The truth about this is the hospital is trying to cut expenses and still be the good guy by contracting out services.  And here is where the rubber will meet the road.  When the level of need for services exceeds the ability of the personnel to provide, the pump company will have to hire more workers.  When the expense of those workers exceeds the profit to the company, they will either cut personnel, cut services or cut salaries.  No difference between contracted providers and in house providers, given the level of expertise is similar.  Not debating that one.  The real issue here is:  can a person working as an LC make a self-supporting living under this method?  I am going to bet NOT. I have heard the woes of some of the private PPLC's on here in getting enough clients to exist.  If she is paid by the hour, the hourly pay will be decreased when the profit decreases.  If she is paid by the consult, only her own personal values will determine the number of clients she will see at the level of service required.  This is true in all work relationships.  Hourly workers or piece workers - it is the level of work ethic and desire to achieve that control what is given to the work. My question is how is the hospital paying the contracter?  If they are paying by the case, it will benefit them to decrease breastfeeding rates to decrease their expenses.  If they pay a flat fee, it won't matter. This is somewhat like fee for service versus drg-based pay vs capitated pay for healthcare. When there's a flat fee involved, there is no motivation to see the patient, much better motivation to NOT see.  When there's unit-based fees, more motivation to see the patient but in less time.  Just logic here.

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Erin Michaud
Sent: Tuesday, November 08, 2011 9:18 PM
Subject: Re: non-nurse IBCLC in Worcester here

Thank you Angela.  I have always wondered why hospitals exclude IBCLCs in favor of RN IBCLCs.  The answer I've often been given is that then hospitals can pull those nurses off lactation consulting if necessary and put them on RN duties.  I don't know if that is true or not but that's what I've heard.  If that is so, isn't it possible that keeping personnel who can ONLY do breastfeeding might result in more mothers served?  Maybe I'm missing something there; I have been wrong before.  But like you I fail to see how non-RN IBCLCs would degrade the services.

Also I was told that my doing PP work might be useful to the outsourcing company because of plans to start a program providing home visits after discharge.  A program that runs at a lower expense can sometimes afford more personnel and allow them to do more, no?  At the very least they seem to be thinking about the needs of mothers in some small way.

I cannot pretend that I understand hospital culture or the politics in all of this or what the result will be.  I most definitely don't.  But we can lay to rest the fear that imposter "lactation consultants" will be taking over UMass.  If anyone knows how to talk to mothers who might be iffy about breastfeeding-- and that would seem to be the demographic at a hospital that bosts 4,500 births a year but has a <40% breastfeeding rate on discharge-- it would be us WIC alumni.  At least that is my humble opinion.  

If I am completely off-base on any of this I apologize; again I am green as all get out and almost certainly biased at this point!

Erin Michaud, IBCLC

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