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

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. 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. 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. 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.