The M.D. was thus the first entry-level professional degree to be awarded as a purely trade school 'doctor'-degree in the United States, before the first European-style doctorate, the Ph.D., was awarded by an American Institution in 1861, although the M.D. was not established as a post-baccalaureate degree until much later. The President of Yale, Arthur Twining Hadley, stated in the early 20th century that: "However convenient it might be to insist on the possession of a bachelor's degree by all pupils in the schools of law or medicine, I feel that it would be a violation of our duty to these professions to hedge ourselves about by any such artificial limitations." This changed (for medicine) after Abraham Flexner's damning report into the state of medical education in 1910: by 1930 almost all medical schools required a previous liberal arts degree before starting the M.D. course.