Graduation day: Not everyone gets there Credit: iStockphoto

A close look at the elite physician-scientist programs in the US has sparked questions about the retention of women and minorities in such programs.

Many students in MD-PhD programs receive financial assistance from the government's Medical Scientist Training Program (MSTP), which received more than $40 million from the US National Institutes of Health last year alone. Although these courses enroll only around 3% of US medical graduates, they have been seen as an important aspect of the American educational system since their founding in the 1960s.

Dorothy Andriole of the Washington University School of Medicine in St. Louis and her colleagues collated information from nearly 80,000 US medical graduates, including almost 2,000 joint-degree graduates. The group's report, released in September, details among other things that only 30% of those graduating from MD-PhD programs were female, compared with 46% of those graduating from regular MD programs (J. Am. Med. Assoc. 300, 1165–1173; 2008). And whereas around three-quarters of the men who entered the dual-degree programs completed them, only two-thirds of the women who matriculated into these programs finished them.

“The real concern on my part is that whereas women are joining these programs, they do not seem to be staying the course,” says Leon Rosenberg of Princeton University. “For whatever reason, we are not retaining women in these programs at the numbers we need to.”

The new study also found that only 7.4% of those graduating from MD-PhD programs were from under-represented minorities, such as black and Hispanic groups, compared with 13% for standard medical degrees.

“I do think there is cause for concern” in the lack of diversity among MD-PhD trainees, says Greg Barsh, head of Stanford's MSTP and a former MD-PhD student himself. “At my program, we work very hard to promote diversity. I think we've been successful, but must continue to work in an affirmative and proactive manner.”

Uncertainties also remain over whether the career intentions of students entering MD-PhD programs match actual outcomes, and whether MSTP support is producing scientific innovation that would not otherwise have come about.

These questions may be answered in the near future. David Engman, director of the MSTP division at Northwestern University and chair of the Association of American Medical Colleges' MD-PhD Section, told Nature Medicine that a system is currently being developed to track outcomes from these programs.

“We have just completed a study of more than 2,000 current MD-PhD students, 1,100 MD-PhD graduates still in postgraduate training and 2,900 MD-PhD graduates who have completed training,” says Engman. He adds that the results show that 16% have entered private practice, whereas 68% have careers in academia and 8% work in the biotech or pharmaceutical industries.