By Kim Fernandez

Megan Zachar didn’t think too much about salaries and benefits when she enrolled in the orthotics program at Northwestern University a few years ago. She’d earned a degree in general engineering from the University of Illinois, but a volunteer stint in an area rehab hospital changed her career course. 

Currently finishing up her residency at Eastern Michigan University’s orthotics clinic, she plans to stay there full-time, making about $40,000 per year. 

“I’m not certified yet,” she says, adding that she’s working on certification now. “I’m under the impression my salary will increase when I get certified.” And while she says she’s talked with her supervisors about the issue, she’s not yet sure exactly what will happen to her paycheck when “CO” is attached to her professional name. 

Not worrying too much about salaries, insurance, retirement plans, and annual bonuses may sound a bit naive to practitioners who’ve been in the field for awhile. But without a spouse or children at home, Zachar’s lack of worry is far from unusual among recent O&P graduates. 

“I feel like I’m paid well for what I do,” says Jared Butler, CO, who is also working at Michigan’s clinic. Admitting he’s “probably at the low end” of the industry salary scale, he earns $46,000 per year after more than a year past residency. He earns another $4,000 to $5,000 a year in bonuses, and says he’s pleased with his medical and retirement benefits. 

“I hope it goes up, of course,” he says. “I don’t see myself staying at the same location for my entire career. And salary may affect how I think about things long-term.” 

O&P practitioners with more experience say that’s a good thought to have, but they wish schools would spend more time giving students a realistic expectation of what they might earn and the kinds of hours they’ll have to put in to reach the top of the industry salary scale. 

“I think the schools need to concentrate on it,” says a Pennsylvania orthotist who asked to remain anonymous. “What [the instructors] told me I was going to make was nowhere near reality. They told me to expect starting out at X amount, and I was nowhere near that. 

“How are they getting these numbers? And they need to stress more that salaries vary depending where you work. If you’re in a rural area, you’re not going to make $100,000.” 

So what is realistic? It varies, sometimes greatly, depending on a number of factors, including location, private practice vs. academic institution practice, bonus structure, size of the company, and experience. 

The survey
AOPA released its Operating Performance & Compensation Report in 2004, computing and summarizing the results of a comprehensive industry salary survey. The next report will be published in 2008, based on 2007 financial results.

Salary Survey Coming Soon

AOPA is planning another Operating Performance and Compensation Survey in early 2008 based on 2007 financial results. The resulting report would be published in the late summer of 2008. If your company did not participate in the previous AOPA survey and you would like to receive a survey next year, e-mail your company name, address and a contact name to Malissa Bennett, AOPA Managing Director of Membership & Communications, at mbennett@AOPAnet.org.

 

Among other things, the report found that non-certified and non-licensed orthotists, such as Zachar, could expect to begin their careers earning around $34,693, and top out at $51,291. Add an average bonus and commission of $1,464, and the average non-certified orthotist earned $45,075. 

Many professionals say that number has gone up since the survey was taken, but it depends heavily on performance and location. 

“We start new practitioners out pretty low,” says the Pennsylvania orthotist, who’s been working in the industry for 11 years. “It depends on the area, but an orthotist just starting out in Pittsburgh might make $10 to $12 per hour. In other areas, they make more.” 

The 2004 survey found that an ABC certified orthotist could expect to start out at around $49,152, while a new BOC certified orthotist earned $41,894 to start. On the prosthetic side, ABC certification bumped new hires up to $59,633 to start (a non-certified and non-licensed prosthetist could expect to earn about $34,011) and BOC certification earned a starting prosthetist about $51,982. 

“I would say that someone who’s just starting out as a certified practitioner would earn about $35,000 to $40,000,” says Sheila Harrington, of CNY Prosthetic Center Inc. in Syracuse, New York. 

She adds, however, that her small company almost always hires family members and hasn’t had a new hire in quite some time. The company’s two practitioners get single-digit percentage raises every year of about five to six percent, and receive bonuses at the end of every year. 

Others have also seen raises. “I’ve been with this company for four years and have already seen raises in the double digits,” says the Pennsylvania orthotist. 

“A lot of it is experience and how much you have. But a lot of it is the practitioner’s attitude. How do you work? Are you bringing in new business, or are you just sitting there in the office? Performance is everything, at least at this company. Are you going to sit in a corner and just do what you have to do, or are you going to get out there marketing?” 

However, he says that the 2004 survey’s average salary for ABC certified orthotists, reported to be $63,897, is still about right for his rural area. The survey found that the average annual bonus for a CO was $5,652, but he says that seems high. 

A CPO at a university-based clinic who also asked to remain anonymous says that outside of cost-of-living increases, raises are few and far between. As a result, he says, hiring has become more competitive and difficult than ever. 

“I’ve had an opening for a CPO for more than a year,” he says. “We’ve changed our hiring figure as a result. I have an 18-year history here and am director of the department, and the new hiree will come in at almost my salary.” He says that opening is now posted at an annual salary of $75,000 to $85,000 per year, and still, no eligible candidates have emerged. 

“We’re not offering any annual incentive,” he says, explaining that the structure of a university-based clinic isn’t conducive to annual bonuses or profit-sharing plans. 

“And I can’t take a fresh recruit, somebody fresh out of school. I need someone with a little more polish. This person lectures to the department of rehab medicine, orthopedic surgery [and] the department of medicine. I need someone who knows how to build a leg and has patient skills and manufacturing skills.” 

“I had a regional manager from a large company come in,” he says. “He told me he’d be silly to take the job because he was earning $250,000 a year where he was. He had 10 facilities under him, and he got a bonus equal to the performance of all of those facilities.” 

Another prospect, he says, was interested in the job—the salary, after all, was on par with what private companies were offering. But she interviewed with another practice that offered her a similar salary plus a performance bonus and a profit-sharing plan. 

“Those four or five individual things blew me out of the water,” says the practitioner. “I cannot compete with the outside practitioners.” 

Why no increase?
The CEO of a multi-facility O&P company says that he, too, thinks the 2004 survey average salaries are still accurate in 2007. But he says there are several factors keeping salaries down. 

“We’ve had a three-year [Medicare] price freeze,” he says. “When we’re not getting those increases, increasing salaries is very difficult to do.” 

“Manufacturers have increased their prices because the cost of materials is going up and the rising cost of petroleum products affects lots of other things. Since 2004, we’ve had a lot of price increases from manufacturers. So we’re paying more for products, but we’re getting paid the same amount for our products.” 

As a result, he says, there is a lot of frustration in the industry. 

“Company profits are down because we’re being squeezed from all sides. And where staff is concerned, everybody wants to earn more money because their cost of living is going up.” 

Harrington says she’s able to keep raises coming at least partially because of the size of her company—she and her two practitioners have worked together for 20 years and have a thorough understanding of what affects the company bottom line and, as a result, their own. But owners of larger companies say that’s a message they have to emphasize and repeat. 

“We have meetings where we discuss those kinds of things at length,” says the CEO. “We talk about purchases of products and we try to ensure that our practitioners know what products cost. That helps a lot.” 

“In the past, if they were unaware, they’d turn in the codes and assume everything was covered. But the product might cost more than they thought, and then it wasn’t covered.” 

Others, including the Pennsylvania orthotist, say that even with regular raises and bonuses, most practitioners’ salaries level off after awhile. 

“Working in the field, you’re going to plateau eventually,” he says. “I think the average [salary from the 2004 survey] is about where that happens, at least in this area. And bonuses depend on what kind of year you had. That’s how we base everything.” 

Benefits
With salaries at many companies staying relatively stagnant, many practitioners place more importance on benefits. Although neither is planning a career shift in the near future, both Butler and Zachar, a few years out of school, say that insurance, retirement plans, and performance incentives will play a significant role in their next job choice. 

But in an environment of cost-cutting and increasing expenses, even those are being creatively massaged to save money. 

“It’s getting expensive for a lot of facilities,” admits the Pennsylvania orthotist, who says that many practices in his area have stopped paying medical insurance benefits for employees’ spouses and children, leaving families to cover those costs on their own. 

“It’s kind of tough when you have a couple of kids and you’re trying to succeed. You’re working for benefits,” he says, adding that his family is insured through his wife’s employer because her plan was cheaper for the family. 

“Some employers will work out a deal if a [practitioner] is worth it [and] give a big enough raise to cover health benefits. We’re trying to hire one guy now and he’s ready to come here, but the benefits are holding him back. And we tried to hire a very good secretary but we couldn’t cover her benefits.” 

The university-based CPO says his employer found a creative way to reduce insurance costs without eliminating benefits for family members. “Because the university has the ability to treat us as patients, it was able to cut a deal where it treats employees in-house and doesn’t submit the bill to Blue Cross,” he says. 

In situations where university facilities aren’t appropriate for the care someone needs, the person can then go to the Blue Cross network and be covered. But because the insurance company isn’t being billed for much of the university employees’ care, it was willing to slash the cost of coverage to the institution. 

On the flip side, if the CPO retires before he’s eligible for Medicare benefits, his wife would not be covered under the health insurance he’d take with him. “If I retire before Medicare kicks in, she’d have to pay for her own insurance,” he says. 

And other benefits, he says, keep him working for the university even though he could make more in private practice. For one thing, he says, he’s not on the road like many of his private-practice counterparts. And with a 17-year-old daughter, the prospect of sending her to college without footing the bill himself is just too good to pass up. 

“My daughter’s heading to school,” he says. “I’m not at a point where I want to work out of the trunk of my car. There are very few just-facility-based orthotists. They want you out on the road attending clinics. And at this point, that’s not what I want to do.” 

The CEO says his company hasn’t cut family insurance benefits either, but has come up with other ways to cut costs in the benefits department. After all, he says, his company’s health insurance costs went up 18 percent in 2005 and another 23 percent in 2006. 

“Whenever I hire someone, the benefits are very important,” he says, adding that it holds true both for practitioners and support staff. “Health insurance is so expensive today, and everybody uses health care so much for tests for this or that. Most of that is necessary, but health insurance is very expensive. It’s a big deal.” 

Instead of leaving his employees to fend for themselves when it came to paying for family coverage, his company signed on with a plan that featured a higher deductible—$1,250 for a single person, and $2,500 for a family—but lower premiums. At the same time, however, the company agreed to cover most of that deductible for each employee. So after a single employee pays $500 in health care costs ($1,000 per family), the company reimburses them for the remaining deductible. 

The company has also instituted a flexible spending account (FSA) that allows employees to set aside part of their pre-tax pay to cover health care costs. 

With salaries flat or slightly above where they were in 2004 and benefits being adjusted to make up for higher costs, professionals say hiring is quite competitive. “The pool of potential employees is limited,” says the university-based practitioner. “From what I understand, there are more people leaving the field than entering it every year.” 

But employers say that hasn’t caused their employees to start looking around. In fact, the CEO says that while he knows practitioners are frustrated by the lack of raises in recent years, he hasn’t lost anyone because of it. 

“Nobody has left because they weren’t being paid enough,” he says. “The problem is that there’s nowhere to go. Where are they going to get an offer for more money if other companies are having the same problem?” 

Kim Fernandez is a freelance writer based in Bethesda, Md.