In 2006, alarmed that the nation’s medical schools were producing too few doctors, the Association of American Medical Colleges issued an urgent call for a 30 percent increase in slots for first-year medical students.
Since that time, 16 colleges and universities around the country have created new medical schools, and an additional seven are in the pipeline for accreditation. At the same time, enrollment at osteopathic medical schools has doubled.
Now, as Washington State University tries to gain statewide support to build a new medical school in Spokane, some regional and national experts say there’s no longer a pressing national need for another one.
And one expert questioned whether the revenue-strapped Washington Legislature has the money to invest in a new public medical school.
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Many experts agree that the most urgent problem now is the shortage of slots in residency programs — the hands-on training that medical- school graduates receive before they can obtain a license to practice medicine.
It’s becoming so acute that some medical-school graduates can’t find residencies at all, said Dr. Atul Grover, chief public policy officer of the Association of American Medical Colleges (AAMC), a nonprofit association that represents all 141 accredited medical schools in the U.S. Residencies are almost entirely funded by the federal government.
In making its case for another medical school, WSU points to a shortage of doctors practicing in Eastern Washington, especially in rural areas — a problem that’s expected to worsen as baby-boom-age doctors retire, and the population of patients born in the baby-boom era grows.
A medical school on WSU’s Spokane campus, already a hub for medical education in Eastern Washington, would help grow the number of doctors there, WSU officials say.
“There is still a definite need for more seats, and I would really emphasize the regional issues,” said Dr. Ken Roberts, director of WSU’s medical science program. “Nationwide is one thing, but if you look at the Northwest, our numbers (of medical students) are dramatically low.”
Only about 15 percent of Washington’s practicing physicians graduated from the University of Washington’s School of Medicine.
But David Longanecker, a regional expert on higher education, said getting doctors to practice in rural Eastern Washington isn’t solved by opening a new medical school on the east side of the Cascades.
“I grew up in North Central Washington, so I understand some of the concerns” about physicians in rural areas, said Longanecker, the executive director of the Western Interstate Commission for Higher Education (WICHE), a regional organization that helps with resource sharing among Western states’ higher-education systems.
“But docs aren’t going to go where they can’t make money, and Omak’s not a place to make money,” Longanecker said.
Longanecker said the field of medicine is changing so rapidly that it’s not clear whether more medical doctors will actually be needed. Rather, the future of medicine — especially in rural areas — may involve medical doctors remotely managing teams of physician assistants and nurse practitioners, he said.
Two current schools
Washington has two medical schools: the UW School of Medicine and Pacific Northwest University of Health Sciences (PNWU), a nonprofit, independent osteopathic medical school in Yakima. The UW accepts 220 students a year, and PNWU accepts 135.
The UW school is the public medical school for four other states: Wyoming, Alaska, Montana and Idaho. The program is known by its acronym, WWAMI, which stands for the five states that are part of it.
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. The cost of running the UW medical program is shared by the five states.
Recently, about 20 WWAMI students began doing their first- and second-year medical training on the WSU-Spokane campus, and the UW says it will ask the Legislature for funding to double that number. They argue that expanding WWAMI in Spokane is more cost-effective than building another medical school from scratch.
WSU has a supporter in Dr. Keith Watson, president of PNWU, who doesn’t think an expansion of WWAMI is enough.
“We’re not opposed to a WSU medical school; in fact, we need all the help we can get,” said Watson, who noted that about a quarter of Washington’s licensed physicians are over the age of 60.
Few residency slots
If the goal is to encourage more young doctors to practice outside of population centers, one of the most effective ways to encourage them to do so is to offer them residencies in rural areas, studies show.
But Roberts, of WSU, said of the 1,500 residency slots in Washington, just 8 percent are in Eastern Washington. The rest are in Western Washington, and most of those are in the Seattle area.
PNWU graduates also have a hard time finding residencies in Eastern Washington. Of the 218 students who have graduated since the school opened in 2008, only some of them were able to find residencies anywhere in the state. The rest had to go to the Midwest or East Coast for residency training, Watson said.
Roberts believes that building a medical school in Spokane would also expand the number of doctors who can supervise residents, as the two types of medical education often go hand-in-hand.
Longanecker, who questions whether Washington has the money to build another medical school, said a new WSU school would — just by virtue of the fact that it’s new — be the lowest-rated medical school in the country.
Medical students tend to be risk-averse, and WSU’s school would be the last pick for most doctors-in-training, he said. “They’d have no trouble filling the classes … what they (WSU) are really saying is, we’d accept students who are willing to come to us because we’re their only option.”
Roberts, of WSU, disputes that idea, saying the pool of Washington applicants to medical school is so strong, and WSU’s reputation as a center of research is so well-established, that the program would start with a reasonably strong reputation.
“I really don’t worry about that,” he said.