May 2011 Issue

The Joys (and Stresses) of Private Practice
By Lindsey Getz
Today’s Dietitian
Vol. 13 No. 5 P. 38

Owning a small business can be just as rewarding as it is challenging. Let our five established RD experts help you determine whether it’s a practical option for you.
Deciding to go into private practice is a big decision, and it may not be the right choice for every RD. Running your own business takes drive—and it often takes guts, too. Today’s Dietitian spoke with five RDs who took the plunge to find out what inspired them, how they got started, what challenges they face, what keeps them going, and what advice they’d offer to others who may be considering the private practice route.

Bonnie Giller, MS, RD, CDN, CDE, owner of BRG Dietetics & Nutrition, PC
Bonnie Giller says starting a private practice was something she always wanted to do, but she also knew she needed experience and a solid foundation. As a result, she worked in hospitals for a while and started her private practice as a side business, doing weight counseling. In the beginning, she ran the business out of her apartment.

She says one key to success is the “P factor”— that is, professionalism. In the early days, she had an area of her apartment sectioned off for business and asked that her family stay clear when clients were there.

Today, she applies that same professional approach to the full-time office she runs out of her home. The lower level was converted into an office, complete with a separate entrance, separate phone line, a waiting room, and a consultation room. Though she always makes time for her family, she says it’s important for her children not to run around her office area, which would take away from the P factor.

According to Giller, one of the biggest challenges she faces in private practice involves insurance. In the early years, she wasn’t a provider, but she says with today’s economy, you almost have to be to succeed. “The paperwork and everything that goes along with being a provider is time consuming and frustrating,” she says.

No-shows and last-minute cancellations are additional challenges. “I find that people paying copays tend to be the worst offenders,” she says. “When they’re not paying much out of pocket, they just don’t put the same value on the service.”

To deal with this problem, Giller has a no-show and late-cancellation policy. She asks clients to cancel within 24 hours and has them sign a form agreeing to this policy. Giller says she often allows clients some flexibility, as there are situations in which a person needs to cancel for a legitimate reason. But if clients make a habit of not showing up, she won’t book future appointments for them. “They’re not a client I want … if they don’t recognize the lost time or money they cost me from continually canceling,” she says.

Giller advises RDs to consider getting malpractice insurance before entering a private practice. “The minute you start giving advice to somebody, you run the risk of a lawsuit,” she warns. “I’d say that should be the first thing you do.”

In addition, Giller says RDs who are considering starting a private practice should be willing to accept that doing so is not for everyone. “I tell students I mentor that not everyone is cut out to be a business owner or in private practice,” she says. “When you go into private practice, you need to be prepared to work harder than you ever did when you worked for somebody else. That’s not something that everyone wants to do.”

Reba Sloan, RD, MPH, LRD, FAED, private practice owner
“I don’t think private practice is for the faint of heart,” says Reba Sloan. “I work with several dietetic internship programs and often talk to a lot of students. I think they have stars in their eyes when they think about private practice, but they don’t always know what’s really involved.”

Sloan says when she started in the field in the late 1970s, dietitians didn’t have many options other than working in a hospital. “However, I quickly found out I wasn’t really cut out to work in a hospital when I almost passed out in the dialysis room. So I eased into private practice, first doing some work with a psychologist in a private setting who was working with eating disorder patients,” she explains.

She says if students or RDs looking to go into private practice can find a way to do some part-time work or shadow someone already doing it, they can discover whether it’s truly for them before jumping in head first. “It sounds wonderful when you hear what a private practice dietitian is making per hour until you factor in all the business expenses like rent, malpractice insurance, health insurance, and more,” she says. “Owning a business also means working weekends and evenings and often giving up vacation time. When you work for someone, those things are handed to you—paid vacation, paid break time, and other benefits like health insurance. You don’t appreciate how much benefits are worth until you work for yourself.”

One challenge of private practice can be feeling like a “lone ranger,” adds Sloan. “Private practice can be isolating and you might feel on your own.”

However, for Sloan, treating eating disorders requires corresponding with other practitioners, which she has found helps keep her engaged. About three years ago, she moved her office of 17 years into a setting where three therapists who also treat eating disorders have office space, which they rent from Sloan.

“It’s great because we can retreat to the break room and talk for a few minutes to clear our heads or troubleshoot a problem,” she says. “If you don’t have some sort of escape like that, you could possibly start to burn out.”

Sloan also says all of the behind-the-scenes work that goes into owning a private practice may be a challenge for dietitians. It’s not just seeing clients. Sloan says her husband has a degree in small business management and handles certain tasks for her. “To be honest, I don’t even know what my phone bill is, but having someone manage that for me allows me to focus on seeing patients,” says Sloan, who averages about 35 clients per week without having to handle those business tasks. “Other dietitians might consider hiring an assistant to help with tasks like billing or record-keeping. If not, they have to expect those jobs to cut into the time they could be spending on counseling. There’s a lot to consider.”

Maggie McHugh, MS, RD, CDN, owner of Eating for You (and baby too), Inc
Maggie McHugh started out doing clinical nutrition in a hospital setting before jumping into private practice. She calls this her “knowledgeable foundation.” McHugh comes from a family of business owners and always knew she would one day run her own company.

“When I had my first child, I decided to start the business,” says McHugh. “I knew at this time in my life I needed to be my own boss and have the flexibility and control of my own schedule.”

In the beginning, McHugh was working for her employer—at that time, it was a community position as the nutrition program director at Cornell Cooperative Extension—raising a baby, and launching her business on the side. That meant she had to work nights and weekends, and she learned a lot during that time.

“Starting a practice and running one means keeping up with finances, networking, business, marketing, advertising and, of course, nutrition,” she says. “For me, it also means out-of-pocket health expenses for a family of five, plus retirement and investment savings and management, all on my own.”

McHugh says she recommends that anyone looking to start a private practice be financially prepared. She advises at least six months of savings be set aside for the business—more if possible. Health insurance ends up being a huge business expense, and she says she considers it one of the biggest drawbacks. But there are many pluses, too. McHugh enjoys having the freedom to explore her own creativity in her business and setting a work schedule that coincides best with her family life. She says that a private practice also requires a lot of patience.

“Timing is everything,” she notes.

Beverly (Beve) Kindblade, MS, RD, CD, owner of Seattle Nutrition and Beve Kindblade Consulting
Before launching her private practice, Beverly Kindblade had been a nutrition professor for about 12 years and, prior to that, an inpatient clinical nutritionist. While she had a lot of experience, Kindblade says she entered the private practice world without a single patient. A lot of hard work has helped her build a thriving business.

Kindblade says her best advice to RDs considering the leap would be to get a website up and running at least six months to a year before even starting the practice. She says it’s the best way to advertise and get your name out there. It can help you build a client base so that you can “open shop” with some patients already lined up.

“I made the mistake of spending thousands of dollars on advertising that never brought me one client,” she says. “A wise person told me to put that advertising money into a Web presence. That’s been a smart decision.”

Setting up your practice to accept health insurance is another key factor. Kindblade says this is an area in which she learned a vital lesson the hard way. “If you already work at a facility where they are using your information to bill insurance, you want to add your private practice on as a second location—even if you’re just adding it as your home address for now,” she explains. “If you leave your current job and there’s a break between that job and your private practice, you need to start the insurance credentialing process all over again. That’s a three-month wait period! Because I didn’t know this, I wasn’t able to accept insurance when I first started out.” 

Another lesson Kindblade learned is to have all your systems in place before the business grows too much. Kindblade’s business grew rapidly, going from just one or two patients per week in the first year to about 18 in year two and ultimately 24 to 30 per week. If you don’t feel totally confident doing all the business tasks on your own, hire a CPA and a bookkeeper, Kindblade advises. An IT person to manage the website may also be necessary.

“The time that you’re trying to build your practice, when you’re not very busy, is the time to get your systems in place,” Kindblade says. “Once you’ve launched the business, you may not have time for that. Take the time now to look around and hire the people you trust who can help your business grow.”

Today, Kindblade has an office manager familiar with tax laws and Quick Books, which saves her time and allows her to focus on the areas in which she’s a true expert. “I don’t believe that healthcare professionals are always business experts, too,” she says. “We may be experts in nutrition, but we’re not always taught the business side.”

Kindblade says when you reach the point where you’re working 50 to 60 hours per week, it’s time to consider hiring an employee to take on some of that workload. “It’s a big expense, but they will take care of many administrative jobs, which frees up a lot of your time,” she says. “My office manager is even taking on the task of insurance billing, which will ultimately save us a lot of money on what we currently bill out.”

Owning a practice has been an eye-opening experience for Kindblade. “I had no idea the things my previous employer was doing to give me a paycheck every two weeks,” she says. “I have a whole new appreciation!”

But Kindblade says the hard work is worth it to her. “I love it,” she adds. “I know that whatever I put into my business, I’ll get out of it. It’s very rewarding.”

Kristin Reisinger, MS, RD, CSSD, private practice owner
Kristin Reisinger took a bit of a different path since she became an RD after building a practice. She began her graduate studies in nutrition to become an RD and enhance an already successful personal training business. Reisinger says becoming an RD has only helped grow her business by benefiting clients even more.

“My original goal was always to have my own business that would help people transform their bodies through fitness and proper nutrition,” she says.

Though Reisinger already had a successful practice, she says she still held some part-time inpatient and outpatient clinical positions to gain more knowledge and experience in the dietetics field. She believes those experiences helped improve her private practice.

Reisinger considers growing a client base to be one of the biggest challenges of owning a private practice. She says doing some free work for the purpose of getting your name out there and becoming recognized can pay off—but you still have to make money.

“Doing something part time while building the business is key in order to make extra money to help pay bills or market the business,” she says. “This can result in seven-day-a-week workweeks and long hours. There is no differentiation between weekends and weekdays when you have your own business!”

Like other private practice owners, she says other big challenges include paying out of pocket for health insurance, not getting paid time off, and dealing with slow times of the year when a paycheck might not be as steady. However, she says planning ahead and being organized can help you overcome these challenges. And she says the freedom of owning a business is a huge benefit.

“It’s the freedom to counsel the way you want, schedule as you want, and create your own salary based on how hard you work,” she says. “It’s also the freedom to stay home with your child if they’re sick one day and not have to worry about taking the day off. Developing a good working relationship with clients so you can reschedule if a situation arises is the key.”

Reisinger believes marketing to anyone and everyone is one mistake new private practice owners make. She believes finding a niche can help set you apart from the hundreds of other RDs competing with you for clients. “Specifically, I work with women and weight loss, sports nutrition, and physique development—my specialty—as my background is in fitness and bodybuilding competitions,” says Reisinger. “If you visit my website, I’m not gearing it toward diabetes, heart health, or pediatric nutrition. I set myself apart from other RDs by knowing what I’m good at and what I’m interested in, then the right clientele finds me.”

To RDs just starting out in the private practice world, Reisinger says to “know who you are and what you’re good at.” That will help you target the right clientele and start a successful relationship with that base. “Represent yourself professionally and work hard,” she adds. “It’s definitely not easy to develop and maintain your own practice, but the hard work does pay off.”

— Lindsey Getz is a freelance writer based in Royersford, Pa.