If there is a downside, it is narrowing of the spectrum, says McMurray.
“You may not be doing the entire scope of what you might be doing in private practice in terms of GYN. You don’t really develop a relationship with the patient—a long-term relationship with the patient. I think that’s true of any type of emergency room, any situation in which you are doing more of a shift as opposed to being on call as a private practice sort of thing. But I don’t view those as negatives. Somebody might, but that’s part of how it’s set up.”
According to Boles, word of the advantages of working as a laborist is spreading among ObGyns as a whole.
“I get phone calls from physicians who are interested in finding out if we have any openings because they would love to close their private practice and walk away from the hassle.”
Does the laborist model pay for itself?
The answer depends on how you calculate its benefits.
“We don’t expect it to make a profit,” says Ohnoutka, “but we do hopefully expect it to get close to breaking even.”
“I think when you look at all the drivers, there are different ways to make that happen,” she says. “If a private doc consults, we can bill consultant fees. If we do a delivery for them, we can bill a delivery fee. But I think when you look at improved physician satisfaction and improved nursing satisfaction, when you look at decreasing liability because you have somebody here at all times, it will pay for itself in many other ways than just the bottom line.”
At Presbyterian Hospital, the case is more clear-cut.
“Our biggest thing is that we are able to increase the number of maternal transports that we are able to take from all over the state,” says Wills.
Because the NICU “traditionally is a profit-maker for hospitals because the babies are all insured or qualified for Medicaid, there is a downstream benefit: It helps out the women’s program overall, it helps out the children’s program overall, if you look at the bottom line,” she says.
At Middle Tennessee Medical Center, hospital administrators aren’t as concerned about the strict bottom line.
“With the goodwill in the local ObGyn community and with the standard of care that we are now able to provide for the community, I think that’s where the payoff comes in,” says Brown.
Will the model spread?
Louis Weinstein, MD, thinks it will. He predicts that, in 10 years, most hospitals with more than 2,000 deliveries a year will have a laborist program.
“Hospitals are offering $100 an hour for call and nobody will take them up on it,” he says. That makes a new model inevitable.
Like Weinstein, Boles sees lifestyle issues as a dominant force.
“Our three full-time laborists are very happy with their work schedule. When they’re working, they’re at the hospital. When it’s not their shift, they go away, they turn their beeper off, they don’t have to answer their cell phone, and they can go do whatever they want to do. So it’s a model that will become increasingly attractive for many, many people as the pressures on private practices increase.”
If the laborist model has significant warts, they have yet to reveal themselves, at least among the programs described here. It may be that the burden of business as usual has become so great that the model’s primary impact is relief. As it matures, areas in need of fine-tuning or overhaul should become apparent.