COVID-19 pandemic offers involved platform for team physicians to impact athletes’ health
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The role and complexity of the team physician at all levels continues to be affected by the COVID-19 pandemic.
When considering an athlete’s concerns, a minority of the issues are within the core teachings of orthopedic surgeons. Most illnesses and injuries can be managed by a nonsurgical specialist, including initial injury evaluation, nonsurgical treatment, diagnosis and treatment with ancillary services. When the injury is severe or not managed successfully without surgery, the orthopedic surgeon becomes critical to provide an athlete with an opportunity to return to play, and if possible, at the pre-injury level of performance.
Additionally, the special needs related to the management of COVID-19 provide a more involved platform for team physicians to have an impact on the health of athletes.
Dyad of leadership
The traditional role of orthopedic surgeons often leads to their designation as lead team physician, although more programs have developed an effective dyad of leadership for medical care between the orthopedic surgeon and primary care sports medicine specialist. This model has been strengthened by the impact of the pandemic, as well as other critical health-related issues, including concussions, performance-enhancing supplements, female physiology concerns, pain management and mental health. Team physicians and athletes recognize that certain injuries are better managed by a subspecialist who has experience and thought leadership in unique issues and, therefore, has an effective working relationship with high-level experts beyond the full-time medical staff for the team.
The American Academy of Orthopaedic Surgeons defines specific qualifications, duties and responsibilities of the team physician. These are an unrestricted medical license with special proficiency in caring for athletes; fundamental expertise in the management of on-field emergencies; availability and leadership of the medical care delivery and decision-making process for athletes; management of ethical issues; and understanding of medicolegal issues related to caring for athletes.
From a practical perspective, leadership as a team physician includes developing a plan that clearly defines sideline and event responsibilities. Considerations include preparation for in-competition injury or illness; necessary equipment to manage all issues, including emergencies; and policies to remove athletes from the field of competition as well as return athletes to play. Team physicians should participate in decisions related to environmental concerns, such as excessive heat or cold, and protocols to send athletes to health care facilities for further care. Following each event, there should be a review of what occurred to ensure consistency of care and needed improvement.
When adverse events occur, it is valuable to establish confidentiality of information, as well as a shared agreement of the facts related to the event before any discussion outside of the organization. Discussions with media or others outside of the team’s inner circle of trust should be primarily managed by the administrative staff and coach. Physicians should refrain from speaking publicly about individual players or their injuries. While this level of involvement may not be established for high school and club sports, it is also valuable to establish and refine these relationships.
Rewards
Being a team physician is a highly rewarding aspect of an orthopedic surgeon’s life. In addition to caring for athletes and participating behind the scenes, there are personal rewards in the overall team success, culture and athlete’s well-being. Financial rewards are generally not part of the decision to be a team physician. The ability to be recognized as a team physician may provide some intangible value in terms of marketing of a practice. However, even at the professional sports level, remuneration for the commitment of time and energy cannot be a motivating factor.
As we resume sports and continue to manage COVID-19 pandemic restrictions, the ideal approach to being a team physician is to establish your own team of interested and committed primary care sports medicine physicians, orthopedic surgeons, athletic trainers, physical therapists and trusted subspecialists to ensure the best care and return to sport for your athletes.
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- Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; email: orthopedics@healio.com.
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