Registered dietitians play an important role in helping patients stay healthy, but historically access to nutrition services in healthcare has been limited. Many dietitians don’t accept insurance and have long waitlists, which creates barriers for patients. However, integrating nutrition services and primary care can lower healthcare costs, improve patients’ quality of life, decrease their chronic disease risk, and help them manage chronic conditions.
What is a Registered Dietitian?
Registered dietitians (RD), also known as registered dietitian nutritionists (RDN), are healthcare professionals who complete extensive nutrition education and over 1,000 clinical training hours. RDs must also pass national board exams for licensure and complete mandatory continuing education to keep their license in good standing. This combination of formal education and hands-on experience ensures that RDs deeply understand the science behind nutrition and its practical application in various healthcare settings.
How does a registered dietitian differ from a nutritionist?
One key differentiator is the level of training and expertise. Nutritionists earn a certificate by completing a few courses, and unlike RDs, they don’t need to complete clinical hours. There is no national standard for the hours of education, clinical training or licensure required to become a nutritionist.
The variability in education and training means that not all nutritionists have the knowledge and skills to support patients, especially those with complex health conditions, in the same way as RDs. Additionally, most nutritionists are unable to accept insurance, while many RDs can.
What does a registered dietitian nutritionist do?
Registered dietitian nutritionists possess the knowledge and clinical skills to provide science-based care rooted in research and cultural competency. RDs provide nutrition counseling and assess patients’ nutritional needs to help them lead healthier lives and prevent and manage diseases.
How a Registered Dietitian Works with a Primary Care Physician
Primary care physicians show strong support for working with RDs, with nearly 95% of surveyed physicians interested in adding RDNs to their care team. However, the respondents also listed a number of barriers that have stopped them from working with RDs. Some reasons include the perceived cost to the patient, the inability to find a local RD for referrals, and questions about insurance reimbursement for RD services.
Virtual, one-on-one nutrition counseling can help to break down these barriers to entry, providing access to RDs who take insurance and can see patients in the comfort of their own homes. Primary care physicians and RDs can then work together to address their patients’ medical and nutritional concerns.
A team approach to healthcare
RDs work closely with primary care providers to deliver comprehensive and well-coordinated patient care. Culina Health registered dietitians collaborate closely with patients’ physicians, updating them after sessions to help leverage different interventions.
Physicians also play a critical role in recognizing when patients need specialized nutrition services and referring them to RDs accordingly. This teamwork creates a cohesive healthcare approach, particularly in areas such as weight management and chronic disease management.
While physicians can provide nutrition advice to their patients, they may lack the expertise or time to spend on the type of nutrition education that an RD can provide. Instead, physicians may focus more on evaluating the patient’s symptoms, diagnosing, and prescribing treatment plans.
An RD who is on the care team can provide specific guidance about nutrition, that considers the physician’s findings and is tailored to the patient’s lifestyle and circumstances. Physicians will also become better educated about nutrition counseling through the feedback they receive from the RDs on their team.
Why Registered Dietitian Nutritionists Should Be Included in Patient Healthcare Teams
RDs are experts in providing medical nutrition therapy. They are well-equipped to assess, diagnose, and treat nutrition-related conditions. Their involvement in patient care extends beyond nutrition education, offering a holistic approach to behavioral health that considers the patient’s unique needs.
One of the primary reasons RDs are vital to healthcare teams is their specialized expertise. For instance, in the case of a patient with diabetes, an RD can offer tailored guidance on dietary choices, carbohydrate management, and meal planning, which is critical for effective diabetes management. An RD’s science-based and personalized approach helps patients see meaningful changes in their health while considering their unique health history, lifestyle, schedule, culture, tastebuds, and relationship with food.
Healthy eating looks different for everyone
In terms of culture, a personalized approach could mean helping patients incorporate their favorite cultural foods in a more balanced way. White rice, for example, is a popular food across many cultures even though it’s a refined grain with minimal nutrition. However, it can still be part of a balanced, nutritious plate.
When I’m working with parents, I consider their busy lifestyle and avoid giving time-consuming recommendations. If cooking is part of their daily routine already, for example, I think about how to help them add more nutrient-dense foods to their meals that even the pickiest eaters in their family will enjoy.
For frequent travelers, I offer healthy on-the-go snack recommendations and help them navigate restaurant menus ahead of time. If I’m working with athletes or anyone with an active lifestyle, we look at optimizing meals before and after exercising.
There’s no one-size-fits-all approach to nutrition care and everyone’s situation is different. I’ve seen firsthand in my practice that when patients work with a dietitian, they’re more likely to comply with the recommendations and see positive results.
The impact of RDNs on patient outcomes
Numerous studies have demonstrated the positive impact of including RDs in healthcare teams. Patients who receive care from RDs experience improved clinical outcomes, reduced healthcare costs, and fewer hospital admissions. This is particularly significant for individuals with chronic diseases such as diabetes, cardiovascular disease, and obesity. RDs play a pivotal role in helping patients manage these conditions effectively through evidence-based nutrition interventions.
As an RD, I typically spend an hour each week with my patients and often have a better understanding of whether or not they need a higher level of care. If someone comes in with pre-diabetes or insulin resistance, I can work with them on lifestyle changes and coordinate with their general practitioner to inform medication management decisions. In most cases, we can avoid sending patients to an endocrinologist by taking this approach.
On the other hand, if a patient with obesity is unable to maintain intensive lifestyle changes or isn’t seeing their desired weight loss results, I will consult with their doctor who can discuss medication options or refer them to a specialist.
How General Practitioner Gatekeeping Curbs Healthcare Expenditure
One of the potential advantages of integrating RDs into primary healthcare practices is the opportunity to curb healthcare expenditure. Consulting an RD could support general practitioner gatekeeping, which is the practice of determining if a specialist is necessary for certain patients.
The role of general practitioner gatekeeping
GPs serve as the entry point to healthcare services for many patients. Typically they are the first medical professionals individuals consult when seeking medical advice and treatment. GPs make critical decisions about referrals to specialists and other healthcare providers. By including RDs in the gatekeeping process, they can help make these decisions, which in turn may lead to lower healthcare expenditure costs.
For example, a patient could have a family history of cardiovascular disease and elevated lipids, but working with their primary care provider to start medication and a dietitian to make lifestyle changes could help them avoid expensive testing and decrease their chronic disease risk.
Curbing healthcare expenditure
Studies have shown that RDs improve treatment efficacy for patients when working as part of an integrated healthcare team. A holistic approach to healthcare that involves dietary and lifestyle intervention guided by an RD can potentially reduce the need for specialist services at a higher level. Positive patient outcomes achieved at the primary care level can in turn reduce healthcare spending costs, while freeing up specialists to see patients who are in critical need of their care.
About Culina Health
Culina Health RDs are clinically-trained nutrition experts who will work with your patients to craft personalized, flexible, and sustainable nutrition and lifestyle plans. Our RDs provide culturally competent care and cover a variety of specialties and approaches. Most major health insurance providers cover one-on-one virtual nutrition care sessions with our registered dietitians. Learn how we can partner with you to provide expert nutritional care for your patients.
