How to Become a Team Physician

1. Military Sports Medicine Fellowship How to Become aTeam Physician “Every Warrior an Athlete” Kevin deWeber, MD, FAAFP Director, Primary Care Sports Medicine Fellowship USUHS

2. Objectives

3. Case discussion You are a new graduate of the sports medicine fellowship, now stationed at Ft. Bragg, NC. You want to be the team physician for a local high school. How do you start?

4. Steps in Becoming a Team Physician • Choose a team to care for • Clarify medico-legal issues involved • Meet key team staff • Agree on coverage to be provided • Assess extent of the sports med network • Establish chain of command • Agree on financial arrangement, if any • Prepare for medical coverage • Be the Team’s Physician!

5. 1. What team should I care for? • Community club teams • Sense of community service and camaraderie • Minimal time commitment • Volunteer status, no compensation • Junior or High School team • Which sport(s)? • Community service and camaraderie • May have some small financial or marketing benefits • Significant time commitment

6. What team should I care for? • College or University team • Which sport(s)? • May have financial or marketing benefit • Significant time commitment • Professional team • Likely to have financial or marketing benefit • Huge time commitment

7. 2. Initial Medico-Legal Considerations • State licensure • Local team: need local state’s licensure • Military team: any state’s licensure • Coverage during training: depends on MOU • Determine state’s sports medicine laws • Maryland: “A physician [licensed in MD] who voluntarily and without compensation [not including reimbursement for actual expenses] provides services or performs duties as a physician for a [school] sports program…is not liable for any damages for any act or omission resulting from the providing of the services or the performing of the duties unless the act or omission constitutes willful or wanton misconduct, gross negligence, or intentionally tortious conduct. Applicability—this section shall apply only to treatment at the site of the sports program, treatment at any practice or training for the sports program, and treatment administered during transportation to or from the sports program, pactice, or training.” Virginia: “Any physician, surgeon or chiropractor licensed [in Virginia] who, in the absence of gross negligence or willful misconduct, renders emergency medical care or emergency treatment to a participant in an athletic event sponsored by a public, private or parochial elementary, middle or high school while acting without compensation as a team physician, shall not be liable for civil damages resulting from any act or omission related to such care or treatment.”

8. Case Study You are already caring for a local high school under your local license and a generous state GoodSam law. The orthopedics doc that also cares for this team cares for a minor league team in the area and asks if you can help him out with them as well. You would love to but just need to check something first.

9. Initial Medico-Legal Considerations • Malpractice insurance • Local team: check state laws and local insurance companies to determine needs • Military team: none needed • Check with military commander first • Check with local military legal advisor

10. Now that you have chosen your team…3. Meet the Team’s Staff • Club: Coach • High School • FIRST: Athletic Trainer, then coach • College: Athletic Trainer, Athletic Director and Coach • Professional: Head AT, GM, Coach

11. What to discuss with team staff • What coverage is needed • Extent of any Sports Medicine network • Establishment of Chain of Command • Financial agreements

12. 4. Determine needed coverage • Settings of care • Games • Away games? • Practices? • Training room clinics? • Level of care • Assessment • Treatment? (meds? Procedures?) • Follow-up care? • Ordering diagnostic tests? • Any combinations of the above

13. 5. Determine Extent of theSports Medicine Network • Other Team Physicians • attend games or practices and meet them • Ask how you can be of assistance • Tour athletic and sports med facilities • Emergency response network and plan • Clinic support (PCM’s) • Insurance coverage for athletes • Specialty referral services/practices • Physical therapy support • Diagnostic services • Lab, xray, MRI

14. 6. Establish the Chain of Command • Who does initial treatment for injuries? • When should physician enter the field? • Who determines removal from and return to for play? • MUST be Team Physician making final call (after discussion w/ athlete and staff) • If not, WALK AWAY • Put this in writing, optimally

15. 7. Financial Considerations for Team Physicians • Team Physicians are usually NOT paid • Numerous financial or reward arrangements are possible • Consider options in advance of providing coverage ≠

16. Types of Financial Arrangements • Gratis (work for free) • Non-monetary compensation • Fee for service • Salary positions • Physician pays team

17. Gratis • Most common • Clubs, high schools, small colleges, some pro • Advantages • Flexibility, less time commitment, no obligation • Sense of community service • Disadvantages • No compensation for time/expenses • Ambiguous role; could lead to liability • Can trend toward over-commitment (“yes”)

18. Non-monetary Compensation • Forms of compensation are unlimited: • Team apparel, parking passes, free tickets, VIP status, free travel to away games • Rights to market Team Physician status • Advantages • Some compensation, but w/o the complications of a monetary contract • Disadvantages • Benefits usually not equal in value to time • Examples • High schools, colleges, some pro’s

19. Fee for Service • Set amount agreed to for time spent • Per game, practice, season, etc. • Costs for your expenses, travel • Advantages • Might make a profit • Exclusive rights to marketing • Disadvantages • Difficult to predict actual cost to your of time away from practice/family

20. Salaried Positions • Full or part-time employment • Advantages: stable income • Disadvantages: hours may be excessive and interfere with personal life • Examples: some universities

21. Case Study: Financial Issues • 2000 season: Washington Redskins team physician is reported to have paid $500,000 for the privilege of being the official orthopedic surgeon for the team.

22. Team Physician and Practice Advertising • Being Team Physician can draw more persons to a practice • Perceived as “better” doc • Pitfalls: • Bidding wars for rights as Team Physician • May lead to violation of athlete-physician trust • Fear of loss of market visibility could obstruct objective decision making • Tendency to please team vs protect athlete

23. 8. Prepare for medical coverage • Pre-season planning • Game-day planning

24. Pre-Season medical planning • Preparticipation Physical Evaluation (PPE) plan • Policy for athletes’ medical info • Documentation • Communication with necessary staff • Establish emergency response plan • Policy for environmental safety • Heat illness prevention • Cold weather precautions

25. Planning for Game-Day Coverage • Assemble an adequate medical bag • Coordinate for sideline medical supplies • Determine clearance status of players • Coordinate all medical operations • ATC may do this on some teams

26. Questions

27. Questions