Sports fans see it on a typical Monday night. The professional football game seems to be progressing smoothly, until a player slumps to the ground in agony. It could be a minor sprain, but it could be major head trauma.

Who is behind the scenes when it comes to treating injured players? Usually the athletic trainer or team physician. Nowadays, though, emergency physicians play a growing role in sports medicine.

Sports medicine has been a subspecialty of emergency medicine since 1992, and sports medicine fellowships gradually are finding their ways into hospitals. Four years after completing his fellowship in sports medicine, Charles Hoidal, MD, an ACEP member, says his entire career has changed.

"A partner and I are going to be cutting back in the emergency department and splitting our time between urgent care, sports and occupational medicine in addition to emergency medicine," said Hoidal, director of the emergency department at Abemarle Hospital in Elizabeth City, N.C. "That way I get the challenge and the excitement and the critical care skills maintenance that I need to feel good about practicing emergency medicine, yet decrease the amount of rotating shift work and high stress medicine as I get into the middle and late stages of my career."

Hoidal, who is residency trained and board certified in emergency medicine, said he is fulfilling a long-time personal desire to become involved with sports through medicine.

"If I hadn’t gotten into medical school, I was planning on going to a Ph.D. program for exercise physiology, and I’d always been active in high school and collegiate sports," he said. "So I've always had an interest there."

Hoidal said he looked at the family practice sports medicine fellowships at other institutions, but in 1994 he found a newly established program at Carolinas Medical Center that is sponsored by the Miller Orthopaedic Clinic and the Department of Emergency Medicine.

Hoidal and others went through the fellowship application process, after which 10 applicants are chosen for an interview. From that group of 10, the fellows are chosen and then start the year-long fellowship the following summer.

Organized and led by ACEP board member Robert Schafermeyer, MD, the program welcomed Hoidal as its first fellow in sports medicine. Schafermeyer said the program answered the needs of a growing trend in sports medicine — the need for emergency specialists.

"Emergency physicians stand in the unique position to provide the expert medical skills they possess in the sports medicine environment," he said. "This is one of those subspecialties where there actually are opportunities out there."

A fellowship participant may work with any kind of sports team from high school to college to professional, and from basketball to football to soccer. They may stand ready on the sidelines of a typical game, or they may become involved in special events like marathons or the Junior Olympics, Schafermeyer said.

"Our second fellow was able to go with the hockey team all the way through the season and championship and even received a championship ring," he said. "The third fellow came at the time of the Olympics in Atlanta and was able to go to the games and serve as a team physician."

During his fellowship, Hoidal assisted with the Carolina Panthers professional football team, the Charlotte Hornets mens professional basketball team, the Charlotte Knights of the American Basketball Association and the Charlotte Checkers minor league hockey team. He also worked with athletes involved in high school football, indoor professional soccer and various college sports. Hoidal said he valued every experience in his fellowship, despite playing the role of a sort of guinea pig for the program.

"I think it’s a great opportunity. I enjoy working with the local sports teams," Hoidal said. "I had input, being the first person through, to help refine the curriculum, and I provided input after I was finished to help tweak the fellowship in a direction I think would be most advantageous for the people who follow behind me.

"I thought for a first year program I got experience that you would have been hard pressed to duplicate at any of the sports medicine fellowships in the country, even the ones that have been long established."

All the participants to date have made sports medicine at least a part of their emergency medicine careers, Schafermeyer said.

"They’ve all found significant sports medicine opportunities after their fellowships, but it does depend on the individual’s interests," he said.

Hoidal’s private practice will have extended weekday hours, and will remain open on weekends. Eventually he hopes to offer rehabilitative and therapy services in addition to evaluation and treatment.

"If a trainer has an injured player that can’t wait until Monday, and he doesn’t really think he needs to go to the emergency department, we’re an alternative site," Hoidal said. "We do have extra space for a possible rehabilitation center for physical therapy, so we would provide one-stop shopping for sports injuries."

The best part of splitting his efforts between the emergency department and sports medicine, he said, is the ability to develop an ongoing relationship with patients in one practice while continuing to treat others on an emergency basis in the other.

"I think I’m better in the emergency department because of the sports medicine training. And I think it’s helped me all around be a better doctor."