Changes in Clinical Dietetics Due to Cost Reduction in Healthcare Systems

Abstract

: Cost reduction in healthcare systems may impact job design of clinical dietitians. Objectives of this qualitative study were to: (1) gather clinical dietetic experts' observations on clinical dietetic job changes, (2) identify visions to improve the professional level of medical nutrition therapy practice, (3) make recommendations on how to prepare students for improved practice, and (4) develop a questionnaire for a quantitative survey. An open-ended questionnaire was designed and sent to nominated clinical dietetic experts in eight states: ND, SD, ME, MN, IA, MO, WI, MI. Responses were sorted into meaningful groups. Selected clinical dietetic experts were interviewed by telephone to clarify their responses.Results indicated changes in staffing and clinical dietitians* activities. In some cases, numbers of clinical dietitians and managers decreased with an increased number of dietetic technicians. In other cases, clinical dietitians' numbers increased to meet increased service needs. Caseloads have changed to include more high-risk patients and outpatients. Results also showed redistribution of activities, efforts to decrease expenses and increase revenue, and changes in department structure and accountability. Suggestions for improving the professional level of dietetic practice included increasing clinical dietitians' capabilities and visibility, proving effectiveness of medical nutrition therapy, and strengthening financial status of dietetic services. Recommendations for educational preparation were increasing student awareness about all aspects of clinical dietitians' jobs (i.e., psychological and behavioral aspects of patients), expanding courses in didactic education, and improving internship programs (i.e., longer duration, more hands-on experiences). Results are the basis for a quantitative questionnaire developed to be field tested with a representative sample of clinical dietitians.