On behalf of the Physician-Scientist Workforce Working Group (PSW-WG), Catalyst Research & Communications conducted two qualitative studies to explore how medical, dental, and veterinary students make decisions to pursue or not pursue a career in research. The first of these studies was a series of focus groups with students; the second consisted of interviews with research deans at medical, dental, and veterinary schools.
To conduct the focus groups, Catalyst developed a moderator’s guide with a standardized set of questions that responded to PSW-WG’s perceived needs for information from medical, dental and veterinarian students about their career decision-making. The guide may be found at the end of this report. OMB clearance was obtained to recruit and collect qualitative data using the set of questions. Catalyst recruited a convenience sample of geographically diverse students via Facebook announcements on student medical/dental/veterinary association pages, referrals from medical deans, and email requests for participation sent out from student medical associations to members and medical/dental/veterinary schools to their students. Wherever possible, students were recruited from among those in their final year of professional training.
Nine telephone-based focus groups were conducted between December 2013 and March 2014. The groups were organized as follows:
Each focus group lasted approximately 90 minutes. Focus groups were audio- taped and transcribed for analysis.
Key themes that emerged across all student focus groups include:
Several of the students in the MD/PhD program applied to their dual degree program as a secondary decision. They initially wanted to obtain a PhD and do scientific research, but decided that the additional MD degree would enable them to do meaningful clinical research and would add variety to their career. Others wanted to be a medical doctor first and then heard about the MD/PhD program, in which they could obtain a dual degree. The MSTP program was also an attractive incentive to fund their training. They spoke passionately about the creativity they find in scientific research and their interest in asking questions and solving problems. The MD/PhD students had a variety of research interests, e.g., bioengineering, behavioral neuroscience, HIV/infectious disease, immunology, epidemiology, electrophysiology, lipid metabolism, ophthalmology (translational research), ontology, pediatric vascular physiology, virology.
Over half of the MD/PhD students in the focus group were married or in a committed relationship. One female had a teenage child and one of the male students was expecting a child.
The majority of the MD/PhD students who participated in the focus groups fell in love with the process of research in high school, during summer research program, or as an undergraduate. Most were exposed at an early age to research role models/mentors, either via a high school program or in a research lab as an undergraduate.
Some of the students were motivated to do research as undergraduates and during the summer in order to be more competitive when applying to medical school, and were then drawn to a research career. The MD/PhD program was a good way to incorporate all of their scientific interests.
One student noted:
"In my situation, I was meeting people that do research that informs clinical practice in my medical training early on--that really flipped the switch and made me decide to get into the MSTP."
In terms of mentors, most students noted that a variety of mentors were important throughout their undergraduate years and medical school.
The students note that they need to be proactive about finding a research mentor. Even though mentors are assigned to MD/PhD students at some institutions, not everyone in the MD/PhD track is able to find a mentor at their own institution. It is critical to reach out and find mentors at other institutions that they may meet at conferences and other venues:
"So I would say that I have to be open to the possibility that anyone that I come across could be a mentor for some very particular part of my career. They play different roles. I have scientific mentors, work/life balance mentors, and mentors for certain areas of research that I want to go into in the future."
Most of the students agreed that early mentors in high school and undergraduate are found by chance. Later, the mentorship search "tends to be a decentralized process." Schools try to set students up with a mentor, but practically it becomes difficult and often depends on the size of the institution and other factors. Many mentors are found by working in a variety of labs, going to conferences, and hearing lectures by those who are doing the type of research a student interested in. All of the students mentioned utilizing the skills and expertise of many mentors during their training.
"A good mentor is able to give you the time and support to learn, but allows you to do things on your own when you are capable--and knows the difference between the two situations."
"A mentor should be focused on helping you advance your career by sending you to meetings, connect with the best quality science researchers, and sharing personal, professional connections."
"A good mentor combines the ability to be both an excellent scientist and a human with good social skills and knowledge of how to expand a career."
All students in the MD/PhD focus groups had many positive comments about embarking on a career as a physician-scientist. A research career is appealing for the following reasons:
"My clinical research really matters - it has direct impacts on clinical practices. I can see the people actually benefit from it. I really believe it is worth doing and it will better people's lives."
"You know...better therapeutics, better devices and instrumentation, understanding a disease better or even understanding normal processes that are not well understood because there is still a lot of that out there which I don't think most medical students even realize that is true. The more we know the more we know there is a lot more left to discover."
"I want a solid academic career and to do that, I need to do research in order to achieve academic ranking."
Thus, among the reasons are:
The students admired successful physician-scientists, who are able to continue getting funded for research. They admire those who have the ability to communicate in both the research world as well as the clinical world. They find it impressive that successful physician-scientist are able to maintain both excellent research skills and excellent clinical skills.
On the other hand, these students described the older physician-scientists who are running a lab, being a mentor, and an academic teacher/advisor, as looking tired.
Each student in the focus group verbalized that the uncertainty of research funding was the major challenge to a career in research. Financing a career in research and the perceived politics of government funding makes each one nervous about being able to sustain a career as a physician-scientist.
Other challenges include:
"Sometimes, we have to make up the difference in lower research pay by doing clinical work. Researchers may be financially disincentivized by the institution for them to do research."
In particular, residency is a time when there is lack of research mentorship. Students perceive this to be the most vulnerable time of research training. When a student is not engaged in research for four to six years, it may be difficult to re-establish a research career. During that time, a student won't be doing research or publishing papers. It makes it harder to be competitive for a K award and ultimately for an RO1.
The pay cap of NIH grants may make it difficult to be hired. Department chairs may think twice about hiring someone who needs 50 percent protected time for research. The department has to supplement salaries to achieve the typical physician-scientist salary.
Work/life balance in a research career is a topic that is top of mind to these students. Most are willing to put in as much time as needed while a student and in training, but perhaps may not be willing to do so when they begin their careers. They understood from the beginning that finishing a dual degree is a long and arduous process. Work/life balance was of biggest concern when looking ahead to their post-training careers. Work/life issues are portrayed in the following student comments:
"The whole work/life balance fear increases with the decrease in research funding rates. I do have a concern that the rest of my life may suffer in a negative way that I am not sure I am completely willing to allow."
"I hear a lot of my colleagues say I want to do well but I am not going to stress myself out and I would settle for a little bit less as long as I am happy."
I want to do well in the workplace, but I also want to be that mother to my kids. I don't want to be an absent parent." This is a stronger issue for women, but men women, but men also stressed this point.
"This is something that concerns me a lot moving forward - not being able to see many females being successful at making things work and balancing having kids with having a career."
Most females did not think it was an option to take time off for family issues. It is hard to take time off in academia or if the physician-scientists has his/her own lab. Many are afraid that it would negatively affect their promotion potential.
It may help to promote "team science"--- this may become more important, particularly with decreasing funding opportunities.
When asked where they expected to be in 10 years, the MD/PhD students said they would just be finishing their residencies, and hoped to be involved in a research career that launches them into a career where they become an independent researcher. Many mentioned they would like to be in an academic setting with some clinical responsibilities.
Several recommendations from MD/PhD students focused on obtaining adequate funding as a student and during residency. Suggestions included:
Other recommendations focused on increasing networking avenues and better communication with NIH. Specific recommendations include:
Several students made suggestions for making their training more cohesive and relevant for the needs of research and clinical practice. These suggestions are:
MD students who were interested in pursuing a research career went to medical school because of their interest in science, in being able to interact with and help people, and in doing research that addresses questions of clinical care:
"I went to medical school because I wanted to do research that was clinically relevant. And I thought doing that through an MD degree would be the way to do it."
The research interests of those interested in pursuing a research career included computational biology/applied math, neurosciences, neurology, and translational research.
Those students not necessarily interested in research career went to medical school because they liked patient care; were interested in the concept of healing, health disparities, and/or teaching; and liked working with people. They would like to conduct clinical research if they could also have a clinical practice that was over 50 percent of their work time. Their research interests were mostly along the line of their clinical specialties, such as orthopedics, anesthesiology, neonatology, oncology, etc.
The majority of the MD students were in a committed relationship or were married, but none had children.
All the MD students who participated in the focus groups thought that research experiences help to increase their critical thinking skills and makes them more competitive for residencies and fellowships.
Those who are interested in pursuing a research career initially became interested in research because it was required for an undergraduate degree, a professor pointed out that there were research opportunities, or they attended a summer research experiences for undergraduates (REU) program.
Many had professors during their undergraduate careers who served as mentors. These students look to mentors who have a supportive financial infrastructure, so they can learn research methods from the senior scientist and lab manager and also be allowed to have an independent project. In addition, they look to mentors for tips on work/life balance. Students mentioned that enthusiastic mentors have broad overlaps with them as far as professional and academic interests.
"And then just because a lot of time we look to these mentors as much more than just a research mentor but sort of as a guidepost for our careers, I think it was -- some of the most memorable things are when they involved me in their own social outlets. We sort of identified areas where they struck work/life balance."
For those students who were not particularly interested in a research career, they got involved in research as an undergraduate to make them more competitive in their applications to medical school and residency, especially for the more competitive residencies, such as plastic surgery, orthopedics, and radiology . Students feel like they need to check the research box to be competitive, it is a "CV booster."
"To be honest, I started to get involved with research initially for applying to medical school; it was one of the boxes that needed to be checked off. And then I got involved in simulation and medical education at school because it relates to my previous career where I was a software engineer so I had that sort of interest and was able to explore it in that direction. But I think I initially got interested mostly because I felt like it would make me a more competitive applicant more than anything else."
"I started doing research to improve my application for residencies but what I found really compelling about it was that both of the projects that I have worked on have been things that my PI was just interested in understanding a little bit more about, and so we designed a project to kind of look at it, and you now see the actual quantitative data behind things."
"I started research in undergrad, mainly to boost my application for medical school, and it was mostly basic science stuff, really. Just get your name on a paper. No true interest in anything. As I went through medical school--the common theme again--you need research to get a competitive residency, so I kind of like -- it has transitioned over a little bit."
"But I think that it is more of just like, you know, a check box, and not a lot of students are really passionate about it. And not to say that they don’t like research. I think they are just more passionate about clinic, about patient care and that realm of medicine as opposed to the behind-the-scenes aspect of it."
Some students have had good mentors. They mostly met their mentors fortuitously via summer research programs or in labs at school. In general, these MD students have had mixed luck with finding a good mentor.
A common concern about embarking on a research career centered around the perception of not being able to have a thriving clinical practice while engaged in a research career:
"The only thing probably holding me back may be not having as much patient interaction as I would like. If patient interaction and research could go hand in hand, being a physician and physician scientist--that would be the best of both worlds."
"I would need to find a balance between being able to see my patients and fulfilling my role as a researcher. And if I could, you know, find that balance, then I would definitely do both but it is hard."
Regarding potential pay differences between those in private practice and those engaged in research, students who are very interested in building a career in research accepted that they will be making less money. They were hoping that the funding landscape will be better by the time they are applying for grants.
"I have the expectation that I would be making less money doing research compared to the private practice. I think that is something that I have accepted to be true."
"And I guess that uncertainty about the future of how funding works and the situation that the government is in now, I think that -- it makes me worry a little bit but at the same time I think it is so far away that it is not something that is in the front of my mind."
These students were concerned about clinical/research balance. When they observed physician scientists in their schools, they found these individuals were mostly doing bench research and not seeing patients. The students thought that was unacceptable for their careers. They believed that a 50/50 split is possible depending on the clinical specialty, and that would be determined when they apply for residency.
Length of training to get a PhD is also a concern. This quote is from an MD-only student with her thoughts about the length of training for an MD/PhD:
"I think in terms of the training, what concerns me about the MD/PhD is--it is not just the not wanting to be in school for that long. I have heard some criticisms of the structure of MD/PhD programs because if you are going down more of a basic science path, which I think a lot of people who do MD/PhD pursue--since the science field is changing rapidly as well, just the techniques that are being used in practice--that by the time you finish your PhD and you go back and finish what you have left of medical school -- you know, you got out and you finished your residency. You got out and you start practicing for yourself and start to have your own lab, and the science has just changed a lot."
Work/life balance issues were also of mind for the MD students:
"I think for me too, you know, time right now is not a big deal, but I feel like, you know, planning a family and raising a family, that is definitely going to take away from the time you have to practice and any time you have to do research. It is something I would have to balance and consider." (male student)
"For me, family is a big priority so I think in terms of the specialty I would choose, I would choose a specialty that wouldn’t take me away from my family too much. So I guess something like surgery, if I get stuck in a surgery and can’t go home, that is not something I would really like. So I probably wouldn’t want to go into surgery because of that lifestyle, and just me personaly, I have wanting to raise a family as a high priority." (male student)
Students wanted to be autonomous when they get out of training. They wanted the flexibility and time to be able to enjoy a family and a life. They were looking to create a work/life balance and also love the work they do. Work/life balance played a major role in the decisions these students were making for their careers.
Most students respected and admired those who are physician-scientists, but they were not particularly interested in navigating the grant funding process. Many students pointed to the reason they went to medical school and that was to take care of patients. That is what they intend to focus on.
"And it is almost like being, to me, how artists have to go out and get gigs and do that whole thing. I feel like researchers have to like go out and find grants, find funding, find people who believe in them, and it just seems really, really tedious."
From a student who has aspirations to do research:
"I think the funding environment now is something that is pretty scary. I think, too, as somebody who has not elected the MSTP track, I am even more nervous about how much legitimacy I will have as a PI one day. But to me something that is comforting too, as someone going into academic medicine, I feel like I have got a marketable skill set in my clinical training that I can fall back on should research need to fall by the wayside if funding, you know, doesn’t work out or something like that."
When asked about their observations of physician-scientists in their school, these MD students admired their incredible focus on a specialty, as well as their persistence and ability to prioritize and juggle multiple roles. They do the groundwork for the rest of medicine. Some felt that, as a whole, physician- scientists may be a bit out of touch with the clinical world because their clinical time is limited; and they have fewer social skills than what they would like to see in a clinician. They were quick to point out, that there were certainly some top-notch clinician-scientists serving as role models in their settings.
For those students contemplating a career in research, the amount of training time, the perceived lower salary, and uncertain potential funding for research were the major influences on their decision to pursue a career in research.
"I don’t want to sacrifice what I want to do in the field of medicine itself to be doing research either. I want to be able to choose a career in medicine, no matter how rigorous, and still have time to be doing well in that and learning in that field but also be doing my research."
School debt/loan repayment was also a big concern.
"I know that I am going to be graduating with a lot of debt, and knowing that research makes less money, I think it makes me feel a little hesitant about it just because I know if I have a lot of loans to pay off. And I know the situation is different for MD/Ph. students, but I think for MD-only students who want to become physician-scientists that having a lot of debt presents a barrier."
When feasible with medical school commitments, MD-only students with an interest in research found a mentor to work with and spent between 10-20 hours/week on research projects, mainly in a lab setting. These mentors may or may not be a part of the medical school. The student proactively sought them out and made the connection.
Funding was an issue for those MD students who would like to pursue a PhD, and are not in an MD/PhD program:
"For me, I am actually considering that right now. My school has a way for MD students to get into the MD/PhD program, so I am in the process of trying to apply for that. It has been kind of difficult for a number of reasons, and I might be in a situation where instead of going into the MSTP, I would have to take a leave of absence and do the PhD separately."
These students would like to be in academia and combining clinical practice with research. Many of the MD-only students foresaw an academic or clinical career with some research involvement for themselves, but not necessarily having their own lab or lab group.
To a person, the MD-only students were not planning or interested in seeking a PhD after medical school. They may consider an MPH or take a year out for research training. One said she would consider working towards a PhD if she could see a very specific reason why she needed it. Many felt that they could do research with their MD degree, especially if they partnered with a PhD researcher.
The MD-only students made the following recommendations for making a research career more appealing or feasible:
"I think in the MD/PhD program, that program provides a lot of -- whether it is like seminars or just workshops that sort of educate about what it looks like to be a physician scientist and the things you need to do now in medical school to build a career toward that. I don’t think the MD students get much exposure to that. Maybe it has to be a top down thing from in the medical school curriculum or just having workshops or seminars that would educate us that a physician- scientist is something that exists, and these are the ways others have done it. I think having that information would help MD students work toward a career as a physician-scientist."
"So for the NIH to further promote research, I think having grants available to junior faculty members or more to fellows, that would encourage people or would allow people to take time early in their career, a little bit of time away from their clinical practice, in order to supplement their income so they are able to do research."
"I know that MD/PhD students are sort of educated about fast-track research or fast-track residency options where effectively your residency is shortened because of the assumption that you will engage in research in your future. And I don’t honestly know if that is even offered to people who may not have completed a PhD but still have significant research experience. I think it could really expand the number of physicians interested in research if their residency was also equipped with some benefits or a fast-track option as well."
"And to my knowledge there are not CME credits available for basic science, like methodology training. And as somebody who is interested in basic science training, like my greatest fear is that I will forever be inadequately equipped to handle changes in science, especially if it only occupies a fraction of my work."
"They should continue to focus on funding the Summer Research Programs and the Summer Diversity Programs, that bring students from multicultural backgrounds into labs, research labs and medical schools in the summer to do research because the program that I was involved with, it was NIH-funded. And also continue to offer research summer fellowships during medical school for medical students because most of the time we can, if we do research at our medical school, we can get funded by internal grants. But when we go outside of our medical school, it is a little bit harder to find funding."
"There is a program called the Summer Medical and Dental Education Program that I participated in as an undergrad that targets underrepresented minority students to prepare them for medical school. And I think that is a program through the AAMC [Association of American Medical Colleges] that the NIH should target. Also implement a research component to that program."
"And what I found is that it is really hard to find a program -- like if you say you are pre-med, a lot of STEM programs, they like look down, like don’t want you to apply if you are trying to do pre-med. Like they want you to go strictly into a PhD or MD/PhD program. Like I found a lot of programs that were like that and very few that were looking for pre-meds."
"I think that having mentors and having role models that are from underrepresented minority groups really inspires a lot of the minority students to know that they can achieve something. They can achieve and should aspire to achieve a career in research or a career in medicine. I know that, and for me personally that was a big driving factor to work hard to, you know, work hard through undergrad, through medical school, knowing that I can achieve what they achieved. And also having them available, having them on the faculty or as mentors for undergraduates and for medical students I think would be another way to increase the number of minority students in medicine and in research."
"So having the NIH encouraging kind of a physician research pathway -- whether it is basic science, public health, clinical research -- in medical schools, and encouraging medical schools to have a set curriculum with mentors in place, with lectures, physician panels in place, for example, would be I think very helpful for doing the first and second years of medical school."
"I think that there are programs out there that I have been lucky enough to hear a little bit about, but I am not sure their overall exposure to people in our shoes is that fantastic."
"I would really love to have some information on how to write grants and where to apply for them and how that all works. So I think that would definitely be something I would be interested in."
"I think honestly having this information more advertised at individual schools, because to be honest I hadn’t heard of anything moneywise that has been talked about in the last two minutes."
Minority MD and MD/PhD students all expressed an interest in careers focusing on health care in underserved areas, public health, health policy, and health disparities They were aware of the National Health Service Corps (NHSC) payback programs for working in medically underserved areas of the country.
Those interested in doing research would like to combine clinical or academic medicine with research. Hopefully a 50/50 split: "I need to find the right balance of the two."
The majority of these students were single, without children.
Research mentors have had a big influence on these students as undergraduates and medical students.
The consensus of the group was that many do research in medical school to make themselves more competitive for hard to get specialties or residencies at institutions that have a strong academic and research base: "People who apply in more competitive specialties take a year out to do some research and to get a couple publications or abstracts that help improve your resume."
Minority students wanted more exposure to minority role models in the sciences, medicine, and research. These students reported that they needed to see the possibilities of a research career early in life, e.g., in elementary or middle school, so they can start in the science track. Most reported growing up seeing physicians provide patient care only. In addition to this exposure, there needs to be opportunity.
There was a perception among the minority MD and MD/PhD students that there isn't a lack of minorities in medicine, but there is a lack of minority role models in research.
"But definitely when I got to the research aspect, and I got in a lab, I did notice kind of a disparity. I definitely saw more Caucasian and Asian physicians participating in research whereas the community physicians that I saw working at some of the clinics that were on sliding-fee scales and in the underserved minority communities--I did see a lot more ethnic diversity there."
The minority MD and MD/PhD students who participated in the focus groups felt that at this point in their careers they don't have to worry about getting funded, but they have observed their research mentors and heard about the dire funding situation and how hard it is for young PIs start out.
"I personally don’t have a really good sense of what it is like to be a PI. I sort of see what my PI did. He was a more senior person, but sort of also overseeing the more junior people. They spend a lot of time worrying about their funding situation and whether or not it is going to be there, the next funding cycle…if it is going to be renewed."
The amount of time needed to pursue a career in research was not appealing to these students, particularly in light of the importance they placed on work/life balance:
"You see PIs, especially young PIs, regularly working 80-hour weeks. Even in fellowships I have seen people working 60, 80 hours, like nonstop, while trying to have a family. And it just looks difficult and draining and tiring."
The uncertainty of finding positive answers to research questions was also daunting to students.
"And if you don’t really love it, then I can see you getting burned out very, very quickly. And that is kind of scary to me. I think the other aspect is that as much as you want -- I think you have to enjoy the journey more than anything else. I think some people really like research and they don’t mind failing and they don’t mind getting answers that are wrong -- well, not wrong, but that go nowhere."
"It is important that you enjoy the pursuit of that answer. And I think for me, I don’t, I would rather -- I would be very upset if I chased something for 10 or 15 years and found nothing at the end of it."
Another concern was the perception that there are not a lot minority physician-scientist role models in research:
"I think a concern for me about going into a research career, what would be scary for me, with me being an African-American woman, a black female, and I mean facing the facts of things -- I have done research before, and I feel like, you know, you see a lot of either white males or you see a lot of Asian males."
"I have been the only person, black person in biology class since I was 14."
Most minority medical students saw themselves 10 years from now in clinical medicine careers with research as a smaller percentage of their time. They also would like to be affiliated with an academic medical institution.
Lifestyle and work balance was quite important to minority medical students. They believed the length of training eats into family life and recreation. They want to enjoy a family:
"I think it is really important consideration because, you know, if you are doing something and that is all you can do, you can’t do anything else, you can’t see your family, you can get kind of miserable."
The amount of loans they need to pay back also played a big role in their assessment of how quickly they are able to get out and practice and make a good salary.
MD and MD/PhD students from underrepresented minority groups made the following recommendations for making a research career more appealing and/or feasible:
"And by senior year I would say 75 percent [of my minority classmates in undergraduate school] were done and they had gone to more of a sociological or humanities-focused majors because that is where, at this point, a lot of minorities tend to flock to just because there are no minorities in science. And I think that is frustrating. People tend to go where they see people who look like them."
"I think it all starts very young because I think better STEM education has to begin way, way early to even like consider how to build that pipeline. I think a lot of times we have done a disservice to very young children who just don’t have a chance later on."
Lifestyle seems to be an important factor in choosing to pursue a DDS degree. The DDS students who participated in the focus groups really wanted to be able to set their own schedules and be their own bosses. How this plays into a career that includes research was not totally clear to the students. Still, one student clearly felt that the time commitment to get a PhD on top of a DDS degree would detract from her ability to have a family and stabilize a career.
Dental students who participated in the focus group offered several different reasons for attending dental school. Most reported attending school in order to provide patient care and because they liked the idea of owning their own business. One student reported that there were many dentists in her family and that helped her choose dentistry as a career. No dental students reported attending dental school with a goal of doing research.
Most DDS students mentioned that their student loan debt is high.
These students were primarily in committed relationships or married, but there were several who were single. None of the participants had children. The vast majority of participants were female.
DDS students reported a variety of reasons for being interested in research. Some were exposed as undergraduates. Others had research interests early on, but when they began to hone in on their true interest figured out that it was not for them and ended up going to dental school. One student reported doing research as a way to help strengthen her application to dental school. However, she ended up enjoying her experience. According to focus group participants, DDS students who are interested in pursuing a residency following graduation have an added incentive to do research. Research is a good thing to help their residency applications.
Even those students who professed an interest in research were unsure how to be good researchers as well as good dentists. DDS students felt that in order to do a good job as a researcher one needed to devote a large proportion of time to research, and that is not why most of them went to dental school.
Dental students reported that they want to be more autonomous in their employment situations. They were not interested in working in a hierarchy of people. They wanted to be their own bosses and set their own schedules. Research doesn't lend itself to that as nicely as private practice does.
DDS students were similar to veterinary students (see below) in that they admire the clinician-scientists they see at school. They were impressed with how they are able to balance their time and how dedicated they are to their careers. However, they do not admire their lifestyles. And, like veterinary students, DDS students felt that dentist-scientists may have lost touch with the bigger picture in dentistry and don't think they are the best teachers.
DDS students in the focus group wished that they had more information about careers in research, especially during dental school. Students reported not knowing about NIH opportunities as they relate to dental training and that there isn't much exposure to research as part of their schooling. One student said that she wished she had known that a DDS/PhD was an option if the PhD portion of her schooling would have likely been paid for. Students were familiar with loan repayment from the military, but they didn't know about other training grant opportunities in dentistry.
DDS students were interested in learning from each other and wanted to find colleagues that are like them. They were particularly open to networking with other students who are interested in research and having people to bounce ideas off of.
The DDS students in the focus group were not interested in pursuing a PhD following their DDS degree. A PhD for science other than bench science seemed unnecessary to these students. They all felt that the time needed to complete such a program was a major drawback. One student felt that it would be very difficult to earn money and stabilize her career prior to having a family if her training took that long. Students do see the value in the PhD degree and understand that it may be a necessity, depending on the career they are choosing (e.g., academic dean).
Two of the students in the focus group hoped to become part-time professors and part-time clinicians in the future, but the remaining participants saw themselves in private practice. They chose private practice primarily for the lifestyle it will afford them.
DVM students want more collaboration between them and medical students.
Veterinary students participating in a focus group chose to attend school for a variety of reasons. Some went to school with the goal of being practitioners, both large and small animal. Some reported very targeted goals, such as working with seeing-eye dogs or lab animal medicine. One student reported having an interest in research and said that was her real reason for getting her DVM degree.
These students reported a variety of family situations. The majority of students we spoke with are either married or in a committed relationship. No participants reported having children. The vast majority of participants were female.
Veterinary students in the focus group generally admitted to not really being interested in a research career at all. Some said that their undergraduate experiences helped shape their research interests.
One veterinary student said that she decided to pursue a DVM because her mentor made her feel like she might not be smart enough or able to pursue a research career. Several students credited their first mentors to really guiding them and helping them choose what further education to pursue.
Veterinary students, while passionate about the care of animals, did not have as positive of an outlook on careers in research. The majority of DVM students wanted to practice clinical medicine. They were not research driven. They felt that veterinary schools were best equipped to prepare them for clinical jobs. Also, they noted that NIH does not have a center dedicated to veterinary science.
These veterinary students would like other professionals to better acknowledge the value of a DVM degree. They thought the DVM degree should be a viable degree to do research, and don't feel the need for a PhD to do research. A PhD for science other than bench science seems unnecessary. Instead, DVM students would like to see more research done by folks who are primarily clinicians. They believed that research can be incorporated into clinical practice settings.
At the same time, some felt that the time commitment of research would be very intimidating, hence raising work/life balance concerns. They felt that their DVM degree might appear to be insufficient in the research world and the time it would take to get a PhD in addition to their DVM was daunting. In terms of balancing research and clinical, most felt that after learning how to balance school and family they would be able to manage their time upon graduation.
A concern about paying off student loans was also raised. Participants wanted to graduate and start practicing medicine in an effort to start paying off their debt. Further studies would only increase the debt and time to pay it back. For those DVM students that wanted to pursue an internship or residency, that means more years of low pay. Lost wages were an issue for these DVM students.
Still, DVM students tended to admire clinician-scientists in their field. They were consistently impressed with their ability to stay current in their field and use their intelligence to problem solve. However, they reported that not all clinician-scientists were good teachers. Students see their clinician-scientist role models as being “out of touch” or lacking certain social/teaching skills. They also observed that clinician-scientists have to deal with a lot of politics related to the university setting as well as communication issues. These factors may be a deterrent to becoming a clinician-scientist.
In an ideal world, DVM students would like to see that their degree has value in the research world. Students were not sure why they need a PhD to do research or if that is just a perception. Veterinary students wanted hands-on experience – that is why they went to school in the first place. The need to find a way to balance that with research would help DVMS in their effort to pursue research as part of their career.
Most of the veterinary students in the focus groups were on a clinical career path. Only one was committed to further schooling and the idea of a future PhD. She would still like to have a clinical career but is worried about the long time it is going to take to achieve her goals. Other students saw themselves teaching at universities or furthering their training to align their education with their specific career goals. For example, there was one student hoping to be a rural food animal veterinarian in a farming community. She wants to help the farmers in addition to the animals and noted that there is no direct career path for making that happen – she will have to find her way. Another student who was interested in sled dogs and wildlife research also noted that there is no direct way to get to her end goal. She was just figuring it out as she goes.
Veterinary students wanted to see more research being done by veterinary clinicians. They felt that their day-to-day experiences are valuable and could be incorporated into larger research projects. This would aid in integrating research and clinical practice.
Student would also like to see more avenues to work with medical students. There is a direct relationship between human medicine and animal medicine research, but little is taught to either group about the concept.
The concern over funding and loan repayment was brought up again in relation to career planning. DVM students would like to see more funding available for DVMs and some felt that there isn't enough respect for the degree on its own. Student loans are massive in comparison to salaries in the field and that is a large issue for new graduates.
Veterinary students made the following recommendations to help make a research career more appealing or feasible:
The DDS/PhD and DVM/PhD students participating in the focus group research were truly committed to their passions and determined to achieve their end goals regardless of the path they need to take to get there. They were not deterred by the amount of time it will take them to complete all their training. With that said, they were very concerned about debt and the ability to achieve the trifecta of research, teaching, and clinical care. Some were worried that they will need to spend a large proportion of their time writing grants and that this will take away from their time to do other things.
The DVM/PhD students unanimously reported that they had always wanted to be veterinarians. However, they were each interested in different types of research, ranging from retrovirology to food production. The DDS/PhD student participant originally wanted to attend school to become a veterinarian. However, she chose to go to dental school and is now interested in public health dental research.
More than half of the combined degree students in this group were currently single. One participant, who was married, had a young child. Again, the vast majority of participants were female.
Students pursuing combined degree programs (DVM/PhD or DDS/PhD) seemed to become interested in research earlier on in their education than those pursuing only a DVM or DDS. Several of these participants reported that their interest in research was piqued in high school. Others stated that they met a mentor early on in their research careers that was helpful in guiding them in their education choices.
The combined degree students really emphasized the need for good mentors.
The appeal of a research career was clear amongst all DVM/PhD and DDS/PhD students. They were passionate about research and love the challenges associated with performing research. They all reported the appeal of problem solving and passion for their chosen research area. Also, the idea that one can truly make an impact in a specific field was a driving factor for some students pursing research.
Most students indicated that the length of training is very long and makes it difficult to have a family life.
"It really is hard to just try and have a family life, try and have children, try and have a husband. Like any of that is just hard because at least the way I do research, you spend a crazy amount of hours in the lab. And when you are not in the lab you are researching and you are thinking."
"I would just comment that the process is, along with being poor for a very long time, the process is just really long and, I mean, I am sure there are some careers like, you know, becoming president or other things that take longer but, you know, I am not aware of too many other careers that take as long as it is going to take us."
One student in a combined DDS/PhD program felt that dental schools try to engage students in NIH opportunities and help them find career opportunities. She has gotten quite a bit of support from her dental school. She feels it is because of the National Institute of Dental and Cranial Research (NIDCR), which provides research information to students. There is not an Institute at NIH that focuses on veterinary research.
The DVM/PhD students believed there was little to no support or guidance for someone looking to pursue a research career, even though they are close to graduating with a combined clinical/research degree. The prevailing feeling was that veterinary schools were not equipped to help graduates move on to a research career after finishing a combined DVM/PhD. There was concern about the transition from research during school to a true research position. In addition, even though there is a big push at veterinary schools to go into research, there is a perception that there are not many opportunities in veterinary research.
The students in the DVM or DDS/PhD focus group had a variety of ideas of where they will be in the next decade. Some hoped to be in academia doing research. They understood the importance of a good mentor and would like to be that person for others. One student was sure that she did not want to be in academia and instead would like to work in industry while continuing some clinical work on the side. Students were concerned with the ability to teach, see patients, and do research. One felt that it might be easier to pursue one thing at a time instead of trying to achieve what might be impossible.
Combined degree students had big concerns about their loans. They pointed out that while some MD/PhD programs may have full coverage for tuition, this is not the case for DDS/PhD and DVM/PhD programs. As a result, combined degree students in these fields are graduating with high debt. Some students were not aware that loan repayment programs were available. They believed that the NIH loan repayment options do not really apply to their fields (the specific example was veterinary medicine) and that makes it hard to achieve the trifecta of teaching, research, and clinical care. The fact that the NIH has little money to help pay back loans is a major deterrent to becoming a clinician-scientist for these students.
Students in the DDS or DVM/PhD focus group recommended:
OMB Number 0925-0648
Expiration Date 1/31/2015
We’re exploring how students like you--those who may be considering a career in research--think about their career decisions. The aggregate findings will be used to inform the deliberations of the Physician Scientist Workforce Committee at the National Institutes of Health about how to improve and support a sustainable and diverse physician-scientist workforce.
This focus group will last about 1½ hours.
A few ground rules for today’s discussion:
Any questions before we get started?
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.
Then let’s begin. First, let’s go around and briefly introduce ourselves. Can you share with us four pieces of information?:
Thank you very much!
Catalyst Research & Communications conducted telephone interviews with deans at 12 medical schools, 2 dental schools, and 1 veterinary school between December 2013 to February 2014. With two exceptions, the interviews were conducted with the dean of the school; the two exceptions were with a dean of education at the medical school and a director of an MSTP program.
The medical schools were selected randomly from among constituent members of the Association of American Medical Colleges. PSW Committee member Vivian Lee, M. D. , sent an introductory email to the deans of the selected schools. Catalyst staff followed up with an email invitation to participate in an interview. Twelve of the 20 deans contacted agreed to be interviewed, yielding a 60 percent response rate among medical school deans. The dental school deans were nominated by the DDS Subcommittee and one veterinary school was selected among schools that offer a DVM/PhD degree. A 100 percent response rate was achieved among the deans of the non-MD schools.
For this research, Catalyst used an interview guide for key informant interviews that was approved by OMB. The interview guide may be found at the end of this report. Each interview lasted approximately 30 minutes.
Key findings from the interviews include:
When asked what suggestions they would make to the PSW-WG, a number of ideas were put forth to strengthen the physician-scientist pipline. A sampling of these:
OMB Number 0925-0648
Expiration Date 1/31/2015
Thank you for making time to talk to me today. As you know, we are conducting research to help inform the deliberations of the Physician-Scientist Workforce Committee at the National Institutes of Health about how to strengthen the nation’s physician-scientist workforce. In particular, we’re exploring how young people make the decision to pursue a career in research. We are talking with other deans, like yourself, as well as conducting focus groups with students.
What is said in this conversation will remain private to the extent allowed by law. That is, no one person’s contributions will be identified to the Committee. Instead, the Committee will be provided with aggregated information to help them in their deliberations. We would like to tape record the interview so that we can be sure our notes are accurate. The tape recordings and transcripts will be stored in a locked file cabinet until June 30, 2014 and then they will be destroyed. Is it okay with you if we tape this conversation?
Do you have any questions before we get started?
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.
Thank you very much!