Toward a better understanding of the retention of physician-scientists in the career pipeline
We question the implications of the study by Jeffe and Andriole,1 who assembled a novel database from disparate sources to investigate the role of Medical Scientist Training Program (MSTP) funding for MD/PhD student training. MSTPs (i.e., MSTP programs) were stratified by duration of MSTP funding to their respective institutions. As reported in Table 2, recent MSTPs were more similar in student prematriculation characteristics to non-MSTPs than they were to long-standing MSTPs. Because the authors did not compare all MSTPs with all non-MSTPs, their concluding recommendation that future studies take into account the MSTP funding status of MD/PhD trainees should be evaluated with the duration of MSTP funding to the institution in mind.The authors found that female and minority students were more likely to graduate from long-standing MSTPs than from non-MSTPs. However, the analysis did not normalize the ethnic and gender diversity of the MD/PhD cohort to the overall medical student cohort at each respective school. Thus, it is unclear whether the increased diversity is due to MSTP funding or certain institution-specific factors. Intra-institutional normalization could also have been performed on other variables (e.g., MCAT score and the undergraduate institution's Carnegie Classification).Another potential confounder of the analysis is the research milieu in which the long-standing MSTPs function, that is, the home medical school. For example, as a crude analysis, out of the 43 medical schools with MSTPs in 2010–2011, 36 (84%) were concurrently among the top 43 medical school recipients of NIH funding in 2010.2 We maintain that the institutional environment plays a more integral role in the development of physician–scientists than does the funding mechanism. Institutions giving higher priority to research are more likely to have invested in the proper infrastructure and resources to support MD/PhD students and to fully fund them. With the authors' finding of increased MD/PhD graduate debt linked to increased likelihood of pursuing a nonuniversity clinical practice, further investigation is warranted regarding the role of institutional trainee support, level of financial support, and sources of funding beyond MSTP support alone.Based on Table 4, there was no significant difference between long-standing MSTP, recent MSTP, and non-MSTP graduates regarding pursuing a career outside that of full-time faculty/research scientist. This suggests that obtaining both the MD and PhD degrees, regardless of MSTP funding, is in itself sufficient for this outcome. However, a comparison of the students' research career intentions at the time of matriculation—from the AAMC Matriculating Student Questionnaire (MSQ)—with their intentions at the time of graduation would have been a better measurement of the influence of MSTP funding on the persistence of career intentions. The fact remains that no studies have shown the predictive value of career intentions on actual outcomes.3,4Incorporating information from the MSQ and implementing postgraduation longitudinal studies would provide a better understanding of the impact of factors such as training environment and funding support on the retention of physician–scientists in the career pipeline.