Paper 41: Orthopaedic surgeons’ perspectives on team physician roles after the maragos case: influence of age, location, fellowship training, and level of sports coverage

Objectives: High-profile malpractice cases, namely the Maragos v. Bradley and Rothman Orthopaedic Associates lawsuit, have raised concerns about medicolegal risk in sports medicine practice. This study aimed to evaluate how awareness of the Maragos case impacts orthopaedic surgeons' interest and perspective of team physician roles, stratified by age, geographic region of practice, fellowship training status, and level of sports coverage.
Methods: A national cross-sectional survey of United States orthopaedic surgeons was conducted using a 16-item questionnaire evaluating demographics, experience as team physician, awareness of the Maragos case and its perceived impact on malpractice coverage, willingness to be a team physician, and recommendations to other team physicians. Responses were analyzed by age group, geographic region, sports medicine fellowship training, and level of athlete coverage (youth vs. professional). Associations were evaluated with chi-squared, Fisher's exact tests, or Kruskal-Wallis tests, with significance defined as p < 0.05.
Results: A total of 235 orthopedic surgeons responded to the survey. Of those, 170 (72.3%) reported having been a team physician for college or professional teams, with 121 (51.5%) having covered professional teams. The vast majority of respondents were male (92.7%), aged 30-49 years old (53.6%), and 5 or more years post residency (83.4%). Further demographic data are depicted in Table 1. Age-wise, respondents were grouped as <50 versus >= 50 years old for analyses purposes, since respondents were similarly distributed between the two age groups (54.0% vs 46.0%, respectively). Awareness of the Maragos case was consistently high and did not significantly differ across subgroups (Table 2). The likelihood of recommending being a team physician was low across all groups, with no respondents being reportedly very likely to recommend becoming a team physician (Table 3). Importantly, fellowship-trained sports medicine surgeons were significantly more likely to recommend serving as team physicians compared to non-fellowship-trained colleagues, as were respondents who covered professional teams when compared with those who reportedly covered only non-professional athletes. Additionally, respondents who covered professional athletes were reportedly more likely to change their malpractice coverage after the verdict compared to those who have not covered professional athletes, as well as more likely to have separate malpractice insurance for sports coverage (Table 4). Similarly, surgeons aged 50 or over were more likely to report having a separate malpractice insurance for sports coverage compared to those under 50, as were fellowship-trained surgeons when compared to non-fellowship-trained surgeons.
Conclusions: Awareness of the Maragos verdict was nearly universal among orthopaedic surgeons, yet its influence on practice patterns varied by training, age, and level of sports coverage. Although the likelihood of recommending being a team physician was low across all groups, fellowship-trained surgeons and those who covered professional teams were more likely to endorse team physician roles. However, team physicians who covered professional athletes also reported far greater adjustments in malpractice coverage compared to those who covered solely non-professional athletes. Older surgeons were similarly more likely to maintain separate malpractice insurance for sports coverage when compared to their younger counterparts. In contrast, regional differences were negligible. Collectively, these findings highlight that medicolegal risk is widely acknowledged among orthopaedic surgeons, and tailored risk-mitigation strategies might be necessary to support continued orthopaedic surgeon involvement in team coverage roles within this evolving medicolegal climate.