Duties and Responsibilities of the Team Physician. Peter A. Indelicato MD Emeritus Professor and Team Physician University of Florida

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1 Duties and Responsibilities of the Team Physician Peter A. Indelicato MD Emeritus Professor and Team Physician University of Florida

2 Disclosure Arhtrex consultant, royalties RTI consultant, share holder

3 Introduction The purpose of this presentation is to provide an overview of the responsibilities of a team physician as described in the Inter-Association Consensus Statement on Best Practices for Sports Medicine Management for Secondary Schools and Colleges

described in the Inter-Association Consensus Statement on Best

4 Introduction Cross reference the TPCC Who should serve as a Team Physician? Team Physician Responsibilities Decision Making Authority Conflicts of Interest Personal Experience /Comments

5 Please note. The points made in this presentation closely reflect back on an updated (March, 2013) TPCC statement soon to be published in Medicine and Science in Sports and Exercise, August, 2013 ACSM, AOSSM, AMSSM, AAOS, AAFP, AOA.

6 Authors and Contributors Stan Herring, MD Seattle, Washington Ben Kibler, MD Lexington, Kentucky Margot Putukian, MD..Princeton, New Jersey John Bergfeld, MD Cleveland, Ohio Lori O Neill, MD Kansas City, Kansas Cindy Chang, MD..Berkeley, California R. Robert Franks, DO Marlton, New Jersey Peter Indelicato, MD Gainesville, Florida Walt Lowe, MD Houston, Texas Yvette Rooks, MD Baltimore, Maryland Robert Stanton, MD Fairfield, Connecticut

.Princeton, New Jersey John Bergfeld, MD Cleveland, Ohio Lori O Neill, MD Kansas City, Kansas Cindy Chang, MD.

7 TPCC March 2013 Team physicians have the leadership role in the organization, management and provision of care of athletes in individual, team and mass participation sporting events. This document describes the definition, qualifications, education, duties and responsibilities of the team physician fulfilling that role..

8 TPCC.March, 2013 The goal of this statement is to delineate the qualifications, duties and responsibilities of a team physician and provide guidelines to individuals and organizations in selecting them. This, then, will provide a foundation for the best practices in the medical care of athletes and teams. Not intended as a standard of care

9 Who Should Serve as a Team Physician???

10 TPCC..Team Physician.Essential Qualifications: MD or DO with an unrestricted license to practice medicine Possess a fundamental knowledge of on-field medical emergency care ( e.g.. Concussions, cardiac emergencies, spinal injuries and heat-related illnesses ) Be trained in basic CPR and AED use Have a working knowledge of MSK injuries, medical conditions and psychological issues affecting athletes

11 TPCC Team Physician Desirable Medical specialty Board certification Fellowship training in sports medicine A significant portion of clinical practice devoted to sports medicine CME in sports medicine Membership in major sports medicine society (i.e. AOSSM, AMSSM) Knowledge of medical-legal, disability and work compensation issues Medial training including communication skills and knowledge of social media

Membership in major sports medicine society (i.e. AOSSM, AMSSM) Knowledge of medical-legal,

12 Inter- Association Consensus Statement Team Physician Responsibilities Like all health care providers, the team physician s first, and most important, obligation is for the wellbeing of the athletes under the care of the sports medicine team. The team physician must have the ultimate authority for making medical decisions regarding the athletes safe participation

of the athletes under the care of the sports medicine team.

13 What does that involve?... Return to play/practice decision making.with input from the athletic trainer, designated consultants, and the athlete, this decision should always have the athletes immediate and long term health in mind

14 Team Physician Responsibilities Development of a chain of command with he/she as the head of the chain this concept needs to be established and agreed upon by all involved parties ( administrative, coaches, legal counsel, etc ) well before the start of the season,,,,

established and agreed upon by all involved parties (

15 Team Physician Responsibilities Coordination of rehabilitation and return to participation Integration of medical expertise with other approved health care providers Provisions for appropriate education and counseling regarding nutrition, strength and conditioning, ergogenic aids, substance abuse and other medical issues affecting athletes

providers Provisions for appropriate education and counseling regarding nutrition,

16 Team Physician Responsibilities Provide provision for proper documentation and medical record keeping Planning and training for emergencies during competition and practice Addressing equipment and supply issues Assessment of environmental concerns and playing conditions

emergencies during competition and practice Addressing equipment

17 Administrative Duties Essential Since the team physician has ultimate responsibility for care provided by the sports medicine team, it is critical that he/she has a voice in the selection/retention of members of that team Therefore, he/she should be involved in the interview/selection/evaluation process for key members of that team i.e. Athletic trainer

selection/retention of members of that team Therefore, he/she should be involved in the

18 Decision-Making Authority Potential for conflict of interest ( COI ) is omnipresent in sports medicine, particularly when members of the sports medicine team are paid employees of the institution To minimize this, the institution must establish a clear line of unchallengeable authority to the team physician and athletic trainers This established line of authority affords the doctor and trainer freedom from personal and professional bias in their ethical and medico legal obligation to the athlete

clear line of unchallengeable authority to the team physician and athletic trainers This established line of authority

19 Keep in mind. All medical decisions made in the athletes best interest are ultimately serving the team s best interest and thereby providing for the institution s well being.

20 Decision-Making Authority The literature well supports the medico legal principle that the team physician retain the ultimate final authority for medical clearance Even when this return to play decision is delegated by the team physician to the athletic trainer, the team physician is still ultimately responsible

medical clearance Even when this return to play decision is delegated by the

21 Decision-Making Authority Communication is essential for this sports medicine team to be successful Health care providers must adhere to HIPAA and FERPA rules Documented communication policies should clearly outline what specific information can legally be shared and by whom and to whom and in what manner.

22 Decision-Making Authority Return to play (RTP) decisions in the midst of the emotion of competition should be made in an objective and unbiased fashion..

23 Decision-Making Authority Delaying RTP decisions until a suitable environment is available ( i.e. training room where a more complete history and repeat physical examination can be performed ) is frequently necessary and should be utilized.

24 Decision-Making Authority The athlete must be an active participant in medical decisions Never impose your authority in a way that impinges on the athletes right to make their own decision Frequent points for discussion: (1) Operative vs. non-operative outcomes (2) Options that may delay RTP but further the athlete s long term best medical interest (3) Options that may hasten RTP but are not in the athlete s long term best medical interest

25 This discussion needs to be made in such a manor that the athlete understands what you are describing The team physician/athletic trainer must work as a team in that they should be both an athlete advocate and an educator to ensure that the athlete understands the risk vs. benefits of all treatment options Documentation that he/she listened to and understands the explanation is very important.

26 Personal Experience

27 What student-athletes want to know about health care team??? (A) Can they trust you?... (B) Will you always do your best for them?. (C) Do you really care about them as individuals in the context of them being members of a team?

28 In other words. Make it clear that even though you are the team physician/athletic trainer, when an athlete gets sick or injured, you are THEIR physician/athletic trainer

29 Recognize and Manage Conflicts of Interest Potential conflicts of interest arise when the team s best interest and the athlete s best interest are not aligned. Advocating strongly for the athlete means that the physician ( or athletic trainer ) may enter into a conflict with the coaches or risk losing his/her job, including all the perks, status and money associated with it..

30 How to Manage that??? Establish, clearly and early, what the chain of command is and who is responsible for what. The school administration/coach should understand that the health and well-being of the athlete is paramount and the selection of the health care team should reflect that fact and be empowered as a result of it..

31 Frank Bassett MD Don t ever do anything that would embarrass you if you were to read about it in the morning newspaper!

32 Conclusion: in my opinion.. There is no one more important in the athletic care network than the athletic trainer Store Window to the sports medicine team Eyes, ears and wisdom of the team physician and therefore deserve the physicians respect and admiration

33 Thank You!!!!

Team Physician Consensus Statement: 2013 Update

SPECIAL COMMUNICATIONS Team Physician Consensus Statement Team Physician Consensus Statement: 2013 Update DEFINITION Team physicians have the leadership role in the organization, management, and provision