Securing the Early Career Research Pipeline

Paul Panipinto, PM, PhD Candidate Washington State University, College of Pharmacy and Pharmaceutical Science

Executive Summary

Post-doctoral researchers have long been a critical component of U.S. biomedical research. Over the last two decades the job quality of these positions has degraded significantly, causing double digit decreases in the number of biomedical post-docs. The NIH has been unable to address this issue substantially leading to piecemeal attempts to address the problem by states. This has caused considerable disruption to academic budgets and workers. Comprehensive changes including a minimum pay scale, attaching the growth of future pay to fair market value and adequate funding by congress to enable this without harming U.S. research output are critical to restoring America’s early career biomedical research pipeline.

Critical Shortages of US Post-doctoral Researchers

Between 2001 and 2021 the U.S. Post-doc rate – the rate at which newly minted PhDs enter a post-doctoral training position – for biological and biomedical sciences declined from 76% to 65%. This substantial drop is even more concerning given that every other field tracked by the National Science Foundation (NSF) demonstrated strong growth in the same 20-year period, with most showing double-digit increases. Anecdotal reports of difficulty finding people to fill post-doctoral positions, even for well-established and funded labs, have been relegated to the career sections of journals like Science and Nature with very little done to improve the issue. The White House and the National Institutes of Health (NIH) have begun to act by holding listening sessions to gather the opinions of stakeholders. However, as the COVID pandemic demonstrated, the security of our biomedical research pipeline is a critical issue that affects the sustainability of the U.S. health science system that the world depends on. As participation in these positions decline in the U.S., they will inevitably move to international competitors, further hindering a field that has long set the standard for the world.

A Decade of Education Rewarded by Low Pay and Poor Working Conditions

The two most common routes for biomedical PhDs have long been either moving to an academic postdoc at a research university or moving into the biomedical industry. Academic post-docs have for decades been the traditional position for those who receive a PhD and are intended provide further training to prepare PhD holders for a faculty position. Over the last two decades these positions have become more focused on producing science than producing faculty with only 9% of post-docs reporting working only their contracted hours and 61% reporting that they work more than six hours a week over their contract, often without compensation. Additionally, 55% of post-docs spend less than an hour a week with their faculty mentor, stymieing development and creating confusion about what the purpose of the position is2. A survey of top concerns by the National Postdoctoral Association found that 94.8% of postdocs thought their lives were negatively affected by their salary, 90.4% reported a lack of clarity about the pathway to their next position, 87.4% had an unclear definition of their current role, 86.6% were insecure about their job and 92.1% of international post-docs reported additional vulnerabilities due to their visa status. Together these data demonstrate that the professional state of some of our most highly skilled and educated workers is one of crisis.

Piecemeal Attempts and a Federal Solution

As noted, the NIH has established working groups to provide potential solutions to this problem. The 21-member committee recently laid out a series of guiding principles that include increasing pay, encouraging employers to provide benefits and capping the length of post-doctoral appointments at the predicted cost of reducing the total number of post-docs supported by the NIH. These would be strong first steps, however, they are nearly identical to the recommendations produced by the working group the NIH convened in 2012. Additionally, reducing the number of post-doctoral positions in the field will lead to a decrease in science produced – the same result we face. Alternatives have also proven problematic with California and Washington State legislatures codifying post-doctoral wages and allowing them to become overtime eligible. This approach has become problematic as faculty mentors – even those who support increased stipends and better working conditions – have found it difficult to reconcile their grant budgets to the new state requirements. This has led to severe responses including a brief strike by University of Washington post-docs.

Solving the problems of poor working conditions and worse pay requires a concrete change in strategy from policymakers at the NIH and members of Congress. Lawmakers have tied the salary cap of NIH grant personnel to the Executive II level ($212,000) of the 2023 Executive Schedule Pay Table. This practice has been in place since 1990 with the most recent update in the Consolidated Appropriations Act, 2023. The median biomedical post-doc salary in 2022 was $52,685, much closer to NIH fellowship stipend levels which have become an anchor for compensation, and drastically below the U.S. median salary of $69,717. Outside of academia, the median salary for a biomedical industry post-doc is approximately $90,000. The piecemeal attempts to address this problem have exacerbated the problem by prolonging the crisis while not substantively providing a solution, though they were good faith attempts. Members of the Congress should set a compensation floor for early career researchers tied to executive pay that acknowledges the critical research work of post-doctoral researchers. The NIH working group has warned that the negative effect of increasing compensation to stem the bleeding of our early career pipeline will lead to drastic cuts in the total number of early career NIH-funded research positions. This means that in addition to establishing a floor, lawmakers should also raise NIH funding to reflect these increases and prevent talented researchers working toward the success of the U.S. biomedical research system to leave either for better paying industry positions or seek a position outside of the United States.

Spending additional money on anything – especially when Congress and the Executive are controlled by different parties can be a difficult prospect. Our national debt is near $33 trillion and the clamor for lower spending levels has steadily increased – so much so that once boring debt ceiling bills have become repetitive crises that have damaged the credit standing of the United States. Still, there have been bipartisan efforts for investment and reform in many similar areas such as support for the CHIPS Act of 2022, the National Science Foundation For the Future Act of 2021 and SASTA in 2019 largely because of the real and perceived benefits of investing in America’s research. The NIH must drastically raise wages and tie them annually to their industrial post-doc peer positions to encourage our most talented workers to fill these critical positions. Meanwhile, Congress must work to both fund this change, and mandate increases to the minimum stipends to avoid reducing the scientific output of our biomedical research institutions.

From Bars to Safe Spaces: Exploring Overdose Prevention Centers

Elijah Ullman, PhD Candidate Emory University

Amidst the ongoing opioid overdose crisis, it is imperative to envision a comprehensive framework for safe drug consumption; we must acknowledge that drug use has persisted throughout human history for tens of thousands of years. Numerous factors contribute to individuals’ motivations behind drug use, and it is worth noting that lab animals will voluntarily self-administer drugs such as fentanyl.

Opioid death overdose rates have increased five-fold between 1999 and 2017, coinciding with an increase in adulteration of the illicit drug supply with potent opioids such as fentanyl. Overdose prevention centers (OPCs), also known as supervised consumption facilities (SCF), are facilities where persons can use drugs while monitored by health care personnel who provide sterile supplies (such as syringes), emergency care if an overdose occurs, primary medical care, and referrals to treatment or social services if needed. OPCs do not provide drugs to people but play a vital role in providing a safer alternative to public drug use. The United States implemented its first SCF in New York City in 2021. Bars can be considered as an existing model for SCFs - people can go to these facilities and consume their drug and are widespread throughout the world. The case for OPCs can be summarized by the following five points:

(1) Preventing fatal overdose incidents.

A retrospective analysis of North America’s first SCF in Vancouver, Canada, revealed a significant 35% decrease in overdose rates within a 500-meter radius of the center, compared to a 9.3% decrease in the rest of the city. Similarly, following the opening of a SCF in Sydney, Australia, ambulance calls decreased 80% in the surrounding area5. Contrary to concerns about increased overdose rates due to ‘acceptance’ of drug usage, there is no evidence that OPCs lead to higher drug usage rates. Therefore, these centers provide a public health benefit not only to facility users, but society.

(2) Decreasing the transmission of bloodborne pathogens.

Approximately half of worldwide HIV-Hepatitis C (HCV) co-infections occur in people who inject drugs. Injection drug use accounts for one-third of HCV deaths and 10% of new global HIV infections8. Despite limited implementation of SCFs in the United States, HIV testing rates among injection drug users were notably higher at 57% compared to the general population’s rate of 14.8% between 2017 and 2018. Treatment for HIV positive individuals costs were approximately $30,000-$50,000 annually, and HCV-related costs are approximately $53,000. Implementing SCFs and syringe exchange programs are associated with a 50% reduction in new cases of HIV and HCV infections. Distinguished from SCFs, syringe exchange centers, such as Denver, CO’s Harm Reduction Action Center, primarily focus on furnishing sterile supplies, such as syringes and alcohol swabs, without providing direct supervision or oversight during.

(3) Facilitating access to addiction treatment, social support, and healthcare.

People who use drugs face significant challenges in accessing adequate medical care due to stigma, the high cost of medical and rehabilitation treatment, and inaccessibility of services (e.g., lack of transportation, especially for drug users living in rural areas). These are massive barriers to care for an already vulnerable population. Additionally, the illegal status of drugs like heroin further discourages seeking assistance due to the fear of criminal charges. OPCs serve as a crucial access point for persons who inject drugs, providing syringe exchange, overdose prevention, on-site medical professionals, and addiction treatment services. Notably, in early February 2023 the first overthe-counter naloxone nasal spray received approval. Naloxone is a potent opioid receptor antagonist capable of immediately reversing overdoses.

(4) Mitigating the issue of syringe litter and reducing public drug use.

Public concern over syringe litter associated with individuals who inject drugs stems from both environmental and public health risks, including the potential spread of Hepatitis C and HIV. However, implementation of SCFs in various cities and countries have consistently demonstrated a decrease in the rate of public usage of injection drug use. These facilities not only reduce syringe litter but also promote safer injection practices, with participants reporting decreased rates of syringe sharing, improved injection safety, and more frequent cleaning of injection sites. These outcomes collectively contribute to enhanced safety for both the community and persons who inject drugs.

(5) Delivering cost savings to the community through proactive support instead of reactive measures like street overdose interventions and associated hospital expenses.

Numerous reviews have discussed the cost of SCFs, consistently concluding that they generate cost savings of $5-7 for every dollar invested. A study from King County, Wash., found that each hospitalization resulting from a non-fatal overdose costs $17,083. Methods have been developed to assign a monetary value to prevented deaths, typically by calculating the difference between the mean age of people who inject drugs and the standard age of retirement, then multiplying it by the annual per capita income. In the case of King County, the economic value attributed to preventing each fatal overdose is estimated at $566,539. Therefore, implementing these centers represents a massive cost-saving measure for communities across the United States.

California’s SB57, vetoed by Gov. Newsom (Nov 2022), would have authorized OPCs. Pennsylvania’s SB 165 seeks to ban OPCs, and Gov. Scott of Vermont signed H.728 (June 2022), imposing a similar ban. In

2021, Pennsylvania and California saw daily overdose deaths averaging 14 and 20, respectively; OPCs have proven effective in reducing such fatalities. However, Colorado’s HB 23-1202, Overdose Prevention Center Authorization, passed the House and awaits Senate approval. It is vital to support nationwide adoption of OPCs whenever such legislation appears on the ballot, as they play a crucial role in preventing fatal overdose incidents, mitigating syringe litter and public drug use, enhancing access to addiction treatment and healthcare, and delivering cost savings to the community.