Clinicians, Care, and Conflicts of Interest in the Sports Medicine Environment

By Christine Baugh

A recent British Medical Journal blog post by Dr. Michael Stone sheds insight into the professional trials and tribulations of physicians working with professional soccer teams in England. As described, it is not uncommon that the team physician is recommended by a team manager and hired by the team’s executive board without thorough review. This hiring process, in turn, leads to the implicit expectation that the physician answers to the manager rather than the entire team, making the physician’s employment with the team insecure and the need for him to appease the manager a required condition of his employment. Beyond leading to an uncomfortable and potentially ineffective working environment, it is possible that this type of relationship could compromise care. These types of conflicts of interest within the sports medicine environment have been documented elsewhere.

A 2013 article in the Chronicle of Higher Education written by Brad Wolverton detailed a similar phenomenon in American collegiate sports. According to their survey of collegiate sports medicine clinicians, approximately one-third of clinicians indicated that members of the football coaching staff had influence over their employment and about half of clinicians reported having felt pressure from coaches to prematurely return athletes to play. Wolverton was able to provide striking examples of professional relationships between coaches and clinicians that led to compromised care. He also indicated that the topic was so sensitive that very few of the athletic trainers contacted were willing to talk about the issue for fear of losing their jobs.

Both the Stone and Wolverton articles highlight the complexity of sports medicine as a field and the specific conflicts that can arise when competing interests from multiple stakeholders are in play. However, critical to both authors’ conclusions, is that seemingly simple structural changes could play a major role in positively affecting health outcomes. Namely, to ensure quality of care, it is critical that the clinician’s employment is based upon the care he gives to his patients, not the team manager or team coach’s opinions of him. This is not a novel assertion. For example, the National Athletic Trainers’ Association, the National Collegiate Athletic Association (page 65), and others have put forth guidelines and recommendations indicating that having the coach serve as a primary supervisor for a clinician is inappropriate. However, it is not clear that these best practices are being implemented uniformly across sports, leagues, and teams. Given the health risks faced by athletes, and the role that sports medicine clinicians can play in mediating those risks, taking steps such as implementing an appropriate supervisory structure for sports medicine clinicians is imperative.

[This post reflects my own views only.  It does not necessarily represent the views of the Petrie-Flom Center or the Football Players Health Study at Harvard University.]

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