This year’s E. Stanley Crawford Critical Issues Forum at the 2025 Vascular Annual Meeting (VAM) in New Orleans, from 11:15 a.m.–12:15 p.m., on the Morial Convention Center’s First Floor (Great Hall A) seeks to address some of the structural and economic issues facing vascular surgeons as individuals—and those that challenge the specialty as an entity.
Empowering vascular surgeons all fronts—professional, financial and emotional— while addressing some of the over-arching issues faced by the vascular surgical specialty underpin the aim of this year’s Crawford Forum, SVS President-Elect Keith Calligaro tells VS@VAM ahead of VAM 2025.
Calligaro has a assembled a panel of four leading vascular surgeons to tackle some of the hottest topics of the day that speak to how vascular surgery is structured in hospitals and medical centers, as well as how vascular surgeons are reimbursed and organized.
“Fundamentally, we want to inform our SVS members what they can do to become better positioned with their hospital administrations and compared to other specialties, so that we are in a better position to take care of our patients for ourselves,” says the chief of vascular surgery at Pennsylvania Hospital in Philadelphia, who as the incoming SVS president is responsible for organizing the forum.
First speaker Malachi Sheahan III, MD, chair of surgery at the Louisiana State University Health Sciences Center in New Orleans, is set to address one of the thorniest topics: the issue of heart and vascular centers and vascular surgery’s position within them.
“He is going to ask, ‘Are heart and vascular centers beneficial to vascular surgeons?’, explore issues around the fact that when you combine a heart and a vascular center, most of the finances and effort go to the heart center, not really to the vascular center,” explains Calligaro. “So, his point, and what I think the audience should question is, should hospitals promote a vascular center independent of a heart center, and would that empower vascular surgeons to hopefully get more funding?”
There is also a marketing dimension to the heart and vascular center question, Calligaro says: “You don’t want vascular patients going to a heart and vascular center to be seen by a heart specialist when they should be seen by a vascular specialist.”
Similarly, next at the podium, Faisal Aziz, MD, the chief of vascular surgery at Penn State University in Hershey, Pennsylvania, will contemplate the position of departments of vascular surgery in both academic and community hospital settings, ultimately asking, ‘Are they worth fighting for?’
“There are probably some positives and negatives to having a vascular surgery department as opposed to a division,” Calligaro continues. “A division is part of an overall Department of Surgery, but if you can form your own independent Department of Vascular Surgery, the big advantage is you don’t have to necessarily answer to a different chair. You don’t have to go to conferences that are not beneficial to vascular trainees or to vascular staff. You are in charge of your own financials, which hopefully would benefit your own staff. It’s more a matter of establishing vascular as its own specialty, as opposed to being part of an overall department of surgery.”
Shifting gears to matters related to vascular surgery compensation, next speaker Sunita Srivastava, MD, assistant professor of surgery at Massachusetts General Hospital in Boston, is set to address how vascular surgeons can attain fair financial reimbursement
From a marketing and fair compensation perspective. Her talk, based on a report of the SVS Population Health Task Force, addresses outside pressures impacting fair compensation.
“One of the issues is that inflation has been steadily rising, as has the cost of living, but reimbursements for vascular surgeons have remained the same over the last 20 years or so,” says Calligaro. “But we are still expected to put in the long hours and come in for emergency cases at night and at weekends, and be available 24 hours a day to bail out other surgeons when they get into a vascular complication. The cost of supplies is increasing if you have an outpatient, office-based lab. But the reimbursements have stayed flat. The salaries for your staff have been rising. But the reimbursements stay flat. The rent has been rising. But the reimbursements stay flat. The bottom line is vascular surgeons almost certainly make less from an overall standpoint than they did 20 years ago, and that’s what she’ll be addressing.”
Last up, Enrico Ascher, MD, professor of surgery at New York University in New York City and CEO of the Vascular Institute of New York, will tackle the question of potential unionization, asking, ‘How can vascular surgeons unionize when 95% of payments come from Medicare?’
“That’s very debatable,” Calligaro considers. “There’s a lot of reasons not to do so. One of the biggest problems—and that’s why it’s in the title—is what is the benefit of forming a union, and how can you form a union when the vast of majority of payments comes from Medicare. You can’t form a union against Medicare. He’s going to address ways to potentially get around that, how to do it, should we do it, what are the benefits of doing it, and, in the end, will it give vascular surgery either more independence, help us financially, or help us legally from the likes of malpractice lawsuits. He is going to look into whether it is worth it for vascular surgeons to join up with other surgeons or even all other physicians to form a union, which is where it gets really complicated because everyone has their own interests. It is something he has been a champion of, but whether or not it is going to be realistic is going to be a question.”
Uniting all of the topics is their focus on helping vascular surgeons achieve the ultimate aim, Calligaro adds: “All four of these things can address better patient care and better patient outcomes. Vascular surgeons need to consider all reasonable strategies to empower themselves to provide better care for their patients and to optimally position themselves when dealing with hospital administrators.”
