The American Medical Society for Sports Medicine (AMSSM) describes the practice of Sports Medicine as focusing on the non-operative medical treatment of musculoskeletal sports conditions. While a large part of the Primary Care Sports Medicine (PCSM) physician’s practice focuses on the management of musculoskeletal injuries, the PCSM physician also evaluates and treats all medical conditions affecting the athlete (including acute illness, chronic medical conditions such as hypertension, acute injury, overuse injuries, heat illness, amenorrhea), overseas all medications the athlete takes, performs pre-participation evaluations, ensures compliance with the respective governing bodies, and oversees nutritional and rehabilitation programs. Practice opportunities for the emergency medicine trained Primary Care Sports Medicine (PCSM) Physician are abundant and might include:

1. Office-Based Sports Medicine Practice: Most of these opportunities are through student health services in the university environment or through a department of orthopedic surgery or family medicine. Many orthopedic practices are beginning to realize the value of having PCSM physicians see nonoperative patients, allowing the surgeon more operative time. 
2. Practicing primarily as an emergency physician, while utilizing your sports medicine fellowship training to provide event coverage services, for example providing medical direction for mass events like the Chicago Marathon. 
3. Many sports medicine physicians serve as team physicians, locally or nationally. The sports medicine physician will function as part of, and often times the leader of, the sports medicine team, which might include specialty physicians and surgeons, athletic trainers, physical therapists, coaches, and other personnel. 
4. Academic Practice: This will include providing didactic education and clinical training for emergency medicine residents in Sports Medicine topics and the training of Sports Medicine fellows. A dual appointment between emergency medicine and orthopedic surgery or family practice is possible.
5. Many funding opportunities are available for sports medicine and injury research. Hot topics include gender equity, gender disparities in injury patterns and risk for injury, mechanisms of various sports related injuries, and investigation of new treatments.

Post-graduate training in Sports Medicine following an Emergency Medicine residency entails a 1-2 year fellowship. The fellow will develop proficiency with in-depth musculoskeletal examinations and a broad range of related topics, such as shoulder, knee, ankle, hand, and back injuries. In addition, the trainee will develop in-depth knowledge and understanding of team physician and training room issues, such as return to play criteria following injury or medical illness, NCAA/Olympic drug testing and banned substances, performance enhancing supplements, performance in the heat, and performance issues at altitude. The fellow will also develop an understanding of, and the skill set to approach issues specific to various age groups and patient populations, for example adolescents with eating disorders, or the workup for chest pain in the young athlete. In addition, the fellow will receive clinical training in the areas of injury prevention, pre-participation evaluation, management of acute and chronic illness or injury related to sports and exercise, and rehabilitation. ¹ The Sports Medicine fellow will become proficient in small and large joint injections, exercise-induced asthma testing, and exercise stress testing. A significant amount of the fellow’s time will be spent covering sporting events (i.e. games, practices), and working extensively with athletic teams. According to the ACGME requirements, the fellow "should participate in planning and implementation of all aspects of medical care at various sporting events. The program must ensure that supervised sports medicine residents provide on-site care and management to participants in these events. In addition, the resident must participate in the provision of comprehensive and continuing care to a sports team." It is preferable that the fellowship provide this experience in several different sports and year-round. ¹ In addition, the fellow will spend at least 1 day per week for 10 months of the fellowship in a Sports Medicine clinic evaluating and treating patients with injury or illness related to sports and exercise. This will include comprehensive and continuing treatment of patients through their illness/injury. The fellow will rotate with an orthopedic sports medicine specialist in his/her clinic and observe representative inpatient and outpatient operative orthopedic procedures.¹ And finally, according to the ACGME guidelines, fellows must spend ½ day per week maintaining their skills in their primary specialty (i.e. emergency medicine, pediatrics, or internal medicine). The 2 year fellowships include some time and emphasis on research.

1. The American Medical Society for Sports Medicine (http://www.AMSSM.org) is an organization that represents primary care or non-operative sports medicine physicians. The core specialties involved in this organization are emergency medicine, internal medicine, family medicine, pediatrics, and physical medicine and rehabilitation. The AMSSM is known for focusing on teaching clinical sports medicine topics. The AMSSM provides many resources on its website, including current sports medicine opportunities, a listing of both accredited and non-accredited sports medicine fellowships, clinical policies and practice guidelines, position statements and other sports medicine resources.
2. The American College of Sports Medicine (http://www.ACSM.org) is an organization that represents physicians from all specialties involved in the care of athletes, as well as athletic trainers and other allied health care professionals. This organization’s national conference provides a forum for presentation of basic science and clinical research. ACSM also sponsors the ‘Team Physician Course’ series, which teaches topics pertinent to sports medicine physicians. The website offers extensive resources including information regarding meetings, grant and research initiatives, links to training programs, and publications.

1. What will be the extent of your experience with sports teams? How much autonomy will you have?
2. Does the program provide you with the opportunity to work with Division I or elite athletes (Olympic or professional athletes)?
3. What is the quality and structure of the relationship between the PCSM faculty and fellowship training program, and the orthopedic surgeons of the same institution?
4. Who will be your mentors and faculty? What has been their level of involvement in team sports on a national and local level? Are the persons supporting the educational experiences in the fellowship (orthopedists and primary care physicians) reputable and able to help you reach your next step?
5. How many fellows have graduated from the program and what types of positions have they obtained following training?
6. Is the program emergency medicine friendly and are emergency medicine resources available to you? The program should have an affiliation and preexisting agreements with an academic emergency medicine program or Level I teaching hospital. (A core requirement of the fellowship is that the fellow work in his/her primary specialty a minimum of four hours per week to maintain their clinical skills.)
7. Does the program have an adequate didactic and research focus?
8. Will you have adequate protected time for research, study time, and development of lectures and other educational tools?
9. How is the fellowship funded? Is this position funded through GME dollars, from departmental funds, or money provided by the athletic teams the fellow covers? Ideally, the fellow should not have to work several days a week in the emergency department to fund his/her fellowship.
10. Is the fellowship accredited?