Sports medicine, or more specifically primary care sports medicine (PCSM), is a field that is as rewarding as it is varied. Those in medicine will likely have heard the phrase “no two doctors have the same career.” The job of a general surgeon versus an OBGYN versus an emergency medicine physician are all completely different. I would like to also posit that no two primary care sports medicine physicians have the same career. Musculoskeletal (MSK) ultrasound, platelet-rich-plasma injections, fracture care, middle school sideline coverage, Olympic sideline coverage, concussion management, skin lacerations, weighing in on how to equitably foster participation of transgender athletes in sport: you name something related to the care of athletes or a person’s MSK health and we likely have a hand in it. 

My name is Dominick DeFelice, I’m a family medicine and sports medicine doctor in eastern North Carolina. I graduated from my family medicine residency and PCSM fellowship in western New York in 2023. I currently practice about 80% general family medicine and 20% sports medicine. In particular, I cover college sports and mass participation events, serve as a ringside physician with USA boxing, and love to do ultrasound-guided MSK procedures. I also work in a family medicine residency practice where I am faculty. I teach medical students and residents all the time and I try to inject (ha) as much MSK teaching as I can. On any one day at the office, I can see a 3-day old for their first weight check then a 102-year-old to talk about their end-of-life wishes then throw some cortisone in a middle-aged man’s aching shoulder. 

And that’s just me! Every PCSM doc does a different collection of things. Some practice only sports medicine, some (particularly those that did a pediatrics residency before fellowship) only see children, some focus more on concussion management, some go through their fellowship only to then ‘keep their day job.’ This might look like, for example, an emergency medicine physician who after a PCSM fellowship chooses to work in an ED as they always could or would have but armed with the special knowledge they gained from having done the extra bit of training.

Whatever led you to read this article, you did so because you have some level of interest in PCSM. Maybe you are a pre-med student, med student, resident, or you are already a practicing physician wondering about the field.  For those interested in pursuing a career in it, let me be your steward. Am I the world’s most experienced or renowned sports medicine doctor (a la Dr. Jonathan Drezner or Dr. Karl Fields)? Certainly not. I can’t aspire to be half of the true giants they are. However, I did just go through the training, am involved in a variety of sports medicine duties, and I like to think I’m approachable.

In case I haven’t already convinced you to join our (definitely not a cult) field, allow me to lay out some things that PCSM is and some things it is not to maybe help you decide. Here are three things PCSM is: fun and exciting, collaborative, rewarding. And here are three things PCSM is not: easy, high-paying, glamorous (usually).

What do I mean by fun and exciting? At the first ever college football game I covered as a fellow, my program director (picture a large man in his mid-40s) was standing right beside me on the sideline to help show me the ropes. The day before, he had two abdominal wall hernias repaired so, as you can imagine, he was quite sore. During the first quarter, the home team intercepted the ball right where we were standing and the player ran to his teammates on the sideline to celebrate. He was promptly lifted upside down and placed into a textbook ‘keg stand’ position above the water jugs. As that chaos was happening, my PD was desperately ducking and dodging the young men to avoid popping any of his stitches. His terrified squeals of “no!” and “careful!” still ring in my ears to this day. Need I say anything else about fun and exciting?

Collaborative. I can think of no warmer environment for learning, sharing ideas, and helping one another out than the half dozen sports medicine conferences I have been to in my young career. PCSM is a small though rapidly growing field of brothers and sisters who all want one another to be the best doctors they can be. There is no competition to figure out who is the best, brightest, or most prestigious. There is no stealing of one another’s patients (plenty to go around), there is no drama. We love one another, love what we do, love our patients, and love helping anyone who asks for it. 

And man is it easy to feel rewarded when you love what you do. Caring for people at the top percentages of physical fitness and motivation, helping someone akin to your grandmother walk comfortably again, using an ultrasound machine to show someone their diseased tendon in real time. These are all things I have the privilege to do routinely. So yes, PCSM is rewarding. 

On the flip side, it is not easy. Standing still for 3 hours in a field on a Friday night when it’s 18 degrees and (somehow) rainsnowing when all of your friends are out having fun can be hard. Spending a good number of your evenings and weekends, often unpaid, traveling to and from games or events is equally hard. Working with patients that have a BMI so low from calorie restriction and over-running that they should be hospitalized is one of the more challenging things I have ever done. 

It is also, as I’ve alluded to, not one of the higher paid specialties. Very few make anywhere near half a million a year, most will make less than half of that. So, if you are looking for an easy way to get rich, I can’t recommend PCSM to you. 

As for glamorous, there are certainly times when it can be. In 2024, at the largest sports medicine conference of the year this particular time held in Baltimore, I got to hear Simone Biles’ sports physician talk about working with the highly accomplished athlete at the Tokyo Olympics. I was entranced as this doctor, a deeply intelligent woman with many accolades of her own, recounted what her work before, during, and after the Olympics entailed. She was right next to Simone (like, as close as I was to my PD on the sideline of that football game) on the biggest stages possible for a PCSM doctor. It was awe-inspiring. However, it is not always like this. For example, in my ringside work with USA boxing, I’m often the last person the athlete, his or her coach, the officials, or the event organizer wants to see. I need to be there (legally for them to have the event), but they would all prefer it if I spent the whole card of fights sitting in my chair completely out of sight. Even my standing up is met with fear from the athletes and spectators. Entering the ring to do any sort of evaluation is invariably met with boos. But I have a job to do, and I need to do it. 

So you want to be a sports medicine doctor? I hope some of the above has given you a glimpse into what life is like as one. I hope to see you on the sideline someday.