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.