Technician, firefighter, risk manager, administrator, communicator, politician or jack-of-all-trades?
– Written by Peter Jenoure, Switzerland, Michael Turner, United Kingdom, Babette Pluim, The Netherlands, Alain Lacoste, France, Mario Zorzoli, Switzerland and Katharina Grimm, Qatar
MEDICINE IN INTERNATIONAL SPORTS FEDERATIONS – A HISTORY OF GROWING INFLUENCE
Over the last 15 to 20 years, medicine in the larger, well-funded International Sports Federations (IFs) has developed from an under-resourced, neglected aspect of the organisation’s work, run by idealistic volunteers, to an increasingly acknowledged, integrated and often professionalised part. Where appreciation had previously tended to be intermittently sparked by an imminent or actual emergency, the contribution of medicine to the achievements of an IF is nowadays more readily accepted by administrators and honorary officials. Protecting the health of the athletes competing under their auspices has today become one of the declared objectives of the board of many IFs. While the progress is noticeable and encouraging, much is still left to be desired from a physician’s point of view, particularly for the majority of the less well-resourced, smaller IFs.
In 2010 and 2012, the Fédération Internationale de Medicine Sportive (FIMS) Interfederal Commission conducted a survey among the chairpersons of the medical commissions of IFs, receiving replies from 24 Olympic and 8 non-Olympic IFs (http://www.fims.org/en/commisions/ interfederal/results-of-the-ifc-survey/). The chairs were first asked to rate the importance of medicine in their IF and then about different structural aspects of their medical bodies, as well as regulations and directives. They were further asked about specific challenges they met and any particular needs they had. The FIMS Interfederal Commission also assessed the websites of all SportAccord-listed IFs to gain an understanding of the activities and initiatives of the different medical commissions. Based on the survey results, further analysis and the personal experience of the FIMS Interfederal Commission members, these reflections on the role of the Chief Medical Officer (CMO) of an IF have been brought forward for discussion. The purpose is to assist the boards and administrative bodies of IFs of different sizes and resources in the identification of their requirements and suitable candidates to meet those requirements.
The survey results and experience show that the nomination of a CMO who can fully commit to the task represents a major factor in forwarding the cause of prevention and health care in an IF. The impressive work of honorary chairpersons and commissions is fully acknowledged, yet the many other commitments of these colleagues naturally limit their capacity to address all medical issues of the IF in full.
Obviously, this theoretical description will require adapting and tailoring to the specifics of the sport and certain points as needed.
IS THERE AN IDEAL PROFILE OF THE IF CMO?
Any ideal candidate for the position of a CMO of an IF, regardless of its size, has first and foremost to be able to understand the vision, mission, values and objectives of an IF and where and how medicine is integrated into the organisation. An appreciation of the fact that medicine is but one of many departments expected to contribute to creating a setting which allows athletes to perform at their best, is essential. Any approach based on the overriding importance of health and medical matters, almost naturally assigned by our profession, will inevitably lead to disappointment in the best and failure in the worst case scenario.
The exact qualifications and demands on a CMO will primarily be determined by the objective and aims of this function and the related department as defined by the IF. By definition, he or she needs to be a medical doctor. Because of the role they are expected to fulfill, it is also highly recommended that he or she has a specialisation in sports medicine. Certain countries recognise sports medicine as a fully registered speciality (Netherlands, United Kingdom, etc), whereas other countries have sports medicine only as a sub-speciality (Switzerland, Germany, France, etc). In our opinion, a medical doctor with an interest in sport or a medical doctor with a background as an athlete, but without specific qualifications, is insufficient at the level of the world governing body of a sport. There are sports, such as motorsports, powerboat racing etc. where, even though considerable physical and mental stress is placed on the athlete, a background in emergency medicine or trauma might be considered just as useful, for example, to competently design a concept of required medical services at events. Which specialisation is considered more important would need to be assessed on a case by case basis and the other competencies then brought in via the IF Medical Committee or consultancy as needed.
Furthermore, it would be very useful if the candidate has experience in the particular challenges and needs of the different levels of daily work in sports medicine, ideally hands-on at the field side, as a team physician and having worked for a regional, national or continental sports federation.
Finally, it is important that the candidate has sufficient language skills in order to be able to work efficiently in an international environment. Good knowledge of at least English and preferably another language such as Spanish or French, is critical to communicate effectively in a multilingual and multicultural organisation and with the associated sports and medical bodies and to establish sound working relationships in the various countries hosting events.
PROFESSIONAL WORKING RELATIONSHIPS ENABLE PROFESSIONAL CARE
To live up to the complex demands of being the CMO of an IF, including, among others, often extensive travelling obligations, the candidate must be able to allocate enough time to the task. This raises the question of the formal working relationship with the employer, the IF. Our experience shows that often the CMO is a passionate volunteer, sometimes originally involved through a personal relationship. Mostly, reimbursement is for their incurred expenses (travel, accommodation, etc.) only, but not for their actual working time. One of the main objectives in future would appear to be an adequate formalisation of the working relationship, whether on a consultant, service provider or employment basis. It is important to have a written agreement on the tasks and responsibilities of both parties, including detailed coverage of any liability and insurance matters, to protect both parties and provide a framework for monitoring and evaluation.
Does the CMO have to be employed and paid full-time? This is surely in the first place dependent on the size, scope and resources of an IF. On the one hand, for a large IF with multiple member associations and several annual high-level events worldwide, the best arrangement appears to be working in formal full-time employment, if simply for the reason that the intellectual and physical time commitment could not be met otherwise. On the other hand, it is often maintained that skills in medicine change rapidly and it is only in daily practice, dealing with real patients and athletes, that the physician remains up-to-date and aware of current challenges. If a CMO works full-time for an IF, he might lose this advantage even though it can be claimed that permanent involvement at events might at least partly make up for this. Furthermore, being part of the administration of the IF, he or she may find themselves in ethically challenging situations when the interests of the IF are in conflict with the health of the athletes (see IOC: Olympic Movement Medical Code http://www.olympic.org/PageFiles/61597/ Olympic_Movement_Medical_Code_eng.pdf).
The best solution for both IF and CMO will need to be individually defined, duly considering the pros and cons of a particular arrangement for both parties. Often, financial constraints will principally rule out full-time employment, especially with smaller IFs. What is clear, however, is that an adequate compensation has to be aimed at, based on the means of the IF, to ensure best practice care supporting athletes in achieving their performance and health goals. While one might claim that with an increasing professionalisation of sports, medical care cannot be managed in an amateur way, this does not apply to many small IFs, where more or less the whole organisation is based on volunteerism. Here, different models maybe considered, such as providing the services of a CMO or a Medical Committee through umbrella organisations or sports medicine associations.
STRUCTURE GENERATES INFLUENCE
Whether established for the first time or reorganised within a restructuring of the IF, one decision shown to be critical to the level of service delivery is whether to separate medical affairs from anti-doping. Often, a double function is practiced, where the CMO leads both departments. However, anti-doping affairs are extremely time- and resource-consuming and strictly controlled by regulations, including the World Anti- Doping Code, which places the IF under immense pressure to comply with these regulations. This might be at the cost of other medical and health matters, that are at least as important, but not subject to official surveillance and therefore taking a back seat on the IF agenda. It should further be clear that the CMO and their medical structure cannot be under the authority of the anti-doping manager, as the scope of medical services goes much further.
The FIMS survey and previous achievements of the medical departments in different IFs show a major advantage if there is a representative on the Board of Directors to support and explain proposals and initiatives to the nonmedical executives. This position requires as much an understanding of medical matters as diplomatic and political skills and might be best held by the Chairman of the Medical Committee. An employed CMO cannot be affiliated with the Board, in order to maintain separation of powers corresponding to the classical structure of associations and federations with staff on the one side and honorary members on the other.
IDEAL OR WISHFUL THINKING?
The detailed job description included as part of this article (available at www. aspetar.com/journal), contains a list of both essential and possible tasks of an IF CMO, that is by no means conclusive and has to be adapted to the specifics of the individual sport. This non-exhaustive description demonstrates that the task of the CMO of an IF is a fascinating challenge for the physician as much as for the manager – when practiced under good conditions. Several colleagues from IFs felt that it might be difficult to find candidates complying with this ideal profile, even more so as the majority of smaller IFs will be insufficiently funded to afford such ideal candidates. At the same time, a sport’s world governing body holds considerable responsibility regarding the health of their athletes and we should apply our minds to how we can best meet this responsibility. Service provision offered by sports medicine organisations to IFs could be one approach deserving more reflection and discussion.
Peter Jenoure M.D.
Ars Medica Clinic, Ars Ortopedica
(Formerly) FIMS Interfederal Commission
(Formerly) International Military Sports Council
Switzerland
Michael Turner M.D.
Lawn Tennis Association
United Kingdom
Babette Pluim M.D., M.P.H., Ph.D.
Royal Netherlands Lawn Tennis Association
(Formerly) FIMS Interfederal Commission
The Netherlands
Alain Lacoste M.D.
FIMS Interfederal Commission
FISA Sports Medicine Commission
France
Mario Zorzoli M.D.
(Formerly) FIMS Interfederal Commission
(Formerly) International Cycling Union
Switzerland
Katharina Grimm M.D., M.Sc. (Med)
Sportsmed SA
Chair, FIMS Interfederal Commission
Aspetar – Orthopaedic and Sports
Medicine Hospital
Qatar
Contact: jenoure@bluewin.ch
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