Medical School Closures, Market Adjustment, and Mortality in the Flexner Report Era

Karen Clay, Grant Miller, Margarita Portnykh and Ethan J. Schmick

No 33937, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: Early twentieth century efforts to overhaul the quality of medical education in the United States (principally between 1905 and 1915 – the “Flexner Report Era”) led to a steep decline in the number of medical schools and medical school graduates. In this paper, we examine the consequences of these medical school closures be- tween 1900 and 1930 for county-level physicians, nurses, and midwives per capita as well as for infant, non-infant, and total mortality. To do so, we construct a school closure intensity measure for all counties in the United States, combining variation in (i) distance from closures, (ii) the historical number of graduates from closing schools, and (iii) the timing of closures. Nearby medical school closures (within 300 miles) led to a 4% reduction in physicians per capita, even after physician market adjustment through physician migration and postponed retirement. Strikingly, we find that medical school closures led infant mortality rates to decline by 8% and non- infant mortality rates to decline by 4%, suggesting that reducing the supply of poorly trained physicians may have reduced mortality.

JEL-codes: I11 I18 N31 N32 (search for similar items in EconPapers)
Date: 2025-06
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