Jan 29, 2015Making Dreams Come True
If your recurring dream is to add more staff to your college athletic training room, you’re not alone. If you want to know just how to fulfill that dream, read on.
By Greg Scholand
Greg Scholand is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected]
Brian Coble was reaching the end of his rope. As the one-man athletic training staff at Carroll College, an NAIA school in Helena, Mont., he was spending 12 hours or more a day at work Monday through Saturday, then covering contests and holding treatment time for the football team on Sunday. Coble had heard that his predecessor was known for working 16-hour days, but as a new dad with a young family, that kind of schedule wasn’t sustainable for him.
Not long into his first year on the job, he decided something had to change. “We were hosting one of the first volleyball games of the year, and I was going to be traveling with the football team,” recalls Coble, MS, ATC, PES, CSCS. “The volleyball coach came to me and said, ‘We need somebody here tonight.’ And all I could say was, ‘Well, you need to help me find someone.'”
The two called physical therapists and high school athletic trainers in the area, scrambling to come up with coverage for the event. “I decided then: We clearly need another staff member,” Coble says.
By effectively lobbying his administration, Coble got his wish, and athletic training at Carroll today is much better for it. With another full-time position in the department, event coverage is reliable, injured athletes receive more attention and better treatment, and teams take part in revamped conditioning programs that help prevent injuries in the first place. What’s more, Coble finally has time for life outside the athletic training room.
For college athletic trainers, long hours and daunting workloads have traditionally come with the territory. But in recent years, more and more are questioning the status quo and strategizing about how to change it. Both collective and individual efforts are making headway, with the ultimate goal of keeping the profession strong.
If you feel like the problem of too much work and not enough personnel has gotten worse in your college program, you’re probably right. Many new demands have been placed on athletic trainers in recent years, mostly without corresponding staffing increases.
“Athletic training involves a heavy workload—it’s always been that way, and most people know it when they enter the profession,” says Josephine Lee, MS, LAT, ATC, Assistant Director of Sports Medicine at Georgia Tech and President of the College Athletic Trainers’ Society (CATS). “But the fact is, the workload has increased in the last several years. Athletics is a year-round operation now, and as teams have gotten more sophisticated, there are many more workouts and practice sessions that need coverage.”
Lee adds a harsh truth: Not all administrators sympathize with overworked athletic trainers. This summer, CATS invited a well-respected former NCAA Division I athletic director to speak at its annual meeting, and he talked frankly from the administrator’s point of view. “He said that when some athletic directors hear a person complain about long hours, they think, ‘If you don’t like it here, you could easily be replaced by another athletic trainer, maybe even for less money,'” she explains. “They see others in the department putting in a lot of hours—the coaches and their assistants, the academic counselors—and decide it just comes with the territory.”
Dennis Miller, ATC, PT, Head Athletic Trainer at Purdue University, believes this trend may be harming the profession in the long-term. “When we have college athletic trainers putting in 80- and 90-hour weeks, it’s no surprise a lot of quality people choose to leave the job entirely. They can make the same money in a different setting and have a better quality of life,” he says. “That’s bad for the athletic training community, and it also means college programs miss out on a lot of great athletic trainers who do excellent work but don’t want the heavy workload. It’s a very legitimate issue for us.”
At Dowling College, Mark Rodman, MSEd, ATC, Assistant Athletic Director for Sports Medicine and Wellness, has noticed a marked decrease in the number of applicants when he posts athletic training positions. “When I had an opening 10 years ago, I would hear from 50 or 60 people, at minimum,” Rodman says. “This year, I heard from two. One of them had no experience at the college level, and the other had taken the last 10 years off. That tells me either people aren’t as interested in athletic training as they used to be, or people don’t want to enter the college setting because they’re worried about the long hours, stress, and burnout.”
At the national level, several groups have efforts underway to help increase athletic training coverage on a broad scale. Last year, CATS surveyed college administrators to find out what they weigh most heavily when allocating resources. The group focused on NCAA Division I, but sought input that could be useful across the board.
“We asked how athletic trainers can improve their position in the department,” says Lee. “We also asked what factors athletic directors pay most attention to when making judgments about coverage—how they weigh the head athletic trainer’s recommendations, staff evaluations, coaches’ and athletes’ evaluations, and so on.”
From the 25 administrators who responded, CATS noticed a few trends. When assessing requests for more resources, several athletic directors said key factors are how the request would increase overall quality of care, and whether the head athletic trainer appears to have a coherent, creative vision for his or her program. Also important was whether the athletic trainers appear to understand the athletic department’s financial “big picture.”
“Administrators said we need to realize we’re not the only ones asking for more staff,” explains Lee. “We’re often vying with coaches, academic aids, the strength program, and sports information, and everyone sees their department as not having enough people. If the administrator can’t clearly see how more resources will tangibly improve the quality of care, we’re probably not going to win that battle.”
The NCAA, too, has taken a recent interest in the state of college athletic training, looking primarily at ways to ease the burdens created by heavy workloads. Ron Courson, ATC, PT, CSCS, Director of Sports Medicine at the University of Georgia, sits on the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports and the association’s task force that is studying work/life balance issues, and he says many new ideas are being brought to the table.
“With the work/life balance task force, we’re hoping to come up with some specific recommendations on how to improve the quality of life for everyone in the athletic department,” Courson says. “For instance, one thing we’ve talked about is encouraging more schools to offer childcare on campus. For people trying to balance being an athletic trainer with being a parent, that could be a real help.
“We’re also discussing ideas like mandatory days off for athletics staff,” Courson continues. “We require that for student-athletes because we see it as important to their health and well-being. So why shouldn’t the same be true for someone in athletic training who might be working non-stop for entire months at a time?”
Courson says the task force’s work could eventually result in a set of NCAA-sponsored best practices athletic departments could apply program-wide, which would help athletic trainers in everything from creating more personal time to attracting more quality people to the profession. “I think we’re realizing more and more that examining these issues is in everyone’s best interest,” he says. “And if we want to keep the athletic training profession healthy, it’s a discussion we need to be having.”
The most direct effort at increasing athletic training coverage, however, has come from the NATA. In 1998, the association formed the Appropriate Medical Coverage for Intercollegiate Athletics (AMCIA) Task Force and charged it with creating a comprehensive formula for determining how much medical coverage a college or university should have to fully meet student-athlete needs. The result of their work, released in 2000 and updated in 2003, was a set of guidelines based on all the important variables related to sports-medicine coverage and student-athlete welfare.
“Every year, it seems like coaches and athletic departments ask more from athletic training, and we’re striving to keep up with those demands and constantly improve,” says Miller, who chaired the AMCIA task force. “But clearly, the amount and quality of health care we can provide is linked to the amount of manpower available to do the job. The guidelines are an attempt to translate all of that into some numbers a program can use to evaluate itself.”
Miller says the AMCIA guidelines are the centerpiece of the NATA’s effort to help college athletic trainers advocate for more staff, so they’ll be revised and improved on an ongoing basis. “We’re just starting the process of re-evaluating the formula a second time, and we’re seeking feedback from athletic trainers who have used the AMCIA document so we can find out what has and hasn’t worked,” he explains. “We’re currently sending out a questionnaire to our entire membership about that, and hopefully next year we’ll make some new recommendations to the board of directors about altering the guidelines so they’re even more useful.”
USING THE GUIDELINES
How can you apply the AMCIA formula to your program to see whether your coverage level meets the recommendations? First, you must understand how the formula assesses coverage demands, using a system of points called Health Care Units (HCUs). Each sport is assigned a base-level HCU score between zero and four, depending on its injury rate, the number of treatments typically required per injury, and the potential for catastrophic injury. A school takes the HCU score for each of its sports and applies a formula that incorporates roster size, number of active days (practice and competition), length of season, the team’s travel schedule, and athletic trainers’ administrative duties associated with the sport.
From there, a total number of HCUs for each sport is determined, and when all sports have been calculated, the HCUs are added up. The formula says a full-time athletic trainer can be responsible for 12 HCUs per year, so dividing the department’s total HCUs by 12 reveals the number of athletic trainers recommended for appropriate medical coverage department-wide.
“One central goal of the AMCIA is to provide a measure of how much time an athletic trainer actually spends on each sport,” Miller explains. “Sometimes when athletes have minor or nagging injuries, they won’t miss any practices or games, but treating them takes up a lot of health care time. If the head athletic trainer talks about needing more help, the athletic director may look at rosters and say, ‘How can that be? We only have three people out this week!’ The HCUs give a more accurate picture of the demands athletic trainers face on a regular basis.”
Since the AMCIA formula uses hard data about a department’s athletic training services and the demands of each sport, it can add a new dimension to an argument for adding more coverage. One way not to use the formula, however, is as a “standard of care” to assess legal liability. Miller says that was never the intention, but acknowledges some misconceptions have arisen since the formula was first released.
“It’s one thing for an athletic trainer to explain to the athletic director that there isn’t enough coverage in the department,” says Matt Mitten, JD, Professor of Law at Marquette University and Director of the National Sports Law Institute. “But it’s quite different to say, ‘Here’s what we need to do to avoid legal liability.’ That is a much more complicated issue, and it’s not an argument I think athletic trainers ought to be making.
“The basic legal standard is that you must use reasonable care to protect against foreseeable harm—the interpretation of that depends on your resources, the plans in place for emergencies, and several other factors,” continues Mitten, a former chair of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. “The law simply doesn’t require X number of athletic trainers for a school to be protected.”
That said, Mitten does believe the AMCIA guidelines can still be a useful tool in evaluating a program’s level of coverage. And Miller feels the formula has succeeded in helping athletic trainers present a case that’s more data-driven. “The NATA has fielded a lot of questions about the document, so we know people are using it,” Miller says. “I think for the most part, when you lay the numbers on the table, administrators around the country have said, ‘Okay, let’s see what we can do to improve our program.'”
Along with using the AMCIA formula to advocate for more staff, another effective strategy is to line up support from those you work with. When Coble first arrived at Carroll, he quickly noticed that in the past, some injuries hadn’t been appropriately dealt with, especially outside of football. “I talked to coaches in some of the other sports and they agreed with me,” he says. “They understood immediately how their athletes would be better off with more coverage, and they supported me in my request for more staff.
“When coaches speak up and say, ‘My athletes aren’t getting the same care as someone else’s,’ that catches a lot of people’s attention,” Coble continues. “I also got the backing of our dean of student life and our athletic director after I talked with them about how it would benefit the athletes to hire another athletic trainer. Their support was critical in convincing the senior administration at our school to make room in the budget for a new position.”
Athletes’ parents can be a powerful ally, too, as they have a larger voice than ever in their children’s college experience. At Dowling, parents aided in Rodman’s campaign to add two full-time assistant athletic trainers to his staff in the past two years. “I keep athletes’ parents in the loop whenever there’s an injury or a rehab situation, and I talk to them every chance I get at contests,” he says. “If parents see the value of athletic training, maybe they’ll notice at the next away game if there isn’t an athletic trainer traveling with the team. Then they’ll start asking, ‘Why isn’t someone there, and what can I do about it?’
“No one is more concerned about student-athletes’ welfare than their parents, so they’ll go right to the athletic director or even the president of the school with their concerns,” Rodman continues. “If enough people start doing that, you can bet it will have an impact.”
Of course, the biggest obstacle in most college programs isn’t that administrators want to settle for less coverage—it’s simply the cost. So another powerful argument can be made by demonstrating how, under some circumstances, employing more athletic trainers will actually save the athletic department money.
At Dowling, the vast majority of student-athletes’ injury rehab used to be performed at private clinics and other out-of-house settings. But since adding more staff, the school has brought 90 percent of its rehab in-house, resulting in major savings. “When our insurance carrier realized that we would be handling more of our own treatments, they reduced our premiums and changed some things in our coverage,” Rodman says. “We ended up saving around $135,000.”
At Syracuse University, Head Athletic Trainer Tim Neal, MS, ATC, argued for a larger staff by explaining how it could enhance treatment in significant ways. “We’ve always been very good at conventional care, but with more people on staff we’ve expanded our repertoire and become even better,” says Neal, who has converted three part-time positions to full-time and created a new position all in the past six years. “Recently, two of our athletic trainers became certified in Active Release Technique, and since we incorporated it into our treatments, we’ve cut down on time lost to injury and helped athletes manage chronic injuries more effectively.
“And just last summer, all of us took an online course in sound-assisted soft-tissue mobilization, which we’ve had great results with,” he continues. “The net effect is, as the staff has grown in numbers, we’ve been able to branch out and expand what we can do for our athletes.”
For Coble, the common thread in all these persuasive tactics is getting administrators to see the many ways athletic training is a wise investment. “It’s part of our nature in this profession to work behind the scenes, out of the limelight,” he says. “But when it comes to proving your worth, sometimes you have to step up and tell your athletic director about those 16 athletes you treated this morning, or how you were in the athletic training room until midnight last night. If we don’t talk about that stuff, no one else will.
“It’s just like the coach who has to prove he can win before he gets a contract extension or another assistant,” Coble continues. “We have to show that we’re doing a great job, and that we’re really helping the department succeed. If everyone sees that, it’s a lot easier to make the case.”
THE SPOILS OF VICTORY
Athletic trainers who have successfully advocated for more staff agree on one more thing: The benefits justify the effort. From quality of care in the program to quality of life for themselves, the positive effects are numerous and worth lobbying for.
“Since we’ve added another athletic trainer, we’ve been able to formulate new strength and conditioning programs for several of our teams,” Coble says. “Not only has that addressed their performance needs, but it’s also resulted in fewer injuries because we’re taking more preventative measures. When the athletes are healthier and we’re spending less time treating injuries, everyone wins.”
Coble is also finding it much easier to balance his job with the rest of his life. “Sometimes it’s just knowing there’s someone else here if I need to go pick up the kids, or get a hair cut, or take half an hour to work out,” he says. “I have more time now for everyday things that come up, and I’m not worried about being burned out all the time. That’s made a huge difference.”
Sidebar: TURNED DOWN
The truth is, not all requests for more athletic training staff will be successful. What should you do when there simply isn’t room in the budget for another position, but your workload is reaching overload?
One solution worth trying is to shift certain administrative duties to others in the athletic department. “A lot of things athletic trainers end up doing, like filling out insurance forms, handling the paperwork for doctor’s visits, and conducting drug testing, don’t need to be exclusively our responsibility,” says Mark Rodman, MSEd, ATC, Assistant Athletic Director for Sports Medicine and Wellness at Dowling College.
“If you can designate someone else to handle insurance issues, or to make sure outside doctors get paid, that can save a huge chunk of time,” he continues. “As more of the job has become administrative work, we have less time to treat athletes, and that’s not ideal for anyone. It’s worth stepping back to look at whether some of those duties should be reassigned.”
Creating a paper trail of your unsuccessful personnel requests is also a good idea. “Anytime you ask the administration for more staff, you need to put it in writing,” says Josephine Lee, MS, LAT, ATC, Assistant Director of Sports Medicine at Georgia Tech and President of the College Athletic Trainers’ Society. “If there’s ever a lawsuit because something bad happens, someone could ask why the head athletic trainer didn’t make sure there was more coverage. If you can show you were raising concerns about gaps in coverage on a regular basis, you can prove you saw the problem and did what you could.”