The highly competitive nature of today's athletics, along with diversity of institutional missions, has developed a unique culture that enhances the student-athlete's experience in higher education.

However, this competitiveness has created nontraditional seasons, year-round conditioning, skill-instruction sessions, and an increased number of scrimmages outside of the regular season that cumulatively place significant stress on the sports medicine departments that provide care. Most recently, the sport of football has added strength and conditioning sessions for its student-athletes during the summer months. These situations potentially put both the student-athlete and the institution at risk.

The health and safety principle of the NCAA Constitution provides that it is the responsibility of each member institution to protect the health of, and provide a safe environment for, each of its participating student-athletes. The additional expectations placed on athletes to participate year-round in competition, practice and conditioning create additional expectations on the medical staff that cares for these athletes.

Institutions are expecting the athletic training staff to provide care for these athletes in their traditional season, including tournaments and championship events, as well as the nontraditional season, which now often includes host coverage for games and tournaments. In addition, vacation periods, which in the past were a relative down time for the medical staff, also have disappeared.

In response to these additional expectations for playing, practice and conditioning and host coverage for tournament events, the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) has recommended that NCAA institutions across all divisions examine how adequate their sports medicine coverage is, particularly the time demands placed on certified athletic trainers. Escalating demands now overextend many athletic training staffs so that extended hours during the competitive season continue into the nontraditional season.

Medical care

All student-athletes should have equitable access to appropriate health care and coverage. Most institutions designate a team physician and certified athletic trainers as their primary care-givers.

Athletic trainers are spending more time in the treatment and rehabilitation of injuries rather than standard event coverage. Consequently, added administrative duties are incurred in conjunction to these tasks that include drug testing, medical record keeping, filing insurance claims and educational programming.

The team physician's role has become increasingly challenging in today's health-care environment. Institutions use a variety of methods for providing physician coverage for their student-athletes, and within the same conferences the kinds of physicians employed and the expectations for event coverage vary significantly. At most institutions, physician coverage for football is provided, yet for other events, the physician coverage provided is quite varied. Each institution must address its needs and resources in an individualized manner. However, the demands on the team physician also are affected by the increased expectations on athletes, and the extended hours that athletes participate.

Medical needs of the student-athlete have become more complicated over the past several years, with more serious medical injuries, previous surgeries, and other medical problems such as depression, anxiety, drug and alcohol problems, and learning disabilities as examples. These are all medical issues that often require comprehensive care. Many issues also require consultation with other medical experts, further escalating the costs of providing medical care to the student-athlete. The team physician often is responsible for coordinating follow-up and ongoing care provided at times by several other specialists.

It is not uncommon for certified athletic trainers as well as the team physician to be involved in the academic curriculum on campus. These faculty members should be allotted the appropriate amount of release time from their athletic duties, consistent with those within their academic department. With the added demands of frequent travel, facility supervision, team functions and administrative duties, many medical professionals find it very challenging to adequately prepare for their academic requirements.

Department scheduling should take into account a sports medicine staff member's overall workload, which includes, but may not be limited to, practice and event coverage, treatments, rehabilitation, administrative duties, service, teaching, and academic course-preparation time. Departments that impose large amounts of additional duties during the day and week, or scheduling obligations and interruptions during the evenings and weekends, may significantly disrupt the ability of a staff member to provide quality health care or meet a level of expectation for faculty members.

Students not a labor force

Students majoring in athletic training have a unique opportunity to combine classroom knowledge and clinical experience during their studies as an undergraduate student. Today, there are approximately 200 education programs in athletic training across the country, amounting to less than 20 percent of all NCAA member institutions. Whether or not institutions have an athletic training education program, all institutions' sports medicine departments strive to provide the most equitable health care possible. Legally, state practice acts regulate those that may practice athletic training.

It is time that institutions begin to recognize that athletic training students are full-time students, and not a free work force to supplement health-care coverage. For example, student-athletes are limited to 20 hours of sport activities during a week while in season and eight hours out of season in Division I. These limits were put in place to ensure athletes are more like students on campus.

Minimally, athletic training students should be allotted the same opportunities as student-athletes to be regular college students.

Addition of summer coverage

A growing trend in all divisions is for student-athletes to stay on campus during the summer months to train and take classes. Football athletes are not the only student-athletes on campus during the summer, and the trend has been that other student-athletes are on campus year-round participating in activities to prepare for the competitive season.

Because of this, CSMAS has recommended that all member institutions examine increased sports medicine and athletic training staff personnel time, as well as the financial impact of the summer conditioning model for football. Athletic trainers at institutions already had job descriptions that outlined a full workload. The accumulation of additional hours of coverage in the summer months for on-field activities, as well as treatment and rehabilitation of injuries that occur during this time, should be addressed systemically.

Member institutions may need to examine additional staff needs due to the additional time commitments of current employees. For the typical athletic trainer, summer commitments are added onto a year of long hours, consecutive days without time off, and extensive travel demands.

All persons participating in, or associated with, NCAA intercollegiate athletics share the responsibility to protect student-athlete health and safety through appropriate medical coverage of sports and supporting activities. Although many institutions may feel that these increased demands should be met by the existing medical staff, it is clear these demands are strapping an already overworked athletic training staff, and therefore impacting the health and welfare of the student-athlete.

With the expansion of playing and practice seasons and the current nature of summer conditioning programs, which appear only to increase demands on coverage, institutions must evaluate their current staffing and compensation for the medical and athletic training staff in order to meet this shared responsibility for student-athlete welfare.

Points to consider

Each sport has a unique risk of injury, and injury surveillance provides a foundation for sports medicine policy decision-making at the local level.

The Committee on Competitive Safeguards and Medical Aspects of Sports encourages NCAA institutions to reference the National Athletic Trainers' Association (NATA)-published document titled "Recommendtions and Guidelines for Appropriate Medical Coverage of Intercollegiate Athletics (AMCIA)."

In emergency care plans, it may be beneficial to design a sport and facility coverage model for practices, games, travel, nontraditional seasons, out-of-season activities, tournaments, vacation periods, skill instruction sessions and clinical instruction.

There is a cost to institutional sports medicine resources whenever new sports are added or playing and practice opportunities are expanded.

Many components of health-care coverage, such as preparation, treatment and rehabilitation, occur outside the practice and competition area.

Variables such as length of season, out-of-season practices, squad size, and the health-care staff's administrative duties and travel schedules may impact the ability to provide health care coverage.