Raising the Educational Requirement for Entry into the Profession of Nutrition and Dietetics: What Does the Evidence Show?

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1 Raising the Educational Requirement for Entry into the Profession of Nutrition and Dietetics: What Does the Evidence Show? Ana Abad-Jorge, EdD, MS, RDN, CNSC NDEP Region 6 Director Nutrition and Dietetic Internship Program Director University of Virginia Health System Food & Nutrition Conference & Expo October 21, 2013 I. Case for a Graduate Degree for Entry into Nutrition & Dietetics Background History a. Healthcare professions have experienced significant changes in: Nutrition and medical science Healthcare delivery and technology Society, culture and demographics b. Despite these changes, the pathway for entry-level education for individuals entering the profession has not changed significantly since c. A bit of recent history.. Dietetic Education Task Force (DETF) 2005: that the Commission on Dietetic Registration (CDR) require a graduate degree for eligibility for the CDR registration examination for registered dietitians and professional entry into dietetics practice. DETF 2006: The dietetics profession and the education of its future practitioners must keep pace with the ever demanding needs of patients, clients, students and customers in order to: a) Thrive in the challenging landscape of healthcare delivery, b) Meet public health challenges, and c)meet professional growth and advancement needs of its members II. Importance of Graduate Level Education in Nutrition & Dietetics (Council on Future Practice) a. Advancement Many view dietetics as an entry-level profession with limited advancement. b. Compensation - Compared to other healthcare related professions, a significant disparity exists between level of education of nutrition and dietetics professionals and salary. c. Credibility and Professional Image - Confusion still exists about the precise role and our educational preparation; often not seen as science-based like medicine, pharmacy, PT. d. Professional autonomy While RDs do have licensure in most states, they still do not have independent prescriptive authority or full professional autonomy when providing inpatient or outpatient medical nutrition therapy. III. A Look at Other Health Diagnosing & Treating Profession (Bureau of Labor Statistics) a. They have kept pace with the expansion in medical science, healthcare practice, and delivery by expanding their pre-professional educational requirements: Doctorate: Physical Therapy, Pharmacy, Audiology (SLP) Master s: Physician s Assistant, Occupational Therapy, Speech Language Pathology b. So.what has held Nutrition & Dietetics back? Our profession is very broad, essentially including various divergent and separate professions under the same professional group: clinical, foodservice, community Our professional culture is one where many do not challenge the status quo and we are risk adverse (Council on Future Practice, 2010).

2 Profession s membership cannot reach agreement or consensus on this issue despite decades of deliberation on this topic IV. Educational Requirements in Health Diagnosing & Treating Professions: Skipper & Lewis, 2005 Profession Entry-Level Credential Post-Secondary Didactic Education College Education Dietitians & RD, RDN Nutritionists Occupational Therapists MS or OTD Pharmacists Pharm D Physician Assistants PA (Require a MS or a Doctorate Physical Therapist DPT Speech Language Pathologist MS, Speech & Language Pathology V. Average Health Care Professional Salary (Payscale 2011) Profession Average Annual Salary Required Years of Education Pharmacist $94,500 - $105,900 8 Physician Assistant $72,200 - $93, Nurse Practitioner $70,800 - $91, Physical Therapist $58,400 - $75,900 7 Occupational Therapist $47,100 - $62,200 7 Registered Nurse $40,500 - $59, Registered Dietitian $38,800 - $51, VI. What is the current education level and practice area of Entry-Level RDs? Source: Entry-Level Practice Audits (Rogers & Fish, 2006, 2010) a) 2005: 31% of entry level RDs had master s degrees b) 2010: 39% of entry level RDs had master s degrees c) Another 12-15% were enrolled in a degree program, most often being a master s degree d) 55-60% of all entry-level RDs are: Clinical dietitian: Inpatient and specialist Outpatient dietitian: General & specialist Clinical dietitian: Long term care Source: Entry Level Practice Audit (Rogers & Fish, 2006, Wards, Rogers, Mueller et al, 2011) VII. Implications for Future Research: Review of the literature reveals a lack of data with regard to the relationship between Entry-Level RD Level of Education and a. Job & Career Satisfaction b. Professional Involvement c. Research Involvement d. Contribution to the profession

3 Educational Requirements for Entry into the Profession of Nutrition and Dietetics: A Comparison of Job Satisfaction and Professional Involvement Between Entry-Level RDs With and Without a Graduate Degree Ana Abad-Jorge, EdD, MS, RDN, CNSC ABSTRACT Background: The profession of nutrition and dietetics has experienced significant changes over the past 100 years due to advances in nutrition science and healthcare delivery. Although these advances have prompted changes in educational requirements in other healthcare professions, the requirements for entry-level registered dietitians have not changed appreciably since The bachelor s degree requirement has remained the same, for example, due to the profession s roots in hospital foodservice. This lack of effective preprofessional education for registered dietitians has limited compensation, advancement, autonomy, and recognition. Objective: This study investigated the case for a graduate degree requirement for entry into the profession. Educational policy changes across other healthcare professions served as the conceptual framework for this study. The guiding research question related to the impact of attaining a graduate degree on entry-level practice on job satisfaction as measured by the validated Job Satisfaction Score (JSS) instrument, on professional involvement as measured by the Professional Involvement Marker (PIM) score, and on compensation. Design, Sample and Statistical Analysis: The study used a quasi-experimental design using a survey comparing entry level RDs with a master s degree to those RDs with a bachelor s degree. Survey data were collected via from both bachelor s- and masters-level entrylevel registered dietitians (n = 96) and were analyzed using both descriptive and inferential statistics, including Chi-square, t test, and ANOVA. Results: The results indicated that entry-level registered dietitians with a master s degree had significantly higher job satisfaction, and professional involvement (p < 0.05) and a trend towards higher compensation. Raising the minimal entry-level educational requirements can lead to significant social change by promoting greater career satisfaction, recognition, and compensation for dietitians, as seen with other health diagnosing and treating professions, as well as a higher level of nutrition expertise and quality nutrition services provided to the public. Note: For detailed copies of Research PPT, Ana at ara6t@virginia.edu

4 VIII. Future Directions for Nutrition & Dietetic Education..Moving Forward a. Timeline for Educational Change: September 6, 2012 Visioning Report released to House of Delegates (HOD) and our Academy Membership and feedback solicited October 5, 2012 HOD conducts dialogue session on Visioning Report January 17 19, 2013 Joint Meeting with ACEND, CDR, CFP, Education Committee and NDEP to discuss feedback from Visioning Report and work towards development of a Consensus Statement March 2013 Consensus Statement developed from Joint Meeting sent out to Program Directors and NDEP Members June 12, 2013 CDR sends to all Program Directors and NDEP Members reporting January 1, 2024 as the deadline for the graduate degree registration eligibility requirement b. Academy of Nutrition and Dietetics Joint Meeting (January 2013) 8 Design Principles Priority is protection of the public Desire career continuum for the profession Greater expertise and more focused areas of practice at higher levels of the continuum Preparation for future practice at different levels Flexibility for educational institutions to pursue various models and approaches; support for educators Transparent process inclusive of perspectives of different stakeholders Evolutionary process of change ACEND and CDR must maintain their accreditation and credentialing standards c. Consensus Statement from Academy Joint Meeting Key Groups: ACEND - Accreditation, CDR Dietetic Registration, Council on Future Practice (CFP) and Nutrition & Dietetic Educators & Preceptors (NDEP) A graduate degree which integrates supervised practice into the curriculum will become the entry to Registered Dietitian (RD) or Registered Dietitian/Nutritionist (RDN) practice in the future upon successful completion of an examination based on a practice audit IX. Future of Nutrition & Dietetics Programs: Options for Transition to Graduate Degree a. Option I: Expand current Coordinated Undergraduate Programs in Dietetics (which already include the supervised practice component) into a Coordinated Master s Program; 4 year 5 year program b. Option II: Expand stand-alone dietetic internship (DI) pro-grams to include a M.S. degree; 8-10 months months University based programs, i.e. Virginia Tech DI Program Hospital or medical center based program affiliated with a University, i.e. UVA Health System DI Program c. Option III: Affiliate current stand alone internship programs with an established university based Master s program in dietetics, i.e. UVA Health System DI Program affiliates with the Master s program in Nutrition at James Madison University

5 X. Our Proposal for University of Virginia Health System Nutrition & Dietetic Internship a. Option IIb: Expanding the current UVA Health System Nutrition and Dietetic Internship Program into a combined Master s and DI Program in collaboration with UVA s School of Continuing and Professional Studies (SCPS) b. Proposal Contains the Following Elements: Executive Summary Program Market & Opportunity Program Background & Approach Request for Funding Project Development Needs and Timeline Reference List 1. Canter, D.D. Dietetics education: Past, present and future. In: A.S. Block, J. O Sullivan Maillet, W.H. Howell and M.F. Winkler, (Eds). Issues and choices in clinical nutrition practice. Philadelphia: Lippincott, Williams & Wilkins; Bureau of Labor Statistics. Health diagnosing and treating practitioners. In: Occupational Outlook Handbook Washington, DC: US Department of Labor, Bureau of Labor Statistics. Retrieved on April 17, 2011, 3. Skipper, A. and Lewis, N.M. A look at the educational preparation of the healthdiagnosing and treating professions: Do dietitians measure up? Journal of the American Dietetic Association, 2005; 105 (3): American Dietetic Association. Dietetics Education Task Force Report and Recommendations. Dietetic Educators of Practitioners DEP-Line Newsletter, 2005; 27(1): 1, American Dietetic Association. Dietetics Education Task Force Report. Dietetic Educators of Practitioners DEP-Line Newsletter, 2006; 28 (1): 1, Council on Future Practice. Issues identified for the Summit of Future Practice, Education and Credentialing, Chicago, IL: American Dietetic Association; Rogers, D. and Fish, J.A. Entry-level dietetics practice today: Results from the 2005 Commission on Dietetic Registration entry-level dietetics practice audit. Journal of the American Dietetic Association, 2006; 106(6): Ward, B., Rogers, D., Mueller, C., Touger-Decker, R. and Sauer, K.L. Entry-level dietetics practice today: Results from the 2010 Commission on Dietetics Registration entry-level practice audit. Journal of the American Dietetic Association, 2011; 111 (6): Academy of Nutrition and Dietetics. Compensation and benefits survey 2011: Moderate growth in Registered Dietitians and Dietetic Technician, Registered, compensation in the past 2 years. Journal of the Academy of Nutrition and Dietetics, 2012; 112 (1): PayScale. Median Salaries by Job. Retrieved on March 6, 2013, Council on Future Practice. (2012). Council on Future Practice Visioning report: Moving forward a vision for education, credentialing and practice. Chicago, IL: Academy of Nutrition and Dietetics. 12. Rhea, M., & Bettles, C. Future changes driving dietetics workforce supply and demand: Future Scan Journal of the Academy of Nutrition and Dietetics, 2012; 112 (3), Supplement 1, S10-S24.