How to Survive a Zombie Apocalypse: What the Walking Dead Can Teach Us About Professional Survival
September 2017 Issue
Why Study Zombie Stories?
According to Platt, "cultural productions reveal something about the societies that created them."1 Consistent with this principle, "zombie ﬁlms, comic books, novels, [and] video games…can be seen as signiﬁcant cultural objects that reﬂect and reveal the cultural and material circumstances of their creation." Platt considers zombies to be "bureaucratically managed representations of cultural anxiety." According to Peter Dendle, PhD, "the zombie can be read as tracking a wide range of cultural, political, and economic anxieties of American society."4 Platt argues that "to ignore these mass-mediated cultural representations of fear and terror is to ignore one of the largest and most enduring cultural sites in which thought and discussion of and about fear and terror occurs."1
This perspective is supported by an article published in 2009 in the Annals of Improbable Research. Researchers investigated the prevalence of zombie movies, which in their study included mummy movies, from 1910 to 2008 and found increases in zombie popularity that "always seem to fall slightly after a huge political or social event has caused mass fear, chaos, or suffering."5 If it is true that "zombies address fears that are both inherent to the human condition and speciﬁc to the time of their resurrection," there may be some value in considering what zombie stories can tell us about our professional survival.1 Reflecting over more than 30 years of involvement in O&P, I cannot think of a time when the profession has not perceived a significant ongoing threat to its survival. It can seem like the profession moves from one crisis to another in striving to provide optimal patient care and improve or gain professional credibility. In some ways, O&P professionals operate with a perpetual apocalyptic mentality—our profession's survival, or at least the professional way of life to which we have become accustomed, always seems to be under threat. This fear can be seen in the questions that prospective students ask when visiting an O&P school such as: "I hear that a lot of practices are struggling; should I even be considering this field?" It can be seen in the advice given by some experienced practitioners to young people who visit their practice: "Find a different job because this one won't be around for long." Traces of fear can be seen in exchanges at national and regional meetings and on the OANDP-L listserv, when practitioners swap stories about how the latest payer policy decisions are making it difficult to practice profitably. This article discusses features of the zombie narrative in popular culture, how fear influences our professional perceptions, and provides insights regarding the survival of O&P as a profession.
Who Are the Zombies?
While there is some dispute regarding the specific origin of the word zombie, both the word and the concept have their origins in Haitian Creole culture and voodoo religion. In these traditions, zombies are human bodies without human souls—they lack the "moral and emotional nature of human beings."6 Bishop states that "although the original term zombi was a Creole word for ‘spirit,' in voodoo culture it ironically refers to someone lacking a soul…."2 For most of us, the word zombie conjures up images of subhuman beings "remorselessly consuming everything in their path," and a "toxic infection that must always be kept at arm's length."7 Part of the reason zombies frighten us is their relentlessness.3
LOSS OF PROFESSIONAL IDENTITY
While it may be hyperbolic to characterize forces that challenge the O&P profession as lacking souls, it can seem that some of these stakeholders are not concerned primarily with the human side of clinical practice. At the very least, third-party payers, policymakers, and even referral sources can seem less concerned with our patients' welfare than we are. It is easy to see payers' representatives, for instance, as concerned only with the economics of patient interactions, and not with providing the best care to patients. Their persistence in denying claims, questioning professional recommendations, and placing unreasonable demands on practitioners can seem ruthless. While we might think of the motives of other healthcare providers more positively than those of payers, we may see our own motives as purer, and ourselves as more aware of and aligned with the patient's O&P needs. If zombie stories reflect our fears, is it worth considering what we fear as professionals and how those fears affect our views of these individuals and situations?
Zombie movies involve a battle against overwhelming opposition and the quest for survival against impossible odds. The plot convention within zombie films of representing a small group of people who are trapped and fighting off a mob of zombies who want to eat them sounds like a fitting description of the O&P profession.2 Like the protagonists in a zombie movie, defeat can seem inevitable just based on numbers. According to the Henry J. Kaiser Family Foundation, more than 440,000 physicians of all types practice in the United States.8 The U.S. Bureau of Labor Statistics reports that in 2014 there were more than 200,000 physical therapists and 7,500 orthotists/prosthetists in the country.9 This data reveals that physicians and physical therapists alone outnumber O&P providers by 85 to 1. The relative size of O&P puts practitioners at a distinct disadvantage when representing O&P interests to government agencies and payers. Additionally, geographical spread and intense regional competition complicates collaboration among O&P practitioners. Small numbers mean a heightened competitive landscape—working together is harder because the success of one individual or practice can be perceived as threatening to others.
Complicating matters, the O&P profession is defined by a specific body of knowledge, training, and expertise that is often not adequately understood by other professionals, and there is great disparity in education and experience levels within it. A physician referring a patient to an O&P provider may have the option within one community of referring patients to practitioners with educational backgrounds ranging from no college to a master's degree. Many referral sources may be unaware of the meaning of the letters that follow practitioners' names, and are even less aware of differences in training represented by each of those credentials. Education alone does not guarantee quality care, especially given the highly customized nature of the services and devices we provide, but it can be difficult to make a credible claim that experience alone makes our opinion valuable. How should we explain to payers or referral sources that the opinion of an unlicensed, uncertified O&P practitioner could be more credible than that of a physical therapist with a doctoral degree who has been practicing for the same amount of time? Making that claim is challenging, particularly if we are unable to communicate at their professional level. These and other factors complicate the protection and expansion of our professional boundaries.
It should be no surprise that our national organizations spend considerable time, energy, and money defining and promoting our professional identity. This professional self-definition is an important part of maintaining direct control over how we can practice and how we are perceived by others. Ultimately, legal regulations and payer policies are the determining factors in defining who can provide what types of medical services. It is up to the people within the profession, however, to ensure that the decision-makers involved in that process are aware of the education, skills, and expertise we bring to the table. We need to recognize that, as important as these larger efforts are, the opinions that referral sources have of our qualifications will be determined more by the day-to-day behavior and practice of individual clinicians than by national and state efforts to define our profession. We all share the responsibility to practice in a way that exemplifies the highest values and integrity. Our survival depends on it.
Loss of Professional Autonomy
Closely related to the issue of professional identity is the fear of losing our autonomy. A loosely defined profession is more likely to lose the freedom to function independently. Self-definition precedes self-determination. The drive for professional independence is deeply rooted in our cultural context. According to Shawn McIntosh, PhD, in a book chapter titled "Evolution of the Zombie: The Monster That Keeps Coming Back," our modern fear of zombies is different than that experienced by those who lived in the context of the original zombie traditions. "Haitian peasants greatly fear being removed from ‘the many' and becoming ‘the one.' This is the exact opposite of what causes fear among modern audiences in industrialized society, who are afraid of losing their individuality and becoming one among ‘the many."'3 According to Bishop, in early zombie films "the central horriﬁc feature is…the loss of autonomy and control…."2 The Creole tradition of dead humans who are "brought to life without speech or free will" can represent a loss of our ability to think, speak, and act independently of a professional force more powerful than we are.10 We see input by payers and professionals with differing priorities as a hindrance to our ability to make decisions in the best interest of our patients. Many of our referral sources are less knowledgeable about O&P than we are, and it can seem that it is a priority for some payers to find reasons to not pay for the devices and care patients need. Many practitioners fear that the O&P scope of practice will be defined, and our professional boundaries violated, by individuals with fewer qualifications and less experience providing those services to patients, so we struggle to retain as much independence as possible. The drive for professional independence is more than a cultural artifact, it is a matter of professional survival.
Cooperation and Collaboration
Cooperation is one of the keys to survival. Unfortunately, one of the enduring features of zombie films is that "the survivors' temporary rampart disintegrates not because of the zombies but because of the survivors' inability to cooperate despite their differences."1 Gerry Canavan, PhD, points out that "the solidarity created among survivors in zombie narrative is always much more unstable than in the typical alien invasion story. Countrymen do not band together in the zombie crisis, and the nation does not have its finest hour; instead, allegiances fragment into familial bands and patriarchal tribes, then fragment further from there."7 Within O&P, this fragmentation can occur at local and regional levels, as well as at the highest levels of the national organizations. Differing constituencies, varied priorities, and strong personalities can lead to disagreements between individuals or among organizations that develop into competitiveness. The quest for survival can degrade into a situation in which zombies (or others perceived as outside) "must be fought, betrayed, abandoned, and destroyed, so the protagonists…might survive."7
I don't speak in an official capacity for any organization, but my involvement on the American Academy of Orthotists and Prosthetists (the Academy) board of directors and committees over the past seven years has convinced me of several things about our national and regional organizations. First, the leadership of our organizations share a common commitment to and passion for our profession and the patients we serve. My experience with the executive directors, staff, and the multitude of volunteer leaders of the Academy, the American Orthotic & Prosthetic Association, the American Board for Certification in Orthotics, Prosthetics & Pedorthics, and the National Commission on Orthotic and Prosthetic Education has shown that they are dedicated professionals who work hard to set aside personal agendas and make decisions based on what they believe is best for the profession. My respect for and trust in the leadership of our profession is stronger because of my involvement. If you find yourself suspicious of either their motives or methods, I suggest you find a role to fill and work side by side with this dedicated group of leaders. Few things build trust like effort toward a common goal.
Second, collaboration is happening behind the scenes every day. There are sometimes important differences of opinion (and intense discussion) within and between organizations. But energy is focused on priorities that positively impact the day-to-day experience of front-line clinicians in practical ways. Leadership of five O&P organizations meet regularly as the O&P Alliance to coordinate efforts and deliver a consistent message on important issues. Their primary focus is doing the work of their organizations, but careful consideration is also given to how information about these activities should be disseminated. Third, relationships with other professional organizations are being evaluated and nurtured. A close working relationship with other professionals will reduce the tendency to compete, reveal areas where our interests overlap, and allow room for collaboration.
Zombie narratives can help us recognize and face our professional fears, as well as develop constructive responses to external and internal challenges. Perceived external threats to our profession can bring out the worst in us as individuals and as a group, or they can be the catalyst for raising our level of professionalism. Too often we are our own worst enemy by adopting an "us-versus-them" professional view. "This is what we do, whenever zombies strike: we build fortifications, we hoard supplies, we ‘circle the wagons,' and point our guns outward. And we do this even, and most tragically, when the zombies don't exist, when outside the walls there are only other people just like us."7 It is worth spending time reflecting individually and collaboratively on what defines us as professionals in our day-to-day practice, and how we can build the trust necessary to expand our influence and autonomy with our colleagues in related disciplines. After all, "…we don't live inside a zombie narrative; we live in the real world, a zombieless world, where the only zombies to be found are the ones we ourselves have made out of the excluded, the forgotten, the cast-out, and the walled-off." Perhaps the most meaningful lesson of the zombie narrative is not that there are forces persistently working against our survival, but that a key to professional survival is collaborating with other professionals in developing constructive responses to challenges we all face. Without that cooperation, we are the walking dead.
John T. Brinkmann, MA, CPO/L, FAAOP(D), is an assistant professor at Northwestern University Prosthetics-Orthotics Center. He has more than 20 years of experience treating a wide variety of patients.
- Platts, T. K. 2013. Locating zombies in the sociology of popular culture. Sociology Compass 7(7):547-60.
- Bishop, K. 2008. The sub-subaltern monster: Imperialist hegemony and the cinematic voodoo zombie. The Journal of American Culture 31(2):141-52.
- McIntosh, S. 2008. The evolution of the zombie: the monster that keeps coming back in Zombie Culture: Autopsies of the Living Dead (Lanham, Maryland: Scarecrow Press) 1-7.
- Dendle, P. 2007. The zombie as barometer of cultural anxiety in Monsters and the monstrous: Myths and metaphors of enduring evil. (Amsterdam: Rodopi) 38:45-57.
- Newitz, A. 2008. War and Social Upheaval Cause Spikes in Zombie Movie Production. MuMMies, ZoMbies & bagels issue. Improbable Research 49:16.
- Canavan, G. 2010. "We are the walking dead": race, time, and survival in zombie narrative. Extrapolation 51(3):431-53.
- Munz, P., I. Hudea, J. Imad, and R. J. Smith. 2009. When zombies attack!: mathematical modelling of an outbreak of zombie infection. Infectious Disease Modelling Research Progress 4:133-50.