It is a sad fact that not only are there are more and more high-risk pregnancies, but there are not enough maternal-fetal medicine physicians to help care for them.
Some fellowship programs are emphasizing outpatient consultation and ultrasound rather than the critical care of the high-risk inpatient. There are not enough perinatologists to treat the growing number of elderly mothers and diabetics or to handle the increase in obese, hypertensive, and multiple gestation pregnancies.
Additionally, just like everyone else, maternal-fetal medicine physicians (MFMs) have the pressure of being in two places at once: the office and the hospital. Small group or solo practices feel this strain even more, and many times limit their practice to outpatient consultation only.
As most of us in the hospital trenches know, this MFM shortage can create the perfect storm for a very bad outcome. However, ob.gyn. hospitalists can step into this void.
In January 2012, ObGynHospitalist.com conducted the first survey to find out how ob.gyn. hospitalists and MFMs are working together. It revealed that more than 70% of ob.gyn. hospitalists work with high-risk patients, and the vast majority work with private-practice or hospital-employed MFM specialists, most often on a daily basis.
Another significant finding from the survey was that the majority of ob.gyn. hospitalist programs do not or rarely share patients with the local MFM(s). In the one-third of programs that always or mostly share patients, the ob.gyn. hospitalist is the assigned admitting physician half the time, a MFM is the assigned admitting physician 14% of the time, and 38% stated that it could be either.
Most shared patients are seen by either an ob.gyn. hospitalist or MFM(s). Ob.gyn. hospitalists perform floor rounds on shared patients 23% of the time, round together with a MFM(s) 12% of the time, and MFMs exclusively make floor rounds on only 10% of shared patients. Separate rounds are performed 24% of the time.
This partnership that is created between the MFM and the ob.gyn. hospitalist means that hospitalists can be MFM extenders, and high-risk patients can be given more immediate attention.
I was recruited by Dr. Reinaldo Acosta, a solo MFM who could only do outpatient consults and couldn’t take call until he started an ob.gyn. hospitalist program in Spokane, Wash., in 2007. The results were tremendous. The hospitalist took care of his inpatients, he could take call because he rarely had to come in at night, and he was usually not disturbed in the office. He was covered for vacations and several weekends a month by a locum, Dr. Jorge Talosa. Over 4 years, neonatal intensive care unit bed occupation numbers increased from 8,302 to 15,625, and Dr. Acosta created new sources of revenue for the hospital by increasing transports of very sick mothers and preterm deliveries. It also allowed the hospital to have both better safety and quality of service, because a board-certified ob.gyn. was present 24/7 to handle emergencies and support the private ob.gyns. and family practitioners.
This new model, where general ob.gyns. act as perinatology extenders, benefits everyone. It also addresses the shortage of MFMs as well as the increasing number of high-risk patients. As ob.gyn. hospitalists develop their clinical obstetric skills and experience, they may complement MFMs as the primary caregiver to high-risk women in the hospital. It will be interesting to see how this develops. Will the 4-year general ob.gyn. residency change? Will there be a special fellowship in ob.gyn. hospital medicine? Will there be a separate board certification?
Ob.gyn. hospitalists want to – and should – have a closer working relationship with their local MFMs. This isn’t just to increase and find new revenue for hospitals; it can benefit all obstetric patients, ob.gyn. hospitalists, and MFMs, as well as community obstetricians and the hospital’s obstetric service, too. The ObGynHospitalist.com survey results lend legitimacy to the relationship, but it’s up to the stakeholders to forge closer ties and adopt this new partnership model to improve high-risk patient care.
Dr. Olson is an ob.gyn. hospitalist in Bellingham, Wash., founding president of the Society of Ob.Gyn. Hospitalists, and founder of www.obgynhospitalist.com. He is a consultant for ob.gyn hospitalist programs. E-mail Dr. Olson at firstname.lastname@example.org.