More Than Admits and Discharges

What an Olympic Team Physician Learned that Every Rural Physician Can Use

A conversation with Dr. Fred Workman, Regional Medical Director at RPG and Team Physician for U.S. Figure Skating.

For Fred Workman, M.D., serving as a team physician for U.S. Figure Skating at the Olympic Games in Milan was “25 years in the making.” At the Games, he focused on caring for the nation’s pairs and ice dance athletes. Back home in Colorado, Dr. Workman serves as Regional Medical Director for Rural Physicians Group and Chief Hospitalist at Sterling Regional Medical Center, balancing leadership in rural healthcare with a passion for sports medicine.

Dr. Workman and I partner in a dyad leadership model, overseeing 11 hospital-based programs across Colorado, Nevada, and Wyoming. That’s the professional version of the story. In practice, our partnership is built on a shared passion for rural healthcare and a genuine respect for what it takes to deliver it well. So when he returned from serving at the Olympic Games, getting him to talk about the experience took some effort. He would much rather discuss his athletes, his patients, or the colleagues he works alongside every day. What follows is the closest I could get him to talking about himself – and even then, his humility shines through.

 

Most people don’t grow up thinking… “I want to be a team physician for Olympic figure skaters”.  How does someone end up in this role?

“I’ve had a passion for sports for quite some time, both playing them, watching them, and coaching. So, when the opportunity came to do a sports medicine fellowship after I graduated from internal medicine residency, I seized it. I was fortunate to be assigned to work as the head team doc for professional hockey and a Division-1 university. My mentor and the director of the program was a well-established figure skating physician, and he basically got me traveling with those athletes for the past 26 years.”

 

What did it feel like stepping rinkside at the Olympics for the first time?

“Most sports medicine physicians have some type of goal to be a team physician for a professional team, maybe go to the playoffs, go to the Super Bowl. Not unlike what an athlete aspires to do. Once I was in the pipeline for U.S. Figure Skating, every doc aspires to be that Olympic physician. So, in the last four years of the Winter Olympic quad, that’s what I’ve been focusing on.

When I walked into the event, no one applauded me, so I took a deep breath. Looked around and paused to take it all in.  Thanked God for giving me the opportunity.  Searched the stands for my wife and family who sacrificed when I was away all those years on trips and calls. I self-reflected and reminded myself that I made it and it was all worth it. Congratulated myself again and then went to work. 

I reminded my colleagues, the physical therapist and the athletic trainer, to do the same thing. When you’re there, you’re on edge, nervous, heightened anticipation. But it’s important to look around, look at people’s faces, look at the event itself, and be in the moment. Athletes talk about that from a performance standpoint, and it’s the same for us.

The hope of a sports medicine physician is that all the work we do is before the event. Fine-tuning the athlete, getting them into the best shape. Then ideally, we don’t have to do any rinkside injury management. The goal is for the athlete to skate at their best and get a personal best. We’re there for support, letting them know we’re there in case anything happens. But hopefully we don’t have to step in.”

 

Figure skating looks effortless on TV. Give us a sneak peek into the physical demands the skaters go through that would surprise fans to learn?

“Some of the best-conditioned athletes all around are the pairs-male. He has to do essentially everything a single skater has to do and lift, carry, throw, and catch another human being. Their coordination, balance, strength, and the responsibility of holding another human above their head with one arm is amazing.

Our athletes get up to their max heart rate in the first 10 to 15 seconds of a program. There are no timeouts. No walking back to the huddle to catch your breath. It’s full on the entire time. Their cardiovascular has to be at peak condition to sustain that effort, with a smile, for the judges and the fans.”

 

You’re working with athletes whose entire career can hinge on a single performance. How does that change the way you practice medicine?

“Some of our athletes, all they’ve worked for their entire lives, can come down to one jump. In figure skating, there are multiple elements in a program, and if they fail to execute them as they typically would, then all their hopes and dreams of medaling have to wait another four years.

For me, I do everything I can to make sure when they go out on the ice, they’re at their peak, physically, mentally, and psychologically. Once that skate starts, there’s no timeouts. It’s like you press play and it happens. There are no halftime adjustments. It’s game on.”

 

In caring for your athletes, what’s the hardest judgment call you have to make as a team physician?

“The rules of figure skating don’t allow timeouts or halftimes to gather resources and get an athlete back into competition. They’re pretty much either a go or a no go. We have a team approach for whether an athlete is safe to even step out on the ice.

The bar is much higher for pairs and dance because the male skater must lift and carry their partner. So, the partner’s safety is at risk too. Those decisions weigh heavy. The last thing I want is to clear a male dance or pairs athlete and then have him buckle and drop his partner.

Fortunately, that hasn’t happened. I feel like 25 years of experience gives me enough that an athlete may not be at their absolute top, but their 80% can still be good enough to medal or do well safely. There’s not one of those calls I regret.”

 

Olympic figure skaters are some of the most disciplined athletes in the world. What stands out most about the discipline required at that level?

“For them, it’s daily preparation. They are models of consistency in their training, on ice, off ice, and in nutrition. They’re meticulous about what they consume. They have to be. Figure skating is not only a performance sport, but also an appearance sport. They don’t have uniforms or masks or helmets to hide behind. All eyes are on them when they compete. They’re not lost in a field of other athletes. They are the spotlight.

What’s also impressive is that we had several athletes in their mid-30s competing on an Olympic stage when most figure skaters have long since retired. Through attention to fitness, nutrition, and listening to their body, they’ve been able to sustain elite careers longer than most.”

 

Are there any behind-the-scenes stories that might surprise people?

“One of our athletes broke their gold medal within the first few hours of receiving it. I got a text saying, ‘I think I broke my medal,’ at like 2 a.m. That was pretty funny. But it wasn’t only us. Several medals of all colors from various nations came unglued. The medal came off the ribbon. It was kind of a thing. A lot of them had to be recast or repaired.

Another thing behind the scenes: when these athletes are done competing, if they’ve won a gold medal, sometimes they’ll be up for 36 to 48 hours without sleep. They’re going from one press interview to another, being driven around Milan for an event here and there. I was with one of our athletes until about 2 a.m. at the rink, and they still had several interviews, appearances, filming, and meet-and-greets to do before breakfast. The reason I stay that late is that part of the job as the team physician is to escort our athletes through the antidoping process, which doesn’t happen until after the media and press conferences are done and the athlete can produce a sample.

And the media is constant. Everyone has a phone. People pay good money for seats really close to the action, and in figure skating it’s not too loud, so they can hear interactions off the ice and record them on an iPhone. Athletes, coaches, staff, all of us, being recorded constantly.”

 

There’s an obvious commitment required before the Games. What goes into being part of Team USA beyond the Olympics themselves?

“In an Olympic year, we held two preseason camps that I attended and fully participated in. Physical exams, athlete evaluations, health goals, training, on-ice coverage. I traveled to three major international events before the Olympics, each a seven- or eight-day commitment. Then 30 days in Italy. And that doesn’t count the meetings and phone calls with athletes, parents, and coaches.

Unlike other Olympic sports, figure skating doesn’t have professional teams or Division 1 college programs where athletes already receive consistent medical care. Our athletes are training all over the world, not always within reach of elite medical care. We’re a decentralized organization, and our decentralization doesn’t guarantee on-site medical care when they’re not competing for Team USA. So, a lot of the work happens in the spaces between events.

I was on the road for about six weeks through the fall and winter before I even got to the Games. I couldn’t have done it without an amazing core team of providers at my hospital in Sterling. They had to backfill me and work extra stretches to allow me to have this experience. And the same goes for the support from all the RPG staff that made this opportunity possible.”

 

Bringing it home, how has being a physician for Team USA carried into your work with Rural Physicians Group?

“Especially in the rural space, and as a regional medical director, there’s no place to hide. The decision is ours. There’s no room for anything other than our best. Everyone turns and looks to one person to make a call about an athlete, a treatment, a plan. There are no consults. There’s no one else to ask. We see that often in rural medicine. It takes a very special, unique provider to be the person who practices at the top of their license, is comfortable making the calls, and is ready to step up when a crisis presents itself.

There’s no backup. There’s no room for anything other than our best. U.S. Figure Skating has one position. Ultimately, my decision carries significant weight for an athlete, a coach, a family, a country, a federation. Same thing as a physician in a rural area. The patient, staff, hospital, family, all depending on us doing our best job. I was on 24/7 for 30 days. And not just for the athletes. I was on for all the coaches, staff, judges, and team officials. Probably 50 or 60 people I was caring for around the clock, and only 16 of them were in top physical condition. The rest of us couldn’t say that.”

 

For the physicians reading this, what is something they can take away from high-performance care and translate to everyday medicine?

“Health is the goal for our patients too. It just looks different for every person. It may not be doing a quad axel. It may be the ability to get out of a chair independently and go about their ADLs. If we look at every person with the same value, the same humanity, that we give the athletes we cheer for on TV, then we’ll serve our communities and our patients better.

Taking what I learned and applying it, I have to have the same urgency and expectation to improve my patients’ lives and let them function at their highest level. That may not be performing on TV or standing on a medal stand. It may be functioning independently, being there for their family, having an improved quality of life because they interacted with us. I hope that encourages physicians and providers to look at every person as more than admits and discharges. They’re humans trying to live their best life outside the walls of the hospital.”

 

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