Sustainable O&P Education:
Are O&P Academic Programs at Risk?

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Are O&P Academic Programs at Risk?
By Karen Henry

Higher education institutions across the country are operating in crisis mode. As state budgets continue to experience unprecedented deficits, higher education has become one of the many targets for states looking to bring their budgets back into the black. Endowments, which help to fund private and public education institutions alike, have also suffered. Results from the 2009 National Association of College and University Business Officers (NACUBO)-Commonfund Study of Endowments (NCSE) show that all college endowments lost money in 2009, with an average loss of 18.7 percent for the 2009 fiscal year. (Editor's note: NACUBO gathered data from 842 American colleges and universities.) And while some of those investments have been recouped as the economy slowly begins to rebound, analysts estimate that it will take years for endowments to fully recover.

The U.S. government has attempted to bandage bleeding higher education budgets with federal assistance. According to a research article by John Aubrey Douglass, PhD, senior research fellow for the Center for Studies in Higher Education at the University of California, Berkeley, the $787 billion American Recovery and Reinvestment Act (ARRA) passed in February 2009, "included $140 billion for states to help lessen spending cuts, service reduction, and budget-balancing actions such as tax increases." ("Higher Education Budgets and the Global Recession," Center for Studies in Higher Education's Research and Occasional Papers Series, University of California, Berkeley, February 2010.) One of ARRA's two main streams of operating funds to states included a $48 billion State Fiscal Stabilization Fund administered by the U.S. Department of Education. Of this amount, $39.5 billion was earmarked for "ongoing operational support to public schools, colleges, and universities...."

Even with this assistance, as of September 2009, Douglass reported that 34 states were considering cuts in higher education. As a result of these budget cuts, public colleges and universities are reducing faculty and staff, cutting salaries, increasing tuition, and cutting financial aid, Douglass notes.

Academic programs are also at risk. In their article, "Disappearing Disciplines: Degree Programs Fight for Their Lives," (The Chronicle of Higher Education, March 28, 2010), David Glenn and Peter Schmidt write that "dozens of [academic] majors and doctoral programs have been suspended or terminated since last year, and many more have been under the shadow of the guillotine. Several state systems...are conducting wholesale reviews of smaller degree programs, aiming to weed out the allegedly weak ones. The pace of program cuts," they continue, "is likely only to accelerate during the next year."

While what constitutes a "weak" academic program varies from institution to institution, some of the more scrutinized criteria include cost per student, as well as low-enrollment and low-completion rates. How programs are quantified as such also varies, but as a frame of reference, in South Dakota, minimum enrollment thresholds are set at an average of fewer than five students per year for the past five years, and Glenn and Schmidt identify low-completion programs as "those with fewer than 30 graduates during a five-year period."

Are O&P Education Programs at Risk?

From left: Educators' meeting organizing committee members Kate Muller, CPO, FAAOP; Arlene Gillis, MEd, CP, LPO; and Géza Kogler, PhD, CO.

In a climate where the largest, least expensive dog gets the bone, O&P education programs have a number of built-in factors working against them. Generally speaking, O&P education programs have enrollment numbers that are on the low side compared to other allied health disciplines. For example, the master of science in prosthetics and orthotics (MSPO) program at the Georgia Institute of Technology (Georgia Tech), Atlanta, has a "cohort of 10 students, whereas other institutions that have physical therapy programs, for example, may have cohorts of 45-60," says Géza Kogler, PhD, CO, research scientist in Georgia Tech's School of Applied Physiology. Plus, because of the laboratory component, most O&P education programs typically cost more per student than academic programs that are based on classroom instruction only.

"The cost to teach orthotists and prosthetists-to give them their education-is higher than comparative allied health programs," Kogler says.

Kate Muller, CPO, FAAOP, lead orthotic instructor for the California State University Dominguez Hills (CSUDH) O&P program, agrees with Kogler's assessment. "Our program is relatively small, yet the cost of running a clinical program such as O&P is quite expensive," she says. "[Costs associated with] the materials, machinery, tools, and space needed to run a thorough clinical program are quite high."

These factors have perhaps contributed to the fact that historically speaking, O&P education programs have not proven to be highly sustainable. "There have been 15 practitioner programs in existence in the United States in the last 50-60 years, but...a third of [them] have closed," Kogler notes, adding that the mandated transition to the master's degree level by 2012 has created an additional layer of vulnerability. Not only is the cost to fund the programs high, "getting faculty trained to a level that they can teach at the graduate level is very difficult...," he says. Usually institutions require that faculty members have earned a degree at or higher than the level at which they are teaching.

"Some universities are in a situation...where they may not even be able to offer a master's degree, and their programs might be dropped," Kogler says.

O&P Educators Come Together

Rather than adopting a "fingers-crossed" approach, a group of O&P educators decided to take a proactive one. For the last several years, O&P educators have been meeting with the leadership of the American Academy of Orthotists and Prosthetists (the Academy) during its Annual Meeting and Scientific Symposium to discuss issues relevant to O&P education. During their meeting in March, faculty members from several O&P academic programs discussed with the Academy leadership the barriers in transitioning O&P practitioner education programs to the master's degree level. "The general consensus [of this discussion] was that we needed to address some of the key problems at a meeting of educators," Kogler says. The educators told the Academy that they would like to discuss these issues at a separate meeting that would include representation from all O&P clinical and technical programs, and the Academy responded by providing funds to help support such a meeting. The group received additional funds from the National Commission on Orthotic & Prosthetic Education (NCOPE) and the American Orthotic & Prosthetic Association (AOPA).

Kogler and Muller then invited educators from each of the ten practitioner programs and the six technical programs, as well as other stakeholders, to meet from August 2-4 at St. Petersburg College (SPC), Clearwater, Florida, with the goal of working together to manage the challenges O&P education programs face with a common voice. They hired a consultant, who was tasked with documenting the discussion and generating a report afterward. "Given that there are only ten practitioner programs [in the United States]," Kogler says, "we felt we were in a crisis mode."

Kogler kicked off the two-day discussion by talking about how education and research can influence the direction and future of the O&P profession. Invited participants from various O&P academic programs then provided perspectives on the challenges their programs face in terms of sustainability, as well as the strengths that can be exploited to help ensure their longevity.

Muller, for example, cited the location of the CSUDH O&P program as both a challenge and an asset in transitioning it to the master's degree level. "Our facility is about 15 miles off the main campus, so it isn't as easy for us to have a daily dialogue with our university administrators," she says. "However, I think our current location is also one of our program's strengths." Because the CSUDH O&P program is housed within a building on the Veterans Administration (VA) Medical Campus in Long Beach, California, Muller says that faculty and students "are able to interact with VA physicians, therapists, and practitioners, as well as their patients."

Ray Burdett, PhD, CO, PT, University of Pittsburgh, Pennsylvania, discussed the challenges an academic institution looking to develop a new master's degree program might face. Burdett is the director of the University of Pittsburgh MSPO program, which launched in the fall of 2009. "There is a substantial financial commitment needed to start up a new program, including lab space, equipment, and faculty," Burdett says. "Certified O&P professionals with advanced degrees are still somewhat hard to find...and recruitment of students may be difficult during the start-up phase of a new program, until it becomes accredited." In addressing long-term sustainability, Burdett noted the pressure for faculty members to engage in scholarly activity, and the "need to bring in a sufficient number of qualified students to provide the tuition money that serves as the basis for the program budget."

Burdett, however, believes his program is "well positioned for sustainability" because University of Pittsburgh "school and department administrators are committed to seeing our program succeed and thrive" and because "we are located within a university, school, and department which are all well known and respected for medical, biomedical, and health-related professional education and research," he says.

Joe Young, CPO, instructor and director of the orthotic and prosthetic technician program at the Francis Tuttle Technology Center, Oklahoma City, Oklahoma, provided an overview of the state of O&P technical and assistant programs. "The important role of a technician in the process of providing an optimally functioning prosthesis in a timely, economical fashion cannot be overstated," he says. "However, the perceived value of the education and certification that leads to a qualified, knowledgeable technician is greatly underappreciated."

Young cites outcomes as being critical to the sustainability of his education program. "The sustainability of our program is determined by outcomes," he says. "If we have good outcomes-students graduating, students employed, certification test pass rates-our program will be very stable. If we have poor outcomes, then our program will disappear very quickly."

Robin Seabrook, NCOPE executive director, stressed the importance of accreditation for O&P education programs. Among other things, she says accreditation "assures that a neutral, external party has reviewed the quality of education provided and found it to be satisfactory, based upon appropriate peer expertise.... [Accreditation] signals to prospective employers that an education program has met widely accepted education standards."

Given the importance of accreditation to the long-term success of an O&P education program, Kristine Hogarty, PhD, director of assessment for the College of Education at the University of South Florida, Tampa, discussed the changing landscape of assessment systems, how to develop a sustainable assessment system, and innovative approaches for the assessment of orthotic and prosthetic education programs.

"In recent years, many accrediting agencies have changed their focus with respect to assessment," Hogarty says. "In the past, there was more emphasis on inputs like facilities, faculty credentials, and curriculum. While those aspects...remain important, there has been a move to increase the emphasis on outcomes.... We are living in an era of data-based decision making and are increasingly challenged to examine and determine how data inform programmatic improvement."

Next Steps

After the program overview and presentations, participants broke off into working groups to discuss common challenges that were revealed and what they could learn from them to build sustainable O&P education programs. Once the consultant's report is finalized-which should happen before the next Academy meeting-it will be distributed to all of the O&P leadership organizations and be made available for public view on the NCOPE website, Kogler says.

Muller says that forming an O&P educators council presents a unique opportunity for collaboration and partnership. "Rather than be competitors, we need to be cognizant of and recognize each program's strong points and support each other. In this manner, we can build sustainable programs and have a stronger influence on the O&P profession in the long term," she says.

"We are at a huge turning point with our profession, particularly with regard to education," Kogler adds. "I don't feel that the profession knows how at risk the programs are. During this transition time, we need to put ourselves in a position where our vulnerability is reduced and programs can be resilient through these hard economic times."

Karen Henry can be reached at