How graduate student health care has failed me: a letter from a Harvard PhD student

In organizing the grad students’ union at Harvard, I’ve heard numerous disturbing stories from fellow grad workers about their experiences with graduate student healthcare and health/disability accommodations: people who face enormous dental bills, who struggle to afford coverage for their dependents or pay for their prescription drugs, or who fear retaliation for advocating for their health needs. One particularly harrowing story — which we were asked to publish anonymously — appears below.

I started my PhD taking 1 medication. Now I take 25: How graduate student health care has failed me.

PhD Candidate, Division of Medical Sciences, Harvard Medical School, Harvard University

When I began my PhD at Harvard, I took one daily medication. After years of an intense work environment, mediocre health care professionals, and insufficient insurance, I now take up to 25 medications and recommended supplements in a given day and have been diagnosed with five diseases and disorders. I spend around $125 per month on medications and $150 per month on copays for out-of-network therapy appointments — that is until the 40 sessions covered by graduate student insurance run out and the monthly cost skyrockets to $800 per month. The insurance seems to model the academic calendar and would be suitable for an undergraduate, but graduate students work year-round and need mental health care for more than 10 months of the year. You may ask why I don’t stay in network for mental health interventions, and the answer is two-fold. First, Harvard lacks the resources to offer weekly therapy appointments. Second, some of the therapists lack training in sensitivity. From the in-network therapists I met through Harvard University Health Services (HUHS) after the death of a family member, I had one tell me that she “couldn’t help me grieve …because [I] wasn’t crying during our session” and another ask me “why [I] couldn’t figure out how to self soothe, when even babies can.”

It is true that Harvard can cover some out-of-network costs for students in emergency health situations. However, the process is insufficient and not intuitive. My last request took four months to reimburse after six reminder emails to the financial aid office. After waiting for a third of a year, I wasn’t reimbursed completely because, as I learned after, the fiscal year (which ends June 30th) doesn’t align with the dates of HUHS coverage (which begins August 1st), so the month of July is not covered.

I have lost faith in our healthcare system at Harvard. We have one of the most prestigious medical schools in the world in the heart of Longwood Medical Area, and yet students don’t have easy access to these resources. When I sustained a severe physical injury early in my graduate career, I was told that there is only one specialist who only works on Mondays for the entire student population, and I would need to wait two weeks before treatment.

I have also dealt with my share of diagnostic odysseys. When I went to seek treatment for mysterious symptoms of chronic fatigue and unexplained weight gain, the endocrinologist didn’t even perform a blood test to check my hormone levels, and told me there was nothing she could do for me. In other appointments to address these symptoms, a nurse practitioner told me that all I needed to do was “not put creamer in [my] coffee,” a nutritionist said that I should read a website on nutrition, and my primary care physician took out his lunch box to show me what a balanced meal should look like. None of these healthcare professionals addressed the pressing issue that this was legitimately unexplained weight gain and that the fatigue was so severe that it impacted my ability to perform even simple daily tasks. Every time I saw a specialist, they looked at my symptoms only within the context of their limited focus instead of looking at me as a whole person. No one magic bullet explained my symptoms, so they prescribed me some medications to appease me and sent me on my way. That’s how I’m now at 25 pills. By the way, the burden of these medications extends far beyond the cost. No medical specialist in network is capable of describing the interactions of all of these drugs and how they may be contributing to my health challenges, and it takes about 10 hours a week to aliquot, manage, and take my medications.

So, how did this happen?

In a healthy working environment, the majority of my diseases and disorders — which impact both my mental and physical health — would have never developed, so I would never have experienced the disappointment of the Harvard health care system. However, the PhD system is structured to disempower students; they are at the mercy of their advisors or faculty members who can threaten a bad letter of recommendation if not every request is met. These requests are often inappropriate. In the last union election, a faculty member contacted me on my cell phone one night to tell me to “not support the student union.” Dissertation advisory committees are in theory structured to support students, but the faculty members are often friends of and chosen by the academic advisor. I remember one committee meeting where I was attacked for asking about a timeline for the duration of my PhD. My advisor’s response was victim blaming, “I learned from this meeting that you need to be tougher.” To make matters worse, this environment can be relentless when you are most vulnerable to mental health challenges. My advisor told me “I thought you were stronger” when I explained that excessive workload expectations resulting in back-to-back all nighters had caused a permanent increased dosage of anxiety medications. Even worse, mental health issues are belittled. My advisor talks about intimate details of mental health struggles that other labmates have faced with ridicule and apathy, so I know there is no guarantee of confidentiality when I am experiencing a health issue. I often choose to suffer in silence.

Not everyone in this system is bad — there are a few gems who have greatly enhanced my life, both on the preventative side (supportive dean, academic mentors, specialty training programs, and student groups) and the treatment side (behavioral mental health professionals). However, these support structures should be the norm rather than a rarity. I also can’t completely blame the health care providers at Harvard. As one former therapist told me, the practitioners manage so many students that they are unable to provide comprehensive care to any one client. Students would benefit greatly from a larger staff who have the time and energy to thoroughly support their patients.

To improve the environment at Harvard, students need better insurance to cover costly prescriptions, access to less overwhelmed healthcare providers, improved flexibility (beyond the six sessions per year) for students to seek appointments out-of-network with specialists for health concerns, coverage for all 12-months of mental health counseling and therapy, aligned calendars for the fiscal year and health care coverage, and training for faculty members on treating mental health as a real disease that warrants confidentiality, respect and concern like any other physical ailment.

I know I am not the only who struggles with these issues here. We must come together, demand real change and build systems of accountability to ensure that graduate school isn’t a game of attrition only suitable for those who arrive in or can maintain perfect health during these demanding years of schooling.