Are MD-PhD programs meeting their goals? An analysis of career choices made by graduates of 24 MD-PhD programs

Abstract

Purpose: MD-PhD training programs provide an integrated approach for training physician-scientists. The goal of this study was to characterize the career path taken by MD-PhD program alumni during the past 40 years and identify trends that affect their success.

Method: In 2007-early 2008, 24 programs enrolling 43% of current trainees and representing half of the National Institutes of Health-funded MD-PhD training programs submitted anonymous data on 5,969 current and former trainees.

Results: The average program enrolled 90 trainees, required 8.0 years to complete, and had an attrition rate of 10%. Nearly all (95%) of those who graduated entered residencies. Most (81%) were employed in academia, research institutes, or industry; 16% were in private practice. Of those in academia, 82% were doing research and at least 61% had identifiable research funding. Whereas two-thirds devoted more than 50% effort to research, only 39% devoted more than 75% effort. Many with laboratory-based PhDs reported doing clinical, as well as basic and translational, research. Emerging trends include decreasing numbers of graduates who forego residencies or hold primary appointments in nonclinical departments, increasing time to graduation, and expanding residency choices that include disciplines historically associated with clinical practice rather than research.

Conclusions: Most MD-PhD program graduates follow career paths generally consistent with their training as physician-scientists. However, the range of their professional options is broad. Further thought should be given to designing their training to anticipate their career choices and maximize their likelihood of success as investigators.

Figure 1

Relationships among MD–PhD program size, time to degree, attrition rates, and the percentage of trainees who are women. (A) The relationship between program size in academic year (AY) 2008 and time to degree for students entering in AY1998–2007 using data from 23 MD– PhD programs (r² = 0.018). (B) The relationship between program size in AY2008 and attrition rate over the period from AY1998 to AY2007 using data from 24 programs (r² = 0.034). (C) The proportion of trainees in AY2008 who are women and the attrition rate over the period from 1998 to 2007 using data from 24 programs (r² = 0.043).

Figure 2

MD–PhD program graduates’ responses to questions about their recent research activities. (A) How much time do you devote to research? Responses from 814 alumni of 16 programs who are now in academia. (B) Which kinds of research do you do? Data from 736 alumni of 14 programs; more than one answer was allowed.

Figure 3

Emerging trends in choices made by MD–PhD program alumni and in the length of time required to graduate from MD–PhD programs. (A) Trends in the choice to do a postdoctoral research fellowship and forego doing a residency. Analysis drawn from data on 3,172 alumni from 23 programs divided into cohorts: 1965–1978 (n = 144), 1979–1988 (n = 551), 1989–1998 (n = 1,160), and 1999–2007 (1,317). (B) Trends in choosing a residency in internal medicine, neurology, pathology, or pediatrics compared with choosing a residency in dermatology, ophthalmology, radiation oncology, or surgery. Analysis drawn from data on 3,172 alumni from 23 programs divided into cohorts as shown in (A). (C) Trends in having a primary appointment in a basic science department. Analysis drawn from data provided by 22 programs divided into cohorts: 1965–1978 (n = 97), 1979–1988 (n = 383), 1989–1998 (n = 820), and 1999–2007 (n = 306). (D) Trends in choosing a career in academia, a research institute, industry, or private practice. Analysis drawn from data provided by 22 programs divided into cohorts: 1965–1978 (n = 163), 1979–1988 (n = 601), 1989–1998 (n = 1,198), and 1999–2007 (n = 306). (E) Average time to graduation. Trainees who graduated between 1998 and 2007 from the programs included in the present study required an average of 7.8 years (weighted) to complete both degrees. The data from studies completed in 1980, 1985, and 1995 are from the National Institute of General Medical Sciences.