Orthotic Consultant: Carol Drang

Today’s non-clinical spotlight focuses on Carol Drang, an occupational therapist who now works as an Orthotic Consultant/Fitter.

What is your full name and title at your current job?

Carol Drang, MS, OT/L
Orthotic Consultant/Orthotic Fitter at Clinicare Medical Resources

Where did you go to OT school, and what year did you graduate?

I went to Towson University, and I was part of the first combined degree BS/MS class! Because I had my first baby while I was in school, I ended up graduating in December 2015, one semester after my cohort.

What did you do when you first finished school, and for how long?

In school, we were required to do one of our level II fieldwork affiliations in phys dys and the other in psych.

I elected to do a third, voluntary, affiliation in pediatrics because I was certain the I would spend my entire OT career working with kids! Ha! Of course it didn’t work out that way…

My first job was as a part-time pediatric OT in a Level 5 non-public elementary school in Baltimore that serviced children with speech and language disorders.

The majority of children who attended this school had autism. I took some CEUs in SI, learned more about sensory issues, and spent a lot of time pushing kids on swings, or trying to get them to focus and re-focus on FM activities at a desk (or on the mat, or anywhere else it worked out!).

Our facility was beautiful and the therapy gym was really top-notch. At some point, I re-vamped my hours so I was working four days per week at the school, and one day per week doing PRN at a nearby SNF, just to keep up some of my geriatric skills.

What did you do after that?

After two and a half years, I accepted a job as a school-based occupational therapist with the Baltimore City School System because the pay and benefits were better. I was also feeling a little burned out from working with kids who needed constant cues to attend and focus.

With the school system, the caseload was a bit more varied, but overall I saw higher-functioning kids. Again, I worked part-time, and received full medical and dental/vision benefits (for, like, $23 a pay period!), as well as a great pension plan.

I had baby #3 while at this job (baby #2 was born during the time that I worked at my first job), and I received 10 weeks of fully paid maternity leave because I “bought into” the Baltimore Teacher’s Union sick bank. Wow! Those were the good old days!

After one year (really an academic year, so only 10 months of work, minus that maternity leave!) of working with Baltimore City Schools, my husband was offered a job in Boca Raton, FL. I initially had a job offer to work at a nearby outpatient practice, but unfortunately, the practice was audited and as a result, they needed to do some massive cutbacks and were not able to hire me.

I took a couple months off to settle in, then started looking for a job of my own. I quickly learned how good I had it in Baltimore!

How were things better in Maryland vs. Florida?

In Maryland, many part-time jobs are available (and they offer benefits). In Florida, the OT jobs are primarily full-time or PRN. Furthermore, whereas in Maryland I was able to work in pediatrics with no specialized certification, most pediatric positions required that I become Medicaid-certified, which involved filling out a 25-page application. If there’s one thing I despise, it’s long applications!

I decided to try my hand at geriatrics. After networking and speaking with local OTs and PTs, I found per diem work in home health. I managed to get some paid hours shadowing a mentor (which was practically unheard of), and then ventured out on my own, ultimately signing up with three or four different home health agencies to keep busy.

I was still doing part-time hours, no more than 28 or so hours per week. I worked a lot with an older, very experienced COTA, whom I adored and learned a lot from. I also loved the home setting, which I feel is really the ideal setting in which to treat OT patients—it is very practical and very real, and I kept my therapy goals client-centered and needs-based.

I know you did some private pay work. How did that come about?

Since I never received my Medicaid certification, but I was experienced in working in pediatrics, I spoke to a few of the local private schools that I knew to see if they could send some referrals my way. This definitely involved a lot of marketing on my part, and promoting myself and my skills. But a tthe same time, I was also desperately looking for a “niche” area—something I could really develop an expertise in.

I did a short stint at a specialty orthopedic outpatient clinic that helped clients with limb deformities and limb lengthening. If you ever want to Google something really amazing, check out Dr. Paley’s website, and the Paley Institute.

It wasn’t a good fit though, and I only stayed for a month or so. A while later, I worked for a short time at a lymphedema clinic that focused on edema management. I only did the initial visits with our patients, and shadowed a bit, and ultimately decided I did not want to go ahead with the intensive lymphedema training.

After four years in Boca, we moved our family a bit further south (and much more urban!), to Miami. At this point, I had five kids, ranging in ages from infant to 10 years old. I needed something steady and reliable (which my jobs in home health never really were). I started working in a SNF, approximately 25 hours a week, at a PRN rate.

Did you deliberately stay PRN?

Well, pretty much. As I’ve made it clear already, I was juggling a young, growing family, and I really wanted to balance my career with my role as a mom. I felt that PRN was the only way to get the flexibility that I needed. After nine months at this SNF, they made me an offer for a full-time job, which I did not feel I could do at the time. They ended up hiring someone else, and I was back to looking.

After a few months of going all over and doing PRN at various facilities, I found a SNF very close to home that hired me to be their sole OTR. The hours varied, but were about 20-27 hours per week, which was perfect for me and allowed me the flexibility I needed and craved to also be able to be there for my children.

After two years at this SNF, with no notice, I was taken off the schedule. I found out that they had hired a full-time OTR (without ever offering me the position). I was crushed.

At what point did you decide you wanted to do something non-clinical, and why?

After my two disappointing experiences working as a steady PRN therapist, I realized that I either needed to take the leap and start working full-time, which would give me some job security, or find something non-traditional.

I still wanted flexibility in my schedule, so I just started thinking about what skills I had and where I could be marketable.

How did you hear about the orthotic consultant job?

While I worked at my SNF jobs, we had used a certain company with a specific representative for all of our Medicare Part B splinting patients. The company was Clinicare and the rep’s name was Jackie. She was a bit older and looking to slow down or retire.

I remembered that she had said that her company was looking for someone to take over her Miami-Dade territory (she had a couple of other counties farther north that she still wanted to service).

I had always enjoyed splinting, I was not put off by the idea of driving around (having done home health for several years), and I am definitely a people person! So, I decided to give her a call. She encouraged me to contact her company, and they hired me a few months later!

Did you do anything special to your resume and cover letter to land the job?

I cut out all my pediatrics experience, for one. I made sure to emphasize my recent SNF experience. In addition, although it’s a side gig for me, I run a home bakery business.

Although this is completely outside of healthcare altogether, it was a good opportunity for me to highlight my non-clinical skills in sales, networking, and time management/organization!

What was the interview like for the role?

My company is owned by a husband and wife team. The husband has a sales background, and the wife was in education, and later became a certified orthotic fitter.

I think this is kind of funny: I had an initial Skype interview (since the company’s home office is remote) with the president, and he asked me several times if I was comfortable going into nursing homes—he specifically mentioned that some nursing homes can have a bad smell or patients that behave in weird ways…it turns out that many of the other reps in this company did not have any clinical experience, and were also “sales” people!

In fact, one of our most successful reps was an amateur golfer prior to becoming a licensed orthotic fitter!

Regardless, I feel that my clinical background has given me an invaluable perspective and understanding of the population I am serving (both the therapists and the patients).

What was the hiring process like for the role?

The hiring process took a few weeks, and I went to Tampa, where my company is based, for my initial training as an orthotic fitter.

Incidentally, a month after I started, I got a call from Jackie saying that she had decided to retire altogether! So I ended up increasing my territory by taking over Broward County, and for a while, I also serviced Palm Beach County.

Eventually, my company hired someone else for Palm Beach (a COTA), and then later on, we also ended up splitting Broward. So I now service all Miami-Dade and Monroe, and half of Broward.

Did you immediately know you wanted to be an orthotic fitter, or did you consider other non-clinical roles?

It’s funny, because when I stopped working at my SNF job, I was looking for other traditional OT jobs, but also decided to think “outside the box.”

I kept thinking about the skills I had that could be marketable, and what I liked best about my previous jobs…when I thought about working for this company. It was like a light bulb just went off in my head.

I was like, “Yeah, I can do that! I really like splinting, I like talking to people and networking, and I also have some business and marketing experience. Plus, because I’ve done home health, I’m used to driving all around.”

Wait, you had a business and marketing background?

Way, WAY back when I was still in college, I worked for a small, newly opened hand therapy clinic. I was hired as a tech, but I ended up also doing a lot of marketing for the hand therapist, which mostly included dropping off donuts and business cards at doctors’ offices!

My other business experience is more recent (and current): during a lull in my OT career—right after we’d moved from Boca Raton to Miami and I was home taking care of a newborn—I wasn’t ready to jump back into the workforce. I decided to open up a home bakery business!

This experience taught me a lot about selling my product and myself, increasing my numbers, and looking for ways to expand my brand—everything I’d need to leverage when moving into a job that strongly focuses on these skills.

What made you choose orthotic consulting/fitting vs. something else?

I felt like this job almost fell into my lap. There was a need in my area, I had the skills and tools necessary to do the job, and I really thought it would be a good change. At the time, I wasn’t really familiar with other possibilities for non-clinical roles.

Did you get any special certifications or training along the way to help you get into your current role?

As I mentioned above, my company provided my initial training in Tampa, which stretched over three days. We learned the products (i.e., the splints/braces/orthoses), as well as the paperwork and the processes.

I was familiar with many of the orthoses we supply to clients, especially the hand splints, but learning some of the lower extremity splints, especially knee splints, took a bit longer to for me to get comfortable.

An interesting note is that my company is a Medicare-licensed Medicare B supplier. What that means is that we provide ALL types of products that are covered under Medicare B: orthoses, obviously, but also diabetic shoes. That was a big learning curve for me, as I obviously never dealt directly with diabetic shoes before this job.

Additionally, while I (usually) consult with the therapy department to select and provide splints, the diabetic shoes are usually handled through nursing or social services.

Did you get any additional training beyond those initial few weeks?

When I got back to my home territory, my training continued “on the job” with Jackie, my predecessor, who went with me on my initial few appointments, lunch in-services, and follow-up service calls. I did three initial in-services with Jackie. After that, I felt nervous—but fairly confident—to continue on my own.

Do orthotic fitters need to be licensed?

It depends on the state.

Florida is one of the few states that require orthotic fitters to be licensed, and the orthotic fitter licensure is actually much more expensive to obtain and maintain than a therapy license!

Since I am an OT/L, I operate under my OT license as an orthotic fitter.

What do you do about CEUs, now that you’re in this orthotic niche?

When I select CEUs, I try to find courses that can augment my current practice, or anything related to geriatrics and aging, general orthopedics, mobility and range of motion, etc. I also do quite a bit of reading up on contractures and contracture management (my company has actually put together a binder of scholarly and non-scholarly articles, which was a good starting point).

Editor’s Note: MedBridge Education has a ton of great courses on orthoses and limb loss. I highly recommend exploring the courses below if you’re interested in this type of role. And you can use code nonclinicalPT to get 40% off unlimited CEUs. MedBridge is the largest provider of non-clinical CEUs, so it’s a great deal!

• Introduction to Orthoses
• Dynamic Orthoses for Mobilization
• Orthoses for Mobilization of the Wrist
• Understanding Lower Extremity Limb Loss
• Pre-Prosthetic Management of Lower Limb Amputation

Is your role full-time or part-time?

Technically, this is a full-time position.

Because I have lots of flexibility in my scheduling, and I make my own hours, I basically work during the day when my kids are in school.

Often, I’ll have some additional paperwork in the evenings, which would mainly be compiling and sending off my orders. This paperwork is much less taxing than having to write evals, treatment notes, and discharges!!

I never count the hours I work per week; I just work! Sometimes, I may only work a couple hours in the field on any given day (usually on Fridays, I try to keep my load lighter). Recently, I had a facility I needed to visit that was a three-and-a-half hour drive each way (it is down in Key West). That day, I worked a 13-hour workday! But that is very unusual for me because, as I’ve stated before, I usually like to be around and available for my kids after school. (Hubby happened to be off that day and was in charge of all the after-school duties.)

Do you still see patients as an OT?

For a while, I maintained my active status at one of my PRN facilities. They didn’t call me often, but when they did, they usually needed a few days at a time. I always found it challenging to juggle my orthotic consultant/fitter job while also putting in OT hours. After some time, I left this job, as there were other conflicts that came up as well.

I do still see some people in my community privately who need OT services. These cases come up infrequently, but it is usually other busy moms (like myself!) who don’t have time during the day to go to therapy appointments. In these cases, I have seen them in their homes or mine, during the evening hours. Generally, these are uncomplicated, hand therapy types of cases.

Roughly speaking, what is an orthotic fitter salary?

Overall, my annual pay is in the same range as when I worked as a part-time PRN OT, and my average paychecks are about the same amount, but I have large variances in both directions (so sometimes my paychecks are much higher, but occasionally, when things are slow, they can also be much lower).

Does that mean you have a non-traditional pay structure? If so, please do tell!

Yes, my job is set up as commission-only. So, that’s been a real change for me.

For the first six months, the company provides a “guarantee” bonus to help you get set up, develop your territory, and build your sales…but after that, it’s strictly commission.

Can you tell us a bit about commission-based pay?

Sure. Here’s the first thing to note: there’s a difference between commission-based and commission-only.

My job is commission-based. So, my company offers benefits, plus they cover all my gas and phone expenses. They also reimburse most business-related expenses (especially lunch-n-learns). However, the amount in my paycheck relates to the volume of products that I supply to patients.

Commission-based pay definitely has its pros and cons! On the one hand, I’ve had days where I “sell” 10 products in an hour! Sometimes, it can take a few days to hit that number. Like therapy, there are busy times and there are slow times.

When things are slow, that means I need to step up my marketing efforts!

On the plus side, I now get medical and dental benefits through my company, which I was not able to get as a PRN therapist. In addition, my company pays for all my gas and my phone, as well as reimbursing our marketing expenses.

(I put “sell” in parentheses because in actuality, we don’t really sell anything. “Provide” or “supply” is more accurate, and those are the terms I prefer. This is because each of our products is ordered for a specific patient, and billed to their Medicare. Our company bills using L-codes. So we are really “orthotic providers.”)

What is a day in the life like for you as an orthotic consultant/fitter?

Well, my first order of business every day is actually just waking up and sending off five children to school!! By 8:15, everyone has left the house, and I settle down on the couch to a cup of coffee while I look over my day’s appointments in my calendar (I use the Google calendar app on my phone to stay organized).

If I have any paperwork or orders I didn’t get to finish up the night before, I’ll take some time before I leave my house to get that done. And then I hit the road! Every day looks different. Sometimes, I work my day around a lunch in-service or rounds, where I’ll block off several hours to be in one facility.

Sometimes, I can go to 8-10 facilities a day. As I get calls from therapists who have orthosis needs, I will set up appointments and then go to those facilities to see their patients and provide consultative services, help with measurements, and gather the necessary documentation.

I’m always multitasking. During the day, I’m constantly responding to calls, texts, and voicemails from therapists and from the home office, which processes the paperwork and ships out the equipment. I use email from my phone, but I also have a scanner app and an eFax account, which sends faxes straight to my phone. My phone is really my “mini-computer!” And my car is my office!

Can you tell us about orthotic in-services?

In-services are basically lunch-n-learns. I usually go to a nearby restaurant myself to pick up the food, then I deliver it to the SNF and set it up. I also display several splint samples.

My audience generally is the rehab team, but often we also include the administrator, DON, MDS, business office, social services—really, I leave it up to therapy, but all of these roles would benefit from hearing about our services.

I speak generally about contracture management, how orthoses can help, and what types of services Clinicare and I provide. The in-service itself takes about 45 minutes, and I’ll set aside time afterwards to see patients and answer questions. Usually, I block off an entire afternoon to do an in-service.

If I find that I wrap things up more quickly, I’ll move other appointments around or I’ll do some cold calls or marketing to other nearby facilities. By 3:00 or 4:00, depending on where I am, I’m usually rushing out so I can be on time to pick up my kids from school!!

It sounds like no two days are the same! Is this the case?

Oh, yes!

Often, my schedule can change several times during the day! My “planned” calendar of appointments can be completely different from my “actual” calendar of appointments. Sometimes, I get cancellations from therapists (unexpected reps from the state drop by so today’s not a good day; patient went out to hospital; family took patient out of facility; etc.), and sometimes, if a therapist calls with a need close to where I am, I’ll detour to see that therapist same-day.

Some days, my calendar is jam-packed with back-to-back appointments, and some days, I have a more loose idea of where I need to go.

I’m gathering that adaptability is key to be able to succeed in this type of role!

It helps that I am by nature a flexible and somewhat spontaneous person, and that I’m able to think quickly on my toes. As I’ve become more familiar with my territory, I also take traffic into account more when planning my days and my routes. In addition, I am a big Google Maps fan!!

How do you stay organized??

As you can tell, I rely on my phone a lot, and use my flexible nature to my advantage. That said, I try to reserve Fridays as my “clean up” days, so I keep new appointments to a minimum and go over any pending orders, trying to follow-up and tie up any loose ends.

What are some of the pros and cons of being an orthotic fitter/consultant?

Pros

• Flexible schedule
• Every day is different! It (rarely) gets boring or repetitive
• I’ve been able to develop expertise in one area, contracture management
• Being able to service an often under-serviced population (in busy SNFs, sometimes the short-term patients get better care and more attention than the long-term-care patients)
• Being able to network with so many different therapists and other healthcare team members! I love the people I work with, and I am always learning from others.
• I have a higher earning potential per pay period than I did as a PRN OT (although I don’t always achieve that!)
• Flexible schedule

Cons

• Sometimes I miss direct patient care
• Variable income
• It can feel a bit like I’m an “island” because I’m working independently out of my car

What type of person do you think would do well in your role?

It’s been said before that the best thing about the job is the flexibility, and the worst thing about the job is the flexibility! So, someone who would do well in this job would be:

• Motivated
• Organized
• Structured
• A self-starter

What are some of the similarities and differences you see between what you do now and what you did in OT?

My schedule is totally different every day, so obviously that is a big difference. Also, as I touched on earlier, my “caseload” of patients I am exposed to now is totally different.

As an OT, I was treating a variety of conditions—neuro, ortho, general debility, etc. Now, 95% of what I am consult on is contracture management-related. The other 5% may be AFOs/knee braces for functional gait or splints for specific orthopedic conditions.

I have no productivity demands, which is really nice.

So, if I need to take time in my day to be in my “home office” (i.e., my dining room table) to catch up on paperwork, that’s okay.

In terms of similarities, when I am consulting, I am using all my clinical reasoning skills to approach my patients holistically and make recommendations to affect their positioning, ROM, comfort, and function. I am definitely also using “therapeutic use of self” in how I approach difficult clients—with or without the referring therapist—in order to explain the benefits of splints and persuade patients to be willing to try them out.

Does the company you work for prefer to hire OT/As and PT/As?

When I first started with this company, I was the only therapist at the time. Since then, they have hired three other COTAs (one in the territory immediately north of me), and a PT (in a different state). So, now therapists are very well represented!

However, I have found that the turnover in this company is somewhat high. I’ve been with the company for nearly three years now, and I’ve seen several other reps come and go.

Jackie, who was my predecessor, worked at this job for 17 years. Some of the other Florida reps are also going on 20 years or more…

Why do you think there is high turnover? Be real with us! 🙂

I think there are two reasons:

1. First, and mainly, not everyone is OK with a commission-based pay structure. I think the main reason it works for me is because I am part of a dual-income household, and having my husband’s salary helps a lot.
2. Secondly, not every therapist is also good at “sales.”

I always say that I am a therapist first and a salesperson second. If I don’t think that a particular orthosis is appropriate for a patient, I will advise against it.

While my company is obviously sales-driven, we are also a Medicare-certified orthotic provider, and we need to provide medically-necessary products and services. So I think they appreciate my honest approach (as do the therapists that I work with!).

What are some of the ways being an OT has helped you as an orthotic fitter?

First of all, I am able to use clinical reasoning skills to help determine the best orthosis for each patient. I know the questions to ask:

• Is this patient getting out of bed?
• What is this patient doing functionally?
• What are you goals for the splint?

My background gives me a lot of legitimacy in the recommendations I make. I think having the therapy experience can be helpful because we’re familiar with the settings, the patients, the disease processes and, of course, the products.

Additionally, I “get” my clientele—who are primarily therapists! I know what their days look like, with productivity demands and all. I try to help them as much as possible, gathering paperwork, etc.

Lastly, working in the field for a few years prior to becoming an orthotic fitter has helped me tremendously with networking. When I first started walking into SNFs as introducing myself as their new rep, many of the therapists recognized or knew me and were glad to refer business my way.

Have you faced any judgment or nay-saying from leaving your OT role?

If anything it’s been quite the opposite! I think I interact with many therapists that are experiencing burnout. They often ask how they can get a job like mine. I usually end up referring them to The Non-Clinical PT as a resource!

What type of growth is there as an orthotic fitter?

In terms of growth, that is one area that I do find limiting in this career. Obviously, I can always try to bump up my sales. Within the company, some of the reps also do field training for new hires… that’s pretty much it, though.

What is next for you? What do you want to do with your career long-term?

As a side thing, I have really enjoyed the consulting and in-service side of this job. Recently, I partnered with a local university and developed a four-hour CEU course for OTs and COTAs, which my company sponsored.

In the future, I am going to look for more opportunities for education in the areas of contracture and orthotic management.

I honestly do not know what my long-long term career path will be. I am open to returning to patient care one day. I think I am lucky in that I do not feel that I ever really “burned out”; rather, I needed a flexible job structure that worked for my overall lifestyle.

However, the more I speak to therapists in patient care, the less inclined I feel to return! I do hear a lot of complaints, and I definitely don’t miss counting minutes or writing evals.

I have thought a lot about broadening my scope of consulting. I often find myself getting upset over patients who don’t have a voice—lying in bed with multiple wounds, multiple contractures, and very poor care.

I can see myself doing something in the future related to patient advocacy, case management, or education, where I can help patients on a broader scope.

Did you read any books, take any courses, or do anything special overall to get you where you are today?

I’ve had to work on some of my entrepreneurial mentality in order to push myself at this job. Being commission-based, if I don’t generate orders, I will not get paid! There is nobody on the outside telling me how to structure and spend each day.

The best piece of advice I’ve come across: Always generate new leads.

I do tend to listen to many podcasts, most of which are for personal growth and enjoyment. Being an orthotic fitter is a great job for people who enjoy podcasts, as I have lots of solo time in the car!

One podcast I enjoy is “Unlocking Greatness” by Charlie Harary. It’s about being and becoming the “best you.” I also listen to podcasts on occupational therapy (!), interviews with famous people, comedy, and history. I guess I’m pretty eclectic and I find lots of topics fascinating!

What would you recommend to someone who is considering going into a role like yours? Do you have any special words of wisdom for the readers?

Make sure to find out about the company and the pay structure before you accept a position. Also try to speak to others in your area who may have worked in this position.

Our company does mostly Medicare, with few HMO contracts. In my territory, the number of patients with HMOs is growing, and often I cannot service their orthotic needs…

For years I wanted to find a specialty or niche area and become an expert in that area. Orthotic fitting really just fell into my lap, but I ended up becoming really passionate about this area.

Be open to new experiences in life and in the job market because you never really know exactly where an opportunity can lead you!

If you could give yourself one piece of career advice you wish you had during your OT program, what would it be?

When you are out in the field, wherever you are, FIND A MENTOR. I think one thing that helped me in every new setting I worked, is that I sought out and found a mentor to whom I could ask questions and receive advice.

I have started over in many different clinical areas—peds, then home health, then SNF, and now orthotic fitting—and each time, I was very fortunate to have someone who was more experienced than me in the field to whom I could turn for advice.

But you also have to be proactive in finding those people, and not be shy in asking questions.

What would you like to change most in your profession, and why?

Moving from Maryland to Florida was a big culture shock for me, career-wise. I found that a lot of the job opportunities I had in Maryland were simply not available here in Florida. For example, landing a part-time OT job with benefits. That would never happen in Florida. Also, in Maryland, there were plenty of jobs for OTs in mental health, but that’s not the case in FL.

And, believe it or not, although my cost of living here is overall higher in Florida, the pay is overall lower. So, those are all were big frustrations that I think have contributed to my straying from a traditional, clinical role.

I wish more part-time jobs could be available in more types of healthcare settings. (Not that I’d necessarily go back, but much of the reason I went into OT in the first place is because I was told that it would be “a great job for someone who also wants to be a mom.”)

Thanks for your insight, Carol!