BOULDER, COLO. – A buzz of excitement – a sense of history in the making – was palpable as the newly incorporated Society of Ob/Gyn Hospitalists held its first-ever annual meeting here.
“We are all witnessing the birth of a new subspecialty,” declared Dr. Brigid McCue, an ob.gyn. hospitalist at Jordan Hospital in Plymouth, Mass., and a member of the Society of Ob/Gyn Hospitalists (SOGH) steering committee.
Present at the birth were officials from both the American College of Obstetricians and Gynecologists (ACOG) and the Society of Hospital Medicine (SHM), two organizations interested in having close ties with the new medical society.
“ACOG recognizes this is the new paradigm of care,” said Dr. J. Joshua Kopelman, chair of ACOG District VIII. “We absolutely want you to be people who provide input about what you do to all of the committees at the executive level of the college.”
“Ob.gyn. hospitalists in this country are the wave of the future. There's no question about it. The model has been going on for a long time in Great Britain, for example, where you have people whose practices are office-based, and you have people who work full time in the hospital and that's all they do. They've had to learn how to do patient handoffs between these two groups of physicians,” he added.
Dr. Shaun Frost, president-elect of the SHM, observed that “it's kind of mind-boggling” to see the parallels between the birth of that organization and the SOGH. Both groups began with a small cadre of enthusiastic people full of outside-the-box ideas about how to improve patient care in the hospital.
Hospital medicine has experienced astronomical growth. The SHM consisted of 23 members in 1997, the year of its birth. Membership climbed to 800 just 2 years later, then to 3,200 in 2003, 6,300 in 2006, and now sits at about 12,000.
“I would anticipate that you're going to experience the same thing we did in terms of rapid and significant growth. Tighten your seat belts – it can be a wild ride sometimes, but I can tell you that for me, after 14 years, it has been nothing short of profoundly gratifying,” said Dr. Frost, who is chief medical officer for the Northeast region of Cogent HMG Healthcare and an internist at the University of Minnesota, Minneapolis.
In an interview, meeting cochair Dr. Rob Olson said at present there are 143 ob.gyn. hospitalist groups spread throughout the country, typically with four to six hospitalists each. Most work 12-hour shifts, some 24-hour shifts.
“Right now hospitalists are doing a very small percentage of all deliveries, maybe 2%. I project in 5 years we'll be doing 20% or 25%,” predicted Dr. Olson, an ob.gyn. hospitalist in Bellingham, Wash., and founder of www.obgynhospitalist.com
The primary mission of ob.gyn. hospitalists is to enhance patient safety in the hospital, he explained. If an emergency requiring cesarean section occurs, the hospitalist can start the operation while the private obstetrician is en route, shifting to second assistant when the private physician arrives and takes over the procedure. Or if a woman who has been in labor for a few hours begins progressing rapidly at 2 a.m., the hospitalist can step in and do the delivery if the private physician can't get to the hospital promptly.
Hospitalists can also provide support when a midwife or family physician has a complicated delivery requiring a vacuum extraction, forceps, or a cesarean section.
“It's kind of like being a lifeguard, where you're sitting at the beach waiting for the problem,” he said.
Ordinarily a hospitalist will never see a patient antepartum. The exception is the unassigned patient who may drop in to the hospital with no prenatal care, who then becomes the hospitalist's responsibility.
Hospitalists also support private physicians by letting them sign out patients as a convenience. “A private physician may say, 'I've got a big surgery tomorrow. Can you take care of all of my patients between midnight and 6 a.m. so I can sleep?' That's another way of utilizing us,” Dr. Olson continued.
In the initial months following introduction of an ob.gyn. hospitalist program, however, patient sign-outs typically aren't a substantial part of the job. “At the beginning the private doctors are a little worried about it. They don't want to sign out. They're suspicious. They're afraid that they're going to give up not only their patients but their revenue. When they realize how helpful check outs are, though, then they sign out,” he explained.
Some ob.gyn. hospitalists are laborists only and prefer it that way. Others also cover gynecologic cases in the emergency department. “I have diagnosed more horrific cancers in 18 months as a hospitalist than in 13 years of private practice,” Dr. McCue said, adding that she feels good about covering gynecologic cases in the ER because it enables her to maintain some of her hard-earned gynecologic skills.