Earlier this year, O&P News conducted an O&P Workforce Survey to gauge feelings on the issues facing O&P professionals. The survey, which was conducted via email and garnered 105 responses from O&P professionals from a variety of career paths, showed a mixed outlook on the future of O&P profession. From education to regulations to new technologies entering the field, O&P professionals all seem poised for change in the coming years.
— Editors of O&P News
Among the O&P professionals who completed the survey, 29% own their O&P patient care facility and 71% do not. Most respondents (55%) see 10 or fewer patients each day, while 29% of respondents do not see patients on a daily basis and 14% see between 11 and 20 patients daily. Most respondents see either retired military patients (61%); active military patients (26%) and inactive military patients (40%).
Work week status
Most respondents (44%) reported working between 41 hours and 50 hours in an average work week, while 25% work between 51 hours and 60 hours, 9% work between 61 hours and 70 hours and another 9% work between 31 hours and 40 hours. More than half of respondents (53%) spend 10 or fewer hours completing non-clinical paperwork each week, but another sizeable group (32%) spend between 11 hours and 20 hours on paperwork. The remaining 15% spend more than 21 hours a week on paperwork.
Randall Alley, CP, BSc, CEO of Biodesigns Inc., O&P News Editorial Board member and O&P News 175 member, was asked to weigh in on the survey. He said he and his staff work between 55 hours and 65 hours most weeks. However, he noted that Biodesigns focuses less on patient care than other O&P facilities due to its focus on HiFi network support, research and development and contract engineering work.
“As for paperwork, I have made it my mission to streamline it as much as possible, so I spend a minimal amount of time on it but have staff [who] fill in the gaps,” he added.
Survey respondent Marmaduke D. Loke, CPO, of Dynamic Bracing Solutions, said he falls into the higher end of the work hour spectrum.
“I enjoy what I do, so I do not mind putting in the long hours,” he said. “I am always working on extra projects besides what I need to do for each client. I am always looking for a way to improve or enable better outcomes. I love to innovate and develop answers to problems that have never been solved before. That eats up time very fast. I look at O&P as also being my hobby.”
Loke added, however, that outside factors can negatively impact an O&P practitioner’s workday.
“Another area that health care professionals at all levels must fight is the excessive rules and regulations that take us away from the people who need our care. It consumes 25% to 50% of a clinician’s professional time. The burden it puts onto the business and the clinician is beyond words,” Loke said.
Marmaduke D. Loke
The majority of respondents (65%) would retire today if they had the means, but they are prevented from retiring by financial issues (66%) and personal satisfaction from working (68%). Most respondents (55%) will continue working during the next 5 years, but 12% plan to retire and 10% plan to cut back on their work hours. Among the respondents who own their business, 30% plan to sell their business in the next 5 years.
Ken Meier, CPO, of Miller-Meier Limb & Brace Inc. in Bettendorf, Iowa was one of the respondents who would retire today if he had the means. Meier said he loves what he does and is proud to work in O&P. However, a major factor in his desire to retire is the struggle with Medicare for reimbursement.
“I do not have the same level of satisfaction from performing my talent that I once had,” Meier said. “Based on the fact that I can no longer provide the same level of care to those I serve, it is hard for me to justify my existence as a prosthetic and orthotic professional. It has gotten so bad in the retail marketplace that I am concerned about what the future holds in regards for our profession, the profession credentialing boards and those we serve.”
Meanwhile, survey respondent Thomas P. Karolewski, CP, FAAOP, supervisor of Orthotics and Prosthetics at Hines VA Hospital, O&P News Editorial Board member and O&P News 175 member, said he would stay involved in the profession if he had the means to retire by contributing to educational curricula or writing a book.
However, he added, “I think the reason baby boomers are not retiring is two-fold: one is a true passion for helping people with amputations and the other — like many people — is fear of outliving their savings.” At the same time, he said, he knows some practitioners who could retire but have continued working because of their passion for the work.
Thomas P. Karolewski
When asked about general feelings toward the O&P profession, 32% of respondents chose “somewhat negative”; 28% chose “somewhat positive”; 23% chose “very positive”; and 7% chose “very negative.”
“I am more of an optimist than a pessimist, but I can definitely relate to all of [the survey] responses, with the corresponding percentages,” Loke said, adding that O&P professionals need to fight for recognition among other health care specialties.
“As a profession, we need to improve our worth. We need to show our services save money and improve quality of life issues. We need to demonstrate we can prevent surgeries, deformities, falls and keep people moving,” Loke said. “We need to show a certain or growing percentage of the people we see are able to return or continuing to work, vs. being forced to live off the system. … We need to leverage our worth to climb up the food chain and prove money spent on quality O&P care can save precious health care dollars while truly benefitting the people we serve.”
Alley said he would have chosen “very positive.”
“We are not only witnessing but in fact deeply embedded [in] the amazing convergence of robotics, prosthetics, orthotics, CAD [computer-aided design], 3-D printing, nanotechnologies, bioengineering, surgical innovations, bionics, mechatronics, the list goes on and on,” Alley said. “What an amazing time to be not only alive but involved, and not just involved but a driver in this assimilation of a multitude of disciplines with the mission of maximizing human performance while enhancing the human experience.”
Alley said he believes the prominence of negative responses is due to the common misconception of O&P practitioners as device providers rather than health care professionals.
“This has to change and change quickly,” he said.
Karolewski also chose “very positive.”
“This profession offers someone the opportunity to excel in so many different ways and I for one am glad I found this profession,” Karolewski said. “Whether someone is employed by a company or becomes a business owner, an educator, a researcher, a clinical specialist or a philanthropist, there is something for everyone.”
He also understood the perspective of negative respondents, though.
“The effort required to secure payment [for O&P services] has taken much of the joy out of the reason people entered this profession and it is a shame when passion is taken out of the equation,” Karolewski said.
Sarah Clark, technician and manager at O&P 1, O&P News Editorial Board member and O&P News 175 member, said she would have chosen “very positive,” but when asked what has changed since she began working in O&P, the negative effects seemed to stand out the most.
“People are getting more lean in their business structure and a portion of the trend in being lean is to eliminate in-house fabrication as needed rather than having it all the time,” Clark said. “In this time of reimbursement constraint and reimbursement uncertainty … people are utilizing central fab in reducing their overhead, making central fabrication a variable.”
Education, career preparedness
Respondents did not have a united stance on education and career preparedness in O&P. When asked for their thoughts on the current education requirements in O&P, 59% of respondents chose “the current education requirements are ideal.” Of the remaining respondents, 25% said “less formal education should be required,” while 16% said “more formal education should be required.” Despite a majority approval of current education requirements, 40% of respondents believe newly certified practitioners are less prepared today than a practitioner certified 20 years ago. However, 36% of respondents believe today’s newly certified practitioners are more prepared and 24% believe they are about the same.
Loke said a mixture of degrees – bachelor’s degrees, master’s degrees and doctorates – would be most beneficial to the O&P profession. Some jobs require more hands-on work while others, such as research-related positions, make use of a higher level degree.
Alley said while he believes education is moving in the right direction with its shift toward outcomes, he is unsure whether changes will need to be made to clinical education in the coming years.
“For the time being, I applaud the increased levels of education, and quietly hope that these students pouring out their hard-earned money and time in O&P schools are not rapidly overtaken by emerging technologies that sideline the profession as we know it by placing even more emphasis on the device over the professional,” he said.
Readers were mostly evenly split on their forecast for the future of O&P. The largest percentage of respondents (42%) said their feelings toward the future of O&P are “somewhat negative,” with 9% choosing “very negative”; meanwhile, 30% feel “somewhat positive” and 20% feel “very positive” about O&P’s future. A little more than half (55%) of respondents would not recommend O&P to their children or other young people entering the workforce, but 45% would recommend it.
“My response regarding the future of this profession is ‘somewhat negative’ and leaning towards ‘very negative,’” Meier said.
While Meier typically takes a “glass half full” view of life, he said, the emphasis of the profession on a single payer – Medicare – is putting the future of O&P at risk.
“Furthermore, it is a real kick in the gut to [Medicare’s] participants when they cannot acquire the services they deserve,” Meier added. “Do you find surgeons operating on patients with stone tools to justify the benefits of laparoscopic procedures? No. And why? Because … advances in medicine have proven to be beneficial and cost-effective – just as the advances in prosthetics and orthotics [are].”
Karolewski said while he has positive feelings toward the field of O&P, he tries to be realistic when offering advice to students.
“When prospective students contact me, I try to be honest and let them know all the variables involved with their decision, the cost of education, the salaries, the residency and the impact of current funding issues,” he said. “I also inform students that the profession can change by the time they graduate, so if they are passionate about the decision then [they should] follow their heart.”
Issues facing O&P
Respondents also shared their level of satisfaction on many of the issues affecting the O&P profession. The issue with the most negative responses was “dealing with audits and other government regulations,” followed by “non-clinical paperwork,” “business issues” and “reimbursement issues.” Issues with mostly positive responses included “technological advancements,” “training” and “hours required.”
Some respondents expressed frustration with communicating the importance of their work to others.
“The average person has no idea what an orthotist does,” Bruce Fogel, CO, orthotist at All Pro Medical in Patchogue, N.Y. and practitioner for more than 40 years, told O&P News. “Most medical people do not know what an orthotist does. We are doing a bad job in that area.”
“What and who we are is so misunderstood by those who are responsible for regulating, paying and authorizing us,” he said, adding that the refusal of government and regulatory agencies to understand and respect the O&P profession is leading to a bleak outlook for future O&P graduates.
“I think the trend in medicine in general is disturbing,” Meier said. “And unfortunately, the O&P profession is caught up in a bigger battle in which we are still the ‘small fish’ with little control over our own destiny until we finally realize who we are and stop letting Medicare and third-party payers dictate to us. This is a battle that I think this profession is in but does not realize it yet and/or is not ready to do what is necessary to fight the battle yet. Unfortunately I am not the future of this profession and this might not be my battle to fight.” – by Amanda Alexander
- O&P News O&P Workforce Survey.
Disclosures: Alley, Clark, Fogel, Karolewski, Loke and Meier report no relevant financial disclosures.