Choices For CNMs/CMs in Private Practice
Nurse-midwives may choose to have their own practice, independent physically and financially from a collaborating physician. A variety of arrangements can exist, and the CNM/CM can have complete control of her practice. This type of arrangement is increasingly rare these days, but the following descriptions may help you understand independent practice.
The midwifery practice may be physically located in the offices of an obstetrician with whom she has a consulting relationship, or she may conduct the practice apart from the physician. With the former, independent midwives will typically pay rent and their share of operating expenses, as well as medical assistant support. The latter describes circumstances in which the CNM/CM rents or owns their own office space. Midwives may employ their own office staff and are responsible for all financial aspects of the practice. This can include managed care contracts and any contracts that they might have with a consulting physician. Such a contract might entail payments for malpractice coverage and any additional fees payable to the consultant for surgical services, collaboration, referrals, and management of high-risk patients.
Physician Collaborative Services, If Required
In either of these scenarios, the CNMs may arrange collaborative services with physicians on a contractual basis, enter reimbursement arrangements based on the collaborator's hourly services, or arrange with third-party payers to reimburse a consulting physician for services provided.1
There are various consultation agreements adopted by individual CNM practices. Depending on whether a CNM practices in a collaborative State, a collaborative agreement may be required by law. Consistent with the particular state legislative situation, practice agreements can be expressed or implied and still satisfy ACNM requirements and Standards of Practice.
An express contract is a legally binding agreement whose terms are clearly stated orally or in writing. Courts will determine whether this kind of agreement was legally formed by analyzing communications between the parties at the time the agreement was made. An implied agreement can be a legally-binding obligation, but no written or verbal confirmation may be necessary.
There are other CNM/CM practice arrangements that are not described here, such as CNM-only and CNM/NP practices outside OB consultation arrangements. A CNM homebirth practice can be an example of an independent practice.
1 Ament, Lynette A. Professional Issues in Midwifery. Jones and Bartlett Learning. P. 195 (2007)
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