Introduction
Sarah St. Clair serves as the Supervisor of Clinical Dietetics for Providence Health and Services, where she oversees nearly 20 outpatient dietitians across 8 hospitals throughout Oregon. She also specializes in the treatment of eating disorders in the outpatient setting. She earned her BS in Food and Nutrition from Montana State University and her Master’s in Dietetics Administration from Utah State University.
What is the role of an eating disorder dietitian in the outpatient setting?
My role as an outpatient dietitian is to see those medically stable enough not to require a higher level of care and/or help those transitioning out of a higher level of care to maintain or reach eating disorder recovery and a more positive relationship with food and body. This role differs from the eating disorder RD working at a higher level of care, as visits are less frequent because patients should be more stable. The goal of outpatient care is to find personalized eating disorder recovery for the patient and eventually decrease visit frequency and discharge them from eating disorder care entirely, if possible.
What is a typical patient like in an outpatient setting?
Most outpatients are motivated to improve since nobody can be forced to seek treatment; however, some are pressured by their spouse or another healthcare provider to attend visits. In addition, kids can lack insight into their current state or be unaware of why their parents brought them to the clinic.
I use many criteria to assess if an individual is appropriate for outpatient care, including medical and psychiatric stability, level of motivation, and strength of their support system. I would recommend a higher level of care if an individual has failed to meet weight restoration goals, deteriorating mental health symptoms, encountered a plateau in progress, a weak support system, or other reasons, depending on the situation.
Unfortunately, there are significant barriers to higher levels of care, and some individuals are forced to remain outpatients. For those patients, I work with them to develop a care contract that integrates therapy visits, vital checkups, safety plans, and more.
What does a day in your life look like?
Day-to-day work can vary, but some basic functions remain the same. I start my day by looking at the charts of each patient I have scheduled and preparing their chart template. This involves reviewing any chart notes or new labs from other care team members. Since I see patients both virtually and in person, I also take time to send out meeting links to my virtual patients. When I am not in an appointment, I am coordinating care with other members of the patient’s care team via phone, faxed notes, and/or secure email. Patient care takes up 6 hours of my day, with the remaining 2 hours dedicated to routine tasks. During that time, I complete chart notes, tube feed orders if needed, send secure emails or messages to other care team members and/or call them if needed, reply to patient messages, etc. Somewhere in there, I have a 30-minute unpaid lunch. This makes my total work day 8.5 hrs.
What is the most rewarding part of your job?
As an outpatient RD, I get to work with patients for a longer duration and in a much more personal way than RDs who work at a higher level of care, including some patients who continue to see me for many years to maintain progress. I’ve seen people go through major life transitions such as starting college, getting married, starting a family, and much more. The most rewarding feeling is seeing my patients recover and discharge into a life that is much freer than the one they had at the beginning of their recovery journey. The relationships I have with my patients keep me going each day, and it’s an honor to have them place their trust in me.
I am a new RD and I want to work with eating disorders in an outpatient setting. How do I get started?
If you know you want to go this path, I’d recommend starting in a general outpatient role and then building experience in eating disorders. Many people would tell you that to be a strong clinical dietitian, you need to start with inpatient care. I believe this is a great option, but for those like me who did not enjoy my inpatient internship experience, do not fret! I started in an outpatient job after I finished school, and I was still able to build strong clinical knowledge and be an effective dietitian. Another common progression I’ve seen amongst my colleagues is starting in day treatment or residential care for eating disorders and then moving into outpatient care. Ultimately, regardless of where you start, you can always end up in the place you want to be, so do what is best for yourself and your life.
What type of person should work in this role?
I think those best suited for the role are people who could have been a therapist in another life and possess strong empathy and a desire to learn about people’s lives. You need endless patience and curiosity if you are going to talk with patients all day. I would say that empathy and empathic listening are the most important skills to have.
How is work-life balance?
I work Monday through Friday, with some days being remote, and I don’t work on weekends or holidays. This type of schedule gives me time to practice self-care, relax, and take my mind off work, which is highly important when you’re working in this field. Most eating disorder patients carry a lot of trauma along with other psychiatric comorbidities, and they are relying on you to care for them. This responsibility can easily overwhelm you, so it’s important to have a strong support network for your mental health. For example, I have my therapist and find that it works great for me. Overall, I enjoy the work-life balance that outpatient care has to offer, even though the work can be overwhelming at times.
Do I need any extra training to work in this role?
I had to seek additional training beyond the dietetic curriculum to become competent in my role. Shortly after becoming an RD, I began utilizing resources like Sick Enough by Jennifer Gaudiani, enrolling in Jessica Setnick’s eating disorder training programs, and exploring counseling techniques through Molly Kellogg’s Counseling Skills for Nutrition Therapists. In the outpatient setting, your counseling skills are vital to helping patients recover. The great news is that you can start training while in school, and I highly recommend doing so if you can!