from the editor
A Vision for the Future
of the Athletic Training Profession
The historic development of the athletic training profession is very different from that of
any other health profession, having originated
outside the clinical medical system when scholastic and professional sports organizations
were formed over a century ago. Creation of
the National Athletic Trainers’ Association in
1950 led to the development of standards for
professionalism and education of athletic trainers, but the extent to which the profession was
viewed as a legitimate component of the medical community was dramatically increased by the American
Medical Association designation of athletic training as
an “allied health” profession in 1990. Although national
board certification, state regulation, and educational
program accreditation standards have established
a very high degree of professional competence to
deliver health-related services to the physically active
population, the identity of our profession remains
strongly linked to the image of a minimally qualified
technician who supplies water and tapes ankles for a
sports team.
Even though an increasing number of athletic
trainers are working in physician practices, rehabilitation clinics, hospitals, worksite occupational health
programs, and other healthcare organizations, many
athletic trainers are extremely frustrated by a public
perception of the profession that seems to undervalue
the benefits that we can deliver to physically active
people in settings other than scholastic and professional sports programs. A factor that has probably been
a primary obstacle to the integration of athletic trainers
within the mainstream clinical healthcare system is differing paradigms of care delivery. Clinical medicine has
historically addressed health in the context of diagnosis
and treatment of disease or injury, and procedures
for third-party reimbursement of charges for medical
services have reinforced a process-oriented approach
to restoration of health that requires documentation
Athletic Therapy Today
of patient need and specified provider credentials. Conversely, athletic trainers have
historically addressed health in the context
of an individual’s functional capabilities with
primary concern for the outcome of treatment
and relatively little concern for economic
factors associated with the delivery of care.
Emphasis on the interrelated areas of injury
prevention and performance enhancement
for a defined group of individuals represents
an additional distinction that is more closely aligned
with a “population health” perspective.
The term “population health” has historically
been associated with the public health field, which is
concerned with threats to the overall health of a population.1 A population may be as small as a few individuals or as large as the total number of inhabitants
of several continents. The public health field includes
epidemiology, behavioral health, environmental health,
and occupational health. Increasingly, the term “population health” is associated with the changing reality
in the organization, delivery, and financing of healthrelated services, with the population defined in terms
of health plan membership, a group of employees, or
the patients treated by a particular clinician, physician
practice, or a healthcare delivery system. Although
clinical care is delivered to individual patients one at a
time, proponents of population-based health care argue
that providers should systematically collect and analyze
clinical data on all similar cases to improve the quality
of care delivered to individual patients, an approach
that is referred to as clinical epidemiology. Having
recognized the growing importance of the population
health concept to clinical practice, the Association of
American Medical Colleges has stated, “A population
health perspective encompasses the ability to assess
the health needs of a specific population; implement
and evaluate interventions to improve the health
of that population; and provide care for individual
november 2007  patients in the context of the culture, health status, and
health needs of the populations of which that patient
is a member.”2 The term “population health management” has been defined as the optimization of clinical,
financial, and quality-of-life outcomes accomplished
by management of the entire range of health risk for
a population.3
The historic professional role of the athletic trainer
has clearly reflected the basic principles of population
health management. The primary population has historically been competitive scholastic and professional
athletes, whose primary health concerns have related
to musculoskeletal disorders. Although other medical
conditions are less commonly encountered, athletic
trainers receive an exceedingly broad education that
ensures competence in managing a wide variety of
neurological, cardiovascular, respiratory, digestive, and
dermatological conditions associated with physical
activity. Increasingly, athletic trainers are managing
the health of physically active populations that are not
limited to young competitive athletes, such as industrial
workers, military personnel, public safety personnel,
entertainment groups, and patients of a healthcare
delivery organization. The susceptibility of middle-aged
populations to development of chronic diseases, and
the clear inverse association between physical activity
and chronic disease prevalence, presents the athletic
training profession with the opportunity to make a
valuable contribution to the growing national crisis
related to obesity, diabetes, heart disease, and rising
healthcare costs.
A population athletic trainers have often treated
on an informal basis is the faculty and staff of the
educational institution that sponsors an intercollegiate
athletic program. Because musculoskeletal disorders
often present a substantial obstacle to participation in
regular physical activity, athletic trainers can provide an
exceedingly valuable service to the institution through
involvement in a formal population health management program for faculty and staff. In conjunction
with physicians and other health professionals who
are affiliated with the institution, provision of a screening program for “metabolic syndrome” can identify
employees who need to become more physically
active to prevent subsequent development of diabetes
and coronary heart disease. Because optimized musculoskeletal function plays a central role in resolving
metabolic abnormalities related to insulin resistance,
athletic trainers should recognize the profound impact
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that they can have on an individual’s future by facilitating an increase in physical activity. In addition to the
improved quality of life realized by individuals, the
athletic trainer is providing the institution with the tangible economic benefits of healthcare cost containment
and improved employee productivity. Many corporations have recognized the value of athletic trainers for
delivery of population health management services at
the worksite, but educational institutions have largely
failed to take advantage of the athletic training personnel and facilities that already exist.
Pharmacists recognized a need to reformulate the
vision for their profession, which led to a shift from
an orientation primarily toward the dispensing of
drugs to a greater focus on pharmaceutical care.4 The
American Pharmaceutical Association now promotes
an approach to practice designed to promote health,
prevent disease, and assess, monitor, initiate, and
modify medication use to ensure that drug therapy
regimens are safe and effective.5 In the same manner
that pharmacists have been changing their image from
pill counters to health facilitators, the athletic training
profession needs to embrace an initiative to change our
image as ankle tapers to population health managers.
Such an approach would not logically be interpreted
as an effort to displace any other health professionals
(e.g., nurses, physical therapists, exercise physiologists), because no other health profession combines
expertise relating to injury prevention, physical performance enhancement, early recognition of conditions,
administration of therapeutic procedures, coordination
of medical care, and return to high-level physical function with a population-based approach. Rather than
classifying athletic trainers on the basis of practice
setting, this paradigm emphasizes the characteristics of
the population whose health is managed by an athletic
trainer (e.g., intercollegiate athletes, industrial workers,
patients of a medical practice).
As health care costs continue to increase annually
at two to three times the rate of inflation, changes
in the structure of the current system for delivery
and finance of health care services are inevitable. To
capitalize on the opportunities that develop, we must
provide athletic training students with clinical experiences that address the needs of populations other than
intercollegiate athletes only (e.g., university faculty and
staff). Rather than limiting ourselves to populations
that are already physically active, we must embrace
a professional role that also responds to the needs of
Athletic Therapy Today
individuals who would benefit from greater physical
activity but experience musculoskeletal disorders that
present obstacles to attainment of an optimal level of
physical activity. Furthermore, we must take steps to
ensure that all athletic trainers, not just researchers,
acquire knowledge in the area of clinical epidemiology
and evidence-based medicine. We can continue to cling
to our primary identity as a profession as it currently
exists and accept the limitations that it imposes, or we
can embrace a collective professional image that more
accurately represents our expertise and offers solutions
to the health-related needs of many populations.
Gary B. Wilkerson, EdD, ATC
University of Tennessee at Chattanooga
Editor, Athletic Therapy Today
Athletic Therapy Today
1.Tufts Managed Care Institute. Population-based health care: definitions and applications. November 2000. Available at: http://www.
tmci.org/downloads/topic11_00.PDF. Accessed August 12, 2007.
2.Association of American Medical Colleges, Medical Informatics
Panel, and the Population Health Perspective Panel. Contemporary
issues in medical informatics and population health: report II of the
Medical School Objectives Project. Acad Med. 1999;74:130-141.
3.Peterson KW. Population-based health management—Focus on the
worksite. In: Hyner GC, Peterson KW, Travis JW, Dewey JE, Foerster
JJ, Framer EM, eds. Handbook of Health Assessment Tools. The Society
of Prospective Medicine and The Institute for Health and Productivity
Management; 1999:145-154.
4.Greiner AC, Knebel E, eds. Institute of Medicine. Health Professions
Education: A Bridge to Quality. Washington, DC: National Academy
Press. 2003;79.
5.American Pharmaceutical Association. Principles of Practice for
Pharmaceutical Care. Available at: http://www.aphanet.org/AM/
Template.cfm?Section=Search&template=/CM/HTMLDisplay.
cfm&ContentID=2906. Accessed August 12, 2007.
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