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. Author manuscript; available in PMC: 2010 Mar 23.
Published in final edited form as: JAMA. 2009 Sep 23;302(12):1271–1273. doi: 10.1001/jama.2009.1355

Postgraduate Choices of Graduates from Medical Scientist Training Programs, 2004-2008

Jason C Paik 1, George Howard 2, Robin G Lorenz 3
PMCID: PMC2778489  NIHMSID: NIHMS148860  PMID: 19773561

To the Editor

There have been questions about the efficacy of medical scientist training programs (MSTPs) in training the next generation of physician scientists. 1,2 Although studies have identified postgraduate specialty choices of a subset of these students, 3,4 to our knowledge none have generated data based on a complete evaluation of graduates from all MSTPs. To better understand postgraduate choices of all National Institutes of Health (NIH)-sponsored MSTP graduates, we conducted a census of graduates from 2004 to 2008.

Methods

Graduate placement data from NIH-sponsored MSTPs were collected from official program websites for 2004 to 2008. Preliminary match data were not collected if the graduate matched into a PGY-2 residency program. If no such website was available, directors of MSTPs were surveyed for postgraduate choices of graduates from their program. Identifying information was removed from data, which were then analyzed for frequency of specialty choice. Number of US seniors entering a specialty was obtained from the websites of the three allopathic residency match programs: National Resident Matching Program 5, San Francisco Match, and the Urology Match.

Relative risk comparing MSTP graduates versus all other US medical school seniors for entrance into a specialty was determined. Data for preliminary-only matching graduates were excluded in calculation of relative risk. P-values for relative risk were calculated using the chi-square test, or two-sided Fisher Exact Test when expected cell frequencies fell below 5, with significance set at 0.05. Analyses were performed using SAS 9.1 (SAS Institute, Cary, NC).

Results

Graduate data were obtained from the websites of 34 of the 43 MSTPs; the remaining 9 programs were surveyed, and all responded. Positions filled by graduates from NIH-funded MSTPs and all other US seniors were tabulated for each specialty (Table). The most common residencies for MSTP graduates were internal medicine (n=367 [24.6%]), pathology (n=154 [10.3%]), pediatrics (n=149 [10.0%]), and diagnostic radiology (n=103 [6.9%]). For specialties with more than 100 positions from 2004 to 2008, MSTP graduates as compared to all other US seniors were most likely to enter residencies in radiation oncology (relative risk [RR], 8.01; 95% confidence interval [CI], 6.40 -10.03), child neurology (RR, 7.65; 95% CI, 4.67 -12.53), and pathology (RR, 5.48; 95% CI, 4.68 - 6.42). MSTP graduates were least likely to enter residencies in family medicine (RR, 0.03; 95% CI, 0.01 - 0.09), emergency medicine (RR, 0.16; 95% CI, 0.10 - 0.25), and obstetrics/gynecology (RR, 0.18; 95% CI, 0.11 - 0.30). Graduates not entering the match constituted 4.4% of total MSTP graduates. MSTP graduates were less likely to pursue residencies in primary care or surgical specialties. Further analysis of these data is available at the study website.6

Table.

Postgraduate choices of graduates from Medical Scientist Training Programs (MSTPs), 2004-2008.

Postgraduate Choice MSTP Graduates, No. (%) (N = 1495) Non-MSTP US Seniors, Categorical Match Only, No. (%) a (N = 69458) Relative Risk (95% CI) b P value c
By individual categories
Internal Medicine 367 (24.6) 13758 (19.8) 1.30 (1.19 - 1.42) <0.001
Pathology 154 (10.3) 1373 (2.0) 5.48 (4.68 - 6.42) <0.001
Pediatrics 149 (10.0) 8359 (12.0) 0.87 (0.75 - 1.02) 0.07
Diagnostic Radiology 103 (6.9) 4047 (5.8) 1.24 (1.03 - 1.50) 0.02
Dermatology 88 (5.9) 1144 (1.7) 3.76 (3.04 - 4.64) <0.001
Radiation Oncology 84 (5.6) 512 (0.74) 8.01 (6.40 -10.03) <0.001
Neurology 81 (5.4) 1569 (2.3) 2.52 (2.02 - 3.13) <0.001
Psychiatry 76 (5.1) 3104 (4.5) 1.20 (0.95 - 1.49) 0.11
Ophthalmology 67 (4.5) 1858 (2.7) 1.76 (1.39 - 2.23) <0.001
Anesthesiology 51 (3.4) 4890 (7.0) 0.51 (0.30 - 0.67) <0.001
Surgery 33 (2.2) 4283 (6.2) 0.38 (0.27 - 0.53) <0.001
Neurosurgery 28 (1.9) 785 (1.1) 1.74 (1.20 - 2.53) 0.003
Otolaryngology 22 (1.5) 1241 (1.8) 0.87 (0.57 - 1.32) 0.50
Orthopedic Surgery 21 (1.4) 2809 (4.0) 0.37 (0.24 - 0.56) <0.001
Child Neurology 18 (1.2) 113 (0.16) 7.65 (4.67 -12.53) <0.001
Emergency Medicine 17 (1.1) 5333 (7.7) 0.16 (0.10 - 0.25) <0.001
Obstetrics/Gynecology 15 (1.0) 4010 (5.8) 0.18 (0.11 - 0.30) <0.001
Urology 13 (0.87) 1140 (1.6) 0.56 (0.32 - 0.96) 0.03
Medicine/Pediatrics 12 (0.80) 1376 (2.0) 0.43 (0.24 - 0.75) 0.002
Plastic Surgery 6 (0.40) 401 (0.58) 0.73 (0.33 - 1.63) 0.44
Physical Medicine & Rehabilitation 5 (0.33) 903 (1.3) 0.27 (0.11 - 0.65) 0.002
Family Medicine 4 (0.27) 5673 (8.2) 0.03 (0.01 - 0.09) <0.001
Nuclear Medicine 3 (0.20) 2 (0.003) 73.3 (12.3 - 438) <0.001
Child Psychiatry 2 (0.13) 81 (0.12) 1.21 (0.30 - 4.90) 0.68
Medical Genetics 1 (0.07) 4 (0.01) 12.2 (1.37 - 109) 0.10
Medicine/Neurology 1 (0.07) 3 (0.004) 16.3 (1.69 - 156) 0.08
Neurology/Psychiatry 1 (0.07) 1 (0.001) 48.8 (3.05 - 781) 0.04
Preliminary/Transitional Only 7 (0.47)
Postdoctoral Fellowship/Research 40 (2.7)
Faculty Position 6 (0.40)
Business/Industry/Consulting 15 (1.0)
Other 5 (0.33)
By group categories
Primary Care Specialties d 553 (37.0) 30279 (43.6) 0.89 (0.84 - 0.95) <0.001
Surgical Specialties e 190 (12.7) 12531 (18.0) 0.74 (0.65 - 0.85) <0.001
Other Specialties 686 (45.9) 26648 (38.4) 1.24 (1.18 - 1.32) <0.001
Not Entering Residency 66 (4.4)

Abbreviations: 95% CI, 95% confidence interval

a

Data for non-MSTP US seniors who had preliminary-only matches or entered alternative careers are unavailable for comparison. Specialties may not sum to 69458 because there were some specialties in which no MSTP graduate matched.

b

Comparison of matching MSTP graduates versus all other matching US seniors, excluding preliminary/transitional matches and those not entering the match.

c

Chi-square test or two-sided Fisher exact test when expected cell frequency was less than 5.

d

Includes internal medicine, pediatrics, family medicine, and any combination of these.

e

Includes general surgery, ophthalmology, orthopedic surgery, otolaryngology, neurosurgery, urology, plastic surgery, vascular surgery, and thoracic surgery.

Comment

These findings are consistent with previous data indicating that MD/PhD graduates are more likely to enter internal medicine, dermatology, neurology, and pathology and less likely to enter family medicine, obstetrics/gynecology, or emergency medicine. 3,4 However, this study also indicated that MSTP graduates are more likely to enter radiation oncology and child neurology, while they were less likely to enter anesthesiology and orthopedic surgery.

This study was limited by the assessment at graduation; data were not collected for graduates changing career path. These data cannot predict long-term outcomes since they did not assess any post-residency career choices. Because only small numbers of MSTP graduates and US seniors entered some specialties, some relative risk estimates may be susceptible to chance error.

Nevertheless, this study provides an initial baseline for further analysis of trends in early outcomes of MSTP graduates. For specialties that are not traditionally associated with strong physician-scientist role models, residency program directors and national specialty organizations may need to explore methods to retain physician-scientists as members of academic medicine communities.

Supplementary Material

Supplementary Data 1
Supplementary Data 2
Supplementary Data 3

Acknowledgments

Funding/Support: Mr Paik was partially supported by T32 GM008361 from the National Institute of General Medical Sciences, National Institutes of Health.

Role of the Sponsor: The funding organization had no role in the design and conduct of the study; in the collection, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.

Footnotes

Author Contributions: Mr Paik had full access to all of the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Paik, Lorenz.

Acquisition of data: Paik.

Analysis and interpretation: Paik, Howard, Lorenz.

Drafting of the manuscript: Paik, Howard, Lorenz.

Critical revision of the manuscript for intellectual content: Howard, Lorenz.

Statistical analysis: Paik, Howard.

Study supervision: Lorenz.

Financial Disclosures: None reported.

Additional Contributions: The directors of MSTPs, the MD/PhD section of the AAMC GREAT group, Bert Shapiro, PhD, (NIH), the American Physician Scientists Association, the San Francisco Match, and the American Urological Association Match supported this project. None of these persons or organizations received any compensation for their support.

References

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Data 1
Supplementary Data 2
Supplementary Data 3

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