Deborah Howell (Host): If you're an OB-GYN and you're considering OB Hospitalist Medicine as a career, you probably have some questions and concerns. Our guests are both OB hospitalists and they're here today to share what it's really like to work as an OB Hospitalist. Joining us is Dr. Susan Passarella, OB Hospitalist Group Site Director at Ocean University Medical Center in Brick, New Jersey; and Dr. Jeffrey Manley, Site Director at Willow Creek Women's Hospital in Northwest Arkansas.

This is the Obstetrics Podcast from OB Hospitalist Group. I'm your host, Deborah Howell. Welcome to both of you. And I'd like to start by asking you, Dr. Passarella, what were your biggest hesitations when you were first considering becoming an OB hospitalist?

Susan Passarella, DO: Thanks, Deborah. I appreciate your time. There are two things I think that really were challenging to me when I made the jump from private practice to being an OB hospitalist. As an OB-GYN, when we're in training, we have full scope of practice when we do both OB and GYN, and I think it's very hard to all of a sudden take that jump, so to speak, into just doing mostly OB. We train in both obstetrically and gynecologically with both surgeries. And it's very challenging, I think, to leave that. You go through your training to really encompass that full course of the whole patient's life and that continuity of care, you give that up. And I think that was one of the more challenging things to give up, that continuity of care. I thought I would be taking care of those patients for their entire lives.

The other thing is GYN surgery, I think, is one of the more challenging things that physicians are concerned with when they become an OB hospitalist. We do do a good amount of GYN surgery, but it's not anything compared to what you do when you're in private practice. And I think the concern is that people will lose those skill sets that we work so hard to gain. Dr. Manley, do you have any other thoughts on that?

Jeffrey Manley, MD: You said the two things that were on my mind when I became a hospitalist. I was in practice for about 12 years, and then decided to try the hospitalist job out and just to see we were moving locations and I didn't know if I wanted to build another practice and that was one thing I just went back and forth with a lot. I did the hospitalist work before, just part time, so I kind of knew what I was getting into. But losing that continuity of care and really knowing your patients, I do miss that part of it. But it all balances out when you're not on call, right? So, I think there's some things that I really do miss. I had pretty robust robotic surgery practice and so I don't get to do that anymore. So, those are the two things that I really miss. But again, balancing out with quality of life and I obviously love delivering babies, so it's not something that I'm lacking in terms of satisfaction, that's for sure.

Host: Sure. And then, Dr. Passarella, on the good side, what do you consider the best part of being an OB hospitalist?

Susan Passarella, DO: The best part of being an OB hospitalist, especially in a place where you've been for a while and established yourself, you really become part of the fabric of that hospital. And whether it be, you know, on labor and delivery with the nursing staff, the medicine hospitalists, the emergency room doctors, you really become part of this big team.

I often joke that, when I'm on call, I refer to the hospital as my home sometimes because I do spend a lot of time there. We do 24-hour shifts and, again, you're there day and night. And you get to know the nursing staff and the physician staff that is there very well. So, they become part of your family. And over time that as your program is there for a long period, you build pretty good trust with that staff. I think that's one of the things I really enjoy.

Host: Sure. Dr. Manley?

Jeffrey Manley, MD: Well, I love not being on call. That's what I love about it.

Host: That's clear.

Jeffrey Manley, MD: Joking aside, but yeah, you know, it is nice we spend a lot of time in the hospital. And I've always enjoyed the hospital setting. To be honest with you, I'm not really clinic, it's just not my thing. It was fine, but as part of the process and part of the deal, right? But now, I'm not having clinic and I just love being in the hospital. I love being able to be at the bedside within a minute or two. And I thought that I might lose some patient rapport, you know, as you come into hospital, unless they don't know you.

But I think that we probably all develop different skills as hospitalists, because you got to build that trust up with those patients a lot quicker than you would if you were seeing them in the office for nine months. So, I don't feel like that's a disadvantage. But I could tell you that the nice advantage is, is you go to work; when you're done, you're done. There's typically no callback or doing charts when you're at home. That's the beauty of that.

Host: And Dr. Passarella, back to you. Do you find this role to be fulfilling?

Susan Passarella, DO: I do. I would hope if I didn't, I wouldn't be doing it. I know OBHG focuses a lot on life saves and near misses and the difference we really make in patient safety and care. It's interesting as you do this longer and longer, they become everyday occurrences where you tend to take them for granted sometimes, even though we are really making a big difference.

The things that are the most rewarding to me sometimes are those personal interactions with those patients, like Dr. Manley was saying. A lot of times people will come in, you know, fully dilated, ready to have their baby and they've not met you before and you really have to establish that rapport very quickly in order to gain their trust to deliver their baby. It's one of the more intimate experiences for, you know, a family to have. And again, to show up where you don't necessarily know someone is a challenge sometimes. I think it's really the way things are going in our world now because medicine has really changed. But I think, again, if you can do a great job of that, the patients are so grateful. And again, afterwards, and when the moment is over, I think they realize the difference that we do make by being there for 24 hours a day to really help them whenever they need it.

Host: That does sound fulfilling. How about you, Dr. Manley?

Jeffrey Manley, MD: Same thing. You know, I think that I was a little worried about it going full time just because I didn't know how much I would miss the other things. But it's extremely rewarding. I tell you, being able to be at the bedside within a moment's notice, being there with the patients, and the patients feel that comfort level of having a doctor, maybe not their doctor, but a doctor right there with them the entire time or readily available, so not sitting at home or somebody that's just in the hospital. So, I think it gives the patient some comfort level too. It certainly gives me comfort level knowing that I'm there and I, don't have to drive in or something when something goes wrong. So, it's extremely rewarding.

Host: Dr. Passarella, what does your relationship look like with patients in this setting versus your private practice? Is there continuity of care there? We touched on that earlier.

Susan Passarella, DO: Continuity of care is different in the OB hospitalist world. When you're in private practice, you see your patients from the time they're teenagers to as they have their children and they go into menopause and that whole spectrum, and you get to know them and their families very well. As an OB hospitalist, you really have no history with them until again, as we were talking earlier, when they hit the door and again, in an emergency situation, you're really there to take care of them.

The continuity I tend to find in the OB hospitalist world is different. I've been at our program for over about five years and I will have patients sometimes that will request me for a C-section and I may have taken care of them during their first pregnancy and they had an emergency and I was helping at that point in time. Often there'll be the nursing staff or the physician staff in the hospital will have their babies at the place where they work. And again, we'll take care of those patients and we know them from just having those collegial relationships, again, different continuity.

Initially when we went into medicine a long time ago, we had these expectations that you were going to take care of everyone forever. I think the world in medicine has really just changed to improve the quality of life for the physicians as well as, you know, give the patients the best safety and care.

Host: Okay. And I mean no offense with this next question whatsoever, but I do need to ask it for those who are listening. Does working as an OB hospitalist feel like scut work to either of you, Dr. Manley?

Jeffrey Manley, MD: I don't think so. You know, we're there, we provide a really crucial role in what goes on in the hospital. And so for us to be there, taking care of the things that really need to be taken care of when physician is not on call or they're at home, it's not scut work at all. It's part of the whole spectrum of what we do is as a health system itself. So, I think, yeah, if anything, it's improved the quality of care we give on labor and delivery units. The things that we do have to be done one way or the other. And it's all for the betterment of the patient.

Susan Passarella, DO: I agree with Dr. Manley. My theory on our OB hospitalist job is really it's all in your perspective of how you look at your day. When I was in private practice and we had a consult in the ER or on the floor, it was rather frustrating and annoying because you were supposed to be in the office doing deliveries and you were pulled in so many different directions.

As an OB hospitalist, you're in the hospital for 24 hours and whatever rolls through the door or whatever phone calls you get, those are your responsibilities. Again, to take care of those patients and provide them the best and the safest care. Again, if you just change your mindset, it really makes it not so much scut work and it's just your job.

Host: And speaking of your job, do you feel like you've lost your GYN surgery skills as an OB hospitalist?

Susan Passarella, DO: I don't. I know I definitely do a lot less if you look at the numbers of GYN cases. However, I think the things we do deal with, whether they be ruptured ovarian cysts, ectopic pregnancies that may be ruptured, ovarian torsions, patients that come in in the process of miscarrying and need an emergent D&C, often those patients are very unstable. And you have to really act quickly in order to provide them the best and the safest care and get them to the operating room and get done what needs to get done. So, I think it's actually improved my skill, again, because we have to be very quick in how we treat those patients. You can't put them off. And again, a lot of times there's bellies full of blood and you have to know what you're doing. I always say I'm very grateful for the training I had in my GYN experience as a resident, because it really made me a great surgeon and I feel comfortable and confident in who I am.

The other way I look at it too is that C-sections to me sometimes are some of the more challenging operations that we can do. Sometimes a patient may have had one prior C-section and you can get in there and everything is a disaster. And sometimes those repeat C-sections, sometimes three or four can be completely fine. Again, you never really know what you're going to find, so you have to be prepared to handle any of that.

Host: Wow, yeah. And Dr. Manley, how about your surgery skills? Still intact?

Jeffrey Manley, MD: Still intact. Yeah. I echo everything that was just said, but I think it is different. You know, we're not doing elective surgeries anymore like we would if we were in private practice. So, it actually changes. We may not be doing as many laparoscopic surgeries and that kind of thing, but I don't feel like my surgical skills have changed. They probably got better, honestly, because you get a lot more emergent stuff than elective stuff. And I think it makes you better, at least keeps you on track. So yeah, I don't think it's changed mine at all.

Host: Okay. And while I have you, Dr. Manley, final question, do you take work home with you or are you able to leave work at work?

Jeffrey Manley, MD: For the most part, I leave work at work. I am the site director now, so that changes a little bit. So, there's some times when I'm home, I'm having to deal with some scheduling things or just some things in terms of the program itself. But in terms of having to take work home, no. Not patient care, not like before in private practice, I might get home and still need to do 15 charts or, for example, in 2020, I went on vacation and every morning, from St. Lucia, I was logging into charts and talking to my nurses. So, I don't have to do that anymore at all. So no, I'm good at just leaving it there.

Host: And Dr. Passarella, how about you?

Susan Passarella, DO: So, I think that there are those patients sometimes that the more complicated cases or if they're bad outcomes, I think, for me personally, I tend to sometimes take them home with me and kind of ruminate over them. But for the most part, the actual physical work of charting and billing and all that stuff, that's done while I'm in the hospital before I leave. So, that's fabulous. I agree with Dr. Manley. I don't miss doing charts from vacation or at home.

When you do take on more management roles, such as a site director or anything else within the company, there definitely are some things like scheduling that will definitely follow you home. We're trying to work to make it more efficient so it doesn't cut into so much of our time at home and we can kind of focus on our family and our home life,

Host: Got it. What parting advice or thoughts do you have for anyone who may be considering a career as an OB hospitalist? Let's start with you, Dr. Passarella.

Susan Passarella, DO: So to me, that was one of the harder decisions. Again, as I said earlier, you know, we go through our training and residency to do that full encompassing OB-GYN specialty and to focus on half of it was a hard concept for me. But once I did it, I actually went out to one of the OB hospitalist society meetings. I really found I enjoyed improving patient safety and giving quality care to the patients and really elevating that standard of care at the hospital. And once I kind of got that insight and saw the difference that we made, I really started to enjoy it. Like Dr. Manley said too, I do love my quality time with my family and my friends. I think work is really a balance.

This to me was the perfect fit for me. It allowed me to spend quality time with my patients when I was in the hospital and give them 110 percent of my attention. However, it also gave me that same balance at home with my family and friends and for myself.

Jeffrey Manley, MD: I completely agree. It was a tough decision for me, even though I'd done hospitalist medicine for a few years part time, but it was still tough. It's not for everybody. Working 24 hours a shift, 24 hours at a time, you know, sometimes you get home and you're pretty exhausted. So, it's not for everybody. But it creates some opportunity, I think, for us as physicians to have that balance in our personal lives, that really is why I decided to do that. Just because I practice long enough and you work 70-80 hours a week and it wears on you after time. So, it's a tough decision. It's not for everybody, but it fits for what I need it to fit for. And I don't ever see myself going back to private practice.

Host: Well, we've come to the end of our conversation today. Dr. Manley and Dr. Passarella, thanks so much for the good work you do and for your time today. We really do appreciate it. That was Dr. Jeffrey Manley, OB hospitalist at Northwest Medical Center in Bentonville, Arkansas, and Dr. Susan Passarella, OB Hospitalist Group Site Director at Ocean University Medical Center in Brick, New Jersey. For more information about OB Hospitalist Medicine as a career choice and to explore careers with OBHG, go to www.obhg.com. And if you found this podcast to be helpful, please share it on your social channels and make sure to check out the entire podcast library for topics of interest to you. I'm your host, Deborah Howell. Thanks for checking out this episode of the Obstetrics Podcast from OB Hospitalist Group, and have yourself a terrific day.