The Flexner Report is the most important document in the history of medical education in the United States, and arguably in the history of medicine in the United States. It is an expansive look at the condition of medical education at the turn of the twentieth century, and is responsible for the condition of such education today.
In the nineteenth century, according to The American Medical Association, most medical education in the United States was administered by one of three basic systems:
This problem greatly upset the American Medical Association, which lobbied the government for a government mandate to standardize American medical education. They sought to restructure or shut down schools that failed to adopt a systematic approach tomedical training, or "scientific medicine." With this goal in view, the AMA created the Council on Medical Education (CME) in 1904 to promote the modernization of medical education. The CME outlined two primary reform initiatives:
Abraham Flexner (1866-1959) was not actually a doctor. In fact, he wasn't even associated with the medical field. Flexner was a secondary school teacher for 19 years in Louisville, Kentucky, where he also had worked as a principal. After these 19 years, however, he went on to graduate studies at Harvard and the University of Berlin, and later joined the research staff at the Carnegie Foundation for the Advancement of Teaching, where he was tasked with taking a critical look at US medicine.
Over the course of 18 months, Flexner visited 155 different US medical schools, where at each he examined 5 major areas:
"We have indeed in America medical practitioners not inferior to the best elsewhere; but there is probably no other country in the world in which there is so great a distance and so fatal a difference between the best, the average, and the worst . . . The point now to aim at is the development of the requisite number of properly supported institutions and the speedy demise of all others."Flexner jabbed at the current view of medical education of the day, which portrayed learning institutions primarily as businesses to make money, rather than to treat patients in the most efficient way possible.
"The overwhelming importance of preventive medicine, sanitation, and public health indicates that in modern life the medical profession is an organ differentiated by society for its highest purposes, not a business to be exploited."
"The right of the state to deal with the entire subject in its own interest can assuredly not be gainsaid. The physician is a social instrument."
Due to Flexner's scathing report, medical schools were forced to implement stricter admissions and curriculum requirements, causing many institutions to shut down altogether. In 1912, a group of licensing boards created the Federation of State Medical Boards, which voluntarily agreed to base its accreditation policies on standards determined by the CME and Flexner's report. Consequently, the CME's decisions came to have "the force of law."
These reforms, though universally thought of today to be necessary for the growth of the medical profession, had many negative immediate effects. The new standards led to the closing of a majority of the country's medical schools. Of the 126 medical schools in America in 1910 (of which there were 166 before the formation of the CME in 1904), in just five years the number dwindled to 96, and by 1930 there were only 76 such schools in the US. Also, the reforms led to a disproportionate reduction in the number of physicians serving disadvantaged communities. Most rural medical schools and all but two Black colleges were forced to close their doors. These also inhibited the economically underprivileged from pursuing medicine, as the sudden lack of schools put tuition far above the reach of many. Compared to the advantages reaped through time, however, these concerns were significant but necessary as the reshaping of America's medical system helped lead to this nation having the highest level of medical care the world over.