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2. HIGHLIGHTS OF CURRENT STUDIES AND RESEARCH As discussed in Chapter I, considerable time this past year has been devoted by the Committee to the development of its research agenda through 1981. Studies have been designed, for example, which will address the serious issues that have arisen in connection with the training of M.D.' s, and hold- ers of other heal th professional degrees, for research in the clinical sciences. A better understanding of the fac- tors that affect the employment of bioscientists is also anticipated as a result of the more intensive market analy- ses that the Committee plans to undertake during the next and succeeding years. Finally, the Committee believes that completion of its national survey of health services re- search personnel contributes to a be tter understand ing of the present role and overall capabil ities of heal th services research invest igators . CLINICAL SCIENCES In its 1978 Report, the Committee noted the likelihood that demand for clinical investigators would continue to be strong for the next few years. At the same time, the report called attention to the decline in attractiveness of a ca- reer in clinical research , and noted the financial and other disincentives that may be contributing to that trend. These implications of a potential ly reduced supply of clinical investigators may portend a supply/demand imbalance in the future . The decrease in the number of physicians being trained in research under the NIH sponsorship in recent years has stirred mounting concern ~ see Table 2.~. Since publication of the 1978 Report, this concern has provided a theme for a<3~3resses by the presidents of four ma jor societies: the Central Society for C] inical Research ~ Kipnis, 1979 ), the American Federation for C, inical Research (DiBona, 1979), the Society of University Surgeons (Skinner, l 979), and the Association of American Physicians (Wyngearden, 1979 ~ . A conference in June 1979 at the University of Chicago's Center for Policy Study explored influences affecting funda- mental, as opposed to targeted, c1 inical research ~ Broad, 1979 ~ . Suggestions were offered for various forms of action to counteract the observed thinning of clinical investiga- tors' ranks in the past decade. Also, as noted below, the Committee's Panel on Clinical Sciences convened a conference to consider problems in the training of research personnel.

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A variety of efforts are underway in the pubI ic and private sectors to reverse the attrition in clinical research train ing . NIH has expanded and modi f fed the re- search gran t mechani sm in order to encourage newly trained investigators to develop research interests and skills, and to furnish research support during the developmental stage of their careers. Several of these types of awards are intended to facil itate the transition of medical school graduates from fed lowship status to a career in independent clinical investigation. Notable examples are : the National Insti Lute of General Medical Sciences' (NIGHS) Special Grants for New Investigators ~ anesthesiology and trauma/burn research); the National Institute of Arthritis, Metabolism, and Digestive Diseases' (NIAMCD) Special Emphasis Research Career Awards (diabetes mellitus); and the National Heart, Lung, and Blood Institute's (NHLBI), NIAMDD's, and the Na- tional Institute on Aging's (NIA) Clinical Investigator Awards. The Committee has been informed that the National Institute of Allergy and Infectious Diseases (NIAAD ~ and the National Institute of Child Health and Human Development (NICHD) will be announcing similar programs. These awards provide a substantial part of a new faculty member's salary for periods from 3 to 5 years, plus some research- support. The Commi t tee also notes the recent announcement from ADAMHA by the National Institute of Mental Health (NIMH) that en- courages clinicians to apply for Research Scientist Develop- men t Awards . More recently NIH has moved to take advantage of the ~ 9 7 ~ Amendmen t s to the NRSA Ac t, wh i ch encour ag e shor t- t erm research training. Health professions students receiving training awards of up to 3-months' duration will not be subj ect to a payback provision under this program. Each institution awarded a grant for short-term research training will be expected to encourage among the trainees a sense of belonging to a community of scientists. Methods that may be used for this purpose inch ude the provision of special sem- inar series on such topics as research methodology, experi- mental design, etc. Some private agencies have announced programs that cl earl y recogn i ze bo th the need to s t imul a te in tere s t i n clinical research careers and the economic real ities of the challenge. An innovative example of these programs is the American Heart Association's Clinician Scientist Award, which is aimed at physicians without substantial research background at a stage close to the complet ion of residency training. Outstanding features of the program are its Sal ary prov i s ions, a mechan i sm a t the end of 2 ye ar s for evaluation of the trainee's potential for independent investigation, and the availability for successful candi- dates of an addi tional grant for estabI ishing a research laboratory toward the Cal ose of the 5-year training period. 25

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The outlook for cl inical investigation has been brightened somewhat by three recent developments. The Com- mittee called attention last year (NRC, 1975-1978: 1978 Report) to a 7 percent increase from 1975 to ~ 976 in the number of physicians reporting research as a primary activ- ity. More recent data from the American Medical Association indicate that this apparent reversal of a long-term trend has continued, with 9,786 physicians reporting research as a primary activity in 1977 compared to 8,514 in 1976 (American Medical Association, 1977~. The significance of this devel- opment will be examined by the Committee during the coming year to determine, for example, its possible relationship to changes in research and development (R&D) funding. Another potentially important development was the substantial increase, between fiscal years 1977 and 197B, in the numbers of cI inical sciences traineeship and fellowship awards made by NIH ~ see Table 4 ~ I, p. 51~ . Indeed, the number of postdoctoral traineeships very nearly matches the Committee's recommended levels for the period 1980-19820 In a few months the necessary information will become available to determine how these awards were ~ istr ibuted between M.D. ' s and Ph.D. ' s. This is an important question bearing on the possible rej uvenation of interest in research on the part of M.D. 's and on the role of Ph.D.' s in clinical inves- tigation. Because of the growing number of biomedical Ph.D.'s and the previously noted declining interest in re- search on the part of physicians, these are issues to which the Committee has assigned high priority for investigation. A resolution that the Association of American Med ical Colleges (AAMC) investigate possibil ities for fostering research opportunities for medical students was approved in October 1978 by the AAMC's Organization of Student Represen tatives (OSR). The results of surreys administered] at the 1979 regional OSR meetings appear to signal a rise in med i- cal students ' interest in research and a greater incl ination toward academic careers than has been evident in recent years. Prompted by the resolution, the AAMC i s currently studying ways to stimulate the schools to improve opportun i- ties for student participation in, or exposure to, research during the undergraduate medical years. S upp] y and Demand S t ud i e s The Committee recognizes the inadequacy of the data base for character izing the marke t for cl inical research personnel . It is therefore continuing to assign a high priority to a study of the factors influencing supply and to efforts to improve estimates of demand. 26

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Supply Studies Study of "Recent Deciders" At the Committee's request, Michigan State University conducted a mail survey of atti- tudes and values of senior residents and fellows com plet- ing their last year of training in internal medicine. A national sample was developed by asking chairpersons of university-redated departments of medicine to select young physicians who were in a relatively advanced stage of trair.- ing and who had already dec ided for or against a career in academic medicine. A key criterion for selection was a judgment by their mentors that these individuals possessed the knowledge, intellect, and skills for academic careers. The purpose of the study is to identify the factors that in fluenced their career decisions. The perceived incentives and disincentives for an academic career, compared with other career choices, will be evaluated. If this phase of the research is successful, the study will be extended to include an additional sample from pedi- atrics, surgery, psychiatry and, possibly, obstetrics/gyne- cology. The Role of Ph.D Investigators in Cl inical Research The ys~cian-inves- tigators is quite remarkable when viewed in relation to increases over the decade in medical school graduates and in the clinical faculty of American medical schools. By con- trast, over the 5-year period between 1972 and 1977 , the number of Ph.D. biomedical researchers has continued to expand, with a net growth at this time of 560 per year in the pool of postdoctoral appointees (NRC, 1975-1978: 1978 Report, p. 42~. In addition, a decreasing proportion of NIH training positions are being f illed by M.~. trainees and fellows (Table 2.l, p. 24) . The Committee's survey of 1971-1975 Ph .13. recipients in basic biomedical f ields shows that approximately 31 percent of the respondents viewed their research as conforming to the Committee's definition of clinical research (NRC, 1975-1978: 1977 Report). Against this background it is not surprising that one of the questions seriously being asked of the Commi thee concerns the role of the Ph.D. scientist in clinical investigation. The Committee has formulated a series of questions and suggested research approaches that bear on this issue. One question to be investigated this year with the cooperation of the Association of American Medical Colleges relates to changes in recent years in the frequency of employment of non-M.D. scientists in c] inical departments of medical schools, as well as in distribution by age and academic rank . 27

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A staff study is planned to shed light on trends in the extent of involvement of Ph.D.'s in projects characterized as cl inical research by NIH criteria. Data from the NIH Manpower Report s from ~ 97 3 -1 97 ~ on per sonnet rece iv i ng any salary from research grants will be analyzed. Completed annually since 1973 by principal investigators, the Report contains data on the <3iscipl ines, academic levels, types of degrees, and number of weeks worked on a grant by each participant. Finally, the Panel on Clinical Sciences and the Panel on Basic Biomed ical Sciences will convene a workshop on the role of non-M.I). scientists in clinical investigation. Special attention will be devoted to the perceptions of clinical investigators ~ including those with joint M.D./Ph.D. degrees) regarding the nature and import- ance of the role the M.D. background pi ays in their research, as well as the means for maximizing the mutual involvement and interaction of M.~. and non-~.D. scientists in cl in ical research . Medical Scientist Training Program The Medical Scientist Training Program ( MSTP ) supported by NIGMS represents for a selected group of physicians an important route of access to academic careers in biomedical research. Previous recom- mendations by the Commi thee for expansion of the program were kept modest, at least partly because of uncertainty about the size of the pool of qualified applicants. An attempt to estimate that pool size has recently been made (Association of American Medical Colleges, 1979~. The judg- ments of 15 MSTP directors suggest that only 48 percent of the pool of ful ly qual if fed candidates could be funded by the program in 1976. The authors conclude that not only could admi ssions to the program be increased appreciably without risk of quality dilution but also that MSTP is only slightly more expensive per graduate than the more common post-M.D. research train- ing programs. The Committee will careful ly examine the implications of these findings and other factors during the coming year in red ation to possible expansion of the progr am . Demand Studies Modeling of Demand Efforts to mode] the demand for cl inical investigators have thus far been ~ imite<] to the academic sector. The Committee is awaiting receipt of data from the ATner ican Med ical Assoc i a t ion, which wi ~ ~ enumerate phys i- cians by primary activity and by emp1 oyment sector for the 1970-1977 period . These headcounts, while somewhat less useful than full-time equivalent measures, which AMA cannot 28

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supply at this time, are nevertheless essential for refining the present demand model to include physician-investigators in the governmental and industrial sectors. The value of these data has been enhanced for the Committee's modeling needs by a recent AMA survey that has added new information about the professional act ivity of physicians . In collaboration wi th the Association of American Medical Colleges, a study is underway to produce estimates of the age-dependent pro<3uctiv i ty prof il es of medical school facuI ty members. Such est imates would improve the Commi t- tee's demand model, which now relies on total clinical facul ty as a surrogate measure for the subset of clinical researchers. Veterinary Research Personnel The role of veterinary scien- fists in biomedical and behavioral research has expanded in the past decade. This has resulted largely from the growing importance of animal studies to an understanding of human health. It is interesting An this connection that the Na- tional Cancer Institute, in the interests of itself, the Environmental Protection Agency, the National Institute of Environmental Heal th Sciences, and other federal agencies, has announced a new 3-year residency training program for veterinary pathologists. Increasing constraints surrounding research on human beings, especially on children, have en- hanced the val ue of an Oman model s that can be used as sur- rogates for man in cl inical studies. It seems reasonable to expect that a growing fraction of cI inical research in the future will use animal models, and that scientists expert in comparative medicine will be employed increasingly in team efforts. The Committee, therefore, will extend its analyses to research training needs in veterinary medicine and its subspecialties. Also, the Committee plans to collaborate with the National Research Council' s Committee on Veterinary Medical Sciences in a study of the needs for veter inary research scientists and the capacity of the veterinary educational system to meet those needs. Invi tational Conference Through its Panel on Cl Vicar Sciences, the Committee in June 1979 sponsored a conference on problems affecting the supply of Cal inical research personnel. Participants in this 1 -day session consisted of ~~ scheduled speakers and an add i t ion a ~ 7 per son s who o f f er ed commen t s ~ ur i ng open ~ i s- cussion periods (Appendix D). A wide range of subject mat- ter was covered, some of which is reflected in the following recommendations of the Committee. 29

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Commi t tee Recommendat ions Some training program directors have expressed concern as to the extent to which research training f unds can and should be used to support c] inical training activ- ities (Association of American Medical Colleges, 1978 ~ . NBSA support of such activities, when judged essential to an individuals s research training program, is in accord with recent indications of Congressional intent. ~ Moreover, support of research-related Cal inical training is clearly not barred by NRSA regulations. Therefore, to counteract the reported perception that such prohibitions exist, the Com- mittee recommends that NIB pubI icize current pot icy on support of research-related cl inical training . The Commi t tee has noted above ~ page 28 ~ the sug- gest ion of a recen t s tudy that the output of the Med ical Scientist Training Program can be signif icantly expanded (Association of American Medical Colleges ~ 1979 ~ . The Comm i t tee recommend s, however, the t con s id era t ion o f a change in the currently recommended level should await the development of additional information by the Panel on Cl inica, Sciences and the NIGMS wi th respect to the intra- institutional impact of increased MSTP awards, the number of additional institutions wi th the potential for mounting an effective program, student "drop-out" rates, and the comparative costs of other research training programs for M . D ~ ' s ~ o From 80 to 85 percent of individuals completing the Medical Scientist Training Program go on to a c] inical residency. Since their research training up to that point has general ly been in teas ic sc fence, there i s an advantage in providing postdoctoral clinical research experience for those who aspire to be cl inical investigators . An experi- ence such as that provided by the NIH Cl inica] Associates Program can serve as a br idge for those in teres ted in ca- reers as clinical investigators. Since inclusion of a clinical research component will require support outside of the usual mechanism for residency funding, the Committee recommends that NIH consider a type of award mechanism for this purpose. Further, to foster movement in this direction for MSTP graduates as well as for other residents wi th a potential interest in clinical investigation, the Committee recommends that special ty Boards and Residency Rev few Com- ~nittees develop pol icies that wound d facil itate combined clinical and research training programs leading to Board certification without substantially lengthening the process. The Committee's recommended level of training in the cl inical sciences area is given in Table 4.2, p. 52. 30

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BASIC BIOMEDICAL SCIENCES Because the training grant ~ as distinct from the individual fellowship) is a special, almost unique, mechanism for re- search training in the biomedical and behavioral sciences, questions about its role, effectiveness, and importance have had a prominent place on the Committee's agenda. Almost from the beginning of its deliberations, the Committee has sought ways to evaluate the impact of training grants upon the quality of training provided .2 A f irst effort in this direction was the 1977 Survey of Biomedical and Behavioral Science Departments, dealing with the impact of reduction in training grant support. This survey, the results of which were summarized in the Commit- tee's 1978 Report (NRC, 1975-1978; pp. 42-45, 67-69), re- vealed the complexity of this issue and indicated a need for further investigation. While the loss of training grant support had the overall effect of dampening graduate enroll- ment increases, there was a substantial amount of variation among departments. Enrollments in some departments con- tinued to increase unperturbed by the reduction in federal support, while enrollments in other departments dropped in apparently similar circumstances. The differential impact of loss of training grants remains unexplained. Perhaps particular local factors are at work or perhaps there are common factors that were not captured in the survey. In addition, the 1977 Survey asked department heads to eval uate the impact of el iminations or reductions of the training grant support on such features of the training programs as colloquia, special equipment, guest speakers, and other "enrichment" aspects of the graduate curricu] um . The heads of departments who responde<3 to the survey fre- quently ma :3e comments that training programs had been adversely affected by loss of NIH grant support, but statistical evidence is lacking to substantiate these comments, and the extent of negative impact is uncut ear. These important unanswered questions suggest that more ef fort should be put into assessing the impact of training grants on the qual i ty of training . An ideal strategy for dealing with this issue would be to study whether scientists who had received training grant support were more productive as a resul t of having this support than those who had note Last year the Commi thee reviewed some of the cliff icul ties in devising a method and col1 eating data that woul d yield a dependable answer to this question. It decided that such an approach warranted further invest igation . Now having com- pleted this investigation, the Committee has reluctantly concluded that such an empirical study is not feasible at this time due to insurmountable difficul ties related to both data collection and methodology. 31

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First, one would have to identify and measure the various other factors ~ in addition to training grant support) that probably influence a scientist's produc- tivity--innate ability and prior education, the quality of the training department, subsequent support for research, and perhaps even the tractab i] i ty of the probI em he/she chooses to work on . Further, i t would be necessary to measure the quality of the former trainee's productivity at some reasonable point "downstream," i.e., 5-10 years af ter completion of training . Many of the requisi te data are unavailable, and those that are available are scattered in ~ i sparate sources . Assemb! ing them would be expens ive and time-consuming, and their usefulness in assessing the impact of training grants could not be determined for several years. Second, there is a serious analytical difficulty. Even if it were feasible to collect the needed data, it would be very difficult to distinquish the contribution that training grant support per se makes to productivity, and to separate that contribution from all of the other influences at work O In fact, such a separation may be impossible because train ing grant support is so highly correlated with many other . and tra inee qual i ty . factors related to program, department, There is an understandable tendency to award training grants to high-quality departments that have faculty, educational programs, and a level of research activity j urged to be superior. When several factors of this sort are highly correl ated, i t i s d i f f icul t to i sol ate the ir ind iv idual con tr ib ut ion s . In addition, there appears to be considerable substitut- abil ity among the various sources of support for graduate study and research training. Departments often distribute their various sources of support diversely among students puree y for reasons of educational strategy. During the course of a 4- to 6-year period of training, a graduate stu- dent may receive training grant support for ~ or 2 years, and hold a research assistantship for a time and perhaps a teaching assistantship in other years. This substitut- abil ity of sources of support further increases the dif- ficu~ty in disentangling the effects of training grants from other means of helping trainees complete their preparation for research. Finally, it seems clear that the benefits of a training grant are not always l imited to the trainees formally sup- ported out of grant monies. Instead, the opportunity to ~ isten to distinquished visiting scientists discuss their work, to participate in special seminars, and to reap other benefits provided through the training grant device is wider y shared . These several considerations have therefore 1 ed the Committee to abandon the idea of carrying out an " ideal, " statistical study that might cone, usively demonstrate the 32

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impact of training grants as such upon research produc- tivity. The state of the art in this area of educational evaluation does not permi t such an empirical study to be undertaken at this time or, it would seem, in the fore- seeable future. Meanwhile, the Committee believes that it is possible to obtain useful, if not completely compelling, evidence by further study of a sample of biomedical science departments and programs, especially those that have experienced a sig- nif icant reduction in training grant support . The Commi t- tee, therefore, plans to make a series of site visits to a carefully designed group of departments/programs for the purpose of examining in detail the impact and consequences, and the changes and adaptations that occur as a resul t of losing training grant support. The overall ~ objectives of such case studies will be to understand better the contexts wi thin which training takes place and the specific impacts, if any, that the reduction of training grant support has had wi thin those contexts . under what condi Lions are training grants an essential or merely a useful supplement? What are the deleterious or benef icial consequences of reducing training grant support? What circumstances determine the impact of such a decl ine? Is the impact long-term or short-term in its effect? Further, the Committee wishes to explore institutional incentives for maintaining enrollment levels, the substi- tutabil ity of training grant funds wi th other sources of support, and contributions of trainees to the research productivity of the department. One of the questions arising from the Committee' s earlier Department Survey is whether hard data or detail ed OCR for page 23
d id not lose enrollments af ter cutbacks in training grant support. Additional criteria for selection will be whether departments are in a pubI ic or private institution or in a graduate or medical school. A teal anced view of the training grant must include the perspectives of many university groups associated with the operation of this program. Central to such an investigation are interviews with training program directors, department chairpersons, and faculty. The Committee will also seek the views of deans and graduate students. In addition to providing detailed examinations of a imited, but carefully selected, group of depar tments , the site visits may also be useful in identifying criteria for evaluation that may be applicable over a broad range of departments. The Committee, therefore, ~ eaves open the possibility of conducting in the future a more extensive study of the role of training grantee BEHAVIORAL SCIENCES In response to changing employment prospects and a growing need for skilled investigators in specialized areas of health research, the Committee and its Panel on Behavioral Sciences have recommended in previous reports a major reorientation of NRSA support to provide for predominantly postdoctoral research training (NRC, 1975-1978: ~ 976-1978 Reports ~ . The Committee has been, and continues to be, concerned that academic demand for behavioral scientists will decline in the mid-1980' s due to a leveling off of growth in college and university enrollments and to the relatively young average age of tenured faculty. Indeed, the Committee's perceptions of the academic market have been corroborated in part by the recen t repor t of the NRC Committee on Continuity in Academic Research Performance (NRC, 1979, p. 47 ): The picture ~ for the social sciences and psycho1 ogy] is mixed . Whit e the correct proportion of young faculty (45% in 1977) is higher than in most sciences and engineering discipl ines, and the retirement picture is less unfavorable than in some other f ields, proj acted enrollment trends are relatively unfavorable.... While these f ields are not ~ ikely to exper fence a severe shortage of openings for new focus ty in the immediate future, they may prove quite vu' nerable ~ ater in the decade, as the effects of demographic trends come to be fel t more strongly. 34

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The Commi ttee does anticipate, however, that the demand for ski ~ ~ ed behavioral inve s t iga tor s in non trad i t tonal se t- tings--such as hospitals/clinics, government agencies, heal th care institutions, and the like--wil1 continue to rise (NRC, 1975-1978 : 1978 Report , p. 59 ~ . It is this phenomenon that has captured the Committee's attention in recent years. In 197S, for example, the Committee reported the results of its analysis by sector of employment of the work activities of behavioral scientists who had received their doctorates between 1971 and 1975. The data indicated that employment in nonacademic settings does not lessen the opportunity for behavioral scientists to conduct heal th- related research. This finding led the Committee to suggest that employment in nonacademic settings may constitute an appropriate means for behavioral scientists to f ulf ill the payback ob] igation required under the provisions of the MESA authority (NRC, 1975-1978: 1978 Report, p. 72). Expansion of the nonacademic marke t i s a phenomenon and, as such, suggests a number of questions to be addressed by the Commi t tee in years:3 recen ~ impor t an t the comina 1. What factors affect the opportunities for behav- ioral scientists to conduct heal th-related research in non- academic set t ing s? 2. Do these settings permi t the effective use of the research training acquired by behavioral scientists holding doc tore te s? 3. What is the potential for continued expansion of the nonacademic sector? What factors will influence such an ex pension? 4. Are different research training goals and empha- ses desirable in the face of a shift toward empty oyment in nonacadem i c se t t ing s? 5. How will the growth in nonacademic employment affect the behavioral science research enterprise and the corpus of behavioral science knowledge? The Committee, through its Pane] on Behavioral Sc fences, i s involved currently in an examination of ex i sting sources of data, such as the NRC Comprehensive Roster of Doctorate Recipients, to determine the extent to which these research question s may be addressed using available information. However, should existing sources prove inadequate, the Committee will also consider the need for f ur ther surveys . In addition to exploring the nonacademic market for behavioral scientists, the Commi ttee pi ens to convene a series of workshops and symposia in the coming years to investigate more ful ly those issues that relate to the implementation of its recommendations for research training in this area. In January 1980, for example, the Committee and its Panel on Behavioral Sciences convened a l-day work- 35

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shop on the topic of " Estab! ishing Research Training Pro- grams in Behavior and Health" ~ see Appendix O) . Workshop participants explored such issues as: the impact of changing patterns in graduate enroll men ~ on the qual i ty of predoctoral education in the behav- ioral sc fences; the experiences of academic behavioral science depar tmen t s in pi ac ing gre a t er empha s i s on po s tdoc tor a l training; and ~ the potential for the NRSA authority to stimulate new directions for research training in the behavioral Sciences e The Commi t tee pi ens to review and report the f indings of this workshop in the coming months and to present speci f ic recommendations in its next report. The Commi t tee and i ts Panel al so plan to hold hearings in 1980 on the recrui tment of cl inicians to conduct mental heal th research. The purpose of the hearings is twofold ~ ~ ~ ~ to provide a forum for a number of professional organi- zations to share the results of their studies; and ( 2 ) to sol ici t from as broad an audience as possible suggestions for the further ref inement of research training that could enhance the cl inical research endeavor in this area O HEALTH S ERVI C ES RES EARCH As early as 1976, the Committee pointed out that for federal research training pol icy to be responsive to the need for health services research (HSR) personnel, an appropriate data base would have to be estabI ished. Hence, for 2 years the Committee and its Pane' on Health Services Research have attempted to develop the necessary statistics. The f irst step in achiev ing thi s goal now has been real ized . In 1978 the Committee launched the f irst national survey of heal th services research personnel to collect information on the training experiences and present em- ployment of a segment of this labor force. Nearly 1,400 individuals were included in the survey. Of these, over 600 had received support as pr incipal investigators on research grants/contracts awarded by the National Center for Heal th Serv ices Re search ~ NCHSR ~ 4 be tween ~ 9 6 0 and ~ 9 7 6 . An additional 770 individuals were included as recipients of federal research training support in this area from NCHSR or ADAMHA be tween ~ 9 7 0 and ~ 9 7 ~ . Over 80 percent of those surveyed responded. While the Committee plans to release the findings of the surrey as a separate report, a few of the survey's more descriptive 36

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f indings that reveal a striking similar) by between the characteristics of this group and those of the biosciences in general are given below ~ Of . NRC, 1975-78 : 1977 Report): Fewer than 2 percent of the respondents were un- employed and seeking employment at the t ime of the survey. ~ The majority of those employed fur ~ or part-time were emp, oyed in educational institutions. More than three-fourths of those individual s respond- ing to the surrey spent some portion of their total work time engaged in health services research. With this prel iminary employment and training picture in hand, the Committee has set as a ma jor goal in the coming years the description of the market for HSR personnel. For example, employment opportunities in such locations as Heal th Systems Agencies and Communi ty Mental Heal th Centers suggest that an examination of the nonacademic emp, oyment sector seems warranted. Questions that use fur ly might be addressed incl ude: Do HSR personnel amps oye<3 in nonacademic settings address different research questions than those addressed by academic HSR invest iga tor s? ~ Is there an adequate supply of doctoral! y-prepared HSR investigators to meet today' s research needs in these nonacademic settings? ~ Is there an adequate supply of doctorally-trained HS37 investigators to meet the expected personnel needs through the 1980' s? In addition to these questions, the Committee hopes to explore the factors that influence the demand for HSR personnel in such nonacademic settings as health insurance organizations and state and county governments. Findings from these studies and others should contribute eventually to the development of market models in this area. SUGGESTIONS FROM THE PUBLIC On March 8, 1979, the Committee held its third public hearing to solicit views from individuals and organizations about the Committee' s work ~ see Appendix D for the program) . These hearings, which have been held following the issuance of the annual reports, have established a continuing dialogue between the Committee and interested parties. The Committee was particularly impressed by the thoughtful- ness of the comments, which reflected an awareness of the complexity of the issues surrounding federal research training support. 37

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At this year's public hearing, 18 persons made formal presentations. In addition, eight other written statements were received and seven other individuals made oral remarks from the floor. Topics discussed included strengthening research training programs for nurses; enlarging opportuni- ties for participation in research by women and minorities; preserving the quality of training programs in light of declining federal support; and special training needs. Considerable attention was given to the growing difficulty in attracting medical, dental, and veterinary degree stu- dents to clinical research. The American Heart Association outlined a small fellowship program that it was initiating to a t trac t phys ic i an inve s t ig a tor s O One of the witnesses at the public hearing called attend Lion to the Congressional practice of earmarking research and development funds to accompany expenditures for new programs of health, welfare, and simile ar services. Such set-asides could have a substantial effect upon research personnel . For example, a 5 percent set-aside from ~ 979 funds for research and development related to Ti tie I of the Elementary and Secondary Education Act would require more than 3, 000 behavioral science investigators. While such numbers may not seem large against the total number of be- havioral scientists, the requirements would ~ undoubtedly have a profound effect on supply of and demand for research personnel . To general ize the point, the provision of set-asides for R&D in newly legislated programs almost surely brings pres- sure on a labor market that is small and del icately balanced between near full employment on the one hand and underutil i- zation on the other, and on a personnel pool that is very expensive to generate and requires a long t ime to expand or to contract. That is not to say that such set-asides are unwise public policy.5 It is red event to note, however, that national needs for research personnel can be created by legislation, and some legislation can have a sudden and severe impact on the scientific research labor force. The case of toxicology is relevant here. The passage of the Toxic Substances Control Act, which mandated the toxico- logical screening of compounds, and of the Occupational Safety and Heal th Act, which required the inspection and testing of workplace environments for the same purpose, abruptly and sizably increased the number of jobs for toxi- cologists . In the view of this Commi thee, as well as other bodies who studied the question, the increased demand re- quired the estabI ishment of new and rather special train- ing programs, for the existing current sources of supply could not produce the needed numbers of special ists . National needs for research personnel, then, fluctuate with changes in national priorities as well as with changes in science itself. While the latter changes are usually gradual, the demands that legislative changes produce are 38

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more likely to be abrupt and difficult for the training institutions to meet in what the Congress might consider timely fashion. Shif ting the emphasis or the focus in training biomedical and behavioral scientists is not easy, for reasons that have to do with the very nature of the training enterprise. These circumstances--the possibil- ity of sudden "legislated" changes in demand coupled with inherently slow response in supply changes--suggest both greater alertness on the part of the Committee to the consequences of legislation that bears on science, and, at the same time, a realistic recognition in the Congress that a body of trained personnel cannot be had by fiat, but must be pursued with constancy. 39

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NOTES ~ ~ In his capaci ty as Chairman of the U . S . House of Representatives' Subcommittee on Health and the Environment, then-Represen ta t ive Pa ul Rogers (D-Fla.) clarified the intent of the NRSA authority in his statement introducing the Biomedical Research and Training Amendments of 1978: ...The committee has heard reports that the agencies administering the National Research Service Awards program have interpreted the provisions of law estate! ishing separate c! inical training and research training authorities in a manner to require totally separate training programs. The committee does not intend that the activi ties engaged in under research training programs and clinical educational programs need to be entirely separate in order to be supported under either type of training authority The best research training programs should obvious y focus on all of the needs of the trainees, not exclusively on whether they provide purely research or purely clinical aspects of biomedical or behavioral science. Therefore, these training authorities should be interpreted to permi t some cl inical training in the curriculums of ind ividual preparing for research careers in certain areas of bio- medical research where such clinical experience would be appropr late . Some research training in cl inical- clinical-directed curriculums should also be permissible where bra in ing in certain methods and techn ique s i s appropriate for the education of a cl inical profes- sional . ~ Congressional Record, HIl96S, October 10, 1 978 ) 2. The Committee's efforts in this regard have been con- centrated in the basic biomedical sciences because the overall ~ magnitude of the training grants program in these f ields makes its role easier to discern here than in the behavioral sciences. This section is therefore directed to the basic biomedical area; however, it does not preclude an analysis of the behavioral sciences at a later time. 3. These questions were raised by Dr. C. Alan Boneau, consul tent to the Panel on Behavioral Sciences, May 31, 1979. 4. The NCHSR is located in the Off ice of the Assistant Secretary for Heal th, DREW. 5. Whether they are or not and what all their ramified consequences might be are questions that far exceed our 40 _e