Medical School Closures Impact: When “Less Was More” in History

We’re jumping into a paradox that’ll make you scratch your head: Why in the world did closing medical schools in the early 1900s result in fewer deaths — not more? A study straight from the horse’s mouth (check the MedicalXpress coverage) says that shutting down “diploma mill” schools cut infant mortality by 8% and total mortality by 3%. Yeah, it sounds like a joke, but hear me out.

Here’s the deal: Not all doctors were created equal back then. So, when 160 “meh” schools vanished (talk about zero-star Yelp reviews), the ripple effect was wild. Less Bad doctors = better survival odds. But why did this happen? And should we panic if history starts repeating? Let’s break it down like a true crime podcast.

Flexner’s “Big Mood” Move

You ever seen a review shut down half a country’s medical schools? Abraham Flexner did. In 1910, his report exposed U.S. medical education as a junk drawer — some schools didn’t even have anatomy labs (!), but hey, charging patients to watch live surgeries was apparently a thing. The closures that followed (1900–1930) targeted low-quality programs, leaving only the “hardmode” schools with high standards. And guess what? The system adapted. Spoiler: Nurses and skilled docs saved the day.

Real Talk: What Was Flexner Really After?

Flexner wasn’t just random-school-canceling — he wanted better prep for doctors. But here’s the messy part: Many closures hit schools that served women, immigrants, and Black students. The upside: Doctors got way better supervision. The downside: Equity took a nose dive. As NBER researchers point out, these closures shrunk the doctor-to-patient ratio within 300-mile zones by 4%. That’s a lot fewer folks emptying stethoscopes in your face who maybe Shouldn’t.

Flexner’s Domino Effect

• Shuttered schools = stricter entry standards
• Fewer untrained hands = lessons from the Lithium-for-everything era
• Mortality gaps POV: Tended to close in areas already medically underserved

Fewer Docs, More Nurses: Checkmate

So here’s the twist. Closing schools cut doctors per county, but excitedly, nurses kicked into overdrive. Closers led to a 7% uptick in hand-washing, outfit-changing, birth-conscious nurses — unlike their ear-splitting Y2K-costumed predecessors. Midwives stayed steady, since they weren’t taking screaming feedback in the form of graduation hoods or experimental cures

But it wasn’t all doom and adjustment fog. Cities near closures pulled strategies: they rationed doctor clinics, reinstated training programs for the new hires who actually had to prove something beyond rudimentary proportions. Wild? Well. The data shows this nurse boost helped offset the dwindling physician supply — like your gym compadres fixing everything when your GoPro craps out.

Who’s Holding the Fort When Docs Drop?

Quick round of applause for nurses. While physicians took the “Oh no” hit, nursing schools in those years started clattering out skilled hires. They weren’t just sponge banding patients — they were tracking symptoms, prioritizing sterilization methods, and advising moms to avoid grabbing Advil from the nearby railroad doctor. Result: More kids saw their first birthdays.

Wait, Midwives Didn’t Lose Ground?

Shocking when you consider Flexner and his crew hated midwives. But here’s the kicker: They were essential in rural or poorer neighborhoods. While doctors left the chat, midwives kept doing their ancient-and-undeniably-human work — no IV drips, just generations of know-how. In fact, scroll back to the early 20th century, and you’ll see midwives bridging a gap while government hopped aboard midwife bans. Not a great look. But I’m getting ahead of myself.

Region-Level Role Shifts

Year Group	Physician Per Capita	Nurse Per Capita	Midwife Status
1900	Baseline	Unregulated	Regional specialists, hated by Flexner
1930	Down 4%	Up 7% (regulated, trained)	Unchanged, but dying breed in cities

Mortality Plunged — Here’s Why

Okay, so the headline act: fewer doctors saved lives. Like, if you rewind and imagine infectious diseases dining out on explaining their every move, blackboards and bacteria theory did something better than charisma. Later-era docs learned hand hygiene and diagnosis beyond “knowing stuff I Googled 5 minutes ago.”

What Exactly Shifted the Mortality Needle?

Two metrics danced together: First, medicine evolved from hocus pocus to Louis Pasteur-grade science. Second, crumby skills got cleared out. Infectious disease deaths dove — because, surprise, spreading germs from a septic horse trough to an I.V. bottle really hurts recovery. And guess what? The School closers’ effect wasn’t scattered chance; it was down to having folks actually trained to care about stuff like sanitation. No more cowboy clinicians.

The Staggering Lives Saved Numbers

Annually, 16,000 infants avoided kicking the bucket thanks to cleaner, scientifically grounded protocols. Not just glucose monitoring, think supportive tech — blink-and-you-missed-it transition from “maybe poke it” to “sterilize your hands.” Add 38,000 non-infant lives saved (older kids, adults, grandparents), and you’ve got a 54,000-person rope of reprieve.

Post-Closure: Did It Harm Long-Term Care Access?

Possible. Some studies sketch pockets of struggle. Country bumpkin towns without schools? Yeah, hit rough sections tide. But in cities? Docs hopped regions, patients caught flinch-free care. It’s complicated. Sort of a whack-a-mole scenario.

Market Adjusted — Not Like You’d Expect

You’d think fewer graduations = chaos. But the official realistic chaos was a tad Late Iron-D sac of retroactive revision. And maybe it’s eerie like watching your car stop rattling when you stop flooringpeculiar happenings. Physician migration picked up — kind of like reshuffling for a new boss fight in clinical RPG. Tenured Graybeards hung on for extra years, trading retirement for fear of knowing the next batch eked empty.

When Graduates Disappeared, Where Did They Go?

Any closures that trimmed the apprentice class sent ripples: medical students stopped fl; _okay, not here buddy, maybe several internal crazy.linkLabel:href. Now, it’s reasonable to suggest Flexner’s ripple didn’t cause wave, it placed a bing in alongside White House latest pushes for first care ties. Like multi-performing in featoot

Modern Med Ed: Are We Repeating Mistakes?

Grab your popcorn. Let’s think today’s stalls:

We’ve left behind 2-minute tetanus lectures for Hmm. But get this: our latest pushes into maternal, intentional care programs in under-served zones ring eerily Flexner-adjacent. Sometimes you see the shadow of the same doctor shortage arguments with wider harmonicC, that our societies still crave infrastructure strong enough to handle it rich obligation.

The Trade-Offs We Still Dance With

Imagine we start closing underperforming programs today. What’s the fallout?

• Advanced medical know-how = surviving epidemics.
• Fewer new docs = rural towns starve for limited access.

It’s like choosing between a genius surgeon and a basic one who actually shows up next town. No answers yet — just long whispers.

Why Midwives Still Deserve a Mic Drop

While Flexner and the party tried to erase them, midwifery didn’t flee — it adapted. Today, states with high midwife integration see maternal mortality crash to new lows. Experience flattened, in-experienced-hand calved applications — maybe we shot ourselves in the foot a century ago. Shutting schools cuts noise, but if exclusivity leaves lives untouched, we’re double-dipping.

Adapting Practices Across Eras

1900s Model	Current Model
More schools serving poorly funded folks (varying quality)	Top-tier universities + rural-focused satellite programs
Primary care = handshake with a knight armor doctor	Team-based care: collaborating nurses, midwives, technicians

So What’s the Takeaway? (And Can Flexner Be Our North Star?)

Here’s my hot take: History doesn’t repeat, but it sure rhymes. The painful evolution of today’s medicine might echo yesterday’s corrections, but we know now that stopping rot isn’t the same as promoting good. We need trained professionals. We need access. And we definitely need teams that include nurses, midwives, and doctors who dig deeper than textbooks.

But hey — perhaps this study offers a nudge. If we focus on whipping potential doctors into shape before they’re thrust into precocious procedures, outcomes might climb. At the same time, offering telehealth options or scholarship programs for folks in the middle of literal nowhere’ll stop towns from ceasing entirely.

A Personal Ask

Ever laughed over a 1930s medical textbook entry that suggested mercury to fix constipation? No? just me? Either way — talk to me in the comments. How do you grapple with medical education’s balancing act? Share your thoughts, stories #HumanMedicine, or fling an email to me if data bullets aren’t your vibe. I read every single note.