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The Career Less Traveled: Choosing OB Hospitalist Medicine

Editor’s note: Earlier this year, we were approached by Dr. Angela Kim, MD, an obstetrics (OB) hospitalist at the Ob Hospitalist Group in Ohio. She wanted to write a piece about her experiences as an OB hospitalist and her journey towards that goal. This is a thoughtful piece about a perhaps lesser-known career that deserves attention in the changing world of medicine.

I loved my residency work at Harbor-UCLA Medical Center, a county hospital in Southern California. I loved the pace and volume, the need for rapid decision-making, the autonomy. I loved the long 24-hour shifts that were go, go, go.

However, I felt increasingly burned out. I told myself that because residency is self-limiting, I would be able to breathe once I was out of crisis mode. I hoped that things would improve once I graduated, but private practice attendings reminded me to not expect regulated duty hours. I knew that I wanted a job where I could be completely present, which meant I needed time to take care of myself and pursue my passions outside of work.

I nearly overlooked the best choice — becoming an OB hospitalist. It was exactly what I wanted — a stable salary, not having to be on-call and the ability to focus on the tasks that had made me passionate for medicine in the first place. More medical students should consider pursuing OB hospitalist careers directly after residency, yet many are unaware that it’s even an option.

Most of my co-residents knew exactly what practice model they envisioned for themselves by the time our fourth year of residency began. We had been lucky to gain training in obstetrics and gynecology (OB/GYN) in multiple practice settings, from county clinics to private practices to large health maintenance organizations (HMOs). However, the available OB/GYN career options required us to choose one setting, and I felt conflicted.

While the ads for OB hospitalist positions had intrigued me, most of them required at least three years of active practice, so I hadn’t given them much thought. And frankly, I saw hospital medicine as an option at the end of my career, not the beginning. But a move to Houston, Texas for my husband’s pulmonary/critical care fellowship led to a chance meeting with Dr. Rakhi Dimino of Ob Hospitalist Group (OBHG).

As a leader in coalescing ideas from physicians, policymakers, and healthcare advocates from across the state, Dr. Dimino is passionate about reducing maternal mortality and morbidity by increasing access to evidence-based health care for all pregnant women. She shared that while in private practice as the mother of two, she felt pulled in too many directions at once. She agonized that she wasn’t able to spend enough time with her own family. But she loved the practice of obstetrics, the honor of caring for expectant mothers, and the thrill of saving a life.

As an OB hospitalist, she was still able to do all of that while carving out important time for her family. Her shifts included everything from managing labor and delivering babies, to responding to a postpartum hemorrhage, to determining whether a prolonged fetal heart rate deceleration required intervention.

Dr. Dimino mentioned that OBHG was starting a program for new grads and asked if I would be interested.

I signed up immediately.

As a new graduate, the OBHG position offered full mentorship support and the chance to grow as a leader. Furthermore, I would not be sacrificing my OB/GYN surgical skills, which I had worked hard to cultivate, as the need for urgent surgical skills was high at this hospital. Plus, at the end of my husband’s three-year fellowship, I would have the flexibility to move anywhere, as OBHG partners with hospitals nationwide.

My first six months as a fellow have flown by, and I’m happy to say that I’m now an OB hospitalist with OBHG. Dr. Dimino and the other physicians I’ve worked with have continued to offered mentorship, support, and advice. I’ve also enjoyed the opportunity to collaborate with local obstetricians as I build my case list, and my goal now is to become board certified by next year. As an OB hospitalist, I have been able to continue to do what I love to do the most — reassure, serve, and treat pregnant women — while still taking time for myself. So far, it’s been everything I hoped my medical career would be.

In the last decade, there’s been explosive growth in hospital medicine, but in medical school, I was only minimally aware of hospitalist specialties outside of internal medicine.

Luckily, the curriculum is changing too. Modern medical students are trained to work in multi-disciplinary teams. We focus heavily on patient safety and quality improvement in systems. The learning curve was smooth as I launched my OB hospitalist career.

Working in a hospital setting is a natural extension of my residency work. I am able to use my surgical skills in emergent cases and care for patients. A few months ago, a woman who was 17 weeks pregnant presented with acute abdominal pain. Because she was so early in her pregnancy, she didn’t have an assigned OB/GYN. It turned out that she had an ovarian torsion, and a diagnostic delay could’ve result in the loss of the ovary. I performed a laparoscopic procedure, my specialty during residency, and untwisted the ovarian pedicle. I can’t describe the thrill of knowing that I might have saved the patient’s pregnancy — all because I was onsite and there was no delay in caring for her.

It’s exciting to live out my passion for women’s health in this dynamic environment. As an OB hospitalist I have a key role to play in minimizing maternal and fetal morbidity and mortality. A 2015 study by researchers at Northwestern University found adverse events or potential adverse events occurred in approximately one in five women admitted to a labor and delivery unit. There’s evidence that an onsite, “first touch” model provides significant benefit in the reduction of serious harm.

Up to 40 percent of women never return to their OB/GYN for a postpartum visit. Frighteningly, adverse outcomes are not limited to the few days around labor and delivery — data shows nearly 35 percent of pregnancy-related deaths occur well after. My hospitalist colleagues and I aid in the diagnosis of conditions like postpartum preeclampsia though close communication with emergency department physicians. My relationship with these patients may be brief, but it’s critical.

During one of my very first hospitalist shifts, I met a Spanish-speaking woman who presented to OB triage in labor. She had not received any prenatal care. Her baby had a non-reassuring fetal heart rate tracing with recurrent decelerations. I immediately went into the room to interview the patient in Spanish and discuss the possibility of an urgent cesarean delivery. The patient was stoic and declined all interventions. When I asked her why, she couldn’t give me an explanation. She had her guard up and wasn’t ready to trust me, someone she had just met.

I stayed by her side and continued to counsel her about her options, knowing deep down that this patient wanted what was best for her baby. However, giving up control was not an option for her. Ultimately, we had a healthy delivery, yet even on the day of discharge the patient remained guarded. When I saw her 2 weeks later for her incision check, the most unexpected thing happened — the patient had tears in her eyes as she thanked me for taking care of her and her baby. She said she had just been scared the whole time. This encounter reminded me that often, we have to put judgments aside and meet the patient where they are, giving them the best care we can deliver and to never give up on her.

Flash forward to today and I enjoy the experience of serving patients and am happy to report that I also have work/life balance. I bring my best self to work every day for patients. When my shift is over, it’s over. This is in stark contrast to many of my former classmate’s situations, who are fighting to juggle on-call responsibilities, bureaucratic demands, and constant stress.

According to an article published in the Mayo Proceedings, 54 percent of physicians show signs of burnout. But after four years of undergrad, four years of medical school, and a multi-year residency — not to mention the cost of those degrees — I don’t intend to let exhaustion derail my career. My time off is my time, and because I have the opportunity to recharge and reset, I’m able to be fully present in my personal life and a better physician in the hospital.

As medical schools are now incorporating the importance of wellness, self-care, and mental health into the curriculum, medical students interested in women’s health and surgery should consider OB/GYN hospitalist jobs as a potential career path. Medical students who falls in love with delivering babies or performing laparoscopy shouldn’t hesitate about pursuing a career in OB/GYN because of some of the traditional negative assumptions about what that lifestyle entails.

I am amazed at how much I am learning on the job every time I am on shift. It’s extremely gratifying when I have the opportunity to teach a fellow hospitalist or nurse who has been practicing much longer than I have something new. I really embrace the motto of being a “lifelong learner” closely and this should start early in medical training. One of the job descriptions of an OB/GYN hospitalist is being a leader in quality improvement. This includes running emergency simulations, improving team communication, and making systems changes from what we learn.

As a medical student, I remember thinking that the OB/GYN field was the most unique because we get to take care of a special subset of patients — pregnant women — who actually want to see their doctor and be in the hospital. When I first considered becoming an OB, I envisioned triaging patients, managing labor, delivering babies, handling real-time emergencies, and saving lives. It’s still an “oh wow” moment for me when I deliver a baby, and see that baby take their first breath outside of the womb. And like an attending physician would say to me in residency, while it might just be an ordinary day for me, it’s a privilege to be part of an extraordinary day for our patients.

My choice to become an OB hospitalist has allowed me to go further — today I help drive positive change for women’s health without sacrificing my own wellness. I’m glad I chose to make that happen at the beginning of my career — not the end.

Angela Kim, MD Angela Kim, MD (1 Posts)

Physician Guest Writer

Ob Hospitalist Group

Dr. Angela Kim did her OBGYN residency at Harbor-UCLA Medical Center and now works as an obstetrics hospitalist with Ob Hospitalist Group in Ohio.