SBJ/June 15 - 21, 1998/No Topic Name

Team physicians star in a relief role

Doctors aren't usually found in the team photograph, and they are all but buried in the media guide. They can play a major role in a team's success or failure, but, other than a few high-profile names, they work anonymously.

The role of team doctor is becoming a lucrative one, however, as the sports medicine industry evolves into a profitable business for health-care companies and doctors associated with sports franchises.

On the other side of the training table, the evolution of sports medicine means better and more sophisticated care for the players, all designed to speed the healing process and prolong multimillion-dollar careers.

"In the old days, the team doctor was a buddy of the owner," said Dr. Harlan Selesnick, team physician for the Miami Heat. "Now, the players have demanded that [doctors] have certain levels of training."

It's not just medicine that has grown more sophisticated. With lucrative contracts at stake, players no longer blindly follow the advice of team doctors without consulting other physicians and agents, and not necessarily in that order.

"The changes in team medicine have been dramatic," Selesnick said. "Players used to come into training camp, have a cursory physical, and then play themselves into shape. Now it's an 11-month-a-year job, and players are expected to be in shape."

To keep an athlete healthy, team physicians prescribe a rigorous screening process that includes a variety of medical specialists using increasingly sophisticated methods. As a result, athletes today have access to some of the best medical care available.

"There are preseason and postseason exams, including internists, cardiologists, orthopedics, podiatrists and dentists," said Selesnick, who developed health screening protocols used by other NBA physicians. "The players get blood work, angiograms, stress tests, muscle strength testing and MRIs on both knees. It's a very intense physical that establishes a [medical] baseline for each player."

And that's before an injury.

Advances in medical technology have pushed sports medicine to the point that injuries that once ended careers, such as a torn anterior cruciate ligament in the knee, now mean the loss of just one season.

The rise of arthroscopic surgery has allowed doctors to treat damaged joints such as knees and elbows with less invasive methods, enabling an athlete to heal faster while lengthening his or her career.

Even the care administered by trainers and physical therapists has become refined and specialized.

"It used to be that the guys who were trainers really weren't trainers," said Dr. Robert Leach, former team physician for the Boston Celtics and the U.S. Olympic team. "Back then, trainers were nice guys who taped ankles. Now, trainers are highly skilled, and everybody is so much more aware of the player's value."

No longer is the team doctor handling the full continuum of care for athletes.

Instead, team physicians essentially act as gatekeepers for the professional athlete, recommending specialists and farming out care to doctors better qualified to handle specific problems.

"It used to be that the team doctor handled everything, but things are very sophisticated now," Selesnick said. "We don't use one group of doctors, and we find the best specialists for whatever problems we have. The care can't be self-contained anymore. We refer everything from neurologists to dermatologists."

As team medicine has grown more sophisticated, so has the cost of delivering care.

It's impossible to pinpoint the cost of care because it depends on the sport and the number and type of injuries suffered. Selesnick said an NBA team spends a minimum of $100,000 for health-care services annually. Football and hockey teams pay a higher cost, given the violent nature of the sports and bigger rosters.

Regardless, costs are rising, causing teams and doctors to get creative when it comes to making deals. Teams will negotiate free services such as rehabilitation care to be included in the contract. In return, the physicians use the team for marketing purposes.

"One of the biggest changes in sports medicine has been cost," Leach said. "Clinics or hospitals may work out a deal where they can use the team to advertise that they take care of the teams. It used to be that physicians never advertised. Now everyone does."

The advertising component is a recent phenomenon in the evolution of team medicine. Doctors, hospitals and clinics have all figured out that being associated with a professional sports team is a surefire way to win business.

Say you've treated Michael Jordan or Troy Aikman, and patients will clamor for an appointment.

As a result, for-profit health-care

giants such as Birmingham, Ala.-based HealthSouth and Nashville, Tenn.-based Columbia/HCA have become heavily involved in professional and Olympic sports medicine. Large physician groups and local nonprofit providers are eager to be connected to a team to better build an image. Tactics include offering free services to teams, buying stadium signs and springing for luxury suites, all in the name of good medicine.

"Everyone wants to be attached to [sports medicine]," Leach said. "If you do a good job, it becomes a captive population. That's how you build up practices."

If there is a profit to be made in sports medicine, will it evolve to the point where teams have their own clinics and facilities as sort of a one-stop health-care center for athletes?

Probably not, experts say, because a doctor working solely for a team will not build a big enough practice.

"Teams will have their own facilities and trainers, but not their own clinics," Leach said. "A football team has only 55 people, and that's not enough for a practice."

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