I'd really like to hop in on this forum. I read this back in 2016 and could attest to most things written. There is truth in a lot of these posts.
I am a CPO that has been working in the field for almost 5 years. I got my masters from one of the more reputable programs about 5 years ago, did my residencies, and have been certified for 2-3 years. I decided to chime in both as a contribution as a way of venting. I appreciated Corland's voice of positivity in this overwhelmingly negative thread. That being said, I think many of the negative comments stated here are a decent reflection of the field, and many people I know who work in O&P have similarly negative feelings, including myself. It's not all bad, but I find myself seriously questioning my decision to go into this field.
I agree with TrueBlue here. A lot of the struggles in the field have taught me many things in life. I have been able to sustain my living thru it but it has come with struggle. If I wouldn't have had this struggle, I wouldn't be working in the place I am now, happier than I was before. When I see my friends who went into other health profession making a ton of money, I think the field hasn't been worth it. Two nursing friends are rolling in over 150k and getting to travel. In some ways, I wish I would have gone this route but I wouldn't be where I am today and I'd be working in a field that is completely undermined by everyone that works in a hospital (nursing).
Orthotics as a field really developed in the 50s and 60s in the wake of the polio epidemic. The orthotists of those days made most brace by hand, patient by patient. This required a lot of ingenuity and craftsmanship, which I think is what attracts people to the field. But those patients now are few and far between, and we as CPOs get stuck with an ocean of patients that require such low-skill-required services that it feels really demeaning and like I'm wasting my potential. Prosthetics almost always requires this ingenuity, but again, 1 out of every 10 patients...
Yes and with the speed of today's clinics, it's actually a burden to come across the patient that has the reliant chairback brace from 1981 and wants it fixed, replicated, or a new one. Clinics are set up like McDonald's drive thru to get people in and out and not spend more than five minutes with any one situation, unless you're making prosthetics. Most doctors want to perform some type of procedure. They can't do it unless all other means of treatment have failed. They prescribe pills, physical therapy, and bracing but aren't concerned if it works because, if it doesn't, surgery is warranted.
If you are going into O&P you should know a few more things about the logistics of the field. I've worked at an O&P residency site and many of the students that we got just didn't realize how Physician-centric our profession is. First of all we need a prescription from a physician for anything we do. Second of all, while the O&P accrediting and regulating bodies require us to document patient encounters, as far as CMS is concerned our notes count for nothing. The physician's notes must have very specific wording to justify a specific device and if that wording isn't exactly correct then the insurance won't deem the device medically necessary. Even if any person with half a brain could clearly put the patient's records together and realize that something is justified, the insurers are all about specificity (This is how a prosthetic leg can be deemed not medically necessary for an amputee). The problem is that none of that stuff is required on the physician's end (for physicians to get paid), only on ours (for us to get paid—which is not high on a physician's list of priorities). They don't know exactly what's required and they're writing the notes, we know exactly what's required but aren't allowed to write the notes (we technically do write notes, but they either don't count at all or are only used to count against us if they don't match a physicians notes. Anything the insurers can do to find discrepancies and send out that denial). It's frustrating. We are constantly calling physicians for clarification only for them to be busy, sending them letters that aren't responded to for weeks if at all, and the patient's are the ones who suffer because their treatment is stuck in limbo until everything is sorted. It's one thing to be at the mercy of the insurance companies (everyone in healthcare is) but it's another thing to be so much at the mercy of the physicians. Also, I'm pretty sure that physicians see us mostly as a nuisance and potentially a source of free food (marketing and luncheons).
Again, very true and has made me want to leave the field entirely at times. On my schools website, it said O&P would be a great field with physicians, therapists, nurses, and O&P professionals working together as a team. Nope, pass the buck because of time and money crunch. Sorry to tell the truth. I'll sum it up like this. There is an entire generation of professionals (baby boomers) that are exiting this field. They all caught the end of the gravy train where insurances paid for whatever without any notes or professionalism. They are the ones attending conferences strutting their names and making big salaries, throwing off the data represented to schools. They live a comfortable life and have lots of expensive toys. You'll also hear them raging in meetings and scoffing at paying new talent coming in. They're still all jacked about ABC and BOC merge and fighting like third graders as to who knows more. They were the ones fattening up the nursing staff at the hospitals taking them donuts everyday and marrying the ones that took interest in them. They're all looking to stay at the top and play chess to stay there both for their name's sake and financially to retire.
I have not seen the money that was promised by the schools in the field, especially for small companies. I made 20k at my first training site, 20k to start at my second and had to beg to be bumped to 50k and had to work on call and excessive hours to reach 60k. I was so desperate to get away from the toxic overworked culture that I took a 10k paycut to move to another company which is proving to be a bunch of flattery about their financial situation. If you want to make money in healthcare and pay your school bills, afford a house, car, one or two vacations a year, insurance, food, etc, do not go into this field. Only do it if you know someone that is willing to hook you up and get you in or if you have a ton of experience already. I got into the field with a physical therapy background and little to no O&P experience. NO company has seen the benefit of me giving my two sense on physical condition. Doctors, therapists, etc get paid to make a patient's condition better even if they use conservative treatment. In my case, when I see blatant fraud that someone does not need an AFO but is being prescribed one, I will see no benefit unless I provide it. The further you get into life's debts, the more apt you'll become to make your company president happy with your numbers, so be cautious. I actually had a business owner that joked about throwing something at a motorcyclist to encourage their prosthetic business. And this person came across as "one that wanted to help people".
There is so much wrong with this field I don't even know where to begin. I guess the biggest problem is that the field is set up around a terrible business model. You are not employed by a large hospital system as a doctor, nurse, P.T., etc would be. Instead there are all of these outside O and P companies selling their services to the hospitals, private clinics, etc. so you are completely reliant on referrals from these sources to keep your business going. What this means for a practitioner is that you are essentially a salesman. Regardless of what anyone says about clinical knowledge or skill, you keeping your job is dependent solely on your numbers (how good of a salesman you are/how much business you can bring in). This is true especially at large companies like Hanger. They are known for being ruthless to their employees, who are nothing more than numbers. From my experience I can tell you that it is no different at the smaller companies either.
Truth. The small companies act like they are out for the good of the patient but they essentially have the same pressure to survive which comes with acts of ruthlessness, regardless of the smile and flattery they will give you out the gate. Also, since you are not employed and paid by the hospital, they care not at all about getting you information, paperwork, or help you whatsoever in some clinics. I found myself walking on needles asking busy staff for demographic sheets, diagnoses, or any basic information whatsoever. Since you come from the outside, there are no repercussions of treating you like trash and like "you're only out for the money". I spent most of my days chasing down information to get paid etc rather than getting down to the science of helping people. Again, in school you have this delusion that your days will be filled around a discussion table engineering products and treatments. This happens in 20% of each business and usually it's the people in control over their time. Unless you know someone pulling strings for you, you'll be tossed in a closet somewhere in a hospital fitting cam walkers and having your boss play manipulative games on supplying what you need only because the staff takes it and doesn't fill out paperwork when you're not there. You end up in the middle of a battle between a private company supplying doctors with what they feel should be free and a boss that is watching every penny not accounted for on their billing sheets. It's an absolute nightmare and I'd say 70% of college grads with any talent will be shuffled into this scenario to frustrate you out of the business. I worked in a city near a school with heavy saturation and they did not want any talent overstepping them in business whatsoever. They planted their powerful people in the schools to scope talent and suffocate it if you tried to stay in that area. Call me a liar, but this is exactly what happened.
The amount of information you have to know to do this job, especially in today's world with YouTube available for people to fact check you, is overwhelming. When you apply certain devices, cast people for specialized braces, or give education, the patient and family are all alert and oriented. A surgeon has their patient under anesthesia when they do their work. The patient is not watching them with extreme caution and suspicion. A lot of doctors know this too. The light eventually comes on that their prosthetist/orthotist is vastly knowledgeable and outsteps what they know about carpal tunnel surgery. Some surgeons will undermine you constantly and play their power game, again getting back to how physician centric the field is. There are plenty of doctors I would have just walked out on if it had been my business. I would have left them in the wake of their stacked schedule of people needing conservative treatment to fail before doing surgery, which is exactly what a lot of otc orthotics has become. The doctors have no hope that all these braces will conservatively treat anything, they just want it to fail so that surgery is warranted which makes they and the hospital that employs them more profitable.
I also want to quickly throw out another topic to continue on which is cadcam. Fortunately, I was able to work for a small company that did most of their own fabrication. Later, I worked for a company that still did hand fabrication, but I wasn't allowed to modify or pull sockets/orthotics, only the technicians were allowed. Lastly, I work for a company that does no fabrication whatsoever. The field is moving this way and I can understand why. I'm tired of fighting with technicians about anything outside of the box. In my last company, one of the hot head techs would lose his mind if we asked their team to make anything out of the ordinary. I understood, because they were so overworked. The field was built on specialized fabrication and attention to detail. Until now, it attracted the personality of a craftsman that makes custom furniture or works on cars/motorcycles. This is why further education is so important to weed out specific personality traits. I was around a bunch of professionals in school, but in most company tech departments you will not find mature minds talking about constructive things. Most days walking into the lab area had conversations about sports betting, sex, and the oil that was used to clean their guns.
I'd most certainly want to work with a machine that is good at making a custom prosthetic or orthotic, but they have not learned tissue compression just yet. Orthotics and prosthetics are successful if you can differentiate between a hard endpoint or soft endpoint with your tape measure and also how much relief is placed and where. If I want fibula relief, I mostly want it below the head of the fibula because the peroneal nerve is situated below the bone head. A machine has a hard time understanding this. I can't explain to a machine what my hands know how to do regarding bone reliefs, reductions, etc. We can't lose our skilled technicians, but I understand why business owners would rather replace them with a machine that doesn't start throwing things across the room when you ask it to make a socket at 430pm, right before the tech needs to be home on time for a soccer game.
I actually have more to add, I'm just tired. I hope people are still reading this, because I've only just begun =) Prosthetics and Orthotics has made me grow in so many ways. I have found a lot of positives. What I am trying to do here is warn people of the storms that will come so they are prepared. I will fully tell you right now that this field is not for someone looking to settle down in their 20s, get married, get a mortgage, and have kids. This field is really about the battle for truth. I got into this field having had four broken bones as a teenager resulting in two major surgeries in my early twenties. I've never worn a brace but have approached everything from a physical therapy standpoint. If you don't have something that really holds you into the field, you won't last. There are other things like nursing that pay 2-3x more. Nursing is definitely a hard profession but nothing like this field for the time and effort you put into it for pennies on the return. And when the doctor is screaming at you as a nurse, there are repercussions because you both work for the same employer! When the doctor screams at a third party orthotist, there will be nothing done.
I guess I'll keep adding to this post as I see daily things about the profession that one does not see from the outside. Today I am reminded of how much retail is involved in the field. We are constantly ordering and piecemealing people's orthopedic needs together. I spent a lot of time helping people shoe shop, picking out transfer paper designs, and ordering components for prosthetics. This part of the job takes a very conscientious person to remember if they ordered socks, pins, gel liners, tube clamps, pylons, waist belts, flexible inners, screws, glue, foam, buckles, rivets, etc. The human brain cannot completely comprehend everything ordered about every patient and replacing every little thing in stock so we plug it all into software systems. Therefore, instead of fabricating and making things, most practitioners end up in a battle for time. If you work in a small clinic where you do your own fab, you'll have some days where you are constantly pulled away from your work to call reps about specific products and answer telephone calls about when things will be done and ready. You have to be able to keep your mind clear and pick up where you left off in this field. You'll be typing a note and organizing materials you have to order and the phone will ring and interrupt your thought. Next you'll start typing your note again and someone will ask you details about a completely different situation which ends up in a 15-20 minute conversation. Then, just as you are about to order something, the hospital will call with an urgent request for a back brace. You'll stop charting mid chart and leave to measure the brace because "the patient is being discharged by noon tomorrow". You'll have a technician frothing at the mouth waiting for you to go cast it so they can get home, your note doesn't get finished, and your boss will be saying "tell them it can wait til tomorrow" (when in reality he'd never say that to the doctor). When you get back to the lab from measuring the tlso you will have forgotten what you were typing about patient "x" the day before and stress because you haven't poured your AFO yet to modify it, all the while dealing with the frustration and anger of your hot head technician. You'll talk with them about putting reliefs in the brace to meet the patient's needs and they'll start cussing you out. The AFO is fixated on your mind because it needs done in the next two days because AFO patient is leaving for a trip in two weeks and their health insurance runs out at the end of the month. You stay at the office late, modifying and making the AFO with the technician that is livid with you only because you are doing your work. (tomorrow they'll see the company president walking by and smile and ask them how they hockey game went last night (free tickets from Dr. SO and SO) You work in completely silence, avoiding any more burden on them because they are already missing their son's basketball game. This is where the story gets good. All that stress made you completely forget about the first patient so you didn't finish your note nor did you order anything for them. That patient calls in two days asking how things are proceeding and your front office person says "so and so is on the phone inquiring about the status of their device but I didn't see a finished note and you didn't order anything". You stand there trying not to boil over because of the mad chaos that ensued that day but has now calmed and they're looking at you like you are a complete waste of a brain. You'll feel completely exhausted because the tlso at the hospital didn't fit right because the technician didn't hear you out on what you wanted. At that moment you'll want to quit but you are still paying for your loans, car, apartment, etc on the 20k they are paying you. I think you get my point.
Yes, this has happened to me and variations of all different type of scenarios. If you work in a city that has very busy clinics, you will be interrupted daily but it will still be your responsibility to not forget ANYTHING, EVER...This situation happened a lot less 30-40 years ago because you weren't pushed to have your cell phone on you at all times and noting/dictation was barely existent. It's different now and a very different game for the new people coming in versus the people retiring. I worked in a place where the older men and women that couldn't figure out email or their phones for on-call work were allowed to slide by while the young people took hard hits if they didn't answer a text or phone call immediately. The one's in control of their time can stack those coming into the field with amounts of work that they simply cannot handle. When you have time to do things, you won't need it. When you need time to do things, you won't have even a minute to spare. Yes, this comes with all professions, but I want to warn you about how it can happen in O&P.
I was wondering when a O and P professional was going to see and reply to my post..
