Published 10/1/2008
Carolyn Rogers

Physician extenders: PAs, NPs, and…athletic trainers?

Athletic trainers moving from the sidelines to the doctor’s office

These days, you’re just as likely to find an athletic trainer (AT) in an orthopaedic exam room—taking a patient’s history or applying a cast—as in a sweaty locker room.

With a growing number of orthopaedic surgeons seeking to enhance their practices through physician extenders, certified athletic trainers are stepping up to the plate.

The role of physician extender in the orthopaedic setting has expanded in recent years to include nurse practitioners, physician assistants, physical therapists, and ATs. Because physician extenders tend to be less rushed than surgeons, they have more time to spend with patients—often resulting in happier patients, greater productivity, and increased practice revenue.

Why athletic trainers?
Physicians and athletic trainers working together is a “natural fit,” says Marjorie J. Albohm, MS, ATC (Athletic Trainer, Certified)—president of the National Athletic Trainers Association (NATA).

Historically, the relationship between the orthopaedic surgeon and athletic trainer has been on the athletic sidelines, where they’ve partnered in the health care of athletes for decades. Now, that relationship is moving into the physician clinical setting as well.

“After years of working side by side on the athletic fields, orthopaedic surgeons are integrating us into their everyday practices so that all of their patients—not just athletes— can benefit from this unique team approach to health care,” Ms. Albohm says.

Although some orthopaedists have been using ATs as physician extenders for 25 years, the concept really began to grow about 10 years ago.

“In the last decade, physicians began to see the benefits of this model from the standpoint of efficiency, knowledge and experience, and patient satisfaction,” she says.

Today, the demand for ATs as physician extenders is greater than ever.

“As more physicians look to refine and enhance their clinical staff, they’re asking themselves, ‘What mix of professionals is best suited to musculoskeletal health care in my practice?’” Ms. Albohm says. “Athletic trainers are increasingly viewed as a key part of that team.”

What do ATs do?
ATs bring many skills to the table, but “triage skills, the ability to evaluate musculoskeletal injuries, and decision-making ability,” top Ms. Albohm’s list.

“Every time an AT sees an athlete, we’re evaluating…we’re triaging,” she says. “Trainers make treatment decisions everyday, so we’re also experienced decision makers. In a clinic setting, that translates into increased efficiency.”

AT physician extenders also take patient histories, evaluate injuries and report findings to the physician, schedule tests, prepare injections, fit patients for crutches or a brace, develop rehabilitation programs, and educate patients on injury prevention. As a result, the physician is freed up to see more patients.

Growing demand
Moving trainers “from the sidelines to the doctor’s office” has been a passion of Ms. Albohm’s for the past 15 years. As NATA’s 25th president, she’s taking her case to physicians and ATs nationwide.

In fact, she expects a “huge demand” for athletic trainers to work as physician extenders in the coming years.

The statistics bear out her prediction.

In 2006, about 34 percent of certified athletic trainers worked in health care, including hospital settings and in the offices of physicians and other healthcare practitioners. That percentage is expected to increase. According to the Bureau of Labor Statistics, AT employment is expected to grow 24 percent between 2006 and 2016—much faster than the average for other occupations. And that job growth will be concentrated in the healthcare industry.

“Every orthopaedic practice I go to is integrating the athletic trainer into their office,” Ms. Albohm says. “NATA’s concern is really the supply and demand issue. We want to make sure we have the athletic trainers available for these settings.”

State regulation, licensure
While practice act oversight varies by state, ATs practice under state statutes recognizing them as healthcare professionals, similar to physical therapists, occupational ther­­apists, and other allied healthcare professionals. AT regulation exists in 43 states, with 33 states now offering licensure. Efforts are currently under way to pursue licensure in the remaining seven states.

“This increased state regulation and licensure has advanced the professional acceptance of the athletic trainer’s role as a qualified healthcare provider,” Ms. Albohm says.

Spreading the word
She knows firsthand what an AT can bring to an orthopaedic practice. After an 8-year stint as head women’s athletic trainer at Indiana University, Ms. Albohm received an offer from the university’s team orthopaedist, Merrill A. Ritter, MD, to join his practice. She accepted the offer and thrived at Orthopaedics Indianapolis (OrthoIndy)—the state’s largest orthopaedic practice—for the next 20 years.

Prior to her retirement earlier this year, she served as OrthoIndy’s director of business development and orthopaedic research. One of her many responsibilities was implementing the AT physician-extender model within the 60 physician-member practice.

Still, she derived her greatest pleasure from “seeing the whole team of healthcare professionals working together to provide the best care for patients,” she says.

That team included physical therapists, occupational therapists, nurse practitioners, medical assistants, and ATs, she points out.

“The goal is not for the athletic trainer to replace another provider,” she insists. “Each provider has a distinct, very important job. We just believe that athletic trainers bring a unique piece to the physician practice that other healthcare providers cannot.”

Carolyn Rogers is a staff writer for AAOS Now. She can be reached at rogers@aaos.org

Athletic Trainers: Education, ATC® certification
Nearly 70 percent of ATC credential holders have a master’s degree or higher advanced degree, according to NATA.

Before earning their certification, students must first complete an academic major or graduate-equivalent program that is accredited by the Commission on Accreditation of Athletic Training Education (CAATE).

Using a medical-based education model, athletic training programs educate students to provide comprehensive preventive services and care in six domains of clinical practice: prevention; clinical evaluation and diagnosis; immediate care; treatment, rehabilitation, and reconditioning; organization and administration; and professional responsibility. Students are educated both in the classroom and in clinical settings.

Upon completion of the program, graduates become eligible to take the NATA Board of Certification (BOC) exam. Trainers who pass the exam are awarded the ATC credential. In states that license athletic trainers, the ATC credential may be modified to LAT, C (licensed athletic trainer, certified) or simply LAT. The NATA board requirements and the ATC credential are currently recognized and required by the 43 states that regulate or license the practice of athletic trainers.