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APPENDIX D 67 Manpower Survey indicated that some 20 percent of NIH âclinical scienceâ grantees were Ph.D.s; by 1990, more than 45 percent of the principal investigators for NIH-funded research grants involving human subjects were Ph.D.s. While Ph.D.s have played an invaluable role in the clinical sciences, it is one that is circumscribed by the extent to which they are able to interact with patients. Without a sufficient cadre of physician clinical investigators, the degree to which we can take advantage of the strides in understanding basic human physiology and pathophysiology is markedly limited. With tuition and stipend payments assured throughout their schooling, students in the Medical Scientist Training Program are clearly more insulated from financial pressures than other trainees. By graduation, their educational debt averages $23,000, while that of the typical graduating M.D. is $56,000, more than twice as much. By all indications to date, the MSTP program has been remarkably successful at cultivating committed physician scientists. A 1992 study of graduates of the Johns Hopkins Universityâs M.D./Ph.D. program found that all of those who had completed their training were actively involved in research: 81 percent in academia, 14 percent at research institutes, and 5 percent in the biotechnology industry. Some have expressed concern, however, that the program could do more to encourage its trainees to pursue problems in human disease--a research area for which they should be uniquely qualified, but, by some indications, are disinclined to pursue. While the goal of the MSTP program is to train both basic and clinical researchers, Washington Universityâs Carl Frieden, Ph.D., and Barbara Fox reported in 1991 that 83 percent of their MSTP graduates were engaged in full-time basic research. Similarly, in a 1990 analysis of the research publications of a sample of MSTP graduates, Edward Ahrens, M.D. found that 75 percent of their work focused on nonclinical research. In making its recommendations, this committee has traditionally counted MSTP trainees in the clinical science category. Yet findings such as those of Frieden, Fox, and Ahrens suggest that at least some portion of that group should be considered basic science trainees. In addition, should further study confirm that MSTP graduates gravitate toward narrow areas of research, broader training would seem to be in order. Enhancing the Effectiveness of the NRSA Program in Recruiting Women and Minorities Although women today are much more likely to pursue careers in the biomedical sciences than in decades past, the NRSA program can encourage even greater participation by endowing its programs with the maximum flexibility possible and developing formal policies for family leave and part-time training. While I understand that such policies are under development at NIH, I would urge their swift adoption. After all, it was in 1977 that this committee first discussed the importance of flexible training opportunities for women. Such policies, moreover, are likely to improve the training environment for all trainees. Increasing the role of minorities in science, however, may require a more activist approach. While some training programs admittedly could do a better job of recruitment, and NIH might do more to highlight and encourage strong recruiting strategies, the fact that recruitment at the pre- and postdoctoral levels has had only minor effects over the last decade suggests that the key to fostering minority scientists lies in the college and secondary school years. To the extent it is able, the NRSA program should broaden its focus to encourage greater participation in programs such as the MARC undergraduate awards. Implications of Current Employment Opportunities for the NRSA Program The great strides that have been made in basic research over the last decade, as well as more recent progress toward health care reform, would seem to call for an emphasis in NRSA training programs on interdisciplinary approaches that pair the biomedical sciences with chemistry, engineering, and computer science, as well as patient-oriented clinical research, clinical epidemiology, biostatistics, outcomes research, and health services research. With regard to the latter, I am pleased to note that you and your colleagues plan to return to the approach of previous committees and evaluate personnel needs in the field of health services research as well as the biomedical and behavioral sciences. It is with less optimism that I note that the fields of epidemiology, biostatistics, and the general arenas of
