Survey Says... O&P Technicians Define Their Scope of Practice

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By Morgan Stanfield

If O&P had a roster of unsung heroes, technicians would populate the top of the list. They spend much of their professional lives manipulating hazardous materials with hazardous tools, enduring heat, cacophony, and fumes to translate clinical prescriptions into life-enhancing, and sometimes life-saving devices. Some of the most creative and respected technicians have on-the-job training only-or as one technician who spoke to The O&P EDGE said dryly, "no, no formal training, just 40 years of experience"-while others are graduates of quality colleges; some are registered and some are not, but no matter what their professional status, they rarely receive the admiration and respect of patients who wear the devices they create. However, consumers, practitioners, and manufacturers all depend on them as essential links in the O&P manufacturing and clinical care chain.

In April, the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) undertook a scope-of-practice-survey exclusively for technicians, and technicians stood up proudly to contribute their knowledge. Their responses will directly impact the credentialing programs, educational curricula, examinations, and other major factors that will shape the future of their profession. Only a smattering of the survey's data was available at the time this article was written, but the results that follow could mean important changes for technicians' scope of professional responsibility.

Just the Facts

Tony Wickman
Tony Wickman, RTPO

Tony Wickman, RTPO, is chair of the ABC committee that developed the survey. He is owner of Freedom Fabrication, Havana, Florida, and writes and lectures across the profession on technical issues. He told The O&P EDGE, "The question that represented the basis of the whole survey was 'What does the modern technician look like-what do they do for a living?'.... And one of the cool things about this whole process was that it was developed from the ground up with the sole focus being trying to figure out what technicians do-instead of having a practice-analysis survey for practitioners and then saying, 'Oh yeah, have the technicians take it, too.'"

The survey was developed during the ABC technician summit in January of this year, in a cooperative effort by ABC, the National Commission on Orthotic and Prosthetic Education (NCOPE), and Professional Examination Service (PES), New York, New York. According to Wickman, the impetus behind the survey was to address reasons why relatively few working technicians register.

"ABC's technician registration program is a valid program that has reached the end of its useful lifespan and needed to be reengineered," Wickman says. "I was really happy that ABC had clearly indicated it was of interest to them to...get some of these problems solved."

Cathy Carter
Cathy Carter

The survey was made available to ABC registered and non-registered technicians alike for four weeks during the month of April. "We attempted to promote it to the entire profession so that both registered and nonregistered technicians could participate," says Cathy Carter, executive director of ABC. "We sent it to all ABC-registered technicians that we had an e-mail address for, and we also made it available to any technician in the profession who expressed an interest.'" According to Carter, ABC promoted the survey in professional publications, direct mailings, and listservs, through letters to practitioners who might employ technicians, and even through flyers in componentry packaging.

The response, Carter says, is something for which ABC is "very grateful to the technicians' profession." According to statpac.com, the typical response rate for online surveys is less than five percent, but the response rate for this survey was 37 percent of respondents invited by e-mail, plus many more who were invited by other means.

What the Numbers Say

Only two major data points derived from the survey results were available during the writing of this article. The first, according to Carter, is that the way technicians spend their time in 2009 is very similar to how they spent it in 1999/2000, the last time ABC conducted a scope-of-practice survey that included technicians. This means, Carter says, "that the numbers that we have been using for the past seven or eight years for the most recent set of examinations, credentialing programs, etc., are accurate."

Photograph courtesy of Scott Wimberley, CIO, RTPO

The second is that, unsurprisingly, technicians spend most of their time fabricating. People who primarily identify themselves as orthotics technicians reported spending approximately 66 percent of their time in tasks related directly to fabricating orthoses. People who primarily identify as prosthetics technicians spend about 62 percent of their time fabricating prostheses.

How these technicians are spending the rest of their time will be of particular interest and potential controversy when it is revealed. In the 1999/2000 survey, data indicated that a significant and increasing number of technicians were providing some level of direct patient care. This is beyond what ABC tests for or describes in its current scope of practice. According to Carter, that data may or may not be valid. Because the 1999/2000 survey used the same questions for both practitioners and technicians, technicians may have answered the same way that clinicians did but meant something different by their answers. The current survey was designed specifically to prevent such muddling of data.

Projecting Forward

What if technicians really are providing patient care? "Then the really hard decisions get made," Wickman says. "Should we get with NCOPE and ask the schools to shift or broaden their emphasis on the clinical aspects for technicians, or should we just come out and do everything we can to squash that behavior? Nobody is really certain about that yet."

Robin Seabrook
Robin Seabrook

According to NCOPE Executive Director Robin Seabrook, NCOPE is delaying curriculum development and the process of gaining secondary accreditation for NCOPE programs through the Commission on Accreditation of Allied Health Education Programs (CAAHEP) until the technician practice-analysis survey is completed. If technicians are providing patient care, no matter how elementary that might be, Seabrook contends, they need a knowledge base for it. However, she comments, "I don't think we'll need to elevate their degree beyond an associate degree though we might see the opportunity to include more and enrich the programs more to include it. Courses that may be included are the orthotic fitter and post-mastectomy level, which may provide future technicians with improved career versatility."

Dan Minert, an adjunct faculty member of the O&P technical education program at Baker College of Flint, Michigan, says that not only will the practice survey allow schools like his to provide the traditional elements of O&P technical education, it may help prepare students for the fast-moving future of the profession. "This profession tends to be pretty conservative...," he stresses. "I think that one thing that manufacturers and people or practices who employ technicians want is people who are forward-looking." Minert believes the survey will help schools prepare students to integrate current knowledge while acknowledging and proactively moving toward the best practices of the future.

Wickman also sees the survey as a key to technicians' futures. He contends that the survey data will bear out his strong belief that the ABC technician program is due for a shift in nomenclature and that technicians are due greater recognition among the profession's associations. Most importantly, he would like to see technicians who complete ABC training and testing be listed as certified, not registered. With certification, he says, "a better argument could be made to insurance companies providing liability coverage that we're doing everything in our power to produce safe products, which might make some room to negotiate discounts. I think there's also some room to argue that as the technicians move up in stature, the clinician's stature is going to move up as well. Their standards are continuing to increase, and so it makes it look much better to our payers and to insurers." This, he believes, would make passage of professional testing "an actual point of ascension" that would attract more technicians.

Whatever the data indicates, Wickman stresses how important that knowledge will be to long-term planning for the profession. "I think we're growing pecans here, not corn-it'll take a while for these things to bear fruit. But you've got to start planting now. If it's going to take ten years anyway, then let's just go ahead and start digging."

Morgan Stanfield can be reached at