How to Become aHow to Become aTeam PhysicianTeam Physician

Kevin deWeber, MD, FAAFPKevin deWeber, MD, FAAFP

Director, Primary Care Sports Medicine FellowshipDirector, Primary Care Sports Medicine Fellowship

USUHSUSUHS

Military Sports MedicineFellowship

“Every Warrior an Athlete”

ObjectivesObjectives

Case discussionCase 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 Steps in Becoming a Team PhysicianTeam Physician

1.1. Choose a team to care forChoose a team to care for2.2. Clarify medico-legal issues involvedClarify medico-legal issues involved3.3. Meet key team staffMeet key team staff4.4. Agree on coverage to be providedAgree on coverage to be provided5.5. Assess extent of the sports med networkAssess extent of the sports med network6.6. Establish chain of commandEstablish chain of command7.7. Agree on financial arrangement, if anyAgree on financial arrangement, if any8.8. Prepare for medical coveragePrepare for medical coverage9.9. Be the Team’s Physician!Be the Team’s Physician!

1. What team should I care 1. What team should I care for?for?

Community club teamsCommunity club teams Sense of community service and camaraderieSense of community service and camaraderie Minimal time commitmentMinimal time commitment Volunteer status, no compensationVolunteer status, no compensation

Junior or High School teamJunior or High School team Which sport(s)?Which sport(s)? Community service and camaraderieCommunity service and camaraderie May have some small financial or marketing May have some small financial or marketing

benefitsbenefits Significant time commitmentSignificant time commitment

What team should I care for?What team should I care for?

College or University teamCollege or University teamWhich sport(s)?Which sport(s)?May have financial or marketing benefitMay have financial or marketing benefitSignificant time commitmentSignificant time commitment

Professional teamProfessional teamLikely to have financial or marketing Likely to have financial or marketing

benefitbenefitHuge time commitmentHuge time commitment

2. Initial Medico-Legal 2. Initial Medico-Legal ConsiderationsConsiderations

State licensureState licensureLocal team: need local state’s licensureLocal team: need local state’s licensureMilitary team: any state’s licensureMilitary team: any state’s licensureCoverage during training: depends on Coverage during training: depends on

MOUMOUDetermine state’s sports medicine Determine state’s sports medicine

lawslaws

Maryland: “Maryland: “A physician [licensed in MD] who A physician [licensed in MD] who voluntarily and voluntarily and without compensationwithout compensation [not including reimbursement for [not including reimbursement for actual expenses] provides services or performs duties as a actual expenses] provides services or performs duties as a physician for a physician for a [school][school] sports program…is not liable for any sports program…is not liable for any damages for any act or omission resulting from the providing damages for any act or omission resulting from the providing of the services or the performing of the duties unless the act of the services or the performing of the duties unless the act or omission constitutes willful or wanton misconduct, gross or omission constitutes willful or wanton misconduct, gross negligence, or intentionally tortious conduct. Applicability—negligence, or intentionally tortious conduct. Applicability—this section shall apply only to treatment this section shall apply only to treatment at the site of the at the site of the sports programsports program, treatment at any , treatment at any practicepractice or training for the or training for the sports program, and treatment administered during sports program, and treatment administered during transportationtransportation to or from the sports program, pactice, or to or from the sports program, pactice, or training.”training.”

Virginia: “Any physician, surgeon or chiropractor licensed [in Virginia] who, in the absence of gross negligence or willful misconduct, renders emergencymedical 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 beliable for civil damages resulting from any act or omission related to suchcare or treatment.”

Case StudyCase 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 Initial Medico-Legal ConsiderationsConsiderations

Malpractice insuranceMalpractice insuranceLocal team: check state laws and local Local team: check state laws and local

insurance companies to determine insurance companies to determine needsneeds

Military team: none neededMilitary team: none neededCheck with military commander firstCheck with military commander firstCheck with local military legal Check with local military legal

advisoradvisor

Now that you have chosen your team…Now that you have chosen your team…

3. Meet the Team’s Staff3. Meet the Team’s StaffClub: CoachClub: CoachHigh SchoolHigh School

FIRST: Athletic Trainer, then coachFIRST: Athletic Trainer, then coachCollege: Athletic Trainer, Athletic College: Athletic Trainer, Athletic

Director and CoachDirector and CoachProfessional: Head AT, GM, CoachProfessional: Head AT, GM, Coach

What to discuss with team What to discuss with team staffstaff

What coverage is neededWhat coverage is neededExtent of any Sports Medicine Extent of any Sports Medicine

networknetworkEstablishment of Chain of CommandEstablishment of Chain of CommandFinancial agreementsFinancial agreements

4. Determine needed 4. Determine needed coveragecoverage

Settings of careSettings of care GamesGames

Away games? Away games? Practices?Practices? Training room clinics?Training room clinics?

Level of careLevel of care AssessmentAssessment Treatment? (meds? Procedures?)Treatment? (meds? Procedures?) Follow-up care?Follow-up care? Ordering diagnostic tests?Ordering diagnostic tests?

Any combinations of the aboveAny combinations of the above

5. Determine Extent of the5. Determine Extent of theSports Medicine NetworkSports Medicine Network

Other Team PhysiciansOther Team Physicians attend games or practices and meet themattend games or practices and meet them Ask how you can be of assistanceAsk how you can be of assistance

Tour athletic and sports med facilitiesTour athletic and sports med facilities Emergency response network and planEmergency response network and plan Clinic support (PCM’s)Clinic support (PCM’s) Insurance coverage for athletesInsurance coverage for athletes Specialty referral services/practicesSpecialty referral services/practices Physical therapy supportPhysical therapy support Diagnostic servicesDiagnostic services

Lab, xray, MRILab, xray, MRI

6. Establish the Chain of 6. Establish the Chain of CommandCommand

Who does initial treatment for Who does initial treatment for injuries?injuries?

When should physician enter the When should physician enter the field?field?

Who determines removal from and Who determines removal from and return to for play?return to for play? MUST be Team Physician making final MUST be Team Physician making final

call (after discussion w/ athlete and call (after discussion w/ athlete and staff)staff)

If not, WALK AWAYIf not, WALK AWAY Put this in writing, optimallyPut this in writing, optimally

7. Financial Considerations for 7. Financial Considerations for Team PhysiciansTeam Physicians

Team Physicians are usually NOT Team Physicians are usually NOT paidpaid

Numerous financial or reward Numerous financial or reward arrangements are possiblearrangements are possible

Consider options in advance of Consider options in advance of providing coverageproviding coverage

≠

Types of Financial Types of Financial ArrangementsArrangements

Gratis Gratis (work for free)(work for free)Non-monetary compensationNon-monetary compensationFee for serviceFee for serviceSalary positionsSalary positionsPhysician pays teamPhysician pays team

GratisGratis

Most commonMost common Clubs, high schools, small colleges, some proClubs, high schools, small colleges, some pro

AdvantagesAdvantages Flexibility, less time commitment, no obligationFlexibility, less time commitment, no obligation Sense of community serviceSense of community service

DisadvantagesDisadvantages No compensation for time/expensesNo compensation for time/expenses Ambiguous role; could lead to liabilityAmbiguous role; could lead to liability Can trend toward over-commitment (“yes”)Can trend toward over-commitment (“yes”)

Non-monetary CompensationNon-monetary Compensation

Forms of compensation are unlimited:Forms of compensation are unlimited: Team apparel, parking passes, free tickets, VIP Team apparel, parking passes, free tickets, VIP

status, free travel to away gamesstatus, free travel to away games Rights to market Team Physician statusRights to market Team Physician status

AdvantagesAdvantages Some compensation, but w/o the complications Some compensation, but w/o the complications

of a monetary contractof a monetary contract DisadvantagesDisadvantages

Benefits usually not equal in value to timeBenefits usually not equal in value to time ExamplesExamples

High schools, colleges, some pro’sHigh schools, colleges, some pro’s

Fee for ServiceFee 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, travelCosts for your expenses, travel

AdvantagesAdvantagesMight make a profitMight make a profitExclusive rights to marketingExclusive rights to marketing

DisadvantagesDisadvantagesDifficult to predict actual cost to your of Difficult to predict actual cost to your of

time away from practice/familytime away from practice/family

Salaried PositionsSalaried Positions

Full or part-time employment Full or part-time employment Advantages: stable incomeAdvantages: stable incomeDisadvantages: hours may be Disadvantages: hours may be

excessive and interfere with personal excessive and interfere with personal lifelife

Examples: some universitiesExamples: some universities

Case Study: Financial IssuesCase Study: Financial Issues

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

Team Physician and Practice Team Physician and Practice AdvertisingAdvertising

Being Team Physician can draw more Being Team Physician can draw more persons to a practicepersons to a practicePerceived as “better” docPerceived as “better” doc

Pitfalls:Pitfalls:Bidding wars for rights as Team PhysicianBidding wars for rights as Team Physician

May lead to violation of athlete-physician trustMay lead to violation of athlete-physician trustFear of loss of market visibility could Fear of loss of market visibility could

obstruct objective decision makingobstruct objective decision makingTendency to please team vs protect athleteTendency to please team vs protect athlete

8. Prepare for medical 8. Prepare for medical coverage coverage

Pre-season planningPre-season planningGame-day planningGame-day planning

Pre-Season medical planningPre-Season medical planning

Preparticipation Physical Evaluation Preparticipation Physical Evaluation (PPE) plan(PPE) plan

Policy for athletes’ medical infoPolicy for athletes’ medical infoDocumentationDocumentationCommunication with necessary staffCommunication with necessary staff

Establish emergency response planEstablish emergency response planPolicy for environmental safetyPolicy for environmental safety

Heat illness preventionHeat illness preventionCold weather precautionsCold weather precautions

Planning for Game-Day Planning for Game-Day CoverageCoverage

Assemble an adequate medical bagAssemble an adequate medical bagCoordinate for sideline medical Coordinate for sideline medical

suppliessuppliesDetermine clearance status of Determine clearance status of

playersplayersCoordinate all medical operationsCoordinate all medical operations

ATC may do this on some teamsATC may do this on some teams

QuestionsQuestions

QuestionsQuestions