The staggering disappearance of tens of thousands of Black physicians from the U.S. medical profession is no mere historical footnote. It is a direct and devastating consequence of deeply entrenched systemic racism that permeated the very foundations of American medicine. This dramatic reduction, particularly evident in the early 20th century, can be overwhelmingly traced back to the profound impact of the Flexner Report of 1910—a document that, under the guise of “reform,” deliberately perpetuated racial discrimination and irrevocably reshaped the demographic landscape of healthcare for generations to come.
A Legacy Interrupted: Pre-Flexner Progress
Before the seismic shift brought by the Flexner Report, a promising movement was underway: the emergence of numerous Black medical schools in the post-Civil War era. These institutions offered vital, often sole, opportunities for Black individuals to pursue medical training. As Margaret Vigil-Fowler meticulously details in TIME’s “The History Behind America’s Shortage of Black Doctors,” schools like Howard University College of Medicine (established in 1868) and Meharry Medical College (1876) were instrumental in educating the vast majority of Black physicians of their time. By 1905, these seven Black medical schools had collectively trained 1,465 doctors, each poised to serve their communities and inspire future generations, laying the groundwork for a burgeoning Black medical legacy.
The Flexner Report: Reform or Racial Exclusion?
This nascent, promising trajectory was abruptly and brutally halted by Abraham Flexner’s highly influential report. Commissioned by the Carnegie Foundation and the American Medical Association (AMA), Flexner’s 1910 assessment of medical schools across the U.S. and Canada advocated for stringent new standards. These included requirements for well-equipped laboratories, advanced facilities, and a significantly higher level of instruction. While presented as necessary steps to elevate the quality of medical education nationwide, these recommendations disproportionately and devastatingly impacted smaller Black institutions, which, due to historical inequities, simply lacked the immense financial resources and endowments required to comply.
The inherent racial bias embedded within the Flexner Report was undeniable and overtly stated. As Dr. Uché Blackstock powerfully reveals in her Washington Post opinion piece, “How tens of thousands of Black U.S. doctors simply vanished,” Flexner harbored explicitly racist views concerning the role of Black people in medicine. He openly asserted that Black students should be trained in “hygiene rather than surgery” and were best suited to be employed as “sanitarians”—a role he believed would primarily “help protect white populations from common diseases like tuberculosis.” His chillingly utilitarian perspective is encapsulated in his infamous quote: “The negro must be educated not only for his sake, but for ours. He is, as far as the human eye can see, a permanent factor in the nation.” He dismissively characterized Black medical schools as “wasting small sums annually and sending out undisciplined men, whose lack of real training is covered up by the imposing M.D. degree.”
The Devastating Repercussions: A Lost Generation
The consequences of the Flexner Report were immediate and catastrophic. “After the Flexner Report, five of the seven Black medical schools in the United States were forced to close, leaving only Howard and Meharry,” Dr. Blackstock explains. This drastic reduction in the number of accredited training institutions directly translated into a massive, unparalleled decrease in the number of Black physicians entering the profession. A study cited by Dr. Blackstock estimated that had these Black medical schools been permitted to remain open and continue their vital work, they “would have educated roughly 25,000 to 35,000 people.” This represents an almost unimaginable, profound, and irreversible loss of medical talent and a severe blow to the health and well-being of Black communities nationwide.
Beyond Flexner: Entrenched Exclusion
Even beyond the immediate closures spurred by the Flexner Report, the increasing professionalization of medicine, largely championed by the AMA, further solidified racial exclusion. The AMA, founded in 1847 by white male physicians who perceived Black doctors as a direct threat to their burgeoning prestige and earning potential, actively worked to prevent Black physicians from gaining membership. They mandated membership in local medical societies, which, almost universally, barred Black individuals. Furthermore, new post-Flexner requirements, such as mandatory post-medical school internships, became standard. As Vigil-Fowler highlights, securing an internship “was a byproduct of personal connections between medical school faculty and hospital staff members—and Black doctors were far less likely to have these relationships.” This created yet another formidable, often insurmountable, hurdle, actively discouraging countless Black Americans from even attempting to pursue medical careers.
A Century of Impact: The Lingering Shadow
The long-term, corrosive effects of this historical injustice continue to reverberate today. In 1900, Black physicians accounted for a mere 1.3% of U.S. physicians, while Black people comprised 11.6% of the overall population. More than a century later, despite Black people now making up 13.6% of the U.S. population, a disproportionately low 5.7% of all U.S. physicians identify as Black. As Dr. Blackstock powerfully articulates, this enduring disparity serves as “a reminder of every Black doctor who is not here with us but should be. It’s a reminder of this tremendous loss and of our nation’s duty to rectify centuries of injustice.” The “vanishing” of these tens of thousands of doctors was not a regrettable accident of history but a calculated, deeply painful consequence of ingrained racial bias within the American medical system.