A National Survey of U.S. Prescribing Clinicians Who Practice Breastfeeding and Lactation Medicine in Outpatient and Inpatient Healthcare Settings.

Abstract

Background: The field of breastfeeding and lactation medicine (BFLM) is a developing area of clinical expertise among physicians and advanced practice providers, though it remains poorly described in the literature. We aimed to (1) characterize the workforce of U.S. prescribing clinicians who deliver BFLM and the clinical care they provide and (2) explore clinicians' perceived barriers, facilitators, and attitudes related to BFLM care. Methods: We performed a descriptive, cross-sectional study of U.S. clinicians who self-identify as BFLM clinicians. Inclusion was limited to medical clinicians who (1) hold a license to prescribe medication (physicians, advanced practice providers) and (2) independently diagnose and manage breastfeeding-related concerns or complications. Results: Our sample of 138 U.S. clinicians had a median of 8 years of BFLM clinical experience and included physicians (81%), nurse practitioners (13.0%), midwives (3.6%), and physician assistants (2.2%). Among clinicians within large healthcare organizations, 20% held BFLM-related positions/titles. Of clinicians who delivered dedicated outpatient BFLM care, 64.5% offered telehealth, 67.4% billed for mother and infant, and 43% offered outpatient frenotomy. A median wait time of 5 days for initial BFLM outpatient evaluation was reported. Few participants provided inpatient and electronic consultation services (i.e., "e-consult") dedicated to BFLM. Most agreed that BFLM care addresses critical gaps in U.S. healthcare (95%). Conclusions: We present the first description of a national sample of U.S. prescribing clinicians who practice BFLM. These findings may assist clinicians and organizations in implementing BFLM care and underscore a need for future research around the integration and impact of BFLM care within U.S. health systems.