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Ob Gyns Support Growing Trend of Hospitalists

June 21, 2010

Washington, DC -- The rising number of ob-gyn hospitalists in the US holds promise for benefiting both patients and physicians while also maintaining safe and effective care, according to a new Committee Opinion issued today by The American College of Obstetricians and Gynecologists and published in the July issue of Obstetrics & Gynecology. Although there are potential limitations to ob-gyn hospitalists, there are many benefits to patients, hospitals, ob-gyns in practice, and the hospitalists themselves.

The term "hospitalist," coined in 1996 by Robert M. Wachter, MD, and Lee Goldman, MD, refers to physicians whose main professional role is the general medical care of hospitalized patients. According to the American Hospital Association, there were 28,000 practicing hospitalists in 2007. The term "laborist" refers to an ob-gyn hospitalist employed by a hospital or physician group to care for women in labor and to manage obstetric emergencies. A general ob-gyn hospitalist may provide in-house gynecologic services, perform inpatient consultations, and see emergency room patients.

"This trend of ob-gyn hospitalists and laborists can be viewed as an overall positive development for patients and their physicians," said Patrice M. Weiss, MD, chair of the Committee on Patient Safety and Quality Improvement. "Of course, as with anything new, there will be issues to be worked out as doctors and hospitals collaborate to further improve patient care and safety."

Some of the benefits of hospitalists to patients include having an immediately available, well-rested physician which can enhance patient safety and improve outcomes. According to the Committee Opinion, a successful hospital laborist program also may be a first step in helping communities that have a shortage of obstetricians. One potential downside for patients is that the physician who delivers their baby may be a laborist and not their ob-gyn with whom they have developed a personal, trusting relationship. Patients should be informed during the prenatal period that laborists are part of the health care team that may provide their care.

Ob-gyn hospitalists, and laborists, who practice solely in the hospital setting, stand to benefit from more predictable schedules, assistance with medical liability insurance premiums, avoidance of work-related fatigue, and freedom from day-to-day practice worries such as overhead costs, billing, and collections.

One of the advantages to general practice ob-gyns is that hospitalists can assume their on-call obligations, which, for the busy ob-gyn practice, can extend beyond 24 hours. Hospitalist programs can give office-based ob-gyns more control over their personal and family life. Ob-gyns in practice also benefit from having a hospitalist cover deliveries for them. For instance, sometimes patients will go into labor and their primary ob-gyns can't get to the hospital in time, or at all, to deliver the baby because they are in the middle of busy office hours seeing patients or have a scheduled surgery at that time.

There are some potential obstacles that physicians and hospitals will need to address when considering a laborist program. One of these problems relates to reimbursement. Pregnancy care is typically billed as one "global fee" that includes the cost of all prenatal care visits and delivery, so having one physician providing prenatal care and another physician attending the delivery raises reimbursement issues. Another concern is that office-based ob-gyns may not reach the minimum number of obstetric procedures to maintain their hospital admitting privileges if most of their patient care is handled by laborists.

"The most important thing when these programs are implemented is to establish and maintain clear, ongoing communication between physicians in practice and hospitalists," said Dr. Weiss. "It's vital that the hospitalist and the primary care provider consult with each other regarding the handoff of patients, progress updates, and follow-up care so patient injury is avoided."

Committee Opinion #459, "The Obstetric-Gynecologic Hospitalist," is published in the July 2010 issue of Obstetrics & Gynecology.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org


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