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Dorothy A. Andriole, MD; Alison J. Whelan, MD; Donna B. Jeffe, PhD

JAMA. 2008;300(10):1165-1173.

Context  MD/PhD program participants represent only a small proportion of all US medical students, yet they are expected to play a major role in the future physician-scientist workforce. The characteristics and career intentions of recent MD/PhD program and other MD program graduates have not been compared.

Objective  To identify factors associated with MD/PhD program graduation among recent medical graduates.

Design, Setting, and Participants  Deidentified data were obtained from a nationally representative sample of 88 575 US medical graduates who completed the national Association of American Medical Colleges Graduation Questionnaire from 2000-2006. Multivariate logistic regression was used to test responses to items regarding graduates' characteristics and career plans in association with program graduation, reporting adjusted odds ratios (ORs).

Main Outcome Measure  MD/PhD program graduation.

Results  Of the 79 104 respondents with complete data (71.7% of all 2000-2006 graduates), 1833 (2.3%) were MD/PhD program graduates. Variables associated with greater likelihood of MD/PhD program graduation included planned substantial career involvement in research (OR, 10.30; 95% confidence interval [CI], 8.89-11.93); lower educational debt (compared with $150 000: $100 000-$149 999, OR, 1.85; 95% CI, 1.35-2.52; $50 000-$99 999, OR, 5.50; 95% CI, 4.14-7.29; $1-$49 999, OR, 17.50; 95% CI, 13.30-23.03; no debt, OR, 17.41; 95% CI, 13.22-22.92); and receipt of medical school scholarships or grants (OR, 3.22; 95% CI, 2.82-3.69). Compared with planned training in internal medicine, MD/PhD graduation was positively associated with planned training in dermatology, neurology, ophthalmology, pathology, pediatrics, or radiology. Variables associated with lower likelihood of MD/PhD graduation included female sex (OR, 0.68; 95% CI, 0.60-0.77); race/ethnicity underrepresented in medicine (OR, 0.64; 95% CI, 0.52-0.80); and, compared with internal medicine, planned training in emergency medicine (OR, 0.58; 95% CI, 0.40-0.84) or surgery (OR, 0.70; 95% CI, 0.57-0.85).

Conclusion  Compared with graduates of other MD degree programs, MD/PhD graduates tend to be less demographically diverse, have a lower debt burden, favor different medical specialties, and have greater planned career involvement in research.

Author Affiliations: Departments of Surgery (Dr Andriole), Medicine (Drs Whelan and Jeffe), and Pediatrics (Dr Whelan), Washington University School of Medicine, St Louis, Missouri; and Health Behavior and Outreach Core, Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine, St Louis (Dr Jeffe).

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