Laborist vs OBGYN

[cubsrule4e]

Would anyone like to share their thoughts on the topic of laborists regarding the future of the field of OBGYN? I have searched the forum and couldnt find any topics related to this so i assume I'm not making a duplicate thread here.

Anyway, im still a 2nd year med student, so I havent yet done any OBGYN rotations to figure out if i have that true passion for the field, but i have been trying to learn as much as i can about it since there are many issues surrounding the field these days (malpractice, male vs female, etc). I was interested to see what current obgyns, residents, or other students thought about the laborist position in health care. The obvious "pro" is that it allows a more predictable work schedule and potentially less stressful lifestyle for the practicing OBGYN, which makes sense, since the recent trend in all fields of medicine have been towards lifestyle, and for OBGYN in particular, the rising number of female doctors who want to devote more time to family. The most prominent "con" is the lack of continuity of care, since the Laborist is simply working a shift and will deliver whoever comes into the hospital. This brings up a few questions for me:
Will other OBGYNs go for this, since many of them like to deliver their own patients to keep their patient relations strong and build their practices based on loyal patients and referals?
Regarding the lack of continuity of care, say you are an OBGYN in a group practice who takes call one day per week and one weekend per month. Presumably you are going to miss many of your own deliveries since the call is spread out amongst a group. But what is the difference between one of your partners delivering for your patient vs a laborist delivering? Presumably your patient doesnt have a pre-established relationship with either one, so if this is such a big problem for the laborist position in a hospital, why doesnt it affect the private group model also? (or does it?) And if theres really no difference, would more private groups want to hire a laborist to cover a few nights per week - sort of like a PA who can deliver babies?

Then there is the economic/litigious side of things which I admittedly know squat about. Ive seen figures that state that the actual delivery cost is about $1200, which would go to the laborist, with all of the other billing for care going to the primary obgyn, and perhaps possible malpractice sharing between them. But then if there is a malpractice case, who and what determines who gets the blame, especially if it is one of those cases in which there is really no one at fault?

Another potential idea...could hospitals in a university setting where there is high volume and low continuity of care to begin with, hire a laborist to cover one or two shifts a week, in order to decrease the work load of the residents? One of the big reasons no one wants to go into OBGYN anymore is the hours, and in residency you dont have the luxury of determining your own - maybe making the call schedules less malignant would draw more students into the field.

The articles I have read are pretty scant and most of them are outdated by several months to a year so I am not sure if all of my information is totally accurate, please correct me if I am wrong. Feel free to share your opinions on the subject or post any article links that you think are informative!

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[vegetables]

I think you've posed some good questions, but I've just got 2 comments & definitely don't have all the answers on this topic!:

1. In reference to the comment about what's the difference btwn a laborist and a private practice model where any partner can deliver your patient and they probably don't know them - that isn't always true. I did a few days in a private clinic with multiple partners, and they went out of their way to schedule at least one visit with all the docs (there were 4-5 I believe) so the patient had at least met everyone, while still keeping her main care with one doc, so she'd at least recognize them at delivery and feel more comfortable.

2. The 80-hour work week is quickly equalizing residencies. I think it's part of the reason the surgery match was so tough last year, and I have a feeling the OB one will be more competitive this year as well. It seemed on the interview trail most schools had increased numbers of students applying to OB this year. Now that we're all doing 80 hours, people are more likely to go back to the "harder" fields. Of course lots of residencies may never come close to 80 hours, it makes it somewhat more of a level playing field.

 

[futureob]

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[tiredmom]

Another positive thing about having a laborist is that you actually have the option of trying a VBAC - and if her first c/s was due to something non-anatomic (breech, herpes, fetal distress) rather than CPD, it's been shown to be more cost effective than scheduling a repeat cesarean. (Chung's study out of stanford).

 

[roxtu]

A random viewpoint that I've heard from an OB/Gyn recently out of residency, now in practice: She told me that she was seriously considering going for a Laborist position when she was looking for her first job for lifestyle reasons, but reconsidered because one of the things that drew her to the field was the bredth of clinical experiences that she could have, i.e. delivering babies PLUS doing hysterectomies/multiple types of laparoscopic surgeries/incontinence evaluations etc. She was worried that she might get bored doing just deliveries and would also miss the continuity aspect. In addition, she was told by other practicing OB/GYNs that if she did get bored as a Laborist after a few years, it might be difficult to go back to having a full scope of practice because she wouldn't have done some of the complicated surgeries for awhile and so she might have difficulties with malpractice coverage and/or licensure.

It will be interesting to see how some of these issues play out over the next few years, especially if we are able to talk with docs who've been laborists and who've gone back to having more complete practices.

 

[cubsrule4e]

In addition, she was told by other practicing OB/GYNs that if she did get bored as a Laborist after a few years, it might be difficult to go back to having a full scope of practice because she wouldn't have done some of the complicated surgeries for awhile and so she might have difficulties with malpractice coverage and/or licensure.

But definitely a positive for an OBGYN who really loves OB and doesnt really care about doing any gyn, granted they still have to go through residency. Itd also be good for older docs who decide they dont want to work as much but who still have a passion for delivering (as opposed to dropping the OB part and doing strictly GYN as is the current norm).