Saturday, March 21, 2015

Thoughts

I'm in an employed group of OBs, fairly largish group. We are looking at expanding due to increased volume - lots of solo docs in this area have left for various reasons. The closest OB group (next town and hospital over) has imploded and those patients are coming to us now. My last few calls have been hellish. My office manager just says "RVUs! Think of your bonus!" Fuck my bonus, at that point, I just wanted sleep.

We're looking at a laborist model when we add our newest doc (and yay, she starts soon!). I have to admit, I would be all over that, no running back and forth between office and the labor deck (which is worth about 4K steps per call according to my new fitbit). No trying to juggle over where we need to be. Just spending shifts on OB, in-house. Or staying in the office & being able to fully be THERE. No need for rescheduling patients because of a delivery.

It would mean that I could effectively work full-time while keeping multiple days off per week. I like the part-time gig, it gives me time to keep my household functional. I can run the kids to lessons and fix dinner. I don't need to hire a cleaner because I can do things over the course of the week. It means I can chaperone field trips (which remind me why I am not a teacher).

Interesting things to ponder. I'm a year into this contract, will need to renegotiate if all of this comes to pass. Overall, this place was a good place for me to land. Reasonable administration, good group, nice hospital, great nurses. It's not perfect, but it's good enough. I'm not stupid; I'm planning on retiring from here unless my husband gets a better teaching job elsewhere. I hope not, I'm not up for moving yet again.

Like I told one of my partners, I'm too old for this shit. OB is hard on your sleep schedule. OB is physically draining. I got home the other day from a post-call office day and made it to the couch. I literally was feeling my legs throb and ache. I just wanted to do something mind numbingly dumb, so I harvested supplies on my Clash of Clans game.

10 comments:

Unknown said...

My daughter is an OB/GYN and I know how exhausted she is at the end of some days. I feel for you both.

Liana said...

Wait... you don't follow this model already?

I'm part of a group of family docs. We do 1500 deliveries a year, and we take turns being on call (we do 12 hour shifts because our volumes are pretty high and 24 hours was getting ridiculous).

The one downside is that with almost 20 doctors in our group, our patients don't get to know all of us before they deliver. But I've been told that they also appreciate having a fresh, well-rested doc instead of one who might have been up every night a few days in a row. The patients also really like not having to wait in the office or be rescheduled.

And as you pointed out, you don't have divide your attention and you get better boundaries between work and personal life.

Anonymous said...

Hrrrmmmmmm, I have mixed feelings on this. I absolutely appreciate that my OB has a life and family outside of work. That being said, she was at both of my 2AM deliveries and I'm so appreciative that she was there. I selected her because I have 100% trust and confidence in her and I wanted her at my delivery.

During my first delivery, I remember thinking that I didn't care if the janitor was there- the baby just needed to come OUT! The truth is, I knew she was showing up and that was such a relief for me. In my most vulnerable state, I am glad that she was there. I would not have had the same level of trust with anyone else.

I think if you don't want to/can't be there for your patient's deliveries (outside of a call rotation schedule)- then possibly you should consider not seeing OB patients? I don't think it's fair to the patient.

Anonymous said...

After receiving my care and delivering my children at an academic/teaching hospital, where they should set up bleachers for the crowds of students, interns, residents, attendings, etc., I can say with great confidence that I was totally fine with whomever it might have been delivering my babies. Besides, let's be honest...the person you really need to trust is whatever L&D nurses are at the bedside in the hours of labor your spend. They're the ones who are going to physically be with you the majority of the time and keeping your physician in the loop of what's going on. I'm definitely NOT minimizing the role of the physician; I'm merely pointing out that it is the nurse who will physically be with you during your 1, 2, 4, 12, 24 however many hours of labor.

If someone was a laborist and that was ALL they did, I'd still be 100% confident in their skill and ability to safely deliver a baby. I'm also very confident that pretty much any OB with experience has delivered an exponentially higher number of babies than I have (um, thousands versus my 2) and are more than capable of performing the task with professionalism and care.

Fortunately, the majority of practices will tell OB patients upfront the procedure for delivery and who will be present. In my experience, in large practices the physician on call is the one who will deliver the baby and not necessarily the OB with whom one has used for her care. I'm not sure how a laborist would be much more different than that?

One of my acquaintances is an OBGYN who sold his half of the practice he founded, went into semi-retirement, and simply picks up shift work as a laborist. He takes 2-3 shifts a week, delivers babies as needed, still gets to do what he likes, but can enjoy retirement and his grandkids.

Ah medicine. One of the very few professions where consumers desire, um I mean demand their providers be accessible to them 24-7. Then turn around and bitch about how expensive medicine is and moan about how "rich" doctors are.

Roles such as the laborist, in my opinion, are humane for the provider, efficient for the patient, and kinda already sort of what large practice/rotating call physicians already do. A work-life balance with benefits for all parties involved!

Anonymous said...

All of my deliveries have been with whoever is on call at the time. I love my main doc who has seen me through some issues, but I understand he needs a life as well.

rural_obgyn said...

I am reading Anonymous 10:19 AM's comment for the zillionth time, still trying to understand exactly what she is saying. She writes:

"I think if you don't want to/can't be there for your patient's deliveries (outside of a call rotation schedule) then possibly you should consider not seeing OB patients? I don't think it's fair to the patient."

Ms. Anonymous 10:19 AM, are you really saying that if I can't be there for every single patient's delivery, then I should give up OB?

With respect, I suggest that you try to be on call 365/24/7 (and not for your beloved children, but for strangers) for a few years and see how you feel then.

ER's Mom said...

I am not going to come in on my days off for most patients. That is why we have a call schedule. I'm sorry, but I value my kids and family more than my patients. I did the solo practice 24/7/365 and it damned near killed me.

Having said that, I have a few patients that I "special", as in I will come in to deliver even if it's my day off. Most of them are psych patients or abused teens with whom I have a good therapeutic relationship. But I choose to do it. My next patient that I'm doing it for is due on my husband's birthday - I have told her that she CAN'T go into labor that day.

Patients in our practice are told at the very first visit - we have a call schedule. You will be delivered by whoever is on call if you come in spontaneously. We don't hide the fact that we share call. I like to deliver my own, if there is need for induction, I always schedule them for my call days or days that I'm in the office and I'm pretty sure it'll be a quick induction (the multip who is already 4 cm dilated, for example). But I will not go back to what I was doing.

And I laugh at the idea that someone thinks I'm not dedicated - I'm part-time yet I'll be at the hospital 6 days this week (Sunday - Friday). Part-time in medicine is totally different from part-time in the real world.

Gina Nelson said...

I just stopped by to introduce myself. I am also an Ob/Gyn, 53, three grown kids, finished residency from UCHSC in 1994. Since then I have been in a busy private solo practice. I know, crazy. There is one other group practice in town, and they are also still private. But that is all soon to change. We are being eroded by lay midwives, our own CNMs who I supervise, now family medicine resident who just came on this year, and new docs the hospital is hiring. So, I decided if I can't beat em, join em. I will be a hospital employee in a couple months and for the first time ever I will have real vacation. So I am definitely picking up what you are putting down. Please add me on Facebook or whatever. You can find me at my site drginanelson.com. I'm enjoying your blog.

Gina Nelson said...
This comment has been removed by the author.
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