A message from the ADA President Judith A. Gilbride

Message from ADA President Judith A. Gilbride (12/05/2006)

Roles and responsibilities of registered dietitians (RDs) and dietetic technicians, registered (DTRs)

December 5, 2006

TO:  ADA Members

FROM:  ADA President Judith A. Gilbride, PhD, RD, FADA

This is to inform you of the recent decisions by ADA’s Board of Directors regarding the important — and distinct — roles and responsibilities of registered dietitians (RDs) and dietetic technicians, registered (DTRs), as well as dietetics licensure. In response to a number of recent events, the Board has addressed questions raised by federal regulators about what constitutes "supervision"; the appropriate qualifications for dietitians in renal practice facilities; and issues relating to the licensure of DTRs.

At its November meeting, the Board approved two motions that are consistent with ADA’s long history of commitment to advancing dietetics and promoting ADA members as the preferred providers of food and nutrition services. In its decisions, the Board:

  • Affirmed the stance that ADA supports licensure of registered dietitians. Given the RD’s defined supervisory role in patient treatment, licensure of the RD automatically incorporates care provided by the DTR, eliminating the need for separate licensure of DTRs.
  • Directs appropriate ADA units to formulate a clear and precise definition of the term "supervision" as it applies to the Scope of Dietetics Practice Framework’s Standards of Practice for the RD and for the DTR and to revise these documents for accuracy and consistency with federal regulations and national standards.

ADA was compelled to review non-RD standards of practice after officials at the Centers for Medicare & Medicaid Services (CMS) highlighted an interpretative guideline describing minimum requirements for the "qualified dietitian" to provide direct patient services in end-stage renal disease (ESRD) facilities. The application of that guideline raised questions about appropriate supervisory roles and responsibilities of RDs working with students/interns and DTRs in all regulated health-care facility settings. Other health-care professions and healthcare accrediting organizations also have initiated reviews and clarifications of what "supervision" means for their standards.

The Board’s action means ADA will maintain its commitment to seek sound state dietetics licensure laws and regulations.

For four decades, ADA has supported affiliates seeking RD licensure to protect the safety and welfare of the public. Effective dietetics licensure laws ensure that consumers can rely upon the competency and accountability of practitioners. Licensure accurately conveys RDs’ specialized background, knowledge and skills to physicians who make referrals to facilities that hire RDs; to individuals seeking nutrition therapies, and to facilities that provide direct patient care. Licensure assures that each of these groups can be confident they are working with the recognized professionals qualified to provide specific care and services.

ADA’s Board of Directors created a Practice Definitions Task Force in 2002 to compile, define and update key tenets of dietetics practice. In response to the task force recommendation in 2003, the Board approved ADA’s position that the DTR works under the supervision of the RD. Accordingly, ADA’s Standards of Practice in Nutrition Care for DTRs, approved by the House of Delegates in 2004, also explicitly state that the RD supervises the DTR in the clinical setting.

ADA has worked to distinguish the RD from other recognized health professionals — such as nurses and chiropractors, as well as those self-proclaimed "nutritionists" and others with little or no training — who might provide nutrition care and services. ADA’s Legislative and Public Policy Committee has cautioned against any stances taken by our Association and its affiliates that would create confusion about the respective roles of dietetics practitioners and more specifically against any measures that suggest DTRs may independently perform the professional level of clinical tasks for which RDs are uniquely qualified. ADA has received reports from members from three states whose institutions have been cited for assigning the task of nutrition assessment to DTRs who work in technical capacities.

ADA’s public policy stances on licensure will continue to reflect the Board’s position that RD licensure incorporates coverage of the DTR and eliminates the need for separate licensure of DTRs. ADA units have started the work of defining supervision and of bringing the scope of dietetics practice framework’s standards of practice documents into compliance with federal regulations and national standards governing roles and responsibilities.

If you have any questions about these decisions by ADA’s Board of Directors, please contact me at ADApresident@eatright.org.

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