The first question a sports physician should entertain is “What type of sports practice do I want?” Many variables factor in the decision of how and where to practice medicine, but defining your “ideal practice” is a good place to start (see Table 38.1).

Sports settings vary, but options usually include working in a private practice as a primary care and sports medicine physician (primary care or orthopedic office), working as a sports medicine physician only (mainly musculoskeletal) in a private office (usually orthopedic or sports medicine center), working in an academic setting with sports medicine opportunities (family medicine residency or sports medicine fellowship), or working at a collegiate student health center with team physician responsibilities. Selecting an “ideal practice” will help guide physicians in determining the type of network they need to build or enter.

When changing jobs, or when leaving residency or fellowship, start looking for the “ideal job” early. Sports medicine colleagues, journal advertisements, local resources (hospitals, practice groups, physician networks, independent physician organizations, managed care organizations), state and regional resources (state medical society, physician recruiters), and national resources (American Academy of Family Physicians [AAFP], American Medical Society for Sports Medicine [AMSSM], American College of Sports Medicine [ACSM]) may be good sources for job opportunities. The World Wide Web is a useful communication link for physicians looking for job opportunities. Three useful web sites that list career opportunities are: www.aafp.org, www.amssm.org, and www.acsm.org. Actively seek out and make job opportunities for yourself. Send a query letter and/or curriculum vitae to offices or institutions in areas of special interest, and follow up written communications with a phone call. Visit groups and communities with attractive sports medicine opportunities. A phone call to the local head athletic trainer often helps identify important sports medicine figures and organizations in the area. Phone conversations with sports medicine (primary care and orthopedic) physicians, physical therapists, and athletic trainers may help assess local attitudes, sports medicine politics and structure, and openness to a new sports physician’s skills.

Published sports medicine demographic studies are limited. A recent survey of primary care sports medicine (PCSM) physicians indicates that most (71%) PCSM physicians are family practice doctors, and that internists, pediatricians, physical medicine and rehabilitation physicians, and emergency medicine physicians also practice PCSM. Among those surveyed, practice settings are diverse (see Table 38.2). Fifty six percent report practicing their primary specialty more than sports medicine, 23% report practicing more sports medicine than their primary specialty, 15% practice mostly sports medicine, and 3% practice mostly primary care (4).

An earlier questionnaire devised to ascertain sports medicine practice content indicates that 45% of responding family physicians serve as team physicians in one or more sports at varying levels (see Table 38.3) (5). A 1987 Physician and Sportsmedicine survey revealed that 46% of team physicians were family doctors and general practitioners, 17% were orthopedists, and other specialties (pediatrics, internal medicine, osteopathy, general surgery, obstetrics/gynecology) made up a smaller percent (6).

The AMSSM recently published surveys to its web site that address current practice demographic, salary, credentialing, and membership trends of AMSSM members in sports medicine (7,8,9). The surveys and additional sports medicine business practice resources may be accessed by members of AMSSM at www.amssm.org under Sports Medicine Practice Tools, a resource developed by AMSSM’s Economics Committee. Table 38.4 highlights pertinent survey points.

A survey addressing potential gender differences in sports medicine illustrates no significant differences with regard to practice types, location, and time spent in sports medicine with the exception of training room and event coverage, where males were more likely to cover all types of sporting events and were more likely to cover all levels of training rooms except Division I (10).

A mail survey of 250 sports medicine centers across the United States indicates that a “typical” sports medicine facility is corporate owned, but that ownership, ownership background, and management varies (Table 38.5) (11). The same survey indicates that most patients at the sports medicine centers are recreational athletes, but that many other types of athletes attend the center (Table 38.6) (11).

A slightly different client distribution was reported in a prior survey, where most patients were high school athletes (12). Most sports medicine centers employ physical therapists, some employ athletic trainers. Treatment of acute injures, injury prevention, and especially rehabilitation are the primary goals of the centers (11,12,13). The surveys (10,11,12) focused on a limited number of “sports medicine centers” in the United States and likely do not reflect the increasingly prevalent sports medicine practices of PCPs, especially in smaller settings and primary care–based offices.