Physician duties · CNM · Puerto Rico
Signing for a Certified Nurse-Midwife in Puerto Rico: what the physician takes on
The agreement is mandatory for the clinician, which makes its duties mandatory for you. Puerto Rico does not name a specific instrument.
Ley 254-2015 Art. 2(e)(2)(b): the 'Enfermera/o Obstétrica-Partera/o' manages uncomplicated prenatal/labor/postpartum care and newborn care as a primary provider, but 'en colaboración con el médico obstetra' for every diagnostic order and medication — no independent-practice pathway or experience threshold is codified.
What you take on as the physician
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · no controlled-substance authority
Ley 254-2015 Art. 2(e)(2)(b)(5)-(6): may order vitamins, antibiotics, contraceptives, and immunizations for uncomplicated pregnancy/postpartum patients and healthy newborns, previously discussed with the patient's physician. No controlled-substance authority is enumerated — materially narrower than the general NP grant.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Corporación Profesional under Ley 164-2009, Cap. 238 — no PR statute found barring CNM ownership of a nursing-services professional corporation.
Legal sources for these rules (1)
What physicians charge for this role
Typical monthly compensation in Puerto Rico
$500 – $600
Estimate for one Certified Nurse-Midwife. Standard-tier state.
About Puerto Rico's rules
PR's 'Médico Asistente' (PA) credential is NOT the mainland PA profession — it is a bridge pathway mainly for internationally-trained physicians awaiting PR licensure (Ley 71-2017), capped at 2 per supervising physician with zero prescriptive authority. APRNs (NP/CNM/CRNA/CNS) need patient-level collaborative protocols with a physician for nearly all diagnostic/prescriptive functions (Ley 254-2015) despite AANP rating PR 'Reduced Practice.' No dedicated esthetician license currently exists.
Other clinicians in Puerto Rico: see the state overview.