Gaining Access to Providing Medical Care to Male Sport Teams: The Female Athletic Trainer Perspective

Our primary purpose was to understand the experiences of female ATs as they gained positions supplying medical care to male sport teams. Phenomenology provided the underpinnings to gain the perspectives of the women who met our inclusion criteria (ie, sex, collegiate setting, medical care to male athletes) and interpret their experiences and perceptions.¹⁴ 

We used a criterion-sampling strategy¹⁵  to actively recruit 15 female ATs in the NCAA Division I setting. After gaining institutional review board approval from the University of Connecticut, a student researcher began a search of all NCAA Division I athletic training Web sites to identify possible participants meeting our inclusion criteria, as previously detailed. An e-mail was then directly sent to the potential participants, seeking their voluntary participation. We sent recruitment e-mails to 40 female ATs meeting our inclusion criteria. We began interviews, and once data saturation¹⁵  was achieved at 15 ATs, we stopped interviewing.

Fifteen female participants (Table) completed the interviews. The participants reported an average age of 33 years (± 9; range = 23–58 years). They had an average of 11 years of experience (± 9; range = 2–35 years) as a certified AT and had been working in their current position for an average of 7 years (± 8; range = 2–33 years). The participants reported various position titles, but a majority (n = 7) served in the role of assistant AT. Four participants reported positions as ATs, and 2 were graduate assistants. One participant identified herself as assistant director of sports medicine and 1 as a head AT (Figure 1). The primary sports participants were assigned to cover varied widely. Although 6 participants reported covering a single sport (football, men's basketball, and men's lacrosse), 9 women covered multiple sports. Six of the participants who reported having multiple sport assignments covered at least 1 female team in addition to their primary responsibility with a male sport. On average, our participants worked a mean of 62 hours a week (± 12; range = 40–80 hours) during the season and reported working fewer hours per week (46 ± 9; range = 35–65 hours) when out of season.

The participants identified a head AT, athletic director, or associate athletic director as their direct supervisor. All participants reported that their supervisors were men. On average, our participants reported a full-time staff size of 10 ATs (± 3; range = 5–18 ATs) at their universities, with an average of 4.5 women (± 2; range = 1–7 women). All of the coaching staffs the participants reported to for the male sport teams were men. Therefore, all the women in our study worked closely with male athletes and male coaches, and they also had male supervisors. Despite the heavy presence of men in leadership positions, on average, women in our sample made up half of the athletic training staffs at their universities.

Before data collection, the primary authors, using current literature and their knowledge and experiences as ATs, designed the interview framework.^5,9,11  To deepen the information collected and truly capture the phenomenon of interest, we asked an expert on gender concerns in sport to review the content and structure of the interview guide (Appendix). This process allowed us to verify the content of the interview guide and the interpretability of the questions. Edits were focused on ordering and grammar. We also asked an AT who met our criteria for study inclusion to function as a pilot participant. The pilot interview served as a final step in establishing the interview framework and content. No changes were made to the interview framework after the pilot interview; therefore, her information was included.

The interview format was semistructured to allow for as much flexibility as possible and to encourage our participants to freely share and volunteer information. This allowed the interviewers to deviate from the established interview questions when findings arose that were not initially anticipated in the development of the interview framework.¹⁶  All interviews were digitally recorded and transcribed verbatim.

We used a thematic analysis with the principles of interpretative phenomenologic analysis (IPA)^17–19  to identify the developing themes. Blending these analyses allowed for a more rigorous examination of the raw data in order to understand the participants' experiences. Both strategies are fundamentally linked through the inductive lens, which involves making sense of the data and those living the experience under investigation.^17,18  The stepwise process is detailed in Figure 2.

We monitored trustworthiness using the guidelines outlined by Creswell,¹⁵  including credibility checks, peer review, and researcher triangulations. Upon completion of our analyses, we shared our findings with the pilot-study participant. She was asked to evaluate our interpretations, compare them with her experiences, and confirm their accuracy. Our peer reviewer, who has strong knowledge of the topic being studied as deemed by her publication record, was able to validate not only the procedures used to collect the data but also the strategies used to interpret the data. We followed the standard techniques of a thematic analysis process with underlying aspects of an IPA, but we did so independently to reduce bias during the coding process. Researcher triangulations continued through consensus between the 2 primary authors.²⁰ 

Upon completion of our IPA, we identified 2 major themes regarding the factors that played a role in female ATs' receiving the opportunity to provide medical care to male athletic teams in the NCAA Division I setting. Access to these positions was based mainly on hiring practices and factors that served as job attractors for the women in this study. A visual breakdown of the emergent themes and subthemes is shown in Figure 3. In the next sections, we provide a description of the emergent themes with quotes from our participants. Pseudonyms have been assigned to protect the confidentiality of the participants.

The hiring of female ATs to provide medical care to male sport teams in our sample was based primarily on the AT having preexisting experience at the university or with a staff member who was involved in the hiring process for her current position. In addition, our participants spoke about their commitment to their positions and the personal drive that helped secure their current employment. The theme of securing the job can be summarized by the premise that the female ATs' previous performance, as well as knowledge of their abilities by those in hiring positions, assisted in their being hired. This theme has been divided into 3 categories: (1) familiarity; (2) previous experience providing medical care to a male sport team; and (3) perseverance, professionalism, and confidence.

Familiarity is a reflection of the previous interactions or personal connections (or both) participants had with the university or an individual from a past position. This connection served as a catalyst for some of the female ATs in our study to obtain the position they currently hold.

Danielle revealed how her part-time job led her to where she is now: “After a year of working parttime at [university], a full-time job opened up, and the day that the person's who[se] job I took resigned, my boss just called me up and said, ‘Hey, you're in line. Do you want it?'”

Danielle was able to attain her current role due to her past position, which gave her supervisor the chance to witness her patient-care skills and her ability to perform as an AT. Two other participants shared similar experiences, explaining how their previous positions opened the door to new opportunities in their current institutions. Candice reflected on the impact her internship had on the job search: “After I completed my internship…, a full-time position opened up, and I've been here ever since.” Similarly, Kayla stated, “I was a graduate assistant here at the school where I am, and then when I graduated we added a position to football and I applied for that.” Danielle, Candice, and Kayla each reflected on the importance of role performance, whereby their past positive experiences provided them with the chance to secure their current position. Some participants were initially hired for another position or assigned to other teams but were then reassigned to a male sport team due to staff turnover.

Leah explained how this eventually led to her current position:

On a parallel note, a past connection, when a supervisor had the chance to actively evaluate an AT's skills and knowledge, can facilitate job access. Emily commented specifically on a personal connection that landed her the position: “[I] worked there for 2 years, and that's where I met [name] who is the head athletic trainer here… He ended up getting the job at [university] and had an opening a few months after he got here, and I applied.” The participants' experiences speak to a more active assessment of their performance before attaining the position to provide medical care to a male sport team.

A more traditional means of hiring a female AT was less common in our sample. Only 4 female ATs were hired directly for their current position without prior experience at the university or familiarity with a member of the sports medicine team. When asked how they arrived at their current positions, 2 participants described the traditional application process of finding the position, applying, and being offered the job. Jasmine explained, “I applied for the open position, interviewed for it, and reached this opportunity in 2006 to work for the sports medicine department at [university].” Ava shared a similar experience of applying for a graduate assistantship position, interviewing, and getting the job.

Many participants reported that they had previous experience with a particular male sport before their hiring. Participants perceived that the prior experience gave them an understanding of the sport and, in some cases, its culture, while providing them with the confidence to succeed in their current position. Emily discussed how her experiences with football in a prior role were the foundation to her overall confidence in her abilities: “I had experience with football… I was basically by myself working football, because it was just me and a graduate assistant [athletic trainer]. So I was kind of in charge, and so I think that helped me gain some independence and some confidence.”

Leah reflected on her educational training and previous background, experiences that allowed her to be successful in her current role. Leah's résumé included providing medical care to men's lacrosse while in school. During her interview, she noted that these experiences had given her the chance to become familiar with the sport and its culture, which allowed for a smooth transition when accepting a full-time position with a men's lacrosse team. Leah said, “I worked with two different men's lacrosse teams while I was [at school], so that has helped.” Anna discussed being involved with wrestling in a past position. Because her colleague provided medical care to multiple teams, she was often assigned to assist with wrestling coverage when needed. This proved to be a catalyst to preparing for her next position. Discussing this situation, Anna stated: “I did a lot with wrestling there [at my university], because the wrestling athletic trainer also worked volleyball. And since I was out of season in the fall, I was able to help, so I did a lot of covering their practices while he was traveling with volleyball.”

Danielle discussed the influence her mentor, a preceptor, had on her development as a female athletic training student:

Danielle's experience, although it occurred before she was credentialed, still offered her real-time, authentic engagement in providing medical care to a male sport. Providing medical care to male sport teams appeared to give participants valuable job experiences and prepared them to be ready to fulfill the role of a female AT working with a male sport. Although participants said their overall experiences (eg, graduate assistant positions regardless of sport or gender) were necessary to become successful and gain access to their current role, demonstrating the ability to provide medical care to a male sport team was deemed more important.

Participants spoke about the importance of being committed to their goals, demonstrating their skills and abilities with professionalism, and being confident in their clinical skill sets. Zoe expressed her belief that female ATs had as much right to fulfill positions with male sport teams as male ATs: “Don't give up. Don't be discouraged. Don't let anyone tell you that you don't belong there. You know more than they [coaches] think you do… You belong there just as much as anybody else does.”

Leah's advice followed a similar path, as she asserted that gender should not even be a factor: “I think the biggest advice I'd share is don't let the fact that you're a female deter you.” Kayla also alluded to aspiring to work with male sports and committing to it no matter what obstacles she faced: “Never give up. If that's what you want to do, then don't let somebody put you in a box… Go find a person that tells you, you can.” Similarly, Natalie stated, “Go for it. Athletes are athletes, and if you are smart, confident, and good at what you do, gender shouldn't matter.” Like Natalie, Olivia spoke about the importance of confidence, among other qualities, and how it helped her navigate her role as a female AT: “I think you just have to be really confident and personable and approachable and someone that is willing to help out whenever, however.”

Multiple participants cited professionalism as an important quality to possess when working as an AT. Being a female AT often poses unique challenges when working with a male sport team, specifically in how interactions, both social and professional, take place. Ava referred to this when addressing the importance of establishing boundaries and how it helped her navigate her role as a female AT working with a male sport: “Establish boundaries very early; if someone says anything out of line you have to learn how to deal with that…and carry yourself very professionally.” Similarly, Anna and Jasmine both identified acting in a professional manner as the top priority. Anna said, “Professionalism has to be number one,” and Jasmine agreed, “Just be a professional and stand out in a positive way.”

In their comments, participants described desirable aspects of their positions, which led them to pursue being hired.

For this group of female ATs, a major attractor was seeking employment in the fast-paced environment and at the high level of competition provided at the NCAA Division I level. Their focus was the setting, rather than the sport or whether they accepted a position with a male or female sport. Candice reflected on the aspects of the job she found most desirable: “I knew I've always wanted to work in college athletics. I just enjoy the competition, the drive, working with student-athletes, obviously the athletics as well.” Emily also commented on these aspects of Division I athletics as the reason for seeking employment in this setting: “I really like the game-day experience, like the high pace of athletics.” A few women actively sought employment at specific locations because of the sport that was offered. Zoe, for example, discussed the level of competition as an attractor but also referenced her love of the particular sport as the ultimate deciding factor:

Of the 15 participants, only 4 directly linked their primary attraction to the position with the possibility of working with a specific sport. Jasmine referred to this attraction as a key factor in her job search: “I also always had a passion and a love for basketball, and when the opportunity came open, I was offered the position…with that coverage. I jumped on that about 6 years ago.” Similarly, Kayla's interest in football was what ultimately brought her to the university where she is currently employed: “The thing that attracted me to my current university is that when they offered me my grad assistantship, they offered me football, so I knew that's what I wanted to work.” The major facilitator for seeking their current position was to be in an environment that matched their interests and was not driven by gender.

Location was another position attractor and included the university itself, as well as the staff that currently worked in the athletic department. The importance of family and being closer to home was a key reason for seeking or accepting the job. When asked what attracted her to her current university, Danielle said, “I'm about 2 hours north…and my sister lives in [the same location], so I guess just kind of staying in the area.” Jasmine also expressed a similar motive in applying for and accepting her current position: “University wise it was an opportunity to come back home.” For 1 participant, the location of the university alone was less of an attractor than her familiarity with the staff currently working there. “Yeah, just, you know, coming back home. The sports. Working with my mentors. I was comfortable here, knowing most of the staff. That is something that really made me interested in the position.” Leah was pleased with all aspects of the university and its location, which was evident: “I really like the university; I really liked the athletic department as a whole. I liked the staff that I was going to be working with, and just the overall environment down here. It's a really nice place to work; the facilities are amazing, which is also a benefit.”

The variety of job attractors reported by participants suggests that reasons for seeking out and accepting positions are often multifactorial. However, the factors having the greatest influence were the environment, specifically the pace and intensity of the collegiate setting, as well as the location of the university and the staff presently working there.

Our purpose was to examine the factors, including attractors and motivators, that contributed to female ATs obtaining positions with male sport teams. We found that participants did not face barriers to being hired in their current positions and that the reasons for pursuing an athletic training position with a male sport team at the NCAA Division I level were multifactorial.

Despite previous literature^2–6  demonstrating challenges for women in the athletic training profession, results from this study show increased opportunity and progression for women in this field. Overall, access to these positions was not a barrier to the hiring of female ATs for male sport teams. Previous authors⁶  have determined that female ATs lacked the opportunity to be hired in administrative roles at the NCAA Division I level and specifically that men controlling these positions set the agenda regarding hiring and work policies. The literature shows that gender bias is prevalent in other sport-related positions as well, including strength and conditioning coaching. Female strength and conditioning coaches employed at the collegiate level have reported disadvantages in their jobs, which were believed to be influenced by their gender.²¹  The presence of a “glass ceiling,” which prevented the advancement of women in the profession, was identified as the largest disadvantage for female strength and conditioning coaches, possibly because men primarily held the administrative positions responsible for promotion and advancement.²¹  Although this has been a key area of concern for the athletic training profession in the past, our findings indicated that despite a majority of the leadership positions still being filled by men, the female participants in this study did not experience resistance during the hiring process. The female ATs in our study were not limited in their access to athletic training positions with male sports and did not face the same professional barriers as the women who came before them.

In addition, having previous experiences working with a male sport team gave some participants the confidence to pursue similar positions. Not only did these result in increased confidence in their overall ability to perform, but they also provided the female ATs in our study the self-assurance to persevere and succeed in their current roles. The idea of familiarity can be connected to the gendered adage of the “old boys' network,” whereby men often supported and promoted other men to leadership and prestige positions.^9,22,23  For our participants, however, gender appeared to not be a concern; rather, past performance served as a strong platform from which to hire the AT for the position.

Women in the profession are following in the footsteps of the first female ATs who obtained positions with male sport teams and are pushing the boundaries that once kept them from male-dominated sports. Social media has played a large role in highlighting these monumental successes and could potentially contribute to the enhanced sense of confidence expressed by women now in the profession. Ariko Iso, the first female AT in the National Football League, spent 9 years with the Pittsburgh Steelers before taking a position as the head football AT at Oregon State University in 2011.²⁴  Iso's experiences, at a time when a very low percentage of female ATs worked in male-dominated sports,⁷  likely provided the groundwork for others to attain positions with the National Football League and other professional sports and in leadership or positions on male sport teams in collegiate athletics.

Another woman to break the professional sports barrier was Sue Falsone, who in 2011 was named the AT for the Los Angeles Dodgers, becoming the first woman in Major League Baseball history in such a position.²⁵  Although she has since resigned, her outlook on taking the position was not focused on her gender.²⁵  In an article from November 2011,²⁵  Falsone described focusing on the opportunity to bring new skills, strategies, and knowledge to the table rather than on her gender. This supports the fact that persons in leadership and those making hiring decisions should look beyond gender and offer the job to the most qualified candidate. The Washington Redskins recently hired their first female intern, Abigail Solis, who reported receiving nothing but respect from the athletes and support staff.²⁶  Despite the challenges and barriers faced by previous female ATs, evidence, including the experiences of our sample, indicates that female ATs are persevering and making strides in male-dominant sports at both the collegiate and professional levels.

Understanding the characteristics that attract individuals to particular job settings provides insight into the factors that most influence the decision to pursue a particular position, as well as reasons that will likely keep them in those positions. Desirable aspects of the job that led our participants to seek their current opportunity included the environment, specifically the level of competition, and the location. These factors are comparable with those reported previously in the literature^27–29  focusing on retention and attrition of male and female ATs, but we are the first to report that those variables created an initial interest in the position.

Gardiner-Shires and Mensch³⁰  explored attractors to an athletic training career in the high school setting and described factors consistent with continuation, service, and interpersonal concerns, some of which were evident in the findings from our study. A few of our participants alluded to interpersonal connections as a job attractor, consistent with the current literature. Specifically, they enjoyed working with student-athletes and wanted to continue doing so. The participants in this study loved the fast pace of athletics, working at a Division I university, and having the opportunity to work with student-athletes at this level. Some participants, however, placed importance on the interpersonal connections with the staff currently working at the university. Having a supportive supervisor, such as the head AT, has been reported⁵  as critical to alleviating gender bias in the college setting. Just as important is support through mentoring, a finding that was evident in our investigation, as many referenced the importance of a supportive staff as a means to succeeding in their current roles. The familiarity of the staff, an established support network, and a positive working environment were key factors in the decision to accept their current positions. Furthermore, some respondents were attracted to their current job because they had a previous working relationship with the staff.

The concept of continuation has been reported as an attractor to the profession.³⁰  In other words, some want to remain associated with sports and an athletics program after their own athletic career has ended. Several participants in the current study sought employment based on their love for a particular sport. They knew they wanted to work in the collegiate setting, primarily due to the fast-paced environment, but their desire to work with a certain male-dominated sport team (eg, football, wrestling) was based on personal interest. It is interesting that this has been deemed an “identity crisis,”³¹  describing 2 conflicting motivators to entering the athletic training profession. These motivators are often the desire to remain associated with sports or the desire to be a health care professional. According to Schrader in 2005,³¹  some ATs were drawn to the profession because of the desire to help people and become health care professionals (the health care model), whereas the team-member model aligns with the others who wanted to remain associated with sports and be a part of the team. Participants in our study identified with both of these models, sometimes simultaneously, which complement the findings of Gardiner-Shires and Mensch.³⁰  Our results provide evidence that working with student-athletes and being involved in athletics continue to be dominant reasons for pursuing the athletic training profession.

We did find that many study participants were attracted to their position because it was located closer to home, friends, and family. Although this attractor has not been previously reported in the literature, kinship responsibility (that is, the need to be closer to family as a mediator for employment selection) has been noted to influence the retention or attrition of ATs in their positions.²⁷  Our finding is novel as it demonstrates that female ATs were not solely looking for a male sport as their primary motivational factor for a position. For our participants, pursuit of their current position was primarily due to the competitive nature and intensity at the collegiate level. It was evident that other attractors were also important to consider when pursuing an athletic training position at the Division I level; the specific location was noted by 6 participants as a contributing factor to their securing the position.

Our findings are notable; however, the study is not without limitations. The participants were all female ATs; thus, the data and perspectives solely reflect this sample population. In regard to hiring practices and job access, we did not interview head ATs, athletic directors, directors of sports medicine, or others who may be in charge of the hiring practices. This could have led to bias in our findings, as we did not obtain the perspectives of other key stakeholders involved in the hiring process. In addition, we cannot generalize our findings to female ATs working outside the Division I setting; all participants were employed at Division I universities, as defined by our inclusion criteria. Similarly, as none of the participants worked at Division II or III schools, or outside the intercollegiate setting, we cannot generalize our findings to these populations or assume similar experiences.

Future researchers should examine the hiring practices of female ATs from the perspective of the head AT, director of sports medicine, or athletic director (depending on the department structure) to gain insight into whether their perspectives match the experiences of the study participants. Additionally, understanding the factors that contribute to female ATs attaining positions with male sport teams at the Division II and III levels would be beneficial. This would allow for a comparison among divisions to determine if job access for female ATs is relatively similar across all levels of competition. These future research ideas could be explored as a follow-up to the findings in our study.

Our purpose was to gain insight into the factors that played roles in female ATs securing a position working with a male sport team. Participants did not appear to face challenges when pursuing their current positions, which is potential evidence that job access for the women in our study was equal to that of their male counterparts. A majority of our participants were made aware of their current positions through established connections with university staff or a former position at the university. However, a small sample of participants used the traditional application process to secure their current job, which entailed applying, interviewing, and receiving the offer. From the female ATs' perspectives, preexisting experiences at the university or with staff at the university (or both), previous experience working with a male sport, and perseverance all played roles in their being hired to provide medical care to male sport teams. Furthermore, motivational factors for attaining a position with a male sport team were not driven only by the desire to work with the sport. Other contributory factors, such as the environment and location, also played roles in the decision-making process.

We would like to acknowledge Abby Fisher, BS, ATC, for her contributions to the development of this research study.

• 1.

  What attracted you to your current role?

• 2.

  What attracted you to your current university/workplace setting?

• 3.

  When you were first hired, what were your outlined job responsibilities, including your assignments for medical coverage?

• 4.

  If your assignment changed since your initial hire, can you describe how/why it happened?

• 5.

  What experiences prepared you to accept the current position you hold?

• 6.

  Can you describe your experiences currently working with your team?

• 7.

  What advice would you share with young female athletic trainers aspiring to battle the gender barrier in athletics?