Welcome to our next installment in So You Want to Be. In this series, we highlight a specific specialty within medicine, such as sports medicine, and help you decide if it’s a good fit for you.
So you want to be a sports medicine physician. You like the idea of working with top athletes and helping them heal from their injuries. Let’s debunk the public perception myths of what it means to be a sports medicine doctor, and give it to you straight. This is the reality of sports medicine.
What is Sports Medicine?
Sports medicine doctors are the non-surgical musculoskeletal (MSK) specialists, taking care of MSK injuries for athletes and active patients. Think of them as doing everything an orthopedic surgeon does without any surgery, but with procedural skills.
While orthopedic surgeons who undergo an ortho sports medicine fellowship are the experts on surgical management of MSK injuries, they are less able to address other realms of the patient’s needs. Since most sports medicine doctors have a primary care background, most commonly family medicine, they’re also well suited in addressing the full spectrum of patient and athlete needs. They serve as a single hub and point person in the patient’s management, including and extending beyond their MSK injuries. Sports medicine physicians provide the full spectrum of care for anyone that wants to be active, whether an athlete or couch to 5k jogger.
For example, they’ll work up a young type 1 diabetic patient who is interested in playing sports, or determine when an adolescent can return to contact sports after a bout of mononucleosis, as to minimize splenic rupture risk.
The age range of patients is wide, from school age to the elderly. Younger patients often break bones and experience concussions, while older patients often develop arthritis and other degenerative conditions which you’ll help manage.
Compared to other specialties, in clinic, there’s less continuity and a larger turnover of new patients. Sports medicine doctors see a high number of new patients who have acute MSK injuries rather than chronic repeat customers. As their sports medicine physician, your job is to diagnose, treat, and have them back to normal or self-managing long term. The main exception to this rule is arthritis.
While not surgical, sports medicine physicians still perform plenty of procedures, including diagnostic ultrasound and ultrasound-guided injections for joints, tendons, nerves etc.
There are a few ways to categorize sports medicine.
Team vs Clinical
A team physician is the sports medicine doctor who is the provider for the athletes on a sports team. For example, you could be the team doctor for a high school basketball team, watching from the sidelines and taking care of any injuries that happen in the game. Outside of game time, you’ll be helping manage their acute and chronic injuries.
This isn’t viable as a standalone business practice, and you’ll also be seeing patients in clinic. In clinic, you’ll work either for yourself in private practice or a larger health entity – regardless, patients will be sent your way through referrals, or you’ll create a patient population where you’re taking care of athlete-related problems, most of which are musculoskeletal in nature.
Work In vs Out of an Orthopedic Practice
If you want to do strictly sports medicine without much primary care, you can work within an orthopedic practice, seeing the non-operative patients. You’ll be employed by the orthopedics group or department, working alongside the surgeons, and handling all the cases that don’t require surgical management or acting as the gatekeeper who sees all new patients to determine whether their issue is operative or non-operative. You’ll be an essential part of the team, helping boost everyone’s productivity.
How to Become a Sports Medicine Doctor
After four years of medical school, there are a few different routes to become a sports medicine physician. The overwhelming majority of sports medicine physicians first complete a family medicine residency, but you can also go through emergency medicine, pediatrics, internal medicine, or PM&R. The specialty you come from is important, as your practice will likely be a blend of sports medicine and your primary specialty.
Fellowship is generally 1 year, although some are 2-year programs which are more research or leadership focused. In fellowship, sideline coverage of team games is required, as is training room time (meaning clinic for the team). This can be done on-site for the affiliated college or nearby sports teams.
Some fellowships will provide opportunities to be the team doctor for higher-level athletes including division 1 college, Olympic, or professional sports. Others will have limited exposure to higher-level athletes. But almost all fellowships work with some kind of college athletics.
You’ll also be spending the majority of your time rotating in primary care sports medicine clinic, but also rotating with orthopedic surgery sports clinic to understand their patients’ recovery process and complications to be mindful of.
Note that as a medical student, you probably won’t get exposure to the specialty unless you actively seek it out. It’s not a core rotation, although you may be able to secure elective time on primary care sports medicine, not to be confused with surgical sports medicine with the orthopods. As a premed, see if you can shadow a sports medicine physician, and as a medical student see if there are any preceptor opportunities with a sports med doc. Explore the specialty and shadow physicians doing sideline coverage of games.
What You’ll Love About Sports Medicine
There’s a lot to love about sports medicine.
Because being mobile and physically active is central to people enjoying their lives, your job is incredibly rewarding – you’ll take patients who are injured and help them get back to living a fulfilling and active life. You’re generally seeing patients that have favorable outcomes, and experience “wins” every day. It’s quite satisfying to have a patient with knee pain secondary to arthritis limp into clinic and then watch them walk out pain-free after you perform an injection.
And speaking of favorable outcomes, another underappreciated aspect is that the vast majority of patients are generally healthier and highly motivated to get better. In some other specialties, you may experience frustration with a non-adherent patient whose condition could improve, but has more difficulty following the treatment plan.
If you’re a big sports fan, you’ll love that you get paid to attend sports games and tend to the athletes. And if you’re lucky, you can even work with high-level athletes who are at the top of their game and are the epitome of peak human performance. It’s fun and inspiring to be a part of that.
If you’re the type of person that enjoys working with your hands but doesn’t want to go all-in with surgery, then sports medicine provides a procedural mix that makes for a great middle ground. And unlike surgery, family medicine has a fantastic lifestyle, with regular 9 to 5 hours and minimal overnight call for most.
For those who have broad interests, you’ll get to do 2 specialties in one. As a primary care sports medicine physician, you’ll always have the option to fall back on your primary specialty, whether that be family medicine, emergency medicine, peds, internal medicine, or PM&R. Depending on your interests, lifestyle, and practice preferences, you can adjust the balance to be more heavily sports medicine or more heavily your primary care specialty.
And finally, it’s an accessible specialty to most medical students as it doesn’t require supremely competitive board scores to get into one of the feeder primary care specialties. Additionally, fellowships are readily available to those interested in the specialty.
What You Won’t Love About Sports Medicine
While sports medicine is an awesome specialty, it’s not for everyone. Many hopeful students are drawn to the specialty, imagining an exciting career working with top professional athletes. The reality is that getting a job with a professional sports team is very rare and requires a lot of work to secure.
And while most people assume that team docs are paid handsomely, the truth is that most are either on a volunteer basis, or the compensation is far lower than what you’d be making in clinic. It makes sense – sports docs are willing to take a pay cut for the opportunity and prestige to work with such elite athletes. Sometimes, healthcare systems will even pay the teams for advertising and provide free healthcare for the athletes.
While the lifestyle is generally favorable, if you want to do sideline coverage with high-level teams, your hours will be far less predictable, and you’ll often be on the road depending on where games are located. The line between being “on” and being “off” is blurred, and it becomes harder to lead a normal 9 to 5 life or even take a vacation.
Compensation for sports medicine is also on the lower end compared to other specialties, with an average of $235,000 per year. And if you’re working with teams, you’ll likely be taking an additional pay cut or volunteering additional hours outside of clinic.
As a younger specialty, it can be frustrating that sports medicine doesn’t have a robust body of scientific evidence to guide management. For something like cardiology, there’s a double-blinded randomized controlled trial for just about everything, but for sports medicine, the body of evidence is far less developed.
Last, for those who know that they only want to do sports medicine in their future career, it can feel frustrating to do 3 years of a primary specialty that you may not use much before getting to do a 1-year fellowship in the specialized area of medicine you want to practice.
Should You Become a Sports Medicine Doctor?
How can you decide if sports medicine is the right field for you?
The stereotype is that if you’re active, enjoyed playing sports, but aren’t a huge jock, primary care sports medicine may be for you. Think of sports medicine as attracting the ortho bros who don’t identify with bro culture. But in all seriousness, anyone can find joy in sports medicine.
If you enjoy musculoskeletal medicine but don’t enjoy the operating room, primary care sports medicine may be a good fit. If you enjoy working with your hands with clinic-based procedures and value lifestyle, sports medicine has a fantastic balance.
Sports medicine is also unique in that the physical exam truly remains the cornerstone of the diagnostic approach. Whereas some other specialties are moving more towards imaging and lab tests, sports medicine has a heavy emphasis on the physical exam. If you’re the student that took pleasure in learning the nuances and intricacies of the anterior drawer test versus Lachman’s test, look no further.
In short, if you love sports, MSK, and working with athletes but don’t want to dedicate your life to the operating room, primary care sports medicine may be for you.
Big shout out to Dr. Jean-Pierre Valette, current attending sports medicine physician and my good friend from medical school. Here are two papers of his, one on the financial implications of being a team doctor, and one on factors associated with sports medicine fellowship selection.
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Thank you all so much for watching! If you enjoyed this topic, you’ll also enjoy our orthopedic surgery post, which covers surgical sports medicine.