Washington State University’s proposal for a medical school deserves a better title. Under the circumstances, “The Cougar Who Kicked The Hornet’s Nest” would be pretty accurate. The University of Washington, 285 miles and a mountain range away, already has a medical school, of course, and really doesn’t like WSU’s idea; not at all; not one bit.
As the public relations effort morphs into a propaganda war economic reality is likely to fade into the smoke and fog.
That doesn’t mean that economics-related numbers won’t be thrown around like hope-infused fourth-quarter passes in an Apple Cup. We’ve already seen some pretty magical numbers floated out there and there are surely more to come. Perhaps the best role that economics can play at this stage of the battle is to provide a useful perspective on the issue.
The initial step that an economics perspective requires is determining whether the project is aimed at addressing demand or supply. WSU’s medical school proposal is clearly targeted at the supply side of the equation, planning to add a significant number of doctors to fill the demand generated by rising population and projected retirements of physicians in our state.
The next economics issue is how good its aim is. The actual supply of doctors in our state is the result of several factors that we know, and perhaps others that we don’t know.
What we do know fairly well are the demographics of the physician population — especially age and location. These factors affect the supply of doctors in very direct ways. If the existing population of doctors is, on average, aging faster than its replenishment rate — new doctors entering practice — sooner or later the supply of doctors will shrink, creating a shortage. While individual, personal decisions are involved regarding retirement age, which introduces some uncertainty about timing, the supply shortfall, or “gap,” can still be forecast with some considerable accuracy.
The location factor is both simple and complicated. Most doctors in our state practice in populated King, Pierce, and Snohomish counties, which together contain the Seattle-Everett-Tacoma people-opolis.
It would be easy, if somewhat cynical, for us if we attributed the concentration of doctors to a single cause, identical to notorious bank robber Willie Sutton’s explanation for his activities: “That’s where the money is.” But it is considerably more complicated than that.
Doctors want to practice the medicine they have been taught, and medical schools, quite rightly, teach them the latest knowledge and the latest technology that delivers the best results in patient care. Newly anointed doctors, fresh out of medical school and residencies, will find that in larger metropolitan areas, which have hospitals and large practices.
Money is a factor, no doubt. One reason is the debt that medical school graduates carry with them. The Association of American Medical Colleges (AAMC) estimates that, nationally, the average debt of a student graduating from a state medical school is about $163,000 from medical school itself and approximately $29,000 in pre-med student loans and other debt.
Independently, Forbes magazine estimated the debt load carry for medical school graduates from the UW Medical School at about $30,000 less than the national average — reflecting state subsidies — but it is still weighs on new doctors’ career decisions.
There are also personal, semi-monetary issues involved. The more densely populated areas offer doctors opportunities for specialization, which brings not only higher incomes but also, usually, a more ordered, predictable life. The life of a general practitioner in a rural setting is very demanding from a responsibility standpoint, and one way or another they are always on call. Generally, the average emergency room doctor in a frantic city hospital keeps more regular hours than a rural family doctor. This, too, is a factor in some doctors’ career choices and when the complications of administrative paper work and insurance claims are added in to smaller practices and rural medicine, it takes considerably more dedication to select non-urban careers.
The WSU medical school proposal still has some work ahead of it to address fully the family practice/rural practice supply picture. Otherwise, there is a real risk that its output of graduates would end up with the same economic and other factors that are now driving new doctors into medical specialties and other areas of urban practice.
From a market analysis standpoint, the national forecasts indicate that there is no need to view a new medical school proposal as an either-or proposition or even a competition. There is room for both schools if state taxpayers are willing to fund them. The UW does not possess a natural monopoly in this area, but of course its experience in training physicians would make a natural partnership with a WSU school focused on the underserved markets.
James McCusker is a Bothell economist, educator and consultant. He also writes a column for The Herald Business Journal.
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