Hospital-based OB/GYN physicians, commonly referred to as laborists, have become increasingly common in labor and delivery departments throughout the U.S. over the last 10 years.
Hospitals and health systems that have a laborist program offer 24-hour OB/GYN hospitalist coverage on-site seven days a week. Laborists are board-certified physicians who specialize in inpatient OB/GYN care. They can admit patients, perform triage, provide emergency services, manage labor, and deliver babies.
Studies have shown that laborist programs provide benefits for OB/GYN physicians, hospitals and health systems, as well as patients.
Support for general OB/GYNs
Traditional OB/GYN doctors split their time between delivering babies at the hospital and seeing patients in the clinic for general OB/GYN exams and procedures. Doctors often establish a relationship with expecting mothers throughout their pregnancy, and when the baby comes, the doctor is there at the hospital to deliver it.
The traditional OB/GYN role makes for an unpredictable and demanding work schedule. It’s not uncommon for an OB/GYN doctor to be called into the hospital in the middle of the night to deliver a baby only to wake up the next morning to a day full of appointments. Other times OB/GYN doctors will receive a call that their patient is in labor while they are out of town or on vacation.
The laborist model provides needed relief and support for general practice OB/GYNs who practice in one of the more than 197 hospitals that have laborist programs. General practice OB/GYNs can let laborists care for expecting mothers admitted to the hospital when they are busy with office patients, catching up on some sleep following the last delivery, or on vacation. The general practice OB/GYN can then resume care for his or her patient when available.
Some general practice OB/GYNs have decided to delegate all labor and delivery responsibilities to laborists. The outpatient OB/GYN provides prenatal care to expecting mothers, and the laborist manages her hospital stay and delivery. This is an attractive arrangement for general practice OB/GYNs who want to take more control over their schedule and focus on providing outpatient clinical care.
Critics of the laborist model say that hospital-based OB/GYNs do not have the same personal connection with patients that general practice OB/GYNs have. While this is true, Debra Gussman, MD FACOG MBA, writes in an article for The American Congress of Obstetricians and Gynecologists that patients “will accept these covering doctors if the system is presented to them in a positive manner emphasizing patient safety and doctor availability. This requires education, discussion and meticulous attention to model presentation, with voluntary participation and maximum flexibility.”
Furthermore, the fact that laborists are free from the outpatient demands of a traditional OB/GYN practice means they can spend more time at the patient’s bedside.
Laborists are not intended to replace traditional OB/GYNs. Instead, they are available for support in case of emergencies or to cover in for an OB/GYN if his or her patient presents to the hospital when the doctor is unavailable.
Better outcomes for patients
One of the greatest benefits of having a laborist program is that it ensures there is a qualified OB/GYN physician available at all times. According to a statement from The American College of Obstetricians and Gynecologists, having an immediately available, well-rested physician can enhance patient safety and improve outcomes.
A cohort study led by Dr. Sindhu K. Srinivas, an obstetrician-gynecologist at the University of Pennsylvania in Philadelphia, further proved this point. The study found that women who delivered in hospitals that had a laborist program were less likely to have labor induction, preterm birth, medically indicated birth, and spontaneous preterm birth.
A separate study, conducted by medical students at Oregon Health & Science University in Portland, found that employing laborists was associated with an 83% reduction in intrapartum stillbirths, a 17% reduction in cases of major neurodevelopmental injury, and a 13% reduction in neonatal death per year.
In addition to providing better care outcomes for patients, laborists offer additional value to hospitals and health systems by providing additional education and mentorship to nurses and residents. They are also available to treat patients who present to the hospital or health center in labor without an established relationship with an OB/GYN or having received any prenatal care.
Attractive career option
Many general practice OB/ GYNs have expressed interest in becoming laborists, due in part to the stability and predictability the role offers.
Laborists work a set schedule (typically 24-hour or 12-hours shifts), which gives them more control over their hours and guaranteed time off. The ability to control one’s schedule is often associated with greater career satisfaction. A survey conducted by The American Journal of Obstetrics & Gynecology found that career satisfaction among laborists is greater than general practice OB/GYN physicians.
The study also found that there seems to be little consistency with regard to the characteristics of laborist work, including type of environment, the number of deliveries, and the level of compensation. But that may change. The first Annual Clinical Meeting (ACM) of the Society of OB/GYN Hospitalists was held in 2012 and one of the goals of the growing association is to define the OB/GYN Hospitalist role and develop core competencies.
As the OB/GYN hospitalist role continues to grow and evolve, Barton Associates is prepared to help hospitals and health systems staff their laborist program with high quality locum tenens laborists. We are also prepared to help providers find locum tenens OB/GYN hospitalists jobs throughout the country.