The purpose of this articler is to discuss methods by which to successfully build a busy clinical sports medicine practice. The authors aim to provide pearls to help facilitate building a successful and busy practice as well as pitfalls to minimize the risk of failure. Topics discussed include how to build patient referral sources, online marketing, sports team coverage, and cultivating relationships with partners and providers within the community.
Key points
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Several important questions must be answered satisfactorily when evaluating prospective jobs before accepting one.
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Important patient referral sources include primary care physicians, certified athletic trainers, physical therapists, and physicians within the same organization. Effort must be made to develop strong relationships with these individuals.
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Having an online presence is essential as a modern sports medicine physician.
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Team coverage, including local high schools and colleges, is time consuming but can be a boon for a new sports medicine practice.
Introduction
Sports medicine is an increasingly popular orthopedic subspecialty. While athletic-related injuries are common among school-aged children and adolescents as well as adults, , and there has been an increase in outpatient surgical cases being performed including anterior cruciate ligament reconstruction, , there is also an increasing number of fellowship-trained sports medicine surgeons. Although completion of a sports medicine fellowship best prepares surgeons to perform procedures including multiligament knee reconstruction, cartilage restoration, hip arthroscopy, and shoulder arthroscopy, there are many surgeons in the United States and elsewhere who do not complete a sports medicine fellowship and perform a high number of sports medicine procedures. As such, it can be difficult to build a focused sports medicine practice during early practice. When initially starting practice following a sports medicine fellowship, many surgeons care for several general orthopedic conditions, performing total joint replacements and fracture care while also taking call in order to build clinical and surgical volume. However, the ultimate goal of many fellowship-trained sports medicine surgeons is to have a practice in which they are caring for sports-related conditions and performing a high volume of surgical procedures including arthroscopy. The purpose of this article is to discuss methods by which to successfully build a busy clinical sports medicine practice. The authors aim to provide pearls to help facilitate building a successful and busy practice as well as pitfalls to minimize the risk of failure.
Job selection—choose wisely
The process of building a successful practice begins with job selection. This topic is covered elsewhere in this special issue but warrants mention here, as it is critically important in setting new sports medicine surgeons up for success. Briefly, it is of the utmost importance to understand the specific needs of the prospective practice, both with respect to the clinical and surgical volume that can be expected and the types of pathologies for which a new hire will be expected to care. Box 1 lists important questions to consider prior to accepting a new position as sports medicine surgeon. It is imperative that all these questions are asked and sufficiently answered to the candidate’s satisfaction before accepting a new position.
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Do the clinical needs of the group fit the desires of the candidate?
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Why is the prospective practice seeking a new sports medicine provider?
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Is the group expanding geographically into a new region and opening an office that the new hire will staff? If so, how specifically will the group assist in helping the physician to build this practice?
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Will the new hire be practicing at a single location or multiple locations?
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Are other providers retiring?
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Did another provider leave for a job elsewhere, and if so, then why?
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How will patients be placed into the new physician’s clinic?
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Who will be the referring physicians?
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Will the new hire be working with or have the potential to hire an advanced practice provider?
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Are there family practice (nonoperative) sports medicine physicians in the practice?
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Is there an appointments center that manages the entire group, and if so, are new patient referrals equally distributed to the providers?
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What is the current volume for the existing providers (clinic and surgical volume)?
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What is the status of potential competition in the market?
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What ancillary services are available in the practice?
How do I get patients in my clinic?
When a physician starts a new position, there may be period of time in which the provider is waiting for credentialing from various payors, and some insurers take longer than others. This process can drastically impact clinical volumes, but the idle time should not be wasted by the new physician. Even if the physician is fully credentialed with all payors on day 1, there is usually a ramp up period during which clinic and surgical volumes are considerably lower than experienced physicians within the same group. New providers should consider consolidating clinic time or making visits during lunch time to health care providers within the surrounding community who may serve as referral sources. It is beneficial for a new sports medicine surgeon to meet as many health care providers within the immediate geographic area as possible, including physical therapists (PTs), athletic trainers (ATCs), primary care physicians (PCPs), advance practice providers (APPs), and even other orthopedic surgeons, who may potentially serve as referral sources. It is advisable to consider setting up visits with these providers at their practice location within an approximately 15-mile radius from the new physician’s primary practice site, as patients may be unwilling to drive much further for orthopedic care. This distance may differ depending on regional population and surgeon density, with patients in rural regions likely to be more willing to drive longer distances than those in dense urban areas with a higher concentration of surgeons.
PTs can be good patient referral sources, and in some areas, there are specific PTs that care for young athletic populations. If those types of PTs exist in the new physician’s practice area, an effort should be made to develop a strong relationship with these individuals. Ensure that any incoming referral from a PT is subsequently referred back to that specific PT if the patient requires PT visits in the future. ATCs, particularly those in high schools and colleges, can be valuable referral sources, especially for young athletes with sports-related injuries. Often, the ATCs expect a physician to provide sideline coverage for football games or other sports at the school, as well as to regularly see injured athletes in the school’s athletic training room. It is also important to know whether another physician already provides these services at the school. More experienced sports medicine physicians within the same group or marketing specialists are likely to understand the landscape of high school physician coverage in the group’s region, and it is prudent to discuss with them prior to approaching the ATCs or athletic directors at a school.
PCPs are also an invaluable source of patient referrals. Although many sports medicine surgeons seek surgical referrals and may prefer young athletic patients, it is advisable to be willing to accept referrals for any (or most) orthopedic issues from a referring physician when starting out in practice. If a new physician makes referral requirements too stringent (ie, “knee pain under 40 years old only”), the referring providers will typically refer to another orthopedist who is willing to see any referral, as this is more convenient for the referring provider. Even if a sports medicine physician does not care for a particular condition that is referred to them by a PCP, the patient can be referred to a partner who specializes in that condition, thereby satisfying the patient and the referring provider. Finally, it is not unreasonable to meet with competing sports medicine surgeons in the area. This may be best facilitated by meeting with these individuals informally during local orthopedic society meetings or other functions in which they are present. If there are certain conditions that the competing physician does not care for, or complications that they do not wish to treat, offering to care for their patients with these problems can build goodwill and establish a solid working relationship with a physician who is already highly valued in the community.
It is far more effective for a physician to make personal visits to each of these potential referring health care providers at their practice locations than for a marketing representative from the group to make visits without the physician. If the marketing representative is willing to organize and attend each visit with the physician, possibly bringing marketing materials such as pamphlets and business cards, that approach may be the best. While visits to area health care providers can be time consuming and may temporarily remove the physician from clinical duties, the time investment on the front end can help establish important relationships within the community and provide continued referrals throughout the physician’s career.
Your organization—make it known what you do
When staring a new job within an orthopedic practice, it is important that the appointments center, marketing staff, physician partners, and APPs know the conditions that the new physician cares for and the procedures performed by the new physician. It is possible, and even likely, that existing sports medicine surgeons within the group have a different scope of practice than the new hire, as not all sports medicine physicians, for instance, perform hip arthroscopy, ankle arthroscopy, elbow arthroscopy, or shoulder arthroplasty. It is also important for the new provider to understand the preferences of the existing physicians and APPs within the group. Referrals to those providers will often generate referrals back to the new provider, thereby developing strong relationships going forward. Unless an effort is made by the new physician to communicate these items to the rest of the group, the providers and staff within the group may not know that the new physician treats certain pathologies. Specifically, consider reaching out and meeting face to face with nonsurgical physicians and APPs within the group to discuss preferences and learn theirs as well. Developing strong relationships with these referring providers early during practice can pay dividends throughout a physician’s career.
Marketing—how do I get my name out there?
Sports medicine is a very competitive field, and in most major metropolitan areas, there is no shortage of physicians willing to provide the same services as a newly graduated fellowship-trained sports medicine surgeon. In general, the existing surgeons within a given geographic area have well-established and busy clinical practices and loyal patient populations. Unless a new physician is replacing a physician who left the practice to retire or take a position in another region, generating new clinical volume and gaining market share can be very challenging. In addition to trying to meet as many health care providers within the area as possible, there are other avenues beyond a “boots-on-the-ground” approach to becoming a known entity within the community. Having an online presence as a sports medicine physician is essential in 2024, and this is especially important in orthopedic surgeon–dense metropolitan areas. Upon starting a new practice, the sports medicine surgeon should open a Google Business Profile ( Fig. 1 ). This is free and allows patients within any geographic area online access to a physician’s profile. New physicians should make every effort to generate as many favorable reviews as possible, as physicians with the highest number of highly rated reviews generally show up at the top of patient search queries. Some orthopedic practices have software programs that communicate directly with the patient after clinic visits, and other methods to seek reviews include business cards with quick-response (QR) code links to Web sites such as a Google Business Profile, Healthgrades, or other physician-rating Web sites. One strategy to generate favorable reviews is to provide patients that are likely to provide favorable feedback with a QR code. It is also recommended that physicians create and maintain updated, viewable profiles on other Web sites including Healthgrades, Yelp, Sharecare, WebMD, Doximity, and LinkedIn. Each of these Web sites provides visibility to the public and to colleagues within the medical field and may help attract new patients to a practice and a specific provider. Generally, the orthopedic group will have a provider Web site for each physician that will generate more online traffic than any other Web site ( Fig. 2 ). However, a personal professional Web site which can house educational materials including information regarding pathologies treated by the physician, postoperative rehabilitation protocols, and other information helpful to patients can help a new sports medicine surgeon to establish a reputation within a specific region. Some organizations do not allow personal professional Web sites, so it is important to verify this before committing resources to building one. Finally, a social media presence can build awareness of a new physician in the community and may help generate patient visits. Web sites such as X (formerly known as Twitter), Instagram, and Facebook are highly trafficked but require regular posting of material and may be time consuming. Some surgeons hire a service to create social media content and maintain their accounts, which may be a consideration in certain competitive markets but also comes at a cost. Most orthopedic practices have 1 or more marketing specialists who can assist in building community awareness of a new provider, and it is important to build a strong working relationship with these individuals if available. Marketing is an important aspect of sports medicine practice building, and while this can be time consuming and take a physician’s focus away from providing the direct patient care on which many physicians prefer to focus, it is essential in building a busy sports medicine practice. Sports medicine physicians need patients in order provide care, and marketing is essential in driving clinical volume.
