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 ADVANCING
THE NATION’S
HEALTH
NEEDS
Committee for Monitoring the Nation’s Changing Needs for Biomedical, Behavioral, and Clinical Personnel

Board on Higher Education and Workforce

Policy and Global Affairs
Copyright © 2005. National Academies Press. All rights reserved.
 THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this 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 study was supported by Contract/Grant No. N01-OD-4-2139, TO#104, between the
National Academy of Sciences and the National Institutes of Health, Department of Health
and Human Services. Additional support was provided by the Agency for Healthcare Re-
search and Quality Any opinions, findings, conclusions, or recommendations expressed in this
publication are those of the Committee for Monitoring the Nation’s Changing Needs for Bio-
medical, Behavioral, and Clinical Personnel and do not necessarily reflect the views of the orga-
nizations or agencies that provided support for the project.

International Standard Book Number 0-309-09427-5

Library of Congress Catalog Card Number 2005928995

Additional copies of this report are available from the National Academies Press, 500 Fifth
Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the
Washington metropolitan area); Internet, http://www.nap.edu

Copyright 2005 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Copyright © 2005. National Academies Press. All rights reserved.
 The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distin-
guished scholars engaged in scientific and engineering research, dedicated to the furtherance of
science and technology and to their use for the general welfare. Upon the authority of the charter
granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the
federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the
National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the Na-
tional Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous
in its administration and in the selection of its members, sharing with the National Academy of
Sciences the responsibility for advising the federal government. The National Academy of Engi-
neering also sponsors engineering programs aimed at meeting national needs, encourages educa-
tion and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is
president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to
secure the services of eminent members of appropriate professions in the examination of policy
matters pertaining to the health of the public. The Institute acts under the responsibility given to
the National Academy of Sciences by its congressional charter to be an adviser to the federal
government and, upon its own initiative, to identify issues of medical care, research, and educa-
tion. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to
associate the broad community of science and technology with the Academy’s purposes of fur-
thering knowledge and advising the federal government. Functioning in accordance with general
policies determined by the Academy, the Council has become the principal operating agency of
both the National Academy of Sciences and the National Academy of Engineering in providing
services to the government, the public, and the scientific and engineering communities. The
Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J.
Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research
Council.

www.national-academies.org
Copyright © 2005. National Academies Press. All rights reserved.
Copyright © 2005. National Academies Press. All rights reserved.
 COMMITTEE FOR MONITORING THE NATION’S CHANGING NEEDS
FOR BIOMEDICAL, BEHAVIORAL, AND CLINICAL PERSONNEL
Gordon G. Hammes, Ph.D., Committee Chair, University Distinguished Service Professor of
Biochemistry, Duke University
Michael M. E. Johns, M.D., Vice-Chair, Executive Vice President for Health Affairs,
Director, Robert W. Woodruff Health Science Center, Emory University
Richard M. Shiffrin, Ph.D., Vice-Chair, Luther Dana Waterman Research Professor,
Director, Cognitive Science Program, Indiana University
Larry L. Bumpass, Ph.D., Norman B. Ryder Professor of Sociology Emeritus, University of
Wisconsin
Christine K. Cassel, M.D., President, American Board of Internal Medicine
William T. Greenough, Ph.D., Swanlund Chair and Center for Advanced Study Professor of
Psychology, University of Illinois, Urbana-Champaign
James S. Jackson, Ph.D., Daniel Katz Distinguished University Professor of Psychology,
University of Michigan
Lynn T. Landmesser, Ph.D., Arline H. and Curtis F. Garvin Professor and Chair of the
Neuroscience Department, Case Western Reserve University
William Lennarz, Ph.D., Distinguished Professor and Chairman of the Department of
Biochemistry and Cell Biology, Stony Brook University, State University of New York,
Joseph B. Martin, M.D., Ph.D., Dean of the Harvard Faculty of Medicine, Harvard Medical
School
Barbara Meyer, Ph.D., Investigator, Howard Hughes Medical Institute, and Professor of
Genetics and Development, University of California, Berkeley
Georgine Pion, Ph.D., Research Associate Professor, Vanderbilt University
Edward H. Shortliffe, M.D., Ph.D., Columbia Presbyterian Medical Center Professor and
Chair, Columbia University Department of Biomedical Informatics

Panel on Oral Health

Robert Genco, Panel Chair, Distinguished Professor and Chair, School of Dental Medicine,
Oral Medicine & Biomedical Sciences, University at Buffalo, State University of New
York
Charles Bertolami, Dean and Professor, School of Dentistry, University of California, San
Francisco
Chester Douglass, Professor, Harvard School of Dental Medicine
Marjorie K. Jeffcoat, Dean, The Robert Schattner Center, University of Pennsylvania School
of Dental Medicine
Edward H. Shortliffe, Parent Committee Liaison, Professor and Chair, Columbia
Presbyterian Medical Center

Panel on Nursing
Copyright © 2005. National Academies Press. All rights reserved.

Ada Sue Hinshaw, Panel Chair, Dean and Professor, School of Nursing, University of
Michigan
Sue Karen Donaldson, Professor, John Hopkins University School of Nursing
Margaret M. Heitkemper, Chair, Professor, Department of Biobehavioral Nursing and
Health Systems, University of Washington
Marla Salmon, Dean and Professor, Nell Hodgson Woodruff School of Nursing, Emory
University
Michael M. E. Johns, Parent Committee Liaison, Executive Vice President for Health
Affairs, Director, Robert W. Woodruff Health Science Center, Emory University

v
 Committee Staff
James Voytuk, Senior Program Officer
Herman Alvarado, Research Associate
Patricia Santos, Senior Program Assistant
Elizabeth Scott, Office Assistant

Board on Higher Education and Workforce

Richard A. Tapia, Chair, Rice University
Burt Barnow, Institute for Policy Studies, Johns Hopkins University
Donald L. Bitzer, North Carolina State University
Nancy Cantor, Syracuse University
Ronald G. Ehrenberg, Cornell University
Carlos G. Gutierrez, California State University, Los Angeles
Nancy B. Jackson, International Security Center, Sandia National Laboratories
Donald L. Johnson, Product & Process Technology, Grain Processing Corporation (retired)
Claudia I. Mitchell-Kernan, University of California, Los Angeles
Michael T. Nettles, Center for Policy Studies and Research, Research and Development,
Educational Testing Service
Debra W. Stewart, The Council of Graduate Schools
Tadataka Yamada, GlaxoSmithKline
Peter Henderson, Board Director
Copyright © 2005. National Academies Press. All rights reserved.

vi
 Preface

This report is the twelfth assessment of the National Insti- of Health, Walter Schaffer and Walter Goldschmidts, the
tutes of Health National Research Service Awards program. program officers for this project, Sharon Gordon, and Bill
The research training needs of the country in basic biomedi- McGarvey provided details on their training support and
cal, clinical, and behavioral and social sciences are consid- other data relevant to the committee’s deliberations. Data
ered. Also included are the training needs of oral health, nurs- and information about training in health services research
ing, and health services research. The report has been broadly were provided by Karen Rudzinski at the Agency for
constructed to take into account the rapidly evolving national Healthcare Research and Quality and Pamela Flattau from
and international health care needs. The past and present are Flattau Associates. A commissioned paper by Donald
analyzed, and predictions with regard to future needs are Steinwachs was also very helpful in addressing issues in
presented. health services research. The committee is also indebted to a
This report represents a team effort of a diverse group of number of people who made presentations at committee
people. The primary committee consisted of experts from meetings: Ruth Kirschstein, Raynard Kington, Wendy
the basic biomedical sciences, clinical sciences, behavioral Baldwin, Judith Greenberg, Patricia Grady, and Lawrence
and social sciences, and demographics. In addition, subcom- Tabak from the National Institutes of Health; Francis
mittees were constituted to assess research training in oral Chesley from the Agency for Healthcare Research and Qual-
health and nursing, and an expert in health services research ity; Marguerite Barratt, and Joann Roskoski from the Na-
was consulted. Information was obtained from many differ- tional Science Foundation; Alan Kraut from the American
ent groups and individuals, including experts within the Na- Psychological Society; and Norman Anderson from the
tional Institutes of Health. The final report is a composite of American Psychological Association.
the many viewpoints that were expressed. Although we at- The committee also appreciates the work of the expert
tempted to base the final recommendations solely on factual staff of the National Research Council. In particular, Jim
information, we found that the data available were incom- Voytuk, the study director, did a magnificent job of gather-
plete. Moreover, even with the best data, the research train- ing data, organizing the committee activities, and doing
ing venue is dependent on unpredictable events such as in- much of the writing. He was ably assisted by Herman
ternational politics and the federal budget. Consequently, the Alvarado with the data collection, Elizabeth Scott with the
Copyright © 2005. National Academies Press. All rights reserved.

bases for the recommendations in the report are a combina- arrangement of meetings and editing of the committee re-
tion of factual data and expert opinion. It is our general con- port, and Patricia Santos whose work in preparing and edit-
sensus that although the research training establishment is ing the manuscript, researching material for the committee,
doing well, implementation of the recommendations would and general oversight of project activities was invaluable.
significantly improve research training. In addition, we be- We also greatly appreciate the work of Rodolfo Bulatao in
lieve that a process allowing continuous monitoring of the analyzing the demographics of the workforce and drafting
research training system would permit more rapid and well- Appendix D of this report. As part of the normal procedure,
tuned responses to a changing external environment. this report was reviewed by a group of experts and was
This report was made possible by funding from the Na- greatly improved as a result. In the final analysis, however,
tional Institutes of Health and the Agency for Healthcare responsibility for the report resides with the primary com-
Research and Quality. In addition, staff members from each mittee. We trust that the recommendations presented will
of these agencies were very helpful in providing information receive serious consideration from the National Institutes of
about their training programs. From the National Institutes Health and associated agencies.

vii
 viii PREFACE

A list of the committee, panel, and staff members who Susan Fiske, Princeton University; Maureen Henderson,
contributed directly to this report is given at the beginning of University of Washington; Hedvig Hricak, Memorial Sloan-
the report. As the committee chair, I commend and thank Kettering Cancer Center; Peter Barton Hutt, Covington and
them all for their contributions. This report has been re- Burling; Paul Kincade, University of Oklahoma; Ruth
viewed in draft form by individuals chosen for their diverse McCorkle, Yale University; Michael Teitelbaum, Alfred P.
perspectives and technical expertise, in accordance with pro- Sloan Foundation; Richard Valachovic, American Dental
cedures approved by the National Research Council’s Re- Education Association; Bailus Walker, Howard University;
port Review Committee. The purpose of this independent and Nancy Fugate Woods, University of Washington.
review is to provide candid and critical comments that will Although the reviewers listed above provided many con-
assist the institution in making its published report as sound structive comments and suggestions, they were not asked to
as possible and to ensure that the report meets institutional endorse the conclusions or recommendations, nor did they
standards for objectivity, evidence, and responsiveness to see the final draft of the report before its release. The review
the study charge. The review comments and draft manuscript of this report was overseen by Charles Phelps, University of
remain confidential to protect the integrity of the delibera- Rochester. Appointed by the National Research Council, he
tive process. was responsible for making certain that an independent ex-
We wish to thank the following individuals for their re- amination of this report was carried out in accordance with
view of this report: Irwin Arias, Tufts University; David institutional procedures and that all review comments were
Breneman, University of Virginia; Gerard Burrow, Yale carefully considered. Responsibility for the final content of
University; Thomas Carew, University of California, Irvine; this report rests entirely with the authoring committee and
the institution.

Gordon G. Hammes
Chair
Copyright © 2005. National Academies Press. All rights reserved.
 Contents

EXECUTIVE SUMMARY 1

1 INTRODUCTION 5
Historical Context, 5
National Research Service Award Program, 8
Study Origins and Related Activities, 11
Past Reports, 11
A Perspective on Research Training Activities, 14
The Present Study, 16

2 BASIC BIOMEDICAL SCIENCES RESEARCH 18

Biomedical Research Workforce, 19
Educational Progression, 19
Early Career Progression in the Biomedical Sciences, 19
A Portrait of the Workforce, 23
Physician-Researchers, 26
The National Research Service Award Program and Biomedical
Training Support, 26
Research Labor Force Projections, 31
Conclusion, 33
Recommendations, 33

3 BEHAVIORAL AND SOCIAL SCIENCES RESEARCH 36

Behavior and Social Sciences Research Workforce, 37
Educational Trends, 38
Copyright © 2005. National Academies Press. All rights reserved.

Employment Trends, 41
Research Training and the National Research Service Award Program, 43
Research Labor Force Projections, 48
Conclusion, 50
Recommendations, 50

4 CLINICAL SCIENCES RESEARCH 51

Defining the Clinical Research Workforce, 52
Educational Background, 52
The Clinical Research Workforce, 54
Clinical Workforce Issues, 58
The Medical Scientist Training Program, 59
The Role of the National Research Service Award Program, 60

ix
 x CONTENTS

Research Labor Force Projections, 62

Conclusion, 64
Recommendations, 64

5 ORAL HEALTH RESEARCH 65

The Shortage of Dental Scientists, 65
Potential Pool of Dental Researchers, 67
Resources for Research Training, 69
National Research Service Award Program and Other National Institutes
of Health Programs, 70
Conclusion, 71
Recommendations, 71

6 NURSING RESEARCH 72
Changing the Career Trajectory for Nurse-Scientists, 73
Enhancing Sustained Productivity for Nurse-Scientists, 73
Responding to the Shortage of Nurse-Investigators, 75
Emphasizing Research-Intensive Training Environments, 76
Conclusion, 78
Recommendation, 78

7 HEALTH SERVICES RESEARCH 79

Federal Support of Health Services Research, 80
Current Market for Health Services Researchers, 80
Degree Production and Employment, 83
Outlook for Health Services Research Funding, 84
The National Research Service Award Program in Health Services Research:
The Agency for Healthcare Research and Quality, 85
Conclusion, 86
Recommendations, 86

8 EMERGING FIELDS AND INTERDISCIPLINARY STUDIES 87

Interdisciplinary/Multidisciplinary Research, 87
Emerging Fields, 88
Training Implications, 89
Recommendations, 90

9 CAREER PROGRESSION 91
Postdoctoral Training, 92
Transition and Career Development, 95
Foreign Researchers, 98
Underrepresented Minority Scientists, 100
Copyright © 2005. National Academies Press. All rights reserved.

Conclusion, 101
Recommendations, 101

10 FINAL COMMENTS 103

Recommendations 104

REFERENCES 106
 CONTENTS xi

APPENDIXES

A Biographical Sketches of Committee and Panel Members 111

B Ruth Kirschstein National Research Service Award Training Grants and

Fellowships 116
Individual Awards, 116
Institutional Awards, 117

C Classification of Ph.D. Fields 119

D Demographic Projections of the Research Workforce, 2001–2011 120

Coverage and Data, 120
Current Workforce and Recent Trends, 121
Inflows of Migrants and Graduates, 131
Outflows and Changes in Status, 135
Workforce Projections, 137
The Growing Workforce, 138
Migrant Scenarios, 141
Employment Projections, 143
Bureau of Labor and Statistics Projections, 145
Workforce Versus Positions, 146
Sectoral Prospects and Postdoctorates, 149
Conclusion, 153

E Characteristics of Doctorates 157

E-1 Characteristics of Doctorates in the Biomedical Sciences 1970–2003, 158
E-2 Employment Characteristics of Biomedical Doctorates from U.S. Institutions,
1973–2001, 160
E-3 Characteristics of Doctorates in the Behavioral and Social Sciences,
1970–2003, 162
E-4 Employment Characteristics of Behavioral and Social Sciences Doctorates
from U.S. Institutions, 1973–2001, 164
E-5 Characteristics of Doctorates in the Clinical Sciences, 1970–2003, 166
E-6 Employment Characteristics of Clinical Doctorates from U.S. Institutions,
1973–2001, 168
Copyright © 2005. National Academies Press. All rights reserved.
Copyright © 2005. National Academies Press. All rights reserved.
 Figures, Tables, and Boxes

FIGURES
1-1 NRSA training and fellowship grants, 1975–2003, 9
2-1 First-year and total graduate enrollment in the biomedical sciences at Ph.D.-
granting institutions, 1980–2002, 20
2-2 Academic research and development expenditures in the biological sciences, 20
2-3 Number of doctorates in the biomedical sciences, 1970–2003, 21
2-4 Postdoctoral appointments in the biomedical sciences by sector, 1973–2001, 22
2-5 Postdoctoral appointments in academic institutions in the biomedical sciences, 23
2-6 Academic positions for doctorates in the biomedical sciences, 1975–2001, 24
2-7 Age distribution of biomedical tenured and tenure-track faculty, 1985, 1993, and
2001, 25
2-8 Employment of biomedical scientists by sector, 1973–2001, 25
2-9 Mechanisms of support for full-time graduate students in the biomedical sciences,
1979-2002, 27
2-10 Graduate support from NIH, 1979-2002, 28

3-1 Graduate students in the behavioral and social sciences by gender, 1979–2002, 38
3-2 Graduate support in the behavioral and social sciences, 1979–2002, 39
3-3 Doctorates granted in the behavioral and social sciences, 1970–2003, 39
3-4 Doctorates planning postdoctoral training, 1970–2003, 40
3-5 Behavioral and social science workforce (excluding postdoctorates) by gender,
1973–2001, 41
3-6 Trends in postdoctoral appointments by sector, 1973–2001, 42
3-7 Behavioral and social sciences workforce by sector of employment,
Copyright © 2005. National Academies Press. All rights reserved.

1973–2001, 42
3-8 Age distribution of the behavioral and social sciences workforce 1985, 1993, and
2001, 43
3-9 Academic employment in the behavioral and social sciences, 1973–2001, 44
3-10 Percentage of women in academic positions, 1975–2001, 44
3-11 Funding sources for graduate education in the behavioral and social sciences,
1979–2002, 46
3-12 Graduate student support by NIH, 1979–2002, 47
3-13 Academic postdoctoral support in the behavioral and social sciences,
1979–2002, 48

4-1 Graduate students in clinical departments by gender, 1979–2002, 53

4-2 Type of support for graduate students in clinical sciences departments,
1979–2002, 53
xiii
 xiv FIGURES, TABLES, AND BOXES

4-3 Doctorates in the clinical sciences by gender, 1970–2003, 54

4-4 Employment sectors in the clinical sciences, 1973–2001, 55
4-5 Academic appointments in the clinical sciences, 1975–2001, 56
4-6 Cumulative age distribution of the clinical research workforce, 56
4-7 Age distribution of research clinical faculty in medical schools, 2002, 57
4-8 Postdoctoral appointments in clinical departments by citizenship and degree, 57
4-9 NIH predoctoral support in the clinical sciences, 1979–2002, 60
4-10 Academic postdoctoral support in the clinical sciences, 1979–2002, 61
5-1 Unfilled full-time positions on dental school faculties, 1992–2002, 66

6-1 Training positions at the postdoctoral and predoctoral levels, 77

6-2 Publications, T32 versus non-T32, 77

9-1 Postdoctoral appointments in the three broad fields, 1973–2001, 92

9-2 Proportion of biomedical doctorates in academic postdoctoral positions by Ph.D.
cohort year, 1973–2001, 94
9-3 Proportion of biomedical doctorates with postdoctoral appointments in all
employment sectors by cohort year, 1973–2001, 94
D-1 The potential research workforce, 121
D-2 Trends in the U.S.-trained potential workforce by major field, 1973–2001, 125
D-3 Percent in conscience jobs by major field, 1973–2001, 126
D-4 Numbers unemployed and not in labor force for all fields combined, by sex 1973–
2001, 127
D-5 Proportion of temporary residents among graduates and proportion of each group
intending to stay in the United States, 129
D-6 Foreign-trained biomedical Ph.D.s: postdoctorates, postdoctorate entrants, and
projected total stock, 130
D-7 Trends in Ph.D. graduates by major field and sex, 1970–2001, 132
D-8 Female behavioral graduates projected using various equations, 134
D-9 Proportion of all graduates intending to stay, and rising and constant projections,
by major field and sex, 1990–2011, 135
D-10 Potential workforce as reported, and projected including and excluding foreign
trained, medium scenario, 1973–2011, 139
D-11 Projected annual increase in the potential workforce in three scenario, by field,
2001–2011, 141
D-12 Projected percentage of workforce not active in research (out of science, not in the
labor force, or unemployed) by field, 2001–2011, 143
D-13 Difference between numbers of employed males and females, by field, 2001–
2011, 144
D-14 Age distribution (percent) of workforce by field, 2001–2011, 145
D-15 Trends in employment by major field and sector, 1973–2001, 147
Copyright © 2005. National Academies Press. All rights reserved.

D-16 Percent excess or deficit of u.s.-trained researchers in relation to various

projections of research positions, 2006 and 2011, 151
D-17 Postdoctorates reported by graduate departments, by field, degree, and visa status,
1983–2001, 152
D-18 Postdoctorates compared from sector data and department reports, by field, 1973–
2001, 153
D-19 Reported and projected U.S.-trained postdoctorates and postdoctorate positions,
1973–2011, 155

TABLES
2-1 Number of M.D.s and Ph.D.s with Grant Support from NIH, 26
2-2 NRSA Predoctoral Trainee and Fellowship Support in the Basic Biomedical
Sciences, 28
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