In the first two decades of the twentieth century, medical schools increased standards for admission and added basic science to their curricula. During this time period, the probability a new medical school graduate located in a rural area declined by 40%. Using novel data from the American Medical Directories, we find that physicians trained in more rigorous programs with higher admission standards were less likely to set up practice in rural areas. While all physicians were being drawn to metropolitan areas during this period, the pull was stronger for graduates of the higher quality schools. We also find some evidence that physicians trained in the more scientifically and clinically based programs were more strongly attracted to places with more hospitals. These findings suggest that the medical education reforms of the early twentieth century contributed to the urban–rural disparity in access to physician care.

中文翻译：

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医学教育改革与农村医师短缺的根源

在二十世纪的前二十年中，医学院校提高了入学标准，并在课程中增加了基础科学。在此期间，位于农村地区的新医学院毕业的可能性下降了40％。使用来自美国医学目录的新数据，我们发现接受更严格计划，更高入院标准培训的医生在农村地区开展实践的可能性较小。在此期间，虽然所有医生都被吸引到大都市地区，但对于高质量学校的毕业生来说，吸引力更大。我们还发现一些证据表明，受过以科学和临床为基础的培训计划的医生被更多医院吸引。