**PLEASE NOTE: The data presented here are part of on-going efforts to update, validate and rigorously analyze the information available on our MD-PhD alumni. Only data collected in the October 2018 data are presented here; more complete data analyses and outcomes statistics on the entire program will be made available soon.
In October 2018 we emailed a career outcomes survey to alumni who graduated from Yale’s MD-PhD Program between 1973 to 2018. The questions were modeled after those in the AAMC National MD-PhD Outcomes Study[1] which was undertaken in 2014 to study the career paths of 6,786 trainees enrolled in MD-PhD programs at 80 institutions nationwide.
The goals of the AAMC and our survey were to evaluate key outcomes of physician-scientist training: where do our alumni work, how long did it take to get there, how do alumni divide their professional time between research and other responsibilities, what kinds of research are our alumni engaged in? The ability to rigorously assess the program is critical to the continued development and success of the program in training creative, curious and caring physician-scientists, and we greatly appreciate the time taken by those who completed this survey.
Survey participation summary
Every question in the survey was not answered by every respondent; percentages in subsequent figures are shown as a percentage of total participating respondents or as a fraction of all alumni. Of the 177 respondents, 38 reported that they are still in-training (11%, in postdoctoral, residency or fellowship training), 137 (39% overall) have completed postgraduate training; 2 did not specify their career stage.
Gender Distribution
Overall, of the 348 total graduates spanning the years 1973-2018, 35% (n=121) are women and 65% (n=227) are men. The distribution of men versus women graduates in each decade of the MD-PhD program, divided into respondent (solid bars) and non-respondent (patterned bars) is shown in Figure 2. The survey respondents were 32% women (n=57) and 68% men (n=120); non-respondents were 37% women (n=64) and 63% men (n=107). The percentage of women rose from 19% (7/37) in the responding alumni that graduated between 1981 to 1990 to 42% (8/43) of the respondent cohort that graduated between 2011 and 2018. Our alumni gender distribution is similar to the percentages reported for MD-PhD programs nationwide (as reported in the AAMC National MD-PhD Outcomes Study1) where women make up 27% of MD-PhD graduates between 1974 and 2014. The gender distribution of all current students in the program (134 students total) is 48% (n=64) women and 52% (n=70) men (data not shown).
Time spent “In-Training”
We used internal records (validated by data obtained in the survey) to examine trends in “time to degree” (TTD) for survey respondents (and comparison to survey non-respondents using institutional data). Figure 3 is a Box Plot of the TTD values (calculated as latest MD or PhD received year minus MD-PhD program entry year) to illustrate the distributional characteristics of the TTD values of survey respondents and non-respondents. Blue boxes and gray boxes are middle 50% (or interquartile range (IQR)) values for survey respondents and survey non-respondents, respectively; yellow dots in the blue boxes represents the mean TTD for survey respondents, the corresponding gray dot in the gray box represents the mean TTD for the survey non-respondents; “X”s are the median values. The upper and lower dashed “whiskers” stretch to the maximum and minimum TTD values. These data do not include “on-board” students after 2001 who matriculated into the MD-PhD program after spending 1-3 years as medical or PhD students at Yale. The data after 2005 are also corrected for official leaves of absences.
There is a trend toward increasing time to degree, averaging 8.1 years for survey respondents who graduated between 2011 and 2018, up from an average of 6.1 years for alumni respondents who graduated between 1973 and 1980. This upward trend consistent with AAMC reports that the average time to MD-PhD degree has increased from approximately 6 years to approximately 8 years in the same period of time.
The total training time for physician-scientists includes not only the time to complete the MD and PhD degrees but also the post-graduate training time as residents, fellows or postdocs. Out of 348 total graduates from our program, 24% are still “in-training”, in part reflecting the increase in the total number of trainees beginning at about 1995. Since 2011, each entering class of MD-PhD students has had over 15 students, so we anticipate that the proportion of alumni “in-training” will continue to grow in years to come. Figure 4 illustrates the residency fields chosen by alumni who responded to this question (175 out of 177 respondents). Of the survey participants that opted for residency training, 25% chose internal medicine, followed by psychiatry, pediatrics, radiation oncology and dermatology, which combined make up an additional 31% of the survey respondents who opted for residency after graduation. Only 5% of survey participants elected to do postdoctoral training instead of residency.
Another measure of the length of physician-scientists training time is the time between obtaining the MD-PhD degrees and their first full-time post-GME job. Figure 5 is a cumulative frequency histogram showing the distribution of the number of years between graduation and first full-time post-GME position reported by the survey respondents. Consistent with what was observed by the AAMC National MD-PhD Career Outcomes study, the average (assuming “3 or less”=3 and “10 or more”=10) time to full-time post-GME job reported by respondents was 5.5 ± 1.8 years (median=5.0 years).
Career Outcomes
Of the alumni who responded to the question “Which of the following best describes your current or most recent position?” 73% of respondents replied that they are in academia, defined as any post-secondary academic institution where training occurs, including colleges, universities, some medical centers, or free-standing research institutions. These included instructors and non-ladder-track faculty, as well as Assistant, Associate and full Professors. 16% of the responses indicated alumni that are in primarily in clinical practice (defined as any organization, e.g., hospital, clinic, private practice, where the primary responsibility is providing healthcare); 12% reported that they work in a for-profit setting (defined as any organization that operates to make a profit, including industry and consulting); 5% are employed in a government organization (i.e., operated by federal, state, local or foreign governments); 3% work in non-profits, and 1% responded other (includes those who are on an extended leave of absence from the workforce. These data are summarized in Figure 6, which include the non-respondent alumni as a category.
Survey respondents who work in academia are engaged in basic (30%), translational (41%) and patient-oriented research (21%), with about half of the respondents doing more than one type of research. The other types of research reported include health services research (5%) and clinical trials research (2%).
Among the alumni respondents who are employed in the academic sector, 89% reported that they work in a clinical department; only 18% described their department as basic science, and 1% work in academic administration. Consistent with previous reports clinical vs research effort of faculty employed in academia, Figure 7 shows that the effort distribution reported by survey respondents who are faculty in basic versus clinical departments varies widely. Alumni respondents employed in basic science departments dedicate the majority of their time to research (65%), whereas those in clinical departments predictively dedicate a relatively large proportion (32%) of their time to clinical duties.
Funding and Leadership
A majority of alumni respondents overall (84%) and in those specifically in academia (93%) report that they have received some kind of research funding at some point following completion of their MD-PhD. Among the 177 alumni respondents, 34% are currently Principal Investigators (PI) on an NIH research grant (including R01, R21, P01, U54, SBIR, etc.) and 28% currently serve as PIs on private foundation grants (including Howard Hughes Medical Institute (HHMI), Simons Foundation, Gates Foundation, Burroughs Wellcome Fund, Doris Duke Charitable Foundation, Whitehall Foundation, Damon Runyon Cancer Research Foundation, Cystic Fibrosis Foundation, etc.). 23% of alumni respondents who have completed their post-graduate training report that they have previously held or currently hold an NIH mentored career development award (K award). Other current sources of funding include other non-NIH federal grants (e.g., NSF, DOD, VA, DARPA, etc.; 11%) as well as research support from Pharma and Biotech (19% current PIs; e.g., Boehringer Ingelheim, Novartis, Bristol-Myer Squibb, Pfizer). 16% of “still in-training” respondents and 41% of “post-GME” survey respondents report that they have issued or pending patents.
60% of the 136 survey participants who are no longer “in-training” report that they have previously held or are currently in leadership positions such as Deans (Vice, Assistant, Associate), Chairmen (Department, Vice), Directors (Training Program, Institute/Center, Chiefs (Clinical Division, Branch/Section), Presidents and CEO/CSO/CMOs; many have held more than one leadership position. Furthermore, our alumni are recognized for their accomplishments as physician-scientists by election to prestigious honorary societies such as the Association of American Physicians (11), the American Society for Clinical Investigation (9), the Institute of Medicine (5) and membership in National Academies of Sciences, Engineering and Medicine (1).
Summary
Based on the outcome measures surveyed, our MD-PhD program graduates are following career paths and having successes consistent with the goals of our program and of the NIH Medical Scientist Training Program in general. We strive to continually evaluate, innovate and improve our MD-PhD training opportunities and experiences so that our graduates are excellent physician-scientists who lead advances in biomedical research, education and clinical care.
Whether employed in academic medicine, industry, government or the private sector, Yale MD-PhD graduates reflect the growing diversity of career choices and excellent outcomes that we look forward to tracking into the future.
[1] National MD-PhD Program Outcomes Study, April 2018, Association of American Medical Colleges, Washington, D.C. https://www.aamc.org/download/489886/data/nationalmd-phdprogramoutcomesstudy.pdf