Steven Lippmann, M.D.

Medical education in the USA was famously improved following a critical review by Abraham Flexner.  Around 1908, he had been recognized for improving graduate schools. At that time there were also many substandard medical schools providing inadequate physician training. Flexner then embarked on a Carnegie foundation prompted study of American medical education.

His 1910 Flexner Report revealed the presence of far too many medical schools that offered little scholarship, minimal clinical experience, and graduated poorly trained doctors – to the detriment of healthcare. The report led to the closure of most medical schools in this country; however, it also included excellent means of fixing some of these problems.

This Flexner report cited these issues: too many unregulated schools, inadequate faculty educator numbers, little patient care experience, absence of scientific, laboratory, or research understanding, inadequate funding, and lack of graduate physician oversight. Most such institutions were closed.

The Flexner Report also offered several solutions that were largely implemented. Medical schools were only to reopen if they precisely complied with the quality of education in Europe as had been already applied in Baltimore’s Johns Hopkins’ physician training program. These included rigorous student admission requirements, full-time well-trained medical educators who also did clinical teaching at university hospitals, and upgraded scientific curriculum, laboratory study, and investigative medical research. His influence also enhanced funding and issued better administered medical licensure regulations. Over the next decades American medical education, physician expertise, and clinical practice improved.

Medicine in this country gratifyingly adopted better training and more research. There was a significant improvement generally in society’s healthcare. Flexner also played a role in bettering curriculum at Columbia University, for graduate schools in general, and for developing and administering the Princeton Institute for Advanced Studies. This was good, but there was a negative to Abram Flexner and his Flexner Report that is not widely publicized.

He and his Report are now recognized with racial and sexist bias. It is somewhat surprising nowadays is to just now newly learn about this aspect of his beliefs; yet it reflects the culturally negative prejudices of many American people and doctors back in the early 1900s, especially in White male society.

His assessment closed all historically African American-based medical school institutions other than at Howard and Meharry. The record suggests that he had a negative impression of Black physicians, indicated that they provided substandard healthcare, should only treat Black patients, and would work best subserviently at providing care that would benefit White society. This worsened medical care for Black people, maintained segregation, and harmed African American physicians.

While some more racial fairness has been applied in recent decades, results of discrimination still persist. Because of this, a previous national, medical Flexner service award was renamed in 2020 to: the AAMC Award for Excellence in Medical Education.

Abraham Flexner is also said to have believed that women would not choose medicine as a career despite many newly opened medical schools that admitted women. Reportedly, he had suggested that women physicians ought to primarily work at gynecology, obstetrics, pediatrics, and occupational health. Fortunately, the status of women in medicine has overcome many hurdles and there are lots of female medical students and women physicians here today.