After more than five years of tireless advocacy by the American Association of Orthopaedic Surgeons (AAOS), the Sports Medicine Licensure Clarity Act was signed into law on Oct. 5. The legislation, which AAOS has championed since its origin, provides legal protection for traveling team physicians and safeguards injured athletes’ timely access to healthcare professionals who know their medical histories best.

The bill’s passage represents a significant win for practicing sports medicine physicians and all orthopaedic surgeons who travel across state lines to care for athletic teams. For AAOS, the Sports Medicine Licensure Clarity Act demonstrates how advocacy and dedication to long-term initiatives can result in successfully creating positive change for musculoskeletal care.

“For too long, team physicians have had to choose between treating patients at great professional risk or handing over care,” said AAOS President David A. Halsey, MD. “The Sports Medicine Licensure Clarity Act now ensures their protection, and we thank Congress for supporting this critical legislation.”

Previously, state licensure and medical liability coverage were unclear for team physicians who traveled across state lines. Most states did not provide legal protection for out-of-state medical professionals, and medical liability insurance carriers did not cover them in states where they were not licensed to practice.

“We just traveled state to state, caring for our teams like we were trained and hired to do, without realizing that we were putting ourselves in a legally vulnerable position,” said Eric McCarty, MD, chair of the American Orthopaedic Society for Sports Medicine (AOSSM) Council of Delegates.

Dr. McCarty, who has treated the University of Colorado football team for more than a decade, said he and an increasing number of physicians became leery of the issue when it was raised by malpractice lawyers. Fortunately, their individual liability carriers elected to extend coverage, but physicians could not believe that legal protection did not already exist.

“We wanted to take care of our teams, and we knew our players best,” said Dr. McCarty. “It wasn’t appropriate, nor in our patients’ best interest, to ask another doctor to step in simply because we lacked the visiting state’s licensure.”

A solution was needed that did not force physicians to choose between treating injured athletes at great professional and financial risk or handing over care to less familiar providers.

Seeking a solution at the state
and federal levels

In 2013, AAOS, in collaboration with AOSSM, set out to find a legislative answer to the all-too-common problem. The initiative involved recruiting physicians to advocate for licensure clarity at both the state and federal levels.

“Half the battle involved educating policymakers on why licensure clarity mattered, because obtaining and maintaining licensure in each state constituted an excessively high administrative and cost burden,” said Wilford K. Gibson, MD, chair of the AAOS Council on Advocacy. “The other challenge involved advocating for legal protection, while respecting individual state licensing rules and regulations.”

Using informational toolkits and grassroots advocacy, AAOS and AOSSM members across the country began engaging state legislators and encouraging them to pass licensure clarity legislation. More than 12 states, including Texas and New York, have successfully adopted laws since the initial push.

At the federal level, medical societies began building a coalition of bipartisan supporters. The work involved securing original cosponsors for the legislation and coordinating with AAOS Congressional Ambassadors to meet with and garner the support of key members of Congress.

A first iteration of the bill was introduced in 2013 (H.R.3722). The current version was introduced four years later in the House of Representatives (H.R.302) by Reps. Brett Guthrie (R-Ky.) and Cedric Richmond (D-La.) and in the Senate (S.808) by Sens. John Thune (R-S.D.) and Amy Klobuchar (D-Minn.).

The legislation ensures that traveling team doctors can appropriately care for their athletes without risking unjust legal or financial penalties. It mandates that liability insurance of a medical professional treating a team in a secondary state should cover that person (subject to premium adjustments) as if treatment was provided in the primary state. Additionally, if two states do not currently have an agreement to provide licensure reciprocity, the provider is to be treated as if practicing in the state in which he or she is licensed.

Precedent of perseverance

Although AAOS has worked on and advocated for countless pieces of legislation over the years, the Sports Medicine Licensure Clarity Act will have the most significant, direct impact on orthopaedic surgeons. It represents years of work and unwavering perseverance to get it across the finish line.

“It took more than five years, three sessions of Congress, and the dedication of hundreds of physicians from various specialties advocating for change at both the state and federal level,” said John J. McGraw, MD, an AAOS Distinguished Congressional Ambassador. Dr. McGraw, along with Russell A. Betcher, MD, personally met with Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-Tenn.) to advocate for the passage of the bill. “The sports bill is proof that perseverance always wins, and our voices can be heard loud and clear by Congress,” Dr. McGraw said.

The AAOS Office of Government Relations (OGR) also credits dedicated partnerships, like the one with AOSSM. Together, they were able to pool the strength of both organizations’ members, staff, and congressional relationships to secure legal protection for physicians.

“Thanks to the continued collaborative efforts of AAOS, the AOSSM Council of Delegates, and the Team Physician Committee, we’ve now closed this long-
standing medical liability loophole,” said AOSSM President Neal ElAttrache, MD.

Another long-term benefit is the laying of groundwork to continue expanding medical liability coverage. The Good Samaritan Health Professionals Act is a similar effort that would cover physicians who travel to volunteer in disaster zones. AAOS is working to get it passed by the end of the year.

“AAOS is committed to increasing physician ability to provide the highest-quality patient care,” said Dr. Gibson. “With the momentum from the successful passage of the Sports Medicine Licensure Clarity Act, we will continue to push for systematic medical liability reform.”

Kristen Coultas is the communications manager in the AAOS OGR.

Catherine Hayes is the senior manager of government relations in the AAOS OGR.