The State of Dietitian Private Practice: Navigating Today’s Challenges
By Jennifer McGurk, RDN, CDN
It’s a privilege and honor to be the CEO of Pursuing Private Practice, a company dedicated to helping dietitians take up space in business. Whether you’re starting your private practice, growing your caseload, or leading a team, you have experienced many changes as a business owner. This post will highlight different areas of private practice that have experienced challenges in the past year, and what you can do in this season of business.
Throughout this post, you will see me compare the journey of navigating business to the journey that our clients experience when working on their health. These parallels are on purpose because I believe there are so many lessons we can pull from the work we do with our clients that ultimately make us stronger business owners.
1. Building Resilience: The Key to Long-Term Success
Running a private practice is not easy. It’s harder to sustain a private practice in today’s environment compared to a few years ago, and this holds true for dietitians at every stage of business. The landscape today is tougher—client acquisition, team retention, and profit growth are more challenging than ever. However, if you’re navigating any of these issues successfully, you’re developing invaluable skills that will pay off. Learning to build a business in today’s market puts you ahead of the game. Resilience isn’t just about getting through hard times; it’s about gaining confidence that you can find solutions to new and unexpected challenges.
This is the same message we share with our clients. Often, clients come to us under less-than-ideal circumstances, hoping to improve their health. We don’t sit back and tell them to “try again when things are better.” Instead, we help them make the best of their current reality and move forward with values-based, realistic solutions that fit their lives. It’s usually a messy, imperfect journey for our clients, full of ups and downs. Sound familiar as a business owner?
Our clients aren’t automatically equipped with everything they need to care for their health effectively; they often have to face obstacles and setbacks to build resilience. Building a business is no different. It requires working through challenges, adapting to changing conditions, and pushing forward with the tools and solutions available in the present. This is the hard work that you will do as a business owner.
2. The Online Nutrition Industry Has Shifted
The involvement of big tech and investor-backed companies is changing our field, with both pros and cons, especially in the online nutrition market. We’ve seen these types of companies “influence” other professions in the past, some more enmeshed with the insurance industry than others. For example, the therapy field has more experience with these types of companies than the dietetics industry. I believe the therapy big tech and investor-backed industry is about 2-3 years “ahead” of dietitians, so we can learn valuable lessons from history, even if we can’t predict the future entirely.
Investor-backed tech companies often have allocated funding for marketing, spending thousands, if not tens of thousands of dollars, on campaigns. This helps raise awareness about the work dietitians do and promotes our field as a brand. These companies also can facilitate a smoother experience with insurance by credentialing dietitians with insurance companies and managing their own Electronic Medical Records systems.
However, some of these companies operate in ways that seem questionable, often prioritizing profit over people. I’ve heard concerning reports about treating contractors like employees, assigning providers to clients in unlicensed states, engaging in potentially fraudulent insurance practices, and withholding payment from dietitians. My best advice to these companies is that your values will make or break you in this field. Dietitians are among the most heart-centered providers; we care deeply about our work, and most of us “over-follow” the rules. Please consider hiring dietitians as consultants, adding dietitians to your leadership team, and even considering a dietitian as CEO. Including more dietitians in business decisions will help build a sustainable company that makes a positive impact. Ignoring dietitians’ needs may lead to failure. Your reputation will be key in attracting and retaining talented dietitians on your team. Also, please lead by example and follow HR laws—do not treat your contractors as employees.
For those working within these tech companies, consider your future options. If history is any indication, many tech companies will need to pivot once investor funding runs out and might not survive. Build your skills now in business, marketing, and—most importantly—counseling. These skills will empower you to understand the business side of practice, navigate insurance if you choose to accept it, and continue doing meaningful work should you decide to leave and open your own private practice.
3. New Pros and Cons of Accepting Insurance
The market demand for insurance-based nutrition services is rising. I even consider it the “new normal,” especially since the tech companies mentioned above all accept insurance directly. Private pay is now less attainable for many clients, not only due to financial concerns but also due to market demand. When there are so many options that accept insurance, it’s harder to sell private pay.
As a result, many dietitians may feel increased pressure to accept insurance in this season compared to a few years ago. Accepting insurance often involves a “trade-off” of more administrative work, organizing systems, and setting aside time to call insurance companies when issues happen (and they will). While this work can help achieve a steady flow of clients—since it’s easier for clients to say yes when the financial barrier is removed—you will still need to market your practice and effectively sell your services.
Because the market has shifted to demand more insurance-based services, if you want to start with private pay (or remain private pay), you’ll need to spend significant time getting to know your ideal client, marketing to their specific needs, and elevating your counseling skills.
As someone who advocates for the value dietitians bring to clients’ lives, I’m honestly sad to say that it’s no longer “enough” to “just” be a dietitian to earn a strong private pay rate in private practice. You have to take up space in business by solving a problem for your client, communicating that value, and providing an exceptional customer experience.
4. Reimagine the Client Experience: What Sets Your Apart?
Private practice is not just about counseling; it’s also about providing a great customer experience for our clients. As a business owner, your goal should be to “wow” your clients whenever they interact with your business. Reflecting on the pros and cons of insurance, today’s market may demand more, especially when clients are paying out of pocket.
It’s worth exploring options that elevate the client experience—think onboarding systems, supplementary support like handouts or workbooks, recipes, or other resources tailored to your ideal client. To stand out, we must go beyond standard appointments and deliver a unique, impactful experience. I especially see the need for this in group private practices, as it helps create a business brand rather than just filling individual caseloads within your group practice.
Are there certain touchpoints you can set up with clients to help them feel supported without requiring your time directly?
Do you want to offer in-person sessions and have an office for clients now that many professionals are online?
Do you want to offer a support group to foster community and connection among like-minded clients?
Do you want to provide additional resources for parents as part of the counseling process?
While it’s challenging that today’s market may demand more from dietitians when we’re already working hard, I consider the “client experience” to be an essential part of the work we do. It’s worth putting effort into this area of your business. You may need to experiment, step outside your comfort zone, and try new things to achieve different results.
I see this extra step as a parallel to the process our clients go through when making changes for their health. It’s often “not enough” to simply “want” different results while keeping everything the same. Clients must experiment with changing habits, behaviors, and step outside their comfort zone to establish a “new normal” for themselves. This is true for business owners as well.
5. Pivot Your Private Practice Offer
Another theme of being a private practice owner is recognizing that your vision for your business may change over time. If you’re no longer passionate about your business, is there another area of expertise you’d like to explore? If market demand has shifted, consider asking your audience what they need from you. If 1:1 private practice no longer aligns with your boundaries, think about how your boundaries have evolved and how your business can better fit into your life.
Many dietitians go through life transitions while running a business. It’s very normal and expected for your private practice to evolve as your life changes.
Especially if you’ve been running your business for a while, you have a skill set that can work to your advantage. You have experience helping clients create transformations and a process for working with your ideal client that you can outline and refine.
Are there different business models you’ve always wanted to try, especially if you now have more time? Do you want to pivot toward developing intellectual property? Do you want to work with professionals in supervision or consulting? Would you like to create a group program or an online offer?
I also want to highlight the option of transitioning from business ownership to a job. If you’ve run a small business, you’re well-positioned to be a leader within a larger organization. You can apply for leadership and upper-level roles because you’ve run a business. You have my permission for your business to serve as a “stepping stone” to new career opportunities. Don’t hesitate to update your resume to reflect all the accomplishments you’ve achieved and apply for a job if you need to. I would never shame a business owner for doing what’s best for them within their boundaries, just as I would never shame a client for making choices that serve them.
If you’re someone struggling with today’s challenges, it may be time to pivot in a new direction. Just like when something isn’t working for our clients, we help them pivot to find new solutions to improve their lives.
6. Instant Gratification vs. Long-Term Solutions for Lasting Change
Society as a whole is moving toward instant gratification. We see this in our relationships with cell phones, same-day delivery, and technology like AI providing instant results. So, the “trend” of clients expecting quick solutions in health isn’t new or surprising. But as dietitians, we know that changing health behaviors is nuanced, challenging, and takes time. Much of the work we do with clients is relational and therapeutic, not just educational and informative. This means that the most transformative work for clients is typically long-term.
There’s a tendency among clients to look for quick fixes, just like the “short-term” “results” promised by the diet industry, which don’t provide lasting change and cause harm. Many factors affect nutrition and health, including genetics, environment, accessibility, food preferences, culture, connection, body image, self-compassion, trauma healing, oppression, mental health, and more. I believe dietitians need to educate and guide clients toward seeing health as a long-term journey while also recognizing the importance of offering clients short-term “wins.” This process often shows up in our marketing messages, onboarding, and especially in our counseling approach.
The desire for instant gratification is also common in private practice. Just as clients often “wish” for immediate change, business owners want quick fixes for their challenges. This is completely normal! Just as we counsel our clients on the many factors involved in health, there are many nuances to consider in building a business. What is the next step on your journey that’s realistic, attainable, and sustainable for you? Can you achieve a “quick win” while also recognizing that growing a business is a long-term journey?
7. Group Practice Challenges and Opportunities
I wanted to create a special section for group practice owners. I’ve had the privilege of working with many advanced professionals Business School, including some incredible group practice owners. Group practices face unique challenges specific to leadership, company culture, and creating a scalable business model.
Now more than ever, it’s essential for group practice owners to build a strong brand and company culture for their teams. In today’s world it’s easy to start your own private practice or join a tech company. Therefore, group practice owners must prioritize company culture, offer competitive compensation, and build strong relationships to retain clinicians and staff.
Group practices also face numerous challenges with insurance. Many group practice owners work with insurance to serve a broader client base and ensure profitability, but this comes with frustrations. Credentialing takes months, providers often work outside billable hours, and insurance frequently changes telehealth rules. Due to these challenges, many group practices diversify their income streams by adding consulting services, group programs, or a membership model. Just as there are many “right” ways to eat, there are various “right” ways to structure a group practice business model.
It’s a lot of work to run a values-based group private practice. It’s very common for group practice owners to prioritize team member’s needs over their own, all while trying to run a business. It’s a delicate balance of caring deeply about your team, while challenging yourself to honor the business’s boundaries. This delicate balance is harder than what most realize.
It’s also a reality that you won’t always have a “perfect team.” You may need to make do with less-than-ideal administrative support or take a temporary pay cut if cash flow is tight. Sometimes team members build up resentment, requiring you to navigate complex team dynamics. Radical candor is essential in leadership. You may never have “perfect conditions” to run your business—just as our clients rarely have “perfect support” on their journeys. But you keep going!
8. Taking Back Our Reputation
In today’s world, when it’s harder to attract clients and business is slow, we all have a role to play in strengthening our brand as a field.
The need to see a dietitian isn’t a “new” concept in private practice. We are constantly networking and marketing to fill our caseloads. However, this environment calls for a stronger message and a fresh marketing approach. While marketing trends come and go, the foundation remains: provide value for your ideal clients so they know you, like you, and trust you.
The healthcare system is broken, especially for physicians. I could go on about the business lessons dietitians can take from this, but for now, I’ll focus on doctors as our referral partners, taking care of our shared clients. Most doctors are burnt out, undervalued, and overworked. Doctors are taking care of complex clients, who oftentimes don’t have comprehensive support in place. As a dietitian, you can be an important team member serving clients, while easing the burden on physicians. Make it as easy as possible for these providers to refer to you. This will elevate their experience of working with your practice, increase your reputation, and build our brand as a profession.
Don’t be afraid to take up space in business. Showcase your unique skillset! Share how your work helps clients. No matter your specialty or ideal client, nutrition is essential to health and well-being. It’s time for us to reclaim our power and recognize the impact we have on the lives of so many clients.
9. Your Mindset Matters
Just as we wouldn’t expect clients to tackle their health alone without support, I never want business owners to feel isolated on their journey.
As we work to grow and improve our businesses, surrounding ourselves with like-minded professionals is essential. These connections provide a sounding board for frustrations, a space for support during tough times, and partners to celebrate our wins. Business ownership can feel overwhelming, and leaning on a trusted network of peers makes a world of difference.
“Mindset” is a term that gets used broadly, but at its core, it’s about our internal dialogue, beliefs, and resilience in the face of challenges. It’s about cultivating the belief that we’re capable of handling whatever comes our way—and that we deserve success. The right mindset helps us shift our focus from challenges to solutions, allowing us to take the “next right step”. Mindset work is so important for business owners to embrace. But it’s also the work we do with our clients.
I encourage you to find a community or mentor who understands what you’re building with your private practice. Remember, reaching out for support isn’t a sign of weakness—it’s self-care. Just as we guide our clients through change, we need guides of our own to help us navigate the journey of business ownership.
10. A Call for Innovation
Now, more than ever, we need to approach private practice with resilience and creativity. Dietitians have navigated many challenges before, and we’ll do it again. With support and innovation, we can continue to uplift each other and our profession, proving that in times of difficulty, we are still here to make a difference.
I am honored to be a leader in the field of dietitian private practice, but recognize I am one person who does not have all of the answers. My lived experience, bias, and work within Pursuing Private Practice have influenced my opinions within this post. A deep desire of mine is to create more connection and community in our field, recognizing we all contribute to this dialogue and can have respectful conversations, especially when we don’t agree on topics.
I always welcome conversation, back-and-forth dialogue, and various perspectives when outlining “the state of private practice”. I would love to hear your thoughts, feelings, opinions, and take-aways!
Thank you so much for the opportunity to share my own.
Want to work with me to build your private practice?
Business School is a comprehensive 6-month program designed to guide you through every stage of building a private practice: getting set up, seeing your first clients, growing until you’re fully booked, hiring a team, expanding your offers—and even learning how to coast when needed. Inside, you’ll follow a step-by-step curriculum with the flexibility to choose the path that fits your current stage of business and life. You’ll get access to advanced toolkits, templates, and systems for business topics like marketing and finances, but also for counseling skills and client support. Beyond the curriculum, you’re supported by personalized 1:1 coaching, weekly office hours, and monthly themes that address the real challenges of private practice. The program keeps you moving forward with built-in accountability that builds resilience and confidence so you feel like a legit business owner. Learn more and apply here!
