In the USA, primary care sports medicine is a subspeciality of numerous disciplines including internal medicine, family medicine, paediatrics, physical medicine and rehabilitation, and emergency medicine. According to the American Medical Society for Sports Medicine, a sports medicine physician is one who promotes lifelong fitness and wellness and encourages prevention of illness and injury. He or she is a leader of the sports medicine team, which often includes other speciality physicians and surgeons, athletic trainers, and other allied health professionals.1 Currently, information is lacking regarding practice patterns, career opportunities, professional affiliations, and income for primary care sports medicine physicians.

In the USA, sports medicine, as a subspeciality, was conceived in the 1970s.2 Postgraduate fellowship programmes began in 1985, and the American Board of Medical Specialties formally recognised sports medicine as a subspeciality in 1993. There are 108 sports medicine fellowship programmes accredited through the ACGME, and currently there are 124 filled positions.3 Of these, 97 programmes and 112 positions are maintained through Family Medicine.3 Currently, there are 1102 family physicians credentialled with the sports medicine Certificate of Added Qualification (CAQ) according to the American Board of Family Medicine.4 84.8% of these physicians are male and 15.2% are female.4 The American Board of Pediatrics reports that 120 physicians hold a CAQ in sports medicine, and the American Board of Internal Medicine acknowledges 172 credentialled physicians.5 6

Several studies have been published describing education and medical practice of sports medicine worldwide.2 7^–14 However, none of the investigations have evaluated the income of practising sports medicine physicians. Moreover, only one study has focused on clinical practice patterns in the USA. In 2001, Pana et al surveyed 144 sports medicine-credentialled physicians, evaluating practice patterns and career opportunities in relation to gender differences.7 Comparably to the overall physician population, men were more likely to be married and have children. They also found men to be more likely to see patients at sporting events and in training rooms. However, they found no gender differences in the distribution of practice types, clinical time dedicated to sports medicine, and overall satisfaction with career opportunities.7

The field of primary care sports medicine has greatly evolved over the last three decades, and, with the addition of over 100 fellowship graduates each year, it continues to grow annually. The purpose of this study is to investigate and to characterise the practice patterns, academic rank, and income variables that exist in order to better understand the career of a sports medicine physician in the USA. It is our intention that these data will enable trainees as well as established physicians to compare practice opportunities when seeking a sports medicine position.

METHODS

The study was approved by the Ohio State University’s Biomedical Institutional Review Board. A web-based survey was designed to examine the different attributes of a primary care sports medicine career. The survey included questions on physician demographics, practice settings, time commitments, academic affiliations, team affiliations, patient demographics, and income. The survey population was entirely family physicians, with valid e-mail accounts, holding a Certificate of Added Qualifications in Sports Medicine through the American Board of Family Medicine as of January 2006.

The web-based survey was broken down into four sections and included a total of 43 questions. Section 1 included questions on location and sports medicine training. Section 2 contained questions on physician demographics including age, sex, and credentials. Section 3 included practice and patient demographic data including questions on income, usage of time, patient demographics, billing, and referrals. Finally, Section 4 included information related to practice management.

The entire population was contacted via e-mail by the American Board of Family Medicine. The e-mail contained a direct link to the online survey site. No personal identifiers were utilised, and all collected data were tallied as response totals. To investigate correlation between the data sets, Pearson χ² and Fisher’s Exact tests were utilised. Finally, a logistic regression analysis was performed to investigate features that were characteristic of high income earners. A high income earner was defined as one with a total gross annual salary of over $200 000, and p<0.05 was utilised as the level of significance.

RESULTS

The American Board of Family Medicine distributed surveys to the 862 physicians with a CAQ in sports medicine and valid e-mail addresses. Three hundred and twenty-five surveys were completed (a return rate of 38%). 240 physicians with a CAQ in sports medicine did not have valid e-mail addresses registered with the American Board of Family Medicine. Of all respondents, 212 (65%) reported completing a Primary Care Sports Medicine Fellowship. Furthermore, 276 (85%) were male and 49 (15%) were female, and 300 (92%) reported having a MD, while 25 (8%) had a DO.

To characterise the practice patterns of primary care sports medicine physicians, we asked the survey respondents to describe their practices. The responders were well diversified in their location, practice description, and type of practice setting (table 1). Significant variability was seen in the day-to-day practices of physicians. Clinical duties represented the largest proportion of the physicians’ schedules, and the majority of physicians performed routine athletic event coverage (table 2).

The collected practice management data included patient flow, billing, referrals, and support services (table 3). Income data described income in relation to gender, region of the country, academic titles, and practice description (table 4). Considerable variability was found in the data, represented by standard deviations from $12 000 to $94 000 for each descriptor. Higher-income groups included: men; regions including Central, South East, and South West; full professors; and non-student health or urgent care clinical work. No statistical differences were found between multiple variables: the inclusion of osteopathic manipulative therapies in practice (Fisher’s Exact test  = 0.671), MD vs DO (Fisher’s Exact test  = 0.344), or how practices were marketed to the customer (Pearson χ²  = 0.466).

A logistic regression analysis was performed to investigate the characteristics of high income earners, defined as those with annual gross salaries over $200 000 US. With control for all other variables, four groups demonstrated significant higher odds of being high income earners. These groups included age over 40, male sex, practice owner, and seeing over 10 patients per half day (table 5).

DISCUSSION

This study evaluated the practice characteristics and income figures for sports medicine specialists in the USA. We described significant variability in practice patterns, career opportunities, academic rank, and income throughout the nation. All regions of the country were well-represented, and all types of practices were included. The majority of physicians described their medical practices as primarily clinical, and the majority participated in team and event coverage. No firm conclusions can be drawn from the logistic regression for high income earners because of the large confidence intervals; however, interesting trends were found. We demonstrated that salary can be related to age, gender, number of patients seen, and practice ownership. No statistical difference among salaries was found between MDs and DOs, OMT practice, region of the country, or how practices are marketed.

We also observed that salary increased with years in practice. Income was described to be higher for physicians holding a CAQ who did not complete a fellowship. These individuals were likely to have trained and started practising sports medicine prior to the mid-1980s when formal fellowship programmes were started. We also demonstrate that the odds of being a high income earner are 3.5 times higher for doctors over 40 years of age. Older physicians are also more likely to be practice owners and full professors, which are higher-income groups.

Despite the large variability in income, the most intriguing observation was the difference in average overall income between men and women. This result was similar to the general family physician population, as demonstrated by Weeks and Wallace in 2006, where they corrected for work effort, provider characteristics, and practice characteristics.15 In the current study, the odds of a male physician being a high income earner were 6.6 times higher than those of a female physician. It has been previously demonstrated that the female sports medicine physician population is younger than the male population, with 65% of women being under 40 years of age compared with 47% of men.7 Therefore, women may generate a smaller income based on their age and years in practice rather than their work effort or gender.

There are limitations to this study. First, we were unable to survey all primary care sports medicine physicians holding a CAQ because 240 physicians did not have valid e-mail accounts registered with the American Board of Family Medicine. Furthermore, the response rate was 38% for this single survey distribution. We have no information on the non-responders or those without a valid e-mail account, and, therefore, some important data may have been excluded. Second, not all physicians responded to all questions. This was particularly true for many of the practice management questions. Third, the survey method that we chose did not allow the data to be corrected for physician work effort. Work effort and number of work hours may be related to the low incomes for certain groups of physicians.

It is our intention that these data should be available for future and current trainees as well as current practitioners looking for new opportunities in sports medicine. It is understood that these data will continually change as the subspeciality of sports medicine grows in numbers and scope. The income data represent the values in spring 2006, and will continue to increase. Future studies should further investigate the financial gap between men and women, and repeated cross-sectional data collections should be continued intermittently to follow current trends in the practice and income of primary care sports medicine physicians.