Why ACOG, CMA & LMs would all benefit from passage of proposed Supervision Regulation

by faithgibson on September 6, 2012

in Physician Supervision Issues

LMs have been working under a fatally-flawed physician supervision clause since 1993 (19 years and counting!) and CNMs have been burdened by it since 1974 (38 yrs and counting).

A few years ago a third professional group – licensed naturopathic doctors — joined the ranks as providers of physiologically-based maternity care . The law for naturopathic doctors has a carbon copy of the LMPA (which itself is a carbon copy of the 1974 CNM act), which is to say that naturopathic doctors have the exact same physician-obstetrician supervision clause as LMs and CNMs.  While the naturopathic law authorizes the practice midwifery, naturopaths join the ranks of a ‘distinct calling’ — that is, a unique and distinct profession with its own specific professional history, education, clinical training, scope of practice and standard of care  — who finds the ability to function professionally to the full extenct of their scope of practice is legally controlled and restricted by a competing profession.

From a logical standpoint, the CMA and ACOG are right to be concerned that freeing LMs from supervision would be immediately followed by CNMs and naturopaths immediately demanding the same relief. Personally, I think organized medicine is more concerned about competition from CNMs and NDs than LMs providing PHB. Women generally prefer hospital-trained practitioners (CNMs) and hospital birth. People in general prefer practitioners with the word “doctor” in their title, such as Naturopathic Doctors. However, the demand for PHB services has held steady at 1% since the late 1960s. It was the same before the 1974 passage of nurse-midwifery licensing as it was after and stayed the 1993 passage of direct-entry midwifery. Practically-speaking, we do not really represent a threat to the obstetrical profession’s “business-as-usual”.

One of the ways that ACOG and CMA could get themselves out of this conundrum is to agree to let the 2 regulations for LMs go forward (collaboration + access to the 6 necessary drugs), but do so with a great show of public reluctance. That would keep midwives from having to take them to court (starting with the Court of Public Opinion!), which would drag the entire AMA-SOPP mess into the national media and cable news cycle.

But equally important to their goals, our accomplishing what i have described (actual public safety!) via this regulation would not be an automatic pass to either CMN or naturopathic doctors, as these other professions do NOT have the equivalent of SB 1950 — that is, they don’t have a statute that would authorize them to pursue regulatory relief. Both groups would have to go independently to the Legislature to get the equivalent of SB 1950, and still have to fight to get a regulation passed.

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