When Arlene Gillis finished college in 1994, she was the only woman in the whole country that year who earned a prosthetics and orthotics degree. In the generation since, women have joined the profession in droves—by 2014, they made up about 20 percent of registered practitioners, and the proportion has continued to grow. Many of today’s O&P degree programs enroll more women than men, often to a lopsided degree. Within another generation, the clinician population may be close to a 50-50 split between women and men.
What, if anything, does this trend mean for the future of limb care? We’ll be exploring that question in the September print issue of Amplitude, which comes out in nine days. That article includes some essential input from Gillis, who now sits on the board of the American Orthotic and Prosthetic Association (AOPA) and operates her own O&P school, the International Institute of Orthotics and Prosthetics.
As always happens in a print article, space constraints only permitted us to share a portion of Gillis’s comments. To put her thoughts into broader context, and to preview the article, we decided to share a bigger chunk of our interview, which took place earlier this year, just as the academic year was wrapping up. This Q+A has been edited for clarity and length.
Trace the arc of this curve for me. We went from 1994, where there’s one woman in the entire country graduating with an O&P degree, to today, where women make up roughly what percentage of O&P students?
I can tell you that in my own classrooms, over the years since 2005, I’ve seen it change from basically 80/20 male students to the inverse. Right now I have a class of 29. And there are five men.
Do you feel that’s reflective of the national population of O&P students?
I believe that all schools are seeing a higher intake of women, and I attribute that to a couple of things. There was a report not too long ago indicating that men are are less likely to pursue the higher degrees. The percentage is dropping off, and more of them are going into the workforce at the baccalaureate level. But we’ve been at the masters level since 2012 to become a practitioner. Another change I see is the overall growth of allied health professions. When I went to school, people usually came into O&P because they had a relative or a personal connection that made them very passionate about limb care, and that’s why they pursued it. Now more people are finding it at the undergrad level as a career opportunity.
This demographic shift has already occurred in medical schools and other parts of the healthcare work force, and there have been some measurable impacts in the way healthcare is practiced. Do you feel there has been a qualitative difference in how limb-care is practiced as more women have moved into the profession?
I want to be very careful in answering that. I don’t want to say any of this is true in 100 percent of cases. But yes, I believe that women, in general, think and problem-solve differently from men. Women are traditionally caregivers, and we approach prosthetic care in that way. We might approach it more empathetically and with a different sort of thought process. And I think the limb-loss community will benefit from having more women in O&P, because we bring different perspectives to patient care.
Female patients specifically are benefiting from having more female practitioners, because casting is a very intimate process. So that there’s not that uncomfortableness for palpation. Female practitioners can relate to those issues, and they have more understanding of some of those sensitive issues. They are more comfortable addressing those things.
Studies have shown that in other areas of healthcare, women clinicians tend to have a more holistic view. They’re more likely to place health issues in the context of mental health, social support, diet, nutrition, those sorts of factors. Do you feel women are bringing that approach into limb care?
Absolutely. I can say—again, with the caveat that this is in a general sense, not that this is true for all men or all women—women have more of a tendency to look at the big picture. Even the students in my program, when they’re doing a patient evaluation, the women take a more holistic look at the information. They’re asking different questions than the men usually do, and as I say this is not all the time. They’re more likely to go beyond the biomechanical issues and ask about whether medications, might be having an effect. If you’re experiencing some weight gain, could that be related to your medications? Or a thyroid problem? I also think women are less hesitant to talk about mental health than men.
Do you feel that as women gain influence, both numerically and in terms of experience and stature, they will change the standards of practice for both men and women?
I think the more that women are successful, the more everyone will take note. All practitioners are very keen to see successful outcomes, so if there’s a process that’s working, there is a definite tendency to mirror that. Another fact is that women are in now leadership positions, and that’s having an entirely different effect.
Who are some of the women in leadership who you think our readers should know about?
Deanna Fish is one. When I was coming out, she was doing all of Hanger’s educational training. She was cutting-edge, and she had her own systems and research presentations. So she’s great. [Fish has served on the advisory board for Amplitude‘s partner publication, The O&P Edge.] Liz Hillen, who’s one of my graduates, is now running education and training programs for SPS. Angela Courtade is one of the regional directors of prosthetics for the VA. There’s a lot of talk right now within the VA about women receiving prosthetic care from other women, and Angela is very knowledgeable about that.
Are there specific improvements in limb care that you feel like women are particularly well suited to push forward?
The biggest thing is that the women may cause more collaboration. Historically, O&P has been very competitive. People haven’t always shared their thoughts and their ideas, because they don’t want their competition to know everything they’re doing. And I think the more women we pump into the field, the more we’re going to start to collaborate and unite the thoughts of people who can move us to the next frontier. I would expect to see more mentorship of young practitioners. That’s already happening among women—women supporting women, and mentoring them as they come into the field.
I also think there’s going to be more collaboration with other healthcare professionals and a more holistic approach to patient care. There has always been a separation [between O&P and other health specialties]. Another thing that might change is the way we interact with insurance companies. Healthcare providers don’t communicate well with insurance companies to explain our patient’s needs. I think women can have an impact on that telling the story better. If a claim for one of my patients comes back denied, I’m picking up the phone and explaining, “Look, here’s why we coded it this way. Who do I need to talk to?” I’m not settling for the frontline answer. I’m saying, “Get me to a decision-maker who can understand the nuances and override whatever the written policy is.”
It’s also having a tremendous impact on the workforce, now that more women are in leadership positions. Because now you’ve got more thought about the needs of a woman practitioner. There is more openness to flexible schedules now, so people can work 30 hours a week and leave the office in time to pick up kids from school at three o’clock. There’s more thoughtfulness about accommodating women who are pregnant or who have child care needs.
How long do you think it will be before patients start to notice these changes?
It’s already happening. For many people, it’s just important to have the option to talk to a woman versus a man. That’s especially true for women, but I think it benefits everyone to have a broader range of perspectives and backgrounds.