates into a common classification as trainees. However, that the interests of the international postdoctoral fellows in order to satisfy IRS rules these fellows must receive a themselves for training in RCR, quantitation, and career formal education component for which they pay tuition cost. planning are met. Also, given the H1-B issue referred to above, this may be an increasingly complicated and perhaps even questionable strategy. Obviously, different institutions have attempted to PoStdoCtoral remuNeratioN aNd BeNefitS develop individual strategies best fitted to their own cultures. A discussion of postdoctoral education would be incom - Possibly the best solution is to combine an excellent health plete without a discussion of the byzantine ways that uni - insurance scheme for all postdoctorates (which is eminently versities have been compelled to categorize and appoint doable) with transparent explanations of the different finan- postdoctorates by the stipendiary nature of the NRSA. At cial circumstances which, while different for the different any one time an institution will likely have the following categories, ultimately end up with all the postdoctorates in a types of postdoctorate, all of whom might be doing compa- more or less similar financial position. rable research and being exposed to similar enrichment and other appropriate training activities. There are U.S. national Career outComeS for graduate StudeNtS postdoctorate trainees who are not supported by an NRSA aNd PoStdoCtoral felloWS and international postdoctorates on J-1 visas who cannot be supported by an NRSA, and both groups are treated (or As was mentioned earlier in the chapter, graduate students should be) as postdoctorate employees in training. Finally, and postdoctoral fellows have traditionally tended to seek since 1990 there has been an increasing number of H1-B careers in academic or industrial research. This paradigm employees, who are usually also classified as postdoctorates. has been changing over the past decade, and the current These international scientists are allowed into the United turmoil in the economy will likely additionally affect career States in response to a defined shortage of workers in high- outcomes for our trainee workforce. The factors of concern tech fields. As such they are admitted because institutions are: (1) the economic distress has hit both industry and aca- assure the Departments of Labor and Homeland Security demia hard, and it is likely that these sectors will not increase that they are already trained and that they will fulfill a work- their rates of hiring in the near term; indeed some downsizing force need not satisfied by the current pool of U.S.-trained seems almost unavoidable, and (2) the downturn in the world workers. However, the reality is that these international economy has had less severe impact on several Asian coun-

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0 RESEARCH TRAINING IN THE BIOMEDICAL, BEHAVIORAL, AND CLINICAL RESEARCH SCIENCES Recommendation 3–2: Peer reviewers in evaluating train- tries that are rapidly diversifying and making major purpose- ing grant applications, especially competing renewals, ful investments in science and in new technologies as a high should be instructed to broaden their concept of “success- national priority. Indeed their investments in education and ful” training outcomes to recognize nontraditional in research and technological infrastructure may soon exceed outcomes that meet important national priorities and our own, and as the major recession continues, the difference needs related to the biomedical, behavioral, and clinical in investment may only increase. It is thus not inconceivable sciences. that the influx of foreign postdoctorates may well slow, and the effect could be severe as we have come increasingly to Recommendation 3–3: One highly needed and extremely depend on this source of fellows to “titrate” our research valuable outcome would be for graduates of the bio- workforce needs in response to changes in R01 funding. In medical training workforce to become involved in a addition, because of the economic distress, faculty at the career teaching K-12, and especially middle and high end of their careers are resisting retirement because their school science. The NIH and the Department of Educa- 401(k) funds were depleted at the same time that university tion should work to provide incentives to attract trainees capacity to create new faculty slots was sharply diminished. to careers in K-12 science and should lead a national All of these factors add up to bleaker prospects for those of effort to accelerate the processes of “teaching accredita- our trainee workforce who are ready to enter the traditional tion” that the committee recognizes is controlled by the job market. individual states. A crisis can oftentimes provide an opportunity for cre- ative, new, and unexpected solutions. The review commit- Recommendation 3–4: The size of the MSTPs should be tee felt very strongly that postdoctorates must be provided expanded by at least 20 percent, and more if financially opportunities to learn about other, less traditional career feasible. options. Prominent among these is K-12 science educa- tion, generally agreed to be in a sorry state in this country. Accordingly, the NIH and other federal agencies, including Currently there are 911 MSTP slots at an average cost of the Department of Education, should devise mechanisms $41,806 per slot. An increase by 20 percent to about 1,100 that enable senior postdoctorates to meet requirements to slots would increase the MSTP budget by about $7.6 million gain accreditation in teaching and should develop incen- or 1 percent of the NRSA budget. If phased in over time, the tives (e.g., educational loans forgiveness) to encourage these impact would be less. trainees to enter high school science teaching. These trainees Recommendation 3–5: The M.D./Ph.D. MSTP should be are highly knowledgeable, well trained, and possess unusual encouraged to include basic behavioral and social sci- capabilities unlikely to be found in individuals with B.S. ences training relevant to biomedical research, including or M.S. degrees. Not only might this provide an attractive the neurosciences. option to some in the trainee workforce, but it could also begin to address a major problem in our educational system Recommendation 3–6: MSTPs should be encouraged to that threatens the future scientific prowess and economic intensify their efforts to identify and recruit qualified competitiveness of our country. nontraditional, underrepresented groups (women and minorities). These efforts should be documented, and reCommeNdatioNS they should be a factor in the evaluation of all requests for MSTP funding increases and be conditions for receipt In the light of this discussion we propose the following of any MSTP funding increases. Success depends on recommendations: having a critical mass (not isolated examples) of under- Recommendation 3–1: The total number of NRSA posi- represented trainees in any given MSTP. tions in the biomedical sciences should remain at least at the fiscal year 2008 level. Furthermore, we recommend Recommendation 3–7: All institutes are encouraged to that future adjustments be closely linked to the total make F30 fellowships accessible to qualified M.D./Ph.D. extramural research funding in the biomedical, clinical, students. and behavioral sciences. In recommending this link- age, the committee realizes that a decline in extramural research would also call for a decline in training.