April 2007 • Vol. 3, No. 2
	Advancing Orthotic and Prosthetic Care Through Knowledge

Finding Sanity in an Insane System

I like O&P…. No, I love O&P, and I bet you do, too. The thing that I find most fascinating about O&P is that those who typically provide the hands-on care are not the ones making the decisions about the type of care that should be provided. Sadly, this is not a new concept to anyone who is providing healthcare in the United States. How many professions, outside of healthcare, require specialty training, certification, and/or licensure and then have someone else with less training and different certification or licensure telling them how to practice and what they will be paid? This is a very strange concept. We charge $1,000 for a service to a patient. Then an insurance company determines that a reasonable charge for this service is $800 and decides that it will pay you, the practitioner, 80 percent of that within six months. At the end of six months, the insurance company decides to deny a portion of the service because it believes it is experimental, and it asks you to agree to take $300 for the service you have rendered to the patient. Have you ever tried to negotiate like this with the last plumber who did work on your house?

Yet we persist. There are a million professions out there where we could provide for our families, not worry about third-party payers, and be home every night at 5:05 PM instead of 7:30 PM. We persist because the core of what we do is so wonderful that most of us couldn’t think of another profession that would give us the same satisfaction as O&P.

"It is not enough to merely exist. It’s not enough to say, ‘I’m earning enough to live and support my family. I do my work well. I’m a good parent.’ That’s all very well. But you must do something more. Seek always to do some good, somewhere. Every person has to seek in his own way to make his own self more noble and to realize his own true worth. You must give some time to your fellow man. Even if it’s a little thing, do something for those who have need of a man’s help, something for which you get no pay but the privilege of doing it. For, remember, you don’t live in a world all your own. Your brothers are here too."

—Albert Schweitzer

So despite the vagaries of an insane healthcare system, how and why do we sustain our love for what we do? For me, the secret to staying passionate about the O&P profession is giving back in the form of volunteerism. The few times I have had the opportunity to visit developing nations and apply the skills I have learned without the concern of reimbursement or business practices to people genuinely in need of those services, I remember why I went into O&P in the first place. Providing care in this unique environment gives me hope and helps me once again connect with why I chose this profession. These practice environments remind me that the human body is an amazing thing capable of surviving in the direst of situations. When I return from these humanitarian trips, I bring home a renewed sense of hope, and I find that I am able to share this renewed enthusiasm with my patients and all the people in my care.

But volunteerism is not just the work I do overseas; it is work I do here at home with the Academy. The Academy allows me to take a proactive role in my profession. Instead of complaining about reimbursement practices, I get to work toward educating Medicare and the insurance companies with a goal of improving our reimbursement rates. I also have the opportunity to put mechanisms in place to enhance O&P research and thus improve the outcomes we can achieve for our patients. These are just a few examples of how working for the Academy allows me to have a positive impact on the profession. I also sleep better at night knowing that I am doing everything in my power to improve the profession for the future.

I have found that volunteering both here and abroad keeps my moral compass squarely in line. Despite the increasing regulation and decreasing reimbursements plaguing O&P and healthcare in general, I know that I am not being steered off course. By volunteering, I am continually reminding myself why I went into O&P in the first place.

What do you believe? Write and let me know. . Your letter may be published in The Academy Today.