Laura, you mentioned the high cost of maintaining our board certification as IBCLCs, in contrast to the lesser expense of maintaining your certification as an SLP.  It is indeed unfortunate that the fee is set so high for this narrow specialty.  For your patient population as a speech therapist, you may provide care across the lifespan, although I will guess (as a non-SLP) that clinicians in speech and language pathology will see a greater number of patients who are younger and learning speech, as well as older patients whose speech may have become impaired by a stroke or a traumatic brain injury.  

Your reference to the cost of maintaining the IBCLC credential reminded me of a friend's similar sentiments in 2012.  I first met her in 1994 when she was a highly regarded labor, delivery, recovery, and postpartum (LDRP) registered nurse who went on to become a certified nurse-midwife, but in the meantime, she was also the first clinician in our 7-county region to obtain the IBCLC credential in 1994 in West Virginia, a primarily rural state.  After hearing this friend describe the IBCLC credential, I was immediately drawn to the field.  I formally entered the lactation and infant feeding field in 1995, and obtained the IBCLC credential in 1998.  As a bachelor's degreed registered nurse, it took me two and a half years to acquire the 2,500 clinical hours that were then required to apply to sit the board exam.  I was in a small town in a primarily rural state, and in order to complete that 2,500 hour requirement, I also went to D.C. and completed a lactation internship under Vergie Hughes.  

In 2000, two years after obtaining the IBCLC credential, I relocated to northern Virginia and drove the long commute into Washington, D.C. in order to be able to find enough work as an IBCLC to allow me to be self-supporting in the lactation field.  Prior to that move, I worked for West Virginia WIC for $5.52 an hour as a breastfeeding peer counselor, even though I was an RN - - it was the only paid lactation position available in that county and surrounding counties.  My WIC hours were limited to 20 hours a week, and I supplemented my WIC income as a registered nurse supervising home health care workers for our local mental health center.   

I am reaching the point of my rambling story.  While having lunch with my nurse-midwife/IBCLC friend in West Virginia in 2012, she shared that both her nurse-midwifery recertification and her IBCLC recertification were coming due soon, and that she had decided to let her IBCLC credential lapse after maintaining it for so many years (since 1994).  She explained that it was more costly to renew than her nurse-midwifery recertification, and she simply could no longer continue to justify the expense.  She was also self-supporting as the sole member of her household, having single-parented her children for many years.  

I urge IBLCE to consider the narrow aspect of our specialty in setting the initial certification fee as well as the recertification fees, in that we do not work with patients and clients across the lifespan.  Although I've been a Florida resident since 2013 in a much larger county of 330,000, I must speak up on behalf of all IBCLCs in rural areas where the childbearing population is very, very small.  

Whereas it is possible to be happily but modestly self-supporting in larger urban areas as an IBCLC, particularly if employed in a hospital setting as a full-time, benefitted employee, most of the land mass in the U.S. is rural, and thus it is simply not possible to be self-supporting solely on IBCLC income anywhere in the U.S. except in large enough urban areas.  In this part of north central Florida with its county population of 330,000, 75% of all births are covered by Medicaid, and we are one of 14 states that has not yet accepted Medicaid expansion monies.  To my knowledge, our local hospital continues to staff at 1.5 FTE for lactation staffing, as the only hospital in the county providing childbearing services.  

We're in such an important field with considerable depth and breadth from a science point of view, although IBCLCs in smallest towns and rural areas cannot possibly generate enough income to be self-supporting, simply due to the exceedingly low patient volume.  I'm speaking as mother of two adult daughters who I single-parented for many years as an RN, and I also supplemented my income as a musician for a number of years in order to make ends meet.  

Rural areas and small towns can be lovely places to raise children, but for a self-supporting IBCLC, it's professionally frustrating to have a passion for the field but limited to a tiny patient population, so that it's simply not possible to be self-sustaining solely as an IBCLC.  This is in stark contrast to the pediatric nurse practitioner in a small town, for example, who will be seeing patients from birth to age 18 for well child checks as well as illnesses, so that making a living is possible in a small town in certain health care specialties.  

As one of many IBCLCs devoted to our field, I know whereof I speak as a native of the beautiful and primarily rural state of West Virginia, even though I have been a Floridian for the past five years.  I came here to help aging parents during my father's terminal illness in 2013, and chose to stay after his passing in order to be of help to my aging mother.  She passed in August 2018, and I am now looking forward to a return to West Virginia in order to near my older daughter and her family there, as well as my younger daughter and her family in Washington, D.C.  I know that the small patient population in WV has not increased during my 5-year absence, but I'm grateful that the state accepted Medicaid Expansion monies several years ago.    

I am happy to speak out in favor of fees that are more in keeping with the narrow nature of our field, in that we do not serve patients across the lifespan.  To reemphasize, most of the land mass in the United States is rural, and patient volumes are exceedingly low in these small towns and rural areas.  

With kind regards,

Debbie

Debra Swank, RN BSN IBCLC
Program Director
More Than Reflexes Education
Ocala, Florida USA 
http://www.MoreThanReflexes.org

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