The Inside Scoop on Nutrition Counseling Start-Ups: What RDs Need to Know
If you’re a registered dietitian who has looked for a job in the past year or two, there’s a good chance that you have encountered remote roles for nutrition start-up companies. With the increased interest in telehealth, the number of companies offering remote dietitian services has exploded in recent years.
In this article, we will cover the pros and cons of working for a nutrition telehealth start-up. We will also dive into some of the biggest companies out there and discuss some factors to consider before you commit to a virtual role.
Let’s first discuss what makes a nutrition start-up so unique.
What is the difference between a nutrition start-up and a small nutrition business?
Start-ups and small businesses often get confused, but they are not the same thing. Start-ups are built on the forefront of innovation, creativity, and the desire to disrupt the market. Start-ups want to grow quickly and capture the market share before other companies do. This approach often means rapid expansion.
On the other side, small nutrition businesses can take a variety of forms such as a sole proprietorship or a small company. While growth might be a goal, this is done without the desire to dominate a market.
One of the biggest differences between small businesses and start-ups is the funding source. The business plan of a startup typically has the end goal of selling the company for a large profit or to going public through an IPO. Small businesses are often growth-oriented as well, but usually, the pace of growth is over a longer timeframe.
Which offers more job security?
You might be wondering, does one option offer more job security over the other?
According to the U.S. Bureau of Labor Statistics (BLS), approximately 20% of new businesses fail during the first two years of being open, 45% during the first five years, and 65% during the first 10 years. Only 25% of new businesses make it to 15 years or more.
Start-ups have a similar first-year failure rate, but it is estimated that over 90% of start-ups end up failing within the first five years.
The true answer is that both small businesses and start-ups are riskier than well-established businesses and companies. This is a risk you’re taking when pursuing these kinds of roles.
How do nutrition counseling start-ups work?
In the past 5 years or so, there has been a rapid explosion of nutrition start-ups that are connecting registered dietitians with nutrition clients. These companies include Fay, Nourish, BerryStreet, DietitianLive, FoodSmart, Alara, Oshi and dozens more! Every day, I learn about more companies. It is truly impossible to list them all.
All of these nutrition counseling start-up companies work similarly. The company hires registered dietitians to provide nutrition education or medical nutrition therapy for clients. The company does all of the marketing, client acquisition, and billing for the RD.
Dietitians in these roles can set their hours and availability (per company policies) and clients book sessions.
How is this different than a private practice or small nutrition company?
Many of these nutrition start-up companies are large! They have serious venture capital funds behind them and they are using this money to heavily dominate the market with SEO and ads.
Most of these companies also have very strict metrics that dietitians must meet. These metrics often include:
-Total number of clients seen per week
-Total number of sessions completed per client (longevity)
-Cancelation/No-Show Rate
-Client Satisfaction
-Client Outcomes
Nutrition start-up companies also vary widely in the amount of support and training that they provide for dietitians. Some of these companies have a robust onboarding process and mentorship opportunities for tough client cases. While other companies are very hands-on and provide minimal or no training and ongoing support for dietitians.
A case for smaller nutrition private practices
With smaller nutrition private practices, there will be a closer relationship between the hiring manager or dietitian and the staff. Oftentimes, the business owner is very heavily invested in their dietitians because the dietitians are representing their brand name.
What are some of the pros and cons of working for a nutrition counseling start-up?
We will dive into the ins and outs of some of the biggest and most well known companies a little later on. But for now, let’s cover the general pros and cons of working for a nutrition start-up company.
Pros of Working for a Nutrition Counseling Start-Up:
Remote Work- This tends to be the biggest draw for most dietitians. RDs want to work remotely, and this is a great way to do this.
Schedule Flexibility- RDs can set their own availability for client sessions usually within company parameters. Some companies require a certain number of weekend or evening availability. Others let the RD dictate their schedule. This can be a great option for working parents who want to set their schedule around when their kids are in school. This also is great for dietitians who cannot work a full 8-hour shift. Other RDs might decide to work 10-hour shifts. There is a ton of flexibility!
Ability to Specialize- Many of these companies will let you specialize in specific disease states. You can determine which clients you want to work with and technically their internal algorithm should feed you clients that meet your areas of expertise. Other companies might have a very specific type of client that they attract.
Focus on Counseling, Not Business Logistics- One of the biggest perks is the ability to focus solely on 1:1 counseling without having to figure out insurance, billing, and marketing. A lot of dietitians are very interested in pursuing the private practice route but are overwhelmed by the business and logistical aspects of running a business. This eliminates this barrier and allows for RDs to test out a private practice-style position without the upfront investment in all aspects of a business.
Part-Time Option- Most remote counseling companies allow you to set your own hours. Some dietitians opt to treat this as a side hustle on top of a full-time role. Others might choose to work part-time in a counseling position and part-time elsewhere.
Build Your Private Practice- I have spoken with a LOT of dietitians who take clients part-time through companies like Fay and BerryStreet. They like having another stream of clients and income, while they also focus on building their own private practice. Please note that some companies allow this and others do not. (And while non-competes may be illegal soon, it is likely that this could prevent you from getting hired by one of these companies if they have a policy against having your own private practice).
Now that we have covered the common perks of working for a nutrition start-up company, let’s dive into some of the cons.
Cons of Working for a Nutrition Counseling Start-Up:
Paid as a 1099 Contract Worker- The vast majority of these nutrition start-up companies are compensating dietitians as 1099 independent contract workers. What does this mean? You will be responsible for all self-employment taxes and your take-home pay will be lower than you might expect. Check out my full article on 1099 versus W2 roles. You must understand what this means before you commit to a 1099 role.
Inconsistent Work with no Schedule Guarantees- Although I listed part-time work as a pro above, it can also be a huge con. The majority of these companies offer hourly or part-time work. You set your schedule, but you will only get paid if a client books a session with you. Certain times of the year might be very slow because clients don’t want to work with a dietitian. Slow times can be around the winter holidays and during summer break. This can be true for full-time W2 positions like with Nourish and Dietitian Live too- you have to maintain the minimum number of clients each week!
Minimal Pay for No-shows- As a contract employee, you will only get paid for the work that you do. Some of these companies will not pay you for no-shows or they will only pay you a very small amount. The majority of these companies will also pay you a much lower rate for any administrative work and they may not pay you for additional work that you might do with coordinating care or charting.
Training and Support Can Be Sparse- The training and onboarding process for companies can be all over the place. In my opinion, part of this is due to the rapid growth of these companies. They are figuring out the process as they go and often this can cause a very disjointed and chaotic experience. It is also possible that most of these companies are hiring dietitians, but do not have expert dietitians on the training/development side of the business and thus are not aware of RD scope of practice. I have heard that some companies have improved their process such as Nourish, it is not unheard of to have a disorganized experience. I have also spoken with newer dietitians who are given clients with very complex cases and they are left to figure out the next steps on their own (not acceptable in my opinion).
Several-Month Onboarding Process- With the majority of these companies, it will take several months to get credentialed with insurance companies. This means that you cannot actually start working for these companies until you are credentialed. Also, you are credentialed under the individual company. If you want to branch out on your own, you will have to restart the credentialing process under your own name.
Minimal Support for Those Without Prior Counseling Experience- The majority of these companies do require at least 1 year of experience, but I have heard of new graduates being hired by companies like Fay. You should always ask about the training/onboarding/support, especially if you are a newer RD.
No benefits, No PTO, No Retirement, No Health Insurance, etc.- Because most of these companies are paying RDs as 1099 independent contractors, you will not receive standard benefits that employees receive. Even if you work full-time hours, you will not be classified as a full-time employee. Make sure to factor this into your compensation calculations when you’re deciding what is the best option for you.
Lack of Higher Compensation for Years of Experience- In all of my research, I have found that it’s fairly common for these companies to offer the SAME pay for a dietitian with 1 year of experience and a dietitian with 10 years of experience. This is baffling to me, but for some reason many companies have set up their pay structures in this model.
Now that we have covered the general pros and cons of working for a remote nutrition counseling company, let’s dive into some of the biggest companies.
Please note that the below information is based on interviews with dietitians who work at these companies. The pros and cons listed about each company are based on my interpretation of these interviews as well as information that is posted on public forums.
Pros and Cons of Foodsmart
Who are they?
Foodsmart offers 1:1 nutrition counseling to clients and they uniquely target individuals that receive Medicaid and Medicare. They focus on food insecurity and helping their clients leverage their SNAP/EBT benefits.
Pay:
Foodsmart offers both full-time benefited roles and 1099 contract positions. Interestingly, they offer the same pay for new dietitians and those with decades of experience. The pay is $48/hr as a 1099 role and $50,000 as a salaried benefited employee. In my opinion, these are both extremely underpaid. I cannot fathom getting paid $50,000 as a dietitian with 10+ years of experience.
If you are a full-time employee, you are eligible for bonuses that range from $20k-$40k per year. I reached out to several Foodsmart dietitians and not a single one was aware of or could validate this bonus potential. It’s possible that it’s a new benefit or only being offered to new hires (hopefully not!).
Benefits:
For those who choose the salaried role, the company offers 10 days of PTO and 11 company holidays. This is pretty average, nothing special. The specifics about the other benefits and the healthcare premiums are not public information.
Client Load:
There have been numerous complaints about the high no-show rate with this company. RDs have complained that it’s very challenging to fill a full-time schedule.
Mentorship/Support:
The website states that mentorship and support are provided. I was unable to find very much information on how true this is for dietitians.
Performance Expectations:
Past RDs have complained that the companies performance metrics are very hard to achieve. For example, one of the metrics is your client retention rate and your no-show rate. This client population does have a higher no-show rate for a variety of reasons.
Overall Feedback:
The feedback on Foodsmart seems to be very divided. I have spoken with dietitians who LOVE this company and dietitians who have had a miserable experience. Some have complained about sketchy and frustrating client experiences when it comes to helping their clients troubleshoot tech issues.
My Opinion:
I love the mission of this company, but I cannot get behind a company that offers their RDs $50,000 as an across-the-board food with no room for negotiation. While there might be bonus potential, you shouldn’t need to earn a bonus to make a living wage. I also find it interesting that the company has recently secured $200 million (MILLION) in funding, but they cannot pay dietitians a living wage.
Pros and Cons of Nourish
Who are they?
Nourish provides 1:1 nutrition counseling for clients and they are credentialed with hundreds of insurance plans. They provide counseling for a variety of disease states.
Nourish employs over 1000 dietitians and they are one of the few nutrition companies that only hires dietitians as W2 employees.
Pay:
Nourish is very transparent about their pay. If you see 25 clients per week, you will be able to earn $70-90k per year (per their calculations). The session rate is $45-55 per session, but note that initials and follow-ups are paid at different rates. Training is also paid at a lower rate and you’re paid a flat fee for charting/admin work. Nourish advertises their pay as in the 70-90th percentile, but it’s unclear what data they are basing this information on because $70k is not the 70th percentile for RD pay. Also, almost every single RD that I have spoken with makes the exact same amount, and annual raises are not great. Nourish has also recently LOWERED its session pay rate. Big thumbs down on that one.
Benefits:
Nourish is one of the few companies that offers benefits. You must carry a caseload of at least 15 session hours per week (unclear what happens if you take vacation time). The insurance premiums are EXPENSIVE. Nourish only covers 50% of the employee premium, which is a lot less than most traditional healthcare companies. But the insurance options are decent.
They also offer tech/office reimbursement and some other perks and minor benefits. Unfortunately, they do NOT offer a retirement plan, which is a huge downside. Truly, this could cost you thousands if not hundreds of thousands of dollars of missed money. Make sure you understand this!
Also, the paid time off accrues very, very slowly. You will accrue 1 hour of PTO for every 12 client sessions. That’s 96 sessions for a single day off. Yikes!
Client Load:
Overall, the feedback about the client load and no-show rate has been positive. Up until very recently, most of my clients and connections had no issues with filling their schedules.
However, Nourish has RAPIDLY expanded their dietitian team, so it’s hard to state if this will continue to be true or if they will hit a saturation point. I am seeing more reports about newer employees having issues with a full client load. This is problematic because you must maintain your client minimum in order to get benefits.
Mentorship/Support:
Overall the mentorship and support provided by Nourish have been excellent. Dietitians have the opportunity to join mentorship calls and trainings and there is an internal platform for questions too. They also have a lot of resources for dietitians to access.
Performance Expectations:
The majority of dietitians have reported that the performance expectations are realistic and achievable. Most of the dietitians that I have worked with have very high provider satisfaction scores, which is a great sign.
Overall Feedback:
The majority of dietitians that I have spoken with appear to be happy with Nourish. The biggest downside is the burnout potential because you do have to maintain a high client load. Others feel that the lack of retirement and the pay are very average.
In general, it does feel like it’s frowned upon to have your own private practice. This makes sense if you’re a full-time employee. Keep this in mind if your ultimate goal is to grow your own private practice. I’ve also heard recently that Nourish is encouraging RDs to do marketing for the company and to find their own source of client referrals- it is unclear if this is paid time or not. My guess is that it’s not paid.
My Opinion:
Nourish is one of the few companies that is paying dietitians as W2 employees and offering benefits. While the benefits could be improved, it’s a great start. I would love to see a salary adjustment though for dietitians with more years of experience. I also love that they offer options to switch between part-time and full-time employees, which is great for those that are balancing multiple roles or family commitments.
Pros and Cons of Fay Nutrition
Who are they?
Fay is a network of registered dietitians with a mission to help people eat better and live better. They heavily market the platform as a tool to help dietitians start and grow their successful private practice. A few years ago, it seemed like Fay was more aligned with intuitive eating, but that no longer seems to be the case.
Pay:
Fay advertises pay of up to $135/hr. However, I have spoken with several RDs and all of them say that the rate varies by insurance company. While RDs are under a non-disclosure for exact rates, they have stated it’s closer to the $70-90/hr range. Since this is a contract role, you would also pay self-employment taxes.
Benefits:
Benefits are not offered since it’s a 1099 contract role. They really don’t even try to sugarcoat this- you are not an employee of Fay.
Client Load:
The feedback on client load is very mixed. I have spoken with dietitians who have maintained a full-time client load with no issues, while others have only had a handful of clients.
Like most companies, there is an algorithm that determines who gets the clients. Being licensed in more states will help as well having more availability. You also need to maintain a high provider satisfaction score.
Mentorship/Support:
There is no support or mentorship available based on reports at the time of publication. It is expected that you have prior counseling experience and can operate independently.
Interestingly, I have heard reports of new RDs being hired and also received clients with complex cases. It’s important to know your scope of practice and when to refer out.
Performance Expectations:
Most of the dietitians that I have spoken with feel that the expectations are realistic since the company is mostly hands-off.
Overall Feedback:
Fay is a good option if you want another referral source of clients. You can maintain your private practice while working for Fay (although you cannot bring Fay clients over to your practice). If you’re confident in your counseling skills and need minimal mentorship, it’s one of the highest-paying options. The downside of course is that they don’t offer any benefits.
My Opinion:
Fay has dominated the market for a few years now and has really pushed their advertising and SEO. Some dietitians have complained that Fay has created Google Business profiles in their name (without consent) in order to get more clients. When dietitians have requested that they get ownership back of their Google profile, Fay has terminated their contract. This sounds like a big red flag to me.
Also, Fay is another company that has recently secured a HUGE round of funding to the tune of $25 million. So again, it’s baffling that they can’t afford to pay their RDs better or to offer benefits.
Overall, it seems like a hit-or-miss experience.
Pros and Cons of Dietitian Live
Who are they?
Dietitian Live offers nutrition counseling services for over 30 specialty areas. They offer counseling in over 35 states and are credentialed with most major medical insurance companies.
Pay:
Dietitian Live advertises pay of $20-45/hr. They only hire full-time dietitians and this is a W2 position. The pay is $45/hr for an hour long session, $20 for no-shows/late cancels and $30/hr for meetings. Their job description states that you can earn $60-80k a year with 30-35 sessions per week. By my calculations, it would only be possible to achieve $80k if you see 35 clients a week.
It’s also appears that all dietitians are paid the same regardless of years of experience.
Benefits:
DietitianLive offers 20 days of PTO and 8 paid holidays which are only paid at $25/hr (this is unfortunate, but I guess they at least offer PTO). They also offer 50% insurance premium coverage, a 401k (unclear if they match) and licensure reimbursement after 1 year of employment. They also offer 8 weeks of paid maternity leave after 18 months of employment!
Compared to a typical job, these benefits are not stellar. But they are some of the best benefits I’ve seen for a nutrition start-up company and very few even offer benefits at all.
Client Load:
This is a full-time position with the expectation to see 30-35 clients per week. This is a lot and I suspect leads to a higher rate of burnout. Dietititans have also complained that while you’re allowed to specialize in different areas, they don’t filter clients by specialty. Clients will randomly be assigned to you so you must know everything about everything.
Dietitians have also complained that there are a ton of required meetings. You should also note that the entire month of January is blacked out, meaning you cannot take time off during January.
Mentorship/Support:
The RDs I have spoken to all have very favorable things to say about the mentorship and support. They offer a 6-week intensive training, which is great to see. They have a tiered employment structure with lead dietitians as well.
Performance Expectations:
Most of the RDs I spoke to stated that the client load is very high and is hard to maintain. Others mentioned that the amount of required meetings feels excessive.
Overall Feedback:
Dietitian Live is one of the few companies offering a benefited, W2 position. A few of the RDs mentioned that they do not get yearly raises, which is a huge downside in my book. Others feel like the workload is extremely high and that it’s hard to keep up with all of the changes with a rapidly growing start-up.
My Opinion:
Dietitian Live seems like a promising opportunity, but I always recommend doing your own research before you decide if it’s the right fit for you.
What the Future Holds
This is not a comprehensive overview of all of the nutrition telehealth start-up companies out there. There are dozens more including companies such as Berry Street, Husk, Swap, Oshi, Alara, Vida and so many more. Many of these companies are rapidly growing and rapidly hiring registered dietitians. These companies will likely encounter growing pains and some will fail financially.
While it may sound like I’ve shared more downsides than perks, I love the flexibility that remote counseling roles offer. Having the ability to set your own work schedule is a tremendous perk and cutting back on commute time is invaluable. As someone who works fully remote, I love being able to take a midday break to exercise or start a load of laundry.
My hope is that dietitians can continue to advocate for their worth and demand better pay structures and more time for administrative work that is paid at a fair rate. Hopefully, with the rapid expansion of these companies, the competition for qualified dietitians will also lead to more fully benefited roles, but only time will tell.
I have also been encouraged to see that smaller private-practices have been hiring dietitians as well. This is a great option if you desire more mentorship and support. There may also be more opportunities to specialize by going this route as many private practices have a unique emphasis.
Final Takeaway
As you can see, working for a nutrition counseling start-up has both its perks and challenges. For dietitians who are looking for remote work, flexibility, and the opportunity to focus on nutrition counseling without the headaches of managing a private practice, these companies offer some intriguing options. However, the downsides, such as inconsistent schedules, minimal pay for no-shows, and lack of benefits for contract workers, can be deal-breakers for others.
Ultimately, the decision to work for a start-up comes down to personal priorities. If you value remote work and flexibility over job security and comprehensive benefits, start-ups might be a great fit. On the other hand, if you're looking for stability, benefits, and long-term job security, you may want to carefully weigh the pros and cons before jumping into the world of start-ups.
If you are interested in hearing more about specific companies, always make sure to reach out to dietitians who have worked there. Their feedback will provide you with the clearest picture of what it’s like to work for a particular start-up.
Do your research, know your worth, and make the decision that’s best for your career goals and personal life balance!
About the Author
Kelan Sarnoff, MS, RD is a Registered Dietitian with over 10 years of experience in the nutrition realm. She has experience in hiring and recruitment in both the clinical and academic settings. Kelan is passionate about helping dietitians land a job that aligns with their passion, values, and skills. She also believes in raising the pay for all dietitians and empowering dietitians to negotiate for desired compensation.
