That’s right, today is National Registered Dietitian Day! Being an RD is so much of who I am on and off this blog. More than anything else, I get emails (almost daily!) of people with questions about what RD’s do, if the job market is good, what RD’s like and dislike about their jobs, and what other advice I could give to someone wanting to enter into the field of nutrition.
To begin, there is a difference — a big difference — between a Registered Dietitian and a “nutritionist”. The term “dietitian” is used synonymously with “Registered Dietitian” – meaning, that individual completed a 4-year degree in a CADE- accredited nutrition/dietetics program, went on to complete a CADE-accredited internship, and then passed the RD exam. At that point, someone is an RD. There are a lot of online courses and weekend courses, and even 4-year degrees in nutrition, that do not meet the CADE-accreditation standards for dietetics. These individuals are not eligible to proceed to a dietetic internship or sit for the RD exam. In short, “Registered Dietitians” are recognized as the nutrition professional that is educated and credentialed in nutrition…anyone else is a nutritionist. To take it a step further, anyone, legally, can refer to themselves a “nutritionist” – there is no legal bind to that title, unlike RDs.
Is the job market good? I believe yes. It is a fact that many RD’s-to-be have difficulty matching (being accepted to) internship programs because the demand exceeds the supply at this time. With rates of obesity, diabetes, and other chronic diseases sky-rocketing, preventative medicine WILL come about. I don’t know when and I don’t know to what extent, but I do know that RD’s will play a huge role in helping relieve the obesity crisis our nation faces. And then there’s the aging Baby Boomer population that will increase the need for RD’s in long-term care.
When someone expresses interest in wanting to enter into nutrition, I think it’s only fair to give a realistic look into what many RD’s do because it’s not for everyone. Most RD’s, at least at some point, work in a clinical setting — a hospital, a dialysis unit…somewhere that works with ailing the very ill. With illness comes the need to know many aspects of medicine — medications, medical procedures, lab work, etc. I always like to point out that RD’s have EXTENSIVE training in diseases that many people wouldn’t correlate with the work of dietitians. I believe that one of the main reasons I enjoy my work as an RD is because I love medicine and I love being a part of a health care team. I work very closely with nurses and physicians and pharmacists every day.
I thought I would talk about some of the roles I have now and have had in the past to give an idea of what I do. Yes, I help people eat better to control their weight, diseases, or symptoms and side effects, but there’s certainly much more than that. I think I am blessed to have worked in so many unique and fulfilling jobs so early on in my career and I truly appreciate each opportunity for all that I’ve learned and been able to apply elsewhere.
Clinical Dietitian working in Native American government health care
I worked in a LARGE clinic in the middle of rural Oklahoma seeing patient in an out-patient setting. Our clinic was ambulatory and non-acute. I liked to refer to the clinic as a “one-stop shop” for health care. We had several physicians on staff (along with rotating specialties – podiatry, endocrinology, etc.), a full lab, 2 dietitians, 2 behavioral health counselors, a full pharmacy, radiology, and WIC…all in one big, beautiful clinic. My average day was spent in diabetes clinic where patients first had labs drawn, saw the physician, and then met with a dietitian, every 3 months. Due to the diabetes rates among Native Americans, we had THOUSANDS of patients. It was busy. I would help adjust insulin with the physicians, download and analyze blood glucose readings, and give diabetic nutrition education. On days we did not see diabetics, my schedule would fill with weight loss, fatty liver, hypertension, and other common diagnoses. I also headed the bariatric program at my clinic that was coordinated with the hospital and met with Lap-Band patients every 2 weeks for weigh-ins and diet analysis. If we hadn’t have moved from Oklahoma, I don’t know that I would’ve ever left this job!
I have been working in nephrology (kidneys) for the past 2 years. I work in several dialysis clinics where my patients come 3 days a week, for 3-5 hours, to run dialysis – a process of filtering the blood and removing toxins. The vast majority of my patients have kidney failure due to uncontrolled diabetes and hypertension. Due to the nature of dialysis, lab work is a huge part of what I do. My patients have labs drawn at least once months, and up to 4 times. The renal (kidney) diet is very challenging – my patients require a LOT of meat and eggs, and need to limit many foods, including milk, cheese, yogurt, peanut butter, nuts, chocolate, cola beverages, wheat, beans, potatoes, bananas, tomatoes, and fluid…just to name a handful. I am responsible for helping my patients eat right and control their labs through diet. I work closely with physicians to change medication orders, obtain medications, begin oral and IV nutrition supplementation, and am responsible for dosing their IV vitamin D. I love that I get to know my patients because I see the same individuals over and over, but dialysis can be challenging and sad — many of my patients die. There is a lot of paperwork and documentation involved and our team is responsible for completing full assessments, including nutrition assessments, on a regular basis.
Instructor at a local community college
I love teaching and have been teaching since December 201o. I teach nutrition “101” for nursing and other non-majors, Medical Nutrition Therapy for the diet technician students (this is a 2-part class that goes over every disease state and the medical nutrition involved in treating that disease/condition), Nutrition Care Process for the diet technician students (this class gives an overview on “how to think like a nutrition professional” and the systematical means by which to assess and chart), and as of next quarter, I will be teaching the hands-on practicum for the diet tech students where we go in to long-term care settings and they actually interact with residents. I think practicing dietetics outside of the classroom enables me to share real-life experiences and stories with my students in the classroom. As someone who HATED to public speak, I lecture anywhere between 8 and 13 hours a week…and that’s just the talking! The prep-work involved in teaching is astronomical (though, enjoyable so long as there’s the time)…and I could sure do without the assignment, lab, exam, and quiz-writing and grading…but I guess that’s part of the gig. I feel very “at home” when I teach and I have loved every group of students I’ve had the pleasure of teaching….it is very rewarding.
Entrepreneur breaking into private practice
I have a business partner, Donna, who is one of the most brilliant and tireless women I’ve ever met. Together, we have worked HARD to get a nutrition practice growing. Due to my time restraints, I have not been able to round-up as much private business as I would like, but we have had some great experiences. Last summer we ran an 8-week weight management group with 10 participants that was a huge success. Our main efforts have been tapping into the diabetic and chronic kidney disease populations because Medicare and many insurance companies reimburse for these diagnoses (we are just beginning to hear about weight management being covered by private insurances…you should check with your policy to see if RD services are covered, by the way!). The thing that limits dietitians is the need for a physician referral in order to see patients and this is what makes having a practice nutrition practice so challenging. Despite the many wonderful “connections” Donna and I have in the physician world, we are yet to find a consistent referral base from any physician. When will doctors 1) start referring their patients and 2) care enough to do so?
So, that’s a little bit about my past and present work. I thoroughly enjoy what I do and love feeling like I can make a difference in people’s lives. I have known since the age of 15 what I wanted to be and to be just as happy with that decision 11 years later is a testament to the love I have for nutrition.
If you’d like to show your resident dietitian some love today, please vote for Prevention RD to in the “Best Healthy Eating Blog” through Fitness Magazine. 😉
And Happy RD Day to all the RD’s out there!