My RD Journey

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


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Working Through Business Slumps

Welcome back to MyRDJourney! If you read my last blog on EMR platforms, you will know that I just switched from paper/doc charting to an EMR! Let me tell you, this alleviated a lot of stress, time, and back-and-forth between clients for appointments and initial paperwork. No matter what platform you end up with, I would highly suggest looking into this for your business.

With the holiday just last week, there has been a major slump in business, which I kind of expected after 4 years of tracking the ebb and flow. I do have a lot of great clients who stay the course throughout the Summer; however, most of my new clients come in September once vacation time is over. This ebb and flow can happen in any business and you will feel it even more as an entrepreneur versus working for a company since the income changes too.

Normally, I schedule days where I don’t see clients so that I can work on my business (i.e. product development, content creation, etc) or so I can have some R&R. I try to have a list of on going to-dos to refer to quickly versus trying to figure out what to do in the moment.

During the Summer, there could be more days of administrative work than client seeing depending on holidays and such. I hit a Monday 2 weeks ago where I had 2 cancellations, 1 reschedule, and 2 client no-shows. What was supposed to be a productive day of seeing clients followed by working on product development turned into a slump of all slumps. While I should have been happy with the extra 3 hours I had to “be productive,” I really ended up unmotivated and downright frustrated.

After wallowing in self-pity for a bit, I did the following mini-exercise which I felt like got me motivated to move forward with the day. I hope this exercise helps you when your feeling an unexpected business slump.

1 – Wallow if you must for no more than 5-minutes
You can do this internally or even vent to a friend about it. Journaling can help in this situation too. Just get all of that negativity out!

2 – Do something non-business related
This can help you to clear your head of negativity and a lack of “productiveness.” I like to either cook a meal for myself, knit, go to the gym, or even go for a walk.

3 – Create an action plan for a 15-minute task
Now, it is time to get the creative juices and productivity flowing. Fifteen minutes is short enough to be “doable” but long enough for you to make progress and have sense of accomplishment. Think about something you have been putting off for the day, week or even month. In my 15-minutes, I ended up making a lesson plan template. I want my lessons to look more professional and consistent when I upload them to sell on Teachers Pay Teachers.

4 – Think about your “why”
Why is it important you do x, y, or z? What will your current or potential clients gain from your efforts? My “why” was not just for income purposes. I wanted to create more credible nutrition lesson plans from RDs in the marketplace.

5. Do it
Plain and simple. I did what I said I would, felt good about it, and even worked for another hour on products because I was motivated and redirected to a positive portion of my business! If after 15-minutes, you aren’t ready to move forward, that is completely fine too. Know your limits for the day and revert back to #2 if needed!

I feel like this simple exercise really helped me when I had an unexpected “slump” in my day and felt particularly unmotivated. I also find it to be really helpful to schedule in co-working dates and meetings with other professionals (dietitians or business owners) at least 2-3 times per month. I always feel encouraged and excited about my business after a coffee date!

One last thing I want to leave you with is more so on a more personal note. If your feeling like nothing is working to get you motivated in your business or in general, NEVER be afraid to ask for help. This could be asking for help from a friend, family member, or even a professional. Sometimes you need a more in-depth emotional work-through and that is 100% okay. I’m always here if any of you reading this need a call, video conference or even want to meet up to chat through some business slumps!

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Why I Made the Switch to an EMR Platform

Welcome back to MyRDJourney! There are a lot of really great things happening this Summer in my practice. I updated my website (again), am finally finishing my first book, and am gearing up to launch a virtual support group! I’m looking into a lot of online platforms for selling subscriptions/courses and I will post a blog once I finally decide on what I want to use.

One other huge thing I finally did this week was to make the switch to an EMR platform for patient charting and appointment keeping. I had been holding off since I started my practice back in 2014. Initially, I used paper charts in a filing cabinet, but realized this was a terrible idea due to my lack of space. For the past 3 years, I have been using an encrypted flash drive that I locked in a filing cabinet. Every one of my clients had a folder where I stored their initial/follow-up notes (Docs) and initial forms (PDFs). This saved me a lot of money initially, especially when I didn’t have a lot of clients.

Why I Switched
I’ve been thinking a lot lately how my “time is money” and trying to cut down or streamline the things that cause me to be less productive. One of those time sinks was how I was scheduling appointments and charting. I would normally email my clients open appointments, have them schedule through me, and then I would send the reminder email. I really wanted to have the ability to do more online bookings and integrate the calendar so reminders were automated. As for charting, I kept my flash drives at home, so I would have to be at home to type up client notes. I also encrypted my USBs with my Mac so I couldn’t use another operating system to open the files. There were also times when I needed to access a client’s information and I didn’t have a number on hand (in the case of a no-show) since I didn’t carry around the USBs. Lastly, I felt like moving to an EMR platform would be more secure and professional.

My Research Process
I’ll be honest; it took me forever to find a platform that I liked. I had tested out a few a couple of months ago; however, I didn’t really find one that suited my needs. I was also too focused on price when I first started looking, which wasn’t the best idea. I mean, I would spend almost an hour or two charting plus 1-2 hours scheduling appointments. If you think about your time as “money” I was losing money by wasting so much time on the admin side of things. So, my price point became more flexible once I thought about the time I would be saving.

What I Wanted
I would highly suggest doing the free trials and actually using the platforms with clients. Just looking around at the platform wasn’t enough to let me get a feel for how it would work with my practice. As you go through some of the free trials, take notes on what you liked and didn’t like to be able to compare platforms. I am already billing insurance with Navinet, which is free, and on specific insurances’ websites, so I knew that was not a feature I was heavily focused on. I also didn’t need multiple logins since I am the only RD in my practice that would be charting.

There were a few key features that I was looking for in an EMR platform. I wanted to be able to:
-Upload past notes
-Schedule client appointments in a calendar myself and to have clients to be able to do the same
-Edit templates for client forms
-Upload my own forms for clients to sign
-Access via an app
-Message clients via portal
-Have the ability to do secure video conferencing

In the end, I ended up with Simple Practice. This platform had the key features I wanted for a decent price. All-in-all I am happy I switched to an EMR platform. Even though it was time consuming at first to upload client files, I am much more efficient at scheduling and charting. I also find that I keep more detailed notes, especially for points of contact between appointments.

If you have any questions about EMR platforms, feel free to post a comment below!

Check out my previous blog for tips to running a weight management support group.

If you are interested in trying out Simple Practice, they have a free 30-day trial (where you don’t have to enter in credit card information). If you wanted to, you can use this link. If you end up deciding to go with them, we’ll both get a $50 credit towards our next subscription renewal. This post was not sponsored or influenced in any way by Simple Practice.

 


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5 Tips for Running a Nutrition Support Group

Have you ever sat through a meeting, group discussion, or any class for that matter and thought, “I really wish ___ would stop talking and give someone else a chance?” This is one of the exact situations you want to avoid in leading group discussions within a support group (or class).

After running multiple weight management support groups and nutrition classes, I found the most effective sessions were those that had a designated topic and were gently guided. Below are 5 of the key tips that will help you run an effective support group style class!

1 – Come Prepared
Having a topic for your group discussion is absolutely key! This gives the class direction and focus. I would also suggest creating an outline with estimated time frames and talking points. I also had “extra” notes on my outline in case the class was smaller and/or a bit more quiet. Think also about 1 relevant topic handout you could provide and a recipe or two.

2 – Set Ground Rules
In the beginning of the first couple of classes, I laid out the ground rules for all of the participants. I made it a point to say that everyone is in a different place in their health journey and to be respectful of others’ viewpoints and struggles. You would be surprised how many times I had to remind adults of this. I also outlined the flow of the class (see below), noted the time constraint, and asked all phones to be put on silent or turned off.  

3 – Be Aware of Group Dynamics
During the first class or two, you will start to see different personalities emerge. I usually had a small group of participants who were the most engaged (i.e. always giving feedback/input), a handful of really chatty ones (who I often needed to cut off), a few silent listeners (some of which preferred to ask questions after the session finished), and maybe one (if any) aggressive or very negative participant. While you don’t want to put anyone in a “box” necessarily, being aware of the dynamic will help you facilitate more effective discussions and know when you might need to intervene. There are a ton of resources online that can help you in managing certain group dynamics if you feel stuck.

4 – Take Charge of the Discussion
After leading quite a few group classes, I began to realize that the most positive feedback I received was in regards to how I kept “in control.” Taking control of the class means allowing meaningful discussion, yet redirecting when needed. This also means (politely) cutting someone off who is chatting too much. This also means spinning negative comments into positive and actionable ones. If you feel like the class got a bit off track, don’t be afraid to redirect the discussion. Often I would say things like, “Suzie, you make a great point about exercise being a struggle. I will make note of your comments so we can focus on them when we get to that topic.” Avoid getting too far off track during every session since many of your participants could be really looking forward to the topic originally planned and may feel upset that it didn’t receive adequate time/attention.

5 – Create Actionable Goals
At the end of every group session, I would take about 5 minutes to have all participants write down an action goal for the week. I would give everyone the opportunity to share their goals and provide encouragement and support for others. I felt like this tied the discussion topic together and gave participants something positive to work towards (other than just weight).

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Sample Class Flow (1-hour)
I have run 45 and 60-minute support groups before. I always did the weigh-ins prior to the class (optional) and avoided talking about weight during the class discussion in an effort to keep things positive for all.
-Optional weigh-ins prior to class
-Introduction to myself (2 min)
-Ground rules/reminders (3 min)
-Discussion of last week’s topic/goals – what worked, what didn’t, questions (10 min)
-Topic introduction from Dietitian – why this topic is important, what I want to discuss (2 min)
-Main topic – Dietitian has talking points, ask class about struggles (8 min)
-Class input on topic – strategies that worked well for them (10 min)
-Additional questions/Dietitian recap (5 min)
-Goal setting + sharing (10 min)

Sample Support Group Topic Ideas
Be specific when choosing a support group topic. I tried to avoid broad topics (like weight-loss) and instead focus on particular habits or health attributes.
-Healthy snacks – components, samples
-Reading labels – what to look for, samples
-Eating on-the-go – can be broken into eating-on-the run and eating out
-Mindful eating – what is it and how to incorporate
-Tips for incorporating more fruits/veggies
-Incorporating exercise into a busy schedule
-What is meal balance – i.e. what should be on your plate
-Strategies for eating well: on vacation, over the holidays, at BBQs, etc


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5 Tips for Running a Cooking Class

Welcome back to MyRDJourney and a hello to all of my new followers! It has been a crazy few weeks with finishing a short-term teaching contract and balancing 30 clients with my practice. To be honest, I was also in a bit of a blog rut. Some of you reading this may have been here before. You feel like there is just nothing left to write about (although there is). Sometimes it just takes one conversation with a fellow RD (or in my case an RD-To-Be) to get those creative juices flowing again. Needless to say, I’ll be back on schedule with my bi-weekly Sunday postings!

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For all of 2016 and most of 2017, I was working with a contract company to do in-person cooking classes. This was a huge learning experience for me since I had only done food demos/samplings and not an hour long class before. I’ve since shifted gears to doing more individual cooking lessons as apart of my home-visit sessions; however, I wanted to share with you some great tips I learned after doing 3-4 classes every month for almost 2 years!

1 – Tailor Your Recipes
Before you even choose your recipe for a class, make sure you know what equipment will be available. If you are not given a full kitchen, think about how many outlets you have and the worktop space. Once you have that squared away, think about the audience you will be working with. Are these experienced adults, beginner cooks, or even children? Knowing your audience will not only help you to choose an appropriate recipe; but will also increase the likelihood of them actually making it once they are home.

2 – Test Your Recipe and Flow
Before the cooking class, test out your recipe and get a sense of the flow and how that relates to how much time you have. By flow I mean, how long did it take you to chop up the vegetables? How long did it take you to cook the soup? One of my biggest mistakes when I first started was not testing a recipe before class. I would think that I didn’t need test it since I made it a hundred times at home; however, making something at home is way different then doing it in a cooking class. It might take you longer to make a 20-minute recipe since you will be explaining every step and maybe having time for questions. Remember to also keep in mind the taste-testing part of the class. I typically allotted about 10-15 minutes for tasting at the end. You don’t want to be rushing your audience out the door with their plates.

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3 – Make Use of Downtime
When planning your flow, think about the downtime too. What will you be doing when the cake is in the oven? Will you have questions? Will you make something else? One of my back-up plans for unexpected downtime was to make fruit-infused water. I would bring a little shaker bottle, some fresh fruit, and fresh herbs. I would make 1-2 combos and have everyone taste to fill any gaps in the class.

4 – Create a Recipe Outline
One of the best things I did for my classes was to create a recipe and time-flow outline. I would include recipe steps, measurements, estimated time, and key talking points. This helped me stay on track during the class since I would often get questions that diverted my attention.

5 – Set-up Your Space
Before every class, I would measure out all of my ingredients into colorful bowls of different sizes and place them on the counter in the approximate order of use in the recipe. It was so much easier to just dump out a bowl versus take the time to measure out everything in front of the audience. If I did everything during the class, I would have much more downtime and would have had to make sure I had double the measuring cups or stopped to wash things in between (which is not an efficient use of time).

When measuring out your ingredients, also think about pre-chopping some. One of my first cooking classes, I made a mango-tomatillo salsa. The recipe turned out great; however, I actually stood there and chopped 10 tomatillos and 3 mangos (talk about awkward silence). In hindsight, I should have chopped about 8 tomatillos and 2 mangos prior to make for a better class flow.

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Often, many of my clients are afraid to try a new recipe or even new ingredient for fear of the unknown (how to make or how it will taste). Running a cooking class can be a great way to show clients how healthy eating can be simple and delicious!

Make sure to check out the PorrazzaNutrition Facebook page since I have a LIVE mini-series going every Friday at 4:00pm EDT with tips on starting your private practice. Post a comment below if you have questions about running a cooking class or have another tip to include!


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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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