We read with great pleasure the article by Olson et al in the August 2012 issue. According to their definition, I am a part-time, full-service hospitalist. My time as a laborist is 5-37% of my weekly hours in the hospital. We share the belief that it is too early to pass a judgment on the effects of the laborist model on efficiency, processes, outcomes, patient and provider satisfaction, and medical education and that further studies are needed. As exposed in the article, this model is the culmination of a change in the professional climate, the practice of the specialty, paralleled by a generational shift.

The variation among laborists is wide for a number of reasons. Many obstetricians became laborists by choice; however, many others became laborists by default. We believe that the variations among practicing laborists due to individual, institutional, and societal/contextual differences should be attenuated to allow a better delineation of laborist model effects.

We propose that the current efforts to define this model should lead to the establishment of an “Inpatient-Obstetrics/Laborist Fellowship” in which the Fellow not only would be versed in the practice of the clinical duties that were well-numbered in the article (including maternal acute and critical care) but also would be trained in protocol writing, human-factors engineering, simulation, team training, evidence-based medicine, and clinical research. Because outcome is affected by training and volume and because the Maternal-Fetal Medicine subspecialty has shifted away from inpatient obstetrics and lost its first “M,” Inpatient Obstetrics deserve a formal framework similar to that of other subspecialties in the hope that it would decrease cesarean delivery rates, improve the skill sets that are needed to perform forceps assistance and repair fourth-degree lacerations, and decrease error and harm, just as examples.

In the beginning of understanding, there are definitions. A better definition of “laborist” can be fostered through training and not only would mitigate any variations that affect outcome but also would improve outcome through concentration of experience and standardization of practice. We share with the authors the promise of this model and believe that bridging the gap between the ideal and the real model should be the next step.