Recognition, value and demand for services are the keys to increased salaries and income potential for Academy of Nutrition and Dietetics members. The Academy and all members must work together to raise the perceived value of nutrition services among all stakeholders. It is important to remember that education and credentials allow registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs) the privilege of providing nutrition services and calling themselves the leading source of food and nutrition information.
The Academy's mission is empowering members to be food and nutrition leaders. One significant way to accomplish this mission is to increase recognition of members' qualifications and expertise in serving and protecting the public's nutritional health. The Academy works to accomplish this mission by helping members achieve their common goals while respecting legal and ethical restraints governing businesses and professions.
The Academy can, and does, work to increase income opportunities for its members by assisting them to shape the environment in which they work. In addition, the Academy creates tools that members can use to raise their perceived values to physicians, legislators, allied health professionals, consumers and compensation departments; to increase their income potential; and to negotiate salaries with employers.
Current Environment: Compensation and Benefits Survey of the Dietetics Profession
The Academy responded to members' requests for information on salaries by conducting its first survey in 2002 and has continued the survey generally every two years. The full report of the 2019 Compensation and Benefits Survey of the Dietetics Profession is available for free for Academy members ($250 for non-members) at eatrightPRO.org/salarysurvey.
In the 2019 survey, specific work settings for which median hourly wages are highest include:
- Trade or professional association
- Pharmaceutical or nutrition products manufacturer, distributor, or retailer
- College, university, or academic medical center
- Food or equipment manufacturer, distributor, or retailer
Positions showing the greatest gains in median compensation since 2017 were:
- Self-employed/private practice
The survey also found that factors associated with higher salary levels include experience, education, specialty, practice area (food management, consultation and business, and education and research), self-employment, supervisory responsibility, budget responsibility and region of the country (East and West coasts earn the highest).
While the 2019 survey shows that RDNs who do not see patients/clients earn more than those who do, that is primarily attributable to the fact that those who do not see patients/clients have other characteristics that correlate with higher wages. For example, being faculty members or consultants, being involved in management and supervisory functions, and having budget authority.
Many factors play a role in a practitioner's salary level; compensation/reimbursement rates are often tied to factors over which the Academy has little control. In addition, the Academy must, under the law, avoid participating in activities that could be portrayed as price fixing.
For example, compensation for the majority of employees working in hospitals or long-term care facilities is tied to the organization's salary structure, frequently called common pay-graded positions. Human resource departments may grade RDN or NDTR positions against a benchmark position, using position descriptions for making comparisons among different types of health care providers. Physical therapists, for example, may have a higher pay grade than RDNs because they have clearly defined practice roles and advanced education is required for entry-level practice. Physical therapists have also been billing for services and contributing to the overall income of the organization for a long time, which increases their pay-grade level.
In other cases, salaries are set according to the market's demand for services and the perceived severity of need for those services. The Bureau of Labor Statistics reported that registered nurse jobs are expected to increase by 16 percent through 2024. The Bureau has predicted that jobs in the dietitian/nutritionist category will increase by approximately 11 percent between 2018 and 2028.
If jobs grow at this rate and organizations experience difficulty filling positions, nurses and pharmacists may experience dramatic increases in base pay and perks, such as sign-on bonuses. The Bureau also reported that pharmacists are becoming involved in drug therapy decision-making and patient counseling. This implies that pharmacists are providing services that make a difference to the overall effectiveness of the organization, its bottom line and the health of clients and patients.
RDNs are not able to compare their salaries to allied health professionals solely based upon similarity of education and experience. Those factors are not the sole drivers of higher compensation that other allied health professionals may be receiving.
Raising Perceived Value, Income Potential and Provision of Negotiation Resources
The Academy is committed to doing all it can to help its members seize and create workforce opportunities to succeed in prevention and well-being, health care and health systems, food and nutrition safety and security, now and in the future.
The Academy's resources support members in their goals of increasing RDN and NDTR brand recognition, workforce capacity and ability of salary negotiation through identification of the depth and breadth of practice area competencies for career advancement in various marketplace settings.
- Reaffirm and/or revise existing publications of Standards of Practice (SOP) and/or Standards of Professional Performance (SOPP) for RDNs in 17 focus areas of practice.
- Revise publications, resources and tools for Scope of Practice for the RDN and Scope of Practice for the NDTR.
- Revise publications for Standards of Practice (SOP) in Nutrition Care for RDNs and Standards of Practice (SOP) in Nutrition Care for NDTRs and Standards of Professional Performance (SOPP) for RDNs and Standards of Professional Performance (SOPP) for NDTRs.
- Develop new publications for Standards of Practice (SOP) and/or Standards of Professional Performance (SOPP) for RDN focus areas of practice, such as Supermarket and Retail; Cardiovascular.
- Develop Practice Tips and Case Studies to assist RDNs and NDTRs with scope and standards of practice (e.g., when to cosign, health and wellness coaching), competencies, implementation of regulations (e.g., order writing privileges), quality improvement and performance measurement.
- Provide the Academy Definition of Terms List, which serves as standardized language for RDNs and NDTRs to apply in various practice settings.
- Develop four malnutrition electronic clinical quality measures and serve as measure steward.
- Serve as one of the visionary founders and member of the leadership team of the Malnutrition Quality Improvement Initiative (MQii). MQii is designed to help organizations improve and standardize malnutrition care and subsequently achieve better outcomes for patients malnourished or at-risk for malnutrition.
- Provide MQii Toolkit to support the implementation of a malnutrition quality improvement initiative.
- Facilitate opportunities for partnerships with hospitals and health systems, and transitions of care including post-acute care and community-based services across the U.S. to support the RDN in leadership roles for acceleration and implementation of malnutrition best practices for patients in the MQii Learning Collaborative. Learning Collaborative participants undertake a data-driven, patient-centered, malnutrition quality improvement project at their respective hospitals and care settings using the best practices Toolkit and can use clinically meaningful measures to track and monitor improvement.
- Publish manuscripts, including an MQii dedicated Supplement (September 2019) to The Journal of Nutrition and Dietetics, showcasing malnutrition best practices, outcomes, and research. Promote MQii with presentations and webinars highlighting RDN best practices and accomplishments.
- Supply an array of Quality Strategies resources, including: learning modules, the Quality Resource Collection, the quality improvement practice tip, infographic and QI project recorded "Quickinars," and published QI examples and poster abstracts.
- Provide opportunities for RDNs and NDTRs to network and educate on quality management concepts and resources via Quality Leader Alliance (QLA).
- Offer the Standards of Excellence Metric Tool and companion resource modules for RDNs and NDTRs to assess their organizations' excellence in meeting and exceeding standards of quality leadership, organization, practice and outcomes.
- Updated the Dietetics Career Development Guide to assist members in planning upward movement within the profession.
- The Council on Future Practice is in the second year of a visioning process to identify recommendations for a preferred future for the profession. Member input during Year 2 of the process will result in a new Visioning Report to be released in 2017.
- Conducting an advanced clinical nutrition dietetics practice audit to form the basis for an advanced practice clinical nutrition credential.
- Offer career-related resources on the member-only website, including resume templates, an online job board, networking and mentoring opportunities and a salary calculator based on the most current Compensation and Benefits Survey of the Dietetics Profession results.
- Promote the services and expertise of the RDN and assist individual members offering consulting services through an online referral service free to Academy Active category members.
- Establish a Code of Ethics for the Nutrition and Dietetics Profession to elucidate the principles and standards that underlie the nutrition and dietetics practitioner’s roles and conduct.
Legislative and Public Policy Efforts:
- Successfully fought back against well-funded, coordinated attempts to weaken consumer protection provisions in dietetics licensure laws in Missouri, Montana and North Dakota.
- Introduced new, strong licensure legislation in New Jersey that passed the Assembly and is awaiting a vote in the Senate. Also introduced new, strong licensure legislation in Pennsylvania and enhanced protections in Indiana by moving from certification to licensure.
- Continuing engagement with 17 affiliates to strengthen their licensure laws and regulations to ensure (1) consumers have access to RDNs as qualified providers of nutrition care services and (2) RDNs are able to provide care at the highest level of their scope of practice.
- Implemented Academy's Dietary Guidelines Engagement Plan, including convening expert members to serve on the Academy’s DGA Collaborative; nominating RDNs to the USDA/HHS expert advisory committee comprised of more RDNs than in any previous iteration; and soliciting member experts and DPGs for individuals to serve on Academy Think Tanks to provide recommendations on specific topics and scientific questions identified by USDA/HHS.
- Submitted oral and multiple written comments to USDA/HHS to ensure the best scientific evidence is utilized, the DGA process in transparent, and the full scope of critical topics are evaluated.
- Advocated for enhanced reimbursement; food security; effective, science-based labeling; and numerous other strategies to accelerate improvements in global health and well-being through food and nutrition in over 50 formal regulatory comments sent in the past year.
- Supported and contributed to efforts to secure 90,000,000 in House and 80,000,000 in Senate appropriations bill to expand the WIC Peer Breastfeeding Program often supported by members in WIC clinics.
- Supported and contributed to efforts securing 35,000,000 in House and 30,000,000 in Senate appropriations bill for School Food Service Equipment which benefits members who work in school food service.
- Worked with staff to introduce the School Food Modernization act to help provide grants and technical assistance for school nutrition operators which benefits members who work in school food service.
- Worked with Congressional committees and member experts to advocate for the reauthorization of the Older Americans Act with improvements in policies and funding levels for older adult nutrition programs.
- Advocated for improved nutrition standards at U.S. Customs and Border Protection detention facilities via letters to, and correspondence with, the administration, meetings with congressional offices, and developing a coalition of other organizations to advocate on this issue.
Coverage and Payment Efforts:
- Work with Congress and the Centers for Medicare & Medicaid Services to include RDNs as providers who can bill for Intensive Behavioral Therapy for Obesity under Medicare. Develop tools and facilitate interdisciplinary state-based coalitions to help member leaders advocate for similar policies at the state level.
- Work to expand coverage of medical nutrition therapy (MNT) services under Medicare Part B to include conditions beyond diabetes, kidney disease and post-renal transplant.
- Work with members and third-party payers to position RDNs as preferred providers of nutrition services.
- Submit comments annually to the Centers for Medicare & Medicaid Services regarding the proposed physician fee schedule to ensure appropriate reimbursement to RDNs for Medicare Part B MNT services. Achieved eligible clinician status for RDNs under Medicare’s Quality Payment Program and coverage for online digital evaluation and management services provided by RDNs.
- Appoint Academy members to Center for Medicare & Medicaid Services clinical subcommittees developing episode cost measures that include MNT for the Quality Payment Program.
- Support the My Healthy Weight Initiative, the first ever collective initiative by private and public payers and employers to offer a standard benefits and coverage for obesity prevention and treatment services for individuals of all ages.
- Partner with primary care provider associations and key health care stakeholders to help shape payment policies for nutrition services.
- Position Academy members in external groups involved with establishing CPT® (Current Procedural Terminology) codes and associated reimbursement values.
- Develop tools and resources to support member efforts to advocate for expanded coverage of MNT services (Medical Nutrition Therapy MNTWorks® kit, Third Party Payer Brochure, Evidence Analysis Library MNT Effectiveness, 2018 Coding Survey).
- Publish free monthly e-newsletter MNT Provider, which provides members with information on how to effectively market and bill for MNT services.
- In collaboration with the American Society for Parenteral and Enteral Nutrition (ASPEN), educate public and private payers on the use of appropriate criteria for identifying malnutrition and advocate for appropriate payment for inpatient claims for malnutrition diagnostic codes.
- Collaborate with medical societies to produce educational programs and journal articles to increase access to MNT services and integration of RDNs into team-based care.
- Collaborate with the Health Resources and Services Administration (HRSA) and their cooperative agreement organizations on efforts to support integration of RDNs and nutrition services into HRSA-funded health centers.
- Committed Partner for the Health Care Payment Learning and Action Network, supporting the integration of nutrition care and RDNs in alternative payment models. Created a model framework for member and stakeholder use.
- Partner with the Centers for Telehealth and ehealth Law (CTeL) to advocate for legislation that supports coverage and payment for MNT delivered via telehealth.
Lifelong Learning Opportunities:
- • Offer programming addressing reimbursement opportunities and new models at the Food & Nutrition Conference & Expo™ (FNCE®) sessions, live webinars, self-studies, online certificates of training and pre-recorded online modules. Focal points include increasing members' business savvy and marketing skills regarding coding, coverage and positioning RDNs and nutrition services in evolving health care delivery and payment systems.
- Offer an array of face-to-face learning to advance critical skills. Examples include:
- Comprehensive Public Policy training that provides mentoring, networking and training opportunities in public policy, communications and leadership.
- Nutrition Focused Physical Examination Workshops (NFPE) to provide RDNs with the skills and knowledge necessary to perform NFPE at their workplace to aid in accurately identifying and providing individuals with the nutrition diagnosis of malnutrition and in turn improve overall health outcomes.
- CDR Certificate of Training Programs, including:
- Academy dietetic practice group (DPG), member interest group (MIG) and affiliate meetings and workshops
- Collaborate with professional organizations, alliances, national thought leaders and content experts in the development of online programming and advanced certificates of training for career and profession development. Examples include:
- Advancing Your Role as Leader (Level 2)
- Chronic Kidney Disease Nutrition Management (Level 2)
- Culinary Nutrition (Level 2)
- Developing Your Role as Leader (Level 1)
- Executive Management (Level 2)
- Food Allergies: Cutting Through the Clutter (Level 2)
- Health and Wellness Coaching Module (Level 2) - New!
- Informatics in Nutrition: Spanning All Areas of Practice (Level 2) - New!
- Integrative and Functional Nutrition (Level 2) - New!
- Nutritional Counseling (Level 2)
- Public Health Nutrition (Level 2) - New!
- Research (Level 2) - New!
- Supermarket Business and Industry Skills to Thrive in Retail Dietetics (Level 2)
- Vegetarian Nutrition (Level 2)
- In collaboration with the American Speech-Language-Hearing Association, the Academy recently announced support of the implementation of a global initiative to standardize diets for the treatment of people who suffer from swallowing disorders. The International Dysphagia Diet Standardization Initiative launched in the United States on May 1, 2019. The Academy has created a monthly, step-by-step IDDSI Boot Camp that empowers dietitians to lead the charge of program implementation in their facilities. The boot camp will include monthly emails providing concrete tasks and timelines to guide implementation in your facility. The suggested tasks reference the complete implementation guides.
Position Members for Leadership Opportunities:
- The Academy's House of Delegates conducts dialogues on issues critical to nutrition and dietetics. Recent examples of dialogues include "Capitalizing on our Strengths to Create a Future Where Credentialed Food and Nutrition Practitioners Play an Integrated Role in Wellness and Prevention," "Championing Nutrition and Dietetics Practitioners in Roles of Leadership in Public Health," "Food Systems and Sustainability: Shaping Dietary Guidance," and "Leveraging Technology/Big Data to Improve Outcomes and Elevate the Roles of Credentialed Nutrition and Dietetics Practitioners." These issues are critical to positioning members for success in the marketplace.
- Promote and facilitate the placement of RDNs in local, state and national leadership positions in government, industry and other advisory committees. (Successfully advocated for members to work on the Dietary Guidelines Advisory Committee, Institute of Medicine and Study Task Force.)
- Comment on rules and regulations to highlight and position RDNs as the nutrition experts. (The Academy has recently increased the number of comments submitted to regulatory agencies by 400 percent.)
- Help draft legislative language that promotes innovative nutrition education, services and interventions under the direction of an RDN.
- Advocate for continued funding for chronic disease prevention programs led by RDNs (e.g. Community Transformation Grants).
The Academy believes there will be a need for more RDNs and NDTRs in years to come, increasing job opportunities and salary negotiating power. Reasons include developments in the delivery of health care; the nation's obesity epidemic, coupled with increases in avoidable diseases and conditions such as hypertension, cardiovascular disease and diabetes; and consumers’ ever-increasing interest in taking charge of their own health.
The Academy remains committed to doing all it can to help its members seize (and create) opportunities and succeed in the health care marketplace, now and in the future.