Sixty years ago, formal articles of incorporation were filed on behalf of a group of orthotic and prosthetic practitioners and orthopedic surgeons to establish the nation’s first O&P standard setting organization. With the post-World War II demand for O&P services at an all time high, these leaders recognized the need for an organization to set clinical standards, further professionalism and begin the process of establishing the O&P practitioner as a member of the allied health community.
Motivated to take action, this group formed the American Board for Certification of the Orthotic and Prosthetic Appliance Industry (ABC). On Sept. 9, 1948 filing to formally launch the organization, an early draft of the ABC’s mission statement was stated clearly: “…To encourage and promote the high standards of workmanship and service…and to foster and promote honest dealings and fair trade practices on the part of persons engaged in fitting prosthetic or orthopedic appliances.”
Although the size, scope and name of ABC has changed during the last 60 years, the organization’s early mission still rings true today,
The first board of directors meeting was convened on Dec. 11, 1948 to develop an early growth plan and set a strategic direction for the organization. This initial board, comprised of president Chester E. Haddon, CPO, three orthopedic surgeons and three O&P practitioners, made a number of decisions that remain ABC policy today.
To begin the meeting, Haddon reported on enthusiastic acceptance of the organization by the O&P community. In 3 months, more than 112 “firms” and 252 “fitters” had submitted applications for ABC accreditation and certification, respectively. In contrast, ABC today has more than 2,500 accredited facilities and 12,500 certified individuals.
A critical decision for the initial board was how to refer to the O&P professionals who would come to abide by the ABC standards. At that time, common vernacular labeled O&P professionals as “fitters.” However, the initial board elected to establish the terms “certified orthotist” and “certified prosthetist” for those who met ABC’s requirements. Establishing independent titles for O&P professionals symbolized the desire of ABC’s founders to further professionalize and distinguish O&P.
At that meeting, the board also decided on a logo to serve as the official symbol of ABC. This symbol consisted of “two pulling tools of the artificial limb profession crossed and intertwined with a traditional simplified back brace, symbolic of the orthopedic appliance profession. The intertwined tools are tied together with a ribbon and support a winged foot indicating the restoration of the handicapped to normal activity and function.” This original design continues to serve as the ABC logo.
Promoting O&P education was central to the early goals of ABC. At a September 1949 board meeting, ABC established the Advisory Committee on Educational Standards. This committee was tasked with addressing the issue of establishing educational programs and standards for O&P practitioners.
The first ABC examination was held on March 3, 1951. This inaugural exam took place in New York City, and later that year, additional exams were held in Atlanta, Los Angeles and Chicago. By year’s end, 67 applicants sat for the exams and 51 passed to become ABC certified.
“The founders of ABC developed an examination process that laid the foundation for today’s comprehensive examination process,” Cathy Carter, ABC’s executive director said.
In 1954, the ABC board endorsed the policy of working from a physician’s prescription. This same year, although the board agreed that there was good reason to cover “corsetieres” and “orthopedic shoe technicians.” Although the board agreed that there was good reason to cover corsetieres and orthopedic shoe technicians, they decided against expanding the scope of ABC until these professionals were recognized by and eligible for membership in the Orthopedic Appliance and Limb Manufacturers Association (precursor to the American Ortotics and Prosthetic Association). It was nearly 50 years before the board revisited and amended this decision.
The board amended the organization’s name for the first time in 1959, dropping the term “appliance industry” and adopting the familiar title of the American Board for Certification in Orthotics & Prosthetics, Inc. This served as the ABC’s the formal title for 48 years.
Focus on education
In the late 60s and early 70s, an active ABC board of directors established a number of policies that continue to guide ABC today. The ABC Character and Fitness Committee was created in 1968 to review ethical misconduct and oversee a consumer complaint process. One year later, ABC published a new “Canons of Ethics.”
In 1970, in recognition that the need for more continuing education options was important to both ABC and the profession as a whole, ABC and the American Orthotic and Prosthetic Association sponsored the establishment of the American Academy of Orthotists and Prosthetists. The board asked former ABC president Ralph R. Snell, CPO, to lead the effort and authorized the ABC executive director to provide “assistance to the initial effort, and if it developed successfully, to the Academy in its formative stages.”
Two years later, the ABC Continuing Education Policy Development Committee was established. Shortly thereafter, the committee recommended to the board the establishment of continuing education requirements for all ABC-certified practitioners. The unanimously approved requirements were gradually phased in throughout the next decade.
Following three years of debate, the 1973 ABC board of directors approved a historic change in the certification eligibility criteria. It was determined that a high school diploma would no longer be sufficient for certification, and that only candidates possessing a minimum of an “associate of the arts degree in orthotics and/or prosthetics” would be eligible for the ABC certification exams.
Modernizing the profession
Thirteen years after approval of the associate’s degree requirement for all certification candidates, the board of directors raised the minimum education standard to a bachelor’s degree requirement. A 10-year phase out of the associate’s degree requirement ensued to allow individuals educated at that level to continue pursuing ABC certification.
ABC’s responsibility for overseeing primary O&P education was passed on in 1991 to the newly created National Commission on Orthotic and Prosthetic Education (NCOPE). One of the first tasks on NCOPE was the establishment of O&P residency programs, which were immediately recognized by ABC.
In the early 90s, overhaul of the ABC facility accreditation program began. As reported in ABC’s 1993 annual report, ABC “recognized the need to look more closely at the (accreditation) standards used to define quality of care. It is not limited to the physical capability to deliver services, but incorporates processes of patient diagnoses, treatment, and outcomes. Further, an organizational environment conducive to supporting these processes must exist.”
To meet these goals, new standards were developed and an onsite survey became mandatory. Inauguration of the modernized program took place in December 1995. At that time less than 800 O&P patient care facilities were ABC accredited.
The new millennium presented ABC with a number of opportunities to expand the scope of credentialing and accreditation options.
Spurred by a desire to provide credentialing options for all O&P professionals, the ABC board unanimously voted in 2002 to create orthotic and mastectomy fitter credentialing programs. Thousands of professionals applied for the new certification programs in subsequent years, validating the viewpoint of the board that standards programs and credentialing services were needed and desired for professional providers of non-custom orthotic devices and post-mastectomy prostheses and products. Four years later, ABC added a certified fitter of therapeutic shoes program for providers of non-custom diabetic footwear and inserts.
Legislation passed by the U.S. Congress in 2003 required the Centers for Medicare/Medicaid Services to strengthen the rules and regulations governing providers of durable medical equipment, prosthetics, orthotics and supplies. This legislation mandated quality standards and facility accreditation for all providers. The ABC board of directors, seeing this as an opportunity to expand the influence of ABC standards and accreditation, directed the organization to seek recognition from CMS as a ‘deemed status accrediting organization.’ This status was achieved in 2006.
Following a vote by certified pedorthists represented by the Board for Certification in Pedorthics, the BCP was integrated into ABC on Jan. 1, 2007. This integration brought more than 2,500 certified pedorthists into ABC, and for the first time joined together all orthotic, prosthetic and pedorthic professionals under one standard-setting organization.
“ABC’s recent history meshes well with the original intentions of the ABC founders,” Carter said. “The original mission, as laid out in 1948, was to create an organization that could set high clinical standards for the entire O&P profession. As the profession has evolved over the years, so has ABC. Today we continue to set the highest standards in orthotics, prosthetics and pedorthics for professional and organizational performance.”
Tom Derrick is the director of public relations, marketing and professional discipline for the American Board for Certification in Orthotics, Prosthetics and Pedorthics Inc.
For more information:
- Singer B. ABC’s 40 years of excellence – a retrospective: part one. O&P Almanac. 1988.
- Singer B. ABC’s 40 years of excellence – a retrospective: part three. O&P Almanac. 1988.