At the core of many of the issues facing Dudley Coe Health Center lies the tension between the educational mission of the College and the necessity of providing healthcare to students.
"Obviously Bowdoin in not a medical facility, it's a college," Student Health Program Administrator Caitlin Gutheil said. "What we excel in is educational practices, not medical practices."
"The idea that Bowdoin should be in the healthcare business is actually, to my mind, very difficult," said President Barry Mills, "because we don't have doctors on staff, and we're not a big university that has medical support. And even big universities that have medical support have problems. This is an incredibly complicated issue," he said.
According to interviews with present and former staff members and administrators, what makes healthcare at Bowdoin a complicated issue is not the quality of healthcare provided to students?by all accounts, the healthcare providers who have worked for the College over the last decade have been excellent?but about the model of care that Bowdoin should adopt.
The Dudley Coe Health Center, built in 1917, has changed significantly from its early days when, according to a Bowdoin's Web site, "the infirmary staff treated infectious diseases, did emergency appendectomies, and nursed students through prolonged convalescence."
Today, the health center serves a variety of student needs beyond diagnosing and treating sick students. It provides "travel medicine, gynecological care, allergy shots and physicals for study away programs and jobs" in addition to "evaluating and treating illnesses and injuries," according to its Web site.
Early in the 1990s, the College discontinued its urgent care model?which provided students with around-the-clock access to care?toward a clinic model that saw students only during the day. Currently, when the College is in session, Dudley Coe is open for about forty hours during the workweek and for two hours on Saturday and Sunday.
"We're in the more unusual position, if you look at our peer schools, of having hospitals nearby," Dean of Student Affairs Tim Foster said.
The College is within close driving distance of two full-service hospitals with 24-hour emergency rooms. Parkview Adventist Medical Center is one mile from the center of campus, and Mid Coast Hospital is about four miles away from Bowdoin.
"There was the question of how much business are we doing after hours," said Foster, referring to the model shift, "and the percentage was tiny...We were not seeing a lot of demand after hours."
"I am absolutely confident that this [clinic model] is the right decision for Bowdoin," Foster added.
Another model of care question is whether the director of the health center should be a medical doctor or a mid-level clinician?a nurse practitioner (NP) or a physician assistant (PA).
Sandra Hayes, an NP, currently serves as interim director of the health center. There are two contracted doctors who provide about four hours of clinical care each day, the same amount of clinical time former Director of Medical Services Jeff Benson devoted to seeing patients.
"When we looked at it and talked about how we wanted to do it when Jeff left, my own feeling on it is you could really go either way. Remember, Sandra [Hayes]'s role is part-time director and part-time clinical care provider and Jeff [Benson]'s role was a part-time director and a part-time clinical care provider," Foster said.
"I think that's a critical piece of the [director] position, to be able to do both?to get her hands really dirty in the work...and also do her administrative work," Senior Associate Dean of Student Affairs Margaret Hazlett, who co-supervises Dudley Coe, said.
"It's a rare physician who can be a gifted clinician and gifted manager/leader," Foster said. "Are there some out there? Absolutely there are. But is it a rare combination? Yeah, I think it is," Foster said.
Michael D. Maves, M.D. M.B.A, the top executive of the American Medical Association (AMA), agreed, for the most part, with Foster.
"I don't know if there are a lot of opportunities to get experience or get that training and background [in administration] when you're going through medical school and residency," Maves said. "You are sort of consumed 24/7 with trying to be a good doctor."
Although admittedly in a state of transition, administration officials are pleased with the way Dudley Coe is running. "We have a lot of new people, a lot of transitions going on, but I think we're doing really well," Hayes said.
Lori Chadbourne, the former administrative coordinator of Dudley Coe who quit after becoming disillusioned with how she felt the health center was being managed, disagreed.
"When I started working at the College I had no idea what the college health center did," Chadbourne said. "I figured it was a little band-aid station, but it's not that at all. That health center is such a part of that College and it's a needed part of that College, just like counseling is," she said.
One of Chadbourne's responsibilities at Dudley Coe was answering calls. "I so know it gave parents peace of mind to know their kids were being taking care of," she said. "And I don't feel like there's that feeling any more."
Chadbourne was especially troubled by the fact that there were only two full-time medical personnel on staff.
"It's a total illusion that you can run that health center with part-time people. There have to be more full time people. It's not a part time health center, it's a full-time health center," Chadbourne said.
Administration officials said that staffing was sufficient and noted that with two contracted physicians, Bowdoin has one of the highest levels of physician hours per student of similar peer institutions.
"We do have a lot of doc coverage," Hazlett said.
"On the physician side, [staffing] is completely sufficient; on the mid-level side I would say it's sufficient," Gutheil said.
Chadbourne also expressed grave concerns about the state of the 90-year-old Dudley Coe facility.
"You've been the Health Center, you know what kind of shape it's in. It's humiliating to have parents come on Parents' Weekend and want a tour of the Health Center," she said.
Chadbourne said she would sometimes stand with other staff members and "look out the front door and we'd see that new copper roof on the hall [Studzinski Recital Hall] across the street and here the health center is falling down. And I totally understand priorities, but I never felt like the health center was a college priority," she said.
"They said it and they gave that impression, but when you get right down to do it, the health center did not get what it needed and I think it's fabulous that the people who work there did what they did with what they had. It just shows you what kind of great people work there," Chadbourne said.
Gutheil agreed that the building was "problematic."
"The design of that building is the worst," Hazlett said. "And so it's really not ideal...but that will be addressed in the new design."
The College plans to move the health center to a new integrated health and wellness facility in 2009. President Mills said he expects the Trustees to approve the plan for the four-story building.