Solo vs group obstetric practices

Solo Vs Group Obstetric Practices I am a solo obstetrician practitioner. By that comment I mean I have my own rooms (office), my own secretarial staff, I see all patients who book with me for pregnancy at each antenatal visit myself, I manage all patients who book with me in labour (with the support of hospital-employed midwives), deliver all my patients’ babies and do all my patients’ Caesarean sections. The exception to this is if I am not available because of a holiday, family commitment or illness. In that case I will arrange for a colleague to cover and provide care for my patients when needed until I return to work. I am always very nervous when I am not available as I worry about my patients’ well-being and it is difficult for me to relax as I know I am not able to be with them if needed.

Being a solo practitioner means I am on call to attend to my patients’ pregnancy needs 24 hours a day 7 days a week.  That has been a huge toll on my marriage and family life over the years. There has been many a dinner, school function, social time out, etc that has been interrupted as I have been called by the hospital staff to attend to a patient. I have an amazing and very supportive wife who I started dating when I was in high school and married when I was medical student. She accepts this crazy unpredictable disruptive lifestyle is unavoidable for me as a solo obstetrician practitioner.

Solo Vs Group Obstetric PracticesI value the relationships I have with my patients and always do my best to provide the best quality care possible. I have been seeing many patients for many years, and it is truly wonderful. I now have many second-generation patients. By that I mean a woman sees me for pregnancy care and I deliver her baby. Her baby grows up and sees me (or has a wife/partner who sees me) for pregnancy care and I deliver her/his baby. This is a great joy.

I recall in the past almost all obstetricians were solo practitioners. In more recent years there has been an increasing trend for obstetricians to be part of  a group obstetric practices, which coincided time-wise with the increasing number of women becoming obstetricians.

In a group obstetric practice there several obstetricians working together. In a group practice a patient may be seen by the obstetrician under whom she has been booked for all antenatal visits, or antenatal visits may be shared by obstetricians in the group and if so a patient will be seen by different obstetricians for her antenatal visits. Sometimes there are midwives employed by the group practice who will do some antenatal visits. Management of patients in labour is usually shared by the obstetricians in the group on a roster basis. That means that even though a patient has wanted to be the patient on one of the group’s obstetricians it is very possible her only sees that particular obstetrician at some antenatal visits and the obstetrician she prefers will only deliver her baby if rostered on when she is in labour. Group practices rostering and other arrangements will vary according to what the obstetricians in the group have agreed on.

All the  office expenses (which are considerable) are shared by the obstetricians in the group. They can include the lease of the rooms, staff wages, telephone and internet, office insurance, office equipment, etc, etc. A solo practice obstetrician must pay for all these overheads. Sharing practice overheads (which are considerable in an obstetric practice) increases the profitability of the obstetricians in the group.

With a group practice it would not be possible to provide what I value so much – personalised care of my patients. I am sure a group practice obstetrician cares about  the group’s patients. But a group practice obstetrician will not necessarily be there at each visit of a pregnant patient and may not be available because of the practice rostering to support a particular patient in labour. Patients’ queries and concerns will most likely be attended to by staff or any of the obstetrician partners in the group. A patient’s special requests are more likely to be overlooked in a group practice as the obstetrician managing the labour most likely has only limited involvement with her antenatally.  Management decisions and experience of obstetricians in the group will vary and so the likelihood of avoidable complications and decisions on what to do if complications occur will vary. This can adversely affect the care received by the patient.

Personally, I believe the only people who benefit from the group obstetric practice are the obstetricians. I do not believe a patient do not get a better quality of pregnancy care with group practice obstetricians than they would seeing a solo practice obstetrician. As mentioned the popularity of group practices coincides with the increase number of female obstetricians and  most group practices have female obstetricians. Being in a group practice I am sure is appealing to a female obstetrician as she  is often trying to balance being an obstetrician with being a wife and mother. A female solo practice obstetrician with children needs good family support because of the job commitments. For example, she can’t leave her small children at home unattended at 3am in the morning when she is called to the hospital for a delivery. This support can come in the forms of a very understanding husband or partner, her parents (living with her), or a live-in nanny. In a group practice her out of hours’ time commitments will be less, will be known in advance and can be planned for.

As a solo practice obstetrician, I am on call to attend to my patients 24 hours a day seven days a week.  In a group practice of, say, five obstetricians then any one obstetrician will only need to be available one night per week and one weekend in five. That mean they have a lot of ‘not on call’ time which they can devote their family and other lifestyle interests, knowing they won’t be getting a phone call from the midwife at the hospital except when rostered on for the group.

As well with a group practice there is more colleagues support available. With the popularity being amongst younger and less experience obstetricians this will have appeal.

For me being an obstetrician is far more than a job or profession. It is life where patient care takes priority or over almost everything else. But I can’t help but conclude that a group practice obstetrician may not have the same commitment. I suspect being a group practice obstetrician is not a lifestyle commitment, dedication and  passion but would be more like any other job or profession.

With more patients opting for public pregnancy care some obstetricians have formed group practices, as well as having their own solo practices. Their chief marketing spin of the group practice is patient ‘out of pocket’ costs are less.  I have been told they are targeting pregnant women who are considering going public because of out of pocket costs in being private. Less out of pocket costs would have appeal to many pregnant woman who decide on private pregnancy care.  This option was suggested to a patient by her well meaning friend. When I told her the differences in pregnancy care between my care and what this group offered she decided to continue in my care. In such a group practice, most antenatal visits are done by midwives not obstetricians. There is a roster for obstetricians in the group, telling them when they need to be available do antenatal visits and when they need to be available for labour ward commitments. Babies are delivered by obstetricians in the group, not by midwives. Because of the rostering approach a patient cannot choose which obstetrician in the group will deliver their baby. It is quite spooky for the woman in labour as she may not have met the obstetrician who turns up for her confinement. With this group care option there would be no personalised pregnancy care.

Most antenatal visits are done by midwives not obstetricians. Management decisions and experience of obstetricians in the group will vary and so the likelihood of avoidable complications and decisions on what to do if complications occur will vary. This can adversely affect the care received by the patient.

Finally, there is the situation where obstetricians who in solo practice share rooms. It could be they have formed a company that jointly owns or leases the office. It could be one obstetrician owns or leases the office and others lease office space from the owner/lease holder obstetrician.  In these arrangements obstetricians manage their own patients. Other doctors using the rooms may not provide cover and so is may be simply an office sharing arrangement.

Posted by Dr Gary Sykes on - Latest Posts, Obstetrics

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