What does an EM sports medicine practice look like?

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NorthwardBound19

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For those of you who completed a sports fellowship after and EM residency, how do you incorporate it into your practice? Does it make you the "MSK person" in the ED? Do you have some sort of clinic? Is it only a way to become a sideline provider? Is it just another credential that helps you get a job but does not objectively change your daily practice?

I've seen a bit of what "sports" can look like from a primary care, PM&R, or ortho surgery perspective, where completing the fellowship allows them to see MSK chief complaints in either clinic and/or the OR. It doesn't seem as easy to do this from and EM perspective, making me wonder if it is feasible to want to incorporate it into a future practice.

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For those of you who completed a sports fellowship after and EM residency, how do you incorporate it into your practice? Does it make you the "MSK person" in the ED? Do you have some sort of clinic? Is it only a way to become a sideline provider? Is it just another credential that helps you get a job but does not objectively change your daily practice?

I've seen a bit of what "sports" can look like from a primary care, PM&R, or ortho surgery perspective, where completing the fellowship allows them to see MSK chief complaints in either clinic and/or the OR. It doesn't seem as easy to do this from and EM perspective, making me wonder if it is feasible to want to incorporate it into a future practice.

The ones that I met during my SubIs that did a sports medicine fellowship usually had a couple/few clinic days a week and essentially referred patients to themselves for MSK complaints/injections, etc.
 
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Is that not a Stark violation......?

I've heard it's not a Stark violation if you tell the patient their options and that seeing you in a clinic is one of them. At least that's what I've heard from the few EM/sports and EM/IM docs I know.
 
Do you have some sort of clinic? Is it only a way to become a sideline provider?

At whatever stage in school/residency you are, do not let the system quietly help you devalue yourself by referring to yourself "provider" unless you went to provider school.

If you're a physician, you're a physician.

Recognize the value you offer society and create for others as there is a long line of people waiting to take advantage of you. And contrary to the picture that hospital admins and midlevel societies will try to paint, docs who don't let themselves be pushed around or manipulated aren't jerks or holier-than-thou. They're just not idiots.

/end rant
 
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The ones that I met during my SubIs that did a sports medicine fellowship usually had a couple/few clinic days a week and essentially referred patients to themselves for MSK complaints/injections, etc.

This sounds like a great way to take off some of the stress/strain of an EM career as you age. Kinda similar to a pain fellowship maybe?
 
As a resident with a few sports medicine faculty, we do a short stint in their clinic

Typically it is management of strains/sprains, overuse syndromes, arthritis, etc. there is virtually zero management of acute fractures, although you do get to make splints from time to time, do joint injections etc. virtually all the patients are insured, and overall there is a good payer mix.

They also provide medical coverage for the local pro sports team

Overall it makes me realize why I hated family medicine in medical school. But I do think as your career progresses it really offers the opportunity to have a family and more regular schedule
 
My question is, what is the minimum clinic days you'd have to work a week? It can offer "stable schedule" - but probably much harder to take time off + It would suck working clinic weekdays leaving the ONLY time to do EM shifts overnight or the weekends.
 
I worked with an EM trained physician in a sports medicine clinic recently. He did a sports fellowship and initially only worked in the clinic a day or two a week while maintaining ED shifts. As he got older he transitioned more and more heavily towards the clinic side to the point where now he has stopped doing ED shifts altogether.
 
I worked with an EM trained physician in a sports medicine clinic recently. He did a sports fellowship and initially only worked in the clinic a day or two a week while maintaining ED shifts. As he got older he transitioned more and more heavily towards the clinic side to the point where now he has stopped doing ED shifts altogether.

Thanks, that's pretty cool I guess, offers variety.
 
How competitive are these SM fellowships for EM docs? Is research needed? Can that research really be obtained during an EM Residency? Do some programs favor FM docs over the EM docs? Do some programs reserve or even prefer EM docs because it offers variety?
 
Is that not a Stark violation......?
I don't believe this would be a Stark violation. It's continuity of care. It's not a Stark violation anymore than it is for an orthopedic surgeon to see a distal radius fracture in the ED and then tell the patient to follow up with him in his office. If you're doing the work, you're fine. (If you're referring to an outside entity you own, where someone else is doing the work but you profit from it, then there's likely a problem; such as owning an MRI facility and sending your ED patients there and then getting a check in the mail from the proceeds, while not being the one providing the care). Seeing patients in the ED, then seeing them again in your clinic, is not a violation of law anymore than it would be for any of the hundreds of consultants you consult per year. That would essentially ban continuity of care in the outpatient setting for anyone that sees a patient in the hospital.

(*Consult a lawyer for legal advice. This is not legal advice*)
 
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I've heard it's not a Stark violation if you tell the patient their options and that seeing you in a clinic is one of them. At least that's what I've heard from the few EM/sports and EM/IM docs I know.
I don't know of any Stark "notification of options" requirement, as you describe. If there is one, please post documentation of that.

This question has come up on this board multiple times. For some reason people in the ED think it's legal for every other physician to see ED patients in the ED and follow up with them in the office, but that it's illegal for ED physicians, and only ED physicians, to do the same. I honestly have no idea where this came from.

If you consult a surgeon in the ED who sees a patient for diverticulitis, who decides to order some IV antibiotics and sends the patient home with orals to follow up with him in the office, are they required to notify the patient of all the other surgical practices in the county and that they have the option of seeing them? No.

It's no different for you as an ED physician to do the same, by following up patients in an outpatient setting.

(*Consult a lawyer for legal advice. This is not legal advice*)
 
In regards to the original post: Options would be to do full time sports medicine. The easiest way to do that would be to join an otho group. You'd likely work regular clinic ours, with minimal if any call and be their non-operative ortho/sports guy. You'd likely have some after hours duties covering local high school, college, perhaps pro-sporting events. I thought about doing a sports medicine fellowship at one point, but I didn't want to have to do after hours sporting event coverage. If I had a gaggle of athletic kids whose games I'd have to be at anyways, it might have been different. (I happen to have a small gaggle of kids that act as if putting them in a sport is medieval torture).

Another option, would be to do part time ortho-sports clinic, and also still work some ED shifts. This would be harder to arrange since it's much easier to find one full-time job, than it is to find two part-time jobs, which are more uncommon. Then you have the whole problem of juggling a regular clinic work schedule with a sprinkling of random ED shifts. But it's doable, if you wanted to make this pathway happen.
 
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I don't know of any Stark "notification of options" requirement, as you describe. If there is one, please post documentation of that.

This question has come up on this board multiple times. For some reason people in the ED think it's legal for every other physician to see ED patients in the ED and follow up with them in the office, but that it's illegal for ED physicians, and only ED physicians, to do the same. I honestly have no idea where this came from.

If you consult a surgeon in the ED who sees a patient for diverticulitis, who decides to order some IV antibiotics and sends the patient home with orals to follow up with him in the office, are they required to notify the patient of all the other surgical practices in the county and that they have the option of seeing them? No.

It's no different for you as an ED physician to do the same, by following up patients in an outpatient setting.

(*Consult a lawyer for legal advice. This is not legal advice*)

I don't know about any official documentation regarding giving patients options--as I said this is what the EM/sports and EM/IM people have done in a few different EDs. And I don't think their doing anything extensive other than saying the patient can follow up with any doc they like but the pt can also see them in their own clinic.

Personally, I think the pendulum has swung entirely too far regarding Stark laws and has facilitated the takeover of medicine by large, soulless corporations out to make a buck. I think it has contributed to increased health costs for patients. And a few bad physician actors in the past have made things worse for the rest of us.
 
To address the OP's questions...The EM/sports people I've met all seem super happy to have done their fellowship. They do sprains/strains and assess tons of MSK issues, injections and similar office procedures, and concussion stuff/return to play. They get to work with a great patient population where folks are polite and compliant and want to get better. They have normal office hours and a chill work environment. One has fully transitioned out of EM and the others have plans to go down to 1-2 ED shifts a week with the rest in sports. Their work setups include: working two PT gigs, being an employee of a large health system, and working for an ortho group. I hear pay is way less than EM but money isn't everything. Do a rotation to see how you like it.
 
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Is it feasible/realistic to complete a fellowship in sports medicine but then not do anything with it until I'm tired of EM? I'm about to start EM residency and plan to work completely in the ED for about 20 years, but I'd like to have an "escape plan" for my 50's when/if I want a more normal schedule. Just wondering if I'll forget too much sports medicine or have difficulty obtaining an SM job if I don't work in the field straight out of fellowship.
 
Is it feasible/realistic to complete a fellowship in sports medicine but then not do anything with it until I'm tired of EM? I'm about to start EM residency and plan to work completely in the ED for about 20 years, but I'd like to have an "escape plan" for my 50's when/if I want a more normal schedule. Just wondering if I'll forget too much sports medicine or have difficulty obtaining an SM job if I don't work in the field straight out of fellowship.

It's a hard question to answer. I'm only a first year - so I can't really speak to this field specifically, but just in general with life and how hectic it is and how priorities and circumstances change... who knows?

I will say that being a sports med fellow for a straight year with moonlighting in the ED will make you very proficient at SM - and after doing it for a year you may have different priorities at that point - you'll have gained a skill you're proud of .. so you won't want to forget it. Depending on where you end up living, I'd reach out to Orthopedic/SM offices and see if you can creep your way in, even if very part time, just to keep those skills up. Otherwise, you'll have wasted a whole year of making **** money for something that won't be useful, or to get re-certified you'll be much more stressed trying to re-learn / keep up to date with everything... There is a certification process for SM, right?
 
I don't know about any official documentation regarding giving patients options--as I said this is what the EM/sports and EM/IM people have done in a few different EDs. And I don't think their doing anything extensive other than saying the patient can follow up with any doc they like but the pt can also see them in their own clinic.

Personally, I think the pendulum has swung entirely too far regarding Stark laws and has facilitated the takeover of medicine by large, soulless corporations out to make a buck. I think it has contributed to increased health costs for patients. And a few bad physician actors in the past have made things worse for the rest of us.
I agree. All this while hospitals employ physicians (which used to be illegal) and force them to self refer to their hospital employer running up higher than market facility fees, who then kick back production bonuses to the docs. Which is what Stark meant to be illegal in first place. Now industry standard, all because hospital boards & CEOs bought odd politicians!
 
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