Many college physicians are caught in a dilemma between the medical needs and the financial problems of students. With rising tuition and fees for education, many administrators are loath to require all students to show that they are covered by health insurance. The expectation of both students and administrators is that the student health service will take care of most health problems. The student’s failure to buy insurance does not relieve the physician of responsibility for providing quality medical care. The student health service and the individual physicians should set policies for dealing with students who are unable to pay for necessary medical care.

For residential students with major medical problems, physicians must consider whether the student can stay in school. If the student is hospitalized or otherwise completely unable to attend school, the decision is obvious. The issue becomes one of where and when to transfer the patient for ongoing care.

For students with less severe problems, the decision is more difficult. Most people do not choose a school based on the availability of medical care. However, if the student has a major disease requiring care that is unavailable at or near the school, the potential for crisis is great. Student health physicians should be cautious about accepting responsibility for caring for students with problems that they would consider beyond their skills in another setting. The presence of such disease in a student constitutes a federally protected handicap. The school must make proper accommodation for the student’s handicap, including arrangements for medical care, or justify why providing that care is impossible.