The global demand for sports medicine physicians has grown concomitantly with the increase in athletic sporting events. The focus of medical care is not only on the evaluation and treatment of an acute musculoskeletal injury but also on the maintenance of general health to promote peak performance of the athlete. Team physicians have the leadership role in the organization, management, and provision of care of athletes in individual, team, and mass participation sporting events. There have been several consensus statements defining the role of the team physician, including one endorsed by the American College of Sports Medicine (ACSM), American Medical Society for Sports Medicine (AMSSM), American Orthopaedic Society for Sports Medicine (AOSSM), and American Osteopathic Academy of Sports Medicine (AOASM). These consensus statements help describe the definition, qualifications, education, duties, and responsibilities of the team physician fulfilling this role.^1–11 The head team physician holds the ultimate responsibility for the medical decisions regarding the health and wellness of the team, including injury and illness prevention, treatment, and management. The head team physician also assists in the coordination of the care of the athletes with other team medical professionals, including other team physicians, athletic trainers, and other allied health providers.

The multiorganization-derived Team Physician Consensus Statement was developed to delineate the qualifications, duties, and responsibilities of the team physician. It provides guidelines to individuals and organizations in selecting team physicians. The purpose of these delineations and guidelines is to provide a foundation for best practices in the medical care of athletes and teams. The team physician’s education, training, and experience uniquely qualify him or her to provide the best medical care for the athlete.¹ The team physician should manage and coordinate the medical care of the athletic team members and promote the well-being of the athlete. The team physician should be proficient in musculoskeletal injuries, common medical conditions, and psychological issues encountered in sports, as well as a fundamental knowledge of emergency care with regard to sporting events and appropriate training in cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED).^1,3,4,9

The team physician integrates personal medical expertise with a developed athletic care network of medical consultants, certified athletic trainers (ATCs), and other allied health care professionals. With the aid of the athletic care network, the team physician also educates athletes, coaches, parents/guardians, and administrators. Ultimately, the team physician is responsible for medical decisions that affect the athlete’s safe participation and the clearance to participate and the return-to-play (RTP) decision.^1,2,6,7

Since the primary responsibility of the team physician is to provide optimal medical care for athletes, a physician considered for this role must possess certain qualifications and education. Additional qualifications and education may be required for team physicians for some collegiate, national, Olympic/Paralympic, and professional teams. It is essential that the team physician at a minimum have a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree in good standing with an unrestricted license to practice medicine.^1,2,12 It is desirable for the team physician to have clinical training experience, including the American Board of Medical Specialties (ABMS) medical specialty board certification with American Council of Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) accredited fellowship training in sports medicine and subsequent certificate of added qualification (CAQ) in sports medicine (if available/applicable, as orthopedic surgery does not currently offer subspecialty certification in sports medicine). The medical specialties that currently offer and are eligible for fellowship training in sports medicine include physical medicine and rehabilitation (PM&R), orthopedic surgery, family medicine, emergency medicine, internal medicine, and pediatrics. Many other specialties, such as cardiology, have a vital role in sports medicine and are often included as part of the medical team or as consultant’ however, they currently do not offer specific training in sports medicine.¹⁰

For a physician to be considered a team physician, a significant portion of clinical practice should focus on sports medicine, and the physician should maintain their knowledge base with continuing medical education (CME) in sports medicine. It is beneficial to maintain an active membership and participation in a sports medicine professional association or society. It is also recommended to have continued involvement in teaching, research, and publications related to sports medicine. Ideally, these physicians have also maintained training in advanced cardiac and trauma life support (ACLS/ATLS), should a life-threatening cardiopulmonary event occur in the field of competition. Additional knowledge of medicolegal, disability, and workers’ compensation issues, particularly with the current issues in major professional sports with concussions and the public push to eliminate amateurism from collegiate sports, may be beneficial. Lastly, depending on the level of sports the team physician may be covering, additional media training, including communication skills, knowledge of social media outlets, and protection of the athlete’s medical privacy, may be required.¹

It is critical for the team physician to be able to dedicate the adequate amount of time to the team. The physician must be cognizant of time required for the successful management of the team’s overall health, well-being, and injury/illness prevention. The physician should provide flexibility in his or her schedule and should be available to assess the athlete not only with an acute injury on the field of competition but also be able to accommodate the athlete in the office or training room for all injuries and illnesses. Good communication skills and the desire to educate are critical; appropriate dissemination of information to the athlete, family, coaches, athletic trainers, allied health professionals, team administrators, and in some cases the athlete’s agent are all important.² The team physician should be able to communicate directly with ATCs on the rehabilitation and progress of an athlete’s injury. One of the most valuable assets of the team physician is trust, which is earned by connecting to the athlete, ATCs, coaches, and team administrators.⁵

The team physician should maintain a schedule that is able to accommodate athletes with urgent and time-sensitive medical needs, which includes on-field coverage, clinical office hours, and training room time. Training room (TR) evaluations should occur once or twice a week. In larger settings, such as major universities, training room coverage is frequently provided by either a team physician/ATC with specific days of coverage, or each sport has an assigned TR with their team physician and ATCs, with available cross-coverage for urgent day-to-day situations. One of the goals of the TR is to provide the ideal “native environment” for the athlete, where they feel comfortable with receiving their care. It is known that not all medical care can be isolated to the TR, but it can be a much less stressing environment for their initial assessment.⁵

Although not a requirement for the team physician, it would be beneficial to attend practices and team meetings whenever possible. It is often difficult to attend all functions due to clinical and educational requirements of the physician, but occasional attendance is beneficial and should be encouraged. It provides the team physician insight into the environment and conditions, including the training of athlete and the team training regimen, as well as the interactions between players and coaches. It helps to build collegial relationships with coaches and players and establishes a role as part of the team.³

Sideline and event coverage is the most visible aspect of the team physician. However, the time spent in sideline and event coverage during competition depends on various factors. The specific requirements for on-the-field coverage should always be discussed before the season/event. Some of the factors include the team physician’s role and availability and the time and number of sporting events occurring.³ The situation is of particular note where a physician may be the team physician for all sports at a specific high school, college, or university and may have several sports in competition simultaneously or multiple events each day. In these cases, a clear plan needs to be established to determine the overall team medical coverage for all sports while splitting coverage duties with the ATCs and team physician. Other factors that govern the presence of sideline medical coverage and emergency medical services (EMS) may be requirements set by county or state laws, as well as regulations of the governing athletic association.³

Once all of these requirements are known, the team medical staff discusses event medical coverage and jointly determines if the team physician will attend all (or a negotiated minimum number of games with cross-coverage) of the games for specific teams or a few games for every team. If the team physician is covering multiple teams, it is recommended that the physician attend at least part of one practice and at least one game for each team they supervise. Should this requirement be too onerous given the number of teams, a discussion with school and athletic department administrators should occur for the team physician to articulate the need for additional medical coverage in the best interest of the health of the athletes. Overall, providing good “team medicine” equates to observing the interactions and conditions of play and practice by the whole medical team, including physicians and ATCs.³

The team physician should have a core knowledge and understanding of the medical conditions common to athletes.² The fundamental core knowledge of a team physician should encompass topics in orthopedics, cardiopulmonary, infectious disease, medicine, neurology, dermatology, and rehabilitation. The team physician should have an expertise in pharmacology, including the evidence behind the efficacy and adverse effects of medications.¹⁰ Additionally, knowledge of supplements athletes may be utilizing is critical. Oftentimes, athletes may investigate the usage of herbal medications or supplements without knowing the adverse effects or even if the substance is illegal to use in competition. Therefore, it is imperative for the team physician be aware of performance-enhancing drugs (PEDs) and all other banned substances from the governing body of the given sport. The team physician should have absolute knowledge of the standards set for banned substances and drug testing for each sport or league for which they are providing medical services. Although these medications/supplements may vary significantly between sports, the major governing bodies on performance enhancement are the World Anti-Doping Agency (WADA) and, stateside, the United States Anti-Doping Agency (USADA). The Global Drug Reference Online (Global DRO) is an easy-to-use and convenient tool developed by USADA that provides immediate real-time medication review and a time-stamped report of your search that the physician can provide to the athlete and keep for medical records.¹³

A general knowledge of behavioral medicine and psychology, including sports performance psychology, is also important. Mood disturbances and depression are common in injured athletes undergoing medical care and rehabilitation, especially if the injury has removed them from competition. It is also beneficial to have a fundamental knowledge of exercise science and nutrition. This is beneficial in terms of preventing injury, maximizing athletic performance, and recognizing overtraining and potential eating disorders.^2,8

Certain medical responsibilities are essential and desirable for the team physician according to the Team Consensus Statement.¹ It is essential for the team physician to establish a chain of command for injury and illness management. Furthermore, coordination of the assessment and management of game-day injuries and medical problems is critical.^1,3 It is imperative that there is a consensus among the medical team, athletes, coaches, and team administrators that the team physician needs to make the final decisions on clearance to participate, same-day RTP, and post–game-day RTP. The team physician should understand the importance of the preparticipation examination (PPE) and determine whether an athlete is fit to participate.^1,3 Although it is beneficial for the team physician to perform the PPE, it is not required that the team physician perform all of the PPEs. However, he or she should review the documentation of every athlete’s PPE performed by others to address identified conditions that may affect athlete health and safety. Preferably, this would be performed at a minimum of 6 to 8 weeks before the start of the athletic training or participation so the team physician can initiate any additional workup that may be necessary after the potential identification of a concerning medical condition.^1,2,10,12

The team physician should understand the medical management and prevention of injury and illness in athletes, as well as recognize other issues that affect athletic performance, including strength and conditioning, nutrition, ergogenic aids, substance abuse, and psychological response to injury. The team physician should provide ongoing medical care beyond game-day/event coverage throughout the recovery and rehabilitation periods to be able to make accurate decisions regarding the RTP of the athlete.¹ Depending on the type of competition, gender, age, and functional ability of the participants, the physician should have a firm understanding of the unique issues in female, pediatric, adolescent, masters, and adaptive athletes.^1,12,14,15 It is also essential for the team physician to integrate their medical expertise with the athletic care network and provide for documentation and medical record keeping for the injured and ill athletes for future reference.¹

Additionally, the team physician should have a comprehensive understanding of the effect of exercise and sports participation on medical conditions. It is imperative to provide the team physician with the opportunity to participate in the development and selection of the athletic care network and to educate athletes, parents/guardians, coaches, and administrators.^1,10

The team physician should assist in the decision-making process regarding the level of services needed for sideline and event coverage. Depending on the resources of a specific institution or event planning committee, the medical care plan needs to thoroughly discuss with the team physician or event medical director.^3,4 If there is only one physician for a high school or university, then a clear medical care plan should be implemented to provide medical coverage utilizing all medical resources. In such a situation, the team physician should cover all collision and high-risk sports events, whereas other low-impact/low-risk sports can be covered by the ATC or any allied health professional with training in recognition and initial treatment of athletic injuries with on-call physician oversight. During the decision-making process, the emotions of the competition must not affect medical decision making, and attention should be directed to the safety of the participants.^3,4 The decision making regarding the type and number of medical staff deployed at the event should place the focus and attention on the aspects of play and individuals prone to injury. Additional discussions should include the handling of nonparticipant emergencies and verifying that proper protocols and policies exist for medical emergencies involving spectators. It should be made clear to the administrators and event planners that there should be a separate medical plan in place for spectators, and the primary duty of the team physician is the safety and medical care of the athletes on the field of play.^3,4

During competition, the team physician must maintain a sense of sideline awareness and encourage others to do the same. The team physician must be focused on the athletes on the field and not be easily distracted. Being alert and aware of the action on the field enables the team physician to visualize the biomechanics of the injury and assists in the accurate diagnosis during the sideline or locker room evaluation. The combination helps determine the need for additional studies and potential specialty consultations.^2,3 The presence of the team physician on the sideline enables them to promptly communicate the player’s condition clearly and confidentially to those “who need to know.”¹⁶

Post-injury, the team physician coordinates the rehabilitation process and determines when the athlete is able to compete again. This may be an arduous process depending on the type of injury, sport, and level of competition and involves active communication between the team physician and the athlete, parents, ATCs/physical therapists (PTs), coaches, administrators, and other medical specialists as necessary. When the athlete requires the services of additional medical specialists, active follow-up of recommendations and treatments is critical to the coordinated recovery process, and the documentation of medical care is of utmost importance.¹⁶

Once the athlete’s injury has been successfully treated and has been progressing through the recovery and rehabilitation process, the final decision for initial clearance and return to play must be the team physician’s.³ There have been guidelines and consensus statements developed regarding concussions and various musculoskeletal injuries.^3,6,7,17 An example of a return-to-play injury guideline is that the inured body part should have 90% strength compared to the noninjured side, because of the risk of reinjury if strength is not adequate on return to play. Additionally, the athlete must demonstrate adequate agility, which is protective in contact sports, as well as against overuse injury in noncontact sports. The returning athlete should pose no increased risk of injury to other players. Therefore, casts, splints, braces, and other protective equipment should be made of material suitable for safe competition. Clear thinking and intact cognition are required before any RTP or practice is considered. Previously, return-to-play decisions regarding post-concussion athletic injuries had been varied depending on the resource/reference; however, over the past decade there has been the development of an evolving consensus on the best criteria for the safe return to play of the post-concussive athlete.¹⁷

In addition to the evaluation and treatment of the athletes, the team physician has numerous administrative responsibilities in coordinating the care of the team and athletes.

It is essential that the team physician develops a written agreement of medical care and administrative responsibilities between the physician(s) and the administration or organizing body, including a reporting structure from the athletic care network. The team physician needs to be an integral part of the development of an emergency action plan (EAP) and should coordinate a rehearsal of the plan in action. The EAP should include knowledge of medical capabilities of surrounding hospitals, emergency treatment protocols, and transport plans to surrounding hospitals as necessary.^1,3,4 Additionally, the team physician should have full authority in establishing medical policy and a medical chain of command and defined roles and responsibilities for members of the athletic medical team.³ The team physician must also be involved in other aspects of sideline and event preparedness (e.g., environmental concerns, supplies, equipment, medication, policies, postseason review).^1,3,4 The team physician should also be included in the education of the athletes, parents/guardians, athletic training staff, administrators, and coaches.¹

Another administrative responsibility of the team physician is the coordination of medical supervision of the athletic trainers and other ancillary medical staff. The team physician should coordinate with the head athletic trainer and other team physicians which medical personnel need to attend the practices and competition. Additionally, the team physician should design a plan for sideline evaluations of injured athletes, including which necessary medical equipment is readily available either on the sideline or in the training room.

The team physician should be familiar with the position statements established by professional organizations associated with sports medicine, as well as the regulations established by sports governing bodies of which the physician is providing medical coverage.

It is important to establish and implement evaluation and treatment protocols to facilitate timely and quality medical care when the team physician is not immediately available.² It is also beneficial to educate the athletic medical team members of potential pre-established guidelines for RTP utilizing current literature such as the ACSM consensus statement on RTP with concussion, illnesses, and musculoskeletal injuries.^6,7

The team physician should oversee the condition of the playing environment for any potential injury hazards. Over the course of the playing season, the team physician should evaluate practice and game facilities for safety issues, as well as work with coaches and staff to ensure the athletes have appropriate and properly fitting protective equipment. It is important to make sure there is adequate access and availability of hydration for the athletes. Additionally, the team physician should have an active role in determining the appropriate activity level for the climate to avoid heat, cold, or adverse weather-related environmental injuries.