James Andrews, doctor to the superstars, calls it a career

January 26th, 2024

What the doctor remembers, all these years later, was the devastation in the young man’s voice, the tears in his eyes.

Dr. James Andrews listened as his 25-year-old patient, who had already had one unsuccessful surgery on his pitching shoulder, explained what it would mean to him to get back on the mound. At a time in baseball medicine in which one shoulder injury -- let alone two -- was typically a death knell for a career, Andrews was reluctant to put the pitcher under the knife again. But he ultimately had no choice.

“I said to myself, ‘He can’t play the way he is,’” Andrews says now. “So I thought of what Yogi Berra would say: ‘When you come to the fork in the road, take it.’”

On that day in 1991, the doc cut into the pitcher’s shoulder one more time and performed one of the arthroscopic procedures that have made him renowned in the sports field.

And that’s the story of how Al Leiter, who had been limited by injuries to a grand total of nine innings over three seasons from 1990-92, revived a career in which he would go on to win two World Series, appear on two All-Star rosters and make $68 million.

“I always want to look Dr. Andrews in the eye, square him up and say thank you,” Leiter says. “Without a doubt, his expertise and comfort guided me through. I pitched 13 more years in the big leagues, had some great moments, and, no question about it, that doesn’t happen if not for him.”

In a half-century of service, Andrews resurrected and prolonged the careers of countless athletes in baseball and beyond with his surgical skill and conscientious care.

Now, the 81-year-old Andrews has decided to call an end to his own career.

He will still be deeply involved with the continued growth of Andrews Medicine, which is partnering with healthcare systems, universities and professional sports organizations to bring Andrews’ brand of orthopaedic and sports medicine to communities around the country. He also still has follow-up appointments with the last batch of athletes on whom he operated.

“I didn’t want to leave them behind,” Andrews says in his gentlemanly Louisiana drawl. “I’m trying to take FaceTime and calls to usher them through their full recovery.”

But the days of us hearing about ballplayers visiting Andrews at his clinic in Birmingham, Ala., for first or second opinions wrapped up, as of the start of 2024.

And that gives us occasion to reflect on the profound impact the sports world’s go-to orthopaedic surgeon made.

Andrews was at the forefront of a dramatic evolution in sports medicine that reshaped what is possible in terms of repair and recovery. He logged what we can only estimate to be tens of thousands of procedures, on everyone from Michael Jordan to Troy Aikman to Jack Nicklaus to Hulk Hogan. And his influence on some 650 former fellows is now being felt by the teams, schools and practices they impact across the land.

It would, however, be no stretch to assert that Andrews’ biggest legacy in sports is reserved for baseball. Not just because of the many high-profile players he’s operated on but because of his commitment to trying to reduce the number of players who need those operations in the first place.

Thanks to the non-profit American Sports Medicine Institute (ASMI) that Andrews founded, the industry has gained a greater understanding of the role of biomechanics in reducing injury risk. And Little League Baseball and other youth organizations have adopted pitch count regulations to prevent overuse.

“Your focus on treating and preventing injuries, particularly at the youth level, highlights your passion for helping players throughout baseball,” Commissioner Rob Manfred wrote to Andrews in a congratulatory letter delivered to him Friday at ASMI’s annual Injuries in Baseball Course. “This important work brought increased awareness to issues that directly affect the future vibrancy of our sport.”

Asked what qualities he deems most important in his practice of medicine, Andrews says, “Availability, communication and humility.”

It’s that last one that prevents him from boasting about his abilities and the arguably Hall of Fame-worthy role he’s served in MLB.

But Glenn Fleisig, who was hand-picked by Andrews to serve as research director at ASMI when it opened in 1987 and still serves that role today, offers an analytical opinion on what makes Andrews special, both as a surgeon and as a person.

On the surgical side, Fleisig had the opportunity to witness Andrews’ scalpel in action.

“In an anatomy book, [body parts] all look very clear,” Fleisig says. “In an arthroscopy, it looks like a bunch of pink blobby stuff. In the early days, doctors are sticking the scope in a three-dimensional person and sticking a camera in and looking at a two-dimensional image, a flat image. He has the extraordinary ability to see the flat image and understand the three-dimensional depth of it.”

On the personal side, Fleisig says Andrews did not treat his patients as science problems to tackle but as people with hopes and dreams that must be tended to. Be it a Major Leaguer or a high school kid, Andrews would take the same approach.

“He sits down, puts his hand on their knee and chats with them,” Fleisig says. “He always says the most important diagnosis is not the MRI or the X-ray but the history. Just by sitting down and talking to the person, he can usually figure out what’s wrong without even looking at the image.”

Jeff Bagwell learned this in a memorable and unusual way.

It was January of 2006. Bagwell had missed 115 games the previous season when his shoulder did not respond well to capsular release surgery. Facing a deadline to file an insurance claim on the majority of the $17 million Bagwell was due to make in the upcoming year, the Astros requested that he visit Andrews.

Then came a snag: Andrews suffered a heart attack.

Bagwell still traveled to Birmingham and went through his workout at ASMI. Still, he figured there was no way he’d actually still have his appointment with Andrews.

But then somebody informed Bagwell that the doctor was ready to see him ... in the intensive care unit at St. Vincent’s Hospital, where Andrews was recovering from quadruple bypass surgery.

“'I heard you want to play baseball,'” Bagwell recalls Andrews saying to him. “'Have a seat.'”

So Bagwell sat on the side of the bed, and Andrews, in his hospital gown, stood on the bed and started examining Bagwell’s shoulder.

“OK, Jeff, you really want to play,” Andrews said when he was done. “I don’t think you’re going to be able to, but I appreciate the fact that you want to try.”

It was the rare doctor’s visit in which the patient was in a polo shirt and the doctor was in a hospital gown.

“It was crazy, and I’ll never forget it,” Bagwell says with a laugh. “But I really appreciated that he knew how it important it was and how he took the time to see me.”

And yes, by the way, Andrews was absolutely right about Bagwell’s shoulder. The Hall of Famer never played another game.

Andrews, who recovered from that major health scare to practice for another 18 years, says he was inspired to get into medicine by a neighbor who served as his family practitioner and his team doctor in high school in tiny Homer, La. An SEC-champion pole vaulter at Louisiana State, Andrews gave up his own athletic career to pursue his degree faster after his father, Rheuben, passed away from lung cancer during his sophomore year. Andrews received his medical degree in 1967, completed a residence in orthopaedic medicine at Tulane University in 1972, and went on to complete surgical fellowships at the University of Lyon in France and with sports physician Dr. Jack Hughston in Columbus, Ga., in 1973.

After joining Hughston’s clinic full-time, Andrews began contributing to major advances in arthroscopy in shoulders and elbows. He also traveled to California to learn directly from Dr. Frank Jobe about a new elbow procedure known as Tommy John surgery.

“I watched Dr. Jobe do it, so I started doing it on the east coast,” Andrews says. “My goal was to be the Frank Jobe of the east coast. That’s how I got involved.”

He got involved in baseball in another way, too. In the late 1970s, he was serving as the team physician for the Double-A Columbus (Ga.) Astros -- a role he cherished, as it gave him a valuable learning experience about how baseball players think and perform and the type of injuries they endure. The team was in dire financial straits and was on the verge of being sold and moved, but Andrews did not want to see them go.

“I went down to the bank, borrowed $40,000 and bought the team and kept them in Columbus, Ga.,” he says. “I was down there selling hot dogs and painting the dressing rooms. It was a family situation, really. But we built it up to where we had a good number of people coming to the games.”

When Andrews moved his practice to Birmingham in 1986, he says he sold the team. For a cool $1 million.

“That’s really how I got started in baseball,” he says.

His real breakthrough came in 1985, when a young pitcher named Roger Clemens was dealing with a shoulder injury and questioning the diagnosis he had received from the Red Sox. Clemens’ agent sent him to see Andrews, who wound up performing the minimally invasive arthroscopic procedure that was just beginning to catch on.

Eight months later, Clemens struck out 20 batters in a game.

“That really kicked off the story of baseball players coming down to Columbus, Ga., and then to Birmingham,” Andrews says. “Roger and I were just damn lucky.”

As the Rocket’s star rose, so, too, did that of Andrews.

“I remember the confidence of when this man walked into the room, he was a rock star,” Leiter says. “Every single Major League training room, the waters were parted when he walked in. You knew you were talking to and around greatness.”

When John Smoltz became the first Tommy John recipient to reach the Hall of Fame, he thanked Andrews for performing it prior to the 2000 season.

“Because of Dr. Andrews and his brilliance and the team that had been before him,” Smoltz said, “I had the confidence that the surgery would work and the rest would write its story.”

But if Andrews had his way, his story would include far fewer Tommy Johns. He says the biggest change he’s seen in baseball in his time in the game is the incident of major elbow and shoulder injuries in youth baseball.

“I started following the injury patterns and injury rates in the year 2000,” Andrews says. “Back in those days, I did about eight or nine Tommy Johns per year in high school aged and younger. The large majority of Tommy Johns were at the Major League level, then the Minor League level, then the college level and then just a handful of high school kids.

“In today’s situation, the whole thing is flip-flopped. The largest number is youth baseball. They’ve surpassed what’s being done in the Major Leagues. That’s a terrible situation.”

Andrews says the obsession with velocity and spin at the youth level is having a devastating impact on arms and the game itself.

“These kids are throwing 90 mph their junior year of high school,” he says. “The ligament itself can’t withstand that kind of force. We’ve learned in our research lab that baseball is a developmental sport. The Tommy John ligament matures at about age 26. In high school, the red line where the forces go beyond the tensile properties of the ligament is about 80 mph.”

Andrews has met countless parents who think that if their sons have Tommy John at age 14 or 15, it will improve their chances of reaching the Major Leagues.

“It’s just the opposite, believe me,” he says. “When they get hurt early in their baseball career, they miss a lot of development, and the parents don’t have a clue about how that affects their career and their ability to move up the ladder.”

Andrews knows too well how hard it is to get this message across. He has 12 grandkids, and they’re all involved in sports.

“I’m trying to teach this stuff to my kids, the parents,” he says. “They won’t even listen to me.”

An entire industry would be wise to listen to a man who, in 50 years of compassionate care, made his mark on the game with more than just surgical scars.

“This guy belongs in the damn Hall of Fame,” says Leiter. “I really think so.”