lessons learned the physician experience in the women’s health movement
TRANSCRIPT
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.
“Waves” of Women’s Health Activism:
1. Popular Health Movement (1830-1850)Campaigns against contraception and abortionAMA Resolution against abortionChastity 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 ReformsBirth Control Activists (Sanger opened 1st clinic-1921)
4. 1960s-1970sWomen’s Liberation and the “pill”Our Bodies Ourselves and the self-help and home birth movementsRoe v Wade Supreme Court Decision
Women’s Health Megamovement
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 providersNaivete – “Build it and they will come.”Over 65,000 hits at the ACWHP.org website to date
Lessons LearnedMoney 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 BacklashACOG
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 plateNational Centers of Excellence in Women’s HealthAMWA’s Reproductive Health Curriculum and
Textbook of Women’s healthHarvard Women’s Health Watch and Primary Care
of Women conferenceToday Show “Debate” (mud-wrestling)
Improvement v Ghettoization Issue
Quiet (Invisible) ProgressHow 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 publicationSeveral books published by Women’s Health
AdvocatesSee 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 IdeasGrassroots Campaign with Creative Marketing
$4M from 4 M WomenCreate 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 materialsOur 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 LearnedWomen 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