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By Andrea Crow
Securing a tenure-track job in 2018 was a relief because it meant I could start going to the doctor regularly.
As a graduate student, low pay and inadequate health insurance prevented me from getting effective medical treatment, including for a chronic hip injury. But in 2018-19, my first year as a tenure-track faculty member, I finally had access to reasonable health care.
One memorable day last fall, I walked out of the office of my new physical therapist and nearly cried — because in that moment, I was free of hip pain for the first time in five years.
In my first two months as an assistant professor, I went to six different doctors. In conversations with other newly hired faculty members, I’ve learned I’m not alone in making a slew of medical visits in that first year. It turns out that finally being able to attend to chronic health issues might as well be a formal part of the academic-career trajectory: dissertation defense, graduation, job search, tenure-track appointment, doctor visits.
In my conversations with other new assistant professors, some have described medical problems brought on by graduate school itself — anxiety attacks, substance-abuse problems, herniated discs. Others told me of chronic conditions — endometriosis, insomnia, eating disorders — that they believe were worsened by the stresses of graduate training and the inadequate (or nonexistent) health insurance.
But as tenure-trackers, at least we finally have good health insurance. Adjuncts and other contingent faculty members often are forced to let chronic health issues go unresolved for even longer since they spend years in temporary jobs with limited-to-no health insurance and are unable to find tenure-track employment.
Most doctoral programs offer bare-bones health insurance to graduate students — coverage that is difficult to navigate and fails to offer many necessary services. A diabetic graduate student I know said the stress of graduate school — financial pressures and uncertain employment prospects — has made his glucose levels more unpredictable than usual. Yet because of the flimsy health insurance his graduate program provides, he has trouble getting testing strips and insulin when he needs them, making his diabetes difficult to manage.
In my own case, I went more than two years in graduate school with amenorrhea (the absence of menstruation). My graduate-school health insurance directed me to its preferred doctors, who insisted that the only thing they could recommend was that I “eat more avocados.”
Fortunately, through a network of friends, I was able to find a doctor outside of my then-university’s health system who prescribed progesterone. It brought me back to normal within a few weeks but, for a long time, I feared that graduate school might have seriously harmed my reproductive health.
My main health problems, however, were teeth and joints. The dental issues began when, as an M.A. student, I was so busy with graduate work and so concerned about making my finances stretch that I avoided going to the dentist until, one day, a molar cracked into pieces and fell out into my hand. I was luckier than most graduate students in that my then-employer, the Ohio State University, offered dental insurance. But the policy didn’t go very far: I ended up having to shell out hundreds of dollars from my meager paycheck to undo the damage I had done to (as it turned out) both of my lower molars.
And the damage wasn’t really undone: In my first few years as a doctoral student at Columbia University I needed root canals on both of those teeth, which again ended up costing me hundreds of dollars I couldn’t afford.
Once again, the high-stress conditions of graduate school were, in part, to blame for my need for these procedures. I had begun unknowingly grinding my teeth in my sleep.
Shortly after my root canals, my then-university abruptly stopped offering dental insurance to graduate students, an all-too-common occurrence. Although graduate-worker unionization campaigns have been spreading rapidly in recent years, the administration at many universities still refuses to recognize the unions or even come to the bargaining table. That leaves graduate-student employees constantly uncertain whether the minimal medical services they rely on will remain available in the next academic year.
My other primary health problem was a hip injury that kept me in a state of low-grade pain for five years. I started running compulsively during the first year of my Ph.D. program because it seemed like a healthy way to de-stress — and it would have been, had it not resulted in injury to my hip.
When I started running, it wasn’t because I was anxious about the amount of work involved in my program or about “impostor syndrome” (or any of the other more abstract concerns that we usually talk about when we discuss the pressures of graduate school). My severe anxieties were fueled by economic insecurity. I struggled to pay New York City rent on a stipend of just under $27,000 a year. At the same time, I struggled to come up with convincing reasons to keep pursuing a Ph.D. after my incoming doctoral cohort was informed — in the first week of classes — that only two of us, at most, could hope to get tenure-track jobs.
Of course, one might say that I could have chosen to leave right then and there, or not put myself at financial risk in the first place by pursuing a faculty career that is both difficult to secure and less than lucrative (at least compared with the incomes that result from other professional degrees like law and medicine). But I believed in higher education and I wanted to be part of it.
The problem isn’t the people who want to commit ourselves to a teaching and research career in higher education — the problem is the material pressures that are making the choice to pursue a Ph.D. dangerous to all but the independently wealthy.
After I injured my hip in graduate school, it was hard to find adequate care that I could afford. I finally managed to schedule an MRI and an appointment with a specialist, and I began physical therapy. After several months, it wasn’t making a difference and my paycheck wasn’t stretching far enough to cover the visits. I certainly couldn’t afford a second MRI or the additional diagnostic procedures recommended by my doctor, since none of that would have been covered by my student health insurance.
Now that I am on the tenure track, I am able to afford regular and effective treatment. I finally have access to the basic care that I should have been able to get in 2013.
Relatively speaking, my health problems are minor, and I was fairly young during graduate school — in my 20s for almost all of it — so I was able to get away with ignoring those problems without many irreversible consequences. One exception: My optometrist says it’s still an open question whether I will be able to continue to wear contacts after so many years of trying to make my lenses last double their lifespan.
I feel angry that I had to take serious health risks just to earn a degree I needed for a job teaching college English at a four-year institution. I feel angry that this ableist logic is so normalized in institutions of higher education. I feel angry that doctoral-granting institutions talk about valuing accessibility and diversity but perpetuate structures that make academe a health hazard for every graduate student who isn’t in a position to depend on outside support for medical care — a norm that disproportionately affects under-represented groups of people in higher education.
Graduate school shouldn’t be a health risk. For higher education to be a viable pathway for anyone other than the independently wealthy, universities need to treat comprehensive and contractually secured health insurance — including dental and vision coverage — for all of its graduate teaching and research employees as a basic right.
Andrea Crow is an assistant professor of English at Boston College.