Medicine on the Sidelines
Team physicians must be able to treat a variety of injuries and illnesses. Most important, they have to love the game.
The night of the opening game of the University of Minnesota men’s basketball season, David Olson, M.D., is on duty. But instead of being stationed in an ER or urgent care clinic, Olson is in the stands at Williams Arena watching the game like any other fan.
Attending the season opener is just one “to do” item on a long list for Olson, who serves as the team physician for the basketball Gophers and several other sports teams. The rest of the week might have him on the road with the university’s football team or the Minnesota Vikings, in the university’s training rooms, on the sidelines at Roseville Area High School football games, seeing patients at the Broadway Family Medicine Clinic, where he practices family medicine, or working with physicians in the University of Minnesota’s sports medicine fellowship program. “I have crazy weeks,” he confesses.
Hectic schedules aren’t unusual for team physicians. “One thing people don’t realize is that being a team physician takes a lot of time,” says Joel Boyd, M.D., an orthopedic surgeon with TRIA Orthopaedic Center in Bloomington and a physician for the Minnesota Vikings and the Minnesota Wild. In addition to his usual patient caseload, he typically spends an additional 40 hours a week working during the football and hockey seasons. “Essentially it’s another job,” he says.
Docs in the Game
To be a team physician, you have to love sports—as a participant or a spectator. Here’s how four team physicians exercise their inner athlete.
David Olson, M.D., a physician for the Minnesota Vikings and various University of Minnesota teams, plays basketball, hockey, and softball. In addition, he still plays flag football with friends from medical school.
Suzanne Hecht, M.D., a physician for the University of Minnesota football and women’s basketball, gymnastics, and track and field teams and USA Figure Skating, is a former gymnast with an international rating for judging gymnastics.
John Steubs, M.D., a physician for the Minnesota Twins for the last 22 years, describes himself as a “weekend warrior.” He plays golf and during the Twins’ spring training shags flies in the outfield.
Joel Boyd, M.D., a physician for the Minnesota Vikings and Minnesota Wild, says he has backed off of basketball and other “pounding” sports. “I got to the point where I like golf a lot,” he says.
But none of the team physicians interviewed for this story complain about the long hours. Many were athletes themselves, many still play sports, and all of them enjoy working with athletes. “What isn’t there to like about it?” asks Suzanne Hecht, M.D., a primary care sports medicine physician at Fairview Sports and Orthopedic Care in Minneapolis and a team physician for Gopher football and women’s basketball, gymnastics, and track and field, and U.S. Figure Skating. “As a team physician, sometimes you’re busy on the sidelines, and sometimes you’re just watching the game,” says Hecht, who is also a member of the university’s faculty. “Sometimes I have residents with me and they say, ‘Really? This is your job?’”
The Life of a Team Doc
Although traveling with teams and sitting in the stands sounds like fun and games, working a game is a lot like working in the ER. “In three hours, the time for most games, you can see any number of things,” says Boyd.
In the late 1990s, representatives from five organizations representing family medicine, sports medicine, and orthopedics set out to better define the role of the team physician. They agreed that it involves knowing the players, doing preseason physical evaluations, covering games, having a regular clinic for players, doing post-season evaluations, and maintaining athletes’ medical records. “The players are your patients,” says Boyd, who was a member of the committee. Physicians who work the sidelines at high school sporting events or who serve as, say, medical director of a marathon and don’t provide regular care to participants are considered “team event coverers.” “If someone running a marathon has a heart attack, you don’t know anything about that person. So it’s hard to say you’re the team physician,” Boyd explains. “If you did, I could see where that could have legal ramifications, whereas team event coverers are pretty much covered under Good Samaritan laws.”
The committee’s work also led to consensus statements on issues such as treating concussion and dealing with musculoskeletal injuries in female athletes. Now, sports medicine and other specialty societies, the National Collegiate Athletic Association, and the societies of professional team physicians offer continuing education on these and other issues associated with caring for athletes.
Like the athletes they treat, the physicians themselves usually are team members, as most major league and collegiate sports clubs have medical teams that include several physicians, certified athletic trainers, nutritionists, and, in some cases, sports psychologists. Boyd is one of four physicians who work with the Minnesota Wild. He and Olson are two of four physicians for the Vikings. Sports teams like to have team physicians who come from both orthopedic and primary care backgrounds.
What those physicians do and where they do it varies by sport, level, and season. Physicians for professional and Division 1 collegiate football travel with their teams. Those who care for professional hockey and baseball teams—both of which play more games during a season—work only the home games and treat players from both the home and visiting teams. Orthopedic surgeon John Steubs, M.D., one of four team physicians for the Minnesota Twins, says he cares not only for the team’s 40 players but also for the 150 or so who play on Twins farm teams. “I’m on call to both the major and minor league teams 24 hours a day, 365 days a year,” he says, adding that for him being a team physician is a year-round job.
Steubs starts his season by spending three of the six weeks of spring training with the Twins in Fort Meyers, Florida. During the off-season, he arranges for rehabilitation of injured players in their home towns. “There’s a little bit of downtime from November through February, but there are Latin players who get hurt playing winter ball, and some of our players play in the Arizona fall league,” he says.
Team physicians deal with a variety of injuries and illnesses. Boyd says the problems he deals with vary by sport. Hockey players, for example, tend to have lacerations, fractures, and shoulder injuries, whereas football players suffer fractures, dislocations, ligament and cartilage tears, and spinal cord injuries. “Football is like a bunch of small car accidents happening on the field,” he says. Baseball players tend to have knee, hip, shoulder, and elbow problems.
The pressing issues for team physicians tend to change over time. “When I was a resident 25 years ago, knee injuries, multiple ligament injuries, ACL injuries were what were taking players out of the game,” Boyd says. Now, thanks to better diagnostic techniques and treatments, players with what were once career-ending ACL injuries come back and play the following year. He says the hot topic today is concussion.
As a family physician who did a fellowship in sports medicine, Hecht says she deals with “all the same stuff regular people get”—colds, flus, pneumonia, and heat illness in the summer. But the consequences can be more significant for athletes. “With influenza, you usually feel bad for a week, then it takes another week to recover. If you’re an athlete, losing two weeks during a high-level athletic season is really a problem,” she says, recalling how the H1N1 outbreak caused some players to miss games last year. “Family medicine is perfect training, and many days, I’m thankful to have that background,” she says.
In addition to providing the initial care for concussions and orthopedic injuries, Hecht and her primary care colleagues also counsel players on issues such as preventing illness, bone health, and good nutrition. They often field questions about nutritional supplements and banned substances. (The pro teams contract with outside organizations that handle drug testing and answer questions about supplements and other substances.) “A lot of nutritional supplements aren’t regulated by the FDA,” Hecht says. “And there have been some interesting studies that have shown some products don’t have what they say is in them or in what ratio. We’re really careful with athletes about this.”
She and other team doctors say athletes make unique patients. “If they’re injured, they want to get back and play 99.9 percent of the time,” says Boyd, adding that sometimes they have to be reined in from rehabbing too quickly. They also know their bodies better than most people and notice if something isn’t right. “It makes a big difference to them if they run 4.4 in the 40 and now do a 4.6,” he says.
In addition to treating athletes and being part of the game, working as a team physician has another advantage. Steubs says it helps him establish credibility with his other patients. “They think, If he’s good enough to take care of the Twins, he must know what he’s doing.”—Kim Kiser