In Search of Tomorrow's O&P Pratitioner

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By Judith Otto

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John W. Michael, C.P.O.
John W. Michael, C.P.O.

It's not just O&P. All healthcare fields have been impacted by a manpower shortage with regard to recent recruitment-not because there aren't talented minds and skilled hands out there; not because O&P and other healthcare professions don't have the charisma to attract them-but because reimbursement problems have become so prevalent since the rise of managed care. Knowledge of this situation has percolated beyond O&P, as well as healthcare in general, and has discouraged candidates who might otherwise consider O&P as their life's work, believes John Michael, CPO, noted clinician and consultant.

"There are certainly a smaller number of people interested in coming into the O&P field," says Michael. Every facet of healthcare has been affected by managed care-and many of them have been hit harder than the O&P field, Michael says, pointing out that physician recruitment is down between 30 and 40 percent. Therapists and nurses have declined too. "The whole system has been disrupted," Michael points out. "Why would a young person choose to enter the O&P field and face the reimbursement hassles?"

As long as the government continues to tamper with reimbursements and encourage managed care, most people will choose a career that is more stable and more lucrative than healthcare, Michael says, adding, "We lose a good chunk of students who are well-qualified, but did the expedient thing.

"On the other side of the coin, I'm impressed with the quality of the people who are coming into the field, undaunted by the financial aspect-good folks who genuinely want to help patients and are willing to get their hands dirty."

Reimbursement: Continuing Influence

How might the reimbursement picture continue to influence recruitment of potential O&P professionals?

A study by Caroline Nielsen, "Issues Affecting the Future Demand for Orthotists and Prosthetists: Update 2002," published in July, concludes that:

• Reimbursement for technologically advanced products will be increasingly dependent on demonstrating improved quality of life and long term cost-effectiveness;

• Without continuing improvements in reimbursement policies, an increasing number of persons are likely to be paying for orthotic/prosthetic products from their own resources;

• An increase in the number of insurers requiring patient care to be provided by an orthotist/prosthetist certified by the American Board for Certification in Orthotics and Prosthetics (ABC) would increase the share of the market and the number of certified practitioners required to meet patient needs; and

• In this fluctuating reimbursement environment, research, public relations, and educational efforts are essential to demonstrate the high quality and cost-effectiveness of patient care by certified orthotists/prosthetists.

The demographics picture presents both challenges and opportunities for the future of O&P.

Robin Seabrook, executive director of the National Commission on Orthotic and Prosthetics Education (NCOPE) points to findings highlighted in Nielsen's newly updated study:

• By 2010 the baby boom population will be between the ages of 46-64, creating a rapid increase in the proportion of the population at highest risk for those diseases/disabilities requiring orthotic/prosthetic care. A dramatic increase in the older age groups after the year 2015, due to the aging baby boomers, will significantly increase the demand for both orthotists and prosthetists;

• The number of persons using orthoses is expected to increase by at least 31 percent by the year 2020. Without an increase in graduates, the projected number of orthotists available in the year 2010 will be able to serve only 61 percent or less of the population using orthoses;

• The total number of persons with an amputation is expected to increase by at least 47 percent by the year 2020. Without an increase in graduates, the projected number of prosthetists available in the year 2010 will be able to serve only 66 percent or less of the population using prostheses. With a 10 percent increase in graduates in the year 2010 and another 10 percent increase in 2015, the projected number of prosthetists available in 2020 will still be able to serve only 66 percent of the population using prostheses.

O&P Schools: What's the Prognosis?

Like the wetlands, are O&P programs and schools vanishing? Do they need federal funding to protect and preserve them? If they disappear, where will tomorrow's practitioners be trained?

Seabrook agrees that there has been a decline in enrollment in O&P schools and programs over the last three to four years: "It's not statistically significant, but any decrease at all in a field as small as ours can be regarded as significant."

 

Graduation rates for the eight baccalaureate and certificate programs in the seven schools accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and NCOPE vary from 194 in 1998 to 216 in 1999, 182 in 2000, 188 in 2001, and a projected 174 in 2002, Seabrook reports.(Four schools also provide accredited technician programs.) Despite the clear need for more and expanded programs, Seabrook notes that attempts to establish O&P masters programs have had poor success rates: "One masters program-in Iowa-folded before it even started."

However, the future appears brighter, Seabrook points out, as the Georgia Institute of Technology, Atlanta, is currently implementing its masters program and accepting the first students this fall. [Editor's note: For more information on Georgia Tech's masters program, visit www.ap.gatech.edu/mspo] .

Mark Edwards, CP
Mark Edwards, CP

Northwestern University, Chicago, is also looking into a master's level program. "A graduate level education is necessary," affirms Mark Edwards, CP, director of Prosthetics Education at Northwestern. "I don't know that a graduate degree will be mandatory, but it is needed to grow the profession from within, so that we have individuals equipped to become the faculty, researchers, and leaders of the profession."

 "We certainly need more schools," believes Morris Gallo, CPO, a member of the Florida licensure board and one of the architects of the state's licensure law. "Classes are very small and not conveniently spread around the country, and they seem to be always teetering for lack of funding." Programs at New York University (NYU) and the University of California-Los Angeles (UCLA) went under after 20 years, because there wasn't enough money to sustain them, Gallo says. "Diminishing funding was only part of the problem; there were also legal limits placed on what they could charge students.

 "To me, it's a national security issue," Gallo continues. "Military personnel are coming back wounded, and they have no place to go. Veterans moving to Florida may not be able to get a new-patient appointment for O&P services at a VA center for three years. And without new practitioners entering the field, it's only going to get worse."

Don Fedder, DrPH
Don Fedder, DrPH

So where is the future O&P practitioner coming from? "The future practitioners are going to come from the same place as they do now," says Don Fedder, DrPH, president and CEO of the Board for Orthotist/Prosthetist Certification (BOC). "But it won't be from the university base. We're competing with large numbers of nurses, pharmacists, and physicians for educational funding; there's just no money left over for O&P. So we have to take the practical approach. I don't have a crystal ball, but unless there is some kind of unforeseen intervention that I can't imagine, the primary route for those who want to train in this field will continue to be apprenticeship.

"I'm not opposed to education," he adds promptly. "As a matter of fact, five PhDs have graduated under my tutelage. There's no question that there is a fundamental scientific and engineering base that underlies O&P. You've got to know something about gait control; you've got to know something about materials; you've got to understand the mechanics of an artificial leg to be able to align it.

Ron Manganiello
Ron Manganiello

"Someone who has been trained in a technical way can advance to a point where they become extremely skilled and know exactly what they have to do, and do it," he continues. "There are alternate pathways to get to the goal, which is to have a competent practitioner who can take care of patients." 

Seabrook agrees that, although the reason applications in O&P programs are down is still "the $10,000 question," healthcare career choices today don't attract as much interest as other fields providing easier, faster money. The good news, she said, is that applications are back up to their usual numbers for the 2003 academic year. "We may be seeing a reemergence of interest," she noted hopefully.

Are Gender Surprises in Store?

Will more women practitioners help fill the gap?

Susan Kapp, CPO
Susan Kapp, CPO

"I am proud to report that about 40 percent of the patient care practitioners at New England Orthotic & Prosthetic Systems are women," says Ron Manganiello, CEO. "We currently have 22 practitioners, of whom eight are women. It is also interesting to note that three of our women practitioners are branch office managers/partners. We are also currently negotiating with two additional certified women practitioners that we haven't yet hired. As far as I know, we have the highest percentage of women practitioners of any O&P company around.

"We haven't targeted women in particular. But for whatever reason-or perhaps simply by coincidence-we are seeing many women practitioners right now, who are either in our markets competing with us, or looking for jobs, or recruiting. I think it's a great field for women to enter."

Susan Kapp, CPO, assistant professor and director, University of Texas Southwestern Prosthetics-Orthotics Program, Dallas, notes that about one-third of Southwestern's O&P classes are females; NCOPE's June 2002 quarterly newsletter reports that 21 percent of 597 graduates completing residencies through NCOPE programs since 1995 were female.

Judith Otto is a freelance writer based in Holly Springs, Mississippi.