[JAMA] Demographics in MSTP admissions

[Mr.Smile12]

Socioeconomic Diversity in Admissions to MD-PhD Programs, 2014-2019

This cohort study of applicants to US MD-PhD programs examines the association of application outcomes with family income.

jamanetwork.com

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[dl2dp2]

Is “diversity” really “critical for innovation in the biomedical sciences and patient care”? I fail to see how having poor students engage in a career that will continue to make them poor is really an important initiative to take by the govt...

 

[UniCrys]

Is “diversity” really “critical for innovation in the biomedical sciences and patient care”? I fail to see how having poor students engage in a career that will continue to make them poor is really an important initiative to take by the govt...

Respectfully, diversity in the biomedical workforce is important for ensuring that research and healthcare practices are inclusive and equitable. Having a diverse workforce helps to address health disparities and ensure that all patients receive high-quality care. It's about providing opportunities for talented individuals from all backgrounds to contribute to the advancement of science and healthcare, ultimately benefiting society as a whole

 

[tr]

Is “diversity” really “critical for innovation in the biomedical sciences and patient care”? I fail to see how having poor students engage in a career that will continue to make them poor is really an important initiative to take by the govt...

Do we really want the scientific enterprise to be directed exclusively by the independently wealthy?

It's true that poor students shy away from a career path that demands 10-15 years of low-paid training positions post-college, only to lead to senior level positions that are still uncertain and have a poor financial payoff relative to the required educational investment.

I don't see why there can't be efforts to change that aspect of the career trajectory, such that people of more varied income levels could contribute to scientific progress.

 

[ddhopeful]

Socioeconomic Diversity in Admissions to MD-PhD Programs, 2014-2019

This cohort study of applicants to US MD-PhD programs examines the association of application outcomes with family income.

jamanetwork.com

“The percentage of applicants reporting household income less than $50 000 decreased annually, from 28.36% in 2014 to 25.14% in 2019”.

“The percentage of accepted students reporting household income greater than $200 000 increased annually, from 16.10% in 2014 to 20.87% in 2019”.

These trends could just be because no inflation adjustment was applied to the analysis?

 

[Mr.Smile12]

Just posting statements regarding the importance of diversity in the scientific workforce.

Executive Summary | In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce | The National Academies Press

Read chapter Executive Summary: The United States is rapidly transforming into one of the most racially and ethnically diverse nations in the world. Group...

nap.nationalacademies.org

Building a More Diverse Biomedical Research Workforce

“There just aren’t enough minority scholars in the STEM pipeline.”“Underrepresented students get so many scholarship offers, there’s no way our university can compete.”“Until we fix our broken K-12 educational system, there’s little universities can do to expand minority student participation in...

www.usucoalition.org

The Importance of Diversity in Biomedical Research | KentConnects Blog Post

Read our KentConnects blog post to learn more about The Importance of Diversity in Biomedical Research

www.kentscientific.com

Strengthening and Diversifying the Biomedical Research Workforce Through a National Institutes of Health and Department of Education Collaboration - Federation of American Scientists

Addressing health inequities and serving our nation's diverse population requires an equally diverse biomedical workforce.

fas.org

 

[SurfingDoctor]

I personally struggle with diversity initiatives because while I like the concept, I think the reality ends up being too complex and without clear goals.

From my own experiences/field, we generate a lot of clinical warm bodies and produce no scientists, which personally I find sad. I also think this makes for worse/more easily replaceable physicians but that's a digression. But a lot of trainees/colleagues are well to do and have the opportunities to pursue medicine. I'll also be frank in that I would use what leverage I have to help my kids succeed in life too, so I get that.

But if there's a group of people who haven't had the same opportunities and want to become scientists, I want those people. We NEED them frankly. On the other hand, I'm not sure diversity initiatives do a good job of that, at least not in their current iteration. I have also seen wealthy people use diversity initiatives to their advantage too which has jaded my perspective on their approach and ultimate appraisal. I know pipeline programs exist, which is probably a better approach, but I haven't seen a lot of outcome data to judge their success. I've actually sat on a number of K01 diversity study sections and even there, most of the applicants aren't coming from challenging upbringings or have already had success, so even though they meet the NIH-criteria for diversity, it's really hard to gauge.

I do hope pipeline programs, especially in science, are successful though. I suppose time will tell.

 

[tr]

I personally struggle with diversity initiatives because while I like the concept, I think the reality ends up being too complex and without clear goals.

From my own experiences/field, we generate a lot of clinical warm bodies and produce no scientists, which personally I find sad. I also think this makes for worse/more easily replaceable physicians but that's a digression. But a lot of trainees/colleagues are well to do and have the opportunities to pursue medicine. I'll also be frank in that I would use what leverage I have to help my kids succeed in life too, so I get that.

But if there's a group of people who haven't had the same opportunities and want to become scientists, I want those people. We NEED them frankly. On the other hand, I'm not sure diversity initiatives do a good job of that, at least not in their current iteration. I have also seen wealthy people use diversity initiatives to their advantage too which has jaded my perspective on their approach and ultimate appraisal. I know pipeline programs exist, which is probably a better approach, but I haven't seen a lot of outcome data to judge their success. I've actually sat on a number of K01 diversity study sections and even there, most of the applicants aren't coming from challenging upbringings or have already had success, so even though they meet the NIH-criteria for diversity, it's really hard to gauge.

I do hope pipeline programs, especially in science, are successful though. I suppose time will tell.

Agreed that microtargeted diversity initiatives are just spitting in the wind, and as likely as not to backfire. To really address the issue we would need bigger-picture changes on a population level.

One piece of this is the issue of scientific interest/ability/capacity, which is very difficult to develop in an under-resourced early developmental environment. The US has very poor social mobility compared to other rich nations, and early childhood supports are pretty abysmal. We have way more children living in poverty vs peer nations, and poverty in the US is more detrimental because the social safety net is so threadbare. Potential scientists and thought leaders need to be nurtured from the ground up. By the time they are 25 years old it's too late for a lot of them. No career development diversity initiative is going to make up for the effects of early life poverty on brain development.

The other piece is the unappealing tournament-scheme structure of the scientific career trajectory, which repels people who aren't independently economically secure. That's much more fixable. I've argued before that we need a stable, achievable career path for scientists that doesn't involve the precarity of the funding hustle.

I think the current movement of postdocs voting with their feet, consequently increasing demand for their services and thereby improving their salaries and benefits, is a good start. For those farther down the path, my institution has a 'research track' (as distinct from investigator/tenure track) that seems to be a parallel of the clinician-educator track designed for basic scientists. These people seem to be mostly right-hand men to rainmaking PIs. This seems like it could be a path towards addressing the job security/career stability issue, although the low pay will probably continue to be a deterrent for people who need to feed their families.

 

[SurfingDoctor]

Agreed that microtargeted diversity initiatives are just spitting in the wind, and as likely as not to backfire. To really address the issue we would need bigger-picture changes on a population level.

One piece of this is the issue of scientific interest/ability/capacity, which is very difficult to develop in an under-resourced early developmental environment. The US has very poor social mobility compared to other rich nations, and early childhood supports are pretty abysmal. We have way more children living in poverty vs peer nations, and poverty in the US is more detrimental because the social safety net is so threadbare. Potential scientists and thought leaders need to be nurtured from the ground up. By the time they are 25 years old it's too late for a lot of them. No career development diversity initiative is going to make up for the effects of early life poverty on brain development.

The other piece is the unappealing tournament-scheme structure of the scientific career trajectory, which repels people who aren't independently economically secure. That's much more fixable. I've argued before that we need a stable, achievable career path for scientists that doesn't involve the precarity of the funding hustle.

I think the current movement of postdocs voting with their feet, consequently increasing demand for their services and thereby improving their salaries and benefits, is a good start. For those farther down the path, my institution has a 'research track' (as distinct from investigator/tenure track) that seems to be a parallel of the clinician-educator track designed for basic scientists. These people seem to be mostly right-hand men to rainmaking PIs. This seems like it could be a path towards addressing the job security/career stability issue, although the low pay will probably continue to be a deterrent for people who need to feed their families.

I definitely think the winner-take-all aspects of research in the US create a lot of research inequality. There's always the argument that the people with the most success is because they generate the best innovations and are senior, so they know the field the best. I'm sure that was true at some point, nowadays it is less clear to me. And the instability in funding has a lot of trickle down effects on the workforce. Personally, I have found it very hard to hire lab personnel. Who wants a job that has no guarantee every 4 years? I wouldn't and don't blame people for not choosing to pursue it. But it definitely sucks for me too. I mean, I like doing experiments still, but it's hard to run a lab and have clinical time too when it just primarily me.

As far as children, I'm in pediatrics. I know all the facets of underfunding children in this country. That won't change though. It's tough enough to convince the US populace that programs that feed and provide healthcare to children are worthy. You're never gonna get some social mobility/career development pathway. I mean, our field is typically poorly paid and this year got hammered in the MATCH. 200+ spots unfilled. It maybe be a nice goal to invest in the children's future, but it's not going to happen.

 

[dl2dp2]

Do we really want the scientific enterprise to be directed exclusively by the independently wealthy?

Honestly, it kinda already is. Current workforce at "top tier research institutions" is:
50% wealthy offspring/people with pedigree/people who married wealth
50% 1st gen immigrants

Top US grads without the above are dropping out like no tomorrow. The survival probability is crazy low. Every other day someone else tells me they are leaving or has already left.

So, if very smart immigrants continue to be willing to fill these holes and do their dirty work so their kids can then go into investment banking or whatever, seems fine to me.

As far as children, I'm in pediatrics. I know all the facets of underfunding children in this country. That won't change though.

Exactly. If you *care enough* to work the system then work the system, start a legislative effort, raise money to influence politics. Short of that, do as best as you can with what you've got. I find that it's better for my mental health if I just *accept* the world *AS IT IS*, and focus on improving my life *on an individual level*.

 

[SurfingDoctor]

Exactly. If you *care enough* to work the system then work the system, start a legislative effort, raise money to influence politics. Short of that, do as best as you can with what you've got. I find that it's better for my mental health if I just *accept* the world *AS IT IS*, and focus on improving my life *on an individual level*.

Well, I don’t agree with that. With that mentality, there’d still be slavery in the country or impairment of voting for women.

Maybe I should have clarified. The “that won’t change though” is more of a reflection of it won’t change fast… like maybe in a lifetime. Certainly there are exceptions to that rule, but generally they involve a lot of killing.

The legislative process on the other hand is slow, somewhat by design. You have to slowly and steadily convince people that the juice is worth the squeeze, usually with brief periods of vocalization. In some capacity, that is already happening and continues to do so. What you can’t do is try to force it try to circumvent quickly because you think faster is better. It rarely works out that way.

 

[dl2dp2]

Well, I don’t agree with that. With that mentality, there’d still be slavery in the country or impairment of voting for women.

Maybe I should have clarified. The “that won’t change though” is more of a reflection of it won’t change fast… like maybe in a lifetime. Certainly there are exceptions to that rule, but generally they involve a lot of killing.

The legislative process on the other hand is slow, somewhat by design. You have to slowly and steadily convince people that the juice is worth the squeeze, usually with brief periods of vocalization. In some capacity, that is already happening and continues to do so. What you can’t do is try to force it try to circumvent quickly because you think faster is better. It rarely works out that way.

Yes. That's what I said, if you can handle it, do it. I can't hence I won't. My mental health can't handle it. I need to focus on my own wellness.

Also, I'm not sure things that principally get better are via policy means. Those well-known examples are almost the ONLY examples. Most of the differences of today's life vis-a-vis changes to our lives in the 1900s are related to *science and technology* that are developed and disseminated *privately*, or at very best had a public seed -- often is the case in health versus engineering. I am actually no longer certain with the standing narrative that things got better then worse again as is the prevailing in academia. Maybe things never got better, or got better very very slowly and it just feels like it's getting worse.

This morning I was checking that Google has an R&D budget that's comparable to the ENTIRE budget of the NIH. ENTIRE NIH... My mental health can't handle this kind of starkness to try to work on some collective action solution.

 

[JoaoMoutinho]

This morning I was checking that Google has an R&D budget that's comparable to the ENTIRE budget of the NIH. ENTIRE NIH... My mental health can't handle this kind of starkness to try to work on some collective action solution.

I hadn't heard this before. I googled it (lol)– you weren't kidding.

Even crazier is that Amazon spent nearly double that last year. Both Google and Amazon have had pretty dramatic increases in R&D spending the last couple years, but that's still nuts.

 

[SurfingDoctor]

So... the government needs to get into data cloud storage...

 

[Fencer]

So... the government needs to get into data cloud storage...

No, they are using the research infrastructure of cloud storage giants like amazon to run their near real-time data-sharing databases.

 

[SurfingDoctor]

No, they are using the research infrastructure of cloud storage giants like amazon to run their near real-time data-sharing databases.

That’s what I meant. The government generates revenue to pay for R&D revenue by doing what Amazon is doing, making its own government web services if you will.

Of course, it would never work and that post was mostly in jest. But I could foresee Amazon/Google/Microsoft/etc actually spinning off biomedical R&D. In some cases, they already do, but just on a much larger scale. They would probably have to partner with Pfizer or Merck or someone with the actual knowledge and equipment as well as production capabilities. My boss’s son went to go work for Pfizer after his PhD. They have him a house, moving expenses and his own mass spectrometer.

Maybe someday we can all be Google employees… joking/not joking.

 

[Fencer]

Imagine there is no cloud R&D (in NIH budget)
It's easy if you try
More bench R&D
Above us, only sky

Imagine all the researchers
Livin' for today
...

I certainly couldn't make a livin' as a songwriter

 

[Mr.Smile12]

But I could foresee Amazon/Google/Microsoft/etc actually spinning off biomedical R&D.

Let's see if Amazon can do pharmacy first.

Data infrastructure is definitely in their wheel-house. See Watson/IBM collaborations. Microsoft HoloLens. Google Health.

 

[Neuronix]

The posts in this thread... I'm doing a bit of shaking my head.

I am a physician-scientist with two active R01 equivalent grants. I am from a poor background, and I am not a first generation immigrant. I am very happy to see this analysis.

As a physician-scientist, I am not poor. The idea that any physician-scientist is poor is ludicrous to someone who actually grew up poor. The MD/PhD stipend got me through the MSTP comfortably, and I continue to be grateful that I could launch my career without staring down hundreds of thousands in student loans.

I do believe that diversity in its many forms is important to enhance medicine, research, and society. I endorse the NIH viewpoint which not only includes race/ethnicity, but also includes disability and disadvantaged backgrounds. I believe it should also apply to AAMC (i.e. diversity is more than just URM). NOT-OD-20-031: Notice of NIH's Interest in Diversity

 

[Fencer]

The posts in this thread... I'm doing a bit of shaking my head.

I am a physician-scientist with two active R01 equivalent grants. I am from a poor background, and I am not a first generation immigrant. I am very happy to see this analysis.

As a physician-scientist, I am not poor. The idea that any physician-scientist is poor is ludicrous to someone who actually grew up poor. The MD/PhD stipend got me through the MSTP comfortably, and I continue to be grateful that I could launch my career without staring down hundreds of thousands in student loans.

I do believe that diversity in its many forms is important to enhance medicine, research, and society. I endorse the NIH viewpoint which not only includes race/ethnicity, but also includes disability and disadvantaged backgrounds. I believe it should also apply to AAMC (i.e. diversity is more than just URM). NOT-OD-20-031: Notice of NIH's Interest in Diversity

MSTP training grants require an appendix indicating the number (percentage) of applicants, interviewees, accepted and matriculants with classes A, B and C (of NOT-OD-20-031). It does apply to AAMC FAP....

 

[UniCrys]

MSTP training grants require an appendix indicating the number (percentage) of applicants, interviewees, accepted and matriculants with classes A, B and C (of NOT-OD-20-031). It does apply to AAMC FAP....

Where can we find the data for this ?

 

[Fencer]

It is part of each program T32 application. NIH does not release that data. As a reviewer and EAB member, I have seen data for about 20 out of the 53 (soon to be 56 MSTPs). One of my collaborators who is a co-author of this paper, has a R01 on studying some aspects of data and at one point was provided with aggregate NIH data for all MSTPs and AAMC for all MD/PhD matriculants.

 

[SurfingDoctor]

The posts in this thread... I'm doing a bit of shaking my head.

I am a physician-scientist with two active R01 equivalent grants. I am from a poor background, and I am not a first generation immigrant. I am very happy to see this analysis.

As a physician-scientist, I am not poor. The idea that any physician-scientist is poor is ludicrous to someone who actually grew up poor. The MD/PhD stipend got me through the MSTP comfortably, and I continue to be grateful that I could launch my career without staring down hundreds of thousands in student loans.

I do believe that diversity in its many forms is important to enhance medicine, research, and society. I endorse the NIH viewpoint which not only includes race/ethnicity, but also includes disability and disadvantaged backgrounds. I believe it should also apply to AAMC (i.e. diversity is more than just URM). NOT-OD-20-031: Notice of NIH's Interest in Diversity

I don’t think really many were arguing that diversity isn’t necessary (sans maybe one) but I do think the question of how you make it successful is a reasonable one. Saying it versus implementing it to achieve meaningful results seem quite disconnected from my observations.

 

[SurfingDoctor]

It is part of each program T32 application. NIH does not release that data. As a reviewer and EAB member, I have seen data for about 20 out of the 53 (soon to be 56 MSTPs). One of my collaborators who is a co-author of this paper, has a R01 on studying some aspects of data and at one point was provided with aggregate NIH data for all MSTPs and AAMC for all MD/PhD matriculants.

I can’t speak to MSTP programs, but often in many fields, including mine which is a primary care based field, the lack of matriculants is often met with the belief that more programs/spots are needed as a primary solution, though that never comes to fruition.

Since you are more involved, is that the logic here? They reason I ask is because often in my field, the new spots are in mediocre programs that shouldn’t have a spot but they meet the most basic requirements to do so and generate subpar matriculants. I would be sadden to see more MD/PhD spots in mediocre programs that get filled because of the perceived deficit in numbers when the issues seem much broader.

 

[tortuga87]

Coming from a low income background myself, I will say that it is still a hard path. You will not be in poverty throughout the process, but you will not be driving a nice car either.

If you are the type of person who can grow up in crime/drug infested Section 9 housing on food stamps but then rise all the way to becoming an R01 funded investigator among elite academics, then something is really special about you. You certainly have the ability to earn MUCH more in another endeavor with the same effort.

It is also strange to want to do science after growing up in such conditions. Usually, the capable people from that level of disadvantage are very hungry to make money as soon as possible. Academics is not respected in these communities. You wont have a quiet place to study until college. You will be bullied and likely jumped multiple times. You need to maintain motivation and mood on low quality foods. You basically need to have an autistic like motivation from within yourself maintained for decades. Not easy for sure.

 

[Neuronix]

Academics is not respected in these communities. You wont have a quiet place to study until college. You will be bullied and likely jumped multiple times. You need to maintain motivation and mood on low quality foods. You basically need to have an autistic like motivation from within yourself maintained for decades. Not easy for sure.

Is this a made for TV movie? Libraries exist everywhere. Getting jumped for studying? Seriously? Autistic like motivation? Isn't that just dedication?

 

[dl2dp2]

I don’t think really many were arguing that diversity isn’t necessary (sans maybe one) but I do think the question of how you make it successful is a reasonable one. Saying it versus implementing it to achieve meaningful results seem quite disconnected from my observations.

I think implicit in the this line of thinking is that there’s good and bad diversity. If you just want poor kids you can get plenty from your H1B and offspring pool. If you want racial and ethnic diversity, poor white kids from the US get the short end of the stick. If you raise salary high enough to be competitive with other jobs, then of course you get a larger pool with which you can play musical chair better.

When you encourage diversity, some form of injustice will need to be handed out through an arbitrary, bureaucratic process. Diversify is a luxury. It’s a luxury that has no intrinsic value.

Now I’m not dissing luxury. I love luxury. But let’s be honest about it. Whether you can be diverse depends less on if you can come up with the right policy than whether you can afford it. And my point is that at this point, maybe we can’t.

 

[Neuronix]

I think implicit in the this line of thinking is that there’s good and bad diversity. If you just want poor kids you can get plenty from your H1B and offspring pool. If you want racial and ethnic diversity, poor white kids from the US get the short end of the stick. If you raise salary high enough to be competitive with other jobs, then of course you get a larger pool with which you can play musical chair better.

Huh? Nobody said they "just want poor kids" or just "want racial and ethnic diversity". Also, what does salary have to do with diversity in MSTP admissions?

When you encourage diversity, some form of injustice will need to be handed out through an arbitrary, bureaucratic process. Diversify is a luxury. It’s a luxury that has no intrinsic value.

Admissions will always be an arbitrary process. What injustice are we handing out here?

Now I’m not dissing luxury. I love luxury. But let’s be honest about it. Whether you can be diverse depends less on if you can come up with the right policy than whether you can afford it. And my point is that at this point, maybe we can’t.

No idea what you're getting at here. Whether you can afford it? Afford what exactly?

Where can we find the data for this ?

I've requested MD/PhD data for analysis from AAMC. It is not cheap.