Medical School Closures & Mortality: 1900s US History
Uncover how the Flexner Report reshaped medical education and impacted mortality rates in the U.S. during the early 1900s. this new study from Carnegie Mellon, Stanford, and Marquette Universities reveals that medical school closures, spurred by the Flexner Report, correlated with a decrease in infant and non-infant mortality. Explore how the report’s call for reform, influencing the quality of physicians, indirectly saved thousands of lives, particularly through the decline of infectious diseases. Counties near closed schools saw significant changes, including fewer physicians but increased numbers of nurses. News Directory 3 dives deep into this pivotal era, analyzing data and presenting this research’s key findings. Discover what’s next for medical advancements.
Flexner Report: Medical School Closures & Mortality Rates in the US
A new study suggests that the closure of numerous U.S.medical schools in the early 20th century, spurred by the Flexner Report, led to a decline in mortality rates. The research, conducted by Carnegie Mellon University, Stanford University, and marquette University, appears as an NBER Working Paper.
Karen Clay, professor of economics and public policy at Carnegie Mellon’s Heinz College, who led the study, said the findings build on prior research regarding the supply of medical professionals in the U.S.
The 1910 Flexner Report, which evaluated U.S. medical schools, advocated for the closure of many, particularly those that were commercial or not university-affiliated. Between 1905 and 1915, over 40% of U.S. medical schools shut down or were absorbed.
Researchers analyzed U.S.Census data from 1900 to 1930 and county-level vital statistics to measure the intensity of school closures across U.S. counties, considering distance from closures, the number of graduates from closing schools, and the timing of closures. Key findings include:
- Counties within 300 miles of a closed medical school saw a 4% decrease in physicians.
- This decline resulted from fewer young physicians entering the workforce and reputational damage to older physicians trained at closed schools.
- physicians migrated to counties more affected by closures, and those in affected counties postponed retirement, offsetting the decrease in new graduates.
- Closures within 300 miles led to a 7% increase in nurses per capita but did not affect the number of midwives.
- Infant, non-infant, and total mortality decreased in areas near closures. Counties with average closure intensity saw an 8% reduction in infant mortality, a 4% reduction in non-infant mortality, and a 3% reduction in total mortality.
- Researchers estimate that closing low-quality medical schools saved 16,000 infant lives and 38,000 non-infant lives annually.
- The mortality reductions were primarily due to declines in infectious diseases and diseases of early infancy, suggesting improved physician quality played a role. Other public health factors showed no correlation or were negatively related to medical school closures.
Margarita Portnykh, assistant teaching professor at Carnegie Mellon’s Tepper School of business and study coauthor, said that while isolating the precise role of physicians is tough, reducing the supply of poorly trained physicians appears to have reduced mortality.
More information: Karen Clay et al, Medical School Closures, Market Adjustment, and Mortality in the Flexner Report Era (2025). DOI: 10.3386/w33937
Provided by Carnegie mellon University’s Heinz College.