Hospitalist programs add a new dimension to health care

By Krista Brick
Special to The News-Post
http://www.fredericknewspost.com

OLNEY — Dr. Gloria Grover wanted to have a life, not just a career as a doctor of obstetrics and gynecology. A new program at Montgomery General Hospital in Olney is helping her find that important balance between work and a personal life.

Grover had a private Ob/Gyn practice in Northern Virginia, including two offices.

“I never got home. I was stressed all the time. I was looking for something where I could have a life and a family,” she said.

She found that compromise working as an Ob/Gyn hospitalist. Montgomery General is one of a growing trend of hospitals using hospitalist programs in different specialties to provide safe care for patients while helping physicians maintain a healthy balance of career and family. Shady Grove Adventist Hospital in Rockville also uses the same type of program.

The OB hospitalist program works by having a dedicated OB physician on-site at the hospital to care for all unassigned OB patients who come to the hospital and also to assist private OB doctors with their patients. The patient benefit is access to a board certified Ob/Gyn upon arrival at the hospital instead of waiting for an on-call physician to arrive.

For the Ob/Gyns in private practice, those doctors can wait longer to attend to their patient who has come in to deliver, knowing an Ob/Gyn hospitalist is in direct communication with them and will alert the private physician when the patient is ready to deliver. They also will no longer be called in to care for patients who are not their own.

“The nice thing about it is that you are fresh and ready for the patients. In private practice you never know when your day will end and you are oftentimes exhausted,” Grover said.

Grover serves as the interim medical director for the OB hospitalist program at the Maternal Newborn Center at Montgomery General, overseeing three full-time and four part-time hospitalists. She said she no longer has to deal with insurance companies and the paperwork that comes with that.

“It’s nice to care for patients without having to do the paperwork. This is a lifestyle issue for me,” she said.

Dr. Daniela Meshkat, an OB hospitalist with Montgomery General, said this program has provided her with more flexibility and relieved the stress of dealing with insurance companies.

“I know ahead of time the hours I will be working, I don’t have to deal with the insurance companies and I receive fair compensation for my work. This type of dedicated program is beginning to evolve around the country and more Ob/Gyns are choosing it. I especially see this appealing to female Ob/Gyns with children,” she said.

Montgomery General launched the OB hospitalist program in April after local doctors approached hospital administration with the concept. The hospital already has an internal medicine and a pediatric hospitalist program in place.

“For us it has been a great physician pleaser and satisfier,” said Lynne Myers, vice president for corporate strategy and professional services for Montgomery General.

And that is important. In Maryland, insurance, malpractice and lifestyle issues have forced nearly 25 percent of the state’s 700 practicing Ob/Gyns out of obstetrics, according to the American College of Obstetrics and Gynecologists. ACOG also lists Maryland as one of the 23 states experiencing a crisis where Ob/Gyns are closing their doors, limiting services or retiring early.

“Our hope is that by creating programs like the hospitalist program and making a safer environment for nurses and doctors to practice in, and patients to be treated in, makes hospitals more attractive to new physicians,” said Dr. Raymond Cox, chairman of the Maryland chapter of ACOG and chairman of the Ob/Gyn department at St. Agnes Hospital in Baltimore.

In addition to the lifestyle challenges, OB physicians also face skyrocketing malpractice rates and low insurance reimbursement rates.

“We need to make sure insurance payment for women’s services is similar to payment for services given to men,” Cox said.

At Shady Grove Hospital, OB hospitalists have been caring for patients for two years. The OB hospitalist program joins many other similar programs at the hospital, including surgical hospitalists.

“Prior to this program, we were dependent on the OB coming in. This is a better system,” said Dr. Gaurov Dayal, chief medical officer at Shady Grove.

Montgomery General uses an outside company that employs the hospitalists. Shady Grove’s hospitalists are part of the staff. While Frederick Memorial Hospital does not have a dedicated team of OB hospitalists, OB doctors rotate on 12-hour call shifts to handle mostly urgent and emergency patients who arrive at the hospital, according to hospital spokesman Harry Grandinett.

“The stipend each OB receives for the 12-hour on-call rotation coverage is additional income they are able to use to help cover the cost of their malpractice insurance,” he said.
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