All right, welcome. Thanks for bearing with us on this advanced MSK and sports medicine day. We hope that you've enjoyed it. The objective has been to offer you high level insight into MSK and sports medicine practice and we're going to get to it. All right, so our session today, you see it on the screen. Think of it a little bit as a corollary to yesterday, Dr. Micheo's session on sports medicine physicians. We're going to go a little bit more in depth about team coverage and with an emphasis on team travel. Our panel will talk a little bit about their experience and the objective of our session today is really to be interactive. We want to leave some time for our audience to ask questions and engage us in a lively discussion. So we'll get to it. So I have no disclosures and we'll talk about the team in just a second, but these are learning objectives and as I discussed, we'll start with a little bit how to get there, how to be a team physician, how to get on a team that travels. But then when you're on that team, it's a multidisciplinary team and so we'll review what it's like to be part of that team. When you travel, there are some considerations, whether you're going within the region, nationally, internationally. We'll get into some of the details of that. And one of the aspects of being part of some of these teams, we do travel with minors and understanding the logistics regarding that. And what I'm excited about, some of the things that you don't necessarily learn in medical school and these are interactions with agents, front office staff, and even the media. Okay. So one of the themes for the last couple of days has been TV shows. We had part of the interruption yesterday. We had Around the Horn just now. So I should call this Dancing with the Stars because in keeping with the ESPN, Disney, ABC theme, because we have some of the all-stars of our field here as part of our panel. So I'm Alexis Tingen. I'm at Jefferson University and my coverage is primarily in the collegiate level and track and field. I'm also the division director of sports medicine there. I'm also on the planning committee for AP Menard. So if you have any complaints about today's session, just come see me afterwards, but I hope it's good. And the rest of our panel will introduce themselves in a minute, Dr. Bowers from Emory, Dr. Casey from HSS, Dr. Finoff from the USOPC, and then Dr. Rubish from HSS, Dr. Rowe from Shirley Ryan and Dr. Pasculli also from Emory. Okay. So what I'll do in the next couple of minutes here is just outline some of the themes that we're going to see that our speakers will talk about and also that you as the audience will engage us. And we'll start the arc, the story arc here with the journey. How's it all start? And as all of us will attest to, none of us got here on our own. We always stand on the shoulders of those who have helped us along the way. So these are some of my mentors on the left, Dr. Kapoor now at the University of Minnesota. He was my fellowship director and he's a team position for University of Minnesota and the Minnesota Twins. On the right, so this is me. So I'm at the Olympics as a fan, which is a great way to go to the Olympics. You can choose where you want to go, when you want to go. But with Dr. Mason, who's the head team physician for track and field, instrumental in my involvement with USA track and field. And mentors don't just have to be within what you do. At the bottom here is Dr. Frank Lopez from NYU and he's been instrumental in my career. And I like this picture because this is the last time we were in San Diego for AAP Menar. So this is PNR party down at Petco field. Okay, so you've made it, you did all the training. If you attended the session yesterday, Dr. Macheo's session, Dr. Fredrickson talked about how to become, or he did talk about the fellowship programs and how to become a sports med doctor. And so now you're ready to go out and to cover things. But you have to first think about your home, right? So all of us have day jobs. And when we travel, we have to coordinate with our staff, we have to coordinate with our colleagues, with how patients are covered, how calls are covered. So this is our team here at Jefferson with our fellows as well. And then don't forget the other home, the very important home. When we travel, often we're away from family. As you see, some of us actually will bring family to some of our events. But I encourage you not to go rogue. Don't fly halfway across the world without telling your family that you're going to leave if you really like them. So some of the things, again, simple things that are very important when you're thinking about traveling here. Okay, so when you are traveling, it's going to be a team, and we're going to see this theme developed as we go through our discussion. And it's not just, of course, physicians and athletic trainers that you see at some levels. You'll have physical therapists that are with you, you'll have chiropractors, massage therapists, and sports psychologists that are in this picture here with me. And this is from Cali, Colombia, under 20 world championships a couple years ago, even logistics. So in the Navy there, Kelsey was logistics for our medical team. And then it's about the athletes. That's why we're here. That's what we do. So one of the things we'll talk about is how to interact with the athletes. We saw a little bit in our around the horn session just before this session. And how do you speak to them in a way that they understand? And of course, as I mentioned, we'll talk about traveling with minors. So this is an under 20 team, so there are some minors here, so there are some implications for that. And what I'm most excited about is the stuff that we don't learn in medical school. And I think that's why you're here. And that's really what I want you to get out of this session, is what are some of the idiosyncrasies of traveling and coverage? And one of them is interacting with the media. And what I hope is that we'll share maybe some anecdotes of lessons that we've learned. This is actually from when I was a fellow about eight, nine years ago. And this is from the Penn Relays. And there was an athlete that got injured. And it was on national TV. And I was excited when I went home to see myself in action. Sorry, Dr. Rowe, we're not supposed to be like wanting to see ourself on TV and not be on TV. But I was a fellow, OK? So I just, you know, it was new for me to be on TV. And then I watched it. And I was kind of in horror because I was like, it looks like I don't care. So I'm there with one of my co-fellows and another resident working. And this is a hamstring. He was going to be fine. But when I watched that, I realized, you know, what we do is not just a medicine. It's also how it looks, how the athlete feels. So it's more than just a medical care. So we'll learn some of those pearls as we go through. OK, so I'm done talking for now until we get to the questions. So we'll go on to our experts here to talk a little bit about their background and also some of the pearls that they've learned along the way. All right, so I made these slides real quick to talk about myself because I love talking about myself. So this is just so I'm Robbie Bowers from Emory. And I'll just run through really quickly my background and then some pearls that I've found from taking care of professional athletes up to this point in my career. And then I'll pass it over. So this is my background. So I, you know, I started in academics thinking I was going to be a college professor. So I went to, you know, I thought extra science was great in undergrad. So I majored in that and realized that you can't really do anything straight out of undergrad without extra science. So I want to be a professor and then got into academia and realized I didn't really like academia full time all that much. And so then I, you know, decided to transition and go to go to med school. So and then I did all my postgraduate training at Emory in Atlanta. So I'm very Emory inbred at this point. I just transitioned over and became associate program director for our primary care sports medicine fellowship just this past year. And then I also lead our baseball medicine program, have a special interest overall in overhead throwing athletes, play baseball in college. And that kind of led me to being interested in those athletes, specifically baseball players. So my team affiliations at this point are, you know, go from high school all the way up through professional. Rosa takes care, she's a head doc for Emory. I just take care of some of their baseball players when they get hurt, but go from the high school level, division three college, division one college with Georgia Tech Baseball. I will say lower level professional sports, so like a minor league side. So the NBA G League, College Park Skyhawks, which are the G League team for the Atlanta Hawks and then one of the docs for the Atlanta Braves and, you know, high level professional sports. So these are my professional sports pearls, so I'm not going to focus too much on too much on the college side or the high school side. This is purely for professional sports and just some things that came to mind as I was thinking about it. So pro sports is definitely a weird world, different than any other in medicine. And so it's not necessarily always evidence based. And so there is your opinion as a physician based on evidence based medicine, but there's lots of other players involved when it comes to professional athletes, and that includes agents and the front office of the teams. And that's where things can get a little bit frustrating. And it just depends on how vocal do you want to be in this relationship. And so when the front office has their desires, when the player and their agent has their desires and you're in the physician or caught in the middle of this, where does your opinion from an evidence based standpoint fall into play here? And a lot of times with the front office or the agents warrant doesn't necessarily fit in evidence based medicine. And you have to figure out how hard you want to battle this because you can put yourself in a poor spot as far as taking care of these athletes. If you push too hard, then either the team or the athletes will push you out from the relationship with them. And so if you are in sports medicine and your goal is to work your way up to get to professional sports, you don't want to do something that's then going to compromise your ability to remain within that world. So there's a learning curve to figure out how to play where you fit into that relationship. And then the other thing that sometimes I battle with and I grapple with is what is best for the team may not be best for the athlete. And so especially at the professional level, you are primarily affiliated with the team and not necessarily each individual athlete. So again, what the team wants may not be what you feel like from an evidence based standpoint is best for that athlete. And so as a team employee and also as a doctor, what do you do here? Do you err towards what the team wants and keep your standing with the team? Or do you err towards and battle for what you feel like is best for the athlete? And I think it's a tough call. And I mean, when you stand up here, I'd say definitely you do what's best for the athlete and that's why you're there. But sometimes you have to walk a fine line without turning off the team and making the team upset while also doing what's best for the athlete. So it's a tough world to be in to try to practice evidence based medicine based on what's best for the athlete or the patient. And this one's funny. Don't ask the athlete how they're feeling unless you're directly caring for an injury or illness. If you're taking care of a specific injury or illness, ask them how they're feeling. That's fine. But if you just walk in and the guy sitting there is like, oh yeah, how do you feel? And they go, some of these guys, they're very quirky and they'll go off and tell you about everything that they feel is wrong with them and they'll want you to weigh in and tell them what you think. And when I first started with the Braves my very first year, I asked the wrong guy how he was feeling and he went off. So not knowing this being very early in my career taking care of professional athletes, I let him know my thoughts. He then took those thoughts to his agent who then took those back to the team and they were not happy with me. So I think if one thing I've learned is if you're not, for a professional athlete, if you're not directly caring for an injury or illness, ask them about their family, ask them how they're doing from that standpoint. But asking them about health-related issues that you're not necessarily taking care of can put you in a tough spot. And this also is the case when it comes to the athletic training staff. So when the doc says what is evidence-based but the team or front office wants something different, the athletic training staff or those teams are in a tough spot because they again are employees of the team and so they have to err towards what the front office and the team wants and not necessarily what the doc wants. And so as a doctor, sometimes it can be frustrating in that world because you don't feel like your, you know, your input is being taken into account as strongly as it should. And so, you know, those are just my pearls real quick that came to the off the top of my head or what I, you know, how I feel about taking care of professional athletes. And again, it's a different world and not necessarily as evidence-based as you want it to be, but you just have to realize you have to walk the fine line between what's best for the team and what keeps you in good standing with the team, but also what's best for the athlete. So that's what I got. Actually, I'm a little short to see my slides here. But hi, everyone. I'm Ellen Casey. As Dr. Tingan said, I'm at the Hospital for Special Surgery. And I think on the panel, tasked with sharing my experiences and taking care of USA Women's Gymnastics national team. I've been in that role since 2019. I'm a co-team physician. Happy to talk about the nuances of that as well. But excited to be here with all these other panelists. So a couple of thoughts about the unique aspects of travel, especially with USA Gymnastics. Because we are the sport of gymnastics and certainly have dealt with a variety of challenges around safeguarding athletes, historically, in the sport. And we also have minors that travel with us quite frequently. We definitely pay a significant amount of attention towards implementing and integrating safe sport principles into our practices. So this picture here is an example of just setting up a training room in a hotel. Our policy is to never have that in a hotel room. That's typically treatment on the bed and things happening in a typical hotel room. So if, like in Tokyo like this, we were stuck with only using a hotel room, you completely remove the bed. You make it look as professional as possible. The door is always open. So one of the tenets of safe sport is that every interaction with a minor athlete has to be interruptible and observable. So we bake that into all of our processes in terms of travel. And now, fortunately, many years later, the entire organization of USA Gymnastics is so familiar with that that they know that, for example, if the medical team has to be split up where the athletic trainer is doing treatments and I have to be at the competition venue, then another coach or an adult is then in the training room of sorts to be that other person that can be chaperoning, observing, and able to interrupt anything so that everyone feels comfortable and we're hearing to those principles. Another concept is to create systems for organization and preparation. So this is just a picture of my medical bag, which I have a PowerPoint schematic for how it's organized, which seems ridiculous. But I will say that there can be months where I'm not traveling and then I can be on a trip for several weeks and to reorganize and think where everything is. Because, of course, when people want something, they want it immediately. And so making sure that your inventory is kept up, expired things are out of your bag, changing equipment in and out can be challenging and time-consuming. So creating a system for that is very helpful. So being aware of national and international policies. So this may come into play in terms of competitive rules. So gymnastics has a lot of odd rules about who can be on the field of play is what they consider the competition floor. There's only one medical provider allowed on the field of play in world championships and Olympic games. So there's a tag-in and tag-out system that the athletic trainer needs me to evaluate something. Then we have to have that process and be ready for that. But that can change from competition to competition. And so making sure that you're aware of those things ahead of time so that it can look seamless if you have to deliver care is really critical. And I would say, lastly, take care of yourself and have fun. So this is a picture of my family joining me after I was finished up in Paris. We got to go cheer on Dr. Rowe and Team USA women's soccer at a game after that. And so my kids don't love it when I travel, but they've decided that this is great because now they get to go to places that are exciting after big competitions. And making sure you take time for yourself to be able to exercise or meditate or whatever you need to do. Oftentimes, travel is long. It's stressful. And unlike everybody else that you're traveling with, they have a reprieve after these big events. But you have to go back to your regular job and make up for all the patients you weren't seeing when you were traveling. So it's important to take care of yourself along the way. All right. So my name is Jonathan Finoff. I'm the chief medical officer for the US Olympic and Paralympic Committee. And nothing I say here has anything to do with USOPC, meaning that it's my opinion and not theirs. So from a professional background standpoint, number one, I chose physiatry because I feel like we are the best prepared to provide sports medicine to our athletes. And so I made a very conscious decision knowing I wanted to go into sports medicine to be a physiatrist. I did my residency at University of Utah. I did my fellowship at Mayo Clinic. And throughout my career, I've worked with a lot of different teams, starting out at the high school level and the semi-professional level and Division III college, and then D1 college, and then national team athletes, and then eventually going to World Cups, World Championships, Olympic Games, Paralympic Games, and moving into my position that I currently have, which is the chief medical officer of the US Olympic and Paralympic Committee. And so just a few pearls from my standpoint. I know this is small, but the nice thing is that you guys are going to have this as a handout. And so you can look at this. I think it's really important when you're going to be traveling with your team or if you're going to be administering over a whole bunch of different teams to have specific policies and procedures in place prior to going and making sure that you communicate those with the people that are involved, so the athletes, the coaches, the other health care providers. And so this is the infection prevention and management guidelines that we developed for the Olympic and Paralympic Games this summer in Paris. And so the first thing that we said is we developed a little tagline, don't let a cold, and in parentheses, or diarrhea, keep you from gold. And we really tried to educate our athletes on even if you have a minor cold, it impacts your performance. And if you're looking at hundredths of a second in terms of first to fourth place, then you do not want to have a cold. You want to be healthy and ready to go at the Games. So we gave them all sorts of different recommendations of how to prevent getting an infectious disease, and that included for respiratory as well as gastrointestinal disease. And then we said, if you get sick, this is what we're going to do. Number one, come and see us as soon as possible. Because if we catch it early and there's some type of treatment that we can implement, like say if you have influenza and we can start you on Tamiflu, or if you have COVID and we can start you on PaxLavid, or if you have E. coli-based gastroenteritis, then we can start you on the relevant antibiotic. If we can treat you early, you're not going to get as sick. It's going to be a shorter course, and you're going to get better faster. But in addition to that, the main risk based on studies that we've done from an epidemiologic standpoint of spreading disease is to your roommate. That's the person who has the highest risk. And so immediately when somebody is symptomatic, you need to get them out of the room so they don't get their roommate sick and it impacts their performance, and then it goes through the whole team. And so you have to have extra rooms available. You have to know, how are you going to transport your athlete over to that? What's the communication pattern for when they're able to leave this isolation room? Are you going to allow them to train and compete? And if so, they need to know that. Are you going to transport them over separately? Are you going to provide them with meals so that they don't have to go to the cafeteria? All of those logistics need to be worked out. You have to have a policy in place, and you have to communicate that with everybody so that they're understanding of what that policy is in advance. I think medical information is super, super important, particularly in my role. So I don't work directly with any one team. I work with a ton of different teams. And a lot of the teams for the Olympic and Paralympic games aren't selected until weeks or maybe a few months beforehand. And so I may never have met the athlete. Frankly, they may not have even known they were going to go to the games. They were hoping. But all of a sudden, they have an amazing performance, and they're going to the games. So you have to have some way of collecting medical information on that individual so you can prepare and have things ready to go when they're at the games. So if they have a medical lead who's worked with them, do a medical handoff contact. That medical lead, have them talk to you about what some of the concerns they may have and the health status of the team. We do health histories. Since I often don't have time to do physical examinations on a lot of these athletes, and thankfully, we have some great team physicians who are doing pre-participation physicals. But a lot of athletes, particularly on national teams in the US, do not receive pre-participation physical examinations. So the first thing that we do is a health history. So we send it to them electronically. Hopefully, they're answering it accurately. But then you find out what medications are they taking. Oh, crap, that one actually needs a therapeutic use exemption, and they don't have one in place. So we need to get that. What type of medical history do they have that we need to maybe bring different medications and be prepared from an emergency action plan standpoint? And we always do a mental health screen, and it is amazing. We are getting between 50% to 80% of our athletes flagging for different mental health conditions. We had 5,000 medical encounters in the Olympic and Paralympic Games for Team USA alone, and 1,000 of those were mental health. We had a suicide attempt. We had a death and all sorts of things surrounding that from a mental health standpoint because it was a team sport. We had, I mean, you just really have to be prepared from a mental health standpoint. And if you do screening beforehand, you can implement, you can get resources in place for those athletes who are at risk so that they can focus on their performance in the field of play. And the last thing is just emergency action plans. And there is a lot to this. It's not just kind of showing up and saying, well, I'm the doctor. If there's an emergency, let me know. It's finding out, what is the 911 number equivalent in the country that you're going to? Can you do that on your cell phone, and will it be recognized? What's their mental health emergency number? Do they have travel insurance? And if so, how are you going to get them home? So repatriate them if they have a serious injury or illness that requires an air ambulance. You need to look at the venue medical services. You need to look at what services are near your hotel. Where are the AEDs? In the village, in particular, in Paris. So they gave us their emergency action plan for the village, and it was super generic and somewhat nondescript and actually inaccurate. They talked about dialing the 911 equivalent. But if you do that, then what would happen is the ambulance would be sent, but they couldn't get into the village because they didn't have access to the village. And so it really delayed response. So then they gave us an emergency number that you could contact within the village. But that emergency number connected you with a triage team. They sent the triage team, who then decided, is this medical, fire, or does it require security? And then they would call for the respective team. And if you think about it, if you have a 10% reduction in survival rate with the cardiac arrest for every minute that passes, and it takes them 5 to 10 minutes to have their first response, and 5 to 10 minutes more for their secondary response, you have 100% fatality in that situation. And unfortunately, not in our delegation, but in another delegation, there was a fatality, and it was due to delayed rendering of care. And so we developed our own emergency action plan and educated people on what is the correct number to call. You can call the triage team, but you immediately call the polyclinic that has an emergency team that will be dispatched to come and see you. That was not a published number, so we were able to find that out. We found out that the fire alarm, if you activate it, it actually doesn't tell anybody anything. It just makes noise. And so in the middle of the night, that is not helpful. So again, it's calling a specific number and having all of that, educating your entire delegation, so athletes, coaches, medical staff, on how this is going to work. And all of the AEDs were in French. Not only was it written in French, but the verbal responses to you were in French. And so people didn't understand the AEDs, so we deployed our own AEDs around the village in the locations where our athletes were going to be. So it's really thinking about that so that when the emergency happens, because the emergency is going to happen, you're ready to go. And finally, we also add a mental health component to it. Because if you do have a suicidal athlete, what are you going to do? What are the resources available? Who do you contact? So take home points. Be clear about your protocols. Write them in advance. Communicate them with the right people. Make sure you collect medical information on the athletes and, hopefully, the staff that you have going to on trips with you. And be prepared for medical emergencies. Thank you. I'm going to lean forward so that I can see my slides. So I like wordplay, so that's why I said breaking into a new Olympic sport. But we're actually going to talk about Olympic travel with a brand new team and how that works when there's not an established culture and sport and you're going into venues who've never hosted this sport and they don't know the demands. Also, I do take care of the U-17 women's national team for soccer, so I have the privilege of also traveling with minors. And we just got back from the Dominican Republic where we took bronze at their World Cup. And also, I take care of, thank you, we lost North Korea, but we'll get them next time. I also take care of Broadway shows, which tend to stay where they're put. However, if they're a successful show, then they have touring productions. And then there's always that, that's being a team physician for touring shows where you're actually never traveling with your athletes. So those are the things that I wanted to try to bring up today. I have no relevant financial disclosures. I think what is maybe the most unique on this esteemed panel that I'm on is breaking was a new Olympic sport, and it was very quickly going to be in the Olympics. And Dr. Finoff was kind enough to let me work with them. None of these athletes had been Olympians before. Many of them didn't know they would be able to be Olympians. And many of the people around them also were not aware of how this Olympic movement typically works, so everybody was learning together. And I kind of divided these up because when I was contracted with them, there were some, as soon as I could, I wanted to start traveling to meet them because we had 14 athletes who were all over the country in Canada. And so they were only together for these competitions. So that was going to be the best way for me to establish a relationship. And as we all know as team physicians, that's the most important thing is building that relationship so when you have to have a difficult conversation, you have that foundation and they trust you. Because if you walk in and you're like, I'm the doctor, you should listen to me, especially in the hip hop culture, you're going to get the opposite response of what you're going for. So I actually never traveled with them to the Pan Ams or to the Olympics or to their final Olympic qualifying series. So all of my recon for what was their safety, how are we going to take care of them, who was the team on the field, was done in those first few months, a year before the Olympics happened. I would say the EAP, like Dr. Finoff said, trust but verify. Also make sure you speak the language because if you don't bring your own AED and you're relying on the venue's AED and you don't speak that local language, that might be a problem. I BYO'd many things. So they would say, we have an AED. The first place I went to, they did not have an AED anywhere in the building, which, as you know, makes my heart stop. So just make sure. And then the next time, we were in a mall. That's where our venue was. And there was an AED. It was locked away because it was the weekend when they had closed things down. So there was an AED in the building that we didn't have access to. So I started traveling with a borrowed AED that we just kept smuggling out of the USOPC every time I needed it. So thank you for that. And then build relationships at all times. So I think that with traveling, especially like I came for the last week of the USOPC, or the U-17 women's six-week World Cup push, and they were exhausted. So I was the fresh legs. So you can't be annoying, right? You show up and you're all excited to be there, and they are tired, right? So you're the one who's doing all the things that they're tired of doing. So just show up where you can. Regular check-ins with athletes before you're traveling, especially if they're not local. Regular check-ins with staff because they might be getting different information from you or they might be hearing different things. And then try to weave connections between the athletes and staff. I think as a traveling physician, you know you can't be everywhere. And so it's really important to make sure that the athletes have multiple touch points with your medical team. So should they get a great relationship with a psychologist? Should they be working with a nutritionist? How can you use your credential with them to maybe share that and expand their trust in the medical team? I think that was something that's really helpful for them. And then also, don't forget that you don't know everything. So find your mentors. So after my first trip, I called up John, and I was like, I have so many things I thought I knew and I didn't know. Who can help me? And he was like, well, I'm going to give you three people to help you because I can see these are different challenges that you're experiencing. Because he was seeing it from one side, and I was seeing it from the other, and we were all learning together. So it was a wonderful learning experience for me as well. And one thing I just think, especially, Robbie mentioned chatting with your famous athletes. I think it's important to remember that it's never about us. It's always about the athlete at all times, especially if it's somebody who has a recording contract or somebody who has a modeling contract or somebody who is very well known. Your job is to make sure they're safe and to make sure you're taking care of them for the long term. And as Monica has said, I really try to make sure I'm not in any of the pictures because if I'm in a picture, that's not the picture you want. And usually, people have questions about things, so you're welcome to reach out to me afterwards. All right. So I'm Monica Rowe. I work at the Shirley Ryan Ability Lab at Northwestern University in Chicago. Since 2017, I've been the head team physician for the US Women's National Soccer Team. So I was very fortunate. I won a World Cup with them in 2019 in France. I went to the Tokyo Olympic Games in 2021, and we came away with the bronze. And then I was just in Paris, and we came away with the gold, so we had a little redemption. So France and the US Women's National Soccer Team does really well together. It's a good combination. Prior to working with them, I was the former head team physician for the US Men's Paralympic Soccer Team, and I did have the wonderful pleasure to go to the Rio Paralympics. I previously was the lead company physician for the Joffrey Ballet in Chicago. And I also worked with Blue Man Group in Chicago, and those were always really interesting things. What's really fascinating is, I will tell you, I know that there's a lot of people who have their hand in a lot of different teams. I'm going to be honest with you, I have found in my career that one team has been enough for me. Certainly now with the demands of the Women's National Soccer Team, it is a full-time job. I have two meetings a week at least. Obviously, I have already a full-time job, because I'm also the residency program director at the Shirley Ryan Ability Lab, and Northwestern's PM&R residency program. But just the head team physician role is a full-time job. I'm on meetings multiple times a week. And then when I go travel, I travel around 60 days a year in a non-Olympic and non-World Cup year. And in a World Cup and an Olympic year, I'm traveling about 100 days on the road. So it is a fairly sizable commitment. So I just have one slide. These are very things that I've learned that I feel like maybe a lot of people aren't aware of. But the way that US soccer works is, I call us a traveling circus. Because we don't have a home base, although US soccer is moving to Atlanta. And hopefully that'll eventually become their home base. But typically, with the Women's National Team, there is no home. And so every time we go and have a camp, we basically establish a home there for four or five days, maybe a week, if we're lucky, two weeks. And so in our environment, we actually have, usually we travel with 20 to 23 to 24 players. And we have around 60 staff members. And that includes medical. That includes marketing. That includes high performance. That includes coaching staff. That includes the equipment staff. It's a large number of people. But with a large number of people comes a large number of things, because we do try to offer the most elite environment for our athletes. And it was interesting, when I first started working with US soccer in 2015 with the men's Paralympic team, after about six months working with the team, one of the team administrators confided in me at a breakfast one morning. He's like, you know what, Monica? I've been working with US soccer for eight years. And uniformly, the person who sucks the most on every trip is the doctor. And then he brought it up, because he was just like, you seem to be OK. But uniformly, across the board, the doctor is the worst person on every trip. And it was really fascinating to hear this reflected back to me, because I asked him. I said, what do they do? What's happening? And so what's really interesting is I think there is probably an older paradigm of where physicians would come into an environment, and they say, I'm here to doctor. I'm here to make medical decisions. I'm not here to pick up a soccer ball. I'm not here to carry a crate. I'm not here to fill water. And I will tell you, when you're on the road and you're living with your co-workers like this, I do think pitching in is very important. I have filled many a water bottle in my day. I have lifted many a Gatorade jug or Powerade jug. I put that picture up there, because that just highlights a little. That's only maybe 1 5th of the stuff that we travel with. So every time we go in and out of a hotel, it takes us about 40 minutes to an hour to load the trucks. And we're not only loading our gear, we're actually loading all the luggage for the athletes. So if we talk about giving athletes 1% advantage, these athletes don't pick. I mean, they don't really do a lot of their own luggage carrying themselves, even though a lot of them want to. The staff and the coaching staff oftentimes are just like, you have to rest. Your job is to rest in between games. It's our job to make sure you guys get that 1% advantage. So I always say, pitch in. Don't sit on the sideline. Nobody's degree is too big to not help out. And I think that the equipment people need the most help. Honestly, in a soccer team, the equipment managers are the ones that are running around the most and doing the most. So I do really think it's important to pitch in and don't sit on the sideline. Be a part of the team. Because I will tell you, you will get so much more street credibility if you are perceived as the doctor that is just doing everything that needs to be done that's necessary. And then people are more willing to listen to you. I mean, athletes notice that. Staff notice that. And then it gets you a lot of credibility in terms of when you actually have to make those doctoring decisions. It gives you credibility of why you're there and you're there. And hopefully, you're there for the right reasons, which is to be a part of the team. It's interesting that John went into all of his very formalized infection prevention policies. I will tell you, one of the anecdotes I always like to share, and this was pre-COVID, I actually think the coaching staff, after we won the World Cup in 2019, one of the things that they cited as one of the competitive advantages that we had was the fact that not a single player or staff member got sick during that six-week period leading up to the World Cup. And I will tell you, that was not by accident. We very much implemented a huge hand hygiene protocol. And this was before COVID, right? So we actually talked to people about airplane travel. We gave them ideas on, listen, we actually had everyone wipe down all their airplane seats, their tray tables, their seat belts, everything. Because we all live on the road with each other, probably the riskiest place in our environment was actually our dining room. Because we all went through the buffet tables and we all were scooping up our own food. So we actually implemented protocols for our staff and our players. It was actually probably more important for our staff to be on board with this. Because I do think the players were probably more sensitive. But some of our staff were just like, what's the big deal? I just came in from training. I'm hungry. I'm just going to grab some quick food. But we actually implemented hand sanitizers and hand hygiene. And we started that months before the World Cup. And we didn't have a single cold the entire World Cup. And I really do think that makes a big difference. Because it made sure that every player was very much available. And it seems like such a small thing. But I gave talks to our staff on how you actually get a cold. And it was amazing to me how many people were like, oh, that's interesting. I didn't realize these are the things I have to do to try to avoid getting a cold. So I do think education is very important, not just for the athletes that you take care of, but really important for the staff that's surrounding them as well. And then I think it's the Boy Scouts' motto to always be prepared. Anyone who works in a team physician environment, you don't know what's going to come up. I liked Ellen's bag. Dr. Casey's bag showed her prepared for everything. And when I travel with the team, I have a little mini over-the-counter pharmacy with me, too, of just all the different things that might come up. And I think it is really important. Because you don't know what's going to happen. It is always good to be prepared, not just with supplies, but just also be available for your athletes and your players at all times. Because it is kind of a 24-7 job. Hi, everyone. I'm Rosa Pasquale. I apologize for my voice. The show must go on, as we say in performing arts. So I'm really excited to be here with this incredible panel. I'm coming to you from Emory. I work with Robbie. I think I'm here representing a little bit of a different take. So I'm head team physician for Emory University, a D3 school that thinks they're a D1 school sometimes, and actually has more varsity athletes than Georgia Tech. So it's been a very interesting experience. I'm really excited to share it with you. I also work with Robbie taking care of the College Park Skyhawks, which is the Hawks G League team. And then I'm a consulting physician for several of our performing arts and dancers in the Atlanta area. I'm so sorry. I just wanted to give you a timeline, because I'm sort of newer, and I'm more junior. And I think there's people here who want to learn more about how they can become a team physician also. And we also have really experienced people here. So I just wanted to give you my take. So I graduated residency at NYU. Had a very similar mentor, actually, as Dr. Tinga and Dr. Frank Lopez. And then came to Emory during COVID, because I needed to get out of New York, and really fell in love with the city, and ended up staying. So for me, I really thought about who were the people I wanted to be taking care of when I was finishing fellowship. And I started building those relationships during fellowship. I've been really lucky that Robbie is one of my mentors, too. And he happily brought me on to take care of the Skyhawks. And I was able to come join the Atlanta ballet team. And then I took care of Emory as a fellow, and made it very clear that I wanted to stay taking care of them as I graduated. And so they were looking for a way to bring me back. And I'll kind of talk about that in my pearls. So for me, I actually don't travel. So I think it's a different part being a head team physician, also for a D3 school. So I'm sort of managing everything. And I'm not actually traveling with the teams. And then working as a consultant for some of the Atlanta-based dance companies. And so for me, a lot of what I'm doing as head team physician, I'm supervising one of our fellows. I do training rooms several times a week. A lot of it is administrative responsibility. And then for me, like I said, no mandatory travel. So pearls for me, and again, this is not so much travel, but just in general. So for me, one thing I found really important, we tell our fellows this, and this was told to me, but to say yes early and often. Because it really shows people that you have an interest and you want to be there. And for me, I made it very clear that I wanted to be involved with this community. And I was very lucky. I didn't have kids who, I have my dogs that take up a lot of my time. But I didn't have other responsibilities. And I have a very supportive partner. And I was able to kind of go and be at these extra things at nights and on the weekends. But it really showed them my commitment to being there. And so I think for all of you who are getting started, that's really something. And finding your mentors has been talked about. Be approachable and responsive. I think that's also been spoken about. That includes with the team. So with the ATs, I unfortunately am on call all the time. I'm actively getting text messages right now. And they know I'm at a conference. And you just tell them, OK, I'll get back to you as soon as I can. But I'm doing this. And you want to be responsive and follow up on things, because things happen and need to be dealt with quickly. And you want to be responsive. You don't want to be someone that they feel scared to go to. It's not going to make for a great working relationship. We talked about this. Or I didn't talk about this. These really incredible people talked about this on the last panel and talking about salaries. And so knowing your worth and what you can offer. For me, part of me staying on as head team physician was a stipend. Because it is almost, to me, like a full-time job also, like Dr. Rowe was talking about. And so I think really knowing what you can bring to the table and advocating for yourself, but also recognizing you take a backstage to the athlete and trying to find that beautiful balance. And so I don't take care of minors. But I take care of people who just are no longer a minor. And so one thing that I found was the feedback I got was that I included parents when I didn't need to. And people really liked that. My freshmen who are coming in, it's the first time they've been on their own ever. And they get thrown into this really crazy environment. They're responsible for their own meals. They're doing all of their workouts now on their own. And they're by themselves. And for me, every time I have a new stress injury, we have a new Reds diagnosis, things that are really serious, I offer to always have the parents on the phone while we're talking about this. And I try to not have it be an afterthought later. And it was actually something like parents called the athletic trainers and were like, we were really impressed with the fact that she included us. And again, the athlete has the final say. If they don't want to include them, they're over 18. And we don't. But I think it can go really far in your working relationships and really building trust with the athletes and showing them that you are on their side. And all you want to do is take care of them. And you have their health and well-being at the forefront. So that's it for me. Thank you. All right, great. We're very efficient, seven of us. We have about 25 minutes for questions. So we did a great job. Great sports docs, direct and to the point. OK, so this is the fun part, I think, of our session here is really for you, the audience, to engage us through the app and those of you online as well to ask questions given some of our expertise. And we'll select some as we get started with our discussion. I just want to throw out our first question here, which is, this is one of my own, is any of you experience imposter syndrome? And how do you deal with that? Everybody here on this panel, right? But it's interesting because we have different levels of experience here in the panel. And what I've found is, as you've gone along, I thought at some point, I feel like you make it. And you almost don't. So a question for the panel, how have you dealt with imposter syndrome? How do you ask for help when you don't know whatever you're with the team and traveling? Robbie's going to jump on. I'm going to say I'm actively experiencing at this moment right now. And I will just say that to really lean into it, to talk about it with your mentors, with the people in your life that you trust, non-medical and medical. But we had a Zoom meeting with all of us a couple of weeks ago. And I fully just said it to all of them and said, I'm having major imposter syndrome right now because I feel incredible to be. This is one of those moments you're going to remember in your career. And it's really amazing. But I think saying the words out loud give it a little less power. And it kind of opens yourself up and makes you a little bit more vulnerable in a good way. And I've been really lucky that I'm able to talk with these incredible people who I now can call my colleagues. That's just the junior faculty response here. Yeah, I'll echo that. I think it's the two probably most junior people up here. Imposter syndrome is, I just posted about this on social media last week. I was invited to Boston Children's to give a keynote lecture. And I was like, what are they doing asking me to give a keynote lecture? And so the imposter syndrome, as far as I'm concerned, I'm not sure it's ever really going to go away. But it's probably a good thing in the end because I think the imposter syndrome makes you realize it's a continued learning process. And there's always more to learn. You've never made it. And you can't kind of rest on your laurels and feel like that you've reached the mountaintop. There's always a learning process. And there's always people you can reach out to and learn from. And regardless of the situation, you can learn things that you do want to do and things that you don't want to do. And so we were doing an ultrasound session yesterday. And someone that was in the ultrasound session is far superior to me. And he was there. And I said, what are you doing here? And he said the exact same thing. He said, I'm here because there's always something that you can learn. And even if there's something that you learn that you don't want to do in your practice, it's still a learning process. And so I think just knowing, sitting in the audience, that that imposter syndrome never truly goes away, as far as I'm concerned. And it probably ends up being a good thing in the end. Thanks, guys. Could I just add one thing about that? Sorry, go ahead. Just be careful if you're trying. You want to be confident. If you're the only person on the road with the team, they need to trust you. So yes, be honest, but also be confident in what you've learned. Be careful not to overcompensate and be arrogant. So just try to find that line is the only thing about that, I was going to say. I would just add, I think it's OK to not have all the answers. Sports medicine is a team sport. Physiatry is a team sport. And you have people that you know that you can call and run things by. Just because you're in a position like the ones we've talked about doesn't mean you don't have to call. I called Dr. Finoff at 2 AM in Tokyo when things happen that you need to run by somebody. And certainly very grateful that you picked up the phone. But sometimes you're not going to have the answers. And you have to have, I think, the humility to acknowledge that. It doesn't mean that people won't trust you, that you don't know what you're doing. I think they'll appreciate that you're involving others. Great. Thanks for that, guys. Dr. Finoff, do you have imposter syndrome still? No. The irony is that I still absolutely feel it almost every day. I feel like I have so much responsibility and so many people looking to me for guidance and leadership. And I don't have all the answers. It's a real struggle. But at the same time, I think it is important to kind of go back and think about the experiences that you do have. Provide advice to people. Often it's more of a conversation with that individual. And they come up with their own answer, rather than me giving them the guidance and the advice. It's just kind of talking them through it. And I absolutely have mentors that I reach out to now in order to get guidance. Yeah. Thanks. All right. So we'll move on to some questions from the audience. And this one is one that we're getting often at our meetings. And it's really about the quality of a physiatrist as a sports medicine physician. So this question was asking, how do we advocate for ourselves as physiatrists who are sports medicine physicians? And specifically to our institutions, as well as our colleagues in family medicine and orthopedic surgery. So how do we advocate for our skills as physiatrists? This was something that came up last year with me. Emory actually didn't want to hire a PM&R doctor as a head team physician. I sort of convinced them otherwise. But the job went unfilled for a while, because they wanted a family medicine trained physician. And I kind of showed up and started doing the job anyway. And then they were like, hey, you actually can do this. And I think the most important thing you can do is show your skills and show that we do have the knowledge to do this. I have people that we call. Like we have a sports cardiologist we work with for our challenging cardiology cases. I have a sports endocrinologist that I call for my very challenging res cases. But on the whole, I try to show them that I can start this and I can take care of this athlete. And again, the imposter syndrome is there. And you sort of push through and know what you know and call when you need help. But I think all you can do is show your skills and show them that we can do this. And everyone on this panel is doing that. And I know everyone in the audience is also doing that. So thank you. Thanks, Dr. Pasculli. So our next question gets to, and this is actually something that none of us, I believe, talked about in our slides, but treating the staff. So when we travel, of course, we're treating the athletes. But sometimes we're with staff. Could be coaches, could be media personnel, et cetera. What experience do any of you have with treating a staff member that may have an injury or that may have fallen ill? This happens all the time. Like I said, we travel with 60 plus staff members. So at the Olympics, we had a staff member who had chest pain. So they had to go to the emergency room. I've had a staff member's spouse who actually was traveling with the team a long time ago who had cellulitis, an infection, an open wound that was draining. I mean, you'll see all these different things that happen. And I think, one, it depends on, are you traveling internationally? Are you traveling domestically? Obviously, if it's domestic and they have physicians that are within their own home physicians, it's obviously really helpful to have their own home physicians kind of manage some of the issues. But if you're traveling internationally, I do think that, and it's an emergent situation, I do think that's a big part of what we do because they are part of the team. And so, yeah, I would say that this happens quite frequently in my experience. Yeah, so absolutely with what Monica said, if there's an emergency, you have a duty to treat. And that's not just your entourage and your athletes, that's anybody around you. But I think it's really important when you're traveling to find out who you're responsible for and who you should be treating. And you need to make sure that your malpractice covers you for that. And you need to make sure that you have clarity around that with everybody. So it's a set expectation. And so one of the initiatives that I've been working on very hard since I've entered this role is developing medical standards or best practice recommendations for the national governing bodies in the US. And it's telling them you should have these different policies and procedures, you should have these different personnel at different events, et cetera, et cetera. But one of them is specifically related to who are you treating? Who are you treating on the road? I will say that with Team USA, our legal team came to me and said, you are able to designate that based on our malpractice insurance. And what we have decided is it's all of the athletes and all of our accredited staff. And so for the Olympic Games, we have 600 athletes, but we have 900 staff. For people, and we had 13 hospitalizations and those were all in staff members. We had a stroke, we had new onset seizures, we had new onset diabetes that presented with a coma and seizures. But there's just all these different things. The people who are the least healthy are usually your staff. And so you take, they take a lot of time. But I think that clarity of role and responsibility is super, super important. All right, so the next question has to do with procedures. So we talked about maybe medications and some protocols as it regards to infectious disease. But this one has to do with procedures. So how do you handle a situation, for example, an athlete has a laceration. This specific question was asking about something like dry needling. Is there any specific protocols you have? What's the decision making process of what may be appropriate procedure to do while traveling? What may not be an appropriate procedure to do while traveling? Keep in mind the therapeutic use exemption. So if you are doing anything, you need to make sure that you're doing all of your paperwork because often this travel is around competition. And if it's high level, then they're often gonna, somebody is gonna be drug tested. And the other thing about like, I do a lot of needling, but you have to know your athlete. Some athletes feel great and they actually have, they have a better endurance that day, but many of them need recovery. So you really need to know the personality and you don't wanna be doing that right before their gold medal match. So you wanna make sure that you know what they tolerate, what their recovery is, and they know the risks and benefits because anything that can help can also harm. So you really want, if they're thinking about that, you wanna play around with that when you're in camp with them at the USOPC and not when they're in their final OQS trying to battle for that last Olympic spot. Two additional points, be aware of any guidelines about needle policies. The IOC has a very strict trying to get away from doing like a Toradol injection or something around that time of competition. So not only the agent that you're injecting, but the actual utilization of a needle, there are specific requirements and protocols for that. In my case, the Federation of International Gymnastics also has different protocols. So you have to be very careful and aware of that. For dry needling that's done in terms of rehab, USA Gymnastics has a, I think it's an annual consent that parents or if they're not a minor in the athlete can sign, but you have that in place so that you're kind of covering yourself in terms of consent and risks. All right, so we'll go back to, we've kind of talked a little bit about being, covering a team. Let's go back to the beginning in terms of starting out of being a sports med doc for some of you are medical students and residents and fellows here. So this question is, what do you wish you knew as a resident with the goal of becoming a sports medicine physician at the level that we all are at? Yeah. I guess one of the things that I think is really important is I think sometimes as medical students, we sometimes get so hyper focused on, oh, I'm gonna be a sports med doc. I'm just gonna need my MSK. I'm gonna need my, maybe a little radiology. I'm gonna need my ortho rotation. But I will tell you as a residency program director, every rotation I've been on in residency has helped me in some way be a better sports medicine doctor. And I'll tell you, I've said this in other panels before, but I actually think that we are all uniquely different from your standard family medicine, sports medicine doctor, because we are physiatrists. I think there's something very unique that physiatrists bring to the table as a head team physician for a sports medicine team. I think that we are really good at coordination of care. And I will tell you, coordination of care and leading a multidisciplinary team, you learn that all in all of your inpatient rotations, coordinating the care of a brain injured patient or a spinal cord injured patient or someone with like a lung transplant. If you can coordinate that care, I will tell you, I mean, what John Finuf does probably 99% of his day is coordinating the care at like this really complex level for thousands of athletes. And so the fact, I can't, I don't wanna speak for John, but I'll speak for myself, but I'll tell you the level of coordination that I have to do, I had years of practice doing this, and it was really important. I think when I approached residency, I did pay attention to all my rotations, and I really tried to get as much as I could out of them. I don't think I realized how much it was gonna inform me in my future career. And it really has been very invaluable. I do try to tell that to my residents all the time, that no matter what you go into, there's gonna be something valuable on every rotation you go on. So really try to take advantage of it, even though you can't see in the moment how that's gonna help you in your future career as X, Y, or Z, you never know what you're gonna need. And I would venture to guess that we've all used some skill that we used on a rotation that wasn't directly sports medicine, that we are glad that we had the experience to learn from. Somebody else want to? So I don't want to be inflammatory with this, but there's been things that have happened as far as PM&R sports medicine in the last several years that has, I think, undermined our training and what we bring to the table. And so I just want, and I'm not gonna go into that, but what I want to say is that everyone is physical medicine rehab that's in here. So for those that are in residency, or if you're a med student, you want to go into sports medicine, just realize that in the world of non-surgical, so take the orthopedic surgery out of it, and in the world of primary care sports medicine, the physical medicine and rehab applicants as someone that reviews fellowship applications on a yearly basis, you're the cream of the crop. We have to separate PM&R applications from the other specialties because the PM&R ones are much better. And that is just being truthful. And so I don't want, so if you're in the audience, don't let some of the things that have happened in the world of sports medicine make you feel like your training is subpar or substandard or anything along those lines. You really are the cream of the crop and you're the best people going into this field. And just be confident in that. Don't be arrogant, but be confident and realize that you bring a lot to the table that other specialties cannot. And so that's just, I just want people to realize that. Not necessarily something that I wish I knew, but just know that where your training is right now is appropriately training you to do this job. And just take that with you when you go. And I'll just add one final comment. I think that I have a leadership talk that many of you probably have seen. I gave it as an address last year at AMSSM. I gave it as a Passor Award for AAPM&R a number of years ago also. But when you're in your residency or your fellowship, you should really look at your end goal. What do you want to accomplish in your career and start mapping out the path of how to get there? What are the skills? How do you get people to give you opportunity? How are you going to work through the system? Who are the people that you need to know? Who do you need from a mentorship standpoint? And kind of the point of it is, is if you know what your destination is and you know how you want to get there, you're far more likely to achieve that in your career as opposed to just saying, yeah, I want to do sports medicine, it'd be really cool. And then kind of hope things happen because that's just going to, the tide will take you wherever it's going to as opposed to you knowing exactly where you want to go. Thanks. So I want to get to all the questions. There's one at the end that I think is very important that I'll save for the end. But there's one question on here that I haven't gotten to yet. So this will be rapid fire. This has to do with an injury that concerns you when you're traveling. So I want you guys to, we'll go down the line, rapid fire, maybe one or two words or three or four, whatever, but quickly. What most concerns you, either injury or some sort of situation when you're traveling? What keeps you up when you're traveling? Rapid fire. So this isn't necessarily for traveling because I don't do a lot of team travel with the teams that I take care of. So not necessarily traveling, but just my personal opinion, what scares me the most is a large joint dislocation with neurovascular compromise. That really scares me and has not happened to me yet. I'm sure it will at some point in my career, but that's the one that I dread and hope never happens. That very one happened to me while I was covering men's gymnastics in Germany. And I just remember it being so adamant about being able to explain to the random hospital that we were taken to what my concerns were, what the imaging that needed to be done. And amazingly, after multiple conversations and navigation of that situation, which they wouldn't let me back in the ER when they brought them in, because it's still COVID policies, this athlete ended up having an X-Fix placed there. I coordinated the care. He was a Stanford athlete and he shared this all on social media, so it's public. But, and then we figured out how to get him home and all of that. So yes, a big injury like that in a foreign country where you have very little control, I think is one of the more stressful situations, but you can definitely make it work. Yeah, so I would say that it's being in a country that you don't have anybody on the team that speaks the language. It has a poor medical infrastructure. You have minors with you and it's a high risk sport where almost certainly somebody's gonna get severely injured. So that's the one that, yeah, keeps me up at night. Mine are the ones that happen quickly. So the first thing I take out of our docs args when I join US soccer is the EpiPen and albuterol inhaler. And I wanna know where the AED is and I check it because those are the things where bad things happen quickly and they're very easy to fix. I have been in a situation where we also had a security issue where we had to evacuate a country due to political unrest. So that's the one that I sometimes have a little PTSD about. I would say EMS response in a foreign country is highly variable. And I think it's not so much the venue where you're actually doing, when the competition oftentimes has a great emergency action plan and they have everything all settled. It's actually all the other time when you're not in competition, you're not on the training field and you might be at the hotel. And there are response times, I think we're very spoiled here at how quickly EMS services make it to places in the US. And that's just not standard across the world. I'm gonna completely echo Dr. Rowe. The EMS times, even though I don't travel, covering high school all the way up to pro, it really varies and it can cause a lot more stress and you can have your EAP in place, but if you don't have the tools to get the athlete to where they need to go, it's the scariest feeling in the world. Great, all right. So we have five minutes left for our last question. This is a lifestyle question. We all have lives and we touched on it. At least I touched on it and some of us touched on it with our initial presentation. So there's a couple of questions that I'll combine together and is essentially, how do you balance life? You have your clinic, your teaching, your administrative and you're traveling around and you're covering teams, but you wanna be a good father, good mother, good husband, good wife, good dog mom, Dr. Rubish. And so how do you balance it all? So I'm married and have three kids and it's a point of contention sometimes for sure, the amount of work outside of my normal nine to five job that I do with these teams. And during fellowship interviews last week, someone asked me, how do you have it together to be able to do all these things? And the answer is, I don't. So it's a constant struggle, it's constantly just trying to keep your head above water and make sure you're not crashing and burning. And so I think any of us up here would say it's not, there's no secret answer to the question or some secret sauce. I think you just have to do your best to do your best job and also realize that probably overall the most important thing, although it's good for your career to take care of these teams and be seen doing that, you still have to go home and I have to be a good husband and a good dad. And I frequently struggle with feeling like maybe I'm not doing the best job of that. And so I think it's just realizing that there's no secret answer and you have to do the best that you can and realize that there's more important things than taking care of professional sports teams. Thank you. Agreed, I think the selling us on the idea of achieving balance is a fallacy that we're never gonna get, at least what I interpret is that would feel like everything's even keel, you've got your head above water in every area. I haven't achieved that. But I think you figure out what the things that are most important to you in multiple domains of your life and careers and lifetimes have seasons. You don't have to invest the same amount of time in these different areas throughout your entire career. It can evolve and change. And I know some of the advice we're always given and I get why Rosa said this is you say yes and say yes often. I think you also need to learn how to say no and learn how to kind of prioritize all these different opportunities and they can all sound wonderful, but you can't do them all. And so learning to be sort of strategic and realistic about that is very useful. I guess for going down the line, I'm gonna pretty much agree with prior comments. Sports medicine is, you really have to choose what the work-life balance is for you. Everybody is unique and different. And sports medicine, it's nights and weekends. And if you are with professional sports, then it's 24-7. Literally, they can call you in to do a pre-participation physical at 2 a.m. in the morning because they want the athlete to be able to practice and compete the following day. And you have to be able to do that. Just get up and do it. So you need a very understanding family. I think, again, it's this whole setting expectations, making sure that your partner has similar expectations about their life because your life will affect their life. And saying no when there are things that are kind of peripheral and not actually helping you achieve your goal and might be diverting your attention from the things that need your attention. I would agree. Something's gotta give. So you won't be able to do everything all the time. There's just not enough hours in the day. I think the main thing is to make sure that what your priorities are are worth it. So to me, if somebody had told me that this would be my job 10 years out of fellowship, I would have told them, who do I have to pay to do it, right? Because I feel such a privilege what I get to do. But that said, I think there's too much work for one person. And so it's about sharing that load too. Think of it as an abundance mindset. If you say no, who can you share that opportunity with? Who do you know would do a great job? Because there are a lot of people who are also trying to do that. And you can share those opportunities and grow the whole sports medicine group in that way. Yeah, I would say, I mean, I agree with everyone here. This is a common theme. But work-life balance is a fallacy. I think what it is is you have to just, the amount of time you have, you should think about like a pie and where you want to slice it and who you want to give which slice to, you know? And I think if you truly love this, if you really do love this work, it doesn't feel like work, right? And it doesn't, when you, if you love it and you're woken up at 2 a.m., you don't complain about it, you know? And if you find yourself complaining about it, then you have to slice your pie differently, right? And you have to make different choices because I think it is, I think outwardly, a lot of people do look at probably our lives thinking like, oh, you guys are sacrificing a lot. And we probably are to some degree, but it probably doesn't feel like a huge sacrifice to us because we enjoy what we do. So it really is, it starts with a passion for what you do and wanting to take care of these athletes. And then it kind of grows from there. But it is not easy. I don't think anyone here thinks it's easy. I'll just echo everyone. I think having a great team at work, at home, your friends, your family, like Melody said, bringing other people into the fold. So for me, if I know there's weeks that are gonna be more challenging, I have my colleagues, including the athletic training staff, our nutritionists, like other people that I know who need to check in on the athletes a little bit more than I'll be able to. If there's things that I know I'm not gonna be able to do at home, like letting my partner know earlier rather than later, trying not to surprise as much as you can and plan when you can. But I think just embracing the team mindset of being a physiatrist, because that is really how we succeed. We can't do anything on our own and really using all the resources available to us. That's great. And as a great really way to end it and say that, I'd say, as I tell my mentees often, make a list of priorities. As Dr. Rowe said, it's a pie if there's only so much time you have. And lean on your colleagues, lean on your mentors. That's, you're not in it alone. The theme that we established here is that it is teamwork that gets us through everything. And it's all about the team winning the victory. All right, so that concludes our time that we have this afternoon. Thank you for joining us. It was a pleasure to speak with you and give a round of applause to our wonderful panel. Thank you.

sports medicine

team coverage

travel logistics

multidisciplinary teams

emergency preparedness

athlete safeguarding

medical emergencies

professional balance

imposter syndrome

teamwork

continuous learning