Duties and Responsibilities of
the Team Physician
Peter A. Indelicato MD
Emeritus Professor and Team Physician
University of Florida
Disclosure
• Arhtrex…consultant, royalties
• RTI…consultant, share holder
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”
Introduction
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Cross reference the TPCC
Who should serve as a Team Physician?
Team Physician Responsibilities
Decision Making Authority
Conflicts of Interest
Personal Experience /Comments
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….
Authors and Contributors
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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
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…..
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”
Who Should Serve as a “Team
Physician” …???
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
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
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…
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…
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,,,,
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
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
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
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…
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….
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…
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….
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..
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….
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
• 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….
Personal Experience
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?
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…
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…..
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…..
Frank Bassett MD
• “Don’t ever do anything that would
embarrass you if you were to read about it
in the morning newspaper!”
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…
Thank You !!!!