The State of O&P: Demand, Forecasting, Statistics, and Workforce Projections

Published in Orthotics & Prosthetics on December 27, 2022

Further fueling demand and growth for the wider O&P market are advancements in robotic
prosthetics. In the U.S., an increase in trauma cases and rates of diabetes is leading to increased
numbers of amputations.

“The growing target population and focus on restoring the mobility and independence of
amputees will drive the growth of the robotic prosthetics market in the U.S. during the forecast
period,” according to a senior analyst at Technavio.

The North America O&P market was valued at $2.4 billion USD in 2021 and is expected to grow at a compound annual growth rate (CAGR) of 3.8% during the forecast period, to reach an expected value of $3.1 billion in 2028.⁴

The O&P market is forecasted to be driven by the uptick of cases of sports- and automobile-related injuries, amputations related to diabetes complications, and the increase of a specific bone cancer, osteosarcoma. At the onset of the COVID-19 pandemic, multiple agencies and organizations took action.

For instance, an open letter dated March 19, 2020, was written by the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) and addressed to the state governors of all 50 states. NAAOP opined that O&P services were essential health benefits that patients would need access to during the pandemic.

According to the American Physical Therapy Association (APTA), the annual sports injury rate in the U.S. was around 8.7 million⁵ in 2018. This, along with greatly increased rates of amputation due to road accidents, is anticipated to drive the O&P demand and growth over the forecast period.

The increase of osteosarcoma cases is also a factor in the demand for O&P products. According to the National Cancer Institute, they estimated around 3,450 new cases of bone and joint cancer in 2018, resulting in 1,590 deaths globally. Each year, according to the American Cancer Society, about 1,000 new cases of osteosarcoma are diagnosed in the U.S. with about half of the cases being in children and teens.⁶

COVID-19 and the Market

As with many providers throughout the healthcare continuum, the COVID-19 pandemic impacted the O&P market, causing slowed growth between 2019 and 2020, even as practitioners adopted telehealth technology. Additionally, companies such as Össur saw a decrease in sales for bracing and supports due a reduction in sporting events. With pandemic-related restrictions lifting, the market is now primed for accelerated growth.

COVID-19 prosthetics and orthotics market impact: marginal growth of 3% from 2019 to 2020

Revenue Breakdown

Orthotics held a dominant share of the O&P profession with over 74% of the global market in 2020.⁷

According to this same report, upper limb orthotics attributed the largest share due to various benefits, in terms of movement, such as pain reduction and quick recovery.

Due to factors such as an increase of spinal injuries, unhealthy lifestyle choices, and rising target population, spinal orthotics are forecasted to have the fastest growth rate between 2021 and 2028.

An increase in disability rate is expected to drive the growth of prosthetics in the coming years. According to a report published by the Rehabilitation Research and Training Center on Disability Statistics and Demographics in 2018, the percentage of people with disabilities in the U.S. increased from around 11.9% in 2010 to 12.9% in 2017, resulting in a rising demand for prosthetics.⁸

Even though prosthetics only represent about a quarter of the O&P market, this market segment is large and growing. Approximately 500,000 people are living with major limb loss in the U.S. Approximately 50% of those with limb loss are due to disease, 47% is due to trauma, and 3% is due to other causes. With 350,000 people with major limb loss using a prosthesis, prosthetics in total makes up approximately 50% of the prescription O&P market.⁹

Workforce Demand Data and Projections

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) reports there are about 3,500 separate and unique certified prosthetists.¹⁰ Based on this information, let’s assume about 6,000 people with a new transtibial or transfemoral limb loss received a prosthesis for the first time (i.e., preparatory) through Medicare this year.

If Medicare is the sample population, then one can project the total population at about 19,000 new individuals who received an initial prosthesis represented by a preparatory base code.

Therefore, each certified prosthetist has only 0.44 new patient billable events per month, or 5.3 per year. This demand does not take into account the existing population with limb loss who need ongoing care and replacement devices.

All nonpreparatory base code utilizations reveal that Medicare paid for about 30,000 lower-limb devices. Projected to the total population, there were about 100,000 devices provided across all payer types.

Therefore, each certified prosthetist had only 2.35 existing patient billable events per month, or 28.2 per year.

Given this, it can be estimated that each certified prosthetist has 2.79 billable new device events per month.

Employment of orthotists and prosthetists grew 22% from 2016 to 2021, much faster than the average for all occupations. However, because it is a small occupation, the fast growth might result in only about 1,700 new jobs over the next five-year period. There is an expected shortage of 4.2% by 2030, based on population growth alone.

The rate increases by 0.40% annually, so that by 2030, a 9.5% shortage may exist if no new O&P schools were to be opened.

A 2014 analysis from Dobson-DaVanzo estimated that by 2025, there will be a 60% higher demand for O&P professionals than the available supply of certified providers.10 Noncertified professionals such as technicians and assistants, for example, will be able to assist in continuing to meet demand.

The composition of the profession will most likely approach drastic change as off-the-shelf products are continually provided by doctors, therapists, and supply chains without certified credentials, as well as credentialed supply struggles to meet demand.

15 states grant licensure for orthotists and prosthetists, and two additional states have regulatory requirements that professionals be certified by either ABC or the Board of Certification/Accreditation (BOC).

The remaining 35 states, as well as the District of Columbia, do not require certification or state licensure to perform O&P services. However, Medicare reimbursement eligibility will only apply to custom-fabricated products provided by state licensed orthotists and prosthetists or ABC/BOC certified professionals practicing in non-licensure states.

Graduation rates of certified providers, as well as the attrition rates of providers leaving the profession, are the main drivers of the supply change. The attrition rate considers retirement as well as movement away from standard patient care (promotions, retail, academia, etc.).

The Dobson-DaVanzo study estimates, “that the attrition rate will surpass the graduation rates and result in a declining supply of certified providers in the O&P profession overall across the study period.”¹⁰

Though not required in every state, certified or state-licensed orthotists and prosthetists will be able to present knowledge and training that may appeal to more employers.

Staffing bottom line: The demand for clinicians exceeds the supply of qualified personnel.

Labor Statistics

The following statistics are from the Occupational Employment and Wages report for Orthotists and Prosthetists from the U.S. Bureau of Labor Statistics¹¹.

National estimates for Orthotists and Prosthetics:
Employment estimate and mean wage estimates for Orthotists and Prosthetics

The relative standard error (RSE) is a measure of the reliability of a survey statistic. The smaller the relative standard error, the more precise the estimate.

Percentile wage estimates for Orthotists and Prosthetists:

Industries with the highest levels of employment in Orthotists and Prosthetists:

Industries with the highest concentration of employment in Orthotists and Prosthetists:

The location quotient is the ratio of the area concentration of occupational employment to the
national average concentration. A location quotient greater than one indicates the occupation has
a higher share of employment than average, and a location quotient less than one indicates the
occupation is less prevalent in the area than average.

Read the Full Report

This article was originally featured in the The State of Orthotics & Prosthetics: 2022 and Beyond. To read the full report, download your copy of the report here!

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