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Lactation Information and Discussion <[log in to unmask]>
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Tue, 12 Jun 2001 10:11:31 +0200
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Susan and anyone else looking to start up a private practice.
I would suggest teaming up with an existing service (drs. offices, toddler/infant activities, pediatric paramedics offices, community centers, medical centers, non-profit organisations) and anyone who is interested in increasing their own enrollment, membership or clientele, or interested in reducing their own overhead by sharing premises and other expenses. But these are things you probably thought of already. 3 of the 4 private practices that have cropped up here in Israel have done this. The 4th is renting a house and I suppose they (a group) are splitting costs. I don't really know. I am sure that the expenses for these are less then had they gone on their own to rent seperate premises. In my case I don't have to pay overhead because I also created the non-profit organisation where we work (enrichment and support center for parents/infants/toddlers) and we have a spare room. This all takes place in a house which we rent in a cental location. A large percentage of the moms that get to me for a consult end up coming to either a baby massage group or one of the many mom and baby groups that we have at Mamash. So it is a great setup. Everyone (especially the board of directors of the non-profit) is happy. It pays for itself in kind.

The other point about fees that I would like to mention is that here in Israel I find that a "private" fee is prohibitive to a great part of our population. Therefore, they will just not bother to come. There will always be those that can and will pay, but I personally wanted to be able to serve the general population but STILL make money. After visiting Oxford, Radcliffe, (thanks to Sally Inch for having me, who was so busy we managed just a few words here and there.) which was right before actually operating our clinic, I did a total switch in my thinking realizing that if we could manage to create a similar scenario whereby moms would just walk in and fill the place up - having two LC's hovering and jumping from one to the next, charge minimal fees, then in fact, at the end of the day, the same amount of money would be generated as opposed to the private one on one fee.  By doing one on one, we automatically limit the number of clients that we can take in on any one day.  We have arrived at a middle of the road solution in the interim learning as we go along. Moms book in, are informed (in a light and positive manner) that they will have the opportunity of meeting others with similar concerns (in other words, you ain't gonna be alone so don't expect to be), will be treated in a relaxed manner and atmosphere (in other words, don't expect this to be a "quickie" visit, you may have to wait a bit) so their expectations are already in tune with the manner in which we work.

We advertise that we charge according to ability to pay. After often getting paid a ridiculously low amount from those who are considered in an upper bracket we now charge a minimum fee.  In cases where we see there is a problem to even pay that, we waiver. There have even been cases where we have paid them to come!! (we offered to pay taxi expenses to get her to us because we detected a serious problem with the mom - depression etc... in the end she came, we referred her on and she was hospitalized with the baby! and the end was a happy one, but could have had a disasterous outcome) But by advising of a minimum there hasn't been a client yet who hasn't shown up because of that fee. We have also been very pleased that most people who we see, do pay more than the minimum. (even up to $100!!!) 

It is still pretty early, but I really believe in this system. Perhaps that isn't feasible maybe in other parts of the world, or according to whats happening in big cities but thought I would share this with you. 
Ellen Shein, Tel aviv

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