The Laborist Model

July 9, 2009
Women's Heath


The Laborist Model

A new model of patient care for mothers in labor is being utilized around the country. It is called the “Laborist Model.” Essentially, there are obstetricians who work in shifts and their only responsibility during that time is to care for pregnant women who are hospitalized. This physician, called the laborist, would supervise the labor and delivery of infants, as well as evaluate and treat pregnant patients with complications, such as premature labor. When his or her shift is over, the laborist goes home and has no other patient care responsibilities.

This is quite different from the current way most ob/gyn physicians work. On a typical work day an ob/gyn wakes up early, performs several hours of surgery, rounds on his or her hospitalized patients at one or more hospitals, sees office patients for six to eight hours, delivers one or two babies, takes phone calls all night from patients and nurses, gets an average of 6 hours of interrupted sleep, and often less if he or she has to go into the hospital overnight to do a delivery or emergent surgery. Then the physician starts a new day with the same busy schedule.

The laborist model allows a physician to work a 12 hour shift, then go home and not have any further work obligations until the next shift. This would mean you would never have a cesarean section or vaginal delivery performed by a physician who did not sleep the night before. You would never have your clinic appointment rescheduled because your physician was called out to do a delivery. Patient care may be safer as physicians may make fewer mistakes that could have been attributed to sleep deprivation.

However, this would also mean that you may not see the same physician for all your prenatal visits, and you most likely would not know the physician who delivered your baby. So, how important is it for you to have the same physician perform your prenatal care and be present for the delivery of your newborn? Would you seek prenatal care at an obstetrician’s office who practiced the laborist model?

  1. Katie

    I understand both the safety concerns as well as inevitable burnout from the current model. And I agree, there has to be a change. One question is, what are patient satisfaction scores like in current-day laborist environments? I see how it would be safer and will ensure our OB/GYN's a healthier lifestyle. But is there a way to give our OB/GYN's a more reasonable schedule, increase safety, as well as still give patients the option to choose who delivers their baby? I chose my OB not necessarily to see her through prenatal visits, but rather, she was who I wanted to be in the room with me on delivery day. When she was called out, I kept my prenatal appointments. I didn't care who went down the routine checklist and ordered the labs. But I did care about my OB's practices and techniques in the delivery room. And I felt confident in her gut "judgment calls" in those practices during delivery. Because of her, I had an excellent delivery experience. Childbirth is scary enough. The laborist model seems as if we are taking away what's important to many OB patients - having the one there who's coached you all along there on the big day. What is patient feedback across the board? Is there a way to give OB's a healthy lifestyle and patients the choice of their Laborist?

  2. Chris

    Dr. Evans makes good points. I would think the most important thing is patient (mother and baby) safety. If the Laborist model proves to make it safer, then patients should be all for it. There isn't enough data to determine this yet, but the concept is a good one for many reasons. In other specialties where similar inpatient specialties have developed (IM- Hospitalists) the data clearly supports the concept as being much better for patient safety. Hospital Lengths of Stay (LOS) are shorter and patient outcomes are better on the whole. In addition doctors are much happier on the whole. I know several women who have had the "physician on call" deliver their baby & it was not the same doctor they saw every time in the office setting. I also know that there are demands on doctors, especially OB's, requiring them to work crazy insane hours, disrupt their office schedule and their malpractice insurance is out of control. There has been a change in healthcare and with a shortage of physicians projected for the next 20 years, many new medical students & residents are choosing medical specialties that offer an attractive quality of life. Doctors can't just go out and hang a sign on the door like they did in 1969. The physicians I know would give up some $ to have a better balance between their personal and professional lives. The shift - based model seems to work very well in other settings. These are some reasons why these inpatient specialties have exploded all over the country in Internal Medicine (Hospitalists), Surgery (Surgicalists), Neurology (NeuroHospitalists), and in OB/GYN (Laborists). If there is a choice between a groggy OB that you know who has been up for 24+ hrs, or a "Labotist" who is fresh & alert, I would think most would opt for the Laborist. There has to be better communication between the office OB's and the patients - helping patients understand the Laborist concept. Most patients need better communication. A Laborist is simply another site - specific doctor (like an ER DOC) who spends 100% of their time caring for inpatients. It is a very safe and a positive thing and a proactive step. I think patients will adapt better if this happens. They (the patients) get the "blessings" from their OB that the Laborist is a good doctor / concept with excellent training and qualifications and works in partnership (not necessarily employed by) with their practice. In other specialties, there are websites and brochures for patients and we are begining to see more of this. The laborist model is relatively new and I have seen some sites that have some additonal resources when I Google the concept like www.laboristjobs.com and hospitalistjobs.com for Internal Medicine.

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