pp 1–45 | Cite as

Medical education reforms and the origins of the rural physician shortage

  • Carolyn M. Moehling
  • Gregory T. Niemesh
  • Melissa A. ThomassonEmail author
  • Jaret Treber
Original Paper


In the first two decades of the twentieth century, medical schools increased standards for admission and added basic science to their curricula. During this time period, the probability a new medical school graduate located in a rural area declined by 40%. Using novel data from the American Medical Directories, we find that physicians trained in more rigorous programs with higher admission standards were less likely to set up practice in rural areas. While all physicians were being drawn to metropolitan areas during this period, the pull was stronger for graduates of the higher quality schools. We also find some evidence that physicians trained in the more scientifically and clinically based programs were more strongly attracted to places with more hospitals. These findings suggest that the medical education reforms of the early twentieth century contributed to the urban–rural disparity in access to physician care.


Medical education Flexner Rural physicians 

JEL Classification

I18 J13 J18 N31 N32 



Thomasson acknowledges support from the Julian Lange Professorship. We thank seminar participants at Queens University, Oberlin College, and the University of Wisconsin-LaCrosse for helpful comments and suggestions.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Rutgers UniversityNew BrunswickUSA
  2. 2.NBERCambridgeUSA
  3. 3.Miami UniversityOxfordUSA
  4. 4.Kenyon CollegeGambierUSA

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