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Being a voice for the voiceless, advocacy in fee-for-service work

By Amy Nielsen

My profession, clinical nutrition, is one that professes to service the general population. What we do is rarely covered by insurance, so we for the most part work on a fee-for-service model. This precludes a huge swath of the public if we want to charge a living wage for our services. This is a problem for most complementary health professions.

The services we offer could, and eventually will, turn around the epidemics of disease we are currently mired in. However until we can offer those service across the board to all populations, especially those underserved and in the most dire need of help, while making a living wage, we will not even make a ripple in the high fructose corn syrup pond.

Unlike many of my classmate in my Master’s program, I live in a rural community. Most of the other students live in or around a major metropolitan east coast city: New York, Philadelphia, Baltimore, or Washington DC. My client base can’t afford my living wage. The living wage charged by some fellow students is more than many in my community make in a week. While I operate on a sliding scale and have offered barter for services, I can’t pay my electric bill with eggs. Of course, with all of the finger-tip information about what to eat, who needs a nutritionist anyway, right? It’s a privilege.

You might be thinking, wait, isn’t my doctor supposed to give me important information about nutrition? Maybe you have seen a registered dietitian for your diabetes management. I’ve even seen hometown pharmacies with health and wellness coaches giving nutrition advice. Guess what, they are all using the same information and it’s flat out wrong - and worse if pressed – they will admit it. There are countless studies proving they are using flawed materials.

My beef in this blog isn’t with the biomedical field who still sees us nutritionist as quacks and hacks at best and dangerous competitors at worst. Of course most of them have had less than ten hours of nutrition training in their entire 12 year medical academic careers. They are having to deal with big pharma and insurance companies daily – they don’t have time to deal with the easy stuff like eating more broccoli or drinking more water.

My beef is with my fellow nutritionist who are not freaking out on these doctors who are giving out terrible nutrition advice to patients thereby perpetuating and creating more disease.

What does terrible nutrition advice have to do with my fellow nutritionist, fee for service, and rural communities? I’ll tell you. Rural communities, like the populations in many high density urban areas, have higher rates of all of the current major health epidemics because they have less access to healthy options for food. If we as nutritionists don’t advocate – loudly – for our clients who are underserved, why the heck are we practicing? If we can’t help the folks deepest in the trenches of disease brought on by a system that keeps artificial foods cheap, delivers them a host of preventable diseases, exasperated by pharmaceutical drugs with worse side effects than the original disease, there is really no point in doing this work.

I’m not saying cut down our fees, destroy our livelihood, or only do sliding scale work. I’m saying step up to the plate and fight to get covered under insurance so we can help rise all boats on our health tide. Refuse to be limited to working only with other complementary health professionals also working on a fee for service basis. Be adversarial. Challenge the biomedical doctors to provide data and research for their protocols like they require us to do.

Until we of the complementary medical fields demand the same rigor the biomedical field does of our modalities, until we demand that they take responsibility for their patient’s lives rather than hospital or practice bottom lines, they will continue to serve the insurance and pharmaceutical companies.

This is true for any career field that lingers outside the norms accepted as mainstream. We must advocate for ourselves and each other. 

Advocacy starts with a single question. Advocacy doesn’t have to be argumentative. Advocacy must be supported with factual evidence based research. Advocacy must encompass compassion for the greater good. Sound individualized nutrition is hard and takes time. Both on the part of the practitioner and client. Until nutritionist embrace advocacy for the underserved, and start demanding services for the most needy clients, the field will remain that of the privileged.

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