I could use the combined minds of Lactnet to help me with a problem.

I work in an HMO with a moderate sized multi-specialty clinic. I work with 5
pediatric providers, an Obstetrics service and there are approx. 250 babies
born each
year. In the past 9 years I have built a Breastfeeding Support Program which
includes lactation consulting (clinical appointments) but also comprises a
pump rental program, group meetings for bf moms, and prenatal as well as
return-to-employment meetings. Since the HMO is within a large university, I
have been able to expand the program to include campus-wide activities. For
instance, we have two "Nursing Mother Rooms" on campus (so far) which are
furnished for women who need to express or pump milk. The Breastfeeding
Support Program is very, very popular (by the way), and has served as a
model for other institutions as they created their own programs.

Now a new medical administration is getting around to looking at my "worth".
It didn't seem to go very well at my meeting, because the only part of my
work
that they will "count" is office visits. There are times when I get
inundated
with office visits. Fortunately -- or unfortunately -- during the past
couple of months I have had very few office visits. I have, however, spent
lots of time on the phone (I know you can all identify with that!) and doing
things like looking up information for patients and providers (medication
safety, unusual medical
situations, etc.) I am very discouraged since the administrator ordered our
data processing folks to forward her a count of the office visits I have had
in the last two months with the clear message that is what she finds
important.

I always have patients come in if there is a problem that requires
observation, but as you know many times phone calls are for support. I even
give out my home telephone number, so that new
parents can reach me in the hours I am not at work (I am only 1/2 time). It
strikes me as ironic that (what I consider to be!) my great job in providing
anticipatory guidance and support to new parents -- which means they are not
racing in with crises -- is likely my undoing!  It occurs to me that since
only clinical visits count, I (and our pediatric providers) should be
pushing formula, since illness = clinic visits :-/

Now I am supposed to be keeping track of all my phone time, which I already
do, but I have the feeling phone time just isn't seen as important. The HMO
is looking at income "coming in the door", and doesn't care about the visits
I am preventing.

Has anyone else had to face this? Did you find a solution? Or, should I be
looking around for a place to open a book store...

I know that the goal of LCs is to bring the world up to where we are no
longer needed, but I didn't think it would happen so quickly...

Margery Wilson, IBCLC