not be manned. Some day, doubtless, posterity may reëstablish a school in some place where a struggling enterprise ought now to be discontinued. Towards that remote contingency nothing will, however, be gained by prolonging the life of the existent institution.
The statistics just given have never been compiled or studied by the average medical educator. His stout asseveration that "the country needs more doctors" is based on "the letters on file in the dean's office," or on some hazy notion respecting conditions in neighboring states. As to the begging letters: selecting a thinly settled region, I obtained from the dean of the medical department of the University of Minnesota a list of the localities whence requests for a physician have recently come. With few exceptions, they represent five states:[1] fifty-nine towns in Minnesota want a doctor; but investigation shows that these fifty-nine towns have already one hundred and forty-nine doctors between them![2] Forty-one places in North Dakota apply; they have already one hundred and twenty-one doctors. Twenty-one applications come from South Dakota, from towns having already forty-nine doctors; seven from Wisconsin, from places that had twenty-one physicians before their prayer for more was made; six from Iowa, from towns that had seventeen doctors at the time. It is clear that the files of the deans will not invalidate the conclusion which a study of the figures suggests. They are more apt to sustain it: for the requests in question are less likely to mean "no doctor" than poor doctors,[3]—a distemper which continued over-production on the same basis can only aggravate, and which a change to another of the same type will not cure. As to general conditions, no case has been found in which a single medical educator contended that his own vicinity or state is in need of more doctors: it is always the "next neighbor." Thus the District of Columbia, with one doctor for every two hundred and sixty-two souls, maintains two low-grade medical schools. "Do you need more doctors in the District?" was asked of one of the deans. "Oh, no, we are making doctors for Maryland, Virginia, and Pennsylvania,"—for Maryland, with seven medical schools of its own and one doctor for every six hundred and fifty-eight inhabitants; for Virginia, with three medical schools of its own and one doctor for every nine hundred and eighteen; for Pennsylvania, with its eight schools and one doctor for every six hundred and thirty-six persons.
With the over-production thus demonstrated, the commercial treatment of medical education is intimately connected. Low standards give the medical schools access to a large clientele open to successful exploitation by commercial methods. The
- ↑ The general distribution in these states shows that over-production prevails in new states as in old ones: Minnesota 1: 981; South Dakota 1: 821; Iowa 1: 605; North Dakota 1: 971; Wisconsin 1: 936.
- ↑ Ten of the fifty-nine were without registered physicians; but of these ten, two are not to be found on the map, two more are not in the Postal Guide; of the other six, four are in easy reach of doctors; two, with a combined population of one hundred and fifty, are out of reach.
- ↑ Occasionally these applications, which create the impression of a dearth, come from apothecaries who have a rear office to rent, a physician with a practice to sell, etc.
