A Pioneer of Adolescent and Young Adult Health: Dr. Charles Irwin

Between 1960 and 1980, adolescents were the only age group in the United States whose mortality rate increased. Charles Irwin, MD, a UCSF fellow at the time, noticed that the group lacked designated practitioners and clinics. His determination to best serve them catalyzed a new field in healthcare.

The first UCSF Teen Clinic was started nearly 50 years ago by Dr. Irwin, who currently serves as the Chief of the Division of Adolescent and Young Adult Medicine. He had a vision to initiate a specific discipline focused on addressing the needs of adolescents and young adults. Through years of his dedication and diligence, this vision became a reality and is now common in modern medicine.

In addition to his leadership at UCSF, Irwin served as Editor-in-Chief of The Journal of Adolescent Health from 2004 to 2019 and Supplements Editor from 2019 to 2023. He recently received a tribute published in The Journal of Adolescent Health for his outstanding transformation of the journal.  During his tenure, the journal became the fifth most impactful in all of pediatrics. Remarkably, the tribute highlights only one aspect of Irwin’s contributions to the rise of the field.

Understanding Young People

When Irwin moved from fellow to faculty in 1977, pediatricians transferred their patients to internal or family medicine at age 12. He knew that continuous care from pediatricians would better serve children through this unique and often tumultuous phase of life, and immediately convinced UCSF to increase the service age for pediatricians to 18. Later, Irwin was instrumental in efforts to increase that age to 25 across the nation. 

“Adolescents are remarkable human beings: exploring, thinking creatively, and struggling with questions about their future,” says Irwin. “Physicians must learn to balance many factors when caring for them, keeping in mind family dynamics and the interplay between behavioral health and physiological issues.”

Drawing from his rounds at the Haight Ashbury Clinic and nearby Planned Parenthoods, Irwin developed a robust research program on STDs and risky behavior, highlighted by a 1986 publication in The Journal of Adolescent Health that outlined drivers of risky behaviors and provided physicians with techniques to best advise teenagers on potential harms.

“Much of my life’s work has been learning about this group of oft-forgotten young people, discovering their unmet needs, and fighting hard to have best practices implemented within the larger medical community,” says Irwin.

Legitimizing the Field

To spearhead growth in the field, Irwin started the UCSF’s Leadership Education in Adolescent Health (LEAH) Training Program back in 1977, with a 500-page grant application written on a typewriter.

With the support of his peers, in the early 1990s, Irwin led a lengthy campaign to establish certification of the field.  In 1994, the effort succeeded, and Irwin was given the unique honor of becoming the first person boarded in adolescent medicine. The field had firmly established itself as vital part of the health system, leading to a surge of new clinics and programs.

Irwin later established the National Adolescent and Young Adult Health Information Center (NAHIC). The center is housed at UCSF and serves as infrastructure for collaborations on pushing policy initiatives, centralized resources for clinics, and a research network focused on accelerating findings into practice.

Training the Next Generation

“We’ve been extremely fortunate that over 90 percent of our graduates have stayed in the field and actively serve as leaders across the globe,” says Irwin.

The program has trained more healthcare professionals than any other of its kind, and many graduates have reached the highest level of leadership and service, including four presidents of the Society for Adolescent Health and Medicine (SAHM), 14 division chiefs, and four department chairs. Irwin himself also served as president of SAHM, a large national organization.

For Irwin’s successes in attracting aspiring researchers to the field, SAHM renamed a preexisting award the Charles E. Irwin, Jr. New Investigator Award. This award is given each year for the best scientific paper submitted for the SAHM annual meeting.

"I couldn’t be prouder of our division at UCSF. We began with the simple idea of improving care for teenagers and young adults, and now we have more than 20 interdisciplinary faculty members overseeing outstanding programs, including those focused on eating disorders, substance use, and reproductive health,” says Irwin.

When hearing from those who have worked closely with Irwin, it becomes clear that his impact on improving the health of adolescents and young adults is immeasurable.

• Sara Buckelew, MD, UCSF Professor of Pediatrics and Medical Director of the UCSF Eating Disorders Program: “Dr. Irwin’s advocacy for the creation of the field and commitment to training adolescent medicine specialists is nothing short of remarkable.”
• Claire Brindis, DrPH, UCSF Distinguished Emerita Professor of Pediatrics and Health Policy: “The field and focus on adolescent and young adult health has been created and advanced through his dedication, vision, and willingness to be at the cutting edge.”
• Marissa Raymond-Flesch, MD, MPH, UCSF Associate Professor of Pediatrics and Program Director for the UCSF Adolescent Medicine Fellowship: “Dr. Irwin’s calm, compassionate confidence with families provides a guiding light during their most turbulent periods. He deepened my appreciation that adolescents are drawn to physicians who are honest and authentic. With his baseball bow ties and suit jackets, he connects with kids just as they are.”