Schooling for Doctors

In 1906 the American Medical Association was so disturbed by the condition of U. S. medical schools and by the laxity of state licensing requirements that it founded a Council on Medical Education & Hospitals, installed the late Dr. Nathan Porter Colwell as secretary. That year Dr. Colwell went to the Carnegie Foundation, asked that a lay survey of the nation's medical schools be made and its findings published. The Carnegie Foundation chose for the job a brilliant young educator named Abraham Flexner, who had ceased teaching in Louisville high schools to earn a Harvard M. A. With Dr. Colwell, Abraham Flexner visited U. S. medical schools, U. S. clinics, studied the by-laws of the state medical boards which licensed new practitioners. His findings he presented incisively in Medical Education the United States & Canada, which was published in 1910, had a wide sale and an even wider influence, shocked the U. S. public into a realization that the education of medical students was a matter of public concern.

Last week in Chicago's Palmer House the A. M. A.'s Council on Medical Education & Hospitals met with the Federation of State Medical Boards for the 32nd Annual Congress on Medical Education, Medical Licensure & Hospitals. Present were 350 elderly physicians.

Dr. Ray Lyman Wilbur, who was to have read a report from the A. M. A. Council, stayed in Palo Alto, Calif, to nurse his bronchitis. By proxy he asserted: "The most hopeless mistake . . . is that of admitting poor students to large medical school classes. One may sympathize with struggling youth but should sympathize more with future patients."

To the next speaker, stout, square-jawed President George Zook of the American Council on Education, the medical men listened respectfully until they realized that he was suggesting that medical schools, like liberal arts colleges, should be allowed to certify that their graduates are fit to be doctors. Due to Abraham Flexner's book and its effect on public opinion, 40 states will not license to practice medicine the graduates of medical schools on the A. M. A.'s blacklist. When heretical Dr. Zook had finished, he was neatly reprimanded by brisk little Biologist Alphonse Mary Schwitalla, S. J., dean of St. Louis University's medical school, who pointed out that the matter was in better hands when it was divided, as at present, between the A. M. A. and the state medical boards.

Chief concern among medical educators of late has been the rapid growth of specialization. As the result of statistics already on hand, the powers-that-be have decided, according to Columbia University's Medical Dean Willard Cole Rappleye, that "beginning in 1938 no physician will be listed as a specialist who does not possess a certificate from a board in his particular branch of practice." Consonant with that idea, the A. M. A. Journal last week published a list of reliable x-ray specialists. The list was surprising, for it contained only 1,274 names for the entire country. Some communities like Des Moines have only one approved x-ray specialist.

During consideration of the subjects taught in the 76 "approved" U. S. medical schools, the subject of obstetrics caused the largest amount of grumbling. Complained Dr. Robert Hickman Riley, Maryland's health officer: "The general practitioner devotes 30% of his time to obstetrics. But the subject dealing with the management of child birth is allotted only 4% of the time allowed for the medical course." Dr. Charles Bert Reed, Chicago obstetrician, was humiliated to learn "that training with a manikin in actual practice of obstetrics was not provided for in about 75% of the medical schools."

Under the influence of Pedagog Flexner, the Carnegie Foundation and the Rockefeller General Education Board, U. S. medical schools since 1906 have striven to be scientific. The disease became more important than the patient. Now the demand by patients that they be cured as well as diagnosed is shifting attention again to the clinical practice of medicine. And wise premedical students are shopping around for medical schools which give the best courses in clinical medicine.

Considered the best clinical schools are: California, Stanford, Georgetown, Northwestern, Chicago, Illinois, Tulane, Maryland, Michigan, Minnesota, New York, Western Reserve, Jefferson, Pennsylvania, Virginia, Wisconsin.

Little perturbed are those few medical schools pre-eminent in scientific medicine, for from their alumni come the professors of the clinical colleges. The list of the best scientific schools: Yale, Johns Hopkins, Harvard, Washington (in St. Louis), Columbia, Cornell, Rochester, Vanderbilt.

New York City is not the best place to study medicine. Nor is it the best community in which to practice that profession. In New York City there are only 456 possible patients for each doctor. Philadelphia provides 485; Rochester, 497; Chicago 504; Cleveland 530; New Orleans 547. On the other hand Boston provides only 286, San Francisco 352, St. Louis 392. Rochester, Minn., seat of the Mayo Clinic, with one doctor for every 68 residents, is the most doctor-ridden city in the country.

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