(UPDATED, 4:28 p.m., to reflect House passage of one of the WWAMI bills Thursday afternoon.) 

The fight over WWAMI has left the University of Idaho blindsided, and scrambling.

The U of I has maintained a cautious public profile this year, as legislators have proposed two bills that would shut down or gut the WWAMI medical education partnership. Largely, Idaho’s key player in the University of Washington-led cooperative has been a silent partner.

Behind the scenes, the U of I has been working in defensive damage control. In an internal memorandum obtained by Idaho Education News — a 13-page document, titled “Medical Education Transition Q&A” — unnamed U of I officials talk bluntly and grimly about political pressure, and the rush to step away from a partnership that has trained Idaho medical school students since 1972.

“We were surprised by how quickly the support of WWAMI had eroded over the past year,” the Q&A reads, in part. “We felt we needed to move quickly to find a path forward to protect our ability to train MDs in Idaho.”

This path forward might or might not continue to include WWAMI — named for the member states of Washington, Wyoming, Alaska, Montana and Idaho. At least for now, WWAMI takes in 40 Idaho medical students per year, with the state spending $7.5 million a year to subsidize their studies through UW. The path forward might well include an expanded role for the University of Utah. As EdNews reported in February, the U of I and the University of Utah signed a memorandum of understanding in January, to work on a regional model “that guarantees Idaho residents access to a medical school.”

The Q&A explains how the U of I wound up on this path in the first place. It also fills in a lot of the blanks in this year’s roiling debate over WWAMI, and medical education in Idaho. And in comparison to the U of I’s public-facing web page on WWAMI, the internal document is unfiltered.

A reluctant partner. The U of I is looking at partnering with the University of Utah, but not of its own initiative. “President (C. Scott) Green is committed to continuing the training of MDs in Idaho. The university wouldn’t make the change now if the Legislature hadn’t forced the issue.”

The legislative pushback. The Legislature’s WWAMI grievances are by now well known. UW has refused to take on additional Idaho students, ignoring a 2022 legislative resolution. UW balked at signing a statement asserting that it does not use Idaho tax dollars on abortion training, finally turning it in last month. But the Q&A sheds a light on the intensity of the opposition.

In December, legislative leadership told U of I that it would transfer WWAMI funding “to another medical training program during this session.” That hasn’t happened. But the latest WWAMI bill would cut at least 10 seats from the program, while adding 30 medical school seats with new, yet-to-be-identified partners.

The ICOM connection. The U of I memo suggests that the state is serious, and moving quickly, to buy the Idaho College of Osteopathic Medicine, a for-profit medical school in Meridian. EdNews first reported on the idea in November, but Idaho State University President Robert Wagner and House Speaker Mike Moyle described the discussions as preliminary.

Or are they?

“The conversations about the purchase of ICOM by the state has gained traction in the past couple of months,” the Q&A said. “The legislative leadership wants to purchase ICOM.”

A competitive climate. The memo offers a behind-the-scenes forecast of the bloodsport of a changing academic marketplace — and how the U of I plans to compete.

The U of I says it can find clinical sites for medical students “by leveraging our strong relationships with existing partners.” The memo names potential partners in a U of I-University of Utah cooperative — Kootenai Health and Northwest Specialty Hospital in Post Falls. “These and other partners do not want to publicly make this type of declaration as they do not want to offend WWAMI.”

The U of I also talks about how it hopes to recruit preceptors, the medical professionals who oversee clinical training. “ICOM offers higher financial incentives, influencing preceptor decisions. If we are able to keep more dollars in the state, U of I will increase our ability to compete.”

And one final question. The U of I posed it, at the end of its own memo, so here you have it. “It feels like you have given up on the WWAMI program.”

The crux of the answer: “We have faced tension from the Legislature in recent years regarding our relationship with UW. We have not given up on the WWAMI program, but we must acknowledge that we need a plan in place if the legislation passes.”

On Thursday, U of I spokeswoman Jodi Walker described the unsigned memo as “a discussion document, with multiple people providing input.” The U of I didn’t distribute it internally, or externally to legislators or the Idaho medical community.

But Sunny Wallace, Green’s chief of staff, did forward it to State Board of Education Executive Director Joshua Whitworth on Feb. 14, hours after the House Education Committee approved a bill that would eliminate the WWAMI program in two years. That’s as far as the U of I distributed the memo, Walker said.

EdNews received Wallace’s email and the U of I memo from the State Board, through a public records request for WWAMI-related documents.

The House passed one of its WWAMI bills Thursday. It doesn’t eliminate the program outright, unlike its predecessor, but it would eliminate at least 10 WWAMI seats, while adding 30 medical school seats with unidentified partners. As this bill heads to the Senate — and the 2025 legislative session heads, ostensibly, into its waning weeks — WWAMI has become one of the big unresolved fights of the year.

At its heart, it is an elemental debate over how to address a chronic doctor shortage — leaving Idaho in the unhealthy position of ranking No. 50 in the nation in physicians per capita.

But it is also a juicy debate over politics, turf and market share. Quiet parts that usually aren’t said out loud. Unless they show up in internal memo.

Kevin Richert writes a weekly analysis on education policy and education politics. Look for his stories each Thursday.