The practical problem remains. How is the existing situation to be handled? The higher standard is alike necessary and feasible. How long is it to be postponed because it threatens the existence of this school or of that? In general, our medical schools, like our colleges, are local institutions; their students come mainly from their own vicinity. The ratio of physicians to population in a given state is therefore a fair indication of the number of medical schools needed. Where physicians are superabundant, and high schools and colleges at least, not lacking, the medical schools cannot effectively plead for mercy on the ground that elevated standards will be their death. New York has two schools on the two-year college basis or better; nine others rest on a lower basis. They would improve if they could "afford it."[1] But with one doctor for every 600 people in the state, with accessible high schools, with cheap—and in New York City, at least, free—colleges, it is absolutely immaterial to the public whether they can afford it or not. The public interest demands the change. We may therefore at once assume (what everybody grants) that the problem is insoluble on the basis of the survival of all or most of our present medical schools. To live, they must get students; they must get them far in excess of the number they will graduate; they must graduate them far in excess of the number of doctors needed. They will therefore require their clientele of ill prepared, discontented, drifting boys, accessible to successful solicitation on commercial lines. Inevitably, then, the way to better medical education lies through fewer medical schools; but legal enactments on the subject of medical education and practice will be required before the medical schools will either give up or relate themselves soundly to the educational resources of their respective states. No general legislation is at the moment feasible. The south, for instance, may well rest for a time, if every state will at once restrict examinations for license to candidates actually possessing the M.D. degree, and require after, say, January 1, 1911, that every such degree shall emanate from a medical school whose entrance standards are at least those of the state university. Such legislation would suppress the schools that now demoralize the situation; it would concentrate the better students in a few solvent institutions to which the next moves may safely be left. Elsewhere, every available agency should be employed to bring examining boards to reinterpret the word "equivalent" and to adopt efficient machinery for the enforcement of the intended standard. Equivalent means "equal in force, quality, and effect." The only authorities competent to pass on such values are trained experts. The entire matter would be in their hands if the state boards should in every state delegate the function of evaluating entrance credentials to a competently organized institution of learning. In many states, the state university
- ↑ The dean of superfluous southern medical school writes: "Our faculty gets only what's left after all expenses are paid, and that averages $400 per session of of seven months. This we will cheerfully forego, and tech gratis, if only a class, or endowment, will pay cost of running the college. We will open next session under highest requirements if the wherewith to pay expenses in in sight." Observe that there is small consideration here for the "poor boy" or the "back country;" it is simply a question of college survival.
