The Need to Protect the Franchise.
As a sub-genre of romance both Inspirational and Medical romances should meet minimum standards for fulfilling reader expectations. I’ve read 'so-called' Inspirational romances that were simply sweet romances with prayers added in italic every twenty pages or so. If you took out all the italic copy, you’d still have a fine Tender romance. The same goes for Medical romances. I’ve read one where if you changed the hero and heroine from being doctor and nurse to being lawyer and paralegal, you would only need to make a few hundred words of change in the entire novel. Everything else in the novel could remain the same.
The problem here is mis-branding the subgenre books. A reader who tries a subgenre book and finds it no different than a general romance, may not try any other books from that subgenre. This hurts the subgenre franchise. It would be like going into a national fast food chain restaurant for the first time and finding the food and service to be of poor quality. Would you really be likely to give that same franchise a try in a different location?
Here’s my test.
If the inspirational or medical components of the story can be removed and the remaining story still constitutes a viable romance, then it is not a genuine subgenre work.