The Young Turks: How Are They Impacting O&P?

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By Miki Fairley

In the O&P field, the Young Turks and the Old Guard complement one another more often than they clash. Just as in  jazz master Dave Brubeck's CD, "Young Lions and Old Tigers," in which older and younger artists blend their unique styles, the old and the new in O&P are working together to combine the best elements of both worlds to the benefit of the patient.

What is fueling this synergy? An explosion of technological advances and growth in the patient population with a corresponding surge in the demand for qualified orthotists and prosthetists appear to be two major factors. In a field still largely dominated by family-owned practices, the pride and pleasure of seeing sons and daughters and even grandchildren follow their forebears' footsteps into the field link the generations.

Like a blast of fresh air through a newly opened window, the younger generation is noted for bringing enthusiasm, energy, and new ideas into O&P.

A high degree of computer literacy and comfort with new technology are other hallmarks of the Young Turks.

Zach Harvey, CO
Zach Harvey, CO

"Our generation has grown up familiarizing ourselves with computers," says Zach Harvey, CO, Hanger Prosthetics & Orthotics, Fort Myers, Florida. Given this digital orientation, new practitioners will likely increasingly embrace CAD/CAM technology as a tool to increase efficiency, Harvey adds.

Young practitioners and technicians bring enthusiasm and creativity into the field, says Judith Oreski, CPO, Median School of Allied Health Careers, Pittsburgh, Pennsylvania. "They are eager to experiment with new techniques and products and are not tied to a routine way of doing things. Because they grew up with computer technology, they are more confident experimenting with and using microprocessor knee units and myoelectric systems," Oreski continues. Computer technology also increases their interaction with other professionals and their access to information: "All the information and communication available through the Internet enables younger practitioners/technicians to service patients more effectively because they can communicate with so many other professionals to problem-solve and access information." Of course, many older practitioners have likewise turned to the Internet for information exchange.

Thinking "out of the box" has been an exciting challenge for Michael Davidson, MPH, CPO, clinical manager, and three "Generation X" colleagues in the Department of Orthotics and Prosthetics, Loma Linda University International Rehabilitation Institute, Loma Linda, California.

Some of their innovative ideas have included new approaches to cosmetics and prosthetic gait. "We wanted to redefine cosmeticsmake devices look cool. We started using art and cool designs for our pediatric patients, but then older patients in the waiting room started to notice and wanted them too. Now we encourage them for everyone."

The team has taken a critical look at defining gait parameters. "We redefined optimum gait as the fastest gait possible, even if it includes a gait deviation," says Davidson. For instance, at the request of a 13-year-old patient, they removed his prosthetic knees. The patient increased his speed from a 24-minute mile to an 18-minute mile to a current six-minute mile.

The prosthetists are getting amputees up right after surgery and doing some non-traditional treatments such as putting on roll-on suspension sleeves while the patient still has surgery sutures. "We are getting them to walk early and even run," Davidson says.

However, in many cases older practitioners are no slouches when it comes to embracing new technology. In fact, both younger and older practitioners name new materials, computerized componentry, and new approaches and designs as the most positive aspects of the current scene. Although older practitioners and technicians might be skeptical of a new idea at first, if it works, they are excited too, says Davidson.

Mutual Respect

Cara Negri
Cara Negri

Mutual respect is common. "Their [older practitioners'] knowledge base complements ours," says Davidson. Combining both old and new "seems to work out for what's best for the patientand that's our goal."

"There is an advantage to having young practitioners working with experienced practitioners in the mentor/apprentice model," says Cara Negri, who will be attending the prosthetics certificate course at Northwestern University, Chicago, Illinois, after completing her bachelors degree in mechanical engineering, with an emphasis on biomedical engineering, at Kettering University, Flint, Michigan. Cara is not a newcomer to prosthetics; she has spent four years in prosthetics development and patient fitting at Springer-Bremer Prosthetics Inc., Flint. "The young bring new and fresh outlooks and ideas," she continues. "The experienced have the wisdom and knowledge to guide the young. Nothing can replace the hands-on experience of working with a certified practitioner."

Les Bauer, CO, and his son Greg Bauer, CPO
Les Bauer, CO, and his son Greg Bauer, CPO

Les Bauer, CO, and his son Greg Bauer, CPO, enjoy practicing together at Westcoast Brace & Limb Inc., Tampa, Florida. "Both young and older practitioners need to have respect for what the other knows," says Les. "Instead of saying, This is how we've been doing it for 30 years, and this is how we want you to do it,' the older practitioner should be willing to listen to new ideas."

Greg agrees. "Older practitioners often know from their experience how well something will work. Experience has given them knowledge. Younger practitioners generally have more book knowledge' about physiology and kinesiology."

Ed Haddon, MEd, CO, director of the Orthotic and Prosthetic Technician Program at Century College, White Bear Lake, Minnesota, recently visited facilities in the Minneapolis-St. Paul metro area. Noting that over 90 percent of the O&P professionals in the area are Century College graduates, Haddon said, "I have observed students that graduated from 1975the first O&P class at the collegeworking alongside graduates from this year's class. A gap of 27 years did not seem to make any difference in the level of enthusiasm and the professional manner in which they interacted with their patients and colleagues." Haddon concludes, "The reasons that attract people to this field have not changedand this binds our professionals at all levels of experience."

Family Synergy

Ed Haddon, MEd, CO
Ed Haddon, MEd, CO

The synergy between young and old practitioners is often exemplified in family firms. For instance, Harry J. Lawall Sr, CP, founder of Harry J. Lawall & Son, Philadelphia, Pennsylvania, has seen five of his sonsHarry Jr. (Bud), John (Jack), David (Dave), Wayne, and Christopher (Chris)become certified practitioners and join him in the business. A grandchild, Andrea, who is currently attending Northwestern, will also be joining the firm.

The Lawall brothers, who are co-owners along with their father, frequently discuss ideas and tap one another's expertise. "We each have our own strengths," says Jack Lawall, CPO. "We, along with our father, confer on solutions."

"It's been a great blessing to see my sons in the business and working so well together," says Harry Sr.

Jim Fenton, CPO
Jim Fenton, CPO

Jim Fenton, CPO, Fenton Brace & Limb, Miami, Florida, speaks with pride of his son, James Fenton, CPO, a third-generation O&P practitioner who owns Orthotic and Prosthetic Clinic, Port Saint Lucie, Florida. Says Fenton, "There are a number of things that he is approaching differently and with a much higher level of skill and understanding than I had at the same point in my career. He also chose early on, to make his career in patient management rather than trying to hone technical skills as well as patient management skills&Many of his generation are making similar decisions, which will lead to a fundamental change in the way P&O is practiced as well as perceived."

Research Opportunities

Some educators and others see open doors to more research activity for young practitioners.

"Young practitioners may have their greatest influence in the research arena," says Bryan Malas, CO, director of Orthotics Education, Northwestern University. Since residents must complete a research project, some may pursue publication of their research. "In the past, most peer-review journal publications related to the field have come from outside the profession," he says. "In the future, we might see more research coming from within the profession."

"I hope to see more young practitioners challenge themselves by integrating research into their profession," says Cara Negri, who participated in a research project with Kettering University and Springer-Bremer Prosthetics. "A masters level program in prosthetics centered on research is imperative for the future of the prosthetics field."

Oreski too would like to see more young practitioners attaining advanced education degrees. "I hope they will realize that to be a respected member of a rehabilitation team, they must have equal knowledge and credentials." Oreski would like to see more masters and even doctorate programs being developed.

Facing the Challenges

What challenges do the Young Turks face now and in the future?

One of the biggest is what almost everyone in the field loves to hate: insurance companies and what has been called "mismanaged care."

"The most frustrating thing young professionals are going to face is the constant haggling with health insurance companies to cover the advanced technologies they want to provide to their patients," says Oreski, a sentiment shared by several other interviewees.

The question of who is a qualified O&P provider and the volatility of the managed care environment are issues likely to affect younger practitioners more dramatically than ever before, says Malas. Young practitioners may also have to provide more evidence and justification of O&P services for reimbursement, he adds.

"Two big challenges are facing the young practitioner. The first being able to provide quality service in an overly litigous, cost-constrained, and heavily regulated industry. And the second, balancing the rigors of work and family life," says Wayne Lawall.

One practitioner, who wants to remain anonymous, stressed the problem of salary levels: "For the profession to attract and retain caring practitioners, the pay and benefits need to be similar to that of registered nurses, physical therapists, engineers, and other professionals with equivalent educational standards. In the present situation, it would be a very poor business decision to enter the field."

"By stepping away from the technical arena, tomorrow's practitioner is going to be seen more as a problem solver and not an assembler of tinker toys or a maker of marvelous gadgets," says Fenton. "If the fabricators can pick up the ball and run with it, there will be no shortage of practitioners, since the current crop will have more time to devote to patients."

Many of both older and younger practitioners see more technology and more choices for patients in the future. Even though "Generation X" is often on the cutting edge of technological advances, "We have to continue to be receptive to new ideas and not become stagnant," says Davidson. After all, Generation Y is coming up!