February 2007 • Vol. 3, No. 1
	Advancing Orthotic and Prosthetic Care Through Knowledge

Are We an Industry or a Profession?

"Hopefully we have to be both. And, are we mechanics, with engineering skills, or are we in the medical field where the structure of anatomy is all important? Again, we have to be both. Therein lies our complicated future."

—Orthopedic & Prosthetic Appliance Journal, 1958

And complicated it is! Negotiated rulemaking, qualified pro­­vider, minimum education requirements, multiple certification boards, evidence-based practice, declining reimbursement, licensure, competitive bidding, fraud and abuse, Centers for Medicare & Medicaid Services (CMS) quality standards, parity, changing medicine, changing technology, and let’s not forget the FDA.

It seems like such a basic issue that you would think it would have been decided long ago: “Are we an industry or a profession?” Yet we continue to debate this amongst ourselves, nearly 50 years after the concept was last presented. The question really is this: Can we continue to be both?

Choosing to be both has led to numerous problems. At the very least, we currently display diverging opinions on minimum education requirements, licensure, professional certification and facility accreditation, scope of practice, and encroachment, not to mention how we appear to other healthcare professions and regulators.

It is my personal opinion that we are already a profession—we just don’t know it.

Why is O&P a profession? Well, we are based on problem solving and ongoing management of a person with a disability. We have a relationship with that patient, our services have significant social value dealing with private matters of the person and his or her body, and we focus on the patient’s well-being (do no harm). We also have a unique body of knowledge and skills, we set our own educational standards, we set our own credentialing standards, we set our own ethical standards, and, finally, we are part of a healthcare team.¹

A profession is defined by a body of knowledge, skills, and an indwelling ethic. Perhaps it is time that we begin redefining what we do from a device focus to a person focus. If we are the only ones who understand the subtleties of materials, alignment, pressure, variable volume control, and their relationship with the human body, why is it that we persist in defining ourselves by components?

So how do we begin to define ourselves as a profession? We begin by raising our minimum education standards. Right away it will attract better students. Better students mean better analytical skills, better rhetorical skills, and an improved ability to handle complex tasks. As the years pass, these students will educate future students in higher-level skills and research, and the cycle continues.

According to the AERTI (Advanced Education Research Training Initiatives) Report, increasing the number of individuals with advanced degrees relevant to P&O will affect the field in the following ways:

• Rapidly increase the knowledge base and science of P&O

• Contribute to the education of the profession, providing academic leaders in P&O

• Enhance the transfer of knowledge from research to clinical practice

• Help create a culture within P&O that values science over marketing and expects clinicians to consume and apply research

• Contribute to research and development in the industry

• Result in the provision of improved patient services and care

• Increase the credibility and parity of the P&O profession within the healthcare realm

Increasing the number of P&O professionals with advanced degrees would facilitate a paradigm shift within the field, emphasizing the importance of self-directed, lifelong learning and creating a culture that values advanced education and scientific research. Such a focus will lead to improved patient care within P&O, and the resulting parity with other health professionals will improve the coordination of care with other disciplines.²

I would contend that we are a profession with all of the responsibility and benefits assigned to that role. We need to act like a profession and move toward enhancing our profession for the future of O&P. Let us not look back in 50 years and say, “We should have.”

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

References

1. Jean Dietz, PhD, OTR/L on training future O&P educators and scientists.

2. AERTI Report, American Academy of Orthotists and Prosthetists, 2006.

A copy of the AERTI Report is available here.