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Career Talk: Where do DTRs fit into MNT and Licensure?
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02/25/12 02:14 PM | Edit ReplyReply   |    Where do DTRs fit into MNT and Licensure?
NourishMe
113 Posts

Educator

Almost all I hear or read about has to do with dietitians. Most jobs are for dietitians and MNT reimbursement is only for dietitians! Almost...

Minimum education requirements to be a DTR is an Associate's and 450 hrs of practice experience. However, as someone that is in "the middle", having the Bachelor's DPD verification statement, but not the internship (have some supervised work experience) and am pursing my Master's, I have long felt there should be more than 2 credentials from AND/ADA, and not simply "allow the opportunity to become a DTR" to Bachelors/Master's DPD graduates, particularly considering the lack of publicity and jobs availabe to DTRs.

Now that they have changed the name from Dietetic Technician to Nutrition Technician, Registered, I still don't hear much else on including this nutrition professional in licensure laws. Yes, some laws have included them as exemptions, but AND isn't fighting for licensure of DTR/NTRs! Subsequently, DTRs (and CDMs) are not eligible for MNT reimbursement, even though they are trained to provide nutrition care services under some areas of MNT.

The link below covers a ruling that denied a (male) DTR the ability to be considered a "nutrition professional" for purposes of being a Medicare approved provider, and thus receive Medicare reimbursement of MNT services. http://www.hhs.gov/dab/decisions/civildecisions/cr2377.pdf

Up until a few months ago, I was always under the impression that only RDs (again no word of DTRs) were eligible to provide MNT, but have since learned that it depends on your state licensure laws of RDs and Nutritionists. Thus, Licensed/Certified RDs and Nutritionists can provide MNT, but not DTR/NTRs (or CDMs). See below for requirements:

"For Medicare Part B coverage of MNT, only a registered dietitian or nutrition professional may provide the services. “Registered dietitian or nutrition professional” means a dietitian or nutritionist licensed or certified in a State as of December 21, 2000 (they are not required to meet any other requirements); or an individual whom, on or after December 22, 2000:

• Holds a bachelor's or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics, as accredited by an appropriate national accreditation organization recognized for this purpose. The academic requirements of a nutrition or dietetics program may be completed after the completion of the degree;

• Has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional. Documentation of the supervised dietetics practice may be in the form of a signed document by the professional/facility that supervised the individual; and

• Is licensed or certified as a dietitian or nutrition professional by the state in which the services are performed. In a state that does not provide for licensure or certification, the individual will be deemed to have met this requirement if he or she is recognized as a “registered dietitian” by the Commission on Dietetic Registration or its successor organization, or meets the requirements stated above." http://www.wpsmedicare.com/part_b/policy/active/national/_files/phys041.pdf

http://cfr.vlex.com/vid/410-134-provider-qualifications-19805887

This is an incredible disservice to DTR/NTRs and does not at all support growth of the dietetics profession, especially with future shortages of dietetic/nutrition professionals, and would love to hear from others, in particular DTRs, on this issue.

Thanks!

[Edited by NourishMe on 02/25/12 02:27 PM]


"Be the change you want to see in the world."

02/25/12 02:35 PM | Edit ReplyReply   |    No
GRD
1001 Posts

Registered Dietitian

I politely disagree. DTRs do not have the education that an RD, even an entry-level RD, has. One can hold an Associates degree and become a DTR; a couple community colleges in my area offer a DTR program. DTRs for all intents and purposes are "dietary aides" - they're a step above diet office personnel but way below the level of an RD in reference to being utilized in a hospital setting. An RD can do everything a DTR does, but a DTR can only do a fraction of what an RD can. I do not know how DTRs are utilized in the community setting, so I cannot comment on that, but I see very, very few jobs specifically looking for DTRs; actually, I don't think I've seen anything posted in my area for a couple years.

To allow a DTR to perform MNT would be a set-back for the profession, as the in-depth level of education/training is not required.

02/25/12 04:01 PM | Edit ReplyReply   |    RE: No
NourishMe
113 Posts

Educator


    Posted by GRD:
    I politely disagree. DTRs do not have the education that an RD, even an entry-level RD, has. One can hold an Associates degree and become a DTR; a couple community colleges in my area offer a DTR program. DTRs for all intents and purposes are "dietary aides" - they're a step above diet office personnel but way below the level of an RD in reference to being utilized in a hospital setting. An RD can do everything a DTR does, but a DTR can only do a fraction of what an RD can. I do not know how DTRs are utilized in the community setting, so I cannot comment on that, but I see very, very few jobs specifically looking for DTRs; actually, I don't think I've seen anything posted in my area for a couple years.

    To allow a DTR to perform MNT would be a set-back for the profession, as the in-depth level of education/training is not required.


Hi GRD,

Thanks for sharing your thoughts! I suppose it may depend on the hospital definition of a "dietary aide", but based on having been one briefly (below minimum wage and too educated for it) I can say that a DTR could be a diet aide (menu checks, preparing meals, etc.), but that a Dietary Aide (usually not requiring nutrition education) cannot be a DTR.

A DTR/NTR's scope of practice mainly stays within clinical, long-term care and food service management, though some do seek their own private practice or other community settings. Their scope of practice, while there are specified roles, has many similarities to an RD, but depending on the facility and risk status of patients, they may be supervised by RDs, where as an RD can (always) practice independently.

Considering that MNT defined by AND is rather broad and includes nutrition assessment, counseling and education. This is within the current and growing scope of practice of DTRs (at the minimum education requirements). Whether they are acting independently in low-risk cases or primarily assisting RDs, they can't get reimbursed for this (except those licensed in Maine prior to December 2000).

Again, we are looking at the current and future shortage of nutrition professionals and it is due to a variety of reasons (see below) that DTR/NTRs may fade away and the current supervisor-assistant relationship hierarchy will dissolve and all that will be left is to be "competitive" with Certified/Licensed Nutritionists for MNT, and beyond. Although, there is talk (and some implementation) of a new hierarchy system, or career ladder, based on level of education, experience and specialized certifications, but it may take years to fully implement.

"Below is a summary of the key issues identified from the Spring 2003 HOD electronic dialogue. These comments were anecdotal and collected by delegates from their constituents.

• DTRs sometimes feel excluded by RD members and ADA Headquarters. New products, services and publications produced by ADA sometimes lack recognition and inclusion of the DTR.

• There is a need to further promote (internally and externally) and utilize the DTR credential and to promote the value DTRs provide in all practice settings (not just food service management).

• Many RDs and administrators still lack understanding of the skills, knowledge, education of DTRs, despite articles promoting the RD/DTR relationship. • There is a need to recognize the DTR as part of the Nutrition Care Team.

• The use of non-credentialed dietetic technicians versus use of DTRs in various practice settings diminishes the credential and possibly the outcomes of the service.

• The use of non-credentialed individuals to manage food service within hospitals and nursing homes, where DTRs would be appropriate to serve.

• Pay rates often are not increased after an employee achieves her/his credential.

• There are shortages of DTRs in some parts of the country and decreased enrollments in DTR programs.

• The overriding question to consider: Are DTRs valuable to the profession and should the credential continue to be offered?

• DTRs are Active members who support the profession and Association, deserve equal promotion and recognition."

http://www.webrd.org/cps/rde/xchg/ada/hs.xsl/governance_5088_ENU_HTML.htm

"Under Medicare Part B, MNT services are defined as “nutritional diagnostic, therapy, and counseling services for the purpose of disease management which are furnished by a Registered Dietitian or nutrition professional ... pursuant to a referral by a physician”." http://tinyurl.com/AND-Defintion-of-Terms (PDF)

Based on the above definition, if the licensure was changed and the requirements specified "under supervision of an RD for DTRs", then they, as they do already, can assist RDs with assessment and counseling, thus allowing both to participate in MNT management and get reimbursed! Win-win?


"Be the change you want to see in the world."

02/25/12 04:43 PM | Edit ReplyReply   |    No
shandstar
1226 Posts
Lewisville TX
Registered Dietitian

A DTR/NTR's scope of practice mainly stays within clinical, long-term care and food service management, though some do seek their own private practice or other community settings. Their scope of practice, while there are specified roles, has many similarities to an RD, but depending on the facility and risk status of patients, they may be supervised by RDs, where as an RD can (always) practice of DTRs (at the minimum education requirements). Whether they are acting independently in low-risk professional ... pursuant to a referral by RD

In Texas, DTRs are extremely important, we utilize them for in patient education ( mostly cardiac, low sodium, low fat). They help us by screening based on nutritional admission criteria: such as weight loss, decreased appetite, BMI> 40 etc. They then refer the high risk patients to us for further assessment. They do not perform assessments, nor do they see TF or TPNs. Just the low risk patients- I wish I had one at my LTAC- they would be greatly utilized. I hope they do find their niche and AND ramps up their education a little ( they want so much to learn from us- which is awesome!)

[Edited by shandstar on 02/25/12 04:46 PM]

[Edited by shandstar on 02/25/12 04:47 PM]

02/25/12 04:45 PM | Edit ReplyReply   |    DTR/NTR Jobs
NourishMe
113 Posts

Educator


    Posted by GRD:
    I politely disagree. DTRs do not have the education that an RD, even an entry-level RD, has. One can hold an Associates degree and become a DTR; a couple community colleges in my area offer a DTR program. DTRs for all intents and purposes are "dietary aides" - they're a step above diet office personnel but way below the level of an RD in reference to being utilized in a hospital setting. An RD can do everything a DTR does, but a DTR can only do a fraction of what an RD can. I do not know how DTRs are utilized in the community setting, so I cannot comment on that, but I see very, very few jobs specifically looking for DTRs; actually, I don't think I've seen anything posted in my area for a couple years.

    To allow a DTR to perform MNT would be a set-back for the profession, as the in-depth level of education/training is not required.


GRD, you are correct in stating that there appears to be not many jobs for DTRs (for reasons previously mentioned). In fact, the program in my city closed down 6 months after I started the DPD program in a neighboring city! Along with that, the only time you would see a posting for a Dietetic Technician was through VA and long-term care, if ever. The rare times a postion posted for a DTR at a hospital, the preference was to "hold out for an RD", instead of filling the spot. Back in 2005, "word of mouth" in the state of Texas was that they did not want to hire DTRs in hospitals. So it was very hard to get relevant experience in dietetics during and post graduation!

That said, there are positions available for those looking (ignoring those that label Diet Tech/Nutrition Tech the equivalent to Dietary Aid/Catering Associate) and to get an idea of the scope of practice, here's a few:

1) Dietary Tech (several medical centers in Colorado)

Position Summary: Conducts calorie counts, nutrition screening and nutrition assessments in TCU, Rehab and other units as assigned. Provides nutrition education to patients and assists in the development of individual care plans. All services provided within scope of practice of dietetic technicians as defined by the American Dietetic Association. Provides clinical dietetic care by collecting and correcting menus and obtaining food tolerances and preferences. Conducts audits of diet assistants as needed.http://www.healthonejobs.com/job/Denver-Dietary-Tech-Rose-Medical-Center-Job-CO-80002/1742225/?feedId=266&campaignId=25&utm_source=SimplyHired

2) Nutrition Technican at Nebraska Medical Center

Provides nutrition care for hospitalized patients, with guidance from a Licensed Medical Nutrition Therapist, to help patients with nutrition related conditions achieve improved health care outcomes. Provides a high level of technical support and assistance to the Licensed Medical Nutrition Therapist and extends the range of nutrition services available to the patient. Maintains enteral nutrition formulary and ensures that patients receive safe and accurate product. https://www.healthcaresource.com/nebraska/index.cfm?fuseaction=search.jobDetails&template=dsp_job_details.cfm&cJobId=829225

3) Nutrition Technician at Johns Hopkins University

Perform an integral part of the nutrition care team of the ICTR's Research Nutrition Program. This position involves computer nutrient analyses of diets, menu planning, anthropometric measurements, instructing and directing patients on research protocols, dosing, light cooking and formula preparation as well as managing nutrition data of certain protocols the pediatric, adult and outpatient research patients. https://hrnt.jhu.edu/jhujobs/job_view.cfm?view_req_id=51477&view=sch

4) Dietetic Tech at Mayo Clinic

Responsible for providing nutrition support to CRU investigators and study teams as part of a multidisciplinary team. Collaborates and participates with the research dietitians in activities such as delivering research education programs, development of research materials, community outreach, etc. Assists the research dietitian in the development/implementation of research nutrition protocols, screens potential subjects for eligibility in research studies, and assists with physiological measurements. Evaluates/monitors nutritional status of research subjects and documents nutritional interventions. Provides guidance to Research Dietary Assistants and new staff. http://www.mayo-clinic-jobs.com/job/Rochester-Dietetic-Tech-Job-MN-55901/1667995/?feedId=205&utm_source=SimplyHired

5) Registered Dietetic Technician at UCLA Health System

In this position, you will help ensure the delivery of high-quality dietetic care to patients at Ronald Reagan UCLA Medical Center. This involves collecting and reviewing nutrition screening information; referring patients to dietitians; providing basic education regarding medical nutrition therapy to patients and their families; helping train dietetic students and staff; assisting with the food service program (e.g., ensuring adherence to nutritional restrictions, food preferences, etc.); monitoring nutritional status changes of patients during hospital stays; and completing nutrient intake analysis reports

6) Diet Aid at Unidine

As a Dietetic Aide, you will be responsible for providing food and nutrition services to patients under the guidance of a registered dietician. You will act as a liaison between the clerical team and dining services as well as with family and visitors.

As a Dietetic Technician, you will assist dieticians with evaluating, implementing, and organizing nutrition programs while meeting and exceeding resident and client expectations.

Essential Functions and key tasks: •Conducts nutrition screening of patients upon admission to determine nutrition risk and level of care required and communicated these findings to the registered dietitian. •Performs routine nutritional assessments under the guidance of the registered dietitian. •Prepares care plans which takes into consideration the patients age, medical requirements, culture, religious and ethnic needs as well as personal preferences. •Communicates with other departments, such as nursing, to optimize patient care. •Monitors food quality and delivery as well as patient satisfaction with meals. •Monitors and evaluates nutritional intake and appropriateness of meals. •Evaluates and monitors the effectiveness and outcome of nutritional services and answers or refers questions regarding patient's nutritional care to registered dietician. •Demonstrates the ability to properly protect patient's health information. http://www.applyhr.com/23056706

7) Dietetic Technician at Virtua

Responsible for performing nutrition screening and assessment, as well as patient education, within guidelines of approved level of care, scope of practice and regulatory requirements. Works closely with clinical dietitians to assure there is a link between patient care and food services.

Position Responsibilities: Routine clinical nutrition tasks: nutritional assessment, education, counseling, and documentation. Collaborates with nursing, physicians and other health care professionals to assure patient nutrition needs are met. Participates in performance improvement data collection and productivity statistic collection. Participates in orientation and/or training of staff or interns when requested. Acts as a resource to health care team, peers, and food services regarding nutrition issues that relate to the patients at the division. http://virtuacareers.com/marlton/allied-health/dietetic-technician-pd-jobs

[Edited by NourishMe on 02/25/12 05:24 PM]


"Be the change you want to see in the world."

02/25/12 05:13 PM | Edit ReplyReply   |    RE: Where do DTRs fit into MNT and Licensure?
Tulip
162 Posts

Registered Dietitian

responding to only a small part of NourishMe's post: Is there a shortage/ future shortage of dietitians? In my part of the country the supply of RD's far outstrips the demand.

02/25/12 05:24 PM | Edit ReplyReply   |    Where do DTRs fit into MNT and Licensure?
shandstar
1226 Posts
Lewisville TX
Registered Dietitian


    Posted by Tulip:
    responding to only a small part of NourishMe's post: Is there a shortage/ future shortage of dietitians? In my part of the country the supply of RD's far outstrips the demand.

I'm seeing the same issue here in Texas, especially entry level RDs, more demand for experienced.

[Edited by shandstar on 02/25/12 05:26 PM]

02/25/12 05:46 PM | Edit ReplyReply   |    No
NourishMe
113 Posts

Educator


    Posted by shandstar:

    In Texas, DTRs are extremely important, we utilize them for in patient education ( mostly cardiac, low sodium, low fat). They help us by screening based on nutritional admission criteria: such as weight loss, decreased appetite, BMI> 40 etc. They then refer the high risk patients to us for further assessment. They do not perform assessments, nor do they see TF or TPNs. Just the low risk patients- I wish I had one at my LTAC- they would be greatly utilized. I hope they do find their niche and AND ramps up their education a little ( they want so much to learn from us- which is awesome!)

    [Edited by shandstar on 02/25/12 04:46 PM]

    [Edited by shandstar on 02/25/12 04:47 PM]


Hi Shandstar,

Thanks for sharing how things are done in Texas, LOL. I'm from there and if you read my post below your's you will see what they were doing in my city.

Among what I've learned from sifting through DTR/NTR job posting is that based on the descriptions, there is no regulation on the definitions of a Diet Aide, Diet Assistant, Nutrition Assistant and Diet Tech as all can imply being a degreed or trained Dietetic/Nutrition Technician or can be a food service worker in the kitchen! Of course, this is because only 2 states (California and Maine) certify or license DTR/NTRs and would explain part of the problem with DTR/NTRs being considered a valuable member of the Nutrition Care Team.

Hope you get your DTR!

[Edited by NourishMe on 02/25/12 05:50 PM]


"Be the change you want to see in the world."

02/25/12 05:50 PM | Edit ReplyReply   |    RE: Where do DTRs fit into MNT and Licensure?
GRD
1001 Posts

Registered Dietitian


    Posted by Tulip:
    responding to only a small part of NourishMe's post: Is there a shortage/ future shortage of dietitians? In my part of the country the supply of RD's far outstrips the demand.

Same here, although I'm not sure it's at the "far outstrips" level here, yet. Still, not a lot of full-time postings for RDs and as Shandastar pointed out, more of a demand for experienced RDs - although there isn't a "demand" in my area, per se, experienced RDs, especially those with a speciality certification, don't have quite as hard a time landing something.

02/25/12 05:52 PM | Edit ReplyReply   |    DTRs
GRD
1001 Posts

Registered Dietitian

BTW: My hospital system does not employ DTRs.

02/25/12 06:15 PM | Edit ReplyReply   |    No
shandstar
1226 Posts
Lewisville TX
Registered Dietitian

Hi Shandstar,

Thanks for sharing how things are done in Texas, LOL. I'm from there and if you read my post below your's you will see what they were doing in my city.

Lol! I should say in the Dallas-Fort Worth area- and especially at the large hospitals, not the smaller ones. Sigh- right now our census is low but when we get higher, I will put in for a diet tech! She/ he can help my patients with menus, do some education, help me prepare for team and PI meetings- I could go on and on...BTW- I also worked, during my internship, on the weekends as a diet tech ( 12 HR days- thank goodness those days are over- course it may start again if I don't get some help ;)

You're from Texas too? :D

[Edited by shandstar on 02/25/12 06:19 PM]

[Edited by shandstar on 02/25/12 06:19 PM]

02/25/12 10:56 PM | Edit ReplyReply   |    RE: No
NourishMe
113 Posts

Educator


    Posted by shandstar:
    Hi Shandstar,

    Thanks for sharing how things are done in Texas, LOL. I'm from there and if you read my post below your's you will see what they were doing in my city.

    Lol! I should say in the Dallas-Fort Worth area- and especially at the large hospitals, not the smaller ones. Sigh- right now our census is low but when we get higher, I will put in for a diet tech! She/ he can help my patients with menus, do some education, help me prepare for team and PI meetings- I could go on and on...BTW- I also worked, during my internship, on the weekends as a diet tech ( 12 HR days- thank goodness those days are over- course it may start again if I don't get some help ;)

    You're from Texas too? :D

    [Edited by shandstar on 02/25/12 06:19 PM]

    [Edited by shandstar on 02/25/12 06:19 PM]


Yup, pretty much born and raised! Sadly, where I lived, there were no DPD programs or internships, but there was a DPD program in Las Cruces, NM. Those of us that graduated from there were each other's friendly competition for jobs. We were all very supportive, but in the end, I didn't know Spanish enough to get hired by WIC (first round) and when I finally got 2nd consideration, I had already accepted another offer out of state (and I love it). That said, very few positions were open to us, and of the one's I kept in touch with, some left for internships (no DIs) and other's pursued the Master's Coordinated Programs in other parts of the state. Due to there not having been an internship program at our former university (there is a Master's Coordinated Program now)nor in town (despite there being a medical school), one of the long-term Dietetic Techs, stayed put (has a family). Hopefully, she'll get to finish school and pursue the coordinated program.


"Be the change you want to see in the world."

02/25/12 11:25 PM | Edit ReplyReply   |    RE: DTRs
MonigueJ
284 Posts
Chicago
Registered Dietitian


    Posted by GRD:
    BTW: My hospital system does not employ DTRs.

My hospital system are slowly weaning them out.

02/26/12 12:01 AM | Edit ReplyReply   |    RE: DTRs
NourishMe
113 Posts

Educator


    Posted by MonigueJ:

      Posted by GRD:
      BTW: My hospital system does not employ DTRs.

    My hospital system are slowly weaning them out.


Again, what an incredible and sad disservice to this professional. From what I gather from this thread and the Future Connections Summit Report, increased education is needed by all. Perhaps if still around in the future, DTRs will have Bachelor's degrees and RDs will have Master's? Although, the current proposed initiatives seem to lean on Bachelor's education and experience toward gaining access to sitting for the RD exam.

Some of the jobs I ran across today were from university and teaching hospitals so this may be one way to boost their need. I suppose another way that AND is trying to increase DTR exposure to RDs (yet to hear anything out in the public) is through this article in the September 2011 issue of Today's Dietitan:

Effectively Using Dietetic Technicians — Building the Right Relationship Can Boost Your Practice By Lindsey Getz

DTRs go through considerable training and put in many hours to get their certification, yet they're often overlooked as critical members of a patient's care team. Many RDs are unfamiliar with what a DTR does, and many RDs have never had the opportunity to work with one. But that may be changing. As dietetics become more complex, the strong support of a DTR can optimize the work of an RD.

One thing RDs may not be aware of is just how much a DTR can enhance their practice, says Corliss Cowan, DTR, chair-elect of the executive committee for the Dietetic Technicians in Practice Dietetic Practice Group (DTP DPG) of the American Dietetic Association (ADA). “It's a true team approach,” she says. “As the RD is supervising the DTR, he or she can see how much the trained DTR can assist her and allow the RD to work at an elevated level.”

In many cases, DTRs do the prep and fill-in work for RDs, allowing an RD to achieve even more than he or she could alone. It's a supporting role that often goes unnoticed but still deserves credit.

DTRs conduct screenings, gather data, perform assessments, and assist in ways that help RDs provide the best possible care for their patients. “RDs are expected to be the front line for the doctor and nursing staff, but we're that technical backup,” says Grace A. Burney, DTR, past chair of the DTP DPG. “Many times the RD is on the front line with the doctor while we're on the front line with the patient.”

That's the case at the large Ohio-based teaching hospital where Mary Marshall, RD, LD, CNSC, works. She says the staff of 12 RDs relies heavily on support from its four DTRs. “We have DTRs screening and assessing generally low-moderate nutrition risk floors,” Marshall explains. “Every day the DTR provides the RD with a list of patients who are high risk, and that list becomes the RD's responsibility. The DTRs also play a big role in educating patients, freeing up that time for the RD to focus on high-risk populations.”

Marshall offers this recent example where strong support from a DTR has optimized the RD/DTR relationship: “We have a DTR teaching nutrition for a pre-op hip replacement class. Together the RD and DTR formulated the initial outline, but the DTR has been teaching the weekly class. Since implementing this, patients are more aware of bone health and nutrition before coming in for their surgery. It also gives us an opportunity to have a 'head's up' for any major food allergies or intolerances when these folks are in our beds. I believe it would be impossible for the RDs on our staff to function alone.”

Batman and Robin

RDs and DTRs should work together as a team. Burney calls it a “Batman and Robin relationship” with a working partnership. While the RD may take the lead, the DTR plays a vital role in assisting. “Batman also had respect for Robin,” Burney adds, “and every once in a while he let Robin drive the Batmobile for him.”

But Alberta Scruggs, RD, LD, DTR, a certified group fitness instructor and older adult instructor, says allowing a DTR to get more experience and to assist RDs with more hands-on aid may not be happening as much as it could. She believes the statement “DTRs can't do that” is used too often in the field and that RDs need to be more willing to let their DTRs on staff get involved.

“It's a misconception that 'DTRs can't do that' when it comes to specific skill sets, like assessing feeding tube rates, evaluating protein and specific nutrients needed of patients with skin issues, or having the ability to determine what type of supplement is needed for a patient with renal or pulmonary issues,” she says. “I learned how to do these things when I was a dietetic technician student. I began to do them as a practitioner. And the more I did them, the better my skills and performance became.”

Scruggs theorizes some RDs may be reluctant to let their DTRs do some of these hands-on tasks for fear they may do them better. But she says that “teaching others to shine allows you to shine too.”

Marshall agrees and says DTRs are “only as expert as you allow them to be.” She urges more RDs to rely on vital DTR support. “Many DTRs have degrees beyond an associate level,” Marshall adds. “Get to know your DTR and the knowledge base they have and then build from there. Training should go both ways. At our institution, DTRs are a strong asset when it comes to education for patients, teaching classes, and obtaining complex food preferences from patients. Encourage your DTR to be a presence on their floor/unit, but always make an effort to be available for questions.”

Communication is the key to a successful RD/DTR relationship, Marshall notes. “By having clearly defined responsibilities, each player knows his duty,” she says. “That being said, it's also important that DTRs know they can contact the RD whenever they feel something is beyond their scope.”

Looking Ahead

Some believe the misconceptions about DTRs may be holding back the field. Some regions don't offer DTR programs, and others have had to close because of lack of participation. The hope is that as dietetics continues to grow and becomes increasingly more complex, the importance of the supporting DTR role will move to the forefront. Dispelling some of the myths is a first step.

Burney wants RDs to know that DTRs aren't out to steal their jobs. She believes this is one of the commonly held misconceptions.

“We don't replace the RD; we complement them,” Burney says. “My hope is that as more RDs find their niche and expertise that they'll realize a DTR can only help make them better and that they're not out to replace you. Another misconception is that we're 'mini RDs,' and that's not the case either. We're DTRs, and we have our own skill sets. Working together with an RD, we can form a great team.” http://www.todaysdietitian.com/newarchives/090111p20.shtml


"Be the change you want to see in the world."

02/26/12 08:23 AM | Edit ReplyReply   |    Texas
shandstar
1226 Posts
Lewisville TX
Registered Dietitian

@ NourishMe- Howdy!

I think I figured out where u went to school- small town, mostly school town- so probably little opportunity and, like u said, competitive. We have 3 DI and 1 coordinated MS/ DI that I know of( not including WIC).

We have 3 major trauma hospitals in Dallas, including 1 county- the 2 large hospitals have techs. I worked at 400 bed trauma, we had 2 techs. Like u said, they are a vital part of the nutrition care process- 1 is a DTR the other was a dietary supervisor that we promoted, trained and established competencies for. At the non county trauma center (1,000 bed)- we have at least 4 techs.

I just wanted to say how important the techs are and too bad they're weaning them from the hospitals ( but I guess it makes sense due to cost). I saw some comment that diet techs are just diet aides and would setback the profession? How untrue.

Ok- off to work I go- have 8 TPNs and an RD left sick yesterday so I have to cover consults for her. I'm a little scared to go in..psyching myself up! :D

02/26/12 01:01 PM | Edit ReplyReply   |    RE: Texas
NourishMe
113 Posts

Educator


    Posted by shandstar:
    @ NourishMe- Howdy!

    I think I figured out where u went to school- small town, mostly school town- so probably little opportunity and, like u said, competitive. We have 3 DI and 1 coordinated MS/ DI that I know of( not including WIC).

    We have 3 major trauma hospitals in Dallas, including 1 county- the 2 large hospitals have techs. I worked at 400 bed trauma, we had 2 techs. Like u said, they are a vital part of the nutrition care process- 1 is a DTR the other was a dietary supervisor that we promoted, trained and established competencies for. At the non county trauma center (1,000 bed)- we have at least 4 techs.

    I just wanted to say how important the techs are and too bad they're weaning them from the hospitals ( but I guess it makes sense due to cost). I saw some comment that diet techs are just diet aides and would setback the profession? How untrue.

    Ok- off to work I go- have 8 TPNs and an RD left sick yesterday so I have to cover consults for her. I'm a little scared to go in..psyching myself up! :D


Shandstar,

Wow, how wonderful that setup seems! Although, I have heard that there IS more competition in locations that do have internship programs, due to the number of intern graduates.

My other theory regarding DTRs decline is that some have moved into foodservice management positions, like one of your's was trained to do. I know at the VA home I gained some field experience at, the DTR ran the show with the RD showing up for a set number of hours (I've heard that is common). However it appears that is not the case at a percentage of hospitals, so why be a DTR and not have the respect and increased pay, when you can (become an RD or) get the management education and certify to become a Certified Dietary Manager?

A CDM's scope of practice is very similar to a DTRs, plus the management portion means more responsibility and more pay! Granted, based on the education programs out there (certificate or associate), a certificate-based CDM doesn't initially train to have as much nutrition education and field experience and still can participate in the Nutrition Care Process just like a DTR, focusing on low - moderate risk patients and passing along the high-risk patients to the RD (if the institution requires). I know where I live hospitals/LTC hire either CDMs only, but sometimes give the option for either a DTR or RD to fill the food service management position. The CDM organization NAFP, is in alliance with AND on most of this (AND would prefer only DTRs do nutrition assesment)

The other option is for them to become School Nutrition Specialists. I saw a job posting for a DTR in one of the school systems and it wasn't for foodservice. It was to be a nutrition assistant in planning and program development (can't find the job now), but did not require the SNS credential. The downside, this SNS exam is currently not available continuously nationwide, only at specific locations at specific times. Here's another posting that's sounds pretty sweet for those interested: School Nutrition Program Specialist (Virginia, $41,000 - $84,000, minimum BS degree)https://jobs.agencies.virginia.gov/applicants/jsp/shared/position/JobDetails_css.jsp?postingId=620694

Actually, all of the above credentials were discussed in the Future Connections Summit Report regarding DPD Graduates. The discussion was to allow them to gain the education/experience or simply sit for the exams upon graduation to become a DTR, CDM/CFPP, SNS (currently w/1 year school nutrition experience), CHES (certified health education specialist) or a CMHC (what IS this?). Most of these are currently already possible for DPD graduates.

Oh and I'm sure you will survive the day, and what's even better? Here's your push for a DTR, even on a PRN basis, as the support would be good now!


"Be the change you want to see in the world."

04/22/12 06:21 PM | Edit ReplyReply   |    RE: No
sameey70
14 Posts
Atlanta GA
Dietetic Technician


    Posted by NourishMe:

      Posted by GRD:
      I politely disagree. DTRs do not have the education that an RD, even an entry-level RD, has. One can hold an Associates degree and become a DTR; a couple community colleges in my area offer a DTR program. DTRs for all intents and purposes are "dietary aides" - they're a step above diet office personnel but way below the level of an RD in reference to being utilized in a hospital setting. An RD can do everything a DTR does, but a DTR can only do a fraction of what an RD can. I do not know how DTRs are utilized in the community setting, so I cannot comment on that, but I see very, very few jobs specifically looking for DTRs; actually, I don't think I've seen anything posted in my area for a couple years.

      To allow a DTR to perform MNT would be a set-back for the profession, as the in-depth level of education/training is not required.


    Hi GRD,

    Thanks for sharing your thoughts! I suppose it may depend on the hospital definition of a "dietary aide", but based on having been one briefly (below minimum wage and too educated for it) I can say that a DTR could be a diet aide (menu checks, preparing meals, etc.), but that a Dietary Aide (usually not requiring nutrition education) cannot be a DTR.

    A DTR/NTR's scope of practice mainly stays within clinical, long-term care and food service management, though some do seek their own private practice or other community settings. Their scope of practice, while there are specified roles, has many similarities to an RD, but depending on the facility and risk status of patients, they may be supervised by RDs, where as an RD can (always) practice independently.

    Considering that MNT defined by AND is rather broad and includes nutrition assessment, counseling and education. This is within the current and growing scope of practice of DTRs (at the minimum education requirements). Whether they are acting independently in low-risk cases or primarily assisting RDs, they can't get reimbursed for this (except those licensed in Maine prior to December 2000).

    Again, we are looking at the current and future shortage of nutrition professionals and it is due to a variety of reasons (see below) that DTR/NTRs may fade away and the current supervisor-assistant relationship hierarchy will dissolve and all that will be left is to be "competitive" with Certified/Licensed Nutritionists for MNT, and beyond. Although, there is talk (and some implementation) of a new hierarchy system, or career ladder, based on level of education, experience and specialized certifications, but it may take years to fully implement.

    "Below is a summary of the key issues identified from the Spring 2003 HOD electronic dialogue. These comments were anecdotal and collected by delegates from their constituents.

    • DTRs sometimes feel excluded by RD members and ADA Headquarters. New products, services and publications produced by ADA sometimes lack recognition and inclusion of the DTR.

    • There is a need to further promote (internally and externally) and utilize the DTR credential and to promote the value DTRs provide in all practice settings (not just food service management).

    • Many RDs and administrators still lack understanding of the skills, knowledge, education of DTRs, despite articles promoting the RD/DTR relationship. • There is a need to recognize the DTR as part of the Nutrition Care Team.

    • The use of non-credentialed dietetic technicians versus use of DTRs in various practice settings diminishes the credential and possibly the outcomes of the service.

    • The use of non-credentialed individuals to manage food service within hospitals and nursing homes, where DTRs would be appropriate to serve.

    • Pay rates often are not increased after an employee achieves her/his credential.

    • There are shortages of DTRs in some parts of the country and decreased enrollments in DTR programs.

    • The overriding question to consider: Are DTRs valuable to the profession and should the credential continue to be offered?

    • DTRs are Active members who support the profession and Association, deserve equal promotion and recognition."

    http://www.webrd.org/cps/rde/xchg/ada/hs.xsl/governance_5088_ENU_HTML.htm

    "Under Medicare Part B, MNT services are defined as “nutritional diagnostic, therapy, and counseling services for the purpose of disease management which are furnished by a Registered Dietitian or nutrition professional ... pursuant to a referral by a physician”." http://tinyurl.com/AND-Defintion-of-Terms (PDF)

    Based on the above definition, if the licensure was changed and the requirements specified "under supervision of an RD for DTRs", then they, as they do already, can assist RDs with assessment and counseling, thus allowing both to participate in MNT management and get reimbursed! Win-win?


04/22/12 06:35 PM | Edit ReplyReply   |    Diet Tech in private practice
sameey70
14 Posts
Atlanta GA
Dietetic Technician

NourishMe, I have been a DTR for almost 20 years and have worked along RD's in the clinical setting. I can honestly say that although I spent less time in school, I have had many more years on the job than an entry level RD. I started out as a diet clerk and believe me, there is a big difference between a diet clerk and tech. I did not only screen and provide basic diet education, I did assessments, tube feedings, and complicated diet instructions. Perhaps your contact with diet techs or their abilities are limited, but please don't generalize. I am now operating my own in home nutrition and personal training business. The possibilities for DTR's are not as limited as you may have been lead to believe.

04/22/12 06:37 PM | Edit ReplyReply   |    Diet Tech in private practice
sameey70
14 Posts
Atlanta GA
Dietetic Technician


    Posted by sameey70:
    GRD, I have been a DTR for almost 20 years and have worked along RD's in the clinical setting. I can honestly say that although I spent less time in school, I have had many more years on the job than an entry level RD. I started out as a diet clerk and believe me, there is a big difference between a diet clerk and tech. I did not only screen and provide basic diet education, I did assessments, tube feedings, and complicated diet instructions. Perhaps your contact with diet techs or their abilities are limited, but please don't generalize. I am now operating my own in home nutrition and personal training business. The possibilities for DTR's are not as limited as you may have been lead to believe.

[Edited by sameey70 on 04/22/12 06:37 PM]

[Edited by sameey70 on 04/22/12 06:38 PM]

04/22/12 07:14 PM | Edit ReplyReply   |    RE: Diet Tech in private practice
shandstar
1226 Posts
Lewisville TX
Registered Dietitian


    Posted by sameey70:

      Posted by sameey70:
      GRD, I have been a DTR for almost 20 years and have worked along RD's in the clinical setting. I can honestly say that although I spent less time in school, I have had many more years on the job than an entry level RD. I started out as a diet clerk and believe me, there is a big difference between a diet clerk and tech. I did not only screen and provide basic diet education, I did assessments, tube feedings, and complicated diet instructions. Perhaps your contact with diet techs or their abilities are limited, but please don't generalize. I am now operating my own in home nutrition and personal training business. The possibilities for DTR's are not as limited as you may have been lead to believe.

    [Edited by sameey70 on 04/22/12 06:37 PM]

    [Edited by sameey70 on 04/22/12 06:38 PM]


Good for you! That's awesome- like I said DTRs are very important. maybe you can educate some RDs about your role as well. I don't know if there are many DTs on this site...

04/23/12 08:35 AM | Edit ReplyReply   |    RE: Diet Tech in private practice
momof2
178 Posts

Registered Dietitian

We have 2 different positions at the hospital where I work- diet techs and diet extenders. The techs are more the clerk level, nutrition screeners. The diet extenders are more what you all are describing as the DTR role- they are our right hand people- able to give basic diet education like heart healthy, coumadin educations, etc. As dietitians, we depend on them to help us with education.

04/26/12 05:22 PM | Edit ReplyReply   |    RE: Diet Tech in private practice
RD654
180 Posts

Registered Dietitian

I know I'm a few days late responding, but I was a DTR before I became a RD. I worked in LTC and I must say I was working in the capacity of a dietitian while a DTR. That is one of the major reasons I went back to school to complete my BS. I was doing the same work, just not getting paid the same. In many cases the staff came to me before the RD (mostly because I was in the building more often). Also, being a DTR I gained alot of experience and this was a hand up being chosen for an internship (this being told to me by my internship preceptor). I still work with a DTR and she is amazing. She has been a DTR for ~15 years. I trust her judgement and she always asks if she has a question.

Just my two cents.

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