In her capacity as Associate Editor to BMJ Open SEM, Dr Diana Robinson was invited to present her perspective on Sport & Exercise Medicine (SEM) in his home country, Australia.
Tell us more about yourself.
I am a Sport and Exercise Physician who has had the good fortune to be a part of Australia’s sport and exercise medicine, developing from a fledgling interest group to a more mature medical specialty. I am the Clinical Lead for the SEM Academy, an online sport and exercise medicine education resource with over 70 online modules. I have project managed the development of these modules over the last 8 or 9 years, which originally were conceived to standardise the training of Australasian Sport and Exercise Physicians across geographical boundaries. As the Chair of the Australasian College of Sport and Exercise Physicians (ACSEP) Curriculum Working Group, we are currently working towards transitioning our training program from a stage based to a competency-based program. I am an Adjunct Associate Professor at the University of Notre Dame in Sydney and externally work as an education consultant. I serve on FINA’s Doping Control Review Board and FINA and the ITA TUE committees. In Australia, I have a role in the Therapeutic Goods Administration (like the FDA in the USA) in scheduling medicines and chemicals. I have had the opportunity to be Chief Medical Officer for several sports, attend Olympic and Commonwealth Games and many World Championships. I have travelled widely with many sports, but particularly aquatic sports, triathlon, and surf lifesaving.
What is the path to becoming a sport and exercise physician in Australia, and what are the main hurdles on this path?
Sport and Exercise Medicine was accredited in Australia as a medical specialty in 2009. Becoming a sport and exercise physician in Australia is like most specialty training insofar as you must complete a medical degree and three post-graduate years in the hospital system. During this time, you are expected to have worked in several areas such as the Emergency Department, Orthopaedics, and at least one medical term. To be considered for a position on the formal training program, which at present takes about 4-5 years to complete, one must successfully pass an entrance examination (Part 1) which ensures that the trainee has the requisite basic sciences knowledge in areas such as anatomy, exercise physiology, immunology, and pathology. Once this hurdle is complete, the next step is acceptance in the training program, which is competitive due to the limited number of positions available in Australia and New Zealand.
Experience caring for a sporting team and providing medical care at events, working or sitting in at a sports medicine practice, and completing some of the academic and other education modules. Following a sports physician to their various activities and assisting where possible is also advisable.
Other than the two significant examinations and securing a training position, the main hurdle is financial. This program is run almost exclusively in the private sector, with very few positions fully funded by the Australian Government, unlike other medical specialty training programs in this country. Finally, to become an SEM Physician, the trainee must fulfil all the requirements of training, including caring for a high-level team for a season, providing medical care at a range of events and sports, publishing research as a first author, and successfully completing the Fellowship examination, which involves both a written and clinical component. 5 university-level academic modules must be completed during training, including Sports Biomechanics, Sports Pharmacology, Sports Nutrition, Research Methodology and Sports Psychology. The training during the program is based on an apprenticeship model, where the registrar consults from sports medicine practices under the supervision of a Fellow of ACSEP. Registrars must move to at least 2 practices during training and preferably more to ensure a broad and diverse training experience. Finding the “right” practice to fill the gaps in an individual’s training can be challenging for some.
How developed is collaborative work in SEM in Australia?
Sport and Exercise Physicians in Australia and New Zealand (Fellows of ACSEP) have a long history of collaboration with sport and musculoskeletal physiotherapists, dietitians, sports psychologists and podiatrists through medical practices and the established referral system, where medical practitioners refer patients to the appropriate allied health professional and work collaboratively to achieve a positive outcome for the patient, whether that be for injury management or the prevention and/or management of a chronic disease. In more recent years, ACSEP members have had closer relationships with Exercise physiologists and sports scientists, as well as sports chiropractors.
Multidisciplinary Sports Medicine Centres were first established in Australia and New Zealand in the 1980s and have become relatively commonplace in the large state capital cities. In most of these practices, one would find sport and exercise physicians, physiotherapists, exercise physiologists, sports psychologists, dietitians, and podiatrists. I joined my first multidisciplinary clinic in 1991, where all these specialties were represented even then, along with a sports radiology practice.
Sports Medicine Australia (SMA) is a multidisciplinary organisation bringing together a range of medical and allied health practitioners in sport and sports trainers and community groups. SMA was first established as the Australian Sports Medicine Federation in 1963 and provides leadership, education, and commentary in the areas of sports exercise and medicine, sports injury, physical activity, sports exercise and science, and the healthy performance and participation of Australians in physical activity and sport. Each year, Sports Medicine Australia holds a sizeable interdisciplinary conference with multiple streams, catering for a wide range of sport and exercise practitioners from medicine, physiotherapy, dietetics, podiatry, exercise science, sports psychology, and sports chiropracty.
Sport and exercise health practitioners in Australia and New Zealand pride themselves on a well-functioning, supportive and collaborative culture, where enthusiasm and stakeholder engagement continues to contribute to healthier communities and safer sport and physical activity.
Are exercise physiologists/scientists integrated into your healthcare system, and does health insurance cover their services?
Exercise Physiologists and sports scientists’ services are well integrated into the Australian Healthcare system. They are increasingly used for their expertise in rehabilitation patients with chronic medical conditions, the aged care area, rehabilitation of patients with workplace injuries, and exercise and cancer management. EP’s work alongside general practitioners, sport and exercise physicians, sports doctors, and physiotherapists. Following the Sydney 2000 Olympic Games, my interest in a career in exercise physiology and sports science has soared. Medicare, the Federal Government, funded free healthcare system gives a rebate for up to 5 EP sessions per year when referred by a general practitioner, and private health insurance, held by about 53% of the population, provides rebates for about 12 sessions per year. While private insurance rebates only cover approximately one-third of the consultation and should be improved, it is better than the alternative!
What is done in Australia to promote SEM among students and young professionals regarding research and clinical opportunities?
Not enough, in my opinion! Much more could be done to promote SEM among medical students and young professionals in Australia. However, the number of SEM Physicians is still relatively small, and most are based in major cities. There is generally good knowledge of the role of sports physiotherapists and EP’s in sport and exercise.
SEM is underrepresented in the undergraduate medical curriculum (on average musculoskeletal medicine makes up about 3-4% of the course). Therefore the exposure of medical students to career opportunities is limited and often only obvious to those involved in high-level competitive sport or who have a strong interest in sports itself. SEM Physicians lecture at some universities in their undergraduate courses. Others will present at careers seminars and be present at EXPO’s for medical students and young doctors considering possible career paths. ACSEP’s website has information for prevocational doctors about careers in sport and exercise medicine
Finally, if you were Harry Potter, what would you change to SEM in Australia?
Harry Potter is magic, right? So, the politicians in Federal Government and its health department would wake one morning and completely change the approach in healthcare from reactive to proactive, with a major push towards physical activity both for the prevention of chronic disease and as a mainstay of treatment. It would not only be effective in so many ways, but it would also most likely save them squillions!
There would be an increased emphasis on physical activity, safe sport, and injury prevention and management in the undergraduate course so that our doctors of the future would be better equipped to manage commonplace injuries and sports-related illness. Throughout their careers, the internal medicine subspecialists would use physical activity confidently, this cheap and effective treatment.
SEM Physicians would be considered equals to their other specialist counterparts by peak organisations and encouraged to use their advocacy, communication, and collaboration skills across a broad range of regulatory, health and sporting organisations. They would be encouraged to promote physical activity as prevention for chronic disease and an effective management technique for a range of conditions.
And finally, all our registrars (trainees) would be paid by the Government, just like the current registrars in any other medical specialty, rather than struggling to survive in a privately funded program, where at times (particularly during covid-19) it has been hard to earn a reasonable income. The commitment our registrars show to becoming Sport and Exercise Physicians in Australia, despite many difficult hurdles, is commended!