I've been following this thread with interest, and finally have enough
thoughts on the matter to consider adding something to the discussion.  I'm
not sure how organized my thoughts will be as I find myself going off in
several different directions when thinking about this.
     It seems to me that we would be best served by trying to stay in the
same general context of other health care providers in how this ends up,
since we are in the health care field, and because it ultimately would make
us more credible (or understood rather) by others in the health care field.
     I am thinking of the delineations between medical students, interns &
residents.  My daughter was an inpatient in a university teaching hospital
this fall, and she and her husband (both 21) referred to anyone who came into
see her in a white coat as a 'DR', so when my husband and I asked if Dr. so &
so had been in, they were a bit confused.  I had to explain that she was
being 'seen' by a team that included all of the above, and that they would
know when the chief of the service saw her, and of course they did, because
of all the students in tow.  Would some of the MD's on Lactnet like to
explain just what differences there are in the supervision, level of skills,
etc there are between the above?
     My husband is a Physician Assistant, so I'm a bit more familiar with the
details there.  (His was a military course so it was accelerated), but it
required a certain level (2 years) of college to enter the program, and a
health care background (Med techs, Pharmacy Techs, etc), 1 full year of
didactic education (which did include as the year progressed hours put in in
a PA student clinic, with direct supervision, videotaped physicals, etc),
then 1 full year of 'residency' or practicums, where they rotated through all
the specialty & family practice clinics, surgeries, etc.  After formal
training, they then sat for a national certifying exam, which they can
recertify every so many years, but they also have to be licensed in their
state every 2 years (in CA), which (again in CA) does not require them to
have a current certification as long as they originally passed the
certification boards, and are eligible for re-certification.  During training
my husband's name tag said "PA student".  Also, an MD has to have obtained
special licensing in order to supervise PA's in order to be a PA's preceptor.

     I believe this is similar for RN's - passing the inititial boards and
then having to be current on their licensing in their state. Also, what is an
RN-C?  Isn't that a designation of some specialty training?
     Do all other health care professions require licensing as well as
certification?
     I guess I'm wondering if there could be a couple of stair steps here -
that of a Lactation Student (who must have finished some sort of basic
educational level), as well as the next level of a Lactation Intern (who is
working on their experience hours).  And what about this licensing thing?  Is
this something that would make us better accepted in the health profession
world/ as well as with consumers?  And could there be some kind of  stair
step levels for IBCLC's who were found capable of 'mentoring'
students/interns, or who have furthered their education in the field?
     Barbara Clay Wilson's comment about a univerity road for LC education
was interesting.  The only current program that I know of is the one through
the Lactation Institute/Pacific Oaks college where you can get your BA or MA
in human development with a specialization in Lactation.  I took the
Lactation Institutes Neonatal Suck:  Anotomical & Physiological Impairment &
Neonatal Suck:  Suck Analysis & Basic Training Techniques Intensives which
each included 15 hours of lecture & 15 hours of reading and field work hours
and found it revolutionized my lactation practice.  I had been a LLL Leader
for 13 years, worked as an LC on an OB ward before anyone was called an LC,
been an IBCLC for 1 1/2 yrs, etc and as much as I knew at the time, I was
overwhelmed at the amount of knowledge I didn't have, or had but didn't know
how to put to use at the time  I have to admit I was pretty cynical about
classroom learning versus hands on experience, but  found the classroom
learning every beneficial, especially since it was accompanied by extensive
slides of case studies documenting what we were learning, plus hands on
experience as well.  I'm not trying to do a commercial here, just sharing my
own personal observations of my experience.
      Linda's comments on the difference's in the knowledge/experience base
of a volunteer breastfeeding counselor/RN's/RD's were very interesting to me.
 When I sat for the IBLCE my weakest areas were in the infant from birth to 7
days.  As a LLL Leader, most of my contact came with infants older than that
when mother's realized they had a problem, or the MD said they had a problem
at 2 wks.  I hadn't worked on a ward for 6 years prior to sitting the exam.
 Of course in private practice the majority of my work has been with babies 1
week or under, as mother's have become more aware of problems with latch-on,
etc, more Peds are seeing bf babies early, and hospital referrals, etc.  And
of course my expertise in more challenging problems has increased because,
like a medical specialist, a lot of my clients are not self referred but
referred from LLLL's, CLE's, MD's, other IBCLC's who have already ruled out
various basic problems.
    I have taken it upon myself to educate consumers, as well as other health
care professionals about what the differences can be between someone calling
themselves a Lactation Specialist, a CLE or IBCLC, etc, I felt this was
necessary after running into a couple of breastfeeding dyads who had been put
in the way of harm by someone representing themselves as an expert, and the
mother thought that all breastfeeding experts had the same base level of
knowledge.  I also have done inservices for LLLLeaders & Wic personnel on how
to know when to refer, etc.  We need to work together, we need to help one
another, and it behooves us to start policing ourselves in terms of
credentialing, education & experience levels.
  My nickel's worth I guess, for what it's worth.
Kathe Catone ([log in to unmask])