Scope-of-Practice Laws Differ So Much That ATs Cannot Move Between States

The scope of practice for a certified athletic trainer is defined by each state's individual practice act, and these definitions vary enormously. In some states, ATs can perform dry needling, order imaging, and treat the general physically active population. In others, they are restricted to working only with athletes under the direct supervision of a physician. This patchwork means that an AT who is fully competent and legally practicing in Pennsylvania may be prohibited from performing the same procedures after moving to a neighboring state. This creates a workforce mobility crisis in a profession that already struggles with recruitment. Military spouses who are ATs must re-credential every time they relocate. ATs in border areas cannot easily cover events across state lines. Employers in underserved states cannot recruit from states with larger AT workforces because the incoming AT may not be allowed to practice at the same level. The licensing friction adds cost, delay, and uncertainty to every AT career transition. The practical impact on patient care is that athletes receive different quality of care depending on which side of a state line they play on. A high school football player in a state where ATs have broad scope of practice receives comprehensive injury assessment and treatment on-site. The same injury at a school 20 miles away in a different state might require a referral to a physician for basic procedures the AT is trained and certified to perform, adding days of delay and hundreds of dollars in cost. An athletic training interstate compact was announced in June 2024 and went through a public comment period ending in April 2025, modeled on the nurse licensure compact that allows RNs to practice across member states. But compact adoption requires each state legislature to pass enabling legislation individually, a process that took the nursing compact over 20 years to reach 40 states. Physical therapy and chiropractic lobbies in some states have opposed expanding AT scope of practice, viewing it as encroachment. The result is that the profession remains fragmented by geography, with each state's practice act reflecting decades-old political compromises rather than current clinical evidence.