"I work full-time all day seeing sick and well children. In between, I run to the phone and return bf phone calls. I squeeze in lactation consults wherever I can...Is there a more efficient way to do this?" Seems to me that you are at a place where you & the doc(s) need to have a "come to Jesus meeting". If your Lactation Consultant service is bringing in money into the office (which I'll bet it is, both obviously - from visits to see you in your LC hat - and less obviously - I'm sure there are pts. who choose your ped practice because it's known that they have LC services), then it should be recognized for the value it gives and compensated. Sounds like it's not more pay you need, but more time, or a better division of your time. Can you establish BF call hrs (like the docs do with "sick call" phone hrs) - specific hours when your one & only job is to take those calls/see the BF pts? Maybe they need to have another nurse do the "regular" office stuff during those times. Maybe they need to add someone, at least part-time, or give one of the other nurses more hrs, or whatever would free you up for X hrs/wk. Right now, the docs are getting something for nothing - they are able to say that they have LC services, without making it a specific time/dollars commitment. You just squeeze it in among everything else you do. (This is a lot like the hospital nurses who are the BF specialists *in addition to* everything else - they too wear 2 hats at the same time. It's what women all too often do in the workplace - I know, 'cause I've done it!) Your services need to be valued differently than they were before, which means time/work load have to be managed differently. Everybody wants to *say* they offer these services, but most want them at no cost. There has to be a way to either free up time for your LC services, or money to cover hiring other RN/PNP services. I don't say it to drive a wedge between you & the doc (who sounds like a good one), but because that is the situation I see locally as well; they recognize that it's a plus to be able to offer this to their pts (and it draws pts, there's no doubt about it), but they don't want to pay for the benefit. Well, they need to make it possible for the LC to function as such, and somewhere it's gonna cost 'em! Cathy Bargar RN IBCLC Ithaca NY (where there is no pediatric practice, family practice, OB, birth center, midwife, hospital, WIC program, Public Health nsg. svc, or home care program that has a position for an LC. And this is in a town that has both me & Diane W., plus 2 other IBCLCs who work in "regular" staff nurse positions at the hospital, and a PNP (non-certified) who is doing exactly what Candace describes as "wearing 2 hats". And Ithaca touts itself as being progressive & "enlightened", can you believe it?) *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html