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IV. SOM13 TRENDS IN TRAINING AND UTILIZATION The Committee's staff and consultants have launched a number of studies, following the recommendations made in the report of the feasi- bil~ty study. It has not been possible for the Committee and its Panels to review these studies more than briefly, much less to assess their significance and assimilate the results into their work. Such fuller development must be left to the next stage of the continuing study. Nevertheless, data on trends in training and utilization in biomedical and behavioral research areas have already emerged and seem significant enough to be included here. GRADUATE ENROLLMENTS AND STUDENT SUPPORT First-year graduate enrollments in the biomedical and behavioral sciences rose from roughly 15,000 in 1960 to 47,000 in 1974, an average annual growth rate of 8.6 percent (TABLE 4~. Each broad field has exhibited different growth patterns. The basic biomedical sciences have shown the steadiest growth of all the fields, rising from 7,000 to 22,000 students from 1960 to 1974. However, its annual growth has slowed. In the years from 1968 to the present, the annual average rate of growth was 7.0 percent compared to 9.9 per- cent in earlier years. The changes in growth rates in the behavioral sciences are much more pronounced than in the basic biomedical sciences. Here the average annual growth rate was 12.4 percent from 1960 to 1968 and only 3.6 per- cent thereafter. Furthermore, there were absolute declines in first-year enrollments from 1970 through 1973 in the disciplines of anthropology, sociology, and psychology (except in 1970-71~. It is difficult to find reliable data for the clinical sciences and health services research. Because most researchers in the clinical sciences are M.D.'s with postdoctoral training, enrollments in graduate programs are a poor and misleading indicator of clinical researchers in training. In health services research, most graduate enrollments are in terminal masters programs, e.g., in public health and hospital 44

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TABLE 4 First-Year Graduate Enrollments2 In All Graduate Departments, by Selective Field, 1960-1973 (l,OOO's) Basic Biomedical Behavioral Year3 Science Science_ 1960 7 0 7 1961 7.7 8.0 1962 8.2 8.7 1963 9.7 10.4 1964 11.8 11.8 1965 12.7 13.0 1966 14.2 15.2 1967 14.9 17.9 1968 14.9 19.6 1969 16.3 22.2 1970 17.2 26.3 1971 18.3 25.5 9721- 18.8 24.0 73l 19.5 22~4 74l 22.4 24.2 Annual Average Rates of Growth 1960-74 8.7 8.6 1960-68 9.9 12.4 1968-74 7.0 3.6 Estimates based on NSF data for 1971-74. 2Both full-time and part-time students. 3Fall enrollment for that academic year. Source: U. S. Department of Health, Education and Welfare, National Center for Education Statistics, Students Enrolled for Ad- vanced Degrees, Annual Reports 1960-71. 45

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administration. Hence, enrollments in this area are also unrepresenta- tive of those being trained for research careers. For these reasons, enrollments in these areas are not included here. There are also significant field differences in the pattern of federal support of graduate students. Of the 164,000 graduate students in the 1973 survey of the sciences and engineering by the National Sci- ence Foundation, over 65,000 were in the basic biomedical, behavioral, and clinical sciences. As one might expect, the basic biomedical and clinical sciences rely more heavily upon federal support (30 percent and 41 percent, respectively) than the behavioral sciences (22 percent) and in fact their reliance exceeds that for all fields (26 percent) HEW and its components, NIH/ADAMHA20 (TABLE 5~. Of the federal sources, _ _ _ . are clearly predominant, with HEW accounting for 18 percent of all science students supported (i.e., providing their major source of support) and 65 percent of all science students supported by federal funds. Support for graduate students in these areas is quite diverse, however. Non-federal support still makes up the largest share (over 70 percent) of major sources of support. Institutional support accounts for roughly 40 percent of all students in these fields. 21 Self-support, including students' own funds, loans, and family support, is also sub- stantial as a percentage of major sources of support. It is highest for the behavioral sciences (32 percent), apparently compensating for the lesser volume of federal support in this area. It should be noted, however, that while federal support makes up the lesser part of total support in the biomedical and behavioral sciences, it is of greater importance to the development of the most talented re- search personnel. Research fellowships, traineeships, and assistant- ships are heavily subsidized by the federal government. Hence, the fact that teaching assistantships, largely concentrated in state universities, and self support make up the greater part of overall support should not cloud the Importance of the federal role in training research manpower. The support of basic biomedical and behavioral science graduate students is further elucidated by noting the type of support or kind of 20ADAMHA is not included in NIH data in TABLE 5. This explains why the percentage of support for behavioral sciences may look low under NIH. It is included within total HEW support. 21 It should be kept in mind, however, that much institutional support is actually unrestricted state aid to public institutions. 46

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appointment received as the major source of support. All of the fields related to this study have a high concentration of fellowships and train- eeships relative to all fields. Over 25 percent of the basic biomedical and behavioral science students are supported by fellowships and train- eeships (TABLE 63. A substantial number of basic biomedical students also receive their support in the form of research assistantships; however, behavioral and clinical science students receive much less of their support in this form (12 percent and 9 percent). The importance of federal support for both fellowships and traineeships, and especially for research assistantships, explains the high concentration of federal support in the basic biomedical sciences. Conversely, the much smaller amount of federal research done in the behavioral sciences explains their lesser volume of research assistantships and federal support. The overwhelming concentration of the clinical sciences support in fellowships and traineeships especially postdoctoral- opposed to minor support for participation in research assistantships may be explained by the historically greater utilization of the training mechanism in clinically oriented programs. Further, the absence of undergraduate clinical programs means that proportionately fewer such students are engaged as teaching assistants although clinical science fellows and trainees do engage to a considerable extent in bedside teaching. Basic biomedical and behavioral sciences, on the other hand, have under- graduate courses and, thus, their Graduate students are actively engaged in teaching undergraduates.22 The "other types of support" category, which is to a considerable extent composed of self-support, is also a major source of support to a substantial number of students- over 30 percent in the basic biomedical and behavioral sciences. As one would suspect, the behavioral sciences have the highest concentration in this area due to lesser access to federal support. Ph.D. OUTPUT 1961-74 In this section, we examine the trends in the production of b~o- medical/behavioral Ph.D.ts. Since these Ph.D.'s constitute most of the pool of basic biomedical/behavioral researchers (the others are M.D.'s), the trends in Ph.D. production have important implications for future trends in the supply. Not all Ph.D.'s become researchers; many perform 22It should be noted that public institutions, through state funds, offer more teaching assistantships than do private institutions. 48 /

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u] ~ ~ o EN o o a) a) v rl v v] em U2 U] a) a) ED fin h U] a) U] U] al Hi: O Q {Q erl I, Marl V ~ a) up ED - ~Q A U2 em v to 0 ~ P: 'A A En A: - U] - o o 'O - U] U] Pi ED a) v o ~ ~ ~ oD o o oo o ~ z u~ ~ ~ o ~ o ~ o ~ ~ o ~ a) ~ v o a p~ ~ o ~ ~o ~ ~ ~ o ~ u~ o Ln ~ ~ ~ ~ o ~r v o o o o u~ ~ c~ Ln ~ \9 ~ ~ ~9 ~ o v o pH o co u) ~ o u) ~ u~ ~ ~ ~ co ~ ~ o o o o ~ o o o o o o o o ~ ~D ~ \9 ~ ) \9 ~o ~ o E~ ~ - v u] U2 ~ v erl ~ v v] o rl m V U] 0 ~ m a) v .~ v U] v rl v U] O ~ rl V ,1 ~ ~: a m 49 o V U) O U] ~q V o U] a) rn O o O ~Q - ~ O .,' ,1 o eQ U] a) a) e O-O V ~ ~ H H O C~ U] V ~ .,! V U] ~ U] ~' 8 U] o a V ~ ~ o .~ ~, V U] U) o . :a

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teaching and administrative duties exclusively, while with others research is a secondary activity. As expected, the number of Ph.D.'s entering research depends on the amount of funds allocated to research and development activities. As the growth in R and D funds slows, fewer research positions become available to the new Ph.D.'s, who therefore seek other jobs. Conversely, increases in R and D funds generate addi- tional positions for researchers. The pool size cannot be increased quickly. Ph.D. output responds slowly to changes in demand because of the average time lag of seven years from the B.A. to the Ph.D. It is questionable how effectively the supply can be increased by drawing from the pool of nonactive researchers. Those who have not done research for a few years may quickly lose contact with the latest techniques and developments and may find it difficult to become proficient researchers again without retraining. Here postdoctoral training plays an important role, but response again is not instantaneous. From 1961 to 1971, the output of Ph.D.'s in the biomedical/behavi- oral fields increased at a rate of approximately 12 percent per year (FIGURE 2, TABLE 7~. Since 1971, the growth rate has slowed considerably. In 1974, there was no growth over the previous year. This was largely due to the fact that Ph.D. output in the basic biomedical sciences actually declined from 1973 to 1974- the first time this has happened in over 15 years. The behavioral sciences exhibit a pattern of growth very similar to the basic biomedical sciences, increasing at a rate of 12 percent up to 1971 and 6 percent from 1971 to 1974. But unlike the basic biomedical sciences, behavioral science Ph.D. production continued to grow in 1974. The health services research field has had erratic but generally continuous growth since 1961 at an annual growth rate of about 13 percent per year through 1974. The number of Ph.D.'s given annually in the clinical sciences is very small. It reached a peak of 55 Ph.D.'s in 1966 and has declined steadily since then to 38 in 1974. RESEARCH AND DEVELOPMENT EXPENDITURES The demand for biomedical/behavioral researchers is strongly in- fluenced by the amount of expenditures, both public and private, for biomedical research and development. Since 1957, these expenditures have grown rapidly, as have those for R and D in practically all other fields. From 1961 to 1964, the growth in actual dollars was about 9 percent per year (FIGURE 3, TABLE 83. But in 1968, inflation began to take its toll 50

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FIGURE 2 Annual Production of Ph.D.'s in the Biomedical/Behavioral Fields Number of Average Annual Ph.D.'s Awarded Growth Rates: 1961-71 1971-74 1 7800 - 7400 - 7000 - 6600 6200 - 5800 - 5400 _ 5000 - 4600 - 4200 _ 3800 ~ 3400 ~ 3000 _ 2600 - 2200 1800 ~ 1400 Source: TABLE 7 51 All Biomedical/ Behavioral Fields Basic Biomedical Sciences Behavioral Sciences All Biomedical/ ~ / Behavioral Fields \ / 11.9% 2.0% 12.1% -0.9% 11.8% 5.6% Basic Biomedical Sciences ~ , / / / Behavioral Sciences 1961 62 63 64 65 66 67 68 69 70 71 72 73 74 Y E A R

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TABLE 7 Production of Ph.D.'s in the Biomedical/Behavioral Fields, 1961-74 Basic Health Fiscal Year Biomedical Behavioral Clinical1 Services of Ph.D. Sciences Sciences Sciences Research Total 1961 1266 1042 39 39 2386 1962 1441 1123 31 34 2629 1963 1538 1185 35 38 2796 1964 1736 1297 46 64 3143 1965 1993 1276 49 61 3379 1966 2163 1489 55 79 3786 1967 2378 1788 54 83 4303 1968 2871 1970 47 86 4974 1969 3206 2406 46 85 5743 1970 3526 2727 53 1162 6422 1971 3873 3072 51 129 7125 1972 3897 3245 48 111 7301 1973 3943 3429 35 130 7537 1974 3744 ~ 3612 38 143 7537 1The clinical science Ph.D.'s are only a small portion of the total number of researchers in the biomedical field over two thirds are M.D.'s. How- ever, as can be seen in this table, a few Ph.D.'s are granted in clinical sciences each year. Some, but by no means all of these are also M.D.'s. The clinical science fields in the DRF are limited to medicine and surgery, dentistry, veterinary medicine, optometry and ophthalmology. 2The large increase in Ph.D.'s awarded in the health services research field from 1969 to 1970 may have been due to a reclassification of field codes in the DRF during that period. SOURCES: Doctorate Recipients from United States Universities, 1958-66: Sciences, Humanities, Professions, Arts, Office of Scientific Personnel, NAS/NRC, 1967. Doctorate Recipients from United States Universities, Summary Reports, Office Scientific Personnel, NAS/NRC, 1967-73. 52

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FIGURE 3 National Support for Medical and Health Related Research . Billion $ 4.2 4.0 l 3.4 d _ 3.2 . _ _ 2.8 _ 3.8 3.6 3.0 2.6 2.4 Actual $ l l J / Pre-1968 growth rate in constant $:/ 9.0% per year /.J } ~ / ~ .^ ~ ~ Act. ;7 L ~ Post-1968 growth rate r-~ in actual $: 8.5% per year , ~ Constant 1967 $ / i \N,,' I \. ; Post-1968 growth rate in constants: 2.6% per year J 2.2 ~ 2.0 ~ ' ~ / 1.8 ~ ,'// 1 1.6 ~ '* ~ _Pre-1968 growth rate J ~ in actual $: 12.7% per year 1.4 1.2 ~ / _ ~ :/ ' / 1 ~ - 1962 64 66 68 70 72 74 Y E A R SOURCE: Basic data provided by Office on Resources Analysis, Office of the Director, National Institutes of Health. Growth rates calculated by Commission on Human Resources, NAS/NRC. 53

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TABLE 8 National Support for Medical and Health-Related Research Actual Dollars Total Federal Private ($ billions) Industry _ 1952 0.197 1953 0.214 1954 0.237 1955 0.261 1956 0.312 1957 0.440 1958 0.543 1959 0.648 1960 0.845 1961 1.045 1962 1.290 1963 1.486 1964 1.652 1965 1.841 1966 -2.056 1967 2.280 1968 2.497 1969 2.691 1970 2.731 1971 3.023 1972 3.354 1973 3.563 1974 4.249 1975 (est.) 4.220 0.103 0.107 0.119 0.139 0.162 0.229 0.279 0.351 0.448 0.574 0.782 0.919 1.049 1.174 1.316 1.458 1.582 1.674 1.667 1.977 2.147 2.225 2.753 2.609 0.052 0.058 0.061 0.062 0.079 0.126 0.170 0.190 0.253 0.312 0.336 0.375 0.400 0.450 0.510 0.580 0.661 0.754 0.795 0.860 0.925 1.033 1.180 1.280 Other 0.042 0.049 0.057 0.060 0.071 0.085 0.094 0.107 0.144 0.159 0.172 0.192 0.203 0.217 0.230 0.242 0.254 0.263 0.269 0.286 0.282 0.305 0.316 0.331 Total 1.267 1.516 1.698 1.840 1.986 2.144 2.280 2.383 2.446 2.354 2.468 2.578 2.619 2.948 2.686 Constant 1967 Dollars Federal ($ billions) 0.695 0.918 1.050 1.168 1.266 1.372 1.458 1.509 1.521 1.437 1.532 1.650 1.636 1.910 1.660 Private Industry 0.378 0.394 0.428 0.445 0.485 0.531 0.580 0.630 0.685 0 _685 0.702 0.711 0.759 0.818 0.814 0.192 0.202 0.219 0.226 0.234 0.239 0.242 0.242 0.239 0.231 0.233 0.216 0.224 0.219 0.210 . R and D Price Index 1967=100) 82.5 85.1 87.5 89.8 92.7 95.9 100.0 104.8 110. ~ 116.0 122.5 130.1 136.0 144.1 157.1 1A Price Index for Deflation of Academic R and D Expenditures NSF 72-310, Government Printing Office, Washington, D. C., May 1972. SOURCE; Biomedical Research Manpower for the Eighties, Resources for Medical Research . . . . . . Report $11, Office of Resources Analysis, NIH, HEW, Washington, D. C. t December 1968, and unpublished data. 54

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TABLE 9 Federal Biomedical/Behavioral R and D Funds Year : - Biomedical & Health- . Related Sciences Behavioral Sciences (all life sciences, Clinical Sciences (psychology, anthro- except clinical pology r sociology) ($ millions) % | ($ millions) % | ($ millions) % | llS9 60.8 514 27.0 233 12.2 1414 63.2 568: 25.4 257 11.5 1398 61.1 661 28.9 229 10.0 1658 61.6 808 30.0 224 8.3 1585 61.4 1 778 30.2 1 217 8.4 Total ($ millions) 1971 1972 1973 1974 (est.) 1975 (est.) 1906 2239 2288 2690 2580 100.0 100.0 100.0 100.0 100.0 SOURCE: Federal Funds for Research, Development and~Other Scientific Activities, Table D. C., various years. , National Science Foundation, Washington, 55

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as R and D costs escalated. The NSF has compiled an index of academic R and D costs23 which shows that 1974 costs for such activities were 57 percent higher than in 1967. As a result, although total national funds for health-related research have continued to expand at almost 9 percent per year in actual dollars, the real growth in constant dollars since 1968 has been about 3 percent per year. During the past five years, about 60 percent of federal R and D funds for biomedical/ behavioral research went to the basic biomedical and health-related sciences, 30 percent to the clinical sciences, and the remaining 10 percent to the behavioral sciences (TABLE 91. CURRENT NUMBER OF ACTIVE RESEARCHERS Reliable data on the size of the pool of biomedical/behavioral researchers as a function of tome are hard to come by. The Committee examined longitudinal data obtained from the several National Registers of Scientific and Technical Personnel, but found them erratic and inconclusive. Further analysis may make it possible to use these data, which cover a span of almost two decades, but there was insufficient time for this to be done for the present report. The Committee has relied instead on data derived from the 1973 Survey of Doctoral Scien- tists and Engineers and the 1975 Faculty Profile compiled by the Asso- ciation of American Medical Colleges (Appendix D). Data on the Ph.D. (or equivalent) component come from the Survey of Doctoral Scientists and Engineers. Individuals counted on the following table are employed in biomedical and behavioral fields and have indicated that research or the management of research activities is their primary work activity. 23A Price Index for Def] ~ on of Academic it-and D Expenditures. NSF 72-310 Government Printing Office, Washington, D. C., May 1972. 56

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Field Basic Biomedical Sciences., Total Anatomy Biochemistry Biomathematics Biomedical Engineering Biophysics Cytology Embryology Genetics. Immunology Microbiology/Bacteriology Molecular Biology Parasitology Pathology Pharmacology Physiology, Animal Physiology, Plant Other Biomedical Sciences, Total Botany Ecology Entomology Environmental Sciences Hydrob~ology Nutrition/Food Science Pharmaceutical Sciences Zoology Biomedical Sciences, Other Behavioral Sciences, Total Anthropology Behavior/Ethology Clinical Psychology Comparative Psychology Counseling and Guidance Developmental/Gerontological Educational Psychology Exper/Compar/Physiol Psychology Experimental Psychology Industrial/Personnel Psychology Personality Psychology Physiological Psychology Psychometrics School Psychology Social Psychology Social Statistics Sociology Psychology, Other Number of Active Ph.D. Researchera (1973) 17,800 347 5,317 151 577 907 340 163 1,056 983 1,930 1,388 215 411 1,624 1,769 622 7,955 332 551 1,272 1,424 90 307 297 248 3,434 6,914 263 78 776 99 115 333 574 5 797 468 77 509 196 86 563 110 1,067 798 1The numbers of individuals shown in the above table do not necessarily reflect the numbers that have been supported by NIH/ADAMHA/HRA training programs. 57

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Field Clinical Sciences, Total Dentistry Medicine & Surgery Veterinary Medicine Health Services Research, Total Biometrics/Biostatistics Hospital Administration Public Health Total Number of Active Ph.D. Researchers (1973) 503 291 212 704 342 30 332 33876 The American Medical Association estimates that about 8,400 M.D. were engaged in research activities in 1974. This appears to be the best estimate available of the current size of the total pool of M.D. researchers. The Association of American Medical Colleges has supplied data on the number of M.D. (or equivalent) researchers on medical school faculties in each sub-field. Under the assumption that this same distribution applies to the total pool of M.D. researchers, we have computed estimates of the size of the pool in each subfield. These are presented in TABLE 10 along with a summary of the Ph.D. pool updated to 1975. In summary, the pool in 1975 is estimated to be composed of approxi mately 47,000 biomedical/behavioral researchers. 58 1 S -

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TABLE 10 Estimated Number of Active Biomedical . . . . . . and Behavioral Researchers in 1975 . M.D.'s Ph.D.'s Total Basic Biomedical Sciences 1,400 29,500 30,900 Behavioral Sciences __c 7,900 7,900 Clinical Sciences 6,800 600 7,400 Health Services Research 200 800 1,000 TOTAL 8,400 38,800 47,200 aThe estimated total of 8,400 M.D.'s in research was derived from Profile of Medical Practice, American Medical Association, Chicago, Illinois, - 1974. The number in each suLfield was estimated from data supplied by the Association of American Medical Colleges, Washington, D. C. Ph.D. data were derived from the 1973 Comprehensive Survey of Doctoral Scientists and Engineers, Commission on Human Resources, NAS/NRC, Washington, D. C., and updated to 1975 on the basis of a 7 percent per annum increment. The number of behavioral science M.D. researchers is small and hence difficult to estimate. The best available information gives less than ten M.D.'s in this category. 59