Dear Jaye:

I have to consider you a gold medal winner in the private practice IBCLC triathalon event.  This is because you are a dedicated outlier and go to the mat for moms even when you are not being paid anywhere close to the value of your services.  Given your particular set of circumstances, I can see why you would want to sign up with Aetna.

You remind me of my sister who has persevered for well over 20 years during the dismantling of the California public school system.  She has endured principals who have embezzled money, principals who have rewarded teachers who fudged grades and passed students who did no work and punished teachers who tried to maintain standards.  She has persevered in situations where her students have no family support or abusive parents or abusive boyfriends or girlfriends.  She has persevered when colleagues have been assaulted -- one was hijacked -- and when students have been murdered.  She still loves her work with her students despite all the administrative hassles and demonization of teachers and is now working on an innovative model with online and in class work as well as getting her masters degree.

Nevertheless, there are many people who crumble under such circumstances and move on to other professions that are easier and more financially rewarding.  I personally would like to see it become EASIER for people to become teachers and IBCLCs and to see far more support provided for these very important professions that really contribute to future generations.  

So, there is a model that had been used in public health that I DON"T think works for everyone.  That model is called positive deviance.  It looks at individuals such as yourself who persevere under adverse circumstances that others can't manage and then adapt interventions based on what positive deviants can do.  Now yes, there are many who will be inspired by role models such as yourself.  BUT, just like with breastfeeding, there are others who just give up because they cannot manage it and then, unfairly I might add, become resentful.  I think this sometimes creates an unfortunate divide such as the divide between the "first women" who broke barriers in professions originally held by men and the "second wave" who comes along and says, "yes, but we shouldn't have to work harder than men and sacrifice so much".

This creates an unfortunate divide epitomized by the "Are you MOM enough" challenge.  I think we need to make sure to set up standards that are achievable for a broad range of people who may not have your level of perseverence and dedication but still may be able to make a valuable contribution with more support.

Now as for acceptance -- I see no reason why we should NOT do a thorough analysis of the costs of doing business for private practice IBCLCs -- a survey (that clearly did not include the opinion of a majority of private practice IBCLCs in New York City) is not sufficient.  I think of Liz Kruger who was able to push through the Breastfeeding Bill of Rights in New York State.  She pushed for MORE than she wanted in what she called a log rolling technique.  We should push for and ask for as much as we really think would be appropriate and even beyond and negotiate effectively for not what might allow us to dangle by a thread financially, but what should help us as a profession prosper. 

If we are constantly stressed financially it makes it much harder to provide excellent professional care.  And while some of us might still manage to do it -- don't we want it easier for many to be able to do it?

Sincerely,

Susan E. Burger, MHS, PhD, IBCLC

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