A Sports Medicine Physician Shares His Journey

Session 95

Dr. Michael Jonesco is an academic Sports Medicine physician at Ohio State. Today, we discuss what drew him to the specialty, the patient base he sees, and why he loves it!

Sports medicine comes in many shapes and sizes but Michael went through the internal medicine route. He found sports medicine late in his residency and quickly made some changes. Finally, he was able to match into a sports medicine fellowship.

Also, be sure to check out all our other podcasts on Meded Media for more resources wherever you are on your journey towards becoming a physician.

[01:20] Interest in Medicine

Michael grew up his whole life exposed to sports as an athlete. His dad was also a physician. His dad stood on the sidelines all the time, but he had no formal sports medicine training whatsoever.

He basically had no idea sports medicine existed as an entity until his second year of internal medicine. In fact, he was already gearing up to apply for critical care fellowship. All of a sudden, he was on a rotation that he had to go on and work with a football athlete.

After sitting about a week of working together, he was asked about actually doing it. The rest was history.

So went through a later application process but he did it anyway and pursued the fellowship after that.

Michael couldn’t initially decide what to do. His dad was family practice and he was already shadowing him. However, he didn’t want to be in his shadow to a full extent.

He wanted to create his own career path but still couldn’t figure out what he really wanted to do. He knew though that he loves being in a hospital way more than he loves being in the clinic.

What he loved about critical care is the acuity, the procedural aspect of it, and the adrenalin rush that comes with it – all three he found in sports medicine. Moreover, the quality of life is better in sports medicine. Not having to live in the hospital where he sees dead, dying and critically ill patients has allotted him a better quality of life. And this puts his head in a much better space.

[06:26] Traits that Lead to Being a Good Sports Medicine Doctor

You have to be a good communicator. This applies to not just other doctors and athletes, but also, with physical therapists, parents, and athletic trainers. You have to be able to discuss different medical topics and injuries. You have to be able to discuss the plan of care with several different people. You have to do it all at the same time and on the same patient at many times in different ways.

You have to be flexible. You have to be somebody who can learn on the go. You have to be able to say yes. Otherwise, others will say yes for you and you’re going to miss out on a lot of opportunities. So you’ve got to somebody who’s open to a fast-changing environment.

Really put yourself out to take care of others. Get the right opportunities and seek job opportunities that you want. You’ve got to be highly motivated and not afraid to say yes to things that put yourself out of your comfort zone.

[08:05] Types of Patients

Michael says sports medicine is way more loaded than you even know. It’s different everyday. The 6’4″ athlete exists but typically, they’re in the athletic world. The clinical world is where he starts his day. It’s his bread and butter.

Michael works at a big academic university, with the tagline that “there’s an athlete in all of us.” Going by that, it means that everyone here has some sort of motivation to be physically functional and active.

They see people who have a lot of pain. It’s not a pain clinic but they’re coming to you because they have an inability to be active. It can be because of lack of education or physical pain.

When you want to see true athletes, you have to do some outreach in your community. You have to be involved with the high school, middle school, semi-professional, and professional team. For instance, Michael goes to a local high school to see the training room.

For him, the diagnosis is never complete until you really have the cause for the root injury. So he goes one step further and talks about why it’s there.

[12:45] DO vs. MD

Michael explains that holistic medicine is not only DO-specific but also sports medicine-specific. So it’s a skill you would get in a sports medicine fellowship. That’s what separates you from the community.

That being said, he thinks DOs have a great advantage in sports medicine. There are some skills he can do and offer that MD couldn’t. In fact, Michael is teaching a course to their fellows at their university for MDs. They would learn about manipulation and treatments with patients.

Michael further explains the importance of continually practicing manipulation. Because if you let this go, you may lose a bit of that experience. Try to find an avenue where you can continue and utilize those skills.

[14:44] Academic vs. Community Setting

Michael did his residency at Indiana University. Then he did his fellowship at Clayton Clinic, which had a big academic setting. He was more comfortable with the academic setting since that was how he was trained. He wants to teach and give back.

Coming out of fellowship, looking for a job was challenging due to its competitiveness. There were jobs which were 100% sports medicine – no primary care patients. While there were jobs where you see 70% primary care and just a bit of sports medicine. He was fortunate to do 100% sports medicine right out of it.

[16:05] Typical Week

A typical week for him would be doing clinic four days a week. He’d have a half day of academic and then the rest of the day, he’d do some things out of the clinic setting. He will see patients about 25 hours a week spread over four days.

His new patients get a 20-minute slot while all the others are given 10 minutes. So they roll to about 25-30 patients a day.

Michael also explains the split in philosophy in terms of sports medicine now because you have some people who are strictly proceduralist.

There is room for everybody. But it’s a very interesting time where you get a shift in how people view sports medicine.

To be competitive for sports medicine fellowship, get exposed to more research and focus on care on the field. Also, do some research on writing chapters. And what used to be just impressive to be doing all this, is now pretty much what’s expected of you.

If this is a specialty you’re interested with, Michael recommends having experience in a sports medicine cleaning. Spend time with somebody in the clinic setting, not just on the field.

Get in with some research. This may not be necessary for some programs. Put more emphasis on the kind of exposure you had to actual sports medicine clinics and field coverage.

Another option is event coverage like marathons, triathlons, basketball events, Special Olympics, etc. Any of these would look great on an application.

[28:55] Subspecialty Opportunities Out of Fellowship

There are Concussion fellowships as well as Ultrasound Guidance. There are some people who do an extra year of Ultrasound training. Michael recommends doing this first before coming to your sports medicine fellowship. He thinks this is a huge advantage or skillset to have.

You can also take Orthobiologics which are new age treatments for chronic tendon problems. In fact, you can have a niche without necessarily requiring further training per se. But Ultrasound and Procedures are big in sports medicine.

[30:00] Working with Primary Care

Michael thinks there is much guilt among primary care physicians, but he stresses that there is no such thing as a bad referral. He wants every provider to feel comfortable sending them patients over because it’s really about their comfort and patient care.

“If you don’t feel confident and you don’t feel like you can provide the best care for your patient, do not feel bad. Send them over. I’m happy to see them.”

Secondly, Michael points out that the musculoskeletal exam is one of the fine things where you don’t need any equipment or any imaging. It’s all bare hands, history, and physical exam.

If you can get comfortable with your physical exam and really focus on your musculoskeletal care, you can provide excellent care. You’d feel more confident in managing patients without referrals.

[31:49] Special Opportunities Outside of Clinical Medicine

There are opportunities for advocating for new treatments, injections, and medications. There are a lot of avenues outside of sports medicine that you can do that are not traditionally clinical.

[32:30] What He Wished He Knew Before Getting Into Sports Medicine

What he knows now that he wished he knew going into sports medicine is that when he first started, he wanted everyone that came into his door would be that 6’4″, 5% body fat person.

And what he found is that he gets more satisfaction when he focuses and pays attention to bringing people from being sedentary to get them moving. He gets more satisfaction when he sees the patient again and knowing how his patient’s quality of life has improved.

[33:30] The Most and Least Liked Things About Sports Medicine

What he likes the most is the camaraderie with the people around him. He gets to connect to who he was in his younger days. He enjoys he still gets to be in the locker room on the field and part of the team. He’s working towards a goal with the team.

On the flip side, what he likes the least about his specialty, which is universal in all of healthcare, is the burden of volume.

You get to a point where you have to rush through your day because you don’t want other patients to wait.

So there’s that expectation that you’ve got to keep up with the numbers and everything has to be turned in. It’s not only specific to sports medicine, but it’s a healthcare thing.

[36:15] Major Changes in the Future

There are going to be people in Sports Medicine who are proceduralists and people who are traditionally more of primary care sports medicine. You want to find a program that fits what you see yourself as.

Fellowships will continue to get competitive, but more concerning here would be the job market.

The fellowship may be easier to get than the job once you’re done. You have to be more open to having a nontraditional sports medicine job initially.

This means you may have to be more open to putting your time in as a primary care physician. Then work your way into sports medicine.

Moreover, every year, there’s a new evolution in stem cell or platelet-rich plasma. What he tells students is that if you have a million treatments for one thing, it probably means that there is not one good one.

Until we find that one good one, sports medicine would always be a rapidly changing field.

[38:15] Doing Primary Care

As a primary care sports person, you are pretty expendable if all you see is musculoskeletal complaints. They have orthopedics for that. So if your niche is that, they can find somebody to do that. But if you’re really comfortable with your primary care skills.

Remember that as a team doctor, you’re not only taking care of athletes. You’re also taking care of the coaches, the strength coaches, and the administrative. And even 20-year-olds may also have issues with mental wellness and neurologic issues and get sick.

If you really understand how to manage the primary care issues that come up, that’s what makes you an asset to the program and to the team. That’s where your niche is. But people forget that.

[40:25] Final Words of Wisdom

If Michael had to do it all over again, he still would have chosen Sports Medicine. He has good and bad days but there’s not a day that he comes to work dreading it.

For anybody who loves to be around the locker room athletics, musculoskeletal care, but even more so, just getting people active, sports medicine is a very satisfying field.

You don’t have to wait for 6 months to see the results of the medication. You can see it in two days and therapies within a week. It’s a very satisfying field for him and he’d do it a hundred times over.

Finally, to those interested in this, Michael recommends doing rotations. Get exposure and if you like it, commit to it for a month. Get on a rotation. Get out there and get involved in sports clinics. Get involved in the field.

Find somebody who can mentor you and really introduce you to sports medicine. Do it with one or two doctors because you’ll be amazed by how different cilnics and your experiences can be.