> RE: Home visits: And how about the homes with white carpets, every
> surface gleams, including ALL kitchen counters (!), mom is dressed,
> hair and make-up done, toddler is impeccable, baby in a darling outfit
> and mom doesn't have enough milk!
I've often pointed out to moms that a clean house with a baby under the
age of 1 year means either she has a maid or her priorities are wrong.
;-)
> It just depends ... if miles and time can be reasonably compensated for
This brings me to a topic I haven't seen - I searched the archives
before writing this and found nothing. I am very curious and would find
it extremely helpful to know how we all "practice" - that is, what is
the nature, the business nitty-gritty, of an LC practice? I developed
mine over several years, groping blindly about determining fee
structures, etc. Mind you, I'm *not* refering to the actual amount
charged (different markets bear different prices after all) but rather
business sense guidelines and protocols. This was a very difficult step
for me in becoming (and feeling like) a "professional." My clients
helped me alot (they would say things like "Let me pay you for your
driving time" or "You should charge more").
As a point of sharing business practices with one another, then, I will
be happy to start the discussion by sharing how I currently practice.
When I get called, I "give away" "free" phone consultations up to 10
minutes. If a woman wants more than 10 minutes of my time, then I
suggest she has enough concerns to warrant a home visit. If her concerns
are actually fairly minor (BFing is actually going okay) and simply
educational in nature or a need for confidence, I'll refer her to her
local LLL group meeting. In this initial phone call, I announce my fee
structure and ask her if this is acceptable to her. If she hesitates, I
encourage her to discuss it with her husband/partner. If she indicates
they can't afford my fees, I ask her what can they afford - then I do it
for that amount. Sometimes, I do it for free.
I do not charge for my transportation time for visits within a 30 mile
radius (30 miles is arbitrary; this is how far I'm willing to drive
before it feels oppressive to me). I track my mileage for tax purposes.
I have a sliding scale for charging for mileage and time beyond 30 miles
(in Los Angeles we measure distance in time because of the traffic
anyway), as well as a "middle of the night" surcharge (pretty hefty
charge) if it is something that *really* can't wait - have only had 2 of
those since 1984. (Things that *really and truly* can't wait, I send in
to the ER.) For the more distant moms, I usually try to refer to
another consultant in the mom's own neighborhood, unless she's insistant
to have my services (ie, if she's worked with me before). Networking
helps here, or I use the Medela referral line.
I prefer doing visits to coincide with morning feeds (there's a better
success rate and nothing breeds success like success!) but will start at
any time. Often, I can help her problem-solve by phone for the next few
hours until my visit, whenever it is. I will not go on a visit if it
will end after 9 PM. If necessary, I have her (actually, I have Dad)
bottle feed that night until my visit in the AM. (Remember me? I allow
bottles at night during BF problems so as to maximize mom's sleep; the
night feeds are the last to become breastfeeds. My clients exclusively
breastfeed perhaps 2 or 3 days later than going the "grit-the teeth"
route, and have their sleep and sanity intact. I've done this for years
now. I know this is not "de rigeur", but before challenging me, please
refer to the archives for my post of 96/12/23 titled "Re: In support of
bottles - sort of". I have many families who can vouch that this
approach works. :-) )
I charge a flat hourly fee for the first hour, and prorate any
additional time by the minute. Primips are usually 2 hour visits;
multips are usually 1 hour with a few exceptions. My fee includes (free)
phone call follow-up (often daily for a week, then less frequently until
mom tells me she doesn't need any more calls) and communication with the
pediatrician as needed (at least once - always after the first visit,
and sometimes more often as needed.) Because I do so much "anticipatory"
teaching with selected handouts (of my making) during my visit, the
phone calls are often only 10 minutes or so. I rarely do a second visit,
except perhaps for SNS follow-up. I may do a courtesy weight check, but
encourage moms to use their pediatricians for that (the peds can remain
aware of the progress and scale consistency can't be beat.)
It took me a long while to finally figure out how many moms I can work
with at any given time, in order to give them my personal best and not
resent my work. I do not go over that number. I refer out any calls over
that number to my colleagues. I also refer out *all* pump rentals or
purchases. I used to do rentals a long time ago, but found it a hassle
(for *me*). This way, I can share my business with other LCs; and there
is more than enough work to do, at least in Los Angeles!
What business styles do you all have? How did you develop your business
"sense"? What business guidelines work for rural LCs vs clinic-based vs.
urban? What are your outcomes? How has your "market" dictated your
practice? What was your most valuable learning "experience"? I would be
fascinated to know and think we could all benefit from such a
discussion, yes? TIA.
Katharine West, BSN, MPH, IBCLC (exp)
Sherman Oaks, CA
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