So this is such a tricky subject. As a registered medical technologist I
found myself for most of my career unlicensed - it was not a requirement in
New York State. After a very long struggle, it finally did become a licensed
profession. Many of us old-timers were grandfathered in and had the
privilege of paying hundreds of dollars to New York State to obtain the
license. At this time, there is no requirement for continuing education, so
I don't see how it will ensure the ongoing competency of med techs in that
state. It has taken away our ability to train folks with biology or
chemistry degree on the job, something that smaller labs in more rural
communities often used to get qualified help that is hard to find in those
areas. Some are glad that this pathway no longer exists, and I could make a
case for either side. But where is the long-term value? Will there be more
jobs at a higher pay? The problem I face now is this. I have moved away from
NY. While I don't envision ever going back there and working in a lab,
nobody can say for sure what the future holds. If I let my license in NY
lapse, the only way I could get it back would be by taking the registry exam
or something similar again - not something I ever want to do at this point
in my life. So, I can continue to send my money to NY every couple of years
to maintain my license on the very off chance that I might need it again
someday in the future. Honestly, I think it is more about bringing money
into the state than anything else.

Do we have any guarantee that a license will make it more likely that a
hospital or other similar institution will hire an IBCLC who is not also an
RN? How much more money will have to be shelled out for the privilege of
licensure? Will it really help us to be able to get reimbursed for our
services and if so, what will that reimbursement look like? How many private
practice LCs out there actually make a living wage? I know that I never did.
My earnings covered my expenses for taking the exam, continuing education,
etc., but did not contribute to the bottom line of our family - that was
what my med tech job was for. And yes, getting that job involved four years
of taking very demanmding college courses and passing a rigorous exam to be
registered. So I guess the question is, what do we want our profession to
look like? Will it eventually look like being a nurse with a specialty in
lactation? In the beginning, it was more like experienced mother-to-mother
counselors who took it upon themselves to become more educated so they could
help more mothers. Now, the mtm part seems to be slipping away and it is
more about the knowledge and skills part. And once upon a time, I actually
thought that was a good idea, that an IBCLC should be a graduate of a
college degreed lactation program. Now I am not so sure.

I got into breastfeeding support to try to help as many women as possible
with as good a skillset as I could acquire. I am a long-time member of ILCA
and supporter of finding ways to grow the IBCLC professional acceptance by
the larger medical world that women must deal with as they grow and birth
and feed their babies. But it just is not looking the way I envisioned it
would and it distresses me no end to think that achieving this professional
recognition may at the same time greatly decrease the actual number of folks
who could be out there helping mothers and babies, not only in this country,
but around the world. What I think will happen is that more and more will
become CLCs or volunteer breastfeeding counselors or just wing it. And maybe
that is OK. But we can't have it both ways and be upset that there are all
these other kinds of breastfeeding support folks out there calling
themselves whatever they like.  I just always thought there might be a
middle ground, where there would be various modules, perhaps, that everyone
who wanted to be an IBCLC would have to complete, no matter what their
original background, and then take the exam. It wouldn't exactly be
equivalent to college, but it would ensure a certain body of knowledge was
there at the beginning. This would be something that could be translated
into any languge, would be easily accessible. I know that things are in the
works that resemble that, but it seems like we are putting the cart before
the horse.

I am actually in training right now for instrumentation related to my med
tech job, so have to run. This a a great discussion, but perhaps we are all
a little late coming to the table.

Sharon Knorr, BSMT, IBCLC

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