I work in two of a large HMO's outpatient pediatric clinics & currently get
45 minutes for each dyad's appointment (cut back from 60 minutes a few
years ago).
That's usually 7-8 families a day, plus 4 scheduled 15minute phone call
appointments.
That's with the institutional help of someone to register them and some
minimal assistance from a medical assistant.

And that's wickedly busy, I have to say. I'm often there overtime,
especially with electronic charting and messaging. I find it stressful,
trying to take the time each family needs, often while knowing that then
next set is waiting. It's hard to feel successful if one measurement of any
job is completing it in a timely way. I guiltily cherish the 'no-shows' as
a chance to catch up.

By "providers getting 12 patients s a day", if you mean MDs or NPs, they
have a very different flow to their appointments, and for better or worse,
their appointment durations are much shorter.

Lactation visits are a bit provider-ish in terms of assessing what the
issue is, but more occupational/physical therapist in developing a plan &
teaching/practicing something physical -and very often, a fair amount of
therapist/counseling role. And certainly the OT, PT or therapist
appointments are much longer in duration.

 It's difficult for those used to 15 minute MD appointments to understand
how it could take 45 minutes for lactation. And they laugh when I mention
the time usually taken in private IBCLC consults.

The Mannel paper does have some recommendations on outpatient staffing:
http://jhl.sagepub.com/content/22/4/409.abstract

I think you yourself have to be a strong advocate for lactation care being
time-intensive.
I think more of us will be facing this as hospitals buy up physician
practices and try to provide some aspect of lactation care to comply with
the Affordable Care Act.

Good luck.
Susan Lawrence, in Berkeley, California







> From:    Kris Nilson <[log in to unmask]>
> Subject: IBCLC coverage for outpatients---question
>
> I am the only IBCLC at a military hospital that delivers about 100 babies
> per month (90% breastfeeding initiation rate). I also cover the peds and OB
> clinics, seeing outpatients for all the lactation issues.
>
> Do any of you know of any recommendations or ratios of outpatients per
> IBCLC in a day? Example - I've  been told that the providers in our clinics
> have 12 clinic patients scheduled in a given day. There is no way 12
> couplets can be seen by one IBCLC in one day!
>
> I am aware of the AWHONN recommendations for 1.3 IBCLCs per 1000 births in
> a level one facility but this does not include my work for the clinics.
>

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