Life has been throwing us a few curve balls lately, and I would really appreciate both prayers and, if you feel so inspired, guidance/inspiration/advice. The email link works pretty well, and comments are also emailed to me as they are posted.
I can't go into a lot of detail, but my employer is a federally qualified health center. That means that our funding is unpredictable and the needs for our services increase exponentially as the economy tanks. Of course, our funding usually decreases just as the need for us increases - that's the way things tend to work. There are non profits and there are non-profits. Some are pretty flush financially - the Ford Foundation, the Kaiser Family Foundation, Planned Parenthood, etc. And some get pretty desperate for funds - your local community health center, your local public radio station, EWTN, etc.
Now, it seems logical to me that midwives are a cost effective and generally good way to provide prenatal care and birth services. But OB residents can not only provide a lot of that care, they can also provide funding to a clinical site (to pay for the providers that supervise them, for one thing). We have OB residents, but there are not enough of them, nor do they have enough time, to take care of all our patients. So we schedule them to see the high risk moms and invite them to meet the low-risk moms and allow them to do labor and birth care under the supervision of OBs for the high risk and midwives for the low risk patients. It is clunky, but it has been creaking along for the last 6 years or so.
Things seem to be poised for a change. Some of the recent changes in funding for health care are having a negative effect. We are already being pressured to see patients every 15 or 20 minutes, and to do not only their care but their teaching and the documentation of that care within this short timeframe. If the financial constraints continue, we may be forced to provide the same care for the same # of patients at 75% of the time and at 75% of the reimbursement level.
I'm not sure where this is going to send me, in particular. I love working with the population that I serve, especially the immigrant moms. I have some patients that have been seeing my since I arrived at this practice more than 5 years ago. I am on second or third babies for some of these moms, and I have whole families for whom I am their partera, their 'doctora'. But I know that I am not indispensible.
Pray that I will be able to discern what, if any, message God has for me as I adjust to some of these changes. Pray that I will be able to be humble and obedient to His will. Pray that I will continue to be able to discuss this openly with my beloved husband. Especially pray that I will be able to get my self out of the way.