I've read these discussions with interest. These are my own opinions are based on my RN license and my experience with the students at UCLA so no flames please. The IBCLC is not an entry level exam like the RN boards. Which the candidate takes once as proof of *entry level competency.* The RN then keeps her license current by completing continuing education and paying the license fee. The IBCLE is an advanced credential. The title follows other credential, if present (eg. RN,IBCLC; BSN, IBCLC; RPT,IBCLC etc...) just as any other advanced certification follows the primary credential, license or registration. A graduate nurse can function in many states before she receives the results of her exam as an Interm Permitee (IP) for about 6 months before it expires. Most hospitals will accept IP's but for legal reasons they cannot practice as RN's because they aren't RN's. An intern is a student physician who is practicing off the license of a mentor. If the intern screws up the supervising MD is in trouble too. A resident is already an MD (having passed boards) who is in the process of obtaining specialization . Past the residency, most have additional board exams to take, at specific intervals, to maintain certification. This is true with nurse practitioners, midwives and a host of others in the medical profession. --Hopefully I haven't lost anybody yet ;-) -- The IBCLC however is not a "tack on credential" to any others that the individual may have. The IBCLE has long pushed for IBCLC as a stand alone credential. You don't have to have any of the others to have the IBCLC. (for example; RN, CPNP: the RN must be there before she can be a certified pediatric nurse practitioner). Board certification in this case (IBCLC) is not the same as a license to practice. A pre-exam title short of LE or LC (which many programs are dropping), wouldn't be appropriate based simply on the above licensed/registered professions. At this point in time anyone can call them self a lactation consultant but cannot use IBCLC unless they have current certification. Does that mean a Lc or Le is less qualified to help mothers and babies--not necessarily. But if we are to obtain insurance co. (third party reimbursement) money for our services the companies must be assured that they are getting *professional services* for their money. The only way that can be accomplished is through the IBCLC. Many of the students I've seen don't go on to take the board because they feel that being an LC won't be their primary work. They will use their LC knowledge as an adjunct to their current practice--which in many cases requires frequent expensive exams, classes etc... to them the IBCLC is just one more expense. If the student plans to do LC work as a primary part of their job, they take the exam. Many have taken the exam before the reach the LC training program. Terriann Shell writes >The hands on experience is where I learned most of my real breastfeeding knowledge and taught me how to counsel so that mothers will accept what you teach. . . What we need is more mentorship programs > The clinical (hands on) component of our program that includes apprentices takes more time than didactic to complete. Working with an experienced LC is vital to those starting out. I would estimate that 90 percent of what I know is in my hands, eyes and that sixth sense that says *something isn't right here.* Additional sensual knowledge is gained though repeated contact with clients. The problem students have is finding someone who is willing to let them observe. Territorial issues and not wanting to *train the competition* are huge. Plus the LC is trying to provide a service that she is charging for--what if the client complains about the student? I have students who started in 95 who still can't get someone to apprentice with. Our clinic takes apprentices one at a time (usually for no more than a day or two of observation) I feel the student should apprentice with more than one LC, because we all practice just a little differently. I want the student to develop her own style not copy mine. Hands on skills aren't easy to pass along and once learned, the challenge is to continue to grow. Part of growth includes passing our skills on to the next generation. and reading Lactnet too- Just MHO Marie Davis RN, IBCLC