Impact of Early 20th Century Medical School Closures on Mortality Rates in the US

During the early 1900s, efforts to reform and improve the quality of medical education in the United States led to significant closures of medical schools. This nationwide movement, largely influenced by the 1910 Flexner Report authored by Abraham Flexner, aimed to close schools deemed substandard and elevate the overall standard of medical training. As a result, more than 40% of U.S. medical schools closed or were integrated into other institutions between 1905 and 1915.

A recent comprehensive study involving data from institutions like Carnegie Mellon University, Stanford University, and Marquette University has examined how these closures affected healthcare access and mortality. Researchers analyzed county-level data spanning from 1900 to 1930, considering factors such as the proximity to closed schools, the number of medical graduates, and the timing of closures.

Findings revealed that regions within 300 miles of a closed medical school experienced a 4% decrease in physicians per capita. Interestingly, this decrease was balanced by market adjustments; physicians migrated to areas with higher closure intensities, and many postponed retirement, partially mitigating the impact of reduced new medical graduates. Additionally, nurse employment increased by approximately 7% in these regions, while the number of midwives remained unaffected.

Most notably, mortality rates declined following these closures. Infant mortality dropped by about 8%, non-infant mortality by 4%, and overall mortality by 3% in counties near closed medical schools. These reductions suggest that closing lower-quality medical schools may have contributed to saving around 16,000 infant lives and 38,000 non-infant lives annually.

The improvements in mortality were primarily linked to reductions in infectious diseases and illnesses of early infancy, which are susceptible to the quality of physician training. The research indicates that better training and stricter standards in medical education directly correlated with improved public health outcomes.

While the study highlights the positive impacts of medical school reforms in reducing mortality, it also underscores the importance of maintaining high standards in medical education to continue improving health outcomes nationwide.

This historical episode underscores how systematic reforms and quality improvements in medical education can significantly influence public health and save countless lives.

Source: https://medicalxpress.com/news/2025-06-early-20th-century-closures-medical.html