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OCR for page 91
APPENDIX
A
A New Database on the
U.S. Health Services Research Work Force
Nancy Cross Dunham, Ph.D.'
BACKGROUND
Little current, definitive information exists about the size arid characteristics
of the U.S. health services research work force. This paper describes how a new
database was created for the Institute of Medicine (IOM) Committee on Health
Services Research: Training and Work Force Issues.
The last effort to gather systematic information on the health services
research work force dates back to the late 1970s when the National Research
Council (NRC) supported a survey of individuals who had received intending for
health services research or training Tom the National Center for Health Services
Research or the Alcohol, Drug Abuse and Mental Health Administration. That
study identified 1,378 health services researchers.2 A 1983 IOM report
estimated that there were between 600 and 1,650 health services researchers in
1979.3 The lower estimate was based on the membership of the Committee on
Health Services Research of the Medical Care Section of the American Public
Health Association, arid the higher estimate was based on assumptions about
growth in the group identified in 1977.
'Deputy Director, Wisconsin Network for Health Policy Research at the University
of Wisconsin-Madison. This paper has been edited by IOM committee members and
staff.
2Ebert-Flattau, P., and Perkoff, G.T. The Health Services Research Labor Force in
the United States. Medical Care 21~3~:253-265, 1983.
3Institute of Medicine. PersonnelNeeds and Trainingfor Biomedical and Behavioral
Research, Washington, D.C.: National Academy of Sciences, 1983.
91
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92 / HEALTH SERVICES RESEARCH
More recently, the membership of the Association for Health Services
Research (AHSR), now the major professional organization for the field, has
been used as a proxy to estimate trends in the supply of health services
researchers. For example, a 1993 report, commissioned by the NRC, noted that
AHSR's membership grew from 450 in 1983 to about 2,000 members in 1992.4
DATA SOURCES AND PROCEDURES
and
.
The database created for the study started with the membership files of the
AHSR (n = 2,31 1 in early 1995~. The files included addresses and, sometimes,
degree information. Not all health services researchers belong to AHSR, and
some AHSR members support the organization but are not health services
researchers.
A second major source of names was HSRProj (n = 1,213 at the end of
1994), a comprehensive database on health services research activities in the
United States developed by the Foundation for Health Services Research and the
Sheps Center for Health Services Research at the University of North Carolina
at Chapel Hill. The database is now a part of the National Library of Medicine's
system of on-line information resources. The database contains information on
health services research projects funded by the federal government and by six
major private foundations.5 Limitations of the HSRProj database include the
omission of researchers funded by smaller foundations and industry. In addition,
only the principal investigators of the funded research projects are included on
the database.
When the AHSR alla HSRProj data were combined, duplicate names were
dropped, as were listings for those who
had addresses outside of the United States;
· indicated they were students on the AHSR membership application form;
did not self-identify as health services researchers on the AHSR
membership application fond.
4B.N. Davidson, "Personnel Needs and Training for Health Services Research,"
background paper prepared for the National Research Council's Committee on National
Needs for Biomedical and Behavioral Research Personnel, Washington, D.C., 1993.
5The Pew Charitable Trusts, the Robert Wood Johnson Foundation, the John A.
Hartford Foundation, the Henry J. Kaiser Family Foundation, the Commonwealth Fund,
and the W.K. Kellogg Foundation.
OCR for page 93
APPENDIX A / 93
The resulting data set included 2,200 names. To this database were then
added (1) names for those registered for the 1992 and 1993 AHSR annual
conferences (n = approximately 700 after elimination of duplicate names and
those with foreign addresses); names listed in the brochures of about 50
university-based and private health research "centers" (n = approximately 250
after elimination of duplicate names); and a list of nurse researchers supplied by
Sigma Theta Tau International, the nursing honor society (n = 789 before
elimination of a small number of duplicate names, the exact number of which
was not recorded).
The final source of names was a written survey of 496 organizational
employers of health services researchers. The list of organizations was compiled
from several sources including (1) AHSR's institutional membership list and
individuals' organizational affiliations indicated on the AHSR and HSRProj
databases, (2) the research "centers" mentioned above, (3) individuals'
organizational affiliations indicated on the registration list for the 1994 meeting
of the National Association of Health Data Organizations, and (4) lists of
relevant federal and state government offices. Survey respondents were asked
to supply the names, addresses, telephone numbers, and degrees of the people in
their organizations whom they considered to be health services researchers,
according to the IOM's definition (see Chapter 1~. They were also asked about
their current and planned recruiting efforts. Of the 496 organizations surveyed
154 returned the survey form, for an overall response rate of 31 percent.
Because the tight schedule precluded follow-up mailings to nonrespondents, this
low response rate was not unexpected. The survey yielded a total of 1,731
names of health services researchers, about 970 of which were not already
included in the database.
SUMMARY OF RESULTS
The final database included 4,920 names, more than double the membership
of the AHSR. This list, however, still does not include all those engaged in the
field, and it probably includes some individuals who would not self-identify or
be identified by others as health services researchers.6
6If it were assumed that nonrespondents to the written survey employed health
services researchers at the same rate as respondents, approximately 600 more researchers
could be added to the database count.
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94 / HEALTH SERVICES RESEARCH
Distribution of Researchers by Region and State
Table A.1 presents information on the distribution of the health services
researchers in the full database by geographic region and state. Geographically,
27 percent of the researchers in the database are located in the South Atlantic
region of the country, primarily because of the concentration of researchers in
Maryland and the District of Columbia. The next highest concentrations of
health services researchers are seen in the Pacific region (16 percent) and the
East North Central region (16 percent). California, with 567 health services
researchers, has the largest state contingent, followed by Maryland (423), the
District of Columbia (321), Massachusetts (317), and Pennsylvania (3059.
Graduate Education
The full database included information on graduate degrees for nearly two-
thirds (3,203) of the researchers listed. Of this group, 52 percent had doctoral
training (including 73 individuals with Sc.D. and 16 individuals with Ed.D.
degrees). Another 28 percent had clinical degrees (of which approximately
three-quarters were M.D.s).
Type of Employer
For analytic purposes, organizations responding to the written survey were
grouped into the following categories: universities, proprietary and nonprofit
health services research organizations and consulting firms, professional groups,
health industry organizations (including managed care organizations, insurance
companies, and pharmaceutical companies), and federal and state government
agencies. Table A.2 presents information on the types of responding
organizations and their reported employment of health services researchers.
Universities (which comprised 30 percent of the responding organizations)
reported the highest numbers of health services researchers, 41 percent of the
total and 55 percent of the Ph.D.-level researchers reported. Again, given the
low response rate, the percentages reported should be viewed with caution.
OCR for page 95
APPENDIX A / 95
TABLE A.1 Number of Identified Health Services Researchers, by Region/State
% of % of
Region/State No. Total Region/State No. Total
New England527 11 East North Central76116
Connecticut80 Illinois226
Maine45 Indiana92
Massachusetts317 Michigan134
New Hampshire34 Ohio129
Rhode Island44
Vermont7 West North Central335
Iowa48
Middle Atlantic694 14 Kansas28
New Jersey118 Minnesota136
New York271 Missouri81
Pennsylvania305 Nebraska26
North Dakota11
South Atlantic1,336 27 South Dakota5
Delaware5
District of Columbia321 Mountain1944
Florida89 Arizona40
Georgia86 Colorado52
Maryland423 Idaho3
North Carolina176 Montana6
South Carolina37 Nevada18
Virginia185 New Mexico31
West Virginia14 Utah38
Wyoming
East South Central109
Alabama57 Pacific77E
Kentucky19 Alaska
Mississippi10 California56
Tennessee23 Hawaii13
Oregon7]
West South Central186 4 Washington12(
Arkansas27
Louisiana14
Oklahoma15
Texas130 TOTAL4,920101a
aTotal does not sum to 100 because of rounding.
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96 / HEALTH SERVICES RESEARCH
TABLE A.2 Reported Employment of Health Services Researchers (HSRs)
by Organizational Type
Responses to Ph.D.-level
Questionnaire HSRs Employed HSRs Employed
Organizational Type No. (%)No. (%) No. (%)
Universities 46 (30)715 (41) 411 (55)
Research or consulting 27 (18)513 (30) 164 (22)
organizations
Federal/state government 45 (29)266 (15) 74 (10)
Heals indushya 14 (9)130 (8) 60 (8)
Professional groups 22 (14)107 (6) 40 (5)
TOTAL 154 (100)1,73 1 (100) 749 (100)
aIncludes managed care plans, insurers, pharmaceutical firms, and integrated systems.
Current and Future Hiring of Researchers
The written survey of employers of health services researchers also included
two questions relating to the demand for health services researchers in 13 specific
research areas as reported in Tables A.3 and A.4. Respondents were asked
· if, in the last few years, they have had difficulty in recruiting Ph.D.-
level researchers for specific research areas; and
i]
if, in the next five years, they intended to recruit Ph.D.-level researchers
n any of these areas and, if so, how many.
Table A.3 shows the number of responding organizations that reported
having had difficulty in the last few years in recruiting qualified Ph.D.-level
researchers in one or more of the research areas listed in the questionnaire.
Overall, more than half of the responding organizations (83, or 54 percent)
indicated that they have had problems recruiting Ph.D.-level health services
researchers. Universities, which are heavy employers of Ph.D.s, were more
likely to report such problems. Over two-thirds of universities (70 percent)
reported having difficulties in at least one of these research areas.
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APPENDIX A / 97
TABLE A.3 Organizations Reporting Difficulties in Recruiting Ph.D.-Level
Health Services Researchers in the Past Few Years, by Type
Organizational Type
Reported Difficulties
No. (%)
Universities
Research or consulting organizations
Federal/state government
Health indusbyh
Professional groups
TOTAL
32 (70)
1 s (56)
20 (44)
6 (43)
10 (46)
83 (54)
aIn at least one area of research.
bIncludes managed care plans, insurers, pharmaceutical firms, and integrated systems.
Table A.4 shows the specific research areas in which these recruiting
problems have been reported by responding organizations. The research areas
have been rank-ordered in terms of the number of organizations reporting
problems (not the number of positions for which difficulties were experienced).
For five research areas, at least 15 percent of the responding organizations
reported difficulty recruiting researchers in the last few years. The areas
reportedas having presented the greatest problems are outcomes/health status
measurement (23 percent), health economics (21 percent), biostatistics (20
percent), epidemiology (18 percent), and health policy analysis (16 percent).
Anticipated Future Demand
Table A.5 presents information on the numbers of responding organizations
that reported that they expected to recruit Ph.D. researchers in the various
research areas over the next five years. Sixty-one percent of responding
organizations indicated that they anticipated recruiting health services researchers
in at least one of these areas of research. Government agencies were the least
likely to report such plans.
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98 / HEALTH SERVICES RESEARCH
TABLE A.4 Rank Order of Research Areas in Which Recruiting Difficulties
Were Reported
Research Areas
Reported Difficulties
No. (%)
Outcomes/health status measurement
Health economics
Biostatistics
Epidemiology
Health policy analysis
Medical informatics
Managed care research
Gerontology
Operations/decision analysis
Quality
Nursing research
Mental health research
Dental health research
Otherb
35 (23)
32 (21)
3 1 (20)
25 (18)
24 (1 6)
17 (1 1)
14 (9)
13 (8)
10 (6)
9 (6)
8 (5)
6 (4)
4 (3)
17 (1 1)
fin at least one area of research. Many organizations reported difficulties in more than
one area.
Categories listed include actuarial science, bioethics, demography, health care
management, health education, health finance, health services research (general), long-
term care, pharmacy services research, modeling, and work force planning.
TABLE A.5 Number of Organizations Indicating Plans to Recruit Health
Services Researchers in the Next Five Years
. .
Organizational Type
Reported Plans
No. (%)a
Universities
Research or consulting organizations
Federal/state government
Health industryb
Professional groups
TOTAL
36 (78)
1 8 (67)
16 (36)
13 (93)
11 (36)
94 (61)
aReported plans to recruit people for at least one area of research.
bIncludes managed care plans, insurers, pharmaceutical firms, and integrated systems.
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APPENDIX A / 99
Table A.6 indicates that the five research areas (outcomes/health status
measurement, health economics, biostatistics, epidemiology, and health policy
analysis) for which responding employers reported having had difficulty
recruiting in the last few years are also the areas in which demand is anticipated
to be strongest in the next five years. Based on the estimates of responding
organizations, they will hire more than 660 health services researchers in the next
five years.
TABLE A.6 Research Areas in Which Responding Organizations (n = 154)
Expect to Recruit Health Services Researchers in the Next Five Years
Research Areas
Total Number of Researchers
Expected to Be Recruited
Nit)
Outcomes/health status measurement
Health economics
Biostatistics
Epidemiology
Health policy analysis
Managed care research
Operations/decision analysis
Quality
Mental health research
Medical informatics
Nursing research
Gerontology
Dental health research
Other
TOTAL
120 (18)
96 (14)
83 (13)
71 (1 1)
62 (9)
49 (7)
39 (6)
38 (6)
26 (4)
26 (4)
17 (3)
14 (2)
1 (<1)
19 (3)
661 (100)
.
SUMMARY
To develop current estimates of the size of the health services research work
force in the United States, a variety of sources were used to build a database.
The process yielded a database containing information on a total of 4,920
individual health services researchers, a number considerably higher than past
estimates. It is important to note, however, that the database is likely to include
some individuals who are not health services researchers and to exclude some
who are. Moreover, it lacks information (e.g., age) that would be useful in
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100 / HEALTH SERVICES RESEARCH
developing estimates of the future supply of researchers. Demand for health
services researchers over the next five years is expected to continue, especially
in universities and the health industry. Researchers with experience in
outcomes/health status measurement, health economics, biostatistics,
epidemiology, and health policy analysis will be in particular demand.
Representative terms from entire chapter:
services research
