Developing a Master’s of Science in Prosthetics and Orthotics to Tackle the New and Ever-Changing Healthcare Environment

This month’s guest blogger, W. Lee Childers PhD MSPO CP from the Department of Prosthetics and Orthotics at Alabama State University, writes about the challenge of establishing a Master’s program in P&O.

Today’s healthcare environment is more comprehensive, complex and dynamic than ever before.  We are treating more complicated patients with ever tightening budgets. Third-party payers are forsaking for evidence demonstrating prosthetic and orthotic treatment effectiveness. No longer is our practice domain a “simple limb or brace maker” but is instead that of allied health care professional, multi-disciplinary team member and patient manager. Treatment technologies (much like our profession as a whole) are evolving rapidly. Take prosthetic foot technology, for example; we had the SACH foot for a very long time, then the advent of the Carbon Copy 2® and Flexfoot© brought with it a rapid growth in design.  Now most prosthetic feet (even some K2 feet) are made of a carbon composite and we are experiencing another shift toward microprocessor control. Therefore, P&O practice and professional education, much like technology, must evolve to meet the needs of this complex and dynamic healthcare environment.

Studying only the fundamental concepts and fabrication processes of P&O will not prepare future practitioners for today’s (much less tomorrow’s) healthcare environment. Practitioners entering our profession need the skills to document their patient encounters; understand how to manage a practice, provide measurable outcomes to third-party payers to justify prosthetic and orthotic care, use and understand P&O research to combat RAC audits, generate a larger body of knowledge to pro-actively demonstrate “comparable effectiveness” (one of many new buzz words in the Affordable Care Act), understand our patients’ complex pathologies, understand how to manage and assist patients throughout their care, integrate and collaborate with other rehabilitation professionals (PT, OT, rehab counseling, etc.), utilize the plethora of different technologies to optimize care, and actually fabricate these devices. The list goes on and on….

Take a minute to think of all the changes you’ve experienced in your long career. Now think about learning enough of that to enter the profession as a resident and contend with the healthcare landscape.

Healthcare delivery is changing, therefore, we must change practitioner education to best prepare them to contend with these changes. Moving the profession toward a Master’s of science in Prosthetics and Orthotics enables educational institutions flexibility to offer courses beyond fabrication and traditional P&O designs to include courses on documentation, practice management, interdisciplinary collaboration across the healthcare team, psychosocial aspects of disability, understanding and interpreting research, and advanced technologies. Universities offering this necessary coursework will enable development of true prosthetists/orthotists; serving our patients and enabling them the best care. A Master’s program enables our profession to embrace its rich history while preparing for its future.

Starting a new Master’s level P&O program is anything but easy. P&O education is unlike any other type of master’s education. It is a professional education incorporating many facets, e.g. fabrication experience, textbook, labs, patient models, and clinical exposure. P&O education is extraordinarily expensive to maintain. As you see your material costs go up, so do the material costs for educators.  Except, the student projects are not delivered, i.e. material costs are not recuperated.  They are fabricated, fitted, and then, hopefully, recycled. A P&O school needs additional space, i.e. additional capital expense, to house a fabrication lab. Our program at Alabama State University (ASU) just finished renovation of an 8000 sqft fabrication facility and built a 1200 sqft biomechanics laboratory dedicated to P&O research. In fact, P&O program start up costs exceed several million dollars before one student starts paying tuition.

Master’s level students now come from a wide range of backgrounds and, although this ultimately benefits the profession, educating these diverse skillsets in a consistent manner poses a challenge. Yet this inevitably provides an opportunity to better integrate future practitioners into the current healthcare environment. The MSPO program at ASU facilitates this by integrating the students with its other programs in PT, OT, rehabilitation counseling, and health information management to offer a more complete instructional spectrum consistent with the needs of today’s healthcare. This interdisciplinary approach enables additional instruction while allowing the P&O faculty to focus on developing student fabrication and clinical skills. In summary, the advancement toward a Master’s of Science degree will elevate and enable our profession to meet the dynamics of today’s healthcare environment while staying true to our heritage of hand fabrication.

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