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The East-West Divide 

Understanding the dynamics behind the debate over a new medical school for Spokane

Herold's First Heretical Law: The quality of any research university, medical or otherwise, will always vary inversely to the attention that university and its faculty direct towards local job-training needs.

Spokane leaders have for decades urged a "research university for Spokane." This was the justification they gave for their midnight raid back in 1998 to have WSU take over EWU. What became clear in the top-level meetings ordered up to resolve the issue? Forget research: Our business community really wanted high-end job training paid for by the state, which in serious academic circles invites loud snickering.

The quality of medical training will positively correlate to the proximity of the medical school to a Level I Trauma Center.

Medical students prefer going to school in Seattle because the UW is in Seattle and so is Harborview Medical Center, the only Level I Trauma Center in the region. When looking ahead to internships and residencies, students know that in such an environment they will get a better education — they will see more, they will learn more if they train at the UW, with access to nearby Harborview.

The UW surgeon who repaired our son's wrist, a surgery he rated a 12 on a difficulty scale of 10, put it this way: "What I do isn't rocket science. I can do it because I get lots of 'seat time.' I do about eight of these operations a year."

That's the UW. That's Harborview. The Spokane surgeons we consulted had no experience with this kind of wrist trauma, nor knowledge of the technique and procedure the UW surgeon employed. And even if they had, we can expect that in Spokane, they wouldn't see eight a year.

The training and education the medical student gets will vary directly with the size, economic base and civic culture ambient to the medical school.

Years back, Travis Rivers, the longtime music critic for the Spokesman-Review, told me that a case could be made that the second-best orchestra in New York City was the Doctors Orchestra, if you get my drift. There's a certain cultural tipping point that attracts doctors.

The location of the medical school is not a reliable predictor of where the newly trained doctor will actually practice.

The claim is made that we need more doctors for rural America. OK, but what makes anyone think that a freshly minted doctor out of WSU-Spokane Medical School will want to practice medicine in rural Eastern Washington? It isn't necessarily where students are trained that determines where they practice. Oh yes, and given those student loans? In the old days they could go out to places like Omak, practice for five or six years in public health stints and work off their loans. A "win-win," as the biz people would say — and likely a more effective strategy to get health care to the places that need it most.

Washington State University has historically viewed dollars spent in Spokane to translate into fewer dollars for Pullman.

A couple of years back, before WSU President Elson Floyd, who now affirms his deep concerns for Spokane, picked a fight with the UW, he supported a decision to move some WSU-Spokane programs — decidedly urban programs — back to Pullman. Some commitment.

The University of Washington administration and its political supporters, truth be told, have typically viewed Spokane interests and concerns to be little more than annoyances that occasionally must be addressed, if only in the form of a placebo — whatever it takes to get them to go away.

About the observation made by one critic that the UW has always had in mind not a medical school here but a "distance-learning" site from Seattle: Well, he's right — point well-taken.

The University of Washington cannot be compared to Washington State University or vice versa.

To my haute-cuisine friends in Seattle (hey, our son is a dyed-in-the-purple Husky), might I point out something perhaps lost on you: Had we relied only on the UW, our state wouldn't have the fourth-highest-rated veterinary school in America, nor its great wine industry, nor would we be producing the wheat per acre that we are.

On the other hand, to hunkered-down Cougars who see aggrandizement around every tree? Relax. UW isn't trying to get into the vet school business, has no interest in wine (well, production of; they probably consume more per capita than do WSU fans) and hasn't a clue about wheat. But they do know about medical schools, they understand research and they have experience running resident training programs. And I'm quite certain they understand the difference between medical school viewed narrowly as training, and medical school viewed more broadly as a reflection of everything urban.

Moreover, since apparently we need more doctors to practice "family medicine" — well, guess which school ranks No. 1 in the entire U.S. of A.? Yep: the University of Washington. ♦


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