Athletic Training and Sports Health Care

Original Research 

Exploring the Effect of the Medical Model Organizational Structure on Collegiate Athletic Trainers' Quality of Life: A Case Study

Stephanie M. Mazerolle, PhD, ATC, FNATA; Steven T. Gerhart, MS, ATC; Christianne M. Eason, PhD, ATC

Abstract

Purpose:

To gain the perspective of athletic trainers employed at a university that uses the medical model as its organizational infrastructure as it relates to job satisfaction, professional commitment, and work–life conflict.

Methods:

Data from participants were collected through semi-structured interviews. Data source triangulation, peer review, member checks, researcher triangulation, and bracketing were used to establish credibility. A general inductive process was used for analysis.

Results:

Three common themes emerged that affected quality of life: role congruity, which addressed the participants' awareness of their role and how they contributed within the department; work time control, defined as the ability to effortlessly modify one's work schedule in response to daily needs; and collegial relationships, which refers to the sense of community, collegiality, and cohesion between the staff members within the department.

Conclusions:

Working within the medical model organizational infrastructure, as is used at a Division I university, had a positive influence on the athletic trainers' quality of life.

[Athletic Training & Sports Health Care. 2018;10(4):158–168.]

Abstract

Purpose:

To gain the perspective of athletic trainers employed at a university that uses the medical model as its organizational infrastructure as it relates to job satisfaction, professional commitment, and work–life conflict.

Methods:

Data from participants were collected through semi-structured interviews. Data source triangulation, peer review, member checks, researcher triangulation, and bracketing were used to establish credibility. A general inductive process was used for analysis.

Results:

Three common themes emerged that affected quality of life: role congruity, which addressed the participants' awareness of their role and how they contributed within the department; work time control, defined as the ability to effortlessly modify one's work schedule in response to daily needs; and collegial relationships, which refers to the sense of community, collegiality, and cohesion between the staff members within the department.

Conclusions:

Working within the medical model organizational infrastructure, as is used at a Division I university, had a positive influence on the athletic trainers' quality of life.

[Athletic Training & Sports Health Care. 2018;10(4):158–168.]

During the past decade, there has been increased discussion regarding the most appropriate organizational infrastructure for athletic training services in the university and college settings.1–5 The most common organizational infrastructure has placed athletic training services under athletics, in which athletic directors, coaches, and athletic trainers are viewed as colleagues. Ultimately, the athletic trainers in this infrastructure report directly to the athletic director. In many cases, this model of athletic training services compromises the level of patient care because conflicts of interest can make it difficult for athletic trainers to complete their jobs ethically.1 Additionally, this conflict of interest can negatively affect the quality of life of the athletic trainer.2,3 Working within the athletic department may compromise patient care because athletic trainers feel pressure to do what is necessary to keep coaches and athletic administrators happy.4 In this model, coaches may try to control the scheduling and hours of medical care or try to influence return to play decisions, which may ultimately create conflict for the athletic training staff.4

In January 2016, the National Collegiate Athletic Association (NCAA) incorporated the idea of independent medical care at the NCAA Division I level in an effort to combat some of the challenges that are associated with the athletics model.5 The concept of independent medical care gives sports medicine personnel (eg, team physicians and athletic trainers) unchallengeable authority in regard to medical decision making.5 This has been set in place to ensure the best quality of health care for student athletes.5 The mandate of independent medical care within the NCAA5 is recent and appears to be grounded in the ideology that infrastructure may not be the focal point for ensuring quality of care, but rather power and authority to make the decision without interference.

Currently, organizations exist that use the medical model, which houses athletic training services within the school's medical department (ie, student health services).4 This structure creates a situation similar to the NCAA's5 version of independent medical care, in which a medical professional (ie, physician) is the direct administrator. Therefore, the reporting structure of members in the department is controlled by an individual with a medical background and appropriate credentials. Advocates of this model suggest that the model may decrease hours worked, overload, and interference from non-medical personnel in medical decision making.3,4 Other benefits have been linked to work–life balance,6–11 job satisfaction,12 and professional commitment.12–16 The platform for advocating for medical or independent care models is also based on the organizational culture that can be cultivated, which is a fundamental factor not only in achieving organizational goals, but also in attracting and retaining desirable employees.17 Leaders are able to create a positive organizational culture by working through a step-wise process that creates a clear organizational direction with the proper support staff to achieve the end goal, which can be done for the athletic trainer in this model.4,18

Considerations for the medical model are founded on the notion that it will not only help reduce the discord that can accompany decision making and patient care, but also improve the working conditions for the athletic trainer. Few institutions within the NCAA formally use the medical model to deliver health care services, despite the presumption and suggestions that it can be a better model.3,4 Although the exact number of institutions operating under the medical model are not currently known, the authors are currently aware of only six colleges/universities in which the athletic training department is under the direct supervision of campus health or a similar medical entity and not under the direct supervision of athletics or academics. Therefore, the purpose of the current case study was to gain a preliminary perspective of those athletic trainers employed at institutions that use the medical model as it relates to work–life balance, job satisfaction, and professional commitment, which are factors considered to be important in the consideration of organizational transition.4 The following questions were used to help guide our study: (1) what are the perceived benefits for athletic trainers employed within the medical model regarding their quality of life, and (2) how does the medical model organizational infrastructure affect collegiate athletic trainers' perceptions of work–life balance, role strain, job satisfaction, and professional commitment?

Methods

Research Design

To guide research, a qualitative case study design was used.19–21 Selection was based on the exploratory nature of the study and building a case around a specific set of boundaries (ie, employment in the medical model as an athletic trainer). Binding was done as a means to keep the scope reasonable, practical, and reflective of our purpose.21 Prior to conducting research, institutional review board approval was obtained.

The Case

Eleven athletic trainers, all of whom worked at a Division I university (pseudonym ABC University), agreed to participate in the study (Table 1). In addition to the primary participants from ABC University, two participants were also included who worked at other institutions that use the medical model as a form of data source triangulation to help establish credibility.17 One of these participants was part of a staff of 17 individuals who provided sports medicine services for 26 men's and women's teams. At the second university, four athletic training rooms provided medical services to the student-athletes. The second participant who provided triangulation worked as part of a staff of 13 individuals who provided care for 39 athletics teams in four athletic training rooms.

Participant Demographic Information

Table 1:

Participant Demographic Information

ABC University

ABC University has a sports medicine department that provides medical care for 22 non–Football Bowl Subdivision level men's and women's sports teams, which include approximately 500 student-athletes. At the time the interviews were conducted, there was a total of 13 full-time staff members working in three athletic training rooms. At this institution, the medical director of athletic training services, a medical physician who supervised all athletic trainers and the head athletic trainer, was the primary supervisor. Medical care was coordinated through work scheduling, not sport assignment. One staff member was the scheduled coordinator responsible for communicating the work schedules pertaining to medical care. All members of the sports medicine staff were involved with the final approval of the schedules.

Participants. Overall, the participant panel included 5 women and 8 men, with an average age of 38 ± 10 years (range: 26 to 58 years).

Professional Life. All 13 participants were full-time staff members at Division I universities with a medical model infrastructure (11 participants from ABC University). Participants had 15 ± 9 years (range: 6 to 35 years) of overall athletic training experience. Of those years in the profession, participants averaged 8 ± 6 years (range: 2 to 21 years) at their current institution. Throughout the calendar year, participants reported working 50 ± 8 hours (range: 42 to 70 hours) per week.

Personal Life. Of the 13 participants, 7 were married and all spouses of the married participants were employed in some capacity (ie, full- or part-time). Five of the participants had children.

Data Collection Procedures

The primary researchers used the literature6–16,18,22–24 and research agenda to design the study protocol, including the interview framework. The interview framework reflected previous research that examined organizational infrastructure and workplace issues.22–24 Prior to collecting data, a peer review of the semi-structured interview guide was completed by an expert in the field of human resource management, athletic training, and workplace issues. After receiving feedback from the peer, changes were made to the structure of the interview guide. These were minor changes, including grammatical edits, reordering questions to improve flow, and the addition of a few questions related to the research agenda.

After receiving institutional review board approval, active recruitment of participants was initiated. Primary participant recruitment was initiated through the head athletic trainer at ABC University. The head athletic trainer was contacted to determine staff interest in participating in the study and help with the recruitment process. After contact was made with the head athletic trainer, all staff members at the target university were sent an e-mail containing information about the study. After receiving majority interest (11 of 13 staff members) from ABC University, in-person interviews were scheduled. A phone interview was completed for one participant because of a scheduling conflict. Semi-structured interviews were conducted as a means to encourage discourse between the researcher and participant. Informal dialogue allowed participants to share and volunteer information whenever possible.25 Interview sessions were conducted between 25 and 50 minutes and were recorded for transcription purposes. All digital recordings from the individual interviews were transcribed verbatim by one researcher. The researcher completed the interview sessions and then each transcript was shared with the individual participant for member checking.

Data Analysis

Prior to the analysis of data, participants were assigned pseudonyms and all corresponding documents were labeled with only the given pseudonym. Analysis procedures followed the general inductive process, which is a common method used in health and social science research as described by Thomas26 and Creswell.27 This method of analysis was selected to help uncover the most dominant themes from the interview responses as they relate to the specific aims of the study. Both researchers (SMM and CME) were familiar with the coding process described next, which occurred independently by each researcher. Data analysis was guided by the following steps: (1) responses were read in their entirety to gain a sense of the data and the participants' holistic experiences, which is an immersive approach to appreciate the most emergent themes; (2) initial codes were evaluated; (3) significant phrases (ie, meaningful units) from each transcript were characterized and coded; and (4) meaningful units were positioned into clusters and themes. For a theme to be established, meaningful units had to be presented by at least 50% of the study's participants, which is a strategy similar to that used by authors of other qualitative studies.28,29 To arrive at the 50% benchmark, the process of enumeration was used, whereby transcripts were coded and the participants who were coded within that theme were counted.25,27 Once coding was completed, the two researchers exchanged coded transcripts and a schematic presenting the data was evaluated. A consensus was agreed on between the two researchers during this process.

Credibility

Data source triangulation, peer review, researcher triangulation, and bracketing were used to create credibility within the data. Two participants employed at other institutions that used the medical model were interviewed with the intention of creating triangulation of the data. Peer review was used to ensure the quality of the interview content and that the purpose of the study was being evaluated. Additionally, transcripts were analyzed by at least two different researchers. Once each researcher individually coded data, they met to discuss their findings. During this meeting, emergent themes were discussed. The authors were in complete agreement with the analysis process before moving to the peer review process. The drafting of the results section helped to limit researcher bias and bracketing was used to help reduce researcher subjectivity and bias.30,31 The researchers identified their own personal beliefs and experiences regarding the factors involved in this model and their own career intentions and articulated them in writing to identify whether biases entered into data analysis. It was important for the researchers to identify their own beliefs to ensure that they were not interpreting results in a prejudiced manner.

Results

After the initial analysis of data, three dominant themes emerged: role congruity, work time control, and collegial relationships (Table 2). The separation of the athletic training department from the athletics department became a noticeable sub-theme within the area of role congruity. Similarly, professional commitment appeared to be a sub-theme of collegial relationships. Each of these themes and sub-themes are presented with supporting quotes.

Operational Definitions

Table 2:

Operational Definitions

Role Congruity

Role congruity emerged as a concept in which participants (12 of 13; 92%) were acutely aware of their role within the organization and how their contributions as health care providers affected the patients that they treated. When questioned about his role within the department, Alex, who had been employed at ABC University for 3 years, stated, “As far as my role with the department, I definitely know what role I serve and how I can serve the department and how I can serve the patients.” Similarly, Allison noted that “Yes, it's laid out pretty clear what's expected of you; what things you should be doing, what things you shouldn't be doing and so forth.” Thomas, one of the athletic trainers in a supervisor role, commented on how members of the staff all reach this level of role congruity. He specifically spoke toward the expectations of each staff member in terms of work–life balance:

What I do say to people who come to work here is that, family, things more important that. . .there should be things in your life as important or more important than your job. And there are opportunities that present themselves in your life that you won't have a chance to do again, and you should not miss those. If neurosurgeons can go on vacation, athletic trainers can go on vacation.

Jason, a participant used for data source triangulation, also spoke about how he was afforded role congruity at his institution. He noted:

And so we do have open feedback. I certainly understand my role within the department and knowing that I've got to try to fit the mission of our overall department.

The current results show that this model is effective in creating a situation in which participants fully understand their roles and are able to see positive benefits from this understanding, regardless of the institution.

Separation From Athletics. Role congruity was shaped by the idea that a “separation” was provided that allowed for athletic trainers to provide appropriate care that aligned with their training and role within the organization without discord because the athletic training services were independent from athletics. The connection between role congruity and separation created a resultant sub-theme that was mentioned by many staff members. Alex spoke about the importance of separation during the interview session. For Alex, separation was viewed as a positive aspect for himself and the organization:

As long as we could move it out of athletics. As long as we could remove the conflict of interest and instill that the medical professionals have the full authority of the patient care then I think we could do that.

In separate interview sessions, Katelyn and Joe also made comments that reflect Alex's statements about separation allowing for congruency. Joe mentioned how the goal as a staff is to provide optimal care for patients and have supervisors who can understand and respect it:

Our goal [everyday] is to provide the best care of the athlete, so it's important to understand that that's what we're doing is, we're trying to get them the best care.

Katelyn believed that the separation between athletic training services and athletics allowed the staff to best care for their patients. Katelyn gave an example about medical care and an athletic trainer's decision making as an area in which she felt the patient-centered model was needed:

I think the pressure of making decisions. Specifically, medical decisions. Obviously, about our student athletes we don't have the same pressures from coaches. Yes, they're going to be upset. . .if you pull somebody for a certain injury or if you say somebody cannot play, but at the end of the day I am not going to lose my job over it. I know that I have the full support of our supervisors and our director and our medical director to make the decision in the best interest of the patient and that is all that matters.

Role congruity within this athletic training staff was developed because of a patient-centered model that allowed for role understanding and a workplace that allowed for the athletic trainer to function in alignment with his or her health care training.

Work Time Control

Operationally defined by participants' experiences, work time control is the ability of an individual to effortlessly modify the work schedule in response to his or her daily needs as a professional and individual. This control allows individuals some sense of flexibility in the workplace. For a workplace to be considered flexible, it traditionally must consist of flexibility in the scheduling of hours, number of hours worked, and place where work is completed.19 Analysis revealed that our participants (10 of 13; 77%) spoke about work time control and the positive influence it had on their work experience, specifically as it relates to the scheduling of work hours. Leah, Katelyn, and Alex, who had all spent 3 years at ABC University, quickly felt the effects of work time control. Leah noted, “I like that you are able to be sick because some places in season you can't be sick, but here if you are sick you aren't coming into work.” Alex, who enjoyed the opportunity to take advantage of flexible scheduling, spoke about how he was able to modify his schedule based on the demands of the sport he was responsible for:

For example, our athletic training room opens at 9:00 in the morning and closes at 6:30. However, women's basketball practices in the morning [at] 8 o'clock. So I get here at 7 and I leave at 3:30 or 4 depending on how things go. So I have the flexibility and opportunity and that's the set schedule.

Work time control allowed many of the athletic trainers the chance to have a normal work–life balance and to engage in outside interests and hobbies. Andre noted:

Yea just personal life and space and being able to maintain a separate space from career to just advancing privately in interest. Whether it be hobbies or family life with both my wife and children.

Additionally, members of the staff with children also experienced some level of flexibility that positively influenced their work–life balance. Abby, who had spent 16 years at ABC University and was a mother of four children, stated:

I am afforded some flexibility to do some things I need to do for my child. For example, kids get sick and I don't hesitate with being able to call in. If I need to take care of my child we can do that. We have that kind of flexibility.

William, another participant included for data source triangulation, also mentioned work time control as he described how his athletic training department was able to create work time control for its staff members. His comments echoed some of the same principles as those of the participants from ABC University:

The other thing we do is we have planned scheduled mornings off. . . . That's when I cut my grass. That's when I rake my leaves. That's when I wash my car. That's when I can go do my shopping. I schedule my doctor's appointments and things like that so our work–life balance is something I'm proud of.

Our findings do not appear to demonstrate that gender or years at the institution had any influence on one's perception of work time control because parents and both male and female staff members commented on the benefits of a controllable work schedule. The general impression among the staff shows the prevalence of autonomy in the workplace. Members appeared to value this control because it afforded them the ability to balance work and life responsibilities while also helping to eliminate role strain.

Collegial Relationships

The relationships among staff members at ABC University and the environment that was produced emerged as a positive aspect of the patient-centered model offered within this institution. All participants (13 of 13; 100%) described a sense of community, collegiality, and cohesion. When asked what he enjoyed most about his current position, Alex stated, “I think the number one thing I like is the sense of community, the sense of family, and how close our staff is.” Matt described a collegial atmosphere in reference to what he loved about his job, stating, “You know, so we have this really strong, cohesive family like environment that we share the responsibility for everything, which is wonderful. . . .”

Corroborating this concept of support, family, and teamwork, Sam referenced a similar story about the importance of not missing out on family or social engagements because of work conflicts:

I can think of a specific example where a staff member was newly hired, and was on the phone and said, “No, I can't make that wedding, I have to work, it's the weekend, we have a game,” and we said, “Call that person back, and tell them you're going, we'll cover for you.”

Cohesion and support among the staff at ABC University were evident and summarized well by Sam. In response to the effect that staff relationships have on her work–life balance, Sam remarked:

I think that helps, and the support we get also to go away, and get to that family vacation, or whatever it might be, a relative's wedding. I think we have a good support system here.

The relationships as described by participants who worked within the patient-centered model appeared to be collegial and supportive of the various roles that individuals can have, including those that are non-work–related and viewed as equally important. These opinions were supported by William, who spoke about the presence of collegiality at his institution: “So for instance I don't have to come in until 2:00 tomorrow. So, somebody else will cover for me if necessary if one of my athletes comes in.” His statement helps to support the opinions of participants from ABC University and shows how these collegial relationships exist at other institutions that use this model.

Professional Commitment. In addition to the collegial relationships and the environment produced, staff members also spoke about the effects their environment had on their level of professional commitment. Professional commitment not only encompasses commitment to the field of athletic training, but also commitment to one's institution. Based on participants' perceptions of how collegial relationships shaped their professional commitment, professional commitment was categorized as a sub-theme of collegial relationships. Alex, who noticed a strong correlation between the environment and his professional commitment to the profession, remarked, “Being in a place that has attracted some of the brightest minds clinically keeps me motivated. Making sure that I am staying up to par.”

Additionally, Katelyn spoke about how her collegial relationships affected her decision to stay at ABC University:

I have the flexibility to take time off if I need and they really push the whole family first mentality. That's one of the reasons why I have stayed here for the past four years.

The participants' opinions showed that, within this university, the presence of motivated individuals and an environment that stimulates professional growth helps to keep athletic trainers committed to both the profession and their institution.

Discussion

There have been discussions empirically22 and anecdotally4 that the medical model of providing athletic training services can improve the quality of life for the athletic trainer because it reduces role incongruence professionally and decreases work time, thereby increasing personal and family time.4,22 The medical model is a vastly different organizational infrastructure from the athletics model because athletic trainers directly report to a physician who is licensed as a medical care provider as opposed to being supervised by an individual with no medical training or credentials.4 Despite the suggested benefits of the medical model,4,22 few data exist that document the perceived benefits related to quality of life. During our examination of this model at ABC University, role congruity, work time control, and collegial relationships were noted to be benefits that played a vital part in ensuring positive quality of life for athletic trainers. The information gained from the current study directly aligns with previous reports of these benefits.22,32,33 Additionally, our study provides new insight into how this organizational structure provides a separation from the athletics department, which ultimately drives the success of the model.

Role Congruity

Role congruity plays a key part in overall satisfaction because it can help to eliminate uncertainty during daily tasks and can bring a sense of accomplishment in being a part of a team.22–24 For participants from ABC University, role congruity referred to their level of understanding regarding what their roles were within the department. According to participants, most staff members had a clear understanding of their roles within the department and what was expected on a daily basis. An important part of role congruity is communication because it allows for members of a staff to properly understand their roles and express personal and professional needs.23 Expectations at ABC University were clearly communicated by the supervisor, which helped to eliminate confusion in daily tasks and led to a strong sense of role congruity. One expectation that was emphasized from the beginning was the use of benefits such as time off and a controllable schedule. This expectation was clearly explained by the supervisor and supported by all members of the staff. The benefits of this controllable schedule were available because of the staff member's engagement and stakeholder-ship in the development of the schedule, as well as the collegiality that existed among them, all of which was ultimately supported by the administration (ie, top-down approach). This type of scenario is unique because the pressures associated with the NCAA Division I setting often make it difficult or uncomfortable for individuals to take advantage of time off. One study reported that in intercollegiate athletics, benefits use is “average at best and benefits are often perceived differently by athletic director's and senior women's administrators” (p. 154).34 This type of support and expectation is a benefit of the medical model because it allows individuals to make time for activities outside of work.

The athletics model places sports medicine services under the department of athletics. In this setting, fear of job termination, coaches attempting to control medical decision making, and decreased consideration regarding funding have all been identified as challenges that athletic trainers may face.4 These challenges can make it difficult for athletic trainers to do their jobs efficiently and ethically. However, the medical model calls for a separation from the athletics department that can help to alleviate these conflicts. Our participants spoke avidly about the importance of this separation and how it positively affected their ability to do their job. This separation from the athletics department seemed to be an integral part in creating quality of life for athletic trainers. Athletic trainers noticed a decrease in outside pressure from coaches and fear of termination while gaining an increase in medical authority and clarity in decision making. The results from the current study help to bolster the current literature by affirming that creating a separation from the athletics department allows for athletic trainers to complete their work ethically and effectively.

Although communication of expectations is important regarding the development of role congruity, it appears that the separation from athletics allowed for athletic trainers to fully engage in their roles as health care providers. This finding brings uniqueness to the current study because we are now able to provide support for a shift to the medical model with evidence to show that it not only helps increase quality of life for athletic trainers, but also helps these athletic trainers provide better quality patient care.

It has been shown that it can be stressful for professionals who experience role conflict or ambiguity.12 A sports medicine department housed within the athletics model can be subjected to additional levels of role conflict and incongruity when supervised by an individual with no medical background.4,24 For our participants, the movement to the medical model organizational infrastructure allowed for a clearer understanding of their roles and created an optimal situation that allowed for a patient-centered approach to health care, which should in turn lead to better care for the athletes.

Work Time Control

Previous research has shown that athletic trainers benefit from a flexible and controllable work schedule.10,11,20,33 The current results parallel those findings; 77% of participants in the current study spoke about the importance that work time control had in creating a positive and balanced quality of life. The perceived benefits of having control over one's work schedule are not novel8,21,23,35; however, the current findings are unique in that participants working in a medical model infrastructure commented on how this model allowed for more autonomous scheduling. Having the ability to use sick time, carve out time each day to attend to personal responsibilities (ie, bills or physician's visits), or simply enjoy a day off was important to participants. Control over work schedules can be beneficial to any working professional, but more so to parents because they can navigate the many responsibilities that accompany being a parent in addition to those of a working professional.8 Beyond the importance of perceived control over one's work schedule, this also spoke to the leadership and management style of the head athletic trainer, who obviously valued his or her employees and their well-being. Again, supervisor support has been critical in supporting work–life balance for athletic trainers.33

Additionally, use of the Support, Transform, Achieve, Results (STAR) approach has been shown to have a positive effect on work–family conflict because it focuses on the importance of work practices that support employees' personal lives (ie, flexibility in work scheduling).21 The work time control finding of the current study was fundamentally similar to the STAR approach because it emphasized flexibility in work scheduling and supervisor support of flexibility. Organizations that place an emphasis on the core values found within the STAR approach have positively affected the work–life balance of their employees.21,33 Our participants shared situations that suggest the STAR approach was unknowingly used and this decreased the level of work–family conflict that they experienced.21 As mentioned, the STAR approach closely correlates with the type of structure at ABC University. We, too, found that employees value this type of autonomy in their scheduling, which directly affects their ability to create work–life balance.

The current findings regarding work time control can provide a unique perspective that contrasts the current definitions present in the literature. In the workplace, flexibility can be classified as operational or temporal. Operational flexibility is the ability of individuals to determine how their work is completed without outside influence.36 In essence, individuals are able to complete their work without unnecessary monitoring or insight from supervisors or coworkers. Alternatively, temporal flexibility gives employees the ability to decide the hours in which they work.36 This form of flexibility allows individuals to adjust their work schedule based on their individual needs. It has been shown that operational flexibility increases overall work satisfaction and leads to a more functional family setting, whereas temporal flexibility has no effect on work–life balance.35 The current study's participants often spoke about the ability to control their schedule regarding taking time off for outside engagements, leaving early to fulfill parental duties, or the ability to come in late because of working late the previous night. Based on the responses from participants, these employees valued operational flexibility (ie, separation from athletics) because it afforded them the ability to make appropriate medical decisions that were not restricted by outside sources. However, we also found that participants valued temporal flexibility because it allowed for more work time control. Members of the current staff valued both operational and temporal flexibility equally because of the effects on overall satisfaction, commitment, and work–life balance.

Although this finding is contradictive, it may in fact be a product of the demands of the athletic training profession. Research has shown that athletic trainers consistently work more than 40 hours per week and often work 6 to 7 days per week.11 Currently, athletic trainers across the nation report that they work an average of 56 to 60 hours per week and these numbers may increase to more than 70 hours in some collegiate/professional settings.18 The average hours worked among the participants in the current study was 50 hours per week. It is likely that our participants understood the challenges of managing working hours in athletic training. Because of this, they were able to value their ability to have temporal flexibility to combat the daily demands of working around an athletics schedule.

Collegial Relationships

Cohesion, teamwork, and collaboration have been reported as important workplace strategies for work–life balance and satisfaction.9–11,22,23,33 Participants of the current study reiterated what has been reported in the literature,33 indicating that job sharing among athletic training staff members can cultivate a positive workplace that can support work–life balance.22,33 This is often accomplished because job sharing via teamwork allows for flexibility and a reduction of the workload for each athletic training staff member. With long, arduous hours and many responsibilities, athletic trainers may begin to struggle both mentally and physically when attempting to handle their workload, which can spill over into personal and family time.6,10,11 When a supportive climate has been created via coworker support and respect of outside obligations, it can create work–life balance.8–11,33

For a group of individuals to embrace teamwork and support one another, they must have a strong leader who shares the same passion for cohesion and the need to have balance. The current results demonstrate this because the supervisor at ABC University took on the responsibility of becoming a strong model for what he expected from the rest of the staff, which is a finding previously noted in the college setting regarding work–life balance facilitation.8–11,33 The participants of the current study, much like those of a previous study,33 often spoke about how the supervisor supported them and worked to be a model for work–life balance.

In addition to support from the supervisor, it is important for members of the athletic training community to feel supported by their peers. Studies have shown that athletic trainers, particularly those who are parents, believe that coworkers without children cannot relate to the demands of parenthood.6 Like-wise, athletic trainers with children also feel that their work environment is not supportive of the demands of being a parent.6 The current results directly contradict the aforementioned statements. Participants from ABC University who were parents felt supported in their parenting role and spoke about the efforts made by other staff members to meet the needs of a working parent. The increased ability to manage parenthood and work responsibilities is, in some ways, related to the medical model infrastructure. The medical model makes it possible for a multi-provider approach to managing the health care of a sports team. For example, if the athletic trainer who primarily covers women's soccer needs to pick her child up from daycare while soccer practice is going on, the athletic trainer for women's basketball can provide medical care. Although it is not impossible for athletic or academic models to use a multi-provider approach, anecdotally it is more common to have medical “coverage” in these structures because one athletic trainer typically provides medical care to one or more specific teams. This infrastructure is not only beneficial to parents, but can also benefit someone who has a family engagement to attend.

Participants from ABC University noted how the presence of collegial relationships positively affected their professional commitment. Current literature shows that individuals tend to leave their profession when professional commitment is hindered.12–15 This departure can be due to a lack of support or compensation, inflexible scheduling, and changes in priorities.12–15 Regardless of the reasoning, it is important to note that professional commitment can be compromised and departure from the field is likely when certain needs are not met. However, in situations where rewards, rejuvenation, and respect are present, individuals often remain because their professional commitment is high.12–15 On average, participants from ABC University spent 8 years at their current university. They strongly believed that their relationships supplied them with the necessary benefits (ie, support and respect) that helped to influence their decision to stay. Additionally, the high level of excellence and knowledge among the staff helped to keep staff members motivated and committed to the profession of athletic training. Staff members felt compelled to continue to grow because other members of the staff were constantly striving to better themselves.

Limitations

The current study is not without limitations. Our preliminary work contained the insight of individuals from only one university, and therefore only the influence of one supervisor. Although the medical model is not the most widely used reporting system in collegiate settings, more than one university does use this infrastructure. As various minds come together to collaborate and infuse this infrastructure into practice, there will be varying opinions on the shortcomings and successes that exist. Additionally, more institutions need to be examined to better understand the influence of the supervisor compared to the true influence of the organizational structure. To fully understand this organizational infrastructure, it is necessary to incorporate additional insight from other universities. Thus, future research should be focused on targeting other universities with sports medicine departments that work under the medical model.

The target university of the current study provided services for 22 men's and women's Division I sports teams. However, this university did not participate in men's college football in any capacity. College football and the culture surrounding the sport create unique pressures that can challenge the core values of the medical model. Constant availability of an athletic trainer, the desire of a head coach to have total control, and the general spotlight that surrounds the sport are just a few of the pressures that can make it difficult to fit Division I college football into the medical model. Future research should focus on gaining the perspective of individuals who work within the medical model and provide services for collegiate football.

Although it was not a main finding in our research, participants often spoke about the medical model as being patient centered, with the needs of the patient being put first. If this is truly the focus of the medical model, it is important to investigate the viewpoint of the patients who seek sports medicine services within this organizational infrastructure. Future research should focus on the patients in the medical model because this input can help researchers understand what the model is doing well and see which areas could use improvement.

Implications for Clinical Practice

The current data indicate that there are several implications for the athletic trainer to consider. First and foremost, regardless of the organizational structure, collegiality among coworkers and supervisors is critical for satisfaction in the workplace and creating work–life balance. It was obvious that participants were satisfied and found balance because of their work setting, but this was likely due to the relationships, supervisor support of the model, and, more indirectly, the medical model itself.

The current findings continue to illustrate the importance of a supervisor who is an advocate for his or her employees and continues to support them professionally and personally. Autonomy and job flexibility were provided to our participants, and this was directly attributed to the management and leadership of the head athletic trainer. Although more research needs to be done examining the medical model, it is likely that the organizational structure enabled the supervisor to have more autonomy over staffing decisions. It is important to recognize that despite the organizational structure, there still needs to be a head athletic trainer who is supportive of work–life balance to see these positive accommodations. Head athletic trainers are encouraged to advocate for the needs of their staff, but also to clearly communicate their role within the department and staff.

Additionally, the medical model allowed participants the chance to function in roles that were reflective of their professional credentials and values as medical care providers. The separation between the medical and non-medical staff, as allowed by the medical model, was a means to facilitate improved working conditions, which directly related to participants' satisfaction and work–life balance. As supported by the NCAA's implementation of independent medical care, the current study suggests that creating separation between the athletic training and athletics departments can provide athletic trainers unchallengeable authority in decision making and afford them opportunities to create a positive quality of life. It is important for athletic training departments to explore the cumulative effects of this type of separation and decide on an individual basis how best to move forward.

Participants referenced the presence of work time control, role congruity, and a supportive work environment as positive aspects of working at a university that follows the medical model. Based on their responses, each of these benefits is recognized as playing a critical role in helping to increase work–life balance, job satisfaction, and professional commitment, while decreasing role strain. Simply stated, the medical model as adopted by ABC University has created an environment that is conducive to work–life balance and satisfaction because the staff are supportive of one another, have flexibility with work schedules, and are clear on what role they must perform.

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Participant Demographic Information

Participant PseudonymAgeSexYears of ExperienceYears at Current JobAverage Hours Worked Per WeekEducation LevelMarital StatusSpouse EmployedChildren
Abby41F181645Master'sMarriedYes4
Alex27M6342Master'sSingleNo0
Allison36F14845Master'sMarriedYes0
Andre40M9650Master'sMarriedYes2
Jasona32M10470Master'sMarriedYes1
Joe30M9248Master'sMarriedYes0
Katelyn28F3345Master'sSingleNo0
Leah26F4360DoctorateSingleNo0
Mary33F11445Master'sSingleNo0
Matt33M11945Master'sSingleNo0
Sam53M302148Master'sMarriedYes3
Thomas56M31854Master'sSingleNo0
Williama58M351850Master'sMarriedYes2
Average3815850

Operational Definitions

ThemeDefinition
Role congruityThe ability of participants to understand their role within the department and how their efforts as health care providers affect the patients they treat. Separation from athletics was a sub-component of this theme because it allowed for the athletic trainer to function as a health care provider in a sport organization.
Work time controlThe ability of participants to effortlessly modify their schedule based on daily personal and professional needs.
Collegial relationshipsThe sense of community, collegiality, and cohesion within the department. Professional commitment was fostered by these relationships because it challenged growth of skills and supported non-work activities through support.
Authors

From the Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, Connecticut (SMM, STG); and the Department of Athletic Training and Exercise Science, Lasell College, Newton, Massachusetts (CME).

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Stephanie M. Mazerolle, PhD, ATC, FNATA, Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, 2095 Hillside Road, Unit 1110, Storrs, CT 06269-1110. E-mail: stephanie.mazerolle@uconn.edu

Received: May 02, 2017
Accepted: September 20, 2017

10.3928/19425864-20180201-01

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