I feel as if the clock has been turned back about 20 years when the profession of dietetics was hard at work lobbying for licensure state by state. Dietitians used OTs and PTs as their model professions back then in many states when licensure was the big push. These are simply my observations and I hope that other RDs chime in with exceptions, corrections, etc.
RDs are credentialed at the national level through the Commission on Dietetic Registration, CDR, a separate entity from the American Dietetic Association, or ADA. This is very similar to the way that IBCLCs are credentialed by IBLCE but are encouraged to be members of ILCA. For RDs, licensure is done at the state level, most typically through the equivalent of the Health Occupations Credentialing Office. Licensure is *not* the same as registration for dietitians. It defines the scope of practice and carries with it legal implications for those practicing dietetics without a license, if that makes sense. Registered dietitians may or may not choose to be licensed dietitians and there are some exceptions in some licensure laws about non-RDs being licensed as dietitians. It gets very confusing if you haven't figure that out!
Although licensure was billed in the beginning as "protection of the public", reimbursement was also part of the big push behind the scene, IMHO. While some RDs are being reimbursed, many (dare I say "most"?) are not. Insurance companies seem to hold that control. (Don't get me going about insurance coverage for cardiac rehab but no coverage for nutritition education/prevenntion for those at risk for cardiac disease.) Hmmm, kind of like coverage for repeated ear infections, but no coverage for preventive care through breastfeeding education and support???
Again, IMHO, I think that the public is confused with titles for dietitians...we have RDs, LDs, licensed nutritionists, certified nutrition specialists, you name it. It comes down to "buyers, beware" and "professionals, educate consumers". In the discussion about IBCLC licensure I see many parallels and I would strongly suggest those of you with a strong interest in pushing for licensing to contact RDs in your states or even at the nat'l level since the comparisons are mightily similar. I hate to see the waters muddied even more with addtitional titles for IBCLCs.
What licensure means (or doesn't mean!) for me as an RD/LD right now sounds awful when I put it into print...I pay my state almost $150 every 2 years and even have separate continuing education requirements to meet than those deemed acceptable for RDs at the nat'l level. Personally, I do not get reimbursed for my RD services given the nature of my work, and the protection of the public in my state has been mostly through the state uncovering unreputable folks posing as LDs...the same kind of folks who would pose as nursing home administrators, etc.
Not sure if this is helpful or even more confusing, but in my state of KS, I have not found licensure to be what I thought it would be back when I was pushing for it.
My < $0.02,
Rebecca DeYoung Daniels, MBA, RD, LD, IBCLC, RLC
P.S. If you want to look at websites, ADA's is www.eatright.org (that would be the equiv of ILCA) and CDR's is www.cdrnet.org (that would be like IBLCE).
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