Jul 29, 2015A Gracious Guest
More and more sports organizations are hiring contract athletic trainers to cover their events. What are the best ways to make the relationship work?
The following article appears in the July/August 2015 issue of Training & Conditioning.
As awareness about the importance of athletic trainers continues to grow, so too will the demand for their services in a variety of settings. From local youth basketball tournaments to masters triathlons, organizers will increasingly look for athletic training coverage at their events. This is where the contract athletic trainer can have a significant impact.
I’m speaking from experience, as I’ve been an independent athletic trainer for more than a decade. What first drew me to this line of work was the flexibility it offered. If I don’t feel like working a late fall football game in the snow, I don’t sign up for it. If I want to have every Tuesday afternoon free to spend with my family, I can.
I also like that my only on-site responsibility as a contractor is athletic training. I don’t have to double as the equipment manager, scorekeeper, or groundskeeper, and I am never asked to look up a locker combination and fetch a uniform before a game.
When I first started contract work, I was in my early 20s, employed as a high school athletic trainer and taking per diem jobs for extra spending money. Now I’m married and a new mom, and all I do is contract work, along with operating Precision Athletic Training, a Massachusetts-based per diem athletic training and consulting company I started in 2009.
Whether you’re looking to do contract work for your primary source of income or pick up occasional assignments, there are plenty of opportunities to pursue. However, a little bit of legwork is necessary up front. Per diem athletic trainers must consider the liability they assume, secure appropriate insurance coverage, and learn to develop professional relationships in a different way.
PATH TO PER DIEM
My journey as an independent athletic trainer began long before I fully understood what being a contractor meant. Employed as an athletic trainer and physical education teacher by a small private secondary school from 2001 to 2007, I rarely had games on weekends, which left plenty of time for additional work. I was on a large list of area per diem athletic trainers and received an email whenever a job came up. If it sounded good, I’d quickly email or call the contact person to secure it.
However, after working per diem jobs for several years, many aspects of the industry began to irk me. I often had to pay for my own supplies, and I didn’t like the ever-changing terms of payment. Athletic directors would frequently tell me what they would pay (which tended to be lower than I would have liked) instead of me setting my own rates. After venting my frustrations to my mother, she said, “You need to start a contracting business for these athletic trainers!” I tucked that advice in the back of my mind.
In 2007, I got a job at a new school, only to be laid off during a round of budget cuts two years later. Instead of looking for a traditional job, I decided to respond to my mother’s suggestion and start a per diem athletic training company.
Since forming Precision Athletic Training, I’ve striven to advance the profession by providing athletic trainers with competitive rates and supplying athletic directors with prescreened, qualified athletic training personnel. In doing so, I’ve also had my eyes opened to the legal complexities of per diem work, which is critical for all athletic trainers to understand before diving in.
The first thing athletic trainers should know about per diem work is the definition of an independent contractor. It can vary from state to state, but generally, contractors are those with a specific skill set who may decide how to use it on a job. Here in Massachusetts, it is someone who is “free from control and direction in connection with the performance of the service.”
Many independent athletic trainers make the mistake of considering their clients to be their employers. In reality, they are the ones in charge.
Independent contractors are considered self-employed, so they do not fill out W-2 or I-9 forms. They don’t have taxes taken out of their paychecks and instead pay self-employment taxes. Before jumping into per diem work, I recommend planning to set aside money for taxes from each paycheck and making quarterly payments to avoid a huge tax bill in April.
Per diem athletic trainers must also understand and comply with state licensure laws, which frequently come into play when crossing state lines to work summer camps and other events. For example, outside athletic trainers who come to Massachusetts can generally work here only two days per calendar year. In New York, Pennsylvania, and Rhode Island, visiting athletic trainers can provide coverage only to teams they are traveling with.
Regardless of licensure laws, all states require contract athletic trainers to work under the direction of a physician. If you do not follow this law and something tragic happens to an athlete, this error can be used against you in a lawsuit, and your liability insurance may not cover you.
If you are contracted to a high school or college, the athletic department’s physician may be able to supervise you. But in many cases, they are only permitted to oversee school employees. If that’s the case, or if you are looking to be employed solely through contract work, you might have to find your own physician to work with.
There are a few ways to do this. Working with a contract athletic training company can ensure a physician supervises you because they should have one affiliated with their organization. Otherwise, networking is key. I have found that many doctors volunteer for large events, and those looking for referrals might want to be your directing physician. I’ve also had success asking other athletic trainers, doctors, and physical therapists if they know any physicians who might be interested in working with me. Four out of the five times I tried this strategy, I found a physician to partner with.
On the topic of insurance, many contract athletic trainers are severely under-protected or paying for policies that don’t cover all of their work. I know of one very popular plan that allows only 120 hours of per diem work per year-just 10 hours a month! Other plans do not cover certain types of overnight camps or treatment of professional athletes who make more than a certain amount of money.
If you already have a policy, read it very carefully and make sure you are classified properly. Double check how many per diem hours are covered to ensure the plan meets your needs.
TERMS OF SERVICE
After taking care of the legal and insurance necessities of per diem work, I highly recommend you come up with a contract for service. This is a document that your client should review and sign before you work their event. If you don’t feel comfortable presenting them with a contract, at least get written confirmation of the terms prior to the job.
I learned the importance of contracts the hard way. One summer, I was asked to accompany a team on a training trip to another country. The athletic director and I verbally agreed on payment terms before I left. When I returned six weeks later, he stated that he remembered us agreeing on a considerably smaller amount. If I had a written agreement stating the rate, there never would have been an issue. It took months of phone calls and emails before I received the full payment. However, the experience ruined my relationship with that athletic director.
Your contract can be as simple as outlining the services you will provide, dates, times, and payment terms, or as detailed as including indemnification and clarifying who pays for legal fees should a lawsuit occur. Once you start working per diem jobs regularly, you can use the same contract for all your clients and simply edit the details for each event. (See “Put it in Writing” below for a list of items I cover in my contracts.)
The contract needs to hold up in court, so care should be taken when creating this document. After you come up with a contract you like, consult with an attorney to make sure it is sufficient.
Once I got the hang of using contracts, they saved me several times. For example, I require two weeks notice for all non-weather summer camp cancellations booked through my company. I once had an organization cancel a camp days before the scheduled start due to low numbers, and the client refused to pay my athletic trainer. Because of the terms laid out in my contract, I took him to small claims court and won.
Another time, I had a client simply not pay for my athletic training services. He did not return any of my calls, emails, or certified letters. I ended up filing a small claim, which explained that we had entered into a written contract, and payment was not made after services were rendered. After being served, he paid immediately.
A word of caution: Try to always get a client’s street address on your contract. I once had an out-of-state camp director use a P.O. Box instead of an address. When he refused to pay, I didn’t have anywhere to send my claim, so I had no recourse.
Occasionally, schools or organizations will want you to sign their contract of service or change yours to better suit their needs. I’ve agreed to this only in circumstances where all of my criteria were still addressed, and the document provided adequate protection to my company and athletic trainers.
Lastly, per diem athletic trainers may encounter Independent Contractor Agreements (ICAs) when working with an agency. An ICA is a document that states the nature of the relationship between a contractor and subcontractor, which usually explains that the contractor is not an employee and is therefore responsible for his or her own insurances and taxes and not eligible for company benefits.
MAKING THE ADJUSTMENT
Along with the logistics and legalities of contract athletic training, there are unique challenges to working at an unfamiliar site with people you don’t know. Over the years, I’ve come up with some strategies for handling emergencies, gaining trust, and diagnosing injuries without any background information.
One of the most significant things to adjust to is not having established emergency action plans (EAPs) or learning them on the fly. The first thing I do when arriving at a new site is obtain a general understanding of its EAP. I ask my contact person about the plan, find out if there is an AED on the premises, and figure out the best way for ambulances to get on site.
However, at most jobs, either the contact person doesn’t know the EAP or one isn’t established. When this happens, I create one on the spot by taking stock of the resources available to me and deciding what will need to happen should a serious injury occur. For instance, many venues don’t have AEDs, and in these situations, I need to figure out the fastest way to get one in an emergency. Sometimes that requires calling the town police, an ambulance dispatcher, or even 911.
In addition, I always make sure I have all the tools I need to treat any injuries that may occur. If a job promised me full access to an on-site athletic training room, I make sure its cabinets are unlocked and all necessary supplies are available before the event starts.
Even if supplies are promised, I always bring my own athletic training kit to every job and stock the trunk of my car with items I could potentially need. This way, I know where everything is if I need it fast.
Another challenge with contract work is building trust among athletes and coaches who don’t know you. I always introduce myself to the coaches and athletes before an event begins. I make a brief announcement and say something like, “Hi, everyone. My name is Mara, and I am the athletic trainer covering today’s game. If you get hurt, I’ll be the one coming out onto the field. I hope I don’t have to see any of you again today.” This seems to make a positive impression. If players know who I am beforehand, they seem relieved when I approach them to treat an injury.
In some ways, developing trust is more critical in per diem work because you won’t know athletes’ medical histories, pain tolerances, or what they looked like before an injury occurred. Even when a job is for a high school or college athletic event, contractors very rarely have access to athletes’ emergency medical forms.
I’ve seen a player writhe around on the field in pain only to find out later that she did this during every game and was usually fine and able to return to play. I’ve also had a patient storm off in the middle of a concussion evaluation because I didn’t know she had a learning disability that made it difficult for her to concentrate while answering my questions. Talking to coaches before games is a good way to gain some insight into athletes’ histories and get a better understanding for what to expect.
Teammates can also be helpful resources when an injury occurs. On more than one occasion, I’ve asked an injured athlete’s teammate, “Does his face look normal to you?” after the player took a blow to the nose, and I always carry a mirror so athletes can tell me themselves.
When treating serious injuries, it can be tough for contract athletic trainers to know what course of action to take, but I find it’s best to err on the side of caution. My first step is to take control of the situation and not let coaches or parents influence my work. I’m conservative about return to play after any questionable injuries, and I always call the parents of minors when there’s an injury-even a small one. Lastly, I follow up with the athlete and document every step of their treatment.
That being said, this process doesn’t always go smoothly. For instance, I once worked an all-star football game in which a lineman came off the field with what appeared to be a dislocated thumb. Upon evaluation, it became clear that I was not just looking at a dislocation-the bone had punctured his skin, as well. The player was adamant that he was going back in, as it was the final game of his career. I felt bad for him, but I calmly explained that he needed to go to the emergency room, have the injury reduced and evaluated, and properly clean and close the wound.
The player persisted and got his mother out of the stands to try to convince me to tape him up and send him back in. Because they were distracting me from the game, I “bargained” with them. The field was next to a hospital, so I said if he went to the emergency room, got his thumb looked at, and came back with a doctor’s note allowing his return to the game, I would let him play. I did not see them again that night. When I followed up the next morning, I learned the athlete had a consult set up for surgery.
WAY OF LIFE
The most frequent question I’m asked about per diem athletic training work is, “Is it possible to make a living this way?” It is certainly possible, but the majority of contract athletic trainers I know find it important to have a second source of income.
Athletic training jobs between the hours of 8 a.m. and 1 p.m. during the week are not easy to come by because games and practices happen mainly after school and on weekends. Therefore, many of the per diem athletic trainers I work with also have daytime jobs as teachers, personal trainers, babysitters, or massage therapists. Others are business owners like me. These secondary jobs can also go a long way toward covering expenses that employers often pay for, such as health insurance, liability insurance, retirement plans, and taxes.
One thing that draws some athletic trainers to contract work is the idea that it can provide a more attractive work-life balance than traditional settings. For instance, many working parents I know like contract athletic training because it allows them to stay at home with their children but still help with expenses. It also gives them the flexibility to work around their kids’ schedules.
However, just like on-site positions, it can take some finesse and planning to keep things running smoothly for athletic trainers with children. If my childcare falls through when I have a job scheduled, I need to have a back-up plan in place or another athletic trainer who can cover for me. Also, unlike my early contract days when I could take any job I wanted, the need to line up childcare makes it difficult to drop everything for a last-minute opportunity.
In the future, I see the need for per diem athletic trainers increasing dramatically. With my own company, we currently list up to 23 after school jobs every day and up to 15 jobs each weekend. Those numbers grow each season. The availability of good jobs with competitive wages along with the flexibility that the self-employed have makes contracting a very attractive option for athletic trainers.
PUT IT IN WRITING
When creating a contract for a per diem athletic training job, I start by outlining the services I am prepared to offer:
• Administering rehabilitative services as prescribed by an athlete’s doctor or as needed during an athletic event
• Taking appropriate steps to prevent, recognize, evaluate, and assess athletic injuries
• Making return-to-play decisions
• Providing interim care while awaiting arrival of medical personnel
• Referring athletes to appropriate medical professionals when necessary
• Communicating with parents, coaches, and administrators about athletic injuries or related issues and alerting them of the need for medical attention
• Documenting and reporting athletic injuries
• Being aware of the nearest AED.
My experience has shown me that it also helps to protect myself by relaying additional terms, which can include:
• Policies that cover weather- and non-weather-related cancellations
• What dates, times, and sports I will be covering
• My rates and payment schedules
• What insurances I will provide
• Who will pay for supplies
• That I will not bring water for the athletes
• That parking fees will be added to the invoice.