Jan 29, 2015Structured for Success
As they work to blend administrative duties with hands-on care, today’s head athletic trainers are experimenting with a variety of nontraditional ways to organize their staffs. They’re also changing who they report to, how they communicate, and what constitutes a sports medicine team.
By Kenny Berkowitz
Kenny Berkowitz is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected].
In days past, a sports medicine department needed only the simplest organizational structure to keep itself running well. One head athletic trainer, a few assistant athletic trainers, and some graduate assistants offered a straightforward hierarchy. But today, as departments continue to grow larger and offer a broader range of services, many schools are searching for new ways to set up their increasingly diversified staffs.
At some universities, sports medicine has become part of the campus health center. At others, athletic trainers are trying new ideas for handling increasing amounts of administrative work. At the same time, many are working on integrating other health services into traditional sports medicine. There are as many ways of structuring a program as there are programs.
“If athletic trainers want to continue to be on the cutting edge of high-performance athletics, we have to figure out how to be part of the larger health care picture,” says Ryan Cobb, MS, ATC, Head Athletic Trainer at the University of California. “If we want to be more than just day-to-day providers and really concentrate on preventing athletic injuries before they happen, we need to collaborate closely with other professionals and create structures that work.”
At the University of Pittsburgh, Rob Blanc, MS, ATC, understands the value of working as part of a group. So in 1998, as Head Athletic Trainer and Director of Athletic Performance, he helped create Pitt’s “Performance Team” to bring together the athletic trainers, strength and conditioning coaches, physicians, dentists, nutritionists, physiologists, and psychologists working with Pitt student-athletes.
“Prior to organizing the team, we had all these allied health professionals who were available to work with us, but there was no cross-communication,” says Blanc. “People who weren’t involved in the day-to-day care of our student-athletes, like the sports nutritionist or the sports psychologist, were only seeing one piece of the puzzle. By developing the performance team, we’re able to share the whole picture with everyone involved.”
At the start of the new system, members met formally once a month. These meetings helped them lay the foundation for effective communication, learn about each other’s disciplines, and share ideas for improving the efficiency of the entire team. Nine years later, there are so many informal conversations between members that official team meetings are only held sporadically.
Blanc is responsible for coordinating the team and keeping in close communication with Freddie Fu, MD, Head Team Physician and Chair of the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine, who has the final say on medical decisions. “Our athletic training staff has a phenomenal relationship with Dr. Fu, which leads directly to our relationship with the University of Pittsburgh Medical Center,” says Blanc. “We have access to a huge number of experts at the medical center, and when we need a specialist, they’re only a phone call away. With the relationships we’ve built, physicians understand the importance of getting our athletes taken care of quickly and thoroughly. They trust us, and we’re not fighting battles to have our student-athletes seen.”
Reporting to a senior associate athletic director, Blanc supervises five full-time athletic trainers, five graduate assistants, and four strength and conditioning coaches. With athletic training rooms in three separate facilities and his office more than a mile off-campus, Blanc’s greatest challenge is finding enough time to spend with each member of his staff. To help remedy this, he compiled a manual of policies and procedures and assigned much of the hands-on supervision of the staff to Tony Salesi, ATC, Assistant Director of the Performance Team.
Now in his 20th year at Pitt, Blanc has learned the key is to trust his staff members. “The strength of our program is that each of our athletic trainers functions in his or her own way,” says Blanc. “That allows the staff to experience personal growth and exposes students in the program to a number of different philosophies.
“Letting individuals be individuals works,” continues Blanc. “Once you hire the right people, you need to give them autonomy. In order for them to grow, I need to be flexible, give them the support they need, and trust them to do the work I’ve hired them to do. I know this system works because our coaches use our sports medicine program as a recruiting tool. Any time they bring recruits and their parents to campus, they can look them in the eye and say, ‘If you come here, you’re going to receive the best medical care possible.'”
THREE HEADS ARE BETTER
For many head athletic trainers, balancing administrative duties with hands-on treatments can be overwhelming. Taking care of budgets, hiring, staff development, communication, and insurance often doesn’t leave time for covering teams or rehabbing athletes. At Ohio State University, the solution was to restructure the department so there are three co-head athletic trainers.
“We started with the philosophy that our athletic trainers should always keep in touch with their clinical side, no matter how many other responsibilities they have,” says Doug Calland, MS, ATC, one of the three head athletic trainers. “At the same time, paperwork has become much more time-consuming, so the department has had to shift. The advantage of having three co-head athletic trainers is that we can divide the load of administrative duties and still have time to focus on our coverage assignments.”
In addition to primary responsibility for specific teams, each of the three co-heads has particular administrative duties. Calland is Head Football Athletic Trainer and responsible for personnel and budget issues. Janine Oman, MS, PT, ATC, coordinates insurance and billing and provides coverage for men’s lacrosse and women’s tennis. Vince O’Brien, ATC, is in charge of men’s basketball and golf, and oversees the drug testing and treatment program.
To make paperwork even more manageable–and give co-workers the chance to gain additional administrative experience–some hands-off duties are assigned to the department’s four athletic trainers and five assistant athletic trainers. “One of this system’s greatest strengths is that it allows our athletic trainers and assistant athletic trainers a way to move up the ladder,” says Calland. “This structure creates opportunities for growth–it allows newer athletic trainers to handle administrative responsibilities which will prepare them for taking that next step in their careers.”
The three co-head athletic trainers work in separate facilities but maintain daily contact through e-mail, phone calls, and in-person meetings. They meet monthly as a management team with their supervisors, Chris Kaeding, MD, Medical Director, and Miechelle Willis, Senior Associate Athletic Director for Sports Services and Sports Administration. Once a month, the three co-heads also lead a 45-minute meeting for the entire medical services and training department, which helps keep the athletic training staff working well with Ohio State’s allied health professionals.
As Calland describes it, everything in the department revolves around its athletic trainers. “We talk about athletic trainers as the hub of a wheel, with spokes connecting our staff to sports psychology, sports nutrition, team physicians, strength and conditioning, and all our other partners,” he says. “We all work closely together, but it’s the athletic trainers who are at the center, coordinating all our student-athletes’ care.”
Though having three head athletic trainers creates the possibility of disagreement, each is generally given the deciding vote in his or her area of interest. “Three seems to work well,” says Calland. “Our administrative responsibilities are spread out well, with enough time for each of us to retain our hands-on work. Most important, we communicate well with each other, which makes this system work.”
At the University of Florida, the sports medicine team has taken the opposite path. After working for two decades as the Gators’ Head Athletic Trainer, Chris Patrick began pulling away from some of the day-to-day responsibilities of treating student-athletes. In the mid-1990s, he became Assistant Athletic Director for Sports Health and five years ago he transitioned to work as a full-time administrator.
“I don’t do much in the way of hands-on athletic training anymore,” says Patrick, MA, LAT, ATC, LMT. “I see myself primarily as a facilitator, making certain our athletic trainers are providing the best possible care for our student-athletes.
“I oversee four primary athletic training rooms and three satellite athletic training rooms, with 10 full-time athletic trainers, six graduate assistants, three athletic training interns, three primary care physicians, two orthopedic surgeons, three physical therapists, three sports massage therapists, a chiropractor, and a host of consultants in just about every specialty you can think of,” he continues. “Counting myself, we have a total of 20 certified athletic trainers involved in the care of our student-athletes. That’s a lot more than we had when I started back in 1970.”
When Patrick first arrived, he was one of only two athletic trainers. Now, he sees continuity as one of the program’s greatest strengths. “One of the advantages to this system is having a full-time administrator who’s worked as an athletic trainer,” he says. “I’ve grown with the program, seen the expectations of coaches and athletes change, and watched the profession evolve to the point where all these different fields can work together within Sports Health.”
As an employee of the University Athletic Association, which independently oversees Florida’s intercollegiate athletics program, Patrick reports to the athletic director. His primary responsibilities are creating policies and procedures for Sports Health, providing support to the department’s athletic trainers, maintaining a budget, running a drug testing program, and monitoring field and equipment management.
Patrick has also developed a medical advisory committee, which includes administrators, athletic trainers, strength coaches, physicians, an insurance coordinator, an attorney, and a rotating group of experts who are brought in for consultation. “Having this group helps keep us open to change,” says Patrick. “It gives us an opportunity to bounce ideas off one another, consider new approaches, and discuss ways to better care for our athletes. We get a wide variety of suggestions, and even if the process occasionally seems slow, it’s allowed us to move decisively in making the right decisions.”
Overall, Patrick feels the reorganization has kept the department moving forward and that discontinuing work as a hands-on athletic trainer has made him a better administrator. “It gives me more time to do other things, like regularly visit each of the athletic training rooms and pay close attention to paperwork and my budget,” he says. “Unlike a lot of athletic trainers, I no longer have to work 15- or 16-hour days, because the athletic association has recognized the value of letting me just be an administrator.” CAMPUS CONNECTION
Over the last few years, there has been a growing trend toward incorporating oversight for sports medicine departments into the university’s medical center. But at Princeton University, that structure has been in place for more than 25 years.
“There are two main advantages to working with health services,” says Head Athletic Trainer Charlie Thompson, MS, ATC. “With this structure, athletic trainers aren’t beholden to the athletic department. They never have to worry about being pressured by coaches.
“The other major advantage is that we have complete access to our university health services,” he continues. “If an athlete has a concussion and needs to be observed overnight, we have a full-service infirmary where he or she can stay. We have access by computer to all the student-athletes’ medical records, so we can write notes to their doctors and their doctors can write notes to us. We have close contact with all the providers who work at the health center, which makes communication much easier. As our colleagues, they’re very familiar with us, so when we call with a request, we can be confident they’ll comply.”
At the same time, athletic trainers have a seamless relationship with the athletic department. “If you didn’t know we were part of another department, it would never occur to you,” says Thompson, adding that he and his staff regularly attend athletic department meetings and social events. “If you watched us interacting with administrators or coaches, you’d think we were all part of the same department. And if you ask any of our staff here, they’d say we have excellent relationships with all the coaches.”
Thompson supervises an associate head athletic trainer, the coordinator of physical therapy, and six athletic trainers, all of whom are employees of University Health Services. They work out of Caldwell Fieldhouse, which houses an outpatient clinic for both varsity and non-varsity athletes, and Thompson reports to the director of athletic medicine services.
When athletic trainers at other schools ask Thompson about adapting this structure, he encourages them to start by carefully evaluating their campus health center. “You need to take a very serious look at the overall ability of your university health services to become a big player in athletics,” advises Thompson. “Can they provide the services you need for first-rate athletic medicine? If they can’t treat a problem, will they be able to provide a referral?
“You could do it on a smaller scale, but you’d have to make sure everything is already in place at the health service unit to handle the things you’d be asking,” he continues. “Here at Princeton, we have a full-service health care system, and if an athlete has a problem, we know they’ll be well taken care of.”
At California, Cobb oversees a sports medicine department so large that he needs two offices. Serving over 900 student-athletes competing in 27 sports, Cal’s Sports Medicine Services provides a wide range of care–and a set-up that’s complex enough to hold all the pieces together.
In some ways, Cal’s structure is a combination of several of the others profiled in this article. Like Patrick, Cobb has given up oversight of any one team to take on more administrative responsibilities. Like Thompson, his supervisors come from the university health center. Like Blanc, he has a system for everyone involved in student-athlete health to work as a team. And like Calland, he makes sure to still find time to provide some hands-on care.
Oversight of Cal Sports Medicine Services falls to two groups: the university’s health center and intercollegiate athletics. At the top of the structure are Peter Dietrich, MD, MPH, Medical Director of University Health Services, and Bill Coysh, PhD, Assistant Athletic Director of Sports Medicine, who is Cobb’s direct supervisor.
“I believe there’s a huge advantage in having the campus medical unit as an integral part of our student-athletes’ lives,” says Cobb. “It allows us to access a full range of services for them. If we had everything housed in athletics, we might miss out on some of the services student fees are providing. It works to the health center’s advantage, too, because they now have all these sports medicine professionals available to treat the regular student body. It’s all the more reason to integrate medical providers into one organization.
“But because this is a joint venture– we have two different worlds trying to operate together–it can be a challenge,” he continues. “Therefore, we spend a little extra time on meetings to integrate the two halves. But essentially, we’re able to agree with each other because first and foremost we’re all looking out for the health of the student-athletes.”
Cobb and his supervisors sit on a sports medicine steering committee, which also includes the deputy director of athletics responsible for overseeing sports medicine, the head team physician, and two head coaches. Between monthly meetings to set policy, committee members keep in touch through e-mail. Twice yearly, the group holds long-range planning sessions.
The key, says Cobb, is communication. “Taking time to meet with the people who help steer policy at your institution, even if it’s just once a month, can make a big difference in preventing problems,” he says.
Cobb also holds monthly meetings of his athletic training staff, which includes 14 athletic trainers and two physical therapists. “We’re going in so many directions, traveling with teams and working away from our offices, that we need to make time to all be in one place once a month,” he says. “These meetings allow us to filter information up and down in a time-efficient way, keep everyone up to date on the latest changes, and ensure our staff is aware of the most current policies and procedures.”
Cal has athletic training facilities at opposite ends of campus, and in a typical week, Cobb spends two days in one, three days in the other, and floats between them on weekends. Although he’s no longer responsible for the day-to-day care of the football team, Cobb remains a hands-on athletic trainer, contributing help whenever it is most needed.
“This position has freed up more of my time to supervise, be a part of multiple teams, and interact with all 27 head coaches, instead of just the relative few who worked on my side of campus,” says Cobb. “And with these structures in place, we have time set aside every month to address concerns and questions. This ensures we’re not just dealing with the crisis of the moment–we’re planning for the future and always moving forward.