J. Warren Perry, Ph.D. *
Barbara R. Friz, M.S. *
For several years, reports from various parts of the country have indicated the existence of a manpower shortage in the fields of prosthetics and orthotics. These reports have stemmed primarily from facility owners and physicians endeavoring to provide quality prosthetic and orthotic services for their patients. This paper reports the results of a survey which was conducted for the purpose of shedding some light on the nature and magnitude of this problem and, in turn, contributing to efforts directed toward its solution.
The survey was proposed and conducted by the Subcommittee on Special Educational Projects in Prosthetics and Orthotics, Committee on Prosthetic-Orthotic Education, whose membership includes representation from the American Orthotic and Prosthetic Association; The American Board for Certification, AOPA; the University Council on Prosthetic-Orthotic Education; the Rehabilitation Services Administration, Social Rehabilitation Service; and the Prosthetic and Sensory Aids Service of the Veterans Administration. The Subcommittee was established in June 1967 to supplement the work of other interested agencies and organizations in developing definitive training and long-term educational programs in the fields of prosthetics and orthotics.
At the first meeting of the Subcommittee the members agreed that, before a program of purposeful activities could be launched, it would be necessary to examine various aspects of the manpower situation in prosthetics and orthotics, to include scope and intensity of shortages, profiles of personnel currently working in these fields, salary ranges, and demand for graduates of existing educational programs in prosthetics and orthotics. A manpower survey was therefore proposed.
Thirty prosthetists and orthotists participated in a pilot study conducted for the primary purpose of evaluating the effectiveness of an initial survey form as a data collection tool. The pilot study experience led to an extensive revision of the form and the incorporation of explanatory material to serve as a basis for more accurately completing a section on employment of graduates. This material consisted of carefully formulated descriptive profiles of graduates of the various educational and training programs in prosthetics and orthotics.
For the purpose of this study, five personnel categories were defined and appeared in the survey form as follows:
- A Prosthetist-Orthotist is skilled in all facets of fabrication, fitting and alignment of prosthetic and orthotic devices; deals with patient; usually certified in both prosthetics and orthotics or qualified to apply for certification in both.
- A Prosthetist is skilled in all facets of fabrication, fitting and alignment of prosthetic devices; deals with patient; usually certified or qualified to apply for certification.
- A Prosthetic Technician performs benchwork only; does not fit or align prosthetic devices; serves as support person for the prosthetist.
- An Orthotist is skilled in all facets of fabrication, fitting and alignment of orthotic devices; deals with patient; usually certified or qualified to apply for certification.
- An Orthotic Technician performs benchwork only; does not fit or align orthotic devices; serves as support person for orthotist.
The revised survey forms were distributed in early July, 1968, and again to non-respondees about a month later. The last completed forms were returned to the CPOE office January 31, 1969. Data were analyzed according to personnel categories and, geographically, according to the eleven regions designated by the American Orthotic and Prosthetic Association. (Appendix A)
Participants And Subjects
Representatives of 203 facilities, institutions and military installations completed the survey forms. A total of 1,374 persons, representing seven categories related to prosthetics and orthotics, were entered in the study. (Table 1 and Table 2)
Data related to corsetieres and shoe specialists will be considered in a separate study. This report is concerned with the remaining five categories of personnel, totaling 1,163, as shown in Table 3. It is interesting to note that, excluding the prosthetist-orthotists, the number reported for the various categories are relatively close.
The incidence of females reported is low—one prosthetist, seven prosthetic technicians, three orthotists, and six orthotic technicians.
Among the three groups who qualify for certification, the prosthetist-orthotists show the highest percentage of certifees (74.8%) and the orthotists the lowest (51.9%). (Table 4)
All categories reflect current and future shortages of manpower (Table 5 and Fig. 1 ). According to the findings in this study, and based on the reported number of currently employed, the groups reflecting the greatest manpower shortage at this time are the orthotic technicians (28.6% ) and prosthetic technicians (27%).
In one year from the time of the survey, the estimates identify the same two groups as requiring the highest percentage increase of personnel, with prosthetic technicians requiring a 53.7% increase and orthotic technicians a 50.7% increase.
In five years it is estimated that the need for prosthetic technicians will be more than double (113.3%) the number currently employed, and that the need for orthotic technicians will be almost double (97.7%). Estimates for personnel requirements for the other three groups also indicate the need for substantial personnel increases in five years.
The estimated personnel needs for all groups average 23% now, 45.7% in one year, and 87.6% in five years.
Personnel Needs by Regions
The pattern of personnel requirements for different categories in the eleven AOPA regions is, for the most part, diffuse and ill-defined. (Table 6, Table 7, Table 8, Table 9-Table 10) After breaking down the total number of personnel into categories and then into regions, the remaining sample is reduced to a relatively small number. Within the limits of this sample, however, the most urgent regional demands for personnel appear as follows:
Prosthetist-Orthotist (Table 6)
Regions V, VI, and VII reflect the greatest over-all demand for personnel in this category, although Region IV reports a somewhat greater current shortage than Region VII.
Prosthetists (Table 7 )
Current personnel requirements for prosthetists appear to be most acute in Regions XI and IV, in that order. In five years, Region IV projects the highest percentage needed increase, followed by Regions V, XI and IX.
Prosthetic Technicians (Table 8)
Regions I and VIII reflect the greatest current shortage in this category. Region IV reflects the greatest future demand, followed by Regions VIII and V.
Region II reports a significantly greater current shortage than any other region. Regions I and V follow, but at a considerably lower level. Region II also reports the largest future demand for orthotists, followed by Regions I and VI.
Orthotic Technicians (Table 10)
Regions V, VII and II report the greatest current shortages. Regions XI and V reflect the greatest demand for this category in the five-year projection.
It is interesting to note the approximate 1:1 ratios in this study. This is characteristic of the ratio of prosthetist to orthotists currently employed and is further reflected in the projected personnel requirements for these two groups. (The ratio of prosthetist-orthotists to prosthetists is approximately 1:2 at the time of the survey and remains the same for estimated future needs. Similarly, the ratio of prosthetist-orthotists to orthotists is consistently 1:2.)
Of greater significance and interest at this time is the ratio of prosthetists to prosthetic technicians and orthotists to orthotic technicians (Tables XI and XII). Here again, an approximate 1:1 ratio is characteristic of the numbers currently employed. Estimates for future needs show some weighting toward the technicians' side, but do not approach the 1:3 or 4 ratio that is sometimes quoted as desirable.
Upon further examination, it appears that these ratios are reversed in some geographical locations, especially in the western regions. In Region X the prosthetist: prosthetic-technician ratio shows a marked weighting toward the prosthetist' side. This is not found in the orthotist: orthotic technician analysis in this region. The reason for the reversal perhaps may be attributed to the inclusion in this area of a large research laboratory where prosthetic technicians are not employed.
Years In The Field
Slightly over half (53.8%) of the prosthetist-orthotists reported in this study have 10-29 years' experience in their field. The group with 0-9 years' experience is only two-thirds as large as the group with 10-19 years' experience, and less than half as large as the group with 20-29 years' experience. (Fig. 2)
Sixty-five percent of the prosthetists and 68% of the orthotists in this study have 10-29 years' experience. In both groups, the number of personnel with 10-19 years' experience approximates the number with 20-29 years' experience. These last two groups are approximately one-third larger than the group with 0-9 years' experience.
Conversely, the number of prosthetic technicians and orthotic technicians with 0-9 years' experience constitutes well over half the total number of technicians in their respective groups. (Fig. 3 ) A sharp drop appears in the groups having more than 0-4 years' experience. (It is possible that further investigation would reveal this drop coming even earlier.) The number of years in the field for orthotic technicians showed the same type of distribution as that for prosthetic technicians.
The educational levels of various groups are shown in Table XII. Excluded in this computation are those persons whose "highest level" was indicated as "intern," "certificate," and "other." Since these often referred to courses which were taken in foreign countries, or were not clearly identifiable, it was decided to include only those levels that indicated completion of recognized school levels and degree courses.
Recommendations For Education
The recommended levels of education are reflected in Table 14 and are much higher than current levels.
Salaries By Educational Level
In attempting to correlate salaries with educational level, it is difficult to see a consistent pattern, except that in certain areas a higher educational level appears to conform with higher salaries. For example, in four of the five groups of personnel, there was a higher incidence of above-high-school-level personnel with higher salaries than the median salary for their specific group. This is shown in Table 15.
Table 16 is a composite of the various groups showing median age, median salary, years in field and average education.
Demand For Graduates Of Degree Courses
The final section of the survey form represented an effort to find out how many graduates of the various prosthetic-orthotic educational programs would be employed and the level of salary they might expect.
The number of graduates whom facility owners proposed to employ was unrealistic in that it exceeded the number required as stated in Section I of the survey form. Some respondees explained that they did not have a choice of one graduate over perhaps two or three others, and therefore entered all possibilities. As a consequence, the figures have been distorted in terms of actual need.
The proposed salaries show an extremely wide range, but for the most part, reflect a gradual increase commensurate with an ascending level of education. (Table 17 )
The magnitude of the manpower shortage in the fields of prosthetics and orthotics, although undoubtedly more acute in some localities, is. generally speaking, comparable to that in other health fields. The situation has spurred intensive efforts on the part of the various health fields to recruit young qualified individuals to their particular field. Perhaps the manpower needs as projected in this study will underscore the necessity of much greater recruiting efforts on the part of those in the fields of prosthetics and orthotics.
Results of data analysis pose several questions. For example, what implications may be drawn from the projected prosthetist-prosthetic technician ratio of approximately 1:1? And the same ratio for orthotist-orthotic technicians? This finding is in contradiction to the well-circulated belief that there should be three or four technicians for every professional person. Does this imply that the industry feels a greater urgency for more professional people than for technicians? Does it point to a comparatively lesser need for technical personnel, perhaps because of an anticipated increase in the use of prefabricated components? Or is it an expression of status quo, inasmuch as the 1:1 ratio is characteristic of the current ratio of prosthetists to prosthetic technicians and orthotists to orthotic technicians?
What is the reason for the short time that technicians remain in the field as reflected in the relatively small size of those groups with more than four years' experience? How much of this may be attributed to upward movement of personnel to the professional level? How will the trend toward higher standards of education affect this group? Is it realistic to try to keep these technicians for a longer period of time? If so, how might this be accomplished?
These are the kinds of questions which, if answered, might provide a clearer perspective in trying to develop long-range plans for educational and clinical programs in the prosthetic-orthotic field.
Two hundred and one survey forms were completed on 1,374 personnel in the fields of prosthetics and orthotics. Reported here are data related to 1,163 persons currently employed in five categories: prosthetics-orthotics, prosthetics, orthotics, prosthetic technicians and orthotic technicians. Current manpower shortages and estimated future manpower needs are also reported.
* * *
Members who have served on the Subcommittee on Special Educational Projects in Prosthetics and Orthotics, CPOE, are:
Dr. J. Warren Perry, Chairman
Dr. Jack D. Armold
Mr. William M. Bernstock
Dr. Sidney Fishman
Mr. McCarthy Hanger
Dr. Alfred E. Kritter
Mr. George H. Lambert
Mrs. Florence Knowles
Mr. Alvin Muilenburg
Dr. Herbert E. Pedersen, ex officio
Mr. Herbert Warburton
* Use of the terms "now," "current," etc., in this discussion denotes time of survey rather than time of this report.