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Title: The Swan Song of the Country Doctor: Flexner and the Economics of the Practice of Medicine
Citation Type: Miscellaneous
Publication Year: 2013
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Abstract: During the first few decades of the twentieth century, the number of doctors setting up practice in rural areas dropped dramatically. Many contemporaries attributed this decline to Abraham Flexner's 1910 report and the accompanying reforms in medical education which resulted in many medical schools closing or merging with each other or with major research universities. Others argued that it reflected the falling income of country doctors due to increasing competition brought about by the automobile and decline in the population in rural areas. We use data from the American Medical Directories (AMD) for 1909, 1914, 1918, and 1923 to examine the location decisions of physicians and determine the factors leading to the shift of medical practice out of rural areas. We find that much of the movement out of rural areas was due to changes in the locations recent medical school graduates chose to set up practice. While the rural share of all physicians in the AMD sample fell from 28 percent in 1909 to 20 percent in 1923, the rural share for recent medical school graduates fell from 29 to 8 percent over the same period. We further find that the location choices of new physicians were strongly influenced by the quality of the medical schools they attended. Graduates of schools receiving unfavorable reviews from Flexner were on average 12 percent more likely to locate in rural areas than their peers who graduated from higher quality schools. For a subset of the AMD data, we have information on city or county of birth. These data reveal that the physicians most likely to set up practice in rural areas were those who were born in rural areas. Rural-born doctors were also more likely to attend medical schools Flexner had criticized in his report. As those schools closed or merged with more prestigious institutions, the supply of physicians to rural areas declined.
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Authors: Treber, Jaret; Moehling, Carolyn M.; Thomasson, Melissa A.
Publisher: Rutgers University
Data Collections: IPUMS USA
Topics: Labor Force and Occupational Structure, Other
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