7 things you should know before working in private practice as a dietitian

Thinking of taking the plunge into working in the private practice setting? Here's everything I wish I knew before I started...

1. It can feel really isolating.  

Imagine sitting in a shoebox clinic room. Alone. Zero clients booked in for entire days on end. My only company, the bleak four walls staring back at me. Accompanied by the torturous sound of the clock ticking in an otherwise silent room. Lordy! That's enough to drive anyone a bit koo-koo. 

No shocker, this wasn't exactly the most motivating environment to work in. It's a nice thought to presume that I'd have spent my ample amount of spare time cramming in as many learning opportunities as I could. I'm not proud to admit that a decent smack of my time working in private practice was spent doing sweet f*ck all. 

At the time, I remember having waves of guilt wash over me. Who did I think I was to be googling flights to India or appointing myself a cheeky early minute while I was still on the clock? Especially coming from me, the high achieving university student who usually prides herself on being proactive and hard-working. But put any new graduate in a room alone for eight hours straight for days on end... and I'd argue that you would get a similar result.  

Confiding in peers with similar experiences served as one of the biggest lifelines in maintaining my sanity during this time. The more dietitian friends I spoke to, the more it it became apparent that this feeling of isolation seemed to permeate throughout the private practice dietitian profession. Oh, the underrated comfort of hearing those two simple words that instantly make you feel less alone: me too. 

Maybe you are different to me and would thrive off the autonomy and solitude that this type of role consists of. But just know that if you do find yourself in a similar boat, you are not crazy!! It's normal to feel despondent and maybe even a tad disillusioned in this scenario. It's also well within your right to speak up and let your seniors know that you are struggling (something I wish I did sooner). 

2. Self-promotion makes up a big part of the role. 

Want to know how to overwhelm a new graduate dietitian? Get them to work independently in a GP clinic with no existing client base. Their first task: mingling with the doctors in the lunchroom in an attempt to gain referrals. Ugh! Even just thinking about the dread I felt walking into that clinic every week still makes me shudder. But it didn't stop there. Buckle up for self-directed visits to local multidisciplinary clinics, awkward cold calls with specialists, and facilitating community education sessions solo. Not to mention the cringey promo letters and posters you most likely will be encouraged to distribute to local clinics (Hello, Canva!). 

With no prior exposure to working in private practice, this felt like an entirely new ball game to the hospital scene I was acquainted with during university. No longer did I have a guaranteed patient list to speed through on the wards. I learnt hard and fast that if you want to gain referrals and even see clients in the community setting, you had to actually... put yourself out there. This presented a challenge to my professional confidence. No lie, it felt pretty daunting trying to promote myself to experienced GP's; considering I only had a few days of experience in the role to back myself with. 

Don't worry! It got easier over time. Mostly because my clinical reasoning and professional confidence grew, the more clients I saw. If I could offer advice to someone embarking on a similar role, I'd say this: Think laterally. Who can you connect with that will channel clients you are genuinely interested in seeing? For example, visiting the school nurse at a local high school allowed me to gain referrals for adolescent eating disorders. You can do it. You will get there. And you are totally worthy of receiving referrals (even if you still feel like there is another dietitian that could do it way better than you, the measly new graduate). 

3. You will be 100% more passionate about your job if you work for a clinic that attracts a client group you are actually interested in. 

My first job as a new graduate was not handed to me on a silver platter; an unfortunate but likely story within this field of work. After nine months of persistent applications, I finally landed my first gig as a dietitian. At this point I didn't care too much about who I was going to work for. I was just happy that my time spent perusing Seek.com had come to a much-anticipated end. Where did this leave me? Working within a physiotherapist clinic centered around sport, injuries and pain management kinda stuff. Looking back... I can see it as clear as day. It was completely out of alignment with my clinical aspirations of up-skilling in the areas of eating disorders, women's health and all things intuitive eating. 

Before singing any new employment contracts, ask yourself... 

What client group will this clinic attract? 

What clinical areas of professional development will assist me in supporting this client group? 

Do I align with the company values? 

Are the other health care professionals in this clinic disciplines I am interested in learning more about? 

What clinical support will I have in this role? 

Write down all your answers. Then take a good hard look at them and seriously ask yourself whether you think you will enjoy working for this company. I know I know, you can't be too selective when you first start out. It's all good experience and yada yada yada. But remember that during the recruitment process, it's not all about whether you are the right candidate for them. It's also about nutting out whether they are going to be the right fit for a superstar like yourself. 

4. You will be winging it for the majority of your consults. 

Working in a generalised dietetic clinic is like a lucky dip. Undiagnosed eating disorder? Complex history of anxiety and depression? Debilitating bowel troubles? Lonely old lady who just wants to come in for a chat? Expect vague GP referrals (if any). Last minute walk-in bookings, and the 'anxious-well' client who spends hours self-diagnosing on Google before attending the first appointment. Oh, the joys of working with humans!

Being the over-prepared type, I initially really struggled with the unease of having no clue as to who or what would be walking through my door next. My mantra on repeat: Sit up tall. Shoulders back. Smile. Validate their concerns. Listen attentively (I can't stress this enough!). 

If you land a client in your room with a totally random condition you have never heard of and have zero clue of how to manage. Breathe! Be transparent with them. Have the humility to admit that you don't know (this is a lot more admirable than bluffing it). Stick to the basics. Do a thorough initial assessment. Then leave the clinical diagnostics and treatment plan for after they have left the appointment. In my experience, clients were always very understanding and appreciative when I took this kind of approach. Not only because it allowed me to show up in a more calm and level-headed manner, but it also resulted in me being able to provide them with a much more comprehensive (and accurate!) treatment plan. Simply because I gave myself permission to acknowledge that I am not superwoman, I do not have to pretend to know everything; but perhaps most importantly... nobody expects me to!

Don't get me wrong, I had my fair share of moments where internally, I was floundering. The well-known aphorism 'fake it till you make it' never ringing more true. It was in these moments I had to adopt a gentle and kind internal dialogue towards myself. Trust your judgement. You know your stuff. You don't have to fix a client's entire life problems in one consult. Back yourself, girlie!

Early on in the piece, I printed out a cute little quote for my wall that read: take a deep breathe and try all over again. Cheesy? Maybe slightly. But it acted as a nice reminder during my time working in clinic that it's ok to f*ck up. Normal, actually! And that with every mistake, I was presented with an opportunity to reflect, learn and grow professionally. 

5. Did somebody say pseudo-psychologist?

It's impossible to talk about food without talking about emotions. No doubt, you are going to encounter difficult conversations relating to mental health, complex social situations and the hardship of managing debilitating health conditions. I'll admit this can feel daunting; my initial reaction being to avoid addressing these topics altogether. Why? Because it can feel scary diving into emotionally-charged conversations with zero qualifications on how to navigate them. What if it gets too heavy? They have a breakdown in my office? Or I don't know what to say? 

With time, I began to conclude that it felt ignorant, and maybe even slightly insulting to avoid hard conversations; simply because they made me feel uncomfortable. My advice? You are a human, working with humans. Be brave enough to probe further on the uncomfortable stuff. Put your ego aside and be willing to show up imperfectly for someone. Don't underestimate the comfort that can be found in the simple words of: 'That sounds really tough' or 'I'm sorry you had to go through that'. As a dietitian, you don't need to know how to counsel someone on debilitating depression or domestic violence. That stuff is beyond your scope. What you can do is offer a safe space for clients to voice their struggles, validate their concerns and point them in the right direction of where to seek help. 

If there is a topic that keeps surfacing during a consult, trust that it's important to the client. Let's say you get a referral for weight loss. But within the first 15 minutes of the consult, the client keeps circling back to their childhood experience of negative messaging from parental figures around food and weight. Bingo! (history of weight shaming). Trust that it is worth spending the first few consults exploring this, rather than jumping straight into lower-calorie food swaps. At uni we are encouraged to dive straight into implementing measurable dietary modifications. But I'd beg to differ that until you start to holistically address what's really going on for a client, you will struggle to make progress towards achieving their clinical goals. 

A final note on this topic before we move on: know that it is well within your scope to direct clients to podcasts, documentaries, books, apps or journalling techniques you think might help. Hint: Familiarise yourself with 'The Resilience Project' by Hugh Van Cuylenberg and 'Stutz' by Jonah Hill. These resonated well among clients who struggled with anxiety and depression. 

6. Paperwork, paperwork, paperwork. 

With every new client you see, comes a stack of paperwork to be done behind closed doors. Brace yourself for the daily drag of writing GP letters (that I am 99% sure no-one ever even reads). Throw in the odd supplement script, patient handover, NDIS report or prep for a group education workshop... and you have yourself a hefty list of monotonous admin to wade through. Yawn! 

I'm not trying to deter you. We work in healthcare, therefore I understand that documenting is a totally valid legal obligation we cannot escape. But I do feel that this is a reality worth mentioning, as it makes up a pretty decent chunk of the role. 

A few words of wisdom: Make yourself templates for the documents you will frequently be scribing (i.e. GP letters, bloods requests). Don't hold back on the medical acronyms and abbreviations - they exist for a reason! Check-in with the IT crew to see if you can personalise the patient documenting system to a format that suits you. This way you won't drive yourself crazy writing out the same old headings for each new client (Pmhx, Social Hx, Diet Hx... you get the point).  

7. You will spend a lot of time sitting at a desk, staring at a screen. 

This might sound ironic, but working as a dietitian catapulted me into perhaps the most unhealthy period of my working life (physically and mentally speaking). Here I was counselling clients on how to eat better and adopt a healthy lifestyle... little did they know that it was at the expense of my body and mind feeling completely out of whack. The reality of a fully booked diary as a dietitian means sitting on a chair. In front of a laptop. Talking non-stop. All. Day. Long. 

Personally, I found the sedentary lifestyle that this workload bred to be incredibly draining. Leaving my body feeling sluggish and my mind feeling scattered on the drive home. Daily. The 9-5 office lifestyle had gotten under my skin. And it didn't leave me feeling great. Like, at all. 

Believe you me, I adopted many new habits in an attempt to manage these icky feelings. Scheduling in weekly swimming after work. Swearing my by daily lunch-break walk. Turning to weekend hikes as my reset button. I felt like I finally understood the middle-age urge to become an avid nature enthusiast. The tranquility of the forest, the fresh coastal air, the invigorating feeling of blood pumping through my veins after completing a lengthy trek. Offering a stark (and welcome) contrast to the stagnant energy of the clinic room I spent the majority of my week residing in. Experimentation helped me realise that no matter how much exercise or technology-hygiene I implemented in my personal life; it would never cancel out the negative impacts that came from spending eight hours a day confined to a desk. 

Personally, I've always had a disposition to prioritise my lifestyle over a pay-check or shiny job title. So take my opinion on this with a grain of salt. But if you know for a fact that living an active lifestyle and spending a healthy amount of time away from screens in a non-negotiable in your life, there is a chance you might struggle with the sedentary reality of working in this setting.