“Respect Your Teens”
words by Eve Jacobs / photograph by John Emerson
hallenging. Hostile. Hormone-driven. Wild. Screwed-up. Out-of-control. Depressed. Withdrawn. Isolated.
A child, once so loving and sweet, appears to have had a personality transplant. A frequently told story.
All adults know that the teen years are filled with jagged edges. And while many valiantly try to navigate a serene path through teen turbulence — careful not to sever fragile arteries of communication — there are only a few who manage to steer around those edges with finesse. Barbara Snyder is evidently one of the few.
Speaking with a firm, quiet surety about her own “growing years,” Snyder is easy to imagine in conference with a rough and tumble 15-year-old. A recognized expert on adolescence — placing among the best on New York magazine’s top docs list year after year — she didn’t start her own journey to adulthood aiming to be a doctor. It hadn’t occurred to her. “I thought I wasn’t smart enough,” she says.
She graduated from Barnard College with a major in sociology, having also enjoyed coursework in anthropology and literature, but with none of the science or math prerequisites for her future career. It was during the second year of a Master’s program in social work at Columbia University — in the midst of a clinical rotation at a psychiatric institute — that she “looked at the psychiatry residents and medical students and realized ‘I can do that.’” She remembers deciding definitively to pursue medical school admission then.
After earning her Master’s, she spent the next few years taking the prerequisite courses for applying to medical school and simultaneously working part-time as a social worker in the emergency room at St. Vincent’s Medical Center in Manhattan, “a real eye-opener.” Snyder was accepted at George Washington University Medical School, which she loved and where she “worked really hard but was very happy, part of a great group — half had come from other careers and many were older, PhDs, actors, even a poker dealer from Las Vegas.”
Although she had initially considered psychiatry, “that faded” and she chose pediatrics, in part because of the wonderful people she met during her pediatric clerkship at Children’s Hospital in Washington. It was there that she completed her residency before beginning her four-year commitment to the Air Force, which had financially underwritten her entire medical school tuition, fees and living expenses.
The young doctor spent her first year post-residency in the Azores (a Portuguese archipelago in the Atlantic Ocean just under 1,000 miles from Lisbon and about 2,400 miles from the east coast of North America) as the only pediatrician for 1,000 miles around, which “scared the willies out of me,” she says, and the next three years at a base near Syracuse, NY, where she primarily took care of kids whose parents were in the military. She enjoyed her patients, but did not like the military, appearing with her hair up and her uniform on (as per regulations) only when absolutely necessary. But Snyder did advance from second lieutenant to captain to major, and was thrilled that she “did not owe a dime” for her education. She also met her husband, rheumatologist Leonard Sigal, while stationed in New York State.
What she discovered during her residency and first years of practice was a talent for talking with young patients, particularly teens, which fit her original bent towards social work. So, she moved on to a fellowship in adolescent medicine at the University of Rochester.
In 1988, the couple arrived in New Jersey, where Sigal had accepted an appointment with UMDNJ’s Robert Wood Johnson Medical School (RWJMS) and Snyder started working at Cornell Medical Center in Manhattan. In 1990, she joined her husband at RWJMS, becoming the medical school’s first-ever specialist in adolescent medicine.
“All ages of children used to be ‘mushed’ together on the Hospital’s pediatric floor,” she says, “but adolescents really need their own space and nurses and doctors who identify with that population. Teens should be treated more like adults, and residents have to learn a different way to interact with them. The questions you ask a teen are different from those you ask a child. You have to deal with their parents differently, and you need to learn to handle teens with chronic illnesses.”
By Snyder’s second year at Robert Wood Johnson, she had become the pediatrics residency program director, which involved a huge commitment of time. She continued in that role for seven years, while simultaneously building her practice. Her patients, primarily young women, although she’s “happy to see guys,” come to her with a wide range of complaints, including menstrual issues, STDs, eating disorders, and many with chronic illnesses, such as diabetes, pulmonary disease, kidney problems, gastrointestinal issues, cancer, and perinatally-acquired or newly diagnosed HIV. They range in age from 10 to about 22, although there are no absolute cut-offs, she says. It is the age group that defines this specialty, not the medical concerns. In other words, she treats everything that comes her way if the patient is a teen or young adult.
“Young women with severe disabilities may want to continue in my care longer, and, for some, I serve as their regular doctor,” she says. Her oldest patient is 28.
Her most recent project is aimed at children and teens with weight issues — a weight management program with nutritionist Andrea Berez and psychologist Alison Morgan, PhD. This program requires the family to become involved in order to help kids change their eating and exercise habits. “Overweight kids are teased, stigmatized,” she says, but only 50 percent of those referred to Snyder pursue the program. “For many families, it’s not enough of a priority,” she continues. “That is frustrating for me.”
For children to lose weight, she points out, parents are crucial. “They need to know that even if the child throws a temper tantrum, the parent cannot back down. If the child is given a choice of foods — either an apple or an orange, for instance — and doesn’t want either, there is no other option.”
Does Snyder have any career regrets? Not even one. “I love to talk with adolescents. Sometimes the beginning is stormy, but then a deep attachment develops. It’s so rewarding to see kids evolve over time.” She has had particular success treating young patients with eating disorders, although it is “often a slow, rocky road.”
“I feel like half of what I do is psychiatric, an extension of my social work background,” she continues. “I like the kids a lot.”
So, what could parents do to smooth the “stormy” years of teen-hood?
“Parents are always walking a fine line with teens,” she says, “but many focus on what the teen does wrong. We should respect teens and serve as their advocates. Most kids are doing well in their lives, despite the rough spots.”
Her only regret is that she didn’t have more time to spend with her own children — now 14 and 18 — as they were growing up. She felt “so stretched. I would do that differently,” she says. She also wishes that she had had more time to pursue research interests.
The world of medicine is becoming a kinder and gentler place for women who are mothers, she observes. Snyder has recently hired a woman adolescent medicine specialist to work side-by-side with her in the practice at RWJMS — on a part-time basis. “It’s a great specialty and many young physicians feel that they don’t have to work all the time — as we used to,” she says.
What is her long-term goal? “To help adults like and respect adolescents more,” she quickly responds. That may sound simple, but as any parent of a teen would tell you, it can be a very tall order!