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Understand the risk involved as collegiate athletics face athletic trainer shortages                                                                                                                                                                                                        

The Institutional Risk Around Athletic Trainer Retention, Hiring Difficulties

Collegiate athletics have noticed an increased difficulty in retaining and hiring athletic trainers (AT), which has become of increasing interest and concern to the National Collegiate Athletic Association (NCAA) and other collegiate athletic organizational bodies. They continue to place significant emphasis on student-athlete (SA) health and safety through best practices and recommendations. Therefore, institutions need to ensure they have appropriate resources and staffing to provide an appropriate level of care for their SAs which reduces institutional risk.

Reasons Collegiate Athletic Trainers Leave

The National Athletic Trainers’ Association (NATA) Intercollegiate Council for Sports Medicine (ICSM) in collaboration with the NATA Compensation Task Force disseminated a survey to collegiate athletic trainers across all NCAA divisions, National Association of Intercollegiate Athletics (NAIA), and two-year institutions to identify key areas of employment. The survey was designed with questions specific to the collegiate AT within the five NATA Compensation Task Force pillars: Fundamentals, Recruitment, Advancement, Retention, and Separation. Compensation, culture, value, burnout, increased work responsibilities, and demands were major themes that came out of our survey¹.

A Competitive Market Drives Down Lure of Higher Education Setting Opportunities

Compensation remains the most important factor for the collegiate AT as they evaluate employment options. When compared with other AT professional settings, the collegiate AT compensation ranks second to last of all athletic training practice settings and last when comparing rate of compensation change since 2019². As the AT profession continues to see increasing employment opportunities within occupational health, physician practice, corporate/industrial, military, municipality, and performing art settings, the market has become more competitive.

The Athletic Trainer to Student-Athlete Ratio

Culture, value, burnout, increased work responsibilities and demands are other leading factors of why ATs are leaving the collegiate setting. One of the alarming metrics that came out of the survey is over half of the respondents are caring for more than 100 SAs³. Athletic training in the collegiate settings has increasingly prioritized one-on-one patient care, reflecting the importance of assessing and treating movement dysfunction and manual therapy benefits. The more time-intensive clinical demands are compounded by the increasing administrative and policy obligations.

Ultimately, there is evidence-based literature supporting the appropriate AT to SA ratios. Research has shown NCAA collegiate athletics injury rates were reduced by 9.5% and concussion injury rates by 6.7% with schools that had one standard deviation below the median number of 118 SA per clinician⁴. In addition, re-injury rates were lower in schools that had lower SA to AT ratios based upon their ability to care for them more attentively and consistently⁴.

Shortages Contribute to Medical Errors

Insufficient staffing is associated with burnout and a lack of emotional stability within the healthcare profession as a whole^4,5. A recent study performed in high school, ATs identified approximately 18% of ATs committing at least one medical error in the previous 30 days⁵. This study is higher than physicians at 10.5% and may be due to physicians having more control of their patient load and schedules. In addition, a direct relationship exists between emotional exhaustion and the number of medical errors committed by ATs⁵. As emotional exhaustion increases the number of medical errors made by an individual increase⁵.

Additional Responsibilities of Collegiate Athletic Trainers

The collegiate AT has numerous responsibilities beyond providing patient care to the SAs we serve. There are 16 Standard of Care domains and Athletic Health Care Administrative responsibilities in which we develop guidelines and/or education promoting SA health and safety, ultimately reducing institutional risk^6,7. These are developed in conjunction with team physicians and/or medical organization(s), athletic administration, risk management departments, and/or offices of general counsels and include:

1. Risk Management
2. Cardiac Considerations
3. Head Injury
4. Doping, Substance Use, and Supplements
5. Medication Management
6. Stakeholder Education
7. Emergency Response
8. Management of Environmental/Exertional Guidelines
9. Guidelines for SA Performance and Wellness
10. General Medical Considerations
11. Health Care Administration and Organization
12. Behavior and Mental Health
13. Musculoskeletal Injury Prevention and Management
14. Medical Examinations: Pre-Participation, Annual, and Exit
15. Facility Management
16. Nutrition and Body Composition

Collectively, the ability to properly provide patient care, coverage of athletic activity, and administrative responsibilities have a direct effect on SA safety. Risk managers can be helpful in properly assessing the role and contributions that ATs make to an institution’s risk mitigation strategies. Specific areas may include:

• AT patient loads and volumes
• AT to SA patient ratios
• Tolerance for medicolegal risks, including medical documentation quality and compliance
• Awareness and respect for independent medical care principles and accountability for those principles
• Assessing different models of health care services that may enhance SA health care services

Additional Information

Additional information can be found through the Collegiate Athletic Trainer Labor Crisis White Paper and Best Practices in the Implementation and Structure of Medical Care for College Athletes

References

1. ICSM Compensation Task Force Survey Results
2. 2021 Salary Survey Executive Summary
3. Collegiate Athletic Trainer Labor Crisis document
4. Baugh, C.M. et al., Staffing, Financial and Administrative Oversight Models and Rates of Injury in Collegiate Athletics. Journal of Athletic Training. 2020; 55(6): 580-586.
5. Oglesby, L.W. et al., Burnout In and Commission of Medical Errors by Secondary School Athletic Trainers. Journal of Athletic Training. 2022; 57(3): 234-239.
6. NATA’s Collegiate Standard of Care Toolkit
7. NCAA’s Athletics Health Care Administration Best Practices

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