We do so much planning to start our midwife business that few people think about “exit strategies” or ending your midwife business. Some midwives don’t envision retiring because they love their job too much. Some midwives don’t think that day would ever come for catching babies. Whether it is retirement, professional burnout, move, new business opportunity, or health, midwives have to stop running their midwife business at some point. It can be abruptly with death, health, or need for change. Wouldn’t it be better for you and your clients to have a plan in place for that day.
There are many ways it can be handled. The most common option I see is a retiring midwife will apprentice another midwife to take over her established practice. Some midwives will sell their brand, practice, and supplies. That is harder since negotiating a price for that value is quite difficult. Sometimes a midwife will send letters out and transfer her patients to another practice if burnout or health reasons makes this transition more urgent. Maybe her husband is in the military and orders have been given to move half way across country.
Maybe malpractice insurance coverage was lost and care “just can’t continue.” Maybe collaborating doctor is retiring and practice can’t find state required doctor to be Medical Director for birth center. May state funding for non-profit birth center was cut with new budget proposal. Maybe state law changed about midwife’s scope of practice and independence level. There are many possibilities to why an abrupt close can happen that may be out of your control. What are your clients supposed to do? How do you handle record transfers and notifying patients that are close to their due date professionally?
There is no easy answer for those more rushed situations. Each midwife would need to make a game plan that works best for her. When you are billing insurance versus cash, it is a bit tricky about getting families financial accounts in order since claims can take some time. It is very difficult to get clients to pay a balance on account when practice has been closed for 6 months. Most clients are now worried about paying the next midwife and moved on themselves.
Having a discussion with couple midwives in community about accepting your patients is helpful. You want a plan in place for referral that your clients can go to (especially if they are close to delivering). Goal is to make it as smooth of a transition as possible for everyone. Having other midwives in area know your upcoming plan without telling everyone before you are ready is a challenge too.
Have a formal meeting with staff and ask for feedback. It is a very different closing a solo midwife practice versus a well established large midwifery birth center. Creating in your business plan potential exit strategies will only help partners and team have clear expectations. If the midwife owning practice is in a car crash tomorrow and can’t make decisions anymore for the team, it is very helpful having a guideline for that situation. It is about being proactive versus reactive. Make a game plan for the good and bad times in your midwife business and it will ease much of the unexpected anxiety present in those closing practice situations.