Hi all -

This is a fascinating discussion.  I am an IBCLC, and I did qualify to  
sit the exam primarily through the volunteer pathway.  As I was  
studying for it, and soon after I passed it, I heard several times  
from several long-time IBCLCs that the exam was an entry-level exam.   
I believe this meant that if I had the knowledge to pass the exam, I  
had enough general knowledge about breastfeeding and supporting  
mothers to A) find a place to specialize (hospital/community/specific  
populations etc),  B) learn whatever additional stuff I needed to  
serve my chosen location/population competently, C) be responsible for  
keeping up with new information coming out that affected my practice  
and D) be ready to retake the general exam again in 5 - 10 years by  
maintaining awareness of information in the world beyond my particular  
niche.

In many ways this puts responsibility on me to access the information  
I need for the needs of my particular practice location.  Some of  
those needs might be required by an employer - CPR, OSHA standards,  
etc.  Some might be required by a professional organization and  
practice standards (ethics, for example).  Some will be useful based  
on the community I practice in (more preemies because my referrals  
come from a high-risk OB's office?).  But it has been up to me to  
acquire knowledge beyond this basic level all those with the "magic  
letters" share to be able to serve the community I practice in.

What I feel is happening now is that the requirements have moved far  
beyond entry-level entry-level expectations, and have become more  
focused on meeting requirements commonly found in hospitals.  I don't  
think this is about RNs vs. volunteer counselors or even pathways.  I  
think it's about creating requirements for everyone that assume  
competence (and hire-ability?)  in the most complicated medical arena.

Morgan Kennedy Henderson, IBCLC, NMC
Massachusetts

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