86 | Listener Questions

 Annie - Well, hey there, Leah.

Leah - Hey, Annie. How are you?

Annie - I'm doing great. It's a new year. We had an amazing deeper dive last month with Maggie Patterson talking all about pricing. It was awesome. I'm so glad we got her in at the end of the year. And then coming up on the 22nd of this month, January, we're going to be looking into our values with Joy McRavish, who's also an IBCLC. She's a certified sleep coach for Babies and children, and she thinks really deeply about a lot of deep stuff. And so I'm excited to start off the year doing some reflecting not on goals and not on what are we going to get done this year?

Leah - Yeah, I think that's a really great framework for thinking about your business because we all come from a different set of values and kind of how we want to live life. And that kind of stems right into how we want to run business. And that looks different for everyone. But I think a lot of people just kind of look at a model of a business from afar and think, okay, well, that person ran a business like this and they seem successful. So I'll just kind of follow what they're doing. But that person might have a different set of values than you do, and it might feel really kind of icky to run things. Not that anything's unethical, not even from that perspective, but just kind of like the framework of their approach and everything. And so I think this is a really important conversation. And as I've, you know, had a business for so many years, this has come up, you know, just a few times in some of the business trainings that I've taken. But this deeper dive into it, I think is going to really help us all have this kind of reflective moment and knowing how to kind of customize our business to really match our life and our values and our hearts. And I just think that's going to make us even better business owners. And so I'm so excited. Like the pricing one was perfect because that was right where my head is at. And I'm trying to make some changes in that area. So I was like, whoa, this is perfect. And then like, yes, I need to reevaluate values. And I'm wondering if this whole thing is just for me to continue to cultivate my business. It's fun to know I'm on this journey journey with everyone else. I feel like it always ends up lining up with something that I'm like, needing right then. Just our schedule just happens to line up and I'm like, it's like the universe knew this is what I needed. And I am so appreciative and I'm so appreciative of our community who wants to hear these things too, because then it makes me feel like I am not alone. I got a lot of friends out there going through the same things that I am and figuring this out too.

Annie - And speaking of not going through it alone, today our episode is we asked for some listener questions and we got some. And these are not questions where it's like, okay, let's put on our expert hats and I'm going to tell you exactly how to do things, but more like getting a chance to sit down and just like we would if we were together in person and say, hey, this is something I'm thinking about, are you thinking about this too? And what do you do about this? So we will kick it off with our first question is from Michelle Clark in Chesapeake, Virginia. Nichelle, we also ask people to give a shout out to someone that they think is doing excellent work. And Michelle wants to shout out Jasmine Crichton, who is a CBS in California. So, Jasmine, your ears are burning. Michelle's been thinking about you and thinking, you're doing a great, great job.

Leah - Keep it up.

Annie - Definitely. So Michelle's question is, how do you handle requests for internships when your practice simply doesn't support it? Or parents consistently select no interns? Wait a second off with a.

Leah - I know that's a doozy. Well, I really think you as a, you know, like a mentor or helping people through that process, you do really need to reflect on your capacity because having it be like a stressful situation or a forced situation like certainly doesn't help anyone's learning, and it can make it feel not like a great experience for everyone. And I know that for me, like right now, it's not. I'm turning interns away. It's just that we had several back to back, which I'm so excited. My most recent intern passed her exam. I knew she would, but we're really excited. So I was like, I cannot do another one right now because I did primary mentorship last time and it was just it's a lot of workload and it is so hard because it seems like at the same time, everybody else's in the area is also turning people away. And it breaks my heart because I'm like, then these people have like literally no way to move towards being an IB CLC. It feels like we're stopping their dream and their tracks, you know, but we also have to reflect on like capacity and what's possible in our practice. And if it's just not possible, telling them no is truly honest. You know, like a place that we can come from, but also like maybe saying I can't be primary mentor, I might be able to do a few here and here, here and there, but you'd have to be very available because a lot of my clients aren't comfortable with people being in the visit, and that does change the dynamic. Like you need to have an intern that's super available and can kind of just be ready on the fly, which, you know, a lot of people are. So it's heartbreaking. I've just just in the last few weeks of like turn two away and I'm just my heart breaks for them. But I know you, you work with a lot of interns to see how you handle this.

Annie - You know, very similar to you. So we have our intern from 2023 passed the exam. There was not a question. She was amazing. Could have done pathway one, chose pathway three. Those are my extra favorite type.

Leah - Yes, like willing to put in the hard like the super hard work.

Annie - And we have somebody that is finishing up with us who were not her primary mentor. And she we're very I'm very lucky that we have a hospital program here at Jamaica Hospital run by Paula Utla. We work only with interns that are also accepted into Paula's program, so they can get the bulk of their hours at the hospital. That takes the pressure off of us to supply them with all of the hours they need in a reasonable amount of time, for all the reasons that you said. So that one will be finishing up soon. And then Kara, the other Ivy Kelsey. In my practice, she and I are each serving as a primary mentor for someone. They're both in the Jamaica program, both at the same point in their journey. They're starting with us in January, so this will be our first time doing Primary Mentor. But like, that's it. I'm just really of the opinion that a brief I'm sorry we're not accepting new interns at this time. Best wishes is the best way to handle those requests, like giving reasons or whatever. It doesn't matter to that person. You're only only give a reason if you're looking for them to talk you out of it.

Leah - Yeah, right. Like, well, I only need a few hours. I can do it. I know we do the same thing, and we kind of have like just a standard response because there are a few other practices in town that I know have, like internship programs always, if I'm not taking somebody, you know, say, we're not taking somebody at this time, we don't have a definitive date on when we will be accepting new interns. Here are some other practices that you could reach out to. And then we just kind of end the conversation because for the same reason, I've had some people that I tried to like, talk to or something. And it just like that, I feel even worse because they're pleading with me and my empathetic heart. It just starts melting. I'm like, okay, well, maybe, maybe I could do like an hour a week. I don't know, you know? So it's really hard. What about the other piece of it? Like the clients not wanting interns in, you know, in the visits? I mean, really, there's nothing we can do about that, right? We just have to know that. But if you know, that's your population, I think you just have to be upfront with interns ahead of time. Like, even if you are going to take somebody on, they need to know, like the hours with you might be very limited because you know, your population and a lot of them just don't feel comfortable with interns being present. I mean that that's the only thing I can think of with how to handle that. Is that your thought, too?

Annie - Yeah. I mean, that's where being connected in your community and hopefully, you know, if you're lucky enough to be in a community where you have other lactation consultants, iPSCs that are willing to serve as additional mentors that you're friendly with, that you can because, yeah, I, I can't promise anybody that I can. You're never going to get all of your hours with me, not even because people say no, but just because, like, logistically, like.

Leah - It is.

Annie - Like it's not possible to have volume, unlike in the hospital where you really can get a large amount of direct patient contact in a short amount of time. So thank you, Michelle. That was a great question. Let's move on. We've got a couple more we want to get through because they were so good. Our next one, it's from Courtney Polk in Dallas, Texas. And Courtney oh thank you Courtney Courtney says she loves the show and agree. Agree. Can't wait for the day. Insurance doesn't make us jump through a million hoops to get clients.

Leah - Oh my gosh, care would that be not correct?

Annie - I know I couldn't agree more. And Courtney wants to give a shout out it to Denise Forge and Tiffany Dickerson. They're both ivy silks here in the Dallas-Fort worth area and are making a name for themselves and killing it. And I was in Dallas with Courtney and Tennis and Tiffany in 2022 for a conference. And tennis is going to I hope she's listening because she's going to be our deeper dive guest in February about planning, because she's like a certified planner. I don't have her bio in front of me, but it's a bit intimidating and awe inspiring. So yeah, shout out to tennis from us too, because we're going to have to run. So Courtney's question is, what advice would you give to someone feeling burned out on lactation when reducing client load isn't an option? I feel that in a very deep place. Courtney.

Leah - Yes, same. Same. I mean, we have to make an income, right? We can't be like, oh, you know, I'm feeling burnt out. I'm going to just reduce my family's income significantly. I mean, it's just not an option. We have three well, one kid graduated in 2023. So two kids in college, you know, it's just like I have to keep working. But I too have had a lot of burnout. And, you know, I can't say that I'm through it all. I still have lots of ups and downs, but I think what's really helping for me is to think about all the time I'm thinking about. And you could even, like, work on making lists for yourself about what fills your cup and like, don't get stuck in, like taking a bubble bath unless that truly, like, fills your cup. But being really, really thoughtful about the time that you do have available that you could, you know, and making that time that you could dedicate a little bit to yourself, but really being thoughtful about how you use that time and honest with yourself about what truly, truly fills your cup. Because we might think, oh, I'm, you know, doing self-care practices, you know, that maybe are the more, I don't know, cliche ones or or the ones that, you know, like, oh, I'm going to go out with friends and, you know, that should fill my cup. But if you're an introvert and that drains you to go out with your friends as much as you like, I want to go out with my friends. I want to hang out. That would be so fun. But you know, you would come back and feel more drained in that because you know yourself and you know you're needing more quiet space to refill your cup. I think that's been so helpful for me to keep reflecting on, like what makes me feel energized versus like, just relaxed, or I zoned out on social media for an hour. Well, I don't leave that feeling energized in any way, shape or form. I did like, relax because I sat there. And did nothing. But that's tweak in how you think about that time that you have, and thinking about what makes you feel energized, I think has helped me. And again, I'm a work in progress here. I haven't quite figured out all the ways that I could feel energized. I'm really trying to explore that. But that was a really big mindset shift for me because I was just doing a lot of like the normal. Like I'd go get a massage and I would, you know, take a hot bath or I would let myself rest. But I wasn't still feeling rejuvenated from that until I really started to take this deeper look. But that's kind of like my $0.02 on what I'm working through right now, but I can't wait to hear if you have other things to add. And please, I'm always like, this is something I'm always looking for help on to.

Annie - I mean, like for me, something that definitely drives burnout is when, you know, like what Courtney said about when reducing client load isn't an option. And the main reason for that is because money income like just trying to work to, you know, you're running a business and you know, things that have helped me on that front have been to take a look at my fees and see, is it time to raise my rates? Is it time to give myself a cost of living increase? Is it time to reach out? To take a look at my in-network contracts with Aetna? I will say I've been in network with them for a long time, and I reached out over the summer and I requested a cost of living rate increase. And I wrote them a letter and I said, my cost of living has increased this much since I went in network with you, and I was given a cost of living increase by Aetna. I had to ask for it. They're not going to do it. I hope they would do it for somebody else, but they did it for me. You know, the one thing you can't do when you're in network is really talk about like what they're paying you, but you know what they're paying you. And if you feel like it is not enough for where you live, make a case. It can't hurt the worse. That good thing that will happen is they'll say no. And you spent some time writing a letter that didn't work. But I don't know, things like that I get I start to get creative. I'm like, where can I find more money so that I can have days off? Like, I just yeah, for me, it's not even, you know, about, like, specific things that make me feel better. It's knowing that I can take a day off that I don't have to pack my schedule and that, you know. And the other thing that also helps with that is just looking at my statistics for the year and saying, okay, am I on track? You know, on average, do I have a good client? Or maybe I'm feeling burned out because last month I saw twice as many people as I usually do. And guess what? If I did that, I can see less people this month. I just need to take a day off. Just take a day off. Look at the bigger picture. I realized recently that I tend to process all my stress through spreadsheets. So I don't know works for me when I get to see everything kind of all laid out, I feel better.

Leah - That's really an important piece, because I think having a really good grasp on one, just your financial needs. And how many clients would you need to see to meet those needs and where you're at? Because it might be surprising to you to know that, hey, you have a little wiggle room space here versus sometimes we just like I always think of it, this is my picture in my head is that you just start tumbling down a mountain and you just get so much momentum and going that you can't even see what's going on around you. You know, you're like, I can't see the trees. I can't see any other people. I'm just like going, going, going. And then you might pick your head up and be like, oh my gosh. Like, last year was so crazy and busy and whoa, I saw like 100 more people than I did the year before. And like, was that actually necessary? We think, well, yeah, it would be great to make more money, but at what expense? Like that. Did you then get burned out and now your body's going to tell you like, no, and you're going to get sick or something. So I think it's really important to have this reflection piece of it. So I think that's great, Andy. And it's definitely a reminder for me to like, let me go back and check where am I at?

Annie - Okay. Our next listener comment is from Shelly Andrews in South Jersey. Hey, Shelly. Shelly did some of her hours with me a few years ago, and she is killing it down there in South Jersey. She would like to give a shout out for Rachel O'Brien's bottle refusal course. It was amazing, she said. And she said, I'm not ashamed to say I took lots of notes and even made a handy reference card after completing it. I may even take it again just in case I missed anything. Thank you Shelly. It is a great course. I'm still working through it because it's a lot. And so thank you for giving that little endorsement for it. Okay. So Shelly has a couple of questions. So we're going to get through these because they're all like, oh gosh.

Leah - I know I don't want to pick one of these. I think they're all so good. So we have to answer them all. But we'll do quick answer versions of them so we can answer them all.

Annie - Okay. How do you stay true to running your own race and not getting caught up in everyone else's success? I stay out of a lot of the Facebook groups.

Leah - Yes, I think that's so helpful.

Annie - I do like go in there and make sure I'm not missing anything, but sometimes I'm like, oh, this whole entire conversation happened in my group and I was off not being on social media.

Leah - Yeah, I do think it helps too. I know it feels weird, but to not follow any of the groups in your area on or any of the other practices on social media, especially if you find that is a trigger for you, because that's where we're usually getting our perspective on other people's success. Obviously, we're not looking at their books. We're not looking at exactly what they're doing behind the scenes, but what everybody's putting out on social media, you know, it's the problem with everything. Whatever I was putting out on social media is probably like their highlight reel. If you're finding that that's where you're kind of looking like, hey, those people are super successful because I saw these posts that they did, and that's a trigger you might consider, just like not following any of the other people in your local area. I think that's like a helpful way to not get too caught up and just know that you're on your own journey. And then I was going to come back to the values talk, because I always talk about earlier, you know, like the way somebody else runs their business might not be the right way to run your business. They might have different values. And so I think it's important to have that reflection. So, you know, come to that deeper dive and we can talk about some of that too. What are your thoughts.

Annie - Yeah definitely. It is about values. And the same thing with Shelly's second question. What do you do when the other lactation consultants around you don't slash won't increase their home visit fees to reflect the current market? You have two choices. One is to engage in a race to the bottom. And that includes, you know, trying to compare yourself to what companies like the lactation network pay their consultants, which again, I know in some parts of the country it's more than fair. I know where I live, I can't even imagine, but it's so much less than what I charge for self pay. And you just have to stand firm and like I charge what I charge because that's what I charge, because that is what I, as a business person, know that I need to charge to deliver the level of care that I'm providing to you, and you can go see someone else who charges less, and that's what they feel their services are worth. And so I think it's just about, you know, not getting in that comparison game. And. Just holding firm and just saying that's what I charge.

Leah - And going back to that, like pricing deeper dive that we had, because I think it's such a good conversation to remember, like, how do we decide that? But then also it coming from a really genuine place and feeling really good about your pricing allows you to just stand firm. You know, like you're saying, stand firm and what you know, you're worse, and then you just let everybody else do what they need to do and move on. Yeah, try not to think about it.

Annie - Her last question, what other credentials are useful once you become an Ivy CLC like sleep training, baby wearing, etc.? I did get another credential this year. I got the PMC through Postpartum Support International, which still not entirely sure if it's helpful. I keep getting enticed by the holistic sleep coaching, but it's like I know $25 million or whatever and like.

Leah - Ah, I just don't know if my brain can do it.

Annie - I don't think mine can either. And like that is a case of like, I am certain that it's delivering the value of that price point. So I'm not even like knocking it for being too.

Leah - Expensive, just like, yeah.

Annie - I just don't think I want sleep coaching to be the way I recoup that investment, because I just feel like they'll sound really too hard for me to guess.

Leah - Yeah, I know a lot of people have done like, well, in the state of Texas, you can't do like, any hands on work unless you have some license, you know. So I know other people have gone through say like massage school and then they go and get their CST or CFT and like are able to do bodywork. And I always think like, whoa, that would be so wonderful to incorporate that. But also again, like logistically having the time to go through all that schooling and then how would you incorporate that and how would that change your fees. And it feels like a heavy load to figure out. But I think if you have a passion for something, so say you are super passionate about sleep and helping families with sleep issues, they will be way easier for you to incorporate that because you're going to have that be like something that's really a high value item for you. And, and you'll kind of push through the heavy workloads. I think if you have some specialty or something that you're really passionate about, then I think it's super worth it. But but it wouldn't be just like, hey, let's like arbitrarily tell you just like some credential to get and you don't really care that much about it because it probably won't end up bringing much value because you do need to have that internal like passion to go work that thing that you learned and add it to your value and your pricing and your services and all that. That's going to take a heavy load. So I would say dig deep inside you and find out, like, what are you passionate about? And maybe seek a credential around that if you feel like you want to add something.

Annie - Yeah. Great advice. I mean like baby wearing car seat tech. Those are all things where I feel like those would absolutely be useful. If those are things that you love get just like be open to it. I think don't look based on like is this going to increase my revenue? But more like, is this going to be good for the way I practice?

Leah - All right. So our next question comes from Charlene in Queens, New York. Close there to Annie. And she had a great shout out because I agree with so many things. She said that she would like to give a shout out to Annie, and she really appreciates the way she supports so many Bipoc lactation consultants get their start in private practice, and she's eternally grateful for her guidance and support. And I agree. Yes. Thank you, Annie, for all your hard work.

Annie - That's especially lovely coming from you, Charlene, because you're a rock star for everything you're doing for families in Queens. So like mutual love fest, keep it up. You're amazing.

Leah - Charlene also mentioned that she felt like the podcast is amazing. It really helped guide her journey and help her know that it's possible to have a private practice. And like many of us, she has no entrepreneurs in her family and no experience to lean on. So we're so thrilled that the show was helpful for you because it's the same for us.

Annie - I have entrepreneurs in my family, so I love talking about it, but I hear from so many people and we all, I mean, even me with entrepreneurs in my family, I didn't get into lactation to run a business. I got to do lactation. So we're learning right along with you. And your question is such a good one. I don't like really don't know if we can answer this, but we'll try. How do you encourage others to support the growth of future Ivcc LLC's so that we can all grow as a profession? And I do have my one answer for this would be I'll give my own shout out to the mentorship toolkit that was put together by Allison Walsh, Lashonda Dandridge, and Patricia McGuire of the Lactation Learning Collective. They are here in Queens, and they're supporting pathway three interns in Queens with education and mentorship hours and other kinds of support. And their mentorship. Training is about training you how to be a pathway. Three mentors. So there are some of us that are turning people away. Well, we need to know who we're turning them away to. So there are a lot of people that want to do this work. They need us. So if you haven't done pathway three mentorship before, I would encourage you to not shanina specifically, but like the general broad you to really think about doing it, you know, especially to help people do pathway three so that we can get IB, CLC exam candidates that have had hands on clinical experience in outpatient settings.

Leah - Yeah, I think that's so important to really elevate our profession and ensure that we have people who, like, see such a huge range of care when you're in the outpatient setting and all the ways that lactation can support support can happen over the entire spectrum of the lactation journey. And I think that really is in this outpatient setting. So I think anyone I totally encourage anyone to be even not a primary mentor if you can't handle it, can't handle that extra workload, but even just any mentorship that you can do to primary three. And I think, you know, even just becoming involved in if you have any local lactation groups just be involved in the communication and the community around lactation consultants as a profession. I think keeping communication lines open, sharing what we're experiencing, like on the ground, out, in, out in the world. I don't know if that's really. You know, connected with maybe people who are higher up in the whole thing. So it's like the more we can keep the communication lines open, I think that's another way that we can ensure that we're growing our profession, and we're talking about what it's like to be here on the front lines and to really do this work so that it really connects. And people understand this important role that we play, but also how we can help and support other people on this journey because it is hard to get into this field for sure.

Annie - Our next question from Katie, Linda in Baltimore is very much along those same lines about how hard it is to be in private practice. Katie's from Baltimore, Maryland. I know she's got a group practice down there, and she just wants to say thank you for being awesome to us. Well, thank you for being awesome. And Katie wants to know, when did you start to feel confident that your practice was actually up and running? Ask me next week right?

Leah - Still a work in progress. It's so funny because I feel like I have ups and downs. Like, you know, with everything I feel like, oh, I found my groove. I feel like I have, you know, got this system flowing and I'm, like, starting to build my confidence. And then, you know, something happens or I have to learn something new and put out some fires. And then I feel like, ah, what? I don't even know what I'm doing out here. And then I'm like, go, this whole roller coaster up and down, I don't know, since it's a journey, not a destination. If any of us will ever be like, I am 100% confident that this business is up and running and sustainable, and it's got all the kinks worked out, because I just feel like we're always constantly getting thrown curveballs, like in every potential way, you know, from pandemics to like government requirements to, I don't know, cost of living change. I mean, like everything. Right? And so I don't know that we'll ever be there. Katie, we're in a misery with you. And the fact that, like, it's hard to know, but I know it's intimidating for a lot of people starting out, like thinking that we are all over here, like, yeah, we got this and everything's great.

Annie - Yeah. And I think it's something that you hear this from anyone that is running their own business is that you always feel like you're like one Tuesday away from going out of business for a year.

Leah - And that's so true.

Annie - That is a normal feeling. I just want to validate that. And also just to know that when do you feel like it's up and running? When it's a new venture, it's up and running. The day you get it up and running like this is happening. So doing that prep in advance before you see your first client, you know, really making sure you've got everything in place that you need to see start as you mean to go on, you know, make that investment in your infrastructure. Don't just wing it from the beginning because, you know, the minute you walk into that first home visit or have somebody come into your office for the first time, or log on to your HIPAA compliant video conferencing platform for the first time, your practice is up and running. You have a practice, so treat it professionally from the beginning. Our next question is from Penelope O'Sullivan and she is just located she says Northern California. So it's pretty pretty big, big area. And Penelope wants to give a shout out to Nichelle Clark for her pumping course because it had some really good info for, for Penelope, who was never an exclusive pumper. And pumps change so fast. Said I learned about primary pumps, different motors, and some good hacks for working parents. Also, I love her conversational style. You and me both. She keeps it fun, fun and professional and yeah, great balance of like really technically in-depth, but also like understanding how people are living their lives. So agree about Michelle's course. Thank you Penelope. So a couple of questions here. So what's a good method for putting money aside from each consult. So I have money saved to cover not making any money while I'm on vacation.

Leah - Oh, I have a good answer for this one. I think kind of acting like you have a pay structure similar to if you had a contract relationship, you know. So it's like usually it's some kind of percentage of a visit fee would be paid to this contractor. So you could do something like that where you're like, okay, I don't get the entire fee. I get a percentage or you specifically set aside a percentage of your consult fees. And that way you kind of have like a little surplus there. The other thing is, just like if you have an auto draft, I love auto drafts. Just auto draft for everything. Because like if I have to go physically move the money, then I'm like, why don't we move that money? Because what if I want to go get something? Something just like auto draft, all these money and my bank account lets me have, like, a bunch of different buckets. Basically it's just for my own mental game. And so I like auto draft out to all these different buckets in my bank system. But do you have any good tips on this? Any.

Annie- It's similar. So my business is structured as an s-corp not an LLC. So as an S Corp, I'm required to pay myself a monthly salary on payroll. So I'm on payroll. I pay the minimum that I'm required just to meet that requirement that my accountant says. And then I have auto transfers set up that go to my business savings and to my personal savings. So that comes right off the top. That is a planned expense. So having that kind of just be happening in the background, I also don't as much as possible. And this is getting a little bit into personal finance. But I don't care. I don't carry any credit card debt, but I put all of my expenses on credit cards so that I have the ability to float those expenses. So it really helps with being able to plan ahead, not to worry that like, oh no, today I, I don't have enough to cover my rent payments or not rent because that comes out of the bank account. But thinking of something else that might come on, go on a credit card, it's going on the credit card, which I'm going to pay in full, but I have until it's due. So I get a lot of flexibility there. And then it's also just a long game of like, you just have to make enough money like you, you know, you can look at like, I want to do an average of X number of consults a month. So if I want to go on vacation, how many consults is that? Let me try to get those in the months previous and looking at it as what do I need to make each month? How do I get to where I'm paying myself? That everything above that goes into savings that I can dip into if I need to when I'm on vacation, knowing that, then I can make it up. So when you're on vacation, you're not not making money. You should be like, my business is making money. It's kind of like looking at a baby's growth chart too close. It can look terrible. And when you take a step back, you're like, oh, those little ups and downs from day to day. On average, everything is looking great.

Leah - So I'm headed in the right direction.

Annie - Take a step back and that can really help. The next question is how do you scale a private practice when it is physically impossible for you to see even one more baby, but you don't have anyone that you've met yet that you want to hire to work for you.

Leah - So this feels like an impossible question. Is this possible? The only thought that came to mind is like teaming up with another somebody that works virtually. That is maybe not local to you, but like could help you with your virtual caseload. That was literally the only thought that I had.

Annie - My only other thought is robots.

Leah - I know, like I'm not sure we're ready for AI to be doing lactation work yet. I don't think that's possible. That's a tough one. I mean, maybe it's just gonna keep your feelers out there, keep talking to people and seeing if somebody finally shows up for you. That's a really tough one. But do take care of yourself and don't push yourself to see one more baby. If you just physically can't do it because you'll get burned out. See, you know, what was that question too?

Annie - And I mean, scale is such a buzzword in the online business space of like, okay, you've got to, you know, get to where you're out of the day to day operations and your business is making money. But that's not really the kind of care that we're in. And I know when you look at health care and there are a lot of healthcare companies that are in the business of scale. Yeah, you know, like these, you know, physician chains or, you know, a dental chain, dental practices where they're just the goal, the practice model is just to acquire practices and grow, grow, grow, grow, grow, scale and then get venture capital investment. Is that the business that you want to be in? That's the case of somebody saying, I got into health care to run a business, not I'm in health care and now I have to run a business. So you have to think about what scale means to you. What do you actually what is your actual goal for it? If your goal is to increase revenue, that's where looking at diversification, I think. So other things that you want to do, rather than trying to take a model and saying, I need to take what I'm doing and scale it because what you're doing might not be scalable. And that's okay.

Leah - Yeah, because it's not necessarily what this type of business is designed for. You can scale some other things. Yeah. The last question here was why should I be CLC? Be careful about patient privacy when venting and Facebook groups. Ooh, this is a juicy one. I mean okay, because it's required by law. That would be the first thing.

Annie - Because you can find out who somebody is. Like, it's just not that hard. You know, you don't know what this Facebook group is. You don't know who's in it. You don't know who's running it. One of the reasons that in my Facebook group we prohibit clinical discussions is for this very reason. I don't want to be responsible for hosting a conversation that could potentially be breaching somebody's patient privacy. Like, and this is personal to me because it has happened to me and it is really devastating. Yeah. To have your privacy violated like that by your healthcare provider. And it really does. It's not only wrong, it's unethical and it's harmful. And when you are in a Facebook group and I think this is really hard for, you know, people of a certain age, I don't know, maybe not maybe for any age. I mean, for people that are in, you know, my age, like, you know, Gen X, we joined all joined Facebook. You know, a lot of us when we were having kids for the first time and like when it was first there and it felt like, oh, you're just talking to people, you know, and it's like, oh, it's just felt like a safe space. It felt like a safe space. It never was a safe space.

Leah - No. We were so naive to what was actually going on behind the scenes. We're like, oh, look, they made a group for us. You know, like, we could all just share all of our struggles here. And it's not private. There's nothing about Facebook on any group, secret or not or whatever that is private in any way, shape or form. And the thing that I always think about is like most people are coming to talk about a case because it's really complicated. So it's probably going to have some unique factors to it that makes it even easier for somebody who to figure out who it is because it's like, oh, this person has a rare disorder, or oh, this person has these specific factors that came together that made it really hard, but then that also makes it really hard to figure out who it is. I mean, really easy to figure out who it is, maybe for other people local to you, I don't know, it's just way, way, way too tricky. I just feel like. You got to be so careful. It's. It's challenging because as lactation consultants, I feel like we're very isolated. We don't have places to safely, you know, talk about things. So I think that makes it challenging. But that's where you have to like, I don't know, Facebook isn't the place to find support around hard cases.

Annie - And one thing is that I see people saying like permission to post and the permission that you're getting from your client to post needs to be they have the right to know who is seeing this. So you can say, can I ask some colleagues? No. You say, I am in a Facebook group. I'm in a closed Facebook group for a course that I took. Can I post? I won't use your name, but you know, can I post about your question there? So they really have informed consent about it. It could not be more important. And talk about a value and ethics around that value. I think that one is a non-negotiable for us, I mean, for all health care providers, but specifically for us, definitely. All right. So let's move on to our very last question. So this is from Ainsley in Knoxville, Tennessee, saying thank you for all that you do to me. And Leah Ainsley's been binge watching over, binge listening over the past year and have learned so many actionable steps were, oh, thank you for putting us in your earbuds. We're very grateful she's going to send us out on a high note. Thanks Lee. Can you all go over pros and especially cons of using the lactation network I see posted online frequently? The ethics are questionable without much explanation. Starting my private practice after I get my exam results, and most other IVC LCDs use it in my area. So yeah, there is a lot in the US talking about those Facebook groups about lactation network. So it's a little bit of a tricky one for me and Leah, because neither one of us participates in lactation.

Leah - So I don't we don't know, like the inner working details, like the types of contracts they have. I know that's come up like some of the things that they have in their contracts or, you know, might be tricky to work through. So advice would be like 100% get that checked out with a lawyer and talk about it extensively. But yeah I think it's really tricky. And it's exploding. So I think a lot of lactation consultants feel very pressured that if they're going to be able to run a business, if everybody else in their area is doing lactation network, then they have no choice but to be forced into participating with them. And I think that's where it gets the trickiest. I mean, this certainly the case in my area, like I think I am the only one that's not in that work. And it does really feel like a lot of pressure. And that's where I feel like it's unfortunate that we're, you know, kind of like everybody's going to get boxed into being with a big corporation and not having control over what's going on behind the scenes. And that's what has always just given me pause and made me just kind of say, I don't think it's a good fit for me. But, you know, my advice would be just make sure you have a really good understanding of all of it and then do a good gut check. And, you know, kind of like, you know, if you don't feel comfortable, don't feel forced. I know it sucks. You'll have to work hard to keep your business going. And that really sucks that we're all getting pushed into, like your choices are to go with this company and do whatever they say you have to do and get paid whatever they say that you get paid or, you know, fight to keep your business alive because everybody else is in the company. So it really is such a challenging place to be, you know? And it's I guess it's just our reality with capitalism. It's kind of like the Walmart thing, you know, it's like everybody starts shopping at Walmart because it's available. And then the mom and pop shops get pushed to the fringes, you know? And that's what happens in our capitalist society. And sometimes it really is not fun. So that's my thoughts on it. I know you have more.

Annie - Thoughts when I see people talking about the pros. I mean, I see them saying, you know, that it gets them clients.So and the clients are happy because they're not paying anything for the visits. And the lactation consultants are happy because they're getting paid for their visits. And so if that amount that this company or any company like lactation network is paying you, if that amount is a fair living wage for where you live, if it is appropriate for your cost of living, that's great. Where I live, it is not appropriate for my cost of living. I posted in my Facebook group about just kind of crunching some of the numbers of the difference between, you know, taking a dollar amount, what $100 is in one part of the country versus in New York City, where I live, and how far that that amount actually goes. So you have to really make sure that it makes financial sense. I would say like one thing to really understand is that working for a lactation network, you are a contractor and you're working for a lactation network. You're not in network with an insurance company. You don't have a contract or a relationship with the insurance company. And that is something that I would really just implore anyone working with the lactation network to be very, very careful around your wording. Just recently, I saw an announcement about litigation against here in New York against psychotherapy companies. So not. Clinicians, not therapists, but companies who are misrepresenting themselves as being in-network in order to get patients. So they'll post like on Psychology Today or whatever in network with Aetna. But when you actually call the company, well, they're not in network with Aetna. But here are self-pay rates. And they're saying we can, you know give you a super bill or bill out of network. That is not the same as being a network. And I need to look more into it. But we'll get a link in the show notes is saying this is potentially it's fraudulent. I'm not saying that lactation network is fraudulent, but I'm saying that there is in New York City coming after companies who are fraudulently misrepresenting themselves as being in network with insurance when they are not in order to get psychotherapy patients. So I thought that was really interesting. And the other piece that I have to want to also bring up is just the whole idea of the gig economy. And this came to my mind recently, was like a very rainy night and we didn't know what it was for dinner. I'm like, oh, I don't want to order because then somebody has to go out in the rain. But then I thought, oh no, if it's a rainy night and everybody's like, oh, it's raining, nobody is going to go out in the rain. All these people that are delivering for Uber Eats and Seamless or Grubhub or whatever delivery companies are, they don't make any money because nobody's calling to order delivery. So in order for them to make money, they have to go out during the rain. And that's so different than when I moved to, you know, like even before all these things came on the online. If you had a restaurant, you had somebody who worked for your restaurant, who did the deliveries for your restaurant. So it was a rainy night. That person still got paid, didn't have to go out. So we're now all living in the gig economy. And do you want to be a part of that? You are putting your fate in the hands of a company who is making money. The more of you there are, the more money they make. So UberEats does not care about that person who is like, I have to go out in the rain tonight or I can't buy groceries tomorrow. They don't care about that because they're like we have, you know, however many thousands of available delivery people. So we're going to get our money. And so the more you're working for a company that has scaled, that is built to this level, and I know we're going really long on this episode, but I also just recently did jury duty, and it was for a dental chain of dental practices in several states. Who were they acquired dental practices. And they're like, we supply your infrastructure and we staff you and we do all of this. And it was an age discrimination case because what they did was they acquired a dental practice, and they use Covid as a as an excuse to fire the hygienist that had worked for this dentist for 18 years so they could replace her with their own hires, their own people. And because they're looking at a spreadsheet and they're saying, oh, it's going to cost us less money to do it this way, the larger and larger these companies get, the easier it is for them to make those decisions that are so disconnected from the reality of people's like a human being's life. Like that was that was a person who thought she had a job, thought she was going to be asked back to her job during Covid, but instead got told, sorry, there's no job for you except for there are jobs. We just gave them to somebody else who's younger than you. It was really eye opening because that is the model of health care is scale and it's harmful and it's and it's not great for patients, but it's really not good for us. And so those are the questions to ask. Like do you use lactation network or not. That's really a personal decision whether or not you use lactation network build your practice. Independent of lactation network.

Leah - Because you never know if somebody, you know, if that's like your entire practice and something does happen. I mean this is like what they say, don't put all your eggs in one basket. Like, you wouldn't want to do that on any level with your practice to put everything into, you know, we wouldn't want all your referrals to have to come from one pediatrician or something like that. You really want to diversify how you're getting income, because what if that pediatrician goes out of practice? What if they decide they don't like you anymore? Then you're really in a lurch with continuing your income and your needs and which can be like super stressful and very detrimental. So I do think it's important to keep it diversified, even if you are going forward with that. But there's a lot to think about with that. It's just a new thing on the market. And we all just, you know, got to keep reflecting on how it's impacting overall lactation care and support that we can give to families, which is, you know, in the end, what's so important to all of us? I hope it is. Well, this has been so fun. Gosh, so many good questions. And I love listener questions. It really gets us in tune and in touch with all of you out there. So thank you all for listening. Keep sending those questions in. And we look forward to a wonderful 2024 with you.

Annie - It was great to chat with you again. Until next time. Bye.

Leah - Bye.