{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/orthotists-and-prosthetists/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Orthotists and Prosthetists",
    "soc_code": "29-2091",
    "category": "Healthcare",
    "us_employment": 9390,
    "median_annual_wage": 81110
  },
  "verdict": "SAFE",
  "risk_resistance": 75,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 15,
    "embodiment": 18,
    "liability_shield": 13,
    "trust_premium": 15,
    "judgment_accountability": 14
  },
  "reasoning": {
    "task_resistance": "CAD carving, socket file prep, and L-code documentation are genuinely being absorbed by software, but the sequence that defines the job — palpating bony prominences through soft tissue, deciding where to build relief versus load, then reading a patient's compensatory hip hike on the third fitting and grinding the socket brim accordingly — has no digital substitute, which is why this sits at 15 rather than higher: a meaningful slice of your billable day is design and paperwork that will shrink.",
    "embodiment": "You are casting a residual limb with plaster or scanning it in a clinic, then moving to a lab with ovens, vacuum forming, routers, and grinders, then back to a parallel bar to watch ambulation — an 18 reflects that the patient's changing limb volume, skin integrity, and gait are physical variables you can only resolve by touching them, with the only concession being that scanning and central fabrication move some work off your bench.",
    "liability_shield": "State licensure in most jurisdictions plus ABC or BOC certification means your credential is on the claim and your name on the clinical note that justifies a K-level and a component choice; the 13 rather than 18 reflects that a physician's prescription originates the episode and carries the diagnostic liability, so you defend fit and fabrication rather than the decision to amputate or brace.",
    "trust_premium": "Patients return to you for socket changes across years as their limb matures, and they disclose skin breakdown, falls, and abandoned devices to the person who casts them, not to their surgeon — the 15 acknowledges that this relationship carries real switching cost while stopping short of 18 because payer networks, hospital contracts, and prescriber referral patterns often assign the patient to you rather than the reverse.",
    "judgment_accountability": "Choosing between a hydraulic and microprocessor knee for a marginal K3 candidate, deciding whether a diabetic patient's insensate foot can tolerate a total-contact socket, and judging when a scoliosis brace is failing versus needs correction are calls with limb-loss and fall consequences and no protocol that resolves them; the 14 rather than 17 reflects that prescription parameters and payer coverage criteria fence in the outer bounds of what you can select."
  },
  "rationale": "The core of this job is hands-on: taking casts and scans of residual limbs, fabricating or modifying sockets and braces, then watching a patient walk and adjusting alignment by feel over multiple fittings. AI and 3D printing are reshaping the CAD/design and documentation layers, but the diagnostic touch, gait assessment, and iterative fit correction sit outside what current robotics can do. Most states license the profession and ABC certification plus a physician prescription gate the work, and payers require documented clinical justification signed by a practitioner.",
  "outlook": "Design and fabrication will largely shift to automated scan-to-print pipelines, but demand from diabetes-related amputations and an aging population keeps skilled fitters in short supply through the 2030s.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "CMS finally issuing the rule implementing Section 427 of the Benefits Improvement and Protection Act of 2000, which requires that custom-fabricated orthotics and prosthetics be furnished only by a state-licensed or ABC/BOC-certified qualified practitioner for Medicare payment. The statute exists but the enforcement rule has never been fully promulgated; a final rule would make a named certified practitioner the payment-gating signer and exclude unlicensed DME suppliers and remote 'central fab' pipelines from billing.",
        "plausibility": "plausible",
        "would_add": 4
      },
      {
        "dimension": "liability_shield",
        "change": "Licensure spreading past the roughly 20 states that currently license O&P (following the Florida/Texas/Illinois practice-act model), with scope language that reserves patient assessment, casting/scanning, and definitive fitting to the licensee — meaning an AI-generated socket design still requires a licensed practitioner's personal fitting sign-off.",
        "plausibility": "already happening",
        "would_add": 3
      },
      {
        "dimension": "judgment_accountability",
        "change": "Payer or accreditation rules (e.g., ABC facility accreditation standards, or Medicare LCD documentation for microprocessor knees) requiring a named practitioner to attest in writing to K-level/functional-level determination and fall-risk suitability, making that ambiguous call personally attributable rather than a form field.",
        "plausibility": "plausible",
        "would_add": 3
      },
      {
        "dimension": "task_resistance",
        "change": "Task-mix shift as the prefabricated/off-the-shelf brace tier migrates to retail, telehealth, and scan-to-print vendors, leaving the licensed practitioner's caseload concentrated in complex custom sockets, pediatric scoliosis bracing, and multi-visit alignment correction — the tier defined by touch and iterative gait judgment. Watch for prefab volume dropping out of clinic billing mix.",
        "plausibility": "already happening",
        "would_add": 3
      },
      {
        "dimension": "trust_premium",
        "change": "Amputee advocacy pressure (Amputee Coalition campaigns, state 'insurance fairness for amputees' laws now passed in ~30 states) framing device fit as a clinical relationship rather than a product purchase, plus VA contracting that specifies in-person practitioner care rather than mail-order fulfillment.",
        "plausibility": "plausible",
        "would_add": 2
      }
    ],
    "ceiling_note": "Already 75/100; the physical and relational core is the score, so the realistic headroom is a few points on the institutional dimensions. The main downside risk is the opposite of these levers — scan-to-print vendors and DME competitive bidding pulling the prefab tier out of licensed hands entirely, which shrinks headcount even as per-practitioner resistance rises."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2017,
        "emp": 7840,
        "wage": 66240
      },
      {
        "y": 2018,
        "emp": 8830,
        "wage": 69120
      },
      {
        "y": 2019,
        "emp": 9830,
        "wage": 68410
      },
      {
        "y": 2020,
        "emp": 9550,
        "wage": 70190
      },
      {
        "y": 2021,
        "emp": 10410,
        "wage": 75440
      },
      {
        "y": 2022,
        "emp": 9150,
        "wage": 77070
      },
      {
        "y": 2023,
        "emp": 8820,
        "wage": 78100
      },
      {
        "y": 2024,
        "emp": 9930,
        "wage": 78310
      },
      {
        "y": 2025,
        "emp": 9390,
        "wage": 81110
      }
    ],
    "from": 2017,
    "to": 2025,
    "change_pct": 19.8,
    "comparable_from": 2019,
    "spans_soc_revision": true
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}