SAN FRANCISCO — The hospitalist movement is now poised to deliver results in the field of obstetrics.
Ten U.S. hospital systems have started or are about to start using “laborists”—physicians whose sole focus is managing the patient in labor—Louis Weinstein, M.D., reported at the annual meeting of the American College of Obstetricians and Gynecologists.
Laborists are expected to improve patient care and ease burnout among obstetricians, said Dr. Weinstein of Jefferson Medical College in Philadelphia.
The laborist profession offers predictable and limited work hours, while offering private ob.gyns. less disruption to their office and operating room schedules.
It also offers women in labor the benefit of prompt, continuous, and efficient care, he said.
Dr. Weinstein said he proposed the laborist model in 2003, modeling it on the rapidly growing hospitalist movement among internists (Am. J. Obstet. Gynecol. 2003;188:310–2). Some criticize the hospitalist movement for disruption of care, but studies have shown a high degree of patient satisfaction, reductions in resource utilization, and good clinical outcomes. Hospitalists report a high level of job satisfaction, a long-term commitment to remaining in the field, and the lowest burnout rates of any medical specialty.
To maintain 7-day, 24-hour coverage by a team of laborists, a hospital would need four physicians, each working four 10.5-hour shifts each week, Dr. Weinstein said.
He reached that estimate by assuming that the laborists would each earn $175,000 per year, and they would be given 1 week of CME time and 3 weeks of vacation annually. The hospital would have to provide a total of 12 weeks' vacation coverage for the time the laborists were away.
Laborists would receive benefits worth 28% of their salaries, and they would be covered under the hospital's liability policy at a cost of about $60,000 per laborist per year. The total annual cost to the hospital would be $1.2 million.
This scenario would make economic sense only in a hospital performing at least 2,000 deliveries per year. If laborists handled half of those deliveries at $1,200 per delivery, that would bring in $1.2 million per year, making the program “revenue neutral” from the hospital's perspective.
But hospitals would come out ahead if the use of laborists improved patient safety such that even one lawsuit were avoided every 5 years, Dr. Weinstein said.
Beyond these economic calculations are the benefits to individual physicians and to the profession of obstetrics and gynecology.
Dr. Weinstein cited studies showing a high rate of burnout among ob.gyns., which he attributed in part to their hectic and unpredictable schedules and to work weeks well in excess of 40 hours.
For the laborist model to succeed, there must be buy-in by the medical staff. “Clearly, if everybody says, 'Well, I'm not going to let the laborist do my deliveries,' then it won't work,” Dr. Weinstein said.
The ideal laborists work hard, respond efficiently but understand that “when it's their time to go [off shift], they go with good handoffs to the next laborist.”