Recent Grads Prepare to Make Their Mark

As in any profession, the baton is passed from one generation to the next. Here's a glimpse of several new faces in O&P. These graduates, each having completed their education within the last few years, are working to make an impression on their chosen profession. This generation of clinicians is not only eager to make an impact, but they're ready to face the challenges and hurdles the O&P profession presents. A Defining Moment

Each of these six practitioners experienced a significant moment in their lives that eventually put them on a path toward a career in O&P. As an undergraduate, Amandi Rhett, CPO/LO, was a sprinter at Georgia Tech. The first track and field workout of her collegiate career stands out in her memory. "I found myself doubled over in utter exhaustion, gasping for air, and clutching my lactic-filled hamstrings," she remembers. "This was a new level of training for my body and it required me to push myself beyond my limits."

As her track practices continued, Rhett says she realized, "as a gifted athlete, my mobility afforded me an education and an opportunity to pursue my sport at a collegiate level." With Rhett's pursuit of an engineering degree and her passion for mobility, she says it became her desire to be part of a team of healthcare professionals who would aid, increase, and enhance mobility for people. "Orthotics and prosthetics is a perfect blend of engineering and patient care," says Rhett, who graduated from Baylor College of Medicine's (BCM's) Master of Science in Orthotics and Prosthetics (MSOP) program in December 2016 and then landed her first O&P position at Shriners Hospitals for Children — Houston, where she continues to work. Anna Kohler, CPO, graduated from Calvin College with a degree in exercise science kinesiology in 2008, and then completed her MSOP at Eastern Michigan University in 2015. She completed an 18-month residency at Teter Orthotics & Prosthetics throughout Michigan and began working at Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan, last July. Throughout Kohler's college years, she experienced numerous sports injuries that resulted in surgery. "I wanted to work with others to help restore their movement," says Kohler, who also considered physical therapy and medical schools with a focus on prosthetics until family and friends told her about O&P schools. Beatrice Janka, CPO, received bachelor's degrees in mechanical engineering and biomedical engineering from Michigan Technological University in 2011 and her Master of Prosthetics and Orthotics (MPO) from the University of Texas (UT) Southwestern 18 months later. The first position she held following graduation was her orthotics residency, followed by a prosthetics residency, both at a UT Southwestern clinic. Janka started working for Becker Orthopedic, Troy, Michigan, once she completed her residencies. She divides her time as an orthotist/prosthetist in the patient care division and a product development engineer on the company's research and development team. Janka's defining moment came when a friend introduced her to O&P. "Originally, I started out in engineering, looking toward a career in biomedical design. I completed several mechanical engineering internships. Although I was performing well, I wasn't particularly passionate about these positions," says Janka. After a friend told Janka about O&P, she volunteered at a local clinic, an experience that changed her professional direction, she says. "I realized O&P was something I was excited about." In 2016, she earned the Thranhardt Award at the American Orthotic & Prosthetic Association (AOPA) National Assembly. Her team's research measured the effects of sagittal mechanical orthosis characteristics on gait and how patterns of biomedical deficits impact the orthotic influence. Kailey Hansen, CPO, graduated from California State University, Sacramento, with a degree in exercise science in May 2014 and finished her MSOP at BCM in December 2016. Her first residency rotation was at Shriners Hospitals for Children — Houston, and she began work as a prosthetist/orthotist with Shriners Hospital — Greenville, South Carolina, in January 2017. She remembers a prosthetist who came to speak during one of her kinesiology classes. "He came with a prosthetic arm and I knew right away that's where I wanted to be," says Hansen, who also has a family friend with an O&P practice in Ventura, California. "I had no idea what it entailed, so I asked him if I could shadow him for a summer to learn more." Nina Bondre, CPO, graduated from Duke University with a neuroscience degree in 2013 and attended Northwestern University to earn her master's degree in prosthetics and orthotics in March 2015. She completed a combined orthotics and prosthetics residency at Dankmeyer Prosthetics & Orthotics, Linthicum, Maryland, in January 2017. Bondre's fondness for O&P began in high school when she volunteered at a local hospital and saw a young woman walking with a prosthesis. It made such a lasting impression on Bondre that she started cold-calling local O&P clinics seeking an opportunity to shadow clinicians. "Dankmeyer welcomed me as a high school student to learn about O&P while shadowing their technicians and clinicians," says Bondre, who also worked abroad with the nonprofit Range of Motion Project (ROMP) to provide O&P care in Ecuador. Scott Bretl, CPO, graduated from the University of Washington with a bioengineering degree in June 2009, albeit, he says, with doubts about his field of study. Following graduation, he participated in Teach For America and taught high school math in California, where he honed his personal and leadership skills, although he says he had no intention of making that his lifelong career. "Since math is dreaded by many high schoolers, I was constantly challenged to relate the material to real-world scenarios and real-life careers," says Bretl, who participated in the program through 2013. "In bringing my students' attention to the field of prosthetics and orthotics, I realized my own interest in O&P and how it spoke to my strengths." He returned to the University of Washington and received his MPO in June 2015. In July 2015, he began an 18-month residency position at Creative Technology Orthotic & Prosthetic Solutions, Denver, where he worked until January. Bretl is now the program director for the master's program in prosthetics and orthotics at Alabama State University. Facing the Challenges

What kinds of challenges do these young professionals perceive now and in the future? Third-party reimbursement, lack of O&P practitioners to meet the growing need for services, and lack of awareness of the profession are some of the biggest factors in O&P today, they say.

The coding system and third-party payers denying claims for expensive devices hinder O&P innovation by making new technology too risky financially, says Bretl. "Coding and reimbursement can be frustrating when you know what is clinically indicated to help a patient, and yet there is not a way to provide what is needed without a high probability of losing money on the transaction or denial of the claim," he says. Another ongoing problem in O&P is that practitioners' notes are not part of the patient's medical record, Bretl says. "It's a large obstacle because this puts a lot of reliance and weight on the physician and their notes. It's a delicate act in getting the doctor to say the right thing to meet the needs for coverage without [the prosthetist] pestering their office to the point that they prefer to send their patients elsewhere," he says. Insurance companies, or payment sources, in general, do present a significant hurdle, says Janka, and it applies to her clinical work as well as her work in clinical development at Becker Orthopedic. "Reimbursement is also a significant and challenging design constraint that our product development team considers when developing new components or devices," she says. Kohler says balancing simultaneous demands is her biggest challenge: "Time to type notes, learning each insurance company's rules, following up with patients at physical and occupational therapies, modify, check in with the tech's schedule." Reimbursement is not an issue at Shriners, Rhett says. "We are able to provide services to patients regardless of their ability to pay," she says. "Shriners does accept insurance for those that have it, however, it is at the forefront of my practice to always be a good steward to the budget we have available." Hansen echoes Rhett's sentiment. "It would break my heart when we could not do something a patient needed because their insurance wouldn't cover it, or they could not afford it," Hansen says. "That was my biggest motivation for working at a nonprofit like Shriners." Hansen also cites the small number of O&P professionals as another hurdle in the field. "There are so many people who need prosthetic and orthotic care, but not enough O&P professionals to help everyone in need," says Hansen, who has made it one of her undertakings as a clinician to educate the next generation on the benefits of working in the profession. "There are many people who would love a job in O&P; they just need to be aware of the possibilities," she says. "Hopefully with more people and students interested in O&P, it will produce more MSOP programs resulting in more professionals in the field." Bondre concurs. "Many patients, physicians, and individuals in other healthcare professions are not educated about our field," she says. "It is unclear to them what our role is in the care plan and what types of requests are reasonable per devices and adjustments. The orthoses and prostheses we provide change the lives of our patients, and that impact has not yet been communicated well both to our potential patients and other healthcare professionals." Plenty to Offer

As relative newcomers to the profession, these practitioners are confident they have much to offer.

Bretl says his teaching experience offers a unique perspective that supports increased interdisciplinary involvement and communication through educational opportunities. "I have already been using my experience in curriculum design for targeted presentations to represent our company," he says. As for Janka, she says she's been fortunate to be in a position that has allowed her to blend her skills as an O&P clinician, engineer, and researcher. She uses her clinical experiences to provide a critical evaluation of new products during the development stage to improve design. "That blend of experience has helped me push the envelope when treating patients or developing new products. Because I am involved in research and product development, I have more flexibility to be creative with complex patients and try new components or orthosis designs," Janka says. Hansen credits her six residency rotations and her schooling at BCM with assisting her in her career. "BCM is research based and that made me very interested in research," she says. "Having also done research, I see how important it is to stay on top of the innovation and continue to learn and grow as the field does." Kohler enjoys the creative aspects of her job and she hopes to pass that along. "I believe new practitioners are eager to make a difference and are open to new ideas and thinking outside the box," says Kohler, who also enjoys troubleshooting unique cases and collaborating with experienced practitioners.

Leaving Their Mark

Though these young professionals are in the fledgling days of their vocation, time passes quickly. By the end of their careers, they each hope to have left their mark on their field—especially as it relates to the next generation of O&P practitioners.

Bondre hopes to eventually transition from clinical care to a research-oriented role or possibly a faculty position. "I would love to be involved in educating the next generation of practitioners and to research the importance of managing spasticity and contractures," she says. "I want to make an impact on the field per changing how others view our work and help to provide more evidence to support the great work we do." When it comes to the mobility needs of the patients Bretl will treat over the years, he hopes to use that perspective "to drive future experience of educating in the field and adding to the body of O&P knowledge through targeted and relevant research." Like many O&P clinicians, Janka enjoys the positive interaction she has with her patients. And by working on research and product design she says she aims to improve treatment methods and devices that can be shared with other practitioners. "I hope to have an impact not only on individual patients, but on the O&P field," Janka says. Kohler had the unforgettable experience of working on a mission with Limbs4Life in the Dominican Republic. "It's amazing how we take healthcare for granted in the USA, yet how many advancements need to come," she says. "I loved working in the heat to provide patients with prostheses who otherwise would not be able to walk. As the family is crying, watching the patient take his or her first step, it's an excellent reminder of why we entered this field—to restore that hope and freedom." Hansen shares a philosophy with many of her colleagues in various stages of their careers. "What I would like to get out of my O&P career is the fulfillment of helping others, making a difference in people's lives, and loving what I do every day," she says. "I love getting the creative juices flowing to figure out how to make another's day a little easier. It's awesome knowing when I leave work that I've made a difference in someone's life." Betta Ferrendelli can be contacted at betta@opedge.com .

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