Since organized MD-PhD programs began to appear
in the United States more than 30 years ago, dual-degree graduates have
been the object of great expectations in the medical community. With
training in basic research and patient care, MD-PhDs have been heralded
as future leaders of clinical research and academic
medicine.1 These children of two worlds embody the
complexity and interdependence of patient care and biomedical research
that characterize the US health care system.
Since the 1960s, the number and diversity of dual-degree programs has
increased to reflect the changing demand for physician researchers in
different settings. When the National Institutes of Health (NIH)
launched its Medical Scientist Training Program (MSTP) in 1964, it
provided funding to only 3 medical schools. Today, the NIH funds 34
institutions and 826 dual-degree trainees each year, and more than 80
schools offer MD-PhD opportunities using other sources of
funds.2 Although early dual-degree students chose graduate
fields almost exclusively in the basic sciences, today's MD-PhDs pursue
a broader range of studies, including medical economics and the
Despite the popularity and prestige of the dual-degree track, a
singular vision of its purpose and necessity is lacking. Some educators
view MD-PhD programs as a flexible approach to scientific training, in
which students can choose to be either basic scientists or clinical
investigators. Others insist that the purpose is to create graduates
who will simultaneously use their skills at the bench and in patient
care.3 In 1979, when James Wyngaarden described the
clinical investigator as an "endangered species," MD-PhD training
programs were thought to be a solution to the problem.4 But
reports since then suggest that many dual-degree programs emphasize
purely laboratory-based sciences rather than clinical
Recent trends in the US health care system have heightened questions
about the relevancy and viability of MD-PhD programs. The highly
trained MD-PhD seems out of place in the new primary care-oriented,
cost-conscious health care paradigm. With academic health centers and
scientific researchers facing growing fiscal pressures from managed
care, future support for these expensive programs is far from secure.
If medical schools are to continue to justify dual-degree tracks, they
must demonstrate MD-PhDs' contributions to the nation's health care
This month, MSJAMA examines some of the issues surrounding dual-degree
programs. Are MD-PhDs fulfilling the goals of "translational research"
for which they were trained, often with public funding? How do their
research choices and results compare with those of PhDs or MDs? As the
relationship between medicine and science changes to reflect new
priorities, so must the identity and the approach of the dual-degree
Between 1 & 3, (silver gelatin print) by Mach Bhati, Louisiana
State University School of Medicine in Shreveport.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early
dhildhood mortality and growth failure data and their association with maternal
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