Health reform put nurse midwives reimbursement rate same as ob/gyn

[Taurus]

What do the ob/gyn's think? Was it worth it to go to through medical school and residency when you could have spent just 2 years in midwife school?

Doc deficit? Nurses' role may grow in 28 states
http://www.msnbc.msn.com/id/36472308/ns/health-health_care/

The new U.S. health care law expands the role of nurses with:

* $50 million to nurse-managed health clinics that offer primary care to low-income patients.
* $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.
* 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.
* A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.

The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.​

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Members don't see this ad.

 

[Diane L. Evans]

First a CNM does not equal an OB/GYN

Second CNM for Obstetrics do simply vaginal deliveries and second degree repairs. Sure both CNM and OB/GYN can get the same reimbursement.

Third a CNM must have OB/GYN backup in most facilities/hospitals. If a CNM calls an OB/GYN for a problem and an operative procedure is performed a Forcep or Vacuum Delivery or a C-section the reimbursement is significantly more.

Fourth OB/GYN's spend over 17,000 hrs of education to do preventative and well women OB/GYN care including obstetric, gynecological, urogynecology, reproductive endocrinology, and oncology services and well as obstetric and gynecologic surgery versus CNM do only routine well women care and NOT surgery.

I don't think its an issue.

 

[Global Disrobal]

I think in this day and age (economy specifically), we are fortunate enough to be making a great living as physicians and having job security. To that end, I don't see increased reimbursements for nurse midwives as a threat to our salaries, quality of life, or profession. I think that for the liability they assume, the care they provide, and the satisfaction scores they often get from their patients, they are well justified in getting better reimbursements.

As mentioned by Diane, there is a lot more that an obstetrician/gynecologist does than pure well woman care and obstetrics. If anything, better reimbursements may attract more folks into the midwifery field, allow better access for women (especially in under-served areas), and free up physicians to focus more on the other aspects of the field (including menopausal care, health maintenance, urogynecology, community education).

Thanks for the post!

 

[DOCTORSAIB]

If CNM (and other midlevels) are given increased reimbursements, what do you think will happen to reimbursements for physicians eventually?

 

[Socrates25]

If CNM (and other midlevels) are given increased reimbursements, what do you think will happen to reimbursements for physicians eventually?

Going down down down.

What Diane and the other guys dont undersand is that all this money is coming out of the same pool. Paying CNMs the same as docs means doctors get paid less because its all a zero sum game.

 

[Socrates25]

First a CNM does not equal an OB/GYN

Second CNM for Obstetrics do simply vaginal deliveries and second degree repairs. Sure both CNM and OB/GYN can get the same reimbursement.

Third a CNM must have OB/GYN backup in most facilities/hospitals. If a CNM calls an OB/GYN for a problem and an operative procedure is performed a Forcep or Vacuum Delivery or a C-section the reimbursement is significantly more.

Fourth OB/GYN's spend over 17,000 hrs of education to do preventative and well women OB/GYN care including obstetric, gynecological, urogynecology, reproductive endocrinology, and oncology services and well as obstetric and gynecologic surgery versus CNM do only routine well women care and NOT surgery.

I don't think its an issue.

Giving up the low hanging fruit to the CNMs is a bad move. You are backing yourselves into a corner where OB/GYNs are surgeons-only, which I expect would take a 50% cut out of some practices.

When the federal government takes over healthcare and starts enforcing W.H.O. mandates that a max of 20% of deliveries are c-sections, are you going to be singing the same tune?

Most ob/gyns need a non-surgical base of practice to mantain revenues; giving that to the CNMs means you get paid less because their rembursement is taking money out of the same pool that you guys drink from.

 

[Socrates25]

I think in this day and age (economy specifically), we are fortunate enough to be making a great living as physicians and having job security.

You are assuming that Medicare sets a roving target for reimbursement thats independent of the number of providers. This is false.

The SGR uses a fixed pool of money for all "providers" and sets targets based on economic activity.

There are $X available to all "ob" providers. If you allow CNMs to bill $Y from Medicare, the money available to ob/gyn doctors is X-Y.

Allowing CNMs to be paid equal to doctors for "routine" prenatal managements and deliveries means that ob/gyn docs get paid LESS for those same procedures. Are you really willing to write off all prenatal management and routine vaginal deliveries to the CNMs? That makes up a good chunk of most OB/GYN practices.

 

[Global Disrobal]

Socrates25, relax, take a breath, and then type . I appreciate the information and perspective you provided.

Now, before taking the discussion any further, can you tell me what percentage of obstetrical care/prenatal care comes from Medicare? In my practice at least, it generally hovers around 1-2% and that is because I care for pregnancies impacted by chronic medical illnesses and the patient is therefore under Medicare. In reality, the new Medicare reimbursement rate (as mentioned in the original article), will likely impact non-medicare scenarios that are not fixed.

Correct me if I'm wrong, but: 1) the market is not flooded with CNMs to the extent it poses a market challenge to the general OB/GYN's bottomline 2) many patients may still prefer to go to an OB/GYN (vice versa as well), 3) OB/GYNs still possess skills (not just surgery) that makes them thrive in today's marketplace and 4) your assumption is that most OB/GYN practices will lose their patients to CNM practices is wrong. The latter would have to be under the assumption that there are competing CNM practices to take away the patients, the CNM practices are financially lucrative enough to thrive on this (despite malpractice costs, need for back up OB/GYN coverage), and that this medicare reimbursement suggestion would change the market that drastically.

Nonetheless, great topic and discussion.

 

[Diane L. Evans]

I agree c Global!

CNM usually do not practice solo so the revenue would be still in the same practice group.

AND

now days there is fewer UNCOMPLICATED well women care (due to obesity, hyperlipidemia, HTN, CVD) including fewer NORMAL OB (due to later age at pregnancy, infertility, higher order multiples, prior Cesarean (avg 35%) etc).
So what % of an OB/GYN practice can CNM see independently without consult in my practice about 15%.

 

[porsche518]

I agree c Global!

CNM usually do not practice solo so the revenue would be still in the same practice group.

AND

now days there is fewer UNCOMPLICATED well women care (due to obesity, hyperlipidemia, HTN, CVD) including fewer NORMAL OB (due to later age at pregnancy, infertility, higher order multiples, prior Cesarean (avg 35%) etc).
So what % of an OB/GYN practice can CNM see independently without consult in my practice about 15%.

Why cant a PA or Nurse Practioner do a primary csection, they are easy enough. Just have a physician on backup for just in case, and they should probably be compansated at the same rate. Heck why not let them do abdo hysts and lap hysts on uncomplicated patients, or simple office procedures like IUDs, colpos, etc, etc.

I think you see where the saying "give them an inch and they will take mile" apt. And it is going to happen, because it is already happening in other fields. Tomorrow I am going to go see my NP who completed a residency in derm!

 

[Dr Oops]

Why cant a PA or Nurse Practioner do a primary csection, they are easy enough. Just have a physician on backup for just in case, and they should probably be compansated at the same rate. Heck why not let them do abdo hysts and lap hysts on uncomplicated patients, or simple office procedures like IUDs, colpos, etc, etc.

I think you see where the saying "give them an inch and they will take mile" apt. And it is going to happen, because it is already happening in other fields. Tomorrow I am going to go see my NP who completed a residency in derm!

People dont care until it hits their field. Even if you dont perceive it as a threat to your specialty stand behind your colleagues in others.

 

[Taurus]

People dont care until it hits their field. Even if you dont perceive it as a threat to your specialty stand behind your colleagues in others.

We are on a slippery slope. Don't be fooled and get complacent, the nurses want to claim as much of medicine to themselves as possible. Over in England, they're even toying with the idea of letting nurses do surgeries. So don't be surprised if routine surgeries like c-sections are in their sights.

 

[THP]

I find it frustrating that so many in Ob/GYN are willing to relinquish their roles to lesser trained individuals.

 

[obpgy1]

I find it frustrating that so many in Ob/GYN are willing to relinquish their roles to lesser trained individuals.

Definitely agree with this. But it's the nature of how things are with physicians in practice as they willingly sell out little by little to make a few extra dollars even if it means sacrificing their profession as a whole.

It's already in full force with anesthesia with the ridiculous levels of autonomy and pay for CRNAs.

The last place I want to see it is in OB-GYN. The field is already overly litigious to an almost insane level, and trusting a mid wife with limited medical knowledge with even simple vaginal deliveries is a mistake. And don't forget how nutty midwives can get with herbal supplements regardless of any studies proving their efficacy.

 

[Global Disrobal]

The last place I want to see it is in OB-GYN. The field is already overly litigious to an almost insane level, and trusting a mid wife with limited medical knowledge with even simple vaginal deliveries is a mistake. And don't forget how nutty midwives can get with herbal supplements regardless of any studies proving their efficacy.

This has definitely been an interesting discussion and everyone's input is appreciated. I guess my opinion toward mid-level providers (CNM, NP, CRNA) is rather different from some members on this thread. Regardless, I don't think using phrases such as "limited medical knowledge" or "nutty" are going to get the point across in an effective way, not do they do midwives any justice. I personally trained at a program with a heavy CNM presence, and must whole heartedly disagree with the above statement at the very least.

Getting back to the original point of discussion, yes, physicians should be protective of their skill set, territory, and profession. However; you must also be cognizant of mid level providers in your specialty, utilize them where needed/necessary, and give credit where it is due. I still challenge the notion that they provide more harm than good for the bottom line. I guess that might be a reflection of my naivete as a subspecialist. I just feel that they are beneficial for improving access to care, and to allow us to better focus our skill set.

 

[Socrates25]

This has definitely been an interesting discussion and everyone's input is appreciated. I guess my opinion toward mid-level providers (CNM, NP, CRNA) is rather different from some members on this thread. Regardless, I don't think using phrases such as "limited medical knowledge" or "nutty" are going to get the point across in an effective way, not do they do midwives any justice. I personally trained at a program with a heavy CNM presence, and must whole heartedly disagree with the above statement at the very least.

Getting back to the original point of discussion, yes, physicians should be protective of their skill set, territory, and profession. However; you must also be cognizant of mid level providers in your specialty, utilize them where needed/necessary, and give credit where it is due. I still challenge the notion that they provide more harm than good for the bottom line. I guess that might be a reflection of my naivete as a subspecialist. I just feel that they are beneficial for improving access to care, and to allow us to better focus our skill set.

1. By definition, midwives DO have "limited medical knowledge." Do you really think they are just as knowledgeable as OB/GYN physicians? If so, then the OB/GYN training pathway is absurdly inefficient if a midwife with less than a third the total time in training has equal medical knowledge.

2. Re the bolded section above. I am under NO obligation to "give credit" to midlevels at all. I will not work with them, I will not "supervise" them, I will not sell my profession out to them. Rest assured you are quite wrong in your assertion that its inevitable that you have to work with them, the implication being that we shouldnt "fuss" with it because we have no choice in the matter. WE DO HAVE A CHOICE! 99.9% of midlevels in private practice are hired by physicians. We can hire them and fire them at will. I refuse to "utilize" them simply so I can make an extra 20% - 50% income. This is what happened with anesthesiology -- the CRNAs got into the tent because MDAs werent happy making 250k. They wanted 500k+ so they started "supervising" midlevels.

 

[Dr Oops]

This has definitely been an interesting discussion and everyone's input is appreciated. I guess my opinion toward mid-level providers (CNM, NP, CRNA) is rather different from some members on this thread. Regardless, I don't think using phrases such as "limited medical knowledge" or "nutty" are going to get the point across in an effective way, not do they do midwives any justice. I personally trained at a program with a heavy CNM presence, and must whole heartedly disagree with the above statement at the very least.

Getting back to the original point of discussion, yes, physicians should be protective of their skill set, territory, and profession. However; you must also be cognizant of mid level providers in your specialty, utilize them where needed/necessary, and give credit where it is due. I still challenge the notion that they provide more harm than good for the bottom line. I guess that might be a reflection of my naivete as a subspecialist. I just feel that they are beneficial for improving access to care, and to allow us to better focus our skill set.

I think you should read some of the links in taurus' profile. Mid levels can have their place, but they want more without doing the necessary work. They are trying to expand their role. I cant possibly imagine why someone with less than half the training is getting paid the same amount. You may claim that they do the same job, which is what they are claiming, but your not paying for someone to stand there and catch. You are paying for the knowledge that you spent years learning. If something were to go wrong I would want an ob/gyn.


If CRNAs practicing independently and FNPs taking over primary care(yet costing the same) and Midwife nurses getting paid the same, doesnt trouble you in the least then I feel sorry for the future of medicine and the patients.

Edit: Here are the links

http://www.forbes.com/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html

Some excerpts:
"This doctoral degree enables advanced-practice nurses to gain the knowledge and skills necessary to practice independently in every clinical setting."

"In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional."

Another article:
http://www.msnbc.msn.com/id/36472308/ns/health-health_care/

excerpt:
"Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay.""


They dont want to be part of the team, they want to take your turf.

They have a great propoganda machine. They tell patients they have the same training, when the clearly dont.
heres a DNP curriculum, first one googled that came up:
http://nursing.duke.edu/modules/son_academic/index.php?id=109

Seems to be lacking all those pathology and physiology and other science classes you had to take.

Also some of these programs can be done almost completely online, with only 500 or so clinical hours.

Dont worry theyre creating other "residency programs" (a whole 1000 hours) so they can go into other specialties.

They are also against the truth and transparency act.

Heres their response to the act (which makes it illegal to represent yourself as a physician in a clinical setting.)
http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/Federal/Issues/Healthcare.aspx

Not surprisingly theyre against it, it would hurt their propaganda machine.

 

[Global Disrobal]

1. By definition, midwives DO have "limited medical knowledge." Do you really think they are just as knowledgeable as OB/GYN physicians? If so, then the OB/GYN training pathway is absurdly inefficient if a midwife with less than a third the total time in training has equal medical knowledge.

2. Re the bolded section above. I am under NO obligation to "give credit" to midlevels at all. I will not work with them, I will not "supervise" them, I will not sell my profession out to them. Rest assured you are quite wrong in your assertion that its inevitable that you have to work with them, the implication being that we shouldnt "fuss" with it because we have no choice in the matter. WE DO HAVE A CHOICE! 99.9% of midlevels in private practice are hired by physicians. We can hire them and fire them at will. I refuse to "utilize" them simply so I can make an extra 20% - 50% income. This is what happened with anesthesiology -- the CRNAs got into the tent because MDAs werent happy making 250k. They wanted 500k+ so they started "supervising" midlevels.

Socrates25,
1. First, please feel free to respond to my post on 5/21, which was related to your previous comments. You seemed to disappear when your knowledge of Medicare/Medicaid in Obstetrics was challenged.

2. Can you please share this "definition" of midwifery with us or cite the source, where it states that they have limited knowledge? Of course their knowledge is limited by their field of practice in comparison to an OB/GYN, but that was not the point of the original post (which I hope you read prior to your response).

3. Can you please remind me again as to where in my post I say that a CNM has equal medical knowledge as a physician since you use it as a counter argument? I merely suggested that using derogatory terms in your argument (i.e. limited knowledge, nutty) would take away from the value of your statements.

4. As I mentioned in my earlier post, relax! You seem to take discussions related to mid-level providers rather personally. This is based not only on this forum, but the majority of your posts on SDN forums. No one is telling you that you "have to" hire, supervise, fire, play with, interact with, teach or for that matter do anything with a mid-level provider. People are just making comments about their roles in our fields. To that end, make up your mind. Are you asserting that hiring them leads to more income for physicians (as in the case of CRNA's you use) or are you asserting that it will lead to less income for physicians (as in your post above on 5/21)?

I can tell you that as someone who has been both on the academics side, private practice side, and military, I'm still at a loss for your arguments. I do however value them and have thoroughly enjoyed reading the various opinions.

 

[Global Disrobal]

I think you should read some of the links in taurus' profile. Mid levels can have their place, but they want more without doing the necessary work. They are trying to expand their role. I cant possibly imagine why someone with less than half the training is getting paid the same amount. You may claim that they do the same job, which is what they are claiming, but your not paying for someone to stand there and catch. You are paying for the knowledge that you spent years learning. If something were to go wrong I would want an ob/gyn.


If CRNAs practicing independently and FNPs taking over primary care(yet costing the same) and Midwife nurses getting paid the same, doesnt trouble you in the least then I feel sorry for the future of medicine and the patients.

Edit: Here are the links

http://www.forbes.com/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html

Some excerpts:
"This doctoral degree enables advanced-practice nurses to gain the knowledge and skills necessary to practice independently in every clinical setting."

"In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional."

Another article:
http://www.msnbc.msn.com/id/36472308/ns/health-health_care/

excerpt:
"Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay.""


They dont want to be part of the team, they want to take your turf.

They have a great propoganda machine. They tell patients they have the same training, when the clearly dont.
heres a DNP curriculum, first one googled that came up:
http://nursing.duke.edu/modules/son_academic/index.php?id=109

Seems to be lacking all those pathology and physiology and other science classes you had to take.

Also some of these programs can be done almost completely online, with only 500 or so clinical hours.

Dont worry theyre creating other "residency programs" (a whole 1000 hours) so they can go into other specialties.

They are also against the truth and transparency act.

Heres their response to the act (which makes it illegal to represent yourself as a physician in a clinical setting.)
http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/Federal/Issues/Healthcare.aspx

Not surprisingly theyre against it, it would hurt their propaganda machine.

I appreciate the links and the comments. As I mentioned above, I think my perspective is just different but I do value and appreciate what you folks are saying. In my opinion, the topic is diluted as different mid-level providers in different specialties make substantially different incomes. Furthermore, I'm looking at the picture more from a healthcare access viewpoint than an encroachment onto the specialty. It may be very simplistic, but I just don't see the situation in as dire of a state as other do, at the very least in obstetrics.

 

[porsche518]

I appreciate the links and the comments. As I mentioned above, I think my perspective is just different but I do value and appreciate what you folks are saying. In my opinion, the topic is diluted as different mid-level providers in different specialties make substantially different incomes. Furthermore, I'm looking at the picture more from a healthcare access viewpoint than an encroachment onto the specialty. It may be very simplistic, but I just don't see the situation in as dire of a state as other do, at the very least in obstetrics.

I am guessing you are MFM, urogyn or some sort of sub specialist that has not had to deal with the mid level situation.

And your attitude is very common amgonst subspecialist in medicine and surgery as well. They feel that their job is secure from midlevels, or they used to think that.

But while the argument for increasing the scope of practise of midlevels began as "increasing access" to care, the reality has been different. Most have gone into the same lucrative fields that attract physicians. They are only trying to set a precedent with primary care that they can carry over into all the other subspecialties. Already there are midlevels doing c-scopes with no supervision and soon they will do routine cardiac caths.

THis might not have spread into ob/gyn yet but it is only a matter of time. Now if you are a sub specialist in a not so lucrative field then you are probably safe.

 

[Global Disrobal]

I am guessing you are MFM, urogyn or some sort of sub specialist that has not had to deal with the mid level situation.

And your attitude is very common amgonst subspecialist in medicine and surgery as well. They feel that their job is secure from midlevels, or they used to think that.

But while the argument for increasing the scope of practise of midlevels began as "increasing access" to care, the reality has been different. Most have gone into the same lucrative fields that attract physicians. They are only trying to set a precedent with primary care that they can carry over into all the other subspecialties. Already there are midlevels doing c-scopes with no supervision and soon they will do routine cardiac caths.

THis might not have spread into ob/gyn yet but it is only a matter of time. Now if you are a sub specialist in a not so lucrative field then you are probably safe.

Great points, thanks! As you guessed and I mentioned above, I am in MFM and that might very well be why my view differs from the other folks on this thread. Nonetheless, it has been interesting reading about this topic and learning more.

Have a good day!

 

[CookDeRosa]

We are on a slippery slope. Don't be fooled and get complacent, the nurses want to claim as much of medicine to themselves as possible. Over in England, they're even toying with the idea of letting nurses do surgeries. So don't be surprised if routine surgeries like c-sections are in their sights.

>>

Respectfully, spend 15 minutes with any CNM and you'll find that the model of care is specifically anti-routine surgery. In fact, google private practices, and you will find that they despise the "medical model of birth" in favor of the "midwifery model of birth." Know thy self, know thy enemy.
As to other specialties, I couldn't say, but to suggest that midwives want to do surgery is completely contrary.

 

[Taurus]

>>

Respectfully, spend 15 minutes with any CNM and you'll find that the model of care is specifically anti-routine surgery. In fact, google private practices, and you will find that they despise the "medical model of birth" in favor of the "midwifery model of birth." Know thy self, know thy enemy.
As to other specialties, I couldn't say, but to suggest that midwives want to do surgery is completely contrary.

Of course midwives don't like c-sections because they're not allowed to do them. Teach them how to do c-sections and allow it in their scope and watch them sing a new tune.

Your argument is like saying the NP's are pushing for autonomy because they want to increase "access" to care, especially in the rural setting, and they have no interest outside of primary care. Oh really? Physicians in all specialties need to take a few moments out of their busy day and study the efforts of the NP's and CRNA's to expand their scope to include as much of medicine for themselves as possible.

Don't be surprised if the "DCNM" or "Doctor of CNM" create residencies to do c-sections and other routine gyn surgeries. You did know that the nurses want to make all of their advanced practice groups to the doctorate level, right? This includes the NP's, CRNA's, and CNM's.

NPs can now do dermatology residencies

USF offers the nation's first Dermatology Residency in a Doctorate of Nursing Practice (DNP) program. The DNP Dermatology Residency program is a collaboration with USF College of Nursing and Medicine, H. Lee Moffitt Cancer Center, Center for Dermatology and Skin Surgery, Bayonet and Memorial Wound Care Centers, and other community physician practices and institutions.

The DNP program includes a core curriculum identified by the American Association of Colleges of Nursing's "DNP Essentials" (AACN, 2006). The dermatology resident must complete 33 core and clinical cognate credit hours and 23 credit hours of dermatology residency which includes a standardized and formal curriculum, evidence-based project, and clinical hours. Total credit hours for the DNP degree and dermatology residency are 56 credit hours.

The program requires the resident to complete a series of clinical rotations that will progress in the level of complexity. In addition to the clinical rotations, residents are required to complete selected projects and to participate in the department's research program. Throughout the program, written and observed tests will be administered and each resident must complete required publication submissions, presentation of ground round lectures, and must obtain teaching experience as guest lecturers in the USF College of Nursing's Primary Care Nurse Practitioner program. Residents are expected to attend appropriate professional conferences and to participate in professional organizations.

The DNP Dermatology Residency Program (USF, 2008) is a challenging academic and clinical endeavor. The program consists of completing the course requirements for the USF DNP program and the dermatology residency. The DNP with a specialty in dermatology will provide a terminal practice degree to prepare advanced nurse practitioners to assume leadership roles in the practice, research, and the health care setting

The purpose of this program is to prepare the graduate for advanced practice in the specialty of dermatology at the doctoral level. It is expected that this program will serve as the benchmark and model for other doctoral dermatology residencies across the nation.

As the DNA, the NP Society, and the AAD work together to develop a core body of knowledge for the dermatology specialist, it will be important to keep in the forefront the effects of health care bills like HB 699 on the practice of nurse practitioners. Developing programs that are supported by these organizations create competent health care providers that are capable of treating various skin diseases seen in the dermatology setting. For the safety and well-being of our patients, it is imperative that dermatology NPs receive formal academic training and demonstrate competency through board certification. In time, the Florida Board of Medicine's perceptions of nurse practitioner practice may improve when future studies show that the development of these formal dermatology educational programs improves diagnostic and treatment skills and positive patient outcomes.
​

 

[obpgy1]

>>

Respectfully, spend 15 minutes with any CNM and you'll find that the model of care is specifically anti-routine surgery. In fact, google private practices, and you will find that they despise the "medical model of birth" in favor of the "midwifery model of birth." Know thy self, know thy enemy.
As to other specialties, I couldn't say, but to suggest that midwives want to do surgery is completely contrary.

The "midwifery model of birth" is just BS marketing that midwives have created in an effort to create more business for themselves and not so subtly try to bad mouth modern day obstetrics which is a victim of its own success in terms of decreasing the amount of morbidity and mortality related to obstetrics within the last 50 years. If midwives were trained to do C-sections and had to deal with complicated obstetric situations, then they would perform C-sections.

The fact is, midlevels are all trying to get a piece of the healthcare dollar action from CNRA, PA, DNP, and midwives on and they do so by slowly chipping away at what physicians hold. And this effects all specialties to some degree even the heavily procedural/surgical ones.

It's naive to think that because on a personal level a midlevel may profess to not wanting to expand their practice scope, but on a national level their organizations are throwing a lot of money in order to increase their scope of practice.

 

[THP]

. . . and they want to do it without going through the same rigorous training.

 

[CookDeRosa]

The "midwifery model of birth" is just BS marketing that midwives have created in an effort to create more business for themselves and not so subtly try to bad mouth modern day obstetrics which is a victim of its own success in terms of decreasing the amount of morbidity and mortality related to obstetrics within the last 50 years. If midwives were trained to do C-sections and had to deal with complicated obstetric situations, then they would perform C-sections.

The fact is, midlevels are all trying to get a piece of the healthcare dollar action from CNRA, PA, DNP, and midwives on and they do so by slowly chipping away at what physicians hold. And this effects all specialties to some degree even the heavily procedural/surgical ones.

It's naive to think that because on a personal level a midlevel may profess to not wanting to expand their practice scope, but on a national level their organizations are throwing a lot of money in order to increase their scope of practice.

>>

Midwives are not going to do C-sections, they don't even take science class. The midwifery model of birth is a marketing gimic? What is that assumption based on?
I agree that NPs, CRNAs, and PAs are all trying to do more with less training.

 

[obpgy1]

>>

Midwives are not going to do C-sections, they don't even take science class. The midwifery model of birth is a marketing gimic? What is that assumption based on?
I agree that NPs, CRNAs, and PAs are all trying to do more with less training.

This is happening in some of the more underdeveloped parts of the world in which midlevels are doing more and more.

http://www.pbs.org/wnet/wideangle/episodes/birth-of-a-surgeon/introduction/747/

A midwife performing Hysts and C-sections.

I know this is an extreme example but it is a precedent and that's really all that is required in order to get a movement going.

The fact that they don't even take science classes is what makes it more disturbing that their reimbursements are equivalent to an OB/GYN who went through 4 years of undergrad, 4 years of medical school, and 4 years of an intense residency.

And yes. I do feel the midwifery model is a gimmick. What does "midwifery model of birth" even mean? I know, it's just spouting off that home deliveries (which is against ACOG guidelines) are fantastic and herbal supplements are natural and safe even with limited or no data.

Medical intervention is what has led labor and delivery to be such a normal everyday event compared to the situation years back or even in third world countries currently.

I've been fortunate to have some experience at a busy academic hospital with nationally known faculty in OB-GYN and I can safely say that the vast majority only want to intervene when such intervention is necessary for a safe outcome for mother and child. That's what the "medical model of child birth" is.

 

[Taurus]

In other areas of medicine, we have medical counterparts to the nurses.

PA's <=> NP's.

AA (anesthesiologist assistants) <=> CRNA's

What is the medical counterpart for CNM's? If one does not exist, it may be time to think of creating one or using PA's more in L&D.

 

[Diane L. Evans]

I agree with Global

Can we please close the thread

 

[Global Disrobal]

The fact that they don't even take science classes is what makes it more disturbing that their reimbursements are equivalent to an OB/GYN who went through 4 years of undergrad, 4 years of medical school, and 4 years of an intense residency.

And yes. I do feel the midwifery model is a gimmick. What does "midwifery model of birth" even mean? I know, it's just spouting off that home deliveries (which is against ACOG guidelines) are fantastic and herbal supplements are natural and safe even with limited or no data.

I'm just fascinated at how some of you are approaching this debate. As I mentioned above, stick to objective comments and spare us the personal attacks. Regardless of your beliefs regarding midwives, I'm positive you can make a coherent and effective argument without utilizing "gimmick" or "spouting off" or "home births," which were not even part of the original discussion.

First and foremost, I practice maternal-fetal medicine. I did go through the training you mentioned and I am as every bit protective and proud of my profession and turf as the next person. I am not your typical pro-midwifery individual but, I do have to step in and point out the ridiculousness of some of the assertions here:

1. They don't take science classes? Seriously? You seriously want the readership of this forum to take you seriously with a statement like that? Have you heard of undergraduate coursework required for a nursing degree or what the curriculum for a typical CNM degree entails? Lets look at UCSF as an example: http://nurseweb.ucsf.edu/www/spec-mwf-curr.htm
I would also submit to you that the biology, chemistry, and physiology courses are in fact "science."

2. You have an issue with reimbursements? Well, last I checked, if you're credentialed by an institution to perform a delivery, and in fact do a delivery and assume the liability that goes along with it, then hell, you deserve to get paid. Does this mean they're equal to an OB/GYN? No. There is a lot more to being an obstetrician than just vaginal deliveries. And, no, I don't see them venturing into operative deliveries to the extent that it will pose a challenge to our specialty. What do you think about FP's doing C-sections or operative deliveries? Has this run the OB/GYN's out of the market?

3. Just because you don't know what the "midwifery model" or "centering" is, doesn't mean that its substandard, non-existent, or simply "spouting off that home deliveries are fantastic." You truly project a poor image of the rest of us when you solely equate midwifery with home births and herbal supplements.

In response to Diane, NO, the thread should not be closed as there is nothing here that warrants it. Folks are presenting their viewpoints and a discussion is taking place, as much as some of us may disagree with it.

 

[obpgy1]

1. They don't take science classes? Seriously? You seriously want the readership of this forum to take you seriously with a statement like that? Have you heard of undergraduate coursework required for a nursing degree or what the curriculum for a typical CNM degree entails? Lets look at UCSF as an example: http://nurseweb.ucsf.edu/www/spec-mwf-curr.htm
I would also submit to you that the biology, chemistry, and physiology courses are in fact "science."

If the link you provided was supposed to impress me I'm sorry to say it hasn't. The training is minimal at best.

2. You have an issue with reimbursements? Well, last I checked, if you're credentialed by an institution to perform a delivery, and in fact do a delivery and assume the liability that goes along with it, then hell, you deserve to get paid. Does this mean they're equal to an OB/GYN? No. There is a lot more to being an obstetrician than just vaginal deliveries. And, no, I don't see them venturing into operative deliveries to the extent that it will pose a challenge to our specialty. What do you think about FP's doing C-sections or operative deliveries? Has this run the OB/GYN's out of the market?

I don't like FPs doing C-section all that much to be perfectly honest but that issue has already been decided. And at the very least, FPs have an MD and have in a lot of cases done an extra year of OB along with their traditional residency structure.

I can't predict what would happen if midlevels were allowed to do C-sections. It may have no effect on the economics for OB/GYNs or it could be an instance similar to general surgery and how GI has taken over scoping (I know this is MD vs MD and not midlevels) but why cross that bridge knowing that there is no turning back?

3. Just because you don't know what the "midwifery model" or "centering" is, doesn't mean that its substandard, non-existent, or simply "spouting off that home deliveries are fantastic." You truly project a poor image of the rest of us when you solely equate midwifery with home births and herbal supplements.
.

I'm still not sure how I'm projecting anything incorrectly. In my experiences, midwives are much more likely than a physician to support homebirths and the like even against guidelines and recommendations. And this just reeks of improper care and poor advice basically because midwives like other midlevels have a poor understanding of what can go wrong in situations generally due to their limited training.

This is my issue. Even with their limited training, they can get equivalent reimbursements. And although they assume some liability they generally need an OB/GYN as backup in most, if not all states. This doesn't seem right to me and gives midlevels an increased scope of practice that you cannot take back all for a few extra dollars.

We've seen it in anesthesia and primary care before and it is expanding to other specialties.


---------------------------------------------------

There's not much more to say on this topic except that some people feel that midlevel encroachment is not a threat while others do.

 

[CookDeRosa]

1. They don't take science classes? Seriously? You seriously want the readership of this forum to take you seriously with a statement like that? Have you heard of undergraduate coursework required for a nursing degree or what the curriculum for a typical CNM degree entails? Lets look at UCSF as an example: http://nurseweb.ucsf.edu/www/spec-mwf-curr.htm
I would also submit to you that the biology, chemistry, and physiology courses are in fact "science.">>


I might have been snarky saying that they don't take science (undergrad), but compared to premed- they don't. That's the path I left, so I'm well versed in the requirements of most of the MSN/CNM programs inside the United States.

Undergrad sciences are required for an RN nursing track (diploma, associate degree, or bachelor degree). Essentially nursing sciences are the same: AP 1, AP 2, microbiology -all with labs, and the prereqs required for entry. In my case, the prereqs for AP1 were intro bio and intro chem. BSNs usually require 1 or 2 upper levels, however, BSNs are not required for midwifery, a bachelor's in any field will do. For my premed courses, I've had to take general BCMP- nothing from nursing counted. Had I stayed on the MSN midwifery path, I wouldn't have had to take any science beyond those I listed that I already took.

I'm not being negative, I'm simply pointing out that midwives are not a "slippery slope" away from doing surgery. The midwives I know who want to do surgery end up applying to med school. I've had manyyyyy midwives tell me how they hate to do first assist and only do it for the patient's well being.

 

[Paseo Del Norte]

Problem being, there is a rather profound difference between introductory chemistry or chemistry for health professionals and say two semesters of Gen Chem, two semesters of O-Chem and some Bio-Chem for the sake of completion. I would agree we take science courses, just not on the level of a pre-med.

As I've stated on other forums, my medical provider has to know more in the way of chemistry, biology, pathophysiology and medicine than me before Ill consider letting him or her touch me.

My personal bias perhaps.