Just had to jump in a bit on this one.  With all due respect to Kathy
D.,  a nurse practitioner, etc., is not an "almost doctor" but a
licensed HCP and a resident is not an "almost doctor" but a real
doctor who is starting out, as we all must do at the beginning of
whatever profession we choose.  I think that the real problem is do
we really want to be a recognized, certified health profession with
educational and credentialing requirements or do we want to
maintain our longstanding "lay" status?  I feel that many want to
have their cake and eat it, too.  They want to be recognized by
doctors, insurance companies, etc., as health care professionals
yet do not want to have to go to college and take exams and pass
credentialing requirements, which everyone else in other health
care professions must do.  We can't have it both ways.  If a person
chooses to remain in a lay position, that is fine, but she(he) could
not expect to present themselves as a credentialed LC.  For
instance, lay midwives, many of whom are highly qualified, have
chosen to remain outside the formalized HCP world and they know
what that means and why they have chosen to do so.  Most times
the women who use their services know that they are not CNMs
and that is OK with them.  Similarly, any woman can use the
services of a lay LC.  But that LC has made the choice to remain in
that capacity and she must accept whatever limitations (or
benefits) that go along with that choice.

I have seen the same type of thing in my world of medical
technology - lab techs.  We can be 2 year or 4 year, we can be
certified or not certified, and by different certifying bodies. Some
states license with rigorous exams, some license without exams,
some do not license at all.  The problem has been that with such a
fractionization it has been difficult to unite as a group and to get the
kind of status, both professionally and monitarily, as do nurses, for
instance, (don't laugh, but you know what I mean, lab techs are at
the bottom of the food chain in many hospitals) even though many
of us have a BS degree after a very rigorous program and the RNs
only have been to school for 2 years.  Some in the lab have only a
2 year degree and complain that they do basically the same work,
but for less money and with less responsibility.  To which I can
only say, go back and get your four year degree and work as hard
as we did to get it and then we'll talk.  When they were starting to
standardize the field, they did grandfather in techs that were trained
by the government or other non-traditional training, but they
eventually went to a college-degree standard. But we really
fragmented when it came to the final step, the credentialing.  I see
this happening with IBLCE where they tried to be very inclusive at
first to anyone who wants to get in on the ground floor.  But
eventually, if we are to be a true profession, then there is going to
have to be some true standardization with college-level courses (I'm
not talking about a nursing degree) and clinicals and some type of
degree when we are done.  I hope that IBLCE remains the only
credentialing agency.  If my daughter can get a four year bachelor's
degree in equine management then we should be able to get
something for lactation.  It may not be offered at many colleges to
begin with, but it will be a start (my daughter had three colleges in
the whole state to choose from).  I see the internet as being a real
help here for those who may not be physically close - this would be
a great program to be presented over the web with clinicals being
managed closer to home, perhaps in cooperation with practising
IBCLCs and nursing and/or medical schools.

To tell you the truth, I am not sure where this is all going to end up.
 I still see hospitals being very reluctant to hire non-RN IBCLCs,
which is a real problem and one which will not have a hope of
resolving unless we do become a full-fledged recognized health
profession.  I have yet to meet very many who are actually making
any kind of a living at all solely being an LC and certainly not
making the kind of money that other health professionals, even lab
techs, are making - unless they are also employed as nurses at
the same time.  Unless we can make a living at this, few are going
to be willing to make the committment necessary.  I hear older LCs
looking ahead to taking the exam for the third time and wondering if
it will really be worth it to them if the profession hasn't advanced by
then to another level.  We will always have women passionate
about this field who will work at the volunteer or lay level.  But will
we ever be a true health profession in every sense of the word?
Only time will tell.  But I think that we all, regardless of our
aspirations, need to unite behind the idea that there does need to
be a definite, high standard set which is consistant with other
health profession fields in order to be a certified lactation
consultant.  In the end everyone, professional and lay alike, will
benefit.


Warmly,
Sharon Knorr, BSMT, LLLL, IBCLC
Newark, NY (near Rochester) USA
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