Dietetics Education: Will Enough RDs Enter the Workforce?
By Jennifer Doley, MBA, RD, CNSC, FAND
Today’s Dietitian
Vol. 26 No. 2 P. 14
Job prospects for RDs continue to increase, with a projected job growth of 7% annually for the next 10 years, compared with 3% for all occupations.1 According to the US Bureau of Labor Statistics, there will be an estimated 5,600 job openings for RDs for each year between 2022 and 2032.1 Some positions will be new jobs, while others will become available when RDs move to other occupations or retire. Regardless of the reason, demand for RDs will be high, but can the nutrition and dietetics education system generate enough new RDs to meet this need? Recent changes and trends in nutrition and dietetics education make this a difficult question to answer.
This article will address the impact that changes in dietetics education and graduation rates may have on the number of RDs entering the workforce.
Graduate Degree
In March 2013, a group of representatives from the Accreditation Council on Education in Nutrition and Dietetics (ACEND), the Commission on Dietetic Registration, the Council on Future Practice, the Education Committee of the Academy of Nutrition and Dietetics, and the Nutrition and Dietetic Educators and Preceptors Dietetic Practice Group released a report that provided consensus agreements outlining recommended future changes for the nutrition and dietetics profession, the first of which was to require an advanced degree to sit for the RD exam.2 The stated reason for this recommendation was “a graduate degree would better prepare individuals to enter the profession as an RD or RDN based on the roles, knowledge, skills, and curriculum required to meet client and customer needs for food and nutrition services.”2 In addition, the committee stated the following:
• Most other health care professions require at least a master’s level degree.
• A graduate-level degree is consistent with the knowledge and skills required in the field.
• A graduate-level degree would address the diversity of areas in which RDs practice.2
The requirement date was set for January 1, 2024, and applies to individuals who receive a verification statement from an ACEND program that provides supervised practice after this date. As long as the graduate is eligible to take the exam before January 1, the degree requirement doesn’t apply even if they don’t pass the RD exam after January 1. Currently, credentialed RDs aren’t required to obtain an advanced degree.2
Nutrition and Dietetics Educational Programs
There are many paths to gaining the credential. Both didactic learning and supervised practice is required, and in most medical professions, these two educational components are combined into one program. However, the nutrition and dietetics field includes several types of educational programs accredited by ACEND.
In the past, the most common pathway to becoming an RD was completing a Didactic Program in Dietetics (DPD) followed by a dietetic internship, which provides the 1,000 hours of required supervised practice. A DPD program isn’t strictly associated with a degree, although most students obtain a nutrition degree while completing DPD requirements. However, students who already have a degree in an unrelated field may complete all of the course requirements to obtain a DPD verification statement, which allows them to apply for a dietetic internship without obtaining a nutrition degree. DPDs and dietetic internships are two separate programs; therefore, after completing a DPD, a student still must apply to a dietetic internship. However, there’s no guarantee a student will obtain an internship position.3
Coordinated programs (CPs) provide both required educational components—didactic and supervised practice. Before the advanced degree requirement, some CPs awarded only a bachelor’s degree. However, because of the new mandate for an advanced degree, many CPs are now required to offer a master’s degree.3
A graduate program (GP), also known as a Future Education Model, or FEM, is a new educational model introduced in 2018. GPs also provide both didactic learning and supervised practice (also called supervised experiential learning); however, these two components are integrated. Upon completion of a GP, graduates are awarded an advanced degree and can sit for the RD exam.3 Since the announcement of the advanced degree requirement, the number of GPs has grown significantly, doubling in just three years.4
The last program type is the Individualized Supervised Practice Pathway (ISPP), which was created in 2011 to address the needs of applicants who didn’t get matched with a dietetic internship. ISPPs provide supervised practice but don’t result in a degree. They must be managed through an existing ACEND accredited program; however, the requirements and application process vary.3
CPs and GPs are operated by universities that can offer a degree. However, many existing dietetic internships are run by hospitals, health care systems, foodservice management companies, and government entities. These dietetic internships often are referred to as “freestanding” internships. Because of US Department of Education requirements, ACEND recently has mandated that a dietetic internship can’t award verification statements to its graduates unless they qualify to sit for the RD exam. In other words, the dietetic internship can’t graduate interns until they’ve completed an advanced degree, even if they’ve met all of the dietetic internship requirements.3
To address this issue, many freestanding dietetic internships are forming affiliations with universities to offer an advanced degree and experiential learning in one program. This program model may not offer integrated education, in which the student receives didactic learning and associated supervised practice concurrently; however, it does benefit students in that they need to apply to only one program instead of two.3
If freestanding dietetic internships choose not to be affiliated with universities, they may decide to accept only interns who already have advanced degrees or those with only a bachelor’s degree and a DPD verification statement but who are enrolled in a graduate program. In the latter case, dietetic internships must withhold the dietetic internship verification statement until interns have obtained an advanced degree.3
Application Process
Currently, the application process varies depending on the program type and may include two components: the Dietetics Inclusive Centralized Application System (DICAS) and computer matching. DICAS is the online platform used to coordinate the application process. The benefit of DICAS is that students need to complete only one application; before DICAS, students filled out separate applications for each program to which they applied.5 While dietetic internships, CPs, and GPs aren’t required to use DICAS, many of them do. However, ISPPs and DPDs don’t use DICAS.
The second component, computer matching, is managed by D&D Digital, a company independent from DICAS and ACEND. Computer matching is only for dietetic internships and occurs twice a year, in the spring and fall. In addition to completing their DICAS application, students must register with D&D to participate in the computer match.5
In past years, the computer match rate has been as low as 50%, but as of 2022 it’s 73%.6 However, this number doesn’t include students who have obtained a position as a preselect applicant or those in the second-round process, and ISPP students, which would make the total match rate higher than 73%.6 It should be noted that for the first time in 2021, there were more open positions than there were applicants, and in 2022, there were over 1,600 more internship positions available than applicants.6
ACEND recently announced that computer matching will be discontinued after the spring 2024 match. It hasn’t yet released a process or guidelines that will replace computer matching, although plans are under development. Therefore, it’s unclear how match rate metrics will be assessed moving forward. DICAS will continue to be used.
Enrollment and Graduation Trends
Program enrollment and graduation trends give insight into the future number of RDs entering the workforce. Excluding DPD programs, whose graduates aren’t eligible to sit for the exam, program enrollment for dietetic internships, CPs, and GPs has increased by 11.4% in the last five years.4 However, graduation rates for these programs have decreased by 5.4% in the same time frame.4 Considering the projected 7% growth in RD jobs, current graduation trends indicate a shortfall of RDs to meet the needs of the job market.
RD Exam Pass Rates
The pass rate on the RD exam is another factor influencing the number of new RDs entering the workforce. The Commission on Dietetic Registration updates exam content specifications every five years to coincide with ACEND’s updates for dietetic program standards. In January 2017, exam specifications were changed, and the pass rate for first time and repeat test takers combined decreased from 79% to 54%.7 The pass rate hit a low of 48% in 2021 but increased when the exam content specifications changed again in 2022.7 The most recently reported pass rate, from January to June 2023, is 65.5%.8 In calendar year 2022, 88.8% of test takers passed within the first year of taking the exam.9 Although this number is more promising, it should be noted that it includes both first time and repeat test takers. Not passing the exam on the first try is a financial burden for graduates, and it delays their entry into the field.
What the Future Holds
Demand for RDs is expected to grow considerably in the next 10 years; however, the ability of the nutrition and dietetics education system to meet this need is uncertain. In total, 4,147 individuals became RDs in 2022, which falls short of the projected need of 5,600 new RDs. Changes in education, including an advanced degree requirement, new pathways to obtain the RD credential, and modifications in the program application process, will undoubtedly influence the availability of RDs in the future. Trends in enrollment, graduation, and RD exam pass rates can be monitored to provide a glimpse of the future supply of RDs entering the workforce.
— Jennifer Doley, MBA, RD, CNSC, FAND, has been a dietetic internship director for 15 years and currently is a corporate malnutrition program manager with Morrison Healthcare. Previous roles include nutrition support specialist and regional clinical nutrition manager.
References
1. Dietitians and nutritionists: occupational outlook handbook. US Bureau of Labor Statistics website. https://www.bls.gov/ooh/healthcare/dietitians-and-nutritionists.htm. Updated September 6, 2023. Accessed October 20, 2023.
2. Commission on Dietetic Registration. Graduate degree registration eligibility requirement. https://www.cdrnet.org/vault/2459/web/files/Graduate%20Degree%20FAQ%202020%20(002).pdf. Published January 2020. Accessed November 26, 2023.
3. About accredited programs. Academy of Nutrition and Dietetics website. https://www.eatrightpro.org/acend/accredited-programs/about-accredited-programs. Accessed November 26, 2023.
4. ACEND Program Statistics 1995-2022.
5. Application process for students. Academy of Nutrition and Dietetics website. https://www.eatrightpro.org/acend/students-and-advancing-education/application-process-for-students. Accessed November 26, 2023.
6. Commission on Dietetic Registration. Percent change in number of openings, applicants, and applicants matched to DI programs participating in Computer Matching Process (April/November). 1993-2023.
7. Commission on Dietetic Registration. Registration Examination for Dietitians Group Performance Statistics. October 1987 – December 2022.
8. Pearson VUE. Registered dietitian: registration examination for dietitians first exam attempt – summary by registration eligible pathway. January-June 2023.
9. Pearson VUE. Registered dietitian: registration examination for dietitians examinees with one year from first attempt period ending 2022. https://www.cdrnet.org/vault/2459/web//Examinees%20with%20One%20Year%20from%20First%20Attempt%20Period%20Ending%202022.pdf