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The Prosthetics and Orthotics Podcast
The Prosthetics and Orthotics Podcast is a deep dive into what 3D printing and Additive Manufacturing mean for prosthetics and orthotics. We’re Brent and Joris both passionate about 3D printing and Additive Manufacturing. We’re on a journey together to explore the digitization of prostheses and orthoses together. Join us! Have a question, suggestion or guest for us? Reach out. Or have a listen to the podcast here. The Prosthetic and Orthotic field is experiencing a revolution where manufacturing is being digitized. 3D scanning, CAD software, machine learning, automation software, apps, the internet, new materials and Additive Manufacturing are all impactful in and of themselves. These developments are now, in concert, collectively reshaping orthotics and prosthetics right now. We want to be on the cutting edge of these developments and understand them as they happen. We’ve decided to do a podcast to learn, understand and explore the revolution in prosthetics and orthotics.
The Prosthetics and Orthotics Podcast
Reimagining Technical Excellence in O&P with Brad Mattear
Brad Matear, who oversees central fabrication for Shriners Children's hospitals, shares insights on the technical side of O&P, highlighting the critical shortage of trained technicians and pathways for advancing the profession.
• Shriners Children's central fabrication serves approximately 19 facilities nationwide, dealing with complex pediatric cases that require exceptional technical skill
• The field faces a serious technical talent shortage with 15-16 clinical schools but only 4 technical schools producing graduates
• Technician compensation and recognition are crucial factors in retention, with approximately 30% attrition rate compared to clinicians
• Digital fabrication including CAD/CAM and 3D printing represents the future for technicians, requiring new educational approaches
• The Assistant Credential offers a promising middle path between technical and clinical roles, similar to the PT/PTA model
• Technical education must evolve to include both traditional hand skills and advanced digital techniques
• AOPA 2025 in Orlando will feature hands-on technical education including custom fabrication and alignment techniques
• Proper disposal and recycling of materials remains a challenge, particularly for foam products used in fabrication
Please recycle your plastics as best you can and if you're an engineer with ideas for recycling carving foam, the industry needs your solutions to reduce landfill waste.
Special thanks to Advanced 3D for sponsoring this episode.
Welcome to Season 12 of the Prosthetics and Orthotics Podcast. This is where we connect with experts in the field, patients who use these devices, physical therapists and the vendors who help bring it all together. Our mission remains the same to share stories, tips and insights that help improve patient outcomes. Tune in and join the conversation. We're glad you're here and hope it's the highlight of your day. Hello everyone, Welcome to another episode of the Prosthetic and Orthotic Podcast.
Speaker 1:And what's crazy is that this is not just another episode. This is the first episode of season 12 of the Prosthetics and Orthotics Podcast, which means that there are Season 12 of the Prosthetics and Orthotics podcast, which means that there are oh man, my math is not mathed too well, but a lot of episodes. So each season has 12 episodes, and so, if we're into the 12th season, there's what is that? 130 plus episodes for you to listen to, and there's a few other bonus episodes to listen to for you to listen to, and there's a few other bonus episodes to listen to. Yoris is actually in Spain, but he's moving houses, so he's not available today, but I have Katie Richmond, my colleague, with me and yeah. So, Katie, what's going on?
Speaker 2:You know, out here working and it's Friday and happy to be here, chat with some people about O&P.
Speaker 1:Okay. So just we've got about a month out actually less than a month out to AOPA and anything that you're excited for as far as the program of Aopa, or have you had a chance to look?
Speaker 2:You know I haven't looked in too much detail, but I know, obviously, being an advanced 3D up, I'm going to be heading to the Osseointegration. It's one of those classes at the end, when everybody else has left the last four hours, they're like do you want to torture yourself a little bit more? And so I said yes, why not?
Speaker 1:Well, that's cool, and hey. The other cool thing is we're going to have our own booth, the Prosthetics and Orthotics Podcast booth, and we're going to be brave enough to step up, drop by.
Speaker 2:And even if someone is currently on with Brent, you can always let me know. Give me a card, we will try and pull you back in. If you have any interest, please stop and talk to us. We're not too scary.
Speaker 1:So tell our audience a little bit of what they might get to see from Advanced 3D at Aopa.
Speaker 2:From us. I have an inkling you might see. What we are calling right now are nitro sockets, which is an adjustable socket that obviously utilizes the Click Medical Reel. That obviously utilizes the click medical reel and uses our it's the posterior floating panel hinge that pulls in the popliteal gastroc area for adjustability. So we're pretty excited about not only the durability but the efficiency and consistency that we can put out and help people provide adjustable sockets if they're not fabbing them in-house or I know personally I had some issues with years ago with central fab making them pretty thick, like the resin would pull around the tubing and you'd end up getting these thick, heavy sockets. So we're very proud of the thin, sleek design and a material we feel is confident to hold up to what the patients need.
Speaker 1:Yeah, I love that, and the other cool thing is we just recently got our data back on the nitro sockets and it's actually quite stunning. So hopefully going to be sharing more of that story along the way. But this material has more. It acts like a plastic or a thermoset plastic, but it also acts like a flexible material at the same time in its failure mode. So there's a lot to unpack there and we're not going to do it on this episode. Some graphs and you're on LinkedIn, go check out my LinkedIn profile and I show some graphs of some different materials, and I think this is a very, very important discussion, and it's not that these materials don't last so ones that have a different curve it's just that they operate in a different fashion. So I'm not saying that you can't be successful with other materials. I'm just saying that we are finding success and we really like this material. Because of what people do to their prosthesis Are you tromping through the woods? Are you jumping off of forklifts up and down? That sort of thing there's an extra safety factor that I think people have to take into consideration, and I think that's what the nitro material gives us. So I'm really excited about sharing that, but we have a long-suffering guest with us today and super excited to have Brad Mateer on the show.
Speaker 1:Brad's been around for a little while but he also brings an interesting perspective to our field. He has more of a technical bend, even as a certified clinician, and has really been involved in some of the for lack of a better term the political stuff right, AOPPA, and on a lot of the committees and boards and all that stuff with having a passion for the direction of our field in general and I'm a little embarrassed to admit I actually didn't care about that stuff. However, after being involved with it for probably just a little bit over a year now, it is so important to our field for people is people that are truly passionate about our field, trying to navigate some of the landmines that potentially could affect the way we operate. And we're not talking like, hey, what's going to happen next year, we're talking five, 10 years down the road. So we're really looking into this crystal ball and so we're really looking into this crystal ball and I would say that those people in that room would welcome, help and welcome even a younger generation of people with the perspective now of the master's program and such, to help guide us into this.
Speaker 1:Next I don't even know the right word next future of orthotics and prosthetics. So the other thing that's neat about Brad is that he is part of the Shriners Hospital Network doing central fab for them, and so I am sure there are lots of things that we can learn from him as far as fabrication, even for kids, because kids just aren't small adults. You definitely have to think of them in a different way, and so I'm excited to talk about that as well. So, Brad, that was a long intro, but I really appreciate everything you do, and I'd love for you to share with our audience how you got involved in the field, and then we'll just kind of springboard from there.
Speaker 3:Yeah, well, hey, first, thank you, brent and Katie for having me on the opening season 12 of the podcast. I've been watching the rise of the podcast and the growth of the podcast and I think the trajectory is certainly on the right path. So keep up the great work and I'm very honored to launch season 12 with you guys. Yeah, hey, you know I would be amiss if I didn't say that I'm very blessed to be where I'm at right now, working at Shriners Children's For those in the community, in our O&P community, that have had the opportunity to do their residencies here, be employed here. You know, have a touch point, be a volunteer, be a donor, whatever it is. You know, at the end of the day, our mission and vision stay static and there's kids at the center of everything we do.
Speaker 3:You know it's not just O&P for us. You know we have a full gamut of healthcare within the Shriner system. You know, obviously, succinctly, I'm responsible for the central fabrication of those devices. I have two central fabs located within the system a 10,000 plus square feet facility located here in Tampa, where I'm anchored at, and then I have another CFAB over in Portland, oregon, which is located within the walls of Shriners Portland Hospital that currently serves four facilities there and we service about 15 here out of Tampa. The ability to work on these devices on a daily basis is amazing. On these devices on a daily basis is amazing.
Speaker 3:I would be amiss if I did not say that I will put our technical team up against any technical team around the country, around the world, because, brent, you actually said it in your intro. There At Shriners Children's we see what people don't typically see outside in what we call the real world. Our pathologies, our morphologies, our kids that are present cases aren't typical what is accustomed in the outside O&P world. I'm not saying we don't get our single shots and our solid ankle AFOs that's certainly not the case. But you know, when you're talking foot-over-foot prosthesis, rotation plasties, no-transcript and just with a whole bunch of comorbidities going on, the presentation of our kids is so much more intense than the traditional outpatient O&P clinic.
Speaker 3:So, we're blessed, though, because you know that keeps us on our toes, it keeps our skill set strong, and my team, our team both here and around the country and in Portland, are just amazing, amazing technicians. So very happy to present that.
Speaker 1:Awesome. Can you share with our audience just how you got involved in O&P?
Speaker 3:Yeah, it's kind of a weird story. So my background actually started after graduate school. So my background actually started after graduate school. I did a sports medicine athletic training undergrad and finished grad school in 97 from Colorado and came back to work here in the Tampa Bay area working for a physical therapy group and then in the afternoons I'd go and do outreach at actually the same high school that I went to, tarpon Springs High School, go Spongers. But while I was there I got picked up by an orthopedic surgeon and he was actually a brand new orthopedic surgeon that had just finished his fellowship from an esteemed orthopedic clinic, the Ochsner Clinic in New Orleans, and he had anchored here in the Palm Harbor, tarpon Springs area and he had mentioned that, hey, when he was a fellow and in residency they utilized athletic trainers to help be an allied extender for the ortho and really what it was, it was an opportunity to build business. So I actually started working for him and helped build the practice.
Speaker 3:To get you know, I would see the kids in the afternoons and if they needed some orthopedic care or you know, whether we had Friday night football games or whatever it was and we needed if there was an injury, I'd always, you know, shuttle them back to the clinic. So long story short, uh, I got a lot of my friends were in um, whether it was in pharma, whether it was in a capital equipment, med capital equipment, whatever it was. These guys were going to play golf with the doctors in the afternoon when I was still going to the high schools in the afternoon and the evening working. So I'm like, wait a minute, this is bad math. And then I realized like there's got to be something else and one of my good friends introduced me into the world of orthotics and prosthetics and at that point I had an opportunity to interview with an American manufacturer called Restorative Care of America and the president of RCAI at the time noticed that I went to undergraduate school in Iowa and he said hey, I see you went to school in Iowa. You ever thought about going back? And I said no. And he said really why? And I mentioned have you ever been there? And he said no, and I said there's really nothing to do. It's Iowa. He said I was actually applying for a job in South Florida at the time. He goes well, look, I don't have any problem keeping people in South Florida. The job's yours if you want it, but I would really love for you to go to Iowa.
Speaker 3:And, honestly, brent and Katie, it was a, it was a scene right out of a movie. He, uh, and I said, so what are we talking about? And he wrote a number down on a piece of paper and slid it across the board, the table, and I looked at it and look, I'm a, what am I at this point? Uh, 25 maybe. And I looked at it and I'm like, wow, that's, that's a, that's a pretty good chunk of change for you, you know, for me at the time. And so I crossed it out and people ask me like what did you cross it out to? And honestly, I have to be honest, I can't remember, but I was probably so scared I probably only threw a couple thousand dollars more and I wrote a new number and I slid it back over to him. He goes yeah, we can do that, you're good to go.
Speaker 3:So I went from South Florida to West Des Moines, iowa, for a couple thousand dollars and that was my introduction into sales of orthotics and prosthetics. Introduction into sales of orthotics and prosthetics. But I will say this I would be amiss if I did not mention the great folks at American Prosthetics, the Chaney family. They actually helped me get into the field. They made me feel comfortable. Andy Besser was part of that program up there and those guys really just took me underneath their wing and really made me feel comfortable in the orthotics world. I really wasn't educated in prosthetics very much, but orthotics it was my wheelhouse. So you know, getting to know those folks and getting them on board with some of that product line really helped me cement where I wanted to go in the field.
Speaker 3:And at that point I also got introduced to Don Schur, who many on your podcast know that name physical therapist, cpo out of the university of Iowa, um, but he was also working, uh, for American prosthetics. He was actually the gentleman that started, uh, the PT program at the university of Iowa, so he's the godfather there, um written many of our, our um O&P textbooks as well. So getting to know Don and getting introduced into the formal world of orthotics and Northwestern and, you know, learning about what are the possibilities, really helped propel my career. That's also how I got introduced to Dennis Clark. You know, at Clark P&O Dennis owned a central fabrication facility and through the years I actually remember this quite vividly Brent and Katie, we were at an AOPA meeting in Miami it was actually Hollywood, I believe, was where it was years and years and years ago.
Speaker 3:And I was heading back to the airport and all of a sudden, sudden, here comes Dennis Clark.
Speaker 3:Again, I'm still pretty new in the industry, but you know, you knew who Dennis was and you know he was kind of way up top and here I am, way down at the bottom and he put his hand on my shoulder and said hey, aren't you Brad Mateer?
Speaker 3:I said yes, sir, yes, sir, mr Clark, and he goes. Where are you heading? I said to the airport, he goes. Where are you heading? I said to the airport he goes. You want to share a ride? Man? I tell you I was tickled pink, I was like a young kid in a candy shop and I said yes, sir, yes, sir, and actually that was one of the greatest taxi rides to the airport that we ever had. I've ever enjoyed and got to know Dennis and I tell a lot of people today, if it wasn't for Dennis Clark I wouldn't be where I am. Dennis got wind through his CPOs that hey, if there's somebody that you want running your CFAB, it's going to be Brad Mateer, and that was my first general manager position running orthotics and prosthetics one O&P one out of Waterloo Iowa and enjoyed a great career there for over five years.
Speaker 1:That is amazing and I think everybody needs to have that person Like. For you it was Clark and some of the other people, but that can cheer you on and I love that part of the story can cheer you on and I love that part of the story. So did you do much in the way of practicing or have you always been on the technical side of things?
Speaker 3:Yeah, a majority of mine has been on the technical side of things. I guess I've been blessed that I can sit down and look in a book and do some hands-on stuff and take a test and be okay. I tell people you don't want me doing any prosthetics, I'll have you walking in circles. Do I know how to make it? Yes, do I know how to break it? Yes, but you don't want me to align your prosthesis, you know, that's just. It's certainly not. It's not to the benefit of the patient, for sure.
Speaker 3:But you know, I've always just really loved the artisan component of what we do. Seeing team members and I talked to a lot of folks in the industry about technicians, seeing team members, the ability to complete a task when they're not given the entire recipe right. That's what, in my mind, is one of the greatest traits of a technician Knowing. You know, hey, I can give you the front part of the alphabet and the back part of the alphabet and they find a way to complete the alphabet in the middle. They don't need hand holding, they don't need to go. You know, hey, do this, do this, do this, do this.
Speaker 3:It becomes second nature through you know, through time and tenure, right Through success and failure. Learning from those things is what I really really enjoy working with team members on and what's almost like you know, when we get to our my age you're younger than I am but when you know as a parent too, you know we don't. We don't get the brownie badges, or. Or you know cookies anymore or anything like that. But when, when a technician comes up to you and says, hey, remember when this happened and we and we did this, I just had the same thing happen and and I remembered and I and I did it, so we're good to go Like. To me that's like a success story right there, and I love seeing and hearing technicians get better on a daily basis.
Speaker 1:So one of the things that we run into a lot and some of our most listened to episodes are actually people that are not clinicians. So there's a lot of people that want to get involved in orthotics and prosthetics but may not want to be in the day-to-day with patients but want to contribute, and so I think that's one of the neat things about the technical side of this. Can you tell us kind of the state of the technician slash, education and such for O&P and where you see the future of it?
Speaker 3:Oh man, I would love to Brent and Katie. Let me tell you, I get asked similar questions quite frequently. I was just blessed to be the director of the technical track at the ISPO meeting in Stockholm last month and I had many conversations with global technical leaders about state of affairs in their regions of the globe and, contrastly, we're not too unfamiliar with some of the same challenges that many people around the globe are facing right now. Regarding, through the technical lens, where we are right now in the US is we're technical deficient. We have currently 15 ENCOPE accredited schools around the country that you could matriculate at to become a CPO. We're about to have 16. And that's awesome, you know, if you go back to the Dobson-DeVonzo study and again showing my age. But when you go back to that, I remember being on an OPGA cruise and reading the study and really kind of getting into it. And you know, when you read some of that data back then you were like, oh my goodness, doom and gloom and holy cow, we're going to be CPO deficient by 2025. We got to make sure that we produce enough clinicians so that we can meet the need, and so a lot of people heard that message and ran with it. You know, obviously that's a testament to the schools that have opened up. We all know the new schools that are in the landscape and that's awesome. They're doing amazing things. They're producing some of the best talent that we've ever produced in the field and we need that. We want that.
Speaker 3:Where we have not shined is on the technical lens. Currently we have four technical schools in the country and it doesn't take a mathematician from MIT to understand that. If you've got 15 to 16, soon to be 16, ncop accredited schools that are pumping out an average of 20 per cohort on the average per year, and you only have four technical schools and their average cohort is about seven to eight annually per school, that's bad math. And the other part of that bad equation is our technicians don't stay in the field as much as our clinicians stay in the field. The attrition rate for technicians is about 30% and that's because there's such a pay discrepancy and it's very regional based. So for example I'll use my own example here in the Tampa Bay area we had a wonderful school for technicians at St Pete College. That grant sunsetted so that funding dried up, so that school closed. The next closest technical school for me in Tampa is Bluegrass State Community College in Kentucky, which is located just on the outskirts of Lexington.
Speaker 3:The problem and I'm on the board at Joliet Junior College and one of the things that we see and can share is that many of the kids that go to these technical schools are very regionally based graduates. They're not like a CPO grad that's going to go to Dominguez Hills and Mark and Katie's program and then cross the country to go work for somebody like a Falk Prosthetics down in Miami. Technicians don't do that. They're very regionally based. So when you're going to school at JJC and Joliet, chances are you're going to work in that Chicagoland area. You're not going to come to Tampa for a technical position and that's strictly because of the wage gap that we are seeing in the technical program. So where are we? We're technical deficient. You can go on the job boards Plenty of people always asking for hey, I need technicians, I need technicians, which, again, people keep telling everybody that the ball is round.
Speaker 3:To argue that the ball is square. What we're being forced to do is revisit, refocus this technical landscape that we are in and evolve it, and that's kind of what we're trying to do at Shriners. It's a slow process but we have to change our methodologies from an old school mom and pop fabrication model to more of a manufacturing silo model. And that's strictly because we don't have the trained talent that you do in the clinical landscape than we have in the technical landscape. Does that make sense, brent and Katie?
Speaker 2:Yeah, it does. I would like to know your thoughts on where I am coming from is I have never owned a business, I have never employed or managed any technicians, but my first job in O&P was as a technician at Riley Children's Hospital and it was easy for me to work essentially for nothing. I was just excited. I would have don't tell them I would have done it for free. But they, they paid me.
Speaker 2:And you know, as I grew out and got more into it and experienced technicians in all sorts of different settings, from, like, a true CFAB to an in-house shop, the issue I was seeing was the owners, or whoever was managing them, were frustrated at the lack of care. And yet for those who did care deeply, they didn't get any more money. And so it became this vicious circle of some, some guys who, similar to me, um, but maybe 30 years before were like well, I started as a technician and this is what I got paid and it's like, well, that was actually now 40 years ago that you were paid that hourly wage. And you know, to have some, somebody who's young and come in and be like I'm really excited, I'm working as this technician point. Uh, at this point I don't know if I should go to school, or how can I progress in the field if I don't want to go to school.
Speaker 2:And then it's hard because some of the the people who sign the checks are like, well, they can't pop, like, how can I pay them this much money? It's like, well, how can they stay if they could go work for Starbucks and they're going to get better health insurance, they're going to get all these better benefits? That's like this vicious circle, because it seems like people want technicians to work care as much as we as practitioners do, and so many do. But then how can you sustain that love and passion on a salary that isn't maybe sufficient? So would you agree that you have seen that, and what is the solution?
Speaker 3:That's a great question, katie. And to answer your question succinctly, yes, I've seen it. I see it every single time I'm at a meeting. Everywhere I go, I talk to technicians and one of the most important things that we discuss is wage gap, entry level to seasoned technician, wage gap. And when you go to a clinic these days and you actually spend time in the lab talking to the fine folks in the lab that are fabricating these devices, the happiest technicians are the ones that are being taken care of by the ownership, that are being taken care of by the ownership, the ones that are the ones that are respected, the ones that are paid, you know, appropriately for their skillset and the ones that are given opportunity for advancement.
Speaker 3:You know, I I got interviewed years ago and and I use this analogy and I kind of go back to it quite frequently and that is, you know, we're in this advanced world now of and this was at the beginning of the assistant credential discussion we're evolving into this assistant credential and that's great, I love it, I think, I think the world about it, it's going to be very valuable for our field. But I also talked to the folks when we were generating this about using a restaurant analogy and that was front of the house, back of the house. There is people that are in the front of the house, clinicians that you do not want in the back of the house. The lab right, there are wonderful, wonderfully talented, uh, clinicians that couldn't fabricate their way out of a wet paper bag. But, conversely, there's also wonderful talented technicians that you don't want in the front of the house, in the restaurant right, they they're, that's just not who they are. They. They like being in the lab, they like getting the you know their hands dirty, or they like you know thermal forming, or they like skiving or bending metal or whatever it is you just that's, that's back of the house stuff.
Speaker 3:So I look at the happiness of the team members. I see them being appreciated and those are the people that stay and are vested in your company. When you treat them right, pay them right, respect them, they're not going anywhere and that was always the. You know, one of the pullbacks you know on ownership was like, yeah, you know, I'm going to teach them up, teach them up, teach them up and then they're just going to leave. I mean that mindset right there, that attitude right there is just old, so old school, right Like I, will never stop somebody from bettering themselves. If they, if I train them and train them, and train them, and they say, hey, brad, you know what? I think I'm going to take this leap, I think I'm going to do this. Hey, good luck. You know, let's shake hands, let's wish you the best and you know what? Let's stay in touch and let's grow together.
Speaker 3:A lot of business owners back in the day were so worried about training and spending time and then losing the technician. I would come back to say what guardrails did you put up so that that technician, when got asked to leave, would come back and say, hey, you know what, thanks for that offer. But man, I'm really happy here, and here are the reasons why I'm happy. Does that make?
Speaker 1:sense I love that and I think it is important on that. So not only investing on the financial side, investing on the training side, and if it is a stepping stone, then you know having it, so be it.
Speaker 1:Yeah, there's a coaching tree in the NFL, isn't there? That's so awesome. Well, I'd love to kind of switch gears into the I said the political side I don't know if that's really the right, the right wording of it but the leadership side and the direction of the field side. How did you start getting involved in it and why did you feel like that's important?
Speaker 3:Oh, thanks, brent. You know, back um some time ago. Um, I was uh working with um, with the likes of Tony Wickman and some of the team members in Opta, and that's kind of where I got my initial exposure. We were responsible for the technical track at AOPA. So under the old AOPA leadership, the, the, the Opta committee, the Opta team, basically AOPA said hey, can you guys run this for us, cause we don't, we don't have a lot of understanding on what it takes to do it. And that was what I always say is like that's strength to power, right, like that is uh Aopa recognizing hey, you guys do a much better job at this than us trying to take it over and and make it work. So we just had a wonderful and we still have an amazing relationship with the team at Aopa. Um, I know Tina, our old director, uh, is probably sitting on a beach right now enjoying an adult beverage with an umbrella in it or something like that. But you know her replacement, ashley, is amazing to work with. We're all like family because we just we can ping off each other.
Speaker 3:But early on it was Opta and we took over the tech program and every year it becomes harder and harder, katie and Brent, and you guys can understand this. It's from a clinical lens. It's not hard for me to jump online or to ask a manufacturer on the latest and greatest you know, mpk, latest and greatest carbon fiber energy, returning K2, k3, foot right. Like all that data is out there, like it's amazing how much stuff is at our fingertips for clinical, for clinical. What's really hard is to get relevant technical information and then also have it so that it can be presented and absorbed by an audience.
Speaker 3:A lot of the team members that we've um, have been blessed to have uh present at AOPAs have retired. Blessed to have present at AOPAs, have retired. Some of them, unfortunately, have passed away. So I say that quite frequently is every year the technical side is losing more than it's gaining. A lot of that. We've all worked with those super techs, right? I have one here in Tampa. We've dubbed him Yoda because he's amazing. He can do all things he's he's from, from soup to nuts. This guy, for over 41, 42 years has been a technician. 39 of them were Shriners and you know he grew up in the lab as as a young man. So, um, that that resource over time is going to retire and we just hope that information is getting parsed down to the next generation and then we're hoping that the next generation stays as long as he does, but we're not seeing that data right now. We're seeing a lot of these folks come into the field lasting five, six, seven years and then departing the field. So hope that answers your question.
Speaker 1:Yeah, how, how do you? And you may not have an answer, you know right right now, but for your um, yoda, Mr Yoda, um, how do you try to get what's in his head out for future generations to leave a legacy? Is that where can? How do you catalog it? Do you catalog it via AI? Do you catalog it via videos, brain dumps? You know what are options for that Because you know my concern with the technical side of things is and I think you even commented on a comment on LinkedIn it was a guy that did a metal and leather corset type of thing and he had the joints done in a certain way. So when he's sitting, the joints splay and then when they all this stuff that I didn't even think about and I and I used to do some metal and leather stuff, but not to that detail, I guess Um, how, how do you capture that? Or, or, or, can you?
Speaker 3:Yeah, and it's really hard, you know it is. It is probably one of the hardest things to do because, well, if we just take a step back and and go back, I don't know, 10, 15 years ago, those, those guys and gals that had that knowledge 10, 15 years ago, that was job security. They, those owners, um, you know, could not get rid of them, um, because they, they were the, the, honestly, the conduit, the lifeline, the bloodline of that lab to the clinical space Progressing forward. You know, we look at how do we get this information out of Yoda down to my younger generation, and really what we're doing right now is cross-training. I put people into the. He actually loves thermoforming and that's where we've just seen such a consistent product on our end because of his hand skill set, right. So you know, whether you use cooperative learning techniques that I learned in grad school where you try and bring that you know he's an A performer and she's a C performer and what you're trying to do is align that C performer as closely to the A so that that C performer now becomes a B performer or hopefully teeters into the A market, right? So what we try to do is we try to align younger I say younger and not in age in technique and in hand skill. We try to bring these other technicians in and work alongside Yoda so that we can get some of that, that hand skill, pass through. And there's just techniques that in today's world he, he, he does today but I can't let other technicians do it because of we're worried about you can't use a torch and a zip knife anymore. We got to use hand tools. You know.
Speaker 3:Yeah, there's some of that stuff too, but no, as long as we bring them closer together, we teach. You know putting together a fabrication manual, obviously. My colleague, joanna Kenton, up at at Century College, is working on a fabrication manual as we speak. That's one of the things that we just don't have in this industry. I have my Northwestern orthotics manual, right. I have the old NYU manual. I have all the old Autobach printed stuff right, like if you go to school right now, you get brand new. If you go to O&P school, you get brand new online technical resources, right. The fabrication stuff is ancient, it's from all these other resources. So we've got to do a better job of bringing elevating the technical field and having some printed material on how to, because that's how we're going to be able to teach.
Speaker 2:I have a question. I feel I would be remiss if I did not ask how you see the digital side being integrated into the education of technicians, because I have had quite a few people come through who are in that stage where maybe they're in undergrad and they come in and they're looking at the O&P field and maybe they see the backside oh, that's cool. Or oh, you're using 3D check and check sockets. How would I do that and what are your thoughts on how that needs to be integrated? And then, how does that change the compensation for individuals? Because if your value is in, I can pull consistent check sockets, I show up to time on work and I can get this much done in a day. Well, if you have someone who knows how to run a machine and make you three times as many, or you know, how is that being addressed? The digital side in the technician education.
Speaker 3:It's a wonderful touch point question, katie, because, like I said before being on the advisory board at Joliet Junior College with Alicia running it up there, alicia Brennan we've actually probably on every single one of our calls talked about additive manufacturing in the technician space. We're bringing that additive component into the technician program so that when they leave the program they not only have additive you know, 3d printing education but also CAD CAM education. For me as an employer, that's the future of the technician right Because, like we said before, some of this hand skill stuff is one getting, I don't want to say replaced, but it's evolving right. But if I'm hiring a technician and they come to me and they throw their resume down and they say, hey, I can run a CAD cam, I can run a 3D printer, I can pull check sockets, and I'm not saying I do everything phenomenal, that's never the and let me just kind of go on a rabbit trail here real quick and that's never the goal. It's never been my goal as an employer. When, when I have a trained tech student graduate coming to me for their first employment, I'm actually paying for education that allows me not to teach you how to use a band song, not to teach you how to pull a diagnostic you know, pull a solid ankle AFOs, or how to apply Tamarack joints, and the list goes on. Right, you're coming in with the baseline of education because there's a value there, there's a cost there for me to train you If I'm bringing you off the street. My, my point is if, if you're coming from a tech school, my expectation is you're coming in day one and you're a valued member of our technical team and you have the ability to do these things at a base level, all right.
Speaker 3:So when a technician comes to me and says, yeah, I can do a CAD, I can, I can, I can, I'm familiar with 3D printing. Here's some of the things that we've done. They're already, they're at the top of the list, katie, you know, and they need to be compensated accordingly as well. Right, because if I'm pulling a kid off the street and I say kid, they're just younger than me, but if I'm pulling a person off the street and having to teach them, there's a cost in doing that. Right Now, I'm vesting in you, I'm going to teach you, but this other person that vested in themselves to get better so that they could go into the work you know the workspace and be a viable member of an allied healthcare profession. They took that leap and they're vesting themselves.
Speaker 3:They should be rewarded and unfortunately not all employers think like I think, but where do I think it's going? I think it has to be included in each and every single technical program going forward. Some of them have some online tutorials, but to me, a lot of these folks that are in additive and are in CAD are on the computer anyway. Let's put the, let's put the tutorials out there so that they can learn and and so that they can immerse themselves in that education. Does that answer your question?
Speaker 2:Yes, it does, yeah, Thanks.
Speaker 1:So I think that's I think that's neat and I think it's a great way to look at it, as not only can you come in and do some of this stuff, but if you, if you also invest in yourself, I think that is something that's worthwhile looking at as an employer. So I've had multiple people on our side of things and I'm just talking to East Point's side say, hey, I'm interested in getting involved in the digital side, and I always will say I would love to help you. I would like for you to have some base understanding of some stuff. Are you willing to do some stuff after hours to learn and better yourself? And I would say not many people take me up on that.
Speaker 1:Now, this is on the clinical side of things, not on the technical side of things.
Speaker 1:But what's interesting is I was recently up in Century College with Joanna and they are the first technical school to have its Geomagic Freeform recently bought by Hexagon, and they have a 3D printer up there and I was super impressed with where they have a vision going. And the other thing that I feel that is neat about that specific program is they actually have a play lab, they have laser cutters, they have 3D printers. They have routers, all kinds of stuff that are available to all Century College students to help with creativity and things of that nature, and I'm just really excited to see that grow. And another thing that I learned is that program both the technical and then the clinical side that program both the technical and then the clinical side is the most cost-effective program in the United States and that's a very important thing. You will not come out of school there with a stupid amount of debt and I love that. So kudos to what Century College is doing and then the name is escaping is Concordia University. Really cool stuff that's going on there.
Speaker 3:Let me just interject and throw one more bookend point to that, if you don't mind, and that is the assistant credential. I just want to say I'm a heavy, heavy advocate of the assistant credential and people look at me kind of like, wait a minute, I thought you're the tech guy. Well, I am, you know. But the inside of the assistant, you know, job, uh, scope of practice, excuse me, is that of a technician, right. So where I, where I kind of sense this is going, is more of we're really want to stress this allied healthcare model and it's the, the, the examples include, like a PT to a PTA, uh, a dentist to a dental hygienist, right, an MD to a PA.
Speaker 3:So I look at our model and I'm looking at these younger folks that are coming out with these master's CPO degrees, where they have engineering backgrounds.
Speaker 3:They can do more with less right, and really, your grandma and grandpa's lab CPO, you know business, including, you know 3,000 square feet and a lab and ovens and all this, you know accoutrement, right. Now these younger folks with this vision are taking this down to its bare necessities and that is one CPO with, you know, three or four or maybe five assistants. Now, out of those assistants. Maybe one of them is solely responsible for fabrication, maybe one of them is solely responsible for fabrication, but the other ones are care extenders for the CPO, and we know the legalities of what the scope of practice lies for that assistant. You know what you can and can't do and what the responsibility of the CPO is, but I really kind of feel like that is that's where the energy is flowing, and so what I'm trying to do is figure out okay, how can the touch point with the technicians of today advance to the assistance of tomorrow? Am I saying that clearly enough?
Speaker 1:I like that. I mean, I think it definitely is a hybrid type of thing. It doesn't diminish what the technicians are doing, but it does also combine kind of front of the house and back of the house, which is a super important opportunity for people as well bring that a clinician can't bring and a technician can't bring. So I definitely see that. I think that's a good insight. We haven't taken full advantage of that, but it is definitely something that I'm interested in doing on the East Point side of things for sure.
Speaker 3:Well, and you talked about. The reason I brought it up was because you talked about debt. You know, not everybody is equipped to become a CPO and not and not everybody wants to to continue their career as a technician. Maybe they they get exposed and maybe they go. Hey, I would like a little bit more, I'd like to do a little bit more, and that opportunity exists in the assistant credential. So just throwing it out there for fodder.
Speaker 1:Yeah, yeah. Well, I'd like to turn one more page, and that is AOPA 2025 in Orlando. Aopa 2025 in Orlando. A couple of cool things is I've been involved in some of the, some of the meetings for the planning and such and the digital track, and then I've seen the got to see the venue early, and I think this Orlando venue is is really really great. I think there's going to be, and not not because Mickey Mouse is really really great, I think there's going to be, and not because Mickey Mouse is there, but more that the Chocolate Factory is there or the Chocolate Museum. That thing was awesome, that's right, but I feel like the venue is good as well. So what are some things that you're looking forward to at AOPA as kind of on the leadership side of things, and then what are you looking to get out of it as well?
Speaker 3:Well, I got to first give props to Joanna Kenton, the Janice family, you know, dennis, eric. We partnered with the Pedorthic Group this year and creating just an amazing program. And no better way to start off the program, katie and Brent, than being in Florida at the technical program in the lab that we're going to have there and shout out to Niles Leonard at Leonard Industries for helping us build a lab on site. So we're going to actually going to have hands-on education, the first one right out of the box, on Thursday at 10 30. How about this one for Florida Custom sandal fabrication, making your own flip-flops, how's that?
Speaker 1:Uh, I, I, I like that.
Speaker 3:That is something that I I I don't know that I've I've seen before, so yeah, yeah, so making your own, making your own foot orthotic right, making your own foot bed and and attaching it to you know, uh, your own foot orthotic right, making your own foot bed and and attaching it to you know, uh, your own, your own sandals, custom sandals. So I just thought it was super cool, being in Florida, the ability to make your own custom sandals, learning how to do it for those who've never done it before, and incorporating a custom FO uh is is super important. So that's starting off. Um, you know we've got a full technical program, everything and we try to balance. That's the other thing, katie and Brent is we really have over the years, kind of perfected this thing through feedback from the attendees and we really try to keep a nice level balance of O&P, p&o, pedorthics, you know. So we've got obviously adjustable socket fabrication. We're getting into the bespoke adaptive sports equipment and I know that's kind of up your guys' alley a little bit too CAFO, carbon fiber stuff.
Speaker 3:So alignment, you know that's been kind of one of my my um, uh, katie, you had mentioned before about, uh, some CFAB conundrums that you had in your earlier career. You know, um, one of the biggest beefs that I have at the management level. And it really does hit home when you send a leg back and you get that dreaded phone call of what happened to my alignment. Does that ever happen to either one of you? It's always the technician's fault.
Speaker 1:But if it goes well, it's because I'm an awesome clinician.
Speaker 3:Understood.
Speaker 1:Have you heard that?
Speaker 3:before More than once, Brent More than once.
Speaker 1:Katie's never heard that before, though have you, katie, all right, keep on.
Speaker 3:So one of the things is you know, we really go back to the old school a little bit on current concepts and prosthetic alignment. You know what has changed. How are you doing it? You know, one of the key things that we picked up on years ago here at Shriners and I did get a couple of phone calls like Brad, what is going on? I spent an hour and a half two hours on this kid and the thing comes back all cattywampus Like what are you talking about?
Speaker 3:We put it in the jig. You know we fill it. We put it in the jig, you know we fill it, we transfer it. Like I mean, what's the problem? Come to find out it's more of an equipment failure than anything. You look at the bolts. You look at where the bolts loose, where they rusted out, and yeah, we had some equipment that needed some love. You know, not every technician is as talented as the next when they're pouring plaster into the lockdown socket and plaster goes dripping everywhere I'm sure that's never happened to either one of you and over time it just eats at some of those bolts and we were losing some alignment because of bolt failure. So we're going to talk about current concepts and how to achieve good transfers, good alignment. A lot of safety stuff is coming up, so we're really excited about that. Partial foot is another one, so really really comprehensive pedorthic technical meeting at AOPEN. I couldn't be more proud of the team, and working with the Janusys is always a treat. They're just a wealth of knowledge.
Speaker 1:I love that and you know, seeing that you guys are going to have a little lab. And then I'm super excited on seeing Niles's new oven. It is now more than a concept and I think it is going to be a game changer for for fabrication and volume like, and and you know, niles does such a great job because he meets the needs of true technicians and companies and tries to make things, uh, you know, much, much better for them so people can be efficient. So I'm really excited to see that.
Speaker 3:We had the ability to test the oven here at Shriners and we were very impressed, very, very impressed. The ability. I know it's never happened to either one of you, but sometimes our attention at the oven level gets taken away for some reason Never.
Speaker 3:And the next thing. You know there's polypropylene on the bottom or copoly or whatever. Heaven forbid it's a foam or surlin or anything like that. But Nile's oven is amazing in that it's kind of like a sous vide machine like a sous vide machine for plastics, I call it. You know it gets to a temperature and it holds it and it holds it. You know where. The sides are still uh, uh, conceptually rigid, but the plastic is set off and it's at a melt temperature. So, um, we were very impressed with with the oven when we had it here and I really look forward to working with it in in orlando I'm gonna have to talk to niles about you get to see it before b.
Speaker 1:That's a problem. No, I, I mean I, I love that and I mean that's a, that's a cool thing. My, my one oven story is um a technician.
Speaker 1:Always blame the technician, but had left a piece of foam p light three quarter inch p light. They were uh in and it was smoking like crazy. So you always wear gloves, right, uh, when you go take out molten lava, a foam, out of the oven. Well, I wore one glove and I put, I went in and grabbed the foam that was literally dripping and as I turned it was so flexible and somehow it caught the back of my other hand and stuck and I still have the scars on the back of my hand stuck and just kept on burning and burning, and burning. It was the worst feeling I have ever had as far as uh, prosthetic injury. I guess, uh, those, those those foam burns are are are no good, not at all.
Speaker 1:Anyway, that's my uh. I'm sure you've got plenty of uh stories. Do you have like one that just sticks out of your mind that you know might be funny now? Now, but it wasn't funny at the time.
Speaker 2:First go for it very first day, very first day of my first residency, you spend the first two weeks in the lab downstairs. Very first day melted a piece of ifact so low, and what did they have at the bottom? It wasn't just a regular flat bottom on the oven, there was a grate, and so I spent the afternoon trying to undo my ms and pull the vivac out of the grate. So, yep, strong start only uphill from there.
Speaker 3:So we had one pretty recently and Joanne Canis, my boss, cpo and director of POPs here at Shriner Children, she says whenever you're gone, that's when things happen. You know it's like Murphy's Law happen. You know it's like Murphy's law. And um, I was up, uh doing a site visit at uh, lexington, at our, our Lexington Shriners, and um, one of the technicians uh, who remain unnamed, um was mixing up some, some resin and in, instead of following procedure, taking the unused resin in the cup and putting it over into the fume room to set off, threw it in the garbage can. And that connected with some other things in the garbage can, some other things in the garbage can, and, let's just say, a smoke bomb, uh proceeded to uh engulf the, the, the better part of the lab, which resulted in the fire alarms going off, which resulted in the fire company showing up. Uh, and yeah, it was it's a whole, nother, a whole, nother.
Speaker 1:Uh, meaning to dumpster fire, huh.
Speaker 3:Exactly. Well done, brent. And and you know we can we can look back on it now and laugh, and, and we learned from it. Though, you know, and it wasn't, it wasn't.
Speaker 3:But a couple of weeks ago I had another technician who was doing some pre-pulling sacrificial layers over foam and she needed to throw some waste away, um, and instead of throwing it like, like we typically do, on the floor and let it cool down and then pick it up and recycle it, um, she threw it in the garbage can, just, you know, probably by habit or something just throwing in trash, um, and there was some plastazote in there and that poofed up and started the fire alarm as well. So, man, the good news, the good news is these are all learnable mistakes and learnable errors and we, like you said, we can sit back and kind of chuckle about them now, but this is how we get better. You know, nobody died, thank goodness. No, there was no issues. I tell a lot of people, hey, we're fine, let's learn from this, let's grow from this, so that we know we don't do it again. And, um, she always brings, brings that up, like, don't worry, I'm not going to set off the fire alarm today.
Speaker 1:That's funny, that's good. So, but this is my last one and I hopefully you and katie will get a kick out of this. So, again, it was uh. So I worked for ots back when they were in barnardsville, um, so this was before their weaverville location. Uh, it was actually, uh, my, as my kids would say, before the turn of the century, um, and and so I was a technician there, um, and just kind of learning the things, and, um, my job was to. They kept molds for 90 days and my job was to break out the whole bone yard, uh, for the 90 days and put them into the dumpster. And I did a thought, I did a really good job filled the dumpster all the way up to the top with plaster. Garbage truck comes, he pulls up, puts the forks in and the whole backside of the dump truck comes up because the dumpster was so heavy.
Speaker 1:And so he was not happy. He marches into the person and said and said, hey, your dumpster is too heavy, I can't do anything. You better get somebody in there and start unloading it. So I can. So literally I had to unload probably two-thirds of the dumpster out. He dumped it. I had to load another third in. He dumped it again, and another third in and dumped it again. But uh, I'll never forget that. So, uh, trick for the technicians don't fill the dumpster up all the way, right, if you're, if you're, assigned to clean out the boneyard well, you know what?
Speaker 3:now we're using foam because we're using a lot of cad cam. Right there you go yeah, that's it.
Speaker 1:So all right, brad. Well, hey, thanks so much for your time, thanks for what you do to advocate for our field, for the technicians, for clinicians. We really appreciate you and I know that our listeners will get a lot from this episode.
Speaker 3:Hey, I really appreciate your guys' time. Can I take a moment of personal preference and just out of respect to Mother Earth, please do recycle your plastics as best you can. Talk to your local waste management people. See what opportunities are there for plastic recycling and I would ask that if anybody knows of a way to recycle our carving foam if there's any engineers out there is there any grad students working on projects I would love to know where we can send this foam other than the landfill. So just a little nod to Mother Earth there and again thank you Brent. Thank you Katie. There and again thank you Brent. Thank you Katie, it's been a wonderful ride, kind of looking back a little bit but also looking forward and keep doing what you guys do great here. Really love the podcast.
Speaker 1:All right, thanks, brad, and I think that's a good thing to do is really take a look at how do we care for the earth and how do we make the most out of recycling things. So, yes, if you're an engineer or something and you have some ideas on how the foam side can be taken care of, that would be amazing. Well, katie, thank you for being on as well. This was great.
Speaker 2:No problem, it's my pleasure.
Speaker 1:And thank you for listening to another episode of the prosthetics and orthotics podcast. Have a great day.
