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3- BEHAVI ORAL SC I ENC ES INTRODUCTION The Commi thee and its Panel on Behav ioral Sciences have responded to the ~ iminut ion of academic empl oyment prospects for new Ph.D. ' s and to developments in behavioral research by recom- mending that a shift to predominantly postdoctoral training be achieved by FY 1981, wi th the ratio of support set at 30 percent predoctoral /70 percent postdoctoral by that year . ~ The shi ft in training emphasis was suggested in order to promote emergence of "special ized investigators in the area of behavior and health, " while maintaining support in traditional fields " impor- tant to the national mental health effort" (NRC, 1975-77: 1977 report ~ . For 2 years now the Committee has had the opportunity to review and discuss the responses of the scientific community to this recommended modification through statements made at the publ ic meetings convened by the Committee in ~ 976 ant] ~ 977 anti through ind ividual communications. These views, together with information provided by NIH and ADA.~IA regarding their actions in implementing these recommendations, have guided the Committee in its de] i'berations. In its present report, the Committee reaffirms its position that a shift to predominantly ,,cost<3octoral training is appro- priate and recommends that the overall ratio of 30 percent pre<3octoral/70 percent postdoctoral be maintained through FY 1982 Chapter I, Table, ~ .2 ~ . Labor market analyses continue to suggest that academic employment prospects for new behavioral science Ph. D. ' s :3epen<3 on academic enrollment growth, given current rates of Ph.D. produc- t ion and current employment cond i t ion s . For the purpose of market anal ysis, the behavioral sciences have been separated into clinical and nonclinical components, defined in the next section. (Training fields are defined in Appendix D3. ~ In recent Years the number of behavioral science Ph. D. ' s sectors has increased at a faster rate aced emic sett i ng s . Indeed, f i ntli ngs Bi omed i Cal and Behav ioral Sc fence report reveal that a majority of t heads perceive a moderate to in the behavioral sciences based on periences. These changes in the . t pattern led the Committee to re in more detail the data from the 1976 NRC Survey of recen behav expl 0 empl oyed i n nonacad em i c than the n umber employed from the 1977 NRC Survey De par behav crate In of tments incl uded in this i oral sc i ence departmen cad surplus of Ph. D. ' s t doctoral pi acement ex ioral science ~m~l~vm~n 59

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Biomedical and Behavioral Scientists reported last year (NRC, 1975-77: 1977 report ) . In the present report the responses of the 1971-75 nonclin- ical behavioral science Ph.D. 's employed in nonacademic settings are compared with those of their colleagues employed in the academic- sector. The findings suggest that employment in nonaca- demic settings does not lessen the opportunity for behavioral scientists to conduct health-related research (Tables 3.3 and 3.4). This has led the Committee to conclude that guidelines for payback should continue to be liberally applied to encourage certain types of employment in nonacademi c settings for behav- ioral scient i sts havi ng rece ived NRSA support. Informat ion has been brought to the attention of the Commi ttee that s ugge st s that cer ta i n barr i er s are pr event i ng the act ive recru i tment of cl i n i Cal psycho log i st s, psych i atr i st s, and other mental heal th professionals to conduct mental health research. The Commi ttee in its present report explores oppor- tunities for predoctoral MRSA support for these personnel, the availability of suitabl e sites for their research training and the potential for interdisciplinary research training. The Committee concludes that an effort must be made in the coming year to more fully document the factors involved in enhancing the pool of clinicians who conduct mental health research. This attempt to develop research training recommendations based on a description of the market outs ook and perceived national research needs awaits testing, which will occur when the first class of graduate students affected by the Committee's recommendations reaches the job market in the early ~ 980' s (Shull, 1978~. However, careful continued monitoring of emerging enrollment and employment patterns suggest that no adverse ef feet as a result of the Committee's recommendations need occur if trends are care f ul ly watched and proper act ion taken . OUTLOOK FOR THE BEHAVIORAL SCIENCES In its 1977 report, the Committee presented the labor market outlook for Ph.D. ' s in the behavioral sciences. The outlook was based on a Compaq i son of expected ~ emend for Ph. D o faculty in the behavioral sciences relative to the annual number of behavioral Ph.D. 's being produced. Last year the Committee observed that the analysis of the labor market in the behavioral f ieids was hindered by treating the behavioral sciences -as a sing, e entity. The Committee concluded that the separation of the behavioral sciences into clinical and nonclinical segments would be a step toward a more real istic characterization of this area and would produce a better basi s for analys i s. Since the 1977 report was published, additional data have become available, and the separation into clinical and noncl ini- 60

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Cal segments has been made. The clinical fields include clinical psychology, counseling and guidance, and school psychology. 2 The remaining fields of psychology, together with anthropology, sociology, and speech and hearing sciences3 constitute the conch inical fields. In separating these fields, it was hoped that a relationship between R and ~ expenditures and the nonclinical faculty/student rat lo could be developed . ~ ile the di saggregated data st ill do not provide much empirical evidence of such a relationship, the analyst s does appear to benef it from the separat ion. Among other things, the greater dependence of the nonclinical f ields on aca- demic employment is clearly revealed, confirming; the tentative findings presented in the Committee's past reports (NRC, 1975-77: 1976 and 1977 reports) . Table 3.1 presents the data in terms of some of the indicators the Committee has relied on to assess the labor marke t . Ph . D . Prod uct ion Noncl inical . The yearly increases in 1976 and 1977 were smaller than in previous years. This is a sign that Ph.D. pro- duction for these fields may be leveling off. The 1977 level was only 1.4 percent greater than the 1976 level in contrast to the average annual increase of about 4 percent since 1971. Clinical. Ph. D. production is also slowing down but at a , lesser rate than in the nonclinical f ields. The increase from 1976-77 was 3.4 percent, while the average yearly increase since 1971 has been over ~ percent. .. Postdoctoral s Nonclinical. The number of postdoctoral appointments has been ~ growing at more than 10 Percent per year since 1972. As suggested in last year's report, the buildup of the postdoctoral pool may be a sign that the academic market is not absorbing new Ph.D.'s in traditional academic positions at a rate commensurate with Ph. D. production . 61

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'l-AEr~ 3.' Currt~lt 't~rend~ in Su~ly/D=nancl ~ndicators for P`~.h.`v~ora] Science l:`h.D. 's P.verage Annual Average Growth Annual . 1972 1975 1976 1977 Rate Change S;~pply indicators: Noncl inical: Ph. r). production b Postdoctoral appts. Cli nical: Ph. . D. production b E`ostdoctvral appts. 2,2137 2,580 389 515 902 1,118 124 247 2,709 2,746 580 644 1, 262 ~ 1, 305 33.3 379 (lg72- Y7) (197~-77} 4. 4t 107 ]~.6. 51 7. 7t 81 25.0, 51 Demand indicators: Behavioral sciences R and D expendi- . tures in colleges (1972-76) (1972-76) and universities (1967 S) $99.B milt $94.5 milt S83.0 milt NA ~4.5, $-4.2 milt r~abOr force: Ph.D.'s employed in nonclinical behavioral f ields: tl972-77) (1972-77) Tota1 18,472 23,682 25,170 26,657 7.6t 1,637 !.cademic (excl. postdocs.) 14,443 18,433 19,269 20,105 6.8. 1,132 Business 1,173 1,6S1 1,770 1,888 10.01 143 Government 977 1,289 1,888 1,651 11.1' 135 Other (incl. selE-eo~. and postdocs.) 1,699 l,g36 2,151 2, 365 6.8. 133 Unemployed and seeking 180 373 S10 648 29~2. 94 Ph.D.'s employed in clinical behavioral f ields: Tota1 10,51]` 14,729 1.6,138 17,547 10.8% ].,407 Academic (excl. postdocs.) 4,159 5,064 5,248 5,432 5.5% 255 Business 1,297 2,383 2,969 3,554 22.3% 451 Government 1,135 1,222 1, 313 1,405 4.4. . 54 C)ther (incl. self-emp. and postdocs.) 3,873 5,99S 6,536 7,077 12.8% 641 Unemployed and seeking 47 65 72 79 10.9' 6 BeJ2avioral scien<:e enrollments: First-year grad. Est. total grad. nonclinical clinical Est. nonclinical undergrad c Total nonclinical grad. and w~dergrad. ?13,035 707,565 789,523 22,604 25,081 26,270 NA 31,033 34, 368 35, 385 NA 10 ,852 14,669 16,411 N7L 682,002 673,}97 754,138 NlL (1972-76) 3.8, 3.39e 10.9% 2.5% 2.6% (1972-76) 917 1,088 1, 390 18,0 34 19,122 In this table clinical behavioral fields include clin~cal and ~chool psychology, counseling, and guidance; nonclinical behavioral fields include anthropology, sociology, and nonclinical psychology. labor force and postdoctoralostimates have been re~ised from tho5e shown in the Committee's 1977 report. Est~mated by the formula U ; (Ai+2/Bi.21Ci, where Ui = behavioral science undergraduate enrollments in year i, Ai+2 = behavioral science baccalaureate degree. awarded in year i+2; Bi+2 2 total baccalaureate degrees awarded in year i+2; C~ total undergraduate enrollments in year i. S~P:: MRC tl973-77), NSF (1960-77), U.S. Office of Educatlon (1959-773. 62

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Clinical . Al though the number of ci inical ~stdoctorals is quite small ~ about 380 in FY 1977 ), it has been growing at a rate of 25 percent annually since 1972. It is not clear, however, whether this represents a tightening of the market for these psychologi sts or a change in the rote of postdoctoral training in cl inical psychology . The Committee notes, for example, that over 50 percent of the 1971-75 cl inical psychology Ph.D. 's taking a postdoctoral appointment within ~ year of completing their doctorate did so for reasons other than getting research experience, switching fields or failing to gain employment (NRC, ~ 975-77: 1977 report, Append ix El.2 ~ . The Commmittee will explore the role of postdoc- toral training for these clinical f ields in more detail in the coming year. Acad emi c Labor Force Nonclinical. More than 75 percent of the none, inical Ph.D. labor force is employed in colleges and. universities. The aver- age annual increase in faced ty positions has been about I, 100 since 1972. Clinical. One y about 30 percent of the Ph.D. ' s in these fields are employed in academic settings. A greater proportion are employed in hospitals or clinics or are self-employed. Enrol Iments The separation of enrollment data into cl inical and noncl inical categories has been made for the graduate level only. Enrollment within clinical fields is al most half the total for all the behavioral sciences. Both undergraduate and nonclinical graduate enrollments are increasing at a rate of 3.1 percent per year, Proj ect ions of Academic Demand Revised projections of academic demand have been developed this year for the nonclinical areas but not for the clinical area, since only a small fraction of clinical behavioral scientists are academically employed. 'The pro jected demand for nonclinical 63

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behavioral faculty has been based on assumptions about future enrol lments and about the magn i t ude of faculty/st udent rat ios Note that the oroj eat ion methodology used here must d i ffer sl ightly from that used in the biomedical and clinical sciences areas. Since no significant relationship can be demonstrated between the nonclinical F/S ratio and behavioral science R and D expenditures in colleges and universities, future F/S levels must be estimated from an examination of past patterns rather than calculated from assumed R and D expenditures. The nonclinical F/S ratio has behaved in a somewhat erratic fashion over the past 15 years as shown in Figure 3.1 (b) . No long term trend is di scernible in this pattern, but the ratio has j umped from less than 0.020 cur ing the 1960' s to higher levels in the 1970' s. As in last year's report, the Committee has made three assumpt ions about future enrollment and used these in combination with three assumptions about future levels of the nonclinical faculty/student ratio ~ Figure 3. ~ and Table 3. 2) . The nonclinical faculty/student ratio in 1976 was 0. 024. Under the high assumption it is projected to increase to 0.027 in 1983; under the middle assumption it will increase to 0.025 in 1983; under the low assumption it wi Il decrease to 0. 023 in 1983 . Enrollments have been projected forward under an assumed high rate of 3.5 percent per year, a middle rate of 2 percent per year ~ and a low rate of zero growth. The middle set of assumptions (Table 3.2 IT-B) is considered to be the most likely case. Under this combination of assump- tions, demand for nonclinical Ph.D. faculty in the behavioral sciences is expected to average about 760 positions annually to accommodate both expansion and rep] acement needs . Thi s i s approximately 370 less than the number of none' inical Ph.D. 's that are currently being added to faculties each year . Thus, at this projected level of academic demand, Ph.D. production would have to be reduced by 300 to 400 Ph.D. 's per year to prevent further imbalances from developing if other employment in other sectors remains constant. However, both the bus iness and government sectors are expanding faster than is the academic sector and, although they employ many fewer nonclinical behavioral Ph.D. ' s, their continued expansion could provide j obs for many of the Ph . D . ' s not absorbed into the academic sector. 4 On the other hand, i f enrollments continue to grow at their present rate, rather than decline to 2 percent per year as expected, and if Ph.D. production stabile izes at its current level, the prospects for new Ph. D. ' s would be much improved . In this case the academic market for nonclinical behavioral Ph.D. ~ s to accommodate practically all Current rate. But i f departmental _ _ correct, then the even more drastically . It is clear that ., ~ ikely would expand j ust enough Ph.l:). ' s being produced at the cat per cept i on s of no gro wth i n enroi l men t s are annual number of Ph . D . ' s woul d have to be curtailed to prevent near term imbalances 64

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1 1 5 105 95 _ As 85 _ o 75 _ - 65 55 - / 45/ 35 1 1 1 1 1 1 1 1 1 1 1 0.01 1961 1 965 1 969 1 973 1 977 1 981 FISCAL YEAR 0.029 1 ~~\~ 0.027 / \ 0.025 o 0.023 0.021 0.019 0.017 At' -/ / High Estimate '' Middle Estimate N' ____ 1 - 1 _ I Low Estimate ~ 1 1 I' 1 1 1 1 1 1 .1 1 1 1961 1965 1969 1973 1977 198t FISCAL YEAR (a) Behavioral R and D in Colleges and Universities (b} ~ Nonclinical Behavioral Ph.D. Faculty/Student (1967 $) 1 ,200 1,000 Cal 800 4 - - Z 600 o ax 400 200 Ratio 1 _ ; _ ~ _ ~ o 1 1 1 1 1 1 1 1 1961 1965 1969 1973 1977 1981 30 MA 25 '' _B ~ ~ ~ 20 ma_ ___C ~ 15 ~ 10 at 5 1 1 1 FISCAL YEAR ; .,. o High Estimate '' Middle Estimate / _.~ ~ ~ Low Estimate / Nonclinical. / / Clinical I I I I I 1 -1.1 1 1 i 1961 1965 1969 1973 1977 1981 FISCAL YEAR {c) Total Behavioral Undergraduate and Nonclinical {d) Behavioral Ph.D.'s Employedin Colleges and Graduate Enrollment Universities FIGURE 3.1 Behavioral science (psychology, sociology, and anthropology) enrollment, R and D expenditures, and aca- demic employment, 1961-76, with projections to 1983. Based on data from NRC (1973-77), NSF (1977), and U.S. Office of Education (1959-77). 65

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TABLE 3.2 Projected Growth in Nonclinical Bc?~aviora1 Pl~.L) ['aculLy, 1976-83, Band on Projections of Enrollment arid Faculty/Studer~t Ratios Assumptions about the Faculty/Student Ratio for Non- cl;nical Behavioral Ph.D. 's III Assumptions about Behavioral Will continue to Increases Declines Science Undergraduate and Non- grow, reaching slightly to to 0.023 clinical Graduate Enrollment 0.027 by 1983 0.025 by 1983 by 1983 A. Will grow at 3.5~/yr, Expected size of nonclinical somewhat faster than behavioral science faculty (F) present rate (about in 1982 27, 121 25, 112 23, 10 3 3 . 1 /yr ), reach ng 1, 004, 500 students by Annual growth rate in F from 1983 1975-82 5.0\ 3.9' 2.6% Average annual increment due to faculty expansion 1,122 835 548 Annual replacement needs due to death and retirement 302 288 275 Expected total annual increment in nonclinical behavioral science Ph. D. faculty 1, 424 1,123 823 B. Will grow at 2.0%/yr, Expected size of nonclinical reaching 906, 900 students behavioral science faculty (F) by 1983 in 1982 24,487 22,673 20,859 Annual growth rate in F from- 1975-82 3.5% 2. 4% 1. 1so Average annual increment due to faculty expansion 745- 486 227 Annual replacement needs due to death and retirements 284 273 261 . . Expected total annual increment in nonclinical behavioral science Ph. O. faculty 1, 029 759 488 Essentially no growth Expected size of nonclinical front 1976 level of behavioral science faculty tF) 789, 500 students in 1982 21, 317 19, 738 18,159 Annual growth rate in F from 1975-82 1. 5% 0 . 3, -0 . 8` Average annual increment due to faculty expansion 293 67 -159 Annual replacement needs due to death and retirements 26 4 254 243 Expected total annual increment in nonclinical behavioral science Ph.D. faculty 557 321 84 ~ a . _ . _ Based on an estimated replacement rate of 1.3` annually due to death and retirement. See Cartter (1976, p. 121). 66

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these trends in enrollments and Ph.D. production, which are important indicators of the system' s movement toward or away from equip ibrium, must continue to be monitored -closely. FINDINGS FROM THE SURVEY OF BEHAVIORAL SCIENCES DEPARTMENTS Over 75 percent of the 474 behavioral science departments with doctoral programs responded to the 1977 NRC Department Survey ~ Append ix E ~ . Re sponses were analy zed by di f ference s among fields and by such characteristics as age of the department, quality of the department, and whether the department was 1 ocated in a pub, ic or private institution or in a graduate or medical school .5 In contrast to the biomed i Cal sc fences, behav iora~ sc fence departments rely less on federal funding for support of their full-time graduate students. On] y 19 percent of the behavioral science graduate students rece ived their pr imary support from the federal government in 1976 as compared to 32 percent in the basic biomedical sciences (Appendixes Ed 9.3 and E40. 3 ~ . As might be expected, however, behavioral science departments receiving federal training grant support had a h igher percentage of f ul l- time students whose pr imary support came from federal funds than id departments without training grants ~ 27 percent versus 11 percent) (Appendix E40.3). Hence, changes in federal support patterns might be expected to affect enrollments in departments rece iv ing such support . In the sections that follow, the responses of these behav- ioral sc fence departments are analyzed wi th respect to the ir per- ception of the labor market; the effect of the availability of predoctora1 support on ful 1-t ime graduate enrol lments; and the impact of lost training grant support on such factors as enrollments and the training environment. Labor Market Issues The majority of behavioral science departments indicated that there is a surplus of doctorates in their field in the labor market (Appendix E34 ~ . The state of the job market was re ported as havi ng a significant impact on the department's predoctoral admissions policy by 42 percent of the departments (Appendix E30 ~ . Furthermore, 64 percent of the behavioral sc fence departments said that a future worsening market would cause them to ~ imit enrollments (Appendix E361. However, departments generally perceived no growth in predoctoral enroll meets through 1981 (Appendix E28 ~ . 67

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There,was little indication that a worsening labor market has resulted in a postdoctoral holding pattern, since only 11 percent of the departments with postdocto'rals indicated that there was a lengthening of time individuals spent in postdoctoral status due to a worsening'job market (Appendix E371. Departments predicted that postdoctoral levels would grow at an average annual rate~of 6 percent through 1901 (Appendix E2'9~. Factors Influencing Predoctoral Support The availability of predoctoral support'was judged by 52 percent of behavioral science departments to be an important factor in determining admissions (Appendix E31). Departments at private institutions, those with training grants, and older departments indicated in general a greater tendency to limit admissions based on anticipated support (Appendix Elm. ' ~ Most departments (78 percent) reported that they guaranteed some of their predoctoral students full tuition-stipend support, training grants were'in As might be expected, departments with the best position to do this (Appendix Am,. Only 28 percent of the departments reported a policy prohibiting regular nonacademic employment for full-time students (Appendix Elm. Such a policy was most likely to be in effect in private institutions or in departments with training grants. However, 50 percent of these departments indicated that they would remove the policy if federal and' other sources of support were sharply cut back. reported a employment for fu Impact of Lost Training Grant Support About 87 behavioral science departments lost traineeships between 1972 and'l975. These departments showed a modest 6 percent decline in full-time enrollments from 1973 to 1976 (Appendix E40.2~. Some of this lost support was recovered by increases in teaching assistantships (7 percent) and other forms of support.' When the 55 departments that experienced both traineeship and full-time enrollment losses were asked their explanation for' the enrollment- loss, over'60 percent marked the nonavailabi'1ity off alternative stipend support as the primary reason (Appendix E42). Where beh avi or al sc i e n ce d e par tmen t s h eve s hown g r owt h i n traineeships, they have also shown a marked increase ~ 53 percent) in the number of self-supported students (Appendix E40.2). The impact of lost training grant support is not limited to changes in the patterns of student support. Program act ivities supporting student research (e.g., research equipment, supplies, and computer time), program support staff, and travel to profes- s tonal me et ing s we re ment toned by near ly 70 percent of the de- 68

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partments as being moderately or severely curtailed by current or potential training grant cutbacks ( Append ix E44 ) . At the same time, the activities most frequents y identified as central to the training grant concept--speciaI seminars ant] interdisciplinary training--were cited less frequently, although by a majority of departments, as being adversely at fected i f training grants were eliminated . TH E MARKE T FOR BEHAVIORAL SCIENCE PERSONNEL . . , In its 1977 report, the Committee reported a sl ight deal ine in the proportion of the behavioral science Ph.D. labor force that was employed in tne academic sector between 197 2 and 1975 and also determined that the proportion of behavioral science Ph.D. ' planning employment in the academic sector upon gradual ion had decreased from 59 percent in FY 1969 to 4 9 percent in FY 1976. Since a shi ft to employment in the nonacad emic sector in the behavioral sciences has been conf irmed by a number of sources (Pallak, 1978; Dynes, 1978), the Committee and its Panel on Behavioral Sciences undertook to explore in greater OCR for page 59
If rl He o V o A o o C) o Q. :r: o U] o - V a ~ MU '-hi 0 'a O Cal In US ~ O Al m ,= EN m 0 0 o 0 0 a) v I em ED LO U] V] 0 0 hi'= at-- Ash - o v o o o o o o o o o o om~ om~ 0 u~ u~ 0 n U) oo ~ ~ oo 0 U~ U~ C~ e 0'0 0 ~ eD ~ ~ 00 ~ Co C~e ~ O O O ~) ~ ~ ~? O U~ ~e ~ ~ ~ O O O O O O ~ O tD C)O e~' e~. 00 ~ ~) e ~ ~ C~ .m ~ ~ ~ ~ C~' '~ - -~ U U ~ ~ O ~ O E-l A., Q1 78 U) o . - o c) a), ~ ~n o tQ o . - o ~ ~ ~? ~ o ~ o E~ P~ ~ ~n o ~l ~; o v ~ a) eq cx) o ~ o E~ ~ ~ l

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applicants to enter and complete graduate training without undue delay" in behavioral and other science research career s (NRC, 1975-77: 1977 report). The Committee notes that this recommendation has not been impi emented . ADAMHA h a s i nd i cased, however, that an e f fort i s being made to develop special targeted training programs s) that limit eligilibility to members of minority groups and do not prohibit supporting students in their first two years of training.8 The Committee endorses this effort and notes that i t i s con s i stent wi th the tenor of some of the ~ i scus s i on at i t s public hearings. - Nevertheless, the importance of cultural heterogeneity in a plural istic society--a point that was emphasized in the public hearings--together with the opinion of some witnesses that special targeted training programs were not sufficient or were i nappropr i at e make the Commi t tee unwi 1 ~ i ng to abandon i t s recommendat ion that AI)AMHA wa ive the I' two-year restr iction. for minority group students. Directors of non-targeted training programs continue to report difficulty in recruiting qualified minority students to begin their training. Whether the two-year restriction is a signif icant deterrent is not wholly clear. The Commi thee ha s commi s s toned a spec i al st udy of cond i t ions that limit minority participation in graduate training for biomedical and behavioral re search; and i t hope s that th i s st udy wi ~ ~ be helpful in suggesting the most appropriate means for overcoming the l imiting conditions. Finally, pending the assessment of effectiveness of existing minority targeted programs in several behavioral sciences, the Committee remains of the opinion that it would be desirable for ADAMHA to waive the two-year restriction in the case of students who are members of minority groups. Recommendat ion . The Commi ttee recommends that ADAMHA wa ive . . its two-year restriction to permit recruitment of minority scienti sts through current NRSA programs. Such a recommendation becomes increasingly feasible in the face of the congressional proposal to extend NRSA predc~ctoral re search tra in i ng support to a total of 5 years. The Committee commends ADAMHA for its ef forts to develop special programs for minorities. At the same time, however, the need continues to recruit such personnel through current programs . CLINIC TANS IN MENTAL HEALTH RESEARCH9 Some psychologists and psychiatrists active in mental health research have brought to the attent ion of the Commi t tee both in 79

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public testimony and private communications their concerns about the administration of programs to train clinicians to conduct mental health research. One important concern is that the separation of research training from clinical training for- the purpose of allocating federal supporti eventually will erode the research base in such service-oriented Ph . D. f ields as clinical psychos ogy (Garmezy, 1978~ . Another concern is that NIMH has provided little "innovative thrust" in recent years toward recruiting psychiatrists into research careers ~ Presi- dent' s Commission on Mental Heal th, ~ 978 ~ . At the request of the Committee, the Panel on Behavioral Sciences, in cooperation with the Panel on Clinical Sciences, has examined these assertions and has developed a pre] iminary analy- sis of them. Specif ical' y, the Panel has reviewed and commented on I) the approach developed by ADA MHA to assign appl ications for predoctora' training support from the mental heal th professions within their agency, 2 ~ some of the disincentives to careers in mental health research, and 3 ~ opportunities for multidisci- pl inary research training . Classification of Predoctora' App] i c at ion s by ADAMHA When the NRSA Act required that a distinction be made between clinical training and research training, ADAMHA, which had long prov ided support for both types of training through NIMH, estab- ~ ished guidelines by which existing awards could be assigned to either the clinical or the research training category "as the preponderance of evidence" ~ ~ from the grant applications sug- gested. Since that time, the agency requires app, icants seeking training support to deal are their intent to pursue research or clinical careers 2 and, accordingly, assigns them to the ap- . propriate program of support. The ef feet of these actions on the development of a pool of clinician investigators in mental health research is not yet clear, although this assignment process appears to affect more signif icantly the acquisition of predoctoral research training support, especially for predoctora, clinical psychologists.'3 As one ADAMHA o f f ic i al has po inted ou t: The necessity of making such distinctions was, of course, related to the requirements of NRSA wi th respect to pay-back, 1 imitation on the number of years of support r etc. We knew of no way to accommodate these 1 egal and other DHEW pot icy requirements within unc] i ~ ferent i atop . . . grants . 14 To ciari fy the relationship between NRSA program adminis- trat ion ant] the recru i tment at the predoctoral ~ eve J of 80

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clinicians for mental heal th research, the for lowing assessments are provided for the f ields of clinical psychology and psych i atry . Clinical Psychology. Traditionally, predoctoral programs in . clinical psychology have involved 4 to 5 years of study toward the Ph.D., during which time the individual has initially focused on acquiring those skills that character) ze all doctorally trained psychologi sts. Invariably these skills include a definitive immersion not only in the contents of one' s specialty but also work in research method- ology, advanced stat i st i Cal and quant i tat ive methods, stat i st ical design, computer train- ing, etc. These skills . . . are joined to active research participation dur ing the predoctoral years . . . . 15 What distinguishes these clinical psychologyl6 doctoral students from their nonclinical peers is the intensive exposure to various forms of human service del ivery, culminating in an internship period at institutions accredited by the American Psychological Association, at which time the clinical psychology student engages in the supervised performance of testing, i agnos i s, and/or tre a tment of cl i ent s . Since Ph . D. cl inical psychos ogy doctorates can either provide services or conduct research, with many actually doing both (NRC, 1975-77: 1977 report), the distinction between clinical and research training drawn by federal agencies for administrat ive purposes appears to some clinical psychologists to be artificial or, at best, arbitrary. This is especially the case when entire training grant programs must be categorized, although the distinction is not entirely impossible to draw on an individual basi s. With respect to individual support, clinical psychologists have been supported as predoctoral NRSA f e] lows i f they have been willing to declare their intention to pursue research careers. Indeed, in recent years about half of the fellowships awarded by the Psychological Sciences Fellowship Section of NIMH have been at the predoctoral level . Of these, about 40 percent are made for research training in the area of "maladapt ive behavior and mental illness. " About 35 percent of the total awards in this area have been made to predoctoral clinical psychologists. )7 In the view of many persons responsible for predoctoral training in psychology, the distinction between clinical and research training appears to be an imped iment in the al locat ion of NRSA predoctoral institutional research training grants. As of FY 1978, no predoctoral institutional research training grants 81

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had been awarded to clinical psychology programs under the NRSA authority . 18 The Committee is aware of the fact that clinical psychology continues to be eligible for training support under both training authorities. However, evidence reviewed in the past year suggests that the oversimplification of the content of clinical programs in order to qualify for training support may, in the long run, adversely affect the development of graduate training in clinical psychology. Some clinical psychologists believe that this manner of implementing the distinction between research and clinical train- ing will erode the research tradition in clinical psychology. They also believe that the distinction encourages the "profes- sional degree" movement in psychoJogy,}9 a situation that in recent years has stirred much controversy within the psychology community. The comp~exity-of these developments suggests that a more extensive examination of the impact of the NRSA authority on research training opportunities for predoctora] clinical psycho1- ogists is required before a clear recommendation can be provided by the Committee. Psychiatry. Physicians get little or no formal research training either at the predoctoral level or during their resi- dencies. The Director of ADAMHA summarized the situation as follows: We must acknowledge that the recruitment of physicians into research and academic careers occurs from a biased population. The vast majority of students who enter medical school do so with the intention of practicing medicine . . . . It follows that psychiatry, along with other medical specialties,-when recruiting for investigators at the postgraduate period, is recruiting among people who most likely entered medical school with a particul ar ob jective in mind and have alreacly made a tremendous investment in pursuit of the ob jective . 2) The National Institute of General Medical Sciences (NIGMS ~ some years ago estate] ished the Medical Scientist Training Program (M.D./Ph.D. ) ,22 now under the NRSA authority, as a means to foster research careers ear] y in the training of physicians. Occasionally, this program has provided research training for Clinicians who subsequently conduct mental he e] th research. 23 [however, there is no program of this type offered by ADAMHA at the present time. ~2

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Currently, research training in psychiatry under the NRSA authority is supported through NIMH programs in the biological sciences, social sciences, and "special areas. " Interdepart- mental grants are made in which departments of psychiatry are coequal to other participating departments. In FY 1977, support for 231 positions was provided through 51 new or continuing interdepartmental grants. However, only 44 of the 231 positions represented predoctora~ awards, and a small fraction of these were made to individuals specializing in psychiatry. This sug- gests that medical students are not being recruited in s igni- f icant numbers into research careers under the NRSA program . 24 It is not cl ear at this point whether the failure of the NRSA program to recru i t phys i c i ens, i nclud i ng psych i atr i st s, i nto mental health research suggests the need for a targeted program such as the M.D./Ph.D. program mentioned earlier. The Committee notes that the Research Task Panel of the President's Commission on Mental Health ~1978) has urged ADA MHA to establish a research training program of this kind in the near futuree The Committee wit ~ explore this and other alternatives to the recruitment of these clinicians in the coming year. Recrui tment Di sincent Ives The Committee notes that the number of psychiatrists in the U. S. 1 abor force actively engaged in research as a primary activity has remained steady in recent years at a level of only I. ~ percent ~ 4 50 persons ~ of the active psych iatry ~ abor force ~ AMA, 1975-77~. The absence of significant expansion may be due to the fact that physicians who elect research careers are more likely to experience a significant net economic loss over a ~ if etime than are those who chose to enter pr ivate practice, although this loss is smaller in the medical specialties of psychiatry and pediatrics than in fields such as medicine and surgery Schef fler, 1975 ~ . The di fference between salaries for clinical and residency training and NRSA stipends has also been cited as a disincent ive to the recruitment of physicians for clinical research (NRC, 1975-77: 1977 report ~ . While thi s may be an important factor, it does not entirely account for the lower recruitment rate from such medical specialties as psychiatry, since NRSA stipend levels are uniform for all M.D. ' s. 2 With respect to nonphysicians, the Committee notes that nearly 60 percent of the 1971-75 cl inical psychology doctorates surveyed in ~ 976 reported that they spent some portion of their total work time in research (NRC, 1975-77: 1977 report ~ . Wh ile these f igures are encouraging, the potential impact of predoc- toral funding patterns discussed earlier suggests that the recruitment of investigators in this field warrants close . mon ~ tor sing . 83

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Barriers to the recruitment of clinicians~are not well documented and typically represent littl e more than the frag- mented observations of experts. The Commi ttee and its Panel on Behav ioral Sc fence s wi ~ 1 cant i nue to ~ eve] op syst emat i c approaches to an examination of these recruitment factors, hoping to draw from the findings of parallel research efforts, such as the current study of academic psychiatry by the Josiah Macy, Or ., Foundat ion . 2 6 Sites for Training Ef feet ive research training requires an appropr late research support env ironment , i . e ., ski ~ led researchers who can guide the research exper fence, suitable space and equi pment, and adequate opportun i t ies for cl i n ical observat ion . As a resu, t of the release of the report by the Pres ident' s Commission on Mental Health (1978), clinicians undoubtedly will be expected to conduct research to an increasing degree not only on the cause s of mental and emot iotas di corders, but al so on the efficacy of various treatments, especially as they apply to the underserved population. 27 Therefore, a renewed emphasis is needed on strengthening the qual ity, number and kinds of sites where formal research training for these c! inicians can take place . For nearly 30 years, the mental health professions, and clinical psychology in particular (Shakow, 1978), have received federal funds to strengthen academi c departments in order to provide suitable clinical and research experiences for these personnel . However, participants at the ad hoc steering com- mittee meeting convened in January by the Panel on Behavioral Sciences (Appendix C) pointed out that few departments of psychiatry are able to provide psychiatrists with high quality research training at this time. The availabil ity of academic departments which are ate, e to provide sound research training to mental health professionals Cal early requires examination in light of anticipated recruitment efforts in this area. Alternat Ives to trad i t tonal department-based research training are also beginning to appear. In recent years, for examp! e, an ef fort leas been made by the federal government to establish centers of research rel event to the component i nst i Lutes of ADAMHA ~ NIMH, NIDA and NIAAA) at qual i f fed un iversities throughout the country. 28 Organi zed around a common research theme ~ e.g., the genetics and epidemiology of alcohol i sm), each research center rece ives support for ind ividual research projects as well as core support for administrative and related services. These centers are el igible to apply for NRSA training support, although research training is not central to the i r operas ion . In the comi ng year the Commi ttee and its Panel on Behavioral Sciences will assess the feasibility of using these Centers as research training sites for clinicians. 84

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Other approaches to predoctoral and postdoctoral research training for psychiatrists, cI, nical psychologists, psychiatric nur se s, and red ated mental heal th prof e ssional s al so need to be examined. Especially pressing is the need to bring clinicians from di fferent <3i scip, ines together for multid iscipl inary tra in i ng i n order to foster ad Vance s i n the comprehen s ive treatment of mental health problems, alcohol, and drug abuse. 85

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FOOTNOTES ~ . In its ~ 976 report, the Committee recommended an orderly tapering down of predoctora~ support in the behavioral sciences "wi th a concom i tent emphasi s on provid ing for research special ization through postdoctoral training" (NRC, 1975-77: 1976 report, page 10 ~ . The shift from the then-current propor- tion of 90 percent predoctoral and ~ O percent postdoctoral to a ratio of 30:70 was recommended by the Committee in the belief that " suff icient opportunity for training in the behavioral sciences at the postdoctoral level will be assured, while an adequate number of awards for basic research training at the predoctoral level will also be maintained" (NRC, 1975-77: 1976 report, page 10 ~ . 2. These three subf ields of psychology have been identi f fed as predominantly service-oriented fields, based in part on responses to the 197 6 NRC Survey of Biomedical and Behavioral Scient i sts (NRC, 1977a) and the recent survey of health service providers conducted by the American Psychological Asssociation (Gottfredson and Dyer, 1978~ . Analysis of the labor market for these person- net wil ~ continue as the relationship between factors which influence the demand for research personnel from these fiel ds is better understood. 3. While it is recogni zed that the speech and hearing sciences may be considered clinical ly oriented f ields, f indings from the 1976 NRC Survey of Biomedical and Behavioral Scientists reveal that over 75 percent of the 1971-75 communication science doc- torates were employed in the academic sector and that over 84 percent of the commun ication sc dentists surveyed reported that they spent some part of their total work t ime engaged in research. Similarly, the findings of the NRC Committee on Manpower Needs for Teaching and Research in Basic Neurologic and Commun icative Sciences (NIH, 1977b) seem to support the Commit- tee's view that this group is most appropriately considered part of the none] in ical behav ioral sc fence labor force. 4. As the Committee analysis of this labor market continues, the relationship between business and government employment of non- clinical behavioral Ph.D. ' s and behavioral sciences R and n expenditures in these sectors will be examined. If such a relationship can be empirically demonstrated, it can be used to make proj ect ions of demand in the nonacademic sectors that compl ement those in the academi c sector . 5 . De f i n i t ions of ~ epar tmental characte r i st i cs may be found in Appe ad i x E ~ . 86

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6. Responses from clinical psychologists and counseling and guidance psychologists have been e' iminated from this analysis because of the special employment characteristics of these service-or iented professions. The 1976 survey ~ f indings for these psychologi sts are provided in the 1977 report of the Committee, al though the data are not disaggregated by employment sector. 7. Petition for a Division of Health Psychol ocy, sponsored by Joseph Matarazzo, University of Oregon, and Stephen Weiss, NIH, to the APA Board of Director s, May 197 8. 8. David Kefauver, ADAMHA, in a statement be fore the Panel on Behavioral Sciences, April 15, 197S, Washington, D.C. 9. The term "clinician" i s used here to denote health profes- sional . While in some instances thi s corresponds to such degree types as the M.D., D.D.S., D.V.M., or D.N.S., it e' so includes the service-oriented academic doctorates from such fief ds as clinical psychos ogy, counseling and guidance psychology and other s . 10. In developing a separate research training authority in 1974, a report of the Committee on Interstate and Foreign Commerce of the U. S. House of Representat Ives notes that: [I] n writing this legi sl ation the Committee has felt it appropr late to restrict its ap- pl i cat ion to act ual re sear ch tra in i ng . . . For this reason, the legislation contains a specific restriction to the effect that train- ing provided shal ~ not include residency train- i ng for hea ~ th pract i t loners . . . . The term 'residency training' used in the aegis ation applies strictly only to post-graduate train- ing of physicians but in fact the Committee would include in this restriction c, inica~ and practice training for other human service profes- sions listed above. (U.S. Congress, 1973. ~ The clinical professional training authority continues under Section 303 of the Public Health Service Act. 11. David Kefauver, ADAMHA, in pr ivate correspondence to NRSA Committee member Peter Barton Hutt, March 24, 1978. 12. Stanley Schneider, NIMH, memorandum to NRSA staff officer Pamela Ebert-Flattau, April 10, 1978. 13. One hundred individuals were classified as "clinical investigators" in FY 1977 which included about 30 M.D.'s and a number of postdoctoral clinical psychologists (David Kefauver, ADAMHA, April 15, 1978, op. cit. ~ . 87

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14 O D. Kefauver, Larch 24, ~ 97B, op. cit. 15. Norman Garmezy, University of Minnesota, in pr ivate correspondence to NRSA Committee Chairman Henry W. Riecken, June 2l, 1978. 16. Service oriented subf ie1ds of psychology include clinical psychology, community psychology, counseling anti guidance psychology, and school psychol ogy. Cl inical psychology has been selected here to represent the situation for related service- oriented subf ields of psychology. 17. S. Schneider, April 10, 197S, op. cit. ~ 8. S. Schneider, ibid. . . 19. The estabI i shment of " profe ssional schools of psychology" has result ted in the appearance of doctorally trained psychol- ogists whose degree, the Psy.D., reflects almost exclusive training in services del ivery at the expense of research training . 20.~ N. Garmezy, June 2l, 197S, I. cit. The Committee notes, however, that an American Psychological Association task force has proposed accreditation guidelines which would permit profes- signal degree programs in cl inical psychology to apply for APA approval (APA Monitor, June 1978). 21. Gerald Kin erman! ADAMElA, in private correspondence to William Bevan, Chairman, Pane] on Behavioral Sciences, May 17, 1978-. 22. See Chapter 4 for the Committee's recommendation for that program . 23e Vincent Price, NIGMS, private communication, NRSA staff off icer, Pame] a Ebert-Flattau, December, 1977. 24. G. Herman, May 17, 197B, op. cit. 25. G. Klerman, May 17, 1978, ibid. 26. Commission on the Present Contlition and Future of Academic Psychiatry, New York e 27. According to the President's Commission on Mental Health, the underserved inch ude children, adolescents, older Americans, racial and ethnic minorities, the urban poor, migrant workers and other s . 28. These include Cl inical Re search Centers, Alcohol Research . Centers, and Drug Research Centers, any combination of which may be located at the s ame in st it ut ion . 88