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Alabama Prosthetics Board Reports Shrinking Licensee Base, Shortfalls Prompt Internal Cuts
Summary
The Alabama Board of Prosthetists and Orthotists told the Legislature's Sunset Committee it is receiving less revenue as higher‑fee practitioners leave the state or retire, creating budget shortfalls that prompted a director salary reduction and a board discussion of further options.
The Alabama Board of Prosthetists and Orthotists told the Sunset Committee on Aug. 15 that the board is collecting less revenue as higher‑fee practitioners retire or move out of state, creating a structural shortfall.
"The primary issue that the board's been having for the past 3 to 4 years is having more expenditures than we're taking in in revenue," Executive Director Ron Ezell said. He said a major driver is a shift in the mix of applicants: "The high end skilled practitioners' license fee is $450 a year, whereby ... an orthotic fitter ... their license fee is $125 a year. So we have lost a good bit of the high end practitioners at $450 and many of the applications are coming into the Board with 125." Ezell added that, despite cost reductions in administrative services, "we were still losing money, having a dip in our cash reserve" for fiscal 2025.
Ezell said the board reduced his own salary by $18,000 a year beginning Oct. 1 to help close the gap. Committee members pressed for alternatives to raising fees. Senator Elliott said increasing license fees while license counts drop is the "wrong way to go," urging the board to seek administrative efficiencies instead.
Committee members and board representatives also discussed access to care. Ezell said some practitioners on the board "are not able to cover all prosthetic and orthotic patients in the state right now based on the shortage" and that "there's at this point there's somewhat access to care issue." Representative Underwood asked how long a patient would wait for care; board members present estimated "a couple weeks" for appointments in many areas.
Regulatory and credential questions were raised about the relationship between state licensure and national certification. Ezell and board members explained that Alabama requires national certification by the American Board for Certification (ABC) or the Board of Certification (BOC) as part of the state licensure application, but that national certification does not fully substitute for state licensure because national boards' historic grandfathering allowed credentialed individuals without the school's coursework now required. Ezell said the national boards currently require a master's degree for prosthetists and orthotists.
The board reported recent outreach and investigations, including one into the national retailer Good Feet. Board staff said Good Feet associates fitted an off‑the‑shelf item in a store and that their lawyers determined the product and interaction did not meet Alabama's definition of a custom orthotic requiring licensure.
The board also described vacancies and recent reappointments. Ezell acknowledged that public appointment records were not up to date on the board website but said reappointments had been made after the report's submission. Committee members urged the board to maintain timelier public records and to actively manage nominations.
The board said it will discuss additional measures at a post‑Sunset meeting. No formal motions or statutory changes were made at the hearing.
