How the health services research workforce supply in the United States is evolving

Abstract

Objective

To investigate how the health services research (HSR) workforce supply in the United States has evolved over the last 5 years.

Data Sources

Membership data of AcademyHealth participants, professional networking websites, PubMed, grant databases, and the Integrated Postsecondary Education Data System.

Study Design

Descriptive study comparing size and characteristics of the HSR workforce and graduates identified across multiple data sources. Lists of authors and principal investigators (PIs) were merged and de‐duplicated to identify unique counts. Pearson's chi‐squared test was used to compare characteristics between members and nonmembers of AcademyHealth.

Data Collection

Downloaded files from websites and received survey data extracted by AcademyHealth between 2016 and 2020.

Principal Findings

The workforce size ranged from 9610 to 28,136, depending on data source. Common employers included universities, government settings, and health systems. Little overlap in employers existed for individuals with potentially competing skill sets. The HSR workforce appeared more diverse than the US adult population, with two to three times greater representation among Asian individuals yet lower representation among Black/African American (30%) and Hispanic (75%) individuals compared with the US population. Exactly 87,721 master's and 3105 doctoral degree graduates from core HSR fields were added over 5 years from public and not‐for‐profit institutions. Including for‐profit institution graduates increased the count by 15% for master's and 30% for doctoral graduates. Hispanic (any race), Black/African American, and multiracial individuals gained representation among core HSR graduates, with for‐profit institutions substantially contributing to the number of Black/African American graduates.

Conclusions

The HSR workforce is growing with increasing diversity among its graduates compared with previous studies. Additional work is needed to understand how employers value the contributions of those trained in HSR. Continued efforts are needed to ensure HSR workforce diversity to frame critical research questions and develop programs and policies that reflect the needs of the community.

What is known on this topic

• Defining the boundaries health services research workforce has been challenging with few data sources available to track its growth and with emerging fields that overlap in skill sets such as data science.

• Available data suggest that health services research workforce has been growing over last couple of decades with signs of deceleration despite growing demand.

• New graduates have been more diverse than the existing workforce, with lower representation of Hispanic individuals compared with the general population.

What this study adds

• Updates supply and diversity data on the health services research workforce.

• Examines the contribution of for‐profit institutions to the diversity of the health services research workforce.

• Compares demand for health services researchers with other related fields.

1. INTRODUCTION

The COVID‐19 pandemic has highlighted the critical need for robust data infrastructure that allows health systems to respond nimbly to diverse patient needs. While major health systems have made significant investments in their electronic health record systems and digital records from health insurance claims files among other sources are increasingly available, connecting data sources across systems remains a challenge. Over the past year, experts have called upon US Department of Health and Human Services including the Office of the National Coordinator, Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention to prioritize initiatives and investments to resolve this challenge. ¹ , ² , ³ To benefit from the data, simultaneous investments are needed to ensure we have a diverse cadre of health services researchers who are poised to not only to shape data collection and analyses but also support the translation and implementation of the findings in a manner that promotes accessible, high‐quality, and equitable care during the pandemic and beyond. ⁴ This study updates our knowledge about the current state and supply of the health services researchers (interchangeably referred to as the health services research [HSR] workforce). We will also discuss the extent to which the HSR workforce is meeting the needs of patients and health systems.

The HSR workforce has grown over the past couple of decades, with signs of deceleration in the most recent study. ⁵ , ⁶ , ⁷ Identifying exactly who conducts HSR and defining the borders of the field has been complicated. AcademyHealth defines HSR as “the science of study that determines what works, for whom, at what cost, and under what circumstances. It studies how our health system works, how to support patients and providers in choosing the right care, and how to improve health through care delivery.” ⁸ Given the nature of the field, individuals across several disciplines such as medicine, nursing, data science, statistics, economics, sociology, and epidemiology may be working on interdisciplinary teams conducting HSR, but without a clear individual identified as a health services researcher. These teams may also be embedded within health systems and are not producing research products that are easily identifiable in the public domain such as federal grants or peer‐reviewed products. While these conditions have limited past studies in assessing the true size of the field and how researchers are deployed, continued monitoring is important to gauge whether the field is on pace with growing needs.

Striving for diversity across multiple dimensions among health services researchers is critical to ensure the voices influencing the field are representative of patient needs. The HSR workforce has been noted to be less racially and ethnically diverse than the general population. ⁶ The lack of diversity has long been a concern of leadership in the field, ⁹ and the urgency to include more diverse voices in research has been heightened with greater awareness of structural racism in health care. ¹⁰ Research underway has found that while institutions have begun to recognize the importance of diversity, equity, and inclusion (DEI), active change of the culture, including the development of pathway or mentoring programs for health services researchers from racially minoritized groups at various levels of their career, remains limited. ¹¹

In this study, we revisited the size and diversity of the current HSR workforce and recent graduates from HSR‐related programs, widening the net of data sources used in previous studies. The findings from this study will expand our understanding of the reach of the field and whether any progress has been made in diversifying the field. The information from this study can be useful for professional organizations, educators, and policy makers who are preparing the next generation of health services researchers to support an increasingly diverse patient population achieve health equity.

2. DATA AND METHODS

2.1. Journals

Similar to past studies, we extracted up to 20 author names (i.e., first and middle initials, last name) per publication with a final publication date between January 1, 2016, and December 31, 2020. We extracted author names from two journals examined in prior studies: Medical Care and Health Services Research. Given the ever‐growing number of outlets for HSR studies, we extracted author names from nine additional journals: Health Affairs, Healthcare, Implementation Science, Inquiry, Journal of Health Economics, Journal of the American Informatics Association, Medical Care Research and Review, Milbank Quarterly, and Value in Health.

2.2. Investigators

We extracted principal investigator (PI) names (i.e., first and middle initial, last name) who received funding between January 1, 2016, and December 31, 2020 as identified from three databases: (1) National Institutes of Health (NIH) Research Portfolio Online Reporting Tool (RePORTER); (2) Patient Centered Outcomes Research Institute (PCORI); and (3) HSRProj. From NIH RePORTER, we identified grants categorized under the spending category called “health services” and awarded in the United States. ¹² From PCORI, we identified PIs of the following project types: “Research Projects,” “Engagement Award Projects,” “PCORnet Clinical Research Network (CRN) 2020,” “Implementation Project,” and other limited competition awards (e.g., “PPRN Award”). ¹³ From HSRProj, a voluntary database of HSR projects housed at the National Library of Medicine, we identified additional studies funded by foundations, Centers for Disease Control and Prevention, Health Resources and Services Administration, Centers for Medicare and Medicaid Services, and other grant making organizations (see Appendix A for further details). ¹⁴

2.3. Professional social network

To gauge the size of the HSR workforce, we revisited two social networking sites that commonly engage researchers. First, we obtained a count of researchers who conducted research in “healthcare policy and economics” as of May 1, 2021 from ResearchGate.net, a social network of authors based on co‐authorship and citations. ¹⁵ ResearchGate does not use the specific term “health services research.” Second, we obtained a count of researchers who self‐identified as having skills in “health services research” as well as the count of individuals who voluntarily joined the LinkedIn group called “health services research” as of May 1, 2021 using Linkedin.com's Recruiter Lite option. ¹⁶ Among individuals with “health services research” as a skill, we obtained information on the job function and current company. We also identified individuals who listed having skills related to HSR including bioinformatics, data science, health economics, implementation science, social epidemiology, and translational science. Within each of these subsets, we also examined job function and current company. Given the size of the data science field, we restricted the analysis to those working in the “hospital and health care industry.” Implementation science was not a specific skill coded by Linkedin.com and was identified by searching the term as a keyword.

2.4. Professional organization membership

AcademyHealth is one of the largest professional societies for health services researchers. We obtained de‐identified data on individuals who were members at some point between 2016 and 2020. We included analysis of those without an active membership (which we also refer to as “nonmembers”) given that this study is taking place during the COVID‐19 pandemic, which could affect individuals' resources available to keep membership current. The database relied on self‐reported information updated each time individuals engaged with AcademyHealth, such as renewing membership or registering for conferences. We examined sociodemographics (i.e., age, gender, race, ethnicity, and degree) and job information (i.e., occupation and industry) by whether the individual had an active membership on the date of extraction (May 12, 2021) versus inactive.

2.5. Recent graduates

We examined the number of graduates from programs that could lead to a career in HSR by extracting data from the Integrated Postsecondary Education Data System (IPEDS). IPEDS is a mandatory reporting system of data on institutional characteristics and resources (e.g., degrees and certificates conferred) collected by Department of Education National Center for Education Statistics from universities that receive federal financial assistance (e.g., Title IV of the Higher Education Act of 1965 and Title VI of the Civil Rights Act of 1964). ¹⁷ We extracted the number of degrees conferred between 2015 and 2019 to students in master's and doctoral degree programs in research/scholarship (vs. professional practice or “other”) with a focus on public and not‐for‐profit institutions in the United States for comparability with previous studies. An additional analysis of graduates from for‐profit institutions was also conducted. We used the 2010 Classification of Instructional Programs (CIP) codes to define a core set of programs and an expanded set of programs related to HSR as used in previous studies (see CIP list in Appendix B of Supporting information). ¹⁸ We extracted gender (female and male), ethnicity (Hispanic/Latino and non‐Hispanic/Latino), and race (American Indian/Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White) data on graduates. Per IPEDS reporting guide, race information was only collected among individuals who did not self‐identify as Hispanic. IPEDS categorized lawful permanent residents by race/ethnicity, while individuals with a visa or otherwise in the United States on a temporary basis were categorized as nonresident individuals.

3. RESULTS

3.1. Size of the HSR workforce

Table 1 summarizes the size of the HSR workforce found across different sources used in this study compared with the last study conducted by Frogner. ⁶ Merging data on authors and PIs, we found a unique count of 28,136 individuals, of which 1292 were identified across both publications and sponsored projects. Compared with the last analysis of the HSR workforce, we found only 10 more health services researchers when extracting only the first three author names from the two original journals, Health Services Research and Medical Care. PIs identified through NIH RePORTER increased the count by 67 health services researchers compared with the last analysis, although PIs funded by AHRQ were not fully identifiable in this study. Expanding the number of journals and authors contributed to the apparent growth of the HSR workforce compared with the 16,743 identified in 2015. ResearchGate.net identified 26,500 researchers in the area of “Healthcare Policy and Economics” as of 2020, which is comparable with the combined count of authors and PIs.

TABLE 1.

Number of health services researchers identified from selected sources, 2016 and 2020

Sources	2010–2015 a	2016–2020
AcademyHealth
Annual research meeting presenters	5792	—
All active and inactive members		9351
Select journals b
Health Serv Res
First three authors	1500	1834
All authors	—	2997
Med Care
First three authors	2580	2256
All authors	—	4080
Authors per article published in at least one of the following journals: Health Serv Res, Med Care, Health Aff (Millwood), Healthc (Amst), Implement Sci, Inquiry, J Am Med Inform Assoc, J Health Econ, Med Care Res Rev, Milbank Q, Value in Health	—	23,817
Sponsored projects
NIH RePORTER and AHRQ GOLD c	5031	—
NIH RePORTER only	—	5098
HSRProj	6630	126
PCORI	—	589
Unduplicated count Note: AcademyHealth not included in 2020 count	16,743	28,136
Linkedin.com
Self‐identified skill of “Health Services Research” in United States	6126	9610
Members of “Health Services Research Group”	6331	6001
ResearchGate.net
Researchers in “Healthcare Policy and Economics” in United States	20,300	26,500

Abbreviations: AHRQ GOLD, Agency for Healthcare Research and Quality Grants Online Directory; HSRProj, Health Services Research Projects in Progress; NIH RePORTER, National Institutes of Health Research Portfolio Online Reporting Tool; PCORI, Patient Centered Outcomes Research Institute.

^a Timeframes are approximate. For AcademyHealth participants, authors and PIs were from 2010 to 2015 versus from 2016 to 2020. Linkedin.com and ResearchGate.com were as of May 1, 2021.

^b Prior studies examined only first three authors of Health Serv Res and Med Care. New analyses include up to 20 authors per paper.

^c NIH Spending Category called “Health Services” for NIH grants; project term search includes “Health Services” for VA grant sources. AHRQ GOLD no longer lists grants by PI names, but subset of grants are identifiable in NIH RePORTER.

Through Linkedin.com, 9610 self‐identified HSR as a skill in the United States, which is a 56% growth over the 2015 Linkedin.com estimate. This number was on par with the count of unique individuals (n = 9351) participating in AcademyHealth over the past 5 years. The number of individuals in the Linkedin.com “Health Services Research Group,” however, slightly declined over time.

3.2. Sociodemographic and work characteristics of the HSR workforce

According to self‐report data from AcademyHealth participants, about half self‐identified as female (Table 2), with greater representation of females among the current members (62.2%) compared with nonmembers (45.7%). About half of AcademyHealth participants self‐identified as White; members were more likely to identify as Hispanic, Asian, Black, and multiracial compared with nonmembers. Over 140 unique degrees were reported, with the PhD being the most common degree held by AcademyHealth participants. All proportions were significantly different at p < 0.01 using a Pearson chi‐square test. Health and education occupations were frequently reported, and the University setting was a dominant industry for the HSR workforce across data sources (Table 3 and Appendix C of Supporting information). The distribution in senior level titles (e.g., manager, director, CXO) among the HSR workforce did not noticeably change since the previous study (Appendix D of Supporting information).

TABLE 2.

Sociodemographic characteristics of AcademyHealth participants, 2016–2020

	All (n = 9351)	Member a (n = 2736)	Nonmember (n = 6615)
Gender
Female	50.5	62.2	45.7
Male	25.9	32.1	23.4
Nonbinary	0.0	0.1	0.0
Prefer not to answer/Other	5.4	2.0	6.8
Missing	18.1	3.7	24.1
Race
White	45.5	60.6	39.3
Asian	12.1	14.7	11.0
Black	5.3	6.7	4.7
Native American	0.2	0.2	0.2
Pacific Islander	0.1	0.1	0.1
Multiracial	1.6	2.2	1.3
Other	1.4	2.1	1.2
Prefer not to answer/other	6.9	6.8	6.9
Missing	26.9	6.6	35.3
Ethnicity
Non‐Hispanic	56.3	77.6	47.4
Hispanic	3.1	4.1	2.8
Prefer not to answer	7.8	8.0	7.7
Missing	32.8	10.3	42.1
Degree type
PhD or equivalent	21.8	29.7	18.7
MD or equivalent	6.5	8.7	5.6
MPH	8.2	10.9	7.1
MA/MS	5.5	7.3	4.8
MHA/MSA/MHSA/MBA	2.4	3.1	2.1
Nursing degree (BSN or higher)	2.6	3.8	2.5
Other	22.8	27.6	20.2
Missing	30.2	8.9	39.0

^a Member status is as of May 12, 2021.

Source: Author calculation of de‐identified data provided by AcademyHealth.

TABLE 3.

Job function and current companies of individuals with HSR and related skills identified on Linkedin.com as of May 1, 2021 ^a

Health services research N = 9610
Job function		Current companies
36.7%	Education	3.1%	US Department of Veterans Affairs
30.1%	Health care services	1.8%	Centers for Disease Control and Prevention
28.3%	Research	1.4%	University of California, San Francisco
17.5%	Business development	1.4%	Harvard Medical School
7.8%	Community and social services	1.1%	Kaiser Permanente

Bioinformatics N = 83,288				Health economics N = 18,735
Job function		Current companies		Job function		Current companies
43.9%	Research	0.7%	Thermo Fisher Scientific	24.3%	Health care services	1.6%	Bristol Myers Squibb
19.1%	Education	0.6%	Illumina	22.2%	Business development	1.3%	Pfizer
12.4%	Engineering	0.5%	Genentech	17.3%	Research	1.3%	AbbVie
10.5%	Business development	0.5%	Google	13.8%	Education	1.0%	Merck
6.7%	IT	0.5%	Bristol Myers Squibb	12.0%	Finance	0.8%	The Janssen Pharmaceutical Companies of J&J

Data science in hospital and health care industry N = 9403				Social epidemiology N = 9232
33.3%	Engineering	2.9%	UnitedHealth Group	24.9%	Research	2.2%	Centers for Disease Control and Prevention
25.8%	IT	2.5%	Kaiser Permanente	24.4%	Health care services	0.7%	University of California, San Francisco
23.6%	Research	1.8%	Optum	19.6%	Education	0.6%	Kaiser Permanente
12.0%	Business development	1.5%	Centene Corporation	15.9%	Business development	0.4%	University of Washington
10.1%	Health care services	1.3%	IQVIA	14.4%	Community and social services	0.2%	Health Resources and Services Administration

Translational science N = 3308				Implementation science N = 3916
43.1%	Research	1.6%	AstraZeneca	30.5%	Education	1.6%	US Department of Veterans Affairs
23.2%	Education	1.1%	University of California, San Francisco	29.5%	Research	1.5%	Centers for Disease Control and Prevention
19.7%	Health care services	1.1%	University of Pittsburgh	20.5%	Health care services	1.3%	University of California, San Francisco
18.4%	Business development	1.0%	Mayo Clinic	17.0%	Business development	1.3%	Johns Hopkins School of Public Health
6.5%	Community and social services	1.0%	Harvard Medical School	12.0%	Community and social services	1.3%	UNC Chapel Hill

^a Multiple responses to categories are allowed so columns do not add to 100%.

Source: Author extraction from: Linkedin.com. https://premium.linkedin.com/. Accessed May 1, 2021.

3.3. Related fields to HSR

In examining six other skill areas related to HSR identified through Linkedin.com (Table 3), bioinformatics was a common skill (n = 84,605) followed by health economics (n = 18,735). Among the 437,847 individuals who identified data science as a skill, only 9403 were working in the hospital and health care industry. Of similar magnitude as the HSR workforce was social epidemiology at 9232 individuals. Translational science (n = 3308) and implementation science (n = 3916) were the least common self‐identified skill among the six. Research, education, and health care services were among the top five most frequent job functions in each of the six areas, except bioinformatics, which did not include health care services among the top five.

Universities, medical centers, and government agencies were common employers for not only those with HSR skills but also those with social epidemiology, translational science, and implementation science skills. Pharmaceutical companies were among the common employers for those with health economics and bioinformatics skills. Data scientists were often employed in companies that provide access to big data to researchers (e.g., Optum and IQVIA) or have reputations for using big data in practice (e.g., United Health Group and Kaiser Permanente).

3.4. Recent graduates

The number of individuals completing a master's or doctoral degree in one of the core HSR fields generally increased over time (Appendix E of Supporting information). During the last 5 years, 87,821 completed a master's degree and 3105 completed a doctoral degree from a public or not‐for‐profit institution. An additional 24,711 graduates completed a master's degree and 5986 completed a doctoral degree when considering extended HSR fields and experienced an upward trend over time.

Among core fields in public and not‐for‐profit institutions, most of the graduates were female with slightly higher and growing rates among master's versus doctoral graduates (Appendix F of Supporting information). Hispanic (any race) graduates were a larger percentage of master's graduates by the end of the 5 years, gaining 2.9 percentage points, while among doctoral graduates, the gain was minimal, although representation fluctuated over time (Figures 1 and 2). White and nonresident graduates declined in percentage among both master's and doctoral graduates, while Black/African American graduates and those reporting two or more races increased their representation. Asian graduates gained representation at the master's level and lost representation at the doctoral level, while nonresidents lost representation at the master's level and gained representation at the doctoral level. The percentage of individuals identifying as Native Hawaiian or Other Pacific Islander or American Indian/Alaska Native remained steady among master's and doctoral graduates over time.

FIGURE 1.

Racial and ethnic diversity of health services researchers graduating with a master's degree from a core field in public and not‐for‐profit institutions between 2015 and 2019. Hispanic and non‐Hispanic values add to 100%. Core fields include public health, general; health/health care administration/management; health policy analysis; health services administration; health services/allied health/health sciences, general. Fields are defined using the Classification of Instructional Programs. Source: Integrated Postsecondary Education Data System: complete data files. https://nces.ed.gov/ipeds/datacenter/DataFiles.aspx?goToReportId=7. Accessed March 1, 2021 [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2.

Racial and ethnic diversity of health services researchers graduating with a doctoral degree from a core field in public and not‐for‐profit institutions between 2015 and 2019. Hispanic and non‐Hispanic values add to 100%. Core fields include public health, general; health/health care administration/ management; health policy analysis; health services administration; health services/allied health/health sciences, general. Fields are defined using the Classification of Instructional Programs. Source: Integrated Postsecondary Education Data System: complete data files. https://nces.ed.gov/ipeds/datacenter/DataFiles.aspx?goToReportId=7. Accessed March 1, 2021 [Color figure can be viewed at wileyonlinelibrary.com]

While gender mix was similar among doctoral graduates in extended fields compared with core fields, females experienced a decline at the master's level (Appendix G of Supporting information). Similar to the core fields, the percentage of White graduates in extended fields declined. Among master's graduates, representation increased among nonresident (3.7 percentage points), Asian (2.4), Hispanic (1.1), and multiracial (0.4) graduates, while Black/African American graduates lost representation by 0.9 percentage points. Among doctoral graduates, however, Black/African American graduates saw the largest gain (2.8 percentage points) among the various racial groups.

Including for‐profit institutions, which was not considered in prior analyses, increased the count of master's graduates from core programs by about 15% and doctoral level graduates by about 30% (Appendix H of Supporting information), with the majority of these degrees conferred by Walden University (the other four common institutions being the University of Phoenix, Capella University, Trident University International, and California Intercontinental University) in either health services or public health. For‐profit institutions had higher percentages of females graduating from both core HSR master's and doctoral programs compared with public and not‐for‐profit institutions. Whereby public and not‐for‐profit institutions saw about half of their master's and doctoral graduates from racially minoritized groups, nearly three‐quarters of for‐profit graduates were from racially minoritized groups, with Black/African American individuals representing about 40% of graduates.

Compared with master's and doctoral graduates across all fields, females had higher representation among HSR graduates from both core and extended fields across all institution types, except female doctoral graduates in the most recent year (Appendices I and J of Supporting information). Graduates from core HSR fields were both ethnically and racially more diverse than master's and doctoral graduates from all fields. Although those graduating from extended HSR fields were slightly more racially diverse compared with graduates from all fields, individuals identifying as Hispanic were underrepresented among those graduating from extended HSR fields. Black/African American individuals at the master's and doctoral level had higher representation among HSR graduates compared with graduates from all fields from for‐profit institutions (13 and 11 percentage points in the most recent year, respectively).

4. DISCUSSION

By expanding the sources used in this study compared with previous studies, we saw a notable jump in the size of the HSR workforce from 11,596 in 2007 and 14,526 in 2015 to 28,136 in 2020. ⁶ , ⁷ Given that authorship added substantially to the count, it is not surprising that this number is on par with ResearchGate.net, which also relies on publications. Both AcademyHealth and Linkedin.com found approximately 9000–10,000 health services researchers in 2020, which is higher than previous studies, but lower than what was identified through publications and grants. While these numbers provide a range from which we can continue monitoring the growth of the field, the variability is based on the sources used, which reflects the challenges of defining the boundaries of the field. Compared with the previous study, the number of master's and doctoral graduates from core fields has been steadily increasing, which is likely to be contributing to the growth of the field. ⁶ Previous estimates of HSR graduates may have been underestimated by not including graduates from for‐profit institutions, which may continue to add to the field given increasing enrollment in recent decades as well as during the pandemic because of the offering of online programs. ¹⁹ The field may see further increases due to a “Fauci Effect,” whereby COVID‐19 events have inspired many more individuals to apply to the health professions, which may spillover into HSR. ²⁰

Future studies should consider the extent to which individuals with skills in HSR are overlapping with skill sets in bioinformatics, data science, health economics, implementation science, social epidemiology, and translational science. Given the size of the fields of bioinformatics, health economics, and data science (without restrictions in industry), the majority of these individuals are not likely to self‐identify as health services researchers although they may conduct HSR. The varied set of employers across these three skill sets compared with the HSR workforce suggests that each field provides unique training. Work would be needed to understand whether employers are making explicit comparisons between those with HSR skills versus data science, for example. The number of individuals with self‐identified skills in implementation science, social epidemiology, and translational science was the same or less than those self‐identified as health services researchers. Further analysis would be needed to determine whether these are subsectors within health services research given the overlapping set of employers with the HSR workforce.

Achieving diversity remains a challenge for the field. Females are well‐represented among AcademyHealth's members and recent graduates compared with the US adult population of 51% in 2020 (Appendix K of Supporting information). Yet, despite the growth of female representation among core HSR graduates at both the master's and doctoral level, which is consistent with the prior study's findings, the percent of female AcademyHealth participants (members and nonmembers) remains at the same level as stated in previous reports. ⁶ AcademyHealth's members are more racially diverse than the US adult population, with two to three times greater representation among Asian individuals yet about 30% lower representation among Black/African American individuals and 75% lower representation among Hispanic individuals compared with national statistics (Appendix K of Supporting information). Black/African American and Hispanic graduates in core HSR fields have been increasing over time, which may improve this gap with intentional efforts.

4.1. Limitations

There are a few limitations to this study. We relied upon multiple data sources that overlap with no one source to track unique health services researchers. Merging datasets by name required assumptions about the unique combination of first, middle, and last names. Each of these data sources was incomplete, often relying on self‐identification into the field. For example, diversity information extracted from AcademyHealth had a quarter to a third of the fields missing information in earlier years, making comparisons over time challenging and requiring pooling of data to get a more accurate picture (Appendix K of Supporting information). Additionally, data availability changed over time (e.g., AHRQ Gold no longer listing grants publicly by PI name; new CIP code for data science being collected starting in 2019). As new journals and alternative forums such as blogs emerge, tracking authors can be challenging if these outlets are not indexed (e.g., Health Affairs blog and JAMA Health Forum, which were not yet indexed as of the end of 2020). Also, health services researchers often publish in clinical journals including JAMA Open Network and New England Journal of Medicine, or international journals such as BMC Health Services Research, but disentangling US‐based authors is difficult without a consistently used Medical Subject Heading (MeSH) term to identify HSR studies. We assumed that health services researchers published at least once in one of the 11 HSR‐oriented journals identified in this analysis over the last 5 years.

5. CONCLUSIONS

Before the pandemic, several reports outlined ways in which HSR should be leveraged to inform specific sectors of health care delivery such as primary care and nursing, while calling for trainees to learn the skills to keep up with increasingly large and complex datasets and to gain real‐world experience to help design and implement relevant interventions in partnerships with stakeholders. ²¹ , ²² , ²³ , ²⁴ The pandemic has created new opportunities for the HSR workforce to answer pressing policy‐relevant questions such as how widespread adoption of telehealth, relaxation of scope of practice regulations, and the pause on the use of low‐value and elective services have affected health outcomes, quality, and costs. ²⁵ , ²⁶ , ²⁷ , ²⁸ Investments by federal agencies (e.g., NIH and AHRQ), foundations, large health care delivery systems, and health insurers will be needed to ensure that the HSR workforce of the future has the skills and resources to keep up with these urgent calls.

Greater investments to diversify the HSR workforce and bring the voices of historically marginalized communities to the field are critical for framing research questions and developing policies and programs that best reflect the health needs of the community. ²⁹ The growing role of for‐profit institutions may serve as a barrier to diversifying the HSR workforce, which has left graduates with high debt burden and without gainful employment. ³⁰ , ³¹ Policy makers need to remedy these burdens disproportionately placed particularly on Black/African American graduates with regulation and oversight, while also providing loan repayment and career support. ³² , ³³ Stakeholders including AcademyHealth and NIH are synthesizing numerous DEI trainings to help academic institutions and employers diversify the health services and broader scientific research workforce. ³⁴ , ³⁵ For example, resources are available on how to conduct holistic admissions processes, provide career mentorship for students and faculty of color, and develop a culture of rewarding engagement in DEI activities. Institutions, however, need to lead in creating an environment conducive to addressing structural racism that serves as a barrier to diversifying the HSR workforce and ultimately improving the health of the population. ³⁶

Supporting information

Appendix S1. Supporting information.

Frogner BK. How the health services research workforce supply in the United States is evolving. Health Serv Res. 2022;57(2):364-373. doi: 10.1111/1475-6773.13934