In 1970, the combined population of the WAMI states (Washington, Alaska, Montana, and Idaho) was over 5.1 million, representing 22% of the U.S. landmass. A significant portion of this population resided in rural areas, with 46.6% of Montana residents and 45.6% of Idahoans living outside urban settings. During the 1960s, rural populations in Montana and Idaho declined by approximately 20%, while urban populations increased. This period also saw a severe national shortage of physicians, especially in primary care. By 1970, the U.S. faced a critical shortage of 50,000 doctors, particularly general practitioners or family physicians. Despite an increase in the overall number of physicians from 292,000 in 1965 to around 357,000. In 1972, the number of general practitioners decreased by 22% during the same period, exacerbating the healthcare crisis in rural and underserved areas.

To address this growing healthcare crisis, particularly in rural and underserved areas, innovative solutions were needed to bridge the gap in medical education and physician distribution. The WAMI (Washington, Alaska, Montana, Idaho) Medical Extension Program was established to decentralize parts of the educational and training program of the University of Washington School of Medicine.

The program allows students to take their first year of medical school at selected universities in the four states; they then join their colleagues in Seattle for the remainder of the basic curriculum. At the conclusion of the first two years, the students enter the elective phase of their education which is predominantly clinical in nature. During this period, WAMI allows undergraduate medical students to receive portions of their training and education at the University of Washington and from physicians in the communities--Community Clinical Units. This approach increases opportunities for residents to enter medical school, boosts the number of primary care physicians, and improves healthcare provider distribution in needed areas.

A most important part of the University of Idaho-Washington State University medical education program is the preceptorship. In this program, medical students spend four to eight hours a week with local physicians, becoming acquainted with medical practice and procedures from the very beginning of their medical studies. As indicated by student evaluations, this is one of the most interesting and valuable parts of their first year of medical education. Other program benefits include providing greater opportunities for area residents to enter medical school by increasing admissions to UWSM. It also increases the number of primary care physicians trained at UWSM and addresses the maldistribution of physicians in the WAMI territory by attracting more physicians to areas of need. Additionally, it brings resources from the Medical Center in Seattle to communities in the WAMI states for continuing physician education.

University of Idaho and WAMI Despite numerous efforts by the Mountain States Regional Medical Program and the Idaho Foundation for Medicine and Biology, Idaho faced financial and logistical challenges in establishing a full-fledged medical school. Key attempts included legislative actions and various feasibility studies aimed at assessing and meeting Idaho's medical education needs. In 1972, the University of Idaho (UI) and Washington State University (WSU) became an integral part of the WAMI program under the direction of Dr. Guy R. Anderson and Dr. Ronald J. Adkins. This phase allowed medical students to complete their first year of medical education at UI before continuing their studies at the University of Washington. The program received significant funding and resources, with endorsements from U.S. government agencies and educational institutions. This partnership with the UWSM addressed the healthcare needs in rural Idaho by training physicians locally and integrating medical education with community-based clinical experiences. Idaho's inclusion in the program was seen as a practical approach to overcoming the state's previous challenges in establishing a medical school.

The program's success was further highlighted by the support of President Ernest W. Hartung, who played a significant role in advancing’s medical education initiatives during his tenure. Dr. Hartung's leadership and the collaborative efforts with Washington State University stressed the importance of regional cooperation in medical education.

During WAMI’s initial university phase, ten medical students were enrolled at WSU and nine at UI for one semester. Students and faculty commuted the eight miles between campuses, classes being held on the Pullman campus in the morning and on the Moscow campus in the afternoon. The curriculum was tailored specifically to parallel that at the University of Washington School of Medicine. Operating costs were supported by subcontracts let to each school by the University of Washington under a major contract with the Bureau of Health Resources Development. Essential equipment items were provided through a grant from the Commonwealth Fund to the University of Washington.

WAMI’s Maturity Since 1972, this cooperative effort continued to be successful, and special courses have been developed to cover the entire first year of medical education. By 1979, the WAMI Program was fully operational, accredited, and recognized for its significant contributions to improving healthcare access and quality in the Pacific Northwest and Alaska. WAMI had already successfully trained 403 students in the University Phase and provided 953 student clerkship rotations in Community Clinical Units, significantly increasing the number of primary care physicians. Key figures like Dr. Roy Schwarz and leaders from various institutions were instrumental in the program's success. In 1996, Wyoming joined the consortium adding the second “W”.