Latest / Becker’s Healthcare - Clinical Leadership Podcast / Anthony Martin, Clinical Assistant Professor of Family Medicine at Wake Forest School of Medicine, Atrium Health

Transcript

Anthony Martin, Clinical Assistant Professor of Family Medicine at Wake Forest School of Medicine, Atrium Health · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - This is Laura Dedo with the Becker's Healthcare Podcast.
• 0:03
  I'm thrilled today to be joined by Dr. Anthony Martin,
• 0:05
  clinical assistant professor
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  of Family Medicine at Wake Forest School
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  of Medicine, part of Atrium Health.
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  Dr. Martin, it's a pleasure to
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  have you on the podcast today.
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  - Thanks so much for having me. I'm excited to chat.
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  - Now, I know we have a lot to talk about.
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  We're gonna dive a little bit into sports medicine
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  and some of the work you're doing to care for elite athletes
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  as well as other athletes within the community.
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  But before we dive into my broader questions,
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  can you tell us a little bit more
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  about yourself and your background?
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  - Absolutely. Um, so yeah, I graduated from, uh, university
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  of Pittsburgh, um, undergrad in, um, 2003.
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  I went to Temple University School of Medicine,
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  graduated in 2008.
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  I did my residency at Reading Hospital in Reading
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  Pennsylvania, which is now Tower Health.
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  Um, and then I did a sports medicine fellowship at Carolinas
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  Medical Center in 2011
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  and joined, um, atrium, which is now advocate.
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  I currently, uh, sit at the rank
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  of clinical assistant professor at the Wake
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  Forest School of Medicine.
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  Uh, I also serve as the associate program director
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  for the Primary Care Sports Medicine fellowship,
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  and I'm also the point of care ultrasound director
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  for Department of Family Medicine in my sports, uh, roles.
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  I am the head team physician for UNC Charlotte Football, uh,
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  although I work with all the sports as well.
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  Um, I also, um, served as ringside physician
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  with USA boxing, covering regional events
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  with Golden Gloves in North Carolina, uh, from
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  around 2015 to around 2019.
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  - Wow, that's amazing. And it seems like, you know,
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  it would take a lot to care for athletes
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  who are competing in such a high level, um,
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  whether it it's locally
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  or kind of in some of those international competitions.
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  - It, it can, um, you know, you have to kind
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  of always be available, um, you know,
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  and communicate well, whether you're discussing
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  with athletes, um, in person
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  or coordinating care through the athletic training team and,
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  and and whatnot.
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  So, um, availability is really important in being able
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  to work in those athletes when those injuries happen,
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  because unfortunately, we don't have a crystal ball.
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  So being adaptable, it's important.
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  - Absolutely. That, that's such great advice, and,
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  and certainly I can imagine for someone who's trying
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  to get into the sports medicine space
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  and really to understand what that schedule looks like,
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  and, um, you know, what you need in order
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  to be successful there is truly helpful.
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  Now, what are some of the big trends
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  that you're watching in healthcare as well
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  as sports medicine in particular? You
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  - Know, one of the biggest trend I've seen in sports
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  medicine is just general awareness.
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  You know, um, we used
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  to talk about Monday morning quarterbacks, uh,
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  and speak that would traditionally be about coaching
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  decisions and players' abilities.
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  Uh, you know, uh, uh, at the beginning of the week,
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  although there's been more of a spotlight on the sports
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  medicine team that I've noticed, right.
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  Some of the, um, specific instances include Tua, um,
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  when he was, you know, at Miami
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  and the management of his brain injury during
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  that NFL game would, in the initial diagnosis
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  of a potential back injury, was highly criticized, not only
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  by medical professionals,
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  but also by commentators in the general public.
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  Um, and his early return to play put him at risk
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  for further injury given he was still
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  suffering from concussion.
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  Um, there was a big, you know, backlash.
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  Um, as a result of that,
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  because of all the awareness, you know,
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  I think there's also been a dramatic increase in the
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  awareness of sudden cardiac arrest in athletes.
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  One of the most public examples of this was DeMar Hamlin
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  with the BLO he received through the chest during
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  and a violent tackle.
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  Um, and then Bronny James who collapsed as a result
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  of his congenital heart condition.
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  Um, you know, the prompt response
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  and recognition of life-threatening condition in these
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  started athletes literally saved lives, right?
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  So awareness not only amongst professional
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  and collegiate sports medicine teams have increased,
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  but also equally, um, importantly at the high school varsity
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  and junior varsity levels as well, just
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  because awareness at all levels are important if we're gonna
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  prevent these events from happening,
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  and if they do happen to make sure we respond appropriately.
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  So I'd say just awareness of the sports medicine team
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  and our role, um, and some of the services we provide.
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  Um, that's one of the key areas that I've noticed.
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  - That's fascinating to hear.
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  And certainly, you know,
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  looking at those big national instances of people guessing
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  or second guessing, you know,
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  what should have happened on the medical side, um,
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  for any given situation, um, you know,
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  it definitely seems like it would be a challenge to have
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  that kind of scrutiny on you,
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  and obviously maybe you're not, you know,
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  on the NFL sideline.
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  But, um, when you think about the decisions
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  that you're making with the athletes, um, you know,
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  from kind of snap decisions in some cases during the game or
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  after the game, trying to decide about, like you said,
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  awareness of avail availability
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  and knowing that in some cases there's gonna be a
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  lot of opinions about that.
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  Um, how much pressure does that put on you?
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  How do you respond to that?
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  And I can imagine, you know, definitely needing
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  to keep the player first and foremost in your mind.
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  - Uh, you just said one of the most important things right
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  there at the end of your statement, uh,
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  keep the player at the formo at first and foremost, right?
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  You, you may be the team physician,
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  but your obligation is to that individual who's
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  who you're treating in front of you.
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  You want to keep them as healthy as possible,
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  and you want to attend to
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  that injury in real time and make the best decision.
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  You know, like I said, I serve in an academic role as well,
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  so I, I usually have fellows
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  or residents with me on the sidelines.
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  Um, and I always tell them, you know, try
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  to forget the cameras are there
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  because, you know, if it's a televised game
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  and it's a lot of pressure, it's a conference game
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  and it, it has eligibility for bowl game implications,
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  you know, that part's not important.
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  What's important is the person in front of you
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  who needs your, who needs your help, who needs your care,
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  um, because literally sometimes lives
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  are on the line, right?
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  So, uh, it's a, it is just important to always be vigilant
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  and, um, be ready to attend to what needs to happen as well
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  as, you know, have a good awareness of the, what's common
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  and what's uncommon, and being prepared
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  for whatever may happen in front of you.
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  I,
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  - I think that's such a great point
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  and so helpful to kind of cut through everything else
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  that potentially arises, you know,
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  when you're in such a high profile situation and,
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  and being able to treat the patient
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  and understand what they need in any given situation.
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  When you look at sports medicine as a whole,
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  what are you excited about
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  for the next year and what makes you nervous?
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  - Uh, yeah, there's a,
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  there's a lot I'm excited about, right?
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  You know, I mean, research, sports medicine is,
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  is a younger field compared to some other areas
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  of medicine, right?
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  So there's still a lot of publications
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  that are, uh, coming out.
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  One of the areas that I'm really excited about
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  is orthobiologics.
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  Um, orthobiologics is a, a broad area that is,
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  you know, it's receiving a lot of attention in the media,
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  the advertising world, and professional collegiate sports.
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  This category of medicine is using human tissues
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  or growth factors to help facilitate recovery in an injured
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  individuals, right?
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  This can be with elite athletes trying to return to sport
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  after an injury such
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  as a partially ruptured pectoralis tendon
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  or maybe some refractory patellar tendon issues, um,
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  and get them back on the field faster.
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  Or it can be a chronic degenerative condition like
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  osteoarthritis in a 50-year-old who used to be an athlete,
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  but just wants to stay in the game
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  and, um, keep up their activity levels, play
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  with their kids, whatever the case is.
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  Um, some examples of this,
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  specifically platelet rich plasma, um, is one
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  that receives a lot of attention,
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  but also some of the, um, up
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  and comers are bone marrow mesenchymal aspirate concentrate,
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  which is known as bmac, as well
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  as micronized fat or lip aspirate.
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  The latter of these two are considered stem cells. Okay?
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  Um, these tissues are harvested from
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  potential donor sites like drawing blood with PRP,
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  doing a bone marrow harvest from the hip or the bone for,
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  or hip or leg bone for bmac,
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  and then aspirating fat from the abdomen or flank region.
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  Um, and then you're injecting
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  that into the target area, right?
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  To try to activate the body's natural inflammatory cascade
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  to either restart the healing process, promote growth,
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  or, or both of these things.
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  Um, the, the data that's already out there,
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  the safety data is robust and, and compelling.
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  The, um, early data is robust,
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  but, you know, there, there's just
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  a little bit of bias out there.
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  'cause a lot of the studies are done
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  by the industry that makes a product.
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  So that always puts an asterisk in people's mind.
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  I'm excited for all the research
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  that's developing in this area.
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  Personally, I've seen a lot of success
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  with it in my patients.
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  I do. All of the procedures that I mentioned,
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  it's been a game changer, not just for my athletes,
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  but my weekend warriors too, who are in their forties
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  and fifties, have some mild to moderate, um,
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  arthritis from prior injuries
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  and just want to keep that active lifestyle.
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  You know, it's exciting
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  because, um, of the success I'm seeing now,
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  the concerns I have in this same vein, um, are also related
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  to some of the bad actors in the space.
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  There's people out there promoting
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  that they're doing quote unquote stem cells when they're
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  actually not, they're, they're using amniotic fluid products
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  or, um, different, uh, variations thereof
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  or other products that, that aren't necessarily regulated
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  by the FDA as well as, um, some, some
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  of these clinicians aren't, uh,
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  actual physicians doing the procedures and, um, and or, um,
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  or advanced practitioners.
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  Um, they're, they're just in a different field altogether.
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  Um, so, you know, concerns for people who are charging,
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  you know, tens of thousands of dollars
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  and creating all this marketing campaigns and,
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  and people are dipping in their 4 0 1 ks and,
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  and paying all this money, um, where they're,
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  they might not be getting exactly what they say they are.
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  So, you know, I, I, I'd I'd recommend for folks
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  who are considering any of these procedures
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  to do your homework and know what you're getting, why,
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  and the reality of what's happening with these procedures
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  and not, um, just listening to the, um,
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  the snake oral salesman
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  who might be lurking around the corner.
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  - That's such a great point,
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  and certainly, you know, fascinating to see some
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  of the different developments on the sports medicine space.
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  Um, like you mentioned, some of the things
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  that are actually, um, science-based and in fact-based
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  and have a really great, um, literature behind them to show
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  that they're forwarding the field in comparing
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  that into something that, you know,
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  really is more hype in marketing dollars.
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  Um, it, it just really seems like there is a lot
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  of opportunity for, um, improving patient care,
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  but then to try and educate patients
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  and understand that, you know,
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  not everything they hear about is gonna be,
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  um, beneficial for them.
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  And some things can actually be hurtful
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  from your standpoint when you're working with athletes
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  and trying to help them decipher
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  what the next step in their care is gonna be.
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  Um, what are those conversations usually like?
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  How do you really make sure that you are partnering
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  with them to help them achieve their goals
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  and then, you know, really looking ahead to, um, what,
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  what is gonna be most helpful
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  for them in different types of treatments?
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  - Yeah. Whenever I'm dealing with an athlete
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  who has a specific injury, I, I try to one, just be,
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  you know, open to all, all avenues of treatment
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  and I try to be complete, right?
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  So there's always a lot,
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  there's always more than one option, okay?
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  So that, that's the complex portion.
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  Uh, the complex part of this is, um, you talk
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  to five different, um, physicians
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  or providers, you might get five different
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  approaches to the same problem.
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  I try to incorporate my athletes', um, opinions
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  and, um, decision-making into it, you know, in,
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  in a model called shared decision making.
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  I give them the information about
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  what's going on with their body.
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  I tell them, Hey, you know, based on my,
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  based on your history, my observation of the actual injury
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  or watching a video of it
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  or whatever, you know, um, your exam findings as well
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  as the imaging that we may have ordered, including MRIs,
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  ultrasounds, lab work, whatever.
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  Here's my understanding of what's going on, right?
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  So here's your actual diagnosis.
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  Now here's everything that can be done about it.
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  Now, some of those things may be conservative, some
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  of those things may be middle of the road
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  and include, um, different types of injections, some
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  of which, like I mentioned
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  before, um, could be a standard corticosteroid injection.
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  It could be different medications.
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  There could be surgery required or optional, right?
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  And there might be several different surgical approaches
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  to the, the same problem, right?
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  So I try to actually educate the athlete on all of the,
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  those options and let them let
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  that kind of resonate with them for a minute.
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  Oftentimes, based on their own personal values,
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  they might have a, one of those areas that
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  sits better with them than others.
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  Um, or sometimes they just say, you know,
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  Hey doc, I trust you.
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  I really want your opinion.
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  What would you do in this scenario?
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  And then I give 'em that opinion.
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  But I, I try to really incorporate their, their values in
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  what we want to do, um, to best treat them
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  and get them back on the field.
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  'cause at the end of the day, I think every athlete just
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  wants to be able to perform.
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  Um, that's my goal is to help 'em get, get back out there,
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  perform, do what's best for themselves to get,
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  get 'em back out there quickly.
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  But, you know, I also try to prep them like, Hey,
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  we could do this and it might get you out there faster,
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  but at the same time, here's what you may have
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  to deal with long term.
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  If we continue to do, you know,
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  things like repetitive corticosteroid injections
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  or if we continue to ignore this ruptured ligament
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  that you may suffer from some arthritic changes over the
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  road, uh, down the road,
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  or, you know, here's what's okay to play through
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  and here's what's not okay to play through, you know, I kind
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  of ge try to guide them in that role.
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  - That's fascinating to hear.
• 13:51
  Well, before we wrap up our conversation,
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  I know you mentioned you work with, um, training physicians
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  and in early career physicians focused on sports medicine.
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  So I was wondering if you could talk about what it's like
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  to care for an elite athlete as a team physician,
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  and what advice do you have
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  for those early career physicians who want
• 14:09
  to follow the same path?
• 14:13
  - One, it's truly a blessing to be able to work
• 14:14
  with like high level athletes, elite athletes.
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  I take care of, um, UNC Charlotte, like I mentioned,
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  you know, I'm, I'm fortunate enough that some
• 14:22
  of my colleagues who work with, uh, the Panthers
• 14:25
  and the Charlotte FC have referred me those athletes in
• 14:28
  helping get them back on the, the field sooner, sometimes
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  with orthobiologics or other endeavors and things like that.
• 14:35
  It, it's an honor and a blessing to be able to work with,
• 14:38
  you know, the folks we're watching on Saturdays
• 14:39
  and Sundays with that, you know, not to quote Spider-Man,
• 14:44
  but I'm gonna do it anyway with great, um,
• 14:46
  power comes great responsibility, right?
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  So you have to, while it's a privilege, you have
• 14:51
  to take it seriously and you have to do your due diligence.
• 14:54
  One, I'd say, um, be vigilant when you're on the sidelines
• 14:58
  to my younger colleagues who are just getting into the game
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  or, um, or interested in the future
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  of it, put your phones away.
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  You can't treat what you didn't see,
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  especially on high velocity plays like kick returns when
• 15:10
  players reach top speeds, have a good understanding
• 15:13
  of what's the worst thing that can happen.
• 15:15
  For instance, there's a, there was a death in a, um,
• 15:18
  hockey player who was a former Pittsburgh penguin.
• 15:21
  I, I say this 'cause I'm from Pittsburgh
• 15:23
  and a big, big fan of Pittsburgh sports in general.
• 15:25
  Unfortunately, he caught a blade to the throat from, uh, uh,
• 15:29
  from somebody's skate and died from the injury.
• 15:32
  Um, now that's a hard thing to predict or prevent,
• 15:34
  but being aware of all potential
• 15:39
  catastrophic things that can happen in your sport, whether
• 15:41
  that's boxing, whether that's hockey, whether
• 15:43
  that's gym gymnastics, whether that's, uh, football,
• 15:47
  you just kind of gotta know what's the worst thing
• 15:49
  that can happen and kind of have a game plan as far
• 15:51
  as far as what you're gonna do.
• 15:53
  Now you can have all the best intentions,
• 15:55
  all the best training, and still have some unfortunate
• 15:58
  circumstances like that one.
• 15:59
  But doing things like making sure your a ED works prior
• 16:03
  to every game, you know, checking that, making sure
• 16:06
  that it's out and, and accessible.
• 16:08
  So if you have any of the events like we saw
• 16:11
  with DeMar Hamlin, you can respond appropriately
• 16:14
  and potentially save a life.
• 16:16
  Finally, the one
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  of the last things I'd say is put your egos in check,
• 16:19
  because at the elite level,
• 16:21
  these folks are receiving usually five
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  or six opinions, right?
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  You may be one of a host
• 16:27
  of opinions that people are getting.
• 16:29
  Be honest with your athletes. Gain their trust.
• 16:31
  Don't be upset if they're getting multiple opinions from
• 16:34
  other specialists, providers, anywhere else.
• 16:37
  Um, and, and don't be expected to be the team doc in the NFL
• 16:41
  or MLS or right out of the gates or, or Division one school.
• 16:45
  Just put in your time, grow your reputation
• 16:47
  and do what's best for athletes.
• 16:49
  And people notice, right?
• 16:50
  So, um, athletes talk, coaches talk and, and,
• 16:53
  and that, that's a great way to just do your job
• 16:56
  and good things will happen.
• 16:59
  - I love it. Well, thank you so much
• 17:01
  for joining me on the podcast today.
• 17:03
  This has been really a fun and fascinating conversation,
• 17:06
  and I look forward to
• 17:06
  connecting with you again in the future.
• 17:09
  - Thanks so much for your time.
• 17:10
  I appreciate the opportunity.
• 17:13
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• 17:16
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