Ep 268: Profile of a sports medicine leader, with Dr Amber Donaldson

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[00:00:54] There were very few PTs and very few women in professional elite sport. And so to be able to set myself apart from both of those areas, I had to really kind of push myself into the darkness in some ways, in spaces that weren't really clearly defined previously, and kind of make my own path.

[00:01:19] Hello, and welcome to JOSPT Insights, the podcast that aims to help you translate quality research to quality practice. I'm Claire Ardern, the Editor-in-Chief of the Journal of Orthopedic and Sports Physical Therapy. It's great to have you listening today. There are many outstanding leaders in the sports medicine and musculoskeletal rehabilitation world. How did they get there? What decisions did they make that have got them to where they are today?

[00:01:48] In today's episode, I ask those questions of Dr. Amber Donaldson. We talk about what she's looking for in the next generation of sports medicine leaders, how she's approached developing her own career, and her advice for early career clinicians who are looking to establish themselves in elite sports medicine. Dr. Donaldson is the Vice President Sports Medicine at the United States Olympic and Paralympic Committee. Dr. Amber Donaldson, welcome to JOSPT Insights. Thanks so much for having me.

[00:02:17] Thanks for making time to join us today, Amber. When we're getting started in our career or maybe if we're wanting to change career direction, it sometimes can feel a bit difficult to see what the path is from where I am now to where I would like to go, which is one of the ways hearing the stories of people like you, Amber, can help. So I want to start by asking you, what does a typical day in the life of Dr. Amber Donaldson,

[00:02:43] Vice President Sports Medicine at the U.S. Olympic and Paralympic Committee actually look like? Dr. Amber Donaldson There is no typical day. I'll start with that. So no two days look the same, which I love. There is no monotony in my job for sure. It depends on kind of who's in town. We have a, I work at our Olympic and Paralympic Training Center in Colorado Springs, and we have a different cohort of athletes that are here almost every day.

[00:03:10] So we have resident athletes who are here sometimes up to 15 years, long periods of time, that are kind of more of our regulars. And then we have individuals that come in for camps or testing. And so what's happening on campus looks very different day to day. My role is also pretty flexible in that I cover a lot of different areas to oversee the clinical work of our clinics, but also very heavily involved in the games preparation.

[00:03:37] So we just came off of the Milan Cortina games, heavy into planning for the LA games. We have youth Olympic games coming up in Dakar at the end of this year, which will be challenging in some new and different ways. So just in leadership, we have a lot of things that we're working on as an organization that sports medicine has a role in that I am a part of in determining how we are making this more of a high performance center

[00:04:04] and how we look at, as we head into home games, how we really streamline the focus of what we're working on. It's so easy to boil the ocean and it's really hard for, everything is good, but really trying to stay focused on what we can be excellent at. The dietitians are newly reporting up to me. And so working on building out our sports nutrition program, our psychological services program, oversee our women's health program.

[00:04:33] So a lot of really cool programs that are really in their infancy in some spaces and more developed in others. All of our funding is from donors and sponsors. And so a big part of my job is also helping tell the story of the athletes we're serving and how we need funding to do so.

[00:04:53] And then I also get to treat athletes, which is also my love and passion and work with a lot of our athletes and some of our more complicated athletes from our Olympic or Paralympic population. And so it's a good mix of all of that. Wow. So many hats, Amber. There's a clinician hat. There's an interdisciplinary team member hat. There's an administrator hat, a leadership hat, a fundraiser hat, many different tasks to make up this complex role, as you say.

[00:05:22] And yes, I can see how that gets to no day looking the same. What was your career pathway from starting out as a graduate PT to today? In PT school, at that time we had the option of kind of setting up our own clinical rotation.

[00:05:39] So way back then I actually sent a letter to every PT in Australia because they were just really known for sports medicine and that was the space I knew I wanted to go into and asked if they would take a U.S. student. And so I got back the opportunity to go over to Australia and work, do some of my rotations there.

[00:06:00] And through those connections where I worked at Olympic Park, which worked with high level athletes, they recommended that I apply for the Masters in manipulative physiotherapy through University of Melbourne. And so I ended up coming back to the U.S., graduated from PT school and then went back to Australia to do another Masters program. It was a small group. We only had 10 of us from all over the world. And it was phenomenal.

[00:06:28] There was a lot of people like, you just need to go get a job. This is more schooling. And I think it was probably the best decision I ever made professionally was to go back and do that program. It just really honed my skills as a manual therapist in sport. It built on my love of the global aspect of sport and the connecting with providers all over the world.

[00:06:51] I finished that program and then was contacted again through those connections in Australia with the WTA tour for pro tennis. And so ended up getting that job to work with the WTA tour and then worked as one of the medical directors for the WTA for several years. And again, really honed my skills. It was a challenging, super challenging role that really pushed me as a clinician.

[00:07:20] As athletes, they want to be better now. You have, you know, 90 seconds to make an evaluation and you have to know your stuff and really be on top of it. And so that really helped make me a better clinician and provider and also had some administrative roles in that job as well that showed that I, you know, really liked that and some of the coordination and connection with setting up events. It's a really challenging lifestyle to travel. It was on the road about nine months, nine to 10 months a year.

[00:07:50] And that's, that's hard to maintain for a long period of time. And so had been approached by the USOC at that time to consider a role. And so came over here about 15 years ago now, just over 15 years and started working for Team USA. So it was a lot of doing some things outside of the box, really setting myself apart in a different way, knowing what I wanted.

[00:08:17] I've always been that kind of person who knew what I wanted and I, I went for it, but also the connections. It is a small world and those have proven to be really impactful throughout my career and continue to be so. When we hear these different stories of people who are working at the top level in medical care in sport, it can sometimes sound like, oh, well, I went and did this and then I fell into this wonderful role. And then I did this wonderful role in this leadership role.

[00:08:46] None of that just falls into place. You don't fall into these roles. And I know, you know that for sure, Amber. So how have you approached shaping your career? You alluded to making some of those connections and making very deliberate choices about education pathways. What does that look like? And I guess, what do you see as the most important decisions you made that have really shaped and built who you are today and what you do today as a PT?

[00:09:14] I think it really was, even from those early days, you know, I think picking my undergrad program was important and that was within, that was in sports medicine. And then I think even, you know, places where I volunteer, just the whole pathway being really intentional. And I'm lucky that I knew, always known what I wanted to do. And I know that that isn't everyone's journey. But I think that that helped me to be really intentional about the choices and the places I decided to put my time and effort.

[00:09:44] And even with my clinical rotations in PT school, I had inpatient rehab and different things that have really come into play in the care of Paralympic athletes. And so, even though I knew I wanted to do sport, these other opportunities have really paid dividends to being able to treat the population that I do. And so, I think just not thinking too narrow about any of the decisions you make.

[00:10:09] I think the decision to go to Australia was really one of the best because it was, you know, that was hard moving to a different country and setting up something, you know, going to a program. No one I knew had ever done that program. I was one of the first Americans to ever be part of that. So, just being willing to do that, I think, was in all the things that came with that.

[00:10:33] But the benefits way outweighed some of the challenges and pieces to navigate that. And I have had lifelong friends and colleagues around the world because of that. There were very few PTs and very few women in professional elite sport.

[00:10:50] And so, to be able to set myself apart in both of those areas, I had to really kind of push myself into the darkness in some ways and spaces that weren't really clearly defined previously and kind of make my own path. You mentioned women in sport, women in PT, and particularly in elite sport. I think we're still seeing there's differences.

[00:11:15] There are fewer women in those leadership roles at the top of elite sport, whether it's in coaching or in clinical work. What are your reflections on that discrepancy and how we continue to make change there, Amber? Amber Yeah, this is a really important area. And I think something, you know, I don't think we quite have it figured out. I definitely still don't. I don't believe in work-life balance. I think there's a harmony.

[00:11:41] There is always something that you have to give up and things that you have to prioritize. I don't know that you can do it all, all the time. I think there are times in which those decisions have to be made. And I've made those throughout my life. Whether I made the right ones, you know, I don't know. But I think just being really thoughtful about that, decisions to have a family or those kind of things that my family knows this is the job.

[00:12:09] And I luckily have a very supportive husband who, from his flexibility in his job, that it allows me to be able to travel as much as I do and do the work that I do. But I sacrifice things. I was just on a trip and missed family birthdays and, you know, some of those things. So I think if those are important things, whether—and that's not just for women. I think that's just a decision that we as a professional sport is not an eight-to-five job. It is weekends. It is travel.

[00:12:39] It is holidays. And so having that understanding. But I do think there are opportunities to be more flexible in the way we think than has historically been done. And I think there are ways to do things differently. It doesn't have to be better or worse. It just looks different. I think we're getting into a space where that's starting to happen and we don't have to be as much of a martyr. And I have felt that, that I have to blaze this trail for everyone behind me and it's all on my shoulders.

[00:13:07] And if I mess up, it messes up, you know, for them. And I think that's probably self-inflicted to a good degree. If we're doing a good job, our value speaks for itself. I know that even within coaching, there's some creative ways with job sharing that have been trialed in different spaces that allow people to have a little bit of both worlds. And I think that's great. I think there are ways for us to think in a different way than what has always been done.

[00:13:36] And it just may require some give and take in some other spaces or to be okay with it not looking exactly the same as it always has. But it is a space we need to continue to work at. And I think that's across sports medicine. It's not just physios. You mentioned things are changing and you mentioned the need to think more flexibly. That brings me to talking about how you build the clinical experience.

[00:14:06] And I think back in the day, and maybe it's still the case, it was you go and volunteer. You give up your time. You work for a team on the weekends. You do all of the things. And it's this constant volunteering, which limits who can do those roles, right? For reasons we've been talking about already. What are your tips for people listening today who are thinking, I have no idea how do I go about building the clinical experience I need to further my career? I want to have this career in sports medicine, but I don't really know about how,

[00:14:36] I don't know how to go about building those experiences and perhaps building those networks too. There is still, I think, a role for volunteering and it's just being around sports. If you want to work in Olympic and Paralympic sports, it's getting out and understanding what does the demands of sports medicine look like for shooting athletes, for equestrian athletes, for swimmers and getting to know sport. It may not even necessarily be volunteering, but it's getting to know the sport.

[00:15:06] Because if you understand the sport and the demands and the biomechanics, then you as a provider can do a better job of analyzing and using your expertise. I think working with our Paralympic athletes, adaptive sport has a massive need for providers in that space. And it's not scary. It's, I love it. It's like the most exciting thing to work in adaptive sport. The athletes are incredible. It's fun and it challenges you in a different way as a clinician.

[00:15:34] And so I think finding those opportunities. As a physio, I also think we need to expand our knowledge base outside of probably what we learned in school. To other areas that historically maybe are not within the curriculum of physical therapy. From, you know, and learn from some of our other colleagues. I'm so lucky to work in a place where we don't have, you kind of look to our field, out into our clinic, and you don't know who is what provider type.

[00:16:04] We just all work together. And I love that. And I love learning from my athletic training colleagues and my chiropractor colleagues and my massage and physician. I may not, never be as good as them at other things, but just knowing how our skill sets work together is a really great piece. So I would say never work alone is my biggest advice to anyone as they, particularly as they start out in their career, because you don't know what you don't know.

[00:16:33] But thinking about the other resources within your community and just understanding what they have to offer, I think really improves your ability to service your patients and athletes because you know what your limitations are and where someone else can fill that. So it may look like some volunteering, but I think it's a lot of that other time. Like the time you spend just getting to know other professions and then getting to know the sports is really an important piece

[00:17:02] because those are the things that when someone comes to look for a job like that, that's what you can tell is being able to speak all different languages, understanding what the mindset of an athlete is, is huge and a big piece of what we do, more than just necessarily the actual skill set. You know, we do very little body weight strengthening. We need Olympic lifting,

[00:17:27] like understanding the power of loading an athlete is very different. Amber, I'm going to get you to put your leadership hiring hat back on for a bit at USOPC. And you might have alluded to a couple of these concepts already. When you're recruiting people into your team, what are you as a leader in the USOPC looking for? What's going to differentiate the good sports med clinician from someone who's exceptional

[00:17:57] and is going to fit into that very complex sporting environment you've been describing for us? I think some of the key pieces are being a team player, not being the person who feels like they have all the answers and is going to do it alone. That type of person does not work. This is kind of coming in, you know, guns a-blazing and has the answer for everything. I look for humility. Absolutely a good provider,

[00:18:25] but someone who is really willing to collaborate. And I don't mean making someone collaborate with me. That's not collaboration, but really coming together, being open to others' ideas. I think that is a big piece. Obviously, having a good skill set, having an understanding of where to go to get answers, because there are so many things that we learn and do that are not textbooks. So how do you, you know, in Tahiti,

[00:18:53] we were using sticks for splinting and hanging things. Like, how is your creativity in coming up with, you've got to make it work, and you've got, you know, duct tape and a stick. Having good emergency and first aid skills, which is, again, not something we're typically taught, and that may be something you've got to go get additional training and understanding. And then an understanding of illness management. Oftentimes, we're it.

[00:19:22] We're the one on the road with them, and we don't have a physician, and we don't have... And so being an extension of them and being able to know what questions and how to screen and evaluate how to do things outside of a clinic setting on the side of a field when the wind is blowing and lights are on you and cameras, and like, how do you manage and still do a good neuro exam? So being able to do things outside of typical settings with different kinds of pressures

[00:19:51] and, you know, rehab is a piece, and that's what I think PTs are strongest at. We don't do a lot of rehab at the Olympic and Paralympic Games. It is first aid. It is taping. It is concussion management. It is illness. It is swabbing biofire noses and cleaning up people who get sick and helping change catheters, and it's a lot of other things that you may not typically do.

[00:20:19] So I think it's that willingness to learn and be open to figuring things out and working with your teammates. Fit, a lifelong learner, self-driven. Bring your colleagues along for the path. Be a good communicator to both the athletes, the whole team. You've got the parents, the coaches, whoever that stakeholder group looks like. We're seeing athletes multiple times a day. We're doing a lot of different things.

[00:20:49] So kind of getting outside of a clinic headspace is a really important piece and a pretty big challenge, I think. Amber, I want to finish by asking your reflections on a PT being in the role you're in, which has been, I think, in sports medicine, we've traditionally seen the very hierarchical, the doctor or the orthopedic surgeon is at the top doing all of these leadership roles. What are your reflections on what PT, and we talked at the start

[00:21:19] about your experience as a PT. I'm interested in your reflections on how things have changed, how you see your colleagues working together truly in an interdisciplinary way and how your training as a PT fits into that. I've been lucky to be able to work in facilities and organizations that are very multi-interdisciplinary and we also don't have insurance and some of these things that kind of create

[00:21:46] some of those barriers to communication. But I think it has been, and I've been here for quite some time, there has been some transition and shift depending on different leadership groups, both within the organization and within sports medicine itself. But I think the ultimate goal is always the athlete. And I think if we always take it back to that, that helps us. It's not about me. It's not about my journey. It is about the athlete I'm serving. And I think that is also a clear,

[00:22:16] those who have been here for the wrong reason don't last. We figure that out pretty quickly. And I think from a leadership perspective, I've reported to a lot of different types of providers and even non-providers as leadership. And I think, again, it doesn't matter who that is. It matters who cares about the athlete and what we're doing to service them in the best way possible. There is no reason we can't have more PTs in this space. And I would encourage people that have that interest.

[00:22:47] It's an amazing way to build different connections. I was just at a meeting this past week as we in LA with a bunch of different chief medical officers, mostly physicians around the world, but also a few other physical therapists from other nations as well, physios who are leading their teams in organization of games preparation. And we have different strengths that we bring.

[00:23:16] The different perspectives are just really important. And understanding where people have come from in their knowledge and training and where their strengths are. And it's an opportunity to push yourself as well to gain new skills that maybe you hadn't even considered before, no matter which path or where they sit in that hierarchy, that you still have a voice and an opportunity to make a difference and impact the care of those you serve.

[00:23:45] I love that you ultimately bring us back to thinking about the athlete and that all of our work is really about the athlete. Dr. Amber Donaldson, it's been wonderful hearing about your career, the steps you've taken, the pathway you've taken to get here. And thank you for joining me today on JOSPT Insights. Thanks so much, Claire. It was great talking to you. Thanks for listening to this episode of JOSPT Insights. For more discussion of the issues

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