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1 . I~TRODU=ION AND RECC=ENDAT TONS HISTORICAL OV~V=W This report is concerned with national needs for high- quality research personnel in the biomedical and behavioral sciences, with federal and other programs for research training. and with program adjustments necessary to continue providing ~ cadre c)f research scientists to meet the future health needs of this country. Research training programs must sense the fields with which such scientists are related. This reFort endeavors to address these relation ships . Historically, federal interest and involvement ire biomedical and be:hav~oral research increased dramatically after world War T3:, in large measure as a result of the demonstration during the war of the i~runediate benef icial impact of well-organized basic and clinical research. The introduction of penicillin into the treatment of infectious diseases was a striking example. It became clear that expansion of the country's research efforts was in the broad national interest because of its potential for improving human health and welfare. Congress concluded that substanti al f edera l funding wa s j ustif i ed becaus e of the unique importance of health for all Americans. A ma jor national commitment was therefore made to support investigation in the biomedical ~d behavioral sciences in order to improve the health and wel3~-being of all citizens. The enormous growth in federal research support that ensued luring the two decades following the war led to the need for a corresponding cons itment to Me training of adequate numbers of qualified research personnel. Initially, the needed scientists were either attracted from other fields car trained through the limited existing postdoctoral support. It was clear, however, that predoctoral support of graduate students EQUIP tC needed- in order to assure a continuing increase ~ the supply of high- quality researchers in these developing sciences. Hence, training grant and fellowship support in the beginning was directed primari7 y at augmenting the capability of the educational system to supply additional researchers while also seeking to improve the quality of their training. This system, with the support of federal funding, rapidly developed to the point where it now provides an adequate supply of research personnel equipped to carry out the 1

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national research effort in many of the biomedical and beha,7iora ~ fields. In vi ew of the recent 1 essening rate of federal investment in biomedical and behavioral research. both the executive and legislative branches of government increasingly have sought to determine the level and kinds of research training support that are needed to meet national health need s. Recognizing the responsibility of the federal government to assess these needs while maintaining its vital role in supporting excel fence in research training, Congress passed the National Research Service Award Act of ~ 974 (URSA Act). This had as one of its primary objectives the continued evaluation of the nation' s needs for biomedical and behavioral -research personnel. The Act directed the Secretary of the Department of Health, Education, and Welfare to commis Lion such a study by the National Academy of Sciences, which accepted the task and in early 1975 establi shed the present Committee. The charge given to the Committee under the Act is a formidable one, covering a wide range of issues that over many years and in Many ways have been addres see by the Congress, the executive branch, and various professional organizations. In previous attempts to study national health research manpower issues, investigators have stated, and indeed, emphasized, the complexity and cliff iculty 0 f the task. ~ In its feasibility - study February ~ 9751, a National Research Council (NRC) committee pointed out the complexities of the charge and, in concurrence with the Congressional intent, indicated that a long-term continuing study would be needed to deal with these issues satisfactorily. In the Acts the Committee is specifically required to: (~) establish {a) the nation's overall need for biomedical and behavioral research personnel, (~) the sub j ect areas in which such personnel are needed and the number of personnel needed in each area, and (c) the kinds and extent of training which should be provided for such personnel; (2 ~ assess the current training programs avail abet e for the training of biomedical and behavioral res earch personnel, including those supported }:y the National In stitutes of Health and the Alcohol, Drug Abus e ~ and Mental Health Administration as well as by other sources; 3) identify the kinds of research positions available to and held by individuals comp1 eting such training; 2

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(4) determine to the extent feasible whether, without NIE and ADAM HA res earch training support, other programs could provide training to an adequate number of individuals to meet the nation's needs established under item ~ above; and (53 determine what modifications in current N3: 11, ADAMBA, and other available training programs are necessary to meat these need s. In its 1975 report, 3 pubs ished only 4 months after the feasibility study, the Committee began to address the issues listed above. It divided the aver all areas of biomedical and behavioral research into four fields: basic biomedical sciences, clinical sciences, behavioral sciences, and health services research. However, because of the complexity of the issues being addressed and the short time available to collect and review data, the Committee stated in that report that it did not have a sufficiently firm basis upon which to recommend ma jor changes or ad justments within ongoing training support programs. The Committee concluded, therefore, that until it could review and evaluate both the existing data and the individual viewpoints and judgments of its own members, and those of its advisory panels and over constituents of the research training comxnur~ity, it would be best to maintain unchanged the mechanisms, categories, and support level s of federal funding of research training programs in each of the four aggregate fields identified above. Thus, while recommending no changes, the Committee responded to the f irst two mandates of the Act. With regard to the third task specified in the Act, that of identi tying the kinds of research positions available to personnel who complete such research training, the 1975 re port pries en te ~ a bra e f summary 0 f the employment activities of former NIB trainees and fell ows. For these data the Committee drew upon the results of a prior study by another ARC committee of the impact cuff NIH training programs on We career patterns of bioscientists. ~ Chapter Iv of the- ~ g7S report addressed the Act' s fourth mandate of whether NIR and AI)ANHA support of research training is required to meet the nation' s needs for research personnel. This was done by examining data collected by the National Science Foundation on other federal and nonfederal programs supporting graduate science students. The impressions gained at that time from this preliminary analysis, although informative, were not conclusive and thus the issue requires further study. These analytical tasks, though initiated last year, are still basic to the Committee's charge of assessing the national needs for biomedical and behavioral research personnel. Thus they constitute a core of continuing 3

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studies that the Committee will reexamine each year as new data are produced and as new developments take place in the research environment. REVI EW OF CURRENT STUDIES It had been anticipated from the start that some of the important issues addressed in the legislation could not be fully dealt with by using existing information. Because of the time constraints- imposed for preparing the Corrunittee's reports, it seemed prudent to use these avail able resources before any new surreys or other extensive data-gathering activities were undertaken. Thus, in preparing the present report, the Committee has relied primaril y upon information from other studies of human resources and graduate education and on special tabulations of data which had already been collected. Much of the available information is incompl ete, and some of it ambiguous. On some points there - is no objective evidence available and the Committee has had to rely almost entirely upon the expert judgment of its advisory panels and the experience of its own members in addressing the compl ex questions specified in the legis lati on . The Committee recogniz es the hazards of ''expert judgment, " but believes it has used such judgments cautiously in arriving at its recommendations. Mea nwhi ~ e, it is proceeding to search out more ob jective evidence bearing on these issues. In attempting for this year' s report to estimate the overall need for biomedical and behavioral research personnel ,s the Committee and panels have considered the most recent Ph . D . manpower pro j actions Inane by the National Science Foundations and the Bureau of Labor Statistics . ~ However, the substantial differences in methodologies and results from these pro jections have made it difficult for the Committee to draw firm conclusions from them. For its examination of the market for Ph.D. scientists, the Committee has also considered various tabulations and analyses of data f rom f iles maintained by the National Res earch Council ~ ~ For the analysis of the market for M. O. researchers, the Committee has examir~d data from the American Medical Association and the Association of American Medical Colleges. 9 Unfortunately, neither source provided complete information on the total number of M.~. ' s and other professional doctorate recipients qualified to conduct clinical research. The identification of the health services research population in all of the cited data sources also presented particu' ar difficulty since many such researchers have earned doctorates in the traditional biomedical and behavio ra ~ di s choline s arid cannot be di s tingui shed by that 4

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criterion from other persons with similar training who are not so engaged. In addition to the information relevant to supply and uti l i z a ti on, data for r es ear ch expen ditures in the a ca demic sector have been compi led by the National Science Foundation. ~ ° Graduate and undergraduate enrollment estimates were obtained from the C)ff-ice of Educations ~ and the National Science Foundation. t2 All of these data have been useful in projecting employment requirements in the academic sector, but the inability to isoi ate selected sub- populations has made it impossible to separate health- related research positions from other employment opportunities in the biomedical and behavioral sciences. Information about alternative mechanisms for support of graduate training has been obtained from several sources. The NTH and ADAMElA have furnished much relevant information about their respective training programs, most of which has been incl uded in the Appendixes . A broader perspective of support for graduate education has been obtained from the information collected by a graduate school departmental surreys 3 conducted by the National Science Foundation and from the National Research Counci1's survey of Ph.D. recipients. t4 However, none of these data sources provides the comprehensive picture needed to respond ef f actively to some of the issues raised by the NESA Act. For exampl e, as described in Chapter 2, although graduate students typically rely on more than one source of support for their education, no data presents y available to the Committee show the extent to which students are dependent upon each source, nor is there adequate information about the distribution or pattern of va rious training modes throughout the training period of individual students. Despite the deficiencies cited, the above data sources and the tabul ations drawn from them have been quite useful in describing trends in the components of suppl y and utilization of the Ph. D. ~ abor force in the biomedical and behavioral fields. The Committee has examined these trends and has concluded that the overall needs for these Ph. D. 's are not expensed to continue to expand as they did during the ~ 960 ~ s, primarily because of the anticipated stabilization of undergraduate and graduate enrollments and a more modest growth in federal research Expenditures. Some evidence of changes in the utilization patterns of recent Ph. D. recipients in these fields has already been noted and is discussed in Chapter 3 of this report. In addition' the age distribution of the current biomedical and behavioral Phe D. ~ abor force is rather young and the indications are that relatively few individuals will retire from it in the next several years. Is Hence, the labor force is expected to continue to expand significantly, even though the rate of growth in Ph. 9. production appears to be slowing down. The market situation for persons with training in the clinical sciences appears to be sub ject to a different set 5

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of factors. As discussed in Chapter 3, there has been an apparent - decline over the period 1968 to 1973 ire the nurser of M.~. Is engaged in research and teaching activities. In contra st, the numbe r o f c lin i Cal f acuity po s iti on s in medical s chools has been increasing substantially and is expected to continue to increase at a rate of between 5 and percent per year up to 1980. Thus the Committee does. not foresee an oversupply situation OCR for page 1
support mechanisms is discussed in further detail in the f allowing paragraphs and in Chapter 2. The fellowship program follows a long tradition in this country of awards based upon individual ability and initiative as shown by past academic performance and personal characteristics. The training grant' through its institutional support, is designed to provide stability and to permit f lexibi lity and innovation in research training-- three factors that encourage continuity of excellence in an academic fief d. Both fell owships and training grants make available a high degree of flexibility in choosing programs ~ The f ellow may personally seeing admission to different programs and departments at various institutions. The trainee is afforded great flexibility in choosing a course of study within his program because he is not bound to a specific pro ject. Training grants represent up to a 5-year commitment to support a broad range of training-related activities designee to establish and maintain an environment conducive to research excellence. AS an independent source of funds that goes beyond the existing financial constraints of institutions and departments, training grants provide inc enti ve s f or p rogra m innova ti on through st art-up and ongoing s upport that can initiate inter- and multidisciplinary programs, overcome the inertia of the current academic disciplinary structure. and provide ~ legitimacy for new discipline- or problem-oriented approaches. Thus, while fellowships and traineeships encourage tal ented students to pursue careers in research, training grants additional y enhance the ability of departments to prepare them for truly productive careers. Tt should be noted as wel ~ that the training grant program has enabled many departments to be strengthened that otherwi se might not have been. Institutions that may not hay" had uniformly strong programs have been able to develop strength and excellence within individual departments. In so doing, they often have strengthened relate departments that have benefited from the training program and its ability to draw in related discip~ ines. The pear review process, conducted through the funding agencies, tends to winnow out the less strong programs during competition for renewal. As the number <:f training grant awards has been curtailed in recent years due to budget constraints, the quality of remaining programs has constant! y been heightened through the peer review system. The Committee believes that the federal responsibility for health research training goes beyond the simple assurance of access to graduate and postdoctoral trainings and exten ds to the provision of programs that are of a high level- of excellence in areas relevant to the national interest . Such re span sibility may include not only particu~ ar research problems but also the development of 7

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whole new areas of research need. Innovation in programs must continua Ily be encouraged. Financial constraints placed on departments and institutions militate against their taking the initiative or being able to follow through on new ideas. The federal government' s support is critical to such innovation and must therefore include, as much as possible, provision for program support as well as trainee support. RECOMMENDAT IONS In this year' s report the Committee is making a number of recommendations for ad justments in the number of pr-doctoral and postdoctoral awards for research training in each of the four broad fields--basic bion~ed~cal sciences, behavioral sciences, clinical sciences, and health services research-- with respect to fiscal years 1976, ~ 977, and 1978. Because of the differences among these four fields, recommendations with re specs to each are di scussed separately. These f our recommendations are based on the Ccmmittee' s review of existing data and on best judgment, and are designed to: (a} reflect the overall needs with regard to number of initiate 1 s to be supported; (b) estate ish the directions for pre- and postdoctoral support through EY ~ 978 given the perceived needs within each }:)roatl field; and (c) provide the appropriate distribution of training grants and fellowships at each level of research training. A fifth reco~ranendation concerns the separation of fields appropriate for training grant awards from these appropriate for fellowships as announced by NIR. In developing these recommendations, the Corrunittee has worked with its advisory panels, who provided advice with respect to the needs in their own areas of expertise, and who propo sed program ad justments in response to the current manpower requirements in the biomedical and behavioral sciences. Not unexpectedly, the resultant recommendations of the Committee differ somewhat from one field to another. In all of its deliberations, the Committee has striven to make those decisions and recommendations that would further the goal of excellence of the individual researcher, the research training programs, and ultimately of the research enterpris e. The committee recognizes that its reconunendations with respect to FY 1976 can constitute only target goals, as much of this f iscal year has already passed. Unless otherwise noted, it s princi Fal specif i c recommendation s relate to FY 1977. Tentative goals for FY 1978 are also included, with the understanding that these will be reviewed in the coning year an d that f ina l spe c if i c r ecornm Invasion s will be ma de i n next year's report. 8

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RECOMMENDATION 1: BASIC BIOMEDICAL SCIENCES Currently availab' e information on the pro jected employment market for research personnel in the biomedical sciences indicates the advisability of a modest but significant reduc tion of about ~ O percent in the number of f ederally funded predoctoral candidates in that field from the level that existed in BY 1975. This reduction should be undertaken in FY 1976. Although this reduced level is shown in Table 1. ~ and Figure 1. ~ as being maintained through FY 197B, the Committee, during the coming year, wit ~ be studying in greater aetail the effects of the reco~Tunended decrease In funding in order- to determine whether an increas e, a further decrease, or maintenance at that fret is warranted. The Committee ~ s Panel on Basic Biomedical Sciences intends to devise a feedback mechanism to assist in this monitoring effort. The Committee also recommends that the number of federally funded postdoctorals in FY 1975-~n the basic biomedical sciences should be continued at this time without change. It is at this level of study that the most able investigators in the basic biomedical sciences receive their specialized training. For Fredoctoral candidates, the Committee concludes that funding by the training grant mechanism represents the most appropriate f own of f ederal res earch training support. In contrast, for postOc~ctora' students, the recommendation is that the ma jority shoul ~ be funded through the fellowship progr am ~ T hi s mec hen i s m not onI y as sur es t hat h igh-qu a lity candidates are selected through the national peer review process, but that rapid adjustments can be made in response to res earch opportunities in various areas. In addition, the fellowship mechanism makes it possible for high-quality ind~vidua ~ training to he obtained in the selected field at the institution of the fell ow's choice. RECOMMENDAT ION 2: BEHAVIOR SCIENCES The Committee recognizes the need for continued federal support of training of the behavioral scientists who are conducting research relevant to the health needs of the country. Current trends ~ behavioral science research, however, suggest that a significant reorientation of emphasis in the federally supported research training effort is desirable at this time. Scientific advances in these fields have vastly increased the complexity of research methods and imposed requirements for more intensive training. While the number of Ph. D. -level individuals currently being trained in the behavioral sciences appears to meet market demands in the conventional disciplines, there is a growing need for more specialized behavioral 9

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science research training to deal with these increasingly complex research questions in the area of behavior and health. The Committee therefore recommends an orderly taper ing dawn of predoctoral support with a concomitant emphasis on providing for research specialization through postdoctoral training, - thus assuring the active application of advanced research training to meet the health needs of the country. The Committee recommends that -the current apportionment of about 10 percent postdo~orals and 90 percent predoctorals trained in the behavioral sciences through this program should be modified so- that ultimate' y 70 percent of the individuals supported by NRSA funds are postdoctoral students and 30 percent are predoctoral students In this way the Committee believes sufficient opportunity for training in the behavioral sciences at the postdoctoral leered will be assured, while an adequate number of awards for basic research training at the predoctoral level also will be maintained. However, it i s recommended that this change should be implemented gradually anti at essentially a constant level of federal funding in EM 1976, FY 1977, and FY ~ 9 7 8, in - ores r to minim) z e the di s lo cat lo ns the t cou ld otherwise occur for both programs and personnel. Because of the greater cost of postdoctoral training, this shift will mean significant reduction in the number of behavioral science investigators trained with federal furies during the 3-year period; however, the change is expected to enhance the quality of both the programs and the trainees. In keeping with the above, the Committee recommends that the level of predoctc~ral candidates funded in FY- 1975 be reduced by 250 in FY ~ 976, 300 in EY ~ 977, and 350 in FY 197S, and that the number of postOc~ctorals simultaneously be increased by about 150-200 each year until the recommended ratio is achieved. ~ 6 The Committee will monitor closely the results o f this change and will discuss in future reports whether modi f ice tion of thi s recommendation is warrantee. Concerning the use of training grants and f ellowships, the Committee concludes that for both predoctoral and postdoctoral students federal funding should remain at approximately the current ratio of traineeships to fellowships (82 percent training grants and 18 percent fellowshi ps} . While the recommendation that postdoctoral trainer in the behavioral sciences should be conducted largely through training grants may appear inconsistent with the Committee' s strong endorsement of the fell ow strip mechanism for postdoctoral training in basic biomedical research, different circumstances in the behavioral sciences cad ~ for a dif ferent approach. Whereas in the basic biomedical sciences postdoctoral training is well established and widely accepted, this is not so in the behavioral sciences, where postdoctoral training is just Beginning to emerge. AS a result, the fur ~ array of training alternatives must be 10

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expanded, especial ly in the area of health and behavior. I?urther~nore, in view of the growing need for interdisciplinary training, the Committee believes that the formation of postdoctoral training programs by the faculties of training institutions wall offer the necessary organization of innovative research training experiences for postdoctoral behavioral scientists at this time. R~COMMENDATION 3: CLINICAL SCIENCES The Committee concludes that the continued need for research-trained clinicians to investigate the applicability of new biomedical knowledge to disease problems in man justifies some emphasis ~ post-M. I). research training in the immediate future. Although virtually al ~ of the researchers in the clinical sciences are M.~.'s, similar principles for training needs also apply to the smaller group of other professional doctorate holders, such as dentists and veterinarians, and Ph. D. ' s working ~ the clinical sciences. The Committee recommends that 2, 800 trainees and fellows at the postdoctoral level be funded by the end of FY 1977, and t ha t th i s l evel t: e mains al n ed during FY 19 7 8 . The Committee will continue to monitor this recommendation to determine future (directions as further information is developed . Thi s ~ecornmenried level for FY 19 77 represents a one-third decrease from the peak level of postdoctoral s funded in FY 1969 (about 4,200) ~ when clinical specialty traineeships and some clinical residencies were also being funded, but a IC percent increase over the number funded by the NTH in FS: ~975 {about 2,550~. The physician, al though trained for clinical practice. has usually not had the same formal training in scientific res earch as a person who has earn Ed the Ph. D . degree ~ There i s a need for high-qua ~ ity prog rams specif i Cal ly des ign ed to provide the rigorous scientific background necessary to produce a clinician with the skills necessary to be a productive research scientist. The Committee therefore concludes that most of the federal funding in this field should be in the f orm of training grants . A ratio of about 80 percent in traineeships and 20 percent in fellowships is considered appropriate. The Comma ttee tool< special note of the NTH-sponsored Medical S cientist Training Program, which supports gradual" level training in medically relevant scientific fields, leading usually to the award of both the M. D. and Ph. D. degrees. It recommends that approximately 600 trainee positions be funded in EY 1977, an increase from the S81 positions authorized in PY 1976 and the approximately 550 trainees supported in FY ~ 975. 11

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RECOMMENDAT70N 4: HEALTH SERVICES REACH The Committee concludes that health services research represents an emerging area of national importance, in New of the ever-incr~asing amount of public and private funds expende ~ in h eel th s ervi ces . In HI ~ an ~ ADAMHA, the only f ormal ly des ignated program in this area Is the mental health services research and evaluation program supported by ADAMHA. In addition, both agencies provide training in a number of basic biomedical and behavioral sciences disciplines, such as epidemiology. sociology, and biostatistics, whose methods are appropriate to health services research. The Committee concludes that present funding of predoctoral and postdoctoral students in these disciplines shout ~ be continued at the existing level as a feeder mechanism for later more focused training in the health services research field. These programs will be assessed to determine whether current levels are sufficient . to meet pro jected needs. The Committee also recommends that both predc~ctoral and postdoctoral training in this area should be undertaken largely through training grants rather than through fellowships. Although funding by the Health Resources Administration (=A3 of the Public Health Service i s not the primary f ocus of the legislative mandate of this Committee, consideration of existing and emerging policies of BRA with respect to health services research has a direct bearing on the recommendations and therefore must also be discussed. Since ~ 96S, the National Center for Health Services Research, which now is part of HP OCR for page 1
sound basic research training to bear upon the special problems of improving the provisions of health care. Third By, training should be provided primarily through the training gran t mecha ni sm. except in tho s e in Stan c es whe re the research fel lows hip is more appropriate to the need for acquiring specialized skills. If BRA is unable to continue its former ro~ e, it is important that NTIl_and ADAMHA deve lop and expan ~ their own formall y designated programs for funding research training in the health services field. NUMERICAL RECOMMENDAT IONS The numbers of traineeship and fellowship awards made by NTH and ADAMS A in FY ~ 9 7 5 f or su pport of train ing in e a ch aggregate fiel ~ are shown in Tatle ~ . ~ and Figure ~ . 1, together with the Committee ' s recommendations for PY ~ 976 through EY ~ 978. The funds estimated to be required by the recommendations, using the assumptions noted in the footnotes, are given in Table ~ . 2. Table II . ~ in Appendix II contai ns additional data relevant to Tables 1. ~ and 1. 2. The Committee strongly believes that periodic ad justments in the magnitude, directions, and types of research training programs, including specif ic changes recommended in this reFort, should be taken In gradual steps rather than by precip' toils action that would produce dramatic disruptions. Prediction of future personnel requirements in any research area is uncertain, and major program changes shoul ~ not be undertakers until their possible con sequences have been carefully studied. Furthermore, any alterations In federal funding wil ~ ine'7i tab! y have an impact on numerous training programs in privately and pub' icly supported institutions that have been receiving f ederal support over the years and on individuals whose livelihoods are intimately connected with these programs. Changes should therefore be instituted with adequate advance notice, so the t severe adverse cons equences can be Art nimized. RECOMMENDATION 5: ANNCONCEME~ AR=S The Committee has reviewed the preliminary announcements issued by NIR on October 24, ~ 975, and by ADAMEA on October ~ O. ~ 975, for this year's NRSA program. (See Appendix VII for announcement s ~ ~ The Committee questions the va ~ idi ty of the distinction drawn by the NIE in its announcements between areas that are appropriate for training grants and areas that are appropriate for fellowships, since no 13

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TABLE 1.2 E:s-;mated Cost of Recommended Programs for EM 1976-78, Ott and ADAM (~ lions of dollars) Aggregate Field Biomedical Sciences Behavioral Sciences Clinical Sciences Health Services Research Act:ua.1 Cost for EM 1975 to millions) ... . . _ Total Pre Post . 95.6 51.? 43.9 18.1 15.1 3.0 55.8 4.1 51.7 0.7 2.0 1.3 TOTAL 171.5 72.2 99.3 Esti me ted Cost of Recommended program _ . . . _ . . . Target Awls _ for }A 1976 (S millions) Total Pee Post .. . , _ . . _ . . . . . _ 91.6 46.1 45.5 18.1 13.0 S.1 55.9 4.9 51.0 1~9 1.2 0.7 167.5 65.2 102.3 Recom~nenda~ons for ~ 1971 ($ millions ) . . . .. . To01 Pre Cost Tentative Gems for MY 19?8 (S millions) Total Pre Pos _ , . 91.6 46.1 45~5 91.6 46.1 45. 18.1 10.4 7.7 18.1 1.4 10. ' 55.5 5.1 50.4 55.5 5.1 50.` - _ 0.7 1.9 167.1 62.8 104.3 167.1 59~8 IC7.3 1.9 1.2 1.2 O.' CODE: Pre = pre-Ph.D. or pre-M.D.; Post = post-Ph.D. or post-M.D. 3 ASSUMPTIONS: 1. The total awarders are distributed among training grants and fellowships approximately as shown in AnpenA;x Table II.1. These average casts were derived from data supplied by the institutes of NIE and ADAMHA. The average cost for a predoctoral trainee is $8,500, including indirect expense at 7 percent. The average cost for a postdoctoral trainee is S14,500 (except in The clinics sciences an explained below), including indirect expense at 7 percent. me average cost for a predoctoral fellow is S10, 000, including S3, 000 institutional allowance. The average cost.for a postdoctoral fellow is S14, 000, (except in the clinical sciences as . . explained below), including S3, 000 institutional allowance. An the clinical sciences, the average cost in FY 1975 for a postdoctoral trainee was about $20,000. This was higher than in other fields for the following reasons: (a) Prior to enactment of the NBSA Act of 1914, considerable flexibility was given to the training grant directors =n setting stipend levels. Thus, higher than normal stipends were often paid to post-M.D.'s, many of whom. had finished their residency and were older and more experienced than other trainees; (b) The costs of the staff and faculty were also generally higher on clinical science training grants. render the NOVA Act, stipends will adhere more strictly to established levels and hence, the average cast per post-M. D. trainee ~ the clinical sciences is expected to decrease to about S 19, 000 in E'Y 1977 . For post-M. ~ . f ellows, We average cost is expected to decrease from $16, 000 in FY 1975 and EM 1976 to S1S, 000 in BY 1977. These decreases accost for the decline ~ the estimated cost of the clinical sciences to nag program despite the increasing number of trainees. For FY 1975, the total cost of S171.5 million was taken frown data supplied by NIB and ADAMMA. The total for predoctoral was estimated by applying average cost figures to the estimated number of predoctoral awards. me total for postdoctorals was obtained by subtraction. 4. The cost estimates above sauce no attempt to estimate possible future increases in stipend and allowance levels due to inflation. 16

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criteria for inclusion or exclusion of specific areas for funding h eve teen stated by the NIH. The ~Cornmittee recommends that this practice be discontinued. The Committee is also concerned that there may be additional areas that are not listed that may also be appropriate for federal funding. Moreover, the Committee notes that some other basic- research areas, such as immunology and biostatistics, are listed for funding by specif ic categorical institutes but not by the National Institute of General Medical Sciences. The Committee is of the opinion that NESA fellowships and training grants shoul ~ be awarded so' ely on the basis of quality within program categories deemed relevant to the national interests At the present there is no basis for determining under Section 472 (a} (3} of the Act that any particul ar sub ject area is not appropriate for such funding. Although. as is pointed out ~ n the last section of this chapter, the Committee is unapt ~ at this time to specify scientific areas or subjects for special emphasis, it nonethel ess wishes to state clears y that its recommended reductions in certain broad fields should not he achieved by exclusion or limitation of specific sub ject areas. Thee Committee wil ~ be meeting with NIE and ADAMEA personnel to consider these matters further in the coming year and will discuss them fully in its next report. THE TAS K OF ID~NTIFYING PRICRITY TWINING YEAS The Committee has carefully considered the broader congressional mandate to identify areas in biomedical and behavioral research that justify special emphasis for research training' either because they are emerging areas of significant promise, or because they represent important national needs not adequately emphasized at this time. The Committee recognizes the importance cuff the r<: le played by informed expert opinion In carrying cut this legislative charge. This task cannot be and has not been taken lightly. In the past year, the Co~runittee has proceeded to consider this matter with each of its four disciplinary advisory panels. The Committee, together with these advisory panels' has determined that existing analytic methods are insufficient and that more satisfactory ones must be developed during the coming year before sound recommendations can be assured (see Chapter 4~. Within the framework of this study the Committee has reviewed data that describe the comfy: sition of, and mobility within, the biomedical and behavioral research fields. However, the dif f iculti es of interpretation suggest that great caution be exercised in the translating n of such information into formal recommendations for federal action. For example, it has been noted that significant portions of 17 1.

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the trained research population have been found to be employed in areas outside of their fields of training. However, it is not possible at this time to determine to what extent these reflect changes in market conditions or are indicative simply of the versatility of the individuals' training. Until the factors underlying field mobility are investigated in greater detail and other rel ated factors are explored, the Committee has concluded that specification of priority areas for research training would be not only incomplete and speculative, but also possibly misleading at this time . Despite the absence of such subfield recommendations in the present report, the Committee has given some consideration to the appropriateness of such specifications with respect to the distribution of research training support within each aggregate field. For exampi e, the Co~Tunittee notes that research personnel from the fields of biomathematics and biostatistics are utilized in and contribute to each of the four broad fields. Some comn~nts with regard to subfield concerns follow. Basic Biomedical Sciences The continuing availabil ity of an adequate number of inves tigators from existing training programs, the broad base of the training they have received, and the close relationship among many basic biomedical disciplines have led to a substantial degree of mobility between different disciplines. The impl ication of these findings with respect to designation of specialty areas for research training for predoctoral support is that important areas of research can be adequately staffed by personnel emerging under the existing types of training programs. This has ledl the Committee to conclude that designation of specialty areas is not warranted at this time. With regard to postdoctoral research training, the C¢~mnittee wil ~ study this matter in the coming year to determine if specific areas can be identified for special consideration. Behavioral Sciences The Committee recognizes that important changes in research training needs are now taking place as behavioral scientists encounter more compel ex and interdisciplinary problems in the biomedical research laboratory and other health-relate<] areas. The Committee believes that further Nonformation is require to discern the impact of such shifts upon the training requirements for specific su})specialty areas within the behavioral sciences. Accordingly, the Committee is recommending greater emphasis on postdoctoral training by 18

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which trainees who have air eady mastered the basic behavioral disciplines can acquire the specialized training they wi l l n ee d to wo rk fruit fu lly on hea l th- rel at ed re s earch problems. Until the share of research training needs in the behavioral sci ences field becomes clearer, the Committee refrains from identifying specific subfields for special emphasis. The Committee will carefully study the views with respect to research training needs that are reflected in the professional judgments of members of the behavioral sciences research community as they propose and formul ate postdoctoral training programs. Sufficient reliance can be placed in this mechanism for the immediate future; the Committee and its Behavioral Scat ences Panel will keep the matter under continuing scrutiny. Clinical Sciences The Committee recognizes that important clinical advances often depend upon research in biomedical or physical sciences not original ly directed toward the diagnosis, treatment, car prevention of specific diseases. Neverthel ess, fur ~ application of basic knowledge to the so' ution of Cal inical probe ems often requires that additional personnel be trained for research in particular Cal inical fields after t hey have received their professional degree . The Committee is aware of some areas of research training that have been suggested by 1 eaders in this field as justifying special consideration, but has concluded that the data present) y available are insufficient to permit a firm conclusion on thi s matter at this time. The Committee wil ~ review these and other suggestions for special consideration in subs equent reports. In the interim, as the basic guiding principal e, it recommends that primary emphasis be given to training for research on the etiology and pathogen~tic mechanisms of disease; it is in this way that the greatest progress wil ~ be made in the ultimate prevention and treatment of diseases. Health Services Research Because the entire spectrum of disciplines comprising health services research requires substantial enhancement through research training, the Committee concludes that it is inappropriate to single out areas suitab1 ~ for priority treatment. The - Committee believes it will be necessary to increase the nation' s overall investment in this field before specific areas of particular need can be targeted. 19

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To summariz e, the Committee emE:hasiz es that there is a need for highly quad if i ed research personnel to be trained in all four of the broad fields into which it has divided biomedical and behavioral research, and that there is a similar need in each specialty sub ject area within those four fields. Finally, the Committee notes the extensive work of the President 's Biomedical Research Panel in reviewing the present course of biomedical research in the nation and making recommendations for the future. The Committee will carefully review the f inal report of this panel, and the public reaction to it, to determine whether additional areas of research should be designated for special emphasis with regard to appropriate petrels for research training. 20

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FOOTNOTES 1. National Board on Graduate Education, Federal Policy Alternatives toward Graduate Education, Washington, D.C. National Academy of Sciences, January ~ 974 ~ 2. See Appendix ~ for relevant sections of the National Res earch Service Awa rd Act of ? 9 7 4 . 3 . Nation a' Research Council, Commission on Human Resources, Personn el Needs and Training for Biomedi cat and Behavioral Research. The ~ 975 Report of the Con tee on a Study of National Needs for Biomedical and Behavioral Res earch . . . . . . Personnel, Washington ~ O.C., National Academy of Sciences, 1 975. 4 . National Research Counci 1:, Commi s sion on Human Resources, Res earch Training and Career Patterns of Bioscientists ~ The . . . . . . . Training Programs of the National Institutes of Health ~ . .. .- Report of the Committee on a StU0Y of the Impact of the National Institutes of Health Research Training Program on . . . . . . . the Career Patterns of Piosci~ntists, Washington, D. C., , ~ . _ _ _ _ _ _ _ , National Academy of Sciences, ~ 975. 5. The Co~ranittee' s interpretation of "need" in the context of this study is based on the concept of personnel requirements expected to exist at prevailing wage levels. Another possible interpretation is discussed in Chapter 2, p. 33. 6 . Nat tonal S cience Foundation, Prod Actions of Science and . . Enqinee ring Doctorate Suppl y and Utiliz ation ~ 9 ~ 0 and ~ 98 5, . . . . . . Washington, D.C., U. S. Government Printing Office, ~ 975 . 7. U. S. Department of Labor, Bureau of Labor Statistics, Ph. O. Manpower: Empl opponent Demand and Supply ~ 972-85, . . . . . · , . ~ Bu] letin ~ ~ 60, Washington, O ~ C . ~ O. S. Government Printing Office' ~ 975. S. National Research Council, ~ Survey of Earned Occto rat es ~ 957-74 (annual); National Research Council, Survey of Doctoral Scientists and Engineers, ~ 973; and National Science Foundation, National Register of Scientific and Technical Personnel, 1960-70 (biennial). 21

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9. Journa 1 of the American Medical Association, Education Number, annually, in November, 1960-74; and Medical Schools Faculty Roster. Washington, D. C., Association of American Medical Call eges. 10. National Science Foundation, Expenditures for Scientific and Engineering Activities at Universities and Cold eves, MY . . _ 1974, Washington, Deal., U.S. Government Printing Office, 1 975. ~ 1. U. S. Department of Health, Education, and Welfare, Office of Education, Students Enrolled for Advanced Degrees, . Washington, D.C. ~ U.S. Government Printing Office, 1960-73 (annuals . ~ 2. National Science Foundation, Graduate Science Student Support and Postdoctorals Surrey, ~ 972-74. 1 3. Ibid., 1 974. 4. National Research Council, Survey of Earned Doctorates, 957-74 (annual} . ~ 5. A. M. Car~ter , ea., Assuring Academi c Progress Without Growth, New Directions Series, San Francisco, Jossey-Bass 1 975. 16. The recommendations for FY 1976 are intended to be target goals rather than imposed ceilings.- It is understood that because of timing considerations, the implementation of the se recommendations may pose probI ems in FY ~ g 7 6 . For example, the Committee is aware that ADANHA' s commitments f or predo ctoral support in the behavioral s ciences in EY ~ 97 6 exce ed their awards in EY ~ 9 75. In honoring such commitments, the agencies may not be able to adhere strictly to the Corr~aittee's FY 1976 recommended! petrels. Therefore, EY ~ 976 recommendations are presented here as indicators of the desired emphasis and direction of program al terations rather than absolute numerical limitations. 22