By Bart Peterson

Bart Peterson is Head Athletic Trainer at Palo Verde High Magnet School in Tucson, Ariz. He is a member of the National Athletic Trainers' Association's District Secretary/Treasurers Committee, a former member of its Secondary School Committee, and one of the three authors of its "Position Proposal Guide for Certified Athletic Trainers in Athletics Programs." He can be reached at: arizatc@cox.net.

When a student-athlete goes down on the playing field, there is always a moment of anxiety. Is it a serious injury? Might it even be life threatening? Does anyone know what to do?

When an athletic trainer dashes to the player's side, you can hear a collective sigh of relief. An athletic trainer's comprehensive knowledge in prevention, assessment, treatment, and rehabilitation of injuries reassures administrators, parents, coaches, and athletes that you have someone on board who "is taking care of the kids." As parents expect more and more accountability from their children's schools, this is becoming critical.

In addition, this individual will have an impact on every sport and every athlete in your program. He or she can be another adult role model for your student-athletes, bring new ideas on risk management to your program, and help coaches with their injury prevention efforts. An effective athletic trainer will make your job as athletic director easier.

That's why hiring an athletic trainer must be a careful, deliberate process. Today, there are many options for securing the services of an athletic trainer and several ways to pay for the position. Implementing a comprehensive strategy for this hire will ensure that you have a competent and caring healthcare professional who fits your specific needs.

BEST FIT
As a certified athletic trainer with 20 years of experience, I've worked at four secondary schools in three states. Each school had different needs and expectations for their athletic trainer. I've also interviewed for a number of positions that I did not accept or wasn't offered because I was not a good match for that particular school.

Just as you strive to hire coaches who are the right fit for your program, any athletic trainer you employ must be a good match for your school. The key is to first figure out your needs and what type of person would fill those needs.

To help schools figure out their needs, in 1996, the National Athletic Trainers' Association (NATA) Secondary School Committee published a document titled, "Position Proposal Guide for Certified Athletic Trainers in Athletics Programs" (PPG), which allows a school to complete a self study of its organization to determine what coverage is needed to ensure a safe environment for the student-athletes.

To identify athletic healthcare needs, the PPG suggests developing an outline for the responsibilities of the athletic trainer at your school, including which practices and games will receive priority coverage. For example, when multiple practices and games occur simultaneously, the policy should specify where the athletic trainer will be situated to provide the most effective and efficient care.

At one of my former schools, a satellite campus was built six miles away from the original campus. During the winter, teams practiced at both campuses, and my position could have become more of a firefighter than an athletic trainer if not for a well-crafted coverage policy. In fact, the athletic director jokingly suggested putting me in a car halfway between the two campuses where I could just wait until something happened.

The policy made it easy to determine where I would be working on which day based on the scheduled activities. When coaches questioned why I wasn't on-site for their team's event or practice, I was able to show them the policy, which helped them understand my well-defined coverage priorities. This also helped guide the coaches in how they scheduled practices.

The best way to craft a policy is by examining current research on injury rates in specific sports. National data can be found in the PPG, and you can also track injuries at your own school over time.

At my school, for instance, we have an injury rate of 3.61 injuries per 1,000 exposures in wrestling, 5.28/1,000 in girls' basketball, 4.39/1,000 in boys' basketball, 3.05/1,000 in boys' soccer, and 4.62/1,000 in girls' soccer. So if girls' basketball and girls' soccer are occurring at the same time, I am obligated to cover basketball due to the team's higher injury rate. But if it were boys' basketball and girls' soccer happening at the same time, I'd be at girls' soccer.

As you examine injury rates for your school, keep in mind that they don't stay static. Changes in injury rates at one school usually closely follow changes in coaches and coaching practices.

Determining your school and student athletes' needs before you hire an athletic trainer is a key step in figuring out what you want. Doing so may clarify whether you need a full-time or a part-time employee, and will better define the qualities you are seeking.

Next, you have to determine what type of athletic trainer fits the "personality" of your school and your management style. Schools that are very competitive every year should look for a similarly minded athletic trainer who can appreciate this kind of pressure. Such schools should also strongly consider hiring a full-time athletic trainer. Coaches, parents, and athletes in this type of setting tend to require more from the administrators and coaching staffs, and the athletic trainer will certainly be no exception.

Another school may benefit from an athletic trainer with great communication skills, or one who has experience working with a diverse population. If football is a priority in your program, you'll want someone well-versed in that sport. An all girls' school may want an athletic trainer with ideas on working with an all-female population.

If this is your first time hiring an athletic trainer at your school, there are also logistics to think about. Is there a facility in which the athletic trainer will work? Do you have a budget line for supplies needed to run an optimal athletic healthcare program? What resources will become available once your new employee is hired? If you are building or remodeling an athletic training room, is your new hire expected to provide design and construction input?

FIVE EMPLOYMENT MODELS
Once you know what type of coverage you need and what qualities you are looking for in an athletic trainer, you can decide what employment model will work for your school. There are several different models currently in use:

Full-Time Athletic Trainer: This has long been held as the best choice for the athlete and school system to ensure quality of care and complete sports medicine coverage, as it allows the athletic trainer time to thoroughly do his or her job. When schools really examine their coverage needs, they often find that 40 hours is barely enough time for an athletic trainer to adequately perform all the duties the job entails. Quality athletic healthcare can be a very demanding undertaking and burnout is one of the major reasons athletic trainers leave the profession or change jobs. While it's true that sometimes you have to start small and build, under-funding and overworking the athletic trainer could lead to the undoing of your program.

Several years ago, Sheila Baize, Director of Interscholastics at the Tucson (Ariz.) Unified School District, switched her nine schools to the full-time athletic trainer model. Prior to this move, Tucson Unified used graduate students from the University of Arizona Athletic Training Education Program. Baize, who was obviously struggling with very high turnover rates with the earlier model, found that settling for the cheapest athletic trainer wasn't paying off when she considered training, unsettled staffing, and hiring costs. She also decided to only hire athletic trainers who had earned master's degrees. Since then, turnover has decreased dramatically--in fact, there hasn't been an open athletic training position in the Tucson district in six years.

Having a full-time athletic trainer will also provide student-athletes with enhanced injury assessment, treatment, and rehabilitation. Athletes can receive care on-site, throughout the day, without having to leave school and miss valuable class time. This helps to reduce absenteeism and medical costs incurred by parents and the school district.

Full-time athletic trainers have more time for communication with parents, outside healthcare professionals, and school employees. They also can build a true athletic training program, which includes educating and overseeing athletic training student assistants in the high school setting.

Athletic Trainer-Teacher: Hiring an athletic trainer who is also a teacher is becoming more popular because it opens up a variety of options. Some schools hire athletic trainers who also teach biology or health and give them a half-time teaching load.

Another option is hiring an athletic trainer who can teach a sports medicine curriculum. This often allows funding to come from two different sources. Career and Technical Education (CTE) funding has been used in many states to cover these positions. Here at Palo Verde, I teach two sports medicine classes in the CTE program.

A nice benefit is having the employee not only in the athletic trenches with the student-athletes, but also in the classroom. Classroom involvement increases familiarity with the students and fosters a better relationship with other staff members. And it affords the chance to have some students assist the athletic trainer after school.

The negative of this model is that it can be difficult to balance the two jobs. There must be a structure in place so that the employee does not feel overused and underappreciated as either a teacher or an athletic trainer.

Clinical Outreach Model: This has been a successful model in which the athletic trainer is employed by a local hospital, rehabilitation clinic, or physician's office. It can be a benefit to schools that may not be able to afford a full-time athletic trainer. The downside is that these individuals are often put on a weekly time limit that can restrict their ability to provide sufficient coverage.

When negotiating with a clinic for athletic training coverage, the following issues must be clear to avoid conflicts:

• length of the contract
• any costs the school has to bear
• athletic trainer time commitment per week/season
• overtime allowances
• interview process by the school to ensure a good fit
• what services will be provided at the school vs. at the clinic or hospital
• special event coverage
• cancellation of the contract
• who provides athletic training supplies
• who pays for professional development such as organizational dues
• performance reviews.

Split-Position Athletic Trainer: In this model, the person works for the school district full time and his or her responsibilities are split between athletic training and another position. This second position could include being a substitute teacher, district health educator, or school administrator.

Part-Time Athletic Trainer: Most athletic trainers have invested a great deal of time and effort in their craft and want a full-time position. On the other hand, some athletic trainers have made career or life changes and embrace the opportunity to hold a part-time position.

FINDING CANDIDATES
The actual hiring process for an athletic trainer should be as thorough as any other significant hire in your school. Start by following your school's guidelines and working with your human resources professionals.

In most cases, you'll be required to advertise the job in a way that reaches a broad audience and follows any affirmative action policies your school or district may have. While you might want to advertise locally, you can also consider posting the position through the NATA's Athletic Training Career Center (see "Resources" below). You can also contact a college in your state with an athletic training curriculum to identify graduates of the program who are looking for employment.

In addition, consider calling a local athletic trainer who works in your area, explaining your needs and management style, and asking if he or she has any suggestions. I get a number of calls every year from athletic directors looking to hire an athletic trainer. I also get calls from athletic trainers looking for jobs. I'm happy to help match them up.

Once you have a pool of candidates, it's helpful to form an interview team. You can include coaches, parents, administrators, school physicians, school nurses, and student-athletes.

One important point is that committee members should be knowledgeable of the profession and what an athletic trainer does. A great candidate might be turned off if a committee member asks an unrelated question or presents an idea that conflicts with the profession's principles.

For example, athletic trainers are accredited healthcare professionals, not fitness trainers, and we should not be confused with personal trainers or "trainers." Athletic trainers have a minimum of a bachelor's degree in athletic training (70 percent have a master's or higher) and maintain certification through the Board of Certification, an organization independent of the NATA. Personal trainers have vastly different academic and certification requirements.

In assessing candidates, it is critical to make sure the candidate will meet your state's requirements. Presently there is state regulation in 48 states that registers or licenses athletic trainers specifically in that state.

For the interview process, develop questions you feel will elicit responses that can help you identify a good hire. Have the candidate discuss their experiences and ask them how they would react to scenarios they could face while working at your school.

When contracting an athletic trainer from a clinic, the school is sometimes afforded the opportunity to interview the candidates, but not always. At the very least you should meet with the clinic administrators to talk about what type of athletic trainer will be a good fit for your school. You might consider putting a clause in the contract that says the athletic director will meet the athletic trainer assigned to the school before the contract is signed.

Finally, make the entire process a learning experience. The more research you do, and the more information you gather, the more everyone will learn. This will lead to finding the perfect athletic trainer for your school--and more sighs of relief from the stands if an athlete goes down with an injury.

Sidebar: THE PITCH
The scenario is repeated throughout the country: You and your school community know that you need to hire an athletic trainer, but your school board says no new hiring can take place in this time of tight budgets and rising costs. So how do you convince decision makers of the need?

I suggest putting together a committee that can construct a compelling and professional proposal. If you can answer the following questions--specific to your school--in the proposal, you will make a convincing argument:

• How can an athletic trainer improve risk management in your school and athletic program?
• How can an athletic trainer improve the delivery of healthcare services to student-athletes?
• How can an athletic trainer relieve a coach of the responsibility of providing healthcare to athletes?
• How can an athletic trainer reduce healthcare costs to athletes and their families?
• How can an athletic trainer provide peace of mind to parents of student-athletes?
• How can an athletic trainer improve the quality of instruction for students?
• If you don't have an athletic trainer, who's taking care of the kids?

Sidebar: RESOURCES

www.nata.org/careercenter/welcome.htm
The NATA's Athletic Training Career Center allows prospective employers and athletic trainers to contact each other.

www.nata.org/employers/ss/PPG702.pdf
The NATA's Position Proposal Guide is available as a PDF at the above link.

Powell, J. and K. Barber-Foss. "Injury Patterns in Selected High School Sports: A Review of the 1995 - 1997 Seasons." Journal of Athletic Training 34, no. 3 (1999): 277-284.