Career of an Athletic Trainer in the Tactical Setting (Military)

Level 1: Amateur

Welcome Players! One of the best settings that could provide a mutually beneficial relationship for a skilled musculoskeletal healthcare provider is within the Military. Advanced athletes? Check. Infrastructure for optimized medical care? Check. Vested interest in the health and wellness of ALL involved parties? Check. This post is guest-written by a Certified Athletic Trainer who has been a Head-AT for a collegiate program, and after experiencing the turmoils more than once moved on to a position where he not only feels valued, but is valued: As an ATC with the United States Air Force.

Please welcome Dominic Worrell to the writer’s circle!

Coaches note: This article is written entirely by Dominic. It has been lightly edited for clarity to the reader by me. Some emphasis (bold, italics, etc.) has been added by me. Comments included by me have been delineated with the quotation box in green, such as this paragraph.

Contents:

• Background & Discovery of AT

• Education

• Early Career

• The Tactical Setting (Military)

• Life as a Tactical AT

• Future of AT

• Message to You

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Background & Discovery of AT

I have a fairly stereotypical initial entry point into Athletic Training. I was a gym rat growing up and played every sport I could get my hands on. My dad was a volunteer firefighter/EMT and I was always around first responders. I enjoyed my high school anatomy class.

Not knowing what I wanted to major in, Athletic Training (AT) seemed like a good fit even though I had no real clue what I was getting into. I was actually told about accreditation for the first time ironically on a campus visit to a college without an AT program. I was a good student and could have succeeded academically in any pathway I chose.

I had no previous exposure to Athletic Trainers beyond one evaluation at a summer basketball camp and a half day of job shadowing in a PT clinic setting. Like many rural areas, we had no AT providing care at our school. We had a chiropractor who ‘covered’ our football games and had let me continue to play with a concussion even after reporting ongoing symptoms, which was wildly inappropriate even based on standards of care in 2003.

Education

I went to Trinity International University, an NAIA school in the northern suburbs of Chicago. I played football my freshman year but didn’t continue to play beyond that since I wasn’t exactly going to the League and wanted to focus on AT. I was stretched thin with 17-20 credits each semester in addition to football demands and then the 150 observation hours we had to get to apply for our program.

Little did I know at the time, that was my first exposure to the difficulty of balancing AT with other elements of life. We had an excellent CAATE-accredited program at a strong academic school, and we got a ton of hands-on experience from day 1. Our program, and my cohort particularly, were seen as the “smart kids” within the kinesiology/physical education realm. I was well prepared to transition from student to ATC. This was also around the time when the decision was made to restrict independent student travel. Having become a Head AT later on in my career, I completely understand why and agree that it was the right decision, however I would be remiss if I didn’t admit that I did develop a ton from being placed in those situations for a couple of years.

Since I had been at a small undergraduate program, I wanted to see the ‘big time’ for Graduate school and went to Michigan State, which had an accredited post-professional program. I had only looked at programs with GA positions offering a full tuition waiver plus stipend, and that set me up well by not adding any more student loans from that stage of my education.

At MSU, I picked up the valuable OMT skillset, which trickled down to us from the DO medical school. OMT/OMM is ‘osteopathic manipulative technique/medicine’, and the skills are commonly referred to as ‘muscle energy’ but are way less woo-woo than they sound.

My GA position included intercollegiate coverage (Field Hockey year 1, Men’s Soccer year 2) and teaching two sections of First Aid/CPR each semester. Like many people who did the GA thing, we traded two years of running ourselves ragged for not having to take out more debt.

I have mixed feelings about the GA model and the fact that it’s no longer available; it facilitated a lot of people getting graduate degrees for free/cheaper and served as an often much-needed transitional step into independent practice… but it also established early on to many of us that we needed to succumb to the overworked and underpaid mindset. Like many, our GA positions were classified as half-time, which is supposed to be an equivalent of ~20 hours/week. LOL. And some of the athletics-only GA positions were rated as quarter-time…

I was fortunate to attend two strong academic programs with excellent teachers, and had great preceptors and mentors along the way. I put in the work to take advantage of these opportunities and was prepared well to transition, both as a student to a certified and then from a GA into a full staff member.

Early Career

Coming out of my educational process in 2010, I knew I wanted to stay in college athletics but liked the smaller school dynamic better - it felt like you were less of a cog in a multimillion-dollar machine (which I can only imagine how that has changed in the last 13 years with the introduction of NIL and conference TV deals skyrocketing).

First was a D3 school in rural Viriginia. After three years getting my feet under me as a staff member, I was hired as Head AT/Director of Sports Medicine at 27 years old, mainly due to the support of my fellow staff members. They wanted me to get the job in order to keep building the strong operation we had established together. I also regularly taught courses and throughout most of my time working in the collegiate setting. I have always enjoyed teaching, both in the classroom and in preceptor roles. Lack of staffing drove me away from that job after one year as Head AT; we were promised another staff position after the school had continued to add sports and they ultimately refused to do so. As would become a common theme across the three universities I worked at as a staff member, the people I worked alongside were of higher quality than the institution and the positions deserved.

I went next to a Head AT position at a D3 school in Iowa with a CAATE-accredited program. This was somewhat closer to family and I liked the idea of working with an accredited program again. In three years there, I worked with our staff to bring both the clinical and academic programs up to appropriate standards. However it became apparent during my third and final year there that we had hit a ceiling of what we were going to be able to improve. Part of my frustration was the mindset of the students in our AT program.

I had come from an AT program I was incredibly proud of; we were challenged academically and held ourselves in high regard that it was a strenuous program. I still hold the field of Athletic Training in high esteem and want the profession to be seen in that light. By contrast, some of the students at the university in Iowa were happy with coasting and not being held to high standards; in fact it created friction that the freshman class outshone some upperclassmen because they came in with the understanding that we were setting the bar higher and bought in to what we were trying to build. I again left, hoping that I just needed to find the ‘right’ college to make it all work, and for me to find happiness and fulfillment professionally.

That took me to what would ultimately become my final collegiate job, a Head AT position at a D2 school in Austin, TX. I was drawn there because we didn’t travel very much, however that didn’t translate into the hours being any better than what I had fought at my previous two stops. We had a program with AT students which was not CAATE-accredited, but they could apply for TX licensure. Throughout some staffing changes on both the academic and clinical sides, it became apparent at the start of my last year that we couldn’t provide the type of clinical care that was expected - particularly considering the amount of practices that happened all throughout the day there.

When I brought these genuine concerns up to my supervisor (a former clinical AT now in an administrative-only role), I was utterly dismissed and no support was provided for me or our staff. I was shell-shocked at the lack of empathy, or even consideration of valid issues within our department. Walking out of that meeting it had become instantly and glaringly obvious that I needed a change. No part of me had really even considered leaving mid-year prior to that meeting. In the coming weeks, I would even have wandering thoughts of what other profession I could transition to, with no good answers. I have always loved our skillset and the career field of AT, but I had never loved a job.

Leaving a collegiate Head AT position mid-year is certainly not common, but I could no longer keep sacrificing myself for situations where I was not getting supported or invested in by the leaders above me. Even in that situation, it took reassurance from some fellow AT friends that I was justified in making the right decision to take care of myself and make my life better; the guilt in the back of my head was real about leaving the rest of the staff short-handed and causing any additional hardship for them or the student-athletes. After a little more than two years there and more than 11 years as a certified in the college setting, I took the leap with a major career change.

Tactical Setting (Military)

            I had previously talked to a couple military contracting companies at the same timeframe of my last job change between colleges, but neither of those opportunities worked out on the timeline I needed. This, combined with having a couple friends who worked with the military, led me to having a pretty good idea of what the military setting could be like as an AT. I also knew that the position I ended up taking would be a good opportunity based on the type of unit I would be working with. I have always appreciated the role of the military and first responders, so I knew that the tactical setting had the potential to be a great fit for me.

            In November of 2019 I took a job as a contractor working with an Air Force pararescue unit (PJ) (video- what is a PJ). This was fortuitous timing considering it would have been hard to make such a drastic change in the midst of all the uncertainty presented to everyone a few short months later. The process of getting hired was a whirlwind and mildly terrifying; because I’m hired through a contracting company, I didn’t get to speak with any of the military personnel with the unit I was going to work with. There was no on-site interview, no getting to check out your clinic in advance - just a few phone calls and go.

About a month after my initial conversation with my company, I was in a moving truck headed to Tucson, AZ, a city I had never even visited. To this day, I have still never met anyone from the corporate/leadership side of my company in person; they are a faceless entity three time zones away. I am a W-2 employee and all my human resource elements are done through my company, not the Dept. of Defense directly.

A quick note about the employment structure of AT positions with the military:

• There are a few GS (general schedule) positions, which is the most common term for when you’re a direct government employee; but the significant majority are still done through contracting companies.

• Some positions require a security clearance.

• There are no active-duty military positions as an Athletic Trainer in any branch, whereas with physical therapists there will be both active duty and contractors.

• There is continual hope of more AT positions transitioning to GS but that conversation ebbs and flows and there hasn’t been much movement recently.

• There would be a similar dynamic with public safety positions where you could be hired through a third party (contractor, hospital system, PT clinic, independent practice LLC) or employed directly by the municipality/agency.

• There are pros and cons to each, and I have heard some advocate for benefits of the contract model for ATs working in the tactical space.

• My two cents after 4 years immersed in this space is that a contracting company just takes a significant cut off the top ($$) usually without adding much value or benefit for either the AT/employee or the end-users.

The financial piece as a contractor can vary widely. There is a sizable range between and even within contracts. On the whole, I believe the salaries will be above average for entry level and younger professionals compared to the traditional setting. For those who are experienced or coming from more advanced positions, your results may vary. I made pretty much a straight lateral move in terms of salary going from a head position in Austin to my current contract.

One important thing to be mindful of is that negotiating and advocating for yourself is more necessary in this dynamic - working in the college environment my experiences were that we got our token yearly cost of living raises and that was pretty much it without a promotion of some sort. In the contracting world, there is more room for initial and ongoing conversations. While I haven’t gotten regular annual raises, I got one 2% raise after about two and a half years (after multiple months of conversations/negotiating), but then managed to get a 16% raise a year later when I had a competing job offer in hand. I also got my ‘CEU’ money increased, although that includes licensure, NATA dues, and CPR renewals, etc. so it still doesn’t go far enough to attend conferences without coming out of pocket.

Other benefits vary depending on the company as well, though all seem to have the standard offerings for full-time employees – health/dental/vision insurance, retirement plan, etc. – but the quality, price, or retirement matching options may be different. The benefits that come with GS positions are pretty solid, usually better than what you can get through a contracting company. PTO can be limited; I get 10 days total per year for sick time and PTO. That is beyond having ALL federal holidays off, and some other days/periods where the military grants their members some free leave when it makes sense - and while we don’t officially receive that, most local leaderships are good with teleworking and being available on an as-needed basis. No more Thanksgiving morning basketball practices and hosting a tournament that whole weekend…

After 4 years in the tactical setting, I am so glad I made the change. The work-life balance is as advertised, and the difference that makes is hard to even articulate. I am trying to remain balanced talking about the different positions I’ve been in, but honestly it’s hard not to disparage the traditional setting having come through to the other side. The analogy that I keep coming back to is that it’s like Stockholm syndrome: you don’t realize how bad it was to you and for you until you’re out of it. And to quote the stereotypical movie ex-con when the cops are closing in again, “I ain’t goin’ back”… and every AT or strength coach I’ve talked to in this setting has similar sentiments.

I am a huge advocate for AT’s in the tactical setting and believe it has the unique potential to create true win-win situations. They should mostly be good jobs for AT’s, tactical professionals can receive better musculoskeletal care (particularly populations that likely haven’t had similar levels of care previously), and it can create substantial cost-savings/decreased liability for the agencies. Recouping far more than the costs of a program/position should be fairly easy to achieve in most situations.

I have advocated locally through some non-profit work to try and start a program for local police and/or firefighting personnel; those conversations are ongoing. I won’t go into the full pros & cons list of the military setting here, but I have developed that and am willing to share with anyone who has an interest in exploring this setting. I have given a presentation to local first responder groups, am scheduled to speak at our state AT meeting this winter, and will continue to find ways to spread the gospel of Athletic Trainers caring for our first responders and other tactical athletes. I’m happy to chat with anyone who reaches out.

There are quite a few differences between the college setting and working with the military. Vastly distinct cultures, as you would expect. There is often a much longer time horizon in focus - there is less emphasis on the rapid turnaround from injuries because there’s no dynamic of getting back to play in the next game in a few days. We are typically more focused about getting people through a training course or an entire career of 20+ years, and in my unit I’m often working with experienced operators with extensive injury histories. I rarely tape and don’t do a ton of wound care (a lot of my Airmen are also paramedics, so I don’t get asked to kiss many boo boos).

Budgeting and purchasing is drastically different than the university world. Working with and through medical treatment facilities is something new to navigate. Public safety would have some of its own quirks, including a big piece of learning workman’s compensation procedures. I don’t want to go on with all the minutia here, but I’m genuinely always willing to speak to it more in-depth with other ATs.

The mindset of a practitioner in this setting is going to be similar in some ways and will change in others when compared to the traditional athletics model (see all caveats given at the start of the section below). An ankle sprain is still an ankle sprain, of course the anatomy and physiology don’t change just because you drive to work past armed security forces troops. Rehab still needs to be tailored to build a patient back to their specific high-level capabilities, some of those capabilities just look different. Separate career fields have varying demands, much like athletes in assorted sports all have unique needs. I have everywhere from office workers who still have to pass a fairly easy yearly fitness test, all the way up to the special warfare operators who have to be incredibly physically competent and able to perform for extended periods of time and in inhospitable environments. But just because we work with some capable individuals, doesn’t mean that the setting is intimidating or difficult to integrate into as a practitioner. There is a lot of frustration with the military healthcare system as a whole, but that can work to your advantage as someone who will take time with patients, listen, be hands-on, and explain what you’re doing for their recovery.

One of the more frustrating aspects in this setting is inconsistency getting the long-term compliance with a treatment/rehab plan. I do a lot of evaluations and especially if it doesn’t take someone off of duty status, it can be challenging to convince some to come in as often or for as long as they should in order to get to the maintenance or preventative stages. There’s less of an element of a regular coaches report to have the external pressure to keep them coming in regularly. And since we’re not a part of any official chain of command, there is no way for us to truly hold people accountable. The end-users also usually haven’t been exposed to the athletics model and that it can be normal if not preferable to seek care daily or even multiple times a day.

My ‘return to play’ decisions do have more gravity in this setting. The example I give is that if I clear a tennis player early for a shoulder and they have pain during the next practice, just stop practicing and likely no harm done beyond an annoyed coach. If one of my operators is in the middle of a freefall and can’t operate his parachute safely, there is no way to call a quick timeout. No substitutions are available when operating scuba gear 30 feet underwater. There’s no limited contact designator jersey in combat. This would translate to other tactical settings as well: there’s no asking someone high on bath salts to take it easy on a law enforcement officer. A firefighter who needs to pull a coworker out of a dangerous situation can’t be second guessing their capabilities in the moment. As much as sports are fun, it is rewarding to feel like you’re contributing to something bigger or more important.

Gaining buy-in/trust/rapport is essential with tactical athletes and word of mouth is going to affect how people perceive you substantially. That can either work to your benefit or be a detriment for people seeking the care that they need. Going to watch training events and jumping in when appropriate goes a long way for showing you’re invested in knowing what the population’s needs are. And while those at the upper levels of the military message all the politically correct things, there is going to be some dark and borderline inappropriate humor at the ground level: if you’re someone who is bothered by that, this realistically might not be the right setting for you. If you break trust in this setting or they get a sense that you don’t belong, it would be incredibly problematic to overcome that stigma.

I know I have a good relationship with my service members if they’re asking if a pregnant spouse can come see me for back pain. Or if they trust me to evaluate their young child when they’re worried about a possible fractured wrist after a fall. You also have to factor more life situations in when working with adults - schedule needs of parenting, the stresses of moving, they take vacation in the middle of a rehab, etc. I once kicked a PJ out of a rehab session so he could go nap - he had young infant at home, had been working a nights schedule, and was preparing to move to his next duty station; I knew that him getting rest was more important that day than a maintenance rehab session.

Life as a Tactical AT

The day-to-day experience and schedule will vary within the tactical setting, even within each branch of the military and down to the unique demands/mission of each unit. So while there will be many similarities and I will describe my dynamic, it’s not representative of all tactical jobs by any means. I work with the Air Force at Davis-Monthan AFB in Tucson, AZ. Our program is part of the Human Performance Optimization initiative, designated as a higher level of multidisciplinary care for USAF assets with a greater demand signal. The unit I work with is the formal training unit for the pararescue community, which means that the Pararescuemen (PJs) and Combat Rescue Officers (CRO’s) come to us for their upgrade training at a couple different points throughout their career. We fall under Air Force Special Warfare and are part of the Guardian Angel program - the USAF’s personnel recovery assets. The PJs will also attach with teams from other services to provide them with medical/rescue assets. I’ve had SEALs and Marine Raiders come through one of our courses. I get to work with some badasses who have cool toys. My history-taking got considerably more entertaining!

My typical daily schedule is Monday to Friday, 7 am - 4 pm with a lunch break. From 7 - 9 am, I’m either out in the gym while our guys are working out or doing evals or rehab in the clinic/gym. The rest of the day is time in the clinic, documentation, occasional meetings. I will sometimes attend training events and have the opportunity to travel a couple times a year to go TDY with the unit. TDY is “temporary duty” and the military’s terminology for their training away from their home base or special circumstances away from the unit and their normal day jobs. Only rarely will they have night events that they ask me to be around for, and when it happens I always have plenty of notice.

There are no weekend responsibilities, although I will offer treatment availability in select situations (almost always when I’m already planning to come on base to workout anyways); to be clear that is 100% my willingness to do so and there are zero expectations or even requests for it. I also frequently have a chance to workout on the clock as long as I don’t have anyone that is scheduled to see me. In fact, working out around the members and joining some group workouts is a great way to build rapport. I’ve passed the Operator Fitness Test, but I guess my beret must have gotten lost in the mail.

Which brings me to an incredibly important point to highlight. Those working in this setting who are not in the military must strike a fine balance between showing that you belong while also respecting the boundaries that we have not taken the oath of service and that there is a distinct separation. Civilians working with the military is more commonplace than most would imagine, so it is not unusual to have a mixture of active-duty, GS, and contractors working side by side regularly. One thing that my coworker (S&C coach) and I have done well consistently is to negotiate that dynamic. Our unit accepts and includes us as a part of the group and we have shown ourselves to be invested in building and improving things much beyond what our contract requires. However, we respect the distinction between us and those who have made that commitment when appropriate.

In terms of providing on-site coverage, I am not expected to be the official medical coverage for dangerous training events. Because there are no active-duty ATs, at the higher levels where policy is set they seem to struggle with truly understanding what we do and our scope of practice. For my situation, there are always paramedics (either the PJs or an IDMT-P) identified as the medical coverage. But they know their limitations in the musculoskeletal realm and are happy to have that layer of coverage in high-risk scenarios as well. The uncertainty of the AT scope/breadth is also true of the medical group who tracks our credentials and sets some policies/procedures; I am embedded, which means that I work with one specific unit and my clinic is on-site at my unit. I have minimal interaction with the medical group proper outside of referrals.

The medical team I work with has a few moving pieces. We are a smaller unit, so other units may have more professionals that play a role. Through my same company, we have another contractor as a S&C coach. We have a dietitian  (contractor) who is shared across much of the base but has priority for the operators in the Rescue community. There are mental health professionals that we have access to through other Rescue units or the med group, and our unit hopes to add a dedicated GS social worker in the coming year. The rest of the personnel are active-duty. We have IDMTs, which are the AF’s medics. We also have a flight physician, who is currently from a primary care sports medicine background but an ER doc has previously filled that billet. Because we have the physician and IDMTs, I do very little on the gen. med side of the house.

There isn’t a teaching element here in the same way I was used to in higher education. I do stay fairly active with a public health messaging approach for our unit, but rarely in a classroom setting. There are lots of opportunities for peer and interdisciplinary learning. AT’s seem to be pretty well respected by other providers and there is really no AT-PT turf war. As embedded providers, the two professions actually operate very similarly day-to-day and with no billing dollars to fight over, it’s all about contributing to the same mission and the well-being of the members.

Documentation is a more substantial piece in the military setting for a couple reasons:

• The EMR is not optimized for outpatient rehab providers.

• Documentation in multiple systems is sometimes required.

• While good documentation should always be our standard, it is essential in this setting because of the back-end dynamics of the military members’ careers - for the purpose of getting an accurate disability rating as well as the potential to transition into VA care following retirement.

I have a love-hate relationship with documentation here: I appreciate having time to do it well since that hasn’t always been the case, but I don’t like how much of my time it takes up.

My Life Now

I’m in a much better place than I was just over four years ago. I am substantially healthier, both mentally and physically. On the physical front, it’s no longer having to compromise being able to both maintain some decent cardio and lift regularly. I can grocery shop and cook the way I want to. My sleep isn’t challenged by both early mornings and late nights, and no time on a bus or regular travel to disrupt my routine. As I get further from my 20s, I definitely don’t have the same capacity to burn the candle at both ends and still persevere for an extended period of time.

The mental health piece is even more important. If you’ve never had good work-life balance, it’s hard to even articulate in a way you can wrap your head around. We - and those around us - are impacted by it way more than we realize. Of course the amount of hours makes a massive difference; I think the even bigger piece for me is the ability to unplug when I’m not on the clock. I can choose not to answer my calls or texts from 3 pm Friday until 7 am Monday and no one will be upset. I can go hiking with my dog and not have anxiety about checking my phone for the first time in three hours. I can’t even have my work email on my phone!

Going above and beyond is appreciated as such, not the expectation day in and day out (and often results in a gift of whiskey or a 12-pack as a thank you). I can’t imagine not having regular weekends off anymore. I no longer constantly feel like I’m giving way more than I’m getting back. I don’t feel like I’m a disposable asset that will just get used up and then replaced when I won’t take it anymore. I can say no to things when appropriate. I don’t have to cater to the unrealistic whims of 18-22 year olds. I can take vacation time at any point throughout the year.

I have finally found somewhere to put down roots, since I’m in a job that I can see myself in for an extended period for the first time. I loved Austin and didn’t want to leave; however it became extra frustrating to be in a place that was a great fit for me but being unable to enjoy it and take advantage of all the things that I loved there. In Tucson, I bought a house as a single earner in a metro area *shoutout to 2020 mortgage rates*. I can regularly invest in my community; I’m a volunteer and board member with a local non-profit organization that supports health and wellness initiatives for local firefighters. I can dedicate time to the hobbies I enjoy. I have the bandwidth to start an independent practice as a side business - I know others have talked about that much more in-depth on this site so I would reference their writings as opposed to going into details about mine, especially since it truly is a side hustle for me (I left working 60-70 hour weeks for a reason so I’m not trying to inflict that on myself again). I can be a better friend, boyfriend, dog owner, community member…

Future of AT

The last 4 years stress-tested Athletic Training for reasons with which I’m sure most reading this are intimately familiar. The combination of the entry-level Master’s (ELM) transition and everything that came along with the pandemic being the most impactful in my opinion. There are ‘shortages’ of AT’s, particularly in the traditional setting. It seems that less AT’s are willing to accept the hours and pay, with the bulk of the change seemingly coming at the entry-level positions. I remain a skeptic that the ELM transition will do everything that it was hoped and messaged to be (that toothpaste is out of the tube so I’ll save getting up on that soapbox until we chat over an adult beverage at a conference).

So where do we go from here? And since this is the story of my journey, where do I want AT to go from here?

As I have navigated my AT educational and career pathway, I have continued to uphold high expectations for the profession and the providers within it. My opinion is that we need to continue to push to elevate from within; I think sometimes there has been a resigned attitude of settling or appeasement that has held us back collectively. First and foremost I hope to see some mindset and cultural changes internally. This will drive many of the more tangible improvements and increase our standing with external stakeholders. If we want others to respect us as highly-trained and credentialed healthcare providers, we need to act like it. Professionalism (dress, communications, messaging, etc.) needs to be more consistent. We have to stop spending bandwidth on water bottles and bench towels instead of medical care. We need to stop taking orders from coaches and parents. We need to stop allowing supervision from non-medical entities to dictate medical decisions/policies. We need to set boundaries and stop being available 24/7.

The biggest mindset shift I would like to see is a true re-establishment of a primary identity as healthcare providers. I think that mainly up to this point, the outside world and some AT’s have seen us as the people within athletics who happen to know something about healthcare. What we should be are members of the medical community who are best qualified to work with physically-active populations. The profession’s name is problematic in this regard but I don’t have a better solution to propose currently so I won’t add any more word-count to that recurrent debate here. These ideas are why I have always liked the term “clinic” over “ATR” and refer to the population under my care as “my patients” instead of “my athletes”.

A better-established role and footprint in the broader healthcare ecosystem would lead to my vision of a sustainable pathway forward for AT into the future. In the traditional settings, I like the idea of the medical model of employment & supervision even though I’m not evaluating it from firsthand experience. In my opinion, we need to go away from the practice of traveling with teams so much. I haven’t heard the traveling piece brought up much in the work-life balance conversations and would love to see some more productive and grounded discussions. I think we should push back on the culture of off-day (on weekends) treatments being expected.

I think we need to continue aggressively expanding into the non-traditional settings. Our skillset is so valuable and much of the world is just gaining awareness and/or access to it. While the military is ahead of police & fire currently, I think those public safety positions will increase substantially in the next 10-20 years. The growth potential there is enormous. AT’s in physician practice roles seem to be developing quickly. The industrial setting seems to be well-established and expanding. Independent practices are more prevalent than they were just a few years ago. These options will allow more people to realistically stay in the profession, while simultaneously pressuring the traditional settings to match salary and working hours expectations. We’ve also got to continue the push for being able to bill insurance.

Message to You

My message to the reader would be one of cautious optimism regarding AT and your role in it. There absolutely are settings and situations that allow us to thrive over the course of an entire career, but it may take some trial and error. And it certainly will take consistent advocacy to improve the different settings and the jobs within each. If I’ve learned nothing else in life to this point, it’s not to assume that you’ll stay on a certain pathway, especially for an extended period of time.

We were and we are the smart kids in class, don’t be ashamed of it! We collectively suck at bragging because we’re so used to being on the sidelines and in the background, both literally and figuratively. We’ve come a long way from the days of throwing ice and NSAID’s at everything, relying on passive modalities and spending a lot of our time taping. We also need to unashamedly practice at the top of our scope of practice.  

Obviously this differs state to state based on practice acts, but we should be advocating for more high-level skills to be included. If you’re in a state that is vague or allows your supervising physician to dictate your scope of practice - lean into the uncertainty and embrace the chance to learn and do more! I had to get comfortable with this on the business side of things, especially with some city regulations. AT and specifically independent practices of AT aren’t common/prominent/visible enough to have many specific guidelines, so it was a major growth point to learn how to leverage that to my advantage instead of being a hindrance or causing the whole idea to be a non-starter.

Throughout my AT career, I’ve had better coworkers and relationships than I have had jobs and bosses. The people - peers and patients - have never been the problem. The profession is fun and lets us work in some great environments. We work with and empower high level athletes, whether they be college/pro athletes and Olympians or military Special Forces operators. Our work can take us all over the country, if not the world. I’ve been on a boat in the middle of the Pacific Ocean and at the bottom of a Titan 2 ICBM silo. But we have to remember that at the end of the day… no matter how much Nike dri-fit gear that you’re hooked up with… it’s just a job and that we all need something beyond that.

It’s cliché but at least notionally true: if you were to pass away, your job would probably be posted before your obituary. And while our co-workers and patients may value us, that doesn’t justify the marginalization of our families, friends, significant others, pets, communities, and most importantly ourselves.

Dominic can be reached at dworrellatc@gmail.com. Feel free to give his side business a follow on IG @catalystmovemed.