Vocation, collaboration, and family: what motivates physicians to continue in or leave research?

With half of medical specialists holding a PhD, the Netherlands offers an insight into why so few physicians continue in research and what separates those who do from those who leave science behind

Daniel Dieb

A Black female physician with short hair, wearing a white lab coat, sits in front of two monitors displaying radiotherapy planning software, with CT scan images and color-coded dose distribution maps. She has a focused expression, with her eyes fixed on the screens. On the desk there is a keyboard, mouse, and tablet.

In the Netherlands, 48% of specialist physicians hold a PhD, a figure far higher than in countries like the United States (US), where only 4% of physicians hold the title, according to a 2023 survey by the American Association of Medical Colleges (AAMC).

Yet only a fourth of these Dutch physicians has maintained a career combining both research and clinical practice, defined as spending at least 20% of their time on each. The conclusion is the result of a study recently published in the journal PLOS ONE.

A 14-year follow-up

The study looked at the careers of Dutch physicians who obtained a PhD in 2008. Fourteen years later, in 2022, the researchers located 479 of the physicians from this cohort and successfully contacted 424 of them. Of that total, 240 responded to a questionnaire—a response rate of 56.6%. The average age at the time of the survey was 48.7 years, meaning that the participants completed their PhDs at an average age of 34.

There are eight University Medical Centers (UMCs) in the Netherlands, each of which awards an average of approximately 200 PhDs per year in medical and biomedical sciences. Almost half of those graduates are MDs. Most begin their doctoral studies soon after finishing medical school, either before or during their residency. In addition to offering the chance to explore a research career, a PhD also provides a valuable credential for those seeking access to more competitive specialization programs.

To understand what motivates physicians to follow this path, the research team used self-determination theory (SDT), which distinguishes between decisions led by autonomous motivation (such as curiosity and personal interest) and those driven by controlled motivation (such as external rewards, obligation, or guilt). According to SDT, autonomous motivation leads to better outcomes in terms of academic performance, persistence, and well-being.

Participants answered questions about their education, career path, and motivations for pursuing a PhD, factors that facilitated or hindered their continuation in research and their satisfaction with the decision. The results showed that respondents were predominantly driven by autonomous motivation, with a median of 3.88 on a five-point Likert scale, in contrast to controlled motivation, which had a median of just 2.00.

The scientific career funnel

The data reveal a growing gap between intentions and practice. Immediately after completing their PhD, 82.8% of respondents said they planned to continue in research. In reality, 73.6% continued with some form of scientific activity, but of that group, 32.9% spent less than 5% of their time on research, equivalent to less than three hours per week. When the researchers adopted a stricter definition of a physician-scientist (with at least 20% of working time spent on research and at least 20% on patient care), only 25.2% of respondents qualified.

In total, 67.5% reported both research and clinical practice, but for most, research occupied a small fraction of their day-to-day work. Just 3.5% devoted 50–80% of their time to science while spending at least 20% of their time on patient care. Of the 60 physician-scientists identified, 78.3% worked in university hospitals.

Although 67.5% of physicians with PhDs reported involvement in both research and clinical practice, only 25.2% spent enough time on both to be considered physician-scientists by the study’s criteria

Autonomous motivation was the strongest predictor of a physician-scientist career. MDs who scored higher in this dimension were almost four times as likely to continue on this career path. Scientific networks and academic collaborations were the most frequently cited institutional factors for staying involved in science.

Medical specialty also mattered: those in clinical medicine were three to four times more likely to pursue a physician-scientist career than physicians in surgical specialties. Among those who completed their PhD before specializing, 55.1% admitted that improving their chances of securing a residency position influenced their decision, but did not impact whether they remained in research. The proportion who went on to become physician-scientists was identical (23.2%) among those who both did and did not report this instrumental motivation.

The main barriers identified were a lack of dedicated research time and a desire to spend more time with family or partners. The outcome is not based solely on funding or infrastructure: work-life balance is a decisive factor, and the results were similar for men and women.

Practical benefits of a PhD in clinical practice

Of the 220 respondents in clinical practice, 152 (69%) stated that their PhD training offered practical benefits. The most frequently cited were that they are able to apply evidence-based medicine (44% of respondents), develop clinical protocols and guidelines (41%), and improve day-to-day care (30%). Other advantages mentioned included critical thinking, perseverance, and the ability to manage complex situations.

Just 13.6% of respondents said there were disadvantages. The most common was the difficulty of simultaneously balancing doctoral studies, a residency, and family life. The second was financial: a research fellowship pays less than clinical work, delaying financial stability, and the respondents acknowledged that this deficit was not fully recovered over the course of their careers.

When asked if they would do a PhD again, 223 respondents (95.3%) said yes, while 46.1% considered it unlikely that they would hold their current position without the degree—either because it is a formal prerequisite for academic tenure or because it opened doors at academic centers.

Despite the reported obstacles, 95.3% of participants stated that they would pursue a PhD again, and 46.1% believed they would not hold their current position without the degree.

Autonomous motivation beyond research

The effect of autonomous motivation extends beyond physician-scientist careers. Among respondents, 22.7% attained a permanent academic position (assistant, associate, or full professor). Physicians with higher autonomous motivation scores were 2.57 times more likely to achieve tenure (Odds Ratio (OR) 2.57; 95% CI, 1.23–5.39). Number of published articles was also a strong predictor: doubling one’s scientific output was associated with a roughly 3.7 times greater chance of attaining a permanent position.

Men were more likely to reach the position of full professor (13 out of 126 against 5 out of 105 women). The study attributes this difference to the higher publication output among men during the study period, with a median of 21 articles compared with 14 among women in the 14 years after completing their PhDs. The authors suggest that shorter scientific careers among women, rather than a slower publication rate, may partially explain the difference.

The Brazilian landscape: gaps in data and infrastructure

No equivalent survey on physician-scientists has been carried out in Brazil. A systematic review published in Revista Brasileira de Educação Médica (“The Brazilian journal of medical education”) in 2022 found that most medical schools in the country did not offer structured undergraduate research programs, even though about 60% of students declared their intention to pursue research after graduation.

In practice, less than 1.5% of graduates expressed a preference for combining teaching and research, according to a 2018 report on medical demographics in Brazil (“Demografia Médica no Brasil”). The gap between the stated intentions of medical students and their eventual career choices highlights a structural problem: the lack of institutional conditions that make remaining in science a viable option.

In Brazil, less than 1.5% of medical graduates chose a career in research and teaching, even though 60% declared their intention to pursue science while they were still in medical school.

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