Hosted by the City of Meridian

Date: December 14, 2015Meridian
11:00 am – 1:00 pm

Location: ISU-Meridian Health Science Center
1311 E. Central Drive
Meridian , ID

11:00 am – 11:10 am
Welcome and Introductions
Mayor Tammy de Weerd
11:10 am – 11:30 am
Meet and Greet – New Treasure Valley
Partnership Members
11:30 am – 11:55 am
Open Discussion. Free flowing discussion on any topic.
Potential tropics include:
Idaho Legislature 2015/16
11:55 am – 12:00 pm
Director’s Report
Monthly Minutes and Financial Statement
 Bill Larsen
12:00 pm – 1:00 pm
Future of Medical Education in Idaho & Tour of ISU- Meridian Health Science
Linda Hatzenbuehler, PhD – Vice Provost  and Executive Dean, Division of Health Center Sciences

Meeting Minutes – December 14, 2015

Hosted by the City of Meridian

Attendees:
Tammy de Weerd
John Evans
Craig Hanson
Bob Henry
Brad Holton
Nathan Leigh
Jim Reynolds
Joe Stear
Darin Taylor
Rick Yzaguirre
Guests and Staff:
Robin Dodson, PhD – Special Assistant to the Dean for Special Projects/Professor; Pharmacy
Linda Hatzenbuehler, PhD – Vice Provost & Executive Dean, Division of Health Center Sciences
Bessie Katsilometes, PhD – Associate Vice President; ISU-Meridian
Bill Larsen – Treasure Valley Partnership

Open Discussion

Tammy welcomed everyone to Meridian and wished everyone a Merry Christmas.

There was a discussion about this last year’s Mayors Walking Challenge. The previous year, Bob Henry won the event and walked 218 miles. This year he walked 374 and came in sixth. Gheen Christoffersen from Homedale came in third.

Tammy mentioned we are going to have an opportunity for a tour of this facility. ISU has had this facility up and going for 4-5 years. It was a originally a business that the School District bought with the thought it would be a partnership with BSU. ISU jumped on the space helping them consolidate numerous locations.

Since then, they have opened an A & P lab and a Bio-skills lab that we will be touring today. This opens up a lot of potential to brining more medical education to the state of Idaho. They have teleconferencing, telecommunication and video capability that is just outstanding. Their students can watch a surgery in Chicago and see every minute detail.

The labs are available for physicians and medical tech companies to come in and test out their devices. This creates a whole host of opportunity for this region and the State.

Tammy said we always hate to lose one of the Partnership’s members. We have really appreciated the involvement of Jim Reynolds. When he first came in as a member, he had to fight for funding to stay on the Partnership. It has been important to have Jim involved and to have the City of Eagle’s voice. She said she wanted to share our appreciation for Jim and gave him a certificate and a small token of our appreciation.

Jim said this is one of the most satisfying things he has done as Mayor. Before he became a Mayor he never met one as he was never involved in politics and never really had any interest in politics. It has been an honor to work with the members of the Partnership. To a man/woman you are quality folks and are doing the best for your city/county that he believes you can do.

John said he had attended Greg Nelson’s retirement function. It was a very nice event and was fun listening to folks talk about Greg’s history. He was a charter member of the lion’s club for upwards to 49 years. They dedicated their green belt to Greg as he was the one that got it going.

Open Discussion

Bob said they had a ribbon cutting for Heartland Industries that is coming to Nampa. They did a partnership with BVEP, the Department of Commerce, the County and private industry. Heartland said they were their last choice in they did not want to come to Idaho. They originally wanted to go to Oregon. They said this valley wowed them. It reaffirms something he has committed to, and that is, we have to sell the valley. We all are committed to our own cities and counties and we should be, however, when we talking to people it is “the valley”. We will all get our share and this guy made it very clear that it was the valley that convinced them to come to here. This is a good one and they will be bringing a lot of good jobs to the area.

Bob continued that Heartland is looking for additional locations here in the area and may very well be in Ada County because their rate for unoccupied manufacturing is 1.9%. Tammy said their biggest challenge for industrial space is churches. They lost one of their prime pieces of industrial property to a church. Don’t get her wrong, it looks great and they upgraded the property, but it was a rare piece of industrial space.

Bob said they have a property in Nampa that has been sitting empty for years. The bank owns it and it has 84,000 square feet ready to go. A charter school put an interest on it and a church had a backup position. Now the charter school wants out and there are two businesses that want it. It is tied up in litigation now because the church thinks they are in first position. These would be good locations for these businesses that would produce jobs. Bob said, as a member of the church, he wrote a letter to the church in support of the private businesses getting the property.

Bob said it is not a question of bringing businesses into our communities. The hard part is finding existing space for businesses right now.

Tammy said they have been talking to BVEP about pursing legislation for allowing spec buildings and giving some kinds of incentives to developers to build spec buildings. The idea is these incentives would forgive costs till occupancy. The point is we need buildings. When these businesses come in, this is what they are looking for.

Tammy asked if anyone else is doing anything in economic development. She mentioned they met with Ada County to talk about the area between Meridian and Nampa. They are hoping to get Canyon County on board as well and start talking about that area and bringing jobs closer to where people live. It is true what Mayor Henry said, that we really need to work together.

Nathan said, Parma has had some recent interest in agricultural ground for a Sorghum Processing facility. Another business is interested in ground that has access to railroad siding. This is encouraging. The Sorghum Processing facility will lead to 80-100 jobs eventually.

Joe said it seems as Union Pacific has been willing to negotiate on rail spurs and things. At least it is his perception they have been. Both Tammy and Bob said their experience is the opposite in they are very hard to work with. Bob said they had a case near the Idaho Center where 15 years ago they got a $1.00/year lease on some property. Last year they raised it to $10,000/year. They have a spur road on their cemetery they have been paying $10.00/per year for a long time. Union Pacific just increased that to $3,000.00 per year. Another example, they are trying to do a pathway on what is called Stoddard Trail. It has been abandoned by Union Pacific and is about a mile long. They want $680,000.00.

Jim said that Gardner & Company just completed a huge Assisted Living Facility with a memory care. The famed tennis club is finally getting built along Hwy. 44 on the east end of town. More recently, there is talk about theater’s and high end restaurants going in.

Bob said, for their old library, they had Gardner and another local developer respond to an RFP. The local developer, Mussel, won the RFP and already has tenants and financing lined up. Mussel will get the building for about free, because there is about $900,000 worth improvements that have to be made to make the facility habitable.

Brad asked if the Partnership would be interested in a letter of encouragement or support towards the increased storage study including the Three Springs reservoir. It is a study that is going on and it is his impression they are not getting much traction. He is not suggesting we throw money at this study. However, we do need to support the concept that better storage and flood control is a good thing as we grow up against the river.

John asked who was leading the effort. Brad said he doesn’t know whether it is the Dept. of Interior or the Army Corps.

Brad said the Dept. of Water Resources lost their case on the refill water rights issue. It was his impression they lost pretty badly, but they are appealing. The Director’s action was overturned.

Additionally, Brad would like the Partnership to figure out a way to address the new water temperature limits that are coming down from EPA. He feels there is no science to support the temperature requirements. Bob said, this is one of the reasons they are moving their infiltration out to dry lake. Their new permit has temperature limits in it but it has been pushed out for 15 years.

The point Brad is making is they have each of our entities singled out as separate entities and there is not unified voice to speak out against the temperature requirements.

Tammy asked that we keep these items on the forefront of our discussions for the next several months.

Rick said that Ada County just approved their second Solar Farm. They are each about 300 acres and one of the Solar Farms is owned by the Harris Family from Harris Ranch in East Boise. The other Solar Farm is owned by Orogis (sp?) which is a Greek Company.

Rick stated that this project included property in Kuna. They applied for the county financial incentive package but the county rejected their application. The county financial incentives are all about jobs and their rate of pay and benefits, and this did not meet their criteria. There was some discussion about the contiguous nature of the project and the company’s desire to be in both jurisdictions instead of being annexed by Kuna.

John said they had a parcel that was zoned C-1 on a development agreement but didn’t have one single use permitted on it. Every single use was conditional use. They had to go to the City Council to get this straightened out.

Bob said the old golf course, Broadmore, in Nampa is getting developed. There is a Maverick store and a church want to go there and found out it was un-zoned and they had to work this out.

Rick said Simplot was putting in a meat processing plant under construction in South Ada County. This will have a huge economic impact with about 650 jobs. These jobs start at $40-50,000 and range up into the $90’s and above. This will have a huge impact on the infrastructure there. It was a BVEP project that the county put in some incentives to help bring it to fruition.

Director’s Report

Bill said March 17 and 18 is his suggestion for this year’s Annual Planning Meeting based on input from the retreat and potential opportunities to rent a facility at Tamarack.

Bill mentioned the other outgoing Partnership members are; John Bechtel from Wilder, Nate Mitchell with Star, Keith Green with Marsing, and Greg Nelson with Kuna. The new mayors with these jurisdictions will be Alicia Almazan, Chad Bell, James Ferdinand and Joe Stear, respectively. Joe has been coming now for a couple of months. Bill said he will be attempting to contact these new members to hold welcoming meetings with these them after the New Year. When the time comes, he encouraged members to volunteer in this effort.

Bill included in the packet, a full color poster of the Just Drive pledge in case anyone would like to display it. Tammy asked the members if they have followed up to see if your individual policies include the commitment toward the language of the pledge. Several members said they had policies and practices in place.

Darin moved to approve the minutes and financial report, Bob seconded. Motion carried.

Future of Medical Education in Idaho

Linda was delighted the Partnership could come see their new facility. She said that Dr. Bayless sends his regrets for missing this meeting but was tied up out of state.

Linda asked why States invest in medical education. There are three basic reasons. One is the States need doctors to take care of people. Two is because students are interested in becoming doctors. This is the same reason we fund law school, ag schools, etc. The third reason is because of economic development.

Think about the big centers such as Rochester in Minnesota. What was Rochester like before the Mayo Clinic was there? Think about Salt Lake City or Seattle. They have huge medical centers which bring people in and bring all kinds of economic development, not to mention the research.

In regard to the need for physicians, she showed that the U.S. in general does not have an oversupply of physicians. In Idaho, we had almost 3,000 active physicians and we rank 47th nationally in primary care physicians and 49th overall.

Idaho has the largest population of any state without a medical school. Alaska, Montana, Wyoming and Idaho are the only states without a medical school. The Dakotas have a medical school. Linda gave some examples of states with similar populations to Idaho and compared the ranking of the population of physicians. Some states even have both public and private medical schools.

Having a medical school does have an effect on the number of physicians operating in your state.

Tammy asked what this lack of physicians’ problem, means to Mayors and County Commissioners. Linda said that when businesses look at moving into your community, they look at education and health care as factors in their judgement to relocate. We are below the water line in the number of doctors per population. The second issue has to do with student interests. People want to move to places where there are opportunities to get into medical school.

Bob asked why we don’t have a medical school. Linda said, in her opinion there is no political will at this point. Thirty plus years ago, they ended up with an arrangement with the University of Washington and the University of Utah. We rent seats at these universities. When it got started, it was even admitted it was a temporary solution, but we have gotten comfortable with the renter mentality.

Tammy asked if it is cheaper to rent than to buy. Linda said we are failing to invest in the equity.

Under an economic development angle, health care itself is a large economic sector in our economy.

If you go to the University of Utah, they have an entire tech-transfer building. This only comes from the inventions that come out of their institution. This is a large issue that never comes up when you talk about renting seats from other places.

Bessie said, the other thing about renters is that where students go to school is they usually end up staying there after schooling is over. We have a difficult time getting our Idaho kids back to Idaho once they have finished their medical education. Robin said that approximately 1/3 of our Idaho kids come back after their education. These are high paying jobs.

Linda said let’s talk about what it takes to be a doctor. So you go to school for four years and you get your Bachelor’s degree. Then you go on to four years of medical school and you get your MD. You can’t get a license in Idaho with just an MD degree. You have to have at least one year of post doc experience called an internship in Idaho before you can get your license.

Most graduates of medical school go on, to what is called; sub-specialty training. This is called residency. The length of residency could be as high as five to six years to become a resident in neurosurgery, for example. In simple terms, the residents are supervised by an experience doctor in that specialty.

How much does medical education cost? For example, the University of North Dakota’s total budget is $52 million. That budget is made up of four sources of money for State schools. The sources include what the State kicks in, the tuition and fees students pay, the income from health care services, and grants and contracts. She apologized that she did not have the exact figure, but she estimated that the State of North Dakota probably contributes $12-15 million.

Grants and contracts end up being a significant portion of what happens annually. For example under her program here in Idaho, her budget is roughly $30 million and less than 45% of that is provided by the State of Idaho. The rest comes from tuitions, fees and grants and contracts.

Robin said the WWAMI (WA, WY, AK, MT, ID) Medical Education Program costs roughly $6 million annually with 35 students this year. The Utah program $1.8 million for 8 seats.

The average cost per student is $52,000 per year in Washington and $42,000 in Utah. Nationally the average is roughly $32,000 per year, with low per student costs of around $12,000 per year.

Besides WWAMI and Utah, Idaho does invest in graduate medical education which is called medical residencies. There are three different kinds of medical residency in Idaho. There is a family medicine program in Pocatello that includes seven medical residents per year. In Boise there is an independent sponsoring organization unaffiliated with a university and there is a brand new family medicine residency that just opened in Coeur d’Alene.

We have three sites, North, West and East where there are Family Medicine residencies. We also have a psychiatry residents program at the VA, which primarily focuses on adult males. And the VA, St. Lukes and St. Al’s have an internal medicine residency program under the University of Washington.

When Bessie talked about how students typically stay where they go to school, this is typical especially for residents. Where they do their residency, they stay. Her son, went to the Maine to do a residency, he is still there.

If we in Idaho are to move forward outside of the renter perspective, what kind of model are we talking about? We are talking about a community-based medical education program. In a snapshot, in the first couple of years of education, there would be a cooperative program for medical students that would be organized by all three University systems. Then the students would do their clinical training in each of the universities. Depending on their rotational requirements, they could go to outpatient clinics, inpatient clinics, and hospitals throughout the state in their third or fourth year. Technically, medical school is four years. It used to be that the first two years were all class work and the third and fourth year would be apprentice ship work.

They are not talking about building a university hospital. They would use the community hospitals and their physicians to teach our students. They would also use technology. So when students are placed throughout the state, they would use technology for face conferences that are needed.

In order to pull off medical education you need three things. You need a research university that has scientists on staff to teach things like biology, chemistry, etc. You also need hospitals and medical centers because students have to go see the application of what they are learning in the classroom. And practicing medical doctors are needed for the clinical training.

They think each of our universities have their strengths. ISU has strengths in the medical field, but they cannot do it alone. They need to have the cooperation and participation of both BSU and U of I.

Bob asked why we don’t have the will to do this. Do need seed money to get it started? Linda said seed money comes from leadership, however the understanding of the three purposes of a medical education is what is needed. Yes we can rent, it is cheaper to do this. But you are not investing anything.

Yes, seed money is clearly needed up front. It is not like they are starting from square one. We do have some infrastructure in place, more would be needed. And there are the personnel costs associated with the activity. Before all the other money such as tuition can come in, you have to have some upfront seed money. The ongoing expenses, after start-up is not the $52 million she keeps getting quoted.

She doesn’t think we need a $100 million building to pull this off. But on the other hand it will be critical that the community hospitals such as St. Lukes and Kootenai come on board and agree to allow students and residents into their facilities. This in and of itself is a hurdle as it will impact their business.

Rick asked what the PA program does for us. Linda said it is one of the ways we can lower the cost of health care. She said they have well over 600 applicants for their 72 seats.

Robin said he wanted the members to come away with the idea for collaboration to pull off creating a home grown medical education. There are too many political bones that have been found as they have tried to help along medical education. We need to get rid of those to make this work.

Meeting Adjourned to tour the facility.