Note: There has already been quite a bit of attention given to this study out of Harvard that describes a potential conflict of interest with NFL team doctors. I have heard people who feel strongly on both sides of the issue. I don’t serve as a team physician in the NFL, although I worked with the physicians of an NFL team in my sports medicine fellowship. I have served as team physician for professional organizations here in Charleston, so I understand the questions brought up by the study authors. The views I express in my latest newspaper column (shared below) are my own.

“Who is responsible for the health of NFL players, why, and what can be done to promote player health?” That question is the first sentence of the executive summary of a study released last week. While the obvious answer would be that NFL team physicians and athletic trainers are responsible for the players’ health, the authors from the Harvard Law School question how objectively doctors can actually do it.

A conflict of interest between NFL team physicians and the teams?

Protecting and Promoting the Health of NFL Players: Legal and Ethical Analysis and Recommendations covers a wide array of health issues, including the use of player health as leverage in collective bargaining between the league and its players, a proposed Code of Ethics and the collection and analysis of injury data. I just want to focus on one key criticism of current NFL team physicians – that they have an inherent conflict of interest.

The report’s authors claim that because NFL team doctors are hired and fired by the teams and because they report to the coach and management, they might not have the players’ best interests in mind. For example, a doctor might try to rush a player back on the field before it is safe to do so in order to help the team win and solidify the doctor’s relationship with the team.

Proposed rights NFL players should have regarding their medical care

The authors argue that NFL players deserve the right to a medical staff that is loyal only to them and not the team. They believe players should have the right to determine if they should practice or play after an injury, the right to waive or not waive confidentiality about their condition, and the right to know the financial relationship between team physicians and the organization.

Also read:

The link between football and CTE and the questions we must answer now

The Harvard authors offer an alternative medical arrangement for NFL teams

The report offers an alternative medical arrangement. The authors propose that a set of doctors be selected jointly by the NFL and NFL Players’ Association. These doctors would focus solely on what’s best for the players on that team. They would not communicate that information directly with coaches or team management. The team could hire a second doctor or set of doctors that would make decisions on behalf of the team. These team doctors would read the health reports written by the players’ doctors and discuss return to play and treatment plans with the team.

Glenn Cohen, co-lead author of the study and professor of law at Harvard Law School, explained the initiative. “NFL football has a storied history, and holds an important place in this country. The men who play it deserve to have their health safeguarded and their health concerns addressed. We hope our recommendations in the report serve as a catalyst for this important work.”

The NFL response to the Harvard study

According to the Washington Post, the NFL’s executive vice president of health and safety, Jeffrey Miller, sent a 33-page response to the study’s authors. He called the proposed changes “…unrealistic recommendations that would not improve player care.” Miller also reportedly pointed out that the authors offered no actual incident in which a player’s health was ignored or where a player’s best interests were sacrificed to benefit the team.

My thoughts on the study and a conflict of interest

I have several thoughts on this study. Generally, I think any discussion of player health and what doctors can do to improve the safety of football is positive. I think it’s important to point out, though, that NFL players can already see any doctor they want. They don’t have to undergo surgery by their team doctor, and they can get a second opinion at any time.

Similarity to Worker’s Compensation?

Second, this is essentially a worker’s compensation arrangement with much higher profile patients. If you have ever suffered an injury at work, you know that you usually see a doctor designated by the Worker’s Compensation system. A case manager gets a report on your condition and treatment. That case manager is often in the exam room with you during the doctor’s visit.

Also read:

Can the NFL make football safer for its players?

Is the proposed medical alternative too complicated?

While I admire the professors at Harvard for proposing a new medical arrangement, I agree with Miller that their complicated system might be problematic. Having a set of doctors affiliated with the team communicating information from the players’ doctors based on medical records and a written report could lead to confusion and even treatment errors.

Another possible relationship between NFL players, teams and doctors

If players and/or the league wanted to change the relationship between team physicians and the teams, a committee made up of league officials and representatives from the NFLPA could select healthcare professionals for each team. They could choose a medical staff based on excellence of care with no consideration of marketing contracts between a hospital and a team. If this system eliminates the ability of a hospital to market its physicians as “the official doctors” of an NFL team (and the ability of the team to sell that title), so be it.

The doctors’ duty to the players

I truly believe NFL team physicians do what’s best for the players. They don’t try to get an athlete to play when he’s not ready just to please the coaches. I don’t think doctors allow their decisions to be influenced by a potentially conflicted relationship with the organization.

On the other hand, there is clearly a perception of at least some players – and maybe the public – that a conflict of interests exists. If so, NFL team physicians need to address it.

What do you think? Is there a conflict of interest between NFL team physicians and the organizations? If so, do you think it affects player care? Please share your thoughts below!

Note: A modified version of this article appears as my sports medicine column in the November 24, 2016 issue of The Post and Courier.

References:

Protecting and Promoting the Health of NFL Players: Legal and Ethical Analysis and Recommendations. The Football Players Health Study at Harvard University.

Executive Summary. Protecting and Promoting the Health of NFL Players: Legal and Ethical Analysis and Recommendations. The Football Players Health Study at Harvard University.

Patient Bill of Rights for NFL Players. Protecting and Promoting the Health of NFL Players: Legal and Ethical Analysis and Recommendations. The Football Players Health Study at Harvard University.

New Harvard report addresses legal and ethical factors affecting players’ health. Harvard Law Today. November 17, 2016.

NFL doctors should not report to teams, Harvard study recommends. By Rick Maese. Washington Post. November 17, 2016.