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Abstract

Dietetics entrepreneurship in the USA has been scarcely researched. The purpose of this study was to explore the experiences of entrepreneurial dietitians by discovering the process of becoming one, the barriers to starting a business in dietetics, and the skills and resources necessary. Semi-structured interviews were conducted. Inclusion criteria included: participants 18 years or older, holding the Registered Dietitian Nutritionist (RDN) credential, living and practicing in the United States, and spending at least 15 hr per week on a dietetics-related entrepreneurial venture. Recruitment was conducted through purposive sampling through social media. Ultimately, 24 dietitians were interviewed virtually. Data were analyzed using a qualitative case study design. After data immersion, the case description framework was determined, and case descriptions were written for each participant. From the case descriptions, 20 uniform categories were identified to organize the data into word tables. Three themes (Getting Started, Business in Action, and Resources) represent the data. Dietitians commonly become entrepreneurs in the pursuit of autonomy, professional fulfillment, and financial growth. The primary barriers were lack of business knowledge, difficulties with legal decisions, and credentialing with insurance. The primary resources used to start a business were the internet, mentors, and business coaches. Participants reported high job satisfaction. Successful entrepreneurial dietitians in the USA faced challenges and overcame them highlighting the importance of education and mentorship.

Plain Language Summary

The Experience of Entrepreneurial Dietitians

Why was this study done? Very little is known about entrepreneurial dietetics practice in the USA. What did researchers do? The team interviewed 24 Registered Dietitian Nutritionists who were successful entrepreneurs and asked about their experiences. Then the team considered all the experiences of the dietitians to share common experiences among the group. What did the researchers find? Dietitians commonly become entrepreneurs in the pursuit of interests, higher compensation, flexibility of time, and working for themselves. The primary barriers were lack of business knowledge, difficulties with legal decisions, and credentialing with insurance. The primary resources used for starting a business were the internet, mentors, and business coaches. Dietetic entrepreneurs generally have high job satisfaction. What do the findings mean? There are more opportunities to study this area of dietetics practice. It also means that dietitians and dietetics students can use these findings to make educated career decisions. There is an opportunity to better support this area of practice through education.

Keywords

entrepreneurship private practice dietetics self-employed dietitians dietetics business healthcare entrepreneurship qualitative research

Introduction

Entrepreneurship has been defined as “the act of starting and running a new business” (Global Entrepreneurship Research Association [GEM], 2025). Entrepreneurs envision, change, and create ideas and systems for social change, economic growth, or problem solving (Dollinger, 2008). In 2024, entrepreneurs made up 19% of the working age population in the USA and two-thirds of those reported being motivated to start a business due to job scarcity (GEM, 2025). In 2022, first-year survival rates of new business establishments in the USA ranged regionally from 74.4% to 78.6%, indicating approximately a quarter of new business establishments did not continue operating beyond 1 year (US Bureau of Labor Statistics, 2024). The cost of starting a business in the USA can be highly variable depending on the nature of the business (U.S. Small Business Administration, n.d), with some estimates for micro-businesses needing at least $2,000 to start and small businesses needing around $30,000 (Chamber of Commerce, 2025).

Registered Dietitian Nutritionists (RDNs or dietitians) are credentialed practitioners who work in a variety of settings providing food and nutrition-related services for individuals, organizations, and/or populations. Most commonly, dietitians (57%) work in clinical settings (i.e., acute-inpatient, acute-outpatient, ambulatory, and long-term care; Dosedel, 2025). Demographically, the dietetics profession is predominantly female (94%) and lacks racial/ethnic diversity (91% self-identified as White; Dosedel, 2025). Over the past two decades, the percentage of dietitians who reported being self-employed has ranged from 7% to 9% of the profession (Dosedel, 2025; Rogers, 2006; Ward, 2012). The most recent data shows that self-employed dietitians have the greatest range of compensation across employment sectors. Specifically, for self-employed dietitians, the range (10th to 90th percentile) of annual full-time pay is $45,000 to $147,000 whereas that same range for all dietitians is $60,000 to $124,900. This wider range of annual earnings for self-employed dietitians shows both the greater risk and potential reward for entrepreneurship in this field.

The recent dietetics-related entrepreneurial research has been conducted outside of the USA and often focuses specifically on “private practice.” Researchers developed a national dataset describing Australian private practice that revealed dietitians were primarily women (90%), spent 26 hr/week working in their private practice, and that the majority were satisfied (90%) and planned to still be working in private practice in 5 years (88%; Kirkegaard et al., in press). Another qualitative study reported that Australian private practice dietitians largely felt underprepared for private practice and faced many challenges in their work (Donnelly, Walsh, Lane, & Hughes, 2025). Regarding training, researchers conducted a content analysis of the Australian university dietetics programs’ curricula to investigate what entrepreneurship-related preparation was taking place (Donnelly, Walsh, Hughes, & Lane, 2025). They found that there was related curriculum but that it was underdeveloped and identified the need to identify what curriculum is needed to prepare dietetics students for this area of practice (Donnelly, Walsh, Hughes, & Lane, 2025). This work is valuable and is likely generalizable in some ways globally, however, due to cultural, economic, and health care system differences, it is important to explore dietitians’ experiences in entrepreneurship in other countries as well.

The theoretical framework for this study was the Process Model of Entrepreneurial Creation (Elango et al., 2007 adapted from Bhave, 1994). This model presents the stages in the venture creation process and has been used in the context of nursing entrepreneurship (Elango et al., 2007). The stages include opportunity recognition, overcoming entry barriers, operational competencies. In this case, a RDN identifies a business need that has not been met and then moves to create the organization to support the service that needs to be offered. Finally, the RDN needs to have the skills/capacity to operate the organization daily (Elango et al., 2007). Using this staged model allows researchers to identify facilitators and barriers to entrepreneurial practice in dietetics and identify opportunities for support or training.

This study was developed in response to the limited availability of recent research that explores dietitians’ experiences in the USA. The purpose of the qualitative study was to investigate how and why dietitians in the USA enter entrepreneurial practice, and how they experience their work.

Methods

Study Design

This qualitative study aimed to explore entrepreneurial experiences and perspectives of dietitians in the USA using semi-structured interviews. The interview guide was developed to assess experiences in each of the stages of the Process Model of Entrepreneurial Creation (Elango et al., 2007). The Brigham Young University Institutional Review Board deemed this study exempt prior to data collection began in 2022 (IRB#:2021-346).

Sample Size and Participants

The study sample size was determined with the consideration of information power (Malterud et al., 2016). Specifically, considerations for sample size included the study’s narrow study aim (focused on specific practice within the dietetics profession), dense sample specificity (small subset of total population of Dietitians in the USA), existing theory (Process Model of Entrepreneurial Creation), high quality dialogue with professionals, and cross-case analysis. Based on these, it was determined that having a minimum of 20 interviews would provide the information power needed for this study.

Dietetic entrepreneurs in the USA were recruited to complete interviews for this study. To meet inclusion criteria, participants needed to be 18 years of age or older, hold the RDN credential, live and practice in the USA, and spend at least 15 hr per week on a dietetics-related entrepreneurial venture.

Recruitment

Purposive sampling was used to recruit through social media. After obtaining permission from the social media group owners, a recruitment graphic and brief survey (including a consent statement and querying demographic characteristics and contact information via Qualtrics) were posted to several dietetics-focused Facebook groups, including the Freelance/Private Practice Dietitian’s Group, Dietitians in Utah, Dietitian Entrepreneur’s Community, and Dietitians in Private Practice. A brief description of the study and information about the incentive ($25 Amazon gift card) were included in the post. The recruitment survey yielded 61 responses. Thirty-five individuals met the inclusion criteria and were invited to interview via email. In total, 24 individuals followed through with scheduling and completing an interview.

Semi-Structured Interviews

Three researchers conducted the interviews. All completed Collaborative Institutional Training Initiative (CITI Program) training and were trained/mentored in conducting qualitative research including interviewing and data analysis. There were no prior relationships between interviewers and participants. Participants knew the interviewers were research assistants and dietetics students. At the beginning of the interview, the interviewer reviewed the consent statement with participants.

The interviews were semi-structured using a 16-item interview guide (Table 1) based on a synthesized version of the Process Model of Entrepreneurial Creation (Elango et al., 2007). The interview guide used open-ended questions to provide structure to the interview while allowing for participants to expand on their own experiences. There were six categories of questions in the interview guide: Background/Introduction, Opportunity Recognition, Overcoming Entry Barriers, Operational Competencies, New Venture Creation, and Other. The interviews lasted about 45 min, were conducted and recorded over Zoom video-conferencing software and were then transcribed verbatim. There were no repeat interviews. The participant and interviewer were the only ones present during the interviews.

Table 1.

Interview Guide Questions Used to Direct Interviews With Entrepreneurial Dietitians.

Background/Intro	1. Tell me about your pathway to becoming a dietitian. When you were a student, what did you anticipate your career to look like? 2. Did you have any other dietetics jobs before pursuing entrepreneurship?
Opportunity recognition	3. What inspired you to start your current business? a. What were the pros and cons you considered as you made the decision to enter entrepreneurial practice? b. When did you start your business? c. *If they worked other dietetics jobs before pursuing entrepreneurship, ask “How was the transition into working in entrepreneurship?” (Abrupt, slowly?)
Overcoming entry barriers	4. What, if any, were the barriers you experienced starting a business in dietetics? a. How did you overcome them? b. What are the challenges you’re facing now as an entrepreneur in dietetics? How are you navigating them?
Operational competencies	5. What skills did you most need when you started your business? What skills did you discover you needed along the way? How did you develop those skills? 6. Can you think of anything (e.g., knowledge, skills, external help, etc.) that could have minimized or mitigated some of the barriers for you as you were pursuing entrepreneurship?
New venture creation	7. How did you approach starting and building your business? a. Can you walk me through your initial process? 8. How would you describe your business now? What products and/or services do you provide? 9. How many employees, if any, do you have? What roles do they play? 10. Do you contract out elements of your business? (e.g., accounting/bookkeeping, website development, etc.)
Other	11. Did or do you have a mentor or mentors who helped you on your way? What influence, if any, did they have on your path to becoming an entrepreneur? 12. What, if anything, did you learn from your formal dietetics education that supported your entry into entrepreneurship? a. What would you recommend the dietetics education programs incorporate in the curriculum to prepare students who want to become entrepreneurial dietitians? 13. What resources were helpful to you as you entered entrepreneurial dietetics? a. Looking back, are there any resources you wish you had when you entered entrepreneurial dietetics? 14. How would you describe your job satisfaction or dissatisfaction? 15. What advice would you give to a dietitian wanting to start a business in dietetics? 16. Is there anything else you think we should know about your experience in becoming and being an entrepreneur in dietetics?

Data Analysis

We used a case study design to analyze and identify “why” and “how” dietitians pursue entrepreneurial practice (Vaterlaus et al., 2018; Yin, 2018). The members of the research team (all identify as White, non-Hispanic females; one was an RDN and three were dietetics students) immersed into the data by reading and rereading the transcripts. After reviewing and acknowledging potential biases and preconceptions, the team determined the case description framework with six headings (Background/The Dietitian, The Business, Barriers/Skills, Growth/Satisfaction, Resources/Support, Advice) to organize the interview data. The interview transcripts were used to write case descriptions which had consistent and coherent narratives for each participant (Yin, 2018). Individually, three researchers wrote case descriptions for each participant, and then each case description was reviewed/revised by a second researcher.

Once developed, the four researchers read and reread each case description. From the data in the case descriptions, all four researchers discussed and agreed on 20 uniform categories (similar to codes in other qualitative methods) to organize the data (Yin, 2018). During that meeting, each researcher brought their ideas and notes from reviewing the case descriptions and shared their proposed uniform categories. Through discussion, the research team synthesized their ideas/perspectives to develop and define a final list of 20 uniform categories.

Next, a word table was created for each of the 20 uniform categories; aggregating the evidence of each uniform category across all case descriptions allowed researchers to discover similarities and differences within the sample (Yin, 2018). Using the word tables, researchers compared and contrasted participants’ perspectives and experiences for each uniform code.

Researchers discussed the 20 uniform category word tables and organized the uniform categories into three themes that represented the data to draft the results. Finally, the complete results narrative and table were sent to participants for member checking to increase the trustworthiness of the results (Creswell, 2013); participants indicated that the results reflected their experiences.

Results

Ultimately, 24 dietitian entrepreneurs participated (Table 2). The participants represented 14 states and primarily self-identified as female (n = 22; n = 1 male, n = 1 non-binary). The majority (n = 19) were between 25 and 44 years old. Most self-identified their race as White (n = 22; n = 1 Black, n = 1 Asian). Participants’ time as business owners ranged from 1 to 30 years. Half (n = 12) were employed in addition to running their entrepreneurial venture. Most participants’ (n = 22) businesses involved private practice nutrition counseling. From the analysis, three themes were identified: (a) Getting Started, (b) Business in Action, and (c) Resources. The themes are described below and when direct quotes are used, the participant number (Table 2) is included parenthetically for context. Additional illustrative quotes are presented in Table 3.

Table 2.

Participating Entrepreneurial Dietitians’ (n = 24) Self-Reported Personal and Work Characteristics.

Participant number	Gender identity	Age	Race	Ethnicity	State	Years credentialed as RDN	Years as business owner	Average hours worked per week on business	Employed in addition to business venture?	Business description
1	Female	35–44	White	Non-Hispanic	TX	<5 years	2	50	No	Private practice nutrition counseling
2	Female	25–34	Asian	Non-Hispanic	CA	<5 years	1	20–30	No	Blogging/Social media
3	Female	55–64	White	Non-Hispanic	GA	>21 years	30	50	No	Private practice nutrition counseling + Teaching platform for licensed health providers
4	Non-binary	35–44	White	Non-Hispanic	UT	11–15	7	35–40	Yes	Private practice nutrition counseling
5	Female	25–34	White	Non-Hispanic	MN	6–10	1.5	15	No	Private practice nutrition counseling
6	Female	18–24	White	Non-Hispanic	OH	<5 years	3	50	No	Private practice nutrition counseling + Blogging/social media
7	Female	35–44	White	Non-Hispanic	UT	11–15 years	13	16–20	Yes	Private practice nutrition counseling
8	Female	25–34	White	Non-Hispanic	NY	<5 years	3	20	Yes	Private practice nutrition counseling
9	Female	45–54	White	Non-Hispanic	NC	>21 years	10	40	No	Private practice nutrition counseling
10	Female	35–44	White	Non-Hispanic	MI	11–15 years	1	18	Yes	Private practice nutrition counseling
11	Female	25–34	Black	Non-Hispanic	TX	<5 years	2	40	Yes	Health club with nutrition counseling and personal training
12	Female	45–54	White	Non-Hispanic	UT	>21 years	4	30	Yes	Private practice nutrition counseling
13	Female	35–44	White	Non-Hispanic	KY	6–10 years	4	32	No	Private practice nutrition counseling
14	Female	25–35	White	Non-Hispanic	MD	<5 years	2	40	No	Health club with nutrition counseling and personal training
15	Male	25–34	White	Non-Hispanic	FL	6–10 years	4	15–20	Yes	Private practice nutrition counseling
16	Female	35–44	White	Non-Hispanic	NY	<5 years	1	20	Yes	Private practice nutrition counseling
17	Female	25–34	White	Non-Hispanic	TX	6–10 years	3	40	No	Private practice nutrition counseling
18	Female	25–34	White	Non-Hispanic	MI	6–10 years	1	24	No	Private practice nutrition counseling
19	Female	25–34	White	Non-Hispanic	CT	6–10 years	4	20	No	Kids cooking and nutrition classes and camps
20	Female	25–34	White	Non-Hispanic	NC	<5 years	2	40	Yes	Private practice nutrition counseling
21	Female	35–44	White (American Indian)	Non-Hispanic	KY	6–10 years	7	10	Yes	Private practice nutrition counseling
22	Female	24–34	White	Non-Hispanic	UT	6–10 years	8	35	No	Blogging/social media
23	Female	25–34	White	Non-Hispanic	WY	<5 years	1	25	Yes	Private practice nutrition counseling
24	Female	25–34	White	Non-Hispanic	CA	6–10 years	9	30	Yes	Private practice nutrition counseling

Table 3.

Theme Descriptions and Illustrative Quotes From Case Study Analysis of Entrepreneurial Dietitian Interviews (n = 24).

Themes	Illustrative quotes
Getting started: Participants shared their initial anticipated careers and previous/concurrent jobs. They described their businesses, products, and/or services. They also shared their motivation and thought process (pros and cons) to starting their business. They described their transition to entrepreneurship.	“I like being in all different types of projects. I feel more stimulated that way, and more passionate, and excited. So that’s why I wanted to work for myself.”– Participant 6 “You also only get when you’re in a hospital, less than an hour to review the chart, talk to the person and chart again. So, when you’re seeing 15 patients a day, you’re not making, in my opinion, a very lasting impact. The rehab hospital is a little bit better because you kind of got to catch up with people a few times before they went home. But here I can meet with people weekly for months and months or years potentially to see life change over their lifespan, which is nice”– Participant 14 “There’s no somebody I can go to fix the problem. I have to fix it. So, it’s far more challenging in some days, but it also comes with a lot more freedom, and frankly, it’s a lot more fulfilling and rewarding.”– Participant 4 “And also, I mean, money is a factor too. It’s notorious that like dietitians don’t make jack, right? They don’t make a lot. And the great thing is being able to say this is what I’m charging, this is what I’m worth, having a cancellation policy. I used to have to rely on my employers to take care of me with benefits or wages or hours, and like now I can rely on myself and that feels really good too.”– Participant 10 “It was this fiery rage…of I can’t believe I’m getting such a small percent of the work that I’m doing, that started motivating me into private practice.”– Participant 13 “In the hospital setting, you see so many patients and it’s hard to really get to know anybody or provide them with solid care because you’re… just putting out fires all the time and not really managing them like I’d like to be.”– Participant 18 “I would say I never really enjoyed working for anybody else, especially when I was a retail dietitian. Your boss isn’t a dietitian, and so they generally have no idea what you do. So that was a big factor: being told what to do by somebody who has no idea what you actually do.”– Participant 19 “There’s nothing straightforward about it [starting a business]. There’s a lot of question marks.”– Participant 8 “And then you get to have a presence and a voice. I think as a clinician, you don’t have as much of a voice. Now, if you’re in the community as a provider of nutrition care, you have a say in how that community is molded and you get to be a part of it.”– Participant 15
Business in Action: Participants described both the barriers they experienced and how they overcame them. They shared what skills they needed and used and explained how they developed them. They clarified how their business functioned (e.g., if they had employees or contracted work out, if they credentialed with insurance companies). They also described their job satisfaction.	“I think the hardest part was financially knowing I was giving up a guaranteed income, for potentially nothing, for a good long time…I actually bill insurance, and so a lot of the painful learning curve that first year was learning how to bill insurance, and the nightmares that come with that.”– Participant 4 “I think the profession breeds – or the training we get and the education that we get – breeds a sense of perfectionism that can be very paralyzing.”– Participant 6 “And then insurance billing. I think the biggest barrier that any private practice would come across, maybe a toss-up between that and physical location if you had one, but I decided to not take insurance.”– Participant 8 “I have to just be very active on social media, trying to come up with different topics and silly things to get your name out there, which sometimes feels like a huge waste of time, but you just have to do it to stay relevant.”– Participant 16 “So, at the beginning of COVID [the pandemic restrictions], doctors weren’t allowing you to come into their practice. Insurances were still figuring out if, whether or not, they were going to cover telehealth nutrition. And so, I definitely had barriers in terms of marketing, because I couldn’t use the normal routes of marketing.”– Participant 20 “It’s hard to know where to spend your effort and your time, because sometimes it takes time for things to come together. You can do whatever you want, which is awesome, but also, I can do whatever I want.”– Participant 22 “Accepting of no. Not everybody is going to like you.”– Participant 3 “People skills are really important in order to have a consistent flow of referrals and building relationships with your referral network has been a big part of forming the company.”– Participant 17 Sample comments regarding job satisfaction: “10 out of 10.”– Participant 7 “Incredibly high”– Participant 10 “It could be better, but I’m happy with where I’m at.”– Participant 11 “Squarely in the middle.”– Participant 9 “Depends on the moment.”– Participant 12 “10 out of 10.”– Participant 14 “Definitely very satisfied”– Participant 16
Resources: Participants shared if they had and who their mentors were, what resources they did use, and what resources they would have liked as they started their business. They also described what was helpful or not for entrepreneurship from their formal dietetics education. Finally, they offered advice to those considering entrepreneurship careers in dietetics.	“Really just making connections with professionals that are kind of where you want to be, and coming from a place of, not what can you do for me, but what can I do for you?”– Participant 23 “Now I go and basically reach out to dietitians who are a few steps ahead of me and say like, ‘what did you do?’”– Participant 24 “It’s worth it. Do it. Even though it gets difficult, do it.”– Participant 11 “I would say to network with other dietitians, who’ve done what you’re interested in. And especially if you have a specific population you want to work with, so if you want to do sports dietitian or something, try to find someone in… working with sports.”– Participant 2 “Like, ‘This is how much you will be making. This is how much you’ll be paying out in taxes. This is the types of expenses that go into running a business.’ So, when you’re thinking about how you need to financially structure your business, you need to think about how are you actually going to make enough money to really get by.”– Participant 21

Theme 1: Getting Started

The anticipated careers (before selecting dietetics) of the participants varied greatly. Some participants mentioned initially wanting to become a lawyer, teacher, or graphic designer, but most wanted to pursue healthcare careers (e.g., nursing, physical therapy). Only six began their college/university education with the intention of becoming an RDN. After becoming dietitians, but before pursuing entrepreneurship, participants worked in a variety of different positions including clinical (n = 11), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC; n = 6), and eating disorder treatment facilities (n = 3). Other previous position types included long-term care facility consulting, retail dietetics, nutrition class teaching, and personal training.

Participants described being inspired to start their own businesses for several reasons. Some saw exciting possibilities related to entrepreneurship and felt the frustrations of working for other people. Other participants saw gaps in the market they wanted to fill while some thought they could provide patients/clients with more genuine and high-quality care by starting their own businesses. A few (n = 4) expressed disappointment and frustration with the patient care at hospitals/outpatient clinics and wanted to provide something better. Additionally, many felt they were underpaid and that they could earn more money as an entrepreneur –“I could eventually make as much money as I want, right? Dietitians starting out, they don’t pay us very much” (Participant 1).

Most participants’ businesses provided private practice nutrition counseling (n = 22) and of those, 10 specialized in nutrition counseling for eating disorders. Other specializations mentioned were celiac disease, maternal health, weight loss/healthy lifestyle, polycystic ovarian syndrome, gut health, children’s nutrition (e.g., picky eating, food aversions), sports nutrition, chronic kidney disease, and blender-feeding diets. Due to the COVID-19 pandemic, participants shifted to offering some or all their sessions or classes virtually. One participant noted, “COVID was a barrier and a non-barrier because people were more open to virtual appointments.”

Participants identified flexibility, autonomy, and control both over their own work and the business decisions as motivators for starting their own business. Additionally, they were drawn to entrepreneurism for personal fulfillment, financial growth, work-life balance (e.g., ability to work from home and have flexibility for family). Conversely, participants described the challenges they considered before venture creation which included their limited business knowledge (e.g., marketing, insurance, and business tactics), financial instability, lack of benefits, and the stress/burden of independently managing the business.

Most participants described their transition into entrepreneurship as slow and/or challenging (n = 15) and few described it as easy (n = 2). Most participants took time to learn, experience trial and error, and become steady in their business before they quit their previous jobs and committed to full-time entrepreneurship. For their initial processes, the participants described the time they took to learn about how to start a business and complete market research. Further, many learned more about the technical niche they wanted to serve by researching topics within that specialization (e.g., maternal health, celiac disease, mental health nutrition, eating disorders, etc.). Some made business plans, found mentors or legal consultants, and/or found a space to rent so they could begin meeting with clients in person. Many discussed the process of legally starting a business according to state and federal regulations (n = 10). Some talked about starting their business by first marketing and building a following on social media (n = 6) or building a website (n = 5). Mostly, participants started by determining their business goals, making plans, making legal decisions, and learning as much as they could about running a business.

Theme 2: Business in Action

This theme provides insight into the participants’ experiences after starting in entrepreneurship and describes barriers, skills, employees, contractors, insurance, and job satisfaction.

Barriers and Skills

Participants described the barriers and challenges they experienced with their businesses initially, and at the time of the study. Initially, the participants primarily struggled with how to get started. One participant said, “I knew how to see clients and the dietetics piece of it…but what do you actually need to do to set up a business?” (Participant 24). They struggled with the financial burdens of investing in their businesses while not earning money, making legal decisions, marketing, building a clientele, overcoming perfectionism, and getting credentialed with insurance companies.

The barriers and challenges the entrepreneurs were facing at the time of data collection were managing billing and insurance (n = 4), achieving work/life balance (n = 6), and not knowing when and who to hire as they expanded their businesses (n = 7). Other challenges mentioned were maintaining continuing education for their RDN credential, the emotional difficulty of working with eating disorder clients, COVID-19 barriers (e.g., switching to virtual, clients canceling, employees becoming ill, guidelines), marketing, and staying relevant on social media. Of those who commented on overcoming barriers (n = 20), 12 used Facebook groups and/or networking with other dietitians or health professionals to receive guidance and advice. Others (n = 7) mentioned researching and learning as their most helpful tools.

Participants described three categories of skills/attributes needed to be successful as entrepreneurial dietitians. The first category included dietetics-related skills including a niche-expertise, nutritional knowledge/competency, nutrition counseling skills, reading and applying current research, behavior modification, motivational interviewing, and the ability to practice in an evidence-based manner. Second, general work-related and personal skills/attributes, including resiliency, perseverance, dealing with change, pivoting, determination, confidence, positivity, hard work, self-motivation, self-awareness, willingness to learn, boundary-setting, and persistence. Finally, business-related skills namely organization, accounting, financial planning, financial management, marketing, accounting, billing, time management, managing others, interpersonal skills, problem-solving, marketing, digital/website management, self-selling, and brand development.

Of those who commented on how they developed their skills (n = 12), 11 described forms of self-driven learning. Internet searching, trial and error, practice, asking questions, continuing education sessions, and seeking learning through webinars, books, and online articles were common self-learning practices. Two of the participants referenced their formal higher education, and three mentioned working with business coaches for skill building.

Employees, Contractors, and Insurance

Eighteen of the participants reported having no employees. Several participants reported having one to three employees (n = 4) and one had six employees. About half (n = 13) reported contracting with other professionals to run elements of their businesses. Of those, a majority contracted with accountants and/or lawyers (n = 11) to help with financial and legal work. However, others (n = 4) contracted out website and marketing work, and a few (n = 2) contracted with other dietitians to help with patient/client load. Of all participants, four described working with dietetic interns who help in various ways with the business. Fifteen participants credentialed with insurance companies, and five did not. The remaining four participants did not comment on insurance.

Job Satisfaction

Most participants described themselves as either satisfied (n = 13) or very satisfied (n = 8) with their work. The remaining three participants indicated they were “mixed” or “in the middle” regarding satisfaction. The factors contributing to satisfaction were autonomy, control, engagement in enjoyable and fulfilling work, flexibility, achievement of financial goals, and helping others. Factors contributing to dissatisfaction included unstable income, loneliness, challenges navigating insurance-related processes, and the feeling that they were working all the time. One participant expressed:

I feel blessed every single day to be doing what I love and to have the flexibility that I have…. So, like I love what I do, and that makes it very easy to overwork… so my body and my brain are like… you’re burning out,” but I’m like, “But I love this.”– (Participant 6)

Theme 3: Resources

Participants described the resources they found most helpful, and shared advice with future dietetics entrepreneurs based on their experiences.

Mentors and Resources

Nineteen participants reported having had a mentor in some form who helped them professionally. Some (n = 5) looked to family or friends, but most (n = 14) looked to other dietitians for mentorship. The participants connected with their mentors through internships, jobs, social media, or local networking.

Almost all the participants (n = 17) used the internet as one of their main resources. Facebook, Google, YouTube, Instagram, online courses, webinars, and blogs offered information and guidance to these entrepreneurs. Other resources mentioned were business coaches, books, the Small Business Administration, continuing education courses, and help from friends or colleagues.

When asked what resources they wished they had to minimize their challenges, the participants answered with a variety of ideas. Some participants (n = 11) wished for affordable and organized information, such as a “how-to” course or roadmap. Others (n = 4) wished they had hired a business coach or hired their business coach sooner. Two participants wished for a resource that could have helped with impostor syndrome and perfectionism.

Dietetics Formal Education

Most (n = 20) felt their formal dietetics education did not prepare them for their transition into entrepreneurship. Fifteen recommended that dietetics education programs include business and/or entrepreneurship classes to better prepare students interested in entrepreneurship. Although, two of the participants said they would not have taken those courses if available because of career uncertainty at that point in their education/career. A few participants (n = 4) felt they learned valuable counseling and education skills that were helpful to them in their entrepreneurial venture. Others (n = 7) mentioned the value they placed on the clinical nutrition knowledge developed in their formal education. Other skills the participants developed from their formal education included organization, confidence, communication, independence, hard work, professionalism, research, and asking good questions.

Advice

Participants were asked to share advice for other students/dietitians considering an entrepreneurial career. Several participants (n = 7) encouraged future entrepreneurs to get started as soon as possible. Two participants offered opposite advice, recommending that future entrepreneurs gain work experience before pursuing entrepreneurship. Some (n = 7) recommended networking with entrepreneurs to gain advice when starting out. Others (n = 8) recommended overcoming perfectionism and “not worrying about what you don’t know” because they will learn along the way. Other pieces of advice included keeping initial costs low, always continuing to learn, not being afraid to put oneself out there, and finding a like-minded community to support and answer questions.

Discussion

This sample of practicing entrepreneurial dietitians self-reported high levels of job satisfaction, greater compensation than their previous dietetics’ positions provided, more flexibility, and more control over their work. Understanding the experience of entrepreneurial dietitians is important and relevant because the topic has scarcely been researched in the USA. The findings from this study can help students and dietitians by providing information about entrepreneurial dietetics and how individual dietitians have started and continued to operate businesses. These findings can inform the Accreditation Council for Education in Nutrition and Dietetics (ACEND, the accrediting body for dietetics education) as they develop new educational standards and educators as they create course content to support entrepreneurial dietetics practice.

Getting Started

This “Getting Started” theme aligns with the Opportunity Recognition stage of the Process Model of Entrepreneurship. In the model, Bhave (1994) describes externally and internally stimulated opportunity recognition. Externally stimulated opportunity recognition is influenced by personal and environmental circumstances (e.g., personal life, unwillingness to relocate, intolerance for working for someone else). In the present study, some participants identified wanting more work flexibility to accommodate family responsibilities, more control over how they did their work, and being frustrated working for others as motivation for starting their business. For externally stimulated opportunity recognition, entrepreneurs will decide to start their business and then recognize opportunities and select one to pursue. Internally stimulated opportunity recognition is different in that these entrepreneurs find needs that are not easily met through other vendors or current practices and find solutions which lead to recognizing the business opportunity (Bhave, 1994). In the present study, some of the dietitians were internally stimulated and described the desire to provide patients/clients with more genuine, thorough, and high-quality care by starting their own businesses. Understanding dietitians can arrive at both opportunity recognition and the decision to start a business differently can be helpful for dietitians exploring entrepreneurship.

Financial growth and autonomy were motivating reasons for this sample to start their businesses. According to the series of existing Academy of Nutrition and Dietetics’ Compensation and Benefits Surveys (2002–2024), self-employed dietitians consistently have had the highest median hourly wage, as well as the highest range of earning potential (Dosedel, 2021, 2025; Griswold & Rogers, 2020; Rogers, 2003, 2006, 2008, 2014, 2016; Ward, 2010, 2012). This provides context for why dietitians may make the choice to start a business when they are dissatisfied with their pay in other practice settings. Importantly self-employed dietitians have greatest variability in earnings relative to those working in other sectors (Dosedel, 2025). While self-employed dietitians have substantial earning potential, the broader distribution of pay also reveals the risk of lower earnings than in other sectors. Additionally, these dietitians sought autonomy with work, whether it be for family reasons or other career pursuits, and increases in job satisfaction, which is consistent with other research findings in this population (Pless et al., 1998; Smith et al., 1994).

Participants described their transition into entrepreneurship to be slow and difficult; many maintaining other employment while they transitioned. Similarly, many Australian private practice dietitians described their transition to private practice as gradual as they worked in public hospitals until they felt that their business was established (Donnelly, Walsh, Lane, & Hughes, 2025). Additionally, Australian dietitians described their preparation as inadequate and that they often learned business principles “the hard way and in the context of business survival and sustainability” (Donnelly, Walsh, Lane, & Hughes, 2025, p. 7).

Business in Action

Consistent with the Process Model of Entrepreneurship, participants in this study had to overcome entry barriers (Elango et al., 2007). When these participants were ready to start their businesses, they faced initial challenges like meeting state and federal legal regulations, facing with the financial investment/instability of a new business, difficulty dealing with insurance, and feeling underprepared and undereducated. These barriers were common among entrepreneurs in healthcare entrepreneurship studies. The research mentions barriers like legal and regulatory barriers, complications with insurance, understanding scope of practice, complicated state regulations, ethical and personal conflicts, lack of entrepreneurship knowledge/business skills, support from loved ones, financial support, cost of malpractice insurance and scope of practice (Donnelly, Walsh, Lane, & Hughes, 2025; Elango et al., 2007; Jahani et al., 2016; Sharp & Monsivais, 2014).

The third stage of the Process Model of Entrepreneurship is operational competence which means the entrepreneur has the managerial capacity to run the business (Elango et al., 2007). Participants in this study described needing three types of skills/attributes to be successful at running their businesses, including dietetics-related, general work-related and personal skills/attributes, and business-related skills. Similarly, Donnelly, Walsh, Lane, and Hughes (2025) shared that Australian private practice dietitians identified similar competencies – specifically: people skills, entrepreneurial attributes (e.g., work ethic, persistence, resilience, confidence), clinical skills, and business acumen. They highlighted that clinical expertise was important but inadequate alone for entrepreneurial success (Donnelly, Walsh, Lane, & Hughes, 2025).

Although the participants dealt with challenges and learning curves, their self-reported job satisfaction was high. Though now dated, there is evidence that management and private practice dietitians in the USA are generally more satisfied with their jobs than dietitians working in other areas, including clinical and community (Pless et al., 1998; Smith et al., 1994). High job satisfaction is consistent with recent research focused on Australian dietitians (n = 176) in which 76% were completely or mostly satisfied with their work in private practice (Kirkegaard et al., in press). Recent research shows that entrepreneurs have generally high job satisfaction, so long as their work-life balance feels appropriate (De Clercq et al., 2021; Jensen et al., 2017). Notably, a few participants mentioned they felt like they were “always working” or had a hard time stepping away from their work. There may be some cognitive dissonance with participants’ report of high satisfaction amid burnout and financial instability; future research should explore these relationships.

Resources

Research indicates that mentorship helps entrepreneurs to shape and refine leadership skills (Hunter et al., 2012; Shirey, 2007). Mentors help their mentees learn important skills that cannot be learned in a classroom (Hunter et al., 2012), which is especially important for the unique experiences of entrepreneurs. At Griffith University in Australia, a mentoring circle was developed to support recent graduates of the dietetics program (Molderings et al., 2024). Through the mentoring circles, these recent graduates were able to receive peer and mentor support as well as receive entrepreneurial-related content monthly for a year. Overall, participants of the mentoring circle found it to be supportive (Molderings et al., 2024). There may be opportunities in the USA to develop and facilitate something like this.

According to these data, it would be helpful for dietetics education programs to have business and/or entrepreneurship classes to better prepare dietetics students interested in entrepreneurship. Dietetics educators and academic advisers may consider highlighting relevant minors to supplement the current dietetics curriculum; they may also consider offering coursework that addresses dietetics entrepreneurial practice. Healthcare entrepreneurs in any setting need education in finance, legal business practice, strategic planning, leadership, billing, and management (Arnaert et al., 2018). Providing business education and encouraging entrepreneurship in higher education institutions can help future health professionals develop and increase their innovation, entrepreneurial self-efficacy, and entrepreneurial tendencies (Ocak et al., 2019).

One of the practical applications highlighted in a recent systematic analysis about healthcare entrepreneurship was the importance of infusing entrepreneurial training models throughout healthcare program curricula (Lim et al., 2024). For the USA, the 2020 ACEND standards for Didactic Programs in Dietetics do have a domain of knowledge requirements called “Domain 4: Practice Management and Use of Resources: Strategic application of management and systems in the provision of services to individuals and organizations” which has a list of seven activities that graduates should be able to do (ACEND, 2022). Some of these include evaluating “budget/financial management plan and interpret financial data,” and “demonstrate an understanding of the regulation system related to billing and coding,” and “explain the processes involved in delivering quality food and nutrition services” (ACEND, 2022). Dietetics educators may find opportunities to teach these concepts/skills in the context of entrepreneurial dietetics or at minimum, help students connect the potential use of these skills to that setting.

Further, the participants sought affordable, accurate, and organized information to guide them in their process. They felt like searching the internet was free, but often disorganized and sometimes contradictory. Some online courses had organized and helpful information, but most courses cost thousands of dollars. It should be noted the Academy has some resources for dietetic entrepreneurs, including a Dietetic Practice Group, Nutrition Entrepreneurs (Academy of Nutrition and Dietetics, 2022).

Limitations

There are limitations to this study. The qualitative nature allowed us to understand how and why dietitians have pursued entrepreneurial practice, however additional quantitative research should be conducted to extend understanding of this practice area across a greater number of practitioners. Due to recruitment strategies via social media, participants chosen may have relied on the internet and social media as a resource more than other entrepreneurial dietitians. Further, while reflective of the current demographic profile of the dietetics profession in the USA (Dosedel, 2025), the sample included primarily White women, which may not accurately reflect the experiences of other racial or ethnic groups in dietetics-related entrepreneurship. Finally, a limitation to this study is the potential for survivorship bias, because participants only included entrepreneurial dietitians actively pursuing ventures and did not capture the experiences of dietitians who have failed in this pursuit. These perspectives may overrepresent successful experiences and may not reflect the experiences of those who discontinued their ventures, and this limitation should be considered when interpreting findings and their generalizability.

Conclusion

This study provides information about those who have been successful in entrepreneurial dietetic practice in the USA. Overall, participants were motivated to start businesses by their desire to have autonomy, professional fulfillment, and financial growth. Most described their transition to entrepreneurship as both slow and challenging, requiring new business skill development suggesting there is an opportunity to strengthen this area of dietetics education. Participants described their job satisfaction to be high despite challenges and learning curves. Finally, education and mentorship were important for their success. These data can be used to support current and future dietetic entrepreneurs through education, resources, support, and mentorship.

Footnotes

ORCID iD

Emily Vaterlaus Patten

Ethical Considerations

Brigham Young University’s Institutional Review Board approval was granted prior to data collection (IRB2021-346).

Consent to Participate

A consent statement was reviewed before initiating the interview and verbal consent was provided by the participants over Zoom.

Author Contributions

EP and SP designed the study. SP, NB, and ET collected data under the direction of EP. All were involved in data analysis. EP and SP contributed to the initial draft of the manuscript. All authors provided comments on subsequent drafts and reviewed the final submission.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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 of the participants.

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Dietitians as Entrepreneurs in the USA: A Qualitative Study

Abstract

Plain Language Summary

Keywords

Introduction

Methods

Study Design

Sample Size and Participants

Recruitment

Semi-Structured Interviews

Data Analysis

Results

Theme 1: Getting Started

Theme 2: Business in Action

Barriers and Skills

Employees, Contractors, and Insurance

Job Satisfaction

Theme 3: Resources

Mentors and Resources

Dietetics Formal Education

Advice

Discussion

Getting Started

Business in Action

Resources

Limitations

Conclusion

Footnotes

ORCID iD

Ethical Considerations

Consent to Participate

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability Statement

References