June 2003 Bulletin

Subspecialty certification in orthopaedic sports medicine

What does it mean?

By Peter J. Fowler, MD

On March 20, 2003, the American Board of Medical Specialties (ABMS) approved the American Board of Orthopaedic Surgery (ABOS) application for subspecialty certification in orthopaedic sports medicine. The American Orthopaedic Society for Sports Medicine (AOSSM) wishes the broader orthopaedic community to understand our reasons for pursuing certification and our commitment to making this a positive, constructive step for the specialty of orthopaedics.

Why certification?

Sports medicine was an identified area of orthopaedics long before the formation of AOSSM in 1972. For the past 30 years, the Society has served as the forum for focused scientific education and discussion for those with an active interest in this area of orthopaedics. Much of the intellectual growth in the specialty has been documented in our publication The American Journal of Sports Medicine, which enjoys a circulation of more than 9,000 AOSSM members and paid subscribers. The body of knowledge that comprises orthopaedic sports medicine is now well established in a formal curriculum.

The decision to pursue certification was not taken lightly or made quickly. The issue was first considered in 1989, when other specialties–family practice, internal medicine, pediatrics and emergency medicine–initiated subspecialty certifications in sports medicine. Resisting a "me-too" urge, the Society initiated a dialogue that lasted for more than a decade about the merits and drawbacks of pursuing certification.

During that decade, formal fellowship training in orthopaedic sports medicine flourished. Today there are 95 programs that train approximately 200 Fellows a year–roughly one-third of the number of orthopaedic residents that graduate each year. Presently, there are more sports medicine programs and Fellows in orthopaedics than in all the other sports medicine specialties, combined. More than half of the fellowships (55) are accredited by the Accreditation Council for Graduate Medicine Education.

In 2000, AOSSM announced that it would seek subspecialty certification. Post-graduate training had reached a point where a standard measure was essential for ensuring the continued health and quality of our subspecialty. Certification provides such a framework–much as is it does for general orthopaedics.

Adding value

Subspecialty certification does not preclude other orthopaedists from caring for athletes. Most orthopaedic surgeons rightfully treat athletes at some level. All residency-trained orthopaedists receive specific training in sports medicine, and all are qualified and capable of treating athletic injuries within their expertise. Moreover, orthopaedic sports medicine is not defined by a particular anatomical or procedural denominator that further underscores its inclusive nature. In fact, other specialists such as those in hand and spine, provide expertise in caring for athletes not routinely found in orthopaedic sports medicine. Put simply, sports medicine does not lend itself well to those who desire exclusivity.

Recognizing the contributions of all orthopaedists in treating athletes does not obviate the breadth or depth of formal post-graduate training in sports medicine. The curriculum for sports medicine reflects a significant concentration not only in orthopaedic treatment, but also in other areas, including on-the-field evaluation, conditioning and dietary supplements. Just as the growth of orthopaedic sports medicine during the past 30 years has contributed greatly to our understanding and treatment of orthopaedic injuries, our goal is to ensure that orthopaedic sports medicine remains a "value-added" specialty for orthopaedic surgery.

Being inclusive

AOSSM is committed to making subspecialty certification a positive step for both sports medicine and orthopaedics. To this end, we have taken several unambiguous measures to set the tone:

First, the Society adopted a policy strongly affirming an expansive role for orthopaedists in caring for athletes. Specifically, the policy states: AOSSM strongly supports the right and ability of all orthopaedists, regardless of post-graduate training and education, to provide sports medicine services in the team, clinical and surgical setting. As the foremost orthopaedic sports medicine organization, we could not be more specific or unequivocal in our position.

Second, as a matter of policy, we have specifically excluded using certification as a criterion for membership. Although certification may reflect academic achievement, we believe that AOSSM membership and fellowship should be available to all orthopaedists actively involved in providing sports medicine care. AOSSM believes there is room for all in orthopaedic sports medicine, and by including all interested surgeons in the Society, AOSSM can continue to understand and advocate the interests of the broader orthopaedic community.

Concluding Thought

Orthopaedic sports medicine, like many other areas of orthopaedics, is a vibrant and dynamic field. All orthopaedic leaders are faced with the challenge of nurturing intellectual growth while remaining true to the broader orthopaedic community. After careful deliberation, AOSSM believes it has achieved that balance. We invite your support and participation as we move forward.

Peter J. Fowler, MD, is president of the AOSSM. He can be reached c/o AOSSM, 6300 N. River Road, Suite 500, Rosemont, IL 60018.

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