Working as a Traveling OB/GYN

Transcription:

Michael Smith, MD (Host):  So, what’s it like to work as a traveling OBGYN? This is the Obstetrics Podcast. I’m Dr. Mike. Let’s talk with Dr. George Kingsley. Dr. Kingsley served in the Army Medical Corps; he has held leadership positions in the Cleveland Clinic Health System. And he spent ten years in solo practice. He is now working as an OB Hospitalist Group Diplomat. Dr. Kingsley, how is your travelling OBGYN program different say from a typical locum tenens position?

George Kingsley, DO (Guest):  I would say the primary difference is our commitment to OBHGs vision and we’re in a unique position where working in a startup new hospital program environment, we’re oftentimes the first people that the doctors, the hospitals, the nurses and the administration are seeing from OBHG while they are getting permanent staff set up. So, we kind of come in as ambassadors of the company, transmitting the company’s values, our goals, our experience, our insights as to what works. Locum tenens, they come in, they fill a spot, they are technically a definition of a placeholder, they just come in and work a shift, but their commitment is not necessarily to the long term success of an OBHG programs. So, I think the biggest difference is just we come in with a broader vision of what we’re trying to accomplish and trying to impart some early success to a program.

Host:  So the OB/GYNs who join the Diplomat travel program are quite experienced with a track record of success and a high level of clinical skill, is that correct?

Dr. Kingsley: So, clinical skills is kind of a given, but then they look for people with leadership experience, they look for people with the ability to do this kind of travel program which requires a little bit special skill set and then see what works to get a new program up and running and with a full head of steam.

Host:  So as a Diplomat you’re not just going in to practice the clinical aspect of OB/GYN – you’re helping to establish how each unique obstetric hospitalist program will be run, is that true?

Dr. Kingsley:  We’re trying to elevate standards across the country. My programs are all Texas based. So, that makes me somewhat unique in the diplomat program in that I’m only working in one state. But we come into a hospital with their goals, their expectations, their unique cultures and the kinds of problems that they are trying to overcome. Some programs, we come into have quality problems, they have high C-section rates, they have high complication rates and we come in as a way to try to help elevate the standard and bring some of our expertise as well as providing the inherent safety of having an in house OBGYN 24/7.

Host:  How is your program, and how are your doctors viewed by the physician community in general that you are going into?

Dr. Kingsley:  It’s kind of a varied mix. At first, a lot of community physicians aren’t sure what our motives and our goals are so some see that we’re going to come in and we’ll somehow be a threat because none of us have private practices and we’re not able to refer patients to ourselves or to colleagues. We’re just basically there to make their labor and delivery environment safer, to always a physician there when an emergency happens while the doctor is on the way or the physician is tied up in surgery or in other clinical responsibilities. We can fill the gap while they’re making their way to the patient. Our company does an excellent job of collecting data on our encounters that raise the level of safety and promote good outcomes.

So, generally there’s a transition period but usually within three to six months, we have 100% physician buy in because they realize the value of what we’re bringing to the program.

Host:  What do you like most about being a I guess we can call it a mobile hospitalist. What’s the good stuff and then of course, Dr. Kingsley, there always is, what’s the stuff you’d like to see changed?

Dr. Kingsley:  I was part of five new hospital startups this past year and so to kind of come into a hospital that really has no idea what our program’s going to bring, they all got the chance to hear what our vision is and what kinds of services that we provide and we tailor make our program to the hospital and its culture and its environment. But it’s just exciting to be able to come in on the front end. Most of the programs that I was part of the startup, we had new physicians coming into OBHG, we had a very large expansion in the company over the last several years so, a lot of physicians were coming in without experience as hospitalists. They are proven clinicians, but they’ve got a lot to learn about what it is to do the job, to do it efficiently, to do it practically, to do it good outcomes. So part of it is kind of being an onsite trainer for new team members and even new team leads. Each program has a team lead or a site director that is responsible for that program but again, many times those people are inexperienced in OB hospitalist work and so, I think one of the most positive things for me is to be able to kind of help be an onsite mentor and trainer for these new physicians coming into the company. And to make sure that our product across the board is consistent.

So, that’s the most exciting part of being a travelling or diplomat with NOBHG. We can see immediately improvements onsite at the different hospitals and the nurses are ecstatic to have someone there to do the things that oftentimes they were being asked to do that might have been outside the scope of nursing care. So, we get that immediate response of wow this is going to be really good. The downsides to travelling is you establish very quick relationships with these new hospitals, but you know it’s the relatively short term contract that you are going to be a part of. Because I’m basically there until they get a full compliment of staff on boarded and credentialing processes take three to six months depending on the hospital so, I might be there at a hospital for two months, or three months or four months but generally it’s going to be a limited encounter and so you develop those relationships quickly which is a requirement for the job is to be able to establish rapport very quickly, to establish relationships quickly to instill trust and then knowing that you are going to leave. So, that’s kind of hard. You establish those relationships quickly and then you know that you’re going to move on.

But by the same token, I’ve circled back to programs that I was part of a start because I’m still a back up for these other programs even when they’re fully staffed and when you come back just to see everybody excited to see you come back and say hi and see what’s happened in the meantime. Logistically, the hard thing is that oftentimes your travel days between these different locations, those are your off days. And so, traveling on your off days is not always a full recharge of the battery. So, most of the time, when I’m travelling for assignments, I’ll go, and I’ll do two or three shifts in close order and then travel back home and have a few days off. But sometimes it’s a travel day home and then the next day is a travel out to the next location.

Host:  Let’s talk a little bit about the logistics because I’m sure there’s some physicians listening to this that are interested. Who decides where you are going and how long you stay? Are you involved in that decision or is this made at more of an administrative level in the company?

Dr. Kingsley:  It’s more at a kind of a combination. We have a separate Medical Director just for the diplomat program that’s kind of a VP level position a physician who is in charge of all the travelling physicians. So, she’s the one responsible for making sure all of her doctors are getting enough shifts and that we have enough diplomats in the program to cover our needs. But that’s always in conjunction with the development side of the company, new programs that are on boarding, what’s the schedule, what are their needs, working with recruiting and HR in terms of getting new physicians in and so there’s lots of different pieces that have to fit and so I’ll be contacted and say heh we are going to have a need at this hospital in this city, we’d like to go ahead and start credentialing you for that and as soon as you are credentialed then we also have a scheduler who has to keep track of how many different places people are at any given time.

So, lots of moving pieces, but –

Host:  Glad there’s a lot going on, right? It sounds like it.

Dr. Kingsley:  There’s a lot to make that happen and then once we get a program fully staffed and everybody’s comfortable and everybody is good and plugged in, then my shift count at that location will go away and I’ll get plugged in somewhere else.

Host:  Do you get to let’s say you’ve been going from one hospital to the next, you said you are in Texas, right, so let’s say you are from Dallas to Houston to Austin and there’s another assignment for you coming up, are you allowed to take a break? Is there vacation time built in to this? How does that work?

Dr. Kingsley:  We are generally contracted to work a certain number of shifts. We work in a 28-day pay cycle, scheduling cycle and so once you’ve worked your allotted shifts so they can say heh, do you want to go, can you pick up an extra one or two, we’ve got a need, and you can say yes or no. but once you’ve done your allotted shifts, then the rest of the time is time off so. That’s one of the beauties of the hospitalist lifestyle is you choose how many shifts a month you want to work and once you’ve gotten those shifts on the schedule, then the rest is time that you can travel or spend time with family or whatever it is you like to do.

Host:  Right. So, which physicians do you think are best suited for this kind of work? And maybe what are some of the important traits and skills that you think are necessary to succeed in this type of mobile hospitalist system?

Dr. Kingsley:  I would say the biggest one is flexibility. A lot of times when I see new physicians coming into the hospitalist role for the first time, they’ve spent a lot of time at one particular hospital and one particular setting, one particular way of doing things. And those people oftentimes have a little bit of a rocky start because they are coming into a different environment, not every hospital operates the same way, not every unit has the same culture and so I’d say the biggest requirement is just the ability to come in and realize that things may not be the way that they were done at your primary hospital or the one that you’re used to doing and that there are different ways to do things and being able to be flexible and adjust your style to the local environment.

In the same light, I would say being able to multitask is a huge plus. Some physicians are really focused on one patient at a time, one problem at a time but our environment is pretty dynamic. There are usually multiple things going on at the same time and then you’re getting called for an emergency, a postpartum hemorrhage on the floor or a patient has a prolong deceleration, fetal heart rate deceleration and you’re getting called to come assess the patient while their doctor is on the way, while you’ve got multiple patients that you are working up in the obstetrical emergency room. So, you have to be able to handle multiple balls in the air at the same time and some physicians are really good at focusing on one patient and one problem at a time; but that doesn’t really work well in the dynamic environment we find ourselves in.

And then the other thing I think being a people person, being extroverted, being able to communicate, spend time with the nursing staff, the community physicians, talk to them, share a little bit of your story, find out what’s going on with them and developing those relationships is really important. People who come into the program and want to stay in the call room or stay in the obstetrical emergency department and have few interactions with other people generally don’t do as well. So, it’s a matter of just putting in the extra effort to get to know the people you are working with, to share a little bit and to find their story and it’s amazing how quickly all of the sudden they are trusting you with their patients, they’re trusting you with making sure that their patients get the best outcomes.

Host:  Right, right. So, again, you mentioned that you’re in Texas. It that how it is for most diplomats that they are in a certain state or region or are most diplomats potentially going all over the country?

Dr. Kingsley:  I believe I’m the only diplomat that is a single state player. So, we had so many new programs in Texas over the past two years that they’ve not required me to apply for licenses in neighboring states or nearby. But most diplomats operate in a multistate environment. We have some states that only have one program so, you could be at that program but then your next assignment you are going to be going to a different state. So, most of the diplomats I believe almost all of the other diplomats have multiple state licenses and have programs that take them a little bit further. Texas is a big state. I go from northeast Texas and Texarkana all the way to El Paso and those are 14 hours apart by car.

Host:  Yeah, that’s true. Texas is like its own country, right? It’s huge.

Dr. Kingsley:  Yeah, it is big. So, I’m used some base and I worked nine different programs in 2019. So,

Host:  Wow, so you were very busy. You mentioned that it’s a lot of the diplomats will have licenses in multiple states. If a physician is interested in this and becoming a diplomat, and they only have one license in the state that they applied for and that’s where they practice; does your program, does the company help them get some more of those multi state licenses? Is there financial help for that? Is there help trying to pass some of those tests that you got to take? How does that work?

Dr. Kingsley:  Yeah, the company will get you a will support financially the process of getting your application. It’s up to the individual physician to apply to each individual state and meet their requirements for licensure. But the costs of licensure, your DEA, if the state has a local DEA which Texas does, you have to – they’ll pick up all of those extraneous costs and sometimes you have to actually do an in person interview and they pick up that. So, they’ll help facilitate. The physician still has to do the leg work of making the actual application to a second or a third or a fourth state. But they have credentialing people that constantly are working with the different hospitals in terms of all the credentialing process. So, they let you know heh this is what we need, and you give them that document and then they have got that on file for the next hospital or the next state. So they do all that for you.

Host:  So the company does help with a lot of that administrative and financial burden that we know happens when you are trying to get other licenses. What if there’s a diplomat who is doing this, travelling around and then they get into a hospital or a program that they really like and maybe they want to stay and settle down in one place. What happens then?

Dr. Kingsley:  They would make that interest known. Each hospital has got a Medical Director assigned to it. And then they would also work with the Medical Director over the diplomat program and they would express an interest and if there’s an availability, if there’s still an unfilled slot, certainly they would be a candidate and they’ve already got a foothold in that program, they already know the hospital, they already know the administrators and the community physicians. So, it’s a pretty easy thing to do to say okay, we’re going to take you out of the travelling rotation and make you a permanent part of this team. so, and that’s one of the nice things about the diplomat program is if you’re flexible about where you live and you want to try on different hospitals, it’s a great way to go and say heh this is really where I want to practice, this is where I want to a part of a team, this is where I want to live.

Host:  So, that works out for some. Yeah.

Dr. Kingsley:  Yeah, so the diplomat program is a nice way to kind of go on and try on different programs and see what’s a good fit.

Host:  Dr. Kingsley, in summary, what would you like other physicians to know about working as an OB Hospitalist Group diplomat?

Dr. Kingsley:  It’s an exciting and dynamic way to practice as opposed to just being at one hospital in private practice where your environment doesn’t change. This give you a chance to be part of a growth of this company and then to be a part of a vision of the company. And to really be a part of making labor and delivery safer across the country. So, it’s a very exciting and dynamic way to practice. Everyday is different. In one week, I was in four different hospitals. So, you just never know your schedule is going to be a little bit unusual. When I first joined OBHG, I was one hospital and I was at that same hospital for over two years and I worked with the same players and the same docs and the same nurses and same administrators and I knew what my schedule was going to be. I was going to do two shifts a week and it was pretty set. The travelling part with the company is a completely different environment. you’re jumping from site to site, different electronic medical records, to the next. You have to keep very good notes for each hospital about okay, how do I get into the hospital. What are the codes? What are the – what’s my password for that EMR. It’s not for everybody. But for me, it’s been an interesting transition at this point in my career and yeah.

Host:  That’s great. That’s Dr. George Kingsley. He’s an OB Hospitalist Group Diplomat. I want to thank you for checking out this episode of the Obstetrics podcast. Please visit www.obhg.com to learn more about the diplomat program. That is www.obhg.com. I’m Dr. Mike Smith. Thanks for listening.