Abstract
Introduction
Despite the presence of the significant burden of vascular diseases in the United States, diagnosis and treatment of these disorders remain suboptimal. 1 This is exacerbated by an inadequate number of practicing vascular medicine specialists, driven by a small number of formal training programs, lack of Accreditation Council for Graduate Medical Education (ACGME) accreditation and American Board of Internal Medicine (ABIM) certification. 2 Top priorities of the Society for Vascular Medicine (SVM) include increasing the number of vascular medicine fellowship programs and formalizing recognition of vascular medicine as a specialty. The Marketing and Communications Committee plays an integral role in carrying out the priorities of SVM. In this issue of SVM Communications, members of the Marketing and Communications Committee discuss, from different perspectives, how we can increase awareness of vascular medicine.
A trainee’s perspective
Nichole Brunton, DO
It was the beginning of my second year of residency when I first heard about ‘vascular medicine’ as a unique subspecialty. A guest lecturer spoke at our community-based hospital, and to be perfectly honest, I thought the moderator had misspoken. But the speaker, a graduate from my program, kindly listed her email on her closing slide with an offer to answer any questions; I had many. She is still answering them today as my teacher and valued mentor during my vascular medicine fellowship.
I wonder what would have happened had I not attended that lecture; it was the only one from a Vascular Medicine specialist in my 7 years of training (medical school and residency). Even after completing away rotations and considering the specialty for my future – online search for salary, hours, etc. – produced scarce results at best. Google informed me that I could make either $50,000 or $2.6 million, work from home, or even be a surgeon. Ultimately, it was my mentors that I leaned into for guidance. No doubt, great strides have been taken to bring the vascular medicine specialty to its current standing. I realize there is more work to be done if it is to grow.
Firstly, though the mosaicism of the specialty is one of its great strengths, it also limits the understanding of the specialty to those outside of it. To promote awareness, we must engage others with a united message. We must answer the question collectively, ‘What does a vascular medicine trained physician do?’. Though we (as a Society) intrinsically understand that vascular medicine covers a panoply of diseases impacting the blood vessels, this is not as evident to those outside the specialty who have compartmentalized these pathologies to either vascular surgery, cardiology, hematology, or primary care. Defining our specialty clearly enables other practitioners to be aware of the niche that vascular medicine can serve.
Clearly defining our specialty also helps to unify the training experience, ensuring that each fellow graduating is equally equipped to care for the broad and diverse patient population that vascular medicine spans. Though each program works to ensure certification of trainees using the American Board of Vascular Medicine exam, training exposure to ultrasound skills, vascular laboratory, and inpatient and outpatient experiences varies substantially between fellowships. After training, transparent insight into job opportunities, including hours, call responsibilities, and compensation is also needed. Without this information, our trainees are limited in advocating for competitive positions and being compensated equitably.
Lastly, one of the largest barriers is the same that I experienced – a lack of familiarity with the subspecialty in community centers. It could be postulated that the lack of the subspecialty is due to the lack of need; but after working a year as a hospitalist, I can attest the need in our communities is urgent. This need will presumably continue to grow with the increasing strain placed on our current medical system. The presence of a vascular medicine service provides a much-needed safety net for a vulnerable and, often times, complex patient population. Our collective voice must reach the level of currently practicing clinicians and, simultaneously, the level of trainees.
This can be achieved through many facets from a growing social media presence, networking at conferences, and providing educational resources to our existing communities. However, perhaps the most impactful measure is to bring education directly to our colleagues through lectures both in-person and virtually. Providing information about the intricacies of our specialty through interesting cases, question and answer sessions, etc., equips other practitioners but also sparks curiosity and creates value to our subspecialty. As I move forward in my career, I recognize the significance this grassroot action can have on medical communities. It was my mentor’s extra time, taken to educate others, which proved to be a truly career-changing moment for me.
An interventional radiologist’s perspective
Roger Tomihama, MD
Vascular medicine epitomizes the mantra of multidisciplinary care. With input from vascular medicine, cardiology, vascular surgery, and interventional radiology, there is great potential for merging these areas of expertise and catapulting vascular medicine care to the highest levels. Multidisciplinary collaboration and knowledge sharing is key to providing the best comprehensive care to our patients.
As an academic interventional radiologist, I have 18+ years of experience in clinical medicine, biomedical research, graduate medical education, and professional organizations. However, even with my experience, I recognized the need for interventional radiologists to learn more about vascular medicine and to join the Society for Vascular Medicine. We see these interdisciplinary interactions with vascular medicine on a daily basis. For example, as interventional radiologists, we treat many complex venous thromboembolism cases daily. Whether it be related to pulmonary embolism treatment or iliocaval deep venous thrombectomy, we are constantly being challenged by determining the optimal postprocedural long-term anticoagulation management regime for these complex patients. We are constantly consulting our hospital’s vascular medicine experts to help provide guidance on the best course of management. Thus, it was important for me to expand my knowledge and understanding of vascular medicine.
It is key for me to keep current with the latest updates in vascular medicine to ensure the optimal level of care for my patients. My long-term goal in the Society is to partner with the experts in the field of vascular medicine to help foster high-quality research initiatives which can benefit the fields of both vascular medicine and interventional radiology.
A vascular medicine specialist’s perspective
Stanislav Henkin, MD, MPH, FSVM
It is no secret that there are not enough vascular medicine specialists; however, at times, vascular medicine itself feels like a secret specialty. As previously mentioned, vascular medicine topics are rarely taught in medical school, residency, or fellowship. I was lucky to stumble upon the field of vascular medicine in medical school and then again in residency, but what would have happened if I attended a medical school or residency that did not have vascular medicine specialists?
Understanding the need to diversify the workforce, the American College of Cardiology is now focusing on medical students with dedicated mentorship, academic exposure, professional development, and support networks. 3 Given a significantly smaller number of vascular medicine specialists, we need to focus on increasing awareness from a grassroots perspective. For trainees, including medical students, residents, and fellows, we can present important curriculum topics, such as diagnosis and management of peripheral artery disease or venous thromboembolism. This is also a great avenue to introduce vascular medicine as a specialty and offer mentorship or a clinical rotation. As important is the introduction of vascular medicine to other practitioners, including internal medicine, family medicine, hematology, rheumatology, nephrology, interventional radiology, etc. Such conversations are a great way to foster cross-specialty collaboration, both in clinical medicine and research. By increasing awareness of vascular medicine as a specialty through different avenues, we can garner more attention about the need for more vascular medicine practitioners, the importance of dedicated vascular medicine fellowship programs, and the importance of specialty recognition.
To help explain and promote vascular medicine, SVM has developed a slide deck, “
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
