A group of prominent medical organizations says it’s growing concerned about what they consider to be a threat to medical care for top-level athletes: increasing liability risks for doctors as salaries for those athletes rise.

The American Orthopaedic Society for Sports Medicine (AOSSM), along with 27 co-signers, distributed an open letter recently saying that “recent and ongoing litigation may have an enormous negative impact on the medical care of competitive and elite athletes.”

The letter comes on the heels of several significant legal cases, including one where former NFL player Chris Maragos was awarded $43.5 million by a Philadelphia jury after accusing his surgeon and the group that oversaw his rehabilitation of malpractice for their decisions related to a meniscal tear. He contended in court that the case cost him at least $8.7 million in future NFL earnings, but was awarded five times that in damages.

Dr. Mark Miller, the AOSSM president, told ESPN the reason and timing for the statement is simple.

“If not now, when?” he said. “We want to raise public awareness that this issue affects the care of all people we take care of. Our ability to serve all of our patients from the playground to the professional level is at risk.”

As salaries have risen for professional athletes, and as college and even some high school athletes have secured big-money Name Image Likeness deals, the liability for future earnings has increased significantly, the group wrote. That could keep some of the nation’s top doctors and surgeons away from treating high-level athletes of all ages.

Dr. Scott Rodeo, the head team physician for the New York Giants, told ESPN potential liability concerns may impact the availability of qualified sports medicine experts for athletes.

“Recent cases may be the tip of the iceberg,” Rodeo said, “and some physicians may decide the visibility associated with caring for athletes may not be worth the liability risk anymore.”

Dr. Robin West, the lead team physician for the Washington Nationals, said she was concerned that younger doctors considering specializing in sports medicine may be deterred by the elevated risk of treating high-price athletes.

“It may lead to young physicians opting to choose a different path entirely because the liability and the risks in sports medicine aren’t worth it,” she said.

And it may not only be physicians deciding to step away from caring for elite athletes that potentially shrinks the provider pool. As risk rises, obtaining malpractice coverage through insurance companies is also more difficult.

“A prominent orthopedic surgeon who takes care of professional athletes has already indicated that his insurance will no longer allow him to take care of this population because of this very issue,” Miller said.

“Subspecialists must work together to fight the unnecessarily high legal risk of practicing sports medicine and the damage that it will do to the profession and the medical care of athletes,” the AOSSM wrote in its statement.

The group is also calling for a higher standard for expert testimony in malpractice legal cases involving injured athletes.

“It’s a level of expertise that requires additional training, additional skills and it takes a tremendous commitment,” said Miller. “In cases that do go to trial, there should be expert testimony that’s on an equal level. That didn’t happen in some of these cases.”

“A concerted effort is needed to preserve the future of the sports medicine field,” the organization wrote, “and in cases where expert testimony is required, this testimony should come from a qualified medical physician expert.”

Sourced from ESPN