Physicians provide more than care in operating a sports medicine practice

Caring for athletes of any ability takes a team effort and the three As — availability, affability and ability.

Issue: November 2006

When a sports medicine practice cares for an athletic patient, treatment goes beyond surgery and rehabilitation. The physicians have a responsibility to all aspects of the patient’s health to get him or her back on the playing field or on the court.

To do this, sports medicine orthopedists must involve a network of physicians, which can open doors of opportunities for athletic team coverage on all levels and can expand referral bases.

Orthopedics Today spoke with four sports medicine physicians who offer advice for those physicians just entering the sports medicine field.

Multidisciplinary approach

Matthew J. Matava, MD [photo]
Matthew J. Matava

Whether in a network or the same practice, a sports medicine group may include orthopedists, physiatrists, physical therapists, athletic trainers and a fellowship-trained primary care sports medicine physician, according to Matthew J. Matava, MD, of the Washington University School of Medicine in St. Louis.

“[Primary care physicians] evaluate a number of nonoperative problems and quite frankly, in my practice and I think in most sports medicine practices, the majority of patients that we see in the clinic have problems that do not require surgery,” Matava, also a physician for the St. Louis Rams football team and St. Louis Blues hockey team, told Orthopedics Today.

He estimated that he sees 10 patients for every one surgery in his practice.

Since his practice acquired a primary care physician 2 years ago, orthopedic surgeons reduced their number of patient visits each month. “Our number of surgical cases has actually increased and so as a surgeon who makes the majority of his income from performing surgery, it’s a much more efficient system,” Matava said.

Practices also often benefit from having a physical therapy office in the same location.

“Physical therapy is a huge part of the patient’s total treatment plan and so it’s very important to have confidence and know the ability of the therapist you’re dealing with,” Matava said.

Together with physical therapists, athletic trainers can devote and guide a patient’s physical therapy toward return to a specific sport, Matava said.

Diverse patient population

W. Ben Kibler, MD, FACSM [photo]
W. Ben Kibler

Sports medicine practices not only care for patients who play competitive sports, but also any patients who consider themselves athletes – even those who simply want to stay in shape, according to W. Ben Kibler, MD, FACSM, medical director of Lexington Clinic Sports Medicine Center in Lexington, Ky.

For these reasons, his office accepts referrals from any doctor, trainer or other referral source. The office also has “drop-in” time from 8 a.m. to 9 a.m. each morning when patients can see a sports medicine physician without an appointment, Kibler told Orthopedics Today.

To encourage referrals, he and his partners are visible in the community. They stand on as many sidelines as possible, speak on talk radio programs and advertise their “drop-in” time and team coverage.

“We also emphasize our experience in sports medicine affairs, so that the individuals may feel they would be in experienced hands,” Kibler said.

Keeping open lines of communication with the primary care physician or referring physician also encourages future referrals.

“With each referral, we send [the referring physician] a detailed letter outlining the latest treatment options and alternatives,” Kyle Anderson, MD, physician for the Detroit Lions football team and former team physician for the Detroit Tigers baseball team, told Orthopedics Today.

Word of mouth is an effective strategy for recruiting new patients, too. “The main influencer … is a satisfied patient, so our main emphasis is on treating the patient quickly, with dignity and with skill,” Kibler said.

Pattern of care

Kyle Anderson, MD [photo]
Kyle Anderson

Stanley M. Herring, MD, of the University of Washington Medical Center in Seattle is a physiatrist and team physician for the Seattle Seahawks football team.

He refers his patients to a network of physicians, including sports medicine orthopedists for operative treatment.

So what does he look for in a sports medicine orthopedist? “Obviously I look [for surgeons] with competency and experience,” Herring told Orthopedics Today. “But I also need someone who will provide the level of care to my patients to which they are used to receiving from me – on time, thorough, compassionate and interested in their long-term welfare.”

His advice: Orthopedists should make sure their pattern of care fits the patient’s familiar value system.

In addition, Herring said, he looks for surgeons with more than the traditional skill set and with interests beyond clinical care, such as research, education or publication.

Injuries are sport-specific

Stanley M. Herring, MD [photo]
Stanley M. Herring

Regardless of the athlete’s level of play, most injuries are sport specific, Kibler said.

It is essential for the physician to know about the specific sport because “treatment is directed to restoring athletic function by any of several means, including surgery,” Kibler said. “Surgery should be thought of as restoring anatomy so that functional rehabilitation can be successful.”

Matava said the most common pathologies are related to overuse, most commonly tendonitis, muscle strains and ligament sprains.

Again, most patients do not require surgery, he said. But in those cases, meniscal and ACL tears, rotator cuff tears and shoulder instability are the most common problems.

“[For] a professional athlete, we tend to be a little bit more aggressive as far as getting them back on the field of play in a safe fashion,” Matava said. “We may allow them to play with a cast on or a splint that at the high school level you wouldn’t think about doing … Certainly we would never put an athlete back out to play if it put him or her at risk for harm.”

“The relationship building with professional teams and their players is no different than building a relationship with your patients,” Anderson said. “It must be clear from the start that the players’ health is of primary concern and that the wins and losses are never as important. Fortunately these two issues do not conflict with one another very often.”

The foundation of success

A successful sports medicine practice can be built on the three As, Matava said: availability, affability and ability.

“You have to be able to get the job done, you have to be willing to see patients within a reasonable period of time for their problem, and then you have to be friendly to them and be empathetic,” he said. “[Patients] want someone who understands their problem and who’s willing to listen to them.”

“We have to remember it is not the patient’s privilege to see us. It’s our privilege to treat them,” Herring said. “So being on time, being thorough in our explanations, being interested in [the patient] as a whole person and working well together with other practitioners is what the current sports medicine practice demands.”