Independent Nurse-Midwifery Practice

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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 prove helpful to understand independent practice.

The midwifery practice may physically reside in the offices of an obstetrician with whom she has a consulting relationship or he/she can conduct the practice apart from the physician. With the former, independent midwives will, typically, pay rent and their portion of operating expenses and medical assistant help. The latter describes circumstances where the CNM/CM rents or owns his/her 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 to be paid 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 for collaborative services with physicians on a contractual basis, have reimbursement arrangements based on hourly services by the collaborator, or arrangements can be made with third-party payers to reimburse a consulting physician for services provided.1

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There are a variety of consultation agreements adapted by individual CNM practices. Depending on whether or not a CNM is practicing 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, the terms of which are clearly stated orally or in writing. Courts will determine if this kind of agreement has been legally formed by analyzing communications made 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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