Private Practice Sports Medicine from Family Practice

Session 70

Dr. Daniel Clearfield is a Family Medicine trained physician who specializes in Sports Medicine. Listen to how he got into the field and what he loves about it.

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Listen to The Premed Years Podcast Session 273, especially if you still have some questions about osteopathic medicine. Dr. Daniel Clearfield is a family sports medicine physician who’s been out of training now for seven years. He used to be in Academics nut now is in Private Practice. He’s going to talk about his specialty with us today.

[02:00] Interest in Kinesiology

Daniel found Kinesiology as a major in college during his Sophomore year. He started studying mechanical engineering but didn’t like it. Then he started doing Kinesiology and just loved it. At that time, he was already a personal trainor and learning about the anatomy and biomechanics exercise and physiology. Trying to figure out how he can continue with it, he found there were different paths you can take. A lot of people in his major ended up becoming coaches or personal trainors. Others started looking into physical therapy as well as other paths until he found primary care sports medicine as something that appealed to him the most during externship. Although he was open-minded to other specialties, it was still something he was passionate about and it was what he ended up doing still.

Daniel did consider different specialties but what really drew him to sports medicine is the fact was being able to see patients of all ages. Plus, the fact that you’re not limited to what you can see or do. In some sense, you will have a limited scope. That being said, Daniel says primary care sports medicine allowed him to delve into all of the different things that can involve a family doctor they might see from a broad scope of things, and focusing more into the sports/ movement aspect. Daniel also shares that one of the things he sees a lot of physicians suffer burnout from is noncompliance of patients, who are just apathetic about doing things to better themselves.

[06:10] Traits that Lead to a Good Sports Medicine Doctor

Daniel says that you have to be a personable as you’ll be seeing a wide range of patients. And although you don’t have to be an athlete to be a sports medicine doctor, it helps. Daniel’s main sport in high school was wrestling. He has also done football and other different sports. He experienced suffering from a lot of sports injuries so he’s able to empathize more with his clients.

In fact, Daniel recently attended the annual sports medicine conference and he saw that everybody was in great shape.

[08:00] Types of Patients

Daniel says he covers patients from toes to nose. He will see anything from broken stub all the way up to nose fracture. He sees fractures, dislocations, etc. He tells people he’s not a surgeon. In fact, an ankle fractured patient was referred to him today and knowing his limitations, he referred it over for a surgical evaluation. He explains that most fractures don’t have to go see an orthopedic surgeon necessarily since they know how to manage this type of things. That said, he sees the common sprains, strains, fractures, dislocations, concussion.

Daniel has become recognized as one of the concussions experts in his area (north Texas). And he considers this as both a blessing and a curse. Although he knows what to do with it, some of the cases they have to deal with are so complex. What Daniel really likes about how mentally stimulating his practice can be. And just like any part of medicine, it’s a lifelong learning experience. So he still keeps on learning, teaching, and going to conferences. And this is the reason his scope of practice continues to grow.

[11:20] % of Patients Coming In Who Are Already Diagnosed

Daniel actually corrects this question as to how many patients are coming to him with a diagnosis that’s correct and need further verification. He adds that it sometimes depends on who your referral source is and what setting you’re in.

Daniel also says he’s able to figure things out because he reads and learns a lot. He has even seen patients that have been to the Mayo Clinic, were not diagnosed there, and he was able to figure it out. Not the best diagnostician, but he admits he’s pretty good who can figure out some things others can’t.

[13:15] A Typical Day

Daniel has a variable schedule but he works 5 days week with a 40-hour week schedule. This is part of his routine. During football season, he would start working Friday nights and if needed, he’d go to a training room with the athletic trainors at one or more of the high schools he covers. He covers them at least once a week to try and go see some of the athletes just at point of care at the school. Outside of football season, his schedule varies depending on events happening around his area. He does have plenty of weekends where he’s free but there’s also plenty of time that he’d be working at tournaments.

A lot of these events he’s just volunteering at. It’s a mix of being a wrestler and loving those combat sports and being a team doctor with USA wrestling and judo. He found himself covering those events when they come to Texas. It’s a passion that he enjoys. He likes to bring medical students and residents so they can experience and see what goes into the mindset of the sports medicine doctor covering those things.

There would still be times that he’d be doing a procedure on every single patient in a single day. Other days, he would not be doing any procedures all day long. More commonly than not, he’d be doing procedures. For example, he did 11 procedures from 8:30am to 2pm.

[16:20] Taking Calls and Work-Life Balance

Daniel doesn’t take calls and he says it basically depends on the kind of practice you’re in. He’s the only sports medicine doctor in a family clinic. Typically, there’d be a call one night a week and then a weekend call once a month, which isn’t that bad. But for the most part, he doesn’t get too many calls and never had any really serious calls that he had to go after. One time, he recalls getting a call and he was out in Colorado rock climbing with his friends. He was half way up the mountain, heard his phone ringing, so he had to stop what he was doing. So he answered the call while he was about 100 feet up in the air. Not the smartest thing, but a cool story to tell.

Back when he was also teaching, they would also be in a similar call which wasn’t too bad. Orthopedic surgeons realized there were three of them not orthopedic with two sports medicine doctors and one of his colleagues was a primary care sports med. They also had one physiatrist (PM&R) doctor with them. None of them took the ortho post operative call from the hospitals but they took any of the clinic call. So they had to divide it into clinic call and hospital call. They weren’t part of the hospital call.

Daniel says he has enough time for family. Being a single father, he has full custody of his daughter. Looking at the type of job he’s in, he makes sure he has time to watch his daughter grow up and be there for her. This is a huge priority for him. Earlier in his career he’d always say family was first but there was a time especially while he was going through his divorce where he was just investing his time in his work because he didn’t want to go home. So he began shifting his priorities when he got custody of his daughter who is his absolute number one. So he set up his schedule in a way that affords him a lot of time to be spent with her.

[19:05] The Path to Residency Training

Going through medical school and you know you want to be a sports medicine doctor, it’s good to start doing some coverage opportunities especially when you’re in your first couple of years because that where’s there’s a lot of opportunities.

This means getting on the sideline for football games, showing up at pre-purchase patient physical events. Make sure you go out there and be in boxing or wrestling tournaments. Get saturated with those sports medicine experiences in your first two years to figure out if this is something you’re interested in doing. Initially, Daniel wanted to do a sports medicine rotation but he knew he had to figure out what he really wanted to do and where he wanted to go. And once he figured out he wanted to do family medicine in his third year, then he figured out where he wanted to go. He then used a lot of his elective rotations in fourth year to do auditions all over the country before he was able to settle on a good program for it.

Currently, there are six different paths to primary care sports medicine that you can take – family medicine, internal medicine, emergency medicine, pediatrics, physical medicine & rehabilitation. Then in the osteopathic world, you can do neuromuscular medicine/osteopathic manipulative medicine.

From the neurology end, there’s one program at the University of Michigan where they have a sports neurology fellowship that you can do from there. For orthopedic surgery, after you do a five-year ortho residency, you can do a 1-2-year ¬†sports medicine fellowship from there. For physiatry (physical medicine & rehabilitation), they have their own specific sports medicine program as well. Then you can do either a primary care sports medicine fellowship or a physiatric sports medicine fellowship.

Additionally, before you can be a good sports medicine doctor, Daniel says, is that you need to be good at whatever your primary field is because you’re going to branch off from that.

As to competitiveness, Daniel describes the subspecialty as a pretty competitive one. He was fortunate to get into one himself but he really worked hard to set himself up to be a very good candidate. He has had mentees that has gotten sports fellowships and one of them he thought to be a really good candidate. But he didn’t get in for whatever reason the first year he applied but got into second year and re-applied. He was persistent, went back and worked for a year. Now, he’s out in practice and doing well.

That being said, you have to be able to groom yourself to be good. Show that continuity. Even if you did well on your boards but if you didn’t show that kind of passion for this field then it’s going to sway program directors from taking a look at you.

From a research standpoint, there are programs that have academic-type requirements where you need to make sure you have some sort of academic work. As a fellowship director back then, he made sure their fellows produce at least one case presentation and one research project and looking to get those published as well. At the very least, have a presentation you put together or a podium or poster presentation to make you a better candidate.

[25:35] Bias Against DOs

Daniel admits he felt discriminated as a DO in some places. For the most part, a lot of the ACGME allopathic programs have open arms and they openly accept DOs into their program. A couple they found were a bit restrictive where they would have wanted you to have gone through an ACGME residency program. Although this could already be changing with the ACGME merger happening.

He adds that when he goes to national conferences that are both DO and MD, he finds that people that have buyer’s remorse on their allopathic degrees are primary care sports med docs and physiatrists. They realize the value of learning the osteopathic manipulative medicine and that having that extra tool to treat people is so helpful. And so many of the athletes appreciate this. When he did his olympic internship at the Olympic Training Center in 2013, he would evaluate them and figure out what’s going on. Then he’d do some treatment. So if you can treat them just with your hands, they would appreciate that just to shy away from taking any pill to prevent any controversies with regards to doping.

[28:30] Working with Other Primary Care Doctors and Other Specialties

Daniel explains a lot of people think they can’t refer over to sports medicine or that patients think the same thinking they’re not athletes. They think they only take care of athletes, primarily elite-level athletes. But he says to them that anybody who moves as an athlete, they can practically see anyone who has aches and pains. There’s a little crossover into the pain management realm here too. They can do things other than pharmacologic means only to be able to keep them moving and active. He sees a lot of their arthritic patients that need therapy and rehabilitation. Mostly, it’s about looking at their whole kinetic chain. They try to see where they have deficiencies and what is transferring their energy through their body that doesn’t enable them to do certain activities or what’s keeping them from being active.

He further believes that family medicine should have a panel of patients and they should be lifelong patients. What he likes other primary care doctors to know about what they do, there is actually so much to learn. Daniel now has a broader scope of things and he now has a better look at how to get people moving and get them active.

For instance, in tendinopathy, he was aware of three things that he could do to treat chronic tendon injury or an acute tendon injury when he was just going through residency. But after going through fellowship and being out in practice for several years, he can probably name 16 things off the top of his head that he could do for chronic tendon type of injury.

Other specialties they work the closest with include physical therapy and athletic trainers, rheumatology, and orthopedic surgeons.

[34:15] What He Wished He Knew that He Knows Now

Being a kinesiology major, one of the paths he could have taken is an athletic training path and become a certified athletic trainor while he was going through his undergraduate degree. He thinks this would have been cool. Just having a little bit of that knowledge was something he would have wanted. He also wanted to learn more of how to run a business and if there’s a combined MBA program, this would be a very good thing as well. This way, you’d be able to manage your business in your practice and be able to manage your money better too.

What Daniel likes the most about being a sports medicine physician is that he can sleep well every night knowing he’s doing the best for his patients. He’s helping people to the best of his ability and he has good humility about what he knows and what he doesn’t. He knows he’s doing his best to try to keep his patients moving and keeping them active. He likes all those little wins.

And if he had to go back and do this again, he would absolutely. But what he likes the least on the flip side is that they’re volunteering so much at events that he’d describe it as not a very lucrative field. Also, he practice with very good ethics and morals so he doesn’t do things just to do them. He makes sure it’s medically necessary. He has seen sports medicine physicians that do things similar to him but doing them irresponsibly. But he makes sure patients need those type of things. All this being said, he is comfortable and happy.

[39:20] Final Words of Wisdom

Daniel recommends to premed students listening to this who might be interested in sports medicine is to find a sports medicine mentor and just maintain good contact with them. Just check in and make sure it’s still something you’re passionate about. Make sure that you’re doing the kind of things that set yourself up for this type of future. And just get involved. Volunteer at events and find events. As with him, he actually created an event to be able to cover the sport he was passionate about. And this was how he became s team doctor with USE Wrestling which was one of his dreams and he made this happen!

Links:

The Premed Playbook: Guide to the MCAT

[email protected]

The Premed Years Podcast Session 273

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