Sports Medicine Physicians Are Experts
Sports medicine experts aren’t experts in every condition, but they’re acquainted with a wide range of injuries that may occur in a sporting setting.
In January 2023, a professional football player was struck with a helmet in the center of his chest during a game. He went into ventricular fibrillation and was resuscitated on the field by the sports medicine team. The team included the athletic trainers and the orthopedic and medical physicians working on the sidelines. This condition, called commotio cordis, is an example of a condition that sports medicine physicians are familiar with.
Commotio cordis is ventricular fibrillation, or an abnormal beating of the heart to the point that it cannot pump blood, which causes sudden death. It’s triggered by a blunt, typically non-penetrating injury to the front of the chest that hits the heart in a certain portion of the heartbeat cycle. Sports medicine physicians are familiar with it because it happens specifically at sporting events, whether from another player or a ball or puck.
Fortunately, this condition is very rare: it only happens about 30 times in the United States per year. When it was first understood, the survival rate was about 5%. Now, with greater recognition of the condition and greater availability of AED devices at venues to treat it, the current survival rate is 50%.
Concussions are a common injury at sporting events. They are taken very seriously because of second concussion syndrome, which can be fatal. It’s very rare and has only been documented about 20 times, but it is the reason why players go into concussion clearance at all levels of play, from high school to professional.
Other unusual conditions
To give another example of the range of training and information that sports medicine physicians have at their fingertips, they are also knowledgeable about teeth. For example, it’s not uncommon for hockey players to have their teeth knocked out, and so sports medicine physicians know how to take care of the tooth and transport the tooth and the patient to the dentist for care.
Education and Training for a Sports Medicine Physician
There are many different types of careers that care for injured athletes, from athletic trainers to non-operative sports medicine physicians and sports medicine surgeons, as well as neurologists and neuropsychologists to help with concussion treatment.
Becoming a sports medicine physician starts as a high achiever in high school to get into a competitive college, because a competitive college helps you get into medical schools. During four years of college or university, you will demonstrate success in mastering the challenging content required by medical school, including biology, chemistry, organic chemistry, biochemistry, physics, etc. to show you can handle complex learning.
Many students will take a gap year between college and medical school. The gap year is not required, but the challenges of getting into medical school are so great that it may be helpful to take an extra year or two to complete the requirements. Some people may go to graduate school for the gap year and get a medical-related degree. Others may do research, which is always welcome as a medical student and doctor. At OrthoVirginia we have many scribes working here to become familiar with a medical office setting before heading to medical school. Becoming an EMT or volunteering are other common options.
A large part of a gap year is studying for the MCAT, a one-day standardized test that puts together all the knowledge that is deemed relevant for medical school.
Medical school is four years with a variety of classes. After medical school, one way of being a sports medicine physician is to apply for an orthopedic surgery residency to give you the ability and the training to operate on patients. Orthopedic surgery residencies are competitive, so you must be a high achiever in medical school before going onto residency for the next five or six years. During your residency you’ll be taking care of patients and working side-by-side with your attendings to learn how to do surgeries as well as doing research and volunteering in the community.
After the residency you can start your own practice or join a group, but doctors who want to gain additional expertise or take care of a professional team will do a year-long fellowship after residency. Some physicians do more than one fellowship; it depends on where your interests lie. During the fellowship, you’ll often help to cover professional sports teams and/or Division I college teams. Depending on the setting of the fellowship and what you’re looking to get out of it, there is typically a research requirement where you’re writing academic papers with the attendings at the fellowship institution. You’ll continue to perfect your surgical skills, particularly for doing things that are more cutting edge or more unusual.
After your first two years of practice, you’ll take your boards to become board-certified. You’ll have an oral interview with a panel of physicians in your specialty. They will question you about your activities and review your case logs to see if you’ve been treating your patients to the standard of care and how you handled any complications or issues.
Once you pass your boards, you can also get a certificate of added qualification for sports medicine which is an additional test to demonstrate your expertise in sports medicine.
Every 10 years you’ll present case logs, demonstrate continuing medical education hours, and take a test to maintain your board-certified status. As long as you’re practicing orthopedic surgery, you’re never completely done with taking tests and improving your knowledge.
Being a Sports Medicine Physician
To be successful as a physician, you need the three As.
- Affable: You need to be able to get along with people and work with medical providers and office staff to take care of your patients.
- Able: You need to be able to diagnose and take care of patients from seconds after the injury through the months and years after.
- Available: You need to be in the community so people can know you and trust you to take care of them, and to have the resources to follow through on that care.
Providing Medical Care for Sports Events
We call providing medical care at games “covering” the game, and it’s a large portion of the work as a sports medicine physician. We’ll cover games for high schools, colleges and professional teams. It’s a pleasure to be able to help the athletes achieve their goals. We’ll also help at events, such as marathons or tournaments.
When you see us on the sideline, we’re there to help out. Hopefully our services are not needed. However, if there is an injury, you can feel comfortable that we have been trained to take care of you and get you back on the field.
Research and Community Education
Many sports medicine physicians are involved in research related to sports and athletics. We want to contribute to overall knowledge to take care of not just formal athletes but anyone who has a musculoskeletal injury, like the mother who runs in the morning before her kids get up or the man who comes home from the office and goes to the gym for yoga.
We do community outreach and education, including Facebook Lives and talks in the community at libraries, hospitals, gyms and similar organizations to share knowledge.
Frequently asked questions
How does an athlete decide when to see their regular primary care provider and when to see a sports medicine physician?
It depends on what the issue is and how the problem started. For example, if you have chest pain that came on gradually, then your primary care physician will be better suited to evaluate the problem to determine if it is coming from your rib, your lung or your heart, for example. However, if it is related to a sports injury, or if it is an acute problem that came on quickly, then a sports medicine provider can often help.
How does the sports medicine physician work with the athletic trainer at an athlete's school to care for the athlete?
It depends on the situation. For college sports, typically I’ll meet with the trainers before the athletes arrive for preseason workouts and training. We’ll go over any NCAA rules that have changed and how that affects what we do, and will set up schedules for when I’ll be on campus to see athletes and when events are.
Once the planning is done, we may help with physicals when the athletes arrive. Incoming freshmen may have had surgery last year with a doctor back home and they’re not quite recovered, so I’ll work with the trainer to plan a rehabilitation program.
Once the season starts, I regularly go to campus to meet with the trainers and athletes. If someone is injured and it’s a more urgent situation, they’ll come to the office. I’ll also be on hand to provide medical care at tournaments and events throughout the year. It requires regular communication with the trainers to work on getting the athletes the care they need.
Is there a specific age range that sports medicine physicians treat?
No, there’s not a specific age range. Organized sports start in preschool, but younger children are resilient and rarely have injuries that require our attention. As children get bigger and faster as adolescents and then into high school and college, we treat more injuries. Patients range in age all the way up to ninety-year-olds playing pickleball.