I somewhat disagree with your take. The first dietician I saw tried to sell me Mary Kay cosmetics and she was attached to the hospital.
The doctor I now see is the third doctor I consulted. He, along with his staff, helped me learn the ins and outs of Celiac. I think a doctor should be aware of these issues in order to send you to the RIGHT dietician, if not having one attached or consulting through his own practice. Of course I do deal with a specialist and I think under the circumstances, a specialist is required.
And speaking of hospitals--I spent several days in one while my mother was being treated for Lung Cancer---guess what. The hospital could not feed me a full meal--near everything had wheat / gluten in it. To get more than fresh fruit--I had to eat out or go to a grocery store. That was just in May 2007. Hope I never wind up in a hospital.