Many, if not most, changes in obstetric care in the past 50 years came about not because the medical establishment or even medical research thought it was a great idea. Change came from CONSUMERS.
Let me try to do this without sounding like a used car salesman:
Are you upset about me leaving?
Do you live in Illinois?
If so, please go here, type in your address, and find out who your Senator and Representative are. Bookmark them, write them down, whatever.
Then write THIS down somewhere: SB 1616 and HB 1682. These are identical bills, one for the Senate and one for the House, and they will eliminate written collaborative agreements.
One of my reasons for moving is because Illinois requires me to have a written collaborative agreement (hereafter called the WCA) with a physician in order to work as an advanced practice nurse (hereafter called an APN). If I don’t have this agreement, and I work without one, I am in violation of the Nurse Practice Act and could lose my license.
So why is this a problem? Shouldn’t I have a doctor in my back pocket in case a patient has a problem?
OF COURSE I should. As should every other health care provider. The problem here is that it needs to be WRITTEN. As in, SIGNED. As in, a doctor needs to sign his/her name to something, which then implies responsibility for my actions as a CNM, which is NOT TRUE.
Just a minute, guys…..
Palms up. Touch middle finger to thumb. Breathe deeply. Repeat as necessary.
OK, better now.
EVERY health care professional collaborates. If the patient of a family practice doctor has a massive heart attack, that doctor will collaborate with a cardiologist. If an internist diagnoses someone with cancer, he/she sends that someone to an oncologist. If a garden variety obstetrician has a diabetic hypertensive pregnant patient with lupus and twins, that obstetrician will consult with a maternal fetal medicine specialist.
The point being: no health care practitioner is an island. The difference between APNs and all of the above examples is that none of those relationships have to be formalized in a written agreement that is required for the referring doctor to work.
The hand waving done by the Illinois State Medical Society is to the effect of, “WHAT? We can’t let APNs work without an agreement! There will be chaos! Mayhem! Blood will run in the streets!”
Um, no. One thing is accomplished by requiring the agreement to be signed: all APNs remain dependent on the good will and signature of a doctor(s) who let(s) them work. Seriously, how many other professions require the support of their competition?
Sixteen states do not require a written agreement for APNs. There is no federal mandate requiring that the agreement be written. Not only is there no evidence that the WCA ensures safety, states that do NOT have this requirement have better health outcomes on several measures, not just maternal & infant health care.
On the runway level, I am leaving because as long as I stay here, I remain in a position of dependence in which I’m no longer willing to stay. Dr. James Gomez is and has been FANTASTIC, but he is one of three doctors willing to sign his name to helping home birth midwives. What if he moves? Or retires? Or dies? Or decides he doesn’t like me anymore?
There are a handful of obstetricians that are willing to help off the record-ie, as long as they don’t have to sign their name to a legal document.
Let’s pause for a quick count. Three doctors willing to sign their names to a document. Somewhere between 5 and 10 more willing to help off the record. HOW many obstetricians are there in Chicago?
Never mind, I don’t want to know.
I’ll spare you details of midwifery in The Great North, I’ll just say that midwives are an independent profession. They still have prejudices to overcome and stakeholders to win over, but they are protected by legislation from what could happen to APNs in Illinois.
OK, enough raging. So here’s what to do:
1) Find out who your senator and rep is. Illinois, NOT US.
2) CALL, WRITE, or VISIT. This is in ascending order of effectiveness, but do SOMETHING. The Illinois Society for Advanced Practice Nursing says NO LATER THAN TUESDAY.
3) If you’re one of the awesome people writing me a letter to help me get to Canada, put it aside for now-it’s not due until April 8th.
4) This may sound strange, but DON’T mention that I’m a home birth midwife. This is a much bigger issue that applies to all APNs in Illinois, not just CNMs, and not just home birth CNMs. Bringing home birth into the conversation confuses the actual issue.
5) Below is my sample letter, but I have an easy one-Senator Steans introduced the bill, and Representative Osterman supports it. Find where YOUR senator and rep stand on this issue, and tailor your letter accordingly.
6) REMEMBER: Your senator and rep work for YOU. You put them in office, you can take them out.
Here is my letter to Senator Steans; my letter to Rep. Osterman will be modified a little. I have a PS at the bottom; please read all the way down.
DEAR SENATOR STEANS:
As one of your constituents, I would like to thank you for your support of Advanced Practice Nurses (APNs), specifically for your introduction of SB1616, to eliminate the Written Collaborative Agreement (WCA) requirement for APNs.
I am a certified nurse midwife with a private practice. While most APNs agree that the WCA is a barrier to practice, those that are employed by hospitals or large multispecialty groups are, relatively speaking, safer than a private practitioner. I, and all private APNs with small practices, am particularly vulnerable to losing the support of my collaborating physician: if he pulls his support, I need to immediately close, or work at the risk of being disciplined (ie, losing my license) by the Illinois Board of Nursing.
For this reason, I have chosen to close my otherwise successful practice and move somewhere where this requirement doesn’t exist. Needing a doctor’s signature in order to do my work is to keep myself in a position of dependence in which I’m no longer willing to stay.
While I am looking forward to my move, I will be closing my six year old practice and leaving behind over 300 satisfied customers, many of whom would return to me should they choose to have another baby. Some of them are your constituents.
Last year my business won the Mindful Metropolis Reader’s Choice Award for “Best Midwife Agency”. On this basis, it is accurate to say that Chicago’s best midwife is leaving. The written collaborative agreement is one of my major reasons.
Again, I appreciate the important work that you do, and for your support of my APN colleagues. I hope that my story will serve as an example of why this requirement has to be changed.
JENNIFER GAGNON, CNM, MSN, APN
PS to my readers: If being in letter writing mode makes this easy, kindly do a quick thank you note to Dr. Gomez. He’s kind of awesome. Here’s his info: 675 W North Ave # 416, Melrose Park, IL 60160-1626.