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1. INTRODUCTION AND SUMMARY OF NUMERICAL RECOMMENDATIONS, FISCAL YEARS 1982-1985 OBJECTIVES OF THE 1981 REPORT The Committee's objectives for this year's report are five-fold: (1) to revise and extend through FY 1985 its specific recommendations on the numbers of NRSA awards that should be provided for the support of predoctoral and postdoctoral research training in the areas of the basic biomedical and behavioral sciences, health services research and nursing research, and the numbers of postdoctoral awards in the clinical sciences; (2) to recommend an appropriate distribution of these awards between traineeships and fellowships for each of these broad categories of training; (3) to present the results of special studies conducted for the Committee concerning recruitment of more M.D.'s into clinical investigation; (4) to report upon recent Committee studies and new analyses of data on recruitment, training, and employment of minorities in research careers in the biomedical and behavioral sciences, and (5) to discuss several program and policy issues, including the need to stabilize federal support for research training. STABILIZATION OF RESEARCH TRAINING SUPPORT Stabilization of federal support for graduate education has been an objective endorsed over the years by many reports that have examined the federal role in graduate education. The National Science Board (1969, p. 21) argued strongly for stability in federal support: A graduate program can maintain high quality only if it can be assured of continuity of essential finan- cial support. Significant short-term variations in funding are especially serious, for they are destruc- tive to morale. It is more difficult and requires longer time to build high quality than to destroy it. The National Board on Graduate important study, also endorsed stability: Education (1974, p. 15), in another Short-run stop-and-go policies toward graduate educa- tion and research are highly destabilizing and very inefficient whatever their origin or motivation. Abrupt shifts in federal policy can be particularly damaging, given the federal governmentts significant role in supporting research and graduate students. More recently, the National Commission on Research (1980, p. 13) cautioned against sharp fluctuations in training support because of difficulties in predicting personnel needs and the complexities of the research training system. The Committee has not directly addressed the issue of stability in its previous reports. It seems appropriate at this time, however, to consider the issue, particularly in light of recent congressional concern regarding "the proper balance between stabilized research support and stabilized training support" (U.S. Congress House, 1980~.

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Over the years of its deliberations, the Committee has had a dual concern in response to its congressional mandate: (1) how to produce a core of talent that will constantly replenish the research labor force, and (2) how to assure a responsiveness to changing national research needs. The first concern emphasizes stability, while the latter flexibility for change. To accommodate these objectives, the Committee has recommended two responses in the federal training system. The first is a realignment of overall training levels to reflect lona-tenm labor _ . . market prospects. In the case of the basic Diomedical and Denavioral sciences, where there have been declining academic opportunities in the 1970's that are likely to continue through the 1980's, the Committee has recommended some reduction in the numbers of persons receiving federal support. In the clinical sciences, where there have been consistent problems in attracting clinicians into research, stabilization of the numbers of persons being supported has been recommended. In the emerging areas of health services research and nursing research, the Committee has urged modest increases in the numbers of trainees receiving support. In this way the Committee has suggested how to stabilize support at levels that are justifiable on the basis of long-term market outlooks. The second Committee response has been to distinguish between train- ing emphases at the predoctoral and the postdoctoral levels. The Commit- tee has argued on the Basis ot strong nel~et-s tnat pre~octora1 training ought to be broadly grounded in the basic disciplinary areas. The emphasis here should be on sound fundamental training. However, the long lag time between entry into graduate school and entry into the labor force (5-8 years, including 2-3 years of postdoctoral training) makes the use of predoctoral training a generally inappropriate device for accom- plishing more highly focused training needs. It is at the postdoctoral level that specialization should primarily occur. Stability is most essential during the long training period at the predoctoral level, while responsiveness to national needs is most appropriate and feasible at the postdoctoral level. Another aspect of the Committee's concern for stability has been its emphasis on the training grant as the primary training mechanism. AS a 5-year renewable grant which provides program as well as student support, the training grant provides an institutional continuity and focus on the research training process that individually awarded fellowships and research assistantships do not. In addition, the institutional component of the training grant provides valuable support for the training program, e.g., guest faculty seminars and research supplies. The case studies recently conducted by the Committee (see Chapter 3) confirm the destabilizing influence that abrupt withdrawal of training grants has had on some high-quality programs. The Committee's consistent objective has been to promote the quality of research training. Its argument for the stabilization of a core of student support should not be construed as meaning that particular programs or institutions should be guaranteed support indefinitely. Training grant and fellowship awards should continue to be made on the basis of national merit competition. Only superior programs and students should receive support. Recommendation. The Committee recommends that federal support for research training should be stabilized and provided at levels commensurate with the scope of national needs. At the center of federal policy there should be an irreducible number of trainees who are supported in the basic disciplines regardless of fluctuations in demand for short-tenm research needs. Additions and reallocations in 8

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support may be undertaken as special needs come and go. In this way the benefits of stability can be achieved while providing a flexibility to respond to changing priorities in the nation's research needs. The level of stabilization should be determined after reviewing available data, find- ings, and recommendations, including those of this Committee. The need for a steady infusion of young, well-trained and creative scientists into research positions in the biomedical and behavioral sciences is absolutely essential for maintaining the vigor of the national research endeavor. Only under a national policy of stabilized federal support for research training will individuals, academic institutions, training program directors, and funding agencies be able to plan and conduct this research training in a manner that will achieve the most effective use of limited available funds. TRAINING QUALITY One of the principal themes of this report is the role of federal programs in enhancing the quality of health research training. This continues a theme that has been addressed in earlier reports (1976 Report, pp. 6-8; 1977 Report, pp. 185-187; 1978 Report, pp. 42-45; 1979 Report, pp. 31-34~; furthermore, at its Endicott House Conference, the Committee gave this issue a high priority for investigation (reported in 1979 Report, pp. 12-15). This commitment to high-quality training is founded on the conviction that research training is a distinct activity and not simply an incidental by-product of research and teaching activities. Without such conviction, research training as a fundamental and long-term investment may be sacrificed to the demands of short-term local or national needs. The Committee's commitment to quality in research training is reflected in its consistent emphasis on merit as the principal criterion for awarding support and its endorsement of stability in the funding process (see preceding section on stabilization of research training support). The Committee's interest in stabilizing funds for meritorious research training is reflected in its consistent endorsement of the training grant as the primary mechanism of support. This endorsement has led to many efforts to investigate the link between training grants and training quality. This past year the Panel on Basic Biomedical Sciences conducted two case studies (and four preliminary site visits) to departments to investigate the impact of the loss of training grant support on predoctoral training quality, with particular reference to the impact on the training environment. The findings of this study, reported in Chapter 3, support the belief that training grants significantly enhance training quality through their focus on graduate training in a milieu of active research, on student support, and on ancillary support of training program activities. In the behavioral sciences (Chapter 4), the Committee continues its emphasis on a greater utilization of postdoctoral training. The growing importance of behavioral factors in disease means that the depth of training must be increased beyond the basic foundations provided by even first-rate predoctoral training programs. Therefore, there has been consistently a recommendation to augment Federal postdoctoral training support in order to improve the quality of researchers. 9

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In the clinical sciences, the central problem has been the recruitment of clinicians into research careers. Part of this year's report (Chapter 2) presents findings on the determinants of career choice, which were obtained from studies commissioned by the Committee. The challenge of the search for new knowledge is seen to be a major incentive for pursuit of a research career. Another factor strongly influencing choice of a research career is experience during medical school as an investigator and as an author of research papers. Finally, quality is a primary concern in the C~mmittee's considera- tion of training support for minorities. The underrepresentation of minorities in the health sciences deprives these fields and the nation of an important source of talent and the benefits of a broader array of scientific interests. The Committee is therefore disturbed at the slow progress being made in the recruitment of minorities and in Chapter 6 makes a recommendation that the various federal programs directed to this purpose be continued, evaluated for their effectiveness, and modified to increase the rate of progress. PROSPECT IVE CHANGES IN RETIREMENT The Committee wishes to note that an unrelated congressional action on mandatory retirement taken several years ago is likely to have impor- tant effects within the coming year on the labor market for newly trained scientists. The 1978 amendments to the Age Discrimination in Employment Act exempted tenured faculty members, for a period until July 1982, from the major provision of the Act, which raised the mandatory retirement age from 65 to 70. Traditionally many colleges and universities required faculty members to retire at age 65 as a method of ensuring the vigor of their institution. Unless Congress now extends the exemption, these institutions will no longer be able to require the retirement of senior faculty members before age 70. The magnitude of the shortrun effects produced by the expiration of the exemption are difficult to predict with precision. If, however, substantial proportions of older faculty members opt to continue teaching until age 70, this will produce a steady reduction in the number of new faculty openings over the next 5 years and thereafter result in a stable but smaller number of new positions than would be available were the exemption made a permanent one. The average age of faculty members will be forced upward and could lead to an overall reduction in research output since it would now be more difficult to retire less productive older faculty members. What will actually happen remains unclear until Congress acts on recommendations of the Department of Labor, which will reflect in part the results of a special study commissioned to appraise the effects of the exemption and its possible expiration. As a consequence, this Committee has made no alterations in its projections to reflect the effects of what could be a difficult transitional period for newly trained young scientists. ESTIMATION OF PERSONNEL NEEDS A fundamental task of this study is to provide an understanding and analysis of the system by which biomedical and behavioral scientists are trained and absorbed into the labor force. The mechanisms that affect 10

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career choices of students must be identified and quantified as far as possible. On the demand side, the forces that determine the number of positions available to these scientists similarly must be identified and measured. In short, a clear concept of how the educate on-training system works must be developed. In its 1977 report, the Committee presented a complete description of this system and laid out the framework under which its study would be conducted (NRC, 1975-80, Chapter 2 ~ . The following discussion is a condensation and modification of: that presentation and is included here in order to describe the process followed by the Committee in developing its recommendations. The population of research scientists involved consists of the following groups of individuals: 1. Academic doctorate recipients (Ph.D., D.Sc., etc.) in the areas and fields that the Committee has defined as biomedical and behavioral sciences for purposes of this study. Academic doctorate recipients in other areas who are employed in biomedical or behavioral fields. 3. Professional doctorate recipients (M.D., D.D.S., D.V.M., etc.) whose primary interests and training are in research and teaching. 4. Other professionals, usually nurses with baccalaur- eate degrees, whose primary interests and training are in the area of nursing research. More than half of all biomedical and behavioral research scientists are employed by colleges and universities (Chapter 3, Table 3.1, and Chapter 4, Table 4.21. A good portion of the nation's biomedical and behavioral research is conducted in academic institutions by this group of scientists with support provided by f ederal agencies such as the NIH and ADAMHA. It is therefore clear that the availability of faculty positions is a critical factor affecting the employment patterns of these research scientists. Faculty positions in turn are largely determined by the level and pattern of student enrollments in the biomedical and behavioral fields and by the availability of research funds at colleges and universities. In medical schools, clinical investigators perform patient care duties in addition to their teaching and research activities (Chapter 21. Even those clinical faculty members who are primarily engaged in research have devoted an increasing amount of tome in recent years to patient care, particularly through the expansion of community health-care programs at university medical centers. This trend is likely to continue and therefore must be taken into account in estimating the future need for clinical investigators. In the biomedical fields, a postdoctoral appointment is commonly viewed as a transition stage between the training phase and an established position as a biomedical or clinical science investigator. But it -s a vital stage in which much Important research is done. In fact, many view postdoctoral training to be a combination of intensive research activity and an opportunity to enhance the research techniques 11

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of the trainee under the guidance of an experienced investigator. It is generally considered to be a necessary element of training for the graduates of health professional schools, and somewhat less necessary, but nonetheless desirable, for those with Ph.D. degrees. In most behavioral science fields, however, where complex laboratory equipment and procedures are not an integral part of research, a postdoctoral period of training has been the exception rather than the rule. As indicated above, that may be changing. Further discussion of the role of postdoctoral training in each broad area is provided in the corresponding chapter of this report. As its principal tools of analysis, the Committee has developed models--analytical schemes--of academic market demand for Ph.D. personnel in the biomedical, behavioral, and clinical sciences. The underlying hypothesis is that academic demand in these fields is composed of teaching, research, and clinical care components. Changes in the amount of funds available to support research (and patient care activities in the case of clinical faculty) cause changes in the faculty/student ratio. Changes in enrollments have a direct influence on the demand for faculty. These are the basic principles upon which our projections are based . The assumptions used in each model cover what are considered to be the likely range of possibilities for funding levels and enrollments in the next 5 years. Projections of demand for "faculty, " defined here as academically employed persons who hold a doctorate, are derived from alternative applications of the models and compared with expected growth in the Ph.D. labor force to determine whether there will be an adequate supply, a surplus (to be relieved by outward migration), or a shortage (leading to additional unfilled positions, inward migration from other f ields, or appointment of the underqualified). On the supply side, the Committee has sought to identify the factors that determine students' choices and their abilities to complete their degree programs, and to explain the system within which these factors operate. Economic factors, some resulting from the interplay of market forces and others from public-policy decisions that affect the cost of education, play an important role in students' decisions to embark upon graduate study and to choose particular fields of specialization. Rela- tive earnings, cost and duration of study, availability of stipends and other support, and prospects of employment in particular fields of study are examples of such factors. The contention that the specific field of study or the decision to obtain a Ph.D. is generally dependent upon economic considerations does not deny the noneconomic motivations in the demand for higher education. Rather, the argument is that marginal choices are influenced by the relative economic attractiveness of various alternative areas of study. Thus, projections of the supply of biomedical and behavioral scientists, and particularly the distribution of this supply by fields, must be grounded in accurate estimates of the future economic status of these fields relative to other fields requiring similar amounts of training. Estimation of the economic prospects for the biomedical and behavioral sciences depends in turn on the supply response of future potential graduate students. That is, the relative salaries and prospects for employment of these scientists depend on their number in the labor force, as well as on research budgets and the numbers of graduate students to be trained. Thus, as Freeman (1971) and others have shown, the dynamics of the supply and demand for any broad area of professional 12

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manpower involves significant interactions among these factors, for which the magnitude and speed of adjustment cannot easily be estimated. For example, a decrease in the rate of real biomedical R and D expenditures can be expected eventually to reduce the relative salaries of research personnel in this area with the reductions affecting most quickly new postdoctoral entrants into the job market. This reduction in turn will tend to discourage first-year graduate enrollments in this area and perhaps undergraduate majors in biology, but may also lead to some increased utilization of the now less costly personnel in the area who have already been trained as researchers. Even more dramatically, news about unemployment or unsatisfactory employment of acquaintances who have preceded them will affect the attitudes of students toward such fields and depress graduate enrollments in the next phase of the cycle. The reduction in numbers of graduating Ph.D.'s will tend to improve their relative salary position and will subsequently affect future enrollments positively. The key questions that these concerns raise for making projections of future needs relate to the length of time these various adjustments will take, how complete they will be, and how strong their influence will be. We do not have precise answers to these questions. They probably differ from field to field and surely are influenced by the degree to which personnel in any field have reasonably close substitutes in related fields. Although numerical estimates must be made, it is essential to realize that projections of manpower supply and utilization inevitably must be based on judgments and assumptions. In subsequent chapters these judgments and assumptions are specified and applied to logical models of particular components of the labor market to derive estimates of future manpower supplies and utilization and recommended training levels for federal programs. The projections of academic demand resulting from the models and the assumptions about future patterns provide the take-off points from which the recommended levels of training are derived. In its deliberations, the Committee has considered how the system has been operating--to the extent that it is revealed by the data that can be gathered--and how it is expected to operate in the next few years. Here the dynamics of faculty accession and attrition become critical factors. Data prepared for the Committee this year have provided some new insight into these dynamics and have caused modif ication of some previously held assumptions about attrition rates, for example, and the training background of newly hired faculty members. One of the most significant new findings is that in recent years only slightly more than 20 percent of newly hired faculty members in clinical departments of medical schools have had postdoctoral research training, whereas a decade ago this rate was much higher. Perhaps more than any other evidence, this statistic highlights the deteriorating capabilities of many young medical school faculty members to conduct clinical research. The Committee's judgment about what this percentage should be over the next few years is a key element in determining the size of the postdoctoral pool required to meet the anticipated utilization of scientists with postdoctoral training. Also to be considered are factors that determine the number of trained postdoctorate available to fill academic vacancies each year, i.e., the average length of postdoctoral training and the number that can be ex- pected to seek academic careers. 13

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While the federal government is an important source of support for postdoctoral training in many fields, it is clear that some support is also available from various other sources. Recent data on the portion of the postdoctoral pool supported by f ederal training funds is the f inal element considered in developing the recommended number of postdoctoral trainees to be supported under NRSA programs. The complete process is illustrated by the flow diagram in Figure 1.1. An analagous procedure for determining the appropriate level of predoctoral training under NRSA programs has proven more elusive. The Key elements nere appear to ne tne level of Pn.D. production and the size of the postdoctoral pool, although the linkage between these variables and the amount of federal support for predoctoral training has not been established in a rigorous fashion. However, the Committee has closely monitored these quantities in this study and has tried to anticipate the needs for the 1980's. Its best judgment is that the emphasis should change from predoctoral to postdoctoral support, and recommendations have been made for a gradual reduction in overall predoctoral training under NRSA programs of more than 30 percent between 1975 and 1985. Considerable uncertainty remains as to what can be said about the statutory mandate that the Committee specify fields that should be given priority in research training programs. This issue is intertwined with the problem of taxonomy--the labeling and classification of the fields within the areas of the biomedical and behavioral sciences. In previous reports, the Committee has made recommendations in five broad scientific areas--basic biomedical, behavioral, clinical, health services research, and nursing research--while attempting to develop a methodology for estimating needs at more detailed levels within these areas. So far, compelling evidence of shortages in specific fields has been developed only in toxicology, epidemiology, biostatistics, and most of the clinical science f ields. One fact is becoming clear as a result of this exploration--considerable mobility occurs within most of the broad areas. Individuals who receive their Ph.D. in one field are frequently found to be employed in a different but related field within the area. From the point of view of the individual involved, this might be called field-switching; from the employer's point of view it represents substitutability among the fields. Although there is little support f or the proposition that research personnel trained in different fields are completely interchangeable, field-switching data indicate that, within some limits as yet undefined, substitution can and does occur. The Co~mmittee's studies are pro- gressing, but have not yet reached the point where fields can be grouped into those that represent homogeneous clusters within which there is considerable mobility and between which mobility is more difficult. TRAINING DATA FOR FY 1979 AND FY 1980 AND RECOMMENDED LEVELS FOR 1982-1985 In FY 1979, the NIH, ADAMlIA, and HRA provided support to 12, 924 trainees and fellows under the NRSA and its predecessor programs. The total was down slightly from the 13,203 trainees and fellows supported in FY 1978 and down significantly from the peak year of training, 1969, in which the pre-NRSA training activity for full- and part-time trainees and fellows totalled 19,820 (12,083 predoctoral; 5,094 M.D., D.D.S., D.V.~., or equivalent professional degree; and 2,643 Ph.D.'s). The largest drop 14

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INPUTS / Current supply/demand indicators: enrollments, / degrees, postdoctoral / trainees, R and D funding, / employment patterns, etc. / r Update models | Assumptions about future / ~ -- ~ / patterns of enrollments / '( Academic demand `` / R and D expenditures, r models based on ~ - / L faculty/student ratios,etc. / ~ most rec lint date i / Data on faculty dynamics: / attrition and accession rates, postdoctoral train ing of new faculty, eta; / Recent data on number of 7 / postdoctoral trainees / / supported by N RSA programs / relative to total post- / L doctoral pool size / OUTPUTS Projections of academic / demand to 1985 l Size of postdoctoral pool required to meet estimated faculty needs through 1985 ~ 1 , / Estimated number of post- / J doctoral trainees to be / / supported by NRSA programs / / under various conditions / FIGURE 1.1 Flow diagram of procedure followed in deriving recommendations for postdoctoral training levels. Historical data on supply/demand indicators are updated annually and used to update the models of academic demand. The committee's assumptions about future patterns of enrollments, R and D funding, etc., are used in models to derive short-term projections of academic demand. These are combined with data on faculty attrition and accession rates and training background of new faculty members to estimate the total postdoctoral pool size needed to satisfy demand under the assumed conditions. The portion of the total postdoctoral pool to be supported under NRSA programs is then estimated also by reference to recent data. 15

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in FY 1979 occurred in ADAHMA programs, which were reduced by 176 training positions from BY 1978 levels, while NIH provided 97 fewer awards and HRA dropped 6. In terms of areas of training, the clinical sciences had an increase over 1978 of more than 100 positions, while the behavioral sciences lost more than 300. The remaining areas of biomedical sciences, health services research, and nursing research had only minor reductions. In FY 1980, the total number of awards went up by 2 percent to 13,191 trainees and fellows, still below the FY 1978 level. All the increase occurred in NIH programs, which gained 407 training positions. Almost 90 percent of these were in the clinical science area. ADAMHA programs were further reduced by 140 positions, and HRA programs were reduced by 16 from FY 1979 levels. Tables 1.1-1.3 show the data on the agencies' training awards for FY 1979 and FY 1980. Table 1.4 shows the Committee's recommended levels of training in each area for FY 1982-1985. 16

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TABLE 1A Committee Recommendations for NDI/ADAMHA/ED\A P~edoctoral and Postdoctoral Traineedhip and Fellowship Awards for FY 1982~85a . . . . Chnical Sciences 1982 TOTAL Total P~edoc. Postdoc. TOTAL Basic ALL Biomedical FIELDS Sciences 12,78S S,99O 6,795 7,450 1,180 4,250 570 3,200 610 Other Medical Chnical Heals Behawore1 Scientist Science Services Nursing SaencesC Program Programs Research Research 725 2,800 330 300 725 _d 190 25S 0 2,800 140 45 Trainees Total 8,720 4,250 970 725 2,400 250 125 Predoc. 5,690 4,250 470 725 _d 140 105 Postdoc. 3,030 0 500 0 2,400 110 20 Fellows Total 4,065 3,200 210 0 400 80 175 Predoc. 300 0 100 0 0 50 150 Postdoc. 3,76S 3,200 110 0 400 30 25 1983 TOTAL Total 12,825 7,450 1,220 725 2,800 330 300 Predoc. 5,930 4,250 S10 725 _d 190 255 Postdoc. 6,895 3,200 710 0 2,800 140 45 Trainees Total 8,750 4,250 1,000 725 2,400 250 125 Predoc. 5,640 4,250 420 725 _d 140 105 Postdoc 3,110 0 580 0 2,400 110 20 Fellows Total 4,075 3,200 220 0 400 80 175 Predoc. 290 0 90 0 0 50 150 Postdoc. 3,785 3,200 130 0 400 30 25 1984 TOTAL Total 12,865 7,450 1,260 725 2,800 330 300 Predoc S,870 4,250 450 725 _d 190 255 Postdoc. 6,995 3,200 810 0 2,800 140 45 Tramees Tom 8,780 4,250 1,030 725 2,400 250 125 Predoc. 5,590 4,250 370 725 _d 140 105 Postdoc. 3,190 0 660 0 2,400 110 20 Fellows Total 4,085 3,200 230 0 400 80 175 Predoc. 280 0 80 0 0 50 150 Postdoc 3,805 3,200 150 0 400 30 25 1985 TOTAL Total 12,905 7,450 1,300 725 2,800 330 300 Predoc 5,810 4,250 390 725 _d 190 255 Postdoc. 7,095 3,200 910 0 2,800 140 45 Trainees Total 8,820 4,250 1,070 725 2,400 250 125 Predoc. S,540 4,250 320 725 _d 140 105 Postdoc. 3,280 0 750 0 2,400 110 20 Fellows Total 4,085 3,200 230 0 400 80 175 Predoc 270 0 70 0 0 50 150 Postdoc. 3,815 3,200 160 0 400 30 25 These are total numbers of recommended awards. See Table 1.1 for number of actual awards made in FY 1979 and PY 1980. The number of new starts in any given year is sensitive to fluctuations in the funding level and thus oscillates more rapidly than does the total number of a~rdlees. Recommenda~dons for biostatishcs, epidemiology, community and environmental health, and other bathing fields not specifically Mown m this table are included here. CThe allocation of awards in the behavioral science fields between traineeships and fellowships is based on the distribution that pre~railedin FY 1976, be., 82 percent trainee~ips, 18 percent fellowships. dA program of ~hort-term research training (3 months) for health professions students during summer and off-quarters was authonzed in 1978. The Committee has endorsed this program in principle but malces no recommendations for the number of students to be supported under it. The 1978 amendments to the NRSA Act authorized expenditures for this program of up to 4% of appropriated training funds. In FY 1980, 50 trair~ing grants were awarded win stipends for 911 trainees. 20

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Estimated Costs The Committee's last recommendations for training levels under the NRSA program appeared in its 1979 report. Cost estimates for the recommended program, also published in that report, were based on the new stipend levels that went into effect on July 1, 1980, and the additional assumption that stipends and other program costs would continue to increase by 5 percent per year. However, according to the most recent information from NIH, there are no plans to increase stipend levels beyond the July 1, 1980, schedule. Thus our previous cost estimates must be revised downward. Table 1.5 below shows the revised estimates for the NRSA programs using the current training recommendations under the following assumptions: (1) stipends will remain at the levels published in the new schedule effective July 1, 1980; tuition will increase by 5 percent per year; and institutional allowances will be limited to $3,000 for predoctoral trainees and $5,000 for postdoctoral trainees. 21

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TABLE 1.5 Estimated Cost of Recommended NIH/ADA~HA/HRA ['raining Programs for FY 1982-85 (millions of dollars3a TOTAL Health Fiscal Type of ALL Biomedical Behavioral Clinical Services Nursing Year Program FIELDS Sciences Sciences Sciencesb Research Research 1982 TOTAL 218.9 123.4 22.0 64.1 S.4 4~0 Trainees 141.4 61.5 18.4 5S.6 4.2 1.7 Fellows 77.5 61.9 3.6 8.5 1.2 2.3 Predoc. 77.3 61.5 8.1 2.2 2.4 3. ~ Postdoc 141.6 61.9 13.9 61.9 3.0 0.9 . . . 1983 TOTAL 223.2 125.8 23.6 64.3 5.4 4.1 Trainees 144.6 63.1 19.7 55.8 4.2 1.7 Fellows 78.6 62.7 3.9 8~5 1.2 2.4 Predoc. 78.4 63.1 7.4 2.3 2.4 3.2 Postdoc. 144.8 62. 7 16.2 62.0 3.0 as 1984 TOTAL 226.9 127.7 25.1 64.4 5.5 4.2 Trainees 147.9 64.9 21.0 55.9 4.3 1.8 Fellows 79.0 62.8 4.1 8.5 1.2 2.4 Predoc. 79.6 64.9 6.6 2~4 2.5 3.3 Postdoc. 147.3 62.8 18.5 62.0 3.0 0.9 1985 TOTAL 230.0 129.0 26.7 64.5 5.5 4.3 Trainees 150.8 66.2 22.5 56.0 4.3 1.8 Fellows 79.2 62.8 4.2 8.5 1.2 2.5 Predoc. 80.3 66.2 5.9 2.4 2.5 3.4 Pos~doc. 149. 7 62.8 20.8 62.1 3.0 as aCalculations were based on 1980 average cost figures derived from NIH data and assume no increase in stipends, but include a 5~O per year increase in tuition. bEstimate includes 1,000 predoctoral trainees in the short-term training program. ESTIMATED TRAINING COSTS PER AWARD IN FY 1980 (dollars) Predoctoral Postdoctoral Behav- Health Behav- Heals Biomed. ioral Clinical Services Nursing Biomed. ioral Clinical Services Nursing FY 1980 Sci. Sci. Sci. Research Research Sci. Sci. Sci Research Research Trainees 11,570 12,850 2,140 11,570 11,570 21,440 22,580 22,200 21,440 21,440 Fellows 11,570 12,850 - 11,570 11,570 18,900 19,130 20,960 18,900 18,900 22