SAN FRANCISCO — Ten hospital systems in the United States have started or are about to start using “laborists”—physicians whose sole focus is managing the patient in labor—Louis Weinstein, M.D., reported at the annual meeting of the American College of Obstetricians and Gynecologists.
Using laborists makes sense, said Dr. Weinstein of Jefferson Medical College in Philadelphia. Laborists are expected to improve patient care and ease burnout among obstetricians.
The laborist profession offers obstetricians predictable and limited work hours, while reducing disruption of their office and operating room schedules. It also offers women in labor the benefit of prompt, continuous, and efficient care.
Dr. Weinstein demonstrated the laborist business model by calculating what it would cost a hospital to maintain 7-day, 24-hour coverage by a team of laborists. It would take four physicians, each working four 10.5-hour shifts each week. Dr. Weinstein assumed that the laborists would each earn $175,000 per year, and they would be given 1 week of CME time and 3 weeks of vacation annually. The hospital would have to provide a total of 12 weeks' vacation coverage for the time the laborists were away.
The laborists would receive benefits worth 28% of their salaries, and they would be covered under the hospital's liability policy at a cost of about $60,000 per laborist per year. The total annual cost to the hospital would be $1.2 million.
This scenario would make economic sense only in a hospital with at least 2,000 deliveries per year, he said. If laborists handled half of those deliveries at $1,200 per delivery, that would bring in $1.2 million/year, making the program “revenue neutral” from the hospital's perspective.
But hospitals would come out ahead if the use of hospitalists improved patient safety such that even one lawsuit were avoided every 5 years, Dr. Weinstein said.
Beyond these economic calculations are the benefits to individual obstetricians and to the profession of obstetrics and gynecology. Dr. Weinstein pointed to studies showing a very high rate of burnout among ob.gyns., which he attributed in part to their hectic and unpredictable schedules and to work weeks well in excess of 40 hours.
Dr. Weinstein said he proposed the laborist model in 2003, patterning it after the rapidly growing hospitalist movement among internists (Am. J. Obstet. Gynecol. 2003;188:310–2). Some criticize the hospitalist movement for a disruption in care when the hospitalist becomes responsible for a patient, but studies have shown high patient satisfaction and significant reductions in resource utilization while maintaining good clinical outcomes.
Hospitalists themselves report high job satisfaction, a long-term commitment to remaining in the field, and the lowest burnout rates of any medical specialty.
For the laborist model to succeed, there must be buy-in by the medical staff. “Clearly, if everybody says, 'Well, I'm not going to let the laborist do my deliveries,' then it won't work,” Dr. Weinstein said.
Additionally, laborists would have to receive respect from other ob.gyns.