Anchorage resident Monica Wright will graduate from medical school in May at age 43.

The mother of two completed most of her degree in Alaska -- a state without its own medical school, but one that participates in the WWAMI program, named for the five partner states of Washington, Wyoming, Alaska, Montana and Idaho.

The state-funded program provides a fixed number of Alaskans with spots at the University of Washington School of Medicine, affording them the chance to complete most of their schooling in Alaska. To pay back a state subsidy that drops tuition costs to in-state rates, students must provide years of post-graduate service in Alaska or send the money back to the state.

WWAMI graduates currently represent about 14 percent of the state's practicing physicians.

Last week, the Alaska House of Representatives passed an operating budget calling for the program's eventual elimination. A cohort of 20 Alaska students will enter WWAMI in 2015 as what could be the final class. The program will phase out by fiscal year 2020, according to the budget amendment.

In the coming weeks, the state Senate will decide whether or not the elimination will stick. Alaska WWAMI has hired a lobbyist to fight for the program to continue in the state.

WWAMI's goals include making medical education accessible to students who live in Northwestern states that lack independent medical schools, as well as helping those states meet physician workforce needs, according to the University of Washington's website.?

Wright said that without WWAMI, she would likely never have "MD" behind her name. She received an undergraduate degree in advertising at Northern Arizona University, moved to Alaska and had children. The desire to have a family trumped her childhood goal to become a doctor.

But in 2005, she found herself working with Providence Alaska Medical Center in Anchorage. She said she asked if the hospital hired many Alaska doctors. Her client said yes, through WWAMI. Two weeks later, with two children in diapers, Wright signed up for a chemistry class at the University of Alaska Anchorage.

She sketched out an education plan, motivated by the prospect of completing medical school without having to uproot her family. In five years, she completed her undergraduate requirements while working full time. She only applied to WWAMI. She got in. To pay for four years of medical school, she would take out more than $200,000 in loans.

"We're going to be the future doctors of Alaska," Wright said of the WWAMI graduates. "If it's not us, who's it going to be?"

She said she hopes to move to rural Alaska with her husband to work as a family practitioner after she completes her residency and her children graduate from high school. She said she wants to take care of a small community.

In many Alaska communities, especially in rural parts of the state, health care facilities continue to struggle to recruit physicians, she said.

"We don't have enough doctors right now, so to cut off this stream of doctors is just not the right decision," she said.

A 'great program'

Rep. Lynn Gattis, R-Wasilla, pushed the budget amendment that would have the Alaska Commission on Postsecondary Education end the contract with the University of Washington Medical School. The termination clause requires three years' formal written notice, the amendment said.

Gattis described Alaska WWAMI as a "great program," one that provides Alaskans with opportunity, but which also costs the cash-strapped state millions of dollars each year.

"I would say that many of the programs that we are cutting are great programs," Gattis said. "We just can't afford them."

Tom Nighswander, assistant regional clinical dean for Alaska WWAMI, said without state funding, Alaska could not continue the contract with the University of Washington. The 20 seats held in the program for Alaska students would be lost.

"Instead of having our own medical school, we buy seats in a medical school," he said. "Without the contract with the University of Washington, our students would really be behind the eight-ball."

Alaska WWAMI started in 1971 in Fairbanks with just five students. By the time it moved to Anchorage in 1989, the class size had grown to 10. In 2007, the class size doubled to 20.

Shelby estimated about 80 Alaskans complete the WWAMI application process each year, and she believes the program could expand.

"I would feel very comfortable increasing the class size to 30," she said. "It's a big, robust pool (of applicants) for the size of population that we have."

Next school year marks the first time Alaska's WWAMI students will spend the first two years of medical school at UAA, traveling to Washington for about eight weeks instead of their full second year. The students spend Years 3 and 4 in clerkships, when they can travel between any of the five WWAMI states to learn different facets of medicine, Shelby said.

Nighswander said it took years to build the program's capacity to keep students in Alaska for the first two years. He said he fears that if the program disappears, it would not be able to bring back all of the clinical faculty it currently prizes.

"If you dismantle the program, you can't restart it again," he said.

Rep. Matt Claman, D-Anchorage, introduced an amendment on the House floor last week to keep the WWAMI program. He said its elimination was short-sighted. The amendment failed.

"This is what we call penny-wise and pound-foolish," Claman said of the WWAMI elimination. "The result is that we will have fewer general practitioners."

Costs to the state

In fiscal year 2014, WWAMI cost the state about $2.9 million to support 59 second, third and fourth-year students. UAA provided funding to support students in their first year. More than 70 percent of the state funds remained in Alaska to pay for classroom and clinical teaching, said Jane Shelby, director of Alaska WWAMI.

"We are sharing the cost of medical school, so to speak, with all the other states," Shelby said. "That makes it very cost effective."

The students pay about $30,000 in tuition costs per year.

Shelby said once the Alaska students graduate and complete their residencies, they can either pay back the state or complete three years of service in rural Alaska or five years in an urban part of the state. Most return to Alaska, she said.

In 2015, 202 WWAMI graduates actively practiced medicine in Alaska, making up about 14 percent of the physician pool. The next largest group of physicians -- 3.1 percent -- come from the University of Minnesota, according to data gathered by WWAMI.

Between 1971 and 2011, Alaska helped pay for 348 WWAMI students, Shelby said.

According to a 2012 Alaska Health Workforce Vacancy Study completed by UAA, rural areas suffered from "extreme shortages" of primary care providers. Rural vacancy rates for family physicians were around 21 percent.

Cody Augdahl, 33, is in his third and final year of residency and recently signed a contract with the Norton Sound Health Corporation in Nome, the Western Alaska hub where he was born. He said he will start in September, practicing full-spectrum family medicine.

WWAMI, he said, exposes students from all over the Northwest to Alaska. He said eliminating the program is not in the best interest of Alaskans, and it would represent choosing not to invest in the potential of the state's young people.

"I think it's just another sad step in the wrong direction," he said.

Sen. Mike Dunleavy, R- Wasilla, chairs the Senate Education Committee and called WWAMI a "good program." But, he said, with the state facing a "catastrophic revenue shortfall," many good programs stand to lose funding, such as pre-kindergarten education.

Dunleavy would not directly say whether he personally felt like WWAMI should stay or go.

"I am rendering things through the lens of 'Is it constitutionally mandated? Is it a fundamental program?' " he said. "This is not constitutionally mandated. This is not a fundamental program. So does it lie on the outer edge of programs that may be cut? Sure it does, for those reasons."