Midwifes: where does all the money go? - Page 2

[carlasher]

Originally Posted by Ragana

Remember that self-employed people have to pay income taxes and the "self-employment tax", which is both halves of Social Security (the employer's half and the employee's half). That's a lot. And, if they don't have a partner with health insurance through a job, that's another huge expense. I'm not a midwife, but am self-employed, and our health insurance is $600 per month (for a family of 4)!!!

I am not self-employed, but I am an independent contractor, pay my own taxes, put this and that away and pay for my health insurance - so I know the deal. I have never grossed $9000 in one month before; thats all.


I was self-employed at one time and that was a nighmare!

[fuschiamom]

Originally Posted by carlasher

I am not self-employed, but I am an independent contractor, pay my own taxes, put this and that away and pay for my health insurance - so I know the deal. I have never grossed $9000 in one month before; thats all.


I was self-employed at one time and that was a nighmare!

just piping in here - i think some REALLY good points have been made by pamamidwife and doctor jen plus the issue of taxes and expenses brought up by many. my partner and i attend between 3-6 births/month at $3500/birth. we try to expense everything possible through the business and there are a lot of expenses (supplies, replacement equipment, bills, assistants, gas, car insurance and repairs, health insurance, rent alone is almost $2000/mo). we even 1099 my babysitter. after expenses we are bringing home about $3000-4000/mo. that is pretax money. in los angeles that is a near poverty wage. my partner (a single mom of teenagers) has to work another job and i am living of rising equity in my home until my husband's new business takes off. someday we may have disability and unemployment insurance or even retirement savings.
basically independent contractors are usually not running an entire small business with its increased expenditures. so $9000/month for an independent contractor would seem like a lot but not for a small business owner in a obscene high cost of living area.
in the end midwifery is a labor of love, but we need to be payed what we are worth so we can eat and live in a simple and non-suffering lifestyle - i'm thinking donald trump here

[theelfqueen]

Never mind, sent PM

[mwherbs]

I noticed that the original person who asked this question is in California. How much does a house cost in California? My cousin has a studio house (which means it is one room) and part of the floor is dirt the cost of the house when he bought it was over $150,000 and it is a very crappy place in a crappy neighborhood. I know from the recent labor disputes that long shore men make $100,000/year, and more if they work overtime.
Midwives are on call for their clients usually 24/7 and from a recent discussion on a midwifery list they pay their assistants about 1000$ to come. So what are the midwife's costs and what does she earn per hour? She is self employed so if she wants health insurance she pays out of pocket, and what about retirement, dental care? A new car costs about $20,000 and we aren't even covering education, childcare, savings for her kids to go to college, license, food, water, lights, medications, cell phones and pager, phone adds, business cards, adds, equipment, car insurance, consult fees, professional organizations, books, magazines, office supplies storage for records for 18-21yrs possibly malpractice insurance which often costs the price of 1 birth/month or more.
Here in Az we charge less but the cost of living is less, I was just talking the other day about how we only charge about 3x the amount we charged 20 years ago but the hospital costs alone have gone up 5x in that same time period, gas, housing and cars as well so for us here in Az we aren't even keeping up with inflation.

[carlasher]

A regular sized 4 bedroom house around the corner from me went for almost $800,000 and our rent on our very small 1 bedroom apt is over $1300. We live in Oakland, not even San Francisco.

My point in the question was just that. I am not a midwife and had no idea of their expenses - especially since I dont know any midwifes that are well off. In my own industry, I know because I work it. I didnt feel comfortable asking a midwife right off, because I am not even working with one at this time.

[Vixenmama]

Originally Posted by pamamidwife

"...I think that there is a belief that in order to be a good midwife you shouldn't focus on the business aspects of your practice. ..."

ITA, that is a very interesting dynamic or assumption, worthy of some intense discussion, but that is sooooo stupid---who would ever expect a dr. to work for free or a token fee---no one begrudges them their salaries (and their wednesday's off).

I think I read some powerful stuff by Gloria Lemay on the birthlove website about that syndrome, where a lot of her clients sort of expected her to work for free, and she sort of agreed with them. Until some clients who "couldn't" pay her took a vacation to disneyland or some such, and she sort of woke up. She also wrote something to the effect that treating her clients as if they needed her charity or "help" only enforced their predicaments---disempowering them and empoverishing her. She had kids to raise too!

[carlasher]

Originally Posted by Vixenmama

ITA, that is a very interesting dynamic or assumption, worthy of some intense discussion, but that is sooooo stupid---who would ever expect a dr. to work for free or a token fee---no one begrudges them their salaries (and their wednesday's off).

I think I read some powerful stuff by Gloria Lemay on the birthlove website about that syndrome, where a lot of her clients sort of expected her to work for free, and she sort of agreed with them. Until some clients who "couldn't" pay her took a vacation to disneyland or some such, and she sort of woke up. She also wrote something to the effect that treating her clients as if they needed her charity or "help" only enforced their predicaments---disempowering them and empoverishing her. She had kids to raise too!

That is nobody's fault but her own. She is running a business just like in every other industry. If you allow people to do that, you will be treated like a doormat.

[3_opihi]

One of my son's was born in the bay area, and by no means was our midwife scraping by (nice cabin in the santa cruz mountains). However, I would gladly pay her again and again. I couldn't pay her enough actually. If she could fly to Hawaii and be at this birth I would pay for it in a heartbeat!

The bay area is really expensive. I don't blame them for charging those rates. Also, insurance in CA pays for many home births, so maybe thats why? I dunno...I know we had to pay out of pocket (stinkin' HMOs) and she cut us a much lower rate.

[Vixenmama]

Originally Posted by carlasher

"....That is nobody's fault but her own. She is running a business just like in every other industry. If you allow people to do that, you will be treated like a doormat..."

That's pretty much the conclusion she came to as well. Finally realizing that if she didn't respect herself enough to expect adequate and prompt payment, no one else was going to either. We do "teach" people how to treat us.

I think what happens in midwifery many times though is that since many midwives are "called" to do this work, they feel a spiritual connection to it that is impossible to put a dollar cost on, and often feel that since they love the work so much "they would do it for free"---of course everyone deserves to get paid for their efforts and expertise....it would be interesting to hear from other midwives about about this issue.