Sep 5, 2018
Orthopedic Physician Extender and the Orthopedic Technologist

For years, the Athletic Trainer (AT) has been on the pursuit towards subsequent, value-added certification to enhance their marketability in a very competitive workforce. The Orthopedic Technologist Certified (OTC®) and Registered Orthopedic Technologist (ROT) credential have been suggested for the AT being routinely employed in hospitals, clinics, and the orthopedic physician practice setting. As such, it has been well documented that Athletic Trainers employed in these settings have improved productivity, patient outcomes and satisfaction measures. [1-5]

The Athletic Trainer should have the option to pursue additional certification that truly matches their educational and clinical preparedness. The OTC® and ROT have traditionally been “on the job” training with a minimal level of educational expectation. On the contrary, the Orthopedic Physician Extender Certification (OPE-CTM), requiring a college degree (minimum bachelor’s degree with eventual transition to a master’s level), in combination with the existing healthcare specialization and credentialing of the AT, provides the marked designation that fully elevates their clinical specialization in the orthopedic setting.

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The clinical popularity of the “physician extender” dates back to the 1970s when the term was used to describe a non-physician provider who worked under physician supervision in an effort to augment the services of that physician. Over the years, along with the robust medical-based educational model, practical competency approach and dedicated clinical education experiences have allowed the Athletic Trainer to further demonstrate their evolving value for the orthopedic practice.

The Orthopedic Physician Extender is a highly educated healthcare specialist in the orthopedic setting who works directly under the orthopedic physician in a guided, supervised setting to support: (1) Orthopedic Triage; (2) Orthopedic Examination & Clinical Assessment; (3) Orthopedic Casting & Bracing; (4) Diagnostic Imaging Review/Intervention Support; and (5) Provide Patient Education/Guidance. [6] The Orthopedic Physician Extender examination is a 125-question online, objective assessment comprised of the knowledge and skills genuinely representative of the OPEs ancillary role in the orthopedic setting.

The Athletic Trainer’s scope of practice is dictated by each state’s practice act, respectively. ATs may be limited by their state practice act in a setting/patient other than the “athletic” population. The OPE-C will provide the marked designation that fully describes the practice qualification to be utilized by the athletic trainer in the orthopedic physician practice setting. Of course, individuals should always consult their practice act, human resource department to meet provider expectations. As such, the orthopedic extender position for the AT continues to be a vast growth opportunity within the field.

In today’s economy, professionals are always seeking an opportunity to facilitate their competitiveness in the marketplace, particularly the orthopedic practice setting. The educational background/preparation of the athletic trainer continues to afford the AT a seamless transition within clinical orthopedics. As such, previous data supports the considerable value the athletic trainer has on patient throughput, clinical outcomes and patient satisfaction, as well as the marked economic impact athletic trainers have in the orthopedic setting.


Although the professional perspective may appear similar, the OPEs and Orthopedic Technologists (OTs) have significantly different educational and clinical pathways as well as certifying examination complexities (see chart below).

The Orthopedic Technologist (OT) dates back to the 1980s with formal organization by the National Association of Orthopedic Technologists (NAOT) in 1982 and the American Society of Orthopedic Professionals (ASOP) in 1999. The OT is a specifically trained allied health care individual who assists the orthopaedic surgeon in their practice. [7,8]

OTCs come from many different backgrounds and often receive training “on the job” with a profession that lacks formally approved/recognized academic programming. There are three different pathways for eligibility for the OTC: 1. An individual has two years’ experience in orthopedic technology; 2) An individual has completed a structured orthopedic technologist program; 3) The individual is a certified athletic trainer [3]. The ROT would possess one year of casting experience under the supervision of an Orthopedic Surgeon OR have attended an ASOP Casting Workshop and works under the supervision of an Orthopedic Surgeon.


OPEs are not OTCs or ROTs. OPEs are college educated from an accredited AT program and possess at a minimum a bachelor’s degree. To obtain the OPE-CTM credential, an individual must be a Certified Athletic Trainer or actively completing a Professional Athletic Training Program, Post-professional Athletic Training Program, Residency Athletic Training Program, or an AT Clinical Doctoral Program. Students in their last semester with the designated clinical programming, may be endorsed by the program directors. As mentioned, OT membership organizations (NAOT/ASOP) do not have any formal academic programming towards professional credentialing preparation and are mostly often reserved for “on the job” training with no educational degree requirements. The intense medical-based classroom preparation and robust clinical education model for the Athletic Trainer solidifies the clinical and financial value to the orthopedic team.

For the last 10 years, the American Society of Orthopedic Professionals has strategically partnered with select Athletic Training Programs to incorporate ASOPs OPE© materials within respective AT curriculums and in the end, look towards its value added credentialing to further strengthen their graduating student’s position in the marketplace. With the newly released CAATE Standards, particularly Standard 78, ASOP has taken the lead in orthopedic casting/bracing instruction for AT Programs. ASOP will continue to support AT Programs’ paths towards compliance with Standard 78 with practical exam skill sheets, course syllabus templates, textbook reference materials, workshop outlines, etc. Feel free to visit for more information.

In conjunction with subject matter experts, ASOP has elevated its certification pathway that is more consistent with the comprehensive role of the AT in orthopedics, but more importantly, formulated the OPE Certification examination that parallels the college-level academic preparation of the Athletic Trainer.  

In the last 15 years, ASOP has trained over 13,000 medical professionals, including orthopedic residents, physician assistants, nurses, certified athletic trainers, orthotic fitters and other healthcare practitioners in the area of orthopedic casting and bracing. As such, ASOP teaches over 80 casting workshops annually at major teaching hospitals, clinics and orthopedic practices from across the US. The consistent conversation with orthopedic practice administrators and human resource directors is their consistent inquiry and utilization of the orthopedic physician extender terminology in the hiring of ATs in their orthopedic practices.  

ASOP will continue to champion for the AT in the orthopedic physician practice setting by providing the educational programming and a certification pathway that continues to (1) enhance the ongoing marketability, (2) elevate the clinical specialty and (3) fosters the ongoing professional advancement of the AT throughout the orthopedic discipline.

For more information on the certification and credentialing process, please visit:

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OPE vs. ORTHO TECH: At a Glance


Orthopedic Physician Extender Certified (OPE-CTM) [6]

Orthopedic Technologist (ROT/OTC®) [7-9]

Eligibility Standards

Must be a Certified Athletic Trainer or actively completing a Professional Athletic Training Program, Post-professional Athletic Training Program, Residency Athletic Training Program, or an AT Clinical Doctoral Program.

ROT – 1 year casting experience under the supervision of an Orthopedic Surgeon OR have attended an ASOP Casting Workshop and work under the supervision of an Orthopedic Surgeon


OTC© – 1. An individual has two years’ experience in orthopedic technology; or 2) An individual has completed a structured orthopedic technologist program; or 3) The individual is a certified athletic trainer.

Education Level

Minimum Bachelor’s degree

Minimum High Diploma or job training

Academic Programming

Accredited Athletic Training programs have opportunity to become ASOP-Approved OPE Programs (teaching resources provided (


NAOT dissolved approved educational programming as of January 2018

Certifying Body

American Society of Orthopedic Professionals

ROT – American Society of Orthopedic Professionals

OTC© – National Board for Certification of Orthopaedic Technologists

Scope of Practice

Orthopedic Triage, Orthopedic Examination and Clinical Assessment, Orthopedic Casting and Bracing, Diagnostic Imaging Review/Intervention Support, and Patient Education/Guidance

Assessment; Casting, Splinting, and Orthopaedic Appliances, Traction, and Surgery


Exam Format

125-question online

Multiple choice, multi-select, focused testlet

ROT – 100 –question exam

OTC© – 150-question exam.

Multiple choice format


Exam Resources

Comprehensive “Exam Candidate Resource Area” fully accessible with registration (manuals, textbooks pdf downloadable format, videos, PowerPoint files (access included with registration)

ROT – member exam resources at no charge; downloadable

OTC© – Reference list available – Exam booklet available for additional purchase $

Examination Fee $

$147 [valid through December 31, 2019); ASOP professional membership included


ROT – $200 (exam access included)

OTC – $475 [$75 Non-refundable app fee Notarized application required, along with $400 Testing Fee; ($100 late fee when applicable)]

Exam (test location)

On your device (OPE-C exam platform has built-in security test measures)

ROT – online

OTC – Must travel to test site location

Continuing Education Units (CEUs)

Twenty-four (24) CEUs required throughout the two year reporting cycle – aligns with AT reporting term. (Certified in 2018 = 24 CEUs ($25 re-certification fee and $100 ASOP membership fee; Certified in 2019 12 CEUs ($25 re-certification fee and $50 ASOP membership fee)

OPE® reporting cycle deadline is December 31, 2019.  CEU hours accumulated as an Athletic Trainer are ACCEPTED along with other medical healthcare related professional affiliations.

ROT – accepts all CEUs reports as an Athletic Trainer

OTC – Requires 120 credits over six (6) year certification cycle; $240 re-certifying CEU fee ($100.00 late fee)


1. Hajart, A. F., Pecha, F., Hasty, M., Burfeind, S. M., & Greene, J. (2014). The Financial Impact of an Athletic Trainer Working as a Physician Extender in Orthopedic Practice. The Journal of Medical Practice Management, 250-254. Retrieved July 30, 2018, from

2. Burfeind, S., & Wetherington, J. (2016, January).Relative Value Unit for the Athletic Trainer[From the NATA Committee on Practice Advancement].

3. Hajart, A., Diekmann, B., Pecha, F., & Doyle, M. (2010).Practice Profiles: Athletic Trainers in Orthopedic Offices[From the NATA].

4 . Mitchell, D. (2009, April 3). Adding Athletic Trainers to Care Team Can Increase Docs’ Productivity. AAFP News Now. Retrieved July 30, 2018, from

5. Pecha, F. Q., Xerogeanes, J. W., Karas, S. G., Himes, M. E., & Mines, B. A. (2013). Comparison of the Effect of Medical Assistants Versus Certified Athletic Trainers on Patient Volumes and Revenue Generation in a Sports Medicine Practice. Sports Health5(4), 337–339.

6. American Society of Orthopedic Professional. (2018). Orthopedic Physician Extender 2018 Candidate Guide. Elevating the Clinical Specialty for the Athletic Trainer.

7. American Society of Orthopedic Professionals. (n.d.). Retrieved from

8. National Association of Orthopaedic Technologists. (n.d.). Retrieved September 5, 2018, from

9. NBCOT Examinations. (2017). OTC® Examination Applicant Handbook [Pamphlet]. Syracuse, NY: National Board for Certification of Orthopaedic Technologists.

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