It’s that time of the year when the job hunt for new dietitians is in full swing.  Although the bulk of available opportunities remains in the clinical setting, with ever expanding roles of dietitians in areas of media, culinary work, and retail dietetics, new grads have the option of skipping the traditional route of hospital-based practice after getting those well-earned RDN credentials.

Is it necessary for new dietitians to start their careers in clinical nutrition? Check out part one of our two-part blog.

The Case for Clinical

For many new dietitians, work in a hospital or long-term care facility takes the number one spot on their list of desired job possibilities.  Sari Schlussel-Leeds, MS, RDN, CDN, a dietitian based in New York agreed, “Starting out in clinical nutrition is a must in my opinion. It’s a great opportunity to hone your knowledge and skills and the clinical information is so valuable to any future endeavors relating to medical clinical findings for those you serve. The people skills that are heightened when dealing with a vast population of differing socioeconomic strata will serve a dietitian not only professionally, but personally as well.”

Zachari Breeding, MS, RDN, LDN, FAND, an executive chef who specifically entered the dietetics field to help him confidently assist his mother who was having some health issues, feels a clinical base is an absolute necessity.  “As a dietetic internship preceptor, I have always advised my mentees and students to begin their careers in the clinical setting. Medical Nutrition Therapy (MNT) is the basis of everything we do in dietetics, from culinary nutrition to community nutrition to public policy.” Zac added, “Regardless of their eventual professional goals, it is beneficial to the new RD to practice independently with acute or chronic disease states.  Just as we see the entire patient and not just the individual disease state, every aspect of dietetics is inclusive to the larger picture of MNT.”

Try It.  You May Like It!

Female doctor talking to female patient lying in hospital bed, laughing

For many dietitians, having an appreciation for the clinical setting doesn’t happen until they try it. “I accepted a job right out of my internship at a local community hospital. Going into the dietetic internship I had no desire to ever be a clinical dietitian,” shared Andrea L Ventura, MS, RD, IBCLC, a dietitian practicing in New York.  Andrea added, “Now that I am one though, I see that the experience and knowledge of medical nutrition therapy I gained is invaluable, no matter where my career takes me in the future.”

Jen Hernandez, RD, LD the owner of a virtual private practice, also experienced the benefits of trying out clinical in several different job settings.  Jen recalled, “I took a long-term care position right out of my internship because that’s what was available to me. But I also grabbed a per diem clinical position at a local hospital because 1) I LOVE calculating tube feedings and 2) I felt it was important to keep my toe in the “clinical waters.”  The hospital setting is a great place to be exposed to- and gain confidence in- skills of caring for a variety of patients and health conditions. You can really learn where your passion lies in which patients you prefer and what types of conditions you feel a pull towards.  I think the hospital setting is a great place for dietitians to start their career, but it doesn’t need to be their full-time gig! And as a BONUS: Per diem pay can be a great way to help pay off student loans!”

Meeting the Needs of Your Future Employer

While it may be difficult to pinpoint exactly what employers are looking for, some common themes can emerge. After Jamie M. Marchetti, MS, RDN, LD completed a combined dietetic internship and master’s degree she noticed a trend as she began applying for jobs. Jamie explained, “I found that many of the dietitian jobs online asked for 2-3 years of clinical experience, even if the job posted was not clinical. This prompted me to seek that coveted experience to open doors for me later. Through nutrition counseling in the clinical setting, I found that I was able to begin developing my counseling skills in the context of specific disease states, for which I felt the recommendations were more concrete.”

For certain positions, prior experience isn’t just a suggestion.  “The Centers for Medicare & Medicaid Services (CMS) require registered dietitians to practice clinical nutrition for a minimum of one year, prior to practicing alone in a dialysis unit, shared Shelley Munch, MBA, RDN, LD, a specialist in renal nutrition.  “I agree that this one-year requirement is essential with this population of patients.  For many patients, CKD is secondary to liver failure, cancer, diabetes, heart failure, wounds, drug addictions, etc. and the year of clinical experience provides the broad understanding of possible nutritional requirements for these patients.”

Building Your Reputation

If your heart is set on opening your own private practice one day, the connections you make with staff members in a clinical setting can be invaluable for future endeavors.  For Lisa C. Andrews, MEd, RD, LD the relationships she established with physicians at a teaching hospital built the base of her referral stream, “When I left, I reached out to many of the doctors that I had worked with side by side and receive lots of referrals for my private practice now.”

Kate Brien MS, RD, LDN, Owner of Kate Brien Nutrition Counseling also pointed out a practical side to waiting to become your own boss.  Kate said, “Becoming an entrepreneur requires confidence and working in clinical can help build your confidence in your nutrition knowledge and expertise.  Starting a private practice can be expensive and the income erratic as you build your client base. Many clinical jobs are part time or per diem allowing you to continue working while building your private practice.”

Although many new dietitians want to focus on areas of wellness, Lisa recommends getting extensive experience with illness too.  Lisa shared, “To me, medical nutrition therapy and knowing how diet affects disease states is what sets us apart from health coaches and other wellness professionals.”

For myself, my first job out of college was in a long-term care facility with more than 600 residents.  I simply needed a job and it certainly would not have been the area of practice I would have chosen for myself.  Surprisingly, I learned I was actually good at clinical, I liked the pace, and learned a tremendous amount about how residents’ relationship with food affects their long-term health outcomes.  While I’ve never used my knowledge of filling out MDS paperwork EVER again in my career, the lessons learned from any first job can always be used as a stepping stone into the area of dietetics that truly holds your passion.

What do you think?

Share your comments below and be on the lookout for part 2- If Clinical Just Isn’t Your Niche.