After nearly a century of dormancy, for-profit medical schools are making a return in the United States. A recent paper by University researchers analyzed the history, reappearance and possible effects that these schools could have on medical education.
Though at one time for-profit medical schools existed in the United States, this changed with the publishing of Abraham Flexner’s 1910 report on the state of these schools, according to the paper. There were numerous critiques of these schools in Flexner’s report, particularly of the standards, requirements, teaching and students’ clinical and research exposure. The report led to a renovation of medical teaching and the subsequent disappearance of for-profit institutions.
The medical education system accepted nearly all students who could afford to pay tuition prior to 1910, Gruppuso said. “There was no standardized set of requirements for medical schools, and it was creating a real crisis in terms of quality for medical care.”
In 1996, the court case United States v. American Bar Association made it possible for for-profit law schools to be established, according to the paper. Though the Liaison Committee on Medical Education had previously been opposed to for-profit medical schools, they slowly began to change their opinions after the court case and eventually allowed for for-profit medical schools to be established in 2013.
According to the paper, a number of investor-owned schools, such as the Rocky Vista University College of Osteopathic Medicine, have been accredited, and more have received preliminary and provisional accreditation.
Philip Gruppuso, professor of pediatrics and an author of the paper, said the main point of the article was to bring both the existence and establishment of these for-profit schools to public attention.
“(This article) sheds light on the fact that not all medical schools in the United States are nonprofit institutions, so I’m not sure that people both in and out of the medical world realize that these institutions are also out to make money for their shareholder and whoever else owns them,” said Paul George, associate professor of medicine, who was unaffiliated with the study.
The Flexner report became the basis for most of what is now seen as the contemporary set of standards for admission and accreditation in medical education and the composition of medical school as two years of scientific education and two years of clinical experience, Gruppuso said.
The report led to two major developments in the area of for-profit medical schools, said Eli Adashi, professor of medical science and lead author of the paper. Students increasingly stopped enrolling because they were losing confidence in these institutions. Secondly, more nonprofit medical schools were established at the time and were often affiliated with a research university, in contrast to for-profit medical schools. “These academic-medical centers educated virtually all American physicians since the Flexner report,” Adashi added.
In the paper, the authors delineated a number of challenges that for-profit institutions face, such as poor reputations. Many of these stem from today’s common Flexnerian viewpoints, as well as frequent comparison to other for-profit educational institutions that are often at the center of many legal disputes, according to the paper.
While high-profile schools like Harvard and Yale have faculty members and administration who are at the forefront of medicine, “aspects like that are just not currently possible with the for-profit model,” Krishna said. “It’ll be interesting to see, as the for-profit schools go, if they will be able to develop that same academic profile and bring the same resources to their students.”
Another challenge is the widespread notion that for-profit medical schools have significantly lower standards than nonprofit medical schools, according to the paper. To assuage these concerns, these institutions will have to prioritize the ethical and educational aspects above profit, the authors wrote.
Though the lenient standards of for-profit schools in the pre-Flexnerian era were a major concern, they are not for today’s for-profit medical schools, according to the paper. The schools now have more stringent academic requirements, such as mandating clinical rotations and providing scholastic opportunities in the curriculum. The report serves to reassure people that these for-profit schools have to meet the same requirements as nonprofit institutions, George said.
“At the end of the day, for many of these students to become physicians, they all have to pass the same board exams and compete on the national level in order to get residency spots,” Krishna said. She added there will always be a demand for medical schools and she would not be surprised to see more for-profit medical schools being established in the future.
For-profit schools could be a significant boon to the shortage of doctors and the easing of medical student debt, according to the paper. Due to their lower cost structure, for-profit medical schools could also provide lower tuition, more scholarships and innovation in medical instruction.
“The major point of the paper is that (for-profit medical schools) are being established. We hope that they will be held to a high standard and that there will conceivably be benefits from their establishment,” Gruppuso said.