-Most Importantly Some Good Wine/Vino
Welcome to the world of occupational therapy (OT). You are about to learn about a profession that can truly make a difference in a person’s life.
As a practitioner in OT you can improve the lives of people, from newborns to the elderly, by providing them with the knowledge, skills and abilities to achieve independence and enjoy life to its fullest.
“I truly enjoy my profession because of its uniqueness,” says Kashala Erby, OTR/L, who works for Sundance Rehabilitation’s Montgomery Village Health Care Center in Gaithersberg, M.D.
“I think the fundamental knowledge that we learn, coupled with clinical reasoning and creativity, makes us a distinct profession,” Erby continues. “I value occupational therapy as a means to influence, restore and rehabilitate.”
Occupational therapy, or “OT” as it is often referred, is a health care profession that uses occupational, or “purposeful,” activity to help those individuals whose tasks of daily living are impaired by developmental delay, physical injury, medical or psychiatric illness, a behavior problem, or a psychological disability. Practitioners in OT evaluate function through an analysis of human performance, relationships and situations. They also engage clients in experiential learning and problem solving activities. Specialties within the field include, but are not limited to: gerontology, pediatrics, developmental disabilities, mental health, prosthetics training, spinal cord rehabilitation, school-based practice and hand therapy.
OTs need to be both people-focused and science-oriented. They must be creative, innovative and well trained in the functions of the mind and body.
Good communication skills are also a hot commodity in the OT field. Brushing up on such skills will greatly benefit all prospective or current OT employees. Emily Groth, who is in the process of completing her master’s degree in OT and serves as the South Carolina representative to the American Occupational Therapy Association (AOTA) Representative Assembly, agrees that communication skills come in handy in occupation therapy, especially for OTs working with children.
“I greatly enjoy interacting with the families and teachers [of my young patients] in order to determine the best placement for them in the school system,” Groth says.
There is no question that occupational therapy is challenging work, however, there are plenty of rewards that come from making a dramatic impact in patient’s lives.
“I really enjoy finding the modification to an environment or activity that will allow a child to be as successful as possible,” Groth adds.
If occupational therapy is an area of allied health that you’re interested in pursuing, you’ll be please to know that this is a great time to enter the field. As the number of middle-aged and elderly individuals increases, the demand for therapeutic services, including occupational therapy, also multiplies. Currently, job growth within nearly all health care disciplines are projected to increase at a much faster rate than other field, but the job outlook for practitioners in OT in particular is expected to increase by 21-35%, according to the U. S. Department of Labor, Bureau of Labor Statistics.
Salaries for practitioners in OT are also on the rise; according to the ADVANCE 2003 Salary Survey, full-time practitioners in OT salaries show an average increase of $9,000 in the past four years. The new national annual average salary for OTs is $51,352, which takes into account professionals in all work settings and with all degrees of experience and education. Occupational therapy assistants, based on all settings and levels of experience, show an average annual salary of $35,635 in the past year $8,000 higher than the average in 1999.
Occupational therapy is a career for individuals who care about people and have a desire to learn, achieve, and contribute their best to society and the profession. OT’s ultimate goal is to help their clients lead independent, productive and satisfying lives.
“Occupational therapy allows me to interact on a deeply personal level with people from every walk of life and with all levels of ability,” Groth says. “I am able to assist them regain independence in activities of daily life that are easy to take for granted, such as dressing, bathing, eating, and participating in play and leisure activities.”
Practitioners in OT may implement physical exercises to increase the strength and dexterity of their patients, or paper-and-pencil exercises may be chosen to improve visual acuity and the ability to discern patterns. A client with short-term memory loss, for instance, might be encouraged to make lists to aid in recall. One with coordination problems might be assigned exercises to improve hand-eye coordination. Practitioners in OT also use computer programs to help clients improve decision-making, abstract reasoning, problem-solving and perceptual skills, as well as memory, sequencing and coordination, all of which are important for independent living.
For those with permanent functional disability, such as a spinal cord injury, cerebral palsy or muscular dystrophy, therapists instruct in the use of adaptive equipment, such as wheelchairs, splints, and aids for eating and dressing. They also design or make special equipment needed at home or at work. Therapists develop and teach clients with severe limitations to operate computer aided adaptive equipment that helps them to communicate and control other aspects of their environment.
Some occupational therapists, called industrial therapists, treat individuals whose ability to function in a work environment has been impaired. They arrange employment, plan work activities and evaluate the client’s progress.
Practitioners in OT may work exclusively with individuals in a particular age group or with particular disabilities. In schools, for example, OTs evaluate children’s abilities, recommend and provide therapy, modify classroom equipment, and in general, help children participate as fully as possible in school programs and activities.
Groth, who works with children aged three to 18 with various levels of ability ranging from severe autism and orthopedic handicaps to mild coordination disorders and difficulty with handwriting, says, “Educating the child, the family and the educational team on how to improve fine and visual motor skills, self-care and sensory processing skills is the biggest component of my job.
“The children I work with bring me incredible joy and often teach me things about life that I’ve never considered before,” she adds. “The first time they can form their name independently or fasten the button on their pants or play with a special toy all by themselves is a very cherished moment.”
Practitioners in OT in mental health settings treat individuals who are mentally ill, mentally retarded or emotionally disturbed. To treat these problems, therapists choose activities that help people learn to cope with daily life. Activities include time-management skills, budgeting, shopping, homemaking and use of public transportation. They may also work with individuals who are dealing with alcoholism, drug abuse, depression, eating disorders or stress-related disorders.
Recording a client’s activities and progress is an important part of any practitioner’s job. Accurate records are essential for evaluating clients billing and reporting to physicians and others.
Practitioners in OT are employed in a wide range of workplaces hospitals, schools, nursing homes and home health care programs and they serve as employees of public or private institutions or as private practitioners.
Groth has worked in acute, sub-acute and outpatient hospital settings, as well as in an assisted living facility for the elderly. “The diversity of practice areas insures that one will never be bored or lose interest [in the field],” she asserts. “No matter what the setting is, the goal of the therapist is to help restore [their patients] to their highest level of independence.”
Along with registered occupational therapists, OT assistants and aides are in increasing demand to assist a ever-growing elderly population. Insurance carriers are also encouraging more occupation therapy to be delegated to OT assistants and aides because it helps reduce the cost of therapy.
In the field of OT, education determines at what level one will work. Those who complete an associate’s degree or certificate program work under the direction of a registered occupational therapist as occupational therapist assistants. Occupational therapist aides however, receive most of their training on the job. Since aides are not licensed, they have more limitations on what they can do in comparison to the range of tasks an occupational therapist assistant is required to do.
However, both OT assistants and aides generally provide rehabilitative services to persons with mental, physical, emotional or developmental impairments. Their ultimate goal is to improve clients’ quality of life by helping them compensate for limitations. For example, a therapist assistant will help an injured worker reenter the workforce through improved motor skill development or may assist a client with learning disabilities increase his or her independence.
Occupational therapist assistants record their client’s progress with rehabilitative activities and exercises outlined in a treatment plan and report back to a registered OT. They make sure clients are performing the exercises and activities properly and provide encouragement. The aide prepares materials, assembles equipment used during treatment, and is responsible for a range of clerical tasks. Duties can include scheduling appointments, answering the telephone, restocking or ordering depleted supplies, and filling out insurance forms.
Those entering at the assistant or aide level of OT should also be aware of the physical endurance that is necessary on the job. Assistants and aides will need some strength in order to lift patients, and they may be required to kneel, stoop or stand for long periods of time. For most, however, this is a minor concern and is overshadowed by the thrill of watching patients succeed and improve through proper care and encouragement.
Occupational therapist assistant candidates interested in improving their admission chances should make sure they have mastered high school algebra, chemistry, biology, English, computer skills and have completed volunteer hours in the field. Training to be an OT assistant includes an introduction to health care, basic medical terminology, anatomy and physiology. During the second year of school, course work will involve mental health, gerontology and pediatrics. Students will also complete 16 weeks of supervised fieldwork. Upon successful completion of academic coursework, assistants must pass a national certification examination in order to receive the title of certified occupational therapist assistant.
Presently a bachelor’s degree is sufficient as a minimum education requirement for entry into the OT profession as an occupational therapist registered (OTR). Starting in January 2007, however, all new occupational therapists registered will be required to complete a master’s degree. In both cases, however, candidates must also pass a national certification examination in order to become an OTR and then receive licensure in the state where they will practice.
Occupational therapy course work includes physical, biological and behavioral sciences and the application of occupational therapy theory and skills. Completion of six months of supervised fieldwork is also required.
Volunteering in a variety of OT areas during one’s education is a critical step in deciding where one would like to work in the field. When students understand what role they want as a therapist, it can make their OT education experience more focused and enjoyable. Kashala Erby, who was a grad student intern and practice associate at the American Occupational Therapy Association, advises practitioners in OT to find a mentor in the field, volunteer in various practice areas, and get involved with the AOTA as a student member.
Erby also brings up the issue of lack of diversity in the occupational therapy field. She believes that the profession needs to embrace and encourage more minorities to enter OT. “While this is a female dominated profession,” Erby says, “as a minority woman in [OT], I face some of the same challenges I would have to face in any other profession.”
The ADVANCE 2003 Salary Survey shows that women greatly outnumber men in the profession. However, men report higher average salaries. The male survey respondents reported average salaries of $55,216 for occupational therapy and $37,425 for occupational therapy assistants; women reported an average salary of $48,763 for OTs and $32,927 for OT assistants.
Of course not everyone who ends up in OT initially starts out pursuing the field. When Emily Groth graduated from high school, she aspired to become a pediatric physical therapist. “I went to the University of Central Florida and enrolled in the appropriate prerequisites, however, I soon realized that it wasn’t a perfect fit for me,” she explains.
“My school guidance counselor gave me a test [to determine a more appropriate field]. Occupational therapy was in my top ten fields, and after I job-shadowed an occupational therapist at work, I knew it was for me.
“Engaged with people on such a personal level, the ability to truly help them regain independence, and the diversity of the practice areas drew me into this field,” Groth says.
As she asserts, the diversity of work environments is a plus for many in the OT field. According to the ADVANCE 2003 Salary Survey, most OTs reported that they are employed in schools or in skilled nursing facilities, but therapists can work in hospitals, offices, clinics, home health agencies, nursing homes, community mental health centers, adult daycare programs, job training services and residential care facilities. As an occupation therapist, your career options are truly never-ending.
Those who will succeed in OT are individuals who have patience and strong interpersonal skills to inspire trust and respect in their clients. Practitioners in OT have ingenuity and imagination in adapting activities to individual needs, a strong commitment to serve people, and an interest in social and biological sciences. And, according to Groth, no matter what area you choose, a career in occupational therapy is “so valuable to society.”
education: Kettering College of Medical Arts
title: Respiratory therapist
workplace: Cincinnati Children’s Hospital’s Regional Center Neonatal Intensive Care Unit (RCNIC)
location: Cincinnati, Oh.
Every eight seconds in the United States a new baby is born. Each newborn begins their lives as independent humans with their very first breath. Throughout our lives, how often we breathe and how much we breathe is often taken for granted. For some children, however, this simple function is not so effortless.
The science of respiration or breathing leads us to the profession of respiratory therapy. Respiratory therapy is utilized in all hospital settings, nursing homes and even home health care. Some respiratory therapists choose to become instructors in the world of education, while others work within the hospital environment where there are various levels of care.
Meet Tonie Perez, a respiratory therapist at Cincinnati Children’s Hospital Medical Center. Perez has been a respiratory therapist for 17 years. She graduated from Kettering College of Medical Arts in Kettering Ohio in 1987. “I chose Kettering because they are state-of-the-art, and I knew I would get a good education,” she says.
At the Cincinnati Children’s Hospital Perez works in the newborn intensive care unitÑthe Regional Center Neonatal Intensive Care Unit (RCNIC)Ñwhere she is involved with the intensive care aspects of respiratory therapy.
The population of the RCNIC varies from pre-term (24-weeks gestation) to post term (greater than 40 weeks). The role of the respiratory therapist in this critical care environment is to work with pre-term infants prior to 40-weeks gestation or a term pregnancy, which requires constant monitoring of respiratory status. The infant’s lungs are not fully mature until 34-weeks gestation, so birth prior to 40 weeks brings potential problems. For example, during the lung development a substance called Surfactant, which is critical for normal lung function, isn’t readily available.
Being born early not only requires more ventilator support, it also necessitates the need to give Surfactant artificially. Oxygen given to the infants must be monitored continuously because of potential detrimental side effects to their eyes and lungs. It’s like that old adage, too much of a good thing is bad.
Some of the patients require medication like bronchodilators to increase the diameter of their airways in order to decrease the work it takes to breathe. Airway management is also needed when patients stop breathing. Immediate intervention is required until the problem is resolved. Respiratory therapists will place a mask over an infant’s face and squeeze a bag that inflates the lungs and breathes for the infant. Depending on the severity of the situation, infants may also be placed on a ventilator. Doctors, nurses and respiratory therapists all work collaboratively for the best care of the child.
Obviously this is challenging and demanding work, but Perez thrives in the environment. She recently received the Zenith Award as an acknowledgement that she has gone above and beyond the call of duty in her position.
Perez originally chose this field of expertise because she felt she could make a profound difference in her parent’s lives. She also enjoys being part of a team that is working together to improve patients’ outcomes.
Perez encourages all students interested in respiratory therapy to learn more about this exciting field. “I can’t stress enough the fact that respiratory therapy is an ever changing and growing field,” she says, “and if you are one who loves new and exciting things and loves people, respiratory [therapy] is for you.”
Read on to discover what a typical day is like for respiratory therapist, Tonie Perez.
Perez’s day starts early; she will work a 12-hour shift, three days a week. Upon arrival to the unit, the night shift gives her a progress report on the patients she is assigned to for the next 12 hours. Once Perez has gotten the report, she checks her orders for the patients.
Perez is in her area making ventilator rounds. She
assesses the patients and their ventilators and makes sure they are working correctly.
The physicians, residents, nurses, dieticians, pharmacists and respiratory therapists go to each bedside and discuss the course of care for that particular patient. Patients on ventilators are assessed and ventilator settings are documented every two hours.
Ventilator rounds are again made, settings are documented, and patients’ lungs are listened to and assessed for secretions or other negative sounds. If needed, corrective intervention is made.
Perez says that this is the predictable element of her job, which makes up about 40%. The other 60%, she says, is not scheduled or predictable because this is a very unstable environment. “Our doors are open 24-hours a day, seven days a week to accommodate the various needs of the infant population,” she says.
A 30-week-old infant is coming in with the transport team from an outside birthing center that was not able to accommodate his breathing needs and possible surgical issues. He is placed in a radiant warmer and connected to a ventilator. The monitors are functional so they are continuously monitoring him. An x-ray is ordered to determine if the ventilator is adequate, and blood is drawn, which will be sent to the lab so that they can access his ventilation.
A half hour has passed while they admit the infant boy. Surgery is called in to assess the need for surgery on a questionable lung mass that was seen on his x-ray. Meanwhile, the staff is doing total supportive care.
With all the activity, the infant in the next bed is becomes sensitive to the increased noise. She starts to show signs of distress; her heart rate drops and she begins to have an apnea episode where she holds her breath and begins to turns blue. Perez attempts to stimulate the infant’s breath by repositioning her and making sure her airway is open. The girl begins to breathe again and her color returns to normal.
Perez begins assessing various ventilator patients. With the new baby boy, she now has four patients to attend to. On any given day Perez can have from two to 12 patients, but she says that she usually has six.
“You’re responsible for those patients’ ventilator assessment every two hours, respiratory medication administration, laboratory blood draws, and constant monitoring of their vitals,” she says.
Surgery returns to the new admit to inform Perez and the nursing staff that surgery is not needed at this time. They continue supportive methods.
Perez is informed that another new admit will be coming in. The mother of the baby girl had no prenatal care and has no idea what the gestation is of the infant.
The infant girl arrives. It was determined by the outside birthing hospital that the infant was approximately 29 weeks old. The birthing hospital was not equipped to take care of her, so she came to RCNIC for supportive care. She’s placed on a nasal cannula so that oxygen can be delivered to her. She’s also placed on monitors and observed. Perez obtains lab values to assess her ventilatory status. Everything appears normal, but the staff will continue to watch her.
Perez makes her last ventilator rounds and takes notes. When 7:00 p.m. arrives she’s prepared to give her progress report on all the patients for that day.
“The average day is very lively but that is what I love the most about my job,” Perez says. She also values her great co-workers and the continuous learning environment.
“There is nowhere else you can get paid to learn,” Perez asserts. “Medicine is always changing and you have to be the kind of individual that accepts change and takes it with open arms.”
“Role models are important!” says Louis W. Sullivan, M.D. founding dean of Morehouse School of Medicine and former U.S. Secretary of Health and Human Services. “Too many minority young people have never interacted with any minority health professionals. [This type of interaction] tells the youngster-even if silently or indirectly-that they can be successful, too.
Sullivan urges all minority health care practitioners to become role models for minority youth in their communities by providing information, guidance, and support.
“Minority health professionals can answer questions with greater credibility for these youngsters. We need minority physicians, dentists, nurses and [other health care providers] to play such a role. We need local involvement; this is one of those local activities that can mean so much. It makes it real, rather than abstract, for a youngster to have [a role model] right in the room or right in the community as opposed to on television.”
Role models for future minority health care practitioners is extremely important in a time when African Americans, Hispanics and American Indians combined make up more than 25% of the U.S. population but represent less than nine percent of nurses, six percent of physicians, five percent of dentists, and similar low percentages of other health professions.
In certain regions, the disproportion is worse. For example, in Georgia, the Hispanic population has surged to four percent, but only 0.8% of the state’s nurses are Hispanic.
The American Council on Education reports that fewer than 8,000 minority men and women earned master’s degrees in health professions in 2001 (the most current year data was collected). That’s only 18% of all the health professions master’s degrees awarded that year.
And the shortage may be getting worse-fewer minority students are enrolling in health care education programs. For example, in 2002, of more than 8,000 medical students in the state of New York, there were only 265 minority first-year students. This was 5.4% fewer than in 2001; it was also a ten-year low. “Deans and university officials are saying that they have none or only one new black or Hipanic student in their classrooms for the first time in decades,” Sullivan reports.
“We know that the lack of minority health professionals is adversely affecting critical racial and ethnic health disparities,” Sullivan adds. African Americans, Hispanics, and American Indians and Alaskan Natives on average receive less prenatal care, lower vaccination rates, less cancer screening, and worse control of diabetes and hypertension. In general, non-majority Americans receive less effective health care and are more likely to report poor or fair, rather than good or excellent, health. For many, life expectancy is cut short.
Louis Sullivan is not accepting deteriorating health outcomes with resignation. Supported by Kellogg Foundation funding, he has organized the Sullivan Commission on Diversity in the Healthcare Workforce in order to create solutions. “This is a problem that can be solved,” he affirms.
Since the fall of 2003, the Commission has held field hearings in Atlanta, Denver, New York, Chicago, Los Angeles and Houston, and a town hall meeting in Boston. At each hearing and meeting, the Commission has collected data and testimony from health experts, community advocates, business leaders and local governmental officials.
In New York, U.S. Representative Charles B. Rangel stated, “Increasing diversity in medicine, dentistry and nursing is one of the key strategies to reduce the alarming health disparities facing our nation. In the last decade, we have seen hardly any increase in the number of minority health professionals despite the growing ethnic diversity of our population. The work of this Commission will provide Congress a needed roadmap on how to solve this health care problem facing our nation’s citizens, including the poor and millions of minorities.”
In Chicago, U.S. Representative Jesse L. Jackson, Jr. stated, “Racial minorities–especially blacks, Hispanics and American Indians–are over-represented when it comes to disease and illness, but underrepresented in the healing professions. Both dimensions-health and healing-must change for the better soon. Increasing diversity in the healing professions is one way to bring about that change. The Sullivan Commission is pointing the way to close these gaps in the health care professions.”
Rupert Evans, president of the American Hospital Association’s Institute for Diversity in Health Management, testified, according to Associated Press reports, that minorities seek out medical care more frequently with providers of the same race. He said that in order to solve the racial disparity issue, the country needs providers that are culturally similar to and sensitive to patients. “It’s all tied together,” Evans concluded. “You can’t have one without the other.”
“Now is the time to confront the crisis in the nation’s health care system and utilize the tool of diversity in crafting solutions,” Sullivan declares. “Barriers that are blocking the aspirations of minority students to become health professionals must be removed.”
The Commission emphasizes that all children deserve quality education from kindergarten on up. “We must strengthen educational preparation so that young people don’t have to leap over a chasm to gain entry to health care careers,” Sullivan says.
The Commission calls for better coordination at each level of school-from kindergarten through junior high, high school, college and graduate programs-so each level doesn’t stand alone “like a silo in a field,” as Sullivan puts it.The transition from two-year to four-year institutions of higher education is especially critical. At the hearings in Denver and again in Houston, the Commission heard that many minority youth enter higher education through community colleges. The Commission believes colleges and universities should smooth the way for these transfer students, with coordinated curricula, guaranteed transfer of credits, and even guaranteed admission to four-year programs for successful two-year students.
Another major recommendation is improved financial aid for students in health care programs, with more scholarships and low-interest loans, rather than unsubsidized loans. The prospect of heavy student debt distorts career choices, Sullivan explains. “It’s hard to explain to a young person from a low-income family that with the professional credential they would be earning enough to pay off the loan. That kind of debt can be a barrier. And financial barriers affect majority as well as minority youngsters.
“We have to find easier ways for youngsters to finance their health professions education than we have now,” Sullivan warns. “Our current system is very threatening for a youngster coming from a low-income background.”
For college graduates seeking careers as physician assistants, pharmacists, and other professions requiring graduate education, the Commission recommends short, “brush-up” programs to improve their preparation for professional school. “Students who have the intellectual capacity but find a weakness or deficiency in some area” would thereby be better prepared for admission to, and success in, graduate programs.
The Commission’s hearings also highlighted the often-overlooked fact that many minority people are already working in other jobs when they decide to pursue their dream of a health care career. “This represents a new career shift for them,” Sullivan explains, and the Commission calls for “strategies to help identify and assist those people in the transition to a second career.”
“Years ago, when we talked about minority populations we were talking primarily about the African-American population,” Sullivan relates. “But today the Hispanic population has increased significantly; it is now larger than the African-American population. We also have Vietnamese, Hmong, Cambodian, Eastern European and so many other groups. The concept of diversity now implies a lot more specific cultural backgrounds that those in the health professions have to be aware of and adapt to.
“We need to meet these people more than half way, Sullivan says. “Even if you have a highly competent, technically and scientifically trained group of health professionals with the best facilities, it doesn’t help [patients] if there is no communication. If there is a communication barrier, then all that excellence is frustrated.
“The ideal that we envision in the Commission,” Sullivan adds, “is a health professions community sufficiently multicultural in orientation and understanding so that they know how to communicate with someone from a different background. They can communicate in such a way that patients are comfortable and develop trust. Then you’ll have patient compliance, whether it’s taking medicine, coming in for a follow-up visit, or any of a whole host of things.” Ultimately, patient compliance leads to better health outcomes.
Similarly, institutions of health care education can create environments that are more “user-friendly,” Sullivan suggests, so that “minority students have an experience that is affirming, rather than hostile or indifferent.”
All health care workers should take on these changes, Sullivan believes. “The health issues of minorities are not going to be addressed solely by minorities,” he says, “nor should they be, from an idealistic point of view. We need everyone involved, because, frankly, this is a problem and a challenge for all of us.
“As we find solutions, not only will there be improvements within the minority community in terms of improved access to health care careers, improved health care and improved health status, but also there will be advances in community development, social stability, and economic development. All of these things are intertwined.”
Sullivan gives credit to neighborhood institutions like the Boys’ Club and Girls’ Club that help young people develop self-esteem and become successful. “Youngsters have to view themselves as capable of achieving something,” he points out. “The more confidence they have, the more willing and able they are to take risks” such as pursuing demanding professional careers in health care.
His own Morehouse School of Medicine invites grade school children to a “Saturday Academy” on campus, collaborates with the Explorer Scouts, and even awards a scholarship to Boys’ and Girls’ Club members.
“Advocating for the necessary changes, including greater availability of financial resources, will be essential,” Sullivan concludes. He invites everyone in the health care field to make their views known.
“Individuals who are decision makers in federal government, state governments, the business community and the philanthropic community will have to be convinced that this is a worthwhile investment. The case has to be made that our society will get important and significant returns on this investment.
“Ultimately, there has to be a broad societal understanding of this problem and a belief that by investing the time, effort, and resources, this is a problem that can be solved.”
While the public may automatically associate athletic trainers, also referred to as sports therapists, with professional athletic teams, their expertise reaches far beyond the playing fields of the NFL, NBA, NHL or MLB. It’s an allied health specialty that’s gaining respect among school districts, sporting clubs, hospitals, physicians, and even in the field of industrial manufacturing.
In fact, the profession has been experiencing significant growth for nearly 30 years. Membership in the National Athletic Trainer Association (NATA), the profession’s leading organization, has grown more than 520% since 1974. Its most recent statistics reveal that membership topped the 28,000 mark in 2001.
And it’s a specialty that continues to create new jobs for sports medicine graduates. In fact, NATA forecasts continued job growth of at least 2,600 more jobs by 2005, and another 7,000 jobs by 2010.
In some ways, athletic trainers assume many of the same responsibilities as triage nurses—they’re usually the first ones on the scene and in charge of making split-second assessments. “The trainer is the first-line soldier, working in the trenches with the athletes,” comments Dale Baker, the Smith and Nephew chair for director of education at the American Sports Medicine Institute, based in Birmingham, Ala.
As in Brown’s case, Falb was able to gauge the urgency of the situation and prioritize the initial treatment steps. In less traumatic cases, trainers determine whether or not an athlete’s injury is severe enough to warrant transportation to the hospital. If not, they treat the injury on site and follow up with a rehabilitation plan.
“We’re trained to splint a fracture, perform cardiopulmonary resuscitation (CPR), assess injuries and illnesses, and rehab an injury,” states Laura Harris, PhD, ATC, assistant professor of athletic training at Ohio State University, School of Allied Medical
But trainers also work in preventative capacities, such as strength training, conditioning, exercise instruction and overall health maintenance. “Athletes are expected to do a job and the trainer is trying to get them back to work as soon as possible,” notes Michael Mandich, ATC, an independent consultant based in Lewisville, Texas.
Because their responsibilities cover such a wide spectrum of health care tasks, athletic trainers and sports therapists are typically required to have a four-year degree that includes classes in anatomy, physiology, psychology, nutrition and conditioning. Employers also require a variety of certifications, namely athletic trainer certified (ATC), CPR and first aid. Additional certifications focus on specific areas within the profession, and requirements vary depending on the needs of the job.
Of course, to practice at the professional sports level, trainers must have several years of experience and usually an advanced degree. Even at the collegiate level, the competition for positions is extremely stiff, and a master’s degree can be a deciding factor.
“Most trainers recognize the need for advanced education in order to be competitive. It’s difficult to make it to Division I, II or even III without a graduate degree, and it’s especially difficult to get into the professional level,” asserts Harris. “It doesn’t necessarily matter what your degree is in, but it proves you’re someone who has challenged your critical thinking skills.”
Unlike physical or occupational therapists (PTs and OTs, respectively), not all states mandate athletic trainers be licensed. However, 43 states currently demand some form of regulation, from licensure to registration, and the average starting salary hovers around $28,000.
Almost without fail, an individual’s introduction to sports medicine comes from sustaining an injury while playing a sport. “I would say about 98% of us in the profession were injured as an athlete and had to be treated by a trainer. We didn’t know about [the field] until a trainer took care of us,” says Harris, a former gymnast.
Of course, there is that small percentage that simply saw sports medicine as a way to stay directly connected to sports without becoming a professional athlete or coach. Mandich is one example: “Growing up in Green Bay, Wis., I always wanted to work for the Packers. I knew I was never going to play for the team, so I thought the closest I could get would be to become a trainer,” he says.
While Mandich hasn’t landed that dream job with an NFL team yet, he has been able to expand his skills through various positions. Since graduating from the University of Wisconsin at La Crosse in 1997, he has worked at PT clinics, hospitals, and with a number of school districts. “I especially like working with kids because it’s challenging work and always changing. You never do the same thing two days in a row,” he comments.
Many athletic trainers start off their careers treating high schools athletes, getting them in shape, and prepping them to compete at the more advanced collegiate level. Unfortunately, there are very few individual schools that can afford to hire a trainer to solely attend to students’ needs. Rather, school districts usually contract with local clinics or hospitals to have staff trainers work with the schools on a part-time basis. These specialists split their time between patients and students. “I like being part of the fast-paced environment during the day and working at a high school in the evenings,” Mandich says.
“In more rural environments, some of the education budgets are not as lucrative, and schools may have to hire a trainer to service the entire district instead of one trainer per school,” notes Harris. “At the high school level, trainers are more often used in the game settings for emergency medical situation rather than for their rehab or prevention skills.”
Yet another sport medicine career path is teaching. In this scenario, individuals are in the classroom during the day and on the field or court after school. “However, that’s a job with a high amount of burnout because they are there from early in the morning to late at night,” states Harris. “Typically after five to seven years, many trainers find a spouse or start a family and want better hours.”
Neither the health care nor the educational communities overlook the importance of having certified trainers to support young athletes. Recent studies have shown that too many children are insufficiently trained and, therefore, sustain unnecessary injuries. According to U.S. News & World Report, there is an alarming rise in the number of overuse injuries among children, such as persistent heel problems among young soccer players.
Complicating matters is the fact that many youth teams are coached by parents or sports enthusiasts who may know about the sport’s fundamentals but aren’t necessarily trained in the finer aspects of conditioning. Without a balanced approach to practices, weight training, and overall conditioning, children are at risk for injuring themselves or, at the extreme, causing permanent damage. Additionally, the medical community has expressed concerns about undiagnosed concussions, particularly among football and soccer players.
With more than 30 million children playing on school or recreation-league teams, it’s no wonder that there’s a growing call for change. More organizations and schools are recognizing the importance of appropriate training and, where budgets allow, are seeking the expertise of professional athletic trainers. Even the American Academy of Pediatricians has publicly advocated the use of ATCs for high school sports. Therefore, industry analysts believe this is a work setting that will continue to grow for entry-level sports medicine grads.
For those who prefer treating a broader range of people, doctors’ offices, PT clinics and hospitals also offer interesting career options. In these settings, the ATC works along side PTs, OTs, doctors and nurses as part of the health care team. Additionally, patients vary in age, race and socioeconomic backgrounds. Specialists may see professional and collegiate athletes, weekend enthusiasts, children, and even the elderly—all of whom may have suffered an injury or require additional training in order to avoid further complications. Says Mandich, “Athletic training is a very interdisciplinary approach. You’re still treating an active population, they’re just not all athletes.”
Regardless of the environment, sports therapists are required to function under the supervision of a physician and are often the link between patients and the rest of their health care team.
“We work with the primary health care team that consists of the patient, parents if a minor, coaches and physician. Then there is the secondary team, which consists of a rolodex of consultants, such as PTs, exercise physiologists, nutritionists, psychologists, social workers, school nurses and chiropractors,” explains Harris. “Our co-workers run the gamut of the health care professions.”
Additionally, trainers in the clinical setting assume more of a rehab perspective, including exercise prescriptions and patient education. In a time of heightened cost-consciousness, ATCs have proven to be a valuable asset. The NATA reports that physicians have indicated a higher rate of reimbursement when employing trainers. Additionally, ATCs free up doctors’ time to see more patients while continuing to cater to an individual’s needs.
As the population ages, industry analysts anticipate a significant increase in the need for sports therapists in the clinical arena. As people grow older, they become more susceptible to activity-related injuries. Therefore, there will be a greater demand for specialists who can help individuals return to their daily life, which includes instruction on how to prevent further injuries.
Another promising development for ATCs is the recent changes in insurance policies that now agree to reimburse providers for sports medicine treatments. “The list of companies that will reimburse trainers is growing, whereas PTs have been billing for their services forever. In terms of reimbursement, trainers have been undervalued and underutilized,” says Mandich.
“As we gain more progress toward reimbursement—and the number of potential services that are covered by reimbursements—we will also see salaries increase,” adds Harris.
Perhaps the most promising employment environment for ATCs is nowhere near a football stadium, ice rink or hospital. Rather, it’s within the walls of high-rise office buildings and manufacturing plants. Corporate America has taken notice of the benefits of being physically fit, including the financial results. At its most basic, active employees are less likely to use up sick days and make fewer medical claims against insurance policies—they even add to high company morale.
Although most evidence is anecdotal, more and more companies are encouraging employees to exercise and maintain healthy lifestyles by providing workout facilities, discounts to private gyms, and even perks like free movie tickets to those who prove to be physically active. But back in 1985, Honda of America Manufacturing (HAM) simply wanted to give its employees and their families a place to exercise, get in shape and enjoy recreational activities. That’s when the automotive manufacturer opened its first Wellness Center in Marysville, Ohio.
Now, nearly 20 years later, HAM boasts three Wellness Centers, each with degreed professionals on staff to assist employees with their physical needs.
“Each center promotes wellness with education. There is nutrition information from a registered dietician, and associates can discuss their wellness concerns and have one-on-one consultations for issues like stress management. The centers’ program departments plan recreational activities, such as intramural leagues and holiday parties. The aquatics departments run the pools, swimming lessons and aqua aerobics. The fitness departments’ staff have the capabilities to help individuals with any from training—from a marathon to body building,” explains Dave Litzke, the coordinator for the Marysville center.
While the centers are designed to accommodate individual needs, their staffs also help HAM employees recuperate from injuries, whether suffered on the job or during their off time. “Injured athletes need to return to playing at the same level of competence in the shortest period of time—that is what the athletic trainer does. A lot of those same treatments also work on other workers and athletes, including the weekend warrior,” notes Baker.
“Nowadays, larger organizations are recognizing athletic trainers as entities that are viable options to help offset or deter health care costs,” adds Casey Kirk, coordinator at one of HAM’s Wellness Centers.
Athletic trainers are particularly valuable in the industrial environment where assembly workers are expected to do heavy, monotonous functions that can lead to workplace injuries, if the workers are not properly conditioned.
“When you look at the volume and repetition of movement an associate does in a fast-paced manufacturing environment, the amount of trauma on the body equates or supercedes that of an athlete. Upon their gaining employment at Honda, some people may not have the baseline physical condition that’s required,” explains Kirk. “Associates who work in these facilities need a high level of conditioning.”
Both Litzke and Kirk agree that it’s satisfying to help people not only obtain better performance on the job, but to also enhance their lives as a whole by becoming physically fit. “We work with a diverse group of people in very different ways. In the morning we could be working with a senior citizen, in the evening we could be working with mom who just had a child, and at night it could be helping a high school athlete,” explains Kirk.
In order for athletic trainers to be effective with their clients, regardless of the setting, a holistic approach is required. Lifestyle, motivations and health care goals are all taken into consideration. “Most of the time, you’re not dealing with sick people but people with health care problems nonetheless. You have address the whole person in treatment,” advises Baker.
And it’s this complete approach that places sports therapists in a unique position within the allied health field. Their broad knowledge, multiple applications, and adaptability to numerous environments make them an asset.
Indeed, it was Kent Falb’s expertise that helped Detroit Lion Reggie Brown not only survive that tumultuous tackle, but allowed him to make a remarkable recovery. Less than a month later, Brown was jogging and doing other prescribed exercises on his way back to a fully functional life and a winning athletic career.