Sports Medicine Physician Decision-Making, Practice Changes, and Mental Health During the Early Phase of the SARS-CoV-2 Global Pandemic.

OBJECTIVE: The SARS-CoV-2 pandemic has had a profound effect on the healthcare system. This study aimed to identify its effects on sports medicine physicians during the early phase of this pandemic. DESIGN: Survey study. SETTING: Sports medicine providers. PARTICIPANTS: Physician members of the American Medical Society for Sports Medicine were surveyed between March 25 and April 4, 2020. A total of 810 responses were obtained from 2437 physicians who viewed the survey. INTERVENTIONS: The survey consisted of questions examining demographics, prepandemic practice patterns, anxiety and depression screening, and new beliefs and behaviors following government-based medical policy changes resulting from the pandemic. MAIN OUTCOME MEASURES: Changes in clinical volume and treatment practices, Patient Health Questionnaire (PHQ-4). RESULTS: The mean in-person clinic visits reduced to 17.9%, telephone visits to 24.4%, telemedicine (video) visits to 21.8%, and procedural visits to 13.8% of prepandemic practice volume. The mean PHQ-4 scores for physicians were 2.38 ± 2.40. Clinic and procedural volumes were reduced less by male physicians, as well as more experienced physicians, nonphysical medicine and rehabilitation training background, in government or private practice, and in the Southern region of the United States (P < 0.05). Physicians were more likely to reduce their anti-inflammatory (37.8% decreasing vs 6.8% increasing, P < 0.001) and opioid (10.5% vs 6.8%, P = 0.003) prescriptions rather than increase. CONCLUSIONS: During the early phase of the SARS-COV-2 pandemic sports medicine physicians reported reducing in-person evaluation, management, and procedure volume by over 80%. Multiple demographic and geographic factors were associated with practice volume changes.

Changes in clinical practice perceptions and mental health of sports medicine physicians due to the SARS-CoV-2 pandemic.

OBJECTIVE: The SARS-CoV-2 pandemic has had an immense impact on healthcare, but little has been published on its impact on sports medicine physicians. This study aimed to assess the perceived impacts of the pandemic on practice changes, financial implications, and mental health of the physician members of the American Medical Society for Sports Medicine (AMSSM). METHODS: Online surveys were sent to physician members of the AMSSM, with questions asking about demographic information and personal associations to COVID-19. The main outcome measures included self-reported clinical practice volumes, visit types (telemedicine, face-to-face), Patient Health Questionnaire (PHQ-4) scores, personal finances, clarity of practice guidelines, and personal protective equipment (PPE) availability. RESULTS: A total of 825 respondents completed the initial survey, with a subset completing follow-ups. In-person clinical and procedural volumes were reported to be reduced to just 17.9% and 13.7% of the pre-pandemic baseline volumes at the first survey (March 2020), but increased to 81.1% and 77.3% (August 2020), respectively. PHQ-4 anxiety subscores significantly decreased over time (p < 0.001); younger physicians and female physicians were more likely to have higher scores (p < 0.05). Reported physician income significantly increased over time (p < 0.05), and financial concerns steadily decreased (p < 0.001). The perception of having an adequate PPE significantly increased over the study (p < 0.001) but not for having clear practice guidelines (p > 0.05). Physicians have become increasingly aware of others testing positive for the virus, but not themselves or someone they live with. CONCLUSIONS: Sports medicine physicians have been heavily impacted by the SARS-CoV-2 pandemic, with some recovery since it started. Sports medicine physicians should be aware of pandemic-related practice changes and resulting mental health and financial implications.

Corticosteroid and Local Anesthetic Use Trends for Large Joint and Bursa Injections: Results of a Survey of Sports Medicine Physicians.

BACKGROUND: Physician decision-making surrounding choices for large joint and bursa injections is poorly defined, yet influences patient safety and treatment effectiveness. OBJECTIVE: To identify practice patterns and rationale related to injectate choices for large joint and bursal injections performed by physician members of the American Medical Society for Sports Medicine (AMSSM). DESIGN: An electronic survey was sent to 3400 members of the AMSSM. Demographic variables were collected: primary specialty (residency), training location, practice location, years of clinical experience, current practice type, and rationale for choosing an injectate. PARTICIPANTS: A total of 674 physicians responded (minimum response rate of 20%). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Outcomes of interest included corticosteroid type and dose, local anesthetic type, and total injectate volume for each large joint or bursa (hip, knee, and shoulder). RESULTS: Most respondents used triamcinolone (50% to 56% of physicians, depending on injection location) or methylprednisolone (25% to 29% of physicians), 21 to 40 mg (53% to 60% of physicians), diluted with lidocaine (79% to 87%) for all large joint or bursa injections. It was noted that 36.2% (244/674) of respondents reported using >40 mg for at least one injection type. Most (90.5%, 610/674) reported using an anesthetic other than ropivacaine for at least one type of joint or bursa injection. Physicians who reported lidocaine use were less likely to report that their injectate choice was based on the literature that they reviewed (odds ratio [OR] 0.41 [0.27-0.62], P < .001). Respondents predominantly used 5 to 7 mL of total injectate for all large joints or bursae (45% to 54% of respondents), except for the pes anserine bursa, where 3-4 mL was more common (51% of physicians). CONCLUSIONS: It appears that triamcinolone and methylprednisolone are the most commonly used corticosteroids for sports medicine physicians; most physicians use 21 to 40 mg of corticosteroid for all injections, and lidocaine is the most-often used local anesthetic; very few use ropivacaine. Over one-third of respondents used high-dose (>40 mg triamcinolone or methylprednisolone) for at least one joint or bursa.