Abstract
The greatest strength of the Society for Vascular Medicine is its diverse and talented membership. In the Society ‘blue pages’ in the months to come, the membership committee will shine the spotlight on some of our active SVM members, learn about their career path to vascular medicine and our society, and the nature of their vascular medicine practice.
Career path and practice
Maria Teresa B Abola, MD, FPCP, FPCC, FACC, FSVM
Head, Division of Education
Department of Education, Training and Research
Philippine Heart Center
Associate Clinical Professor of Medicine
University of the Philippines College of Medicine
Member (Fellow) of SVM since: 1996
Email:
Tell us about your pathway to vascular medicine
I was in my second year of cardiology training at the Philippine Heart Center when I became interested in peripheral artery disease (PAD) when I witnessed patients requiring surgical revascularization take a backseat to patients requiring coronary bypass surgery. I wondered why PAD patients were managed by the cardiac surgical service alone and why the cardiology service was only consulted when the patients were in need of perioperative evaluation.
It was around this time when I came across the article in the Annals of Internal Medicine in 1990 entitled ‘The Time has come for Vascular Medicine’ authored by Drs Cooke and Dzau, which inspired me to explore this new field of vascular medicine. I applied to six of the training programs listed at the end of the article and eventually landed the opportunity to be one of four fellows at the Cleveland Clinic Foundation (CCF) in 1994 with Dr Jess Young as the Vascular Medicine Department Chair and Dr Jeff Olin as my training program director.
Right after training, I went back to the Philippines and started a training program at the Philippine Heart Center (PHC) patterned after the CCF program. It was a cardiovascular surgeon, Dr Florimond Garcia, who then headed the vascular laboratory and vascular service at PHC, and Dr Fatima Collado, a cardiologist, both pioneers in the field of peripheral vascular diseases, who supported my efforts to introduce the field of vascular medicine to the Philippines. Since then, the vascular medicine and vascular surgery services have worked very closely and co-managed patients with vascular disorders, facilitating prompt diagnosis and treatment. Later, I was also involved in establishing the vascular medicine training program at The Medical City.
Tell us about your current vascular medicine practice
My vascular medicine practice currently consists of the medical management of patients with various kinds of vascular disorders, performance and/or interpretation of vascular ultrasound procedures, research work, and teaching cardiology training fellows and medical students.
I have chaired the Section of Vascular Medicine in several medical centers like the PHC, The Medical City, and the Chinese General Hospital Heart Institute, and head several vascular ultrasound laboratories in Metro Manila. I also give vascular medicine lectures to undergraduate students at the College of Medicine of the University of the Philippines, cardiology trainees, and at medical conventions.
I have been heavily involved with the Philippine Society of Vascular Medicine (PSVM), which was established in 2002, and became its third president. PSVM works closely with the Philippine Heart Association (PHA) through its Council on Stroke and Peripheral Vascular Disease, co-sponsoring collaborative national research projects like national surveys on PAD and chronic venous disorders. We have hosted joint scientific meetings with the World Congress of Echocardiography, Vascular Ultrasound and Allied Techniques, Asian Pacific Society of Atherosclerosis and Vascular Diseases, and the International Society of Thrombosis and Hemostasis.
Why did you join the SVM?
I joined the SVM as a Fellow in June 1996 because this was the leading organization that primarily promoted the growth of vascular medicine as a bonafide specialty, held academic meetings that provided updates on advances in the field, and addressed clinical issues in the diagnosis and management of patients with vascular disorders. Moreover, it is a venue where I could keep in touch with my mentors, friends and colleagues. I also took the vascular medicine certifying board exam and became a Diplomate of the American Board of Vascular Medicine. The SVM continues to inspire me to continue to promote vascular medicine in my country. Vascular medicine is one of the more sought-after cardiology subspecialty training programs. We have been working toward having the Philippine College of Physicians (PCP) recognize vascular medicine as a field of internal medicine and have been working for the PSVM to be recognized as a component society of the PCP.
Achieving the goals by changing the direction
Pavel J Levy, MD, FAHA, FSVM
Head, Vascular Medicine Program
Department of Vascular and Endovascular Surgery
Heart and Vascular Center
Professor, Wake Forest University School of Medicine
Member (Fellow) of SVM since: 1995
Email:
Tell us about your pathway to vascular medicine
In my later years in medical school in Israel, I was ‘nailed’ on vascular care in general, and vascular surgery in particular. In the early 1980s, the latter was the only obvious path to achieve my goal of becoming a vascular specialist. To ‘get there’, I completed 7-year general surgery training, with multiple rotations in a small department of vascular surgery at Hadassah. My early clinical experiences and academic curiosity revealed insufficient and truncated medical care of vasculopaths with severe (end-stage) peripheral artery disease, and a paucity of data on how to optimize their care, which was frequently limited to surgical care. Hematologists were ‘in control’ of venous diseases and thrombosis, and nephrologists were ‘good with hypertension’. At that time, I had never heard of vascular medicine, or angiology. Only after coming to the United States in the early 1990s for advanced training in vascular surgery, did I start looking for additional (medical) training in non-cardiac vascular diseases, and was ready to take a hiatus in my surgical career, hoping to make a difference and become a ‘better’ academic vascular surgeon. Training sites in vascular medicine were scarce; the SVM was still in its infancy; and a vascular surgeon seeking vascular medicine training was unheard of!
Who had a great influence on your career?
This question has an easy answer. Drs Jess Young and Jeff Olin rose to the challenge of interviewing, and later training, a surgeon. I spent a total of 5½ years at the Cleveland Clinic (‘the Mecca’), which included both research and intensive clinical fellowships in vascular medicine. Drs Jerry Bartholomew and Kandice Kottke-Marchant were very instrumental in building my expertise in thrombosis and its complications. These formative years at the Clinic completed my long walk to vascular medicine. But this was just the beginning … .
Tell us about your current vascular medicine practice
No more surgeries, or interventions – just pure vascular medicine. ‘Are you sure?’, ‘where?’, ‘how come?’, ‘who cares?’ – just to mention a few questions frequently asked, and challenges faced. My past experience and training lead me to vascular medicine; my vascular surgery colleagues at Wake Forest understood my role and unique contribution, and readily shared their arterial disease patients. Other surgical specialties (trauma and emergency surgery, orthopedics, neurosurgery, surgical oncology and urology) appreciated the contribution of vascular medicine to the prevention and management of venous thromboembolism and evaluation and management of clotting disorders. Our busy hand surgeons shared patients with small-vessel diseases, or other common occupational/environmental complications. However, my foray into vascular medicine at Wake Forest started with taking charge of the Clinical Hypertension Unit. To succeed with a vascular medicine program, one must develop a solid patient base through patience, resilience, and collegiality; and maintain the highest standards of vascular care. Eventually the patients and my peers have voted!
What are the greatest challenges to vascular medicine practice from your viewpoint? And greatest benefits?
The benefits are obvious – making a difference in vascular care at Wake, and enjoying growing regional recognition, which has resulted in continuous expansion of the referral base and true professional and academic satisfaction. The multiple challenges, however, remain. We need to continue to spread the word about our evolving specialty, eventually gaining full recognition, which will assist in the recruitment of younger clinicians willing ‘to cross the bridge’ from their bases in internal medicine, cardiology, hematology, and, even … vascular surgery. Financial compensation reflecting the added value and the uniqueness of vascular medicine must be appropriately established and should facilitate the recruitment of vascular specialists and the vascular medicine faculty. The academic institutions must facilitate the development of vascular medicine programs and put them in charge of clinical activities, education and training, and clinical and translational research. Every additional vascular specialist, faculty, or SVM member counts!