Chapter 1: The Sports Medicine Team

Chapter 1: The Sports Chapter 1: The Sports Medicine TeamMedicine Team

Chapter 1: The Sports Chapter 1: The Sports Medicine TeamMedicine Team

Sports MedicineSports Medicine

• Where Have We Been?

• Where Are We Now?

• Where Are We Going?

• Where Have We Been?

• Where Are We Now?

• Where Are We Going?

Where Have We Been?

• Trainers associated with Greek & Roman Periods.• Increase in sports activities during the Renaissance.• Late 19th century AT’s involved with intercollegiate athletics in the

US.• Rub downs, home remedies, lack of technical knowledge.• After WWI AT’s viewed as specialized in preventing and managing

athletic injuries.• 1950 NATA (National Athletic Trainers Association) founded in

Kansas City• 1980’s Athletic Training Program content for bachelor’s degree.• 1980’s development of NATABOC for board certification, ATC’s.• Recognized by the AMA as an allied health care provider.

Where Are We Now?

• 40% of ATC’s work outside of school athletic settings.

• 2004 End of internship programs• ATC’s regulated and licensed healthcare providers• ATC’s provide the same or better outcomes as

others, including PT’s.• ATC’s demonstrate high patient satisfaction

ratings.

Where Are We Going?

• 2010 21,525 projected ATC jobs

• 2015 25,400 projected ATC jobs

• Continued research to develop new techniques for injury prevention, management, and rehabilitation.

What’s the Difference?Athletic First Responder

Certified in CPR/First Aid

Completes 40 hours of continuing education each year in injury prevention/management

May have additional certifications/degrees in the field of sports medicine/athletic training

Certified Athletic Trainer

Holds a degree in Sports Medicine/Athletic Training

Certified by the NATABOC (exam)

(National Athletic Training Association Board of Certification)

Licensed in the State for which they work

Practice of MedicinePractice of Medicine

Human Performance

Human Performance

Injury Management

Injury Management

Exercise PhysiologyExercise Physiology

BiomechanicsBiomechanics

Sport PsychologySport Psychology

Sports NutritionSports Nutrition

Sports Physical TherapySports Physical Therapy

Athletic TrainingAthletic Training

Sports MassageSports Massage

Goals of Professional Sports Medicine Organizations

• Develop professional standards & code of ethics

• Exchange of professional knowledge, stimulate research, & promote critical thinking.

• Ability to work as a group with a singleness of purpose to achieve objectives that could not be accomplished separately.

The Players on the Sports The Players on the Sports Medicine TeamMedicine Team

The Players on the Sports The Players on the Sports Medicine TeamMedicine Team

• Physicians

• Dentist

• Podiatrist

• Nurse

• Physicians Assistant

• Physical Therapist

• Athletic Trainer

• Adult First Responders

• Massage Therapist

• Physicians

• Dentist

• Podiatrist

• Nurse

• Physicians Assistant

• Physical Therapist

• Athletic Trainer

• Adult First Responders

• Massage Therapist

• Exercise Physiologist

• Biomechanist

• Nutritionist

• Sport Psychologist

• Coaches

• Strength & Conditioning Specialist

• Social Worker

• Exercise Physiologist

• Biomechanist

• Nutritionist

• Sport Psychologist

• Coaches

• Strength & Conditioning Specialist

• Social Worker

The Primary Players on the The Primary Players on the Sports Medicine TeamSports Medicine Team

The Primary Players on the The Primary Players on the Sports Medicine TeamSports Medicine Team

American College of Sports Medicine (ACSM)

American College of Sports Medicine (ACSM)

• Patterned after FIMS (Umbrella Organization)

• Interested in the study of all aspects of sports

• Membership = individuals in the medical field, and those interested in sports medicine

• 18,000 members

• Patterned after FIMS (Umbrella Organization)

• Interested in the study of all aspects of sports

• Membership = individuals in the medical field, and those interested in sports medicine

• 18,000 members

Sports Physical Therapy Section of APTA

Sports Physical Therapy Section of APTA

• Promotes the role of the sports physical therapist to other health professionals

• Supports research to further establish the scientific basis for sports physical therapy

• Offers certification as a sports physical therapist (SCS)

• Approximately 9,000 members• Many sports physical therapists are also

certified athletic trainers

• Promotes the role of the sports physical therapist to other health professionals

• Supports research to further establish the scientific basis for sports physical therapy

• Offers certification as a sports physical therapist (SCS)

• Approximately 9,000 members• Many sports physical therapists are also

certified athletic trainers

National Athletic Trainers Association(NATA)

National Athletic Trainers Association(NATA)

• To enhance the quality of health care for athletes and those engaged in physical activity, and to advance the profession of athletic training through education and research in the prevention, evaluation, management and rehabilitation of injuries

• The NATA now has 28,000 members

• To enhance the quality of health care for athletes and those engaged in physical activity, and to advance the profession of athletic training through education and research in the prevention, evaluation, management and rehabilitation of injuries

• The NATA now has 28,000 members

AMA Recognition of Athletic TrainingAMA Recognition of Athletic Training

• June 1991- AMA officially recognized athletic training as an allied health profession

• Committee on Allied Health Education and Accreditation (CAHEA) was charged with responsibility of developing essentials and guidelines for academic programs to use in preparation of individuals for entry into profession through the Joint Review Committee on Athletic Training (JRC-AT)

• June 1991- AMA officially recognized athletic training as an allied health profession

• Committee on Allied Health Education and Accreditation (CAHEA) was charged with responsibility of developing essentials and guidelines for academic programs to use in preparation of individuals for entry into profession through the Joint Review Committee on Athletic Training (JRC-AT)

AMA Recognition of Athletic TrainingAMA Recognition of Athletic Training

• June 1994-CAHEA dissolved and replaced immediately by Commission on Accreditation of Allied Health Education Programs (CAAHEP)– Recognized as an accreditation agency for

allied health education programs by the U.S. Department of Education

• Entry level college and university athletic training education programs at both undergraduate and graduate levels are now accredited by CAAHEP

• June 1994-CAHEA dissolved and replaced immediately by Commission on Accreditation of Allied Health Education Programs (CAAHEP)– Recognized as an accreditation agency for

allied health education programs by the U.S. Department of Education

• Entry level college and university athletic training education programs at both undergraduate and graduate levels are now accredited by CAAHEP

National Athletic Trainers AssociationBoard of Certification (NATABOC)

National Athletic Trainers AssociationBoard of Certification (NATABOC)

• In 1999 the NATABOC completed the latest Role Delineation Study, which redefined the profession of athletic training

• Study designed to examine the primary tasks performed by the entry level athletic trainer and the knowledge and skills required to perform each task

• In 1999 the NATABOC completed the latest Role Delineation Study, which redefined the profession of athletic training

• Study designed to examine the primary tasks performed by the entry level athletic trainer and the knowledge and skills required to perform each task

Athletic Training Educational Competencies

(1999)


(1999)•Twelve Content Areas

– Acute care of injury and illness– Assessment and evaluation– General medical conditions and

disabilities– Health care administration– Nutritional aspects of injury and

illnesses – Pathology of illness and injuries

•Twelve Content Areas– Acute care of injury and illness– Assessment and evaluation– General medical conditions and

disabilities– Health care administration– Nutritional aspects of injury and

illnesses – Pathology of illness and injuries


(1999)


(1999)– Pharmacological aspects of injury and

illnesses– Professional development and

responsibility– Psychosocial intervention and referral– Risk management and injury

prevention– Therapeutic exercise– Therapeutic modalities

– Pharmacological aspects of injury and illnesses

– Professional development and responsibility

– Psychosocial intervention and referral– Risk management and injury

prevention– Therapeutic exercise– Therapeutic modalities

Certification RequirementsCertification

Requirements

• Candidates for certification must meet NATABOC established requirements

• For students graduating in 2003 and beyond, NATABOC no longer requires clinical hours

• CAAHEP accredited programs must develop and implement a clinical instruction plan according to 2001 Standards and Guidelines to ensure that students meet all AT educational competencies and clinical proficiencies in academic courses with measurable outcomes

• Candidates for certification must meet NATABOC established requirements

• For students graduating in 2003 and beyond, NATABOC no longer requires clinical hours

• CAAHEP accredited programs must develop and implement a clinical instruction plan according to 2001 Standards and Guidelines to ensure that students meet all AT educational competencies and clinical proficiencies in academic courses with measurable outcomes

Certification RequirementsCertification

Requirements

• Accreditation process will be concerned with the quality of experiences and student outcomes and knowledge rather the number of hours accrued

• As of January, 2004 the internship route to certification will no longer be accepted

• All candidates for certification will have to meet CAAHEP requirements

• Successful completion of all parts of the certification exam will earn the credential of ATC

• Accreditation process will be concerned with the quality of experiences and student outcomes and knowledge rather the number of hours accrued

• As of January, 2004 the internship route to certification will no longer be accepted

• All candidates for certification will have to meet CAAHEP requirements

• Successful completion of all parts of the certification exam will earn the credential of ATC

CAAHEP Accredited Programs

CAAHEP Accredited Programs

• Currently 134 institutions offer entry level athletic training education programs accredited by CAAHEP

• 174 are in the process of seeking CAAHEP accreditation

• 13 graduate programs in athletic training approved by the Education Council Post-Certification Graduate Education Committee

• Currently 134 institutions offer entry level athletic training education programs accredited by CAAHEP

• 174 are in the process of seeking CAAHEP accreditation

• 13 graduate programs in athletic training approved by the Education Council Post-Certification Graduate Education Committee

Employment Settings for Athletic Trainers


• Secondary Schools– 1995 NATA adopted a position statement

supporting hiring athletic trainers in secondary schools

– 1998 AMA adopted policy calling for ATC’s to be employed in all high school athletic programs

– ~ 30,000 public high schools in U.S.– Between 20-25% of high schools have ATC’s

• School Districts– ATC floats between several schools in same

district

• Secondary Schools– 1995 NATA adopted a position statement

supporting hiring athletic trainers in secondary schools

– 1998 AMA adopted policy calling for ATC’s to be employed in all high school athletic programs

– ~ 30,000 public high schools in U.S.– Between 20-25% of high schools have ATC’s

• School Districts– ATC floats between several schools in same

district



• College and Universities– Number of ATC’s varies considerably– Extent of coverage varies– 2000 Task Force published Recommendations

and Guidelines for Appropriate Medical Coverage for Intercollegiate Athletics• Based on a mathematical model created by a

number of variables

• Professional Teams– ~ 5% of employed ATC’s

• College and Universities– Number of ATC’s varies considerably– Extent of coverage varies– 2000 Task Force published Recommendations

and Guidelines for Appropriate Medical Coverage for Intercollegiate Athletics• Based on a mathematical model created by a

number of variables

• Professional Teams– ~ 5% of employed ATC’s



• Sports Medicine Clinics– The largest % of employed ATC’s found in

this setting– Work in the clinic in AM and in high school

in PM

• Industrial and Corporate Settings– ATC’s oversee fitness, injury rehabilitation,

and work-hardening programs– Understanding of workplace ergonomics is

essential

• Sports Medicine Clinics– The largest % of employed ATC’s found in

this setting– Work in the clinic in AM and in high school

in PM

• Industrial and Corporate Settings– ATC’s oversee fitness, injury rehabilitation,

and work-hardening programs– Understanding of workplace ergonomics is

essential

State Regulation of the Athletic Trainer


• During the early-1970s NATA realized the necessity of obtaining some type of official recognition by other medical allied health organizations of the athletic trainer as a health care professional

• Laws and statutes specifically governing the practice of athletic training were nonexistent in virtually every state

• During the early-1970s NATA realized the necessity of obtaining some type of official recognition by other medical allied health organizations of the athletic trainer as a health care professional

• Laws and statutes specifically governing the practice of athletic training were nonexistent in virtually every state



• Athletic trainers in many individual states organized efforts to secure recognition by seeking some type of regulation of the athletic trainer by state licensing agencies

• To date 40 of the 50 states have enacted some type of regulatory statute governing the practice of athletic training

• Rules and regulations governing the practice of athletic training vary tremendously from state to state

• Athletic trainers in many individual states organized efforts to secure recognition by seeking some type of regulation of the athletic trainer by state licensing agencies

• To date 40 of the 50 states have enacted some type of regulatory statute governing the practice of athletic training

• Rules and regulations governing the practice of athletic training vary tremendously from state to state



• Regulation may be in the form of: – Licensure

• Limits practice of athletic training to those who have met minimal requirements established by a state licensing board

• Limits the number of individuals who can perform functions related to athletic training as dictated by the practice act

• Most restrictive of all forms of regulation

• Regulation may be in the form of: – Licensure

• Limits practice of athletic training to those who have met minimal requirements established by a state licensing board

• Limits the number of individuals who can perform functions related to athletic training as dictated by the practice act

• Most restrictive of all forms of regulation



– Certification•Does not restrict using the title of athletic

trainer to those certified by the state•Can restrict performance of athletic

training functions to only those individuals who are certified

– Registration•Before an individual can practice athletic

training he or she must register in that state

– Certification•Does not restrict using the title of athletic

trainer to those certified by the state•Can restrict performance of athletic

training functions to only those individuals who are certified

– Registration•Before an individual can practice athletic

training he or she must register in that state

List of Regulated StatesL: Licensure C: Certification R: Registration

List of Regulated StatesL: Licensure C: Certification R: Registration

• Alabama (L) Kansas (R) North Carolina (L) • Arkansas (L) Kentucky (C) North Dakota (L)• Arizona (E) Louisiana (C) Ohio (L)• Colorado (E) Massachusetts (L) Oklahoma (L)• Connecticut (E) Maine (L) Oregon (R)• Delaware (L) Minnesota (R) Pennsylvania (C)• Florida (L) Mississippi (L) Rhode Island (L)• Georgia (L) Missouri (R) South Carolina (C)• Hawaii (E) Nebraska (L) South Dakota (L)• Idaho (R) New Hampshire (C) Tennessee (C)• Illinois (L) New Jersey (R) Texas (L) • Indiana (L) New Mexico (L) Vermont (C)• Iowa (L) New York (C) Virginia (C) • Wisconsin (C)

• Alabama (L) Kansas (R) North Carolina (L) • Arkansas (L) Kentucky (C) North Dakota (L)• Arizona (E) Louisiana (C) Ohio (L)• Colorado (E) Massachusetts (L) Oklahoma (L)• Connecticut (E) Maine (L) Oregon (R)• Delaware (L) Minnesota (R) Pennsylvania (C)• Florida (L) Mississippi (L) Rhode Island (L)• Georgia (L) Missouri (R) South Carolina (C)• Hawaii (E) Nebraska (L) South Dakota (L)• Idaho (R) New Hampshire (C) Tennessee (C)• Illinois (L) New Jersey (R) Texas (L) • Indiana (L) New Mexico (L) Vermont (C)• Iowa (L) New York (C) Virginia (C) • Wisconsin (C)

Reimbursement for Athletic Training Services


• During the past 40 years the insurance industry has undergone a significant evolutionary process

• Health care reform initiated in the 1990’s has focused on the concept of managed care in which costs of a health care providers medical care are closely monitored and scrutinized by insurance carriers

• Managed care involves a prearranged system for delivering health care that is designed to control cost while continuing to provide quality care

• During the past 40 years the insurance industry has undergone a significant evolutionary process

• Health care reform initiated in the 1990’s has focused on the concept of managed care in which costs of a health care providers medical care are closely monitored and scrutinized by insurance carriers

• Managed care involves a prearranged system for delivering health care that is designed to control cost while continuing to provide quality care



• Third-party reimbursement - primary mechanism of payment for medical services in the United States

• Health care professionals are reimbursed by the policy holder's insurance company for services performed

• To cut pay-out costs, many insurance companies limit where and how often an individual can go for care and what services will be paid for

• Third-party reimbursement - primary mechanism of payment for medical services in the United States

• Health care professionals are reimbursed by the policy holder's insurance company for services performed

• To cut pay-out costs, many insurance companies limit where and how often an individual can go for care and what services will be paid for

Athletic Trainer vs. Physical Therapist Wars


• It is not unusual to find a physical therapist interested in sports and athletics working toward certification as an athletic trainer

• A certified athletic trainer interested in working with patients outside of the athletic population may work toward licensure as a physical therapist

• It is not unusual to find a physical therapist interested in sports and athletics working toward certification as an athletic trainer

• A certified athletic trainer interested in working with patients outside of the athletic population may work toward licensure as a physical therapist



• Historically, the relationship between athletic trainers and physical therapists has been less than cooperative – There has been failure to clarify the

roles of each group in injury rehabilitation

• Academic preparation is similar• Individual who holds a dual credential

is more marketable

• Historically, the relationship between athletic trainers and physical therapists has been less than cooperative – There has been failure to clarify the

roles of each group in injury rehabilitation

• Academic preparation is similar• Individual who holds a dual credential

is more marketable

Future DirectionsFuture Directions

• Increase effort to enhance visibility – By making themselves available for local and

community meetings to discuss athletic health care

– Through research efforts and scholarly publication

• Continue reorganize and refine educational programs for student athletic trainers

• Continue to seek and strengthen state regulation of the practice of athletic training

• Increase effort to enhance visibility – By making themselves available for local and

community meetings to discuss athletic health care

– Through research efforts and scholarly publication

• Continue reorganize and refine educational programs for student athletic trainers

• Continue to seek and strengthen state regulation of the practice of athletic training

Future DirectionsFuture Directions

• Increase efforts to create job opportunities particularly in secondary schools, colleges and universities, and corporate and industrial settings

• Increase effort in seeking third-party reimbursement for services provided

• Continue efforts in injury prevention and in providing appropriate, high-quality health care

• Increase efforts to create job opportunities particularly in secondary schools, colleges and universities, and corporate and industrial settings

• Increase effort in seeking third-party reimbursement for services provided

• Continue efforts in injury prevention and in providing appropriate, high-quality health care

Documents

Chapter 1: The Sports Medicine Team