Health Systems Initiative

Family Medicine Leaders During COVID

Sports Medicine Trained Family Physicians

Describe what you/your faculty/department/program/clinic did that demonstrated that family physicians are leaders in health systems.
This is a shout out to ALL the primary care sports medicine-trained family physicians who serve as team physicians at the collegiate level in recognition of the hundreds of unpaid hours that they have put in since the pandemic started to help their institution understand the implications of COVID-19 for athletics, to protect the health and safety of their student athletes, and to plan for and execute practice and competition seasons for their sports teams.

These family physicians have suddenly had to become experts on an emerging viral illness and the consequent public health challenges. They have likely answered countless questions for the athletics' leadership at their institution of higher education as they attempt to plan and execute a sports season in the middle of a pandemic. From questions about viral persistence on metal surfaces in sunlight and heat as it relates to cleaning a football stadium prior to and after a game; to considering the presence of bands (who knew an oboe was such an aerosol spreader?), cheerleaders and dance teams at events; to how best to socially distance while a team is traveling (what about air flow on the bus and how does that impact contact tracing?) and dining on the road; to how best to set up surveillance testing for teams and sports with vastly different risks (football vs golf, volleyball vs wrestling) and what testing method is best for a given institution to use; to managing concerns for myocarditis in athletes who have recovered from COVID-19, no question is considered out the realm of expertise for the team physician. Their institutions have counted (and continue to do so) on them for accurate, up to date, evidence-based scientific information that can help guide planning while ensuring the health and safety of all of those involved in college sports.

These family doctors have also likely helped their institution track quarantine and isolation for affected student athletes in addition to making sure that they continued to focus on the bigger picture. They have advocated for student athlete mental health in a time of great stress and uncertainty and have worked with already strained mental health services to ensure that athletes at their institutions are taken care of. They have worked with campus housing to safely isolate positive student athletes. They have worked with nutrition to ensure that athletes in isolation or quarantine are well fed. They have worked with strength and conditioning and sport specific coaching staff to ensure a safe and graded return to exercise as students returned to campus and as some returned from illness.

Many of these family doctors have likely also served as a liaison between their institution and their local or state health department. These physicians have had to negotiate changing guidelines from the CDC and state guidelines that are often slower to respond. They have had to reconcile guidelines developed at their conference level with those at their state and local level. Team physicians may have worked with local health departments to assist with contact tracing at their institution, thereby unburdening an already overwhelmed and underfunded public health system. These family physicians have contributed data (based on surveillance testing in their athletic populations) at the national level to help inform changes in quarantine length made recently by the CDC and they are contributing data to a national study on post-COVID myocarditis in athletes. They are fulfilling a role that benefits more than just the health and wellbeing of their own athlete population at their institution.

Some of these family physicians also collaborated on a regional or national level, working within their institution's athletic conference or as parts of groups with the NCAA (National Collegiate Athletic Association) to develop policies and protocols to facilitate the safe return to college athletics.

Regardless of your opinion about whether or not sports are essential in a pandemic, all of these family physicians who serve as team doctors have shown the value of a well trained generalist who is as comfortable with public health questions as they are with emerging infectious disease issues and everything in between.

How did you communicate with health systems leaders during the process?
These primary care sports medicine trained family physicians have communicated by phone, over email, on Zoom calls or at socially distanced meetings to make sure that questions are answered be they from the University president, the Athletic Director, athletics administration, event management, marketing, the coach, an athletic trainer, a student athlete or a parent. It is the summation of all these communications and questions answered that helps an institution build trust in their family physician. It's that reassurance that if their physician is unsure, there will be follow up once more information is gained. Over time, it is that trust and confidence in their physician, that helps ensure the health and safety of all those involved in college athletics.

What type of feedback have you received about your efforts?
The feedback in athletics is limited. If you're trusted and helpful, you will get asked more questions and get asked to step up and do more. For most family physicians who work as team doctors, it's all part of the job.

What type of impact do you think this will have on your health systems leaders’ perception of family medicine?
For athletic departments, this pandemic has highlighted the importance of a well-qualified family physician in the team physician role. A family physician's broad expertise enables them to field a variety of issues in an evidence-based, patient focused fashion. They can help leadership understand the problems at hand, focus on patient centered care for their athletes, and negotiate around issues of cost containment and quality care. I think this pandemic has helped athletic departments better understand the skills that a family physician brings to the table.

What type of advice would you give to other family physicians or family medicine faculty about helping health systems leaders see the value of family medicine?
In athletics, it's the combination of hard work and dedication that help leaders see the value in their primary care sports medicine trained family physicians.

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Submitted by: Zoë Foster, MD, Program Director and Team Physician

Institution: Prisma Health - University of South Carolina

"A family physician's broad expertise enables them to field a variety of issues in an evidence-based, patient focused fashion. They can help leadership understand the problems at hand, focus on patient centered care for their athletes, and negotiate around issues of cost containment and quality care."


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