Dear Editor,
I’m writing in response to The O&P EDGE’s August articles on 3D printing. The issue of 3D printing isn’t so much that digital innovation will make prosthetists and orthotists more productive and creative; it’s that it will make them obsolete. Think of the financial prospects of the buggy and carriage builders at the dawn of the automobile or, more recently, photo processing companies with the advent of the digital camera. Since the 1980s, the definition of the prosthetic practitioner as a limb-maker has been systematically erased. The practitioner is now a clinician, a consulting member of the rehabilitation team. This concept has been sold, endorsed, and institutionalized. Educational standards have been raised, a residency model adopted, and countless surveys conducted for student research. Level 100 college classes have mathematically become Level 500 classes; the concomitant rigor perhaps more financial than academic. This clinician model suits large practice organizations and educational institutions; a steady stream of assembly line students keeps offices staffed and costs down. This progress is celebrated, and the new minimum standards exalted. However, the talented independent craftsman has been made obsolete.
CAD/CAM, liners, L-codes, and modular endoskeletal construction have all played a part in retarding technical hand skills. Efficiency is no longer measured in the speed of manufacture or quality of the limb’s build, but the financial optimization of the assembled L-codes and submitted receivables. In the Perspective column, 3D printing was referred to as a disruptive technology and those within O&P were encouraged to embrace it. But, true disruption rarely comes from within a field. It comes from the outside, with a sledgehammer. It was not a typewriter company that created the word processor, although that would have seemed a natural evolution. So, when a truly disruptive system arrives in the future, the quality of the practitioner-delivered device will be at such a low minimum, because of our field’s focus on technology, abstract education, and the active avoidance of practitioner practical technical education, that the eventual adoption will be seamless and, in hindsight, inevitable.
Licensure may provide some modest industry protection. Emotional appeals will be made; there will be tears, congressional testimony, and laments. Imagine a physician’s office or hospital clinic taking a non-contact scan of the limb, a manufacturing company with its proprietary shaping algorithms building the leg, and a representative making the delivery. Prosthetic alignment will be automatically set and checked by computer, and gait by video—all with printouts for the chart. The restrictions of licensure and scope of practice will be navigated and done so adroitly by the physician’s (or physical therapist’s) office. What will be supplied to the user will be an efficient, standardized, clockwork limb achieving acceptable minimum standards. What will be lost is craftsmanship, caring, and, dare it be said, love.
The problem with minimum standards, be they educational or technical, is that they are frequently achieved and rarely exceeded. It wouldn’t be practical to do otherwise. In this imagined and encroaching future, prosthetists and prosthetic practices will not exist as we know them or once knew them.
Hermann Haller, Limb Maker, hhaller1929@gmail.com
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