Cutting through med school politics
Mike FlynnFebruary 12th, 2015
Washington State’s senior congressman has stirred reactions of surprise, disappointment and a bit of irritation for inserting himself, with an op-ed piece in the Seattle Times, into the discussion over a possible new medical school at Washington State University by urging the Legislature to reject the idea.
The University of Washington sits squarely in Rep. Jim McDermott’s 7th Congressional District and he has always done an excellent job over his 24 years in Congress of putting the needs of his constituents first. So it’s not surprising he would step up to help that important constituent when asked.
But it’s unfortunate that McDermott would visibly support UW and his friends there by taking sides on the issue of whether a new WSU medical school should be created, likely to serve large parts of the state whose interests are not McDermott’s concern.
There were some in the Legislature, including from his own party, who were surprised, and a little miffed, that he would advise them in a high-profile manner on how they should decide an issue that is strictly up to the Legislature.
One staunch UW supporter in the Seattle business community told me, “It was inappropriate for McDermott or any member of the state’s congressional delegation to turn this into a political issue when it’s a state and local issue.” He added. “We have an incredible medical school at UW and it will continue to be the mother ship, so to speak, whatever develops. A WSU med school won’t endanger that and it might make a regional health care program stronger.”
Really the only question before the 2015 Legislature is whether the lawmakers will set aside a nearly century old law that prevents any state university other than UW from providing a medical education. There is a bill asking the lawmakers to provide some initial funding for WSU’s effort, but the major issue to decide is whether or not they clear away the legal impediment that dates to 1917.
In an era when it’s become increasingly clear that competition drives innovation and new ways of doing business, it would be difficult to imagine a reason, other than successful lobbying, why the Legislature would decline to remove that arcane constraint. That way the discussion about whether or not there should be a second medical school in the state can continue on.
Would competition be damaging to the University of Washington? It’s not likely that its status as the 12th best medical school in the nation in U.S. News & World Report’s 2013 rankings would be jeopardized with a new WSU medical school in Spokane.
And its ranking as the No. 8 medical school in the country for receiving grants from the National Institutes of Health at $302 million last year would not likely be seriously impacted. WSU would be going after different grants.
Might UW need to be more attuned to the needs of rural parts of the state for medical care and more doctors? Perhaps, even maybe deciding to turn out more than the 120 graduates a year that has been the limit for a decade.
And as a side note on the issue of competition being potentially damaging, it’s worth noting that Stanford University Medical School ranks fourth on that U.S. News list, while University of California Medical School in San Francisco a few miles up the freeway is fifth. Now obviously they don’t compete for state dollars, since Stanford is private, but they compete strongly for federal dollars and grants.
WSU has been attuned from the outset to seeking to explain how it might address the need throughout Eastern and Central Washington communities for more physicians and has looked for models for community-based medical education, and thinks it has found a model in Michigan.
Interestingly, although Michigan’s population is nearly 10 million compared to Washington’s nearly 7 million, it has five medical schools and enrolled a total of 2,941 medical students to 592 students at UW School of Medicine.
And again with respect to the point of competition, it’s worth noting that the University of Michigan Medical School was one ahead of UW in the U.S. News ranking, despite, or perhaps because of, its in-state competition.
And it’s competition that stirred the Michigan State University medical school to focus on community-based medical education and become a national leader in that focus. And competitive innovation led MSU to offer degrees in both conventional medicine and osteopathic medicine, making it one of only two medical schools in the nation with that distinction.
McDermott spent much of his op-ed legitimately extolling the virtues of the highly regarded program in which, in the early 1970s, the University of Washington took the bold challenge to train and prepare physicians to care for patients and communities throughout the states of Washington, Alaska, Montana and Idaho (Wyoming joined in 1996).
This regional medical education program known as WWAMI (an acronym representing the states it serves) has been the most innovative of what were a number of similar regional medical education and training programs in the country. It’s now the last because the centralized model is not what the future holds.
And there have been discussions in Idaho, now shelved for the time being, and currently in Alaska about creating medical schools in those two WWAMI-partner states.
And as one proponent of the WSU proposal put it to me, “More of WWAMI, even if it were to continue, would give us more of what we’ve gotten: concentration of health care resources and talent. How does that help our current problem of access and quality of care away from the population hubs?”
An issue that should attract more attention than it has in this discussion is that virtually all of the emerging biotech startups at UW have come out of the medical school, meaning the medical school is a key to what some hope will be a renaissance of the state’s biotech industry.
It’s logical to assume the same would be true of WSU, which already has one of the best regarded of the nation’s 26 veterinary schools, which is producing some biotech commercialization and would likely seek some innovative medical school partnerships toward that end.
Ultimately the challenge the Legislature faces is the looming serious health care workforce shortfall, since it’s estimated that Washington will need an additional 1,695 primary care physicians in 15 years.
Currently less than 15 percent of this state’s applicants to the UW School of Medicine were admitted in 2012-13 to fill the 120 seats allotted for residents of Washington, which ranked 42nd of the 45 states with medical schools in allowing eligible in-state applicants to attend those in-state programs.
And beginning to address that challenge is the forefront issue before the lawmakers. Thus the underlying factor in any decision regarding a WSU medical school is would it help or hinder dealing with the looming physician availability crisis.
Mike Flynn is the retired publisher of the Puget Sound Business Journal and writes a regular column called Flynn’s Harp.