Athletic Directors’ Barriers to Hiring
Athletic Trainers in High Schools

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

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

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?

Laura McDonald
by: Jeffrey Driban


Mazerolle SM, Raso SR, Pagnotta KD, Stearns RL, & Casa DJ (2015). Athletic Directors’ Barriers to Hiring Athletic Trainers in High Schools. Journal of Athletic Training, 50 (10), 1059-68 PMID: 26509776