It’s a question O&P professionals have been asking for years: How can we feel confident that our certifications have a competitive advantage in providing prosthetic devices and care when other medical providers, such as physical therapists (PTs), occupational therapists (OTs), registered nurses, and physician’s staff, are legally permitted to do so without the education or certification we have worked for?
I recently took a phone call from a PT who requested that I add a buildup to a patient’s shoes after she had fit him with bilateral AFOs. I instantly went from being an orthotist to repairing shoes. These types of encounters have made me think about what the future holds for O&P. Orthotists and prosthetists long ago gave up the fight for certain orthotics markets, including most off-the-shelf (OTS) products, custom knee bracing, cervical and spinal bracing, and pediatric custom bracing. How can we keep from losing more?
We cannot legislate other healthcare professionals out of provision, however we can encourage them to police themselves. What if the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) and/or the Board of Certification/ Accreditation (BOC) created a temporary pathway for PTs, OTs, podiatrists, and physician’s staff who are employed by practices that already bill prosthetic codes to become certified? These professions are already billing for a growing number of custom items that we provide, so we have nothing to lose. We would have more to gain by providing this pathway, because the same therapists and physicians who earned O&P certification would then have an incentive to police the provision of custom prosthetics with their uncertified colleagues in the future.
O&P providers and our associations are also saddled with the mammoth task of lobbying for the separation of O&P care from durable medical equipment (DME). Perhaps these challenges could be addressed in a related effort. With BOC discontinuing its pathway for O&P clinician certification, ABC and BOC could partner and separate clinical custom O&P from OTS DME. This would allow for credentialing of both but play a vital role in separating DME from custom O&P provision.
How the pathway would be provided would likely be left up to our O&P credentialing bodies, but here is what it could look like: ABC and BOC could change specializations. ABC could become the certifying agency for prosthetists, orthotists, pedorthists, assistants, and technicians. In this case, ABC would handle accreditation for all clinical providers who have these professionals on staff. In turn, BOC could become the certifying agency for mastectomy fitters, therapeutic shoe fitters, and orthotic fitters and DME facilities. ABC could maintain a five-year window of this alternative pathway for any physician, therapist, or clinician to sit for the BOC or ABC exam to demonstrate clinical competence in O&P. While it is debatable how many would take advantage of this alternative pathway, it is a sure thing that these newly credentialed O&P providers would help protect our field from non-O&P-certified providers out of self-preservation.
In summary, a merger of this nature could take a “two birds, one stone” approach by creating allies from within the allied healthcare team and separating DME from customized O&P care at the credentialing level.
Jeff Arnette, CPO/L, BOCP; Brandon Arnette, BOCPO; and Michael Arnette, BOCPO/L, are practitioners at Progressive Prosthetics & Orthotics, Tulsa, Oklahoma. Michael Arnette can be reached at .