Hospitalist movement moves into OB

Ob/gyn Andrew Vincent doesn't wear a beeper. When he's off work, he's really off, spending uninterrupted time with his three kids.

That's unusual for someone in his specialty, but then Vincent works exclusively inside Legacy Salmon Creek Hospital in Vancouver, WA, pulling seven or eight 24-hour shifts per month. The biggest part of his job is delivering the babies of uninsured women who appear in the emergency department without having received prenatal care. Less commonly, he delivers the babies of patients under the care of an office-based ob/gyn who's tied up in traffic or catching a baby at another hospital.

A growing number of hospitals are hiring a new breed of ob/gyns such as Vincent who are called laborists or ob/gyn hospitalists. Resembling hospitalists drawn from the ranks of internal medicine, these clinicians are at a patient's bedside in a jiffy. This onsite presence is critical in obstetrics, when a baby in fetal distress demands immediate action. Besides improving patient care, a laborist can lower a hospital's malpractice liability and insurance premiums, says Louis Weinstein, ob/gyn department chair at Thomas Jefferson University Hospital in Philadelphia.

Laborists, who can be hospital employees or independent contractors, also solve the problem of ED coverage. Like other specialists, office-based ob/gyns are increasingly reluctant to take ED calls for unassigned, often uninsured patients. Laborists fill the gap, much to the delight of ob/gyn Stacey Barrie in Fremont, CA. She and her partner are on the medical staff of Washington Hospital in Fremont.

"It's a huge relief not to have to cover the emergency room," says Barrie. "Before, we'd have to cancel office appointments and do procedures on patients we might have never met before."

Some ob/gyns have viewed them as potential rivals, but by all accounts, laborists concentrate mostly on unassigned, walk-in patients. And when the patient belongs to another ob/gyn, laborists come into the picture only during emergencies, often starting a delivery and letting the other doctor take over when he arrives on the scene. In many respects, they serve as unofficial partners who save a trip to the hospital by checking a monitor or breaking a woman's water when requested to. They also assist office-based ob/gyns in C-sections and other surgeries. "Having someone there 24/7 means peace of mind," says Barrie.

Laborists reap rewards, too-predictable schedules, relief from running a practice, and competitive compensation. And with hospitals paying for malpractice coverage, ob/gyns driven from obstetrics by sky-high premiums find it feasible once more to deliver babies.

This division of labor among ob/gyns mirrors what's happening throughout medicine. While the vast majority of the nation's estimated 15,000 hospitalists are internists, you'll find want ads for hospitalists in pediatrics, orthopedics, and gastroenterology. Some argue that a hospital-based physician doesn't automatically qualify for the label hospitalist, which they reserve for clinicians more integrated into the hospital "team." Whatever the term, some ob/gyns believe that house staff who specialize in delivering babies could make the specialty more attractive to new doctors desiring kinder schedules-and that's in addition to offering better patient care.

"Ob/gyns at my hospital are pushing for this," says gynecologist Maxine Klein in Hartford, CT. "The laborist model is the future of obstetrics."