Dogs are cute, but would you want to see one driving? Well, okay, I might! There’s a reason why we have to learn how to drive before we can get a license to. This concept also applies to healthcare professionals. We have to train (through years of college) and prove we are capable (through testing and certification) before we can gain licensure and help the people we did all this for.
For licensed dietitians in Florida, things have been a bit up in the air. Recently, a movement has challenged the way dietitians are licensed – arguing that, in fact, they shouldn’t be licensed at all. Florida, they say, should be what is called a “title state.” Like other states, such as California, this would allow people to practice as “nutritionists” without being licensed as dietitians. And for those in the field – especially those who have spent years and thousands of dollars on their education – this has brought up a very salient point – licensure matters, not just for dietitians, but for all health professionals.
Standards of Care
For many us of, standards of care are an expectation. We don’t think much about the ingredients in the vitamins we choose, the safety of airlines we fly on, or whether the pediatrician we take our children to is qualified. We simply expect it.
We expect that when we buy 1000 mg. of Vitamin C, that it’s what we are getting. We expect that what the personal trainer we just hired – a purportedly qualified health professional – knows what he’s saying when he talks about our diet.
But here’s an example of why we need to do more than expect: A man in recovery from a kidney transplant due to renal failure decides he is going to join a gym and begin regaining his fitness. Upon seeing his muscular atrophy, the personal trainer prescribes him a diet of 300g of protein daily. Within a few days of following this diet, the man begins to feel weak, sluggish, and lightheaded. When he sees his doctor, he learns that his kidney has been rejected and he is back in renal failure due to the extremely high protein diet.
This is why standards of care matter – because they give consumers protection about what they are getting. When you hire a personal trainer who is only qualified to give you fitness advice, that is what you get – and nothing more. When you hire a marriage counselor to help improve your relationship with your spouse, you have the assurance that this professional is trained to work with couples like you, and is truly qualified to help you. When you ask this same professional about your son’s addiction problems, you would expect that they would refer you to another professional trained in addiction. When we remove licensure requirements, what we get is blurry lines, unqualified “professionals,” and an “anything goes” philosophy, that ultimately, consumers pay the price for.
Code of Ethics
Like standards of care, we often take ethics for granted. But here is why they become indispensable for health professionals – because the client is in a vulnerable position. In a typical health professional-client relationship, it is the health professional that is often seen as the expert, and the one who has the power in the relationship. It’s the doctor that tells you what to do about X condition, the psychotherapist who has the knowledge about why you are feeling the way you are, and the psychiatrist that knows what to prescribe to make you feel better. In each of these situations, it is the code of ethics that guides each professional’s decisions. It’s the reason that the doctor who sees that you have an auto detailing business doesn’t ask you to detail his car. It’s reason that the marriage counselor doesn’t suggest that you divorce your spouse and start dating her cousin. And it’s the reason that the psychiatrist doesn’t prescribe more of an addictive medication than you need.
Health professionals don’t have to follow the code of ethics, yet if they don’t, there a repercussions. Suspensions can be rendered, fines can be imposed, and yes, licenses can be lost. Incidentally, the largest category of ethical violations for marriage and family counselors is the category of sexual violations with clients.
Establishment of a Regulatory Agency
Standards of care and codes of ethics are just two reasons why licensure matters, however, without establishing a regulatory agency, they don’t hold much weight.
Standards of care are created through a licensing body which, after much deliberation and study of the field of practice and the client needs therein, determine what is considered a standard for practice in that particular field. Similarly, it is this same regulatory agency that, when ethical violations are made, can be reported to.
So let me give you another example. A “nutritionist” working at a residential fitness camp is told by one of her clients that she is having trouble sleeping. Knowing that this is a concern for the client who is attempting to work out up to eight hours a day in an effort to lose weight, the nutritionist asks one of her other clients to give this client some of her Ambien (a prescription sleep medication) to help her sleep. Let’s say that the client who receives the medication had a negative reaction to it. Who is liable? In a case like this, it depends on the state. In a title state, where nutritionists can practice without license, there is no regulatory agency to report her to. So then the liability falls upon the client who dispensed the Ambien. And while she shouldn’t have given out her prescription medication (there are both federal and state laws that make using or sharing prescription drugs illegal), she was under the care of a nutritionist, and likely expected that this professional would not have asked her to do something illegal.
Practicing without ramifications isn’t only dangerous, it’s unethical, because, ultimately, as in cases like this, it is the client, and not the professional, who pays the price.
Achieving licensure for health professionals is a rite of passage – one that grants entrance into a world where hard earned knowledge, skills, and abilities can be used in the most honorable of ways – to help others in need. And licensure keeps health professionals accountable to practice to the best of their ability, not extend beyond their level of competence, and comply with the standards of care, code of ethics, and rules of a regulatory agency that was created to protect their profession, and the people it serves. Ultimately, licensure isn’t just about those who practice, it is about those who receive care – and it helps us all.
By Claire Dorotik-Nana, LMFT
Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We provide accredited, online continuing education courses for licensed healthcare professionals for the purposes of expanding their education and improving patient care.
The purpose of continuing education is to assure high standards of practice by requiring licensees to participate in on‑going educational activities. Through these experiences, licensees increase their competence and ensure they are providing evidence-based care to their patients/clients.
We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).
Target Audience: Psychologists, Counselors, Social Workers, Marriage & Family Therapist (MFTs), Speech-Language Pathologists (SLPs), Occupational Therapists (OTs), Registered Dietitian Nutritionists (RDNs), School Psychologists, and Teachers
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