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Maternity Maneuvers


Maternity Maneuvers

How do most hospitalist groups manage maternity leave? I recently took six weeks for maternity leave. My colleagues worked my shifts, and I have virtually paid them all back. To do so I often would end up working 18 to 20 days consecutively and numerous weekends. This was not ideal on many levels. I most likely will not [receive a] bonus this year as well. Is there a better way?

New Mom in Midwest

ASK Dr. Hospitalist

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Dr. Hospitalist responds: Congratulations on the birth of your child. As you recognize, becoming a parent is a wonderful experience but also can be stressful. It is not easy to balance the competing demands of family and work.

Medical leave is not unique to hospitalists—but with the average age of hospitalists being 37, it is commonplace to have hospitalist staff start families at this stage of their lives. In fact, as a hospitalist director, it would be foolish for me not to expect and plan for maternity and paternity leaves.

Medical leaves often are stressful for hospitalist programs because of the need to find replacement staff to fill the work schedule. There is no “best” way to cover the schedule during medical leaves. One thing is certain: Not offering medical leave is not only unrealistic, it may be against the law.

Hospitalist directors and those contemplating medical leave from work should familiarize themselves with the federal government’s Family Medical Leave Act (FMLA). Of course, I’m not an attorney; anyone who is looking for accurate advice concerning FMLA and other legal matters should consult a lawyer.

Because the average age of hospitalists is 37, it's common for them to begin families - putting stress on hospitalist programs.

Because the average age of hospitalists is 37, it’s common for them to begin families—putting stress on hospitalist programs.

Briefly stated, the FMLA requires that “covered employers must grant an eligible employee up to a total of 12 work weeks of unpaid leave during any 12-month period for one or more of the following reasons:

  • Birth and care of the newborn child of the employee;
  • Placement with the employee of a son or daughter for adoption or foster care;
  • To care for an immediate family member (spouse, child, or parent) with a serious health condition; or
  • To take medical leave when the employee is unable to work because of a serious health condition.

It is important to know that the FMLA strictly defines eligibility criteria. For example, a covered employer is one who “employs 50 or more employees for each working day during each of 20 or more calendar work weeks in the current or preceding calendar year.” There also are strict criteria that define whether one is an eligible employee. It is important to note that FMLA does not guarantee paid time off—it only requires unpaid leave. You can find additional information about the FMLA online at the government’s Web site:

Peer Pressure

I am an attorney who often represents physicians in hospital peer-review matters. I represent a hospitalist whom the medical staff has recommended be terminated. Two internists have been appointed to the peer-review committee; one has an office-based practice, and the other is a cardiologist. Neither is a hospitalist.

I am trying to convince the medical staff that there should be a hospitalist on the peer-review committee because I believe what a hospitalist does each day is fundamentally different in scope and patient mix than the other two internists. My argument will be much stronger if it is the case that a hospitalist’s practice is now its own medical specialty.

Can you point me to any information or articles that support my belief that hospital practice is now a separate specialty?

Anxious Attorney

I recently heard a doctor describe himself as a hospitalist despite working clinically in the hospital only one month annually. Is he correct in defining himself as a hospitalist? If so, how would we distinguish him from primary care doctors who spend one-twelfth of their work life caring for hospitalized patients?

Dr. Hospitalist responds: Is a hospitalist practice sufficiently different than that of an office-based internist or cardiologist, so much so that peer-review activities would necessitate at a minimum some involvement of other hospitalists? To answer this question, I think we need to understand the definition of a hospitalist.

I recently heard a doctor describe himself as a hospitalist despite working clinically in the hospital only one month annually. Is he correct in defining himself as a hospitalist? If so, how would we distinguish him from primary care doctors who spend one-twelfth of their work life caring for hospitalized patients?

SHM defines hospitalists as “physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital medicine.” Based on this definition, the doctor who spends one month annually caring for inpatients could be a hospitalist if the remainder of his work involved teaching, research, and leadership related to hospital medicine.

In your example, you cite two physicians on the peer-review committee: an office based internist and a cardiologist. Is it reasonable to consider their work similar to or different from that of a hospitalist? In the case of the internist, I think the key point is the fact you described him as office-based. That suggests to me his primary professional focus does not involve hospitalized patients.

One could argue that since both the hospitalist and the office-based internist were trained in internal medicine and both have American Board of Internal Medicine certification, they should be considered peers. I would point out that one’s specialty training has nothing to do with the definition of a hospitalist.

Although the majority of hospitalists in this country are internists, many others are family physicians and pediatricians. Some have subspecialty training, some don’t. Even obstetricians and surgeons are defining themselves as hospitalists.

With all that in mind, would we consider the cardiologist a hospitalist? Again, I think it would depend on the nature of the cardiologist practice. If this cardiologist has a primarily outpatient practice, that would be quite different from a hospitalist practice.

What if this cardiologist’s practice primarily is inpatient? I think it is reasonable to think about the scope of these physicians’ practices. Assuming the cardiologist practice is limited to the care of patients with primary cardiac issues, this would be a much narrower scope than that of most hospitalists.

It also is important to consider the training of the hospitalist. Take geriatrics hospitalists, for instance. The scope of their practice may be quite similar to that of a geriatrician who spends the majority of time caring for hospitalized patients.

Does the hospitalist have additional cardiology training? Does the focus of discussion at peer-review committee involve care of patients with primarily cardiac needs? The issue of which physicians should serve on peer-review committees when evaluating hospitalists is a complicated one that demands further scrutiny. TH

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