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CONTENTS INTRODUCTION AND SUMMARY OF NUMERICAL RECOMMENDATIONS, FISCAL YEARS 1979-81 OBJECTIVES OF THE 1977 REPORT, 2 NURSING RESEARCH, 3 SOLICITATION OF VIEWS FROM THE PUBLIC, 3 REVIEW OF CURRENT STUDIES, 5 Survey of Recent Doctorate Recipients, 1971-75, 5 Survey of Biomedical and Behavioral Science Departments, 6 Survey of Health Services Research Personnel, 7 OVERALL RECOMMENDATIONS FOR FEDERAL SUPPORT, 7 Mechanisms of Support, 7 Basis for Committee's Numerical Recommendations, 9 Summary Tables of Numerical Recommendations, 10 2. ESTIMATION OF MANPOWER NEEDS DESCRIPTION OF THE MARKETS, 17 How the System Works, 17 The Concept of Balance Utilization, 21 Between Supply and ESTIMATION OF NEEDS AT THE DISCIPLINARY LEVEL--THE TWIN PROBLEMS OF TAXONOMY AND MOBILITY AMONG FIELDS, 24 OVERVIEW OF LABOR MARKET ANALYSES, 32 FOOTNOTES, 34 BASIC BIOMEDICAL SCIENCES CURRENT EMPLOYMENT OF RECENT PH.D.'s, 35 RECENT EXPANSION OF THE BIOMEDICAL SCIENCE LABOR FORCE, 50 OUTLOOK FOR BASIC BIOMEDICAL SCIENCES, 57 ENRICHMENT, 65 X1 1 17 35

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RECOMMENDATIONS, 66 Predoctoral Training Postdoctoral Training Levels, 66 Levels, 67 Training Grants and Fellowships, 69 Priority Fields FOOTNOTES, 74 4. BEHAVIORAL SCIENCES for Research Training, 70 CURRENT MARKET SITUATION FOR RECENT GRADUATES, 77 RECENT EXPANSION OF THE BEHAVIORAL SCIENCE LABOR FORCE, 87 OUTLOOK FOR THE BEHAVIORAL SCIENCES, 90 RECOMMENDATIONS, 101 Manpower Employment Characteristics, 103 Predoctoral/Postdoctoral Traineeships/Fellowships, 105 Priority Fields, 106 FOOTNOTES, 109 5. CLINICAL SCIENCES Training, 103 OUTLOOK FOR THE CLINICAL SCIENCES, 114 Numerical Levels, 120 Traineeships/Fellowships, 124 Medical Scientist Training Program, 126 FOOTNOTE, 127 6. HEALTH SERVICES RESEARCH ORIGINS OF FEDERAL SUPPORT, 129 NATIONAL CENTER FOR HEALTH SERVICES RESEARCH, 130 HEALTH SERVICES RESEARCH IN ADAMHA, 132 HEALTH SERVICES RESEARCH IN THE NIH,-133 xii 76 110 128

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CURRENT TRENDS IN HEALTH SERVICES RESEARCH, 133 THE NATURE OF HEALTH SERVICES RESEARCH TRAINING, 135 CURRENT MARKET SITUATION FOR TRAINED HEALTH SERVICES RESEARCH PERSONNEL, 136 ASSESSMENT OF THE LABOR FORCE, 137 OUTLOOK FOR THE LABOR MARKET, 140 RECOMMENDATIONS, 141 Extension of NRSA Authority, 141 Modification of the Payback Provision, 142 Predoctoral/Postdoctoral Training, 143 Traineeships/Fellowships, 144 Midcareer Research Training, 146 Priority Fields, 147 FOOTNOTES, 148 7. NURSING RESEARCH THE NATURE OF NURSING RESEARCH, 152 CURRENT TRENDS IN NURSING RESEARCH, 152 DOCTORAL TRAINING IN NURSING RESEARCH, 155 ASSESSMENT OF THE LABOR FORCE, 157 OUTLOOK FOR THE LABOR MARKET IN NURSING RESEARCH, 159 NURSE TRAINING FUNDED BY NIH AND ADAMHA, 159 RECOMMENDATIONS, 160 Predoctoral/Postdoctoral Training, 161 Traineeships, 162 Fellowships, 164 Summary, 168 FOOTNOTES, 169 ~ x' ~ 150

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8. MINORITIES AND WOMEN MINORITIES IN THE BIOMEDICAL AND BEHAVIORAL SCIENCES, 170 WOMEN IN THE BIOMEDICAL AND BEHAVIORAL SCIENCES, 173 FOOTNOTES, 176 9. ADMINISTRATION OF THE NRSA PROGRAM GENERAL POLICY ISSUES AND RECOMMENDATIONS, 177 Three-Year Limitation on Awards and Criteria for Waiver of Limitation, 177 Payback Provisions and Waiver of Payback Requirement, 179 Stipend Levels, 180 Multidisciplinary Training Grants, 181 Announcement Fields, 182 Acquisition and Dissemination of Employment/ Utilization Information to Individual Applicants and Academic Departments, 183 10. FUTURE DIRECTIONS Federal Support and Training Quality, 185 Field Taxonomy and Mobility, 187 Career Patterns of Federally Supported Trainees and Fellows, 188 Further Development of Models of Supply-Demand Systems, 189 Dissemination of Market FOOTNOTE, 191 SUPPLEMENTS 1 Historical Overview, 195 Information, 190 2 National Research Service Award Authority, 199 x ~ v 170 177 184 193

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3 Issues Raised in Legislative History of the NRSA Act, 206 4 Summary of Findings and Recommendations from 1976 Report, 207 Program for Public Meeting, November 4, 1976, 210 6 Survey Questionnaires, 212 7 Basic Research Obligations and Training Grants Fellowship Expenditures of Federal Agencies, 1966-75, 228 BIBLIOGRAPHY MEMBERSHIP OF ADVISORY PANELS AND COMMITTEE STAFF APPENDIXES (see Volume 2) xv 231 243

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TABLES TABLE 1.1 NIH and ADAMHA Trainee (T) and Fellowship (F) Awards for FY 1975 and FY 1976 including the Transition Quarter 1.2 Committee Recommendations for NIH/ADAMHA/HRA Predoctoral and Postdoctoral Traineeship and Fellowship Awards by Aggregate Field: FY 1979, 1980, and 1981 1.3 Percentage Distribution by Training Level of Recommended Traineeship and Fellowship Awards for FY 1979-81, NIH/ADAMHA/HRA 1.4 Estimated Cost of Recommended Programs for FY 1979-81, Based on FY 1976 Costs, NIH/ ADAMHA/HRA 2.1 The NIH Taxonomy for Trainees and Fellows: Discipline, Specialty, Field Code 2.2 The Two-Dimensional Taxonomy Used by ADAMHA to Classify Trainees and Fellows 2.3 3.1 3.2 3 PAGE 12 13 15 26 27 Taxonomy of the Basic Biomedical and Behavioral Sciences Used in the Committee's Surveys 29 Employment Status of 1971-75 Biomedical Ph.D. Recipients Employment Sector and Work Activities of 1971-75 Biomedical Ph.D. Recipients 37 39 .3 Health-relatedness and Source of Support for Research Conducted by 1971-75 Biomedical Ph.D.'s 40 3.4 1971-75 Biomedical Ph.D.'s Taking Postdoctoral Appointments within a Year after Earning Doctorate 3.5 Tenured and Postdoctoral Positions Held by 1971-75 Biomedical Ph.D.'s in the Academic Sector 3.6 Postdoctoral Appointments Currently Held by 1971-75 Biomedica1 Ph.D.'s 3.7 Relevance of Current Employment or Post- doctoral Appointment Specialty to Doctorate Specialty of 1971-75 Biomedical Ph.D.'s xv' 41 42 43

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3.8 Relevance of Doctoral Degree, Training, and Research Experience to Present Employment Situation of 1971-75 Biomedical Ph.D.'s 47 3.9 Summary of Market Indicators in Selected Biomedical Fields Based on Two Different Criteria 3.10 Employment Plans of 1969-76 Biomedical Ph.D.'s 3.~l Number of Persons in Sectors of the Biomedical Ph.D. Labor Force and Research Component, 1972-75 3.12 Field Mobility of the Ph.D.'s into and out of Basic Biomedical Sciences, 1972-75 Current Trends in Supply/Demand Indicators for Biomedical Science Ph.D.'s 3.14 Projected Growth in Biomedical Science Ph.D. Faculty, 1975-82, Based on Projections of Enrollment and R and D Expenditures 3.15 Projected Average Annual Increment in Biomedical Science Ph.D. Faculty Due to Expansion and Replacement 3.16 Committee Recommendations for NIH and ADAMHA Predoctora~ and Postdoctoral Traineeship and Fellowship Awards in the Basic Biomedical Sciences 4.l Employment Status of 1971-75 Behavioral Ph.D. Recipients 4.2a Employment Sector of 1971-75 Behavioral Ph.D. Recipients 4.2b 4.5 49 52 55 56 58 62 63 68 78 80 Work Activities of 1971-75 Behavioral Ph.D. Recipients 81 Health-relatedness and Source of Support for Research Conducted by 1971-75 Behavioral Ph.D.'s 82 4.4 Research Contribution of 1971-75 Behavioral Ph.D.'s Holding Postdoctoral Appointments 83 Relevance of Current Employment Field to Doctoral Fields of 1971-75 Ph.D.'s 85 4.6 Relevance of Doctoral Degree, Training, and Research Experience to Present Employment Situation of 1971-75 Behavioral Ph.D.'s 86 XV11

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4.7 Employment Prospects of 1969-76 Behavioral Ph.D.'s 89 4.8 Employment Plans of 1969-76 Behavioral Ph.D.'s 91 4.9 Number of Persons in Sectors of the Behavioral Ph.D. Labor Force and Research Component, 1972-75 4.10 Field Mobility of Ph.D.'s into and out of Behavioral Sciences, 1972-75 4.11 Current Trends in Supply/Demand Indicators for Behavioral Science Ph.D.'s 4.12 Projected Growth in Behavioral Ph.D. Faculty, 1975-82, Based on Projections of Enrollment and Faculty/Student Ratio 4.13 Projected Average Annual Increment in Behavioral Science Ph.D. Faculty Due to Expansion and Replacement 4.14 Committee Recommendations for NIH and ADAMHA Predoctoral and Postdoctoral Traineeship and Fellowship Awards in the Behavioral Sciences 5.1 Current Trends in Supply/Demand Indicators in the Clinical Sciences 5.2 Projected Growth in Clinical Faculty, 1975-82, Based on Projections of Medical School Enrollment and R and D Expenditures 5.3 5.4 Projected Average Annual Increment in Clinical Faculty Due to Expansion and Replacement NIH Post-M.D. or Post-M.D./Ph.D. Trainees and Fellows, New Starts 1938-73 5.5 Committee Recommendations for NIH and ADAMHA Predoctoral and Postdoctoral Traineeships and Fellowship Awards in the Clinical Sciences 6.1 Primary Research Specialty of Health Services Research Personnel Trained through Federal Funds (ADAMHA only) 6.2 Primary Research Specialty of Health Services Research Personnel Trained through Federal Funds (HRA only) xviii 92 94 96 99 100 104 112 117 121 123 138 139

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6.3 7.1 7.2 7.3 7.4 Committee Recommendations for NIH and ADAMHA Predoctoral and Postdoctoral Traineeship and Fellowship Awards in Health Services Research Number of Full-time Equivalent Traineeships and Fellowships in Nursing Research Awarded by the HRA Division of Nursing: FY 1968-77 Recommended Distribution of Predoctoral and Postdoctoral Awards for Training in Nursing Research: FY 1979, 1980, and 1981 Recommended Distribution of Traineeships in Nursing Research by Institutional Setting: FY 1979, 1980, and 1981 Recommended Distribution of Fellowships in Nursing Research by Institutional Setting: FY 1979, 1980, and 1981 7.5 Recommended Distribution of Predoctoral and Postdoctoral Traineeships and Fellowships for Training in Nursing Research: FY 1979, 1980, and 1981 x~ x 145 151 161 163 165 166

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FIGURES FIGURES PAGE 1.1 Summary of Committee recommendations for NIH and ADAMHA research training awards 16 2.1 Flop model illustrating the principal paths and decision points leading to the biomedical and behavioral research labor force \9 3.1 Total annual Ph.D.'s awarded in biomedical sciences 5i 3.2 Components contributing to the annual growth of the biomedical science labor force 54 3.3 National support for medical and health- related research 60 3.4 Biomedical enrollment, R and D expenditures, and academic employment, 1961-75, with pro- jections to 1982 61 4.l 4.2 4.3 Total annual Ph.D.'s awarded in behavioral sc fences Components contributing to the annual growth of the behavioral science labor force Behavioral science (psychology, sociology, and anthropology) enrollment, R and D expen- ditures, and academic employment, 1961-75, with projections to 1982 xx 88 93 97

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5.1 5.2 Medical school R and D expenditures, enroll- ment, and clinical faculty, 1961-75, with projections to 1982 Medical school budgeted vacancies and R and D expenditures 6.1 NCHSR research funds by fiscal year 7.1 116 122 132 Total annual expenditure for extramural nursing research and research training, FY 1956-75 Distribution of traineeships and fellowships for training in nursing research including Committee's recommended levels for FY 1979, 1980, and l9Bl xx 154 167

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ABBREVIATIONS AAMC Association of American Medical Colleges ADAMHA Alcoho1, Drug Abuse, and Mental Health Administration American Medical Association Bureau of Labor Statistics, Department of Labor Commission on Human Resources {NBC) Doctorate Records File, Survey of Earned Doctorates Division of Research Grants (NIH} Division of Research Resources (NIH} Full-Time Equivalent Fiscal Year Gross Na~ior~al Product Department of Health, Education, and Welfare Health Resources Administration Institute of Medicine Internal National National National National National National National (ADAMHA) NIAID National Institute Diseases (NIH) NIAMED National Institute Digestive Diseases NICHD National Institute Development (NIH} NIDA National Institute NIDR National Institute NIEHS National Institute (NIH} NIGMS National Institute {NTH) NIH National Institutes of Health NIMH National Institute of Mental Health (ADAMHA) NINCDS National Institute of Neurological and Communicative Disorders and Stroke (NIH} ELM National Library of Medicine (NIB} NRC Hat tonal Re s earch counci ~ NRSA National Research Service Award NSF Nat iona ~ science Foundation OMB Of fice of Management and Budget PHS Public Health service P SAC President' s science Advisory Committee R and ~ Research and Development AMA BLS CHR DRF DEG DER FEE FY GNP HEw HRA TOM IPS NAS NCHSE NCI NEI NELI VIA NIAAA Revenue Service Academy of Sciences center for Health services Research (HRA) Cancer Institute (NIH} Eye Institute (NIH} Heart and Lung Institute (NIH) Institute of Aging {NIB) Institute of Alcoholism and Alcohol Abuse of Allergy and Infecticus Of Arthritis, Metabolism, and (NIH, of Child Health and Human of Drug Abuse (ADAMHA} of Dental Research (NIH} of Environmental Health Sciences of General Medical Sciences ~ .XX1 1

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GLOS SAPY Area--One of the f ive broad areas of tra in inq designated by the Committee as being within the Purview of this study: {~) basic biomedical Pierces, (2) Behavioral sciences, {3) cl inical sciences, (4) health services research, arid (5) nursing research (cf. Field) . A `3iscussi{3n or 1 istinq of the fiel ds cortpr.~sinc~ these areas follows: Basic Biomedical ~Scie~,ces--also referred to as biomedical sciences. see Tat] e 2. 3 {Chapter 2) for a Distinct of f ields included in this area. This area should net he conf used with the designation t~cloo, Cal sciences' which inc1 udes a broader set of fief ds {e.g" botany, ecology, and entomology), or ~ fife sciences, which includes al ~ agricultural, biological, and clinical f ields. Behavioral Scier`ces--see Table 2.3 (Chapter 2) for a listing of f ie1ds included in this area. finis area should not be con f used with the de alienation social sciences, which includes a broader set of fields E., po litica ~ sc ie nc e and econom i cs ~ . C1 inical ~Sc~ences--the fol1~winc; is a list of component training f ields: - Denti stry Medicine and surgery Allergy Anesthesiology Geriatrics Internal medicine Cardiovascular diseases Clinical nutrition Connective tissue diseases Dermatology/syphilology Diabetes Endocrinology Gastroenterology Hematology Infectious diseases Liver diseases Metabolic diseases Nuclear medicine, Oncology Pulmonary diseases Renal diseases Tropical medicine Internal medicine, other Neurology Neuropsychiatry xxiii Obstetrics/gynecology Ophthalmology/optometry Otorhinolaryngology Pediatrics Preventive medicine Psychiatry Radiology Surgery Veterinary medicine Clinical sciences, other

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Heal th Services Research--see Cater 6 for a d~scussicn Of compone nt f ie ld s. Nursina Research-- see Chanter 7 for a discussicn of ~ _ _ ~ component f ic lds ~ Awar+-In the present and previous Committee reports this term refers to the c~rantir~g of a fellowship to an individual or, in the case of a training grant, to a training position made availahie on the grant. It is usual in the latter case for a single training grant to provide for several training po sit ions. Center--Nati onal Center for Hea Ith Service s Re search (~HSR) of the Health Resources Administration (HRA). (if inical Irlvestigator--a medical scientist with ~ professional or academic doctorate doing research In the c] inical s cience s. A Iso, clinical sci en fist. Co~r.mittee--Committee on a Study of National Needs for Biomedical and Behaviora ~ Re search Personnel committee Survev Cor~i~nittee Survey of Recent Doctorate Recicients--:Survey of Biomedical and Behavioral Scientists conducted by the Committee and the National Research Counci 1 (NFC), 197 6. Com~nittee Department survey--survey of Bic~necical and BehavioraI Science Departments conducted by the Committee and the NBC, ~ 97 7. Doctrat e Rec ire ants ~ Academic -received Ph. D. or equiva lent degree. ___ Pro f e ss iona ~ - - rece ~~d M. D., ~ . ~. S -, D. ~ ~ M ., o r other heal th professiona ~ doctorates Enrichment--disp1acement within the labor force of ~ ess- highly-trainee] personnel (with MA. S. or lo~er-leve1 degrees ~ by individuals with doctorate degrees ~ Fie, d--the training or employment specialties within each of the broad areas (cf. Area). ~,eld-switch~na--the movement of individuals between and within fields of training and fields of employment. Labor Force-- inc ludes persons em~:Icyed in positions other than postdoctoral appointments, as field as unemployed persons who are seek ing en:~loy~ent. xx' v

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Medi Cal so ~ent.ist_Irain~nq_Proqrarr--broad, ins ~ itutionally based programs' sponsored by NON, desi gned to assist universities and their medical schools ir, providing selected trainees with the essential scientif ic me<;lical backgrcur~d needed for a career as a medical scientist, generally leading to a combined A. D./Ph. D. degree. National Institutes of Health MENIAL: Alcohols Crud Atuse and Mental Hea lth Admini stra ti on_]ADA~HA ~ .~_lioa 1~. Resow rces Administration {~PA)-- federal agencies of the Public Health Service (PHS I, Department cf Health, Education , and welfare {~:W I, that provide the primary source s of support for biomedical arid behaviors ~ research and research training. The largest agencies, NlR and ADAMEA, are organized into bureaus and institutes that pursue various health problems. National n~:~h ~=r`7~ =~_Award_Act {NRSA Act`_EL_93 348` is 74 ~ --the Act uncIer which this study is undertaken. It charges the Committee Fitly investigating the nation's training needs in the hiemedical and behavioral sciences. For sections of the Act pertinent to this study, see Supp Demerit 2 ~ Panel--refers to any of four specifically cited a, sciplir;ary pane Is associated with this study--Basic Biome<3ica ~ (sciences, Behavioral Sciences, C] ir~ical Sciences, or Health Services Research--or to the Data and Studies Parel, which provides advice and analytical support to the disciplinary pane Is and to the Committee. Report--one c)f the annual reports issued by the Corr~nittee. Survey of Doctorate_Rec~ents--NRC biennie1 survey of Ph. L. scientists currently active in the U. S ~ labor force. Data include information on 1972-75 employment. Survey of Earned Doctorates--NRC annua ~ survey of parsers earning Ph. a. or equivalent degrees in all areas. Survey data include information about. gracInate training and postgraduation e~ployrner3t plans. Training Levels: Predoctoral--study in a graduate program by pr-Ph. D" students and by Are- Is who are engaged in full-tine research training for ~ complete academic year. Beyond what is normally considered graduate educatic~, predoctoral training, as used in this report, also includes clinical science training in the Nedical Science Training Program, often leading to a confined I3 APE,. D. degree! xxv

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Eastaoctora I-- spec ia li zed resea rch train ing ta ki ng place after receipt c: ~ a Ph. {I. or health pro fess ion degree. Post-Ph. D.--sc~cialized research training taking place___ _ after receipt of a Ph-~. degree. Postprofessional-- research training taking place after receipt of a medical, dental ~ veterinary, or other health professional dcctc~rate" Training Mechani~;rcs: fe1Iosvehin--awards Bade directly. to the individual, largely in the form clef a stipend, from a variety of sources, such as the federal qo~rern~nent ~ voluntary health organizat ions foundations, and univer';it.ies; may include an institutional subvention; PHS fel lowships are awarded to individua Is at particular institutions. Training Grar~--awarded to nanE:rof it private or nonfederal pub kc institutions through peer review competitions generally for five-year renewable pericds; in addition to student support, includes institutional program support f or maintenance of the tra ining envi ronment ~ Research Ass istantsh~--graduate student slJE:port _ obta ined through a resea rch grant or contr act to a facul ty member; research assc~ciateships are similar awards at the postdoctoral ~ ever. Teaching Ass istantsh~E~-c~raduate student support provided for teaching services; not specif ically designed for research training" Pi vate_Sun~rt--graduate student support derived from personal resources. including work, laans, and spouse anchor fami ly. transition Quarter--the three-month period, July 1, ~g76, to ~ _ _ __ ~ September 30 ~ 1976, that comprised the one-time shift in the start of the f fiscal year from July 1 to October 1. XXVI