The Impact of Cost Cutting on MD-PhD Programs in Canada: Equity, Diversity, and Inclusion Challenges for Clinician-Scientist Training Programs.

Background: MD-PhD programs play a critical role in training the next generation of clinician-scientists in Canada. However, since 2015, these programs have faced increasing financial pressures. This review examines the impact of cost-cutting measures on Canadian MD-PhD programs and their implications for equity, diversity, and inclusion initiatives in the Canadian context.

Methods: Using a mixed-methods approach, we analyzed funding structures across all 11 Canadian MD-PhD programs and compared them with 120 U.S. MD-PhD programs using publicly available data.

Results: Eighteen percent of Canadian MD-PhD programs (2 of 11) offer full funding, compared to 43% (52 of 120) of U.S. programs. Canadian MD-PhD applicants from two provinces (British Columbia and Ontario) have access to fully funded in-catchment programs (49% of Canada's population). By contrast, U.S. MD-PhD applicants from 31 states have access to fully funded in-catchment programs through Medical Scientist Training Programs (MSTPs) (85% of the U.S. population). Canadian MD-PhD programs have a more uneven geographical distribution and funding landscape than those in the United States, limiting accessibility for Canadian students from underrepresented and lower socioeconomic backgrounds.

Conclusions: Despite recent increases in diversity among MD-PhD trainees, financial constraints threaten to reverse these gains, reducing opportunities for historically marginalized groups. This review highlights the need for renewed provincial and federal investment in MD-PhD training. Without targeted policy and funding supports, the sustainability of Canadian MD-PhD programs-and the future of Canada's clinician-scientist training pipeline-remains uncertain. Addressing these challenges is essential to maintaining Canada's global competitiveness in medical and scientific innovation and ensuring that clinician-scientist leadership reflects the diversity of the patient populations they serve.