Students on Elon University’s campus for the summer should take special care to keep themselves healthy, because the Student Health Clinic is closed for the summer.

According to Jana Lynn Patterson, associate vice president of Student Life and Dean of Student Health and Wellness, the decision to not keep Health Services open for the summer is revisited every year.

“We certainly look at, ‘What is our on-campus population for the summer?’” she said. “We look at course registration and people who are actually living on campus through [Residence] Life.”

A realistic count of students on campus during the summer is hard to find — summer enrollment numbers from the Office of the Registrar include both on-campus and online courses, and numbers from Residence Life only include students in on-campus housing. Using those imperfect estimates, though, is the only way to get a reasonable tally.

According to the Office of the Registrar’s Enrollment Comparison Report, there are 1,709 students registered for Summer I 2016. And according to Nolan Patouillet, community director of The Station at Mill Point Neighborhood, there are about 300 students currently living on campus between summer school and apartments. Add the number of students living in Elon for the summer in off-campus housing — including athletes on campus for summer camps and training — and the true summer student population likely falls in the large gap between those two numbers.

After trying to determine the summer population, Patterson said she calculates the cost of staffing the clinic with a “baseline of staff," that includes a medical assistant, a provider, and physician oversight as well as a pharmacist.

Once the cost of a baseline of staff is determined, then the cost to each student can be calculated. And according to Patterson, that amount is “cost-prohibitive.”

“It could end up being hundreds of dollars,” she said.

But beyond the actual cost, Patterson said there’s also the question of who would actually use the clinic.

“The other thing is, if the staff only see a certain number of students, then you’re wasting money,” she said. “You’re employing people to be here when the likelihood that students will need medical care is very low. Now, maybe we would be busy the whole time. We don’t anticipate that. But if not, you’re paying for health care you’re not using.”

Because Health Services has never been open during the summer, it’s hard to know how many students would make use of the clinic. Patterson did say that Health Services saw about 10,000 visits in the last academic year, and “a lot of those are one-time visits.” Given Elon’s spring 2016 enrollment count of 6,504 students, that’s less than two visits per student in an academic year.

Patterson said the end of flu season and the relatively low number of “viral-related illnesses that tend to go around during the summer as they do during the academic year” would, in her opinion, decrease the percentage of summer student visits.

Looking to other universities' policies, off-campus options

Numbers from other universities in the area may make this percentage easier to imagine. High Point UniversityDuke UniversityWake Forest University and the Universities of North Carolina at Chapel Hill and at Greensboro offer on-campus student health services in some form over the summer, while Davidson College (enrollment of 1,950 for the 2015-2016 academic year) doesn't.

Wake Forest, for example, operates its student health clinic over the summer with the exception of the July 1-5 weekend, which falls between the university’s two summer sessions. Services are available by appointment Monday-Friday, 8:30 a.m. - noon and 1:30-4 p.m.

Wake Forest had a total undergraduate enrollment of 4,846 for the 2015-2016 academic year, according to the university’s admissions website, which is about 2,000 less than Elon.

Fagueye Ndiaye-Dalmadge, assistant registrar at Wake Forest, said that neither the Office of the University Registrar nor the Institutional Research Office have kept summer enrollment numbers since summer 2007. But Darren Aaron, associate director of Wake Forest University Student Health Service, said Wake Forest experiences about the same drop in enrollment as Elon during the summer.

He said that drop in students on campus correlates, as would be expected, with a drop in the number of visits per day to the student health clinic from about 100 patients per day during the academic year to about 20 during the summer. A comparable number of summer visits to the Elon Health Services clinic might be around 11 per day.



Patterson said it would be cost-prohibitive to pay staff to be available for summer student visitors. When the cost of staffing the health clinic is divided among 6,504 students, each student pays $86 (as of July 1, 2016). But when there are significantly less students paying the health services fee, they would have to pay much more each to afford the minimum number of staff Patterson said are necessary to operate the clinic.

Patterson also said limiting hours instead of staff isn’t a feasible solution, either financially or logistically.

She said the goal is “to be good stewards of [the students’] money,” and cutting down on staff or hours wouldn’t work.

“We certainly look at abbreviated hours, but if someone is paying a health fee and the abbreviated hours don’t fit with when they need care, then they’re going to have to go to urgent care anyway,” Patterson said.

When asked if having an off-campus physician available by phone for referrals would be a feasible alternative, Patterson said the current system can provide Elon students with medical needs with the same options for simple medical procedures like a physical, a vaccination or simple bloodwork.

“An urgent care can give an immunization and give a physical,” Patterson said. “So for most of our students, they would be able to do that. For students who called in and said, ‘I need an immunization for a specific reason,’ the administrative staff can direct them to the health department or to urgent care.”

According to Patterson, directing students to outside facilities is the most cost-efficient option because students aren’t paying for access to health services they potentially wouldn’t use.

When contacted, employees at the two urgent care facilities listed on the Health Services website, NextCare Urgent Care and FastMed of Burlington, said that “wellness physicals,” or traditional annual physical exams, are not offered to current Elon students. Urgent care can perform “school entrance physicals,” which are only for incoming first-year college students to send to the college or university they will be attending. Employees at both facilities said a better option for current Elon students is to return home to their primary care doctors.

Employees at Cone Health-Alamance Emergency Department, which was added to the new “After Hours & Summer Care” tab on the Health Services website, also responded that they could not provide a physical to a current Elon student. One employee at the Cone Health-Alamance Emergency Department suggested that students ask their primary care doctors to send a doctor’s order to a private doctor in the area who would work with their insurance.

The employee at the Cone Health-Alamance Emergency Department also provided the number for the Kernodle Clinic, which, when reached out to, also replied that physicals for current Elon students were not offered at that facility.

A sign on the Ellington Center’s main entrance. The text reads: “IF THIS IS AN EMERGENCY CALL 911. Hours are subject to change. Changes will be posted on the Health Services website.”

Catering to students' needs

According to Aaron, the decision process Wake Forest uses to decide whether to keep Health Services open for the summer doesn’t have to do with finances.

“Because Wake Forest has so many students that don’t live in Winston-Salem, don’t live in North Carolina, we are their medical home,” he said. “And so they’re still looking at us for resources or needs that they have even over the summer. They’re still relying on us because we’re their primary care provider for the four years they’re at Wake Forest.”

As Aaron pointed out, students who aren’t used to the healthcare system — especially out of state and away from their home-state doctors — can find it difficult to navigate. He sees the university as a valuable intermediary for students.

One Elon senior, who was granted anonymity based on her medical situation, needed that kind of intermediary when she returned to Elon for the summer to participate in SURE, an on-campus research program at Elon. She's set to have surgery that would relieve chronic back pain when she returns home to Illinois in August, and requires pre-operative services within a month of her surgery.

The student called the Student Health Services clinic in May and reached the voicemail, which listed normal hours and asked her to leave a message. She did, but she never got a call back. She then checked the Health Services website, which at the time did not feature any indication that its hours were different on its homepage, though it did list summer hours on the “Summer Information” tab. The website has since been updated to add that summer information on the homepage.

When the student got the news June 7 that her insurance would cover the surgery, she was already back on campus. She called Health Services again and was informed that the student health clinic was closed and getting pre-operative services on campus wasn’t an option.

“I wish that I had known it was going to be closed,” the student said. “Because then I would have been able to sit down with my parents and look at the health insurance website and make a plan and get that done before I came to school.”

Patterson said Health Services provides information to students through several outlets available to them, as well as on the website. She suggested students use E-Net and Health Services’ social media accounts (Health Services Twitter page; Elon Student Health 101, Elon’s student health newsletter, Facebook and Twitter pages) as ways to keep up to date with hours.

While summer hours were not posted on Health Services social media this year, a June 6 E-Net article says that Health Services is closed, though the article lists normal Monday-Friday, 8 a.m. - 5 p.m. hours for the summer at the top of the page.

After the student realized Health Services was closed and submitted a student complaint, Patterson ultimately connected her with Cathy Lavoie, practice manager for Student Health Services. Lavoie referred the student to a nurse practitioner in Mebane who was able to see her the next week and provide the necessary pre-operative services.

A post-it note on the Ellington Center’s main entrance. The text reads: “Counseling Services — use next entrance.”

Communicating, planning for the future

It’s not just physical health that students have to take care of over the summer — Patterson said Counseling Services, a separate department from Health Services, is available over the summer for students to call.

“If a student has a concern, then if they’ll call counseling services, we do have one counselor on campus during the summer, and that person will see a student if a student is in distress or wants to see them about something,” Patterson said.

While there is one person in the Counseling Services office over the summer, that person doesn’t see any patients. Counseling Services can refer students to professionals in the area but cannot see any patients in-house until Aug. 1. The hours that appear on the June 6 E-Net article (Monday-Friday, 9 a.m. - 4 p.m.) are hours that staff are in the office, not hours available for appointments, as stated in the article.

Patterson said she thinks communication about summer hours will be improved in the future. The Health Services homepage has already been changed to feature summer information more prominently, and Patterson said a new portal, set to launch next fall, will allow students to receive announcements from Health Services over either email or text message.

“I think certainly we can continue to provide information through Facebook, and be clearer in our web information,” she said. “Even though we’re going to say to people, ‘E-net is your best place to get updated information.’ That’s the university’s way to do it.”

The university will research the option of summer health services again this year, though Patterson didn’t indicate whether she thought the decision to keep the clinic closed would change for summer 2017.

In the meantime, students looking for options on campus should visit the new “After Hours & Summer Care” tab on the Health Services website for information. Students can also reach an administrative staff member at the Ellington Center by phone at 336-278-7230 during the hours listed on the website.