BOC has gone on record stating some “reasons” for the merger talks breaking down. Below is a statement of BOC’s position. It is followed by the undistorted truth.
1. The ABC Board of Directors elects its own successors and as such is subject to no oversight or review. In contrast, the BOC Board is elected from and by the BOC certificant body. ABC refused to consider BOC’s system of democratic governance. In addition, ABC demanded they have majority on any new, reconstituted board.
BOC STATEMENT: As certifying agencies, neither ABC nor BOC, has “members” in the sense that professional and trade associations do. Thus, certificants cannot vote on specific governance or other certification issues. ABC has used this fact as the basis for prohibiting its certificants from voting for its Board of Directors (BOD), the policy-making entity that controls the entire form and structure of the organization. Thus, there is no oversight or review process for the ABC Board’s actions. BOC, to the contrary, recognizes the right of the certificant body to elect its Board directly. ABC insisted on continuing its system of board self-selection, which would deprive BOC-certified practitioners of the fair representation they have now, and would ensure the current ABC system of entrenched board member control. In fact, claiming it was “older”, ABC wanted a numerical majority of ABC certificants on the newly constituted Board. Further, ABC does not consider Certified Orthotic Fitters (COF) or Certified Mastectomy Fitters (CMF) to be “practitioners” and therefore ineligible for Board membership. BOC recognizes that every certificant class (including COF/CMF) must be represented on the Board.
TRUTH: The ABC Board of Directors is comprised of people who are nominated by AAOP, NAAOP, AOPA, PVA, ACA and other entities interested in the care and treatment of persons needing orthotic or prosthetic intervention. The Board has term limits and encourages new people to join the Board each year. With more than twice as many certificate holders and more than twice the assets of BOC, ABC generously offered half of the Board seats minus one to the “BOC pool” of certificants. This occurred despite the fact that it is customary for the Board composition to reflect the ratio of assets and members between two unifying organizations. ABC and BOC actively negotiated how they could structure the “new board” to reflect the views of the entire O&P profession (including fitters, assistants and the medical field). In fact, the two organizations had agreed in principle to the new board composition at their meeting on January 12. BOC later rescinded their agreement.
2. ABC’s certification requirements are not adequate to serve current and especially future patient needs.
BOC STATEMENT: Although ABC claims it has “the profession’s most rigorous educational requirements for certification (i.e., Gold Standard)” there are not sufficient NCOPE accredited programs to meet growing patient demand. ABC’s response to this shortfall of certificants has been to promote a “privileging” system that allows non-certified persons (i.e., extenders), trained by their employers or supervisors, to treat patients with minimum to no supervision. Moreover, ABC has created an alternate certification pathway, “Unique Qualification,” that permits ten years of patient care experience before even becoming eligible to apply for certification.
BOC believes that people who have been immersed in the practice of orthotics and/or prosthetics for years, providing direct patient care, should not only be permitted to apply for certification, but, at some point should be required to, as a condition to continue to practice.
BOC’s recognizes that competence is measured ultimately by a demonstrated ability to meet rigorous performance standards. BOC is resolved that comprehensive, objectively developed examinations and periodic re-certifications are the proper standards for measuring and maintaining competency.
TRUTH: On page 53 of the October O&P Almanac, BOC stated: “…[our] examination process is equivalent and interchangeable with ABC’s.” Further BOC stated: “BOC’s only disagreement with ABC is that its highly trumpeted eligibility requirements…are inconsistent with the reality of practice.”
On January 12, 2004, ABC and BOC agreed that an educational pathway is necessary to assure continuing exceptional care for those in need. However, ABC also agreed that an “alternate pathway” would be created that would be similar to the primary pathway offered by the BOC. Regardless of the pathway pursued, the parties agreed that future O&P certification candidates would be required to undertake certification examinations. That pathway would be the ABC-sponsored examinations. In addition, ABC agreed to adopt the eligibility and examination pathway for orthotic and mastectomy fitters currently offered by BOC.
BOC’s objection to privileging is a smokescreen. This concept has long been recognized in medicine as a means of determining, by objective criteria, who is qualified to provide medical/surgical care. Indeed, ABC requires such privileging, even of ABC certified practitioners, in order to assure that patients are treated by O&P practitioners who are qualified to deliver that care. For those that do not possess an ABC credential, ABC requires that they be supervised by someone who is qualified. ABC knows of no ABC facility or practitioner who would allow a patient to be fitted with an orthotic or prosthetic device who wasn’t competent to do so. Further, ABC defined, for each level of O&P care, the scope of practice that an individual is qualified, by training and education, to provide. Please refer to the ABC’s published documents on facility accreditation and scope of practice for more information.
3. ABC hedged with respect to assuring equal standing of BOC and ABC.
BOC STATEMENT: Both ABC and BOC share similar missions of credentialing professionals and accrediting facilities, and have achieved equal status in the eyes of the Congress of the United States, the Centers for Medicare/Medicaid Services (CMS), the Department of Veterans Affairs, most insurance companies, as well as prescribers and their patients. The National Commission for Certifying Agencies (NCCA) accredits both BOC and ABC certification programs. Despite this parity, there was no guarantee in unification talks to ensure the survival of current BOC pathways. Further, in the discussions, ABC was unwilling to give equal consideration to the use of BOC’s more efficient certification examinations processes.
BOC philosophies are maintained so that patients and physicians can place their confidence in its certifications and will have access to comprehensive and safe orthotic, prosthetic and habilitative services. Given its serious philosophical differences with ABC, BOC has chosen to continue its independent status, protecting the certification process, and the BOC representational form of governance. Stay tuned for continuing developments.
TRUTH: On January 12, 2004, ABC and BOC agreed that all “BOC practitioners” would be given “equal and equivalent” certification status in the unified organization. On March 3, 2004, ABC fulfilled this commitment by inviting all BOC certified orthotists and prosthetists, in good standing, to apply for an equivalent ABC certification.
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Finally, it should be noted that contrary to BOC’s statement, ABC negotiated in good faith. ABC entered into the January 12th negotiations with the view that both organizations should reach mutual agreement on the essential issues surrounding O&P certification. When the meeting ended, such agreements had been achieved. Unfortunately, BOC later rescinded its agreements to those essential issues. Since then, as an organization, BOC has progressively articulated a point of view that not only makes further negotiations fruitless but continues to promote devisivness within the profession that can only result in harm to patients who deserve the care of competent practitioners. ABC conducted the negotiations in good faith and in a professional manner. It will not engage in adolescent mudslinging by challenging BOC’s good faith in this open forum.
We welcome individual BOC certificants to join their fellow colleagues and become ABC certified. In doing so, they will give the profession a stronger voice in assuring quality O&P care.
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