Bill that would end UI's ties to WWAMI advances

BOISE — Idaho is considering withdrawing from a 50-year partnership with the University of Washington and three other Western states for medical education, and moving to a new partner in Utah.

The House Education Committee on Friday sent House Bill 176 to the floor in a 9-5 vote, after two failed attempts to hold off on the decision.

Rep. Dustin Manwaring, R-Pocatello, presented the bill, which in two years would begin withdrawing the state from the WWAMI program, which stands for Washington, Wyoming, Alaska, Montana and Idaho. The bill is also backed by House Speaker Mike Moyle, R-Star.

The bill’s statement of purpose cites UW’s inaction so far on a 2022 request to expand seats for Idaho students and a lack of a signed agreement to prohibit state funds from going toward abortion training as reasons for severing the relationship.

UW President Ana Mari Cauce signed the amended contract restricting abortion training for Idaho students on Friday, a UW spokesperson told the Idaho Press.

The WWAMI program allows Idaho students to complete their first two years of medical school at the University of Idaho, then those students get the opportunity to complete clinical training in Idaho or elsewhere, which is coordinated through the UW School of Medicine.

The bill would require a new partnership with at least two medical schools in Idaho or the Mountain Time Zone, but Manwaring on Friday highlighted the University of Utah’s program as the designated new partner. A second proposed medical school partner was not mentioned during the hearing, but the only other available option would be the private Idaho College of Osteopathic Medicine (ICOM). Brigham Young University in July announced it planned to create a medical school in Provo, Utah, which would also be eligible once established.

“I started when I introduced this legislation by talking to you about how Idaho does not have its own state-run medical school,” Manwaring told committee members Friday. “I truly believe this is a part of that conversation and a big way that we can move that conversation forward. But it will not be the only way that we can accomplish the needs in our state.”

Manwaring said that, currently, about 32% of the state funds that go toward the program end up at UI and around 68% goes to UW. Under the proposed new agreement with Utah, that ratio would essentially swap, with more than 65% of the funds staying in Idaho and around 34% going out of state.

UI and the University of Utah have already signed a memorandum of understanding regarding the program. There is also an existing partnership with the state that reserves 10 seats for Idaho students in University of Utah’s medical program, however, those students never train at UI.

Dr. Benjamin Chan, assistant dean of admissions for the University of Utah School of Medicine, indicated that the Utah Legislature was preparing to introduce legislation to expand class sizes to create space for this partnership.

There are currently 40 seats in UW’s medical school reserved for Idaho students, although the Idaho Legislature in 2022 passed a resolution asking the State Board of Education to seek five more seats for the WWAMI program by fiscal year 2025 — but it hasn’t happened yet, Manwaring said. The state is currently in fiscal year 2025, and the resolution also called for an additional five seats by fiscal year 2027.

Physicians weigh in

Suzanne Allen, a Boise physician and vice dean for academic, rural and regional affairs at the UW School of Medicine, said that the university has been working on it, but has been struggling to find enough clinical placements in Idaho for the students currently enrolled, let alone more.

“We’re working diligently to create more high-quality clinical training opportunities for our students, and when those are available, we’re very committed to expanding,” Allen told committee members.

She said students in the program can elect to do clinical rotations in the other partner states if there aren’t enough in-state, but the goal is to keep Idaho students in the Gem State.

Several physicians and some current or recent WWAMI graduates spoke against the bill Friday, and a few supported the bill.

A couple of doctors who practice in Idaho said they had been out-of-state students who did placements in Idaho through the WWAMI program and opted to stay.

Dr. Crystal Pyrak, a family physician in Coeur d’Alene and president of the Idaho Academy of Family Physicians, said she was a Montana native who did training in Idaho Falls and Emmett through WWAMI.

“I made wonderful connections, and through that opportunity, I fell in love with Idaho, and chose to practice here after medical school, despite being a Montana resident,” Pyrak said. “I was effectively recruited here to Idaho through the WWAMI program.”

She said the longstanding program is “complex,” and argued the many clinical sites throughout the state could not easily be transferred to another program. Several testifiers echoed concerns that it would be difficult to recreate the clinical positions for students, as those have taken years to establish through WWAMI.

Dr. Andrea Christopher, an internal medicine specialist in Boise and UW associate program director, also said she was concerned about disrupting the capacity for training in the state.

“At this time, I’ve struggled to be able to expand our internal medicine training capacity, which was one of the core training requirements in medical education, beyond 30 to 35 seats in a year,” Christopher said. “And I’ve been in this world for at least eight years, still working to build those relationships.”

Some graduates of the WWAMI program spoke to the quality of the training, but said they didn’t oppose moving away from it as long as another strong partnership was created.

Dr. Barbara Tesnohlidek, a Boise area anesthesiologist, said she valued her education through UW, but recognizes that “Idaho and Washington have diverged in terms of values and priorities."

“As Idaho looks for a way forward, I strongly recommend Idaho partner with another well-established medical school at the University of Utah,” Tesnohlidek said.

Third-year WWAMI student Alexis Ericsson testified in opposition, and argued UW’s program better suits the state.

She highlighted that Chan, of Utah, had said that one-third of the school’s graduates go into primary care residencies every year, and that WWAMI students go into primary care in Idaho 70% of the time. She also said that WWAMI’s rural placements were longer, whereas many of Utah’s students do much of their training in the greater Salt Lake City area.

Joseph Holmstead, a recent WWAMI graduate currently completing a residency in Caldwell, also spoke in opposition to the change.

“I had the opportunity to attend the U of U, and I declined, because WWAMI makes damn good doctors,” Holmstead said, prompting claps from the room full of mostly doctors and students who came to testify. “I wanted to stay in Idaho, because WWAMI is the best primary care medical training in the United States, full stop.”

He said that while applying to residency programs, program directors told him that WWAMI applicants get put to the “top of the pile.”

Committee members' perspectives

Manwaring in his closing said that the clinical positions could be established quickly, as demonstrated by ICOM, which drew audible groans from the audience.

He argued that the WWAMI program is producing “quality but not capacity,” and the state needed to work to get more doctors in the state more quickly.

Rep. Barbara Ehardt, R-Idaho Falls, made a motion to send the bill to the floor with a recommendation that it pass. She said the move didn’t indicate a lack of appreciation for the program in the past, but that “our needs have changed.”

Rep. Dan Garner, R-Clifton, said he wanted to hold off on the decision, and was concerned about the idea of banking on a program that would grow from 10 seats to 40 in four years.

“I don’t think they can build capacity fast enough as this bill is asking for,” Garner said.

He was also concerned about the university building that capacity through increasing class sizes, which he worried would decrease the quality of education. He made a motion to hold the bill in the committee, which would stop it from moving forward unless members voted to bring it back for a decision.

Rep. Monica Church, D-Boise, said the bill put the cart before the horse, as the Utah Legislature has not acted yet on providing funding to increase class sizes to accommodate the change. Her concerns were echoed by other members, including Rep. Jack Nelsen, R-Jerome.

“Confidence is not a contract,” Church said.

Rep. Mark Sauter, R-Sandpoint, said he didn’t feel the bill was “ready for prime time.”

“I’m not comfortable having us walk away from a long 50-year relationship with WWAMI at all,” Sauter said.

Rep. Dale Hawkins, R-Fernwood, said he felt like there was “football team loyalty,” to one program or the other, which drew snorts and groans from the audience. He supported moving the bill forward.

Rep. Lance Clow, R-Twin Falls, made an amended substitute motion — the third and final allowable motion — to hold the bill until Feb. 19, to give members more time to weigh the decision.

Clow’s motion died in a 7-7 tie vote. Members then moved on to the motion to hold the bill in committee indefinitely, which died in a 5-9 vote.

The motion to send the bill to the House floor passed in a 9-5 vote. The full House will now have it under consideration.

Guido covers Idaho politics for the Lewiston Tribune, Moscow-Pullman Daily News and Idaho Press of Nampa. She may be contacted at lguido@idahopress.com and can be found on Twitter @EyeOnBoiseGuido.