Who Needs a PhD in O&P?

Faced with the wealth of new knowledge, fresh discoveries, and groundbreaking technologies, an increasing number of O&P clinicians are focusing on the need for research and professionalism in the field by considering a doctoral degree, adding to about three dozen people worldwide who hold O&P-focused PhDs. To learn about the rewards and challenges doctoral candidates face, and their potential impact on the profession, we talked with clinicians who have chosen this path. Counting the Cost in Time and Money Shane Wurdeman, PhD, CP, FAAOP(D), chief clinical officer, Hanger, points out that while master’s degrees in O&P come with standardized timelines, doctoral degrees do not. “You might be looking at anywhere from three to seven or more years, depending on what you’re studying and whether you’re studying full-time or also maintaining your employment. One to three years of didactic work on the front end is followed by dissertation work that can take from 12 months to several years, and may depend on variables beyond your control, like recruitment, access to data, etc.” [caption id="attachment_262493" align="alignright" width="410"] worawut/stock.adobe.com[/caption] Kyle R. Leister, PhD, CPO, program director and assistant professor, Master of Science in Orthotics and Prosthetics Program, College of Health Sciences, East Tennessee State University, estimates that four to six years is average to complete a PhD, but adds that it’s “four to six years of the most intense concentration and study that a human can do. The PhD teaches you to think at the highest level—that takes hard training and a lot of time. What makes this especially challenging is that typically people are pursuing a PhD at a critical point in their life, where major decisions are required regarding career, family—getting married, having kids—because by the time you accomplish a master’s degree, you’re into that phase of your life.” “The PhDs are very self-driven,” says W. Lee Childers, PhD, CP, senior scientist, Extremity Trauma and Amputation Center of Excellence, Military Performance Lab, Center for the Intrepid, Brooke Army Medical Center. “The burden is on them to do the work to complete their doctorate, and three years is not an impossible goal. Because I was very focused and knew what I wanted to do, and [the university] knew what they wanted out of me for the PhD, I was in and done in three.” Samantha Stauffer, CPO, MSOP, FAAOP, director of research, Independence Prosthetics-Orthotics, a doctoral candidate at the University of Delaware Limb Loss Studies Lab, agrees that full-time students can finish their PhD as quickly as three and a half years, depending on the program. Stauffer is the first to participate in a new dual-training program at the university, where she is funded through the 20 hours of clinical care she delivers weekly at a prosthetic clinic that provides a grant to the university. “I am anticipated to graduate at the end of my fifth year, but if candidates don’t stay in clinical practice during their PhD, they can get wrapped up sooner.” Ciera A. Price, MSPO, CPO/L, FAAOP, a first-year doctoral student at the University of Texas at Austin, feels that a PhD can be completed in four to five years. “Financial costs can vary, depending on the program requirements and location—whether you’re eligible for in- or out-of-state tuition—and enrollment status. And don’t overlook the opportunity cost of whatever you’re unable to work on during those years that you’re concentrating on the PhD.” Gerald Stark, PhD, MSEM, CPO/L, FAAOP(D), director of clinical operations and technical support, BionIT Labs, and adjunct instructor, University of Tennessee, Chattanooga, (UTC) agrees, and cautions clinicians that investing in a doctoral degree will mean sacrificing a significant amount of time at a financial cost of about $25,000 to $35,000. “Many people have the transactional expectation that the PhD will have a significant impact on your salary or your job status, but often this is not the case in private companies. It is understandable when there is a hope to offset the cost of the degree.” Price points out that there are fully funded programs where the institution offers students a stipend and a tuition waiver on the condition that they teach classes and/or serve as an assistant in a faculty member’s research lab. “The faculty will provide you with funding for teaching or carrying out research that advances their overall mission,” Price says. Full-time students can seek out advisors who have secured grants or other funding and can afford to cover tuition costs and provide a stipend. “This stipend is not what you’d make if you were a practicing CPO,” Price cautions. “Part-time students typically don’t have that option, and must cover their own costs, which can be significant.” Sally A. Kenworthy, PhD, CPO, assistant professor, Baylor College of Medicine Orthotics & Prosthetics, reports that her tuition and funding were covered by a fellowship; Baylor also offered an annual stipend to faculty pursuing advanced degrees. “While you might take out student loans for your living expenses, it’s somewhat rare to be paying and taking student loans to cover tuition and fees. Usually there’s some sort of work-study program or agreement with the institution so your tuition and fees are paid.” Childers agrees. “If the university isn’t finding funding for you in some form—as graduate teaching assistant, graduate research assistant, fellowship, etc.—and they’re demanding that you pay for your tuition, I would reconsider whether they have your best interest at heart. And if you’re planning to do research at a Tier 1 research institution, and that R1 institution doesn’t have funding for you, it may not be the best research group to choose. “This is a synergistic relationship. You’re there to gain knowledge and help them, and they’re there to help you and get more papers out, so they should be happy to support your efforts.” Optimal Timing Should one progress from their master’s directly into a doctoral program, or should that path include real-world clinical practice first? The PhD is less a continuation of one’s O&P education than a culmination, Wurdeman explains. “O&P school prepares everyone to be fully knowledgeable regarding how to effectively provide care to patients requiring O&P services. PhD study helps us advance and evolve care as we examine different elements, different areas that can enrich what we do for patients. The entire O&P field is elevated by individuals who pursue different areas of investigation in their doctoral studies.” [caption id="attachment_262489" align="alignright" width="273"] Photobeps/stock.adobe.com[/caption] In 2011, Stark pursued his PhD in organizational learning and leadership from the Education Department at UTC “largely because I enjoyed the topic of systemic innovation and adoption (or rejection). Professionally, I think it may make a difference at what point in your career you pursue the doctorate. Sometimes when you’re older and you get a PhD, you might already be kind of slotted, or people assign a certain set of values to you,” he says. “It could be challenging to pursue an O&P PhD because we’re seen as a terminal clinical application, so you have to pick a program that may have direct applications. “If you get a PhD, it’s usually because you enjoy the experience of learning, and maybe the way you think changes. To go into it with a transactional expectation can be met with concerns from leadership. Inadvertently, it appears to be the employee independently saying, ‘I want to be something more,’ by pursuing further education—and that can be disruptive, especially if there’s a related expectation that you might have for your salary or your job title, which are determined by your employer. It creates a bit of a shadow resistance.” Dual-training track opportunities like Stauffer’s begin during residency and preclude full-time employment immediately following residency. “But if you’re interested in a different type of PhD, waiting several years or more out of school isn’t necessarily a barrier,” she observes. “It depends on your research goals and how clinically relevant you want your research to be. I believe that the more clinical experience you have, the more clinically relevant your research is likely to be.” “There are benefits to both sides,” Kenworthy says. “The benefit of being a more seasoned clinician before going back to school was that I had probably a broader perspective on the issues that needed to be addressed—because I had experienced them and talked to others who had also experienced them. “I was also 100 percent sure that this was what I wanted to do; it wasn’t a whim. I was 32 when I started my PhD, and some of the younger students in my PhD program dropped out because they were just taking the next step in education—and I don’t think they knew clearly why they wanted to get a PhD. Sometimes a little more experience helps clarify why you’re making your choice.” After three years in clinical practice and another three years conducting O&P research, Price’s passion for clinical research guided her into a translational science program for her doctoral degree. “A lot of people on my research team are engineers who don’t have a patient care background, so part of what I do is ensure that our work is going to be clinically relevant; the translational science program is just the next step to that. It’s about making sure that we conduct biomedical research in a way that we can actually implement our findings into clinical practice and improve human health. “Sometimes when you have people doing research in O&P who don’t have an O&P clinical background, the work doesn’t translate, because they don’t have the same understanding of the things that we’re facing in practice.” Design Your Direction Since there is no PhD in O&P, students typically choose their doctoral subject matter and apply those concepts to O&P. Stark describes the do-it-yourself method: “Normally there are core courses that you take for a PhD program, especially in education. And then you take available electives or create them. I took electives in curriculum design and in innovation adoption, as well as in instructional design. You can tailor your experience with your choices. The core courses and elective courses lead to your dissertation, which is the culmination of everything you’ve learned. [caption id="attachment_262490" align="alignright" width="374"] Lukas Gojda/stock.adobe.com[/caption] “The dissertation should be the result of exhaustive research into a particular expression, which you have based on a foundational theory and then tested methodologically with an experiment or mixed method investigation.” Designing a personalized doctoral course of study can be filled with fascinating possibilities for discovery and exploration. Stauffer explains that at the University of Delaware, doctoral programs are set up as a track within the university, so students with a focus on O&P get PhDs in rehabilitation medicine or in health sciences. “Those may be within a kinesiology department, or a health sciences department. My program, Biomechanics and Movement Science, is an interdisciplinary program, so it includes a combination of professors from the Physical Therapy Department, the Engineering Departments, and Kinesiology and Applied Physiology. There’s a lot of opportunity for collaboration between the different research groups. “There are many biomechanics programs and more than two dozen research labs doing research directly related to prosthetic and orthotic care in the United States, but rehabilitation medicine or health sciences could be alternate pathways.” The American Physical Therapy Association lists doctoral programs suitable for physical therapists, which have crossover with O&P. The American Society of Biomechanics has a list of biomechanics research labs in the United States, organized by state. “One of the most beautiful things about O&P is the diverse backgrounds of our clinicians,” Wurdeman explains. “Some clinicians left former callings in other fields when they discovered O&P. It’s possible that as a PhD graduate in a laboratory setting, they may recognize a connection to their earlier field of knowledge that will pioneer an entirely new and improved patient care experience.” When students ask Wurdeman for advice concerning their studies, “I ask, ‘What is it that drives you?’ The most important thing is that you’re studying an area that you’re passionate about. Let your choice stem organically from your work with O&P patients. What driving question or concern becomes an itch that you just have to scratch? Read about it on PubMed and learn what people are researching and who’s doing the work in this area. “Reach out to those researchers and ask if they take PhD students into their research program. It’s not uncommon that they do.” The Essential Advisor The majority agree that the most important step in pursuing a PhD is to find the right advisor. “When you start your PhD, typically you have an advisor, and that advisor takes you through all of your training,” Stauffer says. “They are the chair of your committee for your dissertation; they provide the majority of the mentorship that you get in your PhD, so it’s a long-term relationship. You want to make sure you pick an advisor whose work you’re really interested in, and whom you connect and work with well on a personal level. They can make or break your PhD.” “The reputation of the school you choose is important—but choice of advisor is primary,” says Childers. “I was interested in a topic, read lots of papers on the topic, and discovered that one of the coauthors was my department chair. I found an advisor who was very interested in what I was doing, and vice versa. If you’re asking a professor to take you on, you should know him or her, and what their interests are. It’s a very close relationship. I make calls to my advisor every couple of months, still—and I completed my PhD ten years ago.” “It is critical to have a very strong PhD advisor, and to identify this person early in your process,” Wurdeman concurs. “Personally, I have my dad, and then there’s my PhD advisor. I send both a Happy Father’s Day wish every year because that’s the relationship you’re likely to develop with your advisor.” If your program is structured differently, or such a strong advisor relationship isn’t possible, Wurdeman recommends identifying a mentor whom you can depend on to offer guidance not available in the classroom. “To me the relationship with your advisor is almost more important than the topic and the research approach and the program,” Kenworthy states. “You can get into a great program at an institution, but if you don’t get along with your advisor, or they’re not a great teacher themselves, you’re not going to have a good experience.” Weigh the Options “This is not a path for everyone,” Leister says. “You don’t have to get a PhD to be a scientist and ask questions; other research avenues are available. A PhD is for people who want to generate new knowledge and be willing to undergo an incredible amount of training to develop the skills needed to do so. And that’s a huge commitment.” Stauffer warns that the doctoral pathway requires a lot of commitment, drive, and passion. “Don’t pick a lab or a research problem randomly or arbitrarily—it needs to be a lab whose work interests you, or a problem you feel is important. If you don’t enjoy reading or critically evaluating research—or if you don’t like writing, you will not fare well with PhD studies.” “If you don’t have a deep, deep sense of purpose and conviction to complete this pathway regardless of the outcome, I don’t recommend you try it,” Kenworthy advises. “You’re going to miss birthday parties, weddings, and more. There is no PhD without sacrifice.” “I know many who are absolutely world-class clinicians that do not have a PhD. It’s a different knowledge set from what you need to be an excellent clinician, and if clinical care is what really drives you, refining your clinical skills may make more sense than pursuing a PhD,” says Wurdeman. “If you decide to pursue a PhD, you will definitely learn skills and knowledge that will give you the ability to contribute things that you wouldn’t have without that PhD, but there are many other meaningful ways to contribute and advance the O&P field.” “There’s a big distinction between being in direct patient care and being in research,” Price points out. “When you’re in patient care you get to make a direct and immediate impact on the individual. When you’re in research, you have the potential to make a broad impact on a large group of people—but this usually takes several years, and you don’t always get the findings or results that you were expecting. “But even then,” she adds, “someone will build on your results.” “In retrospect, the pursuit of a PhD can really be a grind. The dissertation is intended to be an exhaustive discussion, so it can be exhausting,” Stark says. “It’s about being persistent. It’s not necessarily a test of intelligence to complete a doctoral program, but it is usually the most committed people who finish. You do crazy things like wake up at 4 a.m. to read more pages and write more, squeezing out every moment to be productive.” Look Before You Leap Wurdeman says, “Don’t jump into a doctoral program without doing your homework. There are an increasing number of O&P colleagues that have gone down this path; reach out to ask their input on the process and how to approach it.” “If you’re thinking about doing this, contact as many PhD CPOs as possible,” says Kenworthy. “Visit LinkedIn and connect to people you don’t even know. Everyone I reached out to was generous with their time and guidance about how to find an advisor and a program. Judith Philipps Otto is a freelance writer who has assisted with marketing and public relations for various clients in the O&P profession. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.

Who Needs a PhD in O&P?

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