Introducing Two Leaders – OBGYN Hospitalist Field

This month I’d like to introduce you to two leaders in the ob.gyn. hospitalist field.
The first is Dr. Wayne Farley of Questcare Obstetrics, based in Dallas. It currently has ob.gyn. hospitalist programs in Texas, but has recently expanded to Colorado.

Questcare’s first program was established 5 years ago, and in 2008, Dr. Farley stated: “I’m sure the face of our ob.gyn. hospitalist programs will look much different in 2012-2013.” That vision has proven to be very true, and he still believes that Questcare’s programs will continue to evolve with time.

Dr. Wayne Farley

Dr. Farley attributes the program success of Questcare to its focus on the development of perinatal service lines that the facility could not otherwise support. In fact, they have successfully created a variety of these programs for the facilities with which they are currently contracted and hope to expand them in their future contracts.
Questcare Obstetrics is currently expanding perinatal service lines to include high-risk obstetric referral centers. Even more specialized is the Advanced Maternal & Newborn Institute and Specialty Obstetrics Referral Center at Medical City Women’s/Medical City Children’s Hospital in Dallas. This program offers patient-focused outpatient and inpatient care of pregnancies complicated by fetal anomalies and/or chromosomal aberrations.
In addition to high-risk referral centers and specialty clinics, Questcare also has facilitated the development and implementation of a successful maternal transport program.

With this evolutionary change in Questcare’s ob.gyn. hospitalist programs in just 5 years, it should be interesting to see what the next 5 years bring. Questcare Obstetrics is focusing on providing quality ob.gyn. hospitalist programs, while helping expand targeted service lines for its contracted hospitals.

The development of these programs may seem out of the realm of what ob.gyn. hospitalist programs normally bring to a facility, but Questcare’s programs have brought a significant value-added contribution to the hospital without adding to the overall costs of healthcare.

The second person I’d like to introduce is the current president of the Society of OB/GYN Hospitalists (SOGH):

Dr. Karenmarie K. Meyer

Dr. Meyer is a great advocate of the ob.gyn. hospitalist model, and her goals for the fledgling society include defining what an ob.gyn. hospitalist actually is, delineating the criteria for hospitalist core competency; championing patient safety for women in the hospital, emergency department, and in the labor and delivery setting specifically; adding simulation training as part of our core skill set; and documenting our results through research and publications. Dr. Meyer has led significant progress in all of these areas and SOGH has been recognized as an organization whose members will take the lead in determining how ob.gyn. hospital care is provided in the future.

Passionate about the broadening understanding of the model, Dr Meyer recently stated: “Ob.gyn. hospitalists are much more than just an ‘in-house’ doctor available for emergencies. As our membership and visibility continue to increase, others are realizing this as well. Our members are up to date on current management protocols, and our availability to private physicians and their patients has been well recognized in hospitals utilizing our practice model. Our knowledge, consistency, and reliability will continue to define us as the ‘state of the art.’ ”

Dr. Meyer and SOGH are continuing to identify hospitalists’ core competency criteria and how these will be assessed and certified. SOGH also has been asked to help define the core criteria for the first fellowship in an ob.gyn. hospitalist discipline, which is being offered by Dr. Anthony Vintzileos at Stony Brook in N.Y.; the fellowship will be established at Winthrop University Hospital, Mineola, N.Y. The second program will be at the Fountain Valley Regional Hospital associated with the University of California, Irvine.

As the ob.gyn. hospitalist model matures and changes, Dr. Farley’s and Dr. Meyer’s contributions are exciting and are helping to define and drive the future of women’s inpatient care across the country today.

Originally posted MAY 21, 2013 on ehospitalistnews.com

I Love My Job – Hospitalist Job

I love my job.

“Choose a job you love, and you will never have to work a day in your life.” – Confucius
Everyone knows this Confucius quote. Its overuse makes it sound cheesy, unrealistic, and it’s dubious that a Chinese philosopher who died in 479 BC could still be relevant in today’s fast-paced modern world. I am, however, now a believer because I love my job and it doesn’t feel like work. Honestly.

I enjoyed having a solo general ob.gyn. practice and reveled in its multidimensional challenges: running an office, being able to choose my own great staff, developing long-term rewarding relationships with my patients, and doing complex gynecologic surgeries. However, after 28 years, I heard Dr. Lou Weinstein give the first lecture I was aware of at the American College [now American Congress] of Obstetricians and Gynecologists Annual Clinical meeting in 2005 about ob.gyn. hospitalists. I returned home and put my practice up for sale.

I wanted to use my array of skills outside a traditional office setting and reduce my stress levels. To find that elusive work/life balance and influence best practices in obstetric medicine, I needed to find a job that I loved, not merely enjoyed.

Five years ago, I found a second career in which I could do all these things, truly specialize in obstetrics, and hone my clinical skills into a defined purpose: improving patient care and safety. I became an ob.gyn. hospitalist.
Prior to becoming an ob.gyn. hospitalist, my biggest frustration at my private practice was that I constantly had to be in two or three places at once. Balancing this physical impossibility among laboring patients, keeping office appointments, and being required in surgery was my greatest source of stress. Today, my attention is focused solely on labor and delivery (L&D). My hospital doesn’t require me cover to emergency department gynecology, which I believe is safer for the patients because, without additional gynecological responsibilities, I am not overextended and can focus all my energy exactly where it is needed. It is safer for women in labor to have me physically present in L&D rather than be in the ER, or worse, in the operating room.

Safety is what drives the whole ob.gyn. hospitalist movement. It is gratifying to see all of the reports of patients “saved” because of the presence of an ob.gyn. hospitalist. (Become a registered ObGynHospitalist.com member to see more than 40 examples of “saves and “near misses” in the Discussion forum under the Clinical Issues tab [or register at our new site here at ObGynHospitalistConsulting.com]). We are working on collecting data to prove this, and the Society of Ob/Gyn Hospitalists (SOGH) has a dedicated Research, Education, and Safety Committee to document what we already anecdotally know.

One of my first “saves” as an ob.gyn. hospitalist came about when a family practitioner was attempting to deliver a baby at 2 a.m. and encountered a severe shoulder dystocia he couldn’t resolve. By the time I arrived in the delivery room, it had already been between 2 and 3 minutes. I was fortunate to be able to step in and complete the delivery without harm to either the mother or infant. In contrast, if an on-call obstetrician had been summoned from home, there may have been a very different outcome.

The combination of experience, skills, and, most importantly, my presence in L&D created a positive outcome. This is another reason I love my job: I can truly make an immediate difference just by being there. And that’s not work.

Originally posted MAY 17, 2012 on ehospitalistnews.com

ObGyn Hospitalists 101 – What does a hospitalist do?

The term “hospitalist” is commonly thought of as an internist or pediatrician model. However, in 2003, Dr. Louis Weinstein, professor and former chair of obstetrics and gynecology at Thomas Jefferson University Hospital, Philadelphia, proposed the idea of hospital-based obstetricians primarily to improve patient safety.

While there are various evolving models for what type of care an ob.gyn. hospitalist provides, he or she is generally considered to be a board-certified ob.gyn. who is physically present in the hospital, primarily in labor and delivery, although some programs require coverage of gynecology in the emergency room.

The ob.gyn. hospitalist is there for safety: They cover triage, labor, delivery, and postpartum care for all unassigned patients, as well as for those patients signed out to them by a private practitioner. They commonly assist at cesarean sections, respond to almost all true emergencies, and do consults and operative deliveries for family practitioners and midwives. Frequently, they are asked to stand by for deliveries while the private practitioner makes their way in from home or the office. On request, they also perform procedures such as artificial rupture of members (AROM), bedside ultrasound for position, and insertion of pressure transducer catheters.

While it may be obvious, there is evidence-based data which proves that hospitals with ob.gyn. hospitalists have an increased level of safety, which directly leads to a decrease in bad outcomes and subsequent medical malpractice costs. An excellent example is that an ob.gyn. hospitalist can begin a cesarean section for a prolapsed cord before a private practitioner can be there. When they do arrive, the private practitioner can take over the surgery, and the hospitalist can assist as required or requested.

In addition to clinical work, hospitalists teach, run simulations, and are leaders in implementing systemwide changes that increase patient safety, quality, outcomes, satisfaction, teamwork, and overall departmental improvements. They reduce the problems of fragmented care, may work as perinatology extenders, and are immediately available for any situation that arises.

There also are other unintended benefits of ob.gyn. hospitalists. Clinical decision waiting time is reduced, communication is increased, nurses can obtain immediate evaluations and recommendations, and hospital administrators can use them as a tool for marketing to patients as well as recruiting and retaining physicians and nurses.

Ob.gyn. hospitalists also facilitate an improved personal-professional lifestyle balance for general ob.gyns. and family physicians. Ob.gyn. hospitalists allow them to stay in the office or surgery when needed or sign out patients when fatigued or when they simply wish to take a vacation.

I have been an ob.gyn. hospitalist since leaving my solo general ob.gyn. practice in 2007. At that time, I could only identify 10-12 programs within an emerging ob.gyn. hospitalist subspecialty. Now there are over 150 programs across the United States, with one to two new programs emerging each month. My website, ObGynHospitalist.com, was established to provide a professional resource for ob.gyn. hospitalists, where over 800 registered members can access new opportunities, and a forum to exchange ideas and discuss all aspects of our fledgling subspecialty.

In September 2011, the nonprofit Society of Ob/Gyn Hospitalists (SOGH) was established. It now has over 60 paid members, and I am honored to be its founding president.

What Does a Typical ObGyn Hospitalist Look Like?

One of the reasons I started up my website, ObGynHospitalist.com, was to connect with other ob.gyn. hospitalists that I knew were out there. I wanted to know if they were experiencing the same challenges I was, what their program model looked like, if they were part time or full time, and what their pay and benefits were.
As the website membership grew, it was a logical step to ask members these questions directly.

The first Salary and Employment Survey was sent out in 2011 and had 106 respondents. This year, our third survey had 313 respondents and allowed us to clearly see consistent trends, particularly in ob.gyn. hospitalists’ experience levels, the types of shifts we work, and overall pay and benefits for both part time and full timers.

So, what does a typical ob.gyn. hospitalist look like? Our survey tells us that they are mostly male, between 40 and 59 years old, and are at least 6 years post residency.

Most ob.gyn. hospitalists work in hospitals that average more than 1,000 births per year, with most (45%) working in hospitals with 2,001-3,000 deliveries per year and 19% who work in hospitals with more than 4,000 births per year.
Most describe their primary practice activity as obstetrics with emergency department coverage including emergency gynecologic surgery and inpatient gynecologic consultations. They work full time and have had no change in their employment status over the last 12 months.

The most common full-time work schedule is exclusively 24-hour shifts. Those full-time hospitalists who don’t work 24-hour shifts mostly work 12-hour shifts and are happy with this arrangement.

Ob.gyn. hospitalists are “very satisfied” with their career, variety of work, management, recognition, and professional relationships.

Most work with other ob.gyns. and maternal-fetal medicine physicians only rather than with family practitioners or midwives. Half work as perinatology extenders doing some or most of their deliveries and half use perinatologists only as a consultant, like a private practitioner would.

The majority have ob.gyn. physicians sign out to them, and a third supervise midwives.

Most full-time and part-time hospitalists are hospital employees and are almost evenly split between receiving an hourly gross wage and a salary.

The most common full-time hourly rate (41% in 2012 and 34% in 2013) is $101-$110/hour; 4.5% earn more than $140/hour. Most part-time hospitalists earn less per hour than do full-time hospitalists, with an hourly rate of $91-$100/hour.

The most common full-time salary range (31%) is between $224,000 and $249,000; 4.7% earned between $325,000 and $349,999. The most common part-time salary range is less than $150,000. About 40% of full-time salaried physicians receive incentive compensation based on quality, not production.

A third of respondents stated that they need more physicians in their hospitalist program and that they do not have an adequate emergency backup call system in place. This is an important area for safety, and all programs should address the solution of emergency backup for the hospitalist.

It’s exciting to have this information, not only to know what experience our fellow ob.gyn. hospitalists around the country have, but also it’s interesting to know how other programs are structured, what responsibilities are commonplace, and how our salary and benefits compare with our general ob.gyn. colleagues. The 2013 report can be viewed at ObGynHospitalist.com/news, where you can also find previous survey reports, too.

More Than Just a Job – My Job as an OBGYN Hospitalist

It’s bittersweet that this will be my last column, but I appreciate the opportunity that this news organization [ehospitalistnews.com] has given to me, and it’s been an honor to share my thoughts about the new ob.gyn. hospitalist model, how it is changing our profession, and the future that lies ahead.

This is an exciting time to be in this rapidly evolving field because this is a new way of delivering health care to women by utilizing board-certified ob.gyns. who are physically present in the hospital. Their presence has led to proven increases in patient safety, a demonstrable reduction in bad outcomes, as well as decreased malpractice costs.

Additionally, programs not only lead to increased lifestyle satisfaction for hospitalists, but contribute to reducing private ob.gyns.’ stress and conflict of needing to be in the office and the labor and delivery department.Although hospital administrators have to pay the considerable gap between the costs of these programs and the amount of billing provided to the hospital by the work the physician hospitalists perform, administrators also are very satisfied. This can be seen by the veritable explosion of new hospitalist programs across the United States. When I began my career as a hospitalist in 2007, I could only find 15 programs, and now there are 200 nationally.

If I speculate and try to imagine 3-5 years in the future, I think there will be ob.gyn. hospitalists in at least 75% of all hospitals delivering 2,000 or more babies per year. That means there will be at least 102 programs employing approximately 612 (6 × 102) hospitalists.

For those of you considering this opportunity, it is a chance to reduce your work hours by moving to hourly shifts instead of days in the office and nights on call. You can have a good salary while having a life outside of medicine as well. You can hone your clinical skills by concentrating on obstetrics and perhaps emergency gynecology cases as you learn to work in teams; implement systemwide improvement; and have a greater emphasis and potential impact on patient outcomes, satisfaction, and quality.

It is a profession and not just a job. It is one of which I’m proud and love to do. I am convinced that having ob.gyn. hospitalists makes it safer for women. It is an opportunity to get in at the ground floor and help influence our profession’s newest model of care that is changing women’s inpatient care in this country right now and for many years to come.

Originally posted JUNE 20, 2013 on ehospitalistnews.com