Efforts in the early 20th century to improve the quality of medical education in the United States led to a steep decline in the number of medical schools and medical school graduates. In a new study, researchers examined the consequences of these medical school closures between 1900 and 1930 for the number of county-level physicians, nurses, and midwives, and for infant, non-infant, and total mortality. The closures led to a 4% reduction in physicians per capita and resulted in declines in infant mortality, non-infant mortality, and total mortality, they found.
The study, by researchers at Carnegie Mellon University, Stanford University, and Marquette University, appears as an NBER Working Paper.
“Our findings build on previous research on the historical supply and distribution of doctors and nurses in the United States, and offer new evidence on the consequences of medical school closures for nurses and midwives,” says Karen Clay, professor of economics and public policy at Carnegie Mellon’s Heinz College, who led the study.
Many U.S. medical schools opened in the late 19th century, and many were commercial and not affiliated with universities, leading to concern about their quality. The 1910 publication of Medical Education in the United States and Canada —written by Abraham Flexner at the request of the Carnegie Foundation and known as the Flexner Report—was among the most prominent reforms in the history of U.S. medicine. An evaluation of the quality of every medical school in the United States, the report called for closing most of them. Between 1905 and 1915, more than 40% of U.S. medical schools closed or were absorbed by other institutions.
In this study, researchers sought to determine the effects of Flexner-era medical school closures on mortality. Using a variety of data (e.g., U.S. Census data from 1900 to 1930, county-level vital statistics data on mortality), they constructed a measure of school closure intensity for all U.S. counties, combining variation in distance from closures, the historical number of graduates from closing schools, and the timing of the closures. Among the study’s findings:
“Although we cannot fully isolate the role of physicians given other market adjustments in response to medical school closures, reducing the supply of poorly trained physicians appears to have reduced mortality,” explains Margarita Portnykh, assistant teaching professor of business analytics and economics at Carnegie Mellon’s Tepper School of Business, who coauthored the study.
The study was supported by Heinz College at Carnegie Mellon University.
Medical School Closures, Market Adjustment, and Mortality in the Flexner Report Era
18-Jun-2025