If you were looking to designate a “Dean of Athletic Trainers,” Rod Walters would definitely fit the bill. Dr. Walters’ long career in athletic training began when he was a high school sophomore and his career included stops at Lenoir-Rhyne College, Appalachian State, and the University of South Carolina, where he was elevated to the position of Assistant Athletic Director for Sports Medicine. Dr. Walters is a member of the National Athletic Trainers Association (NATA), served on NATA’s board of directors, was awarded NATA’s Most Distinguished Trainer (2003), and was inducted into the organization’s hall of fame (2005). We’re excited to have him speak to us about the business side of being an AT. For more information about Dr. Walters, visit his website at www.rodwalters.com.
There are several things. You can be a business person but remember: we're in health care, so as a health care manager, there are only so many dollars you can spend. Today’s athletics departments are looking to get the most resources with minimal expenditure. If we have an efficient training program that show our dollars go further, we can demonstrate value to those athletic departments. I look at my own career: I started out at a small school (Lenoir-Rhyne College), then a big major (Appalachian State), then at the end of my career on the collegiate side, I was at the University of South Carolina. I could tell you that at every stop along the way there were more benefits and resources, but they were more people who wanted to provide services for our student athletes at a minimum cost. And at the same time there were greater expectations. So you have to look at risks and rewards. From a business perspective, how do we get more for that dollar? How do we get more services for our student athletes? Everybody at a school is trying to add services and there's only so many budget dollars to go around, so we're trying to maximize that. At the same time, you want to be prudent and do the right thing. The expenditures you want to make, it has to be in order to improve the standard of care—not just as a recruiting tool.
I always felt like I didn’t need to talk to the players; I wanted to talk to their parents to let them know I’m going to treat their child the same way I would treat my own child. If I did that, then I’m providing good health care. But I do believe there’s definitely competition today. There’s an arms race for facilities. And it’s kind of like free agency in the NFL—there’s a lot to be said for that. When it comes to recruiting and appealing to a student athlete, facilities and training resources are a big plus and a big concern, and you have to be cognizant of that. We have to look at standards of care, that we can provide the kinds of services student athletes need, and do things for the right reason—not just to be “bigger” and “better” to keep up with the Joneses.
There’s definitely a lot less stability now than in the early 2000s. But the NCAA has put out a statement about independent medical care [Rod is referring to an NCAA document addressing independent medical care for college student-athletes for all sports—click here to view it], where the athletic trainers are not at the mercy of the coaches as far as their jobs are concerned. I think this is a big concern because a lot of ATs feel as if that's not the case; it’s as if they’re at the mercy of the coaches. We've had 15, 20, 30 athletic trainers just in Power Five conferences alone that didn't get reassigned based on coaches wanting somebody else there. But coaches are not supposed to be making those decisions. So the NCAA has a statement out about independent medical care, but many people are saying it seems like a dog whistle: it’s being used, but nobody’s hearing it.
No doubt. And I've always said, how [colleges and universities] feel about you is how they’ll pay you. The bottom line is they’re paying coaches based how they perceive their value. We can all agree on that. However, the problem is when trainers are reassigned, reposition, or fired—and it has nothing to do with independent medical care, it has to do with the coaches wanting their own people there. And that's not independent health care.
The NCAA talks about ATs having autonomy, but it comes down to your administrator and people at the top of the chain. It's comes down to the support you have at the top of the pyramid.
It starts with communication, and “communication” means “I said it and they heard it and they understood it.” If an athlete’s injured and you tell them something, did they understand it? In the case of a concussion, they might not. Because of their mental aspect at the time of injury, they might not understand what you're saying, but at the same time, if you have a devastating injury, you might tell the athlete but they might not “hear” you. I think we have to be aware of those kinds of things. So, communication has always been important for me. Another important thing is transparency. If we say we going to do something, we have to do it. We say we're going to do something we have to do it. If an institution tells me they have a policy on coaches and emergency action plans, but then I learn that only 50 percent of the coaches are certified in CPR first aid—especially CPR for athletes—that’s not transparency. The other thing we need to be is objective. I have to validate and quantify an athlete’s status, whether it’s assessing a knee injury, from muscle testing to range of motion to fault or whatever it might be. You must have objective, measurable outcomes.
It’s important for us to be good clinicians—because if they see you just taping ankles and filling Gatorade cups, they’re not going to see any value in what you do. If we demonstrate that we’re professionals and clinicians, we’re going to show our value. At the same time, though we have all these tools today, we have to be careful that we don't become gimmick happy. So I think it's important to understand all that stuff, but at the same time we must make sure we remain focused on delivering the best clinical care. After all, the tool is only as good as the person using it. There a recent article that talks about apps that can help with assessment, but we have to be careful that we're not just relying on these apps—it’s us, the ATs, who are delivering objective measurable outcomes.
Absolutely. In my time I've seen a big change in how we staff. In the past, we would have a staff of one or two athletic trainers providing care to a multitude of teams. Now we have what we call “silos of care,” where we have a single athletic trainer with the basketball team or with the women's basketball team—especially with the Power Five teams. There’s a change in how we staff, and there’s a different ratio of student athletes per athletic trainer now, especially in the Power Five. Here’s what I tell administrators: You need to staff your people according to risk of injury. If it turns out women’s soccer has the greatest risk of injury, then you need to staff accordingly. I used to prioritize gender equity. I’m still conscious about gender equity, but I'm more conscious about ensuring we allocate money and resources according to the risk.
There’s a lot of discussion today about athletic trainers being evaluated by medical people. It just doesn't happen in many places. We're looking at models today where the athletic trainer could be evaluated by a medical school or at someone with a medical practice, but the bottom line is regardless of the reporting structure, what we're talking about is independent medical care, where there’s a director of medical services to oversee the institution's athletic health care administration and delivery.