The committee has been given the task of assessing present and future demands for research personnel over the entire spectrum of health-related sciences, including the areas of basic biomedical, behavioral, clinical, oral health, nursing, and health services. This chapter puts the task in perspective by considering the issues in a larger context. In addition, what has been done and what is needed for future considerations are assessed.

In a world with an ever-growing and continually aging population that travels and intermixes to an ever-increasing degree, a very safe prediction is that the nation's and the world's vital need for scientific research in health-related areas will continue to grow rapidly. New health problems and rapidly propagating diseases will continue to threaten the entire world, including the United States. It is difficult to conceive of a scenario in which the need for health research will not continue to accelerate.

Given this picture of the future, the distinction between need and demand for research personnel needs to be clarified. The need for improved health care, which ultimately requires research, will continue to grow. However, this committee and its predecessors have been forced to consider demand, rather than need. Demand refers to the research positions that society decides are of sufficient value to fund. It is determined by many variables, including the state of the economy and the extent of perceived threats to the nation's health. The present demand can be estimated by various models, and extrapolations can be made into the future. These estimates, however, are only valid if all factors remain stable, an unlikely prospect. This committee believes it much more likely that demand will grow, rather than decline, relative to the projections from static models.

Manpower models have been developed for the fields of basic biomedical, clinical, and behavioral and social sciences research. Although the quality and quantity of data available for this purpose are limited, the available information suggests that this committee have a system that is roughly in balance: low unemployment currently exists, and extrapolation into the future suggests this will continue. Importantly, the bulge of personnel in postdoctoral positions appears to be dissipating. The committee harbors reservations about the ability to extrapolate into the future, either on the basis of the model or personal judgment, but it is likely that trained researchers will continue to find positions in their fields, at least for the near future. This current situation has been created on the basis of training commitments made over the past 5 to 10 years. Because the committee believes that a healthy environment exists in terms of training possibilities and job opportunities, this committee has recommended that the number of trainees be no less than its level in 2003. However, this committee has made a number of recommendations with regard to modifications in training, stressing the needs of the future and the importance of flexibility.

In the fields of oral health and nursing the data are insufficient to carry out a workforce model, but it is clear that research efforts and research personnel are not at the level that is optimal for maintaining a vital research effort. Breaking out of this situation will require an input of funding and great creativity on the part of the professions and professional schools.

In the committee's consideration of the present and past training of biomedical research personnel, it has become apparent that adequate data are not available for a thorough analysis. In many cases this could be remedied by the National Institutes of Health (NIH) creating and maintaining reliable databases gleaned from the annual reports associated with their research and training programs. Given the importance of biomedical research and the maintenance of a highly skilled workforce, the committee believes that NIH would be well served in establishing procedures to provide workforce data that would facilitate future assessment of the National Research Service Award (NRSA) program. Improved mechanisms for supplying data and coordinating data collection are needed if future estimates of workforce needs are to be more accurate.

Given the present training capabilities in this country and around the world, particularly the existing university systems and research in health-related industries, market forces are an important factor in determining the choices of research careers. Thus, the supply of trained research personnel tends to adjust to the demand. A significant phase difference of several years or more may be required to adjust the differences between supply and demand, but history suggests that this adjustment inevitably occurs. The present training capability is determined by a mixture of federal, state, and private research grants, various group and individual training grants, training received by individuals pursuing professional degrees, and research carried out by for-profit private institutions. This mix of training venues is highly varied and flexible and can adjust to local fluctuations in demand, as long as they are not too extreme. Given this situation, it is probably less useful to base decisions about adjusting training personnel on the basis of stable states of the world than it is to have a system that can respond rapidly to unusual changes. Partly for this reason, the committee recommends that a standing independent committee be established to continually monitor research personnel and to recommend adjustments when needed. This would be more effective than the current method of convening a new committee every four years.

When discussing the supply of research personnel, it is critical to move past discussion of sheer numbers. The quality and skills of research personnel are of paramount importance. Research is continually used to justify far-reaching health decisions that affect large segments of the population. The accuracy, reliability, and validity of such research must be as high as can be reached. In addition, new advances in health treatment are dependent on the creativity and insight of the world's best researchers. This committee has therefore made recommendations to ensure that the training of researchers and of those who will provide training for future researchers is of the highest attainable quality.

The committee is particularly concerned about career development opportunities for research personnel. Although its research efforts are the best in the world, this country may be losing individuals with special talents, especially among underrepresented groups and young people with responsibilities other than research that prevent them from achieving their full potential. Consequently, the committee encourages NIH to continue its efforts to provide unique career development programs, albeit in a more integrative fashion across NIH than is currently being done.

Any large research organization, such as NIH, must necessarily divide itself into units based on categories of related science. The benefits of this type of organization are obvious, but clearly some drawbacks also are present. Such an organization promotes research and research training that tend toward the center of each unit's discipline. Such tendencies work against inter- and multidisciplinary research and research training, despite the well-recognized fact that major breakthroughs in medical research often occur at the interfaces between and across traditional areas. Because of such tendencies, the committee has tailored several recommendations to promote vital inter- and multidisciplinary training.

Both in the past and in the present report, considerable effort has been devoted to analysis of and recommendations concerning training in the form of NRSAs. However, this training, while vital for the nation, is only a small part of research training in this country. A major segment of research training is supported by research grants, as is deemed appropriate by this committee. Even within the subset of training in the university community, NRSA awards are restricted to U.S. citizen and green card holders. This leaves out the training of foreign personnel, which typically occurs on research grants, and the vital role played by foreign personnel in the overall research effort. Ultimately, a significant number of foreign personnel remain in this country and become an important part of the training and research community. This committee has tried to place its recommendations in a larger context, containing both domestic and foreign researchers and the important roles played by each group. In this regard, the committee is concerned about recent visa restrictions that may restrict the entry of foreign students and research personnel into this country. The input of foreign personnel is essential for the vitality of the research and training community. In fact, if the restrictions on foreign researchers continue, the demand for domestic researchers may significantly outstrip the supply.

Finally, the committee notes that this nation does not exist in isolation. Disease and health problems do not respect political borders. It is in the nation's vital interest that health solutions and health services extend to the world at large and that research and research training take place in the larger context of the world's scientific community. Although this committee did not believe its mandate extended this far and time and resources did not permit full consideration of research training in the world at large, some of our recommendations are made with such issues in mind.

It is hoped that this report, with its analyses and recommendations, will serve as a useful guide to NIH in the consideration of research training for both the present and the immediate future and that it will provide a foundation for our successors.