Starting Your Own Midwifery Practice or Join One?
Starting Your Own Midwifery Practice As a new graduate or experienced midwife, it is a big decision to start your own practice or join another established midwifery team instead. There are many pros and cons to each option. I would like to break down some things to think about when pondering these very different midwifery paths. Are you a new midwife or have years of experience? Do you like working for someone else or doing your “own thing?” Have you ever run a business before or always worked as an employee? Do you have any great midwifery practices in your area to join or need to start a practice to stay close to family? Is there a need for another midwifery practice in the area? I will start with all the great advantages of starting your own midwifery practice: 1. Control of your own schedule, services offered, and families you serve. You decide the office hours, fee schedule, mission, and values of your practice. You can take a vacation when you decide versus having to get approved by management. You can work 20hr or 100hr each week, versus a paid salary and being told when you are working and what you will be doing. 2. The income potential is unlimited. You can charge whatever you would like for your care, choose how many births you will do each month, and decide how many hours you will invest into your practice. People will argue that I can only work so many hours so that does limit my income potential. Then I get people to think bigger than their own time restraints. You can hire as many midwives to be part of your team and transition into a business owner versus sole proprietor mindset. Quit thinking of only leveraging your time, but all the wonderful midwives that want to work for a well-established practice. 3. You can make changes on a larger scale. Similar to the prior perk, you can make your practice as small or big as you want. You could create a birth center franchise across your entire state, like New Birth Company in Kansas with Cathy Gorden, CNM. You can provide midwifery care to many more families than if you were just a solo home birth practice. 4. Tax benefits of being a business owner. There SO MANY advantages in the tax realm with deductions compared to being a W-2 employee. You can write off mileage, business meetings, supplies, home office, and continuing education. professional certifications, and much more! Retirement planning has so many better options for being a business owner than an employee. I could go on and on about all the tax benefits for entrepreneurial-spirited individuals. 5. Decrease chances of professional burnout. This can be a possibility for owner or staff, but really depends on the foundational call coverage model practice creates. There is a constant adrenaline flow into a person’s body being on call all the time. If you don’t get collaborating midwives within your practice or another practice that covers each other for vacation, sick time, or family events like recitals or sports events, self-care, and work/life balance are extremely difficult to accomplish. With being an owner, you can choose a staff model of call coverage. You can choose how many midwives will be on the team and how they will support each other. When you work for another midwife, you are more vulnerable to burnout since your boss will be making your employment contract, vacation requests, and terms of your call coverage. Let’s get into the perceived negatives of being a business owner. Some people are not driven to be business owners and that is totally fine. You need to do a good analysis of your own personality and goals of responsibility within a practice. Do you want to know what days you are working and have off? Do you want to not be responsible for the budgets, marketing campaigns, and paying the bills for the business? Do you want a paycheck every two weeks versus waiting to get paid once all your staff and overhead expenses are paid? Being a business owner may not be the best fit for you and that is totally fine. 1. Always available 24/7 for your staff, business needs, and complaints. It is really easy to say as an employee when the client isn’t happy, “Let me get my manager for you to help resolve this issue.” If you are employed, you can pass off many tougher parts of running a business. 2. You may work for many months without seeing your first reimbursement for your hard work and precious time. Business owners put many hours, funds, and risks into starting a business and may never see a return on their efforts if the business doesn’t have a good foundation to grow from with a strong business and strategic plan in place. 3. Starting a business takes time to learn that aspect of midwifery. Most schools don’t teach you how to run a practice and primarily focus on the clinical training of being a midwife. That is a totally different schooling and takes time to learn. Getting certifications, finding business mentors, and reading books from other business owners will really help prevent mistakes with your practice that can increase chances of failure, burnout, and waste of valuable time. 4. There is a lot more responsibility than being an employee. You are responsible for yourself only when employed versus your entire staff needs you to run a successful midwifery practice. There are additional stress, demands, and expectations of the business owners than hired midwives. Are you the type of person that wants that level of expectations? I am definitely biased towards midwives running their own practices, but think it is so important for each midwife to think about their goals in life and style of midwifery. Some midwives are better workers and others are better business owners. Know your drive, personality type, and the life goals you want to
Starting a Midwifery Practice: Supplies Needed
Midwifery Supplies Needed During the initial planning, I broke up my practice into different section of required inventory to function efficiently. I needed office supplies, prenatal visit supplies, birth center supplies, home birth supplies, and administration supplies. There was specific inventory listed that were later used for staff to restock when things were close to expiring or getting low. When Starting Out or Improving your Supply Inventory, there is Lots to Think About. Picture your midwifery practice, what is the volume and setting you will be serving. What challenges will come from having a birth center and home birth practice under one business? There will be double supplies of everything at both locations (car for home births and birth center for deliveries there). How many midwives will work with your team? If you are solo, much easier to keep track of inventory and systems than a group of midwives with multiple birth bags. How will your office flow be? Will there be lab draws on site or sent to the local hospital to be drawn? We did lab draws in house and had to reorder supplies from LabCorp when things were getting low. Start with an excel spreadsheet and just start brainstorming ever item you can think of will be needed to care for women. Picture yourself doing an office day, what will be needed to answer phones, keep track of charts, fax out orders, print educational handouts, see women for prenatal visits, waiting room reading material and toys for kids. My initial brainstorming list had start up supplies versus routine restocking items. Supplies For example, during a prenatal visit my room had in a side basket next to my chair the following: doppler, lubricant, tape measure, sterile and nonsterile gloves, disposable blue pads, clipboard, paper, pens, urine dipsticks, stethoscope, blood pressure cuff, alcohol swabs, hand sanitizer, and more commonly used educational handouts. I had the basket into two sections, items I always used for each visit like the doppler, tape measure, and blood pressure supplies and the other section had things nice to keep close by but not always used. Charts were already prepped for the busy office day night before and had everything ready for each lady’s specific needs prior to start of the day. If someone was coming in that day for her diabetes screening, the Medical Assistant already got her lab order and specific lab supplies ready in a biohazard bag in her chart for me to grab when doing her visit. This saves lots of time running in out of the prenatal visit to grab random supplies when seeing families. For birth supplies, make a list of essentials for safety, things it would be nice to have, and things that are on a wish list. Sometimes budgets are tight starting out and until your first few payments from clients come in, you may need to work with bare bones / essentials at birth for a while. It would be great to have a nice birth stool, but not a must in the beginning. Make sure you have oxygen and ambubag for newborn resuscitation, thermometer, stethoscope, blood pressure cuff, charting paperwork, birth instruments, medications for bleeding, doppler for listening to baby with spare batteries and lubricant. Be resourceful with your funds, but never compromise safety for a few bucks. Water birth Water birth had additional equipment needed. Have the families be responsible for the purchasing of a birth tub and clean up initially. As your volume increases, you can look into having a stock birth pool with liners and training an assistant to clean up tub in time. Think simple and grow as your practice seasons. Administration equipment isn’t something many midwives spend much time thinking about. Trust me, the more planning with administration prep, the better your overall practice flow will go. Find tools and resources that will make your time be utilized better. Birth Tracks is a great resource to keep track of your phenomenal outcomes to brag about to community. Having a great printer, internet service, computer, phone with head set for receptionists, fax machine, chart holder and organizer, online storage system like Google Drive, lap tops, EMR charting system like Athena Health, or billing system like Midwives Advantage are very important to research and get the best products for your needs. Think of equipment that will work for start up and long term needs. Getting the cheapest doppler isn’t always the best idea. Having two dopplers that are waterproof is a must. Don’t skimp on safety and quality (hear me say that lots)! We all became midwives to help women birth their baby in a safe environment, whether hospital, home, or birth center. We are hired by families with assumption of proper training, equipment, and skills present to do just that service. Make a List Every practice will be different detailed equipment needs depending on state regulations, size of practice, and setting of delivery. Spend some time researching what other midwives have for equipment in the office and birth environment. Personalize your inventory list and plan accordingly in budgets for costs in beginning and monthly for replacement of items. What is the radius area you will serve? Last thing any midwife wants is to run out of an item, because proper inventory organization or delegation of ordering task wasn’t being completed by team. Births happen in waves. I always carried in my car enough supplies to do four births in a row before I had to go restock. Max I had to test that was three ladies in a row. Plan your day that if a birth happens, do you have supplies to do that postpartum home visit near the birth back to back instead of driving all the way to the office for supplies. I carried in my car a birth bag, postpartum bag, prenatal visit bag, and suitcase for me with spare birth clothes and office clothes. There has been a couple times I was too tired to drive
Starting a Midwifery Home Birth Practice
How To Create a Home Birth Practice? Creating a home birth practice does take time and planning. You need to make a business plan, figure out what your start-up costs will be, what staff you will need short term and long term, what midwifery regulations you need to adhere to, and how many women each month you would need to deliver to cover operating overhead costs. There is so much to think about and it takes months to prepare and create the home birth practice vision. There are so many policies for office and clinical practice to create. Having a reserve of funds to cover starting up until the first payment for care comes in (whether that is cash towards the end of pregnancy from family or insurance reimbursement after birth). Can you see women on your off day while still keeping that hospital midwifery job? Will it violate your employment contract? What type of business entity should you apply for? Knowing how much to have for marketing and what steps that will look like is really important in your business plan. Will you be doing mostly referrals (takes time and slower option)? Will you make business cards, flyers, and newspaper ads? Facebook is a great, cost-effective way to promote your midwifery practice. Who is your competition in the area? What are the needs like? Do you have a collaborating physician already in place? What do your state regulations say about midwives running their own private practices? There are usually so many more questions than answers in the beginning but have faith. Take each task day by day and make a timeline of your home birth practice opening goals. Timelines of what needs to be accomplished each month will really help keep you on track and see the progress actively happening. Hiring a Business Consultant Another great way to accelerate your home birth practice opening is to hire a business consultant who specializes in midwifery (like us). It will save you hundreds of hours creating policies, business plans, budgets, and legal agreements with our already-made templates available. Why re-work the wheel of success when other midwives have already figured out the best ways to run a home birth practice? Let our experts help you accelerate your timeline of opening and being your own boss! Your midwifery home birth practice will save countless headaches and late nights, and valuable time could be spent with family using the knowledge we have gained over the years about business and finances! Enroll in Our Course on How To Run a Successful Home Birth Practice
Starting a Midwifery Business
Starting a midwifery business is a leap of faith and a decision which you must think about a hundred or even a thousand times. Midwives play a vital role in the wellbeing of the woman and her baby. Establishing care in this manner leads us to prioritize creating a positive experience of care, promoting and contributing to the capability of women, securing attachments and bonds of love, and allowing joy. It enables midwives to think and see their role as practitioners differently from other health care practitioners within the health care system. The moment you decide to start your own practice, you will take boundless risks. It requires extreme commitment and persistence as you may encounter adversities and challenges along your way, but surely the reward is exceptional. When starting a midwifery practice, one of the big decisions to make is what setting to deliver in. Do I want to offer home births, birth center deliveries, or hospital births? Do I want to offer a couple setting options? To help you in the decision process you are doing, here’s the different type of practice that you may want to know before you start your own midwifery practice. There are many midwifery businesses to start, but will focus on the common three I speak with midwives all over the country to help start: Home Birth Practice Wanting to start out small and private? Home birth practice gives midwives the most autonomy possible, but requires extensive business background to be successful. A home birth practice is a birth that takes place in a residence rather than a hospital or birthing facility. Study shows that the ultimate goal of all maternity care professionals and parents is a safe birth and healthy outcome for women and their newborns regardless of setting. Increasingly, women choose to give birth at home because they believe a home setting is a safe option. As a midwife, you will provide care independently in the home for healthy women during pregnancy, labor, and birth within the parameters of setting-specific, clinical practice guidelines. Midwifery care in any setting includes ongoing clinical assessments that inform risk evaluation and clinical decision making throughout pregnancy, labor, birth and the initial newborn and postpartum period. Birth Center Practice Birth Centers is a health care facility for childbirth where care is provided in the midwifery and wellness model, it is freestanding, not a hospital. Birth centers are an integrated part of the health care system and are guided by principles of prevention, sensitivity, safety, and appropriate medical intervention and cost-effectiveness. The birth center respects and facilitates a woman’s right to make informed choices about her health care and her baby’s health care based on her values and beliefs. The woman’s family, as she defines it, is welcome to participate in the pregnancy, birth, and the postpartum period. Are you thinking about working towards accreditation? National accreditation is a prestigious licensure, but it does take a lot of time, money and expertise to get your policies and protocols up to national standards. Many states have regulation requirements that you should fully understand before creating a birth center facility. Hospital Practice Traditional hospital births are still the most common option for birth. This means that the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room, that’s how hospital birth works. There are many reasons why people plan a hospital birth with a midwife. Some patients are still more comfortable in a hospital setting and feel that the hospital is the safest option in case of emergency. As a midwife, you have plenty of options to continue your midwifery practice in a hospital settings. If you want to improve outcomes and lower cesarean rates with mothers, HIRE MIDWIVES! I’ve worked with large hospital practices, community based practices, and private practices with hospital privileges. I know that midwifery care can serve in any setting. I have helped midwifery practices improve revenue reimbursement, implement laborist models, and start midwifery model of care into their maternity system. Another thing you should consider is, if you’re ready. Being prepared will cost you no harm. There are different skills you should manage to attain. While hiring expert personnel to help you in different aspects is significant, learning the skills firsthand is important as well when you decided to walk your way to midwifery. WHAT ARE THE NEXT STEPS? As you decided to take a step forward on your midwifery practice, note that you will be exposed to different tasks aside from providing excellent midwifery care, which surely you are expert on. Midwives need to understand business, accounting, financing, marketing, negotiating, and so much more to be successful in today’s health care system. 1. Accounting Skills You will be exposed to a systematic procedure in dealing with your finances along your practice. Being able to understand this aspect is an advantage. Surround yourself with limitless opportunities in your own practice. 2. Negotiating Skills Good negotiations skills contribute significantly to your midwifery practice’s success as they help you build better relationships and deliver lasting quality solutions. You have the power to increase your profitability and build a long term relationship with your clients. As you may encounter different aspects in your practice like discussing an insurance policy having a strong negotiation skills is a strength. 3. Marketing Skills Marketing plays a major role in establishing and maintaining relationships between your midwifery business and your clients. Good marketing skills will help you attain your midwifery practice’s goals. By establishing a good market strategy, you can maximize your midwifery practice’s opportunity to grow and expand. 4. Communication Skills It is fundamental to communicate effectively in negotiations to ensure you achieve your goals. There are different types of communication, may it be a verbal, non-verbal or written communication skills. Communication also takes an important part within your midwifery business. Effective communication can help you foster a good relationship between you and your clients. 5. Management Skills Management skills are important for
Starting a Midwifery Birth Center – Midwifery Business Consultation
Birth Center Practice Midwifery practice are booming in United States. Covid-19 has really accelerated the demand and midwives are trying to keep up with the demands. Having a birth center for your already established home birth practice would be a great transition to serve more families. The challenge with a home birth practice is the radius a midwife serves and the balancing act of how many clients to take with increasing chances of “needing to be in two places at once.” A birth center will help decrease the anxiety for midwives by having a central location for births versus large birth radius to drive to. The cleaning standards can be controlled better than a home setting by birth team. There are many women wanting an out of hospital birth, but can’t do it at that home for one reason or another (live with parents, have many other children at home, and client’s comfort level). Birth centers are really going to increase in numbers through the United States over the next five years. Reimbursement rates and state regulations will be more conducive to midwifery’s cost effective health care option for birth. Health care system is on the brink of collapse with Covid-19 and families are looking for a way to have a peaceful, safe birth minutes from a hospital setting. Birth centers will be filling that void in our current system in leaps and bounds. Midwives will need to plan, prep, and take business courses to make successful birth center practices. There is so much that midwifery training does provide for clinical care, but nothing about business ownership. Learning by “hard knocks” is rough and causes high burnout rates. Learn from experts that have ran successful midwifery practices for years. Why remake tools, templates, and policies that other midwifery practices have already made. Utilize your midwifery community to accelerate everyone’s business success. Birth center’s have a unique business plan compared to home birth and hospital practices. There is billing for a facility as well as professional services. The operating regulations for a birth center (fluctuates with each state) aren’t present with other birth locations. The initial funding costs for a birth center is astronomically higher than a home birth or hospital midwifery practice. Knowing if you should buy, lease, or build are vital decisions to make in the beginning that will have lasting effect on your business’ success. Get a midwifery business mentor, hire our consultants, and take business courses. We have a great online birth center course that goes into over eight hours of detail about business side of birth center practice ownership. Knowledge is power and learning from other people’s mistakes and “shortcuts” will save you thousands of dollars and time making your birth center profitable! Enroll on our teachable course on How to run a Successful Birth Center
Should You Start a Private Midwife Practice as a New Graduate?
Embarking on a career in midwifery is an exciting journey, full of opportunities to support families during one of life’s most transformative experiences. As a new graduate, you may be contemplating whether to start your own private midwife practice or gain experience in a more traditional setting. Here are some considerations to help you make this important decision. 1. Assess Your Experience Level Clinical Skills Hands-On Experience: Gaining practical experience in a hospital or clinic setting can enhance your clinical skills and confidence. Consider working under experienced midwives to learn the intricacies of care and build your competence. Diverse Scenarios: Exposure to a variety of birth situations and complications is crucial. A solid foundation in clinical practice can prepare you for the unpredictability of private practice. 2. Understand the Business Aspects Business Knowledge Financial Literacy: Running a private practice involves managing finances, billing, and insurance. Familiarize yourself with the business side of midwifery, including budgeting, marketing, and financial planning. Business Plan Development: A comprehensive business plan is essential for guiding your practice. It helps outline your mission, services, target market, and financial projections. 3. Evaluate Your Support Network Mentorship and Guidance Seek Mentorship: Having experienced mentors in the midwifery field can provide invaluable insights as you start your practice. Their guidance can help you navigate challenges and make informed decisions. Professional Networks: Joining professional organizations or local midwifery groups can provide support and resources as you establish your practice. 4. Consider Your Financial Situation Initial Investment Startup Costs: Assess the financial implications of starting a private practice. Consider costs such as liability insurance, equipment, office space, and marketing. Sustainable Income: Ensure you have a plan for generating a sustainable income during the initial phases of your practice. This might include part-time work or financial support. 5. Identify Your Passion and Vision Personal Goals Core Values: Reflect on your motivations for becoming a midwife. Are you passionate about providing personalized, holistic care? A private practice may align better with these values. Long-Term Vision: Consider your long-term career goals. If owning a practice is your dream, starting early may help you build a brand and reputation over time. 6. Research Your Market Community Needs Assess Demand: Research the demand for midwifery services in your area. Understand the demographics, preferences, and needs of potential clients. Competitive Analysis: Identify other midwifery practices and healthcare providers in your community. Consider what unique services or approaches you can offer to stand out. 7. Consider Work-Life Balance Personal Well-Being Time Commitment: Running a private practice requires significant time and energy. Assess whether you’re ready to manage the demands of both clinical and administrative responsibilities. Support Systems: Consider your support systems, both professionally and personally, as they can significantly impact your well-being as you navigate this transition. 8. Start Small Gradual Growth Part-Time Practice: If you’re uncertain, consider starting your private practice part-time while working elsewhere. This allows you to gain experience and build your client base without overwhelming yourself. Pilot Services: Launch specific services or programs gradually to test the waters and gain insights before fully committing. Starting a private midwife practice as a new graduate can be a rewarding but challenging endeavor. While it offers the potential for autonomy and personalized care, it also requires a strong foundation of clinical experience, business acumen, and a solid support network. Take the time to assess your skills, understand the market, and evaluate your financial situation before making this important decision. Whether you choose to start your practice now or gain more experience first, your journey as a midwife will be filled with opportunities to make a meaningful impact on families and communities.
SHOULD I HIRE EMPLOYEES OR INDEPENDENT CONTRACTORS?
Worker classification Worker classification is important as it defines almost everything that a person can or cannot do upon signing an agreement to work in your midwifery practice. It also determines your responsibility as an employer in terms of taxes, social security, the time they should render, and other factors that might affect your job. While this is a very important matter that all business owners especially midwives who practice on their own should know and understand, many are still not aware of the difference between independent contractors and an employee. Most people would probably think that the only difference between the two is how they are being called without even realizing the deeper contrast that lies within the agreement of both parties. Hiring Staff When you hire a person, your first priority as an employer is to determine whether you want a lasting relationship or just for a particular job in a small amount of time. You should know your needs, and your capacity to hire a person. After determining that you already found the perfect person fitted in the job, make sure you don’t forget to discuss every piece of information that they should know before they accept your offer. However, before we dig into deeper understanding of how you can determine the conditions to stipulate in the contract agreement or employment contract, let us first define the difference between an independent contractor and an employee: According to the United States Small Business Association, an employee is defined as someone who “performs duties dictated or controlled by others; is given training for work to be done; and, works for only one employer.”. An “independent contractor,” on the other hand, is someone who operates under a business name or under his own name, may have his own employees, may maintain a separate business checking account, may advertise his business’ services, invoices for work completed, has more than one client, has his own tools and sets his own hours, and keeps business records. The IRS defines a person as an independent contractor “if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done.” Independent Contractor An independent contractor is a person who works autonomously rather than as an employee. They have much autonomy with their job, the time they can render, the flexibility, and such. Although a contractor and employee may have quite a similar task there are significant differences in terms of legalities, therefore it is important to follow the law with regard to taxes, benefits, payments, and the like. While an employee will not have much control over the type of work they will do. Nevertheless, they will have the benefits and the permanence of a full-time job. Health care is often the most desirable benefit. Both contract has advantages and disadvantages, therefore as a midwife who plans to pursue her own midwifery practice, you should take time to study the difference between the two contract. Especially for an independent contractor, your agreement should be really stressing their status with your practice. We don’t want any business owner to be liable for their back taxes that the independent contractor was supposed to submit as being 1099 and thinks you treated them like an employee versus independent contractors. Here are the Top Differences Between Employees and Independent Contractors Employee Relationship Particularly, an employee performs work under the direction and control of their employer. They are “micromanaged “by their boss. The employer determines the hours, work location and how work is done. While the independent contractors run their own time and do not follow certain direction from anyone aside from what are stipulated in the contract agreement. Taxes The issue of withholding taxes is critical to the contrast. It is the responsibility of the employer to withhold an employee’s federal and state income taxes. The employer is also required pay the withheld taxes to the IRS and any applicable state agencies. People working as independent contractors, on the other hand, must pay their own income taxes and the employers (in most cases) need not withhold taxes. Social Security and Unemployment Another distinction between employees and independent contractors concerns Social Security and unemployment insurance. In most cases, employers are required to make payments into Social Security and unemployment insurance on behalf of employees. While, independent contractors make their own contributions to Social Security. An employer also need not purchase unemployment insurance for independent contractors because the independent contractor is viewed as self-employed. Healthcare and Retirement Benefits When employers offer certain retirement plans, those employers must make the retirement accounts available to all employees. Unlike employees, independent contractors are not due any sort of contribution toward a retirement plan or account. Other fringe benefits, such as health care coverage, vacation time, and sick leave are similar to retirement plans. These benefits are available to employees under myriads of federal laws and regulations, but not to independent contractors. The current patchwork of laws across the United States makes it difficult for individuals and potential employers to differentiate between independent contractors and employees. Clarifying this confusion is important because of the harm mistakes may inflict on both workers and employers. Some of the harms that can be caused by incorrect worker classification include: 1. Employees may lose employment benefits such as health insurance, sick days, overtime, and retirement benefits if incorrectly classified 2. Employees and prospective employees may lose protections afforded under occupational safety laws and anti-discrimination safeguards 3. Competing businesses and taxpayers may be forced to pay, for example, emergency medical costs or welfare for uninsured employees who, by right, should have been covered under employer health insurance plans or unemployment insurance. Misclassification also has legal punitive consequences for employers under both federal and state law. First, if an employer misclassified an individual as an independent contractor instead of an employee the employer may be required to reimburse the employee for wages that should have
Short Term and Freedom Galore: Locum Contracts
Locum Contracts Are you wanting to utilize your midwifery skills and have flexibility of changing settings frequently? Locum contracts work perfect for someone wanting 3-6month employment contracts at a time. You can choose where and when you want to work. It works great for filling last minute needs at private practices like maternity coverage, medical leave, and staffing shortages until hiring occurs. For being available last minute with your knowledge, licensure, and training, private practices and hospitals pay top dollar for these assignments. You can choose to work with a locum agency or directly contract with need. Pros of using a locum agency is they find the contracts, advocate for you directly, complete paperwork for contract, and have middle man resource to communicate with practice administration. Down side is losing percentage of profits to this agency. It also depends on how flexible you are. I have seen midwives directly contract with local hospitals, practices, and needs by taking the initiative to stress benefits her services would provide. For example, I met with local physicians and hospitals to learn about current challenges with area. A Family Practice office was having two Physician Assistants retiring in next 6 months. A Certified Nurse Midwife wouldn’t have initially been their first choice. A lot of misunderstanding is present about what the full scope of a midwife is. That is a perfect opportunity to educate and stress the benefits of your services have to their needs. After discussing midwives can do full scope women’s health care and primary care (just can’t do kids and men), I was able to negotiate a contract to see all the women in his practice and bring back women’s health expertise within the office while other staff was found to fill needs in community. If you want to travel somewhere warm in the winter and no as picky location, a travel agency that specializes in working with midwives is a great option. Getting a relationship with multiple agencies is a good idea and make sure their contracts with you don’t have exclusive rights to you. A midwife should be able to work with many agencies at a time, because each one will have access to different opportunities for you to choose from. Another contract I have negotiated was 6 month Laborist coverage with local hospital. The Obstetricians were really drained and short staffed. There was already a CNM that worked with their team and lag of time before finding another provider to work with growing practice. The doctors needed some sleep at night. We did a contract to cover in house Labor and Delivery coverage after office hours and weekends. Doctors only had to be available for high risk situations, assisted deliveries, and cesarean sections. Three CNMs were a quick fill in of the hospital needs to get Obstetricians some less call coverage responsibility. It was a huge success and physicians really appreciate the resources available at night time while additional doctor was found. Negogiating a hourly rate is crucial with these assignments. Too many midwives accept too low of a rate. W-2 salaries for Certified Nurse Midwives range from $80-120k year with benefits. Many locum contracts are around $60 hr which is almost identical to what a midwife would get working for another practice with additional employment perks. You need to pay your own insurance, retirement benefits, self employment and social security taxes. I wouldn’t even consider accepting a contract for less than $70 hour with additional benefits like housing and food stipends. Typical locum contracts are $80-120 hr. Brag your skills, certifications, experience, and availability to fill their urgent needs. When you can create the value of your services and reinforce how you can fill their needs more than what they anticipated. For example, I stress how I can do newborn care on top of labor coverage for additional billing opportunities when delivery occurs compared to an Obstetrician. Finding the driving factors of exactly why an assignment is available creates an advantage for you and the negotiating process. Remember, independent contractor means you are your own boss. You can be presented with an offer, but ultimately you get to choose the work hours, rate of reimbursement, lodging, mileage, and food reimbursement. Everything is negotiable. When you create value for another organization with your skills and availability, the ball is in your court. There are many needs all over the country and far less midwives doing locum contracts. Don’t forget that! Youtube Video: https://www.youtube.com/watch?v=mfw2pOR-nto
Several Types of Business Entities
Several Types of Business Entities? There are several types of business entities, each with its own advantages, disadvantages, legal implications, and tax considerations. The choice of business entity often depends on factors such as the size of the business, the number of owners, liability protection, tax implications, and how the business is to be managed. Here are some common types of business entities: Below are the types of Business Entities that you can review when you start your own Midwifery Practice. Sole Proprietorship This is a business run by one individual for his or her own benefit. It is the simplest form of business organization. Proprietorships have no existence apart from the owners. The liabilities associated with the business are the personal liabilities of the owner, and the business terminates upon the proprietor’s death. The proprietor undertakes the risks of the business to the extent of his/her assets, whether used in the business or personally owned. Single proprietors include professional people, service providers, and retailers who are “in business for themselves.” Although a sole proprietorship is not a separate legal entity from its owner, it is a separate entity for accounting purposes. Financial activities of the business (e.g., receipt of fees) are maintained separately from the person’s personal financial activities (e.g., house payment). Partnerships-General and Limited A general partnership is an agreement, expressed or implied, between two or more persons who join together to carry on a business venture for profit. Each partner contributes money, property, labor, or skill; each shares in the profits and losses of the business; and each has unlimited personal liability for the debts of the business. Limited partnerships limit the personal liability of individual partners for the debts of the business according to the amount they have invested. Partners must file a certificate of limited partnership with state authorities. Limited Liability Company (LLC) An LLC is a hybrid between a partnership and a corporation. Members of an LLC have operational flexibility and income benefits similar to a partnership but also have limited liability exposure. While this seems very similar to a limited partnership, there are significant legal and statutory differences. Consultation with an attorney to determine the best entity is recommended. Corporation A corporation is a legal entity, operating under state law, whose scope of activity and name are restricted by its charter. Articles of incorporation must be filed with the state to establish a corporation. Stockholders’ are protected from liability and those stockholders who are also employees may be able to take advantage of some tax-free benefits, such as health insurance. There is double taxation with a C corporation, first through taxes on profits and second on taxes on stockholder dividends (as capital gains). Small Business Corporation (S-Corporation) Subchapter S-corporations are special closed corporations (limits exist on the number of members) created to provide small corporations with a tax advantage, if IRS Code requirements are met. Corporate taxes are waived and reported by the owners on their individual federal income tax returns, avoiding the “double taxation” of regular corporations. Advantages/Disadvantages Sole Proprietorship Simplicity of organization-this is the most common form of business organization in the United States because it is the easiest and least expensive to establish. Minimum legal restriction-fewer reports have to be filed with government agencies. There are no charter restrictions on operations. Ease of discontinuance-the business can be terminated at the will of the owner. The owner is truly the boss, making all decisions, keeping all profits, and assuming responsibility for all losses and debts. Difficulty in raising capital-this can be a problem since an individual’s resources are typically less than the pooled resources of partners. Limited life of the business-untimely, unanticipated, or unplanned removal of the proprietor from the operation of the business may have ramifications for creditors. Unlimited liability-this is by far the greatest disadvantage to the proprietorship. Even though proprietors may invest only part of their capital in the business, they remain personally liable to the full extent of their assets for the liabilities of the business. Partnership Greater possible capital availability Greater resources for decision making, support, creative activity Unlimited liability in general partnerships Divided authority-having to divide the authority for making decisions among the partners can delay the decision-making process and occasionally lead to disagreement. Limited Liability Company Allow greatest flexibility for customizing the structure of the business Limits member liability In many states, an LLC may have only one member (have the benefits of a sole proprietorship but limits liability). Requires comprehensive operating agreement because of the high degree of variability/flexibility Corporation/S-Corporation Limited liability to stockholders-liability is limited up to the amount invested personally in the business. In addition, personal assets may not be seized by creditors to satisfy debts (although now creditors often request personal guarantees on business loans). Perpetual life-the business continues as a legal entity. Shares in the corporation can be passed on to heirs. Ease of transferring ownership-stockholders can sell their shares when they desire, if there is a market. Ease of expansion of the company-greater capacity to raise capital by legal sale of stock. Government regulation-a corporate charter must be obtained from the state, and the corporation is subject to all state and record keeping regulations that pertain to corporations. Costs to organize a corporation are higher. Unless permission is obtained from other states, the corporate charter restricts operation to the state where it was issued. Double taxation feature unless S-Corporation election is made. It is crucial and important to choose the right type of legal structure for your launched midwifery practice that will operate under. Being introduced to what your options are when it comes to business type and structure is vital for the success of your practice in the future. No business structure is fundamentally superior to another, with each one being appropriate in different situations for particular business objectives. Know your capacity, can you do it on your own? Do you need a partner? Or do you need help from others and create a group
Setting Up Your Midwifery Practice
Setting up your Midwifery Practice Setting up your midwifery practice from the beginning can be overwhelming and daunting. Take things day by day. Make a list of things to do: supply ordering, marketing, business plan, funds, birth assistants, malpractice insurance, legal paperwork like CLIA, business entity registry, consultation arrangements, and license to practice in the state. Find a mentor in your area to help you. Make it a win-win situation by offering to work in her office as a volunteer while the midwife shows you her business model and provides years of knowledge about running an independent midwifery practice. Midwives getting close to retiring want to pass on their skills and wisdom. Your practice will grow much faster with the next retiring midwife as your main referral source for her clients. Talk about a cheap way to market your practice by taking over another midwife’s caseload when she decides to end practicing midwifery. Figure out what your midwife’s practice vision looks like Do you want to do home births birth centers, birth center franchises, well-women clinics, niche services like pelvic floor therapy, or breastfeeding support only? The possibilities are endless. Midwives are pushed to work long hours and in hard situations at times. If you don’t love what you do, it will be hard to stay with the practice during tough times. Starting out, there will be many late nights and days without seeing your family. Make sure your mission and cause are worth leaving your family to create this amazing midwifery practice. Writing a business plan will answer many of the start-up and planning questions. Having a mission, goals, services rendered, budget, competition list, inventory, resources, staff training, birth assistants, billing, marketing, and practice location will really help smooth out the planning and running process once the doors are open. Most start-up businesses close in five years (90%+). Spending time preparing and planning stages of expansion and actual monetary needs for each wave of slowness and rapid growth will decrease your stress level. By focusing on planning before doing your busy midwifery role, the day-to-day operations will become dramatically simpler. Professional burnout is a real thing and grows every day. Health care is a demanding profession and midwives sometimes give their entire lives to serve women. We can still be great midwives while having a family/personal life. Creating a balance from the beginning and boundaries of what your practice will have from you will cut the divorce rates, adult children that won’t talk to midwives anymore, and missing phenomenal vacations away from the practice. Many of my blogs repeat the same theme: self-care. We want successful, long-term, stable midwifery practices. I want women to have more midwives to choose from than OBs for prenatal care. I am grateful for high-risk care providers if a woman is sick. Midwives are the experts in normal birth and need to do business training to compete with the current healthcare challenges in midwifery. Spend just as much time training to be a midwife as business classes. If you want to work for someone, just focus on midwifery. Most midwives dream of running their own utopian practice. We can ALL do that successfully with proper business knowledge. Business Plan We have a sample business plan in the store to save many hours of planning and preparation. Customize it to your needs and be professional, looking to banks for a loan and potential consultation doctors. It is amazing how many more doctors worked with me once I sat down and showed them my business plan. It shows people that don’t know you, “She is serious. This practice will be successful and decrease my risk by interacting with her. She knows what she is doing.” Trust is quickly captured with medical communities when safety is shown with policies of risk-out criteria, transport plans, and evidence-based practice protocols. The unknown causes fear for customers and the medical community. Brag about your planning, training, and policies in the midwifery practice. Many of my long-term established relationships are from repeated meetings ahead of time rather than waiting until there was an issue with a patient or a poor outcome. Be proactive versus reactive with women and their babies. Safety is shown by planning, preparing, and coordinating resources ahead of time. Have family practice physicians, obstetricians, and pediatricians in your communities planning to serve. It is harder to get them to sign a written agreement (especially when employed by a larger organization versus a private practice). Informal relationships are just as important as written ones. Have regular meetings (bring them lunch to their offices every few months) to show appreciation for your collaborative relationship. Kindness and positive gestures really help during 2 a.m. phone calls from patients, and a doctor is needed to be called for consultation recommendations. Inventory is a Tough One My personal preference is to buy in bulk and pay for storing items. That is great for an established practice. When you are starting out, buy just the items you need to safely care for families and the volume you anticipate having. Allows for spares of essential items like a doppler, stethoscope, blood pressure cuff, thermometer, neonatal resuscitation equipment like oxygen tanks, bleeding medications, delivery instruments, charting forms printed, and protective barrier supplies like gloves. Get organized with your office and birth bags. Spending precious time looking for an item when you arrive at a woman’s house when she is close to delivering is not acceptable. Funding is a big perceived barrier for many midwives (especially hospital midwives wanting to branch out on their own). Money is always available if your business plan is strong,, and money will be made. You can find start-up investors, SBA loans from banks, or family support loans for your cause with proper passion and planning. Figuring out what you really need for money is hard. Each midwife will need a different amount. It depends on the size of the practice vision, the area served, birth center versus home birth practice, solo practice versus larger