Passions = nutrition and preventive medicine...advice?

[The Doctor Student]

Hi all–

I am seeking some perspective.
My greatest interest lies in nutrition -- exploring and promoting diets that work best for people to optimize their health and wellbeing.

However, I do not feel I will be satisfied as a dietician. I view this profession as being fairly limited, both financially and in terms of scope of practice.

This is why pursuing an MD is appealing to me, as it grants far more options in terms of the clinic (having more jurisdiction and operating with a greater understanding of the body), and permits research (more of which is definitely needed in the field of human nutrition).

I have played around with the idea of becoming a PA or NP, but there too I worry that I won't know enough or feel competent enough to enter a practice with just a few years of schooling under my belt.


With that in mind, practicing in GI/IM has been the distant goal I've been pursuing.


I am wondering now though if doing so would not be making the most of my time if the nutritional counseling, preventive medicine, and integrative medicine aspects of healthcare are where I see myself being most happy......while the otherwise harrowing pathway toward becoming (and living as) an MD are stresses I think everyone would prefer to live without.

I tried to keep this brief so I'll cut it off here. Any thoughts or suggestions so far?

Much appreciated

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[Goro]

And you know this, how?

Hi all–
However, I do not feel I will be satisfied as a dietician. I view this profession as being fairly limited, both financially and in terms of scope of practice.

 

[The Doctor Student]

And you know this, how?

Am I wrong?
I'm open to hearing your take, but I've spoken with nutrition professors of mine, one of which is an RD and is unsatisfied. My own (limited) research has shown that they make about $50k or less. Unfortunately this is one of the main deterrents for me.

 

[Goro]

Have you thought about trying it first?

In my experience, doctors usually punt their patients to dieticians for dietary advice. Also keep in mind that a lot of patients LIKE McDonalds and Coca-Cola, and will ignore your best efforts as their doctor, and their knowing better.

 

[ProspectiveKidd]

Teaching is a lot like being a doctor; educating/aware-ing patients on nutrition and healthy lifestyles is certainly something doctors do, but not necessarily something you will spend the majority of your time doing.

IMO, it doesn't make sense to say "I didn't want to be a dietician because I'm not happy with the scope of practice" It has more to do with the type of work you're doing. The scope of your practice is, well, being a dietician. If you switched from nursing, that statement would be more in line. I actually wanted to become a nurse, but knowing myself well enough and working around nurses long enough, I realized I would want to learn more; I also feel as though I wouldn't be happy working as an NP/PA knowing a fraction of what my physician counterparts do.

I cannot tell you how many times I heard "no the doctor is booked but you can get in with our NP" when I was in the waiting room last week. Probably 5 or 6 times in the 20 minutes I was waiting I kid you not. I was actually there to see the NP because of this; I wouldn't have otherwise. She is competent and I have confidence in her decisions, but I don't want to be viewed that way by the general public as some second rate provider.

I think you just need to spend some considerable time shadowing both professions, and see where you stand in terms of what you actually want to be doing for the patient.

 

[Krupke]

Tbh, a dietician does limit you more financially and professionally......but it limits you to exactly what you are looking for in a career.

If you definitely want to go into a more medical field, I would vote NP and then choosing a nutritional track or doing a post-NP certification.

What do you want to do in medicine that cannot be done by a NP or dietician? And remember, the amount of debt you might take on for med school may prevent you from wanting/being able to work on just dietary advice.

 

[thatwouldbeanarchy]

You could do a PhD in nutrition. I'm sure this would encompass research in a way that being a RD probably doesn't. I understand being concerned about the money but I also wonder if part of the initial turn-off of being a RD is that it doesn't have the prestige of being an MD. I would suggest shadowing some RD's in different clinical settings before you write off that path. It may not have the name value of being an MD but, if you actually enjoy it, that may not matter so much.

In my experience, doctors usually punt their patients to dieticians for dietary advice.

I'm no expert but this has been my experience as well. For better or worse, I don't think that nutrition is included much in standard medical education/training.

 

[LizzyM]

There are physicians in academic medicine and elsewhere who address patients with obesity and other nutritional disorders as well as doing research and teaching the next generation. There is fellowship training and certification by the American Board of Obesity Medicine (abom.org). There is, I think, a similar fellowship training program for pediatric practitioners.

 

[The Doctor Student]

Also keep in mind that a lot of patients LIKE McDonalds and Coca-Cola, and will ignore your best efforts as their doctor, and their knowing better

Unfortunately so. That's why (through conversations with friends) I've thought that it'd be nice to work in preventive medicine, where people are seeking your knowledge, and want to improve their own health. Does such a set-up exist? Boutique clinics and weight loss centers come to mind, but I have very limited knowledge about this.

 

[ProspectiveKidd]

Unfortunately so. That's why (through conversations with friends) I've thought that it'd be nice to work in preventive medicine, where people are seeking your knowledge, and want to improve their own health. Does such a set-up exist? Boutique clinics and weight loss centers come to mind, but I have very limited knowledge about this.

Meh. Preventative medicine does not =behavioral therapy. Tell people whatever you want, but until a person changes the way they mentally appraise something, actually altering the way they think, they continue to act the same way unfortunately. Im not saying preventative medicine doesn't have its place and is not beneficial, but this is the caveat doctors seem to face in all fields.

 

[Goro]

That seems like work mostly done by PAs, NPs and other mid-levels. But as work for a doctor? If you live in a large urban area, or well-to-do suburbs, you should try to seek these types of places out, and chat up the people there.

Unfortunately so. That's why (through conversations with friends) I've thought that it'd be nice to work in preventive medicine, where people are seeking your knowledge, and want to improve their own health. Does such a set-up exist? Boutique clinics and weight loss centers come to mind, but I have very limited knowledge about this.

 

[ProspectiveKidd]

.

 

[The Doctor Student]

IMO, it doesn't make sense to say "I didn't want to be a dietician because I'm not happy with the scope of practice" It has more to do with the type of work you're doing. The scope of your practice is, well, being a dietician.

You're right, and as @Krupke pointed out: being a dietician does seem like it would be a good fit . . . for now.
However, I have a sinking feeling that it wouldn't pose enough challenge/excitement on its own to last a career. In other words, I'd have to get creative with it—partner with other providers, conduct research, produce a product of some kind—to keep interested (I presume).

I realized I would want to learn more; I also feel as though I wouldn't be happy working as an NP/PA knowing a fraction of what my physician counterparts do.

This as well. Partly ego, but mostly wanting to avoid feelings of inadequacy/regret/letting the patient down that I imagine would go along with not knowing an answer to a medical question.

If you definitely want to go into a more medical field, I would vote NP and then choosing a nutritional track or doing a post-NP certification.

Interesting. "More medical" is essentially what I'm looking for. Thanks for suggestion -- I'll have to look into this.

What do you want to do in medicine that cannot be done by a NP or dietician?

Good question. I wish I had a more satisfying answer for you, but aside from long-term financial considerations, my biggest deterrent from pursuing a mid-level degree would be similar to what I quoted from @ProspectiveKidd above: I want to have the answer to my patients' questions, and am not sure just a couple of years of graduate level schooling can get me there. Instead, part of me would rather spend the extra time getting an MD, have a complete picture of the human body, and not "sell myself short" as several doctors have told me in the past. Wording aside, is this a naive way of thinking about it?

Also, not so much medicine, but I should mention the research component of nutrition that I want to preserve, as I can see myself enjoying that...even if on the side.

the amount of debt you might take on for med school may prevent you from wanting/being able to work on just dietary advice.

Good point. I've been sheepishly looking into financing options but am not yet sure how I will go about it all, depending on which career path I take

 

[ProspectiveKidd]

For better or worse, I'm turning a blind eye to the debt. I know its going to be big, but I know it can be managed with a physicians salary. I promised myself that I will live up to my potential; being a dietician does not mean you haven't. Be the best nutritionist you can be if thats what you want. But you seem to have a thirst for a wide array of knowledge, something that primary care and academic medicine can also provide.

You're right, and as @Krupke pointed out: being a dietician does seem like it would be a good fit . . . for now.
However, I have a sinking feeling that it wouldn't pose enough challenge/excitement on its own to last a career. In other words, I'd have to get creative with it—partner with other providers, conduct research, produce a product of some kind—to keep interested (I presume).

-mostly wanting to avoid feelings of inadequacy/regret/letting the patient down that I imagine would go along with not knowing an answer to a medical question.

-"More medical" is essentially what I'm looking for

- I want to have the answer to my patients' questions, and am not sure just a couple of years of graduate level schooling can get me there. Instead, part of me would rather spend the extra time getting an MD, have a complete picture of the human body, and not "sell myself short" as several doctors have told me in the past. Wording aside, is this a naive way of thinking about it?

Good point. I've been sheepishly looking into financing options but am not yet sure how I will go about it all, depending on which career path I take

 

[The Doctor Student]

There are physicians in academic medicine and elsewhere who address patients with obesity and other nutritional disorders as well as doing research and teaching the next generation. There is fellowship training and certification by the American Board of Obesity Medicine (abom.org). There is, I think, a similar fellowship training program for pediatric practitioners.

This all sounds great to me

 

[The Doctor Student]

you seem like you have a thirst for a wide array of knowledge

100%. Not sure if this has to come through schooling, but paying for it is one way to make sure I study. I am afraid of prematurely 'settling' if I did anything but medical school...less stress, time, and debt for certain if I opt for something else, but also less of a grasp on my future patients

 

[ProspectiveKidd]

but also less of a grasp on my future patients

You will have to accept and be content knowing that all of the extraneous and superfluous information is not pertinent to your career as a dietician. If you want it to be, look into academia/medicine in conjunction with nutrition.

 

[atomi]

As long as your goal isn't to become an MD so you can push gluten-free colon-cleansing anti-hormone locally-sourced unregulated poison made in china from heavy metals and shredded newspaper so you can make millions of dollars, go for it. We have enough of those types already.

 

[The Doctor Student]

As long as your goal isn't to become an MD so you can push gluten-free colon-cleansing anti-hormone locally-sourced unregulated poison made in china from heavy metals and shredded newspaper so you can make millions of dollars, go for it. We have enough of those types already.

This hasn't been mentioned yet and I will probably get harassed for trolling or something by throwing it out there, but some of the most experienced nutritionists I have ever met include... duh duh duh... Naturopathic doctors. While they admittedly can't do jack sh^t for acute diseases, some of the things they taught me about nutrition/ diet and it's relationship to mental and physical health in the context of preventive care was wayyyyyy over my head. And I'm not just talking about the generic "eat well and you'll cure your depression" type word vomit you hear over and over. I'm talking about mechanisms here.

That being said, becoming a naturopathic physician comes with a bunch of other baggage like homeopathy, spiritual counseling, etc. But as for nutrition, their level of education is actually solid. If you shadow one, their main focus is psychiatric counseling and nutrition guidance, and I do lots of gluten-free cooking with a 300 page cookbook I got from Bastyr University, with some pretty positive results on my digestive health. Just a thought.

Interesting you both mention this. My goal is to be in the business of practicing EBM regardless of the profession, and to be a practitioner not a 'believer.' Seeing anything else irritates me to no end.

That said, I try to have an open mind until I see reason to close it. I think the idea of naturopathy is awesome — getting the body to a place where it can heal itself — I just don't know much about it other than yes, in acute cases it'd be dangerous to rely on it alone. It's funny, I entered college with a more natural/holistic inclination toward health and wellbeing, but have not seen this interest through. I owe this to 1) how often it is bashed in the medical community, and 2) being busy with the coursework that is offered at my school. I have yet to justify abandoning this field(?) for myself, however. Because honestly, minus the homeopathy thumbdown, a perceived culture of "natural remedies for everything," and potentially operating based off weak science, I like the idea of it. I just don't know if there's merit to it, and have been turned off by hot tempers on either side of the aisle. Without starting a feud, does anyone have any solid information/perspective that could help my thinking?

Thank you for keeping it civil

 

[CCMDOC9254]

There are obesity/weight management fellowships which you can complete after an IM residency, I have scribed for physicians who have done this, they usually split their time 50/50 depending on the demand for weight management appts. They not only go through diet/exercise with patients but also can start them on weight loss drugs like phentermine, recommend them for bariatric surgery, etc etc

 

[musicalfeet]

Kind of possibly ignorant question, but isn't it the role of the PCP (ideally) to counsel their patients on their lifestyle habits, INCLUDING nutrition? That being said, I totally understand the patient might just do what they want and not heed your advice..but still...

 

[Krupke]

Kind of possibly ignorant question, but isn't it the role of the PCP (ideally) to counsel their patients on their lifestyle habits, INCLUDING nutrition? That being said, I totally understand the patient might just do what they want and not heed your advice..but still...

PCPs generally don't have the time or specific training to address diet and most often will just refer to a dietician.

 

[LizzyM]

The Obesity Epidemic — Understanding the Disease and the Treatment

C.M. Apovian | N Engl J Med 2016;374:177-179

Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents

T.H. Inge and Others | N Engl J Med 2016;374:113-123 | Published Online November 6, 2015 (in the January 17, 2016 print edition, I think)

Saw these today and thought of this thread. See if your university library or local public library can get you access OP
There is a role for physicians who guide patients with severe obesity before and after surgical treatment of their disease. This is done in conjunction with dietitians but there is a role for physicians, too, and the need for practitioners in this field is growing.

 

[DrMason]

If OP is still around I can very clearly see what he/she is trying to tell.

Yes, clinical nutrition in itself is quite narrowed down. If you are interested in building a top knotch nutrition practice then STRONGLY integrate wellness,fitness and supplementation with and without medications clinic is the best way. It is ORIGINAL, other physicians will mostly leave you alone and you will have a VERY rewarding patient pool.

*Look into a combined degree in exercise science and nutrition. Not only are these great programs, but you have lots of things to talk about during medical school interviews. Many of the people interviewing you may also think you are dead set for hamster race primary care and you may be more likely to get in.

*Consider gunning for a good FM program from day one and look into a ABMS sports medicine Fellowship later on. While in residency, you can study other medicine like BHRT, HCG, Cenegenics, MDVIP-style practices. Also, he earlier you let your peers know that is what you want to do (Family medicine and primary care), most hard-ass attendings will leave you alone as well and you will experience much less cutthroat overall. People have funny perceptions and these are one of them. Don't worry, if you do this right, you will make more, work less, be able to coach your kids playing soccer, take good care of yourself and be happy.

Open your own within 1-3 years after fellowship. By the time you get there, this should be even easier than now. Every week, another recovering allopath fanatic wants to "meet up" for a cup of coffee. In 10 years, this is hotter than hotYoga. Integrate biomechanics understanding with proper exercise and judicious use of HCG and hormones is a very cutting edge niche, which, like all cutting edge is disliked by many others. In reality you are lowering most people overall bills in the long run; have a stable income and feel appreciated. Open a cash-practice with $100-200 a month in membership and go third party free. Another option is to take on a job as part time team physician to get your name out more locally. I will say is about that, though. Depending upon what and where you do this, you may be expected to provide athlete care for free (and it will likely benefit you more than "coding" for a knee injection. "Obesity" fellowships or preventive medicine residency is unlikely to get you there, in my opinion. Too theoretical and too population-based to help an individual.

Also, a cash based practice will get you patients that listen to you. If you tell them to do three weeks of squats at lower reps and less resting time in-between and then changing it up to heavy and more rest, they will be likely to follow your advices since hey pay for it. I can pretty much make every 50-something into shape if he/she is genuine about it and has the time and money. It is some of a failure for me, if I have long-standing patients that are unfit.

Finally, optimize yourself, both with fitness and other looks. Then get a great photographer to take good picture of you and put it in paper, bulletin boards or even online ads. No matter how hot you look, you will it be harassed by patients (especially speaking about females here), since these patients are serious people and paying you directly. However, people will seek you out when they see you walk the walk. One of my colleagues is a 70-year old retired urologist. He has all the time in the world and works out as much as he can. He just picked up a new girlfriend, which is a friend of my aunt that is in her early 50's SHE was chasing him for a while, LOL. One special tip. JUST LOOK IT UP. THE CONCEPT AND PROCEDURE OF ICP. A great way to start learning how to make money without having to file a bunch of claims and get 1/3 of what you asked for (while being happy about it).

Anything is possible and chasing the human perfection should never be seen as a sin. Don't let high-minded naysayers tell you to walk,a path they themselves aren't on.