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Athletic Training Status Quo or No?

Over the years of working as an Athletic Trainer I've worked in a wide variety of settings; industrial Athletic Training, Wellness, clinical Athletic Training, the high-school setting, the college setting, sports performance Athletic Training, and minor league baseball, hockey,and basketball Athletic Trainer. Regardless of the setting there were the same problems that prevented any advancement that I noticed:
1) The referral system
2) Working for a physical therapy company
3) Athletes/Patients misunderstanding the profession
4) Being overworked, underpaid, and undervalued

Don't get me wrong I have a great passion for what I do and there are plenty of athletes and patients who appreciate their Athletic Trainer, but why isn't it universally understood and compensated appropriately? I have a few theories to why this is.
To the average athlete regardless of the setting, we are free. What I mean by that is, we literally give away our valuable skills and knowledge for free on a daily basis. Could any of your athletes walk into a physical therapy clinic with no appointment, with no money, and with no insurance and get evaluated and treatment? No, it would be completely unheard of to do such a thing. Yet, in the world of Athletic Training it happens everyday, it has been established as the norm. Some would argue that getting paid a salary would equal being reimbursed for our services but my retort to their statement would be in simple math. Take the number of athletes a day you see multiplied by an average cost of of $25.00-$30.00 times 5-7 days a week times how many weeks per month times 12 months or ((athletes seen)30.00 X 5) 4 X 12= (your salary) vs. the average salary of the average Athletic Trainer. Keep in mind this is just an example of cash for service but when you compare the two the gap is undeniable. How do we as professionals bridge that gap? Or is everyone okay with the status quo?


  • I think part of the issue is ourselves not valuing our time and knowledge and "settling" for an underpaid job. In my experience, there is a lot of time in the training room that is wasted, which leads to long hours. Often times I feel like many athletic trainers like to feel like a martyr, complain about the long hours and the low pay, when in fact it is themselves that are creating that. I feel like in many professions especially in athletic training early in our career we significantly under value our time and skill set.

    I also think that if in a high school or university setting we tracked, on a regular basis the services we provide and how much we are saving the athlete or school in medical costs there would be more leverage for asking for money. You also have to consider how many athletes you are seeing during the day that are truly receiving skilled services of injury/illness evaluation, manual therapy, exercise prescription, emergency care coverage vs. taping, applying modalities etc.

    In the clinical setting, athletic trainers need to fight for what role they have in the clinic as supported by the states scope of practice. In Arizona, I know many ATs in the clinic are utilized as techs, which is a role that has low skill. According to our scope of practice you should be able to have your own patient load and evaluate and treat just like a PT, which can create more revenue for the clinic and free up the supervisory role of the PT for PTAs and Techs.
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
  • I definitely agree on some points with you that we as professionals complain and don't take action however as far as services provided when compared to every healthcare professional we give away everything. Where as in physical therapy they can charge 15-20 dollars for something as small as an ice pack or taping someone. It bears no weight on demanding more money from our employers. Simply because I know people right now at the division 1 level, which is supposed to be the 2nd highest level to professional sports, and they still make 32-35k. It's a combination of the athletic trainer and the system we are a part of. There is no room for growth or development because we don't treat ours as qualified healthcare providers so why should anyone else?
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Audric/Anna,

    This is definitely a hot-button topic in the AT industry and one that needs to be seriously addressed. I think there are a number of factors that go into determining salary. Number of patients/athletes seen is one of them. I also believe we should be recognized as providers and be eligible to bill insurances in certain situations. ATs have skills that compare to PTs and even go beyond. One example is that ATs need to be able to assess an acute injury on the field of play while PTs typically see patients post-op or post-injury and the need to evaluate an injury has already been done by the physician; yet they can bill for evaluation and treatment. I say this with the utmost respect for some PTs as providers because there are a lot of good ones out there. As a physician extender, it is difficult to say what is reasonable and customary for those working on the sidelines since I only see patients on a daily basis. With that said and having worked on the sidelines, I do know that ATs are severely underpaid at all levels. And this is an issue that needs to be addressed quickly since we are moving to an entry-level masters and I don’t know a single person with an MS who would work for what is essentially pennies for their hard work and dedication to their craft. As for the martyrs, I don't know too many people who actually enjoy being underpaid but our skills are too valuable to go unnoticed or unrewarded by employers who say that we are vital to their sports programs.

    Aside from salary, the differentiation from other professions is a difficult task to tackle and needs to be handled as we try to continue to gain respect. “Trainer” gets thrown around too often even by professionals in the field. The phrase “See the trainer” or simply yelling “Trainer!” has become staples in coaches’ vocabularies. We have extensive knowledge of athletics, orthopedics, injury prevention, and treatment of injuries (just to name a few) and we should be treated as such. We constantly get compared to personal trainers many of who hold what I like to call a weekend degree where they sit on their computer and apparently learn kinesiology in three hours. I use that example because I actually had someone I know use that exact phrase: learn kinesiology in 3 hours. I laugh and get angry at that sentence all at the same time since I don’t know a single credible professional in any area of sports medicine who learned kinesiology in just 3 hours. Additionally, anyone who utters that phrase has never actually studied or learned kinesiology. Similar to PTs, there are some really great personal trainers who are fantastic and have an extensive knowledge of how the body works and I do not mean to group them in with the others. Maybe a name change is something we should consider but that’s for another conversation…

    As I hop off my soap box, I hope to have built upon an already great thread here.
  • Great points Frank. It will be interesting to see what the movie to a masters level degree does to the salaries and the industry as a whole.

    As far as insurance goes, at my previous position as Director of Physical Therapy and Athletic Training for EXOS we did bill insurance for athletic training services. We used the CPT code specific to an athletic training evaluation and re-evaluation, and all other CPT codes were the same regardless of what practitioner was billing them. We also asked the insurance company prior to billing if there were restrictions on the type of practitioner allowed to perform evaluation and treatment. Only some specifically required PT, most were non specific. One specifically stated certified athletic trainers were covered. Using this same approach we also successfully billed workers compensation cases as well. Again, so states/companies had specific practitioner restrictions but many did not.

    Agreed with the name change. It is too bad years ago when this came up again we as an organization did not act on it. I fear that now after all the work and progress (though small) at getting people aware of what an AT is, changing the name could potentially make the waters even more murky. Always worth revisiting though with the proper market analysis.
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
  • Thank you for your contribution to the discussion everyone.
    There are no soap boxes here that's what makes Athletic Trainers special is the level of passion they have for their athletes and patients. When it comes to wages I practice in Indiana and we can bill through insurance, it's still a struggle for reimbursement, but it is still an option. I think there are a number of ways Athletic Trainers can change the median salary. I'll give an example of what I do with the contracts that I have, in a facility that I provide sports medicine coverage for gymnastics and cheer in order for the athlete to be under our care they must pay a fee in order to have the benefits of Sports Medicine coverage provided to them. If they have not paid the fee they can not get be taped or receive treatment. They can have an injury looked at but unless they have paid for coverage that is the extent in which they can utilize the Athletic Trainer on site. This Isn't designed to keep athletes from being seen or treated or ousted because they didn't pay. This system is in place so parents and athletes respect the service being provided and the Athletic Trainer is compensated fairly.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Audric - that sounds like a great system you've got going on there to ensure everyone gets what they are there to do. Like many professions in allied health, each state recognizes them differently. I know the NATA is doing their diligent work to make sure we all get recognized for the members' hard work but the individual states need to collectively jump on board with who we are, what we do, the extent of our knowledge, and the services we provide. There are a lot of voices speaking up for us as ATs but it seems like we are constantly fighting an uphill battle and those loud voices are falling on deaf ears.
  • I think it's because the time for talking is over. Every Athletic Trainer has to do their part in moving the profession forward. If we as a collective group don't try to move in the same direction nothing will happen.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • I agree 100% Audric. We need to be responsible for ourselves as a profession, even though the NATA does a great job at taking a stand for us. As I mentioned previously, there are a large number of great ATs out there that are doing their due diligence to ensure we are recognized, but those that aren't as worried will hurt us in the long run (i.e., the ATs who refer to themselves as "trainers", or don't explain our profession when someone asks if we can help them with their workout).
  • Yes we definitely need to at the very least respect our own title. The ones that hurt us the most are honestly the ones who simply hand out ice bags, rarely evaluate /educate the athlete or properly provide treatment, sit in their training room watching netflix, and doll out electric stim like it's a cure-all. These are the ones make it impossible for us and force a lot of good quality Athletic Trainers to find a new profession because of "burnout" or financial reasons. The horror stories I've heard over the years from high school to the pros is astounding and sad all at the same time.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Great in which I have been discussing for 20 years. I Believe the biggest problem right now is the slash. And by that I mean ATC/PT, ATC/PE teacher or health teacher. The ATC we hold so dear behind our name is a full time and more job. How many NPs do you know that are also PAs. Or MDs that are also DOs. When you have the slash as I alluded to, it looks like we sat down and took a course to gain that credential. And our forefathers at the state and national level didnt do anyone any favors with respect to the internship route to certification..there was no standard from an educational standpoint to validate our skill level to employers, insurance companies etc when that was in place. But, the future has never been brighter for our profession and I am excited for the young people starting out. Stick it out , it may take a few years but they will respect and trust your opinion. And when it comes to people's kids it's the tax payer not school officials who will have your back. And if you are an ATC working as a PT aide or tech, you need to leave that job or maybe that state. I wish everyone the best.
  • Paul-Yes I agree that the future is definitely bright for our profession with the changes that are happening. From going to a master's required to insurance companies on giving us the chance to register as qualified healthcare providers for third-party reimbursement. There is so much potential for us as long as we keep making strides as a group we will get there.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • This is a good step in getting people to recognize who we are and what we do:

    Also, in my opinion, third party reimbursement should be low on the list in advocacy. First, we already can and have been billing insurance and getting reimbursed. Second, the health care industry, specifically in regards to reimbursement for services is a sinking ship. Sticking with a cash pay model will be the smarter plan, as the low amount of reimbursement with health insurance leads to a model of needing to see 30-50 people a day to make any money, which leads to a decreased quality of care and a poor view/impression of what we do and are capable of.
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
  • Anna-

    I couldn't agree more with you especially in the sense that the fast food mentality of treatment does a disservice to the people we serve. But I'd like to take a step back and ask how do we get the Athletic Trainer into clinic being seen as an equal, referred to by Physicians, and having their own patient load so that can get reimbursement? I practice in Indiana and it's practically unheard of.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Hello, I have been an AT for 20 years now and reached that burned out stage. I worked my way through the various job options, slowly climbing the ladder. I worked high schools, college/university, clinic, military, minor league, and government/law enforcement. I thought I had THE job. Loved it and felt appreciated and like I was making a difference. I worked for the federal government in a contract position. The contract came due and the new contract holder cut my pay by 25% based on salary information they found on I called the NATA. They wanted to call the new contract holder and educate them on ATs and salaries. I told them it was too late; it was a done deal. I had to leave the position as I couldn't afford to stay either.

    My take on ATs being a larger part of the healthcare field is educating the public. That same contract job I worked with three different doctors and five nurses. I had to educate each of them on what an athletic trainer is, what we can do, how we are trained/educated. They weren't sure what they felt comfortable allowing me to do. I had to explain based on a college setting how we operate and what we offer the injured, active person. I became an asset in their eyes when I was only doing what we do.

    In Philadelphia a couple years ago I attended the forum with the board. I asked what the NATA was doing to educate the public since I could go out to the street, ask a random person what an athletic trainer is an does, and that person not knowing the answer. Their answer was the same as the one they gave me almost 10 years before in Nashville. They work on grassroots. They want us, in the field to spread the word. The people we work with already know what an AT is and does. I said they need to spend money to make money. That we need to work with our sponsors, J&J and Gatorade, for print ads in parent and sport magazines and commercials. We need parents and athletes asking their schools and doctors for ATs to be in their schools and a part of their treatment/rehab plan. They can't ask if they don't know we exist.

    Last I heard, Medicare won't pay for ATs to treat patients. That is the main reason I hear about hiring an AT in the clinic setting. Clinics can't bill for AT services so they don't pay ATs a reasonable rate. TriCare, military insurance, wouldn't pay either. How many years have we been paying for lobbyist in DC to overturn the Medicare billing issue? How much money is that costing us as a profession? Are there better places to put that money? Are we progressing?

    I wish I had answers. I wish we were paid our worth. I wish ATs wouldn't take the low paying jobs to make a statement to the healthcare field, but I know people need money even if it is a low number. I wish there was more consistency in the level of care we provide so the slackers don't give us a bad name. Why should ATs get paid when anyone can hand out ice and tape an ankle. I wish...
  • Hi Audric,

    In Arizona, it is not common practice either, I worked hard to create relationships with the doctors and build my own schedule of patients. I think it is also helpful that in Arizona, physical therapy is direct access. So people would not need to see a doctor first for a referral. I would get someone on my schedule that was cash pay or had insurance / workers comp that did not specify rehab practitioner type. I would evaluate and treat them and either refer to a doctor or send their doctor initial evaluations and progress notes. I would also call, and or go to the office if possible to meet a new doctor. If the patient had a follow up or initial consult with the doctor I would block out time to go with them as well.

    This process really works best in a clinic that provides one on one care, or has the PT and AT in "teams". I cannot imagine it would be successful in a traditional clinic setting where there is a new patient every 15min. I took a lot of time and over communication at first, but over the years eventually had the doctors referring patients to me.

    The model didn't necessarily exist previously, I and the company I was at just had faith in taking a chance on it. In the last 10 years, I have seen a few more AT in Arizona practice this way as well, with some success.

    Hi Stacey,

    Thank you for your thoughts. I hope that the NFL campaign will be a good push in the right direction to educate the public on who we are. It can be frustrating to operate at a grassroots level, but it is an important process even if the NATA was doing a more global approach. Each AT being an advocate for the profession is key.

    I think it is helpful to remember that athletic training is a fairly young profession, with our professional organization just being 65 years old. So, many parents did not have athletic trainers when they were growing up. As we start seeing a 2nd generation of the profession, I feel the recognition/awareness/ and understanding will continue to grow. Especially with the education standards progressing to a more professional type degree.

    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
  • - Audric

    I'm constantly having this discussion with fellow ATCs. I agree that ATCs have trouble advancing because the profession is, in general, undervalued and not enough ATCs are creating niches for themselves. I've had the opportunity to do some contract work and began asking myself, "why am I working for someone else" and "why aren't ATCs in charge of or responsible for these contract"? The opportunities are out there, you just have to know where to look. State laws so play a part in impeding advancement. In states like Wisconsin and Missouri, ATCs can absolutely bill. Most others, they cannot.
    As far as billing is concerned, I'm suspicious of athletic trainers benign granted that privilege. The beauty of athletic training is that we aren't motivated by any external factors others than getting a patient back to activity as quickly and safely as possible. If we had the billing incentive, we take away the one thing makes ATCs unique. I understand wanting to do so from a monetary benefit factor. But the billing system would not work well in all athletic training settings.
    I think we should own some of the responsibility of educating everyone we come into contact with about our profession. Sucks, I know, but c'est la vie. Other allied health professions have this problem. The public will not demand that we get paid more. I'm more concerned with showing and proving our worth to employers. The best way to do this on an individual or local level would be to keep injury and rehab data and convert that to real dollars saved and spend. For example, in a HS or college if all the rehab in done in house that saves the school's insurance a lot of money. If those cases sought outside care, that would cost the school a lot of money. You could argue for some portion of the difference. With the amount of money spent at the DI level in athletic programs. The ATCs should not just be getting by. T-shirts and championships do not pay the bills.
    I also believe advancement is upheld because athletic trainers are cultured to accept being overworked, underpaid, and undervalued. There are not many jobs that do not require/prefer MS of some sort. 30-35K/yr is poverty-level pay but many jump at that to work for a popular school. Compensation improves depending on the setting, but college-level athletic training has not advanced and it will not until ATCs stop accepting those jobs and demand better pay.
    With the passing of the ACA, athletic trainers have an opportunity to break free of traditional settings and roles. I'd like to see more ATCs start businesses geared towards public health and injury prevention, and compete for HS, college, and industrial contracts with PTs. They hire ATCs to do a lot of that work anyway.
  • Stacy-
    It is truly unfortunate when good Athletic Trainers like yourself are getting burnt out. Especially when the slackers you spoke of wind up taking jobs from the good Athletic Trainers, they give us a bad name like you said, and they are perfectly content in doing so. Anna made a really good point about our profession still being young this is a big reason people are still uninformed about what it is that we do. I know that NATA consistently tries and falls short of progressing our profession this is why it's up to the individual Athletic Trainer and the small groups of quality Athletic Trainers to make ripples until those ripples become waves. This involves little changes like not working under physical therapy companies, not accepting jobs that pay less, taking contracts with the highschool, colleges, or other settings we work at where we make a fraction of what the school pays these companies, starting Athletic Training companies of our own, and basically not going along with the "Status quo" of Athletic Training. Until these moves are made we are perpetually going to still be considered water boys/girls or just techs to most people

    You make a very valid point that it does take time patience, and education to move up in being respected by other healthcare professionals and the patients we treat. Do you feel that Athletic Trainers and Physical Therapists can work in the same environment without being in direct competition? It always seems to be a battle among the two in the clinic , more often than not, when it comes to this. I have had plenty of good experiences with Physical Therapists who work together in the teams you describe but there are many PT's that I have encounter that turn it into a PT vs AT thing which is never good for the patient. I mostly ask this because I find that it can be a conflict of interest for the Athletic Trainer ,regardless of setting, to refer to another professional(Physical Therapist) who will often not communicate well, who doesn't take into account the true dynamics of the sport (skill sessions, practice/game restrictions, practice/game observation, or sports specific conditioning), and at the end of the day is the one receiving the reimbursement where a fraction of the work has been done if working in tandem. It seems like a system that is mostly beneficial to the one side of the pair minus the great feeling of watching your athlete succeed which a physical therapist will never have the pleasure of.

    You are absolutely right that it is a double edged sword for Athletic Trainers to getting reimbursed because we are a unique brand of individuals who love what we do and love our athletes but what happens when we make decisions based upon getting paid. If we are going to be truly honest with ourselves we already have been making decisions based upon our paycheck. Many of us have gone above and beyond for our athletes but how many times have we all made a decision based on "we don't get paid enough for this" or leave hoping the grass is greener on the other side or the burnt out Athletic Trainer that goes back to school for another profession. We all have bills but we can honestly have both the pay and the love for the profession. When I started my Athletic Training company it was scary, and still is, but when every single one of my athletes started paying for me to be at their practices, provide treatment, and referring them to a doctor who then referred them back to me in the clinic that feeling was indescribable. Having that love and passion being rewarded by seeing my athletes feel better and succeed, them appreciating my efforts, AND being paid accordingly was the holy trinity for me. I honestly could never go back to the "Status quo" of Athletic Training ever again!
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Audric,
    Sorry for the delayed response.

    I do feel like ATs and PTs can work in the same environment and not be in direct competition. Competition can occur between ATs just as much as between 2 separate professions (AT vs. PT, PT vs. DC, AT vs. DC etc.) In my opinion competition arises when the ego of the clinician is driving the practice instead of having the athletes best interests in mind. If I encounter another clinician that is trying to make it a competition I do not engage with them. Obviously in my current position, and past position I have and had the luxury of picking who I work with. In the times I did not, I always over communicated with all parts of the athletes team to make sure it was the athletes performance and goals being kept at the center of focus.

    When you have the interest of the athlete in mind it is hard not to create an entire team of professionals to help. I do the athlete a disservice if I control them from pre surgery, post surgery and return to play. To have a well rounded approach that is best for the athlete I need help from the doctor, often a different skill set with another AT, PT, DC, or LMT, exercise physiologist, strength coach, skills coach, and sports psychologist. This continuum of care and team approach is essential. It does not mean that I am not knowledgable in all these areas, but I know where my strong points are and when I need influence or assist from people who are experts in these areas.

    In my opinion if you feel someone is not communicating well, you have to take it upon yourself to continue the communication or increase it. As sitting back and waiting for the other person to communicate better doesn't work. I do think there are excellent PTs out there that do understand the demands of sport. I do not think this is something that is specific to profession. As in any profession you have people that are great and get it or are mediocre. The reality is teams are adding sports PTs to their sports medicine team more and more and I do not think this will change, but only become more and more common at the university and professional levels.

    Depending on how you arrange your "team" in the clinical setting will determine the reimbursement, and yes sometimes it will be reflected in collections under someone else name. But, ultimately it is the clinic getting reimbursed not the individual clinicians. The clinic has to have the opinion the the quality of care and outcomes are just as important as the collections. Some will and some will not. In that case as an AT you need to find a place of work that you feel you are valued, not undervalued. They are out there, and sometimes you just have to make your niche and work with the clinic to understand your value.

    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
  • Anna,

    You are fine we are all busy people.

    I appreciate your opinion on the PT and AT collaboration. I definitely agree that the patients interests are always the number one priority. I always wonder what kind of experiences others have had in that arena. I feel all of my experiences have always been polar opposites I either have the most collaborative effort where we both are learning how to make the patient feel better or the other side of the spectrum where I have been blatantly disrespected by the PT on numerous instances. This is something I never understood because we are there to help the person in pain. Or that's what I thought and still think. Have you ever encountered situations where other professionals did not value you or your opinion at all because of your title? And how did you handle it?

    As you said more Universities and professional teams are adding PT's to their teams where do you think the Athletic Trainer will fall in the continuum of care? Do you think we will become obsolete?
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Audric,

    Of course I have encountered situations where other professionals of any credential did not value my opinion, sometimes because of my title, sometimes because of my gender, sometimes because I look very young. Honestly I do not let it bother me. It feels like a waste of energy to get upset about something like that. I do my best every day and treat people with respect, and communicate well. If someone doesn't not want to "hear" me because they are making a judgment on me, then that is their loss. I chose to make my full spectrum of care "teams" with like-minded individuals so we can maximize our brain power and provide the best for the athletes.

    I do not think ATs will become obsolete as teams hire PTs. I think the AT will still be an integral part of the continuum of care.
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
  • Anna,

    Thank you for answering my questions its much appreciated.
    Do you think that Athletic Trainers themselves are a big part of peoples misconceptions about the profession or do you feel that it is mainly the name that throws people off and its just general innocent misconception?
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • this is always a hot topic in our field, wondering - what if, or has the NATA had ever thought of partnering with the APTA, they have the Sports certified specialist, and many P.T's have their AT credentials.
    maybe under PT like an O.T?
  • edited August 2015

    Now I don't mean to shoot this down because it is a thought I used to have. However, once you go that route it would be a move in the opposite direction for the profession. We haven't established ourselves as a profession and by doing this we would move lower on the totem pole, at least that's what I think in my humble opinion. It's bad enough that programs exist that allow us direct access to being a PTA we don't need anymore ways of making us look as if we aren't qualified healthcare professionals.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • hmm i see your point. guess our profession is doomed ( just kidding), curious i know theirs a lot of opinions regarding what should be done , what do you think would be the most effective route to establish us AT as professions/or at least what others say out there that most agree with that makes sense
  • Haha we aren't doomed by any means. Well I personally think the first step involves either the curriculums for undergraduate programs need to change OR our scopes of practice state by state need to be clearer on what it is that we are can and cannot do legally. Our scope of practice is pretty vague and needs detail which is required for the individual practitioners to understand their role vs the other professionals we work with.
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
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