Black M.D. and Ph.D. students found to experience higher rates of attrition than peers

Black M.D.-Ph.D. students are 83% more likely than white students to leave medical school and 50% more likely to graduate with only an M.D., according to a new Yale-led study. The findings, researchers say, have implications for the diversity and innovation of the biomedical workforce.

The study was published July 31 in JAMA Internal Medicine.

Working at the intersection of research and patient care, physician-scientists provide an essential contribution to biomedicine, says Mytien Nguyen, an M.D.-Ph.D. student at Yale School of Medicine and lead author of the study.

"The research that physician-scientists do and the questions they ask are immediately applicable and translatable. They are critical for improving the innovation in biomedical and clinical research," she said. "But we've seen a decline in the number of physician-scientists over the years."

While medical schools and accreditation bodies have put an emphasis on recruiting diverse student bodies, little is known about attrition rates across groups historically underrepresented in medicine.

For the new study, the researchers assessed attrition rates among students who matriculated to M.D.-Ph.D. programs between 2004 and 2012, following their enrollment status through 2020.

"We found that Black students were more likely than other students to leave medical school or to only have completed their M.D.," said Nguyen.

Specifically, 20% of Black M.D.-Ph.D. students graduated with an M.D. only, compared to 12.4% of white students, 11.4% of Asian students, 13.2% of Hispanic students, and 9.8% of multiracial students. And Black students (8.4%) were nearly twice as likely to leave medical school than white students (4.3%). (Data on Ph.D. completion only was not available for analysis.)

In all, 29% of Black students did not complete their full M.D.-Ph.D. training, compared to 17% of white students.

The researchers compared their findings to those from a study assessing attrition between 1995 and 2000. While attrition decreased overall between the two time periods, the attrition rate for Black students remained the same.

"Medical schools have made an effort to decrease attrition overall," said Nguyen. "But our findings indicate that the steps they've taken have not changed what it is like to be on the M.D.-Ph.D. training path as a Black student. Barriers highlighted by previous studies—mistreatment, discrimination, and financial barriers among them—still persist."

To address higher rates of attrition among Black M.D.-Ph.D. students, the researchers suggested medical schools cultivate more awareness of and directed intervention for mistreatment and discrimination.

Further, they said, accrediting and funding bodies—such as the National Institutes of Health, which funded more than 76% of the M.D.-Ph.D. students included in the study—should leverage their influence to promote equity in research training. This could be done, in part, by requiring schools to assess not just overall retention, but retention across groups underrepresented in medicine.

"These are extremely qualified students and it's so difficult to get into an M.D.-Ph.D. program. That anyone would leave either M.D.-Ph.D. component is really unfathomable," said senior author Dowin Boatright, who began the research while at Yale School of Medicine and is now the vice chair of research in the Department of Emergency Medicine at New York University Grossman School of Medicine. "Having a metric to look at disparities in retention will be important moving forward."