Regina here, posting from home on a well-deserved afternoon off :-) Please bear in mind that this is my own opinion, not necessarily that of my primary work setting, my local WIC program.  I hope I can add some light to this important conversation.

Most of my practice thus far in my 16 year career as an IBCLC has been at WIC. Our local WIC program is very large, with a huge monthly caseload (in the multiple tens of thousands). Some of the satellite offices each have thousands of clients per month, and there are several of those in this county. Because of the high speed flow of clients through the office, we do not usually have the option of spending 2 hours or more with a client. We have had, by necessity, to indeed learn how to serve our clients well while also serving them quickly. So for what it's worth, here is my experience, having done both long and short consultations, under very trying circumstances often with the barest minimum by way of an office setting (what do I need? A chair for her to sit in, with a couple of arms on it, preferably one that can lean back. A chair for me to sit in, although I spend a lot of time NOT sitting. A flat surface upon which to write. And a place for our 2gm scale. That's it. Throw in some privacy, which is NOT always available, and I'm a happy Lactation Consultant). But back to the subject at hand - length of consultations. 

I have done long, and I have done short. Short can be done, sometimes. Often, I shall even dare to say - if they are caught early enough and are not yet train wrecks, as Liz said earlier. There are days when I long for those - her nipples are sore, baby is hungry, she has some doubts. Latch is quickly fixed, doubts are quickly answered...call me if you have any more trouble.

Is a short consultation ideal? No.

Do some of our consultations indeed take 2 hours, or even 3 counting detailed documentation or researching her situation afterwards, etc? Yes. 

Can we always predict in advance which moms can be seen in 30 or 45 minutes, and which need the full 2 hours? No.

What is my average, when allowed to spend as much time as I like? 1.25-1.5 hours with the dyad, then detailed SOAP-noting. One learns to quickly triage the situation, both psychologically and physically, and deal with the immediate problem/s. Sometimes I feel like the breastfeeding version of a MASH unit (that dates me - remember Alan Alda?)

Personally, I am looking at the recent insurance developments as expanding my possibilities. A private practice seems more feasible now, house calls less feasible. A house call can consume 3 hours of my time, easily, due to the travel involved; my private fee takes that extra time into account. It is, however, less than $200. What I am envisioning now, in this new world of third-party reimbursement for IBCLCs, is seeing moms in a physician's office, at that first post-hospital visit. That's when they need it most, and that's when the chances for them to go quickly are highest. Or the same sort of timing (baby is only a few days or a week or 2 old) but in a private practice office. Time will tell.

I am DEEPLY grateful to all those who have worked tirelessly to get our profession to this point. THANK YOU! This Aetna business is GOOD news, not bad, IMO.

That said, there is more than one type of LC consultation; there will need to be some codes that allow for those longer visits, so that we can give every mother the level of care that she needs. I am confident that the wonderful people who have been working on this for us thus far know that, are listening to us (THANK YOU), and will continue doing their best for our profession and our clients.

Personally, I am of the belief that I should not complain about that which I am unwilling to help change, and after the wonderful week I just had at the ILCA conference....ILCA, I am all yours! You can find me on Facebook or at [log in to unmask]

Regina Maria Roig-Romero, BS IBCLC
Miami FL

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome