Why do rural hospitals close? Because America
In 1910, The American Medical Association hired a Carnegie Foundation researcher named Abraham Flexner to conduct an independent analysis of medical schools across the country. The resulting report transformed medical education in America - and ultimately led to the closure of more than half of existing medical schools, mostly in poor and rural areas.
In 1904, before the report, there were 160 institutions with more than 28,000 students that awarded an MD. By 1920, the number was down to 85 institutions training 13,800 students.
Responding to the controversy caused by the closure of so many medical colleges, Flexner denied that the poor in America had any particular right to enter medicine “unless it is best for society that he should” and, as Paul Starr wrote in The Social Transformation of American Medicine, Flexner “made no allowance for the inability of low-income communities to pay for the services of highly trained physicians.”
Responding to Flexner, a doctor from Chattanooga, Tennessee, wrote:
True, our entrance requirements are not the same as those of the University of Pennsylvania or Harvard; nor do we pretend to turn out the same sort of finished product. Yet we prepare worthy, ambitious men who have striven hard with small opportunities and risen above their surroundings to become family doctors to the farmers of the south, and to the smaller towns of the mining districts.
The Chattanooga doctor said that graduates of larger schools from the cities could never be expected to settle in those smaller, rural communities. But, he asked: “Would you say that such people should be denied physicians?”
The problem of America
Ever since James Madison wrote Federalist No. 10 (and perhaps earlier), the challenges of governing such a large country have been evident to those who would seek to balance its competing “factions.” America’s multitude of regions, its populous cities and its wilderness, its rich merchants and its poor farmers, its Midwest farms and its coastal traders, have always presented a challenge.