Idaho State University Medical Education Program DATE

Contents of Presentation Frequently Asked Questions ISU’s Role in Delivering Health Professions and Medical Education Existing Resources in Health Professions and Medical Education at ISU A Proposed Distributive Model for a Medical Degree Program How a Medical Education Program Will Benefit Practicing Health Care Professionals and Organizations How a Medical Education Program Will Benefit Research and Associated External Funding How a Medical Education Program Will Benefit Academic Programs (Interdisciplinary Examples) Estimated Phased Cost Analysis of a Medical Degree Program

Frequently Asked Questions

ISU’s Role in Delivering Health Professions and Medical Education

Existing Resources in Health Professions and Medical Education at ISU

A Proposed Distributive Model for a Medical Degree Program

How a Medical Education Program Will Benefit Practicing Health Care Professionals and Organizations

How a Medical Education Program Will Benefit Research and Associated External Funding

How a Medical Education Program Will Benefit Academic Programs (Interdisciplinary Examples)

Estimated Phased Cost Analysis of a Medical Degree Program

Frequently Asked Questions

The Rent vs. Mortgage Analogy Why should Idaho create a medical education program? Doesn’t buying seats do the job? Providing medical education is a lot like putting a roof over your head. You can rent or you can buy . One provides shelter on a month-to-month basis ; the other adds the benefits of autonomy and equity . One is buying a service; one is making an investment. In times of economic downturn, growing medical education (professors, staff, clinicians and students) in state makes even more sense and will have a substantial economic payoff.

Idaho’s Matured Health Care Education WWAMI has worked up to this point. Why not expand it? We have matured since that arrangement began more than 30 years ago. During that time, Idaho has made investments in its own health profession programs and partnerships. We have what it takes to build our own program now. Students who complete their education here are more likely to set up practice here helping to improve one of the lowest physician-to-population ratios in the nation.

Cost to Start Up What would it cost to start our own medical education program? Roughly $11 million of one-time funding , and about $21 million in interim financing. This would allow for: hiring some additional faculty a dean and other administrators investing in some facility expansion and equipment Interim financing is the funding required to pay upfront operating costs, separate from startup costs. This financing could come from any combination of three sources: state funding gifts and donations revenue bonds

Roughly $11 million of one-time funding , and about $21 million in interim financing. This would allow for:

hiring some additional faculty

a dean and other administrators

investing in some facility expansion and equipment

Interim financing is the funding required to pay upfront operating costs, separate from startup costs. This financing could come from any combination of three sources:

state funding

gifts and donations

revenue bonds

Getting Accreditation What does it take for medical program accreditation? A medical education program requires: faculty to teach administrators to operate locations for students to undertake: classroom learning clinical experiences The accrediting agency estimated this model could be in place in Idaho by 2012 and ready to accept 60 medical school students by 2014 .

A medical education program requires:

faculty to teach

administrators to operate

locations for students to undertake:

classroom learning

clinical experiences

The accrediting agency estimated this model could be in place in Idaho by 2012 and ready to accept 60 medical school students by 2014 .

Ongoing Funding What would it cost to continue to fund the medical education program? If students were charged the same tuition as WWAMI currently charges, state support would total $6.6 million annually for 60 students per class, with a total enrollment of 240 students. Students could bear the full cost by paying a $46,952 annual tuition , or pay half the expense at $23,476 annual tuition. Of course, other proportions of student-to-state cost burden could be proposed.

ISU as a Lead Institution Why should ISU lead the state in a medical education program? Education in the health professions (which includes medical education) is ISU’s State Board of Education (SBOE) assigned area of both unique and primary emphasis in the state. (BSU has public policy and urban regional planning; UI has agriculture, architecture, law, and natural resources.) ISU offers 75% of the health professions degrees offered in Idaho . BSU offers 16%, and UI offers less than 9%.

Idaho’s Educational Planning How has the State Board of Education indicated Idaho State University as the right institution to lead the medical education program effort? The SBOE asked for medical-education-experienced applicants when hiring for ISU’s current presidency . Each of the four finalists had medical-education experience. The SBOE also included a medical degree (MD) in ISU’s eight-year plan.

Health Professions Workforce Demand: 2004-14 Position Idaho Growth Annual Openings National Growth Annual Openings Physician Assistants 56.6% 26 49.6% 4,000 Pharmacists 55.9% 80 24.6% 10,000 Dental Hygienists 49.5% 55 43.3% 8,000 Physical Therapists 38.6% 30 36.7% 7,000 Occupational Therapists 35.2% 22 33.6% 4,000 Registered Nurses 38.6% 593 29.4% 120,000 Respiratory Therapists 36.0% 29 28.4% 6,000 Mental Health Counselors 31.8% 15 27.2% 5,000

The Role of Idaho State University in Delivering Health Professions and Medical Education

Idaho State University’s Statewide Mission State Board of Education-approved statewide health professions mission “ The university … has specific responsibilities in delivering programs in the health professions. "Idaho State University will formulate its academic plan and generate programs with primary emphasis on health professions, the related biological and physical sciences, and teacher preparation.” SBOE-approved eight-year plan includes MD degree Begin offering in 2010-2011 academic year (p. 58)

State Board of Education-approved statewide health professions mission

“ The university … has specific responsibilities in delivering programs in the health professions.

"Idaho State University will formulate its academic plan and generate programs with primary emphasis on health professions, the related biological and physical sciences, and teacher preparation.”

SBOE-approved eight-year plan includes MD degree

Begin offering in 2010-2011 academic year (p. 58)

SBOE-Approved Missions Institution Unique Programs Statewide Primary Emphasis “ Regional” or Continuing Emphasis Idaho State University Health Professions Health-Professions-related Biological and Physical Sciences Teacher Preparation Business Education Engineering Technical Training Boise State University Public Policy and Urban Regional Planning Business and Economics Engineering Social Sciences Public Affairs Performing Arts Teacher Preparation Health-Professions-related Biological and Physical Sciences Education University of Idaho Agriculture Architecture Law Natural Resources Agriculture Natural Resources Metallurgy Engineering Architecture Law Foreign Languages Teacher Preparation International Programs related to Primary Emphasis areas Responsible for Regional Medical and Veterinary Medical Education Programs in which the State of Idaho participates Business Education Liberal Arts Physical, Life and Social Sciences

ISU Health Profession Degrees

ISU Health Profession Degrees

ISU Health Profession Degrees

BSU and UI Health Profession Degrees

Health Profession Degree Programs at BSU, UI and ISU 75% 16% 9%

Terminal Graduate Programs in Health Professions Idaho State University Audiology, AuD Counselor Education and Counseling, PhD Physical Therapy, DPT Occupational Therapy, MOT Physician Assistant Studies, MPAS Doctor of Pharmacy, PharmD PharmD/PhD Clinical Psychology, PhD Dental Hygiene, MSDH Nurse Practitioner, MSN University of Idaho Counseling and Human Services, Ph.D. in Ed Food Science, Ph.D. Physical Education, doctoral programs Special Education, doctoral programs

Idaho State University

Audiology, AuD

Counselor Education and Counseling, PhD

Physical Therapy, DPT

Occupational Therapy, MOT

Physician Assistant Studies, MPAS

Doctor of Pharmacy, PharmD

PharmD/PhD

Clinical Psychology, PhD

Dental Hygiene, MSDH

Nurse Practitioner, MSN

University of Idaho

Counseling and Human Services, Ph.D. in Ed

Food Science, Ph.D.

Physical Education, doctoral programs

Special Education, doctoral programs

Growth of Medical Education The original site visit team in 1971 wrote, “Idaho State University … appears to have the greatest long-range potential” as a suitable academic site for a medical education program University of Washington has no plan for a transition to an Idaho-based medical education program A medical education program in Idaho will include efforts to collaborate with University of Washington and other institutions in research, clinical faculty collaboration and other endeavors

The original site visit team in 1971 wrote, “Idaho State University … appears to have the greatest long-range potential” as a suitable academic site for a medical education program

University of Washington has no plan for a transition to an Idaho-based medical education program

A medical education program in Idaho will include efforts to collaborate with University of Washington and other institutions in research, clinical faculty collaboration and other endeavors

Existing Resources in Health Professions and Medical Education at Idaho State University

ISU Inventory Summary

Inventory: ISU Faculty 280 in departments of biological sciences, chemistry, pharmacy and health professions 12 additional research faculty, non-state funded 34 with academic expertise in areas of first two years of medical education 21 have had faculty appointments or postdoctoral experience at medical schools

280 in departments of biological sciences, chemistry, pharmacy and health professions

12 additional research faculty, non-state funded

34 with academic expertise in areas of first two years of medical education

21 have had faculty appointments or postdoctoral experience at medical schools

Inventory: Clinical Affiliate Faculty 176 clinical affiliate faculty (medical doctors) Affiliation agreements with 150 hospitals Affiliation agreements with more than 720 faculty and more than 1,370 sites Statewide, nationally and internationally

176 clinical affiliate faculty (medical doctors)

Affiliation agreements with 150 hospitals

Affiliation agreements with more than 720 faculty and more than 1,370 sites

Statewide, nationally and internationally

Inventory: ISU Administration *These are administrators with experience in a medical school environment.

Inventory: ISU Health Science Facilities Pocatello 16 buildings on campus, two near campus Idaho Falls One building, shared with EITC Boise Four buildings leased ISU-Boise Center, IAGD Residency, Boise VAMC (pharmacy faculty) Meridian One building, under remodel; will house all Treasure Valley programs

Pocatello

16 buildings on campus, two near campus

Idaho Falls

One building, shared with EITC

Boise

Four buildings leased

ISU-Boise Center, IAGD Residency, Boise VAMC (pharmacy faculty)

Meridian

One building, under remodel; will house all Treasure Valley programs

Health Corridor: Community

Health Corridor: On-Campus

Inventory: ISU Distance Learning Network Broadcast nearly 400 hours of class per week 29 video conferencing configurations, ranging from 8-200 students Pocatello - 13 classrooms Boise - 9 classrooms Idaho Falls – 8 classrooms Twin Falls – 2 classrooms Coeur d’Alene – 1 classroom (shared with University of Idaho) Meridian – At least 3 classrooms planned

Broadcast nearly 400 hours of class per week

29 video conferencing configurations, ranging from 8-200 students

Pocatello - 13 classrooms

Boise - 9 classrooms

Idaho Falls – 8 classrooms

Twin Falls – 2 classrooms

Coeur d’Alene – 1 classroom (shared with University of Idaho)

Meridian – At least 3 classrooms planned

Inventory: ISU Residencies Family Medicine Dentistry Pharmacy MD and DO: 3 years DDS: 1 year PharmD: 1 or 2 years (8 total residencies) 65 Graduates 43 Graduates 116 Graduates Started in 1992; full GME accreditation. Started in 2000, expanded to Boise in 2005; Accreditation with ADA, Council on Dental Accreditation in 2001. Expansion site is pending. Started in 1992, full American Society of Health-Systems Pharmacists accreditation.

ISU Medical Residencies: Idaho Sites for Graduate Practice

Inventory: ISU Clinics

Inventory: ISU Health Sciences Library Only health/medical library affiliated with an Idaho educational institution Two medical librarians teach research skills to more than 700 students every year Meets needs of distance students and others, purchasing more than 150 online reference books annually

Only health/medical library affiliated with an Idaho educational institution

Two medical librarians teach research skills to more than 700 students every year

Meets needs of distance students and others, purchasing more than 150 online reference books annually

Inventory: ISU Biomedical Research Approximately 265 ISU faculty (43% of total) 19.5% (34 of 174) of active sponsored awards 30.5% ($8,879,810 of $29,132,916) of active sponsored dollars

Approximately 265 ISU faculty (43% of total)

19.5% (34 of 174) of active sponsored awards

30.5% ($8,879,810 of $29,132,916) of active sponsored dollars

Inventory: ISU Human Simulators Male Simulators: Pocatello, 9; Boise, 3; Idaho Falls, 1 Female Simulators: Pocatello, 4; Boise, 2 Infant Simulators: Pocatello, 8; Boise, 2 Simulation lab environments in development

Male Simulators: Pocatello, 9; Boise, 3; Idaho Falls, 1

Female Simulators: Pocatello, 4; Boise, 2

Infant Simulators: Pocatello, 8; Boise, 2

Simulation lab environments in development

Inventory: ISU Professional Programs Idaho Conference on Health Care annual event offering speeches and presentations by a variety of health care experts Idaho Drug Utilization Review working with Medicaid, improve patient care and reduce overall drug costs in Idaho; conduct retrospective analysis of patient drug usage, physician prescribing, and pharmacy dispensing activities Idaho Drug Information Service answer patient-related drug information questions for health care professionals throughout Idaho

Idaho Conference on Health Care

annual event offering speeches and presentations by a variety of health care experts

Idaho Drug Utilization Review

working with Medicaid, improve patient care and reduce overall drug costs in Idaho; conduct retrospective analysis of patient drug usage, physician prescribing, and pharmacy dispensing activities

Idaho Drug Information Service

answer patient-related drug information questions for health care professionals throughout Idaho

Inventory: ISU Professional Programs Telehealth programs in the Institute of Rural Health research and service projects seeking to increase access to physical, oral, and mental/behavioral health care Continuing Education Mental Health and Counseling Workshops workshops for counselors, psychologists, social workers, nurses, teachers, and other mental health professionals annually in Pocatello, Boise and Coeur d’Alene.

Telehealth programs in the Institute of Rural Health

research and service projects seeking to increase access to physical, oral, and mental/behavioral health care

Continuing Education

Mental Health and Counseling Workshops

workshops for counselors, psychologists, social workers, nurses, teachers, and other mental health professionals annually in Pocatello, Boise and Coeur d’Alene.

Inventory: ISU Anatomy Facilities Total space 2,650 square feet Lab cadaver capacity 8-11 Cadaver cold storage capacity 18 ISU Anatomical Donation Program 12+ annually

Inventory: ISU Space Availability ISU has reserved 20,600 square feet of space for medical education expansion, which would include administration, faculty offices, and research laboratories at the following sites: Nichols Hall Dyer Hall Owen Redfield Hall

ISU has reserved 20,600 square feet of space for medical education expansion, which would include administration, faculty offices, and research laboratories at the following sites:

Nichols Hall

Dyer Hall

Owen Redfield Hall

Clinical and Technological Innovation Cutting-edge Health Information Technology infrastructure Leadership in clinical quality processes Family Medicine Clinical Research Center Hundreds of patients enrolled in large NIH trials of treatments for hypertension, heart failure, diabetes and high cholesterol Ongoing collaborative clinical relationships with Idaho’s Community Health Centers as potential clinical sites serving underserved populations

Cutting-edge Health Information Technology infrastructure

Leadership in clinical quality processes

Family Medicine Clinical Research Center

Hundreds of patients enrolled in large NIH trials of treatments for hypertension, heart failure, diabetes and high cholesterol

Ongoing collaborative clinical relationships with Idaho’s Community Health Centers as potential clinical sites serving underserved populations

A Proposed Distributive Model for a Medical Degree Program

Health Science Centers Administrative unit composed of colleges and schools within existing university For example, existing ISU components similar to makeup of University of Utah’s Health Sciences Center USU’s RDEP and ISU’s IDEP; dental agreements with Creighton University Physician Assistant programs ISU’s College of Pharmacy and USU’s School of Pharmacy School of Nursing Affiliation agreements with hospitals and community centers

Administrative unit composed of colleges and schools within existing university

For example, existing ISU components similar to makeup of University of Utah’s Health Sciences Center

USU’s RDEP and ISU’s IDEP; dental agreements with Creighton University

Physician Assistant programs

ISU’s College of Pharmacy and USU’s School of Pharmacy

School of Nursing

Affiliation agreements with hospitals and community centers

University of Utah

Oregon Health & Science University

Accrediting a Medical Degree Program Liaison Committee on Medical Education (LCME) accredits medical degree programs in the U.S. and Canada Accredits only complete medical programs and not tracks Program is responsible for students from start to completion of MD degree Accreditation is not based on research funding, but on quality of the program

Liaison Committee on Medical Education (LCME) accredits medical degree programs in the U.S. and Canada

Accredits only complete medical programs and not tracks

Program is responsible for students from start to completion of MD degree

Accreditation is not based on research funding, but on quality of the program

LCME Accreditation Stages for a Medical Degree Program Pre-accreditation (2010-12): 1-3 years Prior to accepting students Hiring of administration Business plan approval First Year Enrollment (2014) 60 students First Graduating Class (2018) Total enrollment: 240 students 60 MDs (per year) Full accreditation established

Pre-accreditation (2010-12): 1-3 years

Prior to accepting students

Hiring of administration

Business plan approval

First Year Enrollment (2014)

60 students

First Graduating Class (2018)

Total enrollment: 240 students

60 MDs (per year)

Full accreditation established

Distributive Model First Two Years: Didactics (classroom curriculum and some practice experiences) Second Two Years: Clerkships (clinical rotations) Anchor Clinical Locations near tertiary care centers: Eastern Idaho Magic Valley Northern Idaho Treasure Valley

First Two Years: Didactics (classroom curriculum and some practice experiences)

Second Two Years: Clerkships (clinical rotations)

Anchor Clinical Locations near tertiary care centers:

Eastern Idaho

Magic Valley

Northern Idaho

Treasure Valley

Distributive Model: First Two Years Centralized location for administration and classroom experience Didactic component of medical education program Integrate with existing health-medical education program and faculty inventory Use distance learning capability and encourage statewide faculty involvement

Centralized location for administration and classroom experience

Didactic component of medical education program

Integrate with existing health-medical education program and faculty inventory

Use distance learning capability and encourage statewide faculty involvement

Distributive Model: Last Two Years Multiple locations Clinical rotation coordination offices in four regions: North Southwest (Treasure Valley) East (managed from clinical associate dean’s office) South Central (Magic Valley)

Multiple locations

Clinical rotation coordination offices in four regions:

North

Southwest (Treasure Valley)

East (managed from clinical associate dean’s office)

South Central (Magic Valley)

Clinical Rotation Coordination Centers Proposed clinical rotation coordination offices Develop clinical rotation sites and schedule student assignments

Proposed clinical rotation coordination offices

Develop clinical rotation sites and schedule student assignments

Collaboration Among Universities

Proposed Governance/Advisory Body Statewide Advisory Council Chaired by ISU Includes UI, BSU, LCSC presidents Could include representative from private four-year university Regional representatives from IHA and IMA National ad hoc committee of deans with recent experience with accreditation of a distributive model

Statewide Advisory Council

Chaired by ISU

Includes UI, BSU, LCSC presidents

Could include representative from private four-year university

Regional representatives from IHA and IMA

National ad hoc committee of deans with recent experience with accreditation of a distributive model

Projected Staffing Needs Assessment: Administration LCME Accreditation Guidelines for New and Developing Medical Schools

LCME Accreditation Guidelines for New and Developing Medical Schools

Projected Staffing Needs Assessment: Faculty Generic curriculum to assess faculty needs based on following departments: Biomedical and Pharmaceutical Sciences Biological Sciences Psychology Assessed additional faculty needs and considerations: Workload Expertise

Generic curriculum to assess faculty needs based on following departments:

Biomedical and Pharmaceutical Sciences

Biological Sciences

Psychology

Assessed additional faculty needs and considerations:

Workload

Expertise

Projected Staffing Needs Assessment: Faculty Where appropriate, create courses to be shared by existing health-medical education programs, such as: Pharmacy Physician Assistant Physical Therapy Occupational Therapy Joint faculty appointments between medical education and appropriate campus departments

Where appropriate, create courses to be shared by existing health-medical education programs, such as:

Pharmacy

Physician Assistant

Physical Therapy

Occupational Therapy

Joint faculty appointments between medical education and appropriate campus departments

How a Medical Education Program Will Benefit Practicing Health Care Professionals and Organizations

For Practicing Professionals: What Med Ed Can Build Idaho referral network across health care providers for education, research and services Stronger political alliances to improve health care Idaho Academy of Medicine to recognize Idaho advances in rural medicine Idaho clinical faculty with the greatest retention and recruitment of physicians who desire teaching, better workload distribution and research Improved reputations and recognition Endowments, clinical trial access and other resources to improve clinical salaries and facilities Stronger base for expanded residencies and opportunities to sub-specialize within scopes of practice network for better IT and medical record system, reducing overhead for private practice groups

Idaho referral network across health care providers for education, research and services

Stronger political alliances to improve health care

Idaho Academy of Medicine to recognize Idaho advances in rural medicine

Idaho clinical faculty with the greatest retention and recruitment of physicians who desire teaching, better workload distribution and research

Improved reputations and recognition

Endowments, clinical trial access and other resources to improve clinical salaries and facilities

Stronger base for expanded residencies and opportunities to sub-specialize within scopes of practice

network for better IT and medical record system, reducing overhead for private practice groups

Enhanced Opportunities for Practicing Professionals Practice across state lines by building political alliances in rural border areas for coverage Qualification for clinical trials from government and private industry Participation in entrepreneurial efforts Build preventive medicine programs that improve healthcare and reduce emergency room needs Build rural Idaho extended care by networking with physicians and other health professionals

Practice across state lines by building political alliances in rural border areas for coverage

Qualification for clinical trials from government and private industry

Participation in entrepreneurial efforts

Build preventive medicine programs that improve healthcare and reduce emergency room needs

Build rural Idaho extended care by networking with physicians and other health professionals

For Practicing Professionals: What Med Ed Can Enhance Provide an Idaho source of continuing medical and health professions education Partnership access for building new infrastructure from government, philanthropy and/or private sources through grants, contracts and/or donations Get national attention/recognition to invest in Idaho medical opportunities and programs Federal funding for health professions which requires medical education as a component Strengthen the quality of existing health professions programs Provide for structured interdisciplinary education opportunities as recommended by the Institute of Medicine

Provide an Idaho source of continuing medical and health professions education

Partnership access for building new infrastructure from government, philanthropy and/or private sources through grants, contracts and/or donations

Get national attention/recognition to invest in Idaho medical opportunities and programs

Federal funding for health professions which requires medical education as a component

Strengthen the quality of existing health professions programs

Provide for structured interdisciplinary education opportunities as recommended by the Institute of Medicine

How a Medical Education Program Will Benefit Research and Associated External Funding

Examples of Medical Research Collaborative Projects * All examples taken from collaborations between U. of Indiana School of Medicine and the Indiana University-Purdue University Indianapolis. Medical Discipline Partner Discipline Research Area Neurosurgery Mathematics Mathematical modeling and real time analysis of brain activity in neurological disease (Center for Mathematical Biosciences) Pharmacology Chemistry Medicinal chemistry/new drug synthesis Anatomy Computer and Information Science Analysis and modeling of facial features in fetal alcohol syndrome Medical Records Computer and Information Science Health information database security and access Pediatrics Geology Correlation of soil lead content, weather patterns, children’s outdoor play activities, and blood lead levels in children (Center for Environmental Health) Radiology Physics, Chemistry Development of new medical imaging methods Radiology Nuclear engineering, Physics, Chemistry Medical isotope production for disease diagnosis

Examples of Medical Research Collaborative Projects * All examples taken from collaborations between U. of Indiana School of Medicine and the Indiana University-Purdue University Indianapolis. Medical Discipline Partner Discipline Research Area Medicine Philosophy Medical ethics/bioethics Public Health, Nursing Art, Computer & Information Science Contemporary digital videos to discourage young women from smoking Medicine History History of medicine Medicine Sociology HIV risk and behavioral choices Medicine Engineering Biomedical engineering, e.g. of heart devices or biocompatible materials Medicine Economics Health care economics Pathology Chemistry, Law Forensic Science Medicine Public Affairs Analysis of smoking behavior; smoking policy development (Center for Health Policy)

How a Medical Education Program Will Benefit Academic Programs

Examples of Interdisciplinary Medical Education Programs * All examples taken from collaborations between U. of Indiana School of Medicine and the Indiana University-Purdue University Indianapolis. Medical Discipline Partner Discipline Program Medicine Engineering Ph.D. in Biomedical Engineering M.D. Natural Science or Biomedical Engineering M.D.-Ph.D. Medicine, Biostatistics Mathematics Ph.D. in Biostatistics M.D. Business M.D.-M.B.A. Pathology, Pharmacology/Toxicology Chemistry, Biology M.S. in Forensic Science

Estimated Phased Cost Analysis of a Medical Degree Program

Idaho Medical Degree Program * Based on 60 students admitted annually MEDICAL EDUCATION BASE Administration $1,693,000 Faculty (full-time institutional faculty) 4,854,000 Total Personnel Related $6,547,000 PROGRAM COSTS 1,045,000 Subtotal $7,592,000 REGIONAL CLINICAL SITES Administration $753,000 Faculty (clinical affiliates, partial FTEs) Program Costs and Rotations 646,000 2,277,000 Total Clinical Related $3,676,000 TOTAL OPERATING COSTS $11,268,000

Total Personnel Related

Subtotal

Total Clinical Related

Operating Costs: Buildup Years Classes -4 Classes -3 Classes -2 Classes -1 Administration 700,148 1,467,949 1,692,774 1,692,774 Faculty 0 0 0 2,534,610 Program 39,383 142,650 190,150 577,650 Clinical 0 0 0 0 TOTAL 739,531 1,610,599 1,882,924 4,805,034 Revenue 0 0 0 0 Net Difference -739,531 -1,610,599 -1,882,924 -4,805,034

Operating Costs: First Years of Classes Year 1 Year 2 Year 3 Year 4 Administration 1,692,774 1,692,774 1,692,774 1,692,774 Faculty 4,438,558 4,854,489 4,854,489 4,854,489 Program 901,550 1,044,900 1,044,900 1,044,900 Clinical 603,357 1,636,386 3,676,386 3,676,386 TOTAL 7,636,239 9,228,549 11,268,549 11,268,549 Revenue 2,817,136 5,634,272 8,451,408 11,268,549 Net Difference -4,819,103 -3,594,277 -2,817,141 0

One-Time Startup Costs for Idaho MD Program 60 students per year; 240 total enrolled. PLUS: Facilities (leveraging existing facilities for didactic instruction) $3,502,000 Faculty startup packages 5,000,000 Additional instructional equipment 200,000 Faculty and staff recruitment and relocation 2,337,300 TOTAL $11,039,000 Interim Financing $21,000,000

Funding Options 60 students per year; 240 total enrolled. Option Student Tuition Level From Tuition State Support Total Funding Students pay all costs $46,952 $11,268,545 $0 $11,268,545 Students pay half of costs $23,476 $5,634,272 $5,634,272 $11,268,545

Questions?

Multiplier Effect: Additional Positive Economic Impact The medical school business volume multiplier effect is 2.3, meaning that for every dollar directly spent by a medical school, an additional $1.30 is indirectly generated for a total impact of $2.30. This is driven by keeping doctors, medical students and their spending in Idaho’s state boundaries. This additional economic benefit will occur for Idaho every year. Figures based on Association of American Medical Colleges (AAMC) Study of Economic Impact of AAMC-Member Medical Schools published in January 2007

The medical school business volume multiplier effect is 2.3, meaning that for every dollar directly spent by a medical school, an additional $1.30 is indirectly generated for a total impact of $2.30.

This is driven by keeping doctors, medical students and their spending in Idaho’s state boundaries.

This additional economic benefit will occur for Idaho every year.