From a Private OB/GYN: Hospitalists are the Future of OB Services

David Afram, MD Discusses the evolving OB profession/landscape and the hospital's decision to enlist an OB hospitalist model.
From a Private OB/GYN: Hospitalists are the Future of OB Services
Featured Speaker:
David Afram, MD
Dr. David Afram is a fellow of the American College of Obstetricians and Gynecologists and has been board certified in obstetrics and gynecology since 2009. He is also a fellow of the American Association of Gynecologic Laparoscopists. Dr. Afram attended McGill University in Montreal, Canada, where he graduated with honors with a B.Sc. in biology. After completing his medical degree, Dr. Afram completed his residency training at the George Washington University Hospital where he also received the teaching award for the Council on Residents Education in obstetrics and gynecology. 

Learn more about David Afram, MD

Prakash Chandran: More and more hospitals are adopting OB hospitalist programs, which are beneficial to both obstetricians as well as their patients. Why is this model being called the future of OB services? We're going to talk about it today with Dr. David Afram, A private practice Obgyn managing partner at Capital women’s care in Arlington, Fairfax and manassas Virginia. This is the Obstetrics Podcast from the OB Hospitalist Group. I'm Prakash Chandran. So Dr. Afram, first of all, what is an obstetric or the hospitalists and what do they do?

Dr. Afram: Obstetrics OB Hospitalist is really an obstetrician, which is a Doctor that specializes in the care of pregnancy and delivery. The term hospitalist, meaning what they do is that they strictly work in a hospital labor and delivery floor. And what they do is mainly the act of caring for women who are in labor for delivery purposes. So as compared to a regular OB GYN, they do not usually have any office or outpatient encounters. Mainly they do is being obstetrician in a hospital setting, in a labor and delivery that they admit and deliver a pregnant woman in labor.

Host: Okay. Thanks so much for that clarification. You know, I know that the OB profession is something that's been evolving. So can you talk to us a little bit more about that landscape?

Dr. Afram: So additionally, an OB GYN, usually it's a very broad spectrum because for example, OB GYN is by definition it's for pregnancy and gynecology. So a general standard OB GYN physician will be someone who has a practice whether in a group setting or a solo practice and has an office apart where it sees pregnant patients, outpatient, also gynecological patients for routine gynecology exam, pap smears, breast exams, and also people with other gynecological conditions. And I go to OB GYN in that setup would for example like one day delivery baby the next day do a GYN surgery that has nothing to do with the pregnancy. In the office, see patients who are pregnant or non-pregnant for gynecological issues. That's traditionally how it's been. In the last few years it has developed into being like sort of like a domain focus. So for example, some practices or doctors are focusing more on mainly pregnancy care. Some of them becoming gynecology only in office setup, and some are doing extra training in either obstetrics or in the GI gynecological surgery. So the OB Hospitalist Group is, for example, a branch where those physicians, their passion and their work is mainly for the purpose of delivering. So they take care of pregnant people on the day or around the time of their delivery while they're in the hospital. So they do not anymore see patients in office. They do not do gynecological surgery. They're strictly dedicated to being in the hospital and taking care of pregnant person. A lot of times in association with the practices that actually these patients are patients of that practice.

Host: Yeah. So I remember when my wife gave birth, our OB basically came in as the baby was crowning, you know, other than that, we were just kind of on our own with the nurses, which was fine, but I had not expected that. And so I imagined that this OB hospitalist model is a little bit different. You mentioned that they take care of the patient throughout the day. So maybe talk a little bit about that process and the hospital's decision to enlist an OB hospitalist?

Dr. Afram: Correct. So for example, in the traditional sense of how traditionally it used to be a person who is pregnant and goes to a particular practice. This practice has one doctor or multiple doctors and on any given day one of them is on call covering the practice. So for example, when this patient goes in labor, that physician or whoever is on call for that particular group, if they are two or three or four, will go and handle the labor for that particular patient. That's how traditionally it has been. And to some extent it's also the classic way in a lot of sense. The OB Hospitalists Group is a relatively new, in the last few years it became more for the dedication of the care of pregnancy during the delivery itself. So for example, in this case, in our practice, for example, when the patient goes in labor and goes to the hospital, instead of the care being delayed until the nurses find out whose patient that is, which practice, who's the doctor on call for them, call them, get orders over the phone and then wait for doctor to arrive, in this way in a working relationship with them the OB hospitalist is the hospital employee.

So the OB hospitalist will basically evaluate that patient, decide whether she's in labor, if she's in labor, we'll admit her and we'll manage her in accordance with the patient private physician. What this is good as the hospital employed it is because it's better patient care that is very effective and right on the spot as opposed to how I said that they need to contact a physician and find out who the person on call for that particular group. Secondly, more importantly, it's for patient satisfaction because the patient doesn't have to wait for an hour or so. Her physician is for example, busy in the office or doing surgery or a little bit far away so it doesn't delay the care in that way. At the same time the patient is satisfied because a lot of time they go to the hospital and they get checked for let's say labor check and they're not in labor and they go back home. So this way I believe they saw a physician in the specialty not simply over the phone triaged by the physician and the nurses.

Host: Having just been through this, I can definitely see why the OB Hospitalist model is so much better certainly for the patient side, but Dr. Afram for use specifically. I'm curious how this OB Hospitalist model benefits you and your practice in terms of work life balance and career longevity? So maybe talk to us a little bit about that.

Dr. Afram: It has actually been great because like I explained to the traditional sense how things used to be, you are in the office, you're caring for your patient, your attention is all with the patient you are seeing. You will, for example, get a call that one of your patient is now in the hospital, came in for example in labor you'll have to stop what you're doing to the nurses and advise them of what to do at sometimes have to leave during this as like for example, a normal business hours. What this creates is for example, on one hand, obviously it affected your patient satisfaction who are in the office who now have to wait for an hour or even more for the physician to come in or have to see other physicians that they were not planning on seeing that day or they simply have to reschedule. Which obviously a lot of patients, especially in our domain expect that, but in today's changing world, that's becoming also from a patient perspective is more frustrating than it used to be 20 years ago and the understanding for that in that example, and when you go to the hospital, you're also as a physician, very pressured, very stressed.

You need to get this done as quick as possible because you have 15 people waiting on you in the office or you have something, a surgery in the OR that is being held because you have to deal now with admitting someone in labor and so on. So in that sense it increases first of all, your patients care because your attention is totally focused on what you're doing with a particular patient at that time, whether you're already at the hospital or at the office. Because when you are in the office and someone comes in labor and this way the hospitalist position will evaluate the patient and if they are in labor, they will go ahead and admit them and simply notify you to go manage. But you do not have to send anybody from the office back home or have them wait on you. So that created a lot of extra attention for us to the patients in the office. At the same time when in terms of work and life balance, it used to be that at any given moment you might be called when you're off the clock, so to speak.

So that created traditionally difficulty dealing with like personal life, family time because even if you're a part of physician, part of like three, four people groups, so every third or fourth day you're on call. So it depends on the size of the practice, but the idea of like you might be called at 2:00 AM in the morning and you'd have to go and deliver a baby, and then be sleep deprived and the next day you have your patients to see at the office that you might not have your full mental presence or you're tired or lethargic. But you still have to see those patients or cancel the office if it was a long night. So in that sense it's very much increased when you are at work, you're very productive and you are very much big attention to the patient particular need. That's where it's so much of like you need to get this as fast as possible because you have to run to the hospital to manage something. At the same time the patient satisfaction in labor and delivery with the presence of the hospitalist is a lot higher.

Because now they when they go there, they understand that they will see the hospitalist, the group that we are collaborating with. They will not have to wait for the physician to return their phone call or past time to come evaluate them or to simply be evaluated the nurses who will update the physician over the phone and then they might not even see a position altogether. At the same time, the patient's satisfaction in the office is very high because they know they will come in, come out, if the doctor is not distracted by what's happening in the hospital and after work or at nice weekend, even if you're on call this way, you have much more time for yourself and your family, which will help you recharge for the next day. While you know that your patients are being cared for. And this will provide a long longevity in the career because the burnout was high in our specialty. Like people could not do what I was describing for more than like a 10 year. And then what ended up happening, people either give up obstetrics altogether or they would want to find jobs where they don't have to take calls. So the carriers are becoming shorter and shorter.

Host: Again, speaking from my personal experience, I remember going to our OB GYN who we had a very good relationship with, but you know, we delivered on Saturday during, I think it was one of her child's birthday parties and then she had to leave to come, and we were waiting until she arrived to be with us. I remember feeling bad, I was like, wow, this, I can't believe this. And she had a reputation for never missing a delivery. And it's a blessing and a curse to have it that way because you know, yes, you might be popular, but you're also sacrificing so much of your personal life. So I 100% understand where you're coming from and what you're saying here. I'm curious as to from a patient perspective, what is the OB GYNs relationship with the hospital that's adopting the OB Hospitalist model? Are they clear with the patient, Hey, when you go into delivery, you're going to be handed off to a Hospitalist and they're going to care for you. How does that work?

Dr. Afram: There are different ways of doing it, but in our particular situation, for example, normally the hospital, we do inform the patients from the beginning to pregnant person that as far as the cause and involved and as far as after hours night, the Hospitalist group are part of collaborating with our practice. So they are part of our call group if you will. So they do understand that anytime they go to the hospital because of the pregnancy, for example, the baby's not moving or they think they're in labor or they're actually in labor. The first physician will see them is the Hospitalist. And this is part of our framework and collaboration with the Hospitalist. And they're usually very satisfied or at least, you know, let us do it because they don't understand what is the difference. But then we've been doing it for a long time and it has been very successful from a patient satisfaction standpoint. So the patients are not as surprised on the day they are in the hospital that is the arrangement.

Host: You know from again, when, when we were going through it, it's almost like we had to have permission from our OB GYN to come and to deliver the baby. It would have been great to have a Hospitalist there from the very beginning. And just knowing that we'll as we're going through the different stages of delivery, that they're going to be there throughout the end and it's just, it feels like a much better system for both the patient and the Hospitalist, wouldn't you say?

Dr. Afram: Exactly. And that's why what are talking about that it's an arrangement with the hospital as the biggest standard doc just for an emergency, not just for filling in for, you know, like gaps or short-staffed. Like for example, in our own situation we have the biographies of all the physicians or the hospitals that we collaborate with. They are part of the, when someone is a first pregnancy visit, we give them the patient folder that has a stuff related to the pregnancy. So they do have the buyers of us as well as the hospital. They understand that in the hospital those are the doctors that will be managing them with always available and on call, but as a backup. Like say for example the hospital has three people in the same time to deliver, then we are on a backup call. So for example, we are available but they're not waiting on us because it's not an emergency situation.

So the patient understands from the beginning. Normally we tell them what recent years, to be honest, this has been adopted more and more so it has been less of a sort of surprise by the patient and we've been doing it for over a year now and we have never had a person or a patient who has surprised on the day or was upset how come is this is they actually, if anything they are very satisfied because the care is being very prompt. The physician the Hospitalist who are in the hospital all the attention is on that particular patient. They're not worried they have to run back to the office and that's why someone is waiting on them, Anesthesiologist in the R to start a case and so on.

Host: Dr. Afram's I really appreciate your time today. That's Dr. David Afram, a private practice OB GYN, A private practice Obgyn managing partner at Capital women’s care in Arlington, Fairfax and manassas Virginia. Thanks for checking out this episode of the OB Hospitalist group podcast series. To learn more about the benefits of an OB hospitalist program collaboration, visit If you find this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we'll talk next time.