Does the practice of sports medicine require training in a specialized discipline? - Brief Article - Statistical Data Included

Family Practice News, June 15, 2000

Dr. John McShane

YES To be effective practitioners of sports medicine, we must have an understanding of the importance of physical activity and of sports participation in the lives of the patients we treat. This requires more than just understanding the mechanism of the injury, the healing process, or what treatments can promote healing. It means having a real understanding of how important it is for the patient to continue sports participation.

A fellowship or other sports medicine-specific training offers the best way to gain this understanding. You also have to dedicate time to learn about the different sports that people play, so that you can understand why different injuries occur and how medical conditions can affect involvement in those sports.

Physicians with specialized training in sports medicine practice it on the level of a specialist. Many primary care doctors have a great interest in cardiology, for example, and practice it at a certain level. They don't do it the same way, however, that a fellowship trained cardiologist does. Similarly, family doctors can and should apply the spirit of sports medicine practice, but they cannot necessarily do so at the same level that someone trained in the specialty does.

Treating a skin infection often is a pretty straightforward problem. But if a skin infection occurs in a participant in high school or intercollegiate wrestling, it has wider implications because of the rules about wrestling with a skin infection and the risk of transmitting that infection to someone else. Understanding that context goes beyond treatment of the skin infection itself.

What we do is very specialized, and family doctors who do not have specialized training cannot deliver this same level of sports medicine care. Just as cardiologists, rheumatologists, and other subspecialists need their primary care background, you need that kind of background as well to be a sports medicine physician.

And with the appropriate additional training one can deliver this kind of care at the level of a specialist.

Dr. Doug McKeag

NO The idea of a separate discipline really doesn't make sense to me. This is one of the few areas of organized medicine where people come together from different disciplines toward a common goal: better care of the athlete. So instead of family physicians and internists fighting for turf in sports medicine, they're working together for it. We have our turf battles with the orthopedic surgeons. But eventually I think those are going to disappear as well.

Today in medicine we're steering away from disciplines and specialties. To survive, academic medical departments have to get along with each other. They have to cooperate, which is totally different from the way it's been. To build up a separate academic program for a sports medicine specialty is not wise.

Sports medicine extends well beyond musculoskeletal medicine. We're dealing with a specialized part of the population that happens to do a lot of exercise. In a lot of ways, sports medicine involves every patient I see as a family physician. I may see a 55-year-old businessman, but he's still a recreational athlete.

The background that I received in family medicine as my discipline is probably the most appropriate background for sports medicine. I'm a family physician and at the same time I'm a sports medicine physician who has served as president of the American Medical Society for Sports Medicine. What I do in family medicine is much of what I do in sports medicine, and vice versa.

We physicians who practice sports medicine have a lot of support from our disciplines. Sports medicine physicians are not just not doing pre-participation physical exams anymore. We're doing a lot of different things. And some some people who practice sports medicine are not primary care physicians and are not orthopedic surgeons. Where do they belong?

I think it's time that departments and clinical programs stop calling themselves primary care sports medicine," and just use the more inclusive term "sports medicine."