Thanks for joining us for episode 76 of The Ancestral RD podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show.
Today we are answering the following question from a listener:
“I am looking into various courses of study to become a functional medicine practitioner. I’ve only completed my undergrad and I have all options before me. I plan to get a Master’s Degree in Nutrition and become a Registered Dietician. However, I’ve been told that RDs are limited in their capacity to be functional medicine practitioners because they can’t order all the labs necessary for that kind of treatment model.
I’m curious how you make that work in your practice. Do you feel like being an RD limits your capacity to fully incorporate functional and ancestral medicine treatments? If an RD is not a good path to becoming a functional medicine practitioner, what course would you recommend that isn’t full on medical school? I would like to have a private practice, so I would need to be able to order and interpret labs. Is there a faster path to that status than an MD program?”
Functional medicine is steadily gaining attention in its ability to address the complicated health care concerns of our modern society. If you’re wondering what path to take to become a functional medicine practitioner, you won’t want to miss today’s podcast!
There is no singular, straight and narrow route to a career in functional medicine. Through our personal experience and insight, we discuss important considerations when choosing a career path and discuss pros and cons of the scope of practice of different types of practitioners. Listen now and come away with a reflective mindset that will help you navigate your own unique career path.
Here’s what Laura and Kelsey will be discussing in this episode:
- Laura and Kelsey’s experience with the benefits of being an RD
- Differing levels of responsibility and scope of practice between various health care practitioners
- The difference in training between various health practitioners
- The importance of understanding what aspect of the medical system you enjoy when chosing an advanced degree program
- The significant role nutrition and lifestyle play in helping people recover from illness
- Why the location and type of practice are important factors in choosing a career path
- Why flexibility is beneficial during your education and career
- The value in career counseling
- Etiquette tips in approaching practitioners for career counseling
- The importance of considering the level of liability and risk you are comfortable with in choosing a career path
- This episode is sponsored by SunBasket.com. Receive $30 off your first order here!
- Join Kelsey’s mailing list at HealthyGutHealthyLife.com for updates about her upcoming gut health program.
Laura: Hi everyone. Welcome to episode 76 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always is Kelsey Kinney.
Kelsey: Hey guys.
Laura: Kelsey, I noticed on Facebook the other day that you were putting out a request to your readers for maybe input or questions to ask to help you design an online program about gut health. It sounds like you’re going to be having an individual group program for yourself getting created in the next couple of months.
Kelsey: Yeah. I’ve been thinking about this for probably over a year and a half now and just been too busy to kind of get to it. I’m excited to finally feel like I have a little time to devote to making this actually happen now. But essentially, I’m in the very beginning stages currently of deciding what want to go in the program, and really that’s going to be based on what I hear from people in my audience and stuff. If you’re on my mailing list, look out for probably some surveys and stuff coming soon because I really want to know what you guys want to learn about gut health and what you’re struggling with.
But essentially, the point of the program is to help people kind of walk through the process that I walk through with my one on one clients where I’m kind of figuring out if there might be some kind of underlying infections, maybe doing some sort of antimicrobial protocol, removing gut irritating foods, talking about and really implementing things to help soothe the gut/brain axis because you’re brain and your gut are really connected very intimately. I think that’s a thing that a lot of people forget a lot of times or just don’t really put things into their programs or protocols that deal with that gut/brain connection.
And then we will talk about supplements where we might again do an antimicrobial kind of thing depending on questionnaire answers or something like that. I’m a little confused as to how I want to incorporate maybe some antimicrobials into the program. But for me personally, when I ask myself do I think there is a reason to not recommend an antimicrobial protocol even if we don’t have testing for someone? Honestly, the answer is no as long as it’s a short term thing, and someone’s not on it for a long time, and of course they’re not taking other medications or something that would prohibit them from taking that kind of stuff, and they talk it over with their doctor. But honestly, I think that’s okay. I don’t think you necessarily need to have the testing to try that out if you have a lot of gut symptoms that are really bothering you in your life. I’m probably including an antimicrobial protocol that people can try as long as they talk it over with their doctor.
We’ll talk about probiotics, prebiotics, digestive aids like digestive enzymes, bitters, that kind of stuff, and then things that will heal the gut tissue as well. After you kind of cleared out bacteria, we want to really soothe inflammation in the gut and that really helps to speed along the healing process in terms of the symptoms someone is experiencing on a day to day basis.
And then of course we’ll go through diet. We’ll kind of take out foods that might be irritating, and then add foods back in that are particularly healing later on in the program, and talk about variety which we’ve discussed a lot in our podcast and how important that is for gut health and how you can incorporate that into your day to day diet. And then how to talk to your doctor about some of these infections that you might find on the testing that I will recommend, and just moving forward from there. Maybe you’re revisiting the program if you ever get some gut symptoms or if you just want to do like a cleanse and refresh of your gut maybe once a year or something.
I think it’ll be pretty comprehensive and it probably will be somewhere between 7 and 8 weeks I think how I have it set up currently. I’m hoping people will really enjoy it. I think it’s a good thing to have in your tool box especially if you can’t work one on one with a practitioner for any reason. If you don’t want to work over the phone with someone, and there’s nobody in your area, or if you can’t afford to work one on one with someone, I think a program like this could be really useful to help you feel better without needing to work one on one.
Laura: Mm hmm. Are you going to have this be available all the time, or are you going to have groups go through it like we do with “Paleo Rehab”?
Kelsey: It’ll probably have groups go through it maybe like twice a year or something. That’s my plan so far. For me, I just like doing it that way a little bit better personally because I feel like I can be there a little more intensely rather than feeling like I always need to be answering questions throughout the year which is a little harder to accomplish. I kind of just feel like people would get a bit more personalized attention in a program that does a class a few times a year. That’s my plan currently, but these things evolve over time, so we’ll see.
Laura: Yeah, I mean it’s one of those things where it’s nice to have a group of people go through it together.
Laura: I’ve been a participant in a group like that and it’s nice to be able to talk to people and stuff. But on the other hand, one thing we’ve noticed with the “Paleo Rehab” program is obviously people hear about it, and maybe they’ll hear us talk about it, or they’ll listen to a podcast from a couple months ago, and they’ll say oh this sounds great, this is something I want to do. Then they go to sign up and it’s like oh we’re not doing it until months from now.
Kelsey: Mm hmm.
Laura: It’s tough because it’s like on one hand you want to help people and provide the assistance that they need when they need it. But on the other hand, it can be like you said, a little challenging to give as much attention to people if you’re doing it year round.
Laura: It definitely depends on what the vibe of the program is that you want to do. I guess that’s the nice thing about those programs like we’ve experienced with the “Paleo Rehab” is that there’s always the possibility of changing it to something that’s just available year round.
Laura: Are you going to create it all at once and then launch it? Or are you going to create part of it and then keep creating it as it is in session? I guess that’s a strategy that I’ve heard recommended before.
Kelsey: Yeah. I’m probably going to create it at least most of it. I’ll likely do a beta group for reduced pricing for some people and they can give me any feedback they have about it and what content maybe they felt was missing and I can add stuff at that point. Of course they would have access to that going forward. I think that’s a good strategy to use because I mean I get a little frightened doing a program if it’s not all created.
Laura: Mm hmm.
Kelsey: Or at least I don’t have a very good idea of what I want to include with it. So right now, I have a pretty good idea of what I want included. It’s just that missing element of sometimes as a practitioner you can’t see things from the other side as easily. I do like to hear from people directly about what they’re curious about or what they are struggling with. Maybe they’ve done some programs like this before, but they didn’t feel like they got what they wanted out of it, so what they felt was missing from those programs. That’s all really useful information for me to make the best program out there for people who need to heal from digestive conditions.
Laura: Mm hmm.
Kelsey: I plan to do a beta. I’m not sure when that will happen. It will probably be pretty small too, like a limited amount of people that can join. Again, I’m probably going to send out some surveys though my mailing list. If you guys aren’t already on my mailing list, you can join that at HealthyGutHealthyLife.com. I’ll send out some surveys, I will let you know when the beta is open if you want to join that, and we’ll go from there.
Laura: Cool. Well it sounds exciting and like you said, you’ve been contemplating it for a long time and I know we’ve talked about what you’re hoping to do. And with your wedding and all that, I’m sure that kind of took the attention away from the business for a while.
Kelsey: For sure.
Laura: Now that you’re married, you’ll probably have more free time to plan this. I’ll be excited to see what you come up with.
Kelsey: Yeah, cool.
Laura: Awesome. Well, before we get into our discussion today, let’s hear a word from our sponsor:
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Laura: Today we have a little bit of a different question than usual. We often are talking about health specific recommendations and talking to people about their health issues that they’re dealing and how to fix those. But every now and then we get questions from people who want to know how to become either a functional medicine practitioner or an ancestral type of nutritionist, dietician, that kind of thing. I know I get emails pretty frequently from people wanting to know how to do what we do, which I think you and I, Kelsey, have had kind of like a circuitous route to get to where we are.
Kelsey: Mm hmm.
Laura: It’s not like there was some grand plan that we had going into school being like, first we’re going to do this, and then we’re going to do that. I think working for Chris Kresser was a huge component of developing our skills and also just figuring out how to do what we want to do. That’s unfortunately an experience that’s difficult, if not impossible, to replicate.
Laura: When people say how did you get trained or whatever. I’m like, well, it helps that I was working for Chris for so long. There’s some things that aren’t really easy for us to share advice on because of our circumstances. But there are a lot of things that we’ve done on our own that we have experience with and can help guide people who are looking to pursue a career either similar to ours, or if they have an idea of what kind of career they have and they’re not sure what the next step should be, we can help them with that. But this question we have today is definitely more along those lines.
Laura: This person asks:
“I am looking into various courses of study to become a functional medicine practitioner. I’ve only completed my undergrad and I have all options before me. I plan to get a Master’s Degree in Nutrition and become a registered dietician. However, I’ve been told that RDs are limited in their capacity to be functional medicine practitioners because they can’t order all the labs necessary for that kind of treatment model. I’m curious how you make that work in your practice. Do you feel like being an RD limits your capacity to fully incorporate functional and ancestral medicine treatments? If an RD is not a good path to becoming a functional medicine practitioner, what course would you recommend that isn’t full on medical school? I would like to have a private practice, so I would need to be able to order and interpret labs. Is there a faster path to that status than an MD program?”
Kelsey: Such a good question.
Kelsey: I feel like I get something similar to this kind of question a lot too because people have, like this person, either finished their undergrad or maybe they’re like part way through their undergrad considering changing course, or prepping within their undergrad for what kind of professional degree or certification that want to get after they’re done. I think it’s a really good question, and honestly I think it’s changing a little bit with how we’re able to provide either medical care or medical/nutrition therapy, anything like that. I think it’s a really good question and it’s a smart thing to consider, especially like this person says he or she has all their options in front of them.
Laura: Mm hmm.
Kelsey: They want to choose the right path and I think that’s a really smart way to look to look at it. For me personally, and I think about this fairly often, I wonder if I should have gone a different route to provide the kind of care that I want to. Every time I think about it, I can honestly say that I am very glad with the way that I did things and I wouldn’t change it.
Like I said, I have people ask me a similar question to this often and sometimes I’ll say well you can consider becoming a nurse practitioner because you have a lot of flexibility and leeway with the kind of care that you can provide. It’s very similar to a medical doctor in that sense. But it is still a lot of schooling that you have to go through. Depending on the kind of care that you want to provide, that may not be worth it. For me, every time I think about that, I don’t think it would have been worth it for me to do.
Laura: Also you do have to think about the schooling to become a nurse practitioner, you do have to be a nurse first.
Laura: For me, dealing with bodily fluids, not worth it. I wouldn’t have been able to handle it.
Kelsey: No, and I am the same way. I get freaked out when I get my own blood drawn. I think that you have to think about what kind of practitioner you want to be. For me, and I think it’s probably a little bit similar for you, Laura, I didn’t want to get really, really deep into the medical treatment side of things because I think there’s so much that can be done from a nutrition and lifestyle focus.
I think to a lot of people, that can seem really basic and like well you can’t do what you need to do if you’re only dealing with nutrition and lifestyle. But I think incorporating supplements into that, I think you can do a whole lot actually. Like I was talking about in the intro to this, I work with a lot of gut patients, and that’s why I’m creating a gut program, and I do think an antimicrobial protocol with a lot of my patients. Or I even just counsel them through talking with their doctor if they have a SIBO test that comes back positive because a lot of times their doctor has no idea what that is or what to do about it.
Laura: Mm hmm.
Kelsey: I feel like you can still do so, so much as an RD. And that’s often what I am doing, walking through okay, here’s a study to bring to your doctor about Rifaximin and how that’s used in SIBO cases. They’ll often come back to me and say, wow, that worked really well. They just took that study, they just prescribed exactly what they prescribed in the study, and it worked out perfectly. They just need that help to be able to talk to their doctor about it and get the treatment that they need.
Kelsey: To me, that’s much more interesting too, to be able to do that rather than be a doctor who’s so busy in their everyday practice that I don’t even have time to keep up with the research and know what SIBO is.
Laura: Yeah, I can’t even tell you how many people I’ve recommended go get a SIBO test done that none of their doctors had thought to do that.
Kelsey: Mm hmm.
Laura: I’m not trying to brag or anything. Literally I can’t remember if this 100% true or not, but I think it is, but I actually do think I have 100% success rate with getting people tested and them being positive for SIBO.
Laura: It’s so obvious when people have the symptoms that you’re like, well clearly this is something that should get tested. Every time I’ve recommended it, the person got tested positive. I’d say at least 50% of those people that I’ve worked with, their doctors did the pharmaceutical treatment and they got a lot better from it.
Laura: I had a client recently who she had a lot of different gut issues. She had a Blastocystis hominis infection at one point and she also had post infectious IBS from a trip to either Asia, or Mexico, or something like that where she got some kind of bug from, I think she had Giardia from that.
Laura: She had seen infectious disease specialists, gastroenterologists, and she still had all these symptoms and she couldn’t figure out what was going on. I was like well, has anyone tested you for SIBO? And she hadn’t even heard of it before.
Laura: She ended up getting tested and it was really like one of the highest hydrogen levels that I’ve ever seen in a test. Her doctor put her on the antimicrobials and she’s already feeling a lot better. She’s not 100% better because we’ve only been working together recently. She’s really, really grateful for having had my guidance. Because obviously I didn’t order the test, I didn’t order any of the treatment, I didn’t do any of the actual treating part, but like you were saying, being able to be like an advocate for your patient and be able to be like here’s what you should do, here’s’ what you should ask for, here’s the evidence that you need, and allow them to go get that work done from someone who is a functional doctor or even just a normal gastroenterologist who can order that kind of test and those kind of treatments, you’re still ultimately the one that is helping them, but not in an extreme direct way.
Laura: But it weren’t for you, they maybe would have never gotten that test done. I know that you and I have a little bit of a different focus and approach with our patients. I tend to do more coaching, and disordered eating kind of stuff, and psychology and that kind of thing, but there is a level of testing and supplementation recommendations that I’ll make as well. But I actually really like not being the one that has to do the testing, and do the medical treatments, and that kind of stuff because I feel like that’s a level of responsibility that I don’t really want to have.
Kelsey: Mm hmm.
Laura: Like you were saying before, if you’re a doctor, most doctors don’t have the time to do the counseling piece with people.
Laura: I was a psychology undergrad major and I thought I wanted to do either clinical psychology or research or something for social psychology, that kind of thing. For me, being an RD doesn’t affect my ability to coach at all. And honestly, I feel like with coaching and that kind of stuff, I don’t think there’s any technical requirement for what kind of degree you have to have. I think understanding what aspect of the medical system that you enjoy and making sure that whatever degree you pursue is going to give you the opportunity to do that.
For me, counseling and having a relationship with my patient where I can guide them through any sort of conversations, which lately have gotten quite out of the scope of nutrition. We’re talking about relationships, or career changes, or just doing a lot of that more life coaching kind of stuff which is kind of stuff to mix in there. But being able to have that level of interaction with my clients and not worry, oh we only have 15 minutes, I have to go through all this stuff real fast.
Laura: If there is medical stuff needing to be done, like I just said a few minutes ago, I can say here’s what I would do, go to your doctor and ask for this test. Or if there’s a test that they can order online for themselves, I’ll give them the resources that they need and say either ask your doctor for it, or here’s a website that you can order your own labs if you want to.
I don’t have the level of access to different functional lab testing that other types of clinicians might have, but ultimately that doesn’t really excite me to do that kind of work anymore. I used to do a lot more of it when I first started, but I feel like the coaching aspect has gotten way more interesting to me. The number of clients that I’ve seen come to me that have already been working with functional doctors that they didn’t really get the health improvements they were looking for until they got the lifestyle and mindset piece locked in as well, it just makes me feel like the work that we do is just as important as the work that the functional doctors are doing who are doing the testing, and medications, and treatments, and that kind of thing.
Kelsey: Oh yeah. I think we work a tiny bit differently in the sense that I will order a SIBO test for a patient or I will order a DUTCH test, which I assume you do too.
Laura: Yeah, I think DUTCH testing is the only test I really order myself.
Laura: Everything else I help them find someone else to order it.
Kelsey: Yeah. Those are like the two main ones that I do. Though with the SIBO test because it is becoming more mainstream to be able to get that in a doctor’s office, and when you get it in a doctor’s office it’s covered by their insurance, I will recommend that as a first approach. It’s only if somebody can’t get that through a doctor nearby that I’ll end up order that for them.
Laura: Yeah, one of the reasons I like to have a doctor order it…sorry, I’m still a little sick from the last time we had a conversation. But I also like when they can find a doctor to order it beyond the cost is the treatment options are broader.
Kelsey: Oh yeah.
Laura: If you get it through a GI doctor, I’m not saying that medication is the preferred treatment, but I have had some clients where the antimicrobials didn’t really work and the pharmaceuticals did work better. So I like having somebody, they have the option of doing pharmaceutical treatment if they go through a doctor to order it.
Laura: For me, I like people having options. If you order it yourself, then if they needed something like Rifaximin, then they’d eventually have to find a doctor anyway.
Laura: Then sometimes they find a doctor that’s like well I didn’t order this test, so I don’t know if I’m going to use it, or it just can get a little complicated.
Kelsey: That’s, again, another reason to just go for the doctor if you can find one who is able to do it. But sometimes people can’t, and then if they have a SIBO test in hand, they can go to a GI doctor and give them the test. Yes, you sometimes get a little bit of that push back with like oh I didn’t order this myself, I don’t know what to do with this. But think with the right counseling and talking to your patient about how to talk to their doctor once they have a result like that makes that whole process a little bit easier. Honestly, I don’t think I’ve ever had push back even from very conventional doctors with my patients with getting Rifaximin, which honestly I’m kind of surprised by.
Kelsey: That’s a great thing. But I agree, and honestly I’ll go as far to say that the pharmeuctical options for SIBO can sometimes be preferable and be the right way to go first for some patients. I talk to my patients about what the options are. And I can’t say things like yeah, you should definitely go on this medication because that’s not my scope of practice, but I can talk to them about what their options are.
I like to think of myself almost like a guide through this process, or like you said, an advocate to help a patient get the right treatment for them and help them make the decisions about their health treatments and things like that because a lot of times at least that I’m hearing from my patients, they’re not having their options explained to them. They’re only given, like if they go to their doctor, they just say okay, this is the antibiotic we’re going to do, no information beyond that. That’s really overwhelming and confusing to patients a lot of times.
I’ve gotten a lot of feedback from many clients saying like I’m so happy to have someone to talk through these decisions with because I just feel really overwhelmed and like I’m not getting enough information from anybody, and honestly I trust you the most to help me make this decision.
Laura: Mm hmm
Kelsey: To me, that’s super fulfilling.
Kelsey: That’s the part that I really, really love about the work that I do because I think that’s a big problem within the conventional medical world right now is that people just aren’t getting the information that they’re looking for when they’re trying to make these really hard and important medical decisions for themselves.
Laura: Yeah. It’s funny, I feel like just the act of talking with the client about their options, and not even giving them a recommendation, but just being a sounding board for them to kind of talk through their thoughts and their concerns, and that kind of stuff. I had a client recently tell me that, it was funny because she was telling me about the testing that she had done and the results, and there was all these really complicated results that personally I was like, I honestly have no idea what the doctor is going to do to fix this.
Laura: But she was explaining to me the decisions she had to make and I was just helping her talk through it. I felt kind of bad because I was like I don’t know if I can really do anything to help her. I don’t know if you’ve ever had this experience, but when someone has like a really complicated medical issue that you’re like, I can’t do anything for this.
Kelsey: Mm hmm.
Laura: I don’t like not being able to help someone when I’m on the phone with them.
Laura: The funny part was at the end of call, she just started thanking me because she was like this is the most valuable appointment I’ve had, I feel so much better now. I was just like, oh okay. I didn’t realize I did anything, but I’m glad you felt like that.
Laura: Because in the back of my mind I was like dang it, now I have to figure out how to make this appointment worth her time because when the first thing she talks about is this complicated medical test that she got done and I’m just like I don’t know what to do with that.
Laura: It just can get a little stressful. But yeah, it’s amazing how much people appreciate being able to talk through things.
Kelsey: Just being heard and listened to, I think.
Laura: Yeah I think with the amount of stuff available online for searching this symptom, or this condition, and that kind of stuff, I honestly feel like there’s so much conflicting information out there. I’m not saying that you and I are completely omniscient, and know everything about all medical issues and have this complete understand about human nutrition because nobody does. Nutrition is not something that is…I don’t think it’s possible to ever have 100% confident perfect knowledge about what people should be eating.
Laura: But I think that we have some ability to wade through the recommendations online and decide if it’s something that is actually going to be helpful or not. Because on one hand, there’s a lot of stuff that people try that there’s not a lot of evidence for, and I’m always hesitant to help someone do a diet that doesn’t have a lot of evidence.
Kelsey: Mm hmm.
Laura: But on the other hand, my goal is to make sure that they’re not going to cause harm to themselves. So if they want to try something, like I had a client the other day that wanted to try the food combining approach, which I don’t necessarily think is super evidence based. But she said that she had felt better when she was doing it, so I was like alright, well that’s enough evidence for me if you feel better doing it.
Laura: Let’s just make sure that you’re not under-eating because that was the main concern I had was if you can’t eat protein, or fruit, or carbs, or whatever together, then how are you supposed to get it all in in a single day without just eating all day? I was willing to help her navigate that in a way that kept her from developing worse health, but also just making sure that she knew that there wasn’t much evidence to support it and from a biochemical perspective it didn’t really make sense to me.
Kelsey: Mm hmm.
Laura: It was just nice because I feel like she had wanted me to give her a very specific plan, but that’s not how I work. I don’t know if that’s how you work where you’re just like, eat this, not that.
Laura: And then go on your way. Sometimes when people are feeling overwhelmed, then can want to be just told what to do. I find that to be really disempowering. So I kept telling her, I was like listen, I really want you to be in charge here. I’m here to help you make decisions, but at the end of the day, I want you to feel like you’re in control and feel like you’re the one that is deciding what to do with the right information.
Laura: Even though that wasn’t exactly what she had wanted when we first started talking, I think by the end of the conversation she definitely appreciated the approach. I think that can be something really cool to do with clients as well is kind of put things back into their hands. Because I think a lot of times when you’re going through some kind of functional medicine practitioner, you kind of just get told okay, here’s the testing to do, once we get those tests results, here’s the supplements to take, here’s your diet plan to follow. There’s not a lot of autonomy in the decision making and that kind of thing.
Obviously that’ll depend on the practitioner, but I’ve had a lot of clients that have come to me where they had worked with someone else and just felt like the person had just like thrown a bunch of things at them and not really explained anything and not really give them the opportunity to make any decisions for themselves. Personally, I think autonomy and health decisions is really, really important and it actually I think impacts the results of the treatment.
Kelsey: Mm hmm.
Laura: Being able to help a person feel like they’re in control of the decisions they’re making, and that they understand why they’re making the decisions, and they feel they have the support they had if they start to question those decisions, I find that to be really rewarding because it just…I don’t know. I think it is an area of medicine in general that isn’t really well dealt with in our current system.
Laura: Being able to help somebody through that is, I really enjoy it.
Kelsey: Yeah. Maybe this is this kind of practitioner this person wants to be, but I honestly hope not. I think I have also have had a lot of patients come to me from “functional medicine practitioners” and they come to me and they’ve got like 20 different lab tests that they’ve done, they have a list of 50 supplements that they’re taking, and they’ve got nothing to show for it.
Kelsey: They don’t feel any better. I think that’s all too common with a lot of functional medicine practitioners now. I think it comes down to time again, too. As an MD, you’re just not spending the same amount of time with your patients unless you have a very special circumstance and you’re practice is set up in a way that really encourages that. But it think it’s just really hard with the medical practice to really get the time that you need even if you’re not taking insurance and things like that supposedly help with the situation. The nutrition, the lifestyle, the autonomy of decisions, all that kind of stuff I think tends to go out the window when you get to that level just from a time perspective.
Laura: Mm hmm.
Kelsey: Like Laura was just saying, that part is just so huge and I honestly feel like that’s what people are looking for even if they don’t know it necessarily. I think people go to a functional medicine practitioner thinking okay, I need to get all these tests done, find the root cause of what’s going on, and fix it. Yes, that’s an important piece of this stuff, but so much of what helps to fix those things that are going on is stuff like diet, is stuff like lifestyle, is making your own decisions and feeling confident with those decisions going forward in your life, not feeling like you’re on some plan that was just prescribed to you and you have to stick with that the rest of your life in order to be healthy that doesn’t fit your lifestyle, it doesn’t make sense for you. All that kind of stuff is really, really important and I do feel like as an RD, I have the time to do that and I’ve set up my practice in a way that I do have that time.
Circling back to this original question here, this person is asking about what options there are to be a functional medicine practitioner other than an RD or if an RD is not a good path. But I’d say yes, an RD is definitely a good path to take if you want to do this kind of stuff. You can still order tests depending on what state you live in, whether or not you have an in-person practice. For me, I live in New York, but since my practice is online and I have some other addresses I can use for some labs, I can order most testing, whereas if I had an in-person practice here, I would basically be able to order nothing. It really depends on where you live as well as whether or not you have an in-person practice. But for the most part, even as an RD you can order most of the testing, or at least the majority of what you would need to have successful outcomes with your clients.
Then beyond that, I would say probably the only other thing other than going full on MD, would be to consider the nurse practitioner route if you want to do private practice. Again that’s more time, it’s obviously different training than you would get as an RD. You’re not going to get, as far as I know, much nutrition training at all. It’s going to be very medical focused still. It really depends on what you want to learn in your program and how you want to practice once you’re done with schooling.
Laura: Mm hmm.
Kelsey: I think RD, NP is good. If you didn’t want to do private practice and you were willing to work with a doctor, you could do physician’s assistant potentially. But all of these things have different requirements for amount of time in school, the different type of schooling. It really just depends on what you want and what you hope to do in the future.
Laura: One thing to remember, I don’t know how old this person is, but they do say they’ve only completed their undergrad, so I guess hypothetically they could be at any age. But say you’re like 24 or something, or like mid 20s where you just got out of school and you’re not really sure what you want to do. One thing that my experience was when I was going through school is that you don’t necessarily know what you want to do when you’re starting a program. You kind of just have to make the best decision possible and then be willing to be flexible if things change. Maybe you go through a dietician program and then you realize like I don’t really like counseling and I want to do more medical type work, then there’s the option of doing either, like you said, the nurse practitioner.
This doesn’t really help this person, but we were talking earlier before we got on the call about a physican assistant program which is a lot shorter than an MD program and you can still do a lot of the same things, you just need to work under an MD. If you’re okay to work under somebody, than that’s a good option too. But a lot of times you don’t know what you like and what you don’t like until you’ve actually done it.
Kelsey: Mm hmm.
Laura: To think that you can figure out exactly the perfect type of degree to get for what you want to do, it can be really hard unless you have a very, very specific goal in mind for what kind of work you want to do. Just remember it’s okay to be flexible. It’s not ideal to have to get more degrees than what you were planning on and it would be great to get the degree that allows you to do what you want to do right away, but just remembering that things may change, you may be a dietician for a while and then want to do something else. I know, Kelsey, you mentioned going back to grad school for another degree.
Kelsey: Mm hmm.
Laura: Personally, I don’t think I could…I don’t know we’ll see. I guess I still have time, but the thought of going back to school is completely unappealing to me. But that’s one of those things that maybe you work as an RD for a while and you say I like this, but maybe there’s another level I can take this to or another degree that I can get that changes my scope of practice.
Laura: Just remembering that it’s okay to not be totally sure about what you want to do, about if the path is the right one to be on, because you may find that you do a ton of research and you do this program and you’re like okay, this isn’t what I thought, I don’t enjoy this as much as I thought I was going to be. Or you are like, well this seems like the right approach, I’m not really sure, but let’s just try it. And then you have experience during that program that wow, I didn’t realize that I was going to like that, so let me actually kind of go that direction.
Just remembering to stay open minded and not worrying that you’re wasting time or effort. Because even if you did the RD degree first, and then you ended up doing something like a PA or a nurse practitioner schooling or something, the cool thing is you have all this extra knowledge about food that once you became something like an NP, you could talk to clients about that and say well I’m also an RD so I have this knowledge about food, and nutritional biochemistry, and all that, and then I also have the capacity to order medication and that kind of thing.
Kelsey: Mm hmm.
Laura: I don’t think there’s any wasted education.
Laura: It’s just remembering that there may be things that you like doing, that you can’t do from that program and you might have to switch gears or add another degree. Or you may end up doing something that you would have never though you would like and then you end up following a career path that wasn’t your plan, but ends up being a better fit for you.
Kelsey: Mm hmm.
Laura: That’s my little spheal about flexibility and not thinking you have to have everything figured out from day one when you are choosing to go to any sort of advanced degree program.
Kelsey: Yeah. I think that’s huge because even like within our own practices that we’ve been doing thus far, I think we’ve both sort of changed the way we think about things, how we counsel people, what things we focus on with our clients. That stuff is always going to change, and if it ever changes in such a major way that you have to get some other degree or professional certification, that’s okay. Like Laura said, no knowledge is wasted. You’re always going to be able to use the things that you learned in another program no matter how advanced you get. So keep that in mind.
Then the other thing to consider too is if you can shadow or intern with any practices that you think maybe model the way you would like to run your own practice, I think that’s really, really valuable.
Laura: Mm hmm.
Kelsey: Then for more online practices like what Laura and I have, listening to podcasts like this, asking questions like this to people who are willing to give an answer, I think that can tell you a lot about how that works and you decide if that sounds good to you at least for now. And if it does, great, go down the RD road. And if it doesn’t, if everything we talked about today sounds boring or not what you want to do, then maybe yeah, an MD or an NP program is probably the better fit for you at least for now.
Laura: It’s tough. It’s one of things that, I don’t know, when I went into my program, I think I had a general idea of what I wanted to do. Like you said, our understanding of how to work with clients has changed, and even just personally my understanding of what I am passionate has changed.
Kelsey: Mm hmm.
Laura: I think what I’m doing now is not what I thought I’d be doing, which isn’t a bad thing. It’s just different.
Laura: I may be doing something totally different in the next couple years. I think being flexible and like you said, experiencing a lot of different things and maybe either shadowing, or interning, or interviewing someone if there’s a practitioner that you really admire and like what they do and you want to interview them, maybe spend the money to do some kind of career counseling with them. Because if that saves you 3 years of grad or school or something because you talked with someone that has the job that you want and they advise you against doing something, then investing now in some amount of career counseling from practitioners that you admire is a good investment because it’ll improve your ability to make a good decision for your advance degree. A couple hundred dollars in the grand scheme of graduate degrees is pretty low.
Kelsey: Yeah, for sure.
Laura: So not being afraid to make that investment if there’s people you do really want to get more nitty gritty details with. I’ll get emails from people who are like oh I’m a student and I want to get coffee with you and talk about your job, and I’m just like I don’t have time to do that.
Kelsey: Right, sorry.
Laura: I’m sorry, I don’t just go get coffee with people for fun. I do that with my friends.
Laura: But I’m not going to make my friends pay to talk to me, that’s ridiculous. But as far as just somebody that you don’t know, and maybe this is like a word of caution. I’m not saying I’m like the kind of person that would be offended by it, but you have to be careful if you’re contacting practitioners that you want to talk to or work with about just being like oh I want to interview you and like not mention that you’re willing to either pay them for their services or being respectful of their time. Because I have gotten a few emails that were just like is there a time that I can call and we can talk? Then I mention what my rates are for career counseling, and then the person is just like, oh I didn’t think I would have to pay for it.
I think it’s really bad form to not assume that if you…I mean if it’s someone who, I don’t know, I’m trying to think of someone who would actually not be kind of like a little hesitant to go meet with people for free unless they’re like an actually professor or if they have a job where they just get paid no matter how much time they spend. If you are going to contact practitioners, especially any that are virtually based and do calls for their clients, I would not only assume that you’ll have to pay for it, but I would even offer to pay for it.
Laura: I think that’s going to actually improve your chances of getting a response back. I think it’s a lot more respectful of their time to know that okay, I would have to pay for this. Maybe not how much you’d have to pay if you were a patient.
Laura: But I don’t know. That’s a little bit of a tangent, but I think if somebody is wanting to get in touch with practitioners, that is something that can help them get off to the right foot if they do want to have a more one on one type of experience with that person for career counseling.
Kelsey: Yeah, I totally agree. Honestly it’s not something that I would have thought of as an undergrad or even a little bit after. Being on the other end of that now, it’s like so obvious like why would I think that these people would have time for me to just like call them for an hour for free? I do think that it’s important to expect that. Yeah, expect it basically and if you get a particularly generous person who has the time to be able to offer that for free or that’s something that they really just want to do personally, great. But I would say for the most part, especially for people like Laura and I who have a virtual practice and are doing these calls for our clients, yeah, I would expect to have a rate that’s a little bit below what they’re charging for clients. But you are taking their time and hopefully they’re providing you a lot of information and help. Like Laura said, it’s a good investment if it saves you 3 years or so of grad school and you go down a better path for you to begin with.
Laura: Mm hmm.
Kelsey: So just consider it an investment, or ask questions like this to podcasts of people that you admire where you can get a little bit more general information for free.
Laura: Yeah. One thing to remember is that say you have a couple career counseling calls with someone who has a position that you think you would like, you don’t know what kind of relationship that can spark down the road. If you get a good rapport with that person, maybe they’ll offer you an internship position or even offer almost like an apprenticeship or something. If there is someone that you really want to work with or really want to have the same kind of career as to get off to the right foot and invest in that career counseling with that person if they do offer it. Now they may not, and ome people just don’t do that at all.
Kelsey: Mm hmm.
Laura: But there’s been a couple of people I’ve talked to that we did discuss potentially some interning and that kind of thing. I haven’t had an intern yet, but I’m definitely looking at potentially getting one in the next couple months. We’ll see. But it’s one of those things that if you make a good impression and you value the person’s time by offering to pay them for their time, you don’t know if that might turn into something where they’re giving your either free help or allowing you to work with them.
Laura: Because the respect factor I think makes at least me, it makes me much more interested in helping that person than if they’re just emailing me and being like can we talk? I want to talk to you about your job.
Laura: I’m like, I don’t know you, I don’t have time. I’m sorry.
Kelsey: Yeah. I know. I’m the same way.
Laura: Yeah. It’s just good etiquette, and honestly even if it wasn’t an etiquette piece, I think it just increases your chances of getting better and more useful information from that person if you’re making it an official career counseling interaction as opposed to just trying to email them.
Kelsey: Yeah. Well, good. I think just to overview kind of what we’ve talked about real quick, first of all, good for you for thinking about this question now. You’re basically in the perfect spot to make these kinds of decisions. Basically, at least for what I would recommend as the two best options for what you’re trying to do probably would be to become a dietitian or to become a nurse practitioner. Because again, if you’re in private practice you really can’t be a physician’s assistant because you have to work under a doctor. But if there’s anybody out there who is fine with that, that would be another great option to consider and that’s a lot less schooling than becoming a nurse practitioner.
Laura: Mm hmm.
Kelsey: And then it depends on what kind of counseling or treatment options you want to have available to you. I’d say the biggest difference between an NP and an RD is obviously being able to prescribe medication. For me, that’s not something I care about. I’m happy to send my patients or my clients to a doctor or a nurse practitioner to do that kind of stuff. Then obviously there is the MD route, but that’s a lot of extra time that you have to spend for potentially not offering way more flexibility, or way more treatment options than you would be able to do as an NP.
Laura: Mm hmm.
Kelsey: It depends on what you feel like you want to have as your professional certification. The only other thing I’ll mention from a doctor’s perspective that I feel like I’ve kind of seen within the Facebook group for Chris Kresser’s ADAPT program is people with higher degrees like being an MD, I think they almost have a little bit more trouble incorporating some of these functional medicine treatments and even some of the lab tests just because they’re really worried about the liability of being a doctor because there’s nobody above them basically. If something goes wrong, they’re in trouble if a person wants to come after them. I think they tend to be a lot more hesitant because of that.
If that’s if something that freaks you out too, you don’t want that responsibility of being that last person that prescribes stuff or okay’s stuff for your patients, I would really consider that if you’re thinking about an MD career as well.
Laura: Yeah, it’ll be interesting to see what happens with that over time because on one hand, it seems like this kind of stuff is getting more popular. But on the other hand, various legality and insurance issues can limit doctors just as much as RDs are limited.
Laura: It’s kind of not good, but we’ll see what happens because I mean I think you and I kind of have found a level of work that we feel comfortable with where we’re not doing anything super risky.
Laura: Which when you’re an RD and counseling, that’s another reason why I really like counseling is that I have this technique called motivational interviewing that I got trained in that I can do that all day and I literally am not making recommendations using that.
Kelsey: Mm hmm.
Laura: It’s more helping them make the decisions that they want to make. The liability risk of that is really, really low. If you aren’t actually telling someone to do something and you’re just helping them figure it out on their own, there is no liability because they made the decision for themself.
Laura: For me, that counseling, and coaching, and motivational interviewing stuff makes me feel like I can really help people without having a lot of concern about liability because I’m not prescribing a treatment for them that could potentially go wrong.
Laura: That’s just my experience. Some people may not feel that way. Some people are more or less risk adverse. It just depends on what your level of comfort is. For me, I like minimizing my liability and maximizing my ability to help someone without actually making them do anything thing that involves any sort of risk.
Kelsey: Right. I agree. Yeah, that’s another thing to consider, level of responsibility and risk that you would like to take on because I think at least now within the functional medicine world, that’s something that surely needs to be considered with the path that you choose.
Laura: Yeah. I think we could probably talk about this for a really long time.
Kelsey: Yes. I think so too.
Laura: Yeah, I think being in Chris’ practitioner training program and seeing the kind of things that people talk about is interesting, just seeing different degrees that come into it and seeing the kind of discussions they have. Sometimes I’ll be a little surprised to see the kind of level of treatment that certain degrees are doing just because I’m like, wow, I wouldn’t have thought that person would be doing that, but okay, cool.
Laura: It’s amazing the number of different approaches that you can take to kind of get to the same end point.
Kelsey: Right. Obviously like Chris himself is an acupuncturist. So again, depending on where you live, in California him being an acupuncturist he can do all this kind of stuff. Again, really depends on where you live, what kind of practice you have, what the scope of practice is within the state that you are practicing in. There’s like so many different variables, which of course makes it incredibly confusing. But if you wanted to go down a route like that, like an acupuncturist, or I’m trying to think of another, or a chiropractor, those are options too. But again, probably matters a lot more where you live in that case.
Laura: Anyway, hopefully this was helpful. If you guys have any follow up questions to this career type of conversation in general, Kelsey and I have had weirdly similar but also different experiences. I think our schooling was fairly different at least in grad school, but we obviously both worked for Chis and then we both did some of the same business school training, that kind of thing.
Kelsey: Mm hmm.
Laura: Even though we’ve had different experiences and also have different practices and different approaches, we also have a lot of the same kind of insight to what it looks like to have a career in…I was mentioning to Kelsey, I don’t like calling it functional medicine so I personally don’t consider what I do to be medicine at all.
Kelsey: Mm hmm.
Laura: But just like having that functional approach to health and working from like a deeper level than the average healthcare practitioner would be working from, I think we both really like where we’ve landed at this point. It doesn’t necessarily require the level of either intensity or duration of schooling that you might think you have to go through to do what you want to do. Feel free to ask us more questions about this. But otherwise, hopefully you enjoyed the episode today and we will look forward to having you guys here next week.
Kelsey: Alright. Take care, Laura.
Laura: You too, Kelsey.