Despite sizable hurdles that seemingly could thwart—or at least delay—plans for a proposed four-year medical school here, unflinching backers of the school remain convinced it could be up and producing graduates as soon as 2018.

"That's if everything goes along in an optimum way," says Rich Hadley, president and CEO of Greater Spokane Incorporated, which contracted with a Pittsburgh firm to prepare a business plan for the school.

Hadley has predicted, though, that 25 years from now, the school will have graduated roughly 1,500 physicians and will be the catalyst for creating 9,000 new jobs and an annual economic impact of more than $1.6 billion for the Inland Northwest.

He takes his forecast figures from an economic impact study on the proposed school completed last year by Tripp Umbach, a firm that has done many such analyses nationally and has carried out other impact studies here. GSI contracted with Tripp Umbach for that study, and the same firm also is preparing the $100,000 medical school business plan.

A draft version of that plan was expected to be presented this week to a medical school steering committee headed by Scott Morris, chairman, president, and CEO of Avista Corp., and Washington State University President Elson S. Floyd, Hadley says. He has said that the business plan will focus on how to get to the outcomes projected in the economic impact study.

Another study likely to be released soon and that has been prepared by Chicago-based Huron Consulting Group will focus on how to provide residency programs needed for the school.

A graduate medical education committee on which Hadley sits contracted for that study, and Hadley says Huron has completed a draft report, but that it hasn't been released because it requires further editing. He says that report "will in some respects fold into the business plan."

The chairman of that committee, Dr. John McCarthy, University of Washington School of Medicine assistant dean for regional affairs of WWAMI Clinical Medical Education-Eastern and Central Washington, says the study will delve into some complex challenges.

One of the biggest challenges, aside from residency program logistics, is securing the funding to pay for the graduate medical education (GME) positions, which are hugely expensive.

"In the last three months, we've had attrition of residency slots, rather than the addition of residency slots," McCarthy says. "In the current (economic) climate, it's absolutely difficult to build new GME slots."

WWAMI stands for Washington, Wyoming, Alaska, Montana, and Idaho, the five states that send students to their first year of medical school at five sites around the region. In their second year, the students attend the UW medical school in Seattle, then receive clinical education in their third and fourth years at locations across the five states.

Eastern Washington has just 100 medical residency positions now, including 81 in Spokane, while Washington's West Side has 1,550, but the political and funding momentum to add more here hasn't reached a level that is likely to push the medical school plan ahead quickly, McCarthy says.

Medicare funds a lot of the cost of graduate medical education, and hospitals—where residents often spend lots of time—also bear a sizable part of the expense. McCarthy notes that both of those funding sources currently are under a lot of financial pressure.

For that reason, he's less optimistic than Hadley about how soon a four-year medical school will materialize here. He agrees that it's possible by the end of the decade, but says it quite possibly might be phased in more gradually than what backers of the school here would like to see.

"I think there are creative ways to slay this dragon," he says.

A portion of GSI's website devoted to medical education here says the goal is to accommodate 100 to 120 medical students for all four years of medical school in Spokane by 2013.

That goal already appears unattainable, though, given a recent setback for the proposed construction of a $70.8 million building on the Riverpoint Campus that's needed for the school and what McCarthy says is a necessary, but yet-to-be-launched UW curriculum review that will take two years to complete.

The Washington state Office of Financial Management said last month that the proposed Riverpoint Campus building isn't on a list of proposed higher education projects for the 2011-2013 budget. The building exceeds the most expensive higher-education project on the list—EWU's Patterson Hall—by more than $30 million.

The planned site for the 110,000-square-foot Biomedical and Health Sciences Building is on the north side of Spokane Falls Boulevard, just east of the Intercollegiate College of Nursing Building, which was completed in 2008.

The OFM said only projects that are "shovel-ready" made the funding list for this biennium. The list of higher-education funding requests sent to the Legislature includes 13 projects, for a total of $140 million, which would be paid for through bond sales.

Hadley remains hopeful, though, that the Legislature will find a way to fund the building, which would allow construction to begin in July and to be completed 2013.

"The earliest you could admit students (who would take all four years of medical school here) probably would be the fall of 2014," he says. The strategy then, he says, would be to go to seek legislative approval of an increase in class size—to 80 students here from the current 20—in the 2013-2015 biennium budget.

"It all comes down to the operating budget and the capital budget in this economy. Our goal is to get this building, and our goal is to keep the momentum going," Hadley says. "If they did nothing in this session, we would go back next year and advocate at that point. We would not just wait two years."

He reiterates, though, that, "Our goal is to have some forward action in this session."

Acknowledging that the building project is but one of a number of big hurdles, he says, "This is the critical step right now. Once this is accomplished, there will be another critical step right after that—until such time as we have students in the building."

McCarthy says just getting approval to offer medical students second-year instruction here, essentially creating a UW medical school branch campus, will be a significant step, even if it takes a while to build medical student numbers up to desired levels.

"At some point," he says, "we'll get over the crest and there will be some money available."

Once that happens, the economic impact is projected to be huge.

The Tripp Umbach study estimates that the medical school and related health-sciences complex at Riverpoint, by 2030, will have an annual statewide economic impact of about $2.1 billion, support 13,410 jobs, and generate more than $163 million in government revenue. The bulk of that impact, it says, would occur in Eastern Washington.

In 2009, by comparison, it says the Riverpoint Campus and associated partnerships with academic institutions, health-care and research organizations, and private industry had a total annual statewide economic impact of about $270 million and supported about 1,535 full-time, high-paying jobs.

Also, Tripp Umbach estimated that the value of research on the Riverpoint Campus will grow in annual spending from about $12 million in 2009 to more than $70 million by 2030, which will fuel significant commercial spin-off activity and biomedical industry growth.

Commercial impacts related to research are expected to grow within the region to more than $656 million annually by 2030, up from an estimated $32.8 million in 2009.

All of the estimates for 2030, obviously, are based on medical school-related timetable assumptions that might require tweaking. Also, Tripp Umbach says it's important to note that the assumptions "are grounded in a research-intensive approach to faculty recruitment and program design for the expansion of medicine along with a continued emphasis on research in other health-sciences programs.

"The full economic impact projected here would not be realized," it adds, "if the medical program is focused solely on production of new doctors without a parallel emphasis on recruiting and retaining high-quality faculty who compete successfully for funding from the National Institutes of Health and other major sources."