When Steve Strasburg, CO, thinks back on
the requirements he was expected to complete 20 years ago as he worked towards
becoming a certified orthotist, he remembers there were a number of programs to
choose from. Some were good and some were bad. Among the choices were some
internships that were “pretty loosely run,” he recalled.
“As long as you could get someone to say you completed
your 1,900 hours of work requirement, you could qualify to take the
tests,” he said.
Times
Change
Two decades later, Strasburg now administers the University of
Michigan’s O&P residency program, which is one of the most selective
and demanding of its kind in the country.
Only three candidates are selected to participate each year and
those who step into the program encounter a regimen that is anything but
loosely run.
“We start off with a month in the fabrication room where
you make devices,” said Strasburg. “From there, residents work with a
certified clinician for five months and assist with patient management. At six
months, we phase them into an autonomous arrangement where they can manage
patients and deal with forms. They are also expected to complete a research
project over that 12-month period as well. After all of that, they are ready to
sit for their board exams.”
Making it slightly tougher on the students is the pay scale.
Strasburg said the University of Michigan offers its O&P residents a
stipend salary to help them make ends meet.
“It’s on the lower end of what a resident might make
elsewhere,” he admitted, “but we see it as part of their schooling.
I’ve heard of private facilities offering residents $30,000 to $40,000 per
year. We might pay about half that. But we like to think that if someone is
willing to make the sacrifice, they will be marketable when they
leave.”
Plenty
of Programs
But for those students not interested in making that sacrifice,
Robin Seabrook told O&P Business News that there are still
plenty of programs to choose from. In fact, Seabrook, who is the executive
director of the National Commission on Orthotic and Prosthetic Education
(NCOPE), said her organization accredits more than 350 such residencies across
the United States. Each of those locales, she said, offers accredited
facilities where aspiring O&P professionals can complete the 12-month
residency requirement that its sister organization, the American Board for
Certification in Orthotics and Prosthetics, Inc. (ABC), requires.
And yet even with that array of facilities to choose from and
the two-punch endorsement of NCOPE and ABC, O&P residencies remain a
controversial topic. Some in the industry complain that the programs are not
demanding enough or lack proper supervision. Others believe the residencies are
just an opportunity for commercial O&P facilities to put up-and-coming
professionals on the payroll, while paying less than professional salaries.
Yet in spite of the grumbling, Seabrook said she and her
colleagues at NCOPE remain strong proponents of their 12-month residency
requirement.
Requirements Established
That requirement, which was first established in 1995, was just
one of a series of recommendations that had been laid out by a task force made
up of representatives from the American Orthotic and Prosthetic Association,
ABC and the American Academy of Orthotists and Prosthetists that convened in
1990. The task force’s goal was to establish standardization in orthotic
and prosthetic education as well as strengthen the industry’s credibility
in the public’s eyes. Chief among their suggestions was that the residency
program be created.
“We were trying to lend structure where structure
didn’t exist before,” said Seabrook. “Prior to 1993, there was a
1,900-hour work requirement. But in some cases, those 1,900 hours could be
completed in 10 months. So we eliminated the hourly requirement and simply said
that there was a one-year residency requirement that included completion of a
research project.”
Seabrook’s comments echo those of NCOPE’s
past-chairman Robert Lin, CPO, who explained in a 1999 O&P Business
News interview that the pre-1995 work requirements left a lot to be
desired, at least in the eyes of NCOPE and ABC executives.
“There were no guidelines, no learning objectives, no
educating of the certifee as to how to train a practitioner. They often were
used as glorified technicians,” he said. “Now everyone has a set of
standards and a menu of learning modules.”
Differing Viewpoint
Glenn Garrison, CPO, the director of prosthetics and orthotics
at the Hospital for Special Surgery/Eschen P&O Labs in New York City, said
that residents are now thrown into a marketplace when they really haven’t
proven themselves in terms of technical skills during their formal education.
He compared his technical training 23 years ago with the training O&P
students receive today.
He said that during his first few years in the field, he worked
at the bench almost as much as he saw patients.
“It’s managed experience. Our organization [the BOC] believes that after two years, practitioners are better trained and better prepared to deal with the public. We’ve had employers tell us this.”— Donald Fedder, DrPH, |
“I had to have a certain amount of ability and hand skills
in order to practice in the field,” he said. “In order to be a viable
employee for my employer, I had to have some technical skills.”
Now, he said, schools basically teach theory and some clinical
application, but teach little or no technical skills to O&P students. The
schools ultimately rely on residency programs to complete a third of the
educational process.
“What the schools are doing is creating an O&P
resident that is halfway where they should be,” Garrison said. “They
teach them theory, they teach then some clinical skills, but they don’t
teach the technical end of the field. So they are basically teaching an
incomplete practitioner and depending on the residency to finish the
job.”
Garrsion added that while the students are wide-eyed and
enthusiastic when they finish school, they have little or no technical skills
to give them any credibility in a P&O shop. Additionally, engaging and
teaching a resident is not something most employers want to do because of the
additional salary and time expenses absorbed by the facility.
“When the students look for a job, they have to be able to
pull their weight to a certain degree and earn their pay,” he said.
“A lot of students don’t have enough technical skills to work in the
shop and they don’t have enough professional experience to work in the
clinic,” he said. “They are basically just beginning and they
don’t have enough marketable abilities for someone to hire them.”
Garrison is also the residency director for his facility’s
residency program — the only one in New York City. Currently, the Hospital
for Special Surgery/Eschen P&O Labs has no residents, but may have as many
as three for any given year. He said that at times maintaining a residency site
can be frustrating because his competition may or may not have a residency
program. Facilities, he said, are reluctant to pay someone a lot of money when
they are only going to be there for a year — the first six to eight months
of which are not very productive.
“They [O&P facilities] don’t have an O&P
residency program because it is expensive and time consuming to train a
resident,” he said. “And you are training your competition or your
competition’s help.”
Garrison said that some of his residents have stayed on for
varying amounts of time. Many others have stayed on for a few months past the
end of their residencies, only to leave for more profitable positions.
Despite his perceived pitfalls to the O&P residency
program, Garrison stays active in the process because it can be a refreshing
and rewarding experience. He said he enjoys working with the residents for the
fresh blood, new ideas and innocence they offer the O&P field. Plus,
someone offered him a similar opportunity years ago, and it is a good way to
meet and know people in the field.
“I have fit a lot of legs and braces and, after a while, I
know I can fit a leg and a brace. It is time for a diversion,” he said.
“The enthusiasm can be contagious. You know you are doing something good
for someone else; you are helping the field and you are helping someone
learn.”
Additionally, operating an O&P residency program can serve
as a recruitment tool to “catch a diamond in the rough,” he said.
Maintaining the Programs
NCOPE maintains that it oversees all of its residency programs
and that the people running the programs are qualified, but a difference of
opinion certainly does exist in the industry when it comes to just what
qualifies someone to work in the field.
According to the ABC, any prospective O&P candidate hoping
to get the nod from its organization must have a bachelor’s degree in
O&P or another field with an orthotic and/or prosthetic certificate from a
Commission on Accreditation of Allied Health Education Programs (CAAHEP)
accredited program and a 12-month NCOPE accredited residency program. The
organization has criteria to aid individuals who meet the unique qualifications
standard. This standard recognizes those practitioners who have a high school
diploma or GED, a minimum of 15 credit hours in collegiate science courses and
12 continuing education hours in biomechanics and gait analysis/pathomechanics.
The unique qualifications standard requires 10 years of active patient care
experience, case histories of specific devices, six letters of attestation and
proven achievements in the industry. But ABC certification is just one route
that up and coming O&P providers can follow.
The Board for Orthotist/Prosthetist Certification (BOC) has its
own brand of training and certification. Like the ABC, the BOC’s programs
are accredited by the National Commission for Certifying Agencies (NCCA).
Medicaid, Medicare and the Veterans Administration recognize and reimburse both
BOC and ABC providers.
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Unlike the ABC, the BOC does not require the O&P candidate
to have a bachelor’s degree. Also, the BOC has no requirement in place
expecting its candidates to complete a 12-month residency or a research
project.
“The BOC requires that a person going into the industry
continually serve the public for two years,” said Donald Fedder, DrPH,
MPH, the chief executive officer of the BOC. “And in that two years, a
person must complete 3,800 hours of work. We also ask that the two years be
part of a full four-year requirement that someone work in a position directly
associated with O&P.”
It may sound like a residency, albeit a longer one than the ABC
demands, but Fedder said it is something else.
“Its ‘managed experience,’” he said.
“Our organization believes that after two years, practitioners are better
trained and better prepared to deal with the public. We’ve had employers
tell us this: when a BOC-certified employee shows up, they are ready to
practice. They have the hands-on skills they need.”
Fedder said that the BOC holds the candidate responsible for
all the scientific and technical knowledge underpinning the profession, as well
as the skills and craftsmanship required to be a competent practitioner.
“The 3,800 hours of supervised practice serving actual
patients is, in our minds, more than equivalent to a 12-month residency,”
said Fedder. “It is true that the BOC does not require a
‘research’ project since most practitioners/mentors have not had
‘research training or experience.’”
Fedder also said that neither the ABC or BOC trains or educates
practitioners, since they only certify.
“The role of the certifying agency is to establish
eligibility standards and develop appropriate examinations to test for the
domains of knowledge, skills and abilities required to practice,” he said.
“Since these domains are determined by a recognized process, based upon a
validated task or ‘job’ analysis (also referred to as a ‘role
delineation study’), and reviewed and approved by the NCCA, the results
are comparable but not necessarily identical.”
Value
in Both Programs
Strasburg said there is value in both programs. The BOC, he
said, allows people working in the O&P industry a chance to “profit
from their experience,” but he suspects that a student holding an ABC
certification — complete with its one-year residency requirement —
“holds slightly more prestige” in today’s job market.
But, he said, that doesn’t mean the array of NCOPE
residencies are problem free.
“[The University of Michigan] is an academic facility. We
probably get four or five applications for each of our three resident
positions. There are only a handful of institutions out there that do what we
do,” he said. “But there are a lot of commercial programs out there
that just need warm bodies to fill seats. They might have contracts with
insurance companies that require so many prosthesists be on staff. So they get
somebody who is less than certified to fill that role without having to pay
them what they might have to pay a certified practitioner.”
Although Seabrook agrees that the Michigan model represents
something of an ideal, she said the O&P industry has little choice but to
rely on the private sector if it hopes to have trained practitioners on hand in
years to come.
“The University of Michigan is one of about 20 such
hospital/university based programs in the country,” she said. “We
would like to see all of the residency sites offering a hospital-based program
with a university affiliation, but that is simply not realistic. So we work
with many private care facilities. We have to rely on the private
sector.”
There is a trade-off, she said, “For-profit facilities can
deliver the experience that the ABC and NCOPE demand.”
Work in
Progress
Seabrook admits the research project qualification is a work in
progress.
“We knew when we designed this we would have a huge
failure on our hands early on if we made tight, rigid rules when it came to
research projects. When we first started, all NCOPE wanted was the
project’s title. Then we tightened the reins a little and said we want a
title and an abstract. Now we ask that all projects be turned in for
review,” she said.
Gray
Area
Ken Woodward, CPO, the director of prosthetics for Wright &
Filippis in Michigan, admitted that a gray area surrounds residency research
projects, but he says in the end the quality of the projects speak for
themselves. His company has sponsored 21 residents since 1998, and he said that
80 percent of those residents were later offered jobs with his company.
“When it comes to research projects, some of our residents
have been less than ambitious. They might do a literary review somehow related
to O&P. Those are passable. But when the evaluations are done, let’s
just say we make a note of it,” he said. “Does it mean anything? I
don’t know. But I do know before I hired someone, I would ask what their
research project was about.”
Meanwhile, he said his company makes no apologies for treating
residents as employees first and students second.
“We’re a privately owned company,” Woodward
said. “One of the reasons we’re here is to make money. If all a
person is interested in is doing research, then they are not thinking about the
bottom line. We want people who are interested in getting hands-on experience
as well as doing research.”
And although Woodward speaks as a recruiter for an
ABC-affiliated program, his comments echo those of Fedder of the BOC. He
believes that research and education are vital for the future of the O&P
industry, but he questioned how much of a distraction the NCOPE-required
projects are for students trying to complete a one-year residency.
Coming
Down to the Patients
Paddy Rossbach, RN, the president and chief executive officer
of the Amputee Coalition of America (ACA), represents more than a few of those
patients.
Her organization, she said, does not align itself to any one
organization, be it BOC, NCOPE or ABC. Rather, she said, the ACA supports
anything and everything that improves the quality of care that amputees
receive. What the ACA would like to see is more funding and more resources to
improve education and training for all future O&P professionals, regardless
of their certification.
“My personal opinion,” Rossbach added, “is that
if someone is lucky enough to get into a residency with a really good reputable
provider, they will benefit enormously. However, if they get no training and
are merely used as an extra pair of cheap hands, they will not improve. In my
opinion, excellent training and experience are as important as
education.”
Accredited O&P Residency Programs of
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Alabama ABC Orthotics & Alabama Artificial Limb Company (Montgomery) (P, O) Alabama Orthotics & Prosthetics (Huntsville) /p> Veteran Affairs Medical Center (North Little Rock) California Action Orthopedic Co. (Los Angeles) (P) ADL Orthotic & Prosthetic Service, Inc. (San Advanced Bio-Mechanics (Citrus Heights) (Cameron Advanced Prosthetics & Orthotics, Inc. (San Anacapa Prosthetic & Orthotic Lab, Inc. Beverly Hills Prosthetics Orthotics, Inc. (Van Center for Independent Rehabilitative Services, Desert Prosthetics & Orthotics (Cathedral City) Drew Hittenberger and Associates (Petaluma) (P, O) Dynamics Orthotics & Prosthetics (Los Angeles) Fountain Valley O&P (Fountain Valley) (P, O) Hanger Prosthetics & Orthotics, Inc. (Pasadena) Hanger Prosthetics & Orthotics/ Sabolich Center Los Amigos Research & Education Institute O’Connor Orthopedics (Anaheim) (P, O) Odyssey Prosthetics & Orthotics (San Pacific Orthotics & Prosthetics (Modesto) (P, Ray Tegerstrand’s Orthopedic Appliance (Redding) Rehabilitation Technology & Therapy Center Reseda Prosthetics (Northridge) (P, O) San Francisco Prosthetic-Orthotic Services, Inc. SCOPe Orthotics & Prosthetics (Vista) (P, O) Shasta Orthotic Prosthetic Service, Inc. (Redding) Shriners Hospital for Children — Los Angeles Sunny Hills Orthopedic Services Inc. (Fullerton) Swiss Balance, Inc. (Santa Monica) (P, O) UCSF Orthotics & Prosthetics Center (San VA Medical Center PACT/ Prosthetic Services (Long Valley Institute of Prosthetics & Orthotics Colorado Abilities Unlimited, Inc. (Colorado Springs) (P, O) Audubon Orthotic & Prosthetic Services Hanger P&O Inc/dba Scott Orthopedics of Hanger Prosthetics & Orthotics, Inc. (Pueblo) Connecticut Altman P&O Center-Division of R. F. Altman Hanger Prosthetics & Orthotics, Inc. (Hamden) Hanger Prosthetics/Orthotics Inc /dba Newington District of Columbia Hanger Prosthetics & Orthotics, Inc. Florida Arthur Finnieston Clinic (Coral Gables) (P, O) Brevard Prosthetics, Inc. (Melbourne) (P) Clearwater Limb & Brace (Clearwater) (P) Florida O&P Services (Jacksonville) (P,O) Ft. Walton Orthopedic, Inc. (Fort Walton Beach) (P) Hanger Prosthetics & Orthotics, Inc. (Winter Hanger Prosthetics and Orthotics, Inc./Ft. Walton M&M Rehabilitation, Inc.(Ocala) (O) Norpro Orthotics & Prosthetics, Inc. (Palm O&P Clinical Technologies, Inc. (Gainesville) Ortho Pro Associates, Inc. (Plantation) (P,O) Orthopedic Brace Inc. (Melbourne) (O) Ryder Orthopaedics, Inc. (Fort Myers) (P, O) Saint Petersburg Limb & Brace (St. Petersburg) Sonlife Prosthetics & Orthotics Inc Tampa Bay Artificial Limbs, Westcoast Brace & Limb Inc. (Tampa) (P, O) Georgia American Prosthetics, Inc. (Clarksville) (P) American Prosthetics, Inc. (Decatur) (P) C.H. Martin Co. (Atlanta) (P, O) Children’s Healthcare of Atlanta (Atlanta) (O) Hanger Prosthetics & Orthotics, Inc. (Atlanta) Medical and Health Resources Inc. (Columbus) (P, O) Positive Image Prosthetics & Orthotics Prosthetic Care Inc. (Suwanee) (P) Savannah Orthotics, Inc. (Savannah) (P, O) Hawaii C.R. Newton Co., Ltd. (Honolulu) (P, O) Idaho Rehab Systems (Twin Falls) (P, O) Illinois American Limb & Orthopedic Co. (Chicago) (P, O) Ballert Orthopedic of Chicago (Chicago) (P, O) Bardach-Schoene Company, Inc. (Elmwood) (P) Bio Concepts, Inc. (Burr Ridge) (O) Children’s Memorial Hospital (Chicago) (O) D.J. Peters Orthopedics, Ltd. (Bloomington) (O) Hanger Prosthetics & Orthotics, Inc. (Hazel Keller Orthotics (Chicago) (O) Koebers Prosthetic Orthotic Labs, Inc. (Chicago) MD Orthotic & Prosthetic Laboratory (Chicago) Northern Prosthetics & Orthotics, Inc. Orthotic and Prosthetic Technologies (Kankukee) (O) Plattner Orthopedic CO (Peoria) (O) Quad City Prosthetic Orthotic Institute (Moline) Scheck & Siress O&P Inc. (Oak Park) (P, O) Woodfield Ortho Services, Ltd. (Hoffmann Estates) Hanger Prosthetics and Orthotics Inc. (Louisville) Hi-Tech Artificial Limbs, Inc. (Lexington) (P) Paducah Prosthetics (Paducah) (P) Tom Watson’s Prosthetic & Orthotics Lab Louisiana Jerome’s Prosthetic (Houma) (P) Maine Maine Artificial Limb & Orthotics (Portland) Maryland C.D. Denison Orthopaedic Appliance Corp. Dankmeyer Inc. (Linthicum) (P, O) Maryland Orthotics & Prosthetics CO, Inc. Medical Home Care Orthotics & Prosthetics OrPro Prosthetics & Orthotics (Waldorf) (P) Massachusetts Advanced Orthopedic Services, Inc. (Hyannis) (P) American Prosthetics (Braintree) (P) Atlantic Prosthetic & Orthotic (Westport) (O) Boston Brace International – dba NOPCO of Boston Hanger Prosthetics & Orthotics, Inc. Prosthetics & Orthotics Labs of Worcester Inc. Shriners Hospitals for Children (Springfield) (P) Michigan Able Orthopedics Inc. (Port Huron) (P) Advanced Orthopedic Laboratories Co. (Southfield) Becker Orthopedic Appliance Co. (Waterford) (P, O) Hanger Prosthetics & Orthotics, Inc. (Jackson) Koch’s Orthotic Prosthetic Services (Ypsilanti) (P) Mary Free Bed Orthotics & Prosthetics (Grand Michigan Orthopedic Services (Livonia) (P, O) Orthopaedic Associates of Grand Rapids (Grand Springer Prosthetic & Orthotic Services Inc. Springer-Bremer Prosthetics Inc. (Flint) (P) Teter Orthotics & Prosthetics Inc. (Traverse University Of Michigan Orthotics & Prosthetics Wolverine Orthotics, Inc. (Novi) (O) Wright & Filippis, Inc. (Rochester Hills) (P, Minnesota Dan Rowe & Associates Inc.—Div. of ACTRA Gillette Children’s Specialty Healthcare (Saint Hanger Prosthetics & Orthotics, Inc. Metropolitan Orthotic Laboratory, Inc. Prosthetic Orthotic Laboratories of Rochester Shriners Hospitals for Children/Twin Cities Tamarack Habilitation Technologies Inc. (Saint Tillges Certified Orthotic Prosthetic Inc. |
Mississippi Hanger Prosthetics & Orthotics Inc./J.E. Hanger Jackson Brace & Limb Company (Jackson) (O) Methodist Rehabilitation Center Prosthetics & Missouri Hanger Prosthetics & Orthotics, Inc. (St. Orthotic & Prosthetic Lab Inc. (St. Louis) (P, Precision Prosthetics & Orthotics (St. Louis) Montana Hanger Prosthetics & Orthotics/ Billings Hanger Prosthetics & Orthotics, dba Bozeman Nevada AmPro Orthotics & Prosthetics Inc. (Las Vegas) Hanger Prosthetics & Orthotics, Inc. (Reno) (P, Hanger Prosthetics & Orthotics dba Nevada Limb Superior Limb and Brace Co. (Las Vegas) (P) New Hampshire New England Brace Co. Inc. (Hooksett) (P, O) New Jersey Allied Orthotics & Prosthetics Inc. (Mount Atlantic Prosthetic-Orthotic Services, Inc. C.G. Medical Inc. (New Brunswick) (P) Cocco Enterprises (Trenton) (P, O) Garden State Orthopedic Center, Inc. (Oakland) (P) Hanger Prosthetics & Orthotics, Inc (Manasquan JFK/JRI Prosthetic & Orthotic Labs, Solaris Kessler Wilpage Medical, O&P Services NOPCO of New Jersey (East Brunswick) (O) New Mexico Center for Prosthetic & Orthotic Design UNM HSC/Carrie Tingley Hospital (Albuquerque) (P, New York Advanced Prosthetics & Orthotics Inc. Allied Orthopedics (Brooklyn) (P) Arimed Orthotics, Prosthetics, Pedorthotics, Inc. Center for Prosthetic & Orthotic Design Inc. Creative Orthotics & Prosthetics Inc. (Elmira) Eastside Orthotics & Prosthetics (Riverhead) Hanger Prosthetics & Orthotics Inc. (Utica) (P, Helen Hayes Hospital (West Haverstraw) (P, O) Hospital for Special Surgery/ Eschen Prosthetic La Torre Orthopedic Laboratory (Latham) (P) Lehneis O&P Associates (Rosslyn) (P) Hill) (P, O) Center for Orthotic & Prosthetic Care of NC Faith Prosthetic-Orthotic Center (Concord) (P) Hanger Prosthetics & Orthotics, Inc. (Durham) Hanger Prosthetics & Orthotics Inc./dba J.E. Owens Orthotics, Inc. (Charlotte) (O) Professional Orthotics & Prosthetics Inc. Thoms Rehabilitation Health Services (Asheville) Wilmington Orthotics & Prosthetics, Inc. Ohio ABI Orthotic & Prosthetic Lab Ltd. (Boardman) American Orthopedics, Inc. (Columbus) (P) Clark Orthotic Services, Inc. (Columbus) (O) Cleveland Clinic Foundation (Cleveland) (P, O) Dayton Artificial Limb Clinic (Dayton) (P) Fidelity Orthopedic Inc. (Dayton) (P, O) Findlay American Prosthetic Orthotic, Inc. Hanger Prosthetics & Orthotics, Inc. (Norton) Hanger Prosthetics & Orthotics dba Columbus Hanger Prosthetics & Orthotics, Inc. (Columbus) Leimkuehler, Inc. (Cleveland) (P) OrPro-LaForsch Orthopedic (Dayton) (P, O) R.J. Rosenberg Orthopedic Lab, Inc. (Cincinnati) The Brace Shop Prosthetic & Orthotic Centers Yankee Bionics, Inc. (Akron) (P) Oklahoma Hanger Prosthetics & Orthotics Inc. (Oklahoma Scott Sabolich Prosthetics and Research Center University of Oklahoma (Oklahoma City) (P, O) Veterans Affairs Medical Center (Oklahoma City) (P, Oregon Barnhart Prosthetic & Orthotic Services Hanger Prosthetics & Orthotics, Inc. (Portland) Oregon Orthopedic (Bend) (P) (Eugene) (P) Oregon Orthotic Services, Inc. (Portland) (P) Shriner’s Hospital for Children (Portland) (O) Pennsylvania Allegheny Orthotics & Prosthetics (Altoona) (P, Boas Surgical Inc. (Allentown) (P, O) De La Torre Orthotics & Prosthetics Green Prosthetics & Orthotics, Inc. (Erie) (P) Hanger P&O/dba Teufel Orthotic Prosthetic Hanger P&O/Greiner & Saur Orthopedics Hanger Prosthetics and Orthotics Inc. (Pittsburgh) Harry J. Lawall & Son Inc. (Philadelphia) (P, LTI Orthotic & Prosthetic Center (Bristol) (P, Union Orthotics & Prosthetics Co. (Pittsburgh) South Carolina Capital Prosthetics & Orthotics Inc. (Columbia) Coastal Prosthetic and Orthotic Lab, Inc. (Myrtle Hanger Prosthetics & Orthotics Greenville Hanger Prosthetics & Orthotics, Inc. Orthotics Hanger Prosthetics & Orthotics, Inc./Brace Lighthouse Prosthetics & Orthotics Inc. Palmetto Prosthetics & Orthotics (Florence) (P, Prosthetic Care Inc. (Greenville) (P, O) Shriners Hospital for Children (Greenville) (P, O) Tennessee Central Fabrication, Inc. (Memphis) (P, O) Hanger Prosthetics & Orthotics/Nashville Orth. Orthotic & Prosthetic Associates Inc. Restorative Health Services/ Prosthetics-Orthotics Southeastern Orthotics & Prosthetics Stubbs Prosthetics & Orthotics Inc. Texas Abilene Artificial Limb Co. LLP (Abilene) (P) Allen Orthotics & Prosthetics Inc. (Midland) Central Texas Orthotics Prosthetics (College Corpus Christi Prosthetics, Inc. (Corpus Christi) Dynamic Orthotics & Prosthetics LLC (Houston) Hanger Prosthetics & Orthotics Inc. (Galveston) Hedgecock Artificial Limb Co. Inc. (Dallas) (P) Lubbock Artificial Limb Co. Inc. (Lubbock) (P) Medical Center Brace & Limb (Houston) (P) Muilenburg Prosthetics Inc. (Houston) (P) Synergy Orthotics & Prosthetics, LLC (Plano) Texas Scottish Rite Hospital for Children (Dallas) The LaNair Company, Inc. (Houston) (P, O) The University of Texas Southwestern Medical Center University of Texas Health Science Center at San West Texas Rehabilitation Center (San Angelo) (O) Utah Ability Prosthetic Systems, Inc. (Salt Lake City) Fit-Well Prosthetic and Orthotic Center Div. PPMC Shields Orthotic & Prosthetic Services, Inc. Shriners Hospital for Children (Salt Lake City) (P) Vermont Yankee Medical Inc. (Burlington) (P, O) Virginia Hanger Prosthetics & Orthotics, Inc. (Virginia Old Dominion Prosthetics & Orthotics, Inc. Northwest Prosthetic Orthotic Associates, Inc. Schindler’s Inc. (Spokane) (O) Wisconsin Monroe Prosthetic Associates Inc. (Green Bay) (P) Rehab Designs of America (Green Bay) (P, O) University of Wisconsin Hospital and Clinics |
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