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Tuesday, October 18, 2016
Some millennials reluctant to outgrow their pediatricians
Posted Oct. 16, 2016
These days, Kathleen Kurtz feels less self-conscious when she visits her doctor. Now that the 31-year-old Northampton woman is a mom of three, she fits right in at the pediatrician's office, where both she and her children are patients.
She isn’t the oldest patient at the practice, either. The oldest is 35.
Kurtz is an unusual example of a small, but some believe growing, number of young adults who haven't outgrown their childhood doctor.
Pediatric office visits among those 19 and older jumped from fewer than 1 million in 2002 to 2.4 million by 2012, according to the Annual National Ambulatory Medical Care Survey. But there is debate within the medical community whether the increase is a real trend, or reflects more visits by young adults with special needs who tend to stick with their pediatricians longer.
Some suspect the rise is related to the implementation of the Affordable Care Act, which allows young adults to be covered under their parents’ health insurance plans until age 26. The change alone has added 6 million people between ages 19 and 25 to insurance rolls since 2010, according to the U.S. Department of Health and Human Services.
Some in the medical community express concern about whether pediatricians should be treating young adults, and when the transition to an adult doctor should occur. When young adults such as Kurtz are asked why they've stuck with their pediatrician, continuity of care is one reason that's given, along with convenience, same-day appointments and comfort levels.
“I just feel comfortable with him. It’s easy to go to him. He’s available whenever I need him. I can be seen right away,” Kurtz said. “I’m actually nervous about when he retires.”
Kurtz has been seeing Dr. Isaac Abir at his practice in the Richboro section of Northampton since she was an infant. When she was diagnosed with thyroid cancer at age 24, Abir was very involved in her care. He recommended her surgeon and other specialists, and reviewed her scans and other treatment records. In recent years, she sees him mostly only when she is sick or for her annual flu shot.
In her 20s, Kurtz admits that she felt self-conscious sitting in the waiting room, with its walls of handmade crayon artwork, a laundry basket brimming with children’s books and giant baby bottle.
“Before I had kids I felt uncomfortable sitting in the waiting area because I’m obviously older,” she said. “But now that I have kids I feel I have an excuse to go to him because I don’t feel as odd when I’m there.”
Research has found that people between the ages of 18 and 34 have historically shunned doctors until they have a medical need, and so-called millennials in their 20s are more likely than other age groups to use retail clinics and emergency rooms rather than visiting a doctor's office. Yet recent data suggests young adults who still see their pediatricians are bucking those trends.
Patients ages 18 and older accounted for nearly 7 percent of pediatrician visits in 2012-13, according to the National Ambulatory Medical Care Survey.
Dr. Heidi Weinroth and colleagues in Cooper University Pediatrics in Moorestown, New Jersey, typically see patients until they graduate from college. She estimates fewer than 10 percent of patients in her medical practice are in their 20s, but their reluctance to leave doesn’t surprise her.
With more young adults living at home longer and attending college closer to home, it makes sense to them to stay with a doctor they know and trust, she said. Weinroth added that she is careful not to overstep her medical bounds and refers young adult patients to specialists as needed.
But for general health issues, she said he finds the combination of continuity of care and the longtime doctor-patient relationship makes patients more receptive to talking frankly about their health issues.
“You bond with your pediatrician differently. We know them as well as they know us. These patients have had the same doctor for all their lives, literally,” she said. “Most of us haven’t seen our doctor 10 times. It’s no wonder they don’t want to leave us.”
Not every doctor wants to keep seeing patients into adulthood.
For example, most pediatric practices associated with Grand View Health in West Rockhill don't allow patients to remain in their practice after age 22, health system spokeswoman Susan Ferarri said. Many pediatric practices see age 22 as “really a stretch,” Ferarri said.
While the medical community agrees the relationship between pediatricians and patients is special, experts generally believe it shouldn't last too far into adulthood.
The Institute of Medicine and the National Research Council recently released a report that found that ages 18 to 26 represent a critical developmental period, and that group should be treated as a distinct subpopulation for medical reasons. Among the report’s recommendations for improving health care for this age range is transitioning from pediatric to adult medical and behavioral health care.
Got Transition encourages pediatric practices to set age-out policies so the deadline is known far in advance, said spokesman Daniel Beck. As early as ages 12 or 14, parents should start thinking about transitioning their child to an adult-focused doctor, he said, adding that his group believes the transition should be done between ages 18 and 21.
“We understand it’s a new (doctor) and trust needs to be formed, but it’s certainly something that needs to be happening,” Beck said.
While pediatric office visits by young adults are growing, Dr. Patience White, co-director of Got Transition, suspects a large number of those visits are by young adults with chronic illnesses who require more frequent medical care than their healthier peers.
“Change is hard, and for those with special needs, it’s especially hard,” said White, a professor emeritus of medicine and pediatrics at the George Washington University School of Medicine and Health Sciences in Washington, D.C.
Some pediatricians agreed that the transition to an adult-focused doctor can be difficult for patients with special needs such as Attention Deficit Hyperactivity Disorder or asthma. Frequently, a new doctor will want to start over to reaffirm the original diagnosis or adjust medications, which she said can be time-consuming.
But that's another reason the transition from pediatric to adult-focused health care is critical, said Dr. Katie McPeak, medical director of the Center for the Urban Child at St. Christopher’s Hospital in Philadelphia. St. Christopher's treats patients until age 21. McPeak recommends a two- or three-year transitional planning period, starting at age 15, for patients with chronic conditions.
"You are just prolonging the inevitable,” she added. “We can’t keep kids forever.”
Most pediatricians aren't credentialed to treat patients after age 21 and that can make it difficult to get an insurance company to cover the visit, McPeak said. Pediatricians also aren't necessarily skilled in substance abuse management and also may not be trained in sexual health and women's health issues, she said.
For those looking to delay the transition, a compromise could be a doctor board-certified in pediatrics and adolescent medicine since those specialties require additional training in behavioral and sexual health, White and McPeak said. Abir, Kurtz's pediatrician, fits into this category. He has extra training and experience in adolescent and adult medicine, and formerly was medical director for a residential center for children and adults with mental and physical disabilities.
Abir enjoys treating adults and children, but decided on the latter when he opened his solo pediatric and adolescent medicine practice in 1970.
He sees no reason to move his longtime patients to adult-focused practice once they turn 21, though he doesn’t accept new young adult patients. Abir believes the lifelong connection with patients is mutually medically beneficial.
“I have their whole history of life,” he said. “It’s like they are family.”