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1. Introduction and Summary We are concerned here about the qual.it~ of biomedical and behavioral research conducted in this Coventry and the role that federally supported research training plays in deveZoping and maintaining it. Evidence about the ~ual.itp of research and the scientists who conduct it often becomes available only over a rather long period. Hence, we must be aware of the long-term effects of the training programs. We must also tori to anticipate future research personnel needs tin a quantitative sense. Thus a major part of this report is devoted to an assessment of the current and projected supply of and demand for scientists in the biomedical and behavioral fields. Two fundamental principles underlie the work of this Committee over the past 8 years: 2. vigorous research activity is the key to continual progress in most scientific and technical fields and an adequate flow of well-trained new scientists is necessary to maintain the quality and vitality of research conducted in these fields. With these principles in mind, the Committee has attempted to respond to the task presented to the National Academy of Sciences tNAS) by Congress in the National Research Service Award (NRSA) Act of 1974 (P.L. 93-348) and amendments. The NAS was asked to determine the nation's need for biomedical and behavioral research personnel and to assess the research training programs offered through the National Institutes of Health (NIH), the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), and the Division of Nursing of the Health Resources and Services Administration (HRSA). In the previous six reports issued since 1975, the Committee has outlined its methodology, formulated conceptual models of how the market works in these fields, and developed analytical models that have proved useful in monitoring the system and making projections. In the process, we have compiled a substantial body of relevant data, most of which is presented in the Appendix. 1

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2 The Committee has interpreted national needs primarily, but not exclusively, in terms of the number of positions expected to be available in both the academic and nonacademic sectors for doctorate- level biomedical and behavioral investigators. The number of positions available reflects the market demand for scientists and depends on an array of economic, political, and sociological factors, one of the most important of which is the availability of funds to support research. We have attempted to define the appropriate level of training to be supplied by the above-mentioned federal agencies on the basis of projections of supply and demand, considerations of how the system works to produce trained researchers and teachers, and by examination of employment patterns and practices.) Although these short-term market projections have weighed heavily in our deliberations, we also have been influenced by a perception that training support contributes not only to the quantity of students entering a field, but also to the quality of the training environment and the competence of the program graduates. The immediate effect of training support for a field is to increase the number of students entering the field. In the longer term, the probable effect is to increase the quality of research. We believe that much of the recent progress made in biomedical research in this country can be traced to the strong federal commitment to research and training that emanated from the National Cancer Act of 1937 and subsequent legislation. That commitment has been instrumental in establishing a powerful and effective biomedical research enterprise based on a cooperative arrangement between the federal government, acting principally through the NIH, and the universities. This enterprise is a national resource that has provided this country with a superb base for health related services and technological leadership in many biomedical and behavioral fields. Developments during the past 30 years have transformed our knowledge and understanding of biology. Achievements of research in many disciplines' curing this period have led to new technologies contributing to a flood of discoveries in molecular biology, biochemistry, physiology, and medicine. Recombinant DNA technology, which makes possible the transfer of hereditary units from one species to another, represents a significant addition to the "new biology. n It permits, for example, bacteria to become n factories" that produce substances of biological and medical importance. It has already led~to the synthetic production of human insulin, somatostatin, and growth hormone. The effectiveness of these substances in treating insulin-dependent diabetes and certain types of dwarfism is now undergoing clinical trial. Techniques for combining genes can also yield large quantities of pure antigen which in the For an extended discussion of the system by which biomedical and behavioral scientists are trained and absorbed into research positions, see Chapters 3 and 4 and also the 1981 Report of this Committee (NRC, 1975-81, pp. 10-15).

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3 near future may be used to produce safer and more potent vaccines for immunization against specific infectious agents. Substantial progress has been achieved in understanding of the immune system. Scientists have uncovered genetic mechanisms that control the immune response to such invaders as cancer cells, transplanted organs, and environmental agents that cause allergies. Involved here is the discovery of the major histocompability complex (MCH). A region of this "super gene" appears to be the major regulator of the immune response to foreign substances or antigens. Disorders such as multiple sclerosis, juvenile diabetes mellitus, systemic lupus erythematosus, and myasthenia gravis may be associated with certain recognition antigens on the surface of cells--antigens located under the directions of MHC. Further knowledge of MHC can result in more effective means for supplementing natural resistance to these diseases, as well as better techniques for organ and tissue transplantation. Highly specific antibodies can now be produced in the laboratory through a procedure that consists of fusing in culture a myeloma cell with single lymphocytes from an immunized animal. The resulting hybridoma yields clones of lymphocytes that emit monoclonal antibodies which have the potential for development of specific vaccines, diagnostic tests, and treatments for many diseases. Recently, for example, investigators have used human lung cancer cells to immunize animals and then prepare monoclonal antibodies which can distinguish human tumor cells from normal cells. This technology makes possible the detection of cancer at a very early stage. Eventually, clinicians may be able to attach radioactive or chemotherapeutic agents to the antibodies and thereby kill cancer cells without harming surrounding healthy tissue. The detection and isolation of oncogenes has provided a new paradigm for cancer research. Oncogenes are dominant genetic elements whose expression within a normal cell leads to malignant trans- formation. Some major questions remain to be answered. At what point in the processes leading to malignancy do oncogenes act? What are the functions of these oncogenes and by what mechanisms do they effect cell transformation? Knowledge of the metabolic pathways in which genes and their products interact could ultimately lead to the development of rational strategies for the treatment and prevention of malignant cells. The developments described above may be viewed as dividends on past federal investment in biomedical research and training. But it is critically important to recognize that the federal commitment to support biomedical research and training means that federal budget decisions have great impact on these activities, although other sources of funds are available to some extent. The rationale for government support of biomedical and behavioral research "derives from its responsibility for the general welfare to do that which is necessary whenever other mechanisms do not suffice" (NRC, 1975-81, 1979 Report, p. 19~. Research training is a necessary and vital adjunct to the research program. The Committee's recommendations for research training have been formulated to promote

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4 stability in the market for biomedical and behavioral research personnel, while preserving the quality of the training program and ensuring that adequate numbers of well-trained scientists are available to meet the nation's needs. PRIORITY FIELDS One of the most difficult components of the Committee's task has been that of determining the appropriate allocation of training grant and fellowship funds among fields. For purposes of this study, the biomedical and behavioral fields have been divided into five major categories as shown in the following table along with the distribution of National Research Service Awards made in the last 6 years and the Committee's recommended distribution through 1987: Distribution of National Research Service Awards Categories Actual 1977-82 Recommended 1982-87a . . _ 1) Biomedical Sciences 56% 57% 2) Behavioral Sciences 10% 9% 3) Clinical Sciences 32% 30% 4) Health Services Research 1% 2% 5) Nursing Research 1% 2% 100% 100% aAwards in the short-term (3-month) training program for health profession students have been calculated at 1/4 of a full-time equivalent award. An average of 1,600 such awards per year from 1982-87 (400/yr. on an FTE basis) have been included in the clinical sciences in this table. Although the boundaries between these categories are not always clearly drawn in practice ,2 conceptually they define fairly distinct sets of problems. Each major category has been analyzed separately, and our recommendations have generally been directed to the allocation of training awards among these major categories e It has proven to be an especially difficult task to identify priority fields within each major category. The Committee has in the past identified certain fields such as biostatistics, biomathematics, epidemiology, toxicology, environmental health, and the clinical sciences as meriting high priority for training support. However, we 2 See Appendix Table D5 for the taxonomy used to define the categories.

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s have refrained from being more specific because basic research is such a fluid and unpredictable activity. We have found no way of accu- rately predicting precisely where and when the important scientific developments will occur and we have no recent data to indicate that some or all of the earlier conclusions are still valid. The Committee's position is that the peer review system continues to provide the best available method for distributing training funds within the general guidelines we recommend. Those guidelines are based on the informed judgment of the panelists and Committee members, who have considerable experience relevant to the task and who have reviewed extensive analyses of the current and projected market for scientists in each area and other relevant information. SUMMARY OF CURRENT OUTLOOK In previous reports the Committee has called attention to the sustained growth in the number of biomedical Ph.D.s occupying postdoctoral positions. Although a period of postdoctoral training has long been a traditional and accepted phase in a bioscientist's career, the build-up of the postdoctoral pool was viewed as an indication that the supply of biomedical scientists was growing faster than the number of positions requiring their skills. Indeed, more than 40 percent of the biomedical postdoctoral trainees who received their doctorate degree between 1971 and 1975 reported that they remained in postdoctoral status longer than they might otherwise have done because they could not secure a more permanent position (NRC, 1975-81, 1977 Report, Vol 2, p. 31~. There now are some indications that the postdoctoral pool of bio- scientists may soon level off. Most important, the number of bioscience graduate students has begun to drop, and this is likely to result in fewer Ph.D.s produced and fewer of them entering the postdoctoral pool. There has been very little growth in biomedical Ph.D. production since 1972. The Committee has expressed concern about the lack of interest in research careers on the part of young physicians. The sustained expansion of clinical faculties in medical schools since the early 1960s has contributed to the demand for clinical investigators, and the growing number of unfilled positions is evidence of need. In 1981, the Association of American Medical Colleges (AAMC) reported to the Committee that only about 21 percent of individuals newly hired to fill vacancies on clinical faculties at medical schools were physicians with some postdoctoral research training (NRC, 1975-81, 1981 Report, p. 2~. There is an increasing tendency to rely on practice income generated by medical school faculty members to bolster medical school and departmental budgets. This growing dependence tends to detract from faculty members' commitments to clinical investigation. To the extent that faculty members must help support their salaries and expenses through clinical practice, the research effort is weakened e

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6 Problems in our health care system are increasing while funds for health services research and training are being sharply reduced. There is likely to be additional pressure on federal agencies to stress mission-oriented research and cost containment over other issues of long range importance in the system. The number of nurses with doctoral degrees in biomedical and behavioral fields is increasing but only about 7 percent of these individuals reported research as a major activity in 1980. There is as yet no solid core of qualified investigators in the area of nursing research. In the behavioral sciences, the clinical fields are flourishing as opportunities for careers as counselors and therapists have become more attractive. Coverage of these services by health insurance plans has spread in recent years. But most behavioral science research is performed by nonclinical behavioral scientists, and enrollments as well as Ph.D. production in the nonclinical fields are declining. Only a few years ago most observers were projecting that Ph.D. production would continue to increase until the early 1980s (Cartter, 1976; NSF, 1975~. The flattening out of the Ph.D. production curves since the the early 1970's is a rather surprising event, one that promises to produce more short-term balance in the market for Ph.D.s than was earlier thought possible. However, the demographic patterns that are emerging present another set of problems. Perhaps the most serious is that biomedical, clinical, and behavioral science faculties at colleges and universities are not likely to expand at all for the rest of this decade. This means fewer opportunities for research careers for young scientists in these fields. Persons born during the baby boom that occurred roughly between 1946 and 1965 are now largely past the prime college age years, so enrollments in higher education are expected to decline steadily for the next 10 or 12 years. Faculty size is determined partly by enrollments and partly by the availability of R and D funds. In the biomedical fields, we expect the latter to grow at modest real rates of about 2 percent annually for the next few years. But this probably will not be enough to offset the drop in revenues resulting from declining enrollments. Hence, faculties will not grow and aca- demic vacancies will occur mainly by attrition. Consequently, young researchers will find it difficult in these circumstances to begin their careers as independent investigators. Without adequate numbers of young investigators, who typically are highly innovative and crea- tive, where will the new ideas for advances in basic research come from? Should progress in research be tied so closely to demographic cycles? What policies can be invoked now that would tend to mitigate the imbalances between supply and demand caused by the cyclical demographic and social changes? How can this country's competitive advantage in technological areas such as the new biotechnology be maintained? In our view, these problems are most likely to be solved by greater expenditure of funds to support research. However, this Committee has been asked to determine the nation's need for biomedical and behavioral research personnel, and we have interpreted that task as one of estimating the number of positions that are likely to be available under realistic conditions. A market-based approach such as

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7 this is only one of several possible approaches that could be taken to estimate national personnel needs. One alternative approach would base personnel needs on a projected level of research expenditures somehow tied to total health care costs. But this approach also has problems, e.g., what will health care costs be in 5 years and what is an appropriate ratio of research expenditures to health care costs? No matter what criterion is used, there is always a danger that some unforeseen development will negate the assumptions on which projections are made and will lead to market imbalances--either shortages or surpluses--and a misallocation of resources. There is no known protection against that event. The training recommendations described below have been formulated on the basis of our best judgment as to what the demand for these scientists is most likely to be, given the demographic trends, the most likely future levels of research funds, and the financial conditions of our colleges and universities. RECOMMENDATIONS We direct the following recommendations concerning the level and distribution of National Research Service Awards to fiscal years 1985-87. The analyses, background, and discussion leading to these recommendations may be found in succeeding chapters of this report. Clinical Sciences 1. The number of postdoctoral research training positions in the clinical sciences should be about 2,600 per year from 1985 through 1987, and the number of physicians receiving research training should be increased from the current level of less than 2,000 to about 2,200, or 85 percent of these postdoctoral positions. 2. The training grant is the most appropriate mechanism for post- doctoral training of physicians, most of whom have no prior research experience. At least 85 percent of the clinical science training positions should be on training grants, the remainder on fellowships. One of the most effective mechanisms for training physician- scientists is the Medical Scientist Training Program {MSTP) administered by the National Institute of General Medical Sciences (NIGMS). The costs of MSTP as a share of total NIGMS funds for predoctoral training have been increasing steadily. To ensure an appropriate balance, we therefore recommend that MSTP'S share over the near future not exceed 25 percent of NIGMS-predoctoral training funds with a target goal of approximately 725 trainees. We believe this can be accomplished without loss in quality by introducing administrative changes, such as the recently adopted limitation on length of MSTP support for an individual trainee (6 years). Other modifications now under consideration by the agency have a potential for increasing output per MSTP dollar.

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8 4. We endorse the program of institutional grants that provides up to 3 months research training for health professions students without incurring the payback provision, and recommend that it be continued. If possible, the stipends should be raised to a level which is competitive with other opportunities of these students for summer earnings. Basic Biomedical Sciences Predoctoral training in these fields should be supported at a level of about 4,250 trainees per year. 2. Postdoctoral training in the basic biomedical sciences should continue to support about 3,200 fellows per year. Behavioral Sciences 1. In view of the rapidly developing movement away from the research fields and into the more clinical fields of the behavioral sciences, the Committee recommends that research training support not be further eroded. The number of predoctoral awards in the behavioral sciences should be maintained at the 1981 level--about 650 per year. 2. The development of postdoctoral training programs should be encouraged by gradually increasing the number of postdoctoral research training awards from the 1981 level of about 350 to 540 by 1987. 3. About 80 percent of the behavioral science awards should be traineeships and 20 percent should be fellowships. Health Services Research 1. We recommend that 330 trainees and fellows be supported annually in the catgory of health services research. Earlier efforts by the Committee and others to develop adequate data on health services research personnel and training should be supplemented by further investigations. The Institute of Medicine should convene a meeting of interested parties to review the status of university-related centers for health services research and to outline a plan for collecting additional data on potential demand for investigators in this field. Nursing Research 1. The number of training awards in nursing research should be about 300 per year. 2. A maximum of 15 percent of these awards should be at the post- doctoral level.

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9 TRAINING DATA To give perspective to the resources devoted to training by the NIH, ADAMHA, and HRSA, we present below the training budgets as a percentage of research expenditures by these agencies over the past 10 years. Training expenditures declined from almost 18 percent of research expenditures in 1971 to 7 percent in 1981. This results from a steady 4 percent per year increase in research expenditures and a 5 percent per year decrease in training expenditures over this period after adjusting for inflation. Training Expenditures as a Percent of Research Expenditures 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 SOURCE: See Appendix Table D4. 17.7% 15.1% 10.4% 12.9% 10.5% 7.7% 7.4% 7.4% 6.4% 7.3% 7.0% Nevertheless, the current number of trainees is in fact quite close to that recommended by this Committee. The Point is that large adjustments in_training programs have been occurring right along-- correctly, we think--in view of the ample number of biomedical and behavioral Ph.D.s being produced annually and serving in postdoctoral positions. A transition has been made from a period of high training vels. What Is needed now is not a huge . ~ infusion of funds for training but rather a reasonably stable program geared to preserving the lon~-term quality of research. By definition, there will always be a shortage of the best neoule and it is in the sense of ensuring the number of very good people for careers research that NRSA programs are most useful. _ ~ ,= _ _ ,= _ _ ~ availability of some minimum in biomedical and behavioral NATIONAL RESEARCH SERVICE AWARDS FOR1981AND1982 In 1981 NIH/ADAMHA/HRSA made 13~325 awards under the NRSA program-- a slight increase over the 13,191 made in 1980. In 1982 the number of

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10 awards dropped to 12,907. fields as follows: The awards were distributed among the 1981 1982 Biomedical Sciences: 52.4% 55.6% Behavioral Sciences: 8.0% 7.5% Clinical Sciences:3/ 38.5% 35.8% Nursing Research: 1.1% 1.1% 100.0% 100.0% /Awards in the short-term training program for health professions students were counted as 1/4 of a full-time equivalent award. These distributions reflect an increased emphasis on the clinical fields and away from the biomedical sciences and health services research, compared to recent years. This shift occurred in part because ADAMHA revised its classification of research training awards in 1981. This change resulted in 114 additional awards in the clinical sciences, up from none in 1980, and the elimination of any awards in health services research. Another reason for the increase in clinical sciences is that awards in the short-term (3 months) training program for health professions students increased from 911 in 1980 to 1,275 in 1981 and 1,339 in 1982. Despite the apparent increase in training awards in the clinical sciences category, the number of physicians and other health professionals participating in the research training program was less than 2,000 out of the nearly 2,800 clinical science postdoctoral awards made by the NIH in 1981.3 The remaining awards went to Ph.D.s. . ~ ~ The following tables show the 1981 and 1982 research training awards made by the NIH, ADAMHA, and HRSA under the NRSA program, and the Committee's recommendations for 1985-87. Cost estimates for the recommended programs are also provided. Training grant awards are defined as the number of predoctoral or postdoctoral training positions to be made available on the grant. The number of awards is generally quite close, but not exactly equal to the number of individuals trained, since some training grant awards may provide support to more than one trainee during the year. 3 Special tabulation prepared by the Statistics and Analysis Branch, Division of Research Grants, NIH. October 7, 1982.

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11 TABLE 1.1 Aggregated Numbers of NIH/ADAMHA/HRSA Traineeship and Fellowship Awards for FY 1981 and FY 1982a TOTAL ALL Biomedical Behavioral Clinical Nursing FIELDS Sciences Sciences Sciences Research FY 1981 TOTAL 13,325 6,482 988 5,723 132 Predoctoral 7,264 3,708 639 2,791 126 Postdoctoral 6,061 2,774 349 2,932 6 Trainees 11,430 5,047 861 5,506 16 Predoctoral 7,043 3,656 588 2,787 12 Postdoctoral 4,387 1,391 27 3 2,719 4 Fellows 1,895 1,435 127 217 116 Predoctoral 221 52 51 4 114 Postdoctoral 1,674 1,383 76 213 2 FY 1982 TOTAL 12,907 6,608 896 5,270 133 Predoctoral 6,989 3,673 516 2,669 131 Postdoctoral 5,918 2,935 380 2,601 2 Trainees 11,097 5,202 781 5,101 13 Predoctoral 6,784 3,6 20 484 2,667 13 Postdoctoral 4,313 1,582 297 2,434 0 Fellows 1,810 1,406 115 169 120 Predoctoral 205 5 3 3 2 2 1 18 Postdoctoral 1,605 1,353 83 167 ~ aThese are total numbers of awards for traineeships and fellowships. Data on the number of new starts for FY 1981 and FY 1982 are not available. See Tables 1.2 and 1.3. SOURCES: Office of the Administrator, ADAMHA (5/25/82 and 6/6/83); Division of Nursing, HRSA (4/9/81 and 10/1/82); Division of Research Grants, NIH (9/22/82 and 7/12/83).

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13 TABLE 1.3 ADAM HA Traineeship and Fellowship Awards for FY 1981 and FY 1982 Biomedical Sciences TOTAL Total Epidemiology ALL Biomedical Biological and Behavioral Clinical FIELDS Sciences Sciences Biostatistics Sciences Sciencesb FY 1981 TOTAL 1,423 519 398 121 790 114 Predoctoral 808 235 158 77 524 49 Postdoctoral 615 284 240 44 266 65 Trainees 1,218 423 308 115 697 98 Predoctoral 721 203 127 76 473 45 Postdoctoral 497 220 181 39 224 5 3 Fellows 205 96 90 6 93 16 Predoctoral 87 32 31 1 51 4 Postdoctoral 1 18 64 59 5 42 12 FY 1982 TOTAL 1,246 486 365 121 648 112 Predoctoral 652 212 139 73 388 52 Postdoctoral 594 274 226 48 260 60 Trainees 1,095 409 292 117 584 102 Predoctoral 589 183 110 73 356 50 Postdoctoral 506 226 182 44 228 52 Fellows 151 77 73 4 64 10 Predoctoral 63 29 29 0 32 2 Postdoctoral 88 48 44 4 32 8 aThese are total numbers of awards for traineeships and fellowships. Data on the number of new starts for FY 1981 and FY 1982 are not available. bEffective FY 1981, ADAMHA has been using a different system for classifying their trainees and fellows. In prior years, ADAMHA reported training in Health Services Research but none in Clinical Sciences. SOURCE: Office of the Administrator, ADAMHA (5/25/82 and 6/6/83).

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14 TABLE 1.4 Committee Recommendations for NIH/ADAMHA/HRSA Predoctoral and Postdoctoral Traineeship and Fellowship Awards for FY 1985-87a TOTAL Basic Behavioral Clinical Sciences Health Nursing ALL Biomedical SciencesC Other Services Research FIELDS Sciences b Medical Clinical Research Fiscal Scientist Science Year Type of Program Program Programs _ 1985 TOTAL Total 12,495 7,450 1,090 725 2,600 330 300 Predoc. 6,070 4,250 650 725 d 190 25 5 Postdoc. 6,425 3,200 440 0 2,600 140 45 Trainees Total 8,475 4,250 895 725 2,230 250 125 Predoc. 5,755 4,250 535 725 d 140 105 Postdoc. 2,720 0 360 0 2,230 110 20 Fellows Total 4,020 3,200 195 0 370 80 175 Predoc. 315 0 115 0 0 50 150 Postdoc. 3,705 3,200 80 0 370 30 25 1986 TOTAL Total 12,545 7,450 1,140 725 2,600 330 300 Predoc. 6,070 4,250 650 725 d 190 2S5 Postdoc. 6,475 3,200 490 0 2,600 140 45 Trainees Total 8,515 4,250 935 725 2,230 250 125 Predoc. 5,755 4,250 535 725 d 140 105 Postdoc. 2,760 0 400 0 2,230 110 20 Fellows Total 4,030 3,200 205 0 370 80 175 Predoc. 315 0 115 0 0 50 150 Postdoc. 3,715 3,200 90 0 370 30 25 1987 TOTAL Total 12,595 7,450 1,190 725 2,600 330 300 Predoc. 6,070 4,250 650 725 d 190 255 Postdoc. 6,525 3,200 540 0 2,600 140 45 Trainees Total 8,560 4,250 980 725 2,230 250 125 Predoc. 5,755 4,250 535 725 d 140 105 Postdoc. 2,805 0 445 0 2,230 110 20 Fellows Total 4,035 3,200 210 0 370 80 175 Predoc. 315 0 115 0 0 50 150 Postdoc. 3,720 3,200 95 0 370 30 25 aThese are total numbers of recommended awards. See Table 1.1 for number of actual awards made in FY 1981 and FY 1982. The number of new starts in any given vear is sensitive to fluctll~tionc in the folio le.v`~l end they ncr~ill~tPc murk ranirilu than does the total number of awardees. bRecommendations for biostatistics, epidemiology, community and environmental health, and other training fields not specifi- cally shown in this table are included here. CThe allocation of awards in the behavioral science fields between traineeships and fellowships is based on the distribution that prevailed in FY 1976, i.e., 82~o traineeships, 18% fellowships. dA program of short-term research training (3 months) for health professions students during summer and off~uarters was au- thorized in 1978. The Committee has endorsed this program in principle but makes no recommendations for the number of students to be supported under it. The 1978 amendments to the NRSA Act authorized evnentl't''r~c for thic nr^er~m nf''n tm 4% of appropriated training funds. In FY 1982 1,339 trainees were awarded stipends. _ ~ C, ^~ v ~ -V &~ rat, ~~& -Rae ~^ ~ ~- r A ~ fir ~

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15 TABLE 1.5 Estimated Cost of Recommended NIH/ADA~HA/HRSA Training Programs for FY 1985-87 (millions of dollars Type of TOTAL Biomedical Behavioral ainica1 Sciences Health Nursing Fiscal Program ALL Sciences Sciences Short-Term Services Research Year FIELDS Total MSTP Trainingb Other Research 1985 TOTAL 202.7 107.5 18.2 68.0 10.8 2.1 55.1 5.1 3.9 Trainees 131.1 49.6 15.2 60.6 10.8 2.1 47.7 4.0 1.7 Fellows 71.6 5 7.9 3.0 7.4 - - 7.4 1.0 2.2 Predoc. 77.1 49.6 9.4 12.9 10.8 2.1 - 2.2 3.0 Pos~doc 125.6 S7.9 8.8 55.1 - - 55.1 2.9 0 9 1986 TOTAL 205.9 108.5 20.0 68.4 11.1 2.1 55.2 5.1 3.9 Trainees 134.0 50.6 16.7 61.0 11.1 2.1 47.8 4.0 1.7 Fellows 71.9 57.9 3.3 7.4 - - 7.4 1.1 2.2 Predoc. 78.6 50.6 9.6 13.2 11.1 2.1 - 2.2 3.0 Postdoc. 127.3 57.9 10.4 55.2 - - 55.2 2.9 0.9 1987 TOTAL 209.4 109.5 21.9 68.8 11.4 2.1 55.3 5.2 4.0 Trainees 137.0 51.6 18.3 61.4 11.4 2.1 47.9 4.0 1.7 Fellows 72.4 57.9 3.6 7.4 - - 7.4 1.2 2.3 Predoc. 80.4 51.6 9.9 13.5 11.4 2.1 - 2.3 3.1 Postdoc. 129.0 57.9 12.0 55.3 - - 55.3 2.9 0.9 _ aCalculations were based on 1982 average cost figures derived from NIH data and assumed the following: 1) a 5% increase in stipends for FY 1983, held constant for later years; 2) a NO per year increase in tuition; and 3) a reduction in institutional costs to a maximum per year of $1,500 for predoctoral trainees and fellows, $2,500 for postdoctoral trainees, and $3,000 for postdoctoral fellows. The sti- pend increase and the reduction in institutional allowances are regulations that became effective in FY 1983. bEstimate assumes 1,200 trainees. ESTIMATED TRAINING COSTS PER AWARD IN FY 1982 (dollars) Predoctoral Clinical Sciences Postdoctoral Behav- Short- Health Behav- Health Biomed. ioral Term Services Nursing Biomed. ioral Clinical Services Nursing FY 1982 Sci. Sci. MSTP Training Research Research Sci. Sci. Sci. Research Research Trainees 11,613 13,602 13,776 1,699 11,613 11,613 20,596 21,953 20,987 20,596 20,596 Fellows 11,613 13,602 - - 11,613 11,613 17,321 18,535 19,263 17,321 17,321

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16 ADDENDUM It has been the Committee's practice following the publication of its reports to hold a meeting at which interested persons can present their reactions and comments to the Committee. The last report was issued in 1981 and a public meeting was held in 1982. A number of significant points were made which we feel deserve mention and further consideration. The meeting is summarized below. PUBLIC MEETING, JUNE 2, 1982 Following the publication of the Committee's 1981 Report, a public meeting was held on June 2, 1982, to receive comments from the scien- tific community. Twelve speakers representing a variety of organiza- tions made brief statements about different aspects of the report to the Committee and an audience of about 100 persons. The list of speakers in order of appearance and their affiliations are as follows: Gerald D. Shockman James Ferguson Jr. Frank G. Standaert Robert W. Krauss Thomas Kennedy James M. Jones Ora Strickland Michael S. Pallak Mortimer Appley Edward J. Callahan Martha Pitel Mitzi Duxbury American Society for Microbiology University of Pennsylvania School of Medicine Georgetown University Federation of American Societies for Experimental Biology Association of American Medical Colleges Minority Fellowship Program Director American Nurses' Association American Psychological Association Clark University West Virginia University Medical Center American Association of Colleges of Nursing University of Minnesota School of Nursing Copies of prepared remarks from several of the speakers are avail- able upon request to the Committee. Some of the major points made by the speakers at the meeting are summarized below: 1. The Committee may have overlooked a growing demand for certain types of bioscientists outside the academic sector, especially in the new biotechnology industry. The Committee's estimate of about 1,000 positions per year opening up for biomedical Ph.D.s in industry is probably too conservative. The role of the M.D. in basic research should be examined and encouraged. Medical students are often insulated from basic research and researcher role models.

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17 Data from the placement service of the Federation of American Societies for Experimental Biology (FASEB) show a stable number of job applicants and employers. There is no evidence in these data that an oversunulv of bioscientists exists. Identifying physician scientists and enumerating them remains a critical problem because of the absence of any certification process. An accurate assessment of supply or demand cannot be made without an accurate count of physician scientists. At least 85 percent of funds for training minority students should be used at the predoctoral level. 6. The Committee is urged to reconsider its recOmm~n~A tion for training in the behavioral sciences that drastically shifts the emphasis to postdoctoral training. Although it is recognized that the need for postdoctoral training is growing in some behavioral subfields, the magnitude of the recommended shift is unrealistic. The decline in predoctoral support by the agencies has been devastating. There is no objection to increasing research training at the postdoctoral level, but it should not be at the expense of predoctoral training support. The Committee should extend its horizons beyond the short-term analysis it has traditionally employed. A longer-term view is necessary because scientists needed in the l990s are already in training. We need to know what the situation will be in the l990s when many people trained in the 1960s will be retiring. Nursing research includes many more areas than health services research and should not be combined with it in the report. The Committee's support for Nursing Research Emphasis Grants is to be commended. Although progress has been made in providing training in the area of nursing research, we still lack a substantial nucleus of nurse researchers as principal investigators engaged in nursing research programs. 4. ~ .-~~ , ~ __~.~ ~ _~ 7. 8. The Committee acknowledges these comments and appreciates the constructive manner in which they were presented. The suggestions have been given careful consideration in our deliberations and those of the Panels. While perhaps not all of them are reflected in this report to everyone's satisfaction, the comments are highly valued by our members as representing important points of view on these difficult issues.