This started as a reply to a comment on my previous post. It got long enough that I made it a separate post.
Regarding the tensions between nursing/midwifery and medicine, there is enough there to discuss that it merits a separate post. In terms of nursing, I'll limit my comments to advanced practice nurses (APNs: nurse practitioners, and the newly-created Doctor of Nursing Practice DNP). This has become a significant issue in Virginia, where APNs are seeking increasingly autonomous practice
In my mind, the strengths and limits of both models involved the fact that the training for APNs and midwifes comes from the nursing perspective, with a strongly patient-centered, holistic and preventive focus. This is an approach to which I am sympathetic, and it stands in stark contrast to the increasingly impersonal, test-and-technology heavy nature of much current medical practice. For both APNs and midwifes, this approach leads to patient-centered care and an emphasis on wellness. This is a strength.
The counterpoint is that the depth and extent of training for APNs and midwifes is less than that for physicians. The time involved in medical school and a medical residency is far more than that of APNs and midwifes. In my opinion, this leads to increased ability to deal with complicated illnesses, patients with multiple co-morbid diseases, and patients with undifferentiated symptoms.
I think APNs and midwifes have very relevant roles, but I feel that the nature of the training is more applicable to focusing on certain areas or certain conditions, or working with patients who have established diagnoses. For midwives, this area is that of pregnancy, childbirth and postpartum care--although unexpected problems can arise, many of the complications or problems can be anticipated or more easily monitored for because the underlying condition is defined. In the case of APNs, working with acute problems or patients with defined illnesses allows the provider to focus more directly on the anticipated complications or concerns related to these conditions.
I think that midwives and APNs are valuable members of the care team. I also feel, though, that physicians are best qualified to lead the care team. This is my bias (as evidenced by the fact that I chose to pursue my MD), but I believe it is based on the fact that physicians' training is more likely to allow successful evaluation of undifferentiated problems or complicated conditions, or unanticipated complications.
Physicians have a lot to learn from APNs and midwives in terms of the patient-centered, holistic, wellness focus of care. And I think that an experienced midwife or APN is probably more qualified in many areas than many young physicians. But I do not think that APNs and midwives can take the place of physicians.