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Something is wrong with the NFL's medical culture, and it needs to change

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Injury rates across the league are growing at an alarming rate. At what point do we need to start asking questions?

Ron Chenoy-USA TODAY Sports

One would imagine that being a physician for a NFL team is one of the most sought-after positions in the medical world. A job given only to the best of the best, and rightfully so, as the perks are highly coveted. Your office is the gridiron, and your patients are some of the world's most famous athletes. But most importantly, the pay is great.

However, this isn't exactly how things work. Instead of teams paying their physicians top dollar to treat their employees who earn millions each year, those positions are actually given to doctors whose hospitals are willing to pay up for big agreements where teams offer advertising and exposure in exchange for reduced-cost medical care. Instead of looking towards medical care as an important investment in their players, teams see an opportunity for revenue. And that's just one of many problems with the medical culture in the NFL.

In a recent Associated Press poll, less than half of NFL players believed that their teams and doctors have players' best interests in mind when it comes to injuries and health. As players grew older, their perception of their medical care also became worse, with only 35 percent of players with four or more years of experience felt good about how their teams handled their health.

"Some of the guys I hear stories from, they don’t trust the team opinions. (Teams are) pushing guys and telling them to ‘Go!’ That’s crazy. That’s crazy to hear that."

- Denard Robinson, Jaguars running back

Lacking confidence in their teams' hired medical help, players are now overwhelmingly opting to go at it alone, and are making arrangements with physicians who aren't connected to the league. Broncos' defensive lineman Antonio Smith, who has suited up for all but one of his 180 NFL games, credits his clean bill of health to his own hired help, a plethora of specialists that includes a stretch therapist.

"You’ve got to get yourself a good system. Chiropractor, massage therapist, stretch therapist. A lot of guys are doing IVs now. Take care of your body. You’ve got to do that. If the team doesn’t supply it, you spend the money."

- Antonio Smith, Broncos defensive lineman

In droves, players are flocking to get second opinions, much like then-Giants safety Stewie Brown did when he left the care of team doctor and respected orthopedic surgeon Russell Warren and instead decided to be operated on by Warren's colleague, Dr. James Andrews.

Ravens' linebacker Ray Lewis also avoided team care when he had surgery performed on his triceps and allegedly sought deer antler spray from a shady company.

So where does this widespread distrust of team medical professionals stem from? Most would say that the advent of the "official" health care provider is to blame. Ever since the Panthers and Jaguars cut the first known deals of the sort between a team and medical institution in the mid-90's, the practice has caught on, and now a large majority of the league boasts an "official health care provider."

Considering that these pacts are directly at odds with the Hippocratic Oath, it's astounding that these agreements even exist, especially considering that a 2004 rule imposed by the league "prohibits clubs from entering into marketing contracts with health care organizations that require the team to use doctors from the medical group." In the Ravens' case, their agreement goes even further than the locker room and field on gameday.

"MedStar, for example, also has the contract to provide medical services at Ravens home games, a setting that MedStar Sports Medicine VP Lew Lyon describes as a war zone, albeit one imagined by Joseph Heller. He recalled one incident in which a woman aspirated on a chicken bone and went into cardiac arrest. The medics got the bone out and got her heart going again. When they tried to move her to a hospital, she threw a fit, saying she’d paid to see the game. "They didn’t even sell chicken wings at the stadium," Lyon said. "She had brought in a bucket under a jersey or something.""

All in all, it's an incredibly awkward ordeal for both player and physician. Players may believe that their doctors' judgment and prescriptions are affected by team management, and they may hold back certain critical medical info if they feel that any damning information might find its way to the front office via word of mouth. While current Ravens' head physician Dr. Andrew Tucker says he is "completely comfortable with my own situation and how business is done," some of the guys on the other side would beg to differ. Multiple players, including Steve Smith Sr., expressed concern about a "conflict of interest" between doctors and players, while another went so far as to say that players are "assets" who are rushed back by medical staff on an unhealthy timetable.

"You get your coach or trainer constantly coming up to you, telling you, ‘Oh, you coming back this week? You going to be ready tomorrow? You think you can go today?’ A lot of times, you get in your mind: ‘Does Coach really want to see me healthy? Or do they really want to see me play?’"

Jurrell Casey, Titans defensive lineman

Last season saw 275 players hit the injured reserve during the regular season. That's twice as many players that were on the same list in 2001. The number of ACL tears has also increased significantly in recent years, as 2013 was assumed to be the worst season for ACL injuries on record. While there's no way to prove it, the correlation between the prominence of these "official healthcare providers" and the increase in injuries is certainly thought-provoking.

The Ravens aren't strangers to these severe injuries. Joe Flacco, Jimmy Smith, Steve Smith Sr., Justin Forsett, and Breshad Perriman all come to mind as impact players that have succumbed to the injury bug in Baltimore. And while it just seems like bad luck, the Ravens are apparently having exceptionally bad fortune if it is indeed Lady Luck's doing. By my count, the Ravens led the league in players on the injured reserve, with 24 players. That was well above the league mean of about 14.8 players on the list for each team. 2014 was also another bad season for the Ravens, with 18 players going to the injured reserve. Of course, this really could just be a bad string of luck, but if this pattern holds, you have to wonder about what the team's medical group is doing.

At some point in time, there's going to have to be a serious discussion about the well-being of players and how medical care works in the NFL. Whether it is concussions, painkillers, or this bizarre moral quandary that doctors are placed in between team management and players. Something has got to change soon. Players are people too, and despite the current ethos, they're not disposable either.