Abstract
BackgroundPrior studies have described the career paths of physician-scientist candidates after graduation, but the factors that influence career choices at the candidate stage remain unclear. Additionally, previous work has focused on MD/PhDs, despite many physician-scientists being MDs. This study sought to identify career sector intentions, important factors in career selection, and experienced and predicted obstacles to career success that influence the career choices of MD candidates, MD candidates with research-intense career intentions (MD-RI), and MD/PhD candidates.MethodsA 70-question survey was administered to students at 5 academic medical centers with Medical Scientist Training Programs (MSTPs) and Clinical and Translational Science Awards (CTSA) from the NIH. Data were analyzed using bivariate or multivariate analyses.ResultsMore MD/PhD and MD-RI candidates anticipated or had experienced obstacles related to balancing academic and family responsibilities and to balancing clinical, research, and education responsibilities, whereas more MD candidates indicated experienced and predicted obstacles related to loan repayment. MD/PhD candidates expressed higher interest in basic and translational research compared to MD-RI candidates, who indicated more interest in clinical research. Overall, MD-RI candidates displayed a profile distinct from both MD/PhD and MD candidates.ConclusionsMD/PhD and MD-RI candidates experience obstacles that influence their intentions to pursue academic medical careers from the earliest training stage, obstacles which differ from those of their MD peers. The differences between the aspirations of and challenges facing MD, MD-RI and MD/PhD candidates present opportunities for training programs to target curricula and support services to ensure the career development of successful physician-scientists.
Highlights
Prior studies have described the career paths of physician-scientist candidates after graduation, but the factors that influence career choices at the candidate stage remain unclear
[48] There was a higher proportion of Medical School (M1) students represented (27.5%) compared to Medical School (M2) (20.2%), Medical School (M3) (18.9%) and Medical School (M4) (20.2%), statistical analysis was not performed due to minimum expected cell count violation
The categories Graduate School (G1)-Graduate School (G5) or more represent MD/PhD students in their PhD training years and it was expected that a higher percentage of MD/PhD students than MD students would indicate being in those stages
Summary
Prior studies have described the career paths of physician-scientist candidates after graduation, but the factors that influence career choices at the candidate stage remain unclear. Attrition rates for new medical school faculty, including MD, MD-PhD, and PhD, are approaching 50% [16,17,18], and the proportion able to successfully obtain postdoctoral or career development awards (CDAs, e.g. NIH K08 mentored fellowships) has been in decline for many years, with less than 40% of applicants successfully obtaining a CDA [19] Of those who do successfully receive such awards, approximately one-third never progress to their first independent NIH R01 [13], a difficulty reflected in the ever-rising age at which a junior physician-scientist receives his or her first independent research grant [17, 19, 20]. Physician-scientists are making up an increasingly smaller portion of the overall pool of NIH-funded researchers [11, 20,21,22] In short, the physician-scientist pathway has become a very leaky pipeline [1, 13], with many candidates lost at every stage of training
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