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Chapter 5
RECOMMENDATIONS
LEVELS OF NRSA SUPPORT
Basic Biomedical Sciences
The key findings are as follows:
The number of biomedical Ph.D. awards and labor demand (job openings)
have been in approximate balance since the early 1980s; the ratio of job
openings- to new Ph.D.s is expected to increase through the year 2000.
2.
Industry is and will continue to be the dynamic sector for employment
growth with the majority of new vacancies occurring in this sector.
3. The growth rate for research and development (R&D) employment will
exceed that for total employment for the foreseeable future. This is due in
large part to the relative growth of the industrial sector, whose biomedical
Ph.D.s are heavily involved in R&D.
Women are a growing proportion of the biomedical labor force. Given that
women are less likely than men to be involved in full-time science, their
increasing participation may lead to higher outmigration and less effective
labor supply.
Based on these considerations, the committee recommends shifting the NRSA
program towards Ph.D. production. This could~b-e done in three ways:
Increase the level of predoctoral support. There is evidence that enrollments in
the biomedical sciences are very responsive to increasing student support.)
The committee recommends that the level of predoctoral support be increased
to 5,200 from its current level of 3,681 full-time equivalent positions.
Improve the graduation rate of Ph.D. candidates. This would have a substantial
impact on labor supply.
Decrease the time needed to complete the doctorate.2 There is evidence to
suggest that student support during the thesis considerably shortens this time.
iIt has been estimated that first-year biomedical Ph.D. enrollment increases 1.35 percent
for each 1-percent increase in the number of students who have support. See Joe G. Baker,
"The Ph.D. Supply Crisis: A Look at the Biomedical Sciences, paper given at the Western
Economics Association Meetings, June 21, l9X9, Lake Tahoe, Nevada.
Utile increasing time to the doctorate has hampered PheD. labor supply in two ways.
First, it has retarded the labor supply response to such stimuli as increasing wages and
student support. Second, it has increased the investment costs of graduate education,
resulting in lower enrollment. See Joe G. Baker, op. Cit.
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The committee suggests that NIH examine the potential utility of a program
tailored specifically for student support during the thesis-writing stage.
Needed levels of postdoctoral training support will depend upon (1) the
requirements of industry for this level of training and (2) decisions as to whether the
public sector should support postdoctorals for industry. If the demand/supply balance that
existed during the early 1980s is to be maintained, total postdoctoral support must increase
from its current level of approximately 8,200 to around 11,500. The current level of NRSA
postdoctoral support, around 3,700, should be increased gradually as the number of Ph.D.
degrees increases.
Serious questions have been raised about whether postdoctoral training represents a
useful added educational experience designed to enhance productivity, or whether instead
it is merely a holding tank for those doctoral scientists who are unable to land a suitable
job.3 Evidence on this issue is sufficiently flawed by methodological problems as to leave
it an open question about which convincing research is needed. A suggestive fact revealed
in a survey carried out for the committee is that industrial employers of biomedical
scientists prefer those with postdoctoral training credentials. The committee believes
strongly that postdoctoral training programs in~biomedical fields should be retained and
even expanded moderately, but recommends thorough program evaluations at both
predoctoral" and postdoctoral levels.
Behavioral Sciences
The following are the key findings:
1. Most of the employment of nonclinical psychologists and other behavioral
scientists occurs in colleges and universities. Given the assumption of modest
enrollment growth in behavioral sciences, growth in demand for academic
behavioral scientists will also be modest.
2. The labor market for nonclinical psychologists and other behavioral
scientists has been fairly stable through the 1980s.
3. There is potential for behavioral science demand growth to exceed new Ph.D.
supply in the post-1995 period. This is especially true if degree awards
continue to fall.
Behaviorally-based health problems (AIDS, drug and alcohol addiction,
tobacco, cancer, etc.) are increasing in importance. For this reason, it is
important to the nation s health that NIH/ADAMHA continue to support
behavioral science research and research training.
Given these considerations, the committee recommends that predoctoral and
postdoctoral support be kept at their current levels of approximately 500 and 420 full-time
equivalent positions, respectively. However, the committee also recommends moving
support away from clinical psychology toward nonclinical psychology and other behavioral
sciences. The~level of support for scholars in the area of health services research should be
increased (see below).
3P. E. Coggeshall, et al., Changing Postdoctoral Career Patterns for Biomedical
Scientists, Science, vol. 202 (November 3, 1978), pp. 487-493.
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Clinical Sciences
2.
The committee recommends that the current number of trainees and fellows
for M:D. investigator training remain essentially as it has been
(approximately 2,150~. Although the demand for M.D. investigators likely
will increase, the committee feels that proposed studies of the training
mechanisms and training outcomes for the various programs should be
carried out before significant changes are made. It is hoped that these steps
will be taken soon.
The level of support for M:D. research training in the area of health services
research should be moderately increased.
DATA IMPROVEMENTS, NEEDED RESEARCH, PROGRAM EVALUATION,
AND ADMINISTRATIVE INFRASTRUCTURE
The committee has identified new activities in each of these areas that wouict
improve understanding of scientific personnel issues and improve the quality of future
versions of this report. The committee recommends that NIH/ADAMHA put in place the
necessary interim staff and begin immediately the programs of data improvement, research,
and evaluation proposed below.
Small-Scale Data Improvements (not in priority order)
1. Improve employment specialty information in the Survey of Doctorate Recipients
fSDR): An important component of the labor market Is occupational
mobility;- this mechanism is a source of both labor supply and demand for
new scientists in the biomedical and behavioral fields. It's the opinion of
the committee that the list of occupations included for self-identification in
the existing SDR survey form is too restrictive and makes it difficult for a
Ph.D. who has moved out of science to respond to the survey. As a
consequence, it is likely that outmobility from science is understated. This
issue needs to be examined with a goal of improving the employment
specialty information on the SDR.
Add a salary item in the Doctorate Records File (DRE): The DRF is a census
of all Ph.D. recipients from U.S. universities, collected continuously as
degrees are granted. These data provide information on the new doctorate
recipient's plans after graduation (approximately 60 percent of Ph.D.s have
definite postdoctoral plans at the time the DRF survey form is completed).
The inclusion of an item on expected salary for those with definite plans
would give a mechanism for continuous monitoring of the relative tightness
of the Ph.D. labor market by detailed fields, quality of degree-granting
institution, sector of employment (academic, industry, federal lab, etc.), and
other variables. These salary data would provide a baseline for analysis and
modeling of the Ph.D. labor market at minimal cost.
Improve response rate and evaluate nonresponse bias of the sDR4: The SDR is
the main data set used in the analysis of the Ph.D. labor market. These data
are based upon a biennial survey of approximately 10 percent of the U.S.
doctorate work force. The survey is plagued with relatively low response
4This recommendation is consistent with that contained in a recent evaluation of the
NSF data system. Se-e C. F.-Citro and G. Kolton (eds.), Surveying the Nation's Scientists and
Engineers: A Data System for the l99Os, Washington, D.C.: National Academy Press, 1989.
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rates and the attendant possibility of serious nonresponse bias. Two steps
need to be taken:
a.
b.
Analyze the extent of nonresponse bias. The last such study of these
data was conducted in 1979. The committee endorses the recent effort
by NSF to update this study, now under way.
Assemble an ad hoc committee of experts in survey research methods
to design approaches that will improve the SDR's response rate.
4. Include a postdoctoral identifier in the SDR: The evaluation of postdoctoral
study as a research training method is critical if future policy is to be
suggested. The current structure of the SDR makes it difficult to determine
whether a scientist has participated in postdoctoral study; the inclusion of a
question regarding this activity would allow for a more thorough evaluation
of postdoctoral support.
Larger-Scale Data Improvements (in priority order)
1. Establish a program evaluation data matrix: To assess the numerical adequacy
of the nation's biomedical and behavioral research personnel and to make
judgments about the quality of their training, we need both quantitative and
qualitative information. The data matrix discussed in the appendix could
provide such information. The committee recommends that the trainingSdata
be organized and analyzed as suggested by that data matrix framework.
2.
Reconcile SDR postdoctorate estimates and those of the Survey of Graduate
Science and Engineering Students and Postdoctorates fGSESPJ: There are two
sources of information on the level of postdoctoral utilization: the NSF/NIH
SDR and the NSF/NIH GSESP. These surveys are inconsistent. The
ambiguity of these data made it difficult for the committee to determine the
historical trends in postdoctoral appointments; this, in turn, made
recommendations about future levels difficult. This issue needs to be
resolved to improve the analysis and evaluation of the NIH/ADAMHA
postdoctoral effort. The effort may require a separate one-time survey.
Improve research iclentification on the NIH/Association of American Medical
Colleges fAAMC) Faculty Roster: Historically, the main source for data on
physician/scientists has been the AAMC Faculty Roster. Subsequent studies
have shown that Faculty Roster data are inadequate to define precisely the
actual research activities of faculty and the quality of their research effort.
A better identification of researchers and their activities must be achieved,
in terms of both the AAMC questionnaires to deans of schools of medicine
(Faculty Roster) and the NIH tracking of its institutional National Research
Service Award (NRSA) training grant awards. Simple identification of self-
designated researchers without any effort to quantify the amount and
quality of research is meaningless.
5This recommendation is consistent with that of the Task Forces for the Review of NIH
Biomedical Research Training Programs. See the NIH "Review of the National Institutes
of Health Biomedical Research Training Programs," mimeographed, October 1989, p. xvii.
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Needed Research (both sets of equal priority)
Studies of recruitment and retention throughout the academic pipeline: We
urgently need more comprehensive knowledge on recruitment to and losses
from the pipeline into biomedical and behavioral science, especially about
women and minorities at all stages of the pipeline. The committee
recommends a program of research, beginning with one or more
commissioned papers that summarize and synthesize the literature on the
subject with emphasis on the evaluation of intervention programs at critical
nodes in the pipeline. Given the anticipated labor shortages in biomedical
sciences, improvement of graduation rates and participation in full-time
science after graduation are important issues.
Survey studies of former trainees with control groups: The program evaluations
recommended below should contain several novel components relative to the
prior evaluations described in the commissioned paper by Georgine Pion (see
Volume III). One of these should be a series of surveys of former trainees
and of carefully designed control groups. The surveys should concern career
outcomes that are not reflected adequately in available secondary data,
including job satisfaction and future plans, as well as the success of those in
academe as undergraduate and graduate teachers. They should center on
retrospective evaluations of their pre- and postdoctoral studies and, for
former trainees and fellows, on the value of the programs. Finally, they
should tap aspects of the research career that are not available from other
sources, such as patterns of research collaboration (locally and at a distance)
and sources of research funds other than NIH/ADAMHA.
These studies can feed into the set recommended above by defining study
populations as graduate school entrant cohorts--not just doctorate recipients-
-who received NRSA support or who had the characteristics of a control
group member. If done properly such studies could represent a major
contribution, not only to needed program evaluations, but also to our
understanding of the determinants and career consequences of attrition from
graduate school.
Recommended Program Evaluations
The committee recommends two new, large-scale program evaluations that differ
from prior efforts by including surveys of former trainees and fellows (see above) and
field research that takes investigators onto the campuses at which the selected programs are
locaters We recommend the careful selection of individual programs within the two
training categories for initial evaluation. Program directors, department chairs, trainees,
and other students should be interviewed. Curricula should be evaluated and aggregate
survey results discussed. We recommend 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). We recommend that the sequence of steps leading to these
evaluations parallel those recommended for the two programs of research.
Interdisciplinary Programs
The committee urges NIH/ADAMHA-to continue to evolve its predoctoral and
postdoctoral programs to meet changing national priorities, and we support the need for
some of these programs to be interdisciplinary in nature. But it is imperative that those
trained in interdisciplinary, cross-disciplinary, or multidisciplinary programs be thoroughly
trained in basic disciplines and capable of rigorous work of the highest scientific quality.
Recently developed programs (such as biotechnology training) can accomplish these
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objectives, provided that peer evaluations are sustained at high levels and are based on
clearly articulated and applied criteria. This recommendation is based on the committee's
firm belief that the solutions to complex health problems, such as the AIDS epidemic,
cannot be specified or narrowly targeted. Breakthroughs may come from studies in many
basic fields and are likely to be found at the conjunctions of fields. But they will be found
only by researchers whose understanding of those fields is deep and who have the
flexibility of mind and breadth of training that allow such discoveries to be made.
Needed Organization with Which to Implement
These Recommendations
We recommend that a new committee be activated no later than January 1992 in
order to allow two years for the preparation of the 1993 report. If the preceding
recommendations are initiated promptly, that report will require two years of effort and
should represent a major contribution to our knowledge of scientific personnel. In order
that the studies be undertaken and coordinated, there will have to be one or more persons
responsible for their administration and possibly research involvement.
Special Consideration: The Program of Study
for Physician/Scientist Research Training
Those committee members with experience in the training of physician/scientists
believe that the program of study for physician/scientists, with emphasis on the NRSA
institutional training grant mechanisms, must be radically changed to meet the health needs
of the nation.
Lloyd H. Smith notes that the science taught in specialty divisions of the clinical
departments tends to be goal-oriented and superficial; although some physician/scientists
have thrived in the environment and have had productive careers, most have been poorly
prepared for sustained scholarship.6 Smith believes it is imperative for the serious
physician/scientist to receive in-depth training in a scientific discipline relevant to
medicine and that the- training of the serious physician/scientist should be comparable to
Ph.D. programs in rigor and scope. The physician should not be burdened with clinical
responsibilities during the research training period. Smith believes that at least three years
of rigorous training in modern biological science is usually necessary for most individuals
to achieve independence as an investigator.
Those committee members who are experienced in the training of
physician/scientists support Smith's proposal for such a training program and believe it
should contain the following elements:
1. The training program should represent a consortium between the clinical and
pre-clinical departments of the institution with joint responsibility for
design and administration of the program.
2. Selection of the trainees should be made as early in the academic pipeline as
possible, even during undergraduate medical education, if possible, but based
on evidence of some experience and overall promise in research. Selection
planning can then be coordinated for both basic clinical training and for the
subsequent scientific training. The basic science departments and/or
programs should participate in the selection process so that their commitment
to the individual selected is ensured.
6See Lloyd G. Smith, "Training of Physician/Scientists," in Volume III of this report.
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3. Formal coursework in the physical and biochemical sciences, as well as in the
epidemiological, biostatistical, and economic disciplines,~should also be
available and applied for an individual investigator as the need for that
discipline arises. The committee members who are experienced in the
training of physician/scientists recognize that it is important for graduates
of this physician/scientist program to command a theoretical background
comparable to that obtained by those with graduate degrees in these various
disciplines. Clearly, the extent of required coursework must be
individualized based upon the level of prior training, but it must be relevant
and rigorous at the graduate level.
4.
Such a training program in the sciences, above and beyond what is involved
in the subspecialty training events, must be for not less than three years, and
most of that must be invested in direct research experience under the direct
supervision of a mentor. Completion of this training period, which may
often be extended beyond the formal three-year program, would allow
physician/scientists to rejoin their respective clinical department for
subspecialty training in the chosen disciplines. It is recognized that some
may elect to remain in basic science and will enrich those disciplines with
their breadth of training and interest in human biology.
Those committee members who are experienced in the training of
physician/scientists suggest that over the course of a three-year training period~3modules of
instruction should be specifically tailored to the needs of the physician trainee. This
program of study would provide the physician/scientist with enough scientific depth to
sustain a research career for a lifetime and not merely for a limited time beyond
postdoctoral research training. Improved training in the fundamentals should also enable
the physician/scientist to develop the flexible approach to problem-solving that is critical
for successful pursuit of other lines of investigation stemming from observations made
during the course of a goal-oriented research project.
The committee as a whole finds merit in these proposals and recommends that NIH
establish a committee, conference, or study to address the central issues concerning the
program of study in postgraduate institutional training grants for physician/scientists.
Special Consideration: Health Services Research
Health services research aims to improve the way health care services are delivered
through improved use of existing medical technology. It studies the quality, efficacy, and
appropriateness of health care services as well as how these are affected by the method of
reimbursement, the training of health professionals, and other aspects of the health care
delivery system.
7This is consistent with survey results that indicate former postdoctoral research
trainees favor changing the curriculum to include more formal coursework and less clinical
medicine. See G. Levey et al., "Postdoctoral Research Training of Full-time Faculty in
Academic Departments of Medicine," Annals of Internal Medicine, vol. 109, no. 5 (September
1988).
These modules could include such topics as basic laboratory techniques
chromatography, radioimmunoassay, protein purification, advanced instrumental
techniques, fundamental principles of enzymology and molecular biology, subcellular
fractionation techniques, computer technology, evaluation of experimental data,
epidemiology, statistics and data base management, as well as grant and manuscript
· ~
writing.
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Health services research is an interdisciplinary activity that requires individuals to
be trained in a variety of fields, including medicine, economics, public health, sociology,
statistics, psychology, and other fields in the natural and social sciences. In addition, it
requires specially trained individuals who are capable of bringing disparate disciplines
together to examine questions about the delivery of health services. These individuals
receive interdisciplinary training in programs of health services research or public policy
analysis. Those whose degree is in a field such as medicine or economics require additional
training in the methods and knowledge base of health services research, which is usually
received during a postdoctoral period.
Little quantitative information is available about either the supply of or demand
for health services researchers, although Elizabeth McGlynn's paper (see Volume III)
identifies disciplines for the members of the Association of Health Services Research. The
same paper also outlines a research agenda that would provide some important basic
information about demand and supply. Because of the interdisciplinary nature of health
services research, a study of field migration is central to an understanding of the supply of
researchers in the field. How much migration into and out of the field occurs? What
factors affect migration rates? How long does it take an in-migrant to become productive?
How does migration affect the quality of health services research? A more mundane but
nevertheless important evaluation issue is how one should identify a person, a research
project, or a training program as being part of the field of health services research.
Although we cannot quantify with much precision the current demand for health
services researchers, there is substantial evidence that the demand will increase
significantly in the near future. Members of the Congress, the Administration, and the
private sector all have expressed a keen interest in obtaining answers to complex questions
about controlling the quality and cost of health care. Bills introduced into both the House
and Senate would authorize a wide program of health services research activities at a
greatly increased level of spending beginning in 1990 (S. 702 would authorize spending
$239 million over three years; H. 1692 would authorize $847 million over five years). The
Administration has requested increased funding for evaluation research. Many private
foundations have been funding pioneering work in this area throughout the last decade
and the insurance industry recently has begun to sponsor research in this area. It seems
prudent to increase funding for training in this area so that the research monies will be
well spent.
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Representative terms from entire chapter:
program evaluations
