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APPENDIX D 76 continue a career in research. When stipends for postdoctoral positions are not competitive with beginning faculty salaries, it is easy to see why faculty or other positions are more attractive, and the result is a loss of skilled researchers. Increasing flexibility within the NRSA program is also key to assuring a continued supply of investigators. Access to predoctoral and postdoctoral training throughout the country and in varying types of institutions is needed. The current distribution of training programs is limited primarily to bicoastal areas. Also required are greater interdisciplinary training opportunities to address increasingly complex social/health problems. For example, in the social sciences, we need demographers and sociologists trained in aging research, epidemiologists with a background in economics, and economists sensitive to aging issues. As another example, psychologists researching health-related concerns need to interact with engineers to help frail older adults living independently at home. And as new technologies evolve, health researchers must have the flexibility to shift their research focus. Increasing the flexibility of the NRSA program will be especially helpful in increasing the participation of women and minorities in scientific careers. Women and minorities often are less geographically mobile than men. For example, nursing is working to establish a postdoctoral tradition for scientific training, but many nurses are unable to take advantage of training programs because of the limited locations of the programs. Of the 54 nursing doctoral programs, only 15 have institutional research awards. Efforts to locate individual and institutional training programs where women and minorities can more easily access them will do a great deal to increase their participation. Understanding the social context of womenâs lives is critical to increasing their participation in research careers. The career paths of women and minorities often are interrupted by family demands and economic factors. Women still have the primary responsibility for child care, for maintaining the home, and increasingly, for the care of elderly family members. Adapting the NRSA program so that it takes into account the reality of womenâs lives is a necessary prerequisite to increasing their participation. Developing mid-career mechanisms that would allow women to reenter their research career after absences is one strategy you might consider. In order to assure a high quality research training environment, we offer the following suggestions: First, it is important to recognize that health-related research is being conducted increasingly by multidisciplinary teams. Therefore, the fact that current training award mechanisms often produce scientists without this experience is a major concern. Training mechanisms need to encourage training breadth to prepare current and future researchers from different disciplines to work with each other in addressing increasingly complex scientific and technological issues. A wider research focus, along with experience working in multi-disciplinary teams, will prepare researchers to work in tandem with researchers in industry, academics, and research centers. Second, individual and institutional NRSAs should continue to be offered to ensure access to training and a broad distribution of scientific researchers. We can no longer afford to ignore smaller institutions and rural areas and waste opportunities to attract and train additional local scientists. Although adding additional costs is very difficult in these times of tight budget constraints, we urge that consideration be given to providing mentor salaries on training grants. The incentive of paid time to supervise a training program can make the critical difference in establishing a new interdisciplinary program where the mentors themselves must cross disciplines and department lines in order to build and maintain the program. Lastly, we recommend that provisions be made for site-visiting institutional training award applications. Though we realize it would be impractical to site-visit all applications, a routine provision for site-visiting large Type 1 applications would do much to ensure a high quality review of the training environment. STATEMENT BY CORNELIUS J. PINGS, Ph.D. It is a pleasure to appear before you today on behalf of the Association of American Universities (AAU) to offer our views on the future training needs for biomedical and behavioral scientists. The AAU represents 58 research-intensive universities where much of the research training of predoctoral and postdoctoral students in all disciplines takes place. The National Research Service Awards (NRSA) Program has provided a large portion of the funding needed to support these students and, as such,
APPENDIX D 77 is a program in which the AAU has a great deal of interest. The AAU believes the NRSA Program is well designed, well administered, and very effective in assisting high-quality graduate programs to attract talented students into graduate study and assist them in completing that study. Although I do not think that any major programmatic changes in the program are called for, there are a number of modest changes that the Committee might wish to consider. First, in my view, the most significant challenge we face today in the United States for maintaining an adequate supply of qualified scientists to sustain and advance health research is the provision of sufficient, stable resources for the overall biomedical and behavioral research enterprise. While it is true that federal funding for biomedical and behavioral research has increased over the past years, there are other factors that should be considered when evaluating how stable and predictable the research budget has been and will continue to be in the future. Throughout the 1980s, the Reagan Administration attempted to cut funding to the National Institutes of Health (NIH). While these proposed cuts were consistently rejected by Congress, providing adequate funding levels for the NIH became an annual budget battle that created a great deal of uncertainty among the biomedical community. Even when proposed cuts were rejected and increased funding was provided, there was still a significant shortfall in dollars needed to fund many qualified grant applications. Today, the NIH only funds approximately 18 percent of its approved grant applications. Even those grants that are funded receive significantly less than the dollar amount requested and approved by the NIH Study Sections. This scenario has resulted in individual investigators applying for multiple grants on a variety of funding cycles, constantly wondering if the dollars will be there tomorrow for the research that is started today. Some of these concerns were intended to be addressed by the NIH Financial Management Plan issued by the NIH in June of 1991. According to the Plan, âStability and predictability in the aggregate funding level for biomedical research are essential to maintaining the momentum in knowledge advancement that results from our investment in biomedicine. They are also essential to reassure scientists that their years of training will result in reasonable competitive opportunities to pursue and maintain a research career.â The plan identified a Biomedical Research and Development Price Index (BRDPI) that could be used for an accurate and realistic assessment of inflationary growth in biomedical research costs. Unfortunately, the NIH budget has not even kept pace with the numbers recommended in the NIH Financial Plan, and the overall concern about the adequacy and stability of the NIH budget is still very real among the biomedical research community. It is also worth noting, Mr. Chairman, that government restrictions on certain kinds of research, particularly in the behavioral area, have also sent a very discouraging message to future scientists interested in behavioral and social science, as well as other areas of research such as fetal tissue transplantation. As you know, President Clinton has lifted the ban on federal funding for research on fetal tissue transplantation, but the ban and other restrictions that were imposed on research in the past can have a chilling effect on future research and young scientists. Of course, more money for research is not the sole answer to attracting talented graduate students to a career in biomedical and behavioral research. Nor does it look like an answer we should be relying on to solve all of our problems. As the Presidentâs Council of Advisors on Science and Technology recently reported in âRenewing the Promise: Research Intensive Universities and the Nation,â âA realistic assessment of the next several decades indicates,â¦that no matter how firm our national resolve may be to invest in the future, resources will not expand as rapidly as our intellectual capacity to pursue promising research opportunities.â Given that prospect, the only responsible approach is for the nation to decide what size research enterprise it is willing to support and then to provide the level of federal support that will maintain that enterprise at the highest levels of quality and assure the training capacity necessary for its continuation. As I indicated earlier, the NRSA Program is an extremely effective mechanism for assisting universities to meet the nationâs biomedical training needs. Perhaps the single most important improvement in the program would be to increase the training grant stipend. Most universities augment NRSA stipends, requiring them to divert resources from other university functions. When universities are unable to augment stipends, trainees are forced to take out loans or work to meet their living expenses. Loans increase the already considerable debt burdens incurred in undergraduate education, and work draws students away from their academic program, extending their time to degree. The NRSA stipend is well below those provided in other federally funded