Black students more likely to leave MD-PhD training programs
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Key takeaways:
- Overall, 29% of Black students and 17% of white students did not finish MD-PhD training.
- Black students were likeliest to graduate with an MD only vs. students of other races and ethnicities.
Black students had greater than 50% odds of leaving MD-PhD programs compared with their peers, a recent study published in JAMA Internal Medicine found.
Mytien Nguyen, MS, an MD-PhD candidate at Yale School of Medicine, and colleagues wrote that racial and ethnic diversity among MD-PhD matriculants has grown in recent years; however, “little is known about how attrition rates differ by race and ethnicity.”
“Disparities in retention may be an important contributor to diversity in the biomedical scientific workforce,” they added.
The researchers used deidentified data from the Association of American Medical Colleges to evaluate race and ethnicity attrition rates of MD-PhD matriculants from 2004 to 2012. They also determined the odds of students leaving programs with an MD only and leaving programs completely by adjusting models for Medical College Admission Test (MCAT) score by quartile.
The analysis included 4,702 matriculants, 47.7% of whom were men and 4.6% identified as Black individuals.
Overall, 83.6% of students completed MD-PhD programs, 12.3% graduated with an MD only and 4.1% left medical school.
Nguyen and colleagues reported that Black students (20%) were more likely to graduate with an MD only compared with:
- white students (12.4%);
- Asian students (11.4%);
- Hispanic students (13.2%); and
- multiracial students (9.8%).
The researchers also reported that 29% of Black students vs. 17% of white students did not complete their MD-PhD training, and 8.4% of Black students vs. 4.3% of white students left medical school.
After they adjusted the analysis for MCAT quartile, Nguyen and colleagues found that Black students had 50% (adjusted OR [aOR] = 1.5; 95% CI, 1.04-2.16) higher odds of graduating with an MD only and 83% (aOR = 1.83; 95% CI, 1.06-3.16) higher odds of leaving medical school compared with white students.
Nguyen and colleagues noted that Black matriculants often show more interest in MD-PhD programs, but they “report disparate experiences of mistreatment and discrimination, which may lead to depression, burnout, and leaving training.” Such disparities in attrition rates, they added, could have significant implications for the health care workforce.
“The benefits of a diverse workforce are well documented and include improved translational patient care and innovation,” the researchers wrote. “Despite innovative work, Black scientists remain less likely to receive NIH funding, and in 2020, less than 2% of NIH investigators identified as Black.”
One limitation of the study was that it did not capture the outcomes of 110 students who were still enrolled in MD-PhD training during the time period and were thus excluded from the final cohort, according to the researchers.
“Future research will be critical to understanding and mitigating high attrition rates for underrepresented MD-PhD students, diversifying the biomedical research workforce, and providing the highest quality of medical care for all,” they concluded.
Perspective
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My initial thought is that these results are disappointing but not surprising. The culture of academic medicine and research is challenging to navigate for all students. It also continues to be plagued by systemic racism and bias. For students who hold intersectional identities, that difficult path often becomes nearly impossible. Access to mentorship and support is critical yet the historic, and in some cases on-going, exclusion of underrepresented groups in these fields means that, for some students, their mentors may be unable or incapable of providing them with the support they need.
Much like having an inclusive clinical physician workforce is critical to delivering equitable and inclusive patient and community-centered care, having an inclusive physician scientist workforce is essential to scientific exploration and discovery. Diverse research teams design, develop and create studies that are more inclusive and address issues that allow us to close health disparity gaps. It is unfathomable to imagine that we would not want to nurture all of our best and brightest so we can leverage their talents to improve the health and well-being of all people.
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