CMS established a new physician nutrition specialist specialty code, effective Oct. 1, to make these rare specialists easier to identify.
Who physician nutrition specialists are
A physician nutrition specialist has expertise in clinical nutrition and applies evidence-based medicine to clinical nutrition practice, according to the National Board of Physician Nutrition Specialists website. They generally have backgrounds in other medical specialties, such as internal medicine, pediatrics, family medicine or general surgery, and subspecialties, including adult or pediatric gastroenterology, endocrinology, critical care, nephrology and cardiology. Physician nutrition specialists may diagnose and treat primary nutritional diseases, use nutrition to care for patients with complex nutrition-related conditions and contribute to disease prevention. Nine medical and nutrition societies recognize the board’s credentials.
The board requested CMS make the new code to help identify practitioners. The code does not create a new Medicare benefit or guarantee payment for specific services.
A small specialty
As of Sept. 25, the National Board of Physician Nutrition Specialists physician roster said there are 136 physician nutrition specialists — 133 in the U.S. and three in other countries.
There are specialists in 33 states, with California, New York and Pennsylvania having the most specialists at 19, 18 and 17, respectively. Eighteen states have only one specialist.
“Nutritionist” is not a protected title in most states
Although most states regulate the title “dietitian,” only 17 states and the District of Columbia clearly protect the title “nutritionist.”
All states fall into four models of title regulation: exclusive practice, title protection, certification or no laws. Most states have no law defining who can call themselves nutritionists.
The 17 states that protect the nutritionist title are Alabama, Alaska, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Mexico, North Carolina, North Dakota, South Dakota and Tennessee.
Three credentials cover nutrition specialists: physician nutrition specialists, registered dietitian nutritionists and certified nutrition specialists.
The nutrition training gap
A 2022 HHS survey found medical students get an average of 1.2 hours of formal nutrition education per year, and three-fourths of medical schools do not require clinical nutrition courses. Among residency programs, only 14% required nutrition curriculum. A 2021 Agency for Healthcare Research and Quality review also estimated about 30% of hospitalized patients are malnourished.
In March, HHS and the Education Department announced that 53 medical schools in 31 states committed to provide at least 40 hours of nutrition education starting this fall.
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