Career Intentions and Research-Environment Factors Across the Physician-Scientist Pipeline
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Importance
Physician-scientist careers depend on sustained research funding, protected time, and institutional resources. However, data on career-retention attitudes across career stages are limited.
Objective
To characterize career intentions and associated research-environment factors among MD-PhD students and early-career physician-scientists.
Design
Two independent, national cross-sectional surveys were conducted during nonoverlapping periods in 2025; MD-PhD applicant and matriculant trends were also examined.
Setting
Medical schools and academic health centers in the United States.
Participants
MD-PhD students and early-career physician-scientists (ECPS).
Exposures
MD-PhD exposures included perceived institutional support, training-related mental health impact, and research disruption. ECPS exposures included institutional support, adverse funding-related wellbeing, and direct National Institutes of Health funding-process disruption.
Main Outcome and Measures
Primary outcomes were consideration of leaving the physician-scientist pathway among MD-PhD students and consideration of leaving academic medicine or research among ECPS. Secondary outcomes included likelihood of staying in academic medicine, research-intensive career preference, and consideration for leaving the US to continue research.
Results
Among MD-PhD programs confirmed to have distributed the survey, 838 student responses were received (estimated response rate of 19.3%); 175 ECPS responses were received, with no calculable individual-level response rate. Among MD-PhD students, 423 of 835 (50.7%) reported considering leaving the physician-scientist pathway; 712 of 837 (85.1%) reported a high likelihood of remaining in academic medicine, and 664 of 836 (79.4%) preferred a research-intensive career. Adequate institutional support was associated with lower odds of considering leaving (adjusted odds ratio [aOR], 0.28; 95% CI, 0.14-0.54) and higher odds of staying in academic medicine (aOR, 5.65; 95% CI, 2.91-10.98). Training-related mental health impact (aOR, 2.34; 95% CI, 1.72-3.19) and research disruption (aOR, 1.83; 95% CI, 1.35-2.48) were associated with greater odds of considering leaving. Among ECPS, 57.7% considered leaving, 52.6% reported a high likelihood of staying, and 42.9% considered leaving the United States to continue research. Adverse funding-related well-being was associated with considering leaving academic medicine (aOR, 3.13; 95% CI, 1.52-6.63) and leaving the United States to continue research (aOR, 5.29; 95% CI, 2.35-13.12).
Conclusions and Relevance
Consideration of leaving was common despite continued interest in academic and research-intensive careers. Institutional support, adverse well-being, and research disruptions were associated with career intentions.
Key Points
Question
What research-environment factors are associated with career intentions among MD-PhD trainees and early-career physician-scientists?
Findings
In national surveys of 838 MD-PhD students and 175 early-career physician-scientists across the nation, 50.7% and 57.7% respectively reported considering leaving the physician– scientist pathway, although most anticipated remaining in academic medicine. Institutional support was associated with lower odds of considering leaving among MD-PhD students, while adverse well-being was associated with career-exit intentions across career stages.
Meaning
Consideration of leaving was common despite continued interest in research-intensive careers. Institutional support, research environment stability, and well-being emerged as potential targets for strengthening the physician-scientist pipeline.
