FP are great high school and small level docs but I think you will see ER PM&R take over nonoperative sports care from FP and IM because our training simply translates better.
Also, majority of PM&R residencies have required MSK and Sports rotations. I know mine has both
Not true.
ER docs aren't interested in the primary care, and unless they trained at a program where people use the ER for primary care, most ER docs are pretty bad at primary care. We've talked about PM&R already. Most IM programs have dropped sports medicine as a fellowship (you won't find any IM sports medicine fellowships out there anymore. They're mostly sponsored by FM programs and many IM docs are uncomfortable dealing with pediatric population).
Regarding the first, it is true that FP's make great high school and small level docs. They also are great team members of the sports medicine team for higher level athletes. The issue here is that there really aren't that many elite athletes and they truly only represent a small number of the total population in the US (I mean, for real... every athlete thinks they are an elite athlete; and every mom thinks their child is an elite athlete... but let's get real here, people.)
Many professional teams have easy access to medical care, so there are almost always 5000 physicians ready to serve 20-30 athletes. That means nothing to me. To me, it is more meaningful (and makes more economic sense) to be one of the 20-30 doctors who serve 5000 athletes.
Lastly, most professional/collegiate team physicians aren't the "best" physicians out there. Most professional/college team physicians PAY the team to be their physician... Think about it. When was the last time you paid your patient to be their doctor?
And yet, that's how it's done in sports medicine. Most high level sports medicine doctors are part of a huge hospital/university system because the hospitals pay the team "marketing" dollars in return that they are the "official health care provider" for that team. Most small groups can't afford to buy out a team like that. And, in order for you to get in on that, you MUST work for the hospital, you MUST operate all your cases in their OR, and you MUST send all your PT and MRI's to that hospital, EVEN if the hospital is the worst in town or the MRI is 15 years old. Why? Because a hospital isn't going to spend millions of dollars paying for marketing if the doctor is going to send the business elsewhere.
So, what that means, as a doctor, is that the team AND the hospital got you by the gonads.
And if you are a real doctor with any real courage to advocate for your patient and practice medicine independent from influence and say, no, this elite athlete really needs to go down the street because they are better at this than we are, then your time as a professional/elite doctor will be short because the people who paid your way in will get tired of you breaking their bank.
So, to me, there is more honor to being a small time sports medicine doctor, because at the low level, that honor still means something. At the elite level, you bribe your way in. This is well known in the world of sports medicine. The biggest perks in being a physician on the elite level are 1) having that marketing capability to say that you take care of elite athletes (even when you don't "really" do) so that you can pull in star-gazing low-level athletes into your practice (if they have insurance...) and 2) having bench side tickets to some pretty neat games.
The downside in sports medicine for the elites is that money and politics talk. And you can have the highest USMLE score, the best medical degrees, but when it's time for the team to drop you for whatever reason (usually money), they'll drop you because to them there are 5000 doctors waiting to work for them. Don't think that just because you rub elbows with an elite athlete that it makes you an elite doctor. These teams can afford to ship Kobe Bryant to Europe to get a stupid injection, so don't think they won't second guess you. At that point, nobody really cares what residency you matched into...
Let's call it for what it is, right? In the world of professional sports, people tune in and buy tickets to watch the athlete. Not the doctor. Nobody cares about you, the doctor. In the eyes of the rest of the world, all you do is support the behind the scenes for their athletes. You're no different than the trainers, the equipment manager, the bus driver, or the water boy because at the end of the day, everything is in place to elevate and spotlight the athlete. Many doctors have a problem understanding that, because they're so used to being in the spotlight themselves. And the sooner doctors understand that's the reality in sports medicine, the happier they will be and they'll spend more of their time enjoying their ride until they get canned instead of being cutthroat, territorial, paranoid, obnoxious, and unhappy. And, if you can't handle being treated like a medical janitor, then professional sports is not for you.