Athletic Directors’ Barriers to Hiring Athletic Trainers in High Schools
Mazerolle SM, Raso SR, Pagnotta KD, Stearns RL, Casa DJ. J Athl Train. 2015; 50(10): 1059-1068. doi: 10.4085/1062-6050-50.10.01
Take Home Message: Lack of power, budget concerns, misconceptions about the role of an athletic trainer, and rural location emerged as primary barriers to hiring an athletic trainer by an Athletic Director in the public secondary school setting.
In 2012 the Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs published a consensus statement with the recommendation that an athletic trainer (AT) be available for practices and competitions. While the national average of schools employing ATs has increased in the last decade, only 42% of high schools reported employing an AT. In current organizational hierarchy, hiring and administration of secondary school ATs is typically the purview of the Athletic Director (AD). Despite a rise in the national trend for employment, barriers exist that prevent ADs from hiring an AT, even though they acknowledge their importance in athletic health care. The purpose of this qualitative study was to identify issues ADs face that prevent them from employing ATs in secondary schools. Using data from the Collaboration for Athletic Training Coverage in High Schools–An Ongoing National Study (CATCH-ON), the authors initially identified 1504 public schools that participated in the CATCH-ON and reported not employing an AT. From that pool, the authors randomly selected a subset of schools and categorized by geographic region (north, south, east, and west). The researchers initiated contact with the ADs and conducted semi-structured telephone interviews. Data saturation was reached at 20 participants. Questions for the interview focused on AD perception of ATs, medical care provided for student-athletes, and risk of catastrophic injury or death for student-athletes. Three major themes emerged from analysis: lack of power as well as budget and non-budget concerns. Lack of power was associated with ADs stating an inability to hire and allocate a portion of their budget to an AT salary. Budget concerns were centered on declining state and federal funding for public schools and school board priorities to maintain teacher over AT employment. Non-budget barriers included rural location of the school, misconceptions about the credentials and role of an AT, and community interference (volunteers from the community providing free emergency services).
Budget issues related to hiring an AT are likely not a surprise; lack of funds due to state and federal shortfalls have placed significant strain on school boards. ADs commented that justifying an AT salary is difficult as teachers face potential job cuts. While the concern is valid, it is also places student-athletes at risk. In a typical organizational structure at the secondary school level, the AT reports to the AD. The profession is just beginning to see a shift away from this model, with collegiate athletic medicine programs being realigned with student health services. One of the themes identified in this study was the misconception about the role of an AT, in that a coach who is certified in First Aid/CPR is equitable to a certified and licensed athletic trainer. If ATs were aligned with the school’s nursing staff, the perception may shift away from a line item in an athletic budget to ATs being viewed as a necessary part of the school’s health care team. This study also reminds us that the sports medicine community needs to target advocacy efforts not just at ADs but also at school boards. These efforts may include a continued effort to educate school administrators about ATs.
Questions for Discussion: How can ATs more effectively promote our qualifications to better serve secondary school athletes? Do you feel organizational alignment with a school’s nursing staff could shift the perception of ATs in secondary schools?
Written by: Laura McDonald
Reviewed by: Jeffrey Driban
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