The 100-Year Anniversary of Medical Education Reform

What kind of schools do you think of as being “private ventures, money making in spirit and object. Income was simply divided among the lecturers. No applicant for instruction who could pay his fees or sign his note was turned down.” This sounds like some sort of shady for-profit educational scam like Trump University, but that was how a lot of medical education was characterized in the United States in 1910 when the Carnegie Foundation published the Flexner report. This report helped spur medical education reform and licensing. NPR:

Prof. STARR: …during the 19th century, Americans were distrustful of expertise. There were, through the mid 19th century, no effective medical licensing laws, no regulation of medical practice or medical education. And so the whole field was thrown open to all kinds of practitioners of various medical sects and various kinds of entrepreneurs, who set up schools as money-making ventures… There had been no regulations. So, many schools had no laboratories whatsoever…

SIEGEL: Some of the reforms that Flexner proposed that seem like no-brainers today, but medical schools should be for college graduates, for example…  Or there should be some kind of experience with dissection, actual looking at the body while you’re in medical school.

Prof. STARR: Yes. All of those things made a great deal of sense, but at the same time, what they meant is that there would be new financial obstacles because medical education would become more expensive. It would become more exclusive and that was, on the whole, a necessary change. Unfortunately, it did result in a decline in the supply of doctors and that had very long term, unfortunate consequences for America.

SIEGEL: So we’re witnessing sometime early in the 20th century a change from a well-intentioned, good-natured local physician, who didn’t have much training, frankly, to a kind of a trained scientist with a real medical degree.

Prof. STARR: That was the vision. That was Flexner’s idea that science had to be brought to the bedside. And his report played a very positive role in doing that… I think what you have to bear in mind is that at that time in 1910, American society was undergoing a revolution, in many different respects, as a result of science. The airplane had just been invented. The automobile was coming into use. The telephone was coming into use. People were seeing everyday life transformed by science and technology. They began to have more faith in science than they had before. And the old distrust of professionals as monopolists that ran through the 19th century began to dissipate. And instead, people began to place their trust in science. I think that’s why Flexner had so much influence.

As a result, the government restricted medical schools and the number of M.D. granting institutions fell from 160 in 1904 to 66 in 1935.  The total number of M.D. students graduating fell by half. Flexner viewed blacks as inferior and that black medical professionals should only serve black patients and only under the supervision of white physicians.  At his recommendation, five of the seven historically black medical schools were closed.