Stuff You Should Know

How the Flexner Report Changed Medicine

February 19, 2026

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  • The 1910 Flexner Report, commissioned by the AMA and funded by the Carnegie Foundation, drastically revamped U.S. medical education by favoring the rigorous, science-based German model exemplified by Johns Hopkins University, leading to the closure of over half of existing medical schools. 
  • A major byproduct of the Flexner Report was the effective squashing of alternative medicine practices like homeopathy, which were deemed unscientific by the new standards, and it also severely impacted Black and women's medical colleges. 
  • While the Flexner Report is credited with improving medical outcomes and saving lives by professionalizing medicine, critics argue it simultaneously introduced a dehumanizing, overly scientific focus, marginalized Black doctors, and suppressed holistic approaches to health that are only now seeing a resurgence. 

Segments

Introduction to Flexner Report
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(00:00:00)
  • Key Takeaway: The Flexner Report of 1910 fundamentally revamped U.S. medicine and medical schooling, impacting its trajectory for better or worse.
  • Summary: The episode of Stuff You Should Know, titled “How the Flexner Report Changed Medicine,” focuses on the 1910 report that reshaped American medical education. The show notes indicate the report’s impact was profound and lasting. The introduction also mentions the report’s role in suppressing alternative medicine practices like homeopathy.
Pre-Flexner Medical Education
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(00:04:33)
  • Key Takeaway: Prior to 1910, U.S. medical education was largely unregulated, often consisting of short, underfunded programs lacking hands-on clinical experience.
  • Summary: Before the Flexner Report, the U.S. had 52 medical schools around 1850, where medicine was treated more as a trade than a rigorous science. Many schools were two-year programs, severely underfunded, and some operated as for-profit diploma mills with minimal admission requirements. Graduates often lacked any practical experience, sometimes never seeing a patient or using a scalpel during their training.
Rise of Scientific Medicine Model
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(00:07:56)
  • Key Takeaway: The Johns Hopkins University model, based on the German system, became the standard for American medical schools, requiring college degrees and full-time scientific faculty.
  • Summary: A progressive era movement, led by institutions like Harvard and Johns Hopkins, pushed for better medical training following poor outcomes in the Civil War. Johns Hopkins, opening in 1893, established a model requiring a college degree, full-time medical scientists as faculty, and a four-year curriculum emphasizing laboratory work and hands-on patient assistance. This model was what the Flexner Report ultimately endorsed.
AMA’s Role and Flexner’s Selection
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(00:09:44)
  • Key Takeaway: The American Medical Association (AMA) actively sought the Flexner Report to solidify its authority and eliminate competing practices like homeopathy.
  • Summary: The AMA, founded in 1847 with an initial mission to squash homeopathy, used a consultation clause to forbid communication with non-regular practitioners. The AMA approached the Carnegie Foundation to fund a report that would validate the Johns Hopkins model, leading to the selection of Abraham Flexner, an educator and non-physician, to conduct the study.
Flexner’s Investigation and Findings
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(00:13:43)
  • Key Takeaway: Flexner surveyed 155 medical schools in the U.S. and Canada, categorizing them as good, promising, or hopelessly deficient, recommending the closure of over half of U.S. schools.
  • Summary: Flexner researched European models, favoring the German system, and visited 155 schools over 18 months, including all Black medical schools. He categorized schools into three tiers: those to keep, those needing improvement with funding, and those to close permanently. He was highly critical of proprietary schools and alternative medicine programs, such as osteopathy, which he claimed ‘reek of commercialism.’
Impact on Black and Women’s Colleges
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(00:25:56)
  • Key Takeaway: The Flexner Report recommended closing five of the seven Black medical schools, suggesting the remaining ones focus narrowly on public health and hygiene for Black patients.
  • Summary: The report recommended immediate closure for all proprietary schools and nearly all alternative medicine systems. Flexner dedicated only two pages to Black medical education, suggesting Black doctors should focus only on hygiene to prevent disease spread to white populations. Furthermore, Flexner expressed the opinion that women made better patients than doctors, leading to the closure or regression of women’s medical colleges.
Ideal Medical Education Criteria
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(00:28:48)
  • Key Takeaway: The ideal medical education emphasized rigorous instruction, high admissions standards, and required significant funding for full-time faculty dedicated solely to research.
  • Summary: The recommended model required rigorous admissions to weed out candidates who could not handle the academic demands, necessitating tuition increases of three to four times the previous rates. This new standard required better facilities and equipment, crucially demanding full-time faculty dedicated to biomedical research rather than splitting time with private practices. This shift spurred massive medical philanthropy from foundations like Rockefeller to implement the new, expensive model.
Consequences of Implementation
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(00:33:50)
  • Key Takeaway: Within five years of the report, over 50 U.S. medical schools closed, and the resulting underrepresentation of Black doctors persists today.
  • Summary: Within a decade, more than 50 U.S. medical schools shut down, and only 76 of the original 148 remained after 20 years. The closure of Black medical schools resulted in an estimated 30,000 fewer Black doctors being produced by 2012, contributing to the current underrepresentation of Black physicians (2% of doctors vs. 13% of the population). The emphasis on rationalism over humanism also led to a loss of focus on patient connection and holistic mental health treatments.
Legacy and Modern Reassessment
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(00:41:46)
  • Key Takeaway: The Flexner Report is viewed as a double-edged sword: it professionalized medicine and saved lives, but it also suppressed beneficial alternative therapies and holistic care for a century.
  • Summary: The report is acknowledged for extending lifespans through the adoption of the scientific model, but it threw out the baby with the bathwater by eliminating valuable elements of care. The suppression of lifestyle factors in mental health treatment, for example, is only now being re-emphasized by younger psychiatrists. Many now suggest a ’new Flexner Report’ is needed for the 21st century as the original model has become dogma.
Listener Mail and Conclusion
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(00:42:52)
  • Key Takeaway: The hosts affirm that Stuff You Should Know aims to illuminate essential historical and cultural topics that listeners should know to better understand the world.
  • Summary: A listener praised the podcast’s mission, confirming that the goal is to shed light on topics like the lives of Helen Keller and Ann Sullivan that people should know to learn and grow. The hosts concluded the episode by encouraging listeners to read the original 346-page Flexner Report for more detail.