Objective
The objective of the study was to obtain descriptive information about obstetricians/gynecologists who currently are practicing as hospitalists or laborists.
Study Design
A survey was emailed to all actively practicing member Fellows of the American College of Obstetricians and Gynecologists in April 2009. A second emailing of the survey was sent in May 2009.
Results
Obstetrician/gynecologist hospitalists and laborists are significantly younger than the rest of the obstetrician/gynecologist sample by age and years in residency and have a high rate of career satisfaction. There was a great deal of variation in work schedules and compensation of the respondents.
Conclusion
We analyzed the rapidly growing hospitalist/laborist model of care within the obstetrician/gynecologist specialty. The laborists and hospitalists model provides an alternative type of practice for obstetricians/gynecologists, and it is associated with high career satisfaction. It is important that we continue to monitor the needs of this burgeoning field of clinical practice.
Health care has seen a dramatic shift in how inpatient treatment is delivered with the emergence of internal medicine physicians and pediatricians who work as hospitalists. The laborist model was first described in 2003 as a physician whose sole focus of practice is treating the patient in labor. The “individual is available on the delivery floor to provide prompt, continuous, and efficient care to the laboring patient or to the patient who needs evaluation for an obstetric problem.” It was argued that a laborist system within the field of obstetrics/gynecology would decrease workload, increase job satisfaction, provide better patient care, and lead to decreased malpractice liability for hospitals.
For Editors’ Commentary, see Table of Contents
Since that publication, there have been many news articles on this subject. These articles highlighted the rationale of a hospitalist/laborist system of practice and focused predominantly on physician career satisfaction, flexible work schedule, and patient acceptance. However, to date there has been no description of the hospitalist/laborists workforce: their work schedule, the care they provide, their compensation, or their practice environment.
With this rapidly changing practice environment, our goal was to elicit descriptive information about the individuals and their practice patterns as laborists/hospitalists. We hypothesized the study would identify a high level of career satisfaction of actively practicing obstetrics/gynecology hospitalists and laborists. Additionally, we hypothesized that more women would be working in this type of practice than men.
Materials and Methods
An electronic survey that consisted of 20 questions was emailed to all 28,545 actively practicing Fellows of the American College of Obstetrics and Gynecology in April 2009. A second emailing was sent in May 2009 to increase the response rate. The survey was developed in coordination with the authors in this study and approved by the American College of Obstetricians and Gynecologists institutional review board.
The first component of the survey consisted of 5 questions that detailed basic demographic information. The sixth question asked the respondent if he/she considered him/herself to be an obstetrics/gynecology laborist, obstetrics/gynecology hospitalist, or neither. Obstetrics/gynecology laborist was defined as an individual who cares for obstetric patients on labor and delivery only. An obstetrics/gynecology hospitalist was defined as a person who cared for obstetric, gynecologic, and obstetrics/gynecology patients in the emergency department. If the “neither” option was selected, the survey promptly ended with a note thanking the participant for their time. If the obstetrics/gynecology laborist or hospitalist option was selected, the survey continued with an additional 14 questions that detailed work schedule, care provided, career satisfaction, practice environment, and compensation.
The obstetrics/gynecology laborist and hospitalist respondents were asked an open-ended question about the number of shifts per week and hourly length of shifts. Responses to open-ended questions were evaluated by 2 researchers who were blind to respondents’ demographic information. Full-time vs part-time employment status and availability of moonlighting and working additional shifts for extra pay was asked. Information about type of care provided was ascertained and included information about routine coverage for postpartum patients and type of patient, obstetric or gynecologic emergency that required >50% of the physician’s time.
Career satisfaction was rated on a scale from −5 to +5, where −5 represented “very dissatisfied”, 0 represented “neutral,” and +5 represented “very satisfied.” Number of deliveries per year at the participating hospital, number of deliveries per year performed by the hospitalist group, and presence of a residency program within the hospital were asked within a range of common volumes. Information regarding the amount of annual cash compensation, approximate hourly rate, and benefits provided was requested. The importance of 5 common benefits could be rated as not important, somewhat important, and very important.
Data were analyzed with a personal computer-based version of SPSS software (version 16.0; SPSS Inc, Chicago, IL). Descriptive and frequency data were computed for primary analysis. One-way analysis of variance was used for continuous variables; χ 2 analyses were conducted for categoric variables. Significance was evaluated at alpha < .05 and confidence intervals of 95%.
Results
Of the 28,545 clinicians who were contacted, 339 clinicians had invalid email addresses; 7044 clinicians responded, which yielded a response rate of 25%. Of the respondents, 1020 clinicians (15% of respondents, 3.6% of the entire sample) described themselves as obstetrics/gynecology hospitalists or laborists and completed the extended survey.
The mean age of all responders was 50.4 years; the mean years since completion of residency were 18.9. Hospitalists and laborists are significantly younger than the rest of the obstetrician/gynecologist sample by age (F 1,6842 = 58.1; P < .001) and years since residency (F 1,6916 = 82.4; P < .001), when we controlled for gender in each case ( Figure 1 ). The mean age for the hospitalists and laborists group is 48.8 ± 10.2 (SD) and the nonhospitalists and nonlaborists group is 50.6 ± 10.3. The mean years since residency for the hospitalists and laborists group is 17.0 ± 10.7 and the nonhospitalists and laborists group is 19.22 ± 10.5. Forty-five percent of the respondents were female. In regards to gender, there were no significant findings pertaining to full-time or part-time employment or compensation. Over one-half of the hospitalists and laborists (51.5%) were from American College of Obstetricians and Gynecologists district IV (17.6%; District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Puerto Rico, and the West Indies), district VII (21.7%; Alabama, Arkansas, Kansas, Louisiana, Mexico, Mississippi, Missouri, Oklahoma, Tennessee), and district VIII (12.1%; Alaska, Alberta, Arizona, British Columbia, Central America, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming, American Samoa, Guam, Northwest Territory, Yukon Territory). The top 3 employer models for hospitalists and laborists were hospital systems (31.7%), single specialty medical groups (26.3%), and obstetrics/gynecology hospitalist groups (25.1%).
