Certified Nurse Midwives

[DreamerCNM]

Would love any and all information. Do you work with any? How is your relationship? How competent are they? I'm weighing my career options and would love any feedback I can get.

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[DrMidlife]

I thought about midwifery before going to med school. Trained & worked as a doula. I've worked with CNMs in 2 states and met more on residency interviews.

The CNMs I worked with do exactly the same things as NPs and PAs. They're workhorses getting work done. There are always plenty of patients needing "straightforward" care, and (a) it's cheaper to provide that care with a midlevel and (b) that's the whole point of midlevels. An experienced midwife is as capable of educating students and interns as anybody for a great deal of the patient care, and I had midwife preceptors. (Cue righteous indignation from med students who've never held a job.)

For instance in the hospital, the CNMs run the obstetrics service on their own at various times throughout the week. They carry the pager and run the floor when all the residents are in didactics. There's always an attending on call, but no MD/DO on the floor. It's a mix throughout the week, with CNMs providing coverage where needed. I mostly saw midlevels running triage.

In clinic, the CNMs similarly got patients in and out. Very packed schedules, 10-15 minute encounters, upwards of 40 patients per day. Usually the whole day is prenatal visits, or the whole day is contraception, etc.

There's a sea change in process for nursing degrees, which I don't pretend to understand, but getting a DNP is starting to be required for advanced practice. So if you want to be any kind of nurse with prescribing capabilities and autonomy, that's a lot more school than a BSN+MSN or masters entry program.

Best of luck to you.

 

[DreamerCNM]

I thought about midwifery before going to med school. Trained & worked as a doula. I've worked with CNMs in 2 states and met more on residency interviews.

The CNMs I worked with do exactly the same things as NPs and PAs. They're workhorses getting work done. There are always plenty of patients needing "straightforward" care, and (a) it's cheaper to provide that care with a midlevel and (b) that's the whole point of midlevels. An experienced midwife is as capable of educating students and interns as anybody for a great deal of the patient care, and I had midwife preceptors. (Cue righteous indignation from med students who've never held a job.)

For instance in the hospital, the CNMs run the obstetrics service on their own at various times throughout the week. They carry the pager and run the floor when all the residents are in didactics. There's always an attending on call, but no MD/DO on the floor. It's a mix throughout the week, with CNMs providing coverage where needed. I mostly saw midlevels running triage.

In clinic, the CNMs similarly got patients in and out. Very packed schedules, 10-15 minute encounters, upwards of 40 patients per day. Usually the whole day is prenatal visits, or the whole day is contraception, etc.

There's a sea change in process for nursing degrees, which I don't pretend to understand, but getting a DNP is starting to be required for advanced practice. So if you want to be any kind of nurse with prescribing capabilities and autonomy, that's a lot more school than a BSN+MSN or masters entry program.

Best of luck to you.

I appreciate your input! Don't you think that seeing 40 patients a day is a reality for both physicians and CNMs?


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[22031 Alum]

I worked with CNMs as a resident. Some practices had separate patient panels who were seen and delivered by midwives alone, with the MDs providing backup as needed. Other practices had midwives who would see patients in clinic and postpartum round, but very rarely delivered. Overall I think it's the mid level route that allows the best scope of practice within the specialty. If you don't think you want to do deliveries and would rather focus on outpatient, then WHNP would be fine. In my experience PAs have found more of a niche in the Gyn subspecialty clinics, specifically onc and urogyn.

 

[DreamerCNM]

I worked with CNMs as a resident. Some practices had separate patient panels who were seen and delivered by midwives alone, with the MDs providing backup as needed. Other practices had midwives who would see patients in clinic and postpartum round, but very rarely delivered. Overall I think it's the mid level route that allows the best scope of practice within the specialty. If you don't think you want to do deliveries and would rather focus on outpatient, then WHNP would be fine. In my experience PAs have found more of a niche in the Gyn subspecialty clinics, specifically onc and urogyn.

How competent were the midwives as a group?


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[DreamerCNM]

I worked with CNMs as a resident. Some practices had separate patient panels who were seen and delivered by midwives alone, with the MDs providing backup as needed. Other practices had midwives who would see patients in clinic and postpartum round, but very rarely delivered. Overall I think it's the mid level route that allows the best scope of practice within the specialty. If you don't think you want to do deliveries and would rather focus on outpatient, then WHNP would be fine. In my experience PAs have found more of a niche in the Gyn subspecialty clinics, specifically onc and urogyn.

How competent were the midwives as a group?


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[DrMidlife]

if you're asking if i saw CNMs endangering patients, making poor decisions, or being treated by the docs as less intelligent/capable, no i didn't see that. my obgyn experience so far has been in fairly functional clinical environments where incompetence gets noticed and gets you fired right quick.


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[22031 Alum]

How competent were the midwives as a group?

They were perfectly fine. Incompetence doesn't last too long on a busy labor floor.