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3 . ASS ES SMENT OF MANPC=R WEDS The supply of qualified scientists available to satisfy the nation's needs for health-related research personnel is composed of academic doctorate-ho, ders (Ph. D. or equivalent) and professional aoctorate-holders (M.D., D.V.M., D.D.S., etc.3, who, with specialized training, have acquired the skill s required for productive research on health-related problems. Most of those with academic degrees are employed in ba si c Fiom edi ca ~ or behaviors ~ s ci ence ~ eFartment s o f universities and are involved in some combination of research, teaching, and administration. Those researchers with prof essional degrees generally are on clinical science focus ties in medical and other health profession schools and provide some patient care in addition to these other functions. Although there are exceptions to these characterizations, the factors affecting the market for Ph.D. scientists are somewhat different from those affecting the market for researchers with professional doctorates. For this and other reasons related to data collection procedures, these two markets will be examined separately in this chapter. ~ A third section cuff this chapter will be devoted to the market for health services researchers, which is influenced by a somewhat different set of factors. MARRETS FOR BIOMEDICAL AND BEHAVIOR PR. D. SCIENTISTS The suppl y of and demand for Ph. D. (or equiva' ent) scientists hate keen pro jected using a variety of models. These models share many of the same inherent weaknesses. 2 The complex decisions made by employers and potential employees cannot be completely described by a simple model with a limited set of variables. Supply decisions are based, in part, on individual perceptions of future salary levels, occupational prestige, and other motivational factors that are dif f icult to quantify. Demand decisions are inf luenced, in part, by research funding levels, general economic conditions, and changing needs and priorities . Abrupt changes in the economy, national priorities, societal values, and other dynamic market elements have an important impact on both supply and demand . Furthenno re, ma npowe r pro jections not based on econometric models tend to be self- 36 -

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defeating, because they fail to allow for the feedback mechani sm by which supply and demand components ad j ust to pro jected imbalances in the market. Even econometric models, in their present stage of developments do not take into account mobil ity patterns among disciplines and occupational activities . Hence, it is not surprising that two recently completed studies3 of the markets for Ph. D. scientists and engineers arrive at quite different findings. phi le both studies pro j ect an oversupply of persons with academic doctorates in the life sciences and social sciences (including psychology) ~ by 1985, their specific estimates of supply and demand differ substantially. These differences reflect the uncertainties involved in using recent trends in a few important factors to pro ject future market conditions. Nonetheless, despite their shortcomings, pro jections of the market prospects for Ph. D. scientists in the biomedical and behavioral fields are undoubtedly helpful in anticipating significant changes in the utilization patterns of these highly trained personnel. The Committee's prelimi na ry f ink ings f rom a compre h ensiv e analy s i s s of f actors a ff ecting the supp' y of and demand for Ph. D. researchers in the biomedical and behavioral sciences indicate that the- employment market for these personnel may indeed be declining, as the studies cited above suggest. For the purposes of this analysis, the biomedical sciences included all the life sciences except agricultural discipl ines, and the behavioral sciences encompassed psychol ogy, anthropology, sociology, ethology, and social state stic s. Al though it was recognized that not al ~ of the Ph. D. scientists working in the above disciplines were involved in hea~th-related research, it was not possible from a~railab' employment data to isolate those working in areas that wou] ~ appropriately be of interest to NIB and ADAM PA. In the case of the behavioral scientists, probably only a sunall fraction ware employed in health-related research. However, because of the high degree of field switching among both the biomedical and behavioral discoid ines, it has been assumed that the employment markets for all Ph. D. scientists in these two fields will not be substantially different from the markets for the subpopulations working on health-related research. Tat:]e 3. ~ presents the most current (1973) data availab, e on the populations and utilization patterns of the approximately 47,300 anal 31~800 Ph.D. scientists working in biomedical and behavioral disciplines, respectively. Approximately two-thirds of both labor forces were employed in academia. The ma jority of these behavioral scientists considered teaching their primary activity, 6 while the biomedical scientists were equally divided between teaching and res earch activities. It should be noted that there was minimal unemployment in these labor forces. ~ Although long-term growth in the Ph. D. labor forces wall be influenced by future levels of federal support for 1 37

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research training as well as by many other factorse, the supply of biomedical and behavioral Ph. D. recipients available over the short term line., through 1980) can be estimated with reasonab' e accuracy from knowledge of the number of persons presently in graduate programs and of the age distributions of the current labor forces. Total attrition (death and retirement) between ~ 973 and ~ 980 may be approximated by the number of Ph. D. scientists in the 1 973 pools who will reach the age of 65 during this period {i. e. , the 58-64 age cohorts} . Since these cohorts are comparatively small in both the biomedical and behavioral labor forces (see Table 3.2) , only about ~ percent annual attrition is expected in each field. On the other hand, the number of academic doctorates currently being awarded annually ~ n the biomedical and behavioral disciplines represents more than ~ percent and ~ 2 percent of the respective 1973 labor forces. Hence, the future growth in these ~ abor forces wall be determined largely by the number of Ph.D. ' s produced annually during the ~973-79 period. Estimates of future (1976-79) Ph.D. production can be made based on trends in the ratio of Ph.~. degrees awarded to first-year graduate enrollments six years earlier. 9 Data in Table 3.3 reveal that this ratio has been declining in both fields since the mid-1960' s. For illustrative purposes only, it has been assumed that these ratios will continue to decline between 1976 and 1979 at the same rates they did during the preceding 6 car 7 year period {i. e., 6. ~ percent annually in the biomedical sciences and 4.3 percent in the behavioral sciences). Under this assumption, the following estimates have been made of the number of Ph.~. recipients in the biomedical and behavioral sciences who will be available in 1980: B lo me di ca ~ B eh avio ra :l Sciences Sciences 1 973 Ph.D. labor force 47, 275 31, 800 1973-79 new Ph.D.'s (e stimated) 973- 79 attrition (estimated, 980 [h.~. labor force 70, 100 26, 200 27,500 3,375 2,000 57, 30 0 9 7 3 - 8 0 annua l growth r at" 5 . 8 % S . S' 40

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. e TABLE 3.2 Age Distribution of the Ph.D. tour Forces ~ the Biomedical Ad Beha~rlore1 Sciences, FY 1973 _ . Pool age Bioasedica1 Sciences Size Tot^1 7o (N) (%) t`) (a) (a) (I) t%) it) 47271 100.0. 4~5 40.8 31.0 16.5 6.5 ~ .5 Basic Medical Sciences, Sub~o=1 26380 . 100.0 5.3 43.1 30.4 15.1 S.7 .3 .. . . . Anatomy 1672 100. 0 3 . 2 38 . ~ 31. 7 17 .8 9 . ~ Biochemistry 7442 100.0 6.2 43.5 29.6 14~7 S.5 .4 Biomath,tBiostati sties 878 100.0 ?~1 45.8 28.6 12.8 5.8 Biophysics 1206 100.0 S.2 42.5 33.1 15.1 3.6 .5 Genetics 1923 100. ~ ~ .9 43 .3 28.4 16. 3 6 ~ 4 . 6 Immunology, 1208 100.0 7.1 46.1 28.4 15.1 3.2 ISicrobiology 3812 100.0 2.2 34.~7 33., 21.8 7.2 .4 Molecular Biology 1724 100.0 9. 7 61.5 21.9 4.6 2. 2 Penology 761 100.0 6.0 35.5 32.2 18.4 ?.1- .7 Pharmacology 2374 100. ~ 3 . 7 43 . 4 `2 . ~ IS . 6 ~ . 3 — Physiology 3380 100. 0 5 · 7 44.5 31. 5 11.5 6 .5 . 4 When Biosciences, Subtotal 13&44 100. 0 3.8 37 . 3 3~?, ~ 19 . 2 8 .-1 .6 Biology, General 1623 · 100.0 4.6 36.4 28.6 17.6 11.8 .7 Botany/Plar~t Physiology 2625 i 100.O 3.5 37.1 30.5 20.4 8.2 .2 Cyto1agy 695 1 100.0 10.4 42.6 27.2 12.4 6.S 1.0 Ecotosy 17191 100.O 2.3 46.7 26.9 18.0 5.5 .7 I:ntomology 1756, 100.0 4.3 39.9 31.1 20.6 3.8 .3 Epides~ology/Public Health ~ 821, 100.O .2 20.8 35.9 28.8 12.0 2.2 Nu~ition/Food Science 507 ' 100.0 5.3 32.3 35.9 18.1 8.3 Parasitology 406' 100.0 6.? 28.6 37.5 14.3 11.6 1.2 Zoo10gy 1557 ~ 100.0 1.1 35.1 33.4 17.9 21.1 .4 Other Biosciences ~ 2135' lOQ.O 4.7 37.6 30.6 19.6 6.5 .6 Other Healt}~-Rel2.ed, Subtotal 7047 j 100.0 3.1 39.4 33.9 16.S 6.0 .9 Biomedical Engineering 897 ~ 100.0 6.6 52.2 32.8 7.8 .7 Medical sciences, General 762` 100.O 3.3 40.3 31.4 IS.6 7.5 1.8 Medicine & Surgery 1172 1 J-OO,0 3.6 28.0 29.6 25.9 10.8 1.0 Pharmaceutical Sciences 797~ 100.O 2.4 41.8 3?.9 12.2 3.9 .6 Veterinary Sciences 576 1 100.O — 35.1 40.6 19.6 4.7 Other Bealth-Related_ 2843 j 100.0 2~7 39.9 34.3 lS.9 6.0 1.2 41.5 40.5 42.7 40.1 39.4 40.7 40,6 39.3 C3.9 36.6 42.6 40.9 40.0 42.9 43.1 43.1 39~3 40.4 41.9 48.1 43.4 43.9 44.1 42.S 42.2 38.3 42.0 46.2 41,4 43.7 42.2 Meat Age _ . . . Pool hoe Median Behav~ors1 Sciences SLOG Tot c30 30-39 40-49 50-59 60~69 >70 Age {N) ~ ~ _ 31792 100.0 4~6 38.0 32.1 19.2 5.S .5 42.3 PsychologY, Sub~otal ],gg71 100.0 5.S 41.0 31.3 11.3 4.4 .4 41.1 ClisLical 8377 100 ~ 0 3 ~ 8 38 ~ 4 33 ~ 3 19 ~ 5; 4 ~ 3 ~ ~i 42 e 3 De~relopmental ~ GesontologicM 11?6 100. 0 7.6 41 .0 3Z .1 14 .3 4 . 5 - 40 . 4 Exper/Co¢~/Physiol 3799 100.0 7.9 57.S 25.5 ?.5 1.6 37.3 Industria1 c Personnel 1491 100.O . 6.8 31.1 32.0 22.0 7.3 .? 43.8 Psychology, General 989 100 ~ 0 1. 9 25 .4 33 . 0 28 . 4 10 . 7 .6 46 . 9 Psychc,metrics 505 100 . 0 ~ . ], 41. 8 25 . 0 17 . 2 9 . 7 4t. . O Social 1636 lOG. 0 9 . 2 44 .g 26 . g 15 . 8 3 . 3 - 39 . ~er 1998 ~Q0~0 4.4 32.2 37.2 21.1 4.6 .6 43.6 Educational Psychology, 5ubeota1 4864 loa.o 2.7 27.4 37.8 23.2 7.9 .8 45.3 Comsseiing ~ Gu~dance 217n 100. 0 1. 5 27 .1 36.8 23 . 9 9 . 4 1. 3 45 . 8 ~dUC.tiQ~ lt33 100.0 3.9 29. 4 3S .8 22.8 7 .6 .5 44 .7 SC~i 953 1~.0 3,0 24.7 43.4 22~5 5.0 .4 45.0 O=er Beha~r~ oral Sci, Subtotal 6957 100.0 3 . 3 36 .6 30. ~ 21. ~ 6 .8 . ~ 43 . 2 ---An~opolo~ 1494 l.OQ.O 2.6 38.S 36.2 17.3 4~7 .7 42.5 Beha~rior/Ethology 215 100.0 63.3 24.7 9.8 2.3 37.9 5OCis1 S"tist~ce 380 100. ~ 8.4 40.9 2S . 3 18.2 7.1 — 40. 3 Sociology 4868 100.0 3.2 34.6 2g.2 23.8 7.t .7 44.0 ¢Ot3R=: lastional Research Co~ci1, Su~ey of Doctoral Scientis" ~t ~g~eers, i973. 41 . .

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Reasonable alternative assumptions about the numbers of academic doctorates to be awarded between ~ 976 and ~ 979 will not change appreciably the ~ 9 ~ O labc: r force estimates . For example e, if the annual Ph.D. production in each field decreases from 3,900 degrees awarded in 1975 to 2,50Q degrees in 1979, the biomedical and behavioral labor forces would stil ~ expand at annual rates of growth of 5.3 and 7.5 percent, respectively. On the other hand, if annual Ph. D. production were to rise to 5,000 degrees awarded in each field in 1979, the corresponding annual growth rates would be increased to 6.6 percent for the biomedical labor force and 9 . 2 percent f or the behavioral labor force . The Committee believes from these considerations that it is reasonable to expect that the biomedical and behavioral Ph. D. labor forces will: continue to expand significantly during the next 5 years. Turning to the demand side, it was noted in Chapter 2 that ~ and ~ expenditures and total enrollments have been the primary determinants of the number of emp, oyment positions available to Ph. D. scientists in the biomedical and behavioral fields. While it has not been possible to quantify this relationship, primary work activity distributions imply that the biomedical sciences ~ abor market ha s be e n i n f l u enced more by R an d D f und s the n h a s the behavioral sciences market. The upper graph In Figure 3. ~ illustrates the growth of R and D expenditures in academia in these fields. In recent years the annual growth rates of constant dcllar expenditures in research and deve, opment in the academic sectors ° have fallen below 3 percent in both fields. Since Ph. C. emp, oyment in academia has grown significantly during this same period, the expenditures per academic researchers ~ {lower graph, Figure 3. 1) have declined, especially in the biomedical sciences. The growth rates of total graduate and undergraduate enroll Iments in the behavioral sciences (upper graph, Figure 3. 2) have dece' erated since 1969, and Office of Education pro Sections ~ ~ indicate that enrollments in all sciences are expected to stabilize by 1980. As illustrated in the lower graph of Figure 3. 2, the total enrc'liments per Ph.D. employee in the academic sector have started to decline in both the biomedical and behavioral s ci ences . I t is quite evident from the above findings that the primary factors affecting the de~nand for Ph. D. scientists in these fields are present ~ y growing at substantial ly slower rates than in the past. If these trends continue, increases in ~ and ~ expenditure s an d enrollments will not generate an adequate number of ernploy~nent opportunities for all of those expected to earn a cademic doctorates in the biomedical and behavioral sciences during the next 5 years. The preceding analysis should he interpreted as an indication of what the employment market situation would be like if recent trends in ma jor factors affecting the market for Ph. D. scientists In these fields were to continue. 43

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1 200 1 000 800 he o 600 400 200 R and ~ Expenditures Biomedical /. _ . _ Annual Rates of Grouch (%) _ ~ _ _ ~ ~ __ 60 73 ~ 69-73 _ - iorned~cal 7.6 9.9 2.8 8eha~rioral 9.9 13.2 2.8 Behavioral 1 1 ~ ~ 1 ~ 1 1 1961 1963 1965 lG67 YEAR <, 80 - 6e - ~: I 60 a: u' LLI ~ 40 5: Cal a: us ~ 20 a in w x UJ ~ 1 1 1 1969 1971 1973 : _ Total R & O Expenditures Per Ph. D. Researcher in Academia 8 iornedical - - - 8ehavioral - - 1962 1964 t966 1968 1970 1972 YEAR NOTE: See Table 11.4 in Appendix t1 for supposing data. FIG1JRE 3.1 Total R and D Expenditures in Academia and Expenditures Per Ph.D. Researcher in the Biomedical and Behavioral Sciences, 196~73 (1967 constant dollars) 44

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8~ r Total Grad uate a nd U ride rgrad uate E nro l l meets : in ~ 600 tin a - 0 400 200 40 In - u. 30 c' u' 9 ~ 20 Behavioral . 1 1961 1963 ~ 965 1967 ~ 8i~ned~cal . Annual Rates of Growth (%) Years . 6~73 60 69 . . . Biomedical 73 7~6 B - avioraJ 2.3 14.9 ~73 6.7 6.8 1 969 1 971 1973 YEAR Total Graduate and Undergraduate Enrollments Per Ph.~. Scientist EmaIoved in Academia Fiord — [3;omed~' _ 1960 1962 t 964 1964; 194;8 1 970 1972 YEAR NOTE: See Table 11.5 in Appendix I I for supporting dam. FI(iUfl£ 3.2 Total (iraduate and Undergraduate Enrollments and Enrollments Per Ph D. Scientist Employed in Academia in Biomedical and Behavioral Fields, 196~73 45 1

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However, publication of forecasts such as those referred to in Footnote 2 frequently in jects new factors into the market that change the conditions on which the forecasts are based. As the Bureau of Labor Stati sties notes in its recent manpower study: Underlying the pro jections. . . are the assumptions that changes in relative wages, the desire for education, and other factors will have little effect on the educational patterns and career choices of young persons, and that conditions will not arise whereby employers will significantly change the trend in the utilization patterns for Ph.D. manFower.~3 These underlying assumptions are likely to prove correct only if supply and demand are in equilibrium. The Committee believes that, as a result of perceptions of the pro jected supply/demand imbalance, significant changes ~ the utilization of recent Ph. D. recipients in the biomedical and behavioral sciences are air eady occurring and that no severe unempic~yment situation will develop. During the next 5 years, nearly all of the new Ph. D. recipients in these fields should find employment, although many may take positions that in the past have not been regarded as appropriate for persons with their training. Some of those in nontraditional positions may fully unit ize their Ph. D, training; others may he disappointed because the employment positions available to them do not meet their expectations. I f thi s poten tial imbal ance :m supply and demand in f act occurs and continues well beyond 1960, some ad justment in the number and perhaps caliber of persons attracted to graduate programs in the biomedical and behavioral sciences is also likely to occur. The significance of these market analyses is related not only to the magnitude of any pro jected oversupply, but also to the changes that may reSut t in the supply and utilization patterns of these scientists. To what extent will persons with academic doctorates in these fields not have the opportunity to apply their research training? Will the qualifications of persons entering these labor forces in the future -be af fected by the declining market conditions? Data describing the ~973 Ph. D. ~ abor forces reveal not only that there wa s no serious unemployment situation, but also that more persons were working in the biomedical and behavioral sciences than had received training in these fields. t. Nevertheless, there also have been some indications that the job prospects for new graduates have not been as promising as they once were. AS illustrated in Figure 3 . 3, the proportion of Ph. D. recipients in both the biomedical and behavioral sciences who have had def incite job comma Events at the time of graduation has declined since the mid - ~ 9 6 0 ' s ~ Al though this proportio n ha s not f all en be low 46

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FULL-TIME FACU LTY ENRO LLMENTS 30 ~ TOTALS/ 100 ~ ~ sac 1 / ° ~ ~ ~ r- JJ ~ 50; _¢ u~ ~ /cI;nical Z Students ~ ~ ~ Depar~ents z ~ ~ . ~ ~ 1 1 1 ~ 10 ~ ~ 1962 1966 1970 ~Scionce FISCAL YEAR t:'epa~ments ,1 1 1 1 1 1 962 t 966 1970 F'SCAI Y EAR r ~ 12 r. 3 o - y 4 a, z alncludes nurses, interns, residems, predoctorai and miner students con~rted to medical student equi - lents. SOURCE: Journa/ of the American MedicaIAssociation, Educatson Number, annually in November, 1960-74. / Other Med ical Students ~ Equivalentsa J 1 t962 Enrollrnenu for Advanced Oegrees and Postdocs in Basic Science Depts. 1 1 1 1 1 196;6 1970 FIScAL YEAR FIGtJRE 3.7 hAedical Schoo! Full-time faculty and Enroliments, 1962-72 55

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A. R & D I N MED ICAL SCHOOLS 600 400 oh it o J art 20C} 100 Tmal / 2000 1600 cr co 1200 Z 800 i'\ ~ 4001 t tin , Jr/li/~Federal Non-Federal ,__ I i I I I _ 1966 . 1970 FISCAL YEAR 8. MEDICAL SCHOOLS BUDGETED VACANCIES ~ / `/ Clinical Depts. r = . Basic science 1 1 i I I I Depts. 1 962 1 966 1 970 FISCAL YEAR C. CLINICAL FACULTY/MEDICAL S1-UOENTS 0.50 0.40 0.30 0.20 0.10 aCornputed from the equasion; (CF/M); s QO99 + 7.09 x 1~7 (MR&D};. See Table 3.5. Actual~ i~ ~put~ D 1 1 1 1 ~ 1 962 19~ 1970 1974 FISCAL YEAR SOURCES: National Science Four~dation, Expendi~vres for Science and Engineering Acovities at Univemi~les and Col/eges, FY 1974, Detailed Statistical Tables, p. 5; and Journaf of ~e American h~edicaJ Association, Education Numb - , annually in November, 196~74. FIOURE 3.8 Medicai Schoo} Research and Development Expenditures, Budgeted Vacancies, and Ctinical FaculW/Student Rat~o 56

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(CF/M) i where ( CF/M) i (MR&D) = = 0.G99 ~ 7.09 x 10 7 (MR&D) ratio of size of clinical faculty in medical schools to total medical student enro ~ Iment in the ith year; total research and devel opment expenditures in medical schools in the ith year ~ $ thousands ~ . This mcd=1 fits the data for the ~ 96 1-73 period quite w=1 I, as indicated in Figure 3.S (c3, where the values of CF/~. predicted by the model are compared with their actual values. t9 As with all models, there is the danger here that new factors will emerge that wall al ter the conditions determining the demand for clinical faculty in future years. On" such factor might be i:he tendency for some M. D. ~ s on clinical focus dies to engage more in patient care activities and less in research. In the recent pas-, sponsored research' which currently accounts for about 28 percent of the medical school budget, declined in relative terns, while fees from professional services, which now constitute about 7 percent of the budget, became increasingly important. - For the past 2-3 years, on the other hand' these 1~=Is have remained relatively stable. If they were again to change, then faculty positions would become less dependent on R and D budgets and more an funds generated by patient care. To the extent that these movements may again 'cegin in the future' the demand model as specified above would have to be modified to incorFcrate this new factor, even though it presently provides an adequate explanation of past patterns. min.= model can serve as the vehicle for making rough estimates of the demand for clinical faculty in ~ 980 under various assu.mpt~ons about the future course of medical school enrollments and R and D expenditures. Under a v=ry conservative assumption of no growth in R and D expenditures from ~ 974 to 198O, the need for clinical faculty is pro jected to rise by 5.7 percent per year from ~ 973 due to Fro jested growth in .ned3-cal student enroll Iments (Table 3. 53 Under the less ccnservative assumption that R and ~ expenditures in medical schools will continue to grow at the 1 9 6 8-73 rat 3 c: f 3 . 1 percent p or year J clinical faculty is expected to expand ty 7.7 percent per year to Aged. These result ts are shown in Tabs e 3. 5. rue conclude f ram this analysis that the demand for clinical faculty in medical schools can be expected to grow at a rate of between 5 and ~ percent per year up to ~gS3. This contrasts with indications that the Supply of M. De 51

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"B7.F ].5 ~1 Sc~l ~ol~n=, R ~ D ~es, ~ ~Mca1 Fatty 1961-73, with Projections to 1980 Ac~] Data Fiscal Year 1961 1962 1963 1964 1965 IB66 1967 1968 I"9 1970 1971 1972 3.973 _ . _ Medical Student Esu ollment (M) . 30288 30836 31491 32201 32428 32835 33423 34538 35833 37669 40487 43650 4 ?546 Pro Sections, 1974-~0a Assertion I Medical students increase at 1968-73 rate (4.7/year); R And D "creases a~ ~ 968-.t3 rate {3.1~/yeAr) . Average Annual Gr~ ]?ate, 1973-80 4= . . Assu - tion tI Medical students incsease at 1968-?3 rate (4.?%/year); A-~ D s~ns at 1974 level. Averege Annual 6~th Rate, l9?3-80 1974 lg75 1976 1977 1978 1979 lg80 _ _. lg74 l9?S 1976 1977 1978 1979 1980 ~ . ., ~ Tota1 R L D in Medical Schools (S oullions) . 167.52 206.23 264 .42 311.85 342.90 375.12 420.23 473.27 489.31 489.61 480.98 550.86 587 .68 Size of CI~cal Faculty {CF) . ~ 7108 7698 8965 9632 10381 11489 13292 15435 16627 17183 18451 20902 24041 . - -_ Ratio of Clinica1 Faculty to ~d Student Enroll~n~ (CF/M) _ 0.2347 O.2496 0.2847 O.3010 0.3201 0. 349g 0. 3977 0.4469 0.4640 0~562 0. 455? O. 478g 0.5057 4g808 52150 54600 571?0 59850 62670 65610 605.9b 624 .7 644.0 664.0 684.6 . 705.8 727.7 23643 28260 30340 32570 34980 37560 40340 oo4?sb 0.542 0.556 O. 570 0.584 0.599 0.615 4g80; 52150 54600 57170 59850 62670 65610 635.9 605 .9 605.9 605.9 605.9 605 .9 605.9 23643b 28260 2gS90 30980 32430 339SO 3S550 Q475 0.542 0.542 0.542 0.542 0.542 0.S42 Ho je.cMons to 1980 were based os~ the e~tion: (CF/M)~,- 0.09897 + 7.0901 x 10 7 (~. e (C/~- ratio of size of faculty in clinica1 departments in medica1 schoole to medical student e2`rol.~nts ts~ the i~ y~r: (M=D)1- research a~ develop2sent expenditures in ~cal ~choo~s ~ the i year (in thous~nc}. of dollars3. These da~ wese not deflated becau" ,the unadjusted fi~ures re~ult in a higher correlation ~= tQ./M). S2~e e~ation was des4ved empl::ically fr~ d~4ca for 1961-73, ~th 97.7 percept of the riation in (CEfM) explaineti by ~3. Onder a~su~no~ons ~ ~ It as stated in the ~ove t~le, the values of .HR&;, for 1974 to 1980 ~rere calc~lated and used in tI2$s equation to predict ~relues of {CF/M,. This predicted ratio was ~en mulMplied by the projected values of M (medical a~ent enrollmente) ~ deri~re ~e predict" valu. of CF (ell~ca1 f~ulty) . Ac~. valu.. S on 1 Sc ence Fo nd tlon endit,~res it e nd Colleqes, for Sciene fic and En nee !974 Dc led S . r nq Activ t e. t t c 1 T lcs, p. S Jo rnal of the esican .~:d~cal A3sociatton, Educatl~n Nu~er, ~nnually 4n ~re~s, 1960-74. 58 . . . .

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researchers, while unknown in absolute terms, seems to be on the deck ne . A continuation of tines e trends could ~ ead to shortages of quad if fed M. D. researchers. THE MARKET FOE B=LTH S=VICES AS EARCHERS Heal th services research must be understood as an occupation entered by researchers trained in one of a number of basic fields who apply their research training to the improvement of health care. For the purposes of this study, enidemioloc~Y/nublic health is the discioli ne that most easily identifies scientists whose research training leads directly to work in the field of health services research. However, unlike the basic biomedical sciences, health services researchers cannot be identified simply by the disciple ine in which the academic degree was granted. It is an applied field, not a basin science. and therefore proper classification of an individual as a researcher ~ this area retires knowledge of his or her field of application--- inf ormati on that i s not eas i ly obt apnea . Mo st h eel th services researchers practicing in the field at this time entered from such academic disciplines as economics, social ogy, statistics' .epidemio'ogy, and public heal th. Hence, health services research is not an academic discipline in the traditional sense of the term. The indications are that the number of scientists with experience in health services research is not increasing very rapidly. For example, in ~ 968 the American Medical Association 20 reported that there were about 3, COO physicians who listed public health as their specialty, some 270 of whom were primarily engaged in research or teaching. In 1973, there were just over 2,700, of whom only about 225 were primarily engaged in research car teaching. The same genera' trend i s also observed in the specialty of genera' preventive medicine, which is the other discipline identif fed in the files of the American Medical Association associated with health services research act ivities . So, al though these specialty categories do not adequate! y describe the field of health services research, they are the ones most closely rel a ted to it in the American Medical Association ~ s list, and the trend in both categories is dawn. Also in 1973. there were an estimated 821 Ph.~.'s employed in the f ield of epidemiology/public health. Of these, 351, or 44 percent, were emFIcyed in academia. The others were emp~ oyed by state or local governments (32 percent), the federal government (21 percents, and business (3 percent) . Only 1 4 5, or 1 8 percent, of these Ph. ~ . ' s listed research as their primary activity in ~ 973 . 2 ~ These numbers are not intended to be an estimate of the total supply of qua' if fed health services researchers, but 59

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they may serve to approximate the available pool of scientists in those disciplines most commonly associated with this fiel d. The demand for health services researchers stuns from: (1 ~ developments in the theoretical and methodological aspects of heal th services research toward a greater degree of sophistication; (2) the need to transmit the knowledge and skills required for health services research to- students of this field in which graduate enrollments are rapidly growing; and (3) the Revel opment of health manpower and health services legislation, creating a greater need for persons skilled in research to improve health care organization and del ivery. In its report of March ~ 972, the Panel on Health Services Research and Development of the President's Science Advisory Committeea2 tabulated federal expenditures for health services R and ~ from ~ 967 through ~ 972. As shown in Tabs e 3. 6, these expenditures grew at an average rate of 24 percent per year during that period--much faster than either blame di ca ~ re s e ar ch or nationa ~ hea Ith expen diture s . Furthermore, the report estimated that about $350 million would be spent on health services R and D in ~ 974, an amount considerately above the 1972 figure, indicating that the steep growth in this area is continuing. Estimates of the number of doctoral level health services researchers required by 1980 range from 1, 200 to 2, 0 00 . z 3 Since Ph. O. ' s in public health are currently being produced at the rate of about 100 per year, it does not appear that- the field of health services research is heading for an ov~rsuppl y situation in the next few years. SUMMARY Findings from the preceding analyses of the Ph. D. labor markets in We biomedical and behavioral sciences differ from conclusions reached about the need for clinical and heal th services researchers. Most basic biomedical and behavioral research is performed by persons with academic doctorates, and there is some evidence that the employment opportunities for these, as well as other Ph.~. scien~cists,24 will not abound as they ma during the 196O's. The annua ~ growth rates of both R and D expenditures in academia and total (graduate and undergraduate) enrollments-- and primary determinants of demand for basic biomedical and behavioral Ph. D. recipients--have already declined, and the Office of Education pro Sections show that enrollments should level of f by 19 80 . On the supply side, the number of Ph.D. 's awarded annually in the biomedical and behavioral fields, although not increasing as rapidly as in previous years, 25 will substanti al By exceed the los s due- to attrition, resulting in 60

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TABLE 3.6 Federal Expenditures for Health Services ~ and D and Biomedical Research in Relation to National and Federal Health Expenditures, 1967-72 (millions of dollars) Expends tures National Health expenditures Federal Realm expenditures Health Services R and D: Amount Percent of National Health e~e~d~tures Percent cuff Federal Health expenditures I3:om.ed~cal Research: Amount Percent of Atonal Health expenditures Percent of Federal Health ex~er.~ures 3967 1 1968 1 1969 _ (scullions)| ($millions)| ($m~1lions) ~ r -- ~- 53, 600 59, 900 14,132 16,55-6 47,900 10,8:)1 82 0.8 1,364 2.9 ~3 100 I.0 1970 f $miLllions . 67 ~ 200 18, 072 166 179 1971 l ($~11ions3 75,000 20t698 222 1972 ( $millions ) , 81 000 22, 247 238 O.2 1 0.2 0.3 0.3 0.7 l.0 1.0 1.1 1.1 1,547 2.9 1, 541 1 1,582 2.6 1 2.4 11 9 0.3 0.3 1,747 2.3 2.3 1, 878 8 SOURCE: President' s Science Advisory Committee, Improving Health Care through Research and Deve 7 opment . A report. of We Panel on Health Services Research and Developmer:- or Idle President's Science Advisory Committee, Office of Science and Technology, Executive Office of the President, 'Washington, D.C., U.S. Go~rerrunent Printing Office, March 1972, p. 38. 61 ~ .~

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an expected annual net growth in these labor forces of 5.5 and B. 4 percent, respectively. As an immediate consequence of the potential supply/demand imbalance, the Committee anticipates that an increasing proportion of the Ph. D. recipients in these fields will not find employment that fur ly utilizes their research training. - A slight decrease in the research activity of recent graduates has already been observed. Postdoctoral study in tooth these fields has become increasingly popular and may, in fact, postpone some of the impact of the deteriorating employment markets for those earning Ph. D. ' s. Eventuate y the shortage of attractive employment opportunities may discourage some of the most capable students from pursuing doctoral training in the biomedical and behavioral sciences, especially if there are more promising career opportunities available in other areas ~ Research in the clinical fields is genera!' y performed in medical and other health professions schools by persons with professional doctorates who have had some research training . Al though the prec i se si z e 0 f this pool is not known. there is some evidence that it is shrinking. According to data from the American Medical Association, the number of physicians involved primarily in research-related activities has decreased significantly since 1968. NIR- supported research training at the postprofessional level also has been declining. On the demand side, medical school faculties have been expanding at more than 6 percent annually, with no indication cuff decelerating. Whip e some of these additional faculty positions may be filled by persons with Ph.D.'s, the Co~runittee is concerned by the apparent decline in the research involvement of professonal doctorate-holders. As emphasized in Chapter 2, the M. D. researcher, with his knowledge of the diseases of Nan, plays an important role in extending the fundamental research of the basic scientist to the area of clinical medicine. The rapidly growing need for health services research personnel, although not easily measured because of the small size of the field and its interdisciplinary nature, is reflected by the sharp rise in federal R and D expenditures in this area during the past several years. Other factors, including increases in graduate enrollments (in selected disciplines) and federal expenditures on health care delivery, also have contributed to the expansion in research activity in thi s area . However, little inf ormation i s available on the number of persons qualified to work in health services research. These persons come from a variety of disciplines and may hold either a professional or academic doctorate. Despite the lack of more precise data, the Committee is convinced that continued support of gradual" students through training programs is needed to provide an adequate number of qualified researchers in the health services area to meet the rapidly growing demand. 62

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FOOTNOTES ~ . In adopting this approach, academic doctorate-holders employed in the clinical sciences have been considered part of the biomedical suppl y, and M. D. researchers working in the basic science departments of medical schools have been counted with the ~~ ~ the anti lability suppl y, and M. D. researchers working departments ~ - ~ - clinical personnel. Any fluctuations in of these small groups should have minimal impact on the aggregate supply estimates of biomedi Cal and clinical scientists. 2. For ~ more detailed consideration of the limitations of projection methodology, see Richard B. Freeman and David W. Breneman, Forecasting the Ph. D. Lancer Market: Pitfalls for . . . . . . Policy, National Board on Graduate Education, Washington, D.C., 1974. 3. U. S. Department of Labor, Bureau of Labor Statistics, Ph. D. Manpower: Emplomnent Demand and Supply ~ 972-S5, ~ , . _ . .. . .- Bulletin 1860, Washington, D.C., U. S. Government -Printing Office, ~ 97S; and National Science Foundation, Proiections of Science and Engineering Doctorate Supply and Utilization . . . ., . . . ~ ,_, . .- 1980 and 1985, NSF 75-301 , Washington, D. C., U. S. Government Printing Of fice, ~ 9 75. 4. The life sciences and social sciences dealt with in these studies include much broader aggregations of fields than the biomedical and behavioral discipl ines under consideration by the Committee, and consequently the findings may not be appli cabI e. 5. The Committee felt that the detailed findings should not be released until the analysis has been compl eted, and hence only a sublunary of preliminary results is included in this report. 6. The difficulty for an academician to distinguish between time devotee to research and to teaching raises some doubt about the validity of work activity data. 7. The unemployment rates for sutfields, including zoology, should be regard-d with some caution, since they are based on a 20 percent sample and are sub ject to considerable variation . 8 . Preliminary analysis of the growth of the biomedical and behavioral labor forces: between ~ 9 60 and ~ 97 2 indicates that field switching and migration have had little net effect on the growth of the total Ph. D. labor force. Although the more experienced Ph. O. scientists who had been working in the biomedical and behavioral area have left their research po s it i o n s, mo st have moved i nto a Knin i strati He and teac hi ng 63 !

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positions in these fields. Hence, the size of the total Ph. D. labor force was not reduced. 9. This ratio is influenced by the numbers of master degree candidates in the graduate student population. as well as by the completion rates in doctoral programs. ~ 0 .- Unfortunately, comparable data on research expenditures outside the academic sector were not available. ~ ~ . All Ph. D. -holders employed in academia who designated research as their primary or secondary work activity were included as academic researchers. ~ 2e U. Se Department of Health, Education, and Welfare, Off ice of Education, Projections of Educati onal Statistics to ~ 9 83 - ~ 4, Washington, D. C ., U. S . Government Printing Office, ~ 974. ~ 3. U. S. Department of Labor, on. cit. , p. 4 . . ~ 4. The significance of data on the field mobility of biomedical and behavioral Ph. D. scientists, however, is confounded by the fact that the markets in other potential employment areas have also declined in recent years. ~ 5. Data from National Research Council, ~ 973 Survey of Doctoral Scientists and Engineers. ~ 6. For the purposes of this analysis, all persons with Ph.D. 's who designated research as their primary or secondary wor3< activity were inch uded as researchers. 17. Although it is not possible to determine from existing data to what extent this replacement phenomenon has been occurring, there is some evidence that the proportion of the total academic work force who hold Ph.~. 's has been increas ing. ~ 8. Ameri can Medical Association, Center for Health Services Res earch and Development, Di stribution of PhYsi-cia-ns ~ n the U.S., Chicago, Ill. {annual) . ~ 9. This equation was derived empirically by fitting the lin ear function (CF/M) = a ~ b (MP60) 1 irk to the data to find the best-fitting value of the lag factor k. The best fit was obtained with k = 0. The computed values for the parameters a and b are shown above and in 64

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Table 3. ~ . The average percentage deviation of the predicted from the actual Prague is 3.4 percent. 20. American Medical Association, op. cit. 2 ~ . Data from National Research Council, ~ 973 Survey of Doctoral Scientists and Engineers. 22. President' s Science Advisory Committee, Improving Health through Research and Development. A report of the Panel on Health Services Research anti Devel opment of the President' s Science Advisory Committee, Office of Science and Technology, Executive Office of the President, Washington, D . C ., ~ ~ S . Government Printing of f ice ~ March ~ 9 7 2 . 23. The higher estimate was made in 1 972 by the Panel on Health Services Research and Development of the President' s Science Advisory Committee ~. cit ., p. 3 2 ~ . The lower estimate was made recently by our Panel on Health Services Research, who also feel that it is reasonable to assume that less than half the required number are currently available. 24. O.S. Department of Labor, op. cit. ~ and National Science Foundati on, on . cit . 25. The annual number of Phe D. is awarded in the biomedical sciences has fallen below the peak of about 4, 000 recipients in 197~. 65