Although the National Athletic Trainers' Association (NATA) reported that women comprised 55% of the membership in 2018,1 few female athletic trainers are employed at the professional level. Barriers to employment and reasons for not seeking employment at the professional level include sexual harassment, discrimination, and work–life balance challenges.2
Gender bias has been studied in the field of athletic training, and female athletic trainers describe a perception of bias that can affect their experiences of working in collegiate and professional sports settings because they are frequently male-dominated.3–5 Traditionally, the roles of women in masculine sport settings have been mother, sister, or “lady-like.”6 These perceptions make it difficult for women to feel accepted in the predominantly male sport world.4 The white male has been the traditional gender role in professional sports.
In the National Collegiate Athletics Association (NCAA), men hold more than 70% of leadership positions and 84% of head athletic trainer positions.4 Female athletic trainers have been stepping into more roles in the NCAA but have faced challenges due to the gender bias amplified by female stereotypes.2 Stereotypical communal attributes are being kind, nurturing, and sympathetic for female athletic trainers and being aggressive, self-sufficient, and self-confident for male athletic trainers.4 The difference between these attributes describes the difficult progression for female athletic trainers in male-dominated professional sports.
The pivotal moment for female athletic trainers in the professional sport setting occurred in 1997 when Michelle Leget became the first female athletic trainer in the National Basketball Association.7 In 2002, Ariko Iso was hired by the Pittsburgh Steelers as the first female athletic trainer in the National Football League.7 Janet Panek was the first woman to hold a head athletic trainer position in the Women's National Basketball Association. Sue Falsone was the first woman hired to be the head athletic trainer in Major League Baseball for the Los Angeles Dodgers.2 The history of female athletic trainers in the professional sport setting is brief, which highlights biases and concerns similar to those in Division I athletics.8 The professional sport setting has grown since the first woman entered the athletic training profession, which has expanded the professional sport experiences of athletic trainers. This expansion creates new social interactions and allows different viewpoints to be exposed and researched similarly to Division I athletics.8 Previous research found that female athletic trainers have faced gender bias challenges from coaches and coworkers, mainly within the Division I setting, but a gap exists in the professional sport setting.2,8
The current study focused on the experiences of female athletic trainers in professional sports, with a special focus on their experiences of gender bias or discrimination.
A qualitative method, rooted in a phemenological design, was chosen to understand the environmental considerations that female athletic trainers currently face in this setting as it pertains to gender and gender bias. Credibility was established by researcher triangulation and peer review.
Recruitment followed a criterion sampling,9 which required all participants to be female, full-time athletic trainers, and currently employed in the professional sport setting. Participants were excluded if they were in an internship or fellowship position because they may have different expectations and time commitments.
A total of six female athletic trainers participated in the current study. They represented three different professional organizations: the Woman's National Basketball Association, the National Football League, and Major League Soccer. Although six is a relatively small number, data saturation9 was used as a recruitment barometer and the sample of women working full-time in the professional sport setting is small. The average age of the participants was 35 ± 11 years. To keep the participants' responses anonymous, pseudonyms were used. The demographic information for each participant can be found in Table 1.
Athletic trainers who met the appropriate criteria for participation were identified using the NATA membership directory and professional sports teams' staff directory websites. After athletic trainers were identified, they were contacted via email. Interested participants responded to the lead investigator (SL). Participants were then emailed the open-ended questions, demographic questionnaire, and informed consent. The open-ended interview questions were used in a similar research study and were approved by the study author to use in this study.8 After the participants gave consent and completed the demographic questionnaire, a phone interview was conducted by the lead investigator. To make the interview more concise, participants read the open-ended questions prior to the phone interview. The phone interviews lasted an average of 16 minutes and followed a structured interview guide. The lead investigator conducted one phone interview per participant, which was digitally recorded and sent for verbatim and timestamp transcription.
Under the parameters of a phenomenological study, the data were analyzed using an immersion method, whereby multiple readings of the transcripts were done before the analysis began. The lead author and a fellow athletic trainer (SL, KAP) individually conducted the coding process. The coding process used marginal notes contained within each transcript, which allowed key data to be identified and labeled accordingly. Emergent codes materialized with each reading of the transcripts, and coding was completed when all commonalities were identified and regrouped.10 The lead author and a fellow athletic trainer triangulated their analyses by sharing coded transcripts and themes that emerged. An agreement was reached between the two coders. A peer review of the transcript was completed to ensure accuracy in the analyses, and this was performed by an expert in qualitative methods and gender in athletic training (SMS).8,10 The peer was provided with the uncoded transcripts first and then was given the coding scheme and operational definitions of the themes after completing an unbiased review of the interview protocol.
Two main themes emerged from the data: challenges in the professional setting and navigating the professional sport setting. The first theme was shaped by the perception of age inequality, perception of gender inequality, and traditional gender ideology. The second was defined by mentorship and communication. Figure 1 depicts the two main themes and the supporting concepts.
Depiction of the perceptions of gender bias themes and support.
Perception of Age Inequality
Perception of age inequality was categorized as “ageism,” whereby chronological age was believed to qualify an athletic trainer's ability to provide competent medical care. The female athletic trainers' perceptions that their youth altered how others treated them in their employment emerged as a challenge. Abby shared her feelings regarding her experiences:
Just the idea that, you know, if you don't have X number of years, then you're not qualified to do something. Or the older [you are] the wiser you are, and I think there's some merit to that.
Beth spoke of ageism and its challenge in the professional setting because of the “old school” mentality some coaches maintained when there was a professional age gap: “I did have a lot of issues with the male coaches. . . . Not all of them, but a good number of them were kind of old school.” Catherine spoke of the lack of trust a coach had because of her age: “I don't trust what you're saying. You're too young. You don't have enough experience.”
Perception of Gender Inequality
The perception of gender inequality was defined as sexism in which being a woman influenced her treatment in the professional sport setting. Beth pointed out that some positions would not hire a woman. She quoted a supervisor who said: “Oh, I'm not going to hire another woman because she's just going to get pregnant and then not come to work.”
Another example of sexism in the professional sport setting was described as feeling isolated because of gender because colleagues would limit daily interactions or communication. Emily said: “just didn't talk to me, or, you know, everyone was so cordial. It was just more of a, just an underlying feeling.” A lack of respect through the difference in recognition was another issue shared in the professional sport setting. Beth said: “just getting respect for things. There [are] some males in the organization [whose]. . .titles are recognized. Like, it's in their contracts.” She described another gender bias situation where she felt that being a single woman affected the outcome:
I just feel like [if I wasn't single and] if my husband had done something, then they would've been punished. But, because I'm single and. . .[a] young female, it's kind of like they don't take it as serious[ly].
Catherine went on to discuss the struggle of having to work harder to prove more as a woman. She said:
It's making sure that females understand that you're going to have a higher level of scrutiny, as compared to your male counterparts. It's not fair, and it's not how things should be, but that's the reality of it. And unfortunately, you're going to have to work 10 times harder to get [to] the same. . .place as. . .your male counterpart has gotten to.
Traditional Gender Ideology
Traditional gender ideology was identified by participants, especially regarding how the professional sport setting employed few women. Emily discussed how being the first woman on a football staff created some challenges regarding her qualifications and ability to assimilate into the culture. She said:
I was the first female on the football staff. So, I do know that, you know, there, because they had never had a female, and it wasn't everyone, but I could tell that, maybe, there was just some, just like, a little skepticism from maybe some of the older coaches, who hadn't been around females in the football setting.
Catherine spoke similarly about the traditional gender ideology as a barrier to employment because it was uncommon to hire a woman in the professional setting. She referenced the traditions and norms of the football world: “. . .[T]he culture of football, they. . .flat-out said, ‘We're not willing to take that risk. We're not willing to invest in anyone to work in that setting.’”
Mentorship was described by the participants as an important factor in navigating the professional sport setting. The female athletic trainers recognized the benefit of mentorship in supporting professional development globally and in a career in the professional sport setting. Abby commented on how a mentor can help professional growth:
But I think just having a strong female role model, and then just having a strong, you know, network in general. . .is really important. . .for mentoring and helping you to develop yourself as a professional.
Denise and Emily spoke of the benefits of mentorship in their professional sport setting. They emphasized how helping one another in the profession could address the questions or challenges others could be having:
I had a mentor that was huge on professionalism, and she hammered it into us, whether we liked it or not. . . . [T]hat was a great thing for me. I have a handful of mentors that I still talk to and I'm still close with that still help me to this day. So, I think mentorship is huge for anybody, and I hope that it's alive and well. (Denise)
Learning from them and how they went about their jobs as certified athletic trainers and they were always good to bounce ideas off of and keep in touch with after the fact if you did have questions or concerns or doubts or anything or just questions about athletic training things in general. . . . It's always nice to have those people that you have grown to know and trust and feel comfortable with. So, I think mentoring definitely does support all athletic trainers in some aspect. (Emily)
In the current study, mentorship was an important component to navigate gender bias, but it also was helpful globally in the athletic training profession:
I think every athletic trainer, females and males, should have a support system inside the athletic training community and outside. But, I believe when they enter the work-force or become a part of the athletic training community, a support system is definitely a good thing to have. (Grace)
Communication was used to navigate the gender bias issues that were faced in the professional sport setting. Clear and honest communication was helpful between coaches, supervisors, and other athletic trainers on staff. Abby described her communication with the coaches and how this early communication helped establish rapport in the workplace:
Before I start working with the team, within the first couple days I sit down with the coaching staff and say, “How do you want to be communicated with? What's the line of communication? . . .Who do I need to talk to after? Is it just one person?”
Emily described how nonverbal communication displayed in her professionalism and skill set established a better working environment:
You just need to begin establishing the relationships with the people in the organization, from the athletes to coaches and staff. . .earn trust and respect by doing the job, and showing you are knowledgeable and competent in your skills.
Gender bias has been a concern in athletic training and, although significant strides have been made in creating more opportunities for women, bias can still happen. Research on gender bias in the athletic training field is limited, and many studies have focused on the college setting, not the professional sports setting. Because more women are accepting positions in this setting, it is important to understand their experiences, even if they are the minority.4 Much like the existing athletic training literature,5 our results support the notion that bias does occur, but it can be mitigated by several factors, including age.8
The participants shared their experiences of being treated differently or having to prove themselves as medical care providers, which was a previously reported challenge for women working in the professional sport setting.11 The results of the current study indicate that gender bias still exists and it is frequently based on the gender ideology that women may not be qualified to perform specific jobs or that their gender influences perceptions of their competence.4,12
Discrimination can manifest in two ways: access or treatment.12 From the participants' descriptions, it appears that they experienced treatment discrimination, meaning that once they were in the role of athletic trainers in the professional sport setting, they were treated differently. Our results suggest that female athletic trainers feel pressure from coaches and other athletic personnel to prove themselves as medical care providers, despite possessing the same certifications and experiences as male athletic trainers. These results are comparable to a study by Gorant,11 who found that female athletic trainers can still face discriminatory behaviors from those employed in the sport setting, highlighting the existence of treatment discrimination. This form of discrimination can lead to the perception of having to work harder to gain acceptance as a medical care provider and to overcome the old adage that women cannot fulfill the roles in the professional setting.7,8
Mentorship and communication were previously identified as ways to navigate the impact of gender bias.8 Mentorship has been described as the cornerstone of professional development, and the participants acknowledged that mentorship was a positive influence and helped reduce experiences of bias in their current positions. Many participants spoke of continuing relationships and mentorships with educators and athletic trainers from their education. These individuals provided role modeling and a sounding board for improved communication and management of the bureaucratic issues that can arise in the sport setting.13,14
Communication is a fundamental skill for athletic trainers. For female athletic trainers, effective communication facilitates positive relationships with coaches and other athletic administrators.15 Participants stated that early communication with fellow colleagues and coaches was beneficial because it facilitated trust and effective relationships. This is a consistent finding in the literature regarding reducing gender issues.8 In contrast, our participants shared that miscommunication and lack of communication could cause issues of gender bias, which further supports the need to have ongoing communication with coaches.
The current study describes perceptions of gender bias from the perspectives of women in the professional sport setting. The small sample size documents the experiences of only a few female athletic trainers. Future researchers should expand the study to a comparison of the perception of gender bias between male colleagues and the coaching staff whom the athletic trainers work with. This would give insight into whether others in the professional athletic training setting are aware that gender bias is present, who may be contributing to it, and ways to improve the environment. A comparison from different athletic training settings would be beneficial to understand why women work in one setting over another and learn if gender bias is similar across different settings. Although previous research reported findings in the Division I setting that were similar to the current study, other settings require additional research.
The sample size did not include all possible professional sports organizations. A longitudinal study would better understand the ebbs and flows of different professional sport seasons. In the current study, the saturation for data collections was achieved. Because it was researched early in the process, not all professional sport settings were explored. Further exploration into the different professional sport settings would improve the understanding of the perception of gender bias.