Column: Coaches vs. Medical Personnel - Who Rules?July 19, 2015

Column: Coaches vs. Medical Personnel - Who Rules? With colleges on the cusp of pre-season football practice, there’s an off-field contest worth keeping an eye on: Coaches vs. medical personnel.

Head coaches at a majority of the big-time college football programs insist on hiring, supervising and firing the doctors and athletic trainers that attend to their student-athletes. Not surprisingly, medical practitioners don’t believe that having a coach for a “boss” is in the best interest of student-athletes.

Two years ago, the National Athletic Trainers’ Association, joined by five other medical groups including the American Medical Society for Sports Medicine, issued a public statement against the practice. They also came up with a set of recommendations which were published in the Journal of Athletic Training that were designed to maintain the independence of doctors and athletic trainers. In their words, “Freedom in their professional practice is ensured when neither the team physician nor the athletic trainer has a coach as his or her primary supervisor, and no coach has authority over the appointment or employment of sports medicine providers.”

Dr. James Tucker, Head Team Physician at Syracuse University, told Training & Conditioning, “For the medical community (coaches hiring medical staff is) a conflict of interest. Medical people should do what medical people do and coaches should do what they do…With the pressures that coaches are under I think it’s hard for them to be objective, especially when they don’t have the depth of knowledge that medical staff does.”

While it’s incomprehensible how anyone can disagree with Tucker’s comments, not everyone in the business of collegiate athletics is supportive. Many coaches defend their position by saying it’s a matter of trust. If they didn’t hire a doctor or trainer, how can they trust them to make a decision that is in the best interest of the program? But medical personnel aren’t hired for that purpose. Their responsibility should be to the student-athletes, not to the coach whose primary goal is winning games. Coaches wouldn’t tolerate medical personnel telling them what plays to run or which assistants to hire. Where do coaches get off telling medical staff how to do their jobs?

The answer of course lies in the power and authority that coaches have been ceded by their Athletic Directors and institutions. As Tucker pointed out, coaches are under immense pressure, not to maintain the short or long term health and wellbeing of their athletes or to educate them. In order for coaches to remain employed and earn their multi-million dollar contracts, they need to win. And it’s easier to win with your best athletes in the lineup, healthy or not.

Dr. Brian Hainline, a New York University neurologist, was hired by the NCAA two years ago as the organization’s chief Medical Officer. He was specifically asked to address concussion protocols for NCAA schools. Not surprisingly, Hainline agrees with Tucker. He has campaigned for giving medical personnel unchallenged authority from coaches and athletic departments. Hainline told the Wall Street Journal, “Doctors should have complete autonomy to operate in the best interest of players.” To that end, he released a set of guidelines which include a recommendation that the role and employment status of team doctors should be determined through a formal administrative process, i.e., medical personnel should not be appointed by or report to the coach.

At the University of North Carolina, team doctors don’t report to the coaches or anyone in the athletic department, only to administrative personnel within the campus health system. Such a reporting system obviates any opportunity for coaches – or anyone else in the athletic department - to influence medical decisions, the type of system recommended by Hainline and other medical providers. However, that’s not the reality at most major colleges and universities.

In a 2013 survey of FBS schools conducted by The Chronicle of Higher Education 40% of football athletic trainers said they either reported directly to the coach or a member of the coaching staff, or the head coach or another member of the coaching staff had influence over the hiring and firing decisions. More than half of all trainers who responded to the survey said they had been pressured to return an athlete to play before they felt he was ready. The Chronicle survey also found that athletic trainers who were willing to butt heads with the coaching staff jeopardized their career.

In fairness, the survey results suggest that almost half of coaches don’t try to influence the decisions of trainers. However, many team trainers and doctors say that even well-intentioned coaches can unwittingly exert pressure on them to return athletes to play sooner than good medical practice would dictate.

While it’s easy to blame coaches for pressuring medical personnel to make decisions that benefit the team, there is another dynamic that deserves mention. As much as coaches want to win, and medical personnel want to make return to play decisions without being pressured by athletic personnel, athletes want to compete. It is incumbent on student-athletes, especially concussed players, to give honest responses to medical personnel to allow them to make knowledgeable decisions concerning when an athlete is ready to return to action.

The conflict between medical personnel and coaches doesn’t exist only in amateur athletics. Professional sports have had their share of complaints – and laws suits – over the lack of independence of team medical personnel. In the aftermath of the recently settled NFL Concussion Lawsuit, the league adopted a number of new protocols and policies designed to create a barrier between coaches and medical personnel in an effort to protect the health and welfare of its players.
The NFL has a five-page Return-to-Play Policy for all concussed players. The Policy mandates that “the decision to return a player to participation remains within the professional judgment of the Head Team Physician or Team Physician designated for concussion evaluation and treatment.” Furthermore, “all return to full participation decisions are to be confirmed by the Independent Neurological Consultant.”

Why can’t the NCAA mandate similar protocols? The short answer is they can, but the governing body is afraid of lawsuits should any mandated protocols not be followed by member institutions. Therefore, rather than pushing for passage of legislation mandating protocols, the NCAA maintains that athlete health is the province of individual members. However, the absence of mandates hasn’t prevented lawsuits from being brought against both the NCAA and individual schools.

Ironically, the NCAA was founded to promote the health and welfare of student-athletes. If the governing body and its member institutions were really concerned about student-athletes they would have adopted Hainline’s guidelines long ago. The fact that they haven’t speaks volumes about their real interests.

Until the NCAA adopts Hainline’s recommendations, the battle between coaches and medical personnel will continue unabated. The winners will be undetermined; the losers will be our nation’s student-athletes.