Hospitalists have a unique role in healthcare. While many aren't employees of an actual hospital, they often contract with hospitals that are under some kind of pressure, whether it be physician or nurse burnout of the threat of medical malpractice claims. Obstetricians – the OBs in OB/GYNs – are no exception.
According to Dr. Mark Simon, chief medical officer of the OB Hospitalist Group, a lot of obstetricians get fed up with the bureaucracy inherent in the healthcare system, as well as the various pressures the job.
"You add on top of that the litigation risk associated with obstetrics in the United States," said Simon. "It's one of the top specialties for lawsuits. Regardless of the outcome of the lawsuit, just being in the lawsuit is a very demoralizing kind of experience. Whether you win or not, it's not a fun experience to go through. Some get to a point in their careers where they want to limit obstetrics; you do see a lot of those pressures."
One of the reasons obstetrics is often targeted in lawsuits, said Simon, is because patients' experiences often don't line up with their hopes and expectations. Most pregnant women anticipate a normal birth and a healthy baby – which is indeed what happens most of the time.
But when something goes wrong, there's a tendency, said Simon, to point the finger at the obstetrician. The physician often has a tough time if the lawsuit goes to trial, because any negative medical outcome, especially for baby, tends to elicit a jury's sympathy.
By partnering with a hospitalist group, such as OBHG, those pressures and others can often be alleviated. When a hospital partners with a hospitalist group, members of that group – in this case, OB/GYN board-certified physicians – pull shifts in which they're physically in the hospital the entire time, and don't have any competing activities.
That's of particular benefit to community physicians, who may want to take a night off and have their patients tended to by a competent professional. That helps with the burnout issue, and can mitigate those pesky lawsuits, partly by cutting down on instances of severe harm events. In fact, one large health system that partnered with OBGH cut its severe harm events by about 31 percent.
"With medical malpractice, the most common allegation is a delay in care," Simon said. "The obstetrician or hospital failed to act in a timely manner, which is what led to the poor outcome – for baby or mama or both. Having someone present 24/7 allows you to respond to situations in labor as they happen.
"Labor typically goes well," he said. "They go into labor, they have their baby, nothing really dramatic occurs, nothing untoward happens. For the vast majority of people, that's their experience of labor.
"Some have unexpected events that occur during the labor process. You just never know who's going to have those events and when they're going to occur. For the baby inside the uterus, minutes matter. You want to be able to respond as quickly as you can. You want to have a physician who responds almost immediately. That's why you see better outcomes."
Indeed, that increased safety not only helps to avoid medical malpractice claims, but it also has an effect on basic reimbursement as determined by the quality standards mandated by the federal government, which link financial performance to clinical outcomes.
Hospitalist partnerships can also take some of the strain off nurses, increasing their overall satisfaction. Many times, prior to an OB hospitalist program being implemented, nurses will see patients pretty independently; there are no physicians around to help them manage those patients.
"While nurses are very competent and capable and do a great job at that, some find themselves a little uncomfortable with that," said Simon. "They practice sometimes a little beyond what their licensure is."
Relieving that burden has potentially huge workforce implications: Last year, a national study by RNnetwork, a travel nursing company, showed nearly half of responding nurses were thinking about leaving their profession, with major drivers behind the potential mass exodus including feelings of being overworked.
Simon expects that hospitals groups will continue to grow in popularity in obstetrics, especially as the gender dynamic in the workforce shifts.
"Obstetricians used to be a higher percentage of males, but now there's a much higher percentage of females, especially coming out of residency," he said. "Residency classes are 80 to 90 percent female. It changes the demographics of our profession, and that changes the expectation of what the OB community wants to do. A more scheduled and balanced work environment are what many new OBs are looking for."