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Comment and Controversy

Laborist model is “abhorrent”

November 2007 · Vol. 19, No. 11
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“Laborists, nocturnalists, weekendists. Will the ‘ists’ preserve the rewards of OB practice?” by Robert L. Barbieri, MD

I’ve been in practice for about 30 years, and I have never been so glad that I am approaching retirement. What has happened to our specialty? I really hope your tongue was in your cheek when you wrote that editorial. I find it disturbing that a laborist might be managing the whole labor and then, just before delivery is to occur, the so-called personal obstetrician steps in. Babies are born at all hours of the day and also on week-ends and holidays; it’s the nature of the profession.

Laborists are an abhorrent idea. Just when the patient needs the calming influence of “her” doctor, someone else comes in and introduces him/herself as “your doctor for the night.” What will a patient think when she has gone to a “boutique” practice for 9 months and then shows up in labor to be managed by a laborist? Who is going to manage preterm labors in nervous patients, and who is going to manage postpartum complications if they take place after convenient hours?

Malpractice lawyers must have created this “ists” idea because it will make them all very wealthy. If current and future ObGyns find the work too difficult, they should consider training to be another kind of “ist”: dermatologist, pathologist, psychiatrist….

Roger Cayer, MD
Choctaw National Healthcare Center
Talihina, Okla

Dr. Barbieri responds: OB practice is changing

I appreciate the thoughtful responses from Drs. Cayer, Lurvey, and Mann. I resonate deeply with the commitment to the traditional model of obstetrics in which a small group of “like-minded” obstetricians personally provides direct care to their patients and cross-cover during nights and weekends. However, all indications are that we are at the threshold of a major change in obstetric practice and will need to lead and adapt to it over the next decade. Many dynamic factors, including the patient-safety movement, the growing desire to better balance family and work-life, and the significant problem of physician burnout are pushing us toward a “laborist” model. The Web site mentioned by Dr. Mann provides a good overview of some of the advantages and disadvantages of the laborist model.

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