Healthie is excited to speak with Ann Silver, MS, RD, CDE, CDN, and Lisa Stollman, MA, RDN, CDE, CDN, authors of Making Nutrition Your Business: Building a Successful Private Practice (2017).
This private practice resource guide is described as a “complete ‘roadmap’ to beginning and maintaining a nutrition-based business.” Learn how to structure your business, manage your money, use technology to your advantage, get clients to return, and more!
We learned so much from these private practice gurus on building a successful private practice and hope you do too…
Healthie: What influenced your decision to become a dietitian?
Lisa: When I was a teenager, I developed a passion for cooking and healthy food. I read a book by well-known nutritionist Adelle Davis and became immersed in the field. I learned everything I could about nutrition from popular books. And then I went to college!
I loved that the field can focus on prevention, outside of the clinical setting. I really enjoyed working in hospitals but love having flexibility, creating my own business, and helping individuals prevent disease before it occurs.
Ann: I didn’t know what I wanted to do when I graduated high school, so I started taking courses at community college. I fell in love with biochemistry. My advisor introduced me to the nutrition director at Buffalo State College, and I went through the coordinated program.
Healthie: Tell us about your career journeys.
Ann: I started my career in the hospital. First at the Mt. Sinai Medical Center in New York City as a staff dietitian and climbed the management ladder to be the Assistant Executive Dietitian. From there I became the chief dietitian at North Shore University Hospital in Long Island, New York, but still saw patients in an outpatient setting too. When I moved out east [to Sag Harbor, New York] with my husband, I worked in long-term care, and dabbled in private practice on the side. When my contract in the long-term care facility terminated, I decided to start a new chapter in private practice… and that was many years ago!
When I got started in private practice, dietitians weren’t recognized as third-party providers, with reimbursable services from insurance companies. I had to really pursue becoming in-network with one insurance company at first, when I saw a colleague do it. Then, I was able to use one company as a platform to become in-network with other insurance companies. I had a really good understanding of insurance. So much so, I became the reimbursement chair for New York State.
I started my practice in my husband’s dentistry office. But since I lived in a resort area, I realized I had to go to people, because they weren’t coming to me; so I ended up with offices in East Hampton, Amagansett, and Riverhead.
My area of expertise evolved with my experiences. I furthered my education to include more motivational interviewing and improve my counseling skills, which helps with eating disorder clients and nutrition therapy in general. When one insurance company required my becoming a CDE I expanded my practice to treat patients with diabetes. Now, my practice is a combination of weight concerns, diabetes, eating disorder clients, and everything else.
I also teach part-time and am involved in many volunteer groups and projects with the Academy.
Lisa: Before I started college, I knew I wanted to have a private practice. I started working in hospitals because my professors always said that you have to have a good clinical background to be in private practice, and I do agree with them.
I worked full-time in the hospital while I started my private practice part-time. About eight years after that, I left my hospital work and have been in private practice ever since. I work with a variety of clients in my private practice, but mostly weight management and diabetes.
Now, I do other things too: I see patients about 20 hours per week, but also do a lot of writing, and work with several start ups, and I’m developing my own.
Healthie: What’s one piece of advice you wish someone had told you before you started your business? One piece of advice for nutrition students or dietetic interns?
Lisa: If you want to have a varied practice and be able to see a wide range of people, it’s good to have a clinical background. Even if you just work in a hospital for 1-2 years, full- or part-time, just to get that clinical background. I don’t think straight from college you can see a wide-range of patients with various medical issues [in private practice]; you’ll likely just see weight management clients, which is fine, but you’re limited because, quite often, individuals with weight issues have other issues.
Ann: So many things come to mind, in terms of gaining experience. You need to be a really quick detective to get to the bottom of things. As a provider, being able to think on your feet is imperative. Remind yourself clients need us when they’re at their worst.
Lisa: Often you just need to listen to the patient, so you can put all of the pieces together and determine how to help them. Sometimes it’s just motivational interviewing so the client can come to realizations on their own, and you don’t even have to say it!
Ann: You know, to answer this question, one of the most important things that we as providers need to do – whether you’re just starting out or have been practicing for umpteen years – is listen to your patients. Take the lead from the patient. It’s their agenda. Over time you will get to discuss it all.
As business owners and dietitians, don’t give patients everything at the first visit. You don’t know everything about the patient yet! Don’t overwhelm your clients at the first visit! Give them small things they can work towards, which keep bring your clients coming back, and leads to more follow up visits.
Lisa: Yes, definitely. Don’t overwhelm them. Work on one thing at a time.
Healthie: What is your top tip for budding nutrition entrepreneurs?
Lisa: Find what you’re passionate about, because you need to put everything into it, and want to find something you love.
And today, you can do it all virtually, you don’t need an office, you don’t need to take insurance (although it may take a little longer to build a successful practice). The nice thing about working virtually is that you’re not limited to your local area; it’s really global! Plenty of people realize nutrition is important, so you have to find them! Plus, you have to be a people person, to connect with people.
Ann: Really do your research about what you’re doing, talk to a lot of people, gather information and plan it out so you have an action plan. Have a niche and be unique. Specialize! Even super-specializing can push it further. And be creative; you really have to be very creative to make it! So there’s a lot of top tips!
One word of advice – don’t step on a colleagues’ toes; be respectful. You can do something similar to others, but do it in a respectful way. We all need to work together; we are in a very small field! Be willing to share. Help people, and be nice! That’s one of the reasons I wrote this book and put everything in it – it’s everything you need to know, and then some! I wanted to share and give back to the profession, to help others getting started!
Healthie: In your experience, what is the biggest obstacle nutrition entrepreneurs face?
Lisa: When starting out, it can be hard for nutrition entrepreneurs in private practice to have a steady stream of clients. I suggest having a variety of revenue streams, so you’re not just counting on patients. If you have a full-time or part-time job, don’t leave it until you are financially on your feet with your private practice. Keep yourself busy and stay connected, so people know you’re there – on social media or in your local community. You want people to think of you.
Ann: Getting clients and keeping them. It’s one thing to have a beautiful space, but if you don’t have someone sitting in the chair, or virtually on the other side of your connection, you don’t have a business. So do some marketing and figure out how to get people to come to your office – wherever it is!
Another common question I receive is, “How do I set my fee?” So, I came up with a formula, which is in our new book. This formula helps practitioners figure out how much to charge. One thing we need to be careful about in fee setting is that you cannot charge insurance companies more than self-pay or vice-versa. Determine your fee based on the number of units, since that is how insurance companies are billed for MNT. Whether you accept insurance or your practice is self-pay, charge the same for each unit. Even if you don’t accept insurance, it is good to know about it because you personally have insurance and the more you learn about it, the better you will understand it!
Healthie: What is 1 thing that surprised you when running your own practice?
Ann: Many people think when they go see a dietitian, it will be really fast, a 1 visit thing, and done. Many clients think we have a magic wand to shower them with and they will be done with our services. They don’t realize it takes a long time.
Lisa: Also, how many people aren’t referred for nutrition when they should be! I have many people come to me who have had an issue for years, and they are never told to see a dietitian.
We can do so much as dietitians, and we are so underutilized.
Many chronic conditions we see can very possibly be prevented if they were to see an RDN. We all need to band together to let health care providers and consumers know that many diseases are self-imposed and they have the power to do something about it. It’s not just genetics!
Doctors don’t refer enough. And even insurance companies; for some, you have to have a diagnosis of diabetes to be covered, and patients aren’t covered if they “only” have pre-diabetes.
Healthie: How do you think technology is changing the field of nutrition?
Ann: Technology is totally changing everything! My whole practice is in my computer! When we first started, everything was paper. Technology is totally impacting the field. The fact that we can do virtual visits, everything is in an EHR and in the cloud. Who knows what the future is going to bring? Only that things are going to continue to change as technology changes!
Lisa: Social media is giving a new way to connect with clients. I don’t connect yet with my clients on Facebook, but on Twitter and Instagram, I do. For clients to send pictures of their meals is really great!
Social media and technology are really changing the landscape – there’s so much more you can do!