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A press release states that “the universities have agreed to work together on a subsequent agreement to fully transition the WWAMI program in Spokane to the University of Washington. Assuming completion of that agreement, both institutions agree not to oppose each other’s legislative initiatives to expand medical education opportunities.”

The University of Washington and Washington State University declare war.

After WSU decided two weeks ago to launch its own medical school, UW and  WSU have announced that WSU will be divorced from the WWAMI program.

This is a disaster for Washington state students who want to attend medical school. Whatever Cougar School of Medicine becomes, WWAMI, rated as the number one program for rural medical education in the US, is a program run by the UW that currently serves both Washington state schools as well as Wyoming, Alaska, Montana and Idaho.

The finances of the new WSU school are unclear.   Washington State University Spokane Chancellor Lisa Brown said she’s confident the state Legislature could find money in the state budget to fund both proposals.  “I see our model as being complementary to the UW model.”   This is hard to stomach in the era where Republican aversion  to any taxes dominates the legislature while the Washington State Supreme Court has ruled we MUST come up with about $1,000,000,000 to fulfill the state’s constitutional requirement to fund “basic education.”

I could imagine a Cougar School of Medicine if donors from eastern Washington wanted to donate a lot of money.  So far, however  no local donors have emerged to cover the several hundred millions of dollars required as start up capital .. much less the operating budget of a separate Cougar based administration.  Instead WSU will seek state funding for a new medical school at WSU’s Spokane campus.  This means the plan is for WSU  to drop out of WWAMI, competing for state funds while UW will proceed with its planned expansion of the program in Spokane.

Washington state  students will be  caught in the cross draft. Rather than expanding opportunities for Washington state kids inside WWAMI, they will get to go to what at best will be a much less prestigious school. The feeble excuse for this pissing match come from WSU funded studies claiming that state needs at least 4,000 more physicians in the next 15 years. Washington ranks in the bottom half of all states in its number of medical school slots, graduating 120 students each year.

The need for new seats is not a reason to build a new school branded with  a Cougar.  The real issue is local pride. There are four reasons for not creating a separate medical school:

First, attracting physicians to work in rural locations is not at all the same thing as offering opportunities for Washington state kids to go to medical schools.  Our MD graduates may choose to work in Washington but they may choose to go elsewhere for the usual reasons people choose not to work in rural settings with less than ideal conditions.   The WWAMI program, with its five state region and highly attractive #1 rating, attracts American kids who want to work in a  rural setting here.  Why would a school in Spokane WA be equally attractive?

Second, in the same spirit, rural docs do not come from medical schools, they come from residency programs.  UW has been building a regional medical practice, UW Medicine. Again UW Medicine is rated near the top nationally in primary care and rural medicine,  not least because of the region wide role built on WWAMI.   A WSU SoM will have no equal advantage.

Even more important is the issue of attracting residents.  Experiences in residency determine where MDs look for jobs. A Cougar SoM is not going to have the regional resources to compete for the best residents.

Third, the quality of a medical school depends on a lot of hard work to build strengths…the  “basic sciences.”  Without private sources of funds, the only way WSU could fund these start ups is by taking moneys from other WSU activities. A medical school faculty does a lot more than just teach students how to listen to a heart or deliver a baby.  Patients want and deserve doctors who understand the rapidly changing science that underlies modern medicines .. areas like genetics, molecular biology, infectious disease, pharmacology.  The curriculum for all of these is built on basic science departments and non profitable clinical specialties  that are very, very expensive to build.  For example the UW has world famous programs in trauma and rehabilitation medicine.  A reasonable start up budget for each of the dozen of more academic departments is likely to be  in the hundreds of millions of dollars per Department.

Fourth, start up costs do not mention the need for an annual source of support unlikely to be covered by state approved medical school tuition.    WSU estimates it will need a total of $24 million annually in state funding when the school reaches an enrollment of 480 students by the 2024-2025 school year.  It plans to ask the Legislature for about $2.5 million in the next session — which starts early next year — to get started.  This is a serious underestimate that may reflect a naïve misstatement of a WSU study claiming that that the WSU SoM   generate more than $2 billion in economic activity in Eastern Washington.  The only way they could come up with that number is by confusing cash flow with profit.