Abstract
Welcome to Minneapolis and the 23rd annual scientific session of the Society for Vascular Medicine. I would like to begin by expressing my thanks to Dr Jim Froehlich and the members of the program committee for their ardent efforts in creating an outstanding program. You will learn a lot. I also hope you take time to mingle, see old friends, make new ones, and seek out ways to participate in the Society. We are our own work force and our future.
I had always hoped that when I became President of SVM, I would receive a small volume filled with the secrets of leading a society. I had hoped that each President had accumulated some wisdom that would be added to this book to provide a bit more of the hidden secrets required to advance the mission of the Society while ensuring its future. Well, after the meeting last year, I found out there was no book, no secret guide, and the sum total of past wisdom was passed on from Thom Rooke with a warning: ‘Don’t screw it up’.
This past year has put into focus for me that we have all been participating in two intertwined, but separate histories: the growth and development of the field of vascular medicine and the role of SVM in that process. Since SVM’s founding, I can see the progress of our specialty over the last 23 years, the inexorable march towards medical community recognition, the increasing detection and interest in vascular diseases, and improvements in care for the 25 million patients in the United States with vascular disease. At the same time, every year has been marked by discussions of our difficulties for our society. These past few years have been particularly trying, with the changes in the economy at large, changes in the role of medical societies in the medical community, and changes in the relationship between medicine and industry. Indeed, SVM is a constant work in progress, one that must respond to the current conditions we face, modifying its methods to surmount the current challenges as we continue to try and advance the cause of our field.
To make sure that we were on the right track for the long-term goals of our society, I wanted to go through our history and intuit its fundamental goals. Unfortunately, I quickly realized that outside of Mark Creager’s brain, there really isn’t a definitive history of the Society. So, I did something no other living human has attempted: I read all the published past Presidential Addresses. In my opinion, they represent an ongoing conversation with the SVM and the vascular medicine community that can stand in as guideposts for our future. One thing quickly became clear: SVM has strived to achieve relevance and equality for vascular medicine among the medical community, despite the ebb and flow of events in and out of society.
The first SVM Presidential Address published in our journal was delivered by Dr Jeffrey Olin in 2001. Dr Olin’s address was dedicated to exploring why there wasn’t a critical mass of physicians with expertise in vascular diseases. He noted three reasons that limited the potential of our field: the lack of subspecialty boards, the lack of funds for training, and the incorporation of vascular medicine programs into cardiovascular divisions and departments.
In 2002, Jonathan Halperin bragged about the influence of our members, our interactions with the many organizations that participate in vascular disease care, our efforts in advocacy, and the creation for training guidelines in vascular medicine. He noted the increasing interest by governmental agencies in SVMB and he pushed for continued efforts along the lines of Dr Olin to broaden our specialty and secure its place. In 2003, Dr Halperin reported that the Board commissioned a formal manpower study as a prelude to expanding training opportunities through support from philanthropic and industry sources. From Dr Halperin’s second address, I take my battle cry, ‘We are the Society for Vascular Medicine and Biology – the one and only society for vascular medicine’.
Over the next 2 years, Dr Michael Jaff made clear that great strides were being made for vascular medicine: SVM was participating in every important consensus, guideline, and training document, SVM members were taking lead roles in collaboration with other societies and accrediting organizations, and SVM authored two monograph series. Yet, despite these advances, the Society itself was having trouble: membership was static or shrinking, board certification seemed nearly impossible, and the number of trainees in vascular medicine was small and not growing. To address these issues and advance the Society’s goals, under Dr Jaff’s tenure the American Board of Vascular Medicine was created to develop a certification in vascular medicine to ensure the expertise of those who call themselves specialists and to demonstrate to the community where expertise lies. This nascent step was a giant leap forward in understanding our manpower, linking SVM to quality, and beginning the process of seeking certification. And yet, at the time of his second address, Dr Jaff worried about the state of medicine and about the state of SVM, he continued the previous laments about the lack of membership, the turf battles in vascular disease, and the limitations in training.
Dr John Cooke reported the effect of the new board exam on the Society: more members, ample fundraising, increased submissions to our journal and the expansion of the recognition of vascular medicine. It was a heady time. During his second year, we saw the beginning of the NHLBI-funded training programs in vascular medicine, the changing of our name to Society for Vascular Medicine, and the changing composition of our membership, yet he also bemoaned the inadequate manpower available for vascular disease and the ongoing need for more trainees and training programs.
For the 2009 address, our outlook was commensurate with the national mood: the skies were darkening. Dr Michael Bacharach warned us of the problems of overlap in expertise and competition among the specialties hindering the care of our patients. He suggested a common set of training and a single specialty society to focus diminished resources as an answer to our manpower problems and a method to avoid turf battles. Most recently, Thom Rooke has warned about the perils of conflict of interest, the change in the relationship of both medicine and industry, and the peril that societies face because of their dependence on industry money. Dr Rooke made some suggestions which seemed radical last year: increasing dues, selling educational materials and meetings, limiting expenditures.
In reading the Presidential Addresses of the last decade, two themes become clear: our field has moved forward as our society has hung on by its fingernails, buffeted by the swirling forces in medicine and the world at large. Like my predecessors, I am happy to report that we have been moving the field forward – vascular medicine has been cemented as a necessary player in vascular disease; we are at every table in setting the care for patients with vascular disease. We are requested to join accrediting organizations, writing groups, and provide expert commentary for Centers for Medicare and Medicaid Services (CMS). The National Institutes of Health (NIH) seeks our input into research priorities. We continue to actively engage in the pursuit of certification. We are the compass that sets the middle path in care of the patient with vascular disease. We are recognized as neutral in the interventional battles, a partner to all, a friend to be sought, and reasonable to deal with.
Despite our recognition, participation, and engagement at a national level, our society has fallen prey to severe secular trends in the relationship between industry and professional societies. Surviving on helicopter money drops for meetings, or, shall I refer to them by their proper name – educational grants – is no longer a viable method of survival as this money is going away. Several factors explain these changes: fewer new medications, greater expense in getting medications to market, the realization that funding major meetings may not be the best way to communicate new information, the stricter firewalls erected in the goal of avoiding conflict of interest, and the movement towards unbiased, electronic application methods for grants that diminish the value of personal relationships, each make it harder to acquire the resources to subsist this way. Moreover, medical education is undergoing a revolution. The advent of CME at your desk, whether from the journals you receive or the webinars available on-line make traveling to a meeting seem like a quaint notion. Why lose time from work when I can get so much of what I want to know at home? The great recession has only sped up this transition. In lean times, both companies and health-care personnel must be ruthless in their business decisions. As bottom lines are tested, budgets for ‘donations’ without much clear reimbursement besides goodwill decreased. We are not alone in this problem. Other small societies are having difficulty making ends meet, considering mergers with interventional societies with access to device manufacturers, and scaling back significantly on their activities. Every large society has suffered decreased attendance at its meeting over the last few years. Because we are a society dependent on our single meeting to provide funding, despite the fact that the specialty is finding its wings, the Society teeters.
The future has caught up to us far faster than any of us could have imagined. However, hope should not be lost. It is only in the throes of an existential battle, when maximal pressure is applied, that we will find that we will crystalize like a diamond and not crumble like coal. The Board of Trustees has been working through these issues over the last year and had a strategic planning session yesterday to understand where we are and where we need to go. This transitional period will be challenging. It will require greater efforts by those dedicated to our specialty and to SVM, our home. It will also require, as Dr Rooke made clear, more money from us and some streamlining in our administration. These steps will be needed to ensure that SVM exists and can continue to advocate for vascular medicine.
SVM has several natural advantages. First, we are thought of as a fair arbiter. In the interventional and surgical care of patients, where competition creates an environment of discord, we are sought as an honest broker. Second, we are needed as there is no replacement should we leave the scene. There is no one else with our repository of expertise promulgating the structure of care for vascular disease. There is no one better to educate the populace or medical profession. Third, we are tireless and relentless. I was asked by my chairman of medicine why every vascular medicine person is late in turning in assignments like chapters or papers. After a minute of thought, it was obvious. Because we all do so many things for our field that we are all overburdened. We never say no because we know how important the goal, the advance of our specialty, truly is. Indeed, we have become a regular Seal Team 6, ready on a dime to advance the care of our patients, ensure the proper use of therapy, and advocate for better science and its translation. We will succeed because we do not know how to fail. And that is why I feel confident in asking you to do more.
The near term will be filled with difficult interim steps. These steps will also allow us to redirect our efforts to find new methods of funding, less contingent on unrestricted educational grants, where we can provide the necessary education and input into issues vascular while advancing the cause of our specialty. When the tale of medical professional societies is told, we will be held as the exemplar of the survivor and thriver because we will have relied on our most valuable resource: ourselves. I have faith that we will come through because I have faith in the membership of SVM. I ask you now to join me in preserving SVM, our society, our advocate, our home. Please volunteer to help. Working with others in the Society is an excellent tonic to the rigors of the day. The Society is our mechanism to affect medicine at large, the best method of improving our career, and the only place where vascular medicine is the core. I know we can do it, because our predecessors have done it and we will step up to this challenge. With your help, success will be assured.