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Personnel Needs and Training for Biomedical and Behavioral Research THE 1983 REPORT of the Committee on National Needs for Biomedical and Behavioral Research Personnel institute of Medicine National Academy of Sciences NATIONAL ACADEMY PRESS Washington' D.C. 1983

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NOTICE: The project that is the subject of the report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a aroun other than the authors according to procedures approved by a Report Review committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. '.~s,~,,; ~ :: :~`J74`,,~. ~ .~ At, l ~ ~ \,~ 4; ~ -~ Gem ~ A ' ~ The work on which this publication is based was performed pursuant to Contract No. N01-OD-9-2112jwith the National Institutes of Health of the Department of Health and Human Services. Support for this project came from Evaluation Set-Aside funds (Section 513 of the PHS Act), Evaluat ion Pro jec t No. NIH 75-1. Available f ram: Committee on National Needs for Biomedical and Behav for al Research Per sonne 1 I nst i tu te of Med ic ine Nat tonal Academy of Sc fence s 2101 Constitution Avenue, N.W., JH-640 Wash ing ton, D. C . 20418 ( 202) 334-3186 Publication No. IOM-83-0 3

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PREFACE This is the seventh report of the Committee on National Needs for Biomedical and Behavioral Research Personnel pursuant to the request contained in the National Research Service Awards Act of 1974 (P.L. 93-348 as amended). In that Act, Congress requested the National Academy of Sciences to conduct a continuing study of the nation's overall need for biomedical and behavioral research personnel, the subject areas in which such personnel are needed, and the kinds and extent of training that should be provided by the federal agencies authorized to provide National Research Service Awards--the National Institutes of Health (NIH), the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), and the Division of Nursing, Health Resources and Services Administration (HRSA). The National Center for Health Services Research (NCHSR) was also authorized to provide National Research Service Awards in the Health Services Research Act of 1978 (P.L. 95-623). In the previous six reports issued since 1975, the Committee has concluded that the federal programs for training in these fields should be reoriented to provide less stimulus to Ph.D. production and more support to postdoctoral training, especially in the clinical and behavioral sciences. Accordingly, the Committee has recommended that the agencies change the allocation of their training grant and fellowship awards from predominantly predoctoral training to predominantly postdoctoral. The Committee recommended this be done by: (1) holding the number of postdoctoral trainees in the basic biomedical fields constant at about the level that prevailed in 1975 (3,200) while reducing the number of predoctoral trainees in the basic biomedical sciences to about 70 percent of the 1975 level; (2) revers- ing the allocation of awards in the behavioral sciences from the 1975 distribution which was 90 percent predoctoral, to one which is 30 percent predoctoral and 70 percent postdoctoral; (3) increasing the number of postdoctoral awards in the clinical sciences by about 10 percent over the 1975 level; (4) expanding the existing training programs in the category of health services research and bringing the authority for training by the National Center for Health Services Research under the NRSA Act; and (5) providing support for 300 trainees and fellows annually in the category of nursing research, with no more than 15 percent of these awards to be made at the postdoctoral level. In this seventh report we have extended the data base through 1981-82 and made both short-term and long-term projections of supply and demand in these fields. The short-term projections help to assess demand in the academic sector through 1988 and therefore are most useful in determining the appropriate level of postdoctoral research training to be supplied by NRSA programs. The long-term projections extend into the l990s when many graduate students in the mid-1980s will begin their careers as independent investigators. These projections therefore are more applicable to the determination of appropriate levels of predoctoral research training to be provided by NRSA programs.

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Our recommendations in this report are directed to NRSA programs in FY 1985-87. Although we have made some adjustments to prior recommendations on the basis of our latest assessment of the supply/ demand situation that is likely to prevail in the second half of the 1980s, we have not arrived at conclusions substantially different from those of past reports, e.g.: The primary emphasis of NRSA programs should continue to be on postdoctoral rather than predoctoral training in most of the biomedical fields. Training grants should continue to be the dominant mechanism of support--the institutional component of such grants provide badly needed support to departmental programs. Clinical investigators are still in short supply and efforts to attract them to research careers should be continued. But medical school faculties are aging and unlikely to expand much during the next few years, and so a significant problem will soon become that of providing enough faculty positions to ensure an adequate flow of young clinical investigators into research careers. This is a problem that cannot be solved solely at the training level. It is more appropriately addressed by consideration of the level of research funds and other financial resources available to support faculty members and their research endeavors. If college enrollments decline as expected in the 1980s, compensating growth in the other sources of funds must occur in order to provide research opportunities for young scientists. Robert L. Hill, Ph.D. Chairman 1V

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ACKNOWLEDGMENTS Many individuals contributed information, data, and other valuable assistance on various aspects of this report. We wish to thank in particular the following individuals and their organizations for their contributions. National Institutes of Health Office of the Director: William Raub, Doris Merritt, Charles Sherman, who served as Project Officer, Helen Gee, George Bowden Division of Research Grants: Nicholas Moriarity, Charles Shea, Doris Wallace National Institute of General Medical Sciences: Norvell, Charles Miller Ruth Kirschste~n, John Alcohol, Drug Abuse, and Mental Health Administration Michele Applegate, Leonard Mitnick Health Resources and Services Administration Division of Nursing: Jo Eleanor Elliott, Doris Bloch, Adele Wood, Thomas Phillips, Gretchen Osgood Office of Technology Assessment, U.S. Congress Gretchen Kolsrud, Nan Newell, Susan Clymer National Center for Health Services Research Donald Golds tone National Academy of Sciences/Institute of Medicine The Committee gives special thanks to Allen Singer, Study Director, whose considerable skills were invaluable in fulfilling this Committee's responsibilities. We also gratefully acknowledge the unfailing efforts of the professional staff, Porter Coggeshall, Lori Th~rgood, Prudence Brown, and Kay Harris; consultants Samuel Herman and Charles Kidd; research assistants Jane Takeuchi and Jessica Townsend; and Dorothy Cooper, secretary. Charles Miller, Executive Officer of the Institute of Medicine, and William C. Kelly, former Executive Director of the Office of Scientific and Engineering Personnel, are also thanked for their oversight of the Committee's activities. v

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COMMITTEE ON NATIONAL NEEDS FOR BIOMEDICAL AND BEHAVIORAL RESEARCH PERSONNEL Chairman: ROBERT L. HILL, Ph.D. Chairman, Department of Biochemistry Duke University Medical Center ROBERT BARKER, Ph.D. Vice President for Research and Advanced Studies Cornell University ROBERT M. BOCK, Ph.D. Dean, Graduate School University of Wisconsin-Madison DAVID R. CHALLONER, M.D. Vice President for Health Affairs University of Florida EUGENE H. CORDES, Ph.D. Vice President, Dept. of Biochemistry Merck Sharp & Dohme Research Lab. Rahway, NJ EMILIO Q. DADDARIO, LL.D. Attorney-at-Law Wilkes, Artis, Hedrick & Lane Washington, D.C. CHARLES D. FLAGLE, Ph.D. Professor and Head, Division of Operations Research Dept. of Health Services Administration Johns Hopkins University ROBERT H. FURMAN, M.D. Vice Pres., Corporate Medical Affairs Eli Lilly & Company Indianapolis, IN W. LEE HANSEN, Ph.D. Professor of Economics University of Wisconsin-Madison LYLE V. JONES, Ph.D. Director, The L. L. Thurstone Psychometric Laboratory Univ. of North Carolina-Chapel Hill WILLIAM N. KELLEY, M.D. Professor and Chairman Department of Internal Medicine University of Michigan Medical School CHARLOTTE KUH, Ph.D. District Manager, Business Research American Telephone & Telegraph Company Basking Ridge, NJ BRENDAN A. MAHER, Ph.D. Professor of Psychology Harvard University JERRY MINER, Ph.D. Professor of Economics Syracuse University GERALD T. PERKOFF, M.D. Curators Professor and Associate Chairman Dept. of Family and Community Medicine University of Missouri-Columbia STAFF ALLEN M. SINGER, Ph.D., Study Director PORTER E. COGGESHALL, M.Ed., Associate Study Director Panel Executive Secretaries SAMUEL S. HERMAN, D.D.S., Ph.D. Clinical Sciences Panel CHARLES V. KIDD, Ph.D. Health Services Research Panel Secretary DOROTHY G. COOPER, B.S. a V11 Administrative Officer KAY C. HARRIS, B.S. Research Associates PRUDENCE W. BROWN, B.A. LO RI THURGOOD, B.A.

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BASIC BIOMEDICAL SCIENCES PANEL Chairman: ROBERT BARKER, Ph.D. Vice President for Research and Advanced Studies Cornell University S. J. COOPERSTEIN, D.D.S., Ph.D. Professor and Head Department of Anatomy The Univ. of Connecticut Health Center E. PETER GEIDUSCHEK, Ph.D. Professor and Chairman Department of Biology Univ. of California-San Diego FRANCIS J. HADDY, M.D., Ph.D. Chairman, Department of Physiology Uniformed Services University of the Health Sciences LEE V. LEAK,Ph.D. Professor Department of Anatomy Howard University KENNETH E. CLARK, Ph.D. President Center for Creative Leadership Greensboro, NC LUCY M. COHEN, Ph.D. Professor of Anthropology Catholic University of America ADA K. JACOX, Ph.D. Director, Center for Research School of Nursing University of Maryland OTTO N. LARSEN, Ph.D. Professor of Sociology University of Washington P. HERBERT LEIDERMAN, M.D. Professor of Psychiatry and Behavioral Sciences Stanford University Medical Center H. GEORGE MANDEL, Ph.D. Professor and Chairman Department of Pharmacology George Washington University PETER S. NOCE, M.D., Ph.D. Director of Technology and Research Bio-Science Enterprises Van Nuys, CA FRANK G. STANDAERT, M.D. Chairman, Department of Pharmacology Georgetown University PAUL S. SYPHERD, Ph.D. Professor and Chairman Department of Microbiology Univ. of California-Irvine BEHAVIORAL SCIENCES PANEL Chairman: BRENDAN A. MAHER, Ph.D. Professor of Psychology Harvard University GARDNER LINDZEY, Ph.D. Director, Center for Advanced Study in the Behavioral Sciences Stanford, CA ROBERT McGINNIS, Ph.D. Professor of Sociology Cornell University JEROME E. SINGER, Ph.D. Chairman, Medical Psychology Uniformed Services University of the Health Sciences ELIOT STELLAR, Ph.D. Professor of Physiology and Psychology School of Medicine University of Pennsylvania . . ~ V111

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CLINICAL SCIENCES PANEL Chairman: ROBERT H. FURMAN, M.D. Vice Pres., Corporate Medical Affairs Eli Lilly & Company Indianapolis, IN RUBIN BRESSLER, M.D. Professor and Head Department of Internal Medicine University of Arizona THOMAS B. CLARKSON, D.V.M. Professor and Chairman Department of Comparative Medicine Wake Forest University RODYP.COX,M.D. Professor and Vice Chairman Department of Medicine Case Western Reserve University ROGER DETELS, M.D. Dean, School of Public Health Univ. of California-Los Angeles PAUL GOLDHABER, D.D.S. Dean, Harvard School of Dental Medicine JULES HIRSCH, M.D. Professor and Senior Physician Lab. of Human Behavior and Metabolism Rockefeller University OLGA JONASSON, M.D. Chief of Surgery Cook County Hospital Chicago, IL MORRIS A. LIPTON, M.D., Ph.D. Mr., Biological Sciences Research Ctr. Univ. of North Carolina-Chapel Hill JOHN F. SHERMAN, Ph.D. Vice President Association of American Medical Colleges Washington, D.C. SCOTT N. SWISHER, M.D. Associate Dean for Research College of Human Medicine Michigan State University BABE11E B. WEKSLER, M.D. Professor of Medicine New York Hospital-Cornell Medical Center DAVID PERRY, M.A. (Consultant) Assoc. Dean for Planning and Operations St. Louis University Medical Center HEALTH SERVICES RESEARCH PANEL Chairman: CHARLES D. FLAGLE, Ph.D. Prof. and Head, Div. of Oper. Research Dept. of Health Services Administration Johns Hopkins University RONALD M. ANDERSEN, Ph.D. Dir., Center for Health Admin. Studies University of Chicago KAREN PADGETT DAVIS, Ph.D. Professor, Department of Health Services Administration Johns Hopkins University ROBERT L. EICHHORN, Ph.D. Professor of Sociology Purdue University ADA SUE HINSHAW, Ph.D. Professor and Director of Research College of Nursing University of Arizona EDWARD B. PERRIN, Ph.D. Dir., Health and Population Study Ctr. Battelle Human Affairs Research Ctrs. Seattle, WA CECIL G. SHEPS, M.D. Professor, Social Medicine Univ. of North Carolina-Chapel Hill MICHAEL ZUBKOFF, Ph.D. Professor and Chairman Dept. of Community and Family Medicine Dartmouth Medical School 1X

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