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EXECUTIVE SUMMARY THE COMMITTEE'S INVESTIGATION This is the ninth report to Congress mandated by the National Research Service Awards (NRSA) Act of 1974, but it is the first report submitted by the Committee on Biomedical and Behavioral Research Personnel. Its predecessor, the Committee on National Needs for Biomedical and Behavioral Research Personnel, produced eight reports and was then disbanded following a 1986 conference that is discussed below. The new committee represented an opportunity for a fresh start, and its members and staff have adopted a sharply different approach to the issue. In particular, this report moves toward a substantially greater emphasis on qualitative issues than heretofore, especially with respect to evaluating the merit of training programs and the productivity of individual careers. This shift in direction reflects the strong recommendation of a panel of experts (see below) but has been constrained by limited time and money: the committee has recommended a program of research, but has been unable to implement it. A mechanism by which NIH can get the work done is also recommended. The current committee first met in December 1988. The time schedule required that a draft report be completed by July 1989. As a result, the report differs from earlier versions in ways that were undesirable, but unavoidable. One major departure from previous committee efforts is the abandonment of a formal projection model for physician/scientists. The committee felt that the existing data are inadequate to properly define and track physician/scientists; without a historical data series it was impossible to build a credible model. The committee has also had to forego any serious consideration of dental, nursing, and health services research in the report, although it did commission the caner on health services research that is contained in Volume III of this report. (Volume II contains an updated and enlarged version of the set of tables that appeared as an appendix of the 1985 report.) If the organization and timetable that are recommended for the 1993 report are adopted, these topics can be reintroduced in it. . . In the time that it had, the committee elected to examine the educational process that leads to doctoral degrees in biomedical and behavioral science (and to postdoctoral study in some cases) and the role of NRSA training programs in it. Conclusions from this examination are provided, beginning on page 3. The congressionally mandated analysis and a new and broader projection of the labor market for biomedical and behavioral scientists are described in Chapters 2 and 3. The committee gave greater emphasis to the identification of a research agenda for filling gaps in knowledge needed for sound policy decisions in this area. The committee was able only to sketch such an agenda, presented in Chapters 4 and 5, which if implemented promptly should contribute to a particularly strong 1993 report. The committee's examination of needed research owes much to an intensive discussion of the subject that occurred during the Airlie House Conference on Research Training (Warrenton, Virginia, November 24-25, 1986), sponsored by the Institute of Medicine. The fruit of that conference was proposals for three major initiatives: 1. undertake in-depth evaluations of NIH-supported training programs; 2. develop improved measures of scientific productivity; and

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3. improve the assessment of national needs for biomedical and behavioral scientists. The first two Airlie House initiatives, training program evaluation and productivity analysis, represent an important concentration of the committee. Papers commissioned on each topic are contained in Volume III. These papers form the basis of Chapter 4, which is concerned entirely with these topics and represents an important innovation of the current report. The topics of program evaluation and productivity analysis are linked naturally by the assumption that effective research training programs should have measurable outcomes--namely, enriching research careers and increasing the volume and quality of their output. Research with which to test this assumption in depth is recommended in Chapter 5. The committee also makes the assumption that increased financial support of graduate education, such as that for NRSA programs, yields both an increased number of graduate students and an accelerated path to the doctorate." i, The program evaluations recommended by the committee are intended to get at ssues beyond those of effective educational enhancement. They are intended also to investigate potential negative impacts, such as the possibility that the programs reduce the quality of students available for research assistantships or that the grants may not be used to increase the number of qualified graduate students but, rather, to substitute for other money that is then used for other purposes. The third Airlie House proposal was to extend coverage of future reports beyond the academic sector--the primary concern of earlier reports--particularly to include industry and its burgeoning biotechnology subsector. This is done in Chapters 3 and 4. The committee also examines the rapid changes in- sex and race/ethnic composition of the biomedical and behavioral work force; these changes may have major implications for training programs, labor supply, and the research process itself. The committee's counts and projections of biomedical and behavioral scientists are more comprehensive than in the past and represent an improvement over earlier projections. However, the current model is still forced to make simplifying assumptions that may be unrealistic but that are necessitated by inadequate information. For example, the current model continues the assumption that the labor market for scientists is strictly national, with no local or regional barriers. It is also assumed that any two individuals with degrees in a given field can occupy any job in that field equally well. Mobility among fields of science and into and out of science are taken into account in the models, but are assumed to occur independently of economic or other field characteristics that change over time. The committee did not devote extensive resources to an analysis of postdoctorates because this issue has been thoroughly examined in the past and because there has been very little change in the size of the postdoctoral pool in recent years. Although the current model represents a distinct improvement, its assumptions merit a closer and more critical empirical examination than was possible in the period of this study. iEmpirical evidence suggests that first-year graduate enrollments are positively associated with total student support and starting wages and negatively associated with total elapsed time to degree. See Joe G. Baker, "The Ph.D. Supply Crisis: A Look at the Biomedical Sciences," paper given at the Western Economics Association Meeting, Lake Tahoe, Nevada, June 1989. The influence of student aid on time to degree is examined in Howard Tuckman, et al., On Time to the Doctorate, forthcoming from the National Research Council. 2

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Nevertheless, these labor market descriptions and projections have convinced the committee that there is need for changes in the level of support in biomedical graduate education. The projections played a weaker role than previously in determining the level of support that the committee finally recommended. In prior reports, recommended levels of support were fairly direct outputs of the models used, but in this report the recommendations are products of the collective judgment of the committee, taking the projections into account. For future committees, the recommended program evaluations and related research should prove to be powerful supplements to the output of projection models. None of this should be taken to suggest that the previous committee ignored any of the topics that we consider here. For example, the 1981 report contained a chapter on the race/ethnic composition of the biomedical and behavioral work force, but sex was not included. Both the 1983 and 1985 reports described ground-breaking surveys of scientific employment in biotechnology firms. Instead, we believe that we have an evolving perspective with a substantially greater emphasis on vital issues that determine the quality of the biomedical and behavioral scientific work force. FINDINGS Under the terms of the NRSA Act and its directive to NIH, the committee was asked to address several implicit or explicit research questions. The following summary of this report is couched in the form of responses to seven questions. 1. What are the kinds, extent, and length of existing research training mechanisms in biomedical and behavioral science? There exists no complete inventory of the nation's training mechanisms for biomedical and behavioral science. However, it is clear that they operate within graduate and medical schools and consist mainly of traditional Ph.D. and M.D. programs, with many special programs funded by external sources. The major individual training mechanism is NIH, which awarded $238.8 million in NRSA training funds in 1987. In addition to NIH, the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) awarded $23.5 million, and the Health Research Services Administration (HRSA) awarded $1.2 million in NRSA training funds in 1987. These funds support a large array of training mechanisms, including limited baccalaureate training, predoctoral and postdoctoral institutional grants and fellowships, and career development programs for senior scientists. A historical summary of NRSA support appears in Table 1, page 7. 2. How do existing training mechanisms compare in efficiency? Previous studies of NRSA research training found that program participants performed better than nonparticipants in their subsequent research careers. The design of these studies makes it impossible to determine whether the differences a effects of the training programs or of the selection process. Data and methodological improvements are needed for a true evaluation of the efficiency of NRSA training programs. Even in the absence of systematic data, however, the committee acknowledges inefficiencies in some training programs. In particular, committee members affiliated with medical schools believe that the program of study in M.D. research training programs is deficient in basic scientific content. 3 re

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3. What is the current state of the labor market for biomedical and behavioral scientists? Biomedical scientists: Demand (job openings) has been growing relative to supply (new Ph.D.s) since the early 1980s. Industrial employment growth is over twice the rate of academic employment growth. The proportion of employed biomedical scientists whose work involves primarily research and development (R&D) has . ncreasec .. Clinical psychologists: Total employment of clinical psychologists has been growing rapidly in the 1980s. The supply of new Ph.D. clinical psychologists has not kept pace with this demand. However, only a very small (and declining) proportion of employment is it&D-related; because of this, the committee gives very little consideration to this field. Nonclinical psychologists: The labor market for nonclinical psychologists in the 1980s has been in approximate balance. Employment of nonclinical psychologists is dominated by the academic sector, which has had sluggish demand as a result of falling enrollments. A substantial number of nonclinical psychology Ph.D.s have switched fields to work as clinical psychologists, although this number should decline as state certification requirements increase. The portion of nonclinical psychologists who are involved in R&D work has been fairly stable at about 30 percent of total employment. Other behavioral scientists: The labor market for other behavioral scientists (anthropologists, sociologists, audiologists, and speech pathologists) has been fairly stable in the 1980s; declines in annual job openings have been matched by declines in Ph.D. production. Over 80 percent of these scientists are employed at colleges and universities, where employment growth has averaged 4.2 percent annually. The portion of other behavioral scientists involved in R&D has remained constant at approximately 19 percent. Clinical investigators: The number of NIH traineeships/fellowships for post- professional research training of M.D.s has not increased as fast as health-related R&D expenditures. The percentage of M.D.s who are principal investigators (PIs) on NIH research grants has fallen, although the number of M.D. PIs has remained constant for the last decade at between 1,700 and 2,000. What is the expected future labor market for biomedical and behavioral scientists? Biomedical scientists: Most new positions in biomedical science are expected to be in industry. Unless demand growth falls considerably from historical levels and/or enrollments and degree production increase dramatically, there is projected to be an undersupply of biomedical Ph.D.s into the next century. The undersupply is expected to be even greater in the R&D segment. Clinical psychologists: An undersupply of new Ph.D.s in clinical psychology is expected unless growth moderates considerably or degrees and enrollments increase. However, most of this projected growth will be for counseling; future demand for R&D clinical psychologists will be extremely small. Nonclinical psychologists: The projected labor market for nonclinical psychologists is characterized by approximate balance between supply and demand. However, the strong market for clinical psychologists could draw off labor supply from the nonclinical sector. 4

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Other behavioral scientists: The labor market for other behavioral scientists is projected to be characterized by supply and demand balance through the year 2000. In the R&D sector, demand growth is projected to exceed supply growth by a modest margin. Clinical investigators: For all physicians, growth in supply is expected to exceed that of demand by a large margin through the year 2000. For physician/scientists, however, demand may continue to increase as national health R&D expenditures increase. 5. 6. 7. What is the current state and expected future state of the labor market in the biotechnology industry? Based on the results of our survey of biotechnology firms (see Appendix A), more firms are having problems hiring scientists this year than last year. Over one-third reported having labor shortages (vacancies for over 90 days) in the last year. Over 80 percent of biotechnology firms plan to maintain or increase current levels of hiring, particularly those with postdoctoral training. What are the numbers and conditions of women and minorities seeking careers in biomedical and behavioral sciences? Females have made tremendous strides in the biomedical and behavioral work force in terms of levels of predoctoral support, Ph.D. degrees received, and postdoctoral appointments. However, the labor force particpation of females in full-time science continues to lag behind males. The number of minority scientists, on the other hand, has experienced very little change in status in recent years and continues to lag behind by almost every measurement of participation in science. Given the strong commitment of NIH and ADAMHA to increase the numbers of minority scientists, of particular concern was the finding that minorities are underrepresented in predoctoral support by NIH. Reasons for this underrepresentation are unclear. What data resources need to be maintained or established to carry out the necessary analyses for this study? Several data sets have been essential to the conduct of this study, including the following: Survey of Earned Doctorates (SED); Survey of Doctorate Recipients (SDR); Information for Management, Planning, Analysis and Coordination (IMPAC); the Trainee Fellow File (TFF); and Consolidated Grant Application File (CGAF).2 As vital as they are to the work of this committee, however, they are flawed in a number of ways. More important than the flaws is their incompleteness. Only the SDR provides career outcome measures, for example, and the sample size of the SDR is too small to permit accurate inferences about outcomes of particular sets of trainees. The committee has proposed a continuing program evaluation data matrix that would provide more adequate information. 2The SED is a continuing survey of doctoral candidates administered by the graduate schools at the time of completion of all requirements for the doctoral degree. The SDR is a biennial sample survey of doctoral scientists that focuses on many aspects of the career. The IMPAC and CGA files are maintained by NIH, the former concerned with research grant and training programs and that NIH/ADAMHA administers and the latter with research grant applicants. s

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RECOMMENDATIONS NRSA Support Levels The committee's recommendations for levels of NRSA training support are summarized in Table 1-. Biomedical sciences: The committee projects that growth in demand will exceed that in supply through the year 2000. The committee recommends that the level of predoctoral support be 5,200 full-time equivalent positions (FTEPs), up from the current level of 3,681. To shorten the time to degree and to reduce graduate student attrition, the committee suggests that NIH examine the potential effectiveness of a support program tailored specifically for student support during the thesis-writing stage. The committee also recommends that postdoctoral support be increased gradually as degree production increases. Behavioral sciences: The committee projects that the labor market for behavioral scientists will be fairly stable. The committee recommends that the level of behavioral science predoctoral and postdoctoral support be kept at their current levels of approximately 500 and 420 FTEPs, respectively. Given the low level of research involvement by clinical psychologists, the committee recommends moving support away from clinical psychology and towards nonclinical psychology and other behavioral sciences. Clinical sciences: The committee expects that the demand for physician/scientists will increase in the future as health-related R&D increases, but in the absence of compelling data, this is speculative. Given the lack of data about supply/demand and questions about the effectiveness of physician research training, the committee recommends that the number of trainee and fellow positions for M.D. investigator training remain essentially the~same until current training programs are evaluated. O Health services research: This interdisciplinary activity requires individuals trained in a variety of fields, including not only medicine but also economics, public health, sociology, statistics, psychology, and other natural and social sciences. Given the potential for increased demand for scholars in health services research, the committee recommends that research training for biomedical, behavioral, and M.D. scientists in this field be increased. The current funding mechanism for NRSA health services research training allocates one-half of 1 percent of NIH's NRSA budget to HRSA for research training. In order to support the recommended increases in NRSA research training, the 1987 NIH/ADAMHA/HRSA training budget of over $262.2 million would have to be increased to approximately $282 million in 1990 and grow at approximately $10 million per year to a 1993 total of $312 million.3 This represents a real growth rate of approximately 3.5 percent per year. 3These budget estimates are based on an average cost per trainee of $24,851 and fellow of $25,920. These averages were computed using budget data from the NIH Data Book 1988, Table 16, and the "ADAMHA NRSA Training Tables 1987," Table 1. Trainee/fellow data are from Table I.1. 6

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Tabl e 1 . Ca~ni ttee Recon~nendat i ons for NRSA Ful l -T ime Equi va lent Tra i ni ng Pos i t i ons, 1989-1995, and Actual Full-Time Equivalent Training Positions, 1985-1987 Actual Recommended . _ . . . .. 1985 1986 1987 1989 1990 1991_ 1992 1993 1994 1995 Biomedical 7741 7807 7387 7800 8200 8600 9000 9400 9400 9400 Predoctoral 4008 3856 3681 4000 4300 4600 4900 5200 5200 5200 Fellow 92 93 86 100 100 100 100 100 100 100 Trainee 3916 3762 3594 3900 4200 4500 4800 5100 5100 5100 Postdoctoral 3733 3952 3707 3800 3900 4000 4100 4200 4200 4200 Fellow 1628 1817 1580 1600 1650 1700 1750 1800 1800 1800 Trainee 2106 2135 2127 2200 2250 2300 2350 2400 2400 2400 971 962 924 920 920 920 920 920 920 920 Predoctoral 530 515 504 500 500 500 500 500 500 500 Fel low 40 33 37 40 40 40 40 40 40 40 Trainee 490 482 467 460 460 460 460 460 460 460 Postdoctora l 441 447 420 420 420 420 420 420 420 420 Fel low 91 91 95 100 100 100 100 100 100 100 Trainee 350 356 324 320 320 320 320 320 320 320 Cl inical 2195 2229 2157 2150 2150 2150 2150 2150 2150 2150 Predoctoral 632 687 654 650 650 650 650 650 650 650 Fel low 2 6 17 10 10 10 10 10 10 10 T ra i nee 630 681 637 640 640 640 640 640 640 640 MSTP 629 661 636 640 640 640 640 640 640 640 Other 1 20 1 0 0 0 0 0 0 0 Postdoctoral 1563 1542 1503 1500 1500 1500 1500 1500 1500 1500 Fellow 181 139 113 110 110 110 110 110 110 110 Trainee 1382 1403 1390 1390 1390 1390 1390 1390 1390 1390 Total 10907 10998 10468 10870 11270 11670 12070 12470 12470 12470 Predoctoral 5171 5058 4839 5150 5450 5750 6050 6350 6350 6350 Fellow 135 132 141 150 150 150 150 150 150 150 Trainee 5036 4925 4698 5000 5300 5600 5900 6200 6200 6200 Postdoctoral 5737 5941 5629 5720 5820 5920 6020 6120 6120 6120 Fellow 1899 2047 1788 1810 1860 1910 1960 2010 2010 2010 Trainee 383B 3894 3841 3910 3960 4010 4060 4110 4110 4110 HRSA (not include in above figures) NA NA NA 77 79 81 83 85 85 85 . . NOTE: ~ Actual appointments in 1987 were 12,041 (10,815 NIH and 1,226 ADAMHA). Appointments exceed FTE trainee/ fellow years (10,468 in 1987) because of partial-year appointments. Does not include short-term training positions. ~ ~- 11~~ 1lUL a w sue to rounding. All figures are in full-time equvilalent trainee/fellow veers SOURCE: Historical data are fr x Table 1-5. 7

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Needed Research o o o o o Program of stucly for physician/scientist training: This committee recommends that a conference, committee, or study be implemented to examine the program of study for physician/scientist training supported by postdoctoral institutional training grants. This investigation should focus on the potential merits of including more exposure to basic science and scientists in these ~ tralolog programs. Studies of recruitment and retention: We need far more comprehensive knowledge than we have concerning factors that facilitate recruitment and retention of able students at all stages of education leading to careers in science. These studies should emphasize the recruitment and retention of women and minorities. Survey studies of former trainees with control groups: This should be a first step in evaluating the relative efficiency of NIH training mechanisms. Study populations should consist of cohorts of entrants to graduate school rather than Ph.D. recipients. The committee recommends that the first two programs to be evaluated in this fashion be the Minority Access to Research Careers (MARC) and the Medical Scientist Training Program (MSTP). Studies of women and minorities: The academic pipeline for women is coming more and more to resemble that for men in biomedical and behavioral sciences. Evidently, NIH and other training programs are working effectively, at least in terms of their recruitment and retention through the doctorate. However, once into the career, the professional behavior of women and men continues to differ in important regards, such as numbers of papers published and citations received. The committee suspects, but lacks data with which to show, that some of these differences result from different experiences in graduate school. The committee lacks the evidence . . . . . . . on which to base concrete recommendations In this regard, but does suggest a program of research that is intended to provide specific guidelines. In the case of targeted minorities, recruitment and retention into careers in biomedical and behavioral science remain worse than for whites. Little is known about the careers of minority scientists; we can-only assume them to resemble those of women more than those of white males. Again, the committee lacks data with which to make concrete recommendations for . . intervention and can only recommend research designed to provide them. NIH has several important recruitment programs, such as Minority Access to Research Careers, but measurable changes in numbers of targeted minorities are not yet being seen. Although there are several potential causes of this lack of minority progress in biomedical and behavioral science, this could suggest that these programs are ineffective. The program evaluations proposed by the committee will make this determination possible. Improvements in data and information: The committee also recommends a number of specific improvements in the data sets needed to support more rigorous future analyses. Other Recommendations o Interdisciplinary programs: To meet changing national priorities, the committee urges NIH to continue to evolve its pre- and postdoctoral 8

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programs, and we support the need for some of these programs to be inter- disciplinary in nature (e.g., health services research). o NeecJ[ed organization with which to implement these recommendations: Given the research and evaluation agenda detailed in this report, the committee recommends that a new committee be activated no later than January 1992 in order to allow two years for the preparation of the 1993 report. 9

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