With today’s graying biomed population retiring at a steady pace and fewer younger people entering the field, HTM managers need to heed this alarm and what it means for the future of the profession. Here’s how succession planning comes in.

By C.A. Wolski

COVID-19 contributed to numerous changes over the past year that will undoubtedly be felt for decades to come. One of the biggest may be the pace at which baby boomers are retiring. In 2020, more than 3.2 million baby boomers—those born between 1946 and 1964—retired, according to Pew Research, more than doubling the previous year’s number.

While there are several reasons for this uptick, including retirements due to company downsizing, it points to a stark reality: The baby boomer generation is increasingly leaving the workforce. And this should alarm biomed managers as they look ahead to the next generation.

There’s little question that the HTMs of today are part of a graying profession. Look no further than 24×7 Magazine’s HTM Salary Survey 2020, in which half of respondents were over age 50. The signs and portents are there, and managers, many who are themselves nearing retirement age, need to act to meet the coming surge of baby boomer and older Generation X retirements in the coming decade.

And more to the point, the U.S. Bureau of Labor Statistics estimates that there will be 3,000 new positions that will need to be filled by 2029, a job rate increase of approximately 5%. The question is how to fill the gaps caused by retirements and the expanding personnel needs of the profession as a whole.

Bottom-Up Focus

While much of the succession planning in the past few years has been focused on filling leadership positions held by soon-to-retire baby boomers, it needs to be a broader more all-encompassing approach. “You should have a succession plan for every position,” says Al Gresch, vice president of healthcare strategy at Accruent and an Association for the Advancement of Medical Instrumentation (AAMI) Health Technology Leadership Committee (HTLC) member.

He notes that, without having a plan in place, organizations tend be reactive, instead of stepping back and really understanding what the organization needs now. “The biggest issue is that most organizations are caught off guard with a tech retiring or taking a new job,” Gresch says. “Their first response is to post the job quickly and hire for the same position as the one being vacated. That’s not the best idea, because you limit the opportunities for the existing staff.”

Instead, he advocates filling the position at the entry level—if possible—and using it as an opportunity to promote existing staff. “Hiring at a higher level should be the exception instead of the rule,” he adds. Apart from “setting up a process of legitimate promotions,” Gresch says, focusing more on filling positions from the bottom up will help in reinforcing the department’s spirit of teamwork.

But where do you find these entry-level replacements? That’s the question facing many organizations, and AAMI is helping to cultivate the next generation with its new apprenticeship program.

The apprenticeship program replaces decades’ old curriculum, giving young people just starting out or those looking for a new career an off-the-street opportunity to learn on the job. The program, which was approved by the U.S. Department of Labor, requires that apprentices be employed by the organization while they learn.

Put simply, apprentices must be doing real work as a biomed. As part of the AAMI-developed educational curriculum, apprentices are required to take college-level courses, such as anatomy, that the employer must subsidize.

AAMI lists partners on its website, and employers are subject to a Department of Labor audit. At the end of the two-year program, the apprentice’s mentor must sign off that the apprentice has completed all the requirements set by AAMI. Then, the apprentice must take and pass the CABT and CBET exams, which solidifies that the apprentice really did complete the program and is as proficient as the mentor indicates. Each graduate apprentice will receive a certificate of completion jointly issued by the Department of Labor and AAMI.


“What’s cool is that it’s a nationally recognized credential, kind of like a college degree,” says Danielle McGeary, vice president of HTM at AAMI.

Credentials or the Right Fit?

Certainly, having the right credentials are critical to doing the job, but that’s not the only thing to consider. For Mike Yackley, section supervisor, and Gordon Hosoda, chief engineer, at the Portland, Ore., Veteran’s Administration Medical Center (VAMC), there’s something else to look for when evaluating a potential tech.

“What we’re looking for is not only the technical requirements, but how they fit personality-wise and will blend in with the team,” Yackley says. “If a candidate doesn’t quite have the experience, but fits the team, we’re more likely to hire them.”

There’s a practical component to this approach, Yackley adds: “Personnel issues for us can be a struggle and affect the whole organization. It could take down the whole department.”

The VAMC biomed team is young compared to the industry norm. Most of the biomeds are in their 20s and 30s and 80% are military veterans. About 50% of the new employees come from a partnership VAMC has with Portland Community College. Yackley is on the advisory board for the project.

They also get technicians through the VA’s Technical Career Field (TCF) Program. Like the AAMI apprenticeship, the two-year program provides training for “critically identified positions.”

The careful vetting process and focus on skills- and personality-matching have paid off in two key ways, according to Yackley: Strong teamwork and low turnover. Of the latter benefit, he says, “We don’t have turnover because techs hate working here. Most leave for better opportunities—and if we see a better opportunity, we encourage techs to take it.”

While both Hosoda and Yackley have several years left in their careers, they are evaluating several techs as their potential replacements. For example, Yackley regularly deputizes one of these potential leaders when he’s away from the office, evaluating both how seriously they take their responsibility and how they are thought of by the other techs.

If they determine one of these potential leaders isn’t the right fit, Hosoda and Yackley will look outside the organization. Whether it’s bottom up or top down, Hosoda says that there’s one principle that they always follow. “We always make the decision for the shop,” he says.

Creating the Ladder

Perhaps the best way to create continuity and coherence in any succession planning is by creating a career ladder. Accruent’s Al Gresch says that has been a critical step he has taken during his management career. The ladder for each employee is established during their annual performance review.

Managers talk through the employee’s goals for the next year and beyond—in the context of the employee’s ambitions, giving them ownership of their career path instead of the manager dictating goals. Timing the review process with the annual budget period helps ensure that these goals can be fulfilled.

And while employees need to be held to account for their own career path instead of putting it in the hands of the manager, the career ladder process needs to be a two-way street—managers need to be as involved as their techs.

“It’s important as a leader that you create opportunities for your techs,” says Gresch. The ladder helps prevent techs stagnating and turnover from occurring. “If you end up with senior-level people doing low-level work that’s not challenging, you’ll end up pricing yourself out of existence,” he warns.

And by not developing a succession plan, departments that are suddenly short staffed will have to outsource the work, which is a costly means to solve what could be a long-term problem. “If leaders ask these questions: what opportunities are we missing or don’t have for employees, how can I recruit techs, and how prepared are we if someone leaves, then they need a plan,” Gresch says.

To successfully address or avoid succession issues, managers need to keep their eyes open, ask questions, and create opportunities. And succession planning is more than just deciding how to fill a tech’s position or just creating a career ladder; it can be much broader than that.

Gresch relates how he once did a time study of the techs he was managing. He discovered that each of the 80 techs was spending about an hour a day ordering parts instead of repairing or servicing equipment. To solve that problem and get those 80 hours per day back, Gresch hired a parts procurement specialist.

Making a succession plan—which requires changing conventional thinking from simply filling an open position to really looking at the needs of the department—can be a big step and a sea change for the entire organization. It can also be difficult to get off the ground.

Fortunately, AAMI has developed a leadership guide, which aims to make this task easier. Gresch, a co-author of the guide, summarized the six steps needed to create successful succession plan:

  1. Establish goals.
  2. Set the needs/skills of the techs for the positions.
  3. Assess the current state of your operation.
  4. Identify what you need right now.
  5. Create a plan to meet those needs.
  6. Execute the plan.

“This really is a plan for success for anything,” he notes. One question remains about the career ladder system that Gresch is advocating for: Does it work? Put simply, yes. “After putting the career ladder in place, I never had much turnover,” Gresch says.

Looking Ahead

Apprenticeships, careful vetting, working with local schools, career ladders— they’re all aimed at meeting the need for biomeds today, but what about the future?

Ask a young kid or even a senior in high school what they want to be when they grow up and it’s likely that biomedical technician won’t be on the list. “Most people find out about the field by accident,” notes McGeary, who counts herself among the accidental HTMs. “No one knows they exist. That’s really the crux of the problem. You see doctors and nurses [and other] in-your-face careers. The more real, the more they feel associated with it, the better. Kids can only be what they’re seeing.”

To rectify that, AAMI has created a recruitment tool, HTM in a Box, that features free PowerPoint presentations that biomeds can use to help raise awareness. The three PowerPoints are aimed at children, high school students, and adults, respectively.  Along with those presentations AAMI also has accompanying brochures geared toward these groups. For kids, for example, the brochure has a fun superhero theme.

For high school students there are opportunities to win free BMAT courses, which requires filling out a Google form and watching the PowerPoint presentation. The adult presentations are aimed at career changers, particularly those with medical or technical backgrounds.

These recruitment efforts are coming at a critical time as more biomeds are eyeing retirement, McGeary says. “What we’re losing is the long-term industry knowledge,” she says. “Even if we’re getting new people in, we’re losing experienced people.”

This is also where succession planning comes into play. McGeary notes that the apprentices who are graduating the AAMI program are qualified BMET 1s, but organizations then have to address how to develop these biomeds’ skills.

As part of the career ladder, Gresch says that he developed a program in which the more senior-level biomeds coached and mentored those below them—e.g., BMET 2s mentored BMET 1s, BMET 3s mentored BMET 2s, and so on. The effect was positive and long-lasting, he says. “It creates a culture of teamwork and development,” Gresch says. And perhaps the key to succession planning is biomeds themselves going out and communicating that the field can be a fit for anyone, is rewarding, and is exciting.

While the field may be facing a tough immediate future, there are clearly plans that organizations can follow to meet the succession challenge in the long term.

C.A. Wolski is a regular contributor to 24×7 Magazine. Questions and comments can be directed to 24×7 Magazine chief editor Keri Forsythe-Stephens at [email protected]