The Effect of Flexner-Era Medical School Closures on Physician Geographic Distribution and Population Health

Ethan Schmick, Marquette University

Abstract  This paper studies the impact of Flexner Era (1905-1915) medical school closures on physicians per capita and mortality. The Flexner Era was characterized by an increase in medical school standards and saw the number of medical schools in the United States decline by 40%, due to closures and mergers. The Flexner Era culminated with the release of the Flexner Report (1910), which recommended the closure of all but 28 medical schools in the United States. We begin by documenting the time-path of physician concentration at the county-level from 1900-2020. To do this we make use of publicly available full-count U.S. Census data from 1900-1940 and restricted access long-form Census and ACS data from 1950-2020. We next construct a measure of how impacted each county was by Flexner Era medical school closures based on proximity to closures and the number of graduates from closed schools. Our results indicate that counties more impacted by school closures had relatively fewer physicians per capita in the post-Flexner Era – a result that persisted until at least 1940. We plan to extend this analysis to 2020 using the restricted access Census data to determine if these results persisted into the modern era. We also plan to examine how the decrease in physician concentration resulting from Flexner-era school closures impacted population health by studying mortality. This research might speak to the historical origins of the current physician shortage for underserved areas and people and furthers our understanding of the relationship between health care providers and population health.