The state of diversity in the health professions a century after Flexner

Abstract

Although the 1910 Flexner Report recommended the closure of a large number of operating medical schools, its impact was disproportionately felt on minority schools. The report's recommendations resulted in the closure of five out of seven predominantly black medical schools. Also noteworthy about the report was Flexner's utilitarian argument that black physicians should serve as sanitarians and hygienists for black communities in villages and plantations. A century later, despite decades of targeted programs and advocacy, minorities are still vastly underrepresented among medical students, physicians, and medical school faculty of all ranks. Today's arguments about the need for diversity in medicine in many ways echo Flexner's words. They continue to focus on benefits to minority populations, service in underserved areas, and minorities' role in the primary care workforce. These are valid, in fact laudable aspirations, but when made in isolation, they circumscribe the value of minority medical professionals. Minorities in the medical sciences provide immeasurable services to the entire nation, enhancing educational outcomes, expanding and improving the quality of health care provided, and contributing to the breadth and depth of medical research. This article presents how the Flexner Report shaped medical education and created a culture of medical research leading to narrow performance standards that fail to properly reward teaching activities, patient care, and health promotion. Efforts to achieve diversity in medical education should not end at graduation but should be extended to provide minorities opportunities to excel and to lead.