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Abstract
The earliest MD-PhD programs were small and enrolled mostly men. Here, we show that since 2014 there has been a steady increase in the number of women in MD-PhD programs, the number of women reaching parity with men in 2023. This change was due to an increase in female applicants, a decrease in male applicants, and an increase in the acceptance rate for women, which had previously been lower than that for men. Data from the National MD-PhD Program Outcomes Study show that training duration has been similar for men and women, as have most choices of medical specialties and workplaces. However, women were less likely to have full-time faculty appointments, fewer had NIH grants, and those in the most recent graduation cohort at the time of the survey reported spending less time on research than men. Previously cited reasons for these differences include disproportionate childcare responsibilities, a paucity of role models, insufficient recognition, and gender bias. Institutions can and should address these obstacles, but training programs can help by preparing their graduates to succeed despite the systemic obstacles. The alternative is a persistent gender gap in the physician-scientist workforce, lost opportunities to benefit from diverse perspectives, and a diminished impact of valuable training resources.
Authors
Lawrence F. Brass, Myles H. Akabas
Abstract
The average time to degree for completing a life sciences PhD in the United States is longer for single-degree than dual-degree trainees, supporting a perception that the PhD training of MD-PhDs is less rigorous or fulsome. To determine whether degree format influences the duration and impact of graduate training, we analyzed data for the 2011–2016 graduates of 3 Harvard Medical School PhD programs. Linear mixed effects models were used to determine the association between degree type (MD-PhD vs. PhD) and research outcomes, including time to degree, time to thesis defense, and publications submitted during the PhD. Although pursuing an MD-PhD was associated with a 1.5-year shorter time to PhD degree, basing this calculation on the official PhD period does not account for completion of early PhD requirements, including research rotations and qualifying coursework, during the first 2 years of medical school. There was no association between degree format and total number of first-author or overall publications, though pursuing a dual degree was associated with increased impact metrics of published papers. The results highlight that despite the seemingly shorter PhD durations of MD-PhD graduates based on graduate program enrollment period, research training is on par with their single-degree peers, rendering MD-PhD graduates well equipped to become successful scientific investigators.
Authors
Rory Vu Mather, Temperance R. Rowell, Steve Obuchowski, Loren D. Walensky
Abstract
Physician-scientists play a crucial role in advancing medical knowledge and patient care, yet the long periods of time required to complete training may impede expansion of this workforce. We examined the relationship between postgraduate training and time to receipt of NIH or Veterans Affairs career development awards (CDAs) for physician-scientists in internal medicine. Data from NIH RePORTER were analyzed for internal medicine residency graduates who received specific CDAs (K08, K23, K99, or IK2) in 2022. Additionally, information on degrees and training duration was collected. Internal medicine residency graduates constituted 19% of K awardees and 28% of IK2 awardees. Of MD-PhD internal medicine–trained graduates who received a K award, 92% received a K08 award; of MD-only graduates who received a K award, a majority received a K23 award. The median time from medical school graduation to CDA was 9.6 years for K awardees and 10.2 years for IK2 awardees. The time from medical school graduation to K or IK2 award was shorter for US MD-PhD graduates than US MD-only graduates. We propose that the time from medical school graduation to receipt of CDAs must be shortened to accelerate training and retention of physician-scientists.
Authors
Emily Jane Gallagher, Paul R. Conlin, Barbara I. Kazmierczak, Jatin M. Vyas, Olujimi A. Ajijola, Christopher D. Kontos, Robert A. Baiocchi, Kyu Y. Rhee, Patrick J. Hu, Carlos M. Isales, Christopher S. Williams, Don C. Rockey
Abstract
Previous studies on attrition from MD-PhD programs have shown that students who self-identify as Black are more likely to withdraw before graduating than Hispanic students and students not from groups underrepresented in medicine (non-UIM). Here, we analyzed data collected for the National MD-PhD Program Outcomes Study, a national effort to track the careers of over 10,000 individuals who have graduated from MD-PhD programs over the past 60 years. On average, Black trainees took slightly longer to graduate, were less likely to choose careers in academia, and were more likely to enter nonacademic clinical practice; although, none of these differences were large. Black graduates were also more likely to choose careers in surgery or internal medicine, or entirely forego residency, and less likely to choose pediatrics, pathology, or neurology. Among those in academia, average research effort rates self-reported by Black, Hispanic, and non-UIM alumni were indistinguishable, as were rates of obtaining research grants and mentored training awards. However, the proportion of Black and Hispanic alumni who reported having NIH research grants was lower than that of non-UIM alumni, and the NIH career development to research project grant (K-to-R) conversion rate was lower for Black alumni. We propose that the reasons for these differences reflect experiences before, during, and after training and, therefore, conclude with action items that address each of these stages.
Authors
Myles H. Akabas, Lawrence F. Brass
Abstract
A critical element of physician-scientist training is the development and practice of core competencies that promote success in research careers. The ability to develop compelling training and research proposals is one such foundational skill. The NIH Ruth L. Kirschstein National Research Service Award (NRSA) individual fellowship for dual-degree students (F30, F31, or F31-Diversity) creates an ideal opportunity to provide formal instruction in grant-writing skills to physician-scientists early in training. In the guided process of preparing a predoctoral fellowship application, students learn to formulate clear short- and long-term research and training goals; construct a comprehensive, well-reasoned, and rigorous proposal; become familiar with funding agency priorities; and gain strategic insights into the peer review system. Beyond building scientific writing skills, the application process for an NRSA F30 or F31 is an opportunity for trainees to strengthen mentor-mentee relationships, identify learning opportunities key to their scientific development, and build effective research and mentoring teams. These skills also apply to developing future postdoctoral mentored K applications or faculty research program grants. Here, we outline key features of the structured proposal development training developed for students in the Yale MD-PhD Program and review outcomes associated with its implementation.
Authors
Reiko Maki Fitzsimonds, Fred S. Gorelick, Barbara I. Kazmierczak
Abstract
The 2014 NIH Physician-Scientist Workforce Working Group predicted a future shortage of physician-scientists. Subsequent studies have highlighted disparities in MD-PhD admissions based on race, income, and education. Our analysis of data from the Association of American Medical Colleges covering 2014–2021 (15,156 applicants and 6,840 acceptees) revealed that acceptance into US MD-PhD programs correlates with research experience, family income, and research publications. The number of research experiences associated with parental education and family income. Applicants were more likely to be accepted with a family income greater than $50,000 or with one or more publications or presentations. Applicants were less likely to be accepted if they had parents without a graduate degree, were Black/African American, were first-generation college students, or were reapplicants, irrespective of the number of research experiences, publications, or presentations. These findings underscore an admissions bias that favors candidates from affluent and highly educated families, while disadvantaging underrepresented minorities.
Authors
Darnell K. Adrian Williams, Briana Christophers, Timothy Keyes, Rachit Kumar, Michael C. Granovetter, Alexandria Adigun, Justin Olivera, Jehron Pura-Bryant, Chynna Smith, Chiemeka Okafor, Mahlet Shibre, Dania Daye, Myles H. Akabas
Abstract
The average age when physician-scientists begin their career has been rising. Here, we focused on one contributor to this change: the increasingly common decision by candidates to postpone applying to MD-PhD programs until after college. This creates a time gap between college and medical school. Data were obtained from 3544 trainees in 73 programs, 72 program directors, and AAMC databases. From 2013 to 2020, the prevalence of gaps rose from 53% to 75%, with the time usually spent doing research. Gap prevalence for MD students also increased but not to the same extent and for different reasons. Differences by gender, underrepresented status, and program size were minimal. Most candidates who took a gap did so because they believed it would improve their chances of admission, but gaps were as common among those not accepted to MD-PhD programs as among those who were. Many program directors preferred candidates with gaps, believing without evidence that gaps reflects greater commitment. Although candidates with gaps were more likely to have a publication at the time of admission, gaps were not associated with a shorter time to degree nor have they been shown to improve outcomes. Together, these observations raise concerns that, by promoting gaps after college, current admissions practices have had unintended consequences without commensurate advantages.
Authors
Lawrence F. Brass, Reiko Maki Fitzsimonds, Myles H. Akabas
Abstract
Postgraduate physician-scientist training programs (PSTPs) enhance the experiences of physician-scientist trainees following medical school graduation. PSTPs usually span residency and fellowship training, but this varies widely by institution. Applicant competitiveness for these programs would be enhanced, and unnecessary trainee anxiety relieved, by a clear understanding of what factors define a successful PSTP matriculant. Such information would also be invaluable to PSTP directors and would allow benchmarking of their admissions processes with peer programs. We conducted a survey of PSTP directors across the US to understand the importance they placed on components of PSTP applications. Of 41 survey respondents, most were from internal medicine and pediatrics residency programs. Of all components in the application, two elements were considered very important by a majority of PSTP directors: (a) having one or more first-author publications and (b) the thesis advisor’s letter. Less weight was consistently placed on factors often considered more relevant for non-physician-scientist postgraduate applicants — such as US Medical Licensing Examination scores, awards, and leadership activities. The data presented here highlight important metrics for PSTP applicants and directors and suggest that indicators of scientific productivity and commitment to research outweigh traditional quantitative measures of medical school performance.
Authors
Emily J. Gallagher, Don C. Rockey, Christopher D. Kontos, Jatin M. Vyas, Lawrence F. Brass, Patrick J. Hu, Carlos M. Isales, Olujimi A. Ajijola, W. Kimryn Rathmell, Paul R. Conlin, Robert A. Baiocchi, Barbara I. Kazmierczak, Myles H. Akabas, Christopher S. Williams
Abstract
Authors
Ronald J. Koenig
Abstract
MD-PhD trainees constitute an important source of physician-scientists. Persistence on this challenging path is facilitated by success in garnering independent (R grant) support from the NIH. Published research tracks academic appointments and global R01 success for MD-PhD trainees but has not included information on future funding success of individual MD-PhD predoctoral grant holders. Here, we used data from the NIH RePORTER database to identify and track the funding trajectory of physician-scientists who received predoctoral grant support through the F30 mechanism, which is specific for dual-degree candidates. Male and female F30 awardees did not differ in their success in garnering K (postdoctoral training) grants, but, among F30 grant awardees, men were 2.6 times more likely than women to receive R funding. These results underscore the need for analysis of factors that contribute to the disproportionate loss of NIH-supported female physician-scientists between the predoctoral F30 and the independent R grant–supported stages.
Authors
Shohini Ghosh-Choudhary, Neil Carleton, S. Mehdi Nouraie, Corrine R. Kliment, Richard A. Steinman
Abstract
Authors
Marisa L. Conte, Santiago Schnell, Adrienne S. Ettinger, M. Bishr Omary
Abstract
The 2018 National MD-PhD Program Outcomes Study highlighted the critical need to increase MD-PhD trainee diversity and close the gender gap in MD-PhD enrollment. This Association of American Medical Colleges imperative prompted us to evaluate trends in female matriculation from our institutional MD-PhD program compared with national data. Based on a 10-year review of Harvard/MIT Medical Scientist Training Program admissions, we observed a sharp and sustained increase in female matriculants for the past 5 years that is well above the national average. We report our experience with achieving gender parity among matriculants of our MD-PhD program, identify the specific stage of the admissions process where the gender balance acutely shifted, and attribute the increase in female matriculation to concrete administrative changes that were put into place just prior to the observed gender balance shift. These changes included increasing the number of faculty participants in application screening and awardee selection and establishing gender balance among faculty decision makers. We believe that adopting basic administrative practices geared toward increasing the diversity of perspectives among admissions faculty has the potential to expedite gender parity of MD-PhD matriculants nationwide and could eventually help achieve gender balance in the national physician-scientist workforce.
Authors
Temperance R. Rowell, Robert A. Redd, Donna S. Neuberg, Loren D. Walensky
Abstract
MD-PhD programs were established in the 1950s as a new curriculum for training physician-scientists. Since then, the number of programs has grown considerably; however, concerns about the health of the US physician-scientist workforce have grown, as well. The largest attempt to date to assess whether MD-PhD programs are fulfilling their mission was the national MD-PhD program outcomes study, which was released as an American Association of Medical Colleges report in 2018. That study gathered information on 10,591 graduates of 80 MD-PhD programs over 50 years and concluded that most graduates have followed careers consistent with their training. Here, we provide additional analysis, drawing on survey data provided by 64.1% of alumni (75.9% of alumni with valid email addresses), plus program-supplied current workplace data for survey nonresponders to examine the relationships between medical specialty choices, training duration, research effort, and success in obtaining research funding. The results show that residency choices affect critical aspects of the physician-scientist career path, including where graduates work, how long it takes them to obtain an independent appointment in academia, and the amount of their professional time that is devoted to research. Entrants into MD-PhD programs are older, on average, now than when the programs were first established and are taking longer to graduate and complete postgraduate training. Although we found a positive relationship between professional effort devoted to research and the likelihood of having research funding, we found little evidence that the increase in training duration produces an increase in subsequent research effort. These data should provide both guidance for anyone considering this career path and insights for those who train and hire the next generation of physician-scientists.
Authors
Lawrence F. Brass, Myles H. Akabas
Abstract
In 2015, a nation-wide effort was launched to track the careers of over 10,000 MD-PhD program graduates. Data were obtained by surveys sent to alumni, inquiries sent to program directors, and searches in American Association of Medical Colleges (AAMC) databases. Here, we present an analysis of the data, focusing on the impact of sex, race, and ethnicity on career outcomes. The results show that diversity among trainees has increased since the earliest MD-PhD programs, although it still lags considerably behind the US population. Training duration, which includes time to graduation as well as time to first independent position, was similar for men and women and for minority and nonminority alumni, as were most choices of medical specialties. Regardless of minority status and sex, most survey responders reported that they are working in academia, research institutes, federal agencies, or industry. These similarities were, however, accompanied by several noteworthy differences: (a) Based on AAMC Faculty Roster data rather than survey responses, women were less likely than men to have had a full-time faculty appointment, (b) minorities who graduated after 1985 had a longer average time to degree than nonminorities, (c) fewer women and minorities have NIH grants, (d) fewer women reported success in moving from a mentored to an independent NIH award, and (e) women in the most recent graduation cohort reported spending less time on research than men. Collectively, these results suggest that additional efforts need to be made to recruit women and minorities into MD-PhD programs and, once recruited, to understand the drivers behind the differences that have emerged in their career paths.
Authors
Myles H. Akabas, Lawrence F. Brass
Abstract
Authors
Christopher S. Williams, Audra N. Iness, Rebecca M. Baron, Olujimi A. Ajijola, Patrick J. Hu, Jatin M. Vyas, Robert Baiocchi, Alexander J. Adami, Jeremie M. Lever, Peter S. Klein, Linda Demer, Michael Madaio, Mark Geraci, Lawrence F. Brass, Melvin Blanchard, Robert Salata, Mone Zaidi
