Laborists become the newest hospital specialists

A growing number of hospitals, following the growth of primary care doctors as facility-only hospitalists, are implementing laborist programs.

Laborists, or OB hospitalists, were conceived to fill a void created by ob-gyns leaving the field because of long hours and high liability insurance premiums. Like hospitalists, laborists are employed by the hospital, which determines their role and pays their salary and liability insurance. Some only deliver babies. Others do triage, make patient rounds and deliver babies whose mothers do not have doctors.

In most cases, a patient's private physician decides who will do the delivery. If it is the laborist, the hospital is paid for the delivery portion of the bill.

"Our OB hospitalists are not there to cut in on a physician's patients. They are there to help if they are needed," said Christopher Swain, MD, an ob-gyn and founder of OB Hospitalist Group Inc. of Greenville, S.C., which sets up programs in hospitals.

Hundreds of hospitals across the country have created laborist programs, say physicians who have searched for these positions. The American College of Obstetricians and Gynecologists called use of OB hospitalists widespread but does not have a formal opinion on the practice, according to a spokeswoman.

"Almost all the disruption and chaos of an ob-gyn practice are gone," said Luisa Kontoules, MD, who works as a laborist at Cape Cod Hospital in Hyannis, Mass., every other weekend, from Friday night to Monday morning while maintaining her own gynecology practice.

Dr. Kontoules said her 62-hour schedule is manageable, and she gets plenty of sleep between deliveries.

OB Hospitalist Group has a network of 450 physicians and has placed 60 of them, Dr. Swain said. Laborists' shifts range from 12 hours to 62 hours. Most work nights or weekends only.

Experts say advantages for laborists include set schedules, fewer hours, no on-call work and no office to manage. For private-practice ob-gyns, laborists provide the flexibility of having another obstetrician on hand to do a delivery.

A spokeswoman for ProMutual Group in Boston, the state's largest insurer, said it is keeping an eye on laborists, "but it is too new a trend to determine if it will result in lower medical liability premiums."