Let’s start with a question: how do we communicate coolness? No, I am not referring to a cool or cold foot in the emergency room in need of assessment for acute limb ischemia. We have validated clinical scales to communicate that information effectively. At the risk of dating myself by invoking the spirit of Arthur Herbert Fonzarelli from Happy Days, what I am talking about is, how do we communicate how cool (i.e., chill, sick, drip, Gucci, hip, trendy) our specialty is to bright young minds contemplating their career choices? Biased as I may be, I think if they really knew how cool vascular surgery is, many more would pursue it as a career. This is obviously important for us to recruit the best people to our field. It is specifically important for the learner in their pursuit to find their best fit, but it is also critically important to address the shortage and maldistribution of vascular providers we currently and will continue to face.
This topic came up during dinner with a recent visiting professor. We were discussing our newly formed group in Tulsa, and I was asked to reflect. I said something like what I appreciate most is that we have assembled a really “cool” group of vascular and podiatric surgeons. What I was referring to in part was the individuals themselves—their personalities, their passion for the field, and their passion for clinical care, education, and research. But I was also reflecting on the fact that we, as a team, complement each other very well in each of those areas, support each other both professionally and personally, address challenges with unified advocacy, and, importantly, have fun working together. No disrespect to Simon Sinek who promotes with “Start with why”… I might offer it is important to “Start with who,” and/or “The who is the why” for a team leader.
During the presentations that day, wellness data were presented to the faculty, trainees and students across the entire campus. As is often the case with this discussion, one slide depicted data from a study on distress and career satisfaction compared amongst surgical specialties, and vascular surgery faired poorly. We were dead last in wanting to pursue surgery as a career for either ourselves if we had to do it over again, or for our children. We were second worst in burnout rates, fifth in screening for depression and sixth in low mental quality of life.
A more recent introspective look by the SVS Wellness Task Force shows that vascular surgeons still have high rates of burnout in part due to advancing age, work-related physical pain, and work-home imbalance that led to higher risk for depression and suicidal ideation. This seems paradoxical to our impression of our specialty’s coolness. To be fair, our group has even contributed to this literature showing job dissatisfaction amongst vascular surgeons influenced by factors including unhealthy work-life balance, insufficient hospital support, hostile hospital culture, discontent with supervision, and unhappiness with career choice leading to early retirement. Although alarming and important, these typical metrics somehow miss the mark in being able to convey just how cool our specialty really is and how we have very cool people working hard to address these more visible statistics.
Do we have data on coolness? Well, if you do a simple internet search on how we define or quantify coolness, you get entries describing Fahrenheit, Celsius, Kelvin, etc., as ways to measure temperature. Then you see a few entries on coolness as defined as “a quality lacking friendliness or enthusiasm,” which, for the sake of this discussion, is the “anti-cool.” If you dig a little deeper, you see that the business world, and especially marketing, understandably grapples with this concept extensively in order to predict the next cool product, company or brand. Research in business suggests that descriptors that define cool include: “authentic,” “inspiring,” “creative,” “attractive,” “edgy,” “rebellious,” “surprising,” “mysterious,” “unique” and “takes risks.” One strategy in the business world is to “let cool find you,” meaning if they create a brand that satisfies these criteria, then millennials or members of Gen Z—who are very bright, savvy, and, importantly, information-focused—will find it and make it cool. We can’t do that in vascular surgery, or at least haven’t been able to until now, because the information available to them, as discussed above, is largely negative and works against our brand.
If you search for what makes a surgical specialty cool, you get little specific or quantifiable information. On one end of the spectrum, you will find opinion pieces which commonly portray surgeons as masochists who endure pain, or as cantankerous, dominant, arrogant, hostile, impersonal, egocentric people who don’t communicate well. If they are fair, you might find that we get some credit for being decisive, well organized, practical and hard-working.
Fortunately, on the other end, you will find some practical information aimed at informing and preparing students for a career in surgery. Some of the business attributes listed above seem relevant to defining cool when it comes to a medical specialty, but we should work to define the specific characteristics that apply to our field. We currently spend a significant amount of time with students during clerkships, sub-internships, vascular surgery interest group (VSIG) meetings, regional and national programs like the Next Generation program at the Vascular and Endovascular Surgery Society (VESS) and the SVS Medical Student and Resident Program, trying to convey the concept of the coolness of vascular surgery. We, or at least I, think we do a pretty good job getting the message across, but better defining what coolness means in our case would help us communicate with the target audience more effectively.
Unfortunately, our ability to convey coolness has been hampered by virtual meetings, virtual interviews, and the inability to interact in person. Several creative adaptations have been developed, including virtual open houses, virtual conferences allowing multi-institutional or even multinational attendance, virtual away rotations, etc., which have enabled us to be somewhat effective. I am not a psychologist, but it seems likely that the sense of coolness of any individual or group is best conveyed and, importantly, best perceived in person. It seems we are making our way back to in-person interaction—VAM 2021 was a success, other regional and national meetings are getting back to in-person or at least hybrid formats, and our visiting professor meeting mentioned above was our first in-person visiting professor in over 18 months—so hopefully these opportunities for direct interaction will re-emerge. More positive data are surfacing in several areas. These include how important vascular surgery is to a healthcare system; data regarding the prevalence of vascular disease in a still aging population; data on disparity of care and the need for outreach to underserved communities; data on projected need for vascular surgeons to provide this outreach; data on salaries of vascular surgeons; and data on how we favorably compare to competitive interventional specialties.
Let’s add to this objective (and subjective) data as to our coolness. Do we need a focused, well-designed qualitative study that specifically asks: “What makes vascular surgery cool?” In the meantime, there is currently a large amount of effort being put forth to promote our specialty, so let’s support the SVS DEI and Wellness committees, the SVS branding efforts, and similar efforts from other vascular societies. And during this interview season, let’s show everyone just how cool we really are.
Peter R. Nelson, MD, is the Mary Louise Todd chair in cardiovascular research and chief of the section of vascular surgery at OU Health in Tulsa, Oklahoma.