The University of Washington
MORE DOCTORS, DENTISTS
AND NURSES
FOR THE INLAND NORTHWEST
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The University of Washington, Washington State University and Eastern Washington
University - working cooperatively - request funding to:
Expand UW Medicine & Dentistry in Spokane for:
1.
20 first-year medical students to be educated on
Spokane’s Riverpoint Campus through the UW’s cooperative WWAMI (Washington,
Wyoming, Alaska, Montana, Idaho) program. They will spend their second year with
fellow medical students on the UW Seattle campus.
2.
Third-year and fourth-year medical internships
programs near Spokane through WWAMI.
3.
Eight first-year dental school students to be
educated on Spokane’s Riverpoint campus through the Regional Initiative in
Dental Education (RIDE).
In addition, Washington State University requests
funding to:
Expand WSU Nursing Education in Spokane for:
1.
15 nursing educators to receive instruction in Spokane
through a new PhD in Nursing Education offered through the Intercollegiate
Center for Nursing.
2.
30 new nursing undergraduate students
3.
20 new nursing master’s degree students
The role of each institution:
·
Medical students will be enrolled and graduate from the University of Washington
School of Medicine (UWSOM) through the WWAMI program.
·
Dental students will be enrolled and graduate from the University of Washington
School of Dentistry (UWSOD).
·
First-year medical students will be educated by faculty from Washington State
University.
·
New dental students would spend their first year in Spokane, at the Riverpoint
campus as Eastern Washington University students taught by both EWU faculty and
UWSOD faculty. WSU faculty will also contribute to the program.
·
Washington State University nursing students, who include some Spokane students
who are jointly enrolled at EWU and Whitworth College, will be taught by faculty
at Washington State University.
A. UW Medicine & Dentistry - Spokane
Expansion
AGENCY RECOMMENDATION SUMMARY:
Funding is requested to:
1.
Expand the University
of Washington’s School of Medicine (UWSOM) to include a first-year WWAMI site in
Spokane.
2.
Establish a new
Regional Initiative in Dental Education (RIDE) program through the University of
Washington’s School of Dentistry (UWSOD) with an initial site in Spokane. The
proposal is a joint effort between the University of Washington (UW), Washington
State University (WSU), and Eastern Washington University (EWU) to address the
growing need for physicians and dentists in Spokane and surrounding rural
counties. WSU-Pullman has hosted WWAMI students since 1972 and will expand to
the WSU-Spokane location. EWU’s accredited dental hygiene program at Riverpoint
in Spokane offers a natural site partnership for the RIDE students. Each year,
beginning in fall 2008, 20 medical and 8 dental students will take first-year
classes at the Spokane-Riverpoint campus. First year medical students will pay
tuition to WSU and first year dental students will pay tuition to EWU. After
the first year, medical students will join their UW classmates in Seattle for
second year classes and then will spend much of their third and fourth years in
clinical training sites in and near Spokane. Dental students will join
classmates in Seattle for most of the second and third-year classes and clinical
training sites will be established for extensive rotations for fourth-year
students. All medical and dental students will pay tuition to UW in the second
through fourth years of both programs.
PACKAGE DESCRIPTION:
WWAMI is the regional medical education network of the UW School of Medicine.
The program began in the 1970s in response to a critical shortage of physicians,
particularly those practicing in rural areas. Under the program, students
complete their first year of medical education at their respective state
institution, attend the UW for their second year, and then have the option of
spending much of their third and fourth years in rural community settings. There
are currently WWAMI sites in eastern Washington, Wyoming, Alaska, Montana, and
Idaho. The program has been very successful - more than 50 percent of WWAMI
graduates become primary care physicians and many practice in rural areas.
The idea of expanding
publicly supported medical education in Spokane and across Eastern Washington
has been discussed for many years. Beginning in 2003, a group of Spokane
community leaders representing business, higher education, health care,
biomedical research, and government began meeting to explore possible options.
The group decided to pursue the feasibility of expanding the UW's SOM WWAMI
program to include a new first-year site based in Spokane. The site would be
located on the Riverpoint campus and the program would be operated in
conjunction with UW, WSU, and EWU. The Riverpoint campus, a collaborative
effort between WSU and EWU, is an ideal location as it has a strong focus on
health-sciences training and information technology infrastructure.
In 2004, the UW School of Dentistry was
invited to join these discussions and was asked to consider the feasibility of
implementing a regional initiative in dental education (RIDE) program in
conjunction with the expansion of the WWAMI program. The dental component would
address a predicted shortage of dentists, especially in rural areas, resulting
from current demographic trends and an aging population. While a WWAMI-type
model of regional education is new for the UWSOD, the school has considerable
experience in providing community-based rotations for students, including a
long-standing program in Eastern Washington with the Yakima Valley Farm Workers
Clinics and the Yakima Indian Nation clinic. In addition, the UWSOD has used a
Robert Wood Johnson grant to support pilot rotations in the WWAMI states. A
formal RIDE program will build on these existing efforts and expertise.
Establishing a RIDE program would be dependent on the WWAMI expansion as it
achieves efficiencies by taking advantage of the academic and administrative
resources being developed to support medical education.
Under this proposal:
·
Beginning in
the fall 2008 (FY09), the class size of the University of Washington School of
Medicine (UWSOM) would increase by 20 medical students each year. The first year
of a student's medical education would be spent in WSU Spokane, at the
Riverpoint campus. In the second year, these students would join the
approximately 180 students currently attending the UWSOM in Seattle. Student's
third and fourth years would be spent at sites distributed across the five-state
WWAMI region. A particular emphasis would be placed on expanding community
clinical sites within Spokane and rural sites throughout eastern Washington. WSU
faculty will teach the first-year curriculum. There are currently 180 students
in a class at the UWSOM drawn from Washington (120 students), Wyoming (currently
12 students, expanding to 16 over the next three years), Alaska (currently 10
students), Montana (currently 20 students) and Idaho (currently 18 students).
·
Beginning in
the fall 2008 (FY09), the class size of the University of Washington School of
Dentistry (UWSOD) would increase by 8 students each year. Similar to the
expansion of the medical program, new dental students would spend their first
year in Spokane, at the Riverpoint campus as Eastern Washington University
students. Most of the second and third year would be spent in Seattle, with two
four-week community-based rotations in eastern Washington. The student's fourth
year would include a four to six-month period of extensive community-based
training in eastern Washington. Dental students will share basic science
curriculum with medical students and dentistry-specific courses will be taught
by EWU dental hygiene faculty members. The UWSOD is the only four-year
accredited dental school in the WWAMI region and there are currently 63 students
in a class.
·
Approximately 6
new WSU faculty members would be recruited to teach courses identified in the
curriculum review as requiring new resources (i.e. pathology, immunology,
biochemistry, structural biology). New faculty will also support research
efforts in areas such as infectious diseases, chromosome biology, computational
biology, addictions, and other areas of science. Recruitment costs will include
research support for three years, lab personnel, space, and equipment costs.
New WSU faculty will teach both WSU medical students and EWU dental students.
EWU will buyout a portion of WSU faculty time as needed for the RIDE program.
·
Additional
faculty effort will be required on the Seattle campus to facilitate small group
teaching, clinical clerkships, and support the college system within the School
of Medicine. The innovative college system is a fundamental component of
medical education at the UW. There are five colleges within the SOM, and
students are assigned to a mentor and small group within each college. Each
student interacts with their mentor over the four years of medical school, and
with their small group in hospital-based clinical tutorials.
·
Because a
regional model of dental education is new to the UWSOD, considerable investments
will be needed both UW and EWU as early as FY 2008 to develop course curriculum,
establish program infrastructure, create an evaluation process, and establish
clinical training sites. EWU’s dental hygiene program offers a unique site
partnership for the RIDE dental students offering an overall cost savings to the
state.
B. Expand WSU Nursing Education in Spokane
AGENCY RECOMMENDATION SUMMARY:
Funding is requested to:
1.
Expand the WSU
Intercollegiate College of Nursing to support the first cohort of doctorally-prepared
nurses
2.
Add 30 enrollments at
the undergraduate level
3.
Add 20 FTE master’s
degree enrollments
These new enrollments are needed to address the critical and growing shortage of
nurses and nursing educators. While the shortage of nurses is being felt across
the nation, it is particularly acute in the state of Washington.
PACKAGE DESCRIPTION:
Washington State University
Intercollegiate College of Nursing provides nursing education at three levels,
the basic baccalaureate degree, the baccalaureate degree for registered nurses
(RN-BSN) and the master’s degree (MN). A program of study leading to the PhD in
Nursing is planned for implementation in the summer of 2007 with the proposal
currently under review by the university and subsequently by the HEC Board. The
main facility for the college is located in Spokane and it serves four other
campuses or urban sites: Tri-Cities, Yakima, Vancouver and Walla Walla as well
as many other parts of the state through web-based programming. These other
sites connect through interactive internet-based technology (Academic Media
Services – AMS formerly known as WHETS) making the delivery of content cost
effective for large numbers of students geographically dispersed. Currently,
the College is recognized nationally as a model program for the use of cutting
edge educational technology to deliver synchronous and asynchronous educational
programs. This proposal would capitalize on this connectivity and maximize the
utilization of previous high demand funding, by expanding basic BSN enrollments
in Tri-Cites and Yakima, increasing MN enrollment in Spokane and by providing
funds to implement the proposed PhD in Nursing.
The need for more nurses is well
documented and the WSU Intercollegiate College of Nursing, as well as other
institutions of higher learning, has responded by increasing enrollments.
Recent data from the American Association of Colleges of Nursing (AACN, 2006)
indicate that enrollment in entry-level baccalaureate programs increased by 13.4
percent in the 2005-06 academic year. Yet, 37,459 qualified applicants were
denied admission, primarily due to a shortage of faculty, seat limitations and
other resources to accommodate more students. Additionally, the latest
projections from the U.S. Bureau of Labor Statistics published in the November
2005 Monthly Labor Review, revealed that more than 1.2 million new
and replacement nurses will be needed by 2014. According to a Special Survey
on Vacant Faculty Positions released by AACN in July 2005, a total of 817
faculty vacancies were identified at 409 nursing schools with baccalaureate
and/or graduate programs across the country. These data show a national nurse
faculty vacancy of 8.5% which translates into approximately 2 faculty vacancies
per school. Approximately 47% of the vacancies were for masters prepared nurse
faculty and 52.6% were faculty positions requiring a doctoral degree. Without
additional faculty, nursing programs in the state will not be able to meet the
demand for more baccalaureate prepared nurses, despite large numbers of
interested and qualified applicants. This proposed doctoral program is designed
to not only develop nurse researchers to advance the science of nursing, but
also to provide graduates with the expertise to fully assume the faculty role as
teachers.
Under This Proposal:
-
Fifteen (15) student FTE nurses will be
enrolled in the new Washington State University Intercollegiate College of
Nursing PhD program. Five (5) of these nurses will begin their program of
study in the summer of 2007, fiscal year 2008. Ten (10) additional students
will enroll in the summer of 2008, fiscal year 2009. All courses will be
offered in Spokane but through the use of Academic Media Services and its
distance education capabilities, students may be living in Vancouver or other
areas of the state.
-
Thirty (30) new nursing undergraduate
FTE students will be enrolled over the biennium. In the first year, fall of
2007, 10 additional students, 5 in Tri-Cities and 5 in Yakima, will be
enrolled. This will bring the basic baccalaureate enrollment in those
communities to capacity given the required faculty and space resources. In
the fall of 2008, fiscal year 2009, 20 new students will be enrolled in
Spokane given the increased physical capacity that will occur with the opening
of the new college of nursing building on the Spokane WSU Riverpoint campus.
-
Twenty (20) new FTE master’s degree
students will also be enrolled in Spokane over the biennium. Ten (10) new
students will enroll in the fall of 2007 and an additional 10 master’s
students will enroll in the fall of 2008, fiscal year 2009.
Responsiveness to Economic Needs
A recent study projected the gap between
the supply and demand for registered nurses in the United States to be 808,416
by 2020 (National Center for Health Workforce Analysis, 2002). Another source,
the U.S. Bureau of Labor Statistics projects that, by 2010, the nation may have
a deficit of more than one million nurses (American Association of Colleges of
Nursing, 2002). According to the U.S. Department of Health and Human Services,
the nursing shortage will grow from 30 states in 2000 to 44 sates by 2020, in
part because more nurses are retiring than entering the field (National Center
for Health Workforce Analysis, 2002). The average age of a working registered
nurse today is 43.3, and that average age is increasing at a rate more than
twice that of all other workforces in this country – by 2010, the average age of
the working registered nurse will be 50 (Buerhaus, Staiger & Auerbach, 2000).
By 2011, the number of nurses leaving the profession due to retirement will
exceed the number of individuals entering (National Center for Health Workforce
Analysis, 2002).
The nursing shortage is even more
prevalent in Washington State which has an estimated shortage that will increase
more drastically than the national shortage to reach 23% in the year 2010 and
43% in the year 2020 (National Center for Health Workforce Analysis, 2002).
According to the University of Washington’s Center for Health Workforce Studies’
investigation of how acute care hospitals in Washington are being affected by
the nurse shortage, an estimated 1,987 registered nurses are needed to fill the
1,401 vacant full time positions. The study also demonstrated that urban
hospitals find it easier to recruit newly educated registered nurses than do
rural hospitals, and that the primary reason for nurse vacancies was a lack of
qualified applicants (Skilman, Hurson, Adrilla, Berkowitz & Hart, 2002).
The WSU Intercollegiate College of
Nursing has offered its basic baccalaureate program in Spokane and Yakima for
quite a number of years. In response to a request from the Community Health
Alliance in TriCities and with funding provided by the Higher Education
Coordinating Board, a basic baccalaureate program was established in TriCities
in fall 2004. The demand for this program in all three communities has
continued to increase. Over the last three years, the number of qualified
applicants has far exceeded the capacity of the program (only half of the
applicants were accepted fall 2004, 2005 and 2006) indicating that continued
expansion of the program would be prudent and justifiable. Currently, due to
space limitations, no additional basic students can be admitted in Spokane until
the completion of the new college of nursing building on the Spokane Riverpoint
campus, scheduled for the summer of 2008. With funding, however, additional
students can be admitted in Yakima and Tri-Cities.
The shortage of nurses is mirrored by a
corresponding shortage of qualified nursing faculty. Indeed, nurse educators
are aging as well, with an average age of doctorally prepared faculty being 57.9
for professors, 55.4 for associate professors and 51.5 for assistant professors
(American Association of Colleges of Nursing, 2006). For master’s
degree-prepared nurse faculty, the average ages for professors, associate
professors, and assistant professors is 57.8, 54.5, and 50.0 years,
respectively. According to the 2005-2006 report on Enrollment and Graduations
in Baccalaureate and Graduate Programs in Nursing conducted by the AACN,
insufficient number of faculty was listed as the primary reason for not
accepting all qualified students into baccalaureate programs. In order for
baccalaureate programs to expand enrollment in basic programs and attempt to
meet the need for professional nurses, the availability of nursing faculty must
be assured. The WSU Intercollegiate College of Nursing has available enrollment
slots but insufficient funding to admit more students to its master’s program.
Relative to doctoral education in nursing, the only program in Washington State
offering a PhD in Nursing, the University of Washington, has limited enrollment
and cannot meet the demand. The faculty and administration of that institution,
therefore, have been very encouraging and assistive in developing the proposal
for the WSU nursing doctoral program.
Three surveys were conducted in the
summer 2003, to determine national and regional demand for the proposed doctoral
program. The major findings indicated that current doctoral programs have more
applicants than they can admit, 64% of schools have a need for doctorally
prepared faculty, 95% of deans would encourage their faculty to enroll and 70%
of current students and alumni expressed an interest in doctoral study. Of the
34 respondents who expressed an interest in doctoral study, 92% were interested
in our proposed program and 82% would be ready to start classes between 2006 and
2008. Additionally, AACN data from fall 2005 found that 3,160 qualified
applicants were turned away from master’s programs, and 202 qualified applicants
were turned away from doctoral programs. Again the primary reason for not
accepting all qualified students was a shortage of faculty.
All of these enrollments will help to
make a positive impact on the nursing shortage in Washington State. The
practicing nurse population and, even more significantly, the faculty shortage
will be directly addressed.
NARRATIVE JUSTIFICATION AND IMPACT STATEMENT:
How this package contributes to the strategic plan:
Statewide Results
Improves the value of postsecondary learning
Improves the health of Washington citizens
Improves the economic vitality of businesses and individuals
Reason for change:
In 2003, a group of
Spokane community leaders representing business, higher education, health care,
biomedical research, and government assembled to consider options for expanding
publicly supported medical education in Spokane. Three goals have been
identified:
1.
To increase the number
of physicians trained in the Spokane area, thereby increasing the supply of
physicians in the state, with particular emphasis on Spokane and Eastern
Washington.
2.
To respond to the
need to train physicians for underserved rural areas in Washington.
3.
To increase local
support for biomedical research and to increase economic development within the
Inland Northwest.
Additionally, there is a well-documented need for both nurse practitioners and
nurse educators, who will teach the nurses of the future.
Impact on clients and services:
A regional model of
dental and medical education will produce additional dentists and physicians to
serve clients in rural and underserved areas in Eastern Washington.
Biomedical research
will be enhanced through collaborations between UW, EWU, and WSU and new faculty
recruitment.
Expanding the
undergraduate, graduate and PhD nursing programs will produce more nurses and
nurse educators. The additional nurse educators will further expand the state’s
ability to educate well-prepared nurses for the future needs of the state.
Impact on other state programs:
None.
Relationship to capital budget:
A
total of $9.9 million in capital costs are associated with the WWAMI/RIDE
portion of this proposal. Of this amount, $9.1 million in capital costs have
been identified at the University of Washington-Seattle campus and $800,000 in
capital costs have been identified at the Riverpoint campus in Spokane.
Specific facility
renovations at the UW-Seattle campus include: 1) increase the current capacity
of Room T-439 to accommodate 236 students (up from a current capacity of 185);
2) expansion of the Gross Anatomy teaching space; 3) expansion and renovation of
the student study and lounge space; 4) reconfigure teaching space on the 5th
floor of the Health Sciences Building; 5) expansion of the dental simulation lab
to accommodate additional students; and 6) remodel a large lecture hall to
accommodate distance learning technology.
Specific facility
renovations at the Riverpoint campus include modifications of existing teaching,
administrative, and research facilities. The most significant modifications will
be to the existing anatomy teaching facilities to allow the initiation of a
Willed Body program and the associated processing areas.
A separate capital
request was not submitted for this proposal. Each institution has identified
appropriate funding for any needed renovation or expansion.
There are no capital
costs associated with the nursing portion of this proposal.
Required changes to existing RCW, WAC, contract or plan:
None.
Alternatives explored by agency:
The Spokane committee
explored the option of establishing a new medical school, but the costs are
significant. For example, Florida State University in Tallahassee spent about
$155 million when it developed a four-year medical school in 2000.
Budget impacts in future biennia:
The expansion of the
WWAMI/RIDE programs will be phased-in over three biennia and the full cost of
operating the programs will not be realized until FY11. At that time, it is
anticipated that the program will cost $6.2 million each year. Refer to the
attached spreadsheet "07-09_WWAMI-RIDE.xls" for specific estimates by fiscal
year.
The expansion of the
PhD nursing program will also be phased in over several biennia and the full
cost of operating the program will not be realized in the current biennium.
Refer to the attached spreadsheet “Health Sciences Expansion – Nursing” for
specific estimates by fiscal year.
Distinction between one-time and on-going costs:
There are a number of
one-time or time-limited costs associated with this proposal. These costs are
detailed in the attached spreadsheet"07-09_WWAMI-RIDE.xls" and in the attached
spreadsheet “Health Sciences Expansion – Nursing”.
Effects of non-funding:
Physician shortages,
particularly in primary care and certain specialties, are projected at the state
and national level. Four factors can be attributed to the shortages projected in
Washington State:
1.
Aging population with
an increased need for health care.
2.
Large number of
physicians projected to retire in the future.
3.
Changing practice
patterns among younger physicians.
4.
A growing state
population.
Dental workforce
surveys in Washington show that about half of Washington dentists plan to retire
by 2013. Many of these dentists are in rural and underserved urban areas. In
addition, most Eastern Washington counties have federally designated dentist
shortages.
The nursing shortage
in Washington is estimated to increase to 23% in 2010 and 43% in 2020 (National
Center for Health Workforce Analysis, 2002). Rural hospitals find it more
difficult to recruit newly educated registered nurses than do rural hospitals (Skilman,
Hurson, Adrilla, Berkowitz & Hart, 2002).
Without additional
capacity in Washington's medical, dental and nursing education programs, these
shortages will not be addressed.
Expenditure
calculations and assumptions:
General Assumptions:
1.
The dental component
of the proposal is dependent on funding for the medical component. The WWAMI
expansion can be implemented without the dental component, but the dental
component cannot be implemented separate from the WWAMI expansion.
2.
Costs for the WWAMI/RIDE
programs are based on the feasibility study. FY 2006 costs are inflated by 3%
per year to bring those costs up to FY08 and FY09 levels.
3.
The first cohort of
students for the WWAMI/RIDE programs will be enrolled in the fall 2008 (FY09).
WSU, EWU, and UW will begin to incur costs one-year before students show up on
campus.
4.
Net operating fee
revenues will partially offset the costs associated with the expansion. Tuition
revenue will be retained by EWU and WSU for first-year dental and medical
students. The UW will retain tuition revenue for students in their second
through fourth years. A yearly operating fee increase of 4 percent is assumed.
Refer to the
attached spreadsheet for more detailed calculations and assumptions.
FISCAL DETAILS FOR ENTIRE REQUEST:
