Abraham Flexner's campaign in the early 20th century began with the intentions of improving medical school standards and getting rid of the then popular model of for-profit proprietary medical education in the U.S. It ended in 48 of 133 schools visited to be shut down. Co-author Darel Heitkamp, MD, and his team argue—much like Flexner’s efforts to improve standards—the Accreditation Council for Graduate Medical Education (ACGME) policy has a similar potential of creating closures.

In an opinion piece published in the Journal of the American College of Radiology, Heitkamp et al. note that although Flexner’s efforts improved American medical schools, his work also came with a great downside.

“Some claim that the very ethos of medicine was lost in Flexner’s spirited quest for scientific inquiry, leaving us to this day underdeveloped in many vital areas of professionalism and patient engagement,” wrote the authors. “Indeed, even Flexner himself later lamented that because of his reform efforts, the practice of medicine was so consumed by the scientific approach that it neglected the more human aspects of patient care, such as trust, compassion and empathy.”

Schools shut down due to the lack of finances, quality professors and prerequisite medical training. Many of these practices were unaffiliated with universities and served the urban or rural poor community, thus resulting in underserved populations.  

The authors state that much like Flexner's outcomes, the compliance pressure that the ACGME’s standardization of policy for all programs creates a bias for certain small radiology programs. Making all programs uniform takes away the unique needs and goals which could cause misleading results.

“By subjecting all programs to the same extensive metrics and requirements, the ACGME creates the impression that educators and learners cannot be trusted to do things right. Mounting pressure from an ever-growing list of accreditation mandates serves only to place small and nonuniversity programs more squarely in the cross hairs, just as the Flexner report did more than 100 years ago,” wrote the authors.