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Speaker 1: Well, I don't remember. I mean, I know when I first met her, but I don't remember
meeting her. So there were, amongst the first C up graduates there was class one was
split into two groups Carrie and one and Sue and the other, I believe. And then I came
on as the first, as the only class two cohort. But in typical Joni Slagger style, I blasted
through the program and quickly caught up to the class once and then ended up
proceeding with them only again, it was a distance program and we didn't even have
the internet, so I didn't have any reason to know Sue, but I knew Carrie because she
lived in Michigan and she was doing her clinical education at the same midwifery
practice that I was gonna do mine. And Carrie was the reason that I even heard about
cnet because we went to a conference together in Grand Rapids.

So through Carrie, then she became friends with Sue at the end of their midwifery
program. I think they went into Heiden and maybe took comps together or something
like that. And so I was introduced to Sue through Carrie. And so throughout the first 20
years or so of me being a midwife, then I would interface with Sue. We'd go to midwife
meetings and carried, say, I'm going to dinner with Sue. Do you wanna come? Or she,
and I'd be going out and she'd say to Sue, I'm going to dinner, or, Joanie, do you wanna
come? So I knew her and of course I knew of her work in Frontier because I was busy,
you know, building this clinical practice in Kalamazoo, Michigan. And we took a lot of
Frontier students. And so I continued to have a relationship with the university. And
then I taught for Frontier part-time in the late 1990s.

They asked me to come in and, and do some teaching for them on a part-time basis. So I
did that. But again, very little interaction with Sue, specifically outside of our social
interaction. And then when I became active in the American College of Nurse Midwives,
Sue was instrumental in leadership in the accreditation commission for the education
Midwifery Acme. And so I would interface with her professionally with those two
organizations. And so, you know, we definitely were acquaintances, but unlike what a
lot of people think, we weren't like best friends since school. We kind of had a, you
know, friends by association with Carrie Chuin, who was our common denominator. So
when I decided to retire from clinical practice, I just called Sue because I knew her well
enough to be able to call her and said I would like a job. And she summarily told me I
didn't have any academic experience, so I couldn't be faculty, but she needed me to
lead a program because I had administrative experience.

So I'd say that's one of her leadership gifts is she's not afraid to do something out of the
ordinary cuz you know, puts someone in charge of a doctoral program at a university
who's never taught in a university <laugh>. But she said, you know, you're a manager
and I need a manager for a rapidly growing program that doesn't have a lot of
organization and process, and that's your strength. And so she's not afraid to do the a
wild and crazy thing, knowing that somebody has the right talents to do it, and not the
necessarily what people would customarily think would be a candidate for a physician.
No, it was a hospital-based ob gyn service that lost all of their physicians at once. They
had some falling out with administration and they all walked out. And so they had this,
they had about 600 births a year in this practice, and they were like, oh, what do we do?

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Our doctors all just left. And one of the maternal fetal medicine specialists there said,
well, how about midwives? We work with them from a distance in neighboring
communities, and how about we get midwives here? And so they came over and talked
to us. And another midwife and myself stayed up all night, wrote the business plan,
brought it over, presented it, and a midwife service that's one of the largest in the
countries was born. So it was very opportunistic. They had patients, lost all their
doctors, and so we rushed in and filled the gap. So, wow, that's an essentially how my
practice started.

So I decided my family, my children, all one by one relocated out to Phoenix and started
having grandchildren. And I discovered those babies don't wait for you to retire, to grow
up. And I didn't wanna be the Christmas and birthday grandma. So I decided to leave my
clinical practice. And I thought, you know, I wasn't quite old enough to retire. I was
thinking 58 or something. And so I thought, well, I can teach. And I had precepted well
over, I don't know, a hundred, 150 cnep students. And so still had a good, strong
relationship with Frontier. And I had done faculty in the 1990s for them. So in 2016, I
called Sue and said, you know, I really need flexibility to be able to go to Arizona where
my kids and grandkids are and if there's any teaching position. And she didn't even
hesitate.

She just said, well, you don't really have any academic experience. And I said, well, I
know, but I've lectured in the medical school and worked with residents and, you know,
taught clinically for my entire career. She said, I have a, I have a management position, a
leadership position that's been open for over a year, and you'd be ideal for it. And so the
more she described, you know, what it was. And she put me in touch with a person who
was doing it as an interim who happened to be a former classmate of mine that I did
know because we had done more of our midwifery education together. And so she put
me in touch with her, and the more I did it, I learned that leadership is leadership.
Whether you are preparing for the joint commission to come a credit your hospital or
preparing for ASIN to come a credit your, your school, you know, it's, it's the same thing.

You, you write to the competencies. You know, I learned that I had where I had had
patience, I now had students and that, you know, most of your patients are grateful for
what you do and, and collaborate with you. And they's great to take care of them. Some
of 'em just suck every bit of energy out of you. And that's the same with students,
<laugh>. And I learned that I had midwife colleagues, and now I had faculty and you
know, midwife colleagues, they're flexible, they work great as a team, they are
innovative, and yet there are some of 'em that are just inflexible difficulty. And that was
my faculty. And I just thought, wait a minute, I can use the same exact leadership skills
in administration as I could in clinical practice. So, and all I had to learn was the nuances
of academics, you know?

And I said to Sue, I'm not an academics. And she said that you're surrounded by
academics. They'll help you, you know, I need a leader. I need someone who can come
in and organize this doctorate program. So I came in and I did that for 15 months. And
then the dean left and Sue called me up one day. I was in the middle of a meeting, she
called me. And, and Michael, I rarely talked to her when I became the D M P director.

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She left me to do my job. Like she was, she definitely stuck her neck out and put me in
the position. But it wasn't like she stood by my side and did my work for me or, you
know, protected me from anything. It was just like, okay, you've got what it takes to do
this.

This is your job. Let me know if you need anything. But she was hands off. It wasn't like
she stood around with a shield and protected me from anything. It was like, okay, you
know, I'm giving you this job and, but I, I know you can do it. And so then 15 months in,
she calls me one day and she said, what are you doing? And I said, I'm in a meeting. And
she goes, well, call me when you're done. I said, all right. So I called her back and I said,
what do you need? And she said, I need you to be the dean <laugh>. I, I laughed out
loud and I went, yeah, right. And she said, Nope, Julie is gonna leave. And I, before I
announced that I need to put someone in place, and I said, well, why not one of the
associate deans?

And she said, well, they might want it per permanently and that wouldn't be fair. She
said, unless you want it permanently. And I'm like, no, no, no, no, no, no. Nope, nope,
not at all. Not mm-hmm. And so she said, okay, well I talked to the associate deans cuz
they were my peer group and I didn't want them to go, well, you know, look at you. And
they were all just like, oh, please say yes, please say yes. And so I took it as an interim
and five months later the board came to me and said, we just really want you to stay.
You know, the faculty, you know, really want you to stay. You're doing a great job. We
want you to stay. That's how I became the dean. How much? And Sue, when Sue first
called me and asked me about that and said, you know, will you be, I said, you know
what, your faculty probably thought you were a little bit out there when you made me
the D m P director.

They're gonna think you completely lost your mind. And then I called Kitty and I said,
kitty cuz she said, well, I've talked to Kitty already, she thinks it's fabulous idea. So I
called Kitty and I said, you are crazy. And she's just like, no, you know, frontier, you are
a, you know, a leader, an organizer, you're what Sue needs. Sue is about to be president
of ac and m And she said, Sue is gonna take on this big thing and she needs someone
she can trust to do this job. And so you know, someone that can keep the university on,
you know, track while she's off leading a member organization in some very tumultuous
times. And so then I called Carrie cuz Carrie is the academic, Carrie has been an
academic forever, you know, she's president of a university right now, but I called her
cuz I knew she would be the voice of reason to say, yes, you're right.

That's really stupid. You don't know anything about education. And I called Carrie and I
said, Carrie, Sue and Kitty want me to be the dean. And she paused, no response. And I
thought, okay, she's trying to figure out a really nice way to say, okay, you gotta say no.
And she went, that is brilliant <laugh>. So I was coerced Michael, I <laugh>. Nobody
could tell me I shouldn't do it. So wow. That's, so that's how it happened. Yes. she, yes,
she, she holds people to a pretty high standard. I think what is probably for me the
easiest is the expectations are usually very clear. It's not that she you know, is vague
about what she wants. And so I think that's the toughest part when you work for
someone, if they expect high performance, but then their expectations are not clear. So

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I've always felt like I knew what was expected but I also have never felt like there was
you know, hovering or anything like that.

She from the, from the first moment displayed in a credible amount of trust. But the
other thing is, it's just kind of like when you're working with students, the student that
worries you is the one who doesn't know what they don't know and they don't ask
questions. And so if I really felt like I didn't know how to do something, then I would ask
her and say, I need your help here. So she would be fairly hands off. But if I, for example,
the first time I wrote a federal grant application, I said to her, Sue, I've, you know, I've
never done this before. And she just made time to sit down with me and walk me
through the process, just detail by detail so she can, she can be very hands off, but she
can also come in and just give you, you know, very clear guidance about things.

So that, and I'm, I'm a fairly quick study, so you know, you tell me once I've got it. So so I
appreciated that she wasn't just so aloof in her role as president that I'm out there
trying to make it up as I go without a lot of support. The other thing that I felt that I
always respected about her is when I was still trying to figure out why I should be the
dean and if that was best for the university. And that's one thing I would also say about
her 100% of the time, I felt like any decision she made was not at all about her
personally or about individuals. It was always the university and what was best for the
university. I felt like that was the filter that she ran. Every decision she ever made
through is what is the right thing to do for the university.

But she said to me, one of the reasons you need to be Dean is you're not afraid to
disagree with me. And you know, I was someone who had built my empire clinically, you
know, I'd been there, done that, whatever, I was doing this because it was a challenge. I
wanted to keep working and I was using a skillset that, you know, fit for me. But it also, I
wasn't so desperate that whatever Sue says, I've just gotta keep my head down and do
my job at, you know I could say to her, I, I disagree. I think this is the wrong thing. And
she said, you know, nobody, no leader is smart enough to unilaterally lead a university,
ands. So she she said, you need to be the dean because you're not afraid to disagree
with me <laugh>. And so she'll probably say that's one of one of my jobs throughout the
thing is, you know, we can have some pretty intense discussions about topics.

We disagree, but the thing is, is once we resolve it, it's over and it's resolved. And we
both had on the same path. There's no baggage or resentment or I feel like I never have
to worry about, oh, she's still worried about two years ago when, you know, never,
never even enters my mind. Well, you know, it started as a distance iteration of the
original Frontier Nurse School of Nursing, you know, family nursing and midwifery. And
so it started as that. But I felt like there was never a goal that was too big. And so the
university in a very short time really exponentially grew. And that was, I think it would
be easier to just say, we'll just keep our little thing going and do it. But I think there was
a real commitment to the midwifery model and making it available across the country,
so fulfilling that community need as well as being bold enough to say, how can we do
this on a bigger scale?

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How can we keep growing and yet stay very true to the mission? So, you know, we
haven't, we still produce, I think, midwives that have the same core beliefs that I had 30
years ago in midwifery school. So we haven't become just this machine that cranks out,
you know, robots, we still strongly hold to needing to teach about community-based
birth and needing to be sure midwives understand how philosophically we differ from
medicine. And so, but yet there was always the how do we meet the needs of the
communities? And that's why they added the FNPs into the distance program because
we, frontier started the first front, the first FMP program in 1970 was started by
Frontier. And then, so we resurrected that and added that to the distance program and
then recognizing the, you know, tremendous need for behavioral health in communities
that had to wait months and months to get anybody seen.

Then, you know, they started the psych program. So I think there's always been vision
and yet really strong adherence to the, to the core mission, which was to respond to
communities in need and then particularly midwifery. And she served midwifery on the
accreditation board, the national organization, and she represents midwifery on several
other, you know, the Institute of Medicine and then, you know, the Beyond Flexner, I
know it's called something else now, they changed the name. But you know, she's
always been a very strong advocate and spokesperson for midwifery as, as a healthcare
delivery model, and not ever blurred the lines to sub to be able to get along well with,
with, you know, one group or another. It's just like uncompromising adherence to
Frontier's mission and to the midwifery model of care and the midwifery profession, and
yet not being afraid to, to grow.

So the my, I don't, I mean there was something to do with my flight was delayed, so I
didn't come into the airport at the same time the other students in my cohort did. So
when I went for orientation, Kitty's husband al picked me up in a Volkswagen van, and
so then drove me up into the mountains of this Girl Scout camper, whatever it was
where we were at Camp Una for orientation. And I guess, you know, I come from a small
town, I went to a small all girls nursing school, so I probably felt less shocked by, oh,
dears, this really a school I did the, oh dear, is this really a school thing? When Carrie
[inaudible] was telling me about it. And I'm like, so you do it, it's like by mail and, you
know, but I probably didn't have quite the sticker shock that Sue had of like, oh my gosh,
is this like, what have I done?

I just felt really excited to be able to, you know, do it. But keep in mind, I was class two,
so there was a cohort that was a few months ahead of me, of which Carrie was in. So I
had a little bit more reassurance than what that very first group did. Because I was the
third group to Camp Buna, and then I was, you know, hearing from Carrie all along. So I,
and, and I'm a risk taker anyway, so by nature. So it wasn't I wasn't as shocked as Sue
was when she drove in and went, oh dear. And then my first trip to Hayden was for
graduation. So I'd already finished the program by the time I went to Hayden for the
first time. So there isn't really a lot there in my story about like, oh dear, what have I
done?

Because I wanted to be a midwife so bad, and if I didn't have to drive to Ann Arbor and I
was gonna be able to accomplish it with this program I was all in. So no you know, my

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family are all farmers and so I loved the 17 hundreds farmhouse. And so I thought it, I
mean, I don't remember, I honestly don't remember anything other than, you know, it
was an intimate group. We bonded closely. I thought it was a privilege to be able to be
on Kitty's farm and, you know, develop a relationship with her. So and when I went to
the chicken coop, I, so I worked at a birth center and shortly before, like days before I
went to what we call level three at the chicken coop, you know, our skills intensive, I
had been walked out of the hospital by security because they had closed the birthing
center where I worked.

And they had come and said, we need your keys, your pager and your id, and you're
done as of today. And close the birthing center just like that. So that had happened
literally days before I went to Philadelphia to go to level three. So I spent the first, you
know, 24 hours there, just like in shock, I carried the insurance for my family. I was
gonna be a midwife, but I, I didn't expect that I'd be without a job, you know, before I
was ready to do that. And so I was pretty weepy and grieving that and worried and
whatever, and kitty let me wallow in that for about a day, and then she pulled me aside
and said, okay, enough <laugh>, you can just hear Kitty saying it. And she's like, now you
just need to get on with this, you know, like it's over, it's done with, there's nothing you
can do about it.

Focus on your school, finish up so you can get back to work, you know? So, and that's
what I did. There, I loved everything about her. I wanted to be her. She I, you know, was
born with a business gene. My parents had their own business, you know, we had a
farm and then my dad owned a trucking company. And so everything she said about,
you know, you have to be able to know what you're worth. You have to be able to
articulate that because it's, you know, people aren't always gonna appreciate the, you
know, cosmic births that you can do as a midwife. You have to be able to speak to the
value you bring to a practice or, you know, to outcomes or things like that. And it was,
she talked about data and, you know, she was just like singing for my hymnal.

So I really loved the I wasn't much of the granola. Let's sing around a campfire and chant
and think about lovely birth. I was really into providing safe care that participated with
the patient, that talked to the patient, but I also understood the business side of it. And
that if midwifery was ever gonna survive or thrive, we had to, we could still do the cool
cosmic burst, but we had to be able to establish ourselves as a cost effective way to
provide care, or we were toast. And so I loved all of that about Kitty and just lapped that
stuff up. So so there was a real, you know, affinity for the business side that she talked
about all the time, and that really resonated with me. So that was a thing that we
shared that that just came naturally, I think.

Speaker 2: Can you paint a picture for me or speak to birthing centers in the, in the, in the fifties,
sixties, seventies and healthcare for women and babies during those years? I know it's
exhausting to think about, just just speak to it briefly.

Speaker 1: I don't know that the birth center model was prolific in the fifties, sixties and seventies. I
think what you had around the forties, you know, everyone had at home and then there
was a shift as physicians started convincing the public that birth was dangerous and

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needed to happen in the hospital. And so that shift occurred around the forties, fifties.
And so I think there was still a small cohort that delivered at home still, but the birth
center movement didn't start until maybe the late sixties or seventies with the, you
know, hippie flower children type movement. And it was more of an anti establishment
type of movement. Initially, I don't think there was any thought about, you know what,
maybe hospitals are the dangerous place to have a baby. That kind of started changing
in the, you know, probably eighties, seventies or eighties where all of a sudden people
were like, you know, we don't have to take healthy people into a hospital and then have
our bodies messed with and someone take the experience of birth away from, you
know, the mother and the family.

And so I think that shift started a little bit later than the fifties and sixties. I think, you
know, people were pretty convinced then that they needed to feed their baby's formula
and that birth was dangerous and you needed to do it in a hospital. And, you know, a lot
of women were given scopolamine, so they didn't have any memory, memory of having
their babies. And so, but that was the modern way. My mother nursed her first three
children and bottle-fed my younger sister because all the nurses convinced her that that
was the new upcoming modern thing to do. And I think a lot of people believed that.
And so then it was all of a sudden there was this kind of period of enlightening of, wait a
minute, <laugh>. So and I think the pendulum began to swing back.

Speaker 2: Were stories about hospital births that you want to speak to during No, I, during those
eighties,

Speaker 1: I mean, I worked, I worked in a hospital for 28 years and I felt like we could identify a
normal laboring patient nine out of 10 times. And, but I feel like that was because we
were allowed to practice midwifery. You know, we didn't, we believed in normal birth
and our hospital supported us in carrying out that philosophy. And they saw the cost
effectiveness of it because, you know, in a Medicaid system and our practice was
99.99% Medicaid when we got there. It was about 60% when we left cuz people wanted
to come to midwives. But you know, in capitated care y the hospital got paid whether
the patient had, you know, a five day stay or a 12 hour stay. And so they began to see
the economic value of having midwives cuz we utilized less resources, know all of our
patients didn't get epidurals and all of our patients didn't have C-sections.

And so I think the hospital embraced our practice because they just saw it as a
tremendous cost savings in a managed care environment like Medicaid where you get
cents on the dollar. And so if the workforce costs you significantly less than their
malpractice insurance costs you less, the outcomes were as good or better patients
were happy. They saw the, the, you know, the value in that. So I don't really have any
horror birth stories because I was always able to influence the way birth was handled at
a hospital. So you know, I just anecdotally know that women used to be strapped down
and what they wanted didn't matter and fathers were excluded from the delivery room.
And but I was privileged to kind of come on the labor and delivery scene in the late
eighties where the, the community groups were pretty vocal about being allowed to
have unmedicated birth and their families present and things like that. My first job in

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labor and delivery was actually in a birth center. So so fortunately I, I haven't seen a
whole lot of terrible things happen to women.

Speaker 2: Do you know of an article anywhere that could give me a concise history of midwifery
midwives in America or the world? Has anybody written the history of midwives? We
know it's, it's a very I guess in some respects ancient history that midwives have been
around for a long time.

Speaker 1: I, you know, Varney's midwifery textbook has a introductory chapter on midwifery
history that the that has been modified to include the granny midwives and, you know,
some of the stories that weren't told or originally from, you know, the white authors of
varney's midwifery. So, I mean, even just getting your hands on the first chapter of
Varney I think would be helpful. There's an entire book, there's been a couple of books
written about midwifery in this country one by Judith Rooks and one by Joyce Thompson
that talk about Judith Rooks talks about midwifery in America. And then Joyce
Thompson talks about, you know, the ac and m and how the midwives organized,
originally aligned with the nursing organization that split off because they felt midwifery
was different than nursing uhhuh <affirmative>. So, so I know of a couple of books, I'm
sure there are probably some historical articles, but the, you know, it's hard to
encapsulate history in an article cuz it's very right, colorful and long.

I think, you know, the, the, excuse me, I think when hospitals can see the value, like we
brought to our practice in terms of, you know, physicians are expensive and their
malpractice insurance is ridiculously high. And when hospitals can see that a
collaboration of midwives and physicians with doctors doing doctor stuff and midwives
doing the stuff that they are educated and licensed and prepared to do, you have a
sound sustainable economic model and you have a model that is highly satisfying to
both the patients and the providers. So the care of the pregnant woman who starts out,
you believe she's essentially normal undergoing a normal biologic event. The care that
we provide is emotionally satisfying as well as physically safe. And she is empowered
and people don't like that word sometimes, you know, words gain popularity and fall
out of favor, but she feels in control of her body, her family, and her situation, and is
supported by people who can guide her into making informed decisions.

Then that's highly satisfying knowing that there's a strong respectful partnership with a
physician or a maternal fetal medicine specialist in the event something happens that is
out of the ordinary. And yet that partnership remains. I mean, I've taken care of very
complex patients where I continue to manage the birth and the delivery, but a, you
know, a perinatologist is managing their type one diabetes or the fact that they've had a
kidney transplant or something like that. And the patients are very satisfied because
our, our model of care is very participatory. We partner with a patient, you know, we,
we are, we are experiencing this with them and doing this according to what they need.
And yet if there is something, there isn't this feeling of, oh, can I trust this doctor? Can I,
because the midwife's right there and, and passing along that trust and saying, Hey, you
know, this is Dr.

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Smith and we work together and you know, I've talked to him about your situation and,
and we're both standing there and there's collaborative conversation back and forth.
The doctor doesn't come in, push the midwife aside and say, okay, I'm here to save the
day now that this midwife has managed to screw this up completely or whatever. So
that's the kind of practice I had. And I think that is a strong sustainable, financially strong
model that meets the needs of the patients, the providers, because most of the
physicians I worked with were not challenged by doing, you know, normal prenatal visits
and questions about birth control and, and breastfeeding all day long. They are
challenged by the pathology, you know, how can I use my physician skills? And so a
model like that has the potential to do great things. So birth centers in order to bill,
that's the big thing.

You can have a birth center anywhere. Hmm. It's just in order to be able to charge a
facility fee and bill for like your equipment and supplies, you need to be accredited. And
not all states allow for the accreditation of birth centers. And so that's chiefly the
obstacle. In Michigan, when I was working in this for several years, I was told flat out
and I had perinatologists, I had physicians, I had the medical group, everybody was
supportive of accreditation of birth centers in Michigan and yet Michigan, you know, the
accredited, you know, the the board said we just don't have the bandwidth to write
another set of accreditation criteria and then enforce it. And so they were not
interested in accrediting birth centers cuz they just felt like it wasn't enough, there
wasn't enough business and there wasn't enough interest and they just didn't have the,
the bandwidth to do another accreditation process.

And so that was very frustrating. It wasn't like anybody felt like birth centers weren't
safe or illegal. But what that does is if you don't accredit birth centers, then you do
create a potential for unsafe practice because since nobody has to get accredited to
practice that, cuz what they do is they end up just charging cash from their patients. And
patients who really want out of hospital will pay it. Is you create the potential for bad
practice. Because if you don't have to demonstrate any kind of protocols or safety
procedures to maintain your accreditation, you can do some wonky stuff. And so not
accrediting birth centers is, is dangerous to a community potentially. I think the biggest
barrier to midwifery practice right now, number one is turf physicians just think that
they're the only ones who are safe and they have a god-given responsibility to supervise
anybody that's a nurse.

And I think that it's turf. And then I've had conversations cuz I was on an a c and m
ACOG task force about working together. I've had physician conversations with
physicians who say, you know, I love the idea of working with a midwife and I can hear
what you're saying about expanding my practice because the normal healthy patients
can go to the midwives and, and if I employ them, I bill for those services, I pay the
midwife, the patients are happy and I can focus on the things that I bill, you know, one
hysterectomy is the same as a whole, you know, pregnancy and and yet they say, but I
don't know how to do it. I don't know how to set it up. I don't know like, what's legal, I
don't know how to bill for them. I don't know what I can bill for.

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So a lot of, I think what we need is, you know, a school for physicians interested in
having midwives to say, here's how you incorporate 'em into their practice. Here's how
you blend the practice, here's how you identify what patients go where, here's the
business model. But a lot of patient, a lot of physicians are just scared of what liability
will I have? I mean, because if I'm gonna accept liability for a midwife and I'm home in
bed and I don't even know what she's doing, I'm not gonna lose my practice and lose my
house over something this midwife did. And yet vicarious liability doesn't exist when
states offer licensing to midwives and physicians that is not co-dependent. So I think we
need to get out from underneath the myth. And I think we are getting there that, you
know, the periodontists don't stand over and supervise the dentists. The
ophthalmologists don't stand over and supervise the optometrists and physicians don't
need to stand over and supervise nurse practitioners and nurse midwives. There's a
defined scope. You practice within that scope. You consult when appropriate. And so I
think when physicians start losing their strangle grip on healthcare, then we're gonna
have a stronger model.

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