What exactly is a Team Physician? You see them at every sporting event from the professional level down to the amateur teams and organizations. Whether it is a world-renown surgeon such as Dr. James Andrews or the local orthopedist standing on a high school sideline on Friday night, who are these men and women?
According to the American Academy of Orthopedic Surgeons (AAOS), the Team Physician is defined as having “the leadership role in the organization, management and provision of care of athletes in individual, team and mass participation sporting events.”
But what makes a great Team Physician? In the competitive world of athletics, teams and athletes are always searching for a competitive edge. What separates a physician from a “team physician”?
According to the AAOS’s Team Physician Consensus Statement, it is the team physician’s education, training, and experience that uniquely qualify him/her to provide the best medical care for the athlete. This statement clearly delineates five (5) specific qualifications, duties and responsibilities of the team physician and provides guidelines to individuals and organizations in selecting team physicians. Therefore the questions to ask when looking to define a great team physician would be:
1. Does the team physician must have an unrestricted medical license and be a Medical Doctor (MD) or Doctor of Osteopathy (DO)? The team physician should possess special proficiency in the prevention and care of musculoskeletal injuries and medical conditions encountered in sports (AAOS). In other words, does the practice support the special needs of an athlete? Is the physician best prepared to handle the care of an athlete? For an answer to those questions, look inside the practice and determine how many athletic trainers and physical therapists and other allied health care professionals work daily with the physician. At Sports Medicine South, Dr. Gary A. Levengood currently employs 10 ATC’s, a Physical Therapist, a Certified Physical Therapist Assistant, a Certified X-Ray Technician, a Certified MRI Technician, a Licensed Massage Therapist, Certified Medical Assistants, as well as oversees 9 ATC’s placed at each high school directly under his care.
2. What are their Medical Qualifications and Education Since the primary responsibility of the team physician is to provide optimal medical care for athletes, the team physician must possess certain qualifications and education (AAOS).
• Do they practice or hold privileges at a local hospital? Are they based in the area where the athlete resides and competes? In order to provide optimal care for the athlete, the physician must be able to have a developed line of communication and network of professionals to expedite and oversee the best practices. Dr. Levengood has established a solid working relationship with the Gwinnett Medical Center (GMC), the largest medical facility in Gwinnett County. GMC is the largest sports medicine provider in the state of Georgia. Currently, Dr. Levengood serves as the Chief of Sports Medicine for Gwinnett Medical Center.
• Do they possess a fundamental knowledge of on-field medical emergency care (e.g., concussion, cardiac emergencies, spinal injuries and heat-related illnesses)? Are they trained in basic cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use? Sports Medicine South and Dr. Gary Levengood have worked closely with the Gwinnett Medical Center in establishing the Concussion Institute and created mandatory education coursework for coaches regarding heat-related illnesses. This has become the gold standard in care regarding concussions and heat-related illness across the state of Georgia.
• Does the physician hold a medical specialty board certification, Fellowship training in sports medicine, or additional American Council of Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) certification in sports medicine? Dr. Gary Levengood is not only Board Certified in Orthopaedic Surgery and holds an additional Board Certificate in Sports Medicine by the American Board of Orthopedic Surgeons but he has also completed the world-renown Sports Medicine fellowship at The Hughston Clinic in Columbus, Georgia, where he specialized in Arthroscopic Surgery and Sports Medicine. Dr. Levengood is also a fellow of the American Academy of Orthopedic Surgeon.
• Do they have a significant portion of their clinical practice focused on sports medicine? Do they pursue continuing medical education in sports medicine? Sports Medicine Is not only just part of the name at Sports Medicine South, it is what we do! Dr. Levengood is the Team Physician for 7 schools, has performed over 100 ACL surgeries in the past year alone and sees an average of 15 high school athletes daily in the practice! Just this year, Dr. Levengood has lectured nationally and internationally including his position as an adjunct professor at a local medical college, speaking to the British Board of Orthopedic Surgeons in London and at the prestigious GECO Conference in France.
3. What are their Medical and Administrative Duties and Responsibilities? It is important for the team physician to be available, accessible and maintain sport-specific knowledge and experience to provide medical care for the athlete (AAOS).
Medical Duties of a team physician include:
· Establishes a chain of command for injury and illness management, Coordinates the assessment and management of game-day injuries and medical problems, Makes the final decisions on clearance to participate, same day return to play (RTP) and post-game day RTP
· Understands the importance of the pre-participation examination (PPE)
· Recognizes other issues that affect athletic performance, including strength and conditioning, nutrition, ergogenic aids, substance abuse and psychological response to injury
· Recognizes unique issues in females, master athletes, adolescent athletes, and other defined athletic populations
· Provides for documentation and medical record keeping
· Provides ongoing medical care beyond game-day/event coverage
· Is involved in injury and illness prevention
· Develops and participates in the selection of the athletic care network
· Educates athletes, parents/guardians, coaches and administrators
At Sports Medicine South, we communicate directly with each athlete and parent. A Team Physician must work as a team player, coordinating the services of the entire sports medicine team in order to provide the very best care for the athlete. Information relevant to participation restrictions or modifications is communicated not only to the health care provider at each school, but also with the coaching staff that works with the athlete. We do not simply send a note back with the athlete. We believe on-site and in-person communication is a far more detailed process than a note can provide.
Sports Medicine South is directly involved in other issues that affect athletic performance. We recognize that “Beyond Better” care does not start and end in our office. In order to provide education that will help develop athletes that perform at a higher level, we are the premier supporter to the National Strength and Conditioning Association for the Southeast Region and the State of Georgia. Just this year, we helped bring Eric Cressey and Jeremy Boone in to speak at the NSCA Southeast Regional Conference in Duluth, Georgia on Issues affecting the Overhead Athlete and ACL Prevention Programming!
Administrative Duties of a team physician include:
· Is aware of or involved in the development and rehearsal of an emergency action plan
· Is aware of or involved in other aspects of sideline and event preparedness (e.g., environmental concerns, supplies, equipment, medication, policies and postseason review
· Develops an agreement of medical care and administrative responsibilities between the team physician and the organizing body, including a reporting structure from the athletic care network.
At Sports Medicine South, we review the Emergency Action Plan at each with ATC’s at each school or organization we are involved with. Also, along with the Gwinnett Medical Center, we hold an annual Athletic Trainer Summit that assists in training and educating in the most current issues in Sports Medicine.
In order to keep lines of communication open and to provide the best of care to the athlete, Sports Medicine South and Dr. Gary Levengood and the entire professional staff of Sports Medicine South meet with coaches and administrators of each of the programs we work with to review the past year and develop a continued plan to assist in the goals of those programs.
4. Ethical Issues Ethical challenges are present for all physicians, including team physicians. These challenges may have unique presentations in sports medicine (AAOS). Examples of ethical challenges include Confidentiality, Informed Consent, conflict of interest, Influence of Third Parties, Drug Administration, Advertising & Sponsorship, and the Supply of Medical Products. According to the AAOS, “The overriding principle for all physicians, including team physicians, in managing ethical issues is to provide care focused on what is best for the patient, and only for the patient. An effective way to address ethical challenges is to obtain the greatest possible clarity regarding the team physician’s relationship with all interested parties (athlete, parent/guardian, club/team/organization) when the relationship is established. Disclosure and management of potential conflicts is essential.
5. Medicolegal Issues Medicolegal issues are present for all physicians, including team physicians. Some ethical issues may also be viewed in a medicolegal context.6 Medicolegal issues may have unique presentation in sports medicine (AAOS). Some key areas of potential medicolegal liability include compliance with school and governing body guidelines, standards, policies, regulations and rules, compliance with local, state, and/or federal rules, regulations and laws, compliance with privacy laws, decisions made as a result of the PPE, clearance to play, waivers and RTP, evaluation and management of significant on-field injuries and illnesses (e.g., concussion, cervical spine, cardiac, heat-related illness), and medical record documentation. As with the Ethical Issues, the best way to address these areas is to obtain clarity from the team physician in how each area is handled in their practice and administration.