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Exploring issues of WSU medical school should proceed despite McDermott urging quick end

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 mothership, so to speak, whatever develops. A WSU med school won't endanger that and it might make a regional healthcare 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 number 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 4th on that U.S. News list while University of California Medical School in San Francisco a few miles up the freeway is 5th. 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. That's a difference of 29 students per 100,000 to Nine per 100,000.

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 commercialization.

Ultimately the challenge the legislature faces is the looming serious healthcare-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.

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Colleges, universities seek to explore ways to serve economic development needs

(Editor's NoteThis is the first of two articles exploring the challenges faced by higher education in coming to grips with the role of four-year colleges and universities in serving the economic development needs of their regions and states.)

 

As institutions of higher education come to terms with the expectation that they should adopt a mission to serve the economic development needs of their regions, some in academia may recall wistfully Thomas Jefferson's view that "education, as a lifelong encounter with the delights of the mind, is an end in itself."

 

But a growing number of leaders in higher education might view a different Jeffersonian observation as more appropriate today: "Education is a highly legitimate claimant on public treasuries."

 

The point of the latter quote, in the view of many within the higher ed system and in other segments of society, is that institutions of higher education provide economic value and should receive financial support accordingly.

 

The issue was brought to the fore in this state in recent days with a report to the board of regents of the University of Washington by the Washington Future Committee, headed by former regent William Gates Sr., which suggested UW could do more despite its obvious and significant economic impact.

 

The group of business and civic leaders Gates chaired urged UW to increase the number of in-state students, keep tuition affordable and increase the number of STEM degrees and do a better job of telling its story to key stakeholders.

 

But well before the Gates report, Initiatives have been under way across the country to explore what role colleges and universities should play, and, how, in helping grow the economies of their states.

 

UW President Michael Young and the regents will now have to digest the report and weigh its relevance to how the state's major research university charts its future.

 

Nowhere is the process of higher ed's role in economic development being scrutinized more than in North Carolina. There a process is under way that has each of the state's college and universities being asked to define their mission and answer how the mission is serving the needs of the state today.

 

"It's basically a hard look at what the state needs to meet its education and economic needs," says Sam Smith, the WSU president emeritus, who has been hired as a consultant to help the North Carolina process.

 

"They got me involved to see how they are using modern technology and online education to meet the needs of the state," explained Smith, who as WSU president from 1985 to 2000, launched WSU's three branch campuses and helped the launch of Western Governors University as an online accredited university. Still a member of WGU board of trustees, Smith guided the launch of WGU-Washington in early 2011.

 

Smith says he is currently advising colleges in a handful of states as part of his role with a Sacramento-based higher-education consulting organization called Collaborative Brain Trust, one of whose focuses is consulting for colleges and universities in dealing with the challenges of change they face.

 

"It's as simple as if institutions are doing a better job of meeting the needs of students, they'll get more students and more pay for what they are doing," Smith said.

 

Smith notes there's a challenge for colleges and universities facing increasing budget pressures and for businesses seeking the educated work force necessary to grow and compete and both challenges need to be addressed by those who would have higher education serve economic development needs of their states.

 

Those who help chart the changes higher education needs to make have to understand that "there's little incentive, from strictly a business point of view, for universities to increase the number of students and there's no reward for them to increase the percentage of graduates or to decrease the time it takes to get a degree," Smith said. "And there's little incentive for a university to see to attract middle-income students since those are the student least likely to be able to afford college."

 

And he pointed out that "many businesses don't feel there's a lack of educated people for them to hire because they are hiring students from other states. In essence those businesses think it's easier and less expensive to have a system where they hire those educated elsewhere.

 

"Higher education institutions who hope to become a more essential part of producing the state workforce of the future need to convince those businesses we're talking about that in-state schools can better tailor their programs to fit the changing and emerging needs of the state's economy," Smith added.

Smith lauded the University of Washington Medical School for the partnering arrangements it has developed.

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Smith suggests that the fastest-growing segment of "the new model" for public universities will be what is referred to as the 2-4, meaning four-year institutions partnering with community colleges, which already have built a reputation of working with businesses to determine their workforce needs.

 

"One of the first things I do when I go into state to examine how things are working is to look at the primary medical school to see if it is a silo or is working with others," he said. "If the medical school is a silo, it tells me that the university isn't involved with others and isn't interested in changing."

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(Next: Elson Floyd, president of Washington State University, brought with him when he arrived here in May of 2007 from Missouri a conviction that economic contribution should be a key measure of how well an institution of higher education is fulfilling its mission.

 

 

And James Gaudino, who became Central Washington University president in 2009, spent 15 years looking at higher education from the outside as executive director of National Communication Association. He says "It would be irresponsible for a public institution to ignore the higher-education need" of its state or region. They share their thoughts on the next Flynn's Harp.)

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