Institutional racism, also known as systemic racism, is a form of racism that is embedded as normal practice within society or an organization. Athletic training is not immune to the infiltration of systemic racism within the United States. It is no longer enough to simply, reduce the policies that have led to systemic racism or are a direct result of systemic racism. Instead, we must urgently reflect on how to effectively address diversity, equity, and inclusion within the athletic training profession, and actively seek out and eliminating prejudicial policies within our profession. (1) Currently, the racial backgrounds of athletic trainers differs greatly from the current demographic profile of the United States. (1) As of June 2020, 81.17% of the NATA's nearly 40,000 members, identified as non-Hispanic White. (1)(2) This is similar to other health professions as well such as nursing and physical therapy who have less than 10% of their workforce identifying as a racial minority.
In order to change the population demographics of practicing professionals, we must first ensure that the educational process is inclusive of all individuals and actively fighting against systemic racism barricades. Our profession grows with our young professionals, and if the disparity between white and non-white athletic trainers in the workforce continues, the result will be the continued selection and election of leaders in athletic training who are largely non-Hispanic White. (1)
racial and ethnic disparities in access to higher education
Minorities in the US are constantly battling against workplace issues such as racism, glass ceilings and under representation in higher education. The under representation of minorities in higher education, is one of the primary attributing factors to under representation in the profession of athletic training. (2) To give you an idea of what is meant by "under-representation," Only 12.1% of African Americans over 25 were college graduates, while 24.4%, over double the amount, of White individuals over 25 were college graduates. (3) In order to address this issue, we need to dive deeper into what social determinants and disparities are contributing to this under representation in higher education.
A really obvious hurdle to higher education access in athletic training and the certification process, is the issue of standardized testing. Standardized testing remains commonplace at all levels of the US educational system, in order to rank students on their "abilities." Thorndike, the "founder," so to speak, of standardized testing, undoubtedly and purposely excluded non-white students. He created the tests with the purpose of "diverting resources away from 'inferior' students and toward 'superior' students. This alone is an issue as it automatically limits access to education and resources from those deemed "inferior." When you couple this inevitable result with Thorndike's idea that individuals from different ethnic backgrounds had various mental abilities, it becomes clear that these tests were created with specific ethnic groups in mind as "inferior" and "superior." (1)
The exclusionary design of standardized testing, which persists in 2020, is an example of systemic racism built into the US education system. There is substantial evidence indicating that racial and ethnic minorities, particularly non-Hispanic Black or African American and Hispanic populations, perform markedly worse than their non-Hispanic White counterparts. (1) Regardless of the cause of this disparity, it is abundantly clear that non-White students face a disadvantage in becoming credentialed athletic trainers, a process heavily reliant on standardized testing, namely the BOC.
The issue is not just the disparity in pass rates of standardized testing, more specifically the BOC. The issue begins even farther back in the education process; admission to the program. Because of standards 6 and 7, which indicate that a program must have a 70% pass rate on the BOC exam, athletic training programs have become more selective in their student recruitment and enrollment. Instead of admitting individuals based on the perceived ability of an individual student to become a competent clinician, they instead enroll those who seem more likely to pass a standardized exam. (1) Further more this idea that a specific first time passing rate must be met in order to remain a CAATE certified program, creates a stigma among students and staff alike that first-time performance on the BOC exam is what dictates one's ability to be a competent clinician. (1)
Not only is there a fundamental issue with selecting applicants based on perceived ability to pass a standardized test, but due to the layout of most athletic training programs, there is minimal room for mistakes. The educational pathway has become more expensive and time consuming, now requiring 6 years of higher education and the costs associated with that. On top of this, the clinical experience hours required makes it very difficult for individuals to hold jobs during their time in the program, with many programs discouraging individuals from holding jobs. I personally was told when I applied that my clinical immersion was always to come first (despite being an unpaid, constantly changing, highly demanding schedule). Luckily for me I had preceptors who understood that I had to work in order to pay for school and be able to commit to the program, however not everyone is as understanding. On top of this, the program is usually very structured, so if a student fails a class they have to wait a whole year to take that class again, automatically falling behind their other classmates, potentially graduating later. It is not a education system designed for work-study individuals. This lack of flexibility and time for individuals to continue paid work, creates an even bigger gap in the diversity of the profession. Despite the fact that African-Americans make up just 12% of the US population, close to 1/3 of poor people in the US identify as African-American. (3) This means that a majority of this particular minority group falls into the population that struggles the most with access to higher education due to cost, and now we are trying to encourage more of these individuals to pursue a under-paid, over-worked profession, with little room for income opportunities during their studies. Are we only willing to be diverse if minorities can afford it? That's a problem.
Now that we know about the systemic inequalities that exist in higher education, we can understand how the culture of athletic training helps to perpetuate these disparities rather than break them down and succeed in spite of them.
Athletic training continues to be a "who you know" type of profession. Those with the most connections, who are the best networkers, who know the right people are often the ones who get recommended for or sent the most job opportunities. There are so many institutions that hire based on applicants they receive through word of mouth, never actually posting the job anywhere for the entire profession to see and take advantage of. Employers continue to seek "the best fit" for the job, without actually looking at the entire potential job pool. Additionally, despite laws and regulations against hiring discriminations, the long history of sexism and misogyny continues to make working in athletics as a female difficult. Often times women get told they shouldn't work in male sports, especially "pretty" girls, because they "can't be trusted" to keep the athlete relationship professional. Just like girls in secondary school are constantly told to dress in a way that "doesn't distract the boys," female athletic trainers have to battle to prove that they are not going to be a distraction or unprofessional, a task that men often times do not experience. It wasn't until recently that women were given opportunities to work as athletic trainers in the NFL, and even now it is difficult to do.
I recall a time in undergrad where an NFL team was asking for student aides to help with practices one day a week. I volunteered, excited to experience as many settings and patient populations as possible. Upon hearing I was a female, I was told to send a resume and cover letter … for a volunteer opportunity. I didn't think much of it and complied. A few weeks later, after not hearing ANYTHING back, I found out that 3 of my male classmates had been chosen to help out, without being required to submit a cover letter, resume or anything. This is just a small example of the extra hoops females are constantly made to jump through.
Those with disabilities may struggle with athletic training as well, due to the demanding nature of the job. Athletic training can be a very physical job. There are a lot of manual therapy techniques that require full mobility to perform. Setting up and breaking down a field, packing for an away trip, demonstrating rehab exercises etc. All of these have a physically and mentally challenging aspect to them. The job requires long days and nights, constantly changing schedules, and a lot of time moving, standing and lifting.
(1) Adams WM, Terranova AB, Belval LN. Addressing Diversity, Equity, and Inclusion in Athletic Training: Shifting the Focus to Athletic Training Education. In: National Athletic Trainers Association; 2021.
(2) Nevarez D, Hibbler DK, Cleary MA. Minority workforce issues in athletic training. 2012.
(3) Bankston III CL, Caldas SJ. Race, poverty, family structure, and the inequality of schools. Sociological Spectrum. 1998;18(1):55-76.
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