What sports medicine fellowship program directors look for in applicants

What makes a good sports medicine fellow? How does one become a primary care sports medicine fellow?

As a longtime sports medicine fellowship program director, I’d like to share my insights with aspiring fellows.

While team physician at the University of Notre Dame, I was also faculty for the newly created South Bend Sports Medicine Fellowship. I later founded and currently serve as program director for the sports medicine program and fellowship at Millcreek Hospital in Erie, Pennsylvania. This fellowship has trained 27 fellows in the last 15 years and gained ACGME accreditation.

I am a past president of the American Osteopathic Academy of Sports Medicine (AOASM) and I have spent over 30 years covering Division I and Division II NCAA sports in addition to professional and international competitions.

There are currently over 150 primary care sports medicine fellowship programs now available. Over 90% of fellows come from family medicine residencies, followed by internal medicine, pediatrics, emergency medicine and physical medicine and rehabilitation (PM&R). ACGME recently updated its guidelines to allow physicians who completed osteopathic neuromusculoskeletal medicine (ONMM) residency programs to enter sports medicine fellowships.

Many think of orthopedics when they think of sports medicine doctors. However, over 90% of sports injuries are nonsurgical. In addition to family physicians and orthopedic surgeons, athletic trainers and physical therapists are integral members of the sports medicine care team.

Common duties for sports medicine fellows

Limited to one busy year of didactics, event coverage and office procedures, primary care sports medicine fellows are under the direction of faculty at all times.  Mental health issues are at the top of the list, followed closely by sports-related concussion. Performing pre-participation physical exams is a major component of a physician’s role as a primary care sports medicine doctor.

Emergency action plans for collapse, heat illness and return-to-play decisions are part of the everyday routine of the well-trained team physician. Sideline event coverage with a well-equipped bag of diagnostics and supplies is essential. Use of MSK Ultrasound for diagnosis and treatment has become the stethoscope of the sports medicine specialist.

Understanding sports medicine issues that are specific to female athletes is imperative. Successful sports medicine fellows will also be involved in imaginative research. Fellows are expected to contribute posters, case reviews and/or podium presentations at conferences.  

One must be a good doctor before they can be a good sports medicine doctor. We ask recently trained family physicians to practice medicine and also learn sports medicine injury, treatment and return-to-play considerations. It often takes years to develop this combination of skills.

Communication is key

Communication skills are imperative, as fellows will deal with scrutiny. Parents, coaches, administrators, owners, agents, trainers and the athletes themselves all have expectations of the team physician. 

Million-dollar players working for billion-dollar teams often have trouble listening to the opinions of leading physician authorities, regardless of the current literature. Interpersonal skills are valuable when trying to uncover the mystery in the history. Leadership skills are invaluable when interacting with the ever-expanding care team.

Other important qualities

Sports medicine program directors are looking for fellows who, in addition to a fine academic record, are available, affable and enthusiastic and always prepared, presentable and punctual.

One should be confidant but humble and always open to revision. They must ask for honest feedback and direction and respond without prideful concerns. One-year fellows in sports medicine should be very committed to the role and focused on making the most of the limited time. 

Fellows must have the imagination to solve grey-area problems and the responsiveness and focus to handle the multiplicity of problems and personalities. They should be demonstrated lifelong learners. As part of the care team, being thorough and having meticulous follow-through is essential when handling illness, injury and return to performance.

An osteopathic medical approach is desirable and advantageous when dealing with musculoskeletal structural and functional aberrations in the training room and on the sidelines. A nonpharma, nonsurgical approach to treatments usually allows athletes/teams to succeed without outlandish costs.

Knowledge of the expanding array of sports, positions and associated frequent injuries are more important than the personal athletic pedigree of a fellow.

Gender issues in sports have become paramount.  Our primary care sports medicine fellowships might not exist without women’s athletics and the historic and inspiring work of former U.S. Rep. Patsy Mink and the Title 9 amendment to the Education Act of 1972.

Applying to programs

Potential fellows should briefly visit programs of interest when possible and apply to programs prior to the start of their third year of residency. They should try to attend the annual meetings of the American Osteopathic Academy of Sports Medicine, the American College of Sports Medicine and the American Medical Society for Sports Medicine, making a concerted effort to meet practicing sports medicine physicians and expand their professional network.

Related reading:

Esports: Competitive gaming and its health implications

“Doc Thor” recounts his time on The Titan Games, journey to sports medicine