15 Lessons from a First-Year Private Practice Dietitian

Disclaimer: This article was originally published August 17th, 2020 on taylorwolfram.com.

One year ago I quit my full-time job to work for myself as a private practice dietitian. This first year of business included growth, big changes, some overwhelm, lots of questions, and most importantly – so many learning experiences!

I can’t believe it’s already been a year since I started working for myself full-time! It’s been a wild ride and as I write this, I’m on the edge of burn-out. It’s honestly tough to even sit down and write this. Are you ready for some real talk?

First: I missed my one-year milestone of working in my private practice full-time. I knew it was July 8 but I didn’t put that in my calendar. Because life is so bananas right now, that day was full of work and flew right on by without me noticing! I realized the next day that I had missed my one-year work anniversary when I was talking to my intern and explaining my career trajectory. “Oh, I’ve been working for myself for… one year and one day!”

After work that night, my first instinct was to jump up from finishing dinner and race to the computer to start drafting this blog post, rather than relaxing and celebrating my accomplishments (once I realized this I did close my laptop and pour myself a glass of wine). 

I used to have a really regular blogging schedule. However, my caseload has grown and I’ve cut back on blogging and spent more time in session with clients, on phone calls with clients’ therapists and doctors, dealing with insurance, in supervision, and taking training courses. So now that blogging doesn’t have a protected time in my calendar, I’ve got to fit it in on evenings and weekends.

Second: The fact that it’s so tough for me to find the time and energy to write this post is a big wake-up call that I need some time off. “But my clients.” “But my income” But, but, but. No buts! I preach self-care and time off for everyone else – why can’t I do it for myself? (Through some reflection with my therapist I’ve realized that us helpers can sometimes be the worst at self-care!)

Third: It’s been messy. I don’t have a clear road map to business and I’ve figured out a lot of things along the way. But I will be vulnerable and share my experience with you and what I’m looking forward to in year two!

1. Not All Work Has an Immediate Return on Investment

Lesson number 1: You’re not going to earn a “full-time income” right away. I knew this going in and before leaving my day job I crunched the numbers to make sure we’d be “OK” with me bringing in substantially less money compared to the full-time job I was leaving. I’ve heard various figures like “It takes at least 6 months to get your business running at full capacity,” and “It can take over a year to buildup a full client load.” Honestly, I think it’s different for everyone and I’m glad I didn’t measure myself against other people.

My motivation to work for myself wasn’t about money (I have many privileges that made that possible for me). It was about getting to do all the things I like to do (a mix of seeing one-on-one clients, blogging, freelance writing, consulting, social media, speaking, etc.) and having more flexibility with my schedule.

For the first several months my client load was about half of what it is now. I was blogging every week and I had a more consistent social media presence. I don’t make money from my blog or social media accounts, but they are building my online presence, increasing my SEO and acting as a marketing tool for potential new clients. I look at those time investments as long-term ROI because I’m not getting an immediate pay-out from them (versus seeing a client, you get paid for that time spent in session). Plus, I genuinely enjoy them!

Even though I wasn’t seeing clients or billing consultant hours “full-time,” I was working in my business full-time. I wholeheartedly believe in putting in that “non-revenue generating” work up front (i.e. blogging, social media, podcast interviews, etc.) to put yourself out there and build your brand.

It’s also important to note that I had been blogging and doing social media and even seeing a handful of clients on the side of my day job for years before I started working for myself full-time. So I wasn’t starting from scratch – I already had a following and online presence.

I’m glad I was patient with my slowly growing caseload and invested lots of time in blogging – I created some pretty dope blog posts and eased into my work as a nutrition counselor!

2. There is Value in Both Telehealth and In-Person Sessions

I’ve always been a fan of telehealth and had been seeing a few virtual clients for a handful of years before I quit my day job. When I started working for myself full-time, I decided to do a mix of telehealth and in-person sessions. 

Deciding which to do (or both) involves many variables and depends on your clientele, community, accessibility, etc. I was lucky that another HAES RD had an office in my neighborhood that she was renting out for a very reasonable hourly rate. I’ve been pretty conservative with spending money in my business and the biggest reason I didn’t lease my own office was because of the price (perhaps a newbie mindset – being afraid to invest much in my business – but so far so good).

That low-cost option of paying only for the time I was in-office with clients was a blessing and a really convenient way for me to dip my toes into in-person sessions. There are pros and cons to both telehealth and in-person sessions. I really like getting to see people in person and feel there is an added level of connection to the sessions. On the other hand, telehealth is super convenient for everyone, but also comes with tech issues and potential barriers with not being in the same room (especially when it comes to assessing clients with eating disorders). 

When COVID hit the U.S., I switched all my clients over to telehealth. It was a really easy transition for me because I already had my telehealth system up and running. Phew! (In case you’re wondering, here is a referral link to the system I use – SimplePractice). 

I do miss the option of seeing local clients in person, but I’m so grateful for a safe and accessible option for folks while we’re navigating a pandemic.

3. Becoming Credentialed with Health Insurance

Until April, I only worked with private pay clients, meaning my clients had to pay for our sessions out of pocket. This didn’t sit right with me because I didn’t want to only be accessible to people who could afford to pay for our sessions themselves. Especially since the work I do with clients is long-term and the cost really adds up!

The decision to contract with insurance was to increase accessibility of my services and build my caseload. And I totally underestimated how much it would grow my practice! Within a month I was operating at what I consider “full-ish” capacity (for me) and a couple weeks later I had to officially stop accepting new clients. I’m still learning how to balance my client work with my consulting and other work. I know some dietitians see fewer clients than me and many see more clients than me. It’s such an individual decision and only you can know the “right” number of clients to see in a week.

I’d heard that the credentialing process was arduous – which it was, but not as bad as I expected. What I didn’t expect was my cluelessness with filling out and submitting claims! I messed up a couple things in my first few claims that I am still trying to correct after countless phone calls and re-submissions. At this point I am just going to count my losses and move on. So, there’s definitely a learning curve with insurance but totally worth it in my opinion!

4. Managing the Financials

The not-so fun part of owning your own business is all the admin work. My practice is still relatively small and I do everything myself. I don’t have a biller or a bookkeeper. In the beginning I was really good at updating my books every month. And now I’m afraid to say that it’s been months since I’ve done it! I plan to get caught up soon and then get back to bookkeeping for my therapy practice. It helps it not feel overwhelming (versus trying to do a year’s worth at once), gives me important info to guide business strategy and makes it really organized come tax time. I’m lucky to be married to a CPA who set up my books and does my taxes so I basically just have to do data entry. Every business owner should have an accountant and if you’re not married to one, you probably need to hire one. 

5. Negotiating Rates

Speaking of finances, let’s talk about payment. Working for yourself means you probably have multiple revenue streams. And if you’re doing any sort of consulting or speaking, you have to discuss compensation. Which can be downright awkward. Especially if you’re not used to it and are taught to feel ashamed or guilty for asking to be paid fairly for your services and expertise. 

As for counseling rates, I’ve raised mine a few times over the years and have settled on rates that feel reasonable. I take into account my years of experience, the training I’ve invested in, and the kind of services I offer. Accessibility is always a priority of mine which is why I also take insurance and offer a couple sliding scale spots.

6. The Ever-Elusive Work-Life Balance 

Silly me thinking my work-life balance would improve when working for myself. I find that it can be really tough when you’re in charge of your own schedule, especially when you’re working from home. Creating schedules and setting boundaries that work for you are really important to protecting your energy and making sure you’re not working all the time. 

One thing that helped me pre-COVID was going to yoga classes on my lunch break – something I used to do when I worked in an office that was really critical to my well-being. Scheduling something after work, or at the very least putting an event on your calendar to end the work day, also helps me stop working “on time.” 

There is amazing flexibility and control that comes with working for yourself but if you tend to be Type A or an overworker, it can be a slippery slope into workaholism. Check in with yourself, set boundaries, and remember that the work will be there tomorrow. 

I know most people don’t work for themselves to be more stressed – so consider what it was about self-employment that attracted you in the first place and make sure you’re sticking to it!

7. My Biggest Private Practice Investments: Trainings and Supervision

I mentioned before that I don’t like to spend much money on my business but the two things that are always worth the cost are trainings and supervision. I’ve done body image and eating disorders trainings, attended conferences and workshops, participated in programs and paid for clinical supervision. All of these things are crucial to building effective counseling and business skills as a private practice dietitian. 

A note about supervision – if you haven’t heard of this, you’re not alone. I hadn’t heard of it until I entered the HAES space. It’s a shame that it’s not taught in dietetics training. Supervision is when you meet with a provider who is very experienced in a particular area and you discuss client cases, tricky situations, business dilemmas, etc. Supervision is required in other fields (such as psychotherapy) and it’s imperative for private practice dietitians, especially those working with folks with eating disorders. 

8. The Challenge of Learning When to Say No

This is probably my biggest, ongoing barrier. In the beginning of my practice I was saying yes to almost everything. I wanted to grow, grow, grow and get as much experience as possible. Then I realized I had to start saying no, and I did! Once my caseload was full I had to start saying no to new client inquiries. Once I had a few speaking engagements lined up I had to start saying no to other invitations. I’ve turned down numerous influencer proposals, book deals and collaborations because they didn’t align with my values, passions, goals or where I wanted to spend my energy.

However, I’m still dealing with some burnout and overwhelm and realizing I need to get even more serious about saying no. Perhaps the most difficult thing that I’m currently dealing with is really narrowing in on my ideal client. I feel the need to help everyone who asks for it and feel really guilty turning people away. However, through my own therapy and supervision I’ve realized that referring out more people is actually helpful for both of us. It keeps me doing the work I’m very passionate about and it directs folks to providers who are best able to help them.

9. Continuously Improving Counseling Skills

This is something I don’t think ever ends. I love that I’m in a field where I will always be learning and growing! I obviously learn from supervisors and trainings but perhaps my greatest teachers are my clients. I’m so incredibly grateful to get to hear their stories and support their work. Motivational interviewing is foundational to nutrition counseling and I also really enjoy parts work and internal family systems. I’ve got loads more counseling resources I plan on exploring to continue developing my skills to be the best practitioner I can be! 

10. Precepting Remote Dietetic Interns in Private Practice

I love working with dietetic interns! Yes, it takes time and energy. No, I don’t get paid for it. It’s rewarding and fulfilling and really wonderful to help educate the next generation of registered dietitians. Especially as someone in private practice who is also an intuitive eating dietitian and has expertise in veganism, I want to give interns the opportunity to learn more about this area of practice. I only wish I had this option as an intern!

I’ve precepted interns in previous jobs but never remote interns, which is what I do in my private practice. At first I was unsure how it would go, especially having interns observe virtual sessions. It’s gone relatively smoothly and interns are in dire need of remote supervised practice hours during the pandemic! If you’re an RD reading this, consider becoming a preceptor. If you’re an intern interested in intuitive eating and/or veganism and looking for a remote preceptor, shoot me a message!

11. Taking Time Off

I have no problem taking time off work for vacation. But during the pandemic when we aren’t traveling, it’s been non-stop work. Which is definitely contributing to my feelings of burnout. And I know I’m not the best counselor I can be when I’m feeling this way. I need time off for me but also for my clients! I’m happy to say that I have a week off scheduled at the end of August and have no travel plans! This is the first time in my life that I’ve taken time off work “just because.” I’ve literally never taken a staycation! I’ve been trying to challenge many problematic beliefs about work that have been ingrained by our capitalist culture, and taking time off for self-care is one form of resistance. 

12. Taking Breaks

Let’s talk breaks. When you work for yourself and the work is never-ending it can be tough to “justify” breaks. Thanks again, capitalism. Without in-person yoga classes to break up my day, I’ve been not-so-great at taking breaks from work. But every time I do, I feel so much better and I’m way more energized and productive when I get back to work. 

So whether it’s simply a stretch or a snack, or a leisurely walk or even a nap, make sure you’re keeping up with your breaks. Don’t wait until you’re dragging – make breaks a regular part of your schedule!

13. Communicating with Other Providers

Being in private practice can feel isolating. Collaborating with other healthcare professionals makes it feel less-so and is an important part of medical nutrition therapy, especially for clients with eating disorders. I have a few calls a week with various therapists so that we can share updates and make treatment decisions regarding our mutual clients. Some of those therapists are also my biggest referral sources! I love working with other providers and gain so many valuable insights from them. I have my clients complete a release of information form giving me permission to consult with their providers so that they can get unified care and know their team is on the same page. 

14. Private Practice Dietitian Friends are Invaluable

Working with other dietitians has been invaluable to my career and especially my work in private practice. From formal mentors and supervisors to informal peer supervision chats, emails and texts – I wouldn’t be where I am today if it weren’t for all the amazing dietitians out there I’m lucky to call my colleagues and friends!

Many of us struggle with the same issues and hearing that you’re not alone is so comforting. It’s also nice to know that not everyone has everything figured out either! Peer supervision has been especially wonderful for me – getting to hear client cases and business thoughts of other dietitians in the intuitive eating space is so helpful. 

And I’m especially grateful for my fellow anti-diet vegan dietitians and therapists who are navigating a niche within a niche and straddling two counter-cultural approaches – it ain’t easy!

15. Thoughts Going into Year Two

My biggest takeaway from my first year is the need for more strategy. I definitely led with a scarcity mindset and wanted to gain as much experience and as many opportunities as I could. Now that I’ve done that, I have more clarity on where I want to go.

I’m considering focusing my practice even more on vegan clients: helping folks separate diet mentality from their ethics, meet their nutrient needs without stressing about food, and fuel their bodies and minds for meaningful activism!

I’ve also been planning on creating a vegan nutrition course so that I can help more people than just who I can see for 1:1 counseling. It’s still in the early stages and if you’re interested in sharing what you’d like to see in an anti-diet vegan nutrition e-course, you can submit your input here!

I’m really excited about the trainings and supervision I’ve decided to invest in this year and know that they are going to give me the support I need to move forward in a strategic way that keeps my work aligned with my values and passions. Here’s to year two!