Running head: DIETITIANS IN UNITED STATES AND AUSTRALIA

Dietitians in the United States and Australia: A Comparison

Amanda Venuto

University of Delaware
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Introduction

Dietitians are in high demand around the world as more evidence suggests that food

consumption can directly affect risk for chronic diseases. Certain diets promote chronic disease

progression, such as carcinogenic diets leading to cancer and atherogenic diets to heart disease.

Conversely, there is evidence that suggests certain diets have inverse relationships with acquiring

diseases, such as the Mediterranean diet and heart disease. Medical Nutrition Therapy is essential

in hospitals and outpatient practices—with therapy ranging from trauma patients receiving the

appropriate nutrition support to individuals with diabetes mellitus following carbohydrate

counting to prevent hypoglycemia or diabetic ketoacidosis. With the vital role Registered

Dietitians have in the healthcare system in the United States, it is interesting to compare it to the

role of Accredited Practicing Dietitians in Australia. The education, licensure processes, scope of

practice, and cultural/fiscal components of the dietitian occupations in the United States and

Australia are compared.

Education

To become a Registered Dietitian in the United States, one must first complete a

bachelor’s degree in a Didactic Program in Dietetics (DPD). The Accreditation Council for

Education in Nutrition and Dietetics accredits the Didactic Program. Upon graduation from the

Didactic Program, a verification statement will be sent to the individual. Following completion

of the bachelor’s degree, Dietetics graduates must enroll in a dietetic internship program (5 Steps

to Become a Registered Dietitian Nutritionist, 2018). These programs are typically unpaid,

lasting 10-12 months and consisting of clinical, foodservice, and community nutrition rotations.

In total, the intern must complete 1200 hours of supervised practice (Careers in Dietetics, 2013).
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An interesting aspect of the dietetic internship is the way in which students are accepted.

Students will only get matched with one program: there is no option to choose which one to

attend. Students have only the option to rank programs based on preference in their application

portals. As the number of DPD graduates is on the rise, matching with an internship is becoming

more competitive nationally. Statistically, approximately half of the applicants will be matched

to an internship (Supply and Demand for Internship Sites, 2016). The other half that will not get

matched can choose to earn a Master’s degree, or gain more shadowing and volunteer

experiences before applying again.

Following completion of the dietetic internship program, students must pass the

Commission on Dietetic Registration’s dietetic registration exam and gain licensure for their

state of practice (5 Steps to Become a Registered Dietitian Nutritionist, 2018).

The path to becoming a dietitian in Australia is similar to the process followed in the

United States. Students seeking to become a dietitian must complete a minimum of a bachelor’s

degree from an Accredited Practicing Dietitian (APD) program, which is accredited by the

Dietitians Association of Australia (Accredited Dietetics Education Programs, 2018). Typically,

students choose to pursue a three-year undergraduate degree in nutrition, followed by a Master’s

degree in dietetics from an accredited DAA program. A majority of the accredited programs are

at the Master’s level (Professional Accreditation Requirements for Entry-level Employment as a

Dietitian, 2017). However, upon completion of the APD program, students are eligible become

an Accredited Practicing Dietitian and join the Dietitians Association of Australia: an unpaid

internship is not necessary.

While completing the APD program does give APD status and provides monetary

compensation, an individual must begin as a Provisional APD before becoming a Full APD.
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During the Provisional period, the APD must complete thirty hours of Continuing Professional

Development per calendar year and a 12-month formal mentoring program with a Full APD. The

Full APD mentor must be determined within 6 months of joining the APD, or suspension from

APD will occur. Continuing Professional Development logs must be recorded during this time

and will be audited annually. In addition, the APD must work towards meeting 1000 dietetic

practicing hours after five years from graduation. The Provisional Program must be completed

within two years; however, most complete the program within 12 months (APD Program

Handbook, 2018).

After completing the Provisional period, the APD is qualified to become a Full APD. To

be a full APD, the dietitian needs thirty hours of Continuing Professional Development with logs

that will be randomly audited annually and 1000 hours of dietetics practice in the preceding five

years (APD Program Handbook, 2018). After working five years as a dietitian, an APD is

eligible to apply to become an Advanced APD. This title allows for separation from entry-level

APDs and recognizes Advanced APDs as experts in the field of nutrition (Advanced APDs,

2018).

Licensure/Relicensure

Becoming a licensed dietitian in the United States varies by state. Some states, such as

Colorado and Arizona, do not require licensure. However, most states require either licensure of

dietitian, or certification of dietitian. In Pennsylvania, licensure of dietitian-nutrition is required

to practice (State Licensure, 2018). To obtain a license, an individual must first pass the

Commission on Dietetic Registration (CDR) exam to become a Registered Dietitian. After

successfully becoming a Registered Dietitian, the Application of Licensure should be completed

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and sent to the Pennsylvania State Board of Nursing in Harrisburg (Pennsylvania Nutritionist

Certification, 2018).

To uphold the LDN licensure in Pennsylvania, dietitians must participate in at least thirty

hours of continuing professional education credits every two years. One hour of continuing

professional education is rewarded for each fifty minutes of CPE activity. CPE activities could

include case presentations, academic coursework, research studies approved by the IRB,

interactive workshops, and programs that are sponsored by the American Dietetic Association or

American College of Nutrition (Pennsylvania Nutritionist Certification, 2018). In addition to

maintaining licensure, Registered Dietitians must complete 75 hours of continuing education

every five years to keep the Registered Dietitian credential.

On the contrary, licensure in Australia is universal. To become a licensed APD, students

that have successfully completed the APD accredited program apply to the DAA. After being

accepted into the DAA, they are Provisional APDs. To maintain APD status, 30 hours of

continuing education and professional development must be completed annually (Continuing

Professional Development, 2018). The DAA reviews APD status annually (Nutritionist or

Dietitian, 2015).

Scope of Practice

Dietitians in the United States and Australia have similar scopes of practice due to the

similar educational backgrounds needed to become a certified dietitian. Dietitians in the United

States and Australia can advise patients of all ages and are the only health professionals that can

provide medical nutrition therapy and dietary treatments for clinical health conditions such as

diabetes, nephrology, nutrition support, and cardiac diseases. In addition, dietitians may choose

to extend their scope of practice with proper education. Dietitians can now be seen adjusting
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insulin doses, taking blood glucose, or inserted nasogastric tubes (Dietitian Scope of Practice,

2018).

In the United States, Members of the Academy Quality Management Committee and

Scope of Practice Subcommittee of the Quality Management Committee determine the scope of

practice (Scope of Practice for the Registered Dietitian, 2013). Registered Dietitians can work in

many different fields including hospitals, clinics, sports nutrition programs, food and nutrition-

related businesses or industries, private practice, community and public health, University

settings, and research settings (Careers in Dietetics, 2013). They actively utilize the Nutrition

Care Process in which they must assess and diagnose patients, then develop an intervention

method in which they monitor and evaluate outcomes for these patients.

In Australia, the scope of practice for APDs is determined by the DAA (Dietitian Scope

of Practice, 2018). According to Nutrition Australia, APDs are “tertiary qualified in food,

nutrition and dietetics. They provide expert nutrition advice for people of all ages and prescribe

dietary treatments for many conditions such as diabetes, food allergies, cancers, gastro-intestinal

diseases, and overweight and obesity. APDs work in hospitals and private practice, government,

research and teaching, public health and community nutrition, the food and medical nutrition

industries, and nutrition marketing and communications” (Nutritionist or Dietitian, 2015).

Cultural and Fiscal

When researching dietitian professions in the United States and Australia, it is evident

that a majority of dietitians are female. According to senior nutrition lecturer Rick Hall, “That

sense of home economics beginning to the dietetics field certainly may have driven more women

than men into the nutrition profession” (Getz, 2014). Moreover, when the President of the

Academy of Nutrition and Dietetics was interviewed for US News, Evelyn Crayton explained
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that although she excelled in her science courses in college, “her professor suggested that,

instead of becoming a professor, she should consider home economics because men wanted

women to cook, clean, and have children” (Dietitian and Nutritionist Overview, 2017). While

this advice would be considered sexist in more current times, the attitudes and beliefs held during

those decades may have shaped the demographics of dietitians today. Approximately 90.6% of

Registered Dietitians in the United States currently are female and 94.6% of Accredited

Practicing Dietitians in Australia were female as of 2011 (Australian dietetics workforce in

focus, 2014; Registered Dietitian and Registered Dietitian Nutritionist By Demographics, 2018).

There are differences in pay based on genders in both the United States and Australia. In

Australia, female dietitians make an average of $57,000, while male dietitians make an average

of $55,000 (Average Salary for Certification: APD, 2018). According to Data USA, male

dietitians in the United States made an average of $49,961 in 2015, while female dietitians made

in average of $45,816 (Data USA, 2015). The discrepancy in pay could be due to the national

wage gap the United States faced in 2015: the Census Bureau determined that “women earned

80% of what their male counterparts earned in 2015 when looking at full-time, year-round

workers only” (Brown and Patten, 2017).

Summary

When analyzing the roles of dietitians in the United States and Australia, it was apparent

that their scopes of practices and education have striking similarities. However, one notable

difference is that the United States varies the process of licensure by state, while in Australia,

dietitians only need to apply through the DAA to be a licensed APD. In both the United States

and Australia, female dietitians are significantly more prevalent than male, and pay discrepancies
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exist amongst the genders. Overall, much overlap is present in the dietetics professions in the

United States and Australia.

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