A team physician for the Arizona Cardinals and Phoenix Coyotes and consultant with the Oakland Athletics, Douglas Freedberg, MD, discusses the finer points of being a sports medicine and team physician today. Dr. Freedberg is a sports medicine orthopedic surgeon with Arizona Sports Medicine Center in Scottsdale.
Q: How do you manage the sometimes complicated web of communication associated with treatment for professional athletes?
Dr. Doug Freedberg: There are a few things I do to make something that seems complex actually pretty simple. Beyond explaining the injury or condition and discussing options with the player and athletic trainer, I ask the player if there is anyone else to whom they want me to talk. Often this is the agent, and frequently also a family member. With other players, no calls are needed. This way, we have satisfied the player and adhered to HIPAA requirements.
In regards to communicating with the team, each has its own scenario. Always, I'm speaking with the athletic trainer and sometimes I speak with the general manager directly as well, whereas protocol may dictate the information flows through the trainer. Team physicians should know the preferred approach for their specific team. In some cases for particular players, the agents add to the confusion, but more often are helpful as a trusted advisor to the player.
Q: How do you handle athletes who seek a second opinion?
DF: We encourage the athletes to have second opinions — the last thing they want as a player is to feel steered in a direction they don't want to go. There are some players who have a history with a particular surgeon, whether from high school or college. Agents often have strong relationships with surgeons and may push the player to travel across the country even for a simple procedure. If that's what they want, that's what they get.
In my experience, players will seek second opinions and we often ask if they desire one, but it is very rare that they have an interest in going elsewhere for surgery. The key is to have trust in the locker room and a good rapport with players. Being available and approachable is the best start. Over a period of time, your best advocates are often experienced players who trust you and have seen that you can produce good results, whether surgical or even difficult injuries treated non-operatively. They may tell an injured player, "Why would you travel away from your home and family to have surgery that you can do at least as well right here with our team doc?" This is a process and there will always be the occasional player that opts to travel.
Even if the player does go somewhere else for surgery, the team physicians are still going to take care of them during the rehabilitation and follow-up time. Sometimes, physicians worry about their athletes seeking second opinions, but think about a typical day in the office. Don't patients sometimes decide to seek second opinions, and aren't you often the second opinion? If the patient or player feels confident to undergo treatment with us, great, and if they want to see someone else, that's fine too.
Q: When the athlete is high-profile, what stressors do you encounter when choosing the right treatment path?
DF: For one, you oftentimes need to get more people involved, including agents and maybe additional layers of team management. Also as the perceived importance of the player increases, so too does the media scrutiny. We don't get directly involved with this, as the media relations staff interfaces with the media. Sometimes there are unique issues, such as the NFL lockout, that are added stressors. On a regular year, we roughly know our entire schedule, save for possible postseason. Right now with the lockout, there are rough contingency plans, but nothing is settled. At the moment, we're just waiting to get the OK to be able to evaluate new players and perform preseason physicals on players under contract, but as soon as the lockout is resolved, we'll have to find time ASAP.
Q: What do you do to balance your team physician responsibilities with those of your regular practice?
DF: My time management involves being mindful of the calendar. In each sport, there are some very busy, hectic times and there are slower times. For example, in February during the offseason, the NFL Combine takes place in Indianapolis and team physicians are there for about five days. During that time, and other times requiring time away from the practice, we rely on partners to cover. Being a team physician for multiple sports, there is some overlap and it is essential to have your calendar in sync. We have it set up where between the different surgeons, there's always someone available. This is important because if there's an issue with an athlete, the player and team have the expectation that they will be treated right away.
There are significant benefits to seeing the athlete soon after an injury because it minimizes their down time. Perhaps it could allow them to play in a few extra games or make it back in time for an important post-season game. From the management perspective, a roster spot may need to be filled quickly. There is a certain level of frustration for the general population, because they often have insurance hoops to jump through which take time, whether for a referral or authorization for an MRI or surgery. This doesn't happen with professional athletes.
Q: Do you ever find these responsibilities to the team and athletes disruptive to your practice?
DF: Before taking these responsibilities, physicians need to realize that they're not just going to the games. There is a lot of other time they'll need to spend on their responsibilities to the team, including phone calls. Part of the balance is having some flexibility and availability in the office and OR schedule to handle the urgencies. Since most sports teams have games on the weekends or in the evening, standing on the sidelines or in the stands isn't affecting the practice too much. NFL away games obviously require significant time commitments and injury clinics are twice a week and necessitate scheduling changes during the season.
You also have to make time for the other responsibilities surrounding the game. For the Coyotes, the arena is 35 minutes away from our office without traffic, and for the weekday games, the drive during rush hour traffic is an hour. I have to leave the office a little early on those days and that cuts into my ability to see a full complement of patients and do routine surgeries. Then there's training camp for the Cardinals that is two hours north. These things definitely affect my practice, so if a surgeon isn't comfortable with being flexible, then perhaps a different career choice may be in order.
The largest issue is finding the balance between the practice, sports team responsibilities and my family. I have one-year-old twins and trying to find ways to spread my time is difficult. I've been able to work with the Cardinals so that when there is the occasional Sunday away game that the team travels Friday, I can catch a commercial flight on Saturdays. That way, I can spend Fridays with my family. There is some stress in trying to balance everything, but my wife still loves me.
Learn more about Dr. Douglas Freedberg.
Related Articles on Team Physicians:
8 Points to Consider Before Becoming a Team Physician for Professional Athletes
The Responsibilities of Team Physicians: Q&A With Indiana Pacers Team Physician Dr. Timothy Hupfer
8 Biggest Challenges Facing Team Physicians for Professional Athletes
Dr. Doug Freedberg: There are a few things I do to make something that seems complex actually pretty simple. Beyond explaining the injury or condition and discussing options with the player and athletic trainer, I ask the player if there is anyone else to whom they want me to talk. Often this is the agent, and frequently also a family member. With other players, no calls are needed. This way, we have satisfied the player and adhered to HIPAA requirements.
In regards to communicating with the team, each has its own scenario. Always, I'm speaking with the athletic trainer and sometimes I speak with the general manager directly as well, whereas protocol may dictate the information flows through the trainer. Team physicians should know the preferred approach for their specific team. In some cases for particular players, the agents add to the confusion, but more often are helpful as a trusted advisor to the player.
Q: How do you handle athletes who seek a second opinion?
DF: We encourage the athletes to have second opinions — the last thing they want as a player is to feel steered in a direction they don't want to go. There are some players who have a history with a particular surgeon, whether from high school or college. Agents often have strong relationships with surgeons and may push the player to travel across the country even for a simple procedure. If that's what they want, that's what they get.
In my experience, players will seek second opinions and we often ask if they desire one, but it is very rare that they have an interest in going elsewhere for surgery. The key is to have trust in the locker room and a good rapport with players. Being available and approachable is the best start. Over a period of time, your best advocates are often experienced players who trust you and have seen that you can produce good results, whether surgical or even difficult injuries treated non-operatively. They may tell an injured player, "Why would you travel away from your home and family to have surgery that you can do at least as well right here with our team doc?" This is a process and there will always be the occasional player that opts to travel.
Even if the player does go somewhere else for surgery, the team physicians are still going to take care of them during the rehabilitation and follow-up time. Sometimes, physicians worry about their athletes seeking second opinions, but think about a typical day in the office. Don't patients sometimes decide to seek second opinions, and aren't you often the second opinion? If the patient or player feels confident to undergo treatment with us, great, and if they want to see someone else, that's fine too.
Q: When the athlete is high-profile, what stressors do you encounter when choosing the right treatment path?
DF: For one, you oftentimes need to get more people involved, including agents and maybe additional layers of team management. Also as the perceived importance of the player increases, so too does the media scrutiny. We don't get directly involved with this, as the media relations staff interfaces with the media. Sometimes there are unique issues, such as the NFL lockout, that are added stressors. On a regular year, we roughly know our entire schedule, save for possible postseason. Right now with the lockout, there are rough contingency plans, but nothing is settled. At the moment, we're just waiting to get the OK to be able to evaluate new players and perform preseason physicals on players under contract, but as soon as the lockout is resolved, we'll have to find time ASAP.
Q: What do you do to balance your team physician responsibilities with those of your regular practice?
DF: My time management involves being mindful of the calendar. In each sport, there are some very busy, hectic times and there are slower times. For example, in February during the offseason, the NFL Combine takes place in Indianapolis and team physicians are there for about five days. During that time, and other times requiring time away from the practice, we rely on partners to cover. Being a team physician for multiple sports, there is some overlap and it is essential to have your calendar in sync. We have it set up where between the different surgeons, there's always someone available. This is important because if there's an issue with an athlete, the player and team have the expectation that they will be treated right away.
There are significant benefits to seeing the athlete soon after an injury because it minimizes their down time. Perhaps it could allow them to play in a few extra games or make it back in time for an important post-season game. From the management perspective, a roster spot may need to be filled quickly. There is a certain level of frustration for the general population, because they often have insurance hoops to jump through which take time, whether for a referral or authorization for an MRI or surgery. This doesn't happen with professional athletes.
Q: Do you ever find these responsibilities to the team and athletes disruptive to your practice?
DF: Before taking these responsibilities, physicians need to realize that they're not just going to the games. There is a lot of other time they'll need to spend on their responsibilities to the team, including phone calls. Part of the balance is having some flexibility and availability in the office and OR schedule to handle the urgencies. Since most sports teams have games on the weekends or in the evening, standing on the sidelines or in the stands isn't affecting the practice too much. NFL away games obviously require significant time commitments and injury clinics are twice a week and necessitate scheduling changes during the season.
You also have to make time for the other responsibilities surrounding the game. For the Coyotes, the arena is 35 minutes away from our office without traffic, and for the weekday games, the drive during rush hour traffic is an hour. I have to leave the office a little early on those days and that cuts into my ability to see a full complement of patients and do routine surgeries. Then there's training camp for the Cardinals that is two hours north. These things definitely affect my practice, so if a surgeon isn't comfortable with being flexible, then perhaps a different career choice may be in order.
The largest issue is finding the balance between the practice, sports team responsibilities and my family. I have one-year-old twins and trying to find ways to spread my time is difficult. I've been able to work with the Cardinals so that when there is the occasional Sunday away game that the team travels Friday, I can catch a commercial flight on Saturdays. That way, I can spend Fridays with my family. There is some stress in trying to balance everything, but my wife still loves me.
Learn more about Dr. Douglas Freedberg.
Related Articles on Team Physicians:
8 Points to Consider Before Becoming a Team Physician for Professional Athletes
The Responsibilities of Team Physicians: Q&A With Indiana Pacers Team Physician Dr. Timothy Hupfer
8 Biggest Challenges Facing Team Physicians for Professional Athletes