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CONTENTS 1. INTRODUCTION AND SUMMARY ABSTRACT COMMITTEE'S APPROACH TO ASSESSMENT OF NATIONAL NEED RECENT RESEARCH DEVELOPMENTS TRAINING AND RESEARCH FUNDING TRENDS NATIONAL RESEARCH SERVICE AWARDS FOR 1983 AND 1984 FINDINGS AND RECOMMENDATIONS Clinical Sciences Minority Access to Research Careers (MARC) Honors Undergraduate Training Program Basic Biomedical Sciences Behavioral Sciences Health Services Research Nursing Research 2. CLINICAL SCIENCES ABSTRACT INTRODUCTION AND OVERVIEW MEDICAL SCHOOL TRENDS Medical School Enrollments Clinical R and D Expenditures Professional Service Income Total Medical School Revenue THE CHANGING FINANCIAL STRUCTURE OF MEDICAL EDUCATION THE MARKET OUTLOOK DEMAND FOR CLINICAL FACULTY IN MEDICAL SCHOOLS Assumptions Projections of Demand for Medical School Clinical Faculty to 1990 POSTDOCTORAL TRAINING NEEDS FOR MEDICAL SCHOOL CLINICAL FACULTY DENTAL SCHOOL TRENDS Number of Dental Schools Dental School Enrollments Dental School Faculty R and D Revenue Dental Clinic Revenue Tuition and Fees State and Local Government Revenue Total Revenue DEMAND FOR CLINICAL FACULTY IN DENTAL SCHOOLS POSTDOCTORAL TRAINING NEEDS FOR DENTAL SCHOOL CLINICAL FACULTY SUMMARY 3. BASIC BIOMEDICAL SCIENCES ABSTRACT INTRODUCTION AND OVERVIEW CURRENT SUPPLY/DEMAND INDICATORS Ph.D. Production Postdoctoral Appointments X1 1 3 s 8 9 11 14 15 15 16 16 16 19 19 20 20 22 23 24 24 27 28 30 31 32 35 38 38 38 40 40 41 41 42 42 43 46 50 51 51 51 53 55 55

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Bachelor's Degrees Enrollments R and D Funding Labor Force SURVEY OF BIOTECHNOLOGY FIRMS Shortages of Specialists THE MARKET OUTLOOK Projections of Academic Demand for Biomedical Ph.D.s ESTIMATING PREDOCTORAL AND POSTDOCTORAL SUPPORT LEVELS UNDER NRSA PROGRAMS Postdoctoral Training Levels Predoctoral Training Levels SUMMARY EVALUATION OF THE MARC HONORS UNDERGRADUATE RESEARCH TRAINING PROGRAM A FOLLOW-UP STUDY OF FORMER NIH POSTDOCTORAL TRAINEES AND FELLOWS 4. BEHAVIORAL SCIENCES ABSTRACT INTRODUCTION AND OVERVIEW CURRENT SUPPLY/DEMAND INDICATORS Enrollments Psychology Enrollments Other Behavioral Science Enrollments Reliability of Behavioral Science Undergraduate Enrollment Estimates Ph.D. Production Postdoctoral Appointments R and D Expenditures Employment Sectors The Behavioral Ph.D. Faculty/Student Ratio Part-time Employment Accuracy of Enrollment Estimates Enrichment Graduate Enrollment Trends THE MARKET OUTLOOK Projections of Academic Demand for Behavioral Ph.D.s ESTIMATING PREDOCTORAL AND POSTDOCTORAL SUPPORT LEVELS INSIDER NRSA PROGRAMS Postdoctoral Training Levels Predoctoral Training Levels SUMMARY 5. HEALTH SERVICES RESEARCH ABSTRACT DEFINITION AND EXAMPLES OF CURRENT HEALTH SERVICES RESEARCH Health Maintenance Organizations and Health Care Costs Health Status and Medical Care Utilization SOURCES OF FUNDING FOR HEALTH SERVICES RESEARCH Non-Government Sources Government Sources ~ X11 56 58 59 59 61 63 64 67 72 72 73 75 76 78 79 79 79 80 82 86 86 87 89 91 92 92 94 94 96 96 96 98 98 100 101 102 103 105 105 106 107 108 109 109 110

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The National Center for Health Services Research and Health Care Technology Assessment Health Care Financing Administration (HCFA) National Institutes of Health Other Federal Sources THE MARKET OUTLOOK FOR HEALTH SERVICES RESEARCH PERSONNEL Health Services Research Centers Training for Health Services Research 6. NURSING RESEARCH ABSTRACT EXAMPLES OF NURSING RESEARCH SOURCES OF SUPPORT FOR NURSING RESEARCH AND TRAINING Division of Nursing, HRSA Nursing Research Training for Nursing Research National Institutes of Health Veterans Administration American Nurses' Foundation Robert Wood Johnson Foundation Sigma Theta Tau NURSES WITH DOCTORAL DEGREES Doctorate Degrees Awarded Doctoral Programs in Nursing Nurse Faculty with Doctorates Employment of Nurses with Doctorates SUMMARY BIBLIOGRAPHY APPENDIXES A. Medical and Dental School Data B. Biomedical Sciences Data C. Behavioral Sciences Data D. Miscellaneous Data E. Biotechnology Survey Questionnaire and Summary of Responses F. Summary of Public Meeting, May 10, 1984 ~ x'11 111 113 114 116 117 118 120 123 123 125 126 126 126 128 132 135 135 136 137 137 137 138 140 140 144 147 159 183 203 231 238 240

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TABLES CHAPI ER 1 CHAPTER 2 CHAPTER 3 TABLE 1.1 NRSA Training in Relation to Some National Health Expenditures, FY 1971-83 (1972 $, billions) 1.2 Aggregated Numbers of NIH/ADAMHA/HRSA Traineeship and Fellowship Awards for FY 1983 and PY 1984 NIH Traineeship and Fellowship Awards for FY 1983 and FY 1984 1.4 ADAMHA Traineeship and Fellowship Awards for BY 1983 and FY 1984 Committee Recommendations for NIH/ADAMHA/HRSA Full-Time Predoctoral and Postdoctoral Traineeship and Fellowship Awards for FY 1988-90 1.6 Estimated Cost of Recommended NIH/ADAMHA/HRSA Training Programs for EY 1988-90 (millions of dollars) Estimated Training Costs Per Award in EY 1984 (dollars) TABLE 2.1 Current Trends in Supply/Demand Indicators in the Clinical Sciences 2.2 Trends in U.S. Medical School Revenues ($millions) 2.3 Trends in U.S. Dental School Revenues ($ millions) 2.4 Projected Growth in Medical School Clinical Faculty, 1983-90, Based on Projections of Medical School Enrollment and Total Revenue per School 2.5 Estimated Number of Postdoctoral Research Trainees Needed to Meet Expected Demand for Clinical Faculty in Medical and Veterinary Schools Through 1990 Under Various Conditions 2.6 Projected Growth in Dental School Clinical Faculty, 1983-90, Based on Projections of Dental School Enrollment and Total Revenue in Dental Schools 2.7 Estimated Number of Dental Clinical Research Postdoctoral Trainees Needed to Meet Expected Demand for Dental Clinical Faculty Through 1990 Under Various Conditions TABLE 3.1 Current Trends in Supply/Demand Indicators for Biomedical Science Ph.D.s 3.2 Biomedical Ph.D.s Employed by Biotechnology Firms Responding to Survey 3.3 Inflows and Outflows from Academic Employment for Biomedical Science Ph.D.s, 1981-83 3.4 Projected Growth in Biomedical Science Ph.D. Faculty, 1983-90, Based on Projections of Enrollment, and R and D Expenditures 3.5 Estimated Number of Basic Biomedical Science Postdoctoral Trainees Needed to Meet Expected Academic Demand Through 1990 Under Various Conditions 3.6 Estimated Number of Basic Biomedical Science Predoctoral Trainees to be Supported Under NRSA Programs CHAPTER 4 TABLE 4.1 Current Trends in Supply/Demand Indicators for Behavioral Science Ph.D.s 4.2 Current Trends in Supply/Demand Indicators for Clinical and Nonclinical Psychology Ph.D.s 4.3 Current Trends in Supply/Demand Indicators for Other Behavioral Science Ph.D.s (Sociology, Anthropology, Speech Pathology/Audiology) 4.4 Course Enrollments and B.A. Degrees in Science and Humanities Fields 4.5 Behavioral Scientists Employed in Colleges and Universities, 1961-83 4.6 Inflows and Outflows from Academic Employment for Behavioral Science Ph.D.s, 1981-83 XV 9 0 2 3 7 18 18 21 26 26 33 37 47 49 s4 62 70 71 74 7s 83 84 85 88 97 99

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4.7 Projected Growth in Behavioral Science Ph.D. Faculty, 1983-90 4.8 Estimated Number of Behavioral Science Postdoctoral Trainees Needed to Meet Expected Academic Demand Through 1990 Under Various Conditions 4.9 Estimated Number of Behavioral Science Predoctoral Trainees to be Supported Under NRSA Programs CHAPI ER 5 CHAPTER 6 TABLE 5.1 Annual Research Appropriations for the National Center for Health Services Research, FY 1976-86 ($ millions) Research and Demonstrations Budget for the Health Care Financing Administration, FY 19 79-8 6 ( $ millions) NIH Obligations for Health Services Research and Development, FY 1977-85 ($ millions) Federal Obligations for Health R and D, by Agency and Type of Research, FY 1985 ($ thousands) Characteristics of Health Services Research Centers, 1983 5.6 Field of Highest Degree Reported by NCHSR Principal Investigators, FY 1978 5.7 Field of Highest Degree Reported by NCHSR Trainees, FY 1978 TABLE 6.1 Nursing Research Grants Active at End of Fiscal Years 1969-83, by Content Category 6.2 Doctoral Degree Status of Principal Investigators on Active Research Grants from the Division of Nursing, FY 19 74-8 3 Nursing Research Grants and Contracts Awarded, FY 1956-84 ($ thousands) 6.4 NRSA Awards in Nursing, FY 1982-84 6.5 NRSA Applications Reviewed by Scientific Review Groups, by Status of Application, FY 1984 6.6 Disciplines of NRSA Applicants, by Status of Application, FY 1984 6.7 Activities of NIH Grants with Nursing Research Components, FY 1983 6.8 NlH-Funded Extramural Projects in Nursing Research or with Nursing Research Components, by Supporting Unit, FY 1983 6.9 NIH-Funded Extramural Projects in Nursing Research or with Nursing Research Components, by Focus of Award and Type of Investigator, FY 1983 6.10 V.A. Research Projects with Nurse Principal Investigators, by Position of Principal Investigator and Area of Research, FY 1984 6.11 Doctoral Programs in Nursing, 1983-84 6.12 Registered Nurses with Doctoral Degrees, by Major Area of Degree and Major Function, 1980 6.13 Registered Nurses with Doctoral Degrees, by Employment Setting and Major Function, 1980 6.14 Average Percent of Time Spent in Research by Work Setting and Percent of Nurses with Doctorates, 1980 x~ri 100 101 103 113 115 116 117 119 121 122 127 128 129 130 131 131 133 133 134 136 139 142 143 144

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FIGURES CHAPTER 2 FIGURE 2.1 Medical students, residents, and clinical fellows, 1961-83, with projections to 1990 2.2 Clinical R and D expenditures per school in U.S. medical schools, by control of institution, 1962-83, with projections to 1990 (1972 $, millions) 2.3 Professional service income per school reported by U.S. medical schools, by control of institution, 1962-83, with projections to 1990 (1972 $, millions) 2.4 Total revenue per medical school, by control of institution, 1964-83, with projections to 1990 (197 2 $, millions) 2.5 Clinical faculty/student ratio (CF/WS) vs. total revenue per medical school (T/S) 2.6 Clinical faculty in U.S. medical schools, by control of institution, 1961-83, with projections to 19 90 2.7 Number of operational U.S. dental schools, by control of institution, 1961-84 2.8 Enrollments in U.S. dental schools, by control of institution, 1968-84, wills projections to 1990 Total revenue per school in U.S. dental schools, by control of institution, 1968-83, with projections to 1990 2.10 Dental school clinical faculty/student ratio (CF/WS) vs. total revenue per dental school (T/S) 2.11 Full-tiMe faculty in clinical departments of dental schools, by control of institution 1969-84, with projections to 1990 CHAPTER 3 FIGURE 3.1 Ph.D. production, postdoctoral appointments, and first-year graduate enrollments in doctorate-granting institutions in basic biomedical science fields, 1960-83 3.2 Bachelor's degrees awarded in biomedical science fields compared to other fields, 1962-8 2 3.3 Total biomedical science undergraduate and graduate enrollments in colleges and universities, by control of institution, 1960-81, with projections to 1990 3.4 Biomedical science R and D expenditures in colleges and universities, by control of institution, 1964-83, with projections to 1990 (1972 $, millions) 3.5 Percentage distribution of the year of firms' initiation of operations in the biotechnology industry 3.6a Biomedical science Ph.D. faculty (lo) vs. biomedical undergraduate enrollments (U), 1 960-8 1 3.6b Biomedical science Ph.D. faculty (F) vs. biomedical graduate enrollments (G), 1960-83 3.7 Biomedical Ph.D. faculty/student ratio (F/WS) vs. biomedical R and D expenditures in colleges and universities (M) 3.8 Ph.D.s employed in the biomedical sciences at colleges and universities, by control of institution, 1960-83, with projections to 1990 CHAPTER 4 FIGURE 4.1 Behavioral science undergraduate and graduate enrollments in colleges and universities, 1964-81 4.2 Ph.D. degrees awarded in behavioral science fields, 1961-83 4.3 Postdoctoral appointments in behavioral science fields, 1962-83 4.4 Behavioral science R and D expenditures in colleges and universities, 1964-83 4.5 Behavioral science Ph. D. faculty/student ratio, 1 964-81 4.6 Behavioral science Ph.D.s employed in colleges and universities, 1962-83 XV11 23 ~5 25 27 32 34 39 39 43 44 4s 56 s7 58 60 61 66 66 67 69 82 90 91 93 as 98

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CHAPTER 6 FIGURE 6.1 Funding for nursing research grants and contracts, 1960-83 (1972 $, millions) 6.2 Research doctorates awarded to nurses, 1965-82 (academic years) 6.3 Research doctoral programs administered by schools or departments of nursing, 1963-84 (academic years) 6.4 Nurses enrolled in research doctoral programs, 1965-83 (academic years) 6.5 Percentage of full-time nurse faculty who hold research doctorate degrees, 1964-82 (academic years) ~ XVl l ~ 130 138 139 140 141