Lessons Learned

1. Lessons Learned The Physician Experience in the Women’s Health Movement

2. 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?

3. 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.

4. Women’s Health Megamovement “Waves” of Women’s Health Activism: • Popular Health Movement (1830-1850) Campaigns against contraception and abortion AMA Resolution against abortion Chastity within marriage – sex reserved only for procreation • Late-19th Century Post-War Movement (1860-1890) Campaigns against contraception and abortion • Progressive Era Movement (1900-1960) Maternal and Child Health Reforms Birth Control Activists (Sanger opened 1st clinic-1921) • 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

5. 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

6. 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

7. 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”

8. 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

9. 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

10. 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 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)

11. 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

12. 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

13. 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?

14. Other Ideas Grassroots Campaign with Creative Marketing • $4M from 4M 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

15. 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

16. Obstacles to Consider • Internalized Sexism • Real Sexism • Letting go of Intellectual Property • Including organizations with conflicting goals

17. 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 $

18. In An Ideal World (continuing the “visualization”). . . • Women’s Health has a “home” with budget and staff in every Medical School, Residency, and other training institution. • Research, training and clinical care delivery is sex-and gender-specific. • We create teachers of these programs. • Board-certifying exams or Certificates of Qualification validate to the consumer. • This information is infused into all specialties, clinical venues, “best practices” and electronic record recommendations.

19. 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