A Louisville family of immigrants
Abraham Flexner was born on November 13, 1866, in Louisville, Kentucky, the sixth of the children of Moritz and Ester Flexner, German Jewish immigrants who had settled in the city. The family was Orthodox, and Abraham grew up in an observant home, though early in life he became a religious agnostic. Money was short, and he was the first in his family to finish high school and go to college. The Flexners nonetheless produced a remarkable generation: his brother Jacob became a physician, Bernard a lawyer, and Simon Flexner a pathologist and bacteriologist who worked at the Rockefeller Institute for Medical Research from 1901 to 1935.
Abraham went to the new Johns Hopkins University in Baltimore, where he raced through a degree in classics in just two years, graduating in 1886 at the age of 19. Johns Hopkins, with its German-style emphasis on research and its close links between teaching and investigation, left a lasting mark on him. It would become the model for the reforms that made his name.
A schoolmaster with new ideas
Flexner returned to Louisville to teach classics at Louisville Male High School, and four years later opened his own private school to test his ideas about teaching. “Mr. Flexner’s School” gave no traditional grades, followed no standard curriculum, set no examinations and kept no academic records. Instead it relied on small groups, individual attention and active, hands-on learning. His graduates were soon admitted to leading colleges, and the school’s success attracted wide notice. It also paid for the education of others in his family: Flexner helped finance Simon’s medical studies and his sister Rachel’s education at Bryn Mawr College.
In 1896 he married Anne Crawford, a former pupil, who became a successful playwright; the earnings from her stage hit Mrs. Wiggs of the Cabbage Patch paid for Abraham’s graduate studies at Harvard and his year at European universities, including Berlin, from 1905. The couple supported women’s suffrage. Their daughters were Jean, one of the original staff of the federal Division of Labor Standards, and Eleanor Flexner, a pioneering historian of the American women’s rights movement.
The report that changed medicine
In 1908 Flexner published The American College, a sharp critique of how universities taught their students. It caught the eye of Henry Pritchett, president of the Carnegie Foundation for the Advancement of Teaching, who was planning a study of medical education with the American Medical Association. Flexner was not a doctor and had never set foot in a medical school, but Pritchett chose him precisely because he saw the problem as one of education. Flexner visited all 155 medical schools then operating in the United States and Canada.
What he found was alarming. Many schools were small for-profit businesses owned by local doctors, with no entrance requirements, few laboratories, no access to hospital patients and part-time teachers lecturing to tired students. Some granted degrees after two years. His report, Medical Education in the United States and Canada, published in 1910, named names and described the worst schools in withering language. Using Johns Hopkins as the ideal, he called for medical schools to be part of universities, to require at least two years of college science before admission, to teach the basic sciences in real laboratories, to train students on hospital wards under full-time faculty, and for state licensing boards to enforce real standards.
The report did not spare anyone. Flexner described Chicago’s fourteen medical schools as a disgrace to the state whose laws permitted them and the plague spot of the nation, while praising a handful, among them Western Reserve, Michigan, McGill, Toronto and above all Johns Hopkins, which he called the model for medical education. He proposed that the number of schools be cut from 155 to 31. He also devoted a chapter to the state medical boards, which he found weak, inconsistent and often treated as political spoils, warning that they allowed wretched schools to keep operating by pointing to their graduates’ licensing results.
How it changed health care
The effect was dramatic. Backed by state licensing laws and by large gifts from the Rockefeller philanthropies, the reforms swept North America. In the years after the report, large numbers of weak proprietary schools merged or closed, and the survivors rebuilt themselves around science, research and clinical training. In 1910 only 16 of the 155 schools required two or more years of university study before entry; by 1920, 92 percent of American medical schools did. Medicine became a research-based discipline grounded in physiology and biochemistry, and the average quality of doctors rose sharply.
Flexner went on to study medical education in Europe, publishing a second report in 1912, and from 1912 to 1925 served on the Rockefeller Foundation’s General Education Board, becoming its secretary in 1917. Through the board, which John D. Rockefeller endowed with many millions of dollars, he steered support to medical schools that adopted his model, including full-time clinical professorships. He also helped found the experimental Lincoln School at Teachers College, Columbia University, which opened in 1917. The four-year, science-based medical degree followed by hospital training, which patients across North America rely on today, is in large part the system his report created.
The costs of reform
The reforms also had serious costs that historians and medical educators now acknowledge. Raising standards and closing schools made medical education longer and more expensive, and rural schools that had trained doctors for poor and remote areas disappeared. The report’s recommendations led to the closure of five of the seven medical colleges for African Americans, leaving only Howard and Meharry, and it contains passages about Black Americans that reflect the racism of its time. Opportunities for women in medicine also narrowed as smaller schools closed.
In 2020 the Association of American Medical Colleges renamed its Abraham Flexner Award for Distinguished Service, citing his racist and sexist writings. His legacy is therefore double: he did more than almost anyone to make medical training scientific and rigorous, but the way his reforms were carried out deepened inequalities in who could become a doctor, a problem medical schools are still working to correct.
Founding the Institute for Advanced Study
The department store owners Louis Bamberger and his sister Caroline Bamberger Fuld, who had sold their business to Macy’s, approached Flexner about founding a medical school in Newark, New Jersey, that would give preference to Jewish applicants at a time of widespread prejudice against Jews in medicine. Flexner persuaded them instead to fund something new: an institute where the world’s best scholars could pursue research free of teaching duties and administrative burdens. The Institute for Advanced Study in Princeton was founded in 1930, and Flexner served as its first director until 1939.
He used it to rescue minds from Nazi Europe. Albert Einstein, who had decided not to return to Germany after Hitler came to power, joined the Institute in 1933, and Flexner brought other scholars threatened by the Nazis. Its renowned faculty included the mathematicians John von Neumann and Kurt Gödel. The Institute became one of the world’s great centres of theoretical research, home to work in mathematics, physics and early computing that shaped the century.
The usefulness of useless knowledge
In 1939 Flexner published an essay in Harper’s Magazine titled “The Usefulness of Useless Knowledge”. Written as war approached, it argued that curiosity-driven research, pursued with no practical goal in mind, has repeatedly produced the most useful discoveries of all, such as the theoretical work on electromagnetism that eventually made radio possible. It defended the freedom of scholars against both governments and narrow ideas of usefulness, and in the same essay he condemned prejudice based on race or religion as silly and ridiculous in the light of human history.
The essay is full of lines still quoted today. Science, he wrote, is like the Mississippi, beginning as a tiny rivulet in a distant forest and swelling from countless sources into a roaring river, so that one must be wary of attributing any discovery wholly to a single person. A poem, a symphony, a painting, a mathematical truth or a new scientific fact, he argued, carries in itself all the justification that universities and research institutes need. Writing as nations rearmed, he observed that countries had borrowed billions for war but never borrowed largely for education.
The essay is still widely reprinted and quoted by scientists and university leaders defending basic research. In 1930 he also published Universities: American, English, German, attacking the distractions of college athletics and other pursuits that he felt pulled universities away from serious learning, and in 1940 he published his autobiography, I Remember.
Later years and legacy
Flexner retired as director of the Institute in 1939. Abraham Flexner died in Falls Church, Virginia, on September 21, 1959, at the age of 92, and was buried in Cave Hill Cemetery in Louisville, where a downtown street, Abraham Flexner Way, was named for him in 1978.
The child of Jewish immigrants from Germany, who never trained as a doctor or a scientist, transformed how doctors are educated across North America and created a refuge where Einstein and others fleeing Nazi persecution could continue their work. Most people who see a doctor in the United States or Canada today are treated by someone trained in the science-based system he championed, even as medicine continues to reckon with the inequities his reforms left behind.
Sources & further reading
Abraham Flexner, Wikipedia · Flexner Report, Wikipedia · Thomas P. Duffy, The Flexner Report: 100 Years Later, Yale Journal of Biology and Medicine (PMC) · Abraham Flexner, Wikiquote · Researched from the sources above and checked against them. Spotted an error? Tell us.
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