Health & nutrition insights.

Credible or Concerning? Healthcare Professionals & Scopes of Practice

Health Care Professionals and Scope of Practice

 

To listen to this is podcast form, click here: https://podcasters.spotify.com/pod/show/achievingyourbest/episodes/Credible-or-Concerning–Healthcare-Professionals–Scopes-of-Practice-e2autle

If you didn’t know, there are many types of healthcare professionals who work in a growing number of healthcare areas. These professionals have different levels of education, registration and accreditation requirements to practice in their field. As a consumer, it can be difficult to differentiate between these professionals and what their scope of practice is! Today, we want to provide some practical insight into what each type of healthcare professional does, each profession’s scope of practice and gain clarification as to our roles in helping you achieve your best health. Because frankly, the lines can get kindaaaa blurry sometimes. 

 

Dietitian:

  • Who we are: Dietitians are health professionals who are experts in nutrition and the human diet
  • Education:
    • Undergrad degree from an accredited dietetics program. 
      • Effective January 1, 2024, a minimum of a master’s degree will be required to be eligible for the RDN exam 
      • Complete a supervised practice requirement. Must complete at least 1,200 hours of supervised practice to gain real-world experience and apply knowledge learned in the classroom to the context of a variety of work settings.
      • Pass a national exam 
      • Meet requirements to practice in your state 
      • Stay up-to-date in dietetics through continuing education
  • General scope (not a comprehensive list): 
    • Medical Nutrition Therapy  
    • Apply the Nutrition Care Process 
    • Perform assessments 
    • Complete Nutrition-Focused Physical Exams  
    • Recommend, perform and/or interpret test results related to nutrition status
    • Order and monitor nutrition-related laboratory tests 
    • Order and monitor nutrition interventions to meet individual nutrient needs
    • Provide nutrition counseling, nutrition behavior therapy, health and wellness coaching, and nutrition, physical activity, lifestyle and health education and counseling as components of preventative, therapeutic and restorative health care.
    • Assess and counsel for the treatment of food allergies
    • Evaluate, educate, and counsel related to nutritional genomics and disease interactions
  • Some limitations as a dietitian: 
    • Cannot provide a medical diagnosis 
    • Write prescriptions 

Resource: https://www.eatrightmissouri.org/page/registered-dietitian-scope-of-practice-act

 

Nutritionist:

  • Anyone who completes a degree in nutrition (or a related field) can technically refer to themselves as a nutritionist. This encompasses all varying levels of education. It’s not a title that belongs to any professional accreditation (aka no code of ethics)
  • They are limited in what they can do in many states. For example, because they do not necessarily have a certification, license or clinical experience, they are not allowed to perform MNT (aka medical nutrition therapy).  

 

Chiropractor:

  • Chiropractors are doctors of chiropractic care—aka professionals devoted to providing non-invasive, personalized care by identifying and treating neuromuscular disorders and related symptoms (however, they are not medical doctors).  
  • Education:
    • Undergraduate in pre-medical studies and obtained a bachelor’s degree prior to admission to a post-graduate chiropractic college 
    • May then be eligible to enroll in a Doctor of Chiropractic degree program
      • 3.5-5 years to complete 
      • requires a minimum of 4,200 at a chiropractic college (often includes 2 nutrition courses)
      •  pass a series of exams administered by the National Board of Chiropractic Examiners and secure licensure in the state where you plan to practice.

–What do chiropractors do (aka their general scope):

  • The foundation revolves around the relationship between the spine and the nervous system. Chiropractors believe that structural misalignments of the musculoskeletal system directly and indirectly affect everything. By addressing those misalignments, chiropractors believe they can alleviate other symptoms and improve their patient’s overall quality of life. 
  • General scope (not a comprehensive list):
    • Adjustments
    • Exercise (stretching,  joint mobility, balance, etc.)
    • Soft tissue therapy (ease spasms, tension, etc.)
    • Kinesio taping 
    • Massage therapy, ultrasound, braces, shoe inserts, etc. 
    • Acupuncture
    • Cold laser therapy
    • MLS laser therapy
    • MicroVas therapy
    • Non-surgical spinal decompression
    • PRP injection therapy
    • Vitamin supplementation 
    • Heat/ice/cooling procedures, extension therapy, therapeutic exercises
  • Some limitations vary by state, but some limitations of chiropractors include: 
    • practice of obstetrics or surgery 
    • Venipuncture 
    • Sometimes nutrition limitations (depending on state): In Wisconsin for example, “A chiropractor may not sell, barter, trade, or give away nutritional supplements to a patient unless the chiropractor holds a certificate for nutrition” 
  • In Missouri (as of 2012):  
    • Chiropractic scope does not include the authority to prescribe any drug or medicine 
    • The practice of chiropractic in Missouri shall not include the use of operative surgery, obstetrics, osteopathy, podiatry, nor the administration or prescribing of any drug or medicine
    • No legend drug can be sold to, or purchased and administered by, any health professional that does not have authority to prescribe legend (aka through IV or injection) drugs.
      • In order to be a dietary supplement rather than a legend, the supplement must be one that is intended for ingestion in tablet, capsule, powder, softgel, gelcap, or liquid form.

Resource: http://www.mccoypress.net/docs/drugs_injectables_missouri_state_board_rule.pdf

 DO vs. MD: what is the difference?- MARIA

  • MD= Doctor of Medicine 
  • DO=  Doctor of Osteopathic Medicine 
    • They often do the same job, have similar schooling, etc. However, DOs are known to practice more holistic, whole person care. MDs take a more allopathic or illness based approach (using medication, surgery and other interventions to treat illnesses).  
    • DOs emphasizes the relationship between the mind, body and spirit. It focuses on treating the person as a whole and improving wellness through education and prevention. DOs also receive extra training in osteopathic manipulative medicine (OMM), a hands-on method for diagnosing and treating patients.

                 

Note on nutrition in medical studies: In 1985, the National Academy of Sciences recommended at least 25 hours of nutrition education in medical school, but a survey of U.S. medical schools in 2010 found that only 27% of programs met that recommendation.

 

Functional Medicine:

What is functional medicine? biology–based approach that focuses on identifying and addressing the root cause of disease

  •  In 1991, the Institute for Functional Medicine was founded with 7 defining characteristics of functional medicine. These included:
    • Patient centered versus disease centered
    • Systems biology approach: web-like interconnections of physiological factors
    • Dynamic balance of gene-environment interactions
    • Personalized based on biochemical individuality
    • Promotion of organ reserve and sustained health span.
    • Health as a positive vitality—not merely the absence of disease
    • Function versus pathology focused
  • Training:
    • Once a practitioner is accepted into the functional medicine program, it’s made up of 6 training modules focusing on different systems of the body. 
    • These include: gastrointestinal, detox, immune, hormone, cardiometabolic and energy. Courses are offered onsite (or virtual)  and are an average of 17 credit hours. Once the modules are completed, a case report must be accepted and graded according to IFM criteria, and a written exam must be completed with a passing grade 
    • CAN get a MS in integrative and  functional medicine from various universities 

– How to become a functional medicine practitioner?

  • Eligibility: To be eligible to become a certified functional medicine practitioner, you must have a license in a primary specialty, with one of the following credentials:
    • MD
    • DO
    • Chiropractor
    • Dentist
    • Nurse Practitioner
    • Physician Assistant
    • Registered Nurse
    • Registered Dietitian
    • Acupuncturist
    • Pharmacist
    • Naturopathic Doctor (quick differentiation between a naturopathic doctor and a naturopath):
      • A regulated/licensed ND is a primary care practitioner who is trained to diagnose and treat all health care concerns. An ND uses natural remedies to help the body heal itself.
      • Naturopaths on the other hand have access to any number of programs. Many are delivered online. Program length can vary from a few months to a few years to complete. There is no standardized or accredited curriculum nor supervised clinical experience.  
  • Limitations:
    • Often not covered by insurance 
    • Training is not 100% standardized 
    • Sometimes difficult to find
    • Not all can prescribe medications

Resources: https://my.clevelandclinic.org/departments/functional-medicine/about

 

Personal Trainer:

Eligibility: 

  • 18 years or older
  • High school degree or GED (many have undergrad degrees, masters, etc!)
  • Current CPR certification
  • Current AED certification
  • Prepare for a proctored exam and keep up with continuing education 

Scope: 

  • Personal trainers:
    • design safe and effective exercise programs
    • provide guidance to help clients achieve their personal health/fitness goals
    • pre‐participation risk screening, assessment and sub‐maximal fitness testing, evaluation of clients’ needs and goals
    • respond appropriately in emergency situations
    • referring clients to other healthcare professionals when appropriate 

– Limitations: cannot provide nutrition MNT, prescribe supplements, etc. 

  

There are MANY other health care professional careers out there. However, these are some that consumers may be confused about in terms of what they actually do! We hope this helps you to understand more about the professionals you are seeing.