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Most clinics operate in conjunction with a primary care office or an ortho group. For those of you trying to consider the pathway that is best for you, I will try to explain what to look at - sorry for the length.
- Sports medicine fellowship is obtainable through FM, Peds, EM, PMR, Ortho
- Ortho: 5 year residency with a 1 year fellowship. Scope is mostly surgical and purely MSK. Orthopod's get a little squeamish when an athlete talks about periods or flu like symptoms. This pathway limits the outpatient clinical aspect and makes it difficult to justify missing work to cover events. You typically don't get compensated for sideline management or training rooms. Those are purely marketing opportunities to get patients in to your surgical center.
- EM: 3 year residency with 1 year fellowship. Scope is mostly acute injury and lacks continuity and prolonged follow up. This is great for creating shift work and sideline management skills. Sideline management typically will not pay, so its mostly volunteer. You don't get to recruit to a practice, so there is no marketing opportunity there. You can still work in an outpatient setting, but the training in residency does not focus on this clinical setting so you may feel overwhelmed by the outpatient world of documentation.
- PMR: 4 years residency and 1 year fellowship. This is actually a great option for a balance of interventional procedural training with outpatient clinical aspects. They tend to focus on neuro and the spine a fair amount so you get extra opportunities in procedures that other specialties typically don't do. They have similar sideline issues as ortho because it is mostly a procedure based specialty. This limits the incoming revenue if you are not doing the procedures.
- Peds: 3 year residency with 1 year fellowship. Excellent option for outpatient training and primary prevention. Continuity with teams based on developing a patient panel. Good option for becoming a team physician for point of care issues and sideline management. Scope becomes gray due to age limitations. Peds training focuses on the under 18 crowd. Sports encompasses all ages. If there is an interest in doing college level and above, you may not feel comfortable expanding your scope to handle comorbidities in an aging athlete.
- FM: 3 year residency with 1 year fellowship. Outpatient training for all ages. Continuity care with teams and great option for sideline management. More comfortable with treating all aspects of the athlete including psych and metabolic issues. Limits ability to outpatient procedures.
- Now that the basics are covered, another consideration should come down to probabilities. If you want to be a surgeon, great, your decision is easy... If you want to cover sideline medicine and be a team physician, you have options. What level of involvement do you want to do? What ages do you want to treat? How fast do you want to get there? How much free time do you want? Do you want to be on call? Once you answer all those questions, consider the numbers.
- Which pathway gives you the best odds of getting to where you want to go? Peds and FM have the most available residency spots by far. FM offers full spectrum training in all ages. Fellowship opportunities are also more plentiful in the Primary care arena.
- Job prospects after fellowship can be tricky. Options include Academic, Outpatient specialty, Ortho group practice, Outpatient primary, Occupational medicine, Urgent care, ED, Student Health (college), Private practice.
- The first thing to consider is reimbursement rates. Practicing within a primary care clinic will be reimbursed at that primary specialty rate. Practicing in an ortho group or Sports Medicine specialty office will be reimbursed at a much higher specialty specific rate for the same service.
- Urgent care and ED will be non-selective in patient population and be reimbursed based on fee for service. No garuantee of MSK injuries, but high likelihood you will see many.
- Occupational medicine: unique specialty for work related injuries. Almost purely MSK. Visits and medical decision making are straightforward as they are limited to very specific injuries dictated by the insurance company. Paperwork can be a pain, and every note you produce is filtered through multiple lawyers and the work comp appellate board. Disability management can be a point of contention between provider and patient. If you can stomach the patient personalities this is an awesome job for purely MSK with a great work life balance.
- Student health: College campus has unique opportunities to work with a select subset of patients. Likely the athletics would be happy to build a relationship with you for easy collaboration to get athletes in faster. Can have a relaxed schedule due to the nature of the academic calendar. Everything comes in waves. Pay is typically the lowest of all options. Minimal ability to adjust practice setting. Raises and salaries are budgeted through discussion with the student government. The students determine how much health services are worth because their tuition is what pays for it.
- Private Practice: most freedom you can have, but also the most difficult to pull off with todays environment. You get to call all the shots, make the schedule, negotiate contracts and reimbursement schedules. If you miss a day, you don't get paid. You have to recruit your own patients and retain them.
- Academic: best work life balance. Freedom to expand on event coverage for purposes of training new fellows. Freedom to research new modalities and treatments. Continuity with various teams and training rooms while being paid salary. Nights and weekends can be interrupted with phone calls from residents and fellows. Expected to teach so you must love that part.
- The end game is to produce a clinician that is comfortable handling sideline trauma, interventional outpatient procedures, and comprehensive management of the entire athlete. If this sounds like fun, Sports Medicine is likely what you are looking for. Here is a list of what a program should offer in terms of training:
- Diagnostic ultrasound
- Ultrasound guided procedures
- Regenerative medicine techniques
- Tenotomies
- Exercise prescription
- Fitness testing with modalities like V02 max, resting metabolic rates, C02 testing, stress testing
- Sport Specific evaluations like golf swing analysis, throwing analysis, gait analysis
- nutritional consultations for maximizing workouts or recovery
- fracture management
- Concussion management
- ACLS/BLS
- sideline management and event consultations
- Physician Wellness education (you have to know how to have fun)
- Formal didactics (not just a journal club)
- Research Opportunities
- Board Review help
- Post Fellowship support network (should be able to reach out to old colleagues with questions)
- If anyone has any further information, or would like to add something please do so below. Also, if I have made any mistakes please feel free to point and laugh.
