At Monmouth Medical Center in Long Branch, New Jersey, a laborist program has been in place for a little over 2 years.
“It’s going very well in the sense that the solo practitioners that we have in the area really do appreciate it,” says Raksha Joshi, MD, chief medical officer and medical director of Monmouth Family Health Center. “It prevents disruption to their office practice as well as to their lifestyle.”
That does not mean the program is accepted wholeheartedly by every physician and patient, however.
“I think there may be some resistance from both sides in the sense that, traditionally, ObGyn has been a model where a patient has had a full ride,” says Joshi, “of demanding and expecting that her own physician will be the one to deliver her. That may be a bit of a barrier to overcome.”
Launching a laborist program: Why three hospitals did it (and how)
MIDDLE TENNESSEE MEDICAL CENTER
- Murfreesboro, Tennessee
- 286-bed private hospital (nonprofit); 2,500 deliveries a year
- Launch: November 2006
Motivators: “Before, it was the standard in most communities that an ObGyn had to be available within a reasonable length of time,” says Andy Brown, vice president of medical affairs. “And for a lot of communities, that length of time is 30 minutes. But 30 minutes is a long time when you’re in an emergent situation.”
How things work: Laborists work seven 12-hour shifts over a 2-week period. Responsibilities include managing unassigned patients who present with ObGyn complaints, 24/7 coverage for emergencies, and backing up private physicians who cannot get to the hospital in a reasonable time.
PRESBYTERIAN HOSPITAL
- Albuquerque, New Mexico
- 453-bed tertiary community hospital; 5,937 deliveries in 2007
- Launch: January 2006
Motivators: The need to treat high-risk gravidas from small towns and rural areas of New Mexico, who are transported to Presbyterian Hospital for specialist care and the level III NICU.
How things work: Laborists work three 12-hour shifts a week. Responsibilities include delivering babies of high-risk mothers cared for by in-house perinatologists; managing unassigned pregnant patients who drop into the ED or OB triage area; backing up community ObGyns who cannot get to the hospital in a reasonable time or who have more than one delivery at a time; and first-assisting for a majority of the hospital’s C-sections.
SHAWNEE MISSION MEDICAL CENTER
- Kansas City, Kansas
- 385-bed community hospital (nonprofit); 3,200 deliveries a year
- Launch: February 2008
Motivators: The need for an ObGyn to be “immediately available” for VBAC deliveries, according to ACOG guidelines, says Deb Ohnoutka, administrative director of women’s and children’s services. “We also wanted to take that next notch up and provide the safest, highest quality care.”
How things work: Laborists work two 24-hour shifts a week managing unassigned patients who present to the hospital, precipitous births, and VBAC patients; they also back up private ObGyns who may not be able to get to the hospital in a reasonable amount of time.
Life as a laborist
From the point of view of the laborists themselves, the advantages of the job are many.
“I would say a lot less stress, a lot more free time,” says Kathryn Mills, MD, one of the laborists at Middle Tennessee Medical Center. “I have free time during the week if I’m not on a shift, so it’s great.”
Laura McMurray, MD, a laborist at Shawnee Mission Medical Center, is also enthusiastic.
“I love doing OB and this is the best of both worlds,” she says, “where you can do what you like to do—take care of patients—but you don’t have the call issues and the daily pressures of private practice. It allows you to have more time with your family and to be able to participate in a lot more of their activities.”
Krista Wills, MD, the head of the laborist program at Presbyterian Hospital in Albuquerque, is also a laborist herself. She is very happy with the job.
“I started practice in 1990,” she says. “At the time, a female ObGyn quit OB after roughly 10 years and went to GYN only. Her patient volume was built, her patients had aged with her, and now she could switch over to GYN.”
“If OB is truly your love but you need a more scheduled lifestyle, then being an OB hospitalist gives you that opportunity,” says Wills. “I love the OB part of ObGyn. I still get very excited for deliveries—it doesn’t matter if it’s two or three in the morning, I still get psyched with it.”
“We have no office; we have no overhead; our liability insurance is paid by the hospital. And it allows me to continue doing OB in a manner that doesn’t give me 60-hour workweeks and being up all day, then up all night, then up all day, which is really exhausting,” she adds.