Why Do Dual Degree Students Leave Training? A Cross-Sectional Study of MD/PhD and DO/PhD Program Leadership

Leela Strand; Libby R White; Samuel J Irving; Amy M Schwartz; Melissa B Ludgate; Gordon F Buchanan; Karen I Cyndari

doi:10.1093/acamed/wvag173

Why Do Dual Degree Students Leave Training? A Cross-Sectional Study of MD/PhD and DO/PhD Program Leadership

Acad Med. 2026 Jun 10:wvag173. doi: 10.1093/acamed/wvag173. Online ahead of print.

Authors

Leela Strand¹, Libby R White², Samuel J Irving³, Amy M Schwartz⁴, Melissa B Ludgate^{5

6}, Gordon F Buchanan⁷, Karen I Cyndari³

Affiliations

¹ Harvard University, Cambridge, MA, United States.
² University of Iowa, Iowa City, IA, United States.
³ Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States.
⁴ Department of Epidemiology, University of Iowa, Iowa City, IA, United States.
⁵ Department of Internal Medicine, University of Iowa, Iowa City, IA, United States.
⁶ Department of Psychiatry, University of Iowa, Iowa City, IA, United States.
⁷ Department of Neurology, University of Iowa, Iowa City, IA, United States.

PMID: 42271637
DOI: 10.1093/acamed/wvag173

Abstract

Purpose: MD/PhD or DO/PhD ("dual degree") holders represent approximately 3% of graduating medical students annually. Graduates from this pipeline have a higher likelihood of successfully obtaining research independence than single degree peers. Despite the long-term success, there is substantial concern in the physician-scientist community that the pipeline for these trainees is at risk. While career alignment in dual degree graduates has been previously assessed, data is limited on students. This study evaluates program leadership perceptions of student resources, mental health, reasons for non-completion, and next steps.

Method: This cross-sectional study was administered March 2024 to June 2024 via electronic survey sent to dual degree program leadership across the U.S. This survey queried quantity and reasons for degree non-completion; created a curated list of student support resources; and assessed program leadership responses to admissions of student addiction and/or suicidality. Leadership was invited to share voluntary, free-text responses for additional context.

Results: The response rate was 57% (61/107). There was no difference between responders and non-responders when comparing MSTP status, dual degree cohort size, and/or medical school size. Financial assistance was common amongst dual degree programs (58/61; 95%), while pregnancy (26/61; 43%) or parenting (21/61; 34%) resources were less common. Nearly 87% (53/61) of programs experienced at least 1 degree non-completion in the past 10 years, with the most common reason cited as "change in priorities" (32/42; 76%), and the second most common reason being "mental health" (13/42; 31%).

Conclusions: Change in priorities was the primary driver of student attrition, followed by mental health. Factors confounded with mental health included negative research experiences and struggles with academic performance. Dual degree program leadership stated firm commitment to improving mental health and wellness as requested by students, and suggested a focus on screening for appropriate student expectations for a research focused career.

Keywords: MD/PhD; attrition; mental health; physician scientist; pipeline.