The Orthopaedic Craft of the Federal Republic of Germany
Helmut Ginko O.M. *
Translation by Siegfried W. Paul, C.P.O. *
Translation of address given at the National Assembly, American Orthotic and Prosthetic Association, Las Vegas, Nevada, Nov. 2, 1971.
Note of the Translator:
Many of the terms referred to by the author are either not known in this country or have a different meaning. A mechanic, for example, has professional status in Europe and is recognized as such. The vocations of Orthopedic Merhanic and Bandagist are separate entities during the apprenticeship and journeyman's years. However, they become equally qualified professionals once the Master's examination has been passed. They are then referred to as Orthopaedic Technician, or as in Switzerland, Orthopaedist. The terms Craft and Craftsman are still status symbols in Europe.
Mr. President, Ladies, and Gentlemen:
First of all, I would like to thank you in the name of the members of the German Travel Group for the hearty reception you have extended to us.
I would like to thank one and all who helped, through their time and efforts, to make this journey a success. In particular, I would like to mention Mr. Paul and his wife, Betty, who traveled with us from New York.
I had the pleasure of becoming acquainted with your President, Mr. Snelson, when he was in Bonn in attendance of our Assembly. It was his wish that I, at this Assembly, should talk about professional organization and the situation of the Orthopedic Mechanic and Banda-gist Crafts in the federal republic of Germany. I accept this opportunity with appreciation and would like to title my paper: "The Orthopaedic Craft of the Federal Republic of Germany."
In order to understand the position of us within our society and to understand the structure of our Organization, it will be necessary to look for a moment at the development of the German crafts.
Today's modern German organization of crafts had its origin within the foundation of guilds. The oldest historic document known to us comes from a guild in Worms-at-the-Rhine and dates back to 1106. It was around 1260 when nearly all of the crafts had been organized in guilds. Creation of guilds resulted in full acknowledgment of individual crafts as entities. Other occupations were able to concentrate on their vocation without having to bother with the fabrication of the tools used by them.
The concentration of efforts by the craftsman within his craft resulted not only in outstanding skills, but also in extensive, far-reaching moral development.
Besides being economically and politically important, the guilds also represented religious, moral, and social organizations. Each had a saint, and the churches made available special altars. Brothers of a guild would consider it an obligation to practice brotherly love.
It was not easy to obtain membership in a guild. The applicant not only had to to submit proof of his skills, but had to reveal his social and family history, as well.
This period—from about 1100-1580—was considered the climax of the German crafts. Deterioration of the guilds resulted in weakening of customs, and the power of the crafts suffered severe damage.
Wars and discord within the country furthered the complete paralysis of the political and economical influence of the crafts. In spite of this, some of the old practices survived and should, even today, not necessarily be judged negatively.
This, Ladies and Gentlemen, is a brief history of the origin of the organized crafts of Germany in general.
The Orthopeadic Mechanic of our country can also look back on a long tradition. It was in Berlin in 1656 when the first guild of our craft was founded. This means that this vocation of our country has been organized for over 300 years. Today, there are 125 crafts in the federal republic of Germany which enjoy the protection of the laws.
Also, the organizational structure of the crafts meets the requirements of modern society and its economy.
The guilds are the smallest segment of the crafts' organizational structure. They are public institutions, anchored within the laws written for the crafts. Today, guilds can be compared with organizations of the middle ages. However, their influence and power cannot be compared even though they play a considerable, if not a deciding, role in the economy of individual companies. We shall hear more about this later on.
The guilds, as smallest and lowest group of the strict craft organization, is the basis for two separate directions of the crafts' organizational structure.
One direction is representation of the craft as an entity and is organized as follows: Local craft associations, craft chambers, regional chambers of craft, the federal chamber of craft and the Central Association of German Crafts. The other direction is the vocational classification. Local guilds are organized in state guilds and they compose the national organization, the Federal Guild Association. This organization is the highest representation of a vocation within the crafts.
The guilds have to admit to membership anyone that is listed in the Scroll of the craft, which is a registry kept by the Chamber of Crafts listing all persons who own and operate facilities practicing a craft. The Master Title is mandatory for listing in the Scroll. Having passed the master examination, an examinee has proven that he is capable of managing a business independently and that he is masterly proficient in his craft. He also is granted permission to train apprentices providing that he is older than 24 years of age.
You are probably interested in the various responsibilities of individual organizations of the crafts.
First, let us discuss the Guild. Guilds are obligated to further the professional image and the espirit de corps; to support good professional relations between Master, Journeyman, and Apprentice; to supervise the education and training of apprentices according to the guidelines of the Chamber of Crafts; to hold Journeymen's examinations with authorization of the Chamber, and appoint a Board of Examiners for this purpose; to further the knowledge of master and journeyman, and to establish or support schools for such a purpose; to function within the Administration of Professional Schools according to the provisions of local laws and regulations; to further cooperation to government or other agencies; within the Craft, and to render bipartisan evaluation and information to support other Craft organizations and establishments in their efforts.
The Guild should create and set forth media designed to improve the effectiveness of facility operation; function as non-partisan advisor to agencies for the awarding of contracts and services; and provide support to the publications of the craft. The Guild can create a committee for grievances between employers and apprentices; make contracts for pay scales as long as such a contract was not made by the Association; create foundations for support of their members in case of illness, death, inability to work, or other needs; function as Intermediary in case of grievances between members and financing agencies.
The Guild can also conduct any other business for the betterment of common industrial interests of its members.
The establishing of insurance plans or foundations can only be in accordance with the specific federal regulations.
As you can see, Ladies and Gentlemen, even such a small group like a Guild has to meet a multitude of obligations. Leadership of a guild is provided by an "Obermeister" who is supported by a board of Directors. The "Obermeister," the Board, and all of the committees are elected every three years.
Individuals can run for reelection. I, myself, have led the Orthopedic Mechanics and Band agist Guild of Duesseldorf for eleven years now and have members on the Board who have been in office for 20 years.
It is understood that the responsibilities mentioned can only be tackled if the elected individual has the common interest at heart. A prerequisite, of course, is that their business is well-founded and without financial difficulties.
The next organization to be discussed is the District Association of Crafts. The responsibility at this level is representation of the interests of the facility owners and the overall interests of the guilds within their district; support of the guilds in their efforts and to create medias for the representation and advancement of the social interest of the guild members; giving to agencies advice, suggestion, and information pertaining to the independent facility owner; and conduct of the business of a guild when requested. The District Craft Association will also assist those members of a guild not having their place of business located within the district. Members of a district craft association are the guilds of all of the crafts within a district.
The next level of organization is the Chamber of Crafts. The responsibility at this level is to further the interest of the crafts; to equalize interests of individual groups and their organizations; to support the government agencies with advice and recommendations pertaining to demands of the craft and to give testimony about the status of the craft; to keep the scroll of the crafts, to regulate the education and training of apprentices, to issue guidelines for this purpose, and to supervise their application; to keep an apprentice Scroll; to issue rules for the Journeymen's examination for all of the crafts, and to create Boards of Examiners to conduct such examinations; to issue rules for the Master examinations; to assist local guilds in educational efforts in furthering the technical and business administartive knowledge of master and journeymen, and to maintain an agency for this purpose; to provide experts for the evaluation of quality, service, and fee structures; to further economical interests of the craft designed to support organizations created for the
crafts; to create Review Boards to settle grievances between facility owners (sellers) and their clients; to issue certificates of origin for products manufactured by the craft; to supervise guilds and district craft associations; to make available support for craftsmen and journeymen in need; to govern educational programs and examinations of apprentices employed by a craftsman but not enrolled in the particular craft of the employer. (This is done with permission of industry and the chambers of trade. The Chamber should be contacted for all matters pertaining to important issues of the craft.)
The regional and national craft conferences assemble only every three years.
We would now like to discuss the most important organization: the Central Association of German Crafts. All of the channels of our vocations lead to this organization which represents the interests of the crafts in both internal and external affairs. Its responsibilities are of global nature.
Our vocation, namely the Orthopedic Mechanic and Bandagist Craft, rests also in the lap of this strict organization. I can say that we are most comfortable in this company. Anyone in the Federal Republic of Germany who wishes to manufactrue orthopedic appliances or desires to measure or fit the human body, must meet specific prerequisites.
He must have been trained as an Orthopedic Mechanic or Bandagist. His education is an apprenticeship conducted by a qualified master. The Trainee must attend a professional school while he is in training, where he receives the fundamental and theoretical education needed for the manufacture of orthopedic appliances. Subjects included are material science, arithmetic, anatomy, pathology, and physiology. In addition, there are business administration, civics, and all of the subjects necessary in molding a good crafstman. The manual training course is carried out by the employing facility, and is governed by plans issued and regulated by the Chamber of Crafts.
The Guilds conduct additional instructional courses placing great emphasis on techniques which are not covered by the training facility.
The Orthopedic Mechanic must serve an apprenticeship of three-and-a-half years and the Bandagist three years. A Journeyman's examination is given at the end of this period of training. Excellence of performance can result in shortening of the time required.
Successful completion of this examination entitles the individual to work as a Journey Craftsman, but he is still not entitled to fit appliances to patients without supervision.
He must have passed the Masters' Examination in order to open a business of his own. Prerequisite for this examnation is uninterrupted employment as Journeyman in a qualified facility. Two Masterpieces (Meisterstuecke) have to be fabricated besides a work sample which has to made under observation of the examiners.
As a rule, a prothesis and an orthosis must be fabricated, and the appliances must be worn by the patient at the time of the examination by the Board. The theoretical part of the examination covers all segments related to our work in anatomy, physiology, pathology, material science, and those of orthopedic technical interest in general. Business administration, bookkeeping, taxes, banking, and all of the other fundamentals for the effective operation of a facility are also tested.
Lately, the instruction of training supervisors was added as an additional examination subject. Testing in this area demonstrates qualification for the Trainee Programs. Anyone who has passed the difficult stages of his professional career can say that he is well able to evaluate therapeutic requirements, at least for orthopedic problems, and render the necessary service.
Only now, Ladies and Gentlemen, is the craftsman able to open his own facility after being listed in the Scroll of Crafts. He will now become a member of the guild and will from now on have his position within the professional society. The time scheduled makes it necessary for my statements to be only sketchy —highlighting our organizational structure. However, please permit me to speak briefly about the orthopedic technical care in the Federal Republic of Germany in general.
Almost all of the cost for orthopedic appliances, regardless of type, are financed by some carrier. Only on a rare occasion will a private patient request service. The result is that the fee schedules and carry-out procedures have to be arranged with insurance companies, Welfare Agencies, Workmen's Compensation groups, the Veterans Administration, and other agencies.
These responsibilities are handled by the Guilds, to the greatest extent by the federal association. And here it is where sound organizational structure becomes evident. Here, we learn that the rewards for our work can only be as good as our representation. Earlier, I discussed the organizational direction of the craft in general. I do not want to fail to mention the other direction— namely the vocational direction.
There are 18 guilds of our profession in Germany. All of the guilds are organized in the National Association and represent a single visit. The guidelines, political discussions, and related questions are decided by the President. The Board of Directors acts in an advisory capacity and will assist in the making of decisions. The President and Board of Directors are elected by a delegation from the individual guilds for a period of three years. The election is based on democratic principles. Reelection is permissable.
The nature of our vocation places the National Association in a position where this organization plays a key role in the economical life of every self-employed orthopedic craftsman.
This organization negotiates and signs Union contracts, calculates and controls fee schedules for orthopedic appliances and makes service contracts with the government and other cost carriers. Its tasks are reaching even further. The National Association conducted the affairs of the Frankfurt Professional School until 1970. Foundation of a support organization for this school eased the problems of maintaining this school. The professional journal, "Orthopaedic-Technik" is also published by this organization. Experienced and industrious coworkers are required in order to represent the interests of the entire vocation.
At present, we are staffed with two Executive Directors, Dr. Lamers and Mr. Schuette, and four secretaries. A part-time employee is in charge of mail service and duplicating.
Ladies and Gentlemen, I hope that my report gave you some understanding of the organizational structure of the German crafts. It has been only through our belonging to the German craft organization that we were able to continue our free and independent professional status.
We support any possible cooperation with the medical profession and with medical sciences. However, we refuse to be classified as a paramedical vocation or even as "HILFSBERUF."
I would like to thank you for your patience in listening to my presentation. I believe that I can speak for 1,200 independent orthopedic craftsmen of the Federal Republic of Germany and the 5,000 employees when I express our best wishes for a most successful assembly to you.