headoverfeet
28-12-2010, 15:49
Doctors blocking us, say midwives
MIDWIVES have accused doctors of obstructing arrangements allowing them to practise privately, saying not one private obstetrician has signed a collaborative agreement with a suitably qualified midwife.
Such agreements represent the easiest way for midwives to accept and treat patients for care covered by Medicare, but the Australian College of Midwives says while some obstetricians are refusing, others are demanding upfront payments in exchange for their agreement.
In signs of continuing tensions between the professional groups, the peak standards body for obstetricians is in turn criticising the new rules as unclear and too lax, and a recently released guidance document as biased against them.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists warns that midwives, under the current rules, could satisfy the requirements for independent practice by securing the approval of a hospital's chief medical officer -- even though he or she would almost certainly delegate responsibility to a staff doctor, who may not know anything of the patient's prior treatment.
RANZCOG president Rupert Sherwood said the new National Guidance on Collaborative Maternity Care, issued last month by the National Health and Medical Research Council, contained many examples painting midwife-led care in a positive light, but few taking the same approach to specialist-led care.
"We think the document is a bit biased," Dr Sherwood said. "We think it lacks some clarity about how the whole arrangement is going to work, and how it will be monitored."
More than 50 per cent of women initially categorised as low-risk, and therefore suitable for midwife care, later ended up needing specialist care, Dr Sherwood said.
Yet obstetricians were concerned that under the proposed model they would be summoned too late and expected to deal with problems not of their making.
Two letters to federal Health Minister Nicola Roxon raising concerns over the situation had gone unacknowledged. Although a meeting with her staff had now been arranged, Dr Sherwood called on Ms Roxon to be involved.
"It's not an exercise in wanting to knock over the reforms -- we still support the reforms in collaborative care, we are just being proactive," he said.
Australian College of Midwives president Hannah Dahlen said none of the 10 midwives who had so far qualified to attract Medicare rebates had succeeded in signing an agreement with a private obstetrician. One specialist responded by telling the midwife he was "not in a position to form a collaborative arrangement with any independent midwives in any form", adding, "Please don't correspond with me any more on this particular matter."
"Other obstetricians see this as an opportunity to make money and are insisting on upfront payments for each woman . . . or putting strict requirements in terms of when they see the woman or when they get called during labour," Ms Dahlen said. "Doctors have to get over their own self-importance in the health service . . . they are part of a team, and in a team everyone must be seen as equally important or there is no team."
A spokesman for Ms Roxon said meetings were planned with both obstetricians and midwives to discuss implementation of the changes.
"We are determined to work through any issues that are raised as these new arrangements give a greater choice for patients," the spokesman said.
From the link- http://www.theaustralian.com.au/news/nation/doctors-blocking-us-say-midwives/story-e6frg6nf-1225973579115
MIDWIVES have accused doctors of obstructing arrangements allowing them to practise privately, saying not one private obstetrician has signed a collaborative agreement with a suitably qualified midwife.
Such agreements represent the easiest way for midwives to accept and treat patients for care covered by Medicare, but the Australian College of Midwives says while some obstetricians are refusing, others are demanding upfront payments in exchange for their agreement.
In signs of continuing tensions between the professional groups, the peak standards body for obstetricians is in turn criticising the new rules as unclear and too lax, and a recently released guidance document as biased against them.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists warns that midwives, under the current rules, could satisfy the requirements for independent practice by securing the approval of a hospital's chief medical officer -- even though he or she would almost certainly delegate responsibility to a staff doctor, who may not know anything of the patient's prior treatment.
RANZCOG president Rupert Sherwood said the new National Guidance on Collaborative Maternity Care, issued last month by the National Health and Medical Research Council, contained many examples painting midwife-led care in a positive light, but few taking the same approach to specialist-led care.
"We think the document is a bit biased," Dr Sherwood said. "We think it lacks some clarity about how the whole arrangement is going to work, and how it will be monitored."
More than 50 per cent of women initially categorised as low-risk, and therefore suitable for midwife care, later ended up needing specialist care, Dr Sherwood said.
Yet obstetricians were concerned that under the proposed model they would be summoned too late and expected to deal with problems not of their making.
Two letters to federal Health Minister Nicola Roxon raising concerns over the situation had gone unacknowledged. Although a meeting with her staff had now been arranged, Dr Sherwood called on Ms Roxon to be involved.
"It's not an exercise in wanting to knock over the reforms -- we still support the reforms in collaborative care, we are just being proactive," he said.
Australian College of Midwives president Hannah Dahlen said none of the 10 midwives who had so far qualified to attract Medicare rebates had succeeded in signing an agreement with a private obstetrician. One specialist responded by telling the midwife he was "not in a position to form a collaborative arrangement with any independent midwives in any form", adding, "Please don't correspond with me any more on this particular matter."
"Other obstetricians see this as an opportunity to make money and are insisting on upfront payments for each woman . . . or putting strict requirements in terms of when they see the woman or when they get called during labour," Ms Dahlen said. "Doctors have to get over their own self-importance in the health service . . . they are part of a team, and in a team everyone must be seen as equally important or there is no team."
A spokesman for Ms Roxon said meetings were planned with both obstetricians and midwives to discuss implementation of the changes.
"We are determined to work through any issues that are raised as these new arrangements give a greater choice for patients," the spokesman said.
From the link- http://www.theaustralian.com.au/news/nation/doctors-blocking-us-say-midwives/story-e6frg6nf-1225973579115