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Continuing to address the challenges of human health is a major imperative facing society in the 21st century. Although prior scientific advances substantially contributed to improving the length and quality of life, many diseases still place a burden on individuals and society. Further progress will require an unprecedented convergence of biological, physical, and information sciences.
Over the last 100 years, the United States assumed a global position of unparalleled scientific achievement. The preeminence of the United States, however, is now being challenged by other countries. If the United States is to realize the promise of precision medicine and maintain its scientific leadership, the training of a new generation of scientists and engineers will need to become as innovative as the science that they are expected to deliver. This must be a high priority for the nation and means engaging challenges ranging from exposure to the best science in high school, to the length and expense of training for a scientific career—especially for underrepresented minorities—and on to the persistence of rigid disciplinary silos.
As a result of a number of highly visible reports and recommendations on the nation’s scientific workforce,1- 3 agencies and private sector entities have moved forward to address many of the challenges. Nevertheless, significant problems persist.
The problems start early in the educational continuum. During high school, when it could be expected that the process of developing the next generation of scientists often begins, students get little exposure to the process of science—exploration, discovery, and validation—as opposed to simply memorizing previous discoveries. Today, it is the student who adapts to a rigid system of programs, rather than the opposite. For example, higher-level mathematics, computer science, and data analytics have become critical for success in biomedical research, yet many students do not take courses in higher-level mathematics in high school and even college. Computer science curricula are narrowly focused, with few examples of how analytic techniques can be applied to modern-day biology.
Of all the groups in the biomedical workforce, PhD students and young physician-scientists are under particular stress in the current environment. Most important, after a prolonged period of training, even the most promising young scientists do not become lead investigators until their late 30s. In addition, despite the increasing number of possible careers, these scientists often seek to simply replicate the careers of their mentors, rather than contributing to the exploration of novel ideas through more diverse careers. Such students finish their training with inadequate exposure to the wider array of career options that would allow them to make informed decisions about their career paths. For example, although industry invests much more in research and development than does the National Institutes of Health—by at least $10 billion a year4—few trainees at the PhD and MD levels currently look to explore careers in industry.
In all sectors and at all levels of biomedical science, there is also an important need to improve the diversity of the workforce. It has been argued that a diverse scientific workforce will improve efforts to fully explore the whole array of health issues that affect the diverse demographics of the US population. Yet even though the number of women in science has increased in the last 2 decades, the number of scientists from minority groups remains unacceptably low.5 Clearly, more must be done to attract and retain underrepresented minorities to STEM (Science, Technology, Engineering, and Mathematics) education.6
Today, bold actions are needed to meet the changing educational and training needs. What opportunities exist at the undergraduate and graduate levels to address these problems? Should there be a reinvigoration of master’s programs, especially in such fields as statistics and computer science, in which a PhD may be unnecessary? Should programs similar to those in Europe be considered, where especially talented students go straight from high school to MD, PhD, or MD-PhD programs or where parts of undergraduate and doctoral training are condensed? Is it time to consider debt forgiveness for students completing PhDs in some high-priority fields?
It is crucial that there be a focus on a few immediate and pragmatic changes that may lead to a lasting effect. Two policy recommendations, taken together, could make a critical difference in the nation’s ability to tackle the challenges of creating and supporting a truly 21st-century health science workforce.
Two prominent opportunities for presidential initiatives to improve the nation’s preparation of an adequate workforce for 21st-century science include
Establish a NextGen opportunity fund. A fund of this sort would aim to substantially reduce the financial and disciplinary barriers facing prospective young scientists early in their careers. Resources could come from a 2% set-aside from the appropriations of relevant federal health, science, and education agencies, which could increase to 5% over the next decade, based on effect. Strategic use of the funds could be guided by a presidential panel, comprising heads of federal agencies and divisions, state governors, and representatives of academe, payers, clinicians, health care organizations, industry, and patient groups. The panel could function under the aegis of the Office of Science and Technology Policy’s National Science and Technology Council Committee on Science, using resources strategically to expand current programs and create newer, more focused opportunities in relevant federal agencies. Special emphasis could be given to ensuring that the next generation of health scientists is multidisciplinary, collaborative, and working in an environment that fosters their most creative ideas. The NextGen Opportunity Fund could be used to support existing and new programs at the federal and state levels. New programs funded in this manner should have a 10-year limit, with an opportunity to renew after rigorous evaluation.
Create a health-science corps for the 21st century. The singular goal of the corps would be to attract and train independent scientists ready to contribute to improvements in health. It would address (1) the lack of high school exposure to the best science by the best teachers; (2) the unjustified lengthening of the postgraduate training system with poorly defined career pathways; (3) the increasing financial burden of a scientific education with unsustainable student debt levels that force many, especially underrepresented minorities, to forgo scientific careers; (4) the persistence of rigid disciplinary silos that make the required multidisciplinary training and research experience much harder to attain than necessary. Such an “army of innovators” could be nurtured at all educational levels and stages of career development, from early high school to as late as postdoctoral fellowship and medical residency. Admission would be highly competitive, and the program could provide customized opportunities for participation in advanced curricula designed to speed the trajectory of program participants toward becoming independent scientists. Relevant agencies, state governors, and the private sector could be responsible for operationalizing the corps. The corps could be funded either from the Next Gen Opportunity Fund described above or through appropriations directly to relevant federal agencies and departments.
The scientific workforce of the 21st century will be different from that of the 20th century—it must become increasingly diverse and multidisciplinary. Many workforce initiatives to date have involved directing existing federal and private-sector investments into agency- or foundation-specific initiatives. The United States has gone this route before. The Bio2010 report7 and the Rising Above the Gathering Storm report1 both raised many of the same issues discussed in this Viewpoint. Efforts to instigate change, however, have been uneven and have lacked cohesiveness.
This history cannot be repeated. Enactment of these proposals would immediately and fundamentally change the training of the scientific workforce in the United States. In the absence of such a bold move, the nation is at risk. Historically, presidents have changed the fortunes of the nation by launching specific initiatives, such as the GI Bill and the space program. Today, the nation is at a comparable historical juncture with regard to the advancement life sciences in this century. Motivated and talented human capital is the core determinant of national competitiveness. Nothing is more critical than ensuring that the next generation of health scientists accomplishes even more than the current one. This will require courage, perseverance, and leadership at the highest levels of the nation.
Corresponding Author: Elias Zerhouni, MD, Sanofi, 54 rue La Boétie, 75008 Paris, France (email@example.com).
Published Online: September 26, 2016. doi:10.1001/jama.2016.12410
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: The National Academy of Medicine’s Vital Directions initiative is sponsored by the California Health Care Foundation, The John A. Hartford Foundation, the Robert Wood Johnson Foundation, and the National Academy of Medicine’s Harvey V. Fineberg Impact Fund.
Disclaimer: This Viewpoint on recommendations for training the health care workforce provides a summary of a discussion paper developed as part of the National Academy of Medicine’s initiative on Vital Directions for Health & Health Care (http://nam.edu/vitaldirections). Discussion papers presented in this initiative reflect the views of leading authorities on the important issues engaged, and do not represent formal consensus positions of the National Academy of Medicine or the organizations of the participating authors.
Additional Contributions: Coauthors of the National Academy of Medicine discussion paper included Raynard Kington, MD, PhD (Grinnell College), and Story Landis, PhD (National Institutes of Health [NIH] emeritus). Assistance was provided by Peter Henderson, PhD (University of Maryland, Baltimore County); Bruce Fuchs, PhD (NIH); Lana Skirboll, PhD (Sanofi); and Crispin Woolston, PhD (Sanofi). Elizabeth Finkelman, MPP (National Academy of Medicine), served as the initiative director.
Berg J, Hrabowski F, Zerhouni E. Training the Workforce for 21st-Century Science. JAMA. Published online September 26, 2016. doi:10.1001/jama.2016.12410