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practice applicationsBUSINESS OF DIETETICS

Getting Started in Private Practice: A Checklist to

Your Entrepreneurial Path

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‘How do I get started in Pri-vate Practice?” This is aperpetually hot topic on

istservs, in hallway conversations,nd at networking and business func-ions, such as the Nutrition Entrepre-eurs (NE) Specialty Group meetingt the 2007 Food & Nutrition Confer-nce & Expo in Philadelphia, PA.The following checklist provides a

road yet all-encompassing guide toetting started in private practice.ost this list on your bulletin board orlace it in the front of your daily plan-er. Schedule weekly tasks and com-lete them. As you check off the itemsisted in each step, you will be mak-ng measurable progress towardour career as a nutrition entrepre-eur working in private practice.

. OBTAIN PROFESSIONAL CREDENTIALSND REFERENCEShe first step on your journey is toaintain an updated file of profes-

ional credentials, resources, achieve-ents, etc. When you receive a call

ffering you a significant opportunity,ou will be organized and ready toake action by sending the caller yourrofessional profile.If you live in a state that has a

icensure or certification law, youust obtain this credential to provide

lient counseling services.Plan or update your Professionalevelopment Portfolio Learning Plan

o include educational sessions thatill help you complete unfinished ac-

This article was written by MaryGross, MS, RD, president of Nu-tritional Perspectives in Durham,NC, and director of the PrivatePractice Specialty Group of theNutrition Entrepreneurs DPG,and Cathie Ostrowski, MS, RD,president of Personalized Nutri-tion, Inc, Apex, NC.

cdoi: 10.1016/j.jada.2007.11.007

2008 by the American Dietetic Associat

ivities on your checklist. Make it aabit to submit your continuing pro-essional education (CPE) hours on-ine to the Commission on Dieteticegistration Web site (www.cdrnet.rg) as soon as each program is com-leted. (Check out the new format forubmitting Journal CPE hours onlinen page 79 of this issue.)Obtain letters of recommendation

rom employers and professional col-eagues, patients or clients, businesseaders, educators, and community lead-rs whenever you have completed aonsulting job, taught a program, pro-ided a community service, or other-ise made the world a better place.racking these individuals down tobtain references when needed is aifficult and time-consuming task.egularly contact these individuals to

ouch base and to update their con-act information (1).

Maintain your professional cre-dentials with up-to-date Profes-sional Development Portfolio.Become licensed or certified inyour state, if applicable.Regularly update your curric-ulum vitae/resume.Maintain a current listing ofprofessional meetings attended.Maintain an ongoing file of let-ters of recommendation.Regularly update your list ofprofessional references.Regularly update your list ofpersonal references.

. LEARN AND CONNECToin an affiliate (state) association,ietetic practice groups (DPGs), andpecialty groups. Take advantage ofaluable member benefits and re-ources including the Journal, vari-us newsletters, and other Americanietetic Association (ADA) and DPGublications; the Evidence Analysisibrary; networking, mentoring, and

ontinuing education opportunities; n

ion Jour

iscounts on professional resources;nd business trend updates (2).Excellent reading resources are

vailable in the business section ofhe library and book stores to helpou learn what it takes to start andanage a business. You can also ac-

ess professional materials and con-inuing education program listings athe NE Web site (www.nedpg.org).

US Small Business Administrationwww.sba.gov) offices are located in

any states and cities (3). These fa-ilities offer excellent low-cost classesnd materials covering every aspect oftarting and operating a small busi-ess. Experienced consultants may bevailable to answer questions, pointou to business services available lo-ally—including business loan pro-rams—and provide feedback regard-ng your business plan, strategies,nd materials.SCORE (Service Corps of Retired Ex-

cutives [www.score.org]) offers a freeusiness consultation by a seasoned lo-al professional. This is a wonderful op-ortunity to practice pitching yourusiness idea and to receive helpfuleedback regarding your readiness toeap.

Become connected to your localusiness community prior to apply-ng for a business loan and openingour business to clients. Join thehamber of Commerce and attend

heir functions. Perform communityervice and network through Rotaryr Kiwanis Clubs. Connect withomen in a spectrum of professionalreas through Women in Business or-anizations. Perfect your presenta-ion skills with Toastmasters. Theseontacts will pay off in business refer-als and will lay the groundwork forong-lasting professional and per-onal relationships. You’ll be pleas-ntly surprised to find that successfulusiness owners really want to help

ewcomers succeed.

nal of the AMERICAN DIETETIC ASSOCIATION 21

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BUSINESS OF DIETETICS

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Become an ADA, affiliate, andDPG member.Sign up for ADA, DPG, and af-filiate listservs.Attend programs about thebusiness of dietetics. Readbooks and articles on entrepre-neurship.Register and attend US SmallBusiness Administration classes.Pitch your business to aSCORE counselor.Make time for networking on amonthly basis.Be involved in trade associa-tions.Join and participate in your lo-cal Chamber of Commerce.Be a leader in something youenjoy.

. FIND AND FEED YOUR FOCUSo you want to find a job, or do youant to develop your career? There isbig difference between the two. A

ob is simply making a place for you too each day and work. You fill yourime and make money. A career isour course or progress throughoutife. It is not unusual for entrepre-eurs to take on way too much in thearly stages of business, then to feelverwhelmed and overworked be-ause they are in fact juggling a num-er of jobs.Begin your entrepreneurial en-

eavor by creating a vision of yourream business. Imagine every as-ect of your daily work. Picture yourlients. What will they want and needrom you? When will they consultith you? Where will they consultith you? Why will they select yourusiness over others? A business vi-ion is the critical distinction betweenjob and a career.Will your vision translate into a vi-

ble business? Take an honest look athe business environment for cluesegarding your likelihood of success.dentify the trends in your field re-ated to your idea. Is your service orroduct at the beginning, middle, ornd of its trend life cycle? Look forvidence that consumers feel the needor your services or products. Are ex-sting businesses meeting consumereeds and wants, or is there a marketor additional services or differentypes of services?

Taking the time for this in-depth

nalysis will help you to identify fatal M

2 January 2008 Volume 108 Number 1

aws or potential trouble spots inour vision. An additional advantages that you will be jump-starting yourusiness planning process by identi-ying niche markets that may giveou a competitive edge (4). Nichearketing is the process of finding

nd serving a group of customershose needs are not being served byainstream providers. Many busi-

ess niches evolve over time ashe entrepreneur develops experiencend insight. However, pinpointingpecialty areas early in the life of yourusiness can maximize resource allo-ation and profits.

Create a vision of your dreambusiness.Assess the current business en-vironment.Pinpoint your unique niche.

. CREATE YOUR ROADMAPnce your vision is in place, everyusiness decision should move youloser to achieving this vision. Plan-ing is essential to business success.Your start-up business plan is the

oadmap which will guide you to yourestination. The business plan includesn executive summary, description ofour company along with mission andision statements, product or service, aescription of your target market strat-gy, implementation milestones, man-gement team, an assessment of yourompetition, and financial projections forhe first year including a calculation oforking capital needed. Go to the USmall Business Administration Webite (www.sba.gov/smallbusinessplan-er/index.html) for a comprehensiveuide to writing a business plan (5).Use your business plan to establish

nternal work plans. A strategic planocuses on high-level options and pri-rities. An operations plan will in-lude concrete goals, responsibilities,nd a timeline for accomplishingasks. (Check out the upcoming Feb-uary 2008 issue of the Journal forn article on creating strategic plansnd ADA’s strategic planning tool forembers.)

Create your business plan.Establish internal work plans.

. ESTABLISH YOUR PROFESSIONALUPPORT SYSTEMSs the old saying goes, “Time Is

oney.” Effective business owners s

earn this lesson sooner rather thanater. No one person has the time toe an expert in every aspect of busi-ess. Even a small business ownereeds a knowledgeable team to suc-eed.An accountant will assist you in es-

ablishing effective accounting proce-ures and payroll systems, and wille invaluable in ensuring that you fileour business taxes accurately whileaining available tax advantages.A corporate attorney will help you

etermine and establish the mostppropriate business structure, de-elop basic contracts if consulting,nd provide overall legal assistances needed.A marketing consultant can assist

nd guide you in naming your busi-ess; creating a marketing plan; de-eloping brochures, business cards,nd stationery; developing your Webite; and establishing your clientele.An information technology consul-

ant will help you with the technicalspects of setting up, maximizing usef, and maintaining your computerystems.Health plans can benefit your busi-

ess by marketing your services, re-erring clients, and paying for yourervices, thereby enabling more cli-nts to utilize your business.

Consult with an accountant.Consult your banker for helpwith financing your business.Consult with a corporate attor-ney.Consult with a marketing spe-cialist.Consult an information tech-nology specialist.Become credentialed and con-tracted with health plans, ifdesired.

. ESTABLISH BUSINESS BASICSs an entrepreneur, you must make arofit from running your own business.ou must first cover your costs, includ-

ng equipment purchase and expenses;usiness expenses (travel, continuingducation, business meals); fixed costsrent, phone, insurance, Internet ser-ice, marketing, employee costs); vari-ble costs (file folders, printing, andducational materials for each client);nd employee wages and related ex-enses (6). In determining your de-

ired annual income, consider benefits

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BUSINESS OF DIETETICS

sually paid by employers, vacationnd sick time, holidays, and personalime off. Be realistic about themount of unpaid time spent in activ-ties such as marketing, phone calls,esponding to e-mail, and communi-ating with physicians and thera-ists. Consider that an economicownturn has the potential to affectour business.Setting fees is an art as well as a

cience. The market value for yourervices will depend on such consid-rations as the need for your services,he availability of similar services,ates charged by others in your locale,he convenience of your location andours, and the ability of your targetlientele to pay. Your perceived valueay be higher based on factors such

s marketing effectiveness, personaltyle, advanced expertise, reputation,ducation, experience, and creden-ials. Formulas are available to sim-lify the process of determining bothounseling and consulting fees (6,7).e sure to set your fees high enough

o ensure a profit.You may choose to become an in-net-ork provider with selected healthlans. Provider status will enable youo bill and receive payment directlyrom each health plan for medical nu-rition therapy services provided toour clients. Contact individual healthlans to request information and an ap-lication to become a provider. A typi-al application process involves com-leting the application to becomeredentialed, negotiating and signing

contract, and then registering toubmit billing forms online.Medical nutrition therapy coverage

s a complex topic because paymentetails are unique to specific policiesf each health plan and may differ byegion or state. There is wide variabil-ty in diagnoses covered and paymentates. While contacting individualealth plans can be time-consumingnd detail-oriented, don’t give up ashis effort may be important to yourusiness success. The Private Prac-ice subgroup of the NE DPG sup-orts members seeking insuranceeimbursement (www.nedpg.org/mem.en.html). Helpful information is avail-ble in the archives of the NE listserv.When you are ready to select your

ffice location, consider your optionsarefully. You may plan to work withlients in your home office, or you

ight prefer to purchase, rent, or i

ease a building, suite, or room. Foodnd nutrition professionals oftenhare space with other medical andllied health professionals, provideports nutrition consults in gyms, orounsel in physicians’ offices. Count-ess variations are possible in estab-ishing agreements for space sharingnd collaborative provision of ser-ices. Be creative and assertive to en-ure that arrangements of this naturet your vision and meet your needs,nancially and otherwise. Check withity Hall to learn if you can obtain arivilege license to work at your de-ired location. If you plan to workrom your home office, you will alsoeed to comply with covenants estab-

ished by your home owners’ associa-ion, if applicable.

Professional liability insurance, aecessity for food and nutrition pro-essionals in private practice, is avail-ble at very reasonable rates. Compareates and services when selectingour insurer. Health plans requirepecified levels of insurance in theredentialing and contracting pro-ess.Business checking and savings ac-

ounts must be separate from yourersonal bank accounts. Clients ex-ect businesses to accept charge pay-ents as well as checks. Shop around

or best rates in selecting a credit cardrocessing service; many are avail-ble online, and your bank may alsoffer this service.Selecting the people who will work

n your business is of critical impor-ance. Consider your personal stylend seek people who complement andalance your style, strengths, andeaknesses. Hiring the right people

implifies the management process8). Employees or subcontractors maynclude other food and nutrition pro-essionals, business manager, billingervice, administrative assistant, an-wering service, cleaning service,rounds and maintenance personnel,ecurity, and support staff.Basic business policies and proce-

ures should be in place before therst client walks in your door. Youay wish to post pertinent policies

nline for your clients, including pay-ent and refund policies, cancella-

ion procedures, and missed appoint-ent policy. HIPAA, which stands for

he American Health Insurance Port-bility and Accountability Act of 1996,

s a set of rules to be followed by all

January 2008 ● Jour

ealth care providers. You must ad-ress HIPAA requirements and notifylients of your privacy procedures (9).

Estimate business expenses.Identify the market pricing forsimilar services in your area.Assess your income potentialand set your fees.Identify the insurance reim-bursement rates in your areaand/or complete the applica-tion process to become a pro-vider with health plans.Obtain office space and setup office infrastructure (eg,phones, computers, Internet,work spaces).Apply for a merchant privilegelicense at City Hall.Obtain professional liabilityinsurance.Establish business checking andsavings accounts.Select credit card service toprocess client payments.Hire employees or subcontractwork.Write basic business policies andprocedures.

nal of the AMERICAN DIETETIC ASSOCIATION 23

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. LAUNCH YOUR MARKETING PROGRAMow will your clients learn about

our business? Your marketing pro-ram is the key that will bring clientso your door. Work with a professionalarketing consultant to develop a

omprehensive plan.Generate consumer-friendly mes-

ages about your services for effectiveommunication. Learn by listening toonsumers themselves to understandheir knowledge, beliefs, and values.sk consumers to provide feedback in

nformal conversations or in focusroups.Create your marketing materials.

tart with business cards, brochures,nd stationery. Develop advertisingaterials for telephone directories

nd place the ads. Advertise onlinehrough health-related organizationsnd specialty Web sites. Contact localhysicians and allied health profes-ionals to educate them about yourervices and request referrals.Track direct benefits of each mar-

eting effort. Ask clients how theyearned about your services. Thankach referral source by making a phoneall, sending an e-mail, or sending aand-written note.Work with your marketing consul-

ant to prepare press releases andargeted PowerPoint presentationsor various audiences.

Create consumer-friendly mes-sages and test them.Create your business bro-chure, cards, and stationery.Prepare advertising materials.Place ads in directories andonline.Establish relationships with lo-cal health practitioners.Prepare press releases.Prepare business presentations.

. BUILD ON YOUR SUCCESSucceeding in business is an ongoingrocess. Always be on the lookout forays to improve your business. Pay

lose attention to what clients areaying and respond. The executive cli-nt who grumbles about your e-mailesponse time may seem annoying,ut is alerting you to a concern thatay be shared by others.Actively gather and evaluate spe-

ific types of data to pick up on thingsuch as variability, seasonal trends,

nd changes in client purchasing hab-

4 January 2008 Volume 108 Number 1

ts. Quality-assurance techniques in-lude such activities as conducting cli-nt satisfaction surveys, reviewinglinical outcome data, and evaluatingppointment utilization and no-showate; evaluating marketing effective-ess; and reviewing accounting data.Keep track of global trends and op-

ortunities as these are constantlyhifting. Scan news reports daily tonderstand issues and concerns inour field. Begin to shift your servicesnd products as consumer interestsvolve. Stay ahead of the curve bynticipating changing needs and ex-ectations of your target market.

Develop and implement a qual-ity-assurance program.Continually evaluate and im-prove.Adjust services in response toshifts in client expectations.

. ENJOY THE BENEFITSour business is up and running suc-essfully at this point. As clients suc-eed, they spread the word to theiramily, friends, and health care pro-iders. Your referral base is graduallyxpanding, and your business is be-oming more profitable. You are real-zing your dream. Pace yourself andake time to balance all aspects ofour life.

See clients succeed.Realize abundant client refer-rals.Realize profit.Move toward self-actualization.

DDITIONAL RESOURCES FOR ASPIRINGNTREPRENEURSmerican Dietetic Association. ADA MedicalNutrition Therapy Evidence-Based Guides forPractice. Chicago, IL: American Dietetic Asso-ciation; 2002.rpino L. Nutrition Practice: Policy and Proce-dure Manual. Clifton Park, NY: Cengage Del-mar Learning; 2007.usey JC. Do food and nutrition professionalsreally need professional liability insurance?J Am Diet Assoc. 2007;107:1480-1486.usey JC. When Do You Need a Lawyer? J AmDiet Assoc. 2007;107:733-735.erber M. The E Myth Revisited. New York, NY:HarperCollins Publishers, Inc; 2001.rabhorn L. Excuse Me, Your LIFE Is Waiting—The Astonishing Power of Feelings. Char-lottesville, VA: Hampton Roads PublishingCompany, Inc; 2000.odorowicz MA. Establishing a Successful Out-patient MNT Clinic in Any Practice Setting:

The Complete Guide. Palos Heights, IL:Hodorowicz Consulting, LLC; 2007.

odorowicz MA. Money Matters in MNT andDSMT: Increasing Reimbursement Success inAll Practice Settings: The Complete Guide. 3rded. Palos Heights, IL: Hodorowicz Consulting,LLC; 2004.utrition Entrepreneurs. Nutrition Entrepre-neur’s Tool Kit. Chicago, IL: American DieteticAssociation Nutrition Entrepreneurs; 2001.utrition Entrepreneurs dietetics practicegroup. Experts in the Business of Nutrition.http://www.nedpg.org/.

rice B. Private Practice: Getting that JumpStart. 4th ed. Huntington Woods, MI: Princi-pal Jump Start Consulting, LLC; 2005.

tollman L. Nutrition Entrepreneur’s Guide toReimbursement Success. 2nd ed. Chicago, IL:American Dietetic Association; 1999.

eferences. American Dietetic Association. Scope of Die-

tetics Practice Framework. American DieteticAssociation Web site. http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/advocacy_7225_ENU_HTML.htm?dologin�1. Accessed Octo-ber 20, 2007.

. ADA member benefits. American Dietetic As-sociation Web site. http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_5257_ENU_HTML.htm. Accessed October 20, 2007.

. Local SBA office. US Small Business Ad-ministration Web site. http://www.sba.gov/aboutsba/dis_offices/index.html. AccessedNovember 1, 2007.

. Mullins JW. The New Business Road Test.London, UK: Prentice Hall Financial Times;2003:3-16.

. Small business planner. US Small BusinessAdministration Web site. http://www.sba.gov/smallbusinessplanner/plan/writeabusinessplan/index.html. Accessed November 5, 2007.

. Litt A, Mitchell FB. ADA Guide to Private Prac-tice: An Introduction to Starting Your OwnBusiness. Chicago, IL: American Dietetic Asso-ciation; 2004:71-78.

. King K. The Entrepreneurial Nutritionist. 3rded. New York, NY: Lippincott Williams &Wilkins; 2002:115-124.

. Collins J. Good To Great. New York, NY: Har-perCollins Publishers Inc; 2001:42.

. Price B. HIPPA—What the Driver Needs toKnow. Huntington Woods, MI: PrincipalJump Start Consulting, LLC; 2005.