Time in the Plaster Room

Time in the Plaster Room

Karen Steele

12/22/2000

Dear List �

While I don�t necessarily agree with Stan�s tone, I certainly agree with the
main point of his message.

The O&P profession is schizophrenic right now. On the one hand I hear, �We
want to be clinicians, not technicians.� I hear, �We want to be recognized
like other professionals.� I hear, �We are increasing our educational
standards.� On the other hand I hear Jim Rogers, CPO, say, ��don't slam my
colleagues or my profession until you've worn my shoes for a while and yes,
put your time in the plaster room.�

I�m the mechanical engineer that Stan talked about in one of his previous
posts. I made it through the NWU orthotics program, completed the clinical
hours required to get my certificate, looked for a residency program for
about 4 months, and threw in the towel after I got offered $21K/year.

I am a PE (that�s a Professional Engineer for those of you who are
uninformed). I took one test (an 8 hour written exam covering all the
engineering fundamentals) when I finished my 4+ year (160 semester hour)
engineering degree. After successfully passing that test, I was granted the
title of �Engineer-in-training.� Then, after 5 years of engineering
experience under the supervision of three other PEs who were each willing to
write a letter of reference for me, I was eligible to sit for the PE
license. That was another intense 8 hour exam, covering several specialty
areas like thermodynamics, heat transfer, dynamics, material science, power
generation� I also have a Master�s degree in engineering.

Northwestern cost me $11,500. Room and board at Northwestern cost me
another $5000 or so. Throw in a couple thousand for transportation and
books and a hockey game in Chicago and we�re up to $18,500. I didn�t work
for those 6 months, so I lost wages that amounted to over $30K (check the
average going rate for an ME with 10+ years of experience�. It�s over
$60K/year). For another 3 months, I earned about $30K/year, so if you look
at what I could have been earning vice what I did earn, I made -$7,500. I
spent another 4 months looking for a job, but I was working part-time as an
engineer, so my lost income was only � of 1/3 of a year�s worth of income,
or $5000. All told, my one year attempt at entering the world of orthotics
cost me $61,000.

It was after this investment that I got offered $21K for the �privilege� of
completing a one-year residency. Net earnings for that year, had I taken
it, would have been minus $40K, if you look at what I could have earned as
an engineer vice what I would have earned. Not to mention the fact that I
figured out that if I lived in the cheapest housing I could find and my car
didn�t break down (it was 10 years old with 150,000 miles on it� fat
chance!) I needed at least $25K to break even�. I would have been at least
$5K-$6K further in debt by the end of my residency. To add insult to injury,
when I started looking around for an apartment in the area of the residency,
I quickly discovered that my income qualified me for government subsidy
housing.

The certificate in orthotics and the residency would have cost me over
$100,000 counting lost wages. Not counting lost wages, it would have cost
me $30,000�

My experiences as a patient in the orthotic world mirror Stan�s in the
prosthetic world. I have had one practitioner refuse to treat me. He had
his secretary tell me, �Your case is too difficult. He�d prefer that you
keep your business with *john doe.*� *john doe�s* shop is 100 miles from
where I live�. But he�s my orthotist now. Yep, I drive 100 miles when my
KAFO breaks beyond what I can manage to repair myself at home. I had
another orthotist make me an AFO with my foot pronated and everted. I told
him that the AFO didn�t feel right when I walked on it. Rather than
re-casting my foot so that it was in neutral, he put an extrinsic wedge on
the medial side of the bottom of the heel of the AFO�. This was before I
became educated� Now I�d strongly suggest to the guy that he recast me, and
refuse delivery of the ill-fitting AFO�.. I have had a CPO refuse to
replace a strap on an AFO because I didn�t have a current prescription�.

Jim Rogers, CPO, said, �We need passionate persons with vision and
dedication to our mission. If you're not that person, fine.�

If anyone understands the need for attention to detail when casting for and
fabricating someone�s orthosis, it�s me. I am in intimate contact with
orthoses pretty much every waking minute of my life (well, when I�m not
swimming or lying down�.). I know what happens when an orthosis is
fabricated from an impression that is taken with the leg in a non-ideal
position. If anyone understands the need to repair an orthosis quickly to
allow someone to get on with the business of living their lives, it�s me.
As an orthotics wearer, I look forward to trips to my orthotist�s office
almost as much as I look forward to going to the dentist or getting a
mammogram. It�s one of those things that I have to do, but trust me, I�d
rather be anywhere else. I have a life that is totally independent of, yet
very dependent on, my orthoses. To a patient, orthotics is a means to an
end, not an end in itself.

As it stands now, the residency program caters to insiders � people who have
spent time in an O&P facility as technicians, or who have spent time
practicing orthotics or prosthetics without certification, and who choose to
make a career move and get the training necessary to become a licensed
practitioner. There seems to be little recognition inside the field for
expertise that is gained outside the field. My 6 years of university-level
engineering education and 12+ years of engineering experience made little
difference when I was attempting to find a residency. In fact, a few
classmates of mine at NWU looked at my resume� and suggested I �dumb it
down.� At their suggestion, I condensed 12 years of engineering into 3
lines of text.

When I was interviewing for the residency position that I turned down, I
asked the guy who was interviewing me, �What do you see me bringing to your
residency program?� The guy, who would have been in charge of my residency,
told me, �It�s going to be a challenge for us to not modify our residency
program in order to adapt to your disability.� What he saw when he looked
at me was my disability! The very people who have the job, no � the
PRIVILEGE - of participating in someone�s life by providing them with a
piece of hardware that makes it easier for them to physically participate in
the world have the hardest time seeing beyond the disability and seeing the
ability.

As long as there are people in the O&P profession like John Rogers, CPO, who
insist that everyone has to, �put their time in the plaster room,� the
profession will continue to be schizophrenic and divided. To me, an
outsider, that attitude tells me that O&Pers aren�t willing to consider that
maybe there are some people somewhere who might have some insights into O&P,
even though they aren�t practitioners. Most of the progress in the
development of orthotics componentry and in off-the-shelf orthoses is being
done by manufacturers, NOT clinicians. I would bet that the majority of
these manufacturer�s R&D staff are professionals � scientists and engineers,
not Orthotists or prosthetists.

I�m don�t consider myself a quitter, but I withdrew from my attempt to enter
the orthotics profession. I was worn out emotionally. I was broke. I was
being rejected at every turn. I walked into my engineering supervisor�s
office and asked him if I could have my old job back. He told me he�d
gladly take me back. It was comfortable. I didn�t have to struggle for
acceptance or to make ends meet. I�m glad to be back.

I tried to switch careers. I worked hard at it for over two years, if you
count the year that I spent taking classes on weekends at the local
community college in order to satisfy the prerequisites for the certificate
program. I have learned a lot and I�ve made a few friends on the way. I�m
in a position where I can repair most minor problems that I have with my
orthoses, so I�m less dependent on my orthotist who is a 2-hour, one way
trip from where I live.

� <Email Address Redacted> � had a post today where he suggested that it might be a
good idea for the O&P profession to align themselves with PTs, and become a
specialty of that profession. I think that�s a good idea. In fact, I�d
broaden the suggestion to include multiple paths to become a certified
professional in O&P. Right now, from what I can tell, there are three ways:
   1) be grandfathered in based on past experience; 2) get a bachelor�s
degree in anything, work as a technician or a fitter for a year or two in an
orthotics facility, attend one of the certificate programs, complete a
residency and take an exam; 3) get a bachelor�s degree in O&P, complete a
residency and take an exam.

Ed Neumann published an article in the December 1, 2000 issue of O&P
Business News that discussed creating a masters degree in O&P (see
<URL Redacted>) . I know that Georgia
Tech is attempting to start a master�s program. It seems that the
profession is moving towards a more academic, clinical type of practice.
Might I suggest that this move will contribute to creating a more
specialized type of practice, where a well-trained, registered technician
does most of the fabricating and modifying and the clinician spends his time
with patients?

Hopefully this move might open up the another way for practitioners to enter
the profession. Right now there's no real way for a person like myself to
make a mid-career shift without a huge sacrifice. The only route open to me
is path #2. That path doesn't recognize my past experience. Not only do I
bring my experience as an engineering professional to the table, I also
offer 12 years of experience in the working world where I learned how to
get things done. I know how to work in an organization. I can work
effectively with people from different walks of life, from technicians and
file clerks to CEOs of corporations. I have a good work ethic, and I am
confident in my ability, but at the same time I am experienced enough to
know that I do my best work when I am part of a team and I listen to the
other players on the team. I'm not smart enough to understand every aspect
of the problems I encounter. They don't teach these skills in college. You
learn them through experience. People who make mid-career moves could add
lots to the profession...

Just thought I�d add another nickel�s worth.

Sincerely,
Karen Steele, MSME, PE

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