Many in the O&P field have wondered where the industry is headed, given the still shaky economy. Budget cuts, austerity measures and the costs to serve Medicare patients may leave recent graduates from O&P programs less than confident about their job prospects. The industry trend now points to higher education, leading O&P to a pivotal point in health care delivery.

With the integration of the master’s degree in all O&P programs, students may expect to become more well-rounded clinicians, get current on the latest advancements in the O&P industry, and have better opportunities for future employment.

“The master’s program gives our field more credibility and gives us as individual practitioners more credibility,” Jennifer Richards, LCPO, CPed, FAAOP, chair of the National Commission on Orthotic and Prosthetic Education (NCOPE), told O&P Business News. “Having a master’s degree program puts us on par with other health care professions that we’re similar to.”

When NCOPE approved the standards for the master’s programs, all new O&P programs founded in 2010 or later had to start at the master’s level. Programs that were already established had to be fully transitioned by 2012.

The master’s program offers new course work and places additional emphasis on identifying other aspects important to an individual’s health and well being. According to Chris Robinson, MS, MBA, CPO/L, ATC, FAAOP, assistant professor of physical medicine and rehabilitation at Northwestern University, master’s graduates will obtain a more thorough understanding of biomechanics, kinesiology, neuroscience and material sciences, as well as a better awareness of the current state of practice and technology.

When the idea of a master’s program was first introduced, Richards said there were individuals who were concerned that raising the O&P education level would cause a decrease in the number of graduates from orthotics and prosthetics programs. Fortunately, this has not happened. Although some of the previously existing O&P programs will be graduating fewer students each year, several new programs have been developed at institutions that did not previously have an O&P program, she said. Therefore, it does not appear that there will be any decrease in the number of newly trained orthotists and prosthetists entering the field.

“Now we have a more well-rounded clinician, a true health professional, someone who can identify the pathology and know some of the secondary concerns and then be able to identify a treatment plan that is based on solid evidence and research, as well as continue to conduct clinical research, which will help down the road,” Matthew Parente, MS, PT, CPO, clinical director of the prosthetics and orthotics program at the University of Hartford, said. “If we look at other health care professions, the body of knowledge that we possess in prosthetics and orthotics is just a fraction of what other fields have. Those other fields have had advanced degrees for years, so bringing a more structured academic component to the industry will help to elevate the profession as a whole.”

Obtaining a residency

Although the master’s degree may be a boon to the profession, students may have to search awhile to find a residency program afterward, thus stalling their progress toward final certification.

“We’ve made a residency a requirement to becoming certified and certainly with the business climate being what it is and the cost and additional paperwork involved with having a residency program, many businesses are saying it’s not worth it,”
Brian L. Gustin, CP, Forensic Prosthetic and Orthotic Consulting, said. “That’s problematic for students if they can’t get the residency that is required to become certified. It puts a stop on them getting into a program.”

Recently, NCOPE addressed this issue on its website, stating that, although “the number of accredited residency sites does not equal the number of residency positions available in a given year,” there are residency positions open. Students simply might not be looking in the right places.

For example, in February 2012, at the NCOPE national meeting held in Orlando, Fla., there were 87 residency positions that students could come to inquire about, but only 66 students interviewed for the positions.

“Sometimes people think residency programs are hard to find, and they may be hard to find, but that’s not because they don’t exist,” Richards told O&P Business News. “I think there may be a couple of people who are having a hard time finding a program and these students are who people hear from on the list serve.”

According to Richards, students can look for residency opportunities by attending the national meetings where the American Board for Certification in Orthotic, Prosthetics & Pedorthics (ABC) hosts a student social that allows students to meet residency directors and people in the field; through NCOPE residency workshops at the national meetings where students can meet residency directors; through job postings and interview opportunities at their university; by looking on the OANDP-List serve; and by contacting residency sites on NCOPE’s list of accredited sites.

If students are still unable to find a residency after going through these options, Richards suggested broadening their search to more cities than the one they live in or the city in which they would prefer to work.

“Generally, students should look for a residency they think suits them and that fits what they want, and, if it’s possible, they should put fairly little weight on salary or location of the residency,” Richards said. “It is important to get the best residency experience possible. Later in their career is the time to think about where they want to live and how much money they want to make.”

However, this option may not be available for all students, and if graduation is approaching with no residency in sight, they may begin to panic. For those students, Parente recommended volunteering for O&P organizations.

Jennifer Richards”There are a lot of tremendous organizations out there where students may volunteer and get involved to meet other clinicians and contacts. That is part of the networking that may have to occur to get their name out there,” Parente said. “If there are no residencies to be had within their liking or their geographic location, I would recommend trying to get involved with an organization and staying fresh with their knowledge and what’s going on in the field.”

Jobs in O&P

Whether obtaining a technician certificate, bachelor’s degree or a master’s degree in O&P, the industry comprises different specialties students can look into, including practitioner, certified orthosis fitter, technician of prosthetics or orthotics and assistant.

“Several manufacturers will look for people to work within marketing, education and advertising, and potential engineers for designing and testing, so there are non-clinical type positions like that throughout the country active within the O&P industry that do not require a master’s degree,” Parente told O&P Business News.

Although the industry is hard at work to gain government recognition of O&P as an essential health benefit, some states do not currently recognize O&P as an essential service for everyday living, which may make it difficult for employers to hire new graduates if they do not have the money to pay them.

“Currently, O&P does not fall under what is known as an essential health benefit in many states,” Robinson said. “In the event that sequestration negatively impacts reimbursement from CMS and state level health benefits, the O&P industry is potentially low hanging fruit should it not be considered essential.”

Looming spending cuts and reimbursement issues threaten many O&P providers. According to Parente, reimbursement and encroachment issues can cause a ripple effect on jobs and failing businesses, leading to less income for O&P practices. Students just starting college may be faced with the fallout from current audit overreach, as well as encroachment from other professions.

Non-O&P physician clinics that provide orthoses and prostheses for patients rather than referring them to an O&P clinic may not necessarily hire recent graduates in the field.

“There are certainly more and more physician clinics that are providing O&P services. That doesn’t mean that the physicians themselves are providing those services. It just means that they are providing the personnel that are providing those services under their business,” Gustin said. “Having said that, those physicians don’t necessarily have to hire an O&P clinician. It could be a cast room technician, a nurse practitioner, a physician assistant or a variety of different people who are actually providing the O&P services and devices under the provider number of the physician.”

NCOPE administrators are hopeful that students graduating with a master’s degree in O&P will have more knowledge not only about O&P, but in other health care industries as well.

“The depth and breadth of knowledge that it takes to be a prosthetist or orthotist is rapidly expanding,” Robinson said. “The field has so much additional knowledge that is necessary to graduate a competent clinician. The transition to the entry-level master’s degree will hopefully give the graduates the skills needed to face the challenges of today and tomorrow.”

O&P research

Besides clinical practice, students can also pursue a career in O&P research. According to Steven Gard, PhD, executive director of Northwestern University Prosthetics-Orthotics Center and director of the Jesse Brown VAMC Motion Analysis Research Laboratory, students interested in pursuing a career in research should consider obtaining a master’s or doctorate degree, especially if they are looking to write their own grant proposals. For students who are unsure if the research side of the O&P industry is right for them, they can contact any investigator who is doing O&P research and inquire about opportunities, such as an internship or research assistantship.

“I think students need to be made aware of the abundant opportunities for more research in the field of prosthetics and orthotics,” said Gard, who is also an associate professor in the department of physical medicine and rehabilitation at the Feinberg School of Medicine.

NCOPE’s master’s program offers students the opportunity to delve deeper into O&P research than some previous programs. However, a current issue hindering the research community in the O&P industry is the lack of government funding.

“In theory, there is a lot of good research that needs to be conducted. Under this current health care climate, there is the need to provide evidence for justification for reimbursement from health care providers,” Gard told O&P Business News. “In practice, it’s a bit more challenging because to conduct this research there needs to be funding available and we are being impacted greater than ever before — that I’ve seen in my career — by the federal government’s budgets.”

Through the American Academy of Orthotics and Prosthetics, the American Association of Orthotics and Prosthetics, the Orthotic and Prosthetic Education and Research Foundation and others, advocacy efforts to inform the government about the deficiencies in O&P research have helped procure some federal funding. With the funding that is being provided, albeit limited, both Gard and Gustin emphasized that research should focus on quality of life outcomes provided by devices, as well as justification for reimbursement.

“We in O&P manage populations of people and our research needs to show that our treatment protocols can manage those populations in a very cost effective manner that improves quality of life,” Gustin said. “Showing that a device reduces the energy to walk doesn’t matter to the customer — ie, the payer — because the customer can’t relate that to quality of life or to cost reduction. We need to take that metabolic energy reduction and link it to particular diseases or pathologies and show how it has a positive effect on that person’s life and the overall cost of treating a patient in that population.”

Advice for students

In tough economic times, students going to school for O&P may fear what the future holds for them, wondering if they will be able to obtain a residency and further their career once their education is completed.

“I would certainly caution someone today who is considering becoming an O&P practitioner. If they do not already have some kind of a residency set up for them upon graduation from school, I would tell them to seriously consider something other than O&P,” Gustin said.

However, according to Robinson, the struggle of obtaining a residency can be avoided through networking and connecting with the O&P community, which he always encourages his students to do. Knowing and engaging with clinicians, manufacturers and other stakeholders in the field is important for students because it will help get their foot in the door and also help them stay up to date on industry information.

“A lot of the information that I’ve learned and a lot of the advice that I’ve gotten has been by networking,” Robinson said. “If I have a student who is challenged by networking issues I find that they tend to struggle a little bit more finding those residency spots vs. the students who were very pragmatic about attending the regional as well as the national meetings, speaking with individuals in the area and taking advantage of the resources.”

Ultimately, students should remember why they decided to become an orthotist or prosthetist in the first place.

“My biggest piece of advice for students would be to remember why they got into the O&P field,” Parente said. “If they look at their rationale for why they’re doing what they’re doing to get into the O&P field, the answer comes back to being a people person or comes back to helping people. That should be a great motivator for them.”
— by Casey Murphy

For more information:

NCOPE’s official response to OANDP-List serve “How many each year does our profession lose” email. Available at: www.ncope.org/assets/pdfs/list_serve_response.pdf. Accessed June 13, 2013.

Disclosures: Gard and Robinson are employed by Northwestern University. Gustin is employed by Forensic Prosthetic and Orthotic Consulting. Parente is employed by the University of Hartford.