My RD Journey

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


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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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Top 10 Tips for a Successful Dietetic Intern

I am going to switch gears for a bit from my usual Dietitian-related tips to a focus on dietetic internships. I have been a preceptor for the last 2.5 years and it has been awesome. I would highly suggest any professional to take on an intern at some point in their career. It is such an eye-opening experience when you are teaching and basically helping to mold someone into their profession.

Over the last month, I have had a lot of interns reach out to me to be their preceptor for 2017-2018 dietetic internships. Only a small handful I ended up meeting with and agreeing to become their preceptor. In the process, I had a few asking what the qualities are of a “good” intern. While I hate using the word “good,” I do like thinking in terms of success. The top 10 list I complied below is a blend of tips from my own experience as being a preceptor plus what I observed during my internship (way back when).

Tip #1 – Show up on Time
This is an absolute must. There is nothing more off-putting than a late intern. Get up earlier and never assume traffic will be great (especially if you have a long drive). My practice is super busy and I am usually on a time crunch, especially if running a class that day, so tardiness just won’t cut it for me. If you do happen to be running late for some reason, always contact your preceptor. Let them know why you are running behind and your estimated time of arrival.

Tip #2 – Always Dress to Impress
I am sure you have heard this one a lot, but take it seriously. I have had interns show up for meetings with me in jeans (and not nice looking ones)! It is way better to be overdressed for a meeting. For your actual rotations, always contact your preceptor and find out the dress code. For my practice, there are days where we need to get dressy for classes or seeing clients. Other days, I am just working out of my home so there is no sense in getting all dolled up to just sit around and work.

Tip #3 – Come Prepared 
One of my biggest pet peeves is when an intern shows up with absolutely no work to do, no outlines or class assignments printed (or available on their computer), or nothing to do for downtime. Whether you are heading in for an initial interview with a potential preceptor or your first day on-site be PREPARED! Have an idea of what your rotation entails. What assignments do you need to accomplish? What tasks need to be done? Don’t assume your preceptor will have that information. Set aside time to speak with them to review everything. Also, make sure you have something to do when there is downtime. This could be reading journals, working on assignments, or studying for your RD exam. Again, this is a good time to ask your preceptor what the expectation is. Do they want you to be working on something for them? Do they want you to work on assignments? Lastly, don’t sit on your phone while you wait. Honestly, that makes me think you don’t take nutrition or the rotation seriously enough.

Tip #4 – Engage and Ask Questions
I always have interns tell me they don’t want to bother me with questions. I love questions and to me, this means you are excited and passionate about nutrition. One thing about questions is to time them correctly. If your preceptor is in the middle of a call or email, that might not be the best time to ask a question. Again, find out what they prefer for this too. I had preceptors who would tell me to interrupt them with anything. I had others that told me if they are busy to let them be. Asking questions about something is not a sign of weakness at all, instead it shows me that you are willing to learn, grow, and challenge yourself. If anyone ever gives you heat for asking questions, apologize maybe for your timing, but never, ever, apologize for your curiosity and desire to learn.

Tip #5 – Be Organized
For anyone that knows me personally, they know I am highly organized. My expectation for organizational skills is probably much higher than most professionals; however, it is for good reasons. My practice involves just me. I do all the scheduling, client-seeing, billing, follow-ups, emails, etc. I need to be organized to make sure everything gets done in a timely (and good quality) manner. While I don’t expect my interns to be like me, having some sense of organization will really suit you well.

Tip #6 – Give Good Quality Work
If your preceptor gives you an assignment or task to work on, take it seriously and take your time to produce good quality work. Don’t just slap something together to get it done. Do the research, invest the time, and don’t be afraid to ask for help.

Tip #7 – Respond to Emails (Professionally)
As I mentioned earlier in the post, I have had a lot of interns reach out to me as a preceptor in the last month, yet I only interviewed a few for my practice. A lot of this was due to that first impression I received via email. Frantic and desperate emails were red flags for me. I questioned if they prepared at all for the internship (i.e. finding preceptors). Again, are you taking this seriously? This makes me think about lack of organizational skills. Also, if students reached out for a clinical rotation with me or with incorrect information about my practice, another red flag went up. Obviously, you did not do your research very thoroughly, so this makes me think that attentiveness to detail is not a strong suit. I have also had potential interns reach out to me, interview with me, not get matched and never let me know (though they said they would). While this doesn’t seem like a big deal, I spent the time setting up an interview with you, filling out paperwork and blocking your rotations in my calendar. At least have the decency to let me know if you will actually be coming. I had these same students reach back out again later when they did get an internship and needless to say, I was hesitant to work with them. While some of my perceptions could be totally off from the actual reality of the situation, that first impression is everything for me in choosing an intern that will work well in my practice. After all, this is my business and I rely on it for my income.

Tip #8 – Be Aware of Preceptor’s Time (Assignments)
Your preceptors are taking the time to work with you during your internship, so as much as you can make that process easier for them, the better. This means being on-top of your assignments and tasks, which goes along with being organized. Plan out when you will do your assignments and don’t wait until the last minute and then expect your preceptor to work it all out for you.

Tip #9 – Be Open to Learning
You might not love every rotation and you might already have an idea of which area of dietetics you want to go into. This doesn’t mean you should just do the bare minimum for your other rotations. Even if you know clinical is not for you, engage and ask questions. You never know when you might find a new passion or learning something exciting.

Tip #10 – Be Open to Feedback 
One of the most important pieces of any profession is getting and giving feedback. Feedback is crucial since it can help to shape you into a better professional. Always be open to getting feedback from your preceptor, even if it is negative. After such, do something about it! If your organization is slacking, how can you improve? Get used to giving feedback as well. Don’t just say everything is great when it isn’t. You can always attempt to improve a situation (or work environment) by giving constructive feedback. Are you frustrated with the lack of time your preceptor is giving you for questions? Are you not learning enough from them? See if you can compromise or come up with a solution that will work for the both of you. I always say that the worst that can happen is someone says, “no” but at least you know that you tried.

I hope this list helps any current or potential interns out there to enhance their experience in the dietetic internship. Good luck to everyone beginning their internships and leave a comment to let me know how yours is going!

For more tips on Preparing for Your Internship, check out the BLOG 

For more information on joining the AND Preceptor Database, click the LINK.


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First 10 Steps to Starting Your Private Practice

A few weeks ago, I wrote a blog post about preparing yourself for full-time private practice. I realized afterwards that I hadn’t included a post about getting started with your private practice! So, while this is just slightly out of order, I have included a lot of links and resources for getting yourself set-up for private practice. Some of these resources I used when I was first starting out and others I found out about afterwards. I actually ended up doing some of the steps out of the order mentioned below; however, this is what seems to make the most sense for me now.

1. Get an NPI –> LINK
Even if you decide not to accept insurance, it is still something you want to get. It doesn’t even take long to register for one. Excerpt from the website: “The Administrative Simplification provisions of HIPAA of 1996 mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information.”

2. Get a Tax ID Number or EIN –> LINK
Your EIN is your federal tax ID number that is used to ID your business entity; generally businesses need this. This was a pretty simple process as well. You will need to choose a business name. Here is a LINK for information on registering your fictitious name. For my business I am Felicia Porrazza doing business as PorrazzaNutrition. If you are doing business under your full and proper name, you are not required to register your personal name as a fictitious name. I think I spent maybe 2 hours initially trying to figure out if I needed to further register my name in PA. This may vary state-to-state so be sure to check your individual Department of the State website to see what regulations are in place. You will also need to choose your business entity or business structure in this form. Here is a great LINK explaining the types of business structures by the US Small Business Administration, a great resource!

3. Get Professional Liability Insurance –> LINK
I am a member of the Academy of Nutrition & Dietetics and the one they recommended is Proliability by Mercer. I am pretty sure they still offer a discount for AND members. It is reasonably priced and covered the basics for what I needed as a Dietitian.

4. Insurance Vs. Self Pay Acceptance 
I am not going to go into too much detail here because this will be featured in another post; however, one thing to think about is if you will be accepting insurance or only self-paying clients (or both). If you will only accept self-paying clients, you can move to step 5. If you will accept insurance, I would highly suggest getting yourself set-up with CAQH ProView. This is a free resource that allows you to decrease paperwork for becoming a provider with insurance companies. It will ask for your professional and practice information, credentialing info, directory services, etc. When you go to apply to become a provider for a particular insurance company, they will ask for your CAQH number. It has really helped me to streamline the process and avoid entering the same information 10 times. The application takes a bit of time; however, it was very much worth it! I started working on this step while I was still working a full-time job since it took a few months to get credentialed anyways.

5. Deciding Pricing 
This is again going to be another blog post; however, setting your fees is often the hardest step. I find it difficult to put a number on the valuable service I provide. Needless to say, it has to be done. One way to get started on this is by checking out what other Dietitians or health professionals are charging in your area. Factor in your expertise, years of being a dietitian, etc. If you choose to accept insurance, they will have a contracted amount that you will be paid per unit (15-minutes per one unit and you can have multiple units per appointment). You could also use this as a guideline for how you charge self-paying individuals. I found it to be helpful to include counseling packages for savings with self-paying clients.

6. Payment Acceptance
Along with deciding your pricing, you will need to figure out how you will accept payment. Will you set-up an account with PayPal? Get a merchant account through your local bank? There are a lot of different options out there. You can choose to do only checks or cash; however, I would suggest getting a separate business banking account regardless of the route you choose.

7. Decide Your Online Presence
When developing your online presence, you can choose from a number of sites and hosting services. For your website, you can choose to go with companies like Wix, Squarespace, GoDaddy, etc. You could also use WordPress and update your account to have a .com address. I am not going to get too far into website design and such; however, I am going to just touch on what you may want to include on your site –> information page about yourself and your business, location, services offered (you may or may not include pricing too), contact information, pictures, blogs (or link to blog), testimonials (may come later), newsletter opt-in, etc. I created my website about a year before registering my business and accepting insurance. I didn’t have much on the site and I basically just linked it to my blogs where I was much more active. This is a step you can do at basically do at any time in creating your practice.

8. Decide on Office Space/Set-up
This is definitely a step that you can do earlier in the ballgame. There are a few options for how you choose to see clients. You can do in-home counseling appointments, where you basically go to the client’s home. You will need to make sure insurance will cover this if you are a provider. You can rent office space for yourself or sublet from another provider (doctor, chiropractor, etc), which is usually cheaper. Other options for renting office space can include using a shared office where you schedule times to come in and pay either monthly or on a single-use basis. You can see clients in your own home; however, you will need to need to check to see if there are stipulations or zoning laws. Here is a LINK for some more information on that. You can also provide virtual counseling services, which again have stipulations especially in the insurance provider realm. Here is a great article from Today’s Dietitian on the TOPIC. If you are a member with the AND, you can also check out this LINK. 

9. Create Office Forms
One of the last things you will need to do before seeing clients is to get your office paperwork in order. You will need an initial client form, privacy notices, privacy consents, HIPAA forms, release of information form (for you to speak to family members or doctors), and a policy form relating to your business (for information on cancellation fees, rescheduling, non-payment, etc). I would also suggest thinking about how you will log business income and expenses too. EatRightPro has a great section on HIPAA with education and forms –> LINK.

10. Additional Tips 
There are a lot of free resources out there for starting your business. Some may not be related to the Dietitian realm; however, they can still prove to be quite useful. Check out your local Small Business Administration for tips on building your business. Network with other Dietitians or health professionals in your area to see how you can help one another. I purchased this AND book and found it to be really helpful when I first started out. The AND published another book on credentialing and billing that is free for members; however, I didn’t find it useful at my stage of practice (it may be for those just starting though). I also discovered that the Free Library of Philadelphia had a lot of free online and in-person resources for business owners, so I suggest checking out your local library too.

This is by no means intended to be an all encompassing list. I am sure there are additional steps that you may have heard of or wish to include in starting your own private practice. This was simply from my point-of-view and how I thought might be helpful for others. You can jump around with the steps I have included and even eliminate those that may not apply to your business. Regardless of how the information today was presented, I hope that this helped you in some aspect of starting your business!

Leave me a comment to let me know what I missed, what you found helpful, or where you are in your private practice 🙂


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Tips for Running Nutrition Programs

Over the past few years, I have been creating and running nutrition programs. I have done multiple seminars for adults and classes for children. It is often intimidating to stand up in front of everyone and give that expert knowledge of yours. For those of you who run nutrition programs, or are looking to, here are some of the tips I have.

Tip #1: Prepare
This tip is very generally. It means to not only prepare your material ahead of time (definitely don’t wing it), but to also mentally prepare yourself. If you have your content created, reviewed, and ready for presentation, you will be a lot calmer than if you rushed through it last minute and haven’t looked it over.

Tip #2: Dress professionally
First impressions are very important! Your participants will be judging you before you even begin to speak. You want to look the part. I also found that with being younger, people often discredit what I say or don’t take me seriously. Dressing professionally has helped me to be seen as more of an authority figure.

Tip #3: Arrive early
If you have a lot of equipment, I suggest arriving at least 30 minutes before start time. I found it useful to set up all my handouts, extra pens, business cards, etc on a table off to the side of the front of the room. This was a lot better than fumbling around if someone needed another pen or extra paper. Having materials set out makes the class run smoothly. Also, some participants arrive early. This gives you time to chat with them and make them and yourself a bit more comfortable.

Tip #4: Prepare for set-backs
This tip goes hand-in-hand with tip #3. Besides setting up your room and materials, you want to be early in case of problems that arise. Let’s face it, as much as we prepare, something can always go wrong last minute. I recently began working with a projector, which was complicated to find, let alone set-up. I was in one room with all my materials set-up, half the projector, tables and chairs. I had to move all of my materials, tables, and chairs, to another room to use a different computer system. Since I arrived early, and with the help of some awesome employees, I was able to get set-up and start pretty much on time. Preparing for set-backs means you also have to go with the flow when problems arise. Instead of focusing on “why me,” focus on “what can I do to fix this.”

Tip #5: Have confidence in yourself
Believe in yourself and what you are doing! Stand talk, speak clearly, and speak loudly (not yelling though). Think positively about your program or presentation. Trust your knowledge and your abilities.  Greet your participants as they walk in, and if you can, shake their hands. This gesture helps to break that awkward barrier before you start.

Tip #6: It’s okay to not know an answer
One of the things I was worried about most was that I would get hard questions, not know the answers, and I would lose all of my credibility. When you run a nutrition class, yes you will get questions; however, if you know what you are teaching you will be fine. You know more than you think you do. Also, you don’t have to know everything. If you don’t know the answer to a question, give your best response and be honest about not knowing. I have had a lot of questions on new products or studies, some of which I have never heard of. Sometimes, with my science background, I am able to give an educated response. Other times, I have to say “I haven’t read much on the topic of _____, that will be something I will look into more.” If you are seeing the same class again, you could also tell your participant that you could research it and get back to them.

Tip #6: Enjoy what you are presenting
If you teach nutrition, more than likely you are in the field because it is a passion of yours. Bring that passion to your class. If you are excited and passionate about what you are teaching, it will show. This will also help to motivate the people in your class to be more excited about it too.

****These tips can also relate to speeches/presentations in class.