The December issue of The O&P EDGE contained a poll asking readers, "Do you think the minimum education requirement for those entering the O&P profession as orthotists and prosthetists should be a master's degree?" When I provided my own response, 64 percent of respondents had answered "no." My own answer had also been "no." However, I suspect that my reason was different from most.
I believe that we have met the enemy, and it is us!
Take a moment to go back through the past two years of the Journal of Prosthetics & Orthotics (JPO). Are you satisfied that the lead author of most of the articles is not an orthotist or prosthetist? Is anyone surprised, anguished, or at least a little embarrassed by that?
Is the technology available today going to remain static, or is it going to continue to evolve and leave us in its wake? Will we be the ones designing patient care protocols, or will it be someone else—with more education and a higher degree?
I first broached this question in 1994 at the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) Education Symposium in Phoenix, Arizona. At that time, we were nowhere near being ready to deal with these challenges. Today, we are still dragging our heels and holding onto the past.
How many times have we heard the complaint that there is no mechanism in the Centers for Medicare & Medicaid Services (CMS) system for us to be paid for consultation? How often is it that we are the ones dictating the prescription—for free—while the physician gets paid for signing his name to our knowledge-based recommendation? Why is it that we are content to go to school for four years and then serve a one-year residency to end up being recognized by the clinic chief as the guy or gal who can make anything?
I've looked at the requirements to become a doctor of optometry, and at a number of schools, it is six years. To get a master's degree in O&P, it takes six years plus a year of residency just to sit for our boards! Can anyone other than me see the similarity in the work an optometrist does and the work that we do? To see the similarity, you may have to step out of the lab for a while. Most physicians recognized a long time ago that the real skills were in making people feel better, see better, and be better—not in sharpening knives or grinding optics.
The reality is that we are the ones who have the knowledge and skills to deal with people with amputations. I estimate that out of every 100 medical doctors, there will be less than a dozen who have the knowledge necessary to competently prescribe a prosthesis without the input of an O&P professional. I don't feel that O&P professionals have achieved such expertise in dealing with neuromuscular problems, but that is because of the great range of neuromuscular problems that we encounter. Certainly, a doctoral program would go a long way toward addressing that issue. A doctoral program would also address any lack of computer skills that many current practitioners now have; i.e., in designing new and different algorithms for existing and new products.
With the ever-increasing requirement to quantify our results with each and every patient, it is incumbent on us to be trained to the level necessary to provide the very best care. Products can be provided to us by those with fewer years of academic training and better hand (manufacturing) skills.
The following paragraph is from the ABC website. Could there be a better description for a doctor of P&O? Try substituting the term "doctor of orthotics," "doctor of prosthetics," or "doctor of prosthetics and orthotics" for the term "certified practitioner." I think it fits better.
As the practitioner responsible for all patient care, the certified practitioner independently provides or supervises the provision of comprehensive orthotic and prosthetic care. This includes patient assessment, formulation of a treatment plan, implementation of the treatment plan, follow-up, and practice management. In addition, the certified prosthetist and/or orthotist is obligated to support and conform to the professional responsibilities which promote and assure the overall welfare of the patient and the integrity of the profession. (Editor's note: Italics added for emphasis.)
By heightening the entry-level academic requirement for an O&P practitioner to the doctoral level, we will finally be able to accurately and coherently describe our knowledge base to others. We will be able to fill volumes with experiences otherwise lost. Many of those experiences might be better off if they were lost, but at least if they are recorded, some poor soul will not have to suffer them in the future.
Jim Fenton, CPO, LPO, is the owner of Fenton Brace and Limb in Miami, Florida. He is a past president of ABC, past member of the American Orthotic & Prosthetic Association (AOPA) board of directors, and served twice on the Education Accreditation Commission (EAC).
