Lessons Learned

The Physician Experience in the

Women’s Health Movement
Visioning Exercise

Assume we achieve Universal Healthcare

Access . . .
(Be Careful what You Ask For)
. . .what will Women’s Health Care
Look Like Under Universal Coverage?
What is Women’s Health?
Women’s health is a distinct field of biomedical,
psychological and sociological knowledge and skills
based on the study of women’s experiences

Women’s Health is centered on the whole woman in the diverse

contexts of her life and grounded in an interdisciplinary sex-and
gender-informed science. ACWHP is committed to working across
medical specialties and in collaboration with other women’s health
professionals to advance the most comprehensive model of women’s
health.
Women’s Health Megamovement
“Waves” of Women’s Health Activism:

1. Popular Health Movement (1830-1850)

Campaigns against contraception and abortion
AMA Resolution against abortion
Chastity within marriage – sex reserved only for procreation
2. Late-19th Century Post-War Movement (1860-1890)
Campaigns against contraception and abortion
3. Progressive Era Movement (1900-1960)
Maternal and Child Health Reforms
Birth Control Activists (Sanger opened 1st clinic-1921)
4. 1960s-1970s
Women’s Liberation and the “pill”
Our Bodies Ourselves and the self-help and home birth movements
Roe v Wade Supreme Court Decision

from:Weisman, Carol, Women's

Healthcare, Activist Traditions and
Institutional Change
Women’s Health Agenda of
the 1990s (Fifth “Wave”)

 Anita Hill Testimony

 Clinton/Democratic Administration
 GAO Report of Exclusion of Women in Medical
Research
 Women’s Health Equity Act (Schroeder, Snowe)
 Women’s Health Initiative (Healy)
 NIH Office of Research on Women’s Health (Pinn)
 American College of Women’s Health Physicians
American College of Women’s
Health Physicians
March 1995. 11 women physicians created ACWHP,
with the goal of improving the Art and Science of
Women’s Health. Some Goals:
 Universal Health Care as a Women’s Health Issue

 Translate Gender-Specific Research into Clinical

Practice
 Improve education in women’s health to providers

 Create a Women’s Health Board Certified Specialty

Include non-MD and alternative providers

Naivete – “Build it and they will come.”
Over 65,000 hits at the ACWHP.org website to date
Lessons Learned
Money and Voices are Power
“No Money – No Mission”
 No one with power reaches down and says, “Let
me give you a hand since you are doing the right
thing. We should share the wealth.”
 Sense that “Physicians” organization should be
self-funding
 ACWHP Board: volunteers w/Jobs, and family

 Most medical education funding comes from

Pharma
 Little support for holistic, eclectic healing,
alternative providers, and being “Pharm Free”
The ?Anticipated Backlash
ACOG
 Changed Logo
 1998 Presidential address began: “The gauntlet has been
thrown.”
 APGO developed Competencies in women’s health
 Added 3 months to Primary Care training to the Residency

AMA -adopted a resolution against a specialty

AMWA (most likely collaborating body)

 Reaffirmed their Universal Healthcare Goal as a Women’s
Health Issue
 Differing Missions (Women Physicians v. Women’s Health)

 Again, vying for the same members and dues and

contributions
 Decentralization, Fragmentation
(Everybody’s doing it, and attempting to own it)

ACP, Society for Teachers of Family Medicine, APGO,

developed Women’s Health Competencies
Several Residencies, Fellowships, Women’s Health
Tracks at Universities
 Assigned to division with already full plate
National Centers of Excellence in Women’s Health
AMWA’s Reproductive Health Curriculum and Textbook
of Women’s health
Harvard Women’s Health Watch and Primary Care of
Women conference
Today Show “Debate” (mud-wrestling)
 Improvement v Ghettoization Issue
Quiet (Invisible) Progress
How many of these are you aware of?
Marianne Legato received grant from Columbia as show
of support for Women’s Health
Culminated in two-volume text:
Principles of Gender-Specific Medicine
Journal of Women’s Health began publication
Several books published by Women’s Health Advocates
See the ACWHP.org website
Women’s Health Conferences
Journal Review Tape Series (ACWHP)
“In This Case” Fax of women’s health case studies
(ACWHP)
Jumping on the Bandwagon

Nearly every Pharmaceutical Company

developed a Women’s Health Division
 These generally promoted pharmaceuticals for
“bikini medicine” (breast, gynecology,
reproduction)
 Created new “diseases” for drugs (osteopenia,
perimenopause, PMS)
 Heavily weighted toward plastics, new surgical
devices, and weight control
Learning from the Past
How were other specialties created?
 Pediatrics (60 years in the making)
 Emergency Medicine (similar “turf” issues)
 Family Practice – (Federal $ infused into
Universities to fill the “primary care drain”)
What does it take to create a specialty?
 ABMS is controlled by the AMA
 Must have residencies established and be in
existence for at least 5 years
 Must be a “unique” field of study
 50% of your members must belong to the AMA
ABMS Rules Created Obstacles to
Forming a Women’s Health Specialty

 Most women’s health physicians were

not members of the AMA
 Limited our desire to outreach to non-

physicians
 AMAs resolution against a specialty

would be difficult to change

So what were the alternatives?
Other Ideas
Grassroots Campaign with Creative Marketing
 $4M from 4 M Women

Create a Curriculum with “clout”

 Under larger umbrella with visibility?

 How do we get it validated and functionalized?

Give up “Intellectual Property” idea

The Medpedia Project
 Wiki Concept

 Open to MDs/PhDs

 Collecting sex and gender specific teaching materials

Medpedia
Please visit the site and join us--
Go to Groups @
www.medpedia.com/groups/444
“Advancing Womens Health”
Any MD or PhD can add materials
Our site coordinator, Jodi Godfrey will
help you find and place materials
Obstacles to Consider
 Internalized Sexism
 Real Sexism
 Letting go of Intellectual Property
 Including organizations with conflicting
goals
Lessons Learned
Women Organize Differently than Men
 Consensus vs. Majority rule
 Everything is personal – feelings can trump conviction
 Visionaries think and work differently than pragmatists
 We are sometimes our own worst enemies
 Can be subversive, not collaborative over conflicting
issues
 Our individual missions and passions can obscure the need
to work together to advance an overarching agenda
 Fragmentation dilutes voices, and therefore, power
 Most of the funding for medical education was from Pharma,
which may not support many of ACWHP principles
 Fragmentation dilutes power – competition for the same $
In An Ideal World (continuing
the “visualization”). . .
1. Women’s Health has a “home” with budget
and staff in every Medical School,
Residency, and other training institution.
2. Research, training and clinical care delivery
is sex-and gender-specific.
3. We create teachers of these programs.
4. Board-certifying exams or Certificates of
Qualification validate to the consumer.
5. This information is infused into all
specialties, clinical venues, “best practices”
and electronic record recommendations.
Visioning Exercise

“Be careful what you ask for . . .”

Please join us in moving forward to create
the type of sex-and-gender specific care
needed to treat 51% of the US
Population