How to Become a Team Physician Kevin deWeber, MD, FAAFP Director, Primary Care Sports Medicine Fellowship USUHS Military Sports Medicine Fellowship “Every Warrior an Athlete”

Objectives

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?

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 Team’s Physician!

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

What team should I care for? College or University team College or University team Which sport(s)? Which sport(s)? May have financial or marketing benefit May have financial or marketing benefit Significant time commitment Significant time commitment Professional team Professional team Likely to have financial or marketing benefit Likely to have financial or marketing benefit Huge time commitment Huge time commitment

2. Initial Medico-Legal Considerations State licensure State licensure Local team: need local state’s licensure Local team: need local state’s licensure Military team: any state’s licensure Military team: any state’s licensure Coverage during training: depends on MOU Coverage during training: depends on MOU Determine state’s sports medicine laws Determine state’s 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 program…is 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. Applicability—this 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.” 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 program…is 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. Applicability—this 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.”

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.

Initial Medico-Legal Considerations Malpractice insurance Malpractice insurance Local team: check state laws and local insurance companies to determine needs Local team: check state laws and local insurance companies to determine needs Military team: none needed Military team: none needed Check with military commander first Check with military commander first Check with local military legal advisor Check with local military legal advisor

Now that you have chosen your team… 3. Meet the Team’s Staff Club: Coach Club: Coach High School High School FIRST: Athletic Trainer, then coach FIRST: Athletic Trainer, then coach College: Athletic Trainer, Athletic Director and Coach College: Athletic Trainer, Athletic Director and Coach Professional: Head AT, GM, Coach Professional: Head AT, GM, Coach

What to discuss with team staff What coverage is needed What coverage is needed Extent of any Sports Medicine network Extent of any Sports Medicine network Establishment of Chain of Command Establishment of Chain of Command Financial agreements Financial agreements

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

5. Determine Extent of the Sports Medicine Network Other Team Physicians Other Team Physicians attend games or practices and meet them attend games or practices and meet them Ask how you can be of assistance Ask how you can be of assistance Tour athletic and sports med facilities Tour athletic and sports med facilities Emergency response network and plan Emergency response network and plan Clinic support (PCM’s) Clinic support (PCM’s) Insurance coverage for athletes Insurance coverage for athletes Specialty referral services/practices Specialty referral services/practices Physical therapy support Physical therapy support Diagnostic services Diagnostic services Lab, xray, MRI Lab, xray, MRI

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

7. Financial Considerations for Team Physicians Team Physicians are usually NOT paid Team Physicians are usually NOT paid Numerous financial or reward arrangements are possible Numerous financial or reward arrangements are possible Consider options in advance of providing coverage Consider options in advance of providing coverage ≠

Types of Financial Arrangements Gratis (work for free) Gratis (work for free) Non-monetary compensation Non-monetary compensation Fee for service Fee for service Salary positions Salary positions Physician pays team Physician pays team

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

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

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

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

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

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

8. Prepare for medical coverage Pre-season planning Pre-season planning Game-day planning Game-day planning

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

Planning for Game-Day Coverage Assemble an adequate medical bag Assemble an adequate medical bag Coordinate for sideline medical supplies Coordinate for sideline medical supplies Determine clearance status of players Determine clearance status of players Coordinate all medical operations Coordinate all medical operations ATC may do this on some teams ATC may do this on some teams

Questions

Questions