A Sports Medicine Story

Session 220

Today, we chat with Dr. Brian Gilmer, a community sports medicine physician about his journey from med school to residency and beyond. He’s been training now for seven years. If you’re interested in this field, go check out the American Orthopaedic Society for Sports Medicine.

For more podcast resources to help you with your medical school journey and beyond, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:13] Interest in Orthopedic Sports Medicine

Brian grew up in a hospital at the University of Texas, Houston with his mom as an orthopedic nurse. She later went back to school, became a CRNA and had him in the operating room at a pretty young age.

Brian knew he wanted to be a surgeon by disposition and he believes most surgeons know that about themselves.

And so, he did every surgery rotation and ultimately ended up in orthopedics because he was in a medical fraternity and some of the older guys who were going into ortho knew the ortho residents.

He initially wanted to be a shoulder and elbow surgeon. Then when he married, he lived in a ski town so he ended up being a sports medicine physician.

'The deeper you go, the more you realize there is to know.'Click To Tweet

[04:36] The Biggest Myths or Misconceptions About Sports Medicine

They have an inside joke in the orthopedics world that you always have to be as strong as an ox and half as smart. But he thinks this has definitely changed a lot. Luckily the field has started to be a little more heterogeneous and it looks a little different now.

Even within orthopedics, there are different totalities and approaches. Sports medicine surgeons or restorative surgeons first and they’re activity preserving. All those things shape the decisions you’re trying to help make for people. And so, it’s a little less of a cookbook than other fields.

[06:09] Traits that Lead to a Good Sports Medicine Doc

Brian thinks you have to have at least some level of sports background. Everyone thinks they’re an athlete from a four-year-old to a 97-year-old. But they have their own distinct personalities and you really have to be focused on what people’s goals are.

“You can take two people with the exact same problem and develop two different treatment plans just based on what they're after.”Click To Tweet

You’ve got to be willing to listen to people, who they are, and what they’re after. You’ve got to be flexible and willing to change course on the fly because sometimes the first thing doesn’t work out and you need to change direction.

[08:27] Types of Patients

Sports medicine physicians deal a lot with meniscus tears and ACL injuries, and rotator cuff tears. These are a lot of stuff that you learn very poorly in medical school, but they are very common musculoskeletal injuries.

There are also Family Medicine trained sports physicians that treat overuse injuries associated with sports. These are things like patellar tendonitis, tennis elbow lateral epicondylitis, jumper’s knee, etc. They are often treated with biologic injections and PRP. Some are acute and others are chronic. You get this continuity, but they’re all sort of discrete episodes of care.

'One of the appealing things about our job is, for the most part, things have a defined beginning, middle, and end. And then you don't see the patient again until they have their next injury.'Click To Tweet

[11:11] How Primary Care Docs Figure Out Where to Send Their Patients To

With a lot of encroachment on specialists, Brian suggests sending the patient to somebody who’s giving your patient good care.

In a lot of groups, there is a dedicated PM&R physician within the physician group of the orthopedic practice. They are intentionally there to manage and triage those things too. So if it’s more of a chronic overuse injury, they actually intentionally end up there. Then if it’s more of an acute injury, they end up sent there.

And so, some of it can be just sorted out if you have a specific patient in front of you by determining their history.

[12:37] Typical Day and Typical Week

Brian is in private practice, but he has a lot of academic interests that he is able to pursue. For instance, Mondays would be his travel clinic and he sees patients all day. Sometimes, if he has an operation in the afternoon, he would run back up 40 miles to their main hospital and take care of that. Sometimes, he takes calls in the evenings.

Tuesdays, he operates pretty much all day. They start at eight and generally go till about seven o’clock at night. Then he is sometimes on call for traumatic injury. It’s usually a 12-15-hour day. Then he’d get up and run a clinic on a Wednesday.

Then Thursday and Friday, he does a bunch of other stuff. He does some consulting, teaching, and research. He does some telehealth on Thursday afternoon. So he technically works three and a half days a week in clinical practice, about a day in other stuff, and then about half a day skiing or taking his kids to school.

[13:54] Make It Your Own Thing

Not a lot of students as they’re going through this process understand that urban academic medicine is not the majority of medicine that is practiced in this country. And Brian is the perfect example of someone who has gone out and created his own thing.

'Anybody who tells you that medicine is a dead-end career is just not paying attention... it can be as broad or as narrow as you want but it's absolutely in your hands.'Click To Tweet

Brian explains that you can do as much or as little of so many things. You can be a team physician if you want and cover sports teams. If you want to spend all your free time going to basketball games anyways, you may as well be on the sidelines. If you want to be a person who’s involved in legal stuff or innovation, you can get involved in the industry, you can become an expert witness.

You can choose to teach. You can start a fellowship in private practice and get affiliated with a medical school in your region. There is no end to what the options are. You can pursue medical writing. There are a lot of media outlets, podcasts, journals, and editorials.

It can be whatever you want if you take the time to develop true expertise. And that’s the key! You still got to do the work. But there are lots of ways to find the work you love.

[13:53] Taking Calls & Life Outside of the Hospital

Since Brian lives in a ski town, he is not up in the middle of the night very often. If he’s at the hospital past 1 AM, he would end up spending the night at the hospital if it’s snowing so much. It’s usually like a low-energy fracture or two at the end of the day.

People start skiing at 9 AM and they get hurt at 3:30 because that’s when everybody’s tired. They end up in the ER at five and they’re doing their case by six or seven. And he is usually done with that by nine.

Sometimes on the weekends, they’re going all day and it looks like a war hospital. But that’s not common.

When Brian started coming out, I took 100 plus days a year, and now he’s probably down to two or three weekends every few months, maybe four to six weekends over the course of a year. So gradually whittled that call down. But early on, he was doing a lot of it.

[17:12] The Training Path

After four years of medical school, that’s followed by five years of orthopedic residency. You spend three years as a junior resident and two years as a senior resident. And you’re rotating through the seven or eight main orthopedic service lines. Then you do a year of fellowship training, generally in one of those fields: Tumor, Hand, Shoulder and Elbow, Sports Medicine, Adult Reconstruction (joint replacement), Trauma, and Foot and Ankle. Then you go into practice.

[18:38] How to Be Competitive for Matching

As the program director of their fellowship, Brian says the interest is definitely swinging towards research. It’s swinging away from board scores and grades. Clinical rotations are still critically important. But he is getting a lot more first-year and second-year students saying they need a research project.

Brian says that fellowship decisions used to be based on word of mouth. Then the match was developed and they put a lot of emphasis on the board scores. The pendulum then swung to grades and scores. And the side effect of now taking the grades away, it’s taking some of those objective measures away. As a program director, he no longer has a choice but to call his friend to ask for a reference.

Brian says that if you really want to go somewhere, or you’re really interested in something, just have the courage and authenticity to draft up something that is clearly individual and personal.

[25:10] Overcoming Bias Towards DOs

Brian thinks this is not a big hurdle to climb anymore. He had some great students out of DO programs who matched into orthopedic residencies. In orthopedic residency, everybody has been through the same meat grinder, so to speak.

[26:46] What He Knows Now that He Wished He Knew

Brian says that your job at the early stage of the game in medical school is to keep as many doors open as possible. All you can really do is make decisions that hurt yourself. And as long as you do everything right, you have lots of options, and lots of options are good.

He adds that it’s a really complicated rubric. But the choices are often binary. And you keep making a series of yes/no decisions. And you’ll end up in some little niche of your field in some little corner of the world. And that’s how it works so you don’t have to have it all mapped out.

“You don't have to have a master plan… just keep your eyes and ears open and your options open by not making mistakes.”Click To Tweet

[28:26] Major Changes Coming to the Field

Brian explains that in terms of PRP, the performance curve is crammed all the way to the right. So all of the small incremental gains have largely been done at this point. The next sort of big paradigm shift is probably out there. But it isn’t clear what it is yet.

When we talk about true clinical applications of stem cell therapies and true regenerative matrix stuff, we have a long way to go in those departments. But the pace is fast. So he expects it to be different in another 20 years or so.

[29:23] The Most and Least Liked Things

Brian likes his patients because they are motivated and they want to get better. They teach him a lot of things as well. He has a great group of colleagues and friends that he can just sit around and muse about broad philosophical problems that are framed in the guise of deep pathology.

'It's lifelong learning. It never ends. No one's ever right. It's like sports, but there's always another season and it's always exciting.'Click To Tweet

On the flip side, what he likes the least is running against the wall of insurance issues. He likes everything about his job but it’s the things around his job that sometimes are distractions.

[31:28] Final Words of Wisdom

If he had to do it all over again, Brian says he would still be an orthopedic surgeon and sports medicine specialist.

Finally, he wishes to tell students who might be interested in the field to just show up. You don’t have to be a genius to do what they do. You just have to care a lot.

And if you’re concerned about your dexterity, Brian explains that you can be a good surgeon, and you can decide where you kind of want to stop. You’re going to be trained to a standard. There are some people who should stick to that. You just need to really ask yourself, if you’re willing to put in the additional work to do those things and you have the stomach for the complications that they bring.

But don’t feel pressured thinking that you need to be a world expert in the medial meniscus or lateral meniscus. You don’t have to be necessarily technically gifted. We are now in a world where we have so many resources available for you to learn the skills. And so, if you put in the reps and you do the work, you can conduct safe and effective surgery.