In addition to the recommendation on the number of NRSA positions, there are several other recommendations in this report that will require additional resources. Most call for modest increases and could be accomplished by a shifting of resources within an institute or center. Three, however, would require significant additional funds. They are listed below in priority order. In prioritizing these actions, the committee considered both their cost and their merits, along with likely future constraints on the NIH budget.
NIH should reinstitute its 2001 commitment to increase stipends at the predoctoral and postdoctoral levels for NRSA trainees. This should be done by budgeting regular, annual increases in postdoctoral stipends until the $45,000 level is reached for first-year appointments, and stipends should increase at the cost of living thereafter. Predoctoral stipends should also be increased at the same proportional rate as postdoctoral stipends and revert to cost-of-living increases once the comparison postdoctoral level reaches $45,000 (2–1).
When fully implemented, the estimated annual cost of this recommendation would be about $80 million, or 10 percent of the NRSA budget. If phased in over four years, the $20 million dollar annual increase would be about 2 percent of the NRSA training budget. This increase should not be accomplished by reducing the number of individuals supported by the NRSA program. Despite the cost, the committee thought this increase to be sufficiently important to give it the highest priority.
It has been almost 10 years since NIH endorsed the recommendation from the 2000 National Research Council (NRC) report and subsequently instituted a plan to increase the minimum postdoctoral stipend to $45,000 with proportional increases at the predoctoral level. But after a few years of implementation, there were no compensation increases, and in the past two years the increases were 1 percent. By returning to its targeted minimum, the NIH would allow NRSA stipends to be competitive and would retain the best trainees in the program. The quality of the workforce cannot be maintained without an appropriate level of support. The President also sees this as an issue, and the 2011 budget request for NIH included a 6 percent increase in stipend levels, although it was at the expense of a 1 percent decrease in the number of training slots.
The size of the Medical Science Training Program (MSTP) should be expanded by at least 20 percent, and more if financially feasible (3–4).
Currently there are 911 MSTP slots at an average cost of $41,806 per slot. An increase by 20 percent to about 1,100 slots would increase the MSTP budget by about $7.6 million, or 1 percent of the NRSA budget. If phased in over time, the impact would be less.
The MST Program has proved remarkably successful in attracting outstanding physicians into research. Although the program is expensive, we believe that a modest expansion would serve the nation well. A recommendation to increase the size of the program was made in the previous NRSA study but was not implemented. The committee also recommends, strongly, that this increase in the size of the MST program be accomplished by increasing the total number of MST programs and thereby the number of students trained, and not by expanding the size of existing MST programs. Broadening the scope of MSTP training responds to the current national commitment to improve the effectiveness, efficiency, and accessibility of health resources, while controlling costs.
NIH should consider an increase in the indirect cost rate on NRSA training grants and K awards from 8 percent to the negotiated rate currently applied to research grants. The increase in the rate could be phased in over time (2–2).
This would require a five- or six-fold increase in indirect costs, or $191 million for the NRSA program at its current size and $338 million for K awards. There was not unanimity within the committee on this recommendation because of concerns about costs and the reduction in program size that could result with a stagnant NIH budget. An increase of $529 million is significant, even in light of the reasoning to have NIH share the full cost of administrating these programs, but the committee wanted to record its support for the measure and its hope that it could be implemented at some point.
Many of the requirements and support activities centered in training grants—such as minority recruiting, education in the responsible conduct of research, and professional development—have improved the overall tenor of graduate education immensely over the past decade. However, these activities cannot be covered by the current 8 percent indirect cost allowance and therefore must rely on institutional funds. Similarly the K awards, which have served a tremendously important role in fostering the early career development of both basic and clinical researchers, utilize the same facilities as funded researchers and generate their own significant administrative costs, yet have the same 8 percent indirect cost allowance.
NIH in 2009 issued a detailed policy outlining the agency’s expectations for training in the responsible conduct of research (RCR), along with recommendations on how to establish specific curricula. The requirement of RCR training within the T32 mechanism has led to the development of curricula and educational practices that should benefit