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NIL

Physicians under pressure in name, image and likeness era

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7 months ago

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Physicians under pressure in name, image and likeness era

June 09, 2025

9 min read

Key takeaways:

  • Name, image and likeness policies have professionalized amateur athletics.
  • Physicians have concerns regarding the risks that both themselves and their patients may encounter.

The ruling of the United States Supreme Court in National Collegiate Athletic Association v. Alston, 2021, paved the way for collegiate athletes to monetize their name, image and likeness.

Since then, the professionalization of amateur athletics has evolved rapidly, with name, image and likeness (NIL) policies expanding to apply to high school athletes in states where it has been legalized. However, many physicians fear the rapid, unregulated growth of NIL may put physicians and amateur athletes at risk.

OT0325Anderson_Graphic_01_WEB
Source: Hunter Firment
Eric McCarty

Eric McCarty

“If done the right way, NIL can be very good,” Eric McCarty, MD, chief of sports medicine and shoulder surgery at the University of Colorado School of Medicine and head team physician at the University of Colorado, told Healio. “But right now, it is out of hand and continues to take turns and courses that put a lot of entities and people in an uncomfortable position.”

New considerations

When treating an athlete with NIL opportunities, Robin V. West, MD, president of the Inova MSK Service Line and team physician for the Washington Nationals, said there are new considerations for both the athlete and the physician.

Robin V. West

Robin V. West

“As a surgeon, the shift is that these athletes are viewing their bodies from more than just the medical or injured aspect but looking at them as business assets,” West, a Healio | Orthopedics Today Editorial Board Member, said.

Because of that shift, Brian D. Anderson, JD, partner and global head of the sports industry team at the international law firm Sheppard Mullin, said physicians need to recognize that high school or collegiate athletes with NIL opportunities should be treated like professional athletes.

Brian D. Anderson

Brian D. Anderson

“It does not change the underlying diagnosis and medical advice, but it is more about appreciating the stakes and the pressures that are involved,” Anderson told Healio.

The addition of high school athletics to the NIL landscape poses its own set of unique challenges, according to West.

“This is a different kind of liability because now they have these high school athletes who potentially could earn $8 million a year,” West told Healio. “But if they tear their ACL their senior year and you reconstruct it and they do not get back to play, then all of a sudden are you then bound to that $8 million a year that he potentially could have made?”

Anderson also said high school or collegiate athletes with NIL opportunities may have NIL representatives, agents, accountants and parents involved in their careers and wanting a say in the decision-making process. To navigate the pressures that external stakeholders may place on athletes, Anderson recommends athletes have adequate legal representation and emphasized the importance of involving family, guardians and loved ones to help look out for the best interested of the young athlete and provide crucial support.

“I would recommend having a lawyer and a trusted advisor to help navigate [NIL] issues,” Anderson said. “There are a lot of intermediaries involved that may not have [the athlete’s] best interests in mind. At the high school level, most of these athletes are not legally allowed to sign a binding contract. The parents need to be involved and sign the contract as well to make sure it is enforceable.”

Mental demands

In addition to the physical demands athletes may already experience from performing on the field, NIL has introduced an increased mental burden as well, according to Alex B. Diamond, DO, MPH, FAAP, FAMSSM, professor of orthopedic surgery, pediatrics and neurological surgery at Vanderbilt University Medical Center and team physician for Vanderbilt University.

Alex B. Diamond

Alex B. Diamond

“It is that dual threat of they are just regular people like the rest of us, and they go through the same things we do, but they also have this entirely separate world that is complex and intense and public that can affect their health and well-being,” Diamond told Healio. “NIL only acts to amplify all of those things.”

He said student athletes from disadvantaged backgrounds may even become “breadwinners” for their families in the NIL era, which can pose additional pressure to provide at such a young age.

The sense of a student athlete’s self-worth may also be tested by the pressures of NIL contracts and opportunities, according to Peter J. Millett, MD, MSc, orthopedic surgeon and partner at The Steadman Clinic in Colorado. Because athletes may associate self-worth with performance, he told Healio an athlete may begin questioning their self-worth after an injury that may prevent them from playing.

Peter J. Millett

Peter J. Millett

“Sometimes there is a level of grief that sets in, an imposter syndrome type situation where they start to feel like maybe they were not as good as they thought they were, or they did not reach their potential because of this injury,” Millett, a Healio | Orthopedics Today Editorial Board Member, said.

Transfer portal

Increased use of the NCAA transfer portal — a compliance tool used to manage the student-athlete transfer process — has also created challenges in the NIL landscape. According to McCarty, the transfer of student athletes can happen quickly and sometimes there is a lack of communication on where they transferred.

But just because a player may leave an institution, that does not mean they leave the physician’s care, according to Diamond.

“They are always still your patient, whether you are actively treating them or passing them along to a friend or partner or colleague,” Diamond said. “You have to do the right thing regardless of whatever emotions may be there from a school team perspective. We are part of that team, but first and foremost we are providers for that patient.”

McCarty said physicians want to be able to adequately care for student athletes transferring into their institution, as well.

“If we have an athlete coming in, we also want to take care of that athlete if they are having surgery or treatment for an injury,” McCarty said. “We want to make sure that they are taken care of when they come in and get all the records.”

However, with no national shared electronic medical record database for student athletes, physicians may not have all of the documents needed and may need to rely on the athletic trainers and administrative staff to obtain medical records from previous institutions, according to McCarty.

Private equity

As NIL contracts continue to increase in value, private equity firms may start to dip their toes in the NIL pool, which may lead to some positive outcomes, such as providing more money to the athletic program, according to Anderson, who represents teams, leagues, sponsors and investors in the sports industry. He said private equity firms can also provide “expertise in professionalizing organizations that have typically been departments within nonprofit academic institutions.”

“I am sure there are efficiency gains that a smart private equity fund would be able to find and optimize,” Anderson said. “In terms of maximizing media rights and revenue generation and bringing in expertise in commercializing the stadiums and the venues, it could be a good thing.”

However, Millett said the entrance of another external stakeholder would only further increase the risk and liability placed on physicians as there may be “significant legal ramifications for poor outcomes.”

“The medical responsibility gets heightened, and if there are increased financial incentives, you can argue if there is a bad outcome that there are bigger lost earnings. It creates a situation that can be challenging,” Millett said.

Advocacy

According to Diamond, the advanced professionalization of youth sports is a major concern, as children should participate in sports to learn the game, build fundamentals and learn about fitness and exercise.

“We are throwing those aside when we start bringing in this concept of social media likes and presence, and contracts and money,” Diamond said. “We are eroding that base of what makes sports so special at a young age.”

With the added pressures and money surrounding student athletes, Diamond said it is important that physicians advocate for their patients and provide them with an outlet for education and trust in the NIL era.

“That is where we can be effective, providing them that support and safe place,” he said. “We are an independent group that certainly care about their success on the field or court, but our only responsibility is their health and wellness. We can be a safe place for them to raise those concerns and questions with us, and we can hopefully help them navigate this new space.”

West said specialty societies can also play an important role in advocating for both physicians and athletes in the NIL landscape.

“We do not have the legal backing, but we can go and explain the surgeon’s role. We can help to identify that, define it and advocate for the surgeons, which ultimately we are advocating for our patients,” West said. “We can stay involved by understanding [NIL], by educating ourselves on the latest and greatest of what is going on with NIL and then also representing our members.”

Advice

As the NIL landscape continues to develop, Diamond said the hope is it “becomes more straightforward.”

“We see [NIL] being the Wild West right now,” Diamond said. “The hope is that the larger systems and governing bodies will start working together to provide guardrails and guidance to help with this because the structure helps the families and the kids.”

Regardless of the structure NIL takes as it evolves, Diamond said it is important to recognize that it is not going away, and physicians will need to be involved with the student athlete beyond their injury.

“We have to understand that these [injuries] affect their overall health and well-being,” Diamond said. “We need to be better about recognizing and referring to where they need to be. This is a time where we have to work as a collaborative unit. It is not just the physicians and athletic trainers, but our sports psychologists, mental health professionals and academic partners. It is using that whole network as available to the students and trying to connect them to the right people sooner rather than later.”

According to Millett, it is also important for physicians to overcommunicate with the patient and their team, and to continue to lean on their medical expertise and judgement.

“Do not get caught up in all the noise of the media or the press or the pressure from the team,” Millett said. “If the patient is ready to return to play, you can clear them. If they are not ready to return to play or it is unsafe for them, you do not clear them. If they need surgery, you recommend surgery. If surgery is optional, you tell them it is optional, and then you do a shared decision-making process to help figure out what the best solution is.”

Surgeons should also remain educated on the latest developments in NIL and participate in policy formation and advocacy of both physicians and athletes, according to West.

“The most important thing is staying athlete-centered,” West said. “As this commercialization of sports continues to grow, how do we stay true to our focus and our mission?”

Although the appropriate care of student athletes should be one of the top priorities of physicians, McCarty said it is also important for physicians to protect themselves in the face of financial risk and liability.

“It is important that the physicians make sure they have the appropriate malpractice insurance for the reason that these athletes, because they now have a value attached to them when they are in this NIL, may also have people or agents or attorneys now looking at that value in case they get hurt and cannot return,” McCarty said. “Unfortunately, that is becoming more common, and we need to make sure that physicians and any providers are protected as we do the right thing for these athletes.”

References:

For more information:

Brian D. Anderson, JD, can be reached at banderson@sheppardmullin.com.

Alex B. Diamond, DO, MPH, FAAP, FAMSSM, can be reached at alex.b.diamond@vumc.org.

Eric McCarty, MD, can be reached at eric.mccarty@cuanschutz.edu.

Peter J. Millett, MD, MSc, can be reached at drmillett@thesteadmanclinic.com.

Robin V. West, MD, can be reached at robin.west@inova.org.


Sources/Disclosures

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Source:

Healio Interviews

Disclosures:
Millett reports receiving stock options from VuMedi. Anderson, Diamond, McCarty and West report no relevant financial disclosures.

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NIL

Missouri DE Damon Wilson II sues Georgia, setting up landmark player vs. school NIL legal battle

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13 minutes ago

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December 23, 2025

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Former Georgia defensive end Damon Wilson II has sued the school’s athletic association, escalating one of the messiest player-school disputes of the NIL and transfer portal era.

In a 42-page complaint filed Tuesday morning in Boone County, Mo., Wilson’s attorneys allege a civil conspiracy involving the Bulldogs and Georgia’s collective to try to “penalize Wilson for his decision to transfer.” The suit alleges that they interfered with his ability to enter the portal and lied about his NIL buyout. The former five-star recruit spent this season at Missouri.

The move is a counter to Georgia earlier seeking to go to arbitration to get $390,000 from Wilson, alleging damages after the player signed an agreement to return to Athens for his junior season before entering the transfer portal a month later.

It’s also believed to be the first time a player and school have taken each other to court over an NIL dispute. The resolution could hinge on Wilson’s argument that the NIL agreement with Georgia’s collective was a binding contract.

“Georgia appears intent on making an example of someone, they just picked the wrong person,” said Jeff Jensen, one of Wilson’s attorneys. “Damon never had a contract with them. I don’t see how Georgia thinks intimidation and litigation will help their recruitment efforts — maybe players could bring lawyers with them to practice.”

“As this matter involves pending litigation, we will have no additional comment at this time and refer you to our previous statement,” University of Georgia Athletic Association spokesman Steven Drummond said.

The backstory

Wilson appeared in 26 games at Georgia from 2023 to ‘24 and was expected to be a significant contributor this season when he signed an NIL agreement last December with Georgia’s Classic City Collective. The terms sheet called for him to receive $30,000 per month from December 2024 through January 2026.

A month after signing the deal, he transferred to Missouri, where he led the Tigers with nine sacks. Because the agreement was contingent upon his staying at Georgia, the collective ended the deal.

In October, the UGAAA filed an application to compel arbitration in Athens-Clarke County, Ga. It alleged Wilson owed $390,000 — the unpaid amount on the deal — in liquidated damages, as spelled out in the terms sheet.

What Wilson’s suit argues

The suit alleges Georgia staffers falsely told multiple unnamed Power 4 programs that Wilson would owe the Bulldogs $1.2 million if he left. That action was “an effort to prevent (other schools) from offering Wilson an NIL agreement, thereby impeding his ability to obtain an NIL agreement from a competing program that was the product of free and open competition for his athletic services and NIL licensing rights.”

It also contends the Bulldogs didn’t immediately put his name in the portal but instead launched an “all-out offensive” to try to keep him at Georgia. Those acts were part of what the suit called a “civil conspiracy” to interfere with Wilson’s business endeavors by the suit’s defendants: UGA’s athletic association, the collective and its two now-former CEOs, Matt Hibbs and Tanner Potts.

The suit also includes a count of interfering with Wilson’s business opportunities and accuses UGA’s athletic association of violating the confidentiality provision of the terms sheet by sharing its contents, including through a public court filing.

Much of the complaint addresses the NIL deal itself. The suit said Wilson and several other teammates were simply told by a Bulldogs employee to go upstairs at the football building to sign the agreement during preparations for the College Football Playoff. Wilson’s filing argues the deal is not enforceable because it says its terms would “be used to create a legally binding document.” That document was not created. The filing also notes that the terms sheet encouraged Wilson to “seek legal counsel” before finalizing a full agreement. If Wilson’s reading is correct, he would not owe the $390,000 the Bulldogs claim he does.

Finally, the suit includes a count of defamation over a line from a Bulldogs spokesperson about expecting athletes to honor commitments. The statement, the complaint said, implies that Wilson was dishonest, which hurts his reputation.

Wilson lost out on endorsement opportunities and NIL revenue and suffered emotional and mental distress caused by the Bulldogs’ false claims, his attorneys allege. He’s seeking a “fair and reasonable amount of damages” for the “financial and reputational harm he has suffered” along with legal fees.

Why this case is important

Georgia’s filing against Wilson this fall was the first known instance of a school taking a current/former player to court over an NIL buyout. And this complaint appears to be the first time a player has sued a school regarding an NIL deal.

The closest comparison is one-time Florida signee Jaden Rashada’s pending lawsuit over a $13.85 million dispute. But he filed that against three individuals involved (including now-former Florida coach Billy Napier) and a booster’s private company; the Gators have not been named as a party in the case.

As the player compensation space evolves in the first year of direct revenue sharing between schools and athletes, disputes will continue to arise. Whether contracts are binding is, to some degree, an open question and affects whether players can essentially act as free agents every year. This case is one of the first, best looks into how the issue might be resolved.



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Former Tennessee QB Nico Iamaleava returning to UCLA for second season

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1 hour ago

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December 23, 2025

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Updated Dec. 22, 2025, 10:57 p.m. ET





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Four takeaways from the first weekend of the College Football Playoff

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2 hours ago

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December 23, 2025

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Dec. 23, 2025, 5:35 a.m. ET

If you watched any part of Ole Miss’ 41-10 blowout of Tulane, the one common theme you felt was that the absence of former head coach Lane “Benedict” Kiffin was not acknowledged by the home fans; they even appeared to embrace it. It took a while for Rebel Nation to realize it but Kiffin simply was never “one of them” and, while he built the program, he did not measure up to the “Ole Miss family.” Most Rebel fans would probably tell you now they’d rather lose without him than win with him. Kiffin has now been fully exposed and St. Nick (Saban, now known as Mr. Hypocrite) and Pete Carroll, his self-proclaimed advisers, should be ashamed for their comments supporting the manner in which he tried to negotiate his way to both coaching one team and recruiting for another simultaneously. One is the GOAT who ran away from NIL and the transfer portal while the other is a recognized cheater by many. The best part is Kiffin’s LSU Tigers play at Mississippi next year. Good riddance!



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The Year Schools Paid Their Players

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December 23, 2025

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The Year Schools Paid Their Players


































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Kenny Dillingham-Michigan saga proves college football about money

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December 23, 2025

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Dec. 23, 2025, 6:07 a.m. ET





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No. 1 college football team predicted to sign $2.1 million transfer QB

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5 hours ago

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December 23, 2025

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As Indiana prepares to host its first-ever College Football Playoff game as the No. 1 seed, the Hoosiers are quietly already planning for 2026.

Fernando Mendoza, a redshirt junior transfer who led the Hoosiers to a 13-0 regular season, won the 2025 Heisman Trophy after throwing 2,980 yards and a national-best 33 passing TDs and is widely seen as an early NFL first-round prospect.

Should Mendoza depart for the draft, Indiana would be tasked with replacing an elite, NFL-caliber starter, which explains why numerous quarterbacks expected to enter the transfer portal have been linked to the Hoosiers.

On a December 20 episode of “Hoosiers Football Tailgate,” host Coach Griff specifically named TCU quarterback Josh Hoover, who announced he will enter the transfer portal and skip the Alamo Bowl, as a name Indiana should watch.

“I like this guy as a definite target for Indiana,” Griff said. “So, Josh Hoover, keep an eye on him as a potential target… The one I think they’ll really try to get is Hoover.” 

TCU Horned Frogs quarterback Josh Hoover.

TCU Horned Frogs quarterback Josh Hoover (10) comes off the field during the game between the Horned Frogs and the Bearcats | Jerome Miron-Imagn Images

Hoover was a three-star recruit out of Rockwall-Heath (Texas) and initially committed to Indiana in 2021 before flipping to TCU after the school extended an offer. 

He then redshirted in 2022 and became the starter in 2023, producing breakout numbers in 2024 with 3,949 passing yards, 27 passing touchdowns, and 11 interceptions with a 66.5% completion rate.

In 2025, Hoover threw for 3,472 yards and 29 TDs, with 13 INTs, and projects among the most productive returning QBs in 2026 on career totals of 9,629 passing yards, 80 total TDs, and a career passer rating of 147.8.

On3’s NIL valuations list also shows Hoover ranking among the most marketable college quarterbacks, with a valuation in the neighborhood of $2.1 million.

Hoover is an intriguing option for Indiana due to his proven production and Power Five experience, positioning him as a potential one-year, plug-and-play solution as Curt Cignetti prioritizes continuity.

There is also a “full-circle” aspect to his recruitment, as Hoover originally committed to Indiana before flipping to TCU in 2021.

Read More at College Football HQ

  • Major college football program loses 15 players to transfer portal

  • College Football Playoff team has ‘significant interest’ in 4,000-yard QB

  • College football quarterback enters transfer portal after 4,000-yard season

  • No. 1 ranked transfer portal player predicted to join College Football Playoff team



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