When I became certified as an IBCLC in 1987 my first practice setting was in
a peds office.  They provided me a room, and let me use their scale. I had
to show them my malpractice insurance and get a TB test.  I only worked when
I had an appointment, and I often brought my then 3 yr old with me.   (She
was happy to color quietly for a while in exchange for bribes, and the docs
didn't care.  Their attitude was "what difference does it make to have one
more kid  hanging around a pediatric practice?  Lydia was a great favorite
with the nurses and even persuaded them to help talk me into letting her get
her ears pierced!")  I collected my payment directly from the patient, and
rented pumps (that were stored on the premises) to those who needed them.
The practice made the profit from the pumps, and my tracking them was
considered a fair exchange for the free office space.  The docs liked having
someone who could help with the time-consuming breastfeeding questions.  I
liked (especially when I was clinically inexperienced) being able to walk
out the door of my office and grab a doc to look at mastitis or infected
nipples, etc.  It was good PR for the practice that they had an LC, and
after I left, they later got another LC on staff.  They were very generous
with me, and soon, moms from other peds groups were making appointments.
Having their moms come to our peds group didn't make the other local docs
very happy (as some patients switched over), so I soon got my own office
space in order to be able to serve more moms.  I had a partner in those days
who mostly handled the business while I did consults.  Our practice
typically saw over 300 women a year for consults (I see about half that
number per year now since I travel and write more), and we had a large
rental pump fleet.  For my first year in practice, the situation in the peds
office was very workable, and I still see it as a win-win situation for the
LC who doesn't want the hassle (which is considerable) of setting up her own
office.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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