Sports Medicine (help!)

[6ft3dr2b]

Can someone PLEASE explain to me what Sports Medicine involves? How is it different from PM&R? What are the pros and cons? Whats the big deal if you go into it thru Fam Medicine vs Int Medicine?

I ask many residents and no one has a grip on what sports medicine involve!!!

thanks

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[lowbudget]

For what it's worth, I'll take a first stab and let someone who knows more run with it:

Generically speaking, sports med is about taking care of athletes. It's multidisciplinary and it involves a lot of people from athletic trainers, to physical therapists, to orthopedic surgeons, to primary care, to PM&R. Primary care sports med focuses on diagnosis of injuries, treatment of injuries, appropriate referral for surgery, monitoring progress through rehab (or lack of), prevention of primary injuries, and prevention of complications from injuries. PCSM docs are comfortable treating non-operative injuries and train with trainers and physical therapists to understand the rehab process and monitor the natural history of recovery. Sports med docs understand and make return to play/activity decisions. In addition to injuries, PCSM docs train to take care of neuro, cardio, pulm, endo, derm, heme, fluid/electrolyte, and gyn/women's health issues in athletes. There's training in psych and nutrition. I'm sure through clinical care, you'll see plenty of eye and face pathology. Some programs will get you involved physiology and performance if you're primary care.

In training, you'll learn about particular sports by doing game coverage which will help you understand mechanisms of injury, needs of the athlete, and shed light on injury prevention. You're also right there at the time of injury. There's usually training room rounds where you see athletes for various issues and follow up. You'll also work with ortho (typically SM trained) and learn how to read Xrays & MRIs and how to manage non-op musculoskeletal stuff (cast/splints). There's typically a mass event coverage. You may do a lot of preparticipation physicals and do a lot of clearances to participate.

Honestly, I don't know anything about PM&R (you'll have to ask those guys) or PM&R Sports Med for that matter, but I imagine there's a lot of overlap and niches. I also imagine that PM&R SM are more comfortable taking care of athletes with spinal cord injuries and athletes with special needs (i.e. Special Olympicians/Paraolympians) but I think that division is arbitrary and probably driven by experience more than the label on your lab coat.

You can arrive at PCSM via FP, IM, Pedi, or ER. Let it be known that the number of IM, Pedi, and ER slots are way smaller than those of FP (many programs prefer FP). FPs are required to train in ortho and sports med and tend to be more outpatient/community oriented than the categorical IM which may have fewer orthos, more in-hospital call and therefore more duty hour restriction, less continuity clinic, and more likely to ask residents to use their electives to get SM experience. Pedi will need to learn adult medicine and physical exam during fellowship, and ER would be great at the acute/trauma aspect, but, according to them, may be a little behind compared to FP counterparts on the longitudinal aspects.

Now, there are many different types of sports med doctors and practices. The stereotypical SM doctor is a Team Physician where the doctor takes care of all the issues for a sports team or university. They usually cover games and will have training room rounds. Team Physicians can be involved with academic institutions that does research, education, or both. Depending on the set up, University team physicians may solely take care of the athletic department, or may also be involved in the general college population by hosting a sports med clinic or actually running their student health. If they're involved in student health, they may also be involved in occupational med (taking care of university employees for injuries, primary care, etc.). I've seen people with traditional FM practices who will attract active people (young and old) because of their SM training. Faculty with CAQ in Sports Med may be involved in teaching SM as well as precepting/covering clinic and covering inpatient services. Some SM docs work as essentially non-op orthopedics. They partner up with an Ortho group and see a lot of patients in clinic. They occupy clinic whenever Ortho is in the OR and cherry pick out surgical cases for Ortho. They may or may not take care of primary care issues (which is a business decision based on how they want to manage their referral pattern). Other docs trained in sports med will work urgent care and occupational med clinics (work comp). There's also a lot of sports med issues in the military.

I haven't figured out how sports med docs make money. If they have a traditional FM practice, it's pretty straight forward. You charge for E&M, joint injections, cast/splints. You may have a share on the business end (Xrays, phys therapy). You may see more acute care which is more focused, more homogenous, and require possibly less time. If they work as non-op ortho's that's pretty much the same too. My question is how do you make money if your a college or professional Team Physician without institutional support (from the team, the college, the hospital)? I just dunno.

The rumor I heard was that IM is phasing out Sports Med, which will be a shame because there are a lot of good internists who do SM. I don't know why, but someone may want to double check me on this rumor.

 

[airforce1981]

Can anyone speak from experience about how much a CAQ in sports medicine adds to their potential salary? I spoke with one physician who recommended against doing a 1 year sports med fellowship because it didn't add any value to her degree. I'd really appreciate any input on this subject. I don't want to make a career choice based on salary but to do a year long fellowship without any return doesn't seem like a great idea.

 

[EdibleEgg]

You basically take a 100K pay cut while you are doing your fellowship. I don't have any thing other than discussions with several fellowship trained FP's to support this, but the salaries can vary widely depending on how you practice. The average is probably very close to the salary of non fellowship trained FP's. Only consider PC sports med if you are genuinely interested it, the money basically evens out.

 

[deleted87716]

My question is how do you make money if your a college or professional Team Physician without institutional support (from the team, the college, the hospital)? I just dunno.

Ideally, you have a procedure-heavy, referral-based (meaning you can bill higher-paying consult codes for initial visits) non-operative orthopedic practice, and receive stipends from one or more college or professional athletic organizations for "team physician" services. Most of the better-paid sports medicine-trained FM docs practice alongside orthopedic surgeons.

 

[lowbudget]

Can anyone speak from experience about how much a CAQ in sports medicine adds to their potential salary? I spoke with one physician who recommended against doing a 1 year sports med fellowship because it didn't add any value to her degree. I'd really appreciate any input on this subject. I don't want to make a career choice based on salary but to do a year long fellowship without any return doesn't seem like a great idea.

Like any survey/salary question, there seems to be a wide variation in the numbers. The ACSM numbers below don't look all that different from traditional inpatient/outpatient FM. Two other websites make it look as if there is a difference.
http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm
http://mdsalaries.blogspot.com/2007/02/sports-medicine-physician-salaries.html

I'm more apt to believe the ACSM numbers since in most private practice sports medicine practices are built out of the family medicine or urgent care practices. And if you consider the fresh out of fellowship with a guarantee/subsidized salary mixed in with the seasoned practice partner, the average PCSM starts to look just like FM. Even in non-op ortho practices, there's only so many patients a physician can see in a day, your salary would have to justify the revenue you generate. I'm sure the difference would be if the group subsidizes your PCSM practice but relies on you to indirectly generate surgeries or if you have a share in the ancillary, then maybe your salary may start to pull away from the FM salary. My bet is that academic practices are generally lower paying on a dollar-for-dollar basis but with better benefits and that I'm willing to bet that also applies to university employed team physicians.

If you look at the AAFP 2006 survey of clinically relevant CME that FM docs say are highly important to them, you'll see that 55.3% said that MSK Exam Techniques was in "High" need which, I believe, is the highest sub-category; and as a field, 39.9% said that MSK/Sports was in "High" need, which ranks 2nd as a category only behind Cardiovascular. I love using these numbers to throw at faculty who seem to lose focus in steering the FM Curriculum, using generalities and theories when the data is right in front of them. To me, these numbers also spell out where the opportunities to differentiate yourself from the pack once you go out and practice. It's just an interesting survey.
http://www.aafp.org/online/en/home/aboutus/specialty/facts/30.html

So while there may or may not be any dollar value-add in doing fellowship, there seems to be something left undone in the abscense of it.

Just my opinion & interpretation, of course... be curious to hear what others think...


For immediate release
May 30, 2007

SURVEY REVEALS SPORTS MEDICINE PHYSICIAN STATISTICS
Practice and Salary Characteristics Among Results

NEW ORLEANS – New statistics reveal more information about clinical sports medicine practitioners. The study was developed to investigate and disseminate the practice patterns, career opportunities, professional relationships, and income that exist in order to better understand the career of a sports medicine physician, and released today at the 54th Annual Meeting of the American College of Sports Medicine (ACSM) in New Orleans.

Primary care sports medicine began in the 1970's and has grown into a well recognized sub-specialty of family medicine. Sports medicine fellowships were developed in the 1980's, and the American Board of Family Physicians (ABFP) formally certified its members with a Certificate of Added Qualification (CAQ) in 1993. The practice of the 1,102 family physicians with a CAQ in sports medicine varies significantly. Sports medicine physicians at The Ohio State University designed the investigation to characterize the clinical practices of physicians who hold a CAQ in Sports Medicine through the ABFP.

A non-identifiable Web-based survey was distributed via e-mail by the ABFP to 862 family physicians (members with valid e-mail addresses) holding a CAQ in Sports Medicine. Survey questions included physician, practice, patient and payer demographics as well as income data.

Thirty-eight percent, or 325 surveys, were successfully completed. Of respondents currently holding a CAQ, 212 reported completing a Primary Care Sports Medicine Fellowship. Furthermore, 276 were male and 49 were female, and 300 reported being a M.D., while 25 reported being a D.O. Of the 325 responses, the average net income for all physicians with a CAQ in Sports Medicine was $166,348.

Men who were older than 40 years old, owned their own practice, and saw more than 10 patients each half-day were most likely to have a higher income (>$200,000/year). There was no statistical difference among salaries between M.D. or D.O.'s, OMT practice, region of the country, or type of practice.

The research team concluded the practice of primary care sports medicine physicians varies significantly with location and type of practice. Salary can be related to age, gender, number of patients seen, and practice ownership.

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 20,000 international, national, and regional members are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

-30-

The conclusions outlined in this news release are those of the researchers only, and should not be construed as an official statement of the American College of Sports Medicine.

 

[lowbudget]

Ideally, you have a procedure-heavy, referral-based (meaning you can bill higher-paying consult codes for initial visits) non-operative orthopedic practice, and receive stipends from one or more college or professional athletic organizations for "team physician" services. Most of the better-paid sports medicine-trained FM docs practice alongside orthopedic surgeons.

Yea, I've heard that PCSM's in an ortho practice probably take home more money. The only barrier is whether an FM would want to narrow their practice to only seeing non-op ortho. One guy in a practice like that told me that he (and their group) made the decision to defer cardiac clearance, cardio/pulm management to PCP's because they didn't want to lose their ortho referrals in fear that the PCSM guy would steal Medicine cases. And so his practice is mainly non-op ortho. So, ok fine, so... what's the business argument for why a group would choose a narrow non-op ortho PCSM doc versus an ortho PA? I mean, to me, the value of being board certified FM doctor is the range and breadth of training and knowledge...

As far as receiving the stipend, that depends on practice area and how savvy you are. I've seen both where groups would receive a stipend for services because the team loves the physician and I've also seen teams opting in a competitive environment for someone willing to be team physician on a pro bono basis. On the professional side (and this is well known and discussed), many professional teams ask the *PHYSICIANS* to pay the *TEAM* for the privilege of being the team's doctor. The professional team then turns around and helps the physicians (or hospital) market by allowing them to say "official team doctors". Pretty slimy, if you ask me. Just goes to show that it's never really about the medicine. It's always about the money.

 

[deleted87716]

what's the business argument for why a group would choose a narrow non-op ortho PCSM doc versus an ortho PA?

Liability and overhead. MDs bear their own malpractice risk, and typically share overhead. Midlevels usually are overhead.

It boils down to personal preference.

 

[lowbudget]

Liability and overhead. MDs bear their own malpractice risk, and typically share overhead. Midlevels usually are overhead.

It boils down to personal preference.

Kent, didn't you say once that you've got someone in your group who's CAQ SM? What's like that for this person?

(btw, it's nice having you back. Bickering's just not the same without you.)

 

[deleted87716]

Kent, didn't you say once that you've got someone in your group who's CAQ SM? What's like that for this person?

We've got two, actually. They work with our orthopedists pretty much as I described in my earlier post. Income-wise, they do a little better than the average FP in our group. In most cases, fellowships in FM aren't going to increase your income by a large margin, but they allow you to tailor your practice.

 

[AirforceDOtobe]

If there are any Sports Medicine physicians out there would you mind doing a little break down of how your salary pans out in regards to the payoff of having the CAQ in sports medicine? Do you code higher because you're a specialist? Thanks

 

[secretwave101]

Sorta seems like if you're asking specific detailed salary questions...then the fellowship isn't for you. Everyone I've talked to says the CAQ is pretty much an academic thing. You're really only going to see about 10k more per year and your practice will be more focused (departing from the general idea of family med, so say some critics).

With taxes, it could potentially take you 10 years to make up for the lost salary of that year.

If you're worried about the financial impact, I'd say stay away. I'll admit a bias here...I made this exact decision recently entirely because of the financial impact of the fellowship (and lack of impact of the CAQ on income).

 

[aecuenca2]

Hello,

Sports Med Fellow 2 months from finishing the fellowship.

I agree the CAQ is an academic validation of your training, but not needed to practice sports medicine.

Even the fellowship isn't necessary to "practice" sports medicine.

But I can honestly say this: the pay cut was brutal, but this extra year allowed me to be comfortable with my ortho exam, handling of ortho issues and fracture management/casting, joint injections, handling on the field injuries. As a resident, my experiences working with other docs or attending sports med conferences just wasn't a close substitute for the experience.

I agree the income can vary, but one advantage you could also think about is if you happen to have capitated patients, you can feel comfortable not referring patients out to ortho. add to that the private/PPO patients that your colleagues refer to you for "sports med" consults and that you will do more procedures than your FM colleagues adds to your income. And if you wish, you could always assist on ortho surgery and bill.

Anyways, just my 2 cents.