PMRQUESTION said:
I understand the PM&R establishment is petitioning the American Board of Medical Specialties (ABMS) to allow PM&R trained docs to sit for the CAQ in sports med. Anyone know when we'll know something? Does it matter?
Can a Physiatrist Become a Sports Medicine Specialist?
The field of sports medicine has evolved into a specialty that focuses on treating patients of all ages and all levels of physical activity. As you would expect, it was orthopedic surgeons who began treating most of these patients, and in the middle of the last century the subspecialty was born. It was not until the mid 1980s that primary care sports medicine began to take shape. The specialties that joined together in this new area of subspecialization were led by family practice, and included physicians in internal medicine, pediatrics, and emergency medicine. Fellowships were developed for residents who completed their training in one of these areas. After the residents completed their respective fellowships, they were allowed to sit for an examination known at that time as the Certificate of Added Qualification (CAQ). This was a certificate symbolizing additional training in sports medicine and was an attempt to regulate the field. It was in the late 1980s and early 1990s that physiatry began to break into the sports medicine field. Historically, the field of PM&R was given an opportunity to be a part of the original residency programs that led into sports medicine fellowships. However, other subspecializations (e.g. spinal cord medicine, pain, TBI) with a broader level of interest were pursued.
PM&R physicians interest in sports medicine began to expand in the early 1990s. During that period PASSOR (Physiatric Association of Spine, Sports and Occupational Rehabilitation) was established. This began a trend in PM&R of training specialists in musculoskeletal medicine with a focus on spinal ailments, sports injury and rehabilitation, and occupational injury assessment. As PASSOR membership grew, the number of PM&R physicians and residents interested in sports medicine also increased. Physiatrists began working as team physicians at the high school, collegiate, and professional level. Examples of prior and current team physicians include Stanley Herring, MD (Seattle Seahawks); Robert Wilder, MD (Dallas Burn); and Deborah Saint-Phard, MD (University of Colorado). Some physiatrists were not the primary team physician, but instead served as consultants for spine disorders, musculoskeletal injuries, and electrodiagnostic evaluations. PM&R then developed sports fellowships, which included training in sports injuries, electrodiagnosis, musculoskeletal medicine, and in some cases spinal injections. Some training programs offer team coverage, while others emphasize more of an outpatient-based experience that will expose the fellow to a wide range of sport-related injuries. Although these PM&R fellowships offer additional training in sports medicine, subspecialty certification is not currently available.
A few years ago, the American Board of Physical Medicine and Rehabilitation (ABPMR) submitted a letter of intent to the American Board of Medical Specialties (ABMS) for a PM&R sports medicine subspecialty. ABPMR can already offer subspecialty certification in spinal cord injury medicine, pain medicine, and pediatric rehabilitation. The sports medicine subspecialty application and the approval process could take up to five years.
With the interdisciplinary training that physiatrists receive and their focus on maximizing function, the transition into the sports medicine environment can be a smooth one. The expertise that a physiatrist has in nonsurgical musculoskeletal medicine can be a valuable asset to any sports medicine team. It has been said that 85 percent of all sports medicine issues are musculoskeletal and 85 percent of these injuries are nonsurgical. However, to be a true team physician, physiatrists must continue to sharpen their primary care skills. Physiatrists must be comfortable with treating problems such as exercise- induced asthma and heat illness and be able to suture common lacerations. Most PM&R residency training programs lack this type of training; therefore, this expertise must be obtained and perfected in a fellowship program.
However, this still leaves a few unanswered questions for the future. Will primary care sports medicine programs accept PM&R residents? Will PM&R develop its own standardized examination for sports medicine subspecialization, and will current sports medicine providers be grandfathered into the process? History has proven that even with a lack of opportunity, many physiatrists have become leaders in the field of sports medicine. At this point, you also have to wonder about the value of a subspecialty certification examination. There are plenty of sports medicine physicians without this certification who treat patients daily, produce valuable research, and provide team coverage.
The future is bright, but it will take the efforts of all physiatrists past, present, and future - to enter into a field that is so highly competitive. The physiatrist should maintain focus on maximizing an individuals function, and whether their role is as primary team physician or as a team consultant. Physiatrists have the necessary tools to become leaders and specialists in the field of sports medicine and should be given equal opportunity to serve as primary care team physicians.
John O. Watson MD, MS, ATC
PGY-4
University of Colorado Health Science Center