The ACOG Disconnect: Confessions of an OB/GYN Physician

In May of this year, I attended the Annual Clinical Meeting for ACOG. While there was a wealth of information and innovation shared at the meeting, the conference was missing critical content: collaborative care.

Not one lecture on best practices in collaborative care.

We are facing a physician shortage of great proportions in this country over the next decade and collaborative care is the most patient-centric approach to addressing this crisis. Why aren’t we sharing best practices to overcome that hurdle?

The theme of the conference was “teaming up” for women’s health. I was soooo excited as I thought, “this is it! They are finally going to show us OBGs how important the midwives and NPs are as part of our team!”

But, other than a fairly nasty debate between ACNM president, Ginger Breedlove, and an anti-birthcenter doctor about the benefits of in-hospital vs out-of-hospital birth, Midwifery was nowhere to be found. While some NPs and CNMs showed their faces and attended the scientific lecture series, we never got down and dirty, teasing out the true strengths and weaknesses of our practices. We never had an opportunity to share how a sum of our parts will be the safest way to care for our patients into the future.

Now, I do know we are making progress at the very highest levels. While Ginger was present at the ACOG conference, word on the street is that the ACOG president himself was present at the national ACNM conference.

But why stop there? Shouldn’t we be collaborating more at the conference level?

My midwife director and I debated this issue. She shared with me that physicians had been invited to the recent ACNM conference to discuss collaborative care models (MD-CNM team-based care). We chuckled a bit as we reminisced over the journey we have taken over the past 18 months in our system. We launched midwifery at three hospitals and hired 15 midwives. We created a new compensation model that incentivizes the doctors to support the midwifery model of care and incentivizes the midwives to want to help support the doctors. The current global reimbursement system for professional services in obstetric care does not support teamwork or collaboration and rather pits providers against each other. We decided to work around this reimbursement model and internally created a system that was fair, equitable and supported the desired behaviors of teamwork.

The physicians I work with in our collaborative care practice are extremely productive and highly skilled. The midwives and ARNPs push the docs to their highest levels of licensure. The providers, both CNM and MD, exude confidence in their skills. I am blessed to be part of the team.

But, more than recruitment of midwives and compensation to produce desired behaviors; there is culture change that must occur in order to maximize the benefits of collaborative care in both patient experience and patient safety. Unraveling a culture of very MD-centric maternity care takes education, patience and bravery. But, we keep at it because we believe in the model of care and we believe it is the best thing for our patients.

I’ve worked with midwives for my entire obstetrical career. In fact, my intern year of residency I learned vaginal deliveries with midwives. My first year in my current job, I was thrown into a practice in which I backed-up two midwife call groups. Whenever I was called for a delivery it was either operative, cesarean or a really bad laceration. Never a boring day. A normal, run-of-the-mill routine vaginal delivery was a scarcity for me. But, I learned that midwives were so much better at labor sitting, labor coaching, and labor tinkering than I was. I came to appreciate that our strengths were different. I was raised by midwives and I am a better OB for it.

Patients are becoming more and more connected via social media. Movements such as ICAN, Birth Without Fear, VBAC Support Group and websites such as BellyBelly.com.au with millions of followers are SCREAMING for an optimal maternity experience. Are you paying attention to the maternity experience explosion on social media, ACOG? 

Patients are seeking out midwives and out-of-hospital birth experiences. This movement is growing exponentially. Physicians have a responsibility to lead and connect with ALL of our obstetrical community. Only then can we hold each other accountable to the standard of care.

We need to teach physicians how to work and function in collaborative care models. Many of them don’t know how to do it and as a result, groups are pitted against each other in competition. Communication and clinical accountability suffers due to the dysfunction and the ultimately, the patient suffers.

So I challenge ACOG to take the lead. Invite the midwives to the table. Learn from the physicians and health care organizations that have developed successful collaborative care models. Teach our docs to work in this new world of team health. Help us empower our obstetrical communities to work together as a team in providing the safest, patient-centered care for women.