Jan 29, 2015
In the Right Place

At the University of Vermont, athletic trainers are hired and overseen by the campus health center, not the athletic department. Here’s an inside look at this organizational trend and the many benefits it offers.

By Allison Shepherd

Allison Shepherd, MA, ATC, is the Athletic Medicine Services Director at the University of Vermont. She can be reached at: [email protected].

Think about the tasks that college athletic trainers perform on a regular basis. On any given day, we might find ourselves diagnosing and treating injuries, directing rehabilitation programs to prevent future ones, and helping athletes cope with chronic physical conditions and functional limitations. We counsel individuals with nutritional problems, massage, wrap, tape, coordinate coverage for a wide variety of events–the list goes on.

As medical professionals, our responsibilities, priorities, and the issues we face every day are vastly different from those of sport coaches, strength and conditioning coaches, equipment managers, sports information directors, and everyone else who makes the athletic department run. Does it make sense, then, that all of us should be governed by the same leadership structure?

At the University of Vermont, we don’t think so. Unlike at most schools, where sports medicine is overseen by the athletic department, our athletic training staff is a unit of the Center for Health and Wellbeing. The CHWB is our campus’s student health center, committed to the concepts of wellness and prevention and focused on helping our students achieve lifelong optimal health. The athletic medicine staff answers to the medical director for the university–not the athletic director–and everything about the way we do our jobs is shaped by this medical-model structure.

We feel this model is the best possible arrangement for many reasons, ranging from logistics to professional development and from resource allocation to autonomy in decision-making. But most importantly, we believe it helps ensure that the student-athletes we serve receive the best possible medical treatment and healthcare.

STREAMLINED SERVICE

Vermont is a school of 10,000 students, and our athlete population numbers just under 500. Our sports medicine staff consists of an Athletic Medicine Services Director, two Senior Associate Athletic Trainers, one Associate Athletic Trainer, and four Assistant Athletic Trainers. All of us are certified athletic trainers employed by the CHWB, the same entity that houses our campus’s physicians, nurses, physician’s assistants, lab technicians, registered dieticians, psychologists, counselors, health educators, and various other medical support staff.

On the most basic personnel level–how we as athletic trainers define ourselves professionally–this arrangement makes a lot of sense. It sends a clear message to everyone in the school community that we are trained healthcare workers with specialized skills.

We consider all the healthcare providers within the CHWB to be our closest co-workers. We have excellent working relationships with them, allowing us to easily make referrals for athlete care when necessary, and to take a team approach to treating athletes who need services beyond our scope. We’re closely in tune with the strengths and specialties of all our campus’s healthcare providers, and know exactly who can best solve an athlete’s problem, whether it’s a knee injury, a bout with depression, or a gastrointestinal bug. This system also makes following up with an athlete’s progress after the referral much more efficient.

Many athletic trainers spend a lot of time traveling with athletes to and from appointments with off-campus specialists. Since we have such a great working relationship with all of our campus health resources, 90 percent of our athletes’ referral-based appointments are made with providers within the CHWB. In addition to saving money, this keeps us from spending our time on the road and in the waiting room, and the athletes miss fewer classes, study halls, and practices.

Another major logistical benefit involves record keeping. In many programs, the athletic trainers keep their notes and patient files on athletic department computers and/or paper charts, and other healthcare providers can’t access the information without tedious paperwork, transferring of files, and an authorization process. At UVM, the athletic trainers use an electronic record system that’s shared among all CHWB providers. This way, we can ensure that everyone involved in an athlete’s care is on the same page, while still protecting the individual’s privacy.

If one of our physicians sees an athlete with a broken ankle, he can immediately learn about any previous injuries that individual sustained, what their rehabilitation consisted of, and any other observations, notes, and medical data the athletic training staff may have collected. Likewise, if one of our counselors meets with an athlete who’s showing signs of an eating disorder, she can easily access information on the athlete’s past weight, medical history, and any dietary intervention they may have received from the athletic medicine staff during their college career. The counselor doesn’t lose time playing phone tag with us (or us with them) trying to share this vital information.

The electronic record system also allows all providers to access one another’s schedules. This greatly streamlines the process of getting student-athletes in to see a provider. Instead of calling an office manager to inquire about the next opening in someone’s schedule, we can find it ourselves, which proves quite useful when trying to work around student-athletes’ hectic schedules. Once we schedule the appointment, we can drop that provider a quick note through the system explaining why we are referring the athlete, any special needs or instructions, and how best to reach us with their thoughts.

With everything from x-ray services to mental healthcare practically at our fingertips, athletic medicine is seamlessly linked to all the other health services an individual may need, whether it’s directly related to their sport participation or not. With the built-in efficiency created by these close-knit relationships, we can make the best possible use of our time every day, which further improves athlete care.

INDEPENDENCE FACTOR

When athletic trainers are on the athletic department’s payroll, there’s sometimes the possibility for conflicts of interest to arise in an athlete’s treatment. If an athletic trainer’s closest ties are to coaches and athletic directors whose job security is linked in part to on-field success, there may be pressure to get athletes back into action before they are truly ready.

To be clear, I don’t believe that type of thing happens very often. As athletic trainers, we understand the importance of making decisions based solely on our best medical judgment, and the vast majority of us adhere to that principle without compromise. But under UVM’s medical model for athletic training oversight, the possibility for such pressures is virtually eliminated.

Even at programs where there are strict rules preventing undue interference with athletic medicine, there’s still the risk for a perceived conflict of interest. Those who don’t understand the inner workings of the athletic department may assume that athletic trainers who work for the same supervisor as sport coaches have conflicted priorities. In our setting, that perception is not an issue.

On many occasions, I’ve had an athlete’s parents tell me how happy they are to learn that we are not part of the athletic department and weren’t brought in at the request of their child’s coach. Within our medical model, we continue to have excellent working relationships with the athletic director, coaches, and athletic support staff, but parents can sleep better at night knowing we have complete autonomy from the athletic department when it comes to making medical decisions.

Another benefit of our independence from athletics is job security. In tough economic times when athletic programs are forced to make cuts, support staff positions are often the first to go, and many programs unfortunately place athletic trainers in that category. Because we are part of the medical services unit on campus, we don’t have to worry about losing personnel or facing budget cuts due to an economic downturn or an “off year” for athletic fundraising.

In addition, our contracts are not renewed annually like at many programs. Our continued employment is based on regular performance reviews, which also dictate the yearly increases in our salaries. Overall, our salaries are higher than those at many comparable institutions, because our pay scale is based on our status as healthcare professionals, not athletic department employees.

Our independence from the athletic department also helps shape our work schedule. Most athletic trainers work very long hours, but in athletics, this is often just seen as part of the culture and can easily be overlooked–everyone from the top-level administrators down to the first-tier employees puts in long days. Under our medical model, however, the CHWB administrators pay close attention to our work schedules and ensure that we have enough people and man-hours to cover all the program’s needs without overextending ourselves.

This affords us the opportunity to develop a sound work-life balance. No one is on the road with a team for consecutive seasons, overtime days are reduced, and everyone gets a day off when they need it, even during their primary team’s season. In addition to improving our athletic trainers’ quality of life, this also prevents burnouts and helps promote staff stability.

There are other scheduling benefits as well. For example, our athletic training staff recently decided that the work we were doing with athletes on nutrition planning and counseling wasn’t as effective as it could be. We wanted specialized help with meal planning, weight management programs, and handling special populations, such as athletes with eating disorders, thyroid conditions, and diabetes. We knew just what we needed: more support from registered dietitians.

If we were part of the athletic department, we might have put in a request for a new staff member who could tailor his or her schedule around the needs of our athletes, but the funding probably wouldn’t be there for it. In our setting, however, we were able to discuss our needs with the CHWB director, and with his support, we changed the working hours of the two registered dietitians already employed by the university. As a result, they started spending more time with the athletic teams.

They set up one-on-one meetings with athletes, educated entire teams about eating habits and fueling strategies, and truly added a new dimension to our athletic medicine offerings. Working together with the dieticians, we have been thinking outside the box to teach athletes about nutrition and its role in performance and health. We’ve made short nutritional videos for our Web site, organized a cooking class for student-athletes who live off campus, and gone grocery shopping with teams to help them pick out affordable, healthy options. All this was made possible by a simple scheduling change, which might not have happened if we were tied to the athletic department.

Similarly, some of our coaches like to have a sports psychologist work with their teams. Many had been “hiring” their own professional to assist in this area, which was costly for the athletic department and didn’t lend itself to maximum communication among healthcare providers.

The CHWB already employs two counselors who have expertise in sports psychology, so on a trial basis, we recently increased the hours these individuals spend in athletics and gave them a space in which to meet with individual athletes. There are still a few kinks to work out, such as deciding just how many hours is enough, but the response so far has been great and we are excited about adding this extra facet of healthcare and performance enhancement to our offerings.

WIN-WIN SITUATION

You might be wondering, with all the benefits outlined above, if there are any drawbacks to working for the university health center instead of the athletic department. Does it short-change athletics in any way? Are we less accessible to coaches because our closest ties are to other healthcare workers? Most people unfamiliar with this type of structure assume there must be some downside, and I’ll admit I thought so myself before I started working here.

In reality, however, we see no significant drawbacks to our model. Coaches of course want us readily available to them and involved in the daily activities of their teams, and we accomplish that by being physically located in the athletics portion of campus, where we spend most of our hours in close proximity to our athletic department colleagues. Even though we are part of the CHWB in every way, we still attend athletic department meetings, serve on committees, develop policies, and provide input on decisions that affect athletes. Practices, games, and travel are covered just as you would expect at any NCAA Division I institution.

If pressed to come up with something negative about the way we operate, I might point to all the meetings we must attend. Between committee work, staff meetings, and extra training and continuing education programs for the CHWB and the meetings we participate in on the athletics side, it sometimes feels like there aren’t enough hours in the day to fit everything in. But I’d guess that most athletic trainers in the college setting–particularly those with some administrative duties–struggle with time spent at meetings, even if they don’t follow a model like ours.

Overall, we feel our system is best for everyone. The athletic department enjoys the benefits of having a comprehensive medical services group looking out for its student-athletes, without the cost of funding such a large entity. The CHWB has confidence that all the athletes are cared for through a team approach in the most complete way possible. As athletic trainers, we feel respected and enjoy our jobs. And most importantly, the student-athletes know they are surrounded by people who care for them from every angle and give them every opportunity to succeed on the playing field, in the classroom, and in all their future endeavors.


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