Growing demand: teens need doctors

"They're much more verbal and articulate than little children, and, once they trust you, much less defensive than most adults," says Andrea M. Marks, whose New York City practice is devoted exclusively to adolescents, beginning in the preteen years.

That willingness to speak frankly about the most intimate details of their lives-from menstrual disorders, to risky sexual behaviors, to depression and stress-is part of the excitement of treating such patients, those who do it regularly say. And yet, at a time when the forces affecting the nation's more than 40 million adolescents are among the most complex and frightening in US history, the number of specialists like Marks remains astonishingly low-about 700 physicians nationwide, according to the Society for Adolescent Medicine (SAM).

"Adolescents are betwixt and between," says Kulig. "They're viewed by many traditionally trained pediatricians as too old for pediatrics and by internists as too young for internal medicine." And FPs' "cradle-to-grave care" doesn't necessarily include a carve-out for this age group.

Why the dismissive attitude?

The perceived complexity of adolescent problems is one factor, some say. Another is the notion-not always incorrect-that teens can be tough customers, especially when they're uncomfortable. Even hurdles like these, though, wouldn't deter determined primary care physicians if compensation were fair. What has discouraged many PCPs is that insurers don't always compensate physicians for the extra time and effort it takes to conduct a comprehensive adolescent exam.

"Taking care of this age group can be costly," acknowledges Walter D. Rosenfeld, chairman of the Department of Pediatrics and director of the Adolescent/Young Adult Center for Health at Goryeb Children's Hospital in Morristown, NJ.

Still, as he and others point out, there are ways for PCPs who would like to add teens to their patient panels to make sure their reimbursements are adequate. We'll tell you how-and how to reach out to this interesting, challenging, and unique group of patients without turning your practice topsy-turvy.

Small changes can make a big impact

Unless you plan to transition to adolescent medicine full time, the changes to your office and style of practice needn't be radical. These changes, say Andrea Marks and others in the field, fall into two general categories: the tangible and the intangible.