Christus obstetrics providers now working for a third-party company

Apr. 20—Santa Fe's largest health care provider is now outsourcing direct employment of its obstetrics providers, a change leaders say should help with recruitment but that some in the community fear will jeopardize a comprehensive care approach.

At the beginning of the year, Christus St. Vincent leaders informed doctors and midwives at its Women's Care Specialists practice the health care company would be contracting with South Carolina-based Ob Hospitalist Group, according to Christus St. Vincent spokesman Arturo Delgado.

Those providers were let go from Christus St. Vincent and offered positions with OBHG, joining a nationwide network physician leaders say allows them to recruit from a much wider pool. That's important, those leaders say, in the context of New Mexico's ongoing health care staffing woes.

"We have been working for quite a period of time to increase our number of providers in this particular specialty," said Hope Wade, chief operating officer for Christus St. Vincent. "That was very difficult to do. There's a shortage of this specialty across the nation, and New Mexico has difficulty malpractice scenarios."

The new arrangement at Christus St. Vincent somewhat bifurcates obstetrics and gynecology.

"With the operational way that we have it structured, OBHG has a heavier presence on our OB side and our [gynecologists] will continue to be employed by Christus St. Vincent," Wade said. "But both sets of providers have the opportunity to still provide both types of service."

Dr. Jose Sterling, a physician executive for Christus St. Vincent, said the goal is providing constant physician coverage for obstetrics, in addition to coverage from nurse midwives.

"The hospital's continuing to increase the services they provide for prenatal care," Sterling said. "It was important for us to kind of step it up."

Wade said in the past, Christus St. Vincent has had physician coverage for obstetrics, but it was often an on-call coverage scenario.

"With this new model, we're going to move to having an OB in-house 24/7," she said. "So when any patient presents, it's not calling a physician in. The physician is already here."

That structure has raised concerns with some, including retired family physician Dr. Diane Friedman, who in a recent op-ed contended the shift moves the service away from comprehensive care and toward a "shift work" approach.

"What they had was taking care of pregnant women all the way through birth in their hospital, as well as taking care of other women that were outside of childbearing," said Friedman, a Santa Fe resident who delivered babies as part of her practice, in an interview. "It was nice continuity of care that's gone away."

Friedman said the change also puts more emphasis on obstetrics and less on gynecological care for nonpregnant women.

Sterling said Christus St. Vincent leaders considered different staffing models to try to increase the coverage to where they wanted it to be.

"Unfortunately, they just didn't pan out," he said.

He said there are some shortages in gynecological care at the moment, but he expects that to change.

"Is there a decrease right now ... on the GYN side? Yes," Sterling said. "What we're hoping to do is build something that's going to last for a while."

After the change, some providers left, opting not to apply to OBHG, Wade said. She said OBHG has brought on new midwives since the beginning of the year.

Christus is currently advertising a gynecologist position, while OBHG has a listing for OB/GYN hospitalist jobs in Santa Fe.

While Friedman in her column suggested the move benefitted Christus financially, Wade said money actually played little role in the decision. She described the difference in cost between directly employing providers or using the third-party contractor as "basically neutral."

Delgado said despite pushback from some, physician leaders view the change as "a very positive thing for our community" that was driven by quality, not costs.

But the move could also result in more competition. Dr. Scott Herbert, president of Santa Fe-based Nexus Health, said the independent physician group is planning to open a gynecological service as a direct result of Christus' pact with OBHG and after hearing from several concerned employees.

Friedman said right now her own daughter is pregnant. She's getting care from an OB/GYN in town after being discouraged from seeking care at Christus because of uncertainty about the recent changes. The provider came highly recommended, but Friedman said many of her daughter's friends got care from the Christus midwives.

"The OB/GYNs, they're competent and they're great ... but it's just a different approach to care," she said. "It's so sad to me that my daughter's here ... and she can't get the kind of care that I was offering and that many other people in town were offering."