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Sports medicine in the Netherlands
  1. G C Van Enst
  1. Sports physician, Isala Clinics, loc sophia, Sports Medicine Department, pb 10400, 8000 GK Zwolle, the Netherlands, gvanenst{at}wxs.nl

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    Sports medicine can be defined in different ways. In the Netherlands the definition of sports medicine, the field of work in sports medicine, and training in sports medicine have changed several times since specific sports medical activities began in the 1920s. The Olympic games in Amsterdam (1928) saw the beginning of specific preventive activities in sports medicine. Preseasonal screening was established, and after the second world war more than 300 000 preventive preseasonal screenings were performed a year. Another 200 000 children were screened annually by school doctors.

    In 1965 the Netherlands Association for Sports Medicine was established. Doctors interested in sports medical problems could attend a specific course. The programme was broad and offered general topics ranging from cardiology to orthopaedic surgery and exercise physiology. The character of the course was a retraining course. Its duration was about 40 hours and it formed the basis for membership of the Netherlands Association for Sports Medicine.

    Ten years later the first doctor was fully trained in sports medicine partly modelled on East European standards. This education took four years and consisted of one year clinical cardiology, one year clinical orthopaedic surgery, one year exercise physiology in a university exercise laboratory, and one year practical work in the field of sports medicine in places such as the national centre for soccer and the national centre for sport (Olympic centre). Beside these training activities, there was a (general) course in social medicine (12 weeks). For the organisation and quality control of this new discipline, a foundation for training of specialists in sports medicine (Stichting Opleiding Sportartsen; SOS) was established. The SOS had several committees which controlled training content and procedural aspects. Initially, about two doctors started training every year. The specialists in sports medicine set up a separate section of the Netherlands Association for Sports Medicine (1982) and wrote a profile “Fields of activity of specialists in sports medicine” (1983). The aims of training for specialisation in sports medicine were formulated on the basis of this document (1985), which formed the basis for the recognition of sports medicine as an official discipline of social medicine by the College of Social Medicine. A year later (1987) the degree was given legal power by the secretary of state for health, welfare and cultural affairs. During this period, the inflow of professionals increased to six to eight persons a year, and a new curriculum was formulated. In 1991 the curriculum for the training of specialists in sports medicine was published (77 pages, also published in English).

    Registration or recognition in one of the three fields of medicine in the Netherlands is important in many ways. Doctors in the Netherlands can be divided into three groups: general practitioners, social medicine experts, and specialists. Another division could be made: preventive medicine and curative medicine with subdivision into extramural and intramural. The three kinds of health care and the three groups of doctors are paid from different sources. Each group has to decide what kind of medicine it covers. After acceptance, the ministry of health normally takes the advice of the board of specialists (Central College) and the College of Social Medicine.

    In 1993 the first sports doctor started a full time job in a hospital. The field of sports medicine, described in 1982 by the section of specialists in sports medicine of the Netherlands Association for Sports Medicine, was changed by this initiative. The work was much more therapeutic than previously, and the importance of diagnosis in everyday work was completely different from before 1993. A new discussion about the definition of (the field of) sports medicine was begun. Now, seven years later, about 20 hospitals have a sports medical department (or intend to have one in the near future) run by a professional sports physician. Three university hospitals belong to this group. In the first hospital, about 1000 patients with sports related medical problems visit the department a year sent by their general practitioner or another specialist working in the same hospital. Most of the patients are ordinary athletes not involved in high level training and competition. Along with the patient related activity, there is still preventive screening for specific sports. In addition to this obligatory screening, some athletes and even non-athletes ask to be screened. The third activity is the care provided for top level athletes. This health care is often given outside of a hospital. All the sports medical departments in a hospital have a well equipped exercise physiology laboratory partly for diagnosis and partly for the control of and training advice for top athletes.

    The change from working outside the clinic before 1993 to inside the clinic after was combined with a request for sports doctors to be registered as specialists. One of the most important reasons for this request is that financial support for hospital care is based on registration of the doctor. For a specialist, the financial support for health care in a hospital is much greater than for a doctor registered in social medicine. The request to be specialists was presented to the board of specialists last year and is still very much the topic of medical and political debate. If the request is accepted, training in sports medicine must be changed again in line with other specialist training. The new field of sports medicine will need to be defined again, and a political debate is underway to chart the field and state of science in sports medicine. A new decade in sports medicine in the Netherlands seems to be on the way.

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