The O&P profession is on the cusp of change. Millennials comprise more than one-third of the U.S. workforce and with the recent transition to the master’s degree requirement, new graduates can do anything from fabrication to 3-D printing; the next logical question is where to start.
Before O&P graduates can begin their careers, they must complete a residency. Residencies contribute to continuing education by providing clinical training and hands-on experience.
“Internships and residencies are critical for students and graduates to incorporate their didactic knowledge into clinical practice,” Matthew Parente, MS, PT, CPO, director of the Prosthetics and Orthotics Program at the University of Hartford and national clinical education specialist at Hanger Clinic, told O&P News. “These experiences will reinforce the learning process, and drive the student to have a greater understanding of the material. The clinicians they work with were once in their shoes, and they want to give back to the academic process. This knowledge exchange helps the students and graduates to grow through the shared experience. It also helps the clinical mentors to maintain open lines of communication which can often be overlooked during a busy day.”
For many graduates, though, residency can become a barrier to employment.
“This is not due to the duration or need to complete [a residency], but usually due to the geographic location and availability,” Parente said. “For many graduates finding a residency is much like real estate — it is all about location, location, location. If a graduate is limited to a geographic location, then this could greatly reduce his or her options for securing a residency.”
Although required by the National Commission on Orthotic and Prosthetic Education (NCOPE) for certification, residency opportunities have been hard to come by for many graduates.
“There are certainly economies of scale in O&P now,” Rod Cheney, CPO, LPO, said. Cheney is the executive vice president of American Prosthetics & Orthotics in Iowa. “With all the Medicare regulations, audits [and] overall paper chase, smaller O&P companies are struggling.
“Our company has transitioned a 40-year CPO practitioner to oversee compliance and regulatory issues. This has worked well, yet moves like these are not available to smaller firms, which could reduce residency sites from a dollars and [cents] standpoint.”
In recent years, this problem has grown larger as numerous O&P facilities cut residency programs to remain financially stable. “There are [only] so many out there,” Cheney said. “Let’s say there are 100, 120 O&P graduates throughout the United States … most facilities are only taking on one or two a year, if any.”
“It can be initially disheartening,” Wendy F. Beattie, CPO, FAAOP, O&P clinical and program director at Eastern Michigan University, added. “A lot of people are hesitant to have residents because it could be a financial burden, so students will approach 50 sites and not get a response from any.
“However, all of our graduates have landed residencies each of the last 3 years. They just do not get them as soon as they would have liked,” she said.
Lay the groundwork
Beattie remains optimistic. After receiving her own degree in engineering, she recalls having been turned down multiple times for technician jobs. If students are consistent in the application process and network with other health care professionals, it could help them get their foot in the door, she said.
“If there was ever a field where networking was important, it would be in O&P. I encourage students to maintain contact with associates, with professors and with each other. We are such a small, tightknit community … I think the personal connections are far more valuable than anything,” she said.
Networking opportunities can be found through national organizations and meetings. The American Academy of Orthotists and Prosthetists (AAOP)’s and American Orthotic and Prosthetic Association (AOPA)’s annual conferences provide opportunities to connect with residency directors and top professionals in the field.
The American Board for Certification in Orthotic, Prosthetics & Pedorthics (ABC) and Board of Certification/Accreditation (BOC) also host educational student seminars at national meetings.
NCOPE suggests that graduates who have narrowed their search to a particular company contact the regional residency liaison to inquire about opportunities. The organization has also created the Orthotics and Prosthetics Centralized Application Service, where graduates can search state-by-state for residency sites, as well as the Former NCOPE Resident Networking Directory, which offers insight on companies that have taken residents in past years. The directory is updated annually.
“There are several outlets for networking opportunities, both on- and offline,” Parente said. “Online, there are several chat rooms [and] groups that have formed to allow for quick communication across a vast geographic spread. Most of the ‘offline’ opportunities occur at conferences, some of which offer student [or] guest rates for attendees. There are also usually regional opportunities at state chapter meetings. Lastly, another way for recent graduates to network is through their university’s alumni group. This can be an extremely helpful list of people who can help.”
“There [are] a lot of opportunities,” Cheney said. “The brick and mortar schools have been complemented by a world of online instruction [that] is much more efficient. Students can also research [available] residency positions much easier [than in previous years].”
Find a fit
But it is not just about finding a residency; it is about finding the right fit. Graduates should align with sites that match their interests, but also consider current market supply and demand.
“The demand within most clinical practices has been orthotists outnumbering prosthetists,” Michael Oros, CPO, FAAOP, president and chief executive officer of Scheck & Siress in Illinois, told O&P News.
“It is just the numbers,” Cheney agreed. “It is probably 10 to one in our practice, orthotic vs. prosthetic patients. Looking from the business side, we employ more certified orthotists than prosthetists.”
Though career prospects may ultimately favor orthotics over prosthetics, Justin Hobbs, BOCO, president of Central Brace and Limb in Indiana, thinks students should specialize in both.
“I mean, there is always going to be a need for prosthetics, and there is always going to be a need for orthotics,” he said. “But the more credentials you can have in this field, the better.”
“Students will probably always favor the first discipline that they acquired their certification in; it is just the nature of the process,” Cheney added. There are definitely advantages for the individual to be certified in both disciplines. It is a great bargaining tool on the individual’s resume.”
In addition, sources agreed that with the increasing prevalence of central fabrication, there will be more opportunities for O&P technicians, fitters and assistants.
As far as location is concerned, Beattie said, “The experience is going to be much more determined by the individuals you are learning from rather than by the name on the door.”
She said she encourages students to keep their options open and remain open to new ideas.
In many cases, that requires relocation. According to NCOPE, residencies are available throughout the United States. However, graduates must be willing to look outside of their geographic area to find them.
“Obviously, in the larger metropolitan areas, there are going to be more patients than in rural areas like Iowa,” Cheney said. Hobbs added that the east and west coasts also are likely to have more opportunities.
“With retired populations [set to] triple within the next 5 [years] to 10 years, I could see areas like Florida, Arizona and the Carolinas becoming more saturated as well,” Hobbs said.
Oros, who moved from Illinois to Pennsylvania to Florida before settling back in Chicago, understands that “home is home” for many students. At the same time, he said it is important for graduates to be flexible, try new areas and not be tied to a preconceived notion of where they want to live or what company they want to work for.
Although salaries are a factor in most job searches, Parente cautioned students not to put too much weight on this factor.
“The graduate needs to understand that salaries are typically commensurate with market value, years of post-graduate experience, and individual performance on the job, as well as how their career progresses. There is great potential for both intrinsic and extrinsic awards in this career,” he said.
Once graduates do secure a residency or job, they should absorb any knowledge they can, even if it is not directly related to their specialty, Chris Casteel, MSPO, co-owner of Anew Life Prosthetics and Orthotics in Michigan, told O&P News. Casteel originally joined O&P as a part-time technician before going to graduate school to pursue the profession full-time.
“Get involved with amputee support groups, volunteer for O&P limb loss events such as [the Orthotic & Prosthetic Activities Foundation’s First Clinics], understand what is going to happen, what exactly the job entails,” he said. “Everybody thinks, ‘I am going to make legs. I am going ride into town on this white horse and my life is going to be golden.’ But in reality, it is so much more.”
Graduates should explore, ask questions and seek out new information and technologies, he said, adding that certain things cannot be taught in the classroom and instead require interpersonal and hands-on experience.
“Especially billing, coding [and] understanding third-party payer policies,” Cheney said, “Schools do not have the time to teach these guidelines or paperwork. Obviously, the programs are concentrating on teaching the clinical side first, which is understandable.”
Taking a different path
For graduates who want to start their own practice, there are many considerations, sources said. Among them are market trends, funding, location and regulations. But even with solid planning, outside factors can hinder success.
“The start-up costs are tremendous, “Cheney said. “Insurers are more apt to contract with multi-office facilities vs. the single site operation. Insurance companies are trying to achieve geographic access for their insured. Financial stability is also an advantage when contracting with major pay sources.”
He added, “I tell students that they will need a year of cash on hand, because that is how long it takes for you to get your contracts in place and get your Medicare provider number. It is an uphill battle in terms of cash flow.”
Casteel said graduates should be cautious if they choose this road. “There is an idea of instant gratification that I see with some of the younger students. They have expectations like, ‘I am going to start a residency, make $50,000 a year and as soon as I get my certification, I am going to be at $100,000.’
“[The] reality is … the worst time to start a business is when everything is flushed, and right now we are not sure what is going to happen. I suggest taking a step back before investing a great deal of income.”
If a graduate is taking over a family business, the transition could be a bit smoother, Hobbs said. With proper structure and lines of delegation in place, “you can mesh the minds of past generations.”
Hobbs began working in his family practice before receiving his bachelor’s degree in kinesiology.
Cheney, who had a 25-year career in patient care, has taken over administrative duties as his father transitions into retirement.
“I am fortunate to have my business degree, along with understanding the clinical side of our business. It would be my suggestion that the O&P programs spend time educating students on accounting [and] finance, as these areas must be understood for success in our field,” he said.
Additional information can be found through the U.S. Small Business Administration.
Breaking into the profession may pose initial challenges, but Beattie thinks students should follow their passion despite the barriers. “There are certain people who have that entrepreneurial spirit within them. I would still recommend these individuals start their own businesses if that is their goal,” she said.
National organizations are working to aid graduates in finding residencies, and new areas of technology including CAD/CAM and 3-D printing could lead to post-residency placement.
Cheney advises graduates to keep updated resumes, follow up with post-interview phone calls and stay involved in the community through internships and volunteer work.
As the profession is reshaped by new challenges and technologies, graduates will need to be persistent in order to claim their place. Oros believes they could be the perfect solution for the changing field.
“Certainly audits and budget cuts have made this more challenging,” he said. “But you could argue that that is exactly why you need people with fresh ideas coming in to help support that.
“A lot of practitioners never had to do it this way before, so it could be a better environment for new folks because they are not always wanting to look back to see how things used to be.”
Casteel echoed that idea and suggested graduates keep their heads down and keep pushing. “Tough times are ahead of us,” he said. “But if you are a gambler, sometimes the best odds are when things look the worst.”
Parente’s words of advice to graduates are, “Never underestimate your ability to change someone’s life through your actions. We are an integral part of the health care team, and often see tremendous examples of people overcoming obstacles. Celebrate the success of your patients and give them your best.” – by Shawn M. Carter
- Fry R. Millennials surpass Gen Xers as the largest generation in U.S. labor force. 2015; available at www.pewresearch.org/fact-tank/2015/05/11/millennials-surpass-gen-xers-as-the-largest-generation-in-u-s-labor-force. Accessed Nov. 11, 2015.
Disclosures: Beattie, Casteel, Cheney, Hobbs, Oros and Parante report no relevant financial disclosures.