OTHER GRANT WRITING ARTICLES

The congressionally mandated report--11th in a series that began in the mid-70s--is geared primarily toward the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality, and the Health Resources and Services Administration. And this time around, the NIH specifically asked the committee to consider the overall production of research personnel in the U.S., as well as the impact of its NRSA funding mechanism on research training.

According to the CNNBBS, federal agencies have quite a balancing act to perform. For starters, the committee concludes that there should be no further increases in overall Ph.D. production in the biomedical, behavioral, social, or clinical sciences. The current biomedical Ph.D. population is already "more than sufficient to meet national needs," committee members say, yet the biomedical and behavioral science population is predicted to increase from 93,000 in 1997 to 128,500 by 2005 if current trends continue.

At the same time, the committee recommends agencies find ways to increase the numbers of M.D.s and M.D.-Ph.D.s conducting clinical research, while simultaneously steadying the number of Ph.D.s produced through research assistantships.

Consequently, for both clinically orientated and graduate-level research, the report argues that federal agencies should find alternative ways to promote research training and "ensure the NIH does not permit unlimited increases [in the workforce]," explains Howard Hiatt, professor of medicine at Harvard Medical School and chair of the committee. Allowing the NIH to exercise greater control over the type of training it supports is paramount, he says.

Accomplishing these goals, the committee reckons, does not require new legislation or training programs but better means of tracking training-related activities. Under existing grant programs, the NIH finds it difficult to estimate the number of trainees they fund or the disciplines in which students receive training, says Hiatt. This is because grants made to principle investigators often include training components that can be difficult to oversee. And right now, the NIH is training twice as many scientists as research assistants--training that the CNNBBS considers to be quite narrowly focused--as it is NSRAs, which champion cross-disciplinary opportunities. Changing this 2-to-1 funding ratio is a key step in modifying NIH's funding habits, say officials.

The NRSA is "highly preferred" because it offers "better opportunities for people to establish independent research careers," says Lee Goldman, chair of medicine at the University of California, San Francisco, and a committee member. Postdocs working under their advisor's research grants may not be as independent as they could be if funded through training grants like the NRSAs, Goldman says.

But existing federal policies help to perpetuate the disparity between assistantships and NRSA training positions, because guidelines "inadvertently" provide incentives that boost assistantship applications. For example, assistantships pay out over $7000 a year more in indirect costs than NRSAs. Moreover, NRSA stipends are less than research assistantships ($14,688 versus $16,000) and are not adjusted according to inflation.

NRSA STIPENDS, FISCAL YEAR 1999

Status

Stipend ($)

Undergraduate Students

Freshmen/sophomores

6,780

Juniors/seniors

9,492

Graduate Students

14,688

Postdoctorates (by years of experience)

0

26,256

1

27,720

2

32,700

3

34,368

4

36,036

5

37,680

6

39,348

7 or more

41, 268

TAKEN FROM THE REPORT "ADDRESSING THE NATION'S CHANGING NEEDS"

To help make the NRSAs more attractive, the committee suggests that the NIH stop making modifications of NRSA stipends on an ad hoc basis whenever federal budgets allow and instead adopt a more comprehensive scaling system that would include cost-of-living adjustments. It also recommends providing benefits such as health insurance for the families of NRSA awardees.

The committee is also concerned that too few physicians and medical students are participating in clinical research. They point to statistics showing that of the 12,000 new and competing clinical research grants the NIH awarded in fiscal year 1997, for example, almost 23% were for clinical research projects. But of those, nearly 60% were awarded to Ph.D.-qualified investigators, rather than to M.D.s or M.D.-Ph.D.s. The committee argues that unless more clinical research training opportunities are made available to medical students and M.D.s., the type of clinical studies being conducted around the country will "almost surely fail to fully reflect the nation's needs."

The NIH will consider these and other recommendations in a "high-level" meeting they are to hold "in the next couple of weeks," officials say. The agency then will decide which recommendations to adopt and how to implement the agreed upon changes.

By encouraging universities, predoctoral students, postdocs, and early career scientists to apply for NRSAs, the committee hopes to foster a workforce that is more capable of bridging multiple disciplines. And increasing the pool of research-qualified physicians can only help accelerate advances in disease diagnosis and treatment. Together, the committee hopes their suggested modifications of current training activities and federal funding programs will allow the U.S. to "more comprehensively address the health problems of today and tomorrow."