I'm the chair of the AAPMNR Medical Education Committee and your host for this evening. I have a distinct privilege to introduce our speaker tonight for National Grand Rounds, Dr. Jonathan Finoff. So this introduction is gonna be a little weighty, so hang with me. Dr. Finoff did his medical education and achieved a medical degree from the University of New England. He went on to do residency in PMNR at the University of Utah. From there, he moved to the Mayo Clinic in Rochester, Minnesota, and did a sports medicine fellowship under Jay Smith and Ed Laskowski. He became board certified in PMNR, subsequently in sports medicine, and then added credentials in musculoskeletal ultrasound. He's a professor of PMNR at the Mayo Clinic still. He has worked in the private sector as well as academia with both established practices and startup practices. He has been with the United States Ski Team for almost 20 years, and with them traveled the world for the Winter Games, Winter Olympic Games, World Championships, World Cup events. And in his free time, Dr. Finoff served as the American Academy of Physical Medicine and Rehab Board of Governors, and I believe simultaneously with the American Medical Society for Sports Medicine Board of Directors. He has developed extensive curricula in musculoskeletal ultrasound for both of these organizations. And I know from personal experience, having worked alongside of him, that he's a remarkable teacher and presenter in both the areas of musculoskeletal ultrasound and sports medicine. He has expansive clinical interests in the field of sports medicine and MSK ultrasound that include exertional leg pain, advanced diagnostic ultrasound techniques, and minimally invasive ultrasound-guided interventional procedures. And I think some of these are gonna change the way we deliver care in musculoskeletal medicine. He has developed numerous courses and served as faculty both nationally and internationally. He's highly sought after as a speaker and presenter. He's extensively published in peer-reviewed journals. He's written numerous book chapters, and he's the co-editor of Sports Medicine, A Study Guide and Review for Boards, which is now in its, or coming up to its third edition. And if that's not enough, on March 3rd, 2020, Dr. Finoff was appointed the Chief Medical Officer for the United States Olympic and Paralympic Committee. So John, congratulations. Thank you for doing this, and welcome to National Grand Rounds. Thank you very much. That was, it's always hard to sit there and listen to somebody produce music like that, but I really appreciate it, John. And just so people know, one of my inspirations as I was going through residency and thinking about my career was John Sianca. So right here, I went to the Baylor Board Review Course, and I got to see John Sianca talk about this. The sports physiatrist, and that's what I wanted to be when I grew up. And so here we are talking in the National Grand Rounds, and I'm really proud to be here with you. Thank you. Thankfully, those lectures were not recorded because they were pretty middling. But it was, I remember that day. I remember you as a senior resident coming up and asking me those questions. So that being said, let's kick off our discussion. So when you were as a resident and immediately after, what were your career aspirations? What were you hoping to do with yourself? Yeah, well, I mean, so when I was, for those of you who have heard this story, I apologize, but I'll tell you sort of how I even decided getting into medicine and what I thought about doing in medicine. So when I was in high school and going into college, I was bike racing a lot and ski racing a lot, and had the good fortune and the genetics to do pretty well at them, and ended up going professional in bike racing. And so I was racing professionally and thought that that would be my career and that I would eventually have to retire when I got slow and fat and old like I am now. And I would go into business, and probably business within the bike industry. But kind of after my first couple of years of college, I was riding my bike home from a test kind of late at night and going across this bike bridge in Boulder. I went to CU where I grew up in Boulder, Colorado. And so I went to CU for undergraduate and I was riding my bike home, going across this bike bridge. There's this guy laying in the middle of the bike path. And so I flipped my bike around and went back to see if he was okay. He looked like a college age kid. And as I got closer, it looked like he probably drank too much and passed out and thrown up. There's liquid and stuff. But as I was looking closer at him, that liquid was getting bigger and bigger. And it turns out as I looked closer that I realized that was blood. And he was bleeding. His eyes were open. He had agonal respirations, which I didn't know what those were at the time. And it was obviously super traumatic. I didn't know what to do. I had no medical training whatsoever. There's a pre-cell phone for you. So I rode my bike over to the public library, which was right next door and called 911 on the pay phone and went back and waited with this guy until the ambulance showed up and he stopped breathing and died. And I felt like I didn't do anything. And in hindsight, he had committed suicide. He shot himself in the head and there was nothing that I could do. But at the time it was really traumatic. And I felt horrible that I hadn't done something to render some first aid. And the type of bike racing that I was racing was mountain bikes. And mountain bike racing, of course, is inherently dangerous. And a lot of the training is done in the back country. And so it would be one or two of us out riding. And if somebody got hurt, I thought, man, I need to have some sort of medical skills so that I can take care of them or myself. And so I switched. I decided to take an EMT class, took the EMT class, loved it, thought, oh my gosh, this is what I really wanna do. And so I switched my major to a pre-med type of major and went to medical school. So when I went into medical school, I had every intention of doing sports medicine based on my background and my desire to work with athletes. Which, interestingly enough, at the time it was getting to be a while ago, sports medicine was still kind of fledgling, not probably as rudimentary as when I started, but it was still pretty formative and largely the domain of orthopedics. So even then, it was a pretty bold idea. It wasn't one that was destined to be successful. So after you got done with fellowship, you began your career, you worked academically for quite a while, then went to a private practice and then back to academia in more of a startup program in Minneapolis, which was an expansion of what you'd done at Mayo. Of all these different experiences you had, and I think you were in Utah for a while too, what did you find rewarding and challenging about them? And of those, which was your favorite, if there was one? Well, I mean, I loved working at Mayo Clinic and I'm still very proud to be on faculty and a professor at Mayo Clinic. I think it is an amazing institution to work at and had amazing colleagues to work with. So I loved both my time in Rochester and up in Minneapolis. They were totally different. Up in Minneapolis, it was a new sports medicine center that they were putting together. It was with professional athletics. It was developing a practice. And while I would go down to Rochester once a week, you were in a smaller practice and had some orthopedists that were coming through and so on, but it was a smaller practice. But it was also an amazing opportunity to really help mold a practice and develop what we wanted to do. And it started out with working with the Timberwolves and Lynx. We eventually got a college. We started working a lot with weekend warriors who worked in downtown Minneapolis and were highly educated and really interested in their health and very competitive. So it was pretty exciting and then expanded the faculty in that area and brought on some great colleagues, Jeff Payne and Ellie Gelsing. And really, really enjoyed working with them a lot and then developed it as a destination center as part of Mayo Clinic as a whole. And so having people travel from outside of the community around the country and around the world to come and get their medical care. And so that was really fun. But each of the different locations that I worked had their own wonderful aspects and challenging aspects. The private practices in general are hard because a lot of times, if you're working in an orthopedic group, which those are the settings that I worked in, they value you to some degree, but you're not an orthopedist and so they're running a business and they're all competitors with each other. And often it's just shared overhead. And initially they're excited about having you there, but if you're really successful, then to some degree you become a competitor with them. And so that makes it difficult to be successful in that. And frankly, I don't like that environment. I have no problem with competition, but I want competition for our group to be better than any other group as opposed to me being a competitive with another member of my group. That just makes no sense to me. And I don't think it benefits the patients. So that was a little bit frustrating, but I had the opportunity to live in some amazing areas. I worked and lived in Lake Tahoe and in Bend, Oregon and out of Utah. And one of the other experiences that was early in my career that was quite formative was being the head team physician at Utah State University, which is a division one school with college football and track and it was a big school with a lot of athletes. And I was early in my career and you really learn what sports medicine is when you're taking care of all of those athletes and you're the one who's taking care of herpes gladiatorum as well as their dislocated elbow and whatever else they come in with. And so it really was interesting and showed me that sports medicine is not just musculoskeletal. It is very much medical, but it's not just medical either. You really have to have a broad spectrum of knowledge. And then one of the things I think is great about physiatry is you have to be a leader of a team. And so you need to identify the consultants that are gonna help you to be successful when you're taking care of your athletes. And physiatry really prepares you to be a team leader and to assemble a group of professionals to deliver the best care for your athletes. So John, back then, of course, AAPMNR was not participating in CAQ and of course your fellowship was based in MSK. So how did you acquire the primary care basis that is now routine and part of the curriculum for sports medicine fellowship? Yeah, well, so I think that if, as you're going through your residency, of course, it's really important to make sure that you're learning as much medicine as possible during your residency. And certainly the people that we're taking care of in rehabilitation units, and frankly, as outpatients in general physical medicine rehabilitation are getting more and more sick and have higher acuity. And so you really can hone your medical skills during residency. So if you wanna go into sports medicine, I think it is important during your residency experience to try to learn as much as you can, which I did. I really focused a lot on that during my residency. My fellowship was more MSK based, but I think that the Mayo fellowship and Jay Smith and Ed Laskowski in particular really provided me with a lot of opportunities to learn the medical aspects of sports medicine as well. And then of course, my first jobs involved being the head team physician, major university, working at the Olympics and the Paralympics, starting to work with the US ski team. All of those required a combination of medical skills as well as musculoskeletal skills. And so focusing on it in residency, developing it more in fellowship and then having it as part of your job when you went out, I was constantly reading, I was constantly calling people that I trusted as resources. Frankly, during my fellowship, I developed good relationships with people outside of physical medicine and rehabilitation as well so that I could have them as resources and be able to call them when I had questions. So moving on, as you became a team physician, particularly with the US ski team, you'd be gone for weeks at a time, certainly at the Olympics and Salt Lake City and then in Korea, you're gone three weeks at a time sometimes. So how did you balance that with your practice and not to mention your wife and daughter? Yeah, so I think it's an interesting question, John. And I think that when people talk to me about sports medicine and say, I really wanna do sports medicine and now it's kind of come back to, a lot of sports medicine is volunteer, it's nights, it's weekends and it's time away from home. And so it really is a labor of love and you have to love what you do or else you're gonna hate it. So you really have to know that this is on your spare time. And for the most part, since it is volunteer frequently and you're not getting paid for it, if you're in private practice, not only are you not making money at the events that you're covering, but you're paying your overhead back home and you're not generating any income by seeing patients back home. So I think that in my experience, it worked out better for me when I was in academic settings with groups that were supportive of me being on a salary and that part of my job was covering these different events. And so that made a big difference for me. But when I was in Lake Tahoe, that was part of my negotiation. When I went there to work in a private practice setting, I said, I'm gonna be traveling with the U.S. Ski Team X number of weeks per year. I have these other obligations with AMSSM and AAPMNR on their boards. And so I need to have my income supplemented during those timeframes. And I need to have support from the hospital and from the group that this actually having a national reputation, bringing in patients because of what I'm doing will actually be beneficial, not just for my practice, but for the entire practice. And so overall, I was able to offset my income in that manner, even in a private practice setting. But it is hard and it's hard, you have to have supportive partners, whether you're in academics or private practice, because if you're gone for three weeks, your patients are gonna, they need somebody. You know, they need to see somebody. If you're doing a procedure, there needs to be follow-up. Athletes gets injured while you're gone. You need to have a trusted colleague that can see them. So it's very, very important to have a great set of colleagues that you're working with that are very supportive and are willing to cover for you while you are out of town and with your family. You know, when I got married, my wife, you know, we met while I was in residency and I was busy in residency and I was busy in fellowship. And my life ever since we met and have been together has been like this. And so, you know, there were expectations set early on and we discussed it and I do my best to, you know, when I can, I'm home as soon as I can after work, I do everything I can at work. And when I come home, I try to not, you know, if I'm sitting at the dinner table, unless it's an emergency, I'm not looking at my phone. And then I set specific blocks of time because, you know, sports medicine is 24 seven. And so I work in the evening late, I work early in the morning and I do stuff through the day. But when I'm with my wife and daughter, I try very hard to be extremely focused on them. So it's good quality time. We take good solid vacations and enjoy each other in that manner. When I'm gone, I call, you know, I call frequently, we do FaceTime, but it's hard. You know, those, you know, frankly, I've been gone for five weeks at a time with the Olympics and coming up this year, I've got the Olympics, the Paralympics, the Youth Pan Am Games, the Youth Parapan Am Games, the Winter Olympics and the Winter Paralympics, all within about a seven month timeframe. And so I'm probably gonna be gone a third of that timeframe. That's a lot. That's gonna be the most I've ever been through. And, you know, I've got a very supportive family, but that's gonna be challenging. I bet. So in your leadership roles, particularly with AAPMNR and AMSSM, they're not simple either. I know from being on the board of governors with AAPMNR, there's a lot expected of you. So what did you find that surprised you about those roles and how did those roles affect your career? You know, it's interesting. I love each of the different aspects of my career. So I love clinical care. I love developing a relationship with people. I love using my brain to try to figure out problems. I love delivering really good innovative treatments that affect people's lives positively. So I love that. I love education. It is so cool to have residents and fellows and go to conferences and teach at those conferences and stuff. And with boards being on the AAPMNR board, not the ABPMNR, but the AAPMNR board of governors and the AMSSM board of directors, you have really amazing people that tend to be on those boards. And I learned so much as an individual and from a leadership standpoint, I learned so much from interacting with these people that are just giants in the field in the whole spectrum. It's from musculoskeletal to inpatient and private practice academic. And so I felt like it was a whole different world that really opened up to me and I was excited and I loved the projects and I loved advancing our field and being an advocate for what we're doing. And I truly believe that the AAPMNR absolutely 100% has the best interest in mind of physiatrists. And I loved being a part of that and working with the people on that board. So it was a really gratifying experience despite the fact that it's more time, it's nights and weekends. So USOPC, they've tapped on your shoulder a couple of times. So what got you to sign up this time? And I presume it was late last year. Yeah, it's interesting. I've been working with... So my first experience with the Olympics was back in Paralympics actually, it was back in Salt Lake. So I'd finished my fellowship in 2000. The Olympics came to Salt Lake in 2002 and along with the Paralympics. And I had the opportunity to run the athletes clinic for the Salt Lake organizing committee at one of the venues. And then I ran the entire medical care for the whole venue during the Paralympics. And it was an amazing experience and it was one of the ski venues. And so I ended up meeting the head team physician for the Nordic team. And I had cross-country ski raced when I was in high school and a bit in college. And so really enjoyed him and enjoyed the athletes. Actually saw a bunch of people that I had grown up with, ski racing and stuff who are either on the national team or were affiliated with it as either a coach or wax tech. So loved it, thought the Olympic movement was amazing and then had the opportunity to continue working with the US ski team thereafter. And then went to several Olympics. And just Olympic sports and Paralympic sports, it is amazing. In general, the athletes tend to be, they're not as highly paid as some other professional sports. They're doing it out of pure dedication for their sports. And they tend to be really humble people. And they really, really appreciate the time and efforts that you put in as a physician. And so I had developed these great relationships, loved the Olympic movement, loved going to the games. And then this opportunity came where for the first time, they wanted to hire a physician to run sports medicine for the Olympic and Paralympic movement. And I thought, boy, that's a pretty cool opportunity for somebody. But I deleted the email when they sent it to me because I had a great job. I loved Mayo, had great colleagues. I felt like I had achieved my career aspirations. And frankly, I had some things that I was gonna be doing at Mayo that for me, from a career standpoint, were gonna be very, very fulfilling. But they kept contacting me and saying, well, we talked to so-and-so and they said, you'd be great, you should look at this. And I said, thank you for contacting me. I'm happy where I am. And then some things were happening, some changes were happening at Mayo Clinic. And I thought, you know what, this is an opportunity of a lifetime. And frankly, if you're the first physician that goes into the Olympic and Paralympic movement in the United States, you have the opportunity to really establish what things will be moving forward. This is a big transition for the Olympic and Paralympic movement for a lot of different reasons that people are aware of. But the medical aspects of Olympic and Paralympic sport has been poorly organized. And I'm not saying anything negative about my predecessor. It's just how the structure was before. Things are changing. This was an opportunity to really be very impactful in an area that I loved. So I started talking to them. And as I talked to them more, I felt like that this really was an opportunity that I should take advantage of. And they were excited about my application and my background and experience. And so over the series of several months and talking to several of my mentors at Mayo Clinic included, I decided that this was an opportunity that I couldn't pass up. So I remember reading the announcement and it was stunning. I mean, not only because a physiatrist was gonna be perhaps one of the most important sports medicine physicians in the country, but because now you were undertaking both able-bodied and disabled under one roof, which hadn't been done before. And then of course you had the impeccable timing of being hired on March 3rd, 2020, what, three hours before the pandemic was called or something like that. So what's it been like? You know, it must've just been an absolute tornado of activity. For those of you who know me, I think that when I went to Mayo originally, I had dark hair and then it kind of turned gray and people were like, wow, it must've been challenging. This wasn't the Minneapolis experience. It was actually down in Rochester. I think I was just genetic. My hair went gray a little bit, but I swear I have aged years in the last, I guess, eight months. It has been incredibly challenging for me, for all of you. You know, I'm not telling you anything that you didn't experience, but I'll tell you starting my new job and I immediately formed an infectious disease advisory group. The pandemic was declared within about a week and a half. The Olympic and Paralympic training centers were closed because of public health mandates. All of our athletes were scrambling because the Olympics and Paralympics had not been postponed at that point. And so we were trying to figure out how to get our athletes opportunities to train around the country and how to deal with the pandemic. And then of course, the Olympic and Paralympic games were postponed. Then there was the challenge of figuring out how do we reopen sports safely? And so I engaged a lot of infectious disease experts, sports medicine experts from around the country, you know, people who organize events, people who run training centers, just really tried to get a broad spectrum of input on what are the different logistics and things we need to think about when we're planning a return to sports. And then I wrote two fairly comprehensive documents that are guidance documents on the return to training and the planning of events. And those were posted, you guys can see them at teamusa.org backslash coronavirus hyphen updates. So, but if you go to teamusa.org, you're gonna be able to find these updates under the coronavirus updates. And then we planned, we opened up the training centers. We did that in a phased approach. And we started off with lower risk sports with healthy athletes that had lower numbers of participants that we could keep separated and physically distanced. And so we had success with that. We gradually increased it and eventually had it up to the point where the training centers, they weren't running as they had before because we were still having single rooms. We weren't putting multiple people in rooms and stuff, but we had onsite athletes who were accessing the facility, offsite, or excuse me, onsite athletes who were living and training at the training centers, offsite athletes who were accessing the training centers and had gotten back to essentially near normal operations with all of the COVID mitigation measures in place, which I am happy to talk about if you guys would like. But unfortunately, this third wave has been huge and dramatic and really affected our training centers and differently. So we have a training center in Lake Placid. We have the training center in Colorado Springs. We have a training facility that's out in Chula Vista that's run by a different organization, but we have a lot of our athletes there. And then of course we work closely with a lot of the winter sports who are based out of Utah and Park City in particular. So long and short of it is that this last week, one of the really unfortunate things is we're almost up at 100 cases per 100,000 each day in El Paso County, which is where Colorado Springs is based. And we just didn't feel that we could keep the environment safe and the hospital capacity is full and on surge capacity. And we felt like the most prudent thing to do from a public health standpoint and for the safety, health and safety of our athletes and staff was to temporarily pause training here in Colorado Springs, which was a really, really tough decision for us. And obviously a difficult decision for our athletes who are training for games that are about seven months away. They're just right around the corner. Chula Vista is still open. Utah is still training and so is Lake Placid, which Lake Placid has the safest environment for our athletes right now, but it's almost all winter sports there. But this has been a whirlwind. I work hard. Anybody who has known me, I'm a hard worker. I love what I do. I've worked harder here and spent more time on phone calls and up late and up early than any other job I've ever done. And I think it's a combination of trying to lead the Olympic and Paralympic movement as a whole and reform it. And at the same time dealing with this global pandemic, which is constantly throwing curve balls at us. And another aspect of this, which some people may not know, is of course there's all the individual sports organizational areas around the country and you're more or less interacting with them if not overseeing them, correct? Yeah, so from a structural standpoint, to give people a little bit of background information, the U.S. Olympic and Paralympic Committee, it used to be the U.S. Olympic Committee and they recently incorporated in the Paralympic Committee. I think it's just over a year at this point, year and a half. And we're one of the few national organizing committees that has actually combined the Olympic and Paralympic Committee into one group, which I am very, very proud of. But they are a mandated or they're an organization that is created by a congressional bill and they don't get any funding from Congress. So you have to, it is a nonprofit, but all of the funding has to come from outside of government resources. And they are in charge of taking athletes to Olympic and Paralympic Games, Pan Am and Parapan Games, and then the Youth Olympic Games. They have the training facilities, but the training facilities are for national governing bodies to use to train their athletes, but they're not, it's not like the NBA where they have the NBA bubble, it's for basketball. Our training facilities are for any sports that wants to essentially come and work out and train in our facility. But the national governing bodies are the small businesses of sport and they fall under the purview of international federations. So I'll give you guys some examples. There's the International Ski Federation or FIS, and then, and they run international ski competitions. And then there's the US, the national governing body for skiing, which is the USSA, United States Ski and Snowboard Association. And so they fit underneath FIS. Now, when we go to an Olympics, we get our skiing athletes from the USSA, but the USSA is an independent organization. They are not part of the USOPC and we cannot tell the USSA what to do. However, as everybody's read in the papers, there have been some really bad things that have happened in sport and in particular Olympic and Paralympic sport over the last several years, you know, with Larry Nassar and so on. And so it's recognized that there needs to be a little bit more oversight and the leverage that the USOPC has is funding. And so essentially the USOPC provides some funding for the NGBs. They get a lot of funding from other sources, but in order for an NGB to receive funding, they recently have created a program where the NGBs have to be certified and they have to meet specific criteria in order to have that certification. So all of that means that while NGBs are independent, they have some dependence on us for money and we also want to support them in the development of their athletes. And we also want to make sure that it's a safe and healthy environment. And so all of this means that we're working together closely with NGBs and from my standpoint in particular, trying to develop more specific infrastructure such that the USOPC and NGBs are working closer together in ensuring the health and safety of our athletes and they're getting the medical resources that they need, but also people are accountable and that's super, super important. So, looking ahead, Olympic Games 2021, are we gonna be able to do it? Are we gonna be able to, when obviously it's not strictly a US decision, but what's the forecast? Yeah, I mean, at this point, I would be shocked if we did not have a games. And there are a whole bunch of reasons for that. Number one, Japan has done quite a good job of mitigating COVID-19. And so if they can do it at a national level and handle it well, and they can keep their prevalence quite low, then that helps set them up for success. They have a very strong public health system and a great medical system as a whole. So that also is helpful. They've got good infrastructure. In addition, we've seen multiple success stories from professional sports around the world and how to hold sports events, how to train. And it doesn't mean that people are not testing positive, but there are different extremes where you can do something that is a bubble like the NBA, where essentially after they've come through the bubble, they had almost no positive cases of COVID-19. Whereas sports that have a much more leaky bubble and people are interacting in the community and you look at college sports, they're really, really struggling. The Olympics, I think, would be able to create a more significant bubble environment that would allow them to have a lot of success. So that's right there. I think that there's been demonstrated success. They're learning from those success stories and they've developed a COVID mitigation plan that I think would be successful. On top of that, we have multiple recent developments in vaccines with vaccines already available in several different countries around the world and shortly to be available here in the United States. And while the population will only be partially vaccinated by the time summer rolls around, it is a partially vaccinated population. And so that certainly is going to reduce the overall prevalence of COVID-19. Finally, there's really quite effective treatments that are starting to come out with monoclonal antibodies and so on. So in my eyes, we've seen success in professional and international sports. So people are learning how to do this successfully anyway. Vaccines are on the cusp of being introduced to the general public and we have more effective treatments coming out all the time. And all of those things in my mind set us up for success. And frankly, even if we hadn't had a vaccine or new treatments, I feel like we would have gone forward just through appropriate quarantine, appropriate testing, creating a bubble and separating the athletes and those who work with the athletes from the general public. So it's gonna be different and it will be a partially vaccinated games. And so they're gonna have to treat it as a unvaccinated games because you still have a lot of people who are not vaccinated prior to the games. And frankly, our vaccines, we don't even know how long they last at this point. So if you get vaccinated in February, your vaccine may not be working, you may not be immune this summer, we don't know yet. But I'm really optimistic about it and have been very involved in keeping up to date on what the plans are. So, given the sort of on again, off again, training capabilities of what we'll be the team, how well positioned do you think we will be to compete at our usual, with our usual expectations that is? I think that there are challenges for our athletes and they might be facing more challenges than some other countries. We as a country have not done a good job of addressing COVID-19. We have way higher prevalence in our communities of COVID-19 than most other countries in the world. And that makes it challenging for our athletes because not only are the communities not as safe for them to train, but it restricts their travel because a lot of countries don't want us to come there. And so it makes it more challenging. That being said, our athletes are incredibly resilient. They're finding good, solid training locations and when venues become unavailable, they're identifying secondary training locations and the competitions that have been occurring, our athletes have been incredibly competitive at those competitions. And so I would say, is it a challenge? Yes. Are we gonna do as well as we have in the past? I don't know, but I have a feeling that we are and based on these early results, our athletes are really, they're dedicated and they're getting it done. They're doing what they need to, to prepare for the Olympics and Paralympics. Oh, all right. So COVID-19 aside, what are your goals in the position you hold now? I mean, have you, do you come in with goals? Are there expectations that have been placed in front of you for what to do in the next, I don't know how many years, but obviously there's some very big challenges from the recent past with all the physician sexual abuse and that problem is still being unraveled and hopefully solved. Yeah. So I had very specific goals when I took this job and before they had even identified SARS-CoV-2 and those goals have been, the timeline for those goals have changed. They're not, it's not that, exactly. It's not that I don't plan on doing those things, but obviously all of my attention has been refocused, but there are a lot of things that we have accomplished and things that I want to accomplish. So one thing that was a big priority for me was mental health. So there have been some serious issues with mental health and specifically resources surrounding education, access to appropriately trained mental health professionals. And so one of the things that I wanted to do early on in my tenure here is make sure that we developed a much more robust mental health program for our athletes. And so since I have been here, we have a really impressive mental health emergency action plan that we've developed, not only for our three sites, but also for international travel for our athletes all around the world. It's over 90 pages. It's a very thorough, and I think is a really great resource for our athletes. We have hired a mental health director and we have positions approved for three additional associate directors of mental health, all of them licensed mental health providers, typically at the PhD level. We have been working very closely with our sports psychology department, who some of them are clinically trained for mental health as well, and integrating them into our mental health program, developing telehealth resources, emergency services for people who are in crisis. So that is one area I've been focused on. And we've actually in the last nine months developed a lot of tools and resources for our athletes. So I'm super proud of that, but it has a long ways to go. So I'm working a lot on mental health. Another area is really kind of that structure and organization of medical care in the Olympic and Paralympic community, kind of going down into those NGBs. So, you know, it's interesting. I will develop a policy that we're using at the USOPC. We think it's very successful. We wanna share that with the healthcare providers in the NGBs. There is currently no way of doing that. There's not like an official way of communicating between the USOPC's healthcare providers and the NGB healthcare providers. That system has never been created. And so one of the things that I am doing currently on top of everything else is creating an NGB medical advisory group. And that group is going to have representatives from some NGB lead healthcare providers. So three of them, some people from the USOPC and then athlete representation. So that a third of that representation is athletes to make sure that we actually are meeting the needs that the athletes have. With that group, we're going to start having a national meeting every year of all of the NGB healthcare providers, specifically the lead healthcare providers, but anybody else who is affiliated with an NGB that wants to attend, where we share policies and best practices and develop tools and resources that can help NGBs be successful, improve the communication that's bi-directional between the NGB medical staff and the USOPC, make sure we're integrating our sports medicine clinics at the Olympic and Paralympic training centers with our national medical network partners, where we get value and kind care at exceptional institutions around the country, along with our elite athlete health insurance and how we integrate that into essentially a managed care system to ensure their athletes get the best and most cost-effective care possible. And if we're working closely with the NGBs, we can ensure that all of that is happening. So organizing the structure of healthcare within the NGBs and USOPC. We're doing some changes in staffing models at the different training centers. With our national medical network partners, we have some very specific partners right now, but we have some regions that a lot of our athletes live in that don't have a national medical network partner. And in addition to that, there are some elite institutions that I would love to have as part of our national medical network. And so we're gonna expand that national medical network. I'd like to do a youth campaign that kind of leverages our ability to reach people around the United States and frankly around the world to promote healthy participation in sport for youth and youth athletics. So avoiding single sport specialization, that's too early in just promoting healthy participation in sport. I think that we should leverage our voice to promote public health. So those are just a few of the things that I have on my plate, but I'm really excited. And there are a lot more things that I have on a list, but those are some big initiatives. Well, I mean, USOPC has had physiatrists involved in the past, but never at this level. And how do you feel that your training as a physiatrist informs your role today and how do you see it as being impactful? Yeah, it's interesting because I think there are pros and cons to any specialty track that you take into sports medicine. I love the physiatry track because I really like the neuromusculoskeletal system. I think that that is awesome. And if you're going through the family medicine, internal medicine, ER, pediatrics track, you're gonna be a little bit stronger in medicine, but not as strong in the neuromusculoskeletal realm. And in general, PM and R docs are gonna be stronger in the neuromusculoskeletal realm and not quite as strong in the medical realm. And so there's overlap between the two, but I like the specialty of physical medicine rehabilitation because of the skillset that I learned. So I love that. I think that physiatry prepares you to be a team leader. I mean, from the time you start your residency, you are involved in and or running team meetings that are multi-specialty and almost no other specialty does that. And so I think that physiatrists respect people and their skillset and understand how to utilize them best and leverage the talents of a team for the best outcome of a single patient. And I think that is amazing in sports medicine, which really requires that to the cocoon of a team around the athlete in order to have the best outcome. But on top of that, there are a lot of skills that you need to learn in order to get into a position and be successful in a position like I'm currently in. So working, you're starting to understand national governing body sports medicine. So working with a national governing body, whether it's USA Track and Field or USA Gymnastics, or in my case, the USSA for Ski and Snowboard, starting to have leadership positions. And I kind of point back to the AAPMNR Board of Governors. I mean, good grief, working with Stu Weinstein and Michelle Gittler. There's just all of these different people that really influenced my abilities to be a successful leader. And so I think that taking on leadership roles in national organizations really helps prepare you for a leadership role in sports medicine. So I think that's really important. And never forget to be a teacher. Almost everything we do, whether it's educating our athletes or educating our colleagues, or even developing these programs, if you are a good communicator, you're a good educator, it's going to make your job and your life infinitely, infinitely easier. So really spend a lot of time developing your educational skills because they'll come in handy throughout your career. So speaking of which now, you're in the top, or on the top at USOPC. How do you have the autonomy you envisioned and how does the upper echelon of the organization work in terms of decision-making? Yeah, you know, it's funny that my experience is totally different from what it would have been without COVID-19, right? So I got here, I had my extensive, but NGB focused experience, not global organization, one focal point of games preparation and so on. So my first year or two were really going to be much more about learning. You know, I figure it would have taken me forever to start to develop relationships with some of the NGB CEOs and frankly develop a strong reputation within the organization that allows you some of the autonomy that you're talking about, John, and to make big decisions and move forward with large initiatives. Because if you can't have a big impact right off the bat, it takes a long time for people to develop confidence in you and believe in your vision and your skillset. But I was thrown, you know, right into this crazy pandemic. And thankfully, you know, I had a, I've been very successful with what I've done and have had to have consistent communication across the Olympic and Paralympic movement. So I've met people, I've advised people, I've developed policies and procedures that have been successful. I've made big decisions that have really positively impacted the organization, but also ones that were hard, that weren't necessarily popular. And frankly, you know, one of the people that I've been, I don't know if Stan Herring is listening to this, but Stan has been a great sounding board for me because of his, you know, number one, tremendous experience and number two, great insight and advice. Because I've run into some really, really challenging situations. Anytime you get into a position like I'm in right now, there's gonna be a lot of politics involved in it. And, you know, I don't wanna be a political animal. I'm much more of a, you know, figure out the situation, analyze it and come to a good decision and go in that direction. And boy, I'll tell you, there are times that, that people didn't know who I was and what my experience was and what, you know, my integrity is. And therefore really tried to challenge me and tried to undermine some things. And I held very firm and had some late night calls with Stan to help me get through some of these situations because it's hard for anybody to be in them, particularly when you're new and people are really upset and really scared financially that the organization is gonna struggle. Games are getting canceled. NGBs are upset and filing for bankruptcy. Athletes can't find training locations and you're making decisions that are having huge impacts on people. So obviously I'm gonna get challenged. The fact of the matter is, is that if you do the right thing and you stick to your guns, you listen to people, you know, you're not being totally, you know, not listening to people and stuff. You know, if you listen to them but you explain your situation and you stick to your guns and you do the right thing and you lead with integrity, I think it makes a huge difference. And so long answer to your question, which is, do I have some autonomy? I mean, I think I have a lot of autonomy at this point, way more than I would have expected. They've asked me to be, you know, for the first Olympic and Paralympic Games next summer. They already had chief medical officers assigned for those but they've asked me to step into those roles and be the leader at the games, not just, you know, within the Olympic and Paralympic movement, but to lead the games because of what I have done in the first nine months here and the incredible faith that that has placed for the organization in my skillset. So I think it would have taken me a lot longer to have any autonomy and to really be able to take things to the next level. But because of what we've been through, it was like, you know, it's still like a war, you know, and doing a good job so far. I have a lot of respect within the organization that has allowed me to pursue a lot of new initiatives that I don't think would have been available to me. That's no small achievement. That's tremendous, John. So, you miss clinical medicine at this point? Yeah. It seems like forever. So I'm doing, you know, I'm doing a combination. I am doing clinical medicine still, but it's not near, obviously it's not even near to the degree that I was before. It's far more administrative. I absolutely miss clinical medicine. I think if the training centers were open more so than they are currently, I would be able to do a lot more clinical medicine because our athletes would be here and people would be traveling to see me and so on. So that's been a little bit difficult. You know, I worry about my skillset and I'm seeing athletes, but I'm not doing as much as I was before. And so I've already talked to them about the fact that it's important for me to be able to practice. And if I can't see athletes here, then I might have to do some practicing in the community. And I've talked to some people in the community who are receptive to me doing some practice there. But ultimately what I'd like to do is have the clinics here be robust and busy and provide elite athlete care that they have never had before and do that in conjunction with our National Medical Network partners. That's surprising. And I wouldn't have thought you'd have, even under normal circumstances, the time to even be able to do that. So that's probably very reassuring to you that you can still maintain that kind of involvement. Well, it was one of the stipulations that I had for accepting this job. When they advertised it, they didn't want the person to do clinical. And I said, well, you know, thanks, but no thanks. If I can't do clinical work, which I've spent, I guess it's like 25 years of education to get to, and 20 years of clinical practice, I'm not walking away from that. I love being a clinician and it doesn't have to be the majority of my work, but it has to be some of it. I'm not giving up being a physician. Well, you mentioned Stan earlier, Stan Harry. And of course he was out front for certainly my generation and pretty much anybody that's followed. And I worked probably two or three generations into our sports medicine development as a specialty. And I remember when I was starting and I was being interviewed and one of the highly respected clinicians that interviewed me had said, so John, you don't want to work in a hospital. How's that going to work? So it was the no concept of what was going to happen. And here we are now, 30 years later, several generations of physiatrists. And I look at people like Ken Mountner and Kathy Deck and Monica Rowe and Sherry Bollett and Carly Day. They're all got huge positions. And that just was not the case 20 years ago. So if you had to give advice and of course your position, which is tremendous. So if you were going to advise a physiatrist, a young physiatrist at this point, how to get where you guys have all gotten, which is to me, I'm very proud of. I mean, because it just was unheard of back when I started. Yeah, well, so there's, number one, I think having chosen to be a physiatrist is, in my opinion, it's the right path. So I really am very proud of being a physiatrist and it gave me great training and I love what I do. So you've taken the right step if that's where you started was being a physiatrist. I really like that. One of the other things that I will say is that in order to be a physiatrist and match in a sports medicine fellowship, as a physiatrist, you really have to be the cream of the crop. And I think that that is reflected in the people who go through fellowship and then into practice that we knock it out of the park compared to any other specialty because really incredibly bright people are going into sports medicine within physiatry. So if you wanna go into sports medicine, as a physiatrist, you're gonna have to work hard because it is super competitive because of the number of fellowships that there are that accepts physiatrists, whether it is physiatry based or it's one of the other primary care specialties. So work really hard, do research, cover a lot of sports events, make sure that you identify great mentors who you work closely with, make sure you make a very strong, positive impression on them because you're gonna want a good letter of recommendation. Once you get through your fellowship and choose a fellowship that's gonna give you the skillset that you're looking for. Name is important sometimes because if you're applying to a job after fellowship, some people don't know which fellowship is good and which one's not. And sometimes there's name recognition that does make a difference. So it is a consideration. But getting this skillset is the main thing. Whatever you feel like, I wanna do this in practice or this is an area that I want to get better at because I think it's gonna be important for me in practice, choose that fellowship because that's gonna make a huge difference because you'll need that skillset when you finish your fellowship. After your fellowship, look for a job that is going to position you for what your ultimate goal is. So if you're really interested in doing something with track and field, then you might want to base your position out of a place where USA Track and Field is, which is Indianapolis or where some of their training sites are, such as San Diego, specifically Chula Vista with the elite athlete services facility down in Chula Vista. So identify the sport that you wanna be in, put yourself in a location where those athletes are located, make sure that you start making connections early and you're not gonna start at the top. If you wanna go to the Olympics, you don't call up and say, I wanna go to the Olympics. I mean, it takes decades usually to get to the Olympics. So start out by contacting a national governing body or if you wanna go into collegiate athletics, talk to a mentor who's working with a college, volunteer and assist with them. And over time, not only do you develop experience, but the familiarity and stuff leads to people to do a great job. They end up hiring you. Same thing with NGBs. If you're doing a great job, they're gonna want you to go from their national competitions and covering camps up to their international competitions, eventually the world championships. And from there, that is the stage to go up to the Olympics and Paralympic games. And I will just say right now, I think it's really important for everybody to think about the fact that we're physiatrists and Paralympic sports are underserved and there's just tremendous opportunity to work with elite athletics in the Paralympic realm. And so let's use our skillset and let's deliver them with the best care available and make sure that we're taking care of our Paralympic athletes as well as our Olympic athletes. John, we have a few more minutes and we'll get to some questions, but I guess my last question for you, and this may be way too early to answer, but is there anything beyond USOPC for you? What do you see or how long does this gig go if you can even say? If it doesn't kill me, you know, it's funny because I don't know that I want to have a different job. I don't know if I aspire to go to the IOC and move to Lausanne, Switzerland. I'm pretty happy with my current job and there's a lot of work and it's gonna take years to do the things that I wanna do. And so I'm very excited about that. I think rather than moving to a different position, my goals are gonna be much more about making the Olympic and Paralympic movement better from my having been here. I want to leave this position and people to come in and feel like this is a great structure that's delivering wonderful healthcare to our athletes. And it's kind of achieved the pinnacle that the world looks to. And the US has amazing resources and the fact that our medical care is not the best in the world from a elite athletic standpoint, you know, that we need to reverse. We need to be the ones that every other National Olympic and Paralympic Committee is looking to as the epitome of the best for sports medicine. Well, you know, I've always admired the Olympic movement and it's such a high aspirational endeavor. And I hope we can bring the best to the organizations because it really has been sort of an afterthought in many respects over the years. And I love having you in that position because I think you share that kind of approach to Olympic sports, which are, you know, some of them just aren't glamorous, but they're all interesting and they're fascinating when you hear what people have done to get where they have. And, you know, every four or I guess really every two years we get to dive into the Olympic movement. So, John, congratulations. This is really, I'm proud of you and I'm sure all our colleagues are as well. So, Brian, any questions for Dr. Fennel? Maybe not. So we have time for just a couple. One of them that came through the question was, do you see any gaps in Paralympic athletes' care versus able-bodied and how do you plan to address these inequalities? So, absolutely. And in fact, I was expecting there to be gaps but I didn't realize how significant those gaps were until I got here and I was getting all of these different Paralympic NGBs contacting me and asking me to write their COVID mitigation measures. I was like, well, have your physician do that. They didn't have any healthcare providers affiliated with their teams. So one of the first things that I have done on the Paralympic side is worked on identifying a good group of solid physicians, physiatrists with an interest in Paralympic sports specifically. And I've started sharing that information with our Paralympic NGBs so that they can start connecting with physicians and getting their healthcare taken care of. I mean, they need to get pre-participation physicals, sports labs to make sure that they're not anemic and their vitamin D isn't low and so on, planning the COVID mitigation measures, having emergency action plans, all of that. And so my first initiative with the Paralympic movement was to start setting them up with physicians. And I think it's gonna take a little bit of time and people are resistant to it because they don't wanna be told what to do. But that being said, that's the start and then it's gonna work into the ATCs and PTs and then working closely with USOPC through that National Governing Body Medical Advisory Group. So I'm excited about it, but the Paralympic medical community is it still needs a lot of work to develop. John, is it as broad or is it broader than the able-bodied team, the network that is? The network, well, so there are fewer Paralympic teams, there are fewer Paralympic NGBs. They are decentralized and the athletes tend to be from all across the country. So similar to the Olympic sports, but in general, I think it's gonna take more time. Sherry is amazing. She is, you've got to interview her on one of these Grand Rounds, the National Grand Rounds because she's just amazing. But I think that we just really need to work as a field to provide more medical care and medical resources for our Paralympic athletes. It just has lagged behind the Olympic side. Brian, any other questions? Yeah, I think given the time, I think we could just take one more. And someone wrote in, they are looking to get involved into my local Special Olympic organization. Are there any references you would recommend to prepare them? Yeah, that's a good question. So the Special Olympics are a different organization than the Olympics and Paralympics. And so I'm not looped in with the Special Olympics as much, but they do have a pretty good infrastructure. And I'm sure if you went to their website, they would have resources where you could find out about volunteering. But I'm sorry, I can't answer that question for you. Do you wanna do one more, Brian, since I wasn't able to answer that one? Yep, let me just bring it up. Because there was a question about OMM trained physicians and how you feel like their roles will continue to grow within the Olympics. Yeah, so a lot of the athletes really like and benefit from manual therapy. And so I think manual therapy is another tool in your tool belts that's very beneficial to the athletes. And I would highly encourage people to develop those skills, whether you're an MD or a DO. It's really beneficial for the athletes to bring that skillsets to the table. So we're at a little over eight, so I guess we should close up. And I wanna thank everybody who attended and for your questions. And John, I wanna thank you. It's been a real pleasure to talk to you. And again, congratulations. Thank you very much. It was really a pleasure talking to you as well, John. And thanks to everybody who attended this meeting and thanks to the AAPNR for having the National Grand Rounds. I think this is a great initiative and I'm glad I could be a part of it. Well, get some sleep, John, if possible. Hang in there. Thanks a lot. Good night, everyone. Bye-bye.

Dr. Jonathan Finoff

Chief Medical Officer

sports medicine

clinical experience

mental health support

COVID-19 pandemic

Olympic Games 2021

care for Paralympic athletes

physiatrists in sports medicine

quality of care