Ask any Dietitian and they will matter-of-factly tell you that the profession is in an awkward transition.
Until a decade ago, most dietitians were thought of as “food service people”. E.g. they didn’t so much see and diagnose patients as they helped get them the right meal, with the right consistency, at the right time.
Granted, that component of Dietetics is very much alive and well, despite the hopes of many a new Dietitian. I think there’s a huge disconnect between Dietitians who want to be “Diet Doctors” so to speak, and those who understand that in many respects, Dietetics is a branch of foodservice. Within the hospital, we are the mediators between what the patient wants (tasty food), what the patient needs (nutritious food), and what the doctor wants (easy food). Trying to say “we’re too good for food service” is akin to saying the architect of a building is too self-righteous to deal with the construction crew. Certainly a good way to isolate yourself from the rest of the medical team.
All that being said, it is more common nowadays to see dietitians sitting in their “ivory towers”. No longer integrated with food service, not yet unified with the doctors and nurses.
Which brings me to my next point, where the profession is heading. In many respects, the profession is headed in all directions.
In California, the auditing agency CMS (Centers for Medicare and Medicaid Services) has recently decided to encourage all Nutrition and Food Service Directors to carry an RD credential. Good for Dietitians, bad for the rest.
This is actually great news, because it means that the whole system, from nutrition diagnosis to tray, will be appropriately integrated. I suspect the statement “As California regulates, so regulates the nation” will hold in coming years.
As far as Clinical Dietitians go, the industry is pushing a medical nutrition therapy system that allows appropriate coding (and subsequent billing) for care. What this means is that a code for “Diabetes” gets treated with a specific plan of action, diet, education, and needed supplements. This benefits both patients and Dietitians because it means better justification of our service, and more thorough care for the patients.
Lastly, the Consulting Dietitian. This is the part where non-dietitians can tune back in, the part that could actually affect you. It has long been my hope that the future Dietitian will be seen more like a Dentist than anything else. Not in the sense of “Awesome… another painful appointment”, rather, people will visit them once or twice a year for a checkup.
Imagine a world where every six months people visited their family Dietitian, had their diet analyzed, their blood work interpreted in terms of nutrition, and sent home with nutrition prescriptions. So long as insurance companies would get on board with reimbursing Dietitians, they could even integrate the service with private MD practice.
Visit your Doctor, get blood work, get a prescription, talk to the Dietitian, get a diet/supplement recommendation. Bam! That is the future I want to live in. Medicine and Food working together, to help the patients meet their goals.
And I think it’s happening, but not without birth pangs. Change like that takes decades to come to fruition. Regulations have to change, the nursing union has to loosen it’s grip, health care has to understand the benefits.
It could very well be easier to change peoples behavior then fighting uphill against the agencies meant to “protect” them.
Be good to each other.
– Joshua Iufer, RD
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…and thanks for the great reads.
This post hit home considering I sat in my first foodservice lecture and lad today–with over 10 years in restaurants I went back to get my degree in Dietetics to get out of there! But I see how everything is integrated and the need to be skilled in foodservice is the basis of being an RD.
Josh you truly are an innovative thinker! I love the idea of comparing a dietitian to a dentist in that people really do need to get a nutrition check up every 6 months. That would be so much more efficient rather than excessively expensive damage control. As an RD, Im on board with you!
Hmm it seems like your site ate my first comment (it was extremely long) so I
guess I’ll just sum it up what I had written and say, I’m thoroughly enjoying your blog.
I too am an aspiring blog writer but I’m still new to everything.
Do you have any tips for rookie blog writers?
I’d genuinely appreciate it.
I am glad to see that we “Dietitians” (I am pre-dietetics student) are thinking alike and having the same common dream for the future. Your post is the first that I have read which matches my dream for the future: yearly/biyearly visits (covered by insurance) to the family RDietitian “Diet physician” who performs checkups, diagnoses, and administers patient specific education (self-care, treatment, prevention) and meal plans.
Are you familiar with nutrigenomics (how nutrients effect gene expression), and the product Nutrigenmix? I am curious of you opinion on the potential treatment future of this study and products like Nutrigenomix.
I believe that if we can demonstrate the number$ to the insurance providers, and other benefits of adding an RD into insurance plans for patient-routine check ups for preventative care to the health care professionals (+Public Health individuals advocating for preventative health) and get these folks on board, each could be a great force in helping change regulations. I would really like to help/get help on working through this problem we common-dream RD’s see.
Thanks for letting me know about nutrigenmix! It’s the first service I’ve seen specifically targeted at nutrigenomics and hopefully others pop up over time. My only doubt with the service would be how young the field of nutrigenomics is. In order to effectively use food as gene therapy we need to have a complete map of the human epigenome. There are researchers working on this but it is essentially like sequencing the entire human genome 2-3 times over since each gene can have multiple “on/off/neutral” behaviors. Once we sequence that and then perform rapid sequencing for individuals we will have a game plan.
I’m glad there are other Dietitians who feel as strongly as I do about RDs being an essential backbone for healthcare. As more of us band together we can demonstrate the value of nutrition. Definitely let me know if you’re ever in need of assistance. Thanks for reading!