Table 1.

Current challenges for sports physicians and suggested solutions

Challenge	Solution
Doctors lacking specialist training employed to manage the health of elite athletes Doctors practising in isolation; decisions made without broader team consultation Physiotherapists managing the total health of elite athletes	Employ only well-qualified specialist sports medicine physicians to manage the total health of athletes Doctor should practise and make decisions as part of a comprehensive coaching and medical support team Physiotherapists are qualified to manage musculoskeletal health but not the total health of athletes
Doctors are employed by clubs; this fact might influence their objective clinical decision-making	Clear role definition with internal and external clinical governance (eg, appraisal and revalidation process by the appropriate external bodies such as the Faculty of Sport and Exercise Medicine and General Medical Council in the UK)
Doctors are clinically line managed by non-medical team members or non-clinicians. This fact potentially challenges athlete medical confidentiality, access to medical records and ultimate clinical responsibility	Employ appropriately qualified sports medicine physicians with contractual arrangements detailing their ultimate clinical responsibility Culture and contracts within sporting organisations should consider the issue of medical confidentiality
Managers or coaches refer athletes to specialist medical services without involving the medical team/responsible doctor	The medical department is responsible for all the clinical medical aspects including referring athletes for specialist investigations or treatments. Athletes have the right to more than one medical opinion; it is important to develop and agree on a clear referral protocol/policy
The Head Coach influences/over rules clinical decisions by the medical team or doctor	Within a performance environment, the clinical advice may not always be heeded. The Performance Director to whom the medical team is accountable may, in conjunction with the athlete and in receipt of the medical opinion, choose an alternative path. The procedure and documentation around this process should be clear. It is, however, unacceptable for a non-clinician (coach) to make/over rule medical decisions where the athlete lacks the capacity to make a clear decision (eg, RTP in concussion)

RTP, return-to-play.