Adrienne Oliveira, DPT, PT, NCS, is enthusiastic in her pursuit of continuing education. She actively seeks out O&P educational opportunities to enhance her physical therapy practice and to share the knowledge she’s gained. She learned about osseointegration from Kevin Carroll, MS, CP, FAAOP, who took the time to sit and talk to her about what was then a brand-new technology. When Oliveira wanted to learn about running with a prosthesis, she went to an Össur clinic on the topic taught by Bob Gailey, PhD, PT.
“It was really eye-opening,” she says of the clinic. “We learned so much, and those are things that are not taught in school. I drove two and a half hours for that, and I didn’t even care.”
All the classes have given her knowledge that she uses to improve her patient care and have given her a profound respect for O&P. It’s a perspective she doesn’t always see in the greater medical community. “I don’t think people have as good an appreciation for O&P as they should,” she says.
Indeed, the experts say, when O&P professionals go out of their way to teach other medical professionals, either through classes, demonstrations, or one-on-one help, it builds bridges for the profession and benefits the students, the O&P practitioners and, most importantly, their patients. The profession’s credentials are solidified when they share their knowledge and the benefits include:
- Practice visibility: Instructors teaching classes are viewed as subject matter experts, and because of this, their clinics are often considered for future referrals.
- Relationship building: Medical professionals from other disciplines who interact with their O&P instructors can develop a deeper understanding and appreciation of their work and are more likely to consult them and ask more in-depth questions about their work.
- Better patient care: When other medical professionals understand more about O&P, they also understand how they can work together to get the best patient outcomes.
Educating to Enlighten
While much has been said about how a multidisciplinary team can improve rehabilitation outcomes, part of that success comes from how well that team can utilize the capabilities of O&P clinicians. All too often, unfortunately, the greater medical community doesn’t know the capabilities of the O&P profession or, perhaps worse, minimizes its contribution. So often, Oliveira says, someone who has not had the privilege to work with an O&P clinician can fall into the trap of thinking of that person as a device provider rather than a medical professional. 
“Shamefully, I think there’s a stigma,” Oliveira says. “I don’t know why someone associated the word vendor with CPOs, and I think that’s just shameful because, first of all, they’re healthcare clinicians and most have engineering backgrounds or master’s degrees. I think that word diminishes their capabilities. I think that’s something that we all, as healthcare providers, need to understand.”
To counter this stigma, she says, O&P professionals possess a valuable resource: their professional knowledge. Unfortunately, sharing that knowledge hasn’t always happened.
For a long time, professionals in O&P were protective of their knowledge, according to Jackie Valdez, MEd, CO, BOCP, FAAOP, clinical specialist and technical manager, BionIT Labs. She says that historically O&P practitioners were hesitant to adopt a team-based approach due to concerns that therapists might encroach on their territory. As a result, there was little willingness to share industry practices or professional insights. However, as education advanced, including the attainment of master’s degrees, it has become crucial for O&P professionals to collaborate closely with therapists and educate physicians about their work. Everything changes when O&P professionals take the leap and share their knowledge, Oliveira says.
“CPOs are not there to sell a device; they are there to work as part of the multidisciplinary team,” she says. “We all have a different perspective, and we can provide the best patient care by sharing our knowledge and expertise within the field.”
Practice Visibility
When John Izak, CPO, clinical manager, Hanger Clinic, Pennsylvania, was an up-and-coming practitioner, he learned that the way to gain referrals in the business was to wine and dine the physicians.
“I come from that generation when you could buy them lunches or give them happy hours,” he says. Rules clamping down on kickbacks to doctors don’t allow that kind of behavior anymore, he says. That’s all right, because by providing classes to those physicians, practices can still make physicians happy and get the referrals they need.
“Knowledge is what people are thirsting and hungry for, and we have stuff that they don’t know,” he says. “Sharing our knowledge and bringing them in, we’re partners to them, and they’re partners to us.”
When it comes to building a reputation and garnering referrals, teaching classes and in-services has proven invaluable to Union Orthotics & Prosthetics, Pennsylvania. Practice clinicians have taught at local community colleges and universities, as well as provided classes approved for continuing education credits by the Pennsylvania State Board of Physical Therapy. While direct sales are difficult to pinpoint, the classes make a difference, says Laura Mullin, CPO, who is also one of the owners.
“A lot of it comes from our long-standing reputation,” she says. “By doing these classes, it reinforces who we are, what we do, and our approach and dedication to patient care. By them getting to know us, they’ll hopefully think of us when they have a patient to refer.”
The company’s clinicians teach a wide variety of classes, including general prosthetics overviews and fitting criteria and more specific subjects such as cranial remolding and AFOs. Mullin says they vary in popularity depending on subject, format in which they are taught, and the time of year. For instance, medical professionals are more likely to squeeze in extra classes when they need more continuing education credits before renewing their licenses.
No matter when the contact happens, it helps keep Union Orthotics & Prosthetics at the top of their minds, Mullin says.
“Our courses help them identify when a patient would benefit from our services, and they have our contact information, so they know they have people to call and consult with.”
Studies show that the referral trend Mullin sees happens elsewhere too. While it’s difficult to quantify the impact medical education classes have on creating referrals, studies show there is a correlation.
A 2022 study found that providing education improved lung cancer screenings. According to the study, doctors and medical assistants at federally qualified health centers didn’t know enough about lung cancer screening even though many of their patients smoked and were at high risk.1 For the study, 57 doctors and medical assistants from two health centers took a class about lung cancer and screening. After the class, the group reported more confidence in identifying patients for screenings.1 What’s more, the year before the class, one of the health centers had ordered no screening tests, the other had ordered nine, and the year after, both health centers ordered more than 100 screening tests.1
While it’s great to pass on the information, Mullin says the medical professionals don’t have to remember every detail for the classes to make an impact and to improve a future working relationship with O&P professionals.
“By educating them, they may not remember everything we inform them about, but they know who we are and they know that when they have a patient who needs us, we can talk about that specific patient,” Mullin says. “They have a better understanding of the level of services and advice that we can give and recommendations beyond just the products.”
Oliveira says that practices she has taken classes through often come to top of her mind when she’s considering a referral.
“It’s because you can get a better appreciation for the type of service that is being provided,” she says. She remembers taking a class about a myoelectric upper-limb prosthesis and hearing the clinician talking about their expertise with it and willingness to help others learn as well. “It builds confidence and makes you feel better about the patient care you can provide as a team.”
Building Relationships
When Valdez was a clinician and would make her rounds at nursing homes, the staff and patients there had a couple of nicknames that didn’t feel quite accurate. They called her the “shoe lady” or the “leg maker.” 
She laughs it off now, and says those nicknames began because the people she helped and worked with didn’t have a full understanding of her capabilities and expertise. Part of her job as an O&P educator is to help other people understand that O&P professionals can do so much more than deliver a device. When people in other disciplines fully understand her capabilities, the whole dynamic changes, she says.
“You’re viewed as not just the leg maker or the shoe lady, you’re viewed as a professional on par with their knowledge,” she says. “You’re viewed as a partner as opposed to just a separate entity. Our profession has evolved significantly, and we have to be looked at as a cohesive team member.”
Mullin says conversations about patient care become deeper and more meaningful when each professional fully understands his or her role and the role of everyone on the team.
“There’s a dramatic difference in the understanding of the O&P professional, [of] the physicians or therapists that we work side by side with, compared to the ones that just send their patients to us,” Mullin says.
When those relationships are working as they should, then the whole team performs better, Izak says.
“They get to engage their patients more when they don’t feel they have to watch over us,” Izak says. “They don’t have to create a checklist for us and make sure we meet it because they have a trusting relationship with us.”
Better Patient Care
While educating other medical professionals can be a great business model, the most important benefits are better patient outcomes. When they better understand the work of O&P and the devices, the patient is the beneficiary of that knowledge.
“Patient outcomes rely on our referrals understanding our profession,” Mullin says.
She and her colleagues frequently participate in a scoliosis clinic at UPMC Children’s Hospital of Pittsburgh. There, alongside the physicians, they see new patients who are getting fitted for a brace that day. This is a chance to work with the orthopedic surgeons to get the best fit and to educate patients and physicians about the brace.
“We didn’t always have a clinic,” Mullin says. “When we started up, we saw a much greater compliance from the patients. I think it was because of the better education and more consistent follow-up. When the doctor saw them separately from us, the communication got lost.”
If the others on the team aren’t well-trained in O&P, then the outcomes are not as good, Valdez says.
“I can provide a patient with the very best orthosis or the best prosthesis on the market, but if I don’t have a physical therapist or occupational therapist that can help with the strengthening or range of motion, that patient is not going to get the full capabilities out of that device,” Valdez says. “We really have to work with our physicians, our physical therapist, our occupational therapists to really enhance the full clinical outcomes of our devices. And it boils down to education. How do we educate and get our therapists to trust us?”
She says good training will complement, not replace, the work of O&P practitioners.
“When we look at good clinical out-comes, we need to have that team approach, and they do need to be trained,” Valdez says. “Not trained how to fit them, but they need to be educated on how to take that next step on how to do the rehabilitation part, or strengthening, or whatever is required so we can get our patients to have optimal use of their devices.”
Getting Started
Clinics that want to start educating the broader medical community about their work can start with small steps, Valdez says. It can be harder for a newer practitioner to get in front of physician groups, but hosting a lunch and learn about various topics in O&P for physical and occupational therapists is a quick and easy way to build relationships and drive referrals.
“I made it a point to do it monthly,” she says. “They just needed to know what I did as a professional prosthetist. That’s a great way to get started, and it’s just something small.”
To get the word out even more, practitioners can put in an abstract to speak at a state meeting, which are always on the lookout for new speakers. They can work up to giving talks at larger, national conventions. Valdez says that submitting case studies to journals is also a great way to share knowledge.
“Sometimes we see these patients in the clinic, and we do something that is a little more unique than we would typically do,” she says. “Practitioners can do a case study on that and give the information to other clinicians that might see something similar in their own practice.”
Oliveira says that physical and occupational therapists are always excited for hands-on demonstrations with new products.
“The more demos the better,” she says. “It makes better connections when they can touch the device and see it in action. When O&P clinics have seminars with their clients and invite therapists to come in, it’s instrumental.”
Union Orthotics & Prosthetics has had a lot of luck by creating a variety of accredited continuing education classes for physical therapists. The therapists need the classes for their licensing and can find topics they are interested in.
“We have a variety of topics on our website,” Mullin says. “They can pick and choose, or we can customize something they might need for their group.”
Not sure about what to teach? Izak says practitioners should focus on two things: their passion and their expertise.
When practitioners are talking about a subject they truly care about, that enthusiasm spreads to the rest of the class, he says.
“Even if they’re a newer practitioner and might lack a little experience, when they get passionate about what they are talking about, they’re educating others. And while they’re educating, they’re also selling themselves and representing our field very well.”
For those practitioners with a wealth of hands-on experience, those lessons are great to pass on as well, Izak says.
“If you’ve seen tons and tons of stuff, even if you don’t like it, you know it,” he says. “With vast amounts of experience comes wisdom.”
Even if teaching is not in the comfort zone of some clinicians, practices can still utilize the benefits of education, Izak says. For example, if one clinician is particularly gifted at teaching while others aren’t, then the practice should utilize those teaching skills by ensuring that clinician is given the time to provide the education and build business for the practice. Also, he says, practices can sponsor other O&P professionals to come in and teach on a topic. Even if your practitioners aren’t teaching, the practice is still marketing itself by sponsoring the class.
“Education is your gateway,” Izak says.
Maria St. Louis-Sanchez can be contacted at msantray@yahoo.com.
References
Akhtar, A., E. Sosa, and S. Castro, et al. 2022. A lung cancer screening education program impacts both referral rates and provider and medical assistant knowledge at two federally qualified health centers. Clinical Lung Cancer. 23(4):356-63.
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Photo2: Alexis Scholtz/peopleimages.com/stock.adobe.com
