Tuesday, February 24, 2009

Hospitals and doctors - Hospital-Based Doctorists

I see in the Boston Globe, “The Birth of a Notion,” that Cape Cod Hospital and other Massachusetts hospitals, are hiring “laborists,” board-certified obstetricians, to work regular shifts for the sole purpose of delivering babies.

The problem, in Massachusetts as elsewhere, is that obstetricians and gynecologists are giving up hospital deliveries because of overwork, fear of malpractice suits, and craving for a normal life style.

Hospitals, too, fear these suits. They fear for the safety of their patients as well. The arrival of obstetricians from their offices, may be delayed, and complications may develop while waiting.

This piece of news prompts these thoughts.

Laborists are just the latest in a string of hospital-based doctorists,

Spawned 13 years ago by announcement of a new breed of specialist cat, hospitalists.

Hospitalists were followed by intensivists, proceduralists, nocturalists, and weekendalists,

What drives these new waves of specialists?

It’s a combination of things – the desire of doctors for regular hours, the shortage of specialists, physician burnout, the search for a safer hospital environment, the need for consistent, immediately available physician services, fear of dreaded malpractice suits, and consolidation of hospital-physicians services due to regulatory and economic pressures,- says fundamentalists.


1. Wachter, R, and Goldman,R, “The Emerging Role of ‘Hospitalists’ in the American Health System,’ New England Journal of Medicine, 335, 514-517, 1996.

2. Kowalczyk, L, The Birth of a Notion: Hospitals Turning to Laborarists, : Boston Globe, February 23, 2009


Dr. Marcinko said...

Hello Richard,

More than a decade ago, in another career, I wrote a few articles when you edited a print and emerging electronic trade publication for medical professionals. All very “fly”, at the time.

Blended Generations as Driver

Now, with your above discourse on terminology you are correct, but it is not uncommon today to have three generations represented in healthcare. We have the Baby-boomers, Gen X and now, Gen Y. The Baby Boomer generation is saying with some sense of sadness that, “Medicine sure isn’t want it used to be!”, while Generation Xers are saying “It’s about time things changed!”, and the latest generation to enter the medical workforce, Gen Y’s, are saying “Ready or not, we’re here”.

The Leadership Evolution

Each generation is extraordinarily complex, bringing various skills, expertise and expectations to the modern medical work environment. Determining the best method to unite such diverse thinking is one of the many challenges faced by physician executives and healthcare leaders.

Is it any wonder that many medical leaders and executive in the Baby Boomer generation find themselves at a loss? The days of functional leadership are gone and suddenly, no one cares about the expertise of the Baby Boomers or how they climbed the corporate ladder, in medicine or elsewhere. Leadership in the era of Health 2.0is no longer about command-control or dictating with intense focus on the bottom line; it is about collaboration, empowerment and communication.

And, it is not about titles and nomenclature.

My Thoughts

And so you ask, what drives these new-wave specialists? I’d like to think that, much like my 12 year old daughter, it is just a way of professionally breaking from past generations, and asserting some independence and leadership. And, as Martha Stewart might say; “that’s a good thing.”

You Still Got It

Anyway Richard, glad to see you are well and still got “fly”.


David Edward Marcinko; FACFAS, MBA, CMP™
[Atlanta, GA]

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