What to Know Before Becoming a Private Practice Dietitian — Registered Dietitian Columbia SC

Becoming a private practice dietitian was the scariest, yet most rewarding decision I've ever made. Almost 10 years after launching my nutrition private practice, I can look back and see there’s a lot I wish I knew! Today, I'm sharing what to know before starting starting a nutrition private practice for any of you aspiring entrepreneurial dietitians.

What to Know Before Starting a Nutrition Private Practice #dietitian #coach #healthcoach

When I first wrote this blog post in 2015, it was a year after I launched my private practice. Here’s how I intro’ed my post:

“This year, April 4th has a special meaning to me. One year ago today, I nervously walked into my bosses office, put in my 3-week notice, and quit my well paying, government job with great benefits so I could pursue my dream of becoming private practice dietitian.

When I announced it on the blog last year, I eloquently summed it up by stating ‘OMGAOHTIOAFJDIAFOJESAFSHJIFNJ;AIERORSA.’ I still kinda feel the same way. Y'all, I am one of the most rational and level-headed people on this planet, not to mention, kind of a weenie that's scared of just about everything. The idea of running my own business was terrifying, and still is. I felt confident in my skills as a dietitian and nutrition coach, but running a business?? Not so much.”

Self(ie) Employed, Day 1. Iphones were of a different quality back then lol.

I’m not quite sure what “OMGAOHTIOAFJDIAFOJESAFSHJIFNJ;AIERORSA” means, but I still think it applies to how I feel as a private practice dietitian, almost 10 years later. Making that very out of character decision to go off on my own has allowed me to have some incredible experiences in my career. I wrote a book. I had the opportunity to speak to a giant room full of my colleagues at FNCE, our national dietetics conference, on the topic of self care as a private practice dietitian of all things. I've had other incredibly rewarding opportunities to make a mark on my field, through individual career coaching and supervision, recording training webinars and speaking at local meetings and conferences, as a preceptor for dietitians in training, and through internships and mentorships with Diversify Dietetics. I was awarded South Carolina Outstanding Dietitian of the Year. My recipes, writing and quotes have been published in magazines and newspapers. I've also grown my team, bringing on my lovely associate dietitian Kate Bennett, who I first met right after I became a private practice dietitian and she reached out as a new RD to meet the other non-diet dietitian in our town.

Most importantly, I had the opportunity to walk alongside countless individuals as they’ve healed their relationship with food and their body. I cannot put into words what a profound impact my clients have had on me, and the immense gratitude I feel to each and every one for trusting me to be a part of their journey.

I feel a bit braggy writing all that, but you know what? I also feel super effing proud. As someone who has always underestimated herself and struggled with low-self esteem, I think it’s important for me to brag on myself for a bit!

That said, almost 10 years later and I am still no expert at running a nutrition private practice. When I look back on my career, much of what I’ve learned and accomplished has been through failure and subsequent growth, not immediate success. I still regularly have days that I think to myself “WTF am I doing???” Some days (in fact, literally this morning), I look at my to-do list and feel completely overwhelmed with this sense of “what did I get myself into!” As many rewarding client experiences as I’ve had, I’ve also had some that didn’t feel so great too.

Advocating on Capitol Hill with other SC dietitians for insurance coverage for dietitians

Thankfully, I’ve had enough conversations with friends and colleagues in the field, including many private practice dietitians that looked up to right from the beginning, and know these struggles are all super normal, which I didn’t realize at first. I looked around on social media and it seemed like everyone around me knew exactly what they were doing. I was clearly the odd one out, stumbling aimlessly through my career! If that’s you, I’m here to say nope! Everyone feels lost sometimes, or even a lot of the time!

I vividly remember how scary those early days felt, which is why I am really passionate about passing on resources, support and advice for other private practice dietitians. There’s a lot of things I wish I knew before starting a nutrition private practice, things that would have saved me quite a bit of stress and feelings of failure. As you can see from the 175+ comments, I know this has struck a chord with many of you, so I’m giving this post a bit of a refresh, along with some new resources for aspiring private practice dietitians.

First, I’ll answer my most commonly asked question…

How did you become a private practice dietitian?

I started off as a dietitian as many do: in clinical dietetics. My dietetics internship at Emory was very clinically focused. After I graduated, I started working in a clinical position at a small, community hospital. My job let me dabble in a bit of everything. I spent each morning in the ICU doing critical care nutrition, but I also taught nutrition classes for cardiac rehab, saw outpatient appointments, and covered an inpatient cardiac unit, where I did a lot of nutrition education.

A real throwback! My last day as a clinical dietitian.

After about a year and a half, I left that job and moved to Columbia to be near my boyfriend, now the hubs. I got a job at the VA as an outpatient dietitian, where I was responsible for providing individual nutrition counseling and teaching chronic disease management classes. At the time, I called it my dream job. I loved working with veterans and I felt both successful and challenged in what I did.

Over time however, I realized in that type of setting where client load and numbers rule, I couldn't provide the type and quality of care patients needed and deserved. I wanted to be able to provide more intensive nutrition counseling, rather than seeing my clients once every few months. While I was by no means a HAES® informed dietitian at this point, I was starting to see the harms caused by weight focused nutrition counseling. I was also becoming interested in integrated nutrition, and didn’t feel like the very conservative VA environment would allow for that. It was also an extremely mean girls work environment, I was somewhere between Cady and Janis. Not only that, but had recently started a blog that was starting to become veeery slightly profitable. It nurtured my creative side, and I wanted to what I could make out of it.

Then, over the course of two weeks, I learned my position at work was going to change so my appointment slots would only be 15 minutes long (I know…), Scott got a promotion, and I randomly stumbled upon an office I could sublease for next to nothing. So, without much planning or foresight, I left to start my business.

I still think it’s wild that I am technically an author.

Would I recommend impulse-quitting your job to become a private practice dietitian? No. While there was a lot of scrimping and saving the first couple years, there was a lot of financial privilege involved with being able to pay the bills through my husbands job. Starting a business without a business plan meant I was sorta throwing shit at the wall to see what stuck those first months/years. Highly recommend having at least a slight idea of what you’d like your nutrition private practice to look like before quitting a reliable job with a steady paycheck!

At the same time, I know if I didn’t do it then, who knows where I would be today. It’s a decision I have never regretted, minus a few fleeting moments when times were tough.

What to Know Before Becoming a Private Practice Dietitian: for Students/Interns:

You don't have to be a clinical dietitian.

I repeat, you do not have to be a clinical dietitian to get your "base knowledge." Pursue the path you want, right off the bat, whether that's public health, nutrition counseling, school nutrition or hey, maybe clinical. It's the best way to gain the skills you need for the career you truly desire.

That said, inpatient hospital jobs are easier to find and I hear from many aspiring private practice dietitians that took a clinical job out of necessity. Make the most out of the experience. Many dietitians think patients don't want to learn when hospitalized, so they bump education consults to the bottom of their priority list. To a certain extent that's true - someone halfway anesthetized from surgery or vomiting up blood doesn't really want to chat about food. The hospital is definitely not an ideal counseling environment. But many patients do want to chat about food, and may have a lot of questions after a scary health emergency. When I was working clinical and covered the cardiac floor, I found that inpatient nutrition counseling helped me build a comfort level talking to people about food. It helped me feel more confident when I started working outpatient.

Another throwback! Christmas party with my Emory dietetics internship class

Figure out what you’re passionate about.

Start using this time to figure out you're passionate about, and consider ways you might develop it into a marketable skill. Love cooking? Maybe a career in food styling, recipe development or blogging awaits. Athletic? Consider a certificate in personal training, which would be a great combo with nutrition coaching. Do you find yourself reading a lot of self help books? Maybe getting additional training in psychology and counseling skills would set you apart as a private practice dietitian.

Make the most of your internship.

Most internships offer elective rotations. If you can, work with a private practice dietitian and get a glimpse into what they do. I SO wish I did this when I was an intern.

Start a blog/instagram.

Even if you have no aspirations of becoming a blogger/influencer, I highly recommend starting your own blog or social media account. You don't have to share it with anyone - it can be something anonymous for you keep to yourself! Blogging helps you identify your passions when you pay attention to what topics you're drawn to. By putting everything in writing, it solidifies your personal philosophy and beliefs, and get comfortable communicating to the public.

When I was awarded Young Dietitian of the Year by my state dietetics association. Next goal: Old Ass Dietitian of the Year.

Do things that scare the s*** out of you.

Every day running a nutrition private practice, you're putting your entire heart and soul out there for the entire world to see and embrace or reject. The idea that you can fail in a very public way is terrifying and awful, but also a necessary discomfort when you become a private practice dietitian. Get used to doing scary things, whether it's public speaking, signing up for a new workout class by yourself, or striking up a conversation with a stranger. Aim for things that get you outside your comfort zone, but aren’t panic attack inducing. Exposing yourself to the anxiety that comes with doing these scary, public things can help you learn to sit through the discomfort that comes pretty much every day in private practice!

Sometimes running a nutrition private practice is extremely hard work. Other times you can spend an afternoon in training (i.e. reading a professional development book in the above ground pool - it was Covid summer - with a glass of wine)

What to Know Before Starting a Nutrition Private Practice: for Dietitians:

Start now.

No, I don't mean go out and quit your job today. But do start taking steps towards opening your practice, whether it's networking with other private practice RDs, reading books, taking a business course, or joining the nutrition entrepreneurs dietetic practice group. Start building business skills, brainstorming a business plan, and getting a sense of the steps involved with launching a nutrition private practice so it's not as overwhelming when you finally do open up shop. Instead of keeping your dreams of a private practice relegated to, well, dreams, actually take steps towards making your business a reality.

One of the best parts of this work: connecting with other private practice dietitians I admire. This was after a WIND/InspiRDtoSeek conference in DC.

The legal piece isn’t as scary as you might think.

When I do business coaching with aspiring private practice dietitians, one of the most common questions and stuck points is often figuring out the legal piece. I was pretty overwhelmed too! Part of building your business includes legally protecting yourself by creating a set of contract forms that you can use in your practice. Running your own business can open you up to new risks, so you'll want to understand the ways you can legally protect yourself and reduce those risks.

When I first started my private practice, one of the most helpful things I did was sit down with my accountant and ask all the dumb tax questions I had and set up a system to track income and expenses. Many accountants will offer a free initial appointment, because if you decide to work with them when taxes are due, it’s a lot less work for them if you’re set up correctly!

Another helpful resource for legal matters is a company called Dotted Lines. It was founded by 2 female attorneys with over 2 decades of legal experience who designed legal templates and education specifically tailored to fit the needs of private practice RDs. They have the legal templates you'll need to get your business up and running, from your LLC agreement to your website policies to your client or group coaching agreements, and more. You can download their DIY contract templates instantly, and their contract templates come with an attorney-led tutorial explaining the key contract provisions in plain English (use my affiliate code "RachaelHartley20” to get 20% off your purchase!). If you're not sure where to start, I always recommend downloading their free guide which is a comprehensive 15-step legal start-up guide for health and wellness professionals.

Don’t be afraid to charge what your worth.

This was a big fear for me at first, and still something I struggle with, but it's kinda essential to having a viable business. How much to charge for your services, whether it’s individual counseling, groups, or freelance work, is a common topic of conversation among dietitians. When I first started, I’d often hear warnings from established dietitians about not charging too little, as it devalues the field. While the advice is well intentioned, and to some degree true, it never really sat well with me. It often felt like I was being pressured to charge more than I felt was appropriate for a new private practice dietitian. It also sent the message that our value as a dietitian is measured through our fees.

Unfortunately, I responded to this by charging way less than my time was worth. I felt insecure about the value I was providing, and ended up accepting low paying projects that made me feel resentful. I wish I remembered that my time is valuable, and didn’t let my low confidence dictate my fees.

While I can’t tell you what your hourly fee should be, here’s a few things to think about when setting your prices:

Consider what insurance reimburses per hour as a baseline for your fee. Even if you are a brand new private practice dietitian and still gaining skills and experience, your time is still valuable. If you went to a brand new doctor, and they weren’t able to “fix” whatever you were sick with, you would still expect to pay for the service (or for insurance to reimburse them appropriately). Why would it be any different as a dietitian?
As one of my favorite dietitians Fiona Sutherland says, “your fees don’t determine your value, only who has access to your services.” Remember that deciding to charge a lower fee is also valid, as long as you’re comfortable with it.
You can figure out ways to make your services more accessible without being a charity case. Unfortunately, we do live in a really effed up healthcare system. In the state of SC, where my business is located, we don’t have the option of accepting insurance. I offer sliding scale and reduced fee spots, and while it hardly makes a dent in the problem of access to dietitian services in our state, it means a lot to those clients who need it.

Job perks: fun sponsored trips with food brands! This one was with NC Sweetpotatoes, where I got to bask in the glory of fields full of tubers

Get training in counseling.

I cannot stress the importance of this for everyone who dreams of becoming a private practice dietitian. One thing I’ve learned in working with new dietitians is that we often jump to education, with our engrained “fix it” mentality. While education has a place in outpatient counseling, it’s not the main reasons why someone decides to work with you. By focussing appointments on education, it sends the message that people just need to “know what to do and then they’ll do it.” The reality is that no matter ones health goals, people need coaching and support to make changes.

There’s many different counseling techniques, but here’s a few that you might want to dive into:

Motivational Interviewing (MI) - Motivational Interviewing in Nutrition and Fitness, Molly Kellogg's resources

Acceptance and Commitment Therapy (ACT) - The Happiness Trap, ACT Symposium by EDRD pro,

Mindfulness - free mindfulness course by Fiona Sutherland

Somatic approaches - Embodied Dietitians training, The Body Keeps the Score, Embodied Recovery Institute

Family Based Therapy (FBT) - FBT for Dietitians by EDRDPro

Cognitive Behavioral Therapy (CBT)
Dialectical Behavior Therapy (DBT) or Radically Open DBT (RO-DBT)

Be prepared for clients to have barriers to change.

I frequently hear from aspiring private practice dietitians that they “want to work in a setting where clients want to change." There’s an assumption that the people who seek out nutrition counseling in private practice are ready to be “told what to do” and will follow your advice to a T. This assumption makes people quite unprepared for the realities of being a private practice dietitian!

While almost every client you see in private practice has some desire for change (they are in your office after all!), they will have barriers and likely hold some degree of ambivalence, especially if you’re measuring progress on your agenda and not theirs. Being a successful private practice dietitian is not just about nutrition knowledge. It’s more so about building trusting relationships with your clients, understanding them as the unique individual that they are, and supporting their goals - not yours

Learn to say no, even in the beginning.

When I first started my business, I took every paid opportunity that came my way, along with most unpaid opportunities too. Given the way I started my practice, I was extremely anxious about finances. This led me to make decisions with the goal of making money, not building my business. Some examples:

Taking low paying speaking gigs that never led to any clients and required hours and hours of unpaid work on the backend to prepare.
Working with clients I knew in my heart weren’t a good fit, then spending time and mental energy trying to adapt to their needs.
Taking on brand projects that paid extremely little, and weren’t necessarily a good fit for my personal brand.
Taking on a part time/prn job at a hospital to help provide some financial stability.

In the beginning, I was overwhelmed, unfulfilled, and the prn job had stagnated the growth of my business. Luckily, I was able to recognize that, take a step back, and make changes. When I started saying no is when my practice really started to grow.

This problem with saying yes to everything is a common pattern I see among new private practice dietitians. I wish I had some easy hard and fast rule about when to say yes and when to say no to opportunities, but I don’t! It’s OK to learn through trial and error. It’s also OK to say yes to unpaid opportunities in the beginning (or later on!) just because you want the experience. Similarly, it’s OK to say yes to things you don’t love just for a check - it would be super privileged to say it’s not! That said, I encourage you to do a gut check before saying yes. Ask yourself whether the opportunity moves your business in a direction you want, or if it’s just a check.

I got to be an opening speaker at SC’s NEDA Walk, which was a huge career highlight for me!

More Resources for Private Practice Dietitians

Blog Posts

Since writing this post in 2015, I’ve written more posts for dietitians with career advice. Check out the following articles:

Business Coaching for Private Practice Dietitians

Still bursting with questions about how to open a nutrition private practice? Schedule a coaching call with me! If you’re not quite ready or financially able to invest in a larger business coaching program, I would be happy to schedule a call with you to answer your burning business related questions, or work through a struggle area in launching or running your practice. I offer both 30 and 60 minute career coaching calls. Here’s a link with more information.

Clinical Supervision for Private Practice Dietitians:

Our training doesn’t stop after passing the RD exam. Clinical supervision, while not a common practice in dietetics (yet!), is required for therapists and counselors, and in my experience has been an essential tool that’s allowed for me to reflect, learn, and grow in my career. In supervision, you work 1:1 with a dietitian mentor to build your clinical skills, get guidance navigating difficult cases, and gain confidence as a clinician. It’s also a space for emotional support, as we know how challenging this work can be. Think of supervision as therapy for your clinical practice!

If you’re new to supervision, Fiona Sutherland offers a fantastic free course on what supervision is and how you can make the most out of it. Check it out here. To learn more about the clinical supervision services I offer to private practice dietitians, click here and reach out to schedule your first session.

FNCE Boston circa 2016 (?) with the best roommates. Endlessly grateful for the friendships I’ve gained over the years, and could never have done this without the support of my colleagues.

This post on becoming a private practice dietitian was originally shared April 2015, and has been updated to give you the best possible content.

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