Is Nutrition Private Practice Right for YOU?
After years of being in private practice I can certainly tell you one thing – it is not for the faint of heart. You need to hustle, often put in long hours, multi-task like a mother, and really, truly believe in yourself in order to be successful in private practice.
Over the years, I’ve found that the practices of dietitians who “make it” don’t all look the same. They don’t all have the same degrees or specialize in the same area of practice, but they do share some common traits.
However, with that being said I don’t think there is just ONE character trait you need to possess to secure your success in private practice. I think there are actual many. And in all honesty, I personally feel you need to have most of the character traits I am going to describe in order to be successful in private practice.
If the traits I describe throughout this post hit you at your core – then high-five yourself all daylong. You are ready to dive into private practice. But if the below characteristics don’t describe you then I might seriously consider whether private practice is the best move for you.
The Reimbursement Dietitian’s Top Ten Character Traits and Skills Needed to be Successful in Private Practice
A Strong Why
Being successful in private practice is not only defined solely by financial gains but also by personal fulfillment. One of the most important things before deciding if private practice is right for you is to determine a strong why.
Why do you really want to go into private practice? What is your personal underlying motivation for wanting to run your own business?
This why should be the purpose, cause, or belief that drives you to seek out private practice as your career choice.
Here are critical questions to ask yourself in determining your why:
- What is my practice’s purpose?
- What is the bigger cause I am working toward?
- What is my core belief?
- Why do I get out of bed in the morning?
- … and most importantly why should anyone else care?
Rather than assessing what you are going to do, or even how you are going to do it. First determine exactly why you are going to do it.
Once you are clear on your why, then you will be able to clearly articulate what makes you feel fulfilled. When you can do that, you’ll have a strong point of reference for everything you do in your business going forward. You’ll be able to make more intentional choices for your practice, your career and your life. Therefore, when shit gets hard (and believe me sister it will!) your why will always be stronger than your will to quit.
I LOVE this Simon Sinek Ted Talk on exactly this topic, “Start with Why.” Before you do anything I would highly encourage watching this talk in is entirety. Take notes. There are tons of golden nuggets.
High level of self-discipline
In order to be successful in private practice you must have a significant amount of self-discipline. Remember you are the boss. No one tells you what to do. Which means YOU need to tell yourself what to do and actually do it.
The path to self-disciple in private practice starts and ends with a clear plan. You need to be careful and intentional with your time. This should include a comprehensive schedule that you stick to – as if your life depends on it.
While you obviously need to set specific times in which you will be counseling patients, you also NEED to block time for all the fun tasks of running a private practice. These include but by no means are limited to:
- Writing patient notes
- Requesting patient referrals
- Returning email and phone messages
- Marketing (Social Media, Website, Blogging)
- Designing new products/services/handouts for your business
- Continuing education (reading, conferences, webinars)
- Vacations & personal time
- Downtime to just stare a the wall
Get your time block on!
Another scenario we often run into in private practice are those tasks that are urgent but unimportant. If not managed correctly these tasks have the ability to fill a day and ruin your productivity. With time blocking, you can still drop what you’re doing and handle a true crisis if it comes up. But rather than letting the urgent distractions automatically win you develop the ability to make a conscious, thoughtful choice to do so. Talk about control girlfriend!
Dang you are SO smart!
It is not a surprise that being successful in private practice is riddled with inherent risks. While some risks can be minimized if you play your cards rights – others are down right unavoidable. However, at the end of the day the potential rewards must outperform the risks. If not then private practice should be a no-go for you.
Hasta Luego Benefits!
As a full-time employee you had the luxury of fringe benefits. These include health insurance, 403B and employer matching, paid time off and in some cases even tuition reimbursement. In the world of private practice all those luxuries disappear. If you want those things it is your responsibility to seek them out and front the bill.
There are risks no matter what alley you turn down. If your patients don’t show up for their visits you don’t get paid. That is not to say that you can’t charge them if they don’t properly cancel; however in order to make money in private practice you need to have a steady flow of patients. Also if you have a slow month; you still need to pay your rent and cover the cost of your utilities.
Aside from rent you also have additional expenses like liability insurance and start-up costs like purchasing your own computer, printer and fax. Additionally, small expenses such as toilet paper and paper towels for the bathroom, paper and toner for the printer and costs for your nutrient analysis software can quickly add up. Therefore, in most cases, you need to shell out money before you even start making money. Click here for more information on what expenses you should anticipate in private practice.
Don’t Quit your Day Job
When I started my practice I minimized my financial risk by continuing to work my full-time jobs. That is not a type-o: yes, I had multiple jobs. I worked both at Yale as a clinical dietitian as well as practitioner in residence teaching at the University of New Haven. My Yale job was part-time while my UNH job was considered full time. I received health insurance benefits from both jobs.
Due to the fact that my UNH teaching job was more flexible as my practice started to ramp up – I transitioned away from working at Yale. I worked for about two years just at UNH teaching and as well as in my practice. It was only when I finally out earned my combined salary of both UNH and Yale in my practice did I finally take the plunge and go all-in with private practice.
I also took calculated risks. Before leaving UNH I did my homework on health insurance. I examined all my options and knew exactly what it was going to cost me to insure myself and my husband. The same was true for my investments. I knew it was critical to keep investing in my retirement accounts so I hired a financial broker who walked me through transitioning my accounts from being employer supported to being self-employed.
But truth be told, I am by no means a superstar when it comes to taking risks. I try my best not to fear them and instead think of all the good that could potentially come from most investments. Also whenever possible I do my homework to simply minimize the risks.
If I can give you any advice to be successful in private practice it would be this – do your homework. Examine all the risks involved and make sure the benefits are in your favor. I was acutely aware of exactly what I was signing up for when I decided to take the leap and go and open my own practice. And I sincerely hope you take the time and necessary energy to educate yourself as well.
Open minded and flexible
Quick question. Do you start each day with the mindset that you are prepared to handle whatever might happen that day? Or does the prospect of unexpected events or circumstances leave you feeling anxious and uncertain?
By definition adaptability is the personality trait that helps determine how you respond to change. In private practice, like in life, shit happens. In order to be successful in private practice you must be flexible and able to adapt to your environment and its ever-changing conditions is critical. In fact to survive in private practice it is the only way.
I hate to say it but in private practice things never turn out as planned. Shit often hits the fan. Hard. Being flexible means not allowing yourself to feel hopeless and helpless in these situations. Even if you cannot change the situation you must develop the skills and ability to positively respond in a way that best serves your practice.
Never a dull moment
I remember quite vividly in October of 2015 the ICD-9 codes changed over to the ICD-10 codes. Foolishly, I did not think the change was happening. They had been talking about the switch for years. And despite the emails I received from the Academy describing the up and coming changes I did nothing. Not only did I do nothing. But for the whole month of October after the switch had gone into effect I billed about 160 claims using ICD-9 codes. And guess what? All of those 160 claims got rejected. Every. Single. One. Needless to say, not one of my best moments in private practice.
So, I only had two options. I could either ‘eat’ thousands of dollars worth of claims. Or I could teach myself the new codes (which might I mention are NOTHING like the old ones!) and manually reenter each claim. I chose the later.
Tighten your ponytail and get shit done
While the ICD code example represents a very trying moment in my career sadly it is only ONE of the many moments in my career as a private practice dietitians that I needed to adapt. When you anticipate uncertainty and adjust your attitude and expectations accordingly, changes don’t need to derail you. Instead, they become just another fun expected part of life. Dig your heels in. Fix your ponytail and get shit done.In
An A+ in organization
As a private practice dietitian we wear many hats. Name a hat and I betcha’ I have it in my closet.
Emails, phone calls, patient meetings, documentation to complete, obligations outside of work and just the normal everyday demands of life have a way of keeping us super busy. And the sad truth is this is never-ending. Therefore, you must stay organized in order successful in private practice .
Jack of all traders – master of none
And the sad truth is it is so stinkin’ easy to get distracted by things that keep us organized. In one of my favorite self-help books, The ONE Thing: The Surprisingly Simple Truth Behind Extraordinary Results by Gary Keller and Jay Papasan, the authors point out that as human beings, we kind of suck at multitasking. In fact, our productivity goes down when we try to do too many things at once. Sound familiar?
Kickin’ it old-school with pen and paper
Not surprisingly over the years I have implemented tons of different apps, systems and gadgets to help keep me organized along the way. But I have to say the only “system” I have kept with personally is a good old-fashion pen and paper.
I keep a master to-do list organized by categories in a notebook that I carry with me everywhere I go. An example of some of my categories are: private practice, finance, billing, teaching responsibilities @ Quinnipiac University, Crossfit responsibilities, personal finances, and my websites: Amy Plano.Com, The PCOS Dietitian.com and The Reimbursement Dietitian.
Then each time something new comes to mind I put it under the appropriate category. Then 1-2 times per week I time block my schedule based on the categories and list the items in order of priority that need to get done with the exact time and date in which I intend to execute them. I also place a sticky note on top of my list for random stuff that pops up that needs to get tackled before the day is done.
Does this system work perfectly? Not always. But it keeps me organized and focused on the important things that need to get done.
Automation the bestie you never knew
I have also gone to great lengths to streamline the tasks in my practice to keep me organized. Part of staying organized involves being efficient with your most precious commodity – time. One example of this is by creating ‘scripts’ for responses for commonly asked questions in your practice. This has been a game changer for me and I hope it will be for you as well. By having a prefabricated script I no longer need to type out each response for the questions I receive most often. I have instead created a script that not only answers the question but walks the patient step by step through the process if action is needed.
Please browse my products to purchase some of the commonly used scripts in my practice.
Hooray for Online Scheduling
Another HUGE game changer for me was moving my practice almost entirely to online scheduling. In fact, if you call my office phone no one will likely pick up. But you will get a very detailed message on what steps you should take if you are looking to make an appointment.
Visit my websites here and here to view how I have scripted this process. In addition, my scheduling system captures the patient’s demographics, insurance info as well as credit card. Therefore, we have everything in one location and don’t need to go chasing the patient down. Keeps my practice organized for sure!
Solid clinical skill set in your area of specialty
Having a strong clinical set in your area of specialty is critical to your success in private practice. When I state your area of specialty what I am really referring to is your niche. I am a huge believer of the importance of establishing a niche for your practice.
According to the smart peeps that wrote the Oxford Dictionary a niche is defined as the following:
“A specialized segment of the market for a particular kind of product or service.”
why is having a niche important
Having a niche is important because if you try to cater to everyone your overall marketing and message won’t speak to anyone. Your niche should be intimately tied to your ideal client. Not only does having a niche set you apart from all the other dietitians out there but it also allows you to narrow your focus for your offerings and services.
However, with that being said you MUST be clinically solid in your niche if you decide to pursue it private practice. You need to be able to hold your own as an expert in your area of specialty. You should know the ins and outs of the disease process, be super-duper familiar with all the diagnostic values as they relate to your niche as well as how to aggressively manage the dietary interventions.
My Niche – PCOS
One of my niches is polycystic ovarian syndrome (PCOS). During my tenure working as a clinical dietitian at Yale New Haven Hospital I was fortunate enough to work with the fertility center in creating a PCOS Clinic. I created the clinic from the ground up. Through the process I learned everything and anything about PCOS. Since then I have successfully counseled thousands of PCOS patients as well as authored a chapter in a textbook for physicians on PCOS. I am not afraid to say I know my shit inside and out when it comes to PCOS.
know your stuff
It is critical that you have a STRONG clinical background and some real world experience working with your chosen population. Whether that be working with eating disorders, athletes or Type 2 Diabetics. You cannot open a practice and cater to a population you want to work with but have very little experience actually working with.
do your homework
So once again do your homework. Ask yourself what am I passionate about? What population of crazy awesome patients do I absolutely LOVE working with?
But don’t rush it. If your background in this area is shaky – do whatever it takes to strengthen it. Read textbooks and case studies, seek out a mentor and beg/borrow/steal for supervision. Research any specialty training or certifications that might increase your knowledge base and skillset for your niche. Most of the major clinical focus areas do have certification programs. Getting certified only adds to your expertise and further distinguishes you as a boss in your area of speciality.
Do whatever it takes to gain the clinical insight and experience to become really, really, really awesome at your niche. Then and only then can you open a practice that caters to your specific population.
Being an awesome communicator is critical to the success in private practice. Communication skills are pretty much the prerequisite for everything you do in life and your practice is no exception. Communication is the foundation for all relationships. And forming killer relationships my friend are likely the single most important aspect of your business.
However, I am not just talking about your telephone skills – although those are SUPER important. I am speaking to ALL avenues of communication. From how you communicate with your niche in your marketing materials, the tone and vocabulary in your emails, the message and vision behind your brand, right down to your ability to clearly explain your practice’s policies to customers and clients and answer their questions about your products or services. How you communicate means everything to your business.
Here are some very useful communication skills for building a successful private practice:
- Active listening
- Understanding non-verbal signals
- Maintaining eye contact
- Assertiveness when appropriate
- Being super mindful of people’s individual space
- Using positive body language
- Dealing with different points of view. And lordy lord there are just SO dang many!
While many of these skills may be so obvious – I strongly believe they are critical and worth addressing. Take the important counseling skill of listening. What if rather than being an active listener you are a know-it-all and never let your patients get in a word edgewise guess what? Your patient retention will significantly suffer. You might be able to get the patients in the door; but where the magic happens is in the follow-up sessions. So, essentially in your desire to command the session you have shot yourself in the foot.
The less than obvious
However, with that being said some of the most important aspects of communication are actually not as self-evident. Surprisingly, it is actually your skill and ability to be self-aware that facilitate good communication. These include:
- Understanding the benefits of a positive attitude
- Awareness of how others perceive you
- Presentation – dressing appropriately for different occasions
Once again, I know none of these are shocking characteristics. However, I can almost guarantee if you suck at any of these communication skills your practice will suffer. I would also bet if you rock all the communication skills noted above then you will crush private practice. Having solid communication is that friggin’ important.
While I like to think of myself as a “reach for the stars” type of girl, if you want to succeed in private practice you need to set realistic expectations for yourself and your business. Growing a private practice takes a lot of hard work and time.
Starting a nutrition private practice is much more than hanging up a sign and sitting down with patients. Dietitians who are successful plan a realistic start-up budget for their new practice, recognizing that they will have initial start-up costs as well as ongoing overhead costs. They know it will take time to build their ‘book’ and therefore their income. They are realistic about initial income expectations. They are also realistic about how hard they will have to work (especially in the beginning years) to get their practice established.
Questions to ask yourself:
- Do you have a game plan to cover expenses if your income from patients isn’t sufficient to meet your rent obligation or other items in your budget?
- Do you know how many hours a day you are prepared to invest in your practice?
- Are your friends and family prepared to support the time and financial investment you will make in your practice?
I feel like I could go on and on about the different expectations and how to handle each situation. However, in the end just know it will take time, passion, money and fortitude to succeed in private practice. By setting realistic expectations you will make the journey much more enjoyable. I promise!
Self-motivation is, in its simplest form, is the force that drives us to do some pretty awesome things. In order to create a thriving nutrition private practice that you love and are proud of you must be self-motivated. Motivation is what pushes us to achieve our goals, experience fulfillment and improve our overall quality of life.
Skills involved in self-motivation often include many of the traits we have already addressed:
- Setting high but realistic goals
- Assuming the right level of risk
- Seeking constant feedback to work out how to improve.
- Actively seeking out opportunities that excite you
- Being able to deal with setbacks and adapt in spite of the obstacles
When discussing change with patients, an common expression you may have heard is, “If not YOU, then who?” “If not NOW, then when?” These motivating prompts also apply to you when considering private practice as a career option.
Remember you are the boss
That big dream of yours in opening a nutrition private practice that’s yours. Got goals? I know you do! But guess what? They belong to YOU– not me. There is no one but YOU to crush the goals of your practice. If YOU don’t pay rent on time, YOU suffer the consequences. If you don’t keep up with billing, YOU don’t get paid. If you don’t keep up with your tasks of running your practice, no one will nag you. But if you are one who feels some anxiety about going home at the end of the day without your regular duties completed, it is likely that you have a degree of self-motivation.
Furthermore, self-motivation is also necessary for promoting your services. Even though you may be an introvert, do you have the motivation necessary to make the appropriate contacts to promote your business?
Therefore, I challenge you to ask yourself the questions: if not YOU, then who? If not NOW, then when? I think you know the answers.
One of my favorite sayings is, “You either think you can or you think you cannot – you are right either way.” Well, as you can imagine, I thought I could and not one nanosecond to this very day have I thought otherwise.
In life you get what you expect. If you expect you can do something — guess what – you probably can. Leaning in and taking that first step is always the hardest but just like jumping into a cold ocean – once you are in your eventually get used to it.
When you’re working on something important, is always going to feel like you are not ready. As you embark on this new and exciting journey you’re bound to feel uncertain, unprepared, and unqualified.
But let me assure you of this: what you have right now is enough. You are so much stronger than you even think. And like a typical RD, you can plan, delay, and revise all you want, but trust me, what YOU have NOW is good to go.
Okay my friends – that’s a wrap! So just to recap here are the top ten character traits and skills I honestly feel you NEED to be successful in running a nutrition private practice:
- A strong why
- High level of self-discipline
- Risk taker
- Open minded and flexible
- A + in organization skills
- Solid clinical skill set
- Awesome communicator
- Realistic attitude
- Unwavering self-confidence
Geez – Louise! I know it seems like a lot. But I promise you it really isn’t. Master these traits and skills and I assure you will be well on your way to creating that private practice of your dreams.