Scope of practice in Sports Medicine

[JBM16BYU]

Background: current preliminary medicine resident, beginning a residency in PM&R this coming July. As I’ve been exploring fellowship and career paths, I have some questions regarding Sports Medicine. If y’all could provide answers to any of these, it would be immensely helpful to me.

1) For PCSM docs who practice in ortho practices as the “non-operative” alternative, how do you differentiate yourself practice-wise from PA’s and NP’s that are non-operative sports medicine providers?

2) How do you build a patient pool and differentiate yourself when there are physicians who didn’t complete a fellowship, chiropractors, massage therapists, physical therapists, etc who all claim the title “Sports Medicine”? I feel like 4 years of medical school, 3-4 years of residency, and a 1 year fellowship should mean something as opposed to the aforementioned alternatives who all make the same claim.

3) Certain sports medicine fellowships provide opportunities for fluoroscopy training in both axial and non-axial joints (particularly PM&R sports Med fellowships, JPS, Utah, etc). Do individuals who complete these fellowships have a hard time finding places that allow them to actually use these skills, especially with pain-trained or spine-trained individuals who completed fellowships as competition?

4) For PM&R folks, besides the ability to cover higher level sports teams, does completing a sports medicine fellowship give you any other skills that you can’t (A) learn during residency or (B) pick up on your own after residency?

5) I’ve seen a few sports medicine physicians list on their websites that they are “concussion specialists.” Besides just being a sports medicine physician, is there anything else these individuals are doing to claim this title?

Thanks in advance!

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[runfastnow]

1. You will be a much better diagnostician than an NP/PA ... BUT if you only offer or are willing to see basic diagnoses (knee OA, shoulder impingement, ankle sprains) and only see a limited number of patients per day and do not offer EMG, US, fluoro, etc. then you will only be seen as a glorified NP/PA. [at least in private practice]

2. A lot of those other allied health people need a MD Rx to continue treatment. Building good rapport with orthopedic surgeons, PCPs, community, PTs, etc. will build your patient pool rather than being passive (or starting turf wars).

3. Depends on the practice and what you learn. Overall, more skills you have the more desirable you will be to a practice (at least for getting your first real job and building first patient population). Even if you don't offer cervical injections or pumps/stims you will still have a leg up on non-fluoro people trying to break into the job market.

4. You will be strong at MSK out of residency, but sports fellowship will further develop US and fluoro skills and understanding the subtle differences between various injuries (i.e. various meniscus tears, etc.). Sports fellowship also will allow you to become a team physician with major university athletic programs and professional teams (very rare to work with large D1 program without fellowship ... certainly with the more prestigious sports) and eligible to be a fellowship director if you desire academic career.

5. Generally no. Mainly just willing and interested in taking on chronic concussions that others are either non-interested, don't have the skillset, or do not have the resources to help. Some may have taken the TBI board (which could be done without fellowship in the past) and those would perhaps have a more legitimate claim.

Overall - the more you advance in your career the more specific interests you will find and the more specific jobs will be. Moving from medical school to intern to specialty residency to sub-specialty fellowship to ultimately a job that is looking for a PM&R sports physician to do a mix of sports with US +/- EMG or spine or regenerative (or some other similar set up).

All of your training is focused on getting that first job and patient population and then truly finding what you are best at, enjoy most, can be most successful practicing. You will not be a perfect finished product coming out of fellowship (no matter the program).

 

[galactus]

1. I handle concussions, RTP guidelines, US that our midlevels do not do. I also do a lot of rehab/exercise prescriptions, and cardiac screening for athletes.

2. Building a patient pool is easy. 90% of MSK is non operative. People don't want surgery. Being the MSK guy in a FM practice, as well as the non-op person in ortho (I work in academics), I get tons of referrals from both, as well as the internal medicine department and outside providers. Being a team doctor for high schools and college help as well, as I get the student athletes to see me in clinic. Alsom, It's a symbiotic relationship with ortho. When I refer to them, they know it's already operative because it's coming from me.

3. I didn't train with fluoro in my fellowship, but the ones I know who did, they are practicing it in their respective practices, both in academics and private practice.

4. I'm FM/SM, but I work with my PM&R/SM colleagues regularly. I agree with the above post about wanting to do elite sport coverage they usually want someone with sports medicine training. A good example it's that it's required to be part of Team USA Medical. The sports medicine boards are the same for all specialties, so we all have to learn from each other's specialties to be a board certified sports doc. Sports med is not just a glorified MSK fellowship. There's other organs! Examples off the top of my head are: RTP protocol in a wrestler with herpetic outbreak, anemia in an athlete, RTP in mononucleosis, Eye injuries, dental injuries, EKG and cardiac screenings, etc. Being a sports med doc encompasses the athlete as a whole.

5. All sports med docs are concussion specialists. It's part of our training! I think we consider ourselves specialists because we are comfortable managing it. Not all FM/PMR/Peds/Medicine docs are comfortable managing concussions and return to play. Now some are, and that's fine too.

 

[KeikoTanaka]

1. I handle concussions, RTP guidelines, US that our midlevels do not do. I also do a lot of rehab/exercise prescriptions, and cardiac screening for athletes.

2. Building a patient pool is easy. 90% of MSK is non operative. People don't want surgery. Being the MSK guy in a FM practice, as well as the non-op person in ortho (I work in academics), I get tons of referrals from both, as well as the internal medicine department and outside providers. Being a team doctor for high schools and college help as well, as I get the student athletes to see me in clinic. Alsom, It's a symbiotic relationship with ortho. When I refer to them, they know it's already operative because it's coming from me.

3. I didn't train with fluoro in my fellowship, but the ones I know who did, they are practicing it in their respective practices, both in academics and private practice.

4. I'm FM/SM, but I work with my PM&R/SM colleagues regularly. I agree with the above post about wanting to do elite sport coverage they usually want someone with sports medicine training. A good example it's that it's required to be part of Team USA Medical. The sports medicine boards are the same for all specialties, so we all have to learn from each other's specialties to be a board certified sports doc. Sports med is not just a glorified MSK fellowship. There's other organs! Examples off the top of my head are: RTP protocol in a wrestler with herpetic outbreak, anemia in an athlete, RTP in mononucleosis, Eye injuries, dental injuries, EKG and cardiac screenings, etc. Being a sports med doc encompasses the athlete as a whole.

5. All sports med docs are concussion specialists. It's part of our training! I think we consider ourselves specialists because we are comfortable managing it. Not all FM/PMR/Peds/Medicine docs are comfortable managing concussions and return to play. Now some are, and that's fine too.

Do you only do SM or do you also do traditional FM as well?

 

[galactus]

Do you only do SM or do you also do traditional FM as well?

FM, SM, and inpatient. Pretty much do everything except OB. I keep my admit privileges not just to be the attending on the resident service, but I admit my own athletes for inpatient. It’s rare but I have admitted my college/pro athletes before (DVT, appendicitis, severe dehydration, etc). I’m a HUGE proponent of primary care in sports med. We are the PCP’s for the athletes/teams, and should be able to take care of almost anything.