Here are some tips for consultants in the OBGYN field.
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Hospitals and their doctors request consultants for a variety of reasons, but OBGYN hospitalist related consultations are usually more specific.
Most requests originate from a hospital that is experiencing a series of bad outcomes in labor and delivery, which has led to malpractice events, or because local ob gyn doctors are stressed out and are looking for relief.
Sometimes these obgyn doctors learn of OBGYN hospitalist solutions while they are attending continuing medical education conferences.
The main reason either hospitals, a hospitalist company, an OB hospitalist group, or local obgyn physicians start an OBGYN hospitalist program is because it makes it safer for women in labor.
However, it also has the benefit of improving the work life balance for the private OBGYN’s as well as family practitioners and midwives who do deliveries.
Imagine being on call but yet able to sign out your responsibilities for a few hours in order to attend your child’s birthday party. This is just one example where obgyn hospitalists come into the scene.
Patients benefit because there is an experienced board-certified OBGYN physically present in the hospital to respond to an emergency and be available while their private practitioner is on the way into the hospital.
Patients are seen more rapidly for evaluation and studies show that the hospital experiences a reduced cesarean section rate.
In many hospitals, the OBGYN hospitalist also sees gynecologic emergencies in the main ED with the same rapid evaluation.
So although the reasons can vary for a doctor or hospital to request a consultation with a hospitalist about designing or enhancing a hospitalist program, it usually boils down to better patient safety and overall improvements for physicians and nurses and midwives.
If you have any questions or need to request Dr Olson for a consultation please contact Rob.
OBGYN hospitalists are generally board-certified obstetrician-gynecologists who focus their practice on hospitalized women and generally do not have an outpatient office. Hospitals hire them for several reasons but the most important is for safety. Especially in obstetrics, the clinical situation can change so rapidly that unless a physician is actually in labor and delivery to respond on an emergency basis there can be a bad outcome for mother or baby or both.
Just like the rapid penetration of internal medicine hospitalists, OBGYN hospitalist programs are spreading. Although a few programs have been around for many years, in 2007 there were only approximately 15 in the United States, and currently there are over 244 with two to six new programs starting up monthly. It certainly is not standard of care yet but I’m predicting it will become standard of care within three to five years. Some people use the word Laborist, but a better term is OBGYN hospitalist for those programs in which there is responsibility not only of labor and delivery, but also of gynecologic emergencies in the main ED (Emergency Department). OB hospitalists only stay in labor and delivery and the private OBGYNs staff the main ED.
Financially speaking, almost all programs lose money. Depending on the volume, that loss can be between $1-$200,000 or up to 1 million dollars. Roughly, a program costs $1.5 million and the income it generates can bring in $500-$750,000 a year. Hospitals with 2000 deliveries or more have a lower amount of loss. It is important to look at a wider budget rather than simply profit or loss because:
Many hospitals help pay for the program by transforming their outpatient OB triage areas into OB emergency department (OB ED). This increases the facility fee for evaluation substantially.
Many hospitals are facing the same problems:
An OBGYN hospitalist can help with all of these issues, making the private practitioners happy by taking the call, caring for the unassigned and high-risk patients, consulting for the family practitioners and midwives, evaluating patients promptly, working collaboratively with the MFM specialist, encouraging VBAC by taking responsibility while the private practitioners stay in their office, and studies prove that having professional full-time OBGYN hospitalists reduces the C-section rate.
There are no great downsides other than the direct costs to the hospital. Initially the private practitioners are skeptical, but within a few months they become the program’s biggest fans. Patients are satisfied and studies prove this. Nurses are supported and empowered. It can become a very important competitive advantage for a hospital that has a nearby competing hospital.
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
What do you get when you put 83 enthusiastic ob.gyn. hospitalists, generalists, and administrators together in one big conference room in Denver? You get a lot of fun and great, relevant clinical information essential for hospitalists working all across the country today.
Even though I’ve been an ob.gyn. for 35 years and a hospitalist for the last 5, this annual clinical meeting [SOGH – Society of OB/GYN Hospitalists] taught me new business and clinical information. As our model of practice develops, we also can learn much from each other, and this annual event allows us to meet face-to-face to discuss our common problems, share workable solutions, and socialize.
Here were some of the meeting highlights for me:
Dr. Richard Porreco of Rocky Mountain Hospital for Children, Denver, reminded me to respect the condition of placenta percreta, and his expert advice on ways to deal with it was invaluable. He also reviewed peripartum intensive care and discussed the possible future roles for ob.gyn. hospitalists in leading critical care of these patients.
Dr. John Hobbins of the University of Colorado, Denver, explained the use of sonography in labor and delivery, an area that we will all need to pay attention to in the near future. Personally, I only use ultrasound in triage and to identify fetal position in labor, but he showed some of the benefits of using it to assist prior to operative delivery.
Darrell Ranum, J.D., regional vice president of patient safety for The Doctors Company in Columbus, Ohio, covered the factors that result in the delay in treatment of fetal heart rate abnormalities. His conclusion was that communication issues and the delay in the arrival of the physician can both be alleviated by having an ob.gyn. hospitalist on-site. This is something that we still need more data to prove, but his closed claims data was convincing.
Dr. Arthur Townsend spoke about the importance of hospitalist statistics. Collecting statistics is difficult, and hospitalists may not see the benefits. However, Dr. Townsend demonstrated how to make gathering statistics easier with his Web-based solution and the value in doing so, which we need to embrace to prove the difference we make as hospitalists.
Ob Hospitalist Group hosted the lunchtime lecture by Miranda Klassen on amniotic fluid embolism. Miranda, who founded the Amniotic Embolism Foundation (afesupport.org), is not only a survivor, she has made it her mission to educate physicians to identify and rapidly respond to this potentially fatal and often misdiagnosed condition. This was very worthwhile reviewing.
Dr. Stan Davis of Edina, Minn., spoke about the human factors in labor and delivery. He was able to communicate the TeamSTEPPS system in a concise and effective way that made it easier to understand and more relevant for me than all the other times I’ve been exposed to this complex subject.
Dr. John Nelson (nelsonflores.com), cofounder of the Society of Hospital Medicine (hospitalmedicine.org), spoke about starting and operating a professional society, and lessons learned from medical hospitalists so that, hopefully, we can avoid their early missteps.
Prior to the conference, 56 ob.gyns. participated in The Doctors Company’s highly specialized emergency obstetric simulation workshop. One of the highlights of this workshop was the attendance of Professor Christopher B. Lynch, who flew in from the United Kingdom to personally demonstrate his B-Lynch suture technique for the control of postpartum hemorrhage. In addition, GE sponsored a concurrent hands-on ultrasound in labor and delivery course with live models. It was a fantastic mix of learning and practicing old and new skills.
Questcare hosted a welcome reception, which gave attendees an informal chance to meet and discuss problems and solutions related to being hospitalists. This also gave general ob.gyns. who aspire to be hospitalists a chance to ask seasoned hospitalists about their experiences. This is what the annual meeting was all about: networking, talking with peers, and knowing that we are not alone out there practicing this new model of ob.gyn. medicine.
SOGH will hold its third annual clinical meeting in Denver from Sept. 19 to Sept. 21, 2013. Save the date to come and learn more about both the clinical and the business aspects of being an ob.gyn. hospitalist.
Originally posted NOVEMBER 20, 2012 on ehospitalistnews.com
Soon after I became an ob.gyn. hospitalist, I became one of its biggest and most vocal proponents. I started a website, ObGynHospitalist.com [now ObGynHospitalistConsulting.com], set about learning and educating myself, and eventually became a consultant on establishing different ob.gyn. hospitalist programs around the country.
Through this experience, it quickly became clear which things worked well and which things did not. It also became immediately obvious that every hospital has different needs and problems, and every hospital needs a tailor-made ob.gyn. hospitalist. Fortunately, the hospitalist model is flexible and can adapt to each unique hospital setting.
In a fledgling subspecialty, with hospital corporations investing significant amounts of funding to start ob.gyn. hospitalist programs, there isn’t time (or money) to waste on pursuing the things that didn’t work. It is expected that, even though it’s a new program, it should work well almost immediately. Increased safety, better outcomes, and the elimination of unattended deliveries are immediate results when a program is implemented. What take longer to demonstrate are the benefits to the private obstetricians. But 3-6 months after a program starts, they become ob.gyn. hospitalists’ biggest supporters.
There are some basic ingredients I believe must be present in order to lessen the pain of implementing a new ob.gyn. hospitalist program and increase its chances of success.
Hiring the right people is always a challenge – in any industry. It can be even more so for ob.gyn. hospitalist recruitment. The standard is high: The ideal candidate must not only be board certified, but also a seasoned physician who can handle every true emergency, perform difficult operative deliveries, and counsel, advise, and teach older ob.gyns., family physicians, and midwives who may not be practicing up-to-date evidence-based medicine. This is not a job for a rookie.
The team has to be compatible, flexible, and responsible – and egos must be left at the front door. Communication is vital: Smooth handoff rounds conveying all the necessary information are essential. The hospitalist also must have a personality that enables him or her to quickly bond with all patients and their families after handover. Additionally, scheduling needs to be fair and allow call dates to be traded to fit everyone’s schedule.
Not only do the physicians need to keep their teammates and patients happy, they need to keep everyone happy. They need to look at systemwide improvements, listen to concerns, implement standardized protocols, and always encourage best practices. This is where customer service is imperative, and ob.gyn. hospitalists must go out of their way to ask nurses, staff, and physicians the question: “Is there anything I can do to help?”
Hospital Administration Support
Like all other internal medicine and pediatric hospitalist programs, ob.gyn. hospitalist programs need to be subsidized. It takes approximately $1.3-$1.7 million to start a program, and after a year, it is probably only bringing in about $1 million. The financial investment is worth it to the hospital because it results in better outcomes that lead to lower malpractice costs, as well as happier private physicians. Higher satisfaction in labor and delivery helps with recruitment and retention of nurses and physicians alike. It is also a marketable, competitive advantage that the hospital can use to attract more patients.
Whatever form a local ob.gyn. hospitalist program takes, these four common factors are essential to its foundation. The program must be flexible enough to meet unique local needs while still adhering to proven elements that ensure success.
Originally posted on JUNE 13, 2012 at ehospitalistnews.com
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
The only difference between ob.gyn. hospitalists and general ob.gyns. is work location, right? We all undergo the same residency training, pass the same boards to become board certified, and you have to be a general ob.gyn. to become a hospitalist after all. So, in one sense, there are no differences.
In addition to clinical skills, however, hospitalists do differ. As I outlined in my column “Ob.Gyn. Hospitalist Character Traits,” a hospitalist must be a seasoned professional and a team player, be willing to serve, inspire trust, be a good communicator, and be trained and incentivized to implement system-wide improvements.
Along with character traits, it is generally acknowledged that ob.gyn. hospitalists possess a specific set of core competencies. I began trying to formally define these during my first American College of Obstetricians and Gynecologists annual clinical meeting (ACM) clinical seminar in 2010.
Dr. Bob Fagnant expanded on the initial ideas in a presentation at the second Ob.Gyn. Hospitalists’ special interest group meeting at the 2011 ACOG ACM in Washington, D.C. His presentation was well received, drew much interest from a large audience, and has initiated discussion that continues. The Society of Ob.Gyn. Hospitalists (SOGH) also has dedicated itself to defining the core competencies, but as this is such a new model of ob.gyn. practice, there is much yet to be debated, and discussion should be expected and encouraged.
As stated above, the ideal hospitalist should be a seasoned professional. ObGynHospitalistConsulting.com employment surveys from the past 2 years showed that only 7% of ob.gyn. hospitalists started hospitalist work within 5 years of completing their residency. I think all of us agree that it is very difficult for a new residency graduate to acquire the skills and experience to step in and perform as a hospitalist. Not to say that it’s impossible, just very difficult in light of most residency volumes combined with residency hour restrictions.
One idea that I have heard several academic centers beginning to discuss is that of a fellowship for ob.gyn. hospitalists. Advanced training in a fellowship could provide more experience for new graduates, but it would be especially helpful for experienced, board-certified ob.gyn. hospitalists to hone not only their clinical skills, but also learn the administrative, simulation teaching, team leadership, and information management skills to take existing hospitalist programs from good to great and to start new programs at the highest skill level.
This idea is in its infancy and faces obstacles. Most experienced ob.gyns. may be unwilling to leave their current private practice positions and return to the lifestyle, hours, and, especially, the payoff of a fellow. However, there may be creative solutions similar to executive MBA programs, such as online learning, reviewing curricula designed by the academic center, and periodically traveling to the center for weekends or more prolonged times for the hands-on clinical training and experience portion over a year or two. Introduction of a new additional program needs to be handled carefully because such a program for hospitalists cannot reduce or take away from the clinical training experience of current residents and maternal-fetal medicine fellows.
Like the development of the core competencies necessary for ob.gyn. hospitalists, it will be fascinating to watch the development of academic programs for ob.gyn. hospitalist fellows. It will be exciting to see the first graduates and even more exciting to see the first board-certified ob.gyn. hospitalist in a new subspecialty. Will an old hospitalist like me get grandfathered in if I can pass the new (yet to be determined) American Board of Obstetricians and Gynecologists’ board certification for ob.gyn. hospitalists?
We are lucky to have the SOGH in a position to hear discussion and debate and to advocate for commonly agreed-upon positions. There are so many questions to answer to define the difference between general ob.gyns. and hospitalist ob.gyns., but we are on the cusp of not an evolution in care for women in the hospital, but a revolution. The future is unknown, but the direction from the known is extremely positive. Not only is patient care becoming safer, but the system is becoming safer and more cost efficient while at the same time improving the lifestyle of the general ob.gyn. practitioner. This last sentence will be backed up by data and experience in the near future, I predict.
Originally published JANUARY 18, 2013 for clinicalpsychiatrynews.com
Through my experience as an ob.gyn. hospitalist, it quickly became clear which things work well and which things do not in an ob.gyn. hospitalist program.
Although internal medicine and pediatrics have been using the hospitalist model for quite some time, it is still a model in its infancy for ob.gyn. medicine. With hospitals investing significant amounts of funding to start ob.gyn. hospitalist programs, there is neither time nor money to waste on pursuing the things that don’t work. The expectation is that even though it’s a new program, it should work almost immediately.
Those who have been through the torturous process of establishing, integrating, and/or converting to any new program in any aspect of life know that this is a fairly unrealistic expectation. There are, however, some basic ingredients or attributes that I believe must be present to lessen the pain and increase an ob.gyn. hospitalist program’s chances of success.
The following are some qualities that should be considered when ob.gyn. hospitalist candidates are interviewed:
• A physician who is a seasoned professional. Finding and then hiring the right people are always challenges in any industry, but even more so for ob.gyn. hospitalist recruitment. The best candidates for ob.gyn. hospitalist jobs need to be seasoned board-certified physicians. Not only will they be involved in every true ob.gyn. emergency, but they must also be able to educate and hold their ground against other, sometimes older ob.gyns., family physicians, and midwives who may not be practicing the most up-to-date, evidence-based medicine. This is not a job for a beginner. Physicians with expert clinical skills are essential for a program’s success, as they are the first responders and must be able to deal with or assist in every situation that presents itself.
• A physician who is a team player. The team needs to be flexible and responsible. Smooth handoff rounds, conveying all necessary information, are essential. An outgoing physician needs to introduce the incoming physician to any active patients. Scheduling needs to be fair and allow call dates to be traded to fit everyone’s schedule. Obviously, team members won’t know if they will be compatible until they start working together, but hospitalists must be willing to leave their egos at the door to be “team players.”
• A doctor who is willing to serve. The private practitioner obstetrician needs to keep her own patient happy and safe, whereas ob.gyn. hospitalists need to keep all the patients and all the labor and delivery professionals (and sometimes the gynecology emergency department professionals) safe and happy. Ob.gyn. hospitalists need to go out of their way to ask nurses and physicians the question: Is there anything I can do to help?
One of the great things about being a hospitalist is that the work is so varied, but programs need hospitalists who are willing to help anyone who asks and are comfortable doing so – from the private practitioner who needs a quick ultrasound to determine position, to the OR tech who requires help moving a patient. Some physicians may think these tasks are just scut work, but they are essential to developing a safe, efficient high-reliability organization (HRO) that can avoid catastrophe in a real crisis or emergency.
• A physician who inspires trust. Hospitalists are consistently meeting patients for the first time. They won’t have developed a relationship with patients over the previous months of pregnancy, so ob.gyn. hospitalists need to be able to bond with them and their families quickly. For example, one of the tools I find to be effective when I deal with a mom who has experienced a failed home birth by a lay midwife is this simple phrase: “I know this is not what you planned, but I am so glad that you are here with us so we can take care of you.”
• A doctor who is a good communicator. Hospitalists need to be able to solve problems quickly by using tact, diplomacy, and professionalism at all times. Being involved with emergencies and bad outcomes, they need to be comfortable with debriefing the team and communicating sensitively with patients and families. Highly developed communication skills also extend to documenting the chart and liaising with an absent private practitioner, the nursing team, and the hospital’s administration.
I was one of the original ob.gyn. hospitalists at my community hospital in Bellingham, Wash. Having Dr. Chris Swain’s company, the OB Hospitalist Group, consult helped us to quickly establish a successful new program. Our team of four hospitalists is employed by St. Joseph’s Medical Center. It is a successful program that I’m proud to say encompasses these aforementioned ingredients: We smoothly integrate our scheduling and handoffs; the local obstetricians, family practitioners, and midwives trust us and appreciate our work; and we regularly foster open communication by attending the nurses’ handoff meetings as well as huddling with the anesthesiologist and nurse team leader.
Originally published SEPTEMBER 25, 2012 for ehospitalistnews.com