The role of medical school admissions committees in the decline of physician-scientists.

articles written over the last few years have drawn attention to the disappearance of young physician scientists (1–5). There are nearly 25% fewer physician scientists on medical school faculties today than two decades ago (6) and now we know some of the reasons. The heavy accumulation of debt through many years of research training is one explanation (7). So is the difficulty of providing a useful research experience in the modern training curriculum (8–10), or reaching trainees who have no real understanding of what it means to be a physician-scientist before their career choices are made (3, 11). Some students attend medical schools that offer little investigative opportunity (3, 12, 13), and of course there are questions about earning a living from academic life. While these reasons partly explain the problem, I would add one more. Medical schools no longer matriculate sufficient numbers of students who are deeply interested in science. There is room nationally for only 2% of first-year medical students in the Medical Scientist Training Program (MSTP) leading to an M.D./Ph.D. degree (14, 15) and this percentage has been fixed for some time. The percentage of other students entering medical school who profess a very strong interest in research has been declining since 1987 (16). It now hovers around 10% (17) and many of these students will change their minds (18). Only 6% of first-year matriculants think curing disease is the most important purpose of medicine (17) — the average person on the street (19) seems more committed to medical research than our students. So how did all this happen? I think it may have something to do with the vision of modern admissions committees and the seeming reluctance of physician-scientists to fully engage in the admissions process. Most medical school admissions committees accept students by majority vote or approval of a dean (20), and some states have spoken legislatively on behalf of admissions committees to ensure room for those interested in family medicine or primary care. Committees of the past did little modeling of their selection behaviors (21, 22) and not much is known of the scholarly perch from which they operate today. We do know the composition of admissions committees (23): there are nearly twice as many men as women; 63% are physicians of which 8% are underrepresented minorities and 40% are from primary care disciplines. Medical students comprise 15%; Ph.D. faculty 20%; and most importantly …