One hundred years ago, under the sponsorship of the Carnegie Foundation, Abraham Flexner issued a landmark report after a whirlwind visit of 155 medical schools in the United States and Canada.
When Flexner visited Colorado on his tour, he didn’t like what he saw. Two medical schools existed, one the Denver and Gross College of Medicine, the other the struggling little University of Colorado School of Medicine. Flexner found no full time teaching faculty at Denver and Gross, and, “A total lack of scientific activity.” In a fit of harrumph, the dean of Denver and Gross replied, “I had never heard of Mr. Flexner and didn’t know of his importance in the world, or if he was a prophet, the son of a profit, or the son of anything else.”
Flexner felt better about the University of Colorado, and recommended only it be supported. One hundred years later, the University of Colorado School of Medicine and the associated Anschutz Medical Campus pumps $3.5 billion and 15,900 jobs into the Colorado economy.
The medical school has come a long way from what the Editor of the Denver Medical Times wrote in 1885, “(The Editor) finds it comical and absurd to see this Colorado pygmy try to hold its head up among the national giants we will exert every effort to kill this jackass-incubator and thus rid the state of a flyblown excrescences which cannot be other than a noxious nuisance to every medical man within borders.”
Flexner’s 1910 recommendations revolutionized medical education. They included more stringent criteria for entrance into medical schools, the importance of linking medical schools to first-rate teaching hospitals (eliminating many for-profit medical schools that existed at that time), and affirming that research and clinical investigation are integral to a medical school’s mission.
Given the economic challenges faced by schools such as the University of Colorado School of Medicine, perhaps current medical education needs a firm examination by a modern-day Flexner.
Some of the questions I suggest for consideration include: Does it really take four years to educate a medical student? Duke University School of Medicine has demonstrated for over 40 years that the traditional first two years of basic science education can be condensed into one year.
Elimination of a single year would reduce some of the crushing debt now incurred by medical students, and get students into hospitals and clinics all the sooner. Oh yes, they would start producing income a year sooner, not a trivial factor given that ninety-three percent of University of Colorado medical students receive financial aid.
Are we training the right kind of doctors? The debt of medical education also forces medical graduates into the high remuneration procedure-oriented medical specialties. Is the reemergence of for-profit medical schools good for medicine and medical students? Flexner placed such schools clearly in his crosshairs, questioning their ability to provide high quality education, particularly with adequate clinical experience and exposure to research and critical thinking.
Finally, a Flexnarian examination might also help the University look inward and ask what programs it can afford to support. A form of educational triage. Competition for resources is not new at the University of Colorado. In 1885, the medical school students hung a professor of engineering in efficacy from the tower of Old Main over a state funding dispute about allocation of dollars between the medical school and engineering school. The engineering school won, and Dr. W.R. Whitehead, Professor of Anatomy and Surgery quit, reducing the number of full-time professors in the medical school by fifty percent. To make tough decisions, particularly if they challenge historical assumptions, means walking a fine line between responsible management and cannibalism.
Charles Scoggin, M.D., lives in Boulder. Dr. Scoggin is CEO of N30 Pharmaceuticals, a Boulder-based biopharma research and development company. He is a former tenured professor at the University of Colorado, Trustee of Adams State College, member of the Denver Zoo Board of Directors, and Director Emeritus of the University of Colorado Center of the American West. EDITOR’S NOTE: This is an online-only column and has not been edited.
