Thursday, May 19, 2022

Qualifications

Jim DeWees

I have read all the comments so far on this issue and just feel I need to
make a few additional comments on this issue of qualifications and training.

Just as a warning, this will most likely offend many people out there. I am
sorry if it does, but I am trying to be careful and avoid generalities. I
will use specific issues, specific cases, but for these cases, there are
many other ones very similar to what I am getting at.

I decided to go into prosthetics after having an accident and becoming a BK
amputee myself in 1998. I was already in the medical field, doing pathology
at a university hospital for about 9 years. I had a couple choices to make,
doing the BOC route, which I felt was not a good option. Or I could go to a
legitimate program and earn a degree (on top of what I already had), and
then fulfill the ABC requirements and take the exams.

When ABC opened up the floodgates and let everyone in for the $75 (ok, I
just cannot let that go), I new it was only a matter of time before this
issue would come up with people making charges and questioning the
qualifications and education of the O&P field. This has been a struggle for
decades.

I have a friend in California who finished PT school, then she decided to go
into orthotics and prosthetics. She talked with me a lot about what the
advantages were for going to school. I told her that she would have more
student loans, be a couple years behind in getting the ABC credential, loss
of income while doing her education and residency, looking forward to a job
with some company and make a whopping $30,000 a year while turning around
and paying NCOPE and ABC a couple thousand dollars just for the privilege of
working for a company and getting paid virtually nothing. I personally do
value education, I sacrificed my time, money, among many things, and did
that. I explained to her that there is no good substitute for education,
but ABC obviously did not see it that way. I honestly did encourage her to
go to the Dominguez Hills program or Rancho or whatever it is called (I
attended the prosthetics portion at Dominguez Hills, it was very well worth
the time and money), she was accepted. She opted to do the BOC route, got
the credential, then turned right around and got her ABC CO credential. So,
her only formal education is what she got in the PT program. She is
actually very good at what she does. Unfortunately, she could be better if
she had been required to go to school and take the ABC exams. But then
again, maybe she would not be any better, we will never know.

I personally know another individual (who I used to work for) who had
grandfathered into ABC for his CO credential. He had taken the prosthetic
exam, 3 times, failed it all 3 times. He was not able to take it anymore
unless he successfully completed an NCOPE course. But, he could not do that
because he did not have any college education at all. It would mean leaving
his job, going to college, passing the classes, then attending a prosthetics
program. Well, he never even got his BOC in prosthetics, but he has spent
the past several years doing prosthetics, and has not done a good job of
making a good name for prosthetists in this area. When this offer came
along, he got his BOC credential, and is now a CPO. I talked to ABC about
this very situation, and they know there are many newly credentialed
practitioners that had failed the ABC exam, were ineligible to take the exam
anymore, but were able to pass the BOC exam and now buy the ABC credential.
Nice, huh? These people should never be a CP, CO or CPO by the very rules
that ABC has set, because they failed to demonstrate their ability to prove
some competence in the O&P field. But, they were able to pass the BOC exam
(and I am not passing judgment on this exam, I know they say it is tested
and have been proven to be a valid exam, but I know several people that have
failed the ABC exam and then passed the BOC exam) and then pay the money for
the ABC credential.

It is not too hard to see that the number of ABC credentialed practitioners
has grown by amazing amounts. It is easy to calculate how many new
practitioners that ABC can grow by in a year. There are only so many seats
for the exams (the clinical portion), they only have 75 seats per exam
period, and there are only 2 exams offered a year. There can only be 150
new CPs per year, and that is assuming that there is a 100% passing rate.
It is similar with COs.

I don’t have the exact numbers or statistics, but just by a rough
calculation, I would guess that only less than 30% of all COs, CPs, CPOs
have ANY formal education in orthotics and prosthetics. It would be
interesting if ABC would offer up that information. How many in this field
have a BS or BA in a health care field? How many attended school for O&P?
How many of us in this field actually took the ABC exam and passed? How
many failed and still are now called CP, CO or CPO? I invite you all to go
to the ABC website and look up any name or list of certified people and
check out the certification dates. Over half of them (or so it appears) are
after the ABC offer went out for a $75 price tag.

Also, at that time, there was a free BOC offer for ABC to join them. I took
them up on that. I thought I would see how things settled out, what did I
have to loose by doing that. Well, I have never sent them any money, I did
not renew my fees or membership when it was due. I just let it go. Now, I
am listed as on their website as “suspended”, and then you can see what that
means just above where my name shows up: “Suspended Ethical Violation –
temporarily prohibited from using BOC certification, due to violation(s) of
BOC Code of Ethics”.

I have asked them to take my name off their website, and they told me I have
to pay them money to take it off the list. That was sure not explained to
me before. So, if they want to keep it there, that is fine with me. I
don’t know of any organization that keeps lists of “former members” or
basically a hit list of people that have not renewed their free memberships.
The local lions’ club does not post a public list of members that haven’t
paid their dues. They just quit getting the mail and the newsletters. The
same holds true for almost every organization that I have ever belonged to
or have known about.

Back to the issue of qualifications, here in my area, the PTs have been
doing orthotics, using off the shelf braces (which, by the way, are made and
sold to the PTs by many of our own colleagues and members of our very own
leadership organizations, hmmmm…AOPA perhaps), and then being able to
provide the rehab to the patient in the nursing home. It goes back to the
wonderful 100 day rule which excludes orthotic care for patients in SNF
during the Part A stay. So, the PTs find it more cost effective (and sadly
enough) just as good of a fit as many of the custom made orthotics that have
been delivered to patients in this area for many years. So who is to blame
for this issue? The PTs for encroaching on our field? Or are there any
orthotists out there that are willing to go and make these braces for the
nursing home for free, just to keep the PTs from doing it? What is the
answer here? In an ideal world and setting, it would be best for the
patient to be able to have highly trained and experienced practitioners
doing the best quality work for them. But, we are not living in an ideal
world.

And, then to add more problems, ABC added a new area (or at least it was new
to me) which is the “Certified Orthotic Fitters”. I was shocked when I was
talking to a PT at a rehab facility here, and asked her who they were using
for their orthotics now, she said it was a local pharmacy. I was not aware
that they were doing this, that they had an orthotist on staff, etc. I
checked out the ABC website and found that there are 2 guys that are now
certified fitters. I went to the pharmacy to find out what they had to do
to get their credential. They said they attended some course, which he
thought was a CAMP course, and spend a few hours there, then took some exam
that was not even graded, and then sent that to ABC and paid some money, and
it’s done. Wow! They were kind of laughing about it, making light of the
process, as was I. I shared with them my feelings about ABC, and my
experience with them. But, these guys are DME salesmen. They sell
wheelchairs, oxygen, bedside comodes, etc. Now, they are seeing stroke
patients, fitting them with braces, and getting paid for them. ABC set that
all up for them. As long as they have the DME medicare provider number,
they can bill all the L codes that we can.

I have never met a PT in this area that has any interest or desire to do
orthotics or prosthetics, but the ones doing it said it was out of
necessity. The old company here in this area, which is a branch office and
is only open one day a week, were not delivering quality care, and were not
providing the care in a timely fashion. They have actually made a very bad
name for O&P here, and it has taken me a couple years to try to fix this
reputation and win their trust.

Someone already explained it best: The best providers of O&P will prevail
in this. If it is a choice between a really great CO that can deliver good
quality products and services vs. a terrible PT that is trying to compete,
the CO will win. But, if there is a terrible CO doing horrible things vs. a
really good, educated PT that is doing great work, then the PT will
obviously win. We should not stand behind some credentialing body and think
that they will protect us and make sure that nobody else can steal our work.
We need to be out meeting with PTs, MDs, and other health care
professionals, educating them on what we can offer, what we do, why we are
better qualified and trained (if that is the case) to do the work. Then we
better make sure that we follow up and provide the good service that we have
told them about. We can all do better at that.

I have had several in-services at my facility, educating the PTs, nurses,
and anyone that is interested, including scout troops, science classes, etc.
about prosthetics and orthotics. I show them all the new components that
are out there, how they work, etc. I make sure that when I deliver a
prosthesis to a patient that is in rehab, that I am willing to meet with the
patient and the therapists to instruct them on how to care for the
prosthesis, how to don and doff the limb, what to watch for, and tell them
to call me if there are any issues or concerns. It is amazing how well that
works, and how much better the overall outcome is with the patient.

I know that I am not the best prosthetist that ever lived (who is that
anyway? Is there some god of prosthetics that I have failed to meet along
the way? I have met a few that have tried to tell me that they were that
person, but they sure fooled me), I am not the best business person out
there either. But, I have had many very happy, satisfied patients. I have
to fight the same battles as all of you do, on a daily basis (medicaid,
private insurances, etc…..and that could be a huge email if I ever got
going on that subject). I love what I do, I have a very successful business
going, and it is all good.

We all need to stand up and figure out what we need to do to provide better
quality services and products to the patients. We need to get our
profession, or this field, organized and have an organization that truly
helps up and is not part of the problem. I have been let down over and over
by our organizations….that could be another long email.

Again, I apologize to those I have offended. I am not saying by any means
that just because a person is educated that automatically makes him/her
better at all. I know a few terrible practitioners out there that are
highly educated. I know some great ones as well. I know some great BOC
people. The important thing is that education is very important, that seems
to be a common thread in all these emails. If education is NOT important,
then why are we worried about the PTs doing the work? The truth of the
matter is that there is no real way to offer any exam that will ensure that
a person is competent at what he/she is doing.

Also, I find it very odd that several of these email from the O&P side have
slammed the PT by saying that a few week course is not even close to being
enough education to know what you are doing. But, that is more education
than the majority of ABC certified practitioners have. I know that
experience is also important, but basic education is as well. The PT was
also slammed for the “fabricating” part of the job. She was very clear that
she was taught the concept of fabrication. I know many practitioners that
don’t ever touch plaster, don’t ever touch carbon, or even touch plastic.
There are even a few things that I don’t make here in my office, and I use a
C-fab for some stuff.

Again, sorry to those that are offended. I hope there are a few people in
the ABC office (and they know who they are) that are offended. If they are
not offended, they should be. Just a simple example of how that office
works, they spent hundreds, if not thousands, of dollars sending out letters
to many of us saying that we were delinquent in our dues and that we had to
get this settled immediately. I called them on that, they apologized and
said it was a clerical error and that there were hundreds of these letters
that went out. What a waste of time of the employees, postage, paper, phone
calls, etc. I know that mistakes happen, but it seems like someone would
have caught that before they were all sent out.

Good luck with the fight. Please excuse any typos or spelling errors, I
wrote this fast and did not have time to check it or anything.

Jim DeWees, CP

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