{ "abstract": "ImportancePhysician-scientist careers depend on sustained research funding, protected time, and institutional resources. However, data on career-retention attitudes across career stages are limited.\n\nObjectiveTo characterize career intentions and associated research-environment factors among MD-PhD students and early-career physician-scientists.\n\nDesignTwo independent, national cross-sectional surveys were conducted during nonoverlapping periods in 2025; MD-PhD applicant and matriculant trends were also examined.\n\nSettingMedical schools and academic health centers in the United States.\n\nParticipantsMD-PhD students and early-career physician-scientists (ECPS).\n\nExposuresMD-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.\n\nMain Outcome and MeasuresPrimary 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.\n\nResultsAmong 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).\n\nConclusions and RelevanceConsideration 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.\n\nKey PointsO_ST_ABSQuestionC_ST_ABSWhat research-environment factors are associated with career intentions among MD-PhD trainees and early-career physician-scientists?\n\nFindingsIn 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.\n\nMeaningConsideration 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.", "abstract_shown": true, "affiliations": [ "Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA" ], "article_type": "PUBLISHAHEADOFPRINT", "arxiv": null, "author_total": 18, "authors": [ { "name": "S. Z. Bhagwagar" }, { "name": "A. Abushouk" }, { "name": "J. Dempsey" }, { "name": "D. C. Brock" }, { "name": "A. Obradovic" }, { "name": "A. Faraz" }, { "name": "J. L. Cross" }, { "name": "A. Siebert" }, { "name": "H. N. Tun" }, { "name": "K. M. Lin" }, { "name": "E. M. Wilson" }, { "name": "C. Y. Tang" }, { "name": "A. Ghosh" }, { "name": "M. Nguyen" }, { "name": "A. Jha" }, { "name": "D. Shalev" }, { "name": "E. Noch" }, { "affs": [ 0 ], "name": "J. M. Kwan" } ], "bibtex": "https://research.draconitic.com/paper/fdvbj88r1ngns.bib", "cited_by": 0, "doi": "10.64898/2026.09.12.26362877", "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.12.26362877v1.full", "id": "fdvbj88r1ngns", "issns": [], "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.12.26362877v1", "language": null, "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "medrxiv", "medical education" ], [ "openalex", "2739|Health and Medical Research Impacts" ] ], "openalex": "W7213235508", "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.12.26362877v1.full.pdf", "pmcid": null, "pmid": null, "published": "2026-09-12", "publisher": null, "ris": "https://research.draconitic.com/paper/fdvbj88r1ngns.ris", "sources": [ { "first_seen": "2026-10-30T12:18:31Z", "native_id": "10.64898/2026.09.12.26362877", "source": "medrxiv", "url": "https://www.medrxiv.org/content/10.64898/2026.09.12.26362877v1" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2739|Health and Medical Research Impacts", "subfield": "epidemiology-public-health" } ], "title": "Career Intentions and Research-Environment Factors Across the Physician-Scientist Pipeline", "title_text": "Career Intentions and Research-Environment Factors Across the Physician-Scientist Pipeline", "type": "preprint", "updated_at": "2026-10-30T12:18:31Z", "url": "https://research.draconitic.com/paper/fdvbj88r1ngns", "venue": "medRxiv", "versions": [] }