Legislation to permit California hospitals to hire certified nurse-midwives (CNMs) could resurface in the 2017 legislative session, pitting the state’s medical and hospital associations against each other again.
Assembly Bill 1306, sponsored by Assemblywoman Autumn Burke (D-Inglewood) in the previous session, would have allowed CNMs to perform duties within their scope of practice without supervision by a physician. CNMs are registered nurses with additional training to perform a wide range of services related to pregnancy, delivery, and family planning.
The California Assembly approved the bill 78–1 in 2015 but rejected a Senate-approved, amended version on August 31, 2016. Support for the bill waned in the Assembly amid disagreement by the California Medical Association (CMA) and California Hospital Association (CHA) about whether the legislation should prohibit hospitals from hiring CNMs as employees, which current law allows, Kaiser Health News reported in 2016.
CMA lobbied for applying to CNMs the state’s ban on the “corporate practice of medicine,” which forbids hospitals from directly employing physicians, Kaiser reported.
Luis Quinonez, Burke’s chief of staff, told Health Care News Burke intends to introduce legislation similar to AB 1306 in 2017.
Burke says expanding CNM use would help remedy a shortage of obstetrician/gynecologists (OB/GYNs) in the state.
“California is facing a serious workforce shortage in maternal health care,” Burke said. “Nine counties in California lack a single OB/GYN. In many other counties, there’s less than two OB/GYNs for every 10,000 women.”
Freeing CNMs to practice without supervision by a physician would expand access to high-quality prenatal and natal health care access, Burke says.
“By untethering them from physician supervision requirements, they’ll be able to more easily provide care within their existing scope of practice in communities large and small,” Burke said. “Keep in mind, the requirements for physician supervision do not require the direct presence of a physician or any real involvement of the physician in a certified nurse-midwife’s patient care. It’s simply a piece of paper.”
Ban, Baby, Ban
In addition to allowing CNMs to practice independently of physicians, lawmakers should ensure hospitals retain the right to employ CNMs, Burke says.
“There are already several exemptions to the corporate practice of medicine ban that allow physicians to be employed by certain hospitals and clinics,” Burke said. “At the very least, those same exemptions should apply to certified nurse-midwives and other advance practice nurses.”
California’s ban on the corporate practice of medicine dates to the 1920s, when state courts attempted to protect physicians’ ability to practice without interference by corporate employers, according to a paper by the California Research Bureau.
Jan Emerson-Shea, vice president for external affairs at the CHA, says the ban is obsolete.
“California is one of only four states in the nation to prohibit the direct employment of doctors,” Emerson-Shea said. “This ban on the corporate practice of medicine dates back to the early 20th century. It no longer makes sense in the way that care is delivered today.”
Physicians and CNMs alike should be free to choose whether to practice as independent contractors or as hospital employees, Emerson-Shea says.
“CHA has long supported a policy of allowing physicians to decide whether or not they want to be employed [by a hospital],” Emerson-Shea said. “As to midwives, our position is the same. It should be the choice of the individual provider.”
Working for Patients
Lawmakers should not assume hospital employment would compromise the quality of care CNMs provide, Burke says.
“I believe that California can preserve the core consumer protections that have served all of us well for decades and still allow direct employment,” Burke said.
Freedom is the surest defense against corporate abuse of patients, Burke says.
“If the true intent is to stop corporate influence on care, we need to do a better job of allowing all providers the independence to make care decisions that put patients first,” Burke said.
Christina Thielst ([email protected]) writes from Santa Barbara, California.
The Corporate Practice of Medicine in a Changing Healthcare Environment, California Research Bureau, California State Library, April 2016: https://heartland.org/publications-resources/publications/the-corporate-practice-of-medicine-in-a-changing-healthcare-environment
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