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3 The Radiobiology Workforce This chapter examines the available information about the supply of and demand for radiobiology researchers—a part of the fourth element of the committee’s statement of task. It identifies the wide range of scientists who study radiation health and biology and summarizes the available studies of workforce issues, including data from professional associations in the field. The chapter also notes other efforts to foster training and development of investigators. THE COMMITTEE’S APPROACH The committee encountered several challenges in gathering data to support its evaluation of the supply of and demand for radiobiology researchers, difficulties that have also complicated the analysis of workforce issues in related fields like radiochemistry (NRC, 2012). Notably, “radiobiology” is not among the Bureau of Labor Statistics’ (BLS) Standard Occupational Classification categories and—as a result—BLS does not gather information on employment or make projections regarding it. Further, while educational institutions grant graduate degrees in radiobiology and radiation biology, not everyone who conducts research in the field holds a degree with that name, and not everyone who earns such a degree conducts radiobiology research, complicating the evaluation of supply. And finally, a number of foreign institutions— for which no data are available—grant radiobiology degrees and these some graduates practice in the United States. For these reasons, it was not feasible to conduct a quantitative analysis with any certainty. The committee thus took a broad-based approach to assembling information, including qualitative information. As detailed below, it reviewed material on education, and on workforce supply and demand in related fields; requested and summarized data from professional societies whose members address radiation health issues; searched funding databases for radiation health- and biology-related research opportunities, and examined the available journal and grey literature on the topic. The committee also solicited opinions from prominent professionals in the field and consulted stakeholders concerned with these issues. Additional detail on these issues is provided in the remaining sections of the chapter. RADIOBIOLOGY AS A FIELD OF STUDY Radiobiology, the study of the effects of ionizing radiation on living things, is a diverse field that addresses basic research, medicine, public health, and national security needs. Ionizing PREPUBLICATION COPY: UNCORRECTED PROOFS 3-1

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3-2 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI radiation is found in many environments and used in various ways; as a result, the people who study or apply radiobiology come from a variety of disciplines. Physicians and other health professionals use ionizing radiation for procedures such as diagnostic imaging, accurate placement of medical devices, and therapeutic purposes such as killing cancerous cells. In the nuclear power industry, health physicists and radiological engineers are responsible for preventing and detecting accidental releases that might expose employees or the surrounding communities. Workers who may be exposed occupationally when mining radioactive ores or when manufacturing, repairing, or operating equipment that uses ionizing radiation are monitored by industrial hygienists and other occupational health specialists. Radon, a gas formed naturally from the decay of radioactive elements found in the environment, is a source of concern for public health professionals. Basic research scientists investigate the genetic, molecular, immunological, cancer, cardiovascular, ophthalmologic, and other effects of radiation on a variety of animal models, tissues, and cells. Epidemiologists and biostatisticians are now using biomarker and other information generated by radiobiology research to identify and distinguish populations for study. Military health, science, and command personnel need to control or manage the effects of ionizing radiation emitted by nuclear weapons, depleted uranium munitions, certain monitoring and detection devices, and the nuclear power sources used in submarines and aircraft carriers. Given that these applications typically require different areas of expertise, the educational backgrounds of these professionals are also diverse. Radiobiology is taught through dedicated academic programs but also through specialized tracks in other fields (for example, nuclear engineering and health physics programs). This diversity of disciplines and specializations is evidenced in graduate training programs that make primary use of faculty in several departments and with several different areas of expertise, such as biology, engineering, medicine, or physics. In addition to Ph.D. scientists who traditionally conduct research, physician–scientists who have earned an M.D. or an M.D./Ph.D. and completed appropriate postdoctoral research training may also conduct independent research. Also, individuals who pursue a Ph.D. often have earned their bachelor’s and master’s degrees in fields akin to but outside of radiobiology. The task of assessing the supply of and demand for researchers in radiobiology as well as the adequacy of current research training efforts necessitates recognition of this diversity. Accordingly, the committee adopted an expansive working definition of radiobiology and examined literature from related fields when appropriate. Although personnel in radiobiology are engaged in a variety of roles, including clinical care, radiation-exposure monitoring, radiation protection, and teaching, the committee was charged to focus on researchers. Because a research or professional doctorate-level education1 typically requires the conduct of scientific investigations, this chapter targets the subset of people with such training and the academic programs that educate them. Individuals and training programs primarily involved in applied roles such as nuclear medicine technology and radiation therapy were not included. 1 Ph.D. and Sc.D. are typical doctoral-level research degrees; M.D. is a typical doctoral-level professional degree. PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Radiobiology Workforce 3-3 STUDIES OF THE RADIATION HEALTH AND BIOLOGY RESEARCH WORKFORCE During the last decade, increasing attention has been paid to issues related to the radiation health and biology workforce. The Health Physics Society (HPS)2 has repeatedly examined the radiation workforce in the energy, health, and security sectors (HPS, 2005, 2008; Nelson, 2004; ORISE, 2009). Taking into account all degree levels and roles, the HPS produced what was described as a conservative estimate of approximately 6,700 radiation-protection professionals working in the United States as of 2004. On the basis of a 55% decline in the number of bachelor’s, master’s, and Ph.D. degrees, as well as a drop from 20 to 7 in the number of health physics programs graduating at least five students annually between 1995 and 2002, the HPS expressed concern over whether the pipeline in health physics could actually replenish the pool of radiation professionals in the future. Its conclusion was, “[T]he critical human capital shortage in radiation safety is overwhelming the Society’s efforts to help respond to this crisis.” A report published by ORISE in 2009 on workforce trends for health physicists through 2012 reiterated this concern. It stated, “[I]t is highly likely that the number of job openings for new graduate health physicists will continue to exceed the number of new graduates available in the labor supply through 2012” (ORISE, 2009, p. 5). A 2013 update stated that the number of graduate enrollments in health physics programs was the lowest reported since the early 1970s and anticipated that there would be decreases in master’s and doctoral degree recipients in 2014 and 2015 (ORISE, 2014). A survey by Rosenstein and colleagues (2009) of faculty members employed in radiation biology in U.S. and Canadian residency programs revealed similar concerns over the declining numbers of radiobiologists in this sector. Those data showed both that the faculty members who are responsible for teaching radiation biology to radiation-oncology residents are aging (average age, ∼58 years) and that faculty members whose degree is in radiation biology are scarce. Consequently, the investigators concluded, “[T]he declining numbers of radiobiologists has the potential to threaten the quality of the didactic radiation biology education that radiation oncology residents receive and could also affect research mentoring for residents” (Rosenstein et al., 2009, p. 904). This also has implications for the radiobiology research workforce— particularly the pool of physician–scientists involved in clinical and translational research related to radiation oncology. Stating that “[c]urrent and potential shortfalls in the number of radiation scientists stand in sharp contrast to the emerging scientific opportunities and the need for new knowledge to address issues of cancer survivorship and radiological and nuclear terrorism,” the Radiation Research Program (RRP), the National Cancer Institute (NCI), and the National Institute of Allergy and Infectious Diseases (NIAID) held a workshop in 2003 titled “Education and Training for Radiation Scientists” (Coleman et al., 2003). Several recommendations resulted from this effort, two of which specifically addressed the Armed Forces Radiobiology Research Institute (AFRRI). One of those called for the Institute to continue its coordination with other federal agencies engaged in radiation research and biodefense, and the other advised that AFRRI, in collaboration with other agencies and institutions, “[a]ccelerate plans to develop an 2 HPS is an independent nonprofit scientific organization of professionals who specialize in radiation safety. It comprises ~5,000 members (HPS, 2013). PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-4 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI educational program in radiation sciences within the Uniformed Services University for Health Sciences (USUHS) in collaboration with neighboring regional programs” (Coleman et al., 2003, p. 735). Wogman and colleagues (2005) addressed issues related to the workforce of nuclear scientists and engineers, including those conducting radiobiology research, at the Pacific Northwest National Laboratory (PNNL) of the Department of Energy (DOE). Their assessment noted that the United States is facing serious attrition of nuclear scientists and engineers and their capabilities through the effects of aging. On the basis of the number of personnel eligible to retire by 2010, the investigators estimated that a significant loss of senior nuclear science and technology staff at PNNL would occur by 2015 and concluded that the maintenance and replenishment of the human capital needed to support PNNL nuclear science and technology programs were key issues that required immediate attention. In 2012, Vichare and colleagues (2013) surveyed all members of eight specialty societies to examine the characteristics of currently practicing radiation oncology professionals. In contrast to Wogman and colleagues, these investigators found that respondents3 believed that the overall supply of and demand for the radiation workforce in that field was balanced but that there was a perception of an oversupply of professionals in certain disciplines, including medical physicists (Vichare et al., 2013). However, the meaningfulness of those conclusions is ambiguous, given that only 19% of those surveyed completed the questionnaire and that the assessment of undersupply or oversupply was derived from respondents’ self-perceptions, which may be based more on their own experiences than on objective data on the workforce across all employment sectors. In July 2013, the National Council on Radiation Protection and Measurements (NCRP)— a congressionally chartered private corporation (Public Law 88-376) charged with advising the U.S. government on radiation-protection issues—hosted a workshop titled, “Where Are the Radiation Professionals? (WARP).” The workshop was attended by representatives from federal and governmental agencies, universities, professional societies, and the private sector. Partly on the basis of reports from the National Academy of Sciences (NAS) Committee on the Assessment of and Outlook for Nuclear Physics (2013) and the American Physical Society (APS, 2008), participants concluded that the human capital crisis (in radiation sciences) continues to deepen. They identified four basic needs and recommendations for action (Pryor, 2013): • Collect data on an ongoing basis to monitor current and future supply and demand. • Improve coordination between the government, academic, and private sectors to ensure national capability to manage radiological incidents and maintain the radiation sciences enterprise. • Continue federal support of academic education programs and basic research in radiobiology, medical countermeasures, improved detection capability, and nuclear forensics. • Cultivate radiation professionals who can develop the new science required for the future, ensure the safe use of radiation for the health and welfare of the U.S. population, and respond to radiological incidents. 3 About 15% of the 35,204 the surveys distributed yielded responses that could be analyzed PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Radiobiology Workforce 3-5 A working committee formed as part of this effort was charged with gathering additional information and developing a position statement on workforce issues. The April 2014 edition of the Health Physics Society’s Health Physics News contained an update on this effort. Among the observations offered were that a coordinated, broad-based, and comprehensive effort should be undertaken to address the dwindling number of radiation professionals, that “continued data gathering to monitor supply and demand is needed” and that “increased federal support of academic education programs and basic research in radiobiology, medical countermeasures, improved detection capability, and nuclear forensics is essential” (Boice, 2014). In summary, the radiation health and biology workforce has gained repeated attention from researchers and professional societies, most of whom have concluded that that workforce may soon be inadequate to meet the multiple roles it occupies in the academic, medical, energy, and defense sectors. Anecdotally, Dr. Tom K. Hei, a former president of the Radiation Research Society (RRS)4, expressed the belief that demand for research professionals will outstrip supply because of the growing need for research on radiation and the dearth of graduate training programs to train future independent investigators (Hei, 2013). Others have noted that attrition in the existing workforce will exacerbate shortfalls in the number of new professionals entering the field. Specific information on the subset of professionals who pursue research careers is lacking. CHARACTERISTICS OF THE RADIATION HEALTH AND BIOLOGY RESEARCH WORKFORCE To better understand the characteristics of the radiation health and biology research workforce, the committee solicited input from three professional associations: the HPS, the American Association of Physicians in Medicine (AAPM)5, and the RRS. The HPS requests employment information both when an applicant joins and when a member renews membership. Table 3-1 presents data suggesting that about 4% (261 individuals) of HPS members are involved in “research” or “radiation biology,” even though the organization primarily attracts radiation-safety and radiation-protection practitioners. In contrast, RRS members span several scientific disciplines and are more explicitly focused on research; the proportions of its members with ties to radiobiology-related fields are much greater: biology, 43%; medicine, 25%; physics or biophysics, 16%; chemistry, 5%; and multidisciplinary, 11% (Cucinotta, 2013). 4 The RRS is a professional society whose objectives are to encourage advancement of radiation research in all areas of the natural sciences; to facilitate cooperative research between the disciplines of physics, chemistry, biology, and medicine in the study of the properties and effects of radiation; and to promote dissemination of knowledge. The RRS numbers approximately 1,600 members (RRS, 2013) 5 The AAPM describes itself as “a scientific and professional organization, founded in 1958, composed of more than 8,000 scientists whose clinical practice is dedicated to ensuring accuracy, safety, and quality in the use of radiation in medical procedures such as medical imaging and radiation therapy”(AAPM, 2013) PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-6 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI TABLE 3-1 HPS Members Reported Employment Specialties in 2012 Number of Number of Employment Specialty Members Employment Specialty Members Not identified 1,702 Instrumentation 200 Applied health physics 844 Nuclear medicine 199 Radiation safety/survey 766 Research 164 Radiological assessment 450 Other 119 Medical physics 439 Accelerators 104 Regulations/standards 398 Nuclear fuel cycle 100 Dosimetry 355 Radiochemistry 98 Reactors, power 311 Radiation biology 97 Environmental monitoring 299 Personnel monitoring 75 Waste management 263 Nonionizing radiation 60 Administration 237 Reactors, other 46 Education 208 SOURCE: Hamrick, 2013. One difficulty in interpreting such data is the large percentage of missing responses: about half of the HPS members did not identify a specialty, which raises the possibility of response bias if the nonresponders are distributed differently across the various specialties. Another difficulty is that many radiobiology and health physics researchers may not be members of the HPS, given that its focus is on radiation-protection professionals. If this is the case, then these data may not accurately represent the workforce in radiobiology research. EDUCATION AND TRAINING OF THE RADIATION HEALTH AND BIOLOGY RESEARCH WORKFORCE As already noted, radiobiology research typically requires a doctoral degree. Examining the literature on the number of doctoral degrees awarded in radiobiology and related disciplines may thus provide some insight on the supply of future investigators, although not all individuals with such credentials will participate in radiation health and biology research. Information on master’s degrees is also included because such degrees may be awarded during the pursuit of a Ph.D. The two traditional sources on Ph.D. and research-based degrees—the National Center of Education Statistics (NCES) and the Survey of Earned Doctorates (SED)—have only recently reported relevant data on earned degrees. NCES began collecting information on health and medical physics and radiobiology in 2003, and the SED first incorporated a separate code for health and medical physics and radiological sciences in 2010. The NCES Digest of Education Statistics draws information from various sources, including surveys of degree-granting institutions (NCES, 2013a; NSF, 2014). PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Radiobiology Workforce 3-7 In contrast, the SED6 annually collects information from individuals receiving research doctoral degrees from all accredited U.S. institutions. Every person receiving a doctoral degree is asked to participate, and many institutions require completion of the questionnaire before the degree is awarded. A doctoral degree7 is described as follows: “(1) Requires the completion of an original intellectual contribution in the form of a dissertation or an equivalent culminating project (e.g., musical composition) and (2) Is not primarily intended as a degree for the practice of a profession” (NSF, 2014). These data, however, have limited ability to estimate the flow of new investigators into the radiobiology workforce. First, they pertain only to degrees awarded by U.S. universities; however, many radiobiology researchers have been trained by institutions outside of the United States. Second, these data may include foreign citizens who may or may not remain and work in the United States after their graduation. For example, 28% of the doctoral degrees awarded in medical physics or radiological science in 2011 were to holders of temporary visas (NSF, 2013a). Data on M.D.s trained in radiobiology research are also not readily available. Consequently, although this information gives one indication of the supply of potential future researchers, it should be interpreted with caution. Table 3-2 shows the total number of master’s and doctoral degrees awarded in “health or medical physics” and “radiation biology or radiobiology” from 2003 through 2012, according to NCES8. SED data on doctoral degrees in “medical physics or radiological science” from 2010 through 2012 are also displayed9. The combined number of doctoral degrees awarded for health or medical physics and radiation biology or biology awarded each year as reported by the NCES is small, ranging from 5 in 2005 to 59 in 2012. In all, the NCES reported a total of 171 doctoral degrees—104 in health or medical physics and 67 in radiation biology or radiobiology— granted from 2003 through 2012 (NCES, 2005a, 2005b, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013b)10. However, the total number of doctoral degrees for medical physics or radiological science as assessed by the SED for a much shorter period (2010–2012) is much higher: 61 in 2010; 74 in 2011; and 81 in 2012—a total of 216 degrees awarded over 3 years (NSF, 2013b, 2013c, 2013d). The reasons for this disparity are not clear. For example, they could be a methodological artifact resulting from institutions’ reporting on degree fields (the NCES surveys) versus individuals’ choosing what their degree field was (the SED surveys). Further, some degree recipients earned their Ph.D.s in disciplines other than radiobiology (e.g., physics) but chose to report the track as medical physics. In some cases, the institution may have classified their degree as physics for the NCES survey whereas the individual degree recipient may have chosen medical physics or radiologic sciences for the SED survey. 6 The SED is sponsored by the NSF, National Institutes of Health (NIH), U.S. Department of Education, U.S. Department of Agriculture, National Endowment for the Humanities, and National Aeronautics and Space Administration and conducted by the National Opinion Research Center at the University of Chicago (NSF, 2014). 7 Generally, this refers to degrees such as a Ph.D. or Sc.D.; professional degrees such as M.D. are not included in the SED (NSF, 2014). 8 NCES Classification of Instructional Programs (CIP) codes 26.0209 for Radiation Biology or Radiobiology and 51.2205 for Health or Medical Physics 9 SED code 577 for “medical physics or radiologic science.” Prior to 2010, most respondents who wrote in “medical physics” selected the “physics, other,” “biophysics,” “applied physics,” or “health sciences, other” designation (Latter, 2013). 10 In comparison, the overall number of biological and biomedical sciences doctoral degrees conferred by post- secondary institutions increased from 5,268 in 2003 to 7,935 in 2012 (NCES, 2013c). PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-8 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI The number of master’s degrees in radiation biology or radiobiology awarded over the 2003-2012 period remained relatively unchanged while the number of health or medical physics master’s degrees graduates increased. The latter result may be a consequence of the significant growth in medical physics (both diagnostic and therapy tracks) training programs in the United States. For example, the number of Ph.D. degree programs—including those that may also award master’s degrees—has expanded from 21 in 2009 to 29 in 2012 (Jackson, 2012). Although the primary purpose of medical physics training is to prepare people to perform clinical service and consultation and to help fulfill the demand for technological advances in devices used in radiation therapy and diagnostic imaging, some of that training can be applied to research questions in the field of radiobiology. TABLE 3-2 Earned degrees in health and medical physics and radiation biology or radiobiology in the United States by type of degree, 2003 through 2012. Health/ Radiation Biology/ Medical Physics/ Medical Physics Radiobiology Radiological Science Year Masters Doctorate Masters Doctorate Doctorate* 2003 28 3 17 9 2004 15 2 12 9 2005 25 1 16 4 2006 36 1 21 8 2007 51 1 20 8 2008 52 2 22 8 2009 109 16 12 4 2010 110 15 4 2 61 2011 120 12 13 7 74 2012 79 51 9 8 81 *Data are from the NSF. All other data are from the NCES. SOURCE: (NCES, 2005a, 2005b, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013); (NSF, 2013b, 2013c, 2013d). PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Radiobiology Workforce 3-9 Academic Programs Universities offer radiobiology education within schools of medicine and medical centers as residencies or specialty training for residents; degrees are also awarded through schools of engineering or life sciences. A handful of programs in the United States are dedicated to doctoral and postdoctoral training focused on researching the biological effects of radiation (Purdue University, 2013; University of Iowa, 2013; The University of Texas Health Science Center, 2013; Yale School of Medicine, 2013). However, the number of training facilities for radiological workers around the nation is decreasing, and some of the centers that trained the current leaders in the radiation research community have either been closed or are struggling (Hei, 2013). An important note is that there are also several important educational opportunities and institutions outside of the United States that contribute to the domestic supply of doctoral-level researchers. Data describing the number of persons with doctorates from foreign institutions entering the U.S. radiobiology workforce are not available, although the committee suspects it may be substantial. As Chapter 4 notes, for example, 7 of AFRRI’s 19 principal investigators received their doctorates outside of the United States (India [3], China, Italy, Germany, and Russia) (AFRRI, 2013). Radiobiology Training Programs It is difficult to quantify the availability of support for training and for training programs for those wishing to study radiobiology. A program need not have the words “radiation biology” or “radiobiology” in it in order provide education or funding and not all those who end up conducting research in radiation biology do their graduate training in that field. That said, some programs focused on training radiobiologists or improving research skills are available and a few examples of efforts that assist in investigator development follow. In addition to these, organizations provide training grants to researchers working in related areas like radiation epidemiology (NCI, undated a) and health physics (HPS, 2014), and on specific health issues like cancer that radiobiologists may study (NCI, undated b; ASTRO, 2014). NASA Space Radiation Summer School (NSRSS) Offered each summer since 2005, the NSRSS program consists of approximately 3 weeks of intensive courses primarily focused on high-LET (linear-energy-transfer) radiation, taught by National Aeronautics Space Administration (NASA) biologists and physicists. Eligible participants include graduate students, postdoctoral fellows, and faculty members. NSRSS aims to provide a pipeline of researchers to tackle the challenges of radiation exposure to humans who will travel on space exploration missions (NASA, 2014). The program is administered at the DOE’s Brookhaven National Laboratory (BNL) and is sponsored by NASA’s Space Radiation Program, BNL, and the NASA–/BNL Space Radiation Biology Program. DOE Scholars Program The DOE Scholars Program was created to engage undergraduate, graduate, and postdoctoral students in DOE programs and research to allow them to explore a career at the DOE and to better understand the DOE’s functions. The program sponsors paid internships that include opportunities for research and development of individuals with potential for DOE PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-10 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI employment. The internship lasts for approximately ten weeks. Many disciplines related to the DOE’s operations, from scientific to management, including radiation biology, are considered. The program is managed by the ORISE (DOE, 2014). MELODI (Multidisciplinary European Low-Dose Initiative) MELODI, a collaborative European research agenda on low dose-radiation risk, emphasizes the need for developing and training investigators; to accomplish this, all MELODI programs are required to have an educational or training component. DoReMi (Low-Dose Research towards Multidisciplinary Integration), the programmatic arm of MELODI, is designed to “develop an integrated support system for Education and Training both within the research effort in the other work packages, and more broadly within the low-dose radiation-risk research community as a whole” (DoReMi, 2014a). Annual education and training workshops and a series of short courses have been developed to support the continued stream of scientists dedicated to researching the effects of low-dose ionizing radiation. DoReMi also sponsors conferences and other educational events (DoReMi, 2014b). WE-Heraeus Physics School on Ionizing Radiation and the Protection of Man This 10-day seminar, funded by the WE-Heraeus Foundation and held in Bad Honnef, Germany, aims to teach and engage graduate students and postdoctoral fellows in the field of radiation protection. Lectures are given by interdisciplinary experts. Several topics are covered: basics of radiation physics, radiation biology, and statistics; basics of radioecology and radioepidemiology; natural and anthropogenic radiation exposure; radiation effects from various sources; ionizing radiation in medicine; and practical aspects of radiation protection (Helmholtz Zentrum Müchen, 2012). EVALUATING THE DEMAND FOR AND SUPPLY OF RADIOBIOLOGY RESEARCHERS Current Demand Skipperud and colleagues (2009) carried out a stakeholder needs assessment of several fields that address radiological protection and related health issues as part of a European effort to assess whether educational institutions were meeting the demand for professionals by industry, government, and research entities (Skipperud, 2011). The researchers noted that aging faculty, outdated facilities, inadequate course offerings, and lack of student interest were all contributing to a lack of scientists being trained. The authors concluded that there is a significant and constant need for post-graduates with skills in radiochemistry, radioecology, radiation dosimetry, and environmental modelling and a smaller, but still important, demand for radiobiologists and bio-modelers (Skipperud et al., 2011, p. 1013). Radiobiology needs were being driven by government and research institution stakeholders. Similarly, the supply of and demand for radiobiology researchers are affected by available research funding. For example, the size of doctoral programs may be driven primarily by departmental needs for teaching assistants and research assistants, the latter of whom are largely supported by research grants (Massy and Goldman, 1995). A search of several databases PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Radiobiology Workforce 3-11 for government contracting and sources of funding conducted by the committee in early 2013 showed a range of sponsors, research institutions, and interests involved in radiation health- and biology-related research. Those databases indicate the number of solicitations, grants, and length and topical areas, but they provide incomplete information about funding amounts and workforce requirements. However, they do indicate the contracting and grant activity, important stakeholders, and interests in the field, which are at least indirectly related to the current demand for radiobiology researchers. A compilation of this information is presented in Table 3-3. PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-12 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI TABLE 3-3 United States Sources of Funding for Radiation Health- and Biology-Related Research in Early 2013 Source / Website Topics Sponsors Research Institutions Government contracts Research on countermeasures; Biomedical Advanced Research research on Mayak Techa River, and Development Authority FBO.gov Hiroshima and Nagasaki (BARDA); NIAID; Department of cohorts; services for radiation Homeland Security monitoring (DHS);Department of Health and Human Services (HHS); DOE and NCI Government grants Fellowships, scholarships, and Defense Advanced Research other education; biodosimetry; Projects Agency (DARPA), DOE, Grants.gov study of space radiobiology; National Geospatial Intelligence food safety after a nuclear event Agency, National Research Council (NRC), NASA, and National Institute of Food and Agriculture Government-sponsored Exposure[s]: fluoroscopy, Various U.S. Government NIH Clinical Center, NCI, National Heart, Lung, clinical trials cosmic radiation, occupational agencies and Blood Institute (NHLBI), Memorial Sloan- radiation, computed Kettering Cancer Center (MSKCC), Department ClinicalTrials.gov tomographic (CT) examinations; of Veterans Affairs (VA), University of Aarhus, protective devices; radiation Aalborg University, NIOSH, Ministry of Health injury (France), Health Protection Agency (United Kingdom), Novartis Vaccines, Institut de Outcomes: cancer (lung, Radioprotection et de Surete Nucleaire, Instituto prostate, ovarian, brain, de Cardiologia do Rio Grande do Sul, Group leukemia, breast, angiosarcoma, Health Cooperative, University of California San colorectal, liposarcoma, colon, Francisco, Baptist Health South Florida, Total testicular, neuroblastoma); Cardiovascular Solutions, Centre Oscar Lambret, behavior and cognitive CINECORS – Hospital Ernesto Dornelles performance disorders; chromosomal aberrations; renal insufficiency; well-being; immune function; meningococcal meningitis; aortic valve stenosis; cataracts PREPUBLICATION COPY: UNCORRECTED PROOFS 3-12

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The Radiobiology Workforce 3-13 Source / Website Topics Sponsors Research Institutions and lens opacities; myeloid progenitor cells; coronary heart disease and vascular access complication NIH research portfolio NIH AHRQ, FIC, NCI, NEI, NHLBI, NIA, NIAID, NIAMS, NIBB, NIDCR, NIDDK, NIEHS, NIH Report NIGMS, NIMH, NIMHD, NINDS, NINR, report.nih.gov/index.aspx NIOSH, NLMOD, VA with investigator affiliations at universities, for-profit companies, hospitals, medical schools, and university hospitals; other governmental agencies Department of Defense Predoctoral and postdoctoral DoD Yale; Virginia Commonwealth University; congressionally directed training; idea development; new University of California, San Diego and San medical-research investigator and investigator- Francisco; Cornell Medical College; University of programs initiated research Arizona; Stanford cdmrp.army.mil One award to AFRRI in 2005 to study the carcinogenicity of embedded tungsten alloys in mice SOURCE: DoD, 2013; FBO.gov, 2013; HHS, 2013; NIH, 2013a, 2013b PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-14 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI Drivers of Future Demand As it is with many efforts to construct valid workforce projections, it is difficult to accurately estimate the future need for radiobiology researchers. However, certain trends in the use of radiological materials and information gaps in the science suggest that demand will continue and may increase. Those trends include increased use of radiation for diagnostic imaging, the emergence of new forms of radiation therapy, and a resurgence of interest in nuclear energy (Hei, 2013). Chapter 2, which addresses current directions in radiobiology research, identifies a number of unanswered questions about the human health effects of low-dose ionizing radiation exposures that require attention. Answers to these questions are needed to better quantify radiological risks and derive exposure guidance that can be used when making public health decisions (for example, shelter in place versus evacuation versus long-term relocation) in the wake of a release incident or accident. The Current and Future Workforce The available data are insufficient to determine whether the supply of radiobiology researchers will be adequate to satisfy demand and the information that is available is potentially complicated by a lessening of demand due to weak economic conditions and diminished support for research. Information suggests, however, that although the current supply may be meeting the demand, shortages could occur as the current workforce reaches retirement. As already noted, the DOE and its national laboratories are facing serious attrition of nuclear scientists and engineers and their capabilities through the effects of aging staff. In 2010, three quarters of the radiological professionals within the DOE laboratories were eligible to retire (Wogman et al., 2005). A 2014 U.S. Government Accountability Office report notes that this is a widespread problem in the federal civilian workforce that could produce mission-critical skill gaps if left unaddressed (GAO, 2014). Figure 3-1 illustrates age distributions for the memberships of the HPS and AAPM professional associations who chose to provide this information. These distributions are both heavily skewed toward older members: in the HPS, more than 50% are 50 or older, and more than 80% are 40 or older; in the AAPM, more than a third are 50 and older and nearly two thirds are 40 or older. Further, this characteristic is becoming more pronounced with time. In 2000, 46% of HPS members were at least 50 years old. In 2005, that proportion rose to 53% and, in 2013, to 57%. The respective declines in the 30–39-year-old group were 18% to 15% to 14% (Hamrick, 2013). However, note that because age information is only available for less than half of the HPS membership, these figures must be treated with caution. No information was available on the changes in age distribution of the AAPM members over time. Additionally, it is unknown what percentage of members engage in research and what in other activities. Data reflecting the age distribution of the RRS member were not available. PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Radiobiology Workforce 3-15 AAPM 13 26 24 20 17 HPS 3 14 27 32 24 0 10 20 30 40 50 60 70 80 90 100 % of Membership 20-29 30-39 40-49 50-59 Over 60 FIGURE 3-1 Age distribution of the members of the AAPM (2013) and the HPS (2013). NOTE: Percentages are based on available data: age was reported by about 95% of AAPM members and 41% of HPS members. The RRS does track members’ age groups. SOURCE: (Fairobent, 2013; Hamrick, 2013). Different interpretations of these age-distribution data are possible. One is that in time, there is likely to be a deficit of radiation professionals across all specialties. This interpretation is consistent with the recent decline in U.S. students’ interest in science, technology, engineering, and mathematics (STEM) curricula and the viewpoints of many federal and professional organizations (Martin, 2014). Another interpretation is that professional-society membership in general is on the decline; this trend has been experienced by many other professional societies as well (NCF, 2012; Putnam, 2000). It may thus be the case that millennial-generation radiobiology researchers, health physicists, and medical physicists are simply not joining professional societies at the rates seen in previous generations. Therefore, using society-membership demographics to assess the pipeline of future researchers could be misleading. More generally, the number of retiring society members cannot be directly linked to the number of graduating master’s and doctoral students in radiation-related disciplines because that connection assumes that graduates will become members and that individuals from other fields and educational backgrounds do not join these societies. But as described in early in this chapter, radiobiology researchers come from a variety of disciplines. Even though these data cannot describe a portion of the workforce that does not belong to professional societies and inferences are limited by available data, it is evident that the radiation health workforce is changing. This supports the sentiment of leaders in the field who note the inevitable aging of the radiology-researcher workforce and express concerns over the effects of projected retirements in the coming years (Hei, 2013). SUMMARY AND CONCLUDING COMMENTS Although it does not appear that an acute shortage of researchers in radiobiology and related disciplines exists currently, available information suggests that the number of professionals leaving the field through retirement and other means exceeds the number entering and that this trend will continue. Assuming a continuing need for radiobiology research, it is reasonable to conclude that the supply of professionals will not meet the demand in the coming years. When this committee completed its work, the NCRP was engaged in an effort to better PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-16 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI characterize the magnitude of this problem and to offer recommendations for addressing it on a national level. In Chapter 5, the committee provides recommendations for actions that AFRRI could undertake to help ensure that the military can meet its needs for radiobiology professionals. REFERENCES AAPM (American Association of Physicists in Medicine). 2013. Welcome to the AAPM website. http://www.aapm.org/default.asp (accessed December 30, 2013). AFRRI (Armed Forces Radiobiology Research Institute). 2013. Responses to questions provided by the national academy of sciences regarding the statement of work for the committee on research directions in human biological effects of low-level ionizing radiation. Bethesda, MD, July 12, 2013. American Society for Radiation Oncology. 2014. ASTRO supported grants. https://www.astro.org/Research/Funding-Opportunities/ASTRO-Supported-Grants/Index.aspx (accessed April 15, 2014). APS (American Physical Society). 2008. Readiness of the U.S. nuclear workforces for 21st century challenges. APS Panel on Public Affairs Committee on Energy and Environment: June 2008. Boice J.D. 2014. WARP—Where are the Radiation Professionals? (The boice report #23). Health Physics News Pp. 22. http://www.ncrponline.org/PDFs/BOICE-HPnews/23_WARP_Apr2014.pdf (accessed April 11, 2014). Coleman, C. N., H. B. Stone, G. A. Alexander, M. H. Barcellos-Hoff, J. S. Bedford, R. G. Bristow, J. R. Dynlacht, Z. Fuks, L. S. Gorelic, R. P. Hill, M. C. Joiner, F. F. Liu, W. H. McBride, W. G. McKenna, S. N. Powell, M. E. C. Robbins, S. Rockwell, P. B. Schiff, E. G. Shaw, D. W. Siemann, E. L. Travis, P. E. Wallner, R. S. L. Wong, and E. M. Zeman. 2003. Education and training for radiation scientists: Radiation Research Program and American Society of Therapeutic Radiology and Oncology Workshop, Bethesda, MD, May 12-14, 2003. Radiation Research 160(6):729-737. Cucinotta, F. A. 2013. Personal communication, responses to request posed by the Institute of Medicine Committee on Research Directions in Human Biological Effects of Low-Level Ionizing Radiation to the Radiation Research Society by Francis A. Cucinotta, President of the Radiation Research Society. Las Vegas, NV, November 26, 2013. DoD (Department of Defense). 2013. CDMRP (Congressionally Directed Medical Research Programs). http://cdmrp.army.mil (accessed March 19, 2013). DOE (Department of Energy). 2014. DOE Scholar Programs. http://orise.orau.gov/doescholars (accessed January 14, 2014). DoReMi (Low-Dose Research Towards Multidisciplinary Integration). 2014a. WP3 News. http://www.doremi-noe.net/pdf/WP3_news/WP3_News.pdf (accessed January 14, 2014). DoReMi. 2014b. Training and Education. http://www.doremi-noe.net/training_and_education.html (accessed January 14, 2014). Fairobent, L. 2013. Personal communication, responses to questions posed by the Institute of Medicine Committee on Research Directions in Human Biological Effects of Low Level Ionizing Radiation to the Center for American Association of Physicists in Medicine by Lynne A. Fairobent, Manager of Legislative and Regulatory Affairs of AAPM, November 21, 2013. PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Radiobiology Workforce 3-17 FBO.gov (Federal Business Opportunities). 2013. FedBizOps.gov:Homepage. http://www.fbo.gov (accessed January 28, 2013). GAO (U.S. Government Accountability Office). 2014. Federal workforce – Recent trends in federal civilian employment and compensation. Publication No. GAO-14-215. Washington, DC: GAO. Hamrick, B. 2013. Personal communication, responses to questions posed by the Institute of Medicine Committee on Research Directions in Human Biological Effects of Low-Level Ionizing Radiation to the Health Physics Society by Barbara Hamrick, JD, CHP. Irvine, CA, November 15, 2013. Hei, T. K. 2013. Personal communication, responses to questions posed by the Institute of Medicine Committee on Research Directions in Human Biological Effects of Low-Level Ionizing Radiation to the Radiation Research Society by Tom K. Hei, Associate Director for the Center for Radiological Research, NY, September 22, 2013. Helmholtz Zentrum Müchen. 2012. WE-Heraeus Physics School on “Ionizing radiation and protection of man”. http://iss-kurse.helmholtz-muenchen.de/heraeus-school/index.php (accessed January 14, 2014). HHS (U.S. Department of Health and Human Services). 2013. Grants.gov: Home. http://www.grants.gov (accessed February 19, 2013). HPS (Health Physics Society). 2005. Human Capital Crisis in Radiation Safety: Position Statement of the Health Physics Society. http://hps.org/documents/HumanCapitalCrisis05.pdf (accessed December 30, 2013). HPS. 2008. Human Capital Crisis in Radiation Safety: Position Statement of the Health Physics Society. http://hps.org/documents/humancapital_ps015-2.pdf (accessed December 30, 2013). HPS. 2013. About the Health Physics Society. http://hps.org/aboutthesociety (accessed December 30, 2013). HPS. 2014. Scholarships and Grants. http://hps.org/students/scholarships.html (accessed April 15, 2014). Jackson, E. 2012. Preliminary report: CAMPEP/SDAMPP Graduate Program Survey results, E. Jackson, Ph.D., Chair, SDAMPP Outcome and Statistics Committee (2012). http://www.sdampp.org/documents/Graduate_Program_Survey_2011_Final.pdf (accessed March 5, 2014). Latter, M. A. 2013. Personal communication, Mary Ann Latter, Project Director for the Survey of Earned Doctorates, to Cary Haver, March 19, 2013. Martin, J. 2014. STEM interest declining among teens. CBS News. http://www.cbsnews.com/news/stem- interest-declining-among-teens (accessed January 14, 2014). Massy, W. F., and C. A. Goldman. 1995. The Production and utilization of science and engineering doctorates in the United States. Stanford Institute for Higher Education Research discussion paper, Stanford, CA. NASA (National Aeronautics and Space Administration). 2014. NASA Space Radiation Summer School at the Brookhaven National Laboratory. http://spaceradiation.usra.edu/nsrss/ (accessed January 14, 2014). NCI (National Cancer Institute). Undated a. Research training opportunities in radiation epidemiology. Division of Cancer Epidemiology and Genetics. http://dceg.cancer.gov/fellowship-training/research- training-opportunities/reb-training (accessed April 15, 2014). NCI. Undated b. Training cancer researchers for the 21st century. The Center for Cancer Training. http://www.cancer.gov/researchandfunding/cancertraining (accessed April 15, 2014). PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-18 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI NCES (National Center for Education Statistics). 2013. Appendix A.2. Integrated Postsecondary Education Data System. Institute of Education Sciences. http://nces.ed.gov/programs/digest/d12/app_a2_11.asp (accessed January 31, 2014). NCES. 2005a. Digest of Education Statistics 2004: Table 253. Bachelor’s, Master’s, and Doctor’s Degrees Conferred by Degree-Granting Institutions, by Sex of Student and Field of Study: 2002-03 http://nces.ed.gov/programs/digest/d04/tables/dt04_253.asp (accessed February 3, 2014). NCES. 2005b. Digest of education statistics 2005: Table 252. Bachelor’s, Master’s, and Doctor’s degrees conferred by degree-granting institutions, by sex of student and field of study: 2003-04 http://nces.ed.gov/programs/digest/d05/tables/dt05_252.asp (accessed February 3, 2014). NCES. 2006. Digest of education statistics 2006: Table 258. Bachelor’s, Master’s, and Doctor’s degrees conferred by degree-granting institutions, by sex of student and field of study: 2004-05 http://nces.ed.gov/programs/digest/d06/tables/dt06_258.asp (accessed February 3, 2014). NCES. 2007. Digest of education statistics 2007: Table 265. Bachelor’s, Master’s, and Doctor’s degrees conferred by degree-granting institutions, by sex of student and field of study: 2005-06. http://nces.ed.gov/programs/digest/d07/tables/dt07_265.asp (accessed February 3, 2014). NCES. 2008. Digest of education statistics 2008: Table 275. Bachelor’s, Master’s, and Doctor’s degrees conferred by degree-granting institutions, by sex of student and discipline division: 2006-07. http://nces.ed.gov/programs/digest/d08/tables/dt08_275.asp (accessed February 3, 2014). NCES. 2009. Digest of education statistics 2009: Table 275. Bachelor’s, Master’s, and doctor’s degrees conferred by degree-granting institutions, by sex of student and discipline division: 2007-08. http://nces.ed.gov/programs/digest/d09/tables/dt09_275.asp (accessed February 3, 2014). NCES. 2010. Digest of education statistics 2010: Table 286. Bachelor’s, Master’s, and Doctor’s degrees conferred by degree-granting institutions, by sex of student and discipline division: 2008-09. http://nces.ed.gov/programs/digest/d10/tables/dt10_286.asp (accessed February 3, 2014). NCES. 2011. Digest of education statistics 2011: Table 290. Bachelor’s, Master’s, and Doctor’s degrees conferred by degree-granting institutions, by sex of student and discipline division: 2009-10. http://nces.ed.gov/programs/digest/d11/tables/dt11_290.asp (accessed February 3, 2014). NCES. 2012. Digest of education statistics 2012: Table 317. Bachelor’s, Master’s, and Doctor’s degrees conferred by degree-granting institutions, by sex of student and discipline division: 2010-11. http://nces.ed.gov/programs/digest/d12/tables/dt12_317.asp (accessed February 3, 2014). NCES. 2013a. Digest of education statistics 2013: Table 318.30. Bachelor’s, Master’s, and Doctor’s degrees conferred by degree-granting institutions, by sex of student and discipline division: 2011-12. http://nces.ed.gov/programs/digest/d13/tables/dt13_318.30.asp (accessed February 3, 2014). NCES. 2013b. Digest of education statistics 2013: Table 324.10. Doctor's degrees conferred by postsecondary institutions, by field of study: Selected years, 1970-71 through 2011-12. http://nces.ed.gov/programs/digest/d13/tables/dt13_324.10.asp (accessed April 8, 2014) NCF (National Chamber Foundation). 2012. The Millennial Generation Research Review. Washington, DC: U.S. Chamber of Commerce. Nelson, K. 2004. Human capital crisis report. Health Physics News September, Pp.18-19. NIH (National Institutes of Health). 2013a. http://clinicaltrials.gov (accessed February 19, 2013). NIH. 2013b. RePORT (Research Portfolio Online Reporting Tools). http://report.nih.gov/index.aspx (accessed March 19, 2013). PREPUBLICATION COPY: UNCORRECTED PROOFS

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The Radiobiology Workforce 3-19 NRC (National Research Council). 2012. Assuring a future U.S.-Based nuclear and radiochemistry expertise. Washington, DC: National Academies Press. NSF (National Science Foundation). 2013a. Survey of Earned Doctorates: Table 22. Doctorate Recipients, by Citizenship, Race/Ethnicity, and Subfield of Study: 2011. http://www.nsf.gov/statistics/sed/2011/data_table.cfm (accessed April 2013). NSF. 2013b. Survey of Earned Doctorates: Table 16. Doctorate Recipients, by Sex and Subfield of Study: 2010. https://www.apsanet.org/media/dsp/doctorate%20recipients%20by%20sex%20and%20subfield%2020 10.pdf (accessed April 2013). NSF. 2013c. Survey of Earned Doctorates: Table 16. Doctorate recipients, by sex and subfield of study: 2011. http://www.nsf.gov/statistics/sed/2011/pdf/tab16.pdf (accessed April 2013). NSF. 2013d. Survey of Earned Doctorates: Table 16. Doctorate recipients, by sex and subfield of study: 2012. http://www.nsf.gov/statistics/sed/2012/pdf/tab16.pdf (accessed April 2013). NSF. 2014. Survey of Earned Doctorates. http://www.nsf.gov/statistics/sed/2012/survey.cfm (accessed February 3, 2014). ORISE (Oak Ridge Institute for Science and Education). 2009. Labor market trends for health physicists through 2012. http://hps.org/documents/orise_hp-labor-market-trends_1010.pdf (accessed December 30, 2013). ORISE. 2014. ORISE: Number of health physics degrees up for undergrads, down for grads. http://oakridgetoday.com/2014/04/02/orise-number-health-physics-degrees-2013-increased- undergrads-declined-grads (accessed April 3, 2014). Pryor, K. 2013. The WARP initiative: Where Are the Radiation Professionals? Health Physics News September. Purdue University. 2013. Radiation biology graduate program. http://www.healthsciences.purdue.edu/academics/graduate/radiationbiology (accessed December 2013). Putnam, R. 2000. Bowling alone: The collapse and revival of american community. NY: Simon & Schuster. Rosenstein, B. S., K. D. Held, S. Rockwell, J. P. Williams, and E. M. Zeman. 2009. American Society for Radiation Oncology (ASTRO) survey of radiation biology educators in U.S. and Canadian radiation oncology residency programs. International Journal of Radiation Oncology, Biology, Physics 75(3):896-905. RRS (Radiation Research Society). 2013. Governance General Information and Objectives. http://www.radres.org/?page=Governance (accessed December 30, 2013). Skipperud, L., B. Salbu, H. Garelick, N. Priest, C. Tamponnet, and P. Mitchell. 2009. Stakeholder Needs for Recruitment - EU ENE-II Project on MSc in Nuclear Sciences. Paper presented at Nuclear Energy for New Europe International Conference; Bled, Slovenia, September 14-17, 2009. Skipperud, L., B. Salbu, N. Priest, H. Garelick, C. Tamponnet, A. Abbott, and P. Mitchell. 2011. European MSc programs in Nuclear Sciences - To meet the need of stakeholders. Nuclear Engineering and Design 241:1013-1017. University of Iowa. 2013. Welcome to the free radical and radiation biology program at the University of Iowa. http://www.uiowa.edu/~frrbp (accessed December 13, 2013). PREPUBLICATION COPY: UNCORRECTED PROOFS

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3-20 Research on Health Effects of Low-Level Ionizing Radiation Exposure – Opportunities for AFRRI UTHSC (The University of Texas Health Science Center). 2013. The radiobiology program. http://radonc.uthscsa.edu/Divisions/radiobiology.asp (accessed December 13, 2013). Vichare, A., R. Washington, C. Patton, A. Arnone, C. Olsen, C. Y. Fung, S. Hopkins, and S. Pohar. 2013. An assessment of the current U.S. Radiation Oncology Workforce: Methodology and global results of the American Society for Radiation Oncology 2012 Workforce Study. International Journal of Radiation Oncology Biology Physics 87(5):1129-1134. Wogman, N. A., L. J. Bond, A. E. Waltar, and R. E. Leber. 2005. The nuclear education and staffing challenge: rebuilding critical skills. Journal of Radioanalytical and Nuclear Chemistry 263(1):137- 143. Yale School of Medicine. 2013. Radiobiology and radiotherapy. http://medicine.yale.edu/cancer/research/programs/radio/index.aspx (accessed December 13, 2013) PREPUBLICATION COPY: UNCORRECTED PROOFS