NIGMS has a longstanding commitment to developing the next generation of biomedical scientists through a variety of programs, including the M.D.-Ph.D. dual degree Medical Scientist Training Program (MSTP). This program provides Ruth L. Kirschstein Institutional Predoctoral Training Grant (T32) awards to medical institutions that are responsible for training physician scientists. The Physician-Scientist Workforce Working Group Report [PDF, 6.2 MB] of NIH’s Advisory Committee to the Director highlighted the decline of physician scientists as a percentage of overall NIH principal investigators. NIH data presented at the 50th Anniversary Medical Scientist Training Program Symposium showed that while earlier cohorts of MSTP trainees were highly successful in achieving independent research careers and NIH grant support, more recent graduates have been less successful. Many factors may contribute to this difference, including lengthening of the post-M.D.-Ph.D. training period before achieving independence and increased competition of investigators for limited research funds and positions.
We are seeking input from the biomedical research community and other interested groups through a Request for Information (RFI) on strategies and ideas for the modernization of physician-scientist training that can be addressed through the MSTP.
More specific topics are included in the RFI, but examples of broad areas of interest are:
- Trainees (e.g., time of recruitment to the MSTP, diversity of the applicant pool and selection criteria)
- Financing/funding (e.g., how different M.D.-Ph.D. funding models influence the range of institutions that apply for MSTP support, the pool of trainees and the trainees’ commitment to research careers)
- Dual-degree training (e.g., time-to-degree, integration of curriculum, training areas, mentoring and career advising)
- NIGMS management of MSTP grants (e.g., size, number and distribution of training programs; evaluation of outcomes; and peer review)
- Anything else specific to MSTP training that you feel is important for NIH to consider with respect to enhancing M.D.-Ph.D. training and the persistence of physician-scientist trainees in research careers (note that changes in post-M.D.-Ph.D. training and future research support are outside of the scope of this RFI)
Responses can be submitted via an online form 
and can be anonymous. The due date for providing input is August 9, 2017.
The final year of PhD thesis research, is when things often ‘come together’ for regular PhD students. Unfortunately this period of maturation and growing independence is often truncated for MSTP sudents due to the rigid timelunes for starting the clinical years and the lack of funding for an extra year of research. As a eesult, confidence in research ability may not develop.
The MSTP entering cohort seems to include roughly equal numbers of students highly motivated and well suited for research, on one hand, and others who aspire to the prestige and the Free Ride but who never really enjoy or get motivated during their PhD studies. How to sort them out better? Perhaps a trial year in the PhD training, with lab rotations, and then a decision permittin exit from the dual degree program without a huge financial penalty. This would reduce wasted effort by research advisors and wasted funds on students who will not pursue research careers.
Given the long training period between completion of the PhD in the standard MSTP training program; followed by several years of subsequent MD residency and fellowship training; plus the rapid pace of advancement of scientific technologies, means that many MSTP graduates enter their first faculty position with hopelessly outdated if not forgotten research skills. Recognizing this (many years ago), I created a training program dubbed “The Medical Fellows PhD Program” at the University of Colorado School of Medicine that recruited MD Fellows into an accelerated PhD training program. The reasoning was that these individuals had already chosen a medical subspecialty, already had a solid biomedical education, and should be targeting their research training alongside faculty members, both MD and PhD, in their specialty area. Upon completion of the PhD, these Fellows would be prepared to immediately accept a faculty position having at their disposal state-of-the-art research tools, and relevant contemporary hypotheses, in their field of interest. Frankly, the competing MSTP program and lack of financial support allowed the “Fellows” program to die on the vine. However I still think it’s a good idea and a better model than the standard MSTP order of training.
There are two major perspectives that need to be addressed in optimizing the Medical Scientists Training Programs for the next decade. The first is why would students want to participate in these programs and the second is what is the outcome that the funders should be focused on in order to get a significant return on their investment.
From the perspective of students, the current dual degree programs are long and arduous; involve numerous formal course requirements, some seeming either repetitive or redundant; and require significant personal sacrifices. Fundamental changes in incentives to undertake the rigorous requirements of this career path are needed. These should also address the relevancy of the physician-scientist in 2025 and beyond.
The majority of graduates from dual degree programs tend to continue their careers in academic medicine either as highly successful research investigators or in key leadership and administrative roles. The impact of the rigorous training has set these individuals apart as major thought leaders in medical research and clinical practice. However, when they enter the workforce, physician-scientists face the prospect of starting their independent career paths at an older age than their colleagues, with more debt, and still face a period of professional transition that will involve continued sacrifices in their personal lives while still not reaping the economic benefits from the major investment they have already made in establishing their credentials. This raises serious concerns about the attractiveness of the program for the brightest and best candidates. Developing career trajectories that align more attractively with economic benefits [e.g. student debt relief, more access to early career transitional funding, guaranteed positions at NIH, CDC or tenure–track positions at NIH funded research centers] merits consideration.
While dual degree programs have been highly successful in selected areas of molecular and personalized medicine, it is not as evident that they have adapted and evolved as quickly to embrace the challenges of healthcare economics, the impact of behavioral and social determinants of health (zip code vs. genetic code) or have provided direction in the increasing concerns on rigor and reproducibility in biomedical research. The successful physician-scientists (physician-leader) of the future should represent a spectrum of expertise that has adapted and evolved to reflect the changing world in which we live.
The next generation of health leaders will need to be effective at working in teams and have a broad understanding of multiple disciplines, not all of which fall into the traditional biomedical or clinical research categories. For example, expertise in advanced data analytics, health communications, health economics, health policy, political science, ethics as well as business and entrepreneurship will all have potential roles in enabling the advances in basic medical research to reach all who can benefit.
Future training for thought leaders in health and wellness should transition away from a “siloed” (physician-scientist) approach to a more ”holistic” ( physician-leader) view. A focus on core competencies that will drive the application of rigorous, evidence-based medicine to catalyze a positive effect on health outcomes for all would be the desired outcome. This could be achieved through innovations to existing programs that streamline the development of key core competencies and reduce, rather than simply add, requirements to the dual degree process. There is also a place for the development of new innovative programs that are designed to mentor individuals who can mange and advance a holistic approach to community and population health. Such programs have the potential to attract a wider range of more diverse, highly talented individuals who have a greater interest in behavioral and social determinants of health that reflect their life experiences growing up in medically under-served areas.
At a time when healthcare is such a central focus of our national debate, it is imperative to have well trained thought leaders who can develop practical solutions to the myriad of challenges that impact a healthy society.