Practice Management

  • 1.  MFM Practices

    Posted 06-04-2019 11:29
    Hi All
    I am looking for more information on MFM practices out in the community and how MFMs practice. Our practice details are being assessed by our senior administrators.
    When your practice is consultation only, what is the policy for consultation of MFM? Are there guidelines at your hospitals for criteria to consult MFM?
    When you get consulted, what are your processes? Does there need to be an general OB note prior to your consultation? Does it need to be MD to MD?
    Do you need to see the patient and write a consultation every time or do you "curbside" depending on the issue, i.e. PROM?
    Every step is being reviewed.

    Thank you

    Serena Wu, MD
    Managing Physician


  • 2.  RE: MFM Practices

    Posted 06-05-2019 11:20
    We do not have specific criteria so in theory anyone can consult MFM and we typically do it whenever possible. Any provider, including advanced practitioners, can ask for a consult, though if they work under the umbrella of an OB doc, the OB doc would be involved before asking for an MFM consult. This is good practice. You may request that a generalist evaluate the patient first/instead if the referring provider is NOT an OB doc and the indication for the consultation is typically managed by a generalist rather than MFM. If an OB doc asks for an MFM consult, we always do those we open arms! I typically do not favor curbside consults as patient care may affected by potential miscommunications and not knowing all the patient's facts.

    Fadi Bsat

  • 3.  RE: MFM Practices

    Posted 06-06-2019 01:10
    Serena, all great questions and I think have to be handled for what works best for your group.  Our group we state is co-management.  If someone has a high risk problem we take care of the high risk problem and do not consult only.  However we dont take over OB care of the patient either. If you have senior admins, I would assume you work for a hospital owned practice or university.  We consult/co-manage when a doctor asks for our help.  Each doctor is different and although we think some things are easy, there may be a particular reason we are consulted that we may not think is necessary but for that doctor is necessary.  Now in contrast, there should be circumstances where doctors are consulted but those should be hospital based rules- with your input of course.

    Of course it is ideal that an ob have a note and has seen the patient prior to consultation, but that sometimes is not going to happen.  The patient is in the middle in that case and I dont think it is good to refuse consultation in those cases, I would just do the consult.  We think consult requests should be doctor to doctor.  Why, because I want to make sure the consult answers the doctors specific question and if there is anything special regarding the patient.

    I do not like curbsides except for the simplest of questions- it allows for miscommunication, provides diagnosis and management without seeing the patient, and has legal risk.

    I hope this helps,


    Brian Iriye

  • 4.  RE: MFM Practices

    Posted 06-10-2019 09:21
    Thank you both for your answers. It is really helpful information to go back to adminstration.
    We are hospital owned and are getting queried both on our scope and activity. As you probably can guess, RVU is also part of the discussion.
    The hospital is community based with still private OB and hospital owned OB groups.
    There is still a push and pull of these entities and what is in the purview of the MFM and what should be consulted or not.

    Thank you again for taking the time to answer my questions. I appreciate your consideration!

    Serena Wu

  • 5.  RE: MFM Practices

    Posted 06-12-2019 18:09
    Hi Dr. Wu,

    It sounds like we are both in similar practice settings.  I am in a community hospital (not hospital owned) with all private OB practices and one faculty/resident practice.  My practice is consultative practice with no general obstetrical care -with like Dr. Iriye mentioned - a co-management relationship. Light others have mentioned we do not have specific criteria and anyone is welcome to consult me.  It is easier if they go through the OB first - like when I get calls from our medicine hospitalists but I am always happy to help.

    I agree with the others" curbside consults".  I'm happy to answer general questions, but again the chance for miscommunication, incorrect management and legal risk is there.

    Do have any specific information as to what your senior administrators like to know?  They should understand the value MFM adds to their service line.  The ability to keep higher risk moms in their hospital leads to more babies in the NICU - which is good for their finances.  Most importantly, these women are getting the high quality MFM care they need that would otherwise not have been possible with OB/Gyn physicians alone.  Many OBs are reluctant to practice in a hospital without MFM support or backup.  Providing MFM access encourages OBs to continue bringing their patients, deliveries and surgeries to that particular hospital.  They hate to lose their patients to another hospital if it can be avoided.

    Last point - I also encourage Dr. to Dr. consultation so information does not get lost.  It also helps built good relationships and trust and lets your OBs know that you are available for them.

    Hope this helps and feel free to reach out with any further questions!

    Hope this helps,

    Rizwana Fareeduddin, MD

    Rizwana Fareeduddin

  • 6.  RE: MFM Practices

    Posted 06-14-2019 15:17
    Thank you for your input.
    That is helpful.
    I know that every practice is slightly different but the tone is the same. We are here to help and add quality and help keep patients from being transferred.
    Thank you again.

    Serena Wu