OLYMPIA – For most of the past decade, lawmakers have looked to expand health care in Washington, particularly outside the urban Puget Sound in under-served small towns and rural communities.
That need, along with a tireless push from Elson Floyd, the late Washington State University president, helped create a new medical school at WSU Spokane that gives a preference to students with ties to the state or plans to practice in it after they graduate.
When the school, which was named posthumously for Floyd, began accepting students in 2017, it had a clear plan to ramp a four-year program starting from scratch. It would accept 60 beginning students in each of the first two years, increasing the count to 80 new students in the classes entering in 2019 and 2020.
Finding students to fill those extra slots won’t be a problem. The school received about 1,500 applications for the incoming class and has narrowed the list of students it is interested in to 344, said Leila Harrison, associate dean of admissions, recruitment and inclusion.
Finding the money for them might be.
The school is being warned by legislative budget writers it might not get the money for those 20 extra students in each of the next two years. Enrollment might be capped at 60 new students per year until 2021.
The push for larger class sizes is complicated by the way the Legislature budgeted for those first two classes. Even though medical school is a four-year program, lawmakers didn’t set aside money for their third and fourth years in its projections for the 2019-21 budget. That means WSU and other supporters of the new medical school must lobby the Legislature to get about $10.8 million for those students to complete their education.
As far as the budget is concerned, that $10.8 million for the third and fourth years is new money for a new program, not the ongoing expense of an existing program. Because of the way the budget is constructed, the money for the students in their first and second years is considered an “ongoing expense” for the 2019-21 budget and is not in doubt.
The cost of adding 20 more students to incoming classes this year and next would be another $3.6 million.
To budget writers, those are two separate requests for new money at a time when Democrats are saying the state doesn’t have enough to cover existing programs.
“Priority No. 1 is to appropriate the $10.8 million to maintain the current 60 students” in their third and fourth years, said Senate Majority Leader Andy Billig, a Democrat whose Spokane district is the home of the WSU medical school as well as the nearby medical consortium between the University of Washington and Gonzaga University. Coming up with the money to increase the size of the incoming classes is a secondary priority, he said.
“The medical school is a priority for our region, for economic development and health care,” Billig said. But the list of requests for new money is long, and the projected revenue right now doesn’t cover all of the existing programs after inflation, higher case loads and salary increases are factored in.
“We’re trying to balance all of the priorities in Spokane and throughout Washington state that are provided by state government,” he said.
House Appropriations Committee Chairman Timm Ormsby, a Democrat from the same central Spokane district as Billig, agreed extra students for the incoming classes at the WSU medical school might have to wait. Legislative budgets won’t be released until after the next tax revenue forecast on March 20, but even with another boost in expected tax collections budget writers still will struggle to balance the demand for new and existing programs that outstrip the money available, he said.
Ormsby acknowledged the plan for the WSU medical school was to begin enrolling 80 students per year by 2019.
“Plans change,” he said.
Senate Minority Leader Mark Schoesler, R-Ritzville, doesn’t believe that finding the money for the extra 20 students in 2019 and 2020 should be a problem, regardless of how the budget projections for the school were developed.
“They’re doing exactly what they said they would do,” Schoesler said of the medical school administration’s plans to increase its student count. “Eighty is the original break-even, cost-effective level.”
Plus, the state is projecting an increase of more than $4 billion in revenue for the 2019-21 budget period, he said. “When you have this much new revenue, why are we quibbling over something this small.”
Chris Mulick, a spokesman for WSU, said Schoesler is correct that university projections for the economics of the Elson S. Floyd College of Medicine work best at 80 students in each of the four classes. “Without that, the university is still subsidizing the program,” he said.
That doesn’t mean, however, that taxpayers are subsidizing the program, Mulick said, because only about one-fourth of the university’s $1 billion budget comes from the state. But finding private support for those new slots isn’t a good option because they become an ongoing expense.
“We didn’t come to the Legislature with the idea that it was going to be self-funding,” he said.
The Legislature gave WSU the authority to start its own medical school in 2015 after a cooperative agreement between it and the University of Washington to train medical students in Spokane broke down. UW has since formed a partnership with Gonzaga University, and it, too, eventually plans to enroll 80 state-supported students a year in its Spokane program.
But UW is willing to wait two years to increase its enrollment from 60 students because it is running out of space at its current quarters, said Ian Goodhew, government relations director for the School of Medicine. Several possible sites for a new building are being considered, and an announcement could come as early as next month.
Although the older program isn’t objecting to money to increase medical school enrollment at WSU, the delay means there is no push for parallel funding for more students from UW and its allies.
Democratic Rep. Marcus Riccelli, the third legislator from the central Spokane district, said he’s pushing for the extra students at WSU Spokane and hopes to find support among lawmakers concerned about the need to improve health care around the state. He hopes a new crop of House members will back the increase, noting the authority for the WSU medical school was not popular with Democratic leadership when it passed in 2015. House Speaker Frank Chopp and Health Care Committee Chairwoman Eileen Cody, who voted against giving WSU that authority, remain in those powerful positions.
To get money for the extra students, WSU can’t rely only on lobbying from Spokane sources that always have been strong supporters of the new medical school, Riccelli said. Other communities around the state, where those students will be spending their third and fourth years doing hands-on training in local clinics and medical offices, also will have to push for the added money, he said.
Mulick said support is “absolutely” coming from other communities. The first cohort of 60 third-year students is being split evenly among Everett, Vancouver, the Tri-Cities and Spokane, where WSU has its outlying campuses. Business groups in the other communities are joining Greater Spokane Incorporated in lobbying for the extra 20 students to be added this year.
Meanwhile, the medical school continues with its plans to enroll a larger class this August, although the final slots aren’t likely to be filled until then, Associate Dean Harrison said. “We’re moving toward accepting 80,” she said.
Even though the funding remains in doubt, Billig said that’s a good strategy because it’s possible to make adjustments if necessary between the time the budget is approved – tentatively late April, unless the Legislature goes into a special session – and the start of classes in August.
“It’s prudent for them to be ready for the plan they want to implement,” he said.
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