Abstract
June 17, 2016 – 9:15 AM
Good morning, and welcome to the Annual Meeting of the Society for Vascular Medicine. I am truly honored to be here today as your 14th president. I am not one of the original members (but pretty close); I have been a member since 1990. We are now entering our 27th year and continuing to prosper.
I must first of all congratulate the Scientific Program Committee and Heather Gornik (president-elect) for organizing such a great program. Heather started shaping this year’s meeting last June (the day after the 26th Annual Meeting was over), and unlike her predecessor (me), did not wait until January or February to get things organized. It is an amazing schedule filled with everything you ever wanted to know about vascular medicine.
In addition to the Annual Meeting, the Scientific Program Committee arranged three satellite symposia – a first for us. We have heard lectures on venous disease co-developed with the American College of Phlebology (ACP). And, there is so much more to come with ‘Vascular Jeopardy’ (a long standing tradition now copied by many other societies), more rapid-fire sessions, debates and workshops, and on Saturday, a vascular ultrasound course. Just looking at this schedule wears me out. This is truly a great meeting for the vascular physician, and I encourage you to stay and enjoy all of it.
I would be remiss if I did not acknowledge a number of individuals who make this meeting possible. Our Kellen Company team deserves special recognition including Annie Cox (administrative director), Kim Santos (meetings manager), Tanya Cabrera (exhibits and registration coordinator), Patricia Sullivan (communications manager), Liz Freyn (vice president of meetings), and of course Lee Ann Clark (executive director of the Society for Vascular Medicine), my right-hand person.
I am also grateful for the many SVM members who volunteer their time and talents to work on committees, present at the Annual Meeting, and help us not only with their presence but also in raising funds for the meeting. Along with the Annual Meeting, we are holding the Fellows Course concurrent with the Scientific Sessions, and this year – for the first time in many years – we are hosting the Board Review Course. Special thanks to the committee chairs and all their efforts. We have asked so many of you to give your time and talents to this year’s meeting. I know we have asked a lot, but you have all come through. Thank you, thank you, and thank you again!
I was asked if I would consider running for the presidency of SVM at a VEINS meeting in Chicago in 2013 by Thom Rooke and Suman Rathbun. We were having a few drinks at the time at Thom’s favorite watering hole. I was deeply honored, but also wondering, like all of you – how would I fit one more item into my already busy schedule. Later that year (at VIVA 2013), Josh Beckman also approached me about the presidency. I told him I would think about it, and asked several of my colleagues for their advice. One piece of advice I remember in particular came from my late partner and good friend, Bill Ruschhaupt. Bill said I was ‘too old’ (a la Ronald Reagan), and ‘what you would want to do that for?’ Of course I took his advice (or not…), and here I am.
This is my first shot at being a president. Oh sure, I have held a number of leadership positions in the past. I was captain of the Safety Patrol in 6th grade, and treasurer of the Student Council my senior year of high school, but I lost out in the election for the presidency. I was vice president of my fraternity, where my main job was to be sure there was plenty of beer at the parties (and that the hall was cleaned up the next day), and I was squad leader of two people during my military career in the Army Veterinary Corp. But, I have never been a president.
I have changed over the past year, as have other presidents. I have had to do a lot of on-the-job learning. Thanks to so many of you members who have helped me and played a role in the success of the Society this past year. I have leaned on many of you and learned as well. Special thanks to our immediate past-president, Jim Froehlich, and our president-elect, and my partner, Heather Gornik.
What is a society?
It is an organization or club formed for a particular purpose or activity. Synonyms include: fellowship, group, alliance, brother or sisterhood, and union. One of the things I have enjoyed about our Society over 26 years of membership is our fellowship. We are a small organization where everyone knows your name. That is what makes us unique in a number of ways. We have time to become acquainted with one another, and perhaps like me, you will come to find that many of your best friends and trusted colleagues are members of our Society.
Our Society was formed with three missions which were outlined last year in our journal, Vascular Medicine, in a piece entitled: The Society for Vascular Medicine: The first quarter century. 1 Our mission is:
To promote and advance the field of vascular medicine (and biology), and to maintain the highest standards of practice, research, education and exchange of scientific information.
To stimulate the formation of fellowship training programs in vascular medicine and research and the teaching of these disciplines to medical schools and house officer training programs.
To provide consultation to educational institutions, government agencies and other such organizations.
These are lofty goals!
I have read all of the available past presidents’ addresses and see many similarities and issues that our society has faced over its 27 years as we move forward with our mission.
Mission 1: Promote and advance the field of vascular medicine
Two great examples of our mission were accomplished this past year and/or will be accomplished later next month.
In July of 2015, many of your SVM members participated in the Medicare Evidence Development and Coverage Advisory Committee or MEDCAC in Baltimore, Maryland. We presented a unified view on the topic ‘Scientific Evidence of Existing Interventions that aim to improve Health Outcomes in the Medicare population,’ and addressed areas where evidence gaps exist related to lower extremity peripheral artery disease (PAD). Fellow SVM members including Mehdi Shishehbor, Michael Jaff, Kenny Rosenfeld, Herb Aronow, Jim Froehlich, Josh Beckman, and myself all spoke representing not only SVM but, in total, seven professional societies. We presented our unified recommendations on the management of asymptomatic, claudicant, and critical limb ischemic patients. This collaboration resulted in a manuscript that was co-published by three different journals including Vascular Medicine, Journal of the American College of Radiology, and Catheterization and Cardiovascular Interventions. 2
Later this summer, the Society will again be represented at MEDCAC by several SVM members including Suman Rathbun, who will introduce issues surrounding chronic venous disease, and Josh Beckman and Greg Piazza, who will speak representing other societies. The goal of these individuals and their respective societies is to work together to send a unified message to the MEDCAC committee on best medicine practices for chronic venous disease.
We also promoted vascular medicine by partnering with or providing consultation to educational institutions, government agencies, and other such organizations throughout the year, a process that has been part of our mission since our founding. Your Society members were present and/or participated at many conferences including but not limited to the ACC, AHA, ACP, SCAI, VIVA, SVS, SVU, ISET, SIR, IAC, Alliance of Wound Care Stakeholders, American Board of Venous and Lymphatic Medicine, and the Canadian Cardiovascular Organization to name a few. I may have missed some, and if so, I apologize to those of you who represented us.
We are sharing our knowledge of vascular medicine and exchanging ideas on the best methods for the treatment of patients with vascular disease with other societies. During this meeting, for example, we have hosted representatives from the American College of Phlebology (ACP), and many of us have supported their meeting as well.
Mission 2: Stimulate the formation of fellowship training programs in vascular medicine and research and the teaching of these disciplines to medical schools and house officer training programs
This is another major component of our mission. Many of our former presidents have commented on the lack of training programs in vascular medicine and the need for more. At last count (of those that I am currently aware of) there are 21 vascular medicine training programs in the continental United States (not counting Cardiology programs). Thank you to Rob Eberhardt for compiling this data. I do not know how many fellows are trained each year, but surely not enough to meet our need to grow our specialty and, more importantly, to meet the needs of our patients.
Several years ago to help address this problem, the NHLBI funded seven training programs in vascular medicine at Stanford, University of Pennsylvania, Northwestern, Wake Forest, Boston University, Mayo Clinic, and Brigham and Women’s Hospital. These programs unfortunately were limited to 5 years of funding, and the program was not renewed.
Why don’t we have more training programs? In part, as a result of a lack of funding for these fellowship programs. We train four fellows every year at Cleveland Clinic; however, due to budget cuts, we have been limited to three positions for the 2016-2017 academic year. Due to some innovative thinking, were able to help finance a fourth fellow for one additional year, but we will be unable to maintain four fellows after 2017 unless we come up with another plan.
Fellows are a small price to pay for the rewards they provide. They stimulate us as we learn along with them. I am sure other institutions face the same challenges we have faced. Some programs such as ours are internal medicine-based, while others are linked to cardiology or a combination of specialties.
Clearly the ‘Fellows’ Course’ is another way to educate more physicians about our specialty. This year marks the Second Annual Fellows’ Course, a program initiated by Raghu Kolluri to spread the word of vascular medicine. There were 37 fellows in attendance last year, and I understand we have 49 to 50 fellows here this year. Please reach out to them – greet and meet them. They are our future.
Special thanks to the hard work of Raghu and Ido Weinberg for their efforts and many of you members who are speaking at the Fellow’s Course. Next year Ido and Mehdi Shishehbor will organize the Fellow’s Course, which will be held separately from our annual meeting.
Board review course
This past year we resumed ownership of the Vascular Medicine Board Review Course. This course prepares doctors for the American Board of Vascular Medicine (ABVM) general and endovascular medicine examinations. This started last fall with conversations with Michael Jaff (representing VIVA). The SVM Executive Committee and Board of Trustees unanimously agreed that this was a great opportunity. Unfortunately, it was not possible to hold the Board Review Course at this year’s meeting due to a lack of hotel space. Therefore, to prevent a nearly 2-year time lapse between offerings of the course, we decided to record the Board Review Course with the help of NORTHSTAR Clinical Communications (a medical education company developing innovative medical education activities). Aditya Sharma, Bruce Gray, Steve Dean and others helped to organize this project and have asked many of you to contribute. Thanks to all of you who have agreed to help on such short notice. This course will be available in the next few months to vascular medicine doctors preparing for their first board examination or for recertification.
We will resume our annual Board Review Course during our 2017 SVM Annual Meeting in New Orleans. We, as a Society, are looking forward to this opportunity to continue to promote vascular medicine. We will be reaching out to many of you to help work on this project, and volunteers are welcome. I believe the Board Review Course is extremely important to our Society and its future. Michael Jaff and Bruce Gray were instrumental in initiating the ABVM over a decade ago, and we will continue its great tradition. There are rumors we may have competition for the Board Review course. Therefore, we as a Society must strive to make the Board Review ‘the best damn board review course in the land.’
Vascular Medicine journal
Another part of our mission is the Society’s journal, Vascular Medicine. The journal was first known as the Journal of Vascular Medicine and Biology, and Victor Dzau was instrumental in its origins. Mark Creager was the next Editor, and during his reign of 18 years, the name was changed to Vascular Medicine. The journal continues to prosper under the watchful eye and leadership of Heather Gornik, who took over as Editor in January of 2014. The journal has a new look and should be recognizable to all of you. I urge you to contribute articles and pass the word on this treasure to your colleagues
Membership
We still have challenges in increasing our numbers. If you look at the graph of our membership, we remain stable but are not growing as much as we would like. I am not sure why this is the case, as the efforts of previous presidents and all of you have revolved around spreading the message of our specialty. We are unique. We are often the ‘go-to’ doctors at our respective institutions because of our training and expertise. It is not uncommon that I hear ‘I do not know what the patient has – send them to vascular medicine.’
Why haven’t we grown more rapidly? In part, it may be because we still do not have ABIM certification despite the heroic efforts by Suman Rathbun, Josh Beckman, and others. They continue to move this effort forward to resolve this issue.
We must continue to grow. How to do this? We all must work with our SVM membership committee to introduce and recruit new members and spread the word.
Mission 3: Provide consultation to educational institutions, government agencies and other such organizations
We are well-respected and recognized as national and international leaders in the field of vascular medicine, as evidenced by so many Societies that have asked to partner with us. Many of you have worked on national committees and guidelines, including ACCF/AHA clinical practice guidelines, TASC, JCAHO, as well as Scientific Statements for the AHA on various vascular topics.
Our annual meeting and membership dues provide most of the funding to run the Society. Over the years, many of you have helped meet our annual budget by using your contacts with industry. Nevertheless, we still struggle to meet our budget for each meeting and thus ensure our continued success. Again this year, due to the efforts of many, we have come through. But as many of my predecessors have stated, we must find other ways to meet our financial needs. Industry monies that might have been plentiful in the past are no longer assured, and competition for these dollars from other Societies has increased.
In response to this, we are partnering with industry to make enduring materials that not only promote our Society’ goals, but also help us financially. These programs also have a positive impact on our patients while promoting vascular medicine.
Examples include a partnership with Janssen Pharmaceutical to establish a website on deep vein thrombosis treatment. Special recognition goes to Geoff Barnes, Jim Froehlich, and Lee Ann Clark for their work on this project. We have also partnered with the University of Michigan (MCORRP) and Bristol Myers Squibb on a shared-decision making tool for anticoagulation in patients with atrial fibrillation.
Josh Beckman, Alan Hirsch, and I are looking ahead to develop similar projects regarding guidelines for the management of patients with PAD, and we will be looking for other members to help us in advancing this project further.
At this year’s meeting, we have arranged three satellite symposia through the generous donations of Janssen, Gore, and Portola. We also have a record number of exhibitors, and I urge you to visit the vendors’ booths, as they are important to our meeting.
What have I learned from my 26 years as a member of the Society?
Our size has changed (from the 13 original members) to close to 500 members, but our mission and focus remains the same. We promote and care for patients with vascular disease, an area that is still underserved.
I have been a ‘SVMer’ for most of my professional career. I remember my first meeting in Rochester, Minnesota and my second meeting in Cleveland, where I presented a patient who had overdosed on rat poison. I also remember a doctor from Philadelphia at that meeting talking about a new device – a Circulator Boot, a compression device (a la the arterial flow pump) on a patient with critical limb ischemia.
I have witnessed tremendous changes in our field over the 28 years I have practiced vascular medicine. We have developed new medications for PAD (antiplatelet agents and statins), as well as amazing interventional procedures that have replaced many open surgical procedures. During my training it was not uncommon to treat a DVT for 12 to 24 or more hours with Urokinase or Streptokinase. Now we have interventions and newer thrombolytic agents that cut the time down. We can now treat an acute PE with t-PA for 2 hours or less. We have suction and fragmentation devices for pulmonary embolism and IVC filters that can be retrieved. There have been great strides in anticoagulation that have advanced the field from heparin and warfarin to the low molecular weight heparins to the anti-Xa agents and the thrombin inhibitors, and still there are more to come.
Chronic venous disease that used to be treated with compression stockings is now attacked with endovenous ablations, ambulatory phlebectomy, or stents that were not available at the beginning of my career. Many of you in our Society have been pioneers in these fields.
My vision
We need to promote and advance our field and maintain our high standards.
We need to grow, and that will come only if we teach more fellows, residents, and medical students, and develop more training programs.
We need to continue to exchange scientific information (as we have done at this meeting).
I urge you to remain and/or get more involved with the Society going forward. Let others know how exciting our field is and what we do.
These are exciting times, as our treatment options allow us to do so much more for our patients. We need you as vascular medicine clinicians to continue to promote our mission objectives.
We are a special, highly talented group of individuals. Truly a Society. We are small but mighty, and we have great chemistry together. I am very proud to represent you going forward.