Hello, 
When I had a private practice as an IBCLC, in my contract (phone or email), I stated all the details about my prices: first appointment, hourly rates for follow-up, including (or not) kilometres.

To reduce those follow-ups, I would also return them to their own community agencies or resources: community health agency, support moms, pharmacist (medication), MD or other professional that would be in a position to help.

The first year, I was not seeing the same type of persons/ families than after 4 years at the same prices. At first, the customers (or clients) were much more well-off (obvious higher family income) than after 4 years. Needs for follow up also increased as time went by.

Your prices reflect a lot who you are meeting. I mean: 
-when you started, your fees seemed higher than now; this made you meet people more well-off (I guess) or with insurances offering  better coverage.
-not following the inflation can open doors to other clients, less "rich" who have also less capacity to pay (they have less in their pockets, in general).

I once met an accountant who had the same problem. She decided to raise her fee to reflect a correct hourly salary that would make her be able to live from it: all new customers were being charged the new amounts (her new raised fees), and her "old" clients had to go through regular raises in their bills over a couple of years in order to get charged equitably (does this makes sense???).

The challenge is to increase just enough to raise your net income without losing requests for first consults. 

Good luck in achieving the balance with your goals!

Manon Forcier, RN B.Sc.
Montréal, Qc, Canada

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