As students leave home to attend the University, they’re faced with a variety of new steps. Throughout their undergraduate career, students grow accustomed to the new environment and the academic rigor of the University, make friends, and likely will have to adjust to a new medical provider on their own for the first time.
University Health Services (UHS), often referred to by students as ‘McCosh,’ is Princeton’s primary healthcare provider that provides medical, health, and wellness services to the University population. Among its departments are ‘Medical Services,’ which focuses on providing care related to physical health, ‘Counseling and Psychological Services’ (CPS), which provides mental health care, and ‘Health Promotion and Prevention Services,’ which works towards the prevention of alcohol and/or cannabis abuse.
In a series of interviews with a dozen undergraduates, The Daily Princetonian found that some students express dissatisfaction with McCosh in two categories: the ability to secure an appointment and the level of engagement that they received.
In a statement to the ‘Prince,’ Dr. Melissa Marks, the Director of Medical Services at UHS, wrote, “We send surveys to every patient seen in Outpatient Medical Services, unless they have been seen and received a survey within the prior two weeks.” Marks described the scores as being “above the benchmark at other similar institutions,” with 94 percent of survey respondents being either “very satisfied or satisfied” with their visit in the current academic year.
Medical Services offers three types of care, including general/primary care, which addresses general medical concerns, chronic medical conditions, and good health, urgent care, which addresses acute illnesses and injuries that require prompt attention, and the infirmary, which is available for patients who need overnight or urgent care after-hours.
Three students, with the pseudonyms Eva, Nate, and Chris, were granted anonymity to discuss their medical experiences.
Securing an appointment
In the fall of 2022, Eva, an undergraduate, was scared about something being “fundamentally wrong with her body.” Experiencing irregular periods as a first-year, she went to UHS, seeking answers and treatment.
After she got an appointment, Eva saw multiple doctors for answers to why she was experiencing irregular periods. “I was losing blood at a concerning rate,” she said.
Four appointments, visits to two different medical professionals at UHS, and multiple lab tests did not deliver a diagnosis.
“After [UHS] could not figure out the cause, they just put me on birth control and said that all they could do is regulate the blood cycle,” she recalled.
Eva felt that UHS could have done better. To date, she does not know the source of her medical problem.
Eva’s concerns with UHS started with trying to secure an appointment. “I waited two weeks to get an appointment, which itself was quite stressful because of the nature of the reason I wanted to go to them,” Eva said.
To request a general/primary care or specialty medical appointment students have to call the UHS front desk. Primary care for health maintenance, a health concern for more than two weeks, or management of chronic illness and follow-up of a primary care appointment are also available to schedule online through the MyUHS portal. Students have to call the front desk to book an urgent care appointment and can walk into the infirmary anytime after hours to seek care, though UHS does recommend calling beforehand.
Eva’s concerns over a lack of available appointments are shared by other students. Olivia Johnson ’26 had an infected finger last semester. “When I went [to UHS], the doctor asked me why I didn’t come earlier,” she said. “I had been trying to get an appointment for several days. They were fully booked.”
Another student, Uma Menon ’24, said that she had a persistent cough for a month in Fall 2022. She tried getting an appointment once before fall break, but the waiting time for an appointment that fit with her schedule was around five days.
“I decided to wait [the cough] out and try again after fall break,” she said. Uma was able to get an appointment after fall break and didn’t choose to seek outside care during the break. She instead chose to take medicine at home.
Marks responded to concerns over a lack of appointments.
She wrote that, “[UHS’s] practice goal is to see all patients with acute illness within 48 hours,’’ after it follows a practice of “triage,” wherein a nurse assesses the acute problem that a patient has and then decides whether the student should be “seen immediately, seen that day, seen within 48 hours,” or “managed with supportive care at ‘home’ with close nurse follow-up.”
Marks explained that UHS’s functioning was changed by the pandemic, with COVID-19 forcing them to shift their practice to allow their clinic “to triage and assure appropriate pathways for patients.”
“We are shifting back to pre-pandemic practice. Online appointment making is now available for all appointments except for acute care, which still requires an initial nurse triage,” she wrote.
Triage, Marks said, is critical for medical practitioners to prioritize medical cases. “It provides a way to make sure that students in most need are seen and cared for immediately, whether it be by UHS or a nearby emergency department. To not engage in some sort of initial assessment of students that gauges when a student should be seen might lead to a student not getting the care they need in a timely way,” she wrote.
Students sometimes felt that the triage process led to an underestimation of the seriousness of their illnesses.
“During midterms last fall, I had flu-like symptoms — fever, a cold, and a sore throat — and called McCosh to see if they could see me,” Kira Newbert ’26 said. “Their response was that they could not see me because they were only seeing ‘really sick students,’ implying I was not sick enough.”
When asked about whether she had the time to provide a sufficient explanation of her condition to the nurse on-call, Newbert replied, “Not really. They didn’t ask any follow-up questions about my symptoms.”
“I ended up being so sick that I had to miss my bio midterm,” Newbert recalled.
Newbert is a News contributor for the ‘Prince.’
Marks wrote that “any student who feels that their wait is too long or has a different concern and wishes to provide feedback may do so” at UHS’s feedback website.
“In addition, a link to our grievance procedures can be found on the UHS feedback page,” Marks wrote.
Students also felt that appointment schedules didn’t match a Princeton schedule. “For most of the week, [students] have classes until the evening, and there are no time slots for an appointment post-5 p.m. during the week,” Johnson said.
Newbert echoed the concerns. “Especially when students are already so busy, it can be very stressful to try and find an available time slot,” she said.
Eva felt that having more available doctors and nurses on call may help. “The appointments they had did not fit with my schedule so the process stretched out for weeks, which is not convenient when you have a pertinent health issue. So, they definitely need to have more doctors available to solve this problem,” she said.
UHS declined to comment on requests for data on number of doctors on-call on an average working day, the number of doctors per department, or the funding that each department receives. Marks noted that there is a physician on call for UHS 24/7.
Quality of care
On a school morning, Chris, an undergraduate, woke up feeling discomfort due to a slight swelling in his neck. He went about his day, thinking the pain would disappear. When it did not, he went to UHS seeking care. He saw two nurses, but no doctor on-call, and ultimately left the health center without any answers or treatment.
As opposed to others who waited days for their appointments, Chris was seen immediately. He went to the infirmary outside open hours, which are from 8 a.m. to 4:45 p.m. Monday to Friday, and Saturday from 8 a.m. to 3:45 p.m. “I went to McCosh in the middle of the night, so it was clearly a significant issue,” he said.
There were no doctors on-call, but nurses checked his vitals. “They could not tell me why I had the swelling or what I could do in the immediate term to make it better,” he said.
Other students expressed frustration with their experiences talking to the medical professionals.
“[UHS staff] were kind and compassionate in our face to face interactions, but it didn’t feel like they were willing to take the time to understand what was wrong,” Eva said.
Nate, an undergraduate, described inconsistent guidance. He said that he had a headache, cough, and a sore throat for about two weeks before making an appointment. “The doctor told me to continue taking Mucinex and Ibuprofen and said that they would prescribe me antibiotics in three days if the current treatment didn’t work,” Nate said. However, when he went back after three days, a different doctor said that they do not prescribe antibiotics for people with the symptoms he was experiencing.
Vasudha Bharathram ’26 recounted two negative experiences with McCosh.
“I had a 103 degree fever and decided to book an appointment with McCosh. I got an appointment after two days and they just gave me a packet of salt and told me to gargle with it, running no tests,” she recalled.
“More recently, I had a cold, and they gave me a COVID test,” Bharatham added. “It had expired three weeks ago.”
In response to these concerns, Marks wrote that UHS practitioners follow a two-step process of diagnosis and follow-up. During diagnosis, they try to deduce “what an illness is not, and what it may be.” They also try to assess whether “a student is in danger or is safe to continue self-care and monitoring of symptoms.” Follow-up occurs either through a telephone or an appointment made in the clinic.
She explained that practitioners cannot be fully successful in diagnosis. Rather, they tell patients, “[t]his is what I am thinking you have, but time will tell, or the response to the medication we prescribed will give us information, or let’s check back in a few days and by that time the illness may clarify itself.”
“Diagnosis is a process that often requires time. Students generally come to us in the initial stages of their illness,” said Marks.
“What we can say at this point is often what an illness is not, and what it may be. We can also say whether a student is in danger or is safe to continue self-care and monitoring of symptoms,” she continued.
After their appointment, students are also sent the aforementioned post-appointment survey. Every student the ‘Prince’ interviewed, except one, said they received the survey.
In regards to the quality of providers, Marks wrote that UHS conducts “extensive ‘credentialing’ of healthcare providers, which involves verifying the providers’ education, training, licenses, internships/residency/fellowships, as well as conducting extensive background checks.”
Eva strongly believes that McCosh needs structural changes, specifically because of a lack of healthcare options. “It’s not just that I could not get the care I needed, but that they also didn’t refer me to anyone outside McCosh,” she said.
“Being a student on Cigna Health (the insurance Eva is on), getting access to an outside practitioner is really complex. I don’t quite know what the process is. It’s overwhelming — for the average student who is trying to take undergraduate classes and have a part-time job on top of that,” she added.
UHS provides a set of detailed documents on its Student Health Plan (SHP) section of the website, highlighting healthcare aspects covered for students, for dependents, referral and pre-certification requirements, and its preferred provider network, which is Aetna Student Health.
Eva called for UHS to provide an easy-to-understand explanation of outside care options covered by UHS. “The health insurance logistics are complex, and if not explained properly, can act as a barrier to you accessing care,” she said.
Eva is a low-income student, and she stressed that any problems with UHS affect low-income students the most. “For low-income students like me, there is a limited pool of money available as co-ops and insurance, so we really depend on McCosh,” she said.
“I don’t have the means to get access to outside care — no time, no car, and not many places covered by insurance. If McCosh is going to be my primary healthcare resource, they need to have everything,” she added.
Kaustubh Jain is a Features contributor for the ‘Prince.’
Please send any corrections to corrections[at]dailyprincetonian.com.
Correction: This piece has been updated with further context from UHS administrators.