Contracts depend on what you can negotiate. It can range from marketing/advertising rights, to preferred provider, to fee for service/time (i.e. training room), to full on retainer/employee.
Vast majority of arrangements are marketing/advertising and preferred provider. Depends on where you practice, of course; but the way it looks is doctors/hospitals buy advertising from the team, the team fills doctors waiting room with patients/procedures, the doctors use the hospital for testing/procedures/therapy. So yes and no, in a sense the services you provide to the team may be considered gratis, but some times not really. It all depends on what you negotiate and what the market is like in the area you practice.
That model works best for doctors who are either employed by a hospital system, who are in a partnership where you have a share in surgical, PT, and imaging profits, or if you can bill for and capture high dollar procedures on the back end (i.e. if you are a surgeon).
The financial model for PCSM will continue to evolve to meet the needs of the docs who don't fall in the above categories AND for the teams who can't find docs who fit in the above categories.
I'll tell you this: In my market, the doctors who are providing gratis services at the team level are orthopedic surgeons or PCSM doctors who work in an orthopedic practice. That's because they can capture revenues on the back end. Increasingly, teams are starting to understand that maybe orthopedic surgeons shouldn't be their primary team physician. Increasingly, teams want a PCSM doctor to be the first to see an athlete for all of their complaints; especially when for a non-orthopedic issue where an orthopod functioning as a PCP would make inappropriate referrals to medical subspecialists.
Unfortunately, teams are just like everyone else... You can't find a FM doc willing to work for pay (!) much less show up to the training room to work for free(!). So, right now, the demand/opportunity is with established orthopedic practices to hire and subsidize a PCSM doctor to come in and fill that role. Unfortunately, for most PCSM doctors who work in orthopedic practices, their medical skills atrophy if they only see MSK cases. And orthopedic practices have a problem if their PCSM doctor is doing primary care out of the orthopedic office.
You don't see this on the professional side, since they have so much money to spend that they have no problem accessing the health care system. You will see this increasingly so with collegiate teams who are not affiliated with a medical school and you will see this increasingly to be the case with high schools. It's already seen on the semi-pro/amateur side where there is high demand for PCSM services but no money.
There is a lot of uncertainty for traditional orthopedic-sports med model because the revenue on the back end is under pressure to get cut (outpatient surgery center, imaging, therapy). It's not going to crash or disappear but there will be some downward pressure, so groups and teams on the margin will have to evolve and adapt. Doing a physical here and there for some peanuts is hardly a money maker for a PCSM who is not cross-subsidized by an ortho group.
What you see today isn't what will be around in the future.
