The 21st Century Prosthetist

Often as prosthetists we find ourselves at the center of a discussion that goes something like this:

“So what do you do?”

“I’m a prosthetist.”

“A what?” Laughter ensues, often the result of the listener hearing prostitute or proctologist.

“A pros-the-tist.”

“What’s a proshtecist?

“No, a prosthetist. I make artificial limbs. I work with people who have lost their limbs, or were born without a fully developed one.”

“Wow. That’s cool. Are you a doctor?”

“Not exactly… so where’s the punch bowl?”

The point is, we have not done enough to raise the awareness of who we are and what we do. We are still battling with anonymity, and while it is true that we are a small field dealing with a relatively small number of patients, there really is no one to blame other than ourselves for our current state of obscurity on the world stage and even within our own medical community. For example, how many media stories involving prosthetic successes convey the crucial role played by the prosthetist, much less even mention a prosthetist is involved?

Create a presence

The fact remains that much of the recognition we enjoy today has to do more with the amazing capabilities and accomplishments of those who “wear our wares,” — and yes, it can be argued that this is often despite, rather than as a result of what we make for them.

Emerging technologies, though tremendously beneficial, will often serve only to avert much-needed focus away from the important clinical contribution made by prosthetists. Regardless, if we are ever going to assume our rightful place as “a” – if not “the” – crucial component of a prosthetic success story, then we need to assert ourselves into the story. It is not about the element of fame, but rather our ability to establish ourselves in a more effective way. If done correctly, we will be able to better attract additional talent into our field. With more of a presence, we will also be able to have our voices more easily heard on Capitol Hill and hopefully be more successful in obtaining the resources our patients need. In addition, with greater awareness of what we do and the role we play, perhaps we can motivate that person who had never considered wearing a prosthesis before to give it a shot. In short, we need to make the story more about us so we can be a magnet for that which allows us to create a better overall story in the future for “them.” If we just rely on technology and great patients to do the job for us, we will not get far enough before we are simply left behind. While what we do may not be as exciting as who we work with, we are still – at least for the foreseeable future – a star player in the game.

Celebrate success

One way to improve our image and branding is to be firm about our contribution to a patient’s success. While it is important to ensure we do not overstate our role, it is not good enough to simply hope we get mentioned in a news article or piece. We all enjoy the focus that is placed on our happy patient; however, this does not mean we should feel content to remain anonymous. When interviewed for a particular story, do not be afraid to explain why you feel you and the patient are a good match. Discuss the importance of others in the community understanding what precisely it is that you do and how you differentiate yourself from others in the medical community. Explain that although technology and prosthetic components are extremely important, they are not the complete story. Remember, this is not so much about you as the role we prosthetists play in our patients’ successes. It has little to do with ego and much more to do with the human element that is brought to bear to ensure the patient is truly satisfied. It is not about being a rock star; it is about shining a light on what is often dismissed as irrelevant or extraneous.

Change the language

Another way to improve our “standing and branding” is to be conscientious about how we represent ourselves to both the medical community as well as the public arena. Terminology and CAD/CAM will both play a critical role in establishing a better beachhead in the years to come. As I have mentioned in presentations and previous articles dating back several years, it has been shown there is a causal link between the level of a society’s language and its social advancement. It is both cause and effect. If we continue to call a human limb a “stump,” if we insist on calling our advanced, biomechanically enhanced interfaces “sockets,” or if we refuse to eradicate “above and below knee” or “above and below elbow” for example from our description of amputation levels, we will forever remain firmly attached to our roots in the arts. Even though we came from meager beginnings, our field needs to be more closely aligned with science – rather than art – to elevate our standing. Terminology is one way to effect evolution, the use of digital technology is another.

Look to the future

Plaster. Need I say more? The earliest traces of plaster renders are nine thousand years old. Plaster as we know it today was already well established in the 1700s, its development centered in the city of Paris, hence the term “Plaster of Paris.” Indulge me just for a moment. Perhaps, it is time to toss plaster out altogether? There is really nothing quite like delivering a two-hundred thousand dollar set of high-end myoelectric prostheses derived from rolls of plaster bandage and a Scarpa’s knife.

The use of some type of scanner and its associated software is the future, without a doubt. But let’s make it in the near-rather than far-future for the good of the field. Yes it is expensive, and no, it does not always seem to work out the way we expect it to, but sometimes you have to dive in to get used to the water. While I confess to still using plaster myself, it is not for lack of trying. I have sampled several systems and have not found the perfect one for me, but many have, and in the process we have assisted the developers in making their systems better. I am currently on the hunt for the right solution that I know at some point will free me from the evil clutches of plaster bandage and the primitive rawness it conveys. Digital information is our way out of the purgatory of “analog” impressions, inherently inaccurate and destructible, and toward a world of precision that our patients, our associates and indeed we deserve. At the very least, consider as part of your protocol, obtaining digital limb captures of each of your patients for your database. This capability alone is, in my mind, worth the price of admission.

We need to make ourselves, and more importantly the role we play, prominent in the eyes of the public, not for the pursuit of fame, but rather to assume our rightful place on a seat at the table. Once this is achieved, we can better attract both financial and human resources in order to push the field forward and gain the momentum necessary to remain a viable component of 21st century rehabilitation.

Randall Alley, BSc, CP, FAAOP, CFT

Randall Alley, BSc, CP, FAAOP, CFT is chief executive officer of biodesigns inc. He is chair of the CAD/CAM Society of the American Academy of Orthotists and Prosthetists, an international consultant and lecturer, and a member of the O&P Business News Practitioner Advisory Council. Alley can be e-mailed at

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