Patient Care, Physician Support and Staffing Among Top Concerns for Obstetricians According to New National Report
Greenville, S.C.– Ob Hospitalist Group (OBHG), the nation’s largest and only dedicated provider of customized obstetric (OB) hospitalist programs, released findings from a national survey of OB clinicians identifying top practice and care concerns. The report, “Future of Obstetrics: Industry Survey Report,” found a majority of the 1,130 obstetrics clinicians surveyed in communities across the U.S. cited patient care, physician support and staffing as top concerns in 2021.
“Concerns about physician support, providing care, staffing, maternal mortality, and costs demonstrate there are multifaceted concerns with providing care in these unprecedented times,” said OBHG Chief Medical Officer, Dr. Mark Simon. “Partnering with the Ob Hospitalist Group alleviates some of these issues, but the report findings highlight considerations for additional measures that could be taken to support optimal patient health outcomes.”
Obstetricians concerned over patient access to consistent care. “Inconsistent standards of care” was among the top safety risks cited by 38.5% of respondents. OB hospitalists named “inconsistent standards of care” more than double the percentage of community OBs as a high safety risk (53% vs. 22%). This is likely due to the OB hospitalists 24/7 presence on the unit, and their visibility into the care provided across the unit according to the report.
Obstetricians seek support. Physician support and care was named by 39% of respondents as a significant concern. Physician support and backup was named by 41% of obstetric hospitalists and 30% of community obstetricians as a top concern (no. 2 overall). There was not a significant difference in responses regionally or based on number of years of experience.
Staffing crisis is top concern among hospital obstetricians. In addition to prevalent concerns about physician support, the nursing shortage was named by 58.4% of respondents as the biggest safety risk. Physicians with 25 or fewer years of experience ranked nursing shortages as a higher safety risk than physicians with 26 or more years of experience (55% vs. 46%), while OB hospitalists ranked it higher than community OBs (58% vs. 48%).
“Call schedule” is top factor in employment decisions. 85.4% of obstetricians said “call schedule” was the no. 1 criteria when making an employment decision (no. 2 was “pay” at 74.7% and no. 3 was “type of work” at 69.1%). The report noted younger OB/GYNs are seek more stability and work-life balance through employed vs. independent practices. Younger OB/GYNs are looking for more stability and work-life balance through employed versus independent practices.
OB hospitalist programs are increasingly hired for call coverage. Respondents also identified how the primary hospitals provides call coverage for obstetrical patients. 37.8% of hospitals provide an internal OB-GYN hospitalist serves, 20.5% of hospitals use an outside company to provide hospitalist services, and 13.2% report their hospital uses a private OB-GYN hospitalist service. Despite variations in how programs are run (insourced vs. outsourced, services offered) and variations across geographies, 24/7 in-house coverage appears to be the dominate coverage model solution.
Resources and support are top reasons why obstetricians deliver at their current hospital. The top three reasons obstetricians deliver patients at their current hospital are access to resources for high-risk deliveries (58.5%), presence of on-site support (56.6%) and Neonatal Intensive Care Unit (NICU) level (care based on the complexity of medical conditions the facility is equipped to treat). As support, many obstetricians reported accessible patient education, hospital-wide focus on women’s health, understanding of evolving risk and presence of an OB hospitalist program.
OB/GYNs are also concerned about the national trends in maternal mortalities. Maternal mortality was by far the highest priority for the next five years, with 59.2% of respondents identifying it as “highest priority” and only 6% identifying it as “not a priority.” This pressure will only grow as racial and ethnic minorities face persistent differences in the quality of healthcare, especially in hard-to-serve communities. The increasing national focus on maternal outcomes and safety among vulnerable groups is driving the adoption of maternal level of care designations, many of which require on-site OB coverage. Several survey respondents noted that hospitals and administrators must place more importance on and prioritize women’s healthcare in general in order to effectively reduce high maternal mortality rates.
Telemedicine is expanding rapidly and permanently. When asked to predict changes in obstetrical care, respondents said the use of telemedicine (81%) would increase the most over the next five years. Telehealth expanded rapidly during the COVID-19 pandemic and obstetric medical professionals are advocating for making temporary practices permanent. Respondents who predicted greater adoption of telemedicine had fewer years of experience (6 percentage point differential between 25 or less years and 26+ years) and that more OB hospitalists thought the telemedicine trend would increase (13 percentage point differential between OB hospitalists compared to community OB respondents).
OB specialization is predicted to grow. Respondents also said an increased focus on sub-specialization (79%) and use of mid-levels (76%) will increase the most in the next five years. Maternal care such as gynecology-only and OB hospitalist care increasingly requires medical specialists to care for specific systemic illness. As professional medical specializations narrow, the need for knowledge and skills especially in labor and delivery units will grow.
“The survey reveals some startling gaps in physician and patient support all along the care continuum in obstetrics and OB hospitalist programs filling them,” said OBHG CEO, Lenny Castiglione. “As pressure builds on OB units to improve care and reduce costs, and as clinical resources are stretched in the continuing battle against COVID-19 and its variants, health systems need to take serious measures to fill these gaps through staff recruitment, retention, and training.”
About Ob Hospitalist Group
Since 2006, Ob Hospitalist Group (OBHG) has led the nation in elevating the quality and safety of women’s healthcare by delivering 24/7 real-time triage and hospital-based obstetric coverage to ensure consistent, timely care for patients as well as collaborative, non-competitive support for local OB/GYN physicians. As the original architect of the obstetric emergency department, OBHG ensures that every expectant or postpartum mother presenting to the hospital receives consistent and unconditional medical care by an experienced physician. OBHG leverages its national network of dedicated clinicians in partner hospitals across the United States to develop best practices in care that improves patient outcomes, reduces care variability, and drives operational and financial efficiencies. OBHG is headquartered in Greenville, SC. For more information, visit www.OBHG.com.