A comparison of visits and practices of nurse-midwives and obstetrician-gynecologists in ambulatory care settings

With more than 5 million patient visits annually, certified nurse-midwives (CNMs) substantially contribute to women's health care in the United States . The objective of this study was to describe ambulatory visits and practic es of CNMs, and compare the ln with those of obstetrician-gynecologists (OB / GYNs), Sources of population-based data used to compare characteristics o f provider visits were three national surveys of CNMs and two National Ambu latory Medical Care Surveys of physicians. When a subset of 4,305 visits to CNMs in 1991 and 1992 were compared to 5,473 visits to OB/GYNs in similar office-based ambulatory care settings in 1989 and 1990, it was found that a larger proportion of CNM visits were made by women who were publicly insur ed and below age 25. The majority of visits to CNMs were for maternity care ; the majority of visits to OB/GYNs were for gynecologic and/or family plan ning concerns. Face-to-face visit time was longer for CNMs, and involved mo re client education or counseling. This population-based comparison suggest s that CNMs and OB/GYNs provide ambulatory care for women with diverse demo graphic characteristics and differing clinical service needs. Enhancing col laborative practice could improve health care access for women, which would be especially beneficial for those who are underserved and vulnerable.(C) 2000 by the American College of Nurse-Midwives.