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I. ORIGINS AND ORGANIZATION OF ~ STUDY The present report presents the findings and recommendations of the Committee on a Study of National Needs for Biomedical and Behavioral Research Personnel, as the first of the annual reports in a continuing study called for in the National Research Act of 1974 (PL 93-348~. SUMMARY OF PROVISIONS 4 Approved on July 12, 1974, the Act amends the Public Health Service Act "to establish a program of National Research Service Awards to assure the continued excellence [emphasis added] of biomedical and behavioral research." Title I is called the National Research Service Award Act and will be referred to in this report as the Act. It repeals existing research training and fellowship authorities of the National Institutes of Health (NIH) and the Alcohol, Drug Abuse, and Mental Health Admini- stration (ADAMHA). ~ ~ ~ ~ Research training activities of these agencies will henceforth be carried out under a consolidated authority contained in the new law. The Act concerns research training primarily, although clinical training is also addressed. It is not completely clear how the Act affects authority available elsewhere in the Public Health Ser- vice Act under which the Secretary may enter into contracts with public and private entities and individuals for health services resesarch and health statistics training. The Act is a clear signal of Congressional concern regarding an important sector of the nation's human resources. The Committee regards its enactment as a positive step in which the Congress calls on the re- sponsible agencies of the Executive Branch, its own committees, and the biomedical and behavioral research communities to examine national per- sonnel requirements in an area that has contributed much to the national well-being in the past and that has much to offer in the future. resee Appendix C for further information about legislative authorities for training, including portions of the text of Title I of the Act. 11

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The Act authorizes awards for predoctoral and postdoctoral research training both to individuals and to nonfederal public or nonprofit institutions (which will select individuals for such awards). Not less than 25 percent of the amount appropriated must be made available directly to individuals. Each award recipient must give assurance that he or she will meet a service requirement engage in health research or teaching or, alternatively, (1) serve as a member of the National Health Service Corps, (2) serve in his or her specialty in a geographic shortage area in that specialty or in a health maintenance organization which offers care in a medically underserved area, or (3) serve in an approved health-related activity. Guidelines now under review specify the period of time within which repayment may be made, the type of research and teaching which qualify as payback, and other matters relating to service payback. Recipients who fail to comply with the service requirement must repay the amount of their awards plus interest, less proportionate credit for half of the months they actually served. Effective July 1, 1975, awards under the Act may be made for research training only in those subject areas in which there is need for personnel, as determined by a continuing study which the Secretary is to request the National Academy of Sciences to conduct. The Act states that the purposes of the study are to: 1) establish (A) the Nation's overall need for biomedical and behavioral research personnel, (B) the subject areas in which such personnel are needed and the number of such personnel needed in each such area, and (C) the kinds and extent of training which should be provided such personnel; 2) assess (A) current training programs available for the training of biomedical and behavioral research personnel which are conducted under this Act at or through institutes under the National Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Administration, and (B) other current training programs available for the training of such personnel; 3) identify the kinds of research positions available to and held by individuals completing such programs; 4) determine, to the extent feasible, whether the programs referred to in clause (B) of paragraph (2) would be adequate to meet the needs established under paragraph (1) if the programs referred to in clause (A) of paragraph (2) were terminated; and 5) determine what modifications in the programs referred to in paragraph (2) are required to meet the needs established under paragraph (1) . 12

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FEASIBILITY STUDY Pursuant to this requirement, the Secretary requested the Academy on September 16, 1974, to conduct the study. The NIH was designated the lead agency within the federal government, but it was understood that the study would also require assistance from ADAMHA. Since the National Research Council is the operating arm of the Academy, the Chairman of the National Research Council (NRC) asked the Commission on Human Resources to take a central responsibility within NRC, with the understanding that other NRC units" especially the Assembly of Behavioral and Social Sciences, the Assembly of Life Science.s, and the Institute of Medicine - would also participate. On September 21, 1974, the Governing Board approved the establish- ment of a committee by the Commission on Human Resources to examine the feasibility of the continuing study called for in the Act. Funds were provided by the NIH to carry out the feasibility study. NIH, ADAMHA, and HRA also provided data and other information upon request and con- sulted with the Committee about the requirements for the continuing study. -The committee on a Feasibility Study of National Needs for Biomed- ical and Behavioral Research Personnel met three times under a very tight schedule to complete its task as early in 1975 as-possible. Five panels in disciplinary areas (Basic Medical Sciences, Basic and Applied Biology, Behavioral Sciences, Clinical Sciences, and Health Services Research and Evaluation) and three panels in methodological areas (Supporting Studies, Data and Analyses, and Impacts of Training) assisted the committee in reviewing the adequacy of data and methodology for estimating national personnel needs in the biomedical and behavioral research fields and in considering some possible approaches to the tasks set by the Congress. The chairmen of the Commission and~committee and members of the staff consulted widely concerning ways of responding to the Congress- ional mandate. Within the NRC in addition to the Commission itself- the following units were kept informed and invited to contribute: Assembly of Behavioral and Social Sciences, Assembly of Life Sciences, and Institute of Medicine. The chairmen of related-sections of the National Academy of Sciences were invited to express their views. Out- side the Academies-Institute-Council complex, a number of groups were consulted: the staff of related Congressional committees, NIH/ADAMHA/ HRA, the Office of Management and Budget, the Office of the Assistant Secretary/HEW-Health, and a number of scientific and professional societies and educational organizations. 13

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The committee's report on feasibility was completed early in Febru- ary and submitted to the NRC Governing Board on February 21, 1975.5 It recommended that the National Academy of Sciences, operating through the NRC's Commission on Human Resources, accept the Secretary's invitation to conduct the continuing study, but stated a number of conditions and caveats. The committee viewed the task as difficult, but necessary and in a suitably long time frame feasible. The report discussed the reasons for this belief, but necessarily left a number of important questions to be answered in the continuing study. In response, the Governing Board approved the first phase of the continuing study to June 30, 1975. The Chairman of the National Research Council replied to this effect to the Secretary on March 6, 1975, transmitting a copy of the committee's report. SCOPE OF To FIAT SPORT The legislative date for the annual submission of a report to the Congress by the Academy through the Secretary was March 31. It was agreed, however, that the first report could not be provided before June l, 1975, because of the need to make preparations for the task ahead. The feasibility report made it clear that this task would indeed be complex and difficult: Assaying quality [of personnel] is a difficult problem. There are at present only rough methods for taking this attribute into account, such as assuming that the quality of-institutions or departments Danube measured, and that on the whole institutional quality is related to the quality of those who are awarded degrees. The results of attempts to produce supply and demand forecasts by field and discipline have been spotty. Sizeable differences between projected estimates and actuality are not uncommon... One of the central problems of projections is the difficulty of formulating generally acceptable concepts of underemployment. 3 National Research Council, Report Study on National Needs for Biomedical and Behavioral Research Personnel, . Commission on Human Resources, 1975. Committee on a Feasibility 14

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In addition to methodologic complexity and data shortcomings that plague the projector, there is the well-known fact that published projections are viewed as predictions by the public and the market moves to defeat the predictions. Employers and prospective em- Ployees note where "shortages" or "overages" are fore- cast and shape their strategies accordingly. ~ _ In spite of these problems ahead, the committee on the feasibility study thought that a beginning could be made. Its first recommendation was: The committee recommends that the National Academy of Sciences accept the invitation of the Secretary to con- duct the continuing study mandated by Title I of the National Research Act. The recommendation is based on the belief: (1) that within the methodologic limitations , , _ outlined in this report a productive start can be made during the current fiscal year toward meeting the re- quirements specified in the law; (2) that improvements can be expected in ability to gather and utilize needed information as experience is gained over the next several years; and (3) that the National Research Council through the experience of its Commission on Human Resources and its ability to call upon the skills of the scientific community is the most appropriate agency to conduct the continuing study. The recommendation further assumes that sufficient agreement can be reached on the conditions for the study as outlined below. The feasibility report went on to describe these conditions, some of which could be readily established, others of which (improvement of the data base, development of more sophisticated methodologies) would be realizable only in a period of several years. The 1975 report, it was clear, to be prepared within a period of about 90 days, could not be more than a preliminary response to the Congressional request- the result- of an effort to bring readily available data and professional judgment to bear on the study requirements. The committee for the feasibility report looked to the reports of 1976 and beyond to provide the basis on which the efficacy of the continuing study should be judged. 15

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A concurrent development of great significance to the task ahead was the Presidential appointment late in 1974 of the Panel on Biomedical Research, chaired by Franklin Murphy. It is the Panel's task to assess the federal programs for the support of biomedical research, identify areas of future research need, and - around the end of FY 1976- submit recommendations for federal funding. The committee for the feasibility study pointed out that personnel requirements and federal research support in these fields were very closely related to each other. Several studies had shown that the numbers of research doctorates awarded- suitably lagged to allow for the training period - were sub- stantially determined in a correlational sense by federal R and D funds in the biomedical fields. The federal government, through its system of research grants and contracts and training programs, is the major supporter of biomedical research personnel and - to a lesser extent -behavioral research personnel. Federal decisions to increase or decrease research funds exercise a compelling influence on the labor market in these fields. It would clearly be necessary for the con- tinuing study of personnel to be kept apprised of the development of the Panel's study and to follow trends in R and D support. THE COMMITTEE Appointed by the Chairman of the Commission on Human Resources with the approval of the Chairman of the National Research Council, the Committee on a Study of National Needs for Biomedical and Behavioral Research Personnel (Appendix A) has the overall supervisory responsi- bility for the study and for the annual reports issuing from it. The Committee is a multidisciplinary group, bringing experience from the biomedical and behavioral research communities, academia and industry, different institutional types, and various areas of expertise in studies. Two thirds of the members also served as members of the Committee for the feasibility study. Although the Committee is associated with a Commission within the NRC structure and submits its reports in accord with NRC report-review procedures, the contents, findings, and recommendations of the annual reports are those of the Committee alone. The Committee has held four meetings in the period February 28 to June 1, 1975. 16

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THE PANELS To assist the Committee with its tasks in various ization, five Panels have been appointed (Appendix B). ___ a_ in disciplinary areas related to national ~ ~'~ ~ training: Basic Biomedical Sciences, Behavioral Sciences, Clinical Sciences, and Health Services Research. One of them -Data and Studies - is concerned with the methodology and information sources to be used. About 60 percent of the Panel members took part in the feasibility study. The findings and recommendations of the Panels are transmitted to the Committee for its consideration in arriving at its own judgments. Queries and suggestions from the Committee provide many of the Panel agenda, but the Panels have the prerogative of initiating inquiries on their own. The Panel on Data and Studies has held two meetings in the period February 28 to June 1, 1975, and the Panel on Basic Biomedical Sciences and the Panel on Behavioral Sciences have met once in that period. Members of the Panels in disciplinary areas have submitted individual estimates of the needs for personnel in their areas. Members of all the Panels have reviewed a draft of the present report and have had an opportunity to comment on it. (Appendix B). areas of special- Four of them are research personnel needs and NIH, ADAMHA, AND HRA Although NIH has been designated the lead agency for the study and provides financial support for it, ADAMHA and possibly the Health Resources Administration (HRA) also are affected by the provisions of the Act. All three agencies have an interest in the study. They have provided program data, interpretations of administrative policies and procedures, and other kinds of assistance to the Committee. In turn, the Committee, through its staff, has kept the agencies informed about the progress of the study. To facilitate the exchange of program data and related information, two working groups are being established: (1) Data and Administrative Procedures and (2) Coordination of Studies. Representatives of the NIH/ADAMHA/HRA staffs and Committee staff will serve as members of the groups, which will meet monthly. OTHER ORGANIZATIONS Interest in the study and concern about the problems it addresses are widespread throughout the academic community. The Committee has endeavored to provide information about its work to the several interested publics through a variety of means: news releases, dis- tribution of copies of the feasibility report, interviews, meetings with representatives of professional societies, correspondence with interested persons, and specific queries and requests for information 17

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to individuals and organizations. Many of the members of the Committee and its Panels are active in the affairs of the scientific and profes- sional societies in the biomedical and behavioral sciences and have- served as information links. STAFF AND CONSULTANTS The committee for the feasibility study recommended that adequate resources be provided to assist the Committee in carrying out the demanding tasks called for in the Act, envisioning a steady-state budgetary level of almost $1 million annually and a staff of about 25 persons. It was recognized at the same time that it would not be possible to reach this level Immediately and that indeed some quite different level might seem more suitable upon closer examination of the work ahead. During the period February 28 to June 1, 1975, the Committee has had the assistance of five professional staff members, seconded from the staff of the Commission on Human Resources, and an administrative and secretarial staff of three. It has also received effective assistance from five consultants, who provided specialized services in several areas of concern to the Committee. ORGANIZATION OF THIS REPORT The Committee provides in this first report some data, observa- tions, and statements of principle that are relevant to its recommenda- tions, as well as the recommendations themselves. The latter were presented in the front of this report and include not only numerical recommendations of training levels, but also - and importantly- recommendations to ensure that a high quality of predoctoral and postdoctoral training will be maintained in each of four broad dis- ciplinary areas. Chapter II describes the training programs--their development, current levels, and estimated levels in FY 1976. Included is a brief summary of what is known about the utilization of training by former fellows and trainees. Chapter III deals with a number of principles that have guided the Committee in its thinking about the purposes of research training and the effective allocation of training resources. A number of problems come to the fore in the application ~ ~ ~ ~ ~ ' ~ second half of this or these principles and are ~escrlnea In tne chapter. In Chapter IV, some significant trends concerning the development and utilization of biomedical and behavioral research personnel, selected from a great variety of staff studies, are pre- sented to provide some indication of the way the complex training/ utilization system seems to be moving. Estimates of the size of the pool of biomedical and behavioral researchers conclude this section. 18

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The discussion in Chapter V provides a brief summary of important points . In preparing this report, the Committee has been selective rather than comprehensive. Many additional data were analyzed, but are not included either because the Committee was dissatisfied with the quality of the data base or because the studies could not be pursued to a defini- tive conclusion within the available time. Much of this preliminary work will be of use in writing later reports.6 6See Appendix D for a discussion of data sources and planned studies. 19