A new performance audit — released days after Washington State University’s first class of medical students arrived in Spokane — has renewed questions about whether the new med school was the best use of state money.
A new analysis backs up what many state officials suspected all along: Training doctors at the new medical school at Washington State University probably will cost taxpayers more than training those students at the top-ranked University of Washington School of Medicine.
That news isn’t shocking to state lawmakers, who greenlighted the new medical school at WSU’s Spokane campus two years ago.
But the release of the performance audit last month — just days after WSU’s first class of 60 medical students arrived in Spokane — stirred up long-simmering tensions between politicians on the eastern and western sides of the state about whether the new medical school was the best use of state money.
“I guess I can say, ‘I told you so,’ ” said state Rep. Eileen Cody, D-Seattle and the chairwoman of the House Health Care and Wellness Committee. “A lot of good that does me.”
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In 2015, Cody favored expanding the UW’s contingent of medical students in Spokane rather than starting a new, competing medical school at WSU.
Yet backers of the WSU medical school say the investment in the new school will pay off by helping lure more future doctors to Eastern Washington, while also bringing research and development dollars that will help bolster the local economy.
“It’s definitely worth it,” said state Rep. Marcus Riccelli, D-Spokane and the prime sponsor of the 2015 measure to eliminate the UW’s monopoly on medical education in Washington state.
Riccelli cited a shortage of primary-care doctors throughout the state as one reason the new medical school is needed.
“If we can train folks here and get them out to our rural and underserved areas, I think we’re going to help alleviate this health-care crisis,” he said.
The Legislature dedicated $2.5 million in its 2015-17 budget to getting the WSU medical school up and running, and has committed another $10 million over the next two years to pay for the first two classes of medical students at the WSU campus.
As part of the funding deal, lawmakers in 2015 asked the State Auditor’s Office to examine the costs of medical education at each university, since various per-student figures were flying around the Legislature that year.
The audit that came out last week followed through on that request.
The report estimated the total cost of educating a student at the UW’s medical school in 2015 was $90,640. That’s the cost to the state, not to the student, whose tuition bill is much lower.
At WSU, the state’s tab for educating a medical student is expected to be $125,960 per year. That number is projected for the year 2023, when the new medical school’s staffing, enrollment and starting costs are expected to have stabilized, according to the audit.
Because the audit uses different years for its cost calculations, it is difficult to directly compare the per-student costs, said Tania Fleming, a senior performance auditor who worked on the report.
The inflationary costs calculated between 2015 and 2023, Fleming said, are only one factor.
Other factors contribute to higher costs at the WSU medical school, she said. Those include the school’s smaller student body, which allows for fewer economies of scale, as well as various startup costs, the audit says.
“UW (School of Medicine) is an institution that has been around since before the 1970s, so they’re a well-oiled machine,” Fleming said. “Whereas with WSU, they just started the first class this year.”
State Sen. Reuven Carlyle, D-Seattle, said the audit makes it clear to him that it would have been cheaper to have just expanded UW’s medical program in Spokane. He said one reason he voted against adding a new medical school was because the Legislature didn’t have data about how much it would cost over time.
While Carlyle said there might have been certain “intangible reasons” to start the new medical school at WSU, from a financial standpoint, the decision made less sense.
“I do feel like we should not pretend that the University of Washington Medical Center isn’t viewed as one of the premier medical centers on this planet — we could have expanded it,” Carlyle said. “The idea that they’re (WSU) going to match one of the premier institutions in the world in anything other than many, many years and extraordinary amounts of public investment is just not true.”
State Sen. Michael Baumgartner, R-Spokane and a key advocate for the new medical school, said he sees comments like Carlyle’s as putting Seattle before the rest of the state.
Although the UW partners with four other states to provide regional medical education throughout Washington, Wyoming, Alaska, Montana and Idaho (a program known as WWAMI) the UW medical school is largely based in Seattle, with many key facilities located there.
Baumgartner called the new WSU medical school a “tremendous benefit” to people living in other parts of the state, regardless of the cost — “not just because of the doctors we train, but because of the resources it brings here, and eventually, the research and jobs it will bring here.”
Baumgartner said that although it looks as if the WSU medical school will cost more in the near future, as the school expands he thinks eventually it will be able to bring those costs down.
Baumgartner said it’s noteworthy that the same year the Legislature voted to allow a medical school at WSU, the UW pushed the state to add more students to the UW’s program in Spokane. The UW now hosts 60 medical students at Gonzaga University, up from the 40 students the UW previously had studying at WSU, before the universities’ partnership dissolved amid the debate over the new medical school in 2014.
“By doing the WSU medical school in Spokane, we also greatly expanded the UW’s investment in Spokane, because competition is a wonderful thing,” Baumgartner said.
Where will grads go?
Cody, chairwoman of the House committee on health care, said she thinks where students spend their residency — not their four years of medical school — is more likely to determine where they ultimately stay and practice medicine. For that reason, expanding residency programs that train students after medical school is an area where she wanted to put the state’s money, instead of into the new medical school at WSU.
Mary Kay Clunies-Ross, an official with the Washington State Hospital Association, said both stages of training matter when it comes to where doctors later choose to locate.
“There’s plenty of national research that shows that doctors do tend to stay where they’re educated, and WSU has a big emphasis on recruiting students who are local and interested in rural medicine,” she said.
WSU officials say the new Spokane medical school is planning to sponsor its own residency program in the future, as well as become an academic affiliate to residency programs at other hospitals in the region.
State Sen. Ann Rivers, R-La Center and the chairwoman of the Senate Health Care Committee, said she’s confident the state will see more residencies crop up in Eastern Washington over time due to the new medical school there. WSU’s specialized focus on rural medicine also makes it distinct from the UW program, she said.
Rivers said she expects that down the road, WSU’s medical school could become as cost-effective as the one at the UW.
“It’s only a matter of time before this very specialized type of program is able to develop the same types of cost-saving techniques,” she said.