May 30, 2003
Under The Knife
A Visit with Dr. Tim Kremchek
There is no other hospital I have ever seen that includes its Astroturf infield in the tour. Hidden away just off the Interstate in northern Cincinnati, I was invited to go into, what for me was essentially the mouth of the beast. Swerving through the new construction of a suburban office park, almost anonymous from the outside, Beacon Orthopaedic Clinic beckoned me to come inside, to let my guard down, and to face the man I'd criticized in print more than any other. It was the equivalent of Rush Limbaugh being invited into the Clinton White House. It was Doug Pappas being invited to a Selig family picnic.
In my years as an injury analyst, there was no name that had come up more than Ken Griffey Jr.. When speaking of Griffey, there was no way to avoid involving Dr. Tim Kremchek in the discussion. Like many, my opinion of Kremchek had descended from joking derision. My views were colored by incidents which, from the outside, supported my views. More recently though, Reds Assistant General Manager Brad Kullman convinced me to keep an open mind, that I might be wrong about Kremchek. I decided to try and find out for myself.
Kremchek's background was typical, yet just a half-step from normal. Like many doctors, Kremchek was the son of a doctor. In this case, his father was also an orthopaedist. He grew up in Cincinnati a fan of the Reds and a dreamer that someday he would be out on Crosley Field like his heroes. Instead, he ended up following the path his father had blazed, attending medical school and training under surgical star James Andrews as a fellow at Andrews' Birmingham medical mecca. Even at this early stage, Kremchek's baseball dreams had not been extinguished, but merely redirected.
By 1994, Kremchek wasn't on the field, but he was a Cincinnati Red, being named the team physician. It was almost immediately apparent from the outside that Kremchek wasn't a typical team doctor. He happily accepted the nickname of "Doc Hollywood" from team captain Barry Larkin, a player he both idolized who would soon become a frequent visitor to his office. Where other doctors are even more unrecognizable and are seen as frequently as an assistant trainer, Kremchek seemed to revel in the public spotlight. His pre-game reports on injuries became a fan favorite, while inspiring some bitterness--or perhaps jealousy--from others within the medical community. "Tim's radio spot is just another way for him to look at himself in the mirror," said one team physician.
As I entered Beacon on a grey and windy morning with my friend and radio co-host Scott McCauley, I quickly became unsure if I was in a hospital or the Hall of Fame. Pictures were being hung on the wall in anticipation of the hospital's official grand opening, and there was enough memorabilia around to stock a good-sized museum. A trophy case was filled with not just Reds balls and jerseys but also from high schools, colleges, Olympic gymnasts, and inexplicably, Luciano Pavarotti. (I didn't ask and frankly don't want to know.)
While Dr. Kremchek completed a meeting with his staff, we were given a tour of the facility. Beyond the waiting room, covered in yet more Reds pictures, was a full physical therapy center with room to take up to 20 patients at its various stations. Every modality from ultrasound to massage was set up; the equipment was not only brand-new, but state-of-the-art. A chiropractor was on site and had his own space, something of an oddity in the closed-minded sports medicine world. A major feature was the ability to do imaging on site. The facility sports two MRI machines as well as X-ray and ultrasound imaging. While expensive, the time savings and patient comfort make this setup worthwhile.
"A player--or anyone--can come in with an injury and never have to leave the facility," Kremchek later explained. "The setup is for the players, of course, but works well for everyone. For a player, we can bring him in from the airport and get him in the backdoor. Examination, imaging, even surgery can all be done without having to wait, without leaving, or if it was what we wanted to do, without anyone knowing that player was here."
The setup also works well for non-athletes, he said. "The frustrating part of the process is waiting," Kremchek said, "or getting sent from place to place. If it can all be done in one place, most people are going to feel better about that."
The medical facility is built around two state-of-the-art surgical theaters. The operating area is filled with the latest gear such as Stryker Vision, and includes seats and communication with a small, non-scrubbed area where team officials, family, or even agents can observe surgery and make decisions as needed during a procedure. "We can make decisions on the fly. If we go in on someone and find something more--or maybe less--than what we expected, I can consult without scrubbing out."
It's an interesting image in this era of HIPAA-prompted medical secrecy to think of a Jim Bowden or Scott Boras sitting just 10 feet away from a player undergoing Tommy John surgery or an ACL reconstruction. There are bracing, therapy, and examination areas which also are seamlessly integrated to make any surgery or consultation as smooth and painless as possible. Kremchek's facility also has all the modern paperless records and computer technology, as well as "23-hour beds" where patients can recover from procedures while avoiding a full hospital stay when possible.
Besides the integration of all the facilities, which is becoming less and less uncommon as facilities modernize, there is still a part of the facility that, to my knowledge, is truly unique. As the door swings open from an ultra-modern medical facility, the antiseptic white of medicine gives way to cinder block and Astroturf. Entering the Champions Baseball Academy, we were confronted first with two pitching mounds. It was readily apparent that besides the location, these were not common mounds. Camera gear is built into the walls to take high-speed images of pitchers, and video screens are available just feet away for immediate instruction. Another door away are batting cages, again with cameras and a video setup that makes most major-league setups pale in comparison. Finally, the crown jewel of the facility is a full Astroturf infield where players can run, field, and even hit--just not fly balls--making this a completely integrated facility for all baseball activities.
Adding in instructors like former major leaguers Tom Browning and Bill Doran prove that this is a world-class facility. Designed for major leaguers, the facility also offers instruction for amateurs however. As we toured the facility, a teeming mass of eight-year-olds took infield drills under the watchful eye of instructors.
Returning to the clinic portion of the facility, Scott and I were led into the "VIP Suite." I sat on a leather sofa and gazed at more signed pictures--names like Larkin and Griffey were expected, but a Ted Williams-signed photo caught my eye. It was clear that this room was designed expressly to impress. Any person with only a basic knowledge of baseball would know that this room, this doctor, was important and therefore, must be good.
The door opened in just a few minutes and Tim Kremchek entered the room, greeting me tentatively. There was no white coat, but instead a Beacon logo polo. If you didn't know who he was, he still absorbed the sense of value imparted by the room, yet remained somewhere between casual and aloof. He knew that I had been one of his vocal critics and I knew that this meeting could turn hostile quickly. I was impressed with his facility and let him know, while he discussed some of my work and research. Pleasantries aside, we were still feeling each other out. His ease with media was evident--he wanted to talk about his work, about "his players" and about his new facility. The conversation quickly turned to his mentor, Jim Andrews.
"A lot of my success is based on the work and the teaching of Jim," he told me. Kremchek is the only doctor I knew of that would accompany his players to surgery in Birmingham. "We're hoping that at some point, we can take less athletes to [Alabama]. Jim's not going to do surgery forever and we're starting to see some of the consulting type opportunities that he has."
Kremchek was the surgeon for Matt Lawton of the Cleveland Indians, a major shoulder surgery that was closely watched. Lawton specifically selected Kremchek based on trust. "I'm proud that within the game, people know me. There are only a few doctors doing these types of things regularly--Jim Andrews, Lewis Yocum, John Conway, and maybe a couple others. Frank Jobe is obviously a leader in the field as well, but he's not as active as he once was."
I asked Kremchek about his reputation as a spotlight guy, seeking the media, or even the view held by some that he was a control freak that wouldn't allow anyone else to comment on injuries. "It's a misconception that I won't allow anyone to comment," he said. "It came about with the Griffey situation, of course, where a misunderstanding got blown up into a lot of things it wasn't. Jim [Bowden] used a word he didn't really mean--misdiagnosed--and the media played that into some kind of feud. Jim is one of my best friends"--Kremchek would also use the word "friend" to describe Ken Griffey Jr., Barry Larkin, and Bob Boone--"and we never had a problem. It just made more sense for the organization to have one point man to discuss injuries and it makes more sense for that to be the doctor who's responsible for their treatment. I don't mind doing it."
I raised an eyebrow at the last part of that statement. Kremchek noticed. "OK, I like doing it. I'm probably the only doctor that's willing to stand up in front of the media or go on with Marty (Brennaman) to discuss this. I'm also the only doctor you'll see at every game. I haven't missed a game in I don't know how long. Some guys play golf; I go to baseball games. I love it--getting down there and seeing the guys. They know me and they trust me. They know when they get hurt who's going to be there. When Junior dislocated his shoulder, I was there. The media made it sound like 10 minutes is a long time, but if it was you or me and we managed to do that at home, it would take what--an hour to get into the emergency room and get it reduced?"
Dr. Kremchek didn't seem to mind the moniker "Doc Hollywood"--a couple pictures on his wall were inscribed to him that way. One in particular came from Larkin. Kremchek said: "I don't mind the name. I've been called worse." We discussed the perception of some around the league and in the media that he'd gone too far. "I don't think I have. I don't tell Jim (Bowden) or Brad (Kullman) how to do their job. I certainly don't tell (team owner) Mr. (Carl) Lindner what to do. I'm there as a doctor and as an adviser. I'm in the clubhouse. I'm at the games. I'm down at spring training. When we went to Puerto Rico to play the Expos, I was able to juggle my schedule a bit and go down there with them." He laughed. "That wasn't entirely a baseball decision."
I asked Kremchek about the perception that the Reds were injury-prone or worse, that they didn't know how to prevent injuries from occurring. I mentioned the Redbook, MLB's official measure of injuries, and that it hadn't been kind to the Reds. "The perception is mostly caused by one very high-profile injury: Junior. If that had happened when he was in Seattle, they would have had the perception we have. If Barry Bonds or Mike Piazza get hurt, those teams would look bad in the press. We have some older players like Barry who've had some injuries. We've had a lot of young pitchers and I think some of that is luck. We also have brought in a lot of guys to work with Don Gullett who we knew were injury risks. Some of them worked, some of them didn't. But judged out of context, I guess I can see why people have that perception."
It surprised me that Dr. Kremchek spent as much time as he does with the team. "I have to be there all the time. Those guys trust me. They need to know when they get hurt, I'm there. When they're in surgery, it's with me. When they rehab, I'll be there for that. When they're back out on the field helping us win games, I'll be there for that as well."
Several times, Kremchek seemed as if it was him hitting homers or making pitches. It was clear that not only did he feel he was a part of the team's success, he in fact had become a part of the team. I mentioned that it seemed that he was taking on not only the role of team doctor, but also the role traditionally held my the team trainer. "That's fair," he said. "I'm there a lot and the guys know me. We talk more than most players and physicians. I don't think I get in the way of Mark (Mann, the head trainer for the Reds) or any of the others. I think we work as a team. I work closely with Lonnie (Soloff, assistant trainer), especially recently with Junior. It's a medical team. We all have our jobs to do. I don't tell Mark or Lonnie how to do their jobs, but we all work together to get the result we all need.
"I think Bob (Boone) works the same way with his staff. He listens to all of them, but in the end, the ultimate responsibility falls on him. In the same way, Jim (Bowden) is responsible to Mr. Lindner and we report through him. We're all working for the same thing. We want this team back in the World Series.
"It's an exciting team. Austin (Kearns) and Dunn are becoming everything the team hoped they would and if we can get Barry and Ken where they need to be, this team will have a lot of talent on the field."
After an hour and a half of discussing his practice, his team, and how he saw his role, we thanked Dr. Kremchek for his time and headed down to the Reds new offices. As we drove 20 minutes, it struck both of us that while the perception of Dr. Kremchek as a control freak or media seeker was mostly a problem of perception, the difference in how he performed his function compared to other team physicians was so stark, that it brings up a problem of professional distance. Could Dr. Kremchek do his job properly if it involved telling Barry Larkin--someone he considered a friend and with whom he interacted socially--the hard truth about his declining physical tools? Did his obvious passion for baseball and the Reds in particular act as a strength or weakness?
We were able to talk to Brad Kullman briefly. I admitted to Kullman that my impressions of Kremchek were incorrect. Kremchek is obviously not incompetent, is obviously passionate, and is in a unique position within baseball. It's not out of the question that Kremchek will be, with Lewis Yocum, the pre-eminent consulting surgeon in baseball within a few short years. The facility he has made real from his dreams will be an immense advantage toward that goal and for the Reds going forward. Kullman seemed to enjoy my admission that I was wrong immensely.
I did point out my reservation that Dr. Kremchek seemed perhaps too close to the players. "It's been more an advantage than disadvantage," he said. "It'd only be a disadvantage if the trainers didn't work so well with him and the players didn't trust him. You should talk to them."
Kullman had us taken downstairs to the new training room to talk with Lonnie Soloff. Soloff's physical therapy background has made him one of the top rehab guys in sports medicine, along with Chris Correnti of the Red Sox. As we walked into Lonnie's office--he was completely unaware that I would be coming by and he took time out from working on a player to talk with us--I could see the gorgeous new facilities inside Great American Ballpark. With all the fan-friendly features of new ballparks, it is often the unseen parts that make the most difference. The modernization of training rooms is one of the areas that sees the biggest change. It took me a moment to see just who was working on the inertial machine, but the shoulder work and backwards cap should have been a giveaway.
I asked Soloff what it was like to work with Dr. Kremchek. "He's like a trainer that just happens to have his M.D.," he said. "We don't have to make appointments or wonder if he'll know how the injury happened. He's here. These guys know him and more importantly, they trust him." Soloff shared a couple of anecdotes about working with Dr. Kremchek that told me he wasn't just toeing the party line, he believed it.
As we left the ballpark and walked back to the Volvo for a trip back to Indy, we were able to try and absorb and analyze all that we saw. My impressions of Tim Kremchek were incorrect, colored by a lack of access and the few stories getting out being slanted by professional jealousy or simply not understanding that Kremchek works from a position of near-obsessive passion for the Reds. In the end, what is perhaps his biggest strength--his intense love for the game and for the Reds--might also be his biggest weakness.
Special thanks to the Cincinnati Reds and to the staff at Beacon Orthopaedic.