Preventing hospital OB burnout at the holidays

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As OB/GYNs we are all too familiar with holiday call shifts. On the one hand, our work family on Labor & Delivery always manages to make any holiday more joyful (potlucks and homemade goodies), not to mention the babies we help deliver and mothers for whom we care.

But our own families are where our heart truly lies and we often miss family dinners, elaborate board games and holiday movies on the couch.

Hospitals never close. And newborns never take a day off. OB/GYNs often struggle to strike the right balance between their professional responsibility to care for patients over the holidays and spending time with family and/or taking some time to restock depleted emotional and physical reservoirs. Those pressures are contributing factors to the high rate of OB burnout. According to a 2018 report on burnout, OB burnout ranks fourth out of 29 specialties.

While it is imperative to address clinicians’ struggle with burnout on the individual level to ensure healthy and well-balanced caregivers, OB burnout also represents a serious threat to hospital operations.

In early stages, burnout is associated with mood swings and irritability, which is bad for team morale. Without intervention, burnout can impact care delivery, leading to unintentional errors, legal exposure, and reputational risk. Extended burnout can even result in turnover or physicians leaving medicine altogether. Given the projected scarcity of OB/GYNS – a 2018 Doximity report revealed that many OB/GYNs are approaching retirement, and the American Congress of Obstetricians and Gynecologists projects a shortage of up to 8,800 OB/GYNs by 2020 – OB burnout not only impacts the ability to deliver care to pregnant women right now, it also seriously jeopardizes the patient pipeline into the future, given that the birth of a baby often begins a family’s long-term relationship with their community hospital.

While there is no getting around the need for OBs to “stop, drop and get to the hospital,” hospital administrators can help to lessen the pressure on OB/GYNs by minimizing onsite duties, especially at the holidays:

Consider being an “early adopter” of telehealth options that allow patients to be monitored remotely. Remarkable advances are being made in wireless technology that monitors maternal and fetal vitals such as heartbeat, transmits data to the cloud, and can be viewed on a web portal. A 2015 study in PLOS One of a prototype remote monitoring device found both pregnant women and clinicians found the technology likable (81.3% and 66.7% respectively), useful (96.9% and 66.7%), and would either use it again or recommend its use to another pregnant woman (77.4% and 66.7%). Greater use of these and other telehealth options could maximize clinician time, allowing them to monitor from a remote setting before heading to the hospital when needed.

Implement an OB hospitalist program to support community OB/GYNs. OB hospitalist programs provide 24/7 coverage and support to community obstetricians until they can arrive at the hospital or when the woman has no assigned obstetrician. In addition, many OB Hospitalist programs allow the community physicians to sign out their practice for the night, the weekend, or the holiday. In this way, OB Hospitalists can decrease burnout by improving the work-life balance of OB/GYNs.

For example, at OB Hospitalist Group (OBHG), our Obstetric Services Agreements allow the majority of clinical services [triaging of emergent patients, call coverage, C-section assist and first assist, patient checking and monitoring, daily rounding] to be covered without charge to community OBs. If OBHG hospitalists manage labor or perform a delivery, our OSAs allow OBHG to link our provider number to the community physicians, allowing them to bill the complete delivery bundle and not break the global; OBHG then charges the physician based on time spent. These collaborations relieve pressure on community OB/GYNs and help to preserve the length of their practice.

Collaborate with midwifery providers for postpartum care. It’s not only deliveries that require clinical time, attention and resources; data shows that nearly 35 percent of pregnancy-related deaths occur well after delivery. In conjunction with OBs, EDs are central to identification and treatment for emergent postpartum situations. But in addition to the usual daily pressures, EDs are subject to additional holiday stresses, with lean staffs and more low-acuity patient conditions usually handled in (closed for holiday) offices and clinics. Certified nurse midwives can help with in-person postpartum visits, checking vital signs, and providing ongoing emotional and physical support and counsel. They can provide essential postpartum care and minimize avoidable readmissions, while alerting physicians to any medical concerns that might require an emergency visit.

Physician burnout is at epidemic levels, but hospitals can create a work environment that both respects boundaries and supports the practice of medicine – even at the “most wonderful time of the year.”

Jane van Dis, MD, is a Board-certified OB/GYN and OB hospitalist in Burbank, CA. She serves on the clinical leadership team for Ob Hospitalist Group.

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