Home to the Dartmouth College Health Services, Dick's House on Rope Ferry Road is the go-to location for Dartmouth students in need of medical or psychological evaluation on campus. Dick's House which employs 16 nurses, eight counselors, one X-ray technician and nine staff members in primary care and prevention seeks to address students' clinical needs, ranging from vaccine updates to more specialized medical procedures, according to Director of Health Services Jack Turco.
The health center offers an array of services and is comprised of seven departments, including a sports medicine section and pharmacy. When students' medical needs cannot be handled in-house, the student will be referred to Dartmouth-Hitchcock Medical Center, which is located approximately three miles away and has an extensive collaboration with the on-campus infirmary.
NATIONAL TREND
Although most universities' health centers had infirmaries approximately 50 years ago, many have recently eliminated their infirmaries due to budgetary constraints, according to Ted Grace, a part-time consultant at Hodgkins Beckley Consulting, which specializes in college health care. The College defies the national trend by maintaining Dick's House on campus, Grace said.
Only 10 out of 170 schools included in a 2009 survey by the American College Health Association maintain an on-campus infirmary, according to ACHA Communications Coordinator Rachel Mack. ACHA does not release the names of the schools that participated in its survey due to confidentiality agreements, Mack said.
The 10-bed infirmary at Dick's House is the only one on a college campus in New Hampshire, Dick's House Nursing Director Charlene Bradley said. Grace, who also serves as director of health services at Southern Illinois University, estimated that 13 schools nationwide have an inpatient infirmary. His estimate is based on an online listserv that includes medical professionals, he said.
"When you start looking at the budget crunch, administrations no longer want [their health centers] to keep elevating health fees," Grace said. "A major driver of costs is related to infirmaries."
While Brown University, Princeton University, Yale University and Harvard University maintain on-campus infirmaries, Cornell University, Columbia University and the University of Pennsylvania redirect students in need of medical attention to outside facilities, according to each institution's respective websites.
Eliminating an infirmary does not necessarily erase all costs associated with inpatient care, Grace said. Some hospitals in the vicinity of universities, for instance, have hired individual nurses to tend to each student in the emergency room at high costs to the universities, he said.
STAFF
Dick's House is staffed at all times by two nurses who are also responsible for the medical or psychological needs of students when the infirmary is closed. A mental health counselor and medical physician are also on call 24 hours a day, according to Bradley.
"The nurses are the mental health crisis counselors," Bradley said. "If the nurses have any questions about what they're seeing or what they're finding, that's when they call the counselor or physician."
In order to maintain their registered nurse licenses in New Hampshire, nurses must complete a certain number of continuing education hours, according to Bradley. Dick's House provides in-house programs to help them fulfill that requirement, he said. Four of the 16 nurses at Dick's House possess a certification in college health nursing from the American Nurses Credentialing Center. Although the ANCC college nursing certification was discontinued in 2005 due to a lack of continued nurse enrollment, nurses are still re-certified every five years in a process subsidized by the College, Bradley said.
The college nursing certification is an indicator to patients that they are receiving high-quality health care, according to a statement by the ANCC released to The Dartmouth.
"It shows that the [registered nurse] is qualified and experienced in a defined role and clinical area of practice, and has met rigorous standards to achieve this additional credential," the statement said. "To maintain certification, the nurse must show ongoing professional development and practice expertise in college health."
A formal recognition for college health nursing is essential because it demonstrates that college health is its own specialized field, according to Carol Kozel, ACHA's liaison to the ANCC and the nursing services director at the University of North Carolina, Chapel Hill.
INSURANCE PLAN
Students who receive treatment at Dick's House can use the College's student insurance package, the Dartmouth Student Group Health Plan, which provides extensive benefits and relatively low costs, according to Diane Plumly, chair of ACHA's Student Health Insurance Coalition and student health insurance director at Ohio State University.
All students are required to either purchase the College's insurance plan or have an insurance plan that offers equal services, Director of Financial Aid Virginia Hazen said.
All referrals by Dick's House to specialists at DHMC are covered by the College's insurance plan, Turco said. The plan also fully covers the physician and facility costs for emergency room visits, according to Ginger Lawrence, the Dartmouth Student Group Health Plan's supervisor.
The College's relationship with DHMC the only hospital Dick's House refers students to enables effective communication regarding a student's medical status, Turco said. He contrasted the College's situation with those at urban schools that refer their students to several different hospitals.
"We have the ability to have students seen [at Dick's House] initially, even if they are referred to [DHMC]," Turco said. "We know they were referred and because there's one medical center, it's easier for us to, with a student's permission, find out what when on and coordinate the care."
Plumly endorsed the close collaboration, explaining that physicians at the College's health services are more likely to be familiar with doctors at DHMC which allows them to easily refer students.
The insurance plan also covers athletes and other students even when they are off campus, and pays for all alcohol and drug-related medical treatments, Plumly said.
Insurance coverage for athletes is typically excluded at other schools, some of which also do not guarantee that medical care relating to drugs or alcohol will be included in college health insurance plans, she said.
The lifetime limit of $2 million per student under the Dartmouth Student Group Health Plan is generous compared to other schools, Plumly said.
President Barack Obama's health care legislation is sharply critical of the health plans at many small colleges that offer too few services, Turco said. The federal law currently mandates that college health insurance plans meet a certain standard in terms of the extensiveness of their services, but Dartmouth offers adequate services and will not be affected by that provision, Turco said.
All students on financial aid, regardless of the amount, have half of their student health insurance plans subsidized by the College and can pay for the other half through loans, according to Hazen.
Sharla Grass contributed to the reporting of this article.
