Compensation, Responsibility, and Liability

As I approach the end of the DAT my thoughts have turned to the job market. I alternate between knowing annoyance and surprise as I wonder how our profession arrived at its current state with regard to at the salaries on offer and job descriptions. Some examples include; a full-time NCAA Division I AT listed at $30,000, a full-time NCAA Division III AT listed at $43,000, a full-time technician position listed at $50,000, a full-time secondary school AT position listed at $57,000, an athletic training program director/professor position listed at $80,000, and various residencies and internships ranging from $18,000 to $35,000. I am surprised when I consider such job postings as I now understand the responsibilities of an athletic trainer, particularly in the more traditional settings such as pro, collegiate, or secondary school athletics. We are often directly responsible for the health and well-being of a patient population who place themselves in high injury risk situations. It would seem that such responsibility would be met with appropriate compensation.

Public records regarding salaries are fascinating. At University X, the Senior Associate Athletic Director - Head Athletic Trainer oversees a staff of roughly 19 people providing services to 30 sports. This individual’s salary is roughly $141,000. The Head Football Coach, with a support staff of nearly 40 people, made roughly $3,000,000. As one moves down the totem pole in each of these professions the salaries are equally incongruent. It seems some priorities have been misaligned. There are a number of factors that contribute to the situation described above. I do not intend to debate the economics of the situation, only to lobby that athletic trainers, as licensed health care providers, often in high-risk patient populations, should be compensated for this responsibility. Why are we not? I am knowingly annoyed when I try to answer this question.

Again a litany of factors likely contribute to the abysmal lack of compensation available to most, if not all, athletic trainers. The historically cloistered nature of the profession, a name that increasingly does not describe the profession well, and complacency in advancing the profession academically to name a few. However I would like to ask what role the directing physician plays? Particularly as we move toward 2020 and the elevation of our profession academically, I wonder if the directing physician holds utility for athletic trainers. As athletic trainers, we work closely with other members of the medical community in all practice areas on a regular basis, we carry recognized licenses and insurance, and our educations are continuing to advance to reflect and encourage progress in the profession. Increasingly we are experts in our field and provide depth when included in a team approach to healthcare, yet we are likely the lowest compensated members of the health care community and have less autonomy than massage therapists.

I am increasingly under the impression that this lack of autonomy, as we are required to work under the license of a directing physician in many states, is a factor that costs our profession dearly with regard to compensation. If we explore the directing physican/athletic trainer dynamic a bit, some serious concerns begin to arise. For example, in the event of an adverse outcome, lawsuits often encompass all parties involved. In a traditional setting defending parties may include the institution, coaches, athletic trainers, team physicians/directing physicians, etc. A directing physician must take on more risk as oversight for an athletic trainer while the athletic trainer is not absolved of responsibility or risk. In the case of many traditional settings, a team physician is already part of the sports medicine team, why does this role generally require direct, formal oversight and responsibility, and as such assumed risk, for another professional? This situation does not seem to improve the high cost of physician malpractice insurance allowing physicians who work with athletic trainers, just like those who cover the practices of nurse practitioners to demand compensation for the protection of their own practice. Yet athletic trainers are insured either professionally themselves or by their employing institution. I'm starting to feel as if we have put ourselves in a position to be shaken down for 'protection money' like a movie scene out of 1980s New York City and/or decreased our ability to demand fair compensation.