injuryupdate
20-07-2005, 01:36 PM
Since sports physicians aren't specialists under WADA, attached is a modified form (along with the official WADA form) for notifying banned drug use. Rationale for use of the modified form is included below:
The current issue:
1. The Federal government has just convinced all professional sports in Australia to become compliant with the WADA (World Anti Doping Agency) code.
2. One of the implications of WADA is that all athletes (now including the NRL, AFL, Cricket Australia etc.) who use asthma puffers or who receive cortisone medications (e.g. injections) will be considered to have committed a doping offence, unless they have registered the drug using a special form called an A-TUE (Abbreviated Therapeutic Use Exemption), attached.
3. The WADA A-TUE form must be completely filled-in or it will not be accepted, according to the form. The medical officer completing the form must identify him or herself by indicating his or her “Medical Specialty” or the A-TUE form.
4. The majority (perhaps 70%) of doctors caring for elite athletes (including NRL teams) in Australia are sports physicians, holding a Fellowship of the Australasian College of Sports Physicians (FACSP).
5. The Australian government (via its branches of the Health Insurance Commission and the Australian Medical Council) has maintained for the past 14 years that there is no specialty of sports medicine and the FACSP qualification is not a specialist qualification. However, the HIC does recognise that the FACSP is the appropriate qualification for practising in the “area” of sports medicine. This discrimination against sports physicians is unique in the Australian health system. Even the GP qualification, the FRACGP, is considered a specialty qualification in primary care medicine by the AMC. All other qualifications recognised by the HIC are considered specialty qualifications. The FACSP is considered a specialty qualification in New Zealand, so this issue does not affect the New Zealand Warriors doctor, who holds a FACSP and is considered a specialist in the New Zealand health system.
6. It would seem evident from 1.-5. that Australian sports physicians, who look after the majority of elite athletes, cannot complete a WADA A-TUE form, because they cannot identify themselves as having a medical specialty. This does not appear to be a problem for other medical practitioners, including General Practitioners, who could legitimately identify their specialty as “General Practice” or “Primary Care”.
What courses of action are available to the sports physician who treats elite athletes by giving them essential but banned medications such as asthma puffers?:
OPTION 1. – Complete a WADA A-TUE and indicate the Medical Specialty as “Sports Medicine”. This option would be the most practical, but it would require the sports physician to falsely assert that he or she had a medical specialty, when sports medicine is clearly not a medical specialty in Australia.
OPTION 2 – Complete an alternate form which is identical to the WADA form but where the medical officer indicates that he or she is a sports physician (or registrar/trainee of the ACSP) rather than having a medical specialty. It is uncertain as to whether the form would then be valid. An alternate form is attached.
OPTION 3 – Do not provide the athlete with the banned medication. This would seem to be an untenable option, as asthma is a potentially life threatening condition in some cases, and the doctor’s obligation to treat it correctly would override the WADA requirements.
Legal advice seems to be required as to whether OPTION 2. is the best course of action for sports physicians.
OPTION 1. would seem to leave the sports physician open to an accusation of falsifying qualifications (and perhaps the document may not be legal anyway).
OPTION 2. is a more open and honest approach, but it is uncertain as to whether WADA would accept a slightly altered form. If they declare the form invalid, then the athlete may be subject to a doping charge for using the medication.
Why isn’t the FACSP a specialty qualification?
Only the Federal government in Australia (or their various departments) can answer this question, as it seems beyond rational explanation.
History of the Australasian College of Sports Physicians and specialty recognition is as follows:
1985 ACSP formed as an association of doctors practising primarily in sports medicine. These doctors had various levels of qualifications (some with no specific post-graduate training, others with FRACGP etc.)
1991 Inauguration of the FACSP qualification. This involved the “grandfathering” of those practitioners (approx 40) whose primary area of practice was sports medicine and who had demonstrated adequate experience in sports medicine. All of these doctors had to pass the inaugural exam set up by the college.
1992 ACSP training program commenced, with ACSP college structure now roughly equivalent to existing specialty colleges, having part 1 entry exam, part 2 exit exam and supervised training for 3 years.
1993 ACSP applied to NSQAC (National Specialist Qualification Advisory Committee), the appropriate government body of the day, to have FACSP recognised as a specialty qualification.
1994 ACSP received a letter from NSQAC advising that specialty status should be granted “in the near future”.
1997 Apparently as the FACSP was just about to be granted specialty recognition by NSQAC, the Federal government announced that it was disbanding NSQAC and replacing it with a new structure for determining specialty recognition, administered by the AMC (Australian Medical Council). For further history of this see: http://www.physsportsmed.com/issues/2000/09_00/news.htm
1997 Federal government brings in legislation which states that newly graduated Australian doctors will only be given provider numbers if they hold GP or specialist training qualifications.
1998 Federal government creates special item numbers for sports physicians for their patients to claim from Medicare, recognising that the FACSP is the appropriate qualification for working in the “area” of sports medicine, but still asserting that sports medicine is not a specialty.
2002 AMC announces that it has taken on the role of judging the qualifications of new (and existing) specialties. A media release of this quoted sports medicine as being the example of the first ‘new’ specialty that required assessment.
2003 AMC invites prospective specialities to submit a new proposal for specialty recognition. This to be done in a “priority order” which the AMC determines.
2004 AMC makes a priority order list and includes only “new specialty” applications which are in fact applications for new branches within existing specialty qualifications (e.g. recognition of palliative care as being a subspecialty of the physician specialty qualification; recognition of rural medicine as being a break away subspecialty of general practice). Sports medicine is the only application from a group which is not already recognised under the AMC process but it is ignored in favour of reassessing the structure of existing specialties.
2005 Sports medicine is still not given a position on the AMC priority order for assessment as a specialty. Therefore no date for any decision is set.
Other implications of lack of specialty recognition for sports physicians:
1. Medicare rebates for patients of sports physicians are about half the amount for those of physicians in similar areas which are recognised as specialties (rehabilitation medicine, occupational medicine, rheumatology).
2. Medicare does not recognise MRI scan requests made by sports physicians, so patients cannot claim a rebate if a sports physician orders them an MRI scan. MRI scanning is now an essential diagnostic tool in sports medicine and most other areas of medicine.
3. ACSP cannot negotiate with the HIC for item numbers for new treatments in the area of sports medicine (e.g. shock wave treatment, compartment pressure testing).
4. ACSP registrars are new graduates are only given provider numbers based on a special needs exception to the Health Act. Section 19AA of the Health Insurance Act restricts access to Medicare benefits by Australian citizen or permanent resident doctors who were first recognised as medical practitioners after 1 November 1996 and who are not GPs or specialists. This means that new recipients of the FACSP (if they were first recognised as medical practitioners after 1/11/96) are ineligible to practice unless given a special exemption by the Health Minister (which they currently receive).
The current issue:
1. The Federal government has just convinced all professional sports in Australia to become compliant with the WADA (World Anti Doping Agency) code.
2. One of the implications of WADA is that all athletes (now including the NRL, AFL, Cricket Australia etc.) who use asthma puffers or who receive cortisone medications (e.g. injections) will be considered to have committed a doping offence, unless they have registered the drug using a special form called an A-TUE (Abbreviated Therapeutic Use Exemption), attached.
3. The WADA A-TUE form must be completely filled-in or it will not be accepted, according to the form. The medical officer completing the form must identify him or herself by indicating his or her “Medical Specialty” or the A-TUE form.
4. The majority (perhaps 70%) of doctors caring for elite athletes (including NRL teams) in Australia are sports physicians, holding a Fellowship of the Australasian College of Sports Physicians (FACSP).
5. The Australian government (via its branches of the Health Insurance Commission and the Australian Medical Council) has maintained for the past 14 years that there is no specialty of sports medicine and the FACSP qualification is not a specialist qualification. However, the HIC does recognise that the FACSP is the appropriate qualification for practising in the “area” of sports medicine. This discrimination against sports physicians is unique in the Australian health system. Even the GP qualification, the FRACGP, is considered a specialty qualification in primary care medicine by the AMC. All other qualifications recognised by the HIC are considered specialty qualifications. The FACSP is considered a specialty qualification in New Zealand, so this issue does not affect the New Zealand Warriors doctor, who holds a FACSP and is considered a specialist in the New Zealand health system.
6. It would seem evident from 1.-5. that Australian sports physicians, who look after the majority of elite athletes, cannot complete a WADA A-TUE form, because they cannot identify themselves as having a medical specialty. This does not appear to be a problem for other medical practitioners, including General Practitioners, who could legitimately identify their specialty as “General Practice” or “Primary Care”.
What courses of action are available to the sports physician who treats elite athletes by giving them essential but banned medications such as asthma puffers?:
OPTION 1. – Complete a WADA A-TUE and indicate the Medical Specialty as “Sports Medicine”. This option would be the most practical, but it would require the sports physician to falsely assert that he or she had a medical specialty, when sports medicine is clearly not a medical specialty in Australia.
OPTION 2 – Complete an alternate form which is identical to the WADA form but where the medical officer indicates that he or she is a sports physician (or registrar/trainee of the ACSP) rather than having a medical specialty. It is uncertain as to whether the form would then be valid. An alternate form is attached.
OPTION 3 – Do not provide the athlete with the banned medication. This would seem to be an untenable option, as asthma is a potentially life threatening condition in some cases, and the doctor’s obligation to treat it correctly would override the WADA requirements.
Legal advice seems to be required as to whether OPTION 2. is the best course of action for sports physicians.
OPTION 1. would seem to leave the sports physician open to an accusation of falsifying qualifications (and perhaps the document may not be legal anyway).
OPTION 2. is a more open and honest approach, but it is uncertain as to whether WADA would accept a slightly altered form. If they declare the form invalid, then the athlete may be subject to a doping charge for using the medication.
Why isn’t the FACSP a specialty qualification?
Only the Federal government in Australia (or their various departments) can answer this question, as it seems beyond rational explanation.
History of the Australasian College of Sports Physicians and specialty recognition is as follows:
1985 ACSP formed as an association of doctors practising primarily in sports medicine. These doctors had various levels of qualifications (some with no specific post-graduate training, others with FRACGP etc.)
1991 Inauguration of the FACSP qualification. This involved the “grandfathering” of those practitioners (approx 40) whose primary area of practice was sports medicine and who had demonstrated adequate experience in sports medicine. All of these doctors had to pass the inaugural exam set up by the college.
1992 ACSP training program commenced, with ACSP college structure now roughly equivalent to existing specialty colleges, having part 1 entry exam, part 2 exit exam and supervised training for 3 years.
1993 ACSP applied to NSQAC (National Specialist Qualification Advisory Committee), the appropriate government body of the day, to have FACSP recognised as a specialty qualification.
1994 ACSP received a letter from NSQAC advising that specialty status should be granted “in the near future”.
1997 Apparently as the FACSP was just about to be granted specialty recognition by NSQAC, the Federal government announced that it was disbanding NSQAC and replacing it with a new structure for determining specialty recognition, administered by the AMC (Australian Medical Council). For further history of this see: http://www.physsportsmed.com/issues/2000/09_00/news.htm
1997 Federal government brings in legislation which states that newly graduated Australian doctors will only be given provider numbers if they hold GP or specialist training qualifications.
1998 Federal government creates special item numbers for sports physicians for their patients to claim from Medicare, recognising that the FACSP is the appropriate qualification for working in the “area” of sports medicine, but still asserting that sports medicine is not a specialty.
2002 AMC announces that it has taken on the role of judging the qualifications of new (and existing) specialties. A media release of this quoted sports medicine as being the example of the first ‘new’ specialty that required assessment.
2003 AMC invites prospective specialities to submit a new proposal for specialty recognition. This to be done in a “priority order” which the AMC determines.
2004 AMC makes a priority order list and includes only “new specialty” applications which are in fact applications for new branches within existing specialty qualifications (e.g. recognition of palliative care as being a subspecialty of the physician specialty qualification; recognition of rural medicine as being a break away subspecialty of general practice). Sports medicine is the only application from a group which is not already recognised under the AMC process but it is ignored in favour of reassessing the structure of existing specialties.
2005 Sports medicine is still not given a position on the AMC priority order for assessment as a specialty. Therefore no date for any decision is set.
Other implications of lack of specialty recognition for sports physicians:
1. Medicare rebates for patients of sports physicians are about half the amount for those of physicians in similar areas which are recognised as specialties (rehabilitation medicine, occupational medicine, rheumatology).
2. Medicare does not recognise MRI scan requests made by sports physicians, so patients cannot claim a rebate if a sports physician orders them an MRI scan. MRI scanning is now an essential diagnostic tool in sports medicine and most other areas of medicine.
3. ACSP cannot negotiate with the HIC for item numbers for new treatments in the area of sports medicine (e.g. shock wave treatment, compartment pressure testing).
4. ACSP registrars are new graduates are only given provider numbers based on a special needs exception to the Health Act. Section 19AA of the Health Insurance Act restricts access to Medicare benefits by Australian citizen or permanent resident doctors who were first recognised as medical practitioners after 1 November 1996 and who are not GPs or specialists. This means that new recipients of the FACSP (if they were first recognised as medical practitioners after 1/11/96) are ineligible to practice unless given a special exemption by the Health Minister (which they currently receive).