My RD Journey

From Undergrad -> Internship -> RD -> Private Practice!


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Sprucing Up Nutrition Counseling Sessions

Welcome back to MyRDJourney! With the end of Summer nearing, I have gotten a spike in new clients. It feels good to see my business pick-up after having a previous slump last month. I’m also excited for September since I am running my first paid virtual support group and working with a new company for some contract food demos. I initially had a heavier basis of individual clients; however, I am morphing my business into more online programs/classes. If you are looking to take your business to the next level, you can read my previous blog on that exact topic here.

Today, I wanted to talk about something a bit more personal, the counseling rut. Do you ever start to question your Dietitian-self in counseling skills? Wondering if you are really doing everything you can for your clients? Wondering how to make sessions more effective, especially with long-term clients?

Sometimes counseling can get stagnant. You might feel like you are telling your clients the same things over and over again. The client might not be asking you for much and honestly, they might not know what to even ask for. The flow of your counseling sessions could start to get choppy and even seem forced.

I always felt like the first few sessions with any new client were pretty “easy.” Most came in with a clear idea of what they wanted to get out of the session. The session just seemed to flow with me mainly giving education and answering initial nutrition questions. After a few sessions, the harder work comes in. I started to see a need for more motivational interviewing, as some clients were frustrated that they weren’t hitting their goals as quickly as they anticipated. A lot of my clients at this point “knew what to do;” however, they were just having a hard time “doing it” consistently.

If you hit this point throughout your Dietitian career, that is okay! Knowing how to handle ruts will improve your overall counseling skills and build trust with your clients (ultimately leading to their success).

3 Ways to Get out of a Counseling Rut and Spruce up Nutrition Sessions

1 – Re-Evaluate Their Reason Why
First things first, figure out if your client’s “reason why” has changed. If their “reason why” or motivation for getting healthy has changed, this could mean that their goals, actions, and ultimately feelings are not aligning. This disconnect can impede nutrition progression and cause your sessions to flop.

2 – Ask Open Ended Questions
There are 3 key questions I ask my clients that help to reestablish counseling flow or give talking points and really dig deep:

  • What are you currently struggling with? – Good to ask in the beginning of the session.
  • What do you hope to gain from today’s session? – Also good to ask in the beginning of the session since it give direction.
  • What can I do on my end either now or after our session to help you reach your goals? – Good to ask towards the end of the session. Some clients end up asking for email support or text message motivation. Usually, it ends up being some form of accountability.

3 – Spruce Up Your Handouts/Goal Setting Sheets
If you don’t have a goal setting sheet, now is the time to make one. I created a half-sheet of paper that lists my contact info, follow-up appointment date/time, product recommendations, goals, actions, and any nutrition prescription information (i.e. fiber, carbs). For each goal I set with a client, we determine their daily actions that help them reach their goal. Doing this helps them work through barriers during the session since we can actively brainstorm solutions. I find that a goal  sheet creates more inter-activeness during the session and heightens the likelihood that the client will succeed. I find a lot of clients like physically getting something from the appointment, and the goal sheet satisfies that.

Leave a comment and let me know how you are sprucing up your counseling sessions!

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Tips for Handling Client Cancellations

Welcome to MyRDJourney! I want to talk about handling those dreaded client cancellations. As much as we hate for a client to reschedule or cancel, things happen. There can be many reasons a client cancels on us: weather is bad, kids are sick, or they simply lost their motivation for eating healthy. How you handle your client cancellations can really set the tone for your practice and ultimately the relationship you have with your client. 

1st things 1st, make sure you have a cancellation policy in place that includes details on rescheduling appointments. Do clients need to call/email within 24 or 48 hours of the appointment? Do they need to go on your website to cancel?  Have your policy in writing and make sure the client is aware. You want to be transparent. Usually, I discuss my policy with my clients on their first call with me and include it in their appointment reminder email. I also have it posted to my website for ease of reference for the client. 

Since a lot of my clients use their insurance for the appointments, many do not realize the insurance plan will not cover cancellation fees. I make sure all of my clients are aware of this and ultimately what the charge would be if they reschedule, cancel or no-show last minute. 

Prior to the first appointment with a new client, they are required to review, complete, and sign all of my paperwork. This includes my practice policies (including late and cancellation fees), HIPAA information, privacy notices, client releases and a new client form. The hope is that the client will review everything in detail and sign that they acknowledge all of the information. Despite what you do to make the client aware of your policies prior to the appointment, you may still have clients who do not read the paperwork before signing or forget about it by the time of the session. Again, this is why I like to include the policy (in short) within my appointment reminder email (sent a week prior to the session).

One thing to think about with your policy is consistency. I am all about being flexible; however, you don’t want to be perceived as playing favorites with your clients if you waive the fee for one and not the other. So, create the policy, make the client fully aware, and be consistent in how you handle it. If you are flexible when a client cancels late for the first time, then do that for all of your clients.

You will get thicker skin with this, so don’t be afraid to put your foot down. Every client cancellation, late reschedule, or no show is money that you are not making and time that could have been spent helping others. Also, think about when you schedule a doctor’s appointment, they have similar policies in place too! 

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If you have any questions about cancellations and reschedules, feel free to leave me a comment below!


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Pros and Cons of In-Home Counseling Services

When I first started my practice, I thought I NEEDED to get office space. After a few months of searching, I realized I was either going to be paying the same amount I do for renting a duplex or have to travel a distance for something more feasible. Instead, I decided to try my hand at in-home counseling sessions. It would cut down on costs (as in overhead) and allow me to build a client basis without the added stress of paying monthly rent.

I found a lot of my clients were more comfortable being in their own home versus a formal office. It also allowed them to show me products in their cabinets and give me a visual for their environment. I could also set up sessions for cooking and meal prep, since so many tell me that making healthy food is difficult for them. I find my home-session clients are less likely to reschedule and rarely cancel since weather, running behind, etc is less of an issue.

Most of the insurance plans I take in my practice cover in-home counseling, which was make or break for me when my only option was in-home counseling. Some insurance companies in your area may have different regulations for nutritional counseling, as in only an office setting. I would suggest checking the provider resource center for each individual insurance company or calling your network coordinator to find out what applies to your service.

While home-counseling sessions are definitely a great option, there are also some heavy downsides. One of the biggest downsides to home counseling is the travel. Home-visits really cut down the amount of clients I can see in one day. I really try to chunk my client areas so I am not going all over the place; however, some days this works better than others. Ultimately, you are still paying for gas and wear-and-tear on your car, but, you won’t have the looming monthly rent payment due. This could be great for someone just starting out. I make sure to track all of my mileage and tolls to use for tax purposes.  

To be honest, you never REALLY know what you might walk into with a client appointment, let alone one in the home. I always do a phone consult first to get an idea of the client. A lot of my clients are from referrals from companies or business relations, so I feel comfortable entering the home. I also make it a point to recommend a quiet space in the home (usually the kitchen or living room). Some things you might want to ask before entering a client’s home is if they have a private space available in the home to speak and whether or not they have pets (especially if you are allergic or fear them).

While most of my clients are in-home and on-site (as in worksite wellness), I do have a few clients who would prefer an office-based setting. In that case, I utilize office space at my local Chamber of Commerce since I am a member there. I have met clients at coffee shops; however, this is not a very private setting and is not covered by insurance.

One last thing to keep in mind with home-visits or traveling appointments overall is what you will take with you. I always have with me a notepad, handouts, new client folder, business cards, paper portion models, and a plate picture or model for reference. I almost never bring a scale with me (unless specifically requested) since most clients have one at home. I also don’t like to focus on weight and instead healthy habits.

All-in-all, I wouldn’t change how I started my business; however, for the future, I am starting to move away from a lot of the face-to-face and building more of the virtual end. A lot of my clients want online support, books, programs, etc. The face-to-face component will always be apart of my business, but the amount of time will definitely be changing. I hope my pros and cons will help you in deciding where to take your business!

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Private Practice – 1 Year in Review

I can’t believe I am saying this, but, I have officially been in full-time private practice for 1-year! I have had my practice since 2014; however, December 5th of 2016 was when I left my safe, full-time 9 to 5 job to grow my business.

So much has changed in just one year. I now have a full client load, in which I am scheduling about 6-weeks out for appointments. I am comfortable and competent with billing and calling insurance companies for claims. I eliminated aspects of my business that were just a poor avenue of income or a drain on my emotional well-being. I built and maintained partnerships with companies to bring wellness to them. I started teaching at the college level for the first time and am able to continue doing so with my practice in 2018. There are just so many wins I have had with my business and I am grateful to all of my friends/family who have given me guidance and encouragement along the way.

For today’s post, I wanted to share with you just some of my tips/insights from being PorrazzaNutrition for a full year.

Diversify 
I have had many partnerships change over just a few months. Some, I ended due to lack of professionalism. Some, were a steady source of referrals until they hit a business slump, which caused my client intake to decline too. All-in-all, make sure you reach out and connect with a variety of businesses to get your name out there. Don’t just rely on one company/partnership to make or break your business. Having a diverse number of partnerships will also put you in a better bargaining position, should that time come.

Find Your Passion and Motivation 
What motivates you to be in private practice? Is it the flexibility? Is it the freedom of designing your own path? Is it being able to help a greater network of clientele? Find out what motivates you! If I get overwhelmed or stressed, I stop and think about WHY I am here in the first place. This can really help me to get over the negativity I am feeling and push me to do more.

Always Make Use of Your Time
Being an entrepreneur means that you ride the roller coaster of financial and emotional ups and downs. If you find your business in a bit of a slump, maybe around the holidays, do something productive. Can you work on social media posts, blog topics, website design, or new programs? During my free time, I like to divide my days into “business” and “personal.” I make a list of things I want to accomplish when I don’t have clients to be able to grow my business. On the other side of things, I brainstorm what personal items I want or need to get done. I try to stick to the hours or days I determined I would work on my business to keep a personal boundary for myself.

Create a Positive Support System
The support I have gotten from my boyfriend, family, and friends has really lessened some of my bad days. Find at least one person that can be a sounding board for you. Someone who can tell you that you can do it. Someone who can push you to do more than you think is possible. Someone who can tell you when something is a terrible idea (it has happened to me on a few occasions). If you don’t have anyone personally you can count on for the moment, look to online groups. I am in a few different ones on Facebook and also within email threads. It’s nice to see you are not alone in your efforts and that many have been in your same shoes. It’s also a really awesome feeling to be able to support someone else in their private practice journey.

Take Time to Assess 
I have been keeping a business journal since the first day I started my business full-time. This has been a really useful tool for me. I write about positive and negative things I encounter in my practice, brainstorm new ideas, or just vent when I need to. Over the months, I can go back and see how far I have come in business and also reflect on some of my successes. I feel like keeping a journal has been a very grounding experience and also a way for me to just write and move on from something I may be overthinking.

Take the Chances
You never know what you might become or what you might do in the next month or year. So, don’t limit yourself by saying, “I can’t.” Take the opportunities when they arise, and not just for financial reasons, but for experience and growth. Network with others, keep your business connections, and stay open to new possibilities.
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Business Planning for 2018

The holidays are fast approaching and that means 2017 is coming to a close! I feel like this year flew by for me. This was my first year as a full-time business owner and I have loved every minute of it (even the stressful ones). Over the past few months, I found myself working IN my business versus ON it. I realized with overbooking myself, I was stunting my business growth. While the income was great, I was just going through the motions daily without creating anything new or challenging myself.

With that, I decided to start working on my business goals and strategy for 2018. I wanted to have a plan in place so I can start taking action steps for the many ideas that I have. Below are some of the questions I asked myself when thinking about my 2018 plan.

Questions to Ask Yourself
1. What is your ultimate vision for the end of 2018?
-Think of what you want your business to look like by Dec 2018. What does your day-to-day include? What is your schedule like? What types of clients are you seeing? This can help you to identify goals and action steps to take monthly and daily.

2. What are your large goals for the year?
-This could be launching a practice or starting a new program. Think about larger goals being more long-term (i.e. to accomplish in 6-8 months).

3. What are your smaller goals for this year?
-This could include working on marketing to local businesses or incorporating more social media posts. Think about smaller goals as being more short-term (i.e. weekly or monthly).

4. Why is all of this important?
-Think about the importance of each of your goals. This will help with driving your motivation and also developing a targeted strategy for building and marketing.

5. What pitfalls do you want to avoid?
-Think about the hangups you had this year in business. Did you tend to overbook yourself? Are you doing too much on your own? Are you lacking personal time? Are you saying yes too much? Be aware of the things you want to work on and build them into your goals and ultimately your schedule. Write out monthly reminders to yourself to help avoid these pitfalls throughout the year.

After I asked myself the questions above (doesn’t have to be in this order), I brainstormed all of the steps I needed to take for each of my ideas and goals. I actually did this over a few days while on the train and waiting for appointments. After I had a comprehensive list, I organized the steps into a logical order and began to map them out on my calendar as due dates.

I also planned out the dates I wanted to schedule clients and when I would be working ON my business. One of my main goals for this year is to not overbook myself and instead stick to the boundaries I set. Although this will include my having to say “no” sometimes, I know this will be really important for my business and my sanity!

I hope this post helps you to plan out a successful 2018! Happy holidays!

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Private Practice Tools & Apps

When I first started PorrazzaNutrition, I did a lot via paper (i.e. my accounting, charting, etc) and I soon realized just how many files I was accumulating. Over the past couple of years, I have implemented a few systems/applications in my practice and I have complied a list of just some of them for you today. There are tons of competing products/services on the market; however, these were ones I have used personally and were satisfied with. This is not a sponsored post and I do not work for any of the companies featured below.

Organization
Trello– I have just started using this free app/site and it is awesome for individuals and teams! I love that you can create different boards (topics) and lists. I used for long-term lists and also for some of the committees I am on. I also use the boards as ideas for my blogs and then I list out talking points. It is great for me when I am not able to sit down and write on paper.
Google Drive- If you have not used GD, start now! You get a ton of free storage! I store informational sheets, blank assessment forms, and documents that I use most often on-the-go. It is way better than storing a ton of stuff on my laptop and then only being able to access if I am on it. I use GD a lot for committees I am on. It is easier to share a folder with the minutes than emailing documents back and forth every month.
Tools for Wisdom Planner– I am totally still a pen-and-paper planner person. I tried using an online calendar and hated it! I like crossing things out and being able to flip through the months with a paper planner. I am super picky about my planners and will spend hours trying to find a good one each year (haha). I currently use the Tools for Wisdom since I specifically wanted a planner with a month view plus the days in columns with an hour-by-hour format. The pages are thick enough that highlighters do not bleed through (I am a color coding queen). I might switch up again for next year since this does not include any 2018 months. I am totally open to suggestions here!

Accounting – Quickbooks
When I first began my practice, I didn’t have a ton of income/expenses so I just tracked using ledger sheets. After about 2 years, I started looking around and Quickbooks came up a lot. It is super simple to use and cheap (I pay $5.30/month). You can save different transactions for the future so they are automatically categorized as they come in. I use the app a lot on-the-go, especially since you can scan in receipts. I still use a separate accounting sheet to track unpaid classes or checks that have not been cashed yet. It definitely makes tax season a lot simpler since you can just import your information from Quickbooks without having to enter in everything manually.

Media
Dropbox– I have the Dropbox app on my phone and computers and it makes it really easy to upload files or pictures. I take a ton of photos and it syncs automatically with my computer where I can then move them to an external hard-drive or save to my photos.
-Canva– Awesome for designing posts for social media, blogs, etc. So many free images/templates.
Pixabay–  Royalty free pictures. I take a lot more of my own photos now; however, this was really helpful for me initially.
Snapseed– Free app for editing photos. One of the best I have used so far.
Tiny Scanner– Free app that functions as a portable scanner. Your scans can be saved as a PDF or an image. I have the free version and just delete the scans once they are uploaded to where they need to be. Really useful for scanning large documents especially if you are out or don’t have a scanner at home (mine is a bit temperamental).

Newsletters – MailChimp
I use MailChimp for my bi-monthly newsletters. I also embedded a sign-up form on my website (GoDaddy) that links to my account. I like being able to embed newsletters in emails and then track the statistics after each email blast. I use the free version for my practice and have not felt the need to upgrade further yet.

As I mentioned in the beginning of the post, this is not a complete list of every tool/app I use in practice; however, it does include my main ones. I will be posting another blog to include my counseling/billing resources too!

I am always open to suggestions for tools, so leave a comment and let me know what types of software or applications that you use that have made your business life that much more productive (or simpler).


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Setting Income Goals – Billable vs. Non-Billable Hours

Hey there! A few weeks ago, I posted about setting fees in your private practice. As a follow-up to that, I wanted to break down how I determined my monthly and yearly income/expense benchmarks. This is just my way of setting income goals and it is by no means perfect. I am not an accountant or even have a business background, just a dietitian running a private practice and learning things as I go! You don’t necessarily need to do every step listed in every order, again, I am just posting this as a guide for my fellow private practice RDs and RDs-to-be.

Step 1a: Figure Out Your Personal Expenses
I separated my expenses into business and personal, but since I am self-employed, both get factored in to my equation. I found it easiest to figure out what my expenses were per month and then times that by 12 to get the yearly expenses. Any expense that was paid yearly (car insurance, etc), I divided out to see what a monthly average cost would be. My estimated monthly personal expenses ended up totaling $1470, which brought my yearly personal expense total to $17,640.

Examples of personal expenses: food, living (rent, utilities), medical (bills and medications), car-related (gas, inspection, etc), gym membership, phone bill, etc. I also added in here an extra $100 for miscellaneous expenses (i.e. gifts, clothes, etc).

Step 1b: Figure Out Your Business Expenses
Many of you who have been following me the last year or so may know that I do primarily in-home counseling and some work-site counseling. I don’t have any overhead for office space rentals, etc. I just wanted to throw that out there since my monthly business expenses may seem a bit low. My estimated monthly business expenses ended up totaling $400 initially; however, I did have to add in health care costs since I pay for my own insurance now. That brought me up to about $700/month for business expenses.

Examples of business expenses: office supplies (ink, paper, etc), travel/parking for classes/counseling, cooking class materials, referral fees, memberships, business banking fees, health care, liability insurance, faxing services/machine, etc.

Step 2: Figure Out Yearly Income 
Right off the bat, I know that I need to make at least $26,040 to cover my personal and business expenses (monthly expenses x 12). I also wanted to be able to save some of my income and not just live paycheck to paycheck. When I first figured out my desired income, I settled on $40,000 for the year. This level of income would cover my expenses + estimated taxes. For estimated taxes, I averaged about 15.3% being paid towards federal (SS + Medicare) and about 4% for PA tax. I rounded this up to about 25% just to cover myself. With taking out about $10,000/year for taxes and $26,040 for expenses, that left me with about $3,960. This number could vary in real life since I overestimated for expenses and taxes. Also, when doing taxes for the year (or quarterly), you do get some tax breaks for being a business owner and a lot of my expenses were write-offs. Regardless, I still wanted to have a rough estimate to figure out my income goals. If you wanted to have $40,000 be what you would see after taxes, just do the following -> ($40,000 x 25%) + $40,000 = $50,000. You could also think to yourself that you just want to make ends meet. In that case, you could do the following -> (Yearly expenses x 25%) + Yearly expenses = Desired yearly income.

Step 3: Figure Out Monthly Income Goals
One easy way to figure out monthly income goals would be just to divide out your desired yearly income by 12. Still using the $40,000, that would be $3,333/month. With $50,000/year that would be about $4,167/month. From this point, there are a lot of ways you can figure out client goals; however, below I list just two of them. Before I get into that, I just want to point out that you will need to think about what is considered billable versus non-billable hours. You may work a 40-hour week and end up only being able to bill for 20 hours of that. Billable time is what you are getting paid for (i.e. counseling appointment time, class time, etc). Any office work, emails sent, time prepping for an appointment, etc may not be time that you can necessarily bill for. So, when thinking about client goals just know that this is the billable time or amount of time in which you receive payment for services.

Step 4: Figure Out Client Goals (Option 1)
Let’s say you have an income goal of $3,333 per month, this breaks down into a weekly goal of about $833. If you only have 8 hours available for billable hours (i.e. 8 hours to see clients) then this means you will need to charge at least $104 per client and see at least 8/week ($32/month) to be able to reach your desired income goal. If you don’t take insurance and you already know that you charge $120/hour, this cuts the number of clients you see per month to 28 versus 32. You can think about what your time is worth and determine a rate for counseling or general services that is even higher and ends up cutting down on how many hours you need to spend doing things that count as “billable.” If you accept insurance, you are bound to the fee schedule that they set for you. So, if you get reimbursed $120/hour for initial appointments and $108 for follow-up appointments, you may need 10 initials and 20 follow-ups to hit your monthly goal.

Step 5: Figure Out Client Goals (Option 2)
If you do more than just provide counseling services, you can use this option to determine client goals. Working with the $3,333 as a monthly income goal, let’s say you run cooking classes or a nutrition class every month. Let’s say you make $800 per month to run this class 3 times. This leaves you with $2,533 ($3,333 – $800 class) to still make for the month. This could mean about 24 follow-up appointments at an average of $108/hour or it could mean 5 initial appointments at $120/hour and 18 follow-ups at $108/hour. Although this seems like a lot of numbers and scenarios, it helped me to figure out how many clients I wanted to be able to see per month. Once I figured out a client goal number, I worked on a marketing plan. I mentioned in my last blog post that I wanted to work on more programs and content versus services. I love what I do as a dietitian; however, I find myself working a lot and only being able to bill (I accept insurance) for a portion of that time. I want to free-up my time and still hit my income goals, which would mean decreasing the “service” portion and increasing the “product/program” portion.

Step 6: Overview 
In summary –> Desired Yearly Income (Factoring in Business + Personal Expenses + 25% for Taxes) divided by 12 months = Monthly Income Goal. Another option = Desired Yearly Income divided by 52 weeks (or 50 if you take out a week for vacation and another week for sick/personal time*) = Weekly Income Goal. From your monthly income goal, you can determine how many billable hours (and ultimately clients or classes) you will need to reach this. It really helps knowing your hourly rate.
*Normally, with being employed, you may get paid for personal, vacation and sick days. If you are self-employed and offer a service, if you don’t provide the service you don’t get paid.

As a way to check my progress monthly, I created two sort of “snapshot” documents for my finances. The first is the yearly look at my total income, total expenses, and net profit. I made this so I can see where my peak months are for income. The second document I created was for my monthly overview. I tracked the number of appointments (scheduled, cancelled, re-scheduled), classes ran, business and personal expenses, and total income received from both classes and counseling. I also include how many miles I drove that month for business. I was using apps to track my expenses/income before; however, I really like having the paper copy to just have it all laid out in front of me. I just recently got Quickbooks and I really love it, but again just like having my own sheet that makes sense to me.

I hope this blog helped you at least a bit in figuring out your own income/expense goals. As someone who doesn’t have a background in finance/accounting, I wanted to just be able to share my process for setting income/client goals. Leave a comment and let me know what other resources have helped you with figuring out finances. I hope to post my snapshot documents on my website; however, if you wanted a copy to get you started, shoot me an email 🙂