Lack of Standardization in Athletic Training

California gets a LOT of criticism for not pursuing full athletic training licensure sooner.

But the bigger national conversation is this:

Not every state operates under the same “industry standard” structure.

▪️ CA = registration/title protection

▪️ HI= registration model

▪️TX = LAT & BOC/ATC tracks

▪️CO = registration model (2021)

So while CA became the public example of “lack of standardization,” the reality is the profession still has multiple regulatory identities nationwide.

Each state reflects a different philosophy about what AT is supposed to be

California

Has resisted licensure for decades & ultimately passed a registration/title protection compromise.

Supporters argue:

▪️ it finally created minimum standards

▪️ protected the AT title

▪️ improved accountability

Critics argue:

▪️ does not protect AT functions

▪️ employers can relabel positions

▪️ healthcare identity remains diluted

CA often gets framed as “behind.”

But it also exposed how fragmented the profession already was nationally.

Hawaii

Uses a registration structure rather than traditional licensure.

However, HI registration behaves much more like licensure:

▪️ BOC required

▪️ state oversight exists

▪️ disciplinary authority exists

▪️ legal authorization to practice exists

Likely maintains this structure because:

▪️ smaller workforce

▪️ preference for lighter regulatory bureaucracy

▪️ desire for flexibility without building a large licensing board

Operationally, it is much stronger than CA models despite using “registration” terminology.

Colorado

Historically preferred lighter occupational regulation across many professions

Its registration framework reflects:

▪️ anti-overregulation philosophy

▪️ lower administrative burden

▪️ workforce flexibility

It regulated ATs, but with a less aggressive healthcare-board model

The challenge:

The softer regulatory language weaken public understanding of ATs as autonomous healthcare professionals

*CO moved to licensure in 2020

Texas

The most unique state in the country as it still preserves:

▪️ Licensed Athletic Trainer (LAT) pathways

▪️ state exams

▪️ apprenticeship-style routes

▪️ legacy workforce structures

This exists because it built enormous AT infrastructure before the profession nationally standardized around:

▪️ CAATE programs

▪️ BOC certification

▪️ graduate education

Preserved older pathways:

▪️ protect workforce continuity

▪️ avoid staffing shortages

▪️ respect experienced clinicians

▪️ maintain rural & secondary school access

Is this historic route relevant with the updated educational standards?

The bigger national issue to consider with these states:

▪️ standardization

▪️ healthcare recognition

▪️ interstate mobility

▪️ compact participation

▪️ reimbursement

▪️ professional identity

But nationally, AT regulation still varies significantly.

That creates questions about:

▪️ What defines an AT?

▪️ Is it licensure?

▪️ BOC certification?

▪️ Education?

▪️ State authority?

▪️ Competency?