On Being an Asian Athletic Trainer

Being an Asian athletic trainer is truly special.

Of course, there are a variety of ways to “be” Asian. I conducted an informal survey once & I realized that I had to add options when asking people about their demographics. I made room so people could select multiple races, and they could indicate if they grew up in the States or not, or even if they were adopted. These 69 Asian individuals who responded were raised in 11 different countries, with a variety of different ethnicities as well. Personally, I like to say I’m a hyphen — I’m Asian-American (more specifically, Chinese-American), and my journey as an Asian-American athletic trainer has always been interesting.

So I’m here to talk about what it means to be an Asian athletic trainer, both with some respondent data & some of my personal thoughts sprinkled here & there. There’s this idea that Asians come to America to pull themselves up by their bootstraps, right? It seems like we always have to do things ourselves — to advocate and push for change — and that’s what I’m doing here. I want to celebrate us & talk about why we’re important because we so rarely do it ourselves.

According to NATA surveys from 2020 and 2021, only 4% of athletic trainers are of API descent (I’m using this just to indicate “Asian/Pacific Islander”), which is also just about the number of Black athletic trainers, and a tiny bit less than Hispanic athletic trainers, just to put that into context. Each group is, by definition, a minority. However, each group’s experiences are different, and within each group, every individual athletic trainer’s experience is unique to themselves. Within the Asian community (according to the UN there are currently 48 Asian countries), we do not all look alike, nor all speak the same language, and though we have some shared experiences, much of it may be ethnicity-specific.

I am writing this so that other API athletic trainers might not feel so alone, and might understand the importance of advocating for and networking for each other. I sent this survey out INFORMALLY (I am noting this because I did not have an IRB in place, everyone did fill it out on their own accord, however) in December of 2020 because I was feeling detached during COVID. I realized how important it was specifically to take note of Asian athletic trainers during a time when we became more foreign than ever. Below are the results from my informal survey that packed a very powerful punch for myself when I was reading the responses — I’m not ashamed to say that I shed tears over this.

So, here are some results:

• The average age of respondents was 31 (minimum 21, maximum 55).
• 45 females and 23 males filled out the survey, 1 preferred not to say.
• 16 were raised outside of North America, in 11 countries (not specified in order to maintain anonymity of participants) — 4 were raised in Canada. The remaining 49 were raised in the United States, in 17 states, with 25 from California.
• At the time of the survey, 7 athletic trainers were living in Canada, and 1 was living in a non-North American country. 61 were living in the United States, spread over 22 states, with the large number of 19 athletic trainers being in California.
• In general, 46 athletic trainers were API-American, 4 were API-Canadian, 9 API-Non-American, 3 adopted, and 11 were mixed API (participants could select multiple options).

Settings:

• 8 respondents were not practicing at the time. 3 were AT students, and other routes included PA/PT school, going into research.
• There were a combined 72 different schools for all levels of education.
• Current settings: 20 collegiate, 18 secondary school, 6 industrial, 4 private practice, 3 per diem, 2 outpatient PT clinic, 2 professional sports and 1 each with physician practices, self-employed, hospital setting, national team partnership, and an orthopedic setting.
• Respondents were part of a variety of committees, without detailing specific districts or states: district educators committee, state diversity committee, district student representative, state BOD representative, district DEI committee, state rep to district, state YPC chair, district SLC committee advisor, district secondary school committee.

Isn’t that already pretty cool?? We’re all over the place already & I love it.

Now onto the more exciting part, the actual survey answers. I asked people a variety of questions about their personal background & their perceptions of being an API AT.

Respondents indicated the following reasons for joining any NATA committees: One stated that the board of directors do not reflect and represent the norm in their area — they wanted to give back and serve the profession and add a diverse voice to the leadership. Others stated that they enjoyed the camaraderie, wanted to show the value and worth of athletic trainers; improve, promote, and advocate for the profession.

Why did you want to become an athletic trainer?

• Most said they wanted to be involved at the intersection of medicine and sports (21)
• Others wanted to help others and make a difference (13), played sports previously at any level, with a few at the collegiate level (11), and some previously had an AT who inspired them (11)
• Love of sports (9) and previous personal injury (7) played a part. They also wanted to help people during their worst moments and get people back to what they love doing.
• 2 wanted to increase representation for Asian-Americans and change the perception of API ATs. One noted that they previously had an Asian-American athletic trainer that influenced them.

How their cultural experiences influenced their decisions to become an athletic trainer:

• A large influence was family — such as a family push to do something in the medical field (6), or they grew up in a family of other medical professionals so there may have been influence there (5). 3 of them explained that though they were pushed to be in medicine, they didn’t want the traditional medical route like the rest of their family. For example, one did not want to pursue the stereotypical nursing field like their family, and another did not want to be a doctor, nor did they feel like they had the capacity to do so.
• 3 were not supported by their family, as being an athletic trainer was not a valuable credential in their eyes, yet 3 noted that their parents supported their decisions and simply wanted them to be happy.
• In terms of representation, others stated it was rare to see Asians on the field and that they never saw anyone who looked like them be an athletic trainer, which was influential. Others looked up to specific API ATs who played a role in their education.

Respondents were asked which types of people they had received racist remarks from. There was no definition provided of racism, but it was simply based on a personal belief that they received comments that were unwelcome. One respondent noted that it was hard to know if negatively perceived remarks were necessarily due to racist views or other conceived notions. Detailed below are the numbers:

• Patients: 38
• Coach: 28
• None: 20
• Athletic Trainers: 19
• Athletic Training Students: 17
• ATP Personnel: 13
• Team Administrators: 11
• Fans/parents: 3
• Athletes: 3
• People in general: 2
• Coworker: 1
• Athletic director: 1
• Officials: 1

Respondents were asked about barriers to serving in NATA: Some referenced a lack of representation and examples to follow after (11), not having enough time (5), or that only Caucasian candidates were considered. Other statements: the demographics of the region that is voting was too different, there was a lack of Asian community / coming together within the committees; they felt like inclusion was only to meet a diversity quota; the potential of being unheard or being talked over by those who are a part of the majority.

Respondents were asked about any issues they wanted to mention that API might face in athletic training, or barriers to entering the field. Some included: Cultural adjustment/differences, a lack of cultural competency both in others and ourselves (4), difficulty moving to an entirely new country for school (3). One was less likely to apply for positions with a small % of Asians in the area. Others felt they had a hard time saying no, that it wasn’t necessarily respectful in their specific culture to speak up and be confrontational when issues occurred, or to share their opinion when it isn’t asked for. Another stated that being assertive is difficult.

There was a bit of a general stigma around being an Asian AT. Some (8) stated that some parents may not allow pursuing an AT degree because they aren’t doctors in a medical field (ex. MD, DPT), and there is a stigma that Asians should be doctors or that they are above this line of work (5). Some (4) said that Asians typically seem to gravitate to higher profile professions (doctor, PT, nursing). Others felt insecure about how their family perceived them, and felt left out in a family of healthcare professionals — the job was misunderstood, perhaps, with their family not knowing the difference between personal trainer and athletic trainer.

Representation: Some felt there was a general lack of representation and a lack of diversity (11), especially during their ATP (3). Others (3) reported a lack of a mentor that could represent their culture, and 2 specifically stated the lack of Asian females in the profession. Someone said that it was hard to be the “first” to enter an unfamiliar field.

Stereotypes: 2 individuals stated that the model minority myth was relevant, “where we are expected to be okay with given more work than we can handle, which can lead to superiors taking advantage or even putting expectations on us that can set us up to fail. Also the lack of sympathy if we do fail or have downfalls”. 2 brought up COVID-related racism. 2 mentioned laughing off microaggressions and borderline jokes even if uncomfortable. Other comments: many see Asians as one large ethnic group, patients/clients think we perform “voodoo”, we may not be taken seriously because of our identity, and there is assumption of your ethnicity in the workplace.

Related to profession itself: 2 stated that the salary may dissuade people from wanting to pursue AT, and 2 stated that there is bias during job/internship/opportunity hunting. Other comments were: the lack of API inclusion into the NATA EDAC, it’s easy to feel alone and that you have to break down barriers just to be in the field, it’s hard to get advice from people who don’t understand certain struggles, and there were limited grants or scholarships for first-generation Asian-Americans.

Respondents were asked if there is anything else they wanted me to know about being an API AT or ATS. Here are some direct positive quotes:

• “I love being an Asian-American representation of our profession”
• “Proud to be mixed”
• “Representation and community is more helpful than one might think. Seeing other Asian ATs in the field is encouraging.”
• “It can be rewarding to our younger patients who can see themselves in this field and want to be like us, despite Asian culture expectations and pressures”
• “Athletics is diverse & inclusive as a whole, so I’ve never had any problems.”
• “As a student, I don’t realize most of the time that I am a minority. I have been extremely lucky to meet such wonderful and supporting instructors and friends who always had more faith than I did for myself.”
• “Seeing other AAPI individuals on TV working in sports settings is good exposure for up and coming students. It’s not often that you see AAPI athletes/coaches in mainstream media so seeing other AAPI’s in the professional sports setting gives a sense of representation”
• “I am proud of the AAPI students and interns that I have had in the past and the impact they are having in Athletic Training and in Sports Medicine. They represent AAPIs well.”
• “I like to think that my presence adds value (my talents and personality, and diversity) to the organization.”
• “I reached out to the international committee last year after I saw weird Korean translations on NATA infographics. They have been reaching out to me since then to double-check if the Korean translation is smooth or not. There was a time when ACL was translated as an ‘ankle ligament’ in the translation, which was shocking. Even though it is a small job, I think it’s a fun opportunity”
• “Being a minority here in the US (non-citizen, speaking English with an accent) has been lonely. But it also has motivated me to push myself more and prove to the world that I can do this job”
• “I’ve been blessed to not experience much racism in this field.”

Some frustrations or observations:

• “It’s always interesting for me to not see many Asian Americans ATs considering how many are in health care professions”
• “I think it depends where you live. The SF Bay Area is very diverse and accepting of people of color, but could imagine other institutions in less diverse locations/states may not be as accepting.”
• “Even in a relatively diverse state, I have been the only AAPI AT in many situations. (Athletic contests, AT conferences, etc.) Only recently have I come across some AAPI AT students.”
• “I currently practice in an area with very little diversity and it very obvious that I am considered an outsider”
• “There is not much outreach to AAPI communities about opportunities in sports medicine, or realization of AT profession as a healthcare profession.”

Lastly, and most importantly, without prompting, here are some thoughts on what we, as API ATs, can do moving forward:

• “I just really think there needs to be more POC ATs! We need to make ourselves more visible to stand out among the other allied health professionals.”
• “As an AAPI AT, I hope that I (and others) can be facilitators — and not a barrier — to exploring all that our wonderful profession offers.”
• “We can also be supportive of first generational pressures and help navigate younger generations to finding their place when assimilating to American culture.”
• “While I recognize that I have had barriers along the way, l have learned that I can only control my actions and influence those around me via education and compassion. Educated, passionate, and competent ATs will be the key to changing the course and breaking down any barriers.”
• “I really understood how much we can educate those around us. When athletes (high schoolers) have made racist comments/jokes, I found that they actually didn’t know or were uneducated about how it could be racist. They learned from the experience when I corrected them. It was never an issue after that. While it shouldn’t be, it sometimes is up to us to educate. Now, if someone were to be intentionally racist, that’s a different story.
• “Just be who you are, not conforming to what media, parents and culture think we should act or do.”
• “All POCs need to continue pushing to get their feet in the door at all levels no matter what. To see the change, we need to be the change. They need to make sure they have a solid network and skill set to increase the quality of their resumes and connections so that when opportunities arise they are prepared for the rigors of the profession, regardless of ethnicity, race or gender.”
• “From perspective of a non-American Asian, it’s important to understand there are differences between non-American Asians and Asian-Americans.”
• “I believe that receiving an AT degree is still a rare career choice in South Asia, especially for a female. I don’t see many female nutritionists or Physical therapists or Sports / exercise specialists out on the field assisting male-centric teams or sports or events in general. I also have noticed that females in South Asia tend to switch to more off-field clinic based jobs after their PT degrees. I want to change this narrative and “NORMALIZE” a female PT or AT working with a team out on the field.”

I’ve always believed that every API has their own specific story because there are so many unique factors. For some background — my parents moved here in their mid-20s from China, and I was born here in the United States. I have spent much time trying to understand where my Asian-American self fits in this world, and though I am American through and through, I am also very proud of my Asian culture. I have lived in Philadelphia, Pittsburgh, Salt Lake City, Logan (UT), Atlanta, and now I am in Virginia — all very differently diverse. I see now that it’s important to have people in your life who may understand struggles that others may not.

When I read the results for the first time, I was comforted, knowing that I was not alone in some of the frustrations that I felt growing up and going through my athletic training education. I also felt relieved seeing very different reactions — again showing the world that we, as API, are diverse and unique, and there are different ways to reach the same solution. I felt empowered looking at the reasons other athletic trainers wanted to enter the field. I felt encouraged that I made the right choice even if my parents did not fully understand the reasoning. I certainly hope others reading this feel something as well, whether negative or positive, all to incite change.

Here’s why this is becoming increasingly important in this day and age. Maybe you’ve heard that Asians are “white-adjacent” due to the successes and the protection that our success brings us. I’m here to say, flat-out, that is wrong. There’s a terrible history of mistreatment towards Asians in America, and that continues to this day. During COVID, I adamantly told my parents to avoid Philadelphia. I didn’t want to risk them being hurt by someone who had specific views based on how they look. I’ve seen people claim that they’re okay with being racist towards Asians, or continue to pull the corners of their eyes out. Or people use the word “chink” freely without understanding what it really means. There’s a lack of knowledge and awareness all around, and it’s time that stopped.

I think part of the reason for this lack of awareness is that Asians tend to take a backseat to issues. We tend to work hard with our heads down because that’s what we we’re told matters. Now, of course I’m generalizing, which is the very thing I sought out not to do, but I’m speaking on what I’ve seen myself. There are certainly differences in which we advocate for ourselves, though, compared to other minority groups, whether it’s out of humility, indifference, or anything else. And that’s ok, but for now I’m going to focus on changing the perception of Asians, especially Asian ATs.

There are a lot of reasons that being an Asian AT is special and important. We know we’re different…but we’re still trying to figure out how. Here are some thoughts on why I think we’re different, with plenty of generalizations — but leave room for nuance, please:

1. Cultural differences may dictate our communication styles: I have seen that many API show love and positive emotions through actions, not words. It is seemingly expected that we try to do everything as much as possible by ourselves, and try to maintain that independence. If we need help, we ask. It’s a very direct, blunt, seemingly un-caring way to live, but it’s because actions speak louder than words. When I was in grad school, people always asked me if I needed help with anything before they left, and I always said no. But, I would never ask them that because I just assumed that if they needed help, they would ask. I had never considered the fact that other people may do things differently.
2. Cultural differences may dictate our previous educational background: I was very inexperienced with medications for illnesses and in general. My parents would not hesitate to provide necessary medicine for things such as strep throat, but we barely ever took any medication otherwise. When I had to help athletes find the right medications for their issues during my clinical rotations, I remember opening the cabinet and being petrified, just staring at the medicines and wondering how on earth I was supposed to choose the right one. I felt like we were partially supposed to know these things through our own experiences, and I had none. Rather than admit I didn’t know (because this would be a failure on my part, which I refused to commit), I just stood and stared until someone else did it for me.
3. Cultural differences may dictate our soft skills: as stated earlier, I had a massive fear of failure, and consequently, very little confidence. That is a disaster, personally speaking. It just meant that I was scared to try unless I knew I’d be right, which led to average grades & below-average practice in my critical thinking skills. Sure, this could be more of a personal, case-by-case thing but there’s definitely this idea of “hard work gets you anything you want in life” in the immigrant mentality, but no one ever tells you what to do when hard work doesn’t get you what you want in life. There are just a lot of soft skills that get overlooked & we have to stop doing that.
4. Cultural differences may cause people to perceive us as “different” or “non-belonging”: There is a stereotype that API are meek, docile, and that we do not speak up for ourselves — but I believe that we do not speak up for ourselves because we’ll push through things even if they hurt, and we refuse to let someone know we’re struggling, because it’s weak to show that type of failure. Which is wholly unhelpful, because it keeps our walls up, which isn’t helpful in the high-pressure world of sports and medicine. And it’s perceived we’ll always work hard — which is likely true, but the expectations we set for ourselves can be a detriment to ourselves & our own mental health.
5. There is an elevated stigma around mental health in Asian communities. My parents were definitely more understanding than my friends’ parents, but there was still this lack of understanding about mental health. For example, we weren’t told explicitly that having feelings is bad, but I certainly felt that way for most of my life, which made life difficult as a very emotional person. Then I learned that feelings are not facts — and it changed a lot of things for me. That’s just a small example, but this can certainly make going through your athletic training education difficult, especially when your parents don’t understand the career choice.
6. Stereotyping is a huge issue: The model minority myth is the idea that we are all the most successful, and the ultimate pictures of what a minority should go after. We are the picture of “how hard work can overcome racism”, when there are actually much more complicated problems out there. It only pits different minority groups against each other. The model minority image was nothing more than propaganda to show that the United States was open to immigrants, and to argue that it’s very possible to have success if you just work hard. However, we know now that this is not true.

So what do all of these things mean? They mean that we can make a difference for athletes or patients who feel like an “other”. Though there is not much API representation in higher-level athletics, there is still a small part of us that understands feeling like an “other”. Also, in my experience, Pacific Islanders have stated that they view themselves very differently from being “Asian”, so it’s interesting to be lumped in together sometimes, but it also makes a lot of sense. Just a small thing I’ve noticed & wanted to throw out there.

Keep in mind, I didn’t write this to bash anyone — because the majority of my interactions with people in the world of athletic training regarding being Asian have been positive — in some cases, even neutral. Which is kind of what I want, in all honesty. I feel most comfortable around people who fully recognize I’m Asian & encourage me to embrace it, but they don’t make it everything I am. And I think that’s what I’m aiming to do here. I want to embrace my Asian roots, but I also want to embrace all parts of me — the comedian, the researcher, the “dog mom”, whatever else. This is a small way to show other people that we are more than…

… A token hire/student/person

… A monolith

… “just Asian”

Keep in mind that this was an informal survey, with poorly worded survey questions on my end — these are merely anecdotal, from people who were wonderful & willing to help me understand what it means to be an API AT. If you’re feeling particularly inspired & interested in seeing how we can change things for all API ATs and AT students — please reach out to me. You can find me on Twitter and Instagram.