Why It’s Time to Uncouple Obstetrics and Gynecology

What we’ve come to recognize as the modern OB-GYN specialty first emerged in the early 20th century when obstetrics and gynecology—separate and distinct fields until that time—were combined to offer comprehensive care throughout women's reproductive years. Today, many women indeed rely on their OB-GYNs not just for reproductive health, but as primary care providers for everything from family planning to cancer screening and menopause management.

While the merger of obstetrics and gynecology seems logical, the union has led to "bikini medicine," a remarkably short-sighted approach that reduces women's health to their reproductive organs while short-changing other vital systems like the heart, brain, and gut.

This narrow focus has had far-reaching consequences for women's overall health and the medical profession's approach to treating women. In fact, it has become increasingly clear that a more holistic, specialized approach is needed to address the complex health needs of women throughout their lives.

This realization has sparked a long-standing debate within the OB-GYN community about separating gynecology from obstetrics—a move I, a women’s health expert, wholeheartedly support. The split would foster subspecialty development, research, and innovation in these historically underexplored areas while giving young doctors the opportunity to specialize in one or the other.

Gynecology focuses on the health of the female reproductive system—including the uterus, ovaries and their hormone production, fallopian tubes, and vagina—encompassing everything from routine exams to the diagnosis and treatment of complex disorders. Obstetrics covers the care given to the mother and fetus during pregnancy and delivery. 

A combined OB-GYN practice skews care toward reproduction and neglects many crucial aspects of gynecology to the great detriment of women’s health. Women are up to 30% more likely to be misdiagnosed for major illnesses like cancer, diabetes, and heart disease. This stems from a traditionally male-centric focus in medical research, leaving the unique ways these diseases manifest in women largely overlooked. Cardiovascular disease is a prime example, where women remain underrepresented in clinical cardiovascular trials, making it difficult to fully appreciate sex differences in novel medical therapies, devices, or other interventions. As a result, women also experience more years of poor health compared to men. Heart disease, for instance, is the leading cause of death in women, yet women are seven times more likely to be misdiagnosed and sent home from the ER during a heart attack.

And let’s face it: not all women are interested in reproduction. According to a 2021 Pew Research Center survey, adult men and women alike who are not already parents say they are unlikely to ever have children, citing reasons ranging from simply not wanting to have kids to concerns about climate change and the environment.

The rapid pace of medical advancement further justifies dividing gynecology and obstetrics. Medical knowledge now doubles every 73 days and new treatments take 17 years to reach clinical practice. Both fields have grown too complex for our outdated training model. We're only now grasping how profoundly ovarian hormones influence a woman's physiology throughout her life, not just during reproduction. It's no wonder conditions like menopause remain misunderstood and too often overlooked.

My own experience underscores the challenge. At 43, I was blindsided by sudden anxiety and low-grade depression. Sure, I was working seven days a week with a two-year-old, but this was more than working-mom fatigue. 

As a confident surgeon and businesswoman, I was suddenly gripped by fear and uncertainty. With regular periods, I dismissed hormones—like most doctors in the 1990s—and turned to the medical literature, which pointed to depression.

It was my mother, with no medical background whatsoever, who suggested early menopause changes or perimenopause—something I hadn't even considered. She was right. Given all my training and years as a practicing gynecologic oncologist and surgeon, how could I have missed the signs, I thought to myself.

If I'm being honest, I simply wasn't well-versed in menopausal care then. Mismanaged menopause costs U.S. women $1.8 billion annually in lost work, lack of hormone support, and missed prevention of cardiometabolic disorders. Yet nearly two decades after my misdiagnosis, most young physicians still receive only a handful of lectures on menopause during their four-year OB-GYN training.

The problem extends far beyond menopause as well. Women with autoimmune disorders, which are significantly more common in women, often face delayed diagnosis and treatment due to lack of specialized knowledge. Mental health issues in women, particularly those tied to hormonal changes, are frequently misunderstood or dismissed. Even osteoporosis, a major concern for postmenopausal women, is an area where many OB-GYNs lack comprehensive training.

We need to train dedicated women's health specialists—not just reproductive experts. This would revolutionize the care women receive and dramatically improve outcomes. Beyond the economic losses attributed to mismanaged menopause, consider the productivity losses from undiagnosed autoimmune disorders, the healthcare costs of preventable osteoporotic fractures, and the human cost of misdiagnosed heart disease in women. By creating true women's health specialists, we can potentially mitigate preventable deaths and recoup billions in healthcare costs and lost productivity.

Read More: Why Maternity Care Is Underpaid

Proponents argue integrated OB-GYNs should remain primary care providers for women, given nationwide shortages. However, OB-GYNs often lack comprehensive training in neurology, cardiovascular, and metabolic health—critical for life-long, sex-specific care. This reliance may actually harm women's overall health.

Splitting obstetrics and gynecology will allow practitioners to stay more current and proficient in their specific areas, following the precedent set by other medical subspecialties. After World War II, advancements in medical knowledge and technology led to the development of distinct surgical fields and focused residency and fellowship programs. 

As medical science evolves, so too should the training and structure of OB-GYN. Untethering these specialties would align with the broader trend toward increased specialization in medicine, leading to the development of a well-trained, true women’s health specialist—the 21st-century gynecologist. 

Training programs should create separate tracks for obstetrics and gynecology, and professional organizations like the American College of Obstetricians and Gynecologists should develop new standards. Policymakers must support this shift with funding and legislation to better address the unique needs of women's health care.

Women deserve better than “bikini medicine.” Separating these fields can usher in a new era of women's healthcare—one that truly addresses the complex, interconnected nature of women's health. Today’s gynecologists would be true women's health specialists. Because the cost of inaction is too high.