Last week I was watching the AFC Championship game with friends, and as I have a tendency to do, I speculated that Maurkice Pouncey’s ankle injury might be a fracture. That led to the frequent comment I get about sports medicine – that it must be great working with pro athletes because you can hang out with famous athletes and operate on the best athletes in the world.

Maybe. While certainly being a sports medicine surgeon is a great career, and it is incredibly rewarding to get athletes of all levels back to sports, being a team doctor, especially in the NFL, is not exactly what I would consider fun or easy. I’m the team physician for the Charleston Battery and tournament physician for the Family Circle Cup, which are both challenging in their own respects, but being the doctor for an NFL team is more difficult in many ways.

The first aspect of medical coverage of an NFL team that surprises casual fans is its scope and complexity. Maybe it’s the nature of a sport with some of the strongest and fastest athletes in the world colliding with each other, or maybe it’s the fear of a catastrophic injury occurring in the nation’s most popular sport, but there are standards for each team’s medical coverage.

Me during my sports medicine fellowship over six years ago. I traveled with the St. Louis Rams to their Monday night game in December at a frigid Lambeau Field.
For instance, at every game, home teams usually have three orthopaedic surgeons and two medical physicians on the sidelines, with a neurosurgeon, ophthalmologist, dentist, and anesthesiologist all immediately available. The road team brings two orthopaedic surgeons and a medical physician. Presumably the extra physicians are there in case of multiple injuries, such as a player having to go to the locker room for x-rays or a doctor having to go to the hospital with a player. All of these physicians are on top of the team’s staff of athletic trainers, and the x-ray techs and paramedics on site at games.

Me with Rams' head team physician, Dr. Matt Matava. We returned from Green Bay at 5:00 AM just in time for surgery a couple of hours later.
In addition to game coverage, teams usually request one of the orthopaedic surgeons and medical physicians to either be present during every practice or come by to assess injuries after each one. The doctors travel with the teams to cover training camps in the summer and medically evaluate players for the team at the NFL Combine. And as part of many health services agreements between the NFL team and health care provider, the hospital’s radiology department usually holds MRI slots open so that injured players can be assessed as soon as possible. Several MRIs are often performed the day after most games.

One of the strangest and least publicized activities of an NFL team doctor typically occurs on Tuesdays. Every week, an NFL team loses 2-10 players to injury, which will keep them out the following week. Roster size is kept small enough (currently 53 players) that usually only the second- and third-string quarterbacks don’t play each week. Just about everyone else plays, so if players are out, the team needs to fill those spots with players available to play that Sunday. Therefore, the team sends 2-10 new players to the team doctor’s office or surgery center for physicals every Tuesday. And those physicals have to be done right away so the new players can start working with the team.

And despite all of the hard work, the prestige of being an NFL team doctor surely helps attract other patients with injuries. And while contracts between teams and leagues vary, there is usually some sort of financial advertising arrangement. For example, there is usually a health services agreement between a team and a hospital/physicians group for that organization to be the sole provider of medical services for the team. In return, the doctors/hospitals provide the services mentioned above. Often there is a separate contract that allows the hospital/physicians to advertise that they are the official team physicians. Those contracts involve huge amounts of money. Whether paying a lot of money to advertise serving as a physician for a pro team generates enough patients to make it worthwhile is debatable.

And finally, while treating the best athletes in the world can be gratifying, it can certainly set the doctors up for scrutiny. Watching the Jay Cutler debates last week, I heard several media analysts claim that Drew Brees once played with an MCL injury and Philip Rivers once played with a torn ACL. (I don’t know if that’s true, but it was announced as fact on TV and radio.) The problem is two fold. Most sports writers try to get their facts correct but lack enough medical knowledge to report injuries accurately. And team physicians rarely discuss player injuries with the media themselves. So the decisions they make are frequently, and perhaps unfairly, criticized.

On Sunday, two groups of physicians will travel to Super Bowl XLV in Dallas. It will be an experience they will remember throughout their careers. But don’t think that they didn’t invest a lot of hard work and more to get there.

Note: This post appears in Wednesday’s edition of The Post and Courier.