A common—and often challenging—aspect of the adjustment to college life is seeking healthcare both on and off campus. Finding quality care, trustworthy providers and common-sense solutions can be a hard-to-reach balance. Vassar’s Health Services aim to ease that stress by providing accessible, equitable care on campus. But for years, students have expressed conflicting perspectives on whether the service delivers the standard of care that it sets out to provide. Recently, these concerns have been exacerbated as Health Services deals with simultaneous staffing struggles and a ballooning number of patients.
Earlier this year, Margot Schinella ’06 was brought on as the new Director of Health Services and immediately set out to raise the standard upon her arrival. “A priority for me as a Director of Health Services was to increase awareness of, and accessibility to, medical services on campus,” she explained. She continued, “I have been actively working on expanding how our department can better support all of our students in an equitable and inclusive manner.”
Since her arrival, she’s acted on these priorities: recently adding services including HIV prophylaxis through PrEP preventative treatment therapy initiation, gender-affirming hormone therapy management, IUD and Nexplanon placement and removal of long-acting contraceptive options.
Still, Health Services is facing challenges—namely, struggles with staffing.
Lately, students are feeling the impact. One student, who asked to remain anonymous for privacy reasons, explained that they recently had to wait 45 minutes to see a provider after twisting their ankle, before the staff finally sent them to a healthcare provider working in Vassar’s gynecology unit. The provider instructed them to wrap the ankle, but upon following up with a physical therapist not employed by the College, it turned out that the gynecological provider had provided incorrect information.
In response, Schinella stated, “All of our providers are either board-certified Family Nurse Practitioners or Physicians Assistants. We do not have a gynecologist on staff, however we do have providers who have many years of experience and training in specialty areas such as gynecology, emergency medicine, and pediatrics.”
Another student spoke of a similar situation, indicating that understaffing may feed into a broader lack of expertise, thus creating two separate roadblocks for providing quality care. “In certain circumstances, they can be helpful. But often, they don’t really know what is wrong with you,” they explained. They added, “[Health Services] pretty much [does] not know how to handle my [chronic] illness, which is a shame because they are some of the only people who can actually put me on health advisory when I’m not feeling well, which can be often.”
To address this concern, Schinella assured that Health Services works in consultation with a student’s specialty provider to manage chronic illness and would help refer students to local specialists if deemed necessary.
Schinella explained that Health Services is not technically understaffed but is instead adapting to a significant increase in visit volume. From Aug. 1 to Sept. 30, 2019, Health Services had 409 nurse visits and 536 medical provider visits. This semester, during that same timeframe, they handled 1,119 nurse visits and 853 medical provider visits. Accommodating this rise has required a score of creative measures, including adding on-call nurses and a part-time physician’s assistant, as well as contracting with an outside provider to offer extended medical services.
Although Health Services postponed many routine services last year due to COVID-19, they have returned to providing routine in-person visits this semester while also expanding to include virtual telehealth options. At the same time, Schinella suspects that students are now more aware and mindful of their personal health due to the pandemic. “Students are seeking evaluation for any and all symptoms of concern, whereas in the past they may have tried to just manage it on their own,” she stated. She also added, “I feel that students are acting out of an abundance of caution to help protect the Vassar community and therefore are seeking out healthcare and testing more frequently than in previous years.” On top of that, Health Services is dealing with the onset of the cold and flu season, which experts predict will be severe this year.
All in all, these factors mean that Baldwin is experiencing a patient volume far outpacing that of years past—and expansion may come slowly.
“Despite advertising for open positions in our department, we have not had an overwhelming number of qualified applicants. We continue however, to pursue interested candidates and are also working with temp agencies to fill in staffing gaps when needed,” Schinella said. She clarified that due to the physical and emotional toll of the past 18 months, staffing is currently an issue across the healthcare industry, amongst others, and is not a department-specific occurence (Business Insider, 2021).
Dean of the College Carlos Alamo-Pastrana added that COVID-19 has served as a reminder of the necessary priority that the college should give to Health Services’ resources. “We have not reduced any of the resources devoted to patient care and student service in Health Service as a result of COVID-19. Rather, the College devoted additional funds to help support some of the needs in Health Services during this time, including for things such as testing, housing, and EMT coverage in the evenings,” Alamo said.
Going forward, Schinella stressed that she is managing Health Services’ growth with deep, personal principles in mind. “I think that quality healthcare stems from a foundation of inclusivity and equity. I have been working with my team to strengthen this foundation in our department and we will continue to integrate this into our current practice of compassionate care,” she explained. As far as student concerns go, Alamo encouraged students to reach out to him, Dean Inoa or Schinella with any grievances. “The three of us are passionate about ensuring that students are getting the care they need. We will continue to work hard to assess, improve, and create the best possible experience for all students when they go to Health Services,” he emphasized.