By Deborah Conn

For up-and-coming O&P practitioners, the industry has traditionally been a sellers’ market—and it remains so today. Demand for O&P professionals is outpacing supply, and that demand is growing. 

“From what we have seen, if you graduate from an approved O&P program, you are guaranteed a job,” said Peter Rosenstein, executive director of the American Academy of Orthotists and Prosthetists. (For what you can expect to be paid for the job, see “O&P Salaries & Benefits: On the Slow Side") 

Although the prosthetic needs of soldiers returning from Iraq and Afghanistan have captured the attention of the media, Rosenstein points to other factors in the mounting demand for orthotic and prosthetic professionals. The obesity and diabetes “epidemics” are resulting in more amputations, and since baby boomers are both aging and living longer, they will need continuing care. 

The National Commission on Orthotic and Prosthetic Education, or NCOPE, commissioned a study in 2006 to examine employment trends. The last study, done in 2002, anticipated a dire shortage of practitioners certified by the American Board for Certification in Orthotics and Prosthetics Inc. (ABC). 

Preliminary results from the 2006 study, however, which included pedorthists and practitioners certified by the Board for Orthotist/Prosthetist Certification (BOC) as well as those certified by ABC, are more encouraging. 

According to Robin Seabrook, NCOPE executive director, based on population projections, the industry can expect a less-alarming 4.2 percent shortage of practitioners by 2030—as long the number of O&P schools increases. “Without adding more schools,” she noted, “we anticipate a 9.5 percent shortage. But we do expect more schools to be built.” 

Employers’ point of view
The rosy picture for certified practitioners means a slightly more difficult time for facilities looking for new hires. Anita Liberman-Lampear, MA, administrative director at the University of Michigan Orthotics and Prosthetics Center in Ann Arbor, Mich., takes a systematic approach. The center, a stand-alone division of the University of Michigan Health System, has 50 employees. 

“We hire pedorthists, orthotists, prosthetists, technicians, associates and fitters,” she said. “When we’re looking for new people, we post ads within the institution on an online job list. We also run ads in the O&P Almanac and O&P Business News, and we use the Almanac’s online listings [Interactive Online Job Board]. We send word out to O&P residents and sometimes we call people we’ve known in the past to see if they’d like to come back.”

Recently, finding a qualified pedorthist was difficult enough that the center decided to train an internal candidate. “Our last pedorthics hire was a casting technician in the orthotic department who had moved to inventory supply,” said Liberman-Lampear. “The department hired him and paid for his training.

“We had a similar issue with technicians,” she said. “We couldn’t find any. Eventually, we sent out feelers to people who had trained or worked here in the past, and that’s how we filled the position.” 

The University of Michigan Orthotics and Prosthetics Center created an NCOPE-accredited residency program 10 years ago with an eye toward future hiring. “We often hire former residents,” said Liberman-Lampear. “We know who they are because we trained them.” 

That recruitment method also works for Waldo Esparza, CP, of Tampa Bay Artificial Limbs, Inc., in Florida. “Our clinic is NCOPE-accredited, so we get residents,” he explained. “If my experience with a resident is positive and I have an opening, I’m likely to offer that person full-time employment.”

Hanger Orthopedic Group in Bethesda, Md., coordinates its recruiting activity. According to Scott Hornbeak, MBA, CPO, FAAOP, director of the O&P program at California State University, Hanger, which has more than 600 facilities in 43 states, accounts for about 25 percent of the job market in the United States. “It’s interesting to see that—averaged out over the past three years—about 4 of every 16 students gets employment with Hanger.” 

Sharon King, Hanger’s director of recruitment, runs ads in O&P publications to attract employees. The company also has an online job search feature on its Web site.

“We recruit by showing the benefits of working for Hanger,” she said. “We offer the best of both worlds: a local practice along with the resources of a large company. One of our advantages is geographic, in that we can place new hires or offer transfers to employees who may need to be in a particular area of the country.”

While reluctant to comment on the projected volume of Hanger’s hiring, Brian Wheeler, vice president of human resources, believes that the pool of prospects is improving. “There are more schools opening and more graduates,” he noted. “We are getting excellent candidates.” 

Raising awareness
Although O&P has received increasing publicity as a result of returning wounded soldiers, it continues to be a somewhat “hidden” profession. Most practitioners become interested in the field because their family is in the business or because a relative or friend is a patient. Raising awareness that O&P is an available and viable career choice is essential to creating a larger pool of practitioners and technicians. 

Academy Executive Director Rosenstein is hopeful that a new 10-minute DVD will capture the attention of high school seniors. Funded by a grant from the Department of Education’s Rehabilitation Services Administration, the video highlights careers in O&P. 

“It’s emotional in a lot of ways and shows how satisfying it can be to help other people,” said Rosenstein. “We hope it will drive young people to [O&P] educational programs.” 

The Academy has created a Web site (www.opcareers.org) that offers details about the need for people to enter the field; educational pathways and programs; scholarships; technology; and career information. Visitors can download a Microsoft PowerPoint presentation that describes the field, or use the Web site to locate practitioners in every state. 

Similarly, M.H. Mandelbaum Orthotic and Prosthetic Services, Port Jefferson, N.Y., devotes a page of its Web site to O&P careers, defining each discipline and explaining needed education and certification. 

Alternate careers in O&P
In addition to clinical practice, orthotists and prosthetists can consider other career paths. One possibility is in research and development. 

Christopher Hovorka, MS, CPO, clinical director of the Master of Science in Prosthetics and Orthotics (MSPO) program at Georgia Tech, said, “Current designers of O&P devices tend to be engineers. The problem is they don’t have the clinical experience to relate their products to the needs of the patient. 

“I see an emerging employment market for orthotists and prosthetists as developers of products. We’ve been contacted by a number of large manufacturers that are interested in our students because they are clinically trained and can relate the engineering design to the clinical needs of the patient.” 

In addition to R&D, O&P manufacturers commonly hire practitioners to provide services in sales and marketing, training and technical support. 

Mitch Neff, director of administrative services at Ohio Willow Wood in Mt. Sterling, Ohio, has hired certified practitioners to assist with the company’s marketing efforts by teaching seminars, doing educational training, and handling tech support calls. Practitioners also work at Ohio Willow Wood in research and development. 

Neff said, “Prospective employees for positions requiring clinical background and experience really need to be aware that working in a anufacturing/R&D environment is definitely different from working in a patient care facility. Rather than working one on one with patients, they will be working on a project basis with a wide variety of people within the company.” 

If practitioners are looking for a position in training or tech support, said Neff, they should be good at public speaking and be able to deal with different groups of people. 

Ohio Willow Wood recruits clinicians by placing ads in O&P trade publications. The company looks for certified individuals with some level of experience who have the ability to interact and work well with all kinds of people. “In addition,” Neff said, “we look for a real interest in the type of work we want them to do, whether that is education and training, or research and development.” 

One practitioner who finds it satisfying to work for a manufacturer is Duane Romo, CPO, director of clinical education and technical services at Ossur, located in Aliso Viejo, Calif. Before joining Ossur, Romo had been in clinical practice for 16 years, including seven at the University of Texas Southwest Medical Center in Dallas, where he taught O&P at the baccalaureate level. 

“My interest is primarily in education,” he said, “and I see working for Ossur as an opportunity to continue at a different professional level. 

“One thing that makes this job so interesting is that we are always improving or introducing new technology to the field. As components become more complex, they require more education, and this keeps things exciting for me.” 

Not only is Romo responsible for internal training at Ossur, such as providing clinical education for the sales staff, he also heads up a nationwide group of practitioners who provide professional training on the company’s products. 

When seeking new hires, Romo said, “We look for experienced practitioners who would like to utilize their skills in this profession to educate and bring new technologies into the marketplace.” 

Those who can, also teach
Another option for O&P practitioners is pedagogical. “We would very much like for more people to come into education,” said Edward N. Haddon, CO. 

Haddon is program director and an orthotics instructor for practitioners and technicians at Century College, located in White Bear Lake, Minn. “We have some attrition with instructors retiring, and I think the situation is similar at all the O&P schools.” 

“There is a strong market for educators,” agreed Georgia Tech’s Hovorka. “But there is no formal training program for how to educate an O&P educator.” 

Although each school may have some unique requirements, a master’s degree is usually the minimum requirement for college or university faculty status. Primary instructors in O&P schools accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) must have ABC certification and ideally possess at least a bachelor’s degree. 

The minimum degree for assistant professors is usually the master’s degree. For positions beyond the level of assistant professor (such as associate or full professor), a doctoral-level degree, such as the Ph.D., is typically required. 

“Because Century is a technical college, we require a bachelor’s degree plus 6,000 hours of experience,” said Haddon. Since there are so few master’s programs in O&P, those interested in pursuing an academic career earn advanced degrees in related fields, such as biology, anatomy and, of course, education. 

Because of income disparities, said Haddon, “it’s hard to lure people from private practice to education. But I would plead with people in the field to explore the possibility. Teaching is quite rewarding in other ways than financial.” 

Hovorka hopes another career path opens up: that of research scientist and pure academician. “We don’t have that in O&P,” he said. “We don’t have a solid evidence base for what we do.” 

With an increased focus on outcomes-based practice, Hovorka believes there will be an emerging market for clinically trained scientists who choose an academic path, pursue academic doctorates and conduct primary research.

Preparing for an O&P career
The key to any job in O&P, of course, is education. According to NCOPE Executive Director Seabrook, the commission has accredited O&P programs at nine schools in the United States (see sidebar, “Educational Programs in O&P”), which offer degrees ranging from baccalaureate degrees and post-baccalaureate certificates to the master’s degree in orthotics and prosthetics. 

At Georgia Tech, which offers an entry-level master’s program in orthotics and prosthetics, enrollment is capped at 10 students per year, although, like most other schools, they have seen a steady increase in applicants each year. “In addition to the clinical practice and technical O&P device design, fabrication, and fitting portion of the curriculum, we’ve altered elective courses and infused more research methodology, including more time for research. 

“We’ve also beefed up clinical rotations for the clinical practicum, where students go off campus each semester and participate in supervised clinical experiences in hospitals, medical centers, O&P practices, and related clinical sites. 

“We’ve added more medicine, physical therapy, occupational therapy and pedorthics, so students can also be exposed to a variety of clinical environments outside of traditional O&P and learn more about the perspective of their future O&P referral sources and interdisciplinary collaborators. 

“In the first semester, students focus on clinical pathology, how to evaluate and treat a variety of conditions of the body. We break these [conditions up by] disciplines—orthopedics, physical medicine and rehabilitation, neurology, vascular surgery, etc.—and then students rotate with appropriate medical specialists. 

“With an orthopedic surgeon, for example, they’ll have the chance to view an amputation surgery or joint replacement. This really helps students understand what referral sources do and get a broader picture of their place in the continuum of care.” 

At Century College, enrollment in the certificate program is limited to 24 students a year, 12 each in orthotics and prosthetics. “We’re unique in that our technician program becomes a feeder program for the practitioner program,” said Haddon. “Students have the opportunity to enter with a high school diploma and go all the way through the practitioner certificate program.” 

The educational system in O&P is gearing up for a big change in 2010, when NCOPE will begin implementing a single educational path for practitioners. After a transition period, NCOPE-accredited institutions will be required to offer a master’s degree in orthotics and prosthetics rather than the current bachelor’s degree or post-baccalaureate certificate programs. 

Not only will the requirement upgrade educational requirements for the profession, “it will streamline the process, rather than having two or three different educational pathways,” said NCOPE Executive Director Seabrook. 

Cal State’s Hornbeak noted that by adopting degree programs that encompass both orthotics and prosthetics, the United States will become better aligned with the rest of the world, which does not separate the two disciplines. Seabrook expects that schools will offer a transitional program for a period of time to accommodate post-baccalaureate certificate holders in one discipline who wish to extend their credential. 

According to Catherine Carter, executive director of ABC, the board has not determined whether credentialing will also require the master’s degree, but she expects that ABC is likely to follow NCOPE’s lead. 

Seabrook is hopeful that the advanced degree requirement will draw more students, not deter them. “We will be able to attract students from other professions, particularly those who already have advanced degrees, such as PTs. 

“We anticipate a positive impact on student enrollment and getting future schools to come on board,” she said. “This is very exciting for O&P. It puts us on a comparable level to our colleagues in health care.” 

As to what effect the requirement for a master’s degree will have on the job market—that’s a subject for a future article.  

Deborah Conn is a freelance writer based in Falls Chuch, Va.