I recognize that the variety of OB/GYN Hospitalist job characteristics in these studies makes it difficult to compare them. However, it serves to reinforce the fact that what the job a hospitalist actually does depends on where he works and what he’s asked to do.

One common concern among OB/GYN Hospitalists is the difficulty of maintaining a minimum number of procedures in order to maintain privileges and competencies. In my experience, adding a Locum Tenens job to my workload meant that I had to be supervised doing certain procedures. This was because of my small case numbers, especially in GYN.  OBs worry that they will not be able to switch jobs if their case lists dwindle.


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I have also heard OB/GYN Hospitalists express concern about appropriate outpatient follow up.  Are we solely hospital workers, or do we have a responsibility to manage certain patients as outpatients? Follow up of patients seen in the emergency department, such as ectopic pregnancies or pregnancies of unknown location, should ideally be sent to a private physician. However, because of insurance issues and scheduling issues, this is often difficult for an OB/GYN Hospitalist to accomplish — especially if he has no office in which to see patients.

On a personal note, I enjoy working in a hospital and not having an office. My shift work allows me some flexibility so that I am able to participate in family activities, and I feel that I am paid adequately for my time.

Still, problems do remain. Many private OBs are reluctant to embrace this model, and for good reasons. Poor communication and handing off of patients is an ongoing problem. While I love most of the people I work with, there are a few who tend to take advantage of my availability. (Medical hospitalists also complain about this.) I am often told what to do and who to admit. And many of the patients I’m given are underinsured and difficult to treat.

There also seems to be more business on weekends and at night. I work part-time, yet I have a disproportionate number of weekend and holiday shifts. While 12-hour shifts are ideal, 24-hour shifts (or longer) are the norm — which undermines the goal of reducing physician fatigue. When I am called to see patients emergently, I do not have any prior relationship with them. They are often in an emergent, stressful situation, not an ideal basis to establish trust. During my shifts, I am never in control of my time, which patients I see, nor whether they are transfers or admissions. Sometimes I am tacitly asked to absorb medico legal risk for other providers. I am only a generalist— “the hospitalist,” interchangeable with the next person on duty. This seems to me a perfect set-up for potential malpractice claims, rather than a way to prevent them.

Does the hospitalist work model help or hurt obstetrics? The jury is still out on that. It does give us an opportunity to improve obstetrical care, but we should proceed with caution. We need a mechanism to allow for maintenance of skills. We need to keep communication open and improve communication skills. Importantly, hospitalists need to be more fully integrated into the whole medical team and be used less as coverage for weekends, night and holidays. But in the end, I am hopeful that this work model will continue and advance our field — one in which I am excited to be a part of.

References

Metz TD, Allshouse AA, Babcock Gilbert SA, Doyle R, Tong A, Carey JC. Variation in Primary Cesarean Delivery Rates by Individual Physician Within a Single-Hospital Laborist Model. Am J Obstet Gynecol. 2016 Feb 25. doi: 10.1016/j.ajog.2016.01.002. [Epub ahead of print]

Srinivas SK, Small DS, Macheras M, Hsu JY, Caldwell D, Lorch S. Evaluating the Impact of the Laborist Model of Obstetric Care on Maternal and Neonatal Outcomes. Am J Obstet Gynecol. 2016 Aug 13. doi: 10.1016/j.ajog.2016.08.007. [Epub ahead of print]

Yee LM, Liu LY, Grobman WA. Obstetrician Call Schedule and Obstetric Outcomes Among Women Eligible for a Trial of Labor After Cesarean. Am J Obstet Gynecol. 2016 Aug 30. doi: 10.1016/j.ajog.2016.08.032. [Epub ahead of print]

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