Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

The Scope of Practice for Midwifery in America (or, Why Physicians Are Shaking in Their Boots) March 11, 2009

I recently read an article published on (a publication of the American Medical Association) entitled Scope of practice expansions fuel legal battles by Amy Lynn Sorrel. The article reports on the increasing number of physicians and professional medical associations bringing forth court cases against state boards of health on what they refer to as “scope of practice expansions” by a growing number of health care professionals.  Two examples of this phenomenon that are highlighted in the article include the right of nurse anesthetists to provide interventional pain management services to their patients and the right of certified professional midwives to practice independently (as was passed in the State of Missouri in 2007).  If you have 10 minutes, the article is pretty short can be found at the link above.


This article immediately caught my eye as the main initiative behind these recent physician led court cases happens to be one of the greatest hurdles that both Direct-Entry Midwives and Certified Nurse Midwives find themselves trying to overcome in many states around this country every day.  This hurdle is played out in a battle waged by physicians to protect their own interests (including the “business” of medicine) by fighting to legally prevent other health care professionals from their right to practice independently and within their scope of practice. 


Attorney Timothy Miller, the Federation of State Medical Boards’ senior director of government relations and policy, states in the article that, “There is this overall push by allied health professionals to try to increase their scope of practice, and what’s landing people in the courts is when they actually meander outside of their scope into areas considered the practice of medicine.”  What is particularly frustrating about this statement is that throughout the relatively brief history of modern medicine, it is physicians who have defined the “scope of medicine” which really is just a fancy term for “anything that physicians want complete monopolized control over”.  Talk about job security…if you lobby for legislation to make it illegal for any other healthcare professional to perform any service that you perform as a physician, then every consumer by default has to come to you to receive the service…Cha Ching!


Author Sorrel continues by stating the physicians’ side of the story, which is that “in many cases physicians warn that allied professionals are overstepping their bounds without appropriate medical expertise,” and AMA Board of Trustees Chair Joseph M. Heyman, MD states “Nonphysician health care providers serve a vital role on a physician-led health care delivery team but [scope of practice expansions] put patients at risk.”  Not only do these statements skew the facts, but they promote a gross misconception of what these healthcare professionals are actually fighting for. 


In truth these allied health professionals are fighting to gain legal support for what they feel they ARE appropriately educated to do and are not just trying to “skip medical school”!  In regards to the fight for the legalization and independent practice of both Direct-Entry and Certified Nurse Midwives, these professions aren’t just fighting for legal support to perform services they have the education, expertise, and authority to do as well and as safe as physicians, they are fighting for the legal support to perform services they have the education, expertise, and authority research has proven they do BETTER and SAFER that physicians (i.e. attending the prenatal care and normal vaginal deliveries of low risk, healthy pregnant women in any venue they see appropriate, including the home, out of hospital birthing center, and hospital.)



Furthermore calling allied health providers part of “physician-led” health care delivery teams automatically puts them in a subordinate role which is an antiquated and borderline offensive school of thought.  More appropriately, research has found that patients get the best results, both in and out of the hospital, when cared for by an interdisciplinary health care team that combines the expertise and experience of many health care professionals (including nursing, nutrition, physical therapy, complimentary medicine, management, pharmacy, etc.) to attain a more holistic delivery of care.  The physician might be the one writing the final “orders,” but the best patient outcomes are obtained when all member of the team are considered to be professional “equals.” 


Len Finnocchio, DrPH, a senior program officer at the California Health Care Foundation states, “These battles are not going away, and the challenge for professions is to accept that we are going to have overlapping scopes in some practices.”  He states, “We should be using every resource to its optimum to provide health care to everyone possible at the lowest cost possible. And it boils down to: If a professional can demonstrate they have the judgment, competence and skill to provide certain services, they should be able to do that.”


And in today’s world with today’s economy, who in their right mind can argue with that!?



2 Responses to “The Scope of Practice for Midwifery in America (or, Why Physicians Are Shaking in Their Boots)”

  1. Molly Says:

    This really is crazy! Its not like they would loose all of their business! GOOD doctors would (do) still have all the patients they could possibly handle. The only doctors who would suffer is the bad ones. So it is the perfect solution and doctors should welcome more trained professionals! Competition leads to higher standards!

  2. nursingbirth Says:

    Competition DOES lead to higher standards! Right on Molly!

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