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The reasons that a hospital or healthcare system starts OB/GYN hospitalist programs generally fall into eight categories:

  • It has experienced a series of bad outcomes, with subsequent high malpractice costs and payment amounts.

  • There is a shortage of private-practice OB/GYNs because of retirement, loss of privileges, or an increased number of patients creating demand. The small number of OB/GYN practitioners causes the institution stress because nobody wants to take calls or respond to consultation requests from family doctors and midwives.

  • There is high turnover among the nurses because a lack of timely response from the overworked staff of OB/GYNs results in the nurses performing deliveries unattended by physicians, caring for high-risk patients with no physician in the hospital, and dealing with dissatisfied patients waiting for evaluation in OB triage.

  • The administration is dissatisfied with paying for call coverage but receiving no financial return, as well as unhappy OB/GYNs forced to be on call. The money spent by hospital administration does not result in improved quality and safety.

  • The hospital or healthcare system is losing obstetrical patient volume.

  • The neonatal intensive care unit (NICU) has excess beds, but there is a lack of high-risk maternal transports with premature infants.

  • Academic programs lack high-quality experienced OB/GYNs for teaching residents, especially in Family Practice–only settings.

  • Local Maternal Fetal Medicine (MFM) physicians need support.

TABLE 3-1Reasons to Start OB/GYN Hospitalist Programs

The drivers for change generally include one champion who recognizes the problem or problems and realizes that an OB/GYN hospitalist program is the solution. If it is the Chief Executive Officer (CEO), he or she appoints a committee to study the problem and solution. If it is a private OB/GYN, the director of maternal-fetal health, or risk management, they convince the CEO first. The committee will then begin to formulate a plan using local resources, engage a consultant, or issue a request for proposal (RFP) to the various national staffing companies. (See Table 2-2 for a list of staffing companies and their contact information.)

The timeline from initial consideration to opening a full-time OB/GYN hospitalist program can range from 3 to 6 months to as long as 12 to 18 months, depending on the following:

  • Whether staffing is done with local doctors or out-of-state physicians are recruited

  • The geographical location and desirability of living conditions

  • The reputation of the hospital, morale of the nurses, and availability of support from anesthesia, pediatrics, neonatology, lab, and blood banking

  • The pay and benefits offered

  • The state licensing requirements and the hospital credentialing timeline


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