If still open, historically Black medical schools could have increased physician workforce

If medical schools at historically Black colleges that closed had remained open, they may have provided training for more than 35,000 additional medical students by 2020, according to research published in JAMA Network Open.

“During the first 2 decades of the 20th century, the number of medical schools that provided training to African-American students rapidly decreased, a development associated in part with the 1910 Flexner report, which recommended that, among the historically Black medical schools, only the Howard and Meharry programs should remain operational,” Kendall M. Campbell, MD, senior associate dean for academic affairs for the Brody School of Medicine at East Carolina University, and colleagues wrote. “The present study aimed to examine a long-standing question regarding the ways in which the continued operation of additional historically Black medical schools would have changed the physician workforce in the U.S.”

Campbell and colleagues conducted an observational economic evaluation of historically Black medical schools that were closed after the Flexner report and four historically Black medical schools that remained open. They used steady and rapid expansion models to evaluate how the closures of these schools affected the number of Black medical school graduates.

The researchers used historical records to determine the number of graduates from the closed schools, and school-specific and Association of American Medical Colleges reports for data on the four open schools.

Campbell and colleagues identified 13 medical schools that are now closed, but focused on five that closed following the Flexner report: Flint Medical College of New Orleans University, Knoxville Medical College, Leonard Medical School of Shaw University, Louisville National Medical College, and the University of West Tennessee College of Medicine and Surgery–Memphis. The researchers estimated the hypothetical outcomes if these schools had remained open and expanded over time.

They also examined a second scenario with Leonard and West Tennessee, which remained open for a time after the Flexner report and were still operational in 1912.

The researchers created two models to estimate patterns in the number of graduates from these schools. One, a steady expansion model, was based on data from Howard and Meharry, which remained continuously open after the 1910 report. The second, a rapid expansion model, was based on data from Morehouse, a historically Black college with a new medical school.

Campbell and colleagues estimated that the mean number of graduates per year was 5.27 students at Flint, 2.6 students at Knoxville, 11.06 students at Leonard, 4.17 students at Louisville and 6.74 students at West Tennessee.

They determined that the five closed medical schools would have trained an additional 27,773 graduates in the steady expansion model and 35,315 graduates in the rapid expansion model from the time of their closure to 2019.

In the separate analysis of Leonard and West Tennessee, Campbell and colleagues found that these schools would have trained an additional 10,587 graduates using the steady expansion model and 13,403 graduates using the rapid expansion model from their closure to 2019.

Campbell and colleagues estimated that the number of Black medical school graduates in 2019 may have increased by 29% in the five-school scenario, and by 11% in the two-school scenario.

“Given the persistent challenges of increasing the representation of medical students and graduates from underrepresented minority groups at predominantly white institutions, which currently operate all but four of the medical schools in the U.S., these results suggest that investing in the creation of additional medical schools at historically Black colleges and universities may have long-lasting implications for the size and diversity of the physician workforce in the U.S.,” Campbell and colleagues wrote.