Americans anticipate a major overhaul of health care in 2010, as promised by President Barack Obama. The O&P profession, too, expects continued changes in the way of licensure and parity. Is this the time for O&P technicians to accept a drastic revamping of their credentials?
From grassroots meetings to the 2009 Technician Summit — held jointly by the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) and the National Commission on Orthotic and Prosthetic Education (NCOPE) — experts have been debating this issue for some time, and continue to work toward a resolution.
Current regulations
In the early years of the profession, the primary way to gain experience as an O&P technician was by receiving on-the-job training from those with experience. The natural progression of O&P was to begin sweeping floors and move up the ladder, learning the business, and eventually become a fabricator.
As O&P education programs become more refined, however, they offer students more opportunities to learn the profession. Practitioners now have the option to enroll in an associate’s, bachelor’s or master’s degree certificate program, putting them well on their way to becoming ABC-certified orthotists, prosthetists or orthotists/prosthetists. Likewise, those looking to become ABC-registered technicians can choose from one of several NCOPE-accredited associate’s degree programs, and exit with a training technician certificate .
“Young men and women have more choices than they ever had before,” Brad Mattear, MA, CFo, general manager for O&P1, said. “With the advent of the technical schools, it really helps our field, because now [students are] getting more of a formally proven educational module than just on-the-job training.”
ABC’s Practice Analysis of Orthotic and Prosthetic Technicians, released last year, described the role of O&P technicians as they currently exist in the United States. The survey seems to indicate that about half of them came through an accredited educational program, Tony Wickman, RTPO, chief executive officer of Freedom Fabrication Inc. and treasurer of The Orthotic and Prosthetic Technological Association, said.
The exam process for becoming an ABC-registered technician encompasses a 1-hour written test and a 6-hour hands-on demonstration of skills per discipline, designed to cover a broad range of skills.
Title change
Whether or not the difference in name will make a difference in practice is still up for discussion, and opinions on this are mixed. Some view the switch as a title change only; the word “certified” would merely give already proven technicians the credibility they deserve.
“If you look at the actual procedure, it is a certification procedure, not a registration procedure. The idea that we go through a complete certification procedure and then end up with the status of registration, that just doesn’t make a lot of sense to me,” Wickman said.
The only difference between a registered technician and a certified technician would be the letterhead, he told O&P Business News.
“I think the public perception of a registered person is substantially less powerful than the public’s perception of a certified person, and the process we’re going through now is a certification process,” he said. “We’ve essentially been meeting the standards for certification all along.”
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Catherine A. Carter, ABC’s executive director, said that ABC not only is committed to continuing to refine all aspects of the technician registration process, but to communicating the value of this credential to the O&P community as well. The ABC board has placed a great value on its technician credentialing program, she said. Volunteers supporting the effort have worked with the board to complete the comprehensive practice analysis study evaluating the thoughts within the profession.
“The board believes that O&P technicians are a critical part of the patient care continuum and if the issue of changing the credential from ‘registered’ to ‘certified’ will increase the visibility of our credential in the technician community, then this issue is open to consideration,” Carter said.
Switch to certification
Those on the other side of the argument, however, believe that technicians must do more to prove that they are capable of completing the tasks required of a certified technician. Mattear said he would like to see an increase in education requirements for any technicians to be deemed certified. Additional education would guarantee consistency in ability from technicians. Now, Mattear said, practitioners are not able to count on consistency in product fabrication among — or even within — fabrication facilities.
“I would like to see us move away from registration completely,” Mattear said. “You register for a wedding. You register for a golf outing.”
To become certified, on the other hand, you must actually complete a process. If the only aspect of technician credentialing that changes is the title, then the change brings no additional value to the position, because whether your title is registered or certified, at the end of the day, you are still exactly the same as you were before, he said.
Furthermore, Mattear wants to see a level of certification available for technicians, like the higher degrees offered to practitioners. This master’s level technician certification would include those able to complete highly technical jobs such as upper extremity prosthetics, myoelectrics, lower extremity orthotics with the use of bionics, and increased use of CAD/CAM.
“I think our field is screaming for that advanced technical level,” he said.
Implications of change
That advanced technician level would be useful for facilities that already employ master-level practitioners, Mattear said. Highly technical upper-extremity prostheses, for example, require a practitioner who specializes in that area; the more practitioners treat this type of patient, the better at it they become. The same is true of technicians, and if a master-level technician works alongside a highly skilled practitioner, the patient — the O&P practice, the third-party payer — benefits from that increased experience and proficiency.
The conversations about technician credentialing have included the idea of making technician certification or registration a component of facility accreditation, which would increase trust in O&P by those outside the profession, Wickman said. This regulation would help convince third-party providers that a quality standard applies to each level of O&P, from patient contact to production to fitting.
“This industry has got to be trusted. If we don’t have certain base competency levels established for the industry, then our providers … tend to lump us with DME,” Wickman said.
In addition, Wickman said that this change also would serve to improve morale among technicians. The role of technician no longer is a stepping stone to practitioner, and technicians should be respected for their mastery of advanced O&P technology.
“There’s also a perception among technicians — whether it’s real or perceived, I have no idea — that technicians have been treated like second-class citizens. The vast majority of them don’t feel like they are wholly a component of this industry,” he said. “And that’s a shame, because … it is a critical partnership.”
He added that gaining the right to vote within the Academy would be an incentive for more technicians to join, and would provide them representation in the O&P governing process.
ABC stands by its belief that there would be no difference in the quality of the work put forth by technicians, whether they are called registered or certified.
“The ABC technician registration program is a very viable credentialing program and the whole issue of terminology is mostly semantics,” Carter said. “Even if the board decides in the future to change the name from ‘registered’ to ‘certified’ that would not fundamentally change the program.”
Industry reaction
Within the O&P profession, opinions about the technician’s role differ.
“I have never heard a single technician voice anything but extreme enthusiasm about the change,” Wickman said.
He said he has spoken to some practitioners, however, who view it with skepticism, and thinks that a clear delineation between the jobs of a practitioner and a technician would prevent what he refers to as “juggling nomenclature.”
“They are completely different, and they come with completely different ethical standards and completely different capability levels,” he said.
Mattear agreed that the line between technicians and practitioners should not blur. With an increase in education for the practitioners as well as the technicians, the profession can successfully avoid that situation.
This is why Mattear said he wants to get the word out to technicians, who should involve themselves in an issue this important.
“The so-called new-school technicians need to challenge ourselves and challenge the schools to up their game, so that we can be prepared to accept and complete the jobs that the practitioners are sending us,” Mattear said. “With the advent of scanners, lasers, rings and wands, and the utilization of CAD/CAM increasing each and every single day, the role of the practitioner is changing, as well as the role of the technician.”
If technicians do not accept this opportunity to increase their knowledge base and master this new technology, they will be left behind, he said. — by Stephanie Z. Pavlou
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