The Spokane County Medical Society has been discussing with the Seattle-based University of Washington School of Medicine ways in which the school could expand education opportunities here.


Dr. Don Cubberley, the societys president, says the discussions have occurred as the society has looked at the idea of opening a medical school here. Its one of three groups to look at that idea. Those groups concur that medical education here can and should be expanded, but disagree on what that should entail.


Cubberley says he believes that at some point, the state will need to establish another medical school.


Twenty years from now, assuming the continued growth of the states population, we wont be able to produce enough physicians, he says. At that point, the state will have to build a second medical school.


The medical society supports the creation of a four-year medical school in Spokane, but hasnt endorsed any method of establishing such an institution. Members of the medical society, many of whom teach third- and fourth-year UW medical-school students in Spokane, will discuss ideas with UW about how to pursue a medical school, but wont try to set up an independent school, Cubberley says.


Rich Hadley, president of the Spokane Regional Chamber of Commerce, says the chambers health industry development group has been examining how Spokane can link the health-care industry here to beneficial public policies and economic-development plans.


The chamber wants to help Spokane reach a consensus on what types of health-care programs should be advocated to boost the economy and health-care sector, he says. Its holding a health-industry forum at 1 p.m. next Monday to present data about the economic impact of the health-care industry and to explore ideas about how Spokane can make that sector more effective, Hadley says.


The half-day forum, which will be at the Riverpoint Higher Education Park Phase 1 building, also will include a discussion about what options Spokane should consider regarding an expansion of medical-education facilities here.


The third group that has evaluated the medical school idea, which is headed by former Local Planet editor Tom Grant and includes doctors and businessmen, isnt put off by the expense of opening a medical school here.


If we can raise $77 million for the convention-center expansion, why cant we raise $70 million for a medical school? Grant says. Were not talking about something thats impossible.


A UW expansion


Dr. John Coombs, associate dean for regional affairs, rural health, and graduate medical education for the UW School of Medicine, says UW is interested in pursuing ways it can increase publicly supported access to medical education. Before UW can increase its programs, however, its medical school must expand its facilities and hire more faculty members to accommodate additional students.


Wed need to have strong support from the Legislature in terms of an infusion of public funds to do that, he says.


Its possible, however, that such an expansion could happen here, he says.


The UW medical school currently enrolls 178 students annually, about 110 of whom are Washington-state residents, Coombs says. Most of the remaining students are residents of Wyoming, Alaska, Montana, and Idaho who attend classes through a program that allows those states to buy 18 to 20 medical-school seats per state, he says.


That program, named WWAMI for the participating states names, provides publicly supported medical education at in-state resident tuition costs to students who attend first-year classes at universities based in those states, Coombs says. UW offers a 20-student WWAMI class at Washington State University, in Pullman.


About 650 Washington-state students apply each year for the states 110 UW medical school slots, and roughly half of them are academically qualified to attend, he says.


UW last expanded its medical-school class size in 1996, when Wyoming joined the WAMI partnership that began in 1972, and hasnt expanded the number of seats available to applicants from Washington since the 1960s due to a lack of Legislative funding, Coombs says.


The UW medical school offers about two seats per 100,000 residents in Washington state, which falls short of the national average of six seats per 100,000 residents, he says.


The school would like to expand seat availability to Washington residents possibly by adding a class in Spokane, Coombs says. To do that, though, the Legislature would need to appropriate money to pay for the additional 20 seats and for renovation of medical-school classroom space in Seattle, which only can handle 180 people now, he says.


Setting up a 20-student WWAMI class here could cost up to $12 million, Coombs says. Operating expenses, including state funding and tuition, would account for about $4 million of that estimate, and building and faculty expansions in Spokane and Seattle would account for between $7.5 million and $8 million, he says.


A WWAMI class here?


If the Legislature provides the funding, establishing a WWAMI class here would be feasible, but Spokane would need to determine what kind of medical-education program expansion is best for the community before the project could proceed, Coombs says.


Spokane needs to decide what it is its looking for, he says. It requires the support of hospitals, physicians, the Chamber of Commerce, and the community to put a package together and take it to Olympia.


Creating a two-year program here through UW isnt possible anytime soon given the number of faculty members that would have to be hired, Coombs says. Also, expanding the WSU-based WWAMI class size likely wont happen either unless UW received enough money to expand the faculty and facilities there.


The UW medical school doesnt support the creation of a free-standing, separately accredited medical school here because that would cost an estimated $100 million to $200 million to set up, and the school would take decades to develop a program like UWs, Coombs says.


Weve had 50 years to get to where we are, he says. A separate institution probably would take us in the wrong direction.


Michael Wilson, president of Sacred Heart Medical Center, says he agrees that establishing a medical school here apart from UW wouldnt be the best use of the resources of the states current medical-education system.


Wilson, who is chairman of the Inland Empire Hospital Services Association (IEHSA), which sponsors medical-education programs in the region, says UW has the infrastructure, buildings, faculty, and curriculum to support medical-education expansions here.


It would be much more economical to draw upon the strength of UW, he says. Its just the reality of creating something new versus drawing from whats existing.


IEHSA supports expanding the class in Pullman and setting up a WWAMI class in Spokane, which would require the cooperation of hospitals here, where third- and fourth-year students and medical residents are trained, Wilson says.


Coombs says that expansion also would require a university in Spokane to host the WWAMI class.


Stephen Jordan, president of Eastern Washington University, says he hasnt talked with anyone about EWUs hosting a WWAMI class. He would, however, like to see the UW medical school establish a physical presence here.


EWU and other colleges in the region offer basic science programs that could work in conjunction with a medical school here, says Jordan, who worked for several years as vice chancellor at the University of Colorados Health Sciences Center. He says EWU might participate in discussions about a WWAMI expansion, but doesnt support the creation of a four-year medical school here.


No ones building medical schools in the country, he says. People dont fully appreciate what it costs to do that.


Phil Talmadge, until recently a candidate for the Democratic gubernatorial nomination, didnt seem to be deterred by the cost issue when he jolted Spokane months ago by issuing a press release saying he would make establishing a medical school here a priority. Grant also hasnt been deterred by it.


Tallying costs, advantages


Grant says his research shows that such an endeavor wouldnt be extraordinarily expensive.


Florida State University in Tallahassee spent about $70 million when it founded a four-year medical school in 2001, and two universities in Ontario, Canada, estimate they are spending the same amount to launch a collaborative medical school thats expected to open next year, Grant says. About $60 million of Florida States costs and $33 million of the Canadian schools costs involved the construction of the respective schools medical facilities, he says.


Based on that cost information, Grant thinks a new medical school here is affordable.


Grant asserts that besides filling a physician shortage, a medical school here could boost the economy.


Researchers at the University of Minnesota-Duluth calculated that since the medical school there was founded in 1972, it has graduated 500 doctors who have practiced medicine in rural Minnesota and generated $1 billion in economic impact to that region, Grant says. Another study shows that one doctor is worth another 17 jobs and creates $350,000 a year in economic impact in a rural setting, he says.


Its hard to deliver that kind of economic impact at a rural community, but thats what educating physicians can do, he says.


Rob Brewster Jr., a Spokane developer who participated in Grants study, argues that a medical school here could bring in millions in research dollars and an influx of students, which could increase demand for housing.


It could provide prestige to the community and better representation in Olympia and Washington, D.C., he says. Even if its a money loser at first, the spinoffs are what really make a huge impact.


Brewster says he would like to see UW set up a medical school that could collaborate with the planned new Intercollegiate College of Nursing and a pharmacy school to create a medical-education complex. Many cities smaller than Spokane have established medical schools, and with support from the state and federal government and local sources, the community here could fund that kind of project, he asserts.


In addition to boosting the economy, a medical school would draw intelligent people here, boosting the number of residents with doctoral degrees, he says.


Garman Lutz, CEO of Spokane-based Empire Health Services, which runs Deaconess Medical Center and Valley Hospital & Medical Center, says hospitals here cant expand medical education without an appropriation of tax money.


If the Legislature allocates more money for medical education, however, expanding such education here would help Eastern Washington recruit and retain physicians, he says.


An academic presence helps to create an environment physicians would be attracted to, he says.


Also, research shows that medical-school students often opt to practice medicine where they were raised and where they received their training, Lutz says. If medical education is expanded here through WWAMI or another program, students would be able to train in Spokane, practice medicine in rural areas where theres a lack of physicians, and maintain their skills through programs at hospitals here, he says.


Tom Fritz, CEO of Spokane-based Inland Northwest Health Services, says that high liability-insurance premiums and other factors in the health-care system have deterred some students from entering medical school. That, he says, has resulted in a shortage of physicians and an influx of graduates from foreign medical schools.


Establishing a medical school in Spokane might encourage local students to consider practicing medicine as a desirable occupation that they can study here rather than in another state, Fritz says. It wouldnt guarantee, however, an increase in physicians working in rural areas unless the school specifically placed students there, he says.


Fritz says he agrees that the presence of a medical school in Spokane, which already has a strong health-care sector, could draw research dollars 10 to 15 years down the road, but hes not convinced that Spokane has enough money to fund that type of undertaking.


The concept is great, but how do you make it happen? he says.


Fritz says he doesnt know how INHS, which handles the collaborative activities of Spokane-based Providence Health Care and Empire Health Services, might be involved in the formation of a medical school here, but a number of health-care organizations here would be interested in promoting it.


Theres a vested interest to have a seat at the table to see it be successful, he says.