I’ll start small.
Five years ago, my youngest kid changed their very gendered name to make it tougher to classify them. Nothing else specifically changed (except the thousand changes that turn children into teenagers). I’m sure, though, it changed how others approached and evaluated them.
I liked that.
I thought about it again this summer when my feeds filled with headlines of a one-letter change for one of the most common medical conditions affecting women of reproductive age: PCOS (polycystic ovary syndrome) was renamed PMOS (polyendocrine metabolic ovarian syndrome).
The women living with the condition were the same as they had been the day before—but perhaps a little more hopeful that the way medicine understood them had finally caught up. The new name also asks clinicians to recognize the broader metabolic and endocrine nature of the disease, beyond the ovaries.
Beneath the headlines, another story: More than 22,000 people took over a decade to agree on the PMOS name—a label long known to mislead both clinicians and patients. Meanwhile, seven in ten women living with the condition were dismissed or misdiagnosed, one failed appointment at a time.
The announcement was quick. Developing a shared understanding of what the name represented took much longer. Labels shape what we notice, the questions we ask, the options we consider, and the decisions we make. Ultimately, they determine who gets seen, believed, and valued.
I’ve been a science journalist and a health researcher, so for me, the story surrounding PCOS/PMOS was a rabbit hole worth falling down. After years researching with physicians in neurology and nephrology—fields historically dominated by men—I’m especially interested in the women shaping healthcare.
Consider who actually provides women’s healthcare: Roughly 40% of routine women’s health visits begin in primary care. Most of the nation’s 600,000 nurse practitioners and physician assistants practice there. And these professions—as well as obstetrics and gynecology itself—are overwhelmingly female: about 90% of NPs, two-thirds of PAs and OB-GYNs, and 85% of active OB-GYN residents.
In other words, when we talk about women’s healthcare, we are talking about women caring for women. And, chances are good that if you’re diagnosed with PCOS/PMOS, an NP, PA, or other female healthcare professional will be part of your care team along the way.
Which led me to connect a few more dots: While medicine was celebrating the power of renaming a disease to improve how women are understood and treated, another decision was redefining the professionals who provide much of that care. Shortly before the PCOS/PMOS news hit, the Department of Education had reclassified NP and PA programs as non-professional, intentionally cutting students’ tuition borrowing capacity in half. (A judge has since temporarily stayed the order.)
Educational funding shapes who enters a profession. Fewer students able to afford NP and PA programs today means fewer clinicians available to care for patients tomorrow. Meanwhile, the number of primary care physicians is shrinking, and there is a shortage of OB-GYNs. Maternity care deserts are an actual thing. Yet here we are.
It is striking (but not shocking) that the same government that allows NPs and PAs to prescribe Schedule II controlled substances, formulate differential diagnoses, order and interpret diagnostics, manage chronic disease, and perform medical procedures has also put up a clear barrier to the education needed to do those very things.
A label by any other name
My kid’s name didn’t change who they are. The PCOS/PMOS name change didn’t alter core diagnostic criteria or treatment. Both represent a reframing that opens new possibilities.
It works in reverse, too. Reclassifying NPs and PAs didn’t make them less educated. But it did change their relative importance by influencing who gets funded, who gets trained, and—eventually—who is in the room with the patient.
Renaming and reclassifying are mundane, affordable, and remarkably effective ways of reshaping systems.
I have so many questions about what comes next: What happens to patient access when the physician workforce continues to shrink while the clinicians who increasingly fill those gaps become harder to train? Who will care for the patients who make up that 40% of routine women’s health visits? Who will be available to diagnose PMOS, regardless of what it is called?
Most importantly: who cares enough about women’s health to recognize the shape these puzzle pieces are taking—and is prepared to put a hand on the table before another piece is added?
Me.
I want to explore these realities as a journalist, using the approach I know best. I’m seeking the experts—the medical professionals, scientists, and advocacy leaders—to understand the tensions, challenge assumptions, and translate their knowledge and experiences into something people should know.
Firsthand is not another women’s health newsletter tracking funding rounds and founder announcements. I want to share the perspectives of the professionals who treat women—not their life stories or personal calling, but their professional expertise, opinions, and experiences.
I want readers to understand the people and systems shaping women’s healthcare, so when decisions emerge, we are not simply watching. Instead, we know enough to ask better questions, challenge assumptions, and help shape the system.
I see a bigger picture forming, and I hope you do, too. It’s a puzzle I have no interest in putting down anytime soon. This writing adventure is my Wonderland: a sprawling, illogical place I’m exploring indication by indication, learning from the knowledgeable people—NPs, PAs, OB-GYNs, and many others—who understand it best.
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