The role of the modern team physician is demanding but rewarding.Here are the nuts and bolts of what's involved and what you need toknow to do the job.
DR. McCAMBRIDGE is an assistant professor of pediatrics, the Johns Hopkins School of Medicine, Baltimore, Md., and a member of the staff of Orthopedic Associates, Towson, Md.
The author has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in anypart of this article.
The role of the physician in athletics has changed dramatically over time. In premodern times, the physician's role was to treat injury and illness resulting from sports participation. In fact, the fathers of modern medicine, Hippocrates and Galen, were unaccommodating of athletes because they felt that health was based on the principle of moderation and success in athletics precluded moderation. In contrast, the role of the contemporary team physician is comprehensive. It includes, but is not limited to, diagnosing and treating illness and injury, supervising rehabilitation, promoting safety, and providing nutritional and training guidance.1
Board certification for primary care sports medicine began in the 1990s. A complete list of sports medicine fellowship programs is posted on the Web page of the American Medical Society of Sports Medicine, http://www.amssm.org/, and at http://www.physsportsmed.com/fellows.htm. There are eight accredited pediatric sports medicine fellowships in the United States.
In 2000, six major professional organizations convened to recommend minimum qualifications for team physicians. Their recommendations, published in the journal Medicine and Science in Sports and Exercise,2 specify that a team physician should have an unrestricted medical license with an MD or DO degree, skills in cardiopulmonary resuscitation (CPR), and knowledge of orthopedic and medical issues affecting athletes. The physician should also be comfortable managing emergencies on the field.
At higher levels of competition (college, Olympic, and professional) the team physician should have completed a fellowship in sports medicine, maintain board certification, have a predominately sports medicine practice, and be active in a national sports medicine society. Recommended certifications include CPR, first aid, and advanced cardiac life support.
The team medical staff
The composition of the team medical staff depends on the level of athletic competition. At the high school level, it generally includes a certified athletic trainer (ATC), the athletic director, a physician, and, sometimes, the school nurse. In college or professional athletics, the medical staff may also include a nutritionist, several physicians (primary care and orthopedic), physical therapists, dentists, and sports psychologists.
Regardless of the athletic setting or number of medical personnel involved, communication and advance preparation are the keys to avoiding problems. The team physician needs to address the following logistical issues:
Surgical consultants who should be available for urgent referral include an orthopedic surgeon, neurosurgeon, otolaryngologist, plastic surgeon, gynecologist, urologist, and general surgeon. Medical consultants should include a pulmonologist, cardiologist, gastroenterologist, infectious disease specialist, dermatologist, and psychiatrist.