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INTRODUCT ION As an introduction to this report on the Committee's activities, the Committee be] ieves that it would be appropriate to review ~ ~ ~ recent changes in the congres- sional mandate to the Committee as reflected in the legi s- lative history and the 1978 Amendments to the National Research Service Award (NRSA) Act of 1974, and ~ 2 ~ the Committee's (deliberations over its future study directions as reflected in its conference held in 197SO RECENT DEVELOPMENTS IN LEGISLATIVE HISTORY AND COMMITTEE RECOMMENDATIONS The NRSA legislation was renewed by Congress for 3 years on November 9, 1978. The "Biomedical Research and Research Training Amendments of 1978, " of PubI ic Law 95-622, extended the authorization of the National Research Service Awards through FYl98l, and increased authorization levels from $161,390,000 for FYI978 to $197~500,000 for FYI979, $210 ,000 ,000 for FYI980, and $222,500'000 for FYl981. In the 1978 Amendments a number of important changes were made in the substantive provisions of the Act. These were designed to minimize unnecessary hardships or e] iminate certain inequities for individual recipients of NRSA awards, or to make the administration of the program more eff icient O Minimal Percentages for Individual and Inst i tut tonal awards The HRSA Act of 1974 required that at least 25 percent of the amounts appropriated be used for ind ividual NRSA awards, i.e., fellowships, in contrast to institutional awards ~ training grants) . This recognized the importance that the federal government attaches to individual competition at the national level as a basis for providing research trainings The exper fence of the agencies wi th the program, how- ever, has demonstrated that in any g iven year the number of superior appl ications that are received for individual awards may be insuf f icient to meet this requirement . A re- lated consequence may be that appl ications for outstanding inst i but tonal awards wil ~ go unf under . The House Committee Report for the 1978 Amendments US. House of Representatives, 1978 ~ stated that it is not the desire of Congress to withhold the funding of excellent institutional programs, a position fully supported by the Senate Committee (U.S. Senate, 19781. The 1978 Amendments, 4
therefore, provide that a minimum of 15 percent of research tra in ing f unds be expended for ind iv idual awards wh i l e a t the same time providing for a minimum of 50 percent for institutional awards. This change clearly recognizes the need to maintain the avail ability of both of these support instruments while assuring flexibil ity in the administration of the program. While the Committee has not made specif ic recommenda- tions with respect to the overall distribution of in<3ivid- ual and institutional awards, in each of its reports it has explicitly endorsed the underlying principle of util izing these mechanisms (NRC, 1975-1978: 1976 Report, pp. 6-~; 1977 Report, pp. 7-9; 1978 Report, p. Il). It has pointed out consistently that the appropriate usage of each of these instruments should be determined by the specific area of study in question, the level of training intended, and the extent to which the potential trainees/fel~ows have had prior research experience. In each of its annual reports, therefore, the Committee has set forth specific recommenda- tions with regard to the use of fellowships and training grants for predoctorals and postdoctorals in each of the following broad areas of research training: basic biomed i- cal sciences; behavioral sciences; cl inical sciences; nurs- ing research; and heal th services research. Dura ~ ion of E] ig ib i ~ i ty In the 1974 Act, recipients were permitted to receive sup- port for up to 3 years n in the aggregate" unless the Secre- tary, DHEW, waived this ~ imit. The House Committee was informed that the language was ambiguous wi th respect to whether the 3-year duration of el igibil ity referred to pre- doctoral and postdoctoral support combined or separately. This ambiguity apparently deterred some individuals from seeking NRSA support for their predoctoral training because of their desire to preserve their el igibil ity for this support for their postdoctoral training . Al though the Act authorized the Secretary to waive this ~ imit, it generally was unclear to the average person just what constituted a sufficient basis for a request for waiver. As a conse- quence, the ful l potential of the support al lowable under the provisions of the Act was not real i zed in some ins iv idual cases . In its 1977 Report (NRC, 1975-1978; pp. 177-179), the Commi thee addressed in some detail this issue of a 3-year ~ imitation on awards, and recommended that the agencies determine the proper interpretation of the 3-year ~ imi tation and establish the specific criteria by which requests for waiver of the ~ imitation would be determined . It was the Committee's view that 3 years of support each at the pre- doctora, and postdoctoral levels would provide suf f icient 5
f ~ ex ib i ~ i ty to mee t the needs of the HRSA programs and be consistent with the spirit of the existing legislations At the same t ime, the Commi t tee emphas i zeta the spec i al add i- tiona~ needs of minorities with regard to the amount and duration of financial support, and also the need for its availability at the start of graduate training (NRC, 1975-1978: 1977 Report, pp. 171-l 73 ~ . The Congress resolved th i s probI em in the ~ 97 ~ Amendments by extending the maximum period of support available to fellows and trainees under NRSA authority to 5 years for predoctoral students and 3 years for post- doctorals. As the House Committee Report noted, this more ~ iberal provision has the ef feet of provid ing greater free dom for predoctoral and postdoctoral students, and al so permitting a more flexible util ization of research grants by freeing an individual scientist's research funds that now are used to support graduate students working on those proj eats . Finally, the extension in the duration of NRSA support undoubtedly will have a benef icial impact upon the recruitment and retention of promising but economically disadvantaged students (particul arly women and minorities) into research training programs because of their often special needs for outside sources of support throughout their training, a point that is reflected in a recent change in training pot icy by ADAMBA and is ~ iscussed in Chapter 3. Cost-of-Living Ad j us tments in St mend Al lowances The NRSA Act of 1974 included no provision for stipend levels to be adj usted to continuing inflation. Without additional funds being made avail able, stipend levels have remained the same since 1974--53,900 for a' ~ predoctoral students and an average of $l2, 000 for postdoctoral awards . In its 1977 Report (NRC, 1975-1978; pp. 180-181), the Committee voiced great concern about these matters and rec- oIIunended that stipends be increased immediately and that future legislation provide for annual cost-of-living increases. Both the House and Senate Reports strong1 y endorsed the need for increasing stipends now and period- ically as the cost of ~ iving increases. The 1978 Amendments thus require the Secretary to consider cost-of-1 iving changes in setting stipend level s . In Chapter 3 the Commi thee comments upon the Depart- ment's recent announcement of increased stipends, effective July I, 1980. IRS Tax Liabil ity of Awards Af ter the inception of the NRSA Act, the Internal Revenue Service ~ IRS ~ ruled that NRSA awards were payment for ser- vices and fun ly taxable under IRS law, and recipients no
longer would be entitled to the exclusions allowed for ed ucat tonal schol ar ships . In its 1977 Report (NRC, 1975-1978; pp. 189-191 ), the Committee urged that DHEW request the IRS to withdraw its opinion. The Committee argued that the implementation of this rul ing would further erode the purchasing power of the stipend and divert students from their studies to search for additional income. The House Committee Report, although noting the possi- bil ity of resolving this problem by el iminating the ser- vice/payback provision entirely, determined that this was not the best course of action at this time. This issue was resolved temporarily through passage of separate legisla- tion ~ PL 96-16 7 ), which res tored the exclusions previously allowed for educational scholarships for NRSA awards made in 1979 and 1980. Limit on Institutional Support from Training Grant Awards With the beginning of the NRSA awards, DHEW imposed a 25 percent limit on the amount of institutional support that could be requested by ind ividual training programs . Thi s percentage, which was based upon the total program award, marked a decline from the average of 50 percent that NIH data show prevailed under the prior training grants program. The House Report (U.S. House of Representatives, 1978~ suggested that DHEW review its policy with respect to insti- tutional support in ~ ight of complaints from ind ividual institutions that actual costs sometimes exceed the permis- sibl e amount. The House urged that greater flexibi~ ity be provided in order to reflect the particular needs of indi- vidua~ institutions, provided such needs were adequately demonstrated . While this Committee has not previously made recom- mendations on this topic, in light of past policy i t en- dorses the House position. The recent change in DHEW policy relevant to this matter and the Committee's views are presented in Chapter 3. Shor t-Term Tra ining Wi shout Payb ack Ob ~ ig a t ion A new provision of the 1978 Amendments permits up to 4 percent of the amounts obl igated in any fiscal year to be expended for NRSA support for short-term training for peri- ods up to 3 months without having the recipient incur a service/payback obligation. The primary purpose of this exemption is to allow individuals to broaden their training experience by taking brief intensive courses in f ields outside their own area of expertise. 7
The Committee until now has not addressed this issue except in the special ized case of the need for support for midcareer training in the area of heal th services research where its possible use was suggested! (NRC, 1975-1978: 1978 Report, pp. ~ 25-1 26 ~ . However, in Chapter 3 of the present report, the newl y announce] program by NIN for providing short-term research training support for students in the heal th professions is presented together with the Commit tee's endorsement and comments. Deletion of Requirement for National Advisory Councils' Review of Individual NRSAt s In 1978 the Committee was asked info~a, ly for its view on a proposed change in the ~ eg i sl at ion that would remove the requirement that individual NRSA fellowship appl ications be reviewed and approved by National Advisory Councils before awards are made. It supported the proposed change because it would reduce the del ay in the t ime before an appl icant is not i f fed of the act ion taken on hi s app] ice t ion f and remove f rom Counc i ~ s a he avy admin i stra t ire burd en of prov id i ng a second review, but necessarily more superficial, due to the number of appl ications that have to be considered ~ This change was incorporated in the 1978 Amendments. Removing Inequi by in Service And Payback Requirements The provisions of the NRSA Act of 1974 authorized the Secretary, DHEW, to permit clinicians and other individual s qualified to provide heal th care services who received NRSA support to discharge their payback obligations by providing approved heal th care services in 1 ieu of engaging in heal th research or teaching if the Secretary determined that no suitable heal th research or teaching positions were ava~- able. Simile arty, the Secretary was authorized to permit Ph.D. recipients who received NRSA awards to engage in other health-related activities if suitable heal th research or teaching positions were not available. In each of these instances, however, individuals were required to provide 20 months of service for each 12 months of NRSA support rece Ives . Another provision of the 1974 Act establ ished that fract tonal credi t would be given for per iods of payback service that constituted onl y partial repayment of the individual' s total obligation. Finally, the 1974 Act authorized waivers and suspensions of the payback and service requirement in cases of " extreme hardship. " The Committee in its 1977 Report (NRC, 1975-1978; pp. 179-1 80 ~ called attention to the issue of even-handed 8
treatment of NRSA recipients in the pol icies, procedures, and administration of the program. It further urged that all acceptable forms of alternative service be clearly spec if fed . The House Commi t tee Report noted that the payback provision, whit e patterned after those established in the health manpower legislation that provided federal support for training in the medical professions, had caused much controversy. Testimony was provided to the Elouse that research is intrinsically different from medical practice, and that finding employment in a field of training frequ~ent- ly is more difficult in research than it is in medicine. It was reported that a strict interpretation of the require- ments of the Act deterred some students from seeking re- search training in more than one area, or in obtaining a position in a field different from that of their areas of training. It was also pointed out that many students received their research training support from employment on federally funded research grants (usually NIH) while incurring no payback or service obligations as do NRSA recipients. On the basis of these considerations, three changes were made in the payback and service provi signs in the 1978 Amendments. First, all recipients of NRSA support now incur the same payback obligation of one month of appropriate service for each month that support is received . Second, fur ~ credit now is provided to recipients even though their periods of service constitute only partial repayment. Third, the word "extreme" was deleted before "hardship" in the provision concerning waiver of payback and service requirement. This allows the Secretary to exempt individ- ual s who cannot f ind employment in the areas in which they were trained, encourages individuals to acquire training in more than one area, and relaxes the monetary payback requirement if it would ~ impose a genuine hardship on the individual . Together, these changes remove some of the major deterrents, especially for those in the health professions, to individuals who would 1 ike to accept NRSA support . Reports on Stud ies of Needs for Research Personnel National Academy of Sciences on its assessment of national needs for research personnel was changed in the 1978 Amend- ments to require a report at least once every 2 years . Thi s change recognizes the fact that national research needs that affect manpower pol icy issues do not change rapidly enough to justify the annual modification of training priorities and the issuance of extensive reports. 9
The House and Senate Commi t tee Reports issued in connection with the 1978 Amendments state that this Commi t- tee's reports have made a ma jor contribution to keeping the Congress informed on relevant issues. The House Report a' so commended the Committee for its practice of holding public hearings following the issuance of its reports to allow interested persons and groups to present their views on the report and the Committee's work. The removal of the annual reporting requirement will permit the Committee to under- take more compl ex and longer range stud ies than would otherwi se be possible. Determination of Subject Areas for Awards--The Advisory Ro, e of the NAS/NRC Committee The overall purpose of the NRSA Act that led to the establishing of the NRC Commi ttee on a Study of National Needs for Biomedical and Behavioral Research Personnel was to provide an independent study group to evaluate the role of and need for federal training sunoort in heal th research charge, however, the DREW, was to make which there is a need __ personnel as determined by the Academy's study. In reviewing this provision in connection wi th the proposed 1978 Amendments, the House Committee concluded it might be inappropriate for the recommendations of the National Academy of Sciences to be binding on a government agency. The Senate Committee's view was that the responsi- bi~ ity for determining eligible areas of research training should continue to be pi aced wi th the NAS/NRC Commi thee, which provides an independent assessment of national need. The Senate' s view prevailed, and the role of the Academy remains unchanged in the ~ 978 Amendments . careers . In addi t ion to that general Act also specified that the Secretary, awards only in those sub j ect areas for for n~r~onn - 1 an d - Fermi n - H hv the Dec.] ining Interest of Physicians in cl inical Research Careers Al though a number of changes were made in the provisions of the Act by the 1978 Amendments, the Senate Committee noted that further refinements may be needed as time passes. In particular, the Senate and House Commi ttees voiced concern about the reported recent decline in the numbers of physi- cians who are attracted to careers in c1 inical research and who are receiving research training under NKSA awards, and observed that the NAS/NRC study currently is focusing its attention on this important issue ~ see the discussion below o f th i s Commi t tee ' s End i cot t House Conf erence and the 10
section on "Clinical Sciences" in Chapter 2 ~ . The House Commi t tee expressed the hope that the ~ iberal ization of the payback and service provisions made in the 1978 Amendments will assist in al leviating this problem. The Senate Com- mi t tee noted that i t will g ive close attention to any statu- tory changes that may be ind icated following a review of the concl usions drawn from these studies . COMMITTEE 'S ENDICOTT HOUSE CONFERENCE In carrying out the Congressional mandate to assess the national need for biomedical and behavioral research person- nel, and to specify the kinds and extent of training to be provide] under the NRSA Act, the Committee has collected and analyzed a substantial body of data. Starting in 1975, i t has presented its f indings in a series of four annual re- ports. Each report has incorporated an increasing amount of data, reflecting the Committee's intent to gather as much information as possible about the current labor market for biomedical and behavioral scientists, about the short-term outlook, and about existing federal training programs in these fields. The Committee's last report, issued in Sep- tember 197S, presented a brief cumulative summary of its f indings and recommendations (NRC, 1975-1978: 1978 Report, pp. 2-4 ~ . The reader who desires such a synopsis is refer- red to the t repor t . With a growing body of data to call on and the develop- men t of some mathematical models to assist in its anal ysis of the data, the Committee concluded after pub! ishing its 1978 Report that its research program for assessing the system in quantitative terms, al though by no means complete, was making substantial progress. It decided then to focus on some of the long-range issues concerning the federal training programs that it had discussed previously but for which no specific research plans had been developed. For this purpose the Committee held a 2-~3ay conference at Endicott House near Boston on November 30 and December I, 1978. Members of the Committee and Panels were invited to submit papers on a ~ ist of issues ranging from methods for detec-~`,ining training priorities to the special problems involved in training cl inical investigators . As a resul t of the discussions at the Endicott House conference, the Committee compile ed a list of issues to be investigated and assigned priorities to each. Among the issues with the highest priority were those pertaining to the training of clinical investigators, including the extent to which non-M.D. 's participate in clinical research and their potential for increased participation in this area. Another was to assess the impact of the ~ oss of training grant support on the qual ity of graduate training . Sum- marized below are the issues accorded highest priority and major points presented in the Committee's discussion of them . 11
The Training of Clinical Investigators In its previous reports, the Committee repeatedly has expressed concern over the decl ining interest of physicians in academic research . The evidence of this decl ining interest over the past 10 or 15 years is manifest in the data cited in the Committee's 1978 Report showing declining proportions of physicians as principal investigators on NIH research grants, dec] ining numbers of physicians reporting research as a primary activity in a survey by the American Medical Association, fewer physicians participating in the research training programs of the NIH, a growing number of budgeted vacancies in clinical departments of medical school faculties, and a smaller number of recent medical school graduates expressing interest in research careers. A major cause of these trends is believed to be the income differential between physicians in private practice and those in academic or research positions Studies have documented the substantial net loss in ~ if etime income to a rel at ive to one who are other aspects of the add i t tonal tra in ing requires for a research career, One instabil ity of research funding, and the ~ imited experience in research as a basis upon which the individual must assess his/her chances of becoming a successful clinical investigator. The Committee has also noted the increasing integration of the basic biomedical sciences and the cl inical sciences . Research in the former is generally performed by PhoDe ~ s and in the latter by M.D. 's. But with the growing integration o f the two areas, there is apparently more opportun i ty for PheDo ~ s to participate in clincial research and for M.D.' s to conduct investigations in the basic sciences. These topics were discussed at length at the Endicott House conference and were j udged by the Commi t tee to be of the greatest importance for future studies. phys ician choosing a research career chooses private practice. But there this issue that must be considered: for a research career, the t t he 1 im i ~ ad exDer i ence Training Grants and the Qual i ty of Training A second set of high-priority research topics concerns the contribution that training grants have made to the quality of training in the biomedical and behavioral sciences and the impact that the reduction or loss of training-grant support has had on departments and programs. At the heart of these topics is the question of the effectiveness of the training grant compared to alternative mechanisms of support. In order to understand the special role that training grants pi ay in the training of biomedical and behavioral scientists, it is important to recognize two distinguishing 12
characteristics of these fields that explain why many educa- tors place a high value on the training grant as opposed to other support ~nechani sms such as research grants . The first characteristic is that biomedical and behav ioral research programs exh ib i t grea t ~ ivers i ty and are truly multidisciplinary. Almost all fields of science are represented to a greater or lesser degree in the research and training programs of the National Institutes of Heal th (NIH ), the Alcohol , Drug Abuse , and Mental Heal th Administra- tion ~ ADAMHA), and the Heal th Resources Administrat ion (EIRA) . The heaviest representation, of course, comes from the core fields such as biochemistry, physiology, psychol- ogy-, and the clinical sciences. But substantial contribu- tions also come from physics, chemistry, engineering, mathematics, and the computer sciences. Table 1.l shows the range of fields in which scientists were employed on re- search grants sponsored by NIH in 1973. Note the large participation of scientists in mathematics, statistics, com- puter sciences, and the physical sciences. To underscore this point, it may be noted that the 1979 Nobel Prize in Physiology or Medicine was awarded to two radiological physicists for their work in developing the X-ray diagnostic technique known as computerized axial tomography (DiChiro and Brooks, 1979~. Their work, furthermore, was made pos- sible by recent developments in the computer sciences and mathematics . Because of the <diversity of biomedical and behavioral research, the federal agencies have attempted to provide flexible mechanisms for training research personnel in this area so that trainees may obtain exposure to a variety of fields and be able to understand and util ize developments in the several fields related to their own special ity. The training grant facil itates broad, multidisciplinary train- ing, allows for interdisciplinary training at the predoc- toral level, and for flexibi] ity to special ize at the post- doctoral ~ ever. The second distinquishing feature of biomedical research is that it requires the participation of people wi th degrees in the heal th professions, especial ly physicians. The training of physicians prepares them for cl inical practice but not research. They rarely receive adequate training in the techniques, procedures, and methods of research during the course of their education as health professionals, since the curricula of medical, dental, veterinary, and nursing schools are designed to produce practitioners, rather than investigators. One y a very small fraction of these graduates choose a career in research, but their participation is vital to the research effort and there i s a recogn ized need to provide them wi th the research training necessary for such a career . Some opportuni ty for research training for health professional s is provided on research grants, but the experience is usually too restricted and is narrowly focused on the research topic 13
. DU" \.1 Muir of Personnel P~lcipat$nq in ItTH Research Grants in 19730 ~ Field of ~1~- TOS=. All Fields - 17 709 ' 91- tatal, Ante Ited. ~ Bio. Sell 9,875 Total Chin. Med. te~ceept Internal) 1,082 Total, Other Nealth-Related Flde. 95 anatomy 322 Anesthesiology 36 Audiolo" C Speech 7 Bacteriology 92 Owootherapy, Cancer 111 Den - 1 Hygiene aloehe"atcy 2, 921 Dermatology 47 Dietet$ce ~ Biology 401 Neurology IlS Epidemiology 6 ~ophyel~ 36S ~luclear medicine 18 Health ~nistra~cion 3 Downy 7 Qbetetrice C Gynecology 33 nursing 51 Call Biology 689 oncology 116 Op~try Biology 12 Oph~logy 104 Pharmacy 1 "~logy 52 Osteopathy 2 Physical Therapy G~tice 621 Otorhinolaryugology 28 Socks Work ~ ~~ 582 P"ia=ice. Audiology 12 Very medicine 6: medical, G~ere1 40 ~tatrics, NEC 137 Other ~lth~lated Fields S' l~c~b"1 15io.:he~strs~ 167 Ecology, Clinic" 32 lilarobiolqy, sEC 286 Preventive Ted. ~ Public Health 9 Em, End. Sci. ~ Engineers 40 Ihtsition 73 Psychiatry 10 Parasitology 97 Radiology . 74 Air ~ water polls Patbolo" 594 Surgery, ~diovasd~ 17 =~r~g 9. Pt~cology 529 Surgery. General S7 ~ngineerl~g, Bimoadica1 24 physiology 18 351 Surgery. Neurological 26 "g~r~g, Environment }by, ~liz~ie" 61 Surgery, Orthopedic 20 Other l=viro~' 5Cio !;. TWO - y 396 Surgery, Plastic 2 MY 59 Surgery, Thorecic ~ Otto Em Biro 5ci. 1S8 Surgery, MEC 2 Tropical Hedicine 3 - _. Urology 35 Other Cacao icicle AS ,!o~=nt~1 Hed: Clinical 1,129 19 Sots Deneistrv 84 Satan, Bath., St., ~ ~ter Sci. 62 Cardio~scul~ Diseases 2S. Cam. Dentistry, Cleft Paleee 6 Bios~t$stics ~inology 167 Cam. Dentistry, Oral Pathology ~ Computer Applications 24 C~ts~nterology 71 Clin. Dentistry, Oral Surgery 8 . Mater ~ Snfor~tion System 17 Scot 2S3 an. Dentistry, P-riodontia 22 34~ statics 3 Colony 51 Dentistry, General 4 Statistice 3 infectious Diseases S? Other Den1 Specialties 43 0~ math. ~ Stat. 1 internal md$C~, General 66 told 93 To=1, P~qrsic.1 Sciences S7 Pulmonary Die 44 Rcna1 Diseases 60 Q~_istry, Inorganic ~ Other internal nedie~n- 34 Tonal, Behav. c SOCKS act, 582 Chall~sery Med;e~1 262 Anthropology 10 Chemistry, Physical ~ ~ncoice 1. C~stry, me: 7 Psychology, Clinical 24 Physic. 7 Psychology, Develo~enta1 14S o"er Physical Sciences Psychology, Gen. c Exp.eri - . 141 Psychology, Physiological 104 Tool, Other Fields 2C Psychology, NEC 34 arts ~ Eh~nities 1 Sociology 45 Audio-Visua1 Other Behav. L Soeia1 Sci. 65 education L;ibrary Science ~ Other, Specify l- Total, Unknot Fields 22C O:~s flit! ~npo~r Report, 1973. Data in this table represent Al estimate of the full- equivalent ~n-years of paid and unpaid "r~nne1 on NTH sponsored research graner in 1973. mere data Arc derived from the Manpower Report Surrey after adjusting for nonres,oondente. . 14 .
of the grant. On the other hand, the training grant affords the flexibil ity needed by those whose education has, so far, been practice-oriented. Thus, it is a significant aid in the recruitment of M.D. 's into research because it provides for the selection of candidates locally without their having to compete nationally for ind ividual fellowships at a time when they have not acquired previous experience in research. It is for these reasons that the Committee has paid special attention to training grants and is planning to examine further both their effect upon the qual ity of training and the impact that the loss of training grant support has had upon departments and tra ining programs. Specifically, the Committee plans to collect informa- tion from departments on a case-study basis with regard to what occurs when training grant support is lost, how coopera t ion wi th in depar tmen t s i s a f f ec ted, and wha t the impact has been wi th regard to innovative courses and seminars . Research Product ivi ty anal Academic Careers A third major issue discussed at Endicott House is the reduced prospect for academic careers that faces young investigators in the biomedical and behavioral sciences. Historically, the universi ties have been the major employer of such investigators. Currently, however, the universities have faculties that were expanded rapidly during the 1950's and 1960's. Accordingly, most colleges and universities have rather young facul ties in tenured positions and low rates of attrition due to death and retirement. Further- more, the rapid-expansion era of the 1960' s has given way to a siow-growth period in the 1970 ' s, which, by al l current indications, will be replaced in the 1980' s by a no-growth situation and possibly a contraction. Thus, the prospects for additional permanent ~ i.e., tenured), academic positions becoming available in the near future are poor. On the other hand, there is a large pool of biomedical scientists, most of whom aspire to an academic career, who now occupy postdoctoral positions. They have had the most recent training and are bel ieved to be at a very productive stage of their research careers. The Committee is concerned about this situation for two reasons: the careers of the younger cohort of scientists may be thwarted by the lack of academic opportunity; and this blockage, coupled with a gradual aging of the present faculty, may have a detrimental effect on the nation's total research productivity. There are several important relationships that the Commi thee bel ieves must be investigated and certain facts _ con trac t ion. Thus, the 15
that must be gathered before any recommendations can be formulated on this issue. A key question is the relation- ship between age and research productivity. Some work has been done on this question using publications and citations as productivity measures, but more study is needed to explore this red ationship in the fields of concern to the Committee. More knowledge also is needed about the facul ty age distributions and attrition rates in specif ic disciplines. Another committee of the National Research Council has recen tly compl eted a study o f thi s research-produc t iv i ty problem in all science and engineering fields (NRC, 1979~0 The NRC Committee on Continuity in Academic Research Performance has concluded in its 1979 report that the 1980 and 1990 decades wil ~ bring "a substantial and sustained decline in openings for new faculty in a number of science and engineering f ields, " and that decl ine is ~ ikely to damage the nation's research effort unless steps are taken to so f ten i ts impac t O Tha t commi t tee recommended the establishment by the National Science Foundation of a program to support academic research by means of ''Research Excellence Awards. n These would be 5-year, nonrenewable grants to tenured or nontenured faculty members nominated by the ir depar tmen ts O The awards wou1 d provide par tial Sal ary support to recipients, and the university would agree to devote an equal amount to the hiring of additional facula ty in the same departments, thus accompl ishing The main objective of the program, i.e., to create additional academic opportuni t ies for young researchers . Th is program is estimated to cost about $380 mill ion over a 20 -year period of operation and would provide for approximately 250 awards per year at i ts peak. Identification of Priority Fields for Training A fourth point that received considerable attention at the Endicott House conference involves the identif ication of fields or areas of research that merit higher priority in the al location of training funds . By way of background for this issue, it will be recap led that the NRSA Act of ~ 974 requested the National Academy of Sciences to conduct a study of the nation's overall need for biomedical and behav- ioral research personnel and the sub j ect areas in wh ich such personnel are needed . This Committee has responded to the t task by subdividing the biomedical and behavioral f ields into four broad areas: basic biomedical sciences, behavioral sciences, clinical sciences, and health servi ces research. It has made separate recommendations for training support in each area. In a few special ties such as toxicology, epide- miology, and biostatistics and in most clinical science fields, the Committee has inferred from the available data that personnel shortages exist and has recommended that these fields be given special consideration in the training programs. 16
The Committee has not attempted to construct a ~ ist of specific fields el igible for federal support, and indeed considers it inadvisable to do so. The rationale for this position is that the Committee believes it is impossible to foresee accurately enough where major developments and contributions will occur. Thus, it has suggested that training support be provided in accordance wi th its recommendations in each of the four broad areas and, within these guidelines, that training support be allocated on the basis of merit as judged by peer review of applications for the support of specific research training programs. At the conference, the Committee reaffirmed its earlier position on this issue. But the question arose as to whether further efforts should be devoted to the problems of identifying emerging fields and of attracting students into those fields with the incentives provided by training stipendse At the predoctoral level, training should be broad; yet is there reason for considering that some of this training should be targeted or directed to areas where so- ciety's needs are clearly evident--aging, cardiovascular problems, environmental hazards, etc.? At the postdoctoral level the peer review system does better in matching train- ing funds with relevant needs/opportunities. But should the Committee identify critical areas even in the predoctoral period and emphasize these areas for training? That is, should it be satisfied that field switching and midcareer training will accompl ish all of the fine adjustments that it anticipates will occur in the postdoctoral period? Previous attempts to identify priority fields for training have not been successful primarily because of cliff icul ties in developing ob jective criteria. The resul t- ant dependence on sub jective j udgment in this case is fel t to be an unsatisfactory basis for <decision. The question really has two aspects: (~) identifying fields in which current supply is inadequate relative to the number of positions available; and (2) identifying fields that are ~ ikely to become more or less important than they curren tly are in the research en ter pr i se . In the first case the task is one of gathering and evaluating current data on the labor-market situation in specific disciplines. The Committee has been doing this with moderate success in some cases, but ill-defined boundaries between fields and the ability of scientists in closely related disciplines to switch fields readily have prevented the Committee from making definitive statements about more than the small number of fields cited above. The second aspect of this question, namely, the identification of emerging fields, is even more difficult due to the lack of objective criteria. Subjective judgments appear in this case to be a poor basis for recommendations by the Committee. Yet there is considerable appeal in the 17
notion that current training programs should try to anticipate future research needs. This means not only identifying f ields that are ~ ikely to grow in importance but also those that are likely to decline in importance. The Committee concluded that these various facets of the issue cannot be resolved readily but, because of their importance' should be accorded high priority for continuing attention. Other Topics Discussed at the Endicott House Conference In addition to the foregoing issues 9 a number of other topics were discussed, all of which were considered to be important to the Committee's task, but which for several reasons did not generate high-priority research questions. In some cases, the topic raised very general questions about the federal role in biomedical and behavioral research training the t were nonquantitative in na tur e and no t amena- b~e to a structured research task. In other cases, the topic was considered amenable to research, but the method- ology was not readily apparent or the topic simply was j udged to be of somewhat lesser importance to the Commi t- tee's major tasks. These other topics and the ~~Commit- tee' s discussion of them are summarized bed ow. What is the Nature of the Marke t for Biomedical/Behavioral Tra ining? In discussing this market, it is important to distinguish between the demand for the services of scientists trained in these fields and the demand for training on the part of stu- dents seeking research careers. The former involves ques- Lions about the supply of scientists compared to the number of positions available that require their skills. More is needed to be known about the costs of shortages in research personnel, induced by abrupt changes in demand, relative to the costs of having a reserve of skilled people in anticipation of future needs. The latter requires more know1 edge about factors affecting career choice and the responsiveness of students to changes in employs ent opportunities . Discussion of these questions led to the issues above concerning the distinquishing characteristics biomedical/behavioral research and the impact that grants have on the qual ity of training provided in f ields . 18 outl ined of . . training these
Are the Biomedical/Behavioral Sciences Disproportionately Favored with Federal Support for Training? This equity issue is difficu~ t to address quantitatively because federal programs are so broad that it often is difficu~ t to categorize them by field. It was noted, however, that since public policy accords high priority to health matters, it is not surprising to find a large federal effort devoted to biomedica1/behaviora' research and training. Different federal agencies (e.g., Defense, Agriculture) have different missions, use different strategies to accomplish them, and have different profiles for their expenditures. To What Extent Does the Federal Government Bear a Respons~- bility for Ma in ta in ing the Viability/Quality of Biomedi- cal/Behavioral Training Programs? It was suggested that the government's responsibility in funding research derives from its responsibility for the general welfare to do that which is necessary whenever other mechanisms do not suff ice . By virtue of its heavy investment in biomedical research, the federal government also has a responsibi] ity for maintaining the quality of the research training programs. Thus, an appropriate criterion for determining the level of federal support for research training might be the desired size and vigor of the research effort, and not market perturbations in the usual sense. Ordinary market forces may work against decisions to enter scientific careers. Research training actual ~ y is research participation, and early recruitment into science is necessary to maximize research productivity. The following questions relevant to this issue were formulated: (~) What is revealed by a comparison of the current and 1967 levee s of research support, number of doctorates awarded, and rates of production of new research personnel ? ~ 2 ~ What would have to be the training rate (e.g., in 1980) to maintain a steady-state output of new investigators? ~ 3 ~ How could a mixture of early-career, mid-career, and late-career support programs achieve this? What Should be the Rationale for Federal Support of Graduate Students or Post-Professionals--Personnel Shortages, Re- search Need, Academic Merit, Financial Need, or Cultural Di sadvantage? The traditional rationale for federal support for research training has been to provide the capabil ity to get research 1 9
done of the type, quality, and quantity that has been de- cided by the Congress through legislation and appropriation. Thus, from this point of view, the categories of personnel shortages and research needs, at least in the operational sense, are essentially identical. Wh it e financial need and cul tural disadvantage may al so be appropriate reasons for providing federal support, the Committee bel ieves these should not be superimposed on the manpower issue. Separately funded prograns should be devel- oped to meet social ob jectives, although, of course, purely soc i al barr ier s shout d no t bar academ i Cal ly mer i tor iou s students. In turn, the ob jectives for training programs should be clearly stated both by the supporting agency and the applicant applying for federal support, thus avoiding misunderstandings such as that which accompanied NIH-sup- ported cl inical training programs in the 1960 ' s . Al though factors other than f inancial affect career decisions, it does appear that the availabi~ ity of trainings grant support affects decisions at the margin. Some dis- cussants thought that basing fell owship support on financial need alone would lead undesirably to ignoring academic merit, aptitude for the occupation, and related aspects signif icant for scientific work. An important aspect of the discussion of the rational e for federal support is the power of training grants to direct students to priority areas. Do students move into specialized programs ~ like aging and others) that have a very high priority from the federal point of view when training grants are provided? It has long been assumed without adequate evidence that financial incentives can redirect students' interests. This question deserves fur ther study. It may be possible to look into i t in connection with the Committee's plans to do case studies of departments and programs that are ~ osing training grants. What Is the Role of the Postdoctoral--Trainee or Provider of Research? From the perspective of more than 50 years of experience with postdoctoral fellowships in the U.S., it is clear that they have been of tremendous benefit to the development of American science. Starting in 1919 with the National Re- search Fellowships (Cochrane, 197S, p. 239) and continuing today with the National Research Service Awards and other federal and private programs, these postdoctoral appoint- ments have served the dual purpose of advancing the sciences and providing additional training opportunities for young scientists. In recent years, the role of the postdoctoral appointee as a producer of research has grown in importance 20
relative to the training function. The use of the postdoc- toral mechanism as a holding pattern for promising young researchers for whom no immediate opening on a regul ar faculty or tenure-track position is avail able is also a recen t phenomenon . The se deve ~ opmen t s pr e sen t d i f f i c ul t policy issues, e.g., whether or not it is sound policy to use funds appropriated for research training to support postdoctoral appointees whose principal function in practice would be to increase the research output of the laboratories of their mentors. The use of training funds for the support of Scientists awaiting appropriate job opportunities involves similar ambiguities. On the one hand, it is a realistic adj ustment to a steady state instead of the expanding universe of the 1960' s. On the other hand, it may prod ong unreal istic hopes and undesirably delay other in- iv idual adapta t ions . Further, the absorpt ion of wel ~ - traine<3 investigators into an " unfacul by" (Walsh, 1979 ~ could delay the overhaul of university pol icies regarding scienti f ic personnel . The question of how productivity in research changes with age, and the <tiff icul ties inherent in evaluating publications, etc., was discussed at length, including the observation that citations may increase wi th the age of the publication ~ and therefore, obviously, with the age of the author). It was suggested that the Committee may wish to investigate these relationships and the role, if any, that midcareer training has or might pi ay . The e f f ec t o f r ecen t ~ eg i sl a t ion on re t ir emen t ag e and its impact on the availability of academic positions, the costs of maintaining nontenured research facul ty, and the changing concept of tenure were discussed. The Committee indicated some interest in doing a prospective study of the cost of providing support for nontenured doctoral research staff, as well as looking at the age distribution and pro- ductivity of facul ties in different bioscience departments. Summary As can be seen by these brief summaries of the maj or topics discussed at the Endicott House conference, the Committee rev dewed a number of basic issues relating to the training of biomedical and behavioral researchers . It is dif f icul t to convey briefly all the points that were raised in the discussion; and, indeed, for this reason we have not attempted to summarize the extensive discussion of topics such as the marginal utility of federal funding for training, the extent to which federal funds should be used to supper t inch iv id ual s who pur sue nonre se arch and/or 21
nonacademic careers, and the selective pattern of ~ istribu- tion to institutions of federal support for research train- ing . Al ~ the topics generated considerable comment, wi th the ~ iscussions of one topic of ten overlapping that of another. The length of the summary presented for each is by no means an indication of the amount of consideration given the topic by the Committee. Overall, the conference was a useful forum for reviewing these issues and for assisting the Committee to set some priorities on its future research agenda ~ the details of which are presented in Chapter 2. 22
