Stuff You Should Know
Episode Summary: How the Flexner Report Changed Medicine
Podcast: Stuff You Should Know
Hosts: Josh Clark, Chuck Bryant
Release Date: February 19, 2026
Episode Overview
In this episode, Josh and Chuck dive into the history and lasting impact of the 1910 Flexner Report—a document that overhauled the American medical education system. They unpack how the report modernized medicine, wiped out many "alternative" medical practices, and discuss its more problematic aspects, including its role in entrenching racism, sexism, and medical elitism. Throughout, they weigh the balance of positive outcomes with lasting negative effects, posing the question: was the Flexner Report a necessary revolution, or did it throw out too much with the bathwater?
Key Discussion Points & Insights
1. Setting the Stage: Medicine in America Pre-Flexner
- (03:24) Medical education in mid-1800s America was chaotic, underfunded, and often lacking practical experience. Doctors could graduate without ever touching a patient or taking an exam.
- Josh Clark: “Medicine was a trade...Even at places like Harvard, they had to pay for their own teaching supplies. And those were the good ones…” (04:06)
- (04:30) Diploma mills proliferated, with admittance based mainly on the ability to pay tuition.
- Chuck Bryant: “Your admission requirement was the ability to pay the tuition fees essentially.” (04:30)
- The Civil War exposed glaring inadequacies in doctor training, sparking calls for reform.
- Josh Clark: "I think the person who had their leg chopped off unnecessarily complained, and I think the doctor who did the chopping might have complained as well." (05:58)
2. The Progressive Push for Reform
- By late 1800s, leading universities like Harvard and then Johns Hopkins pushed for rigorous, science-based, hands-on medical education, inspired by the German model.
- Josh Clark: "Johns Hopkins was the one that really hopped on it." (06:53)
- Entry prerequisites and length/difficulty of curriculum greatly increased.
- (08:35) The American Medical Association (AMA) formed to professionalize and to combat alternative medicine/homeopathy. Their charter even openly targeted homeopathy as something to eliminate.
3. The Flexner Report: How It Happened
- (10:54) The AMA, wanting to solidify the Johns Hopkins model, partnered with the wealthy Carnegie Foundation to commission a study. They selected Abraham Flexner, an education reformer and outsider—not a physician.
- Josh Clark: “This is not to say he was cooking the books…that was just sort of—the AMA was definitely after that.” (10:54)
- Flexner was already known for his critique of higher education.
- Flexner studied all 155 North American medical schools, judging them against the rigorous Hopkins/German model (and, in Europe, displaying uncritical admiration for German institutions).
4. Flexner’s Findings & Judgments
- Flexner toured 155 schools (18 months), classifying each as:
- Good (keep open)
- Promising but needing upgrades/funding
- Hopelessly deficient (recommend closure)
- Josh Clark: “The school is good…show promise…or, I’m sorry, please close your doors forever.” (17:44)
- His reporting was notably harsh, even “muckraking.”
- “Apparently the inexcusable degree of ignorance begins just where the ability to pay fees leaves off.” (Flexner, via Josh, 20:25)
- On osteopathic schools: they “reek of commercialism…exploit crude boys or disappointed men and women." (Chuck Bryant, 20:52)
- Proprietary (for-profit) schools, black medical schools, and women's colleges were especially targeted. Alternative medicine (homeopathy, osteopathy, etc.) was summarily dismissed.
- (24:49) Flexner suggested black doctors should be trained “to treat black patients only” and focus on hygiene to prevent disease from spreading to whites—a profoundly racist stance.
- Chuck: "The medical Education of the Negro...he shows a real disdain for black medical schools." (24:49)
- Women’s colleges were minimized: “I don’t think women can withstand the mental rigors of being a doctor.” (25:49)
5. Implementation & Philanthropy
- Flexner’s recommendations were enacted via vast philanthropy (e.g., Rockefeller Foundation), allowing university-affiliated, research-based schools to thrive and others to shutter.
- (30:23) Within five years, over 50 U.S. med schools closed; after 20 years, only 76 remained from the original 148.
- “80% of the alternative medicine programs were shut down. And the handful of schools that had admitted women were either shut down or not admitting women anymore for a while.” (30:23)
- The reformed system further increased expense and exclusivity—now, only those with means and strong academic credentials could hope to attend.
6. Lasting Impact: The Good and the Bad
- Positives:
- Standardized, scientifically rigorous, and effective medical care in the U.S.
- Acceleration of medical advances (e.g., successful cancer treatment, overall improved public health).
- Elevated medicine from trade to respected profession; doctors’ autonomy and societal influence increased.
- Chuck Bryant: “You can point to a lot of stuff. A lot of lives that were saved, a lot of lives that were improved, a lot of lifespans that were extended because of this…" (38:20)
- Negatives:
- Disproportionately harmed black and women physicians—only 2% of American doctors are Black, though 13% of population is Black. Estimated 30,000 Black doctors weren’t produced due to med school closures. (31:00)
- Racist and sexist attitudes institutionalized.
- Dismissal of alternative/holistic traditions, some of which are seeing renewed interest (meditation, nutrition in mental health).
- Josh Clark: “He definitely threw the baby out with the bathwater in a lot of cases.” (38:29)
- Over-emphasis on science/rationalism led to a depersonalized medical system; doctors seen as detached from patient humanity. Research prioritized over clinical relations.
- “Because Flexner was not a physician, he really ignored the idea of the physician as a healer. The patient became… a walking bag of medical issues.” (32:31, Chuck)
- Helped set the stage for “Big Pharma.”
Notable Quotes & Memorable Moments
- “If you enjoy being treated successfully for cancer, you can pretty much thank the Flexner Report for that. But at the same time...if you believe there are alternative therapies...then yeah, you probably don’t like that part.” – Chuck Bryant, 02:37
- “The inexcusable degree of ignorance begins just where the ability to pay fees leaves off.” – Josh Clark quoting Flexner, 20:25
- “Five of the seven black medical schools were recommended for closure...” – Josh Clark, 23:40
- “I don’t think women can withstand the mental rigors of being a doctor...women make better patients than doctors.” – Josh Clark recounting Flexner’s sexism, 25:49
- “The curse of medical education is the excessive number of schools. The situation can improve only as weaker and superfluous schools are extinguished.” – Josh Clark quoting Flexner, 22:01
- “The medical profession lost a lot of, I guess, connection with the rest of us...doctors are kind of looked at as looking at the rest of us as not fully human.” – Chuck Bryant, 32:31
- “He had his sights set on them, on chiropractors, on all kinds of things that a lot of people put a lot of great value in today. So he was off base on some stuff for sure. But again, this was 1910.” – Josh Clark, 21:10
- “It derailed black doctors, it derailed women doctors, it derailed alternative medicines. It even took the stuff that was part of the medical establishment and twisted it around. And it took a full century for things to start to even come back.” – Chuck Bryant, 37:28
- “It would have happened at some point...I doubt if we’d still be sitting here today had the Flexner Report not been written, and like, I’m sitting here with like, a leech on my forehead.” – Josh Clark, 38:31
Timestamps for Key Segments
- 01:15 – Episode intro; why the Flexner Report matters
- 03:35 – State of medicine in America before Flexner
- 06:53 – The rising influence of Harvard, then Johns Hopkins
- 08:35 – AMA’s anti-homeopathy crusade
- 10:54 – Why and how Flexner was chosen
- 16:51 – How Flexner conducted his study
- 17:44 – Flexner’s three-way classification: Good, Needs Improvement, Close
- 20:25 – Scathing language, criticism of for-profits and alternative medicine
- 22:01 – Call for mass closures
- 24:49 – Racist prescriptions for black medical schools
- 25:49 – Sexism: On women in medicine
- 27:57 – Medical philanthropy and new school standards
- 30:23 – Closures and impact in the following decades
- 31:00 – The impact on black doctors and representation today
- 32:31 – Loss of patient focus in medicine
- 35:01 – Erasure and slow return of non-allopathic modalities
- 37:26 – The century-long backlash and recovery
- 38:20 – Balancing the positive and negative legacy
Tone and Style
True to SYSK form, Josh and Chuck maintain their conversational, witty, and thoughtful tone, balancing serious critique with humor and approachability. They cite personal anecdotes, throw in historical side notes, and make the story accessible—while occasionally riffing with pop culture asides and gentle sarcasm.
Conclusion
This episode delivers a rich, nuanced exploration of a complex event in medical history, inviting listeners to consider both the necessity and cost of reform—and suggesting (as modern critics do) that medicine may be overdue for a new kind of Flexner Report oriented toward inclusion, humility, and rediscovered humanity.