Athletic training as a profession was around long before the National Athletic Trainers’ Association (NATA) was founded in 1950. Although NATA has grown to more than 43 000 members all over the world, it is important to consider how the demographics of the association have changed since its inception. At the time of its creation, NATA and the athletic training profession as a whole were for White men. To put this into a bit more perspective, the case of Brown v Board of Education did not happen until 1954, and the Civil Rights Act was not enacted until 1964. These issues directly affected the look of the workforce in the United States. By the time the Board of Certification (BOC) and the Commission on Accreditation of Athletic Training Education (CAATE) were incorporated in 1989 and 1991, respectively, the profession’s cultural framework was well established.

The foundation and mission of the profession were cultivated without the influence of underrepresented groups. With the advancement of affirmative action, the workforce across the United States began integrating more women and underrepresented racial groups into historically exclusionary spaces. Although the profession began to diversify along with the rest of the United States, it was not until 1986 that NATA overtly addressed concerns regarding racial diversity within athletic training. After concerns were brought to their attention, the NATA Board of Directors supported the creation of the Minority Athletic Trainers’ Committee (MATC). This committee set out to bring awareness to the issues minority athletic trainers (ATs) were facing. After a restructuring of the MATC in 1991, the MATC transformed into the Ethnic Minority Advisory Council. With more structure, the council changed its name to the Ethnic Diversity Advisory Committee (EDAC) in 1999 to capture the narratives of a wider range of underrepresented ATs.

One of the key contributions the EDAC has made addressing issues surrounding the diversification of NATA is collecting demographic data of the athletic training profession. Since 1997, the EDAC has collected the demographic information of the NATA membership. In 1997, the Ethnic Minority Advisory Council reported that 1280 ATs described being African American (1.2%), Asian (1.9%), Hispanic (2.1%), Native American (0.49%), or other (0.38%), in contrast to 16 834 who described being White (79.7%); the remaining ATs did not select an ethnicity. This meant that 6% of all ATs in NATA identified with an underrepresented group. The diversity snapshot reported by the EDAC in 2021 showed that 18.09% of ATs self-categorized as Black not of Hispanic origin, Asian or Pacific Islander, Hispanic, multiethnic, American Indian/Alaskan Native, or other. The changes in available race and ethnic categories demonstrated the EDAC’s continued efforts to draw attention to all underrepresented groups. Although that increase was almost 3 times the percentage first reported in 1997, ATs who identified as White accounted for 81.45% of all NATA members. The percentage of ATs identifying with underrepresented racial and ethnic groups has increased, yet more work is needed to diversify the profession.

Creation of the EDAC has helped to develop a space for ATs of underrepresented groups to feel supported, but it may also create a “tale of 2 cities” within NATA, leaving underrepresented ATs to navigate 2 spaces differently. It might benefit all for NATA to review the impact the EDAC should have on the larger population; the EDAC should not be the only space where ethnically diverse ATs feel affirmed. In fact, as its name suggests, the EDAC should act and advise NATA on how to tackle diversity within itself, which is one of the EDAC’s objectives. For this and a few other reasons already mentioned, the chair of the EDAC should be included as a member of the NATA Board of Directors.

In 2010, Marra et al found ATs to be less culturally competent than self-reported.1  The assessment was completed by many ATs who identified as White or Caucasian, not unlike the demographic of NATA overall. Results of this study showed ATs identifying as multiracial/other and Black/African American with higher cultural competence scores. Such findings could inform how difficult issues surrounding race and diversity, equity, and inclusion (DEI) need to be taught and assessed by CAATE–accredited programs and within the BOC examination. The need to increase cultural competency is now explicitly highlighted in the 2 new CAATE standards that were added in 2020. The BOC could consider mandating online cultural competency training every 3 or so years to ensure it is an important part of the way ATs are practicing as clinicians and as professionals. Similarly to mandating evidence-based practice continuing education units, the BOC can help to institutionalize the need to address cultural competence in the profession. The training could include elements of recognizing and addressing racial bias and gender equity and providing safe spaces.

When examining diversity through a gender-focused lens, the demographic breakdown might suggest that gender equality has been solved in athletic training. Currently, women outnumber men in NATA by almost 10%; that ignores the fact that a mostly dichotomous gender breakdown excludes those who do not fit the binary classification. Although women outnumber men in NATA, currently 76% of female ATs have no supervisory responsibilities, compared with 61% of male ATs. Additionally, women with supervisory responsibilities are supervising more people for less money on average compared with their male counterparts. The work to promote equity within the profession and advocate against these gender differences is not complete, and yet, the Women in Athletic Training Committee was dissolved in 2008. This hints that the profession is not absolved from perpetuating implicitly biased gender-based differences, which preserve a “boys’ club” environment.

A missing piece of the assessment of diversity within the profession is that of the lesbian, gay, bisexual, transgender, queer, intersex, and asexual community. The NATA LGBTQ+ Advisory Committee was not considered a volunteer committee until 2017, although issues facing this population existed long before then. The concerns of underrepresented groups might unfortunately be overlooked by simply creating a committee and making it the responsibility of the committee to handle those concerns. Intersections of these diverse communities exist and they need to be viewed together, not in isolation and not only within those committees. Devoting a day during the NATA convention to address the concerns of these underrepresented populations with workshops and lecture series would be appropriate. Although some DEI content is offered during the convention, a day devoted to these topics could have greater impact on multiple parts of the athletic training profession, from collegial interactions to patient care, especially if DEI is recognized similarly to evidence-based practice as a continuing education priority. These issues are not going away, and the profession needs to holistically lean into addressing them head-on.

Assessment of certified athletic trainers’ levels of cultural competence in the delivery of health care
J Athl Train