Laborist movement oversold.(LETTERS)(Letter to the editor)

According to Dr. Louis Weinstein, "using laborists makes sense" ("Laborist Movement Poised to Take Off," June 15, 2005, p. 1).

Calculating their hours, pay, malpractice insurance, and benefits, he concluded that at 1,000 deliveries per year, hospitals would break even financially. He went on to argue that this method would improve patient safety and that hospitals would "come out ahead" even if they avoided one lawsuit in 5 years.

There is no evidence that the use of full-time staff is less likely to generate malpractice suits. In fact, a patient whose delivery was performed by a total stranger may be more apt to sue for a bad result. It also is possible that the laborist profession will be rated at the highest risk category for the malpractice premium. If actuarial calculations will raise the premium for these superspecialists with high exposure, that will undermine the delicately balanced break-even calculation offered by Dr. Weinstein.

The acceptance of this system by the American public also is questionable. The bond between doctor and laboring patient starts in the doctor's office. The patient rightly expects her trusted doctor to be at her bedside during the critical phase of labor. I can imagine the reactions of a pregnant mother who is told by her obstetrician that he will not be in the labor room for her and that she will be delivered by "someone." If the practice across the street will not use the system, doctors using it will not have to worry about burnout, but about bankruptcy.

We already have laborists in the United States. They are known as board certified midwives. Up to now, these well-trained professionals have been underutilized in our health delivery system. With much lower salaries and malpractice premiums they, ...