Marsha
1) No one has posted anything on Lactnet about being reimbursed at $500 per visit.   Some have posted about needing more than an hour and needing more than $100 for a 2-3 hour visit to be able to earn a living.  
2) No one has been complaining about being a "recognized health care practitioner".  That is a great thing.  It doesn't negate the need to negotiate reasonable reimbursement for the complex and complicated situations that necessitate a home visit.  
3) No one has posted anything calling you stupid.  I did question the validity of survey that may not have sufficiently sampled private practice IBCLC
4) Posting about the challenges being faced by some private practice IBCLCs is also not accusing you of selling out IBCLCs.  


On the other hand, I find that your responses to legitimate challenges to lead me to the assumption that you are not keeping an open mind about our concerns during negotiations for developing appropriate mechanisms for adequate reimbursements for varying levels of care.  

Again, I suggest the the Visiting Nursing Services is a more appropriate model than ASSUMING that we are going to work in pediatric offices or in outpatient clinics.  I do not like the term "medicalized" which is often used in vague ways. But in this case, I have to say the assumption that we should be working in medical offices rather than community centers or in "wellness" oriented facilities such as the Pilates studio where I do groups that is providing all sorts of pre and postnatal body work does strike me as "medicalized".  Breastfeeding is about parenting and nutrition and developing healthy mother baby interactions. It goes far beyond pediatric practice which in its current state in the United States is about screening and treating illness.

Sincerely

Susan E. Burger, 

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