Medical Education in the United States and Canada

A REPORT TO THE CARNEGIE FOUNDATION FOR THE ADVANCEMENT OF TEACHING WITH AN INTRODUCTION BY HENRY S. PRITCHETT PRESIDENT OF THE FOUNDATION. . . the trustees of the Carnegie Foundation at their meeting in November, 1908, authorized a study and report upon the schools of medicine and law in the United States and appropriated the money necessary for this undertaking. The present report upon medical education, prepared, under the direction of the Foundation, by Mr. Abraham Flexner, is the first result of that action. No effort has been spared to procure accurate and detailed information as to the facilities, resources, and methods of instruction of the medical schools. They have not only been separately visited, but every statement made in regard to each detail has been carefully checked with the data ill possession of the American Medical Association, likewise obtained by personal inspection, and with the records of the Association of American Medical Colleges, so far as its membership extends. The details as stated go forth with the sanction of at least two, and frequently more, independent observers. In making this study the schools of all medical sects have been included. It is clear that so long as a man is to practise medicine, the public is equally concerned in his right preparation for that profession, whatever he call himself, --allopath, homeopath, eclectic, osteopath, or whatnot. It is equally dear that he should be grounded in the fundamental sciences upon which medicine rests, whether he practises under one name or under another. . . . The report which follows is divided into two parts. In the first half the history of medical education in this country and its present status are set forth. The story is there told of the gradual development of the commercial medical school, distinctly an American product, of the modern movement for the transfer of medical education to university surroundings, and of the effort to procure stricter scrutiny of those seeking to enter the profession. The present status of medical education is then fully described and a forecast of possible progress in the future is attempted. The second par of the report gives in detail a description of the schools in existence in each state of the Union and in each province of Canada. It is the purpose of the Foundation to proceed at once with a similar study of medical education in Great Britain, Germany, and France, in order that those charged with the reconstruction of medical education in America may profit by the experience of other countries. . . . The significant facts revealed by this study are these: (1) For twenty-five years past there has been an enormous over-production of uneducated and ill trained medical practitioners. This has been in absolute disregard of the public welfare and without any serious thought of the interests of the public. Taking the United States as a whole, physicians are four or five times as numerous in proportion to population as in older countries like Germany. (2) Over-production of ill trained men is due in the main to the existence of a very large number of commercial schools, sustained in many cases by advertising methods through which a mass of unprepared youth is drawn out of industrial occupations into the study of medicine. (3) Until recently the conduct of a medical school was a profitable business, for the methods of instruction were mainly didactic. As the need for laboratories has become more keenly felt, the expenses of an efficient medical school have been greatly increased. The inadequacy of many of these schools may be judged from the fact that nearly half of all our medical schools have incomes below 10, 000, and these incomes determine the quality of instruction that they can and do offer. Colleges and universities have in large measure failed in the past twenty-five years to appreciate the great advance in medical education and the increased cost of teaching it along modern lines. …