This issue of HMPI is focused on the question of women both as healthcare entrepreneurs and as patients. Overall, the issue provides support for innovation in women’s health, and for an expanded role of women to lead these efforts. The issue also addresses the challenges of OB-GYN practice in the US, illustrating the impact of workforce and payment models on women’s access to services.  Finally, Reggie’s case corner features insights from the first tenured professor at Harvard Business School, and her case studies featuring women entrepreneurs in healthcare.Together, this is an exciting set of articles. We hope they will engage you in this effort to advance women’s health in the US.

Dzinoreva et al. provide a case study of the crisis in maternity care in rural America. This piece carefully documents the many challenges facing rural obstetric providers, from reimbursement to how clinical practice has evolved to offer very different career paths between urban and rural providers.

Fitzgerald et al. provide a detailed assessment of how the mechanics of payment, the Resource-Based Relative Value Unit System (RBRVS) systematically undervalues the procedures performed by OB-GYN physicians, and how the system undercompensated procedures performed on women compared with similar procedures performed on men. They describe several approaches to correcting this systematic bias in the payment structure.

Owen et al. provide a systematic framework for discussing women’s health and an analysis of business opportunities in this space. Their effort is based on a synthesis of the medical literature and provides an exciting roadmap for innovation in this space.

Creo conducts an interview with Laura Yecies, the CEO of Bone Health Technologies, an entrepreneurial approach to developing new treatments for osteoporosis. Yecies describes her personal motivation for trying to tackle this significant clinical problem, and how she approaches entrepreneurship in this space.

Quarshie et al. develop a life-course analysis to examine women’s health and offer an argument that the FemTech market offers the potential for significant improvement in the health of women in the US and globally.

Walker describes the gender differences in innovation roles in healthcare, and argues that we are facing a significant opportunity cost by not have more women in leadership roles as healthcare innovators. This article draws from an extensive body of research developed on this topic by the author.

Together, this is an exciting set of articles. We hope they will engage you in an effort to advance women’s health.

Kevin Schulman, MD, MBA
BAHM President & HMPI Editor-in-Chief
Professor of Medicine, Stanford University

Melissa Dzinoreva, School of Medicine, Stanford University, Nicole D’Andrea, Carteret OB-GYN, James Whiteside, Eastern Carolina University, Brody School of Medicine, and Kevin Schulman, School of Medicine and Graduate School of Business, Stanford University

Contact: kevin.schulman@stanford.edu

Introduction

Maternity care deserts are an increasing concern in the United States as access to comprehensive reproductive healthcare continues to decline. According to the March of Dimes 2024 Report, 3,142 counties (35%) are classified as maternity care deserts (Figure 1). These counties lack hospitals or birth centers offering obstetric care and have no obstetric providers, creating a growing public health crisis.[1] Over 2.3 million women of reproductive age reside in U.S. counties classified as maternity care deserts.¹Nearly two-thirds of maternity care deserts are in rural areas, where the average time to access care is 38 minutes, over twice the average travel time (16 minutes) for those in full-access counties.[1] Living in a maternity care desert increases the risk of death during pregnancy and up to year post-partum (aRR for pregnancy-associated mortality=1.91, 95% CI=1.15–3.18; aRR for pregnancy-related mortality=3.37, 95% CI=1.71–6.65).[2] Living in a maternity care desert or low-access county is associated with a 13% and 11% increased risk for preterm birth, respectively, compared to living in a full-access county.[1] Further exacerbating these challenges is the essential role of comprehensive maternity care in breastfeeding initiation, which can improve maternal and infant health outcomes.[3]

 

Figure 1. Maternity care access designation by county, US and Puerto Rico¹ (Reprinted with permission of The March of Dimes).

While current data provide some information on the extent of this challenge, there are few data informing why a community has lost its obstetric services. We used a case study approach to examine one community at risk of becoming an obstetric desert—Carteret County, NC. North Carolina’s overall maternal health metrics underscore the urgency of this situation. The state ranks 30th in maternal mortality and 39th in infant mortality.[4]

Carteret OB-GYN

Carteret County, located along the eastern coast of North Carolina, has a population of approximately 70,000. The area is renowned for its beaches, including Emerald Isle and the Cape Lookout National Seashore. It also houses marine laboratories for Duke University and the University of North Carolina, underscoring its importance to both the local community and academia. Carteret OB-GYN is the sole obstetric care provider for the county. The six-physician practice operates at Carteret Health Care, a 135-bed independent nonprofit facility. The nearest referral hospital, ECU Health Medical Center, is a two-hour drive away.

Since its establishment in 1977, Carteret OB-GYN has become an integral part of the community. Physicians frequently encounter former patients and the children they delivered, a testament to their longstanding presence in town. The practice was also a leader in the innovative Maternal Outreach Through Telehealth for Rural Sites (MOTHeRS) Project, established in 2020. This initiative was developed in response to gaps in care exacerbated by the COVID-19 pandemic, when many patients missed clinic appointments due to fear and limited information.[5] Women receiving care at Carteret through the MOTHeRS Project reported high satisfaction with the program’s resources, such as food and nutrition education. The practice has maintained the food initiative for patients even after the project’s formal study period ended. Interviews with participants revealed that addressing food insecurity within a clinical setting reduced stress for vulnerable households and lessened the stigma associated with traditional food assistance programs like SNAP and WIC.[6] Carteret OB-GYN believes that their care approach highlights the value of integrating holistic patient support into maternal care.

The Carteret physicians see patients in the office and then take call for deliveries. With six physicians, they average being on-call every 6th night. Vacations are carefully coordinated across the group to minimize the impact on the call schedule. Despite the benefits of practicing in such an intimate fashion with the community, the practice has struggled to recruit new physicians. In fact, at the end of 2024 the most recent member of the group joined six years ago but the rest have been there for between 13 and 27 years. The physicians in the group are realistic about the future of the practice. The oldest member of the group is now 63. Should one physician retire, the remaining physicians are reluctant to do more frequent call. The practice could stop offering obstetric services if they cannot replace the retiring physicians. If that happens, Carteret County could become another maternity care desert.  This problem of obstetrician staffing is a common theme across NC labor and delivery units with retirement, practice restriction, and providers leaving all being sources of attrition.

The Rural Obstetrics Practice

Practice restriction has long been a feature of OB-GYN. This cause of obstetrician attrition has accelerated in recent years in part due to professional preferences. CMS funding for graduate medical education (GME) perpetuates a system where most residents train in urban areas with low or stagnant population growth. Since one of the strongest predictors of where residents are employed is where they train[7] physician-density is not commensurate with population growth or need. Further complicating GME training issues, accreditation of OB-GYN residency training programs requires exposure to care that can only be found in more urban areas.[8] Additionally, the demographics of OB-GYN physicians has been cited as a source of practice restriction with a female dominance of physicians entering the specialty[9] More recently, work-life expectations and burn-out have also fueled practice restriction. These factors favor urban practice where there are better employment opportunities for two-career couples, and better access to high-rated schools and cultural attractions.

Commonly medical students applying for OB-GYN residency will say what attracts them to the specialty is the ability to do a little bit of everything. This job characteristic has been both a source of attraction and trouble for the specialty since doing everything meant doing less of any one thing potentially undermining quality. OB-GYN practice is comprised of three “services” – ambulatory, labor and delivery, and gynecologic surgery. This trifurcation is the genesis of sub specialization in OB-GYN. As an untoward effect, specialization reinforces urbanization of care. Subspecialists need a larger captive population to sustain a focused clinical practice. Laborists, while not a formal subspecialty, emerged as a solution to address inpatient obstetrical quality as well as to address labor and delivery staffing.[11] The laborist trend was also fueled by the dramatic shift from self-employment to employment models over the last decade – 55% of physicians now work for hospitals or health systems and 78% are employed in some capacity.[10] All of these restrictions and practice issues have become a “perfect storm” of factors that reducing the availability of OB-GYN physicians outside of urban America. While these issues are far upstream of Carteret County, access to OB-GYN care in the county is an unintended externality of who, how and where OB-GYNs are trained.

Irrespective of its size every community must have a fire department.  Similarly, irrespective of how many deliveries a hospital may see there are fixed costs to support the service. Beyond those fixed labor and supply costs, the laborist staff model requires 4.2 full-time equivalents for 24/7 coverage and an attractive call schedule. As these physicians are paid based on compensation benchmarks reflecting urban practice environments, a laborist model is prohibitively expensive for a rural hospital like Carteret Health Care with a modest number of deliveries each month. An employed laborist arrangement also would not address OB-GYN ambulatory or gynecologic surgery care. Hospitals can fill in coverage gaps with locums physicians although these physicians are also expensive and can introduce quality concerns. For an independent hospital seeking to sustain OB-GYN services in a low delivery volume setting, these costs add up to closure of labor and delivery units.

Financial Challenges

Financial instability continues to challenge Carteret OB-GYN, particularly due to its payer mix. From 2014 to 2024, the clinic recorded 7,835 total deliveries. Of these, 3,152 (40%) were covered by commercial payers such as Blue Cross Blue Shield and other private insurers, while the remaining 4,683 (60%) were covered by government sources—including Medicaid, Tricare—and self-pay patients. This heavy reliance on public reimbursement (well above the national average), which typically offers lower payment rates than private insurance, contributes to ongoing financial strain. Essential services such as high-risk prenatal care and mental health support operate at a loss, continued primarily by the dedication of the healthcare staff rather than sustainable funding.

To illustrate the financial challenges further, recent changes to the Medicaid fee schedule in North Carolina highlight the systemic underfunding of obstetric care. As of July 2023, Medicaid reimburses $1,747.98 for obstetric care and vaginal delivery (CPT code 59400), or $697.93 for a vaginal delivery (CPT code 59409) or a cesarean delivery (CPT code 59514) when only delivery services are provided.[12] These rates often fall well below the actual cost of providing the care and do not account for necessary support services, clinic overhead, or the high on-call burden required of rural providers. This structural mismatch between reimbursement and cost contributes directly to Carteret OB-GYN’s financial instability.

Referral Center Perspective

ECU Health Medical Center, the referral hospital for Carteret County that lies two hours away by car, faces significant challenges in assisting Carteret OB-GYN. ECU Health is committed to maintaining its six smaller (less than 500 annual deliveries) labor and delivery units across eastern North Carolina facing similar staffing and financial challenges as Carteret OB-GYN. Over the last five years, ECU Health has documented nearly 25,000 encounters with pregnant women, of whom half had an obesity diagnosis and one in three a hypertensive disorder. Additionally, more than 1 in 10 experienced gestational diabetes while overall one third listed diabetes as a clinical problem. Like elsewhere in the country, the proportion of pregnant women with a chronic medical condition is increasing and placing strain on Greenville’s already understaffed specialists and subspecialists, contributing to longer patient wait times. Greenville-based, ECU Health Medical Center’s capacity issues challenge its ability to manage referrals from Carteret Health Care.  Carteret County is not the only county in the ECU Health service area suffering from this rural health care crisis. Given the transportation challenges of poor women living in rural eastern North Carolina, travel to a tertiary medical center beyond Greenville to access care is an unrealistic option for many patients.

The Incoming Tsunami: Workforce and Financial Challenges

The profitability of rural hospital labor and delivery units is not related to low Medicaid or Medicare payments or losses on uninsured patients, but rather to differences in private insurance payments that vary across rural hospitals. Nevertheless, the financial challenges facing Carteret OB-GYN stem largely from inadequate physician funding through the state Medicaid program. While efforts to better compensate obstetric care are essential for sustaining these services, they only address part of the problem. These challenges are exacerbated since, as of October 1, 2025, North Carolina Medicaid has implemented significant reimbursement rate reductions for physicians and other healthcare providers due to a state budget shortfall and insufficient appropriations from the General Assembly.

The deeper, more pressing issue is the workforce. Beyond the issue of specialization, urban training injects another variable into how services are provided to patients in these settings. For example, the explosion of robotic assisted surgery has changed how trainees perform many gynecologic procedures, even when the robotic approach is comparable to the less expensive laparoscopic approach.[13] Since the capital costs of robotic surgery are beyond the means of many rural hospitals, physicians may reject rural practice in favor of working in an urban setting where robotics is available. If GME funding reflected population growth and need, that would be a powerful catalyst for changing some of these biases against rural healthcare. State-level GME funding and loan repayments strategies focused on rural access can also be a source of relief. OB-GYN residency training could prioritize high value care available across all hospital resource settings. Hospital and physician’s payments should similarly incentivize highest value care and not reward the most expensive care. Finally, payments for standby services and low volume adjustments can ease the financial strain experienced by low volume rural labor and delivery units.

After speaking with the dedicated physicians involved, it becomes clear that we are witnessing a crisis slowly unfold. While proposed solutions to address the nations maternity care challenges can focus on adding additional health resources (e.g., doulas), without an obstetrical practice, there is no hospital service. Carteret OB-GYN is under no obligation to maintain its obstetric practice. Meanwhile, the local hospital may soon find itself unable to staff its obstetrics service, either due to the high cost of locum coverage or the complete lack of available providers, potentially forcing the closure of its labor and delivery services. The referral hospital, already challenged by the needs of a high-risk population, is not affiliated with the local hospital and is under no obligation to step in. At the county or state level, there is no designated authority responsible for ensuring the delivery of clinical services.

Watching this crisis unfold, Carteret Hospital and the practice’s ownership group pitched in financially to recruit a new physician to the practice. There was a single candidate who applied, but the practice was able to recruit them and stave off their staffing crisis in the short-term. Other practices in similar circumstances may not be as fortunate.

Conclusion

Carteret OB-GYN’s predicament underscores the broader struggle of rural healthcare systems to balance financial viability with community needs. By implementing targeted policy reforms, increasing financial incentives, and fostering integrated care models, stakeholders may be able to prevent Carteret County from becoming a maternity care desert. However, all of this requires leadership charged with addressing this crisis. Given that nearly 25% of the nation’s population lives in a rural area, access to quality maternal healthcare is a national priority and an investment in the well-being of future generations.

 

References

1. Stoneburner A, Lucas R, Fontenot J, Brigance C, Jones E, DeMaria AL. Nowhere to Go: Maternity Care Deserts Across the US. (Report No 4). March of Dimes. 2024. https://www.marchofdimes.org/. Accessed June 15, 2025.
2. Wallace M, Dyer L, Felker-Kantor E, Benno J, Vilda D, Harville E, Theall K. Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana. Womens Health Issues. 2021 Mar-Apr;31(2):122-129.
3. Howell EA, Zeitlin J. Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Semin Perinatol. 2017;41(5):266-272. doi:10.1053/j.semperi.2017.04.002
4. North Carolina Department of Health and Human Services.Maternal and Infant Mortality Statistics Report. 2022.
5. United Health Foundation. MOTHeRS Project seeks to improve maternal outcomes in rural North Carolina. UnitedHealthcare Community & State. Published 2020. Accessed May 18, 2025.https://www.uhccommunityandstate.com/content/state-profiles/north-carolina-profile/mothers-project-seeks-to-improve-maternal-outcomes-in-rural-nort
6. Saeed SA, et al. Maternal Outreach Through Telehealth for Rural Sites: The MOTHeRS Project.N C Med J. 2023;84(1). https://ncmedicaljournal.com/article/67809-maternal-outreach-through-telehealth-for-rural-sites-the-mothers-project.
7. Lee M, Newton H, Smith T, Crawford M, Kepley H, Regenstein M, Chen C. The Benefits of Physician Training Programs for Rural Communities: Lessons Learned from the Teaching Health Center Graduate Medical Education Program. J Health Care Poor Underserved. 2016;27(4A):83-90. d
8. https://www.acgme.org/globalassets/pdfs/milestones/obstetricsandgynecologymilestones.pdf. Accessed May 29, 2025.
9. Sabbah, G. et al. Bridging the gap: how gender representation in obgyn residency programs compares to other specialties. American Journal of Obstetrics & Gynecology, Volume 226, Issue 3, S1331
10. https://www.statista.com/statistics/1479176/share-of-physicians-in-health-systems-us/. Accessed June 1, 2025.
11. Tessmer-Tuck JA, Rayburn WF. Roles of Obstetrician-Gynecologist Hospitalists with Changes in the Obstetrician-Gynecologist Workforce and Practice. Obstet Gynecol Clin North Am. 2015 Sep;42(3):447-56.
12. https://ncdhhs.servicenowservices.com/fee_schedules. Accessed February 11, 2025.
13. Bauer HH, Sahmoud A, Rhodes SP, Sheyn D. Inpatient Hospital Costs and Route of Hysterectomy for Management of Benign Uterine Disease in the 90-Day Global Billing Period. Obstet Gynecol. 2024 Aug 1;144(2):266-274.

Laura Yecies is the CEO of Bone Health Technologies, whose first product is Osteoboost, a device for treating postmenopausal women with osteopenia. Osteoboost is the only FDA-approved device that addresses the very common loss of bone mass density in this patient population.

Ben Creo is a Visiting Lecturer at Harvard Business School, where he co-teaches the “Innovating in Health Care” course alongside its founder, Prof. Regina Herzlinger, and Executive Fellows Brian Walker and Dr. Lee Kaplan. Ben is an author of the HBS case study: Herzlinger, Regina E., Ben Creo, Jacob M. Cook, and Rachel Lev-Corn. “Osteoboost: Go-To-Market Strategy in a Healthcare Startup” Harvard Business School Case 325-135, July 2025.

 

Ben Creo: Laura, you’ve held leadership roles at major tech companies such as Netscape, Yahoo, Checkpoint, you’ve led startups in the tech space. What catalyzed the shift from the tech sector to leading a healthcare startup?

Laura Yecies: I grew up in a family of doctors, and when I was a kid, I thought I’d be a doctor. When I was in college and business school, the PC era grabbed my attention because I just really love using technology to solve problems. I was lucky to be able to do that for about 25 years at companies that touched many millions of users. After I sold one company, Catch, to Apple, I knew I didn’t want to retire and thought about moving into healthcare in a clinical role. I took pre-med classes at Berkeley, but I really missed what I was doing in technology and having so much more of a leveraged impact. I saw the convergence happening in health technology and realized that was going to be my focus. I had also encountered health issues in my family and saw a lot of gaps in healthcare that were of interest to me. I’m really glad I made that shift into healthcare, and very glad I worked in tech companies before that.

Ben Creo: What were some of the gaps in healthcare that motivated you to say, ‘I can solve that’?

Laura Yecies: I saw gaps in product usability. I saw gaps in diagnostic accuracy. I also saw gaps in attention and innovation focus, even when a health problem seriously affects many people. For instance, more women die of hip fractures, which, of course, relates to osteoporosis, than die of breast cancer. While I’m glad about the many new developments in breast cancer, they’re disproportionate when compared to osteoporosis.

Ben Creo: How did your early experiences at tech companies shape the way you now lead in healthcare?

Laura Yecies: You can move quickly in tech companies, so I can get very impatient. When you’re working in a clinical field, you can’t always rush the science and the clinical studies. But I think my tech experience has kept my foot on the gas. Tech has also taught me to focus on user experience and usability; it’s those products that would typically win, particularly in consumer tech and increasingly, in enterprise tech.

Ben Creo: What motivated you, then, to step into the CEO role at Bone Health Technologies?

Laura Yecies: My grandmother had osteoporosis, my mother has it. My dad worked in a nursing home as medical director, and I worked there in college. It gets back to this unmet need and lack of innovation. We didn’t know if our osteopenia product would work. We had reasons to believe it would, but it wasn’t proven. My personal investment thesis was that if it worked, there would be a great commercial opportunity. It’s exciting, several years later in this early stage of commercialization, to see the demand and interest from patients and doctors.

Ben Creo: Your first product, Osteoboost, is a wearable device for women with osteopenia. What has surprised you the most about building this company at the intersection of women’s health, medical devices, and digital health?

Laura Yecies: I am not surprised that there’s a lot of demand, but it’s surprising that there isn’t more consensus around the importance of fighting osteoporosis. A lot of patients just accept that older women will get frail, that it’s a natural part of aging to lose bone. And of course, that’s true. But it’s also a natural part of aging that your arteries get stiffer and that you get high blood pressure, and we don’t accept that. Cancer is tied to aging, too, and we fight it. But there are visionary researchers, investors, employees and team members who are really focusing with me on this area. I have found the lack of investment in women’s health in general very surprising. It means that there is a bigger opportunity for those who do invest, but it does seem like a market failure, to use the business school term.

Ben Creo: Absolutely. McKinsey & Company has called women’s health “a $1 trillion opportunity.” What unique perspectives do you believe women leaders bring to healthcare innovation, especially in a product category like yours that affect female patients?

Laura Yecies: An HBS study found that patents for women’s health were mostly filed by women scientists or women inventors. This idea that we tend to be motivated to work on problems that touch us personally reminds me of my late father-in-law, who was an allergist and had terrible allergies. He empathized with his patients. Now, I’ve had male physicians, and I’ve seen male women’s health executives who are very empathetic, but I do think that women leaders bring a more intimate, deep level of empathy to the problem. Things may be more obvious to them, both what the need is and how to address it.

Ben Creo: Are there unique challenges you face as a female CEO that maybe your male counterparts have not experienced?

Laura Yecies: Women do raise a disproportionately low amount of capital, but I’m not sure if that’s been a challenge for us. Because there are fewer women CEOs, you may stand out more. Raising capital has been challenging for us, but we have managed to do it in a time when many other medical early-stage medical devices have not. There are certainly people who are not as comfortable with women in leadership roles. I’ve interacted with those individuals. But I’ve also had advisors and supporters who try to support women entrepreneurs, so I’ve benefited as well. And I try to pay that forward with other women CEOs.

Ben Creo: How do you handle those moments when there is pushback, when someone is maybe underestimating, second-guessing you? What strategies have you used that might be helpful for others?

Laura Yecies: I find it motivating. I want to prove people like that wrong, though that doesn’t mean you’ll bring them around. Sometimes you also have choices about who you work with, like when building a board. Would these people choose to be on my board? Probably not. Frankly, for the most part, my experience has been the opposite. As I mentioned, osteoporosis hasn’t been a high-investment area, so people who are working in the field are mission driven. It couldn’t be more of a pleasure to work with them, learn from them. For instance, I look at my two independent board members: They have stock in the company, they don’t get cash compensation. They’re mission-driven, too.

Ben Creo: What do you think about strategies to increase women representation in healthcare startups and in leading healthcare firms? There’s an enormous financial opportunity there, but their leadership is very underrepresented.

Laura Yecies: I think you have to look at different areas. Take investors. How are they screening their deals? How are they getting connected to deals? People in their networks are people like themselves. And so, I think there are strategies to broaden and level the playing field in education. Women comprise more than half of med school students. We’re seeing women go into healthcare, and I see women experience more leadership success in biotech, in digital health, than in pure tech. I see less progress in medical devices, which is very unfortunate because there are important medical devices that need to be developed.

But, when you have some successes and some exits, that ignites more success. When I was raising my first round of equity, one angel group asked if they could increase their investment. The group had an exit from another women’s medical device company, which was acquired by Merck. That success led to greater investment in Osteoboost. We need to highlight those wins because they really influence the mindset.

Ben Creo: Are there mentors whose advice stands out or who you’ve turned to for guidance?

Laura Yecies: Definitely. Karen Drexler has been an important mentor to me, especially as I transitioned into healthcare. My first boss at Netscape has always been an important mentor to me on leadership development. So yes, I’ve had several mentors along the way in different areas.

Ben Creo: Is there any advice they’ve given you that has resonated? Or any advice for other women who might aspire to lead startups in healthcare?

Laura Yecies: This is not specific to women, but general startup advice I’ve given is around the problem of not having the resources to create attention or to market in the same way as, say, a big consumer packaged goods company with a huge advertising budget. They can sort of manufacture a problem or at least accentuate something that people might perceive they need. When you’re a startup, you need to be sparking something. The problem needs to be so important to the consumer, the doctor, the patient, to solve, that they’re going to want your MVP product. And this is what makes me so bullish and optimistic about Osteoboost: you have 90% of patients with clinically diagnosed low-bone density who are not receiving standard-of-care treatments. So, either postmenopausal women don’t care about their bone density, or they don’t like the available options. I’m convinced it’s the latter. I think that’s why we have had a successful pre-order program and why people will purchase the product even without insurance. I think as you’re assessing a startup, you need to really believe in the urgency and importance of what you’re doing, what that problem is, what your solution is.

Ben Creo: Osteoboost is the only FDA-approved medical device for treating this significant problem. Why are you the first device and not the fifth?

Laura Yecies:. The more sanguine, view-of-the-world answer is that it’s biochemically and biomechanically very hard. Bones remodel slowly. It’s hard to come up with drugs that make a meaningful improvement without unwanted side effects, and it’s hard for a device to show a statistically significant benefit. Because it’s hard, people haven’t done it, or they’ve stopped doing it. Pfizer, Lilly, Merck have all exited the field. So that’s one potential answer. It’s not a very satisfying answer, though: We have CRISPR gene therapy, a new vaccine for pancreatic cancer, all kinds of cool artificial limbs.

Osteoboost is leveraging existing technology. It’s not like we split the atom. So then, you get to the why. That seems to be around a lack of motivation. Society accepts that older women get frail and fracture. Do we care less about the health of older women than men? There’s lots of data that argues that maybe we do. We love our grandmothers and mothers and aunts, but as a society or as a system, we’ve accepted substandard care. I think there’s some combination of those two, the difficulty and the lack of priority and focus.

Ben Creo: Why might it seem less care is invested in the needs of our grandmothers and moms?

Laura Yecies: I see women say this about themselves – fractures are a natural part of aging. The other thing about bone health is it’s a bit insidious. The hip fracture scenario is dramatic. But, in your 50s, 60s and 70s, bone loss might not seem so dramatic. Maybe that’s part of the problem. But then, when you look at high blood pressure, we generally intervene early, managing blood pressure in the 40s, 50s, 60s to prevent stroke in the 70s. So why aren’t we doing that with osteoporosis? I address that issue in an article I wrote. The quality of someone’s life in their last decade, maybe their last two decades, typically comes down to their musculoskeletal health and their brain. Have you been able to keep your mind intact? And then, with your musculoskeletal system, can you get around? Can you play with your grandchildren? Can you do your activities? If you’ve had a pile of vertebral compression fractures, it’s not so easy to do those things.

Ben Creo: When you’re communicating with both medical professionals and patients regarding a new medical device, how do you build trust to change the narrative?

Laura Yecies: With medical professionals, it is partially FDA approval. We could have pursued a Class 1, over-the-counter route, but we believed gaining trust and credibility would be harder. So, we held ourselves to a higher standard, conducting a randomized controlled trial. And then, through the FDA de novo process, we can build trust with both patients and doctors. Doctors also want to see peer-reviewed studies. We have a manuscript available on JBMR+, a highly regarded bone journal. We also need to talk to medical professionals. They want to see the device. We’re seeing a lot of demand driven by patients who are looking for non-drug options or looking for early interventions. And then we’re also fortunate that our scientific advisors and our investigators are highly respected; as my chief medical officer says, ‘you are who you hang out with’.

Ben Creo: As your firm is growing, as you’re trying to fulfill your mission, what are the values that drive you, or the non-negotiables you have?

Laura Yecies: How I treat people, what I’m doing for the people on our team, how I work with them, that they get meaning and enjoyment from their work. And then what we’re doing for patients. If we’re not benefiting patients, we have to change what we’re doing. That’s our whole purpose.

Ben Creo: What motivates you day-to-day as you build Osteoboost?

Laura Yecies: When I was CEO of SugarSync, I used to hear from users helped by the product. Now I hear from patients, and it’s even more motivating. These early patients found us, they pre-ordered the product, they really care about their bone health, and they’re so excited to have the product and this sense of empowerment. I feel very grateful for the opportunity to work on that, and it keeps our team going.

Ben Creo: Are recent decisions you’ve made as a CEO that you’re especially proud of?

Laura Yecies: I think our general strategy. We acquired another company to build out our solution, so I’m proud of that decision. I’m proud of the team I brought together. I’m proud of how we’ve built the product, the quality of our research.

Ben Creo: In five years, what’s your vision for Bone Health Technologies? And what might be some of the key indicators or metrics that say, yes, we’ve succeeded?

Laura Yecies: My vision is that we are impacting millions of patients. There’s clearly an enormous market, and so that’s my goal: To be improving bone health for millions of people – that we’re intervening early, that patients slow or delay or prevent bone loss. My goal is that women can expect their bone health to be treated and optimized. Half of all women now are fracturing due to osteoporosis. How can we cut that in half? We’re an aging society and other health conditions are also harming our bones, so it’s a growing problem. We want to reverse that and go in the other direction.

Now that people see that women do care about their bone health, maybe there’ll be additional solutions that are complementary.

Ben Creo: You’re a small firm in the healthcare space. If you could change one thing about how the U.S. healthcare system treats innovations from small firms, what would that be?

Laura Yecies: The whole process of getting reimbursement is expensive and difficult for startups to navigate. In the medical device field, there’s been a lot of research, especially out of Biodesign, showing that the process is much slower than for pharmaceuticals. And I don’t see any good reason for that. Devices can be economical, they can have tremendous health impact.

Ben Creo: Final question: What advice would you give to someone stepping into their first startup CEO role?

Laura Yecies: Put the right team in place and have the right skills around you. Do you need regulatory? Do you need clinical? Is it really a software play? As the CEO, you’ll have some skills, you won’t have all. Of course, you need to make sure that you have defined a problem that can drive funding, patient purchase, clinician purchase. And then, make sure you have the passion for what you’re going to do. Look at big recent healthcare exits, like Hinge, they’ve been at it for a while. You have to have that mindset. It’s not typically a quick hit. But hopefully, it’s something that you’re passionate about, and you’re working with a good team. After all, it’s the journey—life, liberty, and the happiness of pursuit.

Ben Creo: That’s great advice. Laura, thank you so much.

 

Kendall Owen, University of Central Florida, Fernanda Gushken, University of Miami/Jackson Health System, KD Frick, Johns Hopkins University

Contact: vina.frick@jhu.edu

Introduction

What does the “business of women’s health” imply?

The term is sometimes interpreted as narrowly as the business of producing reproductive health services, hence our title. However, there are several examples of efforts to expand the definition of women’s health and the related conceptualization of the business of women’s health. For example, the mission of the Jacob Institute for Women’s Health is to: “Identify and study aspects of healthcare and public health, including legal and policy issues, that affect women’s health at different life stages” (https://jiwh.publichealth.gwu.edu/about accessed on 2025-08-20). Further, the institute’s official journal, Women’s Health Issues, describes itself as, “a peer-reviewed… journal…related to women’s health care and policy…dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities” (emphasis in the original, https://www.sciencedirect.com/journal/womens-health-issues, accessed on 2025-08-20).

Neither source formally defines women’s health; each emphasizes a lifetime approach extending beyond reproductive health. Generative AI system Claude proposes a working definition: “the branch of healthcare that focuses on the treatment and diagnosis of diseases and conditions that affect women’s physical and emotional well-being.” This includes gender-specific conditions and prevention to reproductive health.

All individuals assigned female at birth face must take care of their reproductive systems, regardless of intent to have children. There are also conditions that inordinately affect individuals assigned female at birth, including breast cancer and autoimmune conditions.[1],[2]  At the same time, all who present as female may experience mental well-being issues linked to discrimination and inequity.

Essue et al. outline a lifelong model that highlights virtuous and vicious cycles for society related to investment or disinvestment in health.[3] Building on this, our goal is to present a narrower conceptual model that examines how health impacts business and then the opportunities available to business when accounting specifically for women’s health as a part of the innovation process.

The Impact of Health on Business

Even a model narrower than Essue et al.’s must move beyond viewing the business impact of women’s health as simply the improved management of a healthcare practice for women; the same would be true for men. A discussion of the impact of men’s health on business could be treated similarly. This discussion will focus on the unique aspects of women.

Reducing health to a single sector ignores the daily struggles related to health and understates the broader impact of health on business and society.[4] For example, poor maternal health has lasting generational effects, shaping a young child’s development, behavior, school performance, and ultimately, adult health and productivity.[5] Women’s health directly influences labor force performance and economic production, with broader consequences for society.

Women’s health impacts the labor force both within healthcare and across other industries. It also affects the production of goods and services related to women’s health, influences women’s (and the family’s) health behaviors connected to broader markets, and drives research that expands knowledge of the implications. These same factors feed back into women’s health, creating a cycle that can drive innovation and economic growth.

The business of providing women’s healthcare fits into a much larger framework in which other businesses impact women’s health — and women’s health can impact all businesses. Figure 1 illustrates the bidirectional relationship that health has across consumption, production, and human capital. Consumption related to health goes beyond healthcare, including categories such as alcohol, food, and gym memberships. While many goods and services, such as entertainment, may not directly affect health, healthier women generally earn more income and spend less on healthcare. This increases discretionary spending, stimulates demand, and accelerates economic growth. At the same time, women make up a significant share of the labor force — especially in healthcare — further reinforcing these dynamics.

Figure 1. Conceptual Model of Business Interests in Women’s Health

Human capital affects production and consumption, although the term is more often applied to production. Healthier individuals are more likely to pursue education and training (see Asigbee et al.[6] for an example) and develop stronger information processing skills, participate in the labor force,[7] and earn higher income.[8] These factors improve the efficiency of production and drive greater consumption.

Reasons for Business Interests in Women’s Health

Businesses have incentives to engage with women’s health that go beyond the production of health services specific to women. One estimate suggests that improving the lives and health of women, will increase annual GDP by approximately $1 trillion by 2040.[9] On average, women live longer and experience 25% more of their lives in poor health than male counterparts.[4]

Women’s health issues begin with reproductive health, including but not limited to abortion bans and maternal mortality. Additionally, chronic disease (particularly autoimmune conditions), mental health, and some cancers can affect women differently than men (e.g., unique conditions, conditions that are more severe for women, or conditions with a higher incidence for women). Notably, approximately 56% of the women’s health burden is made up gynecological conditions, headache disorders, and heart conditions.[9]

One study found that 64% of health interventions are less effective for women than for men, or women lack access altogether.[9] For example, asthma inhalers are 20% less effective in women.[10], [11], Research sometimes overlooks women’s conditions resulting in disability but not death.[9] Preventing disability can generate broad societal benefits. Improving women’s health expands participation in the labor force, increases productivity, reduces the prevalence of health conditions, and reduces early deaths, allowing women to contribute more significantly the economy.[9]

Labor Force

Women make up 40% of the global labor force.[12] Women outside the formal labor force still contribute to the economy, in part by helping to make those in the labor force more productive: caring for loved ones, cooking, cleaning, and raising children.

Workplace health benefits, including mental health support, expanding digital health offerings, and addressing cost barriers, have been shown to positively impact the productivity and participation of women.[13] Greater access to these benefits can decrease absenteeism and presenteeism, improve productivity, talent attraction, retention, workplace culture, and brand reputation.[13]

Women in the Healthcare Labor Force

Women account for more than three-quarters of healthcare workers, including physicians, dentists, veterinarians, nurses, medical assistants, and speech pathologists.[14] In the United States, approximately 85% of resident doctors in obstetrics and gynecology are women,[15] underscoring the importance of optimizing women’s health and workplace safety for the future of humanity.

Women may spend nearly nine years of their lives in sub-optimal health, limiting their ability to be present or productive at work.[9] In healthcare settings, that can increase the risk of medical errors. Decreased availability of female healthcare workers can delay appointments, result in fewer patients being seen, and ultimately decrease community health. Women’s health affects the health of society as a whole.

Healthcare Goods & Services

Women influence healthcare through money and time allocated to their own healthcare and that of those for whom they care. On average, women spend more on healthcare than men.[9] Women live an estimated 5.7 years longer than men, resulting in more years living with poor health.[9]

Many products are not tailored for gender-specific use, overlooking differences between men and women. For example, women are 52% more likely to have adverse side effects from medications than men and 36% more likely to have serious or fatal events.[9] Even safety features like seat belts and airbags rely on crash tests using dummies based largely on the male body’s build.[16] Goods and services driving women’s health can be used to identify health issues and treat dysfunctional body systems, to protect women from injury, to track health behaviors, and to support mental health.

Women’s health also influences the quantity and quality of general goods and services sold in the market and put to use. Healthier women spend less in formal healthcare settings, such as primary care appointments and ER visits, freeing up resources for other health-related products. As women are more commonly primary caretakers,[17] a society with healthier women can provide better care for others, contributing to economic growth.

Health Behaviors

Health behaviors include lifestyle factors and actions impacting health, e.g., alcohol consumption, smoking, diet, exercise, and seeking healthcare. A woman may exercise and diet, and then purchase a fitness tracker or diet plan. These could improve health and contribute to GDP. Women and men adopt different health behaviors; e.g., women are more likely to use meditation as a way to decrease stress and are more likely to experience stress reduction after meditation.[18] Variation in lifestyle factors is important in understanding opportunities to improve women’s health. Tailoring gender-specific strategies can amplify the impact.

Research

Women make up approximately 33% of researchers in the world.[19] Many of these women study women’s health conditions. Given women’s poorer health, over a third of the research workforce is limited in their availability to do research. Deficits in knowledge regarding women’s health impacts the health of researchers. For example, with an incomplete understanding of disorders like endometriosis, diagnosis and treatment may be delayed by years. While women are not the only ones capable of advancing research on women’s health, having researchers who share lived experiences with the populations they study can increase empathy and accelerate translation of findings into practice.

New research suggests that sex chromosomes are active in every cell of the body throughout the entire course of a person’s life, not just their early development.[20] Women, however, are often underrepresented in research areas like heart disease, HIV medications, or COVID-19 vaccinations.[20] Women only recently began to make up 50% of those included in clinical trials; these participants are mainly white women.[4] Women of different races or other diverse characteristics are often excluded due to their “complexity” or “complicated history.”[9]

Researching heart disease, cancer, and mental health in women could lead to fewer missed, inaccurate, or delayed diagnoses. Some disabling conditions lack efficient diagnostic procedures, creating long processes that lead to the need for research to produce higher precision diagnostics and treatments.[20] Less than 15% of funding goes towards research on women’s health-specific conditions.[9] More funding for women’s health-specific research, along with research on conditions affecting women disproportionally, could drive economic growth.[9]

Business of Innovation Considering Women’s Health

An exploration of how business might innovate in light of the realities of women’s health issues, particularly ones that are inherently biological, is a logical follow-up to the discussion on the impact of women’s health on business. For inherently biological issues, a moral argument would be made for business (and society at large) not to necessarily expect exactly the same of women, but to innovate to maximize opportunity and potential for growth around women’s health concerns. (This might extend to other demographic subgroups, but the biological nature of health concerns specific to women is unique.)

Figure 2 summarizes the process of innovation with women’s inherently biological health concerns in mind. Starting from the upper left-hand quadrant, innovation often begins with framing an existing issue in a way that identifies an opportunity for change that was not noticed before. Allowing the framing to explicitly recognize unique risks that, on average, impact more of women’s potential productive time than men’s, could help in the redesign of leadership, products, and processes to allow women to have a greater amount productive time, to be more productive, and to have greater choices of their use of time associated with well-being.

Figure 2. Business Innovation and Women’s Health

Moving around the circle, leadership willing to normalize the discussion of women’s health in decision-making, product development, and business processes will encourage the most relevant innovation. Leadership can develop a workplace culture providing space to discuss women’s health, its impact, and the moral, ethical, and economic implications of approaching women’s health issues directly. As mentioned earlier, women may spend nearly nine years of their lives in sub-optimal health;[9] leaders prioritizing facilitating human capital development, productivity, and positive life experiences around the less than optimal health experience is an opportunity to enhance economic growth for women, their families, and their communities.

Proceeding to the lower right-hand quadrant, some of the innovative product solutions will allow more women to choose to be more productive. These will more likely be produced to maximally benefit women if the framing is approached through the lens of leaders spearheading innovation focused on the biologically inherent concerns.

Finally, business processes that might be adapted include general human resource policies, benefits policies within human resources, and teamwork expectations and norms; these might be adapted to account for the cyclical nature of reproductive health issues, flare-ups that occur in many autoimmune conditions, and intensity of treatments for female-specific cancers. For example, the provision of health benefits through an employer that are used more by women, such as mental health or reproductive health support, will give women increased access to healthcare. Greater use is expected to yield increased participation and productivity in the workplace.[13]

More advanced technology can keep teams connected and allow for continued productivity. Better data facilitates understanding the impact of biologically inherent women’s health conditions on productivity. Technology may allow women to be as productive as they choose. Given these factors, the goal of innovating can be to allow women and those who depend on them, the maximum opportunity for economic success while accounting for biologically inherent women’s health concerns.

Conclusion and Preview

This article adds to the understanding of the business of women’s health by summarizing often underexplored opportunities for the innovation of products, processes, leadership, and problem identification. The goal is to enhance businesses by developing products, processes, and norms that account for women’s biologically inherent health issues rather than expecting them to behave exactly like men despite these issues.

One piece in this issue of HMPI focuses on women not being included in decisions on what innovation should occur, and another on encouraging innovation with a life course perspective. While many of the papers focus on healthcare, there remain opportunities to explore innovation both to improve women’s health and to account for women’s health in the way businesses is conducted.

 

References

[1] de Blok CJM, Wiepjes CM, Nota NM, van Engelen K, Adank MA, Dreijerink KMA, Barbé E, Konings IRHM, den Heijer M. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019;365:l1652. doi: 10.1136/bmj.l1652.

[2] van Drongelen V, Rew J, Billi AC. Sex bias in autoimmunity: new findings and new opportunities. JID Innov. 2025;5(5):100391. doi: 10.1016/j.xjidi.2025.100391.

[3] Essue BM, Danforth K, Langer A, Acharya P, Knaul FM. The economics of investing in women and health. Nat Med. 2025 Aug;31(8):2532-2545. doi: 10.1038/s41591-025-03864-8. Epub 2025 Aug 7. PMID: 40775054.

[4] Johnson PA, Brindis CD, Donelan K, Goodwin M, Harris L, Kozhimannil KB, Rosenbaum S, Weitz TA. New directions for women’s health: expanding understanding, improving research, addressing workforce limitations. Health Aff. 2025;44(2). doi: 10.1377/hlthaff.2024.01004.

[5] Onarheim KH, Iversen JH, Bloom DE. Economic benefits of investing in women’s health: a systematic review. PLoS One. 2016;11(3):e0150120. doi: 10.1371/journal.pone.0150120.

[6] Asigbee FM, Whitney SD, Peterson CE. The link between nutrition and physical activity in increasing academic achievement. J Sch Health. 2018;88(6):407-415. doi: 10.1111/josh.12625.

[7] Johnson CY, Rocheleau CM, Lawson CC, Grajewski B, Howards PP. Factors affecting workforce participation and healthy worker biases in U.S. women and men. Ann Epidemiol. 2017 Sep;27(9):558-562.e2. doi: 10.1016/j.annepidem.2017.08.017. Epub 2017 Aug 25. PMID: 28890283; PMCID: PMC5836747.

[8] Pinna Pintor M, Fumagalli E, Suhrcke M. The impact of health on labour market outcomes: a rapid systematic review. Health Policy. 2024 May;143:105057. doi: 10.1016/j.healthpol.2024.105057. Epub 2024 Mar 26. PMID: 38581968.

[9] Ellingrud K, Pérez L, Petersen A, Sartori V. Closing the women’s health gap: a $1 trillion opportunity to improve lives and economies. McKinsey Health Institute; 2024 Jan 17. Available from: https://www.mckinsey.com/mhi/our-insights/closing-the-womens-health-gap-a-1-trillion-dollar-opportunity-to-improve-lives-and-economies#/

[10] Loymans RJ, Gemperli A, Cohen J, Rubinstein SM, Sterk PJ, Reddel HK, Juni P, ter Riet G. Comparative effectiveness of long-term drug treatment strategies to prevent asthma exacerbations: network meta-analysis. BMJ. 2014;348:g3009. doi: 10.1136/bmj.g3009.

[11] Wells KE, Peterson EL, Ahmedani BK, Severson RK, Gleason-Comstock J, Williams LK. The relationship between combination inhaled corticosteroid and long-acting β-agonist use and severe asthma exacerbations in a diverse population. J Allergy Clin Immunol. 2012;129(5):1274-1279.e2. doi: 10.1016/j.jaci.2011.12.974.

[12] World Bank. Labor force, female (% of total labor force) | World Bank Gender Data Portal. Washington, DC: World Bank; 2025. Available from: https://genderdata.worldbank.org/en/indicator/sl-tlf-totl-fe-zs?view=trend&geos=WLD.

[13] Ghouralal S-L, Bonner C. Innovative benefit design for women’s health. Integrated Benefits Institute; 2024.

[14] Cheeseman Day J, Christnacht C. Your health care is in women’s hands. Washington, DC: U.S. Census Bureau; 2019 Aug 14. Available from: https://www.census.gov/library/stories/2019/08/your-health-care-in-womens-hands.html.

[15] Sabbah G, Tsai D, Sheffler P, Nahas S, Stuparich M, Behbehani S. Bridging the gap: how gender representation in obgyn residency programs compares to other specialties. Am J Obstet Gynecol. 2022;226(3):S1331. doi: 10.1016/j.ajog.2021.12.105.

[16] Linder A, Svensson MY. Road safety: the average male as a norm in vehicle occupant crash safety assessment. Interdiscip Sci Rev. 2019;44(2):140-153. doi: 10.1080/03080188.2019.1603870.

[17] National Alliance for Caregiving. Caregiving in the US: family caregiving by gender. Caregiving in the US 2025; 2025. doi: 10.26419/ppi.00373.006.

[18] Upchurch DM, Johnson PJ. Gender differences in prevalence, patterns, purposes, and perceived benefits of meditation practices in the United States. J Womens Health. 2019;28(2):135-142. doi: 10.1089/jwh.2018.7178.

[19] UNESCO. One in three researchers is a woman. Paris: UNESCO; 2023. Available from: https://www.unesco.org/en/articles/one-three-researchers-woman.

[20] Snair M. Overview of research gaps for selected conditions in women’s health research at the National Institutes of Health: proceedings of a workshop—in brief. Washington, DC: National Academies Press; 2024. Available from: https://doi.org/10.17226/27932.

Irene Afua Quarshie, QL Consulting, and K. Davina Frick, Johns Hopkins University

Contact: iquarshie@qlconsultinggroup.com

The Untapped Potential of Women’s Health Innovation

For decades, women’s health has been systematically sidelined in research and innovation (1). This neglect has materialized in tangible ways: women spend 25% more of their lives in substandard health compared to men (2), a disparity that carries significant costs for individuals, employers, and the healthcare system. The economic consequences are staggering, with estimates suggesting that addressing these gender-based disparities could add up to $1 trillion to the global economy by 2040 (2).

The root of this gap lies in a history of structural exclusion where formal policies and deeply ingrained societal norms reinforced one another (1). Menstruation, menopause, and fertility have been enveloped in taboo, leading to their marginalization (3). This societal posture, which often viewed the female body as overly complex or simply through the lens of reproductive risk, provided a rationale for codifying this exclusion into policy (3). A case in point is the 1977 FDA guideline which formally excluded women of childbearing capacity from phase 1 and early phase 2 clinical trials until teratogenicity studies in animals were completed and effectiveness was established in either men, older women or both – an action intended to be protective, yet exclusionary (4).

In some instances, this pattern of exclusion was not driven solely by protective concerns; it was also rooted in flawed scientific convenience and outright bias (4). For instance, a 1970 study to examine the effects of estrogen on preventing secondary cardiovascular disease in postmenopausal women focused exclusively on males, with researchers justifying the choice by arguing that the hormonal fluctuations in women would complicate the analysis (2) – an assumption as untested as the intervention itself. This was not an isolated occurrence. Instead, it illustrated a more extensive pattern of systematic exclusion. Together, these examples illustrate a pervasive and systematic exclusion that created a healthcare system designed, by default, around a male model, leaving critical gaps in our understanding of female-specific conditions and sex-based biological differences (2,5).

This history of neglect makes the rare moments of progress all the more telling. Landmark developments, such as the introduction of the contraceptive pill and the pap smear, demonstrate the immense potential that can be unlocked when innovation is focused on women’s health. The contraceptive pill did so much more than grant reproductive autonomy; according to Nobel Peace Laureate Claudia Goldin, it was one of the major disruptors of the modern labor market (6). Additionally, the pap smear did more than just detect abnormal cells; it revolutionized the very concept of preventative medicine (7), establishing the world’s first successful mass cancer screening program. By demonstrating that cancer could be detected at a precancerous stage, it laid the foundation for contemporary preventive oncology and shifted the primary focus of medicine from treatment to prevention.

These advancements are not merely exceptions to the rule of neglect; they are proof of the transformative power of investing in women’s health. Yet, they have remained the exception, not the rule. Pervasive gaps in women’s health persist today, fueled by a continuing lack of gender-disaggregated data and a legacy of underfunding that hinders research and development (R&D) and impairs healthcare delivery systems (2).

The Landscape of Women’s Health: Unmet Needs & Market Gaps

In response to these deep-seated challenges, a new industry, appropriately named FemTech (Female Technology), has emerged to meet demand.
FemTech is the subdivision of the medical device industry that focuses on building devices, software applications, and providing services specific to female health care (8). FemTech was coined in 2016 by Ida Tin, co-founder of the fertility-tracking app Clue. She reasoned that a unique term for this industry would legitimize the female health tech market and remove the stigma that still frequently surrounds conversations around topics such as menstruation (9).

Despite evidence that innovation improves patient and healthcare system outcomes, women’s health has not advanced much since it has generally been viewed as a niche medtech market (8). While the term “niche” may allude to a special segment, it is frequently incorrectly associated with a small audience. This characterization of FemTech is therefore misleading: while women’s health may require specialized approaches, it in no way represents a small market opportunity.

Quite to the contrary: FemTech is a rapidly expanding market with immense potential, propelled by technical developments, greater awareness and ventures frequently led by female entrepreneurs. By 2027, this market is expected to generate $60 billion in revenue (10). Beyond gynecologic care, this field of medical technology covers a wide range of women’s health needs, including wearable sensors for pregnancy and hormone monitoring, telemedicine platforms for specialized women’s health consultations, digital therapeutics for conditions like endometriosis and mental health, mobile applications for fertility tracking and symptom management, and diagnostic hardware like portable ultrasound and screening devices (11).

The Life Course Perspective

The life course perspective offers a robust conceptual model for understanding the relationship between women’s health and innovation. According to the World Health Organization, the life course perspective (or life course theory) is a multidisciplinary approach to understanding the mental, physical and social health of individuals (12). In this context, it recognizes that women’s health challenges are not discrete occurrences. Rather, they are shaped by a complex interaction of physiologic, social, and economic elements that evolve across various life stages. And each of these stages – menstruation, pregnancy, menopause, and the management of chronic conditions – affects women’s well-being, workforce participation, career progression, and economic productivity (8).

Building on this understanding, the life course framework is particularly helpful in addressing the inclination to restrict women’s health solely to reproductive events such as childbirth, abortion and contraception. As Mishra et al. (13) argue, when these experiences are treated as isolated episodes rather than connected milestones, care becomes fragmented and ignores women’s long-term health trajectories. The framework challenges this fragmentation by demonstrating the connections between reproductive events and the subsequent risk of chronic disease later in life. Instead of treating women’s needs in discrete silos, it reframes reproductive health as a component of a continuum across the lifetime, emphasizing the need for innovations that support a more integrated and longitudinal model of care.

Women’s health needs are inextricably linked to workforce participation and economic systems (14). Reproductive health frequently overlaps with critical career milestones, influencing decisions around education and employment (6). Pregnancy and maternal health often precipitate challenges in the workplace, where mothers can face biases regarding their competence and commitment that affect hiring and compensation (15). As women age, menopause and age-related health needs can impact career longevity by creating notable retention challenges, with studies showing that many women consider leaving the workforce due to their symptoms (16).

However, these health needs remain inadequately addressed by both workplace policy and the innovation of FemTech solutions (1). The situation is further complicated by chronic health conditions, such as autoimmune diseases and mental health disorders, which add another layer to women’s health needs.
Beyond social and economic factors, sex-based biological differences introduce another dimension to women’s health, particularly in how diseases present and progress. Cardiovascular disease offers a clear example: women often present with non-specific symptoms for myocardial infarction (MI), have a higher mortality rate within a year of an MI, and typically develop Coronary Artery Disease (CAD) 10 to 15 years later than men (17).

These interrelated health themes underscore a clear need for integrated solutions that support women’s health across the full arc of their lives and enable their full participation in the economy.

Figure 1: A framework showing internal and external factors that impact the health of women across the lifespan. Adapted from the extended NIH ORWH multidimensional framework (1).

For healthcare managers, the life course perspective offers a way to reframe women’s health, shifting the focus from an episodic cost center to a continuous, quality-enhancing service line with long-term value. This shift in perspective provides a strategic lens for addressing the financial, operational, and competitive challenges that define success in modern healthcare markets.

The Managerial Case for Life Course FemTech Investment

Why Fragmented Approaches Fail: The Hidden Costs of Episodic Women’s Health

Healthcare systems organized around discrete episodes rather than longitudinal women’s health management, miss critical opportunities to prevent costly chronic conditions, as evidenced by the $350 billion annual cost of treating chronically ill women in the United States (18). This presents a fundamental issue for healthcare administrators working under value-based care contracts. The life course perspective explains why fragmented methods lead to cascading expenses that reduce profits and compromise patient experience and hospital quality ratings.

Consider the total financial impact of untreated Polycystic Ovary Syndrome (PCOS), a condition affecting women of reproductive age with a pooled mean prevalence of 21.27% (19). A 31-year-old woman with PCOS receives fragmented therapies under an episodic care approach, including sporadic gynecological appointments, emergent contraceptive consultations, and reproductive treatments. This fragmented approach creates poor patient experiences characterized by disruptions in treatment, and a lack of time and attention to patient concerns (20). According to Rubin et al. (21), PCOS patients are four times more likely than controls to develop type 2 diabetes. This amounts to a total economic burden of $4.36 billion annually in the United States, with costs spanning initial evaluation ($93 million), hormonal treatment for menstrual dysfunction ($1.35 billion), infertility care ($533 million), PCOS-associated diabetes ($1.77 billion), and hirsutism treatment ($622 million) (22).

The fragmentation that characterizes traditional women’s health services (23), is addressed by comprehensive FemTech platforms. At the population level, this coordinated approach becomes essential for health systems managing thousands of women with PCOS under value-based contracts.

Strategic Investment Framework: High-Impact FemTech Categories

Considering the investment priorities of healthcare managers – measurable returns and alignment with value-based care objectives – this analysis identifies three high-impact FemTech categories that deliver quantifiable financial and operational benefits.

Maternal Health Technology: The Highest-Return Investment

The strongest commercial case for FemTech investment is in maternal health, where evidence suggests mHealth interventions may be cost-effective, particularly those featuring notifications, reminders, and personalized health education. Pregnancy is a crucial time frame during which treatments may be used to enhance health outcomes and provide long-term advantages (24).

One example of the direct impact of FemTech investment is remote patient monitoring for postpartum hypertension. In contrast to standard care, which had 33% and 70% compliance rates among Black and non-Black women, respectively, Penn Medicine’s text-based blood pressure monitoring program had >90% compliance rates in both groups. While there were four readmissions in the standard care group, the remote monitoring technology completely avoided readmissions (25). For health systems addressing maternal health disparities, this text-based approach not only improves clinical outcomes but also reduces costly readmissions while ensuring equitable care delivery. The integration of comprehensive maternal health platforms can address several value-based care needs (25) by enabling early identification of high-risk patients (26) through combined clinical and socioeconomic risk assessment (27).

The benefits of employee retention generate value that is sometimes disregarded in conventional ROI calculations. Research demonstrates that family-supportive policies, including maternal health initiatives, can help organizations retain women by reducing perceptions of discrimination and subsequent turnover decisions (28). This is particularly relevant given that over 60% of healthcare employees are women and nurses comprise more than 80% women in provider organizations (29). Healthcare organizations must invest substantial resources to advertise, recruit, hire, and train new nurses to replace those who resign, while also losing intellectual capital and productivity (30). Given that nurse turnover costs range from $21,514 to $88,000 per nurse in the United States (30), comprehensive maternal health benefits could serve as a cost-effective retention strategy that simultaneously enhances employee satisfaction and patient care quality.

Menopause Management: Addressing Peak Career Impact

Menopause management represents an underrecognized investment opportunity with significant implications for workforce productivity, patient satisfaction, and long-term health outcomes. Comprehensive FemTech solutions have the potential to be more cost-effective than episodic care at addressing the unique issues created by the confluence of biological changes with peak earning years, especially considering the significant economic losses from untreated menopausal symptoms and the underdeveloped nature of this market.

Menopause affects 20% of the US workforce and causes a 10% drop in earnings four years after diagnosis. This makes menopause management an underappreciated investment opportunity with substantial impact on workforce productivity (31). The combination of biological changes and peak earning years results in economic losses equivalent to job displacement (31) with women becoming 4.8 percentage points more likely to obtain disability insurance and leave the workforce earlier. Comprehensive FemTech solutions that increase access to care show quantifiable cost-effectiveness; women who receive more therapy report lower earnings losses and improved labor market outcomes (31). Digital menopause platforms offer hormone optimization, symptom management, and lifestyle coaching.

The long-term health impacts enhance value under risky contracts. According to Hodis and Mack, hormone replacement treatment started within 10 years of menopause lowers coronary heart disease by 32% and all-cause mortality by 39% (32) with some studies reporting even higher reductions. While targeted osteoporosis treatments like raloxifene can reduce vertebral fractures by up to 40% (33), standard-dose hormone therapy reduces hip fractures by 28% and vertebral fractures by 35% (33). Early intervention through comprehensive menopause management, including appropriately timed hormone optimization, bone health monitoring, and cardiovascular risk assessment, represents a high-value intervention that delivers quantifiable health outcomes and supports long-term workforce productivity. Geriatric hip fractures cost an average of $13,113 per episode (34), while individuals with coronary artery disease may cost up to $150,000 in healthcare over the course of their lifetimes (35). These substantial downstream costs make fracture prevention and cardiovascular risk reduction through comprehensive menopause management a high-value intervention.

Chronic Condition Management: Preventing High-Cost Complications

Uterine fibroids exemplify the financial burden of fragmented chronic condition management. In 2003, uterine fibroid treatments represented over $1.5 billion in national hospital costs, with hysterectomies accounting for the majority of cases and individual procedures averaging $6,364 per patient (36). The most common surgical procedure, total abdominal hysterectomy, averaged 2.9 days length of stay with mean costs of $6,331, while laparoscopically assisted vaginal hysterectomy had the highest costs at $7,108, despite shorter stays. These figures, representing only inpatient costs without accounting for outpatient management, specialist consultations, and productivity losses, underscore the substantial economic impact of conditions affecting millions of women.
The pattern repeats across other women’s chronic conditions. Endometriosis, affecting 10% of women of reproductive age, demonstrates the financial consequences of delayed diagnosis and fragmented care (37). Diagnosis takes an average of 4.4 years, during which patients accumulate $2,801 per year in direct healthcare costs through multiple specialist appointments, emergency visits, and unsuccessful treatments, plus an additional $1,023 in productivity losses (37,38). FemTech solutions like Phendo and Syrona Health address these inefficiencies through AI-powered symptom tracking, lifestyle modifications, and coordinated care pathways designed to enable earlier diagnosis and comprehensive symptom management.

Mental health integration across women’s health conditions delivers additional value through improved care coordination and medication adherence, reducing crisis interventions and emergency utilization while improving patient outcomes. Health systems that successfully implement comprehensive chronic condition management platforms can expect measurable reductions in emergency department visits, decreased specialist referral patterns, and improved patient satisfaction scores alongside the direct cost savings from preventing high-cost complications.

Implementation Strategy: Metrics-Driven Deployment

For FemTech to be implemented successfully, measuring frameworks must be methodical and compatible with current financial management and quality reporting systems. Clear performance metrics that satisfy payer standards and regulatory compliance are essential for healthcare management board members, medical directors, and CFOs.

Financial Metrics and ROI Tracking

Implementing life course FemTech solutions requires robust financial tracking that records both potential revenue enhancement and immediate cost reductions. Key performance indicators(KPIs) should include ED utilization rates, hospital readmission rates, trends in specialist referrals, and costs associated with chronic care management. Since value-based care agreements usually monitor outcomes-based metrics like readmissions and ED utilization, these metrics are in perfect alignment with the requirements of value-based care contracts (39). These metrics provide clear evidence of investment returns while supporting quality reporting requirements.

Maternal health platforms demonstrate measurable impact through key metrics including cesarean section rates, NICU admissions, postpartum readmissions, and breastfeeding success rates. These metrics provide clear ROI calculations through direct correlations with quality and cost scores, enabling health systems to track substantial improvements and cost savings.

Medication adherence rates, trends in emergency department utilization, specialist visits, and patient-reported outcome indicators should be the main emphasis of tracking. Digital platforms enhance these measures for disorders like PCOS and endometriosis, with financial benefits recognized when improved continuous care prevents downstream consequences.

Quality and Patient Experience Integration

FemTech implementation must align with existing quality measurement programs, including HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, CMS star ratings, and specialty-specific quality metrics. These platforms can enhance care coordination and access to specialized women’s health services, potentially improving competitive positioning in consumer choice marketplaces and supporting performance under value-based purchasing programs. Patient engagement metrics offer leading indicators of long-term performance: monitoring patient-reported outcomes, care plan adherence, and app usage offers early warning systems for program optimization and modification. Provider satisfaction represents another crucial area of evaluation. Digital health solutions in maternal care, including telemedicine interventions and remote monitoring, have demonstrated high provider satisfaction through time savings, reduced administrative burden, and improved care efficiency (40). These improvements may correlate with reduced physician turnover and enhanced recruitment capabilities.

Population Health and Risk Stratification

Life course FemTech uses risk categorization and ongoing monitoring to provide population health management. Rich data streams produced by platforms can identify high-risk individuals before urgent treatments are required. Under capitated contracts, where early intervention avoids costly complications, this capability is advantageous.

Risk stratification algorithms integrated into comprehensive FemTech systems can identify individuals at high risk of developing menopausal complications, postpartum depression, or gestational diabetes before they manifest clinically. Predictive analytics enable health systems to make proactive decisions about patient care and inclusion using historical data by identifying nuanced criteria for early intervention (39).

Data analytics skills enhance population health reporting and regulatory compliance by automating the monitoring of social determinants of health effects and health disparities, while facilitating community health needs assessment reporting, adherence to the Healthcare Effectiveness Data and Information Set (HEDIS), and health equity programs.

Competitive Advantage and Market Positioning

The strategic implementation of life course FemTech creates sustainable competitive advantages that extend beyond immediate financial returns.

Comprehensive women’s health programs are patient attraction and retention tools, especially given women’s active roles in family healthcare decisions. Health systems that demonstrate genuine commitment to women’s longitudinal health needs can capture disproportionate market share in family healthcare decisions. Market differentiation with cutting-edge FemTech products puts health systems at the forefront of technology while meeting patient expectations for accessible care. Integrated platforms that transition seamlessly from pregnancy care to pediatrics to women’s primary care create “sticky” relationships that are likely to generate higher patient lifetime value through continued engagement. Brand positioning around innovations in women’s health creates value through favorable press coverage and opportunities for community engagement. By putting comprehensive FemTech strategies in place, health systems could experience benefits in brand perception and market positioning that help with patient acquisition and community engagement.

Strategic FemTech investment represents a fundamental shift from reactive, episodic women’s health services toward proactive, longitudinal health management. Comprehensive women’s health efforts generate quantifiable results while addressing various strategic objectives for healthcare leaders navigating workforce challenges, value-based care transitions, and competitive pressures. The business case is based on proven gains in clinical outcomes, operational effectiveness, and financial performance – all of which characterize organizational success in contemporary healthcare markets – and the life course perspective offers the foundation for comprehending this potential.

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Jocelyn J. Fitzgerald, Assistant Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Urogynecology & Reconstructive Pelvic Surgery, University of Pittsburgh Medical Center, and Christina Vosbikian, Blavatnik Fellow in Life Science Entrepreneurship, Harvard Business School 

Contact: cvosbikian@mba2025.hbs.edu 

Introduction

The Obstetrics and Gynecology market seems to defy basic principles of supply and demand.

OB-GYN workforce shortages are intensifying^[1],[2]. The American Congress of Obstetricians and Gynecologists (ACOG) projects a shortage of up to 22,000 physicians by 2050.^[3]  Today, the average wait time for an American woman to see an OB-GYN is 31 days^[4] and OB-GYNs have 15 minutes on average for appointments with their patients, each seeing 30-40 patients per day.

Demand for OB-GYN services, on the other hand, is relatively sticky. Given this, in the face of such low OB-GYN supply and sustained high demand, we would expect the “cost” of OB-GYN services – reflected in OB-GYN compensation and hospital-generated revenues – to reflect an increase. We might then expect supply to increase with OB-GYNs staying in the market and new OB-GYNs entering, hypothetically improving conditions for providers and patients alike.

Of course, this hypothetical free market homeostasis is far from the reality, as is true in many medical specialties. Unlike other specialties, however, unique disadvantages faced by OB-GYNs add to reimbursement-driven difficulties for patients and providers alike.

Between the supply side – provider shortages and closing sites for care – and lagging demand for women’s health innovation, the business fundamentals of women’s healthcare have driven the system to a precipice.

The Foundations of OB-GYN Payment

The System of Reimbursement “Price Setting”

The current reimbursement system for healthcare services in the U.S. was established through the Omnibus Budget Reconciliation Act of 1989, which authorized the Medicare Resource-Based Relative Value System. The Medicare Physician Fee Schedule was then implemented in 1992, more formally assigning all medical procedures a unit of measure and value commonly referred to as a Relative Value Unit (RVU). The move to an RVU-based system represented one of the most wide-reaching reforms in payment since Medicare’s establishment in 1966 and came on the back of wide-ranging physician demand for uniformity in payment structure versus discretionary payment practices commonly employed up until that point^[5].

The AMA’s Relative Value Scale Update Committee (RUC), established in 1991, advises CMS on the relative value of physician services for Medicare reimbursement. Each medical specialty’s society appoints a representative of their own to the RUC. OB-GYN is represented by a single appointee from ACOG^[6]. As such, the OB-GYN seat reflects the interests of ACOG’s majority Obstetrician-Gynecologist membership. Specialty Gynecologic Surgery, which includes Gynecologic Oncology, Urogynecology, and Minimally Invasive Gynecologic Surgery, is structurally underrepresented. Physicians within ACOG note that Gynecologic Surgery is the only sub-specialty within the RUC without its own representation. This is important especially because reimbursement decisions and policy impact Obstetrics and Gynecology differently.

Calculating OB-GYN Procedures’ Value

There are three types of RVUs: 1) physician work RVUs (wRVUs); 2) practice expense RVUs (PE RVU); and 3) professional liability insurance RVUs. Without getting into the differences between facility and non-facility fees, the basic Medicare Fee Schedule rate formula is such that: Payment = [ (Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GCI) ] * CF

The Conversion Factor (CF) is a number that CMS sets every year, to account for overall cost of care fluctuations in a simple multiplier. The Geographic Practice Cost Index (GPCI) is a more specific multiplier that accounts for differences between geographies, applied to each RVU section. Services and payment for them are categorized under Current Procedural Terminology (CPT) codes, which are the individual codes per service that clinicians submit to insurance for subsequent payment.

Within this formula, wRVUs are often the biggest needle movers on final payment. To calculate foundational wRVUs, the Office of Health and Human Services (HHS) asked the Harvard School of Public Health to conduct a study “Estimating Physicians’ Work for a Resource-Based Relative-Value Scale” published in 1988, which accounted for time, mental effort, technical skill and psychological stress to determine RVUs via a Resourced-Based Relative Value Scale (RBRVS).^[7] The new, RBRVS-based schedule was fully implemented by 1996. Some initial critique suggested that the new system “resulted in underpayment of office-based practice expenses and overpayment of hospital-based practice expenses.”^[8]

The RUC uses annual surveys that are sent out by ACOG, asking a small percentage of their membership to evaluate the time and effort spent doing different procedures in order to reassess the appropriateness of their value. The most recently published data showed that 10% of ACOG’s membership responded to the surveys. Sending the survey to ACOG as a whole creates the dynamic whereby members, most of whom are not subspecialist Gynecologic surgeons, are asked to evaluate the sub-specialty’s work. This makes it especially difficult to surface conversations about Gynecologic surgeries like endometriosis excision or vaginal reconstruction to the negotiating table^[9].

Foundational Rate Setting Disparities in OB-GYN

As outlined by Dr. Rosa Polan and Dr. Emma Barber^[10], studies of initial rate setting from as early as 1997 show that sex-specific procedures for women are undervalued and poorly reimbursed, without any surgically justifiable reason for this disparity^[11].

More recent work “Price and Prejudice: Reimbursement of surgical care on male vs. female anatomies” published in 2024^[12] shows must of the same:

1. Significantly Lower RVUs for Female-Specific Procedures: Among the procedures analyzed, RVUs were, on average, 30% higher for male procedures, with some disparities reaching as high as 142.8%.
2. Lower Reimbursements in Facilities: In facilities, procedures on male patients often received reimbursements averaging 25.6% more than those for female patients. For example, reconstruction of the urethra was reimbursed at a maximum difference of $772.96 more for males than females.
3. Greater Disparity in Minor Procedures: Minor procedures on female patients were particularly undervalued, with 84% of these procedures receiving significantly lower RVUs than equivalent male procedures.
4. Differences in Urinary Tract Procedures: For urinary tract procedures, 75% of those performed on male patients received higher RVUs and reimbursement rates, averaging 49.1% higher than those for females.
5. Stagnation in Reimbursement Progress: Between 2003 and 2023, there was no statistically significant progress in closing these gaps, meaning male-specific procedures consistently received an average RVU 31-34% higher than female-specific procedures.

Zero Sum Gain in Obstetrics and Gynecology

The other critical context to understanding OB-GYN reimbursement is the establishment of budget neutrality, which was written into the Omnibus Budget Reconciliation Act of 1989. This required that changes to the physician fee schedule not increase total Medicare spending by more than $20 million, a number that has not been changed since despite physician advocacy for an increase^[13]. In the years that followed the original implementation of the physician fee schedule, CMS implemented budget neutrality by reducing work RVUs across all services. This is particularly important for OB-GYN,  because if one procedure is determined to require an increase in relative value (RVU),  then the relative value of other procedures must go down.

Polan and Barber illustrate the practical application of this point in women’s health:

Effective January 1st, 2021, the Centers for Medicare and Medicaid Services increased the relative value of evaluation and management billing codes. Because of mandated budget neutrality, meaning Medicare expenditures cannot significantly increase or decrease from year to year, this change necessitated a reduction in the reimbursement of surgical procedures. The work relative value units (RVUs) assigned for procedures did not change; however, the dollars per RVU decreased. As a result, Obstetrics and Gynecology was projected to have an 8% increase in payments. This is because Obstetric care is paid for using global codes, meaning labor and delivery, prenatal, and postpartum office visits are paid for using a single code, valued at evaluation and management billing rates. However, if an obstetrician-gynecologist derives most of their income from gynecologic surgical procedures, they are likely to experience a 7% decrease in reimbursement, as these changes in evaluation and management billing rates do not apply to global surgery codes.

This dynamic has led many to advocate for a delineation of specialties, with Drs. Jocelyn J. Fitzgerald, MD, URPS, FACS, and Louise P. King, MD, JD, FACS, writing: “…the health needs of the female public cannot sustain a budgetary competition between Obstetrics and Gynecology when both are severely undervalued in terms of revenue generation.”

Other providers, like Dr. Lyndsey Harper, MD, FACOG, also note that OB-GYNs should be at the negotiating table when Purchasing Organizations – who often manage contracts even for private OB-GYN practices – are working with payors to set rates at systems where OB-GYNs are working, with little transparency.

The Difficult Business of OB-GYN Care

With a high-level understanding of the OB-GYN reimbursement policy history, we may consider how recent market dynamics layer on to payment trends to uniquely exacerbate current challenges faced by OB-GYNs and, in turn, their patients.

Provider Supply: Fixed Legal Costs and Salary

As of 2021, HRSA estimated that between 2018 and 2030, there would be a 4% increase in demand for OB-GYN services and a 7% decrease in supply. They estimated this would result in a projected overall deficit of 5,170 full-time OB-GYNs nationwide by 2030^[14].

These shortages are, in some ways, not unlike shortages in Primary Care and other specialties, where an aging workforce and mountains of paperwork loom ahead of once-hopeful students with an interest in the medical field.

However, in other ways, OB-GYN burnout and the difficulty in practicing in the field stands out. OB-GYNs join general surgeons with the highest number of liability claims, according to an AMA study^[15]. Malpractice rates have, unsurprisingly, risen steeply as vague abortion bans have been introduced in certain states. Post-Dobbs restrictions have created new, massive risk for lawsuits and, often, even jail time for OB-GYNs who deliver healthcare to their patients. This has created difficult situations where providers, at the fear of being jailed and sued, do not perform necessary healthcare procedures on patients – leading to increases in near-death hemorrhage for women experiencing miscarriages in Texas^[16], for example. All in all, surveys suggest 30% of OB-GYNs stop practicing obstetrics – despite it being more highly reimbursed than gynecology – within 12 years of practice, citing malpractice insurance costs as a primary factor^[17].

Other factors, such as provider compensation, in the largely female field of OB-GYN also play a role in the unique shortage we see. Pelley and Carnes^[18] outline this:

The salaries in obstetrics and gynecology were 20% to 25% higher than the mean physician salary in the mid-1970s and 1980s when the female share was 8% and 18%, respectively. However, by 2017 with a female share of 57%, an obstetrician/gynecologist became an average physician earner.  In contrast, urology, earned 123% of the average physician salary in the mid-1980s when it was 1% female and 125% of the average salary in 2017 when the female share rose but was still low at 9%.

This work also cites a 20% decline in salary relative to the average physician seen in the two most female-predominant specialties, Pediatrics and Obstetrics and Gynecology, over the past four decades.

Normalized Average Physician Salary vs. Share of Female Physicians

Note: Dark bars show specialty’s average salary relative to median at the time; gray lines show share of female physicians over time.

Closing Sites of Care

March of Dimes reported that 35% of U.S. counties are considered maternity care deserts, with no birthing facility or obstetric clinician and that over half of counties do not have a hospital that provides obstetric care.^[19] This leaves more than 2.3 million women of childbearing age in the U.S. living in a county where there are no OB-GYNs, birthing centers or hospitals that deliver babies. March of Dimes’ report shows that “ women living in maternity care deserts and counties with low access to care have poorer health before pregnancy, receive less prenatal care, and experience higher rates of preterm birth.” These are often in rural areas[20].

Reasons are reported as a mix of declining birthrates, lack of providers, increased costs and comparatively low revenue versus other specialties. With hospitals facing razor-thin margins, it is not unsurprising that management teams would look to prioritize higher-revenue departments. For example, the table below exhibits what a hospital might gain by prioritizing other non-gynecological surgical care.

Procedure	Specialty/Training Time	Time to complete by high-volume surgeon	wRVU	wRVU / Hour
Sacrocolpopexy (complex laparoscopic or robotic vaginal reconstruction)	Urogynecology 7 years	3-4 hours	17.03	4.87
Complex Hysterectomy >250 grams	Minimally Invasive Gynecologic Surgery 6 years	2-4 hours	20.06	6.69
Radical Hysterectomy with lymph node dissection	Gynecologic Oncology 7-8 years	3-5 hours	30.91	7.73
Endometriosis excision	Minimally Invasive Gynecologic Surgery 6 years	1-8 hours (if significant frozen pelvis/disease invasion)	12.15	2.70
Shoulder arthroscopy	Orthopedic Surgery 5-6 years	30 minutes-1 hour	15.59	20.79

Note: wRVUs are illustrative (calculated as wRVU / mean time to complete), for ease of comparison.

Demand for Women’s Health Innovation

Though venture capital investment in women’s health has tripled between 2019 and 2024^[21], there is a long way to go before positive feedback loops cement enthusiasm for building up the space. There are many reasons for this, including historical under-representation of women as decisionmakers in scientific and capital-allocating authorities. Other reasons include a relative lack of exits^[22] – and thus lacking a track record of making financial returns – in the space, whether in medical devices, care delivery, healthcare IT / services or therapeutics. Of course, this is unsurprising given the space is so “new” – but it lends to a persisting view of women’s health investing as a money-losing game.

This shows up in patient care. Dr. Harper notes that, if a patient has endometriosis and wants a new endometriosis drug, that patient’s physicians must prescribe that patient a traditional birth control regimen, regardless. Only with a track record of failing the standard, likely less expensive treatment – even if the patient’s physician knew this regimen would likely not work for their patient – is the new, more effective drug likely to be approved by the patient’s insurance company.

While this type of cost-control is familiar across many medical specialties, it is especially damaging in women’s health, where a drug may represent a pharmaceutical company’s first-ever investment in a female-specific condition. If their sales are stagnant because of likewise new and changing prior authorization requirements, it creates an especially harmful negative feedback loop against any future women’s health investment.

The same holds for non-life science investors, like Private Equity or Venture Capital, when or if they decide to invest in women’s health. If overall especially difficult market dynamics in an early market push early players into capital impairment, firms are unlikely to put more money to work in the next women’s health companies that come to market.

Policy Reform and the Road Ahead

With uncertainty in Medicaid – which covers more than two out of five births – continued shifts in post-Dobbs legislation, and more, the road for women’s health providers, patients, and innovators is likely to be rocky for the foreseeable future.

That said, there are key steps forward we should prioritize that could promise to reform parts of the system, specifically: 1) under-reimbursement in Gynecology versus comparable male-focused procedures and related reimbursement tension between Gynecology and Obstetrics; 2) shortages and downstream lagging patient outcomes in Obstetrics; 3) RUC-focused adjustments that would benefit both Obstetrics and Gynecology.

To address the relative under-reimbursement in Gynecological procedures specifically versus other specialties and inherent tension between Obstetrics and Gynecologic service reimbursement, Dr. Fitzgerald aptly outlines that policymakers and advocates might:

1. Re-evaluate RVU Standards: Advocacy for studies to reestablish fair reimbursement standards for gynecologic surgeries, led by relevant professional groups. There is no reason to believe that Gynecologic services are less complex than other surgical services. A re-issued survey of physician work using empirical time-based data such as time-motion studies could be a first step in codifying this and re-establishing correct relative work measures versus the more qualitatively-rooted surveys that were originally established and are still in-use.
2. Pursue policy and legislative action: Engaging government agencies like the CMS, the Secretary of Health, and members of Congress to review and revise existing policies, particularly the budget neutrality clause and the composition of the RUC to include a seat for Gynecologic Surgeons. Explore legal recourse under the Affordable Care Act and the 14th Amendment, with the aim of addressing potential gender-based discrimination in healthcare reimbursement.

To address the acute shortages in Obstetrics care, we offer different policy considerations. Given Obstetrics services are not generally provided to the Medicare population – there may be a strong case for moving towards more bespoke measures to account for the current provider shortages and lagging outcomes in Obstetrics.

One consideration is whether state payors might include network adequacy measures when setting prices for Obstetrics care, to “price in” acute shortages and, over time, make strides to re-balance supply and demand. Regulatory bodies typically refer to network adequacy as a measure of whether the size of a network (i.e., providers, hospitals, specialists, etc.) is adequate to ensure reasonable time to care and coverage for members. Though this system can be flawed – with research findings suggesting that measures are not always accurate and likewise are loosely enforced[23], a tighter incorporation of state Medicaid-led network adequacy measures in Obstetrics could have the potential to rebalance supply and demand in at least some of women’s healthcare.

To avoid reporting of adequacy metrics without action, state Medicaid programs might:

1. Define baseline adequacy metrics, for example 1 Obstetrician per 1,000 women of reproductive age within a 30-minute drive.
2. Measure networks against this standard annually
3. Adjust reimbursement proportionately to any shortages using a reimbursement factor – requiring a plan to increase reimbursement by the % they fall short of their state’s adequacy formula, until such time that provider participation meets the adequacy standard. Though this may feel punitive to payors initially, there should be rebalancing over time as payors see cost savings during the pregnancy episode (within payors’ 1-3 year ROI focus window) as more sites of care deliver better care for women.

This might look like Adjusted Payment = Base Payment x (1 + Adequacy Gap %), to be re-evaluated on an annual basis as adequacy metrics are re-collected.

By strategically raising reimbursement only where it addresses access gaps, like Obstetrics in underserved areas, Medicaid can target its limited funds efficiently rather than broadly inflating payments across all specialty services.

Of course, Obstetrics services are primarily reimbursed through global maternity care codes, which have remained largely unchanged for decades. These codes do not adequately compensate providers for additional patient support during pregnancy and the postpartum period, nor for the administrative work required to deliver such care. That said, implementing an adequacy-gap adjustment to global obstetrics codes should still represent an important first step in addressing the longstanding underpayment in obstetrics, a factor that has contributed to the closure of care sites and reduced access to maternal health services nationwide.

Finally, it is worth revisiting years of debate surrounding the existence of the RUC itself, with many pointing most recently to implications from the Supreme Court’s decision regarding the USPSTF, issued on June 27, 2025, affirmed that its members, as “inferior officers,” do not require Senate confirmation, upholding the ACA’s preventive services mandate. The RUC, by contrast, is a private committee convened by the AMA, with CMS retaining final authority over recommendation adoption. Because the RUC itself is not a federal body exercising delegated regulatory power, it is technically not directly analogous to the USPSTF under the Court’s reasoning. Nonetheless, the decision highlights broader concerns about transparency, accountability, and the influence of non-governmental bodies in shaping reimbursement policy, especially given the reality that CMS broadly adopts the RUC’s recommendations each year.

Foregoing a broad overhaul of the RUC given the massive complexity and likely infeasibility of any such efforts in the near to medium term, we might nonetheless pursue more scoped RUC-focused reform that could have wide-ranging positive effects for Obstetrics and Gynecologic care:

1. As mentioned, introduce separate representation for Obstetrics and Gynecology (specifically gynecologic surgery) in the RUC
2. Given novel services get higher reimbursements than more established services (and procedures more than E&M services), create a one-time true up by CMS that would outstrip the RUC’s decades of undervaluing Obstetrics and Gynecology care

Collective, policy-oriented action has the promise to positively affect the business of OB-GYN care. In doing so, we can begin to right-size supply and demand—and build a future where OB-GYN care is sustainable for providers and more accessible for patients.

 

References

[1] Medicus Healthcare Solutions. Insights into the OB/GYN shortage: Understanding the supply and demand gap. Available from: https://medicushcs.com/resources/insights-into-the-ob/gyn-shortage-understanding-the-supply-and-demand-gap

[2] U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce. Projections of the supply and demand for women’s health service providers: 2018–2030. Rockville, MD: Health Resources and Services Administration; 2020. Available from: https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/projections-supply-demand-2018-2030.pdf.

[3] Association of American Medical Colleges. Labor pains: OB-GYN shortage. Association of American Medical Colleges News. Available from: https://www.aamc.org/news/labor-pains-ob-gyn-shortage.

[4] Healthgrades. OB-GYN appointment wait times vary in 15 metro markets. Available from: https://resources.healthgrades.com/pro/ob-gyn-appointment-wait-times-vary-in-15-metro-markets.

[5] American Medical Association. Development of the Resource-Based Relative Value Scale. Chicago, IL: American Medical Association; [date unknown]. Available from: https://www.ama-assn.org/system/files/development-of-the-resource-based-relative-value-scale.pdf

[6] American Medical Association. Composition of the RVS Update Committee (RUC). Chicago, IL: American Medical Association; Updated July 8, 2025. Available from: https://www.ama-assn.org/about/rvs-update-committee-ruc/composition-rvs-update-committee-ruc

[7] Hsiao WC, Braun P, Yntema D, Becker ER. Estimating physicians’ work for a resource-based relative-value scale. The New England Journal of Medicine. 1988 Sep 1;319(13):835-841. doi:10.1056/NEJM198809293191305. Available from: https://www.nejm.org/doi/full/10.1056/nejm198809293191305

[8] Proudfoot ML. A critique of the practice-expense values of the resource-based relative value scale. Journal of Family Practice. 1993 Jul;37(1):57-67. PMID: 8345341. Available from: https://pubmed.ncbi.nlm.nih.gov/8345341/#:~:text=Abstract,zero%20by%20the%20year%202001.

[9] The evaluation of payment for obstetric and gynecology services. Obstetrics and Gynecology. 2024 Feb;143(2):[page numbers]. https://journals-lww-com.pitt.idm.oclc.org/greenjournal/fulltext/2024/02000/the_evaluation_of_payment_for_obstetric_and.27.aspx

[10] Polan RM, Barber EL. Reimbursement for female-specific compared with male-specific procedures over time. Obstetrics and Gynecology. 2021 Dec;138(6):878-883. doi:10.1097/AOG.0000000000004599. PMCID: PMC8602770. PMID: 34736273.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8602770/#R2

[11] Benoit MF, Ma JF, Upperman BA. Comparison of 2015 Medicare relative value units for gender-specific procedures: Gynecologic and gynecologic-oncologic versus urologic CPT coding. Has time healed gender-worth? Gynecol Oncol 2017;144(2):336–342. DOI: 10.1016/j.ygyno.2016.12.006. [DOI] [PubMed] [Google Scholar], Watson KL, King LP. Double Discrimination, the Pay Gap in Gynecologic Surgery, and Its Association With Quality of Care. Obstet Gynecol 2021;137(4):657–661. DOI: 10.1097/AOG.0000000000004309. [DOI] [PubMed] [Google Scholar], Goff BA, Muntz HG, Cain JM. Comparison of 1997 Medicare relative value units for gender-specific procedures: is Adam still worth more than Eve? Gynecol Oncol 1997;66(2):313–9. DOI: 10.1006/gyno.1997.4775. [DOI] [PubMed] [Google Scholar]

[12] Penn M, Colley D, King LP, Fitzgerald JJ. Price and Prejudice: Reimbursement of surgical care on male vs. female anatomies. Accepted by Journal of Women’s Health, 2024.

[13] American Medical Association. Medicare physician payment adequacy: Budget neutrality. Chicago, IL: American Medical Association; 2024. Available from: https://www.ama-assn.org/system/files/medicare-basics-budget-neutrality.pdf

[14] U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. Projections of Supply and Demand for Women’s Health Service Providers: 2018-2030. Rockville, MD: Health Resources and Services Administration; March 2021. Available from: https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/projections-supply-demand-2018-2030.pdf

[15] American Medical Association. Guardado JR. Medical Liability Claim Frequency Among U.S. Physicians. Chicago, IL: American Medical Association; April 2023. Policy Research Perspectives Report 2023-3. Available from: https://www.ama-assn.org/system/files/policy-research-perspective-medical-liability-claim-frequency.pdf

[16] Surana K, Presser L, Suozzo A. Under Texas’ Abortion Ban, More Women Nearly Bled to Death During Miscarriage. ProPublica. Published July 1, 2025. Available from: https://www.propublica.org/article/texas-abortion-ban-miscarriage-blood-transfusions

[17] Schloemann M. OB/GYN Medical Malpractice Insurance. MEDPLI Insurance Services; 2024 Feb 20. Available from: https://medpli.com/specialties/obgyn-medical-malpractice-insurance/

[18] Pelley E, Carnes M. When a Specialty Becomes “Women’s Work”: Trends in and Implications of Specialty Gender Segregation in Medicine. Academic Medicine. 2020 Oct;95(10):1499-1506. PMID: 32590470. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7541620/

[19] Stoneburner A, Lucas R, Fontenot J, Brigance C, Jones E, DeMaria AL. Nowhere to Go: Maternity Care Deserts Across the US (Report No. 4). March of Dimes; 2024. Available from: https://www.marchofdimes.org/sites/default/files/2024-09/2024_MoD_MCD_Report.pdf

[20] March of Dimes. Nowhere to Go: Maternity Care Deserts Across the US, 2024 Report. Arlington, VA: March of Dimes; 2024. Available from: https://www.marchofdimes.org/maternity-care-deserts-report

[21] Silicon Valley Bank. Innovation in Women’s Health Report. Santa Clara, CA: Silicon Valley Bank; 2025. Available from: https://www.svb.com/trends-insights/reports/womens-health-report/

[22] Silicon Valley Bank. Venture Capital Investment in Women’s Health Startups Reaching Record Highs; Silicon Valley Bank Releases Report. San Francisco, CA: Silicon Valley Bank; April 2, 2025. Available from: https://www.prnewswire.com/news-releases/venture-capital-investment-in-womens-health-startups-reaching-record-highs-silicon-valley-bank-releases-report-302417682.html

[23] Hinton E, Raphael J. Medicaid managed care network adequacy and access: current standards and proposed changes. KFF. Published June 15, 2023. Available from: https://www.kff.org/medicaid/issue-brief/medicaid-managed-care-network-adequacy-access-current-standards-proposed-changes/

 

Regina E. Herzlinger, Nancy R. McPherson Professor of Business Administration, Harvard Business School

Contact: rherzlinger@hbs.edu 

The three women CEOs of the healthcare case studies highlighted in this issue of HMPI (see below), had one thing in common: they were gutsy. Each saw a critical gap in the healthcare system and built something to address it.

Smart, strategic, tough. No Spanx, makeup, cooking, or clothing firms for them. There’s nothing wrong with traditional women entrepreneur routes; but these three women wanted to change the world, so they did what the big boys did: IT, wellness, and, get this, biotech– arguably the most complex and capital-intensive sector in healthcare innovation [1].

These women ignored the barriers that stymie most healthcare entrepreneurs: a powerful, consolidated status quo that blocks the innovators that threaten it; a bureaucratic and politicized third-party financing system; tough governmental requirements; islands of information, each with their own language, that impede outcomes accountability;  powerful rival technologies; and fickle consumers  who, unaware that their taxes and income pay for all of healthcare, demand that any healthcare innovation should be free. They never questioned their ability to build healthcare companies that did good—by controlling costs, expanding access, and improving quality.

And they did well. Did they ever.

One of those three is Judy Faulkner, the genius entrepreneur who started EPIC [2]. The dominant Electronic Medical Record firm in the United States, Epic was launched in 1979 by Judy with just $70,000 of seed capital from family, friends, and early colleagues. Faulkner grew the company from that point without any outside investment or acquisitions, , creating her own world on her own terms. When Epic built their “Intergalactic Campus” in Verona, Wisconsin back in the early 2000s, Judy encountered a surprising problem: the underground parking garages could not accommodate the local fire trucks. Rather than accept the mismatch, she worked with the city to build a new, smaller fire engine and donated it to the Verona Fire Department., When the campus opened, Judy came riding through on the new truck with her white Samoyed dog, McKinley, taped with black paper dots  to resemble a Dalmatian. You have to love this woman: smart, and a lot of fun, too [3].

Just as iconoclastic is Amy Burroughs, who captained the Dartmouth women’s rugby team, Elegant Violence Inc., some 30 years ago while a  student at Dartmouth College. After starting a small business in high school and programming for the CIA, she followed a conventional route only when she started working in brand management and became one of my Harvard Business School students. I knew almost immediately that she not only would become a Baker Scholar (top 5% of the class — very rare for a woman, especially in 1997 , but also, and much more difficult, that she would build a successful career. She joined Genentech and then moved into working with biotech startups and even did a tour in executive recruiting.

Burroughs eventually wound up at Cleave, a firm with a drug in testing to combat multiple myeloma but that had a serious side effect: blindness in some patients [4]. Who would want to take on that kind of challenge and head this firm? Well, Amy became the CEO, solved the blindness issue, and did it on a budget that felt like $3.50 cents in the wildly costly biotech world. And then she sold the company’s assets in 2023. Today, she is the CEO of Terns Pharmaceuticals, a publicly owned firm developing important new therapies for cancer and obesity.

Kelly Close has a different approach from Burroughs and Faulkner. Mild and self-spoken, she is a lioness at heart [5]. Close is a childhood diabetic who told her investment banking boss to go fly a kite when he refused to let her work remotely on the weekends while she cared for her ailing father. I believed in her, too, when she was my student in 1995 ; I know a lioness when I see one, even if she looks like a lamb.

In 2002, Kelly Close founded Close Concerns, a diabetes-focused healthcare information company, with her husband. The venture was entirely self-funded, launched with a lean and profitable model centered on subscription-based newsletters and consulting services for companies and organizations in diabetes care. Kelly personally handled both sales and strategy in the early days, and soon after, created a distinctive full-time and summer associates program that attracted undergraduates eager to work on meaningful problems in healthcare. The program became a launchpad for top medical and business schools—and a draw for high-performing students who wanted to travel the world to scientific conferences, gain mentorship, and contribute to work that mattered. It was a brilliant business model, and a brilliant success.

Simple Lesson: Believe in Yourself. Not so Simple: Making It Happen

Like all management bromides, ‘believe in yourself’ is easy to say. But you had better be good. All three women are fantastic, substantively and strategically. They know their IT, pharma, medical conditions. They are also extremely competent businesspeople: sneaky with their market strategies, brilliant with customer acquisitions, creative in scaling strategies, with a profound knowledge of finance. They know that success comes to she who works hard.

I cannot teach anybody how to be gutsy (although, as a personal aside, poverty helps. You have no way to go but up.)

But, with these case studies featured in this issue of HMPI, and many others, I can teach you how to align with the factors that block most entrepreneurs. And, I can help you to evaluate, start, scale and exit your healthcare innovation. Read our new book, Innovating in Healthcare: Text and Cases (HBS publishing, 2026), and tell me what you think.

References

1. Herzlinger, Regina E., and Erik R. Sparks. “ABC Pharmaceuticals.” Harvard Business School Case 313-041, August 2012. (Revised August 2024.
2. Herzlinger, Regina E., and Brian L. Walker. “Epic: The Future of Health Information Technology.” Harvard Business School Case 325-028, September 2024. (Revised March 2025.)
3. Bruce, Giles. https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/why-judy-faulkner-bought-a-fire-truck/?utm_source=chatgpt.com. January 20024
4. Herzlinger, Regina, and Brian Walker. “Cleave Therapeutics: Taking a Risk on Oncology Drug Discovery.” Harvard Business School Case 323-045, January 2023.
5. Herzlinger, Regina E., and Brian L. Walker. “Close Concerns: Diabetes Research and Advocacy.” Harvard Business School Case 323-047, March 2023. (Revised June 2025.)

Christina Vosbikian, Blavatnik Fellow in Life Science Entrepreneurship, Harvard Business School 

Contact: cvosbikian@mba2025.hbs.edu

According to the Graduate Management Admission Council (GMAC), 2024 saw a record 12% increase in MBA applications – marking a sharp reversal in two prior years of lagging application rates. As the Wall Street Journal noted, the rebound was most pronounced in full-time, in-person programs, where applications rose 32% – the highest level in a decade.¹ ²

Conjecture varies about why the MBA is, seemingly, on the rise. Some cite economic uncertainty, which presumably makes the opportunity cost of a two-year hiatus feel less stark for MBA hopefuls. Others cite a post-COVID right-sizing of demand. Still others turn to doomsday scenarios and speculate that AI may be pushing white-collar workers to up-skill themselves to insulate against their own looming obsolescence.

Yet even amid these encouraging trends, articles like When Harvard MBAs Can’t Find Jobs: How the Job Market Has Changed highlight a more sobering reality – especially for those entering fields like healthcare, where complexity and fragmentation require more than just general business training.³ This article and others note that MBAs may not be getting the “dream jobs” that were once synonymous with a top degree and that, even if they are, the path is anything but smooth.

Why is this? The Wall Street Journal cites the hiring freeze in “top” sectors like tech and finance, the evolving nature of work whereby technical skills trump general management knowledge, the influx of alternative education pathways, and the rise of the “unspoken” job market where internal hiring and other non-public hiring is replacing external searches for advanced positions. Anecdotally, many point to the MBA as being outdated in a time when the democratization of productivity technology like AI or great equalizers like social media have possibly made it easier than ever before to succeed as a business owner through self-teaching and informal channels. One need only to look at formal education drop-outs like Mark Zuckerberg or Steve Jobs to see why. Those who cite these titans of industry often forget many success stories, often in healthcare, in which MBA alumni have launched and led companies after completing their degrees – like Epic Systems’ Judith Faulkner, Elevance Health’s Gail Boudreaux, and many others.

Let us take a look at the numbers behind MBA graduates and their employment using HBS as an example. Despite the Wall Street Journal’s provocative headline, HBS’s data show a steady 23% to 30% of graduates not seeking employment post-MBA from 2020 to 2024 – and either starting their own businesses, going back to prior employment, with only 4% to 5% postponing their job search, continuing their education or otherwise filling their time.⁴

If we consider “double-digit” post-MBA employment buckets, the data show that Private Equity, Consulting, Tech, Entrepreneurship and Company Sponsorship – remain the most popular paths for graduates over time. That said, Consulting, the path perhaps most associated with general management programs, has declined in popularity. This could be driven by industry hiring trends, but it could also be a symptom of the overall change in what today’s MBA value proposition and post-program job search looks like.

The Wall Street Journal’s point – that the road to post-MBA employment is paved with different motivations and competitive factors – should not be ignored. If the value of the MBA is no longer “guaranteed” placement in top, legacy industries, what is the value? This is the question MBA hopefuls and top programs alike are grappling with.

In this article, we will add to this discussion by examining the case for the MBA, as it pertains to a career in healthcare, drawing both from industry trends and my own direct experience.

Healthcare and the MBA

As of 2023, approximately 50% of healthcare CEOs held an MBA, compared to an average of 43% across all industries.⁵ At Harvard Business School,  the percentage of graduates pursuing careers in healthcare has hovered at 5% to 7% between 2020 and 2024.⁴ It is worth noting that this count may obfuscate an even higher percentage of MBAs pursuing careers in healthcare. At least at HBS, a number of graduates, myself included, are entering or re-entering the industry by starting their own healthcare companies, whether in life sciences or healthcare IT / services.

Healthcare-Specific MBA Programs

Many fulltime MBA programs allow students to specialize in healthcare. One prominent example is the Health Care Management Major at the University of Pennsylvania’s Wharton School that boasts 2,200 alumni, according to the program’s website.⁶ These include C-Suite and senior executives at DaVita, Kaiser Permanente, Oak Street Health, UnitedHealth, and other healthcare giants.

Of programs routinely in the top 10 of MBA rankings, whether in formal tracks or specialized programming, most boast some form of focus on healthcare. Whether through coursework, healthcare-focused networks, or direct career support, there are many reasons an MBA can be of great value to those pursuing a career in healthcare.

Other Core Tenets of the MBA for Healthcare Hopefuls

Coursework. Most MBA programs, Harvard Business School’s included, have some level of course requirements. Beyond that, students are free to choose coursework that interests them – whether to help them explore completely new fields or delve deeper into areas of interest.

At HBS, students spend their first year in the Required Curriculum (RC), with no choice in coursework. The second year, or Elective Curriculum (EC), is completely at students’ discretion. During this year, HBS has classes like Innovating in Healthcare taught by Professor Regina Herzlinger, Entrepreneurship in Life Sciences with Senior Lecturer Satish Tadikonda, and Innovating in Healthcare Delivery with Professor Robert Huckman.

Innovating in Healthcare is an example of both, with the first quarter focused on learning the pillars of successful healthcare innovation by examining industry leaders, and the subsequent three focused on creating cohort-based learning where students work on and share learnings from building their own healthcare ventures while pursuing their MBA.

Professor Regina Herzlinger, the Nancy R. McPherson Professor of Business Administration at HBS, recently reflected on why she created healthcare-specific programming at the school:

“…I started a second-year EC MBA course, Innovating in Health Care. It was not about wish fulfillment in health care, but about how to make innovation happen. At that time, the school did not teach many verticals, but health care innovation requires so much specific knowledge that they allowed me to open this course. Virtually all the other courses in health care management in other schools were about hospitals, and hospitals are great, but they cannot be the only way that health care is delivered. For example, 20 percent of the US population lives in rural areas, but they have 1 percent of the ICU beds. I thought that all these creative MBAs could do something. The endpoint was to build a plan for innovative health care. This year I had six prize-winning teams, who obtained their series A and beta sites for their ideas, and I am so proud of them.”

Professor Herzlinger’s class has, indeed, been a springboard for healthcare innovators. My own cohort, the Class of 2025, obtained $5 million in seed funding and won the HBS Shark Tank prize; Grand Prize of the Social Enterprise track at the New Ventures Competition; the iF Gold Design Award; and a Blavatnik Fellowship.

What makes the course so special is our focus on the fundamentals. Is a healthcare innovation primarily a technology, consumer-facing, or cost-cutting innovation? When companies succeed or fail, what can we learn about how they approached the core six factors of healthcare innovation: structure, financing, technology, public policy, accountability, and consumers?

As I have begun my own journey of healthcare entrepreneurship, founding Coord Health, a consumer-facing venture focused on serving OBGYNs and their patients, I constantly consider the pillars Professor Herzlinger taught us – which we saw play out in the stories of Agilon Health, Podimetrics, Sword Health, Epic, Phreesia, Ajax Health, and others.

People: Alumni, Professors, Peers. Professors and other people encountered during an MBA are likewise critical. In my own journey, I have benefited immensely from the close mentorship of the professors mentioned, as well as Professor Trever Fetter, a seasoned healthcare executive.

Career Support. Finally, whether through HBS’s general career center or programming from the Health Care Initiative, the direct career support HBS and other MBAs provide for those looking for healthcare careers can be invaluable. For myself, these have manifested in the Blavatnik Fellowship for Life Science Entrepreneurship, which offers me a springboard after graduation to continue working full-time on my Coord Health venture.

The MBA: Offering Flexibility to Innovate and Grow in Healthcare

Healthcare, perhaps more than any other industry, requires a multidisciplinary approach and the space to explore what benefits can be created for patients, providers, and payors alike. In a time when the value of the MBA may feel murky to some, I hope this reflection and context present the case for why the degree is uniquely suited for those seeking to contribute to the business of healthcare – and to do well while doing good.

References

1. Graduate Management Admission Council. Application Trends Survey 2024. Available at: https://www.gmac.com/market-intelligence-and-research/research-library/admissions-and-application-trends/application-trends-survey-report-2024. Accessed August 30, 2025.
2. Korn M. Applications to M.B.A. Programs Soar. Wall Street Journal. November 2024. Available at: https://www.wsj.com/lifestyle/careers/applications-to-m-b-a-programs-soar-aeb6fce0. Accessed August 30, 2025.
3. Westfall C. When Harvard MBAs Can’t Find Jobs: How the Job Market Has Changed. Forbes. January 15, 2025. Available at: https://www.forbes.com/sites/chriswestfall/2025/01/15/when-harvard-mbas-cant-find-jobs-how-the-job-market-has-changed/. Accessed August 30, 2025.
4. Harvard Business School. Employment Data. Available at: https://www.hbs.edu/recruiting/employment-data/Pages/default.aspx. Accessed August 30, 2025.
5. Becker’s Hospital Review. The most common degrees for healthcare CEOs. April 2023. Available at: https://www.beckershospitalreview.com/hospital-management-administration/the-most-common-degrees-for-healthcare-ceos/. Accessed August 30, 2025.
6. The Wharton School, University of Pennsylvania. Health Care Management Major – MBA Alumni. Available at: https://hcmg.wharton.upenn.edu/programs/mba/alumni/. Accessed August 30, 2025.

Brian Walker, Harvard Business School

Contact: bwalker@hbs.edu 

When we talk about innovation in healthcare, we often talk about science, strategy, and scalability. But we don’t talk enough about who gets to decide which problems are worth solving in the first place. Right now, in most corners of the healthcare innovation ecosystem, those decision-makers are overwhelmingly men.[1]

This matters—not just symbolically, but materially. Who makes the decisions shapes what gets funded, what gets built, and who benefits. And in healthcare, where innovation can mean the difference between suffering and survival, between dignity and neglect, it’s not just a missed opportunity when women are excluded from shaping the future — it’s a direct risk to health outcomes.

To be clear, women are already a driving force in healthcare innovation, whether they’re launching new ventures or leading transformative work inside existing institutions. They’ve led the global proliferation of electronic health records, built hospital systems, advocated for systemic change, and designed solutions that reflect the needs of diverse populations.

Still, healthcare is a massive, complex industry, and it’s one where gender disparities show up in subtle but deeply consequential ways. For example, while women make the majority of healthcare decisions in households and comprise the vast majority of frontline healthcare workers, they’re still vastly underrepresented in leadership roles and investment decision-making.[2] And when women do build companies — particularly in overlooked areas like caregiving, maternal health, or chronic disease management — they face steeper hurdles for funding and recognition.[3]

But here’s the kicker: the exclusion of women from innovation isn’t just unjust, it’s inefficient. It suppresses valuable insight, narrows the range of ideas, and weakens the overall quality of solutions being developed. Healthcare innovations shaped by more diverse leadership, and particularly by women, are more likely to address long-ignored clinical problems and reflect the needs of those most impacted by the system.[4]

This exclusion is especially troubling because of three interrelated realities:

First, women are central to healthcare decision-making, both formally and informally. They make the vast majority of healthcare decisions at the household level, serve as the primary caregivers across generations, and make up roughly 76% of all healthcare workers.[5] Their firsthand exposure to the system makes them uniquely positioned to identify pain points and opportunities for improvement. When they’re not part of the innovation conversation, entire categories of need may go unaddressed.

Second, the market for health innovations that directly affect women is enormous. In areas such as reproductive health, maternal care, autoimmune disease, and eldercare, women represent not only the majority of users but also the majority of informal care providers. Ignoring these markets is not just a moral oversight, it’s a commercial misstep. The historical underinvestment in these areas reflects a failure to recognize opportunity, not a lack of it.

Third, entrepreneurship and innovation are the crucial engines of change in a capitalist society. As Joseph Schumpeter famously wrote, “the function of entrepreneurs is to reform or revolutionize the pattern of production.”[6] And yet, women founders are routinely locked out of the systems that govern that transformation. Their work spans fields from AI-enabled detection of intimate partner violence to novel therapeutic platforms for reproductive care.[7]^,[8] It’s not about doing what’s nice, it’s about doing what’s urgent, systemic, and impactful. These aren’t fringe goals; they are essential to fixing what is broken in today’s healthcare system [9]

Despite all this, women continue to receive a disproportionately small share of investment and support: between 2019 and 2021, healthcare organizations founded by women received just 16.6% of venture capital funding. This isn’t because their ideas are weaker — it’s because the system is wired to reward the familiar. And too often, “familiar” still means male.

Managerial Decisions That Matter

Disparities in funding and leadership are often described as structural, but in truth, they are the sum of everyday choices. It’s in these choices — who to invite to pitch, how to define traction, where to recruit board members — that we see how gendered power operates in practice. These are managerial decisions that can, and must, be redesigned.

Drawing from my research, here are several high-impact shifts organizations can make:

Supplement entrepreneurial skillsets to unlock capital:

Many women founders bring deep subject-matter expertise or community-rooted insight, but may not have the same networks or exposure to traditional venture-building playbooks. Instead of seeing this as a shortcoming, investors and organizational leaders can make managerial decisions to provide structured support—pairing operators, advisors, or platform teams to help translate vision into scale. As one investor shared in my research, “It’s not about questioning her credibility—it’s about asking what scaffolding we can offer to help her build bigger.” These decisions mirror well-established methods in management development, where scaffolding—through intentional support such as feedback loops, mentoring, and progressive responsibility—is used to safely accelerate growth and mitigate perceived risk.[11].

Secure internal buy-in from limited partners (LPs):

Investment committees often attribute the underperformance of a startup to a founder’s lack of prior executive experience in a narrowly defined vertical — conclusions that are rarely applied with the same scrutiny to male founders. These sweeping generalizations risk becoming self-fulfilling prophecies. Venture firms and LPs alike must be cautious not to apply anecdotal outcomes as universal truths. Changing this norm requires more than data; it demands intentional messaging and internal advocacy. General partners must educate LPs on the cost of exclusion and the upside of diversification, not only in social terms, but in terms of differentiated deal flow and innovation.[12]

Provide familial support structures that address caregiving realities:

For both founders and those innovating within established institutions, women often navigate disproportionate caregiving burdens.[13] Managerial leaders can address this by offering paid parental leave, childcare subsidies, flexible scheduling, and return-to-work fellowships. These supports are not “extras”—they are enablers of participation, retention, and long-term leadership.

Foster both women-only and gender-integrated solutions:

Organizations need both dedicated spaces for women and broader engagement with men. Research shows that women-only forums improve mentorship satisfaction, reduce isolation, and spark innovation.[14] At the same time, including men in diversity efforts leads to more sustainable change. In fact, recent research found that 96% of organizations that involve men in gender diversity initiatives report progress, compared to just 30% of those that do not.[15] Leaders must invest in both: creating protected spaces for candid peer exchange while designing inclusive pathways for shared accountability and cultural change.

These managerial shifts, whether inside startups or within large health systems, hold the power to transform not only who leads but what gets built, leading to better health outcomes for women and, ultimately, for all of us.

Conclusion

These actions are not just about fairness; they are about performance and innovation. Creating a more inclusive healthcare innovation ecosystem doesn’t require waiting for a generational shift, nor do we have time for that. It requires intentional, managerial decisions about who is funded, who leads, and how we support them. By redesigning the conditions under which ideas are evaluated and ventures are supported, we can unlock a wave of health innovation that better serves women — and everyone else who depends on a more equitable system.

 

References

[1] Walker, B. (2023). Justification of Women Entrepreneurship in Health Care Research. Doctoral dissertation, Johns Hopkins University.

[2] Bureau of Labor Statistics. (2021). Labor Force Statistics from the Current Population Survey.

[3] Brush, C., Greene, P., Balachandra, L., & Davis, A. (2014). Diana Report: Women Entrepreneurs 2014.

[4] Gupta, V., Turban, D., Wasti, S., & Sikdar, A. (2013). The Role of Gender Stereotypes in Perceptions of Entrepreneurs.

[5] Bureau of Labor Statistics. (2021). Labor Force Statistics from the Current Population Survey.

[6] Schumpeter, J. A. (1942). Capitalism, Socialism and Democracy.

[7] Khurana B. (2024). AI‑Powered IPV Detection: Brigham Radiologist Develops AIRS to Flag Domestic Violence. Becker’s Radiology.

[8] Maven Clinic (2024). Women‑focused health startup Maven valued at $1.7 bln in funding round. Reuters.

[9] Commonwealth Fund. (2024). Confronting the U.S. Maternal Mortality Crisis: International Comparison. Commonwealth Fund.

[10] Walker, B. (2023). Justification of Women Entrepreneurship in Health Care Research. Doctoral dissertation, Johns Hopkins University.

[11] Elliott J. (2006). Leadership Scaffolding. Oxford: Chandos

[12] Walker, B. (2023). Justification of Women Entrepreneurship in Health Care Research. Doctoral dissertation, Johns Hopkins University.

[13] Thomas, R., Cooper, M., Urban, K., Cardazone, G., Bohrer, A., Mahajan, S., Yee, L., Krivkovich, A., Huang, J., Rambachan, I., Burns, T., & Trkulja, T. (2021). Women in the Workplace.

[14] Vial, A. C., Brescoll, V. L., & Tyler, J. M. (2023). The Benefits of Gender-Specific Networking in Organizations. Journal of Applied Psychology, 108(1), 23–34.

[15] Catalyst. (2020). Engaging Men in Gender Initiatives: What Change Agents Need to Know.