For those of you who are drooling over the high fees of IBCLCs in New York,
as was my psychologist husband when I started my training, those fees do
not translate into nearly that much in terms of actual profit.  I actually
don't know of an IBCLC in New York City that charges as much as $125/hour.
I do know the fees of at least two groups, one that charged $145, and one
that charges $165 for an initial home visit that lasts an hour an a half.
Follow-up visits cost less and last an hour. Office visits cost less than
home visits, but generally the travel time and transportation costs exceed
the differtial between the two.  Some IBCLCs offer flat case rate fees for
complicated situations that require repeated follow-up.

I was forced by horrible financial management practices at the non-for-
profit organization where I last worked, to protect the $13 million in
grants that I pulled from the "OVERHEAD" that ate away at the $$$$$ meant
for field projects. After a seven year losing battle in that regard, I
became very attuned to losses from "OVERHEAD".

What are the expenses that I've observed in New York City?  Very high
office rents, retailing taxes and fees(though some people do rent equipment
and supplies without paying these taxes and fees, they are at high
financial risk should it ever be discovered), transportation costs (either
in lost time on the subway, looking for parking spots or paying parking
fees), last minute cancellations, phone consultations and call-backs, case
reports for referring pediatricians, free breastfeeding support groups
(some IBCLCs charge a minimal $5 fee which would not come anywhere close to
the $125/hour), health insurance, liability insurance, and occaissional
scheduling problems that leave gaps are just some of the expenses I see. I
can sometimes spend an hour and a half getting across town from the Upper
West Side of Manhattan to the Upper East Side, yet make it to Brooklyn in
an hour. I'd be surprised if the profit after losses even approaches 40%,
but I haven't sat down and asked nitty gritty detailed questions about it
yet.

It seems to me that these are expenses that any group practice would incur,
but perhaps in rural areas (I'm missing Ithaca right now where I lived for
six years) or in less high risk practices, the overhead would be less. But
I'm not sure about that because there might be other expenses in those
settings that I haven't even thought about.

It is something I am very aware of when I think of what type of practice to
set up when my son is much older. I would probably start with home visits
just to avoid the outrageous real estate fees in Manhattan.  Any tips from
those of you with busy practices that have conquered the overhead problem
are greatly appreciated.

I've concluded that I'm not going to make nearly as much as an IBCLC as I
would consulting in the International Nutrition field.  BUT even though
some of you with very busy practices might not be able to imagine it, I
actually find even the complicated cases far less stressful than
international work.

Susan Burger, PhD, MHS
In training to become an IBCLC

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