Disparities in sports medicine health care

Most days of the week I see my pediatric sports medicine patients in two very different clinics:  one is within the inner city of Columbus, Ohio itself; and one is in the foothills of Appalachia, a region described in the recent bestseller, Hillbilly Elegy.  Among the patients I frequently see, I have many who could be described as urban poor (the former location), and many as rural poor (the latter).

In my care of these patients, I frequently see them (and their families) struggle with several barriers to excellent care — these range from financial issues, to issues of transportation and distance traveled, to issues of understanding related to educational levels, to a relative lack of resources at their home schools or clubs (e.g. no certified athletic trainers).  I feel at a great loss, at times, in trying to help them achieve the same results I would want for any of my patients.

I read with great interest then, in the November 2017 CJSM, a newly published, original research study: Disparities in Athletic Training Staffing in Secondary School Sport: Implications for Concussion Identification.  I found it so impactful, that I wanted to talk with the author — and so I tracked down Emily Kroshus ScD, MPH for this episode of the CJSM podcast.

Dr. Kroshus is a Research Assistant Professor of Pediatrics at the University of Washington, who is developing a body of academic work that focuses on “….identifying social and contextual determinants of help seeking behaviors, with an overarching interest in addressing disparities related to gender, race, sexual orientation, and socioeconomic status.”(1)

I hope you are as interested in this sort of research as much as I am.  So take a listen to the podcast on iTunes or go to the CJSM website for the podcast (look for the radio button) and the study itself.


(1) Dr. Kroshus’ biography can be found at the University of Washington faculty page:  https://depts.washington.edu/uwgenped/directory/emilykroshus

5 ? With Primrose Pisares, ATC of the UCSC Banana Slugs


Primrose Pisares, ATC, and Sammy the Slug of UCSC

I’ve written recently about the dreams I’m having of the upcoming Australasian College of Sports Physicians (ACSP) 2016 conference–dreams of the warmth and sun of ‘Surfer’s Paradise,’ Australia.

Well, these mid-winter dreams have also included other surf spots I’ve been to before, including my home of 10 years in Santa Cruz, California (aka ‘Surf City’).

Before coming to Nationwide Children’s Hospital’s Division of Sports Medicine in Columbus, Ohio, I was a Team Physician and doctor of collegiate student health at the University of California, Santa Cruz (UCSC).  If you have never heard much about the place, I’d wager you have heard about their sporting team’s mascot, rated one of the best in the USA:  the fighting banana slugs.

Dreams mixing with memory, I turn today to an interview with an esteemed colleague with whom I once worked while at UCSC:  Primrose Pisares, the head, certified athletic trainer (ATC) for those fighting banana slugs.  She shares her thoughts on her profession, on her athletes, and on her beautiful community in our ‘5 Questions’ series.


1) CJSM:  How long have you been the head ATC for UCSC? What was your training and/or ATC working history prior to coming to UCSC?

PR:  My path to becoming an athletic trainer was not direct, as it is for many of today’s ATCs. I started as an undergraduate majoring in Physiology at UC Santa Barbara and had intended to be a physical therapist. Athletic training was something that I had discovered as I progressed in my pre-physical therapy studies. From the extracurricular athletic training classes I took, I found that I liked working with active patients more than working with the general population. I’ve always wanted to go into a profession that helps people, and the challenge of rehabilitating an athlete from an injury and getting them back to full athletic performance was intriguing and satisfying. After I completed all the requirements and sat for the certifying exam, I attended the Arizona School of Health Sciences at A.T. Still University, which is where I received my Master’s degree in Sports Health Care.


Primrose hard at work with one of her athletes.

I am going into my tenth year as the head ATC for Intercollegiate Athletics at UCSC. Now that I am saying it out loud, I am kind of amazed at being in one place for that long! I have had prior experience working in high schools, physician’s clinics, and with semi-pro athletic teams. Right before I started at UCSC, I was employed at a few community colleges in the area and my intention was always to work in the community college setting. The opportunity to work at UC Santa Cruz just kind of fell in my lap as I had never considered DIII athletics. I have come to really enjoy working with student-athletes at this level and getting to know them as more than just an athlete but as a person with academic goals and interests. I love it when my student-athletes achieve what they have worked hard for.

2) CJSM: As you’ve pointed out, UCSC is a DIII Athletic School, the only one of its type in the UC system. Based on your experience with UCSC athletics, what are the special opportunities or challenges for managing athletes’ health care in DIII NCAA sports?

PR:  I think the DIII level offers up a different type of student-athlete as opposed to DI & DII. Read more of this post

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