In less than two months, the internship route to certification for athletic trainers will be a thing of the past.

Beginning in 2004, anyone wishing to become a certified athletic trainer must graduate from an accredited college or university program, which consists of an academic major and a minimum of two years of clinical experience.

Although athletic training staffs at nearly all NCAA institutions are headed by a certified athletic trainer, many schools have benefited from the manpower provided by prospective student athletic trainers, who, through the internship route to certification, needed 1,800 hours of practical experience to be eligible for the certification test.

When the switch was first announced more than five years ago, some in the profession predicted "nothing but gloom and doom," said Chad Starkey of Northeastern University, who chairs the National Athletic Trainers' Association's Education Council. But he says the change has not damaged the profession.

"The majority of athletic trainers support this move, but that doesn't mean they all do," Starkey said. "There has been a vocal group that has expressed ongoing concern about the elimination, about the course content that athletic trainers will have to learn, but I think all in all I'm proud of the way our profession has pulled together to see this thing through."

How to meet needs

The decision to eliminate the internship was well-conceived, Starkey said, based on the findings of task forces that looked at the differences in performance on the certification exam between those who went through an accredited program and those who took the internship route.

"(The decision) certainly wasn't made on a whim," Starkey said, adding that the change was announced with enough advance notice that schools could make any necessary adjustments.

But for some, the issue is more complex than just how athletic trainers should be certified. There's also the question of how schools without accredited athletic training programs can meet the needs of their athletics departments -- especially in tight economic times when many schools, particularly smaller institutions, may not be able to afford to hire more people.

That was one of James Watson's concerns when he learned of the change back in the 1990s. Watson is the director of athletics at West Liberty State College, and his school does not have an accredited athletic training program, or the money to pay for more athletic trainers.

Watson said he wanted to find a middle ground, rather than the all-or-nothing approach taken by the NATA, that wouldn't hurt smaller schools.

"My intent was to find some middle ground that would not eliminate an entire class of young people who are going to non-curriculum institutions who had an interest in possibly pursuing careers in athletic training," he said. "I just didn't want to see the door slammed on that group of people.

"Is it realistic to think that we can have certified athletic trainers at every institution, covering every athletically related activity where there's potential for either injury or medical illness? I would rather have a well-motivated, trained student-athlete or student trainer who has a career interest covering our weightlifting session with a radio than to be tying up one of my two precious athletic trainers who need to be doing lots of other things."

Since May 1999, the number of accredited athletic training programs at colleges and universities has nearly tripled. At that time, there were 87 programs. There are now 242 programs according to the Commission on Accreditation of Allied Health Education Programs. Starkey said there are more programs in the pipeline for accreditation.

Starkey said he predicted the large jump in the number of programs, though he said the outcome isn't necessarily a benefit of eliminating certification-based internships.

"From an academic and professional standpoint, it's not professionally healthy," he said. "The more marketplace you have, the more people you're going to produce and there is such a thing as overproduction."

Starkey noted, however, that most professions go in cycles. In five to six years, he said the numbers should stabilize.

Even though the number of training programs has increased, Watson noted that they are available at less than 25 percent of the more than 1,000 NCAA colleges and universities. That leaves more than 75 percent of the NCAA schools making up that loss of students who previously used internships to attain certification.

Starkey said a school without an athletic training program still can acquire athletic training students. In fact, he emphasized that those students still need clinical experience as part of the program. Also, he said that many schools did not previously rely on interns for coverage of team practices or games.

At Northeastern, he said, students in the athletic training program don't just stay on their campus for clinical training. Starkey said they go to other schools, professional teams and hospitals to get a well-rounded education.

But what works at Northeastern does not necessarily work elsewhere, Watson said.

"If you're talking about being in a city like Boston, where you have one of the highest concentrations of institutions in a very small geographical area, something like that works," he said. "But if you come to West Virginia where you have lots of rural campuses that are hours apart, that's probably not a realistic solution."

'Good for the profession'

Georgia Southern University is one of the many schools that has received accreditation for its training program since 1999, said Paul Geisler, the school's athletic training program director. While the decision to seek accreditation likely was prompted by the elimination of the internship opportunity, he said the decision to add the program was based on academics rather than athletics.

"I think it's something that we should have done a long time ago," Geisler said. "You can't go through an internship program and become a physician or a physical therapist or a dentist, you have to go through a formal program. To the outside eye, and to people looking at the profession, it's kind of ridiculous to have this other thing."

Carla Stoddard, program director at Barton College, which received its accreditation last month, agreed.

"In the long run I think it's good for the profession," said Stoddard, adding that she received her certification by serving as an intern. "Everyone in the future will know what an athletic trainer is and what an athletic trainer does, and we'll all have the same degree and the same credentials, the same baseline knowledge."

Geisler said as part of the program at Georgia Southern, athletic training students do work in the athletics department, but they also try to get their students into the community to work in doctors' offices, high schools or other areas where they can gain additional skills.

He said about 70 percent of entry-level athletic trainers are obtaining jobs outside the university setting.

"From the academic side, we certainly don't want to be perceived as free labor, and we're working hard to get away from that perception," Geisler said. "It's educationally wrong, it's professionally wrong."

Starkey said as internships cease to become a way to become certified, more changes may follow, though none of this magnitude is likely.

"It's not perfect," he said. "But hopefully now we have the momentum going and we'll keep on top of this and in the future, I'm sure there will be some changes going on, but certainly not as drastic as we've seen with the elimination of the internship."