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Survey: Are Dietitians Bringing Home the Bacon?By Sharon Palmer, RD Today’s Dietitian Vol. 8 No. 3 P. 34 The results are in. Find out what your dietetics peers are earning and learn the strategies to help a struggling salary sizzle. In today’s world of high-cost housing and gouging at the gas pump, how do dietitian wages fare in covering the lofty cost of living? Dietitians have been complaining for years that their take-home pay doesn’t measure up. According to the American Dietetic Association (ADA) House of Delegates in 2001, the No. 1 issue for members was salaries, and dietitians continue to rant about their dismal earnings. On the forum of DietitianCentral.com, recent postings by dietitians have been slamming the profession’s salaries. “I became depressed after looking at the Bureau of Labor Statistics [BLS] Web site. The average salary in my area is $41,000 a year. All other healthcare professionals with similar or even less education are averaging $54,000 and higher. This includes nurses, OT, PT, and ST. I certainly think these professionals deserve a high pay, but we do too. I don’t understand how over half the U.S. population is obese, yet dietitian jobs are so limited. Obviously, we are doing something wrong. We should be in high demand! Does this bother anyone else?” asked an anonymous RD who posted her message to the DietitianCentral.com Web site under the heading “Underpaid Dietitians.” Her question was answered by several dietitians empathizing with her sentiment. One even responded by posting the declaration, “Dietitians unite and demand max money!” Climbing
Up the Pay Grade Carolyn Caesar, RD, editor and publisher of Jobs in Dietetics, says, “In general, salaries for dietitians have gone up steadily in the past five years, especially in higher cost of living areas—such as the Mid-Atlantic, East Coast, and West Coast—and in areas of dietitian shortage.” Created by Caesar in 1978, Jobs in Dietetics is a job listing service for nutrition, dietetics, and foodservice professionals in which ads are listed for free for the employer and the job seeker pays for the subscription. An online, national, and California edition of Jobs in Dietetics is available. The
Going Rate for Dietitians These results are higher than the most current BLS median wage estimate for dietitians and nutritionists because the ADA Compensation & Benefit Survey is more current and it restricts its estimates to RDs.1 The BLS reports median annual earnings of dietitians and nutritionists at $41,170 in 2002, with the lowest 10% earning less than $25,520 and the highest 10% earning more than $58,700. The BLS also predicts that employment of dietitians is expected to grow about as fast as the average for all occupations through 2012 as a result of an emphasis on disease prevention, a growing and aging population, and public interest in nutrition.2 “Location is a big factor in the country. A dietitian will make more money in California than in Mississippi, but the cost of living is lower in Mississippi, so maybe it balances out. The housing factor is huge. I see less dietitians willing to relocate to California because they can’t afford the housing, even with a better salary,” says Caesar. “Stay informed about the world around you, read the business section of the newspaper, and know the trends in business. Right now, the trends for salaries are up in the coming year. It is a good year for employment and businesses are dong well,” says Caesar. Indeed, according to a recent study by CareerBuilder.com and America Online, nearly 80% of companies plan to increase pay for current staff and 50% expect to offer better compensation for new employees in 2006. With the economy and job market expanding and the work force tightening, it seems that employers are ready to dole out financial incentives to keep their employees happy.3 “As far as how dietetics compares to other professions, we are still low. We have a lot of work to do,” says Sandquist. “We are an underpaid profession. But we’re still fighting; we haven’t given up yet. There have been some successes, but we need more of them,” says Caesar. Dietitians’ salaries do tend to pale in comparison with other allied health professions. For instance, according to the BLS, the median annual earnings of physical therapists was $60,180 in May 2004. Factors
Depressing Paychecks
Historically, numerous dietitians put their careers on hold to raise families. When they reenter the workforce, they can be at a salary disadvantage. “The dietitians [who] have been gone for five to six years may not have been involved with the association, perhaps have gone to per-diem or part-time work, or dropped their membership during this time, which makes them fall behind in salary. They may have even dropped their RD, which is catastrophic. Dietitians need to take their RD to the grave with them,” says Caesar. Caesar also believes many dietitians entering the profession are not fully aware of the salary range for dietetics and that a number of dietitians leave the field after 10 to 15 years because of disappointing salaries. The state of healthcare and Medicare and insurance reimbursement hasn’t helped dietitian salaries prosper, either. Hospitals are still the most common place that dietitians work.1 Undergoing a financial crunch, hospitals may preserve direct care positions such as nursing and make staff cuts in other areas such as the nutrition department. Caesar has observed plenty of full-time dietitians being reduced to part-time or per-diem status yet still maintaining the same work load. “The lack of reimbursement is a problem. When it is available it is so low,” says Caesar. Sandquist agrees: “We need to continue to work with insurance agencies and other payors. ADA is coming up with national, clinical pathways, and as a profession we’re headed in the right direction.” Clinical dietetics, the backbone of the profession, is still the most commonly held position in dietetics. However, it is also the job that seems to be targeted for the poorest compensation. Wages tend to be lower in the areas of acute care/inpatient, ambulatory care, and community dietetics.1 “I’m seeing a lot of disappointment in clinical dietetics. These days, the clinical dietitian [has] the lowest salary in the profession,” says Caesar. Nevertheless, she reports positive changes. Inventive hospital managers are setting up clinical ladders for dietitians, offering room for professional growth and salary increases. Smaller hospitals may not have these opportunities for growth and clinical dietitians can get stuck in their entry-level position for years. Contract food companies may hire dietitians at a lower rate than if they were hired directly by the hospital, but they can offer many opportunities for upward mobility. “Unions are going after professional people. I talk to dietitians across the country [who] belong to unions. Some say it has helped a little bit with compensation; others say it’s useless with huge dues to the unions and little benefits in return,” comments Caesar. Making
the Most Money With Your RD Caesar also believes dietitians entering the culinary field will find financial success. Wages are the highest in the areas of food and nutrition management, consultation and business, and education and research. Specific work environments where wages are highest include school foodservice, food manufacturers/distributors/retailers, pharmaceutical or nutrition product companies, and college or university faculty. Supervisory and budget responsibilities on the job are also associated with higher wages.1 “More and more dietitians are becoming successful,” says Caesar. “But dietitians need business skills in order to hang out the shingle and go into private practice.” Sandquist believes there are many opportunities to start your own business as a dietitian in nontraditional roles, even though there may be risks associated with them. “RDs have a great variety of skills to offer. We all need marketing skills. It’s a vital part of our education,” says Sandquist. Beefing
Up Your Value Sandquist notes, “If someone is looking to expand their knowledge with competencies such as the CDE [Certified Diabetes Educator], they can upgrade the salary level.” Sandquist believes venturing into new roles may give dietitians room to grow and add value. Why not learn more skill sets such as starting insulin or inserting feeding tubes? She also hopes to see national standards for licensure on the horizon, which may increase dietitians’ worth. “Part of the challenge is that anyone can call themselves nutritionists. This is not as common in other fields. Not anyone can call themselves a nurse or pharmacist. It makes it difficult for the public and the payors to appreciate the value of dietitians. ADA has done good work with reimbursement and evidence-based resources that show value.” Joanne V. Lichten, PhD, RD, hosts a seminar aimed at helping dietitians earn better wages called “How to Make More Dough in Dietetics.” She includes interviews with dietitians earning in the top 10% income bracket according to the ADA’s salary survey—those earning roughly $75,000 or more per year. Lichten focuses on where the best paid jobs in dietetics are hiding, what skills and education can put you on the fast track for higher salaries, the art of self-promotion, and how to negotiate higher salaries. At
the Bargaining Table “The inability of dietitians to negotiate is one of the reasons that the salaries are low. Dietitians need to take a risk. If you don’t ask for it, you won’t get it,” says Caesar, who compares negotiating a salary to buying a house or car. “The employer is going to try to get you at a lower price and you need to try to sell yourself at a higher price. You need to know your bottom line.” Often, dietitians will agree to a salary, only to find out later that it is $2,000 to $3,000 less per year than comparable positions. “Ask for 10% to 15% higher than you made in your last job, sometimes even 20% higher to allow for negotiation. You want to earn 10% more than your last job. Otherwise, you are never moving up,” says Caesar. But if you choose to move down the career ladder—from management to patient care—this rule may not apply. Keeping up with salary trends is also essential. Some dietitians in the same job for 10-plus years may be surprised to find that they’re currently making an entry-level salary because their annual increases haven’t been keeping up with market trends. Sandquist says, “If it’s a matter of staying with an organization, look at their compensation system. Some may have levels, pay variations, or performance-based pay opportunities.” Caesar suggests, “Be careful to negotiate pay at the beginning. Do research to find out what you should be paid and don’t go below that level. Be willing to walk away when you don’t get a good offer. That’s hard to do, but once you get locked into a salary, it may be difficult to go up.” When considering employment, dietitians should look not only at the hourly rate but also at the entire benefit package. Dietetic practitioners as a whole are offered considerable fringe benefits compared with a reference group of white-collar workers in private industry.1 “Sometimes dietitians don’t think about benefits. If you take a per-diem job with no benefits, you have to know what they are worth and whether you are being paid in lieu of those benefits. You may not need them, but maybe the next person in that job will,” says Caesar. If you become self-employed, you need to consider what it costs to pay for Social Security, sick leave, vacation pay, and insurance premiums. Sandquist adds, “There is value in considering the whole comprehensive employment package, not just the salary per hour.” Work
to Be Done In the end, the profession as a whole needs to do a better job of proving its worth. “Market, market, market,” says Sandquist. “We have to educate people what a dietitian is and how we can help. The key is really showing the value and cost effectiveness of the services we provide.” Caesar stresses, “Demonstrate your value to the organization. If you bring value, you need to be compensated more. Be informed, network, get out there, and know what’s going on. If you don’t, you’ll get steamrolled.” — Sharon Palmer, RD, is a freelance food and nutrition writer in southern California. References 2. U.S. Department of Labor, Bureau of Labor Statistics. Dietitians and Nutritionists. Available at: http://stats.bls.gov/oco/ocos077.htm 3. Castellini R. Survey: More to See Pay Increase in 2006. CareerBuilder.com. Available at: http://cnn.worldnews.printthis.clickability.com/pt/cpt?action=cpt&title=CNN.com+-+Survey:+More+to+see+pay+increase+in+2006+-+Jan+4,+2006&expire=-1&urlID=16755944&fb=Y&url=http://www.cnn.com/2006/US/Careers/01/04/cb.aol.survey/index.html?section=cnn_latest&partnerID=2006 4. Moen RS. What is ADA doing to increase dietetics professionals’ salaries? CEO Digest, June 2003. Available at: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_5833_ENU_HTML.htm
• Career Coach RD • DietitianCentral.com • How to Make More
Dough in Dietetics • Jobs in Dietetics • Salaries: The
Who, Where, When, and What’s Next! • Salary.com • U.S. Department
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