Maybe some doubts arising about the Medical Scientist Training Program? Part 1

I recently completed a several-year stint on my institution's Medical Scientist Training Program (MSTP) admissions committee. The MSTP is an NIH-funded program that pays for combined M.D./Ph.D. training at various research-oriented medical schools. The applications I saw--from the subset of candidates who were offered interviews--were highly (scarily) impressive: they sometimes (OK, often) made me wonder whether I would have been admitted had I applied in recent years.

The applicants I interviewed uniformly stated they envisioned a career in academic medicine with something like 20% of time devoted to clinical work and the rest being devoted to research (with teaching and administrative work also thrown into the mix). This distribution of effort conforms to the classic model of an academic physician-scientist. Out of curiosity (not as part of the formal interview), I asked a few of the applicants if they knew where their salary would typically come from if they pursued such a career. I was surprised that only one applicant (of the four I asked) was familiar with "soft money" (this applicant's parent was an academic physician).

I stumbled upon an online student forum with many participants applying to MSTP programs or at various stages of MD/Ph.D. training. It's not surprising to see that after they learn about the soft money system and become aware of its downsides, many of the trainees begin to reevaluate things, thinking much more concretely about how they want to structure their careers and about trade-offs involving risk, stress, job security, etc. We should probably ensure that students contemplating applying for MSTP positions are made aware of the practical realities of a career as a clinician-scientist up front.

My impression--based not on any formal analysis but rather on my first-hand knowledge of the career paths of other MD/Ph.D grads and my perusal of residency match and alumni information on the MSTP websites of various medical schools--is that a large fraction of MD/Ph.D. graduates go on to careers in which the ~4 years of intensive research training that goes into the Ph.D. is unnecessary and a waste of public funds. This could be the subject of an entire post or two, and I'm not going to go into detail here; just one observation along these lines. The nature of my graduate school work would have made me an ideal candidate for a dermatology residency. My research mentor (himself a physician-scientist) made it clear to me that he hoped I did not take this route. Why? Because, I would encounter sirens, the lifestyle and pay of dermatology private practice, that would lure my research career to its doom. As others have noted, it seems now that an increasing number of MD/Ph.D. candidates leverage the caché of their Ph.D. degrees to gain admittance to competitive residency programs in clinical specialties--such as dermatology, ophthalmology and radiology-- known for good lifestyle and lucrative salaries. Over 40% of MD/PhD graduates choosing dermatology, ophthalmology or radiology, for example, end up in private practice.

I recently learned that there are people paying attention attention to all this and that questions about the future of the MSTP program are being raised at the highest levels of the NIH. I will provide specifics in my next post.*

*Update: part 2 now posted.