I've read these discussions with interest. These are my own opinions are
based on my RN license and my experience with the students at UCLA so no
flames please.

The IBCLC is not an entry level exam like the RN boards. Which the candidate
takes once as proof of *entry level competency.* The RN then keeps her
license current by completing continuing education and paying the license
fee. The IBCLE is an advanced credential. The title follows other
 credential, if present (eg. RN,IBCLC; BSN, IBCLC; RPT,IBCLC etc...) just as
any other advanced certification follows the primary credential, license or
registration.  A graduate nurse can function in many states before she
receives the results of her exam as an Interm Permitee (IP) for about 6
months before it expires. Most hospitals will accept IP's but for legal
reasons they cannot practice as RN's because they aren't RN's. An intern is a
student physician who is practicing off the license of a mentor. If the
intern screws up the supervising MD is in trouble too.  A resident is already
an MD (having passed boards) who is in the process of obtaining
specialization . Past the residency, most have additional board exams to
take, at specific intervals, to maintain certification. This is true with
nurse practitioners, midwives and a host of others in the medical profession.
     --Hopefully I haven't lost anybody yet ;-)  --
The IBCLC however is not a "tack on credential" to any others that the
individual may have. The IBCLE has long pushed for IBCLC as a stand alone
credential. You don't have to have any of the others to have the IBCLC. (for
example; RN, CPNP: the RN must be there before she can be a certified
pediatric nurse practitioner).  Board certification in this case (IBCLC) is
not the same as a license to practice.
A pre-exam title short of LE or LC (which many programs are dropping),
wouldn't be appropriate based simply on the above licensed/registered
professions.  At this point in time anyone can call them self a lactation
consultant but cannot use IBCLC unless they have current certification. Does
that mean a Lc or Le is less qualified to help mothers and babies--not
necessarily.  But if we are to obtain insurance co. (third party
reimbursement) money for our services the companies must be assured that they
are getting *professional services* for their money. The only way that can be
accomplished is through the IBCLC.

Many of the students I've seen don't go on to take the board because they
feel that being an LC won't be their primary work. They will use their LC
knowledge as an adjunct to their current practice--which in many cases
requires frequent expensive exams, classes etc... to them the IBCLC is just
one more expense. If the student plans to do LC work as a primary part of
their job, they take the exam. Many have taken the exam before the reach the
LC training program.

Terriann Shell writes >The hands on experience is where I learned most of my
real breastfeeding knowledge and taught me how to counsel so that mothers
will accept what you teach. . . What we need is more mentorship programs >
The clinical (hands on) component of our program that includes apprentices
takes more time than didactic to complete.   Working with an experienced LC
is vital to those starting out. I would estimate that 90 percent of what I
know is in my hands, eyes and that sixth sense that says *something isn't
right here.*  Additional sensual knowledge is gained though repeated contact
with clients.
The problem students have is finding someone who is willing to let them
observe.  Territorial issues and not wanting to *train the competition*  are
huge. Plus the LC is trying to provide a service that she is charging
for--what if the client complains about the student?  I have students who
started in 95 who still can't get someone to apprentice with.  Our clinic
takes apprentices one at a time (usually for no more than a day or two of
observation) I feel the student should apprentice with more than one LC,
because we all practice just a little differently. I want the student to
develop her own style not copy mine.
Hands on skills aren't easy to pass along and once learned, the challenge is
to continue to grow. Part of growth includes passing our skills on to the
next generation.

and reading Lactnet too-
Just MHO
Marie Davis RN, IBCLC