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In the Midst of a Concussion Crisis, Why Does Oklahoma Artificially Limit the Number of Athletic Trainers?

Several Oklahoma news outlets have recently taken a deep dive into the problem of concussions in high school football. Stories have examined the inadequate data tracking of the Oklahoma State Schools Activity Association (OSSAA), an effort to legally require schools to keep an ambulance on site at football games, and even the differences in rules between high school and college ball that encourage quarterbacks to take additional hits rather than throw the ball away. 

Notably absent from the coverage has been mention of the overly restrictive licensing regime the state has set up for athletic trainers, which artificially restricts the supply of athletic trainers when they are apparently sorely needed.

 My research on the subject found that half of Oklahoma’s counties (38 of 77) do not have a single licensed athletic trainer. Others present an even more dire situation, reporting that only 13% of schools have a full time athletic trainer and only 32% even have a part time trainer. Of those counties that do have practicing athletic trainers, 10 have only 1 in the entire county.

This dearth of athletic trainers is unsurprising given the relatively cumbersome process of obtaining a license. Budding athletic trainers must obtain a 4-year college degree to be licensed. Contrasted with Oklahoma’s paramedic training requirement (itself unnecessarily onerous) that can be completed in just over six months, the 4-year degree requirement seems a little overboard.

What’s worse, the way Oklahoma’s licensing law is written creates a perverse incentive to avoid seeking the advice of a medical doctor. The law defines athletic training as rendering certain services to athletes “upon written protocol from the team physician or consulting physician to effect care.” Accordingly, any activity undertaken without consultation of a physician falls outside the scope of the license, and thus cannot be prosecuted for unlicensed practice. A volunteer or coach who effectively serves as the trainer on the team puts himself at risk of prosecution if—and only if—he follows a doctor’s protocol. For a high school with strained resources or located in an area without a licensed trainer, it is likely this practice occurs regularly.

The spate of recent news coverage of concussions has examined the usual policy prescriptions proposed by interest groups and politicians to address such hard to manage problems (more legal mandates, more funding from the state, more data tracking), but there is a simpler option that never gets talked about. Rather than erecting unnecessary barriers through lengthy and cumbersome licensing schemes, let’s reduce the obstacles to training and deploying athletic trainers. That is, let’s get rid of the licensing requirement all together.

Our athletic trainer licensing law unnecessarily restricts otherwise qualified individuals from providing needed services to our kids. Consider a retired military medic who wishes to volunteer as an athletic trainer for her son’s high school football team, at a school without the resources to hire a licensed athletic trainer. Under current law, it is a crime for her to volunteer her services, unless she does so without following a doctor’s protocol. The athletes on the team must make do with unguided assistance, or simply do without any assistance at all. How does this promote health and safety?

Concussion protocols are actually fairly easy to come by, and have been successfully implemented at the college and pro level in recent years. The information (and training) is available. It shouldn’t take more than a short, once a year training course to get that information and training to every high school in the state. It certainly doesn’t require a 4-year degree. What is needed to make protocols successful is a dedicated person on each team whose primary job is to see them through.

If the Legislature wants to make a dent in the concussion problem, it can do so - without spending a dime - by repealing the athletic trainer license.

Benjamin Lepak is Legal Fellow at the 1889 Institute. He can be reached at blepak@1889institute.org.

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