Athletic Trainer Perceptions of Life-Work Balance and Parenting Concerns

Abstract

Context:

Life-work balance may be one reason for retention concerns among athletic trainers (ATs), yet evidence does not exist to support the supposition.

Objective:

To assess the perceptions of ATs regarding life-work balance, specifically on parenting issues.

Design:

Survey.

Setting:

Online survey at www.surveymonkey.com.

Patients or Other Participants:

A random sample of National Athletic Trainers' Association members (N = 9516) received the survey; 20.6% (n = 1962; male = 954, female = 816; age = 37 ± 10 years, experience = 13 ± 9 years) completed any portion of the survey. Most respondents worked in the college/university (34.5%, n = 657 of 1908) and secondary school settings (25.9%, n = 476 of 1908). A majority of participants (50.7%, n = 898 of 1770) were parents.

Intervention(s):

We calculated frequencies and percentages and used Mann-Whitney U tests and Kruskal-Wallis tests to identify the differences between sexes and among job settings on life-work balance measures among parents.

Main Outcome Measures:

The questionnaire included 8 life-work balance items, 7 parenting challenge items, and 3 nonparent items.

Results:

The results indicate that sex and setting significantly affected perceptions about parenting. Males articulated a stronger sense of difficulty in finding balance as a working parent (P < .001; 1.95 ± 1.98). Females felt more strongly than males that managing work and family was stressful (P = .04; 3.86 ± 1.13) and caused burnout (P = .004; 3.50 ± 1.24), and that their energy tended to fall short of their needs (P < .001; 3.74 ± 1.15). The decision not to have children was strongly affected by the work setting (P = .014; 3.37 ± 1.42). Both college/university (4.14 ± 0.85) and secondary school (4.03 ± 0.90) ATs would prefer to spend more time at home, as compared with ATs in other settings (P < .001). College/university ATs (P = .025; 3.17 ± 1.23) felt most strongly that their families were neglected because of work. In none of the settings did ATs feel that their employment settings were particularly tolerant of their parenting responsibilities (P = .027; 1.72 ± 1.97).

Conclusions:

Male and female employees had similar perceptions of life-work balance, but occupational setting may affect these perceptions.

Key Points.

• Sex and employment setting had a significant effect on perceptions of life-work balance and parenting.

• Men reported more difficulty finding balance with being a working parent, yet women struggled with dual roles, which may lead to increased stress and burnout.

• Athletic trainers in the college/university and secondary school setting would prefer to spend more time at home with their families, but college/university athletic trainers reported neglecting their families because of work.

Retaining health care providers, such as athletic trainers (ATs), in their respective professions is imperative to maintain mature practitioners and ensure mentorship of young and future practitioners to continue to facilitate optimal care of patients.¹ Athletic training employment trends indicate that a large number of employees either leave the profession or move to a different athletic training setting, primarily from the university/college setting, at around age 28 for women and 35 men.² The transition parallels national data on women shifting or changing employment after children.^3–6 Life-work balance is suggested as one of the reasons health care professions see employees transition to different settings or professions. Women, however, have been the focus of investigations; therefore, an understanding of male perspectives and employment transitions was the focus of this investigation.

Life-work balance has been theorized as one reason for the reduction in athletic training and health care provider trends, yet evidence does not exist to support the supposition. Multiple demands on parents related to both work and child rearing have been reported to create time-constraint issues and adversely affect both the quality of work and attention to family.^7–10 Current literature^11,12 has highlighted several themes that may influence life-work balance, including work-family conflict and organizational factors such as flexible work hours, control over work hours, practitioner to patient/athlete ratios, and institutional support. In addition, positive life-work balance is linked to job and life satisfaction and potentially reduced turnover in the athletic training profession.^11,12 A considerable amount of literature^2,11–15 has been dedicated to life-work conflict and balance in the athletic training profession; however, a specific investigation into both male and female perspectives on family obligations as they pertain to maintaining employment in athletic training or a specified work setting has not been conducted. Work overload and organizational expectations appear to have a significant effect on work, thus interfering with family.^11–15 Understanding the degree to which parenting and family obligations influence life-work balance and the ability to perform in the work environment may provide further insight into athletic trainers' transitions. The purpose of our study was to assess the perceptions of ATs regarding life-work balance and the relationship with sex, parenting status, and work-setting choices. In addition to presenting a general overview of life-work balance perceptions, we investigated differences between sexes and among job settings on parenting and life-work balance measures.

METHODS

Participants

We conducted an online survey using www.surveymonkey.com (Palo Alto, CA) of 9516 randomly selected National Athletic Trainers' Association (NATA) members. The NATA provided this randomly selected list of full-time, certified members from all employment settings. In addition to employees with part-time employment status, certified graduate students and retired members were excluded. A total of 20.6% of the participants surveyed responded (n = 1962). The Indiana State University Institutional Review Board awarded human subjects approval before data were collected, and consent was implied by responding to the survey.

Instruments

We adopted the survey instrument previously used to assess how family obligations effect life-work balance (Table 1).¹⁰ The original instrument was created based on a review of literature.^{2,7–10,13,14,16–22} and evaluated for face validity by 5 ATs with 1 to 15 years of experience.¹⁰ Further, the instrument was refined by a committee of athletic training and sport sociology faculty (n = 3), who spanned setting, age group, and parent/nonparent criteria.¹⁰ Information regarding the content and style of the survey were assessed to eliminate errors, and 1 additional question regarding the respondents' current level of employment was changed based on reviewer evaluations. The demographic section of the instrument was modified from the original survey to include sex and work setting to capture a broader population of ATs.

Table 1.

Survey Instrument Sections and Question Stems

Audience	Statement
Life-work balance	I enjoy my job
	I would rather spend more time at home
	I am able to do some of my work duties from home
	I have to do some of my work duties from home to keep up
Family obligation	My colleagues are understanding of my family obligations
	My employer is understanding of my family obligations
	I feel guilty when I have to leave work for my family obligations
	I feel guilty when I have to choose work over my family obligations
	Work is usually neglected over family
	Family is usually neglected over work
	Managing both, energy levels tend to fall short
	Managing family and work affects my interpersonal skills
	Managing family and work affects my temper
	Managing family and work is enjoyable
	Managing family and work is stressful
	Managing family and work causes burnout
Parenting	I would rather be a full-time parent
	The working parent setup is difficult to balance
	My work environment is tolerant of my parental responsibilities
	Having children has affected my work environment
	I changed my career after having children
	I changed my job setting after having children
	I changed my hours after having children
	I changed my position/title with current employer after having children
Nonparenting	I am planning to have kids in the future
	My decision to have children will/does affect my work setting
	I have chosen not to have children because of work
	There is too much commitment from both family and work to do both
	Both family and work can be managed equitably

The survey consisted of questions regarding demographics, life-work balance (4 items), family obligations (12 items), parenting (8 items), and nonparenting (4 items) based on previous research and validated instruments regarding family decision making processes in the workplace.^22–24 Question formats included multiple choice, fill in the blank, and Likert items (1 = strongly disagree; 5 = strongly agree). A Cronbach α = 0.80 indicated good internal consistency and therefore good reliability for the instrument.

We collected demographic variables including information regarding age, sex, years of experience, employment setting, relationship status, sexual orientation, and parental status. In the section relating to general life-work balance and parental status, we asked participants questions pertaining to employment-setting selection and perceived balance. In addition, we asked respondents with children questions regarding the number of children they had, changes that occurred with respect to career after having children, the use of child care, and how the respondents felt as working parents. The fourth section of the survey queried individuals who were nonparents. We also included 3 questions regarding employment-setting selection and perceived changes after becoming a parent or potential parent.

Procedures

We obtained contact information from the NATA using a broadcast system specific to research. We sent an initial e-mail to potential participants that included an introduction letter and a direct link to the survey. Two weeks after the initial e-mail, we distributed a follow-up e-mail requesting participation in the study to boost responses. We did not accept any additional responses 1 week after the follow-up e-mail.

Data Analysis

We calculated frequencies and percentages to determine demographic and descriptive data. Data were analyzed using Mann-Whitney U tests and Kruskal-Wallis tests to identify the differences between sexes, between parents and nonparents, and among job settings on parenting and life-work balance measures. Significance was set at P < .05 a priori.

RESULTS

Gender

Respondents were representative of ATs in the profession and were identified based on NATA membership data on sex, setting, and age (Tables 2 and 3). The results indicated that both sex and the desire to have children (Table 4) affected perceptions about parenting (Table 5). Notable findings included the differences between sexes in feelings of guilt. Women demonstrated an increased feeling of guilt, both when having to leave work for family (3.31 ± 1.25, P = .02) and when having to choose work over family (4.12 ± 0.97, P < .001). Both sexes indicated a strong sense that their work environments were not very tolerant of parental responsibilities, and, surprisingly, men reported stronger feelings of disagreement with the statement (P < .001; males = 1.97 ± 1.98, females = 1.44 ± 1.92). Both sexes also disagreed that having children had affected their work environment (P < .001); women (1.32 ± 1.84) indicated more disagreement than men (1.64 ± 1.79) on this item.

Table 2.

Participants' Demographic Characteristics

Characteristic	Males, Mean ± SD (n = 954)	Females, Mean ± SD (n = 816)
Age, y	38 ± 0	35 ± 0
Experience, y	14 ± 0	11 ± 0
Time worked per week, h	51 ± 0	49 ± 0
With children, No.a	481	417
No. of children	2 ± 0	2 ± 0
Without children, No.	528	465

^aNot all participants answered all questions.

Table 3.

Participant Job Setting by Setting

Setting	Men	Women	No. (%)
College/university
Junior college	24	29	53 (2.8)
Division III or NAIA	109	103	212 (11.1)
Division II	69	53	122 (6.4)
Division I	159	111	270 (14.2)
Instructor	50	47	97 (5.1)
Secondary school	243	233	476 (24.9)
Clinic/hospital
Clinic	76	59	135 (7.1)
Hospital	32	19	51 (2.7)
Nontraditional
Amateur/recreational/youth	9	3	12 (0.6)
Business/sales/marketing	16	18	34 (1.8)
Health/fitness/sport/performance	40	20	60 (3.1)
Independent contractor	6	15	21 (1.1)
Industrial occupational	10	9	19 (1)
Military/law	8	4	12 (0.6)
Professional sports	37	8	45 (2.4)
Other/unemployed
Other	124	144	268 (14)
Unemployed	7	14	21 (1.1)
Total	1019	889	1908 (100)

Abbreviation: NAIA, National Association of Intercollegiate Athletics.

Table 4.

Participans' Desire to Have Children

Desire to Have Children?	No.	%
Yes	519	26.5
No	191	9.7
Plan to in the future	238	12.1
Undecided	122	6.2
Unanswered	892	45.5

Table 5.

Statistical Findings for Sex and Desire to Have Children

Statement	Comparison	Statistical Finding
		U	Z	χ2	df	P
I enjoy my job	Sex	431 678	−1.932			.053
I would rather spend more time at home	Sex	447 897	−0.449			.653
I am able to do some of my work duties from home	Sex	434 278	−1.632			.103
I have to do some of my work duties from home to keep up	Sex	449 085	−0.333			.739
My colleagues are understanding of my family obligations	Sex	445 274	−0.691			.490
My employer is understanding of my family obligations	Sex	435 094	−1.592			.111
I feel guilty when I have to leave work for my family obligations	Sex	425 599	−2.381			.017a
I feel guilty when I have to choose work over my family obligations	Sex	413 954	−3.489			<.001a
I would rather be a full-time parent	Sex	398 560	−4.963			<.001a
The working parent setup is difficult to balance	Sex	398 522	−4.974			<.001a
My work environment is tolerant of my parental responsibilities	Sex	390 057	−5.766			<.001a
Having children has affected my work environment	Sex	407 744	−4.180			<.001a
Work is usually neglected over family	Sex	445 751	−0.657			.511
Family is usually neglected over work	Sex	443 778	−0.801			.423
Managing both, energy levels tend to fall short	Sex	398 912	−4.938			<.001a
Managing family and work affects my interpersonal skills	Sex	432 569	−1.760			.078
Managing family and work affects my temper	Sex	437 020	−1.391			.164
Managing family and work is enjoyable	Sex	447 151	−0.504			.615
Managing family and work is stressful	Sex	431 057	−2.057			.040a
Managing family and work causes burnout	Sex	419 866	−2.894			.004a
I changed my career after having children	Sex	82 035	−2.397			.017a
I changed my job setting after having children	Sex	81 624	−2.964			.003a
I changed my hours after having children	Sex	76 867	−4.201			<.001a
I changed my position/title with current employer after having children	Sex	84 904	−1.077			.282
I am planning to have kids in the future	Sex	422 673	−3.675			<.001a
My decision to have children will/does affect my work setting	Sex	389 303	−5.503			<.001a
	Childrenb			92.074	3	<.001c
I have chosen not to have children because of work	Sex	435 074	−1.565			.118
	Children			31.590	3	<.001c
There is too much commitment from both family and work to do both	Sex	420 485	−2838			.005a
	Children			1.421	3	.701
Both family and work can be managed equitably	Sex	431 893	−1.391			.060
	Children			10.547	3	.014c

^aDifference between sexes.

^bChildren = desire to have children.

^cDifference between those wanting and not wanting children.

When asked about having to balance work and family responsibilities, we also identified differences between sexes (P < .001). Men articulated a stronger sense of difficulty in finding balance as a working parent (1.95 ± 1.98). Women felt more strongly that managing work and family was stressful (3.86 ± 1.13, P = .04) and caused burnout (3.50 ± 1.24, P = .004), and that their energy tended to fall short of their needs (3.74 ± 1.15, P < .001). Women also indicated that they made fewer changes to career (P = .017), setting (P = .003), and hours (P < .001) after having children (Table 6).

Table 6.

Career Modifications by Sex

Career Modifications	Men		Women
	Yes	No	Yes	No
Career (P = 0.017)	63	459	60	274
Job setting (P = 0.003)	152	384	128	209
Hours (P < 0.001)	203	329	178	160
Position/title with current employer (P > 0.05)	145	384	80	252

Perceptions of Nonparents

Nonparents demonstrated a unique perspective on work-life balance and children (Table 5). Both those who wanted and those who did not want children indicated that their choice was not affected by work (P < .001), but those wanting children more strongly disagreed (1.52 ± 1.17) that work was the reason than those who did not want children (1.67 ± 1.22). When asked about the ability to manage both work and family (P = .014), those who wanted children more strongly believed (3.19 ± 1.19) in that balance than those who did not want children (3.09 ± 1.25).

Setting

When reviewing the results for perceptions about parenting across the different settings, we identified several trends (Table 7). Both college/university (4.14 ± 0.85) and secondary school (4.03 ± 0.90) ATs would prefer to spend more time at home, as compared with ATs in the other settings (P < .001). The results are consistent with the perceptions that secondary school ATs (2.86 ± 1.27, P < .001) were least able to work from home and college/university ATs (3.26 ± 1.22, P < .001) were more likely to require work from home to keep up. In addition, the college/university ATs (3.17 ± 1.23, P = .025) felt most strongly that their families were neglected because of work. Although the clinic/hospital ATs felt their working environments were most tolerant of their parenting responsibilities (2.33 ± 2.09, P < .001) among all the settings, they also felt the working parent setup was the most challenging for them (2.25 ± 2.01, P = .002). In none of the settings did ATs feel that their employment settings were particularly tolerant of their parenting responsibilities (1.72 ± 1.97, P < .001). Furthermore, ATs in all the settings felt strongly that having children had not affected their work (1.49 ± 1.82, P = .004).

Table 7.

Comparisons of Employee Perceptions Among Settings

Statement	Statistical Finding			Setting	Mean ± SDa
	χ2	df	P
I would rather spend more time at home	32.181	4	<.001b	College/university	4.14 ± 0.85
				Clinic/hospital	3.97 ± 0.99
				Secondary school	4.03 ± 0.90
				Nontraditional	3.92 ± 1.07
				Other	3.76 ± 1.10
I feel guilty when I have to leave work for my family obligations	15.898	4	.003b	College/university	3.34 ± 1.19
				Clinic/hospital	3.02 ± 1.24
				Secondary school	3.31 ± 1.19
				Nontraditional	3.16 ± 1.23
				Other	3.12 ± 1.25
I am able to do some of my work duties from home	27.277	4	<.001b	College/university	3.14 ± 1.30
				Clinic/hospital	3.01 ± 1.45
				Secondary school	2.86 ± 1.27
				Nontraditional	3.39 ± 1.36
				Other	3.08 ± 1.34
I have to do some of my work duties from home to keep up	35.344	4	<.001b	College/university	3.26 ± 1.22
				Clinic/hospital	2.96 ± 1.29
				Secondary school	2.86 ± 1.25
				Nontraditional	3.11 ± 1.34
				Other	2.93 ± 1.23
I would rather be a full-time parent	14.197	4	.007b	College/university	1.05 ± 1.38
				Clinic/hospital	1.45 ± 1.49
				Secondary school	1.24 ± 1.50
				Nontraditional	1.18 ± 1.39
				Other	1.18 ± 1.60
The working parent setup is difficult to balance	16.992	4	.002b	College/university	1.63 ± 1.98
				Clinic/hospital	2.25 ± 2.01
				Secondary school	1.75 ± 1.98
				Nontraditional	1.84 ± 1.98
				Other	1.59 ± 1.98
My work environment is tolerant of my parental responsibilities	24.183	4	<.001b	College/university	1.61 ± 1.93
				Clinic/hospital	2.33 ± 2.09
				Secondary school	1.73 ± 1.94
				Nontraditional	1.75 ± 1.91
				Other	1.60 ± 1.99
Having children has affected my work environment	15.400	4	.004a	College/university	1.38 ± 1.78
				Clinic/hospital	1.91 ± 1.85
				Secondary school	1.50 ± 1.79
				Nontraditional	1.61 ± 1.88
				Other	1.42 ± 1.86
Family is usually neglected over work	11.175	4	.025b	College/university	3.17 ± 1.23
				Clinic/hospital	2.88 ± 1.22
				Secondary school	3.12 ± 1.18
				Nontraditional	3.13 ± 1.20
				Other	3.04 ± 1.22

^a1 = Strongly disagree, 5 = strongly agree.

^bSignificant for main effect.

We found that the decision not to have children was strongly affected by the work setting (3.37 ± 1.42, P = .049). Employment changes from one setting to another occurred the least between the college/university and secondary school settings (P < .001, Table 8). These findings suggest that more transitions occur in the other settings to accommodate the start of a family.

Table 8.

Comparisons of Employee Perceptions Between Changes in Career Characteristics and Setting

Statement	Pairwise Comparisona
I changed my career after having childrenb	College/university (1.92 ± 0.27)	Clinic/hospital (1.81 ± 0.39)
		Nontraditional (1.74 ± 0.44)
		Other (1.76 ± 0.43)
	Secondary school (1.89 ± 0.31)	Nontraditional (1.74 ± 0.44)
		Other (1.76 ± 0.43)
I changed my job setting after having childrenb	College/university (1.76 ± 0.43)	Clinic/hospital (1.55 ± 0.50)
		Other (1.50 ± 0.50)
	Secondary school (1.75 ± 0.44)	Clinic/hospital (1.55 ± 0.50)
		Other (1.50 ± 0.50)
I changed my hours after having childrenb	Secondary school (1.67 ± 0.47)	Clinic/hospital (1.46 ± 0.50)
		Other (1.42 ± 0.50)
	College/university (1.59 ± 0.49)	Other (1.42 ± 0.50)
I changed my position/title with current employer after having childrenb	Secondary school (1.87 ± 0.34)	College/university (1.73 ± 0.45)
		Clinic/hospital (1.63 ± 0.48)
		Other (1.63 ± 0.48)

^a1 = Strongly disagree, 5 = strongly agree.

^bSignificant at P < .001.

DISCUSSION

The practitioner population in athletic training significantly decreases between the ages of 27 and 40, which may affeact patient care and professional maturity with a dearth of mentors to support the growth of young professionals.² Life-work balance has been theorized as one reason for this trend.^10,14,25 Multiple demands on parents related to both work and child rearing have been reported to create time-constraint problems and adversely affect both the quality of work and attention to family.^7–12 Literature on life-work balance indicates that organizational support, control over work hours, and practitioner to patient/athlete ratios may mitigate work-family conflict and increase job satisfaction. The effect of familial and institutional support on employment-setting retention and transition had not been previously assessed. Interestingly, the findings in this study, in general, indicated that AT male and female parents both perceived their employment setting as a good working environment, yet they changed positions to accommodate family life. Extreme perceptions of strongly agree or strongly disagree were not present; however, within the range of perceptions, differences between sexes and settings were identified.

Perspectives on Parenting and Employment

Interestingly, male and female ATs articulated similar feelings on parenting, specifically that they changed positions (into clinic/hospital, nontraditional, and other settings) once children entered family life. In addition, parents of both sexes, indicated that they enjoyed their jobs and perceived they were able to complete some work duties at home to maintain balance, yet they felt their colleagues lacked an understanding of family obligations. The literature on female ATs articulates the same findings.¹⁰ Similarly, an assessment of nonparents in the literature, as well as in this study, indicates a potential resentment of individuals with families who leave work to participate in parental obligations.¹⁰ The mismatch of perceived obligations and life-work balance may be one reason why both male and female ATs feel that work is often neglected for family, a perception that is not uncommon for ATs and other health care professionals.^{8,13,15,16,18,25} The literature has mainly focused on females,^8,13,16,18 yet this study showed males have similar feelings, which may suggest that life-work balance and parenting issues are a universal mismatch of values between parents and nonparents, not sexess, in the workplace. Rectifying the conflict in values may be complicated in certain organizations and should be an ongoing component of staff development. Conversely, parents in this study and past literature¹⁰ also indicate that they feel both that home is neglected for work and that energy to create a balance between both falls short. The current investigation into how males perceive life-work balance compared with females is supported by the literature.^8,13,14,16 An increased focus on concerns of male parents, as well as female parents, should be addressed in the workplace. Furthermore, understanding of parental obligations should cross gender lines, instead of pursuing the more traditional female-centered approach.

Internalization of life-work conflict does appear to be different for women and men. Women have articulated an increased perception of guilt, decreased energy, and increased burnout and stress, which is consistent with current literature.^{10,14,15,26,27} Balancing occupational responsibilities with parenthood and other life responsibilities appears to be difficult and caused more stress among females respondents compared with their male counterparts. However, male ATs articulated greater difficulty in balancing work and family life, which may be due to the traditional role both working and nonworking women have had in facilitating the family schedule, activities, and social engagements and responsibilities.²⁸ The changing landscape whereby men are engaging more in familial responsibilities²⁸ clearly affects both sexes, albeit manifesting differently. Regardless, life-work balance should be addressed in the workplace equally for men and women.

Comparisons Across Employment Settings

Initial indications that female ATs in the college/university setting did not change settings as a result of parenthood, combined with individuals in the clinic/hospital, nontraditional, and other settings who stated they did change careers after children, appear to contradict past literature.² A more global assessment of athletic training employment data demonstrates shifts for men into other athletic training employment settings and for women out of the profession.² An increase in the male population of ATs was observed in the secondary school setting at the approximate age of 30, which may be because of the decrease of females ATs or because of changing family dynamics.¹⁰ The shift in occupational setting for males may also be attributed to the same family responsibilities and a desire to participate in both family life and work life. Previous literature² indicates that ATs in college/university settings changed employment to high school, hospital, clinic, and nontraditional settings after having children,which resonates with the current data. Athletic trainers in college/university settings intimate that the irregular work hours and job requirements make balancing home and work more difficult than for ATs in other settings.

Based on the previous literature describing the exodus from the AT profession among women in their 30s,^2,10 it is difficult to assess their life-work balance concerns , as these women become inaccessible. They have not changed settings but have left the profession, which presents a challenge to truly ascertain their reasons for leaving the profession. The possibility exists that female ATs, much like other female health care providers, leave for reasons associated with having children,^8–10,16,17 yet a clear assertion cannot be made without assessing this population. In fact, when sex and setting are considered jointly across the employment age, they account for 94% of the variability, meaning that unknown factors account for only 6% of the variability.¹ Individuals choosing not to have children may have purposely selected a time-intensive work environment. Future research regarding employment and setting transitions should focus on characteristics specific to each setting. Information in this regard can be very helpful in socializing preprofessionals into the settings that best meet their work and personal goals.

Employees in college/university and secondary school settings tended to have similar perceptions: had greater desire to have more time at home, guilt in having to leave work for family obligations, and neglect of family for work than those in the clinic/hospital or other settings. Irregular hours are commonly associated with these settings, have been described in the literature by females as challenging in these settings,¹⁰ and may also be one of the contributors to life-work balance stressors in the parents in our study . Although irregular hours are inevitable in sport-driven schedules, some adjustments can be made to alleviate this stressor in the college/university and secondary school settings. Adjustments to reduce the work-family conflict and perhaps improve life-work balance can include modifying the daily schedule to adjust “open times” to fit the scheduled practices so that the ATs are not in the clinic all day, eliminating or modifying summer hours, or creating a mandatory vacation postseason. Clinic/hospital ATs reported that the working parent setup was more difficult to balance than did college/university ATs, secondary school ATs, and ATs in other settings. Conversely, individuals in the college/university setting perceived that they had flexibility, which may be true given the irregular hours and ability to leave the environment to attend family obligations (appointments, athletic events, recitals, presentations, illness, etc). This finding is contradictory to past findings in which health care practitioners with irregular hours described difficulty with life-work balance¹⁰ but does mirror data that indicate individuals in the college/university alter work hours after having children. In addition, the data suggest that college/university ATs alter their work hours after having children more than do ATs in other settings. Specific information as to how hours are altered is unknown, but in the collegiate setting, the varied practice, treatment, and rehabilitation hours may allow providers to negotiate time off without affecting health care, as opposed to high school or clinic settings in which the hours are more likely fixed due to the structure of the institution. Health care providers who are in more structured settings (for example, a physician office or rehabilitation clinic) may face more severe consequences for schedule alterations, such as a negative effect on salary and revenue when patient appointments must be adjusted needed to, making flexibility in scheduling difficult.

Literature^{6,8–10,13,14,16,17} regarding female parents in other health care professions reports the need for more flexibility for family and parenting responsibilities as a significant factor for changing employment settings. Past literature^{6,8–10,13,14,16,17} has focused on women and the need to increase flexibility in the college/university setting, which conflicts with the findings in the current study. The dissociation may be an indication that a segment of the population, specifically women who have left the college/university setting, has yet to weigh in on the conversation.

Nonparent Perceptions of Life-Work Balance

Approximately half of the population surveyed did not have children at the time of the survey. The decision not to have children was strongly affected by the work setting (3.37 ± 1.42), with individuals in the college/university setting most likely not to have or desire children. This finding is consistent with past literature,¹⁰ perhaps suggesting that individuals with a particular value set that places more emphasis on work than family may be more likely to work in a time-intensive, irregular-hours environment, and this value set may give them have greater longevity in that setting. A glimpse of differences in values may be evidenced in that individuals who desire to have children believed more strongly (3.19 ± 1.19) in the ability to manage both work and family than those that did not want children (3.09 ± 1.25). Those perceptions may add to employment selection or simply validate personal choices.

Although the statistical analysis indicated that settings affect the desire to have children, perception means suggest that both individuals who want children and those who do not believe their choice is not affected by their work environment. Athletic trainers desiring children more strongly disagreed (1.52 ± 1.17) that work was the reason than those who did not want children (1.67 ± 1.22). The disconnect between perceptions and what is actually occurring in athletic training employment settings, specifically the college/university setting, may contribute to individuals leaving the profession or employment setting for other environments. Individuals may purposely enter the college/university setting to gain some experience before transitioning to other settings. Additional research is needed to ascertain whether individuals, particularly new professionals, have a clear employment plan, such as starting their career in a Division I setting and purposefully changing settings as a planned reaction to potential caregiver needs (eg, children, parents), or whether they react to life changes as they occur, economic climate (need for a greater salary), advice, etc. A better understanding of longitudinal goals may aid educators in counseling students regarding employment options, as well as aid employers in understanding employment trends.

Although the data in the current study indicate that sex and setting account for 94% of the variability in individuals changing settings or leaving the profession, children appear to be a closely related factor to sex and setting. The stressors of life and work for individuals with children may add to burnout and fatigue, which are factors discussed in the literature common to ATs.^{6,8–10,13,14,16,17} The change in settings may be related to changing values that exist after children and therefore may be inevitable and simply a function of life evolution. Consequently, if maturity through the life span inherently affects an individual's values and focus, employment settings and employers should recognize the effect of aging practitioners and make accommodations in order to maintain experienced professionals. An investigation into values of practitioners over a life span may be warranted to contribute to the literature on employees who shift settings and careers. Similarly, an assessment of age and changes across the profession should be conducted in order to determine if employment changes are related to life maturity or planned employment changes (or both) through the life span. An understanding of how life maturity and life changes affect employment trends may aid educators in preparing practitioners and aid employers in anticipating employment trends and employee needs over the life span. Nonetheless, continued employer and peer support in a culture of life balance may minimize the loss of critical personnel.^26,29

Future Studies

A global understanding of life-work balance cannot be accomplished without understanding additional family obligations, including care of parents, siblings, and partners. A broader assessment of factors that influence life-work balance would advance the literature. In addition, an investigation of individuals who have left the profession may enhance our understanding of what precipitates individuals' leaving athletic training, particularly as young professionals. Further research on why individuals stay in the college/university setting may help us to understand characteristics of long-term employees in that setting.

CONCLUSIONS

Male and female employees in the current study had similar perceptions on life-work balance as parents, yet setting was highly affected by parenting. Both the irregular hours typical of college/university and secondary school settings and the more traditional hours in the clinic/hospital setting had positive and negative aspects for the working parent and should be highlighted during preprofessional education to enable students to make appropriate employment decisions. What is difficult to ascertain is whether these and past findings are related to life progression and are therefore somewhat inevitable. Thus, employers of ATs in the college/university and secondary school settings should assess environmental needs, such as limiting hours worked per week, patient/practitioner load, adding staff, requiring vacation, creating duty performance priorities (ie, game coverage only, practice and game coverage, or rehabilitation) and make accommodations to maintain mature practitioners, whereas the clinic/hospital and nontraditional settings should evaluate the ability to increase flexibility for employees to attend family functions and obligations.