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Josh - Prosthetist
42 Plays1 month ago
Sometimes we are born into a situation that seems bleak but as we move thru life, it becomes our greatest strength. When Josh was very young, he had to have his foot amputated and now, he helps create prosthetics for other folks that need them. Josh has a unique insight into what the end user experiences and he can cater his approach. In this interview, we talk about the design process, the fitment, the materials typically used, how prosthetic devices work, as well as the cutting edge advancements in Prosthetics. Of course, like we always do on the jobs podcast, we dive into the details of pay, education needed and what makes a successful prosthetist. This was really a unique dive into a topic most of us know very little about. SO if you want to get into this line or work, or you just want to learn something new, this is the episode you do not want to miss.
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Transcript
Introduction to the Jobs Podcast and Guest Josh
00:00:00
Speaker
Hey folks, you're listening to the jobs podcast. I'm your host, Tim Hendricks and today's guest. His name is Josh. He has a very interesting career helping people and he is a prosthetist.
00:00:11
Speaker
ah Hey Josh, how you doing? I am well. Thanks for having me on Tim. That's a, It's been treat listening to your interviews you've done, and um I'm excited to be a part of this.
00:00:22
Speaker
Oh, well, thanks. I appreciate that. So let's go ahead and and get right to it like we always do.
Josh's Early Life and Inspiration for Career
00:00:27
Speaker
Go ahead and tell us where you were born, a little bit about your upbringing, and we'll just go from there. Yeah. Well, I was born in Oregon, actually, but I don't have many memories. i was about two whenever my parents moved to Tulsa, Oklahoma, and that's where I grew up.
00:00:45
Speaker
My brothers and I were pretty blessed to grow up in a pretty stable environment. Yeah, same childhood home. My parents are pastors there in Oklahoma, still pastor in the same church they moved to back when I was two years old.
00:01:01
Speaker
And um yeah, it's it's been fun and life has kind of taken me little bit farther away, but ended up on my way back here in Texas. So not too far away from home. Great state of Texas. they're They're proud of their state I've picked up.
00:01:18
Speaker
So, yeah. So were there any early influences? the Your line of work is such a unique one. And i don't know if most folks typically kind of find themselves in that line of work or you want to basically, for anybody listening, explain what your line of work actually is and and what you do before we get going any further.
00:01:40
Speaker
Yeah, yeah. So um my official job title is a prosthetist. I'm an individual. I'm a practitioner for a company, and we provide prosthetic legs ah primarily. I'm certified to do arms and even on some orthotic side, which we'll get into little bit later. But um the essence of my job is in the simplest way is I fit and make prosthetic legs for people that have amputations in their lower extremities.
00:02:11
Speaker
Hmm. What was it that drew you to that career? How did you find yourself going to school to learn how to do this? Yeah. Yeah. I, um, you know, actually am one of the rare, I guess you could say rare amputees, um, where having an amputation myself has actually enhanced my career.
00:02:34
Speaker
i knew from a very young age, um, that like I was probably 14 years old whenever I knew this is what I want to do. And it was a result of being an amputee myself. I grew up with a birth deformity that there were several procedures that tried to save the foot. But by the time I was about two, two and a half years old, they went ahead and amputated and portion of my right lower limb and had a prosthesis ever since. So exposed to it at a young age and and knew pretty soon that this is what I want to do.
00:03:12
Speaker
What types of early, i guess, experiences did you have with prosthetic devices to where you thought this is the kind, you said at 14, you wanted to get into this.
00:03:25
Speaker
What was kind of the catalyst besides having that? Was it just ah wanting to help others or wanting to better your your personal situation or both? Well, yeah, I mean, it definitely was was both. I mean, I'd be lying if I said, you know, I didn't have, you know, ah probably a vested personal interest in that.
00:03:45
Speaker
But, I mean, i would say the biggest influencing factor for me was um growing up, my prosthetists in the children's hospital were also amputees. And so um for me, as a patient, I just felt incredibly connected um with them. I felt like they knew what they were Not necessarily they what were doing because of that, but they they knew what I was going through because they also had an amputation. And so went through like a couple, I don't know, maybe a year or two ah between like 14 and later on whenever I actually went ahead and did it where I questioned and was like, is this really what I want to do? But at the end of the day, I always knew this is this is what I want to do. And a lot of that was because of the influence that those prosthetists had on me as ah as an amputee and practitioner.
00:04:35
Speaker
Are there classes in high school that you can take to kind of prepare yourself for this? Or do you really ah kind of hit the ground from square one when you start college?
Educational Path and Career Specialization
00:04:45
Speaker
Yeah, I mean, so formal classes, no, not really. i mean, there might be, but I've i've never heard of them.
00:04:52
Speaker
um You're going to have your um high school classes that have, you know, your science, tech, engineering based or geared towards that, then the student could kind of lean into that. um I've got a high school student that I'm actually working with now. And she's in one of those science and technology classes that gives her the freedom to kind of choose what kind of career she want to lean into. And so she reached out to us and I've been able to kind of in afternoon hours after her school, show her what we do, but it's not through a formal classroom setting by any means.
00:05:37
Speaker
I would assume that anatomy is a probably a pretty common ah core class that everybody would have to take, correct? Oh, yeah, absolutely. So, well, like, ah I guess I'd say this, the education requirements to um to become a prostitutist have changed quite a bit, even in the past 20, 30 years from kind of more of an apprenticeship um approach to, you know, needing a bachelor's degree and then an apprenticeship as well. And now it's a master's degree.
00:06:10
Speaker
But to answer your question, yeah, yeah, it's you got to have your your bachelor's degree that has quite a few prerequisites in order to get into the master's degree and anatomy and physiology are at the top of that list for sure.
00:06:26
Speaker
are there specific schools in the United States since that's where we're located that are the kind of the meccas that you go to for this line of work or do most universities have a program for your career?
00:06:40
Speaker
Yeah. Um, so the, the current, you know, um, paths that is overwhelmingly the most common, um, is you get your bachelor's degree and it can really be,
00:06:54
Speaker
um For the most part, it can really be in whatever you want to study, but it has to require or meet the prerequisite requirements from the graduate schools. so um Typically, for an individual who's wanting to get into prosthetics, they're going to do a bachelor's degree in and mechanical engineering is probably the most common. There's a lot of kinesiology, pre-physical therapy,
00:07:20
Speaker
um some biology, that kind of majors will satisfy the prereqs for the graduate studies. um I've got a friend of mine who actually Her bachelor's degree was in art and she was a sculptor and and and did that for a while and then kind of came into prosthetics and had to go back to school to satisfy those prerequisites. But the undergraduate is really pretty pretty open. it's that It's that master's degree that is pretty specified.
00:07:53
Speaker
You had said at the beginning that you, your company can kind of do everything, but you primarily focus on the lower extremities. Do folks typically pick an area of specialization or do you come out of your education being able to do everything and then you pick a...
00:08:13
Speaker
you know i I can assume that if someone needed and a lower arm that they would want to focus on that or hands or something. how How does the specialization kind of play out?
00:08:24
Speaker
Yeah, yeah. So it's similar to kind what you alluded to there. um So prosthetics is actually really just about half the side of the industry of um ah what I'm mean It's really prosthetics and orthotics. So the orthotics side is going to be your custom bracing.
00:08:42
Speaker
Not always custom em bracing, but typically it's going to be those custom molded braces for an individual that um may have a condition, um whether it was a stroke or a neuropathic condition where they obviously have their, their limbs, but they don't function the same way, um, that they're intended to. And so there's, there's the bracing side and then there's the prosthetic side, which is for individuals that don't have, um, their arms or or legs.
00:09:12
Speaker
And so the master's degree really equips, um, individuals to come out of the program fully certified or ready to take their board exams to become certified in both orthotics and prosthetics.
00:09:28
Speaker
I would say, and don't quote me on this, but I think I heard last year that 95% of individuals that graduate from their master's degree get certified in both prosthetics and orthotics. So typically it's it's pretty common to hear CPO, certified prosthetist orthotist,
00:09:48
Speaker
But after that, you can kind of see um some areas of specialization. um You can have folks that work in a hospital setting that um mostly do some those custom of bracing. you can have folks that do prosthetic only.
00:10:06
Speaker
There's scoliosis is another pretty large part of the industry for um custom back braces. um And then, yeah, you'll see you'll see different settings and then different companies specialize in different things. There's also like cranial remolding helmets for ah for little babies that have some flat spots on their head that need to be rounded out. And so there's quite a few different areas for for specialization.
00:10:31
Speaker
Upper extremity is definitely one of them as well, upper extremity prosthetics. But for me, it was being a lower extremity amputee. It's what I was exposed to for my whole life and even before I got into graduate school. um Yeah, I knew that that was really where where my heart was at what I wanted to be doing. And so I didn't spend a ton of time doing the orthotics side. I did go through the certification, or I didn't get certified in orthotics, but I did get through the the education requirements. So I'm eligible for the orthotics side, but that's just not something that I've really pursued.
00:11:09
Speaker
the tests that you had mentioned a minute ago that folks have to take, is that just a written exam or is there a practical portion to
Prosthetic Technology and Innovations
00:11:17
Speaker
it? Oh, I wish it was just a written exam.
00:11:20
Speaker
It's yeah, it's actually, I think they're working on making it smaller. Um, in fact, I know they are, I don't know how, um, where they're at in that process, but, but basically as it stands now, um,
00:11:37
Speaker
After your... right, so i just I'll just kind of ring you through the whole timeline, and maybe this is long-winded answer of a simple question, but you get your undergraduate degree, then you go and get your master's degree. The master's degree is in orthotics and prosthetics. There's about 12 to 13 schools across the U.S. that offer that degree.
00:11:58
Speaker
After the degree of master's, then you get your residency. um The residency is about a year and a half long. on average, sometimes more and sometimes less.
00:12:10
Speaker
And then after you finish your residency, then what you are referred to as a board eligible practitioner. And so as it stands now, there's separate board exams for prosthetics and orthotics.
00:12:24
Speaker
So there's the there's a combined written exam, which is about 200 questions long, Um, you take that like a local testing facility. There's a computer of simulation exam for prosthetics and a computer simulation exam for orthotics where it's like, I don't know, seven or eight scenarios, patient scenarios, and you have to work through the treatment plan and, and how you would treat this patient, what you would do with certain clinical results.
00:12:53
Speaker
And then there's also the separate, um, clinical practice management prosthetic exam and clinical practice management orthotic exam. And these exams are about four hours long each. And you have to fly to Tampa Bay, Florida to take those.
00:13:11
Speaker
So in total, you're looking at five. grief. Yeah, it's it's kind of insane. That's why, like, for me, I just did the prosthetic ones. And I'm eligible to do the orthotic ones, but I don't practice orthotics. I'm um frankly not very good at it.
00:13:24
Speaker
um And being a patient myself, I i wouldn't want... ah to go to a practitioner that's fitting me for something that they're not familiar with. So that's kind of been ah an influencing factor why I haven't done it. But then, yeah, you look at the five total exams and you're like, okay, I'm going to try and shave off as much of that as I can.
00:13:44
Speaker
but I don't blame you one bit. Yeah. yeah mean So as somebody who I don't have any exposure to prosthetics, the devices themselves,
00:13:58
Speaker
for someone like me who just wants, I'm just curious about what, like your, if someone has lost their leg from the knee down, what types of materials are you using in today's,
00:14:11
Speaker
ah your field? Is it carbon fiber? Is it stainless steel, titanium? What, what makes up the bulk of the actual materials that make the devices?
00:14:23
Speaker
Yeah. Yeah. So, um, um I think the problem easiest way of answering that is to kind of break apart the components of the prosthesis. And and just the simplest way, you have the socket, which is the portion of the prosthesis that the residual limb actually goes down into.
00:14:43
Speaker
And this is custom fit, and it's ah it's a pretty involved process. Yeah. um The residual limbs fit down into that, and then the socket is connected to the foot in a below the knee um example, like you're saying. And so the socket is typically comprised of, and it kind depends on on, it depends on the design if patients have, you know, a certain fabric or logo or something that they want to have on there. But typically it's going to be a carbon fiber.
00:15:12
Speaker
or fiberglass weave that is impregnated with an acrylic resin under vacuum. And that is the that's the socket.
00:15:23
Speaker
And then there's an attachment plate that's laminated in there as well that will give you the structural integrity to connect the socket to the foot. And that's typically...
00:15:35
Speaker
um aluminum, titanium, or stainless steel, kind depending on the weight of the components and the weight of the individual. So the you know if the individual has higher weight, you have to use a little bit heavier metals, but the objective is to always keep the weight of the prosthesis as low as possible.
00:15:51
Speaker
And then obviously the foot is comprised of few different options. There's a glass composite and that we see quite a bit. There's also carbon fiber is probably the most common for prosthetic feet.
00:16:05
Speaker
um There's some softer foam type feet for individuals that may not need quite as much spring, for lack of better words, but those are your typical ah materials that we're working with.
00:16:21
Speaker
How does the fluidity as far as the the natural gait that you would have how is that replicated in a prosthetic device? Is it a, are there springs to return it back or how, how does that kind of play out in mechanics? Yeah.
00:16:38
Speaker
Yeah. It's, it's definitely, um, come a long ways, um, over the years when you think back to, you know, the, the old wooden legs and ways that, that this field once was, um, a lot more research and science has gone in into,
00:16:55
Speaker
um the exact type of carbon layups that are needed to provide the energy return the patient, as well as different types of feet. So um now you see a lot more common hydraulic ankles that can have that natural tibial progression, which is just a ah way of describing that smooth gait pattern to where you're not seeing this kind step two gait um or that hyperextension at the knee that we can see. But ah yeah, I would say it's it's a really fine-tuned process of getting that dynamic alignment dialed in to where you can have um an individual who, you know, at times can wear pants and you couldn't tell which leg was was the prosthesis and which one wasn't because it is so smooth.
00:17:45
Speaker
And then you have other individuals that aren't able to quite get to that point. And a lot of it has to do with underlying ah strength and balance. um There's just so many factors that influence gait.
00:17:58
Speaker
And so it's, you know, it's my job just to control as much as I can control and make this um prosthesis as um as optimal as we can in alignment. But I would add to it as well, you know you also have a constant conflict, like with everything in life between comfort and stability.
00:18:18
Speaker
And so that's also a consideration as well. Whenever you have something that is very giving, ah typically does not provide the stability that you need. So that's a consideration that we have to have to keep in mind whenever we're designing these from an alignment and and performance standpoint as well.
00:18:38
Speaker
When someone comes in and they get fit and and you take the measurements and and decide about the materials that you're going to use, then I'm assuming you start building it and then in the future they come back and they try it on for the first time.
00:18:55
Speaker
what What is that experience like? And then how long does it typically take? And I know that there may be no typical timeframe, but how long does it typically take for someone when they first have ah a prosthetic device for the first time to get used to just normal activities.
00:19:16
Speaker
Yeah. Yeah. Well, um I mean, to answer the back end of that question, I know it's a, it's a bailout answer, but it really does depend. Um, I know it's like, I can't stand it whenever you like, you know, a little more specific, but it really does depend because I've got, I've got patients and the same patients that have, um, been an amputee and walked out of the door with no walker cane on their first day, they got their leg.
00:19:43
Speaker
That's incredibly rare, but it happens. And then, um Other times it takes weeks and even months to to really go from that progression. Typically, ah new amputee is going to start just walking in parallel bars or with a walker um and then gradually...
00:19:59
Speaker
start to um regain some of that strength and balance. And then eventually, um you know, depending on the patient's goals, ah progress to a cane and at times just jump straight to, okay, I'm just going to do this. And it's scary. It's intimidating.
00:20:17
Speaker
um But every patient kind of approaches that differently. And It also kind of depends on this patient setting too. You know, um company is mostly mobile prosthetics. I'd say like 75% of the patients that I see, I'm actually going to their home or their doctor's office or their work or their physical therapy or, Oh, you name it. So yeah, I, I, I would say that depending on the patient setting, if they're like in a nursing home, for example, uh, that may be a prosthesis that they really only wear, you know, whenever they're doing their therapy sessions.
00:20:53
Speaker
Um, but then i also may have patient who's in their thirties and is on their feet 16 hours a day. And so, uh, they don't have time to, to, you know, gradually progress, they' they're, they're going to get going.
00:21:06
Speaker
Um, so it just kind of depends on each patient. ah Just out of curiosity, how you see people that are in the Olympics or they're running and they have those specific prosthetic devices. I think they've, they're calling blades. Is that kind of the slang term for them?
00:21:22
Speaker
Yeah. Um, how do those, how do those stay attached to the leg? I don't, I don't understand the mechanics of that part. Yeah, yeah.
00:21:32
Speaker
Well, it depends on the level of the amputation for starters. So if it was an amputation that's above the knee, typically it's the same um concept as the way we would attach a normal prosthetic knee.
00:21:46
Speaker
So I described earlier that kind of lamination ah step in the making of the socket. At the bottom of the socket, there's ah an attachment plate that is laminated into the socket, and that is pretty universally um adopted throughout all different component manufacturers.
00:22:07
Speaker
So you can attach a knee to that portion at the bottom of the socket relatively easily. um And then the knee, if it's a running leg in this example, would perform quite differently than a traditional,
00:22:24
Speaker
um just walking knee, for lack of better words. And then the foot, that blade portion is then connected to the knee. Typically, depends on the height of the individual and the clearance that we have to work with, just meaning the space between the bottom of that knee and the floor.
00:22:41
Speaker
But there's typically what we refer to as a tube clamp and a pylon system that's connected to some adapters, male and female adapters.
00:22:52
Speaker
So it's pretty modular system and that allows us to make it as tall or short. um And then, and then if it's leaning or or anything like that, that's kind of where the alignment comes in.
00:23:03
Speaker
I would say for a below the knee running leg, um There's two of the primary and really two of the only ways that I'm familiar with on it on fabricating a running leg for a below-thin amputee. You're going to have either a distal um attachment, which is the same principle as um your traditional prosthesis, where that running blade um comes out throughout the back but then comes back underneath the bottom of the socket.
00:23:33
Speaker
um That's pretty common. But for your high, high Paralympic runners, you're typically going to see ah that running blade attached on the back end of the socket, referred to as a posterior mount or posterior attachment.
00:23:51
Speaker
And the fabrication for that can be pretty tricky, but it simulates the calf muscle quite a bit better than distal attachment plate. And so...
00:24:02
Speaker
and that's why That's why you see that used most of the time in those high performance, um like Olympics and whatnot.
00:24:12
Speaker
You had mentioned a little bit ago that the ankle movement, I believe, was hydraulic in nature. and is there Is there any, and this is kind of a bit of a rabbit hole as far as the futuristic side of things, are we anywhere near electronics and batteries and movements as far as, ah you know, I remember seeing Star Trek where Luke had a prosthetic hand and, you know, he could move his fingers and things. Are we, you know, it seems like the future is is getting closer and closer, but is that stuff kind of on the fringe working its way in or is that still science fiction?
00:24:48
Speaker
Yeah, yeah, no, it absolutely is already working its way in. um so I would say that um ah for the ankle, um we see very common hydraulic ankles are used, not always, kind of depending, again, on the ah goals and the needs and the strength of that individual. Yeah.
00:25:12
Speaker
There's nothing too crazy fancy about the hydraulic ankle aside from the ability to manually adjust the resistance settings. Um, but there's no electronic components to it.
00:25:25
Speaker
They're the next step up from that. As far as the ankle is concerned is a microprocessor ankle. Um, and these are, they're, uh, approved through Medicare.
00:25:36
Speaker
Um, so, We do see that they're used. There's a little bit of other concerns you have to consider whenever doing microprocessor ankles.
00:25:48
Speaker
The weight of that can be pretty ah pretty extreme compared to a conventional foot and ankle system. um but But they're approved and they work really well for the right individuals.
00:26:02
Speaker
And then I would say knees are, microprocessor knees are incredibly common, um even for um lower activity individuals um can be approved for microprocessor knees.
00:26:17
Speaker
um Or you can just have a traditional mechanical knee as well. So that's pretty common. I would say that for like the Star Trek that you're referring to,
00:26:29
Speaker
when you go into upper i now When you go to upper extremity, um the electronics change from a control standpoint. um So you don't necessarily refer to an upper extremity arm that's electronic as as microprocessor. It's more myoelectric is the common terminology. Just basically, um if I were to like oversimplify this,
00:26:58
Speaker
The way you control a microprocessor foot or knee is going to be dependent on ground and every force is an equal and opposite force to it. So when you're standing, how does that ground um push back on the knee? And that can be controlled through that alignment.
00:27:18
Speaker
When you go into upper extremity, you're controlling that more through um the muscle tissue. that is remaining in the residual limb.
00:27:28
Speaker
So you'll see electrodes that are implanted inside the sockets of the arms. And whenever the individual has a ah you know a muscle belly that they can still actively fire and move, they can trigger that electrode within the socket to control that hand ah or elbow um or both to position the way that they desire ah is probably the simplest way of of putting it.
00:27:57
Speaker
Wow. Man, that's crazy. Yeah. That's neat though. It's really come a long ways. Yeah. How are, this is a, I feel silly asking this. How are these powered?
00:28:10
Speaker
ah Yeah. Is there bat batteries or what? Yeah. Yeah. That's pretty much it. Battery powered. um Battery lives have come a long ways. I actually. ah Oh yeah.
00:28:21
Speaker
I couldn't believe it, but I was in a, uh, in a CEU course last year, and there was this knee that had come out um that had a ah truly unheard of battery life of up to 15 days, which is... Good grief. I don't know that I'd put it to the test for that, but it definitely was ah way more than, you know, a few hours at a time.
00:28:44
Speaker
um But common practice is just charge it like you charge your phone overnight. If you skip a night, you're probably going to fine. i Skip two nights. ah You may be pushing it, but it's it's the same process as you charge your phone or anything else.
00:29:03
Speaker
Does it have a default mode where if you happen to lose power and you're out and about, does it then just perform like ah hydraulic or does it stop working altogether? Yeah, it depends on the manufacturer, right? So so kind of back to like the um the job i don't know description.
00:29:22
Speaker
As a practitioner, my job is to evaluate and treat the individual um to fit and fabricate the socket portion, but I don't make the knees or the feet...
00:29:35
Speaker
um Those are from companies typically over in in Europe or are the most common, but there's several companies in the US and and really just kind of all over the world but that manufacture ah the feet and the knees. And so it's my job to pretty much ah be very knowledgeable of what is out there, what works, what doesn't work, what's indicated for certain patients.
00:30:00
Speaker
um And so every manufacturer is going to manage manufacture their their feet and ankles differently. But the pretty common trend is if it like loses its battery, ah that it just goes into stiff mode.
00:30:14
Speaker
So you can still walk on it. It's not going to be comfortable. so i'm going to simulate any kind of normal gait pattern. But it's right it's like a donut tire. you know You're going to go 50 miles an hour on the max and and get home as soon as you can kind of thing.
00:30:31
Speaker
What an example. Yeah. i mean, maybe it's oversimplifying it, but that's really that's really the best way I know how to put it. Sure. Did you have to to just kind of shift gears when you were in early in your career and you were learning, I know that you have firsthand experience and and you were just kind of headed down that path with a familiarity that some folks may not have.
00:30:55
Speaker
But did you have any mentors in your education or you had mentioned the folks at Children's Hospital that you had a good relationship with? But when you were learning, did you have anybody that you you kind of gravitated towards or that was exceptionally influential in your education process?
00:31:14
Speaker
Oh my goodness. Absolutely. And I, there's no way I would be where I'm at now if it wasn't for, for all the folks that, that somehow managed to put up with me in those early, early learning times.
00:31:29
Speaker
um I had the benefit of, so I went to Baylor college of medicine down at Houston for my master's program. And Baylor has a little bit of a unique ah model.
00:31:40
Speaker
They incorporate the residency portion into their curriculum. And so their model is is one. It's shared with one, maybe two other schools of the 13 where you go to the to the school.
00:31:58
Speaker
So I went down to Houston and I did my all my ah didactic classes, cadaver bio lab anatomy, all the prosthetic orthotic courses for a year. And then I went into residency.
00:32:13
Speaker
And what was unique about Baylor is I had the opportunity to travel pretty much all across the country um learning from different practitioners and seeing different types of clinics and hospital settings and small companies and large companies.
00:32:31
Speaker
And every place I went, i was in I was in Fort Worth, Texas. I was in um Columbia, South Carolina. i was in Salt Lake City, Utah.
00:32:42
Speaker
I spent some time in Kansas City, a little bit time in Arkansas, and then And then ended up here in Dallas. And every place I went, it was just an incredible learning opportunity.
00:32:56
Speaker
and And I had some insane mentors that really, really knew what they were doing and knew how to teach what they were doing at a very high level. um so ah there's just no doubt. i I would not have any idea with what I'm doing or or where I'm at if it weren't for for the folks that kind of helped me along the way.
00:33:17
Speaker
Is the residency program something that, is it a any kind of a paid internship or are you, is it part of the education where you just have to really plan ahead financially?
00:33:28
Speaker
Yeah. I mean, so in the traditional path, it is paid where you would go to your master's
Professional Experience and Career Insights
00:33:34
Speaker
degree, you take a year or two, sometimes like 30 months, I think was one of the longer ones, um,
00:33:42
Speaker
and you'd get your master's degree and graduate there, and then you'd get a residency for a really low salary, like, I don't know, $30,000 to $40,000 maybe, and that's ballparking. I really don't know it. I know it's it's enough to to basically barely make ends meet, um and so that's a traditional route. In Baylor, and our because they incorporate the residency into the curriculum, we didn't get paid,
00:34:10
Speaker
but we also graduated a lot faster because the didactic portion was only a year and the residency was a year and a half. So in total, you're looking at two and a half years.
00:34:22
Speaker
And I know it's like at first when I was looking, I was like, this doesn't make sense. Why would I go there? But when you, when you zoom out and look at the big timeline, it actually made a tremendous amount of sense because I would graduate and be board eligible sooner. And when you get board eligible, that's whenever you're seeing those,
00:34:40
Speaker
you know, a little bit more, uh, appropriate salaries and and compensations that, that makes sense. So yeah, with Baylor, I did not get paid.
00:34:54
Speaker
actually, I lived with, well, you, you talked about the city, but I was, I was in Kansas. Yeah. I know your grandma, she's, she's pretty awesome. So that's a, that's a, yeah.
00:35:05
Speaker
Um, What you, you mentioned pay. So let's go ahead and and touch on that. And I'm not asking you what you make, but what types of salaries? And I know it, you know, I always throw this clause as it depends kind of on where you live. If you live in California or New York, you know, you're going to make more, but it's probably going to cost more to live there. But what, what can someone ballpark expect to make when they're done with their education and they're first starting out in your line of work?
00:35:34
Speaker
Yeah, i would say, um to expect to make just on a general rule of thumb $70,000. There's companies that will offer less than that.
00:35:47
Speaker
There's companies that will offer a lot more than that. But I would encourage anybody that's going into the industry to not accept anything less than that.
00:35:56
Speaker
And then from there, it does depend on if you're doing orthotics and prosthetics, if you're just doing prosthetics, um what kind of company are you working for?
00:36:08
Speaker
ah the larger companies typically pay less than some of the smaller companies. um not always the case. I've i've heard large companies that that do pay quite a bit more, but the trend that I've noticed has been the opposite.
00:36:23
Speaker
um But yeah, you'll you'll see a salary range from anywhere between probably 70 and 100 is common for someone starting out.
00:36:34
Speaker
And then ah from there, You know, the unfortunate reality is from a ah billing, you know, and revenue perspective, the orthotics side um doesn't typically generate the revenue that ah correlates with the clinical demand to be an expert at that.
00:37:00
Speaker
It's really pretty unfortunate and frustrating, and it's something that is constant battle for us and in O&P, um prosthetics is typically the the area of the industry that generates a little bit more revenue not always the case you know depending on the referral source and the uh the streamline that you have a volume of that patient population but if you're working in a prosthetic only facility or primarily prosthetic facility you're going to see
00:37:31
Speaker
some of those higher salaries be more common than in a ah strictly orthotic setting, unfortunately. Okay. What types of soft skills, if someone wants to get into your line of work, what, is there a ah commonality that you see with the people that do well as far as their, their depth of the soft skills that, that they should have?
00:37:57
Speaker
Oh yeah. um Well, I think, there's the clinical skill that you know ultimately comes first. you know you You do, at some point pretty early on, have to be pretty good.
00:38:11
Speaker
And and i'm not being arrogant. i'm just You have to be good and you have to be consistent. um Because if the leg doesn't fit, it doesn't matter how nice of a person you are. you know it and If the patient's in pain, if they can't walk, um that then everything falls to that.
00:38:31
Speaker
And so that's a clinical skill that that has developed over time. But aside from that, I would say the ability to really um meet each individual patient like where they're at.
00:38:47
Speaker
ah We see this in like all of medicine. I'm sure you have, too, where. you kind of just go and you feel like a number and yeah no one really knows your name. And so with prosthetics being so specialized and being an area of medicine where, you know, the area that that you're treating is never going to heal.
00:39:10
Speaker
You know, it's unlike ah some other forms of medicine where the patient heals and you don't see them again. These are typically lifelong treatments. ah patients, relationships develop over that time. And so um that just soft-spoken people skill is is probably the most crucial um to just really meet that patient where they're at. And I would say, i would say, honestly, the biggest thing is like just being an attentive listener.
00:39:39
Speaker
um That's probably the biggest skill that that I think is underrated because a lot of times,
00:39:49
Speaker
There can be maybe redundant or long-winded stories or um kind of irrelevant information that's brought up in meetings that you just know clinically doesn't apply. And so natural inclination is to just tune it out.
00:40:05
Speaker
um But, I mean, patients see that. And I see that myself as a patient in in past ah clinical settings where patients I'm like, I can tell you, you're not even listening to me. And so um really, really being an attentive listener, um asking questions and, um and then also probably being able to explain what you're doing and why you're doing it is another huge, huge um skill to have.
00:40:34
Speaker
I do, I do incorporate in my practice a pretty huge collaborative approach. um And I think a lot of that's influenced as a patient myself where, It's pretty rare that I will recommend a prescription on a patient for a certain design, whether it's a foot or suspension or whatever it might be.
00:40:57
Speaker
Would I recommend that without telling them that this is what we're doing? um i would say that's incredibly rare. Almost every primary clinical decision that we make I want to make collaboratively with the patient.
00:41:11
Speaker
um And unfortunately, that's not done everywhere we go. it's It's common, but it's not as common as I wish it was. So it's definitely something that that I prioritize and really encourage anyone in the industry to make sure that but that's something we're we're doing.
00:41:30
Speaker
You mentioned something a minute ago that I always ask folks how they recommend or what's their their advice for dealing with failure. And when you have someone who comes in and they're they're trying something on or they've been wearing it for a short amount of time and it's uncomfortable or even it's even painful,
00:41:48
Speaker
Something needs to, I mean, this is a custom fit to that individual. And I can imagine and I can appreciate no one will be the same. So if someone comes in and it's just not progressing how you would like there, you can't seem to get it right or just failure in general, what's your approach and what's your advice for anyone coming up behind you that is going to enter your field?
00:42:16
Speaker
Oh, man. um Well, I mean, the cliche answer is, you know, learn from it and keep going. And I think that that's cliche because it's true. But I would probably focus on the first part of that um as a more common practice for me.
00:42:36
Speaker
ah learning from it um really, i think, is not something that is easy to just say say it and keep going, like analyze it, study it. um really really identify what what went wrong what was the cause for this failure don't blow it off don't under you know analyze it um but really have a concrete understanding of what it is that went wrong what are you doing differently to not have the same results um
00:43:10
Speaker
And then, yeah, you then incorporate that into the next patient and the next and know clinical application. But I would say the simplest way is just analyze, analyze, analyze, analyze what went wrong, study it and know um why why the results failed and what we can do differently is the biggest, biggest takeaway from that.
00:43:33
Speaker
You're always just fine tuning your customer service, your empathy, your approach, and just making it better. Even if it's minutely, you're just making it better every time you encounter a patient. ta Try to, try to.
00:43:46
Speaker
and What, uh, every job has things that they like and every job has things that they
Patient Care and Personal Satisfaction
00:43:53
Speaker
dislike. Um, what is it that you like most about your job?
00:43:57
Speaker
And then is there an aspect of your job that you wish you could do away with? Yeah, so I mean, what I like most about my job is probably what you would expect, just seeing the smile on someone's face, get up and walk again.
00:44:11
Speaker
ah Simple as that may sound. It's it's ah incredibly giving. You know, we put a lot of mental oxygen and and and resources and time and dedication into some of these ah devices that we're making and to see the results bear fruit is the biggest reward.
00:44:32
Speaker
um Selfishly, I'll admit it, but it is it is incredibly satisfying, not just for me, but just genuinely for the patient to see individuals, the tears running down their face saying, okay, there is life after amputation.
00:44:46
Speaker
Nothing beats that I would say the thing that I dislike the most, again, the cliche answer for anybody that works in any kind of medicine is going to be health insurance.
00:44:59
Speaker
But yeah full transparency, that's really not even what I dislike the most. What I what i really just hate with everything in me is the mental effect that I see amputation can have on an individual.
00:45:13
Speaker
you know I've spoken at a couple of different funerals. um for patients. And so kind of the relationships you build with these patients over time, seeing that um not turn out into the results that we, you know, intended is, you know, devastating, but it's the reality that we have to face.
00:45:34
Speaker
And, and I think that it's also, the more you're aware of it, the more you're going to consider those things, even if it's not even clinical relevance, but just like,
00:45:45
Speaker
scheduling. I mean, if I have a patient who I know is, is really, really depressed, um, I'm going to go out of my way. And if that means I have to stay after five o'clock or come in on a weekend or something, I'm going to do that every single time. If that means that they get their leg three days sooner, because, um, you know, that's just,
00:46:07
Speaker
there's There's sometimes nothing nothing to hold on to for some of these patients but that but that leg. And so I take that incredibly seriously. One of the things that folks may not realize is the human side, the empathetic side, the you're you're not a counselor per se, but you have to be there for people when when you're in your line of work.
00:46:29
Speaker
And it's something that maybe, I don't know if they prepare you for that. Like when I started in the fire service, You know, there wasn't much talked about as far as when you go and you're in somebody's home that their family member has passed away.
00:46:43
Speaker
How do you deal with that kind of a thing? You may not be prepared for it, but it's it helps a lot to be aware that this is what you can encounter. Yeah, I mean, it's definitely come a long ways. I think as with everything in this industry, i know that whenever I was down at Baylor, there was some health behavioral classes and some of those mental awareness um campaigns that we see kind of in, excuse me, like every industry really now, which is wonderful.
00:47:09
Speaker
And full transparency, I think a lot of it is just kind of learned. um It's a skill you have to develop, unfortunately, through practice. And i don't,
00:47:20
Speaker
typically it's pretty uncommon, you know, for me to to have an individual who, you know, has come to me on a death you know note, but You do have some pretty involved emotional and otherwise situations that you're kind of inserted into.
00:47:39
Speaker
And people look to you as, you know, I'm the guy that, you know, every now and then I know how to make a ah good leg. Right. But I don't know how to how to how to help someone cope.
00:47:53
Speaker
And so, yeah. And unfortunately, it's not. But but the reality is like, that's not something i like you can just use as an excuse. Like, I can't just sit here say, well, that's not my area. Let's transfer you over to someone else.
00:48:05
Speaker
You have to be able to develop. yeah You have to be empathetic. You have to be a people person who, again, back to that attended listening. I think like that's really the essence of where it all comes down to. um any kind of therapy or or emotional mental awareness ah classes or anything that's worth their salt. Like that's the first thing they're preaching is listening. And, and, you know, if you're the guy that's, you know, knows all the answers in the room and needs to, Oh, you do. Okay. Let me tell you how to do it Well, it's just a mouth breather in my opinion.
00:48:36
Speaker
And, uh, you know, you're not going to do it good. So it's just that listening that you just have to develop over time. Experience teaches you a lot. It does, yeah.
00:48:47
Speaker
So is there any other career, like when you were younger, did you have your eyes set? I know you kind of from an early age knew this is what you want to do, but was there something else that got your attention for a while that you thought you may take a different career path or something that if you could go back, you think would be something you would enjoy doing?
00:49:07
Speaker
Well, I definitely wouldn't do anything different. um that That much I do know. I love what I'm doing. I've spent too much time and money getting to where I'm at to ever even entertain the idea of doing anything different. Thankfully, and as and you know, i'm there's a handful of individuals, as with most industries, that they spend a lot of time and resources getting to where they want to be and then find that's not where they want to be. Thankfully, that wasn't the case for me. I ah love where I'm at, but if I were to do anything different, say just this field didn't
00:49:41
Speaker
you know, ever rev evolved into a career that I wanted to get into. i really don't know. i think I went through different phases. So, you know, I worked, I worked for Delta Airlines for like four years, four or five years in Oklahoma city before I went to grad school.
00:49:57
Speaker
And so there for a while, and it was just a couple of months. I kind of kicked the tires on, do I really want to go be broke for the next two and a half years or work my way up with a pretty massive corporation?
00:50:12
Speaker
But I knew that this is what I want to I think paramedic has also been something that probably on more realistic level has always been something that naturally have been gravitated towards as a plan B. But also don't, it's funny, I don't do super great with like blood and needles. So, and you probably would expect the opposite of like excessive limbs that have been cut off.
00:50:36
Speaker
But ah paramedics, you yeah have to be good with blood needles. And so I don't know how well I would have been in that field. and Might want to put a pin in that one. I think someone who spent a lot of time in the back of an ambulance in my line of work, it's definitely two things that you'll see a lot of is blood and needles. so Yeah, yeah.
00:50:56
Speaker
But... Well, I'm really glad that you're obviously passionate about what you do and and you you have the firsthand experience and it gives you, um i want to say a leg up, but that I don't really mean that look quite like that. But um you know what I'm saying? that you have You have an advantage.
00:51:15
Speaker
Apologies to anybody out there if that offended you, but ah you have an advantage where you know where these people are coming from and it's that kind of um ability to bridge that gap when when someone comes in looking for your help.
00:51:30
Speaker
You just have that extra touch that you can give them. and And I can see the trust. ah It would be, you have valid you're valid, you're authentic right from the very beginning.
00:51:41
Speaker
And you obviously know what you're doing and you're passionate about it. So you're the type of person that needs to be doing exactly what you're doing. So I commend you for for your hard work and your education and everything getting here. Well, I appreciate that, Tim. I would add a little bit to that. Just because you tear your ACL doesn't make you a physical therapist or just because you have a heart surgery doesn't mean you're heart surgeon.
00:52:05
Speaker
And like I said at the beginning of this thing, you know I recognize that I am one of the very, very few amputees in the population at large that having an amputation has in many ways enhanced my career.
00:52:22
Speaker
um And I know that that's just not the case for for most folks. And so and incredibly passionate about it, but also incredibly self-aware of there can be, um i think, an urge for individuals like myself who have an amputation and they're also a practitioner kind of rely on that um experience a little bit more. And they kind of need to make that known kind of thing.
00:52:48
Speaker
And that's just amazing. you know really pretty sad because what you're doing is you're taking the attention off the patient and putting it on yourself. And yeah I've got a handful of times where, I mean, i would say 50% of the appointments or patients that I work with, I don't even tell them that I'm an APT. don't even pull my pant legs up from in scrubs or something. and And then I've got another, i mean, half patients that they love it. And we talk about the struggles and and what to expect and different things. And, you know, some patients, they like golfing or something like that, that I'm into. And so, you know, hey, this is how I do it, you know.
00:53:24
Speaker
And so it's just kind of a, it's a delicate balance of how much you talk about it. um But typically, i let the patient lead that conversation. I really try and refrain from trying to bring that up and tell a patient, well, I'm an amputee, so I know what talking about. sound like a real mouth breather, is all I can call No, I can see what you're talking about. that Yeah, it depends on the patient for sure.
00:53:53
Speaker
Hey, yeah thanks a lot, Josh, for letting me pick your brain today and and learning all about your education, your career.
Conclusion and Farewell
00:54:00
Speaker
um This was something that i I knew very little about, and I think that you represented your your company and your career very well.
00:54:08
Speaker
So thanks for taking the time. Well, thank you, Tim. I really appreciate it.
00:54:14
Speaker
And that wraps up another episode of the Jobs Podcast. Thank you so much for joining me today. Hopefully you found that interesting. As always, I wait until the end of an interview to ask you to like, subscribe, and share.
00:54:25
Speaker
I feel it's important that I earn that support from you. Thanks again, and we will see you on the next one.