Dietetics Salaries
By Marsha Bonne, MS, RD
Vol. 6 No. 1 p. 26

What is your top concern in the dietetics profession? In spring 2001, the American Dietetic Association’s (ADA) house of delegates, the governing body of the profession, found that “the number one issue for members was the concern that salaries do not always meet expectations when compared with the required scientific background for dietetics professionals.”1 In response, we’ve seen resources and workshops emerge to help practitioners assess the adequacy of their salaries, increase their income potential, and negotiate higher compensation.

Early in 2003, the ADA released its groundbreaking 2002 Dietetics Compensation and Benefits Survey. Marianne Smith Edge, MS, RD, LD, FADA, president of the ADA, explains that “the survey was conducted in response to members’ requests for an objective and reliable source of information on dietetics professionals’ salaries.” Although the ADA has previously conducted database surveys of salaries for the major dietetics practice areas, the 2002 survey represents the most comprehensive assessment of compensation in the profession to date. It reports hourly wages for approximately 50 distinct dietetics-related positions, and with a 46% response rate, it represents data from nearly one in five of all dietetics practitioners.2,3

And the Survey Says…
The median hourly wage among all RDs in all positions is $22 per hour, according to the ADA’s 2002 survey. On an annual basis (assuming a 40-hour work week and 52 weeks per year), this amounts to a full-time salary of $45,760. For the dietetic technician registered (DTR), the survey revealed a median hourly wage of $14.74 per hour, which equates to an annual salary of $30,660. For both groups, the 2002 results were higher than previous surveys, but recency of the data as well as variations in measurement methods and definitions likely contributed to the observed differences.2

Smith Edge elaborated on the results, saying, “The survey showed that 25% of dietitians are making at least $56,000 in total cash compensation per year. Only 10% are earning less than $34,000 per year.” April Duong, MBA, RD, CDE, a part-time diabetes educator and a PhD student at Purdue University, adds, “That spread represents nearly a doubling in salary and tells me that you have a tremendous opportunity for salary growth in the profession.”

To evaluate the adequacy of your own income, it’s important to be aware of factors that impact salary. The 2002 survey showed that major influences on compensation in the dietetics profession include the number of years of experience, level of supervisory responsibility, budget responsibility, and practice area. Several other aspects play a role, including education level, employer, and location.2 Following is a discussion of some of these factors, including a review of additional results from the ADA’s 2002 survey.

Years of Experience
As shown in Table 1, the survey revealed that the number of years of practice as a dietitian is strongly associated with compensation.2 However, it may take several years to see this relationship, as the data revealed that entry-level wages for dietitians in a position for less than one year are not substantially different from wages earned by dietitians with one to four years in the position.3 For DTRs, a relationship between years of experience and compensation was also evident, but the impact was not as great.2

It is not necessarily a smooth ride to higher salaries once you obtain additional experience, according to some seasoned dietitians. “I frequently hear from dietitians who are distressed that entry-level dietitians are making more than those who have been in the job 10 years,” says Carolyn Caesar, RD, editor and publisher of the national newsletter Jobs in Dietetics. Sylvia Moore, PhD, RD, FADA, a dietitian for 30 years and currently a professor and director of the Division of Medical Education & Public Health at the University of Wyoming, also comments: “We have the same problems as everyone else does with compression. I was adequately compensated when I started the job. If I wanted to receive adequate compensation now, I would have to find another job. That, unfortunately, is not uncommon in academe, particularly in state-funded universities. The budgets get tight, and the flex you get in your budget is for new hires.”

Practice Area and Responsibility Level
Table 2 illustrates that RD compensation tends to be highest in certain areas of practice, namely food and nutrition management, consultation and business, and education and research. Many factors likely contribute to this variance. For example, in foodservice management positions, responsibility levels may play a role. Cindy Krainen, RD, a nationwide dietitian recruiter for Harper Associates, explains, “If you’re responsible for 92 FTEs [full-time equivalents] and feeding a large number of patients, as well as overseeing employee satisfaction in the cafeteria, that’s a big responsibility. Plus, management positions often require well over a 40-hour week. If the cook doesn’t show up and you get called to come in at 5 in the morning, you’re in at 5 in the morning, and there’s no guarantee that you’ll be able to leave on time either.”

Looking more closely at the impact of responsibility level, the 2002 survey showed nearly a $5 per hour difference in median wage between RDs employed as directors or managers compared with those without supervisory or managerial roles. Similarly, the survey showed that DTRs carrying supervisory or management responsibility earn a median wage $2.65 per hour higher than those without such duties.2 “You have to remember that there is a tradeoff between compensation level and responsibility,” advises Smith Edge. “If you accept a job with a higher level of responsibility, you should expect higher compensation. If you desire more flexibility and less responsibility, your compensation may reflect that. Our pay and what we accept may be affected by what we desire from our jobs.”

Responsibility levels can also change, so it’s important to monitor these shifts and reevaluate your compensation. Moore tells the true story of a woman whose boss asked her to take on some additional responsibilities. When Moore asked the woman how much more she was going to get paid, the woman looked at Moore flabbergasted and remarked that she didn’t know she would get more compensation. Under Moore’s guidance, the woman talked with her boss and told him that she would be happy to take on the additional role but would need more compensation. Laughing, her boss replied, “I was wondering how long it was going to take you to ask.” Moore elaborated, “Employers understand perfectly well that to do more things requires more money. I would caution people to take a look at how their jobs are expanding and whether they’re receiving added compensation for taking on the extra responsibilities. Of course, it’s not that you should request additional compensation for every extra thing you do, but you should pay careful attention to the things you’re doing that are adding value to the organization and make sure you’re adequately compensated for them.”

Education Level
The 2002 survey revealed that 45% of dietitians hold a master’s degree, and the overall difference in median wage between those with a bachelor’s degree vs. those with a master’s degree is approximately $2.30 (although the impact is not equal across different positions). Similarly, the 26% of DTRs with a bachelor’s degree (or higher) earn almost an additional dollar per hour in median wage.2 “Although the typical DTR does not have a bachelor’s degree, I’m noticing more and more DTRs who are attaining this additional education,” comments Denise Elmore, BA, DTR, chair of the ADA’s Dietetic Technicians in Practice DPG and a junior research coordinator at MD Anderson Cancer Center in Houston.

Krainen adds, “I do believe any supplemental education, certification, or training in a specialty area can be beneficial. I’m not necessarily suggesting that every RD needs a master’s degree, but any little bit can help—whether it’s attending an advanced workshop, taking a class on a particular computer program, or obtaining specialty certification. Those things can make a job candidate more marketable than the next person.” Carol Bradley, MA, RD, LD, a public relations manager for Brookshire Brothers Food & Pharmacy in Texas, reinforces the importance of being involved in professional associations, saying, “It was my volunteer work as a state media spokesperson for the ADA that helped me land my current job. Don’t worry in the beginning as much about compensation, but instead focus on gaining the experience. When you prove your competence, you’ll create a demand for yourself.”

Type of Employer
Who you work for can impact your salary, and RDs who are self-employed in private practice or as a consultant earn significantly higher salaries than those employed by others, on average. The 2002 survey revealed that self-employed RDs, who comprise approximately 11% of dietitians, earn a median hourly wage of $27.47.2 However, Smith Edge, who has been in private practice for 17 years, cautions, “You have to remember that someone who is self-employed has other expenses and overhead. Plus, if you have a private practice, it’s a 24/7 job sometimes. The buck stops with you.” Duong adds that benefits are an important consideration, commenting, “If you have a significant other who can provide those benefits, then you have a good opportunity. Otherwise, purchasing benefits for yourself or for people you might employ can be a very expensive venture.”

Location, Location, Location
As logic would dictate, where you live can affect your paycheck, and although cost of living is also a consideration, it’s interesting to review the impact of location. The 2002 survey compared dietitians’ salaries across nine standard census divisions. Regions showing above-average median wages for RDs include the middle Atlantic/New England states and the Pacific states. Conversely, states showing below-average median wages include the east south central states, west north central states, and mountain states.3 For illustration, South Dakota ranks among the lowest compensated states for dietitians, showing a median hourly wage of $19.90, which is $2.10 less than the average median wage for all dietitians.2 Melissa Kruce, RD, LN, employed by Children’s Special Health Services in Rapid City, S.D., comments, “I am concerned about inadequate salaries in South Dakota, but it’s a problem for many professionals in South Dakota, not solely dietitians.”

In evaluating the impact of location, Smith Edge reminds us of the basic laws of economics, explaining, “Salaries are partly a product of supply and demand, and location is definitely a factor. Salaries are not as high when there is more supply, and there tends to be more supply in areas where there are universities.” Speaking from personal experience, Duong adds, “In my case, living in the area of Purdue University that educates dietitians—it’s job saturation.” According to the ADA’s 2002 survey, the median hourly wage for dietitians in Indianapolis, which is a little over an hour down the road from West Lafayette, the home of Purdue University, posts a median hourly wage of $19.26, or $2.74 less than the median hourly wage for all dietitians. At the same time, the median hourly wage for Indiana as a whole is higher at $20.14.2

Avoid Cross-Profession Comparison
When evaluating compensation, it may be tempting for dietetics practitioners to compare their salaries with those of other allied health professionals, reasoning that education levels and experience are similar. However, the ADA’s CEO, Ronald Moen, cautions against this type of cross-profession comparison, explaining that “those factors are not driving the higher compensation that other allied health professionals may be receiving.”4 Moen explains, “Recognition, value, and demand for services are the keys to increased salaries and income potential for dietetics professionals. The ADA and our members must work to raise the perceived value of nutrition services to all stakeholders, including physicians, legislators, allied health professionals, the consumer, and compensation departments.”4

Peter Beyer, MS, RD, LD, an associate professor in dietetics and nutrition at the University of Kansas Medical Center and a member of the ADA’s Standardized Language Committee (charged with developing diagnoses and interventions unique to and specific to dietetics practice), stresses the importance of raising decision makers’ perceived value of nutrition services. He advises, “When talking with administrators, be prepared with outcome-related data and talk in terms of dollars and cents. Identify even the mundane things you do as part of clinical practice for cost maintenance, cost savings, revenue generation, or improved customer satisfaction. For example, in the hospital GI [gastrointestinal] department where I used to work, we did fecal fat tests. A fecal fat test could be absolutely worthless or ruined if the patient didn’t take in a sufficient amount of fat in order to administer the test, ultimately resulting in repetition of the test and as a result, an extra day in the hospital and more laboratory procedures. So, every time you prevent that from happening, you can save X number of dollars.”

Sachiko St. Jeor, PhD, RD, FADA, a professor of internal medicine and director of the Center for Nutrition and Metabolic Disorders at the University of Nevada School of Medicine, further stresses the importance of revenue generation and reimbursement. She comments, “Physicians generally know what medical nutrition therapy can do, but they may not hire you for the medical clinic if you don’t network and produce revenue. Dietitians must become more knowledgeable about the limitations and opportunities of reimbursement systems, improve their documentation and cost-effectiveness, and move forward together.” Bradley adds, “We need to keep lobbying the legislature about what services are covered, and we need to keep working with insurance companies on increasing coverage for dietitians’ services.”

Dietetics professionals in nontraditional positions may need to pay special attention to self-promotion. One of the first things Betsy Dietsch, RD, LDN, did in her role as a marketing specialist and community liaison at Whole Foods Market in Raleigh, N.C., was communicate her value by writing a column in the store’s monthly newsletter, explaining what the credentials of a registered dietitian mean and what services RDs can offer. Dietsch explains, “Consumers can’t demand something that they don’t know they need. Many consumers are still unclear about the expertise a registered dietitian holds. So, it’s important to explain what RDs actually do.”

And the Money Will Follow
In conclusion, Smith Edge comments, “The 2002 survey has provided a framework for helping HR personnel provide appropriate salaries for dietitians and to increase salaries. Dietitians have shared many personal stories of pay increases they have been able to obtain for themselves and their staff as a result of the survey.” Moore added, “Dietitians should keep their options open and decide in which areas they can find some passion because if you don’t like what you’re doing, you aren’t going to be particularly good at it or get people to notice you. So No. 1, choose that area where you can be enthusiastic. Once you’ve chosen that area, constantly be on the lookout for ways to enhance not only your skills but also your ability to interface with others in the arena. You have to team up with others to accomplish things, and that includes gaining recognition and obtaining increased compensation.”

— Marsha Bonne, MS, RD, works for Novartis Nutrition and enjoys freelance writing.

References
1. Performance, proficiency, and value of the dietetics professional: An update. J Am Diet Assoc. 2003;103(10):1376-1379.
2. American Dietetic Association. 2002 Dietetics Compensation & Benefits Survey. Chicago: American Dietetic Association; 2003.
3. Rogers D. Salary Survey Work Group. Report on the ADA 2002 Dietetics Compensation and Benefits Survey. J Am Diet Assoc. 2003;103(2):243-255.
4. Moen RS. CEO Digest. 2003;2(9). Available at: http://www.eatright.org/Member/index_16222.cfm. Accessed October 30, 2003.

Resources
• 2002 Dietetics Compensation and Benefits Survey available through the American Dietetic Association
• Get Paid What You’re Worth: The Expert Negotiators’ Guide to Salary and Compensation by Robin L. Pinkley and Gregory Northcraft (St. Martin’s Press, 2003)
• Surpassing Ourselves: An Inquiry into the Nature and Implications of Expertise by Carl Berieter and Marlene Scardamalia (Open Court Publishing Company, 1992)
• Women Don’t Ask: Negotiation and the Gender Divide by Linda Babcock and Sara Laschever (Princeton University Press, 2003)

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