Adding Athletic Trainers to Care Team Can Increase Docs' Productivity
'Physician Extenders' Fill Variety of Functions
By David Mitchell
4/3/2009
According to the National Athletic Trainers' Association, or NATA, nearly 8,000 of its members worked in hospitals, clinics and physician offices last year, and the number is growing. That figure, which represents more than a quarter of the association's members, is up more than 4 percent since 2001. The services these health professionals provide can bring significant value to a medical practice, says one family physician.
Thomas Kohl, M.D., left, a family physician at the Comprehensive Athletic Treatment Center in Wyomissing, Pa., and athletic trainer John Howell talk with patient Patti DeGrasse about her chronic knee condition. Howell serves as a "physician extender" in the practice to improve patient quality of care and efficiency in the doctor's office.
Thomas Kohl, M.D., who maintains a private practice and serves as medical director at the Comprehensive Athletic Treatment Center in Wyomissing, Pa., told AAFP News Now that the six full-time and one part-time athletic trainers he employs increase overall productivity and improve patient outcomes.
"They do rehab, review exercises, fit braces, do orthotics, perform testing -- things I don't have time to do, but they can do and generate revenue in doing it," Kohl said.
"They do rehab, review exercises, fit braces, do orthotics, perform testing -- things I don't have time to do, but they can do and generate revenue in doing it," Kohl said.
Physician Extenders
One of the athletic trainers in his practice, Berkshire Family Medicine, P.C., serves as a medical assistant, he explained. She escorts patients to exam rooms, takes their medical histories, starts evaluations and sends Kohl's prescriptions to pharmacies electronically. She also can fit braces and offer exercise counseling, Kohl noted.
All of the functions that that one athletic trainer provides allow him more time to spend with other patients, said Kohl.
"Athletic trainers have an expertise in musculoskeletal health and practice this every day," said John Howell, who is a certified athletic trainer, a certified strength and conditioning specialist, director of human performance services and director of industrial medicine services at Comprehensive Athletic Treatment Center.
"We can take a patient's history, go through a necessary evaluation using special testing to better address a patient's health issue and also recognize specific mechanisms of injury that could steer the assessment in a particular direction," he added. "Athletic trainers are also valuable for post-assessment initiation of a treatment plan. Whether it be bracing, splinting, casting or something as simple as home exercise program prescription, athletic trainers excel in such areas while decreasing a physician's needed face time."
According to an NATA report, having athletic trainers -- not to be confused with personal trainers -- working as "physician extenders" allows physician offices to see 12 more patients per day by moving patients through the evaluation and management processes faster.
All of the functions that that one athletic trainer provides allow him more time to spend with other patients, said Kohl.
"Athletic trainers have an expertise in musculoskeletal health and practice this every day," said John Howell, who is a certified athletic trainer, a certified strength and conditioning specialist, director of human performance services and director of industrial medicine services at Comprehensive Athletic Treatment Center.
"We can take a patient's history, go through a necessary evaluation using special testing to better address a patient's health issue and also recognize specific mechanisms of injury that could steer the assessment in a particular direction," he added. "Athletic trainers are also valuable for post-assessment initiation of a treatment plan. Whether it be bracing, splinting, casting or something as simple as home exercise program prescription, athletic trainers excel in such areas while decreasing a physician's needed face time."
According to an NATA report, having athletic trainers -- not to be confused with personal trainers -- working as "physician extenders" allows physician offices to see 12 more patients per day by moving patients through the evaluation and management processes faster.
Dieticians, Other Ancillary Providers Add Expertise to Physician Practices
Athletic trainers aren't the only health personnel who can help patients, make physicians' jobs easier and add value to a practice.
Massage therapists, nutritionists and dieticians are just a few other examples.
These "physician extenders" don't even have to be employees. Family physician Jane Murray, M.D., of Overland Park, Kan., said a dietician regularly sees patients in her practice, but the dietician is not on the payroll.
Dieticians play a crucial rule in treating patients with a variety of conditions, said Murray, including diabetes, metabolic syndrome and hypercholesterolemia, as well as those who are underweight or obese.
"They have more time and expertise to get into the details of diet, cooking, shopping,
etc.," she explained.
Although some physicians refer patients to nutritionists or dieticians at local hospitals, Murray said she found it advantageous to have an expert on-site.
Massage therapists, nutritionists and dieticians are just a few other examples.
These "physician extenders" don't even have to be employees. Family physician Jane Murray, M.D., of Overland Park, Kan., said a dietician regularly sees patients in her practice, but the dietician is not on the payroll.
Dieticians play a crucial rule in treating patients with a variety of conditions, said Murray, including diabetes, metabolic syndrome and hypercholesterolemia, as well as those who are underweight or obese.
"They have more time and expertise to get into the details of diet, cooking, shopping,
etc.," she explained.
Although some physicians refer patients to nutritionists or dieticians at local hospitals, Murray said she found it advantageous to have an expert on-site.
Kohl said his patients like working with the athletic trainers, who help them better understand their path to recovery.
Although Kohl noted that his practice specifically includes school contracts for sports medicine services, he said he thinks working with athletic trainers could benefit other family medicine practices.
"About 25 percent of visits in a family medicine practice are musculoskeletal-based -- back pain, shoulder pain, etc.," said Kohl. "The majority of my practice is general family medicine.
"I have taken new athletic trainer graduates and molded them to be excellent assistants by teaching them 'other medicine' and allowing them to use their skills in musculoskeletal medicine."
He added that athletic trainers also can assist in medical weight loss and helping design diet and exercise plans.
"Athletic trainers are educated and trained to achieve outcomes," Howell said. "We are educated with the mindset of getting our athletes back to safe participation as quickly and effectively as possible. This mindset has been a great resource to all patients.
"Whether they are athletes, recreational athletes, casual walkers or joggers, or simply a retired gardener, everyone who enters a doctor's office is having trouble doing something they want to do. Athletic trainers have the education, national certification and specialized skill set to make that happen as fast and as safely possible."
Although Kohl noted that his practice specifically includes school contracts for sports medicine services, he said he thinks working with athletic trainers could benefit other family medicine practices.
"About 25 percent of visits in a family medicine practice are musculoskeletal-based -- back pain, shoulder pain, etc.," said Kohl. "The majority of my practice is general family medicine.
"I have taken new athletic trainer graduates and molded them to be excellent assistants by teaching them 'other medicine' and allowing them to use their skills in musculoskeletal medicine."
He added that athletic trainers also can assist in medical weight loss and helping design diet and exercise plans.
"Athletic trainers are educated and trained to achieve outcomes," Howell said. "We are educated with the mindset of getting our athletes back to safe participation as quickly and effectively as possible. This mindset has been a great resource to all patients.
"Whether they are athletes, recreational athletes, casual walkers or joggers, or simply a retired gardener, everyone who enters a doctor's office is having trouble doing something they want to do. Athletic trainers have the education, national certification and specialized skill set to make that happen as fast and as safely possible."
Increasing Billing Opportunities
Howell said he prefers working in a physician's office -- as opposed to working for an athletic team or school -- because the clinical setting presents a greater challenge, offering a wider variety of disorders than team and school settings. In addition, said Howell, there is greater earning potential in the practice setting.
According to NATA, the average athletic trainer earns $48,000 a year.
But the bottom line, said Howell, is that athletic trainers do more for a practice from a financial standpoint than just increasing physician productivity.
"Adding an athletic trainer to your staff opens up other services to a practice," he said. "You can start prescribing and giving home exercise programs, which are billable. You can offer durable medical equipment, which, if done correctly, can add huge value to a practice. Casting and splinting of nondisplaced, nonsurgical fractures can also be added to any practice where a physician feels comfortable with (trainers handling) simple fracture management.
"Also available are 'incident-to' therapy services. This allows for athletic trainers to perform musculoskeletal therapy to patients with any variety of deficits, all of which is physician-billable," said Howell.
According to NATA, the average athletic trainer earns $48,000 a year.
But the bottom line, said Howell, is that athletic trainers do more for a practice from a financial standpoint than just increasing physician productivity.
"Adding an athletic trainer to your staff opens up other services to a practice," he said. "You can start prescribing and giving home exercise programs, which are billable. You can offer durable medical equipment, which, if done correctly, can add huge value to a practice. Casting and splinting of nondisplaced, nonsurgical fractures can also be added to any practice where a physician feels comfortable with (trainers handling) simple fracture management.
"Also available are 'incident-to' therapy services. This allows for athletic trainers to perform musculoskeletal therapy to patients with any variety of deficits, all of which is physician-billable," said Howell.
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