6 Goals for Sports Medicine From Dr. Kevin Plancher

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Last December, Kevin Plancher, MD, founder of Plancher Orthopaedics and Sports Medicine, chaired the "Emerging Techniques in Orthopedics Sports Medicine & Arthroscopic Surgery" conference, co-hosted by the Orthopaedic Foundation for Active Lifestyles and The American Journal of Orthopaedics. More than 400 physicians and medical professionals attended the conference to learn new techniques and discuss the latest trends in the field. During the conference, panel members from around the country were challenged to debate opposing sides to controversial issues in sports medicine, with honored professors Russell F. Warren, MD, and Richard J. Hawkins, MD, overseeing many of the debates.
"We made the faculty debate each other even if they agreed on principle so they saw the other side on fairness," says Dr. Plancher. "We wanted to create the debate so participants could see what was going on. Next December, we'll have more of an international faculty to gain a global perspective on clinical issues in sports medicine."

Here, Dr. Plancher discusses six goals for sports medicine this coming year.

1. Educating the public about injury prevention. A large portion of a sports medicine physician's patients suffer from overuse injuries. Many young athletes are pushed to overwork their basic skills while older patients are likely enjoying too much of one activity. Recreational athletes often don't consider cross training or doing the appropriate stretches to prevent overuse or acute injuries.

"Professional athletes, such as those heading to the Super Bowl, are learning yoga and doing Pilates, not just the same core drills over and over, because they know these other things are increasing their performance and decreasing the risk of injury," says Dr. Plancher. "The more we educate the public, the fewer of these types of injuries we will see."

The American Orthopaedic Society for Sports Medicine, along with other sponsoring organizations, promotes the STOP Sports Injuries campaign among youth athletes, and joining the campaign can provide valuable information for your patient base. Otherwise, single physicians can spread the word relatively easily through online articles stressing the importance of cross-training and stretches among all types of athletes.

2. Taking a multidisciplinary approach to sports medicine.
An increasing number of sports medicine physicians and groups are partnering with other medical professionals to deliver care through a multidisciplinary approach. Physician practices often include physicians' assistants, nurses, primary care sports physicians and physical therapists who all have the same goal: to find the root of athletes' problems and return them to play.

Dr. Plancher's office includes all of these specialists as well as diagnostic imaging modalities. "We are going to treat you with dignity and thoroughness to find the problem, and then give our patients different treatment options," says Dr. Plancher. "We can do physical therapy to correct someone's biomechanics, fit them for a brace or perform arthroscopic procedures, returning them to play faster than was possible before."

3. Supporting a national joint replacement registry. Physicians and scientists are rapidly developing new technology with the potential to make sports medicine procedures more precise and heal patients more quickly. However, all new technology and treatments must undergo extensive clinical trials, and sometimes even then widespread use of the device can include unforeseen complications. Other countries have developed national joint replacement registries to monitor devices after they are released on the market, but the United States hasn't fully implemented a national registry yet.

"Some companies put out devices that are great ideas and then the clinical trial comes up and we realize they don't work as well in application," says Dr. Plancher. "We have to share information in a national joint replacement registry where it is okay for physicians compare outcomes among patients in similar situations. Other countries have great registries which allow for full evidence-based medicine and I would love to see that for orthopedics and sports medicine in the United States."

Beyond just including joint replacements, a national registry could also focus on other types of ligament and cartilage repair. For instance, one of the biggest controversies right now is the effectiveness of platelet-rich plasma. Anecdotal evidence shows it could have a positive impact with appropriate use, but some studies show it isn't clinically effective.

"We're hoping for some great evidence based studies to see where PRP works," says Dr. Plancher. "We are finding it works in the elbow, but not necessarily in the knee or shoulder. Regardless, it may lead to new products, enzymes and studies to help us enrich the mechanical repair of some minimally invasive procedures."

4. Fighting coverage denial from insurance companies. Most physicians, including sports medicine specialists, are experiencing push-back from the insurance companies on specific procedures and treatments — especially those with a high cost. Some companies deny coverage for procedures they deem "experimental," and others deny surgery in favor of conservative care, even when the patient has gone through the commonly-accepted treatment algorithm to become a candidate for surgery.

"Physicians and hospitals have to work together and not let third parties make all the decisions for us," says Dr. Plancher. "Sports Medicine physicians have felt this pinch for 10 years, and now patients are speaking up for themselves. I'm happy about that."

In some cases, Dr. Plancher has seen patients come in without a clear understanding of their healthcare benefits and realize they have limited services from their plan through employers. They'll watch him phone the insurance companies to extend coverage, which is sometimes successful and sometimes not. Regardless of the outcomes, the bottom line for the insurance companies is their bottom lines.

"People are making financial decisions, and I understand why, but we have to understand rationing healthcare is happening and I'm not sure we've found the best solution out there," says Dr. Plancher.

5. Containing the cost of healthcare. As the cost of providing care has gone up in the United States, reimbursement to physicians has gone down. There are several different payment models being discussed for the future, but without a solid structure physicians are unable to plan for the future. "We have to decide what payment system will prevail," says Dr. Plancher. "I know there are really smart people who can guide us and we have to meet somewhere in the middle so the patients are cared for but the physicians are also able to run their private practices."

Orthopedic surgeons are signing contracts for hospital employment at higher rates than ever before, due partially to the increasing cost of running a private practice. One of the biggest contributors to an independent practitioner's fixed fees is malpractice insurance, which physicians don't have to pay individually under hospital employment.

6. Inspiring others to enter sports medicine. Dr. Plancher says when he first began studying sports medicine, it wasn't a very popular subspecialty among physicians. Now, sports medicine programs and fellowships (he is a director for two ACGME slots) are very competitive and include both clinical and scientific professionals. However, he still sees room for growth.

"I always encourage people to look into sports medicine — we need a lot of smart people in sports medicine," he says. "I support through The Orthopaedic Foundation for Active Lifestyles a unique program entitled Doctor for a Day. We teach kids about orthopedics and sports medicine from 9th to 12th grade. This particular program is completely funded by orthopedic companies and the foundation. It sponsors these high school students and experience in fixing a broken forearm." The program simulates an operating room setting and provides the students with the same drills, plates and screws surgeons use. Each group of four students is mentored by an orthopedic surgeon or health professional. The students take X-rays, make their cuts on their simulated cadaver, and perform the surgery.

"These kids are from all different walks of life and they do an amazing job," says Dr. Plancher. Some students come from inner city schools, others from private schools.  "No matter what, we hope to get some kids so excited about going into science and orthopedics through this program."

More Articles on Sports Medicine:

13 Orthopedic Surgeons Recently Treating Professional Athletes

12 Sports Medicine Physicians on the Move

8 Keys to Success in Sports Medicine From Dr. James Andrews


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