My RD Journey

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


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Dietitian Q & A – Offices, Marketing, & More

Welcome back to MyRDJourney! Things have been going well around here. I’ve gained quite a few new clients with the weather breaking and more people ready to get back into the swing of healthy eating. I have a walking group launching in April and I am so excited for it! I spent some of my downtime this past month re-evaluating my business and deciding what my next “move” will be. I like what I am currently doing; however, some of the parts I love are the in-home cooking sessions and personal training. I really want to work on promoting and building up that aspect of my business this year.

Today’s post is a bit of a Q&A based on the top 5 questions I get from fellow Dietitians who are just starting out in private practice. Let’s get started!

How Do You See Clients if You Don’t Have an Office Yet?
There are a couple of options for this one. You can do in-home counseling sessions (if insurance allows), which means you go directly to your client’s home. Some perks to this would be that it is more comfortable for the client, client’s can show you products they have in their home, and you may even end up with less cancellations. Some cons to this are that you will be doing more traveling so scheduling your clients geographical smart is key. You can read more about in-home counseling here. If you don’t feel comfortable with that, you could look at shared office space (cuts down on the cost). You could also check out co-working spaces where you can rent office space for an hour or two (way cheaper than a lease + more flexible). Another option is to join your local Chamber of Commerce as many of them will allow you to use office space as apart of your membership. Lastly, you can do virtual consultations, which is very convenient; however, if you take insurance, a lot of plans don’t cover this just yet.

How Do You Get Started with Marketing Your Business in Your Community?
The first place I started with was Google. Literally. I Googled every business in my area and made a list of those who aligned with my mission. I reached out to some through email and then followed up with a call. Other businesses I just showed up and dropped off promo materials (newsletters, business cards, flyers for events I was hosting, freebies, etc). Depending on the business, an email is more appropriate first since the person you may need to talk to may not actually be available for drop-ins. You can always schedule an in-person meeting once you make that first contact. You can read more on building partnerships here.

How Do You Advertise Your Business?
Outside of what I mentioned above, I would strongly suggest an online presence in the form of a website and at least one social media platform. I consistently use Facebook & Instagram. One big thing to keep in mind is where your ideal client is hanging around. Are they using YouTube? Twitter? Facebook? Instagram? No matter what platform you use, remember to be consistent with your messaging and when you post (even if it is just once per week to start).

How Do You Figure Out Your Appointment Structure?
Honestly, getting your counseling flow can take a bit of practice and even with that, you are bound to have a client through you off. Most of my counseling sessions start off with me asking the client, “Are there any initial questions you have?” (initial) or “How have things been going?” (follow-up) or “What would you like to gain from today’s session?” (initial or follow-up). Usually, clients will jump into a story or a bunch of questions, which is great! Sometimes, I have clients who are a bit unsure of what to ask or even how this interaction should go, especially if they are new to seeing a Dietitian. From there, I take the reins and start with a 24-hour recall. We then talk about where they see possible areas of improvement or positive aspects of their diet already. That is usually the first 30 minutes right there. At this point, I stop and ask if they have any questions. Depending on the time, I talk about other things besides food like exercise, fluid, sleep habits, and even family expectations. If we don’t cover this in the first session, I always weave it into the first follow-up. I end all of my sessions with goal setting and acknowledgement of possible barriers (so we can make a plan around them). All of my clients get a physical recommendation sheet with their goals and action items so they can post it as a reminder to themselves.

How Do You Go About Taking Insurance?
First things first is you want to create an account on CAQH ProView. This is going to take you a while, but it is worth it! You basically put in all of your information as a Dietitian and business owner. Once you have that completed, you will use your ID number for individual insurance companies. What I mean by this is that every insurance has its own form for becoming a provider. I started by Googling “become a provider for ______ (insert insurance company name here).” Usually, the individual insurance forms are shorter since most of your information is in the CAQH. Once you submit the provider interest form or application for each insurance company, you will be contacted by the contracting department to do all the signing. Getting in network with insurance is a lengthy process, so I would highly suggest getting started sooner rather than later if you are going this route.

This surely wasn’t an exhaustive list of all Dietitian questions, so feel free to email me or schedule a Free Coaching call via my website for anything you are wondering about!

If you are new to private practice, check out my blog on The First 10 Steps to Getting Started, which covers professional liability insurance, deciding pricing and more.

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A Week in the Life of a Private Practice Dietitian

When I first started brainstorming my blog for the month, I was planning a “day in the life” post. I realized that this wouldn’t truly be representative of what I do as a private practice dietitian since every day is different. Here’s a little peek into what this past week looked like for me. I hope this is helpful for someone thinking about private practice and what that looks like (or if you are just plain curious).

Background
My weeks will vary based on client cancellations/reschedules or new partnerships/appointments. There also tends to be an eb and flow with private practice based on the seasons (i.e. more clients in Jan, Feb, April, May, Sept, and Oct). I also primarily see clients in-home with the occasional on-site appointment for employees of businesses that I work with. Mixed into that are various classes (cooking or virtual). My income isn’t solely based on insurance, which is a good thing and outside of what I mentioned before, I also sell hats on Etsy and lesson plans on Teachers Pay Teachers.

Most days, I am up by either 6am (teaching days) or 7am. If I see morning clients, they are typically 10am or later. I spend the majority of my morning hours planning out my day, prepping last minute for an appointment, answering emails, and returning voicemails. I also don’t always note this below, but I do spend some time keeping up with social media for my business (Instagram on the day-to-day) and hanging with the BF. Besides having a private practice, I also teach part-time at a local community college. I am also the Community Liaison for the Greater Holmesburg Business Association, which means I am apart of event planning and managing their social media (i.e. Facebook).

Monday
The first couple hours of my Monday were spent on the phone with an insurance company that I had been battling with since last JULY. I had 8 claims denied due to an error in their system (saying I was out of network when I wasn’t). While on hold, I planned out my to-do list for the day, wrote an outline for a class I was running that night, scheduled a newsletter for my virtual class, and answered some emails. After an hour and a half on the phone, I finally had confirmation that they were paying out! I’m only partially celebrating until I get that check in my hand.

Mid-afternoon, I went to the gym with my Dad, which ended up being about an hour. Once home, I quickly ate and started getting myself together for a new client in-home fitness assessment. The assessment ended up being about an hour and a half, even though I only blocked off an hour. That was totally my fault since I am still working on my personal training flow and ultimately being more efficient. Once home, I grabbed a small snack before my 6pm virtual Healthy Habit Jump-Start class started. I had originally planned to do a virtual workout at 7pm; however, by the time I finished up my class and tried to log-in, it was past 7pm (and I hate showing up late, even if it is virtual). I spent another hour or so creating a landing page for my new walking group (created this after feedback from my class). Finished up the day by making dinner and knitting.

Tuesday
I teach an 8am face-to-face nutrition class on campus at my local community college on Tuesdays and Thursdays. This particular Tuesday was a faculty meeting, so I stayed after class and did some reading on the latest fitness research while I biked at the gym. Made it back home around 2pm, ate and then headed out for a night in-home session. Usually, my in-home sessions are always an hour. I try to do my charting and billing right after the appointment, so it is doesn’t pile up and seem so overwhelming. I had a little bit more time this night to cook, so I prepped for tofu and veggies for the next few days.

Wednesday
I was up at 7am this day and answered emails and returned calls. I also packed my lunch for Thursday and then headed out for an in-home appointment. After the session, I went straight to the grocery store to buy stuff for myself and also for the cooking demo I was running Thursday. Came back, charted, ate lunch and brainstormed my new walking group I am planning to launch in May. Then, I had a video call in the afternoon with a fellow Dietitian. We typically chat every month or so to catch up on our businesses and lives in general. This particular call was about an hour and a half. Went to the gym right after (again with my Dad). Once I got home, I spent a good 2 hours prepping for my cooking demo (muffins and chia jam). Ended the night with some dinner and of course, knitting.

Thursday
This was probably my busiest day for the week. I had class in the morning, followed by office hours (that no one ever comes to). I typically use my office hours to grade papers/quizzes and lesson plan for the following week. After office hours, I had an hour downtime before my cooking demo, so I worked on some business stuff (emails/calls + client check-ins). I started setting up for the demo at 12pm and finished cleaning up by 2pm. Once I was home, I unpacked everything, ate, wrote my demo event report, and then headed out for back-to-back in-home night sessions. I wasn’t home until after 7pm (2.5 hours for the two sessions) so I didn’t feel much like charting and billing then. Ate and just relaxed until I passed out on the couch.

Friday
Mostly my Fridays are spent cleaning and catching up on business-related stuff. I wasn’t really in the mood for social media planning, so I pushed that to do on Saturday. I returned voicemails mid-morning and scheduled a new client for March, so that meant I needed to create their profile in my EMR and send them the initial welcome email with paperwork. After that, I reviewed my end-of-month financials from February, assessed client appointments, did some cleaning/laundry and prepped for a mock personal training session with a fellow Dietitian/friend. I’m still fairly new to the personal training piece and am working on my “flow.” It really helps having some awesome friends that let you practice with them! Hit the gym mid-afternoon and then prepped for dinner that night. The rest of the night was spent doing my personal training session, eating, and just all-around good conversation.

Weekend
Usually, I try not to do too much “business-related” stuff on the weekend. This past Saturday morning, I planned out my social media calendar for March (Facebook posts, blogs, and videos). After hitting the gym and doing some food prep, I originally planned to visit family. That fell through due to someone having the stomach bug, so I spent the remainder of the night finishing up a personal training workout plan for a new client.  

Today (Sunday), outside of posting this blog, I plan to do some reading (research articles on fitness), vacuum, knit, and of course, go to the gym. I have a busy week coming up, so I’ll also plan to prep some food for the next few days!

Hope this gave you some insight into my life. I am curious to see what a week-in-the-life of other dietitians looks like, so drop and a comment (or send me a message) and let me know!

Click here to schedule a FREE phone consult. Click here to check out the Etsy store. Click here to visit my website for more information.


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What Nutrition Counseling Is REALLY Like (A Dietitian’s Perspective)

In my field of work, I do nutrition counseling with a lot of people (about 10 per week on top of my other duties). More and more, I notice people have this skewed idea of what counseling is like. Some examples: “So, you’ll tell me what to eat right?” or “You make diet plans, right?’ or when non-clients state, “Your job must be so easy” or when co-workers say “Don’t people know this stuff already?” The truth is, I won’t tell you what to eat (exactly), I don’t typically make a “diet plan,” my job isn’t always the easiest, and people certainly do not know this stuff (to put it simply).

So, if nutrition counseling isn’t any of those things, then what is it? Counseling is not only an assessment of the person’s diet and health history, but also their emotions towards food. Counseling is establishing a rapport with the client so they will trust your suggestions. Counseling is working with clients to figure out how they can be motivated to make changes (and see them through). Counseling is not only being the credible knowledge source, but translating that knowledge into practical strategies that will work for various clients. Counseling is….. well you get the idea 🙂

Besides being all of those things I mentioned, doing one-on-one nutrition counseling can be a little intimidating when you first start out (whether it is inpatient or outpatient). When I first started doing outpatient counseling, I would stumble over what I was explaining. I was nervous about clients asking crazy questions and me not knowing the answer. I brought every handout I owned JUST in case. I was constantly saying to myself, “I wish I had said this instead of _____.” I had a lot of bumps in my early stages of counseling; however, I began to find my own rhythm (trust me, you will too!) and things ran much more smoothly. It seemed like the information just came out so easily when I needed it to! Just a side note here, if you ever do any courses or credits for counseling, it seems like so much to learn (being empathetic, saying key words, phrasing properly, etc); however, once you get practice, these strategies become so natural!

One of my greatest pieces of advice is that it is perfectly okay to say, “I don’t know much about the research for ______, but I can find out and get back to you.” People look to you for credible information and yes they can Google it themselves, but lets face it, they don’t/probably won’t. Plus, most of the people I see in counseling say they get overwhelmed and just don’t know where to look. Again, where the Dietitian comes in 🙂 Just an example, I had a client come to me looking for the Vitamin K content of edamame. This person had to watch their intake because of the medication they were on. I certainly do not know how many micrograms of Vitamin K are in edamame (41mcg for frown unprepared in case you were dying to know). So, I said to this client that I wasn’t sure off the top of my head, but I could get back to them about it. They were very happy with that and came back later for a print-out. Again, MOST people just want the information handed to them and know that you are the credible source to give it. Just a side note, the USDA has an awesome database for this!

Another thing I learned in nutrition counseling is that you can PLAN for what you want to cover; HOWEVER, always be prepared for a curve ball.  Like a client who brings you a list of 15 supplements they are taking or a client who doesn’t have time for snacks because they exercise for 2 hours between meals (aka 10000 crunches, push-ups, etc) or a client who has an underlying pre-occupation with food or a client who said they would be bringing their family and that meant 6 other people. And if you are wondering, these people exist because I have counseled them! Don’t let situations like these rattle you! Go with the flow and just make do with what you have. Again, situations like these will get way easier with more practice.

The way I handled the first person in counseling consisted of me mostly asking about the supplements and the reasons for use. I didn’t tell the client to stop taking them, we just discussed ways of spacing them out or how combining a few into one pill would be better. You are not going to change people’s mind by telling them they should or should not do something. It is best to give them all the information and allow them to have tools to make a more science-based decision. With the second client, we talked about bulking up the meals for more calories instead of having snacks. The third client, started off talking about sports nutrition and turned into obsession over calories. This client was a lot more rational than the typical eating disorder patient; however, they did have a history. That being said, I didn’t refer out since the client was focused on being healthy and eating enough for both exercise and the potential carrying of a baby. The last client(s) was a bit chaotic, since I have a small counseling space; however, it worked well to have most of the family sit while I stood in front of the “U-shaped circle” to talk about nutrition.

With all that being said, hopefully you have a better idea of what nutrition counseling is like as a client or Dietitian. Feel free to leave a comment or send a message of your experience with nutrition counseling 🙂


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Job Searching, New Career, and New Stage of Life!

It’s been quite a while since I made my last blog post. I could say life got in the way; however, it was really that nothing too crazy happened to want to write about. Just being honest 🙂 So, quick recap is: I passed my RD exam, got my PA state license ($65), renewed my PA state license (another $65), applied for a bunch of jobs (most of which said they wanted people with their RD title for more than a year aka NO), paid for an Adult Weight Management Online Self-Study Module (through the Academy of Nutrition and Dietetics for 16 credits), looked at the first section of the module because it is super long, brainstormed some blog ideas, looked into private counseling, worked my current job, did some webinars for free CPE credits, went on a few vacations, and lastly….got a job!

I’m pretty excited about that last part, not only for the nice pay increase from my current position at the YMCA, but also, it was exactly what I was looking for! I will be a part-time retail dietitian at my local supermarket. The position will also be heading towards full-time in the Fall/Winter when the programs get up and running. The RD will do everything from counseling to store nutrition tours to kid’s day events.  I really love working in the community and doing so many different things each day. I hate the whole 9 to 5 boring job routine. I like that I will be doing tons of different programs with all ages and stages of life. The job is also super flexible (I will eventually be creating my own schedule), I will be doing a lot independently (good thing I am a go-getter/self-motivated type of person), I get the opportunity to network with other RDs in the surrounding supermarkets, and I will be doing what I love 🙂 Today’s Dietitian sums up the role of a supermarket dietitian pretty well (for those of you who aren’t sure what they do). The supermarket I will be at had 26 events last month, so I will definitely be a busy bee until I find my own routine.

So, how am I feeling about my new job and starting tomorrow? I am obviously very excited and anxious to just get in and get started. I am also a wee bit overwhelmed. There is a lot that goes on each week and besides all the events, I also schedule counseling, store tours, additional classes, and answer customer nutrition questions. It is also a new atmosphere with tons of new faces (been at my current job for 9 years so I pretty much know everyone and everything there is) and I don’t really have an idea of what I will be doing every day. Like, how will I structure my day? I will be the only RD in the store, so it is not like I will be trained by the person in the position last. I am so grateful that I will get the opportunity to head to 2 other stores this week and meet the RDs there. I have a huge list of questions I want to ask them! I am very glad I have had experience running programs, creating materials, and working with the public at my current job. I feel like that is giving me a great basis for my new position.

I don’t know if this is job where I will be forever (still keeping my YMCA position), but who knows! I am definitely leaning towards becoming a private practice RD. And by leaning towards, I mean I want to do it and get started, I am just slacking a bit 🙂 It is a bit overwhelming to learn about everything you need to do to get started in private practice! I just need to break it down into smaller, more manageable steps (instead of avoiding getting started..haha). This will be something I will be getting back to in future blog posts.

I feel like I am at the stage in my life where all my friends and acquaintances are either having babies, getting married, or getting their career job. I mentioned this to my boyfriend this past weekend and his response was that I am now in this crowd with my new position.  It feels a bit weird to me. I mean you go through college, finish an internship, take a test, but I don’t think it really hits you until you land that first job or just do something with your new title (like start a private practice). I feel like I am finally spreading my wings at a place that will give me the tools and knowledge to make even more of an impact on people (and way more people that is). But anyways, moving on from my emotional part of this blog 🙂 Stay tuned for my upcoming blog posts on: “My First Week as a Supermarket Dietitian” and “Dietitian You Say? That Means You Make Meal Plans.” (I am especially excited about writing that last one)!


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The Start of My Inpatient Clinical Rotation

As of today, I am 18 weeks into my dietetic internship! Just to recap, I completed food service management with school nutrition education and community (at WIC). I am currently in my inpatient rotation in a 200-bed hospital.

I have only been at my clinical facility for 2 days now, but, I really like it. I’m pretty surprised too. I used to work as a Food and Nutrition Aide at a hospital and I hated it! Most of the patients didn’t care what you had to say. They just wanted to “go home and eat their bacon” (a quote I heard fairly often of cardiac diet patients). It is different being with the RD and seen as more of a professional.

My first day, I mostly had orientation to the facility. I was introduced to all the hospitals procedures and protocols. I spent a lot of time learning their EMR system with all the patient information. My preceptor gave me a booklet with equations (for calculating calories and protein for certain BMIs) and tube feeding protocols. This is literally my go-to book for the rotation. If you don’t receive something like this, ask your facility what procedures they use to calculate calorie and protein needs. You can make your own sort of “cheat sheet.”

My second day was where most of the action occurred. I learned how to complete a nutrition profile for new patients that needed nutrition consults. This involved researching the patient past medical history, current medications, diagnoses, lab values, BMI, anthropometrics, and calculating requirements for calories, protein, and fluid. I was able to shadow the RD for the second half of the day. I got to see a range of medical diagnoses in such a short time; congestive heart failure, acute renal failure, hypertension, dementia, hyperlipidemia, hypothyroidism, and more! I even got to chart on 2 of the patients 🙂

When I first started, I was afraid that I wouldn’t know what to say to patients. The more I learned about diets in clinical, the less I felt I knew! After the first few days, I began to feel more comfortable. You find out everything you need to know about the patient prior to going in to do an assessment. The assessments are usually short (<30minutes). Also, my facility (and probably many others), have access to the nutrition care manual, which lists every disease, lab values, educational handouts, and more. So, if you don’t know something, you definitely have the tools to find out.

Just some tips I have for the first few days of inpatient clinical:
-Ask as many questions as you can about nutrition assessments and patient procedure. I think it really helps to hear it explained different ways by different RDs.
-Practice finding nutrition information on patients. The one RD had me on a nutrition profile hunt my first day. I would get a patient and find out their BMI, calorie needs, medications, etc. It helped me to navigate through their system and to research different medications.
-Follow the RDs on their rounds; even if they don’t outright ask you, ask them!
-If the facility has access to the nutrition care manual, peruse through it. It is such a great resource (it is expensive to buy).
-This website was useful too: http://www.uptodate.com/home

Hopefully, I will be seeing patients on my own in the next few weeks! 🙂