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Comment and Controversy

Stable group practice can eliminate need for “ists”

November 2007 · Vol. 19, No. 11

“Laborists, nocturnalists, weekendists. Will the ‘ists’ preserve the rewards of OB practice?” by Robert L. Barbieri, MD

All of the models suggested are poor substitutes for a stable group practice of like-minded physicians who share a patient base and call schedule. A group that can provide a 1:5 or greater call schedule preserves continuity and protects ObGyns from being replaced with nurse practitioners in the office and nurse midwives in the hospital. It allows one physician or her partners to continue to share the patient’s goals for the pregnancy through prenatal care, delivery, and postpartum. It can address safety issues as well. What it cannot do is lower the cost of obstetric malpractice premiums. That—rather than lifestyle—may be the root of the problem for many ObGyns in private practice.

Nathana Lurvey, MD
Culver City, Calif

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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