Personnel Needs and Training for Biomedical and Behavioral Research 1985 Report (1985) / Chapter Skim
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2 Clinical Sciences
2 Clinical Sciences
Pages 19-50
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From page 19... ...
Tuition, accounting for over 20 percent of total revenue in dental schools compared with less than 6 percent in medical schools, highlights some important differences between medical and dental education. In contrast to medical education in which residents and fellows receive salary or stipend during training, many dental trainees in advanced specialty programs must pay tuition and receive no financial support from federal or other sources.
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From page 20... ...
The question that concerns us in this study is how many clinical scientists should receive postdoctoral research training each year under NRSA programs? That depends in part on the number of clinical faculty positions in medical and dental schools, which in turn depends on enrollments and the availability of funds from research grants, tuition, faculty practice plans, and other sources.
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From page 21... ...
A' ·c} of · · o Ed · ~ ·~ in Em v Oc ~ o > or ~ ~ ~ ~ c' |
From page 22... ...
Instead of proceeding at modest growth rates for a few years as expected, reported professional service income in medical schools had huge gains in FY 1982 and again in FY 1983. This revenue source increased by 16 percent in FY 1982 and 21 percent in FY 1983 after adjusting for inflation.
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From page 23... ...
See Appendix Table Al. OinicalR and D Expenditures Since 1980, estimated expenditures for clinical R and D in medical schools have increased moderately after adjustment for inflation (Table 2.1, line 2a21.
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From page 24... ...
Up to 1980, private medical schools have had higher levels of research expenditures than public schools in the aggregate {Appendix Table Alp. But since then, public schools have overtaken private schools with respect to these expenditures.
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From page 25... ...
, ~ 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 FISCAL YEAR FIGURE 2.3 Professional service income per school reported by U.S. medical schools, by control of institution, 1962-83, with projections to 1990 (1972 $, millions)
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From page 26... ...
Medical service income is generated largely through medical school faculty practice plans whereas clinic income in dental schools is largely generated in student clinics. A1SO' the tradition of research in medical schools is much stronger than in dental schools, but the rapid growth of service income in medical schools portends relatively less emphasis on research, especially in clinical departments.
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From page 27... ...
Gradually during the 1970s, aggregate revenues from research were overtaken by medical service income and state and local government contributions. By 1983, service income generated by faculty practice plans accounted for almost 33 percent of total revenue and had become the largest single source of funds.
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From page 28... ...
Privately controlled schools are at particular risk in that respect because they do not receive large state and local government contributions. Publicly controlled schools are able to partly cushion the loss of federal funds with increased appropriations of state/local government monies e For most private medical schools, these funds are a relatively minor source of support.
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From page 29... ...
The committee has recommended that the training system be adjusted so that 35 percents of all new hires to clinical faculty positions in medical schools would have completed a period of formal postdoctoral research training. With estimates of demand for clinical faculty, and with a target level for the number of new hires with research training experience, the committee can estimate the number of clinical science postdoctoral trainees who should be in the pipeline each year.
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From page 30... ...
But the financial structure of medical education is changing in ways that tend to lessen the dependence of clinical faculty growth on the number of students. Service income from faculty practice plans is now the single largest source of revenue in medical schools.
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From page 31... ...
t = 1/6 (St + 2St_1 + 2St-2 + St-3~, where S = total of medical students, residents, and clinical fellows T = total revenue per school (1972 $, millions) c = scaling constant: CF/WS = c when T = 0 a,b = parameters to be determined empirically The parameters of the model were estimated from 20 annual observations covering the 1964-83 period.6 The model shown in Figure 2.5 is used to derive estimates of clinical faculty size for given levels of revenue (T)
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From page 32... ...
medical schools; WS = 4-year weighted average of students, i.e., (WS)
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From page 33... ...
to Expected size of clinical faculty in 101,800 students by medical schools (CF) in 1990 43,300 39,900 36,500 1990 Annual growth rate in CF from 1983 to 1990 0.5~o -~.7% -2.0~o Average annual increment due to faculty expansion 200 - 290 - 780 Annual replacement needs due to: death and retirements 640 610 590 other attritiond 2,130 1,840 1,570 Expected number of positions to become available annually on clinical faculties 2,970 2,160 1,380 a Faculty in this table is defined as a full-time appointment in a clinical department regardless of tenure status.
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From page 34... ...
medical schools, by control of institution, 1961-83, with projections to 1990. Faculty is defined as full-time appointments in clinical departments regardless of tenure status.
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From page 35... ...
But attrition would create an estimated 2,160 positions per year for a minimum demand of 1~380 positions. POSTDOCTORAL TRAINING NEEDS FOR MEDICAL SCHOOL CLINICAL FACULTY Translating our projections of demand for clinical faculty in medical schools into estimated postdoctoral needs under NRSA programs requires certain additional assumptions about how the system has functioned in recent years with regard to postdoctoral training and its sources of support.
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From page 36... ...
For several years now this committee has been recommending that the system be adjusted so that more clinical faculty recruits will have had research training experience. Line 5 indicates the size of the clinical science postdoctoral pool required to supply the necessary number of individuals with postdoctoral research training under certain assumptions about the length of the postdoctoral training period and the proportion of the pool seeking academic employment.
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From page 37... ...
` 5. Size of clinical science postdoctoral pool annual average Size needed to meet academic demand assuming a 2-3 year training period and portion of trainees seeking clinical faculty positions is: a.
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From page 38... ...
In 1968, the 50 dental schools were equally divided into 25 public and 25 private schools. Currently there are 35 public and 25 private schools.9 Dental School Enrollments (Figure 2.S and Appendix Table A20)
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From page 39... ...
dental schools, by control of institution, 1968-84, with projections to 1990. Includes predoctoral, advanced specialty, and general purpose residency students.
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From page 40... ...
Prior to 1981, real R and D revenue had increased at an average annual rate of only 1 percent since 1968. Nevertheless, R and D funds in dental schools are relatively minor sources of revenue, accounting for only about 7 percent of total revenue in 1982 compared to 22 percent in medical schools.
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From page 41... ...
In contrast to service income in medical schools, which stems largely from faculty practice plans, clinic revenue in dental schools is generated largely by students. Clinic revenue has had a dramatic growth pattern during the past decade and probably is one of the keys to understanding what has been happening in dental education during the 1970s.
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From page 42... ...
As a result of the expected increases in most revenue components-especially tuition -- the committee expects growth in total revenue to continue through 1990 at about 4 percent per year, with upper and lower limits on this estimate of 7 percent and 1 percent, respectively. Average revenue in public dental schools has been consistently higher than in private schools.
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From page 43... ...
Recall that the purpose of this analysis is to estimate the future demand for full-time clinical faculty members in dental schools -- and ultimately to assess the need for training of dental clinical investigators. The methodology that has been applied to a corresponding analysis of medical schools involves the development of a conceptual and empirical model of the interrelationships among the variables.
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From page 44... ...
dental schools; WS = 4-year weighted average of students, i.e., (WS)
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From page 45... ...
where: St = predoctoral plus advanced specialty enrollments in year t, T = total revenue per school in U.S. dental schools (1972 $, millions)
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From page 46... ...
One reason for a higher figure is the growing tendency for dental schools to restrict tenured and tenure-track appointments in clinical departments to individuals with a background of advanced education (specialty or general practice residency) and research training.
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From page 47... ...
in 1990 3,810 3,760 3,540 Annual growth rate in CF from 1983 to 1990 0.09% - 0.08% - 0.09~o Average annual increment due to faculty expansion — - 30 Annual replacement needs due to: death and retirements 60 60 50 other attritions 190 170 110 Expected number of positions to become available annually on dental clinical faculties 250 230 130 B Will decline to 21,050 Expected size of clinical faculty in students by 1990 dental schools (CF)
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From page 48... ...
Since there are currently so few qualified dental clinical investigators, a strong effort should be made to bolster the research capability of dental schools. One way of doing this is to try to modify the system such that about 1/2 of all newly hired faculty members in clinical departments of dental schools have some postdoctoral research training.
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From page 49... ...
140 105 35 5. Size of dental clinical science postdoctoral pool annual average Size needed to meet academic demand assuming a 3-year training period and portion of trainees seeking dental clinical faculty positions is: a.
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From page 50... ...
Postdoctoral Trainees Needed Under NRSA Programs For clinical faculty in medical and veterinary schools: 2,250 - 3,240 For clinical faculty in dental schools: 320 - 400 Total: 2,570 - 3,640 This spread of estimates is partly due to the difficulty inherent in making assumptions about the future levels of revenue, especially at a time when medical schools are facing possible dramatic changes brought on by demography, a potential physician surplus, and by efforts to curtail the growth in medicare/medicaid expenditures. And it is partly due to the fact that for the first time in more than 25 years, medical school enrollments are expected to decline while revenue is expected to continue to grow.
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