The current survey shows that MD-PhD graduates from the University of Geneva who obtained their degree in the decade 2010-2019 have very heterogeneous characteristics and outcomes. In agreement with similar surveys of other physician-scientists’ populations (5), we observed a multinational profile amongst graduates. Considering the wide span of ages by the time of MD-PhD graduation, it is also noticeable that physician-scientists in Geneva enrol this training program in different stages of their professional and personal career. Nevertheless, we also identified common aspects, challenges and career choices between the respondents.
For a better understanding of this study findings, it is important to note that, differently from North America, a medical diploma is required to enrol in the MD-PhD program in Geneva. Therefore, the MD-PhD program in Geneva is a 3- to 5-year post-graduate scientific training, intended to empower medical doctors with research skills, but is not designed for undergraduate medical students.
MD-PhD students can follow varied types of research projects during the degree. Our data shows that 57.1% followed a scientific training in fundamental sciences, however, only 14.3% pursued this type of research in the current position. Considering our results, MD-PhD tracks in clinical research seem to be of ease to manage post-graduate research activities and were also associated with a higher number of original publications during MD-PhD training. These aspects may be important to candidates, mentors and policy makers, in order to better shape the education conveyed in MD-PhD programs and to help career planing. Likewise, funding and institutional strategies may be required to allow physician-scientists who received highly specialized training in fundamental sciences to dedicate time to research after graduation from an MD-PhD program.
It is important to note that 28.6% of the MD-PhD graduates complained not having protected time to be devoted to research in their current position. While in most cases young physician-scientists with full-time clinical duties did not have research time during residency, there were also graduates who left the University to pursue a career in private care and peripheral hospital. Similarly, studies from the United States have found that 14–16% of MD-PhD graduates do not pursue research careers (5, 10). Taking into consideration that the lack of protected time for research was the main obstacle acknowledged by our respondents, it could be of great interest for hospital policy makers to accord research protected-time to physician-scientists, in order to avoid high attrition rates amongst the MD-PhD workforce.
In addition to the lack of protected time for research, a complain of 61.1% of respondents, about a third of MD-PhD graduates also faced lack of mentoring, under-compensation, lack of funding and difficulties balancing family and work responsibilities. Suboptimal supervision and mentoring were already reported in a Swiss survey analysing MD-PhD program outcomes between 1992 and 2007 (4). Despite these different challenges, almost all graduates (85.7%) consider that this degree gave an edge in their career and they were globally satisfied with the program in Geneva. In result, graduates highly recommend this programme for future newcomers and 95.2% reply that they would do it again.
This 10-year survey revealed that the female gender represented only 28.9% of the MD-PhD graduates from the University of Geneva. Accordingly, a Swiss survey analysing MD-PhD program outcomes between 1992 and 2007 reported 23% of women (4). Additionally, in our study, female physician-scientists had a lower rate of publications per year after the MD-PhD degree compared to their male counterparts. Noteworthy, somewhat similar findings are reported in the United Sates (19) and Canada (7), where female physician-scientists were less likely to be funded and had lesser sustained research involvement. Although these discrepancies are currently under improvement (20), it is important to encourage equal opportunities in the MD-PhD career.
We did not assess in depth the scientific impact of the MD-PhD programme by collecting data on the impact factors and/or the number of the respective quotations from the published articles. Thus, the number of original papers is an estimation of the scientific output of the surveyed physician-scientists.
The main limitation of this study is the small sample size. For this 10-year single-centre survey, there were 31 eligible physician-scientists. Despite this, we obtained a response rate of two-thirds of the surveyed population. Moreover, the respondents have a wide distribution in terms of age and they have the same distribution by gender than the total surveyed population . These aspects should limit the risks of biased conclusions based on the obtained responses. Thus, we expect our data to accurately represent the reality amongst all the MD-PhD graduates from the University of Geneva. Also due to the small sample size, we did not perform regression analysis to adjust for potential confounders and the statistical tests are of limited power. Hence, generalizations to other physician-scientists populations based on our dataset should be cautious.
Although concerning a small sample size, this 10-year survey brings up-to-date information in a field of scarce literature. As shown by previous studies (21), the assessment of individual MD-PhD program outcomes and its graduates’ challenges may favour future improvements and help policy makers.