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V. SUMMARY We recapitulate some points of the earlier discussion: 1. Federal support of research training contributes to the con- tinuing vitality of biomedical and behavioral research, and, thus, con- tributes a vital buttress to health care in the United States. The federal presence brings with it national standards. The peer-review system ensures that the standards will be uniformly applied to recognize excellence. Biomedical research training itself (a) aids in selecting the next generation of research leaders, (b) accelerates their graduate education, (c) gives M.~.'s essential research tools and Ph.D.'s essential contact with medical problems, (d) makes it possible for postdoctoral scientists to move into undersupplied fields of speciali- zation, (e) stimulates the development of new fields of research, and (f) provides opportunity for the most able students to have access to biomedical and behavioral graduate education, independent of their private resources. 2. The competitively awarded research training grant is a unique and versatile mechanism that offers advantages beyond those of supplying trained personnel. Among them are: (a) maintenance of a complete training environment, (b) encouragement of existing interdisciplinary linkages and of new interaction of disciplines, and (c) recognition of excellence of training environments in the same way that fellow- ships recognize excellence of individual performance. 3. Largely due to training efforts of the last decade, a cadre of about 47,000 biomedical and behavioral researchers exists in the United States. About 70 percent of them conduct research in the basic bio- medical sciences, 14 percent in the behavioral sciences, 14 percent in the clinical sciences, and 2 percent in health services studies. Seventeen percent hold M.D. degrees, and 83 percent hold Ph.D.'s. 4. Essentially full employment currently exists for doctoral scien- tists in these fields of research. Unemployment in 1973 was at the "frictional" level of about 1.2 percent for all fields and age groups combined, but may be higher now- perhaps 2 percent overall with somewhat higher rates for some fields and for the most recent recipients of the Ph.D. In a few fields - health services research is an example personnel shortages exist. The commonly used market indicators, such as trends in relative salaries, suggest that, overall, no serious disequilibrium exists at the moment. 5. There is reason, however, to be concerned about future over- supply in some of the fields and about the costs thereof. Graduate enrollments have been growing strongly, indicating a plentiful supply 60

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of graduating Ph.D.'s over the next five years. The cadre of established research workers is relatively young, and attrition will be relatively low. Research and development funds are stabilizing, and demand for per- sonnel will stabilize accordingly. Although M.D. researchers can tulle to private practice for alternative careers, similar opportunities will be more limited for Ph.D.'s. The demographic facts suggest there will be relatively few new appointments to faculties in the 1980's. Some caution is needed, and the Committee is not prepared on the basis of its limited studies to urge significant farther growth of research training. 6. The training "pipeline" is long seven years on the average from baccalaureate to Ph.D., 10 years from the baccalaureate to the M.D. researcher. The flow cannot be rapidly turned on or off. Time is required to set up high-quality training programs, and stability is Chary nor an errs cat ens ana n~gn-qua'~y system. In this regard, the federal-budget decision not to include any funds for new stats in training at the predoctoral level in FY 1976 causes the Committee ~ ~ _ ~ ~ . ~ . ~ . ~ . . great concern. 7. Certain structural and administrative problems connected with research training have emerged. In the past, some two thirds of post- doctoral M.D. trainees and fellows in these programs entered medical practice soon after completion of training. This result was expected _ . _ _ ~ ~ . . . on an earlier person or one training programs when program goals included the training of clinical specialists in shortage fields. Now, however, this goal has essentially been met, and there seems to be little reason to maintain training for clinical practice in the future. A second issue, almost as old as the training programs themselves, concerns the percentage of training-grant funds allotted to various forms of insti- tutional support faculty salaries, salaries of supporting staffs, equipment purchases, library and computer costs, purchase of supplies, and so on. The Committee believes there should be a limit on the per- centage of training funds used for these purposes, but notes that the matter is complex. The strength of the training-grant mechanism resides in large part in its ability to create a strong and vital total environment for training. Stipends for trainees are an essential requirement for training, but so are a strong faculty, adequate equip- ment and supplies, and other training elements. 8. The difficult problem of proliferation of programs that results in excess training capacity cannot easily be disposed of. The decade of the 1960's witnessed a rapid growth of training programs in response to perceptions of national needs. Now that some of those needs have been met, the situation is changing. The Committee urges upon agencies of government and training institutions a readiness for change in both the character and the magnitudes of the training programs. Legitimate aspirations of institutions and departments can best be accommodated within an adaptive mechanism that recognizes new needs, establishes excellence as the governing criterion, and sets a high priority on flexible response. 61

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9. We have found existing data and field taxonomies insufficient for our task of forecasting personnel needs and the adequacy of the supply. The recommendations in this report are limited by that con- sideration to statements about Immediate training requirements in broad fields. In the course of the year ahead, we expect to acquire more satisfactory data about the training pipeline, the research-personnel pool and the mobility of persons in it, and the components of demand. We also expect to develop a more adequate list of the training and research specialties in these areas. 62