The first two decades of the 21st century may well be viewed by future generations as the second great expansion of post-Flexnerian medical education in the United States. Given that medical schools are now significantly increasing class size for only the second time in 100 years, it is instructive to remember the last era -- the 1960s and 1970s -- when these challenges were also forefront in the minds of the medical education community.A review of the literature from that period indicates that medical educators had similar concerns as today: the cost of expansion, national health policy, graduate medical education, community-based clinical education, interdisciplinary health professions education and care delivery, and the management of expansion efforts. Two other issues not fully represented in the literature from the 1960s and 1970s are apparent in 2007: graduating a diverse cadre of physicians and creating regional four-year branch campuses. While many concerns about medical school expansion from 50 years ago are with us today, one of the most significant responses from the 1960s and 1970s -- a large influx of federal funding -- does not appear on today's horizon. The novel strategies that today's generation of medical educators will adopt to address projected physician shortages are still emerging.