New life for old obstetricians

By Rob Olson, MD

In the “olden days,” ob/gyns would drop the ob part of their practice (ie, delivering babies), as soon as possible because of ob’s numerous challenges, among them  long and erratic hours, enormous and expensive malpractice risk, and the fact that the unpredictability of labor and delivery interferes with office hours, scheduled elective surgeries, and any semblance of normal family life. Baby boomer ob/gyns who did not want to stop obstetrics had few options except to assume the high risk, terrible hours, high insurance costs, and stressful lifestyle, or stop doing obstetrics entirely and change to a gynecology practice only. The latter was not a good option for doctors who, like me, love obstetrics.

Today, however, there is another option that gives old obs a new life and second career. A new model of ob care offers a chance for today’s older physicians who are highly experienced and motivated to alter their career paths and avoid “forced” retirement from ob by becoming ob/gyn hospitalists.

Sometimes referred to as “laborists,” ob/gyn hospitalists are experienced, board certified ob/gyns who are physically present in a hospital to respond to all ob and gyn emergencies. They commonly triage all incoming ob patients and are responsible for all unassigned laboring patients. Private ob/gyns who cannot be physically present in the hospital can sign out their patients to the ob hospitalist to monitor or treat as required. OB hospitalists assist with surgeries, do patient rounds, teach, consult, and are immediately available when needed for emergencies.

The medical reasons for this model are straightforward: Immediate treatment or intervention leads to increased patient safety, which in turn can reduce bad outcomes, lessen malpractice situations, shorten hospital stays, and increase patient satisfaction. Hospitalists can also look after high-risk patients as “perinatologist extenders,” helping to augment increasingly scarce maternal-fetal medicine physicians who would traditionally perform this function.

The personal implications for the ob hospitalist are just as exciting. I love delivering babies as a hospitalist, working defined shifts without the responsibility of an office, and honing my clinical ob skills to assist medical personnel and improve the safety of hospitalized women.

Next: Why are ob/gyns burning out?

With change comes resistance-not just from other ob/gyns and family physicians who may be concerned that hospitalists will poach their patients and take their income-but also from nurses, hospital administrators, and patients who may initially regard this new model with caution. The advantages, however, quickly become apparent: Increased maternal and fetal safety; improved quality of life for both ob/gyn hospitalists and private ob/gyns; immediate back-up for family doctors, midwives, and nurses; and system-wide improvement for labor and delivery.

The most recent studies show that full-time ob hospitalist programs are associated with substantial 15% reduction in cesarean delivery rates¹ and a decline in induction of labor and preterm deliveries.² Also the newly established Society of OB/GYN Hospitalists and its committees are working to increase the model’s visibility and acceptance and to prove its legitimacy as the future of ob/gyn care in the United States.

While still in its infancy, and with at least 2000 ob/gyn hospitalists³ in more than 300 programs across the United States, the hospitalist model offers a better quality of life for private ob providers and hospitalists. Importantly, it allows the wealth of knowledge and clinical experience from an older group of physicians to be leveraged rather than lost through early retirement or abandoning ob. It offers boomer-aged ob/gyns a chance at a second, more balanced career that many are racing to take.

References

1. Iriye B. et al. Implementation of a full-time laborist program is associated with a substantial reduction in cesarean section rate. Am J Obstet Gynecol. 2013 Sep;209(3):251.e1-6.

2. Srinivas S et al. Does the laborist model improve obstetric outcomes? SMFM 2013; Abstract 79.

3. Funk C, Anderson BL, Schulkin J, et al. Survey of obstetric and gynecologic hospitalists and laborists. Am J Obstet Gynecol 2010;203:177.e1-4.