Building an O&P Technician: New Paths to an Evolving Occupation

Formal education has long been considered the preferred path to becoming an O&P technician. With just four accredited programs remaining in the United States, however, employers and would-be technicians are increasingly choosing informal apprenticeship arrangements as an equally valuable, if not more accessible, alternative. These arrangements allow upcoming technicians to gain hands-on experience while employers simultaneously benefit from fresh talent. But as the field evolves, educators and technicians are modernizing their approaches to increase accessibility and respond to changes in the workforce. We spoke with employers, educators, and technicians about their experiences with the formal and informal paths into the profession. Brad Mattear, LO, CPA, CFo, central fabrication program manager, Shriners Pediatric Orthotic and Prosthetic Services, Florida, began his career in orthotic sales before moving into central fabrication, where he discovered a passion for the craft side of O&P. “I always wanted to be around fabrication technicians,” Mattear says. “Even in sales, I was always talking about the technicians, not just the products.” Mattear, who sits on the advisory board for Joliet Junior College (JJC), one of the accredited institutions for O&P technician education, is a proponent of formal training. Still, he understands the need for alternative points of entry in light of technician shortages, which he says were predicted a decade ago. “The industry has done a good job expanding the number of clinical programs for certified orthotists and prosthetists over the past ten years, but when it comes to technical schools for fabrication, I think we’re moving backward by shuttering so many of these.” Shriners CFAB East fabricates for over 14 hospitals and clinics nationwide, including international outreach clinics that Shriners Children’s/POP’s performs yearly. CFAB West is located within the hospital at Shriners Children’s Portland, Oregon. Both locations employ a mix of certified and noncertified O&P technicians. Mattear stresses to team members that there is inherent value in being certified. He says that while the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) assistant credential is a good option for some, it does not address training for those who want to remain solely on the technical side of O&P. “There are a lot of people that don’t want to be a clinician or assistant seeing patients,” he adds. “They want to make things and fix things—and we have to have off-ramps for these folks.” Securing the Future Without continued, specialized focus on fabrication skills, Mattear questions who will remain to build the O&P devices patients rely on. “A lot of these students coming out of master’s-degree-level programs have very little hand skills,” he adds. “They’ve gone from undergrad to grad school and haven’t spent much, if any, time in a lab.” He believes the technical portion of the education results in better clinicians and cites the benefits of programs such as the former one at Century College, which required students to go through the technical track before they could attend the clinical portion. That program has since been modified and is now aligned with Concordia College for students who would like to pursue an MSPO degree. Century College and the remaining three technical schools are still graduating talented technicians—the issue, Mattear says, is that most of them want to stay regional and aren’t looking to relocate like a new MSPO clinician might be. Mattear understands that roadblocks to certification aren’t just about access to education; high student loan burdens and stagnant wages have compounded the issue. Alisha Brennon, CTPO, assistant professor of the Orthotics & Prosthetics Program, JJC, says she never expected to lead an O&P technician program—especially considering she had never picked up a hand tool before entering the field. But after a career change from business to radiologic technology, she found her true calling. After graduating from JJC’s program, Brennon began working at an O&P facility. When the former program director Desmond Masterson retired, she stepped in to help lead the program. She’s now entering her fifth year of teaching. Brennon is a passionate advocate for raising awareness about formal education for O&P technicians, but like other educators she recognizes the systemic challenges. “It’s the chicken and the egg argument,” she says. “There are so many people who want a certified technician, but we aren’t willing to pay them more after they’ve made that investment in training. These degrees are specific to O&P, and we need to incentivize students to pursue them.” Pay is a pressing issue, she says. “Some students come out and are offered $15 an hour. That’s just not sustainable, especially for someone who’s spent two years investing in their education. A minimum-wage job isn’t going to get anyone anywhere.” While JJC receives weekly job postings, many positions are outside the Chicago area. “We get a lot of opportunities in the Pacific Northwest and the Southwest—Arizona, Nevada,” Brennon says. “If students are open to relocating, there are jobs out there.” Incentivizing certifications and accreditations through various channels offers a potential solution, Mattear says. Employer requirements are one, but Mattear believes adding requirements around insurance coverage could help, too. He was involved in creating the original ABC Central Fabrication Accreditation requirement. “That was great because organizations like Medicare and private insurance companies require accreditation from entities such as ABC and [the Board of Certification/Accreditation].” Payers requiring CFAB accreditation would keep fabrication standards higher, he says. “It only takes one to say they want that protection in the case of something like a broken AFO,” Mattear adds. “If someone sues a private clinician, they will just shut their doors—but if there was a requirement and they came back to the ABC accreditation, then you would know the proper standards had been met. It’s no different than a clinician being certified.” Chad Smith, CO, CPed, director of Orthotics/faculty, Orthotic Technology, Century College, also sees the value of incentivizing employers through accreditation requirements, as well as in educational institutions working with employers to motivate them to hire trained technicians. Century College is revamping its O&P technician program to make it more attractive to students, and in Minnesota at least, he says things are improving. “We’re moving to a unified curriculum. Every student completes the same skill-based coursework, but they can choose to enter the workforce at the technician level or continue into fitter, assistant, or practitioner roles without repeating or losing credit.” He is encouraged to see the number of O&P technicians, and their entry-level wages, increasing in Minnesota. With the decline in technician training programs, Smith understands the motivation to hire off the street. But Century works with local employers, encouraging them to promote formal training. Part of that is explaining to employers that when they’re hiring untrained people to fill an immediate need, they have to hit the ground running and they don’t get the benefit of ample training time. Formal programs, on the other hand, offer a low-pressure learning environment where students build confidence and technical skills before facing fabrication production expectations. “That’s the value in the educational pathway.” Century’s training is comprehensive, with a wide base of information and solid foundation of transferable skills including understanding the clinical purpose for what they’re fabricating. “Formal education develops hard skills and soft skills. They aren’t going to get that off the street, so we better prepare them,” Smith says. “Students don’t just learn how to fabricate—they learn why it matters in the patient’s care plan, and they build the communication and collaboration skills to contribute as part of the care team.” In addition to program changes, Century is working with the Minnesota Department of Labor and Industry to develop the Minnesota Dual Training Pipeline by 2026. The initiative gives employers $6,000 a year to put employees through its program. “From my experience, employers want formally trained technicians and advanced skill sets like CAD,” Smith says. “Instead of pitting the industry against educational institutions, we can work together through this program with employers promoting formal education.” More Programs Streamlining Spokane Falls Community College (SFCC) is also streamlining its technician program to make it more accessible. Ambrose Cavegn, BOCP, CPA, CTPO, has been teaching since 2017, and has served as SFCC’s program director since 2020. “While I don’t fully support informal apprenticeship arrangements as a substitute for formal technical training, I understand that these programs have been riddled with problems of viability, staying up to date with the industry, and accessibility for busy practices and potential students that already work full time,” Cavegn says. “But I think we’re beginning to come up with some solutions. I would love to see the development of a formal apprenticeship model that would allow noncertified technicians to work toward certification via structured on-the-job training.” A lack of consistency across programs is one of the problems with O&P technician training. Cavegn says most of the technicians he meets haven’t completed technician education and don’t plan to, which he attributes to a lack of incentive to go through formal training and certification programs. Still, the demand for technicians continues to grow, so SFCC fast-tracked its program from a two-year associate program to a one-year certificate program in a bid to attract more people to the profession. “We were getting practices calling us all the time that were looking for technicians and they didn’t want to wait two years for them to be employable.” Cavegn is also part of the committee involved in revising the National Commission on Orthotic and Prosthetic Education (NCOPE) standards. “Streamlining included eliminating some of the obsolete fabrication project requirements,” he says. “We’ve been careful to make sure that anything we eliminate is covered in other areas of the program.” Students who complete the SFCC program typically leave with multiple job offers. Cavegn says the O&P technician industry is at a confluence, and the days of every practitioner being well versed in fabrication are gone. “Some of the newer practitioners don’t have that fabrication background, so as the older generation retires, it’s leaving a gap. Addressing that gap was a central part of the impetus to revamp the SFCC program. We set this up to be more real-world relevant, accessible, and an easier sell overall for both students and employers.” Cavegn acknowledges a lack of buy-in from the industry at large for technician certification, which further contributes to the problems and gaps. “From the point of view of someone who is formally trained and certified, it can be somewhat disheartening to stand next to someone that was trained off the street and treated as an equal,” he says. “But on the other side, a person trained off the street that finds a good fit in a practice where they’re well trained is certainly capable of doing the same job.” Cavegn sees substantial value in bringing in some of the noncertified technicians and training them in place, whether through online learning components or on the ground. He says such an approach, which reflects technical practice in the real world, would entice more people to get trained. He says SFCC will continue to promote the fundamental skills to build devices. “We graduate students that have knowledge of anatomy and human gait. They know the terminology, tools, and equipment so they can hit the ground running from day one.” The revised curriculum will be stackable with online options so that courses can be offered asynchronously, similar to earning continuing education units. SFCC is even adding a pedorthist program in the fall to help address lower enrollment. This modular approach enables students to get their certificates, go to work, and then continue their education and training remotely as new certifications are needed. Quarter-long, online courses are designed to be less disruptive, enhance employability, and increase a person’s skill level. SFCC also plans to offer a two-part digital workflow course that covers front-end processes like scanning and digital modification, with a second section that teaches how to execute 3D printing and finishing out a fabrication. “The second year, if the student wants to complete all of that, could add up to an O&P assistant credential,” Cavegn explains. “We are trying to become a one-stop shop for any certifications in O&P below the practitioner or clinical level.” SFCC’s revised program still has to be approved by NCOPE, but Cavegn doesn’t anticipate any issues with gaining that. Apprenticeship as a Practical Path Anthony Wickman, CTPO, says he has seen firsthand that apprenticeship can offer a practical career path. He’s spent four decades in the field, with nearly 30 of those years as the owner of Freedom Fabrication, Florida. While he’s worked with several formal training programs over the years, he’s found just as much success training technicians on the job. “I’ve worked with a number of schools in the past and seen great results and not so great results,” Wickman says. “Some stick with it and some don’t.” He estimates that nearly all of the people he’s hired came from nontraditional backgrounds. “All the guys we hire off the street have a trade background,” he says. “I haven’t hired anyone that came out of a formal education system.” He’s hosted interns from formal programs, but never sought out graduates directly, largely due to geography. “We’re in a tiny place here in Havana—it’s a great town, but because of its size there are other, more appealing places to go as an O&P technician.” For Wickman, the apprenticeship model offers a more efficient weeding-out process for those uncertain about the demands of the profession. “A lot of people don’t realize it’s not the job for them until they get all the way through school and into a job,” he says. “An apprentice can get to that point faster.” Despite his preference for on-the-job training, Wickman remains a proponent of certification. He served on the technician registration exam committee for ABC, where he helped establish a third pathway into the field—allowing aspiring techs to train under certified technicians, not just practitioners. “If nothing else, certification opens doors for you,” he says. “If you’re on a list somewhere, there are opportunities that otherwise wouldn’t be available to you. These are all positives for a pretty small investment.” At Freedom Fabrication, employees start by focusing on a specific task but are encouraged to train across specialties. “I tell everyone that works here, ‘The more you know, the more you’re worth,’” Wickman says. As O&P faces uncertainty—tariffs, healthcare shifts, and rapid technology advances—Wickman reflects on its future with cautious optimism. “Life is transition. There will always be a need,” he says. “I’m not sure how far into the future this industry goes, but I hope it’s far.” For now, his focus is on staying profitable and mentoring future technicians. “I did it long enough that I want to hand the torch off to the younger generation,” Wickman adds. Expanding Educational Options Brennon says the future of the profession lies in expanding educational options, including assistant programs that blend technical and clinical skills. But no matter the direction, she stresses the need for industry support. “If we’re not putting as much into the technician path as we are into clinician paths, then we’re going to fail.” She says that the educational programs must do a better job of promoting their students to employers, too. Drawing from her business background, Brennon encourages students to advocate for themselves. “I tell them to fight for their salary. Be proud of your education and let it speak for itself and really represent who you are. After all, if someone doesn’t want to pay you, do you really want to work for them?” Sadie Bowman, CPOA, CTPO, coordinator, O&P Technology, Bluegrass Community and Technical College (BCTC), says a technician career is still worth considering because you never know if you’ll love it and it will be a great fit. Bowman herself almost missed out on a career she now loves. A chance open house at a local program ultimately led her to the occupation. She started with an internship and transitioned into a full-time role, gaining critical hands-on experience. For Bowman and many others, informal training led to a successful career, though it wasn’t without its drawbacks. “I had all these hand skills and patient experience, but there were technical questions about things like mold temperatures on the exam that were unfamiliar,” she says, emphasizing gaps in knowledge and procedures that formal education might have covered more thoroughly. Bowman also highlights the challenges educators face in ensuring formal programs are relevant and accessible. “At BCTC, we’ve taken inspiration from programs like Century College’s curriculum, but adjustments are still needed,” she says. “For example, some accreditation standards require students to fabricate devices they will almost never encounter in their careers.” To that end, she advocates for a reform of standards, ensuring a balance between foundational knowledge and practical, real-world application. She also emphasizes the need to improve awareness about O&P. “People don’t realize what we do, but seeing the impact of your work, even if you aren’t patient-facing, is so rewarding.” Ultimately, Bowman has seen that formal and informal paths can lead to success in O&P. As an educator, she aims to get others excited about the profession, which she affectionately refers to as “medical arts and crafts.” She suggests that flexible options, such as bridge courses to fill technical knowledge gaps for those entering the field through alternative routes, would make technician careers more appealing to newcomers. Bowman also sees a disconnect with many programs being run by clinicians instead of technicians and says that some of the more technical information can be lost in translation as a result. “CPO and technician are different jobs with different focuses, even if they have some overlap or end up working together as a team,” she says. “I don’t know if that causes or stems from this dichotomy that exists in O&P where technician careers are viewed as just a stop on the road to becoming a CPO. But being a technician is a perfectly valid and valuable career on its own—and we can elevate the profession by ensuring that both educational pathways prepare techs for sustainable, fulfilling careers.” Wade Hallstrom, CPOA, operations and technical director, Heidi’s Legs, Minnesota, graduated from the Century College program decades ago, blowing through the one-year prosthetics track in just six months. He then moved to Stanford University and Children’s Hospital, eventually overseeing four O&P production departments. After 28 more years of patient care in Minnesota, his family-owned business now focuses solely on fabrication. While formal training offers structure and a comprehensive curriculum, he doesn’t necessarily see its value for everyone. Hallstrom’s perspective highlights the need for flexibility in how technicians are trained and brought into the field. Throughout his career, he’s hired both certified and noncertified technicians. “When you look at the pay scale, there isn’t always a significant difference between those who have completed formal training programs and those who have learned through hands-on experience or apprenticeships,” he says. Hallstrom emphasizes that, in many cases, on-the-job training can be just as effective, allowing practical skills development without the burden of student debt or lengthy program commitments. He says the O&P industry has been undermined by the thinking that everyone must go to college. “Most of the good prosthetists and technicians I know never needed a master’s degree,” he says. “They are smart in different ways…. People need to know it’s not all about seeing patients, and there will always be a need for the technicians that can fabricate things.” Demetrio Amador, technician, Prosthetics in Motion, New York, was also trained on the job. Having now logged 26 years in O&P, he began in an entry-level role. Working as a mechanic in a cemetery allowed him to transfer his tool skills, and, coupled with some great mentors, paved the way for his technician career, he says. “I started from the very entry level in fabrics and textiles, and I quickly realized I was in a great field,” Amador says. “If you fall into this career like I did, I believe there is still a lot of opportunity.” Amador is now a lab manager and for his part, says he prefers to hire and train people that are totally new to the field. “Each facility is unique in how they fabricate,” he says. “I find it easier to train someone for the nuances of our facility versus having to potentially untrain bad habits they picked up someplace else.” Regardless of the path, Amador says he would absolutely recommend being an O&P technician as a career. Although he believes CAD will play a role, he says the value of the hands-on craft can’t be understated. Looking Toward a Sustainable Future As the technician field evolves, it’s clear that both formal education and alternative, experience-based pathways will be essential to building a sustainable and skilled O&P workforce. Although the educational pathway to a technician career is in flux, it’s clear that more communication about how to get there—as well as advocacy for fair pay—will be critical in carrying the profession into the future. Tara McMeekin is a writer and editor based in Colorado. Photo credits: getty-images/unsplash.com; getty-images/unsplash.com. Pixel-Shot/stock.adobe.com; asem arab/stock.adobe.com; New Africa/stock.adobe.com; getty-images/unsplash.com; Elena/stock.adobe.com; Ольга Іщенко/stock.adobe.com.

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