How much training do you get during fellowship with respect to management of fractures? How often do FPs or sports med CAQ holders tx fx's in the office?
Also, while I understand that treatment for overuse injuries, sprains and strains are typically non-operative, what types of tx's are available and in what percentage? For example, in a typical day at the office, are you referring 50% of pts for PT, 30% get injections (or some other non-surgical procedure), 10% advised to rest and 10% sent for surgical evals? I made the numbers up as an example.
I have recently developed some interest in the field but had limited exposure in training. The impression I get in perusing the forums here is that people are doing injections, prescribing PT, maybe managing medical conditions that affect the athlete but not much else? The sports med organizations have focused on head injuries and clearing athletes for playing again as well. Is my impression far off?
Setting dependent, referral dependent, and brand-recognition dependent; so you'll have to ask when you're on the interview trail.
Generally speaking, front line settings will get you the most fractures: orthopedic office, family med office, emergency department, and urgent cares. If your program has a sports medicine clinic that is the fellow's own, you want to know where those patients are coming from (usually family medicine and urgent care, but more and more programs are running it out of orthopedic offices, so you might be getting first stab as ortho shunts them to you for evaluation). It also depends on whether the community is aware of what sports medicine is and what the scope is for primary care physicians. If a patient has a broken bone, they usually think ortho and emergency med; but if your community has a good awareness of what sports medicine is, they might come to you first. I don't know much about PM&R settings, but my guess is that they don't get a lot of fracture management. As a fellow, you want to know what settings you will be working in, which settings are ones that you can call your "own", and have an understanding of the community ecology.
Distribution of cases and what you follow naturally will follow the setting you are in and types of patients you see. Urgent care vs primary care office vs orthopedic office vs emergency department. It will depend on what types of insurances you accept and what referral/ordering patterns those insurances dictate.
Yes people are doing MRI/ultrasound, injections including regenerative biology, rehab vs convservative vs surgerical treatment decisions and outcomes research, concussions and return to play, and medical conditions that affect athletes, obviously; but those are all for the sick and fallen. There's a whole expansive field for the well that focuses on performance, nutrition, training, and naturally doping. And then there's a third cluster of knowledge focused on injury and sudden death prevention.
With the more recent inclusion of PM&R into the field of primary care sports medicine, hopefully there will be an expansion and diffusion of knowledge regarding disabled athletes and prosthetics.
