M.D.-Ph.D. programs have increased diversity — but there’s still work to do

Physician scientists with both medical degrees and Ph.D.’s are major contributors to the biomedical workforce. While they represent just 4% of medical school graduates in the United States, they receive around half of all the National Institutes of Health (NIH) research funding awarded to physicians.

However, the M.D.-Ph.D. population has historically lacked gender and racial/ethnic diversity. So in 2009, funding agencies began to tie financial support to diversity efforts. In a recent study, Yale researchers examined whether those changes have made an impact. According to their findings, recently published in the journal Academic Medicine, M.D.-Ph.D. programs have become more diverse, but there’s still room for improvement.

Dowin Boatright, assistant professor of emergency medicine and senior author of the study, and Angela Martinez-Strengel, who led the research as a postdoctoral fellow at Yale and is now a pediatrician at Randall Children’s Hospital in Portland, Oregon, sat down with Yale News to talk about the progress that has been made and the gaps that still exist.

This interview has been edited and condensed.

What led you to conduct this study?

Angela Martinez-Strengel: Around 2009, there were a lot of changes and specific regulations for medical schools and M.D.-Ph.D. programs when it came to diversity. For example, the Liaison Committee on Medical Education, which accredits medical schools, introduced a diversity accreditation standard mandating all schools to have policies and practices in place to recruit and retain a diverse student body. Around the same time, the National Institute for General Medical Sciences, which is the group that funds about half of M.D.-Ph.D. programs in the U.S., added specific funding rules requiring these programs to demonstrate structured and concerted efforts to train diverse students. And so a lot happened during that time that we felt like could have an impact on what the demographics of M.D.-Ph.D. programs look like.

Were there improvements?

Martinez-Strengel: Yes. We looked at all M.D.-Ph.D. programs that are accredited in the United States. Overall, we saw an increase in the percentage of female matriculants as well as the percentage of underrepresented racial and ethnic minorities.

Between 2009 and 2018, the percentage of female matriculants — we didn’t have access to self-identified gender, just sex — rose from 38% to 46%. For underrepresented minorities, we went from 9.8% of matriculating students in 2009 to 16.7% in 2018. But the majority of that change was led by Latinx/Hispanic populations, with Black and Native American populations experiencing lower increases, and no statistically significant increases in Native Hawaiian/Pacific Islander students unfortunately.

It sounds like there is still more work to be done.

Martinez-Strengel: There’s definitely still work to do because the demographics of M.D.-Ph.D. programs do not yet reflect the diversity of the United States population.

Dowin Boatright: And there’s still about 22% of programs that don’t have any underrepresented students matriculating. So I think even though we’ve had progress, there are ample opportunities for growth.

Are there strategies that might help bridge this gap?

Martinez-Strengel: We looked at whether programs were supported by NIH Medical Scientist Training Program (MSTP) funding. NIH MSTP-funded schools represent approximately half of all M.D.-Ph.D. programs, and we found that gains in matriculant diversity were concentrated in NIH MSTP-funded programs.

Boatright: One of the things we hypothesized was that when the NIH linked program funds to diversity standards, it created a very strong behavioral incentive for programs to achieve a certain level of diversity.

Martinez-Strengel: So it’s not just a mission on paper, but something you actually have as a requirement that you need to have in order to meet very specific goals. Expanding MSTP funding could be one way to increase matriculation of underrepresented minorities. Having that financial incentive and that specific standard to meet seems to be important. So looking at other ways to keep programs accountable, whether it’s to the school or other funding sources, could be another way to do it.

Are you continuing this line of research?

Boatright: Yes, we are doing some qualitative interviews with representatives from the programs that have been most successful in recruiting diverse applicants and trying to identify unique aspects of their organizational culture and specific strategies that have allowed them to be successful.