The current state of the economy affects more than the big-time brokers on Wall Street. People in every industry feel the heavy press of recession on their shoulders, as cutbacks and layoffs continue to increase. Individuals just leaving the shelter of colleges and universities are not immune to this stress. In fact, with school loans piled high atop a tenuous income, pressures might be even greater.
O&P students now find themselves graduating into a world where the next step — an orthotic or prosthetic residency — remains uncertain. This, ultimately, delays an O&P career.
O&P Business News spoke with several sources close to the issue for some strategies to win this unintended game of hide-and-seek.
Economic effects
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Despite the economic downturn and its effects on job placement, the National Commission on Orthotic and Prosthetic Education (NCOPE) continues to report 100% placement of students into a residency program, based on a survey of residents.
Michael Oros, CPO/LPO, FAAOP, chairman of NCOPE, however, has seen a slightly different picture in his own practical experience.
Historically, “our practice has employed four to six residents each year, and we cut back on the number of resident positions that we are offering as a result of the economy,” Oros, who also serves as a residency director for a private practice in the Chicago area, said.
He blames the need to cut residency spots on the economy.
“The state of Illinois is pretty far behind in the payments to providers,” he said. “The consequence of that is you start looking at tightening your belt.”
One way Oros reduces costs is to cut the number of orthotic residents the company typically employs from four to two.
That business strategy also applies to those companies with job openings, and results in fewer available jobs after residency. Alicia J. Davis, MPA, CPO, FAAOP, residency program director at the University of Michigan Orthotic and Prosthetic Center, has found that it is much more difficult for graduates to find jobs once they complete their residencies.
“This is the first time in UM’s 15-year history of O&P residency that our residents haven’t had jobs lined up before April 1,” Davis said.
Location plays a significant role in this problem, she said.
“Michigan has been particularly hard hit economically, and there are fewer jobs to be had in O&P.”
The lack of available positions is not limited to O&P, but affects the entire health care sector, Christopher Hovorka, MS, CPO, LPO, FAAOP, director of the Master of Science in Prosthetics and Orthotics (MSPO) program in the School of Applied Physiology at the Georgia Institute of Technology, told O&P Business News.
“Health care professions, including P&O, appear not to be insulated to the economic downturn,” Hovorka said.
Current MSPO program students have had a reduced number of offers compared to those graduating in previous years. Overall, residency directors and hiring clinical practice managers explained to these students that, while they were interested in hiring, the residency sites were financially unable to hire at this time.
“This meant that our students had to look at a greater number of potential residency sites before securing offers for residency positions,” he said.
Other factors
While the current state of economic affairs may be starting the conversation about lack of available job positions, it does not mean that the economy is the only factor.
At Northwestern University Medical School’s Prosthetic-Orthotic Center (NUPOC), there are several elements contributing to the wax and wane of lack of available residencies for graduates, including each program’s difference in number of applicants.
Thomas Karolewski, CP, FAAOP, director of prosthetics education at NUPOC finds that time of year of graduation, for one, impacts students’ ease at securing both residency positions and jobs. Of NUPOC’s three graduating classes in December, March and June, June graduates are more likely to find an influx of open positions. The reason for this, he said, is because people tend to not change jobs during winter.
“There is usually a drop off in the need for practitioners when we get into the winter months,” Karolewski said. “In June, things start to pick up again. That was always a trend for us.”
In addition, since the O&P profession has begun to grow, and educational institutions have responded by creating new O&P programs, competition for students among institutions has increased. Where there were only a few O&P programs, now there are several. Likewise, where only a handful of graduates fit into the number of residency spots, now a larger group of recent graduates fight for a smaller number of spots in residency programs.
While some O&P institutions may experience a decrease in applications, in contrast, others may find an increased number as individuals look to return to school. NUPOC has felt the effects of both.
“I had an increase in inquiries of the program since the economy has gone down,” Karolewski said. “In the past 6 months, a lot of individuals have called me requesting information about the program because they just got laid off or they lost their jobs.”
These circumstances may leave people thinking that, if they are not able to find the job they want, or in the industry in which they have been employed, this might be a good time to return to school or switch career fields.
Many of these students interested in switching careers have roots in the area and are unwilling to relocate to different areas of the country where they might find open residencies.
Student experiences
Stephen Carubia is one of the recent prosthetics graduates who has yet to find a residency spot. While he thinks his circumstance is unfortunate, he understands the reason behind employers’ hesitation. Residency spots are just one aspect of uncertainty for businesses.
“As school progressed and I started looking into it more and talking to more people, [I found that] it is really not so much a residency as a job. You are marketing yourself to get out there,” Carubia said.
Carubia, who graduated in March, believes that businesses see it that way now, as well.
“They don’t want to just bring a student in, teach them and have them go,” he said. “They are looking to secure someone who can benefit their business in the long run or else why take them for a year at all?”
Throughout his search, Carubia has spoken with various company representatives who were looking for graduates who had completed both their orthotic degree and their prosthetic degree, so that the residency position would last for 2 years instead of just 1 year. In addition, some residency descriptions call for potential candidates seeking residency, employment as a practitioner and eventual promotion to branch manager. This reduced turnover provides the company with a steady employee who does not require additional training each year.
Overall, Carubia worries most about keeping to his schedule for becoming a practitioner.
“The timeframe that it takes to get a residency, finish the residency and still have to go on and take the certification test, it kind of puts off your certification a couple more years down the line,” he said.
Thus far, Carubia has applied to nearly 20 different residency sites throughout the country, and has seen interest from two Veterans Affairs (VA) positions on opposite shores, in Long Beach, Calif. and in New York City.
“I think that is what might favor me is that I’m willing to take that year of my residency and go where I can get one,” he said. “I know, with a couple of people I spoke to at school who wanted to stay local, it’s a little bit tougher to try to find one in your locality, when it’s becoming so tough to find one at all.”
Jocee Wolf, another prosthetics graduate from NUPOC, is experiencing some of that difficulty in finding a residency specifically in the Chicago area.
“I’ve been trying to base everything on looking in the Midwest because my husband has a job [here]. I would go somewhere for a year, but I would like to stay where he is,” she said.
Wolf, who already had a master’s degree prior to graduating with her prosthetics certificate in September, worked in rehabilitation for 5 years, most recently as a fitness coordinator for the Rehabilitation Institute of Chicago, running the health and fitness center program for people with physical disabilities.
“It has been more of a challenge finding a residency than I thought it was going to be,” she said.
Wolf’s frustration stems from her eagerness to keep up with the skills she learned at Northwestern and to get started in the profession. As a partial-foot amputee since age 3, she has been inspired to work in prosthetics and help other amputees.
She has found that there is an increase in the number of graduates applying for the same residency positions, which have been decreasing.
“The competition is good for the business, but it makes it harder for us students to get into the field and start practicing,” she said.
Wolf has spoken with hiring managers at a few residency sites who have eliminated their positions, while others have placed them on hold until early 2010 or summer of 2010.
Help for graduates
Each O&P institution will offer different degrees of assistance for its students to find residency locations.
First and foremost, NCOPE encourages residents to look outside of their geographic area.
“We advise them to expand their search options, and then we typically have 100% placement when they are willing to do that,” Oros said.
NUPOC invites several O&P companies to the university to interview students every semester. Karolewski also forwards any leads to students, and helps set up either one-on-one interviews or opportunities for students to fly to residency locations around the country for interviews. When his students graduate without securing residencies — as with Wolf and four other graduates from September’s class — he maintains contact with them to ensure they receive the most updated information.
To combat the lack of outside positions, the University of Michigan has added a resident position this year. However, directors at O&P institutions like Michigan still need to work overtime to help their students move on after graduation.
“In the past, other companies would contact me asking if we have any resident applicants that might be interested in a position somewhere else. Now just the opposite is happening: I’m contacting colleagues in the field trying to help the students find residency positions,” Davis said.
This lack of acceptance is not only one-sided.
“On the other hand, residents are also becoming more choosey,” she said. “They talk to their colleagues and find out which residencies are good and which need some improvements, so facilities and residency directors need to make their residencies more enticing to the prospective residents as well.”
Because this process of identifying and securing a residency has taken a bit longer compared to previous years, the sooner students begin searching for a residency position, the better results they will find, Hovorka said.
“There were some students in our recent graduating class that began the process of identifying potential residency sites, corresponding and interviewing as early as 8 months,” Hovorka said. “Some of these students secured positions early and others did not secure positions until just before the date of graduation.”
Students in Georgia Tech’s MSPO program are paired with faculty advisers who serve as guides throughout the process, and encourage students to meet and network with MSPO alumni and additional ABC-certified clinicians outside of the Georgia Tech alumni network.
“Networking is probably one of the most powerful resources students can tap into as part of the process of identifying and securing a residency position,” Hovorka said.
The MSPO program also allows for its students to attend the state and national American Academic of Orthotists and Prosthetists meetings each year, as another means of networking with potential residency site representatives.
Each year, Georgia Tech’s MSPO program holds a residency workshop where students learn about residency procedures and experiences from Robin Seabrook, NCOPE’s executive director, and have another opportunity to mingle with — and even be interviewed by — representatives from several residency sites.
Another suggestion for the future of O&P education from both Carubia and Wolf is that more closely aligning the O&P degree and the O&P residency might make it easier on the graduates. If residencies were seen as part of the degree instead of as the first step toward an O&P job, then it might streamline the process and keep graduates fresh on their skills.
This setup would be easier for students than spending so much time after graduation searching for sites on their own, Wolf said.
With other health care providers, like physicians and nurses, getting a residency is more connected to the school than it is to the individual, and this would benefit all parties involved if it were implemented in O&P, Carubia said.
Online resources
On the Internet, there are several sites where prospective residents can find programs.
NCOPE’s Web site features an online directory of facilities offering residencies. Residency sites post information about whether they are actively hiring, what is expected from the resident, and a resident contact. As long as the residency facilities update their material, NCOPE’s directory serves as an up-to-date means for graduates to access available listings.
“That is usually the best direction we can provide in terms of letting them know where residencies are available,” Oros said.
Karolewski points his students to several additional Web sites, such as the VA Web site, to determine if there are any open residencies within the VA.
Another helpful site is the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) registry, where graduates can find listings of accredited facilities in each state.
“Students generally pick a geographical area they would like to be in and then use ABC’s registry to start cold-calling facilities,” Davis said.
Karolewski also suggests that graduates take advantage of the O&P listserv, and post questions about open residency sites.
Graduates help themselves
Many of the students should begin with a better knowledge of how to conduct themselves in interviews and how to sell themselves, Karolewski said.
He advises students to keep their resumes updated, and to follow up with phone calls after applying to potential residency sites. After interviews, follow up with e-mail thanking the interviewers for their time.
He also suggests that students volunteer at some of the companies where they would like to secure a residency.
“Essentially what that does is get your foot in the door,” he said. “Even if it means sacrificing in the beginning, if the end result is that you get a job with them and you get your residency, it’s something that could be a huge benefit for people.”
Wolf followed that advice. She made use of other contacts who can help, as well, like her prosthetist and her sister, who works in the medical field.
Carubia has tried another approach to gaining experience: working in his family practice. As an assistant fitter and a lab technician at Prosthetic Rehabilitation Center in Newburgh, N.Y., he has been able to gain hands-on skills. Because it is a small facility, he also has had a significant amount of patient contact, which may make him more marketable to residency sites where he can gain additional experience outside of his family practice.
Davis believes that the ultimate goal of the residency is for students to absorb as much as they can from the experience to become well-rounded, knowledgeable and competent clinicians.
“When screening applications, we look for a rigorous academic background, excellent oral and written communication skills, volunteer experiences, and other indicators that people have the potential to become excellent practitioners and colleagues,” she told O&P Business News.
And approaching an employer with a unique skill set — such as pediatric prosthetics or functional electrical stimulation — may serve to expand that practice, thus making the graduate even more attractive, Oros said.
Hovorka suggests that graduates prepare a clear description of the ways in which they will become an asset to specific residency sites. Specifically focusing interviews on how their skills will contribute to organizations’ bottom lines may make the individual more appealing to potential employers.
Advice for the future
Despite the difficulty that some graduates have faced in finding residency positions, most agree that the end result will be worth the wait.
“I think this is a great field to go into,” Wolf said. “Sometimes it might be a little frustrating to get a residency, but the thing is to stick with it … Something will come up. And if you like working with people, what better way is there to help individuals and make something better?”
Karolewski advises his struggling students to remain consistent with their applications.
“At some point, it is the right time and the right place, and you have to be ready for it,” Karolewski said. “If you send out all your resumes once and say nobody is hiring and you disappear, then you are never going to get anything. The squeaky wheel gets the oil.”
Oros encourages O&P facilities to step up and become residency sites by completing NCOPE facility applications. The requirements include: facility accreditation; a residency director certified for at least 5 years; and mentors or other teachers with at least 3 years certified experience in a discipline.
Hovorka feels that the benefits of taking on residents far outweigh the burdens.
“I hope that the readers who are considering taking on a resident will remain open-minded,” he said. “There certainly are financial and time burdens to doing so but the rewards can be significant. These rewards can come in the form of giving back to the profession, having a positive influence on the first phase of the professional training and educating of the next generation of new professionals in P&O.” — by Stephanie Z. Pavlou
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