In my state you need a license to paint nails! I mean really, to paint
nails! You can go to any school that teaches the course and pass the test, and
get your license. This is not to be confused with a occupational license
which you need just operate any business at all. That is a separate license.
You go to school for 9 weeks, you learn about nails, and take a test, and then
you are able to work in a salon doing manicures and pedicures. How odd is it
that you can work with a dyad where the possibility of real harm is there
without any such thing? An 18 hr. course and you can be a certified...fill in
the blank and be in a position to manage newborn health outcome -- and it is
only the IBCLC that requires we report to a physician. Those that just call
themselves 'lactation consultant' have no code of ethics to follow other than
whatever they make up for themselves.
The way I see it is, if insurance companies only recognize licensed care
providers, the only way women will have fair access to care in the USA is
licensure. As for the qualifications, lets face it, IBLCE did not protect the name
lactation consultant. CAPPA did it...they claimed the name "certified
lactation educator' as their very own. Why lactation consultant did not get
claimed eons ago, I don't know. (Maybe we need a new name that we can copyright
and trademark) I am sure there was a logical reason and maybe it wasn't
possible. But, since it wasn't done, anyone, and I mean anyone, can claim
themselves to be be a lactation consultant and charge for services. There is a woman
in my area who not only charges, but claims to be superior because she did
not 'learn' her breastfeeding knowledge from a book, she breastfed. ARGH! She
gets the same fee I do--and I also breastfed -- and did the work and
education needed to become IBCLC. It is what it is. Licensure will not likely
change anything in terms of competency of practitioner. The very same people
providing care at whatever level of competency will continue to do so. They
will likely even be able to become licensed. And just like any other health
field, some are great, some rot. But, what will change really? Not much.
Except that insurance companies may or may not choose to pay for the service.
But, they more likely will pay for a licensed care provider than one that is
not.
The concern about volunteers providing help being in trouble for practicing
without a license? I can see that as an issue. So, the solution may be to be
sure the goal is 'only licensed persons are able to accept pay for
services', or something that protects the volunteer.
As for the credential itself, and the recertification process....I don't get
it. I have already used cerps for my 5 year recert, and now I take the exam
again this year. It keeps being said that re-examination provides assurance
of competency. I don't know what other health care field has to take the
board exams again. They have to have proof of continuing education for sure,
but do they take the test again? And, if they do, wow, that is scary since I
assure you I question the competency of some and they do indeed have their
license to practice. Even re-exam guarantees nothing. Nothing guarantees
competence really. If it did, malpractice insurance would be a non issue and we
would not be discussing the dumb things docs say and do that sacrifice
breastfeeding. We all know great doctors and nurses, and those that really should
pick a new career. The same is likely true of IBCLCs...seeing as we are all
human.
Once a lawyer, do you take the bar again? Once you are a doctor, do you
have to take your medical boards again and again and again? How about nurses?
How many times do they take their nursing boards to remain nurses? I don't
see the point of taking the exam over and over again. I do see the point of
expecting continuing education hours yearly and even a yearly renewal of the
certificate for that matter at a reasonable fee would not bother me.
Licensing issues will likely vary state to state just as insurance payment varies
from state to state. But, the bottom line seems to be if lactation
consultants want payment in the private sector, they will have to comply with the
powers that be that provide that payment or depend on fee for service and accept
that it leaves out a large part of the population in terms of access to care.
Yes, we all care about competency and want some assurances that women and
babies will not be in danger, but we cannot guarantee that in any other health
field either. I don't see a future for private practice LCs if something is
not done to increase the likelihood of payment from insurance companies, and
the fact that an entire segment of the population is under served without
medicaid payment available is abhorrent. We will never guarantee competence.
We may know that IBCLC is the gold standard, that the qualifications and
education requirements are higher than the CLE or the CLC or the "I call myself a
lactation consultant therefore I am", but the truth is, the public in general
doesn't see that or know the difference.
Maybe, just maybe, creating a licensure requirement for pay in the private
sector will make a difference. Maybe, just maybe, it will give the field a
name in the public view and the medical community and with that maybe we can
become the gold standard of something that actually exists...an allied health
care field at the very least. I do see the possibility for good, and for
harm. I can see where licensure may help, and where it may hurt...especially
considering who will manage the licensure, state to state, nation wide, global
(if that is even an issue), etc. But, when I think of all things I am
certified as .... eeks.... I don't see it being much of a big deal to be called
"certified" anything in the USA unless you are also "licensed to practice"
whatever that is you are calling yourself.
Interestingly enough, this is not what I believed 5 years ago, or even 10.
It is where I have grown to though watching this field change, watching it go
from women working very hard to learn all they can about lactation to be
worthy of the exam, to mostly nurses who take a couple of quick courses, and
pass a test. And watching organization after organization jump on the bandwagon
and offer a 'credential' of some kind for the most minimum of time and
expense when compared to the IBCLC credential. At this point, I don't see it
gaining value at all, but losing value in a sea of certifications with the word
lactation or breastfeeding attached. And it is much more expensive to obtain.
I have watched this with midwives in my state also. Some balked at the idea
of licensure and government interference. Others welcomed the licensure
along with the qualifications and examination that brought with it the
possibility of insurance reimbursement and medicaid payments---opening the right to
choose midwifery care to the larger population. I see the same with IBCLC, or
lactation consultant licensure. The cost in terms of autonomy and our own
ideas of ethics, etc. may be lost but the gain will be more women with access
to care. Some of it will be substandard care in lactation...just as it is
ob/gyn and pediatrics and a slew of other medical fields and allied health
fields. You should see what is offered on late night tv for education in a health
field. ILCA may become the organization of IBCLCs in the same way AAP and
ACOG are for peds and ob/gyns. Maybe if there is more of us, and there likely
will be if there is a possibility of actually making money at this outside a
hospital (Like I said this is expensive and at the end of the year, my
husband calls it a nice hobby that at least pays for itself!!) then ILCA will have
some clout and some financial backing to push for what we want to see as the
minimum standard of competency for licensure.
As things are now, I don't see a future at all unless it is only going to be
a tag on for health care providers. Which realistically, is not profitable.
And, in today's changing medical climate, the importance of IBCLC may not
be growing. The reality is that other less expensive credentials and
certifications can easily be obtained by nurses and those can be used to say they
have "lactation specialists" as a window dressing.
I think this issue is very important for those of us who do not desire
hospital employment.(Nothing personal, and I do so respect those who beat their
heads against a stone wall every day, day in day out, but I would go insane!!
Five years of WIC taught me that bruises on your head lead to insanity.
Hahah.) I do hope I pass the exam! Haha. If I don't, well, the truth is, I can
call myself a lactation consultant anyway, and continue to work as I do
today...actually minus the hassle of reporting to the docs. Haha. I can continue
to go on as if nothing changed. Why? Because nothing is required to practice
lactation consultancy unless you want it to.
Take care,
Pam MazzellaDiBosco, IBCLC
Florida, USA
P.S. Am I a member of ILCA? Some years yes, some years no. If I make any
money that year, I join. If not, then I don't have the funds. Would I be a
member at a reduced fee without the JHL? Absolutely. Then the years I see a
black number I could buy the JHL subscription, and those years that my work
costs money and I end in red, I could still be a member, but minus the
benefit of the JHL.
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