ATCs can take patient histories, evaluate injuries and report their findings to the physician, prepare injections, schedule tests, fit patients for crutches and braces, develop rehabilitation programs, and educate patients about injury prevention.“Orthopaedists have taken the healthcare team from the athletic field sidelines and integrated it into their practices,” says Ms. Albohm. “More than 43 percent of NATA members work in a clinical setting.”


Published 10/1/2009
Jennie McKee

Are ATCs right for your practice?

Athletic trainers offer musculoskeletal experience, financial benefits

“The optimal solution to many of the problems orthopaedists face is to hire an athletic trainer, certified (ATC)—a single clinical orthopaedic/operating room assistant with a great work ethic, significant musculoskeletal care experience, and the clinical, surgical, and business skills to support his or her costs,” said John Xerogeanes, MD.

During a symposium at the 2009 annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM), Dr. Xerogeanes and Marjorie J. Albohm, MS, ATC, president of the National Athletic Trainers’ Association (NATA), explored the ways that ATCs can benefit patients and orthopaedists.

The growing popularity of ATCs
Ms. Albohm has been involved in developing the ATC physician extender model for the past 20 years. During that time, she has seen an increased demand for ATCs in the clinical setting.

Marjorie J. Albohm,

Education, experience
Training and experience can give ATCs an advantage over other physician extenders, such as physician assistants (PAs). Although orthopaedic knowledge can vary among individuals, Dr. Xerogeanes noted that “many PAs don’t know much about orthopaedics when they come out of training, but ATCs have an average of 6 years of musculoskeletal training.”

There are a small number of orthopaedic athletic training fellowship programs recognized by the NATA, such as the one Dr. Xerogeanes helped develop at Emory University. The program is patterned after the school’s orthopaedic surgical fellowship and residency programs.

“We teach program participants about orthopaedics, surgery, and coding,” he said. “Prefellowship requirements include a master’s degree, 6 years of musculoskeletal experience, graduate work in intercollegiate athletics, and experience in rehabilitation and research. Program participants have no outreach responsibilities—they are not working for us for a few hours and then going out and covering high schools.”

Students in Emory University’s PA program don’t have an orthopaedic elective, but orthopaedic athletic training fellows learn how to conduct orthopaedic physical examinations and fit casts and braces. They also receive radiology grand rounds training, complete an orthopaedic surgical anatomy lab with residents, perform a research project, and receive business training in issues such as billing, coding, and completing preoperative and workers’ compensation forms.

Although ATCs are helpful, their abilities only go so far, cautioned Dr. Xerogeanes. “ATCs can’t go on rounds for you and they can’t run the clinic on their own,” he noted. “They also can’t do things such as listening to the heart and conducting preoperative physicals.”

Athletic trainers don’t have to complete a fellowship program to work at medical practices, said Ms. Albohm, although such a program does provide more experience in some areas, such as in the operating room. She noted that NATAapproved standards for athletic training residency programs in May 2009.

Forty-six states license and regulate athletic trainers and an independent agency provides national certification. Seventy percent of athletic trainers have a master’s degree or higher, and their academic majors are accredited by the Commission on Accreditation of Athletic Training Education.

Financial benefits, increased patient satisfaction
According to Dr. Xerogeanes, the average starting salary of an orthopaedic ATC is $45,000 to $55,000 per year, while PAs earn approximately $77,000 per year.

ATCs can bill for services using Current Procedural Terminology (CPT) codes for physical medicine and rehabilitation. On average, orthopaedic ATCs collect a similar amount for assisting in the operating room as PAs—17 percent to 25 percent of the amount billed.

“They can also bill for many therapeutic procedures, such as crutch training and training in rotator cuff strengthening,” he said. “They scrub in on all of our cases and make our anterior cruciate ligament grafts; however, we don’t bill for their assistance because we’re in an academic setting with fellows and residents.”

Dr. Xerogeanes noted that working with ATCs can help orthopaedists spend more time with patients. He and his colleagues studied the impact on patient encounters when an orthopaedic ATC worked with primary care physicians.

“We looked at their billing, collections, and number of patients they saw,” he said. “One physician had a 13 percent increase in patient encounters when he went from working with a medical assistant to working with an ATC; the other had a 23.2 percent increase.”

Patient perceptions of orthopaedic ATCs are also favorable. In a study comparing how patients viewed orthopaedic residents and orthopaedic ATCs, the ATCs were perceived to have comparable knowledge as the orthopaedic residents.

“I think orthopaedic ATCs are a viable option for providing educated help in the orthopaedic practice,” summed up Dr. Xerogeanes.

“They can make orthopaedists more efficient, increase patient satisfaction, and generate a fair amount of income.”

Jennie McKee is a staff writer for AAOS Now. She can be reached at

For more information
To view case studies, financial models, and other data related to using ATCs in an orthopaedic practice—and to search for ATCs available to be hired in your area—visit the NATA online at

Additional Links:

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