In this episode, Michael Leach joins us, a certified prosthetist and orthotist who began his career as a high school volunteer in 1975. Michael shares his journey, highlighting key mentorships and the evolution of education in the field, from certificate programs to degree-based training. He emphasizes the significance of hands-on learning in developing skilled professionals.
We also explore the impact of climate and financial factors on prosthetic fitting and accessibility. Michael discusses how issues like sweat in humid environments and the need for waterproof systems affect prosthetic design and usage. Additionally, we examine the financial dynamics of the industry, comparing reimbursement practices across countries like Germany and Scandinavia, and how these practices influence innovation.
The episode covers the latest advancements in prosthetic technology, including microprocessor knees and 3D printing, which are redefining the possibilities for amputees. We hear the inspiring story of Robert, an amputee athlete who motivates others with his determination. Through engaging stories, the conversation emphasizes the importance of personalized care, professional support, and the role of clinicians in advancing patient care and inspiring the next generation of prosthetic specialists.
Special thanks to Advanced 3D for sponsoring this episode.
00:00:00.681 --> 00:00:03.650 Welcome to Season 9 of the Prosthetics and Orthotics Podcast.
00:00:03.650 --> 00:00:11.446 This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen.
00:00:11.446 --> 00:00:19.646 Our goal To share stories, tips and insights that ultimately help our patients get the best possible outcomes.
00:00:19.646 --> 00:00:22.547 Tune in and join the conversation.
00:00:22.547 --> 00:00:27.751 We are thrilled you are here and hope it is the highlight of your day.
00:00:28.981 --> 00:00:34.671 Hello everyone, my name is Joris Peebles and this is another edition of the Prosthetics and Orthotics Podcast with Brent Wright.
00:00:34.671 --> 00:00:35.353 How are you doing, brent?
00:00:37.424 --> 00:00:40.732 Man, how does it feel after recording the 100th episode?
00:00:47.000 --> 00:00:47.159 episode.
00:00:47.159 --> 00:00:47.701 It feels amazing, dude.
00:00:47.701 --> 00:00:51.194 I feel blessed that we can do this and that we keep getting to do this, and it's a really wonderful time.
00:00:51.194 --> 00:00:53.822 Every week we do this and I enjoy it still, and I hope you do too, right.
00:00:54.343 --> 00:00:55.645 Oh yeah, for sure.
00:00:55.645 --> 00:01:12.671 I mean, what's been crazy is there are people that I talk to that aren't even in the orthotic and prosthetic field, that are curious, and so they'll actually say hey, man, I just listened to such and such episode Because we have had some kind of cross-linking right.
00:01:12.671 --> 00:01:33.944 We've had Duan on and we've had a few other people like Brooke Drum you know he's not in O&P and so that's been really fun to have interest from people that are kind of sidebar, can see how additive manufacturing specifically for orthotics and prosthetics can be so valuable.
00:01:34.426 --> 00:01:35.287 Yeah, super cool yeah.
00:01:35.287 --> 00:01:36.331 I'm just still.
00:01:36.331 --> 00:01:37.835 I'm really happy we can still get to do this.
00:01:37.835 --> 00:01:39.319 Uh cool and um yeah.
00:01:39.319 --> 00:01:41.421 So who is sponsoring this, this episode?
00:01:42.022 --> 00:01:45.468 for this episode continues on with advanced 3d.
00:01:45.468 --> 00:02:03.965 Um, so advanced 3d as a contract manufacturer, we meet you wherever you are, uh, along with paul and tyler, and you met katie actually just a little bit ago, on a couple episodes ago and, um, whether you're trying to figure out, hey, how do I start scanning?
00:02:03.965 --> 00:02:05.727 Or I'm looking at definitive sockets.
00:02:05.727 --> 00:02:08.413 We're here to help you on your digital journey.
00:02:09.280 --> 00:02:09.661 Super cool.
00:02:09.661 --> 00:02:11.348 So who is our guest today?
00:02:11.500 --> 00:02:16.231 So I'm super excited to have Michael Leach on the show today.
00:02:16.231 --> 00:02:51.927 I've known Michael for a long time and he's been in the field for a long time, so he's seen a lot of progress over the years on where we've gotten to and what's brought us to today, and so I'm really excited to dive in to some of the history of the prosthetics, of what he's seen, what he's seeing in the future and he is newly retired, so I know he still has his finger on the pulse, but he's getting a lot of time in the outdoors and also with grandkids, so I think that's pretty cool.
00:02:52.568 --> 00:02:54.173 Welcome to the show, Michael.
00:02:54.800 --> 00:02:55.883 Thanks Great to be here.
00:02:55.883 --> 00:02:57.068 I appreciate the invitation.
00:02:58.542 --> 00:03:00.368 So, michael, how did you get started in OMP?
00:03:01.819 --> 00:03:04.552 Well, like I mentioned, I've been in the field a long time.
00:03:04.552 --> 00:03:09.388 I started in 1975 when I was a senior in high school.
00:03:09.388 --> 00:03:13.858 Going to college was not really an option.
00:03:13.858 --> 00:03:16.264 Not going to college was not an option for me.
00:03:16.264 --> 00:03:27.153 So I knew I was going and my high school had a program where if you volunteered in a career path you might be interested in, you could get credit towards graduation.
00:03:27.153 --> 00:03:34.913 And I had two older sisters, an occupational therapist and a speech pathologist, audiologist, who introduced me to O&P.
00:03:36.259 --> 00:03:47.411 So I grew up in Detroit and I volunteered at the Detroit Rehabilitation Institute in downtown Detroit and I really got kind of excited about it.
00:03:47.411 --> 00:03:52.639 It was hands-on for me and they were really a great group of people.
00:03:52.639 --> 00:03:58.731 I still consider that cadre of professionals that I met there as some of my best mentors.
00:03:58.731 --> 00:04:14.360 They really drove my sort of professional compass where it needed to be and led to a summer job and halftime job when I started going to college.
00:04:17.024 --> 00:04:22.915 And back then the field was transitioning from certificate programs to baccalaureate programs.
00:04:22.915 --> 00:04:26.238 I know that kind of seems funny now that there's the master's degree pathway, but they were just starting the baccalaureate programs.
00:04:26.238 --> 00:04:28.838 I know that kind of seems funny now that there's the master's degree pathway, but they were just starting the baccalaureate program.
00:04:28.838 --> 00:04:36.473 So, being a senior in high school, it only made sense for me to go in that direction.
00:04:36.473 --> 00:04:41.733 And there were only two schools back then University of Washington and New York University.
00:04:41.733 --> 00:04:51.471 So as a kid growing up in Detroit, it was kind of exciting to know that I would either be living in New York or Seattle to pursue a professional path.
00:04:52.132 --> 00:04:55.209 Okay, that's cool, and then, and how would you like to study back then?
00:04:55.209 --> 00:04:57.891 Was it very practical or was it kind of like?
00:04:57.891 --> 00:05:01.266 Did you really feel, felt like it did a good job of informing you what you were actually supposed to do?
00:05:02.081 --> 00:05:03.225 Yeah, I think it did.
00:05:03.225 --> 00:05:13.504 And I started in the field primarily interested in orthotics and so this volunteer work that I did really exposed me to that in a very practical way.
00:05:13.504 --> 00:05:22.406 I saw patients and casted and fit devices and so forth so I knew what I was really getting into when I went to school.
00:05:22.406 --> 00:05:24.411 I think it was very practical at the time.
00:05:24.411 --> 00:05:27.449 You know you don't fit a lot of devices.
00:05:27.449 --> 00:05:30.322 At least back then when you went to school you didn't fit a lot of devices.
00:05:30.322 --> 00:05:41.091 You know if you in your trans-tibial prosthetic course you may fit one or two, I remember transferable I fit one.
00:05:41.132 --> 00:05:48.795 So you're hardly an expert, you know when you leave but you get the fundamentals and there was no residency program when you graduate.
00:05:48.795 --> 00:05:56.021 You just uh, sort of entered the field and you had to have a certain number of years experience before you could you could sit for the exam.
00:05:56.021 --> 00:05:57.163 It was a year back then.
00:05:57.163 --> 00:06:17.829 So you know I don't know how graduates feel now, but I know that I became a certified orthodist first before a cpo and um I I I didn't feel like I was particularly, I was competent really in certified orthodist until I had about five years under my belt, even though I was credentialed.
00:06:17.829 --> 00:06:22.990 It took a number of years before I I could reflect on my career and say you know if anything walked through the door, now I have enough experience that I can figure it out.
00:06:22.990 --> 00:06:27.108 Okay, and then and say you know if anything walked through the door, now I have enough experience that I can figure it out.
00:06:28.502 --> 00:06:30.807 Okay, and then did you go for your own practice?
00:06:30.807 --> 00:06:31.689 Did you work for other people?
00:06:31.689 --> 00:06:32.651 What was your path after that?
00:06:33.000 --> 00:06:34.264 I never did my own practice.
00:06:34.264 --> 00:06:37.612 I worked for other people my entire career.
00:06:37.612 --> 00:06:46.507 I was not kind of entrepreneurial or a risk taker in that way, but throughout my career I've worked in almost every professional setting you could think about.
00:06:46.507 --> 00:06:49.331 I worked for a large.
00:06:49.331 --> 00:06:54.423 You know like I worked for Wright and Phillips.
00:06:54.423 --> 00:06:59.002 When I came out of school they had 30 offices in Michigan back then, so they were very large.
00:06:59.002 --> 00:07:05.891 I worked in a couple of institutional settings along the way the Detroit Rehab Institute, university of Michigan Hospital.
00:07:05.891 --> 00:07:25.646 I worked for small, single-owned mom-and-pop practices along the way and then I worked for the large sort of multinational organizations the Hanger, nova Cares until I transitioned into the kind of medical device manufacturer side, transitioned to the kind of medical device manufacturer side after about I don't know 27 years.
00:07:25.646 --> 00:07:26.807 I worked for Autobach.
00:07:26.807 --> 00:07:31.211 For 18 years I worked for PhilHour.
00:07:31.211 --> 00:07:38.536 So I enjoy the education aspect and the product development aspects of those experiences.
00:07:45.660 --> 00:07:53.687 This is really interesting because, like, okay, so imagine, if you contrast these mom and pop stores, the more chain kind of medium chain stores, the larger chains, and then the device manufacturers, and then the institutionals right, those are like the main groups, I guess.
00:07:53.687 --> 00:07:54.831 Right, there's more, I guess.
00:07:54.831 --> 00:08:03.545 Do you think that they're optimal for a different stage in your career or a different type of person, or are you like no, no, everyone should just work for autobalk.
00:08:03.545 --> 00:08:08.012 That's the end of everything, that's the best employer ever, or something well, I think there.
00:08:08.673 --> 00:08:15.682 I think there are a number of stages in your professional career, I think when you first are, when you're doing your residency and you're you're first in the field.
00:08:15.682 --> 00:08:25.987 So maybe your first five, ten years, um, I think it's a good idea to expose yourself to a very busy practice that sees a wide diversity of work.
00:08:25.987 --> 00:08:32.885 If you want to be, you know, so you can determine what you want to maybe focus your career on.
00:08:32.885 --> 00:08:47.682 If there's a particular aspect of the field that interests you, like pediatrics, for example, or you prefer orthotics versus prosthetics, or whether you want to be more of a generalist, you know.
00:08:47.682 --> 00:08:51.059 And then after that it sort of has to fit your personality.
00:08:51.279 --> 00:08:55.565 There are certain work related.
00:08:55.565 --> 00:09:16.764 You know, pressures and obligations that go with each sort of niche that you were there, like when you, when I worked for university of michigan hospital, I worked primarily in spinal orthotics and pediatric orthotics and the spinal orthotic was very intense.
00:09:16.764 --> 00:09:18.489 It was an on-call practice.
00:09:18.489 --> 00:09:22.442 I could I remember this was long before uh scanning.
00:09:22.442 --> 00:09:32.307 I mean I remember casting for, you know, 10, 12 TLSOs on a clinic day and then being called in at 2 o'clock in the morning to fit a halo.
00:09:32.307 --> 00:09:41.788 So I think it's good early in your career to get a lot of exposure and then you can see where you fit.
00:09:41.788 --> 00:09:48.874 If you want to live in a rural community, you need to be a jack-of-all-trades, because it's hard to.
00:09:48.874 --> 00:09:51.620 There's no niche in uh or specialty.
00:09:51.620 --> 00:09:52.501 There's not enough.
00:09:52.501 --> 00:10:05.104 You know critical mass of any one thing where you would be a specialist uh per se, if you follow my meaning and so, and how about working for like, like these device manufacturers, because that could be very different, right?
00:10:05.124 --> 00:10:05.163 we?
00:10:05.163 --> 00:10:11.754 We see, the people we've talked to so far, all did this after doing going to practice first and are going to professional life first.
00:10:11.754 --> 00:10:18.544 Is that a very different thing, cause that could be very corporate, I guess, or very or, and you also, all of a sudden, you don't see patients anymore.
00:10:18.544 --> 00:10:19.609 That could be very different, right.
00:10:25.480 --> 00:10:25.900 Well, uh, yes and no.
00:10:25.900 --> 00:10:27.703 I mean you do see patients, but you don't have the lifelong relationship.
00:10:27.703 --> 00:10:34.475 You know, if you work in a clinical practice and you're there for any length of time, you have this long-term relationship with the people that you work with.
00:10:34.475 --> 00:10:41.289 When you're working for a medical device manufacturer, depending on your role, many of these roles are clinical education, right.
00:10:41.289 --> 00:10:53.873 So the devices are sophisticated and you would go out and partner with your colleagues in clinical practice to make sure that they would always get an optimal result.
00:10:53.873 --> 00:11:03.633 That was the goal to make sure they felt comfortable and familiar enough with the technology that when you weren't there, they could be outlandishly successful with it.
00:11:03.633 --> 00:11:08.639 You know each human being that you work with presents with a unique set of circumstances.
00:11:08.639 --> 00:11:12.287 No transfemoral amputee is like I fit.
00:11:12.287 --> 00:11:20.772 I don't know thousands and thousands of sea legs, but everyone was a little bit different because each human you're working with is a little bit different.
00:11:20.772 --> 00:11:27.501 So that's, you know the education role and it's a road warrior role for anybody who's doing that.
00:11:27.501 --> 00:11:32.812 You're traveling 75% of the time, so you have to appreciate that.
00:11:32.812 --> 00:11:34.942 I would say it's a lifestyle.
00:11:34.942 --> 00:11:36.104 You have to appreciate it.
00:11:36.104 --> 00:11:49.769 So you are seeing patients, but the longer you stay in that role, the less how familiar you are with the rest of the field, if you will, because you're fitting a brand all the time.
00:11:49.769 --> 00:12:07.827 When you're in clinical practice you're choosing what componentry is going into a prosthetic system and I'm sure you know your experience has been that most prosthetic systems represent a number of different brand manufacturers.
00:12:07.827 --> 00:12:20.875 I've seen many medical device manufacturers want to try to capture the entire system from foot to socket, but I rarely see that in practice.
00:12:20.875 --> 00:12:26.567 Now that may change as the current paradigm is changing with consolidation in the industry.
00:12:26.567 --> 00:12:29.142 So that's sort of the education role.
00:12:29.142 --> 00:12:36.346 You get very good at a very specific type of thing and you are often also called into troubleshoot, which is also a lot of fun.
00:12:36.346 --> 00:12:39.683 You know if someone's not getting an optimal outcome.
00:12:39.683 --> 00:12:43.902 So that's the education side and that's what most clinicians are doing.
00:12:43.975 --> 00:12:48.626 I was fortunate enough to also get into the product development side of it.
00:12:48.626 --> 00:13:01.184 I transitioned into the R&D group at Audebach and in the last, I'd say, 10 years of my career for Audebach and Phil Hour I did a lot of R&D.
00:13:01.184 --> 00:13:08.215 I was involved in a lot of product launches, so I really enjoyed working with the engineers in the industry.
00:13:08.215 --> 00:13:20.508 You know your role in that team is to make sure they understand the clinician's mindset, what the clinician's work environment is like, what they confront, you know, in their day-to-day.
00:13:20.508 --> 00:13:22.722 So it was fun working with the engineers.
00:13:22.722 --> 00:13:32.690 It was fun fitting prototypes and various iterations of prosthetic components before they went to launch.
00:13:32.690 --> 00:13:47.592 And for me, it allowed me to travel the world and work with clinicians throughout the world Because, you know, autobot, for example, is the largest manufacturer in the world the largest manufacturer in the world.
00:13:47.592 --> 00:14:00.147 So I got to see various different perspectives and views on what was important to people in different parts of the world and for users in different parts of the world when it came to their devices.
00:14:01.176 --> 00:14:15.330 That's what I want to hear about is I want to hear about some regional differences, because I've heard and I've seen, because I've done some traveling not like what you've done, but like even regional differences of how people practice in the US.
00:14:15.330 --> 00:14:30.226 But then I'd love to hear some of your international stories of like some of the differences between, say, a US practice and and somewhere else, and what kind of struck you as interesting or eye-opening.
00:14:30.748 --> 00:14:35.419 Oh, yeah, sure, you know regional differences.
00:14:35.419 --> 00:14:51.009 Climate has a lot to do with how a prosthetic system is fit and what some considerations are and how the list of priorities might change for a clinician or for a human being.
00:14:51.009 --> 00:14:52.350 You know using the device.
00:14:52.350 --> 00:15:03.767 The southeast, for example, is a very, you know, humid, hot climate and you know clinicians and users struggle with liners.
00:15:03.767 --> 00:15:15.403 With liners, you know, I remember early in the day after Autobach acquired tech interface, I was teaching and fitting a lot of elevated vacuum.
00:15:15.403 --> 00:15:28.110 You know harmony systems back then and it was perspiration management was a daily conversation with a clinician in the southeast.
00:15:28.110 --> 00:15:35.203 But working with someone in the northwest, for example, it wasn't nearly as common.
00:15:35.203 --> 00:15:37.543 I mean, the northwest is very dry.
00:15:37.543 --> 00:15:39.241 Now I live near Portland.
00:15:39.241 --> 00:16:01.480 It's very dry in the summertime, hardly any rain, low humidity, and so even when it gets hot, perspiration isn't as big as an issue, like also like arizona compared to savannah, georgia, um, but when they do get rain it's in the wintertime, but it's it's cooler, so the perspiration isn't as much of the conversation.
00:16:01.480 --> 00:16:16.895 Uh, when it comes to liners and suspension systems and you know those sorts of considerations, you know having a system waterproof is a big thing in the industry now and that's.
00:16:16.895 --> 00:16:21.607 You know, that can also be regional depending on where you live.
00:16:24.056 --> 00:16:34.691 An interesting story globally would be how reimbursement drove clinicians to have to make decisions on what to include in a prosthetic system.
00:16:34.691 --> 00:16:53.379 I remember I was in Germany doing some training for some of my colleagues in Scandinavia, sweden, switzerland, uh, sweden, switzerland and, um, you know, when I was teaching I was talking about, in a perfect world you would fit a custom liner on everybody.
00:16:53.379 --> 00:16:54.943 I mean, they just fit better.
00:16:54.943 --> 00:16:57.616 It's, it's made for unique individual.
00:16:57.616 --> 00:17:15.019 You're, you're making some sort of compromises in and off the shelf liner, uh, you know, they stretch a lot, they can accommodate a lot of shapes, but they're, uh, they're creating different tensions at different points along the limb depending on how they they make the shape of the limb out of the box.
00:17:16.143 --> 00:17:27.384 And one of the breaks um, one of my colleagues was talking to me says you know, I just can't fit custom liners because I I don't get reimbursed in a way that I could make that work.
00:17:27.384 --> 00:17:43.755 You know, I get a flat fee for a trans-tibial prosthesis, for example, and so I have to make my selections of componentry and try to optimize everything for each individual that I work with in a way that I can stay in business.
00:17:43.755 --> 00:17:47.756 It's not that they didn't want to fit custom liners on, everybody can stay in business.
00:17:47.756 --> 00:17:53.406 It's not that they didn't want to fit, you know, custom liners on everybody, just so that the the uh reimbursement environment, you know, just wouldn't permit it.
00:17:53.586 --> 00:18:01.923 In essence and also like do you see, like uh, is there like something where you have an optimal reimbursement environment, or do you have an idea that everyone, ever, all over the world, has?
00:18:02.002 --> 00:18:08.448 like every system has its advantages and disadvantages oh, there's yeah, I would say the latter to that.
00:18:08.448 --> 00:18:15.207 It's unique everywhere you go, and so it's a different conversation that you know, that you have.
00:18:15.207 --> 00:18:35.592 You know we're seeing some nice things happening now in terms of, you know, reimbursement, but there was a period of time that you guys all remember not too long ago where there were lots of audits and there still is a lot of administrative oversight.
00:18:35.592 --> 00:18:38.021 I can't speak to that as intimately to some.
00:18:38.021 --> 00:18:41.076 Maybe Brett can touch on that, since he still does some clinical practice.
00:18:41.115 --> 00:18:49.710 I've been out of it, you know, too long, but every province in Canada is different.
00:18:49.710 --> 00:18:52.605 It's not even though they have a national health care system.
00:18:52.605 --> 00:18:58.126 Each country in Europe, part of the EU, it's all different from country to country.
00:18:58.126 --> 00:19:15.701 So it really is different and unfortunately, decisions about building the optimal prosthetic system is not in the clinician's hands as much as it should be.
00:19:15.701 --> 00:19:30.529 They should be the ones making the decisions, along with the people that they work with, the actual users of the devices, whether it's an AFO or a prosthetic, a trans-tibial prosthesis or a trans-tumor prosthesis.
00:19:30.529 --> 00:19:47.608 That ought to be made locally between the clinician and the user, certainly backed up by clinical evidence and outcome measures, but not driven by things like prior approval or an unregulated insurance industry.
00:19:49.096 --> 00:19:50.140 And how about these different people?
00:19:50.140 --> 00:19:51.805 You mentioned trained Germans and other people?
00:19:51.805 --> 00:19:54.644 We noticed we talked to a bunch of people from different countries.
00:19:54.644 --> 00:19:57.463 The training seems to be very, very different, right?
00:19:57.463 --> 00:20:04.167 Do you see a lot of difference in people, how they approach a certain case, or how they kind of look at it or how they solve it?
00:20:07.963 --> 00:20:12.636 I think that is critically important early in one's career.
00:20:12.636 --> 00:20:24.320 You need to have a foundational uh uh approach, um, so it's good to have sort of uh a specific process you follow.
00:20:24.320 --> 00:20:29.777 But again, we work with unique humans and individuals and they don't always fit into that so neatly.
00:20:29.777 --> 00:20:55.044 So as you get experience and you start getting successes around the edges and solving unique problems and you're left or right from textbook uh solutions, you uh gain some experience and develop some personal you know know philosophies and techniques and we see some you know really you know, sort of super exciting innovations happen.
00:20:55.044 --> 00:20:58.994 The hard thing about that is it's still very human experience.
00:20:59.336 --> 00:21:07.077 So what one clinician can do around fitting a socket is different from the next clinician.
00:21:07.077 --> 00:21:12.060 It's hard to have you know uniformity around that.
00:21:12.060 --> 00:21:17.936 I've seen a lot of socket styles over the years that I've, you know, been in the field.
00:21:17.936 --> 00:21:41.981 In transfemoral there's hi-fi sockets, narrow MLs, narrow mls mass sockets, uh northwestern university sub-issue type socket and some clinicians are wildly successful with with those techniques and approaches and some clinicians have tried them and have not had that success and moved away from that.
00:21:41.981 --> 00:21:47.922 So, um, I think it's a very hard thing to teach socketology, if you will.
00:21:47.922 --> 00:21:49.146 I don't know if that's a real world.
00:21:49.146 --> 00:21:50.109 Real to teach psychotology if you will.
00:21:50.131 --> 00:21:52.002 I don't know if that's a real word, but I think it's very hard.
00:21:52.002 --> 00:21:52.713 That should be a word.
00:21:54.280 --> 00:21:54.683 I like it.
00:21:54.683 --> 00:22:00.623 I think it's very hard to teach clinicians.
00:22:00.623 --> 00:22:10.781 Of course they have a cross to bear when it comes to adopting these technologies because there's a learning curve to it and they're constrained financially.
00:22:10.781 --> 00:22:40.113 How many iterations can you do in an office and are you willing to accept, as you try to adopt a new technology you think might be, you know, promising, or new approach that you think might be promising before you can't keep going on that path because you haven't had the success that you want or desire, or your access to um mentors, uh, to help you along the way isn't?
00:22:40.113 --> 00:22:43.601 Uh is available, uh, you know, as you you would like.
00:22:43.641 --> 00:22:48.222 I remember when I, when, when vacuum first came out, I was teaching harmony systems where I always struggled.
00:22:48.222 --> 00:22:54.827 The adoption of the vacuum still to this day is not widespread in my view.
00:22:54.827 --> 00:23:11.358 I mean, I'm a big believer in the benefits of that technology and we struggled with developing a paradigm that would keep someone engaged with it and use it as a more regular part of their tool bag.
00:23:11.358 --> 00:23:27.924 For example, when we first started teaching these courses, a clinician would come to a course in person with the amputee they were working with and we would work with them for two or three days and build an entire system in-house to get success.
00:23:27.924 --> 00:23:45.065 But then they went home and you have to confront again the unique presentation of a human being and you didn't necessarily have the experiential breadth to confront that, and so your success was maybe marginal the next time.
00:23:45.065 --> 00:23:53.340 Or you took on a challenge that was beyond your reach at that specific, you know, moment in time.
00:23:53.500 --> 00:24:02.576 Often clinicians would come to these courses with patients they've tried everything on and we were the you know, depository of last, you know resort, if you will.
00:24:02.615 --> 00:24:14.330 But really what was going on was that there was some condition beneath the skin that you couldn't see, that the patient had, that needed to be resolved before they could have a prosthetic outcome.
00:24:14.330 --> 00:24:18.709 Anyway, long story short, this paradigm of teaching would change over the years.
00:24:18.709 --> 00:24:55.307 I would go out, we would ask clinicians to give us permission to come in and see them once a month for three months, and we would fit two patients the first month and then on the second month we'd file those two patients, fit another two patients, and the third month we'd file those four patients and fit another two patients, all trying to get them you know as much exposure and experience with a newer approach to fitting amputees so that they would be comfortable and have had enough breadth of experience and fail enough times along the way and overcome those failures to become confident.
00:24:55.307 --> 00:25:02.239 But if you look at the utilization of vacuum technology, it's been pretty static over the past 10, 15 years.
00:25:03.161 --> 00:25:10.284 I'd love to dive a little bit more into that because you know, we, we I say we struggle with some of the 3d printing side of things.
00:25:10.284 --> 00:25:16.124 So I'd love to get your perspective from the product development side.
00:25:16.124 --> 00:25:41.891 And, as you, you know, you with the C leg coming to market and there's a little bit of a lag in adoption of that and then it became more mainstream and then, you know, I think we're kind of in that, as you were talking about this like vacuum technology thing with the 3d printing it's like there are benefits, we don't have the experience or the know-how to do it, so we're just not going to do it.
00:25:41.891 --> 00:25:50.016 And I'm seeing that a lot with 3D technology printing and even just scanning and design.
00:25:50.016 --> 00:25:58.930 Can you kind of extrapolate some of your experience and maybe put it onto this idea of additive manufacturing or digital technology?
00:26:00.987 --> 00:26:01.931 Yeah, I mean, I think I can.
00:26:01.931 --> 00:26:04.888 I mean it's like so when does something become one of the bill?
00:26:04.888 --> 00:26:12.025 Every day it reaches enough critical mass that it's, you know, common, you know common practice.
00:26:12.025 --> 00:26:20.498 I think you have a number of things work against any new, innovative approach to technology.
00:26:20.498 --> 00:26:25.327 One, of course, is reimbursement and the other is having.
00:26:25.327 --> 00:26:31.730 Others are a wide breadth and depth of
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