Three basic functions underlie the team physician concept. The first and most important is the evaluation and treatment of injured athletes. The second is the provision of physician coverage at some athletic events, especially American football. The third is the arrangement of preparticipation physical examinations when necessary. With the exception of events such as marathons, the head or only team physician will generally be an orthopaedic surgeon since the vast majority of conditions needing medical attention are musculoskeletal injuries. The physician will then be responsible for providing consultants when needed. The arrangement logistics and intensity of involvement of the team physician vary by level (e.g., professional, collegiate, or high school) and by sport (e.g., American football vs. other sports).

The basic benefit to the team of having a team physician derives from the time efficiency of having one physician, instead of many physicians, with whom to communicate. Secondary benefits to the team occur when the team physician provides reduced-price or free services to the team. Such services include any or all of the three described earlier (i.e., injury treatment, game coverage, and physicals). Secondary benefits can also include the physician buying advertising with the team or in some other direct or indirect manner providing cash flow to the team. The provision of discounted or free services to the team by the physician is common at all levels. Advertising or other payments,
however, are more prevalent in professional teams, less so with college teams, and rare with high school teams.

Benefits to the team physician include the provision of patients for treatment for which services the physician will charge. Second, there may be marketing benefits to the physician of being associated with the team. Third, there may be direct payment to the physician, usually only at the professional or major college level, for provision of services. In recent times, these relationships have evolved toward the physician providing revenue to the team rather than receiving it from the team.

There has always been an inherent conflict of interest in the team physician’s role. This conflict arises from the team physician being hired by the administration of the team yet being the treating physician for the athlete. At times, the interest of the team in having the athlete play sooner after an injury may seem to conflict with the interest of the athlete in playing less soon so that they may heal more. The athlete or his or her family may suspect that the physician represents the team’s interest more than the athlete’s interest. This is particularly true if it is perceived that the physician receives benefit from the team that the physician may not want to jeopardize. This potential conflict is inherent in any situation in which an organization hires a physician to treat its members, whether in sports, occupational medicine, government, the military, or other areas. In such situations, it is increasingly common for the athlete to find a physician who is not hired by the team to render another opinion or take over care entirely. Pressure may indeed be exerted by a sports organization on the team physician to not “coddle” an athlete and allow them to play sooner. This is particularly true in American or Canadian football where injuries are common and playing with them is expected. In such situations, it is important that the physician and athletic trainer are united in their desire to protect the athlete from such administrative pressure. Even the most aggressive coach will usually defer to a reasoned presentation by the physician who is, of course, always the advocate of the injured athlete and not the team. In fact, the team physician will always be second guessed more and be more at risk for legal repercussions in the event of reinjury after the athlete’s return than a perceived “independent” physician. The physician should further realize that his standing with the team may be jeopardized by his faithfulness to his medical principles on behalf of the athlete and not let this potential eventuality cloud his judgment.

For several reasons, the team physician in the United States is evolving into a less influential position that it has traditionally been. With the increasing sophistication of sports medicine technology, there have come increased patient expectations. Professionals with salaries, collegiate athletes with scholarships, and high school athletes with potential scholarships want to maximize their chances of complete recovery for economic as well as enjoyment purposes. They are increasingly not content to entrust significant surgery to a physician selected by their organization rather than by themselves. For this reason, the modern team physician will spend more time coordinating care and less time delivering it than was true in the past. This may make the team physician concept less attractive to some practitioners. To others, the athletic environment involvement and perceived marketing benefits will continue to outweigh the time, financial, and potential legal liability costs.

The team physician should be prepared to be at least as much of a triage officer as a treater. Some injuries, such as those to the face and head, should be referred to plastic and neurosurgical colleagues. Skin rashes and cardiac and respiratory problems are also common and are obviously beyond the scope of practice of an orthopaedic surgeon. However, in this era of increasing specialization, even many of the orthopaedic problems may need to be referred. Orthopaedic sports medicine subspecialists will typically handle all knee and shoulder problems. However, they may not be the best practitioner for a complicated hand or spine problem. Ultimately, it is important that the desire to treat the injured athlete not cause the practitioner to treat injuries for which he or she may not be the best available practitioner. It is extremely important that the head team physician have a cadre of specialists, whether within their own group or not, to which problems can be referred. The athletic trainer will feel comfortable referring such injuries to these affiliated doctors without needing to find the head team physician in each case.

The dramatic increase in professional salaries has resulted in increased medical malpractice liability for the team physician at every level. Settlements and judgments at the professional level will potentially exceed the policy limits of team physicians due to the high salaries and potential lost wages involved. However, even the collegiate and high school athlete can lay claim to potentially high-lost earnings that could escalate malpractice judgments into seven figures. If the athlete demonstrated high potential at a lower level, the award may be nearly as high as if the athlete had in fact realized that potential. Furthermore, the adverse outcome leading to these judgments does not need to be as severe as in everyday life. An elite athlete who does not regain the ability to run or throw at an elite level, while being otherwise healthy and functioning normally, may lay claim to huge lost earnings.
Furthermore, juries may favor celebrity athletes in such proceedings. Jurors commonly obtain the autographs of plaintiff athletes after the conclusion of their trials. The legal liability risk has reached crisis proportions in the United States with no good answer in sight.