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

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.

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.