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Want to makes lots of money and have a quiet life? Sports medicine is not for you. Domhnall MacAuley describes how his love of sport turned into a passion for sports medicine

Sports medicine: "Everyone wants to be cured yesterday"

Belfast, 6.15 pm on a wet winter Monday evening. The last patient has left but I still have two home visits and a mountain of paperwork. No time for training tonight. Tomorrow is a "London" day so it's an early start to catch the 7 am shuttle. Combining jobs can be thrilling, exhilarating, and exciting but it's also exhausting. In general practice there is a new challenge around every corner but trying to combine practice with editing a journal, clinical sports medicine with some research, and trying to stay fit requires a pretty elastic timetable and an understanding family.

Normally I spend most of my time in general practice, although I have two sessions where I do research, teach, or work on the journal. I see a lot of sports medicine at the practice and will often see athletes in the early morning or the evening. Most of my sporting patients are involved in endurance sports such as running, cycling, or rowing and as they are usually students or full time athletes there are no huge private fees.

The journal is a constant commitment and I do some work almost every evening. On Fridays at lunchtime a large bundle of papers and correspondence arrive from the editorial office and this is collected again on Monday. I can tell how busy I will be at the weekend by the size of the parcel.

I grew into sports medicine rather than making a positive career decision. General practice seemed a natural career choice as both my parents (and two of my grandparents) had been general practitioners. As a student I had been a keen rower. Indeed it almost completely dominated my entire student life. I even spent my elective at training camp. In my final year, I joined a local running club. Rowing took up too much time and final exams were a major hurdle so common sense took precedence, albeit briefly.

Career by default
After my preregistration year I moved to Exeter to a three year general practice training scheme during which time I attended almost every available sports medicine course. If you are involved in sport, and people know you are a medical student or a doctor, athletes, coaches, and training partners continually ask about injuries, training, diet, and all aspects of medicine and physiology. Inevitably my knowledge and interest increased. I remember the thrill the first time I saw my name in print. It was a case report in the British Journal of Sports Medicine, which I now edit, of a cyclist who had been swept into the sea. And that was the start.

Throughout my time in Exeter I continued to row, and on my return to Belfast I was able to win back a place in the national rowing squad for the World Championships and to race at the Commonwealth Games the next year. By now, of course, I was hooked on sports medicine and although general practice was my day job, sports medicine was my passion. When the first postgraduate qualification became available, a diploma in sports medicine, I was the only candidate in the first exam.

Countless opportunities
Sports medicine offers many unusual work experiences. I was once asked to go as medical officer to training camp with the British Olympic rowing team. Three weeks in Italy. Although it was serious for the athletes, I had time to row myself, enjoy the fun, and even get a sun tan. Later, when cycling in Britain was at its peak, a colleague asked if I would like to join him in the medical team at the professional races. I jumped at the chance. What a thrill, to work at the Kellogg's Tour of Britain, the Wincanton Classic, and the Nissan Tour of Ireland. The race doctor has a grandstand view from the front of the cavalcade (the long trail of vehicles following the race) and during racing you could almost touch the riders.

At this time there was no real academic structure in the discipline, although this is changing now, and it was clear that I would have to create any educational career initiative myself. My next step was to do an MD. So in 1992 I took a year out of general practice and became a research fellow in cardiovascular epidemiology as principal investigator in the Northern Ireland Health and Activity Survey. Learning research skills and clinical epidemiology unlocked a whole new area of medicine. It has been of particular interest with the current vogue for evidence based medicine and critical appraisal and helpful in my role as an editor.

Getting into sports medicine
It was these experiences that equipped me for the rather strange existence I have now as a general practitioner, sports doctor, epidemiologist, and editor. Most sports doctors have a combination of jobs. There are few full time posts available and the specialty is still in its infancy in the United Kingdom.

A career structure is developing, however, and there should soon be a recognised training curriculum with a specialist examination recognised by the royal colleges. If you are interested in sports medicine I suggest that you aim for general specialist training and watch closely for developments. There are opportunities to work abroad, and the specialty is much further developed in North America and Australia.

As a student you may wish to do an elective in sports medicine. There are academic centres of sports medicine at the universities of Glasgow, Nottingham, and London that may be able to help as well as many centres of excellence in North America, South Africa, and Australia. A quick glance through the sports medicine journals will get you some useful addresses.

A lower leg fracture in a skier

If you want to learn more about sports medicine you could join the British Association of Sport and Medicine which is the major educational body. For your (reduced) student membership fee of £40 you will receive the British Journal of Sports Medicine and notification of all the association's local and national educational events.

Sports medicine is a great career because sport is so enjoyable but its not all fun and games. It is challenging, demanding, and everyone wants to be cured yesterday. Most sport takes place during leisure time and that means that a lot of your work will be during your leisure time too.

Where to go next
Domhnall MacAuley is the editor of the British Journal of Sports Medicine. To find out more about the journal see the "specialist journals" web page via the BMJ home page (www.bmj.com).

British Association of Sport and Medicine, The Anatomy Building, St Bartholomew's Medical College, Charterhouse Square, London EC1M 6BO.

The following universities have some involvement with sports medicine: University of Birmingham Medical School, Manchester Metropolitan University, University of London Hospital Medical College, and the Universities of Bath, Glasgow, Nottingham, Sheffield, and Strathclyde.