Melanie Cole, MS (Host): Welcome to UF Health MedEd Cast with UF Health Shands Hospital. I'm Melanie Cole. And today, we're exploring what it's like to be a team physician. I'm pleased to introduce you to Dr. Ryan Roach. He's an orthopedic surgeon and team physician for the University of Florida Gators Basketball.

Dr. Roach, it's such a pleasure to have you join us today. When people hear team physician, especially at the collegiate or professional level, what do they fully not appreciate about the role? I'd like you to tell us a little bit about yourself and your journey to being a team physician and what it's really like to work at such a high level.

Ryan P. Roach, MD: Melanie, thank you for having me and UF Health for hosting this. So, yeah, probably the most underestimated thing is just the amount of time it takes to actually get into orthopedic surgery sports medicine. And I think we can hit on that a little bit later that there are other ways to become a team physician.

I chose the orthopedic surgery route, and that started way back as an undergraduate student. I was a soccer player at Purchase College, and that kind of sparked my interest in sports. I quickly realized that I wasn't going to make a career in soccer. And so, I had to pivot to something that I enjoyed equally.

And thankfully, I enjoyed science. And so, the natural bridge for me was to do something that allowed me to enjoy biology and use that science, but also to treat athletes. And so, that led me to orthopedic surgery. So then, I did a master's year to get myself ready for medical school, and that was at Tulane University, and then did medical school down in New Orleans. Then, five years of orthopedic surgery residency, one year of fellowship training, and then that led me to University of Florida.

Melanie Cole, MS: Wow, that's quite an exciting story, Dr. Roach. Before we get into the team physicians specifically and what it's like day to day, have you ever had the opportunity to treat upper level athletes? Can you discuss a little bit about that and UF Health's partnership as the medical provider for the United States Olympic and Paralympic Committees?

Ryan P. Roach, MD: Yeah. So, I think University of Florida and University of Florida Health, we have an amazing opportunity to treat all different forms of athletes. So, we have a huge outreach program in terms of our high school athletes. We obviously take care of high-level athletes through the University of Florida and the Gator Athletics. But we also have the tremendous opportunity to take care of Team USA, and what an honor that is through our partnership with USOPC.

And so, just today, I had an athlete phone in to discuss potential treatment options. So, I think, that's why we do it as a team doctor. It doesn't really matter about a professional or Olympic, but it's such a thrill to meet these people and to talk to them about how they've gotten to their position and how their injuries are affecting them. And then, to be part of the process of getting them back out there, it really is the thrill of why we do this.

Melanie Cole, MS: Well, it certainly is exciting. And Dr. Roach, there's a unique pressure when balancing athletic health with team performance. So, how do you navigate that tension? When you think of your ultimate patient, the athlete, the team, the organization, tell us about some of those intense pressures associated with being a team physician at that higher level.

Ryan P. Roach, MD: Yeah. Well, I think the thing about sports medicine is that it really is team-based. And so, you have the athlete who's injured, and then you have the bigger picture of how that athlete fits into the team and the sport and the season. And I think the most critical part of that is to appreciate what the athlete wants. They may need surgery. Their injury may dictate that they should do something about it. However, the timing may not be right.

And to be successful, I think you have to balance all of the aspirations of the athletes, the goal of the athlete, the timing, the schedule, the specifics of what's going on in that athlete's life with the pathology and what you know as a treating physician to get an outcome. You can't just treat every injury the same. You have to treat every injury according to whatever that athlete requires. And so, I think the goal or the key really to success is just understanding what's important to that athlete, and then melding that into a plan with the background of a treating practitioner.

Melanie Cole, MS: Well, that's certainly true. And when we think of a major program like the Florida Gators Men's Basketball, how integrated are you and your medical team with the coaches, the athletic trainers, the strength conditioning staff, the nutritionists, all of the different people that are involved in working with a team like this? How do you integrate with everybody?

Ryan P. Roach, MD: Well, I have to give credit to the University of Florida and the UAA, the University Athletic Association. They have such a well-functioning system that prioritizes healthcare of athletes. And I'll just tell you, that isn't the case everywhere. And so, the system just functions very well.

And I also got to credit Coach Golden. I mean, he just runs an incredibly tight ship. And so, I think, you know, just like you have the athletes on the court and that team, you also have the healthcare team. That includes an amazing athletic trainer, John Michelini, who I tell people to think of as the quarterback of healthcare. He's the day-to-day person, really kind of in tune with how the athletes are feeling. Then, you have the amazing strength and conditioning coach, the nutritionist, that keep the athletes—hopefully keep them from getting injured, and they do a great job of that. And then, you have the team doctor. We are all in communication basically weekly, just making sure we understand the athletics, the team's schedule.

If there are any injuries, we see them basically on the day of injury. And if we're not around, we'll see them the next day. But the key to success there is really the communication.

Melanie Cole, MS: Well, it certainly is. And Dr. Roach, basketball is such an explosive, high-demand sport. When we think of the most common injuries that you see over the course of a season, are there certain injuries that are becoming more prevalent as the game gets faster, more positions, more year-round? Tell us what you see with these teams on a day-to-day basis.

Ryan P. Roach, MD: Well, I think the things that I see are not exactly what everyone else sees. So, the more common injuries are going to be kind of the small finger injury, ankle sprain, things like that, or muscle strain, things that don't necessarily require surgery or time away from athletics, but certainly require treatment.

The more kind of public-facing injuries are the ones that require time away. And certainly, we've seen an increase in Achilles tendon injuries and other tendon injuries such as patella or extensor mechanism injuries. And we don't exactly have an answer in terms of why that's happening, but I think you hit on it.

The game is changing. It's becoming more explosive. The amount of time in terms of training has changed, and how these athletes are training has changed. And certainly that plays a role in this increase, but it isn't the whole thing, and we really haven't figured out why that's happening.

Melanie Cole, MS: Yeah, that's such an interesting point that you're making. And when you're talking about these injuries, soft tissue injuries can certainly be tricky because imaging doesn't always tell the whole story. So, how much of your decision-making comes from your clinical experience? You're an orthopedic surgeon. Understanding and getting to know the athlete themselves. And Dr. Roach, I mean, it's such an exciting time in the world of sports medicine and orthopedic surgery with the imaging technology and biologics and rehab science and things that we've learned over the years. So, how did all that tie together for you when looking at this athlete's injuries and deciding what's next?

Ryan P. Roach, MD: Well, yeah, I think have to consider everything. We have a saying that you don't treat the X-ray or the image, you treat the patient. And so, certainly, you have one MRI finding that may affect one athlete one way. And then, you know, it doesn't affect another athlete the same way.

And so, I think you take every element of the patient and of their presentation. And you kind of combine that with what you know of the injury, and you try to come up with a plan. You know, a great example would be an ankle sprain. Some people can bounce back from an ankle sprain much faster than another. And that takes a lot about knowing the athlete and what their tolerance level is and what their commitment to the rehabilitation is. And so, again, it's kind of like you just take every piece of information and help formulate a plan that's best for that athlete.

Melanie Cole, MS: One of the things, Dr. Roach, that I've seen in sports over the years is the challenge, and this is a challenge in sports medicine for the coaches, for the trainers, for the team physicians, is balancing that rapid return to play with long-term athlete health. So when we think of navigating that tension and those return-to-play decisions can be so incredibly high pressure, especially during conference play, March, that sort of thing, who ultimately has the final say when determining if an athlete's ready to return to play? And what are you thinking when you're deciding this?

Ryan P. Roach, MD: Again, I got to give a shout-out to the organization and to the coach. Here there is zero pressure. We all want the athlete to be back out there. And certainly, I just won a national championship. The expectations this year are high. And obviously, an injury can change and derail all of that. So, there's always the motivation to get an athlete out there.

However, there's never a pressure from coaches or administration at the University of Florida. And so, that decision ultimately is always on myself as the team doctor, my partner, Dr. Cluxton, who's also one of the team physicians, again, the athletic trainer, John Michelini, who's the captain of the ship and the athlete. And we sit down. Often we include parents, sometimes now agents in the world of the NIL. And really, it's a decision between the provider and the patient, what's the safest and balancing their motivation with what we know in terms of protecting them as an athlete.

Melanie Cole, MS: Dr. Roach, for listeners that are looking to go into this field, but they want to know about that pressure, they want to know about what's going on, let's talk about your game-day responsibilities. What does it look like from start to finish? How do you prepare mentally, physically for the unpredictability of acute injuries, for helping these motivated athletes? What does your game day look like?

Ryan P. Roach, MD: So yeah, I think, you know, the one thing I always counsel people that are thinking about this is all the other stuff. So, I have my own practice, I have my own family, I have all these other things going on in my life. And then, I have athletic coverage. And so, that is a big commitment.

And if you don't love it, that can be incredibly taxing to do a full day of clinic or a full day of operating, and then have to go to a basketball game or a football game and spend that time on the sideline. But if you love it, there's no bigger thrill. And so, on a game day of basketball, generally, I'll show up a half an hour early. I'll meet with the athletic trainer and my partner, Dr. Claxton. We'll kind of just talk about what's going on. Sometimes there's injuries that require treatment, preoperative medication, sometimes preoperative injections. And then, ultimately, we get the team out there, and we hold our breath, and we just hope that nothing bad happens.

I know, in basketball, we've been pretty fortunate in terms of injuries. I'm knocking on wood right now. But historically, we've had some pretty scary things. We've had cardiac arrests, we've had open fractures, all the way to, again, just like dislocated fingers and things like that.

And so, I think as a team physician, you kind of have to be ready for everything, which I think is exciting. But that if you don't have that personality, it can be a little stressful too, because you really don't know what the game's going to throw at you. It could be an eye injury, which for an orthopedic surgeon, obviously, you know, we don't have extensive training in that, to, you know, a skin rash to everything. So, you got to be comfortable with being uncomfortable a little bit, if that makes sense.

Melanie Cole, MS: It does make sense, and I'm so glad that you spoke a little bit about some of the aspects and personality traits that you find most advantageous if someone wants to break into the sports world as a team physician. Before I ask you for your last bit of advice, I'd like to ask you a really fun question about what do you do for fun? I mean, here you are, this busy orthopedic surgeon. You mentioned your family. You've got your team during season. What do you do for fun, Dr. Roach? What is something your colleagues and your patients and even, you know, your friends might not know about you?

Ryan P. Roach, MD: Well, my family is a big part of my life. So, I have three young kids and a wonderful wife who's also a physician. So, a lot of my fun is just hanging out with them. Outside of that though, I do a tremendous amount of other stuff I like to do. I played sports. I still dabble. I like to consider myself a soccer player, although last time I played, I limped off the field with so many aches and pains that I don't know that I'll ever play again. But I love sports. I'm playing golf and tennis at least weekly. I love to cook. I love to garden, actually. My kids and I have a nice garden that we keep up and eat from. I bake. That's kind of a weird one, but people that know me know that I bake because I'm always eating baked goods or bringing in some of my test stuff. But, yeah, I kind of like to dabble in a bunch of things.

Melanie Cole, MS: Very cool. Thank you so much for sharing that. Now, best advice for clinicians interested in entering this field. What keeps you passionate about the work despite the pressures, and what would you like them to know about how exciting this field is?

Ryan P. Roach, MD: Well, I think the best advice I can give is test it out. Try to shadow, try to get involved. Because if you can experience it firsthand, you can get an idea of whether or not it's something you'll enjoy. If you enjoy it, there's no better job in the world. And I think that could be said for anything. But if you don't enjoy it, then all these extra stresses and all these extra time commitments will really weigh on you.

So, I think if you can somehow experience it firsthand, either through shadowing or whatever your access may be, I think that'll give you a glimpse into it, which will give you some perspective and help you make a really good decision.

Melanie Cole, MS: That was a great discussion. Dr. Roach, thank you so much for joining us today and sharing what it's like to be a team physician at that high level, at that collegiate level. Thank you again. And to learn more about this and other healthcare topics at UF Health Shands Hospital, please visit innovation.ufhealth.org. And to listen to more podcasts from our experts, please visit ufhealth.org/medmatters. That concludes today's episode of UF Health MedEd Cast. I'm Melanie Cole. Thanks so much for joining us today.