The Most Overlooked Bet in Women’s Health Is the Doctor

Monarch co-founder and CEO Anna Lohrfink on what women's health physicians told her, why a volume-based system leaves them no time, and why she thinks investors are underpricing doctors.

Before Monarch existed, Anna Lohrfink interviewed about 100 women in midlife about their healthcare.

She asked what they had been through and where they had gone for help, and most of them told her the same story.

Perimenopause had hit harder than they expected. "It wasn't just like, oh, I had hot flashes. It was like, this threatened my marriage, or I left my career, my 30-year career," she said.

Many went to their doctors and left without the care they needed. "I felt ignored. I felt dismissed. I felt rushed through the appointment," Lohrfink said, describing what women told her. Some saw several providers and had the same visit each time.

Then she interviewed the doctors.

"We asked the question, what's going on with doctors?" she said. "Most of them get into medicine because they want to take care of people. They know how to provide good care. They're good doctors. They care about their patients."

The women's health physicians she spoke with described the same appointment from the other side of the exam table. "We don't have time to provide that type of care. We're rushed through our appointments. We're forced to see 30, 40 patients in a day," she said, recounting what they told her.

"That was the moment when we said, oh, this is a problem with the model."

The doctors already knew what their patients needed, she said. "A lot of the times they're so frustrated because they know what their patients need and they cannot give it to them because of the economic model that they're practicing in."

Monarch helps women's health physicians leave high-volume, insurance-billed practice and reopen as independent membership practices. It began transitioning its first practice at the end of 2024 and now counts 10 practices in six states, according to Lohrfink, three in California, two each in Texas and Florida, and one each in New York, Michigan and South Carolina. Monarch puts up the capital, takes no equity and charges physicians a fee for its services. Each practice sets its own membership price, which Monarch told MedCity News at its June 2025 launch typically ran $300 to $550 a month.

Lohrfink believes the doctor is the most underpriced part of midlife care.

A team at the University of Chicago tried to measure how much time good care takes.

Justin Porter and colleagues built a simulated panel of 2,500 adult patients and added up the hours a primary care physician would need to deliver every recommended preventive, chronic and acute service. Their answer, published in the Journal of General Internal Medicine, was 26.7 hours a day.

The estimate is based on guidelines, not real workdays, and it covers primary care, not gynecology. When the model spread the work across a care team, the physician's share fell to 9.3 hours.

Actual visits run far shorter than an hour. Hannah Neprash and colleagues at the University of Minnesota analyzed more than 8 million primary care visits from 2017 and found the median physician averaged 18.9 minutes with each patient, according to their 2023 study in JAMA Health Forum.

"It's really all about volume," Lohrfink said. "As long as we have a volume-based system where physicians have to do more, test more, get through more appointments in order to make the economics work, there just isn't going to be enough time to provide this type of care."

OB-GYNs are among the most burned out doctors in the country. In the American Medical Association's 2025 national comparison report, 45.7% of them reported at least one symptom of burnout, compared with 41.9% across all specialties. In the same survey, 31.1% of physicians said they were at least moderately likely to leave their organization within two years. The nearly 19,000 responses came from 106 health systems and organizations that chose to survey with the AMA, so the sample is not random.

Fewer physicians own their practices, too. According to the AMA's Physician Practice Benchmark Survey, the share of US physicians working in practices wholly owned by physicians fell from 60.1% in 2012 to 42.2% in 2024.

Lohrfink, who worked in asset management at J.P. Morgan before Monarch, said the no-equity structure was a response to that shift.

"There are a lot of forces in healthcare right now making it very difficult for physicians to own their own practices and to remain autonomous and independent," she said. "Having clinical autonomy is not a barrier. That's actually an important piece of the puzzle."

On the patient side, most women with symptoms never reach an appointment at all. A Mayo Clinic study led by endocrinologist Ekta Kapoor and published in Mayo Clinic Proceedings in October 2025 surveyed nearly 5,000 women aged 45 to 60 at four Mayo primary care sites. More than 80% had not sought care for their menopause symptoms, and about one in four was receiving any treatment. Every respondent came from one health system and reported her own symptoms, so the figures describe that group, not all US women.

The Luteal reported in August that insurance pays for menopause care at two moments, when a woman sees a clinician and when she fills a prescription. Monarch's model sits outside both.

Converting takes most of a year. Monarch says a physician first goes through a mutual evaluation of a couple of months, in which the company studies whether the doctor's existing patients are likely to follow into a membership. Over roughly six months after that, Monarch handles the office build-out, equipment, records system, staff training and outreach to patients. Physicians can also join clinical programs the company runs with outside specialists, in breast health with OB-GYN Corinne Menn, in midlife sleep with sleep physician Andrea Matsumura and in weight care.

"We're their business partners," Lohrfink said. "They know how to provide the clinical care better than we ever could."

In March the company said Suzanne Gilberg, a Beverly Hills OB-GYN who is also Monarch's co-founder and chief clinical officer, had cut her schedule from more than 25 patients a day to about 8, with a 91% average member renewal rate. Those figures come from one practice and do not include a member count. Monarch has not published outcomes data yet, and Lohrfink said an outcomes report is in progress.

What surprised her most was what the switch did for the physicians. Many had been seriously considering leaving medicine, she said.

"It's more than admin burnout," she said. "The soul friction that comes from not being able to deliver the care that they wanted to their patients and that they knew they were capable of giving."

Some now tell her the move kept them practicing. "A lot of them will say, this has kept me in medicine longer than I would have stayed, and it's made me remember why I went to medical school," she said.

Monarch's materials put the average visit at 45 minutes or more. Lohrfink said a typical visit runs an hour, and some physicians book 90 minutes for annual visits.

Part of that hour goes to symptoms, which take trial and adjustment. The part she thinks gets overlooked is prevention.

"Women have two major hormonal transitions in our life," she said. "Men just have one. They just have puberty. We have puberty and menopause, and this major hormonal transition is a window of opportunity for women to either get ahead of things and lay the groundwork for really great healthspan and longevity and quality of life for the next few decades, or to fall behind."

The American Heart Association made a similar argument in a 2020 scientific statement in Circulation led by Samar El Khoudary of the University of Pittsburgh. It found cardiovascular risk rises faster during the menopause transition and called midlife a critical window for early prevention. Cardiovascular disease is the leading cause of death in women, the statement notes. Much of the evidence behind it is observational, and its authors called for more trials in women going through the transition.

Heart disease is where Lohrfink thinks a doctor's time matters most. "Heart disease shows up differently in women than it does in men, but a lot of our screening and diagnostic tools, what we look for, how we look for heart disease in this country was designed for men," she said. "So because it shows up differently in women, we miss it all the time."

Patients reacted in a way she did not expect. When Monarch physicians announced the switch, patients signed up, and some congratulated their doctors.

"I'm happy for you and I wish more doctors would do this," Lohrfink said, describing what patients told physicians. "They've tried to get this care through insurance and they can't, so they know that there needs to be a different model."

Medicare's own rates show why the hour is hard to fund. Since 2021, physicians can bill an office visit by the total time they spend on it that day. Under the 2026 fee schedule, a visit of at least 20 minutes with an established patient pays $95.19 nationally, and a visit of at least 40 minutes pays $192.39. Medicare adds nothing more until the visit passes 68 minutes.

By The Luteal's math, three 20-minute visits bring in $285.57, about 48% more than one hour with the same patient. The figures are national Medicare rates before geographic adjustment, private insurers set their own, and a gynecology visit can include other billable services. The incentive still points toward the shorter visit.

Monarch's model moves who pays for the hour and how many women each doctor sees. Members pay the practice directly, $3,600 to $6,600 a year based on the range Monarch gave at launch. Gilberg now sees roughly two thirds fewer patients a day.

Each converted physician gives longer visits to fewer women who can afford them. Reaching more women would take an employer or insurer willing to pay for the hour, and outcomes data is the first thing a payer asks for.

Lohrfink was careful about who funds Monarch, too. "Our primary investors are family offices and individuals who are former healthcare operators," she said. "We have a few VC partners, but it's really family offices and individuals, and there's just a different set of expectations and incentives."

When asked what investors are underpricing in midlife care heading into 2027, she answered in one word, then said it again.

"Doctors."

Medicare pays about 48% more for three short visits than for one long one, and 45.7% of OB-GYNs report burnout.

The appointment is still built for volume.

Midlife care still takes an hour.

Lohrfink is betting that the way to give women more time is to give it to their doctors first.

The Luteal covers the business, science and policy of women's health. Nothing here is medical advice. Monarch's figures and plans are company-stated.

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Sources

Porter J, Boyd C, Skandari MR, Laiteerapong N. "Revisiting the Time Needed to Provide Adult Primary Care." Journal of General Internal Medicine 2023;38(1):147–155 (online July 2022). Simulated panel of 2,500 adults based on NHANES 2017–2018; 26.7 hours a day, 9.3 with team-based care. Primary. https://pubmed.ncbi.nlm.nih.gov/35776372/ Neprash HT, Mulcahy JF, Cross DA, et al. "Association of Primary Care Visit Length With Potentially Inappropriate Prescribing." JAMA Health Forum 2023;4(3):e230052. 8,119,161 primary care visits, 8,091 physicians, calendar year 2017; median physician average 18.9 minutes per patient. Primary. Interview with Anna Lohrfink, co-founder and CEO, Monarch, October 20, 2026, arranged by JBC PR. Quotes verbatim with filler words removed. Practice count, state breakdown, visit length, transition timeline, clinical programs, physician retention accounts and investor mix are company-stated. American Medical Association, 2025 national physician comparison report (Organizational Biopsy), press release April 2026. Nearly 19,000 physician responses, 38 states, 106 participating health systems and organizations; burnout 41.9% overall, 45.7% obstetrics and gynecology. Primary; opt-in organizational sample. https://www.ama-assn.org/press-center/ama-press-releases/ama-physician-burnout-rates-are-falling-specialty-gaps-remain American Medical Association, "Physicians in these 10 specialties are less likely to quit," May 14, 2026. 31.1% of physicians reported a definite, likely or moderate likelihood of leaving their current organization within two years; same 2025 sample. Primary. https://www.ama-assn.org/practice-management/physician-health/physicians-these-10-specialties-are-less-likely-quit American Medical Association, Physician Practice Benchmark Survey 2024, and Kane CK, "Physician Practice Characteristics in 2024," Policy Research Perspectives, May 29, 2025. Private practice share 60.1% (2012) to 42.2% (2024); physicians providing at least 20 hours a week of patient care, non-federal. Primary. https://www.ama-assn.org/about/research/physician-practice-benchmark-survey Kapoor E, et al. Survey of nearly 5,000 women aged 45 to 60 at four Mayo Clinic primary care sites. Mayo Clinic Proceedings, October 28, 2025. More than 80% had not sought care for menopause symptoms; about 1 in 4 receiving treatment. Primary, via Mayo Clinic News Network release, October 29, 2025. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-study-finds-majority-of-midlife-women-with-menopause-symptoms-do-not-seek-care/ El Khoudary SR, Aggarwal B, Beckie TM, et al. "Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. A Scientific Statement From the American Heart Association." Circulation 2020;142:e506–e532. Primary. Monarch, "Monarch Expands Nationwide Footprint, Names Anna Lohrfink CEO Amid Rapid Physician Adoption," Business Wire, March 24, 2026. Gilberg patient load and 91% average member renewal. Company-stated. https://www.businesswire.com/news/home/20260324940960/en Monarch, Lotus Gynecology launch release, September 2, 2026. Average visit of 45 minutes or more; upfront capital; Suzanne Gilberg as co-founder and chief clinical officer. Company-stated. Plescia M. "Startup Launches to Help Women's Health Providers Build Independent Practices." MedCity News, June 10, 2025. Membership fees typically $300 to $550 a month set by each practice; Monarch takes no equity and charges physicians a fee. Secondary, company statements. https://medcitynews.com/2025/06/women-health-independent-practices/ Centers for Medicare & Medicaid Services, CY 2026 Physician Fee Schedule final rule, November 2025. Conversion factor $33.4009 (non-qualifying APM); time-based E/M services excluded from the efficiency adjustment. Primary, conversion factor as reported by Holland & Knight, November 12, 2025. CMS 2026 National Physician Fee Schedule Relative Value File. 99213 total non-facility RVU 2.85 ($95.19); 99215 total non-facility RVU 5.76 ($192.39); national amounts before geographic adjustment. RVUs as reported by FastRVU and PayerPrice from the CMS file, which agree with each other; payment amounts reproduced as RVU times conversion factor. Aggregator-reported. CPT 2021 office visit guidelines (AMA) and CMS CY 2021 final rule. Established patient visits selectable by total time on the date of service, 99213 at 20 minutes, 99215 at 40 minutes; Medicare prolonged service code G2212 billable at 69 minutes for 99215. Primary. The Luteal calculation. Three 99213 visits at $95.19 total $285.57, 48.4% more than one 99215 at $192.39. Membership range $300 to $550 a month annualized to $3,600 to $6,600. Gilberg patient load from 25 to 8 a day is a 68% reduction. Primary (The Luteal's own arithmetic on the sources above). American Academy of Sleep Medicine, Talking Sleep podcast, Andrea Matsumura as national advisor for Monarch MD. Background. The Luteal, menopause billing codes issue, August 18, 2026. Prior coverage.