Why Educated Technicians Are Critical to the Future of O&P Care and How Your Contribution Matters
ABOUT THE HOPE CAREERS CONSORTIUM
In 2013, the HOPE Careers Consortium, which includes Century College, Spokane Falls Community College, Oklahoma State University Institute of Technology, Baker College - Flint, and St. Petersburg College, received an $11.1 million grant from the U.S. Department of Labor (DOL) to expand the ability of the colleges to deliver O&P education and career training. Through the DOL grant, our unique work has helped us learn much about the O&P industry and the potential job market for graduates of O&P technician programs. The trends we have discovered provide essential information for students entering our programs as well as for the O&P profession's ability to meet the demand for services in the future.
Changes in the O&P profession show that certified O&P practitioners are becoming more focused on clinical patient care management, outcome measures, and evidence-based practice, and they are spending less time in the O&P fabrication lab. With these changes in patient care, certified practitioners have less time to focus on technical knowledge and skills, thus increasing reliance on technicians for fabrication of devices. While the shift in division of labor impacts the complexion of the O&P workforce, the need for O&P professional care clearly remains. In 2015, the National Commission on Orthotic and Prosthetic Education (NCOPE) retained the healthcare consulting firm Dobson DaVanzo & Associates, Vienna, Virginia, to evaluate future personnel demand and projected personnel supply for the O&P profession, both of which the evaluation shows will increase by 2025. A variety of factors contribute to this projection, including an increased need for services for an aging baby boomer population, an increased prevalence of diabetes, and a sizeable population of veterans with amputations, as well as the number of current O&P personnel reaching retirement age.
In evaluating the job market for O&P technicians entering educational programs, it is interesting to look at the current demographics of the workforce. Among Americans, the average retirement age is 63. Survey data shows that in the United States, 42.7 percent of the technicians are over 50 years old, and in Canada, 29 percent are in this category.1 As more technicians retire, more opportunities will exist for new technician graduates. For technicians, employment options are available throughout the United States and Canada in small and large practices, acute care hospitals, central fabrication facilities, U. S. Department of Veterans Affairs (VA) facilities, and rehabilitation hospitals. This finding is reinforced by DOL data. The O*NET OnLine website (www.onetonline.org) shows that tracking of job growth potential for O&P technicians for 2014-24 has changed to "faster than average growth."2
The hidden job market represents jobs that are not readily visible to job seekers—they are not posted on the internet, on career sites, or in newspapers and journals—but are circulated by informal or nonpublic means. Networking seems to be an effective key to finding unpublished jobs through word-of-mouth information shared among employees in a particular field.3 For O&P technicians, advertised job opportunities abound even without tapping into the hidden job market.
During the 2015 and 2016 calendar years, the authors collected and compiled employment ads for O&P technicians that appeared in journals, online, and through O&P networks to compare the number of advertisements with the number of graduates from the seven colleges teaching O&P techs during the corresponding calendar years. It was important to gather this information because of occasional reports from graduates that there are no O&P tech jobs available and, thus, that they have to find employment in another field.
In 2015, 252 jobs for O&P technicians were posted on career sites, in journals, and online. Among those advertisements, most of the jobs were offered in the following states: California (13), Florida and Georgia, (14 each), North Carolina and Pennsylvania (12 each), and Texas (38). During the same calendar year, only 71 people graduated from the seven O&P college technician programs. Similarly, in 2016 the number of available advertised positions was considerably higher than the number of graduating O&P technicians. In 2016, there were 317 advertised positions for O&P techs but only 77 tech graduates throughout the United States. The states with the highest numbers of positions offered were: Tennessee (23), Texas (25), California (22), Florida (24), New York (21), North Carolina (19), Minnesota and Michigan (13 each), and Oregon (12). This data shows the wide range of available advertised positions for O&P technicians throughout the country.
To help students avoid searching in states without any posted positons or with only one position listed each year, in 2015 and in 2016 five states had no advertised positions listed in journals, online, or in newspapers: Delaware, Iowa, Maine, Vermont, and West Virginia. Similarly, in 2015 and 2016, only one position was listed in either year in Washington DC, Hawaii, Kansas, Nebraska, New Hampshire, Rhode Island, and Wyoming.
Tracking in 2015 showed that among the advertised positions for O&P technicians, only a small percentage (11.7 percent) of positions sought techs with O&P technician education. However, a large percentage (59.3 percent) of the advertised positions sought technicians who had O&P experience. In 2016, the data showed a similar outlook, with 10.3 percent of the employers seeking employees with O&P tech education and 38.5 percent seeking technicians with experience.
Informal surveys of techs and comments shared by O&P employers indicate that salaries for O&P technicians are higher on both coasts than in the middle area of the country. Initial salaries for entry-level techs on the coasts generally begin at $30,000-$41,600 per year plus benefits; experienced techs can earn $50,000-$73,000 per year there. For O&P technicians who are working full-time in the Midwest, salaries ranged from $10,000-$50,000 per year. Survey data shows that certified technicians earn about $10,000 more per year than noncertified technicians. Additionally, throughout the country, most O&P tech positions offer medical, dental, and vision insurance; vacation; sick leave; and 401k benefits.
Proposed Changes in the Profession
Another factor that has surfaced recently is the proposed rule interpreting Section 427 of the Benefits Improvement and Protection Act (BIPA) of 2000, which was submitted by the Centers for Medicare and Medicaid Services (CMS) regarding the establishment of special payment provisions and requirements for qualified practitioners and suppliers of O&P prostheses and custom-fabricated orthoses. In the proposed rule, published in the Federal Register (Vol. 82, No. 8/Thursday, January 12, 2017/ Proposed Rules/page 3678-94), CMS is proposing that "claims for prosthetics and custom-fabricated orthotics that are submitted by qualified suppliers or by beneficiaries must have been furnished by a qualified practitioner and fabricated by a qualified practitioner or a qualified supplier." The proposed rule also defines the requirements for a "fabrication facility" and states that the facility will "have full-time appropriately credentialed staff member(s) who are qualified practitioners or qualified suppliers onsite to fabricate and to supervise fabrication." This proposed rule states that failure to meet these requirements may result in denial of Medicare reimbursement. It also supports the training and certification of O&P technicians to "ensure that only those who are qualified to do so can furnish, fabricate, and bill for the prosthetics and custom-fabricated orthotics addressed by the proposed rule."4
In a November 2014 article written by Tom Padilla, CPO, Brownfield's Prosthetic & Orthotic Technologies, headquartered in Meridian, Idaho, he portended this outcome, stating, "Third-party payers and government organizations require all providers/ practitioners to be certified in order to be reimbursed for their services. As healthcare continues to change, all members of the healthcare team, including O&P technicians, will likely be required to be certified in order to receive reimbursement for services."5
The Importance of the Educational Pathway
The aforementioned proposed rule should serve as an alert to the potential challenges facing the orthotic, prosthetic, and pedorthic communities in the not too distant future. It is imperative that the entire O&P profession become immediately proactive in meeting these challenges. Our proposal is a multipronged approach:
· - Support the existing technician education programs by serving on their advisory boards to ensure compliance with standards
· - Provide feedback to NCOPE when new standards are proposed
· - Encourage employees to enroll in continuing education programs
· - Provide internship and clinical experiences for technician students
· - Hire graduates of the technical programs at sufficient wages to support their cost of education, certification, and potential relocation
· - Encourage current practicing technicians to seek certification (thus documenting their level of knowledge and skills for interested third parties) and subsequent continuing education
The changing face of O&P practitioners and their practice models, which has moved toward advanced degrees and evidence-based practice but away from fabrication skills and techniques, also reinforces the need for tech education. To meet the demands of an educated and certified technician workforce in a changed practice model, the educational pathway to certification is key to assuring success.
What Can Current Practitioners, Technicians, and Business Owners Do?
The challenges ahead are significant, but they are also surmountable, and overcoming the challenges will involve everyone playing their part. Our experience suggests that an increase in the following activities may go a long way toward hedging against a potential personnel shortage in the future.
Promote the Profession in Your Community
Many middle schools and high schools are on the lookout for professionals in the community who are willing to share what they know and what they do—some through designated career days. Imagine what could happen if every practitioner and technician in the industry visited his or her local school just once every other year.
Another way to raise awareness for the profession is through community-based associations. Your local Chamber of Commerce is an excellent place to showcase your business and to situate the profession more prominently in the community. Several associations that host national college fairs for incoming high school students focus on key groups of people who may be more inclined toward a career in O&P such as the Health Occupations Students of America, Recruit Military, and the National Association for College Admission Counseling. Being an O&P ambassador can meaningfully affect the standing of the O&P profession in your community.
Provide Information for Workforce Centers
Our nation's workforce centers are vehicles designed to get Americans back to work, but they also assist in helping people identify new career paths, like O&P. However, workforce center counselors are ethically obligated to guide people toward careers that provide a high probability of employment.
Before a workforce center counselor makes a recommendation for career change, he or she considers the opportunities that are available within any given industry. One of the easiest ways for a counselor to tell if a job is in high demand is by checking the number of available job postings in the area. More job postings equal more opportunities, which equal more referrals in the selected industry. If employers post available job positions online, workforce center counselors can more readily identify O&P opportunities, and the postings improve the overall visibility of the profession.
Counselors may also use lists of high-demand jobs available within a region compiled by workforce investment boards to gauge job demand. These lists are compiled from labor data that track high-growth industries and higher-wage job opportunities.
A workforce center may also have close working relationships with local businesses, and those relationships will encourage companies to share job opportunities with the workforce center counselors. Thus, having a working relationship with your local workforce center is an excellent way to help maintain the flow of new professionals into the profession.
Forge Relationships With Regional Tech Schools
In the United States, there are seven colleges teaching O&P technology. The combined number of graduates from these schools averages in the low to mid 70s each year, creating a sustainable source of trained professionals for the industry. Unfortunately, because of funding cuts and continued lack of awareness about the O&P tech programs, the future of these programs is uncertain. Perhaps now more than ever, the O&P technician schools need the strong support of everyone working in the O&P industry.
As public and private institutions have grappled with budget cuts for years, the provision of technical programs has become more difficult and challenging, especially since the economic recession of 2007-09. While many sectors of the economy have recovered, higher education has continued to struggle. Tough budgetary times have caused institutions across the country to cut expensive technical programs when enrollments have declined. Training O&P technicians requires a significant amount of lab space and equipment, making these programs expensive to operate. The best method to hedge against cutting a program is to fill the seats with students. This is where each of you can help.
Every interaction you have in your clinic or with community members is an opportunity to inspire someone to become another great O&P professional. Spreading the word about the O&P profession will help ensure that the technician schools remain well attended, and in turn, will provide clinics and hospitals with high-quality candidates in the years to come. It is a symbiotic relationship and the support must go both ways. We ask you to contact your regional technician school and ask how you can get involved.
Ruthie H. Dearing, MHSA, JD, has an educational background in management, healthcare, and the law, and was president of a consulting firm specializing in women's and children's healthcare programming for 20 years. As part of the HOPE Grant Consortium, she is the program manager for the O&P Technology Programs at Spokane Falls Community College.
Stephen Kelly, MS, is a project manager for the Orthotics, Prosthetics, and Pedorthics HOPE Careers Consortium. He currently works in collaboration with the Century College orthotics and prosthetics program.
Daniel Minert, MS, CO, served as the director of the O&P Technology Program and as the HOPE TAACCCT Grant Program manager for Baker College. He has more than 25-years of clinical practice in orthotics, emphasizing foot, ankle, and sports-related issues in support of his passion for education.
1. American Board for Certification, Board of Certification/Accreditation, Orthotics Prosthetics Canada 2016
2. O*Net Online US Department of Labor Employment and Training Administration, 2013-2016
3. Livecareer.com/quintessential, 2014-2016
4. Federal Register / Vol.82, No.8/Thursday, January 12, 2017/ Proposed Rules
5. O&P Programs SFCC Volume 1, Issue 1, Fall 2014 http://www.spokanefalls.edu/TechProf/OrthoticsProsthetics/_pdf/News/News2014Fall.pdf