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I transitioned into an OB hospitalist role after 3 years in private practice, hoping to find more freedom in time and to relieve myself from much of the administration burden and burn out I was feeing with private practice.
Now a few years into life as an OB hospitalist, I can say it was the greatest career transition I could have done for myself (so far). I had a baby, and the freedom of not being mentally tied to my patients in practice is priceless. I went on maternity leave and parental leave (5 months total) without guilt, as there was company coverage through their network of providers. I work 7 24-hour shifts a month. I can go home after a shift and be present with my family, without the anticipatory fear I can be called any minute and without the burden of needing to take work home. I make frequent trips to visit my family out of state without taking vacation because I can tell the scheduler when to schedule my shifts. My pay significantly increased as well, at least doubled from the move. (But this was also because I moved states and compensation is higher overall for physicians in the new state I am in.)
To be honest, I think my marriage is good because of the career switch. If I were to be stressed out coming home as I had been previously to a stressed-out husband caring for a baby all day, it would be disastrous.
In private practice, I could theoretically take as much maternity leave as I wanted, but with the cost of not bringing any revenue in, as well as the burden I would place on my colleagues to cover my patients. In private practice, I found myself juggling phone calls from the hospital, patient messages, a clinic schedule, patients in on L&D, and in the OR, which I didn’t like at all. In the clinic, I found myself dreading filling out patient disability forms and pre-authorization requests. My compensation was low, off the charts low from any national survey that reported what OBGYNs were making, and I didn’t see it increasing until I significantly increased my revenue and patient volume. However, I found myself not wanting to increase my patient volume, because that would just mean doing more juggling and work that I didn’t want to do. How can I contribute to a company that I don’t want to help grow, and not like the work I am doing it?
I really questioned my decision to be an OBGYN back in private practice. I mean, I still question it now, but at least I have more breathing room to reflect and step away from work to figure everything out.
As great as I think being an OB hospitalist is, I do think there are some important things to consider, and it is not meant for everyone.
First, the hospital setting where you will practice matters the most. It’s not perfect, but hospital I currently work at is fairly well run. Nurses are overall happy and are easy to work with. However, I have heard horror stories of other sites where hospitals are not well run, have poor systems in place that make it feel ‘unsafe’, and being overly too busy for comfort. If there is a way to speak to a colleague at the site you are about to work in, that is the best way to gauge what your practice setting will be like. The recruiter does not have accurate information in my experience.
Second, are you ready to give up potential GYN and office skills? Depending on your responsibilities and hospital volume, the amount of GYN procedures you will encounter during ER consults may be limited. Clinic skills are easier to pick up after having left for years, but I can see it being a rough transition back to the clinic if you decide to return. One way to get around this is to pick up a side gig at a clinic a day a week to keep up office skills and to get GYN cases. You could also see if being a GYN assist for other private practice OBGYNs are possible. Some say to avoid hospitalist positions within the 5 years post-residency since you are still refining your skills as an attending. Others say you shouldn’t worry too much about it because the way things are going, there are going to be more specialists as time goes on. At Northern California Kaiser for example, the OBGYNs are tracked to either clinic, OB, or GYN. Rarely anyone does GYN and OB anymore. In addition, private practice physicians are referring major GYN cases to MIGS (minimally invasive gynecologic surgery) specialists or gyn oncologists.
Third, are you willing to be the first call for OB emergencies?
Other things to ask the recruiter or consider when comparing different hospitalist positions. Is there PTO and how is it accumulated? Does the company provide malpractice coverage and tail coverage? What is the maternity leave policy? What are the benefits (401k/matching, health insurance, disability insurance, etc)? Is it a W2 position or a 1099 position? How does the company ensure a competitive rate over the years? Will you be working with midwives and/or residents? What is the patient population? What is the back-up call system like and how effective is it? How has it been to request change within the hospital company or the hiring company?
