busupshot83

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What is the difference, in relation to types of care provided, between a Physical Medicine and Rehabilitation Physician (Physiatry), and a Primary Care Sports Physician (Family Doctor with a fellowship in Sports Medicine)?
 
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Read this old thread...

Short answers to your questions are:

1) yes--but not through family medicine boards.
2) no--sports injury rehabilitation (and sports medicine generally) is already in the primary scope of practice of general PM&R. It would be like a family physician getting a CAQ in "diabetes management." That's not to say that you wouldn't want the extra training. Being fellowship trained in sports medicine means something to recruiters and employers!
3) yes, but depends on who is sponsoring the program. A sports fellowship sponsored by an FP program is going to be a "primary care sports medicine program" whereas a sports program sponsored through a ortho department is going to be a "surgical sports medicine program."
 

Freeeedom!

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The fellowships are essentially the same, the backgrounds are different.
Personally, I think the EM fellowships in SM are where its at...but I am biased. I think the EM doc is easily the best doc for on field acute injuries including life threatening ones as well.
 
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PMRQUESTION

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Thanks to Drusso for once again having the answers.
Anyone interested in compiling a list of resources (ie web sites or individual programs) of Sports Fellowships for which PMR trained docs are eligible to apply? The only resource of which I am aware is at <physiatry.org>. There are other lists on the web, for example, the ASSM with lists but I don't know how accurate they are. Please add any info and thanks.
Also, I think Tulane has a PMR Sports fellowship through their Ortho Dept. Any others? Please post.:clap:
 

busupshot83

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Thanks for the replies.

Here's another question:

What is the best route (in your opinion) to become a professional sports team physician (non surgery)? Is there a "best" route?
 

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There was yet another thread just like this. Here's my response from that thread.

don't know much about this topic but throughout my interviews - there were Physiatrists who served as team physicians for college/professional sports teams. There were residency programs with stronger sports programs - so I don't know what level of training you are in but if you're still a student, you may consider doing a Sports rotation at a good PM&R program. You can go to the AAPMR website and look for Sports/MSK fellowships.

Examples -
Temple - Dr. Weinik(???) - used to be team physician for Flyers

Stanford - Dr. Fredericson - Men?s and Women?s Cross-Country &Track Teams, Men?s Swimming, Men?s Gymnastics,Women?s Softball and Field Hockey Teams - see http://guide.stanford.edu/VARehab/S...redericson.html

UCDavis - Dr. Brian Davis - Sacramento Rivercats, Pan American Junior Championship - see http://www.ucdmc.ucdavis.edu/update..._03/bdavis.html

VCU - Dr. Silver - Team USA WKA Kickboxing Amateur division

Hopkins - Dr. Eaton - United States Cycling Federation, Junior World Track Team, Cycling World Championships, Master's National Cycling Championships and the New York City Marathon.

Baylor Alum - William J. Bryan, M.D., '75, (left), pictured here with Astros first baseman Jeff Bagwell, has been the Senior Team Physician for the Houston Astros for more than 15 years and has worked with Olympic cyclists and many other professional athletes during his career (http://www.bcm.tmc.edu/alumni/newsl..._/fall_00_.html)



Also, here's a list of sports fellowships - for primary care AND PM&R http://www.physsportsmed.com/fellows.htm

There's also a thread on Primary Care vs PM&R Sports Medicine on this forum. I'll bump it up.


Sorry I'm not much help.
 
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briandavis

Dear Readers:

I luckily stumbled across this thread to be able to clear up some significant misconceptions.

PM&R is very different from any other primary care or other sports medicine practice. PM&R looks at individuals with disabilities - from minor (ankle sprain, ACL tear, RTC tear) to catastrophic (TBI, SCI, amputation) and all ground inbetween. Part of the difference between PM&R and other fields, including the aspects pertaining to sports medicine are engrained in the depth with which we review the injury history, its biomechanics and its social impact. This is not to say that other specialties CAN'T do this, they just frequently don't - mostly due to time constraints in practice. Additionally, the most frequent area of no overlap for me in my practice are the neurologic injuries - from mononeuropathies to radiculopathies to plexopathies.

Fellowships are VERY different. I toured the country looking at all different types of fellowships for sports. PM&R fellowships often incorporate EMG/NCS training aas an extension of residency. This continues to advance the PM&R knowledge base on nerve injuries and sequelae.

Becoming a team physician is based upon how much you do and for whom. My involvement started with high school and college football and professional soccer because of my training director. Everything after that was all work that I procured - being at the right place at the right time. Sometimes it meant covering the crappy event to get the good one later. When you get an opportunity to cover an event, spend less time worrying about seeing the action and more time on the care of athletes.

I agree that Emergency Medicine training can be very helpful for sideline management, but I have augmented my skills by learning and keeping up-to-date with ACLS and ATLS. I have also spent volunteer time in the ER learning/ re-learning suturing and fracture management. Some areas of emergency care will always be better handled by an EM doc, but the likelihood of a sever on-field event is exceedingly rare. Management of cervical and and head injuries and nerve injuries are so commonly taught in PM&R programs that they are second nature.

That's what got me where I am today. I am always glad to answer questions about PM&R sports medicine. After being out for 7 years, I can still say I would never do it any other way.

Hope this helps....
 
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Freeeedom!

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Disagreeing with a professor is never a good idea...I am not asking for a fight on your "home turf".

Ok, each SM fellowship has its own individual strengths and weaknesses. When i was in medical school, I VERY MUCH wanted to become a Physiatrist, but as a former PT, I wanted something that dealt with greater acuity of pathology. THE profession for that is Emergency Medicine.
As a 2nd year medical student I helped a Physiatrist with a Rugby tournament...she promptly told EMS that THEY would handle any emergent problems (codes, intubation, etc). That was the day I decided against the PM&R route Sports Medicine (this is an individual decision).
Today, I am entering my 3rd year of EM residency. Just last weekend there was 3 codes and one death at the Indianapolis Mini Marathon...the EM docs provided coverage. It is rare, but when it happens...I want it to be second nature (and it is), that leads to the optimum in care of emergent sports medicine conditions.
I applaud anyone wishing to further their education by ongoing fellowhip training.
 

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can anyone give examples of what kind of jobs sports med docs get after fellowship. Do they do full time team sports, do they have to travel, do they have to work in an othropedic group, and how much $$?

Thanks
 

rehabdoc

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I believe everyone will look at a profession at a certain angle. Sports medicine is a branch of medicine that could be practiced in many setting, some require resuscitation and airway management, some require orthopedic intervention, some require acute TBI/SCI management and in some cases further w/u in hospital by diagnostic studies including MRI/CT and EMG.

I guess there is no perfect specialty as prerequisite for sports medicine training but I believe in non-surgical field, physiatrists have an advantage of being great diagnosticians, can work up pt at side line and in hospital, have vast knowledge of radiology/CT/MRI/Bone scans and also can further diagnose nerve injuries with NCS/EMG and further plan treatment

In a way, they could provide a comprehensive diagnostic /treatment plan from sideline to ICU to medical/rehab floor to home all in one package. That is hard to match by any other specialty.
 

Disciple

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IMO, physiatrists have a more comprehensive understanding of kinesiology, the kinetic chain and the interrelatedness of structure and function.

I believe these are indespensible in rehab of sports injuries, correcting bio-mechanics, injury prevention and strength conditioning/therapeutic exercise.
 

rehab_sports_dr

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I disagree with the ER reisident who commented that ER is the ideal training for sports medicine.

IMO, the best training for sports medicine depends on what types of sports medicine one is interested in.

By far the most common of sports injuries are chronic overuse injuries. The specialty the provides the best training in a comprehensive musculoskeletal examination, the diagnosis of overuse syndromes, and the principles of their rehabiliatation injuries is Physical Medicine and Rehabilitation.
Therefore, PM+R training makes the most sense for coverage of events like marathons, triathlons, bike races, tennis matches, gymnastics, etc.

For traumatic injuries, the specialty with the best training is orthopedic surgery. They have the best skill set for the diagnosis and management of fractures, ligamentous injuries, etc. They would be the doctor of choice for a football game or lacrosse match.
The one caveat is that for spinal cord injuries, concussions and brachial plexopathies, PM+R provides better training, since that is a regular part of our training.

I think that ER docs are excellent for diagnosing initial trauma, but are not especially well trained in their long term management, which is a very important part of sports medicine (the majority of sports medicine is NOT sideline coverage, but long term follow-up), and ER docs are not well trainined in chronic overuse injuries like rotator cuff tendonapthies and patello-femoral syndrome. Those are far more common that sideline heart attacks, which admittedly ER docs are better trained to manage.
 

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This question might have been answered in the above posts, but I was not able to catch it. What advantages would a physician having done a residency in Internal Medicine, or Family practice have in not only successfuly completing a sports med. fellowship, but also being a successful sports and rehab doc as well??

Also, for somebody who hopes to work for a sports team (either hockey, basketball etc.), would going the IM or family practice route be ideal, or would they be more successful if they went through pM&R residency.
 

busupshot83

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HussainGQ said:
This question might have been answered in the above posts, but I was not able to catch it. What advantages would a physician having done a residency in Internal Medicine, or Family practice have in not only successfuly completing a sports med. fellowship, but also being a successful sports and rehab doc as well??

Also, for somebody who hopes to work for a sports team (either hockey, basketball etc.), would going the IM or family practice route be ideal, or would they be more successful if they went through pM&R residency.

I've seen team physicians from all different backgrounds, but it seems orthopedic surgery is the most common. I guess it comes down to the individual: if you are good at what you do, then you will be in demand (as is the case in any career).
 

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In the NYC, pro sports teams are covered by a med center (the Mets by HJD/NYU ortho, for example) that bids to provide the sideline MDs and actually pays the team for it as a marketing tool.

The bidding was written up in the NY Times last year as a new trend in sports med. Anyone seen it outside the NYC area?
 

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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?
 

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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 individual’s 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
 
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