Provider Staffing Models on Military Labor & Delivery Units: A Cross-Sectional Study

Area of Science:

• Obstetrics and Gynecology
• Healthcare Management
• Military Medicine

Background:

• Labor and Delivery (L&D) units nationwide exhibit diverse provider staffing models, influenced by patient volume, acuity, resources, and training needs.
• U.S. military treatment facilities (MTFs) also display variations in staffing for their L&D units.

Purpose of the Study:

• To describe and analyze provider staffing models in stateside U.S. military L&D units.
• To correlate staffing models with delivery volume.

Main Methods:

• A cross-sectional study surveyed 28 stateside military treatment facilities (MTFs) providing in-house L&D care.
• Data included de-identified staffing schedules, residency training presence, call structures, and laborist models.
• Staffing ratios were compared to delivery volume using descriptive statistics and the Kruskal-Wallis test.

Main Results:

• Delivery volume ranged from 7 to 461 births over three months (mean 166).
• The median provider staffing was 3.1 deliveries per provider per month (range 0.2-9.1).
• Most sites had one attending provider per shift, all used midwifery care, and 50% utilized Family Medicine physicians; seven departments used 24-hour call shifts only.

Conclusions:

• Stateside military L&D units demonstrate significant variability in provider staffing models.
• While most units employ a single attending provider per shift and incorporate midwifery, approaches to provider type, shift length, and on-call systems differ.
• A notable difference exists in monthly birth rates per provider between lower and higher volume units.