The necessity for the obstetric/gynecologic (OB/GYN) hospitalist model, with its primary focus to care for and improve the welfare and outcomes of the female laboring patient, has become evident over recent years. The advent of the hospitalist has led to better patient outcomes and increased patient and provider satisfaction.¹ The presence of the OB/GYN hospitalist in Labor and Delivery (L&D) and on the inpatient floor suggests a considerable modification in the way that obstetrics and gynecology has been practiced from both the patient and provider viewpoints.

The increase in hospital-based physicians has been driven by a number of reasons. The major factors are patient safety and a potential reduction in obstetrical malpractice suits by providing in-house continuity of care on the labor floor, where constant oversight and the ability to treat quickly are critical. In addition, newly trained OB/GYN providers are seeking alternatives to private practice that can provide more predictable work hours. Staff hospitalists can oversee and implement the protocols set by the hospital to properly maintain the labor suite, while providing needed teaching and research that are so vital within a hospital setting.² These are physicians whose only role is to supervise and administer obstetrical care to improve overall patient outcomes.

In a 2014 survey of OB/GYN hospitalists, the average age of these providers was found to be between 40 and 59 years old, and the number of years since residency was 17 years.³ At the same time, the demand for trained hospitalists is increasing. Therefore, in the coming years, it is predicted that the number of practicing hospitalists will decrease and the need for newly trained graduates will increase. The development of new fellowship programs nationwide will address this dilemma.⁴ The first OB/GYN hospitalist fellowship was created in 2013 by Winthrop University Hospital in Mineola, New York. Since its inception, an additional fellowship has been established at University of California, Irvine. This chapter will outline and describe the components, objectives, and ultimate goals of the medical education of the OB/GYN hospitalist.

The purpose of the OB/GYN hospitalist fellowship is to provide focused care in the inpatient setting to improve patient safety and the outcomes of women requiring acute obstetrical and gynecologic care. The main philosophy of the fellowship is to train physicians to act competently as OB/GYN safety officers for the hospital. Fellows develop their skills and experience beyond what is taught in a traditional OB/GYN residency program by focusing on the more complex and clinically challenging cases, as in any training program; the objectives at the completion of training are associated with the six Accreditation Council for Graduate Medical Education (ACGME) competencies. These include medical knowledge, patient care, professionalism, interpersonal and communication skills, practice-based learning and improvement, and system-based practice.⁵ At the end of the fellowship, the goal is for the fellow not only to be able to practice independently in a hospital setting but also to effectively teach their learned skills to other physicians and residents. After graduation, the OB/GYN hospitalist fellow should be a primary source of assistance in diagnosis, consultation, and clinical management on L&D, as well the management and treatment of emergency room (ER) as well as operating suite consultations. Private, community-based physicians, if in need of either consultative or emergent assistance, can use hospitalist services for guidance or assistance in acute critical care cases.

Another objective of the OB/GYN hospitalist is to ensure that hospital safety protocols and clinical guidelines are followed and updated as necessary. Quality improvement in the delivery of hospital-based services is a primary focus of the OB/GYN hospitalist. It has been postulated and borne out by outcome assessment that hospitals which have embraced and implemented the hospitalist staffing model will experience significantly better clinical outcomes as well as cost containment and resource utilization. Inpatients receive a more immediate care response that addresses their needs in a timely manner because of the on-site hospitalist presence. This response is also available for community-based physician patients, whose primary-care provider may not be readily available. The hospitalist model serves to facilitate communication and coordination of inpatient care among the many providers involved in the treatment of a single patient, such as medical students, residents, Physician Assistants (PAs), nurses, faculty, and community physicians. The delivery of services and treatment becomes more streamlined, effective, and safer with the coordination of care by hospitalists among the many specialists, consultants, and providers involved in the care of a patient.

This interdisciplinary communication and collaboration model leads to a safer transitioning of care between all parties involved in the treatment of patients. Effective transitions of care reduce potential errors that can negatively affect patient outcomes and are important for patient safety. In addition, the hospitalist model can serve to reduce medical costs by efficient resource utilization. Hospitalists can also help teach residents and students about resource utilization, cost containment, and efficient consumption of goods and services, which are all part of reducing the high cost of healthcare delivery systems.

CLINICAL RESPONSIBILITIES

The hospitalist fellow works under the supervision of the in-house hospitalist-attending physician during his or her set hours. The clinical responsibilities of the hospitalist may include, but are not limited to, the list given in Box 7-1.