Staying Relevant: How Are Pedorthists Blazing Their Professional Trail?
November 2012 Issue
O&P professionals are facing new challenges that may color and re-direct the future of their respective professions. The pedorthic profession in particular faces its own set of unique challenges in terms of building awareness and credibility, not to mention succeeding in a marketplace that is demanding an increasingly diverse skill set. While a number of key issues and questions remain, pedorthic professionals have taken some concrete steps to solidify their position as an integral member of the OP&P allied healthcare team. The pedorthic experts interviewed for this article agree, though, that there is more work to be done, and they provided some additional strategies to help raise awareness about the benefits of quality pedorthic care and the stature of the certified pedorthist credential.
One of the biggest issues facing today's pedorthist is one of awareness. Much of the general public has very little idea what pedorthists do, says Dennis Janisse, CPed, president and CEO of National Pedorthic Services, headquartered in Milwaukee, Wisconsin; director of scientific affairs for Orthofeet, Northvale, New Jersey; and past president of the Pedorthic Footcare Association (PFA).
"The problem in public perception is that pedorthics is regarded as 'just foot orthotics'—when it is much more, especially with regard to care of the diabetic foot," Janisse says.
Although patients can find items on the pedorthic menu of services through other outlets, pedorthists provide the only "one-stop-service" destination for shoe fitting and foot care for traumatic injury, deformity, diabetes, and more.
Awareness about the pedorthic profession is also an issue among physicians. "Physicians aren't trained in who we are," Janisse adds. "Only podiatry and ankle-foot surgery specialists know what pedorthics is or what pedorthists do, and they admit that their training doesn't provide the kind of in-depth knowledge that pedorthics has and utilizes."
It's up to individual pedorthists to promote their profession, not just themselves as individual providers, he says. The best way to start is to educate the public and essential referral sources regarding what the profession can do for them and their patients. "Then," Janisse says, "we can promote ourselves as individual professionals; otherwise, it's more or less wasted effort."
He advises pedorthists to get involved and be vocal in protecting and promoting the profession, advocating for pedorthists to join professional organizations—even if that means they are the only pedorthist on board.
Séamus Kennedy, CPed, president and co-owner of Hersco Ortho Labs, New York, New York, agrees that people outside of O&P and pedorthics don't really understand what a pedorthist is or what they do and that the responsibility for raising awareness within their marketplace falls to the individual practitioners.
"It's up to the pedorthist to educate potential referral sources, and that means calling on the physicians personally, holding inservices in hospitals and in doctor's groups—and in my mind, presenting your real-life case studies," he says. "No matter how good you are, if you don't promote your value and your worth, then it's very hard for you to be successful."
The hidden gems of the pedorthic profession, Kennedy points out, are the far-reaching benefits it can achieve with custom shoes and foot orthotics, changing and relieving other parts of the body indirectly impacted by the feet: the lower leg, knee, hip, back, and beyond. "The potential is tremendous, but we have to individually explain that and tell the story."
Outcomes results can help raise awareness while making the pedorthist's case. Janisse points to a Center for Disease Control and Prevention (CDC) study that reported a recent decline in amputations corresponding to Medicare's funding for diabetic shoes. "The study recognized that since the introduction of the Therapeutic Shoe Bill and its provision for preventive care, amputations are down 65 percent."
Perhaps pedorthists will be able to integrate themselves into the team approach to healthcare through that personal contact and awareness building, an approach Jerry Wilson, MEd, CPed, education specialist at Pro- Learn, Tulsa, Oklahoma, also recommends. "Pedorthists need to continue to forge forward to be recognized as part of the total team approach to footcare, a team that includes the attending physician, the orthotist, the physical therapist—everybody who is treating the diabetic patient."
Chris Robinson, MBA, CPO, ATC, FAAOP, assistant professor of physical medicine and rehabilitation, and assistant director of orthotics education at the Northwestern University Prosthetics-Orthotics Center (NUPOC), Chicago, Illinois, says that the collaborative model is better for the patient because it provides them with comprehensive prosthetic-orthotic and pedorthic care. "If I give a patient an AFO, but I don't have the right shoe to work with the AFO, I have the wrong AFO-footwear combination and it doesn't work as well. I think that every P&O practice should have a good CPed; they're a real asset."
Wilson also believes that the need for greater awareness and public education extends to Congress, where the immense savings possible through preventive pedorthic care would be welcome news. "This country is spending over $90 billion a year for just diabetes alone—including $75,000 for foot amputation surgeries and another $10,000 for artificial limbs, at a cost of way over $100,000 per patient," Wilson observes. "If they would turn to pedorthists to prevent foot amputation...it would save this country billions of dollars!"
Robinson agrees. "To be honest...I think a lot of my prosthetic clients wouldn't be my prosthetic clients if they actually had [a] pedorthist intervene in the first place! In terms of the treatment model, I think that pedorthists could be incredibly invaluable— but the most important thing is that they need to define their areas of knowledge, expertise, and strength because there's such a huge market for it. Unfortunately a lot of these patients and the public are not aware that the guy giving them the shoes...doesn't have anywhere near the ability or knowledge that a certified pedorthist has to offer."
While the pedorthic profession continues to face its share of awareness-related challenges, Kristi Hayes, CPed, immediate past president of PFA, says she has seen a shift in perception and awareness over the last decade. "More than ten years ago, the [pedorthic] profession was treated as just shoe salesmen, but that perception has changed among many referral sources as more information has spread about the profession."
Wilson's assessment is similar. "What we need in this country is more clinical pedorthists," he says. "It's a matter of all of us continuing to market the profession of pedorthics because I would say that consumer awareness only started rising in the last ten years." He estimates the awareness level at only about 20-25 percent of all the people with foot problems.
He continues, "Because we have over 25 million diabetics in the United States, and [the number is] growing every year, if you really serve that total market of just diabetes, and not other foot injuries and foot diseases and arthritis and more, I think this country could use 100,000 pedorthists. I think that would be a realistic figure—that's the demand for the discipline."
Awareness through Education
Hayes says that the new education requirements for those seeking to become certified pedorthists "should help to bring more awareness and professionalism to the profession."
Effective January 1, 2013, a four- to six-month program of study will replace the current two- to four-week training course as the minimum pedorthic education requirement. Education programs must be housed within or sponsored by "a postsecondary academic institution accredited by an institutional accrediting agency that is recognized by the U.S. Department of Education, and must be authorized under applicable law or other acceptable authority to provide a post-secondary program, which awards a minimum of a certificate at the completion of the program," according to Standards and Guidelines for the Accreditation of Educational Programs in Pedorthics, published by the National Commission on Orthotic and Prosthetic Education (NCOPE) in 2011.
"Interestingly, pedorthics is thriving around the world due to a better and higher educational system and, in fact, pedorthists who live in other countries make more money than most here in the U.S.," Hayes continues. "Many equate higher education with higher value in any profession; I have to agree. If a physician or referral source has a choice between a credentialed pedorthist with a three-week education or one with a year or more, who do you think they will tend to trust more?"
There are drawbacks to the new pedorthic education requirements, however. Wilson worries that pedorthists may have trouble finding time to earn the degree. "I recognize the need to elevate the prestige of the profession, but at the same time, I think it may decrease the supply of pedorthists because most are already working part time or full time. They may be able to get away for a couple of weeks, but some of the education standards are going to require them to get away for a lot longer."
He also wonders how many students will choose to invest in a full-time pedorthic program. "A beginning student...is going to see nursing, therapy, orthotics, prosthetics, and other allied health programs they can choose from—so pedorthics is going to be competing for those students with other fields—many of which pay better. A registered nurse can make an average of $80,000, for example. So if I'm a student looking for a career, that's something I'm going to consider."
Building Business Acumen
Another tough choice pedorthists face is whether to join an O&P practice that helps protect, promote, and share skills and mutual support—or to fly solo as an independent entrepreneur.
"There's an allure to being independent," Janisse says. "However, in the current environment, and also in the specific market that you're in, it may be better to have a larger perspective or a larger practice, so if you can partner with an O&P facility—if you can be part of a hospital group or part of a doctor's group— you might find that it's easier to get consistent referrals and a broader patient base coming through your doors. So, while independence is to be valued, it may not always be the easiest path."
According to Hayes, the last PFA survey revealed that approximately 70 percent of pedorthists responding were sole proprietors, and most of the rest were employees of those, while the percentage of O&P practices that included pedorthists was small. "The ratio of storefront type versus clinical type operations was very close. Approximately 55 percent were in clinical settings with the rest in retail or other settings. The survey we had done before that was the opposite—more retail than clinical."
Hayes finds that "the skill pedorthists require most is business acumen, that is, how to market referral sources, how to keep a proper inventory, how to handle billing and sign up with third-party payers, how to deal with insurance companies, marketing to the public, things of that nature.
"As a practitioner, business owner, and consultant for 20 years, I've seen this over and over again," she continues. "Nine times out of ten, if a practitioner has a good educational foundation in pedorthics, the area they are deficient in is business basics. Likewise, you can be a great businessman but if your pedorthic skills can't back up the amount of referrals you drive in, it does you no good. There has to be a balance of education and continuing education to keep any practitioner in any field not just afloat, but successful."
Indeed, a dearth in the availability of continuing education resources for certified pedorthists has been worrisome, but those concerns have been somewhat allayed by the American Board for Certification in Orthotics & Prosthetics (ABC)- Board for Certification in Pedorthics (BCP) merger in 2007, Janisse believes, which stimulated the American Orthotic & Prosthetic Association (AOPA) and the American Academy of Orthotists and Prosthetists (the Academy) to bring more pedorthic education into their meetings.
"The American Academy of Orthotists and Prosthetists' online learning center also has and is constantly adding new courses," Robinson adds, "including one that I'm personally teaching, called Dermatologic and Wound Care Management of the Prosthetic and Orthotic Patient."
Wilson, whose ProLearn facility addresses the problem of helping pedorthists become better businesspeople by including a segment focused on practice management skills in the curriculum, agrees that being a successful businessperson is an essential skill set that a lot of good pedorthists are forced to learn on the job. He encourages his students to go further, taking additional business classes at local community colleges. "Obviously there needs to be continued education, professional education to help the practicing pedorthist become more of a businessperson and manager, a leader, a visionary, a marketer—all those kinds of skill sets it takes to be a successful businessperson. And that takes away from their clinical time. So they find themselves needing multiple skill sets very quickly."
Robinson says that the collaborative model—pedorthists working as part of a full-service OP&P practice—can furnish the pedorthist with a solution to their personal business-skills shortfall. "In all the big P&O private practices, there are probably about 15 practitioners and one of them is a CPO who happens to be a helluva businessman—and that's why they do well," he says.
For today's pedorthic professional, blazing a professional trail and solidifying a position as an integral member of the allied healthcare team means that current and aspiring pedorthists must be nimble. "People want things to stay the same," Kennedy observes. "They want to know the rules, and then go about their business within that framework. I hear constantly frustrations that things are changing—that it is not like it used to be. If the rules stayed the same for a little while, we could figure out the best way to deal with patients, insurance companies, Medicare, etc., but as rules keep changing, people get overwhelmed and frustrated. I think that's what wears them out; they just can't believe there's another change. But we have to understand that change is the only constant.... Be flexible, adapt to the incessant change, and above all, be positive.
Kennedy advises pedorthists to take the path of least resistance and make it work for them. "Partner with an O&P if there's a steady referral source or stream of patients there. Contact podiatric physicians' groups. Affiliate yourself with a hospital." He looks back and reflects that constantly adapting their product line, changing the way they do business, and expanding their offerings is what has kept Hersco relevant and successfully growing over his 17 years in business.
"It's tough out there, and it's tough everywhere," Hayes says. "The practitioners that continue to thrive and grow, however, have the knowledge and the expertise to back up their claims of what they can really do. Referral sources and consumers go back to who and what they can trust, and trust is earned over a long period of proving yourself. For those who honestly have the gift of expertise and knowledge, follow the rules, and are consistently good, there is no competition, and the marketplace isn't very tough to navigate."
Robinson concurs. "The most important thing that pedorthists can do is reaffirm their additional training and knowledge above and beyond the lower-level credentials that a lot of individuals are pursuing in terms of therapeutic shoe fitters and fitters of orthoses. Certified pedorthists have a pretty decent working knowledge base, but I think they need to make sure they capitalize on and articulate it to other healthcare providers and referral sources."
Judith Philipps Otto is a freelance writer who has assisted with marketing and public relations for various clients in the O&P profession. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.