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how laborists are changing health care for ob gyns

Despite concerns about turning the obstetrical specialty into “shift” work similar to emergency physicians, the laborist trend is growing as hospitals seek to improve patient safety and physicians increasingly recognize they need help responding to emergencies.

Some hospitals use laborists 24 hours a day, while others use them just nights and weekends. Some use community doctors to take 12- or 24-hour shifts as laborists. Other hospitals hire doctors as laborists who only work in the hospital and don’t have an office practice. Some, like Milford, use a hybrid approach.

Regardless of the laborist model, pregnant women like knowing a doctor — even one they don’t know — is there when they show up at the hospital rather than waiting 30 minutes or more for an on-call physician.

“I was very glad a doctor was here and I could just come right up to the labor and delivery floor,” Kelsey Katro, 27, said in early July while at Bon Secours St. Francis Hospital in Charleston, S.C., which adopted the model two years ago.

Katro had come to the hospital when she thought her water had broken, signaling the start of labor. Tests, though, showed it had not, which relieved Katro since she had been scheduled for a cesarean section the following week in anticipation of a breech birth.

Doctors say problems in childbirth can occur so fast that having patients wait 20 minutes or more for a doctor can make the difference between a healthy baby and a mom or baby facing severe complications.

Dr. Caroline Keller, a laborist at St. Francis, gave Katro the news that she was fine to go home. “Patients like knowing I’m just outside their door … it gives them comfort,” Keller said. Nurses also like knowing a doctor is there so they can have help if mother or baby is in trouble, and doctors don’t have to leave a busy office at a moment’s notice. “It’s hard to walk out of the office with 10 pairs of eyes staring at you,” she said.

The laborist trend is being driven by several factors, among them hospitals striving to improve patient satisfaction rates and reduce their malpractice risk, and doctors wishing to work for a salary instead of running their own practice. Obstetricians, who are increasingly women, also want more time away from their practice and relief from treating an emergency patient who may lack insurance and often prenatal care.

“There has been a generational shift that modern physicians who come out of residency programs tend to want a better work-life balance and the hospitalist program allows doctors to have that so you can go home and have dinner with your family and not have to pay constant attention to the labor deck in the hospital afraid that something bad is happening,” said Dr. Kyle Garner, chief of obstetrics and gynecology at Sarasota Memorial Hospital in Florida.