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OCR for page 23
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.
OCR for page 24
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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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Representative terms from entire chapter:
grant support
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
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
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
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
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
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
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
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
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