Understanding the changing boundaries between pediatricians, general practitioners, and geriatricians in a shifting medical world.
Pediatrician Alexis Lieberman recently got a request for help from a former patient. The 23-year-old needed a physical for her new job. Lieberman obliged. Though she typically sees patients up to the age of 21, she says their shift to a primary, adult-care physician isn’t always seamless. While other pediatric practices draw the line at age 18, she’s flexible with patients who have a tough time with the transition.
“The graduation of older adolescents from my practice often doesn’t ‘take’ with the first or second try,” says Lieberman, who sees patients at Advocare Fairmount Pediatrics in Philadelphia, East Norriton and Ardmore.
A 2025 study showed that our brains don’t actually reach “adult mode” until around 32, and scientists are still learning about how they change in our 60s and 80s. But what about our bodies? And how should that inform which primary-care physicians you choose, from pediatricians to geriatricians? We asked Philadelphia-area doctors for clarification.
What pediatricians do best, according to Lieberman, is “anticipatory guidance” for young patients and their families.
“We say things like, ‘Here’s the age your kid is now, here’s what your kid should be doing. Here’s the age your kid will be soon, here’s the things you need to think about going into that next stage,” she says. With the parents of a four-month-old, she’ll talk about introducing solid foods. At age five, there’s learning to cross the street and kindergarten readiness. At 16, “we have a long talk about driving safety.”
Children with health complications are a different story, she says, depending on severity. “Older adolescents who develop adult diseases, like high cholesterol, would either see a specialist to manage just that condition, or they’ll switch all of their care to an adult-care doc.”
Over time, Lieberman prepares all of her patients for the day they’ll leave her care by encouraging them, early on, to speak up at their appointments with her.
“When they’re three years old, they have to answer one question, like ‘What’s your favorite color?’ Or, ‘Do you like animals?’” she says. “By 11, in my practice, most kids are handling the bulk of the visit themselves. I’m always trying to get them to the point where, by the time they’re an adult, they can function at an adult doctor.”
Research shows that adults with a regular primary care physician — or an internist or family medicine doctor — benefit from prevention and early detection of chronic diseases like heart disease and diabetes. Good ones get to know each patient’s medical history. They keep an eye on cholesterol changes, blood pressure and vaccinations, and recommend screenings for cancers in which early detection makes a measurable difference in survival. They also coordinate referrals to specialists when needed and help make sense of what can be bewildering medical jargon.
“My job is to coordinate and make sure the right hand knows what the left hand is doing,” says family medicine physician Kenneth J. Veit , who has practiced at the Philadelphia College of Osteopathic Medicine’s primary-care centers for four decades. “Notoriously, patients come back to me. They see their ear, nose and throat doctor, and they have no idea what he said.”
Family medicine doctors like Veit add a twist: They’re trained to treat patients of all ages.
The age of Aimee Ando ’s patients at Penn Family Medicine University City range from newborns to 100 years old and beyond, which means she often treats multiple generations of the same family. “I’ll see a whole family get vaccinated together, and I think that’s a really sweet experience – for kids to see their parents” getting inoculated right alongside them, Ando says.
Like Lieberman, Ando says health complexities can prompt her to refer a patient elsewhere. “I will sometimes send an older patient to a geriatrician if I feel like they need more specialized, multidisciplinary treatment around memory care, dementia and mobility,” she says.
Just as pediatricians are trained to focus on kids, geriatricians do the same for those on the other end of the age spectrum, mostly by tracking “the 5 Ms”: mind, mobility, medications, multimorbidity, and “matters most.” In practice, says Katherine Galluzzi , of Philadelphia’s PCOM Geriatric Services clinic, that means screening for dementia or depression; assessing fall risks; managing multiple prescriptions and avoiding drug interactions; treating patients with several chronic conditions; and asking, “What matters most to you?”
While some of her steps mirror an internist’s, Galluzzi notes there are important differences, too. For example, she always looks at the bottom of a patient’s feet; problems there can indicate issues with circulation, mobility and daily self-care. Geriatricians also routinely perform mental-status tests to assess cognitive function. Another plus: They’ve also got valuable experience coordinating with other health care professionals (like physical therapists, speech therapists and social workers) and with navigating Medicare and benefits – “and the lack of benefits.”
Just as Lieberman thinks flexibly about the age range for pediatric patients, Galluzzi advocates for starting geriatric visits earlier than you might expect.
“Somebody who comes to see a geriatrician in their 50s is very forward-thinking because that’s the kind of person who says, ‘I want to age well,’” she says, noting that studies show “your levels of activity and engagement in your middle years strongly correlate with how you age.” For these younger patients, she will record physical and mental baselines that will be helpful as they get older. She can also help prevent overprescribing and drug interactions from ever arising.
Ultimately, deciding when to say hello to a geriatrician (or so long to your pediatrician) depends more on your health picture than an exact age. And maintaining a lasting relationship with whichever primary care doctor you choose correlates with a longer life. For good measure, while you’re weighing whether to move doctors, don’t forget to just move . “If there’s a fountain of youth, it’s physical and mental exercise,” Galluzzi says. “I try to convey that to all of my patients, and I try to model that as well.”
This primary-care health series is made possible by a generous donation from PCOM.
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