The Threat to Practitioners and to Public Health
PART 1: LICENSURE OVERVIEW
- In 16 states, it is a criminal offense for anyone to perform nutrition counseling, except for Registered Dietitians (RDs) and a few specifically exempted parties
- A broad range of qualified practitioners who use nutrition tools are excluded from providing quality care regardless of their level of training
- In another 10 states, while it is not illegal for others to perform nutrition counseling. Only RDs can obtain a state issued credential and the benefits it may confer such as insurance eligibility or perceived status.
- Each year, the Academy of Nutrition and Dietetics (formerly American Dietetic Association) national leadership pushes more state legislation to create or tighten exclusionary licensure laws
- Cost jobs and careers of highly qualified nutrition care providers
- Limit consumer choice
- Restrict field to a single philosophy and practice limiting advancement of knowledge and best practices
- Create a monopoly on the practice of nutrition, raising cost of care
- Negatively affect local economies
- Protect one subset of the nutrition practitioners, exclude all others, and damage public health
- Create confusion and instability with laws that vary from state to state
- AND's own reports demonstrate that exclusionary licensure is a tool to help marginalize their competition (AND Licensure HOD Backgrounder, 2011)
- It creates exclusive access to insurance reimbursement opportunities
- It could elevate the reputation and respect of RDs within the medical community
Unless licensure with exclusive scope of practice laws that enable only RDs to provide nutrition care are thwarted, huge numbers of qualified practitioners will have no right to legally provide nutrition care. Your livelihood and the future of the practice of nutrition depend on your willingness to act!
No. First, there are thousands of RDs who are excellent nutrition practitioners, and deserving of the right to practice. The exclusionary licensure campaign is a top-down effort from national AND leadership, not from the rank and file.
Some Registered Dietitians (RDs) appear in favor of exclusionary licensure but are unaware of the negative impacts. And a greaty many RDs who are familiar with the issue or who have been exposed to excellent non-RD nutrition care providers oppose exclusionary laws. Many RDs are extremely dissatisfied with the AND leadership’s aggressive and divisive approach.
There is a clear opportunity for collaboration among all nutrition care providers to ensure a diverse workforce which puts public health ahead of professional self interest.
The AND claims they are promoting these laws to “protect public health.” Exclusive healthcare licensure is typically sought by practitioners who are the financial beneficiaries, not the public. Every exclusionary nutrition licensing bill has been pushed at the behest of the AND leadership. The public is adamantly opposed to RD-only nutrition licensure. In Colorado in 2012, there were approximately 3,000 comments in favor of RD-only licensure, and 19,000 opposed.
Preventing care providers in a given field from practicing is helpful when the likelihood of bodily harm to individuals as a result of that care outweighs the benefits of increasing the number and diversity of care providers. We have never been presented with evidence of widespread physical harm from nutrition advisers providing care within the scope of their training. Unlike medicine, which deals in controlled substances such as pharmaceuticals and inherently dangerous activities, such as surgery, nutrition counseling involves advice about products that are legally available to everyone on their own: food and nutrients. Regulation has a role, but it should have be applied in a way that optimizes the health of our society, not the interests of one subset of providers.
Regulation is not necessarily detrimental in and of itself. There are ways it could benefit society and practitioners of varying training levels. Some approaches could include:
A law restricting the use of a title to those with specific training and experience,without criminalizing those who do not meet the specified qualifications, could:
- Clarify a standard of preparation and a scope of practice to inform the consumer
- Maintain a diverse and robust pool of qualified nutrition care providers
- Minimize government administrative and enforcement costs
- Nurture a competitive market and keep care affordable
- Increase access to care
- Promote jobs and foster healthy economies
A law that explicitly outlines the criteria for recognition of multiple professional disciplines within the field of nutrition, could:
- Preserve a diverse, quality nutrition workforce providing a range of complimentary services
- Allow for the possibility of insurance reimbursement for a diverse range of providers
- Equip consumers to make informed choices
- Nurture a competitive market and keep care affordable
- Increase avenues of and access to care
- Promote jobs and fosters healthy economies
PART 2: FIELD OF NUTRITION DEFINED
Each of the following groups fills a distinct and important niche in our healthcare system. We would be best served by ensuring the right of each group to practice nutrition within the scope of their training:
- Advance-degreed nutrition professionals with robust credentials
- Undergraduate-degreed nutrition professionals
- Professionals trained to use nutrition in other professional contexts, such as: Medical Doctors, Chiropractors, Naturopaths, Acupuncturists, Pharmacists, Nurses, Mental Health providers, Athletic Trainers, etc.
- Coaches and others from training programs in lifestyle and wellness coaching
There is a health crisis in America. Reducing the supply of qualified nutrition practitioners to protect one private trade association is a threat to public health, and the economy.
Skills, actions and knowledge that a broad range of providers are trained to apply to help people improve health or prevent illness, include:
- Health histories
- Dietary & lifestyle assessment
- Assessment for possible drug-nutrient interactions and drug-nutrient depletion
- Assessment to identify appropriate supplemental herbs, vitamins, and nutrients
- Laboratory tests to assess nutrient status
- Therapeutic diets
- Traditional, culturally based, healing diets
- Counseling (e.g. behavioral counseling, motivational interviewing, and goal setting as it relates to nutrition, food choices ,and physical activity)
- Individual and group education/training (e.g. outlining the relationship between food, body function, and health)
- Follow-up reassessment and monitoring for treatment efficacy and modification, where necessary
Many types of professionals are trained in these skills--no one sub-group should own the exclusive right to use them
Any healthcare professional that does not have a state license with a scope of practice that includes nutrition is threatened. In a state with exclusive scope of practice nutrition licensure, those other healthcare professionals would not be able to legally perform nutrition counseling unless explicitly exempted. Many professionals are potentially impacted:
- Athletic Trainer, Acupuncturists, Chiropractors, Naturopathic Doctors, Nurse Pracitioners, and Pharmacists
Laws vary significantly from state to state for the following professions with respect to nutrition care: Chiropractor, Naturopathic Doctor, Pharmacist, Acupuncturist, or Nurses.
- Nutrition providers (such as health coaches or nutritionists from non-accredited programs), herbalists, massage therapists, mental health professionals, personal trainers and others
In general these categories of practitioners do not have laws that explicitly allow them to practice nutrition.
PART 3: TAKE ACTION
Many states have nutrition laws that block qualified professionals from being able to provide nutrition care as the primary practice or block qualified professionals from using nutrition advice as a tool within another profession. In addition, bills are presented each year that attempt to change the existing laws to create further restriction in the practice of nutrition care by qualified professionals.
To protect your right to use nutrition tools in your practice: