By Michelle Crouch
Co-published with Charlotte Ledger
The term “women’s health” tends to conjure images of gynecology offices, hospital maternity centers or other facilities focused on women’s reproductive health.
But at the Novant Health Women’s Center in Charlotte’s SouthPark area, you can find neurology, psychiatry, pulmonary and cardiology clinics tailored specifically to women.
The center also includes traditional women’s services such as a sexual health clinic, an ob-gyn practice, breastfeeding support and mammography, all housed in a spa-like setting with soft white light fixtures with undulating curves, eye-catching artwork and other feminine décor.
Meanwhile, Charlotte’s other health care giant, Atrium Health, recently announced its plan to open its own suite of women’s health services just down the road, in a space formerly occupied by an Atrium urgent care center.
The fact that the two competing health care giants will soon offer health services targeted at women within a mile of each other underscores the importance of this market, both in Charlotte and across the state, said William Brandon, a professor emeritus of health policy at UNC Charlotte.
“The clinical differences between men and women are now much more widely recognized,” Brandon said, “and that certainly makes for a great marketing niche.”
While the trend may serve a hospital’s marketing goals, experts say it’s also an important and long-overdue recognition of the many ways that women’s health needs differ from men’s.
A one-stop shop for women
The 36,000-square-foot Novant women’s center, which opened in 2020, is designed to be an integrated center where physicians of different disciplines can work together to meet a woman’s health needs, said Stephanie Appling, women and children’s service line leader for Novant Health.
The women’s center occupies the fourth floor of a larger medical building. Appling hopes to expand to other floors, perhaps by adding women’s dermatology and family practice clinics.
Appling said she wants the center to be a “one-stop shop” where women at different life stages can access care.
“We want women to be with us from start to finish,” she said. “Women have so much they’re already managing and taking care of, so we wanted to make it easier.”
Other systems expanding services
In other states, hospitals have opened stand-alone women’s health centers dedicated to all aspects of health care for women.
So far, the Novant center appears to be the most comprehensive facility dedicated to women’s health in North Carolina, but other hospitals have started offering more gender-specific health services.
In the Triangle area, Duke Health offers women’s cardiology at its Duke Center for Women’s Heart Care, while UNC Health has a Women’s Heart Program and the stand-alone Women’s Heart & Health Clinic on its REX campus in Raleigh.
Duke also has a Women’s Cancer Center in Raleigh and is developing a Female Athlete Program in its sports medicine department, a spokeswoman said.
Atrium’s plans include opening a women’s sexual health practice and its first women’s cardiology program in the former urgent care center space in mid- to late 2023, said Suzanne Fox, service line leader for women’s care at Atrium Health. Also being considered: women’s physical therapy or a menopause clinic.
“We have people that are really good at menopause, but I’d love to expand that into a true menopausal center,” Fox said. “That is probably one of my next priorities.”
Why sex-specific care?
Men’s and women’s bodies are obviously different, yet the medical field ignored those differences for decades. Clinical studies were conducted by men, on men. Researchers worried that women’s varying hormone levels would affect their data, so women were left out of clinical trials for most of the 20th century. It wasn’t until 1993 that federal law required their inclusion in research.
As a result, women historically have been underdiagnosed and undertreated, said Katie Schubert, president and CEO of the Society for Women’s Health Research, a nonprofit based in Washington, D.C.
“There was this idea that women are just small men, so if you extrapolate your results out, then whatever treatment or disease you’re studying, you can apply to the whole population,” Schubert said.
“Now we know that not to be true.”
The latest research shows that men and women often experience the same disease in different ways. For example, it’s well-established that symptoms of heart disease in women are different than they are in men. Female life transitions such as pregnancy and menopause can also affect heart health.
Treatments may also work better for one sex compared with another or have different side effects. In addition, some conditions such as Alzheimer’s disease and rheumatoid arthritis affect women in far greater numbers than men.
How gender makes a difference
Gender differences affect just about every medical specialty. Take neurology, for example.
Women are four times more likely to have migraines and eight times more likely to have cluster headaches compared with men, said Megan Donnelly, head of women’s neurology at Novant.
Women’s headaches are often related to hormonal shifts that occur during menstruation or when they get close to menopause, Donnelly said.
“We risk missing things if we don’t think about the sex differences,” she said.
Donnelly said she works closely with the ob-gyns in the Novant women’s center, and they send many pregnant patients down the hall to her clinic. A pregnant woman with a migraine is at greater risk of having a serious underlying issue, Donnelly said.
Sex-specific differences also come into play in sports medicine, said Kendall Bradley, an orthopedic surgeon in Duke Health’s sports medicine department.
The department is developing a female athlete program that will take into account the anatomical and hormonal factors that play a role in the likelihood of injury for women, she said.
“We are not only focusing on the injuries women tend to get more of, like ACL tears, but we are also looking at having a multidisciplinary team that addresses all facets of women’s heath related to sports,” Bradley said. “We have a nutritionist, primary care, sports medicine and a physical therapist whose area of focus is also on women.”
Women: the big health care spenders
Offering a suite of sex-specific specialties in one location is important for capturing female patients who are often pressed for time, said Tina Marsh Dalton, an economist at Wake Forest University who studies health policy. “You can just refer a patient down the hall,” she said.
Health care systems want to attract women because studies show women make 80 to 90 percent of the health care decisions for their families, Dalton said.
Women also spend more on medical care than men over their lifetimes, in large part because they have babies (pregnancy and labor/delivery is care-intensive and expensive) and they live longer.
Of course, the women that health care systems most want to attract are those who can afford care, Brandon said.
So perhaps it’s not surprising that the Novant women’s center and Atrium’s planned cardiology program and sexual health clinic will both be located in Charlotte’s SouthPark area.
“SouthPark is right in the heart of affluent Charlotte,” Brandon said, “so they are targeting women who are in a position to pay for care or who have great health care coverage.”
And the clinics’ proximity to one another also reflects another reality: the fierce competition for patient dollars. Brandon noted that health care systems generally don’t like to let a rival have a monopoly in any one area or specialty.
“It’s certainly the case that where one builds a health care facility, another follows very closely,” he said. “They tend to track each other rather than move into unserved areas.”
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