The Team Physician
Anthony I. Beutler
John H. Wilckens
The views expressed herein are those of the authors and should not be construed as official policy of the Department of the Navy, the Department of the Air Force, or the Department of Defense.
WHAT IS A TEAM PHYSICIAN?
Very little has been published about the duties and responsibilities of a team physician, and few formal studies exist as to the qualifications and skills necessary to be effective in these duties.
In 2000, the American College of Sports Medicine® (ACSM), American Medical Society for Sports Medicine (ASSM), American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, and American Academy of Pediatrics issued a consensus statement on the duties and qualifications of a team physician (5). Since that time, the same conglomerate has published statements on sideline preparedness (6), concussion (4), and issues of the adolescent (3) and master athlete (9) for the team physician.
The following consensus statement from the ACSM defines the unique role of a team physician:
The Team Physician must have unrestricted medical license and be an M.D. or D.O. who is responsible for treating and coordinating the medical care of the athletic team members. The principal responsibility of the team physician is to provide for the well-being of individual athletes — enabling each to realize his or her full potential. The team physician should possess special proficiency in the care of musculoskeletal injuries and medical conditions encountered in sports. The team physician also must actively integrate medical expertise with other healthcare providers, including medical specialists, athletic trainers, and allied health professionals. The team physician must ultimately assume responsibility within the team structure for making medical decisions that affect the athlete’s safe participation (5).
Practitioners from many specialties serve in the role of team physician, with primary care physicians comprising the majority. The most common fields of medicine (percentage of the total in parentheses) are family practice (25.5%), orthopedic surgery (16.2%), osteopathic medicine (10.9%), internal medicine (10.1%), general practice (6.3%), pediatrics (5.4%), emergency medicine (4.9%), general surgery (4.5%), obstetrics/gynecology (2.8%), cardiology (2.0%), and all others (11.5%) (10).
The team physician is part of a team of professionals that cares for the athletes and contributes to the athlete’s success by maximizing training and competition preparation. He or she also assists by accurately diagnosing ailments and promptly, yet completely, rehabilitating injuries to return athletes to competition as quickly and safely as possible. In addition to expertise in the common medical conditions encountered in athletes, other necessary qualities include: flexibility and availability, good communication skills, a desire to educate, and an understanding of injury prevention principles (5).
TIME REQUIREMENTS OF A TEAM PHYSICIAN
A team physician must have an office schedule that can accommodate athletes with urgent and time-sensitive medical needs.
Most team physicians have designated training room time each week, at least one to two evenings, where they can evaluate new and follow-up existing injuries of team members. Training room time is an especially important setting in which to communicate with the athletic trainer on the rehabilitation progress of athletes’ injuries (7). An athlete’s behavior and responses can vary widely, depending on the familiarity of the environment; therefore, training rooms should ideally be held in the athlete’s “native environment,” at a location convenient to the athletes and close to practice or training facilities.
Although knowledge and ability are certainly important, the most valuable asset to the team physician is trust. Trust is earned by connecting to the athletes, coaches, and school officials.
Team physicians often neglect team practices. Although it is not necessary that all practices be attended, occasional, brief appearances during practice will allow the physician to gain insight into the environment and conditions in which the athletes train, the team’s training regimen, and interactions between coaches and players. A better appreciation of all these factors can prove invaluable in the physician’s medical decision making. Additionally, brief appearances at practice help the physician build collegial relationships with coaches
and players, establishing his or her role as a part of the team and distinguishing the physician from other officials, support staff, and media representatives who participate only in game-day activities.
The amount of time spent at the actual competition depends on the team physician’s role and availability, as well as on state laws and the regulations of the governing athletic association. Some laws mandate that a physician be in attendance for every game. Other laws allow nonphysician medical personnel, such as an athletic trainer, to cover an event with oncall physician backup (6).
The clinician who is the team physician for an entire institution must decide whether to attend all the games for a few teams, or to attend a few games for every team. We recommend that team physicians attend at least part of one practice and at least one game for each team they supervise. Providing good “team medicine” is very difficult without observing the interactions and conditions of play and practice.
CORE KNOWLEDGE OF A TEAM PHYSICIAN
To perform his or her duties effectively, a team physician needs an understanding of the medical conditions common to the athlete. This knowledge should encompass many areas of medicine, including but not limited to, orthopedics, cardiopulmonary medicine, neurology, dermatology, and rehabilitation (5).
The team physician also needs expertise in pharmacology. Practical pharmacology for the team physician includes knowing how to treat illnesses, but also an understanding of performance-enhancing drugs and herbal medicines. Team physicians must be familiar with which substances are banned by the governing athletic association so that an athlete does not inadvertently lose eligibility to compete (10).
A team physician must have a general knowledge of behavioral medicine and psychology. Mood disturbances and mental illnesses such as depression affect athletes and can be very common in injured athletes.