I was surprised by the letter I received from our AOPA [American Orthotic & Prosthetic Association] president, Michael E. Hamontree, but not upset. The simple fact is that a break between AOPA and the Academy [American Academy of Orthotists & Prosthetists] has been coming for a long time. While in theory the three "sister organizations" are equals, in practice AOPA has long dominated any discussions of policy or politics.
[Editor's Note: For background information on this issue, visit http://www.oandp.com/edge/issues/articles/NEWS_2005-03-16_01.asp ]
This is a serious matter and calls for careful thought and judgment, not angry rhetoric. Since physical therapist direct access is on the legislative agenda here in Michigan, I have been mulling it over for some time now. I will admit that my first reaction to the idea of PT direct access was to oppose it. I've come to conclude that this is not only a waste of time but is counterproductive. The simple truth is that PT direct access changes almost nothing for the O&P professional. PTs currently provide O&P devices and will continue to do so, whether a physician is involved or not.
O&P Future: Custom Devices
The future of the O&P profession lies in the complexity of custom devices, not in fitting soft goods. I believe that the entire profession would benefit if we could stop being distracted by turf battles and could focus on building constructive long-term relationships with our professional neighbors.
Incidentally, I am an Academy member and the president of an AOPA member company, and thus have one foot on each side of the fence.
Michael Hamontree wrote, "...the Academy took its position on the highly visible direct access issue without alerting AOPA, without determining our stated view on the issue, and without even letting us know after the fact that the organization had weighed in on a public policy issue critical to the O&P community."
As a counterpoint, one could ask if AOPA consulted with the Academy prior to announcing its position.
The battle is already lost here in Michigan, as O&P was written into the PT Standards of Practice years ago without anyone in O&P even knowing about it. Direct access is now in the legislature, and I've had to ask myself carefully if I want to fight it. I've decide to come down on the side of practical reality. While PTs routinely provide O&P devices such as back supports and knee orthoses, they have shown little interest in supplying the custom-made devices that are the focus of my practice.
I believe that a better pathway lies in the area of increased communication and cooperation with the PTs of my community. Change is the only constant. The O&P profession is in a period of transition and is undergoing wild oscillations between business and professional interests. I do not see PT direct access as a threat to my skills or my knowledge. If I was in the business of fitting soft goods, I might well be very threatened, but that is not what I went to school for, and I do not see it as an effective use of my time or a viable avenue for my business.
Differing Constituencies
It is unfortunate that AOPA and the Academy have presented a broken front in such a public manner, but it is not surprising. AOPA and the Academy represent very different constituencies. In the past I have often felt that AOPA has supported positions that make business more profitable, but at the expense of the individual practitioner. "The profession" cannot do well unless individuals who practice O&P have respect, dignity, and significant compensation for their skills. The interests of supplier companies and employers cannot be expected to always be congruent with those of O&P clinicians.
If AOPA wants the Academy leadership to cooperate with its priorities, it would do well to better understand and support the priorities of the Academy. In recent years the Academy has become a more mature and independent organization. I expect we'll see more disagreements in the future, not fewer.
Ted A. Trower, CPO, is president of A-S-C Orthotics & Prosthetics, Jackson, Michigan. He can be contacted via e-mail: ted@amputee.com
