Future Changes Driving Dietetics Workforce Supply and ... · Future Changes Driving Dietetics...

WORKFORCE DEMAND STUDYResults and Recommendations

Future Changes Driving Dietetics Workforce Supplyand Demand: Future Scan 2012-2022Marsha Rhea, MPA, CAE; Craig Bettles, MA

EXECUTIVE SUMMARYThe dietetics profession faces many workforce challenges and opportunities to ensure that registered dietitians (RDs) and dietetic technicians, registered(DTRs) are at the forefront of health andnutrition. The professionmust prepare for newpublic priorities, changes in population, and the restructuring of howpeople learn andwork, as well as new advances in science and technology. In September 2010, the DieteticsWorkforce Demand Task Force, in consultationwith a panel of thought leaders, identified 10 change drivers that affect dieteticsworkforce supply anddemand. This future scan report provides an overviewof eight of these drivers. Two change drivers—health care reform and population risk factors/nutrition initiatives—are addressed in separate technicalarticles. A change matrix has been included at the end of this executive summary. The matrix contains a summary of each change driver and its expectedimpact and is designed to present the drivers in the context of a larger, dynamic system of change in the dietetics profession. The impact of any of thesechange drivers individually and collectively in a dynamic system is uncertain. The outcome of any change driver is also uncertain. The dietetics professionfaces many choices within each change driver to meet the workforce challenges and seize the opportunities for leadership and growth.

J Acad Nutr Diet. 2012;112(suppl 1):S10-S24.

THE DIETETICS WORKFORCEDemand Study Task Forcecommissioned this future scan,as well as a series of technicalarticles to inform its workforce

projections. Signature i, LLC—with assis-tance from Trend Spot Consulting—de-signed and facilitated a 1-day workshopon September 27, 2010, with 14 thoughtleaders offering diverse perspectives onthe future of the field. Through analysisand prioritization, the thought leaders(Textbox) narrowed the possible trendsand issues shaping the profession to 10change drivers. After facilitating this ses-sion, futurists Marsha Rhea from Signa-ture i, LLC and Craig Bettles from TrendSpot Consulting researched eight of thechange drivers. This futures scan is thesynthesis of a wide-ranging literaturescan using futurist methodologies to

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Statement of Potential Conflict of Interestand Funding/Support: See page S24.

Copyright © 2012 by the Academy of Nu-trition and Dietetics2212-2672/$36.00

doi: 10.1016/j.jand.2011.12.008

S10 JOURNAL OF THE ACADEMY OF NUTRITI

identify and analyze changes and theirimplications.

HOW TO READ THISFUTURES SCANThis futures scan has been designed toserve two purposes: to help the profes-sion explore the future, and to support theDietetics Workforce Demand Task Forcein creating scenarios to use in modelingworkforce supply and demand projec-tions. Each change driver opens with anarrative image of the future that comesfrom the futures scan research and meetsthe standards of plausibility and probabil-ity. However, it is not intended to presenta view of the expected future, but ratherto demonstrate implications for work-force supply and demand.Each section presents a Figure that con-

tains a summary statement of that changedriver, lists some of the workforce chal-lenges and opportunities, and then closeswith a statement assessing the impact onthe dietetics workforce. How much of animpact each change driver will have onsupply and demand is indexed as low,middle, or high. This is a subjective indexthat is a first step toward a quantitativeestimate of the relative influence eachchange driver should have inmodeling di-etetics workforce supply and demand.A future research directions section fol-

lows for each change driver. These shortsummaries explain key or provocativefindings from the futures scan. Selectedreferences are included for those whowant to read more about these trends, is-sues, and developments.

Change Drivers MatrixThe change driver matrix (Figure 1) offers

an at-a-glance view of the change drivers

ON AND DIETETICS © 2

and makes it easier to consider how theymight interact with one another in a sce-nario view of workforce supply and de-mand.

Aging Population DrivesOpportunities and ChallengesFigure 2 summarizes the dietetics workforceimplications of an aging population.The US Census Bureau has projected

that the elderly population, those aged 65years and older, will grow by �36% be-tween 2000 and 2020. Keeping this grow-ing population healthy and involved inand contributing to society is a key chal-lenge for the future and anopportunity forthe dietetics profession.The “Baby Boomers”—a generation

whose 65th birthday celebrations startedin 2011—are the leading edge of a rapidlyaging America. The Boomers are not onlythe largest generation to enter retirement,they are also the most educated, wealthi-est, and most diverse generation to enterretirement. For both personal and finan-cial reasons,manymembers of this gener-ation will remain active in the workforceand their communities after retirement.Keeping elderly workers engaged is also a

priority for many organizations. Older work-ershavevaluableskillsandexperiencebutarelooking for more flexibility in work arrange-ments as they get older. This desire will leadto expansions of flex-scheduling, phased re-tirement, mentorship programs, and com-panywellness programs.Keeping the Boomers active and in-

volvedwill require better health andwell-ness programs. Aging dramatically in-creases the risk of preventable chronicdiseases and disability. Much of this canbe prevented with better nutrition com-

bined with physical and mental activity.

012 by the Academy of Nutrition and Dietetics.

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WORKFORCE DEMAND STUDY

Figure 1. Change drivers matrix. aH�high; bM�medium; cL�low.

March 2012 Suppl 1 Volume 112 Number 3 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S11


ThegrowthofBoomers,combinedwiththeneed to keep them active and involved, willcreate opportunities for a range of geriatriccare specialties focused onprevention.

Future Directions ResearchThe Aging of America. The aging of Amer-ica is rapidly forcing industries across thecountry to develop new ways to keep olderAmericans ingoodhealthastheyvolunteer inthecommunityandare involved inthework-force. TheUSCensusBureauprojects that theelderly population, those aged 65 years andolder, will grow by an estimated 120% by2050.Themajorityofthoseindividualswillbeinterestedinleavingtheworkforceoralteringtheir work lives, prompting organizationsacross the country to develop new ways tokeep talented and knowledgeable olderworkers on their payrolls (1). The problem ismost acute in thehealthprofessions,where arapidly aging workforce is encountering in-creaseddemand fromanagingpopulation. Inthe dietetics profession, based on historicalworkforce data, dietetics expects to experi-ence a rate of attrition (dietetics practitionerswho leave the workforce for reasons of emi-gration,extendedleave,retirement,ordeath)of2%to5%,whichwillhaveanimpactonsup-ply (2). Some of the methods used by busi-nesses to keep older Americans engaged inthe workforce include flex-scheduling,phased retirement, tailoredbenefit packages,mentorshipprograms,supportservicesforel-derlyworkers, andwellness programs (2).

The “New Older” American. Greater re-sources and higher educational attainmentthroughout their lifetimes will likely meanthat retiring Baby Boomers will be in betteroverall health,will work or volunteer in theircommunities longer, andwill demand bettergeriatric care in their retirement. In 2011, the

Figure 2. Aging population implicatiotechnician, registered.

first of the Baby Boomers (those born be-


tween1946and1964)will turn65andbeginto leave the workforce. The Baby Boomers,particularly thosebornearlier,were themosteducatedgeneration inAmericanhistory.Ac-cording to Census Bureau data, 43% of menand 40% of women aged 55 to 64 years haveattained some type of college degree. Corre-spondingly, theBabyBoomers are also oneofthe wealthiest generations to enter retire-ment. However, Baby Boomers also have asmaller pool of potential family caregiversthan current older people because of smallerfamily sizes andhigher divorce rates (3).

The Needs of the “Oldest Old.” Greaterlongevity because of better nutrition, safety,and medical care means that the “oldestold”—those aged 85 years and older—havebecome the fastest growing cohort amongage groups. According to Census Bureau pro-jections, the population of this group is ex-pected to grow by 377% by the year 2050.These individuals are themost frequent per-capitausersofhealthcareservices.Theyoftensuffer frommultiple chronic diseases and re-ceive aggressive end-of-life care (4-6).

Healthy Aging. Keeping the growing gen-erationofelderlypeoplehealthyandinvolvedis vital to adapting to the aging of America.Older people are at higher risk for a variety ofpreventable chronic healthproblems, includ-ingcertaintypesofcancer,cardiovasculardis-ease,diabetes, andosteoporosis.According toresearchpublishedintheNewEnglandJournalofMedicine, almost75%ofelderlypeoplehaveat least one chronic illness, and roughly 50%haveat least twochronic illnesses.Evenmorealarming is the rise in disability. Recent re-search conducted by The Rand Corporationshows substantial increases in disabilityamong thoseaged50 to64years. Increases inthedisabilityof thepopulationwill likely lead

RD�registered dietitian; DTR�dietetic

to higher levels of unemployment, underem-

ON AND DIETETICS

ployment, and need for home care in the fu-ture (7).Registered dietitians (RDs) can play a vital

roleinpreventingchronicdiseaseanddisabil-ity inelderlypatientsandclientsbyprovidinggood nutrition counseling as part of a com-prehensive health and wellness program.Such programs, focused on improving dietand increasing mental and physical activity,cangreatlylowertheincidenceofchronicdis-ease and disability. Unfortunately, the UShealth care system is primarily focused ontreatingdiseaserather thanpreventing it.TheCenters for Disease Control and Preventionestimates that 75% of the nation’s health carespending—approximately $5,300 per personin the United States each year—is spent onchronic disease. Only approximately 3% isspent on public health and primary preven-tion activities, comparedwith approximately84%allocated to some formof care fromphy-sician services tohospital care toprescriptiondrugs,accordingtotheKaiserFamilyFounda-tion (8).

Population and WorkforceDiversity Challenges Professionto ChangeFigure 3 summarizes the dietetics workforceimplications of population and workforcediversity.Globalmigration is reshaping the future of

America. High rates of immigration duringthe last 20 years have led to vibrant immi-grant communities across the United States.Although thebleakUS jobmarkethas sloweddown immigration in the last 2 years, thesecommunities remain some of the fastestgrowing in the United States, and children ofrecent immigrants are the fastest growingsegment of theUSpopulation.However, many of these growing com-

munities suffer from poor health related todiet, exercise, and social andenvironmentalconditions. These groups need programsthat target behavior change in schools, uni-versities, and community centers. Goodgovernment- and foundation-sponsoredprograms that target these points of inter-action exist, but their reach is limited.Manyof these programs, particularly school andcollege foodservice and food programs,need to be overhauled to improve nutritionand provide more nutrition counseling toimprove eating habits.Creatingmeaningful change in commu-

nities of color requires a high level of cul-tural competence. Meals are a chance forfamily and friends to come together, sharestories, and build bonds of identity andmeaning, and every community has itsown cultural approaches to food and nu-trition. Professions that wish to make ameaningful impact in culturally diversecommunities will need to embrace diver-sity at all levels (including racial, ethnic,and sex). For many professions, this willrequire improving cultural competency,

ns. a

raising awareness, and actively recruitingnew members from these communities.

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ersity


Future Directions ResearchAmerica Becoming More Diverse. TheUS Census Bureau forecasts that by 2050,minority populations will outnumber non-Hispanic whites because of a combinationof population growth and immigration. TheUrban Institute observes that children inimmigrant families (87% of whom are UScitizens) are the fastest growing segment ofthe nation’s youth population. An analysis ofblack andHispanic households performedbythe US Department of Agriculture between1999and2005showedthatthesehouseholdsexperiencedfoodinsecurityatfarhigherratesthan thenational averageand food insecurityimpacts children in these households thehardest. Hunger is linked todecreased schoolperformanceandbehavioralproblems. Theseproblems can persist later in life, leading todecreased economic production and a lowerquality of life. Community- and school-basedfood programs, which are an important areaof growth for RDs, are a vital component ofhealth andnutrition in underserved commu-nities,especiallyinculturallydiversecommu-nities (9).

Inequity and Impact of the ObesityEpidemic. Obesity is growing across theUnited States, but it is impacting commu-nities of color the hardest. The BrookingsInstitute recently estimated that obesitycost the US economy �$215 billion annu-ally in premature death, medical costs,and lost productivity. Evenmore alarmingis the growing trend of obesity amongchildren. The number of adolescents whoare overweight has tripled since 1980 andis disproportionately impacting commu-nities of color. According to the US De-

Figure 3. Population and workforce div

partment of Health and Human Services,


roughly 16% of all adolescents aged 6 to 19years are overweight, compared to 22% ofMexican-American children and 20% ofAfrican-American children (10).

Community Assistance Nutrition Pro-grams Vital. The prolonged economic re-cession has increased the importance ofnutrition assistance programs adminis-tered by the federal government. The Sup-plemental Nutrition Assistance Program,also known as the Food Stamp Program,now servesmore than 1 in 8 Americans. In2008, according to the Food and NutritionService, the number of people eligible for,and the number of participants in, theSupplemental Nutrition Assistance Pro-gram increased by 5% and 7%, respec-tively. Increases in participation rateshave beendriven by increased outreach tolow-income families and engagement ofcommunity partners by state agencies.Unfortunately, many of these outreachprograms are endangered by recent statebudget shortfalls and the end of federaleconomic stimulus funds (11-13).The Special Supplemental Nutrition

Program for Women, Infants, and Chil-dren (WIC) provides supplemental foods,nutrition education, andhealth care refer-rals to low-income women, infants, andchildren up to 5 years of age who are atnutritional risk. The WIC program has ex-perienced considerable growth in partici-pation: In 2010, according to the Food andNutrition Service, the average monthlyparticipation in the WIC program com-prised 9.1 million individuals. Like theSupplemental Nutrition Assistance Pro-gram, the WIC program is vulnerable to

implications.

budget reductions as the federal fiscal

JOURNAL OF THE ACADE

year 2012 and future year’s budgets aredebated in the US Congress (11-13).There has also been growth in the need

for the National School Lunch Program,the National School Breakfast Program,and other food programs for children. Na-tional School Lunch Programprovides onethird of the energy a child needs duringthe day and, according to the US Depart-ment of Agriculture, is often the most nu-tritious meal of the day for the 19 millionchildren who receive free or reduced-price lunches. Both the participation rateof the program and the number of chil-dren receiving free lunches have in-creased steadily in the last decade, partic-ularly among minority students (11-13).

Dietetics Practitioner Diversity Gap.The growing diversity of the nation is notmatched by diversity in the dietetics pro-fession and this can affect quality of care.Recent data obtained by Readex Researchestimate that 84% of RDs and 81% of DTRsare non-Hispanic white, compared with74% of the entire US population. There isalso a considerable sex gap in the profes-sion. Within the profession, 96% of RDsand 95% of DTRs are women. Populationdiversity at the student level largely mir-rors the larger body of the profession,with slight increases in Hispanic students(2). Numerous studies have shown a cor-relation between increased diversity andquality of care in culturally diverse com-munities.

Workforce Education Meets JobMarket DemandsFigure 4 summarizes the dietetics workforceimplications of workforce education.More diverse and older students are

more likely to opt for professional and ca-reer education that fast-tracks them intoemployment. Institutions and alternativeeducation providers that can meet theneeds of these nontraditional students arethriving. They are using online educationand creative scheduling to make learningmore convenient and flexible.Continuing education now supports

people as they pursue serial careers. “Earnwhile you learn” takes on new meaning,asmost people will have to study for theirnext occupation even as they pursue theircurrent career. Companies that can pro-vide diverse, cutting-edge training willhave a strong recruiting advantage overcompetitors that offer fewer opportuni-ties to improve their workers’ skills andknowledge.In the health care professions, students

are migrating to either 2-year programsor advanced degrees to prepare for em-ployment opportunities. Interprofessio-nal learning is gaining momentum as in-stitutions change to educate health careprofessions towork as a team. Students inmany fields are interested in interdisci-

plinary learning to improve their employ-

MY OF NUTRITION AND DIETETICS S13

ions.


ability in a fast-changing, team-orientedworld.Colleges and universities are adjusting

to new standards and measures for out-comes assessment. Accountability for re-sults comes through accreditation, stu-dent financial aid requirements, andthird-party rating sources. After a decadeof public and personal austerity and jobinsecurity, studentswill demand a provenreturn on their financial investment inpostsecondary education.

Future Directions ResearchOlder and More Diverse Student Pop-ulation. In 2007, the percentage of Amer-ican college students who were minori-ties was 32%. The National Center forEducation Statistics estimates that by2020, the resident population will be 64%non-Hispanic white, 13% black, 17% His-panic, and �6% Asian/Pacific Islanders. By2050, the US Census Bureau says �53%will be non-Hispanic white; 16% will beblack; 23% will be Hispanic origin; 10%will be Asian and Pacific Islander; andabout 1%will be American Indian, Eskimo,and Aleut (14,15).A Chronicle Research Service survey of

college and universities found only ap-proximately half of the 121 respondinginstitutions believe that in 2020 their en-rollments will be primarily made up oftraditional-age, full-time students. Theenrollment of nontraditional-age stu-dents in postsecondary education in2007-2008 (the last data available at thetime of publication) was 19.1% studentsbetween the ages of 25 and 39 years and4.7% students between 40 and 64 years(16). Student population trends indicatean increasing number of low-income highschool graduates who will need financial

Figure 4. Workforce education implicat

assistance or have to combine college ed-ucation with employment (17).


College Affordability Critical to Stu-dents. Any workforce initiative to enticemore students into a particular careermust factor in what it could cost to secureeducation for that field. According to theCollege Board, most undergraduates en-roll at institutions where tuition and feesare relatively low. Of all degree-seekingundergraduates in the academic year2008-2009,more than 41% are seeking as-sociate degrees in public community col-leges, where tuition and fees averaged$2,713 in the 2010-2011 academic year.An additional 36% are enrolled at in-state,public, 4-year institutions, where tuitionand fees averaged $7,605 in 2010-2011.On average, full-time students who en-rolled in public 4-year colleges and uni-versities received approximately $6,100and students in 2-year public colleges re-ceived $3,400 in grants from all sourcesand tax benefits in 2010-2011 (18).

Rapid Growth of Online Education. In2007, roughly 1million students in grades9 through 12 were enrolled in onlinecourses—a number 22 times greater thanin 2000, but still representing only ap-proximately 1% percent of all educationcourses nationally. Christensen and Horn(19) suggest that in approximately 6years, 10% of all courseswill be computer-based, and by 2019, approximately 50% ofcourses will be delivered online. The shiftto online education is growing not only inthe formal education system, but also inprofessional development and continuingeducation required for certification. Ap-proximately 1.8 million students are en-rolled in degree and certificate programsin for-profit colleges that rely extensivelyon online learning (19).

Students Want à la Carte Convenience.

More students will attend classes online,

ON AND DIETETICS

study part-time, take courses frommulti-ple universities, and stop and start theircollege education. Students will demandmore options for taking courses tomake iteasier for them to do what they wantwhen they want to do it (17).

Bifurcation of Health Care Professions.Analysis of National Center for EducationStatistics and American Medical Associa-tion data show a small increase in associ-ates of the arts degrees for allied healthprofessions and a large increase in mas-ter- and doctoral-level degrees. This bi-furcation may be occurring because thejob market favors specialized skills atlower costs, while the professions seekmore advanced degrees to boost salariesand prestige. Collier found that advanceddegrees do not deter student interest in ahealth professions career (20).

Transformative Learning for HealthCare. The Commission on Education ofHealth Professionals for the 21st Centurycalls for a new century of transformativeprofessional education involving threefundamental shifts, that is, from seekingprofessional credentials to seeking corecompetencies for effective teamwork inhealth systems; from institutions adopt-ing their own educational models to cre-ative adaptation of global resources to ad-dress local priorities; and from isolated tocollaborative education and health sys-tems throughout the world. The Commis-sion on Education of Health Professionalsfor the 21st Century proposes these corecompetencies for all health professions:patient-centered care, interdisciplinaryteams, evidence-based practice, continu-ous quality improvement, use of newinformatics, and integration of publichealth.In fact, the Commission on Education of

Health Professionals for the 21st Centuryposits that these core competencies canbecome objective criteria for reclassifyingthe role and scope of health professionals.Instruction should be reformed to pro-mote interprofessional and transprofes-sional education that breaks down silosand enhances collaborative learning andteaming. Educational institutions shouldexploit the power of information technol-ogy for instruction reform, faculty devel-opment, and access to global resourcesthrough networks, alliances, and consor-tia (21).Incorporating team-based learning ac-

ross the disciplines into education forhealth professions has long been viewedas desirable, although widespread imple-mentation has not become a reality (22).The Institute of Medicine in 2009 calledfor redesigning continuing education forthe health professions to bring health pro-fessionals from different disciplines to-gether in carefully tailored learning envi-ronments. This change would align

learning with team-based health care de-


tions


livery. Continuing professional develop-mentwould stretch beyond the classroomto the point of care (23).

Outcomes Assessment and Accou-ntability. Assessment of learning out-comes provides external accountabilityand fosters internal efforts to improve.Accreditation agencies, certification orga-nizations, and licensing boards spur mostassessment of learning outcomes now, al-though the federal government is taking agreater interest as its financial role inhigher education increases. Some stu-dents may use third-party assessments inchoosing a school, but other factors likeaccessibility and cost are more importantto students (24).

Interdisciplinary Teaming DrivesInnovationFigure 5 summarizes the dietetics workforceimplications of interdisciplinary teaming.The innovators in health care, science,

business, and government programs areusing interdisciplinary teams to managecomplexity and solve tough challenges.Dietetics practitioners will have manymore opportunities to have their knowl-edge and skills become part of the solu-tion inhealth care, public health, research,and industry.Many professions will find it increas-

ingly difficult to draw hard lines aroundtheir work scope and competencies to ex-clude others. Instead, theywill be asked toaccept a more fluid and collaborative en-vironment that relies on and rewards suc-cessful teaming.Health care is reorganizing around the

concept of high-functioning teams to ad-dress problems. The medical home andchronic care models depend on coordi-nated care teams. Health promotion and

Figure 5. Interdisciplinary team implica

prevention initiatives rely on interdisci-


plinary strategies to create healthy com-munities and individuals.Interdisciplinary teams are essential to

scientific research and product develop-ment. Corporations are trading theircross-functional teams for more ad-hocconnections to expertise inside and out-side their enterprise that can swarm toproblems, solve them, and quickly dis-band.Dietetics practitioners with sufficient

interdisciplinary literacy and leadershipskills are joining and leading teamswherenutrition plays an integral role. They areon the frontlines of chronic-disease man-agement. They are helping food researchand development teams reformulatemore healthful products and are planningefforts to organize communities for activeliving and healthful eating.

Future Directions ResearchTeam-Based Care Vital in ComplexSituations. Teams already dominate ac-tual practice in increasingly complexhealth settings. A study in 12 Pennsylva-nia hospitals found that a multidisci-plinary team could get results similar tothose of specially trained physicians forpatients in intensive care units. The re-searchers speculated this outcome is pos-sible because multidisciplinary teams fa-cilitate the implementation of bestpractices, including the application of ev-idence-based treatments, potentially ad-verse drug indications identified by phar-macists, and application of respiratorytherapy and nurse-driven protocols to re-duce ventilation time and shorten thelength of intensive care unit stay (25).

Medical Homes Coordinate Patient-Centered Care. The health care reform

.

law includes a number of provisions pro-moting the use of “patient-centeredmed-


ical homes,” a concept strongly endorsedby the Institute of Medicine and severalphysician groups. Amedical home coordi-nates “caring and continuous healingrelationships centered around patientneeds and values.” Medical homes willdramatically improve care for peoplewithone or more chronic diseases and are animportant element in a related caremodelcalled the “chronic care model.” Underthese approaches, each patient has an on-going relationship with a personal physi-cian who leads a team of patient care pro-viders responsible for providing all thepatient’s health care needs and, whennecessary, arranging for appropriate carewith other qualified physicians. Nutritiontherapy and counseling could be an im-portant aspect of the medical home andchronic care models (26).The US Department of Veterans Affairs

(VA) is undertaking a transformation tohave at least 80% of its clinics using themedical homemodel by 2012. Among thecore features of the VA transformation areteam-based care that emphasizes conti-nuity; a bigger role for nurses in coordi-nating care; e-mail, secure messaging,and other alternative forms of contactwith patients; and more attention on be-havioral health issues. TheVA follows sev-eral smaller-scale efforts by systems suchas Kaiser Permanente and Group HealthCooperative. The VA’s nationwide experi-ment is viewed as a critical test of how toadapt the concept in diverse settings. RDsare expected to have a key role on theseteams (27).The Centers for Medicare and Medicaid

(CMS) has established a new innovationcenter to provide a seamless care experi-ence, better health, and lower costs. CMSis undertaking demonstration projects ofthe medical home concept for primarycare in eight states, an initiative to providemore coordination of care in health clin-ics, and a new state plan option that coor-dinates care for patients with at least twochronic conditions (28).

Accountable Care Organizations Rep-resent Another Reform Innovation. Un-der the health care reform law, CMS willauthorize accountable care organizationsin 2012. Accountable care organizationsare networks of physicians and other pro-viders who work together to improve thequality of health care services and reducecosts for a defined patient population. Al-though reimbursement will still be man-aged on a fee-for-service basis, account-able care organizationswill receive part ofany savings as an incentive to deliver in-tegrated care. Kaiser Permanente, MayoClinic, and the Cleveland Clinic are trail-blazers in accountable care. CMS hopes toexpand the concept beyond hospitals to

physician networks (29).


r pa


Task Competencies Blur Roles andScopes. The Commission on Education ofHealth Professionals for the 21st Centuryobserved that “the walls between taskcompetencies for different professionsare porous, allowing for task shifting andtask sharing to produce practical healthoutputs that would not be possible withsealed competencies.” Health care profes-sional education needs to do a better jobin both team-based learning and interpro-fessional education. Team-based learningis an instructional approach aimed at pre-paring students for effective, collaborativework within a cohesive group. Interprofes-sionaleducation involves studentsof twoormore professions learning together—espe-cially about each other’s roles—by interact-ing with each other within a common edu-cational agenda (21).

Community-Based Health RequiresCollaborative Teams. Engaging the com-munity to changehealth behaviors requirescollaboration with health departments,employers, community leaders, and medi-cal care providers. This team can includenonphysician clinicians—including dietet-ics practitioners, pharmacists, social work-ers, caseworkers, andoccupationalorphys-ical therapists—to help patients focus onexercise andhealthful eating habits beyondthe clinical setting. Potential care for peoplewith chronic diseases could include reim-bursed group visits, patient-directed self-management teaching, case management,and educational home visits (30).

RDs Contribute to InterdisciplinaryResearch. Major health issues and scien-tific challenges often require interdisciplin-ary teams. The National Institutes of Healthhas an interdisciplinary research programas part of its current roadmap to buildbridgesbetween thebiological sciences andthe behavioral and social sciences. Three ofthe new multidisciplinary research pro-grams—at the University of North Carolinaat Chapel Hill, the University of TexasSouthwesternMedical Center inDallas, andthe University of Washington—are bring-ing together investigators to address thenation’s obesity epidemic. These researchefforts span nutrition, biomedicine, ge-netics, psychology, epidemiology, healthbehavior, public health, urban planning,economics, and public policy (31).In clinical care, nutrition clinical scien-

tists and RDs with research training canlead andplay a key role in these teams andhelp accelerate knowledge translationand transfer to practice. These interdisci-plinary research teams are also workingin the food andpharmaceutical industries.RDs play an important role in reviewingand translating the science for policy andmarketing purposes. By participating inthese research teams, RDs contributetheir expertise, and develop the knowl-edge to ensure nutrition has a recognized

role in creating and maintaining health


(32). Although doctoral-level researchersand scientists are currently more likely toparticipate in these interdisciplinary re-search teams, all dietetics practitionershave the potential to make importantcontributions to this continuous flow oflearning between research and practice.

Swarming Teams for Chaotic Envir-onments. Gartner says that by 2020, anew form of teaming, called “swarming”will help organizations adapt towork thatis less routine and characterized by in-creased volatility and hyperconnected-ness. Gartner defines swarming as “awork style characterized by a flurry of col-lective activity by anyone and everyoneconceivably available and able to addvalue. Swarms form quickly, attacking aproblem or opportunity and then quicklydissipating. Swarming is an agile responseto an observed increase in ad-hoc actionrequirements, as ad-hoc activities con-tinue to displace structured, bureaucraticsituations.” For example, in the future, di-etetics practitioners might be part ofswarms of experts targeting specific pub-lic health challenges or trying to improvea hospital’s outcomes for a particular pa-tient segment or innovating on a newproduct line for the food industry. Individ-uals in a swarm may only know one an-other throughweak links. Peoplewill nav-igate their personal, professional, andsocial networks to survive and exploitswarms for business benefit. Hypercon-nectedness will lead to a push for morework to occur in both formal and informalrelationships across enterprise boundar-ies (33).

Generalists Gain an Edge onSpecialistsFigure 6 summarizes the dietetics workforce

Figure 6. Generalist and specialist caree

implications of generalist and specialist ca-reer paths.

ON AND DIETETICS

Career security and growth depends moston continued learning and a willingness tohelp organizations adapt and change. Newentrants to the dietetics profession will needto be broadly educated for careers that willmorphmanytimestomeetnewdemands forfood andnutrition expertise.Employers of all types want to hire po-

tential leaders who can innovate, solveproblems, and organize diverse individu-als into results-oriented teams. Peoplewith a career portfolio of different workexperiences and project knowledge aremore attractive candidates to prospectiveemployers than those who have followeda defined career pathway. With old rolesand boundary lines blurring in every field,organizations need people who haveproven they can learn deeply and quicklyand become specialists and change agentsfor the moment in the latest opportunity.Core knowledge and skills are still nec-

essary to enter the dietetics profession.RDs with the business acumen to developand improve programs and services andlead teams of people are the ones who as-cend the career ladder. They serve in ex-ecutive and director positions and assumemajor responsibility for the success oftheir organizations.A small number of specialists do thrive

as on-call experts and researchers. Theydeliver their advanced knowledge toother practitioners and organizationsthrough such channels as consultancies,centers of excellence, expert systems, andtelemedicine.

Future Directions ResearchExperience and Increased Responsibil-ity Valued More than Specialization.The Academy illustrates dietetics educa-tion and career progression in its careerdevelopment “double helix” diagramguide (34) as moving through stages from

th implications.

novice to beginner, competent, proficient,



advanced practice, and expert. This dou-ble helix diagram affirms that as dieteticspractitioners gain knowledge and skills,they advance in their career. The Acade-my’s compensation data suggest that pur-suing a focus area as a specialization is nota proven path to financial success. Spe-cialization is not common among RDs andis rarely rewarded by increased compen-sation. In 2009, only 19% of RDs special-ized in focus areas. Only a few of thoseemployed in these focus areas earnedsubstantially more than a general practi-tioner. For example, a clinical RD special-izing in cardiac nutrition earned $21.11/h,less than the generalist clinical RD whoearned $21.75/h. RDs specializing in on-cology did only slightly better at $21.91/h.The best-paid focus area was the pediat-ric/neonatal RD at $22.85/h. However, thebest-paid RD was a generalist working asan outpatient RD at $23.72/h (2).Aswithmostprofessions, themosthighly

paid RDs are executives and directorsman-aging large budgets and supervising manyemployees.Wages are trending upward forRDs with a professional focus in weightmanagement, diabetes, and pediatrics.However, the greatestwagegrowth is in re-search, sales, and public relations andmar-keting; the latter two occupations are likelygeneralists in dietetics who have honedvery specialized business skills throughpractice (2).

Uncertain Value of Advanced Degrees.Advanced degrees or training in other healthcare professions appear to expand graduates’job scope or functions beyond that of entry-level professionals and increase their level ofpracticeautonomy.Advancedpracticenursesearn higher salaries than registered nurses.However, RDs who completed entry-level orpostprofessionalmasters’ degrees did not re-port greatermarketability formorepositions.Health care professionals with advanced de-grees tend tohavehigher self-esteemandat-tain a higher profile within the profession aswriters, researchers, and leaders (35).

Employers Value Generalist Skills.Workforce skills surveys routinely reportthatemployerswantavarietyofbasic skills,such as reading and writing, critical think-ing, problem-solving, teamwork, profes-sionalism, and leadership. Employers areaddingemergingpriorities to theirwish list,such as innovation and creativity, culturalcompetency, and digital literacy (36,37).The Commission on Dietetic Registrationhas conducted employer surveys that alsoattest to a preference for professionalism,management, and leadership skills.

Broad Education Increases Career Flex-ibility. Career counselors advise youngpeople to become broadly educated andversatile to keep their career options openin a fast-changing world. Workforce pro-jections are unreliable; tomorrow’s high-

demand occupations can quickly become


oversupplied or out of date. Themost use-ful skill is to know how to learn for themultiple careers people are likely to havein a lifetime. The more broadly educatedpeople are, the more options they willhave when it comes to choosing andchanging careers. The best career strategyis to choose employerswho offer substan-tial education benefits and professionaldevelopment (38).

Multidisciplinary and Multidimen-sional Jobs Grow. Some employerssearch for peoplewith hybrid careerswhohave combined the expertise of two dis-tinct careers to address new challenges.They provide a multidisciplinary outlookin such fields as consulting, technologydevelopment, and research and develop-ment (39). Winterfeldt and colleagues(40) sum up future demand for multidis-ciplinary knowledge in dietetics nicely asfollows:

Dietetic jobs will evolve from beingnarrowly defined and task-orientedto more multidisciplinary and multi-dimensional roles; nothing will bepermanent . . . . Members of the pro-fession will have to bring a generalistmindset to the practice area. Job flex-ibility will be a reality as profession-als move in and out of careers andorganizations many times through-out their lives.[Dietetics is a] generalist professionwith the capability of easily movinginto multidisciplinary and multi-functional careers . . . . The newhealthcare environment will see di-etetic professionals managing multi-ple departments or providing trans-disciplinary health services, in whichnutrition is only part of the practicerole. In the future, it will not be un-common to see food and nutrition ex-perts earn dual degrees in medicine,pharmacy, nursing, physical therapy,law or hotel and restaurantmanagement.

Change Agent Skills for Health Sys-tems. Commission on Education of HealthProfessionals for the 21st Century recom-mends health professionals strive to ac-quire competencies and undertake func-tions beyond their purely technicaltasks—such as teamwork, ethical conduct,critical analysis, coping with uncertainty,scientific inquiry, anticipating and plan-ning for the future, and most importantlyleadership of effective health systems.The commission advocates for transfor-mative learning that develops leadershipattributes and produces “enlightenedchange agents” who can address localchallenges and innovate with their col-leagues and communities to achieve

health and well-being (21).


Technology Transforms NutritionCounselingFigure 7 summarizes the dietetics workforceimplications of technology transformations.A radically different landscape for the

delivery of nutrition information andcounseling is technologically feasible infewer than 10 years.The technology will exist to wirelessly

capture nutrition and physical activitydata in health records contained onsmartphones. Customers at restaurantscould electronically access a full range ofnutrition information, and food productscould contain radiofrequency identifica-tion tags that can be easily scanned to in-put nutrition information. Unobtrusivearmbands will be available to capturedaily activity and energy expendituresand customers will have access to soft-ware that uses expert systems to helpthem develop and adhere to their ownhealth and nutrition goals.What is not clear is whether people will

embrace these new technologies, aban-don privacy concerns to gain these bene-fits, or adopt the lifestyle changes theywill encourage.Researchers will also be able to aggre-

gate health data to develop nutrition in-formation and recommendations for en-tire communities. To address privacyconcerns, nutrition data collected by cus-tomers from their wireless devices couldbe stripped of any personal identifiers andcombined with health data from personalhealth records. The results could be linkedto changes in public policy or the physicalenvironment, such as the addition of newbike lanes in a community.New methods of delivery, from social

media to virtual worlds, will allow healthcare providers to reach and interact withpatients in different cities or even coun-tries. Health providers will interact withpatients on multiple levels, from simple“tweets” to online videos.

Future Directions ResearchFuture Role of Health and NutritionInformation. Proactive patients are cur-rently using the Internet to access infor-mation about health and nutrition and us-ing that information to make betterdecisions about their health.Missing fromthis vast array of Web resources are ex-pert systems that deliver health informa-tion directly to patients when and wherethey need it—but this is changing. Soft-ware companies areworking onnew toolsdesigned to capture real-time informa-tion and refining it based on the profiles ofindividual users. These systems could eas-ily merge with existing expert systemsthat mimic expert knowledge and judg-ment, creating systems that bridge thehealth knowledge and literacy gap be-tween patients and health care providers.Increasingly, this information will be

available at a moment’s notice on the In-


plic


ternet and on mobile devices like smart-phones (41,42).

The Evolution of a Virtual NutritionCoach. One deterrent to using onlinetools for tracking nutrition and physicalactivity is that they rely heavily on usersto input data. These systems appeal tohighly motivated users, such as profes-sional athletes or those suffering severehealth problems. However, studies of av-erage users have shown poor adherenceand not much linkage between the use ofthe tools and changes in physical activityor diet.That outcome may change as physical

hyperlinks make it easier for anyone tocapture real-time information in any eat-ing situation (43). For example, a smart-phone could use global positioning sys-tems, a type of physical hyperlink, toaccess nutritional information on menusitems when a customer steps into a store.When the customer makes a purchase,the phone could automatically track thenutritional value of purchased items us-ing credit card data. Consumers couldthen run applications on their smart-phones to track this information in com-parison with personal health goals.Eventually, a virtual nutrition coach

that provides real-time nutrition counsel-ing could emerge. The coach would drawon the patient’s health information aswell as nutrition information about foodsconsumed—all accessed through physicalhyperlinks. Expert systems inside the vir-tual nutrition coach would mimic the

Figure 7. Technology transformations im

knowledge base of health care providers


to provide nutrition counseling and lifecoaching.

Government Support for Informatics.Many experts are counting on the broaderimplementation of informatics to reducemedical errors, reduce health expenses,and improve food safety and nutrition.The 2009 American Recovery and Rein-vestment Act included $30 billion in fund-ing and incentives to encourage the adop-tion of health information systems. Thefood safety bill thatwas signed into lawbyPresidentObama in January 2011 beefs upregulations for food safety, providesmorefunding for enforcement, and speediersurveillance of potential outbreaks. Im-proved informatics systems for food pro-ducers and regulators will be needed tomeet many of the food safety and record-keeping requirements established in thebill (44).Informatics can also be used in public

health to detect and intervene to createhealthy communities. One of the immedi-ate goals of the government is to developan interoperable national health informa-tion infrastructure. Information capturedfrom patients could then be used to con-duct long-rangeoutcomes researchonpa-tients from the community level to thenational level (45). In the future, informa-tion on diet, exercise, and health frompersonal and home health monitoringwill be included in these records. (Moreinformation on health monitoring is pre-sented in the section of this article aboutthe evolution of personalized nutrition).

ations.

RDs could use this information to evaluate

ON AND DIETETICS

the impact of new public health policiesand changes in the physical environmentof a community.

Delivering Care through Virtual Worldsand Social Media. Virtual worlds and so-cial media may soon become another av-enue in which dietetics practitioners in-teract and provide nutrition counseling topatients. Currently, virtual worlds such asSecond Life are mostly used for entertain-ment, but some large companies have be-gun to invest time and money in utilizingvirtual worlds in how they conduct busi-ness. For example, IBM (Armonk, NY) isheavily invested in such programs, put-ting more than $10 million into virtualworlds to reach customers and even con-duct virtual meetings. Virtual worlds arejust onepart of a larger expansionof socialmedia that can be used to reach custom-ers and encourage behavior change. Lead-ing businesses and health care providersare using onlineWeb portals to set up vis-its and track data. Video visits and onlinechats can be captured and recorded for fu-ture reference. Instant messaging ortweets can be used to give remindersabout healthful eating. Patients can joinpatient groups that provide knowledge,support, and encouragement for partici-pants. All of these tools help provide aweb of support to improve health and en-courage behavior change (46).

Personalized Nutrition EvolvesFigure 8 summarizes the dietetics workforceimplications of personalized nutrition.Advances in science and technology are

transforming health care from a systemfocused on the treatment of disease to asystem that stresses prediction and pre-vention.Nutrition counselingwill be a keycomponent of this shift, opening new op-portunities for dietetics practitioners. RDswith expertise in preventing life-threat-ening genetic metabolic disordersthrough nutrition intervention and coun-seling will lead the way.The human genome project has opened

up new fields of medicine devoted to pre-dicting and preventing disease. However,this progress is likely just the early stagesin a long discovery process, as researcherscontinue to explore the molecular path-ways inside the cell. Researchers are alsodeveloping amore holistic understandingof biological systems through the field ofsystems biology that should lead to moreeffective tests and treatments for disease.Patients and health care providers will

also have the ability to monitor healthboth in the home and in the community.There are alreadywireless devices, placedin the home, that are able to track weightloss, energy expenditure, and a widerange of molecules in the blood, such asblood sugar. Future devices will be able towirelessly monitor a wider range ofhealth indicators and track this informa-

tion in a personal health record.


tions


Wireless home and communitymonitor-ing, combined with privacy protections,will build a strong scientific base for con-ducting outcomes research. Better out-comes data should shift the focus of healthcare reimbursement to prevention, includ-ing lifestyle and nutrition counseling.

Future Directions ResearchEmerging Health Monitoring Tech-nology. New health monitoring technol-ogieswill improve outcomes research andcould illuminate the value of preventivecare and nutrition counseling, opening upreimbursement for these services. A num-ber of technologies for monitoring healthfrom sophisticated blood glucose moni-tors to thehumble bathroomscale alreadyexist in the home. Technology developersare using recent advances in wireless net-working and computing power to createnewer, smarter versions of these old de-vices. They are also expanding the abilityto collect health data with new devicessuch as floors that monitor for falls, mat-tress pads that monitor sleep patterns,and airmonitors that check for pollutants,among many others.Health-monitoring technology will

likely move slowly into specific popula-tions at high risk for expensive diet- andlifestyle-related illnesses mainly due tothe limitations of current health-monitor-ing technology. First, many of these tech-nologies are new and expensive. Second,collecting and monitoring the data re-quires a large time commitment fromboth the patient and the health provider.Third, there are legitimate concerns aboutdata privacy. Technology developers are

Figure 8. Personalized nutrition implica

well aware of these concerns and are


working to develop solutions, such astechnology that is easier to use, betterprotocols, anddata security and collectionprograms that automatically use the datato spot concerning health problems (47).

Evolution of Genomics in Dietetics. Inthe near future, it will be commonplacefor patients to be fully screened for arange of genetic disorders, creating newdemand for advanced practice RDs. Ad-vances in genetic testing have led to theearly diagnosis of numerous nutrition-re-lated disorders, creating a unique and rap-idly growing group of advanced practiceRDs. These RDs use genetic testing, usu-ally of newborns, to identify serious ge-netic metabolic disorders, such as phe-nylketonuria. Early testing combinedwith nutrition intervention and counsel-ing can prevent serious, debilitating, andlife-threatening disability. However, sev-eral hundred genetic metabolic disordersremain for which screening tests do notcurrently exist. Testing for these disordersis likely to expand as the price of genomesequencing falls. Cheaper sequencing willlead to awider range of testing for geneticdisorders and a broader range of knowl-edge that canbeused todevelopnew testsand therapies (48).

New Opportunities Created by Sys-tems Biology. Systems biology will cre-ate new opportunities for dietetics practi-tioners. Systems biology is an emergingfield that draws heavily on the advancesof computer technology and what areloosely termed the -omic sciences, such asgenomics, proteomics, transcriptomics,

.

glycomics, and metabolomics. Systems


biology seeks to create amore holistic un-derstanding of biological processes,which will lead to rich, complex under-standing of the emergent properties of bi-ological systems (49). The -omic sciencesare related fields of study that look at therole of molecules and molecular mecha-nisms inside and outside the cell. Under-standing the emergent properties of bio-logical systems will create a betterunderstanding of the environment’s rolein the creation of disease and help re-searchers develop new tests formetabolicdisorders as well as new options for treat-ment (50). Many of these treatments willrequire intensive nutrition counseling,creating new opportunities for RDs andpotentially new fields of advanced prac-tice dietetics (51).

Personalized Health and Nutrition Out-comes. Researchers, with appropriatesafeguards for privacy and data security,can use data collected from genetic test-ing and health-monitoring technology toidentify new ways to prevent disease,provide new interventions, and monitorpatient outcomes. Inmany cases, these re-searchers are finding the best way to pre-vent disease is through nutrition inter-vention combined with lifestyle changes.This is hardly news for many patients orhealth providers, but the ability to iden-tify high-risk groups early combined withthe ability to collect data for outcomes re-search could dramatically alter the waythe health care system works. Treatmentplans, including nutrition and lifestylechanges, can be personalized to the indi-vidual patient, leading to less waste in thesystem, fewer dangerous and unnecessaryprocedures, and fewer complications frominappropriate medications. Better out-comes research will also open up reim-bursement for lifestyle and nutrition coun-seling to prevent expensive chronicdiseases. In thisnewhealth care system, thefocus will shift from the often expensivetasks of treating disease to predicting andpreventing disease before it happens (52).

Food Industry Transforms forPublic PrioritiesFigure9summarizes thedieteticsworkforce im-plications of food industry priorities.Moreconsumersareinterestedinhealthful

and ethical eating. They expect to knowwheretheirfoodcomesfrom,therouteittookto get it to their table, andwhat it will do fortheir health. Food companies from produc-tion to consumption must now answer toconsumer preferences and government de-mands to support public health and environ-mental priorities.Companies are reworking and reposi-

tioning their foodproducts and services tomeet these new demands. They are work-ing to build public trust and competitiveadvantage through the nutritional value

and environmental impact of their prod-


ation


ucts. Price, convenience, and marketingstill make or break food businesses, butconsumers are less willing to give upthese advantages at the expense of health,safety, and sustainability.People are still living hectic lives but

they have different expectations even ofwhat fast food should be. Once engaged inasking the right questions about their re-lationship with food, more consumers areinterested in the source, quality, and vari-ety of the food they eat.Food is recognized as a key indicator of

quality of life and consumed as a celebra-tion of health and good living. People arebecoming fascinated by the culinary artsand seekmore knowledge and experiencein nutrition planning and food prepara-tion. This rediscovery of the joy of cookingis happening in homes, restaurants, andother dining experiences.

Future Directions Research

RDs Better Compensated in Foodser-vice and Manufacturing. Only approxi-mately 1 in 5 RDs is working in foodservicemanagement, business, or consulting, ac-cording to an analysis of surveys (2). Thebest-paid RDs are executives in any field; in2009, among the subsequent top nine posi-tionswith regard to salary, sixwere in non-clinical care positions, such as public rela-tions and marketing, research anddevelopment, director of food andnutritionservices, sales representative, school food-service, and manager of nutrition commu-nications. Thebestwagesare found inphar-maceutical and food manufacturing,distributing and retailing, and contract food

Figure 9. Food industry priorities implic

management (2).


Long-Term Eating Preferences Difficultto Forecast. Estimating demand for di-etetics practitioners requires a good un-derstanding of future patterns in foodconsumption. Demographics and eco-nomic studies can provide some clues towhat future eating preferences might be.However, these studies assume future se-niors will eat like today’s seniors do andethnic populationswill retain cultural tra-ditions in future generations.However, thereare somechanges ineating

patterns that can be expected, creating op-portunities for dietetics practitioners. An ag-ing population is more likely to eat at home,driving demand for in-home delivery of pre-pared foods. Growth in per-capita incomeand education levels will drive demand forquality and diversity over quantity. Highereducation levels, higher income levels, andtrend toward healthy aging could lead to agrowing preference for varied diets featuringmore fruits, vegetables, and fish. All of thesechanges in eating patterns are likely to shiftthe food system to becomemore service-ori-ented, creating opportunities for dietitiansworking in the foodservice industry (53).

Multinational Food Companies AdoptPublic Health Priorities. Major multina-tional food companies are signing ontoglobal compacts to address obesity, diabe-tes, and chronic diseases. For example,PepsiCo (Purchase, NY) is reformulatingand revising its products to encouragehealthful eating. Leading companies arealso realizing the importance of collabo-ration with their consumers and publicgroups to prevent chronic disease (54).The Dow Jones Sustainability Index andthe Global Reporting Initiative provide in-dependent monitoring and incentives to

s.

urge food manufacturers, distributors,

ON AND DIETETICS

and retailers to participate in socially re-sponsible practices.

Food Safety, Quality, and Sustainabil-ity Linked. Ensuring food safety and qual-ity and reducing environmental impactsare all related operational challenges forfood producers, processors, distributors,and retailers. The food service sector islagging behind the food retail sector in op-erations research to achieve food safety,quality, and sustainability. Hazardousanalysis critical control point systemsprovide a structuredway to identify food-safety risks. This systemhas been adaptedto include nutritional control points toprotect product quality. More research isneeded in the dynamic process of qualitychange and nutritional values. Any assess-ment of sustainability in the food industrymust consider life-cycle assessments acrossthe entire supply chain fromproduct devel-opment to consumption (55).

Job Opportunities from Food LabelingLaw. A new requirement in the healthcare reform law mandates restaurantspost kilocalorie counts for menu items. Anumber of prominent US cities such asNew York, NY; San Francisco, CA; Seattle,WA; Philadelphia, PA; and Portland, OR,have already mandated menu labeling infast-food restaurants; however, the fed-eral mandate is meant to override thepatchwork of varying laws in municipali-ties across the country. This could be anear-term employment boost for RDsskilled in nutrient analysis and may, overtime, encourage more restaurant ownersand chefs to partner with RDs skilled inthe culinary arts (56).

Industrialized Food System Backlash. Aseries of recent popular books anddocumen-taries have warned consumers about large-scaleagricultural and foodcorporations.TheyarguethatUScornsubsidieshavecontributedto poor diets and that concentrated animalfeeding operations threaten food safety andthe environment. Many consumers and foodbusinesses are rejecting the industrialway ofproducing food and transitioning to local andregional producers for better-quality food.Restaurants and catering services, includingsomefast-foodrestaurants,havebeen instru-mental in the local foodmovement (57).

Global Challenge of Food Security andSustainability. Food prices are climbingglobally, threatening the food security ofeven prosperous nations. Food consump-tion in the developing world is growing.Rising oil and energy prices make foodmore expensive to produce and process.Farmland is being converted to housegrowing populations in residential com-munities and support economic develop-ment. Climate change is expected to dis-rupt growing seasons. Global watershortages threaten the food supply. Fish-

eries are declining and collapsing (58).


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March 2012 Suppl 1 Volume 112 Number 3 JOURNAL OF THE ACADE

Linking food recommendations to envi-ronmental and health outcomes will berequired to ensure food security for thefuture. However, corporate decisionmak-ers and makers of public policy are in-volved in a vigorous debate as to whattruly sustainable food recommendationsshould include (58). Does a sustainablediet minimize water, energy, pesticides,and carbon emission? Should it also pro-mote humane treatment of animals andeconomic opportunity for poor farmers?Europe is currently leading the move-

ment to incorporate environmental sus-tainability into food policies. For example,the Barilla Center for Food and Nutritionin Italy has proposed a double food pyra-mid for the European Union that illus-trates that foods with higher recom-mended consumption levels also have alower environmental impact (59).

CONCLUSIONSFuture scanning is a systematic approach toidentifyingandanalyzingchange,whichis in-herently never static. The eight change driv-ers in this future scan report are an assess-ment of how the world is changing in waysthat could influence dieteticsworkforce sup-ply and demand. Another group of expertsmaking a similar assessment at a future datemaychooseanentirelydifferentsetofchangedrivers, and their assessment could lead todifferent insights, scenarios, andassumptionsabout workforce supply and demand. Futurescanning shouldbea continuous studyof keytrendsand issues todiscover thechangedriv-ers thatcouldhavethegreatest impactonthefuture. The most valuable outcome of futurescanning, however, is not scoring the likelyimpact of different trends and issues; it is an-ticipating the future challenges and opportu-nities that arise from these changes.

References1. Longman P. Think again: Global aging. New

America Foundation. October 13, 2010.http://www.newamerica.net/publications/articles/2010/think_again_global_aging_38390. Accessed November 9, 2010

2. Rogers D. Compensation and Benefits Sur-vey of the Dietetics Profession. Chicago, IL:American Dietetic Association Commis-sion on Dietetic Registration; 2009.

3. Frey WH. Mapping the growth of olderAmerica: Seniors and Boomers in the early21st century. June12, 2007. Brookings Insti-tute. http://www.brookings.edu/papers/2007/0612demographics_frey.aspx. Ac-cessed November 18, 2010.

4. Rogers CC. Growth of the oldest old popu-lation and future implications for rural ar-eas. Rural Dev Perspect. 1999;14(3):22-26.http://www.es.usda.gov/publications/rdp/rdpoct99/rdpoct99d.pdf. Accessed Nove-mber 18, 2010.

5. Vincent GK, Velkoff VA. The next four de-cades: The older population in the UnitedStates: 2010 to 2050. US Census Bureau.

Future Scan Meeting Participants

The Commission on Dietetic Registration and the Dietetics Workforce Demand StudyTask Force expresses gratitude to these individuals who contributed their time andexpertise in developing this future scan.

Dietetics Workforce Demand Study Task ForceSusan H. Laramee, MS, RD, LDN, FADA (Chair)Manager, Clinical RecruitmentSodexoNaples, FL

Council on Future Practice RepresentativeNora K Nyland, PhD, RD, CDDietetics Program DirectorBrigham Young UniversityProvo, UT

Education Committee RepresentativeGail E. Gates, PhD, RDAssociate Vice President Academic AffairsOklahoma State UniversityStillwater, OK

Accreditation Council for Education in Nutrition and Dietetics RepresentativeKevin Haubrick, MS, RD, LDDirector, Food and Nutrition ServicesBaptist Medical CenterSan Antonio, Texas

Academy of Nutrition and Dietetics Board of Directors RepresentativeChristina K. Biesemeier, MS, RD, LDN, FADADirector, Clinical Nutrition ServicesVanderbilt University HospitalFranklin, TN

Linda J. Lafferty, PhD, RD, FADADirector Dietetics Internship/Associate DirectorRush University Medical CenterNaperville, IL

Margaret J. Tate, MS, RDConsultantPhoenix, AZ

Alice J. Lenihan, MPH, RD, LDNChief, Nutrition Services BranchNC Department of Health and Human ServicesRaleigh, NC

Thought Leader Meeting Participant ListGeorge Balch, PhDPrincipalBalch AssociatesOak Park, IL

Jessica Bogli, MSDirectorBogli ConsultingPortland, OR

Ronni Chernoff, PhD, RD, FADAAssociate Director, GRECC for Education/EvaluationGeriatric Research Education and Clinical CenterCentral Arkansas Veterans Healthcare System;Professor, Geriatrics

Director, Arkansas Geriatric Education CenterReynolds Institute on Aging and Department of GeriatricsLittle Rock, AR

Stephen N. Collier, PhDDirector and Professor

www.census.gov/prod/2010pubs/p25-1138.pdf. Accessed November 18, 2010.


http://www.newamerica.net/publications/articles/2010/think_again_global_aging_38390http://www.newamerica.net/publications/articles/2010/think_again_global_aging_38390http://www.newamerica.net/publications/articles/2010/think_again_global_aging_38390http://www.brookings.edu/papers/2007/0612demographics_frey.aspxhttp://www.brookings.edu/papers/2007/0612demographics_frey.aspxhttp://www.census.gov/prod/2010pubs/p25-1138.pdfhttp://www.census.gov/prod/2010pubs/p25-1138.pdfhttp://www.es.usda.gov/publications/rdp/rdpoct99/rdpoct99d.pdfhttp://www.es.usda.gov/publications/rdp/rdpoct99/rdpoct99d.pdf

.

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S22 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

6. Federal Inter-Agency Forum on Aging-Re-lated Statistics. Older Americans 2010:Key indicators of well-being. Washington,DC: US Government Printing Office; 2010.http://www.agingstats.gov/agingstatsdotnet.main_site/default.aspx. Accessed Novem-ber 18, 2010.

7. Lohr S. Thewellness industry as an echo ofthe internet in the 1990s. The New YorkTimes. May 23, 2010. http://bits.blogs.nytimes.com/2010/05/23/the-wellness-industry-as-an-echo-of-the-internet-in-the-1990s. Accessed November 22, 2010.

8. Kaiser Family Foundation. US HealthcareCosts. March 2010. http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx#footnote6. AccessedOctober 22, 2010.

9. Cook J, Jeng K. Child food insecurity: Theeconomic impact on our nation. Feed-ing America. 2009. http://feedingamerica.org/our-network/the-studies/child-food-insecurity-economic-impact.aspx. AccessedOctober 15, 2010.

10. Prevention Institute. The imperativeof reduc-ing health disparities through prevention:Challenges, implications, and opportunities.October 2006. http://www.altfutures.org/draproject/index.php/site/reports. AccessedNovember 15, 2010.

11. Nord M, Coleman-Jensen A, Andrews M,Carlson S. Household food security in theUnited States. http:www.ers.usda.gov/publications.err108. Accessed November18, 2010.

12. Gundersen C, Kreider B, Pepper JV. The im-pact of theNational School Lunch Programon child health: A nonparametric boundsanalysis. J Econometrics. http://www2.econ.iastate.edu/faculty/kreider/webpage/papers/downloads/GKP_school_lunch_program.pdf. Accessed November 3, 2011.

13. RalstonK, NewmanC, ClausonA, Guthrie J,Buzby J. The National School Lunch Pro-gram: Background, trends, and issues.www.ers.usda.gov/publications/err61.err61pdf. Accessed November 18, 2010.

14. HussarW, Bailey T. Projections of educationstatistics to 2020. September 2011. http://nces.ed.gov/pubs2011/2011026.pdf. Acces-sed October 30, 2011.

15. Day JC. National population projections.www.census.gov/population/www/pop-profile/natproj.html. AccessedOctober 30,2011.

16. Center for Education Statistics. Enroll-ment in postsecondary education, by stu-dent level, type of institution, age, andma-jor field of study: 2007-08 [Table]. http://nces.ed.gov/programs/digest/d10/tables/dt10_242.asp. Accessed November 3,2011.

17. Chronicle Research Services. The college of2020: Students—A chronicle report. http://etcjournal.com/2009/06/19/the-college-of-2020-a-chronicle-report. Accessed Septem-ber 30, 2010.

18. College Board. Trends in college pricing 2010.http://trends.collegeboard.org/college_pricing/. Accessed October 15, 2010.

19. Christensen C, Horn M. How do we trans-form our schools? Educ Next. 2008;8(3):12-19. http://educationnext.org/how-do-

Future Scan Meeting Participants (continued)

Office of Health Professions Educationand Workforce DevelopmentSchool of Health ProfessionsUniversity of Alabama at BirminghamBirmingham, AL

Michael DeAngelis, MS, MPH, RDVice President and Nutrition DirectorPorter NovelliWashington, DC

Kathy Duncan, RNFaculty, National Network LeaderInstitute for Healthcare ImprovementCambridge, MA

Mary Kimbrough, RD, LDPartner/OwnerCulinary Nutrition Associates, LLCDallas, TX

Robert Kushner, MD, MSProfessor of MedicineNorthwestern University FSMChicago, IL

Patricia Luoto, EdD, MS, RDProfessor, Food and NutritionDirector, John C. Stalker Institute of Food and NutritionDepartment of Consumer SciencesFramingham State CollegeFramingham, MA

Colleen Matthys, RDFormer Nutrition Research ManagerUniversity of WashingtonBellevue, WA

Sasha Perez, RDChild Nutrition ConsultantCalifornia Department of EducationNutrition Services DivisionGlendale, CA

Georgie ShockeyPrincipalRuck-Shockey Associates, IncThe Woodlands, TX

Nancy Hakel Smith, PhD, MS, RDManager, Clinical Nutrition Services; Adjunct FacultyBryan LGH Medical CenterLincoln, NE

Martin Yadrick, MS, MBA, RD, FADADirector of Nutrition InformaticsComputrition, Inc.Los Angeles, CA

Academy of Nutrition and Dietetics/Commission on Dietetic Registration StaffPatricia BabjakCEOAcademy of Nutrition and DieteticsChicago, IL

Christine Reidy, RDExecutive DirectorCommission on Dietetic Registration

Grady Barnhill, MEdDirector, Professional DevelopmentCommission on Dietetic Registration

we-transform-our-schools/. Accessed No-vember 12, 2010.


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Future Scan Meeting Partic

Jeanne BlankenshipVice President, Government RelationsAcademy of Nutrition and DieteticsWashington, DC

Ulric ChungExecutive DirectorAccreditation Council for Education inChicago, IL

Harold Holler, RD, LDNVice President, Governance and PractiAcademy of Nutrition and DieteticsChicago, IL

Esther Myers, PhD, RD, FADAChief Science Officer, Scientific AffairsAcademy of Nutrition and DieteticsChicago, IL

Project ConsultantsCraig BettlesFounder, Trend Spot ConsultingSeattle, WAMarsha RheaPresident, Signature i, LLCAlexandria, VA

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AUTHOR INFORMATIONM. Rhea is president, Signature i, LLC, Alexandria, VA. C. Bettles is president, Trend Spot Consulting, Seattle, WA.Address correspondence to: Marsha Rhea, MPA, CAE, Signature i LLC; 1214 W. Abingdon Dr, Alexandria, VA 22314. E-mail: [email protected]

STATEMENT OF POTENTIAL CONFLICT OF INTEREST:Author C. Bettles: C. Bettles, co-author, is president of Trend Spot Consulting.Trend Spot Consulting provides scanning research, facilitation, andconsulting services to organizations to help them better understand and respond to future challenges and opportunities. This article drew onknowledge and learning gained through work with other clients including: American Association of Medical Society Executives, Commissionon Dietetic Registration, American Dental Hygienists’ Associatio

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