Skip to comments.Seeking Independent Practices
Posted on 06/13/2010 5:39:48 PM PDT by NYC GOP Chick
Seeking independent practices
Nurse practitioners, midwives ask end to pacts with doctors
By CATHLEEN F. CROWLEY, Staff writer
First published: Saturday, June 12, 2010
ALBANY - Midwives and nurse practitioners in New York are trying to break free of formal ties to physicians.
Both groups of have bills before legislators that would remove the legal requirement that they have written practice agreements with a doctor.
"The piece of paper doesn't mean anything because we are going to collaborate with the person who is the most appropriate (for the medical situation)," said Laura Sheperis, president of the New York State Association of Licensed Midwives.
More than a dozen states allow midwives and nurse practitioners to practice without a formal agreement with a doctor.
The Medical Society of the State of New York vehemently opposes eliminating the written agreements for midwives and nurse practitioners.
"They should not be practicing independently,' said Dr. Leah McCormack, a Queens dermatologist who is president of the society. "They are less trained than physicians and they don't have the levels of training to give the best care, and when there are issues, where there are questions, they really need to turn to their collaborating physician for help and advice. It's really a public safety issue."
Midwives and nurse practitioners sign written practice agreements outlining their working relationship with a physician and setting protocols for what happens when a patient has a health problem outside their scope of practice. The agreements are not needed because it is their professional duty to consult with physicians, midwives and nurse practitioners said.
"Midwives are trained and credentialed to take care of healthy, uncomplicated pregnancies and births," said Kelly McDermott, who specializes in home births through her Stillwater practice Sage-Femme Midwifery. "As soon as a birth shows signs that it is outside what is healthy and uncomplicated, we are obligated to consult, collaborate and/or transfer care to a higher level practitioner."
The advocacy groups for the medical professionals say doctors are reluctant to sign the agreements because they fear legal liability. Also, there is an underlying element of competition, said Sheperis, who is a midwife at Bronx Lebanon Hospital.
The nurse practitioner legislation remains in committees and is not expected face a vote in this session.
The Midwifery Modernization Act was voted out of the Senate's Higher Education Committee and is going to the floor of the Senate. The Assembly version of the bill is in the Rules Committee and may be amended to clarify that midwives must have a backup plan for pregnancies that encounter problems.
"What we've come to realize is that this written agreement doesn't necessarily insure patient safety," Sheperis said. "But it has become a barrier to access."
Not only do a lot of women ALREADY see midwives and APRNs as their primary provider, they routinely refer to the PAs and APRNs as “my doctor”.
Our local hospital practice charges exactly the same for an appointment with an MD or with their PA. The local orthopod does not do initial appointments, history, basic tests. First, the patient sees his PA for these, then they get a subsequent appointment with the surgeon.
That’s disgraceful. They can call it what they want, but it is NOT medical care.
Of course the Obamas and families of other top Dems will never have to suffer substandard care like this. They’ll never get pushed off to a non-physician for medical care. But that’s what they want for the rest of us.
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