- Email: [email protected]
Commission on Dietetic Registration 2008 Needs Assessment
from the association Report on the American Dietetic Association/Commission on Dietetic Registration 2008 Needs Assessment
W
ith the cooperation of the American Dietetic Association Foundation (ADAF) and the American Dietetic Association’s (ADA) credentialing arm, the Commission on Dietetic Registration (CDR), the ADA in 2004 undertook a comprehensive assessment of the needs of those involved in dietetics and ways ADA and its sister organizations can best serve them: members or not, students as well as practitioners (1). That assessment built on both ADA’s 1999 Member Satisfaction/Needs Assessment survey (2) (which represented ADA’s practitioner members) and its 2000 Survey of the Dietetics Profession (which represented ADA student members as well as registered and non-registered nonmember practitioners). The 2008 Needs Assessment reported here, again cosponsored by ADA and CDR, builds on all of those prior efforts, as well as ongoing quantitative and qualitative studies on the dynamics of practice in the profession. As in 2004, extensive questioning and an exceptionally large survey sample size make this a most comprehensive effort to understand and respond to the profession’s needs. METHOD The study was conducted for ADA and CDR by Readex Research of Stillwater, MN, an independent research company with broad experience in This article was written by Dick Rogers of Readex Research, Stillwater, MN. He was also responsible for execution of all aspects of this study and preparation of the initial report of the results. Address correspondence to: Dick Rogers, Readex Research, 2251 Tower Dr W, Stillwater, MN 55082 or [email protected]. 0002-8223/09/10907-0020$36.00/0 doi: 10.1016/j.jada.2009.05.022
both qualitative and quantitative research for the dietetics profession. All aspects of the study were directed by a review group of staff leaders representing the organizations. The 2008 assessment instrument was designed collaboratively by ADA and CDR staff and volunteer leaders and Readex. Sampling, data collection, analysis, and reporting were all handled by Readex Research. Data were collected via mail survey (with the option of completing the survey on the Web) between September 30 and December 1, 2008. A stratified probability sample of 12,000 —member students, plus member and nonmember registered dietitians (RDs), dietetic technicians, registered (DTRs), and others in the field of food and nutrition—was invited to participate. A total of 6,955 usable responses were received, for an exceptional 58% response rate (strong evidence for the representativeness of survey results). The margin of error for results overall is ⫾1.1%; for most major subgroups analyzed, it is less than ⫾4%. Where possible, survey results were compared with known characteristics of the population as a whole; these data also strongly support the contention that survey results are highly representative of the larger population. POPULATION OVERVIEW Using a stratified sampling approach, the 2008 Needs Assessment represents most (though not all) segments of the US population professionally involved with dietetics: ● ● ●
All RDs, whether currently ADA members or not. All DTRs, whether currently ADA members or not. Non-Credentialed Persons (NCPs), both ADA members and not. This segment includes ADA Active and Retired members not eligible for registration; it also includes non-
© 2009 by the American Dietetic Association
●
members eligible for registration as RDs or DTRs who are not currently registered, but excludes those unregistered nonmembers initially eligible for registration before 1999, a group of over 30,000 believed to have long since left the profession. ADA (nonregistered) Student members. (A few in ADA’s Student member category achieved registration just prior to this research, and were sampled as part of the RD or DTR cohorts, rather than as Students). Current dietetics students who are not members of ADA are not represented in this research.
Taken as a whole, the projected population represented by the 6,955 survey respondents is 96,505: 75,418 RDs, 4,027 DTRs, 7,501 NCPs, and 9,559 students (Figure 1). RESULTS Respondent Profile The typical (median) RD is 45 years old, with 25% under the age of 35 and 23% 55 or older. Age of the typical (median) DTR is 48, with 12% under the age of 35 and 22% 55 or older. Median DTR age is up 4 years since 2004. NCPs have a median age of 47; median age of ADA’s Student members is 25 (Figure 2). The proportion of males in each segment varies somewhat: 2% for RDs, 4% for DTRs, 6% for NCPs, and 4% for Students (Figure 3). RDs are the least diverse of the segments in terms of heritage and race as well, with 84% calling themselves white (not Hispanic/Latino), 5% Asian, 3% Hispanic/Latino, 2% black or African American, and 2% some other response. The proportion white is 78% for DTRs, 65% for NCPs, and 75% for Students (Figure 4). Because they represent a small and heterogeneous segment, further results for noncredentialed persons will not be addressed here.
Journal of the AMERICAN DIETETIC ASSOCIATION
1283
100,000
#
96,505 Nonmembers Members
80,000
75,418
60,000
40,000
20,000 4,027
7,501
9,559
NCPs (535)
Students (600)
0 TOT AL (n=6,955)
RDs (5,120)
DT Rs (700)
Figure 1. Population and sample sizes by ADA membership for registered dietitians (RDs); dietetic technicians, registered (DTRs); noncredentialed persons (NCPs); and ADA Student members surveyed for 2008 Needs Assessment. 100%
80%
55+
60%
45-54 35-44 40%
<35
20%
0%
T OT AL
RDs
DT Rs
NCPs
Students
Figure 2. Age ranges of registered dietitians (RDs); dietetic technicians, registered (DTRs); noncredentialed persons (NCPs); and ADA Student members surveyed for 2008 Needs Assessment. According to the 2008 survey, 34% of RDs hold an advanced degree in dietetics, food, nutrition, or a related field. An additional 6% indicated holding an advanced degree in a field not related to dietetics. Most other RDs hold undergraduate degrees granted by an accred-
1284
July 2009 Volume 109 Number 7
ited/approved dietetics program, as do 92% of DTRs (Figure 5). About two in three RDs (68%) are currently employed in a dietetics-related position, with another 10% selfemployed in dietetics. Eight percent hold a job outside dietetics, and an-
other 14% are not currently employed (3% retired, 7% raising a family, 4% something else). Even more DTRs (78%) are employed in dietetics, though only 3% are self-employed in the field. Nine percent are employed elsewhere, with 9% not currently em-
100%
80%
60%
Male Female 40%
20%
0%
T OT AL
RDs
DTRs
NCPs
Students
Figure 3. Sex of registered dietitians (RDs); dietetic technicians, registered (DTRs); noncredentialed persons (NCPs); and ADA Student members surveyed for 2008 Needs Assessment.
100%
80%
White
60%
Other Asian Black
40%
Hispanic
20%
0%
T OT AL
RDs
DT Rs
NCPs
Students
Figure 4. Heritage/race of registered dietitians (RDs); dietetic technicians, registered (DTRs); non-credentialed persons (NCPs); and ADA Student members surveyed for 2008 Needs Assessment. ployed. 2008 results for both RDs and DTRs are similar to those seen in 2004 (Figure 6). The typical (median) RD was first employed or self-employed in a paid dietetics-related position in 1991; for
DTRs, the median is 1993. For those either currently working or expecting to work in dietetics in the future, median planned retirement age is 2025 for RDs, and 2023 for DTRs. Results suggest that a quarter of current RDs
may be retired within 10 years (by 2018); a quarter of current DTRs may be retired 1 year earlier than that. RDs and DTRs currently working in dietetics are found in a wide variety of settings. For RDs, the main set-
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1285
34%
Advanced dietetics degree
1% 54%
Undergrad degree/ accredited/approved
92% 3%
Undergrad degree/ not approved
4%
Began study, 0% changed goals 1%
Currently a student
0%
RDs
0%
DT Rs
0%
20%
40%
60%
80%
100%
Figure 5. Education (highest dietetics degree held) by registered dietitians (RDs) and dietetic technicians, registered (DTRs) surveyed for 2008 Needs Assessment.
68%
Employed in dietetics
78% 10%
Self-employed in dietetics
3% 8%
Employed elsewhere
Retired
9% 3% 1% 7%
Raising a family
2% RDs
4%
Other
DT Rs
6%
0%
20%
40%
60%
80%
100%
Figure 6. Employment status for registered dietitians (RDs) and dietetic technicians, registered (DTRs) surveyed for 2008 Needs Assessment. tings are acute care/inpatient (22%), ambulatory/outpatient care (10%), long-term/extended care (11%), and community or public health programs (7%). A majority of DTRs are found in two settings: acute care/inpatient (29%) and long-term/extended care (25%). Around one in 10 in both seg-
1286
July 2009 Volume 109 Number 7
ments indicated work in multiple settings (Figure 7). About half of both RDs and DTRs work in one of the three clinical practice areas asked about. For RDs, 21% are in clinical/inpatient, 17% are in clinical/outpatient, and 10% are in clinical/long-term care. Eleven per-
cent named community nutrition, 8% food and nutrition management, 4% consultation and business practice, 8% education/research, and 15% either multiple or other practice areas. For DTRs, 29% are in clinical/inpatient, 1% in clinical/outpatient, and 21% in clinical/long-term care. Eight
22%
Acute care - inpatient Acute care - outpatient 0% Ambulatory/outpatient care
10%
1%
11%
Long-term/extended care Private practice
25%
4%
1%
5% 5% 7% 7%
Government agency Community or public health program Non-profit agency
2% 2%
College/university faculty
2% 2% 2%
School food service (K-12)
29%
5%
5%
11% 9% 11% 7%
Multiple Other 0%
5%
10%
RDs DT Rs
15%
20%
25%
30%
Figure 7. Primary setting for registered dietitians (RDs) and dietetic technicians, registered (DTRs) currently working in dietetics surveyed for 2008 Needs Assessment.
21%
Clinical - inpatient Clinical - outpatient
17%
1% 10%
Clinical - long-term care Community nutrition
8%
Food and nutrition management
8%
Consultation/business practice
1%
Education/research
21%
11% 15%
4% 5%
8% 11% 10%
Multiple
RDs
4% 3%
Other 0%
29%
5%
DTRs 10%
15%
20%
25%
30%
Figure 8. Primary practice area for registered dietitians (RDs) and dietetic technicians, registered (DTRs) currently working in dietetics surveyed for 2008 Needs Assessment. percent named community nutrition, 15% food and nutrition management, 1% consultation and business practice, 5% education/research, and 13% either multiple or other practice areas (Figure 8). Although the 2008 categories asked about differed somewhat from 2004,
distributions of settings and practice areas remained fairly similar to prior results. A question new to the 2008 survey asked those currently working in dietetics to rate their satisfaction with their current position. Eight in 10 RDs (82%) and three in four DTRs
(75%) rated themselves either satisfied or very satisfied; only 6% of RDs and 9% of DTRs expressed dissatisfaction (Figure 9). The focus of this summary now shifts slightly, to look not only at those currently working in dietetics-related positions, but also those not currently but
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1287
39%
Very satisfied
34% 43%
Satisfied
41% 7%
Neither
9% 5%
Dissatisfied
8%
Very dissatisfied
1%
RDs
1%
DT Rs
0%
10%
20%
30%
40%
50%
Figure 9. Satisfaction with position for registered dietitians (RDs) and dietetic technicians, registered (DTRs) currently working in dietetics surveyed for 2008 Needs Assessment. eventually planning to—respondents “in dietetics.” RDs in dietetics also appear to be satisfied with their RD credential: 72% agree that the RD credential is valued in the marketplace, while only 11% disagree. (The balance were neutral, or didn’t answer.) Their assessment of the value of the DTR credential is more mixed, with 26% agreeing but 24% disagreeing that it is valued in the marketplace. More than four in 10 RDs see marketplace value for each of the specialty Board Certifications currently offered by the Commission: Renal Nutrition, Pediatric Nutrition, Oncology Nutrition, Gerontological Nutrition, and Sports Dietetics. DTRs in dietetics rate the RD credential and the various specialty certifications similarly, but are somewhat less favorable with respect to their own credential: 42% agree it is valued, but 37% disagree (Figure 10). Association Membership As was the case in 2004, relatively few of either RDs or DTRs belong to professional associations other than the American Dietetic Association. The most common affiliations for RDs are the American Association of Diabetes Educators (8%), the American Diabetes
1288
July 2009 Volume 109 Number 7
Association (8%), and the American Society for Parenteral and Enteral Nutrition (6%). DTRs are most commonly members of the American Diabetes Association (5%) or the Dietary Managers Association (5%) (Figure 11).
● ● ● ●
ADA Membership The survey sample was drawn in August 2008, only 3 months into ADA’s membership year, so these figures do not describe market share at the end of the membership year. That said, at the time of sampling 62% of RDs and 34% of DTRs were ADA members, results identical to those seen in 2004. Only 2% of RDs in dietetics say they have never been members; for DTRs, that figure is 18%. About three in every four current or former member RDs (74%) and DTRs (77%) pay/paid ADA membership dues themselves, down a bit from 2004. The typical current member RD in dietetics has been a member for 18 years; former RD members report a median of 5 years. For DTRs, medians for current and former members are 12 and 4, respectively. The primary reasons given by current and former member RDs in dietetics for initially joining the association are similar to prior years (Figure 12). They include:
● ●
because ADA is the profession’s leading membership organization (69%) for professional and career development (58%) to receive the Journal of the American Dietetic Association (43%) because ADA advocates for the dietetics profession with health care providers and government (36%) to network with colleagues (36%) to access ADA patient or client education/information materials (31%)
Also frequently cited as reasons for joining (but far less frequently as reasons for renewing) are: ● ●
encouraged by another (employer, professor, colleague) (33%) required by employer or school (30%)
Some reasons become more important in the renewal decision than they were in deciding to join, including accessing patient/client education materials, receiving other ADA publications, and obtaining member discounts. Especially noteworthy are gains observed for supporting ADA’s legislative, regulatory and public policy efforts, and for accessing the Evidence Analysis Library (EAL; a new membership benefit). Among members, the EAL jumps from 10% as a reason to join to 35% as a reason to renew. Reasons given by
Credential is valued in marketplace: RD credential
72%
11%
DT R credential
26%
24%
Certification is valued in marketplace: Renal Nutrition
8%
47%
Pediatric Nutrition
7%
48%
Oncology Nutrition
8%
Gerontological Nutrition
9%
Sports Dietetics
44% 41% 47%
8%
100% 80% 60% 40% 20%
0%
Disagree
20% 40% 60% 80% 100%
Agree
Figure 10. Opinions of Commission on Dietetic Registration credentials and certifications by registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment. DTR⫽dietetic technician, registered.
American Association of Diabetes Educators
8%
1%
American Diabetes Association American Society for Parenteral and Enteral Nutrition 0%
RDs DT Rs
8% 5% 6%
National Kidney Foundation 0% 4% 3% American Heart Association 2% 2% American Cancer Society 2% 2% School Nutrition Association 2% Dietary Managers Association 0% 5% + Others ONE OR MORE 0%
19% 5%
34%
10% 15% 20% 25% 30% 35% 40%
Figure 11. Other association memberships held by registered dietitians (RDs) and dietetic technicians, registered (DTRs) surveyed for 2008 Needs Assessment (multiple answers accepted). DTRs for joining and renewing follow roughly similar patterns. Questions new to the 2008 survey sought to understand the extent of volunteer involvement with the association, as such involvement has
been seen to correlate with member satisfaction and continuing affiliation. Following one classification scheme, we see that 13% of current member RDs in dietetics have been active in ADA at the governance
level in the last 2 years, typically through service on state or district boards; 6% at the committee level (again most frequently at the state or district level); and 15% in ad hoc activities, most frequently present-
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1289
Profession’s leading organization Profession/career development Receive the Journal ADA advocates for the profession Network with colleagues Access patient/client education materials Receive other ADA publications Obtain member discounts Access Evidence Analysis Library Support legislative/policy efforts Assistance in locating a job Reasons for: Joining
Encouraged by another Required by employer or school
Renewing
+ Others 0%
20%
40%
60%
80%
100%
Figure 12. Reasons for initially joining/later renewing American Dietetic Association (ADA) membership given by current and former ADA member registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment (multiple answers accepted). ing, and/or participating in a listserv or community of interest. Two in three reported no volunteer involvement with ADA in the last 2 years (Figure 13). That there might be room to increase involvement is suggested by the related result that 47% of member RDs in dietetics volunteered their professional knowledge/skills on a pro bono basis for charitable or nonprofit organizations other than ADA in the last 2 years. Levels of volunteer involvement with ADA and with other organizations are lower for member DTRs, and for nonmember RDs and DTRs both. Member and nonmember RDs in dietetics were asked to rate the importance of the programs, products, and services currently offered as part of ADA membership (Figure 14). Benefits found most important in 2004 are again at or near the top of the list in 2008: ● ● ● ● ● ● ●
Web site position papers Food & Nutrition Conference & Expo (FNCE) the Journal opportunity for DPG membership published materials for clients affiliate (state) membership
1290
July 2009 Volume 109 Number 7
None
67%
Ad hoc
15%
Committee
6%
Governance
13%
Figure 13. Level of involvement with the American Dietetic Association in last 2 years by member registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment. ● ● ● ● ●
professional publications National Nutrition Month Standards government affairs/lobbying professional liability insurance
Noteworthy are very strong showings for several offerings introduced
only in the last few years. Given the amount of time it typically takes to build awareness and knowledge of new offerings, high “importance” scores for online learning, free CPE for the Journal, ADA’s Nutrition Care Manual, the Evidence Analysis Library and evidence-based guidelines, the Journal
Web site Online learning Position papers Food & Nutrition Conference & Expo Journal Opportunity for Dietetic Practice Group membership Nutrition Care Manual Published materials for clients Free Continuing Professional Education in the Journal Affiliate (state) membership Professional publications National Nutrition Month Standards Government affairs/lobbying Professional liability insurance Evidence Analysis Library Journal online Evidence-based guidelines ADA Times 0%
20%
40%
60%
80%
100%
% rating important Figure 14. Most important benefits of American Dietetic Association membership for registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment (multiple answers accepted).
3-year reduced-rate membership
77%
Regional Continuing Professional Education programs
75%
Downloadable ed materials for purchase
65%
Online membership directory
63%
Cultural food/nutrition resource center
62%
Self-help materials on career development
60%
Mentoring program by practice area
59%
News feeds through ADA site
56%
Career path/career laddering info
55%
Podcasts
55%
0%
20%
40%
60%
80%
100%
% rating desirable Figure 15. Most desirable prospective benefits of American Dietetic Association (ADA) membership for registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment (multiple answers accepted). online, and ADA Times, are impressive. The list of top membership benefits for DTRs in dietetics is similar.
On the other hand, a number of current ADA member benefits are unknown to majorities of nonmem-
ber RDs in dietetics (and even in some cases* to majorities of members):
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1291
33% 27%
Advanced Practice Certification Health Promotion/ Disease Prevention
37% 41%
Food/Food Protection and Service Management
19% 35% 19% 23%
Clinical Healthcare
12% 9%
Public Policy
11% 12%
Research
RDs
8% 9%
Higher Education 0%
DT Rs
20%
40%
60%
80%
100%
Figure 16. Desire for additional certifications/credentials by registered dietitians (RDs) and dietetic technicians, registered (DTRs) in dietetics surveyed for 2008 Needs Assessment.
Recognition of value of dietetics Public awareness of our field
64%
Reimbursement
74%
51%
Keeping up with new info
73%
59%
Expanding body of knowledge
68%
50%
Keeping pace with technology
57%
Achieving high-quality outcomes 40%
68% RDs
63%
46% 20%
75% 74%
49%
Compensation
0%
77%
62%
60%
DT Rs 80%
100%
% rating a challenge Figure 17. Major challenges facing the profession as rated by registered dietitians (RDs) and dietetic technicians, registered (DTRs) in dietetics surveyed for 2008 Needs Assessment. ● ● ● ●
ADA Student Scoop* Medicare MNT Provider* Issues Management Process* Behind the Scenes at ADA*
1292
July 2009 Volume 109 Number 7
● ● ●
On the Pulse Scope of Dietetics Practice Framework* CEO Digest (now ADA News Bytes)
● ● ●
Leadership Institute Meeting* ADA Daily News opportunity for Member Interest Group membership*
● ● ● ● ● ●
ADA Times online travel services Knowledge Center Public Policy Workshop Registered Dietitian Day state legislative/licensure assistance
Future Possibilities RDs in dietetics expressed high interest in a number of programs, products, and services that might be offered in the future as benefits of ADA membership (Figure 15). Rated desirable by the largest proportions were: ● ● ●
●
● ●
● ● ● ●
3-year ADA membership at reduced rate regional continuing professional education programs downloadable publications and client education materials available for purchase online membership directory (searchable by name, practice, interest, geographic location) cultural food and nutrition resource center self-help materials on career development and alternatives (eg, interviewing best practices) mentoring program by practice area news feeds from other trusted sources available through the ADA Web site career path/career laddering info podcasts (eg, Food & Nutrition Conference & Expo presentations, interviews with RDs expert in specific practice areas, Journal article author point-counterpoint discussions)
It is interesting to note that most of the tested possible “Web 2.0” offerings—things like blogs, social networking capabilities, personalized Web presence, and video or photo sharing— were among the lowest-rated items: apparently existing generic capabilities already satisfactorily fill these needs, and there is little point in ADA duplicating those efforts. Significant proportions of RDs and DTRs in dietetics expressed desire for CDR to consider offering additional new certifications or credentials (Figure 16). Thirty-three percent of RDs and 27% of DTRs feel CDR should develop an advanced level practice certification examination, though about equal proportions feel CDR should not, and the rest had no opinion. Beyond those already offered, RDs and DTRs in dietetics would most like
to see CDR develop and offer new specialty credentials in the areas of Health Promotion and Disease Prevention, Food and Food Protection and Service Management (appeals especially to DTRs), and Clinical Healthcare. In the prior survey, an open-ended item attempted to learn what respondents saw as the greatest challenges facing the profession. In 2008, a new item sought a more quantitative answer to that question, asking respondents to rate 18 possibilities as to the degree of challenge, and how effective they believe ADA has been in responding to those challenges (Figure 17). The four items rated challenges by the greatest numbers of RDs in dietetics (also selected by large proportions of DTRs) echo a persistent theme—the need to improve the recognition, respect, and reward received by those in the dietetics profession: ●
● ● ●
effectively as possible within the constraints of limited resources. Leaders and staff have the opportunity to continue enhancing value by using the results to improve current programs, products, and services; to guide the development of new offerings; and to set strategic direction consonant with the profession’s needs. References 1. Rogers D. Report on the American Dietetic Association/ADA Foundation/Commission on Dietetic Registration 2004 Dietetics Professionals Needs Assessment. J Am Diet Assoc. 2005;105:1348-1355. 2. Member Needs Assessment/Satisfaction Study Review Group. Report on the American Dietetic Association’s Member Needs Assessment/Satisfaction Study. J Am Diet Assoc. 2000;100:112116.
recognition of the value delivered by the dietetics profession to the larger society public awareness of our field reimbursement for services compensation
The next tier of candidates, considered important challenges by around two thirds of RDs in dietetics, includes: ●
● ● ●
keeping up with new information in food, nutrition, and dietetics practice an expanding body of knowledge keeping pace with technology achieving high-quality outcomes
Concern about the respect, recognition, and reward received by those in the dietetics profession has persisted through surveys and qualitative research dating back to the mid-1990s. There is the fundamental question, however, of whether a moderate-sized professional association like ADA can generate the considerable resources necessary to create the types of public relations and promotional impacts desired by dietetics professionals to improve the profession’s image and status. CONCLUSION The results of the 2008 Needs Assessment provide a framework for ADA and its sister organizations to understand the priority needs of the profession and to respond as efficiently and
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1293
W
ith the cooperation of the American Dietetic Association Foundation (ADAF) and the American Dietetic Association’s (ADA) credentialing arm, the Commission on Dietetic Registration (CDR), the ADA in 2004 undertook a comprehensive assessment of the needs of those involved in dietetics and ways ADA and its sister organizations can best serve them: members or not, students as well as practitioners (1). That assessment built on both ADA’s 1999 Member Satisfaction/Needs Assessment survey (2) (which represented ADA’s practitioner members) and its 2000 Survey of the Dietetics Profession (which represented ADA student members as well as registered and non-registered nonmember practitioners). The 2008 Needs Assessment reported here, again cosponsored by ADA and CDR, builds on all of those prior efforts, as well as ongoing quantitative and qualitative studies on the dynamics of practice in the profession. As in 2004, extensive questioning and an exceptionally large survey sample size make this a most comprehensive effort to understand and respond to the profession’s needs. METHOD The study was conducted for ADA and CDR by Readex Research of Stillwater, MN, an independent research company with broad experience in This article was written by Dick Rogers of Readex Research, Stillwater, MN. He was also responsible for execution of all aspects of this study and preparation of the initial report of the results. Address correspondence to: Dick Rogers, Readex Research, 2251 Tower Dr W, Stillwater, MN 55082 or [email protected]. 0002-8223/09/10907-0020$36.00/0 doi: 10.1016/j.jada.2009.05.022
both qualitative and quantitative research for the dietetics profession. All aspects of the study were directed by a review group of staff leaders representing the organizations. The 2008 assessment instrument was designed collaboratively by ADA and CDR staff and volunteer leaders and Readex. Sampling, data collection, analysis, and reporting were all handled by Readex Research. Data were collected via mail survey (with the option of completing the survey on the Web) between September 30 and December 1, 2008. A stratified probability sample of 12,000 —member students, plus member and nonmember registered dietitians (RDs), dietetic technicians, registered (DTRs), and others in the field of food and nutrition—was invited to participate. A total of 6,955 usable responses were received, for an exceptional 58% response rate (strong evidence for the representativeness of survey results). The margin of error for results overall is ⫾1.1%; for most major subgroups analyzed, it is less than ⫾4%. Where possible, survey results were compared with known characteristics of the population as a whole; these data also strongly support the contention that survey results are highly representative of the larger population. POPULATION OVERVIEW Using a stratified sampling approach, the 2008 Needs Assessment represents most (though not all) segments of the US population professionally involved with dietetics: ● ● ●
All RDs, whether currently ADA members or not. All DTRs, whether currently ADA members or not. Non-Credentialed Persons (NCPs), both ADA members and not. This segment includes ADA Active and Retired members not eligible for registration; it also includes non-
© 2009 by the American Dietetic Association
●
members eligible for registration as RDs or DTRs who are not currently registered, but excludes those unregistered nonmembers initially eligible for registration before 1999, a group of over 30,000 believed to have long since left the profession. ADA (nonregistered) Student members. (A few in ADA’s Student member category achieved registration just prior to this research, and were sampled as part of the RD or DTR cohorts, rather than as Students). Current dietetics students who are not members of ADA are not represented in this research.
Taken as a whole, the projected population represented by the 6,955 survey respondents is 96,505: 75,418 RDs, 4,027 DTRs, 7,501 NCPs, and 9,559 students (Figure 1). RESULTS Respondent Profile The typical (median) RD is 45 years old, with 25% under the age of 35 and 23% 55 or older. Age of the typical (median) DTR is 48, with 12% under the age of 35 and 22% 55 or older. Median DTR age is up 4 years since 2004. NCPs have a median age of 47; median age of ADA’s Student members is 25 (Figure 2). The proportion of males in each segment varies somewhat: 2% for RDs, 4% for DTRs, 6% for NCPs, and 4% for Students (Figure 3). RDs are the least diverse of the segments in terms of heritage and race as well, with 84% calling themselves white (not Hispanic/Latino), 5% Asian, 3% Hispanic/Latino, 2% black or African American, and 2% some other response. The proportion white is 78% for DTRs, 65% for NCPs, and 75% for Students (Figure 4). Because they represent a small and heterogeneous segment, further results for noncredentialed persons will not be addressed here.
Journal of the AMERICAN DIETETIC ASSOCIATION
1283
100,000
#
96,505 Nonmembers Members
80,000
75,418
60,000
40,000
20,000 4,027
7,501
9,559
NCPs (535)
Students (600)
0 TOT AL (n=6,955)
RDs (5,120)
DT Rs (700)
Figure 1. Population and sample sizes by ADA membership for registered dietitians (RDs); dietetic technicians, registered (DTRs); noncredentialed persons (NCPs); and ADA Student members surveyed for 2008 Needs Assessment. 100%
80%
55+
60%
45-54 35-44 40%
<35
20%
0%
T OT AL
RDs
DT Rs
NCPs
Students
Figure 2. Age ranges of registered dietitians (RDs); dietetic technicians, registered (DTRs); noncredentialed persons (NCPs); and ADA Student members surveyed for 2008 Needs Assessment. According to the 2008 survey, 34% of RDs hold an advanced degree in dietetics, food, nutrition, or a related field. An additional 6% indicated holding an advanced degree in a field not related to dietetics. Most other RDs hold undergraduate degrees granted by an accred-
1284
July 2009 Volume 109 Number 7
ited/approved dietetics program, as do 92% of DTRs (Figure 5). About two in three RDs (68%) are currently employed in a dietetics-related position, with another 10% selfemployed in dietetics. Eight percent hold a job outside dietetics, and an-
other 14% are not currently employed (3% retired, 7% raising a family, 4% something else). Even more DTRs (78%) are employed in dietetics, though only 3% are self-employed in the field. Nine percent are employed elsewhere, with 9% not currently em-
100%
80%
60%
Male Female 40%
20%
0%
T OT AL
RDs
DTRs
NCPs
Students
Figure 3. Sex of registered dietitians (RDs); dietetic technicians, registered (DTRs); noncredentialed persons (NCPs); and ADA Student members surveyed for 2008 Needs Assessment.
100%
80%
White
60%
Other Asian Black
40%
Hispanic
20%
0%
T OT AL
RDs
DT Rs
NCPs
Students
Figure 4. Heritage/race of registered dietitians (RDs); dietetic technicians, registered (DTRs); non-credentialed persons (NCPs); and ADA Student members surveyed for 2008 Needs Assessment. ployed. 2008 results for both RDs and DTRs are similar to those seen in 2004 (Figure 6). The typical (median) RD was first employed or self-employed in a paid dietetics-related position in 1991; for
DTRs, the median is 1993. For those either currently working or expecting to work in dietetics in the future, median planned retirement age is 2025 for RDs, and 2023 for DTRs. Results suggest that a quarter of current RDs
may be retired within 10 years (by 2018); a quarter of current DTRs may be retired 1 year earlier than that. RDs and DTRs currently working in dietetics are found in a wide variety of settings. For RDs, the main set-
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1285
34%
Advanced dietetics degree
1% 54%
Undergrad degree/ accredited/approved
92% 3%
Undergrad degree/ not approved
4%
Began study, 0% changed goals 1%
Currently a student
0%
RDs
0%
DT Rs
0%
20%
40%
60%
80%
100%
Figure 5. Education (highest dietetics degree held) by registered dietitians (RDs) and dietetic technicians, registered (DTRs) surveyed for 2008 Needs Assessment.
68%
Employed in dietetics
78% 10%
Self-employed in dietetics
3% 8%
Employed elsewhere
Retired
9% 3% 1% 7%
Raising a family
2% RDs
4%
Other
DT Rs
6%
0%
20%
40%
60%
80%
100%
Figure 6. Employment status for registered dietitians (RDs) and dietetic technicians, registered (DTRs) surveyed for 2008 Needs Assessment. tings are acute care/inpatient (22%), ambulatory/outpatient care (10%), long-term/extended care (11%), and community or public health programs (7%). A majority of DTRs are found in two settings: acute care/inpatient (29%) and long-term/extended care (25%). Around one in 10 in both seg-
1286
July 2009 Volume 109 Number 7
ments indicated work in multiple settings (Figure 7). About half of both RDs and DTRs work in one of the three clinical practice areas asked about. For RDs, 21% are in clinical/inpatient, 17% are in clinical/outpatient, and 10% are in clinical/long-term care. Eleven per-
cent named community nutrition, 8% food and nutrition management, 4% consultation and business practice, 8% education/research, and 15% either multiple or other practice areas. For DTRs, 29% are in clinical/inpatient, 1% in clinical/outpatient, and 21% in clinical/long-term care. Eight
22%
Acute care - inpatient Acute care - outpatient 0% Ambulatory/outpatient care
10%
1%
11%
Long-term/extended care Private practice
25%
4%
1%
5% 5% 7% 7%
Government agency Community or public health program Non-profit agency
2% 2%
College/university faculty
2% 2% 2%
School food service (K-12)
29%
5%
5%
11% 9% 11% 7%
Multiple Other 0%
5%
10%
RDs DT Rs
15%
20%
25%
30%
Figure 7. Primary setting for registered dietitians (RDs) and dietetic technicians, registered (DTRs) currently working in dietetics surveyed for 2008 Needs Assessment.
21%
Clinical - inpatient Clinical - outpatient
17%
1% 10%
Clinical - long-term care Community nutrition
8%
Food and nutrition management
8%
Consultation/business practice
1%
Education/research
21%
11% 15%
4% 5%
8% 11% 10%
Multiple
RDs
4% 3%
Other 0%
29%
5%
DTRs 10%
15%
20%
25%
30%
Figure 8. Primary practice area for registered dietitians (RDs) and dietetic technicians, registered (DTRs) currently working in dietetics surveyed for 2008 Needs Assessment. percent named community nutrition, 15% food and nutrition management, 1% consultation and business practice, 5% education/research, and 13% either multiple or other practice areas (Figure 8). Although the 2008 categories asked about differed somewhat from 2004,
distributions of settings and practice areas remained fairly similar to prior results. A question new to the 2008 survey asked those currently working in dietetics to rate their satisfaction with their current position. Eight in 10 RDs (82%) and three in four DTRs
(75%) rated themselves either satisfied or very satisfied; only 6% of RDs and 9% of DTRs expressed dissatisfaction (Figure 9). The focus of this summary now shifts slightly, to look not only at those currently working in dietetics-related positions, but also those not currently but
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1287
39%
Very satisfied
34% 43%
Satisfied
41% 7%
Neither
9% 5%
Dissatisfied
8%
Very dissatisfied
1%
RDs
1%
DT Rs
0%
10%
20%
30%
40%
50%
Figure 9. Satisfaction with position for registered dietitians (RDs) and dietetic technicians, registered (DTRs) currently working in dietetics surveyed for 2008 Needs Assessment. eventually planning to—respondents “in dietetics.” RDs in dietetics also appear to be satisfied with their RD credential: 72% agree that the RD credential is valued in the marketplace, while only 11% disagree. (The balance were neutral, or didn’t answer.) Their assessment of the value of the DTR credential is more mixed, with 26% agreeing but 24% disagreeing that it is valued in the marketplace. More than four in 10 RDs see marketplace value for each of the specialty Board Certifications currently offered by the Commission: Renal Nutrition, Pediatric Nutrition, Oncology Nutrition, Gerontological Nutrition, and Sports Dietetics. DTRs in dietetics rate the RD credential and the various specialty certifications similarly, but are somewhat less favorable with respect to their own credential: 42% agree it is valued, but 37% disagree (Figure 10). Association Membership As was the case in 2004, relatively few of either RDs or DTRs belong to professional associations other than the American Dietetic Association. The most common affiliations for RDs are the American Association of Diabetes Educators (8%), the American Diabetes
1288
July 2009 Volume 109 Number 7
Association (8%), and the American Society for Parenteral and Enteral Nutrition (6%). DTRs are most commonly members of the American Diabetes Association (5%) or the Dietary Managers Association (5%) (Figure 11).
● ● ● ●
ADA Membership The survey sample was drawn in August 2008, only 3 months into ADA’s membership year, so these figures do not describe market share at the end of the membership year. That said, at the time of sampling 62% of RDs and 34% of DTRs were ADA members, results identical to those seen in 2004. Only 2% of RDs in dietetics say they have never been members; for DTRs, that figure is 18%. About three in every four current or former member RDs (74%) and DTRs (77%) pay/paid ADA membership dues themselves, down a bit from 2004. The typical current member RD in dietetics has been a member for 18 years; former RD members report a median of 5 years. For DTRs, medians for current and former members are 12 and 4, respectively. The primary reasons given by current and former member RDs in dietetics for initially joining the association are similar to prior years (Figure 12). They include:
● ●
because ADA is the profession’s leading membership organization (69%) for professional and career development (58%) to receive the Journal of the American Dietetic Association (43%) because ADA advocates for the dietetics profession with health care providers and government (36%) to network with colleagues (36%) to access ADA patient or client education/information materials (31%)
Also frequently cited as reasons for joining (but far less frequently as reasons for renewing) are: ● ●
encouraged by another (employer, professor, colleague) (33%) required by employer or school (30%)
Some reasons become more important in the renewal decision than they were in deciding to join, including accessing patient/client education materials, receiving other ADA publications, and obtaining member discounts. Especially noteworthy are gains observed for supporting ADA’s legislative, regulatory and public policy efforts, and for accessing the Evidence Analysis Library (EAL; a new membership benefit). Among members, the EAL jumps from 10% as a reason to join to 35% as a reason to renew. Reasons given by
Credential is valued in marketplace: RD credential
72%
11%
DT R credential
26%
24%
Certification is valued in marketplace: Renal Nutrition
8%
47%
Pediatric Nutrition
7%
48%
Oncology Nutrition
8%
Gerontological Nutrition
9%
Sports Dietetics
44% 41% 47%
8%
100% 80% 60% 40% 20%
0%
Disagree
20% 40% 60% 80% 100%
Agree
Figure 10. Opinions of Commission on Dietetic Registration credentials and certifications by registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment. DTR⫽dietetic technician, registered.
American Association of Diabetes Educators
8%
1%
American Diabetes Association American Society for Parenteral and Enteral Nutrition 0%
RDs DT Rs
8% 5% 6%
National Kidney Foundation 0% 4% 3% American Heart Association 2% 2% American Cancer Society 2% 2% School Nutrition Association 2% Dietary Managers Association 0% 5% + Others ONE OR MORE 0%
19% 5%
34%
10% 15% 20% 25% 30% 35% 40%
Figure 11. Other association memberships held by registered dietitians (RDs) and dietetic technicians, registered (DTRs) surveyed for 2008 Needs Assessment (multiple answers accepted). DTRs for joining and renewing follow roughly similar patterns. Questions new to the 2008 survey sought to understand the extent of volunteer involvement with the association, as such involvement has
been seen to correlate with member satisfaction and continuing affiliation. Following one classification scheme, we see that 13% of current member RDs in dietetics have been active in ADA at the governance
level in the last 2 years, typically through service on state or district boards; 6% at the committee level (again most frequently at the state or district level); and 15% in ad hoc activities, most frequently present-
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1289
Profession’s leading organization Profession/career development Receive the Journal ADA advocates for the profession Network with colleagues Access patient/client education materials Receive other ADA publications Obtain member discounts Access Evidence Analysis Library Support legislative/policy efforts Assistance in locating a job Reasons for: Joining
Encouraged by another Required by employer or school
Renewing
+ Others 0%
20%
40%
60%
80%
100%
Figure 12. Reasons for initially joining/later renewing American Dietetic Association (ADA) membership given by current and former ADA member registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment (multiple answers accepted). ing, and/or participating in a listserv or community of interest. Two in three reported no volunteer involvement with ADA in the last 2 years (Figure 13). That there might be room to increase involvement is suggested by the related result that 47% of member RDs in dietetics volunteered their professional knowledge/skills on a pro bono basis for charitable or nonprofit organizations other than ADA in the last 2 years. Levels of volunteer involvement with ADA and with other organizations are lower for member DTRs, and for nonmember RDs and DTRs both. Member and nonmember RDs in dietetics were asked to rate the importance of the programs, products, and services currently offered as part of ADA membership (Figure 14). Benefits found most important in 2004 are again at or near the top of the list in 2008: ● ● ● ● ● ● ●
Web site position papers Food & Nutrition Conference & Expo (FNCE) the Journal opportunity for DPG membership published materials for clients affiliate (state) membership
1290
July 2009 Volume 109 Number 7
None
67%
Ad hoc
15%
Committee
6%
Governance
13%
Figure 13. Level of involvement with the American Dietetic Association in last 2 years by member registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment. ● ● ● ● ●
professional publications National Nutrition Month Standards government affairs/lobbying professional liability insurance
Noteworthy are very strong showings for several offerings introduced
only in the last few years. Given the amount of time it typically takes to build awareness and knowledge of new offerings, high “importance” scores for online learning, free CPE for the Journal, ADA’s Nutrition Care Manual, the Evidence Analysis Library and evidence-based guidelines, the Journal
Web site Online learning Position papers Food & Nutrition Conference & Expo Journal Opportunity for Dietetic Practice Group membership Nutrition Care Manual Published materials for clients Free Continuing Professional Education in the Journal Affiliate (state) membership Professional publications National Nutrition Month Standards Government affairs/lobbying Professional liability insurance Evidence Analysis Library Journal online Evidence-based guidelines ADA Times 0%
20%
40%
60%
80%
100%
% rating important Figure 14. Most important benefits of American Dietetic Association membership for registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment (multiple answers accepted).
3-year reduced-rate membership
77%
Regional Continuing Professional Education programs
75%
Downloadable ed materials for purchase
65%
Online membership directory
63%
Cultural food/nutrition resource center
62%
Self-help materials on career development
60%
Mentoring program by practice area
59%
News feeds through ADA site
56%
Career path/career laddering info
55%
Podcasts
55%
0%
20%
40%
60%
80%
100%
% rating desirable Figure 15. Most desirable prospective benefits of American Dietetic Association (ADA) membership for registered dietitians (RDs) in dietetics surveyed for 2008 Needs Assessment (multiple answers accepted). online, and ADA Times, are impressive. The list of top membership benefits for DTRs in dietetics is similar.
On the other hand, a number of current ADA member benefits are unknown to majorities of nonmem-
ber RDs in dietetics (and even in some cases* to majorities of members):
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1291
33% 27%
Advanced Practice Certification Health Promotion/ Disease Prevention
37% 41%
Food/Food Protection and Service Management
19% 35% 19% 23%
Clinical Healthcare
12% 9%
Public Policy
11% 12%
Research
RDs
8% 9%
Higher Education 0%
DT Rs
20%
40%
60%
80%
100%
Figure 16. Desire for additional certifications/credentials by registered dietitians (RDs) and dietetic technicians, registered (DTRs) in dietetics surveyed for 2008 Needs Assessment.
Recognition of value of dietetics Public awareness of our field
64%
Reimbursement
74%
51%
Keeping up with new info
73%
59%
Expanding body of knowledge
68%
50%
Keeping pace with technology
57%
Achieving high-quality outcomes 40%
68% RDs
63%
46% 20%
75% 74%
49%
Compensation
0%
77%
62%
60%
DT Rs 80%
100%
% rating a challenge Figure 17. Major challenges facing the profession as rated by registered dietitians (RDs) and dietetic technicians, registered (DTRs) in dietetics surveyed for 2008 Needs Assessment. ● ● ● ●
ADA Student Scoop* Medicare MNT Provider* Issues Management Process* Behind the Scenes at ADA*
1292
July 2009 Volume 109 Number 7
● ● ●
On the Pulse Scope of Dietetics Practice Framework* CEO Digest (now ADA News Bytes)
● ● ●
Leadership Institute Meeting* ADA Daily News opportunity for Member Interest Group membership*
● ● ● ● ● ●
ADA Times online travel services Knowledge Center Public Policy Workshop Registered Dietitian Day state legislative/licensure assistance
Future Possibilities RDs in dietetics expressed high interest in a number of programs, products, and services that might be offered in the future as benefits of ADA membership (Figure 15). Rated desirable by the largest proportions were: ● ● ●
●
● ●
● ● ● ●
3-year ADA membership at reduced rate regional continuing professional education programs downloadable publications and client education materials available for purchase online membership directory (searchable by name, practice, interest, geographic location) cultural food and nutrition resource center self-help materials on career development and alternatives (eg, interviewing best practices) mentoring program by practice area news feeds from other trusted sources available through the ADA Web site career path/career laddering info podcasts (eg, Food & Nutrition Conference & Expo presentations, interviews with RDs expert in specific practice areas, Journal article author point-counterpoint discussions)
It is interesting to note that most of the tested possible “Web 2.0” offerings—things like blogs, social networking capabilities, personalized Web presence, and video or photo sharing— were among the lowest-rated items: apparently existing generic capabilities already satisfactorily fill these needs, and there is little point in ADA duplicating those efforts. Significant proportions of RDs and DTRs in dietetics expressed desire for CDR to consider offering additional new certifications or credentials (Figure 16). Thirty-three percent of RDs and 27% of DTRs feel CDR should develop an advanced level practice certification examination, though about equal proportions feel CDR should not, and the rest had no opinion. Beyond those already offered, RDs and DTRs in dietetics would most like
to see CDR develop and offer new specialty credentials in the areas of Health Promotion and Disease Prevention, Food and Food Protection and Service Management (appeals especially to DTRs), and Clinical Healthcare. In the prior survey, an open-ended item attempted to learn what respondents saw as the greatest challenges facing the profession. In 2008, a new item sought a more quantitative answer to that question, asking respondents to rate 18 possibilities as to the degree of challenge, and how effective they believe ADA has been in responding to those challenges (Figure 17). The four items rated challenges by the greatest numbers of RDs in dietetics (also selected by large proportions of DTRs) echo a persistent theme—the need to improve the recognition, respect, and reward received by those in the dietetics profession: ●
● ● ●
effectively as possible within the constraints of limited resources. Leaders and staff have the opportunity to continue enhancing value by using the results to improve current programs, products, and services; to guide the development of new offerings; and to set strategic direction consonant with the profession’s needs. References 1. Rogers D. Report on the American Dietetic Association/ADA Foundation/Commission on Dietetic Registration 2004 Dietetics Professionals Needs Assessment. J Am Diet Assoc. 2005;105:1348-1355. 2. Member Needs Assessment/Satisfaction Study Review Group. Report on the American Dietetic Association’s Member Needs Assessment/Satisfaction Study. J Am Diet Assoc. 2000;100:112116.
recognition of the value delivered by the dietetics profession to the larger society public awareness of our field reimbursement for services compensation
The next tier of candidates, considered important challenges by around two thirds of RDs in dietetics, includes: ●
● ● ●
keeping up with new information in food, nutrition, and dietetics practice an expanding body of knowledge keeping pace with technology achieving high-quality outcomes
Concern about the respect, recognition, and reward received by those in the dietetics profession has persisted through surveys and qualitative research dating back to the mid-1990s. There is the fundamental question, however, of whether a moderate-sized professional association like ADA can generate the considerable resources necessary to create the types of public relations and promotional impacts desired by dietetics professionals to improve the profession’s image and status. CONCLUSION The results of the 2008 Needs Assessment provide a framework for ADA and its sister organizations to understand the priority needs of the profession and to respond as efficiently and
July 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
1293