The signature that lets a Texas athletic trainer treat an injured athlete would no longer have to come from a doctor, under a rule change the state licensing board sent out for public comment Oct. 5.
Texas licenses 4,738 athletic trainers — the people who tape ankles on high school sidelines, judge head injuries at football games and run rehabilitation in clinics and training rooms. Each must hold a signed document from a physician setting out which injuries they may treat. The state began demanding that document on June 1, 2025. The proposal keeps the document and strikes the word physician, opening the signature to what the agency’s lawyer called “a broad range of qualified licensed health professionals and not just licensed physicians.”
The Advisory Board of Athletic Trainers, which advises the Texas Department of Licensing and Regulation, recommended publishing the change 5-0. Then its five members, polled one by one, said the signature really ought to come from a doctor of medicine or of osteopathy anyway — a standard the rule they had just advanced will not require. “we stand by best practices as a board being an MD or a DO,” said Britney Webb, the presiding officer and an athletic trainer from San Marcos.
Nobody at the state collects the documents. Asked whether the department tracks who directs each trainer’s work, licensing manager Leonard Rivas said it does not: it records where an applicant went to school and how they qualified, not who signs for them. David Schmidt, a San Antonio physician in one of the board’s two public seats, wanted that changed.
we should require all of the licensed athletic trainers to submit their delegated authority document to TDLR so that we are assured that they have that document intact and we know to whom they are working under the authority of.
The department says the law leaves it little room. Texas defines athletic training as care given “under the direction of a physician licensed in this state or another qualified, licensed health professional”. Assistant general counsel Robert Reyes told the board “physician is a qualifier and that qualifier unnecessarily restricts” what the statute already permits. The wording is not new: lawmakers rewrote the definition in 2023, but only the list of what a trainer does. The phrase about who may direct the work was already there.
The push came from outside the profession. Reyes said the Texas Chiropractic Association wrote about four months after the rules took effect, arguing the physician-only requirement did not square with the statute. He and the department’s general counsel at the time concluded it was “not a hill that we should die on,” and that the risk of being sued “far outweighed the utility of the rule as written.”
Schmidt pushed on who else would qualify. A physical therapist, Reyes answered, the definition would allow; a nurse, probably. On a massage therapist he was more cautious.
I have not read their statute, Dr. Schmidt, but if there is no conflict with their statute, and by conflict, I mean their statute saying there are specific items that they cannot do, then it’s possible.
A licensed vocational nurse, he said, would be for the trainer to judge. “I think we’re really going down a slippery slope,” Schmidt replied, adding that “athletic trainers know a whole lot more about athletic injuries than a lot of chiropractors.” Joseph Eberhardt, an athletic trainer from Pearland, said such arrangements are often sealed on a handshake. “I do find this very uncomfortable,” he said.
Two things cut the other way. The phrase the department relies on carries a condition the exchange never tested: the professional must be “authorized to refer for health care services within the scope of the person’s license” — narrower than holding any Texas health license. And the department’s own rules have contradicted each other from the day they took effect: the same 2025 adoption put a “physician-delegated authority document” in the conduct rule and, in the renewal rule, an affirmation “that all services provided will be directed by a qualified health professional”. Reconciling them is what Reyes said the amendments do.
The state association for licensed trainers says on its site that “As our scope of practice requires physician involvement, athletic trainers work under their direction.” It has taken no public position on this proposal. Tedric Woods, the compliance specialist who answers the program’s email, tells trainers “the best practice is the MD or a DO.”
Nothing changes yet. Publication in the Texas Register starts a 30-day comment clock; Reyes said comments will be taken there, on the department’s athletic training page and by email notice to licensees. The board has penciled in Dec. 7 to read what comes in. Webb spent her closing minutes pushing trainers to send something.
The same rulemaking lengthens the chair’s term. The other half of the package rewrites the board’s own governance: it drops the requirement that one or two members’ terms expire on Jan. 31 of each odd-numbered year, and doubles the presiding officer’s term from one year to two. Reyes attributed both to Senate Bill 2075 of the 89th Legislature; this desk did not open the bill to confirm the section numbers he cited. Most candidates are failing the licensing exam. Education and examination director Michael Strong showed the board a new breakdown of exam performance by subject area, and under questioning confirmed that the overall pass rate sits below the 70 percent needed to pass — repeat takers, he said, score worse than first-timers in at least one content area. The tool goes on the department’s website this month. Enforcement. Five cases were opened on criminal history and none cost anyone a license; two licenses were suspended and one revoked, and all but one of the cases ending in discipline involved sexual contact or behavior.