1. (1) A physician may enter into a collaborative agreement with certified nurse midwives not exceeding a cumulative three hundred and sixty (360) hours (nine FTEs) per week. The physician shall not collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding three hundred and sixty (360) hours per week (nine full-time equivalent positions). "One full- time equivalent" (FTE) is herein described as a person/persons collectively working forty hours a week, excluding time on call.

   1. (a) A physician collaborating with more than four FTEs per week shall engage in documented quality assurance review with each CNM every month for six (6) months following the commencement of a collaborative practice with a new CNM.
   2. (b) A physician shall disclose to the Board of Medical Examiners the existence of all collaborative and supervisory agreements to which the physician is a party, including collaborative and supervisory agreements in other states, and shall not be eligible to collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding three hundred and sixty (360) hours per week (nine full-time equivalent positions), inclusive of collaborative and supervisory agreements existing in other states. Agreements with an individual certified registered nurse practitioner, certified nurse midwife, and/or assistant to physician in multiple states shall only be counted once for purposes of calculating the total number of full-time equivalent positions.
2. (2) Employees of the Alabama Department of Public Health and county board of health are specifically exempt from the requirements of paragraph (1) of this rule.

3. (3) A physician in collaborative practice may request approval for additional full-time certified nurse midwife positions by the Joint Committee, with consideration given to the following factors to ensure that an acceptable standard of care is rendered:

   1. (a) Availability of the physician
   2. (b) Practice settings and staffing needs for extended hours of service
   3. (c) Risk to patients
   4. (d) Educational preparation, specialty and experience of the parties in the collaborative practice
   5. (e) Complexity and risk of procedures to be performed
4. (4) A physician in collaboration with CRNP, CNM or supervising Physician Assistant personnel totaling 360 hours per week (nine (9) FTEs) may request a transitional allowance increasing the total weekly hours for the purpose of orientation of the incoming CNM. The transitional allowance shall not exceed 45 days. The physician shall request the transitional allowance in writing and specify the starting date for this FTE allowance.

Author: Alabama Board of Medical Examiners

Statutory Authority: Code of Ala. 1975, §§34-21-87, 34-24-53.

Editor’s Note: Was previously Rule 540-X-8-.23, renumbered as per certification filed August 25, 2003; effective September 29, 2003. Was previously Rule 540-X-8-.24, renumbered as per certification filed April 23, 2004; effective May 28, 2004.

History: New Rule: Filed June 20, 1996; effective July 26, 1996. Amended: Filed August 25, 2003; effective September 29, 2003. Amended: Filed July 2, 2015; effective August 6, 2015. Amended: Published April 30, 2021; effective June 14, 2021.