On the Horizon: Defining the Future of Sports Medicine and the Role of the Physiatrist (original) (raw)

This is an incredibly exciting time for physiatrists who are interested in sports medicine. The science of exercise and sports medicine is novel when compared with that of other medical disciplines. Sports medicine specialists are at the forefront of an exciting wave of new research that will provide a better understanding of the mechanisms and prevention of injury, improve cutting-edge diagnostic and treatment protocols, and aid in the prevention and treatment of chronic disabilities by ensuring wider dissemination of the principles of sports and exercise medicine to the general population. Although many of us have been practicing sports medicine for the past several decades, the advent of physical medicine and rehabilitation (PM&R) subspecialty certification in sports medicine has created opportunities that were never before possible. As the science of sports medicine advances and its scope of practice expands, physiatrists must even more thoroughly understand the origins, evolution, and future of sports medicine specialization. THE STATUS OF ACCREDITED PM&R SPORTS MEDICINE FELLOWSHIPS When I decided to pursue sports medicine fellowship training 20 years ago, the options were limited. There were very few Accreditation Council for Graduate Medical Education (ACGME) sports medicine fellowships that would consider accepting PM&R candidates, and all of the fellowships within PM&R were nonaccredited and biased toward spine medicine, with a sprinkling of sports medicine exposure. In 2007, the American Board of PM&R granted a subspecialty in sports medicine that allowed PM&R physicians the opportunity to sit for subspecialty board certification in sports medicine. By 2008, the first PM&R directed sports medicine program had received accreditation, and, by spring 2012, there were 15 such accredited programs with 16 available positions. The National Resident Matching Program (NRMP) results for 2011 showed that 53 PM&R physicians had registered, 45 had entered certified rank lists, and 24 were matched; thus 47% of the candidates were unmatched. Although those numbers are discouraging, I know that a number of the applicants eventually found a position outside the match. In addition, 2 PM&R programs were accredited in 2012 and did not participate in the 2011 NRMP. In 2011, 194 accredited positions were available in primary care sports fellowships (internal medicine, family practice, emergency medicine, pediatrics, and PM&R) in the NRMP, the majority of which were through family practice. If we define strength by numbers, then clearly in PM&R we shall have more power as sports medicine professionals if more ACGME fellowships are available. This will be particularly important in 2013, when an increase in the number of PM&R applicants who apply for sports fellowships is anticipated because after 2013 only those who graduate from an accredited fellowship will be allowed to sit for the subspecialty board examination. However, it is encouraging that some of the other primary care fellowships are now accepting PM&R candidates and are thus increasing the potential number of fellowship positions. WHY PURSUE SPORTS MEDICINE FELLOWSHIP TRAINING? Sports medicine is a logical stepping-stone for PM&R physicians whose goal is to synthesize expertise in exercise medicine, rehabilitation, and human performance. Sports medicine, like PM&R, forces the physician to go beyond diagnosis, focus on functional assessment,