I left my job as a hospital based LC because of this skewed math. It has
always amazed me that "bean counters" couldn't seem to do the simple math to
determine that our hospital needed more than the LCs that we had to give
good service. Our hospital alone delivers approx 3000 babies a year. We
would get approx 10 "warm line" calls a day. At only 15 min per call (and
that isn't very realistic) that would take 2 1/2 hours a day. Then there
were the f/u phone calls for consults done as inpatients. Those were avg of
4 a day (sometimes as many as 10). Using the same 15 min (again not at all
realistic) that would be another hour. So with an 8-hour shift, that would
leave 4 1/2 hours to see inpatients. If someone wanted to see the LC as an
outpatient, there was that much less time to see inpatients. An avg of 20
mom-baby pairs on the floor with an avg of 8 SCN babies. Even seeing only
the most desperate of moms it was an impossible task. And we were
constantly being called on the carpet for working overtime. We kept being
told to find ways to do the work in less time. We were expected to keep a
log of how much time we spent on everything (no one else in the hospital was
expected to do this!). And eventually the whole LC department was cut for
budget reasons.
1.) Why do LCs tend to not want to refer a mom to other resources in the
community?
We were not allowed to refer to anyone outside the hospital because, they
told us, if we did, the hospital would be responsible for the outcomes of
those referrals. That wasn't just for LC, that was for anything... peds,
ob/gyns, pumps, anything. Plus the fact that at the time we were also doing
outpatient consults and that would cut into our own business. No one wanted
to listen to the fact that we didn't have the time to do outpatient
consults. So, did we want to work at that hospital or not? If we did, we
followed the rules, regardless of our personal feelings.
I was speaking yesterday to a nurse, LC at the other hospital in town (which
still has LCs) and she told me that the way they coped with that demand was
to limit all consults / contacts with inpatients to no more than 30 minutes.
And even then, there were many of the LCs who would work "off the clock" in
order to get the work done.
Whenever I *did the math* for our manager, I got a blank, I don't want to
hear this look and no response. And I left as soon as I could. I'm much
poorer now in money, but richer in peace since I started private practice.
2.) Why do area doctors (of which there's approx. 50 of them) think that 1-2
LCs can cover all of their patients' needs?
In our community, I don't think it's so much the doctors as the hospitals.
Many of the doctors in our community were outraged that our hospital cut
lactation services. But I personally think they also have much going on in
their professional and personal lives and don't want to take the time to
pitch a fit. So nothing changes.
I think also that there is the issue of payment. If I wanted to give my
services for free, I'd be swamped for business. The doctors in town do
refer to me, but if they had the option to refer to a private practice LC or
a hospital outpatient clinic, they'd refer to the LC clinic simply because
the hospital can bill insurance and the PPLCs don't. And patients don't
want to pay.
...the other consult is a mom who was
> talking on the phone
> with an LC....she didn't want a consult from me...but, she called
> back in 2
> days stating she's frustrated as to why her milk isn't in after a
> week and she
> can't make it work with talking to the LC over the phone.....
I get soooo many of these calls! Two days ago a call from a mother of twins
who was referred to me by the SCN nurse, for low milk supply. Didn't want a
consult or anything, I guess just wanted me to cast a spell over the phone
to give her milk.
Just today I got a call from a mom whose baby is 6 days old and "wants to
nurse all the time" The mother was in tears. Nipples are very sore, but no
cracks or bleeding. Baby is peeing and pooping appropriately according to
mom. I still can't understand how she expected me to help her without
seeing her. When I told her that I'd have to see her feed the baby to
really be able to help her, she backed up and asked how expensive it was. I
told her my prices but also told her that if payment was a problem we could
work it out somehow but that being seen by *someone* skilled in helping with
breastfeeding was important. At that point she put me on hold to take
another call and after 10 minutes of waiting I hung up. I called her back
in an hour and she said that she'd decided to just quit and feed formula.
I discussed this with a colleague later and her thought was that I was just
part of this mother's "process", meaning the process of "trying" to
breastfeed. Now I guess she can say she talked to the LC who couldn't help
her.
To give the hospital where I worked credit, they do hand out a flyer now
with LC resources in the community. And the docs *do* refer (some of
them)... but the patients don't want to pay (for the most part).
So what's the solution? I don't know, but I suspect that if I billed
insurance companies for the patient as my dentist and doctor do, I'd again
be swamped with work. But will the insurance companies pay me?
My question for any other PPLC is do you bill insurance companies for
patients? If you do, do you have a hassle getting reimbursed? Is it worth
it?
I'm hoping the upcoming ILCA regional conference in Denver will address
these issues of reimbursement.
Regards,
Cindi Swisher, RN, IBCLC
Private Practice LC
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