By Matt Skoufalos
In the early 1980s, just a few years after David Weaver graduated from his Indiana high school, its electronics program was cut due to a lack of funding. A similar story has been told in many rural communities since, he said. Eventually, districts banded together to establish regional vocational schools for the provision of technical education, but by then, Weaver had already begun a career in logistics, followed by a stint in insurance. Nonetheless, he still held out hope of working in education (and electronics), and eventually returned to the field, joining the research and test development department at ETA International (the Electronics Technicians Association) of Greencastle, Indiana.
ETA was founded in 1978 as a nonprofit association of electronics technicians who gathered in the absence of more formally organized programs to troubleshoot one another’s technical concerns. Weaver describes them as “the radio guys, the TV guys; guys just getting out of the service, guys looking for jobs as college professors” who sought to advance their careers and those of their peers.
“Once we started getting together, we would answer one another’s problems,” he said. “We thought, ‘Why don’t we take our knowledge and try to put together a certification program?’ It’s been growing and growing ever since.”
Today, the agency provides more than 80 accredited, vendor-neutral certification programs in tech fields like fiber optics, communications, electronics, biomedical engineering, smart homes, and renewable energy, but its mission remains the same: to represent and support the technical professional in his or her chosen field of specialization.
ETA International doesn’t provide any education itself; rather, it’s accredited by the International Certification Accreditation Council (ICAC) to certify the training that those technical professionals complete. Weaver sees his role as supporting technicians while they get their feet underneath them in a field that often presents younger workers with a chicken-and-egg problem: how to get their first jobs in an resume-driven career.
“For a technician, there’s two sides of that coin: the education side, and the experience,” he said. “If you don’t have the experience, you can earn the certification. You get that training that you need.”
To Weaver, certificate programs are equally valuable to any professional looking to enter a technical field, regardless of their formal education status.
“If you’ve got a guy with a diploma and a guy with a diploma and a certification, you’re going to hire the second guy,” he said. “That’s starting to become the norm: you see techs bypassing colleges, going straight to certification programs, jumping into the workforce.”
While a lot of companies want to train their new hires in their specific company’s practices, especially in the imaging service and biomedical space, certification programs offer a way for employers to know that their employees have had some hands-on experience, or at least some level of formal knowledge about the fundamental concepts in the field. He described biomedical technicians as working with “at least a journeyman’s level of experience” – a basic understanding of electronics and safety concerns, at minimum – principally because that’s required when working on patient safety equipment.
“We make sure you guys get hired, and can do the job and keep up,” Weaver said. “We try to use subject-matter experts, guys in the field who’ve gone through that knowledge. We try to be vendor-neutral; we don’t use proprietary information. We want to get you a certification just to get you in the door so you can be certified by companies to work on their equipment.”
In the past, the only pathways for many individuals who showed promise in the early stages of their careers would be to proceed to a college degree program for electrical engineering. Others would hone their chops in branches of the U.S. Armed Services, particularly the Navy or the Air Force. Many biomeds still enter the field via those channels, Weaver said, but with alternative accredited certificate programs, there are a broader variety of ways for prospective technicians to gain relevant qualifications.
“Today, in New Jersey, Texas, Florida, North Carolina, you see a lot of high schools trying to get into the electronics game,” Weaver said. “A lot of the community colleges can’t hold onto their students because the business community comes headhunting. Then, a lot of times [technicians] are doing so well they don’t finish that college degree unless they really want to get after it.”
For Nate Smith, vice president of sales and co-owner of Elite Biomedical Solutions, the more training a biomed has, “the better they can get; the more they can grow.”
One area of growth for biomeds and HTM professionals includes making a move to specialize in imaging service.
Smith said the bare minimum requirements for technicians at his company include a CBET certificate; from there, depending on what devices employees will be assigned to service, Elite Biomedical will pay for them to receive supplemental training at original equipment manufacturer (OEM) schools.
“I think it’s worth the investment to continue to educate your employees through OEM schooling and training,” Smith said. “We put every resource behind that to make sure our techs are trained to OEM standard, outside of the cross-training that they’ll get with our other employees. We’d go into the highest accreditation that there is for the piece of equipment that we’re fixing.”
Back-end, third-party support provision is a secondary line of business for Elite Biomedical, but Smith said the company seeks to differentiate itself among its competitors by certifying that its service professionals possess certifications in their areas of expertise. Although he estimates that only half his clients ask whether the staff are educated to such a level, Smith believes it’s important to employ trained professionals.
“If you don’t have it, it will ultimately show up in your work if a customer gets equipment back that’s not working properly,” he said. “I wish more [clients] would ask for those certifications, because I think it would help differentiate us from our competitors.”
Greg Johnson, co-owner of Southeastern Biomedical, said that without some proof of aptitude in the field – whether from a college, military school or certificate program – he won’t hire a service professional. Without the benefit of a global licensing program, such as those physicians and nurses complete, “we need some type of method to determine whether people are qualified or not,” he said.
“A degree certainly helps, but a certification is a way to make a biomedical person stand out,” Johnson said. “If two individuals are applying for the same job and they have similar credentials, and I’m sitting on a fencepost, that would be the decision factor for me.”
Johnson himself has been a certified biomedical equipment technician (CBET) since 1986, which he earned through the North Carolina Biomedical Association. While many state biomedical associations help technicians to get their CBET certificates by offering study courses, coaching, and other forms of support, there are no requirements to become certified in the field other than those stipulated by your employer. In the absence of such a mandate, Southeastern Biomedical has obtained a pair of ISO certifications – ISO-9001 and ISO-17025 – for its equipment servicing processes. Johnson believes that upholding those standards reflects his company’s commitment to continuous improvement. Unlike Smith’s experience, Johnson said “a lot of our industry [and] our customers are requesting this.”
“We do a quality operation, and we want to adhere to those standards,” he said. “Quite honestly, it’s drilling down to the individuals now. I want my staff to be certified. It shows that you care about the industry, you care about the job you’re doing, and you’re taking that next step.”
“The ISO process has forced us and our company to be better and stronger,” Johnson said. “We’re still going to make mistakes, but it really forces you to have better processes. It’s something that, once you start doing it, you can’t stop.”
At some point in the not-too-distant future, however, such process improvement mechanisms may shift from being voluntary to being required by federal statute. Stephen Grimes, principal consultant at the Swampscott, Massachusetts-based Strategic Healthcare Technology Associates, thinks that day will come sooner rather than later.
In 2018, OEMs lobbied the U.S. Food and Drug Administration(FDA) hard for regulatory action that would require all third-party medical equipment refurbishers, repairers, and servicers to adhere to standard guidelines defined by the manufacturers of that equipment. The FDA didn’t bite, indicating instead by its comments that it “would like very much to see the industry solve it itself,” Grimes said, adding that, regardless of the agency’s position, “the manufacturers are not going to stop” pushing for it.
“The bottom line is, for a variety of reasons, we do need to develop a quality management standard that’s appropriate for this industry,” he said. “We do need to ensure that the people doing this work are able to demonstrate and document their credentials. I just want it to be a solution of our making, and not a solution of manufacturers or legislators who may have a different agenda.”
Grimes chairs the Healthcare Technology Certification Commission (HTCC) which certifies clinical engineers, and sits on the board of the AAMI Credentialing Institute (ACI), which offers certifications in biomedical, laboratory, and radiology equipment, sterilization, quality management, and healthcare technology management. He believes that the sooner imaging service and clinical engineering professionals and the companies that employ them progress toward credentialing, the better for the industry.
“Technology today is certainly not the technology of 40 years ago, of 20 years ago; not even that of 10 years ago,” he said. “What that means is that the people that have to support the technology similarly have to change. How do we ensure that these professionals – engineers, technicians, technology managers – are adequately prepared to support today’s technology and the equipment that’s coming up in the next few years?”
Grimes believes the industry must approach the problem from a systems standpoint, developing credentialing programs that create an appropriately skilled workforce, and support the evolution of their talents as the jobs they perform likewise evolve.
“It’s going to require continuous education, continuous on the job training, and getting new skills,” Grimes said. “It’s also likely that we will introduce additional levels of certification that requires the person to demonstrate that additional competency,” such as the continuing education credits requirements of other health care professionals.
In the future, Grimes believes the evolution of that education could incorporate certifications in things like clinical systems engineering, cybersecurity, artificial intelligence, robotics or 3D imaging and printing. At some point, he said, credentialing agencies will make the determinations, based on industry surveys and other factors, as to which job classes and responsibilities will necessitate specialization.
“We need more appropriately qualified engineers and technicians to do the job,” Grimes said. “Many are still being trained in an old mode of thinking. One of the challenges we have is to work with the institutions to ensure that they’re appropriately training both the technicians and the engineers for what the need is. Too often they’re training people for yesterday’s technology.”
Whether a hospital customer asks for workers’ credentials or not prior to service being performed on its equipment, Grimes points out that the Center for Medicare and Medicaid Services requires that equipment be maintained by qualified staff. It is therefore the responsibility of the hospital contracting for the work to make sure that it’s being handled by qualified personnel.
“I suspect more often than not no one’s bothering to do that, and technically, they’re not complying with the regs,” he said. “There’s some things that are going on that will probably be forcing a change.”
Grimes also believes that any approach to the standard begin with small steps. Generating buy-in from the imaging service and biomed community and incorporating its feedback will help groups like HTCC and ACI to develop more robust certification guidelines over time.
“But don’t make it so onerous that only the largest organizations will sign up,” Grimes said. “Give them a roadmap, a path that’s not impossible, and you can place additional demands in the future as necessary.”
He envisions a modestly priced certification exam that young imaging biomedical professionals could take after completing their schooling, and which increases incrementally in costs and work to advance, level by level.
“Get people to start in a modest way, and as time goes on, you can ask more of them,” Grimes said. “Get them on a road going in a particular direction. Once one is on the path, they’re more likely to stay there.”