The role of clinical dietitians as perceived by dietitians and physicians.

In the early 1970s, researchers began examining the role of clinical dietitians. A 1971 study by Spangler (1) found that 55% of surveyed physician chiefs of staff did not believe members of the dietary department should contribute to the decision making within a health care team. The dietitians, however, believed they should perform fewer kitchen duties and more patient care activities. In 1974 (2), a similar study revealed that although dietitians and physicians agreed that dietitians should contribute to the health team, there was less consensus about their specific tasks. Physicians could not agree on whether making decisions, assessing, planning, or evaluating medical nutrition therapy (ie, attending rounds, initiating diet orders, recommending diets after diagnosis) should be part of the dietitian's functions. In a 1988 study (3), a larger percentage of physicians expressed the view that nutrition support dietitians were more competent and knowledgeable than general clinical dietitians and more a part of the hospital team. A 1990 investigation (4) of clinical decision making revealed that more than half of nutrition support dietitians believed they should be the primary decision makers in the ideal circumstances questioned whereas 11% to 35% of physicians believed dietitians should be the primary decision makers in the ideal circumstances questioned. These studies point to a continuing need for examining the perceived differences between these two professional groups.

The primary objective of this study was to examine dietitians' and physicians' perceptions regarding the roles and responsibilities of clinical dietitians. Ancillary objectives included determining the internal consistency of the measurement instrument and exploring whether the variables of gender, years of practice, specialty area, and type of practice setting contribute or confound any between-group differences that may exist.

METHOD

Design and Subjects

A cross-sectional survey was conducted in the fall of 1995, in which internal medicine physicians and clinical dietitians were randomly selected from the American Board of Medical Specialties Directory of Board Certified Medical Specialists (5) and from the listing of clinical dietitian members within the 10 district dietetic associations in Michigan (6-15). The total number of clinical dietitians in the district directories was 412. From this population, a random sample of 205 dietitians was selected. The same number of internal medicine physicians was randomly selected from the physician directory. The sample size of 205 per occupational group was determined according to the power tables of Kraemer and Theiman (16). Given an approximate return rate of 50% per group (ie, 106 per group), an anticipated small effect size of .24, and using a two-tailed t test with [Alpha] set at the .05 level, the sample size results in 80% power, which is the recommended level.

 
Table 1 
 
Specialty areas of physicians and dietitians 
 
Specialty                             n         %(a) 
 
Physicians (n=88) 
Generalists                          34          39 
Gastroenterology                     10          11 
Cardiology                            9          10 
Pulmonary/critical care               6           7 
Others(b)                             6           7 
Endocrinology                         5           6 
Infectious disease                    5           6 
Oncology                              4           5 
Nephrology                            4           5 
Two or more specialties               3           3 
Gerontology                           2           2 
 
Dietitians (n =149) 
 
Generalists                          52          35 
Two or more specialties              37          25 
Nutrition support                    12           8 
Diabetes                              8           5 
Management/administration             8           5 
Others(c)                             7           8 
Gerontology                           6           4 
Cardiology                            4           3 
Oncology …