Some students may have been surprised by the additional $75 per semester Health and Counseling fee tabbed onto their tuition invoices. Many likely didn’t notice at all. But the new fee, introduced at the beginning of the school year, comes at an awkward transitional time for the Health and Counseling Center (HCC).
According to University Vice President of Financial Affairs Alan Timmins, the fee was implemented as a “catch-up” for all added costs to the HCC in the last four years, stemming from new programs like Green Dot, the new call line for mental health emergencies ProtoCall, and new positions like the coordinator for Early Alert, who takes calls and emails from faculty, staff and parents concerned about a student's mental health.
But while the Health and Counseling Center's mental health services have become more responsive and robust, the medical services offered have become deficient. A flood of staff departures has left students seeking prescriptions and care off campus, and there has been very little communication coming from the University about the health care options students have. Many are asking: “What exactly am I paying for?”
The university went without a full-time medical care provider licensed to prescribe medicine on campus from the start of October until late November, when an interim physician assistant from Providence Express Care was hired in the clinic. The University has hired two full-time nurse practitioners to begin work on campus next semester. One will start in mid-January, and one will start in mid-February, according to an email sent out by Vice President of Student Affairs Fr. John Donato two and a half days after a Beacon article reported several departures in the HCC.
The University is also rolling out a new health model called Express Care Virtual where students can have medical appointments virtually with a licensed health provider at Providence, according to Associate Vice President of Student Affairs Matt Rygg. The service costs $39 an appointment, but Rygg said the University will pay the fee. Students can access the service on any mobile device.
“We have been really trying to help students get what they need during this time,” Rygg said. “We understand that it’s not ideal.”
Donato’s initial email on Nov. 20 said the University would pay for students’ co-pays if they went to another urgent care center and would go as far as providing transportation to other health providers, whether it be paying for an Uber or offering a lift from a Public Safety officer.
The email came nearly two months after the university’s only full-time nurse practitioner Megan Volkov departed, and many HCC staffers didn’t even know they could offer students the options Donato detailed in the email.
“The first time that most of us knew we were doing that was when the letter came out to you all,” said Tiger Simpson, wellness education and prevention coordinator. “We knew that was an option. If somebody ever comes in with an emergency, we know we can get them places. But as far as advertising, as far as letting people know, we didn’t know we could or should be doing that.”
Many students were not aware of any options or amenities the University was offering in terms of care. Freshman Lily Landers, who is on the rowing team, enlisted her coach Pasha Spencer to drive her to an urgent care center when she believed she had pink eye.
“I knew we didn’t have a nurse and I thought we were kind of on our own after that,” Landers said.
The Fee
Timmins explained that the fee ($150/year) has been a long time coming, before the campus was down two nurse practitioners and a director of primary care.
“Basically, we looked back at the last few years and in that time, the services offered increased dramatically and prices too,” Timmins said.
In lieu of a hike in tuition (though the cost of tuition did go up by 4.4 percent from last year), Timmins said that a semester fee of $75 ($150/year) could help cover the added costs. Deciding on the fee amount was essentially a large math problem, Timmins said. The formula was an incremental increase in costs divided by the number of full-time students at the University of Portland.
The HCC has a budget of $945,000, which accounts for one-eighth of the Student Affairs budget, according to Associate Vice President of Student Affairs Matt Rygg. The health fee will now cover $500,000 of the costs, and the additional $445,000 comes out of overall tuition, according to Rygg. $700,000 of that amount goes towards salaries for the 11 full-time employees at the center.
Director of the HCC Carol Dell’Oliver, who started working at UP in August, did not respond when asked for more specific details about the cost of Health and Counseling Center programs and resources.
Both Rygg and Timmons said that the market price for health care professionals has gone up significantly in the past four years, and as a university, not a hospital, UP has struggled to keep up.
Timmins said there has been a 25 to 35 percent increase in the salary budget at the HCC over the past four years. Much of this though has come in the form of new hires, not raises.
“The market is really, really tough and we made a commitment to increase the salaries of the nurse practitioners and even with the increase we were not able to retain the nurse practitioners that we had,” said Rygg, who was put in charge of the Health and Counseling Center just over a month ago. Donato previously presided over the department.
Rygg said the University also added a myriad of programs and positions in the last year and a half that has caused an increase in expenses, including an additional full-time psychologist, a partnership with the consultative group JED Foundation, ProtoCall, and Gina Loschiavo’s position of coordinator for Early Alert & Special Projects.
Timmins said the fee was a part of the overall tuition cost approved by the Board of Regents, and for now, it will stay stagnant, instead of increasing incrementally the way tuition does.
A Rocky Start
Medical services at the Health and Counseling Center have become increasingly scarce throughout this semester. At the start of the year, Volkov was the only nurse practitioner in the clinic.
When she left UP for Portland State University on Sept. 29, the HCC became unable to offer any services just as flu season was about to begin.
“Zero. We could do absolutely nothing,” Simpson said. ”So even for instance, Susan (Chisum, former director of primary care, who resigned last month) was a registered nurse. Susan could see people but she can’t prescribe. She can’t diagnose. So it was really redundant. Like why come to us? Because we’d have to send you somewhere else to get actual medication or actual treatment.”
Several students rely regularly on the nurse practitioners on campus to get prescriptions, and some were upset because no one alerted them when Volkov left for good.
Senior Tatiana Spisz wouldn’t have known that her health provider had left campus if she hadn’t been working a shift at the Pilot House coffee bar during Volkov’s last week.
“I literally ran into Megan (Volkov) at work in the Pilot House,” Spisz said. “I was making her coffee and that reminded me that I had wanted to check in. And so I said ‘I want to get into see you soon and she’s like ‘Oh well Friday’s my last day.’”
Spisz had previously relied on the Health and Counseling Center to issue her prescriptions for antidepressants and anti-anxiety medication. Without a car or an established relationship with a care provider outside of campus, Spisz scheduled an appointment with Volkov a day before she left, and Spisz said Volkov wrote her a prescription for the rest of the year.
Still, Spisz’s treatment is up in the air until she finds a more stable provider off campus.
“It’s been really frustrating because even though I wasn’t seeing her as a therapist, Megan knew almost everything,” Spisz said. “She knew my whole medical history, so I felt really comfortable. It was really nice to just have her around and know that I could go see her.”
While Spisz was able to schedule an appointment at the HCC before Volkov left, other students weren’t so lucky. Junior AnneMarie Scott called the HCC office at the start of October to refill the prescription that Volkov wrote her over the summer for severe stomach problems. She was told over the phone that Volkov was gone and she’d have to go somewhere else for care. She said that none of the clinics she was referred to accepted her insurance.
“I’ve spent a couple of weeks just living with these problems because my insurance charges me a hundred dollars for urgent care and I just simply do not have the money to go some place else,” Scott said.
Two weeks ago, Scott ran out of her three-hour Monday night class early because her abdomen was in so much pain. But obtaining care somewhere else has been difficult and expensive.
“I just don’t understand,” she said. “It’s supposed to be something that’s easily accessible for students.”
In reference to questions about the Health & Counseling Center’s lack of communication with students, Rygg said that the University doesn’t usually send out emails to students when members of staff depart. “I mean we don’t do that for any department,” he said.
A health center at a university differs greatly from regular clinics, but on page 21 of the physician handbook provided by the Oregon Medical Board, it is said to be common ethical practice to notify patients when their relationship with a physician has ended, “to give the patient adequate notice to allow time for the patient to establish a new relationship with another healthcare provider.”
Simpson said that the University hoped to fill the position rather quickly, and refrained from letting students know as to not cause alarm. However, Rygg said that finding an interim practitioner was a long process.
“We partnered with two temp agencies as soon as we knew that there was going to be a vacancy and it took weeks to work on the contract because it had to be reviewed by both legal offices,” Rygg said. “These processes take a long time.”
One interim nurse practitioner started mid-October and was gone from the university within a 24-hour period. Another temp began on Tuesday, Nov. 14 and left within the same time frame.
“When the person got here, it wasn’t a good fit, both times,” Rygg said. “We didn’t want to sacrifice student health and so it was important for us to maintain the highest standards of excellence.”
Simpson said that the current interim physician assistant is more likely to stick around.
“With temp agencies you can hire someone who’s still licensed but that doesn’t mean that they’ve practiced recently,” Simpson said. “This person, from my understanding, has been practicing and also has experience in this demographic.”
A physician assistant is different from a nurse practitioner. While a nurse practitioner can work alone, a physician assistant must work under a supervising physician. This is why the University is partnering with Providence Express Care. A physician will work remotely with the interim PA, and Rygg said that the standard of care should be back to where it was before the departures.
Moving Forward
Now that the University has hired a more stable temporary replacement for Volkov and two more permanent practitioners will be joining the clinic next semester, the center can focus on filling other vacancies.
Like Chisum, the nurse who was director of primary care, receptionist Aubrey Holt also left the center in November. Neither positions have been filled as of this week, but Rygg said that the University is looking to fill them as soon as possible.
In the meantime, staff has been doing double duty to make up for the departures. Walking into the center in Orrico Hall, students can find Simpson and medical assistant Lisa Van Tilburg answering phone calls at the front desk.
“It’s getting jumbled up between quite a few different versions of us,” Simpson said. “If somebody calls and requests medical records, we have to get them in there. It’s not a, ‘tough luck, you have to wait.’ Between all of us, we try and get stuff done.”
Rygg said the University is considering changing the position of medical receptionist to “medical administrator,” shifting more responsibility to the role, which is currently still vacant. But nurse practitioners still have no medical professional to report to at the HCC after Chisum’s departure. Director Carol Dell’Oliver is a licensed clinical psychologist.
However, the staff feels optimistic that the incoming nurse practitioners will help relieve many of the challenges the HCC has faced.
“We’ve all met them,” Simpson said. “They got the demographic. They’re both great ladies. It seems like they would be a good fit.”
But Simpson said that it would be a few weeks into the semester before appointments would be back to their usual capacity after the mass departures this year, as the newest practitioners will begin training as the spring semester begins.
“You could be a physician's assistant or nurse practitioner for years, but it doesn’t mean that you know how to use the computer program that we have,” Simpson said. “The number one thing is I’d rather bring in less people and make sure they get quality care than try to jam a bunch of people in and be like ‘I think we got your diagnosis right, good luck!’”
The HCC is still fully staffed with mental health counselors, and Simpson encourages students to come in and talk any time they need to, even if they feel like it’s not an emergency.
And if students are still frustrated, wondering, “What am I paying for?” Simpson says the best solution is to make their voices heard.
“I would encourage people to keep asking the questions,” Simpson said. “And students have the power, so if students have questions or concerns, talk to Fr. John, talk to Carol, talk to me. Use the power you all have cause your voices matter. And ask the question you want to ask because you deserve an answer.”
