James R. Andrews, MD, is a founding partner and medical director of the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. He also is a co-founder of the American Sports Medicine Institute in Birmingham, Ala. His blog adds perspective and commentary on current sport medicine initiatives and other related orthopedic news.

BLOG: Team physicians in the NFL face numerous challenges

There are certainly unique challenges associated with being a team physician in the National Football League. A team physician must be able to deal with not only individual professional football players but also agents, team management and other paramedical personnel, including athletic trainers and team physical therapists. Of utmost importance to a team physician is to develop a relationship with players’ agents and to carry out dialogue among the team physician, player and agent at the same time.

Preparticipation history

The preparticipation history and physical exams are essential prior to beginning any type of practice or competition. The player must absolutely be honest about any prior injuries when he reports his preparticipation history. If a player hides any previous history, then it is detrimental to be able to provide him the ultimate care as he proceeds with his football career.

One of the common challenges for a team physician in the National Football League (NFL) is when a player under-reports his conditions. It is not unusual, especially for lower-level athletes trying to make the team or trying not to get cut, to underreport their conditions secondary to injuries. The player must have a trusting relationship with the athletic trainers as well as keep open communications about any complaints related to their injuries.

The other problem is when players over-report their injuries. In these cases, the physical exam is based on subjective complaints and it is hard to verify the complaints. In the preseason, the problem often arises to avoid mini-camp, organized team activities and preseason workouts and games. There is no great solution for over-reporting of injuries. In many cases, the team physician must make a decision based on the patients’ subjective complaints and agree that the patient-athlete is right. The team physician is put in a tough spot in making recommendations to the player and team relative to this  common scenario.

Preseason workouts and games

As you know, the first part of a NFL season is the preseason workout and games. A number of lower-level players are brought in for workouts and games to make the numbers work for practice and participation in games. A large percentage of the lower-level athletes are later periodically released during the preseason, especially when the team comes down to the exact number it will carry for the regular season.

This brings up a complicated set of circumstances, which is called “injury settlement.” It is not uncommon for these so-called “filler players” to sustain injuries during the preseason, which preclude them from participating in practice and continuing their goals of making the team. In these cases, the players are quickly released with an injury and their release is related to some form of injury settlement. This not only includes the appropriate care for the injury but also monetary reimbursement for games missed during preseason and perhaps into the season. Therefore, there is a legal conflict between what the team wants and what the players and agents want. The team wants a quick release and minimal injury settlement. The players want the most they can get and an injury settlement that lasts into the regular season, which pays them substantially more money than preseason games alone.

Back to the playing field

As I conclude, the most important challenges occur during the season because of the numerous injuries that occur in professional football. There is tremendous pressure both from the team’s perspective, as well as the player’s perspective, to get players back to playing as quick as possible during the season. This often leads to the players playing so-called “hurt.” When this occurrs, the team physician gets caught in the middle and perhaps a compounded re-injury complicates the original problem. Therefore, the team physician must make return-to-play decisions based on what is best for the player and what is best for his long-term career with due consideration of the team also.

Future blogs will focus on the special situation that arise in Major League Baseball, National Basketball Association and the National Hockey League.

James R. Andrews, MD, is a founding partner and medical director of the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Fla. He also is a co-founder of the American Sports Medicine Institute in Birmingham, Ala. He can be reached at the Andrews Institute for Orthopaedics & Sports Medicine, 1040 Gulf Breeze Pkwy., Suite 203, Gulf Breeze, FL 32561; email: info@theandrewsinstitute.com.