Private Practice Dietetics Workforce Development: Experiences and Perceptions of Australian Academic Educators

ABSTRACT

Background

Private practice dietetics is a rapidly growing work domain for graduate and experienced dietitians due to a competitive job market, expansion in remuneration options from health insurance systems and a desire for self‐employment and flexible working conditions. Private practice dietetics requires core dietetics skills and business acumen, however, tertiary training opportunities for private practice preparation and development are unclear. This qualitative descriptive study aimed to explore the experiences and perceptions of academic educators from accredited Australian dietetics programmes on workforce development in private practice dietetics, with a focus on graduate preparedness, curriculum models, competency development, and placement opportunities.

Methods

Academic educators from accredited tertiary training programmes were purposively sampled for participation in semi‐structured interviews on their experiences and perceptions on workforce development aspects for private practice. Data was analysed using qualitative thematic analysis methods.

Results

Nineteen academics participated from 15 universities. Sixteen themes emerged across seven constructs; pathways, the work of private practitioners, preparation, competency development, placements, competency requirement, and workforce challenges. Preparing future private practice dietitians presents notable challenges within the context of tertiary education, particularly due to challenges around private practice placements, curriculum crowding and competing educational priorities. Additionally, significant professional and structural barriers were identified in relation to building capacity within the private practice dietetics workforce.

Conclusions

Addressing the issues raised with tertiary educators will require a collaborative approach, including the development of consensus on key workforce development strategies. Such efforts are essential to support this important career pathway, which plays a critical role in delivering nutrition services to the community.

Summary

• A qualitative descriptive study is provided with in‐depth insights of the experiences and perceptions of Australian academic dietetics educators on tertiary curriculum, placements, post‐graduate support and workforce development aspects for private practice dietetics.

• Academic educators experienced significant challenges in preparing students for private practice dietetics, in part related to curriculum crowding challenges and navigating the implementation and viability of private practice placements. They called for more structured post‐graduate support.

• Our findings demonstrate that more research is needed around the preparation and training needs for students and graduates, along with strategies to build capacity of the private practice dietetics workforce.

1. Introduction

Currently, more than one‐third of accredited practising dietitians work in private practice [1, 2]. Private practice dietetics in Australia represents a dynamic and expanding area within the nutrition and dietetics profession marked by evidenced‐based individualised client‐centred nutrition services delivered through autonomous, small or larger business models [3]. Practitioners support clients across a broad spectrum of health conditions, often operating independently or embedded in multidisciplinary teams in primary healthcare settings, virtual settings, or community‐based environments [4, 5, 6, 7]. Dissimilar to traditional institutional roles, private practice dietitians must combine clinical expertise with robust business acumen, including marketing, finance, client retention strategies, digital health delivery, navigation of health insurance systems, and legal and regulatory requirements related to both core dietetic practice and business management [8, 9].

Over the past two decades, the growth of private practice has been catalysed by shifts in consumer behaviour and health system restructuring [3, 10, 11]. Increasing awareness of the role of nutrition in preventable disease, the increasing prevalence of chronic diseases, and the widespread adoption of telehealth technologies have expanded the reach and appeal of personalised dietetics services [12, 13]. In Australia, policy and insurance reforms, including the expansion of Medicare [14], National Disability Insurance Scheme (NDIS) [15, 16], and Department of Veteran's Affairs benefits [17], and the government's priorities shifting to future proof primary care [18], have made dietetics services more accessible through public and private channels and encouraged entrepreneurial models of care. As a result, private practice is no longer a niche career path, but a mainstream and viable option for practising and early career dietitians with 30%–50% taking up this study opportunity [19, 20]. The recent establishment of evidence‐based data [21], and quality standards [22], may be helpful in this regard.

Despite this trend, dietetics education and training has been seemingly slow to evolve in ways that adequately prepare graduates for success in private practice, despite calls from graduates for more business skill training [23]. The Australian professional body, Dietitians Australia, provide competency standards offering a foundational framework for entry‐level practice [24]. A recent broadening of competency standards has seen the inclusion of contemporary and future focused areas such as the inclusion of Aboriginal and Torres Islander Peoples, consumer perspectives and emerging dietetic roles [25]. Despite this, the standards have reduced specificity or benchmarks for skills specific to private practice, including business development, client retention strategies, digital marketing, financial and legal responsibilities of running a practice [25]. Although allowing for flexibility in teaching and learning opportunities, it does leave standards open to interpretation.

Additionally, curriculum crowding and bureaucratic barriers have been identified as challenges to responding to evolving professional needs [26]. Academic educators play a key role in the planning of curriculum and preparation of students for private practice dietetics within accredited tertiary programmes [26]. The Dietitian and Nutritionist Regulatory Council govern the accreditation of dietetics programmes in Australia, with curriculum designed around the competency standards within the governance of accreditation standards [27, 28]. Challenges in prioritising curriculum to support current and future areas of practice over historical training have been reported [26, 29]. While some universities have introduced some entrepreneurship and private practice specific curriculum, the inclusion is varied and unclear [3, 30]. Effective competency development in this area requires intentional scaffolding of learning across the qualification, including foundational business concepts and culminating with hands on opportunities to apply these skills in practice‐based settings [31, 32, 33]. Both graduate and experienced private practitioners describe feeling underprepared for private practice at the graduate entry level, thus it is imperative that an understanding of current preparation, needs and gaps are determined, to ensure capacity building of this study domain to support the patients and clients it cares for [8, 19, 20, 23, 34, 35].

Our previous study has investigated private practitioners’ experiences of workforce development aspects [8], and a curriculum content analysis examined the extent to which entrepreneurship preparation for private practice is embedded in dietetics education [30]. While these studies provide valuable insights into practitioner experiences and educational content, they do not capture the intentions, challenges and pedagogical strategies of those responsible for designing and delivering relevant curriculum. By addressing academic educator's experiences, this study addresses a critical gap in understanding how private practice preparation is conceptualised, prioritised, and operationalised within dietetics education programmes, including strategies, gaps to inclusion and challenges to implementation. It also enables exploration of their viewpoints and insights about broader workforce development aspects in private practice dietetics and the alignment or misalignment with preparation and workforce needs to those seen in earlier studies. This study also offers the opportunity for data triangulation, strengthening the validity and comprehensiveness of findings across the research programme. Insights from educators help contextualise the practitioner and curriculum data, reveal systemic or institutional influences on workforce development, and identify opportunities for curricular restructuring and professional collaboration.

The aim of this study was to explore the experiences and perceptions of academic educators from accredited Australian dietetics programmes on workforce development in private practice dietetics, with a focus on graduate preparedness, curriculum models, competency development, and placement opportunities. Additionally, it also aimed to identify gaps and opportunities in workforce preparation, examine placement constraints and present emerging strategies used by academic educators to enhance private practice readiness.

2. Methods

This study employs a qualitative descriptive approach, utilising semi‐structured interviews following seven stages of inquiry (designing, interviewing, transcribing, analysing, verifying, thematising and reporting) [36, 37]. The researchers adopted an interpretivist theoretical perspective, acknowledging that the realities are derived from the participants’ interpretations of their lived experiences and recognising that the researchers’ viewpoint might influence the study [38]. The protocol was approved by The protocol was approved by Swinburne University of Technology Research Ethics Committee (Approval No. 20248156‐19691).

The research team included those with pragmatist philosophical standpoints, which informed the design and supported reflexivity during the analysis phase [38]. Collectively the research team brought extensive experience in health professions education and research, comprising two dietitians and two physiotherapists. The first author is undertaking a PhD in workforce development of the private practice dietetics workforce, she has worked as a private practitioner since graduation and is involved in the preparation of graduates for private practice dietetics. These experiences provided valuable insights while also necessitating deliberate reflexivity to minimise potential bias during data interpretation.

Participants were selected based on specific inclusion criteria: those currently working as an educator in a Dietitians Australia accredited dietetics programme and who were 18 years or over. Those not meeting these criteria were excluded. Academic educators were recruited through purposive sampling [39], using publicly accessible contact information from university websites, and complemented by snowball sampling [40]. Potential participants were invited to participate in the study via email. If initial contact did not elicit a response, follow up contact was made. At least one academic from each accredited university was offered participation, with multiple offered participation as a result of snowballing. If no response was obtained after two follow‐up emails, it was assumed the participant did not wish to participate, in which case an alternate academic within the same university would be offered participation. Where a participant declined participation due to time constraints, no longer teaching into the programme or feeling they were not the best person to speak to private practice, all recommended alternative academics.

The research team developed a semi‐structured interview protocol, informed by previously published literature [9, 41, 42]. Inquiry logic and semi‐structured interview questions for conducting interviews are outlined in Supporting Information S1. A pilot interview was conducted with an academic to gauge timeframes and the adequacy of questions, with only minor changes made. The pilot interview was not included in the final data set.

Participants received the consent form and participant explanatory statement via email and were asked to provide suitable times and dates for the interview if interested. Upon returning the consent forms via email, participants were scheduled for a 30–45 min interview via teleconference using Microsoft Teams (office/home setting). An emailed copy of the interview questions was provided at least 1 week before the scheduled interview time.

One researcher (J.D.) conducted all interviews with each participant. Field notes were taken throughout the interview process. All interviews were audio‐recorded and stored on a password protected database—OneDrive Business. All interviews were transcribed using Microsoft Teams, then reviewed and corrected by one researcher (J.D.) as needed. All participants were given the opportunity to review their transcripts, with six participants opting to verify the accuracy of their transcript which was emailed to them for approval. No changes were requested. Transcripts were also available for download via Teams after the interview for all participants. Transcripts were then de‐identified for further analysis. Data collection ceased based on saturation principles [43], when no new major concepts were introduced in the interviews and as agreed upon by two researchers J.D. and R.H.

Participant attributes were descriptively analysed. The de‐identified qualitative interview transcripts were analysed using qualitative thematic analysis, following the systematic approach described by Braun and Clark [44], and guided by framework analysis from previously published literature [3, 8], covering seven workforce development constructs. Constructs were pathway (to practice), the work (of private practitioners), preparation, competency development, placements, competency requirements and challenges. Two authors (J.D., R.H.) analysed the interview transcripts to determine codes describing key concepts, categories, themes and subthemes based on the responses against the analytical framework, using software (J.D.) (NVivo14) [45], and manual analysis (R.H.). Discussions to reach consensus on analysis between the two coders were conducted in team meetings. Final themes were presented in a table and as a narrative synthesis.

3. Results

A total of 19 academic educators completed an individual semi‐structured interview via online videoconference. Demographic characteristics of the participants are described in Table 1. Women represented the majority of participants (n = 17, 90%), similar to the representation within the profession of 93% [46]. Fifteen universities with accredited programmes were represented (83%), while programmes from the two Australian territories and one from the state of Queensland choosing not to participate. Three universities were represented by two participants each (Queensland n = 2, Western Australia n = 1). Years of experience ranged from 2.5 to 22 years in academia, with almost 50% teaching in their current programmes for 0–5 years. All but two academics held a Doctor of Philosophy qualification, with four also holding senior academic positions including Professor (n = 2) and Associate Professor (n = 2) roles. Table 1 outlines the characteristics of participants.

Table 1.

Characteristics of academic educators from accredited programmes (n = 19) interviewed in this study.

Category	n (%)
Gender
Women	17 (90)
Men	2 (10)
Non‐binary	0 (0)
State
Victoria	5 (26)
Queensland	6 (32)
New South Wales	4 (21)
South Australia	1 (5)
Western Australia	3 (16)
Northern Territory	0 (0)
Australian Capital Territory	0 (0)
Tasmania	No accredited programmes
Number of years in academia
0–5	5 (26)
6–10	6 (32)
11–15	5 (26)
16–20	2 (11)
21+	1 (5)
Number of years in current programme
0–5	9 (48)
6–10	5 (26)
11–15	3 (16)
16–20	1 (5)
21+	1 (5)

The participants were experienced dietetics practitioners and tertiary educators. Eleven academics had work experience in private practice dietetics during their career, from brief work as an employee to more than a decade as a business owner. Generally, experience was limited to early career work or part‐time work alongside other positions. The career trajectory tended to follow a pathway that included hospital or private practice work after graduation, stepping up to part‐time teaching roles and undertaking doctoral degrees, before assuming full‐time academic roles as dietetics academics.

Academic educators shared insights spanning the workforce development landscape encompassing both university‐based training and workplace settings. Analysis led to the identification of themes and sub‐themes related to the a priori framework constructs including pathway, the work of private practitioners, preparation, competency development, placements, competency requirements and challenges (Table 2). A detailed analysis of findings related to each workforce development construct is presented under their respective subheadings (in bold) throughout the remainder of the results section. Themes and subthemes are presented in italics in the narrative.

Table 2.

Constructs, themes and subthemes of the semi‐structured interview analysis.

Construct	Theme	Sub‐theme
Pathway	Historical perceptions versus present trends in private practice	Desire Default entry Growing numbers of graduates Trend to be an entrepreneur
The work of private practitioners	Trend for flexible work arrangements	Desire to work the hours they choose
	Conflicting perceptions around work arrangements for new graduates	Graduates should not work as Sole Traders Graduates can work as an employee Conflicting viewpoint on private practice as core work versus not entry level work domain
Preparation	Graduates are underprepared for private practice	Lack of understanding of work functions to align with competencies and training needs Current curriculum lacking Lacking business skill training Need to bolster counselling skills
	Tertiary training challenges	Curriculum crowding Competing priorities from other emerging areas University bureaucracy
	Historical misalignment with clinical preparation and neglect of private practice	Reliance on past work and life experiences, volunteerism and nepotism Competency standards align with private practice preparation, but interpretation is the challenge
Competency development	Student dependent	Previous business or customer relations experience Students with innate entrepreneurial attributes Initiative dependent Difficult to develop business competence when focusing on clinical competencies
	Assessment inconsistencies	No assessments Authentic business‐related assessments across some universities
	Post‐graduate support strategies strained with perceived ethical tensions	Further post‐graduate training is needed Supervision models or improved mentoring models Tension between support for micro‐credential or internship versus cost and time burden
Placements	Models	No placement Limited placements as part of individual case management placements Elective option Student‐led clinics
	Barriers	Lacking governance Client burden Health insurance systems prohibitive Resourcing challenges Accreditation impediments despite standards supporting diversification of placements
Competency requirements	People skills and enhanced counselling skills	Client relationship skills to foster client connection and maintain networks Self‐motivation Reflective practice and self‐awareness skills Strengthened resilience Strong work ethic Confidence The ability to elicit and support behaviour change
	Business acumen and an entrepreneurial mindset	Included in competency standards, but interpretation is the issue Innovative thinking needed
	Strong clinical skills	Increasing complexity of cases in private practice sector Tangible results
Challenges	Professional limitations to success	Undervalued profession Advocacy needed Improved marketing of the profession is needed Perceptions of an oversupply of graduates A shift from the historical emphasis on clinical dietetics is needed
	Multiple structural impediments to viability	Community services cut in some states Health insurance inadequacies Confusing health insurance systems A call for standards in private practice to assure quality Improved systems needed to ensure continuity of care e.g. referral pathways

3.1. Pathway

Academics have conflicting viewpoints regarding historical versus present trends in private practice, with some still perceiving graduates as aspiring to hospital positions versus contemporary evidence of increasingly students enroling in dietetics programmes with the intention of working in private practice.

I think that it's just the opportunities are rapidly increasing but our perception is not rapidly changing. I think we just need to acknowledge that private practice is the way of the future. This is where the opportunities are and we all just need to do whatever we can to support students into this area.

(ID07)

They want to become hospital dietitians, but reality is there isn't enough hospital jobs to cater for all the graduates, so some would miss out…so somewhat aligned with the clinical interest, private practice is much more attractive compared with food service and public health in some students’ minds.

(ID14)

Academics agree that there is a growing momentum for private practice as an employment domain, with graduate dietitians entering the private practice workforce either as business owners or employees, with a desire to work in private practice or by default entry due to the increasing competition for traditional hospital jobs. Student debt and increasing opportunity with the availability of work were other factors deemed to be influencing surging graduate entry into private practice. They appeared unsurprised when presented with data that indicated 30%–50% of graduates were entering private practice post university and agreed that there are growing numbers of graduates entering private practice dietetics, with their respective estimates aligning with workforce published data.

It would be …similar to the likes of 30 to 40% of our cohort would end up working in private practice.

(ID15)

It's probably around the 40 to 50% at this stage…

(ID16)

Likewise, social media and the public interest in nutrition and the trend to be an entrepreneur are thought to be reasons why students have an interest in private practice work.

I think social media might also play a role, and I think that's because the people who are influencing the dietetic space on social media tend to be private practice dietitians.

(ID06)

However, default entry into private practice due to the inability to secure other employment is a concern for academics, who fear business failure, graduate burnout, a lack of clinical governance and exploitation of graduates due to perceived unfair contractual agreements.

I think just knowing statistics in terms of businesses and how many businesses fail, it's kind of almost setting them up for failure in itself, that because they can't get a job in the health service [hospital], which is what they wanted, they go well I'll just do this cause it's like it gives me a job, but I know that they're not prepared for it.

(ID15)

3.2. The Work of Private Practitioners

Adding to the momentum for private practice and increasing growth in this sector of the workforce, is the trend for flexible work arrangements and the desire to work the hours they choose. Self‐employment is a component of private practice and being one's own boss lends itself to this. The trend is also likely enhanced by the experiences acquired during the COVID‐19 pandemic where there was more flexibility, self‐directed learning and working from home, was felt may also be adding to this trend.

I also think that the flexibility of private practice is enticing to new graduates.

(ID06)

Academic educators expressed conflicting perceptions around work arrangements for new graduates. Some viewed it as a viable option for well‐prepared graduates, particularly when graduates had pre‐existing business acumen or if working under supervision or as an employee. Others cautioned against sole trading or directors of their own companies due to concerns around competency, risk management and working out of the professional scope of practice. There was also a conflict among academics regarding whether entry into private practice as a graduate constitutes an entry‐level domain, whether graduates should avoid or be mandated against working as sole traders or company directors.

Private practice work is core dietetics work. It's not separate.

(ID07)

I don't suggest people go straight from uni to work in private practice, or you need to put really clear boundaries around what you will see…

(ID03)

The ideal scenario is perceived to be that graduates should initially work as employees to gain experience before transitioning to solo practice. However, experiences for graduates as private practice employees have varied, including issues such as inadequate remuneration for work completed and strict restraint clauses in contracts.

It's like the Wild West. You've got really good practitioners who are probably quite ethical and then you've got some that go, “Ohh yeah, I'll take some free labour.”

(ID03)

3.3. Preparation

Academics agree we need to better understand the function of private practitioners to ensure that competencies and training aligns. All academic educators agreed that graduates are underprepared for private practice from a tertiary training perspective with current curriculum lacking. Many felt that more work is required either at a tertiary training level and/or at the post graduate level to better support graduates moving into private practice.

I think education should really, in university, should really support people to be able to enter any area of practice at an entry level, including private practice.

(ID06)

I think as universities, we absolutely could do a better job at preparing our graduates, and we've added a little bit of things in over the years to support that private practice training, but certainly not where it needs to be and where I'd love to see private practice.

(ID19)

Current tertiary programmes were described as limited to single units for entrepreneurship versus an elective option or little to no content. Embedded content within other units and scaffolding were also tools to build in content to support preparation.

So, I think we need more of it. We do bits and pieces…nowhere enough.

(ID10)

There's a wonderful unit run by our very experienced colleagues and students rave about it, and I believe this unit opened their eyes into the world of private practice dietetics, which is needed.

(ID14)

Overall, there was a feeling that business skill training is lacking within programmes, however, there were conflicting viewpoints as to whether this should be bolstered in training programmes or whether it should be completed post‐graduation.

We definitely don't have enough in terms of business side of things at the moment.

(ID15)

It's really, really just scratching the surface.

(ID18)

Some academics described attempts at bolstering counselling skills and building in more private practice style case studies to address clinical gaps, others had private practitioners attend to provide private practice workshops. Some argued that with the broadening of competency standards, training needs to be less specific to one domain over the other and the goal is graduate entry training level competency.

I think education should really, in university, should really support people to be able to enter any area of practice at an entry level, including private practice.

(ID06)

There was also a concern that underprepared, under‐supervised new graduates in private practice dietetics posed a reputational risk to the profession.

So, if they don't have that support around them from a multitude of angles, then they're probably going to set themselves up to fail and going to find themselves in situations that they don't want to find themselves in.

(ID09)

Academics reported numerous tertiary training challenges to expanding more private practice specific curriculum. Curriculum crowding was a unanimous challenge with academics reporting that although they may want to include more in the curriculum, they already struggled to find space in their programs to adequately cover other emerging areas of practice, especially in Masters programs that run between 18 months and two years. They also had concerns about student welfare, with academics feeling that students were already overloaded by the current program content and adding more would result in cognitive overload and negative effects on the mental health of students. Similarly, they raised concerns around inadequately covering topics when adding more topics into programs and the impact on graduates then being underprepared for other areas of practice or struggling to acquire work ready competence. Competing priorities from other emerging areas was a barrier and the struggle to include more private practice preparation whilst ensuring adequate coverage of other key priority areas from recent competency standard updates.

….there are so many emerging priorities, …obviously and it should be, Aboriginal and Torres Strait Islander Peoples health and sustainability.

(ID04)

Navigating university bureaucracy was a challenge highlighted by participants, including the numerous hurdles to incorporating more curriculum into programmes, which often delays timely roll out of new curriculum. Nevertheless, many acknowledged a desire or plan to implement more private practice specific curriculum with some referring to the professional body to provide more guidance around preparation and support.

Academics report a historical misalignment with clinical preparation and neglect of private practice, with training programmes traditionally focused on preparing graduates for hospital work, despite academics agreeing that the employment landscape has changed. They reflected on their own preparation as inadequate with minimal preparation at university in their own training programmes.

Not ready at all…it wasn't really a part of the curriculum.

(ID08)

Academics who had work experience as private practitioners emphasised a reliance on past work and life experiences, volunteerism and nepotism to support their development on the job. A number who had entered private practice deeper into their careers felt clinically competent, but found it challenging to navigate business set‐up, with some describing working as employees to avoid having to manage a business.

So my history and background definitely helped with business management. It also definitely helped with interacting with people because it's easy to form connections with someone when you have a lot of life experience.

(ID07)

One even described the need to Google everything and navigate as they went.

Very unprepared, I felt that I had to Google everything…I was making it up as I went along.

(ID16)

Several academics incorporated content into their programmes on gaps they identified in their own training, drawing on personal experiences to fill what they had been missing in their education. Others expressed a strong desire to expand the curriculum from similar motivations, but felt constrained by the institutional challenges, as outlined earlier.

Academics generally felt that the broadening of competency standards align with private practice preparation, but interpretation is the challenge. These challenges around interpretation are also impacted by the challenge in prioritisation of content tailored to private practice over other priority areas, and more broadly, ensuring consistent preparation across institutes. In contrast, some academics argued that competencies like business acumen did not form part of the current accreditation framework and if programmes were to include this aspect it was a “like to have” rather than “need to have”.

I think the competency standards already encompass the private practice skills.

It's just that I think we're not all interpreting those standards the same way or developing education in the same way…

(ID06)

I'm not 100% sure that [entrepreneurship] is relevant to the current accreditation framework. This is something we offer to student as an addition.

(ID14)

3.4. Competency Development

Interview participants discussed current opportunities for students to develop competence specific to private practice within their institutions. Participants viewed current competency development opportunities as student dependent, and assessment based, and discussed the level of post‐graduate support for new graduate private practitioners.

Competency development for private practice was considered by many participants to be student dependent. Academics’ experiences of students who had previous business or customer relations work experience positively influenced their competency development. Similarly, those with innate entrepreneurial attributes including well‐developed soft skills, like being initiative driven, supported their preparation for private practice, irrespective of university training, compared with those without such skills or experiences. Many academics contend that it is difficult to develop business competence when focusing on clinical competencies as a graduate, however, some acknowledged that graduates who secure positions in highly supportive private practice settings can still succeed, even without strong foundational business knowledge. These environments were described as providing the mentorship and structured learning opportunities necessary to bridge gaps in business acumen, facilitating the simultaneous growth of both clinical and business competence.

I think it's really contextual and depends on a lot of factors.

(ID04)

And then there's others who fall into a great practice and have the mentorship, and they thrive.

(ID10)

Assessments form an important part of competency development according to academics. Assessment inconsistencies were evident. They varied from authentic business‐related assessments across some universities, including business models, business pitches and business case study assessments, to unrelated assessments, to no assessments present in a programme.

… more practical elements within that unit around, you know, examining requirements for setting up and running private practice or a consultancy and…social enterprises and…things like building business plans, developing marketing strategies…

(ID09)

Post‐graduation support was deemed imperative to building the capacity of the profession and the success of graduates working in private practice.

We teach graduates to entry level and then it's kind of like making sure that there's those supports and opportunities for them to then grow or get the extra professional development outside of here.

(ID11)

Academics believed graduates were under supported post‐graduation for private practice, however, their post‐graduate support strategies were strained with perceived ethical tensions. The provisional mentoring programme whereby graduates need to be mentored by a fully Accredited Practising Dietitian for 12 months [47], was deemed helpful, but inconsistent in terms of its offerings to graduates, and success was largely dependent on the mentor, and the mentee's ability to maximise the opportunity. Academics described the need for more structure, however, graduate accessibility to mentors in private practice is perceived to be challenging as many private practitioners are self‐employed. They have the extra workload of navigating business management and business viability. A number of academics mentored graduates out of concern for graduates causing reputational damage, feeling that if they did not, no one else will.

…it's not guaranteed [the level of support] that it's going to meet their requirements or the types of support that someone needs if they're going into private practice.

(ID04)

Academics were in agreeance that further post graduate training is needed, with supervision models or improved mentoring models suggested solutions, however, a tension between support for micro‐credential or internships versus cost and time burden was raised. Concerns were raised around mandating something solely for private practice and expecting graduates to pay for future study after years of significant university acquired debts from their training.

I think there's probably some value in considering you know something like a micro credential or… a graduate certificate or something similar around… private practice.

(ID09)

Continued professional development opportunities were felt to be improving, but academics felt further work was needed to provide financially viable options.

3.5. Placements

Private practice placements were viewed as needed and a necessary part of the preparation and curriculum for private practice. Many academics reported that their programmes have no placement in private practice, however, few had limited placements as part of individual case management placements or an elective placement. A number previously had private practice placement sites, but no longer used them due to accreditation impediments despite standards supporting diversification of placements. Multiple academics described receiving advice to avoid private practice placements due to the perceived challenge for students to meet National Competency Standards in such a placement.

While academics believe competency standards are more inclusive of the necessary competencies required for private practice placements, these are perceived to present numerous hurdles, such as lack of governance structures, client burden, and health insurance systems that are prohibitive of students consulting clients. Resourcing challenges are faced by private practitioners when running a business and supervising a student.

…with an acknowledgement from the governing body around the fact that elements of competence can actually be achieved outside of those traditional domains, that does open up this scope to use private practice for placements. You know, I'd say as little as ten years ago, it was probably frowned upon that can you know, what are students going to learn.

(ID09)

Numerous academics reported either having or planning to establish student‐led clinics as a potential solution—something better than nothing to private practice placements. However, the major drawback was the reported lack of authenticity, as student‐led clinics are often free or low‐cost. Additionally, challenges such as university funding limitations have led to the reduction or cessation of these clinics.

I don't think it's a true representation, obviously, because the members of the community, they're not paying for this service. The consults are long. So, I think it's kind of…not a true representation, but it's kind of giving some idea of some of the things that would be involved in in that service…

(ID18)

3.6. Competency Requirements

Competency requirements for private practice were identified as people skills, enhanced counselling skills, business acumen, an entrepreneurial mindset, and strong clinical skills. Academics emphasised people skills, including client relationship management to foster client retention and maintain networks. These were deemed critical for business viability.

Enhanced counselling skills were regarded as essential with the ability to elicit and support behaviour change through motivational interviewing and other counselling techniques were determined as key requirements for success in this study area, and the acquisition of such skills were transferrable and necessary in the hospital sector.

Counselling is the key thing that we need in private practice, like you need to be able to counsel clients through behaviour change and often students, because we do seem to separate this as private practice and clinical, I often get students with the perception you don't need that for the hospital setting, and I can categorically tell you that if you do it in the hospital setting, you will be a champion dietitian and you will have better patient outcomes.

(ID07)

Business acumen and an entrepreneurial mindset emerged as a key competency for success in private practice regardless of whether one works as an employee or a business owner. However, some academics had a strong feeling that competency requirements for private practice were transferrable across all domains with many academics acknowledging that most work environments require human resourcing, self‐management skills, financial management, marketing and innovation amongst other aspects of business acumen, enforcing the need for training in these areas in preparation for entry level.

…all the things that apply to private practice, apply broadly, and even business skills…lots of dietitians are moving up through management roles in hospitals and we're trying to promote that. We want more dietitians in management roles to get there. You need basic business skills, so by teaching business skills to dietitians, we're not just teaching them that for private practice. These are good skills that can be used in lots of different areas.

(ID07)

Self‐motivation, reflective practice and self‐awareness were viewed as critical beyond other professional domains. Strengthened resilience was highlighted as vital, given the solitary nature of work in private practice alongside a strong work ethic, confidence, and innovative thinking.

Strong clinical skills were also reported to be crucial due to the increasing complexity of cases in private practice as a consequence of the overloaded tertiary healthcare sector. In private practice, some academics felt there is also a requirement to provide tangible results at each client interaction, contrasting with the hospital system, where professionals have the opportunity to step away and return later.

3.7. Challenges

Numerous workforce challenges were outlined by academics, including professional limitations to success and multiple structural impediments impacting viability. Professional challenges included the feeling that dietetics is still an undervalued profession compared to its competitors and as such, more advocacy and improved marketing of the profession is needed. A perception of an oversupply of graduates is also of concern and likely impacting the employment outcomes of graduates leading to default entry into private practice, as discussed earlier. There was an overall feeling that as a profession a shift from the historical emphasis on clinical dietetics is needed which would support workforce development of the private practice dietetics workforce with some acknowledging that business skills are relevant to all areas of practice.

Structural challenges included community services cut in some states of Australia which has a detrimental impact on the tertiary healthcare system and a demand for cost effective primary healthcare. Health insurance inadequacies for example inadequate remuneration and inadequate allocation of sessions under Medicare Chronic Disease Management plans were areas where advocacy was needed to support client access and to build capacity of the private practice workforce and enhance the sustainability of those currently working in this critical area.

There's scope to advocate for…higher rebates or additional visits via enhanced primary care.

(ID04)

Confusing health insurance systems including the NDIS compound the influx of perceived underprepared graduates entering private practice.

It's an absolute minefield. Absolute minefield.

(ID16)

Some called for standards in private practice to assure quality and improved systems needed to ensure continuity of care e.g. referral pathways, understanding the challenges around just receiving and then translating referrals to patient bookings.

4. Discussion

This qualitative study explored academic educators’ experiences and perceptions on workforce development of the contemporary landscape of private practice dietetics. Findings highlight momentum for this study domain as a legitimate and attractive employment pathway. However, this study also exposed tensions across the domains of preparation, competency development, and post‐graduate support. Academic educators’ viewpoints describe a complex interplay between historical perceptions, shifting graduate pathways, structural, professional and tertiary level limitations around this evolving area of practice.

Academic educators observed a growing trend to private practice in line with published workforce data of 30%–50% of graduates entering the domain, with some identifying a clear intentional desire to pursue entrepreneurial roles that offer autonomy, flexibility and alignment with personal values [1, 3, 19, 20]. The trend towards entrepreneurship post COVID‐19 pandemic has also influenced this shift [48]. However, secondary or fallback entry often due to lack of hospital roles, also described in previous literature, was highlighted as a concern for graduates, the profession and their clients [8].

Academic educators expressed conflicting perceptions regarding the appropriateness of private practice for graduate dietitians, also a theme in a recent study where experienced private practitioners raised the challenge of trying to build strong clinical competency as a dietitian post‐graduation whilst also setting up and running a business [8]. Similar sentiments were outlined in previous literature where educators highlighted the risk of underprepared dietetics graduates to the profession [49]. Given that 43% of all small businesses fail [50], frequently attributable to lack of profitability, small business ventures raise legitimate concerns, as their collapse significantly contributes to attrition rates, particularly through elevated rates of burnout, a predominant issue in the professional sector and allied health at large [4, 9, 51]. Unsuccessful ventures may cause reputational harm within the industry. The perception that graduates are inadequately prepared for business may contribute to the notion that they should be discouraged from pursuing entrepreneurship. With enhanced preparation, this perception may be reconsidered, with greater confidence in graduates’ capabilities as business owners.

Educational institutions play a crucial role in preparing students for employment. Academic educators acknowledged that current dietetics education remains heavily grounded in clinical models of care, with limited content and scaffolding of business acumen and counselling skills which has been raisedpreviously [29]. Lack of business training has been reported across various allied health professions [9, 20, 23, 52, 53]. Our recently published curriculum content analysis assessing private practice dietetics entrepreneurship training [30], in conjunction with our qualitative study examining the experiences of experience private practitioners [8], align with the findings of this study. Collectively, these studies consistently highlight the persistent gap in business skill training in dietetics training programmes. Clark et al. [1] highlighted the perceived necessity of business training or formalised business mentoring in private practice dietetics to enable the effective implementation of 45 business standards. The intricate relationship between business acumen, client retention strategies and finance aspects in private practice sustainability have also been discussed in previous studies [4, 9, 54, 55], with education in these aspects (whether in tertiary programmes or post‐graduation) of critical importance in supporting dietitians, generally, in business management [4, 9, 54, 55]. Given competency standards are perceived to be inclusive (in the most part) of private practice dietetics preparation, ensuring interpretation that includes these training areas seems imperative given the influx of graduates entering this space.

To bridge the gap curriculum planning must move beyond the historical clinical dietetics focus, integrating entrepreneurship and digital health literacy into core learning outcomes. However, well documented issues seen in dietetics training, including curriculum crowding and conflicting priority areas were barriers to building in more educational opportunities to support private practice preparation [26]. Rolling out new content in a timely fashion to keep up with contemporary employment domains can be challenging due to university bureaucracy as highlighted in this study, along with concerns around students cognitive load and potential impacts on student mental health with increased educational content [26]. Comparable issues have been observed in preparing students to work in the eating disorders space, which also forms part of private practice work [56, 57, 58]. Although graduates may not be expected to manage a patient with an eating disorder, they will be exposed to such cases. In this study, academics called for more guidance from the professional body around including private practice specific preparation. Further research is needed to gain consensus on the educational requirements for successful preparation and it is recommended that the expertise of experts successful in this employment domain is leverage along with relevant Thought Leaders.

Placements in private practice dietetics are desired by students and private practitioners, and are included in limited capacity in few accredited Australian programmes [3, 30, 35]. However, many unique challenges have been reported [8], compared with historical placement locations like hospital and community settings [59, 60]. Private practitioners often operate as sole traders or within small teams, limiting their capacity to take on students due to concerns around time, resources, and client burden [8]. Additionally, there is limited formal or standardised governance, infrastructure or funding to support private practitioners as preceptors, which can make students placements in this sector difficult to scale [61, 62].

Limited exposure to private practice dietetics work in tertiary training programmes was highlighted in this study. In particular around the inclusion of private practice placements in the curriculum, which have been historically lacking with graduates and experienced private practitioners reporting limited to no placement in private practice in their training programmes [3, 8]. Academics across most accredited universities reported limited opportunities for private practice placements. This is similar to that seen across placements in the disability domain, in particular in working with patients under the NDIS, which forms part of many private practice dietetics workloads [63]. Governance issues, client burden and prohibitive health insurance systems were outlined as challenges by participants in this study, with placements further complicated by financial aspects directly impacting students including placement poverty [64]. A step in the right direction is the release of the Scope of Practice Review, an independent review of Australia's primary care sector [65], which provides recommendations around reducing the barriers to supervision in primary care education and training, including advising accreditation bodies to review and revise standards to remove supervision barriers in primary care. Additionally, it includes recommendations to address Medicare Benefit Scheme funding regulations that preclude students from consulting with clients. Looking to other allied health professions and health professions in general to gain an understanding of how competency and placements are achieved in private practice, would be a good starting point. Internships are used in pharmacy training at the Masters level [66]. In dietetics these would require early specialisation or reduced opportunities for exposure to more than one or two placement types which is worth consideration. An adjustment to the national competency and accreditation standards may be warranted by regulatory bodies to ensure competencies and learning opportunities for private practice dietetics are representative of the work of private practitioners. A united approach between tertiary training programmes, accreditation bodies and private practitioners is essential to ensure dietetics placements reflect contemporary work domains.

Lack of structured post‐graduate support, through mentoring, was also flagged as a concern, with potential structured solutions offered. However, some educators raised ethical concerns about the burden of further unpaid training or costly training, given graduates already spend up to 5 years navigating costly university fees and the financial challenges of being a student. Co‐designed solutions such as supervision models, structured transition programmes and competency‐based micro‐credentials could support safer, more confident entry to private practice. Supervision models are used in occupational therapy [67], psychology [68], and other allied health professions [69]. Dietitians require further training to obtain the professional title Sports Dietitian. Credentialling is also offered for eating disorder management [70, 71]. In this study there were conflicting viewpoints around whether private practice should be considered similarly with a numer of academics arguing that private practice is core dietetics work and tertiary education programmes had an obligation to do better at preparing graduates for private practice. Highlighting inequities in readiness, experienced private practitioners, including those academics in this study who entered private practice as graduates, concur inadequate preparation in their training programmes and a reliance on pre‐existing attributes or experiences, volunteerism or personal networks to become a competent practitioner [8]. Micro‐credentialling is one solution highlighted by academics in this study and should be part of the strategy to enabling adequate preparedness for business management. This could be completed alongside, or post attainment, of a dietetics qualification. This would be an investment in formal training. Formal supervision, if not carefully structured and with meticulous guidance, would not be a positive cost–benefit. Ideally a combined approach with micro‐credentialling programmes embedding structured supervision as part of the programme, which offers a multi‐pronged approach to competency development and support.

This study has numerous strengths. The success of the purposive sampling method is demonstrated with academics providing in‐depth insights from most (83%) accredited universities across Australia. The findings provide the first examination of academic educators’ perceptions on private practice dietetics workforce development. Previous studies exploring private practitioner's experiences on workforce development aspects [8], and a curriculum content analysis investigating private practice entrepreneurship preparation [30], assisted with building the interview schedule and the framework for the deductive thematic analysis, allowing for triangulation of data. Measures such as double coding, collaborative debriefing, and reflective practices were employed to mitigate bias and enhance the trustworthiness of the analysis. However, a limitation of this study is that caution should be exercised when interpreting the findings from the 19 participants, as they may not fully reflect the wider range of views and experiences captured from the participants in this study. The study participants also had varying years of experience and exposure to private practice dietetics which may have limited the depth of some of the participants’ awareness of the broader workforce development challenges.

5. Conclusion

Findings from this study emphasised persistent gaps in workforce development for private practice dietitians, especially regarding practitioner training and support. Collaboration and consensus is needed between tertiary educators, universities, private practitioners, accrediting bodies and professional associations to develop solutions to support workforce development aspects. Further research and a sector‐wide shift is needed to challenge outdated assumptions, reframe and support private practice to ensure a viable and vital component of future dietetics workforce.

Author Contributions

J.D., L.W., and R.H. contributed to the design. J.D. completed data collection. J.D. and R.H. completed formal analysis. All authors participated in conception, writing, reviewing and editing of the manuscript.

Ethics Statement

The protocol was approved by Swinburne University of Technology Research Ethics Committee (Approval No. 20248156‐19691).

Conflicts of Interest

The authors declare no conflicts of interest.

1. Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/jhn.70126.

Supporting information

Supplement 1: Academic Interview Study Questions Investigator Guide and Inquiry logic.

Donnelly J., Walsh L., Hughes R., and Lane R., “Private Practice Dietetics Workforce Development: Experiences and Perceptions of Australian Academic Educators,” Journal of Human Nutrition and Dietetics 38 (2025): 1‐14, 10.1111/jhn.70126.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.