Athletic trainer employment, physician access and care delivery in secondary schools.

: To evaluate the source of employment of athletic trainers (ATs), access to team physicians, and usage of up-to-date (implementation of the most current international sports medicine societies' position statements and evidence-based literature policy and procedure manuals in secondary schools. : We conducted a cross-sectional study among National Athletic Trainers' Association (NATA) members. NATA 'Research Survey Request' was contacted to obtain 1,000 e-mail addresses of ATs who actively worked in the secondary school setting. We evaluated AT employment, access to team physicians, and usage of up-to-date policy and procedure manuals within different residential areas (urban, suburban, and rural) and school distinctions (public vs. private). : Two-hundred ninety-six responses were received (30% response rate). The majority (72%) of ATs reported having an assigned team physician for their school. Approximately one-third (36%) of ATs reported being employed by a hospital, clinic, or outreach facility. Fifty-one percent of ATs reported having a policy and procedure manual that was developed and reviewed with their team physician. There was a significantly greater amount of suburban ATs who reported having an up-to-date policy and procedure manual (urban 45% vs. suburban 60% vs. rural 39%; p = 0.007). Significantly more ATs who were employed in a public school setting reported conducting annual policy and procedure manual reviews than those employed in private school settings (public 63% vs. private 49%; p = 0.045). : The majority of ATs have assigned team physicians and a third is employed by a medical group. A high number of ATs reported not having a policy and procedure manual that was developed and reviewed with their team physician. Sports medicine teams within secondary schools, particularly in private schools, should strive to develop and maintain an up-to-date policy and procedure manual that is frequently reviewed with their team physician.