"With the walk-in system, students often had to sit and wait up to two hours because everyone tried to come between their classes," Rosenthal says.

Princeton adopted a similar shift 18 months ago, says Elizabeth B. Langan, director of administration at Princeton University Health Services.

"We have enough open appointment slots that we can usually fit students in to see someone the same day," Langan says.

Langan says that about 50 percent of the students who go to Princeton's health service are seen by nurse practitioners. But no more than 20 percent of students consulting Harvard UHS receive primary care from the nurse practitioners, Rosenthal says.

Yale and Penn still work on a walk in system, though they also give students the option of scheduling appointments with physicians or nurse practitioners ahead of time.

"We try to see everyone within two days, but sometimes it takes a bit longer during flu season," says Dr. Marjeanne Collins, the director of Penn's Student Health Service.

Collins says the majority of students at Penn are seen by physicians, although the primary care staff of 13 includes two nurse practitioners.

Officials from the health services at all four schools say that appointments with most specialists first require a referral from a primary care visit. But while nonurgent cases often take a back seat for weeks at Harvard and Yale and Penn, Princeton students receive more prompt attention.

Langan says that because the Princeton community is "so much smaller than at larger settings such as Harvard," most patients can see their specialists--who come in from local hospitals--within the week.

"We don't have a crunch with specialists," Langan says.

A Crimson survey of the four health services also found this difference in the speediness with which appointments could be obtained. When the services were called and asked the date of the next available appointment in a number of departments, Princeton consistently quoted the shortest wait (see table).

Personal Touch

While competency and efficiency are clearly key components of a quality health service, some of the campus health programs specifically work on making students feel comfortable. And Yale appears to be a leader in this area.

"I think you have to have trained personnel whose specialty is this age group, so most all of our people here are trained in adolescent and college health," says Dr. Jane S. Rasmussen, the chief of undergraduate medicine at the Yale Health Plan.

"You have to like this age group to do a good job," Rasmussen says. "We can't be upset when college students question our authority, because that is the nature of this age group. But some doctors would get upset because they want their word to be accepted as fact."