IVY LEAGUE HEALTH SERVICES:

When U.S. News and World Report ranks the nation's colleges every year, it makes comparisons based on everything from the quality of professors to the caliber of athletic fields.

On this campus, students are often curious about how other schools measure up to Harvard in each of the categories.

But the magazine has consistently stayed out of one complicated component of the academic institutions--their health care programs.

How does Harvard's University Health Services (UHS) match up with other schools' health services? Are Harvard students receiving the best medical care, or can the University improve its health services by learning from its counterparts at other schools?

A look into the health services at UHS and its counterparts at Yale University, the University of Pennsylvania and Princeton University reveals that the students at these schools generally receive the same level of care.

While appointments may be obtained faster at one school, or doctors may be friendlier at another, the systems share the same basic structure.

Primary care appointments in each school are handled by a mixture of nurse practitioners and physicans, and appointments with specialists almost always require a referral after a primary care visit.

One aspect of UHS that does distinguish it from most other systems is the sheer volume of its work. While health services on other college campuses usually treat only students, UHS also cares for faculty, staff and retirees--comprising about half of its workload.

But the large scale and broad scope of Harvard's program is a blessing in disguise for the students, according to Dr. David S. Rosenthal, director of UHS.

"It works to the benefit of the students because it allows us to have more services available for the students," Rosenthal says.

In comparison to the services offered by most smaller schools, Rosenthal says, "We're pretty rich when it comes to health care."

However, students at other schools can obtain those same services from specialists. Instead of having specialists from affiliated teaching hospitals come to the university, as done at Yale and Harvard, many colleges send students to nearby hospitals--where they may be seen sooner than the students waiting for care on campus.

Rapid Access?

One of the most common complaints among college students about campus health care is that they have to wait too long to be treated in a non-emergency situation. In the last few years, both Harvard and Princeton have changed their appointment systems to alleviate such problems.

Three years ago, UHS replaced its walk-in clinic, in which students waited--sometimes for hours--to see the next available doctor, with its present policy of arranging same-day "rapid access" appointments.

"With the walk-in system, students often had to sit and wait up to two hours because everyone tried to come between their classes," Rosenthal says.

Princeton adopted a similar shift 18 months ago, says Elizabeth B. Langan, director of administration at Princeton University Health Services.

"We have enough open appointment slots that we can usually fit students in to see someone the same day," Langan says.

Langan says that about 50 percent of the students who go to Princeton's health service are seen by nurse practitioners. But no more than 20 percent of students consulting Harvard UHS receive primary care from the nurse practitioners, Rosenthal says.

Yale and Penn still work on a walk in system, though they also give students the option of scheduling appointments with physicians or nurse practitioners ahead of time.

"We try to see everyone within two days, but sometimes it takes a bit longer during flu season," says Dr. Marjeanne Collins, the director of Penn's Student Health Service.

Collins says the majority of students at Penn are seen by physicians, although the primary care staff of 13 includes two nurse practitioners.

Officials from the health services at all four schools say that appointments with most specialists first require a referral from a primary care visit. But while nonurgent cases often take a back seat for weeks at Harvard and Yale and Penn, Princeton students receive more prompt attention.

Langan says that because the Princeton community is "so much smaller than at larger settings such as Harvard," most patients can see their specialists--who come in from local hospitals--within the week.

"We don't have a crunch with specialists," Langan says.

A Crimson survey of the four health services also found this difference in the speediness with which appointments could be obtained. When the services were called and asked the date of the next available appointment in a number of departments, Princeton consistently quoted the shortest wait (see table).

Personal Touch

While competency and efficiency are clearly key components of a quality health service, some of the campus health programs specifically work on making students feel comfortable. And Yale appears to be a leader in this area.

"I think you have to have trained personnel whose specialty is this age group, so most all of our people here are trained in adolescent and college health," says Dr. Jane S. Rasmussen, the chief of undergraduate medicine at the Yale Health Plan.

"You have to like this age group to do a good job," Rasmussen says. "We can't be upset when college students question our authority, because that is the nature of this age group. But some doctors would get upset because they want their word to be accepted as fact."

Rasmussen says she monitors new physicians and nurse practitioners for the first 90 days to make sure they are doing their jobs correctly.

As for Yale's new students, Rasmussen says her staff gives first-years special attention because "Mom has always been there" to make appointments and to check that they are taking medicine. "And these patients can be difficult because they don't always understand the symptoms," she says.

Princeton's health service holds an orientation program that is attended by about 85 percent of the first-year class, says Dr. Pamela A. Bowen, director of the Princeton University Health Services.

In addition to routine immunization shots and measurements of height and weight, "We give them a tour of the building to show them where everything is located, which is an easy way to make them comfortable coming in for treatment," she says.

Harvard and Penn distribute handbooks at the beginning of the year, providing students with detailed information about the health services' resources--including everything from primary care to mental health treatment.

UHS also distributes a handbook that deals solely with peer counseling and health education groups at Harvard, including Room 13, Peer Contraceptive Counselors, the Eating Concerns Hotline and Outreach and other organizations.

The different health systems all have efforts in place to work with students in improving their services. For instance, Harvard has a Student Health Advisory Committee to keep lines of communication open between UHS and students.

"It's a good way for us to hear about student issues and perceptions so we can address them," Rosenthal says.

Princeton and Penn have similar committees.

One final area in which the four schools are on par is their apparent commitment to eliciting feedback from all of their patients.

While Harvard conducted a survey last fall asking students to evaluate their services--which Rosenthal says produced "lots of useful information"--Penn's health service polls its students twice each month for half a day at a time.

Collins says the Penn questionnaires ask students to "evaluate the efficiency and professionalism of everyone from the front desk to the doctor."

Princeton polls students in its clinical area four times per year, but Langan says the complaints at Princeton rarely concern more than dissatisfaction with the infirmary food or a long wait for an appointment.

"For some people, 10 minutes is a long wait to see a doctor. Basically, we try to respond to everyone's complaint with a call or a letter and talk about it," Langan said.

Students at the different universities are also encouraged to talk to a health service administrator whose primary responsibility is to consult on their complaints. At Harvard, Patient Advocate Kathleen Diaz fills this role.

Furthermore, the directors all say their doors are open if students want to talk to them about their concerns.

"I'm available to see anyone who has a question about anything from financial aid to the quality of our health care," Rosenthal says.

The health service officials do not project any major changes in the near future, but Collins says Penn is making a concerted effort to better meet the concerns and needs of international students.

"One of our goals is to work with the officers of the international program because international students come from different cultures and have different languages, and they have different expectations of health care."

While some university health services may be a step up in some areas, but less attentive in others, the overall accessibility of health care at the schools is comparable. In fact, it seems safe to hazard a guess that U.S. News and World Report will not be initiating a health care category any time soon. Long Time No See?

The Crimson called undergraduate health services at a number of schools last week and asked how long it would take to set up appointments with physicians in the following areas. According to secretaries in the different departments, these were the current waits for non-emergency situations.

Standard Physical  Dermatology  Ophthalmology  Ort hopedics  Dentistry   If you have a case of severe acne.  If your eye has been irritated for a week  If your knee has been bothering you for a couple of weeks  If you have a toothache for a week Harvard  more than a week  four weeks  one week  two weeks  one week Penn  within 24 hours  four weeks  three weeks  two weeks  one week Yale  one week  four weeks  24 hours  four weeks  n.a. Princeton  within 24 hours  one week  n.a.  one week  n.a.

n.a.--The health service doesn't have a specialist in this field, so an appointment is arranged for the student at a local hospital.

NOTE: Dermatology, ophthalmology and orthopedics appointments can only be made after referrals from primary care.