When I was doing research for my book The Human Odyssey, I was surprised at how few organizations there were out there actively working to meet the developmental needs of adolescents. With all the problems of adolescence — gang violence, eating disorders, unwanted pregnancies, STDs, depression and suicide, school drop-out, and substance abuse among others — it seemed to me that there should be lots of local and national organizations with the word “adolescence” in them. There aren’t (check the Internet and find out for yourself). Now I read in The New York Times, that adolescent medicine is not a hot ticket item for physicians, either.
In an article entitled “Treating the Awkward Years,” staff writer Jan Hoffman points out that while there are 40 million people aged 10 to 19 in the U.S., and adolescent medicine has been a sub-specialty for the past decade, few doctors seem to be signing up. From 1996 to 2005, only 446 certificates were issued in adolescent medicine (compared with 2,839 for geriatric medicine). The article points out that although there are many medical problems specific to this age group, few pediatricians (who are the ones that usually end up treating adolescents) feel adequately prepared to address most of these issues. This situation is compounded by the fact that adolescents are often reluctant to seek treatment (since that involves submitting to yet another adult authority figure).
Reasons for doctors not seeking to train in adolescent medicine usually have to do with the fact that they can make more money in other specialties. Although doing a work-up for a 16- year-old may take twice as long as a 6-year old, managed care companies treat them as identical as far as reimbursement is concerned. Also, in a field where high-tech specialties earn higher incomes and greater prestige for MDs, the low-tech dimensions of adolescent medicine (which often include careful observation), do not garner much esteem in the medical community.
Finally, adolescents are often difficult to work with: noncompliant, sulking, morose. “American society is not particularly fond of its teenagers,” according to Dr. John Santelli, a professor of pediatrics and public health at Columbia University. “The 2-year-olds, everyone fawns over them. But the guy with the pin through his nose is not cute.” (a 1999 American Academy of Pediatrics poll revealed that 75% of pediatricians did not want more adolescents in their practice).
All of this is very disconcerting, given the fact that adolescence represents the bridge from childhood to adulthood. Adolescents in particular need to have responsible adults in their lives who can help them across that often dangerous chasm, and a trusted physician with expertise in adolescent medicine could be a vital part of that support system. We need to expand our efforts to provide services — medical, psychological, educational, social, moral, spiritual — that assist adolescents in their slippery journey to maturity. To read The New York Times article, click here. To access an adolescent health website run by Atlantic Health, click here.