The Upper Extremity Physician Extender: The US Army Model

US Army Occupational Therapists (OTs) are trained as physician extenders in upper extremity neuromusculoskeletal evaluation and treatment. In the role of physician extender, OTs are trained and credentialed to work independently in support of the orthopedic caseload in both a hospital and deployed environment. OTs undergo a rigorous year-long, 3-phased training program. Phase 1 includes a 6-month preceptorship under the supervision of a hand surgeon. During Phase 1, OTs demonstrate the basic knowledge necessary to be successful in the training program. During this phase they attend hand rounds, assist in fracture clinics, and learn to rehabilitation upper extremity disease and trauma. Phase 2 is a 2-week comprehensive didactic training program designed to train OTs in the evaluations required for an upper extremity exam. This phase also includes a cadaver dissection, and classes and practicum in ordering and interpreting radiographic studies, nerve conduction studies, and laboratory studies; ordering medications and pharmacologic agents, and ends with a comprehensive final examination. Phase 3 includes a 6-month residency designed to demonstrate proficiency and competence in all of the aspects trained in Phases 1 and 2. Here the OT performs the role of physician extender and completes other requirements such as operating room observations, hands-on assistance with fracture reduction and treatment, case studies, journal/literature reviews, and diagnosis reviews. Once OTs satisfy the requirements of upper extremity physician extender, they are credentialed by their local hospitals and are able to perform in the role, autonomous of physician direct supervision. In the primary care role, OTs may be required to diagnose and treat fractures, order laboratory tests and radiographic studies that may lead to a diagnosis of rheumatoid arthritis, or diagnose and rehabilitate a cumulative trauma disorder. This presentation is designed to describe the role of upper extremity physician extender including the requirements leading to credentialing, as well as review 2 cases completely evaluated and treated by a US Army OT, who would normally be diagnosed by an orthopedic surgeon. This role saves time and money for the military, and OTs who undergo and succeed at this rigorous training program are force multipliers. This 5-minute clinical paper is designed to describe a program, briefly discuss 2 cases, and enlighten the audience as to the role of upper extremity neuromusculoskeletal evaluator. Reference: Army Regulation 40–68, Clinical Quality Management; February, 2004.