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There apparently is discussion about making the sports fellowship 2 years long. Anyone have thoughts or know about that? How many years before that is implemented if so?
I am against the switch to 2 years, but the argument at AMSSM was that fellows are supposed to be masters at the medical aspect of Sports Medicine, and not just the MSK part. That means EKG interpretation, sports pulmonology, etc. If you are the team physician for a college or pro team, you will need to do a lot of primary care stuff.
I agree that having the ability to do/focus on these things would be great, but the problem I’d see with it is job market when you’re done. Primarily sports/MSK jobs can already be kinda limited in terms of availability. One thing I wish I’d gotten more of was concussions outside of sports/in adults. It seems like a real need but also seems like it could be a paperwork nightmare.I wish they would offer a sports medicine residency instead of a fellowship. The vast majority of SM fellowships are primary care related. However, I have not met any sports med applicants that get really fired up about OB care, or inpatient medicine. It would be great to have a Sports Med residency to build more of a collaborative environment with the surgical specialties and more procedural stuff. I would like to see a 3 year program like this -
1. Heavy ultrasound training, sideline medicine, trauma, MSK radiology, cardiology, sports psych
2. Sideline medicine, Ortho surg, Spine, Physical therapy and exercise physiology, and increase the outpatient clinic for SM
3. Heavy outpatient clinic, heavy procedural based clinic, Sideline medicine, Sports Optimization
Having a residency or a multi-year fellowship will allow for a more well rounded provider that can do more than refer to PT or inject things with ultrasound guidance. Our scope is much more inclusive of things like nutrition, performance optimization, psychology, exercise phys, radiology, rehab. However, not many fellowships do more than the basic intro to sideline trauma, ultrasound, and injections. For current fellows out there, how many of you have done muscle biopsies, compartment pressure testing, VO2 max testing, or spent time with an athlete on an alter-G?
Education should be broad and encompass as many aspects of your future scope of practice as possible. Many of these activities are not readily available for various reasons. I think it would be great to have some extra time to really reinforce certain things that typically do not get regular attention within a single year. Personally, I think we are selling ourselves short as a specialty if all we focus on is ultrasound guided procedures and referring to PT.
Do you have a source, and starting when?Looks like this is really happening...
Hmm, but what year would this start, if so? Like 2021, 2022, 2023? etc.The program directors in here can answer these questions better. Word on the streets is that AMSSM isn’t making this an option or a vote...
I hope you're right lololI hear there is still a lot of pushback from this from several programs. I wouldn't bet this would happen anytime soon.
Hmm, but what year would this start, if so? Like 2021, 2022, 2023? etc.
Looking at fellowship myself and I think it’s a terrible idea. When in doubt of WHY something is happening, bet that it’s money related. How many new programs have opened up recently in the last few years? I’m willing to bet that the decision to make the training longer is several fold and not all in the trainees’ best interest:
1. Cheap labor for any extra year and able to generate more RVU’s for the program/ hospital. Any program’s number of fellows will be doubled which means more days covered for clinics and patients seen. Purely a money grab.
2. More Gate-keeping to keep the labor market skewed towards demand although this may not necessarily be a bad thing. 1 year of additional training? No big deal. Another 2 where you are now out 2 years worth of attending salary? Now that is enough to make anyone pause. To put in perspective that’s is $400k+ lost in lifetime earning potential. Are those 2 years going to allow you to command a high enough salary to overcome this deficit in addition to the interest your loans will continue to compound away like a ticking time bomb? Willing to guess that will be difficult to do.
3. As a side-note to putting the brakes on the number of applicants, just take a quick look in the EM, pathology, and rad-onc subforms to see the ramifications of supply overcoming demand. May be the old guard of program directors and current attending want to make sure that their position/ compensation/ $ per RVU is still justified by making sure there isn’t a wave of fresh fellows every year willing to work for worse conditions and pay just to find a job.
Part of what is supposed to be accomplished here is less fellows per year, a much more competitive fellowship and official recognition as specialists. They also want sports med docs to be considered first to be head team physicians
less fellows/more competitive
- if that is the goal, then perhaps decrease the number of fellowships? That would make it more competitive and there would be less fellows
official recognition as specialists
- from who? Will the desired entity(ies) be impressed by the extra year?
Head Team physicians
- will an extra year get this accomplished at program/team of interest that otherwise would not want us if we were only trained for 1 year?
less fellows/more competitive
- if that is the goal, then perhaps decrease the number of fellowships? That would make it more competitive and there would be less fellows
official recognition as specialists
- from who? Will the desired entity(ies) be impressed by the extra year?
Head Team physicians
- will an extra year get this accomplished at program/team of interest that otherwise would not want us if we were only trained for 1 year?
I certainly favor expanding educational opportunity and expanding one’s practice and set of skills in a systematic and organized fashion, I just have a sense that there isn’t appropriate consideration with this plan.Obviously I could be wrong
It’s consultation fees. Certain insurance companies pay consultation fees but I don’t see how this matters either. I don’t get the point of specialty recognition other than saying “I’m a specialist”, which most people already consider sports med doctors...I thought cms payments per rvu are the same across specialties. I’ve asked this question before here and people said that.
It’s consultation fees. Certain insurance companies pay consultation fees but I don’t see how this matters either. I don’t get the point of specialty recognition other than saying “I’m a specialist”, which most people already consider sports med doctors...
however, this article (http://www.medpac.gov/docs/default-...ciancompensationreport_cvr_contractor_sec.pdf) says “For individual specialties, family medicine physicians earn a median of $50.37 per work RVU. Three specialties (pediatrics, nephrology, and ophthalmology) have median compensation per RVU that is lower than the median among family medicine physicians.” (2019)
Honestly, I’m family medicine and I’m not against a two year fellowship. That being said, PM&R has a huge advantage when it comes to msk medicine and I can NOT see any reason why someone who was trained in PM&R should do 2 years. I had zero MSK ultrasound training in residency and my msk anatomy and physical exam was meh...I agree with the above sentiments that say that if PM&R sports medicine fellowships are to become 2 years, (or frankly any sports fellowship that routinely takes PM&R) I would hope that each would offer (1) fluoroscopy training for interventional spine (at least lumbar) procedures, (2) enough EMGs to become boarded by ABEM, (3) enough MSK US experience to obtain RMSK (or something similar), (4) advanced ultrasound procedural training, such as carpal tunnel releases, trigger finger releases, Tenex, tenotomies, etc. Essentially creating a non-operative "interventional orthopedist" or "interventional physiatrist" or "interventional sports physician," at least from a PM&R standpoint. While sports cardiology might be interesting and you might pick up tidbits, I'd be most likely referring them to cardiology anyways since they spend years on solely the heart. The same goes for sports allergy, sports pulmonology, sports dermatology, etc. There are bread and butter things I think we could all feel comfortable managing, at least acutely on the sidelines if needed, but I'm not a pulmonologist who has mastered treating asthmatics, just as an example.
Honestly, I’m family medicine and I’m not against a two year fellowship. That being said, PM&R has a huge advantage when it comes to msk medicine and I can NOT see any reason why someone who was trained in PM&R should do 2 years. I had zero MSK ultrasound training in residency and my msk anatomy and physical exam was meh...
This was definitely on me. We had orthopedics, a home based sports medicine fellowship, etc. But, most non orthopedic/pm&r residents don’t know how to do a good physical exam and most don’t remember msk anatomy. This wasn’t just a “me” thing. Residents are too focused on HTN, diabetes, heart failure or whatever their respective field requires them to know. I occasionally teach residents physical exams and review anatomy, and this is a pretty consistent finding. Orthopedic surgeons agree with this.Did you not have any elective rotations with ortho, PMR, PCSM? If you had zero MSK ultrasound along with lackluster anatomy understanding as well as exam skills, I think that’s more on you than the program. My program was heavily into OB (which seems to be the “cool” thing these days) but I had more than ample opportunities to learn and understand the above to the point where I (without bragging) was at a level beyond my attendings simply because they have no interest in them.
So is the average sports med doc able to bill as a specialist?
This. I practice more sports medicine than family now, but I'm under the taxonomy of family medicine, so in regards to billing it's all the same. Do I do more procedures than my FM partners? Of course. I usually my ultrasound daily and that adds to the billing as well.There's no such thing as "billing as a specialist," unless you're talking about consult codes, which are increasingly becoming unreimbursed. We all bill the same E&M codes for office visits. As a sports medicine specialist, you'll likely be doing a lot more procedures than traditional FM (e.g., joint injections under US guidance, casting, splinting, interpretation of imaging, etc.), so you should be able to bill more for these. You can also get paid for serving as a team physician, but that's been severely curtailed by the 'Rona.
I agree with the above sentiments that say that if PM&R sports medicine fellowships are to become 2 years, (or frankly any sports fellowship that routinely takes PM&R) I would hope that each would offer (1) fluoroscopy training for interventional spine (at least lumbar) procedures, (2) enough EMGs to become boarded by ABEM, (3) enough MSK US experience to obtain RMSK (or something similar), (4) advanced ultrasound procedural training, such as carpal tunnel releases, trigger finger releases, Tenex, tenotomies, etc. Essentially creating a non-operative "interventional orthopedist" or "interventional physiatrist" or "interventional sports physician," at least from a PM&R standpoint. While sports cardiology might be interesting and you might pick up tidbits, I'd be most likely referring them to cardiology anyways since they spend years on solely the heart. The same goes for sports allergy, sports pulmonology, sports dermatology, etc. There are bread and butter things I think we could all feel comfortable managing, at least acutely on the sidelines if needed, but I'm not a pulmonologist who has mastered treating asthmatics, just as an example.
Love that idea, though there are a good number of PM&R programs that can do 1, 2 and 3 already within a year, but only a small number of academic centers that do 4 due to turf wards with ortho (at least with CTR and trigger finger releases). A lot would have to change for this to happen.I agree with the above sentiments that say that if PM&R sports medicine fellowships are to become 2 years, (or frankly any sports fellowship that routinely takes PM&R) I would hope that each would offer (1) fluoroscopy training for interventional spine (at least lumbar) procedures, (2) enough EMGs to become boarded by ABEM, (3) enough MSK US experience to obtain RMSK (or something similar), (4) advanced ultrasound procedural training, such as carpal tunnel releases, trigger finger releases, Tenex, tenotomies, etc. Essentially creating a non-operative "interventional orthopedist" or "interventional physiatrist" or "interventional sports physician," at least from a PM&R standpoint. While sports cardiology might be interesting and you might pick up tidbits, I'd be most likely referring them to cardiology anyways since they spend years on solely the heart. The same goes for sports allergy, sports pulmonology, sports dermatology, etc. There are bread and butter things I think we could all feel comfortable managing, at least acutely on the sidelines if needed, but I'm not a pulmonologist who has mastered treating asthmatics, just as an example.
Isn't that so frustrating? Our program didn’t teach us ultrasound guided carpal tunnel releases (“sonex”) Bc ortho intervened and blocked the hospital from allowing PCSM docs from learning/performing/teaching these...Love that idea, though there are a good number of PM&R programs that can do 1, 2 and 3 already within a year, but only a small number of academic centers that do 4 due to turf wards with ortho (at least with CTR and trigger finger releases). A lot would have to change for this to happen.
Do you all have any advice about learning some of these more advanced techniques post-fellowship?
Our program taught us tenex and hydrodissections. After learning how to comfortably guide needles under ultrasound, these procedures are very easy to learn. Seriously, the hardest thing to learn is sonoanatomy, diagnostic ultrasound (this is a requisite to all the above procedures) and how to guide needles under ultrasound. If u can do these things comfortably, the above mentioned procedures can all be learned in one month or lessPrimarily things like Sonex, Tenex, nerve hydrodissections, etc, but thank you, I will definitely check out that book!
The actual needle work for those is not incredibly challenging. As was mentioned, we will run into trouble if we turn into proceduralists only without knowing your anatomy stone cold. You need to know what nerves, vessels, tendons run where so you don't get into trouble damaging structures inadvertently. Especially something like Sonex, if you can't tell me in great detail the distal median nerve with its cutaneous and recurrent motor branches, its variable locations for branching off, and be able to identify this on ultrasound before the procedure, you should not be doing this procedure. Sonex makes it safer than just using a cutting needle, but a solid understanding of anatomy and sonoanatomy is a requisite. I think honestly during fellowship just getting that down, and knowing when they are appropriate to be done should be the focus.Primarily things like Sonex, Tenex, nerve hydrodissections, etc, but thank you, I will definitely check out that book!