A Medical Economics Web Exclusive

College health—the career choice for me

A college health physician describes a typical day on her job—and the many reasons why she loves it.

By Laurie Elwyn, MD
FP/Fort Collins, CO

"Have you been running a fever?" I ask the young man on the exam table.

"Yeah, man," he says, nodding his head, dreadlocks swinging wildly. "I was so hot, the other dudes could feel it from across the room."

Suppressing a smile, I ask, "Did you take your temperature?"

"No, dude, I don't have one of those things."

Those thermometer things, I assume he means. Of course he doesn't have one; almost none of my patients do. I'm a physician at the student health center of Colorado State University in Fort Collins. A thermometer is probably not at the top of anyone's list when packing for college. This teenager is unique, though: Never in my 17 years of practicing medicine have I met a patient whose fever literally heated up a whole room. And never before have I had a patient refer to me as "dude"!

The next patient enters my office, plops down in the chair next to my desk and tells me about her URI symptoms. After listening to her recitation, I guide her up onto my exam table. Tongue blade in hand, I ask her to open her mouth, and she says, "I don't want you to be shocked, but I had my tongue pierced." I assure her that I can handle it, and proceed with the exam. I don't say so, but I could probably shock her with tales of the piercings I've seen.

Another teenager with a cold comes next, followed by a young woman with an ankle sprain, and a 21-year-old man with concerns about STDs. In the afternoon, I sew up a finger laceration, refer a Taiwanese woman to an ENT for a peritonsillar abscess, and field a phone call from an anxious mother 600 miles away.

Then it's time to go home, and I really go home. I'm completely free to concentrate on my family because I have no after-hours call and no weekend work.

Why I love my job

My job as a college health physician is ideal in many ways. True, I don't make the salary I might in private practice, but my work is challenging and satisfying. And some days, I really do make a difference. Sometimes it's as simple as recommending over-the-counter cold medications to a student who has never had a cold without Mom there to help. Often, it's acting as a surrogate parent, offering sympathy and calm reassurance to a frightened student far from home.

Lots of times, it's lifestyle counseling.

"I don't know why I'm so tired all the time, I can't even stay awake in class," one student complains.

"How much sleep are you getting at night?" I ask.

"I usually get at least four or five hours," she replies.

Bingo!

Years ago, college health physicians got a bad rap. College health centers were sometimes seen as the bastion of last resort for physicians almost ready to retire, or those who couldn't make it in private practice. A colleague regales me with horror stories of some of the physicians she worked with 15 years ago. One older gentleman was notorious for falling asleep with a patient in the room. Another was less than accurate in his aim: He froze the skin a good centimeter away from the wart he was trying to treat. And one was dismissed for self-prescription of narcotics. But times have changed.

Now, I work with a staff of six other physicians—some of the brightest and most dedicated I have ever encountered. Our clinic also has numerous nurse practitioners, a part-time psychiatrist, and a dental clinic. And there are weekly visits from a dermatologist, allergist, optometrist, gynecologist, and orthopedic surgeon. My job is made easier by a full staff of health educators in our building, as well as drug and alcohol counselors. And the campus counseling center is only a few buildings away.

With fully equipped lab, X-ray, pharmacy, and physical therapy departments, we provide one-stop shopping for a campus of 24,000 students. We're also blessed with easy access to the city hospital, good relationships with community physicians, and most of the resources we need close by.

Although many of the students have health insurance, our billing system is simple. A health fee, paid by all students each semester with their tuition, covers unlimited clinic visits. Our pharmacy, lab, and radiology charges are billed to the student's university account held through the bursar's office, so no cash is ever required. If needed, receipts are provided to students to submit for third-party reimbursement. Although not without some insurance hassles, such as preauthorization battles for medications and tests, mostly we are free to concentrate on medicine.

College health: anything but dull

A misperception of those outside college health is that our days are filled with simple diagnoses like colds, STDs, and minor injuries. True, like every primary care physician, I have days when the most interesting patient has exudative pharyngitis, with really big tonsils. But because of the large population of foreign students and the propensity for college students to travel, some days are anything but mundane. Several times every year we see a case of malaria or another unusual infection.

And the increasing number of older students also keeps us on our toes. A few years ago, a woman in her 70s was a familiar sight around campus. She rode an antiquated bicycle, dressed in layers of stale-smelling clothing, and was rumored to be homeless. As a senior citizen, she was allowed to attend the university tuition-free. Without health insurance or any means of support, her medical concerns were challenging.

Sometimes I would groan when her name appeared on my daily schedule, knowing how little I could do to help her. She seemed to be having a series of TIAs, but refused any workup of her "spells." But I'll never forget the day she told me about her childhood, complete with daily whippings across her bare legs. As I handed her a tissue for the tears pooling on her wrinkled cheeks, my feelings for her turned to admiration that she was still physically and mentally active and pursuing her education.

The students from the university's veterinary school can pose challenges, too. Not only do they sometimes come in with interesting zoonoses, they also teach me things. I recently learned that when a horse has strep throat it is called the "strangles," and that fluoxetine can be used for cats with behavioral problems.

There are more than 900 institutional members of the American College Health Association. Some health centers are small, with just a part-time nurse on staff, and some are large and all-inclusive like the Hartshorn Health Service at Colorado State University where I've been practicing for the past seven years. But virtually all college health centers emphasize preventive care. In fact, the university administration encourages us to view every encounter with a student as a "teachable moment."

My final patient at the end of a long day has a temperature of 104.1 degrees. Surprisingly, he doesn't appear especially ill. When I remark on his fever, he says, "Yeah, I thought I might have one. I think it's so high because I've had my coat on all day." Aha, I think, another teachable moment!

Interested in a career in college health?

According to the American College Health Association in Baltimore, the median salary for an FP working as a college health physician was $91,800. This figure is from the association's 1998 survey, the most recent one available. For more information on job openings, check out the organization's online classifieds at www.acha.org (click on "Professional Development & Networking").

Laurie Elwyn. College health--the career choice for me.

Medical Economics

Sep. 19, 2003;80.