Last week I had the chance to go out for coffee with a fellow IBCLC, Michelle, who has been in private practice for 12 years. One of the many things we discussed was how many hours of work go into each home visit that we do, what we charge for a home visit, and how that computes into an hourly wage. Seems like it’d be incredibly easy to compute that hourly wage- if I spend two hours in someone’s home, then I just take my fee and divide it by two, right? I was charging $120 for a home visit, so I figured the math was easy (even for me).
Except… is that two hour home visit really only two hours of work? Michelle gently prompted me to think about all the time spent working before and after the visit as well. The wheels in my brain started to spin and once I got home, I wrote out all of the time that actually goes into each home visit.
I started with the obvious- it takes time to drive to and from the client’s home, and that time is included in my fee. I have a 10 mile service area, and on average I spend 45 minutes round-trip getting to and from my visits.
What about the preparation I do before a visit? I speak with the family, find out what the problem is and when they are available, make sure they have my intake and consent forms and have read my “before your visit” page, schedule a time that works for them, and locate any childcare I need. I spend time prepping for the consult by gathering handouts and reference material to bring with me, depending on what the family is going through. That’s an average of 40 minutes of work and prep before I set foot in my car to head to the client’s home.
Once the visit is over I do my charting for the encounter and write a report that I fax to the family’s pediatrician and/or OB or midwife, with another copy sent to the family directly. I always intend to chart during the visit, but more realistically I spend my time waving my hands emphatically in the air, talking to the baby, and not writing down a single note. That means that my post-visit charting and reporting after the visit takes about 60 minutes.
It turns out that I actually spend an average of between 4 and 5 hours working on each “1-2 hour” consult. This does NOT count any time I spend doing free phone/email/text follow-ups for the next two weeks. Obviously it also doesn’t count all the time I spend doing general admin work like answering my phone, writing emails, running to the bank, update or edit my website, do my own accounting, read as many articles and books as I can get my hands on to keep my knowledge current, give general free breastfeeding advice to around 5 families a day who are not and will never be paying clients, answer breastfeeding questions on Facebook and Reddit to try to stem the flood of bad information out there… the list goes on and on. All of those “extras” aren’t directly related to the time spent on each home visit, but they are all part of my cost of doing business.
So, 4.5 hours of work for each 1-2 hour home visit. I’m a freshly-minted IBCLC and I’d never heard anyone talk about this before. Was it just me? Was I just really, really slow? Did other IBCLCs take less time working before and after each consult?
I asked a large group of IBCLCs, many of whom have been in private practice for lots and lots of years (you know who you are- I know who you are- I am NOT calling you old). Here are some of the answers I got in no particular order:
Paula Santi, IBCLC- Albany, California– 4 hours
Jennifer Welch, IBCLC- Montreal, Canada– 5 hours
Debi Miller, RN IBCLC- Columbus, Georgia– 5.5 hours
Laura Gruber, IBCLC- San Antonio, Texas– 3-4 hours
Jennifer South, RN IBCLC- Pensacola, Florida– 4.5 hours
Christine Roca, IBCLC- Bethlehem, Pennsylvania– 4.5 hours
Michelle Kunschke, IBCLC- Sacramento, California– 5 hours
Leah Segura, IBCLC- Midland, Michigan– 5 hours
Joy Funston, RN IBCLC- Central Virginia– 5 hours
It’s not just me! Turns out that MOST of the private practice IBCLCs I spoke to estimated that they do at least 4 hours of work for each initial home visit, not including any phone or email counseling after the visit.
So in terms of the fee I charge for a home visit, that means that I divide it (conservatively) by 4 to see what my hourly wage is. And that number doesn’t look too bad…
… until you look closer.
See, most private practice IBCLCs work for themselves. That means we pay self-employment taxes on our earnings, along with any other taxes related to owning and operating a business. Math is not my strong suit, but my understanding is that you should expect to pay at least 30% of your income in taxes if you are self-employed. As I just opened my private practice I haven’t done this yet, but I know it’s coming.
That brings my hourly wage down to my fee, minus 30%, divided by 4.
Which wouldn’t be terrible (but certainly not great for someone with a graduate degree and such in-depth knowledge, and of course it doesn’t include health insurance, paid time off, or any benefits at all)… if I didn’t have business-related expenses. The IBLCE exam was around $800 all by itself. I spent about $300 for this year’s membership in both USLCA and ILCA. Malpractice insurance is around $100 a year. To register as a Limited Liability Company in Massachusetts is $500, and then $500 a year after that. I designed my website myself but I pay for the domain and hosting. I have to pay monthly for an online fax service to send reports with. I pay for all my own advertising and marketing. I pay to print my forms and my handouts for clients.
Then there’s continuing education- IBCLCs spend a TON of money on conferences, courses, and books. We have to earn 75 Continuing Education Recognition Points (CERPs) to re-certify every five years- each CERP is about an hour of course time, so that’s a total of around 75 hours of additional education. We pay for all of those CERPs out of pocket on top of a re-certification fee of $470.
But wait, there’s more!
Am I dating myself with this one?
IBCLCs need at least a few key pieces of gear. Have you ever stopped and thought about how much money a highly sensitive baby scale costs? I’m guessing you haven’t, since I certainly never did.
something tells me these scales aren’t sensitive to 1-2 grams…
The Tanita BD-815U is well-loved by IBCLCs as the “affordable” baby scale. It’s currently $844.99. That’s considered “affordable” because the comparable Medela scale is over $1,500. Many IBCLCs also keep various breastfeeding supplies on hand- nursing pads, syringes and tubing for finger feeding, nipple shields, hydrogel pads for nipple healing, nipple creams, cold packs, sometimes formula (please do close your mouth, it happens!)… can you see how it all adds up incredibly quickly?
Once I did all the math, I realized that at my current price I’d have to see 44 babies this year just to break even. Not to pay myself a penny of salary, not to make a living wage, not to contribute financially to my family in any way- just to break even.
I know, muffin, I’m making the same face right now!
Listen, I know that a lot of people think private practice IBCLCs charge a lot of money. Our fees may seem high to you; but when you really break it down, we are not rolling in the dough. Not by a long shot. As the fabulous lawyer-and-IBCLC Liz Brooks says, “being an IBCLC in private practice is not for the faint of heart.”
(TL;DR: I raised my fee. If you’re also a private practice IBCLC, perhaps you need to as well.)
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40 thoughts on “Breaking down the price of IBCLC home visits”
Thanks for compiling all this information! In my practice additionally I have many clients that live in underserved geographic areas which
I take long drives to see in their homes. If I take on one of these clients that will be the only appointment I have on that date, so you can imagine the profit margin of that endeavor! Basically it’s a passion…. Not a business one enters to get rich!
Great breakdown!
Wondering if in 2022 (6 years after this original post) things are any better? Is there any profit financially to working as private practice IBCLC? *worried* perusing my IBCLC now, exam in March…
Are there any nurse practitioner owned LC businesses out there? I have my FNP and looking at possibilities of incorporating my nurse practitioner license into the mix. Any thoughts or ideas on this?
Yep, there are quite a few. NPs can bill lactation services to insurance companies so in general they’ve got the ability to be more successful in PP.
Hello Rachel,
I currently work as a ‘Breastfeeding Peer Counselor’, under the supervision of an IBCLC, but being so in love with this position and the joy I’m able to experience in seeing mothers overcome their breastfeeding concerns and complications, I very greatly desire to become an IBCLC myself.
I understand the exam is only offered twice a year, and I would love to be able to take the exam some time before 2020. Given my current position, I have and continue to gain experience in this field, and I am able to go to my supervisor/boss, the IBCLC, with various questions I come upon as I increase my clientele at work. But I would love to expand my knowledge and be able to handle the more complicated concerns of breastfeeding mothers and babies. Being that I would like to take the exam before 2020, do you have any recommendation as to how I could complete the required schooling between now and 2019, and also take the exam in 2019? Given certain knowledge I have pertaining to this world, and my own life in particular, it is very possible that if I don’t take and pass the exam before 2020, then I may not be able to at any time. Please help if possible. Thank you so much!
I actually found that doing the lactation specific education was the easiest part of the test requirements! This is a GREAT facebook group to join to learn about the best ways to complete various requirements https://www.facebook.com/groups/wanttobeanibclc/
Thank you for the information on your site. Have been an IBCLC since July 16 2016 but other than a few part time jobs with home Health haven’t really done anything with it. I am older than most so working for others, I run into age discrimination. So as funding becomes available and I am able to,purchase what I need to get,started I will venture,out into private practice! Thanks again! BTW where did you get your Masters in Lactation?
Hi Sharon! I got my MA in lactation through one of the higher ed pathway 2 programs.
How many clients do you on average see her day? Do you only see mom’s m-f? Thank you
Hi Chelsea- I also work as a hospital IBCLC and run a weekly support group, so I average around 16 home visits per month. I’ll see families any day of the week as long as there’s room in my schedule but I don’t have openings every day.
Oh, and CFM is $250 to start, not the $100 I was quoted from another LC in the Seattle area I live in.
CF&M pricing varies by state and by what your qualifications are.
Thank you. I am new at Private Practice, and looking to find as much info as possible. How do you get super bills? How do you advertise? How do you find this info? Thanks
This will help with some of your questions! https://www.rachelobrienibclc.com/blog/business-advice-private-practice-lactation-consultants-rachels-toolkit-part-1/
Your post is perfection!
yes, excellent insight!
Hi Rachel. Love your site. After 30 years in maternal/child. And 15 years as a IBCLC. I am looking into private practice. So I was wondering whom do you get your malpractice insurance through. If you register as a RN or IBCLC. Thank You Tina
Hi Tina! I get my IBCLC malpractice insurance through CM&F.
As an LLC, do I need malpractice insurance? I assumed since I was an LLC (I have my own IBCLC business) that I didn’t need insurance….
You absolutely need malpractice insurance if you’re working as an IBCLC in private practice. I get mine through CM&F, it’s not terribly expensive. https://www.cmfgroup.com/lactation-consultant-ibclc/
Love this post. I’m a CLC currently and in the next couple years will be sitting for the exam to become an IBCLC. I work for WIC and will keep my fI’ll time job but am considering doing lactation work on the side.
Anyone know how much people are charging in WI?
Good question, Heather! I can’t think of any WI IBCLCs off the top of my head- doesn’t mean they don’t exist, I just probably don’t realize where they live. A quick ILCA search shows one IBCLC in the Madison area charging $75-$100 per visit and another in Wauwatosa charging $150 for a initial visit plus follow-up. Honestly, after checking the ILCA site for private practice IBCLCs and only finding 6 in Wisconsin, it looks like you’ll be in demand!
Great article Rachel only problem is I live in Canada. Points well taken. Have just opened practice office and am good with building slow. You never mentioned what you decided to raise your fee to?
Hi Samantha- I actually have raised my price twice! I originally raised it from $120 to $180 and now I charge $245, which is in line with other private practice IBCLCs in my area.
Hi Rachel,
Are you or your clients submitting claims to insurance companies for your visits? If so, how much of the $245 are they recouping? Also, if you don’t mind, what is your fee for follow up visits?
Hi Summer! Right now my clients are about 50% in-newtork (Aetna, pay nothing out of pocket) and 50% out-of-network (pay in full out of pocket and then submit my superbill for reimbursement). I don’t keep records on who gets reimbursed and by how much, but nobody has ever told me they only got reimbursed a portion and not the entire fee. My follow-up visits are $120 and about an hour long. Hope this helps!
I too, started out at $125/hour. Now after seeing how much extra work I put in and miles on my car and how much I owe the IRS….I raised it to $175/hour, $225/hour and half, $275/2 hours. I barely broke even too with everything.
Hey friend-
Wondering if you’ve thought of updating this article reflecting your current fee & including investment in online tools for paperless practice & wear & tear on car etc.
you know, in your free time….
Ahahahahahaha free time hahahahaaaaahahaa
This is so right on target for me. I HAVE done the math and am charging more than most in my area. However I have 30 years experience doing outpatients in a hospital OLC and realize I can ask for what I need to make it profitable. And in the cost of doing business you didn’t include a pump for that mom that still doesnt have one, gloves, sanitizer, office supplies Etc. it’s tricky but you have to do it right or you are not going to be able to keep doing this.
OMG! this is soooo ME! So happy someone understands what being a passionate IBCLC really is. 😧 THANK YOU! For speaking out loud
AMEN!!!!
Yep!!!
I think y’all are doing great work, and you DO need to calculate your total wage so you know if you’re charging enough … BUT anyone drumming up business, small business owner or freelance dance teacher or commissioned salesperson or many similar business models spend a lot of time GETTING business … but you can’t factor that into the paying service call. So maintaining your FB presence or answering questions from a perspective client is NOT really related to taking care of Mrs. Jones and her 6 day old. (and yes, it’s still a lot of time, but separate.)
You’re absolutely right. Good catch! I’ll need to move things around a bit.
Great I just retired to home from hospital it reminded me what heard years ago in my initial lactation management course when we were told 10 yrs to clear a profit. This should be easily accessible. I won’t charge WIC mom’s I’ll telephone counsel and get them to WIC asap. If they insist I will see them for a fee . I told my hospital pts ask how much for how long. 200 a session vs 200 an hr.
Excellent, much needed post!
Wonderful article! Thanks for doing that math.
Once again, you hit the nail right on the head!