I'm not losing sleep over this issue yet, but it's getting close, so I'm
going to post this, and hope I can finally let go. Being a more practical and
blunt (to a fault, ask my colleagues) person, and not widely know for my
intellectual prowess, many of your posts are beyond me intellectually and
esoterically, so I'm just going to shoot straight from the hip on this one, one more
time. Be patient with me, please.
Pam Morrison's post on the SOP issue makes some really great points and I
think/hope we all (including the leadership at ILCA and IBLCE) should consider
them very seriously. And, it's not just because she happens to largely agree
with me!
The fact that she doesn't "... have "a snowball's chance in hell of being
registered" in England, as you might remember, hit a nerve with me, as I try to
get American insurance companies to reimburse for my services. This is not
news to anyone here. The main reason? She says " I hadn't received a
recognized form of training. ..." We all know, unless we have been living under a
rock in America, this is a serious issue. We are the only allied health care
profession here without a university, college or associate (2 year degree)
program offering the consistency and validity of a standardized (or even
vaguely standardized program) that can be recognized by the employer, insurance
agency, government and/or consumer.
There are excellent, quality education programs in breastfeeding out there;
I know, I work for one. They fill the need in many ways. And when clients
ask me about my background, I say that I have an undergraduate and master's
degree, have practiced in the US and abroad, have taken college level courses
in nursing, anatomy and physiology, etc., attend many professional
conferences, speak at them, write, am a retired LLLL, and regularly read professional
journals. This satisfies them, but I am lying by omission--unless I
specifically specify my degrees are in French, International Relations and Development
Economics. Like so many of us, I got to IBCLC-dom circuitously. Nothing to
be ashamed of, certainly, and in many ways, it probably helps me;
nevertheless that and $4.50 doesn't buy me a grande double-decaf mochachino soy-skim
latte whatever at Starbucks.
Indeed, Pam, I believe you are right: There is a big sticking point, as you
put it. Even ILEAC's efforts, noble as they are, I don't think, are going
to be viewed as sufficient by licensing boards, health professions councils,
other healthcare providers and insurance companies
who need to be reassured before reimbursing a consultant who is not a
something else. As good as we might be, and as much as we tout the "gold standard",
it really just isn't enough.
Why? In a nutshell, certification can be bestowed by anyone for anything.
Simplifying it somewhat, the fact of the matter is that I can open Barbara's
Dog Walking School, set up a board, charge a fee, give an exam, issue a
certificate, and the graduates can call themselves "board certified dog walkers".
I can even guarantee continuing competence by recertification by exam. I
could, in fact, if I had the money, energy and put in the effort, even be
certified NCCA, join NOCA, and become the gold standard of dog walking
certification organizations. I know this sounds terrible, disrespectful and flip, but it
is true. If you research certification, you will find this to be accurate.
Certification is only one part of the complete professional picture.
Pam said that she feels that the IBLCE Board could be more active in seeking
recognition of the credential as a stand alone certification. I agree with
this, and I don't. Being a fairly young profession, in some ways I feel that
IBLCE should only concentrate on developing and administering the exam.
Developing the data bank, updating the security of the administration of the
exam, the policies and procedures of the organization, the operations of the
Board and other internal issues desperately need attention. On the other hand,
she says the organization could take a more active role in seeking
recognition of the credential. I believe it should, and tried to do that while I
worked there. But, the fact is, IBLCE is too small, too poor and the staff is too
overworked to do that. And besides, is that not a role, truly, for the
profession's professional association? I think some education is required
regarding the different roles of the certifying agency and the professional
association. The roles are not identical. For example, if you want to become a
doctor, during medical school, you take boards, after graduation, internship,
residency, and fellowship, then you seek licensure, and you set up practice.
At some point, you may take special exams to become a specialist in a
subfield. At some point, you may join the American Academy of Pediatrics, the
American Academy of Psychiatry, Neurology or another association representing your
specialty. These organizations inform the public, offer education,
conferences, lobby for your interests on Capitol Hill, at the state government level,
and charge dues to do so. They do NOT examine you, they do NOT renew your
certification or license, although they might offer continuing education
opportunities.
Now, not to lay blame, and I want to make that VERY CRYSTAL CLEAR (sorry,
but I mean it) ILCA is as young as IBLCE, and for a long time, both
organizations have been run by volunteers with lactation credentials only and on
minuscule budgets, and both organizations were operated with Boards with little
business acumen. Inevitably mistakes were made. A confusion of roles, lack of
progress in some areas, duplication of efforts and other issues arose at the
expense of the creation of a new profession, remarkable progress and
innovation, and the unfathomable benefits to millions of mothers and babies. I think
we all recognize that these pioneering professionals have made a tremendous
contribution to our profession, to each of us personally, and to mothers and
babies. They deserve our admiration and our thanks. Despite our current
annoyance, anger and frustration, we need to keep that fact in clear view.
Nevertheless, so now we have a serious, if not earthrocking mess, with the
SOP issue. It's no wonder. Everyone, on Lactnet anyway it seems, is out
there twisting their guts, absolutely tortured about how this affects their
practice, whether or not to recertify, how or if to report to physicians, whether
or not to be or not to be RNs, etc....remember Lactnet is only about, what
3000 (Rachel, ?) of the about 20,000 IBCLCs worldwide, some of whom, even in
the US, have NO IDEA this is happening. Think about that for a minute, will
you? It all depends on where you sit. Is it that earthrocking? Are there
issues that are not equally important, if not moreso?
[Some of you will recognize the following, as I have sent it to friends in a
different discussion. Sorry for the repetition.] The SOP has been withdrawn
from the IBLCE website, but technically they are still 'reconsidering' it.
We don't yet know what happened at the board meeting, as of now, as far as we
know, I think, they are still planning to meet with ILCA on the topic.
IBLCE still could withdraw the whole thing and go home with their tail between
their legs. I don't know how likely this is, but it might happen.
Now, as to how this whole SOP nightmare got started, I have been thinking.
IBLCE does a role delineation study about every 5 years. From the role
delineation study before last, done in or about 1998 (when I lived in Australia,
was a voluntary participation exercise) only a couple of results have emerged.
One was the requirement for the "related background in" courses for
non-health care professionals. The courses in anatomy and physiology, counseling,
child development and the like. Because of the length of time it takes to
compile and analyze the information and for the board to act, this whole SOP
thing could also be an outcome of that RDS. What I'm saying, in fact, is that
somehow they may have extrapolated from the data that their version of the SOP
was necessary. If you think about it for a minute, we don't know the sample
size, and "n" was self-selected. What if the information they used was
largely composed of originally LLLL IBCLCs with no background in health care?
Would it make sense that they'd come up with this? Could this thing be a huge
research error? Could there be no "evil intent"? Yes, we would certainly
hope not, but that is as possible as the fact that IBLCE might not have
realized or have indeed forgotten that ILCA had issued a previous SOP just as ILCA
had forgotten to date their SOP. I have no doubt that the majority of the
board had no idea that it existed, but I question why the ILCA rep on the board
didn't speak up loudly enough to be heard while this SOP was being discussed
and voted on. Did she not know ILCA already had an SOP? I posted on this
earlier, and to my surprise, no one, not even the ILCA rep or an ILCA officer
commented. Why not? Again, I repeat my message. In the board's discussion
of the new SOP, why didn't this happen? Of course, these hypotheses are pure
conjecture, based largely on my knowledge of the past and my carefully
honed deductive skills after watching years of Law and Order.
It is time for both ILCA and IBLCE to be operated as businesses. I
certainly am not saying to get rid of the lactation heart of the ILCA and IBLCE.
Absolutely not. I think the Exec Dir of IBLCE should be an IBCLC. I think the
Exec Dir of the IBLCE should be the public face of the organization--a
person who is constantly out there--speaking at conferences of all allied health
care professionals, showing the flag so to speak, promoting our profession,
lobbying for our cause, working hand-in-hand with the IBLCE Board Chair, ILCA
president and ILCA exec dir to get the job done. I would much rather see a
charismatic, public leader who can bring us attractively, positively,
knowledgeably, and enthusiastically to the public and make the insurance industry,
legislators and the public sit up and take notice than someone who can balance
the books and manage the office as the next Exec Director of IBLCE. The
analogy I can best draw comes from my former profession as a diplomat. The
Ambassador is the President's personal representative to the foreign country. He
does the public stuff. He makes sure that the foreign country understands
what the President's view is, what the US thinks and needs from them, and what
the US can do for them. His deputy stays home in the Embassy and tends to the
mission--she supervises the administrative needs -- oversees the balancing
the budget, making sure the place runs like clockwork so the ambassador can
accomplish the big picture without having to worry that the place has enough
toilet paper. That's what I did and I can tell you it works. (And you can
send your campaign contributions me at Grand Central Station, PO Box 555, New
York, NY 10001. LOL!)
Seriously, right now, both Boards are not composed of business people. They
are full people who know lactation, professors, and pediatricians. The
public member of the IBLCE board has almost always been a person interested in
lactation but again, someone with little, if any, business acumen. At IBLCE,
until recently, as I understand it, the staffing at both the international and
regional offices is the same. While I have no business training myself, I
can tell you my feeble efforts to open the organization to the concepts of
advertising, hiring consultants to handle what staff could not, and expanding
contacts with people who could help us (e.g., lobbying the insurance industry,
lawmakers on Capitol Hill) were met with opposition, if not downright
disdain.) I have no doubt that these are the some of the reasons the board reaches
the decisions they do. Revamping the by-laws to include business people in
addition to lactation people will take years, if they were to occur at all.
Undoubtedly, they will be met with opposition, as is all change. Many
Lactnet members have said they also want IBCLCs from the trenches included. That
may be a good idea, too, but I would also like to remind Lactnetters that they
larger the board, the more unwieldily, and the more unwieldy, the more
expensive to operate (which, in my past experience with IBLCE it was already,
eating a very large chunk of the budget, for, in my opinion, very little payback),
and the more unlikely to reach timely decisions.
Currently, the IBLCE meets twice annually. While I can't speak for ILCA,
and have no idea of their practices, I do know that it is critical for board
members to work diligently between meetings, by phone, e-mail, and as
opportunities present for face-to-face interactions. From my past experience as a
former IBLCE employee (and not, as some people mistakenly believe, NOT as a
board member), the people on the board are stretched thin with many other
professional and extracurricular lactation responsibilities.
NeverthelessNevertheless<WBR>, it is critical, and if they cannot do this, they should not And it
is equally critical for the two boards to communicate frequently and to
exchange representatives; a one-sided exchange is unacceptable. It has to be all
or nothing. The organizations are not at odds. Their missions are not
identical. To have a one-way relationship, to me, is vaguely suspicious and
requires an explanation, one I never was able to extract during my time at
IBLCE.
I want to reiterate that my opinions and statements about operations about
IBLCE are based on when I worked there from 2002-2005. I do not have contacts
there now, and do not know how things operate there now, beyond information
provided on the website. It would be completely inappropriate to assume
otherwise. I post information to Lactnet from the IBLCE website because I often
read it out of desperation for information and curiosity as to when it will be
updated. I consider it a service to all of you, also, because I just have a
gut feeling it doesn't get that many hits.
I believe it is high time for IBLCE to end its silence -- so far we have
lots of excuses, but no website updates, no newsletter, and no responses to the
many IBCLCs who have written and called is unacceptable, at least in terms of
good business practice.
While they are currently without an executive director, and there is no
indication of who is the acting director on the website, I look forward to IBLCE
to take the high road, tell us what is going on, and if they feel that they
made a mistake, admit to it, and move on. All we know for sure is that at
least one former board member reads Lactnet. Maybe staff or a current board
member does too. Maybe if we all back off, let them get it together, and
somehow, via the website or something, they will publicly respond, and then we can
all get on with something else. Nothing else has worked, right? God knows
IBLCE, ILCA and USLCA have a lot of other issues to work on, and if they need a
list, I and probably all of you would be happy to help.
Barbara Ash
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