The professionalization of college sports has prompted concern among team physicians that they will be exposed to a greater risk of being sued by athletes who claim a poor outcome from treatment caused them to lose future earnings.

Before July 2021, when college athletes were cleared to be compensated by third parties for the use of their name, image and likeness, analysts say such lawsuits would have been virtually unwinnable.

Four years later, and with schools set to share millions directly with their athletes, team physicians are wary.

Some of the most high-profile college athletes are already signing multimillion-dollar deals and
six-figure contracts are common.

Though no malpractice lawsuits seeking lost future earnings at the college level are known to have been filed, it’s only a matter of time, said Dr. James Borchers, Big Ten chief medical officer and president and CEO of the U.S. Council for Athletes’ Health.

“The complexity for the clinician is going to be significant,” he said. “I do think there are people who are going to evaluate this and say, ‘I didn’t sign up for an 18-year-old making a million dollars and then saying the decision I make affected their ability to make money.’ I think you may see people say this isn’t for me.”

The case of former Philadelphia Eagles player Chris Maragos jolted the sports medicine field in 2023 when a jury ordered his surgeon and an orthopedics group affiliated with the team to pay him $43.5 million for lost future earnings and pain and suffering after he alleged improper care of a knee injury.

The orthopedics group ended its two-decade association with the Eagles out of fear of future lawsuits.

At the college level, it still would be hard for an athlete to contend a team doctor’s errant care cost them an opportunity to make money in professional sports because there are no guarantees to play at the next level. A college athlete who didn’t have an optimal recovery, however, could argue treatment reduced his or her ability to make NIL money or to transfer to a higher-level school where he or she could make more money.

“You had an ACL tear, I did surgery and you never quite made it back — back in my day, you just had bad luck,” said Borchers, who played football at Ohio State from 1989-93. “You’re making a million dollars and that happens, you’re probably having a different discussion.”

Borchers offered a hypothetical situation to illustrate his concerns about the pressures faced by team doctors.

A receiver is treated for a hamstring injury, returns to play and reinjures the hamstring. The receiver says the injury never felt fully healed and his agent takes him to another doctor who has a different opinion on how the injury should have been treated.

Borchers said the receiver would have been better off to sit out longer and miss a few more games.

“But there wasn’t money tied to that,” he said. “Now you could say you hurt my ability to go out and perform, so I’m not going to get as much money or (it) has cost me the ability to put more tape out there so I could have transferred to a better situation and made more money. Those are the types of issues we’re hearing about that used to not exist in college sports.”

Typically in college sports, team physicians are employed by a university-affiliated medical center or local medical group. Athletic trainers are employed by the athletic department. Team physicians must carry liability insurance either individually or through the medical center or group. The most common limits for a malpractice insurance policy are $1 million per incident and $3 million total in a year, said Mike Matray, editor of Medical Liability Monitor.

“You can see how an athlete’s economic damages, should a medical error end his/her career, would easily exceed those limits,” Matray wrote in an email to The Associated Press.