Kim asked about lactation consulting as a career path. I was interested in the comments that hospitals in her area do not seem to be hiring LCs on staff. I do not understand that. I thought that California had a high penetration of capitated groups. How can a managed care provider afford NOT to have a high percent of their market breastfeeding? And how can these mothers breastfeed without any help? (Around here the attidude of mothers and hospital nurses and physicians is that a mother has to be seen by the IBCLC to breastfeed!) I think that lactation has great potential. It our job to be sure that those who can make a difference understand breastfeeding and IBCLCs. We must promote our value at every opportunity and more. The more we can integrate ourselves and our services into existing structure, the greater the chance that we will be taken seriously. I also am convinced that those of us who are female must remove ourselves from nursing to do much in lactation. It may not be the case in other areas, but in the southeast, the nurse who credentials as IBCLC is still considered the nurse and is often given nursing duties that crowd out lactation. They also tend to be locked into a lower salary range. The nurses that do seem to do well in the hospital setting have completely removed themselves from nursing as much as possible. Of course, how possible this is varies institution to institution. But back to the field of lactation as a career choice. IF the hospitals are marketing their services to managed care providers, having lactation support and services available could be a marketing tool. Remember that it is important to keep the capitated population healthy = $$$ to managed care provider. It is important to have patient charges to the hospital (if they are still using the old style arrangement) = $$$ to hospital. Lactation support and services can do both. Market, market, market. Pardee