Medical Education Reform Efforts and Failures of U.S. Medical Schools, 1870–1930

The dramatic decline in the number of US medical schools in the early twentieth century has been traced to a medical education reform movement that gained momentum after the Civil War. The major parties to reform—the universities themselves, the Association of American Medical Colleges (AAMC), state licensing boards, the American Medical Association (AMA), and Flexner—had different interests and strategies, however, and scholars have continued to debate the impact each had on the decline. To isolate the independent effects that the temporally intertwined forces for reform had on medical school failures, this study applies statistical survival analysis to an extensive and unique data set on medical schools operating in the United States between 1870 and 1930. Contrary to the views of some scholars, the results indicate that schools closed in response to critical evaluations published by the Illinois State Board of Health in the nineteenth century and the AMA and Flexner in the twentieth century. Additionally, the results indicate that schools were less likely to have failed if they adopted certain reforms implemented at leading schools or joined the AAMC, and were more likely to have failed if their state’s licensing regulations mandated lengthier premedical and medical training.