Dr.Sidney Fishman / Dr. of O & P Education and my friend!

> It is with great respect that I honor the life, the recent passing and
> the many important contributions made by the late Dr. Sidney Fishman,
> not as representing myself as a provider, but as a patient wanting to
> be better assured that I and millions of “patients” requiring proper
> O&P services receive them from only qualified and educated health care professionals.
>
> I am proud to of known and worked with him.
>
> I first had the privilege of meeting Dr.Fishman at the series of CMS /
> Negotiated Rules Committee Hearings which began in 2002 and lasted for
> about a hundred years!
>
> He was appointed as the alternate representative of the American
> Academy of Orthopedic Surgeons. I represented the Barr Foundation.
> Much to his colleagues chagrin, Dr. Fishman, on numerous occasions,
> expressed his concerns with CMS’s ” little understanding of the
> surgeon’s and physicians clinical contribution and responsibility ”
> to this process of determining a O&P provider’s qualifications.
>
> It was at these meetings I noticed he was often alone during the
> breaks or he was quickly abandoned in any dialogue he had been having
> with ” the provider” representatives whom were also in attendance and represented ”
> their interests” at the hearings..
>
> I remember on more than one occasion, when I was speaking to a
> practitioner or industry leader during the breaks, as Dr.Fishman
> approached, he would say ” I gotta go, here comes Dr. of O&P Education !
> ”
>
> I said to myself what is wrong with O&P education ? That allured me
> since I was often receiving most of my ” for the sake of the patient ”
> education and advise from that same provider/credentialing/trade
> industry group of Neg Reg representatives, (must often in the Men’s
> lavatory). I thought I would introduce myself to Dr. O&P Education and
> learn more.
>
> Coincidently, unbeknown to me, he had met my father 30 years previously.
> He, like myself, was an amputee advocate 35 years ago, and of all
> things, also believed O&P providers should be educated and that they
> should seek higher degrees of formal education in the O&P field, as
> do all others in any other legitimate health care profession. How
> crazy is that ? Sounded reasonable to me.
>
> Since this PhD had endured 50 more years of experience in this
> industry than I had and probably most of the participants of the
> hearings, I concluded it wouldn’t to any harm in learning more about
> this man and his philosophies
>
> Sid and I became quite close in the hundred years during and two years
> following the “turf wars” in Baltimore, via frequent visits with him
> in Florida, many e-mails and many many lengthy telephone
> conversations. Like many PhDs there was no “cutting to the chase ” in
> discussions with Sidney, so you had to be prepared to listen and to
> reply intelligently ! I think he took great delight in capturing a
> unrealistic reply or simplified solution from me ! The solution was
> far from simple but turned out to have precedence.
>
> He claimed the regulation drum I beat was secondary to mandating
> meaningful formal education requirements. He laughed when I ask why
> would any provider without a mandatory licensure requirement go to
> the expense or have the desire to become formally educated when
> absolutely no education criteria was required in 84 % of the states
> to legally provide O&P services ?! Why would colleges and post
> graduate universities have O&P courses if no one had to take them to progress in the field ?
>
> He was always interested in what I had to say, a mere BA degree
> graduate but one whom required these services and had daily contact
> with amputees that were victims of unqualified care or had minimal or
> non existent coverage.
>
> Although I may have not known him as long as some of you whom were
> fortunate to be educated by him, from a patient advocate’s
> perspective, I found he was a wealth of information in providing the
> significant historical background of the industry, and more recently,
> trying desperately to revolve its providers into a worthy recognized
> health care “profession”.
> Some members on the CMS panel insisted formal education nor hands on
> experience was not necessary for a provider to fit prefabricated and
> central fabricated braces and prosthetic components and that since the
> demand of such specialized services outsourced the supply of providers
> we should lower the qualification criteria from none to less than none !
>
>
> Perhaps the most profound statement that I and as we, as patients,
> manufacturers, physicians, prosthetists ,orthotists , physical and
> occupational therapists should remember, and adamantly support, is his
> quote and excerpt in a May 21, 2004 submission to CMS, attached with a
> host of signatories, that reads like “Who’s Who” of medical
> directors, clinical professors, physicians and Chief of Staffs of
> major hospitals and universities i.e. Shriners,Association of
> Children’s Prosthetic-Orthotic Clinics,Hpward University, University
> of Southern California,Childrens Healthcare of Atlanta, Scottish Rite,etc.
>
> “With the passage of time, one fact has remained unchallenged-that
> there was, and is, no existing, identifiable single occupational
> (professional or otherwise), in a position to provide the full range
> of prosthetic-orthotic services required by the skeletal and
> neuromuscular disabled population.”
>
> Sidney Fishman,Ph.D
> Clinical Professor & Sr. Research Scientist, NYU Post Graduate Medical
> School Chairman & Professor,Dept.of Prosthetics& Orthotics, SEHNAP,NYU
> Retired
>
>
> Dr.Fishman was the only one of 26 representatives at the CMS hearings
> that was attempting to bring the various interests together not
> separate them.
>
> He advocated then and up to the time of his passing, that the
> “clinical approach” developed initially in the mid 1950’s under the *
> Artificial Limb Program, conducted by the National Research Council
> (on behalf of the Veterans Administration) be activated to all
> civilian and adult recipients .These clinics consisted of a orthopedic
> surgeon, a physical or occupational therapist, and a prosthetist,all
> with appropiate specialized training in prosthetics. Later ,the clinic
> membership grew to include specialists in Rehabilitation Medicine and
> Orthotics, as research and development in orthotics matured.
>
> More can be read about this in the Prosthetics Research Board National
> Academy of Sciences-National Research Council 1958 publication, titled
> Artificial Limbs.
>
> Some fifty years later this “clinic approach” serves as the standard
> approach to the prosthetic-orthotic care provided for our pediatric
> and veteran population.
> If we can rely on the records, writings and experiences of the
> membership of the Association of Children’s Prosthetic -Orthotic
> Clinics (ACPOC) as well as the Veterans Administration, why not
> consider this multi-discipline approach to the prosthetic-orthotic
> care of Medicare -Medicaid beneficiaries ?
> A reasonable approach, I thought.
>
> I can think of no other individual who loved the “profession” of O&P
> as much as Sidney, but was gradually loosing respect primarily due the
> profession’s indifference and apathy, their inability to unite
> themselves and separate their educational credentials from the grasp
> of “alphabet soap” and “turf wars” that strategically unraveled from
> a handful of self serving entrepreneurs in a generally unregulated and
> unaccountable industry.
>
> Every provider whom would like to be EDUCATED and properly informed,
> should read Dr. Fishman’s practical and precedent submission to CMS
> titled,
>
> RECOMMENDATIONS TO CMS REGARDING A MEDICAL APPROACH TO THE PAYMENT
> PROVISION FOR PROSTHETIC-ORTHOTIC SERVICES AND APPLIANCES
>
> and his published article
>
> “THE EDUCATION OF THE PROFESSIONALLY COMPETENT ORTHOTIST/PROSTHETIST
>
> Dr.Fishman taught me two more important lessons. Its never too late to
> be properly educated.
> And that Dr.Fishman never really did retire !
>
> Thank you Sidney for everything you have done for advancing the need
> of O&P education and …for me personally.
> Today’s O&P providers may not need education to practice their trade
> but you may need more of it to save it !
>
> I leave you with one of Dr.Fishman’s e-mails to me as we worked on the
> post Neg Reg/CMS submission which was offered, however not signed on
> by provider /industry groups and associations, prior to its
> submission to CMS on May 21, 2004
>
> Hope you don’t mind Sidney. You are a hard act to follow !
>
>
> ======================================================================
> ==== ===============================================
> Tony: Responding to your encouraging E MAIL, I have revived my
> statement for inclusion in your submission to CMS with the
> understanding that I will take responsibility for its content. Let me
> have your reactions upon receipt and don’t hesitate to suggest changes
> as you see fit. I will then do a final version.
>
> Best regards.
> SF
>
> It is readily apparent from the failure of the recent NEG-REG meetings
> to reach any agreements regarding the educational and experiential
> competencies of several “allied health” groups .(physical therapists,
> occupational therapists and orthotists). to provide custom-made
> appliances for Medicare and Medicaid beneficiaries, that proper
> patient care demands that this situation calls for urgent independent review and study by CMS.
> Bearing in mind the risks of oversimplifying a very complex situation
> which has been some half a century in the making, the following brief
> summary is offered.
>
> As a group the therapists receive a comprehensive. well-documented
> didactic training, and clinical exposure in the rehabilitation of
> individuals with neuro-muscular disorders which are offered within a
> medical setting(hospitals,clinics,medical offices etc.).However this
> includes little training or experience in the prescription,
> evaluation, measurement, custom fitting and delivery of the large
> number of sophisticated appliances required by the large variety of
> disabling conditions.Concurrently,as far as the “certified
> practitioners” are concerned, the current accreditation standards
> describe a limited and variable didactic training and experience in the medical sciences (i.e.:
> human anatomy, physiology, kinesiology) as well as the clinical
> characteristics of disabling diseases. It is to also to be noted that
> the overwhelming number of O&P certifees practice without any
> recognized academic degree to attest to his professional competence
> in his field of specialization.
>
> A solution may be found in a five year Masters Degree curriculum with
> a Specialization in Orthotics and Prosthetics, offered at existing
> accredited schools of: Allied Health where probably 75 to 80% of the
> necessary liberal arts, humanities as well as basic and medical
> sciences courses are already available to accommodate the additional O
> & P students within existing curricula offerings.. This educational
> approach becomes feasible in view of the recent development in O & P
> for skilled technical workers (a relatively new occupation )to
> fabricate appliances in centralized laboratories based on
> specifications provided by the clinically oriented O&P professional. .
> Accordingly the length of the specialized training required for
> individuals responsible for clinical patient care is being markedly
> reduced. and can be conveniently obtained during the last year or two of the individual’s professional education.
> This educational model simply follows the one, successfully developed
> in Dentistry over many years.
>
> The history of the past 50 years presents indisputable evidence that
> such changes will not occur left to the adversarial groups per se,
> without joint leadership, direction and support from the medical community (i.e..
> AAOS & AAPM&R) and most importantly, governmental agencies such as CMS
> and others who fund research, education and /or clinical services in O&P.
>
>
> Sidney Fishman PhD
> Professor & Chairman (retired), Dep’t of Prosthetics and Orthotics New
> York University
>
>
>
>
>
>