The current survey shows that MD-PhD graduates from the University of Geneva who obtained their degree(s) in the decade 2010-2019 have very heterogeneous characteristics and career outcomes. In agreement with similar surveys of other physician-scientists’ populations (5), we observed a multi-national profile amongst graduates. Considering the wide age-span by the time of MD-PhD graduation, some of the differences noted can be attributed to trainees being at different stages of their professional and personal career. Nevertheless, we also identified common aspects, challenges, and career choices between the respondents.
MD-PhD students participated in a variety of different types of research projects during their training. Our data shows that 57.1% pursued scientific training in fundamental sciences, yet only 14.3% pursued this type of research in their current positions. Considering our results, the MD-PhD pathway in clinical research was associated with a higher number of original publications during MD-PhD training. This aspect may be important to candidates, mentors, and policy makers, in order to tailor MD-PhD programs to better encompass post graduate career planning. Likewise, increased funding and institutional strategies may be required to finance more dedicated research time for MD-PhD graduates in the fundamental sciences.
It is important to note that 28.6% of the MD-PhD graduates mentioned not having any allocated research time in their current position. Most of these were young MD-PhD graduates with full-time clinical duties at the University hospital. However, it also included graduates who had left this environment in order to pursue a career in a peripheral hospital or the private care sector. 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 allocated research time was the main obstacle acknowledged by our respondents, it may be necessary for hospital policy makers to allocate specific research time to young physician-scientists, in order to ensure a vigorous and vibrant research environment for the future and to avoid high attrition rates amongst the MD-PhD workforce.
In addition to the insufficient research time that was mentioned by 61.1% of respondents, about a third of MD-PhD graduates also faced lack of mentoring or lack of funding. 27.8% expressed a sentiment of under-compensation and 38.9% mentioned difficulties balancing family with work responsibilities. Indeed, sub-optimal supervision and mentoring had already been reported in a Swiss survey analyzing MD-PhD graduate outcomes between 1992 and 2007 (4). More recently, since 2017, the Swiss Academy of Medical Sciences, in collaboration with the Gottfried and Julia Bangerter-Rhyner Foundation have been supporting research by young medical doctors during their residency, with the Young Talents in Clinical Research (YTCR) program (20), to help counteract the scarcity of time and funding. Other actions have been taken in recent years to help under- and postgraduates who lack supervision and mentoring. Several mentoring programs are available at the University of Geneva (21-23) to provide guidance during the academic career and facilitate the transition after graduation.
Despite the reported challenges, almost all graduates (85.7%) considered that this degree was beneficial to their career and were satisfied with the program in Geneva. As a result, graduates highly recommended this program for future newcomers and 95.2% replied that, faced with the same choices, they would take the program again.
This survey which collected data on graduates spanning 10 years revealed that females represented only 28.9% of MD-PhD graduates from the University of Geneva. Accordingly, a Swiss survey analyzing MD-PhD program outcomes between 1992 and 2007 reported 23% of women finished the program (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 States (24) and Canada (7), where female MD-PhD graduates were less likely to be funded and had lesser sustained research involvement. A possible reason for this finding is that balancing family life with work responsibilities may be a harder challenge for young female researchers in comparison to their male peers. Although these discrepancies are currently being addressed (25), it is important to realize the challenges involved in providing equal opportunities in the MD-PhD career setting.
Even though there is lack of data to compare the MD-PhD program in Geneva with that used in the USA (combined medical and PhD training), this study was still insightful in that the training format entails completing PhD years after one's medical training. This format is also being used in the US at certain programs, such as the UCLA STAR Program (26). As such, it is debatable whether it would be best to do the PhD in a combined MD-PhD program or after graduating medical school during post graduate training. Despite these two possible tracks, similar issues with funding, having protected research time and work life balance are still major challenges. Given that funding levels and structures are different between the USA and Europe, direct comparisons would be limited.
We did not carry out an in depth assessment of the scientific impact of the MD-PhD program by collecting data on the impact factor of journals accepting the articles and/or the number of respective quotations from each published work. Thus, the number of original papers serves only as an estimation of the scientific output of the surveyed MD-PhD graduates.
The main limitation of this study is the small sample size. For this single-center study that surveyed graduates from the past 10 years, there were 31 eligible MD-PhD graduates. Despite this, we obtained a response rate of two-thirds of the surveyed population. Moreover, the respondents had a wide distribution in terms of age, and they had the same distribution by gender compared to the total surveyed population; thus, this should be a representative sample. This, in turn, should limit the risks of biased conclusions based on the obtained responses. Therefore, we expect our data to accurately represent the situation of most of the MD-PhD graduates from the University of Geneva. 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.
This survey of 10 years’ worth of graduates brings valuable information in an area that suffers from a paucity of literature. As shown by previous studies (27), the assessment of individuals following MD-PhD training and the recognition of the challenges graduates face may favor future improvements. Furthermore, such challenges appear to be similar whether that be in the United States or in Europe. Hospital policy makers may need to address the issues brought up in this article so that that the future of research carried out by medical doctors working in the clinical setting can be ensured.