What is a Sport and Exercise Medicine Physician?

In 2016, the College of Family Physicians of Canada (CFPC) determined that members who practice in a focused practice have an enhanced expertise and are a resource to other physicians and patients [1]. The Certificate of Added Competency (CAC) recognizes this additional expertise and skill set. Emergency medicine (CCFP-EM) and anaesthesia (CCFP-FPA) have long been identified as areas of focused practice, as have Palliative Care (CCFP-PC) and Care of the Elderly (CCFP-COE). Now, physicians who are qualified in Sport and Exercise Medicine can be awarded a CAC, which allows them to use the credentials CCFP-SEM. The leaders in Sport and Exercise Medicine in Canada have been identified, and awarded certificates of added competency. Now, all residents successfully completing a third year post-graduate training in sport and exercise medicine will be eligible to receive a CAC.

In 2017 the CFPC published the Sport and Exercise Medicine Key Features and Priority Topics. This outlined what is required to assess and determine competence at the enhanced skills level required for awarding a Certificate of Added Competency. This is the first such publication since the CFPC’s introduction of the CAC designation for the 5 domains of family practice.

Sport and Exercise Medicine (SEM) physicians have specialized training and skills directed towards assessment, diagnosis and treatment of acute, sub-acute and chronic injury and illness as they pertain to participation in an active, healthy lifestyle. More than just expert musculoskeletal assessment, the knowledge and expertise of the SEM physician extends to fracture management, joint reductions, joint and soft tissue injections, and interpretation of imaging studies, as well as rehabilitation of injury, nutrition, concussion/head injury, sport psychology, and orthotics/braces. SEM physicians are experienced in injury prevention, exercise prescription and assessment of pre-participation fitness for activity.

SEM physicians have a keen interest in sport, but also in the lifelong promotion of physical activity for wellness and the prevention and treatment of chronic diseases (i.e. diabetes, hypertension, obesity, arthritis). The SEM physician is well versed in the intricacies of medical management of disease and athletic performance, and has a thorough understanding of issues and problems of doping in sport.

A large measure of the SEM physician’s work is collaborative and multidisciplinary with other medical and rehabilitation professionals. Many sport and exercise medicine physicians also serve as team physicians for local and/or national teams, and are also responsible to coaches/team management for making decisions regarding return-to-play and fitness to participate. The SEM physician is also skilled and knowledgeable about the unique issues pertaining to persons with disabilities and inclusive sport participation.

Because of their expertise in musculoskeletal medicine, SEM physicians are often asked to work with “industrial athletes” in workman’s compensation settings, helping to prevent injury and to foster a safe and sustained return to work plan with minimization of disability. Many SEM physicians in Canada work in a comprehensive family practice setting, as a member of a group of physicians and increase the collective competency of the group.

In Canada, prior to the establishment of the CFPC-SEM certification, Sport and Exercise Medicine physicians were identified with a Diploma in Sport Medicine. This accreditation is conferred by the Canadian Academy of Sport and Exercise Medicine (CASEM) upon successful completion of a rigorous, 6-hour Objective Standardized Clinical Examination examination. Physicians can challenge the exam after completion of a recognized Fellowship (PGY3 residency) training program in SEM. Alternatively, there is a practice eligible route to challenge the Diploma exam, after a physician has established benchmarks in primary care and SEM practice, including a minimum of 50 hours of event coverage and/field-work with a sport team. Only physicians with a Diploma in Sport Medicine are considered for provision of care to national teams and medical teams at major multisport events such as Olympic and Paralympic games, Commonwealth, PanAmerican, and Universiade games.

Accredited primary care Sport and Exercise Medicine category 1 PGY3 enhanced skills programs are offered at 8 universities in Canada. All SEM Fellowships and Enhanced Skill Programs are governed by a uniform curriculum initially developed by CASEM. More recently the CFPC Working Group on Assessment of Competency in Sport and Exercise Medicine has completed the SEM Key Features and Priority Topics for the Assessment of Competency in Sport and Exercise Medicine. A link to this curriculum can be found here: http://www.cfpc.ca/uploadedFiles/Education/SEM_KF_Final_ENG.pdf

In 2017 in Canada, to be recognized as a Sport and Exercise Medicine physician, the physician must have a CFPC(SEM) designation and/or the Diploma in Sport Medicine. To find a sport and exercise medicine physician to refer patients to in your area, the Canadian Academy of Sport and Exercise Medicine (casem-acmse.org) and the College of Family Physicians of Canada (cfpc.ca) maintain national listing of diplomats and certifcants.

Reference:

1. College of Family Physicians of Canada. Online: https://www.cfpc.ca/CFPC/media/Resources/Education/SEM_KF_Final_ENG.pdf