As part of the state budget, Gov. Mike Dunleavy has proposed opening up the regional medical school program that serves Alaskans to 10 additional Alaska students each year — from 20 students to 30 instead — beginning with this year’s incoming class.
University partners say they’re glad to see funding earmarked for the state’s WWAMI program and that expanding the class size could be a good thing: The pandemic has highlighted Alaska’s need for more doctors, and the program has a track record of training and retaining a significant proportion of the state’s physicians.
But they say that the logistics of enrolling 50% more students per class will take time — and that it’s likely unrealistic the program could make the changes needed to accommodate an expansion for this year’s incoming class. The schools also say their top concern is improving the stability and certainty of the funding for the program before expansion can occur.
Training future Alaska physicians
Jessica Reisinger always knew she wanted to be a doctor when she grew up.
The 22-year-old first heard about the collaborative WWAMI program nearly a decade ago, just after her family moved to Wasilla from Washington state. The acronym stands for the five northwestern U.S. states involved: Washington, Wyoming, Alaska, Montana and Idaho.
“Moving up to Alaska, I wasn’t really sure if they had a medical school, if that was even a thing up here,” she said. She was excited about the chance to study in both Alaska and Washington, and was accepted into the program last spring during her final year of college.
While WWAMI students officially receive their medical degrees from the University of Washington School of Medicine, they’re able to receive training in any of those five states — and an Alaska-specific track allows students to complete the majority of their training in-state.
Currently, the WWAMI program each year accepts 20 Alaska resident students, who pay in-state tuition to the University of Washington during the last three years of the program. The state of Alaska pays to offset the approximately $3.3 million in total costs not covered by tuition.
Alaska students who do not return to the state to practice medicine after they graduate are required to pay back half of the costs the state paid on their behalf. WWAMI is currently the only medical school program where Alaskans are eligible for in-state tuition.
WWAMI graduates also account for almost 14% of Alaska’s licensed physicians, making it the largest contributing medical school to the state’s physician workforce. By 2019, 500 Alaskans had earned medical degrees through WWAMI; about 60% returned to practice in the state.
A few weeks before her first week of medical school began, a dispute in the Alaska Legislature caused Reisinger and her Alaska classmates to receive warning emails that said in-state tuition was not guaranteed.
Without a resolution, that would have meant around $40,000 more in educational costs, and likely debt, over the course of Reisinger’s four-year education.
Reisinger said she knew when she applied that securing reliable funding for the program had been an on-and-off-again challenge for years, and she was hopeful that the issue would be resolved soon.
“I definitely don’t think it dampened my excitement to be going into medical school,” she said. “I guess I just had a lot of faith that people would see the value in the program.”
Questions about expansion
The reason for the funding turmoil: While WWAMI’s funding has traditionally come from the state’s Higher Education Investment Fund, that account was emptied last year into the state’s Constitutional Budget Reserve under a provision of the Alaska Constitution.
The Alaska Legislature normally votes to stop that provision from taking effect, but it failed to do so last year amid Republican opposition.
A few weeks after students received that ominous email, the Dunleavy administration used one interpretation of state law and legal precedent to allow a year of funding for WWAMI and other programs, even though the accounts used to pay for them may have been emptied.
Last month, with a lawsuit underway to resolve the status of that fund, Dunleavy said in his State of the State address that his newly proposed budget included a 50% increase in funding for the WWAMI program, which would allow for 10 additional students in the incoming class.
On Thursday, an Anchorage Superior Court judge ruled against a few Alaska college students who sued the Dunleavy administration, challenging a decision that drained Alaska’s $410 million Higher Education Investment Fund.
The decision, unless challenged, means that WWAMI does not have a dedicated funding source and must compete with other programs in the state’s annual budget process.
Administrators at the University of Alaska and the University of Washington said that after what happened last summer, they were heartened to see the program included in the state’s budget — but that there were a few steps that would need to happen before expanding the school would be possible.
“We were excited and delighted to see that we were in the budget, and really appreciate the governor’s support of the program,” said Dr. Kathy Young, a director and dean with WWAMI at the University of Alaska Anchorage, where Alaska students in the program spend their first year and a half in the classroom.
“We have had a rocky couple of years. So it’s really positive and exciting to see that he would like to see the program expand,” she said.
The good news is that in terms of physical classroom space, UAA has the capacity to add more slots, Young said.
However, she said that while the school “fully recognizes that there is a need for more physicians within the state of Alaska, and will absolutely work on trying to make this a reality,” finding 10 additional Alaska doctors willing to take on medical students as part of clinical rotations and classroom practicums will take time.
From her perspective, Young said “it would take a miracle” to add 10 spots to the incoming class. Prospective members are undergoing interviews beginning this month, and students are scheduled to start classes in July.
“I would like to think that there is a strong possibility that we could extend the class for the following year,” she said. “The issue is having everything in place for this year.”
Other steps include working with the school’s accrediting body to make sure expansion is possible, said Dr. Suzanne Allen, vice dean for academic, rural and regional affairs at the University of Washington School of Medicine.
When developing the budget for the program, the governor’s administration worked with Sana Efird, the executive director of the Alaska Commission on Postsecondary Education, to develop a cost estimate for expanding the program, Dunleavy spokesman Jeff Turner said.
Efird said that at the governor’s behest, she spoke with the universities to assess how possible expansion would be — and heard from them that many steps would need to be taken first.
Whether it would be possible to use some of the money this year, whether the funds could get approved in this year’s budget but then be used at a later date, or whether it would be better to wait until next year’s budget to allocate the funds still needs to be resolved by all stakeholders involved, Efird said.
“There’s absolutely a recognition that there are lots of logistics pieces that need to be worked through from the university side, but the governor wanted to support and put forward something that showed that health care was a priority. And this was the way to do that,” she said.
Allen said she would also like Alaska to settle where its state funding for the school is coming from rather than be something that needs to be voted on year after year, which “has created a lot of stress for our students.”
“For us, the No. 1 thing that we need really to be able to move the conversation forward, we need to know that we have stable funding,” she said.
Dunleavy’s budget will need to first be cleared by the Legislature before it can go into effect.
Some coalition House majority members say they’re confident that the state will find funding for WWAMI no matter what happens — but that they would prefer for the money to come from the state’s Higher Education Investment Fund rather than from the state’s general fund.
“A higher education fund is a signal to future generations that this is a thing that will exist, be stable, earn interest and be available in perpetuity, rather than a yearly annual battle,” said Rep. Andy Josephson, D-Anchorage.
Rep. Adam Wool, D-Fairbanks, said his preference, too, was to restore the funds to the Higher Education Investment Fund as a more stable source of funding for the program.
“Revenue goes up and down every year, and if it’s a general fund budget item, then you know, people can veto it and say, well, that’s too much money for me this year,” he said. “So it’s at the whim of every legislature.”
Turner said in a statement that the Dunleavy administration believes including the funding as part of the budget rather than the Higher Education Investment Fund “ensures that the program itself is not subject to the programmatic uncertainty that was caused by recent legislative discussions.”
“Our hope is that the legislature work with the administration to ensure that these two questions, support for Alaskan medical students and financial structure of state funds, will be separate pieces of discussion throughout the budget process,” Turner added.
Past funding uncertainty has taken some toll on the program and on incoming classes, said UAA’s Young.
In 2019, the year Dunleavy proposed cutting funding for WWAMI, Young said the admissions team had to select 11 students off the alternate list to fill the class when typically, that number is closer to two or three.
“So it does make students make decisions,” she said. “And if they have other options, and they feel the program’s threatened or uncertain, they certainly have the opportunity to go somewhere else. These are bright, gifted students.”
Reisinger, the first-year WWAMI student, said she’s loving the program so far — and that learning to practice medicine in the midst of a pandemic hasn’t deterred her from wanting to become a doctor.
“For me, I really like feel like (the pandemic) drove me even more towards medicine,” she said. “Knowing that in the future I’ll be able to do something and have a positive impact.”