Latest / UF Health MedEd Cast / It Goes Beyond the Game: Dr. Farmer's Role within the UF Athletic Association

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It Goes Beyond the Game: Dr. Farmer's Role within the UF Athletic Association · UF Health MedEd Cast

• 0:03
  Melanie Cole (Host): Welcome to UF Health MedEdCast with UF Health Shands Hospital.
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  I'm Melanie Cole.
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  And today, we're going beyond the game, being a team physician and handling
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  the pressures of Division I sports.
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  Joining me today is Dr.
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  Kevin Farmer.
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  He's a professor in the Department of Orthopedic Surgery and Sports
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  Medicine and team physician at the University of Florida.
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  Dr.
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  Farmer, thank you so much for joining us today.
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  When people hear team physician, and especially at the collegiate
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  or even professional level, what do they not fully appreciate?
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  If you were telling people about this role, help us understand the
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  role of a team physician and at such a high level, how would you define
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  this role within these organizations?
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  Dr Kevin Farmer: thank you for having me.
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  I appreciate the opportunity.
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  I think, you know, when people hear team physician at, at the D1 level or,
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  the NFL level or professional level, they think it's, just a lot of, fun
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  and glory, and you come in on game days, and that's about all you do.
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  But that really is just a very small token of what we do on a
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  day-to-day and a week-to-week basis.
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  I mean, being a team physician, really tasked with, first and foremost, looking
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  out for the health and the well-being of the athlete, both in the short term,
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  such as, getting them back for a game.
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  And, and in the long term, worrying about their futures and not doing something that
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  may jeopardize their health long term.
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  And you do that in the aspect of having to work both with the team, with
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  coaches, with parents, with agents, and kind of synthesizing all that
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  information and all their input, to help kind of make a, decision or, give
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  them information to make a decision that allows them to decide on, what
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  path they wanna go as far as treatment.
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  So really, you're herding a lot of cats, so to speak.
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  You're trying to get everyone on the same page and, make a decision
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  that's both in be-best interest of the athlete, but also to some extent,
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  in the best interest of the team.
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  and it's a tightrope you have to walk in many cases.
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  Melanie Cole (Host): also
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  Well, it certainly is.
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  And before we get into a little bit more about those unique pressures and
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  balancing athlete health, as you're saying, with team performance, I'd
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  like to know if you've ever had the opportunity to treat upper-level athletes.
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  briefly discuss your experience a little bit and tell us about UF
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  Health's partnership as the medical provider for the United States
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  Olympic and Paralympic Committees.
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  Dr Kevin Farmer: Yeah.
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  Th-that's been a great partnership.
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  You know, there are a lot of, Olympic athletes that train in the
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  state of Florida, and that train at the University of Florida.
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  I think at o-one of the more recent Olympics, they said that if University
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  of Florida was its own Country, I think we would've been like, top 10
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  or top 12 for medals for countries.
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  So we have a lot of athletes here at University of Florida that
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  are Olympic athletes, not just American Olympic athletes, but
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  athletes from other countries.
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  And so that partnership, I think, has been very beneficial that these
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  athletes don't need to leave the state.
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  they can stay here, get their care and, then get the proper
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  rehab and, therapy afterwards.
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  And so, these athletes are, are high-profile athletes.
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  They're under time constraints.
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  They're, they're trying to get back so that they can be prepared to, qualify
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  for the next step and, and stay in the mix because, you know, there's always
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  someone else, trying to get that spot.
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  but I think that relationship with UF Health and, the Olympics has been
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  mutually beneficial, and we've had a lot of high-level athletes that have
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  done well and had good outcomes with us.
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  And, once the word gets around that, the athletes are comfortable to stay
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  here and don't feel they have to leave to go to other states or other
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  areas 'cause we, can provide that high level of care here in Gainesville.
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  Melanie Cole (Host): Well, thank you for telling us about that, Dr.
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  Farmer.
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  And so I'd like you to speak about the transfer portal and the name, image,
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  and likeness, the NIL, how that deals and changes the physician-athlete
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  relationship within the NCAA.
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  Do you see differences in continuity of care or medical documentation
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  with increased athlete movement?
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  Tell us how that transfer portal affects the care of college athletes.
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  Dr Kevin Farmer: Yeah, it's a great question, and something that's
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  become more and more of an issue for us in the last five years.
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  You know, unlike the NFL or other professional
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  organizations that effectively have shared electronic medical
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  records, we don't have any of that.
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  And so at this point, there's no SEC shared medical records medical
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  records amongst different conferences.
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  And
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  so it's not uncommon for me to operate on, an athlete
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  and then find out,
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  next day or the
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  next week that they're transferring to a different school and then not to really
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  get any kind of follow-up or,
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  any kind of discussion or anything to make sure
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  that they, have the care that I would want them to have.
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  And so, vice versa, to get an athlete that shows up for physicals
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  with us that had surgery a week
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  ago that I didn't know about at a different school, and now
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  they're kind of our problem.
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  And so in that situation, who pays for the rehab afterwards?
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  You know, how do we make sure that they're following the rehab plan that the surgeon
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  wanted, that I wanted before they left?
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  And so it takes a lot of initiative amongst ourselves.
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  We have to reach out to the other teams.
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  We have to find out where they went.
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  A lot of times we don't even know where they transferred to.
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  We don't hear about it.
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  And so There's a lot of effort on our part to make sure that there's some,
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  line of communication to make sure these athletes are taken care of appropriately.
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  Because end of the day, you know, every year I'm at the NFL Combine with the
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  Dolphins, if one of my athletes comes through that I did surgery on and then
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  they transfer and I lose track of them, they're gonna come back to the combine
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  and my name is still gonna be on that chart for the one who did the surgery.
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  and if they have a poor outcome because they didn't follow the postoperative
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  plan, I'm the one that looks bad.
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  And so have to make sure you, make the effort to communicate and find
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  out where where they're going.
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  And, likewise, if we get somebody from another school that's had surgery,
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  I, try to reach out to the, team physician there to get some information.
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  But it is not ideal, unlike the other professional serv- leagues
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  that have figured this out.
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  We have not figured that out at the Division I level and, we need to find
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  a way to figure it out, because as the athletes get put in this, back-and-forth
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  situation, and we need to make sure that we get this down where we're
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  all on the same page, we all have the ability to get the records easily
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  and can continue to take care of them no matter if they transfer or not.
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  And I suspect in the next five to 10 years we'll have that, but right
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  now that is not where we are.
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  Melanie Cole (Host): That is so interesting, Dr.
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  Farmer.
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  And when we think of professional free agency model that's so affecting athlete
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  care these days, and we think of the mental health strain from high stakes
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  negotiations and the scrutiny on social media, that's a big one, the pressure.
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  I'd like you to speak a little bit about the physical health to determine
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  injury risk, how the teams assess draft prospects as the medical evaluations
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  are considered one of the most crucial elements of the combine that really can
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  determine a player's draft stock more than even sometimes on-field drills.
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  Walk us through the medical evaluation process at the combine.
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  What's actually happening behind the scenes?
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  Dr Kevin Farmer: at the combine level, every athlete will get a, grade, so an
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  orthopedic grade and a medical grade.
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  And, so the primary care doctors do the medical evaluation, heart, lungs,
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  labs, all those different things.
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  And then the orthopedic doctors for each team will do the evaluation
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  and, give them a, orthopedic grade.
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  And teams do it differently, but it's effectively A, B, C, D, kind of an F.
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  And, and so that grade, based on, if they've had a meniscus tear and,
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  have had part of that trimmed out, do they have cartilage injuries,
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  that gives the teams an idea what is the long-term risk of, this athlete.
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  Is somebody has bone-on-bone arthritis in their knee, they're probably gonna get
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  a D or, maybe even a failing type grade.
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  So that way when the team looks at them, they know that there is a risk
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  with taking an athlete that may not have a, a long-term, perspective
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  because of some underlying injury.
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  And so, you know, at some point the talent level and the medical grade they go
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  head-to-head and, and you make a decision on which of those is more important.
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  if the talent exceeds the medical's concern, then they'll get
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  drafted and it doesn't affect it.
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  But if the medical concern is enough where, doesn't exceed the talent, then
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  those are the people that unfortunately probably fall down in the draft because,
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  the l- the higher you're drafted, the more guaranteed money you get.
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  And so if there's a concern that you may not last a year or two because of the
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  underlying issue, then a team doesn't wanna, invest money in you upfront.
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  Now the same thing happens now to some extent at the Division I level.
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  We never had that issue, but now because of revenue share agreements,
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  all these kids are guaranteed, at least in football, are guaranteed some amount
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  of money, and that varies amongst the schools based on how they divide up the
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  revenue shares amongst the different athletes and the, different teams.
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  And so now that these kids n- not only get a scholarship, now get some
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  sort of guaranteed money, now their health history comes into play.
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  Whereas in the past it maybe wasn't quite as big of an issue, now if somebody's
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  a, had a bad injury or missed the previous season because of an injury,
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  we often get asked to weigh in on that.
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  what's the likelihood this kid could play four more years?
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  You know, is it worth us investing whatever amount of the revenue share
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  that they're gonna invest in somebody that's got a long injury history?
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  So that was something in the past that we didn't have to really deal with, that
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  now you really have to weigh in because now there's a monetary tie or monetary
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  number to each one of these athletes, unfort- uh, good or for bad, depending
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  on how you look at it, but there is a monetary tie now to these athletes.
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  Melanie Cole (Host): So Dr.
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  Farmer then, is there both hospital and on-site testing, and is there a
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  standardized assessment for injury risk before the draft when we think
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  of these specialized scans that would have to take place in the hospital,
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  and then orthopedists looking at injured areas, risk for injury?
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  Tell us a little bit about that.
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  Dr Kevin Farmer: at the NFL Combine, it's been done in Indianapolis now for the last
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  20 years, and I don't see any way that they could possibly move it out of there.
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  They've talked about moving it just for kind of a moving road show like they do
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  the NFL Draft, but it's so well organized and, set up in, downtown Indianapolis.
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  I don't see any way you could do that in a, different town because they
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  have, Lucas Oil, so the Colts stadium is connected to the convention center.
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  All of that is hardwired into the, University of Indiana hospital system
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  so that we all have access to imaging.
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  So an athlete comes in initially, they get an intake evaluation
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  by an athletic trainer.
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  Often they will already have most of their injury history just from
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  communicating with the college teams and the college athletic trainers.
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  So they'll know they missed, last season because of a knee or they
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  missed this season because of a foot.
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  And so they'll get X-rays and typically MRI right then at, that point at, the
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  University of Indiana hospital system.
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  And then at the combine we have access to view all those, to see the reports.
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  And they also have MRI units in the Lucas Oil Stadium if we need to get more MRIs.
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  And so it's not uncommon for an athlete to get five or six MRIs
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  as part of the combine evaluation, just based on their injury history.
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  And then that goes into the evaluation a- and deciding on
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  what their orthopedic grade is.
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  Melanie Cole (Host): So then let's talk about your game day responsibilities.
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  What does that look like for a team physician from start to finish?
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  How do you prepare for the unpredictability of acute injuries and
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  then some ongoing chronic injuries?
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  Dr Kevin Farmer: part of it is the preparation before.
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  So, you know, make sure that you have, all the, potential medications,
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  anti-inflammatories, those kind of things, you have those, stocked and refilled.
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  So if you do need those, pre-game or in the game that you're ready.
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  you make sure you have, have X-ray, available and set up.
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  we typically have, X-ray brought into the stadium for game day so
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  that it's right there immediately available just off the field.
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  You know, you make sure you have an X-ray tech available.
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  Make sure all those kind of things are lined up.
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  you would've already met with, paramedics and EMT, before the season
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  to make sure you have a plan in place where they're gonna be positioned.
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  what's the plan if somebody has to get spine boarded and put into an ambulance?
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  All those things are all worked out.
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  We call it a, an emergency action plan.
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  we've gone over that.
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  We've rehearsed it.
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  Everyone's on the same page.
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  so those are the first steps, the first line, steps.
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  And then on game day, you know, typically my game day I get in about two and a
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  half hours before the game, give or take.
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  I try to be there before the, home and visiting team get there.
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  So about two and a half hours before the game, you know, you get set up, I
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  talk with the athletic trainers, who's having any ongoing issues that we may
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  need to discuss, plans, before the game.
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  who's having any problems that are on the fence that may not be able to play.
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  You get those things lined up.
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  , If anyone needs to be evaluated before the game starts, , be ready for them.
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  , And then obviously the game usually lasts about three or four hours, so that's,
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  , seven, eight hours that you're there.
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  Usually hang around another hour afterwards and make sure there's
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  no evaluations afterwards.
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  You don't need any X-rays.
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  The visiting team doesn't need any X-rays.
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  You know, we also-- I skipped one part.
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  We do a timeout about an hour before the game with all the visiting team physicians
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  and medical staff so that, so that they know where X-ray is, where paramedics are,
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  what's the plan as far as the emergency action plan if we need to get somebody,
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  in the ambulance and taken to the hospital so that they're all on the same page.
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  And so, then in the night, you know, an hour after the game, you're able to
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  go, and then the next day you come in and, you do injury checks all over again
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  and make a plan for the upcoming week.
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  so game day weekends is a lot more than just what you see on TV.
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  There's a lot more that goes into it that, keeps you pretty busy.
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  Melanie Cole (Host): Well, I imagine that is true.
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  This is such a great topic to talk about of, interest to so many people.
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  You have a cool job.
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  I mean, Dr.
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  Farmer, let's put that right out there.
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  You have a really cool job.
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  And so as we wrap up, what are some of the most important aspects and personality
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  traits And I love this question because I, want to hear from you about what
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  you feel are your best personality traits that make it so that you can
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  not only handle the pressure and the scrutiny, because social media and all
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  of that, as we said, but the pressure of keeping these athletes healthy.
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  And if somebody wants to break into the sports world as a team physician, as I
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  imagine many, young upcoming physicians would like to do, what do you find are
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  some of the important traits that you yourself have, and what advice would
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  you give to these clinicians that are interested in entering this field?
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  Dr Kevin Farmer: Yeah, I think first and foremost it's, communication.
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  The ability to communicate well with the rest of the team.
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  End of the day, that it's a team approach.
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  and so that's got to be first.
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  You know, number one is, is, you know, your ability to communicate
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  with the athletic trainers, the athletes or family, the coaches.
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  I think that's critical.
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  I'm a former athlete myself, and so I think having that experience can
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  be very helpful, understanding a team approach and working well with a team.
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  You know, but also developing sort of thick skin.
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  , As you said, there are gonna be some shots fired on things on social media
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  that people may not have really the understanding of what's going on,
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  but they're still gonna fire some shots, and you just got to let those
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  things roll off your shoulders.
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  And, you know, as long as you're doing what's in the athlete's
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  best interest and, doing the right things then nothing to worry about.
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  So I think, being a hard worker, being used to being in a team
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  environment, working well with a team, having support, I think it's
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  critical to have support at home.
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  as I mentioned that, these are long days and long weekends and, having, support at
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  home that, know, allows you to, do that I think is critical 'cause you miss out on
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  a lot of different things in your personal life that maybe if, you weren't doing
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  those things that you'd be able to do.
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  And so I think having good support and a good, social
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  system I think is very important.
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  But I think end of the day, being a hard worker, doing what's, in the
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  best interest of the athletes and being able to communicate well and
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  work well a team are probably the most critical aspects to being successful
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  as a sports medicine physician.
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  Melanie Cole (Host): Thank you so much, Dr.
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  Farmer, for joining us.
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  What a great episode this was.
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  Thank you for joining us.
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  And to learn more about this and other healthcare topics at UF
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  Health Shands Hospital, please visit innovation.ufhealth.org.
• 16:15
  And to listen to more podcasts from our experts, you can always
• 16:18
  visit ufhealth.org/medmatters.
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  That concludes today's episode of UF Health MedEdCast with
• 16:25
  UF Health Shands Hospital.
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  I'm Melanie Cole.