Underfunded and understaffed, Student Health Services is buckling under the pressure. Students say they’re “rushed in and rushed out” and “feel like [they’re] going to get screwed over every time”. Many have given up on Student Health Services altogether. There are steps being taken by senior staff, however, that could significantly improve things. Staff care deeply about their work, but students still complain. Critic Te Ārohi investigates.
When Tai* called Healthline about the severe heartburn and stomach pains he was experiencing, they told him he needed to see his GP in the next 24 hours. When he told Healthline that his GP was Student Health Services (SHS), and that they were booked out, they told him to ask for an emergency appointment the next morning. Tai called up right as SHS opened, and after waiting for an hour on the phone, he was told that there were no more emergency appointments available for the day. The earliest he could be booked was three weeks away.
After being passed between SHS, Urgent Doctors and the Emergency Department at the hospital, Tai gave up and went to his family doctor in Invercargill. “From now on, I 'see' my doctor at Invercargill using phone or video chat consults because it is far easier that way than waiting for Student Health.”
Tai’s story is not unique. After falling and cutting her elbow, Leah “just needed a plaster” and popped into SHS on her way home to see if they could help her out. Leah said “they were like ‘you need an appointment and there's nothing for 2-3 weeks’,” and felt that SHS could have just given her a plaster and she would have been on her way. But it’s not all skin-deep; other students had more serious issues they felt SHS should have been able to see them about.
“This year I've gone to the emergency doctor to treat a really bad chest infection just because Student Health couldn't get me in for two weeks,” said Megan. “I was up before 8am calling every morning for those two weeks, but every time I called, the line was booked or the spots for the day had been taken.”
“They tell you you can make an appointment in a month's time [but] by then your sickness will have either gone or developed into something much worse that requires urgent doctors,” one student remarked. Another student had a surgical cut that was infected, and wanted to get it checked out. “I kept trying to get an appointment and they [SHS] were like ‘we've got none, go to the Emergency Department’ and the Emergency Department was like ‘go to Student Health’ … It feels very disconnected at the moment because they are so understaffed and overworked.” A dozen other students we interviewed agreed, with one saying that “it feels like you can’t get the help when you need it cause the wait is so long”.
Even when students have managed to book an appointment, some were left waiting for a call from SHS. Kayli had a telehealth appointment recently that was scheduled for 4:00pm. “I start work at 5:00, and at 4:30 I need to get ready for work. They still hadn’t called by then, so I called in and they said ‘very soon’, and then they didn't actually call me until 5:10 and by then I was at work. Not really a comfortable place for a telehealth appointment.” Four other students had appointments they were told they would receive a follow-up call about. They never received a call, and weeks later (months later, in some cases) they called SHS and were told that their follow-up call had simply been lost in the system.
58% of the respondents to our annual census said they’d had issues with booking appointments at Student Health, and another 22% said that while they hadn’t, their friends had. Margaret Perley, Head of Student Health Services, told Critic that routine appointments currently have a three to five week waiting time and acknowledged that it’s “a struggle”. In addition to routine appointments, there are also a limited number of urgent and same-day appointments available, but “when they’re gone they’re gone,” which, in practise, means students have to call up exactly when SHS opens at 8:30 in the morning and hope they get through before all the appointments are gone. Gemma, one of the students we interviewed, said that “You have to have the number plugged into your phone ready to call when they open. If I woke up five minutes after they opened I’d have this feeling of defeat ‘cos I still couldn't go to a doctor."
Margaret told Critic the number of same-day appointments available depends on the amount of staff working that day. This can range from “15-20” appointments to “quite low numbers” and on a bad day they “may not have any” same-day appointments available. SHS will reserve some urgent appointments throughout the day, but acknowledged that these may often be all booked out too. Richard Mooney, the SHS mental health and wellbeing leader, said to Critic that “students may call with urgent concerns, but we do have a finite resource and we're acknowledging it's diminished quite significantly”. He stressed that in those cases it’s important to go to the Emergency Department or other options, and that SHS can help students explore other options if needed.
Margaret noted (and students agreed) that behind the backlog of appointments is “a huge issue with GP staffing in New Zealand and worldwide, and that's been a problem prior to Covid as well”. The funding for student health comes partially from government subsidies, but most is paid by students in the form of the Student Services Fee and the appointment fees at SHS. Student Health Services is budgeted to employ the equivalent of 10.88 full time staff (FTE), but as Margaret explained, they’ve currently only got about half of that. “We're currently running with 4.65 vacancies for GPs. That's huge.”
There are steps being made to hire more staff, and Student Health Services has just finished the paperwork to hire 2.4 FTE for next year. However, Margaret reckoned there are a few other factors affecting the dearth of available appointments. Firstly, there’s the newcomer: Covid appointments. “Because there's full PPE for the doctors… those appointments are for a longer time period and therefore there's less capacity.” Second, Margaret pointed to the “complexity of appointments”, particularly when it comes to mental health appointments. This involves a higher workload as the issues students are coming in with are “not as simple as they used to be for a GP appointment.” But Richard and Margaret both stressed that taking care of students, both mentally and physically, is the top priority of every Student Health staff. There just aren’t enough staff.
The vast majority of students we talked to pointed to the need for more staff as being behind many of the issues at Student Health Services. Many students also highlighted the lack of an online patient portal system to allow students to book appointments, order repeat prescriptions, and check health records easily – and hopefully prevent appointments and follow-up calls from being forgotten. ManageMyHealth was used until the pandemic, but SHS suspended it as they had to “be very very risk averse” and screen patients individually throughout Covid.
Fortunately, Margaret told Critic that ManageMyHealth is “being turned on again at the end of the month”, which could help solve a lot of these issues. Margaret and Richard made it clear, however, that repeat prescriptions will always be a bit more complex at SHS, where students aren’t seeing the same GP every time, and it can be important to have appointments with a GP to check up on how a medication and dosage is affecting someone, and if it might need adjusting. Specifically with ADHD medication, Richard said “there's really quite strict parameters in terms of how you can and can’t administer and prescribe those medications without checking in with a [patient] in person. So it's not so much trying to create hoops for people to jump through, but being certain we are adhering to best practice in that space”.
Every single person Critic Te Ārohi talked to brought up appointment availability as a key issue undermining SHS, which is a systematic obstacle that Student Health staff are actively working on. But some students had more specific issues. David, a trans man, faced “ridiculous” hurdles getting the care he needed because the computer system wasn’t set up to account for transgender people existing. “If you were having a vaginal swab you couldn't select you were male in the system. I felt very embarrassed, and not super comfortable.” David also felt uncomfortable with some of the questions he was asked, like ‘do you think you’ll ever have a sex change?’, which he thought was well-intentioned but made him feel “humiliated” in a vulnerable setting.
Margaret said that SHS has been listening to feedback on things like the use of pronouns, and that it was something staff “are constantly working on”. Richard told us that making SHS an inclusive and safe place for all students was an “ongoing challenge in terms of continuing our upskilling and education for the team” and was something they would continue to work on.
Regarding forms being unable to fully recognise transgender patients, Margaret and Richard explained that this was still a problem when referring information to other places like SCL laboratories, because SHS has to send in data compatible with their electronic referral messaging system. Those places are working on updating their software to fix this. But within SHS itself, just a matter of weeks ago, staff implemented a patient information system that recognises patients' correct gender and is still able to get them the care they need, which “is much better” according to Margaret.
When Bella talked to a nurse about contraceptive options, she said the nurse “asked if I was willing to try the pill and I said ‘no I don’t want to get anything else’,” because Bella was at risk of blood clots. When Bella looked at her patient records online afterwards, she said the nurse had written “discussed other contraceptive methods and patient is willing to try the pill”, even though Bella was clear she didn’t want to take the pill. “Ideally my records would reflect what actually happened.”
Initially, when Bella went into SHS to discuss contraceptives, a nurse “quite heavily persuaded me to get an IUD which I wasn't comfortable getting”, and Bella was eventually convinced after being told it was “super painless”. For Bella, it was anything but painless. “I had to pull over and stop [my car] because I had really bad cramps. I got home and went to bed and couldn’t move because the cramping was so bad… The idea was to get it so I could have safe sex with my boyfriend, and I couldn’t even do that [because of the pain].” She told us that the pain was so intense that “For the whole [first] week I just couldn’t really move. I went downstairs for food and that was it. I had bad cramps for six months and it’s only gotten normal a year and a half later.”
Eleanor and Gemma also weren’t happy with how their IUD concerns were handled. “I got an IUD last year and I complained that since I got it I've been having daily cramping. They said it was normal,” said Eleanor. “It lasted nine months”. Gemma told us that “[a SHS nurse] sorta kept pushing, saying I should get one… Asking the first time is a fair response, but I was so adamant that I didn't want one.”
When informed about these experiences, Margaret told Critic that IUDs are always an option that is given, and that they can have a lot of benefits, but readily acknowledged that it is an invasive procedure. Margaret said that she “would not expect anyone to feel pressured into having that [procedure]” and said she would meet with the nurses' team to discuss how these options were being presented to patients.
Reproductive health was not the only time students felt ignored; one student recounted how he went in for counselling and left feeling like his concerns had been dismissed because he didn’t meet the criteria for depression. “There’s a difference between communicating ‘you’re not that depressed’ vs ‘you’re not experiencing a crisis but let’s see if we can improve things’,” he said. Leah told us “I don’t go to them at all anymore. The way they’ve handled my issues is they've just brushed them under sorta thing.” A few other students also said they felt “judged” and “told off” about their smoking, vaping, or weed use and that they thought students would be less likely to share relevant medical information if they thought they would be judged for it.
Margaret from SHS said she “wouldn't like to think any student in a room with a clinician felt brushed off or not listened to, however, there are time constraints with appointments, so there can be a sense of being rushed.” She said that the feedback she has heard from clinicians is that “wearing masks at appointments is also quite prohibitive for reading body language” which can hinder communication, which Richard added was especially pertinent in mental health appointments. Mental health is always at the front of student’s minds, and the same is true for SHS staff. But as the conversation around mental health becomes more and more commonplace, more and more people are seeking treatment for it, putting more and more stress on the limited resources at SHS.
While Margaret and Richard understand that “it’s not perfect”, they are proud of the work of the staff at Student Health Services over the past year, and they encouraged students to “continue to contact us if unwell… we will do our very best to provide care or refer onto other providers when needed”. Richard described the team as “motivated and committed to doing the best we can”, and said that “the people who work here wouldn’t work here if they didn’t enjoy it … we’re not here to get rich”. Richard said he sometimes has to tell his staff in the mental health team “stop putting extra appointments in your templates, I know we’re busy and demand is really high but you need to look after yourself”.
Efforts to fill out the vacancies at Student Health Services are ongoing, but Margaret indicated that even the full 10.88 FTE of staff they are budgeted for wouldn’t be enough to fully meet demand. “Our staffing level really hasn't changed for many, many years” Margaret said, and to be able to offer every student appointments when they wanted them they would “almost have to double the workforce”. Margaret also indicated that offering higher salaries could help attract more staff, but they didn’t have the funding for that either.
As mentioned, Student Health Services is funded by government funding and students directly. None of the funding comes from Otago University itself, and some students thought that the Uni ought to help fund SHS so that students can study without worrying about their health. Responding to this, a University of Otago spokesperson said the Uni “annually receives a finite amount of funding” and highlighted “Disability Information and Support, Te Huka Mātauraka (the Māori Centre) and Te Pokapū mā kā ākoka o kā Moutere o Te Moana Nui ā Kiwa (the Pacific islands Centre)” as areas they were putting funding into.
The spokesperson told Critic Te Ārohi that “funding allocation is considered annually based on priority needs. Currently, funding is not the main issue affecting Student Health Services, rather the shortage of GPs means their budget is underspent.” We showed their response to one student who had recently been to SHS, who found the Uni’s answer to be “a bit of a cop-out, really”.
“The Uni has a duty to care for its students, right? If money is the problem, then the Uni needs to throw money at that instead of just getting us to pay for it. They have a massive budget, and ‘finite’ doesn’t mean ‘small’, it just means ‘not infinite’. But if the number of GPs is the problem, then the Uni needs to help them find those GPs. I don’t understand how they can tell me that med school is insanely competitive, and then say they can’t find any GPs. But at the end of the day, I know they don’t want this to be the situation. We don’t want this to be the situation. So why is this the situation?”
*All names changed for privacy.