Professional Exclusion The Flexner Report

In 1906 Abraham Flexner, an educator, obtained a grant from the Carnegie Foundation for the Advancement of Teaching to review the quality of medical schools. When his report was published in 1910, it revealed wide discrepancies among the 155 schools studied and produced a strong impetus to regulate medical education at the state and federal levels. Having no independent standards of their own, nor any idea of how to develop them, the states appealed to the American Medical Association's (AMA) Council on Medical Education, which set new standards for accreditation of the medical schools. Physicians also staffed the state licensing boards. The consequence of this major public intervention in the healthcare professions was that by the mid-1920s the AMA had a virtual monopoly, guarding the gate to the medical profession at several levels: admission to medical school, choice of specialty, and obtaining a license to practice.

Such a state-sponsored monopoly is clearly subject to abuse, but it was widely imitated as succeeding levels of health professions sought and obtained state endorsement and protection. By tradition, the major regulatory role in the United States is played by the states, and the licensing laws are typically administered by state agencies and boards dominated by professionals.

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