OB/GYN (and GP with Obstetrics) vs Midwife salary?

[AnxiousBoy]

Hello,

 

I'm a medical student thinking about the possibility of doing obstetrics and I was curious about the pay scale for OB's vs midwives. My concern is that from the info I can find online, it seems as though midwives get paid far superior than physicians for the exact same work. Here is what I found from MSP payout for British Columbia in an uncomplicated straightforward pre- and postnatal care (the extent of a midwife's expertise):

 

Physician:

1. Initial prenatal visit: 79.06

2. Subsequent visit: 29.64 (max 1/month up to 32weeks, then 2 visits next month, then 1/week until delivery). Assuming 40 weeks, that's 14 visits.

3. Post-natal visit: 29.64 (billable once 6 weeks following delivery)

4. Delivery and postnatal care: 547.81

Total: $992.41

 

Optional: Extended labour: 79.56/half hour (kicks in when the mother is in 2nd stage labour longer than 2 hours and the physician has to be present the whole time before and after)

 

Midwife:

Full Course Care: $3042.19 (broken down into the following (I know the numbers are off by a dollar or two))

First trimester: 253.50

Second trimester: 253.20

Third trimester: 507.11

Labour and Delivery: 1014.04

Post Partum Care: 1014.04

 

Can anyone with better knowledge of how MSP or other provincial billing system work give better explanation or accuracy of how this works? It seems unfair that midwives are being paid 3 times as much for the exact same work. While money isn't everything in the practice of medicine, it plays a large role in how you want to set up your office, so hence my question. I have read online antidotes of how OB's try to scuttle you out of the office, how impersonal some are, and how great the midwives are to the patients' experiences. It seems as though if they are being paid three times as much, it would give them that much more time to see patients. This also has future repercussions, such as will OB's decide to just stop delivering uncomplicated cases altogether and leave it for the midwives? What happens if OB's refuse to associate themselves with particular midwives or all of them altogether?

[moo]

What you're looking at is what GPs are paid. I'm pretty sure obstetricians get paid much more than that. Initial consults for specialists in BC are at least 200 dollars, I think much more usually.

 

But I remember meeting an OB in Alberta who wanted to become a midwife due to malpractice, fees, etc. but the college of midwives wouldn't let him in, even though he trained most of them!

[AnxiousBoy]

No, those rates are the same for both OBs and GPs. They are if the patient came to you initially and had an uncomplicated vaginal delivery.

 

Other OB rates:

Consultation: 134.64

Repeat Consult: 68.08

Repeat Intrapartum assessment (payable only after initial consult and must be separate event): 199.52

Complicated Delivery: 600.07

 

http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/index.html

[moo]

Yeah, but to see an ob you need a referral. An ob just can't seen any pregnant woman off the street. So they would bill the initial consultant fee. Subsequent prenatal visits would be paid at the GP rate. Also, obs are often consulted on difficult cases and may necessitate c-sections, etc. which are charged at much higher rates. For an uncomplicated delivery, though, yes rates are the same.

 

When I was a resident in family medicine, the ob I worked with told me he billed 20K one weekend while on call, so they make a ton more than FPs with obstetrics.

[JewelLeigh]

Yeah, but to see an ob you need a referral. An ob just can't seen any pregnant woman off the street. So they would bill the initial consultant fee. Subsequent prenatal visits would be paid at the GP rate. Also, obs are often consulted on difficult cases and may necessitate c-sections, etc. which are charged at much higher rates. For an uncomplicated delivery, though, yes rates are the same.

 

When I was a resident in family medicine, the ob I worked with told me he billed 20K one weekend while on call, so they make a ton more than FPs with obstetrics.

In the town I work, OBs don't need a referral to see a pregnant patient and they bill the same codes as family doctors. They cannot bill consult codes for regular run-of-the-mill prenatal care - only if the patient is referred to the ob because of pregnancy complications or concerns.

 

Additionally, in Ontario at least, there are premiums on top of the regular doctor billing codes for delivering babies during non-business hours - 50% more on weekday evenings and weekend days, and 75% more for nights.

 

The difference in pay is likely related to the fact that midwives do ALL of the care for the patient (at least where I work they do), including the jobs that for doctors' patients, are usually done by nurses. So as a doctor, I check in with my patient throughout her labour, but I am not there providing the ongoing minute-to-minute monitoring and support of the mother nor am I doing the minute-to-minute monitoring of the baby, nor am I administering any treatments being given. So for a, say, 12-hour labour, the midwife would basically be working the majority of that 12 hours, where a doctor would work maybe 2-3. This is also why a doctor could have 6 people in labour at one time, but a midwife would not be able to do that safely.

[medgoal]

I had a teacher complaining about this topic today....a GP with obs....

 

Midwives deliver 20-30 babies a year....and roughly have 90K salaries with no overhead and no insurance costs

 

He delivers 200 babies a year, pays overhead, insurance etc....and doesn't make 900K to do so....

 

He also said nurses can't become midwives very often because they think too "medical" to be allowed in....

 

Things to think about!

[hking03]

I had a teacher complaining about this topic today....a GP with obs....

 

Midwives deliver 20-30 babies a year....and roughly have 90K salaries with no overhead and no insurance costs

 

He delivers 200 babies a year, pays overhead, insurance etc....and doesn't make 900K to do so....

 

He also said nurses can't become midwives very often because they think too "medical" to be allowed in....

 

Things to think about!

are you saying that your Doctor/Teacher didn't make 900k a year and then comparing it to a midwife who makes 90K? Or was that a typo in that your doctor doesn't make 90k after tax and overhead? Or were you saying that he should get paid 10x the amount because he did 10x the number of births? Did he work 10x the number of hours as a midwife?