O&P Technicians Catch the Wave

Although changes in the O&P technician's role, status, education, and training aren't happening overnight, the wave is definitely rolling. Energizing forces include the knowledge explosion throughout the healthcare continuum, the surge of new O&P technologies, the changing role and education of the practitioner, and the projected increase in the population needing O&P care. Lin When I first entered this field almost 30 years ago, the physician and orthopedic surgeon were trained much more in the specifics of orthotic and prosthetic prescription principles," recalls Bob Lin, CPO, FAAOP, immediate past president of the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC). "They had to write detailed prescriptions for devices." Procedures such as microsurgery and arthroscopic surgery did not exist, he notes, and with the dramatic increase in the orthopedic knowledge base, "their curriculum became much, much broader." He continues, "Concomitantly, our curriculum went from just learning how to make and fit limbs and braces to such subjects as biomechanics, pathophysiology, [and] the prescription and treatment process. Physicians and surgeons began deferring device design and other specifics to us so they could learn enhanced competencies within orthopedics itself." As O&P practitioners become more involved in the clinical aspect of patient care and therefore require increased knowledge of pathology, epidemiology, motion analysis, and treatment protocols, the technician's role must expand as well, Lin points out. "The technician's role has to grow in terms of materials science and fabrication principles—aspects involved in an associate degree—as well as a concentration in some of the academic areas, so they can function more efficiently and effectively in a fabrication arena without as much oversight." Most technicians today have simply learned their O&P skills through on-the-job training, Lin adds. Wickman Tony Wickman, RTPO, owner of Freedom Fabrication, Havana, Florida, points out that technicians are taking on more of the device-design process. For example, in the past, the dividing line between the practitioner's role and the technician's was often mold modification; however, most technicians now perform that function, he observes. As technicians assume an expanding role in the fabrication, modification, and fitting process, practitioners are freer to spend more time seeing patients. "From a purely business standpoint, should a person with an advanced degree and a very high salary be back in the lab fabricating—or is his time better spent in the clinic?" Lin asks rhetorically. Wickman says, "As practitioners' responsibilities move toward more clinical and administrative areas, technicians must move forward to fill that gap. We need to be sure we have the education to be comfortable with that." ABC's Practice Analysis Provides Insight Carter A practice analysis survey to obtain a current picture of today's technician culminated in the publication of the 2009 "Practice Analysis of Orthotic and Prosthetic Technicians" in October. According to ABC Executive Director Catherine A. Carter, a practice analysis specifically provides a tool for setting contemporary credentialing standards, education curricula, and continuing education. "Re-validating any profession's scope of practice every five to ten years is an important step," Lin says. His term as ABC Board president, which ended December 1, encompassed the time period for the survey and practice analysis. "Methodology changes, technology changes, materials change. A practice analysis is the basis for curriculum models, credentialing—everything." The survey, which culminated in the Practice Analysis, was developed during the 2009 Technician Summit as a cooperative effort by ABC, the National Commission on Orthotic and Prosthetic Education (NCOPE), and Professional Examination Services (PES). PES worked with Carter and the ABC Practice Analysis Task Force (PATF) chaired by Wickman and including William Beiswenger, CPO, FAAOP; Chris J. Harrigan, RTP; Timothy E. Miller, CPO; and Steven R. Whiteside, CO, FAAOP. The survey received a gratifying response, with a yeoman effort to also contact and include non-registered technicians for a more comprehensive picture. The response rate, as measured by dividing the number of completed surveys by the number of valid e-mailed invitations, was 34.5 percent. The overall response rate, including other forms of contact, was an estimated 37 percent—better than one out of three. So, what does the Practice Analysis reveal, and what changes is it likely to bring? A surprise, in a sense, was that there were no significant surprises. The 2009 Practice Analysis revealed little change in the technician's tasks and responsibilities from those shown by the 1999-2000 Practice Analysis. Based on anecdotal experience and evidence, many professionals expected to see more change reflected, particularly in time spent in patient care/interaction versus fabrication. For example, "It doesn't reflect the significant change I anticipated [in direct patient care/interaction]," Wickman says. Catching the Wave in Education, Credentialing Even though the current Practice Analysis shows little change in the status quo, technicians are catching the wave of new developments in education and credentialing. Oros For some time, various O&P leaders have expressed a need for revising and redesigning technician educational curricula and credentialing. NCOPE and educators from NCOPE-accredited technician programs developed a new standards and curriculum guide in January 2009. At press time, the guide was under review by the Commission on Allied Health Education Programs (CAAHEP), which, in cooperation with NCOPE, also accredits the practitioner-level programs. The technician-level educators reviewed the ABC Practice Analysis against the new standards and curriculum draft guide before forwarding it to CAAHEP but did not make any significant changes, according to Michael Oros, CPO, FAAOP, NCOPE Board president, and Robin Seabrook, NCOPE executive director. The new guide is expected to be ready soon for adoption by all current technician-level programs as well as hoped-for new ones, Seabrook says. Seabrook ABC's technician exam and credentialing process is being reviewed for possible redesign, with a meeting of ABC's Technician Examination Committee and some other individuals who attended the January 2009 Technician Summit. The Practice Analysis results will be considered at this meeting, which is tentatively slated for February 5-6. "Generally, a practice analysis generates change—whether sweeping or small," Carter says. "Just exactly what those changes will be is not clear now." Why Not More Registered Technicians? The question has arisen as to why more technicians have not become registered. The Practice Analysis revealed why technicians pursue registration—such as for increased independence, responsibility, respect, job opportunities, and pay—but it did not reveal why they do not. "We don't have a handle on that yet," Wickman says. ABC currently has 638 registered technicians. The total number of technicians in the field is unknown but has been estimated to be as high as 10,000. Lin provides one possible reason that technicians do not become registered. He notes that some O&P business owners no longer give salary increases to technicians who achieve registration because the employers simply don't see that it makes a significant difference. A solution to this, according to Lin, is to add value to the credential with upgraded education that brings more benefits to employers, such as knowledge of manufacturing techniques and principles, materials science, workplace safety, quality control, etc. "For instance, some central fabs have brought in industrial engineers who don't know an orthosis from a prosthesis to help them improve their central fabrication production process. If we can give the technician more value-added tools with the credential, we can increase the perceived value of that credential to both technicians and employers." Just a Matter of Semantics? A controversial area possibly impacting the perceived value of ABC's technician credential is titling it "registered" rather than "certified." To many, the title is simply a matter of semantics. However, Lin asks, "Is a credential more coveted if it is considered 'certification' rather than 'registration?' You register your car, but that says nothing about your qualifications as a driver." "Registration" was originally chosen to differentiate the O&P practitioner from the technician to the healthcare community and public, since to many people outside O&P, certified orthotists and prosthetists are considered technical people providing technical services, Lin explains. Wickman is passionate about changing the term to "certified." He asserts, "How can you 'certify' someone to fit therapeutic shoes or breast prostheses [ABC certifies these specialties] but not 'certify' technicians when their exam process is far more difficult?" To most people, Wickman says, "certification" involves an exam process and implies a recognized level of competence, whereas "registration" only implies that the person signed up for something. Mattear "I would like to see more recognition for technicians, and 'certified' indicates that you have met qualification standards," says Brad Mattear, MA, CFo, general manager of O&P 1 , Waterloo, and a strong technician advocate involved with education and credentialing. "It enhances the credential more than 'registered.'" Although this reporter did not happen to speak with a "registration" proponent, it is noted that ABC's certification programs involve working independently of practitioner supervision, while the technician scope of practice requires this oversight. BOC Weighs In "'Certification' is more easily understood by the allied health community and patients than 'registration,'" says Claudia Zacharias, MBA, CAE, who joined the Board of Certification/Accreditation International (BOC) as president last August. Zacharias Zacharias came to BOC from the American Nurses Credentialing Center (ANCC), the credentialing subsidiary of the American Nurses Association, "so I have a lot of experience in the credentialing area." Zacharias notes that all of BOC's certification programs are recognized by the National Commission for Certifying Agencies (NCCA), "which does not accredit registration programs." Although BOC does not have a specific prosthetic and orthotic technician certification program, it does offer a Certified Orthotic Fitter (COF®) program, basically analogous to ABC's Certified Fitter-Orthotic (CFo) certification. Under both programs, individuals are certified to provide off-the-shelf orthoses and can work independently; practitioner supervision is not mandated. As a side note, BOC too is catching the wave with incoming elevated standards for its prosthetic and orthotic practitioner certification programs. (For more information, visit www.bocinternational.org ) Technicians in the Future Looking to the future, what would these technician experts like to see happen? Says Mattear, "I'd like to see more recognition of the technician with training and credentialing that would provide higher-level custom fabrication support to practitioners." Mattear would also like to see manufacturers donate more products to education programs in order to give students more hands-on experience in fabricating devices incorporating new components and technology, as well as provide more continuing education opportunities to working technicians. To aid educational consistency, Mattear suggests a standard core curriculum for the technician schools, with opportunities to specialize in various areas such as upper-limb prosthetics. "I'd also like to see more people attracted to the technician field—people who enjoy working with their hands and don't want to—or can't afford—four or more years of college," he adds. Lin has a similar desire. "I'd like to see an identification of the true value of the credential, and then I'd like to see a marketing effort to attract people to the technician field. Today's job market includes many displaced people who don't want to return to college to get a bachelor's degree—shortly to be a master's—to enter at the practitioner level, but who would enjoy the technical aspect. I'd like to see an effort to increase awareness of the technician profession along the lines of the [American Academy of Orthotists and Prosthetists'] very successful program to market the O&P practitioner career." Says Wickman, "I'd like to see the ABC technician credentialing process be realigned with current industry goals and to increase in popularity, being updated and easier and less expensive to access. I'd like to see the technician's role elevated to the stature I think it deserves." He adds, "We need to increase the recognition of O&P across the board, and we can't leave anybody behind. Consumers want to be sure every link in the healthcare chain is competent in what they do." Miki Fairley is a freelance writer based in southwest Colorado. She can be contacted via e-mail at linkEmail('miki.fairley','gmail.com'); Today's Technician: 2009 Practice Analysis Highlights What does ABC's 2009 Practice Analysis reveal about today's technicians? To answer that question, here are some highlights: Professional Background, Work Setting, Demographics Fifty-seven percent answered from the prosthetics perspective, 43 percent from the orthotics perspective. Average years of experience: 14.5. Primary work setting: Almost one-third work in a publicly owned multi-facility orthotics or prosthetics practice; almost 20 percent in a hospital-based practice; nearly 16 percent in a privately owned single practice; and about 11 percent in a privately owned multi-facility practice. Employment: More than 80 percent are employed by a single or multi-facility practice; 6 percent are employed by a central-fabrication company; about 6 percent are practice owners; and another 6 percent are employed by a central fabrication company. Educational level: High school/GED with O/P certificate, 35 percent; high school/GED alone, 17 percent; associate degree, 11 percent; high school/GED and O/P short-term courses, 9 percent. Race/Ethnicity, Gender: Respondents were predominantly Caucasian/white (86 percent) and male (91 percent). Tasks Orthotic perspective: Sixty-six percent of time is spent in orthotic fabrication, 9 percent in prosthetic fabrication, and 12 percent in clinical patient care (either with or without supervision). Seventy-one percent of work time is spent in the lower-limb practice area, with a majority being spent on AFO devices. The spinal area consumes 12 percent, followed by the upper-limb area, 7 percent, and scoliosis, 6 percent. Prosthetic perspective: Sixty-two percent of time is spent in prosthetic fabrication; 16 percent of time in orthotic fabrication; and 13 percent of time in clinical patient care, either with or without supervision. Forty-two percent of work time is spent in the transtibial practice area, followed by transfemoral, 26 percent; Symes, about 7 percent; and partial foot and knee disarticulation areas, both about 5 percent. No other practice area required more than 5 percent. Clinical Patient Care At varying percentages, patient care tasks included performing follow-up/evaluation/ adjustment; performing initial patient evaluation; measuring/molding/digitizing/scanning patient; and fitting. The report noted that it is unclear whether technicians are performing these tasks independently or are assisting the practitioner. The complete 2009 Practice Analysis can be downloaded at abcop.org/certification/registeredoptechnician/documents/technician%20practice%20analysis%202009.pdf The 1999/2000 Practice Analysis can be downloaded at www.ncope.org/summit/pdf/practiceanalysis.pdf

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