Certification of the Individual: Some Comments on Current Questions
Robert Mazet, Jr., M.D. *
The Executive Director of the American Board for Certification continues to receive letters from many brace and limb makers throughout the country which indicate that there is considerable confusion in the minds of the writers about several matters. Some of these are:
- Why should I be put to the expense and inconvenience of appearing before an examining board when another man who is not as well qualified as I was granted certification several years ago under the grandfather clause?
- Having been certified, why should I be assessed ten dollars a year?
- Since I (or someone else in my shop) am certified, why should my shop be separately certified at additional expense to me?
- How does it profit me to belong to an organization (OALMA) which appears to be run by and for the benefit of large firms? This last question does not concern Certification at all. My colleague, President Frank Harmon, President of OALMA, discusses this point in his column on page 9.
An effort to clarify the first three questions appears indicated. They will be discussed in the order presented.
But first let us review the brief history of the ABC.
1. Until 1946 there was no central body which truly represented the many brace and artificial limb shops operating in our country. The industry had no uniform standards of ethics, no training program for individuals desiring to learn the arts of brace and limb fabrication. Its relationship with medicine and the public was haphazard. In some areas brace makers were as little respected as witch doctors and hawkers of patent medicines. The old Association of Limb Manufacturers was essentially a trade organization in which a few large firms were active. The foresighted leaders of the old Association realized the necessity for the formation of a trade group with a much broader base, which would adequately represent both small and large shops, to the benefit of all. At the same time they recognized the imperative need for bettering the relationship of industry members to medicine and the public, for formulating a code of ethics, and for instigating a comprehensive training program for apprentices on a nationwide basis.
These men were not motivated by selfish ends. They were opening a new road toward better service to the handicapped, public confidence in artisans of their craft, and pride of workmanship among their numbers. From their exertion the OALMA in 1946 and the ABC in 1948 emerged. The structure of these bodies was initially rather nebulous, and they have not been free of growing pains. They may now be considered healthy youngsters, not yet fully developed, still exhibiting change and growth.
If educational programs are to fulfill their purpose, standards must be set, and there must be a responsible body to assure these are met. This is the responsibility of the ABC. The Board believes, however, that it exists not only to set standards and conduct examinations to see that these are met. One of its functions is the gradual raising of educational and training requirements in order to constantly improve the quality of men certified and their workmanship. This is an arduous process which must be accomplished step by step. This effort is reflected in the evolution of the examinations conducted by the Board.
At first no examination was required for certification. Every individual who had been manufacturing braces or limbs for four years was given an opportunity to become certified under the "grandfather clause" by reason of seniority. As the apprentice training program has evolved, the requirements which applicants must meet prior to appearing for the Board Examination have slowly been made more inclusive. As increased opportunities are provided by the developing educational program these will be further changed.
As a means of broadening the base on which the apprentice training program rests, and to make certain that certified men in small as well as large shops are represented, there is an advisory committee to the Board composed of two representatives from each of the 36 districts.
In an effort to make the examinations fairer the Board has for the past two years secured the active help of Dr. Miles Anderson, a professional educator on the faculty of UCLA, who has revolutionized the method of conducting these tests.
Certification of facilities is a function of the Board unconnected with the certification of individuals. Facilities must meet certain specific requirements. If they do so certification is readily obtained.
The relationship of the OALMA to the Board might be likened to that of a big brother. The two are separate groups. As stated above, the Board is essentially an examining body. The OALMA is the body which sponsors Board activities. It sets standards, initiates the educational efforts and maintains the apprentice training program. Thorugh the journal and at regional and national meetings, it offers special programs to keep certified men and members up to date on developments in the practice of the orthotists' and prosthetists' arts.
OALMA, however, is essentially a businessmen's association, representing firms rather than individuals. Its efforts arc being directed toward an equitable representation of all firms. It has successfully striven to elevate the ethics of its members. It has cooperated with the investigative activities of such bodies as the Advisory Committee on Artificial Limbs and the Mellon Institute. The Executive Board is composed of eleven regional directors elected by secret mail ballot, one from each region each year. This Board nominates officers of the Association, who are then elected by the members. Each member firm has one vote.
In answer to the first question: Anyone who had conducted a brace or artificial limb shop for four years or longer had ample opportunity to become certified prior to the adoption of the present requirements for certification.
In answer to the second question: The successful operation of the certification movement necessitates expenditure of certain monies. The processing of applications, checking on references, correspondence, preparation of forms of diverse types, the expenses of running the Central Office and printing the journal require a considerable yearly financial disbursement. Without this outlay of funds, the certification program would collapse, and the chaos of former years would quickly return. It should be pointed out that the expenses of running the Central Office and printing the Journal are shared with the OALMA, that the greater part of the ABC budget is derived from income from certified facilities rather than individuals. It must also be emphasized that no remuneration is received by any member of the Board, or by any facility which is used for the practical tests. The Examiners have until now received no expense or fee. In the future those who are not Board members will receive the modest stipend of fifteen dollars per day.
Perpetuation of the high standards of the certification program, and its implementation, are the duty and privilege of certified men. The yearly assessment is made to assure our spiritual successors that such will occur.
In answer to the third question: Certification of the individual and certification of the shop should not be confused. The first means that the certified man has met the requirements for certification, that he is honest, ethical, and dependable.
The certified shop must employ at least one certified individual, but it must meet additional requirements. Its relationship with patients and doctors must meet certain standards. Its business practices must be ethical. It must provide adequate fitting areas, toilet facilities, stand behind its products, and be a respected business in the community. In other words, certification of the shop assures the patient that he can have confidence in its products.
The certification movement has undeniably raised the standards of shop practice and business conduct. It has restored the faith of patients and doctors in the integrity of brace and limb makers for the good of all of them. The advantages of this renewed public confidence is worth far more than the yearly contribution the shop makes to the Central Office for continuation of the activities of the Board. The fee is, of course, a legitimate business expense, tax deductible. In thirty states the State Rehabilitation Commission procures devices and services only from certified facilities.