With a midwife business, it is essential to have a minimum of a collaboration with an Obstetrician. Many states require a written collaboration or the term supervisory is used instead. In those states where it is mandatory, a midwife can legally practice without that agreement in place. For professionalism and practice safety improvement processes, I recommend a written collaboration with two Obstetricians, Family Practice physician, and Pediatrician.
When asked why two Obstetricians, I instantly reply with long term planning in mind. What if one doctor moves, retires, or gets in a terrible car accident and can’t be your collaborating physician tomorrow? Do you want your entire practice to close next day, because you can’t fulfill the state laws or safety guidelines for care outside your midwife scope of practice? I have seen many practice close quickly, because a physician retired and couldn’t find another replacement. Your business shouldn’t consider its long term success on the whim of a doctor willing to be your collaborating physician.
You should have MANY informal collaborating relationships with specialists in your community. What if your pregnant women comes into the office with a concerning mole on her back during initial physical exam? Knowing a great dermatologists you trust and covers her insurance plan in area is a huge improvement in quality of care. Physical therapy is vital postpartum to help every women with pelvic floor revitalization. Have part of your collaborative relationship a great practice to send families to.
As far as written agreements, Obstetricians are the most important. I really like having a written agreement with a Pediatrician to call or refer to if doing newborn care during postpartum period. We are trained to be low risk care providers to mothers and their children. What happens when the baby’s jaundice level is too high to be continued care at home? Do you always send them to the hospital for care outside of your scope?
Save the health care system additional unnecessary costs and families transition anxiety of having established relationships with other medical providers like a baby doctor in the area. Family Practice doctors that are currently doing deliveries at the hospitals are great collaborative relationships for mothers and babies. Family Practice tend to care for the whole family when treatment and options are considered which is similar to a midwife’s care plan.
There are many ways to set up this collaborative relationship. Buy the doctor supper or bring lunch to his or her office if schedule it busy. Meet with them and have them get to know you and your wonderful midwifery practice. Teach them about scope of a midwife (most doctors and health care team don’t really understand this profession). Discuss vicarious liability with them and have documented letter from malpractice carrier of what that relationship would look like to protect the doctor and the midwife. When a midwife can present how this relationship will benefit both practices while serving women wanting both styles of pregnancy care, written collaboration is more likely to occur.
Be proactive on building relationships before consultation services are needed. Create a win-win relationship to that doctor. Will you be sending all your referrals for obstetrics their direction? Is there a monthly flat rate or commission from referred care to continue this collaborative relationship? What is the payment for the doctor’s valuable time in working with your practice long term? Some providers will do this relationship based on their belief in your mission, but those relationships typically aren’t stable for long term dependability. Money talks. If you make the doctor money and not increase their liability risks, the collaboration will have long term success.
Set up quarterly meeting while your relationship is new to help keep communication open between midwife and doctor. Eventually, annually meetings unless a recent outcome occurred that needs discussion is only needed. Create a trusting relationship and make the doctors have confidence in your midwife business, practice mission, and safety protocols in place. We all want safe care for women and need to keep that core value at the top of discussions when creating these collaborating relationships.