Labor and delivery, emergency care: ob.gyns. seek new arrangements with hospitals; Hospitalist programs emerging, fueled by malpractice crisis and lifestyle issues.(News)

In a few select areas of the country. ob.gyn. hospitalist programs are starting up, a trend motivated not just by the malpractice crisis, but also by lifestyle issues and the need to run ob.gyn. practices more efficiently.

The concept of ob.gyns. working exclusively in the hospital has been around for a long time, but terming them "hospitalists" is a recent development, Roger Heroux, who owns the consulting firm Hospital Management Associates in Colorado Springs, Colo.

The Society of Hospital Medicine, the trade organization for inpatient medicine, does not have complete records of how many ob.gyn. hospitalists there are in the country. "Since this is such a new thing, we're not sure how groups really classify themselves as subspecialists in this area at this time," said Lisa Freeman, a society spokeswoman.

"More and more hospitals are going to be setting up ob.gyn. hospitalist programs," Mr. Heroux predicted.

Washington Hospital in Fremont, Calif., established such a program in January. It recruited ob.gyns, to work in the hospital, doing labor and delivery and covering the emergency department.

As a condition of privileging, many hospitals require private ob.gyns. to be on call for emergency care and unassigned patients. This raises a number of issues, said David Joyce, president of Delphi Healthcare Partners, a consulting and contract medical management firm in Durham, N.C., that designed the program for the California hospital.

"Some obstetricians don't want to take care of patients in the emergency department anymore," he said. "If a patient walks in with no prenatal care, that's a tremendous malpractice risk."