Presidential Address: Change and challenge

30^th Annual Scientific Sessions of the Society for Vascular Medicine: McLean, VA, USA

May 30, 2019

Colleagues and friends, it is hard to believe that just short of a year has passed since I stood before you in Chicago to deliver my first Presidential address. I spoke about my journey within the Society for Vascular Medicine (SVM) over the past 15 years and the familial connection I (like so many of you) have with this organization. I referred to our SVM Scientific Sessions as our annual homecoming – a chance to reconnect with those who have trained us, those we have trained, and so many of the friends we have made along the way. ¹

I’m not sure about you, but for me, the meeting in Chicago feels like it was a lifetime ago. It has been a highly eventful year since then; a year of unexpected events and major changes, not only within my own personal and professional life but also within our Society.

For me, it’s also been a year of intense reflection and self-assessment. Since I stood before you last year, my father, Leonard Gornik, died somewhat suddenly after an 8-month battle with an aggressive form of multiple myeloma. My dad taught me the value of a strong work ethic and commitment, as well as a self-deprecating sense of humor. He was the hardest working person I’ve ever known. He made it through a stem cell transplant and asked, ‘When can I go back to work?’ at every follow-up visit. His job wasn’t glamorous (he worked and managed the deli counter of a grocery store for 46 years), but it gave him additional purpose outside of his love of family, and he enjoyed connecting with people (employees or customers) every day and making their lives a little better if he could, even in the smallest of ways.

In addition to the death of my dad, during the past year I made a tough decision to leave my job, with its comfortable and familiar routine of 13 years and a group of beloved colleagues, to start a new chapter of my professional life.

I’ve crossed town to a new institution and have enjoyed building programs and collaborating with others (including SVM leaders and good friends Drs Terri Carman and Mehdi Shishehbor) to grow the presence of vascular medicine across a very large and diverse health system. I’ve begun again with a new team, new facilities, new house staff and culture, new EMR (don’t get me started), new vascular lab criteria … the list goes on and on. There are days when I struggle and ask myself ‘what were you thinking?’, but overall, the transition has been one of the most rewarding things I’ve done in years. I’ve had to rethink how I do things … and why I do them … decide what practices are most important to carry forward and what behaviors, born out of routine or convenience rather than purpose, I should have abandoned long ago.

During this year of major change, I’ve realized that change provides an opportunity to hold tight to the things that matter most – be it a physical memento, a cherished memory, or a fundamental value.

Concurrent with the changes in my own life, our Society and our specialty have encountered a number of changes and challenges as well. Since we met last year, we had an unexpected and somewhat abrupt turnover of our administrative leadership. As a result of this, our Executive Committee and Trustees spent much of the past 8 months rolling up our sleeves and diving deep into the most basic functions of our Society – fundraising, maintaining our membership, and the logistics of meeting planning. I am pleased to report that our organization seems to have weathered this particular storm. We welcomed a new Executive Director to our team last fall, Ms Julie Webb, who brings with her extensive experience in organizational governance and fundraising.

During this period of transition, we also realized that we need to increase administrative capacity to support the activities, ideas, and projects of our committees and members. Our portfolio of activities has grown significantly over the past decade – we now run two separate live educational meetings per year (these Scientific Sessions and the highly successful Fellows Course) in addition to publishing our journal Vascular Medicine six times per year and producing three vascular disease toolkits, developing online and print educational products, managing our website and social media platforms, and even conducting a salary and compensation survey. To support these and future programs, we have welcomed a new member to our administrative team, Mr Michael Hagedorn. Michael will work with Julie, our Trustees, and committee chairs as a project manager to translate our ideas into action items, and most importantly, into results and tangible new products that bring more value to your SVM membership.

Through the hard work of so many in this room, our assets have grown year upon year since 2011, and this has allowed us to diversify the scope of our organization’s activities and also think about building a durable foundation for our future. We will be working with our Kellen team during the months to come to maximize our administrative capacity and Societal productivity, and I can think of no one better than our former Treasurer and now incoming president Dr Raghu Kolluri to lead that effort. I would like to take a moment to thank our Kellen team: Julie Webb, Annie Cox, Justin Dreyfuss, Kim Santos, Tonya Cabrera, and Greg Schultz for their collaboration with SVM over the past 2 years and to welcome Michael Hagedorn. Together we have accomplished a lot, and I know we can do even more.

What are the other challenges that our Society faces? Without question, the slow progress to achieve formal recognition of vascular medicine as a subspecialty stands at the top of the list. Just a few hours ago, Dr Jay Bishop, leader of our vibrant Taskforce on Vascular Medicine Practice, gave our membership a preview of our Society’s first ever salary and compensation survey. The survey demonstrated the diversity of our clinical practices and the viability of vascular medicine practice as a professionally and financially rewarding career path. A copy of the survey results will be made available to our members later this summer, so I want to take a moment to highlight a few of the findings.

When asked about the greatest challenges in our field, by far the most common themes were related to the need for increased awareness of our specialty among patients and providers, and recognition of vascular medicine by the American Board of Medical Specialties (ABMS). Similarly, when asked how SVM can further support you and your career goals, ABMS subspecialty recognition was the number one theme, again followed by efforts to increase subspecialty awareness.

For those of you at the front lines of vascular medicine practice, and especially those of you who have come to vascular medicine from an internal medicine pathway, this is not at all surprising. Almost every other month during my Presidency, I have heard from one of you about the challenges you have faced locally to have your services and your practice recognized for the high level of subspecialty care you provide. Just a few months ago, I received an e-mail and a forwarded letter from a highly respected member of our Society – a vascular medicine specialist who has presented at national meetings and international congresses, and has dozens of peer-reviewed publications to her name. She is an internal medicine specialist and diplomat of the American Board of Vascular Medicine (ABVM). She has added credentials in vascular laboratory testing and interpretation and wound care, but despite all of these accolades, she needed to assemble a small mountain of paperwork to demonstrate her qualifications to maintain credentials and have her work reimbursed by an insurance plan.

Please know your Society hears you loud and clear. We need to fix this. Though a number of our leaders have worked tirelessly over the past decade to achieve ABMS recognition of vascular medicine as a subspecialty, especially our Past President, Dr Josh Beckman, and former Trustee, Dr Suman Wasan, we have not achieved this goal. There are many reasons for this – both practical and political – and the road to achieve recognition will be a long one, but our leadership recognizes that achieving this goal is the most important objective we can work toward in the next few years.

During the past year, SVM has closely partnered the ABVM to explore opportunities to pursue recognition of our subspecialty and our training programs. As a result of this partnership, ABVM and SVM co-hosted a strategic planning summit on April 3 at Kellen/SVM Headquarters in Oakbrook, Illinois. ² Attendees included the majority of SVM Past Presidents and current senior leaders, ABVM senior leadership, and early and mid-career SVM members with diverse training pathways to vascular medicine practice. During the meeting, we reviewed past and current efforts to achieve accreditation of vascular medicine fellowship programs and subspecialty recognition. We had a frank collective conversation about our past struggles, slow progress, and potential paths ahead. We reviewed Dr Jeff Olin’s brilliant Presidential address from 2001, which lamented the lack of substantial progress in recognition of our subspecialty over then 50 (now almost 70) years and outlined the debate as to whether to move forward pursuing vascular medicine as a distinct subspecialty of internal medicine or be incorporated within the rubric of cardiovascular medicine. ³ The debate is as timely and relevant in 2019 as it was in 2001, and while we did not come to a final conclusion – and indeed there was equipoise among attendees as to the next steps – it was clear to all that we need to work together to try to get over the subspecialty finish line in the years to come. As ABVM and SVM leadership continue to discuss the next steps, which may include seeking outside consultation on the best pathway ahead, this meeting has strengthened the partnership of our organizations to work together and pool resources to achieve recognition of our subspecialty.

In addition to our partnership with ABVM, I am pleased to report that SVM is collaborating with the American College of Cardiology in the development of an advanced training statement in vascular medicine. As we revisit the definition of what constitutes adequate training in our subspecialty in 2019, I am comforted by the fact that leadership of the document falls to two trusted SVM members: founder and Past President, Dr Mark Creager and former Trustee, Dr Naomi Hamburg. I know Mark and Naomi will seek broad input and respectfully weigh all perspectives as they lead the development of what will be a critical document in our field. I also hope that this document will inspire the development of new training programs in vascular medicine.

Beyond our lack of subspecialty recognition, we have other major challenges to face. Although our Society’s activities are more diverse and robust than ever, our membership has been flat. Is this a manifestation of global frustration with our lack of subspecialty recognition? Perhaps in part, but I do not think this is the whole story.

I think our lack of growth also reflects a shifting interest away from peripheral vascular disease among cardiovascular medicine and interventional cardiology specialists. With transcatheter aortic valve replacement (TAVR) and mitral clips capturing the imagination of cardiology fellows and early career faculty nationwide, there seems to be less interest in vascular medicine. As a result of this trend, the ABVM is struggling with declining demand for its examinations.

According to data provided by Dr Bruce Gray, the ABVM gave its lowest number of examinations by far in 2018 (only 42 total examinations). This very concerning trend threatens the long-term survival of this most-important organization, and all members of SVM need to do everything in our power to reverse this. I have learned from Bruce that the organization must administer at least 100 examinations per year to remain viable; last year’s totals were less than half of that number. We need to find unique ways to engage young physicians, internists, and cardiology fellows alike in seeing the potential of our field and the value of vascular medicine training. And, we need to make sure that all of those we train sit for the ABVM examinations.

A final challenge we must tackle head-on is our own complacency. We have come far as an organization in the past 30 years, and there is much to celebrate. Beginning with this initial gathering of our founders in 1989, our Society has had an amazing journey. According to Dr Mark Creager in his Founder’s Lecture from 2 years ago, ⁴ ‘Those of us who met in Anaheim, California, in March 1989, only dared to hope that the Society would blossom into this nationally and, indeed, internationally, acclaimed organization that so profoundly impacts the care of patients with vascular diseases’. Indeed, SVM has come very far and is doing quite well. We are solvent financially and our membership has certainly grown since this initial group of 13. Our programming is diverse, and we generally have a seat at the table of national vascular organizations for guideline development and policy discussions. We may not have subspecialty recognition, but we have a functional examination board, the ABVM. Things are not perfect … but they are good enough.

But good enough won’t carry us through the next 30 years or take us to the promised land of subspecialty recognition. In my final act as President, I implore each of you to commit to SVM and engage more than ever before in supporting our Society.

What can you do to help? Make an active effort to recruit others to join SVM or make a financial donation to our 30 for 30 campaign, funds from which will be used to support novel strategies for membership growth in 2020. As of last night, we have raised more than two-thirds of our goal, but we need your help to achieve our target and allow us to fully invest in our future.

Each of us needs to make support of the ABVM a top priority. A strong ABVM is the foundation of all future efforts to gain recognition of our training programs and ultimately our subspecialty. This seems intuitive, yet only a minority of us have actually gone through the effort of recertification. Though I recognize the negative connotations that have been associated with recertification in the past, we need to get beyond this and embrace ABVM recertification as a way to demonstrate our ongoing support of this vital institution. If it’s been 10 or more years since your initial ABVM exam, it’s time to sign up! Don’t do it because it’s mandatory (which it’s not) … do it because you care about our field and want to support its advancement.

I speak now to our youngest members and our SVM Next Generation Committee. You have impressed me with your ideas and your enthusiasm, and I now call upon you to further engage and translate your ideas into action. You are the future of our Society, and we need the full commitment of each of you … this is your SVM as much as it is mine or that of our founders.

As I wrap up, I would like to thank all of our members and Trustees for allowing me this 2-year adventure. I’d particularly like to thank Drs Jerry Bartholomew, Raghu Kolluri, Herb Aronow, and Ido Weinberg for 2 years of hard work, innumerable evening teleconferences, and frank and honest discussions. At the business meeting this morning, I passed our new SVM gavel to my friend, Dr Raghu Kolluri, who I know will find creative new ways to help us progress beyond our current challenges. And while I will no longer be your President, please know that supporting our Society, our specialty, and all of those who practice vascular medicine, will always be a top priority for me. In the decades to come, no matter where I go, who signs my paycheck, or how I continue to evolve, my commitment to SVM will persist. To Raghu, Herb, and all SVM Presidents that follow (SVM #NextGen, I mean you!), please know you can call on me, always and at any time, to support our great Society.