OB/GYN is a surgical specialty, even though many OB/GYNs find themselves in the position of primary care providers (PCPs). OB/GYNs do indeed function that way for many women patients of childbearing age. We develop long-term, trusting relationships through regular check-ups as a PCP does. But women patients deserve comprehensive, whole-person care, too: a baseline of healthcare like preventive care, annual physicals, and a source of coordinated care.
An OB/GYN should be a part of a woman's healthcare team, but not her only provider.
I would know, as an OB/GYN myself. I left a career on Wall Street to devote myself to healthcare. I felt called to focus on women’s health during medical school and chose to become an OB/GYN because I wanted to be in an action-oriented speciality and wanted to develop long-term connections with my patients.
Over the course of my career, I realized that nuances of the impact of women’s reproductive lifespans on their future health are not well understood by non-OB/GYNs. Preeclampsia is a risk factor for cardiovascular disease, which is often overlooked in a medical history. The delay in diagnosis and treatment of a pregnant woman with abdominal pain contributes to the high complication rate in this patient cohort. Delay in care happens because of non-OB/GYN physicians’ fear of unnecessary procedures and tests due to a lack of understanding of the physiology of pregnancy.
The reasons for our healthcare system’s failures are complex, but I believe the solution starts with a simple acknowledgment that is missing in all the great debates about healthcare: women are people too.
Women's health shouldn’t be treated as specialized care
The idea that women's health requires separate, specialized care starts early in a physician's education. Only 9% of medical schools in the U.S. offer women's health as a course or elective. The overwhelming majority of patient case examples have white men as patients, giving students a limited view of what various conditions look like for different people. I couldn't help but see some connection between this fact and the recent JAMA study that showed women patients had a 32% increase in the risk of death when operated on by a male surgeon.
There are enormous gaps in the way women patients are seen and understood by our medical institutions.
Women's bodies are complex, with a whole set of special organs and hormones for childbirth. Whether or not a woman decides to have a child, that reproductive system significantly impacts her health. This includes all the things we traditionally associate with the women's health category, like the experience of giving birth, premenstrual syndrome (PMS), and it's more severe relative, premenstrual dysphoric disorder (PMDD). It also includes many other effects of that complex, under-studied reproductive system.
Women's health can’t be isolated to the reproductive system, either. Historically characterized as a condition that affects men, cardiovascular disease is a leading cause of death in Black and white women in the U.S. and presents differently between men and women. Women have a greater number of additional non-chest pain symptoms preceding a heart attack than men, regardless of the presence of chest pain. Because of this, healthcare providers are more likely to attribute non-chest pain symptoms to another cause, e.g., reflux.
Asian American women who do not smoke are at twice the risk of developing lung cancer than their non-smoking peers. Women are also twice as likely to develop multiple sclerosis and 2 to 3 times as likely to experience migraines. Women's health is multi-disciplinary by nature, informed by emerging studies and cultural and psychological factors.
Why you need a primary care provider
Primary care is associated with better outcomes for all patients. Numerous studies show that patients who see PCPs have improved health. A healthy distribution of PCPs in a given area is associated with an increase in life expectancy. Patients under the care of a PCP spend less on their healthcare, too, with fewer unnecessary or wasteful tests, decreased hospital stays and lowered use of emergency roomss.
Despite the proven benefits that primary care has for patients and providers, the U.S. is facing a primary care crisis. Approximately 13 million Americans live in a "primary care desert"—an area with inadequate access to a PCP—and in 294 counties, the majority of residents live in a region with a primary care provider shortage. Some projections estimate that by 2034, there will be a shortage of 17,800 - 48,000 primary care physicians.
How the lack of primary care hurts women
A lack of primary care has measurable impacts on a woman's financial burden and quality of care.
Women's yearly health expenses are more than 80% higher than men's.
Women are paying more, but receiving less care. One analysis showed that women who only saw an OB/GYN were missing out on key preventive care and screenings. A PCP was more than twice as likely to address concurrent medical issues with a woman patient, including mental health, circulatory, respiratory, and digestive conditions. Without a PCP, a woman’s care is less coordinated, especially when she’s referred to a series of different specialists. It also means more of her time is taken up by going to different medical offices and navigating various providers' schedules. Seeking healthcare becomes a larger burden for women patients, especially those who are low income, are caretakers, or are part of a vulnerable community.
To be clear, I'm not discounting the value of specialists—I am one myself! Although my medical focus is always on a patient's health, I care about my patient’s accessibility to care as well. My patients aren't just bodies to be examined and treated—they are whole people, who deserve a healthcare team who sees them as such.
Where technology comes in
Telemedicine is seeing rapid growth, interest, and mainstream adoption. Its momentum picked up with the COVID-19 pandemic, but the signs show that it's here to stay.
For patients who can't take time off from their work schedules or find childcare, asynchronous telemedicine provides them with the care they need. Secure platforms enable patients to submit medical information to their providers seamlessly.
Another benefit of virtual primary care is that it opens up space for patients who may feel anxiety or fear judgment from a provider. By removing the need for an in-person visit, patients may feel more comfortable seeking care on their terms. For example, telemedicine is improving access to gender-affirming care. In one study, nearly half of transgender youth expressed interest in receiving telemedicine for gender-affirming care, and this percentage was higher among youth who perceived lower parental support. Higher-weight patients who may feel uncomfortable at a doctor's office can also access quality care with telemedicine. Many higher-weight patients report that they’ve experienced weight bias from a provider. Physical cues at an in-person clinic, such as waiting rooms that can't accommodate higher-weight patients or a lack of blood pressure cuffs in the right size, are not an issue with telehealth.
The bottom line
The biases and barriers women face in healthcare are old, long-standing problems that need open-mindedness and new solutions. It's time to question if the "old ways" of personalizing care are fit to solve the problems that persist. (If it wasn’t working before, it certainly isn’t working now.) New and unfamiliar technology should be examined and tested, but its adaptability and potential make it promising. The most effective innovators in telemedicine won’t be who can most accurately reproduce the feeling of an in-person doctor’s visit. It’ll be who can truly treat a patient like a fluid, nuanced, whole person.