July 2020

Career Support

Esports Medicine and the Appalachian Trail: Finding the Less Trodden Path to Your Dream Job

Lindsey Migliore, DOLindsey Migliore, DO
PGY4, Medstar Health/Georgetown-National Rehabilitation Hospital PM&R Program



In 2020, how often are you alone with your thoughts?

Truly alone. Free from colleagues, roommates, loved ones. Away from your laptop, that Netflix show you’ve been binging for a week, and not touching your phone. What’s the longest time you’ve been truly alone with your thoughts in the past year? That level of introspection is a privilege that underpaid and overworked residents are not often privy to.

Try it. What you find inside your head might surprise you, and change your life.

Why did I go to medical school?

I’m not talking about the flowery statements of selflessness that peppered your personal statement, or the tales of medical marvels you witnessed as a child that were so carefully crafted for your residency interviews. I’m talking about the real reason you said, “Yes, I want to spend the next eight years of my life—while my peers are getting paid, buying houses, living their 20s out like I never will—buried in textbooks and in a chronic state of vitamin D deprivation.”

My reason? My 8th grade teacher, who I adored and admired, said that she respected physicians.

That is why I went to medical school.

After I got there, a base level of panic set in as I tried to fit the square of my passions into the circle of specialties that didn’t make sense to me. As an osteopath and an athlete, physiatry made the most sense. Prevention and education. Nonsurgical management. These were all things that I could get on board with. But something still felt off.

So, the day after medical school graduation, I packed a bag and took off down the Appalachian Trail. When I came out two months later, my path was finally clear.

It was during that time, completely alone, that I had the privilege to truly think about my passions and how they could align with my skill sets.

Esports medicine.

Over 211 million Americans reportedly play video games. Professional video gaming, known as esports, grossed over $1.1 billion in revenue in 2019. By 2021, viewership is set to eclipse that of every other professional sport other than the National Football League.[1] Gaming has evolved far beyond a casual hobby, and serves as a legitimate path to higher education and viable career options. Colleges now offer scholarships based on video gaming prowess and prize pools from weekend tournaments can range upwards of $30 million in a single weekend. Remaining competitive in this lucrative field often requires 8-12 hours of training a day, with complicated hand movements toppling 600 individual movements per minute.[2]

This lifestyle places the population at risk for a specific set of illnesses and disorders, ranging from musculoskeletal complaints like extensor carpi ulnaris tendonitis and DeQuervain’s tenosynovitis, to carpal tunnel syndrome, computer vision syndrome, and much more. In a recent study, over 70% of college esports athletes reported hand pain from gaming, yet only 2% sought medical attention.[3]

Preventable musculoskeletal injuries that can be managed with non-operative treatment—If that isn’t the bread and butter of PM&R, I don’t know what is.

The esports medicine field is still in its infancy. Good data is lacking, and healthcare professionals with actual hands-on training are few and far between. The supply is negligible, yet the demand is insurmountable.

At the end of 2019, I withdrew from the sports medicine match because I had figured out exactly what I wanted to do with my physiatric training. With the end of the academic year rapidly approaching, soon some of us won’t be residents anymore. Others will be applying for fellowships, selecting jobs, and planning audition rotations.

We have been struggling for so long to get to this point. The end of residency can come as a relief. But the end of residency is also the start of a 30-year career. So before you start a new journey, take some time for introspection. Think back to why you originally went to medical school.  Think about your passions. Think about what is going to motivate you to get up and go to work for the rest of your adult life. If that level of critical thinking changes your plans, or makes you question your decisions, good. Now is the time to find your dream job, and if that doesn’t exist, create it.

We are way too smart to settle for anything less.



  1. Statista. eSports audience size worldwide from 2012 to 2022, by type of viewers (in millions) https://www.statista.com/statistics/490480/global-esports-audience-size-viewer-type/ Accessed October 30,2019.
  2. NBC News. How fast is fast? Some pro gamers make 10 moves per second. https://www.nbcnews.com/technolog/how-fast-fast-some-pro-gamers-make-10-moves-second-8C11422946 Accessed October 30, 2019.
  3. DiFrancisco-Donoghue J, Balentine J, Schmidt G, et al Managing the health of the eSport athlete: an integrated health management model BMJ Open Sport & Exercise Medicine 2019;5:e000467. doi: 10.1136/bmjsem-2018-000467