Sports medicine is a rewarding but demanding medical profession. The intricacies of treating professional athletes along with balancing front office, coaching and player demands, while being under constant scrutiny from fans and the media can be overwhelming.
At the end of the day though, sports medicine offers providers unrivaled opportunities.
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1. One of the most difficult aspects of sports medicine is landing a job in the field. Gulf Breeze, Fla.-based Andrews Institute for Orthopaedics and Sports Medicine physician Steve Jordan, MD, said new physicians should volunteer in a Becker’s Spine Review article. When physicians are involved with a community and its teams, they create inroads with local sports medicine providers and teams. Pair those volunteer opportunities with injury awareness speaking engagements and a physician begins to build trust that helps coaches and players.
Salary and benefits of sports medicine
2. The benefits of sports medicine are undeniable. James Andrews, MD, one of the world's richest and most prolific physicians, created an entire career off his sports medicine expertise. Patients from around the world ask for consults from Dr. Andrews. He has standing speaking engagements with ESPN, and his fellowship program has produced some prolific names in sports medicine.
3. According to the 2014 Orthopaedic Surgeon Census, for sports medicine physicians, salary and benefits range from:
- Bottom 10 percent: $148,983
- 25th percentile: $192,043
- 50th percentile: $239,339
- 75th percentile: $297,091
- Top 10 percent: $349,672
4. Passion is required for a successful sports medicine practice. Michael Milligan, MD, also from Andrews Institute, said sports medicine physicians have to have a passion for the field because of the often long and unusual hours, including nights, weekends and holidays.
5. In sports medicine, although two separate players could have a tear in the ulnar collateral ligament, the recovery plans could vary drastically. Physicians have to have a passion for caring for patients and formulating individualized goal-based treatment plans, said Dr. Milligan.
6. Be prepared to communicate with several different people while caring for athletes, including coaches, team owners and family members. When you’re dealing with young athletes, set the right expectations for recovery with the athlete as well as their parents. When you’re dealing with professional athletes, you may also need to confront agents and the media, according to Bert Mandelbaum, MD, of Santa Monica (Calif.) Orthopaedic Group.
7. When it comes to sports medicine, surgical intervention is the last option, according to orthopedic surgeon at Chicago-based Midwest Orthopedics at Rush and team physician for the Chicago Bulls and Chicago White Sox Brian Cole, MD. In a DocThoughts interview with Nirmal Gosalia, Dr. Cole said the majority of the cases he sees never make it to an operating table because of the abundance of nonsurgical options available. "You have to say 'Look, are there nonsurgical options?' … As a sports medicine specialist most of our decision making is based on [whether] a patient need treatment, and if they need treatment, is there a nonsurgical option?”
8. Dr. Cole emphasized the importance of physician's intuition. With so many factors affecting care, intuition and experience based on repeated interactions is one of the most important things in a sports medicine physician's arsenal. For example, when a patient with a rotator cuff tear comes to Dr. Cole and this patient has lived with the tear for years, he said the best course of treatment may be no treatment at all.
9. Analytics and wearable technology are transforming care. According to this Becker's Spine Review article, the Golden State Warriors are one of several teams using the SportVu camera to monitor player movement, intensity and acceleration levels. The camera allows coaches to track drop-offs, fatigue and overuse. Coaching and medical staff would have the film available for use.
10. Sixteen NFL teams, 15 NBA teams and four NHL teams along with several college, high school and independent leagues are using Australia-based Catapult to track players' heart rates, movements, energy levels and more. A similar device, the United Kingdom-based StatSports' Viper Pods, have seen wide adaptation throughout the NBA and in European soccer clubs. The aforementioned wearables allow providers a wealth of medical information from in-game action.
11. A study presented at the 2016 MIT Sloan Sports Analytics Conference examined the use of data analytics in managing NBA players playing time. Researchers used SportsYu data to conclude, "If we rested the top 20 percent of high risk [NBA] players it would potentially prevent 60 percent of all injuries ... This is a 300 percent increase compared to randomly selecting 20 percent of all players to rest. This provides a data driven way to rest players to potentially prevent injuries."
On becoming a team physician:
12. The complexity and pressure sports medicine providers face has been well established, but for the physician just getting started it's important to realize the extent of the role. Joseph Burkhardt, DO, an orthopedic physician at Battle Creek, Mich.-based Bronson Health, warned against going into the profession with illusions of fame. He said being a team physician is about being a part of the team and the team environment. Star athletes often travel to specialized clinics or renowned providers, according to a Becker's Spine Review article.
13. Patient privacy and avoiding getting starstruck is of the utmost important aspects of sports medicine. Robert Watkins Jr., MD, of Marina Del Rey, Calif.-based Watkins Spine, suggested if a physician couldn't handle the job like they would with any other patient that "perhaps being a team physician isn't for you."
14. Providers need to gain certification in sports medicine and complete fellowship training, according to a Becker's Spine Review article. Fellows shadow team physicians in locker rooms and can gain both experience and exposure. Robert Dimeff, MD, a sports medicine provider at Dallas-based UTSouthwestern Medical Center said besides providing invaluable experience, fellowships also help new physicians sell themselves to the organization and team owners.
15. David Geier, MD, a sports medicine provider in private practice, said specializing in a single sport is an effective way to establish yourself as an expert in that field. He said training can often start at a fellowship level and progress as a new physician works in his community. Specializing in a type of orthopedic area specific to a sport also works to build credibility and expertise.
Concussions and the controversy around them
16. Debates rage about proper concussion protocol and recovery. A study in the American Journal of Sports Medicine investigated patient adherence to designated symptom-free waiting periods prior to returning to play. The study found that 99.3 percent of 143 athletes utilized and followed a symptom free waiting period. Researchers withheld the athletes from activity for 12.3 days and found that 72.7 percent of athletes reported symptom recovery within a week with symptoms lasting 6.35 days. Those athletes had low rates of repeat concussions.
17. Former football star and neurosurgeon to be Myron Rolle shared his thoughts on concussions with The Washington Post. Mr. Rolle said understanding concussions and the science and the effects they take on the body is a complex subject, that even he, a studying neurosurgeon, had a hard time prioritizing. Sports medicine providers need to think how they can convey the importance of medicine to their patient.. Mr. Rolle said, "I’m always thinking, how can I influence other players to have that light turn on sooner? Think about it: I had an interest in neurosurgery and still didn’t make it a priority. Can you imagine someone with no interest in the brain? What’s their level of concern?" Mr. Rolle believes that lack of concern contributes to players attempting to play though their concussions or undervaluing treatment protocols.
18. Researchers have conducted several studies on concussions and their overall incidence rates. The NFL made several changes years ago implementing a concussion protocol and banning helmet leading tackles, but an analysis by The Charlotte Observer claims open field tackles put players at the greatest risk for concussions, especially receivers and tight ends.
In the 2016 regular season, 93 players missed a game related to concussive symptoms. Of those players 59 played an open field position.
Shaping the professionals of tomorrow
19. The sports medicine field isn't only in the major leagues. High schools across the country are partnering with orthopedic practices to ensure their students are getting top notch care in high school. According to a Becker's Spine Review article, several northwest Florida county high schools are employing Andrews Institute trainers to provide medical services at sporting events.
20. Two high schools in Louisiana have taken such preparation to the next level, opening sports medicine clinics on campus, according to Becker's Spine Review articles.
At Baton Rouge, La.-based North Oaks Health System, the clinic is not only providing training, rehabilitation and sideline services, but it is also teaching high schoolers the fundamentals of sports medicine.
21. Another intricacy of sports medicine relates to liability insurance. Currently, sports medicine providers have to obtain a separate license for every state they want to practice in. The Sports Medicine Licensure Act would change that.
The act would allow providers to practice across state lines and to travel with their teams. With the current procedure, sports medicine physicians either have to stay in state or risk malpractice suits. The law will allow protect providers if they're traveling with their teams.
The U.S. House introduced legislation and later passed it in late 2016; the legislation is now being considered in the Senate.
Setting recovery expectations
22. According to a Becker's Spine Review article, sports medicine providers face several different challenges. One of the biggest concerns return-to-play. Providers are under constant pressure to get the athlete back on the field. Dr. Watkins again shared his experience. With most injuries timetables are fluid, but providers need to use their intuition and past experience to provide estimates to all the involved parties, and detail treatment plans as best as they can to team administration.
23. Team physicians need to treat each patient like an individual. For example, a rookie and a 10-year veteran are going to have drastically different timetables for injury recovery. Dr. Dimeff said providers have to take athlete's opinions into consideration when planning their rehabilitation. Although the immediacy of returning to play is important, a player's long term health after they've hung up the cleats is just as crucial.
Spine surgeons treating athletes
Professional athletes will sometimes see spine surgeons when the need arises, according to a Becker's Spine Review article. The surgeons are held to the same standards of traditional sports medicine providers. Here are some things providers should be wary of.
24. Athletic culture often minimizes pain. Ian Armstrong, MD, medical director of the Southern California Spine Institute in Los Angeles, said athletes often live by the mantra, "No pain, no gain." This attitude is acceptable for muscle pain, but not with nerve pain. Dr. Armstrong says athletes shouldn't push through nerve pain. Spine surgeons and specialists should recommend physical therapy or medication.
25. Degeneration often occurs earlier in athletes. Dr. Armstrong warns that spine surgeons should be on the lookout for disc degeneration at an early age. He frequently sees stress fractures with slippage of vertebrae. Physicians should also be aware of spondylolysis problems because it often masquerades as back pain. He said whenever he sees athletes now, spondylolisthesis is his differential.
8 keys to success from Dr. Andrews
Dr. Andrews shared eight keys to success with Becker's Spine Review.
1. Practice humility and compassion as the firsts step toward greatness. There are a number of qualities sports medicine physicians must adopt to build a foundation for success, with the most important being humility. "If you take too much personal credit for your successes and dwell on them, you are going to have a problem," says Dr. Andrews. "You aren't going to be good at medicine without humility."
In some cases, physicians have gained a reputation for being arrogant and under-serving their patients. Showing humility and compassion rejects this reputation and fosters respect and credibility.
"Humility and compassion are very important parts of your success," says Dr. Andrews. "You've got to show compassion for people who are injured. Remember that patients are always right, even if they aren't in the best frame of mind after dealing with a knee injury or chronic illness. You have to understand that situation and be compassionate for them; otherwise, they'll think you are arrogant."
2. Consider sports medicine a profession first, a business second. Taking care of patients and returning them to play should be the number one priority of sports medicine physicians; the economics of the business should be a distant second, according to Dr. Andrews.
"Orthopaedic sports medicine is a people's business and in general deals with taking care of people with an active lifestyle of all ages," he says. "You've got to have a positive relationship with your patients. To think of the business of medicine as the cornerstone of your practice is wrong. For me, medicine is more of a profession than a business."
The definition of sports medicine is taking care of active, athletically-engaged individuals of all ages and experience levels. Taking good care of patients could mean the difference between being healthy and active or abandoning activity for a sedentary lifestyle. While it's important to keep your sports medicine practice open, accruing high profitability should not be the physician's number one priority.
"I've never treated practicing sport medicine as a business and I've never tried to figure out the financial aspects of medicine," says Dr. Andrews. "Economics is important, but if you let that economic aspect overshadow doing what is best for your patients, you'll never be successful in any type of medicine. That's the key to how I would think about our profession."
3. Focus on public relations resources on research and education, not marketing. Everybody wants to build an outstanding reputation among their patients and colleagues, which means investing in public relations. However, instead of spending money on billboards or television advertisements, physicians at the Andrews Institute concentrate on research and education in orthopedics and sports medicine.
"You can't be criticized when you are spending your extra time developing young sports medicine physicians in a fellowship program," says Dr. Andrews. "I've spent my time over the past 40 years building a foundation in research and education to give young physicians an opportunity to excel in sports medicine. If you are involved in research and education, it will make you and others better. Research and education gives back to the field, which is key to our success at Andrews Institute."
In addition to training fellows, Dr. Andrews gives presentations at national society meetings. As for marketing, Dr. Andrews depends on the word-of mouth technique, gathering referrals and reputation from one patient to another.
"We developed our practice patient-to-patient, athlete-to-athlete," he says. "Let someone else tell the good story for you and you won't be tempted to toot your own horn."
4. Make yourself always available. Availability is important because if you don't make yourself available to take care of patients, they will go somewhere else. This may mean working long hours — even on weekends — and adding extra patients into an already packed schedule, but it will build the foundation for a strong and well-respected practice.
"You can't tell patients you don't have time to see them or try to schedule them two months in the future," says Dr. Andrews. "You have to be available in sports medicine when things happen. You have to make time to take care of patients in an orderly and reasonable period of time — that's very important to your success."
As the practice grows, it becomes harder to fit everybody in. However, seeing patients in a timely fashion is still important, regardless of how successful you are. "You can never become too busy to see patients," says Dr. Andrews. "When I get a call about professional athletes or college athletes who get hurt on the weekends, I have to be available to see them the next day."
5. Build strong communication skills and strategies. When sports medicine practices fail, it's often because there is a lack of availability and communication for the athlete's treatment. Within the line of communication, Dr. Andrews says the number one priority is the player, followed by the player's parents. Once the players and their parents are updated, communication with the team coaches, management and ownership are required.
"You have to be able to communicate with your patients and those around you in sports medicine," says Dr. Andrews. "Especially important is communication with the athlete's parents. If the athlete's mother isn't happy, nobody is happy — that goes all the way up the professional ranks. You have to contact the athlete's parents and make sure to communicate with them; that's very important."
In addition to communicating with the players' parents and coaches, talking with their agents also becomes important in professional sports. "The further up the ladder an athlete goes, the more communication you have to consider," says Dr. Andrews.
6. Think positively throughout your career. Physicians are bombarded with negative situations in their practices, and negative thoughts can easily overtake them. Negativity is a hindrance to success in the medical field and sports medicine physicians must find a method for overcoming this stress. Dr. Andrews recommends physicians have a positive to negative thought ratio of at least 5-1, preferably 10-1.
"People that have positive thoughts are much more successful than those who have negative thoughts," says Dr. Andrews. "It's easy for physicians to slip into the negative category. Focus on positive thoughts and goals for your life and practice instead."
7. Exhibit confidence and moral character in all activities. Confidence is a key quality in medical professionals, especially for sports medicine physicians who work with athletes every day. Athletes are often very confident people and appreciate confidence in others, including their physicians.
"Physicians should exhibit confidence in their activities, thought processes and recommendations to patients," says Dr. Andrews. "You should be confident in your diagnosis and treatment recommendations. If you are wishy-washy to patients, particularly athletes, they recognize that. You still have to be realistic with them, but always display confidence."
Along with confidence, physicians must exude a strong moral and ethical character. "In medical ethics, if you do what is right for your patient, your ethics won't be questioned," says Dr. Andrews. "If you have a question about whether something is right for your patients, it probably isn't. If you don't have good ethics, sooner or later people will catch up with you and you will be unsuccessful in your medical career."
8. Be patient and persistent with career development. Orthopedic surgeons and sports medicine specialists are unique; only the top applicants are selected for medical schools and orthopedic residencies only accept the very best students out of medical school to complete their programs. Sports medicine fellowships are even more exclusive, which means anyone completing a sports medicine fellowship and earning certification is an unusually bright and highly motivated individual. However, once physicians begin their practice, they must be patient and build a foundation of good medicine before rising to the top of the field.
"Sometimes, if young physicians are too aggressive in moving up the ladder, they can run into trouble," says Dr. Andrews. "They have to build their reputation gradually, demonstrating quality in sports medicine. You can't expect to come out of training and take a spot at the top of the field. You have to continue to listen and learn throughout your career. The man who says he knows everything is headed for disaster, and young physicians must be careful not be a know-it-all because that leads to self-made controversy."
Dr. Andrews says that today's young physicians must have completed a sports medicine fellowship and a certificate of added qualification to become a leader in the field, especially if they are planning on serving with a professional athletic team. In addition to training, involvement with the American Orthopaedic Society of Sports Medicine (AOSSM) and other professional organizations becomes a crucial aspect of career development. Begin by volunteering for committees and taking your place at the bottom of the ladder and be willing to work your way up to the leadership positions.
"It's those who are qualified who will be able to get involved and move up the ladder," says Dr. Andrews. "It takes 30-40 years to reach the elite levels of these societies. Young physicians have to realize it takes a lot of persistence — which is another word for success — but you must earn it. Becoming involved in AOSSM is crucial for young physicians to enter into the elite world of sports medicine."