By K. Richard Douglas
There are organizations that develop and publish standards adopted by entire industries. These standards create guidelines that ensure consistency, specifications and characteristics in products, processes and materials.
AAMI covered healthcare technology management (HTM) career progression in its “Career Planning Handbook,” illustrating a leadership progression path, a technician progression path and a clinical engineer career path. The guide delves into the accrued skills and experience garnered at each level.
Nomenclature has crept into many facets of life, and the HTM profession, through a meeting of minds, evolved into a more accurately defined profession with the introduction of healthcare technology management as a more apt descriptor.
While many biomed departments have embraced this updated description, the descriptions for positions within an HTM department have lagged, with no standardized nomenclature. An industrywide standardization of titles is not required, however the articulation of titles, roles and responsibilities, along with remuneration, is an important topic.
Leadership within HTM organizations have been focused on determining the titles and salaries of their HTM staff based on capabilities, responsibilities, roles and focus. The efforts of leadership have been determined more on getting these things right within their organizations instead of an effort to align titles and roles across the entire profession.
Perry Kirwan is vice president of technology management at Banner Health in Phoenix, Arizona.
Kirwan says he doesn’t see much disparity in the titling of general biomedical technicians and imaging service engineers. He says that the titling of the roles that go beyond these two areas, such as roles in cybersecurity, medical equipment planning, application management, technology specialists, database/CMMS administrators, might be the exception.
He says that while the titling of the biomed and imaging positions seems mostly consistent, it is defining what each position means and what is expected in terms of capabilities of those who hold a particular title, that may present some disparities.
“The other issue is salary range within those positions and continuing to find a way to calibrate those in such a manner that it reflects the talent and skills that it takes to be an HTM professional at any level. What I’d like to see is work to try and standardize what the requirements are between the levels because you should expect a BMET I, II, III, etcetera, to be of a certain caliber anywhere you go throughout the country,” Kirwan says.
This is why having some consistency within a biomed department with position titles, expectations and responsibilities can help with defining those positions more clearly and finding candidates who are the best fit for the position.
“I determined job titles for my program by my experience as an HTM professional through the years. One of the biggest influences on my job description structure was the disparity I saw with technicians who had medical imaging system experience versus ‘biomeds.’ The imaging engineers acted like prima donnas. They looked down upon the ‘biomed’ and the lack of teamwork and respect was palpable. This was troublesome to me, and I vowed to work to make the playing field more suitable to teamwork,” says Christopher G. Nowak, CBET, CHP, CSCS, senior director of healthcare technology management at Universal Health Services (UHS) in King of Prussia, Pennsylvania.
Nowak says that when he developed the job titles for the HTM program, he wanted to recognize the strengths of the skill sets that each employee brought to the table and what could be contributed to make the patient experience exceptional, i.e., little, if any downtime to medical devices.
“This meant that the value that an experienced imaging systems technologist brought was equivalent to the value an experienced clinical laboratory technician brought. HTM professionals who brought an IT skill set were equally compensated based on their experience, competency, and value they brought to the program. I did not want the technician working on the nuclear camera performing a PM, to not touch the physiological gating monitor sitting in the corner because that device is a ‘biomedical’ device and beneath me to also perform the PM on that device. That inefficiency drives me crazy. I sought to streamline the role responsibilities to gain efficiencies,” Nowak says.
A Unique Approach
Applying critical thinking to the process of determining job roles and compensation led one biomed director to categorize those in the biomed department into two general groups. Further delineation was then applied to these roles to determine both the team member’s focus and skills.
“When I first started in biomed at Stanford in 2007, there were only six job roles; three management and three tech roles. We had a director, assistant director, manager, lead biomed tech, certified biomed tech and biomed tech. Things didn’t make much sense, considering the work was so broad and there were varying degrees of responsibilities that overlapped most roles,” says Michael Kozuma, BSM, CBET, director of biomedical engineering/technology and digital solutions at Stanford Health Care and School of Medicine in Palo Alto, California.
He says that over the years, more job titles were added to the pool and more confusion commenced.
“When I started the journey of job title alignment a couple years ago, I was bound to the organization’s job title library. As I navigated what made the most sense without creating tsunami for the bureaucratic system most of us are boxed into. Into the first year of the process, it made sense to ‘tweak’ job roles and compensation, and I was pleasantly supported by HR, Compensation and IT (TDS) leadership,” Kozuma says.
He says that during this process, they determined there are two types of employees; project-focused and operational-focused.
“The general rule is all operational employees should have 10 percent of their work time available for ‘projects.’ We carved the two types of employees into different buckets within project types and operational support. The ‘end’ result is as follows: Assistant Biomed – 90 percent operations; Biomed – 90 percent operations; Certified Biomed – 90 percent operations; Lead Biomed – 50/50 percent operations/projects; Biomed Systems Engineer – 25/75 percent operations/projects; Senior Biomed Systems Engineer – 25/75 percent operations/projects; Lead Biomed Systems Engineer – 25/75 percent operations/projects; and Biomed Applications Manager – 90/10 percent projects/operations,” Kozuma says.
He says that the assistant manager, manager, senior manager, director and administrator director are all at the needs of the department.
Why Standardized Titles Don’t Exist
Differences in the terms used across the biomed field have precluded the standardization of roles and descriptions. There will need to be a large-scale effort to create real standardization.
“A lot of the issue with job titles has been self-imposed by the industry as the field developed. Much of this started with the variation in the industry and department names. We have everything to include medical equipment repair, medical equipment service, clinical engineering, biomedical engineering, medical engineering, clinical technology, medical instrumentation, clinical equipment maintenance and now healthcare technology management. Because of this, the job descriptions have varied across the industry and they continue to evolve,” says Mike Busdicker, MBA, CHTM, AAMIF, FACHE, senior director of healthcare technology management at Intermountain Healthcare in Salt Lake City, Utah.
He says that another factor in the wide variation of job descriptions includes different duties and responsibilities across the industry.
“We have caregivers working for manufacturers, independent service organizations, academic institutions, stand-alone hospitals, health care systems, and other service providers. This has resulted in the creation of multiple job descriptions to cover things like field service, depot repair, biomedical equipment, imaging equipment, dialysis systems and sterilizers,” Busdicker says.
He says that over the years, many of these titles and job descriptions have been adopted and utilized by organizations across the industry.
“It would be great if we could get these standardized and everyone using the same terminology and titles. Some of the issue is the resistance, or reluctance, to change and the desire to stay with the current terminology,” Busdicker adds.
Nowak says that he suspects the reasons why job titles are not standardized relate to the difference in leadership in the career field.
“Some leaders have not evolved as the technology has evolved. Some leaders have not recognized the changes to the fiscal pressures, i.e., the need to drive efficiency. Having an ‘imaging engineer’ sitting at a computer reading a newspaper or watching a video movie while the ‘biomed’ team is killing themselves trying to complete the infusion pump planned maintenance cannot happen in 2023,” he says.
He says that everyone is on the same team and helping one another achieve the goals of the department is tantamount to the success of providing patients and the clinical staff, who directly treat the patients, with a great experience.
Titles and Compensation
Determining both titles and compensation can help more clearly define roles while providing some transparency regarding expectations and rewards for contributions.
Kozuma says that compensation is a challenge to overcome and that there is still work to be done.
“We restructured the pay scale to align with job roles, duties, responsibilities, and difficulty, alongside individual qualifications such as education and experience. It was far too common with the old biomed structure, for someone with similar qualifications to get compensated lower than another employee a grade or two, sometimes several grades below,” he says.
Nowak says that he has five technical positions in the career ladder.
The entry-level role is MST (medical systems technologist), then there is the MSET I (medical systems engineering technologist 1), MSET II (medical systems engineering technologist 2), MSET III (medical systems engineering technologist 3) and the Senior MSET (senior medical systems engineering technologist).
“There are no ‘imaging engineer’ titles because the compensation plan for the role’s rewards experience, competency and the value proposition that is delivered by the technician. As an example, the person with an imaging service skill set, but with little competency since they may be inexperienced, i.e. cannot change an X-ray tube and perform required calibrations, is compensated similarly to the biomedical professional who might not be able to work on clinical lab gear or perform anesthesia system planned maintenance,” he says.
“I have witnessed that since developing and deploying this strategy of job descriptions, the teamwork among the technical staff is very effective. No longer is there an us-versus-them attitude among the team,” Nowak adds.
Expectations May Not Align with Reality
When a biomed is applying for a job, the disparities in job titles and responsibilities across health care systems may result in expectations or assumptions that are incorrect.
“Absolutely, at times job titles may not accurately reflect the overall duties, responsibilities and span of control of the position. For example, health care systems across the country vary in size and the job titles within healthcare technology management are not always consistent. Leadership positions can range from vice president of CE to HTM manager. This disparity can cause a difference in pay along with several other implied job duties, responsibilities and educational requirements within the industry,” Busdicker says.
Kozuma agrees and says that these assumptions are common.
“We often have experienced biomeds apply for senior or lead roles because they are used to the ‘time in service’ mentality. Just because you did a biomed job elsewhere, doesn’t qualify you by default to be in an elevated role. In addition, the senior biomed systems engineer is a biomed that manages multiple systems and can handle the project aspect in a project manager capacity. Lead biomeds must be able to flow between operations and projects. A biomed with 10 years of bench work experience will most likely not be the right fit for these roles,” he says.
Nowak says that the technical skill set, the clinical skill set and the personality must mature as the technician grows in the career field.
“Fixing a medical device is only one aspect of the total repair process. ‘Fixing’ the clinical or technical (lab tech, rad tech, respiratory therapist) professional who uses the medical device must take place and that requires a mature personality. The ability of the technician to communicate and provide the clinician or technical professional with the confidence that the medical device is repaired and ready for service is critical to the success of patient care. If I have a 20-year technician who all they do to contribute to the team is fix infusion pumps, then that person does not qualify for a senior level technologist. Time in service is not the arbiter of position or compensation,” he says.
While few leaders in HTM expect a national standard anytime soon regarding titles, skill sets and expectations; most are focused on a well-defined structure within their own departments to make clear what a particular title entails along with expectations and compensation.
Within the efforts to ascertain that HTM is a true profession by any measure, the precise defining of a position is a key ingredient.
