I'm a student enrolled in a MD/PhD program in Canada. I don't know about NIH very well, but our experience here is that it is very difficult to continue research. I agree with eykanal: it takes a lot to be a great clinician (and being a mediocre clinician is very hard on one's conscience). 50%+ of students rethink their decision during their first year of medicine and do not begin the PhD portion of the program. Only those who begin 80/20 in terms of devolution (80 research, 20 clinician) seem to be able to continue the research path, with considerable sacrifice of their clinical skills (fewer clinical elective during both medical school and residency), as well as many more years of education.
Once done, however, the career path in academic medicine is relatively good. The PhD really helps with those jobs and their attendant excitement and opportunities, although they often pay significantly lower than a pure clinican job.
I know that in the States, the culture of MD/PhD's is more pronounced than in Canada, since there's a massive amount of NIH funds. I heard that nearly a quarter of the class in U of Pennsylvania at least begin as MD/PhD's (don't quote me). Dropping out of the PhD is harder, because you have to give up your funding. I expect that many of them are able to complete the program, but few manage to continue in the research path.
Many of the professors who are MD and PhD's often complete their PhD separately from the MD - they either had it before the MD or got it afterwards. Materially, it's a more difficult path, with less funding and guarantees, but there's less room to regret and it's easier to cut one's losses, since it's 2 big decisions, not 1.