Medicine: Doctor Who?

IN SIMPLER TIMES, childbirth was fairly straightforward: A woman picked a doctor, and that doctor attended to her from day one to delivery. But if, with HMOs, HSAs and sky-high malpractice premiums, there was any doubt that the days of family docs are on their way out, another nail was hammered in the coffin last spring, in the form of a “Dear Mom” letter from Pennsylvania Hospital.

In March, the hospital at 8th and Spruce — long known in Philly as the place for childbirth — sent a missive to patients of its OB/GYN group practices announcing that come July, there’d be changes in the maternity unit. It would be hiring full-time “laborists” — hospital-based obstetricians whose sole focus is labor and delivery. This meant that the doctors who attended to a pregnant patient might very well not be there come delivery time. Immediately, playgrounds around Philly were abuzz with the news.

“I was taken aback,” says a Center City mom due this month. “You go to a doctor because you like their bedside manner and quality of care, and have spent eight months communicating with them. Then I don’t have that doctor in the delivery room?”

Amid rumblings from patients, the hospital remains tight-lipped about what seems like a radical shift. In June, it said simply that the plan would bring more “specialized physicians” to the 30-plus “physicians and midwives … dedicated to the safe delivery of both mother and child.” But outside the hospital, advocates are vocal about the laborist model.

“This is a safer way to practice obstetrics,” says Louis Weinstein, OB/GYN chair at Thomas Jefferson University. Though Jefferson Hospital has yet to adopt the system, Weinstein promotes and implements it around the country. The idea, he says, is to schedule the laborists to avoid the 48-hour work marathons that leave busy OB/GYNs bleary-eyed. (In 2007 alone, Pennsylvania Hospital delivered more than 5,100 babies.)

Another plus, says Arnold W. Cohen, chair of obstetrics at Einstein Hospital — which has its own laborist system — is a less grueling schedule. “Before, doctors didn’t have predictability,” he says of Einstein’s program. “They were on every three or four nights. If a patient came in to deliver, they had to cancel office hours. I can tell you, the doctors are all happy with the system we put in place.”

But will happier doctors make happier patients? “For such a personal experience, if my doctor wasn’t on call, I thought I would have someone from the practice,” says another Center City mom-to-be. She moved her August delivery from Pennsylvania Hospital to Lankenau, in Wynnewood.

“I think it’s going to take away from the relationship between a doctor and patient at the most sacred time of life,” says obstetrician Victor A. Zachian, who’s delivered at Pennsylvania Hospital for 26 years. “When I started out, if you had told me health care would be like it is today, I would have said no way, that patients and doctors wouldn’t stand for it.” But one-doctor-one-mama is going the way of the cloth diaper, Weinstein says: “Within 10 years, this is going to be the way it is everywhere.”