Five things to do before you join that Midwifery Practice Group

You've completed your education, you've passed your exams, and you've applied for New Registrant (NR) positions, and now you're waiting for an offer. This is an exciting time in your midwifery career - congratulations! Sometimes the excitement comes along with a sense of overwhelm and uncertainty. After all, it's a big jump from being a student, or even from holding down other jobs you may have had in the past. As a New Registrant, you will be a self-employed, contracted member of the partnership of the midwifery practice group (MPG), not an employee. As such, it is your responsibility to ensure that you are both meeting the requirements of and able to take advantage of the benefits of being a self-employed worker.

The AOM is here to help you understand all of this. So here's our top five tips for protecting yourself before you jump in to your NR role.

Tip #1: Get a written contract

Once you have a verbal offer of a new registrant position, be sure to ask for a written offer and a copy of the contract (often referred to as an "agreement"). Agreements used by midwifery practice groups are often called the Mentored Midwife Retainer Agreement (for graduates of the MEP) or the Supervised Midwife Retainer Agreement (for graduates of the IMPP/OAP or those midwives for whom the College of Midwives of Ontario (CMO) requires a period of supervision). The practice group you're joining may have based the contract they will offer you on AOM template documents that you can see here

Before you start doing any kind of work, including visits with your new clients, have your contract reviewed by a lawyer (your own lawyer, and not the clinic's lawyer). After your lawyer reviews it, you and the practice partners can sign it. Be sure to retain a copy for your records. Only THEN should you start work.

Unfortunately, sometimes New Registrants start working without a signed contract, and when disagreements or disputes arise, there's nothing in writing to provide support. This is really the whole purpose of a signed contract: it ensures that all parties are clear about their expectations within the relationship, and outlines how any challenges are to be managed if they arise.

Most agreements of this nature will include some conditions. These most commonly relate to the confirmation of:

  • funding for a New Registrant at the practice by the Ontario Midwifery Program and Transfer Payment Agency, and/or
  • hospital privileges.

The AOM strongly discourages you from moving your home to your new community until you have a confirmed agreement, hospital privileges and, if required, an approved CMO supervision plan in place as, sadly, sometimes these expectations fall through at the last minute.

Tip #2: Ensure the contract reflects the terms and conditions discussed during the interview process

Signing a contract isn't just about formalizing verbal agreements and understandings. It protects your rights in the unfortunate event that things donā€™t work out. That's why it's so important that the agreement you sign reflects the understanding that you came to either during the interview process or in follow-up conversations when a verbal or written offer might have been made.

The written agreement helps to clearly define the rights and responsibilities of both you and the practice group - not just while you're in the practice group together, but upon leaving the practice group and after leaving the practice group. When you sign the agreement, you're actually committing to following the administrative protocols and procedures that have been established by the practice. Take the time to review all relevant practice group documents that outline some of the more practical aspects of how the practice group is managed, and what your rights and obligations will be when you are part of the group, and if and when you leave the practice group.

Tip #3: Understand your compensation

The agreement or protocols referred to in the contract (either explicitly or implicitly) should clearly outline how a practice group will compensate you, both for clinical and non-clinical work. For those who may have financial commitments such as student loans, you may want to discuss the possibility of compensation options (e.g., advancing funds prior to the discharge of initial clients). Any such agreements should be clearly outlined in the written contract. Given that practice groups cannot bill for care until after the client gives birth, you may receive your final compensation cheque after the day your New Registrant contract ends.

Many midwifery practice groups build up caseload for New Registrants. If you are not staying on beyond your New Registrant contract, it would be reasonable, in return, for the practice to expect you to contribute to clinical workload during the time when your own caseload starts to decrease. So you may want to discuss what your responsibilities will be near the end of your contract once assigned clients have delivered. For example, will you continue to be on call and attending clinic?

Tip #4: Stay cool

Some new graduates might be concerned that by focusing on the specific details in a contract partners may interpret this as mistrusting or "difficult" behaviour. On the contrary, reviewing the details of practice group relationships demonstrates a professional, mature and responsible attitude. You're being very practical about engaging with members of a practice in what is, in fact, a contractual relationship. Reviewing, amending and negotiating the terms of the contract allows both you and the practice partners to demonstrate your commitment to effective communication and the pursuit of a positive, healthy relationship. Isn't that what everybody wants? By making it your goal to start things off on a positive note, your efforts will go a long way in helping to build trust and good will.

Tip #5: Get a lawyer (Did we say that already? Believe us, it's worth repeating)

The AOM, in consultation with legal counsel, has developed guides and template agreements to assist practice groups with developing all the contracts they need to run their clinics. These documents are templates designed to be altered to suit the unique setting and nature of individual midwifery practice groups. Don't assume that because an agreement resembles an AOM template that this makes it "acceptable" for you to sign - but you also don't need to be concerned if your agreement appears very different to the format of an AOM template. This is because some MPGs will have consulted their own legal counsel who may have used a different format and style.

The bottom line is that practice partners should seek legal counsel when drafting contracts and those entering into New Registrant positions should have a lawyer review the contract. The money you spend on legal fees for this purpose can be considered a well-spent investment as it may help protect you from potential future disputes and financial losses.

In choosing a lawyer you may wish to:

  • ask other midwives or colleagues if they have used a lawyer they would recommend;
  • consider whether the lawyer or firm has previously worked with midwives, and/or has experience with "contract law";
  • ask more than one law firm or lawyer about their fees and the type of legal work that they are experienced in.

The Law Society of Ontario has resources to assist the public in finding appropriate legal assistance, including a Lawyer Referral Service. Midwife members may be eligible for legal advice through the AOM's Legal Expense Insurance.

If you have any other questions about entering into your New Registrant position, please feel free to contact for assistance.