Adolescent Medicine: Connecting with Teens

Session 219

Today, we chat with Kenisha Campbell, MD about her experience working in Adolescent medicine. She is also one of the hosts of the Melanin Hues Podcast. If you want to learn more about this specialty, check out The Society of Adolescent Health and Medicine.

For more podcast resources to help you with your medical school journey and beyond, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:12] Interest in Adolescent Medicine

Kenisha became interested in adolescent medicine in med school. She always knew she wanted to do pediatrics, but wasn’t sure what specialty of pediatrics she would do. then going through her day to day patient interactions, she realized she loved interacting with adolescent patients the most.

And so, she decided to do a sub-I as a fourth year in DC, and made the decision to go into adolescent medicine. She also realized she could do academic medicine, and still feel she’s contributing to the community.

Kenisha saw the need of the adolescent population to discuss sensitive topics, which she doesn’t shy away from. The population needs you to get down with them and be able to talk about it. And if you can’t talk about it, then you really can’t take good care of them.

'The adolescent population needs physicians who are willing to get down and discuss sexuality, sex, relationships, substance use, emotions, all those things that a lot of doctors ignore.'Click To Tweet

[02:53] Traits That Lead to Becoming a good adolescent medicine physician.

Kenisha has to be more on the liberal side, with adolescent medicine being a mix of medicine and social justice.

'You have to be more on the liberal side in order to practice adolescent medicine.'Click To Tweet

You have to be nonjudgmental and treat adolescents and young adults like they’re real people. They’re not little kids, they’re not adults, but they’re individuals that have their own identities and they want to be treated that way. So you have to be able to do that in order to take care of adolescent patients.

[03:41] The Biggest Myths or Misconceptions About Adolescent Medicine

One of the biggest misconceptions about adolescent medicine physicians is that they’re psychiatrists, but they’re not. They deal with a lot of psychiatric or psychological issues because that’s just part of development, but they are not psychiatrists.

They are also not OB-GYNs. They do reproductive health, contraceptive care, and mental disorders, but they’re not OB-GYNs. Many people in adolescent medicine give birth control, but they do a lot of different things within adolescent medicine.

[04:54] Why the Adolescent Population

Kenisha explains she was drawn to a variety of specialties including anesthesiology, dermatology, and allergy and immunology. She loved all of those specialties but the reason she didn’t do any of those specialties is she didn’t want to have to train with adult patients. And all three of those specialties required at least one year training with adult patients, and she just wasn’t willing to do it.

She adds that adolescents are still developing and growing so you have a lot of opportunity to make a difference and help them to become wonderful adults. But adults are already adults and they don’t change much, which for her, is frustrating. And she feels she wouldn’t have as much impact as she would want to have.

'Even if most of the adolescents don't necessarily have syndromes, you're still able to help shape them.'Click To Tweet

In her subspecialty practice, they see a lot of eating disorders, patients with gender dysphoria, HIV patients, patients with mental disorders and contraceptive needs. They deal with depression and anxiety, but it’s usually linked to another disorder, such as a somatic disorder.

[08:24] Typical Day

Kenisha has a mixture of responsibilities. She does 50% clinical, and her other time is administrative time. In the clinic, she does primary care clinic and specialty care clinic every week. Some weeks, she is on the inpatient service. They have three full inpatient services in her institution that are just adolescent medicine. So those are very busy weeks.

For her non-clinical time, she is the medical director of both their primary care and family planning clinics and their sub specialty care clinic. So it’s a lot of admin with that. Kenisha also works on diversity, equity, and inclusion projects throughout the institution.

There are not a lot of procedures in adolescent medicine. In fact, they do the long-acting reversible contraceptive, which is pretty much the only procedure they do in adolescent medicine. They do progestin-only implants and intrauterine devices.

[09:53] Taking Calls and Life Outside of the Hospital

When on call, they only do a week at a time so seven days at a time and probably 50 to 60-hour weeks, depending on how busy it is. They have fellows who, for the most part, take calls most nights. The two attendings call two nights out of the seven. So they don’t usually take overnight calls. They’re just there to back up the fellows that night and then work during the day and see the patients in the hospital.

As Kenisha got older and realized how important life outside of work is. So she makes more time and the pandemic has made that happen. Since the pandemic, she works remotely, at least two days a week. This has given her a lot more flexibility in her schedule.

[11:30] The Training Path

You can come to adolescent medicine from several different specialties, including pediatrics, OB-GYN, Family Medicine, Internal Medicine, and Medicine and Pediatrics combined. So you can come from five different specialties.

Then you have to do a three-year fellowship in adolescent medicine to be board-eligible. They have had people come through and do two-year fellowships who were in family medicine and internal medicine because they have that option. And it wasn’t enough time when they finished and weren’t as quite as ready as they needed to be.

Kenisha cites a few good reasons for this three-year fellowship. A lot of people barely see adolescents in their residency and that’s the first problem. Residency also fosters fear amongst the residents about adolescence so they don’t delve into it at all.

Second thing, the things they specialize in, you don’t learn in pediatric residency. You don’t learn eating disorders in pediatric residency, nor do you learn menstrual disorders or contraception and how to give it yourself. And so, developmentally, they just don’t focus on adolescents so people have no idea how to take care of adolescents a lot of the times. In adolescent medicine, they have to do a lot of education for pediatricians to help them to understand how to take care of adolescent patients.

[13:42] Competitiveness for Fellowship

Adolescent Medicine is not competitive in general because it’s a small subspecialty for various reasons. First of all, a lot of people don’t like adolescents. Second, it’s a three-year fellowship, and third, the pay is not the best. And for these three reasons, only those that love adolescent patients are going to adolescent medicine.

'Only people that love adolescent patients are going to adolescent medicine.'Click To Tweet

Similar to the gender pay gap out in the world, there’s the pediatric pay gap as well. You add pediatrics to any subspecialty and automatically, you get paid less, and that’s just sad.

[15:50] Other Further Opportunities to Subspecialize

In terms of other further opportunities to subspecialize, there are a few people who get boarded in substance use and HIV.

[16:20] Message to DO Students and the Future Pediatricians

Kenisha says they have a lot of DOs in their program. They’re treated exactly the same, and you don’t even know they are DO so there are no issues with that.

In terms of her message to future primary care physicians, Kenisha wants to remind them that they are not monolithic and they can help with lots of things. And if they think that something is beyond what they’ve been trained in or beyond their experience, they should go ahead and hand them off to adolescent medicine specialists.

'Pediatricians should be aware of what their limits are in terms of knowledge and training in adolescent care.'Click To Tweet

They see kids with eating disorders, who are extremely sick and they immediately have to be hospitalized. And they’ve been seeing their pediatrician for six months to a year with weight loss, and nothing happened and they just got worse. And that kid should have been handed to them months or years ago. They get them in a really bad place because pediatricians weren’t really trained on it. And so, they don’t really understand.

Unless pediatricians could get kids to them sooner before they’re severely ill, or they’re really stuck in their illnesses, it’s really difficult to treat them at that point.

[18:13] Specialties They Work the Closest With

Some of the specialties they work closely with are psychiatry, psychology, nutrition, OB-GYN. And the people who consults them the most are hematology, oncology, GI, and surgery.

[18:39] What She Wished She Knew Before Going into Adolescent Medicine

When Kenisha started out, she thought you had to do academic medicine. And there’s really not anything else you can do because you did a three-year fellowship. But you don’t have to do academic medicine.

You could be in the community and work for the federal government, and do clinical care. Or you can do non-clinical care.

There are lots of things you can do. You can work with government organizations for advocacy. You just have a lot of options, and you don’t have to limit yourself at all.

[19:31] The Most and Least Liked Things

Kenisha loves her patient population. They’re fun and they love to talk a lot, as long as you’re open and you’re not judging them. Because the minute they think you’re judging them, they will not say a word.

Adolescents are complex and trying to figure out who they are. And as healthcare providers, Kenisha believes they could have a major impact on them.

She adds she loves working with their families, for the most part. And if you can get a good relationship with both the parents or caregivers in the adolescent, then you’re in a much better place. At the end of the day, she likes the relationships she gets to build with families and patients.

On the flip side, what Kenisha likes the least is the lack of resources that are out there for behavioral health issues. Many of the kids they see, even if it’s not for behavioral health problems, have comorbid behavioral health disorders.

It’s very difficult to take care of a patient when they don’t actually have the behavioral health services that they need. It puts a lot of stress on adolescent medicine physicians to act as if they were behavioral health providers, and they’re not trained to be behavioral providers.

[20:59] The Impact of the Pandemic on Kids

Kenisha reveals that since the beginning of the pandemic, their inpatient units have been inundated with kids who are suicidal, with eating disorders, and lots of substance use. It’s been honestly horrible, and it hasn’t gotten any better.

Kenisha explains that even if these students have returned to school, you can’t just turn depression on and off.

There are not enough resources out there and providers to really take care of these patients. There are so many other complex things going on with their families. They’re witnessing death.

It has just been a really horrible time, Kenisha admits. And she’s very concerned about the long lasting impacts of the mental health crisis that the pandemic has caused, in addition to the educational deficits.

[24:06] Major Changes Coming to The Field of Adolescent Medicine

Kenisha says the field is definitely growing and expanding. The Society of Adolescent Health and Medicine is a very large organization and it’s now international. It includes not only doctors, but also nurse practitioners, educators, social workers, psychologists and nutritionists – anyone who cares for adolescents and is passionate about adolescent health care and adolescent outcomes.

And they’re going to continue to grow and expand to broaden their impact and not just focus on medical issues, but all the broader issues that impact kids and adolescents worldwide.

[25:07] Picking a Specialty That You Really Want

If she had to do it all over again, Kenisha would still be an adolescent medicine physician. A lot of people in general, pick a career for other reasons other than they really enjoy it and it excites them every day, and they’re passionate about the patient population.

Instead, they pick something either because their bored scores allowed them to or because a different subspecialty paid more. Then people are burned out. Because in medicine, it’s really hard to switch specialties.

[26:42] About the Podcast

Kenisha and her friends started a podcast called Melanin Hues: Conversations on Health and Wellness. Especially during the pandemic, they wanted to really focus on the disparities that were being seen in populations of color, especially women.

They’ve been focusing on physical health and emotional health on women of color. They want to be the voice that helps people maneuver everything that’s been going on with the pandemic. So they talk about topics that uplift people and try to improve their overall wellness.

[27:52] Final Words of Wisdom

Finally, Kenisha wishes to tell students who might be interested in the field that if you’re passionate about adolescents, young adults, adolescent health and social justice, this is the specialty for you.

You are going to feel good about the difference you’re able to make. Obviously, there are poor outcomes. But if you know you are doing this, because you love it and you are passionate about it, then it is fulfilling at the end of the day.

“Make sure you're open to all the possibilities in terms of your career options and not limit yourself.'Click To Tweet