Perspective

Athletic trainers report low collegiate compliance to athlete-centered care legislation

Results of a survey presented at the National Athletic Trainers’ Association Clinical Symposia and AT Expo showed a greater need for collegiate institutions to adopt and adhere to an athlete-centered independent medical model of care administered by athletic health care providers.

“The [Intercollegiate Council for Sports Medicine] ICSM believes that independent medical model of care is the cornerstone to ensuring that athletic trainers have the unchallengeable and autonomous authority to do work ... out of the interest of the student athlete,” Murphy Grant, MS, ATC, LAT, first executive chair of the ICSM, said in his presentation.

Adherence to independent model of care

The National Athletic Trainers’ Association (NATA) ICSM distributed a survey to 9,223 collegiate athletic trainers on their institution’s adoption and adherence to an independent medical model of care for collegiate student-athletes. Overall, 1,796 collegiate athletic trainers responded, for a response rate of about 19%, of whom 43% reported working at the division 1 level.

“The results showed that only about half, 52%, of the collegiate level sports medicine programs identified themselves as following the independent medical model of care,” Grant said.

Further, 76% of athletic trainers reported having medical autonomy, defined as the authority to make decisions related to the health and safety of an athlete without the influence of non-medical personnel, vs. 24% who reported not having medical autonomy.

Influence of non-physicians

Grant said that more than one-third of athletic trainers reported that coaches influenced the hiring and firing of sports medicine staff. Of these respondents, 17% also reported “receiving pressure from a coach, administrator or member of the coaching staff to make a decision that was not in the best interest of the student athlete’s health,” Grant said.

He noted that 58% of athletic trainers reported pressure from an administrator, coach or member of the coaching staff, and about 59% reported receiving pressure at least once a month.

“The NATA believes that it is appropriate and expected for coaches, as well as other relevant athletic partner personnel, to ask questions and request updates on student athletes,” Grant said. “However, when acquiring turns into an attempt to influence, dictate, coerce or challenge the athletic trainer’s autonomous authority to make medical decisions, this is problematic.”

Although 82% of athletic trainers reported that a coach has never played an athlete who was deemed medically ineligible, Grant noted that one of five respondents said the coach has played the athlete.

“While collegiate athletics have made monumental strides to advance the safety of sports, the results of the survey suggest a greater need in compliance to independent medical model of care,” Grant said. “It is important that institutions infuse this model into their culture, so it remains even if there are changes in leadership and/or staff.” – by Casey Tingle

 

Reference:

Grant M. Collegiate setting: Athlete safety first press briefing. Presented at: National Athletic Trainers’ Association Clinical Symposia and AT Expo; June 24-27, 2019; Las Vegas.

 

Disclosure: Grant reports no relevant financial disclosures.

Results of a survey presented at the National Athletic Trainers’ Association Clinical Symposia and AT Expo showed a greater need for collegiate institutions to adopt and adhere to an athlete-centered independent medical model of care administered by athletic health care providers.

“The [Intercollegiate Council for Sports Medicine] ICSM believes that independent medical model of care is the cornerstone to ensuring that athletic trainers have the unchallengeable and autonomous authority to do work ... out of the interest of the student athlete,” Murphy Grant, MS, ATC, LAT, first executive chair of the ICSM, said in his presentation.

Adherence to independent model of care

The National Athletic Trainers’ Association (NATA) ICSM distributed a survey to 9,223 collegiate athletic trainers on their institution’s adoption and adherence to an independent medical model of care for collegiate student-athletes. Overall, 1,796 collegiate athletic trainers responded, for a response rate of about 19%, of whom 43% reported working at the division 1 level.

“The results showed that only about half, 52%, of the collegiate level sports medicine programs identified themselves as following the independent medical model of care,” Grant said.

Further, 76% of athletic trainers reported having medical autonomy, defined as the authority to make decisions related to the health and safety of an athlete without the influence of non-medical personnel, vs. 24% who reported not having medical autonomy.

Influence of non-physicians

Grant said that more than one-third of athletic trainers reported that coaches influenced the hiring and firing of sports medicine staff. Of these respondents, 17% also reported “receiving pressure from a coach, administrator or member of the coaching staff to make a decision that was not in the best interest of the student athlete’s health,” Grant said.

He noted that 58% of athletic trainers reported pressure from an administrator, coach or member of the coaching staff, and about 59% reported receiving pressure at least once a month.

“The NATA believes that it is appropriate and expected for coaches, as well as other relevant athletic partner personnel, to ask questions and request updates on student athletes,” Grant said. “However, when acquiring turns into an attempt to influence, dictate, coerce or challenge the athletic trainer’s autonomous authority to make medical decisions, this is problematic.”

Although 82% of athletic trainers reported that a coach has never played an athlete who was deemed medically ineligible, Grant noted that one of five respondents said the coach has played the athlete.

“While collegiate athletics have made monumental strides to advance the safety of sports, the results of the survey suggest a greater need in compliance to independent medical model of care,” Grant said. “It is important that institutions infuse this model into their culture, so it remains even if there are changes in leadership and/or staff.” – by Casey Tingle

 

Reference:

Grant M. Collegiate setting: Athlete safety first press briefing. Presented at: National Athletic Trainers’ Association Clinical Symposia and AT Expo; June 24-27, 2019; Las Vegas.

 

Disclosure: Grant reports no relevant financial disclosures.

    Perspective

    In 2017, the National Collegiate Athletic Association mandated that the medical care of collegiate athletes needs to be independent from the influence of coaches, strength coaches or other university officials as this was perceived as a potential conflict of interest. There have been several high-profile cases where athletes were allegedly pressured to play while injured or pushed beyond reasonable physical limits resulting in physical harm. These instances call into question the efficacy of that mandate for independent medical care and the difficulties in its implementation. The recent presentation of a survey by the Intercollegiate Council for Sports Medicine at the NATA annual meeting was noteworthy as it showed the persistent influence of coaches on the athletic trainers when it comes to participation and return to play decisions. In fact, over half of the respondents (57.8%) reported receiving pressure from a coach or administrator to make a decision that was not in the best interest of the student-athlete’s health. Further, 18.7% reported a coach playing an athlete who was deemed medically ineligible. The authors of this study should be applauded for taking a fair and transparent look at their own profession and the environments in which they are asked to care for patients/players.

    While these survey results are disappointing, they are not entirely surprising. An athletic trainers’ primary responsibility is to protect the health and safety of the players. This a responsibility that all members of the sports medicine staff take very seriously. Trainers are educated, dedicated and work long hours to help keep players healthy and rehabilitate them when they are not. While this directive seems obvious, trainers are usually employed by the University and their hiring, promotion, sport assignment and future job recommendations can be based on how accommodating they are to the coaches and university administration with whom they work.

    Many of the colleges use orthopedic surgeons as their team physicians, and often as their head team physician or medical director. However, we occupy a privileged space as we are often not employed by the athletic department, and more often than not, unpaid volunteers. While we may enjoy the camaraderie of playing a part in college athletics, our livelihoods are rarely tied to our continued involvement with these teams. As such, it is imperative that we recognize the pressures that can be placed on the athletes and trainers in the highly competitive environment of college athletics. We are often in a unique position to be the independent advocate for the health and safety of our players, which both the NCAA mandate and our Hippocratic Oath require. Orthopedic surgeons need to be clear and unambiguous in our discussions with coaches and trainers. We need to use protocol and evidence-based practices that leave little room for misinterpretation. We need to help establish and enforce an organizational structure that is independent and always puts the patient first. The key to good medical care of our athletes is to truly care for them and their best interests above that of the team. Trainers need to know that we have their backs, because this study shows that they are feeling pressured, and we cannot do our jobs well without their unencumbered judgment and skill.

    References:

    Grant M. Collegiate setting: Athlete safety first press briefing. Presented at: National Athletic Trainers’ Association Clinical Symposia and AT Expo; June 24-27, 2019; Las Vegas.

    Survey: NCAA coaches’ clout concerns athletic trainers. Available at: https://www.espn.com/espn/otl/story/_/id/27048906/survey-ncaa-coaches-clout-concerns-trainers. Accessed July 4, 2019.

    • Patrick C. McCulloch, MD
    • John S. Dunn Chair in orthopedic surgery
      Houston Methodist Orthopedics and Sports Medicine
      Head team physician, Rice University Athletics
      Houston, Texas

    Disclosures: McCulloch reports no relevant financial disclosures.