Phenomenon: Despite a high degree of interest in research among matriculating M.D. students, very few apply to combined M.D.-Ph.D. training programs. Even fewer of those applicants are female, leading to a gender disparity among M.D.-Ph.D. trainees. We used a qualitative approach to understand why students choose not to apply or matriculate to M.D.-Ph.D. programs. Approach: We recruited recently matriculated medical students at a private research university with a self-reported interest in academic medicine and biomedical research to participate in focus groups, in which students discussed their career and life goals, general knowledge and sources of information for M.D.-Ph.D. programs, perceived benefits and downsides, and barriers to applying to such programs. Findings: Twenty-two students participated in focus groups. Participants desired careers combining clinical work, research, and teaching. Students had knowledge of the structure and goals of M.D.-Ph.D. training and received information about dual-degree programs from research mentors, the Internet, and peers. Tuition remission and increased grant access were cited as benefits of M.D.-Ph.D. programs, whereas duration, perceived excessive research training, and early commitment were downsides. Perceived competitiveness, misconceptions about training, a lack of M.D.-Ph.D. program-specific advising, discouragement from applying, and duration of training all served as barriers preventing students from pursuing dual-degree training. Insights: Through this qualitative study, we identified perceptions and misconceptions that recent medical school applicants have about M.D.-Ph.D. programs. These findings suggest targetable barriers to increase applications from interested students, such as improving awareness of programs, increased accessibility of advising and resources, and addressing concerns over training length, with the goal of improving training access for aspiring physician-scientists.