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After eight years in this field, I can't help but wonder if it was a mistake to enter. It was a major career change--a very expensive career change.

I was a custom home and interior builder before answering to this calling&Today as I look back on my educational gains: a two-year technical degree in O&P fabrication technology, then a bachelor of science in industrial design; then becoming an ABC [American Board for Certification in Orthotics & Prosthetics]-registered RTO, RFO [registered technician-orthotics and registered fitter-orthotics] and BOC [Board for Orthotist/Prosthetist Certification] and COF [certified orthotic fitter], I have a hard time convincing myself that I am a better practitioner or a technician with the education than without.

The ABC still sends all correspondence to me as a tech, treats me as a tech, and ignores my standing as a BOC prosthetist. I have met many ABC practitioners who received ABC certification when all that was required was a two-year degree.

Your article [September 2003] about PTs [physical therapists] is fine if you only consider them to be competition. It looks to me that PTs are more in control of O&P's future than orthotists and prosthetists are. [I read] an article&that touted the two curriculums as having at least 80 percent common ground. One can only assume the other 20 percent, that PTs don't receive is the fabrication and modification content, which isn't the emphasis in the clinical education for orthotists and prosthetists.

I haven't seen a licensure bill yet that recognizes the technician who has at minimum a two-year degree specific to the field and/or the accompanying registrations of RTO, RTP, or RTPO. The technicians are the backbone of this industry in the absence of--or with the guidance of--a highly skilled practitioner. Technicians outnumber practitioners in many clinics. Technicians have only recently been extended membership opportunities in various associations as nonvoting members. It is great that we have a technical forum to improve our skills, share tech tips, etc. [However,] enlightenment in no way is the same as the empowerment of a vote.

PTs have a tremendous advantage over orthotists and prosthetists in that APTA [American Physical Therapy Association] is a very powerful association at the state and national level. I have heard figures that give them a ten-to-one margin over our numbers. I was told that PTs were extended the scope of practice in orthotics and prosthetics within the [Ohio] licensure bill because they would have shot the bill down if excluded. We do not have a common association that ties us together and represents the profession as a whole&

There have been statements made that suggest we won't be able to meet the needs of future patients due to shortages of quality providers. On the other hand, we have a hard time attracting new professionals into the field. Our field would be flooded with applicants if they were told about the reimbursements on some of the items, especially with the choice of components used. Instead, we raise the entry-level degree for the profession and the prerequisite course work for those with degrees without requiring those already in the field to pull themselves up to the same level.

In my opinion, this does not benefit the patient or the profession. It does, however, limit newcomers to the field through the exclusionary tactics of licensure and effectively preserves future revenues for long-standing interests. Sadly, licensure leaves the patients to the same practitioners who provided services both good and bad prior to implementation of licensure.

I do believe in continuing education, but my options are geographically limited. It isn't practical to leave my employer and move my family to another state for the sake of an O&P degree. Instead, I have to examine what I can obtain locally. I am looking into a master of science in physical therapy, not because I want to be a PT, but because I want to continue to use my skills to help patients and improve myself&.I welcome the opportunity to share and learn expertise within a professional body that is cohesive and more often than not, placed in higher regard. I do not fear or believe that PTs are going to march on to the field of O&P and push us aside. I have come to witness a well-orchestrated political move on the part of APTA&that has insured a place for PTs in the field.

In the end, patients' opinion matters the most. Patients will come back and recommend my services if I serve them well and with respect. Patients admire all the degrees and certificates, but their primary concern is that I deliver a [well-fitting] brace or limb. I don't look at success by degrees and I would ask the profession to measure success by the degree to which we are willing to help the patients to succeed.

Douglas M. Barlay, RTO, RFO, BOCP, COF

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I receive The O&P EDGE in the mail and online. Today I saw that Ramona [Ramona Okumura, CP, October 2003 issue] was being profiled and clicked on the article you wrote. Below her profile, I saw your listing of other practitioners you've profiled. Why hadn't I noticed this before?? I took time out of my busy day just to learn about some of my colleagues.

How fun! Kudos to The EDGE for this little, innovative column. What a great idea! Keep up the good work; I appreciate your efforts.

Lisa Urso, CPO
Albuquerque O&P
Albuquerque, New Mexico