Sport and Exercise Medicine: The UK trainee perspective (A BJSM blog series)
By Dr Bhavesh Kumar
Background
There has been recent debate on appropriate remuneration for the provision of medical services at sports events by junior doctors involved in Sport & Exercise Medicine (SEM). This has in part been prompted by a reduction in tariffs offered by some sports in this era of financial pressure. In certain cases, this results in a change in the prioritisation of sports within which doctors would prefer to work.
Historically most, if not all budding sports physicians and doctors with a special interest in SEM have provided pitchside sports medicine cover pro bono, at least in the early part of their careers. In some instances, medics have retrospectively discovered that they were the only unpaid member of the entire team of support staff. Indeed in the USA some doctors themselves will pay top clubs to be their physician as a form of self-marketing to help boost private practice.
Many matches or tournaments take place in evenings and weekends, outside of usual clinic times for which doctors are remunerated by their training program. Therefore doctors for this ‘out-of-hours’ work usually seek pay. Exceptions have included, but are not limited to, work at amateur mass participation events, such as annual triathlons, marathons or charity events. One could argue that such events employ many staff to enable the smooth and safe operation of the event, and so why shouldn’t the medical staff be paid as well?
Some sports will pay doctors a standard sessional or daily tariff regardless of their seniority or the level of competition. Others appear to operate within pay bands, determined by factors that may include seniority, urgency, negotiating skills, and level of interest in the role.
Issues for training doctors
Most work timetables allow a registrar to take one session (a morning or afternoon) per week to attain pitchside or club sports medicine experience and the associated curriculum competencies. If further time is required, for example to cover a camp or competition, then registrars will usually have to resort to using annual leave or unpaid leave, and therefore invariably seek adequate remuneration.
Pressures, standards and the necessary medical training are quite rightly becoming increasingly stringent and professional, at least in elite sport, and therefore registrars invariably pay to attend training courses and accredit to be a team physician, as well as subscribe with an appropriate indemnifier. These costs need to be covered.
Some doctors feel that they have provided plenty of pro bono sports medicine cover, and feel they cannot continue to justify their time without remuneration, particularly whilst trying to balance sports work during anti-social hours with family commitments. They feel that their considerable training and experience deserves some financial recognition. Individual registrars will have their own ideas of what they personally deem as fair pay. This can result in fragmentation amongst the pool of junior doctors, because as long there are enough medics prepared to work for less or free, then tariffs can potentially be kept low or lowered.
Personal opinion
In an ideal world, the hourly or daily rate for medics covering any professional sport would be the same, or very similar. Clearly, differing budgets will always preclude this. There is no simple solution to overcoming relatively large variations in pay.
My own feeling is that as trainees, we should be taking opportunities to learn and attain experience in a variety of sports covering different age groups, gender and abilities. On occasions, this will invariably involve working for little or no money. Also see two BJSM blogs for junior doctors and physios wanting to moving their career forward. Here is one…..by Karim Khan Here is the other…by Liam West
At the end of the day, it is up to the individual registrar to decide the opportunity cost for them. Factors will likely include the duration of the event, whether it involves out-of-hours work or 24 hour cover, the intensity of the work, geographical proximity and desirability, potential liability and indemnity cover necessary, and of course their previous experiences, personal interests and future aspirations.
If the next generation of registrars all chose not to take up opportunities for picthside work unless a certain threshold of remuneration is met, particularly as far as elite or professional sport is concerned, then this could either prove a catalyst for better remuneration, or Chief Medical Officers may look elsewhere for willing practitioners from different specialties or allied professions where appropriate.
Remuneration will most likely continue to evolve, as changes occur to sports budgets, the perceptions of registrars, Training Program Directors and Chief Medical Officers, and potentially the funding of SEM registrar training. If recent history is anything to go by, then notable increases in pay are unlikely to ensue anytime soon.
A final thought
I wonder what proportion of registrars who have worked pro bono at very high profile events such as the Olympic Games and London Marathon for example will choose to work unpaid at similar but less high profile and perhaps geographically less convenient events such as the next Commonwealth Games or regional half-marathons, particularly if travel and accommodation costs have to be personally met.
Your opinions
It would be interesting to hear the experiences and strategies of sports medicine consultants and registrars from home and abroad! Just send an email to karim.khan@ubc.ca with “BJSM BLOG” in the subject line.
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Dr Bhavesh Kumar is a General Practitioner and senior registrar in Sport & Exercise Medicine in London, currently working at DMRC Headley Court.
Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.