OB Call Workgroup Updates

9/2/2025

Benefits

Considerations

Can increase satisfaction and well-being of community providers who do a lot of call

Could make having in-house presence more sustainable

Decrease call burden for community providers

Compensation

There will need to be clear expectations of everyone’s roles

Would need a robust backup system with shared understanding on when it should be used

Some residency providers do not want to decrease the number of FMONS weeks that they have (delivery numbers)

Rounding volume will be higher, so will need additional rounding help

Community providers will need to get credentialed at St. Mary’s

Survey Review : What are your thoughts on merging residency and community call groups? What considerations would need to be addressed to make this successful?

Current State

~21 residency faculty*

-cover FMONS service on weekdays 7a-6p (2-3 weeks/year); weekends 12 or 24 hour shifts (as January 1st)

-nighttime weekday call 6p-7a

-21 call shifts per year

-FMONS backup 2-3 weeks per year outside of when they may be backup on inpatient

-10 community faculty

-Providers are available 365/24/7 for their patients

-Weekday backup call is 24 hours (providers in clinic)

-Weekend call is 72 hours

-39 call shifts per year

-5.5 weeks of rounding (providers still in clinic

-6 Access faculty

-Providers available 365/24/7 for their patients, but can have residency call group cover patients as well

-1 week of FMONS/year

-12 call shifts per year

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Residency

Community

Access

Today’s Proposal

Is a foundation from which to start a conversation

Assumptions

• Access providers will continue to have 1 FMONS week per year and take 1 call shift per month
• This was used as an assumption for modeling a merged call group, however this is also a great time to discuss Access’s call and compensation, so this may change
• Weekend call will be 7a-6p and 6p-7a, though people can choose to combine their weekend calls into 24 hours if desired
• Residency and Access faculty will continue to be the attendings for the FMONS weekday daytime coverage

Proposed Merged Call Group: Basic Structure

1st call responsibilities:

• Daytime
• 1st call for all triage patients
• Rounding on dyads
• Manages laborers for all call providers when asked
• Calls 2nd call provider when additional help is needed
• Nighttime
• Same as above without rounding
• Responsible for nurse newborn calls overnight

2nd call responsibilities:

• Daytime
• Rounding on dyads until 10 AM (clinic schedule blocked)
• Preferentially handles St. Mary’s rounding if attending there is unable to, circumcisions
• Can be called in by 1st call to assist with laboring patietns
• Nighttime
• Can be called in by 1st call to assist with laboring patients

Proposed Merged Call Group: Basic Structure

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• Daytime 2nd call in presented model is presented as 5 consecutive days M-F by one provider, then the weekends are a different provider each day
• We could consider having daytime 2nd call be 7 days in a row which would decrease number of random weekend shifts in a year
• We could consider 2nd call provider be both weekend days

A patient at 26 weeks comes into triage and won’t be admitted

Resident calls 1st call OB provider

A laboring patient comes in at 38 weeks and is being admitted

Resident calls patient’s primary OB faculty member to see if they would like to be involved and admit patient.

• Primary OB provider can choose to have 1st call OB provider completely manage labor
• If continuity attending already knows they won’t be managing, can indicate in patient’s problem list
• Primary OB provider can choose to have 1st call OB provider manage until patient is active or until primary OB provider is able to take over patient care
• Should be communicated attending-to-attending as well
• Primary OB provider can choose to completely manage their patient’s admission, labor, and delivery
• Should be communicated to 1st call attending as well

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A laboring patient develops pre-E with severe features and requires Mag

• Requires in-house coverage until 24 hours after delivery
• Lots of flexibility in how this could be done
• Primary OB provider can be involved as much as they would like
• 1st call OB would otherwise be responsible for in-house coverage

There are 4 active laborers in the AM and 18 patients to round on

• 1st call OB is responsible for all active laborers for whom the primary OB is not involved
• 2nd daytime call person should already be scheduled to round until 9:40ish AM and help get through the list
• 1st call OB is responsible for requesting additional help if needed to finish rounding or to cover dueling cervixes at the same hospital or different hospitals
• If the 1st call provider asks for help, the 2nd call providers answer should almost always be yes!

There are 4 active laborers and 2 latent laborers at night

• 1st call OB is responsible for all active laborers for whom the primary OB is not involved
• 1st call OB is responsible for requesting additional help if needed to provide safe patient care
• We have to decide if there are clear guidelines for this or if it should be entirely up to each provider’s comfort

There is 2 active Meriter laborers, 12 Meriter patients to round on, and a dyad at SM that needs to be rounded on with a circ

• 1st call provider will ask SM inpatient attending if they are able to round on SM dyad
• If SM attending is unable to round on that dyad, 2nd call provider will round at SM.

There are no laborers and 10 patients to round in the AM

• 1st call OB could consider calling 2nd call and telling them their rounding assistance is not needed that morning

Some Numbers

Other considerations

• We could make daytime 2nd call 7 days which would decrease weekend call numbers.
• Alternatively, could consider 24 hr 2nd call on weekends
• These numbers could change if we change Access providers call responsibility and compensation structure
• Compensation model would not necessarily have to change. Community providers can still come in for as many of their deliveries as they like and still be compensated for that, but now have the flexibility of a more robust call group
• We could address Christmas week holiday call (right now 24th and 25th are on holiday call schedule; would propose making it just one day)

What we still need to know

• Feasibility of 2nd call provider having time blocked off for rounding .
• Community faculty already do this, so in theory this should be possible.
• Could consider 2nd call daytime week being scheduled as same day visits only so there is less disruption if 2nd call provider gets called in.
• Access conversation
• St. Mary’s credentialing process

Questions/suggestions?