This week, we’ve been asked to give our insight on the difference between clinical and private practice dietetics. So, to get the ball rolling… Let’s just start by saying there is no difference! As a private practice dietitian, you are STILL providing valuable clinical advice. Assuming that most people mean a hospital setting when they talk about “clinical dietetics,” the real question here is what is the difference between the two environments?
Whilst there are many major similarities between the two, what you should do for your dietetics career comes down to what you value and what it is you want to do with your clients. Long story short, if you love working with a close-knit team, often under extremely acute conditions, then you might thrive in a hospital setting. However, if you appreciate autonomous work, being a part of somebody’s health journey and emphasise the relationship you have with your clients, you are probably going to feel more fulfilled in a private practice setting.
However, that just skims the top of the two working environments for a dietitian. Let’s delve a little deeper into the key differences.
So, as we said earlier, if you love working with a close-knit team and perform well in acute situations, you are most likely the ideal candidate for a hospital job. There is a good chance you will be working in a single ward (on a 6- or 12-month rotation) as a part of what is known as a “treatment team”. Meaning that, there might be a doctor who is leading the treatment plan. As well as nurses and other specialists like yourself all working together towards one/several patient’s recoveries.
Support can be abundant in these environments as you can interact with the other clinician’s face to face, immediately. However that is not always the case as dependant on the hospital this ability may not exist, or other dietitians may not be interested or have time to support you while also achieving their responsibilities and workload.
That being said, when it comes to making dietary recommendations, hospital environments can be restrictive. It can’t be guaranteed that your recommendations will take priority as the Medical Officer/Doctor and you are limited to the foods supplied by the hospital. Sometimes this might extend to what the family brings in – which is generally sweets/chocolates, although I have seen the odd KFC feast).
At the end of the day, hospital dietetics can often be about providing a band-aid solution to see your patient released from the hospital as soon as possible – rather than necessarily trying to achieve a long-term goal and lifestyle change. Don’t get us wrong, that band-aid could be a VERY valuable, essential and clinically complex band-aid to apply. Your input has the power to truly saves someone’s life, but also improve patient outcomes and decrease the length of stay in hospital (which is always a priority).
It is also much more difficult at times to build relationships with clients, or even talk to clients (e.g. ICU and TPN). Thus your clinical knowledge, experience and competency on a particular topic/disease/conditions can become very high but your counselling skills may suck.
Private Practice Dietetics
As for private practice, this is where you can further exercise your compassion as a dietitian and connect with the people you are working with. First, they have chosen to come and see you (and to continue seeing you), so in most situations, they WANT your help. Now yes, some people will want your help more than others, and some clients will say they are only seeing you because their doctor told them to. However, they are still there, available in front of you to motivate them towards the achievement of their goals.
You actually may deal with a lot of the same conditions as a hospital, however, the day to day is going to be more varied and the clinical complexity is different. In private practice, you often are faced with these rare conditions and compounding chronic conditions that you have to manage and treat at the same time. Whereas, in a hospital, there is usually one main clinical indication you are faced with to treat. You might handle a client who has malnutrition and anorexia (loss of appetite) in both settings… however, in private practice, it’s probably more likely that they are looking for ongoing guidance in line with their lifestyle and normal eating habits for the prevention of ongoing malnutrition and recommendations to combat their anorexia. Rather than the possible need for a period of enteral feeding in the hospital to get them back into the community.
Working in private practice also provides more of an opportunity to educate your clients on nutrition and why you are providing your recommendations. Though, with this comes the importance of performing well and providing a great service to your clients. As they are seeing you because they WANT to learn and they WANT to make a change, if you aren’t facilitating those things, you may see a decline in your client base.
Another large component of private practice versus inpatient hospital dietetics is the increased need for substantial and ongoing counselling with clients. The relationships you build with your clients are an essential component of success – both in achieving positive clinical outcomes for your patients but also positive relationships. Achieving this is the only way you will succeed in private practice and see clients on an ongoing basis. Versus a hospital where you are guaranteed to have clients coming through “your door” consistently.
The big one that always comes up is the support available to individuals in private practice. In private practice, you are generally autonomous, in clinics with clients by yourself. You would generally never consult a client as a team, and you need to make decisions on the spot.
Working in private practice can be incredibly isolating if you don’t have a team you can reach out to and connect with. You also can have much less opportunity for an assessment of your growth and development from more experienced, skilled and knowledgeable practitioners – especially if you are working for yourself. That is why we always recommend that if you want to work in private practice as a new graduate, work for someone else that can provide you that support, don’t go out on your own. We have seen it time after time. Your development suffers exponentially without things like someone shadowing you, providing clinical feedback, weekly/monthly clinical case studies, professional development etc.
All in all private practice is generally where there will be a much broader scope of work and less acute. However, you need to develop and hone your counselling skills to get the greatest achievements for your clients and to maintain a client load in private practice.
As you can see there are several different aspects to consider when comparing the two dietetics environments. What it boils down to though, is your skillset, why it is you want to be a dietitian and what you want your day to day to look like. I know we could talk about this in 12 other ways – such as job prospects, salary, opportunities when the security of PP actually trumps hospital dietetics and much more.