For months, student-athletes scrambled to get their physical examinations done by a physician because having their health checked so they could be approved to play sports could no longer be done by a nurse practitioner or physician’s assistant.

The reason: a change in IHSAA guidelines in March stating that only a physician licensed to practice in Indiana could sign the form that clears the student for athletic participation. IHSAA commissioner Bobby Cox felt the initial move was necessary in reducing or altogether eliminating the situations where a certified physician with knowledge of a student’s medical history isn’t the one who performs the physical exam.

But the change was not well-received by certain medical groups, and in June, the IHSAA reversed its decision, Cox said.

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Center Grove athletics director Jon Zwitt agrees with the IHSAA’s decision to return to previous policy regarding physical exams.

“I can understand the concern of the IHSAA trying to ensure that there wasn’t a wink and a nod and a stamp. There’s too much at stake, especially the safety and well-being of the student-athlete. On the flip side, in this day and age of litigation and liabilities, there are very few people that will attach a signature to a physical form unless they are absolutely sure that there are no issues,” Zwitt said.

“Most physician’s assistants and nurse practitioners are extremely conscientious, diligent and professional.”

Physical examinations are designed to identify health risk factors prior to athletic participation through a combination of a physical examination of that student-athletes and close review of their medical history, Cox said.

Cox doesn’t like the fact that sports physicals have become big business, shifting the emphasis from the standard of care for young people to money, he said.

The IHSAA takes guidance from the Indiana State Medical Association commission on sports medicine, which Cox served on. When he was a member, nurse practitioners and other groups would make presentations about independently providing physicals, Cox said.

“There are more and more pressures being exerted. There are more and more considerations being made. The argument by the medical side of this is that the doctors are overtaxed and that nurse practitioners and P.A.s can do these types of medical assignments with the same level of proficiency that a doctor can,” Cox said.

“From my perspective, what I want to make sure that people understand we’re not trying to lower the standard of care. But it’s not a battle that the IHSAA’s going to risk getting sued upon, and there were groups out there that were lining up to exert more pressure on this association because there were threats that we were interfering with their commerce.”

So the IHSAA changed back to its former rules in June.

The overall goal of physicals is see if athletes have particular ailments or anomalies, such as asthma or specific allergies, to better prepare for upcoming practices and competitions, said Dave Buchholz, the athletic trainer at Center Grove High School since 2001.

And in recent years, the IHSAA has required the examinations to put a stronger emphasis on heart conditions and concussions, he said.

“Heat illness and sudden cardiac death have become big topics, too, along with the concussion issue,” he said.

At a glance

Under IHSAA rules, between April 1 and a student’s first practice, the student shall have a physical examination or provide a certification from a physician, nurse practitioner or physician assistant to clear the student for athletic participation.

In March, the IHSAA changed the guidelines to require:

• The most current version of the form must be used and may not be altered or modified in any way.

• The form must be signed by a physician only after the medical history is reviewed, the examination performed and the form completed in its entirety.

• No pre-signed or pre-stamped forms will be accepted.

But in June, the IHSAA changed back to the old requirements, which allow physicals to be done by a physician, nurse practitioner or physician assistant.

Mike Beas is a sports writer for the Daily Journal. He can be reached at