Career Intentions and Research-Environment Factors Across the Physician-Scientist Pipeline
- 1Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
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.
ObjectiveTo characterize career intentions and associated research-environment factors among MD-PhD students and early-career physician-scientists.
DesignTwo independent, national cross-sectional surveys were conducted during nonoverlapping periods in 2025; MD-PhD applicant and matriculant trends were also examined.
SettingMedical schools and academic health centers in the United States.
ParticipantsMD-PhD students and early-career physician-scientists (ECPS).
ExposuresMD-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 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.
ResultsAmong 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 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.
Key PointsO_ST_ABSQuestionC_ST_ABSWhat research-environment factors are associated with career intentions among MD-PhD trainees and early-career physician-scientists?
FindingsIn 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.
MeaningConsideration 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.
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BibTeX
@misc{bhagwagar2026career,
title = {{Career Intentions and Research-Environment Factors Across the Physician-Scientist Pipeline}},
author = {S. Z. Bhagwagar and A. Abushouk and J. Dempsey and D. C. Brock and A. Obradovic and A. Faraz and J. L. Cross and A. Siebert and H. N. Tun and K. M. Lin and E. M. Wilson and C. Y. Tang and A. Ghosh and M. Nguyen and A. Jha and D. Shalev and E. Noch and J. M. Kwan},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.12.26362877},
url = {https://www.medrxiv.org/content/10.64898/2026.09.12.26362877v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Career Intentions and Research-Environment Factors Across the Physician-Scientist Pipeline
AU - S. Z. Bhagwagar
AU - A. Abushouk
AU - J. Dempsey
AU - D. C. Brock
AU - A. Obradovic
AU - A. Faraz
AU - J. L. Cross
AU - A. Siebert
AU - H. N. Tun
AU - K. M. Lin
AU - E. M. Wilson
AU - C. Y. Tang
AU - A. Ghosh
AU - M. Nguyen
AU - A. Jha
AU - D. Shalev
AU - E. Noch
AU - J. M. Kwan
PY - 2026
DA - 2026/09/12
PB - medRxiv
DO - 10.64898/2026.09.12.26362877
UR - https://www.medrxiv.org/content/10.64898/2026.09.12.26362877v1
AB - ImportancePhysician-scientist careers depend on sustained research funding, protected time, and institutional resources. However, data on career-retention attitudes across career stages are limited. ObjectiveTo characterize career intentions and associated research-environment factors among MD-PhD students and early-career physician-scientists. DesignTwo independent, national cross-sectional surveys were conducted during nonoverlapping periods in 2025; MD-PhD applicant and matriculant trends were also examined. SettingMedical schools and academic health centers in the United States. ParticipantsMD-PhD students and early-career physician-scientists (ECPS). ExposuresMD-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 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. ResultsAmong 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 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. Key PointsO_ST_ABSQuestionC_ST_ABSWhat research-environment factors are associated with career intentions among MD-PhD trainees and early-career physician-scientists? FindingsIn 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. MeaningConsideration 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.
ER -