why more hospitals are adding laborists to their rosters

Over the last decade, hospitals across the U.S. have been working hard to raise satisfaction scores, improve patient safety, lower the number of readmissions and, of course, limit their medical malpractice exposure. While these are rather lofty goals, many have actually been able to achieve them thanks to the deployment of a new patient care model.

The patient care model in question involves the expanded use of hospitalists, meaning those physicians who are tasked solely with managing the care of hospital patients and are therefore always on site. Specifically, hospitals are now employing these hospitalists in more specialized capacities, such as working in intensive care units or surgical wards.

The latest development in this area is more hospitals are now employing OB hospitalists — referred to as laborists — to help manage deliveries, as well as any obstetrical and gynecological emergencies that arise. In fact, while only 10 hospitals employed laborists in 2005, this number has now jumped to 250 and appears likely to climb even higher.

While the capacity in which these laborists work varies from hospital to hospital — some are employed full-time, some only work nights and weekends, some are private practitioners who pick up a few shifts per month — the idea of having a dedicated OB/GYN on standby has been widely embraced by nurses and many physicians who welcome the work-life balance provided by predetermined hours.

Outside of sparing patients, particularly women in labor, from the potential discomfort — and danger — of waiting for their OB/GYN to come to the hospital after being paged, proponents argue that having laborists on staff also has other advantages.

Indeed, one study found a Las Vegas-based hospital that employed full-time laborists actually saw the rates of cesarean sections decline by 6 percent, a reality that saved money, shortened hospital stays and eliminated the malpractice risk naturally attending these major surgical procedures.

Proponents also argue that worries about fatigue affecting patient care are entirely absent, as laborists work regular hours and are often unencumbered by the rigors of private practice. 

Many older OB/GYNs, however, have expressed concerns over this patient care model, arguing it transforms what is otherwise a highly complex specialty into nothing more than shift work and jeopardizes the all-important building of relationships with patients. 

What are your thoughts on the use of laborists? Do you share any of the concerns expressed by these older physicians or are you happy just to have any OB/GYN present at the hospital?

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