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:
- Bad outcomes lead to malpractice costs
- Hospitalists can increase the volume of high-risk pregnancies that can help to fill up the neonatal ICU, which can be a profit center for hospital
- Retention and recruitment of not only physicians but of the expensive-to-train labor and delivery nurses
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:
- OBGYNs do not want to take call
- There are unassigned patients
- There may be midwives and family practitioners doing deliveries without backup
- No one wants to accept the transfer of high-risk patients
- Patients wait a long time for evaluation
- Maternal Fetal Medicine specialists want to do an outpatient practice only and not come to the hospital
- No one wants to do vaginal births after cesarean section (VBACs)
- The cesarean section rate is too high
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.