How to Become a Team Physician

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How to Become aTeam Physician
Military Sports Medicine Fellowship
Every Warrior an Athlete

• Kevin deWeber, MD, FAAFP
• Director, Primary Care Sports Medicine Fellowship
• USUHS

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Objectives
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Case discussion
You are a new graduate of the sports medicine
fellowship, now stationed at Ft. Bragg, NC. You
want to be the team physician for a local high
school. How do you start?
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Steps in Becoming a Team Physician

1. Choose a team to care for
2. Clarify medico-legal issues involved
3. Meet key team staff
4. Agree on coverage to be provided
5. Assess extent of the sports med network
6. Establish chain of command
7. Agree on financial arrangement, if any
8. Prepare for medical coverage
9. Be the Teams Physician!

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1. What team should I care for?

• Community club teams
• Sense of community service and camaraderie
• Minimal time commitment
• Volunteer status, no compensation
• Junior or High School team
• Which sport(s)?
• Community service and camaraderie
• May have some small financial or marketing
  benefits
• Significant time commitment

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What team should I care for?

• College or University team
• Which sport(s)?
• May have financial or marketing benefit
• Significant time commitment
• Professional team
• Likely to have financial or marketing benefit
• Huge time commitment

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2. Initial Medico-Legal Considerations

• State licensure
• Local team need local states licensure
• Military team any states licensure
• Coverage during training depends on MOU
• Determine states sports medicine laws

• Maryland A physician licensed in MD who
  voluntarily and without compensation not
  including reimbursement for actual expenses
  provides services or performs duties as a
  physician for a school sports programis not
  liable for any damages for any act or omission
  resulting from the providing of the services or
  the performing of the duties unless the act or
  omission constitutes willful or wanton
  misconduct, gross negligence, or intentionally
  tortious conduct. Applicabilitythis section
  shall apply only to treatment at the site of the
  sports program, treatment at any practice or
  training for the sports program, and treatment
  administered during transportation to or from the
  sports program, pactice, or training.

Virginia Any physician, surgeon or chiropractor
licensed in Virginia who, in the absence of
gross negligence or willful misconduct, renders
emergency medical care or emergency treatment to
a participant in an athletic event sponsored by
a public, private or parochial elementary, middle
or high school while acting without compensation
as a team physician, shall not be liable for
civil damages resulting from any act or omission
related to such care or treatment.
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Case Study
You are already caring for a local high school
under your local license and a generous state
GoodSam law. The orthopedics doc that also cares
for this team cares for a minor league team in
the area and asks if you can help him out with
them as well. You would love to but just need to
check something first.
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Initial Medico-Legal Considerations

• Malpractice insurance
• Local team check state laws and local insurance
  companies to determine needs
• Military team none needed
• Check with military commander first
• Check with local military legal advisor

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Now that you have chosen your team3. Meet the
Teams Staff

• Club Coach
• High School
• FIRST Athletic Trainer, then coach
• College Athletic Trainer, Athletic Director and
  Coach
• Professional Head AT, GM, Coach

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What to discuss with team staff

• What coverage is needed
• Extent of any Sports Medicine network
• Establishment of Chain of Command
• Financial agreements

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4. Determine needed coverage

• Settings of care
• Games
• Away games?
• Practices?
• Training room clinics?
• Level of care
• Assessment
• Treatment? (meds? Procedures?)
• Follow-up care?
• Ordering diagnostic tests?
• Any combinations of the above

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5. Determine Extent of theSports Medicine Network

• Other Team Physicians
• attend games or practices and meet them
• Ask how you can be of assistance
• Tour athletic and sports med facilities
• Emergency response network and plan
• Clinic support (PCMs)
• Insurance coverage for athletes
• Specialty referral services/practices
• Physical therapy support
• Diagnostic services
• Lab, xray, MRI

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6. Establish the Chain of Command

• Who does initial treatment for injuries?
• When should physician enter the field?
• Who determines removal from and return to for
  play?
• MUST be Team Physician making final call (after
  discussion w/ athlete and staff)
• If not, WALK AWAY
• Put this in writing, optimally

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7. Financial Considerations for Team Physicians

• Team Physicians are usually NOT paid
• Numerous financial or reward arrangements are
  possible
• Consider options in advance of providing coverage

?
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Types of Financial Arrangements

• Gratis (work for free)
• Non-monetary compensation
• Fee for service
• Salary positions
• Physician pays team

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Gratis

• Most common
• Clubs, high schools, small colleges, some pro
• Advantages
• Flexibility, less time commitment, no obligation
• Sense of community service
• Disadvantages
• No compensation for time/expenses
• Ambiguous role could lead to liability
• Can trend toward over-commitment (yes)

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Non-monetary Compensation

• Forms of compensation are unlimited
• Team apparel, parking passes, free tickets, VIP
  status, free travel to away games
• Rights to market Team Physician status
• Advantages
• Some compensation, but w/o the complications of a
  monetary contract
• Disadvantages
• Benefits usually not equal in value to time
• Examples
• High schools, colleges, some pros

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Fee for Service

• Set amount agreed to for time spent
• Per game, practice, season, etc.
• Costs for your expenses, travel
• Advantages
• Might make a profit
• Exclusive rights to marketing
• Disadvantages
• Difficult to predict actual cost to your of time
  away from practice/family

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Salaried Positions

• Full or part-time employment
• Advantages stable income
• Disadvantages hours may be excessive and
  interfere with personal life
• Examples some universities

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Case Study Financial Issues

• 2000 season Washington Redskins team physician
  is reported to have paid 500,000 for the
  privilege of being the official orthopedic
  surgeon for the team.

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Team Physician and Practice Advertising

• Being Team Physician can draw more persons to a
  practice
• Perceived as better doc
• Pitfalls
• Bidding wars for rights as Team Physician
• May lead to violation of athlete-physician trust
• Fear of loss of market visibility could obstruct
  objective decision making
• Tendency to please team vs protect athlete

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8. Prepare for medical coverage

• Pre-season planning
• Game-day planning

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Pre-Season medical planning

• Preparticipation Physical Evaluation (PPE) plan
• Policy for athletes medical info
• Documentation
• Communication with necessary staff
• Establish emergency response plan
• Policy for environmental safety
• Heat illness prevention
• Cold weather precautions

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Planning for Game-Day Coverage

• Assemble an adequate medical bag
• Coordinate for sideline medical supplies
• Determine clearance status of players
• Coordinate all medical operations
• ATC may do this on some teams

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Questions
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Questions