In The News

State Licensure: Joining the Ranks of the O&P Community

By Joe Sansone

In last issue's commentary (O&P Business News, June 1 2003, pages 22-23), I recounted my elation upon learning that, as an eager young sales representative my job duties would entail measuring and fitting patients for custom orthoses. Fitting knee orthoses later evolved into providing various other types of orthoses. By providing superior service, I was eventually able to steal away several large physician customers from competitive O&P facilities.

I typified the brace representative that practitioners love to hate. Does this synopsis sound familiar? A practitioner has been servicing a physician for years. He has never received a complaint from the physician and does his share of charity work when asked. Suddenly the prescriptions stop coming. Upon investigation, the practitioner discovers that a sales representative for a national orthotic company has stolen his largest account. Unencumbered by overhead (which sometimes includes no liability insurance), the sales representative has offered the physician something the practitioner did not. He goes to the patients' houses to measure for bracing, he takes the physician golfing or he provides bracing for a nominal fitting fee. He thinks of himself as an expert and a certified practitioner as overkill.

Armed with this mindset, I cursed unnecessary governmental imposition when I discovered that state licensure was looming and vowed never to succumb to the tyranny of others. I harkened to the phrase, "If you can't beat 'em, join 'em." Since could I no longer compete with the O&P community, I would join their ranks.

I realized that there was more to patient care than just accepting prescriptions and determining the quickest and easiest way to get an orthosis on a patient.

If looming legislation would force me to hire licensed professionals and maintain licensed facilities, I would do what was mandated. As I saw it, the alternative of bowing to this new legislation and discontinuing the provision of bracing was not an option. This choice would cost my company a significant portion of its revenue.

Unique Practitioner

I began networking in the O&P community and initiated a search for a practitioner that was different from those I had met previously. It would indeed take a unique practitioner to "turn his back" on the norm of the industry and joint forces with a sales representative and his sales force. I soon found the right man - a promising practitioner who had begun his career years ago in the fabrication department of an O&P facility and had since become an orthotist/craftsman. This person had become disenchanted with standard O&P providers in our market and was looking for a change. He was searching for something different - an opportunity to get involved in something new and the chance to control his own destiny.

I then decided to move forward and open an O&P facility. I was determined to approach this new project without assistance from anyone in the industry, other than my lone practitioner. I embarked upon this venture looking at the O&P market from a unique perspective and not from what I viewed as a typical O&P perspective. I chose to build on the attributes that had been developed in our company's previous O&P marketing experience. I stressed what had become the key to our success the provision of an unsurpassed level of service.

Conducting Business

Just four months after making the decision to enter into the O&P industry, our orthopedic distributorship opened its first location. My company conducted business differently than every other known O&P business. Our name was different, our location was different, and our office looked different. We would sink or swim based on my own naïve assertions of what the market wanted. With the help of an additional orthotist, we would let the market determine our success.

Then, much to my surprise an interesting thing began to happen. I started learning. I realized that there was more to patient care than just accepting prescriptions and determining the quickest and easiest way to get an orthosis on a patient. I began to see that the care we had provided in the past, although adequate, was simply not up to par with that offered by a certified and experienced practitioner.

Unstoppable Force

After nine years of fitting and allowing my sales representatives to fit orthotic devices, I became so convinced of the advantages of using licensed practitioners that within a few months (still before state licensure had become law), I forbade any of my sales representatives from providing orthoses. By following the requirements of state licensure, I found the key to our newfound success. My sales representatives would give unsurpassed customer service and competent licensed professionals would treat our patients. Commingling the two would make my company's orthotic aspirations an unstoppable force.

After nine years of fitting and allowing my sales representatives to fit orthotic devices, I become so convinced of the advantages of using licensed practitioners that within a few months (still before state licensure had become law), I forbade any of my sales representatives from providing orthoses.

Using strategies from the past and accept the superiority of practitioners, this new venture thrived as we grew from one location to five in less than a year. Our company was soon to be named one of the 100 fastest growing businesses in the city for an unprecedented third time. The culmination was our company being named on the Inc. 500 as one of the 500 fastest growing privately held businesses in the United States.

Success and Licensure

Our level of success would not have been achieved had it not been for the onset of the threat of state licensure. Because of state licensure, I was forced to become a "legitimate" O&P facility with licensed practitioners. State licensure became the impetus for developing a bulletproof business plan. State licensure's once greatest opponent has now become one of its major proponents.

I now realize the obvious need to restrict the provision of orthotics and prosthetics and the need for licensure requirements for individuals who provide these products and services. I also voice the unpopular opinion that state licensure requirements seem to be far too restrictive in some instances. In my opinion, while state licensure is definitely necessary, to some extent it is onerous and has been taken to the extreme on occasion. But given the alternative of no licensure requirements, I remain one of the state licensure's most supportive fans.

Joe Sansone is chief executive officer of TMC Orthopedic.