Trends in MD-PhD representation and match outcomes across competitive specialties, 2007-2024

Physician-scientists trained through MD-PhD programs play important roles in translational research. Despite the growing emphasis on research in residency applications, it remains unclear whether competitive specialties demonstrate a preference for MD-PhD graduates. This study evaluates differences in representation and match outcomes between MD-PhD and MD applicants across select specialties from 2007-2024, as well as the influence of specialty-level compensation and structural research infrastructure on outcomes. We analyzed data from the Association of American Medical Colleges (2015-2023), the National MD-PhD Program Outcomes Study (1975-2024), and the National Resident Matching Program's Charting Outcomes in the Match™ (2014-2024). Chi-square tests compared match rates between MD-PhD and all U.S. MD senior applicants across dermatology, orthopedic surgery, neurosurgery, otolaryngology, plastic surgery, and diagnostic radiology. Negative binomial models measured changes in MD-PhD resident representation. Spearman rank correlations assessed associations between specialty-level physician compensation, NIH departmental funding, number of dedicated Physician-Scientist Training Programs, and MD-PhD outcomes. From 2015-2023, MD-PhD representation among residents remained stable with match rates varying by specialty and year. Dermatology and diagnostic radiology demonstrated strong match outcomes for MD-PhDs, whereas orthopedic surgery showed declining success for MD-PhD applicants. Neurosurgery, otolaryngology, and plastic surgery,had variable or inconsistent trends. Compensation and NIH funding were not significantly correlated with MD-PhD representation or match advantage. Physician-Scientist Training Programs availability showed the strongest associations with both outcomes but was not statistically significant given the small sample size. MD-PhD training does not consistently confer a match advantage in competitive specialties. The availability of research training infrastructure, compensation, and NIH funding may influence MD-PhD match success. Additionally, residency program preferences, such as clinical metrics, as well as MD-PhD applicant preferences may both affect match outcomes. Enhanced mentorship, specialty-specific exposure, and financial support may help support the physician-scientist pipeline across specialties.