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 may use to raise their perceived value 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 2017 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 2017 survey, specific work settings for which median hourly wages are highest include:
- Pharmaceutical or nutrition products manufacturer, distributor or retailer
- Contract food management company
- College, university, or teaching-hospital faculty
Positions showing the greatest gains in median compensation since 2015 were:
- Outpatient/Ambulatory Care
- Food and Nutrition Management
- Long Term Care
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 2017 survey shows RDNs who do not see patients/clients earn more than those who do, that is attributable primarily 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 often are 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. And physical therapists have been billing for services and contributing to the overall income of the organization for a long time, which also 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 nursing jobs are expected to increase by approximately 22 percent between 2008 and 2018 and pharmacist jobs will grow by approximately 17 percent over the same period. The Bureau has predicted that jobs in the dietitian/nutritionist category will increase by approximately 9.25 percent between 2008 and 2018.
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 therefore 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 working to support members in their goal of achieving recognition, respect and remuneration. For example:
- Develop new publications for Standards of Practice (SOP) and/or Standards of Professional Performance (SOPP) for RDNs focus areas of practice.
- Reaffirm and/or revise existing publications of Standards of Practice (SOP) and/or Standards of Professional Performance (SOPP) for RDNs in 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 Practice Tips and Case Studies to assist RDNs and NDTRs with scope of practice, competencies and implementation of regulations, standards, and quality improvement and performance measurement.
- Update 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.
Coverage and Payment Efforts:
- 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 Congress and the Centers for Medicare & Medicaid Services to include RDNs as providers who can bill for Intensive Behavioral Therapy for Obesity for Medicare beneficiaries.
- Work with members and third-party payers to position RDNs as preferred providers of preventive nutrition services as part of implementation of the Affordable Care Act.
- 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.
- Participate in activities of external organizations, such as the American Medical Association and the Center for Medicare & Medicaid Services Innovation, to shape alternate payment models that appropriately recognize the value of the RDN and NDTR.
- Partner with the Alliance for a Healthier Generation to expand coverage of nutrition services provided by RDNs for childhood obesity. More than 2.8 million children have access to at least four visits with an RDN per year.
- Partner with primary care provider associations and key health care stakeholders to help shape payment policies for nutrition services.
- Advocate for inclusion of MNT in the federal essential health benefits package under health care reform. Develop tools to assist member leaders with similar efforts on the state level.
- Position Academy members in external groups involved with establishing procedure 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, 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), develop characteristics for identifying adult malnutrition for use by RDNs to help increase their value on the health care team and positively influence facility reimbursement. Similar work was developed in collaboration with ASPEN and the American Academy of Pediatrics (AAP) for pediatric malnutrition.
Legislative and Public Policy Efforts:
Targeted advocacy and public policy efforts have resulted in successful outcomes that benefit members and enhance job opportunities, including:
- The passage of the Farm Bill which:
- Restored funding for SNAP-Ed which employs thousands of members
- Retained funding for fresh fruit and vegetable program, in which the majority of state directors are RDNs
- Secured new funding for food and nutrition research through the establishment of the Foundation for Food and Agriculture Research
- New funding for Regional Centers of Excellence in Nutrition Education and Obesity Prevention providing new job opportunities for members
- Provided input to the United States Preventive Services Task Force for its recommendations to expand screening for prediabetes. With an undiagnosed population of 87 million Americans, this will provide a huge market opportunity to expand RDN services.
- Advocating for the expanded reimbursement of MNT for people with prediabetes in Medicare by working with members of the Congressional Diabetes to hold hearings.
- Led efforts to increase the value of Academy members in school nutrition by the implementation of the Professional Standards in the Healthy, Hunger-Free Kids Act.
- Worked with key Congressional committees to include nutrition education in the reauthorization of the Child Nutrition Act.
Lifelong Learning Opportunities:
- Offer programming addressing reimbursement opportunities and new models at the Food & Nutrition Conference & Expo sessions, live webinars, 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 annual Public Policy Workshop that provides mentoring, networking and training opportunities in public policy, communications and leadership.
- In collaboration with the National Kidney Disease Education Program/National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, revise online development programming and an advanced certificate of training for use by RDNs to help increase their facility and individual reimbursement.
- In collaboration with supermarket retail experts and marketed with the Food Marketing Institute (FMI), offer supermarket business and industry skills as an online certificate of training for use by RDNs to help expand skills for this emerging field.
- In collaboration with the National Peanut Board, offer advanced training as an online certificate for use by RDNs to assist with the diagnosis and management of food allergies through the lifecycle and working with manufacturers, restaurants and school foodservice.
- Develop three online certificates of training on executive management and Level 1 and 2 leadership for use by RDNs to expand skills in mentoring, career laddering, communication and appreciative leadership, ethics and emotional intelligence in different practice settings.
- Create an advanced nutritional counseling online certificate of training to help RDNs balance mental, physical and cultural influences, share counseling techniques and approaches that support behavior change.
- In collaboration with the DCE DPG, offer an online training module to assist RDNs to define their functions and roles as generalists, specialists and advanced practitioners in a variety of areas including diabetes and enhance their understanding of the diabetes standards of practice and standards of professional performance and application.
Position Members for Leadership Opportunities:
- The Academy's House of Delegates, as the governing body for the profession, conducts dialogues on issues critical to nutrition and dietetics. Recent examples of dialogues include the Academy's sponsorship program, business and management skills for RDNs and NDTRs, engaging members in research and nutrition services delivery and payment. 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.