We are seeing similar situations at hospitals in our state as well.
Consulting and educational services are viewed as "soft" services by some
administrators, managers and even some hospital staff.  However, those of
us who educate and consult with mothers and babies as well as HCPs know
what a difference those services make.

Childbirth educators across the country are telling us on similar listservs
that they are being told they have to reduce their numbers of classes to
reduce costs.  I myself have been told to reduce the number of cont. ed
classes we offer, even though they almost always break even.

We presently have a full-time LC at our hospital which has about 750 births
per year.  Her salary is not paid for by pump rental, etc. as the hospital
is not a retail station.  Correct me if I am wrong, listmates, but isn't
the norm for LC staffing 1.0 FTE per 1,000 births?  This comes to mind
since we have been working on productivity measures at our hospital.  If
this figure is accurate, then you've been understaffed for LC services for
a long time.

Two strategies come immediately to mind.  First, are the physicians aware
that you won't be as available as you once were?  You need a supportive
physician(s) to discuss the importance of your services with your
administrator and explain the negative impact it will make upon his or her
patients if they have access to you only 10 hours per week.  It amazes me
how administrators will make decisions like this without talking it over
with the physicians first.  The physicians need to know this information
BEFORE the decision is made to cut your hours.  They are customers of the
hospital too.  It sounds like there may be some turmoil on that front
already at your hospital if one large practice has already decided to take
their admissions elsewhere.  Perhaps one reason is because of such poor
communication between administration and the medical staff.

Second, what about patients who have been very pleased with your services
writing or meeting with your administrator?

What about remaining competitive with the other hospital in town?  What
happens when you've already worked your 10 hours that week and a mom needs
your expertise?  Are you expected to work beyond that 10 hours per week?
Is administration prepared to deal with complaints from patients and
physicians if this service is no longer as available to them as it once
was?

Is your hospital not-for-profit?  To maintain that status, they have to
demonstrate to the IRS that they provide a community service to their
customers.  How many other educational or consulting services in your
hospital are being eliminated or decreased?  D they plan to stay
not-for-profit

Last resort, have you considered hanging your own shingle?

Let us know how things go and good luck.  Perhaps you can find some comfort
in knowing you are not alone in this ongoing struggle in US healthcare for
justifying your existence.

Maurenne Griese, RNC, BSN, CCE, CBE
Birth and Breastfeeding Resources  http://www.childbirth.org/bbfr
Manhattan, KS  USA
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