health programs, and dual- or multiple-degree holders. These scientists play an important role in improving the capabilities and the delivery of the nation’s health care, because their research spans the spectrum from discovery to delivery to critical assessment of delivery and the functioning of the health care enterprise. Some areas of research, however, are purely clinical, such as health services, oral health, and nursing, and they will be addressed in later chapters of this report. We also address individuals who fit the expansive Graylyn definition, which embraces research in health services and in the social and behavioral sciences; these topics likewise will similarly be addressed in later chapters of this report.

With this definition in place, it has proved difficult to analyze the specific number of individuals in the clinical research workforce because current workforce databases focus on their current research areas. Therefore, the basic workforce analysis for this report will include Ph.D.s with degrees in the health fields listed in Appendix C, as well as that fraction of the M.D. population in medical school clinical departments that conduct NIH-supported clinical research, along with doctorates with a degree from a foreign institution that are in some way identified as clinical researchers. A major shortcoming of this approach is that does not capture the complete workforce, especially M.D.s who are involved in the design and oversight of clinical trials and as well as those conducting research in non-medical areas of an academic institution or in industrial laboratories.

EDUCATIONAL BACKGROUND OF THE CLINICAL RESEARCH WORKFORCE

The problems discussed in identifying those currently engaged in clinical research make it difficult to assess the educational background of clinical researchers in the same detail as is done for researchers in the biomedical and behavioral and social sciences, because such studies can only be done for those individuals who are currently participating in or have completed graduate programs that offer a Ph.D. in the clinical fields. The difficulty of such an approach to computing the overall workforce is underscored by the increasing numbers of Ph.D.s (both postdoctoral workers and faculty) from the basic biomedical sciences who are pursuing careers in clinical departments of medical schools and at major teaching hospitals. There are presently more of these Ph.D.s employed in the clinical departments than in basic sciences departments.

Many of these Ph.D.s, however, are likely to be involved in basic biomedical research, which happens to be performed in the labs of M.D. or M.D./Ph.D. scientists involved in biomedical research, albeit in a clinical department environment. At present there is no way of distinguishing between Ph.D.s conducting basic biomedical research from those involved in clinical research (see Figure 5-1).

GRADUATE STUDENTS

The following discussion draws on data from the National Science Foundation Survey of Graduate Students and Postdoctorates in Science and Engineering and records individuals who are studying in clinical departments (as defined in Appendix C). The graduate student population in these clinical departments at doctoral-granting institutions grew by 67 percent from 2000 to 2008 (see Figure 5-2). The growth in the number of graduate students is greater than that in the other broad fields in this study where the size of the graduate population has increased more slowly. It should also be noted that the robust growth is primarily reflects an increase in the number of female graduate students (see Figure 5-2). (Nursing graduate students were excluded from the data, because many of these students will not receive a doctorate, and the pool of students pursuing a doctorate is discussed in the nursing chapter.)

However, one has to be very cautious in interpreting the data of Figure 5-2. Given the fact reported below that only about 2,000 students graduated with a Ph.D. and that the best available evidence suggests that the time to degree was not much more than six years, we have to assume that 40 percent of the students listed in Figure 5-2 either quit or graduated with an M.S. degree. This is supported by the observation (see Figure 5-3) that typically 30 to 40 percent of these students were self-supporting, a circumstance more characteristic of master’s students than of those pursuing the Ph.D. The type of financial support the students in the clinical sciences receive is quite different from that in the other fields (Figure 5-3).

GRADUATE SUPPORT AND THE ROLE OF THE NRSA IN TRAINING

Figure 5-3 shows the mechanisms of support for full-time graduate students in the clinical sciences. The number of traineeships and fellowships for graduate support in the clinical sciences has held relatively constant, at about 4,000 students each year over the past decade. Support for the increased number of students has largely come from increased teaching assistantships, research assistantships, and, especially, from self funding. The sources of external support have also changed over time with NIH support growing from 10 percent in 1979 to 25 percent in 2008, and non-federal support (excluding self-support) growing from 25 percent to 60 percent over the same time period (see Figure 5-4).

NIH data for traineeships and fellowships shows a smaller number of National Research Service Awards (NRSAs) slots ranging from 823 in 2005 to 1,035 in 2008 (see Table 5-1). Like the other two broad fields in this study, support was rather constant in the 1990s. The decline in 2000 might be the result of higher stipend levels and the fixed NRSA budgets for the training programs. The difference among the numbers shown in Tables 5-1, 5-2, and Figure 5-4 is



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