This year’s Match Day for graduating medical students had the highest number of unfilled pediatrics residency spots in recent years. Fewer pediatricians means fewer pediatric subspecialists. Like too many of our deepest health disparities, this hurts teens the most and the current political climate may be to blame.
About 1 percent of pediatricians pursue fellowship training in adolescent medicine, a board-certified subspecialty devoted to the care of youth and young adults aged 12-25. Adolescent medicine physicians are experts in reproductive and sexual health care, eating disorders, mental health, growth disorders, substance use, and gender-affirming care. They deftly handle the medical and emotional struggles of adolescence that are increasingly common. Many chronic conditions, like diabetes and attention deficit disorder, are diagnosed in adolescence and young adulthood, which take time and a trusting relationship to investigate. They are trained to collaborate with like-minded professionals in psychology, psychiatry, social work, nutrition, education, and legal advocacy. Adolescent medicine’s role in medical education has been so valued that, historically, all pediatrics residency programs are required to have at least one board-certified adolescent medicine specialist to be an ACGME-certified residency training program.
Caring for society’s greatest emerging assets is its own reward, but adolescent medicine physicians know that this career choice requires sacrifice. In their lifetimes, adolescent medicine physicians who pursue a three-year fellowship earn over $1 million less than a general pediatrician who enters the workforce after residency training. But money isn’t why it’s hard to be an adolescent medicine physician now, and the fate of this field is inextricably linked to the well-being of youth.
Adolescents and young adults are in the crosshairs of a harmful political agenda engineered to appeal to extremist voters. The teen-parent-provider relationship faces unprecedented legal attack through interference in confidentiality and reproductive health, as well as criminalization of abortion services and gender-affirming care. Nearly a third of the pregnancy-capable population faces bans on reproductive health care. Disinformation dominates the discourse about LGBTQ+ youth. Due to bans on gender-affirming health care, over 30 percent of all adolescent medicine physicians face punishments ranging from licensure loss to imprisonment in their home states.
Instead of being scientists, researchers, and clinicians, adolescent medicine physicians now expend enormous energy to manage the fallout of political targeting. False claims about gender-affirming care have given tacit permission for extremists to harass and threaten pediatric providers throughout the United States. In a shocking violation of social norms, children’s hospitals across the country offering services for LGBTQ+ youth have experienced bomb threats, prompting the American Academy of Pediatrics to petition the Department of Justice to investigate. As these bans are challenged in court, this professional community will grapple with moral injury from being unable to provide standard medical care that vulnerable youth deserve.
Providers in all disciplines face record levels of burnout, but adolescent medicine providers must not be forgotten. The current political climate is causing historic levels of interference, but immediate and concrete steps can help ensure the longevity of this field.
Emphatic statements of support from all relevant medical societies are needed that denounce disinformation, the criminalization of essential health care, and harassment of providers. Such statements can inform state legislators and protect individual physicians from being the focal point of advocacy. Leaders in medicine with access to legacy media must amplify these statements and flood America’s consciousness with correct information.
Current harms in medical training should also be mitigated with a sense of urgency. The American Association of Medical Colleges and the American College of Graduate Medical Education must create alternative opportunities for medical students, residents, and fellows to rotate in geographic regions where these essential health services are protected. This will reassure trainees that political interference will not irreparably harm their education and answer their legitimate concerns. Providers of all disciplines should stand beside and defend their adolescent medicine colleagues in state legislatures when intimidating legislation sways hospital leaders to close our clinics. To do so protects all patients, because scientific disinformation somewhere is a threat to health justice everywhere.
Whether or not our society is ready, more youth than ever are coming of age. Upfront investment in youth protects their health and ensures a triple dividend of wellness. Healthy youth become healthy adults who raise and support thriving younger generations. They’re diverse and dazzling. Up to 10 percent of high school students experience some form of gender diversity, which should be celebrated rather than attacked. First-generation students are moving into college campuses at the highest rates yet. But it’s not easy to come of age in today’s world, and youth need skilled clinicians to walk alongside them.
Meredithe McNamara and Joseph Waters are pediatricians and adolescent medicine specialists.
