The Social Transformation of American Medical Education: Class, Status, and Party Influences on Occupational Closure, 1902–1919

Abstract

Applying Weber's theorizing on action and stratification, this study examines whether the early 20th-century extinction of half of the medical schools in the United States resulted from actions intended to serve class, status, and party interests by achieving social closure. Analyses reveal closure intentions in the school ratings assigned by the American Medical Association, although not in the recommendations in the 1910 Carnegie-sponsored Flexner report. In contrast to claims that schools failed largely because of economic exigencies, analyses indicate that failures were influenced by the AMA's and Flexner's assessments, as well as by state regulatory regimes and school characteristics.

ACKNOWLEDGMENTS

An earlier version of this article was presented at the Meeting of the American Association for the History of Medicine, Montreal, May 2007. The authors thank Bliss Cartwright and archivists at the Association of American Medical Colleges, College of Physicians of Philadelphia, National Library of Medicine, and New York Academy of Medicine.

NOTES

Notes

¹ The year 1902 is the first year for which lagged data are available, as JAMA's medical education reports were not published until 1901.

² Available from the Association of American Medical Colleges, Mary H. Littlemeyer Archives, Washington, DC.

³ When used as a dependent variable, AMA ratings are treated as binary (A-rated or not) for reporting simplicity. Cumulative logit analyses that treated the A, B, and C ratings as ordered categories indicated that, with minor exceptions, the coefficients for variables differentiating A from B and C schools were comparable to those differentiating A and B from C schools.

⁴ In preliminary multinomial logit analyses, coefficients for predictors of disbandings were comparable to those for mergers and absorptions, suggesting that all three were alternative means of “failure” for schools no longer viable.

⁵ Schools are designated as all-male based on their multiyear enrollment patterns; those that routinely enrolled women as well as men are considered coeducational (coded 0 for all-male) even if no women were enrolled in a particular year.

⁶ Our analyses exclude three very small black schools for which data are unavailable; the results nevertheless suggest that the remaining black schools had greater longevity than might have been expected (given, e.g., that most were proprietaries with little fee income).

⁷ In 2008, the AMA formally apologized for their long record of discrimination against black physicians (Davis 2008), but accompanied their apology with a historical analysis (Baker et al. 2008) implicating Flexner in the elimination of black medical schools.