THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 9 - SEPTEMBER 2021
Australian Sports Medicine Specialty Faces Political Hurdles
Imagine if sports medicine in the United States were just on the verge of becoming a fully accredited specialty, only to have the surgeon general disband the American Board of Medical Specialties. This frustration is real for Australian sports physicians, who had hoped that the Sydney Olympics would break a political logjam that since 1997 has halted the discipline's progress toward specialty recognition.
"The government is relying on sports physicians to provide top-quality care during the Olympics," says Peter Fricker, MBBS, head of sports science and sports medicine at the Australian Institute of Sport in Canberra. "Wouldn't this be a great time to recognize the work that sports medicine physicians have done?" Fricker is also an editorial board member of The Physician and Sportsmedicine. (See "What Is Sports Medicine?: International Views," below.)
An Emerging Field
The Australian College of Sports Physicians (ACSP) is modeled after other medical colleges in Australia and Great Britain, Fricker says. Medical school graduates who intend to specialize in sports medicine undertake 2 to 3 years of hospital training, then sit for part 1 of the ACSP exam. After passing the exam, aspiring trainees apply for placement in 1 of 11 accredited sports medicine training posts, where they spend 4 years as "registrars" in sports medicine. "Each year is like a fellowship. They cover the content of sports medicine as defined by the ACSP," Fricker says. Registrars are required to:
At the end of the fourth year of this advanced training, registrars take a two-part exam that includes written essay questions and an oral exam that involves one long case presentation, three short cases, and a viva voce exam that includes x-rays, electrocardiograms, blood test results, and other investigations.
Approval Momentum Builds
Official recognition of a new specialty in Australia had required the National Specialist Qualification Advisory Committee (NSQAC)—roughly the equivalent of the American Board of Medical Specialties—to seek the approval of all other medical specialties, Fricker says. Evaluators are asked to judge (1) if the discipline is recognized as a specialty and (2) if the training and examination process is appropriate for the level of practice.
At the time the specialty application was halted, only the college of surgeons had not yet granted its support for sports medicine specialty recognition. "They hadn't rejected sports medicine, but they had unfounded concerns about us teaching arthroscopy," he says. "We encourage our registrars to assist in surgery, but we do not teach orthopedic surgery."
Fricker notes that the surgeons' concerns had nothing to do with the two evaluation criteria.
Process Grinds to a Halt
In 1997, however, Australia's minister for Health and Aged Care disbanded the NSQAC and in 192021 asked the Australian Medical Council to undertake the evaluation of new medical specialties. The council has accepted the role and expects to release a draft of accreditation guidelines and procedures some time in 2021.
In the interim, Fricker says sports physicians have asked the current health minister, Michael Wooldridge, MBBS, a general physician and member of parliament, to step in and expedite the specialty recognition process. He has refused to do so. "He's saying he didn't want to spend any more money on specialists," Fricker says. Wooldridge's office did not respond to several requests from The Physician and Sportsmedicine for comments on the issue. Fricker rejects the argument that accrediting sports medicine specialists would raise medical costs. "The cost for sports medicine is less than 1% of the national budget for magnetic resonance imaging," he says. "Sports medicine physicians keep patients out of the hospital and order fewer diagnostic images."
Nearly 100 physicians are awaiting official accreditation as sports medicine physicians. "We've been seen as one of the countries with a solid specialty training program, and that's the frustration for our college," Fricker says.
For now, Australian sports physicians are waiting for the Australian Medical Council to set up an accreditation system and are lobbying other politicians for their support. "We realize that specialty decisions are no longer based purely on medical expertise," Fricker says. "But you can't stop the evolution of medicine."
What Is Sports Medicine? International Views
Though the basic interaction between physician and athlete may not vary much throughout the world, opinions on the scope of sports medicine are diverse. We put the question to several international members of our editorial board.
Mark E. Batt, MB, BChir, Nottingham, United Kingdom: Our working definition of sport and exercise medicine is a discipline including health education, illness and injury prevention, treatment and rehabilitation, all underpinned by basic and applied research.
Peter Fricker, MBBS, Belconnen, Australia: Sports medicine is the practice of those who care for the exercising individual, whether an elite competitor or a recreational athlete. It concerns the impact of illness or injury on healthy individuals and those affected by disease states as well as the impact of exercise on injury or disease states or in altered physiological or environmental states (eg, pregnancy, high altitude, heat).
Willem van Mechelen, MD, PhD, Amsterdam: In my view, sports medicine aims at the promotion, care, and cure of the health status of persons engaged in organized and unorganized sports activities, taking into account the sport-specific stresses placed upon that person, in light of that person's physical and mental capacity.
Nicholas G. Mohtadi, MD, MSc, Calgary, Alberta, Canada: Sports medicine is the practice of medicine as it applies to all aspects of physical activity, including health promotion and disease prevention.
Ilkka M. Vuori, MD, Tampere, Finland: In Finland, exercise is used instead of sports to emphasize the wide, largely public health scope of sports medicine. Exercise medicine is a mosaic discipline that aims to use the science, art, knowledge, and skills of medicine for the benefit of exercise and exercisers and to utilize exercise opportunities to benefit medical goals.
John O. Holloszy, MD, will receive the International Olympic Committee (IOC) Olympic Prize for Sport Science in September in Sydney, where he will be an honorary United States team physician, according to an announcement made by the American College of Sports Medicine (ACSM) in July.
Holloszy is a professor of internal medicine, chief of the division of geriatrics and gerontology, and director of applied physiology at Washington University School of Medicine in St Louis. He has published extensively on muscle adaptation and its role in maximizing muscle endurance. The ACSM notes that Holloszy's research has helped generate public awareness of the health benefits of exercise and contributed to the fitness revolution of the past 30 years. The IOC prize is considered the Nobel Prize of sports medicine and sports science. It is awarded in conjunction with each Summer and Winter Olympic Games, and was first awarded in 1996. The award includes an Olympic gold medal, a $500,000 cash award, and a certificate of recognition.
Former Drug Testing Chief Sues USOC
In the lawsuit, as reported in the July 18 issue of The Denver Post, Exum states that about half of the American athletes who have tested positive for prohibited substances have not been disciplined. According to other published reports, no athletes were named in the lawsuit. Exum is a psychiatrist and occupational medicine specialist in Colorado Springs.
According to a USOC press release, Exum resigned from his post on June 5, alleging that his working conditions were hostile and racist. The USOC, in a public statement, said upon cursory review of the lawsuit that Exum's complaints are without merit. In the statement, Norm Blake, the USOC's chief executive officer, says he regrets Exum's raising the claims 2 months before the opening of the Sydney Games that "raise unwarranted allegations which tarnish the outstanding reputation of our American athletes and the talented professionals who work so hard to support them."
This Bud's for Rehydration?
In a recent issue of The Athlete's Kitchen newsletter, its author Nancy Clark, MS, RD, points out that alcohol has a diuretic effect, which can counter rehydration efforts. And drinking beer on an empty stomach puts anyone on the fast track to intoxication. Clark says the bottom line is to eat while enjoying beer or another alcoholic drink after a race or game; the carbohydrates and sodium improve recovery.
Clark based her comments on a study of alcohol's possible role in exercise recovery by Australian sports nutritionist Louise Burke, PhD. In the study, presented at the 1996 annual meeting of the American College of Sports Medicine, Burke compared carbohydrates alone, vodka alone, and carbohydrates plus vodka. Burke found that alcohol does not convert to glycogen, but it did not impair glycogen storage if carbohydrates were available.
USOC Names New Sports Medicine Director