There is a clear opportunity for care delivery innovation in the field of women’s health. The field encompasses a spectrum of gender-specific needs that a woman will encounter over her lifetime; however, common understanding and practice can incorrectly limit women-specific healthcare to the reproductive system.
Critical biological and behavioral differences between genders often impact the manifestation, epidemiology, pathophysiology of common diseases and alter the methods of resolving them. Consider heart attacks as an example: the symptoms of cardiac disease can vary widely between men and women. The former tend to experience crushing pain in the chest or arms, while the latter often report pain that moves through the shoulder, neck, jaw, and back. However, because the majority of what clinicians know about the diagnosis and treatment of heart disease stems from research done on men, there is a pronounced focus on male symptoms as the “typical” manifestation. One 2011 literature review published by the Texas Heart Institute Journal found that while cardiac disease affects men and women at similar rates, the population of a typical CVD clinical trial is predominantly (85%) male. Female-specific symptoms under-recognized, under-studied, and perhaps even under-treated. The same review also found that the CVD mortality rate of women is notably higher than the rate for men. All told, this indicates that women’s specific health needs both extend far beyond reproductive care and do not always receive the attention they need.
However, the medical attention women receive for their gender-specific health needs is typically focused heavily on gynecology and serviced primarily by OB/GYNs. A woman will enter the medical system for a number of reasons over the course of her life. These visits are typically sporadic and episodic. A young woman might undergo her first exams and receive oral contraceptives in her late teens, return for her first pap smear at 21, then come back five or ten years later for obstetric care. Another decade or two might pass before she returns to address age-related gynecological or urological interests. In theory, the female patient bridges these sporadic visits with regular visits with a primary care physician. In practice, the situation can be somewhat different.
While the majority of women do visit a family practice doctor for their routine care needs, some rely solely on their OB/GYN for primary care treatment. According to one study published in the Journal of Reproductive Medicine, a full 20% of participants identified their OB/GYN as their primary care provider. Another 28% did not identify an additional primary care physician, a finding which suggests that their OB/GYN might be their sole or principal source of care. The report further found that women who were pregnant, new mothers, or without chronic health conditions were more likely to use their OB/GYN as their primary care provider. Interestingly, OB/GYNs themselves may partly reinforce this trend; another study published in the Journal of Women’s Health found that just over half of surveyed OB/GYNs considered themselves to be specialists who also provided primary care.
Depending on an OB/GYN for non-gynecological concerns can be a good choice, but it does have drawbacks. While specialists are capable of providing primary care services — and indeed, many offer them — they tend to focus on the reproductive system first. Family medicine doctors and other general practitioners are often better at addressing the patient’s health as a whole. A 2014 study published in the Journal of the American Board of Family Medicine revealed that primary care physicians are significantly more likely to address concerns such as mental health conditions, metabolic issues, and respiratory, digestive, and circulatory diseases during a routine gynecologic visit than an OB/GYN.
Women want to access healthcare services that are tailored to their gender, and they shouldn’t feel as though they have to go to an OB/GYN to receive it. The health care sector needs to innovate the way it approaches care delivery by better integrating specialty services for women into primary care. To that point, I believe that there is a place in the market for multi-specialty clinics that provide convenient and gender-recognizant care to women. These would house both general practitioners, specialists, and testing facilities under one roof, thereby facilitating more convenient referrals, better communication between treating physicians, and more integrated clinical care than a woman might have with geographically-disparate providers.
To apply this solution to a hypothetical, consider a woman who approaches her primary care physician about an age-related urology concern. After discussing her case, the doctor sends the patient down the hall to the clinic’s in-house urologist. The urologist consults with the patient and decides that she needs more information. She asks the patient to step into another room for a few tests. The whole process is done on-site, allowing the patient to receive her diagnosis and treatment plan in a matter of days rather than the weeks.
This solution works well for the patient because she doesn’t have to take multiple trips across town for her referral or testing procedures; she also feels more comfortable meeting her doctors within a single space. The lack of bureaucracy in a single-site facility also helps doctors communicate better and provide higher-quality clinical care to their patients. Providers who focus exclusively on treating women may even be able to address female health concerns more effectively or offer a more satisfactory clinical experience. According to a 2003 study that investigated patient satisfaction rates among female veterans, women tended to have better care experiences in women’s clinics than they did in traditional primary care clinics. While more research is needed to link women-centered providers to quality care experiences, this study does suggest that they could offer women better care than a general provider would typically provide.
The women-centered clinics I propose would conveniently and effectively address the broad spectrum of health issues women face throughout their lives — and could be just the innovation those working in women’s health need to provide comprehensive, gender-tailored care to women.
