The modern OB-GYN specialty, which emerged in the early 20th century, marked a pivotal point in women’s healthcare by combining the previously distinct fields of obstetrics and gynecology. This merger aimed to provide comprehensive care for women throughout their reproductive years, and today many women rely on their OB-GYNs for everything from family planning to cancer screenings and menopause management. However, this combined specialty has inadvertently created a narrow view of women’s health—what some call "bikini medicine"—focusing predominantly on the reproductive system while neglecting other critical areas like cardiovascular, neurological, and metabolic health.
The Unintended Consequence of a Narrow Focus
The historical merging of obstetrics and gynecology may seem logical—both deal with aspects of reproductive health—but this union has led to unintended consequences for women's overall health. By reducing women's healthcare to just their reproductive organs, many crucial health concerns are often overlooked. This reductionist view contributes to misdiagnoses in major illnesses and inadequate care in areas like heart disease, mental health, and autoimmune disorders, which disproportionately affect women.
For instance, women are 30% more likely to be misdiagnosed for conditions like cancer, diabetes, and heart disease due to male-centric medical research that often fails to capture how these diseases manifest differently in women. Cardiovascular disease is a glaring example, as it remains the leading cause of death among women. Yet, women are significantly underrepresented in cardiovascular clinical trials, and they are seven times more likely than men to be misdiagnosed and sent home from the ER during a heart attack. This alarming statistic underscores how the "bikini medicine" approach shortchanges women, reducing the complexity of their health needs to a narrow focus on reproduction.
The Case for Separating Obstetrics and Gynecology
A long-standing debate within the medical community questions whether obstetrics and gynecology should remain unified. I, along with other women’s health advocates, believe the time has come to split these two fields. This separation would allow for more specialization, research, and innovation in each area. Gynecology could become a dedicated discipline that not only deals with reproductive health but also delves deeper into issues like hormone-related disorders, autoimmune diseases, and menopause.
Obstetrics, on the other hand, would remain focused on pregnancy and childbirth, which are complex and crucial in their own right. As medicine advances, it is increasingly difficult for doctors to stay proficient in both fields. The rapid pace of medical knowledge—doubling every 73 days—makes it impossible to cover the depth and breadth required in both obstetrics and gynecology during the four-year training period. A split would give young doctors the opportunity to specialize and better serve the specific needs of women at different stages of life.
The Impact of Misunderstanding Women's Health
The problem extends beyond just the lack of focus on non-reproductive issues. Take menopause as an example. The profound hormonal changes women experience during menopause can significantly impact their mental and physical health, yet it remains one of the most misunderstood areas of women's healthcare. Mismanaged menopause costs U.S. women an estimated $1.8 billion annually due to lost work, inadequate hormone support, and missed prevention of cardiometabolic disorders. Despite these staggering numbers, most physicians, including OB-GYNs, receive minimal training in menopause management.
My own experience serves as a cautionary tale. At 43, I began experiencing sudden anxiety and low-grade depression—symptoms I initially dismissed as work-related stress. I was a confident surgeon and businesswoman, but I found myself gripped by fear and uncertainty. Even with regular menstrual cycles, I didn’t consider the possibility of perimenopause. It was my mother, without any medical training, who suggested that my symptoms might be related to hormonal changes. She was right, and I realized that even with all my medical expertise, I had overlooked something fundamental.
This lack of focus on non-reproductive health issues extends to autoimmune disorders, osteoporosis, and even mental health. Autoimmune diseases, which disproportionately affect women, often go undiagnosed or misdiagnosed for years due to a lack of specialized knowledge. Similarly, mental health issues linked to hormonal changes are often misunderstood or dismissed. And osteoporosis, a significant risk for postmenopausal women, is frequently ignored by OB-GYNs who lack the necessary training to manage bone health.
A Call for True Women's Health Specialists
The time has come to train dedicated women's health specialists—experts who focus not just on reproduction but on the complex, interconnected systems that affect women's health throughout their lives. By splitting obstetrics and gynecology, we would enable healthcare providers to gain a deeper understanding of the unique health challenges women face at every stage of life. This would allow for better diagnosis, treatment, and prevention of conditions that are often overlooked or poorly managed under the current model.
The economic case for change is clear: mismanaged menopause alone costs billions, and the productivity losses from undiagnosed autoimmune disorders and osteoporosis add to the financial burden. But the human cost is even greater. Women deserve better than “bikini medicine.” They deserve healthcare that acknowledges and addresses their full range of needs, from heart disease and mental health to autoimmune conditions and bone health.
Moving Forward
Some argue that integrated OB-GYNs should continue to act as primary care providers for women, especially given the current shortage of healthcare professionals. However, OB-GYNs often lack the comprehensive training required for neurology, cardiovascular care, and metabolic health—areas critical for long-term, sex-specific healthcare. Continuing to rely on this outdated model may actually harm women's overall health by perpetuating the narrow focus on reproduction.
By separating obstetrics and gynecology, we could develop a new breed of women’s health specialists who are experts in all aspects of women’s health, not just reproduction. This split would follow the precedent set by other medical subspecialties, which emerged after World War II in response to advancements in medical knowledge and technology. As medical science evolves, so too must the training and structure of women's healthcare.
Training programs should offer separate tracks for obstetrics and gynecology, and professional organizations, such as the American College of Obstetricians and Gynecologists, must develop new standards to support this shift. Policymakers should also play a role, providing funding and legislation to ensure that women's health is treated with the comprehensive care it deserves.
Conclusion: The Cost of Inaction
The current OB-GYN model is outdated and fails to meet the needs of 21st-century women. Separating obstetrics from gynecology will allow for more focused and effective care, ultimately improving women's health outcomes. We have the opportunity to revolutionize women's healthcare and provide true, holistic care that addresses all aspects of a woman's health—not just her reproductive system. The cost of inaction is too high, both in terms of lives and healthcare dollars. Women deserve better, and it's time we deliver.