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1 . INTRODUCTION AND SUMMARY OF NUMERICAL RECOMMENDATIONS, FISCAL YEARS 1979-81 Th i s i s the thi rd in a series of annua ~ report s that the Commit tee ha s prepared in response to the request of the Congress under Ohm National Research Service Award Act of 1974 {NBSA) "to assess the national needs for biomedical and behavioral research personnel" and to "recommend the kinds and extent of training to be provided" under federal programs. In its second annual report (National Research council, 1976~), the Committee provided a brief "Historical Overview," which reviewed both the federal interests and involvement in biomedical and behavioral research and the specific charges that the Congress established for a continuing study of research personnel needs in these fields. That overview, together with the Act and a summary of several important redated questions that emerge from the legislative h story of the NRSA Act, are reproduced in supplements 1-3 at the end of this volume. These and the synopsis given in supplement 4 of the major findings and recommendations of the 1976 report place the present report and its recommendations in perspective. For purposes of carrying out its responsibilities in its second annual report (1976), the Committee divided the biomedical and behavioral sciences into four broad areas-- basic biomedical sciences, behavioral sciences, clinical sciences, and health services research. The Committee made a number of recommendations for adjustments in the number of predoctoral and postdoctoral awards for research training under the programs of the National Institutes of Health (NIH) and t he Alcohol, Drug Abuse, and Mental Health Administrated on (ADAMHA} in each of these four areas for fiscal years (FY) 1976, 1977, and ~ 978. In that report the Committee set target goals for FY 1976, realizing that they woul ~ come too ~ ate f o r the f unding agen ci e s to be ab ~ e to make ma jor changes toward implementation. The first specific recommendations made by the Committee, which permitted the agencies suff icient time for implementation, were made for FY 1977; these are summarized in Supplement 4. 1

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OBJECTIVES OF THE 1977 REPORT The ob j ective s f or the current repo rt are to ~ ~ ~ revi ew, update, ant] extend the Committee' s specific previous recommendations about the numbers of predoctorals and postdoctorals who should receive federal support within each o f the broad area s ink o which the biomedica ~ and behavioral sciences have been aiviaea; ~ 2} make recommendations concerning appropriate usage of the different support me chant sms f or ea ch of the s " ar ea s; ( 3 ) speci f y, whe re possible e, the sub ject matter or training fields that the C omm i -t ee be ~ i eve s de s e rue s pe cia ~ empha s i s at thi s tire; (4) assess the current training programs of the agencies covered by NBSA, including for the first time the nursing research program of the Heal ~ h Resources Administration tHRA), which was brought within the scope of the NFSA ~ eggs anion when the Act was amended in ~ 976; (5) identify the kinds of research positions that are available to and he 1 ~ by recent graduate s of f ederal ly supported training programs; and (6) propose modifications in the administration of the NRSA program in order to achieve its ob j ectives more f us ly. Beyond these primary ob jectives, the committee this year uncle recook ~ study of ca reer pa stern s of Li omed i Cal and behavioral research personnel. This report summarizes data on the pos+--raining activities of both former trainees and former fed lows from federally supported predoctoral and postdoctoral programs and of those not so supported (Chapters 3 and 4 ~ . The Committee al so begins to addre ss the i s sue s o f whether there are alternatives to federal support programs available to students planning research careers in these fields, and whether there are more appropriate and ef festive alternatives to the training grant and felic~wshiF mechanisms. Because the studies relating to these issues have not been completed, the results will be reported next year (see Chapter ~ O. "Federal Support and Training Qual ity") . Iwo other areas of responsibility manifested in the ~egisla' ive history of NESA are touched upon by the Committee this year, bu ~ not explored in depth. One is the que s tion o f whet her the f ed e ra ~ government provide s disproportionate support for ~ raining in the biomedical and behavioral sciences than in other areas in relation to the gave rnment ' s ove ra ~ ~ i nv" stme nt i n re s ea rc h in tho s e area s . The Comma tte" has included some readily availatIe data pertinent to this topic (Supplement 7~. The second issue is whet her the net rate of return to individuals trained in certain f ields that are hea~ri ly supported by ADAMHA, HRA, or NIH i s of such a magnitude as to make it reasonable to require them to bear the cost s of their Own training. This matter is left for future consideration except for citations to scone recent studies (Scuffler, 1977~. 2

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In surmnary, ~ he Commit' ee's report this year addresses a number of the points within its Aegis ativ" charge, and, for the first time, precepts data about the underlying issue of training and career patterns that, although no' expi icitly included in the s tatute, emerged during the ~ egislat~ve debate about the MESA Act. NURSING RESEARCH In the spring of ~ 976 the Congress passed the Health Re search and Health Services Amendments of ~ 9 7 6, Title II of which extended the NRSA authority to include the research train' ng programs of the Division of Nursing of the HRA. The Committee responded to ~ his Congressional action by appointing nurse investigators as members of three of its f ive advi very panels (Behavioral Sciences, Clinical Sciences, and Health Services Research), and ty estate, ishing nursing research as a f if th broad area for study by the committee. The current report ~ bus presents for the first time a discussion of and specific recommendations for advanced training in the area of nursing research (Chapter 7) . SOT ICITATION OF VIEWS FROM THE PUBLIC Prior to the issuance in May 1976 of the second annual report, the Ccmmit~ee both formal ly and informal ly had invi ted the viewpoints of others with regard to the i ssues posed by the legislation and how best to conduct the continuing study no as to accomplish the several Casks set for it. Many useful comments were received, but the number of performs having opportuni' y to comment was small . AS a resul t of the heightened interest in the work of the coon i ttee that a ro se a f t er the wide di s tribut i on o f the ~ 9 7 6 report, the Committee decided to solicit reactions and comments from a broader pubs ic on a more formal basis. Accords ngly, a public hearing was held for this Purpose on November 4, ~ 976, in Washington, c. C., at the National Academy of sciences (NAS), approximate ly f our months after the Committee ' s ~ 976 report had become generals y available (S upplemen~ ~ ~ . The purpose of this hearing was to receive the views of representatives of professional societies, academic institutions, ~ ay organizations, and individual citizens as the Commi ttee proceeded to work toward i ts ~ 9 7 7 report . The committee requested criticism of any aspect of its ~ 976 report. The Committee specifics ly solicited any quantitative evidence that would ~ help verify or refute the array of anecdote' information that always surfaces when 3

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manpower issues are discussed. In addition, the Committee sought sugge stions f or improving it s procedure s and performance ire carrying out its responsibilities. During a full day and evening session, the Committee heard from 36 scheduled speakers and an additional ~ 6 persons who presented brief statements from the fig oor during open discussion periods. The points raised and opinions of fered touched on virtual ly every ma jor topic either addressed in the ~ 976 report or planned for inclusion ire future reports. These included access by minorities and women to research training opportunities, the importance of distinguishing the research -raining needs for behavioral scientists from those f or health services research, the specificity with which numerical recommendations for research training ~ evels should be made by the Committee, the significance of mul tidisciplinary training programs, the training needs in the emerging areas of nursing research and health services research, the impact that new health legislation frequently has upon manpower needs, problems related to the NRSA payback provision, the emphasis given to a number of specific fields, and the division of fields among the Committee's disciplinary panels. All documents submitted to the Committee in connection with the public hearing have been reviewed by the appropriate advisory panels and the Committee and are a part of a file available to the public. The viewpoints and recommendations expressed have assisted the Committee in reaching its conclusions on various policy issues. As noted in Chapters 3-8, representations were made at the hearing on the need for additional training of research personnel in a number of selected fieJ ds. However, the quantitative evidence produced at and subsequent to the hearing was insufficient to support specific proposals. In this report the Committee has not attempted specifically to address each individual's views as expressed at the hearing. Rather, the Committee and its advisory panel s have reviewed the opinions presented there and have attempted to take them into account in making their f indings and recommence ons. The influence of the hearing was most clea rly shown in ~ he Committee ' s speci al ef for ~ s to study the needs for increa sed opportunities for women and minorities, to clarify the re lationships between the training of behavioral scientists and that of health services researchers, to review whether emphasis should be given to particular fields identified for priority consideration by various participants, and to assure that all fields are given adequate review by one or more of the appropriate discipl inary panels. 4

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RE37I EW OF CORRENI STUDI ES The issues that the committee has beer asked to consider cannot adequa ~ ely be addressed f ram data that heretof ore have been available. Consequently, the Committee conducted three special nationwide surveys in order to obtain needed data. One questionnaire collected information from i ndi vidua ~ inve st i gator s i n the b iomedica ~ and behavi ore s ci ence s, an othe r f r om unive r s ity depa rtment s in t he biomedica ~ and behaviora ~ sciences in which all predoctoral training and most of the postdoctoral training is provided, and a third from personnel who had received federal support for graduate training in health services research. Also, a study was conducted by the AS sociation of American Medical Colleges (AAMC} on the research training of M. D. ' s in medi cal cent ers and teaching hospitals . These three studies provided extensive inf oruration that added significantly to the data previous y available to the committee f ram net ~ anal surve y data f i le s main t a in ed by the National Research Council (ARC, ~ 95 8-76} . In addi tion, specialized program data were provided by the federal agencies that administer the NRSA program (ADAMHA, BRA, and NIH). Other data from the National Science Foundation (NSE, 1972-75) and nonfederal organizations, including the American Medical Association (AMA) and AAMC, also were very helpful to the Committee and panels . The Commi tte e a l so reviewed and ana l yz ed thr e e ct he r sour ce s o f inf orma ti on: ~ ~ ~ the comprehen sive stu dy by Cart ter ~ ~ 976 ~ on the pro jected supply of scientists and the future demand for them within the academic sector, (2) the results of a special study conducted for the Ccm~r,ittee t:y Freeman ( 1977) on the development of manpower models in the biomedical sciences and psychology, and (3} an ongoing market study sponsored by NIH that uses periodic surveys to assess the current supply and demand for biomedical and clinical investigators ~ n both academic and nonacademic employment settings (We s tat, Inc., ~ 977) . Together, the se surreys and Saudi e s have provi deaf the Committee with a Such broader ba se of information upon which to develop the present recommendations than previously has been avai fable . Bec ause of the scope and pertinence of the thre e net ion a ~ que st i onnai re s urvey s ~ eve ~ ope ~ by the committee, a brief overview of each is provided below. Survey of Recent Doctorate Recipients, 197 1-75 The purpose of this survey was to collect current information on the training and subsequent work activities of recent Ph. D. recipients in biomedical and behavioral fields. This information is valuable in determining the 5

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impact that declining market conditions flay have had in these fields. Of particular interest were data on the number of graduates taking postdoctorals and the extent to which these appointmer.8s had been prolonged because of cliff iculty in finding employment. From the survey findings the committee also hoped to be able to differentiate among the employment opportunities for graduates in particular biomedical and behavioral fields. Findings from this survey are reported in Chapters 3 and 4. Special efforts were made to survey nurses who had earned doctorate s between ~ 9 7 ~ and ~ 97 5. Many of these individuals received degrees in f ields other than the biomedica ~ and behaves ore ~ sciences (e. g., education} . Survey re sul t s f 0 r thi s group a re reported in Chapter 7 . Survey of Biomedical and Behavioral Science Departments Whil e much i s known about the demographi c characteristics of trainees and training programs, little firm data are available about the role and impact of f ederal training support on academy c departments . For examp, e, the NSF' s annua' departmental survey of graduate science student support and postdoctorals is not sufficiently disaggregated to prove de the detailed information about individual agencies and types of support {fellowships and traineeships) needed by the Committee. Therefore, a questionnaire survey was undertaken to obtain objective data about the academic depar-=ner.+ as a training environment and about the pattern of funding for pre- and postdoctoral trainees. The survey also inquired about sources of nonfederal funding in order to estimate the posse ble impact of the loss of training grant support on departments. Among other issues examined were (~) recent trends in graduate enrollments arid pos+doctorals, (2) substitutability of alternative sources of support for loss of training grant support, and (3} importance of training grants for supporting high-quality training. In addition, information was solicited on departmental perceptions of the current job market, anticipated future faculty needs, the possible lengthening of the postdoctoral training period, and the impact of a worsening job market. Although some preliminary findings are available to the Committee, the task of making a complete analysis of the survey's results for publication could not be completed in time to be included in this year's report. The Committee expec' s to continue analysis of the data and include it in the ~ 978 report. 6

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Survey of Health Services Research Personnel The Comma ttee has found it difficult to assess the current supple y of health services research personnel because an adequate data base does not exist in this recently established area . In order to make a start toward constructing such a data base, the Committee conducted a survey of personnel in health services research whose training had been federally supported (Chapter 61. The survey provided i nformation about training and current employment expert ences . Whi le it is c tear that the persons surveyed do not constitute a sample from which results can be generalized to ~ he population of health services research workers, the Committee believes that ~ hese fin dings are an important first step toward a substantive analysis of needs in thi s area . ~ OVERALL RECOMMENDATIONS FOR FEDE~L SUPPORT In the following sections the Committee presents ~ ~ ~ its views and recommendations with regard to the two program mechani sms by which the agencie s pro,7i tle support f cr research training, and (2) a discussion of the basis for and a summary of its numerical recommendations for FY 1979-~1 for each of the four broad areas into which the study has been ding deaf. Additional recommendations concerning selected policy ~ ssues and the administration of the NRSA program will be f ound in Chapter ~ and Chapter 9 . Mechanisms of Support As the ma jor supporter of health-related biomedical and behavioral science research, the federal government has sought to promote excellence in research through high- quality training. In its ~ 976 report, the Committee pointed out that historically one goal of NIH/ADAMHA training policy has been to increase the number of researchers; "another was to bolster the quality of training programs and to ensure that training was available in areas of national interest." To this end, NIH and ADAM HA have followed two complementary paths in fostering research tr~aining-- individual support of high-quality students through fellowships, and the underwriting of superior training programs through training grants. These paths converge. Where quality training is conducted, the programs attract and select ~op-quali ~ y students who, by their presence, strengthen the programs designed to train them. The focus of training support, the refore, has be en the department or 7

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program, directly through a training grant or indirectly through an individua ~ f e llowship. The Administration' s proposed termination of the NIH and ADPMHA research training grant programs in FY ~ 978 is the late st in a serie s of such actions in recent years to limit supper ~ f or predoctora~ and postdoctoral research training to f en lowships only . The Congres s has not accepted thi s position and has maintained the training programs. The Committee reaffirms the wisdom of Congress in maintaining this tradition of federal support for high-quality research training . Within the context of the overall excellence of federal training programs, there has been continuing debate over the relative merits of training grants as compared with fellowships . Thi s debate is one of the reasons Congress request ed the study that this Committee undertook under the provisions of the NRSA Act of ~ 974. Critics of the training grant approach argue that such grants allow a limited number of unit varsities to recruit students and expand faculty to the d~ sadvantage of institutions that do not have training grants. These critics also say that training grants limit students ' freedom of choice, whereas an individual fed 1 cowslip, awarded on the basis of personal excellence and scientif ic promise, al lows the student to choose the tra ining envi Convent be st suite ~ to hi s or her nee ds and promotes a healthy competition among institutions. On the other side, critics of the individual fellowship argue that, at the predoctoral level at least, students' interests are likely to be so unformed, and their knowledge of training opportunities so limited, that they cannot make truly informed choices . These critics contend that it is expensive to administer individual fellowship competitions on a nationwide basi s, and the balancing of awardees ' institutional preferences against available places is a cumbersome and slow process. They also point out that complete reliance upon individual f ellowships could lead to erratic and unpredictable f ~ actuations in enrollment pressures at ~ ndividual institutions, which would have a destabilizing effect upon the training environment and would imit ability to plan sound programs. The Corrunittee has considered these and other arguments carefully and at length. On balance, it is persuaded that both fell owships and training grants are needed in an ef festive national research training program and that each has a role to play. Because the needs and problems of re se arch trai ning di f f er among the var ious so ienti f i c area s with which the Committee is concerned, recommendations about the appropriate means and magnitude of support must be particular to the area and level of training involved. One aspect of this matter seems so signif icant that it deserves specie 1 comment . The Committee strong ly holds to the view that the training grant approach should not be suddenly abandoned or drastically altered, as the training 8

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capabi' ities of university departments are not quickly or cheaply r~const=' used. Dismantlement of the training grant program could wed ~ impair the ability of some of the nation's leading educational institutions to train high- qual ity researchers for productive careers in the biomedical and b~haviora ~ s cience areas . Recommendation. The Commit' ee recommends that, while saute on and a differential approach are called for, the fedora goverurn~nt should conti rue to support and maintain both training grant and fellowship programs in the be Medical and behavioral sciences. More specific recommendations f or each of the broad area s i s reported upon in the for ~ owing chapters. Basis for Committee ' s Numerical Recommenda' ions The numerical recommendations mad" in the present report are derived in large mea sure f rom the much greater data base now avail abet e to th" Comma thee. Interpretations of the data have been di scus s ed and yes bed against -he inf orbed judgment of the Commi' tee, with the cl ose advice and cooperation of th e parse l s and the s ' a f f . P a rt i cular at tension ha s b e en paid to assessing the quality imps ication of each suggested eco~nendation or position in terms of the Committee' s corclus~ on, stated i n the ~ 976 report, that ''in ad justing public pol icy to reflect changing market conditions, federal poll cy should seek to sustain and enhance this tradition of high qual ity tra ining . " The Committee' s judgments about the nation' s need for by Medical and behavioral manpower are intimately and necessarily linked to its forecast for the level of research support. Admittedly, this forecas' is uncertain, and we make it with hesitation, but make it we must. The Cocci ~ tee ~ s view is that the amount of support for biomedical and behavioral research is likely to continue at about its current ~ evel {with some allowance for inflation} in the next f "w years. Should the 1 evel of support change greatly, either increasing or decreasing, personnel needs would be correspondingly affected. As to the appropriateness of the cu rent ~ ever of support, the Committee takes no position, for it has not studied this question, and indeed believes that it falls outside ~ he Commit ~=e' s charge. Nevertheless, the Committee no+ = s that many indi vi dual s and groups f am i l far wit h the situation believe that the level of re search support is currently inadequate. For instance, the President's BE omedical Research Panel recommended a substantial increase 9

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in national expenditures on health-related R and D. Secondly, many sc ienti st s se e enormous potent a ~ f or ba sic anti applied research on unsolved problems. Thirdly, it has been pointed out that the R and D expenditures in health and medicine are now no more than 3 percent of the health care expenditures, whereas it is not unusual for knowle<3ge-based industries (such as medicine, aerospace, pharmaceuticals} to sperd B- ~ 2 percent of their operating budget on R and D. Others might contend that the current level of R and ~ is adequate. Whatever the appropriateness of the current level, the Committee must act on the basis of its estimate of what ~ s likely to happen rather than on what should be ~ he case. On balance, the Committee believes that in constant dol ~ ars the steady state win ~ continue in the short run. Summary Tats es of Numerical Recomrnenda' ions In its report last year, the Committee made specif ic numerical recommendations for FY ~ 977 and set tentative goals for FY ~ 978 for each broad area. At that time it was intended to review during thi s pa st year the FY ~ 9 78 goals and to make specific recommendations for FY ~ 978 in the present report. However, with the passage of the Health Research and Health Services Amendmer.ts of ~ 97 6, the date for the submission of this and fu Lure annual reports was advanced from March 31 to September 30. The net effect of this charge, together with the change in the starting date for the federal fiscal year from July ~ to October 1, which was made last year, would have made ~ t impractical to make recommendations for FY ~ 97S, as they would b" too late. In the report this year, therefore, recommendations are made for FY 1979, JUMBO, and 1981 for predoctoral and postdoctoral traineeships and fellowships. The recommendations for FY ~ 979 are considered f ire, whereas those for FY 1980-~1 should be considered as tentative goals that the Committee wi ~ ~ review during the coming year and di scuss in its 1 978 report. In Chap ~ ers 3 through 7 the Commit tee pre s ents its f indings and specific recommendations covering each of the fib ve aggregate areas into which this study is divided. However , for the convenience of the reader, a background informal ~, on table and a set of tables that summarize the recommendations for all five areas have been provided: (~} Table 1. ~ shows the number of NTH and ADAMHA trainee and fellowship awards made in EY 1975-76 (including the transition quarter, July 1, 1976 - September 30, 1976, which occurred in 1976 when the start of the federal fiscal year was advanced from July 1 to September 30; (2} Tables 1 .2 and 1. 3 give Comma ttee recommendations for numbers and 10

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decrease ~ 975. This percentages of NIH/ADAMHA/HRA predoctoral and postdoctoral trainee ships and fellowships by aggregate area for FY 1979- 81; (3) Table 1.4 gives estimated costs for the recommended program levels for FY ~ 979-~1 , based on average cost data for sty per.ds, Eric., for FY 1976 obtained from NIH; (4} Figure 1. ~ provides graphs of the Comnittee's recommendations for each aggregate Note should be made in Table ~ in numbers of awards made -~ occurred because of a Decrease in the appropriations provided for the program for FY 1976. For comparisons between the numbers of awards the agencies made in FY 1976 and the targe ~ goals recommended by the committee last year for each broad area, the reader is referred to the following tables: Basic Biomedical Sciences, Chapter 3, Table 3.16; Behavioral sciences, Chapter 4, Table 4.14; Clinical sciences, Chapter 5, Table 5.5; Health services Research, Chapter 6, Table 6.3. Of 14 area. .1 of the significant in FY 1976 compared to FY

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14 12 10 - ~5 In 8 - cn LL o cr 4 us m at (a) Total O 1 1 1 1 1 1 1975 1977 1979 1981 FISCAL YEAR 800 In c, <: 600 0 400 UJ m 200 z ~ =.k~ O .1 1 1 1 1 1 1975 1977 1979 1981 FISCAL YEAR (eJ Health Services Research. From 1979 includes HRA programs. O in 200 m 3 He O 1975 1977 1979 1981 FISCAL YEAR (f) Nursing Research O:.l I I 1_ 1 1975 1977 1979 FISCAL YEAR (b) Basic Biomedical Sciences en ~ 4 _ _ c ~ ~ ~2 O O O: LIJ m 1981 __ O . 1 1 1 1 1 1 1975 1977 1979 FISCAL YEAR (c) Clinical Sciences in cr <:= 2 O ~ cc 0 UJ m - o 1 975 1981 1977 FISCAL YEAR (d) Behavioral Sciences - -- Total ~~ Predoctoral ~ Postdoctoral FIGURE 1.1 Summary of Committee recommendations for NIH and ADAMHA research training awards. Training grant awards are made at the end of a fiscal year and support trainees on duty in the subsequent fiscal year. Fellowship awards are made throughout the fiscal year in which Me training occurs and in this report it is assumed that the fellowship awardee starts his training in the fiscal year of the award. Predoctoral training in the clinical sciences refers to the Medical Scientist Training Program leading to the combined M.D./Ph.D. degree. See Table 1.2 and NRC (1976a, p. 15). 16