Originally created 08/12/01

Programs look toward future as rivals



Katie Sutherland's body is still trying to catch up with a growth spurt in eighth grade that put extra strain on her ankles, knees and hips.

The junior outfielder for the Greenbrier High School softball team has turned to orthopedic surgeon and sports medicine physician Jewell Duncan to ease her pains and get her back onto the field. Now, though, she is turning to him somewhere else - at Sports Medicine Associates of Augusta.

After sometimes-contentious negotiations broke down with MCG Health Inc., Dr. Duncan left MCG Center for Sports Medicine last month with most of his staff and, he says, most of his patients. By moving on, Dr. Duncan, Dr. Robert Gambrell and Dr. David Minter and their staff gave up a $1.9 million center at MCG that they opened just two years ago. But the talkative Dr. Duncan practically bounces through the new offices near Doctors Hospital, where most of the faces are familiar even if the surroundings are not.

"I actually lost about 90 percent of the stress I had," he says, greeting patients in the waiting room as he passes through. He points past the reception desk.

"Windows," he says, as the receptionists laugh. "They've got windows now."

The view isn't the only thing that's changed. Instead of attending meetings between seeing patients, Dr. Duncan now has time to think about where he wants to take his program.

"Little things can add to this," Dr. Duncan said. "And I couldn't do that at the Medical College."

For its part, MCG Health Inc. has hired replacement physicians for the departed sports medicine faculty. But MCG Health CEO Don Snell concedes the college is losing a multimillion-dollar-grossing program and gaining a fierce competitor in Dr. Duncan. Across Augusta, the competition has just been ratcheted up.

Growing strong

Sports medicine grew out of orthopedic surgery, with repairs to knees and shoulders damaged on the field. Surgery using an arthroscope, a thin tube-mounted camera-and-light apparatus that requires only a small incision to get inside the joint, needed less recovery time and got athletes back in the game faster, a concept that quickly caught on.

"They literally have been the reason the arthroscope exploded in this country, the sports medicine guys," Dr. Duncan said.

Sports medicine now encompasses a broad range of disciplines and services from physical therapy and rehabilitation to training. Athletic trainers now go out to work with high school football, basketball and soccer teams, not only doing the required physicals but also working with players on nagging injuries and referring them for more serious ones.

Nearly every full-service hospital has a program it calls sports medicine.

"Augusta has always been a good active, athletic town, a good sports town," said orthopedic surgeon LeRoy R. Fullerton with Orthopaedic Associates of Augusta. "The competition is there, and I think the various hospitals realize that the sports medicine aspect can be real attractive in a young, growing community."

Some programs, however, don't measure up, Dr. Duncan said.

"It's funny because you see sports medicine stuck on everything," Dr. Duncan said. "I am an orthopedic surgeon, and I have a passion for doing these sorts of things, and I have a tremendous amount of experience doing it. But literally, if I just had my practice, to call it sports medicine would be a little bit ridiculous."

The explosion in programs and their promotion by hospitals can be explained this way - people who take pains to buy the right mountain bike or who dedicate themselves to running a 10K would also seek out the right care for their aches and pains.

"As it is more desirable to participate in athletics, it becomes more desirable to see people who specialize in that area," Dr. Duncan said.

Sports medicine also takes a different approach to caring for an injury, Dr. Fullerton said.

"The difference would be, if you have a sprained ankle, I could say to you, 'I don't want you to do anything for four weeks,' or I could say to you, 'I want you to do some exercises. We'll do some ice baths, we'll do some progressive running, and we'll see if we can get you back with taping and bracing in two weeks or one week,"' Dr. Fullerton said.

"If you're doing sports medicine, the philosophy is not to quit," Dr. Duncan said. "The philosophy is not to stop what you're doing. The philosophy is to determine how best can we move you into a position to play."

The sports medicine market in Augusta was changed a few years ago when MCG began advertising its program heavily, Dr. Fullerton said.

The fracture

Records obtained by The Augusta Chronicle show MCG spent at least $200,000 promoting sports medicine in 1997 and 1998. There were tens of thousands of other expenditures likely connected with the program that were not included in the total because the records were vague.

Dr. Duncan said he asked that the advertising blitz be curtailed the last couple of years and did not approve of some of it.

"When we put the billboards up, that was not my idea," Dr. Duncan said. "I didn't care for them."

Since he arrived at MCG to start the program in 1992, sports medicine had become a thriving program at MCG, accounting for about $7.5 million a year. Yet Dr. Duncan contends that MCG Health did not really negotiate with the group to stay. At first, there were many discussions. But then MCG Health officials met by themselves to create their own offer, Dr. Duncan said.

"And I was never asked to be in these meetings," Dr. Duncan said. "And so basically, they told me what they were going to do and I told them, as I told them before they met and made those decisions, that it was unacceptable. And they decided to do it anyway. You call that negotiation?"

Mr. Snell of MCG Health said that there were good-faith efforts and that the talks were amicable.

"I think both parties - I can't speak for Jewell - but I think both parties were disappointed that it didn't work out," Mr. Snell said. "We liked and still like very much Jewell and his team."

In fact, Dr. Duncan still performs surgeries at MCG and will still refer patients there for physical therapy or rehab if it is more convenient for them. Mr. Snell said the negotiations "didn't burn bridges or close doors" and even hinted that there may be a reunion.

"I think we're thinking long term we may re-cement the relationship," Mr. Snell said. "That wouldn't be out of the question."

In the meantime, MCG Health has hired orthopedic surgeons Edwin C. Bartlett of East Carolina University and David Montgomery "Monte" Hunter, assistant team physician for the UCLA Bruins football team.

"If this became an eventuality, it was never our intent to back down or go out of business or say, 'Gee, we lost sports medicine,"' Mr. Snell said. "We hope to get back to our former market share and then take it to the next level."

Dr. Duncan said all but a few teams, those closest in distance to MCG, came with him to his new practice, as did 95 to 98 percent of his patients. MCG said it is hoping to retain half the market and has a few high schools, plus recreation departments in Richmond and Columbia counties.

But Mr. Snell said MCG Health is talking with some universities and colleges, such as the University of Georgia in Athens, about providing sports medicine services there.

"For the foreseeable future you'll see the competition for sports medicine services here intensify," Mr. Snell said. "We're going to compete head to head with Jewell; he knows that. We know he's a formidable competitor. Augusta benefits from that."

Dr. Duncan agrees.

"I think it is a wonderful thing," Dr. Duncan said. "I think it's much better to have an area where you can have people participate and compete for the same things because it makes you better."

Dr. Duncan is still interested in maintaining research ties with MCG and in expanding to such things as specialized training. It's that sort of thing that 15-year-old Katie is interested in as she rehabilitates from arthroscopic knee surgery and works toward rejoining her team. She laughingly agrees that Dr. Duncan has almost become her mechanic, getting her back on the road when she breaks down.

"He's taken care of all of them," she said.

Reach Tom Corwin at (706) 823-3213 or tomc@augustachronicle.com.