How Do I Start a Midwifery Practice
The first thing you need to do when starting a Midwifery practice or service is investigate the licensure and regulations process in the state where you want to practice. If you are planning to practice on a state line or in more than one state, you will need to look into each state’s regulatory requirements.
You need to understand how the design of a practice is legally regulated. What are your states regulation requirements for consultation, collaboration, and referral to a higher level of care for clients who need care outside the Midwife scope of practice? Do you license yourself with the State Board of Nursing? The Board of Healing Arts? The Health Department or Public Health Board?
If you’re operating a midwife-owned practice, other essential elements include finding a location. It’s probably going to be based on insurers who are going to reimburse you and assurance you can be credentialed from the hospital at which you want to attend births.
What’s your staffing model going to look like? Solo or with a couple partners? How are you going to run the office and non-medical side of the practice? There are a variety of things to consider just in terms of legal and financial questions.
If you are attending women in a hospital, does that hospital have bylaws that allow non-physician providers to maximize hospital privileges. If they do, what do those bylaws indicate in terms of scope of practice, admission, and discharge: things that are elemental to hospital providers, and delineated in bylaws of that hospital.
Then, is there an understanding of how to create a list of privileges that allows the Midwife to practice the scope that they are trained to do and beyond. Can they first assist? Can they repair a third or fourth degree? Can they use a vacuum extractor? I’ve mentioned things that are all not taught in Midwifery education, but are skills Midwives do beyond their educational training through additional certification programs. How do you credential somebody who wants to first assist in surgery with your patient needing a c-section? How do you know they have the necessary skills and training? There are mechanisms that can be put in place to assure competency.
How Do I Open an Accredited Birth Center
Opening an accredited birth center would start with understanding what the American Association of Birth Centers (AABC) promotes as exemplary models of free-standing birth centers. Creating environments that emphasize family centered care for low risk maternity patients in an out-of-hospital setting.
Alongside the AABC, is an accrediting body that is not affiliated with, but works in tandem to promote accreditation of freestanding birth centers, the Commission for Accreditation of Birth Centers (CABC).
Birth Centers can be owned and operated by midwives or physicians or hospitals. When you think about accrediting a birth center, again you need to go back to state regulations. About half the states in our country have state licensure regulations that are additional to an accreditation process. Some insurance companies are likely to mandate both state licensure and accreditation before reimbursing for a facility fee. Additionally, some states do not require accreditation of your birth center or have regulatory requirements. Optimal safe practice is best provided by meeting minimum requirements of CABC accreditation. There is a cost associated with accreditation as with any oversight organization that provides recommendation of quality review.. However, Grow Midwives believes this is the most rigorous process demonstrating public safety and accountability. We believe this is a requirement for safe care.
How Do I Address Burnout and Attrition in the Workplace
Burnout and attrition are significant issues for all health professionals, especially for people whose careers require call time. Physicians and Midwives face this challenge of having to cover 24/7 every day. In addition to a shortage of providers caring for women’s health, there is an overabundance of patients.
Grow Midwives has learned over the last few years that there is an exhaustion factor that comes with working really long shifts. Sometimes for 24, 48 or even 72 hour shifts Midwives are literally on the entire time.
They may have short, little breaks that are built in, but early in 2017 ACNM released a Position Statement suggesting Midwives should not work longer than 16 continuous hours without 4-hours of uninterrupted rest, as well as additional recommendations.
The question then becomes, “Are we not staffing the units properly?” Are we so committed to continuity of care that we don’t realize that a specific Midwife doesn’t have to be the one attending the birth. It could just as easily be one of the other partners. It could be another person in the hospital who doesn’t know the patient at all. What is an appropriate level of personal sacrifice and safety in care delivery versus patient expectation?
Hiring raises its own needs and questions. Are you hiring people with similar philosophies? In that case, does it really matter which of us is there if we are all going to provide the same style and quality of care?
Burnout and attrition in midwifery is high. People are leaving the profession every year or considering leaving. Some feel that they aren’t being paid enough, some don’t feel like they are being acknowledged for the importance of the job they do, some can not take earned vacation time, so simply are exhausted from poor staffing.
Taking care to structure a balanced and supportive collaborative practice will keep both Midwives and Physicians from feeling overworked, underpaid and underappreciated.
How to Facilitate Difficult Conversations in the Workplace
The idea is how to approach the problem with some preparation to dispel what you would call “intention invention” or projecting what the other person is doing and why they are doing it.
Try to come up with some ideas, so that you have some kind of empathy. Try to start a dialogue in an open question environment. You will then begin to discover things you might not have found if you stayed mired in the original position.
Facilitating difficult conversations requires the ability to look at things with an empathy to the other side, with some preparation in regards to what you really want, how you want it, and alternatives to how you want to get there.
Good negotiators are civil, well informed, will challenge tresspasses, but be quick to forgive those tresspasses. To train people to deal with difficult conversations is a matter of both an empathetic review of how to deal with conflict, but also raising the bar on what truly is difficult.
In many environments, when you are dealing with one that is in collapse, every issue is so impacted and so layered with “this is what it really means” kind of statements, that almost anything from the whether the birthday cake for the last employee birthday was vanilla or chocolate becomes an issue. If you can figure out how to raise that bar back up, past an adult level and into a professional level of what an insult really is, you can then have conversations that ease those tensions and open up dialogue.
A difficult conversation tries to drill down to a more granular level on both sides of what really are the needs, concerns and points on both sides.
How to Negotiate Mutually Beneficial Employment Agreements
For the most part, a normal employment agreement for a Midwife deals with salary versus how many hours they work on call and in the office, as well as other perks. The way a compensation package is structured in terms of rate and style can help alleviate overwork, feelings of underappreciation, and burnout.
The most common issue that normally happens is that after an employment agreement is entered into, the number of working hours increases substantially. There are also questions related to the realities regarding malpractice coverage, non-compete agreements, and a host of other legalities.
How to Maximize Reimbursement for Services
When negotiating reimbursement, you first have to be credentialed by both commercial and public payers. If you are not able to be credentialed on a payer panel as an independent provider, you will not be visible to patients and you will not be able to negotiate what your reimbursement rates are.
Medicaid negotiates reimbursement rates on a state by state basis. Midwives often have to partner with physicians who speak on their behalf to payer panels trying to convince them that Midwives deserve the same reimbursement as Physicians for a normal, healthy birth.
Common questions to answer in a hospital setting include: Is a midwife going to bill under their name or under a physician’s name? Who is going to be reimbursed and how much? Whose name is on the birth certificate? There are many strategies that can be employed to navigate all of these questions and more.
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