Several IOM studies of educational and work force issues have been congressionally requested, and federal agencies have also supported a number of other studies. Private foundations have been particularly instrumental in studies of the primary care work force (the Robert Wood Johnson and Kellogg Foundations), the representation of minorities in the health professions (the Josiah Macy, Robert Wood Johnson, and Pew Foundations), and the future of dental education (the Robert Wood Johnson Foundation).

POLICIES AFFECTING THE SIZE AND COMPOSITION OF THE HEALTH WORK FORCE

A number of IOM studies have examined the size, composition, and distribution of the health professions and health research work force. Particularly notable are a series of studies, conducted by the National Research Council (NRC) or the IOM, on national needs for biomedical and behavioral science research personnel. The National Research Service Awards (NRSA) Act of 1974 requested the reports to guide decisions about the level and distribution of federal research training awards. A novel element of the 1974 act was that training awards were to be restricted to areas in which the NRC committee determined shortages of research personnel existed (NRC, 1975).

The NRC issued six reports between 1975 and 1981 (Personnel Needsand Training for Biomedical and Behavioral Research). These were followed by IOM reports in 1983 and 1985, and then by NRC reports in 1989 and 1994. The core areas of focus for this series of reports have been the biomedical, clinical, and behavioral sciences, and health services research. Nursing research was added in the late 1970s as a result of legislative changes. Oral health research was explicitly addressed in 1985 and 1994, although earlier reports referred to research training needs in a number of specific clinical areas including dentistry. While under the aegis of the IOM, the study committee also undertook a detailed analysis of the career achievements of National Institutes of Health (NIH) supported predoctoral trainees and fellows and an analysis of NIH postdoctoral fellows.

The 1994 NRC report Meeting the Nation's Needs for Biomedical andBehavioral Scientists made recommendations regarding the number of NRSA predoctoral and postdoctoral training grants and fellowships that should be funded in several areas and called for higher stipends and a better system to track program graduates. The report also devoted a chapter to a review and critique of models of supply and demand used by previous NRSA study committees, and the panel responsible for that chapter is continuing its exploration of demographic techniques for estimating future supply. The reports have also analyzed the problems of projecting future need or demand



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