CHAPTER TWO

APPROACHES TO THE ESTIMATION OF NATIONAL NEED

The vitality of the U.S. health research effort depends upon the availability of scientists who are personally committed to research, have mastered the theories and techniques of science, and can communicate their findings and assimilate new knowledge. In the biomedical and behavioral sciences, the nation's need for these research scientists is tied closely to problems of human health as well as opportunities for employment.

Previous National Research Council study committees have focused largely on education and employment in the biomedical and behavioral sciences and the role of the National Research Service Awards (NRSA) program in maintaining an adequate supply of well-trained scientists to maintain stability and efficiency in that system (IOM, 1985).1 Given that approach, a substantial data base was developed over the years that permitted study committees to monitor trends in enrollment, degrees, employment patterns, and funding in certain of the fields. Analytic models of the training system were developed through surveys and special studies (see, for example, NRC, 1978). Supply-demand models were generated in the basic biomedical, behavioral, and clinical sciences to gauge the nation's need for scientists to maintain the balance in the education-employment system (see, for example, NRC, 1975, 1981, 1989).

With this report we mark a departure from the activities of previous NRC study committees. In recognition of the dynamic forces that create the demand for these highly skilled investigators, we present information on what we believe to be the key contextual variables that influence the size and quality of the research work force in the biomedical and behavioral sciences: the priority given by the nation to health research; recent major advances in the fundamental knowledge base, which works both to attract young people to scientific careers and to challenge them to master the latest scientific and technical developments; and changes in the demographic composition of the biomedical and behavioral science work force and recent employment experiences of its members. Our focus is the development of the science career and the role of the NRSA program in facilitating career development.

On the basis of our review of available information, we conclude that the demand for skilled research personnel in the biomedical and behavioral sciences continues to be strong. In the sections that follow, we identify what we believe to be the primary forces influencing the nation's need for skilled scientists in the next several years.

HEALTH RESEARCH AS A NATIONAL PRIORITY

The remarkable productivity of biomedical and behavioral research in the United States is largely a result of national patterns of investment in research and development (R&D). In the past decade alone, U.S. support for health research and development nearly tripled, growing from a total investment of $9.6 billion in 1982 to $28.1 billion in 1992 (NIH, 1993). This significant growth occurred when other research sectors experienced less dramatic support, often influenced by shifting priorities in federal budgets. The Defense Department 's support for R&D, for example, grew rapidly in the early 1980s but peaked in 1986 and then declined. This change is reflected in the relative standing of the life sciences, engineering, and the physical sciences since 1980 (Figure 2-1).

The primary sponsors of health research in the United States are government agencies, industry (primarily the pharmaceutical industry), and private nonprofit organizations (including foundations, voluntary health agencies, and medical research organizations). (See Appendix Table F-1).



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CHAPTER TWO APPROACHES TO THE ESTIMATION OF NATIONAL NEED The vitality of the U.S. health research effort depends upon the availability of scientists who are personally committed to research, have mastered the theories and techniques of science, and can communicate their findings and assimilate new knowledge. In the biomedical and behavioral sciences, the nation's need for these research scientists is tied closely to problems of human health as well as opportunities for employment. Previous National Research Council study committees have focused largely on education and employment in the biomedical and behavioral sciences and the role of the National Research Service Awards (NRSA) program in maintaining an adequate supply of well-trained scientists to maintain stability and efficiency in that system (IOM, 1985).1 Given that approach, a substantial data base was developed over the years that permitted study committees to monitor trends in enrollment, degrees, employment patterns, and funding in certain of the fields. Analytic models of the training system were developed through surveys and special studies (see, for example, NRC, 1978). Supply-demand models were generated in the basic biomedical, behavioral, and clinical sciences to gauge the nation's need for scientists to maintain the balance in the education-employment system (see, for example, NRC, 1975, 1981, 1989). With this report we mark a departure from the activities of previous NRC study committees. In recognition of the dynamic forces that create the demand for these highly skilled investigators, we present information on what we believe to be the key contextual variables that influence the size and quality of the research work force in the biomedical and behavioral sciences: the priority given by the nation to health research; recent major advances in the fundamental knowledge base, which works both to attract young people to scientific careers and to challenge them to master the latest scientific and technical developments; and changes in the demographic composition of the biomedical and behavioral science work force and recent employment experiences of its members. Our focus is the development of the science career and the role of the NRSA program in facilitating career development. On the basis of our review of available information, we conclude that the demand for skilled research personnel in the biomedical and behavioral sciences continues to be strong. In the sections that follow, we identify what we believe to be the primary forces influencing the nation's need for skilled scientists in the next several years. HEALTH RESEARCH AS A NATIONAL PRIORITY The remarkable productivity of biomedical and behavioral research in the United States is largely a result of national patterns of investment in research and development (R&D). In the past decade alone, U.S. support for health research and development nearly tripled, growing from a total investment of $9.6 billion in 1982 to $28.1 billion in 1992 (NIH, 1993). This significant growth occurred when other research sectors experienced less dramatic support, often influenced by shifting priorities in federal budgets. The Defense Department 's support for R&D, for example, grew rapidly in the early 1980s but peaked in 1986 and then declined. This change is reflected in the relative standing of the life sciences, engineering, and the physical sciences since 1980 (Figure 2-1). The primary sponsors of health research in the United States are government agencies, industry (primarily the pharmaceutical industry), and private nonprofit organizations (including foundations, voluntary health agencies, and medical research organizations). (See Appendix Table F-1).

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FIGURE 2-1 Federal obligations for research, by field (in billions of constant 1987 dollars). SOURCE: National Science Board, 1994. Of the estimated $28 billion invested in health R&D in 1992, industry sponsored 45 percent, federal government agencies sponsored about 41 percent, and the nonprofit sector sponsored 4 percent. Health research has also grown as a share of total national R&D, from about 13 percent in 1980 to 18 percent in 1992. As Figure 2-2 reveals, health R&D has grown as a fraction of total federal investment since 1984. However, health R&D has grown more rapidly as a share of all other national sources of support for research and development. In summary, although government budgets for health-related R&D have grown steadily over the past decade, other sectors have absorbed a greater share of the sponsorship of health research. Patterns of Federal Support The principal sponsor of government research in the health sciences in the United States is the National Institutes of Health (NIH). It is estimated that NIH will provide over 90 percent of the $10.9 billion of federal budget for health research and development in 1994. (See Appendix Table F-2). Research highlights from the fiscal 1994 health budget for the federal government reveal that the National Cancer Institute has the largest share of R&D funding within NIH ($2.08 billion in 1994), closely followed by the National Heart, Lung, and Blood Institute ($1.3 billion). These two institutes account for about one-third of the total NIH R&D budget. Although the administration proposed a 3.2 percent increase over fiscal 1993 levels for each of the 20 institutes and centers within NIH over fiscal 1993 levels, the U.S. Congress responded by increasing fiscal 1994 levels by over 5 percent. However, this rate of growth between fiscal years 1993 and 1994 represents a lower rate than that observed in the late 1980s which averaged about 8 percent a year. Components of the NIH budget in 1994 receiving the largest increases included: the Human Genome Center (23 percent), the National Library of Medicine (16 percent), the Fogarty International Center (10 percent), the National Institute for Allergy and Infectious Diseases (8 percent), and the Division of Research Resources (6 percent). In summary, federal support for health research remains strong although the rate of growth has slowed somewhat in recent years (AAAS, 1992 and 1993). Coupled with current economic considerations (described below), it is uncertain, however, whether anticipated growth for health research will match that observed in the 1980s. Trends in Industrial Support In 1987 the pharmaceutical industry provided almost $5.4 billion and the biotechnology industry provided $1.4 FIGURE 2-2 Funding of health R&D as a percentage of total R&D, by source. SOURCE: National Science Board, 1994.

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billion for health R&D (OTA, 1988). The Pharmaceutical Manufacturers Association reported that the combined R&D expenditures of its member firms exceeded the total NIH budget in 1989. For several years industry has been viewed as the most rapidly growing sector of health R&D, but recent reports suggest that the growth of industrial investments in R&D may be leveling off, a result of corporate restructuring, slowdowns in productivity and economic growth, and other general economic conditions that inhibit industrial spending in activities that yield long-term payoffs rather than short-term gains (GUIRR, 1992). Other Factors In considering the future of health research in the United States during the next decade, it is important to realize that research progress may be in conflict with or limited by economic possibilities. These limiting factors include the impact of the budget deficit on federal spending, the economy, the unknown effects of health care reform, and the regulatory costs of research investments. Impact of the Budget Deficit Federal agencies throughout government are experiencing the costs and uncertain future associated with the mounting federal debt. As a result, efforts are underway throughout the Congress, the Office of Management and Budget, and elsewhere to cut unnecessary government spending and to reduce costs. In recent years there has been little annual increase in the research budgets for NIH after adjustment for inflation, apart from certain areas designated as priorities or major initiatives (such as the Human Genome Project). The Economy Industrial investments in health R&D were a major source of the growth experienced in this sector in the 1980s and compensated in part for reductions in federal growth patterns. However, slower economic growth and the lack of short-term market payoffs from prior research investments have raised questions as to whether significant increases in private sector funds allocated for health R&D can be sustained in the 1990s. Unknown Effects of Health Care Reform National interest in health care reform has raised many questions about the extent to which fundamental changes in physician-patient relations, co-payment arrangements, and the financing of medical and hospital care will affect the conduct and support of research. The emerging shift in emphasis from diagnosis and treatment of disease to the promotion of good health and the prevention of physical and mental disorders, for example, may deeply influence future research priorities in the health sector. Regulatory Costs of Research Investments The conduct of research has become part of a broader social and institutional context, and various social objectives or interests have generated a range of regulatory requirements and oversight mechanisms that carry additional costs. Issues such as the protection of human and animal research subjects, the protection of the environment (including the handling and disposal of toxic substances and the siting of hazardous facilities), and the need to ensure research integrity and fiscal accountability have raised new questions about the full costs of the research enterprise and the extent of the impact of hidden infrastructure costs on future research budgets. ADVANCES IN RESEARCH Another factor that plays a significant role in influencing the nation 's need for biomedical and behavioral scientists is the growth of science. If we start, for example, from the work of the biologists and physicists who first gave us the structure of DNA 40 years ago, we can trace how that very fundamental discovery opened the field of molecular biology. The introduction of recombinant DNA technology was another milestone that gave us the tools to understand the gene. In addition to being able to sequence genes rapidly, we can clone them and over-express proteins. The tools of physics and computer engineering have allowed the development of instrumentation that enables us to determine the structures of the macromolecules rapidly and accurately. This, in turn, has given rise to the field of structural biology. The point is that basic science has given us the field of biotechnology, which now allows us to explore biology and medicine in more effective and exciting ways. It is this kind of serendipity that has caused science and medicine to advance. The remarkable accomplishments of the biomedical and behavioral sciences are evident in the answers that are emerging to a host of disease problems—such as cancer, heart disease, acquired immune deficiency syndrome (AIDS)—and to the revolutionary advances in every branch of medicine. The success of fundamental research in the past few years can only be expected to accelerate the pace of discovery in the near future. In the chapters that follow we identify the recent advances in the biomedical and behavioral sciences which we

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believe hold promise for attracting bright students to think creatively about the further development of science and its application to the health needs of the nation. Certain of these advances have been driven by significant investment in problems of national concern such as substance abuse or violence. However, other advances represent the next steps that will occur through the accretion of knowledge or the development of new technologies that make exploration of new problems possible. MARKETPLACE REQUIREMENTS The first report of the National Research Council on the subject of national needs for biomedical and behavioral research personnel was issued in June 1975, only 4 months after the Council accepted the task proposed under the NRSA Act of 1974. Because of time constraints, the first study committee devoted its initial report to a description of the organization of the study, an outline of the issues involved, and a presentation of the limited data available at that time. Each subsequent study committee updated or enlarged the scope of topics addressed in prior reports and included some new issues. In organizing the first study, the 1975 NRC committee divided the biomedical and behavioral fields into four areas: (1) basic biomedical sciences, (2) behavioral sciences, (3) clinical sciences, and (4) health services research. 2 A panel of experts was formed to assist the committee in each area, and an additional panel was created to guide the data collection and analyses. It was recognized very early in that study that the legislative request to specify the nation's personnel needs in the fields of biomedical and behavioral research would be impeded by the difficult problems of definition and classification. An attempt was made, therefore, in the first report to define each of the four broad areas in terms of the disciplinary fields included in them. These initial definitions were revised in subsequent reports, but the problems of taxonomy and determining need at the disciplinary level continue to be among the most intractable ones facing every committee. The major problem, as pointed out in the 1975 report, is that the boundaries between disciplines are difficult to draw. This problem is compounded by the adaptability of biomedical and behavioral scientists and their capacity for mobility within and across fields. This is especially true for transfers from more fundamental to more applied fields and for transfers facilitated by postdoctoral training. Lastly, there is the difficulty of predicting major scientific developments and their potential impact on personnel requirements. In view of these considerations, the recommendations of previous NRC committees have been directed almost exclusively to broad areas rather than to disciplinary subgroups. The 1975 study committee commented on the weaknesses inherent in all available manpower models when it first began to assess methods of projecting the labor market. That committee observed that supply depended largely on such intangibles as students' perceptions of the prestige, prospects, and value of various careers. Demand, in turn, responded to another set of factors—future economic conditions, levels of federal funding, and evolving research priorities—all of which could change abruptly and unpredictably. Nonetheless, during the 1970s the study committees used supply and demand models to assess the relationships between the production of Ph.D. scientists, the need for research personnel in universities, and the commitment of funds from various sources to R&D in the basic biomedical and behavioral sciences. However, in 1981, another study committee reported that significant problems existed in making projections from available data. First, the latest data were not always available for use in the model. Second, changes within specific disciplinary subgroups were not measurable (only the number of people in broadly defined categories was known), thus limiting the utility of the analysis to estimate “national need”. Third, assumptions about job mobility were flawed: it had been assumed in the past that turnover in the pool of career scientists in U.S. colleges and universities was principally due to retirement and death. More recent assessments indicated this was not the case, that there was a substantial amount of switching between academic and nonacademic positions. During the mid-1980s, succeeding committees continued to use supply and demand models, introducing certain improvements. In particular, the 1989 study committee enhanced earlier analyses of the labor market for biomedical and behavioral scientists in several ways: expanded the labor market analysis to include industry, government, hospital, and other nonacademic sources of labor demand; developed separate projections for the labor market in general and for scientists working in R&D or management of R&D; included a demographic-economic model for estimating scientist attrition due to death, retirement, and net occupational movement; brought labor supply into the labor market assessment; and projected labor market variables to the year 2000. Another improvement over the years has involved the disaggregation of disciplinary fields for purposes of analysis, specifically in the behavioral sciences. In the earliest reports, study committees presented the labor market outlook for Ph.D.s in the behavioral sciences as a whole, without distinguishing between the subfields of psychology, so-

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ciology, anthropology, and speech and hearing science. In 1978 the study committee, realizing that the analysis of the labor market was hindered by treating the behavioral sciences as a single entity, separated the data into clinical (clinical psychology, counseling and guidance, and school psychology) and nonclinical fields. This disaggregation enabled the identification of divergent market trends within the behavioral sciences. Status Report on the Work of the Panel on Estimation Procedures The Panel on Estimation Procedures was asked by the present committee to analyze models of supply and demand used by previous NRC study committees. The panel decided to analyze the model used by the 1989 committee 3 and presented their results to the committee in September 1993. 4 While the Panel on Estimation Procedures plans to prepare a separate report summarizing its deliberations, a brief overview of their work follows. 1989 NRC Model The 1989 NRC model includes a demographic model that projects the numbers and characteristics (primarily age) of the supply of scientists in the work force and a curvefitting procedure that forecasts the demand for scientists by sector (NRC, 1989). The panel concluded that all components were found wanting. The demographic projection model confuses age and cohort effects; it could only project accurately in a steady state, when no projections are needed. It has no mechanism for projecting new entrants into the labor market. The demand model restates earlier ad hoc committee models and assumes, falsely, that ratios of students to teachers and of scientists to research dollars are fixed and do not change as economic and technical conditions change. Finally, the treatment of equilibrium implicitly (and incorrectly) assumes that today's excess demand or supply has no effect on tomorrow 's market. The panel recommended to the committee that the 1989 NRC committee model “should not be the base the committee uses in developing its recommendations”. 5 Instead, the panel recommended the exploration of alternative approaches to estimating supply and forecasting demand. New Techniques for Estimating National Needs The panel explored the feasibility of developing projections of supply through demographic techniques. (Preliminary work using this technique may be found in the next two chapters of this report.) These techniques begin by listing the characteristics of a given population (e.g., age, sector of employment, and employment status) and projects changes in the population based on the life history of members of the population. These multistate life tables (Keyfitz, 1985) are useful for answering the questions, What will be the characteristics of the labor force in 5 years? How long do workers remain in a particular job? The answer is generated through a series of statistical calculations by making assumptions about both the rates of transition of individuals from state to state (employed to retired, for example) and the rates of new entrants to the system. The panel expects to continue its work in this area in 1994 and will prepare a final report containing recommendations for the further development of forecasting activities along these lines. 6 The panel is skeptical, furthermore, about the possibility of generating useful forecasts of demand and gave two reasons for doubting that useful long run forecasts of demand could be made. First, the conceptual basis of current forecasting models is questionable. Demand forecasts in the tradition of previous reports assume the existence of some fixed function relating scientists needed to students and research dollars. They assume, in the simplest case, that student-faculty ratios are fixed and that the number of dollars required to support one scientist is fixed. This is, on its face, silly. Student-faculty ratios depend on market conditions and historically have varied considerably. The relationship between research dollars and Ph.D. scientists employed depends on the cost and capability of machinery and the relative costs of technicians, postdoctoral appointees, and Ph.D.s, all of which are absent from these models. More complex models assume complicated (and completely ad hoc) relationships between students and faculty and scientists and dollars spent on research; they continue to assume that these relationships are fixed and independent of economic and technological conditions. The second reason the panel is skeptical about the possibility of generating useful long-term demand forecasts is simpler. To be of use, the forecasts must predict accurately a long period in the future. Those who enter graduate school today will be beginning their independent research careers 6 to 8 (or more) years from now. The predictions of forecasting models become imprecise when projected 5 to 10 years. Models that previous committees developed are a case in point. The panel believes it is both feasible and useful to develop short-term indicators of demand. Monitoring these will provide information about current employment conditions. This information is of limited use to policymakers because today's decisions about fellowships and traineeships primarily affect the scientific labor market a decade from now. Nonetheless, it is useful for two reasons. First, it may suggest ways in which current policy should be changed. For example, if a field has an extremely tight labor market, a shift from post- to pre-doctoral support may be appropriate.

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Second, current market conditions are an important influence on young people's decisions to become research scientists. Summary The Panel on Estimation Procedures has conducted a series of preliminary assessments of available models of supply and demand and has concluded that they are of no utility to this present effort to establish the nation's overall need for biomedical and behavioral research personnel. The committee has accepted this conclusion and suspended use of mathematical models of supply and demand with this study. The panel has concluded that new approaches are needed to project the supply of these researchers and to estimate demand. The panel has suggested the use of multistate life tables for assessing changes in the composition of the labor force over time. The committee has accepted this suggestion. The panel has also offered sample short-term indicators of demand, some of which are included in this report. 7 The committee believes that the panel has made a significant contribution to the process of establishing overall need for biomedical and behavioral scientists by demonstrating the potential value of techniques that monitor changes in the supply of scientists and the value of short-term indicators of demand over previous mathematical approaches to estimating supply and demand adopted by the NRC. Although the product of their work, found in the next two chapters, must be viewed as preliminary, it already shows promise as a policy tool in human resource studies. NOTES 1. See, also, Appendix A for a brief overview of the key features of previous NRC reports in this area. 2. Legislative reform in the 1970s resulted in the inclusion of nursing research personnel around 1978. Oral health research personnel (included by that name in this present study) represented an outgrowth of the clinical sciences. Research training needs in that area were addressed separately as “dental research training” in the late 1970s. 3. The Panel reviewed earlier models developed by previous NRC committees but concluded that their attention to “academic employment opportunities ” restricted their utility to present market concerns, and removed them from serious consideration for further use by the National Research Council. 4. M. Rothschild, report to the Committee on National Needs for Biomedical and Behavioral Research Personnel, September 11, 1993. 5. M. Rothschild, ibid. Rothschild continues: “Tinkering with the model while retaining its basic structure will not make it a useful tool.” 6. Since future Ph.D.s are produced only by those prior Ph.D.s who entered academia, projections of the supply of future Ph.D.s must separate these two components of doctoral supply. Simple projections of future supply based on the current entire doctoral population are misleading. 7. The committee restricted the application of these new techniques to the market outlook in the basic biomedical and behavioral sciences. This was due to the fact that data requirements made detailed analyses possible only in those areas. To the extent data were available for a similar set of variables, they were included in other chapters. However, the multistate life table method was restricted to work in chapter 3 and chapter 4 owing to the lack of information of sufficient detail to permit the application of that method in the other areas. REFERENCES American Association for the Advancement of Science 1992 Congressional Action on Research and Development in the FY 1993 Budget. Washington, D.C.: AAAS. 1993 Congressional Action on Research and Development in the FY 1994 Budget. Washington, D.C.: AAAS. Government-University-Industry Research Roundtable 1992 Fateful Choices: The Future of the U.S. Academic Research Enterprise. Washington, D.C.: GUIRR. Keyfitz, N. 1985 Applied Mathematical Demography. 2nd Ed. New York: Springer-Verlag. Institute of Medicine 1985 Personnel Needs and Training for Biomedical and Behavioral Research. Washington, D.C.: National Academy Press. National Institutes of Health 1993 NIH Databook 1993. Publication No. 93-1261. September. Bethesda, MD: National Institutes of Health. National Research Council 1975 Personnel Needs and Training for Biomedical and Behavioral Research. Washington, D.C.: National Academy Press. 1978 Personnel Needs and Training for Biomedical and Behavioral Research. Washington, D.C.: National Academy Press. 1981 Personnel Needs and Training for Biomedical and Behavioral Research. Washington, D.C.: National Academy Press. 1989 Biomedical and Behavioral Research Scientists: Their Training and Supply. Washington, D.C.: National Academy Press. National Science Board 1994 Science and Engineering Indicators - 1993. Washington, D.C.: National Science Foundation. Office of Technology Assessment 1988 New Developments in Biotechnology. Washington, D.C.: Office of Technology Assessment.