These days doulas have a lot of options for how to operate their business. You can be completely independent and have a solo practice where you are the only doula in your business. (You should always have a backup doula, even in this type of business, but the main person you are promoting is yourself.) You could work as a team with another doula, do interviews together, and share a call schedule. You could work for a hospital in a volunteer program or some hospitals offer a paid position with rotating call schedule. There are many ways you can run your business in addition to these. One of those options is to work with an agency.
Today I’m going to focus on agencies because it seems there are more and more popping up everyday and some of them are not following the legal rules when it comes to how they treat their independent contractors. Now, if you are being offered the opportunity to be an independent contractor, not an employee, this means that you will still be operating your solo practice in addition to clients from the agency. You still will be promoting yourself, taking personal clients outside of the agency, and when you work with the agency clients, you do so in a way that is chosen by you. How many prenatal visits you do, what you wear to a birth, even what you charge is all decided by you.
Recently I partnered with two other doulas to start the first agency in our area. We had a vision for helping doulas have a sustainable income that would allow them to keep doing doula work without having to get a second job. We also wanted to make it easier on families who didn’t have time to contact lots of doulas and have multiple interviews in order to find the right one.
We set out by looking at how other agencies were modeled and initially figured we would take the pieces we liked from each one and then build our own. The next thing we did was to meet with a business lawyer, and that lead to meeting with an employment lawyer. After that meeting we realized that we had to restructure a lot of what we had planned. What we learned was that a lot of agencies are running businesses in a way that breaks the rules of employee vs independent contractor and they are treating their IC’s as employees but not giving them the perks that come with being an employee. I don’t believe they are doing this on purpose, if we hadn’t met with the employment lawyer then we wouldn’t have known any better either, but the fact is, it’s happening and you might be offered to work with one of these agencies. You might even be thinking of starting your own agency.
The line between employee and independent contractor is very fine. Crossing it is unfair for the doula and very dangerous for the agency. Let’s say the doula gets injured on the job, maybe she lifts a mom and hurts her back. She goes to the emergency room and they ask, “were you injured on the job?” “Yes.” “Where do you work?” The doula says, “I was working for so and so agency.” That hospital is going to then look for workers comp insurance. Now, if they are an employee then the agency would be paying for that insurance. However, they are an independent contractor and so the agency didn’t pay that. The next thing that will happen is an investigation to see if the doula REALLY is an independent contractor. So, she works exclusively for the agency, isn’t allowed to get other clients, or is punished for getting other clients. She is told what to wear and how to do her job. Guess what, it doesn’t matter that her contract said independent contractor, she is an EMPLOYEE and the agency is 100% responsible for her medical bills.
There are also tons of federal tax issues, social security, and unemployment insurance. The punishment for those who break the rules is very costly if they are caught, and it’s not fair to the doula that they be treated like an employee on the working end of the deal and yet not have the benefits I named above that come with being exclusive to a company.
I have created info graphic below so that doulas can see where they stand and make sure they know their rights when working with an agency. I also want to inform fellow agency owners so they can better understand the laws when decided how they want to operate their agency.
(When starting a business it is always best to consult with a lawyer for the laws specific to your state. This blog was written based of my own personal experience in the United States and is not to be used as legal advice.)
