There’s no question that quality nutrition advice can be invaluable for patients, especially given that the Standard American Diet—aptly referred to as the SAD—is heavy on highly processed, non-nutritive food. Many people either don’t know what constitutes good nutrition, or—if they do know—they don’t have the strategies, access, or motivation to implement it into their daily lives. And yet, we face massive—yet preventable—population health concerns, like type 2 diabetes and obesity, that dramatically and negatively impact quality of life. Furthermore, a well-balanced, nutrient-dense, anti-inflammatory, whole-foods diet has the potential to reduce pain, speed injury healing, improve recovery outcomes, and even prevent future injury—all things are that uber-relevant to a physical therapist.
With that in mind, it’s imperative that those with the knowledge of good nutrition share it. But how—and when—you can do so (and get paid for it) as a PT isn’t cut and dried. Here are four questions to help you determine if you can—and should—provide nutrition services in your practice:
1. Do you have the knowledge and training to support your recommendations?
Nutrition is a complex subject that requires in-depth knowledge, research, and training. Unfortunately, not all healthcare providers receive comprehensive and current nutrition education as part of their training. In fact, according to a 2010 report, “US medical schools offer only 19.6 hours of nutrition education across four years of medical school.” (For reference, my certification in holistic nutrition for pregnancy, postpartum, and babies—only a small [yet essential] piece of the vast nutrition puzzle—required more than 200 hours.) That said, times are certainly changing, and physical therapists’ holistic approach to health care as well as the frequency at which they see their patients makes them well qualified to support their clients in this capacity—as long as they are comfortable doing so.
Supplementing Your PT Education
According to a 2012 meta-analysis in the Journal of Physiotherapy Theory and Practice, cited here, “physical therapists can effectively counsel patients with regard to lifestyle-related interventions, including nutrition.” In a debate at the 2018 APTA conference, all panelists ended up agreeing that “physical therapists are qualified to give nutritional advice.” That said, depending on your personal proficiency, it may be worth pursuing additional or even specialized nutrition education to strengthen your expertise.
Referring to Your Network
According to the APTA, you should refer out when a client’s condition requires intervention beyond your education level—as well as when the information required to support a patient “is beyond general information that can be found in the public domain, or involves information that is outside of [established] dietary guidelines...”
So, who should you refer to? Depending on your nutrition philosophy, your patient’s needs, and the rules governing nutrition advice in your state (see below), you’ll want to have a few nutritionists, holistic nutritionists, nutrition consultants, nutrition therapists, and/or dietitians in your network. You may even want to consider partnering with a certified nutrition professional as part of a collaborative care practice model to offer advanced or niche services to your patients in-house.
2. Does your state practice act include nutrition in the PT scope of practice?
According to the APTA, “Nutrition is part of the professional scope of practice for physical therapists.” In fact, the association’s position “is that it is ‘the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapist practice.’” That said, each state establishes its own rules for what PTs can and cannot do. Thus, it’s imperative to review your individual state practice act. If your act doesn’t specifically address nutrition, then the APTA advises reviewing the state laws on nutrition, which brings us to question number three.
3. Do your state’s laws limit who can provide and bill for nutrition services?
Ultimately, state laws govern which professionals can and cannot legally provide individualized nutrition advice. In some states, only licensed dietitians are allowed to provide personalized nutrition services. Other states, like California, are much more lenient as long as certain conditions are met. In states like Alabama, licensed health professionals are legally allowed to provide “nutrition counseling incidental to their primary practice, but they may not market any nutrition services.”
According to the APTA, “Unless you or someone on staff is licensed or holds a certificate in diet and nutrition, and is covered by professional liability insurance, it would not be advisable to advertise services that you may not be eligible to deliver.” On that note, you probably don’t want to use the term “nutritionist” to describe yourself either, unless you happen to hold that specific designation. This is yet another reason to consider partnering with a certified nutrition professional or obtaining certification yourself—especially if you work with a niche client base who would benefit from specialized, in-depth nutritional support.
4. Will your services be reimbursable?
That depends on the format of the services you provide, your state laws, and your third-party payer contracts. According to the APTA, “If the information a physical therapist provides is substantial in content and time, falls within the patient's plan of care, and is documented, it is possible that nutrition education reasonably could be charged as patient education (for example, self-care).”
Complying with Laws and Payer Contracts
However, as with everything else on this list, you’ll want to consult your state laws—as well as the terms outlined in your third-party payer contracts. In some situations—like when your state laws allow for it—you may be able to charge cash for nutrition-focused wellness services. However, you’ll want to review your contracts and liability insurance—and perhaps even reach out to a healthcare attorney to ensure you’re complying with all the rules and practicing within an appropriate personal scope of practice.
For further reading and resources on physical therapy and nutrition, check out this APTA page. And if you’re passionate about nutrition, consider completing additional coursework on the subject. The author of this article (cited above), Joe Tatta, PT, DPT, is a physical therapist and a board-certified nutrition specialist who teaches healthcare professionals how to implement functional nutrition to reduce pain. Just be sure to do your due diligence prior to beginning any nutrition program so you ensure it aligns with your goals and is reflective of the most current research. Nutrition is highly bio-individualized, and philosophies have changed a lot over the years (to the point that some trends simply haven't aged well).