The Absurd in Pediatrics: the free or $25 sports physical

Every year, as the back-to-school rush approaches, primary care pediatricians brace themselves for the inevitable: the sports physical season. What was once a thoughtful and comprehensive assessment has been reduced to a rushed, impersonal experience by urgent cares and "sports physical rodeos," drawing patients away with promises of convenience and speed. As a pediatrician, it’s frustrating to see the essence of what a real annual check-up should be diluted into a mere formality to check boxes.

Every year at this time—the flood of requests for sports physicals, the hurried phone calls from parents desperate to get the forms signed before practice starts. And increasingly, these parents opt for the quick and easy solution: a visit to an urgent care or, even more disheartening, a pop-up clinic where a cursory exam suffices to tick the necessary boxes. Forms signed but care sketchy at best. A couple of quick measurements, a heartbeat check, and a signature on a piece of paper.

What’s missing is everything that truly matters. These quick-stop shops can’t offer continuity of care. They don’t know patients’ histories, their ongoing conditions, or their mental health struggles. They don’t check in on the holistic well-being of the child—their emotional, social, and academic health. They’re not equipped to have meaningful conversations about the myriad of issues that can affect a young "student" athlete’s performance and overall well-being.

The phenomenon of the "sports physical rodeo," where kids are herded through makeshift exam stations in a school gym or community center is a farce. Picture this: a long line of young athletes, each clutching their forms, moving from one station to the next like an assembly line. Height and weight measured in one corner, blood pressure taken in another, a quick listen to the heart in the next. It’s a fragmented, impersonal process where the goal is efficiency, not thoroughness.

In these rodeos, the focus is on speed and volume. The practitioners, often volunteers or staff pulled from various places, do their best within the constraints, but the environment doesn’t allow for depth or raising concerns. There’s no time to discuss chronic conditions, mental health, or any other nuanced issues that might come up in a proper medical setting. It’s all about checking the boxes and moving the line along.

As our kids struggle increasingly with so many issues -- it's time for the "sports physical" farce to go away. Schools, states and policy demanding this ineffective form a care should be abolished.

The Difference Between a Sports Physical and an Annual Well Check

As pediatricians, it’s also disheartening to see a once-a-year visit turn into this diluted checkbox exercise. Schools and states demand these "school physicals" right before the academic year begins, creating a last-minute crush that strains resources and leaves little room for comprehensive care. If we are short on primary care providers and demanding that every child get a physical in August, it makes zero sense. Why not accept a truly annual check-up—one that includes mental health, depression screening, continuity, and a full assessment of overall well-being?

An annual well check is a comprehensive visit that covers multiple aspects of a child’s health:

• Detailed Medical History: Review of past medical history, family history, and any ongoing conditions.
• Growth and Development: Tracking height, weight, and developmental milestones.
• Vaccinations: Ensuring the child is up-to-date with immunizations.
• Screenings: Vision and hearing tests, blood pressure checks, and other relevant screenings.
• Mental Health: Screening for depression, anxiety, and other mental health issues.
• Lifestyle Counseling: Discussions on nutrition, exercise, sleep, and healthy habits.
• Chronic Conditions: Management and follow-up on any chronic illnesses or conditions.
• Preventative Care: Identifying and addressing any potential health risks early on.

In contrast, a sports physical often involves:

• Basic Measurements: Height, weight, and blood pressure.
• Heart and Lung Check: Listening to the heart and lungs for any abnormalities.
• Musculoskeletal Exam: Basic assessment of joints, muscles, and overall physical readiness for sports.
• Questionnaire Review: Brief review of the child’s health history and any recent symptoms or injuries.
• Form Signing: Filling out and signing the required sports participation forms.

The differences are stark. A sports physical is a brief, surface-level check focused on immediate clearance for athletic participation, while an annual well check is a thorough, in-depth examination aimed at overall health and long-term well-being.

By valuing the depth and continuity of care provided by primary care pediatricians, we can restore meaning to these visits. We can ensure that they’re not just about clearing a child for sports, but about supporting their overall health and well-being.

In the United States, we have a tendency to favor fragmented, superficial solutions when more integrated, intelligent approaches would serve us better.

This is a problem that would be so simple to remedy. With basic policy adjustments and a bit of common sense, we could mandate annual check-ups tied to a child’s birthday or close to it and ensure every child has the ability to obtain a real annual check in -- or better yet to be monitored over the course of their childhood for holistic issues that need attention.

A standard and comprehensive annual evaluation that doesn't need repetitive, duplicative or lesser quality built on speed of checking boxes vs real care.

If we are truly facing problems with access to real primary care.. why do we create "workarounds" that only add work to our system and deliver very little in real value? By promoting true annual check-ups, we can make our children healthier, more connected to real care, and ensure they receive the full benefits of a thorough history and physical examination.

So here’s another plea from this pediatrician to those who think school physical rodeos or $25 to buy a signature is a good idea: please consider the bigger picture. Remember the value of a comprehensive visit, where your child is seen, heard, and cared for in a holistic manner. Don’t let the convenience of a quick fix overshadow the importance of continuity and depth of care. Because in the end, a signature on a form is just that—a signature. But a thorough, thoughtful examination? That’s the foundation for a healthy, thriving child.

Let's solve the primary care access problem and not replace or ensure it's failure by overwhelming it with check boxes and copious paper forms.