Free White Paper—6 Questions Asked by an Actual Hospital Client with Answers

 

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an Actual Hospital Client with Answers

By Dr Rob Olson

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hospitalist consultant

Why do Hospitals Ask for an OBGYN Hospitalist Consulting Visit?

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

The ABCs of OBGYN Hospitalists

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:

  1. Bad outcomes lead to malpractice costs
  2. 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
  3. 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:

  1. OBGYNs do not want to take call
  2. There are unassigned patients
  3. There may be midwives and family practitioners doing deliveries without backup
  4. No one wants to accept the transfer of high-risk patients
  5. Patients wait a long time for evaluation
  6. Maternal Fetal Medicine specialists want to do an outpatient practice only and not come to the hospital
  7. No one wants to do vaginal births after cesarean section (VBACs)
  8. 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.

 

hospitalist jobs

12 Tips for OBGYN Hospitalist Job Contracts

1 The first tip is if you do not ask, then you will not get. Too many physicians accept the “standard” contract, sign it without a careful review, do not ask nor negotiate more favorable terms, and do not pay the $500-$1000 to have an attorney review it.

2 It is harder to get major changes in subsequent contracts then it is in the first one. But even in subsequent contracts, it is easy to ask for things like pay raises, more paid time off, more paid CME, and if on salary-to ask for fewer shifts per year. You will be surprised to find that the human resource people, or whoever reviews your contract, frequently will grant you these increases, BUT ONLY IF YOU ASK!

3 If your hospitalist group all have their contracts renew at once, it is worthwhile getting together to try and negotiate a better deal for all of you. You can share the cost of the attorney to review for you (and possibly negotiate for the group).

4 Compensation: Read the salary survey results in www.societyofobgynhospitalists.org . Have a good idea what other OB/GYN hospitalists are being paid in the geographical area. Just call them up and ask. Most colleagues will give you a general idea. After all, you would do the same for a newcomer, correct?

Most OB/GYN hospitalists get either hourly pay or salary for so many shifts per year with only the exceptional position also having productivity factored in. Beware “bonus” additions to salary—be sure they are easily obtainable (ask currently employed hospitalists if they have received their “bonuses”).

5 Watch out for restrictive covenants—how long and how large a geographical area (footprint)? Are they restricted to OB/GYN hospitalists versus general OB/GYN in private practice? Will you have to leave the area if this hospitalist job does not work out for you?

6 Malpractice insurance: Do not sign unless employer provides occurrence malpractice insurance or claims made with employer paying “tail coverage.” If you are working part-time and pay for your own malpractice insurance, ask for an increased hourly wage because the hospital (or employer) does not have that expense in your particular case.

7 Especially with your first contract, engage an attorney who concentrates his or her practice on physician employment agreements. Let them negotiate the deal for you without you alienating your future employers. You can let the attorney be the “bad guy.” You can just say, “I don’t understand this legal stuff,” or “My attorney is making me ask for…”

8 Ask for a sign-on bonus and/or ask for moving expenses (why not? They can just say no).

9 Negotiable costs: Employer paid CME, medical staff dues, DEA fees, transportation costs, and medical Society dues are all negotiable, while disability, health insurance, and retirement packages are generally less negotiable.

10 Other negotiable expenses: Payment of previous malpractice tail insurance, debt, and/or loans can sometimes be negotiated over years of service (generally at least three years).

11 Not-for-cause termination: 90 days is common; try for 120 days—the duration should be the same for both you and the hospital (employer).

12 If you are working for a staffing company, will there be “ownership” opportunities in the future-stock options, etc.?

Further resources:

As an independent contractor, I have been negotiating my own contracts for over eight years (using my accountant as an advisor) I have taken some of these ideas from a recent book I reviewed: The Final Hurdle: a Physician’s Guide to Negotiating the Fair Employment Agreement by Dennis Hursh, published 2012.

Also…

Information for Hospitalists on Legal Issues, Contracts, and Negotiation:

Click here to open webpage in new window

A sample hospitalist contract:

Click here to open PDF

I, of course, am not an attorney and I am not offering legal advice here or anywhere, but I have spoken to a lot of different OB/GYN hospitalists about their contracts and would be glad to share my experience if you would like to contact me.

Good luck in negotiating your own contracts!

Rob Olson, MD, FACOG

The Society of OB/GYN Hospitalists Takes Off

Did you know that the Society of OB/GYN Hospitalists is holding its second annual clinical meeting on Sept. 27-29, 2012, in Denver? Did you know that the Society of OB/GYN Hospitalists (SOGH) even existed? With more than 100 paid founding members, SOGH is not yet widely known within the ob.gyn. community; however, it did not emerge overnight.

Formally established in 2011, it came about due to a group of like-minded and dedicated ob.gyn. hospitalist volunteers who, like me, wanted to create a formal community that would address our specific needs, answer our particular questions, and reinforce, bolster and support our emerging position of influence in ob.gyn. hospital care.

With the concept of the “ob.gyn. hospitalist” widely embraced only since 2003, I wasn’t sure how many other physicians were practicing this model of ob.gyn. care. I was certain I wasn’t alone, so in 2008 I launched my website ObGynHospitalist.com [now obgynhospitalistconsulting.com] to make sure. It was a fairly “homemade” effort at first, but approximately 175 ob.gyn. hospitalists of varying descriptions joined my site in its first 2 years. I had gathered together a community of disconnected, somewhat frustrated, and often isolated hospitalists who were motivated to connect and exchange answers with one another.

As the number of members grew, and the website became the only professional resource for ob.gyn. hospitalists, there was increasing interest in getting together in person. In 2010, I requested that the American College of Obstetricians and Gynecologists (ACOG) allow us to hold a Special Interest Group meeting at its annual clinical meeting (ACM) in San Francisco. I was thrilled that more than 75 people showed up and a lively discussion of hospitalist-specific issues clearly showed that there was a need for a more formal organization to be formed.

An organizational meeting was held in Denver in October 2010 with 17 people in attendance. A pivotal moment at that meeting was when Dr. Larry Wellikson, the Society of Hospital Medicine’s CEO, gave us invaluable advice on how to form a nonprofit medical society.

A second Special Interest Group meeting was held at the 2011 ACOG ACM in Washington, D.C. This provided the impetus and the volunteers to start organizing the society’s first ACM. In September 2011, it all came together. With 43 enthusiastic ob.gyn. hospitalists, generalists, and administrators in attendance, SOGH was officially born.

Cochaired by Dr. Karenmarie Meyer and myself, the conference covered a range of important clinical and business issues that affect ob.gyn. hospitalists. Presentations included best practices in obstetric triage and evidence-based cesarean section techniques. Data collection techniques, safety and malpractice issues, and ob.gyn. hospitalists’ core competencies also were discussed. The SOGH board of directors was elected. Volunteers signed up for four separate committees, and committee chairs were elected.

Following the ACM, The Doctors Company conducted a first-of-its-kind Obstetrical Emergency Simulation Workshop. One of the highlights was the attendance of Prof. Christopher B. Lynch, who flew in from the United Kingdom to personally demonstrate his B-Lynch suture. He will again be in attendance for the simulation workshop on Sept. 27, 2012.

Last month SOGH achieved another milestone with the launch of its website SocietyofOBGYNHospitalists.com, which is where you can find this year’s ACM schedule and registration form, as well as SOGH membership applications.

As SOGH’s outgoing founding president, I’m proud to have overseen its inception, birth, recognition as a nonprofit 503(c)3* organization, and the preparation for the second ACM. Dr. Meyer takes over as president after the ACM, and I look forward to watching it mature in the years to come.

Originally posted AUGUST 17, 2012 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