Birthing my practice: My first nine months as a self employed IBCLC

On a page for breastfeeding professionals, someone asked about leaving the hospital for private practice. After a long hospital career, I started a private practice just nine months ago, so this query caused me to pause and reflect. The conversation that followed in the post were pros and cons of having a private lactation practice. I’ve been so busy starting up my business and running the day to day operations, that I have put so little thought into what I love about it, what I struggle with, what is hard, what is amazing…

This is different than considering the financial aspects. This is about how I feel on a day to day basis about “what I do” or “what I’ve done” by starting my own practice.

First, it is a business. I had a feeling that there would be behind the scenes work to running a business, but until you get into it, you really have no idea. I thought I had set up and prepared things before I left my job, but I really hadn’t. Until you are actually operating the business, you don’t know what you will have to do to operate the business. Systems need to be set up, tried, adjusted, tried again. Things like selecting and arranging the office space, deciding on  items such as furniture, equipment, desks, chairs, scales, exam tables, filing systems, phone system, fax lines, internet and computers. Setting up vendor accounts, bank accounts, lab accounts, malpractice insurance, business certificates, tax records, legal issues, credentialing with insurance etc.

Advertising and promotion is a large part of what I do. This includes social media, website development and maintenance, business cards, outreach to other providers, and mother’s groups. And, as in most start ups, this had to be done with a very small budget. Challenging, but I actually enjoyed this, being an extremely organized person. Organization is key.

Next, comes the clinical aspect. Setting up protocols, gathering or writing handouts, customizing electronic medical records to reflect the needs of the population that I serve. Scheduling and seeing clients. Then following up with clients.

Scheduling is on my terms, but it’s not really. I can plan for a 3 day weekend and then get the urgent call from a mom who has a 4 day old who isn’t latching. Either I visit or they are going to buy formula. There goes the 3 day weekend.

This is emotionally exhausting work. Seeing four couplets in a day can leave me spent. With barely enough energy to write up the care plans and send in the billing.

Ok, that all sounded kind of negative, so here’s the good part: I do what I do because I love it. It brings me joy to know that I am making a difference in the lives I touch. I know that the service that I provide is unique and no one in my area is doing what I do for moms and babies. I am jumping through the hoops of insurance companies to provide access to professional lactation services to moms who could not afford it otherwise.  The fact that I see clients in an office that is set up for this specialty is advancing the profession for those who will come after me, and normalizing breastfeeding in my community.

And did I mention my office? I LOVE my office space. It is small, but welcoming and comfortable. Soothing colors, homey furniture, artwork on the walls and books on my shelf that reflect my views and values. I have the privilege of sharing space with an amazing clinical nutritionist. We work in the same holistic paradigm, have some mutual clients and are learning from each other.

Working with moms and infants outside of the hospital is different and similar at the same time. There are many frustrations, just different ones. As someone posted in the online conversation,  on some days I still bang my head against the wall, but now it’s my wall!  I am frustrated when I hear stories of poor lactation care in the hospital. I am often the first person to perform an oral exam on their child and explain what I am observing. I am often the first person to say “so tell me your story” and really listen to them with an open heart and mind, to figure out what has happened so far and what I can do to put them on the path to meet their goals.

Goals…sometimes another frustration…Not every family has the goals that I would want them to have, but I will support them nonetheless. That is my role. Supporting families to reach their feeding goals.

So both hospital and private practice have frustrations, but I now I am in control of what I do about those frustrations. I can educate without being afraid that I am going against policy or rules of the health care system. I can tell them what wasn’t the best advice in order to correct it. I can help them to advocate for themselves in the system without being afraid that I am stepping on someone’s toes. I can refer to the providers that I know will support their feeding goals without worry that they aren’t the “right” consultant according to the rules. I can use a spoon or a cup to feed a baby, without worrying that the policy isn’t written yet. I can finally be an advocate, let the chips fall where they may, because they are MY chips! I am free to stand up for what I know to be the best course of treatment for this dyad.

So now let’s talk about “course of treatment”. Biggest frustration in private practice is a family expecting to reach their goals without following the course of treatment that I recommend. This happens for many reasons, and it happens often. Some go half way, bargain with the plan of care, and then look to me for assistance when it fails. Some never come back to the second appointment, making a different decision or following the advice of another health care provider who knows nothing about oral restrictions related to breastfeeding or breastfeeding management. Others jump ahead to revision, without any preparation. I am learning to be able to support all of these situations and be here if or when they return to me for guidance. Big learning curve here, and the support that I get from those that I collaborate with is helping me to handle this with increasing confidence.

Speaking of collaboration- working in a hospital setting had so many more opportunities for social interaction than private practice. I miss my hospital family. I belonged to that community for over twenty eight years. Nothing will replace that. But now I am part of a worldwide support system, connecting via social media to those that do what I do in many parts of the country and abroad. I am learning from them, referring to them, posting their blogs as links on my website, sharing successes and failures with them- did I mention learning from them? I am inspired by these colleagues every day.

So, how do I feel about what I do now? I am loving it. No regrets, no turning back. It is an honor and a privilege to have a career that makes such a difference to the well being of a child and a family. It may sound cliche, but when I get a thank you or a referral from a past client, it makes it all worthwhile. 

And did I mention that I don’t have to wear a mask during flu season?