The ideal O&P facility goes beyond bricks and mortar, hardware and software. A facility houses a practice—professionals and support staff who have their own procedures and styles of work.

So, what would be the perfect O&P practice? "Ideal," it seems, is somewhat elusive and—as in O&P and so many other areas—is often in the eye of the beholder.

The O&P Almanac caught up with Brian Gustin, CP, to discuss his philosophy on creating the ideal O&P practice. Gustin has strong ideas about how the O&P practice should evolve.

Q: In your ideal practice, what is the role of the O&P practitioner?

A: The orthotist and/or prosthetist needs to transition from being a provider of care to being the manager of the care that is provided.

The nature of O&P—and health care in general—is changing quickly, with decreasing reimbursements, increasing patient numbers and increasing documentation demands. To survive, the old traditions need to change to keep pace with the rest of health care.

The traditional practitioner is a quasi- professional and craftsperson. He or she makes stuff and fits it on patients. But today and especially moving into the future, practitioners are being paid from the neck up. The days of a practitioner functioning as a craftsperson need to be gone.

Q: If the orthotist/prosthetist isn't doing the technical work, then what is he/she doing?

A: I believe the demands on practitioners are increasing.

We certainly know there are not as many people coming into the field as there were five or 10 years ago. So, practitioners simply won't have time to be both clinicians and technicians.

Furthermore, a move—ill founded—to require a master's degree for entry-level practitioners will result in increased salaries and fewer O&P applicants, and we can't afford to pay practitioners those kinds of salaries if they're doing fabrication, modifications and adjustments. Practitioners should be paid for their brain power, and someone else needs to focus on fabrication and other technical aspects.

Having a master's degree for O&P is fine and is needed to do the necessary research to prove our methods, but it should not be the barrier to O&P entry.

Q: What will the typical patient visit be like?

A: The ideal O&P practice would include one or two well-trained assistants. The practitioner would evaluate a patient and instruct the assistant to take an impression. While the assistant worked with that patient, the practitioner would move on to evaluate the next patient. Moving back to patient number one, the practitioner would check the assistant's work and explain to the patient what will be happening next.

Meanwhile, the assistant would be working with patient number two, making an impression or performing an adjustment according to the practitioner's orders.

The practitioner would then move on to address the concerns of patient number three before ensuring that the assistant had followed out the treatment plan for patient number two.

Practitioners don't get to do impressions or make modifications. They need to teach others to do what they used to do. I believe that this can be a practical approach, since someone has taught each and every practitioner how to do these tasks. So either the schools need to train O&P assistants or the practitioners themselves need to train assistants in their specific methods.

Q: What, then, is the role of fabrication?

A: Without in-house fabrication, it becomes a bit more difficult.

The practitioner would have to break down any modifications very specifically in writing and would need to have a very good working relationship with the technician at the central fab. Communication will be a key factor; however, video telecommunications should make this easier.

Q: Who performs the fitting?

A: After the device is made, the assistant would begin the fitting.

Of course, the practitioner would come in to observe and make sure the treatment plan was being followed.

And, if all worked well, the practitioner would be available to see new patients, perform evaluations and work on special problems that require attention from a more skilled professional.

Q: Wouldn't this approach leave practitioners with time on their hands?

A: When practitioners have non-patient time in their schedules, they will need to do tasks they traditionally dislike the most: documenting treatment plans and writing letters of medical necessity to obtain insurance pre-authorizations and payment.

Normally, practitioners ask administrative staff to deal with insurance concerns, as they are too busy with patients. But, this needs to change if the O&P facility of the future wants to get paid to do the high-tech devices that the baby boomer generation will demand.

No one knows the details of the cause and effect of the treatment plan like the practitioner. Therefore, the practitioner needs to replace the time spent fabricating, modifying and adjusting with writing.

What are your thoughts? The O&P Almanac would like to hear from you. E-mail us at mbennett@AOPAnet.org or call (571) 431-0876, ext. 213.