Laborist movement poised to take off.(News)

SAN FRANCISCO -- Ten hospital systems in the United States have started or are about to start using "laborists"--physicians whose sole focus is managing the patient in labor--Louis Weinstein, M.D., reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Using laborists makes sense, said Dr. Weinstein of Jefferson Medical College in Philadelphia. Laborists are expected to improve patient care and ease burnout among obstetricians.

The laborist profession offers obstetricians predictable and limited work hours, while offering private ob.gyns. less disruption to their office and operating room schedules. It also offers women in labor the benefit of prompt, continuous, and efficient care.

Dr. Weinstein demonstrated the laborist business model by calculating what it would cost a hospital to maintain 7-day, 24-hour coverage by a team of laborists. It would take four physicians, each working four 10.5-hour shifts each week. For the sake of the calculation, Dr. Weinstein assumed that the laborists would each earn $175,000 per year, and they would be given 1 week of CME time and 3 weeks of vacation annually. The hospital would have to provide a total of 12 weeks' vacation coverage for the time the laborists were away.

The laborists would receive benefits worth 28% of their salaries, and they would be covered under the hospital's liability policy at a cost of about $60,000 per laborist per year. The total annual cost to the hospital would be $1.2 million.

This scenario would make economic sense only in a hospital performing at least 2,000 deliveries per year, he said. If laborists handled half of those deliveries at $1,200 per delivery, that would bring in $1.2 million per year, making the program "revenue neutral" from the ...