Dietitian Education, Schools and Career Overview

Dietitians, as their title suggests, are professionals in the field of nutrition. Sometimes you might hear of dietitians referred to as registered dieticians (RD or RDN for registered dietitian nutritionist), when those individuals have met the right criteria to earn the titular credential.

Both a dietitian and a nutritionist may have similar educational backgrounds and perform similar functions, but a dietitian must be licensed in almost every state. Therefore, the licensing state has a specific list of credentials required, which may include a degree, an internship and passing an exam. The state also reviews the professional activities of licensees and punishes those who call themselves dietitian without state credentialing, attempt to practice outside the prescribed boundaries of the job (e.g., by prescribing medication, suggesting exercise therapy routines or encroaching on the job descriptions of other health professionals) or receive complaints from patients or other professionals.

Another different between nutritionist versus dietitian is that the term nutritionist is generally not a licensed or registered profession, whereas dietitians are credentialed and registered by their state. Not all nutritionists are registered dietitians, but registered dietitians could call themselves nutritionists, if they so chose. Of course, almost anybody can call themselves a nutritionist, since the title is rarely protected by state law. In fact, if a person completes an online class in nutrition, they may call themselves a nutritionist. Although certifications are available through online and other schools, there is no legally governing body for this, and it is up to the client to determine if the nutritionist’s credentials are sufficient to work with them.

Dietitians assess clients' dietary goals, develop individualized meal plans, and monitor patient progress. They continually seek out the latest research, but their journey always begins with a formal education. Most dietitians hold a bachelor's degree in dietetics or a related area, according to the Bureau of Labor Statistics (BLS), and many also have advanced degrees.

What does a dietitian do?

Dietitians work in hospitals, outpatient clinics, nursing facilities, and government-run establishments, and some are self-employed. Depending on the work environment, dietitians may perform any of the following duties on a given day:

• Evaluate nutritional and health needs of patients
• Create meal plans
• Advise patients on their unique nutrition issues
• Evaluate and write reports on the effects of the meal plans they created, and adjust as needed
• Maintain an understanding of, and contribute to, the latest research in food and nutrition

They work with both inpatients and outpatients, offering dietary guidance for all sorts of conditions. Reasons a patient may need to see a dietitian include:

• Cardiovascular disease/hyperlipidemia
• Heart disease
• Cancer
• Diabetes
• Kidney/renal disease
• High blood pressure
• Obesity/weight loss
• Eating disorders
• Digestive disorders
• Food allergies
• Sports nutrition

Typically, patients will come in for an initial assessment by a dietitian and then, depending on their specific situation, have a follow-up appointment. For a patient with diabetes, for instance, 10 hours of diabetes education at the hospital is required. That length of time is often broken into four visits, some of which are spent with a nurse and others with a dietitian. Dietitians who work frequently with diabetes patients often obtain an extra certification in diabetes education so they are more qualified to address the needs of these patients. Outpatient dietitians that are focused on helping clients with weight loss or eating disorders may see patients several times over the span of a year or two. Sometimes patients will come back repeatedly as needed or as covered by their insurance plan.

The total number of patients a dietitian will see depends on the setting and type of position. A dietitian working in an acute care (hospital) facility may see anywhere from 8-12 patients per day, depending on the size of the hospital and their other job duties.

Dietitians work as a team; collaborating with other healthcare professionals including doctors, nurses, physical therapists, speech and language pathologists, social workers, psychiatrists and pharmacists. Many hospital settings have team meetings daily to review patients' courses of treatment and bring in the necessary specialists.

How to Become a Dietitian

The first step towards becoming a dietitian is choosing a dietitian degree program. According to the BLS, most nutritionists hold at least a bachelor's degree in dietetics, clinical nutrition, or a related area such as food service systems management. Students can choose either a didactic program, which consists entirely of traditional classroom learning followed by an internship, or a coordinated program that combines classes with clinical experience. While in school, students can expect to focus on the following subjects areas:

• Clinical nutrition
• Anatomy and physiology
• Chemistry
• Culinary arts
• Business and economics
• Food service management
• Food science
• Family and consumer science (FCS)
• Biology
• Biostatistics

Dietitian degree programs

Typically, a bachelor's degree in nutrition and dietetics from an American Dietetic Association accredited institution is the most direct route to a career as a dietitian. However, some individuals chose to earn their bachelor's degree in another field and then go on to earn a master's in nutrition. Others chose to earn both a bachelor's and master's in nutrition and dietetics, which may make them more marketable than those with just a bachelor's degree.

The next step towards becoming a dietitian, if you chose a didactic degree program, is to complete a Dietetic Internship (DI). DIs take anywhere from 8-24 months to complete, and must include at least 1200 hours of supervised, practical experience, according to nutrionED.org. Aside from those basic requirements, however, DI programs can vary quite significantly. Sports nutrition, pediatric nutrition, community nutrition, and clinical nutrition research comprise but a handful of the internship options available to graduates of dietetics programs.

Your third and last stop on the road to becoming a nutrition professional is certification; specifically, the Registered Dietitian Nutritionist (RDN) credential. Although state certification mandates can differ from one another, the RDN often fulfills licensure requirements regardless of your location.

Dietitian certification

Passing a board exam through the Commission on Dietetic Registration is required for entry into the field. Upon graduating from an approved bachelor's or master's program in dietetics, and completing the necessary internship, students are eligible to sit for the RD exam. Since the exam is nationally governed, the regulations are the same across all states. The exam is computerized with between 100 and 150 multiple-choice questions. Each question has a different degree of difficulty and everyone sitting for the exam gets a different batch of questions. The questions are divided to include testing knowledge on three domains: clinical, food service, and community. It takes approximately two hours to complete and the results are shared immediately.

Oftentimes, the dietitian's internship organization requires them to attend review classes for the board exam to increase their chances of passing on the first attempt. From the organization's perspective, they want to maintain a solid reputation by having their interns pass the exam with flying colors on the first attempt.

Individuals who have passed the Commission on Dietetic Registration exam have an RD behind their name, which stands for registered dietitian. In addition, after paying the fee and becoming licensed by their state, dietitians can put an LD behind their name for licensed dietitian. Other initials may be added depending on if the individuals have obtained a specialty certification. For example, for a certified diabetes educator the initials would be CDE.

For the Commission on Dietetic Registration, a portfolio of 75 continuing education units (CEUs) must be submitted online every five years. These credits must be based on learning goals and needs identified by each RD every five years. The state licensure does not require submitting actual CEUs unless an individual is audited. There are a variety of courses and online seminars that qualify towards CEUs. The Commission on Dietetic Registration typically sends members a portfolio binder to track CEUs through the course of the five years span. It is important for RDs to not only track the class or seminar that was taken toward CEUs, but also the objectives and a brief synopsis of what was learned.

Dietitian Salary and Career Outlook

Many healthcare careers might expect to see an increase in demand due to an aging population living longer, healthier lives thanks in part to advances in medical technology. Dietitians might expect to see the following types of salary or job growth numbers in the coming years:

Sources:

1. Bureau of Labor Statistics, Dietitians and Nutritionists, http://www.bls.gov/oes/current/oes291031.htm

2. Bureau of Labor Statistics, Dietitians and Nutritionists, http://www.bls.gov/ooh/healthcare/dietitians-and-nutritionists.htm

3. Dietetic Internship (DI), nutritionED.org, http://www.nutritioned.org/dietetic-internship.html

4. ExploreHealthCareers, Dietitian, http://explorehealthcareers.org