This section provides our assessment of national research on how occupational restrictions related to nursemidwife practice affect (1)the safety and quality of womens health care, (2)access to such care, and (3)the costeffectiveness of such care. Previously, we discussed the potential safety and quality impacts of such developments. Third, we find empirical evidence that access to nursemidwife servicesand potentially womens health care services overall, at least in certain regions of the stateis limited. State Scope of Practice Laws, NurseMidwifery Workforce, and Childbirth Procedures and Outcomes.Womens Health Issues26(3):26267. At least some of these alternative requirements couldin effectbe established statutorily in one of two main ways. Midlevel practitioners are an increasingly important part of how we deliver primary care in North Carolina. The law limits a physician to supervise no more than four PA's, except as provided in Business and Professions Code (BPC) section 3502.5. The second section of this report contains our analysis. Figure10 shows that the Greater Bay Area, Orange County, the Sacramento region, and Los Angeles have more practicing OBGYNs per 1,000 births than the statewide average. However, importantly, the lack of prescriptiveness also limits the laws potential effectiveness. In addition to the abovenoted specialist providers, family practice physicians also regularly provide womens health care services, with a small portion (according to national statistics) regularly attending childbirths. 225 ILCS 95/7.5 . We also find that the states physiciansupervision requirement for nurse midwives likely brings tradeoffs by reducing access to nursemidwife services, and potentially womens health care services more broadly, and making such services relatively more costly. To Practice, Nurse Midwives Must Obtain Consent From a Potential Competitor. There are a number of reasons why a physician may choose not to supervise a nurse midwife. As discussed in the background, California state law requires nurse midwives to practice under the supervision of a physician and places certain other scopeofpractice restrictions on nurse midwives. Slightly more than 69 percent of employers have cut back on physician clinical hours, ranging from 5 to 30 percent, with an average of 15 percent. Wow, It's a miracle. Supervision is included in my salary. JavaScript is disabled. But Are Recorded as Attending a Significantly Smaller Share of the States Births. About Half of States Require Physician Oversight. "Immediate availability of the supervising physician to the physician assistant for necessary consultations." "Personal and regular review within 10 days by the supervising physician of the patient records upon which entries are made by the physician assistant." Some states limit tasks that can be performed under indirect supervision. In contrast to California, most other states do not have a physiciansupervision requirement for nurse midwives, and a majority of other states do not even have the requirement for nurse midwives to maintain collaboration agreements with a physician. Figure2 summarizes the major practice differences between nurse midwives and OBGYNs in terms of where they typically practice and how they can practice. California Sample of at least 10 charts per month, for at least 10 months during the year. Minimum of 104 weeks of supervision. Nurse Midwives Comprise an Appreciable Share of the Women's Health Care Workforce in California There are over 2,000 OBGYNs in California, compared to more than 700 n urse midwives and almost 400 l icensed midwives. Because these studies examine basic associations (while controlling for certain relevant differences among states, such as demographics and average educational attainment), they do not establish a firm, causal relationship showing whether or not occupational restrictions on nurse midwives improve health outcomes. Later in the report, we describe how nurse midwives could serve to fill the gaps in access in the more rural and inland regions of the state. Asked or forced? Between 1996 and 2005, the number of PAs practicing in North Carolina increased by 100 percent, according to an analysis published in 2007 by researchers at the Cecil G. Sheps Center for Health Services Research. While we recognize that changes to other occupational licensing requirements on nurse midwivessuch as their scope of practicemay bring certain benefits, we focus in this report on the states physiciansupervision requirement since its effects are likely more pronounced and better studied than other occupational licensing requirements. (Hereafter in this report, we refer to these services as womens health care services.) Three specialist provider types are permitted, through state licensure, to provide such services with high, if varying, degrees of autonomy: physicians, nurse midwives, and licensed midwives. There are no other limits on the number of NPs that a physician . You're giving them liability without compensation. This report contains three main sections. Practice as a part of a health system (generally defined as a hospital, provider group, or health plan). On the compensation front, only 21 percent of respondents reported salary cuts for physicians, ranging from 5 to 20 percent, with an average of 12.5 percent. Accordingly, for example, highrisk pregnancies include the birthing of twins or significantly pre or postterm deliveries. Aug 18, 2022. As previously discussed, physiciansupervision of nurse midwives is just one of a variety of policies and procedures currently in place with the intention of ensuring and improving the safety and quality of womens health care. Supervising physicians therefore should use caution when deciding whether to supervise more than four PAs. Removing Californias physiciansupervision requirement could potentially facilitate more lowrisk births being attended by nurse midwives. As licensed clinicians, they must obtain a license in their state of practice before seeing patients. Some employers took steps to prevent cuts . The supervising physician must also be able to discharge the chart review and site visit obligations specified by Board rule. nurses and physicians - a mid . In the office setting, the incident-to guidelines described . This provides further evidence suggesting that demand for nurse midwives exceeds their supply. On balance, we find that removing the physiciansupervision requirement would have a limited but somewhat uncertain impact on safety and quality outside of hospital settings. Safety and Quality Can Be Promoted Outside of the PhysicianSupervision Framework. For freestanding birth center and home births, referral typically will entail transportation to a hospital. The requirement improves safety and/or quality of womens health care. Practice in a licensed or accredited facility. Model 1. As such, nurse midwives account for somewhat more than 20 p ercent of advanced health care providers who specialize in women's health care and childbirth. Research suggests that between 50percent and 75percent of births are normal and therefore eligible for nursemidwife services. In the first section, we provide background on the various provider types that deliver womens health care services, the major settings where these services are provided, and how occupational standardssuch as licensure requirementsimpact their practices. Townsend says that as a cost-cutting measure, many urgent care facilities and even emergency rooms are choosing to staff with nonphysicians. As NP training becomes increasingly watered down, expect malpractice cases involving NPs to continue to increase (they already are). For example, this training includes advanced procedures such as cesareans and hysterectomies and advanced treatments for illnesses such as for cancer. Some scopeofpractice rules are established in state law while others are selfdetermined by individual health care systems and/or professional societiessuch as the American Board of Family Medicine. CDPH to host Test to Treat Equity ECHO learning series. Authority has been delegated by the supervising physician to provide the covered benefit or service pursuant to their scope of practice. Don't volunteer to give away your power and your profession. A significant portion of the remaining 75percent cited reasons related to accessdefined as the ability to have an appropriate and preferred providerfor why they did not use midwife services. Midwifeled Care and Obstetricianled Care for Lowrisk Pregnancies: A Cost Comparison.Birth, November. California has over 2,000 practicing OBGYNs, around 700 nurse midwives, and roughly 400 licensed midwives. Given the lack of differences at the national level for safety and quality between states with and without physician oversight requirements, Californias supervision requirement specifically likely does not significantly improve safety and quality for maternal and infant health. (California Nursing Practice Act Article 8 BPC 2834 2835 2835.5 2835.7 2836 2836.1-3 2837) I am a pediatric nurse practitioner and the physician wants me to start treating adults. (Minimum of 5% of the PAs medical records). Due to the flexibility of Californias physiciansupervision requirement, described above, we find that Californias requirement is unlikely to be any more effective than other states similar requirements at improving safety and quality. Among only lowrisk pregnancies, births attended by nurse midwives tend to have lower rates of intervention in the labor and delivery process compared to births attended by physicians. https://www.ncbi.nlm.nih.gov/pubmed/1635724. For a better experience, please enable JavaScript in your browser before proceeding. Illinois PAs with proper training or appropriate experience can receive a federal waiver to dispense buprenorphine-containing products, as long as the supervising physician is certified, trained, or permitted to treat and manage patients with opioid use disorder. However its going to take some time. Im in anesthesia and supervising midlevels is absolutely and posititvely the dumbest thing you can possibly do. California Is Among 23 States to Require Physician Oversight of Nurse Midwives. In our assessment, these alternative requirements could be more costeffective than the states physiciansupervision requirement. We recommend that the Legislature consider removing the states physiciansupervision requirement, while adding other safeguards to ensure safety and quality. Better Outcomes Associated With Nurse Midwives? cCare guideline is to reduce when medically unnecessary. In addition, labor and deliveries attended by nurse midwives are less likely to be intervened in, as evidence by the lower usage of episiotomies, forceps, vacuum extraction techniques, and cesarean sections. https://doi.org/10.1016/j.whi.2017.01.002. Figure3 summarizes our evaluation framework for assessing occupational restrictions in health care broadly. Nineteen other states require nurse midwives to maintain collaboration agreements with a physician. R. & Regs. LAO Evaluation Framework for Assessing OccupationalRestrictions in Health Care. In Indiana, for example, the collaborative physician is required to review "at least a five percent (5%) random sampling of the charts and medications prescribed for patients". Infants whose births are attended by nurse midwives are no more likely to require emergency or other heightened forms of care than infants delivered by physicians, as measured by low scores on the common Apgar assessment (a test done on newborns to assess whether they are healthy). The second two pieces of evidence show that (1)nursemidwife services overall appear to be in high demand and (2)access to womens health care services overall could be limited in the more rural and inland areas of the state. Maybe it's time for a physician slow down of some sort. https://doi.org/10.2202/15380637.1589. PhysicianSupervision Requirement Potentially Is a Factor Contributing to Limited Access and Raising Costs for NurseMidwife Services. Currently, 40 states delineate a maximum number of physician assistants a physician may supervise at one time. The previous section largely summarized national research findings on the relative safety, quality, and costeffectiveness of care by nurse midwives, as well as how access to nursemidwife services varies based on differences among states in their occupational restrictions. For nurse midwives, a supervisor must be a physician with a current practice or training in obstetrics. As Figure10 also shows, nurse midwives fill the gaps in womens health care in three of the five regions with relatively few OBGYNs: the Central Coast, San Diego, and the northern and Sierra counties. It opens by laying out the evaluation framework by which we assess the states physiciansupervision requirement for nurse midwives. And Raising Costs for nursemidwife services. other safeguards to ensure safety and quality,. Section of this report contains our analysis be a physician may supervise at one.! Lowrisk births being attended by nurse midwives nurse midwife by laying out the evaluation for. 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