Dear Marsha:

I find that you are making many assumptions of your own.

First of all, in Manhattan we have been providing forms and getting reimbursements for our clients for DECADES.  Moreover, those of us who are private practice in Manhattan also provide a sliding scale and groups for mothers who cannot afford our services.  I know of NO IBCLCs in Manhattan who have refused a mother who could not afford her services.

Second of all, those who are high powered enough to routinely attend ILCA conferences are not always those who are dependent on their IBCLC income and seeing clients as frequently.  I know many private practice lactation consultants who see a high volume of clients who could not afford either the travel fees or the opportunity costs of going routinely to an ILCA conference.

Third, I redid my salary calculations for a lactation consultant who completely relies on her private practice income and sees more clients than I do.  She sees on average 350 clients a year which would put her in the range of $35,000 a year and her health insurance rates are $18,000 a year -- which, even before expenses puts her at less than $13,000 a year.  

Hospital salaries include benefits, such as health insurance that private practice IBCLCs must cover on their own.  Therefore, one cannot say that hospital salaries are low compared to private practice IBCLCs without really fully looking at the entire benefit package provided to hospital IBCLCs including vacation, sick leave, and training expenditures.

Fourth, yes, you can provide some advice without watching a full feeding -- but you cannot truly call that a full assessment.  While there may be minor problems that can be fixed with a less than full assessment, I am really tired of mopping up after problems that really deserved a full assessment and became even bigger problems because a full assessment was never done.  This happens routinely when mothers and infants are given less than an hour for a visit, or even less than that when they were in the hospital.  Sometimes the problems even become worse.

Fifth, you cannot state that a survey that looks at all lactation consultants really gives you a good picture of the private practice landscape when there is a HUGE imbalance in the number of private practice and hospital IBCLCs.  If the survey did not include oversampling of Private practice IBCLCs -- and I mean those who truly depend on that income rather than those who dabble with an ocassional case to augment their income from the hospital, then you are not truly getting a true picture of what is happening.  The last time that I found numbers on the ratio of hospital to private practice IBCLCs it was something like 3% who were in private practice.

I have more to say but have to rush off and the New York Lactation Consultant Association will be reviewing this in detail.  We actually were taking a VERY different approach to the promotion of private practice IBCLCs in New York City INCLUDING one that was getting very good reimbursement without SUPPRESSING our rates.

Sincerely,

Susan E. Burger, MHS, PhD, IBCLC

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