Jan 29, 2015

Who’s the Boss?

A recent study by the Chronicle of Higher Education has yielded some results that members of the athletic training community may find troubling. In a survey of 101 athletic department head athletic trainers, head football athletic trainers, and other sports medicine professionals from the NCAA’s Football Bowl Subdivision (FBS), nearly half of the responders indicated anonymously they have felt pressure from football coaches to return concussed players to action before they were medically ready. These results, say some experts, indicate that it’s past time to re-evaluate the structure of some collegiate sports medicine departments.
The Chronicle of Higher Education’s survey was distributed to hundreds of athletic trainers and training-staff members from the NCAA’s 120 FBS programs. Of the 101 who responded:

• 11 said they reported directly to the football coach or a member of the coaching staff
• 32 said a member of the football coaching staff had influence over hiring and firing decisions for their position
• 53 said they had felt pressure from football coaches to return a student to play faster than they thought was in his best interest medically
• 42 said they had felt pressure from football coaches to return an athlete to the field even after he suffered a concussion.

According to the Chronicle, comments included:

“Too many medical decisions are made by individuals outside of the medical profession,” wrote one athletic trainer in the Mid-American Conference. Others told of coaches steering players to outside medical providers who rubber-stamp their calls.

Two former athletic trainers in the Pac-12 Conference described how they had lost their jobs after clashing with coaches over concussion treatment.

“It was scary,” said one trainer, who left a prominent California university over the conflict. “It was uncomfortably close to infringing on the medical well-being of the athlete.”

Kevin M. Guskiewicz, ATC, PhD, Department Chair of Exercise and Sport Science at the University of North Carolina and a leading concussion researcher, believes the survey findings are disturbing and says schools need to re-evaluate how they structure their sports medicine chain of command.

“Any institution that places a coach in a supervisory role over the athletic trainer or allows a coach to put pressure on medical decisions is just asking for trouble,” he told the Chronicle.

John Infante, a former compliance officer at NCAA Division I schools and author of the popular and informative Bylaw Blog, agrees with Guskiewicz and says:

“When it comes to the credibility, authority, and independence of trainers and physicians in college sports, the NCAA absolutely has a role to play when it comes to the relationship between coaches and sports medicine staff.”

Furthering his point, Infante says it’s time for the NCAA to advance legislation on the issue:

“Proposal 2013-16 is the next step. This proposal, which could be voted on as soon as January, requires Division I institutions to appoint a team physician for each or all of their teams. There are a couple of problems with Proposal 2013-16, though. The legislation was originally offered as an emergency/noncontroversial proposal but was then moved to the standard legislative cycle. Apparently, there was significant debate about whether teams should be required to have an appointed team doctor.”

The proposal, however, does need some tweaking, writes Infante. He says the language covering authority given to team physicians is not as clear or as strong as it should be. The proposal currently reads: “The team physician shall be authorized to oversee the medical services for injuries and illnesses incidental to a student-athlete’s participation in intercollegiate athletics.”

According to Infante:

“Authorization to oversee medical services is a far cry from being empowered with unchallengeable authority. The strong language currently reserved for voluntary workouts should be the standard way the NCAA talks about the power of sports medicine staff to make medical decisions.”

Instead, he says, the NCAA needs a new, more expansive proposal which addresses the following:

• Requires institutions to designate both a team physician and full-time athletic trainer for each of their teams to oversee medical care;
• Requires members to give final and unchallengeable authority to the sports medicine staff on all decisions involving student-athlete medical care; and
• Prohibits the sports medicine department or staff from being overseen by a coaching staff member or a non-coaching staff member with sport-specific responsibilities (i.e. a director of operations).

Believing time is of the essence, Infante calls for the proposal to be passed as emergency or noncontroversial legislation as soon as possible, either by the Legislative Council or Board of Directors.

“At the very least, it would show that the NCAA is attacking this problem,” he writes. “If the members want to object via the override process, that would lay bare where the resistance is.”