There are about 70,000 registered dietitians in the United States, including about 7,000 in California. But Judy Fields lays claim to being the only R.D. in the Sacramento area with a full-time private practice.
There's a reason for the rarity: It's not easy to go solo. First, there's the mentality that anything medically related should be paid for by somebody else, and a lot of health maintenance organizations won't cover her services.
At the same time, much of her work involves helping patients lose weight, and it's hard to counter the big marketing budgets of the commercial weight-loss chains. Fields says her $70 hourly fee isn't that expensive when compared to the national chains, once you factor in the special foods and other extra costs they often entail.
But to convince potential clients, she first has to reach them. That has required a combination of networking, cold-calling, a positive outlook and time -- she regularly makes herself available to patients on evenings and weekends.
Fields started out working in a more traditional setting, as a clinical dietitian in hospitals. But after 10 years of that, she began moving toward independence. She became a consultant to medical groups, working out of doctors' offices and working as an instructor in a weight-control center.
The catalyst to go solo was a set of skinfold calipers, for measuring body fat. She asked her employer to buy the device, and after a year she was still waiting for the OK. That was enough, she thought. Within a few weeks she had her own calipers and her own practice.
"It has been very, very difficult to establish a reputation," she acknowledges. But she did, and now has offices in Fair Oaks and Vacaville.
She had one source of referrals among the physicians she already knew. To expand that pool, she started cold-calling doctors. Fields also does a lot of public speaking, has written articles for publication and self-published a book, "E.A.T. and Be Healthy."
But her best source of new business has been word-of-mouth from past patients.
"She did wonders for me," says Steve Hix, a territory manager for Red Wing Shoe Co. He showed up at her office weighing 365 pounds and suffering from diabetes and high blood pressure. "I guess I've been going to her for almost four years. I was able to lose about 180 pounds with her and have been able to keep most of that off."