SEATTLE -- Washington's two biggest universities are squaring off over how to train more doctors to work in rural Eastern Washington, where there's a critical shortage of primary care physicians.
To remedy that, Washington State University wants to build and operate a new medical school in Spokane -- a step that would require several years of accrediting work, at an unknown cost.
The University of Washington, which operates one of only two medical schools in a five-state region, says a better way is to expand an existing program it runs on WSU's Spokane campus, ultimately creating what in effect would be a new medical school there -- but without the accrediting work and administrative overhead a new school would require.
Because medical schools are so expensive to operate, millions of dollars in scarce higher-education funding are at stake and both universities are fighting for their share. The issue has created tensions between civic leaders on both sides of the state, and resulted in a kind of turf war between the state's top two universities.
Washington is hurting for doctors in part because the UW School of Medicine has funding to admit only 120 Washington students a year, although six times that many apply. Another 100 students are admitted from outside Washington every year, as part of a cooperative five-state program, bringing the total size of each class to 220.
Both WSU and UW have commissioned consultants to examine ways to deal with the medical school's inadequate capacity -- WSU to determine the feasibility of creating its own separately accredited medical school at its Spokane campus, and the UW to assess the cost and benefits of that option versus expanding the training the UW already oversees in Spokane.
The issue will likely be decided by the Legislature next year.
The battle could cloud the future of an innovative five-state program that is administered by -- and central to -- the UW medical school.
The 43-year-old program is a cooperative effort known by its acronym -- WWAMI (pronounced "whammy") -- for the five states that are part of it: Washington, Wyoming, Alaska, Montana and Idaho.
Under the program, medical students study the first year in their home state, then come to the UW for their second year of medical training. Students do their last two years of medical school in clinical rotations, which can be in Seattle, in their home state or in other WWAMI states.
It's considered an efficient, cost-effective model because the cost of running just one medical school, in Seattle, is shared by the five states. And it's also a model for quality: The UW School of Medicine has been consistently rated one of the top medical schools in the country for primary care doctors.
"WWAMI works," said Paul Ramsey, dean of the medical school. "The quality's there. They (doctors) stay where they train ... the cost is an average $40,000 less per student, per year, than the average medical school."
Eastern Washington WWAMI students have been able to study their first year at the WSU-Pullman campus for some time now; that program is moving this fall to WSU's Spokane campus, which already houses WSU's pharmacy and nursing programs.
In addition, for the first time this year, a pilot WWAMI program allowed 20 students to do all of their second-year medical training on the WSU-Spokane campus. Students in the first year of the program study primarily with WSU faculty, and during the second year with UW faculty.
The number of students in that second-year program in Spokane will double to 40 this fall, and UW officials say they'll go to the Legislature next session and ask for the funds to increase it to 80.
"We are effectively proposing a four-year medical school in Spokane, with all of the benefits and none of the added administrative costs," said Margaret Shepherd, UW director of state relations. Many WWAMI students in Spokane do their clinical rotations at hospitals in Spokane.
But WSU says opening a medical school is about more than efficiency.
"The UW simply cannot accommodate all the qualified students who are desirous of going to medical school," said WSU President Elson Floyd during a meeting with The Seattle Times editorial board in April. Under WWAMI, Washington has lagged behind other states in the growth of slots in medical school, and prospective medical students who are turned away often go outside the state, or the country, to become doctors, he said.
Floyd said the UW has made promises before that it would expand medical offerings in Spokane.
"The reality is, they haven't done it," Floyd said. "How much longer do we need to wait?"
Spokane leaders point with pride to the city's growing importance as a provider of medical services, and cite a 2010 consultant's report which says that a new medical school there would have a $2.1 billion statewide economic impact -- $1.6 billion of that in Eastern Washington.
The city's civic leaders have been working for nearly a decade to create an academic health science center in Spokane, and they argue that doctors who train in that part of the state are more likely to practice there.
"The important question for our legislators is not which university should run medical education," wrote Spokane doctors Jeremy Graham and Henry Mroch in a recent opinion piece in the Spokane Spokesman-Review. "The important question is whether Spokane will host only a WWAMI extension site or will have its own full-fledged medical school to serve our region."
WSU's decision to build an $80 million pharmaceutical and biomedical sciences building at its Spokane campus and move its pharmacy and nursing programs there speaks volumes about WSU's commitment to creating a campus for medical education in Spokane, said Anne Marie Axworthy, a project manager for the medical school project. Axworthy works for Greater Spokane Incorporated, a regional chamber of commerce and economic development council.
WSU's newest Spokane medical building opened in January and is large enough to accommodate a new medical school, Axworthy said. Already it houses the WWAMI program.
"I don't think anybody disagrees at all that WWAMI is an incredibly innovative model," Axworthy said. But, she said, perhaps more than one approach to medical education is needed -- both WWAMI and a WSU-run medical school, for example.
In May, after WSU began vigorously pursuing its own medical school, UW President Michael Young created an advisory committee to discuss the future of WWAMI.
The committee is made up of both UW and WSU regents and civic leaders, and held its second meeting at Harborview Medical Center earlier this month.
The dispute seems to be highlighting a competition between the state's biggest universities that goes beyond ordinary intercollegiate rivalry.
"I was very concerned that, in the last (legislative) session, that some of the cooperativeness of universities was not there," said state Rep. Larry Seaquist, D-Gig Harbor, who chairs the House Higher Education Committee.
Because so many budget decisions are made in backroom deals, Seaquist said, the universities are starting to go around each other, instead of presenting a united front over funding issues.
"And you can understand why," he said. "We don't have enough money. It's like starving people, with a few crumbs on the table."
The controversy over building a new medical school in Spokane first emerged more than a year ago, when Floyd and Young traded barbs in a Spokane Spokesman-Review story.
State Sen. Jeanne Kohl-Welles, D-Seattle, was at a higher-education reception for Young in Spokane when the story ran and, "I could feel the tension in the air," she said. "I think this will be a big issue for the state this session, if it's not resolved before then."
By KATHERINE LONG
The Seattle Times