Wednesday, July 17, 2013

Working as a HS AT: Some Descriptive Statistics

Regular readers of this blog and the Advocates for Injured Athletes Facebook page know that A4IA is a big advocate for athletic trainers, especially in high schools.  I’ve spent a lot of time talking about various topics in an effort to help people become aware of the information and skills that can make sports safer for them and their children.  I’ve also had the opportunity to present local stories about the work others are doing to keep kids safe.  Today I wanted to bring to your attention a recent article published in the Journal of Athletic Training that defines the practice characteristics of those athletic trainers working in the secondary school setting.  We've already established that approximately 40% of high schools in the United States have ATs, with the highest rates being in Florida (79%) and Wisconsin (86%).  Now we have information on what their work setting is like and the services they’re able to provide.

This particular study is important because it helps us understand the current working conditions for secondary school athletic trainers and the athletes who utilize AT services.  It also provides the opportunity to direct future research for a deeper understanding of the setting, to improve the care provided to the young athletes and improve the working conditions for ATs.  According to current statistics almost 55% of secondary school athletes participate in interscholastic athletics, resulting in about 2 million injuries annually.  Athletic trainers have already been shown to reduce injuries, so understanding their high school work settings can help get ATs in more schools and provide improved medical care.

Article citation:
McLeod, TC, Bliven, KC, Lam, KC, Bay RC, Valier, AR, & Parsons, JT (2013).  The National
     Practice Characteristics.  Journal of Athletic Training, 48(4):  483 – 492.

Additional Reference:

The study, using data collected as part of the National Sport Safety in Secondary Schools study, solicited participation in the descriptive study using NATA members as potential participants.  Over 4054 secondary high school athletic trainers completed some portion of the study.  The authors did acknowledge that there may be potential participants that were missed because they are not members of NATA.  The results of the study provided descriptive data regarding three primary areas:
  • AT demographics 
  • Secondary school demographics
  • AT practice characteristics
Based on the data collected the typical high school athletic trainer has the following characteristics:        
  • Only slightly more likely to be male (51%) than female
  • Average age is 35.7 +/- 9.9 years
  • 55.4% have master’s degrees
  • 69.6% hold title of Head AT (most often as a the only AT in the school)
  • 91% are licensed/regulated by state credential
  • 48% hold ATC© as their only credential, additional credentials include teaching certificate, CSCS, EMT    
Reflecting on these characteristics, most ATs who work at the high school level are relatively young professionals, many with 10 years or less of experience in the profession and tend to work alone as the school’s Head AT.  A slight majority have a master’s degree and likely hold additional certifications.  This is great news, as young ATs with master’s degrees they are likely to be familiar with some of the most recent information published on the care of young athletic patients and additional certifications also mean additional skills, making them more prepared to care for your child.  Working alone may present challenges for a young AT in executing their responsibilities and their overall professional development (particularly in very young professionals (less than 2 years)).    One of the things I like most about working in the college setting with a staff of ATs was that there were always other professionals to ask questions and seek advice from.  Also, there was always easy access to library resources and current sports medicine information.  This is not to say that an athletic trainer cannot be successful on his/her own as a clinician and take significant steps to continue growing professionally at the secondary school level (ATs are a very committed group when it comes to professional development), but school administrators, team physicians and others need to make sure the resources are available so this development happens.  Everyone  wants their athletic trainer to apply the most current information and techniques with their athletes, we all can help with this.

Based on the data collected the typical high school with an athletic trainer has the following characteristics:
  • 77.2% of high schools are grades 9 – 12, with 73.5% being defined as public
  • 80% of schools have football
  • 35% have 200 – 399 male athletes
  • 34.3% have 200 – 399 female athletes
  • 33% have a total enrollment of 1000 – 1999
These are very basic descriptive statistics, but at least they give an idea of the types of schools who are hiring athletic trainers.  Based on this data public schools have done well to get ATs into the schools, it’s not just private and charter schools employing ATs.  Based on the data it appears that one of the factors in having an AT is having the sport of football.  Also, you cannot use school size to predict who may have an AT, as ATs work at schools of all sizes with the largest percentage working in medium-sized schools.  While this data may be useful, there is also additional information that could be helpful in understanding the types of schools and students who have access to an athletic trainer, including other socioeconomic and geographical data.  Data could include looking family income, school location (rural, suburban, urban), etc.  This information could help us better understand the distribution of available AT care among various types of students/families.

Based on the data collected the typical job characteristics for an athletic trainer in the secondary school setting are:
  • 57% of ATs use a budget or bidding mechanism to get supplies; typical budgets are around $2000
  • 47.1% of ATs hold full-time positions that are paid by the high school
  • 65.1% of ATs are supervised by the Athletic Director (non-medical personnel)
  • 22.8% of ATs hold a teaching credential, 62.7% of these are paid a teaching salary and a stipend for AT duties with about 56% working between 20 – 40 hours per week as an AT (on top of teaching)
  • 72% of ATs travel to away FB games, 45% travel to non-FB playoff events, 15.6% travel during regular season and playoffs for non-FB events
  • 72% perform on site evaluations regularly, with a lesser percentage performing treatment (60.3%) and rehabilitation (39%)
  • 46.9% of ATs work under the direction of an orthopedist, while 19.1% work under the direction of a primary care physician 
Looking at this information almost half of all ATs are in full-time positions in the high school setting with a particular focus of covering football games and practices (especially travel).  ATs, considered medical professionals, are often supervised on a day-to-day basis by the athletic director, but also function under the school’s physician.  Their primary job function is injury evaluation, but where appropriate many also provide regular treatment and in some cases rehabilitation services. 

I am glad to see that almost half of the ATs are in full-time positions that are financially funded by the high school I believe this provides consistency of care for all athletes involved in the athletic program and students know there will always be someone available.  I know in the case of clinic-outreach positions limits (if in place) on hours allowed in the high school can sometimes be a challenge to negotiate because of clinic commitments.  While it is better to have an AT than, not I would hope that someday all ATs would be full-time and funded by the school.  Additionally, for those that are teacher-athletic trainers I would hope that there would be additional resources for them to avoid burnout since they are working two very challenging jobs within the school.  I have had the pleasure to know many teacher-athletic trainers and I know their primary challenge was always balancing both responsibilities since teaching and being an AT are easily full-time jobs on their own. 

I am also glad to see that many ATs have an orthopedist who is responsible for overseeing the healthcare of the athletes, along with primary care sports medicine physicians they are most familiar with the injuries the AT will be addressing.  It can be challenging to work with a physician who is not familiar with the challenges specific to sports medicine. 

Finally, I would invite all schools to look that money budgeted for AT supplies and be sure it is enough to appropriately meet the medical needs of the student-athletes (the authors of the article discuss this briefly).  ATs are very good at doing more with less, but that can only go so far.  Let’s make sure we’re offering the best care possible.  You've taken the first step by hiring an AT, now let’s make sure they have the resources they need.

Reflecting on the study in its entirety I think it paints a generally positive picture of the work setting for high school ATs and the athletes to whom they are providing care, but that is not to say there isn’t room for improvement.  While we have a long way to go before all high schools have an AT, perhaps understanding this information can help get us there faster.  I hope it opens up the dialogue between ATs, school administrators, sports medicine physicians, and parents about who is providing care for their athletes/children.  I hope it will also cause people to reflect on whether the AT has the necessary professional and financial resources to provide the appropriate standard of care for all athletes.  Given that ADs are most often the direct supervisors of the AT I encourage them to do the necessary work to learn what it takes to operate a safe and high-quality athletic program that includes appropriate sports medicine services.  There is much work to be done, but in order for us to move forward we must first understand where we are, our strengths, our weaknesses and our opportunities.  I think this study is a first step in the right direction.

Submitted by Heather L. Clemons. MS, MBA, ATC

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