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a. ADMINISTRATIVE ISSUES AND POLICY CHANGES
SHORT-TERM TRAINING
The Co~ittee has followed wi th interest the steps NIlI has
taken in planning and impl ementing the provi sion of the MRSA
leg islation permitting the use of up to 4 percent of ap-
propriated funds for short-term training programs. Al-
though a few short-term training programs for pre-Ph.~.' s
and post-Ph.D. ~ s have been supported prior to this new pro-
vision, it is noteworthy that now recipients will be able to
take up to three 3-month training sessions wi shout being
subject to the payback requirement. NIH currently plans to
use most of these f unds to provide heal th professions stu-
dents with an exposure to research problems and techniques
(Appendix C) in the hope of attracting some of these stu-
dents into careers in cl inical research . The Committee en-
dorses such a program for heal th professions students, but
bel ieves that shor t-term training programs in other areas
should not be expanded significantly until additional funds
are made ava il able .
The Committee believes that establishing a short-term
training program for heal th professions students can be an
important step in helping to revisal ize the interest of
these students in pursuing cl animal research careers. In
its 1978 Report (NRC, 1975-1978; pp. 101-103 ), the Committee
noted that recent cliff iculty in attracting heal th profes-
sions students into research careers is the resu1 t not only
of financial disincentives but also of a lack of first-hand
experience in a research activity dur ing the period of pre-
doctoral training and residency. Flaking such experiences
available through short-term training programs should enable
students to test their interest and ability in research.
Students who confirm their interest can then pursue with
confidence a research training pathway. Those who discover
little interest or ability in research can resume their
training as practitioners without incurring the obligations
of payback. Such sorting will also allow the valuab1 e
training resources of training grants and fellowships to be
directed to those heal th professions students with confirmed
interest and abil ity.
The 3-month program for predoctoral students will not
augment the diminishing supply of physician investigators.
For this purpose it may be highly desirable, even necessary,
to provide a more substantial exposure to research during
the physician' s residency period by offering ~ or more full
years of research training to medical doctors who are so
inclined. Those who have a positive experience would be in
a better position to decide about further research training
following completion of the residency. It is worth noting
that opportunities to interrupt a residency with research
exper fence would serve to reduce the long hiatus in research
training for M.D./ Ph.D. program graduates who otherwise
enter standard residency programs.
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The utilization of this short-term training mechanism to
introduce health professions students to research suggests
that other obj ec t ives , research areas, and types o f studen ts
may also benefit from this kind of program. In the basic
biomedical sciences, where the supply of researchers is not
a problem, there already exists a few examples of short-
term programs that have been designed to provide opportu-
nities to acquire current research techniques ~ for example,
at the Marine Biological Laboratory at Woods Hole, Massa-
chusetts and the Cold Spring Harbor Laboratory, New York).
The short-term training mechanism could also play a role
with respect to nursing researche The Committee has learned
that the Health Resources Administration's Division of Nurs
ing hopes to develop a short-term training program in ad-
i t ion to the ex i s t ing inst i but tonal research tra in ing gran t
program. The purpose of this program would be to encourage
nursing facul ty to become more active in research. The Com-
mittee endorses this proposal and offers two suggestions:
first, that the program permit individuals to participate
for two or three consecutive summers; and ~ second, that prom
gram policy permit the use of short-term training support in
a broad range of institutions with ongoing research activi
ties rather. than be restricted to only those institutions
that currently have research tra ining grants O ~~
STI PEND LEVELS
In its 1977 Report (NRC, 1975-1978; pp. 180-181), the Com-
mittee noted that the absence of any increase in stipend
Iesrels since 1974 has seriously eroded the economic position
of trainees and fellows O The Committee pointed out that a
continuation of this situation could result in difficul ties
in recruiting individuals for research training and in
enabling trainees and fellows to pursue their work on a
fu11°time basis without diverting their attention from mat-
ters of training to those of subsistence. In recommending
that stipend levels be raised, the Committee advised that
increases should be effected through additional funding
rather than by reducing the recommender] number of trainees
and fellows to be supported.
The Commi t tee notes that Congress and DHEW have
addressed this problem this year and have done much to
correc t the underlying inequi ty . DHEW has approved a pi an
for raising stipend levels, effective July 1, 1980 (Appendix
C ~ . Under the approved pi an, predoctoral st mends wi 11 in-
crease from $3,900 to $5,040 ~ a 29 percent increase) and
beginning postdoctoral stipends will increase from $10, 000
to $13,380 ( a 33 percent increase) . These increases are
consistent with the Committee's 1977 recommendation for an
42
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immed i a te cos t-o f- l iv ing increase, and the Commi t tee notes
that the plan will do much to compensate for the effects of
inflation over the last 5 years.
The implementation of this plan of stipend increases
faces certain cliff icul ties that are traceable to the current
provisions for NIH funding. In November 1979 Congress
passed a con t inuing revel ut ion, ef f ec t ire through September
1980, which allows the NRSA program $33 mill ion more than FY
1979. The "additional" $33 million, however, was not a net
increase in the total NTH budget, but rather an instruction
to reprogram funds from other purposes to the support of
training. Such a reprogramming scheme was clearly intended
by the Congress to assist training but not to reduce re-
search grant support. The reprogramming was to be ef fected
on an institute by institute basis.
For most institutes with relatively large research
contract programs, this reprogramming adjustment is being
accompl ished by shif ting between these two categories . The
Institute of General Medical Sciences, however, has found it
impossible to make this adjustment. This Institute has the
largest predoctoral training program in NIH. It makes two-
thirds of all NIH predoctoral awards, and it has a compara-
tively small research contract program from whose resources
it might draw to increase stipends .
The Committee understands that the NIGMS may have to
reduce the number of predoctoral trainees to be supported in
1980 by as much as 20-25 percent in order to provide the
newly increased levels. A few training programs may not be
renewed; and most of the continuing programs will have fewer
trainees than in 197 9 .
Thus, the outlook for support of predoctoral trainees in
1980 is for an NIH-wide reduction of approximately 13 per-
cent in number of positions, wi th al most all of this reduc-
tion taking place through NIGMS programs. ADAMHA also was
not provided with any additional funds to implement the
planned increase in stipends, and this will resul t in a
reduction of approx imately 14 percent in the number of
positions that can be supported in FYl980.
The Committee hopes that this significant reduction in
predoctoraI training in 1980 will be a transient, temporary
phenomenon. The Commi t tee i s pi eased the t Congress and DHEW
have recognized the problem of stipend levels and urges that
Congress provide appropriate levels of funding for research
training while avoiding unintended, but serious, inequities
and disruptions such as those which appear to be occurring.
A particular problem with regard to stipend level s has
been the case of the potential physician investigator. In
addition to the considerable gap in lifetime earnings, there
is a growing gap between the incomes of house staff and
research trainees. The situation raises the possibil ity of
estabI ishing a differential stipend policy that would take
into account those areas where market disincent Ives are
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particularly acute. The Commi t tee recognizes that differen-
tials might have other disadvantages and wil ~ devote further
attention to this issue when addi tional data on f inancial
and other disincent Ives, currently being sought, become
avail ablee
INSTITUTIONAL SUPPORT COMPONENT OF
THE TRAINING GRANT
DREW has recently announced a modification of the procedure
for determining the max imum level of award for the institu-
t tonal support component of the training grant O The pre-
vious administrative procedure, insti tuted wi th the beg in-
ning of the NESA program, used a formula which allotted a
maximum of approximately 25 percent of the total of each
training grant award for institutional support. Under that
procedure private universities received larger sums for
their institutional support than did public institutions be-
cause the tuition costs, which are significantly higher in
private schools, were included in the base amount of the
training award to which the 25 percent fo ~ foul a was appl fed .
The new procedure, to commence on July I, 1980,- will be
based on a maximum allotment per trainee--$3,000 per predoc-
toral and $5,000 per postdoctoral trainee. The overall
amount of support budgeted for institutional purposes is not
expected to change markedly. The result of this ad justment,
however, will be to redress the imbalance that has existed
between public and private universities in the amount
awarded for institutional support.
The Committee is pleased that the present inequitable
condition has been corrected, but believes that in the new
procedure greater flexibi] ity should be available to meet
the training needs of individual programs. It is proper that
agencies require each appI icant to justify the amount of
institutional support needed . In this regard, there is no
more reason in the case of any ind ividual program to impose
an absolute ceil ing than there is to impose an absolute
floor on the institutional support component. While the
agencies, of course, must place some overall ceiling on the
amount of funds available for this purpose, the distribution
of these funds to ind ividual programs should be based on
program-justified needs and not on a universal ceiling.
This position is consonant with that expressed by the U. S .
House of Representatives (197B, p. 33), which urged greater
flexi3oi1 ity in the distribution of such funds.
The Committee recommends that greater fiexibil ity be
incorporated in the procedure for distributing the institu-
tional support component of training grant funds. Agencies
should permit waiving the rigid ceiling of 33,000 per pre-
4aS
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Representative terms from entire chapter:
nrsa authority
of predoctoral trainees under NRSA institutional
grants . (This change in pot icy does not apply
to individual Fellowship awards. ~ Accordingly,
as of this date, predoctoral individuals may
be appointed during any years s) of their graduate
training,. as long as such appointments are
cons i s tent wi th the s tat utory max imum of f ive
years of predoctoral support under the Na t tonal
Research Service Award Act. ThiS change is
appl icable to currently supported programs, as
wel l as those funded in the f uture .
Program Directors are strongly encouraged to
provide stipends in the f irst and second years
of graduate work only in cases where promising
students ~ especially women and minorities) would
not have suf f icient resources to enable them to
pursue their training on a full-time basis, and
such students have expressed their commi tment to
pursue research careers in areas related to
alcohol ism ~ drug abuse, or mental heal th .
The Committee is hopeful that abol ition of the 2-year re-
striction will enhance the recrui tment and retention of
well-qua, if fed first- and second-year students in research
careers relevant to the goals of ADAMHA.
With respect to their efforts to develop targeted
research-training programs that would recruit members of
minority groups into research careers, ADAMHA has also
announced a new program of support2:
ADAMHA has initiated a Minority Access to
Research Careers ~ MARC) program modeled on
the MARC program of the National Institute
of General Medical Sciences at NTH.... We have
high hopes that these mechani sms will help to
assist institutions with substantial minority
enrol ~ ment in the training of greater numbers
of scientists and teachers in f ields relating
to alcohol i sm. drug abuse, and mental heal th .
The Committee commends ADAMHA on the signif icant
stridestaken these past months to enhance the availabil ity
of NRSA support to minority-group members, women, and stu-
dents from disadvantaged backgrounds. The Committee shares
the hope expressed by Dr. Kit erman that these actions will
enhance the representation of these individual s in the
scientific labor force and in the national alcohol, drug
abuse, and mental health research effort.
46
CLINICIANS IN MENTAL HEALTH RESEARCH
In its 1978 Report (NRC, 1975-1978: p. 79), the Committee
explored for the first time some of the barriers to the re-
cruitment of clinicians into mental health research. Among
the factors identified by the Committee was the separation
of federal support for research training and cl inical train-
ing as a result of the enactment of the NRSA authority.
Specifically, the Committee observed:
When the NRSA Act required that a distinction be
made between clinical training and research
training, ADAMHA, which had long provided support
for both types of training through NIMH, estab-
lished guidelines by which existing awards could
be assigned to either the clinical or the research
training category "as the preponderance of evi-
dence" from the grant applications suggested.
Since the release of its 1978 Report, the Committee
notes that former Representative Paul Rogers (D-Fla. ~
clarified the intent of the NRSA authority relative to pro-
viding research training opportunities to clinicians when he
introduced the Biomedical Research and Training AInentiments
of 1978 ~ see note ~ to Chapter 2 of this Report) . The Com-
mittee welcomes this clarification of intent. It recognizes
the real ity of introducing cl inicians, including cl inical
psychologists and psychiatrists, to research during the
course of their cl inical professional training and g ives the
agenc ie s fl ex ib i l i ty to prov id e appropr i a te suppor t under
e i ther tra in Fig author i ty . 3
HEALTH SERVE CES RESEARCH UNDER
THE NRSA AUTHORI TY
The Committee is pleased that its earlier recommendations in
this area have had a far-reaching impact. The Commi thee
notes specif ically that its recommendation to expand the
NRSA authority to include the NCHSR has been real ized. The
Health Services Research, [lealth Statistics and Medical
Technology Act of 1978 (PL 95-623, Section 3 ~ a) ~ 3 ~ ~ amended
the previous authority to permit the use of NRSA support for
training in heal th services research4:
The Secretary shall, through the National
Center for Heal th Services Research, the National
Center for Heal th Statistics, and the National
Center for Heal th Care Technology and using
National Research Service Awards and other
appropriate author i ties, undertake and suppor t
47
training programs to provide for an expanded and
con t i nu i ng suppl y 0 f ind iv id ua 1 s qual i f i ed to
perform the research, evaluation ~ and demonstra ~
Lion pro jects set forth in sections 305' 306, and
309.
The Committee is hopeful that this expl icit extension
of the NRSA authority to inc] ude the NCHSR will result in a
more stable "federal commitment to the total heal th services
research effort" (NRC, 1975-1978 1977 Report, pa 129
48
NOTES
~ . Memor and um f rom Adm i n i s tra tor, ADAMHA, to ADANHA NRSA
Research Training Program Directors and Potential Research
Training Grant and Fellowship Applicants, December 19, 1979.
2 . Or . Gerald K] erman, ADAMHA Administrator,
munication to Dr. Henry Riecken, January 3, 1980 .
personal com-
3. The Committee notes that the NRSA guitlel ines issued
jointly by NIH and ADAMHA in 1976 and now the cl conical
training guidel ines issued by NIMH in 1979 both contain
language that permits under either authority support of
clinical and research activities to the extent required to
fulfill the principal purpose of the training program.
4. This amendment makes research training support mandatory
rather than permissive, and extends the NRSA authority to
include the National Center for Heal th Statistics and the
new Of f ice of Heal th Technology in add i t ion to the NCHSR .
49
