In December 2002, The O&P EDGE published an article about a few of the up-and-comers in the orthotics and prosthetics profession ("The Young Turks: How Are They Impacting O&P?" The O&P EDGE, www.oandp.com/articles/2002-12_02.asp). As The O&P EDGE celebrates its tenth anniversary, we wanted to touch base with these professionals and find out how their careers have progressed over the last decade, what insights they have gained to share with peers, and what they think
the future holds for their chosen field.
Their careers span a wide spectrum. Greg Bauer, CPO, LPO, is the president of family-owned Westcoast Brace & Limb, Tampa, Florida, where he works with his father Les Bauer, CO. Michael Davidson, CPO, MPH, is co-director of the post-professional master of science in orthotics and prosthetics program (PP-MSOP) at Loma Linda University, California. James "Jim" R. Fenton, CPO, LPO, owns Orthotic & Prosthetic Clinic, Port St. Lucie, Florida. Zach Harvey, CPO, chief prosthetist at Walter Reed Army Medical Center (WRAMC), Washington DC, moved with the center as it merged with its Navy counterpart to become the Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland. Cara Negri, CP, is clinical director at Össur Asia-Pacific, Sydney, Australia.
Why They Chose O&P
Their reasons for choosing O&P as a career are as varied as the individuals themselves. Bauer originally wanted to be a small-business consultant because he liked the dynamics of working with marketing, sales, management, and finances. "However, I found most of my college projects based around Westcoast Brace & Limb," he says. "I realized that everything that I wanted to do was here, plus being able to do patient care and fabrication. And working with my father is pretty special, too."
Davidson was drawn to inventing, especially to creating robotic arms, and wanted to pursue an engineering degree. His older brother Peter, however, became an orthotist. "He was my inspiration," Davidson recalls, "and I realized that orthotics and prosthetics was my calling, not engineering."
Fenton is a third-generation O&P practitioner. He grew up in the family business working for his father, R. James Fenton, CPO, and decided to make O&P his lifetime career.
For Harvey, the "biggest draw…was the ability to custom make a device with my own hands, or at least my own knowledge, and receive gratification, sometimes immediate, when it becomes beneficial to the patient." He adds, "The difficulty of completely satisfying the needs of our clients is in part what motivates me to continue to learn and improve."
A book she read as a third-grader about an amputee who became a Paralympic winner sparked Negri's interest in prosthetics. "I read the book so many times the librarian gave it to me at the end of the year," she recalls. Her interest in prosthetics was further fueled by one of her high-school classmates who was a transradial amputee and by hearing Paralympic champion and amputee Bonnie St. John Deane speak.
When asked about the most rewarding aspects of his career, Bauer answers, "Being among the first companies to try out new technologies and having the freedom and resources to learn about new technologies and use them without worrying about red tape." Daily involvement with patient care is another highlight.
For Davidson, developing and facilitating Loma Linda's master's-level O&P education program has been the most exciting and rewarding aspect of his career. One of the challenges associated with the impending move to an entry-level master's degree requirement for orthotic and prosthetic practitioners is the shortage of prosthetists and orthotists with advanced degrees who are qualified to teach at the master's level, Davidson points out. "The purpose of the post-professional master's program is to groom faculty members to expand their educational level while still being able to work," Davidson explains.
Loma Linda recently launched its new entry-level master's program, and Davidson envisions even further advancement. "I'm currently working on my doctorate in public health so that I can groom and help prepare a doctorate program in orthotics and prosthetics."
"My highlights are more on the personal side—the relationships I've forged over the years," Fenton says. After completing his O&P education, Fenton worked at the Braintree Rehabilitation Hospital, Massachusetts, which provides a team approach to O&P and is a teaching facility for physiatrists. "That experience gave me the foundation for my total team approach for my patients. I involve physical and occupational therapists, directors of nursing, physicians—everyone."
Before opening his own practice, Fenton worked for a large company and found himself on the fast track to burnout. "Although the company was very good, the environment was high stress and extremely busy," he says. Fenton felt unable to provide the same quality of care that he had provided in a family-owned business. "I took my father's advice and started my own business. That was one of the best things I've ever done; it rekindled my drive and passion."
Fenton says his referrals continue to increase—especially in prosthetics. Except for one small company, he does not contract with health-maintenance organizations (HMOs), saying that he is proud that "doctors send patients to me because they want to, not because they have to."
Fenton recalls an especially rewarding professional and personal relationship with a patient who was a bilateral transtibial amputee. Fenton is a devoted fisherman, and he and his patient often went fishing together. "When you spend time 20 miles out in the ocean, you truly get to know a person, and when he is a double amputee [you get to know] what works and doesn't work for him." He adds, "He became an even more avid fisherman than I am. The stories he told and the pictures he took made me proud that I was able to help him have that kind of life."
Harvey's career highlights include working with military amputees and new technologies, plus authoring several journal articles and a chapter in the recently published book, Combat Orthopedic Surgery: Lessons Learned in Iraq and Afghanistan, edited by Brett Owens, MD, Maj MC, and LTC Philip Belmont Jr.
Harvey was recognized in 2008 by then-President George W. Bush for his work with Volunteers for Prosperity/Physicians for Peace in Latin America. He has traveled internationally for the Department of Defense (DoD) in order to treat coalition forces.
Last year, Harvey served as team prosthetist for the USA Upright Track and Field Team at the Parapan America Games in Guadalajara, Mexico, and also taught his first semester-long prosthetics and orthotics class to physical therapists at George Washington University, Washington DC.
To help meet the needs of the patients he serves, Harvey has developed a crutch arm and "house legs." The crutch arm was created to help multiple-limb amputees, since they weight bear more on their arm prostheses for various activities than do unilateral upper-limb amputees. A quick-disconnect wrist joint makes switching between crutch and terminal device easier.
The house legs were developed when Harvey worked with a marine who sustained knee disarticulation, transfemoral, elbow disarticulation, and transradial amputations. The marine excelled quickly in walking on "shorty" legs with microprocessor knees but still used a wheelchair inside his home; the house legs completely freed him from the wheelchair. Harvey's house legs are lightweight, easy to don and doff, and incorporate suspension using anatomical features or an elastic belt. The design often uses a sock-and-Pelite® interface with shoeless carbon feet and sockets and frequently varies for patients with heterotrophic ossification, depending on its formation topography.
Negri earned a bachelor's degree in mechanical engineering from Kettering University, Flint, Michigan. She says her engineering knowledge, prosthetics training, and eight years in patient care at Springer-Bremer Prosthetics, Flint, have been invaluable for her career with Reykjavik, Iceland-headquartered Össur, from which she has derived most of her professional highlights. Negri has completed several research projects, presented educational lectures, and has presented Össur product expertise internationally as an Össur Academy educator.
With Össur, she says, "I was able to achieve my dream job, working with research and development on testing new products." Her career has taken her to 46 U.S. states and numerous countries. She currently works "in the land down under." "I have a unique opportunity to engage in global healthcare and continue my lifelong goal to keep learning," she says. Australia is undergoing healthcare reform initiatives, including in rehabilitation care, and although not a citizen or permanent resident, Negri says she finds it rewarding to be able to provide information to involved entities.
Progress, Change, Challenges
For most of the interviewees, the technology explosion is the past decade's biggest change. Besides dazzling, headline-grabbing high tech, they cite big improvements in everyday clinical applications such as socket-interface suspension mechanisms, component designs, liner materials, specialized composite AFOs, and stance-control orthoses. "Orthotic technology has been enhanced," Bauer says, "so it's not just prosthetics now that get all the glory."
Although the interviewees foresee steadily forward-moving technology, the elephant-sized concern is—no surprise—reimbursement and the ability to provide the technology that improves patients' lives.
Other changes are impacting O&P businesses as well. For instance, both Bauer and Fenton say that their off-the-shelf orthotic and knee brace business has almost disappeared as physicians provide these products and services themselves. Bauer says he is also concerned about the potential impact of accountable care organizations (ACOs) for Medicare beneficiaries as created under the new Patient Protection and Affordable Care Act (PPACA). (For more information, visit: www.cms.gov/aco/.) "It's a challenge because there is so much uncertainty," Bauer says. "We have to figure out how to stay profitable and keep the cash flow coming in while jumping through these new hoops."
Given technological advances and reimbursement issues, justifying reimbursement with evidence-based-practice research is a continuing need, interviewees agree.
They also cite the progress toward higher-level education in O&P, a trend Davidson, for one, would like to see continue. "As O&P technology, clinical care, and research advance, we need to be on the same level as other allied healthcare professions, such as physical therapy," he says. "Otherwise, I see a lot of our technology and leadership in the profession going to engineers and the other sciences.
"We look to other professions and industries to develop O&P components; then we purchase them for our patients. We need clinical involvement," he stresses. "I'd like to see more prosthetists and orthotists become involved in product development, design, and research. We should be not just consumers of new technology, but also activators of that technology."
Davidson also would like to see a greater influx of new practitioners to take care of the increasing number of patients as the population ages and diabetes and obesity epidemics run rampant. "Increased volume should drive down the costs of technology while keeping O&P businesses profitable," he says. To illustrate his point, he references personal computers, which today are far more powerful, yet much more affordable, than ten years ago.
Words of Wisdom for New Professionals
"Find your own niche—what you really like and do well," Bauer advises. He notes that as physicians and others expand more into O&P-related care such as off-the-shelf bracing, orthotists and prosthetists need to offer specialized care that other providers are not qualified to do.
"Everybody should go to a Challenged Athletes Foundation (CAF) event and watch how someone with a physical disability participates," Davidson says. "We know how difficult a triathlon is for any athlete. It's really inspiring—especially for orthotic and prosthetic practitioners—because we can create an idea, fabricate that idea, fit that idea, and then watch that idea run by on that athlete with a disability. That is really life-changing."
Fenton encourages new O&P professionals to seek the highest level of education they can. "Our field needs a higher level of education to keep up with other healthcare professions and to continue on our advancing technology path," he says. "I also would advise trying to work in a quality teaching environment, which gives you a strong foundation in multidisciplinary patient care."
Harvey says, "Treat your patients as though they were part of your own family. Don't get too caught up in searching for solutions only in the latest and greatest technology; synergy often comes when all of the basic principles are followed and mastered. Relish the success of well-fitting devices and satisfied customers. Always have a next step in mind in case 'Plan A' doesn't work. Encourage therapists to approach you with problems so that they aren't forced to come up with their own solutions. Have fun at work, and encourage your co-workers to lighten up as well."
Negri stresses the value of clinical and technical training. "Try to become part of the rehabilitation team as soon as you can," she says. "Cultivate relationships with physical therapists, physicians, and other rehabilitation professionals, and be up to speed on research and the literature. Take time to read it; don't just get into the routine of things; keep progressing."
In many ways, these individuals personify the O&P profession itself—its past and its future. During the past decade, all of these practitioners have enjoyed satisfying careers and achieved some stellar accomplishments. But ten years is only the beginning. More is yet to come. Life is a journey, and there are more chapters yet to be written.
Miki Fairley is a freelance writer based in southwest Colorado. She can be reached at