My first job in O&P started in January of 1986, at the SPS central fab. I was doing above-knee exoskeletal setups, which have mostly been replaced by modular componentry. The next department I cycled to was plaster, where my task was to take the measurements from the patient chart, pour a blank with plaster, then grab my trusty rasp and get to work. After short stints in above-knee/below-knee and lamination, I moved on to orthotics. My next stop was the newly arrived CAD/CAM system, which was fresh off the boat from England. Who knew it would catch on like it has? My last move was to upper extremity, and I'm still there! Thirteen years after those first exoskeletons, I'm an upper-extremity fabrication specialist at my own company, Peaster & Williams, and I still provide customer service and technical support at SPS. Why am I telling you this? Because I believe that technicians are first and foremost about their hand skills and their ability to meet each new challenge they are presented with in the lab or practice. The speed at which this industry is changing requires that technicians update their skill sets constantly by reading industry periodicals and attending state or national meetings (when you can get the funding). With that in mind, how important is it or should it be that technicians have college-level training or degrees? That depends. A tech's future education choices could depend either on personal factors or ones they have no control over. On a personal level, if P&O is your career of choice, I think it can be valuable to go to one of the tech schools. From what I've observed, graduates of these programs come out with great hand skills and basic knowledge. Beyond that, once you have completed the program, the office you choose to work in will train you in its way of doing things anyway. If you are interested in P&O but aren't sure if it will be a long-term career choice, finding an open position and applying for on-the-job training is still a good option that has worked well for a long time in this field. Even as the technology in O&P has gotten more advanced, the basic job of the tech is still to make stuff. The resins and materials have changed, it's true, but do we need to know the chemistry and physics of why one is better than the other? At this point, not necessarily. The knees have gone from wood to computer-controlled, but isn't it the practitioner's job to pick the appropriate one for the patient and program the processor? Techs shouldn't lose sight of the division of responsibility within the shop. This brings me to my next observation. Should O&P techs have more responsibility than they do now? It is clear that a good tech is a valuable part of the prosthetic/orthotic team. If practitioners are petitioning to elevate their status within the healthcare industry, should the tech have an increased level of importance as well? If, and perhaps when, certification is a requirement for techs to get their foot in the door of an O&P facility, then more education will become a must, no matter what the individual technician prefers. Initial findings from the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) scope-of-practice survey for technicians indicate that the status quo is okay for now, so we, the techs, need to decide what we want to have happen to us in the not-so-distant future. (Editor's note: See related article "Survey Says...O&P Technicians Define Their Scope of Practice") We need to have a say in what is going on in the industry today so that our voices are heard. If our voices will be better heard if we have four-year degrees and sit for a national board, then that may be the future for us. But I think that for now, our hand skills and adaptability to new technology will keep our importance high and our practitioners happy. After all, they are the ones signing the checks. I feel certain that very few of you out there will be doing a knee-shin-foot setup anytime soon, but the CAD/CAM era is here to stay. With education comes knowledge, but how we get that knowledge is not as important as having it. How we use the skills we acquire will depend on the practice we find ourselves working in and the people we work with. I've had a good run so far and plan to stick around for a while yet, so let me know what's going on for you, the technician who builds the O&P industry every day, one limb or brace at a time. Jim Williams has worked in a variety of technical roles for SPS, Alpharetta, Georgia, for a total of 18 years, and is co-owner of Peaster & Williams Central Fab, Cumming, Georgia. He has recently been invited to teach CAD/CAM techniques to technicians and residents at the University of Texas Health Science Center, San Antonio. He can be reached at linkEmail('peasterwilliams','bellsouth.net');
